Showing posts with label LEGO. Show all posts
Showing posts with label LEGO. Show all posts

Monday 15 February 2021

Core vs extended Maths? An unexpected dilemma. And yet they say “Autism is untreatable and you should not try to treat it”. Plus Lego


This time the “Professor” wears the Dunce’s cap

I had a surprise last month, talking to my son’s 1:1 assistant, this time about maths (or math in US English).

Normally I am trying to simplify school academics, and so if something really is not important, like argumentative writing, I am all for skipping over it.  The idea is that Monty, aged 17 with autism, should focus on useful learning that he has a chance of mastering.

Monty’s international school follows an English curriculum and in that model you have a choice in some subjects of studying the core or the extended version. So a typical child who wants to become a doctor, or an engineer, will have to follow the extended version of all their subjects, but someone who is going to shift boxes in a warehouse might opt for the core/simplified versions. Most people lie somewhere in between.

People with severe autism would not normally follow any of these academic curricula, because it is all way above their heads.  Their school is about life skills and providing day-care, while the parents are out at work, or having some respite. Realistically, “graduation” is often just a photo opportunity - things could and should be better.

There is very little published about literacy and numeracy in severe autism.

I thought an ambitious target for Monty would be to try and sit exams, aged 18, in five subjects, but at the easy level where possible, the so-called “core” version.  These exams are normally taken at the age of 16, which is the minimum school leaving age in the UK.

The maths teacher has been thinking about which of her students should be aiming at core or extended.  She thinks five pupils should be aiming for extended and the others should settle for core.  Monty is one of the group of five.

The assistant was almost apologetic, because she did not want to change my plans for Monty. He is now "too good" for core maths.

I do know Monty’s mathematical abilities very well, because I teach him maths at the weekend.  He is no maths savant, but he works extremely hard and now has a good understanding of what they learn at school. I am just amazed at the other kids, with no disability, who do not keep up with him. Prior to pharmacological autism treatment, starting at the age of nine, Monty could not subtract single digit numbers, like 9 – 2 = 7.

Even more recently Monty’s school assistant proudly announced his results in the half year maths test. He got 68%, making him 3rd out of the 15 people in class.  68% certainly does not make you an “A student”, but given he was a “basket case” at maths not many years ago, it is truly remarkable. The teacher even told the whole class his score, which you might think would lead to resentment, but the others are actually very supportive. They have seen his progress over the years. They are currently involved in helping him to reliably tell the time. For some people solving algebra is easier than telling the time – who would have thought that?

The other day I skimmed through an article about some Professor who was quoted as saying “Autism is untreatable and you should not try to treat it”. What a fool - more of a dunce than a Professor. 

Literacy and Numeracy Rates in Autism

People rarely talk about literacy or numeracy in autism. I think it is another issue that people do not want to discuss. We would rather hear about people with savant skills, or characters from those TV shows like the Good Doctor, with trivial autism.

It is clear that many people with severe autism currently cannot read or write, so I suppose they are also innumerate.

You can be non-verbal but literate and numerate; there are specific teaching methods.

I was recently asked to present at an autism conference in Russia. I did click on the organisation’s website and I was pleased to see on the first page its message to Russian parents that you can teach people with autism to read and write and indeed that non-verbal kids belong in school. I agree with them, but it may seem like a Herculean task at times.

My last conference presentation was very simple and not controversial, at the request of the US organizer.  Russians like science and they have asked for a long presentation, so they will get the real deal. A big job for the person who has to translate and then dub it into Russian!


 Any human brain can be taught to read, write, count


One to one teaching, as above in Russia, is the only way to teach those with severe autism.

Reading and writing do matter. Look at the literacy rates by country and guess where you find countries like Afghanistan, Ethiopia, Sudan and Nigeria?

In Afghanistan the male literacy rate is 55% and for females it is 30%.

Even India has 25% illiterate and they tell us it is the world’s largest democracy. In India literacy ranges from about 66% in Andhra Pradesh in the South East to over 95% in Kerala in the South West. In China illiteracy is just 3% and it shows.

In the US 4% are non-literate and the average American adult reads at the 7th- to 8th-grade level, i.e. like a 13 year old child; plenty of room for improvement.  The problem is the large group at the bottom who drag down the overall results. This is why countries like Finland do so well in skill assessments; they do not have a forgotten underclass.


Why bother with Mathematics?

It is certainly worthwhile reconsidering what to teach people with severe autism. If you cannot cut your own fingernails, or tie your own shoelaces, why do you need to know any maths?

Maths is all about following instructions/rules. If you can follow instructions, you can do maths. Daily living skills are also all about following instructions; before emptying the dishwasher, check the dishes are actually clean! Monty has learnt that lesson.

What do you do when the toothpaste has run out? Find some more and if that does not work, ask for help.

