How Words Can Reduce Behavior Breakdowns for Kids with ASD

kaboompics.com_Young boy sitting on sofa with tablet pc-ipad-child-teen-stock

This is a guest post for parents by Karen Kabaki-Sisto, a certified Speech-Language Pathologist and Applied Behavior Analysis Instructor.

Imagine that you suddenly awoke today in rural Peru with only the limited knowledge of Spanish from when you studied it many years ago in high school. Undoubtedly, you will be struggling to communicate with the locals in this region who do not speak English. As your words and gestures continue to get misinterpreted, your frustration, fear, exhaustion, and anger rises.

This is how your child with autism can feel every day – every minute, in fact – right here at home in the company of people who do speak the same language.  Even though your child with autism understands and expresses to some degree, it is not always easy.  Difficulty understanding and being understood can cause your child to feel embarrassment, confusion, and frustration which can lead to challenging behaviors.  Just as adults and other family members may be frustrated by your child’s behaviors, your child can be frustrated by others’ behaviors toward him – or the lack of actions to help him – resulting in a continuous cycle of communication and, ultimately, a behavior breakdown.

A key way you can communicate more effectively to maintain positive feelings is to turn indirect language into direct language by being very explicit and specific.  Let’s explore some examples that I have witnessed:

EXAMPLE #1
A family was painting their walls, and some paint had fallen into a puddle onto the floor.  Their son was about to step in it when his father loudly shouted his name.  The boy saw his father’s shocked and nervous face and heard his dad say, “Be careful!”. However, the son proceeded to step into the paint, then walked throughout the house. Needless to say, no one was thrilled.

Child’s Perception: I see Dad’s face, but I can’t perceive what his expression means.  I hear Dad’s words, but I can’t interpret what they mean.

Child’s Thinking: Life as usual.

Social Outcome: I’ll continue my course of action, which is to step into the paint that I don’t know is there.

Why?  This child doesn’t understand implied or indirect language, the meaning of which requires interpretation. What exactly does “Be careful” or to literally ‘be full of care’ mean? Even if he realizes that it is a warning, he’s unsure of what the concern is, where the danger is coming from, what exactly he should or should not do, and what could happen.  Further, this child does not understand non-verbal body language, facial expressions, and tone of voice, so he could not make sense of these cues to take the proper action.

Solution: Turn indirect language into direct language.  This dad can give specific details about where the problem is and what action(s) the child should and should not do next. He could say, “Be careful!  There’s paint on the floor next to your right foot.  Look down at the paint.  Don’t step in it.  Walk around the paint.”  He can explicitly define his facial expressions and tone of voice by saying, “Look at my face and listen to my voice – this is my worried/shocked/nervous face and voice.”

EXAMPLE #2
A child asks her mother if they can go to the park.  The mother says, “I don’t know.” The child continually asks her, and she gives various responses like, “Maybe…we’ll see. I’m not sure.”  Then, the child threw herself on the floor crying.

Child’s Perception: Mom is withholding information that she does, in fact, know.

Child’s Thinking: I want a definite “yes/no” answer.

Social Outcome: I’ll tantrum until she tells me “yes” or “no”.

Why?  The actual words are a problem as this child does not understand probability and uncertainty.

Solution: Turn indirect language into direct language. This mother can guide her child’s understanding with pictures or word-like formulas to explain conditional “if/then” situations.  Explain that we first have to wait for certain events to happen before we know which activities we’ll be able to do.  This mom can tell her child, “Look at the clock.  Right now it is 12:00.  If it is sunny at 12:30, then we will go to the park. If it is raining at 12:30, then we will stay home. At 12:30, you tell me if it is sunny or raining.

Or, this mother can use pictorial formulas like:
[Sunny picture] at 12:30 = [Park picture]
[Rainy picture] at 12:30 = [House picture]

EXAMPLE #3
Your daughter with autism kicks her brother by accident under the table. Your son shouts, “Cut it out!”. Despite his shouting at her, she continues to keep her chair and legs in close proximity to him, causing the accidental kicking to continue.

Child’s Perception: Something might be wrong.

Child’s Thinking: I’m not quite sure what it is, so it’s life as usual.

Social Outcome:  I’ll continue my course of action, which is to stay where I’m seated and continue swaying my legs.

