Friday, April 26, 2013

Never Overlook an Opportunity to Teach

There are people in the world who wonder why I do what I do.  I get a comment on it almost daily.  "Why do you do BLANK  for the special ed kids?  Especially when it comes to school field trips.

"They don't know what that is all about."
"They would rather be home watching TV"
"What are they going to get out of it?"
"It's too much work."

And, unfortunately, there are still those that frequently comment on why special ed children are even allowed in school.

There are so many things an autistic child can learn from a field trip it is hard for me to even know where to start.

1. Experiencing the world

Getting out and about in the world...experiencing new places and meeting new people makes any individual more well-rounded.  I always tell people who live in our small town, they need to move to city somewhere far away and live for at least a year, just to have the experience and see what life is like in other places.  It really opens your eyes to so many cultural things and you become more thoughtful about the dynamics of where you live.  Being Autistic doesn't make that fact not true.  They are seeing, tasting, hearing and feeling things outside of their normal life that help them to understand the world better and in more depth.  It also helps with their overwhelming anxiety to experience new things and realize everything is still o.k.

2. Learning to cope with new places

Maybe the soda from the fountain tastes different because the water they use to mix it is different.  Maybe the sound of the bumps in the road are different.  Maybe the air smells different because of the trees and dirt. Learning to cope with these changes of a new place will increase their awareness of the outside world and help them to compare and contrast things they may never have had the chance to before.

3. Learning to cope in large groups of people

There is a certain energy about a crowd.  You can feel it when you get too close, and especially when the crowd is anxious or excited, it can be very unsettling for an autistic child.  I find staying calm just outside of that surge of energy....a few feet back, is the best way to help the child cope.  Still close enough to hear, see, smell, sense the idea of what is going on around him/her, but not close enough to become so overwhelmed a meltdown may be in order.  Keep him/her calm with familiar songs, toys, games, rocking, cuddling.  (I save the extra special lap-time or cuddle time for these very tense moments, because at a certain point the child gets older and those sort of things become inappropriate.)  Even if the child will be in a group home, dealing with crowds at the care facility or on outings will be a must.  It will be much easier if the child is exposed to it frequently, to help build a tolerance for social situations.  Learning how to act appropriately in public, like being quiet (if that concept is understood), personal space issues (if the child likes to caress hair or clothing of strangers), and to keep their mannerisms calm as well (if this is also understood),

*My son is 15 and has autism.  He giggles to himself and spins in circles at home, but he knows when we are on an outing he must refrain.  I believe self-control helps the child to pull out of his/her "head" and join the real world when it is appropriate to do so.  When it is his free time, he can do as he pleases to stim or spin in a way that is familiar and comfortable to him.

4. Learning to cope around new people

People sound, smell, feel and look different, each and everyone, which can be overwhelming to a child who is very sensitive and detail oriented.  Helping him/her to be comfortable and not scared by a new person is essential for a fulfilling adult life.

5. Learning to adjust to a different schedule

I personally like to keep schedules the same for my autistic friends.  I know it eases their anxiety and it helps to keep them calmer when a change does occur.  When we are on an outing, I like to incorporate the same phrases where applicable and mini routines he/she will recognize from school.  We might set up our lunch the same way we would at school, using the same key phrases.  We always do the same bathroom routine, even using picture cards he/she is familiar with from school.  In a way, I want them to know that even though there are changes and it will be a little frightening, I am there and I will keep you safe and calm.  I do not talk much on field job is to show the anxious child I am calm.  He/she can sense my mood and judge my actions very easily.  Also, if you are too worried about getting your own social time in, how can you focus on the needs of the child?  The day is not about you. The children I have worked with can tell quickly when they are being ignored, and tend to act up, get into things, revert to bad behaviors, whine, or have bathrooming accidents when this occurs.