Learning to follow instructions is extremely important to those with learning difficulties; just like practising motor skills helps them overcome their initial challenges with fine and gross motor skills.  In the end, the problems just fade away.

Lego is a great way to combine following instructions with improving fine motor skills. It is a perfect therapy for autism; at the very beginning you can use large bricks to get a young child to replicate simple colour patterns (so-called “block imitation”) by stacking bricks. You can use Lego to develop team skills; one person locates the next bricks, while the other assembles them.

We have a lot of Lego at home, but until recently it was mainly the simple models of planes and helicopters that were of interest to Monty. People would give complicated (expensive) models for birthday presents, when actually what you want are the cheaper, simple ones.

We have now progressed to the point where Monty has completed a model that was intended for people older than himself. All the Lego sets have an age recommendation on them. Yes, Lego has some very complicated Star Wars models meant for those 18 and over.  A Christmas present from big brother, it did have a ridiculous number of pieces (several hundred) and some mistakes were made. 

Monty actually calls it “doing the instructions”, rather than making Lego.

The key seems to be to leave him entirely alone and let him make the occasional mistake.  If a later part does not fit, he asks for help and you then intervene, find the earlier mistake and correct it.  If you hover behind him to prevent any mistake being made, then you are not achieving much.



You definitely can treat severe autism, meaning raise IQ and/or improve quality of life.  The evidence is overwhelming and is sitting there in the peer-reviewed science.

It looks like you can avoid/prevent some autism by taking certain steps prior to conception and during pregnancy. This is quite clever.

After birth, can you “cure” severe autism? I think this will only be possible in rare cases, for example correcting an in-born error of metabolism at an extremely young age. One example in this blog was the young Greek boy with biotinidase deficiency, that responds to high dose biotin. Our reader Roger is a rare example of an adult whose central folate deficiency was only treated in adulthood.

You can minimize many troubling features of autism at any age; this applies to Aspies and those with more severe autism.

Learning maths develops much broader skills than might be initially apparent.

Lego is a great activity and a fun therapy.  You can of course re-use it, particularly the most basic sets, which you can use over and over.

Wednesday 10 September 2014

Adaptive Behavior and Autism

Today’s post is rather off subject, since it is not about GABA or complex pathways mainly researched for cancer.  It is about struggling to put on your shrunken socks, that shirt that was left inside out, or finishing your Lego by yourself.

Adaptive Behavior / Coping Skills

Most people never need to think about adaptive behavior; it just comes naturally.  When adaptive behavior is very weak, then daily life becomes a challenge.

Adaptive behavior is a type of behavior that is used to adjust to another type of behavior or situation.  Adaptive behavior reflects an individual’s social and practical competence of daily skills to meet the demands of everyday living.

Adaptive behavior is often measured by psychologists using the Vineland Adaptive Behavior Scale .

This post looks as adaptive behavior and some ways to improve it.

What prompted this post was a recent post on the excellent Simons Foundation blog:-

Fragile X is rare, but is associated with autistic behaviors and often MR. It is viewed as the most widespread single-gene cause of autism.  Fragile X is frequently used by autism researchers because there is a mouse model of it.

In fact what the study showed was that the acquisition of coping skills in fragile X is much slower that with typical children and as they get older, the wider the gap becomes.  They do not lose their existing coping skills with age.  This fits perfectly with how Deborah Fein, my favored Neuropsychologist, describes skill acquisition in autism. 
Her chart below is actually more optimistic than how she actually describes it.

She is just past half way down the long list of lectures.

Fein’s small “recovered” group has a spurt of development that allows them to catch up. This is extremely rare, but evidently can happen.

By interfering with Nature’s chosen path, as is the objective of this blog, we should be able to change the trajectory of skill acquisition.  

ABA and Adaptive Behaviours

One of the good things about the ABA approach is that it includes, and indeed prioritizes, developing adaptive behavior, in the form of daily living and self-help skills and developing fine and gross motor skills.  

The “bible” of skills to teach is The Assessment of Basic Language and Learning Skills - Revised (ABLLS-R), when starting with a young, non-verbal child, the document is extremely daunting.  But looking back, it really does have all the key skills and what order to teach them.

People only slightly familiar with ABA might think that it is the opposite of “adaptive”, since ABA is teaching you to follow exact rules and instructions.  So what happens when the situation is slightly different? Then what?

Some of these situations are predictable, like what to do when you are brushing your teeth and the toothpaste tube is empty.

The options might include:-
1.     Start screaming
2.     Give up
3.     Ask for help
4.     Brush with water alone
5.     Find a new tube of toothpaste
I think that the early emphasis on fine/gross motor skills helps the brain develop pathways that can later be used for more complex processes.  So insisting on learning to catch a ball, control a pencil, stack colored block in order is much more important than it may seem.