Why?  The actual words are a problem as this child does not understand figures-of-speech. Her brother’s words might be literally interpreted that is that there is nothing here to ‘cut out’ with scissors.  Even if your daughter knows that this phrase means he is upset with something she is doing, she might not be aware of exactly what behavior to which he is referring.

Solution: Turn indirect language into direct language. Model a new set of direct words for your son to use as an explanation: “Josh, tell Kayla, ‘You are kicking me.  Please stop kicking me.  Move your chair away from the table a little bit.  Keep your feet on the ground.’”

We all try to improve how to be considerate of each other’s needs.  At first, it may be challenging to use these re-phrasing techniques because of emotions and the urgency of a situation.  Over time, you will learn how to communicate in more effective ways with your child that will, in turn, improve his or her communication with you.  As you more consistently model language from your child’s point-of-view, your child will be able to develop stronger skills of perception, thinking, and social communication which leads to stronger family and social relationships.

 


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unnamedAbout the author:
Karen Kabaki-Sisto, M.S. CCC-SLP, is a Communication Expert and Advocate helping people with autism for over 20 years. As a certified Speech-Language Pathologist and Applied Behavior Analysis Instructor, Karen has been empowering people with autism & special needs to have more meaningful conversations like never before. Her highly effective “I CAN! For Autism Method™” – perfected for over 10 years and now incorporated within the iPad app “I Can Have Conversations With You!™” – is changing lives through improved social and language skills. It is 100% fun for both kids and adults to use! Check it out at www.iCanForAutism.com.

Tips For Calming Your Child With Autism – Calm Yourself First! (Part 3)

boy-child-stress

This blog is part of a four-part support series for parents by Marci Lebowitz, OT and Autism Specialist.  Watch for Marci’s blogs to help you distinguish between tantrums and meltdowns, tips to manage tantrums and meltdowns and meltdown prevention tips.   Find out more about how Marci supports autism parents and professionals at www.marcilebowitz.com.

An Autism Parent’s Approach to Calming
Recently my brother and my son joined me at an outdoor event that I was working at. Wyatt, my 15 year old who has autism, was not interested in sitting with me so they went for a nice stroll, lunch and later returned to the relative peace and quiet of our van.

All the changes in a the environment, the sounds, the lights, the crowds were too much. In a short period of time, Wyatt had escalated and had a meltdown.

When my cell phone rang, I could see the call was from my brother and I was curious to hear how things were going. However it only took a couple of words from my brother to recognize the alarm and anxiety in his voice. He was using what we call his 911 voice. This triggered a refined and honed process for me. The first step was to calm myself and to walk quickly with an air of relaxation over to where my van was parked, which had become the focus of many people.

I quietly approached Wyatt and my brother saying nothing and taking in the scene. The fire department, the paramedics, patrol cars and onlookers surrounded them. I recognized Wyatt’s severe discomfort and knew he was very close to the point where he could injure himself.

It was all escalating very rapidly.

It was time for me to take control of all aspects of this situation. The first thing I did was to become as calm as I could. I worked to slow down my breathing. Then I began to support Wyatt as he was escalating rapidly. I gently explained to him that I was there for him, he was safe, and I was helping him. I never tell him to calm down. For most people with autism this simply makes things worse. I gently acknowledged his state with firmness and resolve while keeping us both safe and letting him sense that I was comfortable and in control of this situation.

Within a few minutes of my arrival, I reassured the onlookers and convinced the town’s emergency services that we were fine, I used the simple system to help Wyatt de-escalate.

I have learned that I calm my son by:

  • Being able to calm myself first.
  • Helping him feel emotionally understood, safe and surrounded by people who are in control.
  • Finding effective sensory comfort combinations that relieve his stress.

~Kelly Green, Parent/Advocate, autismhwy.com

Tips For Calming Your Child: Please Calm Yourself First
breathe-paintingThis article is going to help you learn how to work with Kelly’s point #1 – The importance of being able to calm yourself first.

Most of us have been taught to calm a child by doing specific techniques on the child. While these are very important, there is something else you can do as a first step that will profoundly impact your ability to soothe your child.