6. Learning to use public restrooms.

This to me is the most important reason to take a child on frequent outings.  Many people do not like public restrooms for various reasons and the autistic child is no different times 10.  They are concerned about the sound, the echo, the feeling of the toilet, is it too high, too low, too cold, too warm, how does it flush?, does it flush on it's own?, how small is the stall?. how does the toilet paper feel?, is it rough?, is it soft?, how does it smell? etc etc.
I like to start every entering of a building with a bathroom break....just get it out of the way first thing.  We enter a new place, we find the bathroom and we go through our routine.  In early potty-training years, I have brought a picture schedule from school with each step on it and candy for a reward for handling the situation appropriately.
There is never a question if the child has to go or not, we go, go through our routine and try.  That's it.  This is best to avoid accidents and rid one of the need for diapers.

7. Learning to cope under different sensory overload, such as sound, texture, temperatures

Everything around him/her will be bombarding this child.  I like to have my bag-o-tricks handy.  I start with the expectation of the child having to sit quietly and "listen" for an appropriate amount of time...each child is different.  When I know the child has done his/her best at this, we may start with a special fidget that he/she only gets to use on fieldtrips.  This is only done if the child has not melted down to receive the toy, which would be reinforcing the negative behavior.  Carefully watching them should tell you when they are getting agitated before the meltdown if you are observant. Rocking may be a cue or hand wringing, etc.

When that fidget has lost it's appeal, I may have another fidget, or maybe a favorite book.   After a while of good behavior, we may sit down and have a snack.  It is good to change objects with each transition as well.  This type of ritual makes sense to autistic children and helps them to remain calm and cope.
My last resort, before technology, would be candy.  I believe candy should also only be used in delicate situations such as this.

For a big-time upset, like a bus breakdown or traffic jam stand-still, I get out the Ipad.  I hesitate to do this too soon in the trip, as the child loses out on many learning experiences when immersed in the technology.  They are missing out on the learning experiences I mentioned earlier.

8. Any teaching opportunities that may arise.

I like looking for ways my child can learn while on an outing...something they may be working on as a goal at school, or something difficult for them.  For example, if a child had trouble going up the stairs, maybe he/she only stepped up with the right foot instead of right left right left....take the time and be patient and encourage them to use their right, then left, then right, then left.  If they struggle opening doors, be patient and let him/her open the door when entering a room.  Praise them and be excited for their efforts.

Never overlook an opportunity to teach.  Take chances and try new things with autistic individuals.  Instead of thinking what they can't do, think about what they just might be able to do, if you were only to try.  Kids in general live up to what they are expected to do.  If we just expect these children to be constantly cared for and secluded in the house, that's what they will be.  We have to give them the chance to reach their potential.  You just might be surprised!

Friday, April 19, 2013

Field Trips/ Outings

If you are going to a place the child has never been before, you may have to be creative when explaining where you are going.  For example, if you were going to the movie theater to see a movie that maybe the child is unaware of or he/she is uninterested in, you may need to tell them you are going to eat popcorn.  If the child knows what popcorn is, and enjoys eating it, it will lessen their anxiety about where they are going without lying to them.
Some other tips on movie theaters:
Autistic children already live in a world similar to a movie theater.  We enjoy going to the movies because of the large screen and surround sound in a dark room, making it the ultimate experience for our senses.  Children with autism, who experience sensory overload everyday, may not think this is an exciting place to be.  It may be overwhelming and over-stimulating.
They may also not be able to handle the anxiety of not knowing what to expect from a new movie they have never seen, especially when going into sensory overload.  We should always remember, that just because something is fun and enjoyable for us or most children, does not mean it is fun and enjoyable for Autistic individuals.
You may wonder how someone with autism who has very specific, delight from movies or television could not like to go to the movies.  You may also wonder how they could ever like any video or program if they don't like watching things they haven't seen before.
This is where their unique heightened senses come in to play.  First thing children with autism like is commercials.  They are short...often funny in a exaggerated sort of way....catchy or have theme music or jingle.  They are too short to get too much anxiety worked up about it, and don't  have a plot or characters to really be concerned about.  Plus, they could hear the sound from the TV  in a non-confrontational in the back of the house in their bedroom.
Once they have heard something at least once and realized it is nothing to be scared of, they will either LOVE it or HATE it!
We started taking my autistic son to the movies when he was about 3 or 4.  Periodically, children's movies for military families would be shown for free on post, and so we liked to take advantage of the opportunity  thinking the boys would really love it.  But it was the opposite.  Tristen, even with popcorn, pop and goodies, could not take the booming sound and anxiety of what was about to happen on screen.  We spent the whole movie hiding behind the back wall and him peeking around the corner periodically with one eye.  He never cared for that movie even as he got older.  But we kept taking him and trying to work his way into the audience.  Sometimes it would end up being a favorite movie we would later buy and he would watch and watch until the tape broke.  And it got better each time we tried taking him, to where now at 15, we could go to just about any movie and he will be ok.  (If it gets a little too intense, he will ask to go to the bathroom)
The purpose of field trips and outings it to help the kids to overcome their fears so they can have more enjoyment out of life and be out in public without completely melting down.
I always take the autistic child to use the bathroom as soon as we reach our new destination.  It is good for them to get familiar with different bathrooms because they tend to be a scary place for them.  Once they are introduced to the bathroom, I ask them if they need to go now and then to be sure they do not have an accident.
It's good to have your "bag of tricks" just as if you were taking your toddler out.  Books, toys...favorites...treats and maybe even candy as a last resort.
As always, remain calm.  Be respectful an courteous  but do not worry about what others are thinking about the situation you may be in.  Be in the moment, there to help your child.

