An Exceptional Children's Guide to Touch: Teaching Social and Physical Boundaries to Kids 9781849058711, 1849058717

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Autism and Appropriate Touch

Abigail Werner James Illustrated by Kaiyee Tay

A Photocopiable Resource for Helping Children and Teens on the Autism Spectrum Understand the Complexities of Physical Interaction

Autism and Appropriate Touch

of related interest

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Sexuality and Relationship Education for Children and Adolescents with Autism Spectrum Disorders A Professional’s Guide to Understanding, Preventing Issues, Supporting Sexuality and Responding to Inappropriate Behaviours Davida Hartman Illustrated by Kate Brangan ISBN 978 1 84905 385 3 eISBN 978 0 85700 755 1

Teaching Theory of Mind A Curriculum for Children with High Functioning Autism, Asperger’s Syndrome, and Related Social Challenges Kirstina Ordetx ISBN 978 1 84905 897 1

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Autism and Appropriate Touch

A Photocopiable Resource for Helping Children and Teens on the Autism Spectrum Understand the Complexities of Physical Interaction

Abigail Werner James Illustrated by Kaiyee Tay

Jessica Kingsley Publishers London and Philadelphia

First published in 2015 by Jessica Kingsley Publishers 73 Collier Street London N1 9BE, UK and 400 Market Street, Suite 400 Philadelphia, PA 19106, USA www.jkp.com Copyright © Abigail Werner James 2015 Illustrations copyright © Kaiyee Tay 2015 All rights reserved. No part of this publication may be reproduced in any material form (including photocopying of any pages other than those marked with a , storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner except in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, Saffron House, 6–10 Kirby Street, London EC1N 8TS. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher. Warning: The doing of an unauthorized act in relation to a copyright work may result in both a civil claim for damages and criminal prosecution. All pages marked  may be photocopied for personal use with this program, but may not be reproduced for any other purposes without the permission of the publisher. Library of Congress Cataloging in Publication Data A CIP catalog record for this book is available from the Library of Congress British Library Cataloguing in Publication Data A CIP catalogue record for this book is available from the British Library ISBN 978 1 84905 791 2 eISBN 978 1 78450 061 0

To Eric, my husband and absolute favorite person, for always knowing what I mean without any explanation; to our beautiful babies, for their regular patience—but also for reminding me in no uncertain terms to take breaks; to Suzanne, John, Susan, and Wayne, for being supportive in more ways than I can say; and to Ashley, Andrew, Hunter, and several others who shall remain nameless—fabulous people to whom I am grateful for all they have taught me.

Acknowledgements

Thank you to Kayla Sollenberger and Luana Robinson for taking time out of their busy schedules to offer their professional opinions and provide valuable feedback. Also, I am most grateful to Emily McClave for all of her knowledge and guidance, as well as to Jessica Kingsley Publishers.

Contents

Introduction 9 How to Use This Book

13

Part 1: Introductory Lessons Lesson One: Understanding Traffic-Signal Colors and Using Them to Relate to Actions

16

Lesson Two: Identifying and Listing People According to Groups

20

Lesson Three: Introduction for the Learner to the Topic of Touch

31

Part 2: Learning about Touch with Different People-Groups Lesson Four: Physicians, Nurses, Medical Technicians, and Emergency-Helpers

36

Lesson Five: Close Family Members and Adult Friends who Are Like Family

49

Lesson Six: Younger Children

62

Lesson Seven: Peers

75

Lesson Eight: Teachers

88

Lesson Nine: More Distant Family Members and Adult Friends

101

Lesson Ten: Community Members and Strangers

114

Part 3: Follow-Up Discussions Follow-Up Discussion A: Protection from Abuse

128

Follow-Up Discussion B: Explanation of Urges to Touch Inappropriately

130

Follow-Up Discussion C: Touching Oneself

132

Follow-Up Discussion D: Proximity when Not Touching

134

Follow-Up Discussion E: Accidental Touches

135

References 136

Introduction

This resource is written for professionals and parents or guardians to assist in teaching school-aged individuals with moderate to high-functioning autism or Asperger’s diagnoses about appropriate touch. As many of us are aware, even without a spectrum disorder affecting our social abilities, it can be tough to know how much touching is acceptable within certain relationships. We may have experienced a waiter or waitress putting a hand on our shoulders for what seemed like too long while we ordered food. Or we may have had difficulty deciding whether it would be appropriate to offer a hug or just a handshake when congratulating a co-worker. Often individuals on the autism spectrum have even greater difficulty understanding the underlying social norms that many people learn without explicit teaching, due to deficits in the ability to attend to others, difficulty reading social cues—not understanding that someone glaring or taking a step back means a touch is unwanted—or a lack of processing ability to compile the information that could assist them (American Psychiatric Association, 2000). It may be a more difficult task for individuals on the spectrum to understand which people in their lives they may touch, in what settings, where on the body, and for how long (Wehman, Smith, and Schall, 2009). For example, an individual on the spectrum may mistake an adult community member who seems pleasant for someone who is akin to an immediate family member—since the level of friendliness seems the same to the individual. The individual may try to hug the community member, assuming that it would be just as appropriate to hug this friendly stranger as it would be to hug a family member with a similar personality. In the same way, individuals on the spectrum may have difficulty understanding which people may touch them. They may not even know if they are being abused. This book is intended to help provide concrete examples and visuals to help in teaching appropriate touch. While developing the ability to read others’ social cues is important, those on the spectrum may find it easier to first memorize specific examples and lists of appropriate touches as provided in this book. This topic of touch, especially when children reach reproductive age, is often

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Autism and Appropriate Touch

uncomfortable for parents, caregivers, and even professionals who may be helping the child (Steinburg, 2011); adults who are assisting those on the autism spectrum may avoid the subject altogether. However, there is great importance in spending some time with this topic. Waiting for a situation to arise where an individual has touched someone inappropriately may certainly be more embarrassing for the individual on the spectrum than talking about scenarios beforehand. Parents and professionals owe it to this population to help prevent humiliation and increase the ability to interact in a way that cultivates positive social interaction. It is also important in preventing legal consequences; while an individual on the spectrum may have innocent intentions, touching another person inappropriately can still result in someone pressing charges and at least would cause a great deal of emotional distress for all involved (Gerhardt, 2012). Additionally—and also with great importance—the individual on the spectrum needs to know how to protect himself or herself from abuse. This book gives professionals and parents a resource that may help them to be more comfortable with the topic to ensure that it isn’t neglected. While this book will help instructors address the topic concretely and give professionals and parents visual assistance, since visuals often help children with autism in comprehending topics (Bruey and Urban, 2009; Gammeltoft and Nordenhof, 2007), it would be difficult to cover every possible situation; personalizing this book is important. The guidelines in this book are only that— guidelines. Professionals and parents should adapt the material to be more or less “strict” and add specifics that are individualized based on the family’s norms, the child’s level of functioning, and unique circumstances. For example, in the section about teachers, the professional may have to explain that due to the individual’s sensory diet or physical needs, an Occupational Therapist may be doing brushing activities, or a teacher may be assisting with self-care—both touching areas of the body at a greater frequency than teachers from inclusion classrooms. Also, in the section that talks about touch with community members, a parent may have to explain that one of the librarians at the local library is a close friend of the family, and that it is therefore OK to give that librarian a hug—whereas one would not hug other librarians. As illustrated in those examples, there is considerable “gray area” in terms of touch that even those not on the spectrum experience when interacting physically with others. The difference between an appropriate touch and an inappropriate touch can sometimes be the intention behind the touch— which may be difficult for someone on the spectrum to determine. Therefore, while it may seem difficult to establish “black and white” rules, as this book aims to do, clear directives make life easier for those on the spectrum (Koegel and LaZebnik, 2004). Sometimes the guidelines discussed in this book may seem too harsh for an affectionate child. There is undeniably great developmental importance in receiving touch from the appropriate people in nurturing ways (Field et al., 1997; Heller, 1997). While it can be debated whether or not cultural norms about touch are too restrictive, if we would prefer that individuals on the spectrum abide by

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Introduction

these unspoken rules, it is important to give as many clues as possible to help the individual ascertain whether or not a touch is currently considered acceptable. The goal of this book is certainly not to reduce an individual’s desire to express physical affection, but rather to direct the affection through channels that will enhance relationships with others—and not unknowingly frighten peers or alarm strangers. It seems likely that those in the community will be more willing to figuratively embrace the individual with autism if the individual appears to understand physical boundaries—enabling interaction that is mutually beneficial. For the reason of establishing clear “rules,” it may seem that some portions of the book are obvious and that much of the content is repetitive. Some individuals may need this level of repetition and clarity to fully understand the content. Conversely, some individuals may only struggle with understanding certain aspects of touch. To accommodate a range of learners, one can adjust how much time to spend on each lesson or certain topics. For example, some individuals may understand all aspects of touch except for “length of time”—perhaps trying to give handshakes that have a duration of 20 seconds. This individual would need to spend less time with the other aspects of touch and more time discussing “length of time” examples. Some individuals may not need to complete all of the activities, but this resource can help parents and professionals review and be aware of the many aspects of touch that they need to teach individuals on the spectrum that are not often discussed. This text is not meant to teach sexuality or human anatomy, as there are other books that cover the breadth of those topics extensively. Sexuality is a much larger topic than rules about touch—and this book is not meant to be a substitute for a human sexuality textbook or a resource for explaining anatomy, functions of anatomy, or sexual development. While sexuality is a part of touch, often children on the spectrum are not touching for sexual reasons. They may simply be seeking emotional comfort or trying to interact socially at a platonic level—and they may unintentionally overstep the boundaries that are established by social norms. A teenager with autism attempting to hold hands with a librarian while walking to find a book—imitating a young child holding hands with a parent—is not sexually driven, but the touch is still inappropriate in many cultures. However, for the topic of touch to be covered in its entirety, sexuality does enter into the conversation. The idea of feeling a sexual urge to touch oneself or touch another person is addressed briefly, but this resource does not provide information on the functions of the anatomy, arousal, sexual intercourse, or similar topics. Since the learner may not yet be familiar with the correct anatomical terminology, male and female external reproductive organs and breasts are referred to as “areas that underwear or bras cover.” For individuals who are approaching a maturity level at which they are becoming interested in having a dating relationship, the professional or parent should also direct the learner to more detailed information as listed in the References section for understanding when and how touching others in a romantic relationship is acceptable. Instructors must be sensitive to the individual’s needs,

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Autism and Appropriate Touch

so that if the learner is ready for a romantic relationship, the instructor does not shame the individual’s desires, but supports a healthy awareness, and provides resources for further learning. Some individuals on the spectrum may continue to struggle with appropriate touch even after they understand touch guidelines due to difficulty regulating their impulsivity. They may require additional behavioral interventions to assist them in using their knowledge—such as using visual reminders before a touch situation and providing reinforcing items after a successful touch interaction. Additionally, individuals may struggle due to difficulties with sensory integration, possibly seeking such high levels of sensory input that they overstep touch guidelines to meet their needs. These individuals may benefit from a personalized sensory-input routine to assist in meeting their sensory needs, which could be provided by an Occupational Therapist. Finally, this book is written to align with typical social norms from the United States and is not intended to make judgments on other cultural norms. Also, the resource is not meant to persuade families that are especially tactile or restrained to change. Acceptable cultural and familial differences regarding touch are vast, and therefore the book should be adapted if a family’s norms are different from those in the book’s examples. The section that discusses the interactions between close family members is the most difficult to complete, because often the line between appropriate and inappropriate touches between close family members is thin and based on intentions. Keeping this in mind, it is important to give as many specifics about proper and improper touch scenarios as possible—so that the learner both feels empowered to protect him or herself from abuse, and is also not suddenly suspicious of well-meaning parents or caregivers.

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How to Use This Book

This book is organized into three sections: Introductory Lessons, Learning about Touch with Different People-Groups, and Follow-Up Discussions. The first three lessons provide some background on skills and concepts that will be needed to complete the main portion of the book. Lessons Four through Ten are each organized in a similar manner, repeating the same activities—with the only difference being that each lesson addresses a different group of people with whom the individual may interact. The five follow-up discussions offer ideas for navigating the topics of physical or sexual abuse, urges to touch someone inappropriately, touching oneself, proximity when not touching, and accidental touches. Prior to working through the material with the individual, photocopy the visuals provided in the lessons. Some sections offer ideas for practicing a skill with a doll, so obtaining some kind of clothed, human-like toy for role-play may be helpful. Also, since motivation will enhance the learning experience, be sure to understand the kind of reinforcement that the learner prefers. Offer reinforcement in whatever ways the learner requires to increase participation in the experience (Wehman et al., 2009), such as giving breaks with preferred toys after successful periods of attending. The first lesson should be completed before the subsequent lessons to be sure that the individual understands the concept of the colors of a traffic light correlating with “stop,” “slow down,” and “go.” These concepts will be used within the later lessons to communicate where on the body the individual may touch another person and where on the body someone may touch the individual. The second lesson—organizing the people in the child’s life according to groups—is a definite prerequisite for the rest of the book. Placing people on visual lists to make the groups more easily distinguishable is the idea around which this book is based. A parent or guardian should assist in making these lists of people that the professional or parent can then use throughout the book. Each people-group has a corresponding lesson, so it is imperative that the learner has access to these completed worksheets before beginning the lessons.

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Autism and Appropriate Touch

The third lesson is an introductory explanation to help prepare the individual for the topic ahead, providing an overview of the various factors that influence whether a touch is acceptable. Lessons Four through Ten—one for each people-group listed in Lesson Two—provide activities and visuals to help the child understand appropriate touch. The factors of “who,” “types of touch,” “where on your body,” “where on their bodies,” “setting,” and “length of time” are addressed in each lesson. These sections within each lesson build on each other, working together to help the individual develop a sense of the kinds of touches that are acceptable. A parent or guardian should be involved in either working on the process of completing the photocopiable worksheets or at least indicating whether they are accurate for the individual’s needs after completion. If a professional is working with an individual without the parents being present, it may be beneficial to photocopy entire lessons, especially the “Close Family Members and Adult Friends who Are Like Family” lesson (Lesson Five)—due to the variability in family norms—to get input about any examples that may not apply to the learner. At the end of each of these lessons, there is a “Quiz Time” box that offers questions to be sure that the individual understands the inappropriateness of touches that are relative to the section but with at least one aspect (body area, length of time, setting) that makes them “wrong.” The questions are all intended to have the answer of “no—not appropriate.” The five follow-up discussions in Appendix A to E provide some talking points about five critical issues on the topic of touch. They address what the learner should do if touched in a way that is inappropriate; how the learner may feel urges to touch others in a way this book suggests is inappropriate; touching oneself; proximity when not touching; and accidental touches. These subjects can certainly be discussed at any time if the parent or professional feels the learner would understand—or especially if the learner asks about these topics. However, it may be easier for the learner to understand the content after completing the lessons, so that the individual has some context to reference. Since the content of this book may be useful for individuals with varying levels of functioning, the wording should be adapted to best communicate the concepts with the learner. Each section of each lesson provides talking points to cover in some manner. The professional or parent knows the learner best, so using more familiar terms, repetition, pictures, photographs, or role-play when appropriate are all ways that may help convey the content to the learner. If the learner appears to be embarrassed when discussing the material, acknowledge that this topic is uncomfortable for many people—that whatever the learner is feeling is OK. Encourage the learner to express if he or she needs a break from the material. Also, convey that he or she does not need to feel guilt or shame if he or she has innocently touched someone in the past in a way that the book suggests is inappropriate—that today is a new day, and the learner can start over with what he or she now knows.

