Autism and the value of adaptive functional living skills

by Ishanthi Perera

Autism is a neuro developmental disorder, characterised by impaired social interactions, impaired verbal and non-verbal communication and by restricted and repetitive or stereotyped behaviour. It typically presents before a child is three years old, although in some instances children appear to regress after developing along an age-typical trajectory.

Along with the characteristic symptoms of autism, many individuals with the disorder also have deficits in their ability to function independently and need extensive assistance or instruction to complete daily living activities.

It is important to teach adaptive functional living skills to such individuals to increase their independence, provide the ability to make choices and to alleviate stress on the family.

There are four primary skill sets that should be taught to individuals with autism and two secondary skill sets that can be taught depending on the individual's functioning.

The primary skill sets are:

Basic living skills

This includes basic self-help, self-care, self-management, hygiene routines, and core communication skills. These skills are considered a prerequisite for any functional skills program for any individual regardless of age, setting or disability.

These essential skills, if not mastered, will have a profound impact on an individual's ability to live independently, to be successful in school, and to take advantage of various social and recreational activities throughout their life.

Home skills

Regardless of the individuals living arrangement (living with parents, in a group home or independently), home skills provide essential skills required for living in the home. Some examples include meal preparation, laundry and general housekeeping.

Community participation skills

Participating in the community begins with learning to physically navigate the environment in a safe manner as well effectively communicate with people encountered while walking or while being transported. To be able to shop in grocery and department stores (independently or with a caregiver), use public transit or travel in a private vehicle in a safe manner and eat a fast food or sit-down restaurants requires a wide variety of skills.

The ability to tell time and use time related concepts, making and keeping appointments and other skills to help the individual interact with others in the community are also considered.

School skills

It is important for the individual to be an active participant in a variety of skills, routines and social situations in educational settings. These skills are essential in striving for independence and successful functioning in different types of classrooms, in all parts of the school campus, and with peers and various staff. Some examples include following instructions, following routines and social skills.

The two secondary skill sets are the following:

Vocation skills

It is important to teach vocation skills if an individual is of a higher level of functioning and can learn skills that will enable that individual to find meaningful employment. Vocation skills need to be paired with a workplace that will be willing to accommodate the individual.

The individual, family, clinician involved with training and the workplace management need to agree upon certain rules and guidelines which both the individual and workplace will follow and create a job task list for the individual to independently execute.

Independent living skills

These are skills that an individual needs to learn to live independently (or semi-independently). Most individuals with autism typically live with a family member who cares for them; although there is a certain population that also find themselves in a group home type setting. It is important that these individuals learn independent living skills to gain independence with their lives and the choices they make as well as to be safe.

Adaptive Functional Living Skills (AFLS) should be taught when the child is young and more malleable to learn. When routines for learning these skills are put in place early, it is easier for the child to understand and follow, for the clinician to teach and for the family to maintain.

As the child gets older, if any maladaptive routines and behaviours exist (or lack of any routine exist) they become stronger and more persistent.

The longer these behaviours are exhibited, the longer they will be reinforced. The longer such behaviours are reinforced, the harder it will be to replace those behaviours.

Thus, the individual will be more resistant to change and may exhibit behaviours such as aggression or withdrawal if the existing situation is altered.

Responsibility

As the individual gets older, it becomes harder for the family to continue shouldering the responsibility of carrying out adaptive living functions for the individual and this can cause excessive stress and burnout for the main caregiver or the family as a whole.

As the main caregivers get older and ultimately become unable to care for the individual with autism, the individual is often left helpless, as they do not have the skills to help themselves or know how to receive help from others. Furthermore, it becomes more challenging for unfamiliar adults to assist adults with autism who have no AFLS (as opposed to children). Other issues to keep in mind with this population are the individuals’ inability to understand and accept change (e.g. A different adult attending to them, a different living arrangement), change related aggression as well as the risk of being taken advantage of and abuse by unknown individuals.

Understanding how an individual learns is vital in deciding which teaching strategy to use to teach adaptive functional living skills.

Furthermore, teaching these skills properly and accurately the first time is imperative, as it is difficult for individuals with autism to ‘unlearn’ what they have already learned. If you or a family member will benefit from learning adaptive functional living skills it is important to connect with an experienced and qualified behaviour therapist to get the process started.

The writer is a Consultant Behaviour Therapist.

‘Deadly’ diet and no exercise make obesity the ‘new norm,’ warns WHO

Worst countries include Greece, Portugal, Ireland and Spain, though the UK isn't far behind

A “deadly” epidemic of physical inactivity and diets high in fats, salts and sugars has led to obesity and overweight becoming “the new norm” throughout Europe, the World Health Organisation (WHO) has warned.

Up to 27 percent of Europe's 13-year-olds and 33 percent of 11-year-olds are overweight, officials said ahead of an EU summit in Greece with a special focus on “the grave public health concern” of childhood obesity. Countries with the highest proportion of overweight 11-year-olds included Greece, with 33 percent, Portugal (32 percent), and Ireland and Spain, both with 30 percent.

Overall the UK is performing slightly better, but in Wales 30 percent of 11-year-old boys are overweight.

The WHO's regional director for Europe, Zsuzsanna Jakab, said that Europeans’ “perception of what is normal has shifted”.

