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Book Excerpt: Helping Children with Autism Learn - By Bryna Siegel, Ph.D.

Imitation as the Gateway to Early Learning

Why Is Imitation Important? Imitation is a very crucial conduit through which the one- to four-year-old child normally takes in a tremendous amount of information. Throughout that period of development when language has not yet been established as an internalized means of narrating and planning behavior and problem solving, imitative schema (maps) guide typically developing children through practice and mastery of new skills. Originally, psychologists referred to key aspects of this process as "assimilation," meaning that the child would first see something new, and then take parts of what she saw into herself and reenact what had been observed as self-initiated activity. Later, the child could be described as taking the newly acquired information and being able to use it to "accommodate" variations on the theme: A toddler seeing a new type of sand toy in the sand pit at the playground might be expected to first watch as a slightly older child added sand, turned a crank, and extruded small blobs of sand. If t his looked incredibly interesting to the toddler, she might be expected to run up to the toy and either join in, or, if she was a more shy child, wait for the older child to leave the toy alone, and then pounce on a chance to imitate what she had just seen. That imitation of the first child`s use of the sand-cranking machine would be "assimilation" of a new play schema. Later, the toddler might decide to pour water or small stones through the machine instead. She might decide to turn the machine upside down and see what happened if the sand went in the other end. The results of all these little "experiments" would allow the toddler to construct a database of information about this type of sand toy; first, by assimilating what she had seen the other child do, and second, by conducting her own experiments to "accommodate" the results of new information produced by her experiments with the sand-cranking machine to her understanding of how things like this might work.

Imitation as an Experimental Method. When a child with autism lacks the ability or drive to imitate things in the world around him, he fails to engage in critical self-initiated experiments that should allow him to construct a world of meanings for the objects and activities he sees. Imitation is a complex ability, and it is also a complex disability. Difficulties with imitation can be thought of as a convergence of at least two main areas of innate disability that may affect children with autism. As we discussed earlier, much of what we recognize as formal symptoms of autistic spectrum disorders can be seen as the result of multiple and converging innate disabilities that coexist in a way that makes for a characteristic pattern of disability as well as possible adaptations. This coming together of innate deficits was referred to earlier as the "matrix of abilities and disabilities" through which the child`s difficulties as well as strengths form self-accommodations to what he cannot process in the usual ways . We will now examine possible components of a failure to imitate, with the goal of developing a better understanding of which underlying innate deficits may need to be addressed for a particular child when lack of imitation is identified as a learning deficit.

Imitation and the Desire to Be like Others. The first component of an innate disability that contributes to problems in imitation is the lack of an affiliative orientation. A big part of imitating is wanting to be like, and do like others. Typically, we do not teach our children to imitate; it is just something they begin to do spontaneously. When a child lacks the expected amount of drive to be like others, to be where others are, or to do what others are doing, the drive that underlies learning through imitation is gone or diminished. A child who is shy may seem to lack a desire to join with others, but this can be distinguished from autism because, in the child with autism, the lack of desire to join in is pervasive and present across many situations, but in the shy child it is usually most notable with groups of peers, in busy situations, or around relative strangers.

Imitation and a Theory of Another`s Mind. The second innate ability that underlies imitation is the capacity for a theory of mind. When a child copies the actions of another, he implicitly reflects the understanding that there is something salient, something to be understood, a positive experience to be gained by doing what another is doing. Imitation is a way of "assimilating" what is in the mind of another through experiencing the experience of another. This explains the attraction to imitating peers: Peers have minds of similar complexity and organization, so the child can most readily "see" what it is that the peer is doing. (This may also explain why some parents and teachers note that autistic children will imitate a bad behavior more readily than a good behavior: Bad behaviors tend to be mentally simpler behaviors to execute. A bad behavior, like biting or hitting, is often a means to an end, which does not require theory of mind, just simple cause and effect, to understand.)

Imitation and Novelty Seeking. A third innate ability that drives imitation is response to novelty. As we discussed, children with autism often have the opposite response to novelty from other children. They tend to run from novelty rather than seek it. The typical toddler is most likely to want to imitate something rather novel and salient, something that really catches his attention. Therefore, Barney is more interesting to copy than Peter Jennings. The child with autism, however, does not attend to novel things as readily, and so, in avoiding novelty, misses the salience that novelty brings -- the Barney traits (purple-ness, bulbous-ness, gawkiness) that might otherwise seem captivating. This is not to say that children with autism don`t like Barney -- many do. However, it is more likely that Barney`s familiarity and the repetitiveness of what he does, not his novelty, makes him attractive.