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Introductory Lessons

Part 1

Understanding Traffic-Signal Colors and Using Them to Relate to Actions

Lesson One

To enhance the transference of information about touch, each of the seven people-group lessons features several visuals that the individual can color with green, red, and occasionally yellow to correlate with the meaning of each color of a traffic light. If the learner does not have a solid understanding of what the colors of the traffic signal indicate—or if the instructor wishes to practice the idea of “stop” and “go” with a physical activity as a refresher—complete these traffic signal coloring activities before beginning the following lessons.

Traffic Signal Activity Instructions ▶▶ Photocopy the Traffic Signal worksheet from the following page. ▶▶ Instruct the learner to color the top circle red, the middle circle yellow, and the bottom circle green. ▶▶ Discuss that when a car on the road approaches a traffic signal, red means “stop,” yellow means “slow down,” and green means “go.” Then relate the colors to this activity: that red will mean “stop—do not touch,” yellow will mean “slow down, think, ask—may not be OK to touch,” and green will mean “go—OK to touch.”

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 Traffic Signal

Copyright © Abigail Werner James 2015

Autism and Appropriate Touch

Traffic Signal Color Cards After discussing the idea of colors corresponding with actions introduced in the last activity, this activity gives the learner a chance to practice not touching, touching, and thinking/asking before touching.

Activity Instructions ▶▶ Photocopy the Traffic Signal Color Cards worksheet from the following page. ▶▶ Color and cut out the rectangles—or ask the learner for assistance. ▶▶ Place or attach the colored cards around the room, attempting to put green cards on items that are OK for the learner to touch (such as something that belongs to the learner), red cards on things that are not OK for the learner to touch (such as a stove, or the teacher’s bag), and yellow cards on items that the learner should discuss with someone before touching (such as a parent’s bag, or the classroom art supplies). ▶▶ Explain to the learner that if he or she sees a red card, he or she should not touch the item; that if he or she sees a yellow card, the learner should think and ask before touching; and that if the learner sees a green card, he or she may touch the item. ▶▶ Walk around the room with the individual, pointing out colored cards if needed, and assist in processing how to handle each item with a color. This activity may assist the individual in better understanding how the body visuals in the following lessons communicate where on the body one may touch and where one may not touch.

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 Traffic Signal Color Cards

Red

Red

Red

Red

Red

Yellow

Yellow

Yellow

Yellow

Yellow

Green

Green

Green

Green

Green

Copyright © Abigail Werner James 2015

Identifying and Listing People According to Groups

Lesson Two

This activity, on which the rest of the book relies, is for a parent or guardian to assist the individual in making lists of people with whom the individual comes into contact. While a professional may be able to assist with these lists, a parent or guardian is likely to be the only one with the knowledge about who to include. These lists can be completed on photocopies of the Organizing People into Groups worksheets provided at the end of this lesson. This allows professionals who are not serving in a role where they are able to be physically present with parents to send the sheets home with the student with instructions for parents about how to complete the lists. These lists can use words alone or, to assist the learner, can also include attached photos of the people listed. This activity is important because it will help the individual to understand how, when, where, and for how long it is appropriate to touch or be touched by those in each of these groups, since appropriate touches differ greatly between people-groups. The later activities will help explain the appropriate kinds of touches that can be exchanged between the individual and a person in each group, and the learner can look at each people-group list while completing the activities. While there can be gray areas about who belongs in which group, the following pages give some ideas about how to organize people. These guidelines should also be photocopied for parents or guardians.

Activity Instructions ▶▶ Photocopy the Descriptions of Different People-Groups guidelines for parents or guardians to assist the learner in creating the lists as outlined. ▶▶ Photocopy the Organizing People into Groups worksheet for each peoplegroup to assist parents or guardians in making these lists. ▶▶ Indicate to parents or guardians whether the learner’s lists should include photos (if possible) in addition to written words.

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Lesson Two: Identifying and Listing People According to Groups

▶▶ After completing or obtaining completed copies of the learner’s people-group worksheets, set them aside for later. In Part 2 there is a lesson dedicated to each of the people-groups featured in the worksheets. Note: While numerous categories may be helpful for higher-functioning individuals, if the parent or professional feels that the learner will not be able to comprehend this number of categories, one can adapt the material to have fewer categories. For example, there could be a “Close Family Members” category for the mother, father, and grandparent, and then a “Community Members” category for everyone else, with exceptions noted for people such as an Occupational Therapist. This would allow the parent or professional to communicate to the learner that more permissive touching, such as hugging and kissing on the cheek, is only allowed with the mother, father, and grandparent, and that for everyone else, the individual should only shake hands. This may help the parent or professional to be sure that the individual knows where to seek physical affection without accidentally touching someone in a way that is inappropriate—making the guidelines more rigid, but also clearer.

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 Descriptions of Different People-Groups Physicians, Nurses, Medical Technicians, and Emergency-Helpers should include any doctor or nurse who the individual knows by name as well as the titles of generic positions or generic pictures of those in the medical field. Close Family Members and Adult Friends who Are Like Family should include any trusted adult who plays a caregiving role or who the parent or guardian views as being emotionally nearly as close as a trustworthy parent. This list may range from including only one parent or guardian, to including many people—both parents, older siblings, cousins, grandparents, aunts, uncles, personal-care helpers, or family friends who are emotionally close and trusted by the parent completing the list. If a family is very physically affectionate with extended family members, there may be more people on the list. If a family is not as physically affectionate, there may be fewer people listed. It may be helpful for the parent and professional to view Lesson Five while compiling the list to better ascertain who to include based on the kinds of touches that are discussed as appropriate. Younger Children should include the names of younger children— approximately four years old or younger—with whom the individual comes into contact. The age of four is based on the idea that it is often after that age that most children can toilet with more independence. This is not to say that children beyond age four suddenly require less physical touch—but rather that it may help individuals on the spectrum to understand that around this age, some of the physical interactions that were acceptable with babies and toddlers are no longer appropriate. This list may include siblings, cousins, neighbors, or children of family friends. Peers should include the names of children around the same age as the individual with whom the individual interacts. This list may include peers from school, religious activities, neighbors, or clubs. This list may say “kids from school,” if names are not known. Teachers should include the names of teachers or coaches with whom the individual interacts at school or after-school clubs, as well as helpers or other professionals who may help the individual at home, in the community, or at school.

Copyright © Abigail Werner James 2015

 More Distant Family Members and Adult Friends should include the names of family members and family friends with whom the individual’s relationship is similar to that of an acquaintance—friendly, but not as emotionally close or trusted as a “close” family member. This list may include grandparents, aunts, uncles, neighbors, or other adult friends. Friends who are older than the individual —not peers—should be included as well. Community Members and Strangers should include the names or the job titles of those community members with whom the individual comes into contact. This list may include waitresses, mail carriers, store clerks, librarians, bus drivers, etc. Include actual or generic pictures of community helpers, as well as pictures of people the individual does not know to represent strangers. While it may seem odd at first that community members with whom the individual may be familiar are in the same list as “strangers,” this is an opportunity to talk with the individual about how they are similar; just because one is accustomed to seeing the same smiling person deliver the mail every day does not mean that the mail carrier is a friend. One can discuss how familiarity with seeing a person does not mean that the individual knows the person well. If, for example, the mail carrier is in fact a friend, he or she should be listed in the “More Distant Family Members and Adult Friends” list. Strangers of any age may be included.

Copyright © Abigail Werner James 2015

 Organizing People into Groups: Physicians, Nurses, Medical Technicians, and Emergency-Helpers

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 Organizing People into Groups: Close Family Members and Adult Friends who Are Like Family

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 Organizing People into Groups: Younger Children

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 Organizing People into Groups: Peers

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 Organizing People into Groups: Teachers

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 Organizing People into Groups: Community Members and Strangers

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Copyright © Abigail Werner James 2015

Introduction for the Learner to the Topic of Touch

Lesson Three

This activity is an introduction for the learner to the topic of touch. It explains different types of touch and provides a brief overview of the factors that influence touch. The instructor should adapt the activity to be more or less thorough based on the learner’s understanding of the concepts.

Variables Affecting Touch Discussion Communicate to the child that touching other people and being touched by other people is sometimes OK and sometimes not OK. Explain why touching is sometimes OK and sometimes not OK—that there are certain variables that determine whether or not a touch is OK. Convey that factors which affect whether a touch is OK will be discussed later in the book. List the factors: ▶▶ Who ▶▶ Types of Touch ▶▶ Where on Your Body ▶▶ Where on Their Bodies ▶▶ Setting ▶▶ Length of Time.

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Autism and Appropriate Touch

Activity Instructions ▶▶ Obtain a doll that is dressed and looks similar to an actual human. ▶▶ Model or provide examples for each of these variables. For example, point to a person while pointing to the word “who”; demonstrate patting the doll on the head or giving a high five while pointing to the words “Types of Touch”; point to a part of the learner’s body while pointing to the words “where on your body”; point to a part of the doll’s body while pointing to the words “where on their bodies”; offer ideas about setting by gesturing to pictures of various settings in books or in the actual environment surrounding the learner while pointing to the word “setting”; model counting to three while shaking the doll’s hand while pointing to the words “length of time.” ▶▶ Ask the learner to use the doll to give examples to check for understanding of common types of touch, such as handshake, hug, kiss, and tickle using a toy doll, being sure that the learner understands the differences between touches. For example, ensure that the individual understands and can demonstrate the difference between “patting” and “petting”—that patting is similar to tapping and an appropriate way to gain attention, while petting is a term used for stroking an animal and would not be used to interact with other humans at this level of development.

Some Rules Change with Age, and Some Rules Stay the Same Discussion Following the activity, explain how touching changes as we age. For example, babies need to be held and hugged frequently to help them feel safe, but as one grows up, the rules about touching change. Discuss that tickling is often more appropriate for younger children; while it may have been fine for a close neighbor, for example, to tickle the individual’s stomach when he or she was three years old, he or she may now be too old to be tickled by the neighbor. Explain that, in addition to that fact that touching changes based on age, touching also changes when one enters a romantic relationship. Give examples of older people the child may see engaging in romantic touches that—while possibly not appropriate for the child at this point in life—may at some point become very appropriate. Communicate that it is OK if the child is not sure what the rules about touching are—that it can be difficult to figure out. Talk about the fact that while it can be difficult to analyze the situation to know whether or not a touch is appropriate, the following rules do not require the individual to use the factors listed earlier—that these rules apply to all individuals, whether dating or not. Teach these rules:

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Lesson Three: Introduction for the Learner to the Topic of Touch

Rules about Touch that Always Apply ▶▶ The individual is in charge of his or her own body and should communicate “stop” to anyone he or she does not want to touch him or her. ▶▶ The individual does not have to engage in any type of touch if he or she does not feel comfortable. ▶▶ Hitting, biting, or any kind of touch that is a result of frustration is not acceptable, unless the touch is to defend himself or herself.

Communicate that, in addition to the “always” rules, there are more rules that apply to those who are not yet ready for a romantic relationship. Teach these rules to individuals who are not ready for dating:

Rules about Touch for Those who Are Not in a Dating Relationship ▶▶ No one should expose a part of his or her body that underwear or bras cover in the individual’s presence for the purpose of showing the individual. ▶▶ No one should touch the individual with a part of the body that underwear or bras normally cover if the part is not covered by clothing. ▶▶ The individual should never deliberately expose a part of his or her body that underwear or bras cover and purposefully make that part of the body touch another person. ▶▶ Tongues should never be used to touch the individual in any area. ▶▶ The individual should never use his or her tongue to touch another person.

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Learning about Touch with Different People-Groups

Part 2

Physicians, Nurses, Medical Technicians, and Emergency-Helpers

Lesson Four

This lesson focuses on the interaction between the individual and physicians, nurses, medical technicians, and emergency-helpers. Begin by showing the learner the list of physicians, nurses, medical technicians, and emergency-helpers that was developed in Lesson Two. Keep this list visible and available for the learner to reference throughout this lesson to enhance comprehension.

Who This first section assists the learner in understanding how the factor of “who” influences whether touch is appropriate or inappropriate. This means: with whom is the individual interacting?

Activity Instructions ▶▶ Direct the individual to look at the “Physicians, Nurses, Medical Technicians, and Emergency-Helpers” list made in Lesson Two and explain that the “who” in this lesson refers to these people. ▶▶ Discuss the people on this list to check for recognition. ▶▶ Give visual examples with generic pictures of physicians, nurses, medical technicians, and emergency-helpers if needed. ▶▶ Explain that there are many different kinds of doctors and medical technicians, offering types the individual may encounter. Communicate that different kinds of people could be emergency-helpers, such as a doctor or nurse, firefighter, police officer, family member, or even a different person from the community who is trying to help save one’s life during a time of danger or disaster.

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Lesson Four: Physicians, Nurses, Medical Technicians, and Emergency-Helpers

Types of Touch This section assists the learner in understanding how the “Types of Touch” play a role in determining whether a touch is appropriate or inappropriate. “Types of Touch” means: how is the person touching? This factor is divided into “receiving” and “giving” touches, since the touch interaction between a doctor and patient should not be reciprocal.

Discussion Explain that the “Types of Touch” in this lesson will refer to how physicians, nurses, medical technicians, and emergency-helpers may touch the individual, and how the individual may touch physicians, nurses, medical technicians, and emergency-helpers.

