How You Can Help Children With Autism Enjoy the Holiday Season

Marshal D. Haneisen

The holiday season is supposed to be a time of celebration, renewal, family appreciation, and peace. We celebrate with music, prayer, decorations, twinkling lights, gifts, and food — so many wonderful things,many of which are not part of our regular routine. Changes in routine and all this sensory input can create challenges for children with autism or sensory processing disorder. We asked four experts for their adviceon what parents can do to help their child have a more enjoyable holiday season.

The Occupational Therapist: Ashley Clarke MS, OTR/L

May Center School for Autism and Developmental Disabilities, Randolph

First, how would you describe sensory processing disorders?

Sensory processing is the way a person interprets sensory information. Simply put, we interpret sensations as being too much, too little, or just right. Each person can interpret the same sensory information differently. This is commonly seen with room temperature, as what one person finds a comfortable room temperature could be too hot or cold for another.

Sensory processing disorder comes into play when a person's interpretation of sensory information impacts their day-to-day life. As with autism, sensory processing disorders fall on a spectrum. One end of the spectrum represents an overresponsivity (sensitivity) to a stimulus, while the other end of the spectrum represents an underresponsivity.

Generally speaking, individuals who show an overresponsivity (the stimulus is too much) will have a tendency to avoid the stimulus. Those with an underresponsivity (the stimulus is too little) will either seem disinterested or seek out a higher intensity of the sensation. Individuals can fall on many different areas of the sensory processing spectrum based on the sensation, such as showing overresponsivity to sound, and underresponsivity to touch.

The holidays are abundant in out-of-routine sensory inputs for all senses. What tips could you offer in mitigating the stress?

The first line of approach would be to modify the environment based on the needs of the individual, but this often isn't possible during the holidays, as we don't always have control over the environment. The best recommendation I can provide for these sensory experiences is provide the child with a sense of control in modifying the way they receive sensory information.

Lights: If a person shows overresponsivity to light, try giving them a pair of sunglasses or a brimmed hat. They can put these on and take them off as needed to dim the intensity of lights.

Sounds: Provide the option for noise-reduction devices. Noise cancellation headphones are often used in loud settings, such as on a plane, and can be an option if an environment becomes too loud. Other options include the use of earplugs or earbud headphones. Headphones can be used without music to lower the volume of the environment and can also play music the person enjoys or finds soothing. If the noisy situation is causing escalation, look for a place to take a quiet break, such as a side room, the bathroom, the car, etc.

Crowds: Provide opportunities for breaks from the crowd and a coping strategy to use while in a crowd. It can be useful to trial “fidget” toys that can be squeezed or manipulated, such as a stress ball or putty, as these can provide a distraction and a source of stress relief, as well as an enjoyable sensory experience.

Scents: This is one of the most difficult sensations to avoid. Modifying the environment is ideal by avoiding scent sensitivity triggers. If this is not possible, try breathing through the mouth instead of the nose, use chewing gum or hard candy if safe to do so, and provide breaks from highly scented areas.

From allergies to sensitivities to preferences, food creates a range of challenges for some children. The holidays are loaded with foods we don't have the rest of the year. From an occupational therapy standpoint, what do you recommend parents do about food challenges; perhaps they can bring a dish or two the child likes, being sure to include enough for everyone to share? Who knows, macaroni and cheese might make a nice addition to the holiday meal?

Absolutely. Food is often the highlight of holiday gatherings, so I completely agree that bringing a dish or two of food the person enjoys is a great idea, and will also help build positive associations with holiday gatherings. It is not always possible to anticipate what other guests are bringing, so it is highly recommended to bring food items that you know your child is safe to consume related to allergens, and willing to consume based on preferences. Allergen-free food can be expensive, and the child's preferred food may not be appropriate for the holiday setting, so if preparing a dish to share with guests isn't an option, you can pack a separate bag of food for your child. The packed items can be combined with food they are willing to try.

If introducing food is a challenge within the daily routine at home, a holiday gathering is likely going to be even more challenging. But that doesn't mean you shouldn't encourage your child to try new foods.

Before the event:Prepare before the gathering. If you know their aunt makes a certain dish each holiday, try preparing it at home and introducing it to them the weeks preceding the event. You can consider providing an incentive for trying new foods at the holiday party, such as, “For each bite of new food you try, you'll earn ___.” This should be something very motivating for the child and does not have to be food-based.