In many ways, the absence of imitation, or a low or limited level of imitation, is probably one of the biggest learning handicaps of a developing child with autism. There is so much he should be taking in via observation of others. Lack of observation of others has a pervasive effect on the amount of information the child takes in. This failure to "assimilate" new information, in turn, profoundly affects the child`s ability to "accommodate," or to develop further information by relating new experiences to existing schema.

How Children Learn Imitation. Let`s go through an example that demonstrates learning through imitation in a typically developing child that may provide a model for the way children with autism also can be taught to imitate: The 14-month-old gets a present. It is a stuffed cow. The father waves it around, saying, "Cow! Cow! Moo! Moo!" He tickles the baby with it. The baby is interested, thinks this is very cool, grabs for the cow, waves it, and says, "Ca-Ca! M-o-o-o-!" several times. He gets a lot of parental attention for having done so well at this little lesson. Later, the 14-month-old`s five-year-old sister is playing with her farmyard set, and the 14-month-old toddles through her neatly arranged corral, grabs a plastic cow, and shows Dad, saying, "Ca-Ca! M-o-o-o!" A behaviorist would say that the 14-month-old has "generalized" what a cow is. We could also say that the 14-month-old "assimilated" his dad`s cow use, and then accommodated his newly acquired cow schema to include plastic cows as well as stuffe d cows.

Imitation and the Behavioral Concept of "Generalization." Understanding how and why a 14-month-old imitates is critical because we often hear behaviorally oriented teachers commenting on how something the autistic child has learned hasn`t "generalized" yet. What is meant is that the child has learned to respond to one example of a learning target, but has not shown the predilection to use that information elsewhere. For example, a child might learn to "touch cow" using a six-inch, hard rubber cow, but will not yet "touch cow" if a larger, soft-flocked cow is used. Why not? How is the process of learning different for the child with autism? He has not learned through imitation. Usually, the procedure is to "motor prompt" the child with autism, taking his hand and putting it on the cow (rather than the pig) when he is asked to "touch cow." The prompt is used less and less until the child can discriminate between a cow and a pig on his own. When he does this correctly, he gets half a pretzel stick or some other treat he likes.

There are several key differences in the learning process so far for the 14-month-old and for the child with autism. First, the autistic child`s actions are motivated by cause and effect, not a desire to imitate (that is, to do like, or be like someone else). He has figured out what to do to get the pretzel stick. (He did not use theory of mind -- "I will have fun if I do this with this cow, too!" but rather simple cause and effect.) He did not begin the activity spontaneously, but his behavior was systematically "shaped" to "touch cow" starting from the level at which he was physically shown to do it. (He did not seek novelty.) The child with autism likely engaged in this activity with no social reference to the teacher before or after identifying the cow. (There was no affiliative orientation motivating a desire to do as the teacher had done.) There was no "generalization" because critical components of the learning experience -- the novelty seeking as part of the learning experience, and motivation to enga ge in this activity because someone else interesting did it first -- were lacking.

What does this mean? Is motor prompting not a good way to teach children with autism? No, it doesn`t mean it`s not a good way of teaching. It can help the child attend to something he might otherwise avoid attending to. Giving a food reward sustains and organizes attention around a goal (the food), which is important for the child when social attention alone is not that relevant. It does work to teach specific examples, and sometimes in the process, the child becomes interested enough in the materials or in the way the teacher is teaching to retain this information in a qualitatively different way that promotes assimilation and accommodation. In this case, teaching must include materials that are intrinsically interesting to the child to increase the probability that the materials themselves will stimulate the desire to learn more, just as they do in a typically developing child.

This slightly different understanding of imitation should help one understand how to construct teaching situations. If the child is interested in some qualities of the teaching materials, there is a chance that the child will become increasingly interested in the teaching interaction. By providing opportunities for imitative learning for children with autism in a way that stimulates the same innate functions that govern more typical patterns of learning through imitation, there is a better chance that acquired information will be retained, used, and added to, as it is with a typically developing child. The point is that an aspect of typical development, like imitation, can be deconstructed into its innate components -- affiliative drive, theory of mind, and novelty seeking (things we talked about in chapter 2) -- to describe how, why, and when imitation promotes learning. In the case of autism, the first step in remediation of the failure to imitate is to deconstruct it into these same innate components -- af filiative drive theory of mind, and novelty seeking. Weakness in any of those areas, or often in all three, will limit imitative learning. Any of these possible innate weaknesses must be addressed to improve capacity for imitative learning. By bolstering the underlying deficits (such as by using intrinsically interesting materials so the novelty of the materials benefits rather than inhibits learning) we model typical development of imitative learning and thereby give momentum to the generative, motivating qualities of learning through imitation. Said more simply, the child with autism may start to imitate after he has been stepped through imitation of an activity, and it has turned out to be fun.

