Saturday, November 30, 2013

Book Review: Chaos to Calm: Discovering Solutions to the Everyday Problems of Living with Autism


The demands placed on parents caring for a child with autism can contribute to a high level of parental distress and adversely affect family functioning. Unfortunately, families are often exposed to unsubstantiated, pseudoscientific theories, and related clinical practices that are ineffective and compete with validated treatments. The time, effort, and financial resources spent on ineffective treatments can create an additional burden on families. As a result, parents and caregivers everywhere are eager for credible, research-based information on the most effective treatments for autism. Chaos to Calm: Discovering Solutions to the Everyday Problems of Living with Autism by Martha Gabler describes an evidence-based method that can be used by parents and caregivers to address the everyday challenges associated with autism and improve the quality of life for their children and families.
The book is a personal account of Martha Gabler’s journey from chaos to calm and how she discovered and implemented an effective teaching method for decreasing the challenging behaviors of her non-verbal son Doug, who was diagnosed with severe autism. Gabler shows parents how to use a method called TAGteach to address many of the common and difficult problems of autism. Briefly, the acronym TAG stands for “Teaching with Acoustical Guidance.” The method utilizes an acoustical signal such as a click or a hand clap to “mark” the behavior that will earn positive reinforcement. TAGteach is based on the principles of applied behavior analysis (ABA) and relies on the use of positive reinforcement, prompting, fading, and shaping to increase desired behaviors. It is a completely positive approach that is relatively easy to learn and implement by parents and other “non-experts.”
Chaos to calm consists of 15 chapters. The first chapter introduces the reader to TAGteach and describes how the method works. At the outset, Gabler takes a reasoned and reasonable approach by commenting that TAGteach is not a substitute or replacement for other behavioral methods, but one that can serve as a powerful adjunct to these and other teaching strategies. She also notes that TAGteach is not a cure for autism, but a method that was uniquely successful at teaching her son functional behaviors that allowed her family to experience a better quality of home life. The subsequent chapters are arranged to describe what Gabler feels are a logical progression of skills to learn. She begins by describing step-by-step how the TAGteach process can be applied to a single, less challenging task (“Quiet Mouth” behavior) and then to more complex and difficult problems such as tantrums and transitions; self stimulatory behaviors; aggression, self-injurious, and destructive behavior; and arguably one of the most challenging and stressful behaviors of children with autism, chronic sleep problems. There are also chapters focusing on “going into the community” and social, life, and play skills. The final chapters provide a summary of the TAGteach approach, answers to some common questions regarding application of the method, and future directions for the use of TAGteach.
Chaos to calm is more than a “how to” book or guide to behavior management. Gabler puts a human face on applied behavioral methods and describes her challenges and experiences with thoughtfulness, compassion, and humor. She also emphasizes the importance of responsibility; following rules and understanding limits; and “learning the rules of society.” As Gabler notes, it’s important to teach the concept of a rule for the child. She also reminds adults to follow a very important rule: only ask your children to do what they are capable of doing.
Chaos to Calm: Discovering Solutions to the Everyday Problems of Living with Autism is highly recommended to parents and caregivers of children across the autism spectrum who will find the book a source of inspiration and encouragement as they begin their own personal journey from chaos to calm. Professionals will also find the book a valuable resource for use with families and teachers who have a pressing need for practical, evidence-based interventions to deal with the daily struggles and challenging behaviors of children with autism.
Gabler, M. (2013). Chaos to calm: Discovering solutions to the everyday problems of living with autism. Waltham, MA: TAGteach International.
Reviewed by Lee A. Wilkinson, PhD
Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also editor of a recent volume in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools and author of the new book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT.

© Lee A. Wilkinson

Monday, November 11, 2013

Facial Expression and Peer Judgment in Autism

Autism Spectrum Disorder (ASD) is a neurodevelopmental dis­order characterized by two core-defining features: impairments in (a) social communication and (b) restricted and repetitive behaviors or interests (American Psychiatric Association [APA], 2013). Social-communication deficits include difficulties making affective (emotional) contact with others. This includes deficits in nonverbal communicative behaviors used for social interaction which range from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to a lack of facial expression or gestures.
Research investigating facial expressivity in children with ASD has reported “flat affect” or odd facial expressivity within this population. “Flat affect” is a term used to describe a lack of emotional reactivity. With a flat affect, expressive gestures are minimal, and there is little animation in facial expression or vocal inflection. Facial expressions are a form of non-verbal communication essential to interpersonal relationships. An inability to read facial and social cues makes “connecting” to others very difficult. Likewise, reduced or odd expres­sivity may impede social discourse or provoke negative initial reactions to the person with ASD.
Research
A study published in the journal Autism examined the impact of facial expressivity on first impression formation and found that typically developing children formed their impressions of peers with ASD in as little as 30 seconds. Videos of children with ASD were initially rated for facial expressivity by adults who were unaware of the condition. Researchers further investigated the friendship ratings given by 44 typically developing children to the same videos. The children making friendship judgments were also unaware that they were rating chil­dren with ASD. These ratings were compared to friendship ratings given to video clips of typically developing children. Adult participants rated children with ASD as being less expressive than typically developing children. The 44 child participants also rated peers with ASD lower than typically developing children on all aspects of friendship measures. Children with ASD were rated not as trustworthy as the typically-developing children in the films. Moreover, study participants were less likely to say that they wanted to play with or be friends with the video subjects on the spectrum. These results suggest that impression formation is less positive towards children with ASD than towards typically developing children even when exposure time is brief.
Implications
The findings of this study have important implications for intervention in the school context. Children with ASD experience more peer rejection and have fewer friendships than their typically developing peers. Limited facial expres­sivity may further remove children with ASD from meaningful interactions and reciprocal emotional related­ness with others. Negative peer responses can be especially upsetting for more socially aware children with ASD who may be strive but fail to form friendships. Further, distress often increases as children approach adolescence and the social milieu becomes more complex. 
Social relationship skills are critical to successful social, emotional, and cognitive development and to long-term outcomes for all students. An increase in the quality of social relationships can have a major influence on the social and academic development of both typically developing children and those with ASD. Consequently, intervention needs to be focused on both groups in poten­tial interactions rather than solely on the child with ASD. This includes strategies designed to promote skill acquisition in building social relationships such as direct instruction, modeling, role-play, structured activities, social stories, formal social groups, pivotal response teaching, self-monitoring, and coaching. Students in general education could help the process of cohesion by serving as prosocial role models for students with ASD. Teachers may also provide reinforcement for prosocial behavior or assign students in general education to work with students with ASD in small groups on class projects together to promote positive interaction. Teaching social skills can have both preventive and remedial effects that can help reduce the risk for negative outcomes not only for children on the autism spectrum, but also for all children. 
Does facial expressivity count? How typically developing children respond initially to children with Autism. Steven D Stagg, Rachel Slavny, Charlotte Hand, Alice Cardoso and Pamela Smith. Autism published online 11 October 2013 DOI: 10.1177/1362361313492392 
The online version of this article can be found at: http://aut.sagepub.com/content/early/2013/10/10/1362361313492392
Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also editor of a text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools and author of the new book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT.



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