Background
Purpose
Characteristics of Children with Autism
Program Considerations
Conclusion
References
Resources

Background

Autism is a lifelong developmental disability, in which individuals may experience difficulty in language/communication, social development, and behavioral responses to their environment.

Autism occurs along a spectrum from mild to severe. Autism in its mildest form may resemble a learning disability. However, the communication and socialization difficulties of autism still result in a need for individualized planning. Of persons with autism, only 2-3% fall at the very severe end of the spectrum, which is often accompanied by severe behavior difficulties, such as intense self-injury and/or aggression. Autism may also be associated with other disabilities due to developmental delays.

Purpose

Families who have a child with autism often experience ongoing stress. Aspects of the family’s life that may be impacted by a family member with autism include family recreation, finances, social relations with friends, relatives, spouses and neighbors, and the emotional, physical, and mental well-being of parents and siblings. Because of the additional care required by a child with autism, families identify respite care as a basic need, with the need increasing as the child gets older. Families who report less stress usually are the recipients of formal support services, such as respite care. Respite care for families who have a child with autism helps maintain family stability and may provide opportunities for the child to participate in special activities.

Characteristics of Children with Autism

All children who are autistic do not display the same characteristics. The following characteristics are among the most common:

Impairment in Socialization

• Lack of awareness of others
• Social aloofness
• Lack of cooperative and imaginative play
• Does not imitate
• Does not seek comfort or cuddle as an infant

Language/Communication Deficits

• Language is not used in a communicative function, instead there may be immediate or delayed echolalia (i.e., what is said to the child is mechanically repeated); perseveration (i.e., the repeating of phrases of speech over and over); pronominal reversal (i.e., The pronouns "I" and "you" are reversed, so that the child may say, "You want a cookie," when s/he desires a cookie)
• Abnormal pitch, rate, rhythm, and/or intonation
• Lack of appropriate nonverbal communication (e.g., eye contact, gestures, pointing, postures)

Abnormal Responses to the Environment

• Stereotypes or self-stimulatory behaviors (e.g., rocking)
• Resistance to change
• Preoccupation with parts of objects, or an attachment to unusual objects

Behavioral Concerns

• Self-injurious behavior (e.g., head banging, biting)
• Aggression
• Tantrums

Inconsistent Sensory Responses

• May appear as if s/he is deaf (e.g. no reaction to very loud noises)
• Stimulus over selectivity (e.g., very sensitive to very soft noises)
• Apparent insensitivity to pain

Program Considerations

Provider Training
Providers who are working with children with autism should be trained about the characteristics of autism. Because of these unique characteristics, children with autism typically require specialized therapeutic and educational services. Respite care providers should be well trained in the basic principles of applied behavior analysis. Training should also include information on communication, behavior management, developmentally appropriate instructional strategies, social skills and incidental teaching.

Child Care Provision
1. Respite care providers should meet with each family before beginning the provision of child care to discuss the child's routines and established patterns. This helps ensure consistency of care for the child and develops a sense of trust between the family, child, and provider. The need for predictability, structure and routine is an important element when providing respite care for children with autism. Children with autism typically insist on sameness. When the environment is altered, they often become anxious. Respite programs should:

• Establish routines: set specific times for certain activities, such as snack time, naps, toileting.
• Be consistent: children with autism experience difficulty in learning. Often, they are unable to generalize what they learn across people, settings, or situations. However, if persons caring for children with autism are consistent, the children do not need to spend as much time testing limits.

2. Respite programs should address the need for behavioral intervention. Behavioral approaches have proven successful in remediating behavioral excesses (e.g., tantrums), as well as behavioral deficits (e.g., lack of self-help skills)

• Use redirection: when children with autism are engaging in inappropriate behavior, redirecting the child to another, more appropriate activity may be effective.
• Use rewards: choose rewards that are meaningful to the child. The rewards must be individualized, and may require some creativity. For example, some children with autism become attached to specific objects, such as a familiar piece of clothing. Extra time with that object could be a reward.

3. Respite programs should incorporate educational components to assist in completing activities of daily living.

• Use clear and simple instructions: due to the attentional problems that children with autism often experience, it is helpful to keep instructions short and concise.
• Use prompts and teach in small steps: verbal instructions, gestures, or physical assistance are three prompts that are often used in working with children with autism. Use only as much prompting as is necessary for the child to complete the task, to ensure the child's is active participation. In addition to the use of prompts, it is helpful to divide the task into smaller steps. For example, if the child was being instructed to pull down his/her pants for toileting, the first step may consist of having the child only grasp the waistband; the second step could be pulling the pants over his/her hips, etc. The child is taught one step at a time, and does not move onto the next step until s/he can successfully complete the previous step.

Conclusion

Respite care for families of children with autism provides assistance through the provision of emergency and planned care as well as access to other family support services.

References

American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders, (3rd ed., rev.). Washington, DC

Cohen, D. & Donnellan, A. (Eds.). (1987). Handbook of Autism and Pervasive Developmental Disorders, New York: John Wiley. (Available from John Wiley & Sons, 605 Third Avenue, New York, New York 10016).

Powers, M.D. (Ed.). (1989). Children with Autism: A Parents’ Guide. Rockville, MD: Woodbine House. (Available from Woodbine House, 5615 Fishers Lane, Rockville, Maryland 20852; (800) 843-7323).

Schopler, E., & Mesibov, G.B. (Eds.). (1983). Autism in Adolescents and Adults. New York: Plenum Press. (Available from Plenum Press, 233 Spring Street, New York, New York 10013).

Schopler, E., & Mesibov, G.B. (Eds.). (1984). The Effects of Autism on the Family. New York: Plenum Press. (Available from Plenum Press, 233 Spring Street, New York, New York 10013).

Resources

Autism Research Institute (formerly Institute for Child Behavior Research), 4182 Adams Ave., San Diego, California 92116

Autism Society of America (ASA), 8601 Georgia Ave., Suite 503, Silver Spring, Maryland 20910, (301) 565-0433.

About the Author: Marie Taras, Ph.D. is the Director of the Autism Support Center which provides respite care and other services to families who have children with autism in northeast Massachusetts.

ARCH Fact Sheet Number 9, May, 1992