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Common Skill Deficits in Children with Autism

Tara Warwick, OTD, MS, OTR/L

September 28, 2017

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Question

What are some common skill deficits seen in children with autism?  

Answer

There are several skill deficits common in children with autism that can significantly impact behavior; deficits which may need to be addressed before you can work on more specific therapy goals. These deficits include:

Asking for and Taking a Break. Many times, we have to start off by just giving them a break, because they don't yet have the skills to ask for a break. They don't know when they're at a point that they need a break until it's too late. Not only do we have to teach them how to ask for a break, but also how to take a break. The 25-year-old gentleman that I work with doesn't know how to chill out and take a break. We've had to use reinforcers to teach him how to relax because he doesn't know how to slow down, let alone ask for a break.

Asking for Help. Inability to ask for help relates to the individual's theory of mind. Theory of mind is the ability to attribute mental states (i.e., beliefs, intents, desires, pretending, knowledge, etc.) to oneself and others, and to understand that others have beliefs, desires, intentions, and perspectives that are different from one's own. Perception of other people's thoughts and feelings can be challenging for individuals with autism. That is why asking for help is difficult for them: in their mind, they think if they don't know the answers, no one else will know the answers either. I've also had children who feel that if they don't know the answers, and if they need to ask for help, that they are a failure. We have to work with them on being aware that everyone needs help sometimes. They need to know that there are a lot of different ways that a person might need help. Sometimes they may need help with the whole activity; sometimes, assistance may be needed for just one piece of the activity. We have to try and make them understand that it is not always black and white.

Emotional Regulation. Children with autism have a difficult time monitoring their emotions. I have been on many consults with teachers who have commented that one of their students "goes from happy to having a meltdown in two seconds." That's because the child doesn't know those in between stages; they don't know what to do when they are escalating. We have to work on that emotional regulation, and on teaching children when to take a break, how to ask for a break. Think about a five-point scale, where a five is a child having a tantrum or going off the deep end, and a one is a very happy child. We need to enable these children to evaluate their situation and think about what they need to do when they are at a three or four so they don't get to a five. That ability to regulate emotion is extremely hard for some children. 

Initiating Interaction with Another Person.

Transitioning. For individuals with autism, moving from one activity to another can be extremely difficult, as was the case for the young man I worked with today. Leaving an activity and transitioning to another -- even going from something that he didn't like to something that he liked -- was a struggle. We had to break down the transition for him, and we had to reinforce that transition. We have to think about that as a learning opportunity. Instead of simply avoiding transitioning, we had to think about teaching him how to transition. We needed to teach him how to go from something that he likes to something he doesn't like, and vice versa because school and life are full of transitions. 

Giving up a Preferred Item. Often, what I see happening is that an individual likes something (e.g., an iPad), but they don't know how to give it up. What happens then is teachers, parents, therapists will say, "We don't use the iPad anymore because he won't give it back to us." My response is that we need to teach him how to give up something that he likes. Because when we can do that, it gives us more leverage. We need leverage to teach them skills. We have to teach them how to give up a preferred item by breaking it up into small steps.

Dealing with Losing. I have several children who don't know how to handle situations where they lose or when things don't go their way. I had to work with a young boy on this, and we had to break it down by starting with games that have a short duration. I couldn't begin with a long game like Monopoly for example, where you play for an hour or more; if the child lost after that long period of time, he would have been too emotionally wrapped up. We had to start with a card game called War, where each person gets one card and the highest card wins. I had to reinforce him for that because the world is full of situations where sometimes you're going to win and sometimes you're going to lose. You have to know how to deal with it.

Occupying Time (Waiting and Down Time). The student I saw today transitioned very well into the room this morning. However, he went to his little area and there wasn't an activity there for him. He didn't know what he was supposed to do. All the other children were waiting until the next activity was going to happen. This child started roaming around the classroom. Before too long, his behavior had escalated, and he started getting in a little trouble because he didn't know what to do during downtime. He didn't know how to wait. We're going to have to teach him how to wait and how to occupy himself during downtime.

Motor Skills. Do they know how to use their motor skills during PE? Do they know how to use their motor skills when they're out at recess, and how to play with others? Do they know how to do imitation? 


tara warwick

Tara Warwick, OTD, MS, OTR/L

Dr. Tara Warwick is an occupational therapist and the co-owner of Blue Sparrow, a national training and consulting therapy firm, and Today’s Therapy Solutions, an Oklahoma-based pediatric therapy company. She has over 20 years of experience working with children with disabilities across all settings. A graduate of the University of Oklahoma, Tara obtained her bachelor’s degree in occupational therapy in 2000, her master’s degree in Rehabilitation Sciences with an emphasis in pediatrics in 2005, and her Post-Professional Occupational Therapy Doctorate in May 2021. Tara spends her days providing in-home therapy to children, conducting training and consultations for schools on challenging behavior and autism, and consulting with other therapy companies on practice management. Tara’s areas of intervention expertise include behavior management, sensory processing, self-care training (potty training, eating/feeding, dressing, play, etc.), assistive technology, and home programming. Tara enjoys thinking outside the box and developing creative ways to help her business run more efficiently and effectively.


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Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for .5 hour of general and 1.5 hour of Direct Access CE credit.

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