Framework: Support

A person may experience one or more of the features of autism to a greater or lesser degree. An altered developmental trajectory may result. The unique cognitive, linguistic, and social skills that come about can often obstruct learning and social interaction. These features of autism may be very resistant to intervention and remain throughout life. Interventions that target missing or delayed milestones seek to right the path. It may be a long and incremental process. Support can be provided as treatment proceeds. It may ease the struggle that can be experienced in daily activities and create an atmosphere more favorable for treatment. Effort can be made to engineer the environment prior to and during a problem activity. These supports may include control of sensory stimuli, reduced oral communication, lower task complexity, added physical/visual/oral prompts, monitoring and personal assistance when needed, and helpful and accommodating peers.

Sensory Stimuli, Oral Communication, Task Complexity, Prompts, Monitoring/Personal Assistance, and Helpful Peers:

Sensory Stimuli:
 - Underlying sensory sensitivities may often cause engagement in personal, social, and academic activity to be limited or absent.
 - Careful observation may reveal some aspect of the environment that can be changed or eliminated.
 - Lighting, noises, talk, furniture, touch, temperature, clothing, and smells can be distracting or offensive.
 - If the person is seeking sensory input this should also be considered and accommodated if possible. Sensory diets and breaks might help.
 - Caregivers and staff should be alerted to possible sensory sensitivities and remedies.

Oral Communication:
 - In most homes, schools, and community locations there is a more or less constant background of talk. Superimposed on this chatter is the verbal exchange that occurs in interactions.
 - The message may be too complex, abstract, rapid, or difficult (in some other way) to process for an unsophisticated listener.
 - Care can be taken to check for understanding. Comprehension can be increased with the help of images and props.
 - Speech and text can be constrained and simplified.
 - Text removes the auditory and some visual aspects of a message that may be causing difficulty but limited language skills must still be considered and accommodated.
 - Delayed processing and response time may be a factor.
 - Most often a listener is inclined to fill a pause or quiet space with chatter and verbal prompts. It may be more helpful to wait quietly until there is a response.

Task Complexity:
 - A lesson or activity may prove to be to difficult for a person to attempt or master.
 - A shorter, less complex design may help.
 - More images and less text may supply more understanding.
 - Fewer answer choices that contain no wrong responses may be the best way to introduce new concepts.
 - Printed materials can have uncluttered format, large print, color images, and line drawings of basic objects that are clear and iconic.
 - Dialogue in text can be presented cartoon style with text and thought bubbles.
 - Velcro can be used with manipulatives to reduce movement.

Prompts:
 - A prompt may be needed to assist a person with a task or activity.
 - A prompt can be verbal, visual, or physical.
 - A verbal (spoken) prompt alone may not be helpful. It is always important to check for understanding. The nonverbal communication that accompanies it may cause difficulty.
 - A text prompt should be checked for understanding. Length and complexity of language may need to be altered.
 - Picture prompts can often be the least distracting and most easily understood. They can be displayed in a sequence and manipulated or checked off.
 - Physical prompts are sometimes necessary. Pointing to and touching an object can be effective. Hand-over-hand prompting may be helpful to introduce a task. Care should be taken that physical touch is not aversive to the person.
 - A prompt should be faded so that skill mastery is prompt free.
 - Care should be taken that a prompt is not offered to quickly. It may be helpful to allow extra time for processing and response formulation.

Monitoring/Personal Assistance:
 - Monitoring and assistance from a caregiver or trained staff person may be helpful especially when a new task is introduced.
 - An assistant may help most by beginning with observation and monitoring.
 - If a prompt is needed one that is easily faded might be tried first.
 - An assistant will want to monitor his or her own nonverbal communication. Posturing, gestures, and tone of voice that are threatening or intimidating should never be employed. Ridicule and embarrassment also should not be used.
 - Timing of a prompt can be very important. Too soon and the opportunity for independent response may be lost. Too late and the connection between direction and response will be weak or not made at all.
 - Hand-over-hand prompting may be helpful to introduce a task. Care should be taken that physical touch is not aversive to the person.
 - A prompt should be faded so that skill mastery is prompt free.
 - When monitoring task activities care should be taken to stand apart from the person and show as little visual interest as possible, intervening only when absolutely necessary.
 - An assistant should focus diligently on the actions of the person completing the task. Extraneous instruction and chat with other persons should be avoided.
 - Various individuals should assist so that attachment to one particular person does not become too strong.

Helpful Peers:
 - Peers can affect interactions in helpful and harmful ways.
 - Certain peers will have greater empathy and nurturing tendencies.
 - Certain peers will tend to bully persons that appear unsophisticated or "quirky" in some way.
 - When arranging a task, activity, or interaction it is critical that all persons involved are inclined to kindness.
 - It is helpful if a communication partner is observant, perceptive, and patient and is willing to provide mild prompts that are not obvious. Most often this is the role of an adult caregiver or staff person but a peer can sometimes assume this quasi-parenting support.
 - Games should be arranged so that there is a mix of helpful peers and peers needing assistance.
 - Pairing a person with a helpful peer for social outings in the community can encourage positive interactions and lower the safety risk.