Receiving Touches from Physicians, Nurses, Medical Technicians, and Emergency-Helpers Explain that physicians, nurses, medical technicians, and emergency-helpers may touch the individual in various ways to try to solve a medical problem, gain attention, demonstrate care, or assist with needs. They may push down on parts of the individual’s body, touch parts of the individual’s body with a hand or medical tool, and may need to reach under an individual’s clothing during certain parts of an examination. Physicians, nurses, medical technicians, and emergency-helpers may touch to gain attention by patting or tapping the individual. They may touch to demonstrate care by offering a handshake or pat on the back. They may need to assist the individual with needs by moving, lifting, or holding on to the individual. Nurses may need to assist an individual with using the toilet or shower if he or she is hurt and in the hospital. Emergency-helpers may need to touch to assist with needs by holding one’s body or lifting to help one out of a dangerous situation during a fire, car accident, or similar incident. They may need to touch to assist with needs by performing emergency first aid, ranging from acts such as wrapping a wound to compressing one’s abdomen to dislodge food. Touch interaction with an emergency-helper does not occur very often—and may never happen to the learner. Physicians, nurses, medical technicians, and emergency-helpers will usually tell one how they are going to touch and what one will feel before it happens. The individual can tell a physician, nurse, medical technician, or emergencyhelper if the touch hurts, but sometimes medically necessary touches need to hurt for a short time. The learner can ask his or her mom or dad to be in the room when the physician, nurse, medical technician, or emergency-helper is touching if it helps him or her feel more comfortable. If the learner is a girl, a female nurse should be in the room with her if a male physician, nurse, or medical technician needs to touch a part of the body that underwear or bras cover. Physicians, nurses, medical technicians, and emergency-helpers should never

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Autism and Appropriate Touch

kiss the individual and should never ask the individual to sit on his or her lap unless necessary for the emergency. Any touch that a physician, nurse, medical technician, or emergency-helper tells the individual not to tell anyone about is not acceptable. Physicians, nurses, medical technicians, and emergency-helpers should never touch the individual in areas that bras or underwear cover for reasons other than medical concerns.

Touching Physicians, Nurses, Medical Technicians, and Emergency-Helpers Explain that the individual may touch a doctor, nurse, medical technician or emergency-helper to gain attention, demonstrate caring, and seek assistance. The individual may touch a doctor, nurse, medical technician, or emergency-helper to gain attention by patting or tapping. He or she may touch to demonstrate caring by offering a handshake. The individual may touch an emergency-helper by leaning, holding on to, or putting an arm around to seek assistance. Remind the learner that anyone can become an emergency-helper when the individual is in danger. The individual should never kiss, tickle, or massage a doctor, nurse, medical technician, or emergency-helper. The learner should never try to remove clothing from a doctor, nurse, medical technician, or emergency-helper. He or she should never try to hurt a doctor, nurse, medical technician, or emergency-helper, unless the touch is to defend himself or herself. The individual should never touch a doctor, nurse, medical technician, or emergency-helper in areas that underwear or bras cover.

Activity Instructions ▶▶ Photocopy the Types of Touch for Physicians, Nurses, Medical Technicians, and Emergency-Helpers worksheet from the following page. ▶▶ With the learner, complete the worksheet, making a written list, adding photos, or drawing pictures of appropriate and inappropriate touches that may occur between the individual and a doctor, nurse, medical technician, or emergency-helper. ▶▶ After making the lists on each portion of the chart, direct the individual to use a crayon to lightly shade the side with appropriate touches in green and the side with inappropriate touches in red to reinforce the “go” and “stop” concept.

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 Types of Touch for Physicians, Nurses, Medical Technicians, and Emergency-Helpers Ways it is OK for a physician, nurse, medical technician, or emergency-helper to touch me: 1. Example: touching stethoscope to chest to listen to heartbeat

2. 3. 4. Ways it is NOT OK for a physician, nurse, medical technician, or emergencyhelper to touch me: 1. Example: kissing

2. 3. 4.

Copyright © Abigail Werner James 2015



Ways it is OK for me to touch a physician, nurse, medical technician, or emergency-helper: 1. Example: shaking hands when doctor holds out hand

2. 3. 4. Ways it is NOT OK for me to touch a physician, nurse, medical technician, or emergency-helper: 1. Example: tickling

2. 3. 4.

Copyright © Abigail Werner James 2015

Lesson Four: Physicians, Nurses, Medical Technicians, and Emergency-Helpers

Where on Your Body This section assists the learner in identifying the places on the body that a physician, nurse, medical technician, or emergency-helper may touch the learner for the types of touch discussed previously in this lesson.

Discussion Explain that “where on your body” in this lesson refers to where on the individual’s body physicians, nurses, medical technicians, and emergency-helpers may touch the individual. A physician, nurse, medical technician, or emergency-helper may need to touch all areas of one’s body if there is a medical problem or one needs a checkup. Convey that “where on your body” sometimes varies depending on the type of touch. For example, a nurse would only touch areas that underwear or bras cover for a medical reason, not to demonstrate care. During an emergency, the goal of an emergency-helper is to make sure the individual is safe, and the adult may have to touch all parts of the body. Physicians, nurses, medical technicians, and emergency-helpers are the only people who are allowed to touch all areas of the body (unless the individual requires physical assistance for self-care, which will be discussed later).

Activity Instructions ▶▶ Photocopy the body outline given in the next worksheet—making two copies to represent both a front and a back that can be glued together. ▶▶ Explain that this body represents the learner’s body when interacting with a physician, nurse, medical technician, or emergency-helper. If available, glue a picture of the individual’s face onto the body, so that it is clear that the picture represents the individual. ▶▶ Direct the individual to color the entire body outline green. Explain that green does not mean that it is acceptable for a physician to be touching that part without good reason or constantly—but rather that the area is acceptable for the Types of Touch listed previously in this lesson.

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 Individual’s Body when with a Physician, Nurse, Medical Technician, or Emergency-Helper

Copyright © Abigail Werner James 2015

Lesson Four: Physicians, Nurses, Medical Technicians, and Emergency-Helpers

Where on Their Bodies This section assists the learner in identifying the areas of the body of a physician, nurse, medical technician, or emergency-helper that the learner may touch for the types of touch discussed earlier in this lesson.

Discussion Explain that “where on their bodies” in this lesson refers to where on physicians’, nurses’, medical technicians’, and emergency-helpers’ bodies the individual may touch. The individual may touch doctors, nurses, medical technicians, and emergency-helpers on the hands, arms, shoulders, or upper back under normal circumstances. The individual may touch other areas on the emergency-helper’s body during an extreme emergency that would require holding on to someone anywhere possible—but since that is unlikely, the individual should understand that generally he or she should not touch any other places on their bodies.

Activity Instructions ▶▶ Photocopy the body outline given in the next worksheet—making two copies to represent both a front and a back that can be glued together. ▶▶ Explain that this body represents the body of the doctor, nurse, medical technician, or emergency helper when interacting with the learner. If available, glue on a picture of a doctor or nurse with whom the individual is familiar. ▶▶ Direct the individual to color the hands, arms, shoulders, and upper back with green. Explain that green does not mean that it is acceptable to be touching that part without good reason or constantly—but rather that the area is acceptable for the Types of Touch listed previously in this lesson. ▶▶ Direct the individual to color the rest of the body red.

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 Body of Physician, Nurse, Medical Technician, or Emergency-Helper

Copyright © Abigail Werner James 2015

Lesson Four: Physicians, Nurses, Medical Technicians, and Emergency-Helpers

Setting This section assists the learner in understanding how the factor of “setting” influences whether or not a touch is appropriate or inappropriate.

Discussion Explain that “setting” in this lesson refers to places or locations where one is standing, sitting, or lying down when in the presence of a physician, nurse, medical technician, or emergency-helper. A physician, nurse, medical technician, or emergency-helper may offer certain touches, such as a handshake or pat on the back in numerous settings. Certain settings such as a closet, a shower (unless assistance is necessary), a bathroom stall (unless assistance is necessary), or any setting in which the physician, nurse, medical technician, or emergency-helper tells the individual not to tell anyone about the touch are not acceptable settings for touching. Some settings may sometimes be appropriate and sometimes inappropriate, depending on the touch. If a physician, nurse, medical technician, or emergencyhelper is touching the individual on areas of the body that underwear or bras cover, the individual should be in a hospital’s exam room, in a doctor’s office exam room, in another medical building’s exam room, in an ambulance, or at the scene of an emergency. Not all of the possible settings are covered in this worksheet, so explain about other settings that may be pertinent to the learner.

Activity Instructions ▶▶ Photocopy the Settings for Physicians, Nurses, Medical Technicians, or Emergency-Helpers worksheet from the following page. ▶▶ Direct the learner to color or shade using green the settings in which it would be OK for a physician, nurse, medical technician, or emergency-helper to touch the individual’s body. ▶▶ Direct the learner to color or shade with red the settings where it would not be OK. If there are settings where limited touching would be acceptable, discuss exactly what kinds of touch would be OK.

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 Settings for Physicians, Nurses, Medical Technicians, or Emergency-Helpers

Medical Examination Room

Fire

Library

Car Accident

Copyright © Abigail Werner James 2015

Lesson Four: Physicians, Nurses, Medical Technicians, and Emergency-Helpers

Length of Time This section assists the learner in understanding how the duration of touches plays a role in determining whether a touch is appropriate or inappropriate. The section is divided into “receiving” and “giving,” since touch between a doctor and the individual should not be reciprocal.

Discussion Explain that “length of time” in this lesson refers to how long the touches should last between the individual and a physician, nurse, or medical technician.

Receiving a Touch from a Physician, Nurse, Medical Technician, or Emergency-Helper Explain that touches from a doctor, nurse, or medical technician to gain attention or demonstrate care by offering a handshake or pat will last one to two seconds. Touches from a doctor, nurse, or medical technician during a medical exam will usually only last two to five seconds at a time. The touches may be repeated in various areas. If medical testing needs to be done by a doctor, nurse or medical technician, the person may be touching a part of the individual’s body for several minutes or even longer. The medical worker should tell the individual why the longer touch is needed and how long it will take. The individual should ask the physician, nurse, or medical technician if the individual has questions about how long the procedure will take. Lengths of touch from an emergency-helper at the scene of an emergency may vary from several seconds to longer amounts of time, depending on the situation.

Touching a Physician, Nurse, Medical Technician, or Emergency-Helper Explain that touches that the individual gives to physicians, nurses, or medical technicians by shaking hands when arriving or touching the arm or shoulder to gain attention should last one to two seconds. If the individual touches a physician, nurse, medical technician, or emergency-helper for physical stability, the length of time could last several seconds to several minutes. The length of time between touches is also important to consider. For example, the individual does not need to offer another handshake if he or she already shook hands with that person.

Activity Instructions ▶▶ Obtain a doll that is dressed and looks similar to an actual human. If helpful, attach a picture of a familiar physician’s face to cover the doll’s face.

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Autism and Appropriate Touch

▶▶ Model and prompt the individual to offer a handshake to the doll that lasts the appropriate amount of time.

Checking for Understanding This final section in this lesson gives the learner a chance to put together pieces of information to determine whether or not a novel situation would be appropriate or inappropriate in terms of touch.

Activity Instructions ▶▶ Take some time to review the material covered with the learner in this lesson. ▶▶ Read aloud the following “Quiz Time” examples and discuss, using visuals if needed. The answer to all questions should be, “No, not OK.” ▶▶ If the learner requires more practice, review the material again, and offer other situational examples.

Quiz Time ▶▶ Would it be OK for a doctor to touch your stomach in a grocery store if you are not hurt? ▶▶ Would it be OK for a person serving food in a hospital cafeteria to touch a part of your body that underwear covers? ▶▶ Would it be OK for a doctor in an exam room to keep his or her hand on your chest for several minutes without telling you why it is necessary? ▶▶ Would it be OK for you to try to shake a doctor’s hand seven times while the doctor talks with you?

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Close Family Members and Adult Friends who Are Like Family

Lesson Five

This lesson focuses on the interaction between the individual and close family members or adult friends who are like family. Begin by showing the learner the list of close family members and adult friends who are like family that was developed in Lesson Two. Keep this list visible and available for the learner to reference throughout this lesson to enhance comprehension.

Who This first section assists the learner in understanding how the factor of “who” influences whether touch is appropriate or inappropriate. This means: with whom is the individual interacting?

Activity Instructions ▶▶ Direct the individual to look at the “Close Family Members and Adult Friends who Are Like Family” list made in Lesson Two, and explain that the “who” in this lesson refers to these people. ▶▶ Discuss the people on this list to check for recognition. ▶▶ Give visual examples with pictures of these people if needed. ▶▶ Explain that for this lesson, “close” means “emotionally close” and “familiar”— that the people in this section are those who the individual’s mom, dad, or caregiver trust; those with whom the individual feels comfortable; and those whom the individual is likely to see often. Other family members may be listed later in the “More Distant Family Members and Adult Friends” section. Some families touch more frequently and for longer amounts of time than others, so together with parent or caregiver instruction, the professional can let the individual know what is OK in his or her family if the individual is ever unsure. 49

Autism and Appropriate Touch

Types of Touch This section assists the learner in understanding how “Types of Touch” play a role in determining whether a touch is appropriate or inappropriate. “Types of Touch” means: how is the person touching? This factor is divided into “receiving” and “giving” touches, since the touch interaction between a close family member and the individual may not be reciprocal if the learner still requires certain kinds of assistance.

Discussion Explain that the “Types of Touch” in this lesson will refer to how close family members or adult friends who are like family may touch the individual and how the individual may touch close family members or adult friends who are like family.

Receiving Touches from Close Family Members and Adult Friends who Are Like Family Explain that close family members and adult friends who are like family are likely to touch the individual’s body in various ways to gain attention, demonstrate caring, and assist with needs. “Close people” may touch for gaining attention by patting or tapping the individual. They may touch to demonstrate they care by giving hugs, kisses, tickles, pats, and massages. They may touch to assist with needs. These touches vary greatly depending on age and ability, so adapt this for the learner. Some may include brushing his or her hair, tying a shoe, closing a zipper/button/necklace that fastens at the back, putting sunscreen on his or her face, or holding a hand when crossing a street. If the individual requires assistance with bathing or toileting, discuss this as another kind of touch to assist with needs. If clothing is covering a part of the learner’s body, “close people” should generally not move clothing aside to touch areas under the clothing unless the individual is hurt under the clothing. For example, if he or she is badly hurt, a parent may have to look at a part of the body that clothing would normally cover to see if he or she needs to go to a hospital. However, if the individual is wearing shorts, a close family member should not reach under the shorts during a time of play. While a young child may sit on a close family member’s lap frequently, teenagers often stop sitting on anyone’s lap in many families—so unless sitting on laps is a norm for everyone in a family, this would not be an acceptable touch. Close family members and adult friends who are like family should never try to remove the individual’s clothing unless the individual is asking for help with a piece of clothing that is stuck. Any touch that a family member or adult friend who is like family tells the individual not to tell anyone about is not acceptable. “Close people” should never try to hurt the individual with a touch, and they

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Lesson Five: Close Family Members and Adult Friends who Are Like Family

should never touch the individual in areas that underwear or bras cover (with the exception of toileting help if necessary).

