Archive for October 2017

Monthly Archive

Ask Dr. Emily – Challenging Behaviors and Encouraging Creativity

Welcome to the October edition of Ask Dr. Emily!

We often receive questions that we want to share with all our readers. To help with this, Dr. Emily Rastall, a clinical psychologist at Seattle Children’s Autism Center, will share insights in a question and answer format.

We welcome you to send us your questions and Dr. Rastall will do her best to answer them each month. Send your questions to

Q: Please help, I have an adult son with autism who is nonverbal and has a habit of urinating all over the floor and/or seat in our bathroom. As a consequence, I insist that he clean it up, I take things away, I follow him in and prompt him (which is hard to do in the middle of the night). I have tried ignoring the behavior and I have tried rewarding him when he uses the toilet effectively, but nothing seems to work. He is eager to please about other things, so I don’t understand why this issue is so hard for him.

A: Thank you for writing in. The first thing you will want to do is consult with your primary care doctor to rule out a medical condition that might explain this behavior. Next, as with any challenging behavior, you will want to start by determining the purpose/function of the behavior using a Functional Behavior Analysis (FBA); FBA’s are most accurate and helpful when performed by behavioral specialists who are trained to provide behavioral assessment and treatment. Based on the data obtained by the FBA, you will want to seek behavioral treatment, like applied behavioral analysis (ABA); preferably, this treatment would occur in the home, as this is where the behavior is occurring. Good luck to you as you work to remedy this challenging behavior.

Q: My 8-year-old daughter, who has autism, talks at us, but not with us. She is starting to ask little questions like, “Where are you going?” but this is a very recent development. She seems like she is more engaged, but she would still prefer to watch her iPad all day. Her play is a verbatim re-enactment of everything she just saw on YouTube. How do I help her be more creative and think for herself?

A: Research in the area of child development tells us that imitation is the first step to creating novel narratives; typically developing children first imitate play and actions observed in others (or on television) and then begin to build off of it. All of this to say, there is some element of imitation in all children’s play.

Children with autism spectrum disorder (ASD), however, tend to prefer routine and things that are concrete and “known.” Thus, they tend to be more rigid about their play and have a harder time working in the abstract, creative arena. While the “ASD brain” will always prefer routine and sameness, there are ways to encourage more creativity. First, it makes sense to limit screen time. The American Academy of Pediatrics has historically recommended limiting screen time for children ages 2-18 to two hours or less per day. If you think about it, less time spent on screens means more time for play, exploration, and creativity.

In addition, you’ll want to be sure to make time for unstructured play time, which fosters creativity. Neutral toys, such as blocks, Legos, or boxes, in addition to toys that promote make-believe, such as dolls/action figures, kitchen items (like plates, forks, etc.), puppets, or dress up clothes, are important to have on hand. You may need to model the use of these toys and items so that your child knows how to play with them. Research has shown that children with autism are more likely to imitate videos so you might show your child videos of you or someone else engaging with the make-believe toys. Once they are imitating your pretend play, you can model expanding and ask open-ended questions (like, “What do you think happens next?”). Praise creativity (“You have such creative ideas.”), and slowly you may begin seeing your child expand their play.

Wyatt Wears Jeans

Wyatt wore jeans today.

He came home from Kindergarten last night and informed me that he had to wear jeans in order to be able to ride a horse on his field trip.

Fortunately, I keep a pair of jeans around in his size.  They are usually from a garage sale or Value Village and for the remote possibility that he might actually want to wear them.  I never imagined it would ever happen!  So, when he announced this I headed up to the attic and retrieved the jeans.  We put them on this morning and off to school he went looking very handsome and ‘normal’. 

I laughed with delight when the aide helped him out of the car.

Wyatt replied, “Don’t laugh at me.”

I said that I was laughing because I was happy. I actually cried all the way home.  That is one of the privileges of having a child with special needs…you never take for granted the little things…like wearing jeans.