At the event:If appropriate, provide a plate containing a small portion of their preferred food, along with portions of new foods. Encourage your child to try the new food before filling up on preferred items. Prepare for the possibility that they will not feel comfortable trying new foods. To appease the request of party goers urging them to “Just try one bite, I know you'll like it,” make a “to-go” bag. They can make a plate or fill a bag with all the goodies they were uncomfortable trying at the party, while reassuring relatives that their homemade recipe will be tasted tomorrow.

After the event:If you've made a to-go bag, you can introduce these foods the next day. If they still don't feel comfortable at home, you can encourage them to lick, sniff, or simply touch the food depending on their level of sensitivity.

The two previous items are more about coping, how about embracing and enjoying the season? What activities could parents try during the holiday season to encourage sensory exploration?

Food preparation is an excellent sensory experience, as well as a functional skill. Involving your child in food preparation is a great way to provide sensory input and holiday sentiment, as well as a useful life skill.

Provide your child with a responsibility at the holiday party. Helping to prepare a dish, carry in the food, pass out gifts, set the table, these are all opportunities to keep your child moving, engaged in sensory and social activities, and will provide them with a sense of accomplishment.

For multisensory activities related to your specific holiday, websites such as Pinterest have an enormous amount of activities. Searching “sensory holiday activities” will provide multiple sensory crafts, games, and other activities that are appropriate and interesting for your child.

Finally, please offer any other thoughts you wish to share relative to making the holiday relaxing, enjoyable, and meaningful for our kids.

Making the day more predictable can help with reducing stress. Review the schedule of events ahead of time, and provide a set time of how long the event will last. If appropriate for your child, think of ways to provide incentives in increments throughout the event, such as earning a break with a preferred toy every 30 minutes.

As it can be overwhelming to be hugged and kissed by multiple guests, consider giving your child an alternative to hugs and kisses, such as a pat on the back, hand shake, high five, etc.

Think of activities your child loves and how to incorporate them in the event. Does your child love to take pictures? Give them the task of being a photographer for a portion of the party. Do they love computer or iPad games? Look for games they can play with a partner at the event. Do they have a game they love to play? Bring it to the party and have them introduce it to their peers. Think of your child's strengths and interests, and how to incorporate them into the party. You might even start a new holiday tradition.

The most important recommendation I have is to pack a bag of tricks. Prepare for your child to reach a point where they can no longer tolerate being at the event and have preferred activities and food ready to use.

The Board Certified Behavior Analyst:Robert Shapiro, Ph.D., BCBA-D, LABA Owner, Shapiro Educational & Behavioral Consultants, Fitchburg

For readers who might not know what behavior analysis is all about, please offer a short explanation of what you do and how understanding behavior is important for children, particularly those with intellectual disabilities.

As behavior analysts, our primary goal is to affect meaningful behavior change. This means teaching or improving skills that improve the lives of those with whom we work and open them up to new opportunities. With children who engage in behavior that might interfere with their ability to form meaningful relationships, participate actively in their community, be as independent as possible, or remain safe, we seek to understand why that behavior is happening, so we can teach the child a more effective, efficient, safe, and socially acceptable way to gain what he or she is seeking through their interfering behavior.

Why are the holidays so difficult for some children, especially children on the autism spectrum?

Let's face it — the holidays can be difficult for everyone. Nothing happens the way it usually does; we see people we rarely see, we go to different places, we participate in traditions that we only engage in once a year. While that can bring joy and excitement, it can also bring discomfort. Now, multiply that discomfort immeasurably for a child on the Autism Spectrum, who may struggle with social interactions, sensory stimulation, lack of predictability, and impulse control.

From a sensory standpoint alone, the smells, tastes, and sounds of the holidays can be strange and overwhelming. Add to that changes in routine, the stress level of those around them, and the unclear expectations that go hand in hand with crowds, large family meals, present giving and receiving, and dozens of other things, and it's easy to see how someone on the Autism Spectrum could struggle in that situation.

Listening to some people talk about their holiday schedules overwhelms me. We don't fully understand how a child with autism processes overstimulating chaos, but we often see it makes them unhappy, restless, upset, or frightened. Could you offer a few steps on helping parents recognize their child's limit so they can prioritize how to adjust the holiday plan?

I think the most important thing with regard to preventing children from becoming overwhelmed in these situations is parents being willing to be flexible. It's critical to be tuned in to how your child is feeling, and recognizing those early warning signs that a situation is becoming overwhelming.