Touching Close Family Members and Adult Friends who Are Like Family Explain that the individual may touch close family members or adult friends who are like family to gain attention and demonstrate caring in similar ways to how these people touch the individual for those reasons. The individual may touch close family members or adult friends who are like family to gain attention, such as by patting or tapping the person. The individual may touch them to demonstrate caring, such as by giving hugs and kisses, holding hands, or putting an arm around the person. Touching for assisting with needs may be different, because unless the caregiver has some kind of physical limitation, the individual will probably not need to touch “close people” to assist with safety or grooming needs. The individual should never try to remove clothing from a close family member or adult friend who is like family unless the person has asked the individual for help with a piece of clothing that is stuck. Stress that if the individual assists with removing this piece of clothing, it should not result in the other person being in underwear or naked—unless it is the family’s norm to wear underwear in front of others. The individual should never try to hurt a “close person” with a touch, unless the touch is to defend oneself. The individual should never touch a close family member or adult friend who is like family in areas that bras or underwear cover.

Activity Instructions ▶▶ Photocopy the Types of Touch for Close Family Members and Adult Friends who Are Like Family worksheet from the following page. ▶▶ With the learner, complete the worksheet, making a written list, adding photos, or drawing pictures of appropriate and inappropriate touches that may occur between the individual and a close family member or adult friend who is like family. ▶▶ After making the lists on each portion of the chart, direct the individual to use a crayon to lightly shade the side with appropriate touches in green and the side with inappropriate touches in red to reinforce the “go” and “stop” concept.

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 Types of Touch for Close Family Members and Adult Friends who are Like Family Ways it is OK for close family members or adult friends who are like family to touch me: 1. Example: hugging

2. 3. 4. Ways it is NOT OK for close family members or adult friends who are like family to touch me: 1. Example: tickling an area that underwear covers

2. 3. 4.

Copyright © Abigail Werner James 2015



Ways it is OK for me to touch close family members or adult friends who are like family: 1. Example: kissing

2. 3. 4. Ways it is NOT OK for me to touch close family members or adult friends who are like family: 1. Example: hitting

2. 3. 4.

Copyright © Abigail Werner James 2015

Autism and Appropriate Touch

Where on Your Body This section assists the learner in identifying the places on the body that a close family member or adult friend who is like family may touch the learner for the types of touch discussed previously in this lesson.

Discussion Explain that “where on your body” in this lesson refers to where on the individual’s body a close family member or adult friend who is like family may touch the individual. A close family member or adult friend who is like family may at times touch all areas of the body for the Types of Touch listed previously in this lesson, except for the areas of the body that underwear or bras cover and slightly past those areas. If the individual has some sort of physical disorder or injury that makes him or her unable to bathe or toilet independently, that is the only time a close family member or adult friend who is like family should be touching areas that underwear or bras cover—for the purpose of wiping or cleaning. Convey that “where on your body” sometimes varies depending on the type of touch, especially for older children and teens. For example, a parent may massage the individual’s shoulders as a way to express caring, or a parent may massage an individual’s lower leg if the individual has a leg cramp, but the parent would not be likely to massage an individual’s upper thigh to express caring. In the same way, a parent may kiss an older individual on the cheek or head, but a parent would not be likely to kiss a teenager’s stomach. Offer any other examples that may assist the learner in understanding. In some families, members kiss on the lips; in others, they do not. Assist the individual in understanding his or her own family’s norms about kiss placement.

Activity Instructions ▶▶ Photocopy the body outline given in the next worksheet—making two copies to represent both a front and a back that can be glued together. ▶▶ Explain that this body represents the learner’s body when interacting with a close family member or adult friend who is like family. If available, glue a picture of the individual’s face onto the body, so that it is clear that the picture represents the individual. ▶▶ Direct the individual to color the body green, except for the areas that underwear and bras cover, and slightly past underwear areas (inner thighs). Explain that green does not mean that it is acceptable to be touching that part without good reason or constantly—but rather that the area is acceptable for the Types of Touch listed previously. Direct the individual to color the areas that underwear and bras cover, and slightly past underwear areas (inner thighs) in red (unless the individual requires physical assistance with bathing and toileting, in which case those areas could be colored yellow).

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 Individual’s Body when with Close Family Members or Adult Friends who Are Like Family

Copyright © Abigail Werner James 2015

Autism and Appropriate Touch

Where on Their Bodies This section assists the learner in identifying the areas of the body of a close family member or adult friend who is like family that the learner may touch for the types of touch discussed previously in this lesson.

Discussion Explain that “where on their bodies” in this lesson refers to where on close family members’ or adult friends who are like family members’ bodies the individual may touch. The individual may touch close family members or adult friends who are like family on all areas of the body except the areas that underwear or bras cover and slightly past those areas. Convey that “where on their bodies” sometimes varies depending on the type of touch.

Activity Instructions ▶▶ Photocopy the body outline given in the next worksheet—making two copies to represent both a front and a back that can be glued together. ▶▶ Explain that this body represents the body of a close family member or adult friend who is like family when interacting with the learner. If available, glue on a picture of a close family member’s face, so that it is clear that the picture represents a close family member. ▶▶ Direct the individual to color the body green, except for the areas that underwear and bras cover, and slightly past underwear areas. Explain that green does not mean that it is acceptable to be touching that part without good reason or constantly—but rather that the area is acceptable for the Types of Touch listed previously in this lesson. ▶▶ Direct the individual to color the areas that underwear and bras cover, and slightly past underwear areas (inner thighs) in red.

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 Body of Close Family Member or Adult Friend who Is Like Family

Copyright © Abigail Werner James 2015

Autism and Appropriate Touch

Setting This section assists the learner in understanding how the factor of “setting” influences whether or not a touch is appropriate or inappropriate.

Discussion Explain that “setting” in this lesson refers to places or locations where one is standing, sitting, or lying down when in the presence of a close family member or adult friend who is like family. Close family members or adult friends who are like family may offer certain touches, such as a hug or kiss, in numerous settings, but there are certain settings that may not be acceptable. Settings such as a closet, a shower (unless assistance is necessary), a bathroom stall (unless assistance is necessary), under the covers in bed (depending on the individual’s age), or any setting in which the close family member or adult friend who is like family tells the individual not to tell anyone about the touch are not acceptable settings for touching. Some settings may sometimes be appropriate and sometimes inappropriate, depending on the touch. For example, a dark room in the middle of the night would be an appropriate setting to hug if the individual has had a nightmare and asks a parent for a hug; a dark room in the middle of the night may be an inappropriate setting for a parent to come uninvited into a teenager’s bed and kiss the individual repeatedly under the covers. Not all of the possible settings are covered in this worksheet, so explain about other settings that may be pertinent to the learner.

Activity Instructions ▶▶ Photocopy the Settings for Close Family Members or Adult Friends who Are Like Family worksheet from the following page. ▶▶ Direct the learner to color or shade using green the settings in which it would be OK for a close family member or adult friend who is like family to touch the individual’s body. ▶▶ Direct the learner to color or shade with red the places where it would not be OK. If there are settings where limited touching would be acceptable, discuss exactly what kinds of touch would be OK.

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 Settings for Close Family Members or Adult Friends who Are Like Family

Closet

Neighborhood Sidewalk

Shower

Living Room

Copyright © Abigail Werner James 2015

Autism and Appropriate Touch

Length of Time This section assists the learner in understanding how the duration of touches plays a role in determining whether a touch is appropriate or inappropriate. This section is not divided into “receiving” and “giving,” since the length of time touches last between the individual and a close family member or adult friend who is like family is likely to be similar—although some kinds of touches discussed would not be reciprocal.

Discussion Explain that “length of time” in this lesson refers to how long the touches should last between the individual and close family members or adult friends who are like family. Touches between the individual and a close family member or adult friend who is like family to gain attention or demonstrate care, such as hugging or tickling, will usually last for a few seconds, unless a person asks to be hugged or tickled longer. There may be times when a “close person” could touch the individual for longer amounts of time if the individual asks, such as if the individual is sad and wants a hug that lasts several minutes. Touches between the individual and a close family member or adult friend who is like family to demonstrate care, such as putting an arm around or holding hands, during certain tasks, such as watching a movie or taking a walk together, may last for several minutes or longer. Kisses would usually last for one or two seconds. Touches from a “close person” to assist with self-care needs, such as if the individual needs help toileting or showering, should last one to three seconds per touch for the purpose of wiping or cleaning and may be repeated several times until the task is complete. Touches from a close family member or adult friend who is like family to assist with grooming needs, such as brushing hair, may last several minutes until the task is complete. Touches from a close family member or adult friend who is like family to assist with checking an injury may last a few seconds at a time and may be repeated several times. The length of time between these touches is often important to consider, both in giving and receiving. For example, many families may hug or kiss when waking up in the morning, when departing or arriving somewhere, when congratulating or praising for even the smallest accomplishment or quality, when consoling after distress, and when going to bed at night. While variability is acceptable due to family norms, a close family member or close friend is not likely to try to be hugging or kissing at a frequency that far exceeds what occurs for these functions with older children. Adapt this for the learner’s situation according to the family’s preferences. Similarly, while it may be acceptable for a child to ask a parent for a hug one time while waiting in line at the grocery store, it may be unacceptable to ask for a hug every few seconds while waiting in line.

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Lesson Five: Close Family Members and Adult Friends who Are Like Family

Activity Instructions ▶▶ Obtain a doll that is dressed and looks similar to an actual human. If helpful, attach a picture of a close family member. ▶▶ Model offering the doll a kiss that lasts two seconds while counting, and prompt the learner to imitate offering the doll a kiss that lasts an appropriate amount of time for kissing a close family member or adult friend who is like family to demonstrate care.

Checking for Understanding This final section in this lesson gives the learner a chance to put together pieces of information to determine whether or not a novel situation would be appropriate or inappropriate in terms of touch.

Activity Instructions ▶▶ Take some time to review the material covered with the learner in this lesson. ▶▶ Read aloud the following “Quiz Time” examples and discuss, using visuals if needed. The answer to all questions should be, “No, not OK.” ▶▶ If the learner requires more practice, review the material again, and offer other situational examples.

Quiz Time ▶▶ Would it be OK for a close family member to try to kiss you for 20 seconds? ▶▶ Would it be OK for a friend who is like family to ask you to come into a closet with the door closed for a massage? ▶▶ Would it be OK for a close family member to assist in washing your body if you do not require help with bathing? ▶▶ Would it be OK for you to smack a close family member’s bottom?

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Younger Children

Lesson Six

This lesson focuses on the interaction between the individual and younger children. Begin by showing the learner the list of younger children that was developed in Lesson Two. Keep this list visible and available for the learner to reference throughout this lesson to enhance comprehension.

Who This first section assists the learner in understanding how the factor of “who” influences whether touch is appropriate or inappropriate. This means: with whom is the individual interacting? These may be younger siblings, younger cousins, or children of friends.

Activity Instructions ▶▶ Direct the individual to look at the “Younger Children” list developed in Lesson Two, and explain that the “who” in this lesson refers to children who are approximately four and under. ▶▶ Discuss the people on this list to check for recognition. ▶▶ Give visual examples if needed. ▶▶ Explain that young children are grouped together separately from other groups for several reasons: because they may require extra help with safety and selfcare that older people do not, because younger children appropriately seek a great deal of physical contact for comfort, and because younger children are still learning about personal space and appropriate touch—so they may innocently touch in ways that are inappropriate. ▶▶ Talk about how more than any other group discussed, younger children may violate the “rules” of touch—but also how more than with any other group, it is most often not a reason for alarm.

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Lesson Six: Younger Children

Types of Touch This section assists the learner in understanding how the “Types of Touch” play a role in determining whether a touch is appropriate or inappropriate. “Types of Touch” means: how is the person touching? This factor is divided into “receiving” and “giving” touches, since the touch interaction between a younger child and the learner is not always reciprocal.

Discussion Explain that the “Types of Touch” in this lesson will refer to how younger children may touch the individual and how the individual may touch younger children.

Receiving Touches from Younger Children Explain that younger children may touch the individual’s body in various ways to gain attention and demonstrate caring. Younger children may touch the individual to gain attention by tapping or patting. They may touch the individual to demonstrate care by hugging, kissing, tickling, putting arms around, holding on to a part of the body, and holding hands. A younger child may try to sit in the individual’s lap to listen to the individual read a story or watch television. Younger children will not likely need to touch the individual to assist with safety or grooming needs, because the individual will not be likely to require that kind of help from a younger child. Younger children should never purposefully try to remove the individual’s clothing, and they should not try to purposefully hurt the individual with a touch. They should not purposefully touch the individual in areas that underwear or bras cover. Younger children have often not yet developed an understanding of the kinds of touches that are appropriate, so at times a younger child—even one who is a stranger—may touch in a way that is inappropriate. If a younger child tries to remove the individual’s clothing, hurts the individual, or touches the individual in an area that underwear or bras cover, the individual can first tell the child politely not to touch, gently move the child’s hand, and then talk to someone in charge of the situation, such as parent, caregiver, or teacher to let that person know what happened.

Touching Younger Children Explain that the individual may touch younger children in various ways to gain attention, demonstrate caring, and assist with needs. The individual may touch younger children to gain attention by tapping or patting. He or she may touch younger children to demonstrate care by patting, hugging, tickling, putting an arm around, and holding hands if the younger child is a baby or if the younger child is

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entrusted to the individual’s care. The individual may touch to demonstrate care by offering kisses or holding if the younger child is entrusted to the individual’s care. He or she may touch to assist with safety needs, such as holding hands when crossing a street or preventing from falling. The individual may need to touch a younger child in ways to assist with grooming needs if the younger child is entrusted to the individual’s care. For example, if the individual’s parent is caring for a younger child—whether a younger sibling, younger cousin, or younger community member—the individual may provide caregiving touches if needed, such as assisting with getting dressed, brushing hair, and wiping off after eating. If the individual is helping someone to care for a baby, the individual may be assisting with changing diapers—which may mean wiping parts of a baby’s body that diapers cover. The individual may see a mother holding a baby to a part of her body that a bra would normally cover to feed the baby, and this is an acceptable act for mothers to feed babies. Discuss that this does not mean the individual should imitate this action, join in with this action, or report this action as an adult exposing oneself to a child. The individual should never try to remove the child’s clothing without being directed to by a caregiver. He or she should never try to hurt the younger child with a touch. The individual should never try to touch the parts of the body that underwear covers (unless changing a diaper).

Activity Instructions ▶▶ Photocopy the Types of Touch for Younger Children worksheet from the following page. ▶▶ With the learner, complete the worksheet, making a written list, adding photos, or drawing pictures of appropriate and inappropriate touches that may occur between the individual and a younger child. ▶▶ After making the lists on each portion of the chart, direct the individual to use a crayon to lightly shade the side with appropriate touches in green and the side with inappropriate touches in red to reinforce the “go” and “stop” concept.

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 Types of Touch for Younger Children Ways it is OK for a younger child to touch me: 1. Example: tapping on the leg

2. 3. 4. Ways it is NOT OK for a younger child to touch me: 1. Example: pulling down pants

2. 3. 4.

