Both Autism and ADHD Have
Working Memory Problems

There is lots of crossover between ASD (Autism Spectrum Disorder) and ADHD.  I have talked to many parents where their child’s diagnoses has been switched back and forth between autism and ADHD.  Tara Stevens and her colleagues at Texas Tech University found that 59% of children who were diagnosed with ASD also had ADHD.  This was more likely to occur in fully verbal children diagnosed after age six.  Canadian researchers have also found that there were similarities in brain circuitry problems in both ASD and ADHD.  Individuals with both labels are also more likely to have problems with working memory.

Give Them a Pilot’s Checklist

When I worked milking cows, I was saved by a checklist taped to the wall that outlined the steps on how to set up the equipment for milking and how to put it through the wash cycle after milking.  The checklist saved me because I absolutely cannot remember a sequence of instructions.  Set up required seven or eight steps and wash up was another three or four steps.  On the job, a checklist can help an individual on the spectrum keep their job.  It will help prevent an employer from becoming frustrated when the person cannot remember how to operate a piece of equipment after being shown several times how to do it.  For example, if a person with ASD gets a job at McDonald’s, they will need a checklist to help them to remember the sequence for tearing down and cleaning the ice cream machine.  After they have done it for a few weeks, they will have the process videotaped into their memory.  At this point, the checklist will no longer be needed. 

When I first started working with the met packing industry, I learned to remember the sequence of how the plant operated by videotaping the entire production line into my memory.  To do this required many days of observation.  Playing the “videotape” back in my imagination puts absolutely no load on working memory.  In my imagination, I turn on the “video player” and walk through the plant.  This videotape provides the sequence.

In conclusion, avoid giving long strings of verbal instruction.  Demonstrate the task that requires a sequence of steps and provide a written checklist.  Each bullet point on the checklist needs only three to five words to job the memory.

References

Ameis, S.H. et al. (2016) A diffusion tensor imaging study in children with ADHD, autism spectrum disorder, OCD, and matched controls, American Journal of Psychiatry (in press).

Englund, J.A. et al. (2013) Common cognitive deficits in children with Attention Devidit Hyperactivity Disorder and Autism, Journal of Psychoeducational Assessment, Vol. 32, pp. 96-106.

Kercode, S. et al. (2014) Working memory and autism, Research in Autism Spectrum Disorders, Vol. 8, pp. 1316-1332/

Stevens, T. et al. (2016) The comorbidity of ADHD in children with autism spectrum disorder, Research in Autism Spectrum Disorders, Vol. 21, pp. 11-18.

Schoh, J.M. and Eigsti, I.M. (2012) Working memory, language skills and autism symptomatology, Behavioral Science, Vol. 2, pp. 207-218.

 

Too Much Screen Time has a
Bad Effect on Child Development

At conferences, more and more parents of a recently diagnosed teen or elementary school child have told me that they may be on the autism spectrum.  In some cases, they have an official diagnoses and in other cases, they do not.  Almost all the parents who have been told they are on the autism spectrum have worked successfully in a variety of occupations. The question is: why was their life relatively successful and their child is now having problems with a lack of friends, bullying or is extremely hyper and anxious? In most of these cases, the child had no early childhood speech delay as a toddler.  When I was in college, I had friends that today would be labeled as having autism.

There may be two reasons why both these mildly autistic parents and my geeky classmates got and kept decent jobs.

  1. Learning how to work at a young age.  I have written extensively about this.
  2. In my generation, kids played outside with their peers and learned social interactions.  They were not glued to electronic screens.

In the September/October 2016 Carlat Report of Child Psychiatry, I read two articles that were a great “light bulb” moment.  One was written by Mary G. Burke, M.D., psychiatrist t the Sutter Pacific Medical Foundation in San Francisco and the other was an interview with Michael Robb, Ph.D. of Common Sense media. Dr. Burke explained that both babies and children need to engage with other people who react to their behavior.  The problem with watching endless videos is that the video does not react to the child’s responses.  Today, Michael Robb recommends no more than 10 hours of screen time a week until the kids are in high school.  This is the same rule my mother enforced for TV watching.

Electronic Device Free Times

Both specialists recommend that every family should have specific electronic device free times so they can interact and talk.  There should be at least one device free meal per day where both parents and children turn off and put all electronic devices away.  In her practice, Dr. Burke has observed that reducing use of electronics improves symptoms of OCD, panic attacks, and hyperactivity.  A report from The Centers of Disease Control reported that in a four-year period from 2003 to 2007, attention deficits increased 22%.
            Children and families need times where they can interact without interruption from screens.  One study showed that a session of five days at an outdoor nature camp with no electronics improved the ability of middle school children in reading non-verbal social cues.  A farmer who ran a summer camp for 8 to 11-year-olds had an interesting observation.  During afternoon periods of free play in a walnut orchard, the boys sulked around for two days.  On the third day she said a switch flipped and they discovered free play.  My three recommendations are:

  1. Have one electronic device free meal where EVERYBODY including parents puts away all screens.
  2. Limit video watching, video games and other non-school screen time to 10 hours a week.
  3. Engage the entire family in activities where people have to interact with each other.

References

CDC Mobility Mortal Weekly Report (2010) (44):1439-1443. Increased 7.8% to 9.5% 2003-2007, 21.8% increase in four years.

Increasing prevalence of parent reported attention deficit/hyperactivity disorders among children, United States 2003-2007.

Uhls, Y.T. et al. (2014) Five days at outdoor education camp without screens improves preteen skills with nonverbal emotion cues, Computers and Human Behavior, 39:387-392.

 

Using Teachable Moments to Learn
Manners, Social Skills, and Language

I was brought up in the 1950’s and my mother and all the other mothers in the neighborhood used “teachable moments” to teach children correct behavior.  When a social or manners mistake was made, Mother NEVER screamed “No” or “Stop it.”  Instead, she calmly gave me the instruction of what I should do.  Below are some examples.

  • If I twirled my fork around above my head, she said, “Put it on your plate.”
  • If I ate mashed potatoes with my fingers, she said, “Use the fork.”
  • If I touched merchandise in a store, she said, “Only touch the things you are going to buy.”
  • If I forgot to say “thank you” she would give me a cue and say, “You forgot to say pause.”

In a day there are many “teachable moments.”  At a hotel, I observed an excellent example of this.  A little boy started to get on the elevator before the  people in the elevator got off.  His mom said, “You must wait for the other people to get out of the elevator before you get on.”  She did not scream “No” when the child stepped forward towards the open elevator door. Instead, she calmly gave the instruction.

Wait for the Child to Respond

Teachable moments can also be used to encourage use of language.  When a child has attained the ability to use a lot of words, he/she needs to be encouraged to use them.  If the child wants juice, say “use your words.” WAIT FOR THE CHILD TO RESPOND.  An autistic child’s brain processes information more slowly and he/she MUST BE GIVEN TIME TO RESPOND.  The most common mistake that both parents and teachers make is to say the word before the child says it.  There is a bad tendency to say the word too quickly. Give the child’s brain time to process the request.  The processing speed of his/her brain may be like a computer with a slow internet connection.  It takes longer for he/she to respond.

In kindergarten when I was age five, I remember an extremely frustrating moment where I was not given sufficient time to respond.  The class assignment was to mark pictures when an object’s name began with B. I marked the suitcase picture as B for bag.  The teacher marked it wrong and spoke so quickly that I could not explain that in our house suitcases were called bags.  I could not respond quickly enough to tell her.  If she had waited 2 or 3 seconds, I could have explained that I understood the B concept and explain why I marked certain pictures with a B.