Archives for September 2013

There are two main issues for sensitive ears when flying. First there is noise, loud, unfamiliar or both, and there is pain associated with changes in cabin pressure. While the latter can be uncomfortable for anybody, it’s a whole lot harder when you have difficulty communicating how it feels. Noises are a problem that lots of us see with our children in other situations aside from flying.

The good news is that you can do a lot in preparation before you ever leave home. You have two things to figure out. The first of these is which remedies will your child tolerate ? Some of the things that work for others may just be totally unsuited to your child. The second thing to find out is, of the “acceptable” remedies, which ones actually work.

Let’s look at noise. The really good news here is that you can answer both questions at home. No, we’re not saying that your house is noisy ! What we are saying is that, if your child is upset by loud or strange noises, you’ll find plenty of those somewhere locally.

If your child is considerably affected in this way, you probably have already figured the best means to deal with this and could possibly tell us some of the answers.  In your case, take whatever works at home with you, when you travel. There’s a very high probability that you’ll need it. In fact, if two different things work, take both.

If your child is only overwhelmed by noise occasionally, then you should work on something before you leave. One of the best answers here is noise-cancelling headphones attached to the device of your choice. The choices are limitless. You could go crazy and spend well over $ 300. Alternately, we found something good, that worked, in Wal-Mart for around $ 20. Once you’ve found something, try it out in a situation where you have reason to suspect that your child would struggle without them.

You might be able to use the, generally cheaper, type of earphones that fit into the ear but there are things to consider with this. The obvious one is, does your child tolerate things being placed into their ear ? The other possible issue is for kids that can hear a pin drop from a block away, they may still be disturbed by “outside” noises.

The remaining possibility is plain, ordinary, foam ear plugs. The plus side of these is that they cheap and they’re easy to find. The downside to these will be, are they tolerated ?

Now let’s look at cabin pressure changes. In this case, you don’t have a good way to see if they work in advance of actually using them. That may be not quite true. Somebody did suggest that you could try this out in a very fast elevator in a very tall building. While we accept the theory of this, we have to guess that packing your child into a tiny, crowded, space full of strangers and then closing all possible exits, may lead you to have more problems that just their ears !

Now, it’s not all bad news. Everything here can be tested in advance for how well it is tolerated. Once you know which things are accepted, take them all !

Start by looking at EarPlanes^TM by Cirrus Healthcare. These are plastic plugs that fit into the ear and help to stabilize pressure. They’re easy to buy at stores like Walgreen’s and CVS. They work well for many people. They come in child and adult sizes. Try a pair and see if your child can tolerate having them in their ears. If they do, take them with you.

Next, how is your child with either chewing gum or sucking hard candy ? Food issues may mean that these remedies are unsuitable for some. On the other hand, if they merely represent things that you prefer to discourage, this might prove to be a worthwhile “exceptional case”.

How is your child with drinking through a straw ? The sucking can really help. Either your child can already do this or it’s a skill that may be easily taught. Take some straws with you.

Our favorite variant on this is sucking on a straw from a juice box. Here’s why. If you are careful when puncturing the box with the straw, you are left with a, nearly, air-tight seal between the straw and the box. This means that you end up sucking against a vacuum and that requires much more sucking effort than drinking with a straw from ,say, a glass. Of course, you can’t do this if you wiggle the straw around to enlarge the hole ! The tough part about this suggestion is that there are few, if any, juice boxes smaller than the 3.5 oz limit that you can take through security. You need to be able to purchase them from a concession after you’ve gone through. If unable to purchase them there, you still have those straws (see above), don’t you ? If you don’t ordinarily permit your child to drink juice, think “exceptional case”, as above.

Then, there’s nose blowing.  Have plenty of tissues with you just in case none of the above has worked. This will work best if you can assist and, gently, constrict the nose enough to close it off. This builds internal pressure while attempting to blow and may be enough to overcome the changes in the cabin pressure.