Copyright © Abigail Werner James 2015



Ways it is OK for me to touch a younger child: 1. Example: helping younger child put on a coat

2. 3. 4. Ways it is NOT OK for me to touch a younger child: 1. Example: tickling when the younger child is saying “stop”

2. 3. 4.

Copyright © Abigail Werner James 2015

Lesson Six: Younger Children

Where on Your Body This section assists the learner in identifying the places on the body that younger children may touch the individual for the Types of Touch discussed previously in this lesson.

Discussion Explain that “where on your body” in this lesson refers to where on the individual’s body a younger child may touch the individual. A younger child may at times touch all areas of the body for the Types of Touch listed previously, except for the areas of the body that underwear or bras cover and slightly past those areas. Convey that because younger children are shorter when standing up, they may touch a person’s legs more than other groups of people, simply because they cannot reach an arm or shoulder to gain one’s attention or offer care. Also, because babies are curious about the world, they may touch one’s body, especially the face, in ways that other people would not normally touch. Stress that—again—since younger children are not aware of parts of the body that are inappropriate to touch, younger children may touch areas that will be colored in red in a way that is not threatening—and that moving the child’s hand is a fine way for the individual to redirect until a person in charge of the younger child teaches the child about touch or the child learns social norms. Discuss that if it happens repeatedly and the individual believes the younger child is touching purposefully, telling an adult in charge is fine.

Activity Instructions ▶▶ Photocopy the body outline given in the next worksheet—making two copies to represent both a front and a back that can be glued together. Explain that this body represents the learner’s body when interacting with a younger child. If available, glue a picture of the individual’s face onto the body, so that it is clear that the picture represents the individual. ▶▶ Direct the individual to color the body green, except for the areas that underwear and bras cover, and slightly past underwear areas (inner thighs.) Explain that green does not mean that it is acceptable to be touching that part without good reason or constantly—but rather that the area is acceptable for the Types of Touch listed previously in this lesson. ▶▶ Direct the individual to color the areas that bras and underwear cover, and slightly past underwear areas (inner thighs) in red.

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 Individual’s Body when with Younger Children

Copyright © Abigail Werner James 2015

Lesson Six: Younger Children

Where on Their Bodies This section assists the learner in identifying the areas of the body of a younger child that the individual may touch for the Types of Touch discussed previously in this lesson.

Discussion Explain that “where on their bodies” in this lesson refers to where on a younger child’s body the individual may touch. The individual may touch younger children on all areas of the body except the areas that underwear cover and slightly past those areas. For this body visual, the areas of the body that diapers cover may be colored yellow—if the learner would ever be changing the diaper of a baby. The yellow areas are not areas that the individual would touch frequently, so even more thought and caution should be taken to determine the appropriateness. Stress that wiping the parts of the body that diapers cover when changing a diaper is the only time it would be acceptable to touch there. If the learner would never be changing a diaper, the areas that a diaper and underwear cover should be colored red.

Activity Instructions ▶▶ Photocopy the body outline given in the next worksheet—making two copies to represent both a front and a back that can be glued together. ▶▶ Explain that this body represents a younger child when interacting with the learner. If available, glue on a picture of a younger child. ▶▶ Direct the individual to color the entire body green except for the areas that underwear covers. Explain that green does not mean that it is acceptable to be touching that part without good reason or constantly—but rather that the area is acceptable for the Types of Touch listed previously in this lesson. ▶▶ Choose yellow or red for areas that underwear covers—depending on whether the learner would be changing diapers. Remind the individual that yellow indicates that, even more than usual, the individual must stop and think to be sure the reason makes it acceptable to touch this area.

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 Younger Child’s Body

Copyright © Abigail Werner James 2015

Lesson Six: Younger Children

Setting This section assists the learner in understanding how the factor of “setting” influences whether or not a touch is appropriate or inappropriate.

Discussion Explain that “setting” in this lesson refers to places or locations where one is standing, sitting, or lying down when in the presence of a younger child. Certain settings such as a closet, bathroom stall, shower, or under covers in a bed are not acceptable settings for touching a younger child who does not require the individual’s assistance. If the younger child is a baby and is in the individual’s care, it may be appropriate to be touching a baby in a bed, bathroom stall, or shower, but only for the types of helpful touches discussed previously. Some settings may sometimes be appropriate and sometimes inappropriate, depending on the touch. For example, under a table may be appropriate if the individual and the younger child are holding hands while hiding from someone while playing hide and seek; under a table would be inappropriate if the younger child is tickling the individual in areas that underwear covers and the individual purposefully hides there to prolong the opportunity for inappropriate touch. Not all of the possible settings are covered in this worksheet, so explain about other settings that may be pertinent to the learner.

Activity Instructions ▶▶ Photocopy the Settings for Younger Children worksheet from the following page. ▶▶ Direct the learner to color or shade with green the settings that it would be OK for the individual and a younger child to touch. ▶▶ Direct the learner to color or shade with red the places where it would not be OK. If there are settings where limited touching would be acceptable, discuss exactly what kinds of touch would be OK.

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 Settings for Younger Children

Kitchen

Playroom

Cupboard with Closed Door

Front Yard

Copyright © Abigail Werner James 2015

Lesson Six: Younger Children

Length of Time This section assists the learner in understanding how the duration of touches plays a role in determining whether a touch is appropriate or inappropriate. This section is not divided into “receiving” and “giving,” since the length of time touches last between the individual and a younger child is likely to be similar— although some kinds of touches discussed would not be reciprocal.

Discussion Explain that “length of time” in this lesson refers to how long the touches should last between the individual and a younger child. Touches between the individual and a younger child to gain attention or demonstrate care, such as hugging or tickling, may last for a few seconds, or may last much longer if the younger child is upset or excited. Younger children may touch the individual or ask to be touched for longer amounts of time than other people would. Babies may need to be held for many minutes or even hours to keep them calm. The amount of time between touches may be less than with other peoplegroups, with babies and young toddlers needing to be held or requesting hugs every few seconds or minutes, since—again—the younger child seeks more physical contact for comfort.

Activity Instructions ▶▶ Obtain a doll that is dressed and looks similar to an actual human. If helpful, attach a picture of a familiar younger person. ▶▶ Model holding hands with the doll for several seconds while counting, and prompt the learner to imitate holding hands with the doll to demonstrate care. ▶▶ Utilize the doll to help the learner practice listening to the requests of others, making the doll talk to say what a younger child may say, such as, “Hold my hand longer, because I’m scared,” or, “I’m all done holding hands now.” Prompt the learner to respond.

Checking for Understanding This final section in this lesson gives the learner a chance to put together pieces of information to determine whether or not a novel situation would be appropriate or inappropriate in terms of touch.

Activity Instructions ▶▶ Take some time to review the material covered with the learner in this lesson. ▶▶ Read aloud the following “Quiz Time” examples and discuss, using visuals if needed. The answer to all questions should be, “No, not OK.” 73

Autism and Appropriate Touch

▶▶ If the learner requires more practice, review the material again, and offer other situational examples.

Quiz Time ▶▶ Would it be OK for you to kiss a younger child who is not in your care? ▶▶ Would it be OK for a younger child to put objects into your underwear? ▶▶ Would it be OK for you to wipe a younger child’s bottom when you have not been asked to change a diaper or the child is not in your care? ▶▶ Would it be OK for you to tickle a younger child for ten minutes without stopping?

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Peers

Lesson Seven

This lesson focuses on the interaction between the individual and peers. Begin by showing the learner the list of peers that was developed in Lesson Two. Keep this list visible and available for the learner to reference throughout this lesson to enhance comprehension.

Who This first section assists the learner in understanding how the factor of “who” influences whether touch is appropriate or inappropriate. This means: with whom is the individual interacting?

Activity Instructions ▶▶ Direct the individual to look at the “Peers” list developed in Lesson Two, and explain that the “who” in this lesson refers to peers. ▶▶ Discuss the people on this list to check for recognition. ▶▶ Give visual examples with pictures of peers if needed. ▶▶ Explain that for this lesson, “peers” are those of a similar age whom the individual sees in the neighborhood or with whom the individual attends school or clubs.

Types of Touch This section assists the learner in understanding how the “Types of Touch” play a role in determining whether a touch is appropriate or inappropriate. “Types of Touch” means: how is the person touching? Receiving and giving are not separated in this section, because peers—being at the same ability level and sharing the same role in relation to the other—can interact similarly.

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Discussion Explain that the “Types of Touch” in this lesson will refer to how peers may touch the individual and how the individual may touch peers. Peers commonly touch for the purposes of gaining attention, demonstrating caring, and for structured activities. Peers and the individual may touch each other to gain attention by tapping or patting. They may demonstrate caring by giving high fives, pats on the back, or putting an arm around the other. Peers sometimes hug, depending on age and how close they are. For example, depending on the culture, hugs may more often be exchanged as greetings between girls and not between boys—but adapt this for the learner. Friends may hug each other to say “hello,” “goodbye,” or “congratulations,” but this varies. Communicate that it is best to do less touching rather than more if the individual is not sure—that a high five or pat can be offered instead of a hug during uncertain situations. Some peers who are close may touch each other’s faces if they are putting makeup on each other and may touch each other’s hair if they are fixing each other’s hair for fun. Some peers tickle each other’s stomachs or sides, but explain that this varies with age and closeness. Apply the learner’s situation to tickling, and explain what would be appropriate for the learner, stressing that tickling is not for all peers. Peers and the individual may touch each other during structured situations by holding a hand if instructed by the teacher when making a circle, playing a game, or doing a dance for a performance. A peer may tag the individual on the back, shoulder, or arm when playing a game of tag. Some sports require contact to try to block another person with one’s body, and during some sports, peers may even tackle each other—meaning they pull each other to the ground. Some of these touches—holding hands and tackling—that are part of organized activities are often not appropriate during regular interaction. While a family member or teacher may attempt to gently communicate verbally to the individual that a touch is inappropriate, a peer may be less understanding—possibly not knowing the individual’s intentions. A peer may use body language to convey disapproval—or may even yell. Peers may take steps back, make frowning faces, or even physically try to stop the touch. If a peer does not reciprocate a touch—meaning doing the same or similar action back—the peer may not like the action. For example, even though this section discusses that it is acceptable to tag a peer on the shoulder at recess, if the peer does not run around to try to participate in tagging another, the touch may be unwanted.

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Lesson Seven: Peers

Peers do not usually exchange kisses or sit on each other’s laps, unless the peer group is younger. Observe the individual’s peer group if there is any question about whether this would be appropriate. Peers should never try to remove each other’s clothing, unless a peer has asked for help removing a piece of stuck clothing—stressing that if this piece of clothing is removed, the other person should not be in his or her underwear or naked. Any touch that a peer tells the individual not to tell anyone about is not acceptable. Peers should never try to hurt each other with a touch. They should never touch each other in areas that bras and underwear cover.

Activity Instructions ▶▶ Photocopy the Types of Touch for Peers worksheet from the following page. ▶▶ With the learner, complete the worksheet, making a written list, adding photos, or drawing pictures of appropriate and inappropriate touches that may occur between the individual and a peer. ▶▶ After making the lists on each portion of the chart, direct the individual to use a crayon to lightly shade the side with appropriate touches in green and the side with inappropriate touches in red to reinforce the “go” and “stop” concept.

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 Types of Touch for Peers Ways it is OK for a peer to touch me: 1. Example: tapping shoulder

2.

3.

4. Ways it is NOT OK for a peer to touch me: 1. Example: kissing on lips

2.

3.

4.

Copyright © Abigail Werner James 2015



Ways it is OK for me to touch a peer: 1. Example: high five with hands

2.

3.

4. Ways it is NOT OK for me to touch a peer: 1. Example: tickling peer’s bottom

2.

3.

4.

Copyright © Abigail Werner James 2015

Autism and Appropriate Touch

Where on Your Body This section assists the learner in identifying the places on the body that a peer may touch the individual for the types of touch discussed previously in this lesson.

Discussion Explain that “where on your body” in this lesson refers to where on the individual’s body a peer may touch the individual. Peers may touch the individual’s hands, arms, shoulders, back, top of head, lower legs, and feet. For this body visual, the face, stomach, back of head, and upper legs will be colored yellow. The yellow areas are areas where not all peers touch each other or touch frequently, so more thought may be required to determine the appropriateness. Convey that “where on your body” sometimes varies depending on the type of touch. For example, a peer may put his or her arms around another peer’s stomach if instructed to tackle or wrestle the peer in gym class, but a peer would not pat a peer on the stomach to demonstrate caring.

Activity Instructions ▶▶ Photocopy the body outline given in the next worksheet—making two copies to represent both a front and a back that can be glued together. ▶▶ Explain that this body represents the individual when interacting with a peer. If available, glue a picture of the individual on the body, so that it is clear that the picture represents the individual. ▶▶ Direct the individual to color the color hands, arms, shoulders, back, top of head, lower legs, and feet green. Explain that green does not mean that it is acceptable to be touching that part without good reason or constantly—but rather that the area is acceptable for the Types of Touch listed previously in this lesson. ▶▶ Direct the individual to color the stomach, face, back of head, and upper legs yellow. Remind the individual that yellow indicates that, even more than usual, the individual must stop and think to be sure the reason makes it acceptable for a peer to touch this area. ▶▶ Direct the individual to color areas underwear and bras cover and slightly past underwear areas (inner thighs) red.

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 Individual’s Body when with Peers

Copyright © Abigail Werner James 2015

Autism and Appropriate Touch

Where on Their Bodies This section assists the learner in identifying the areas of the body of a peer that the learner may touch for the types of touch discussed previously in this lesson.

Discussion Explain that “where on their bodies” in this lesson refers to where on a peer’s body the individual may touch. The individual may touch peers’ hands, arms, shoulders, back, top of head, lower legs, and feet. For this body visual, the face, back of head, stomach and upper legs will be colored yellow. The yellow areas are not areas where all peers touch each other or touch frequently, so more thought may be required to determine the appropriateness. Convey that “where on their bodies” sometimes varies depending on the type of touch. For example, a peer may tap the top of a peer’s head to get the person’s attention if he or she is seated on the floor, but a peer would not massage the top of a peer’s head to demonstrate caring.

Activity Instructions ▶▶ Photocopy the body outline given in the next worksheet—making two copies to represent both a front and a back that can be glued together. ▶▶ Explain that this body represents the peer when interacting with the individual. If available, glue a picture of a peer’s face onto the body, so that it is clear that the picture represents a peer. ▶▶ Direct the individual to color hands, arms, shoulders, back, top of head, lower legs, and feet green. Explain that green does not mean that it is acceptable to be touching that part without good reason or constantly—but rather that the area is acceptable for the Types of Touch listed previously. ▶▶ Direct the individual to color the face, back of head, stomach, and upper legs yellow. Remind the individual that yellow indicates that, even more than usual, the individual must stop and think to be sure the reason makes it acceptable to touch this area. ▶▶ Direct the individual to color the areas that underwear and bras cover, and slightly past underwear areas (inner thighs) red.