Wednesday, April 17, 2013

What You Need to Know about the Gluten-Free Casein Free Diet

There are not always clear instructions when going gluten and casein free. It is easy for someone to  become confused about it's effectiveness.
My children and I have been gfcf for about 4 years.   We have allergies and sensitivities.
When I first started the diet, I did not see a huge difference or withdrawals from my children.  I myself went through the worst withdrawal from when I cut out sugar and starches.  We cut things out slowly and replaced them with substitutes and some things we just stopped eating all together.
One of the biggest misconceptions of the diet, is that there will be an immediate reaction to a food that the child does not tolerate well.  Most of the time, the reaction comes the next day.  It is their mood when they wake up in the morning as well.  They may sleep so hard they wet the bed or sleep for 10 to 12 hours and still feel tired the next day.  Everything will irritate them.  They will CRAVE the food and search desperately for more.  This is not a fun day for anyone.
Another myth is that oats and barley do not contain gluten.  If you are not cutting these out, you may not realize the benefits of eliminating wheat, because they are still consuming gluten.  One way to confirm a reaction to these foods is to look for what I call "the bottomless pit".  The eating of this food usually goes on and on and on as if the child cannot tell when they are full.  They will eat and eat and eat it as long as you put it in front of them.
The severity and timing of the reaction also depends on the status of the gut.  If the child is having regular bowel movements, the reaction might not last as long...maybe 24 hours.  If a child is severely constipated, his bowel being so impacted, he may not react to the food right away because it is not reaching his intestines as quickly as when proper digesting is occurring.  In addition, if a child is not completely expelling his bowels, and sticky feces is coating the intestine, they may not feel the effects as quickly because the sludge lining is not allowing the in-tolerances through and into the blood stream.  Alternately, if a child often has loose bowels  has just had a large bowel movement, or had a laxative of some sort, the reaction to a food may be immediate.
The cravings for foods such as these are severe.  The longer time you space in between infractions the better.        If a person were kicking an addiction to cocaine, you would not give them "just a little" crack because it  "won't hurt".  It DOES hurt, mentally and emotionally, because it sends you back to square one of kicking the habit.
Be careful not to substitute with sugar and other starchy carbs.  These can become just as addictive.  Sugar causes yeast to grown in the intestine causing more cravings and gut dysfunction.  It should be avoided indefinitely.
I have observed many children on the spectrum and their reactions to food.  I myself have food reactions, allergies and intollerences.  My son with Autism reacts to gluten and casein even though he does not have a confirmed "allergy" to them.  My other son who is not clinically diagnosed with Autism, but has sensory issues is allergic to wheat and dairy and has very obvious reactions after eating them, like mood swings, fear and anxiety.
Eliminating foods is an easy way to help children with issues navigate the world.  It is easy because it is only food.  It is amazing because it is only food.  No one would go to that much effort to change their child's diet and then stick to it, if it did not work.

