Young child: (0-5 years)

As a parent of a young child with Autism you are probably trying to understand both the diagnosis as well as how this will impact your family.

Some general advice is given in section 4 Here are some of the common problems that families of young children with Autism often face; they can be related to your child’s sleep rhythm, to behaviour(s) which you feel are difficult to handle. Many children with Autism tend to be fussy eaters and this can be a worry for parents as does the often emerging issue of toilet training.

Sleep Problems

Many young children with Autism have sleep problems such as difficulty in getting to sleep, minimal sleep requirements (waking up early or sleeping very late), an irregular pattern of sleep and disturbed sleep ( due to nightmares). Disturbed sleep can result in a restless and inattentive waking child and exhausted parents!

Some helpful tips to help your child sleep are

• Set a regular time for your child to go to bed each night and try and maintain it.
• Do not give your child any caffeine containing products in the evening ( tea, coffee, cold drinks)
• Try and create a relaxing bedtime routine, which your child enjoys this can include a bath, a massage or reading him or her a story.
• Avoid activities and games that may over excite your child before bedtime such as tickling
• Make sure your child has eaten two hours before bedtime.
• Make sure the child is not over or under dressed in bed.
• Use the same consistent words to describe the bedtime activities.
• Use a visual chart if this helps with your child
• Make sure the bedroom is dark, use a small nightlight if necessary.
• Keep the noise level low in the house (switch off the TV!)

If these simple steps do not help your child to settle it may be worth speaking to a specialist to help you with finding specific solutions for your child.

Challenging behaviours

Sometimes individuals with ASD develop problem behaviours which may include aggression towards others, self-injury (self-biting or head banging) and hyperactivity.

It is important to understand that most behaviour serves a certain function. That is a behaviour that you as a parent feel is ‘challenging or unwanted’ results in something specific for the child. The function of behaviour may be:

• a direct result of the behaviour ( e.g., hitting a classmate may result in the child getting the toy he wants, getting attention either positive or negative or may help the child by calming him down) ,
• or may be an indirect consequence of the behaviour ( e.g., throwing a tantrum prior to break time, may mean that the child is allowed to sit at his/her desk ).

The best way to understand the reason for the child’s behaviour is to systematically observe the behaviour but also what happens ‘before’ and the consequences or the ‘after’ of the behaviour.

This is technically called functional analysis but can also be called the ‘ABC’ of behaviour.
A= Antecedent= what happened before the child behaved in an unacceptable manner
B= Behaviour= the behaviour itself; how long did it go on, how severe was it
C= Consequences= what was the result of the child’s difficult behaviour.

Since we know that children with Autism have a difficulty in communicating their thoughts and feelings, a key question to ask yourself is

“what is my child trying to tell me with his/her actions?” The answer to this may be as varied as

• My child in pain
• My child trying to tell me something
• My child over stimulated
• My child feeling over whelmed by expectations
• Something changed in my child’s environment

Once you have been able to identify a plausible explanation for the unacceptable behaviour; there are a number of general guidelines you can follow:

1. Most children with Autism feel secure when they have a predictable routine and schedule. Hence structuring the day into specific time slots which are clearly scheduled with activities may help your child.
2. Visual schedules and social stories help a child to understand what is going on and also prepare for unscheduled activities. These can be made along with your child.
3. Identify ‘rewards’ or ‘reinforcers’ which can be used to motivate your child. These can be used pre-emptively in situations which you know may potentially unsettle him.
4. Try and control the environment in which the behaviour is most often seen.

Certain rules and routines can help a young person with Autism manage their own behaviour. This would include

1. Whatever the age of your child with Autism; clear limit setting and guidelines in age appropriate language will set the ‘road map’ for acceptable behaviour.
2. As a parent the most important thing for you to do is to be CONSISTENT with your rules and your responses. Hence graded rewards whether they are social ( e.g. praise, a hug) or tangible ( e.g. a star or food) should be given immediately when behaviour which you want to see is observed.
3. Certain behaviours may be more ‘annoying’ then challenging e.g., flicking fingers; consider whether allowing such a behaviour allows the child to settle and think about ignoring it.
4. Disregarding the behaviour while attending to the child; may also be a strategy that could avoid bringing unnecessary attention to behaviour(s) you do not want repeated.
5. When you know that your child is going to be exposed to an environment which will upset him; prepare him with social stories.

