Having a vaccination generates anxiety in most people. However if the purpose of a Covid-19 Vaccination is understood, people will endure momentary discomfort in order to benefit from the health benefits the vaccine brings.
Armed with this knowledge people visit a vaccination centre, which may be a hospital or GP hub. It may also be a football stadium, church or other venue which has been adapted for the purpose.
There they are guided through a process by helpful staff who wear tabards or lanyards identifying them as people who can help. In the vaccination area there are visual clues such as a chair, a table with medical items and a nurse wearing PPE, which guide people to where to sit and who to expect will be doing the vaccination.
Typical people recognise the context of each part of the vaccination procedure. This context guides them to pay attention only to the social factors described above that are relevant to the context, ignoring all other irrelevant factors.
This relieves anxiety and leads to the choice of a safe and effective social response. For typical people who are inherently context sensitive this happens for them without any conscious thought.
For an autistic person with context blindness, this may not happen for them. Without the information that comes from reading context the situation may be profoundly frightening. Not knowing what will happen next, how long it will take, when will it finish, and why it is a good idea can cause extreme anxiety.
A Social Story about vaccination will describe the purpose and the procedure and bring together all those relevant cues that may be missing for an autistic child or adult. I am attaching an example below. It will not match the child or adult you are supporting and must be adapted to the individual concerned. Their perspective must be paramount.
The Story needs to be exactly at their level of understanding and should follow the 10 criteria that are so important in writing a safe and reassuring Story. Factors that might cause an individual anxiety or distress need to be considered, explained and as much as possible any reassuring ‘props’ accommodated and included within the Story eg noise sensitivity and the use of headphones.
Any comfortable way of counting out three seconds of time will give a clear indication of when the pain will finish (I have used the idea of counting to three penguins for this person). It is important to include the idea that there may be delays, and that when the Covid-19 Vaccination is done there is additional waiting time.
I have also included a page related to the understanding that this is the first of two vaccinations to avoid confusion when recalled. Having a Story like this illustrated with photos from the actual vaccination centre is ideal, and of course will help recall what happens when the person has to return the second time.
As a population we are all feeling anxious as we cope with continual uncertainty. We are in fact experiencing a taste of life on the autism spectrum, where uncertainty and unpredictability rules the day, with all information vague and ambiguous. The two things neurotypical people now crave, just like our autistic population, are accurate information and certainty of outcome, two things which are in short supply. One benefit of the pandemic may be a deeper awareness of how it may feel to experience life on the autism spectrum!
We are in fact experiencing a taste of life on the autism spectrum, where uncertainty and unpredictability rules the day, with all information vague and ambiguous.
As we begin to prepare for a cautious and stepped return to another kind of normal life, we need to prepare our autistic children and adults for another change. This is problematic in itself because so little in our life is currently certain, every future step dependent on the subsequent response. Our young people crave predictability and certainty and in this fluid situation we are unable to give them exact dates and times.
Social Stories provide social information that inform and reassure, filling the gaps left by a different interpretation of the world. A Social Story can therefore reassure that although timings remain undefined, there is certainty that we, their loved ones or carers, will deliver information in good time before any change happens for them. This is important for them to know and important for us to do.
Return to school
It seems likely that a phased return to school will happen soon. There will be a lot of change to become familiar with. For our children all of these changes will need to be explained and described with concrete visual information and Social Stories, preferably before returning to school.
(A chapter on transition Social Stories, with an example of a school transition Social Story, is included in my book, ‘Successful Social Stories for School and College Students’.)
It is not all negative however. Lockdown has brought positive change too. Many of our families have discovered that the slower pace of a life lived more simply, with reduced social expectations has been a relief. As we return to school some positives may continue for our children. Instead of returning from the quiet sanctuary of home after a holiday break to a full classroom and assembly hall, they will be returning to a quieter, less social atmosphere, and importantly not to a full week’s timetable.
Children who found the proximity of other children in busy school corridors, noisy classrooms, crowded assemblies and playtimes may actually find social distancing much more comfortable. Once one-way systems in school corridors are understood, our children may prefer the reduced noise and likelihood of others bumping into them.
many of the changes the population will have to embrace in the future may make school and workplace more autism friendly, as well as safer for all!