Sunday, April 14, 2013

Tips for the ER

We had a trip to the ER.  First one in a LONG time.....since the days of the high week-long fevers and "my brain is on fire".  When you first see Tristen, you wouldn't realize he has Autism.  If you watched him for a while, you might wonder why this weird kid keeps talking to himself.
First thing I immediately realized was I should have had one of the famous "How would you rate your pain?"  charts with all the faces on it.  At first glance, the doctors and nurses do not realize he has autism, so they want him to rate his pain, which is tricky at best for most people, not to mention those on the spectrum.  Making a wallet sized chart for my purse is on my list. I tried to explain it the best I could, but really should have gone through each number and what kind of pain that meant.  He said, "Uh.....10??????"  He wasn't sure how to answer.
My son is verbal and 15 and not obviously autistic, so not until after a few times of me translating directions into a way he could understand and hearing  his speech delay, did they start to understand his situation.  I do not come out and tell people in front of him that he has Autism, because he doesn't really know he has it or what it is.  I don't want him to feel like it's a derogatory thing that identifies him.  If I can work it into the conversation without it being directed at him, that's how I do it.
"Who is his primary care physician?"
"He sees an Autism Specialist."
That usually does the trick.
Be prepared to explain calmly what is going on to your child in case they do not understand the obvious (which they probably won't).  The doctor told Tristen he was going to put his hand in a splint.  He immediately tensed up and whined at the thought of a "splint-er" which was his only frame of reference.  Being prepared to translate directions and also unfamiliar words will make your visit to the ER go much more smoothly.
When the doctor went to cut the gauze on his injured hand, Tristen screeched thinking the doctor was going to cut him.  Calmly explaining that he was cutting a hole for his thumb to go through kept him from going into full melt-down mode.
During the painful process of setting a splint, Tristen was having difficulty dealing with the pain, so I asked him if he was thinking of his favorite SpongeBob episode.  He immediately went into his own world and told me all about the time Patrick was trying to blow bubbles.  We were done before he could finish.
During the X-ray we talked about the equipment and what it did.  We talked about how cool it was to see our bones inside our body.
Being as patient and calm as possible during an event where you might not feel so calm is your best line of defense for an uncomfortable situation such as this.  Autistic kids take their cues from us, their caretakers.  If we lose it, they lose it.  We have to be pros and putting our feelings aside and making their comfort our first priority.

Thursday, April 11, 2013

Random Tips

One at a time.  Simplify.  Break down into small steps.  Be Patient.

Tips for Directing Autistic Children:

1) Give them one direction at a time and be specific.  If you need him/her to clean up their desk after snack, tell him/her to first take their cup to the sink.  Wait for him/her to complete the task.  Then, tell them to throw away their napkin.  Wait for task to be completed.  Finish by telling them to push in their chair.  Do this in the same order each time.  This causes them to be successful rather than just saying "clean up your desk" and walking away, which will cause the child to fail at the task.

2)  One thing in their hands at a time.  If the child needs to put his/her things away in their locker, hand each item to them separately and in the same order each time.  First, jacket.  Once they have it hung up, hand them the next item.  One at a time is much easier...for them it is to think when too many things are in their hands or too many general directions are given at once.

3)  Do things the same as much as possible.  Take the same route to the same locations.  Use the same words each time so they become familiar with them.

4)  Kids on the spectrum love TV shows and movies to be enjoyed over and over again because they are predictable and animated.  They like knowing what is going to come next, and they also like the over-acting or exaggerated dialogue in children's shows.  Use the same language to encourage good behavior.  For example, if a child has completed a task, give them praise in a silly accent in an exaggerated way.  They will look for that praise and come to enjoy it!

Wednesday, April 10, 2013

Autism, Sign Language and PEC's

Sign Language can be a miracle intervention for children with Autism.  It was after introducing signs to my autistic 3 year old that he used his first words and signs simultaneously "more juice"....still gives me goosebumps!
What I have come to learn from using signs with other children with Autism, may be surprising.

If we are teaching a child a sign, such as "more" during lunch and snack time, and the child is learning to do the sign when he wants "more" food on his/her plate.  We may think we have successfully taught them how to communicate "more", when what we have actually taught them is to communicate "food", or more specifically    "I want food now".

