Treatment Strategies to Promote Anticipation and Reduce Environmental Complexity

Strategies:
1. Adapt Internal and External Environments to Reduce Complexity and Stress:

A) External Environment:

a) Sounds: Eliminate or reduce environmental sounds: Place padding under computers and noisy machinery; place refrigerators, furnaces, and washing machines on special vibration mountings; dampen noise with carpets, upholstery, drapes, wall hangings, and acoustic panels and tile while removing sound reflecting materials like plaster, glass, concrete, and sheet plastic; provide "white noise" like fans or humidifiers; play soft, soothing background sounds like music, chimes, or running water. Wear ear plugs. Use vocal chanting like "om" and therapeutic listeningCD's.

b) Lights: Provide natural lighting or dim lighting; turn off flourescent lights; pull shades/blinds; provide visual stimuli that is soothing like aquariums or oil and water toys; "de-clutter" a busy environment; provide a harmonious space that is easy to navigate, with colors that are soothing, furniture that is comfortable and inviting, with simple wall hangings, and rounded plants.

c) Scents: Avoiod wearing strong perfumes; use essential oils, not artificial fresheners; reduce indoor toxins, i.e cigarette smoke, etc.

d) Tactile/Touch: Allow child to wear comfortable clothing; allow child to hold a blanket or other hand fidget while working; make sure the classroom/home is at a comfortable temperature; honor child's desire for space.

e) Multisensory: Allow child to leave for secondary classes early to avoid loud, crowded hallways. Divide classroom up into well defined work, play, and relaxation/calming centers.

*Once the environment is conducive for learning, it is essential to gradually increase complexity to enhance child's ability to learn and grow .

B. Internal Environment:

a) Teach "How Does Your Engine Run?" Self-Regulation Program (Williams and Shellenberger, 1996) to Students and Staff to Decrease the Stress Associated with Novelty and Complexity:

1. Teach child how to identify "engine" speeds.

2. Allow child opportunity to experiment and adjust engine speeds using a variety of alerting and calming sensory strategies.

3. Help child to identify when their engine speed is influencing their performance and allow them to choose picture cards with strategies on them to self-regulate.

4. Teach Alert Program to families and set-up a routine-based sensory diet for the family to implement into daily activities.

b) Hunger, Fatigue, and General Ill Health: Poor nutrition, poor sleep patterns, and general ill health can influence one's ability to process information effectively. Allergic reactions to foods and other environmental toxins (metal, etc) can also influence one's overall performance. It would beneficial to have a DAN doctor evaluate the child and make any changes to diet or supplementations deemed necessary. Strategies to improve poor sleeping may be beneficial (weighted blankets, a warm epson salt bath prior to bedtime, increased physical activity/heavy work throughout the day).

2. Increase Anticipatory Skills:
a) Picture Schedule: A visual schedule provides a list of sequential activities of the day's/session's events. It helps to reduce anxiety by providing anticipation and predictability while decreasing the demands for memory.

b) Social Stories: Social stories can help a child prepare and better anticipate unpredictable events. They can be used in advance to help prepare the child for an upcoming change in routine or to practice appropriate social interactions.

c) Identify Transitions Verbally and Visually: A picture signal coupled with a verbal cue "In a few minutes, we will go to math" and then, a picture signal coupled with "We are finished, it is time for math now" will help the child anticipate an upcoming change in routine and give them time to prepare for it.

Resources:

Heller, S (2002). Too loud too bright too fast too tight.

National Education Association (2006). The puzzle of autism. 1-44.

Miller-Kuhaneck,H. (2004). Autism, a comprehensive occupational therapy approach, 2nd edition.

Williams, M & Shellenberger, S. (1996). How Does Your Engine Run?" The Alert Program for Self-Regulation.