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Preparing Children with ASD for New Siblings

Introducing a new baby is a wonderful, joyous time for a family. When preparing children with Autism Spectrum Disorder (ASD) for a new sibling, your approach may need to begin long before the new baby arrives. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), individuals with ASD may demonstrate inflexible adherence to routines, poorly integrated communication, and adverse responses to specific sounds (American Psychiatric Association, 2013). In general, a new baby is accompanied by unpredictability, frequent, loud noises, inconsistent schedules, among other new challenges. Establishing protocols and teaching new skills to your children prior to a baby’s arrival may be essential in facilitating the transition for a growing family. Here we will briefly introduce a variety of strategies to teach these skills that may be beneficial to add to daily routines.

A small toddler boy with a newborn baby brother at home, sitting on bed.

The first drastic change for your child will be the new noises associated with a baby, such as crying, cooing, etc. Effective preparation for baby noises, most markedly crying, for individuals with sensitivities can allow for fewer challenging reactions. Systematic desensitization, or shaping, where the individual is reinforced for tolerating successive approximations of increased duration or intensity of a baby crying is one way to assist in the preparation. This procedure may include the individual being reinforced for listening to a video of a baby crying for systematically increased durations and volumes. Upon meeting a predetermined criterion (e.g., listening for five minutes, at volume three, across ten days), the individual would be expected to listen for a progressively increased duration and/or volume until they were able to listen at the final duration or volume. As an alternative or supplemental strategy, individuals may benefit from embedding the sound into positive, playful activities or use noise-canceling headphones. It is important to pair the use of noise canceling headphones with the functional communication response in which the individual is taught to recognize the need for the headphones and either requests or retrieves them independently.

Another skill to apply desensitization strategies to is tolerating diverted attention from a parent or caregiver. A new baby, while already having other children, requires a great deal of multi-tasking. However, there are going to be times when you will need to solely focus on the new baby. Teaching your child to tolerate not being in your vicinity or accessing your attention for a period of time while they occupy themselves will be an extremely helpful skill. Ways to begin this process are similar to exposing the child to new noises. First begin with brief periods of time that you cannot attend to them (e.g., 5-10 seconds). Once the child is able to tolerate the diverted attention and engage with other items or people, slowly begin to increase the amount of time. As with any procedure, promoting communication is the key to success.

As indicated above, when teaching a child to request for noise canceling headphones, teaching the request to access this item can effectively decrease the likelihood of challenging behavior. Functional communication training (FCT) to teach communication responses has been shown, repeatedly, to effectively prevent or reduce challenging behaviors (Tiger et al., 2008). FCT can be taught using a variety of modalities including but not limited to vocalizations, picture exchange, or Augmentative and Alternative Communication (AAC) devices. Different types of communication responses that can be taught using FCT in these scenarios could be requests for attention, alone time, special time with a specific person, to interact with the new baby, etc. It is important to ensure the response chosen to teach matches the function or reason the child is engaging in the challenging behavior in order for the intervention to effectively replace the problem behavior with communication.

Another major, initial disruption to the family will be sleep patterns. Sleep protocols to help individuals stay in their room when the baby cries at night may include the implementation of a bedtime routine, specific reinforcement for staying in their bedroom during disruptions, and scheduled awakenings. When implementing these strategies ahead of time, it may ease the need for intensive protocols once the baby arrives, relieve stress for parents and caregivers, and reduce the likelihood of challenges in the middle of the night when sleep deprivation may play a role in running the procedures with fidelity. As described by Mindell et al. (2006), scheduled awakenings require parents to wake their child at a specified interval prior to when the child would normally wake throughout the night. Scheduled awakenings may be implemented around the baby’s awakenings to preemptively prevent the child with ASD from leaving their bedroom; when starting these protocols, you can estimate, potentially on your previous children’s awakening schedules or consult with a pediatrician on typical awakening times. In conjunction with scheduled awakenings, it would be beneficial to include specific reinforcement for staying in their room or even their bed and redirecting back to the designated space with minimal attention. Families may also consider setting rules or expectations related to overnight activities as appropriate.

Although the addition of a new baby may seem challenging and even scary at first when you have other children, especially those diagnosed with ASD, with effective preparation and dedication, you can have a successful transition. The strategies outlined here can promote the necessary skills prior to the new baby’s arrival. However, once the baby does arrive, maintain and practice these skills and additional skills will most likely need to be introduced. Initially, particularly for children with autism who are anxious about changes in the environment, pairing positive interactions and fun activities with babies may be helpful. This might include practice visits with a friend’s or family member’s new baby or even a baby doll in which the child is given some of their favorite snacks or toys contingent on appropriate interactions with the infant. When their own baby sibling comes home, this can be continued to help facilitate generalization. An evidence-based strategy known as Behavioral Skills Training (BST) which involves instructions, rehearsal, modeling, and feedback, has been effective in teaching a wide variety of skills across a variety of populations (Seiverling et al., 2009). In applying this methodology to practicing with a newborn, the child might be given short instructions on how to hold or touch the baby while a parent models the skill. The child would then practice the skill and would receive feedback including reinforcement for demonstrating the skills and corrections when making an error. A great way to include your child in a positive way with an infant is to incorporate them in their care, such as feeding, burping, playing, changing a diaper, etc. as appropriate for each individual child. If appropriate, you can apply the BST procedures described here to teach these skills. Overall, addressing challenges and skills needed to best prepare a child with ASD as well as their entire family for a new baby is crucial.

Devon Ritenour, MEd, BCBA, LBS-PA, is a Consultant/BCBA, Jennifer Rosenblum, MS, BCBA, LBS-PA, is a Consultant/BCBA, and Samantha Smith, MS Ed, BCBA, LBS-PA, is Clinical Supervisor at Exceptional Learning, LLC. If you would like more information about Exceptional Learning, LLC, please contact our office via phone at (610) 287-4000 or visit our website at www.exceptional-learning.com.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Mindell, J.A., Kuhn, B., Lewin, D.S., Meltzer, L.J., & Sadeh, A. (2006). Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep, 29, 1263-1276. 10.1093/sleep/29.10.1263.

Seiverling, L., Pantelides, M., Ruiz, H.H., & Sturmey, P. (2009). The effect of behavioral skills training with general-case training on staff chaining of child vocalizations within natural language paradigm. Behavioral Interventions, 25, 53-75. https://doi.org/10.1002/bin.293

Tiger, J. H., Hanley, G. P., & Bruzek, J. (2008). Functional communication training: A review and practical guide. Behavior Analysis in Practice, 1(1), 16-23.

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