Why should we use Visual Support System?

Many children with ASD, ADHD, SPD respond positively to schedule charts, sign posters, and other visual strategies. This form of information presentation encourages them to communicate appropriately and helps to develop language and process information. Thus, it helps them to be more independent and self-confident to verbalise or make other understand their own feelings.


Visual strategies can be purposeful for expressing and understanding feelings and emotions, while going through transitions or changes, visiting a new place or meeting a new person.

A visual schedule is a representation of what is going to happen throughout the day or within a task or activity. It helps in carrying out life skills activities or task in hand in a planned manner and reduces high levels of anxiety 

It encourages structure and organisation in daily routine.

It can be in form of timetables, behavioural sheets, safety charts, activity sequencing for self-care skills (example-tooth brushing) or independent living skills (driving, sex education), emotion’s chart, social skills, instructions or reminders.

Marlene J. Cohen and Donna Sloan are authors of book Visual Supports for People with Autism: A Guide for Parents and Professionals (2007) which highlights the significance of visual support strategies for children and adults with autism.

Children with ASD often display anxious behaviours or act out when their routines change or they are in unfamiliar situations. Visual reminders can support them understand what to expect and what will happen next to reduce the anxiety. They help them to pay attention to details and understand situation visually in a better manner.

One of the main problems of people having ASD is social interaction, using language and repetitive behaviours. They have difficulties understanding instructions and display limited interests in activities. A visual support system helps in countless areas helping the child to work systematically and rationally.

Finally, some children with ASD are anxious or act out when their routines change or they are in unfamiliar situations. Visuals can help them understand what to expect and will happen next and also reduce anxiety. Visuals can help them pay attention to important details and help them cope with change.

Often ASD children get anxious due to changes in routine, classroom schedule, while meeting new people, and in unfamiliar situations. Visual support strategies can help them understand what to expect and when will it happen. Rather than getting panicked, agitated, angry, and anxious these children can look into the picture cards, or visual charts and follow the plan.

Moreover, parents’ teachers can easily communicate with them using visual reminders. This decreases frustration and may help decrease problem behaviours that result from difficulty communicating. Visuals can promote appropriate, positive ways to communicate.

The visual schedule breaks down the activity into multiple steps so that child can understand, plan and execute the task easily and complete the task (e.g. life-skill, such as brushing, shoe lace tying) successfully with reduced anxiety levels. According to Zigmond et. al (1999), anxiety caused by any reasons can aggravate sensory defensiveness in children with sensory modulation difficulties. Therefore, to minimise the sensory issues, caused due to raised levels of anxiety and stress visual reminders can be a helpful tool to a great extent.

Furthermore, anxiety resulting due to lack of information or fear of unfounded apprehension results in concentration difficulties, restlessness, hyperactivity, distractibility as well as learning abilities.

The manifestation of anxiety has been found to be associated with complex brain structure, known as limbic system and components of the reticular system.

It is better to have a portable schedule such as on a clipboard or a   binder or it can be fixed to a permanent place such as child’s bedroom or washroom wall or refrigerator. 

Fundamentally, the schedule should be visible to a child frequently and easily so that he can access it before or while performing planned task. Initially, verbal cues such as “check your schedule” can be prompted if a child gets baffled to perform any task.

Resources for Using Visual Supports: 

❏ www.do2learn.com 

❏ card.ufl.edu/content/visual.html

❏ www.kidaccess.com/index.html 

❏ Eckenrode, L., Fennell, P., & Hearsey, K. (2004). Tasks Galore for the Real World. Raleigh, NC: Tasks Galore. 

References:

Autism Speaks (www.autismspeaks.org/)

National Autistic Society (http://www.autism.org.uk/)

Bernard-Opitz, V, and Häußler, A. (2011) Visual support for children with autism spectrum disorders: materials for visual learners. Shawnee Mission, Kansas: AAPC Publishing  Bondy, A. and Frost, L. (2011).

A picture’s worth: PECS and other visual communication strategies in autism. 2nd ed. Bethesda, Maryland: Woodbine House  Cohen, M.J. and Sloan, D. L. (2008) Visual supports for people with autism: a guide for parents and professionals. Bethesda, Maryland: Woodbine House

Six Hacks to Reduce Stress among Kids

                                                         

Stress is a reaction to a stimulus that disturbs our physical or mental equilibrium. A stressful event can trigger the “fight-or-flight” response, causing hormones such as adrenaline and cortisol to surge through the body. 

Stress is the sometimes strong hidden cause of Anger among children. This can be from positive as well as negative event however majorly it is destructive in nature due to its unconstructive occasion. Reasons of stress related anger may be, parent's angry and negative behaviours, separation, rejection from peers or parents, lack of trust, perfectionist tendencies, school stress, loss of grandparent etc.

As parents, we should be considerate enough towards ourselves as well as kids. Expecting too much from both the sides is like living in a fantasy World of Alice in Wonderland or Disney World where everything is charming, sumptuous, resplendent and magical. Expecting too much from our kids in areas such as academics, behaviour, socialisation can be unrealistic and unjustified and we might look like an immature parent who is still not ready for truthful parenting. Every child, parent and parent-child relationship is different.