During this time people have had to change their way of greeting others and it has become normal not to shake hands, or kiss both cheeks in the continental way, but instead just nod, smile or say hello. As we face a new normal and the potential return of Covid-19 in the future these greetings will continue to be recommended for safety. How helpful that they have always been more comfortable for our young people. It seems to me that many of the changes the population will have to embrace in the future may make school and workplace more autism friendly, as well as safer for all!
Once you have more information from school about your child’s return, make sure they know what days they will be in school and what days they will be at home on a visual timetable displayed at home. This can be very reassuring. On return to school, take a photo of the entrance and exit they will be using, and place these on the calendar along with the time they will be entering and leaving school each day. Knowing that there is an end to an experience is crucial information to those who have difficulty making predictions. These times are likely to be different to normal, and building familiarity as quickly as possible with the new routine will be helpful.
Always put on the timetable anything you can find out that will be the same as before. If you cannot find out much, don’t panic, you know your child will have, for example, their lunchbox with their usual food in, and maybe a snack too that they know and like. A photo of this can be placed on a timetable and be a positive, familiar anchor point in the structure of the day. The child will begin the day at home with a familiar breakfast activity then return home and do another familiar activity at the end of the day and a photo of these two activities can ‘frame’ the start and end to the day on the visual timetable.
Remember that some of the activities that were hard for your child before may not be happening. So it’s important that they know that Assembly, or Games, or P.E. may not happen. This may be reassuringly good news!
School is unlikely to be able to give details of everything your child will be doing, but they will be able to say who the child can turn to for information at school. Their usual LSA, who would know when to tell them of change, may not be available with the resourcing changes. If this is the case, telling the child who knows what is happening helps them know who to ask, and practicing the question at home, ‘Whats next?’ enables them to do this.
Understanding the words people are using
Many of us are now familiar with the new vocabulary that has emerged during the pandemic. It is important that our children understand these new words. Without understanding the context, they may assume a different meaning that may be quite inaccurate, and even more frightening than the reality. On return to school it is likely they will hear more of these words and therefore it is sensible for parents to ensure their child has a good understanding, explained in a positive reassuring way.
It is always a good idea to ask the child what they think the word means first, to uncover their perspective, before sharing your understanding of the word with them. Use Social Stories to do so if possible, adapting them for your unique child. Notice that in each Social Story included below I always try to mention that most people recover quickly from the virus and only a few have to go to hospital. It is easy to forget to emphasise this, but putting the situation into perspective is really essential.
Practicing at home.
Understanding the reason behind social distancing is crucial if it is to be adhered to, so once understood, model a safe social distance in a way that is meaningful for your child in a fun way.
For example, for a child interested in snakes identifying what snake would be 2m long could be his instantly recallable ‘long-snake’ social distance.
For a child that loves his bed, perhaps the distance from the head of the bed, where teddy sits, to the foot of the bed where giraffe sits. This distance can then be labelled with a name the child decides eg ‘teddy-giraffe distance’.
Use favourite toys eg teddy bear and place it on a marked spot and place another 2 metres away and have the teddies have a safety ‘lesson’ with the child as teacher.
Mark the sitting room floor or garden with cushions on the floor, 2m apart and practice sitting on them to read a story or watch TV.
The idea is to make social distancing another part of fun normal life and not scary!
Modelling and reinforcing the handwashing technique is crucial. Use the cocoa powder technique I first described in the earlier blog to refresh how well your child is currently doing in washing hands. Children are always touching their faces, and it will be almost impossible to stop them doing so, so effective handwashing really is important, and is a good habit to establish for a healthy life! Reward them when they remember to do it, and praise any improvement in technique. The more we all learn and practice this, the more automatic it will become. Effective handwashing can prevent a virus on the hands from entering the body and causing infection. This is so important as we all return to touch and use surfaces that have been touched by others.
One-way systems may be in place on return to school where previously there were two-way systems eg in corridors. Make sure they understand the term and demonstrate to your child using lego figures or toy cars how this works, or use figures from their special interest. If you have a garden, start up a one-way system, with home-made signs and move around it.