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 Peer’s Body

Copyright © Abigail Werner James 2015

Autism and Appropriate Touch

Setting This section assists the learner in understanding how the factor of “setting” influences whether or not a touch is appropriate or inappropriate.

Discussion Explain that “setting” in this lesson refers to places or locations where one is standing, sitting, or lying down when in the presence of a peer. Peers may offer certain touches, such as a high five, in numerous settings, but there are certain settings that are not acceptable. Generally during a structured activity organized by adults, the adults make the rules about touching and will let the individual know when to touch someone else—such as when playing a group game. When the individual is supposed to be focused on a task, such as sitting in a school classroom, walking in line in school, or completing an independent task at an after-school club, generally, the individual would not need to be touching peers. During free-time activities, such as recess or when playing in the neighborhood, may be when it is most difficult to know whether touching is acceptable (Koegel and LaZebnik, 2004). Certain settings such as a closet, bathroom stall, shower, under covers in a bed, or any setting where the peer tells the individual not to tell anyone about the touch are not acceptable settings for touching. Some settings may sometimes be appropriate and sometimes inappropriate, depending on the touch. For example, a quiet classroom where everyone is working would be an appropriate setting to pat a peer on the back to communicate “good job” on a project; a quiet classroom where everyone is working would be an inappropriate place to tickle a peer. Not all of the possible settings are covered in this worksheet, so explain about other settings that may be pertinent to the learner.

Activity Instructions ▶▶ Photocopy the Settings for Peers worksheet from the following page. ▶▶ Direct the learner to color or shade with green the locations in which it would be OK for a peer to touch the learner’s body. ▶▶ Direct the learner to color or shade with red the places where it would not be OK. If there are settings where limited touching would be acceptable, discuss exactly what kinds of touch would be OK.

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 Settings for Peers

Bathroom Stall

Game of Basketball

In a Bed

School Lunch Room

Copyright © Abigail Werner James 2015

Autism and Appropriate Touch

Length of Time This section assists the learner in understanding how the duration of touches plays a role in determining whether a touch is appropriate or inappropriate. Again, “receiving” and “giving” are not separated in the section, because a peer—being at the same ability level and sharing the same role in relation to the individual— can touch for similar lengths of time.

Discussion Explain that “length of time” in this lesson refers to how long the touches should last between the individual and peers. Touches between the individual and peers to gain attention or demonstrate care, such as a pat or tickle, will usually last one to two seconds. Touches between the individual and peers during a structured activity may last longer as directed by the teacher or leader of the organized activity. If a peer is tackling the individual during a game of football at a park, the tackle should not continue longer than the amount of time it takes to pull a person down. The amount of time between touches is also important to consider, both in giving and receiving. For example, during a contact sport, the individual may be touching a peer every few seconds to try to block or tag the peer. During interaction that is not a part of an organized game or sport, the individual and peer will probably allow some time to pass between touches. For example, after patting a peer one time to say “good job,” one does not need to pat again for that same occasion. Discuss that times between touches vary depending on the activity, and offer examples that would be pertinent to the learner.

Activity Instructions ▶▶ Obtain a doll that is dressed and looks similar to an actual human. If helpful, attach a picture of a peer. ▶▶ Model offering the doll a pat that lasts two seconds while counting and prompt the learner to imitate offering the doll a pat that lasts an appropriate amount of time for patting a peer.

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Lesson Seven: Peers

Checking for Understanding This final section in this lesson gives the learner a chance to put together pieces of information to determine whether or not a novel situation would be appropriate or inappropriate in terms of touch.

Activity Instructions ▶▶ Take some time to review the material covered with the learner in this lesson. ▶▶ Read aloud the following “Quiz Time” examples and discuss, using visuals if needed. The answer to all questions should be, “No, not OK.” ▶▶ If the learner requires more practice, review the material again, and offer other situational examples.

Quiz Time ▶▶ Would it be OK to touch a peer’s shoulder for the purpose of playing tag at a funeral home during a funeral? ▶▶ Would it be OK to give a peer a hug during a math test? ▶▶ Would it be OK to keep your hand on a peer’s shoulder for 20 seconds while eating lunch? ▶▶ Would it be OK for a peer to tickle you if you say “stop”?

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Teachers

Lesson Eight

This lesson focuses on the interaction between the individual and teachers. Begin by showing the learner the list of teachers that was developed in Lesson Two. Keep this list visible and available for the learner to reference throughout this lesson to enhance comprehension.

Who This first section assists the learner in understanding how the factor of “who” influences whether touch is appropriate or inappropriate. This means: with whom is the individual interacting?

Activity Instructions ▶▶ Direct the individual to look at the “Teachers” list made in Lesson Two; explain that the “who” in this lesson refers to teachers. ▶▶ Discuss the people on this list to check for recognition. ▶▶ Give visual examples with pictures of teachers if needed. ▶▶ Explain that for this lesson, “teachers” means teachers at school, helpers or professionals (Occupational Therapists, Speech Therapists, Behavior Specialists, etc.) who may help the individual in school or at home, coaches, or leaders of other clubs in which the individual may be involved.

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Lesson Eight: Teachers

Types of Touch This section assists the learner in understanding how the “Types of Touch” play a role in determining whether a touch is appropriate or inappropriate. “Types of Touch” means: how is the person touching? This factor is divided into “receiving” and “giving” touches, since the touch interaction between a teacher and the learner is not always reciprocal.

Discussion Explain that the “Types of Touch” in this lesson will refer to how teachers may touch the individual and how the individual may touch teachers.

Receiving Touches from Teachers Explain that teachers may touch the individual’s body in various ways to gain attention, demonstrate caring, and assist with needs. Teachers may touch the individual to gain attention by patting or tapping the individual, and some coaches put an arm around an individual’s shoulders to gain attention while talking. They may touch the individual to demonstrate caring by giving high fives, handshakes, patting the individual, or possibly putting an arm around the individual’s shoulders. Teachers may or may not hug students, depending on various circumstances—but if they do, they would not hug students as often as “close” family members. For example, they may give the individual a hug to say “hello” or “goodbye” at the beginning or end of the school year or on a special occasion—but usually the teacher would not initiate the hug, especially with older students. Teachers may touch the individual to assist with needs, such as assisting with tying a shoe. Teachers in classrooms that are specifically for children with autism or other developmental disabilities may have different rules for touch than teachers in regular education classrooms. For example, teachers in classes for children with autism may give frequent hugs or tickles if children are requesting hugs and tickles. They may be allowed to give therapeutic compressions to calm or deescalate students. They may help a student in the bathroom if the student cannot clean himself or herself. They may need to hold a student’s hand or put a hand on a student’s back while walking to guide the student. Adapt this lesson to include the kinds of specific touches the individual should be receiving at school if the learner is not in a typical-education setting. In regular-education settings, unless the student is quite young, teachers should not tickle the individual. Teachers should not massage the individual, unless the teacher is in a coaching role, and massages are performed for the purposes of helping with a medical problem associated with the sport in the presence of others. They should not kiss the individual. Teachers should never ask the individual to sit on his or her lap. Teachers should never try to remove the individual’s clothing unless the individual is asking for help with a piece of

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Autism and Appropriate Touch

clothing that is stuck. Stress that if this piece of clothing is removed, the individual should not be in his or her underwear or naked. There may be situations where younger children may need assistance with clothing removal from teachers if involved in swimming lessons, but tailor this to the learner. Any touch that a teacher tells the individual not to tell anyone about is not acceptable. Teachers should never try to hurt the individual with a touch. They should never touch the individual in areas that bras and underwear cover.

Touching Teachers Explain that the individual may touch teachers in various ways to gain attention and demonstrate caring. The individual may touch teachers to gain attention, such as by patting or tapping. He or she may touch teachers to demonstrate caring, such as by giving a high five or handshake. The individual may hug a teacher on occasion, but these times would normally be limited to saying “hello” or “goodbye” at the beginning or end of a school year, or on a special occasion. The individual is not likely to need to touch teachers to assist with teachers’ safety or grooming needs. The individual should not tickle a teacher. He or she should not massage a teacher. The individual should not kiss teachers. He or she should never try to remove clothing from them. The individual should never try to hurt a teacher, unless the touch is to defend himself or herself. The individual should never touch teachers in areas that bras and underwear cover.

Activity Instructions ▶▶ Photocopy the Types of Touch for Teachers worksheet on the following page. ▶▶ With the learner, complete the worksheet, making a written list, adding photos, or drawing pictures of appropriate and inappropriate touches that may occur between the individual and a teacher. ▶▶ After making the lists on each portion of the chart, direct the individual to use a crayon to lightly shade the side with appropriate touches in green and the side with inappropriate touches in red to reinforce the “go” and “stop” concept.

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 Types of Touch for Teachers Ways it is OK for a teacher to touch me: 1. Example: patting on upper back

2. 3. 4. Ways it is NOT OK for a teacher to touch me: 1. Example: putting me on a teacher’s lap

2. 3. 4.

Copyright © Abigail Werner James 2015



Ways it is OK for me to touch a teacher: 1. Example: tapping arm

2. 3. 4. Ways it is NOT OK for me to touch a teacher: 1. Example: massaging shoulders

2. 3. 4.

Copyright © Abigail Werner James 2015

Lesson Eight: Teachers

Where on Your Body This section assists the learner in identifying the places on the body that teachers may touch the individual for the types of touch discussed previously in this lesson.

Discussion Explain that “where on your body” in this lesson refers to where on the individual’s body a teacher may touch the individual. A teacher may touch the individual’s feet, hands, arms, shoulders, upper back, and the top of the head. If the individual has a condition that makes him or her unable to toilet independently, that is the only time a teacher (who may instead be some kind of personal assistant—and may be listed in the “Close Family Members and Adult Friends who Are Like Family” list) should be touching areas that underwear or bras cover—for the purpose of wiping or cleaning. If the individual is in a classroom specifically for children with autism, there may be more areas that teachers may touch. For example, if the child requires sensory input from a brushing procedure, a teacher may be touching legs and stomach areas. Adapt the visual for the learner’s situation.

Activity Instructions ▶▶ Photocopy the body outline given in the next worksheet—making two copies to represent both a front and a back that can be glued together. ▶▶ Explain that this body represents the learner’s body when interacting with a teacher. If available, glue a picture of the individual’s face onto the body, so that it is clear that the picture represents the individual. ▶▶ Direct the individual to color feet, hands, arms, shoulders, upper back, and the top of the head green. Explain that green does not mean that it is acceptable to be touching that part without good reason or constantly—but rather that the area is acceptable for the Types of Touch listed previously in this lesson. ▶▶ Direct the individual to color the rest of the body red (unless any of these areas are involved in brushing, therapeutic compressions, or any other activity with teachers, in which case those areas could be colored green or yellow).

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 Individual’s Body when with Teachers

Copyright © Abigail Werner James 2015

Lesson Eight: Teachers

Where on Their Bodies This section assists the learner in identifying the areas of the body of a teacher that the individual may touch for the types of touch discussed previously in this lesson.

Discussion Explain that “where on their bodies” in this lesson refers to where on teachers’ bodies the individual may touch. The individual may touch teachers on the hands, arms, shoulders, and upper back.

Activity Instructions ▶▶ Photocopy the body outline given in the next worksheet—making two copies to represent both a front and a back that can be glued together. ▶▶ Explain that this body represents a teacher when interacting with the learner. If available, glue on a picture of a teacher’s face, so that it is clear that the picture represents a teacher. ▶▶ Direct the individual to color hands, arms, shoulders, and upper back green. Explain that green does not mean that it is acceptable to be touching that part without good reason or constantly—but rather that the area is acceptable for the Types of Touch listed previously in this lesson. ▶▶ Direct the individual to color the rest of the body red.

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 Teacher’s Body

Copyright © Abigail Werner James 2015

Lesson Eight: Teachers

Setting This section assists the learner in understanding how the factor of “setting” influences whether or not a touch is appropriate or inappropriate.

Discussion Explain that “setting” in this lesson refers to places or locations where one is standing, sitting, or lying down when in the presence of a teacher. Teachers may offer certain touches, such as a pat or an arm around the shoulder, in numerous settings, but there are certain settings that are not acceptable. Certain settings such as a closet, a shower, a bathroom stall (unless assistance is necessary), under the covers in bed, any setting in which the teacher and individual are alone and secluded, or any setting in which the teacher tells the individual not to tell anyone about the touch are not acceptable settings for touching. Not all of the possible settings are covered in this worksheet, so explain about other settings that may be pertinent to the learner.

Activity Instructions ▶▶ Photocopy the Settings for Teachers worksheet from the following page. ▶▶ Direct the learner to color or shade with green the locations in which it would be OK for the individual and teacher to touch. ▶▶ Direct the learner to color or shade with red the places where it would not be OK. If there are settings where limited touching would be acceptable, discuss exactly what kinds of touch would be OK.

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 Settings for Teachers

Classroom full of Students

Alone under the Bleachers

Soccer Field during a Game

Empty Locker Room

Copyright © Abigail Werner James 2015

Lesson Eight: Teachers

Length of Time This section assists the learner in understanding how the duration of touches plays a role in determining whether a touch is appropriate or inappropriate. This section is not divided into “receiving” and “giving,” since the length of time touches last between the individual and teachers would be similar (unless the individualized plan for the child requires longer therapeutic touches from teachers).

Discussion Explain that “length of time” in this lesson refers to how long the touches should last between the individual and a teacher. Touches between the individual and a teacher to gain attention or demonstrate care, such as patting or handshakes, will only last a few seconds. Touches from a teacher if an individual requires assistance with needs, such as tying a shoe, will only last as long as it takes to complete the task. The length of time between these touches is often important to consider, both in giving and receiving. For example, unless required for individualized needs, a teacher would not put a hand on the learner’s upper back to demonstrate care every few seconds.

Activity Instructions ▶▶ Obtain a doll that is dressed and looks similar to an actual human. If helpful, attach a picture of a teacher. ▶▶ Model offering a doll a pat that last two seconds while counting and prompt the learner to imitate offering the doll a pat that lasts the appropriate amount of time for patting a teacher to gain attention.

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Autism and Appropriate Touch

Checking for Understanding This final section in this lesson gives the learner a chance to put together pieces of information to determine whether or not a novel situation would be appropriate or inappropriate in terms of touch.

Activity Instructions ▶▶ Take some time to review the material covered with the learner in this lesson. ▶▶ Read aloud the following “Quiz Time” examples and discuss, using visuals if needed. The answer to all questions should be, “No, not OK.” ▶▶ If the learner requires more practice, review the material again, and offer other situational examples.