Have you considered that your own emotional state may play a role in your child’s responses? Autistic children are extraordinarily sensitive to the emotions of others and they mirror the state of those around them. If you are anxious and your child is already anxious, your child may become overwhelmed. While your being calm, relaxed and feeling in control will not totally relax your child, it is a fundamental step to beginning to help your child to relax. Besides your own state of calm, there is a need to help them feel understood, safe, and to have effective sensory calming strategies.

An integral part of feeling calm is efficient breathing. Please refer to my first blog post if you haven’t read it to understand the importance of breathing in self-regulation. When breathing is inefficient, it creates anxiety which can make a person become more amped up and anxious. They can feel spacey, have difficulties focusing, thinking, problem solving, following directions and cooperating.

When you are around someone who is anxious, have you ever noticed yourself becoming more anxious and wound up? Have you ever experienced being around someone who is calm? Do you notice that you relax just being around them? The same is true for children with autism. Their anxiety can come from: not understanding what is expected of them, not understanding sequencing or timing and also feeling the anxiety and unrest of others. As mentioned in Blog Post #1, I have found that most children with autism are chest breathers. Chronic chest breathing can contribute to anxiety, heightened sensory awareness and stress.

As A Parent, What Can You Do To Help?
I’d like to encourage you to begin to explore ways to relax yourself, so that you are able to change your state to one of calm during the times your child needs you most. I know you have a lot on your plate, however, investing in learning to calm yourself can have rich rewards. As a result, you can have a calmer, more relaxed child.

In this article I will offer you simple, do-able suggestions that you can implement in the course of your daily life. These won’t require you having the perfect environment, to stop what you are doing or have a lot of time to practice. These can be easily integrated into your daily lifestyle and routine, possibly in the car, washing dishes, doing laundry, making dinner, putting kids to bed, etc.

Tip #1 – Understand The Impact Of Your State On Your Child

Being calm at your child’s times of need gives them a feeling of calm they can begin to mirror.
Managing your own state as a parent influences your child’s behavior as well as the emotional state of others around you. If we are out of control and frantic, other people will mirror this. If we can learn how to approach the situation of our child melting down in public calmly, and are able to calmly reassure others around us, everyone will sense that you know what you are doing, you are in control of the situation and that they are safe.
With this sense of control, it helps the autistic child move within the energy of others, and you can begin to relax when you and your supersensitive child is outside of the house.

Tip #2 – Learn Simple Breathing Patterns To Be Done During Daily Life Routines

Children will mirror your breathing patterns. This is called resonance.
The most important part of the breathing pattern is the exhale. Allow yourself to take a gentle inhale through your nose, and exhale through your mouth as if you are sighing while gently pulling in your tummy.
body-lungs-breathA simple practice is to focus on exhaling three times. This will help you to begin to slow down and relax. Though very simple, this practice is very powerful to quickly settle down.
You can put a notes around the house reminding you to breathe three times. These reminders are great when it is hard to think in the chaos.
Observe your child after you’ve done some gentle breathing to see if they may have relaxed a bit.

Tip #3 – Practice Breathing When You Lay Down In Bed

It is easier to do this next step if you are laying down. Place your hand on your belly and gently inhale through your nose and exhale through your mouth. The hand placement will help you focus on using your diaphragm to breathe. Remember, if you try to breathe in harshly when you don’t have strong diaphragmatic control, it can make you feel more anxious.
Instead of your hand, you can place a warm compress, water bottle, heated buckwheat bags on your belly and see if it helps you breath more deeply and relax.

Summary
Learning to shifting your state and calm does not happen over night. Please be patient with yourself as you learn to do this. I hope you find that it is worth exploring, to not only provide you with some peace, as well as, your child and possible your entire family.

In next weeks post, we will explore calming solutions that you can do directly with your child to help prevent meltdowns.

Please leave me your thoughts about how your ability to calm has impacted your child.
I love hearing from you!


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Join the social network for parents of children on the autism spectrum: MyAutismTeam.com.

PictureMarci has been an Occupational Therapist for 28 years and an autism specialist for over a decade. During her expansive career, she has worked in schools, private outpatient practices, hospitals, a prison medical facility and skilled nursing facilities.

Known as “The Mary Poppins of Autism” she has developed effective behavioral management systems, sensory calming strategies and alternatives to physical restraints and seclusion.