Fast-forward 8 years…

Wyatt wore jeans today. He told me that he wanted to look nice for his 8th grade promotion.  So, up to the attic I went and retrieved another pair of jeans.  He complained about the button, but went off to school looking very handsome and ‘normal’. 

He informed me that I was allowed to show up for promotion, but he insisted that I didn’t ‘make a big deal’ and let me know the he preferred I didn’t come up and talk to him too much afterwards.

I smiled and told him how proud I was of him for making it through 8th grade.  I actually cried through the whole ceremony.  We had both worked so hard to get to this point. That is one of the privileges of having a child with special needs…you never take for granted the little things…like wearing jeans.

So, while other parents were celebrating their children’s promotions and snapping photos, I’m standing in the background celebrating jeans. For in wearing jeans, Wyatt reminded me of the need in all of us to be loved and accepted for who we are.  The need in all of us to be a part of the common community that we call the ‘human race’.  To me that is nothing less than a miracle.


Practice Trick or Treating at the Autism Center

Trick or Treat at the Autism Center!

Seattle Children’s Autism Center holds an annual Trick or Treat practice party in the welcoming halls of the Autism Center. A (very) autism-friendly event for the entire family. Bring friends! All welcome at this relaxed fun-filled event designed for your family. 


Come enjoy door-to-door trick or treating, costumes, treats, games, prizes, and our memorable sensory room.  Dr. Travis Nelson from  The Center for Pediatric Dentistry will be on hand with toothbrushes and non sugar goodie bags.  Saturday Oct 21st from 10 am – noon.  Seattle Children’s Autism Center  4909 25th Ave NE, Seattle 98105.  Plenty of parking in front.  Lots of volunteers to play with your goblins.  Come feel at home in the hallways of the Autism Center. 

8 tips for a safe and enjoyable Halloween for your child with autism:

  1. Let your child practice wearing their costume at home. This gives you time to make any last minute modifications and time for your child to get used to it.
  2. Write a social story describing what your child will do on Halloween.  
  3. Create a visual schedule. This might include a map of where you will go.
  4. Practice trick or treating in a familiar environment. Visit friends and family, if possible, even neighbors.
  5. Keep trick or treating short and comfortable. Consider letting siblings (that might want to go longer) go trick or treating with a friend.
  6. Use role play to practice receiving and giving treats.
  7. If your child has difficulty with change, you may want to decorate your home gradually.
  8. Remember, Halloween looks different for every child on the spectrum and you know your child best. Use your intuition and if you only make it to three houses, that’s okay!

Hope to see you there! 

Mindful Monday – The Voices Inside Our Head

Have you ever thought about the voice in your head? You know the one I’m talking about. The “I”, “Me” voice that seems in constant chatter to narrate the story of our lives. This is the voice of the 50,000 thoughts per day that stream through our consciousness.

Do you listen to this voice? Believe that all it tells you is true? Are you aware of the pauses or spaces between the thoughts, when the voice quiets to a background hum instead of the front-and-center megaphone we’re used to? If you aren’t tuned in to those fleeting in-between moments, then you might try a mindfulness strategy or two to help. Simply taking a few deep breaths to slow down in mind and body or repeating a mantra (simple word or sound) to do the same can help us tune in to these healthy, healing pauses where the chatter stops and we experience the present moment, right here right now. We experience the essence of whom we are – the one who observes the voice.


The Autism Blogcast – October Edition

News Flash: The September edition of The Autism Blogcast, featuring autism experts Raphael Bernier, PhD and James Mancini, MS, CCC-SLP.


In an effort to keep you up to date on the latest news in research and community happenings, we welcome two of our favorite providers best known as Jim and Raphe, the autism news guys.

In this edition they discuss research on fevers lessening behavioral problems in children with autism, promoting inclusion for people with disabilities and events that promote inclusion.

Watch our first installment in a new series from our team of reporters sent into the field! Lindsey Miller, ARNP starts off this special series asking the question “What does inclusion mean to you?”.