If behaviour that your child exhibits are harmful to himself or others it is important to get a professional opinion as soon as possible.

Fussy eaters

Many pre-school children who are normally developing or with Autism often are ‘picky’ in their food choices and intake. For most children this fussiness is temporary and if they are consistently exposed to new foods they will learn to explore and possibly enjoy these.

However as a parent you should keep in mind the following

• As long as the child is getting a range of foods from the various food groups; he will be receiving a balanced diet
• Children slow down in their growth in the pre-school years and often do not need as much food as they required during the first eighteen months
• As long as your child is active and maintaining good physical health, do not get too focused trying to balance his/her diet

However in some children with Autism there may be specific issues which result in them

• Rejecting certain foods because of the colour, textures or smells
• Eating a very limited range of foods
• Playing in a repetitive manner with their food, such as lining it up, rather than eating it.

As with challenging behaviour, when your child with Autism is fussy about his/her food intake, it is worth trying to analyse what he eats and the foods he refuses. Trying to understand whether the refusal is related to the quality of the food being offered may help you as a parent find initial solutions.

Simple steps to try for a fussy eater

1. Think about the texture, colour and smell of the food that you are offering your child, can these be adapted to make them more acceptable
2. Make the plate of food attractive to your child
3. When you are introducing a new food, make sure that you also have something to offer which your child likes and is familiar with.
4. Talk to your child about the new food you plan to introduce
5. Allow the food to be placed on the plate and not eaten the first couple of times it is introduced
6. Allow your child to alternate a food he likes with a new unfamiliar item
7. Do not insist that he ‘finish’ the new food. Praise all efforts even a tentative lick or smell.
8. Do not give up on new food, introduce it consistently over one or two weeks.
9. To not plead and beg your child to eat a new food, make the occasion stress free and fun!
10. Minimize the ‘fast food’ aspect of your child’s diet. Think about the amount of ‘milk’ your child drinks every day, could this be interfering with his/her appetite?
11. Remember some children prefer small amounts of food frequently while others are happier to sit down and eat a large meal.

If a child with Autism has persistent long standing eating problems it is important to get a medical opinion to rule out problems such as difficulties in coordinated swallowing, constipation, food allergies and deficiencies such as a lack of iron.

Toilet Training

The first question to ask yourself is whether your child is ready to be toilet trained. Starting too early may result in your child developing a phobia for using the toilet.

Three questions to ask yourself to determine your child’s toilet training readiness are:

• Does your child act differently or seem to notice when his/her diapers or clothing are wet or soiled?
• Has your child shown any interest or difference in behaviour related to the bathroom, toilet, hand-washing, dressing, undressing or other related tasks?
• Has your child shown any interest or change in behaviour in response to seeing other people involved in activities or with objects related to toileting?
• Are you aware of your child's elimination pattern? Have you noted the duration between one elimination and the next?

Answering “yes” to any of these questions may indicate an appropriate level of awareness for initiating toilet training.

• The child should also be able to sit and get off the toilet or trainer seat.
• He should be able to cooperate with undressing and dressing before and after using the toilet

If your child is passing bowel movement regularly and is not soiling during the night you may be ready to try to toilet train your child for bowel movements. Keep an initial diary of the times that your child eliminates so that you can follow his/her rhythm.
Steps to take in preparation for toilet training

• Create a visual schedule for eating foods and drinking fluids as well as for elimination during toilet training;
• Identify appropriate times for toileting and include those times in the visual schedule;
• Make sure undressing and washing hands are part of the schedule.
• Take the child 10-15 minutes prior to the time on the chart; and allow him to relax and focus
• Keeping toileting within a natural framework (e.g. around mealtimes or bedtimes) will allow a rhythm to evolve.

If your child is resisting toilet training take a break for a few months. Don’t see it as failure... just a postponement of skill building