So, imitation can be increased by manipulating the novelty of the teaching materials: A child with autism may be happy to imitate "waving" using a twirling battery-operated pom-pom with online game for kids ing lights, but may remain uninterested in waving a baton. Similarly, imitation can be increased by tweaking the "affiliative-drive" component of imitation, such as when a peer provides a model of an activity that is developmentally at the child with autism`s own level, and so is more readily experienced as interesting. In the next section, then, we`ll discuss how peers fit into learning.

Reprinted from the book Helping Children with Autism Learn: A Guide to Treatment Approaches for Parents and Professionals by Bryna Siegel, Ph.D.; (June 2003; $30.00US; 0-19-513811-2) Copyright ? 2003 Oxford University Press, Inc.; Permission granted by Oxford University Press; For more information please visit the publisher`s website at www.oup.com


Dr. Bryna Siegel is Professor of Psychiatry at the University of California, San Francisco and Director of its Autism Clinic. As a developmental psychologist specializing in developmental disabilities, she has worked with families of children with autism for the past 25 years. She has closely studied early diagnosis for autism, diagnostic methods, and the effect of autism on the family. Her books include The World of the Autistic Child: Understanding and Treating Autistic Spectrum Disorders (OUP, 1996) and What About Me?: Siblings of Developmentally Disabled Children. She lectures frequently to parents and professionals, comparing and contrasting treatments for autism and focusing on how to design and tailor treatment programs for the individual child.

For more information, please visit www.writtenvoices.com.


Adult Attention Deficit Disorder - By Jeannine Virtue

 

Attention Deficit Disorder tends to focus predominately on children, leaving the ADD adult population largely under served. Most of the information presented about Attention Deficit Disorder focuses on children, parenting and school issues. All but one ADHD medication currently on the market achieved FDA approval for adult Attention Deficit Disorder treatment.

Attention Deficit Disorder simply was not in vogue when the adult of today was a child decades ago. While today many express concerns of over diagnosis of Attention Deficit Disorder in children, many also acknowledge the under diagnosing of adults with Attention Deficit Disorder.

Adults with ADD often realize that they have Attention Deficit Disorder when their own child is diagnosed. Looking through the list of symptoms, the parent often sees similarities in their own present or past behavior.

Yet, the hurdles of Attention Deficit are often the same, whether in a child or an adult. The ADD adult might have trouble with staying on task, staying organized and procrastinating, just as the Attention Deficit Disorder child does. The Attention Deficit Disorder adult might have trouble maintaining relationships and controlling their mood, just like an ADD or ADHD child. The main difference between the ADD adult and the ADD child is that the adult with Attention Deficit typically has more sophisticated coping mechanisms.

For the better part, the Attention Deficit Disorder ADD ADHD symptom test outlined for children is about the same for the adult, with the word "work" substituted for "school." You can also look at the Attention Deficit Disorder test for children and ask yourself if, as a child, you had such symptoms or currently have such Attention Deficit Disorder symptoms.

Below is an adult symptom test with symptoms unique to the Attention Deficit Disorder adult. This self test is not a diagnostic test but a source of information for the adult trying to determine if Attention Deficit Disorder might be present in their life.

Adult ADD Symptom Test:

If you experience more than 10 points on this adult ADD self symptom test, Attention Deficit Disorder is likely present.