Face masks and visors may be more in evidence at school. These may be very scary to children on the autism spectrum. Describe what the term face mask means using a Social Story (link) It is important for them to be reassured the person is the same underneath when the face mask comes off. Showing how a visor made from a piece of see through plastic works and that you are still the same underneath may help. Play with other masks for fun in dressing up as favourite characters, just to make the idea less scary. Teddy or a favourite toy could wear a home-made mask or visor too?
By making what is unfamiliar familiar we can dispel fear and inaccurate assumptions. There is a great deal that parents can do to help their own children in the transition back to school, whenever it occurs, and preparation can start now.
Adults teach young children the basic hygiene rules of washing hands from a very young age. We wash hands when they are dirty, before eating, and after using the toilet. We teach our children a reasonably thorough method that is likely to get general grubbiness and grime off, and on the whole with a few exceptions it is successful. Children and adults usually know how to wash their hands, but sometimes forget to do so.
In a pandemic this is not enough. We are all required to wash our hands in a more thorough way to eliminate any trace of virus in order to prevent infecting ourselves and passing it on to others. Viruses on our hands picked up from touching things transfer to our face and find their way into our body resulting in illness.The problem is we cannot see a virus in the same way as we might notice a smidge of dirt left behind after a quick wash of a dirty hand.
Most of the information we have received tells us to wash our hands for a prolonged period of 20 seconds, singing a song to ourselves or counting to remind us to continue washing longer than we normally would. We tell our children to follow the 20 second rule and facilitate that for them by encouraging them to use their special interest to make it fun.
But the information we, and our autistic friends and family may be missing is how to wash to eliminate virus from all surfaces of our hands. A child or adult with autism may feel patronised when asked to wash their hands in a new way as they have already learned this skill as a young child. For those that are challenged by reading the implied context of the situation, information may be missing. We need to fill that information in so that the instruction makes sense.
We need to be cautious though, as an over emphasis on germs may stimulate an obsessive interest which could make life very difficult in months to come. We want to establish good effective handwashing at all times but extra careful handwashing at times when there is a dangerous infection about like at the moment.
I have found that providing visual concrete evidence to support the information I am sharing is always helpful. In a previous post I mentioned the ‘cocoa-virus technique’ using cocoa powder on the hands to demonstrate to a child/adult how viral particles can shed with a simple touch on household items and all over our faces. This can be used again to help with the technique of handwashing. An adult covers both hands all over with cocoa powder back and front, between fingers, up to the fingertips and around the base of both thumbs. Then they wash their hands like they normally do. Asking the child or adult to ‘spot’ any residues focusses their attention on missed places – the back of the hands, between the fingers etc. This is helpful work to do before reading the following Story, which provides useful information on why we need to learn to wash hands in a new more careful way and also the detailed steps required to do so.
We need to be cautious though, as an over emphasis on germs may stimulate an obsessive interest which could make life very difficult in months to come.
In the following Article I describe how after finishing handwashing it is important to use a paper towel or a clean tissue to turn off the tap. This is because the tap was turned on by a hand that may have had virus on it and virus may have transferred to the tap. If a clean hand is subsequently used to turn the tap off, the hand gets virus back onto it. Keep some clean tissues by the tap for this purpose alone. (to concretely explain this show how a ‘cocoa powdered hand’ will transfer brown dust onto a tap!)
Teach the technique carefully to everyone. Be aware that concentration on the task is required. Not everyone will be able to count or sing at the same time as paying attention to what they are doing. A timer may help here. Done carefully this technique will take over 20 seconds from start to finish.
Lets’ share this Story and make this new skill make sense for our young and old people on the autism spectrum!
To download our social article – learning to wash hands carefully, click the image below. This should allow you to download our pdf.
Main photo courtesy of the Centre for Disease Control, via unsplash.com
Children are watching and listening to daily news reports and hearing frightening information. Everyone is rightly anxious at the moment but in our children this anxiety can spiral and become a huge problem. Adults are talking openly on the phone and to other family members in the home about the seriousness of the current escalating situation.