Quiz Time ▶▶ Would it be OK for a teacher acting as a coach to put an arm around your shoulders for 15 minutes while watching a soccer game? ▶▶ Would it be OK for a teacher to reach into your pants pocket to help you find your lunch money? ▶▶ Would it be OK for an adult leader at an after-school club to kiss the top of your head when greeting you? ▶▶ Would it be OK for you to take off your teacher’s shoes?

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More Distant Family Members and Adult Friends

Lesson Nine

This lesson focuses on the interaction between the individual and more distant family members and adult friends. Begin by showing the learner the list of more distant family members and adult friends that was developed in Lesson Two. Keep this list visible and available for the learner to reference throughout this lesson to enhance comprehension.

Who This first section assists the learner in understanding how the factor of “who” influences whether touch is appropriate or inappropriate. These means: with whom is the individual interacting?

Activity Instructions ▶▶ Direct the individual to look at the “More Distant Family Members and Adult Friends” list made in Lesson Two, and explain that the “who” in this lesson refers to these people. ▶▶ Discuss the people on this list to check for recognition. ▶▶ Give visual examples with pictures of these people if needed. ▶▶ Explain that for this lesson, “more distant” is just a way of differentiating these family members and friends from those who are especially close and in a caregiving role.

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Autism and Appropriate Touch

Types of Touch This section assists the learner in understanding how the “Types of Touch” play a role in determining whether a touch is appropriate or inappropriate. “Types of Touch” means: how is the person touching? This factor is not divided into “giving” and “receiving,” since these adults will not be in a caregiving role where physical assistance would be offered.

Discussion Explain that the “Types of Touch” in this lesson will refer to how more distant family members and adult friends may touch the individual and how the individual may touch more distant members and adult friends. More distant family members or adult friends and the individual may touch for the purposes of gaining attention and demonstrating care. They may touch each other to gain attention by tapping or patting. More distant family members or adult friends and the individual may touch each other to demonstrate caring by giving high fives, handshakes, pats on the back, or putting an arm around the other. More distant family members or adult friends and the individual may or may not hug to greet each other or say goodbye—and hugs would occur for fewer reasons than with close family members. They may or may not tickle the individual’s stomach or side, depending on the learner’s age. Apply the learner’s situation to tickling, and explain what would be appropriate for the learner. More distant family members or adult friends and the individual may or may not kiss to greet each other—but kisses would surely occur for fewer reasons than with close family members. Since kissing varies depending on the family’s level of physical affection, apply the learner’s situation to kissing and explain what would be appropriate for the learner. They would not be likely to sit on each other’s laps—but again, apply the learner’s age and levels of family affection. More distant family members or adult friends and the individual would not be likely to assist with grooming needs, especially not toileting or bathing. They should never try to remove each other’s clothing, unless the individual has asked for assistance with a piece of stuck clothing. Stress that if a piece of clothing is removed, no one should be in his or her underwear or naked. Any touch that a more distant family member or adult friend tells the individual not to tell anyone about is not acceptable. More distant family members or adult friends and the individual should never try to hurt each other with a touch. More distant family members or adult friends and the individual should never touch each other in areas that bras and underwear cover.

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Lesson Nine: More Distant Family Members and Adult Friends

Activity Instructions ▶▶ Photocopy the Types of Touch for More Distant Family Members and Adult Friends worksheet from the following page. ▶▶ With the learner, complete the worksheet, making a written list, adding photos, or drawing pictures of appropriate and inappropriate touches that may occur between the individual and a more distant family member or adult friend. ▶▶ After making the lists on each portion of the chart, direct the individual to use a crayon to lightly shade the side with appropriate touches in green and the side with inappropriate touches in red to reinforce the “go” and “stop” concept.

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 Types of Touch for More Distant Family Members and Adult Friends Ways it is OK for more distant family members and adult friends to touch me: 1. Example: arm around the shoulder when greeting

2. 3. 4. Ways it is NOT OK for more distant family members and adult friends to touch me: 1. Example: kiss on the lips

2. 3. 4.

Copyright © Abigail Werner James 2015



Ways it is OK for me to touch more distant family members and adult friends: 1. Example: pat on the back

2. 3. 4. Ways it is NOT OK for me to touch more distant family members and adult friends: 1. Example: sitting on a lap

2. 3. 4.

Copyright © Abigail Werner James 2015

Autism and Appropriate Touch

Where on Your Body This section assists the learner in identifying the places on the body where a more distant family member or adult friend may touch the learner.

Discussion Explain that “where on your body” in this lesson refers to where on the individual’s body a more distant family member or adult friend may touch the individual for the Types of Touch listed previously in this lesson. More distant family members or adult friends may touch the individual’s hands, arms, shoulders, upper back, and the top of the head. For this body visual, the face, back of head, stomach, legs, and feet may be colored yellow if the situation is such that it would be appropriate for a more distant family member or adult friend to engage in actions such as tickling the individual’s stomach or kissing the individual’s face. The yellow areas are areas where not all distant family members touch each other or touch frequently, so more thought may be required to determine the appropriateness. Convey that “where on your body” sometimes varies depending on the type of touch. For example, a more distant family member or adult friend may pat the individual on the leg to gain attention to signal that it is time to transition away from watching television to go and eat dinner with the family, but a more distant family member or adult friend would not hug or kiss the individual’s leg to demonstrate caring.

Activity Instructions ▶▶ Photocopy the body outline given in the next worksheet—making two copies to represent both a front and a back that can be glued together. ▶▶ Explain that this body represents the learner’s body when interacting with a more distant family member or adult friend. If available, glue a picture of the individual’s face onto the body, so that it is clear that the picture represents the individual. ▶▶ Direct the individual to color hands, arms, shoulders, upper back, and the top of the head green. Explain that green does not mean that it is acceptable to be touching that part without good reason or constantly—but rather that the area is acceptable for the Types of Touch listed previously in this lesson. ▶▶ Direct the individual to color the face, back of head, stomach, lower back, and legs in yellow if appropriate for the learner or red if not appropriate. Remind the individual that yellow indicates that, even more than usual, the individual must stop and think to be sure the reason makes it acceptable for a more distant family member or adult friend to touch this area. ▶▶ Direct the individual to color areas underwear and bras cover and slightly past underwear areas (inner thighs) in red.

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 Individual’s Body when with More Distant Family Members or Adult Friends

Copyright © Abigail Werner James 2015

Autism and Appropriate Touch

Where on Their Bodies This section assists the learner in identifying the areas of the body of a more distant family member or adult friend that the learner may touch for the types of touch discussed previously.

Discussion Explain that “where on their bodies” in this lesson refers to where on a more distant family member or adult friend’s body the individual may touch. The individual may touch a more distant family member or adult friend on the hands, arms, shoulders, and upper back. For this body visual, the face, head, stomach, legs, lower back, and feet may be colored yellow if the situation is such that it would be appropriate for the individual to kiss or tickle a more distant family member or adult friend. The yellow areas are areas where not all distant family members or adult friends touch each other or touch frequently, so more thought may be required to determine the appropriateness. Convey that “where on their bodies” sometimes varies depending on the type of touch. For example, the individual may touch the more distant family member’s shoulder to reciprocate putting an arm around the person but should not kiss the family member’s shoulder.

Activity Instructions ▶▶ Photocopy the body outline given in the next worksheet—making two copies to represent both a front and a back that can be glued together. ▶▶ Explain that this body represents a more distant family member or adult friend when interacting with the learner. If available, glue on a picture of a more distant family member or adult friend’s face, so that is it clear that the picture represents a more distant family member or adult friend. ▶▶ Direct the individual to color the hands, arms, shoulders, and upper back green. Explain that green does not mean that it is acceptable to be touching that part without good reason or constantly—but rather that the area is acceptable for the Types of Touch listed previously. ▶▶ Direct the individual to color the face, head, stomach, legs, lower back, and feet yellow if appropriate for the learner, or red if not appropriate. Remind the individual that yellow indicates that, even more than usual, the individual must stop and think to be sure the reason makes it acceptable to touch this area. ▶▶ Direct the individual to color the areas that underwear and bras cover, and slightly past underwear areas (inner thighs) red.

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 Body of More Distant Family Member or Adult Friend

Copyright © Abigail Werner James 2015

Autism and Appropriate Touch

Setting This section assists the learner in understanding how the factor of “setting” influences whether or not a touch is appropriate or inappropriate.

Discussion Explain that “setting” in this lesson refers to places or locations where one is standing, sitting, or lying down when in the presence of a more distant family member or adult friend. More distant family members or adult friends and the individual may offer certain touches, such as pats on the back or hugs, in numerous settings, but there are certain settings that are not acceptable. Certain settings such as a closet, bathroom stall, shower, under covers in a bed, or any setting where the more distant family member or adult friend tells the individual not to tell anyone about the touch are not acceptable settings for touching. Some settings may sometimes be appropriate and sometimes inappropriate, depending on the touch. For example, a guest bedroom where a family member is staying may be an appropriate setting to offer a high five; a guest bedroom where a family member is staying with the door closed may be an inappropriate place to offer a kiss. Not all of the possible settings are covered in this section, so explain about other settings that may be pertinent to the learner.

Activity Instructions ▶▶ Photocopy the Settings for More Distant Family Members or Adult Friends worksheet on the following page. ▶▶ Direct the learner to color or shade with green the locations where it would be OK for the individual and a more distant family member or adult friend to touch. ▶▶ Direct the learner to color or shade with red the places where it would not be OK. If there are settings where limited touching would be acceptable, discuss exactly what kinds of touch would be OK.

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 Settings for More Distant Family Members or Adult Friends

Dark Bedroom

Front Porch

Church full of People

Bathroom

Copyright © Abigail Werner James 2015

Autism and Appropriate Touch

Length of Time This section assists the learner in understanding how the duration of touches plays a role in determining whether a touch is appropriate or inappropriate. Again, “receiving” and “giving” are not separated in the section, because a more distant family member or adult friend and the learner would probably touch for similar lengths of time.

Discussion Explain that “length of time” in this lesson refers to how long the touches should last between the individual and a more distant family member or adult friend. Touches between the individual and a more distant family member or adult friend to gain attention or demonstrate care, such as a pat or hug, will usually last one to two seconds. The length of time between touches is also important to consider, both in giving and receiving. For example, a more distant family member or adult friend may hug the individual as a greeting if the two have not seen each other in some time, but a more distant family member or adult friend would not be likely to continue hugging the individual every few minutes after the initial hug.

Activity Instructions ▶▶ Obtain a doll that is dressed and looks similar to an actual human. If helpful, attach a picture of a more distant family member or adult friend. ▶▶ Model putting an arm around a doll for two seconds while counting, and prompt the learner to imitate putting an arm around the doll for an appropriate amount of time for putting an arm around a more distant family member to demonstrate care when greeting.

Checking for Understanding This final section in this lesson gives the learner a chance to put together pieces of information to determine whether or not a novel situation would be appropriate or inappropriate in terms of touch.

Activity Instructions ▶▶ Take some time to review the material covered with the learner in this lesson. ▶▶ Read aloud the following “Quiz Time” examples and discuss, using visuals if needed. The answer to all questions should be, “No, not OK.” ▶▶ If the learner requires more practice, review the material again, and offer other situational examples.

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Lesson Nine: More Distant Family Members and Adult Friends

Quiz Time ▶▶ Would it be OK for a more distant family member or adult friend to rub your stomach while alone in the back of a car? ▶▶ Would it be OK for an adult friend to put his or her fingers in your mouth? ▶▶ Would it be OK for a more distant family member to pull down your pants? ▶▶ Would it be OK for you to try to kiss a more distant family member if the family member starts to back away from you as you approach?

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Community Members and Strangers

Lesson Ten

This lesson focuses on the interaction between the individual and community members or strangers. Begin by showing the learner the list of community members and strangers that was developed in Lesson Two. Keep this list visible and available for the learner to reference throughout this lesson to enhance comprehension.

Who This first section assists the learner in understanding how the factor of “who” influences whether touch is appropriate or inappropriate. These means: with whom is the individual interacting?

Activity Instructions ▶▶ Direct the individual to look at the “Community Members and Strangers” list developed in Lesson Two, and explain that the “who” in this lesson refers to these people. ▶▶ Discuss the people on this list to check for recognition. ▶▶ Give visual examples with pictures of community members if needed. ▶▶ Explain that for this lesson, community members who the individual can identify by facial recognition or even by name are still grouped with strangers— because the individual does not know enough about the community members to consider them to be trusted friends. Convey that more so than any other previously discussed group, touching between the individual and community members or strangers is not likely to need to occur frequently—that the individual does not need to touch community members or strangers often.

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Lesson Ten: Community Members and Strangers

Types of Touch This section assists the learner in understanding how the “Types of Touch” play a role in determining whether a touch is appropriate or inappropriate. “Types of Touch” means: how is the person touching? This factor is not divided into “giving” and “receiving,” since the kinds of physical touches exchanged between the individual and community members should be similar.

Discussion Explain that the “Types of Touch” in this lesson will refer to how community members and strangers may touch the individual and how the individual may touch community members and strangers. Community members or strangers and the individual may touch for the purposes of gaining attention and less often for demonstrating care or during structured activities. They may touch each other to gain attention by tapping or patting if verbal means are not successful. They may touch for the purposes of demonstrating care by exchanging a handshake or high five when greeting or thanking each other. Community members or strangers and the individual may touch each other in structured activities when a group is participating in some kind of community activity and a leader instructs the group to touch by holding a hand to make a circle or tapping as part of a game. Community members or strangers and the individual may touch if the community member’s job requires touch, such a person putting an individual’s hand on a screen to obtain fingerprints or to secure a person on an amusement park ride. Community members or strangers and the individual would not touch for the purposes of assisting with grooming or self-care needs. They should not hug unless some kind of disaster has occurred that evokes an elevated level of connection with those involved in the disaster. Community members or strangers and the individual should not tickle each other, should not massage each other, should not kiss, should not sit on each other’s laps, and should never try to remove each other’s clothing. Any touch that the community member or stranger tells the individual not to tell anyone about is not acceptable. Community members or strangers and the individual should never try to hurt each other with a touch, unless for self-defense. They should never touch each other in areas that bras and underwear cover.

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Autism and Appropriate Touch

Activity Instructions ▶▶ Photocopy the Types of Touch for Community Members and Strangers worksheet from the following page. ▶▶ With the learner, complete the worksheet, making a written list, adding photos, or drawing pictures of appropriate and inappropriate touches that may occur between the individual and a community member or stranger. ▶▶ After making the lists on each portion of the chart, direct the individual to use a crayon to lightly shade the side with appropriate touches in green and the side with inappropriate touches in red to reinforce the “go” and “stop” concept.