“Being overweight is now more common than unusual. We must not let another generation grow up with obesity as the new norm,” she said. “Physical inactivity - coupled with a culture that promotes cheap, convenient food high in fats, salt and sugars - is deadly.” Inactivity, listed by the WHO as the fourth leading cause of death globally, is now viewed as one of the major health threats affecting developed countries.

In the UK more than two thirds of people over the age of 15 were insufficiently active, according to the WHO's latest data, from 2008.

It is recommended that adults get 150 minutes moderate-intensity exercise per week, while children and adolescents should have an hour per day, according to international guidelines.

Countries which were praised for efforts to “contain the epidemic” of overweight and obesity included France, Norway, the Netherlands and Switzerland.

Measures which had been a success included taxes and restrictions on advertising of unhealthy foods, as well as the promotion of physical activity, the WHO said.

WHO's program manager for nutrition, physical activity and obesity at the European Regional Office Joao Breda said the food industry and government could help, but “the urban planning sector” could also play a part by building in a way that encouraged exercise by providing green space and attractive walking routes, indoors and out.

“We need to create environments where physical activity is encouraged and the healthy food choice is the default choice, regardless of social group.

Physical activity and healthy food choices should be taken very seriously in all environments - schools, hospitals, cities, towns and workplaces,” she said.

- The Independent

'DenGone' to create dengue awareness

The country is presently facing the worst ever epidemic of dengue fever, speaking to Sunday Observer, Chief Medical Officer CMC Dr. Pradeep Kaiyawasam said. He said that this years’ outbreak was far more worse than the one experienced last year.

The worst affected are children and so far statistics have demonstrated that over 50 percent of schools in Colombo have been found to have dengue mosquitoes breeding in their premises. This has led to 70 percent of the patients being under 20 years of age.

To combat this menace we need a change of attitude and we do have to start at the bottom, he said.

Speaking of the casualties he said that this year has so far seen four deaths.

According to Dr Kariyawasam, 466 school children in the Colombo municipal area have contracted dengue and 229 of them are children under the age of five.

Over 47 percent of dengue cases in 2013 have been in the Western Province.

Over 85 percent of mosquito breeding places are found in garbage or discarded items. Most of the discarded items are usually found near residences.

There has however been a noticeable drop in the number of cases reported this year in comparison to 2012.

With the view to raise awareness of how the message of ‘prevention’ can be spread a massive walk will be organised shortly, he said.

As a totally new approach to combating this menace ‘DenGone,’ an educational video game on dengue eradication has been launched by Union Assurance.

This multimedia highlights the importance of prevention of dengue targeting children and adults as well.

Union Assurance in collaboration with the Public Health Department of the Colombo Municipal Council has developed this educational video game which is especially designed to educate children about the risk of dengue while highlighting the innovative and yet simple steps that can be taken to eradicate it.

New variety of sausages are normal and super healthy, say scientists

Researchers say they have discovered a way to ferment sausages that could turn the fatty meat product into a health food similar to probiotic yogurts. The secret ingredient? A type of bacteria found in baby faeces.

Although this may sound like either the stupidest or the most disgusting thing you've heard scientists get up to in recent years, the research is actually a fascinating insight into the common usages of bacteria.

Bacterial fermentation is already a big part in making sausages and many varieties (including favourites such as pepperoni and salami) owe their rich and tangy flavour to bacteria, which even create lactic acids that stops the development of germs in the meat.

However, while traditional manufacturing techniques mostly rely on the bacteria that occur naturally in raw meat, researchers in Spain have been experimenting with adding probiotic bacteria instead.

The reason for the sensationalist headlines? They've been collecting their samples from human faeces.

Now, to go over the why's and wherefore's of probiotic bacteria a little, the term is one that's applied generally micro-organisms that are believed to provide various health benefits. Ever since the invention of the microscope, scientists have known that the human body is full of various bacteria - a primitive form of life typically just a few micrometres in length.

However, in the beginning of the 20th century scentists began to suspect that the bacteria that lives in the human gut (typically around 100 trillion bacterial cells) might actually be helping us out, breaking down the foodstuffs that our stomach acid can't handle and tackling the nastier germs we might accidentally ingest.

In recent decades this has led to many theories that adding probiotics to food products will help with a number of ailments - anything from gastrointestinal disorders such as constipation to allergic reactions. Although the science surrounding this is still not entirely conclusive, this doesn't stop researchers finding new ways to add the human-friendly bacteria to our food.

With this particular batch of sasuges the probiotic bacteria used (specifically Lactobacillus and Bifidobacterium) was sourced from 43 stool samples from healthy babies up to six months old.

This may sound like a bizarre step to take but it is in fact a standard (if not common) method for isolating probiotics. For example, Lactobacillus rhamnosus GG, a commercial strain found in a variety of yoghurts and ‘daily dose’ drinks, was first isolated from human faeces in 1983. And why faeces? Because, if you're on the hunt for naturally-occurring bacteria that have been busy helping the body, looking in the material that has recently passed through the body of a healthy individual is a good place to start.

Speaking about the research, co-author Anna Jofré, a food microbiologist at Catalonia's Institute of Food and Agricultural Research's (IRTA) food-safety program, added that “infant faeces are natural samples, easy to obtain.”

After isolating the bacteria from their samples (this process involves letting the bacteria develop in a petri dish - it's not simply plucked from the faeces and dropped into the sausage), the researchers created six batches of fuet - a Catalonian pork sausage that's similar to chorizo minus the paprika.

- The Independent