If we are teaching the child to do the sign for "bathroom" or "potty", and every time they show us the sign we rush them to the bathroom.  Instead of  "bathroom", they may have learned "leave".  Their thought may be, if I don't like this activity, or if I'm tired of it, or bored, I can do this sign to get out of the situation."

If we are teaching the child to ask for "help" when they come to a difficult part of a game on the Ipad, and they learn to get the "help" PEC  and bring it to you so you can "help" them with that part of the game, it may be easy to think they could apply that to any time they need "help" with something, like opening their juice box.  But if given the PEC, the child would be expecting the Ipad, even at lunch, even holding his juice he is unable to open.  To him, the PEC of the helping hands means that specific Ipad game.

Keep these thoughts in mind if you have children you are working with sign language and PEC's.

A Reward Side-Note: Updated

Choosing rewards can be tricky.  You may think it's easy to "bribe" toddlers with suckers or stickers to go potty.  Then, when they get older, maybe a trip to the park after the grocery shopping if they are "good".
Some children have such undesirable behaviors, parents or teachers may give up quickly when conventional forms do not work.

When helping children learn, you need three key things:



3)Think of child's needs above your own and weigh what really matters.


Individuality:  Always remember each child is an individual, despite knowing a sibling, or their diagnosis....whatever preconceived notions should come second to simply getting to know the child.  See what really makes them interested...what makes them smile...what they are good at and enjoy.  At the same time, note what weaknesses they have and be in tune to why they might have this behavior.  One size does not fit all when it comes to picking goals and/or reward systems.

A sticker chart.  Teacher's LOVE themselves a good 'ole sticker chart.  Cheap and easy.  And may work really well for some students.  Others will not care one bit.  I saw this with my son's.  One uses a sticker chart proudly.  The other needed to earn a cookie after getting five stickers.  Be flexible and be ok with changing a reward system.  Some kids like time outside, running in the gym, being read to, talking to them, playing a board game one on one with an adult.

This leads me to the next key:  Creativity.  Once you know the student, you can be creative in encouraging the good behavior with something specific to their "likes".

I once worked with a four year old who just would not poop on the potty.  He would poop in his pants or squat on the floor in his bedroom rather than go on the toilet.  This particular child was constantly on the go...tons of energy and his parents thought he was just too busy to stop playing to run to the bathroom.  He was also an only child, who had two bedrooms with piles and piles of toys, daily candy and treats anytime he wished.  It was a challenge to figure out something he would like enough to encourage that trip to the bathroom.
This child also had Sensory Processing Disorder, so I was aware of the possible discomforts of bathrooms he would need to overcome.  After establishing a bathroom routine, the sensory issues in the bathroom started to fade, but he was still having accidents.
Sticker chart. Nope.
Candy Reward?  Nope.
Then I found one of his true loves....ChuckECheese.  The idea was forming and I weighed whether I could really pull it off.  He asked me everyday since he had been to ChuckECheese for a birthday party if he could go back.  It was a twenty five minute drive away, so this was something new and fun he did not get to normally do. 
I took a leap of faith.  I told him he could go if he went poop in the potty.  And then I had to be prepared to follow through.
He did.  That day, in fact.  And the minute he was wiped up, we headed out the door.
I gave him four quarters and we were there for 20 minutes, but he was ecstatic!
Two days accidents....he goes in the potty....same routine.
So how long were we going to pull this off??  His parents asked the same question....but I had it all planned out.  After two weeks and six trips to ChuckECheese...I told him the next time he went on the potty we would go ride the toys at know the one's the kids always want to ride?  It was closer and cheaper and he loved it...didn't even care it wasn't ChuckECheese.  Then we worked our way to the park....just across the street.    It was amazing how this kid, who seemed unteachable to some, learned so quickly once he had my trust.

Most interventions are not this elaborate. 