_ An internal sense of anxiety

_ Impulsive spending habits

_ Frequent distractions during sex

_ Frequently misplace the car keys, your purse or wallet or other day-to-day items

_ Lack of attention to detail

_ Family history of ADD, learning problems, mood disorders or substance abuse problems

_ Trouble following the proper channels or chain of commands

_ An attitude of "read the directions when all else fails"

_ Frequent traffic violations

_ Impulsive job changes

_ Trouble maintaining an organized work and/or home environment

_ Chronically late or always in a hurry

_ Frequently overwhelmed by tasks of daily living

_ Poor financial management and frequent late bills

_ Procrastination

_ Spending excessive time at work due to inefficiencies

_ Inconsistent work performance

_ Sense of underachievement

_ Frequent mood swings

_ Trouble sustaining friendships or intimate relationships

_ A need to seek high stimulation activities

_ Tendency toward exaggerated outbursts

_ Transposing numbers, letters, words

_ Tendency toward being argumentative

_ Addictive personality toward food, alcohol, drugs, work and/or gambling.

_ Tendency to worry needlessly and endlessly

_ "Thin-skinned" - having quick or exaggerated responses to real or imagined slights.

So you hit a number of points on the adult ADD self symptom test, now what?

First, it is important that a physician rule out conditions like anxiety, depression, hypothyroidism, manic-depressions or obsessive compulsive disorder that can mimic Attention Deficit Disorder symptoms. Hormonal imbalances in perimenopause and menopause can produce foggy thinking, anxiety and exaggerated outbursts. Women should rule out perimenopause if the Attention Deficit symptoms appear in their late 30s or 40s.

Physicians typically first prescribe antidepressants like Prozac for an adult with ADD, since depression issues often go hand-in-hand with adult ADD. Physicians usually move to stimulant medications like Adderall, Concerta or Ritalin or Strattera if antidepressants do not work.

The stimulant medication treatment route is not recommended for people with a history of drug or alcohol use or abuse since these are controlled substances with a fairly high degree of addiction potential in adults. Some adults find that the side effects of ADHD medications are not worth the benefits of the medication.

The Attention Deficit Disorder adult can find help naturally without the side effects of ADD medication treatment by incorporate diet, exercise and lifestyle modifications.

Release the Steam, Quiet the Mind:

Regular and vigorous exercise can be very helpful for the Attention Deficit Disorder adult. Attention Deficit Disorder adults tend to have addictive personalities. Exercise is a good addiction. Aside from the obvious health benefits, regular exercise is also a great way to release steam and quiet the mind. Some studies also link regular exercise to decreased depression - a condition common with Attention Deficit Disorder adults.

Diet:

The brain is a hungry organ that cannot function at optimal levels without the proper fuels. To keep the brain functioning at top performance, ADHD diets packed with brain boosting essential fatty acids and amino acids is a must. A diet high in lean protein provides amino acids necessary for brain functioning.

The ADD adult can also meet these crucial dietary requirements for Attention Deficit Disorder by taking a high-quality nutritional supplement to ensure that they are giving the brain the fuel it needs to function properly.

Restructuring the ADD adult environment:

The Attention Deficit Disorder adult should get into the habit of making lists. The list should include any and all tasks required for the day, from "Mop the kitchen floor" to "Finish the sales proposal."

Write your list with the tasks of highest priority first. Once the highest priority task is completed, mark it off and go to the next. Warding off the urge to skip around on the list will take some discipline but the sense of accomplishment at completed tasks is well worth the effort.

The Attention Deficit Disorder adult should also keep a notepad in their car, purse, coat and on their bed stand. Thoughts come and go quickly. Jotting the good ideas down will ensure that they don?t go away quickly - assuming the notepad does not get lost in the process

The alarm clock or a wristwatch with an alarm can be a great tool for the Attention Deficit Disorder adult. If you need to pick your child up from soccer practice at a certain time, set the alarm. If you have food cooking on the stove and you leave the kitchen, set the alarm. If you have an important appointment, set the alarm.

Large tasks tend to overwhelm the Attention Deficit Disorder adult and they often put off large task as long as possible. It is not uncommon for the Attention Deficit Disorder adult to procrastinate until the "11th Hour" and then pull an all-night jam session trying to meet a deadline.

For large tasks, the Attention Deficit Disorder adult will do well to break the task into smaller, more manageable tasks and attach deadlines to the smaller tasks. If you need to finish a large project in one week, for instance, schedule specific time each day to work on a specific aspect of the project.

An adult with Attention Deficit Disorder might also find it beneficial to enlist the help of a coach. A coach is a close and trusted friend, co-worker or therapist whose specific function is to help the Attention Deficit Disorder adult stay organized, on track and focused while providing encouragement.



Jeannine Virtue is a freelance writer and mother of an Attention Deficit teen. For information on effective drug-free Attention Deficit treatment, visit http://www.add-adhd-help-center.com

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