In some cases, children may be able to effectively communicate that they need to take some time away, while at other times it may be necessary to look for nonverbal signs. in either case, it's important to be proactive and honor a child's need to escape a situation before that situation escalates. While it can be disappointing to have to cut an activity short, or even to take a short break, it is far preferable to do so (and in the process teach the child that he or she will be listened to) than to forge on, only having to take evasive action later.

From a behavior standpoint, what factors should parents consider when planning holiday activities?

The two things that come to mind here are antecedent management and replacement behavior.

Antecedent management refers to changes that can be made to the environment before things become difficult, which may serve to reduce some of that difficulty. For example, does a particular activity or tradition involve particular smells, tastes, social interaction, waiting, or anything else that your child might struggle with? If so, are there small changes you can make to that tradition that eliminates or reduces some of those things that you know might result in your child struggling? If you can eliminate or reduce those, can you do things like pre-teach (expose your child to those situations in a calm learning environment ahead of time so he or she is more likely to be successful) or work on coping skills so your child will be better equipped to handle those situations.

Replacement behavior refers to a socially appropriate and safe way for someone to gain the same outcome they sometimes gain by engaging in problem behavior. For example, if your child sometimes engages in tantrums when in a difficult situation, and often is removed from that situation as a result, a replacement behavior might be asking to take a break or to get away. If you teach your child that replacement behavior (and then honor the replacement behavior when it occurs), it makes it less likely that problem behavior will occur.

How might social stories help in planning for a family gathering?

Social stories are a great example of pre-teaching. By going over with your child events that are upcoming, including planning for unexpected changes and letting your child know what options he or she might have if the going gets tough, this makes it more likely that the event will be at least somewhat predictable, and that your child will have a strategy in advance for handling challenges. Social stories often include visuals, are framed positively, and can be a great tool when going into novel situations.

What other tools and tips might you recommend for attending holiday parties?

In general, I often talk to the parents I work with about “thinking like a chess player.” A good chess player doesn't just think about what move he or she is going to make; the good player thinks about how his or her opponent is likely to respond to that move, and what he or she is going to do next. The great players think many moves ahead.

When going into a new situation, think like a chess player. What is going to be present, and how are you going to set things up for success? What things might happen when you're at the party, and how is your child likely to respond to those things? In turn, what is your plan if their response is less than ideal? The more you can be prepared and forward thinking, the more likely a new activity is to be successful.

Of course, a piece of this is learning to be flexible; our predictions aren't always right, and we have to be ready and willing to roll with new situations that may arise, and adjust our plans accordingly.

You know parents might feel self-conscious when their child has an outburst or meltdown. You appreciate how discouraging it can be to feel the judgmental looks of other people who don't understand our children. That hurt seems amplified when it comes from our own extended family. What encouragement or advice can you recommend to parents when they dread the holidays because it is a time when they feel the child they love so much will be in settings that set him or her up for failure and judgment?

It would be wonderful if we lived in a world where no one judged others, especially when often they have no idea what is really going on. Unfortunately, judgment is passed all the time. When this happens with strangers, it's a very personal decision whether to take the time to educate those strangers and set them straight; I think it's important to try not to personalize (as difficult as that is), and to realize that anyone who is passing judgment in those situations is doing so from a place of ignorance. Hopefully that ignorance is lessening as the overall awareness of children with disabilities is increasing, but it will always be there to a certain degree.

As far as family members responding that way, I can appreciate how much more disheartening that must be. Again, I think it often comes from a place of ignorance. In being proactive on that front, it may be worthwhile to have a frank conversation with your extended family regarding some of the challenges your child may face, what you are doing about those challenges, and the rationale for why you are doing that. For example, if a professional has recommended that you minimize the attention you give to your child when he or she engages in problem behavior because the attention seems to exacerbate the problem, that may look to the untrained eye like you're being passive or ineffective, or that you don't know what to do. However, by letting your family know what your plan is, and why that is the plan ahead of time, you may be able to cut off some of those judgmental responses before they have a chance to gain traction.

The Licensed Clinical Psychologist: Kirstin Brown Birtwell, Ph.D.

The Lurie Center, Massachusetts General Hospital, Lexington

Several years ago, I took my son to a children's holiday party sponsored by a local organization. I wasn't sure what to expect when we arrived. My son decorated a cookie and made a craft. Then the children were all asked to yell as loudly as they could for Santa Claus to come. My son was terrified. We left the event and I felt like I had failed him. What should I have done differently?