Now let’s look at both issues. Oh boy ! It does make things harder if you have to deal with both issues. It doesn’t, however, make them impossible.

The first thing to consider in this case is, when is each issue going to come into play ? For the airport, the issue will be noise and not cabin pressure. In fact noise will, probably, be the bigger issue throughout with the exception of the ascent and descent portions of the flight.

There are a couple of things that you can do and, again, you can do some of the testing at home. You could, for example, see whether the EarPlanes^TM help with noise tolerance. They aren’t made for that purpose but they do reduce noise somewhat and, with luck, that somewhat may be good enough.

If that isn’t the answer, you can’t reply on noise cancelling headphones to deal with cabin pressure but they will still be effective against noise and you can go with the candy, gum or straw drinking solution in order to tackle the pressure.

So, find your noise solutions before you leave home and check which pressure solutions might work and take all that do.

Our last post was about how we did with following our own advice at the airport. This continues the story to the resort. Some things we couldn’t try because they simply don’t apply to us. Some worked extremely well.

 

Be specific with room requests. Here we mean more than high-floor/low-floor. It is well worth the effort to call or email the resort ahead of time with a resort map in front of you. If you need a quiet location, ask in detail about which locations might work.  In general terms, rooms nearer to all of the main facilities are noisier and those furthest from those facilities are quietest. That isn’t, however, always the case. Reservations staff at the resort do know, but only if you ask them.

In our case, location wasn’t a huge issue but we did want to be near to the smaller pool and away from any late-night noise. Planning this ahead worked very well. We got exactly what we wanted and, as a bonus, a beautiful view. (That picture isn’t from the resort’s gallery. It is a random shot from our balcony !)

 

Take appropriate measures against wandering off. Sorry to tell you that we didn’t get to try any and, thus, can’t report on any of them. (Of course, the good news is that this is because our son isn’t a wanderer).

Take a pillow, or other bedding, from home. We recommend this, if a child is a poor sleeper. The familiarity may help. In our case, the bedding wasn’t as important as having some familiar soft toys for him to snuggle with. (Basically, his entire carry-on was taken up with these.) This worked very well and stopped the unfamiliarity of the surroundings from becoming an issue.  Those same toys illustrate the point with another tip.

 

Involve your child in the preparations. Of course, this is to the extent that is feasible for you to do so. Each toy in that carry-on was very carefully selected – by him and not by us. He was pleased to have “helped” with the packing and he had all of the right characters when he got there.

Work with your child’s strengths and interests. Actually, for this, the best illustration takes us back to the security screening at the airport.  Since he is under 12 years old, we could have asked for him not to take his shoes off. However, he actually prefers to walk around in socks without shoes. Clearly that doesn’t work in lots of situations but we were able to turn it into a game of “how cool is it to walk through a big building in your socks ?”.  Our point is that, for most people this is somewhere between an inconvenience and a real ordeal. Knowing him and his likes allowed us to make it fun.

 

Try lots of different activities. This is another “doesn’t apply” scenario. Given a huge choice of possible activities, playing in the pool was such a great hit that he wouldn’t try anything else ! This shouldn’t stop you from trying lots of things but, if you find something that really works – stop looking.

 

Get support. THIS IS BIG. No matter where you get it, support is worthwhile. This can be by vacationing with friends and family, going with a supported group or, as we did in this case, using appropriate resort staff. We were able to obtain the services of a young gentleman from the entertainment department. He had experience working with kids on the spectrum and was just a lovely, warm-hearted person. Our son took to him as a new best friend. We were able to enjoy that perfect mixture of some time to ourselves and some family time. We have tried, in the past, to do this without support and had disasters. Having support really, really works.

If you aren’t sure how to arrange the right support for your vacation, please ask us. There are a number of ways to do this so that you can have a vacation that is, well… a vacation. We just did.