According to Carrie Wendel-Hummell, a researcher at the University of Kansas, there are various factors contributing to stress among parents as well as children. It is not just because of too much of work and responsibilities added towards new parents after the birth of a baby too but also social and peer pressure to project themselves as perfect families within the society. 

Everyone is eager to see each other’s photographs and status updates on Social media (Facebook, Twitter, Instagram) and make judgements of their good being. Seeing X friend’s vacation album mount’s unseen pressure and stress on parents to provide better support and luxuries to their children.

Tim Elmore, in his book entitled “Twelve Huge Mistake Parents Can Avoid” mentions that parents should have high BUT healthy expectations for themselves and children. He states that parents should not be guilty of failing on different as care takes rather they should prepare kids for the real world and its true colours.

Having marital discord or separation from spouse affects the child adversely leading to extremely complicated relationship with the left-behind parent. In some cases, unfortunately, child not only loses the separated parent but also faces unintentional negative and un-genuine side of left behind parent.
Another massive cause of stress can be bullying in school that can cause personality

development failure in both typical and atypical children. A popular child can also be bullied in school, regardless of any reason. Bullying which can be verbal or physical germinates stress, anger along with fear to be accepted among peers.

So there can be infinite reasons of stress among teens and children which can be reduced using appropriate strategies after analysis of exact reason of stress within child. According to Lancet 2007 Global Mental Health Report, the commencement of mental health issues is most likely between the age groups of fifteen and twenty-four, making it a primary time for problems to emerge if parents are not careful. Numbing behaviours like over- or under-eating, cutting, drinking, drugging and, ramping up perfectionistic behaviors are modern traps for our children and teens.

As a paediatric OT, I have seen a number of parents being concerned about their child’s behaviour within the community. A common concern for parents is how to support their children in dealing with stress-related anger, and how to prevent them from resorting to aggression. Many parents are concerned about a number of violence children are exposed to at school, on the television, while watching video games, and in their friend circles.

Here are Six practical strategies which can be used by parents to reduce Stress levels among children and improve parent-child relationship.

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Improve Socialisation: Let your child have a good number of friends. Making and keeping friends reduces stress. This also helps to get rid of anxiety or depression. This supports a child in becoming  well-connected to peers as well as makes them a good communicator. 
Facilitation of positive behaviour among peers helps in establishing cognitive and emotional skills that are required to engage competently. This reflects child to be socially accepted by his crowd and he is able to understand the relevance of gestures, facial expressions and other social cues.

However, this does not mean that parents should not be aware of (Four Ws) where, when, with whom and why their child is going. One should be inquisitive about child's

behaviour in home and outside. 
Discuss with the child that there can be a possible solution to his or her problem or situation. Implementing Problem Solving Approach is advantageous. 
Reassurance is important from parent’s side so that child can trust them and share any issue, for example, being bullied in school or stressed due to a school trip.  He should be sure that my mummy and daddy have a solution to every problem. This confidence among parents will make their bond strong.

Hugs and Kisses for Reassurance: Often children find nothing better than hugs and kisses for calming down and getting support from parents. Hugs give deep pressure (proprioceptive input) to our bones, joints and muscles which help in calming down and

reducing stress level. This helps raised levels of Cortisol hormone to decrease. This hormone is often measured as means of quantifying physiological response to a stressor. Therefore, any reason (bullying, loss of the pet) which can raise Cortisol levels (stress) can be decreased by hugging or kissing the child. 

Stories Make a difference:Telling stories about children with similar problems and feelings make your child realise that he is not the only one to struggle from stress.Discussing problems on Stress Forums or Groups can be a Self-help or joining Stress Help Communities can reduce anxiety and stress. 
Parents may share their childhood situations to overcome stress and anger. I find this

as one, of best ways to change child's negative behaviours. Parents should mention their struggle and hard work to stressed children. 
Sharing own stories will motivate kids to stay calm and think better. 
Watching movies together or telly shows related to the hyper-competitive world of today will support the child to discuss professional issues with parents. Stress due to academics, competition, bullying or grief will disrupt the learning and healthy development of individual physically, mentally and emotionally.

Praise the Child: Appreciation and encouragement help children realise that they are worthwhile doing a particular given task. This also helps to develop self-confidence. 

Notice, praise and encourage good behaviour rather than focussing on bad behaviour. 
One of my student diagnosed with Asperger’s Syndrome always faced high levels of stress just before couple of weeks before exams. 
On talking to him, I discovered it was high parental expectations to achieve good grades in exams. Rather than being focussed, this young boy had big struggle to concentrate on studies. During one to one session, we sat down with a white sheet and a colour pen of his choice. 
We started listing his achievements and failure in past 6 months. Lastly, it was concluded that his sports, extra-curricular, and Information Technology achievements are greater than his failures This discovered fact about himself, made him feel better and positive. 
Therefore, it’s important to improve child’s self-esteem and confidence level time and again to make him feel affirmative and relevant towards himself.