You totally didn't fail, and I say that for a couple of different reasons. First, you and your child obviously learned a lot from the experience. The second reason you didn't fail is because you tried. The biggest thing I would stress on this topic is that a lot of parents of a child with autism isolate themselves because of the fears of what can go wrong. They may try to recreate the experience at home, but in doing so they are really taking away the chance that it could be a wonderful experience. Also, by not trying, you will otherwise create a pattern where when things are really hard we escape them. These behaviors can create a socially isolated family and the research shows this to be true.

So how do parents address and overcome their fears of what can go wrong?

Preparation and practice.

Tell me about preparation first.

Do a little research to learn what is available in your community. This is such a great time for autism, particularly in Massachusetts. There are autism and sensory-friendly performances and shows, like The Nutcracker, which might be a great opportunity. Consider the language capacity of the child. Would they not be able to understand and access a particular show? Maybe a more visually stimulating show would be more appropriate? There are a lot of options.

Make sure you know the environment for the venue. Do a walkthrough so it is not your first time there when you go with your child. Locate the exits, bathrooms, and quiet room if one is available.

Know your child. Know what sets him or her off. Bring things that will help. It is a great idea to consult with the school professional who works with your child, the occupational therapist specifically. These people may understand what kinds of supports will best help your child on the outing. I have found that most school teams are inviting and welcoming. They might even say, “I use this….why don't you bring it home for the weekend.”

What about practice?

Visual stories and social stories are wonderful. Using the show venue example, go to the venue ahead of time and do a walk through with your child. Call and tell the staff the situation. They can help you plan appropriately.

Any other recommendations?

Bring extra help, make sure you have enough adults to support yourself and the other children. You may be able to bring a support provider like an ABA therapist or a community mentor.

Know where you will park and arrive early so you don't get yourself stressed out by being late.

Choose seats near an aisle so you can either leave or take a break and come back. Be thoughtful about the way in which we do things.

Engage with the holiday season. It is always easier to stay home. Take the chance!

The Mental Health Counselor: Kelci Schulz, MS Art Therapy and Mental Health Counseling

Outpatient/school-based clinician at Community Healthlink-Lipton Center, Leominster

For some families, the holidays may be the only time certain relatives see or interact with a child. What thoughts do you want to share with parents about family gatherings?

The holidays can be a stressful time with typical children, not to mention for a child with a behavioral need. You know your child best. Friends and family don't live with your child every day. Don't shield your child from extended family. Family members need to understand the challenges you face. Talking to your loved ones during this time can be difficult, not wanting to upset traditions.

What are some points to consider when talking with extended family about tweaks or accommodations a child might need at a family party?

Keep in mind these four key skills when communicating your child's needs to others:

1. Become an engaged listener

2. Pay attention to nonverbal signals

3. Keep stress in check

4. Assert yourself

What things do you recommend parents consider in advance of the party date?

Consider your child's sensory and behavioral profile and how your child will interact with certain traditions.

Ask to schedule an early dinner, eat in advance, or pack a small bag of snacks or preferred foods if you think there will be difficulty at meal time.

Ask about a spot in the environment to which your child can go if overstimulated.

Consider bringing an activity he or she can use with headphones in order to decompress or encourage the children to play outside. Bring a small plastic basket with handles for preferred activities or items handy to keep their things contained.

How can parents support their child during the family party?

Keep an eye on your child for signs of anxiety or distress. Is your child humming or rocking more? Is your child very active or easily agitated? Try and take a short walk or find a place where they can freely move to help them calm down.

If your child has a meltdown, simply say to family, “We are practicing feeling (insert emotion, i.e. frustrated, sad, angry) and need a moment to calm our bodies.” Then walk your child through deep breathing, counting each breath up to their age (3 years old = 3 breaths, 10 years old = 10 breaths). Be sure to ask your child if they are calm and ready to rejoin the activity. If not, take a moment with your child away and re-access why you are staying. Is it important to you? Your family? What is your child trying to tell you?

If you need to leave an event or family gathering, make sure you and your support have a go-to word, phrase or look that means “It's time.” It's all about communication between you and your immediate supports during a difficult behavioral moment.

Are there any final thoughts you would like to share?

Of course there may be an event or tradition that others won't budge to make doable for you and your child — and that's OK. You may want to consider making new traditions, like making popcorn garland or paper chains to decorate. The holidays are about your child enjoying themselves — you, too, Mom and Dad! So enjoy yourself whether that be with a busy packed weekend and a possibly fussy overstimulated child or skipping the hustle and bustle to stay home and make new traditions! You know your child best. Enjoy the holidays!