A couple of weeks ago we promised that we would follow our own advice while taking a family vacation in Negril, Jamaica and report back which tips worked and which didn’t. Here, then is half of an item by item report. The second half follows, next week.

Plan and book ahead. Wow, it would be a huge shame on us if we hadn’t done this. It, of course, continues to be our strong advice that you do this. Something unexpected may happen anyway but thoughtful planning will reduce the number of unexpected events and leave you better able to deal with the ones that do arise.

Use stories (social stories) in preparation.  Our son doesn’t use stories a lot. We did use one though; to set expectations for having to finish whatever activity he was engaged upon in order to actually stop and eat meals at the proper times. This had been, very kindly, prepared by his special education teacher and it did help. If you child is helped by social stories, do use them in conjunction with your vacation.

Avoid long-term parking at the airport. We suggest getting friends or family to take you to and pick you up from the airport. They can drop you directly at the terminal and avoid that extra transition of on/off shuttle buses to the parking lot. We did this, albeit more expensively via car service, and it worked very well. This is particularly so when compared to trips where we had used long-term parking.  If taking car service, do your own math. Add parking fees, gas both ways and any tolls and compare that to the cost of the car service. The direct-to-the-door/avoid shuttle bus is well worthwhile unless car service is prohibitively more expensive.  If friends or family charge you more than either, you probably need new friends and family ! They should be your least expensive option.

 

Use a Practice Boarding Program. Since these remain scarce, we didn’t have the chance to do one. In cases like that, our advice is to do your own “dry-run” and look at as much of the layout of the departure airport as possible. Shame on us. We didn’t make time to do this and it would have helped if we had. See reasons below. So, do take a practice run whether via one of the programs or on your own.

Call the airline ahead of times to tell them about your special needs. We did this and, for half of the time, the result was superb. The customer service rep made a note in our booking record and told us that, in order to have a faster, less crowded check-in line, we could go to the business class check-in counter. Cool, huh ! Why only “half-of-the-time” ? It turns out that the rep wasn’t aware that the departure was from a refurbished terminal and that all check-in, business and coach, was only by means of self-service kiosk. Of course, if we had done the “dry-run” we would have known this in advance. Luckily, this worked out well. The kiosks were plentiful enough that lines were minimal and far apart enough that nobody felt crowded. On the return departure, we were second in line at the business class check-in. The line for coach was horrendous. Not every airline will allow you to check-in with business class but do ask. It really can help.

Call TSA Cares and ask for a Passenger Support Specialist. We did this. They said that one would be provided. In our case it didn’t quite work out. As instructed, we told the first TSA agent that we could find that we had requested a PSS. Since the security screening area was actually fairly quiet, he directed us to a nearly empty line and we sailed through. He told us that this would be a lot quicker than locating the PSS. We do, however, recommend that you still go through this step. If security is crowded, it will really help you. If you are lucky enough to find it as quiet as we did, count your blessings.

 

Ask for priority boarding. Now, we’ll add to that. Ask for priority boarding as soon as you can. Here’s what can happen. Priority boarding is arranged by the gate agent at the departure gate. If you ask for it and tell them why, they will allow you to board first, or very nearly first.  They may ask you to wait until they’ve boarded anybody in a wheelchair but, probably, will have you board ahead of business/first class passengers and holders of high level frequent flyer status. OK, so why “as-soon-as-you-can” ? On the outbound flight, our airline started priority boarding much, much sooner than we would have expected. We had it figured that we had time to grab something to eat at a quick-service restaurant and still be ready. When we asked the gate agent for priority boarding the response was, “certainly I can do that for you, we begin in 5 minutes”.  We grabbed the quickest food-to-go that we could and were back there within the 5 minutes and had plenty of time to eat on board while everybody else was fighting their way on-board.  If we hadn’t asked the gate agent as early as we did, we’d still have had something to eat but would have missed the priority boarding opportunity.