There are a few things we can do to reduce our risk of catching the virus and also to help our children cope. Overheard comments by adults can be reduced by choosing to talk about this subject away from the child in a quiet voice, being mindful that our children sometimes have exceptional hearing. Reducing the amount of information reaching the child unsupervised through TV, radio or online channels is only sensible.
Providing information in an accurate but reassuring way is extremely important and also updating it when things change, as they will, with as much preparation as possible will help. Social Stories can help here (see attached Story below).Remember to be as positive and reassuring as possible, recognizing that our children are less able to read the current context and may leap to even more terrifying conclusions than is the case.
Demonstrate to the child how viruses can spread to surfaces with just a touch of the hand. One way of doing this is to sprinkle cocoa powder on a plate and then place the palm and fingers of both hands in the powder. Then walk around the room touching the back of the chair, the table, the handle of a cup or a door. Touch your face briefly, wipe your chin. Brown cocoa prints will be everywhere. Explain the cocoa powder is like a virus and then demonstrate thorough washing of both hands how the brown powder is washed away.
Parents will need to help children learn how to wash hands thoroughly for a prolonged period of 20 seconds. Using the child’s special interest may help here. Choose a song that is special to the child, sing it with them until 20 seconds is up. Alternatively use their special interest to employ them in counting to 20 eg counting to 20 penguins. Wash all areas of the hands – between fingers, around the nails, covering the tips of the fingers to the wrists back and front. Leave no area not covered in soap and wash off with warm/hot water. Doing it thoroughly will take 20 seconds. Doing it twice will prevent any area being missed.
Place a photo of penguins/ whatever favourite character is being used or the song above the sink as a reminder, and of course praise your child when they manage it well, and reward them.
Learning About the Corona Virus
Dr. Siobhan Timmins
Most of the time people are healthy and feel well. Sometimes people become unwell because of a cold or flu. Colds and flu are caused by viruses. Colds and flu are caused by viruses. Viruses are very tiny germs that we cannot see because they are so small.
Most of the time peoples’ bodies get rid of a virus in a few days or weeks. While the body is getting rid of the virus sometimes people need to stay at home or in bed to rest. Soon they are back to normal again.
Corona virus is a new virus that makes people unwell. Because it is new lots of people all over the world have caught the virus. Most people who have corona virus may feel like they have a cold or flu. They may have a temperature and a cough. After a few weeks they will feel well again.
A very very small number of people who have corona virus may become very very very very unwell. They may need to go to hospital so the doctors and nurses can help them while their bodies try to get rid of the virus..
Because Corona virus is a new virus doctors and scientists are busy learning about it. They are trying to find ways to treat this virus. Scientists are also working hard to make vaccinations and shots to stop people from becoming unwell from the virus.
While we wait for the scientists and doctors to make a vaccine or find a things all adults and children can do to avoid catching it.
Viruses are usually caught by people touching something that has a virus on it and then touching their face. Sometimes people catch the virus by being close to someone who has sneezed or coughed.
Viruses are so small we cannot see them. It’s important for people to wash their hands often with soap and warm water. This gets rid of the virus and helps to keep us healthy.
I will try and wash my hands with soap and warm water for 20 seconds before I eat, after I use the toilet and when I come home from school, the park, shops or seeing friends. My Mum or Dad will show me how to wash my hands carefully. They will remind me when it is time to wash my hands. To get rid of any virus doctors say it is important to wash our hands for 20 seconds (20 Pokemon/penguins…) This takes as long a singing ………………….. (my favourite song) twice or counting to 20 penguins (or favourite character).
Sometimes to stop a virus from spreading doctors and scientists tell people to stay away from crowds or groups of people. Schools may close and children stay at home. Workplaces may close and mums and dads work from home. Shops, buses and trains may stop running too. This is okay. It helps to stop the virus and keep people healthy for when things are normal again. We can stay at home until it is safe to go back to school or work. Mum and Dad will have ideas to keep me busy and happy at home. Mum and Dad will be told when it is safe to return to school or work. This is okay. It helps to stop the virus and keep people healthy for when things are normal again.
I am learning about Corona Virus.