She is a dynamic speaker and loves educating autism parents, extended families and professionals about the underlying causes of challenging behaviors; distinguishing between tantrums, sensory overload and meltdowns; and how to have fun with children with severe autism!  Find out more about how Marci supports autism parents and professionals at www. marcilebowitz.com.

Can You REALLY Tell the Difference Between A Tantrum and a Meltdown? Part 2

angry-child-boy

This blog is part of a four-part support series for parents by Marci Lebowitz, OT and Autism Specialist.  Watch for Marci’s blogs to help you distinguish between tantrums and meltdowns, tips to manage tantrums and meltdowns and meltdown prevention tips.   Find out more about how Marci supports autism parents and professionals at www.marcilebowitz.com.

Can You REALLY Tell the Difference Between A Tantrum and a Meltdown?

One of the most widely discussed characteristics of autism is when your child becomes overwhelmed, inconsolable and totally out of control. For the unknowing, non-autistic on-looker, it can appear that your child behaves badly and probably in need of real parenting!

How wrong they are!

We are becoming aware that behind the challenges of autism, many of these children are highly intelligent, are masters at using this intelligence to manipulate situations and can use behavior to attempt to get their way.

tantrumHowever, could it be that not all episodes of screaming are the same? That they are not always trying to get their way?  I think that there are two distinctions.  The first are meltdowns that are caused by sensory overload and the second is willful tantrums.

The examples below may help to illustrate this distinction even better.

Olivia was sitting at her little dining room table her eating snack.  She wanted more, so she simply started to scream at the top of her lungs. Periodically she would turn around and check to see if her mother was watching.  She threw her bowl and banged her hands on the table.  When she took a break from that, she would check for her mother’s reaction, gauging to see if her mother was going to give her what she wanted without using her PECS.

On day, Olivia had not had enough sleep, she appeared to be getting sick, and she was not getting what she wanted.  I guess you know these sorts of days very well and you know what follows.  Olivia begins screaming at the top of her lungs and throwing things.  This escalates.   She has no regard for safety and complete disregard for her parent’s reaction.  No connection.  She is out of control, unsafe, inconsolable and checked out.

Which do you think is a tantrum and which is a meltdown?

girl-504315_1280This is the second in a series about how to understand and work with severely challenging autistic behaviors.  This post will help you to distinguish the differences between tantrums and meltdowns.

Believe it or not, it really is possible to tell the difference between a tantrum and a meltdown once you know what to look for!

Here’s how you can begin to distinguish the differences.

Temper Tantrums Defined:
A temper tantrum is very straightforward: the child does not get his or her own way and, as grandma would say, “pitches a fit.”

Qualities of Temper Tantrums
• A child having a tantrum will look occasionally to see if his or her behavior is getting a reaction.

• A child in the middle of a tantrum will take precautions to be sure they won’t get hurt.

• A child who throws a tantrum will attempt to use the social situation to his or her benefit.

• When the situation is resolved, the tantrum will end as suddenly as it began.

• A tantrum will give you the feeling that the child is in control, although he would like you to think he is not.

• A tantrum is thrown to achieve a specific goal and once the goal is met, things return to normal.

Fact
If you feel like you are being manipulated by a tantrum, you are! A tantrum is a power play by a person not mature enough to understand subtle politics. Hold your ground and remember who is in charge.

A temper tantrum in a non-autistic child is simpler to handle. Parents simply ignore the behavior and refuse to give the child what he is demanding. Tantrums usually result when a child makes a request to have or do something that the parent denies.

Upon hearing the parent’s “no,” the tantrum is used as a last-ditch effort.

Meltdowns
A meltdown is a loss of control due to sensory overload. It can begin as a tantrum and then escalate into a meltdown very rapidly. The child needs you to recognize this behavior and rein him back in as he is unable to do so. A child with autism in the middle of a meltdown desperately needs help to gain control.

Qualities Of A Meltdown
• The child does not look at you, nor care, if those around are reacting to the behavior.

• The children do not consider their own safety.

• The child has no interest or involvement in the social situation.

• Meltdowns continue as though they are moving under their own power.

• A meltdown conveys the feeling that no one is in control.

• A meltdown can occur because a specific want has not been met, the children becomes over stimulated, goes into full-blown sensory overload and cannot calm themselves.