Have multiple options for dealing with pressure changes.  We always recommend that you are prepared with more than one option to help with ear discomfort when the cabin pressure changes. Having a second, and third, option really did help. Here’s how. We used EarPlanes^TM as first choice. Of course, you have to try them in advance in order to know if your child can tolerate these in their ear. Ours could and they worked well for the ascent.  We switched to headphones a little later, when the pressure had settled so that he could watch movies but we were a little too slow to get the EarPlanes^TM back in as we started the descent. We had him chew some gum in order to get over the initial discomfort and allow time for the EarPlanes^TM to start working. We found them to be good at prevention but not enough, alone, for “cure”. We didn’t need to deploy the third and fourth options but we did have them available. You should do so too. This is a predictable source of upset for many kids on the spectrum and there are plenty of available ways to be prepared.

 

Next time, we’ll look at how things worked out beyond just the flights.

While the purpose of this blog is to provide useful information to families taking vacations with their ASD child, it is even better when the content helps with everyday living. We certainly are doing that today.

You will, almost certainly, need to think about dining out while you are on vacation. It is highly probable that you would like this to be a pleasant experience at other times.

In this instance, we’ve invited a guest blogger, Connie Hammer to share some strategies. Connie is a Certified Parent Coach and the founder of Parent Coaching for Autism.  She is an excellent resource for parents in many areas and we would suggest pay a visit to www.parentcoachingforautism.com when you’ve finished reading this post.

Over to Connie:

 

Enjoy Dining Out with Your ASD Child

 

Going out to eat can be a wonderful experience when it is just you and your partner on a ‘date night out’ but when you have to dine with your children it is a different scenario entirely.  Going on a family vacation is one of those times when dining out with your children is a must – at least most of the time.

 

When you have a child with an autism spectrum disorder you may cringe at the thought of eating out in a restaurant on a daily basis. I know some parents who have avoided family vacations for that very reason until I helped them discover how a fun family respite could occur with success.

 

Here are four of the most common ‘let’s-NOT-go-on-vacation’ reasons related to eating in restaurants parents have shared with me.

 

1. Because being on the road or on vacation is a big change in routine for a child with autism who thrives in a predictable environment and going to a different place for breakfast, lunch and dinner everyday can be too much change.
2. Because restaurants can be over-stimulating to the senses and easily trigger a meltdown.
3. Because the transitions in and out of an eating establishment can be overwhelming.
4. Because it is too much work and it just isn’t any fun!

 

Allow me to address each one of these issues.

 

1 – Yes, a vacation is a big change in routine but you can create a vacation that has a basic daily routine to it in order to make it as predictable as possible for your child.

 

–          Create a visual calendar or daily schedule for your child before you leave – do this together if age appropriate. The time you take talking about the sequence of the trip, putting it down on paper – whether in writing or picture format – will help establish it in your child’ memory. Even the most basic daily schedule will make each day more predictable and lessen any anxiety that might be lurking underneath.

–          While on vacation you fill in around the basics as you decide more specifically what you will be doing the following day. Adding more details to the calendar and reviewing it each night will help your child feel even more secure.

–          Don’t forget the power of a personalized social story that can be read each night before bed, weeks before you leave. Yes, that does mean you have to plan in advance – at least one month prior to take off – but the benefits you will reap are worth it.

–          Inform and educate your child. Don’t ever assume your child can’t learn new things or adjust to new situations. Every action of everyday should be spent educating your child and answering the question, “How is what I am doing today helping my child become the person I want him to be?”

–          Practice. That’s right, ‘practice makes perfect.’ – well almost. Children learn by seeing, hearing and doing, so make sure you provide enough hands on opportunities to build muscle memory for a new skill. Have a family meal at home and practice being in a restaurant. Give each family member roles; wait person, other customers, cashier, etc and play it out!

–          Play “What If?” – While in character, present ‘what if’ situations that can be brainstormed and role-played in advance. Example: “What if they are out of what you want to order?”