A simplified version of the Social Article above, for those whose who are younger, have a cognitive impairment or reduced attention span, is available as a Social Story here
I plan to use this space to post news of upcoming events and also from time to time to share ideas or Social Stories™ that I believe may be helpful……
Now that the new school year is well under way I am being asked once again to write Social Stories™ for children on the autism spectrum around the topic of school breaktime (called ‘recess’ in the U.S.) specifically to help them join in games and to ‘be social’ and ‘make friends’.
Break time is often one of the most challenging and uncomfortable periods of the day for our children.
Break time is often one of the most challenging and uncomfortable periods of the day for our children.It is easy to guess why this might be. Autistic children have a different sensory and social experience to typical children. They may become quickly overwhelmed by noise, the proximity of other children, the chaotic atmosphere of the playground – by all the things that make breaktime so interesting and exciting for their typical peers.
There is a problem here, and it is not with the children on the autism spectrum, but more with typical people expecting, and wanting to see the development of social behavior in all children at break time.
I believe it is important for everyone to take a step back here and think about the purpose of breaktime. After sitting still and following directions all morning children need to let off steam and ‘reset’ at breaktime in order to be able to return to the classroom refreshed and ready to learn again. Many typical children enjoy the freedom of breaktime to be noisy, running and shouting with their friends, playing games, and sometimes chatting within a group.
the needs of children on the autism spectrum are likely to be different to their typical peers. Solitude and silence are often sought out to recover from the confusing social demands of a busy classroom
However, the needs of children on the autism spectrum are likely to be different to their typical peers. Solitude and silence are often sought out to recover from the confusing social demands of a busy classroom. Pacing up and down the perimeter fence may bring comforting predictable proprioceptive input. Looking at subjects connected to their special interest in quiet areas such as the library may take the child to a comfortable and familiar place in their mind outside of the uncomfortable school experience. They may shy away from games they find difficult to understand, or interactions that they find continually baffling. It is important to affirm that it is okay to choose these activities at breaktime, and also to provide access to autism friendly environments in which to do them. Everyone has different ways of winding down and resetting.
Providing social information proactively before sending the child into the playground really does level the playing field for them and this is where Social Stories™ can really help. For this reason in the book ‘Successful Social Stories for School Students with Autism’ I have included a section devoted to Breaktime.These Stories are examples that describe the unseen, unwritten social information that guides children to more successful play with others. The first Story, ‘What Happens at Breaktime?’is a helpful reminder to child and staff of the purpose of breaktime as well as an affirmation that it is okay to choose activities that help. It is included below. Other titles in this section of the book include,
Who is the owner of a game in the playground?
How to join a game in the playground.
What is a chasing game?
What does home mean in a game?
What does the whistle mean in the playground?
What is lining up?
Who is in charge of the playground?
What happens at break time?
– A Social Story™ taken from ‘Successful Social Stories for School and College Students with Autism’ by Dr. Siobhan Timmins, published by Jessica Kingsley Publishers
At school children usually work hard in lessons. At break time children usually stop work and relax. Break time mostly happens outside in the playground. Sometimes when it is raining break time happens indoors in the hall.
Relaxing at break time usually helps children get ready for the next lessons. Some children like to run to relax. This is okay.
Some children like to play a game to relax. This is okay.
Some children like to talk to other children to relax. This is okay.
Some children like to be on their own in a quiet place to relax. This is okay too.
At break time: I may join a game or I may talk to another child or I may run around or I may be on my own in a quiet place or maybe do something else.
Usually the junior library is a quiet place to go at break time. Relaxing at break time usually helps me get ready for the next lessons. I am learning what happens at break time.
Watch this space for the next post on the more adult form of Social Stories™– ‘Social Articles’
Dr Siobhan Timmins has been writing Social Stories™ for 25 years and is a published author. She has more than a decade of experience in teaching social understanding in autism to parents and professionals, delivering workshops in Social Stories™ nationally and internationally.
Dr Siobhan Timmins has been writing Social Stories™ for 25 years and is a published author. She has more than a decade of experience in teaching social understanding in autism to parents and professionals, delivering workshops in Social Stories™ nationally and internationally.
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