One autistic child I worked with did not have a lot of physical energy.  He was often carried by his parents and caregivers and had come to expect it.  He was always very tired and did all tasks with the least amount of effort possible.  This proved challenging when encouraging him to participate in Gym class.  I took what I knew about him personally.  He followed me everywhere.  I knew he loved it when I was silly and played with him.  So, when he was expected to run with the class for a game, rather than focusing on "playing the game" which he did not understand, I worked on getting him to run.  How?  Well, I ran with him!  I started walking off to get him to follow me.  Then, I would go faster and he would go faster to catch up with me.  I turned around and laughed and asked him if he was trying to catch me.  He giggled and smiled and started to gallop.  So, I ran started to jog, and let him catch me once he jogged to my pace.  I grabbed him around the waist from behind and picked him up about 1 inch off the ground and swung him giving him praises for "catching" me.  He LOVED this game!  I increased the speed and length of time before I would let him catch me and soon he was running laps with periodical "swings" in between.

One of my favorite experiences was potty-training an autistic kindergartner.  This kid reminded me so much of my son, with all his "TV-talk" and animated movements.  He was so fun!  When teaching him to use the potty, he was not very interested.  We tried special books and social stories.  The first time he used the potty, I was so excited for him, I swooped him up under the arms( his pants around his ankles) and swung him in a circle giving lots of animated praise.  Because of his love for routines, he preferred me taking him to use the restroom so this could be part of our routine.  As time went by, he would go potty on his own, and then spin in a circle and act our our routine on his own.  Some people will criticize, I know, but in my experience, these types of rewards are weaned away as you begin to tackle other behaviors or goals.

In my opinion, an example of a reward system that doesn't work, looks like this:

A child is expected to participate in shooting hoops with a playground ball.  This particular child has difficulty understanding tasks, especially when left alone, and when he is in an unusual setting....where maybe he has not practiced this skill before.  The caregiver puts him in the middle of the gym in front of a hoop that is very high.  She gives him a piece of candy and then sits in the bleachers.  The child stands there with the ball, not knowing what to do and starts to get agitated after a few minutes.  The well-intentioned caregiver runs out to him with lots of "good-job" praises and gives him another piece of candy.  She continues this cycle.  The child never attempts to throw the ball.
In this situation, the child has learned, only, when I get agitated, someone will give me candy, thus reinforcing behavior to become whiny when he wants candy.

So, when you choose a reward system, it has to make sense to the child.  It has to be what they think is a reward and for the right reasons.

One student was given Ipad time as a reward for doing a required task.  (Another new fav of teachers in this technology age.)  Even though it was her free time, she was expected to use the Ipad appropriately...sit at a desk, and no hitting the screen.  This is reasonable, and if she did these things the Ipad was taken away and she could choose from another reward activity she enjoyed.  But, when she used the Ipad she was just learning about, she would click on app after app after app.  The teacher did not like this and thought she should stay on one app for the whole time and used a special lock to keep her there.  Even though she had chosen the app, she didn't want to stay there, and so when it locked up she lost interest and left the Ipad after only a minute or two.
Looking at it from another perspective might help one to understand why this child might have used the Ipad in the way she was.

Do you remember the first time you used apps, an Ipad, or Android?  Was it confusing at first?  Did you spend a lot of time clicking on things you didn't mean to until you figured out what you wanted?

When this child was able to explore this device, as long as being appropriate, she was figuring it out!  She was trying to see what everything was....what was fun and interesting and what wasn't.  Once she had the hang of it, she found the photo app and took pictures of herself.  One time, a boy she had a crush on got in the picture.  She was soooo happy that every time she was allowed Ipad time, she was able to find that picture and smile the biggest grin!

Think of child's needs above your own and weigh what really matters.

If it is their reward, let them choose it and deal with it.  I don't care how many times you have to listen to Barney, read a book, or sing a song....GET OVER IT!  This is about THEM and NOT YOU.  Don't change up their routine when it is their choice time.  If it is recess and all the kids get to do whatever they want for 45 minutes (granted it is safe) then let your special needs child pick their activity as well.  And if that means you push a swing for each recess for five years...DO IT! :)

Consistency:  They are smart.  They are only going to comply if you have shown them they can trust you to hold up your end of the bargain!
I know this has been a long post and if you have stuck with me this long, I appreciate it!  I hope this helps some people who may be looking for ways to help their special needs loved ones!