Charity Work or Fund raising for a cause: Children should be encouraged, to help others (E.g. making the cross road to elderly or differently able) or perform Community Work through charity.
Parents may develop habit of performing, at least one good deed or favour per month

which involves children in charity. This makes a child more resilient. Charity can be to spread awareness about a particular topic or to help for a cause. This can be a marathon for Macmillan Cancer Patients or even picking litter for community welfare. Many charities focus on the environment, for example, work to help people to learn about threats to the climate and too fragile ecosystems. Sparing out time for charity not only improves self-esteem and kindness skills but also gives opportunities to meet and communicate with new people from different spheres. 
Charity begins at home, they can even support the mother in cooking or washing dishes after dinner. This will not only improve parental relationship but also enhance child’s skills on particular task.

PROBLEM SOLVING BEHAVIOR

This remedy works in few simple steps, however, requires patience, strategic organisation, motivation and understanding for both parents as well as the child. Problem Solving Approach is a common procedure which can act as Self-Intervention strategy to control higher levels of Anger.

 It raises awareness of child in regard to his own temperament, emotion and behaviour and how to resolve conflicts within him and outside world.

However, all defined remedies work on the principle of Will Power. It is very important that child should realise his misbehaviour in order to rectify it and parents should coordinate with him, without blaming or tagging him for bad behaviour. 

Problem Solving Behaviour involves to:

IDENTIFICATION OF TARGET BEHAVIOR LEADING TO LABEL THE CHILD AS AGGRESSIVE:

• Having excessive pattern of overreacting
•  Lying
• Low Self Esteem
• Being impulsive in particular situation
• Getting aggravated by provocative situations
•  Complaining about students treating him or her badly
• On lookouts of Annoyance (Negative Bias)
• Blaming others for their Behaviour (Blame Game)
  Parents should work collaboratively with children to identify target behaviour that is labelling the child to be aggressive.
  
  
  SET A PLAN:
  Set a plan to eliminate such behaviour.

• Try to develop attitude of tolerance and respect,
• Use of Positive Self Statements (E.g.: Chill Out! exhale away anger, Ignore them, Stop Shouting etc)  
• Actively listening to others,
• Being a buddy (Helping out bullied peer),
• Ignoring Distractions and Provocations
• Sharing ideas and views in classroom
• Using e-mail support that is chat rooms for confidentiality
• Use sense of humour to defuse situations of provocation
  Parents should monitor and record the child’s behaviour and each time there is misbehaviour in a day it should be counted. Every time child gets angry he should be prompted with increasing number of counts of a day. Child should be rewarded if number of counts of misbehaviour decrease on a particular day. This positive reinforcement will encourage him to control his habit of losing temper frequently. If your child refuses to follow positive self Statements or Self Talk Statements just offer an extra incentive for trying it. Sometimes children need extra care and attention along with reward to follow particular instruction (Extra Time Playing in Playground, Buying new set of Clothes, Treat party on weekend).
  Obstacles are very common during implementation of plan but parents and teachers also have to follow never Give up Spirit!!
  
  
  WORKING DURING THE EVENT:
  Now, it’s time to practice and apply the above plan at the time of Provocation or Situation that may Trigger Anger. One has to maintain calm and nice attitude when location of Aggression (School, Club, Community, Peer Group) otherwise previous hard work will go in vain!! Use of Positive Statements like:

• This is Challenge so I just need to relax
• I don’t have to take words seriously
• Easy Go!!
• Yes, I’m doing great, See No anger
• I m cool right now and in control!!
  REVIEW LEFT BEHIND ANGER:
  Now, it’s time to celebrate and review the behaviour!!
  Take a Deep Breathe and as you have conquered your anger!!
  Mostly children will have problems in getting adapted to habits but using Problem solving approach one can Control his Impulses with the course of time.
  Satisfaction and Self Confidence improves if the child tries to follow above rules. Strive or attempt to achieve target is essential. Parents may motivate children by saying (“You did your best, that’s OK.” This wasn’t so difficult, isn’t it”, It’s essential that you keep on following this behaviour, it suits you!!)
  
  
   
  
  
  CHANGES REQUIRED WITHIN ENVIRONMENT :( HOME AND CLASSROOM)
  
  

• Use of Flash Cards with Positive Self Statements written on them
• Sticky Notes (I will not Get angry!, I’m a cool Guy!!, I’m at my Best!!, This is a Challenge for me!!), in Each Copy reminding the child not to lose temper in Class.
• Teachers or parents may give child Smiley face each time he Controls his Difficult Temperament
• Making Child Sit with Polite and Quiet attitude rather than with excessively talkative and Impulsive Kids (Good Neighbour)
• Parents may beforehand understand his requirements for Books and Pencils and other things so that there is no creation of Situations leading to Annoyance (Annoyance Avoidance Circumstances).
  
  
  
  
  ADDITIONAL CHALLENGES:
  
  

• If possible parents may involve with child them Topics of disagreement and have Debated with him or her to watch Level of Controlled Anger.
• Movies showing Dissimilarity to child’s thoughts and then parents may have the debate with him.