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What Can Help a 19-Month Old Reduce Troubling Behaviors?

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This question originally appeared on Quora: What are specific exercises or trainings, that help a 19-month old baby with reducing troubling behaviors, that has not yet started any therapy?.

Let`s consider the following scenario: You are a trained professional for ASD diagnosis (not therapy) and you have seen extremely strong signs of autism in a neighbors kid, with so many red flags, that in your own practice you would diagnose the kid with ASD. However you dont have a strong relation with these people and you are not sure how to proactively address them.

Hence, you want to help them, by pointing them to some exercises that help reducing or treating some of the unwanted behaviors for which the mother has voiced concerns so far, thus avoiding the need to throw them into cold water with an `autism` diagnosis.

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Answer by Jen Brown, Mom

I'm going to tell you everything I remember doing when my son was that age. I had a lot of therapists and support then; speech therapy, occupational therapy, early intervention (that's through the school it was a twice weekly group and a once weekly home visit), a home nurse, a music therapist... my point is that I hope you can get professional intervention soon and that this just fills a waiting gap.

You listed some specific issues and I think these things will help but the progress will be slow and you should try not to get overly concerned about any specific behavior issue. You listed a lot of them, it sounds like the speech delay is causing a lot of frustration so if you want to skip ahead and just read the speech part of my answer that seems like a good place to start. Perhaps you could just print this out and give it to your neighbor, I'm going to write it to her.

Sensory:
You need to be thinking a lot about sensory experiences and touch. So at this age, I was still holding my son a lot, when I held him he was the world, my eyes on his eyes for the brief moments he allowed it, touching noses, tickling checks; I guess I was just in his face until he couldn't help but start being in mine. Also baby massage is a really soothing touch, take a class or search videos on the internet to learn how. Just remember that it's a firm gentle touch, too light and it tickles which isn't what you want. 

You also want to think about having them cross their midline a lot, imagine a line drawn right down the middle separating left from right, you want the left and right to connect. So you take their little hands and pat right hand on left knee, left hand to right arm, right foot to left cheek (my son thought using his feet to touch his face was hilarious). I remember doing midline stuff during diaper changes so I could work it in regularly.

When I say sensory experiences I mean that you should think about textures and exposing your child to a wide variety of them. Finger paint with pudding (I did this in the bathtub because it's very messy fun), get a space blanket and cut large pieces for your baby (the crinkle sound is fascinating to them), and just touch things throughout the day to your child (like at the grocery store hand each item to your child sitting in the cart so they feel the cans, crinkly bags, smooth apples, etc). Also, take them outside, take them to the sand, to swings, to dirt, to creeks, expose them to their world and the many ways we connect to that world through touch.

Play and Speech:
At this age these interventions are a little enmeshed. You need to talk a lot, label what you're doing as you do it, talk about what your child is doing, label their feelings for them (you're happy right now, oh you're frustrated, I think you're bored, etc). Also, give a heads up about transitions because these are especially frustrating for spectrum kids. Say, "Right now we are playing bubbles, in two minutes we are going to clean you up (hold up the washrag) and then eat a snack. They might not seem to understand this (it's tough to know what they actually understand) but they will understand that things are going to change and internally prepare for that. This also trains you for when they get older, the preschool age is really hard and having a way to manage transitions and warn your child they're coming will be so helpful. You might want to think about making little cards with pictures of common activities. You can draw the pictures or cut them from magazines. So you might make them for: bath, eating, a walk, play time, diaper change.

If your child is nonverbal then also introduce sign language. The signs are usually a bridge to get your child to using words so you don't need the 'correct' sign you just need consistent signs that mean the same thing to you and your child. My son knew and used signs for: eat, more, all done, yes & no.

This next piece is critical, when you play you need to get into their world and then slowly bring the child into yours. I did a modified 'Floor time' program (search Greenspan Floor Time for specifics on what that means) which I was trained in at twice weekly appointments with The Hearing and Speech Institute. So my son is also visually impaired and he played by dropping objects over and over. I got on the floor and dropped with him, then when he got used to that I changed it a bit. He would drop a pingpong ball and I would catch it after one bounce and roll it back. We slowly changed his play into a bouncy game of catch. This is where I would address the throwing things problem this specific child exhibits, I would copy it and throw things too. Then once I figured out what was making that so exciting for the child, I would change it into something else.

You can use the floor time model for the verbalization that is currently frustrating you. Copy the sounds the child is making and slowly morph them into something usable, that was usually most effective if I did it through song, and I'm going to focus on music next.

Music:
It doesn't matter the type but music can be a great tool for connecting with your child. I had a little kid instrument kit with shakers, clacking sticks, cymbals, a tambourine, and a drum. I played different music and we added in the instruments. We played with sound and danced a lot. I also found songs that seemed to resonate for him and played and sang them repeatedly so that he had a different way of hearing and using his voice.

So let's say your child is going 'argggggggargggg' over and over. Use that same intensity and copy exactly what he is doing. Then slowly add a tune to it, let's say Three Blind Mice is the tune for this, you would sing : arg arg arg, arg arg arg, a a r g, a a r g, arg arg arg. I hope that makes sense, an in person talk would be much easier!

Routine:
You want your day to be reasonably predictable but you don't want to trap your child with routine. For example, every day when baby wakes up, if you change diaper and get baby dressed then that's a comforting routine. However sometimes put socks on and then pants, sometimes put a shirt on and one sock, then pants and the other sock. You need to change your own little habits so your child understands that while life is predictable it is also about constant change. Move furniture around, walk different routes to the library, just mix it up. Kids with autism get stuck in their routines, your job is to gently get them unstuck by altering and modifying routines while keeping their overarching themes constant.

This is where I would manage the sleep issue, through routine. Our bedtime routine was exact: take a bath, put on pj's, brush teeth, read story, listen to mommy sing softer and softer as you fall asleep. I sat in the room softly singing until sleep took over. It sometimes took an hour, but it got him to sleep without hassle.


That's all I can think of at the moment. Like I said, I hope that this helps bridge the gap while you wait for professional interventions. I think a support group either in person or online would help this mother get even more ideas and have a place to vent frustrations.

Remember that progress is slow. The thing where my son dropped toys lasted YEARS, but it ended, then when he was two as he started talking he only said the word yellow for months which felt like forever, then he got obsessed with cars and carrying them around and lining them up which also felt like it lasted forever. Just remember that the place you're stuck in will change and patience will get you through!

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