***Be prepared! If you use a reward for something like going to the bathroom, the child may figure out they can go to the bathroom 10x throughout the day and squeeze a little tinkle out to get the reward. You need to be prepared to keep up your end of the bargain! If you promised a 30 min Elmo video each time, you may be in trouble, because you need to keep up your end of the bargain for the child to trust you enough to listen to you. This relationship is built and functions on trust. You have to do what you say you are going to do or they will not believe you or comply. That being said, you have to think ahead if your reward is practical.

Avoiding Forceful Compliance

Most of working successfully working with an autistic child is finding out what they like.  It's like what candy is to ABA therapy.  In most cases, I would guess, there would be little to no need of restraint and seclusion for Autistic individuals if a patient, consistent system were to be put in place to encourage their learning.
Often children with autism will act out aggressively as a protest, saying in a non-verbal way "this is how much I do not want to do what you are asking me to do".  An observant caretaker should be able to keep them safe from harming themselves or others by evaluating each situation that arises before actually speaking and/or giving any directions.

1)Is the child able to carry out the required task?

2) Make sure the tasks you ask the student to do are IMPORTANT.  Think about how this pertains to their life as it is now and how it may be in the future.  Does it make sense to them what you are asking them to do?  Many times teachers make the mistake of thinking that practicing a task will somehow train the child to go into autopilot and do the task unassisted.  If they have no interest in the task, or if they see no way it benefits them, they will not do the task un-monitored or without some kind of reward. ( For example: Practicing pedaling on a stationary bike to "train" the child to pedal on a tricycle.  The child is getting nothing out of pedaling on a stationary bike, except maybe burning in their leg muscles, which will make him NOT want to comply.  Even if he does comply, he will need repeated prompts.  If you start out on a tricycle that the backwards motion of pedaling puts on the brakes, he will learn pedaling-forward-means-I'm -moving-which-is-fun-so-i-want-to-pedal.  Teaching him on a stationary bike only teaches him pedaling causes my legs to hurt.  Then, he may not even want to try on a tricycle.)

3) Are you willing and able to enforce this task?  What are the possible outcomes?

Once you decide the task is important enough that requesting it and enforcing it will be worth the time, patience and possible struggle it may take to get there...STICK WITH IT.  Simple words, repeated calmly each time the child refuses will keep your intentions clear.  This is when the "first, then..." strategy works best.  If the child refuses to comply immediately, give them time to think about it.  They may be thinking on whether you are going to give in or change your mind.  NEVER change the expectation at that point.  Later, you may re-evaluate after that experience, but you must always stick to what you have said.  That does not mean that you have to forcibly make a child comply at the exact moment you  gave the direction.  Give them a chance to do it on their own in a reasonable amount of time.  Tell them you will help them carry out the task if they cannot comply reasonably.      Sometimes waiting with the "first, then..." direction is all they need.  Sometimes you must redirect with  something they might like that will take their mind off of the situation like their favorite sport or a silly song.  Many times a child goes into crisis mode when forced to do something they do not want to do.  Using the method above, avoiding restraint and seclusion should be attainable.
When learning Crisis Prevention Intervention, you are taught to use it as the LAST RESORT at all times.  If you are vigilant in evaluating situations and have thought through requirements for the child, this should not be hard to do.

1) Toilet Training-  Is there any way to FORCE someone to use the toilet?? No. So, you must always approach this topic using "first-then" with the child's FAVORITE thing to done once using the potty.  They cannot have or use this item until they have used the bathroom successfully.
2)Laying on the floor so as to not comply-  WAIT.  Be silly.  Change their thought process.  Change their mood.  Don't be in a rush.  Use a "first-then".  Let them choose the "then".  There may be a natural consequence of missing something they enjoy if they do not follow directions.  Never get frustrated and take it personally.

***Be prepared!  If you use a reward for something like going to the bathroom, the child may figure out they can go to the bathroom 10x throughout the day and squeeze a little tinkle out to get the reward.  You need to be prepared to keep up your end of the bargain!  If you promised a 30 min Elmo video each time, you may be in trouble.  This relationship is built and functions on trust.  You have to do what you say you are going to do or they will not believe you or comply.  That being said, you have to think ahead if your reward is practical.