ABA may be teaching the brain to structure itself, which may be a pre-requisite for it to become more adaptive later on.

Motor skills and adaptive behavior skills in children with ASD

Thanks yet again to funding from the Simons Foundation, the following study looks at just this very subject.  The abstract is rather better laid out than the copy of the full version that I managed to locate.

To determine the relationship of motor skills and adaptive behavior skills in young children with autism.
A multiple regression analysis tested the relationship of motor skills on the adaptive behavior composite, daily living, adaptive social and adaptive communicative skills holding constant age, non-verbal problem solving, and calibrated autism severity.
Majority of the data collected took place in an autism clinic.
A cohort of 233 young children with ASD (n = 172), PDD-NOS (n = 22) and non-ASD (developmental delay, n = 39) between the ages of 14–49 months were
recruited from early intervention studies and clinical referrals. Children with non-ASD (developmental delay) were included in this study to provide a range of
scores indicted through calibrated autism severity.
Not applicable.
Main outcome measures
The primary outcome measures in this study were adaptive behavior skills.
Fine motor skills significantly predicted all adaptive behavior skills (p < 0.01). Gross motor skills were predictive of daily living skills (p < 0.05). Children with
weaker motor skills displayed greater deficits in adaptive behavior skills.
The fine and gross motor skills are significantly related to adaptive behavior skills in young children with autism spectrum disorder. There is more to focus on and new avenues to explore in the realm of discovering how to implement early intervention and rehabilitation for young children with autism and motor skills need to be a part of the discussion.

Fine and gross motor skills were predictive of those important adaptive/living skills.
Does this mean that by improving fine/gross motors skills you will improve adaptive/living skills? This comes to the recurring issue of correlation and/or causality.  Since this my blog, we can apply that overriding factor which is “common sense”, and say yes, in most cases, it will.

Our Experience of Adaptive Behavior
After a few years of ABA, adaptive behavior did gradually improve, albeit from a baseline of near zero.
It is clear from the literature that some children do not respond to ABA; I think it is really a case that they do not respond to anything.  In these children overcoming the biological origin of their autism is a prerequisite for meaningful progress.
It is also likely that the earlier a biological intervention is made the better the final outcome.  Typical kids can spend twenty years in education and so the more time an autistic child has in full time education with a “re-tuned” brain the better.  Adaptive behavior typically emerges/develops from birth to early childhood, a time when many with ASD are not “present”. 
If you can progress with ABA, then additionally treating the biological dysfunctions should boost the learning trajectory.
Only recently though did I start to observe some spontaneous developments.  Getting dressed after swimming, when your feet are still a little damp, it can be hard for anyone to put their socks on, so I am really pleased that Monty, aged 11 with ASD, now manages all by himself.
In the not too distant past, untangling his inside out jeans, re-attaching the half detached belt would have been the source of great frustration.  You could use ABA to train somebody to untangle their jeans and thread their belt neatly, but we never did.  This he is figuring out all by himself.
Another recent example is his latest Lego model.  We are big Lego fans, but in the earlier times Monty was more interested in “crashing” his Lego than playing with it.  It was a case of build it, crash it and then somebody else look for all those tiny pieces. 
His latest toy plane has extremely fiddly little stickers that you have to stick on the bricks.  If you do not get them lined up nicely, you have to pull them off and start again.  It really is a test of both fine motor skills and patience.
So I was assuming that when Monty came to the stickers, either he would not bother or he would ask for help.  But no, he just said “stickers” and stuck them on.

Things are definitely changing for the better.  

Monday 1 April 2013

LEGO Therapy

You may not have heard of LEGO therapy; not only does it exist, but it has been proved to be effective in several studies, including at the University of Cambridge, Autism Research Centre (home of Borat's brother, Simon). 

While they were playing with LEGO, two very bright researchers over in the New York State Institute for Basic Research in Development Disabilities were busy writing and editing an amazing 458 page book of scientific research called  AUTISM: Oxidative Stress, Inflammation and Immune Abnormalities.  I say amazing, because it has in one place, what would take me a month to find in tiny pieces all over the internet.  There were 54 contributors including from big names like Harvard, Columbia and Johns Hopkins.

The good news is that an American charity ( has been sending out complementary copies of the book to various leading Medical Schools.  This is funny because Nela, Monty's assistant at school, suggested the same thing, that we should send it to everyone.  Hopefully the Autism Research Centre of Cambridge University has already bought a copy, but don't be surprised if they have not.

Back to LEGO Therapy

The therapy was developed by Daniel Legoff; and yes, it appears that is his real name.  Just for a change, I decided to include a short film that explains all about the therapy. Just click on the arrow, it takes 15 seconds to get to the actual film.  (if you have an iPad or Apple click here instead)