–          Don’t forget about your child’s food sensitivities, allergies or intolerances. If your child needs a special diet keep that in mind when looking for a place to eat. Try to bring their menu up online and if that is not possible – call them and ask before you get there.

 

2 – Pay attention to all of your child’s sensory issues before leaving home. Be prepared to address any sensory sensitivity your child has and therefore reduce the possibility of a meltdown.

 

–          Sight: A busy restaurant may have too many visual distractions. Use sunglasses for glaring lights; ask to sit in a more secluded section such as a booth or a corner of the room; sit by a window for something different to look out of and focus on; bring a magazine to look at or book to read.

–          Sound: Don’t forget the auditory commotion that typically occurs in family restaurants. Consider noise-cancelling headphones to drown out sound; bring an iPod with ear buds that has been pre-programmed with calming music or your child’s favorites.

–          Smell: Restaurant kitchens can have some over-powering scents wafting through the dining room. We all have smells we don’t like that can trigger unusual reactions, this is even more pronounced for a child on the spectrum. A handkerchief or piece of cloth doused in your child’s favorite scent can come in handy at times like these.

–          Taste: Most children on the autism spectrum have particular tastes and are used to having things prepared a certain way. Even when you order food items you know your child likes the chef’s cooking may be different from yours.  Just in case, be prepared with some condiments that will help make the food more palatable to your child or always have nutritious fruit or snack food on hand if all else fails.

–          Touch/texture: Whether it is the hard chair, the scratchy material on the booth, the cold toilet seat, or the texture or temperature of the food – be prepared to shift gears. You can always ask to be seated elsewhere or send food back to be reheated. Bringing an item along that is soothing to your child to touch is always a good distraction to have on hand.

 

3 – Practice transitions and other known restaurant related occurrences – such as talking to other adults, using table manners, ordering food, waiting for your meal, appropriate behavior in public places, etc. This is a great real life laboratory for practicing and developing social skills. Help your child put into practice what you have been so patiently teaching her.

 

–          No surprises. Give your child advance notice that he will be going to a restaurant so he can have time to adjust to the idea. Use the time to pre-teach by reviewing the do’s and don’ts about dining out.

–          Prepare for and anticipate what to do while waiting – bring items to occupy your child or have another adult take your child for walk after ordering. If you know your child is already overwhelmed call your order in ahead, if possible?

–          Most likely your child will have to use the bathroom while there. This is the time to implement your strategies for using strange bathrooms while on vacation.

 

4 – Plan things that will make it fun! Yes, creating a relaxed and festive atmosphere does take time, energy and effort but all good outcomes require that.

 

–          Bring books, small puzzles, crayons and paper, or other small items you know your child likes to occupy her time with. Better yet, make these items special by using them just for eating out.

–          Use apps. There are a variety of apps that you can use to entertain your child if necessary. I would, although encourage you to find ways to entertain your child by interacting with her or encourage him to entertain himself. One app that will not only entertain your child but reinforce social messages about going places is the visual support app from Model Me Kids called Going Placeshttp://www.modelmekids.com/iphone-app-autism.html

–          Don’t go at the height of breakfast, lunch or dinner – choose slow times deliberately. It is difficult to have fun when there is too much stimulation and distraction around you.

–          Never dine with children when they are too hungry or too tired. If your child is too cranky – for whatever reason – your dining experience will not be enjoyable.

 

You may also want to contemplate the pros and cons of alerting the wait staff about your child’s special needs. Every parent feels different about disclosure, so consider it carefully. Using the words “disability” or “autism” can help others understand and be supportive. A good guiding question might be – “What would the benefits be right now of telling the restaurant staff my child has autism?” The answer may differ with each situation.

Also, As much as you would like some down time with your spouse you don’t want to let your guard down. Don’t get lost in conversation and pay close attention to your child’s moods and behaviors so you can stay one step ahead – anticipate, anticipate, anticipate and always have an escape plan if things aren’t going well.