• Meltdowns go on for extended time periods unless the caregiver or the child themselves knows how to take themselves out of sensory overload.


In order to know how to manage both of these types of situation, the adults need to understand how to distinguish between a tantrum and a meltdown, to have effective behavior management tools to deal with the situation and then additional skills and tools to help the autistic child gain sensory control and to work during the meltdown to bring the child safely and calmly back to being in control once more.

Tune in for the next blog post in this series where we’ll be discussing tips to manage tantrums and meltdowns!

Please feel free to comment below how this information has helped you understand how to distinguish between a tantrum and a meltdown.  I’d love to hear from you!     


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Join the social network for parents of children on the autism spectrum: MyAutismTeam.com.

PictureMarci has been an Occupational Therapist for 28 years and an autism specialist for over a decade. During her expansive career, she has worked in schools, private outpatient practices, hospitals, a prison medical facility and skilled nursing facilities.

Known as “The Mary Poppins of Autism” she has developed effective behavioral management systems, sensory calming strategies and alternatives to physical restraints and seclusion.

She is a dynamic speaker and loves educating autism parents, extended families and professionals about the underlying causes of challenging behaviors; distinguishing between tantrums, sensory overload and meltdowns; and how to have fun with children with severe autism!  Find out more about how Marci supports autism parents and professionals at www. marcilebowitz.com.

What Causes Meltdowns May Be Different Than You Think, Part 1

girl-smiling-child


This blog is part of a four-part support series for parents by Marci Lebowitz, OT and Autism Specialist.  Watch for Marci’s blogs to help you distinguish between tantrums and meltdowns, tips to manage tantrums and meltdowns and meltdown prevention tips.   Find out more about how Marci supports autism parents and professionals at www.marcilebowitz.com.


What Causes Meltdowns May Be Different Than You Think

For many parents, the very thought of taking your autistic child to the mall can stir up anxiety and brings up memories of previous experiences.  This can come from the concern about how others may react if you child has a meltdown and also evoke feelings of helplessness and shared pain for your child.  As a result, you may limit your treks out into the world because it is easier to stay out of the public view and in a calmer environment like home. Though meltdowns can easily happen at your home, somehow they feel more manageable in the safest environment.  The reality is that there are times when you have to go with your child to the mall and you are willing that this time it will go well.

Things can be okay and then wham, too much stimulus coming in so fast.  Too many lights, sounds, smells, emotions, touch, hot and stuffy air.   Simply too much of everything bombards them.   Because their heightened nervous and sensory system are constantly “switched on”, they seem to be constantly receiving too much input from the environment or some subtle, internal reaction. Each stimulus builds on the last and can create a feeling of overwhelming suffocation.  This is also known as sensory overload.

Although it may not be clear what specifically is causing the overload, you know the signs when your child is beginning to escalate.  You watch their reactions heighten and their anxiety rev up.  They may begin to yell, to cry or screech.  Then it comes on fast, the meltdown occurs.  Full-blown with maybe hitting, biting, kicking and screaming.  Their focus is gone and the outburst takes over.  Your baby, your child, your love.

What Can Cause These Extreme Reactions?

There is a link between poor breathing and heightened anxiety.   What will register as extreme anxiety for an autistic, may feel like simple fear to us.  Their fight and flight mechanism is running all the time. When caught in a constant feedback loop of fight or flight, these children have an extremely difficult time making accurate value judgements of situations.  They experience stimuli and circumstances as threatening, intrusive or painful.  Because of their exquisite sensitivity, they often feel that many people and situations are unpredictable and frightening.  Fight, flight or freeze becomes their primary option.

If you observe a child when they are in complete sensory overload or during a meltdown you may notice they are holding their breath.  They do not exhale and are only able to take tiny shallow inhalations, so over time there is more and more stale air in their body and less space to breathe in fresh air. They simply cannot breathe fully which I believe contributes to their panic and escalation of challenging behaviors. Some believe that the child may feel like they are suffocating which must be very terrifying for them.
Think about when you are anxious…   Do you notice your breath may become short, ragged or you may even hold your breath?   This is amplified for people with autism.

