Autism Consult - NC
Steven C Altabet, Ph.D
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Keeping Your Finger on the Piece

1/25/2015

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     Ok, one last chess analogy.  This one has to do with the idea that in chess a move is not official until you take your finger off the piece you are moving.  It's the only game I know where you can make a move, say "wait, let me think about it," then decide "never mind I'm going to do something else."   It's not exactly a 'do-over' like kickball or a 'mulligan' in golf, but its pretty close and more applicable to real life.
     When we make mistakes in during our daily lives we can often atone for them, but we cannot erase them and make them disappear.  The mistake, once made, never goes away which can be a very difficulty concept for many people with Autism to accept I'll address that issue another time).  The beauty of putting your finger on the piece is you have a chance to realize your mistake before it happens and take measures to prevent it. 
     Preventing actions that have potential negative outcomes can be difficult, but is achievable with practice and instruction, just like chess.  When a thought or urge comes to mind, that is the initial move.  It is usually a reaction to something else you experience and typically not preventable.  However, just because that thought or urge is there does not mean you have to act upon it.  While it may be easier to go ahead with the thought or urge, like the chess player, you can tell yourself "Stop"  "Wait"  "What might happen to me if I do this?"  "Will it be good or bad?" "Is there something else I could do or say?"  These little messages can you save a lot of heartache.  Even if you do decide to go ahead with the urge or thought, at least you know what you are getting into.  Knowing what to expect is also very important for people with Autism. 
     The final aspect of this approach that is needed to be successful is time.  Time is needed to process these thoughts and make a decision.  The person making the decision needs to allow themselves enough time to make the choice and others around that person need to provide that time as well.  For the person with ASD, this means requesting the time you need to think things through.  For the parents, caregivers, and educators that means allowing the person the time they need or asking the person with ASD "Do you need some time to think about it."  Sometimes I find it help to provide visual cues.  Single words such as Stop, Wait, and Think can often be good triggers for the process.  They can be printed on index cards or saved on a phone or tablet.  This approach can be especially helpful for people who more impulsive.  While quick decisions may be better for simpler decisions, you will gain more benefit by keeping your finger on the piece before making a complex decision or important move.

Steven C. Altabet, Ph.D              
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Increasing Awareness

1/18/2015

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Continuing with the chess theme from my last post, I'd like to discuss the concept of putting someone into 'Check.'  When a player is about to capture someone's King and end the game, they first have to warn their opponent of the impending move by saying "Check."  This alerts the opponent of the danger and forces them to move their King out of danger before they can make any other moves.  In life, parents, educators, and other well meaning people try to warn other of potential dangers.  Sometimes, especially with younger children, the person can be forced to avoid the hazard before doing anything else.  However, many times, especially when the children get older, they cannot be forced to heed the 'check' and must make a conscious choice to take safety measures. Therefore, a key component of independence is being able to exercise caution when no one is there to provide the warning signal. 
     While ther may be many reasons for this, in my practice I have noticed three main variables.  The first is impulse control, which was discussed durng the previous post.  The second is knowledge of potential dangers and their signals.  While it is important not to assume that the individual knows the potential dangers and warning signs, this is knolwdge that can be taught and shared with amny people with ASD.  The third, and perhaps the most innate variable to Autism is awareness. Awareness is essential not only for receiving information, but for making sense of it an acting upon it as well.  People with overly sensitive nervous systems have difficulty with awareness because being fully aware can overwhelm the system, so lack of awareness is sort of a defense mechanism.  However, just like with other behaviors and experiences, awareness can be gradually encouraged and increased through exposure and coaching. 
     The easiest way to increase awareness is to begin with everyday routine activities, particularly ones that the person finds pleasurable.  For example when taking a walk, instead of having a conversation or thinking of an unrelated thought, encourage the person to focus on what they see, hear, feel, or smell.  At first you may only want to bring awareness to one sensory experience at a time and the total time of awareness may only be a few seconds or minutes.  Additionally you may need to provide an incentive since the person may have to stop engaging in thoughts related to a person interest in order to become more aware.  Once engaged in the awareness, have the person relate to you what they are experiencing.  This will force the conscious mind to be more active and gradually strengthen neural connections that promote awareness.  Awareness can also be increased by overtly talking about current activity, rather than just doing it silently and passively.   This can be done with a variety of sensory and active experiences. 
     With continued practice over time, you will notice awareness gradually increase.  With increased awareness, it becomes easier for information to taught, retained, and brought back into consciousness when needed.  While building awareness, it is important however to respect the person with ASD's need/desire to have time when they can lost conscious awareness and drift into their own thoughts. It allows their nervous system to recover from the increased awareness, but also allows them to generate the elaborate thought which makes their life fulfilling for them.  The goal is not 100% awareness, but rather a situational awareness that can be turned on and off when needed.  That will allow for greater independence and effectiveness in situations where caution is needed thus resulting in being to keep one's life out of 'check.'       
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Chess and Autism

1/10/2015

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I listened to a comedian who was talking about how he was learning to play chess and certain things about the game struck him as odd.  The first aspect that he brought up was the concept of Checkmate.  "I haven't captured your king yet, but I will in three moves so I WIN!"  "It's like the quarterback going up to the line and before he even stats the play saying TOUCHDOWN!  THIS DOESN'T HAPPEN IN REAL LIFE" he exclaimed, but actually it does.  It's called planning and anticipation.  If we think about head of time what we want and how we are going to achieve it them we can anticipate a likely outcome.  Many people with Autism whom I've worked with have difficulty with these concepts.
     When your life is primarily visually oriented, it is difficult to think about concepts you cannot physically see, like the future.  If you cannot see the future or predict with 100% certainty what is going to happen, then why bother thinking about it?  This thought process leads to having to frequently react to unexpected events, also very difficult for people with Autism.  There is hope, however.  The first step is to help the person to a see their future.  On a simple level, this could be showing basic cause and effect relationships through modeling, demonstration, pictures or diagrams.  "If you only want to play the game by your rules, then other children are less likely to want to play with you."  You can also develop more complex models. "Here are the steps needed to get into college, applying for a job, going on an interview etc.."  Listing the steps on paper, poster, dry erase board etc... makes the future concept and steps to be planned out real for the person and because they see them, it makes the ideas be part of the person's awareness.  
     Regarding anticipation, many of my clients with Autism do anticipate, but they typically anticipate negative outcomes and the negative outcomes are often exaggerated.   This is typically referred to as anticipatory anxiety.  For those who anticipate the worst, there are a couple of ways to address their fears.  The first is "Yes that could happen, but is it LIKELY to happen? If it isn't likely then what is likely to happen?"  If the feared action is likely to happen then what can be done to help the situation.  Another possibility is to ask what is the best thing that could happen?  that will at least balance out the thinking and allow for the possibility if a more moderate response.
    With increased planning and positive anticipation, future events can be prepared for and the person with Autism can be on the giving end of the checkmate rather than the receiving end. 

Steven C. Altabet, Ph.D.             
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    Steven C. Altabet, Ph.D. Licensed Clinical Psychologist with a specialty in Autism Spectrum Disorders  

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