When a threatening situation ends, our bodies and breath should calm.  For the children because of their constant state of fight or flight, they may calm down a bit and take a deep breath at the end of a threatening situation, but it is usually from their chest, not from their diaphragm.  If you watch them closely, they are calmer but they never seem to fully calm down.  A telltale sign is that they put all their effort into inhaling, not exhaling. In efficient breathing the effort is on the exhalation in which the muscles relax and the inhalation is gentle and without effort.

In my decade of work as an Occupational Therapist with children with severe autism and aggression, I have consistently noticed these children breathe only from their upper chest, rarely do they breathe deeply from the diaphragm.  It is easier for us to see that they have poor core strength.  This is actually an indicator that the diaphragm is weak and does not work effectively.

Do You Know The Signs Of Upper Chest Breathing?

-Pressured speech or vocalizations.
-Shrill voice.
-Difficulties listening to others.
-Not present.
-Difficulties with focus, processing and memory.
-Absent, glazed look.
-Muscle tightness.
-Anxiety.
-Difficulties taking a breath.
-Difficulties pausing when talking.
-A clenched jaw.
-Poor Posture:  hunched or high guard.
-Inability to sit up straight.

Does this remind you of your child?

Other Causes of Sensory Overload  

There also may be severe, underlying or undetected medical conditions causing sensory overload including conditions like toothaches, stomach aches, seizures, earaches and headaches.   Medications or medication changes can also cause heightened reactions.  For many, particularly those that are non-verbal it is extremely difficult for them to communicate to us what they are experiencing.
Many but not all manifestations of underlying medical conditions also are present with compromised breathing.

Effective Respiration and Diaphragmatic Control Is Essential For:

◦ Strengthening the immune system, brain and gut.
◦ Reducing inflammation.
◦ Speech.
◦ Posture.
◦ A good nights sleep.
◦ Motor control.
◦ Emotional regulation.
◦ Ability to self-soothe.
◦ Processing, thinking, concentration and focus.
◦ Effective colon motility.
◦ Lymphatic drainage.
◦ Neural development.

Gentle Tips To Promote Breathing

I encourage you to examine your child’s diaphragm to see if you can detect movement.  You’ll see the belly go in and out while they are breathing.  Also, look at the chest.  If the rising and falling occurs only at the chest and not at the belly, this indicates that they are only upper chest breathing.  Look for where they exert their maximum effort.   Is it on the inhalation or the exhalation?

A simple thing you can do to begin to help open your child’s diaphragm is to gently place your (warm) hand on their belly with the intention to help them relax.  It is easier to do this when they are laying down.  I would recommend only doing this when they are in a calm.  Please do not attempt this when they are upset or melting down as this may not relax or calm them.  You don’t have to tell them to breathe, your gentle hand on their belly should help them to relax and their breathing may slow.  Simply hold your hand on their belly for two-three minutes and breathe yourself!  Bedtime or couch time is a really good time to try this.

straw-in-glassWe’ve been taught to focus on the inhale.  However, research shows that the part of the breath cycle that is most important for relaxation is the exhale.  Usually we tell people to inhale if they are upset to calm.  If they do not have good diaphragmatic control, a strong inhalation can make them feel more anxious as the chest can become tighter.  By getting them to exhale first, it creates more space for fresh air to be inhaled.

You want to gently exhale the stale air out of the lungs.  Try taking a very small, gentle inhale through your nose and blow out the air through your mouth.  See if this helps to relax your body.  You can do this with “low functioning” children by having them use a straw to breathe.  It is really difficult to take a hard inhale through a straw and much easier to exhale.


I’d love for you to share your thoughts with me.  Leave me a comment and let me know about your child’s breathing.  Do they have any movement in their diaphragm or is it all in their upper chest
?



 

 

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Join the social network for parents of children on the autism spectrum: MyAutismTeam.com.

PictureMarci has been an Occupational Therapist for 28 years and an autism specialist for over a decade. During her expansive career, she has worked in schools, private outpatient practices, hospitals, a prison medical facility and skilled nursing facilities.

Known as “The Mary Poppins of Autism” she has developed effective behavioral management systems, sensory calming strategies and alternatives to physical restraints and seclusion.

She is a dynamic speaker and loves educating autism parents, extended families and professionals about the underlying causes of challenging behaviors; distinguishing between tantrums, sensory overload and meltdowns; and how to have fun with children with severe autism!  Find out more about how Marci supports autism parents and professionals at www. marcilebowitz.com.