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 Types of Touch for Community Members and Strangers Ways it is OK for a community member or stranger to touch me: 1. Example: tapping on the back

2. 3. 4. Ways it is NOT OK for a community member or stranger to touch me: 1. Example: tickling

2. 3. 4.

Copyright © Abigail Werner James 2015



Ways it is OK for me to touch a community member or stranger: 1. Example: handshake

2. 3. 4. Ways it is NOT OK for me to touch a community member or stranger: 1. Example: hugging

2. 3. 4.

Copyright © Abigail Werner James 2015

Lesson Ten: Community Members and Strangers

Where on Your Body This section assists the learner in identifying the places on the body where a community member or stranger may touch the individual for the types of touch discussed previously in this lesson.

Discussion Explain that “where on your body” in this lesson refers to where on the individual’s body a community member or stranger may touch the individual for the Types of Touch listed in the previous section. A community member or stranger may touch an individual’s hands, arms, shoulders, and upper back.

Activity Instructions ▶▶ Photocopy the body outline given in the next worksheet—making two copies to represent both a front and a back that can be glued together. ▶▶ Explain that this body represents the individual when interacting with a community member or stranger. If available, glue a picture of the individual onto the body so that it is clear that the picture represents the individual. ▶▶ Direct the individual to color the hands, arms, shoulders, and upper back green. Explain that green does not mean that it is acceptable to be touching that part without good reason or constantly—but rather that the area is acceptable for the Types of Touch listed previously in this lesson. ▶▶ Direct the individual to color the rest of the body red.

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 Individual’s Body when with a Community Member or Stranger

Copyright © Abigail Werner James 2015

Lesson Ten: Community Members and Strangers

Where on Their Bodies This section assists the learner in identifying the areas of the body of a community member or stranger that the learner may touch for the types of touch discussed previously in this lesson.

Discussion Explain that “where on their bodies” in this lesson refers to where on a community member or stranger’s body the individual may touch. The individual may touch a community member or stranger on the hands, arms, shoulders, and upper back.

Activity Instructions ▶▶ Photocopy the body outline given in the next worksheet—making two copies to represent both a front and a back that can be glued together. ▶▶ Explain that this body represents a community member or stranger’s body when interacting with the learner. If available, glue a picture of a community member onto the body, so that it is clear that the picture represents a community member or stranger. ▶▶ Direct the individual to color the hands, arms, shoulders, and upper back green. Explain that green does not mean that it is acceptable to be touching that part without good reason or constantly—but rather that the area is acceptable for the Types of Touch listed previously. ▶▶ Direct the individual to color the rest of the body red.

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 Community Member or Stranger’s Body

Copyright © Abigail Werner James 2015

Lesson Ten: Community Members and Strangers

Setting This section assists the learner in understanding how the factor of “setting” influences whether or not a touch is appropriate or inappropriate.

Discussion Explain that “setting” in this lesson refers to places or locations where one is standing, sitting, or lying down when in the presence of a community member or stranger. Community members or strangers and the individual may offer certain touches, such as a handshake, in numerous settings, but there are certain settings that are not acceptable. Certain settings such as a closet, a shower, a bathroom stall, the individual’s bedroom, the community member’s bedroom, under the covers in any bed, any setting where the individual and the community member are alone and secluded, or any setting in which the community member or stranger tells the individual not to tell anyone about the touch are not acceptable settings for touching. Not all of the possible settings are covered in this section, so explain about other settings that may be pertinent to the learner.

Activity Instructions ▶▶ Photocopy the Settings for Community Members or Strangers worksheet from the following page. ▶▶ Direct the learner to color or shade using green the locations where it would be OK for a community member or stranger to touch the individual’s body. ▶▶ Direct the learner to color or shade with red the places where it would not be OK. If there are settings where limited touching would be acceptable, discuss exactly what kinds of touch would be OK.

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 Settings for Community Members or Strangers

Bedroom

Restaurant

Dark Alley

Bus

Copyright © Abigail Werner James 2015

Lesson Ten: Community Members and Strangers

Length of Time This section assists the learner in understanding how the duration of touches plays a role in determining whether a touch is appropriate or inappropriate. This section is not divided into “receiving” and “giving,” since touches between a community member and the individual are likely to be similar.

Discussion Explain that “length of time” in this lesson refers to how long the touches should last between the individual and a community member or stranger. Touches between the individual and community members or strangers to gain attention or demonstrate care, such as giving a handshake or tap, should last one to two seconds, unless directed by the leader of an organized activity to extend the length of time for the activity. The length of time between touches is also important to consider, both in giving and receiving. For example, once the individual shakes someone’s hand, he or she does not need to shake the person’s hand again at that time and location.

Activity Instructions ▶▶ Obtain a doll that is dressed and looks similar to an actual human. If helpful, attach a picture of a community member. ▶▶ Model offering a doll a handshake that lasts two seconds while counting, and prompt the learner to imitate offering the doll a handshake that lasts an appropriate amount of time for shaking hands with a community member when greeting.

Checking for Understanding This final section in this lesson gives the learner a chance to put together pieces of information to determine whether or not a novel situation would be appropriate or inappropriate in terms of touch.

Activity Instructions ▶▶ Take some time to review the material covered with the learner in this lesson. ▶▶ Read aloud the following “Quiz Time” examples and discuss, using visuals if needed. The answer to all questions should be, “No, not OK.” ▶▶ If the learner requires more practice, review the material again, and offer other situational examples.

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Autism and Appropriate Touch

Quiz Time ▶▶ Would it be OK for a community member or stranger to hold your hand while riding in a taxi cab? ▶▶ Would it be OK for a community member or stranger to tickle your back while standing in a line? ▶▶ Would it be OK for a community member or stranger to pat you on the back five times while alone in the bathroom? ▶▶ Would it be OK for you to massage a community member’s back if you see that the community member is massaging someone else?

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Follow-Up Discussions

Part 3

Follow-Up Discussion A Protection from Abuse This section provides some information about covering the critical issue of protecting oneself from physical or sexual abuse. While the majority of the content of this book is spent giving examples of touches that are acceptable and unacceptable, it is imperative to tell the learner what to do if he or she experiences a touch that is not acceptable.

If Someone Touches You in a Way that is Wrong Discussion Explain that sometimes a grown-up may say that the grown-up needs to be touching the learner to keep him or her safe or help—communicating the kinds of safety touches that may be appropriate for the learner based on his or her age and ability level. For example, one may need to hold a hand while crossing the street. Safety touches for helping are acceptable—even if the individual may prefer not to hold a hand when crossing the street—and are not a reason for calling the police or threatening the helper. However, the individual may at some point experience a touch that is not for helping and is unacceptable. Stress that he or she is in charge of his or her own body, and if the individual does not like the way another person is touching him or her, it is OK to say “stop.”

Activity Instructions ▶▶ Model communicating “stop” in a way that the individual with whom you are working feels comfortable. ▶▶ Prompt the individual to practice communicating “stop.”

Discussion Explain to the individual how to tell if he or she has been touched in a way that is inappropriate, offering the following signs.

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A: Protection from Abuse

Warning Signs that a Touch is Wrong ▶▶ The other person tells the individual not to tell anyone about the touch—that it’s a secret. ▶▶ This book, a professional, or a close family member states that the touch is not acceptable. ▶▶ The touch makes the individual feel uncomfortable.

Explain that if the learner thinks a person has touched him or her in a way that is wrong, he or she must go to someone trusted, like a parent or a teacher, and tell that person. That person can help decide if the other person was touching for a good reason or a bad reason. Even if one adult says the touch was OK, he or she can talk to another trusted adult to get a second opinion if the learner still thinks someone touched him or her in a way that is wrong. Convey that he or she does not have to be embarrassed to talk to an adult about this—that it is good to get help. Stress that even if a person is touching the individual in a way that feels good or that he or she likes—but that this book says is not OK—the individual should still tell another trusted adult, like a parent or a teacher. Sometimes following the rules is more important than following feelings, because some adults may try to use touch as a way to gain power over a younger person or take advantage of a younger person in a way that may cause the individual physical or emotional pain immediately or later in life (Coulborn Faller, 1993). Provide information about who to call if the individual is capable of using such information and needs further help regarding abuse. (See the Child Welfare Information Gateway website for numbers to call in the United States; details are provided in the References section.) Explain that anytime anyone touches the learner in a way that is forceful and not trying to be helpful, such as hitting, kicking, biting, or holding one’s body down—this is not OK. Provide contact information for the individual about how to contact local police if he or she experiences touches that are dangerous.

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Follow-Up Discussion B Explanation of Urges to Touch Inappropriately This section gives some discussion points about guiding the learner through how to handle the urge to engage in inappropriate touch and why the urge may occur. The majority of this book gives information about how to know if it is acceptable to touch another person based on external variables rather than internal desires. While sexual impulses are not discussed in previous lessons as motivators for touch, it is important to let the individual know that one of the reasons he or she may feel compelled to touch is due to sexual development.

If You Feel Like Touching Others in a Way this Book Says is Wrong Discussion Explain that sometimes the individual may feel an urge to touch another person in a way this book says is wrong. This may be for comfort, for fun, or for reasons he or she cannot identify. Sometimes the individual may feel compelled to touch another person in the areas that a bra or underwear covers. He or she may have feelings that seem like something flying around or tickling the learner in the stomach or in the areas that the bra or underwear covers when the learner thinks about this. Convey that it is normal to have these feelings and that these are sexual feelings—if the learner’s parent or guardian consents to such a discussion. Communicate that even though it may seem like the areas that the learner’s bra and underwear cover are urging the individual to touch others in a certain way, it is not OK for him or her to touch others in this way until he or she is older and until the learner’s mind is ready to have a romantic relationship with someone. Explain that grown-ups may call this readiness for a romantic relationship being “mature,” which, in this situation, means that certain areas of one’s brain have grown enough to be able to think about the feelings of others and the consequences of certain actions. Sometimes the learner may see people who are older who are touching each other in ways that this book says are not OK for the learner. Older teenagers and grown-ups sometimes decide that they want to have a boyfriend, girlfriend, husband, or wife. In these kinds of romantic

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B: Explanation of Urges to Touch Inappropriately

relationships the two people may kiss each other on the lips or touch each other’s bodies in ways that this book says are not OK for the learner. When two people are old enough and have enough information to make this decision, they talk about what kinds of touching are OK between them. Discuss that just because the learner sees other people touching each other does not mean it is OK for the learner to join them. Empathize with the fact that it may be difficult for the learner to wait for the brain to emotionally mature to the same level as his or her physically maturity. Encourage the learner to talk to a trusted grown-up if he or she thinks his or her brain is mature enough to prepare for a romantic relationship, explaining that some teenagers’ brains may be ready, and some may not. Provide resources for understanding touch within a dating relationships for those who express an interest, such as The Aspie Girl’s Guide to Being Safe with Men: The Unwritten Safety Rules No-one is Telling You by Debi Brown (2012), or Exploring Friendships, Puberty, and Relationships: A Programme to Help Children and Young People on the Autism Spectrum to Cope with the Challenges of Adolescence by Kate Ripley (2014). Explain why the individual should not touch someone else’s body in a way that this book suggests is wrong, using the following points.

Why One Should Not Touch Others Inappropriately ▶▶ The individual should respect others’ body space and requests not to touch in the same way that the individual would want others to respect his or her body space. ▶▶ The individual may hurt someone else with an unacceptable touch. ▶▶ The individual could get into serious trouble with parents, teachers, or even police officers and face unpleasant consequences after attempting an inappropriate touch.

Activity Instructions ▶▶ Obtain a doll that is dressed and looks similar to an actual human. ▶▶ Model touching the doll’s head, and then, acting as the voice for the doll, say “stop,” and stop touching the doll. ▶▶ Role-play using the doll, prompting the learner to touch the doll. Act as the voice for the doll, saying “stop,” and prompt the learner to then stop touching.

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Follow-Up Discussion C Touching Oneself This section offers some ideas about how to assist the individual in understanding when it is OK to touch oneself. While this book focuses mainly on touches exchanged between the individual and others—since the variables influencing those kinds of touches vary greatly—it is also important to briefly discuss the idea that the individual may need to also regulate where and when he or she touches himself.

If You Feel Like Touching Yourself Discussion Explain to the learner that sometimes one may feel an urge to touch one’s own body on the areas that bras and underwear cover. Acknowledge that he or she might like the way that it feels and that the individual is allowed to touch his or her own body, because it belongs to the individual. Sometimes the individual may find that touching oneself is a suitable alternative to touching another person in a way that is not acceptable.

Guidelines for Self-Touch ▶▶ The individual can touch himself or herself in the areas that bras and underwear cover only when alone (unless the touch is for the purpose of urinating at a public urinal). ▶▶ The individual can touch himself or herself in the areas that bras and underwear cover only when in a private area with closed doors and closed windows, such as the learner’s own bedroom or in a bathroom at home. ▶▶ If someone else is watching the individual, the individual should not be touching his or her own body in the areas that bras and underwear cover.

Discuss the fact that there are no rules about how often one can touch oneself. For example, some people do several times a day and some never do. Communicate

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C: Touching Oneself

that if the individual wants to touch his or her own body in the areas that bras and underwear cover so much that he or she doesn’t want to do anything else and can’t focus on school or other activities, he or she should talk to a trusted grown-up about seeing a doctor to help manage this.

If You Are Experiencing Discomfort Discussion Explain that if the individual feels any kind of agitation in the areas that underwear covers due to clothing or irritation, he or she should go to an area where no one is watching to adjust this area or scratch, preferably a bathroom if the adjustment will take longer than a few seconds. If agitation is occurring frequently, the individual should talk to a parent or doctor about resolving any issues that may be causing discomfort.

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Follow-Up Discussion D Proximity when Not Touching This section offers some ideas about how to assist the individual in understanding appropriate proximity when not touching someone. While most of this book focuses on touching, the topic of distance that should be maintained in between touches is closely related and important.

Discussion Explain that for the purpose of making sure others are at ease when interacting, it is important to keep a certain amount of space between the individual and others. When sitting beside someone on an airplane or in a movie theater, one’s body may be only inches away from the side of another person’s body. When standing in a line or on a subway, the front of one’s body may be only inches from the back of another’s. However, if it is not necessitated by a line or tight quarters, more space should be maintained. When facing the front of someone, most of the time, if the individual can stretch out his or her hands and touch the front of the other person from where he or she is standing, the individual is too close.

Activity Instructions ▶▶ Model holding out hands in front and prompt the individual to imitate. ▶▶ Place a doll at the individual’s fingertips and direct the individual to observe the distance. ▶▶ Explain that the distance practiced with the doll is the minimal distance— that taking a step back after measuring an arm span between the individual and doll may be optimal.

Discussion Communicate that there are times when someone may stand closer to the individual, such as if a close family member is talking with the individual or if someone needs to maintain a low volume. If the individual is talking to someone and the other person takes a step back, that means the other person needs more space; explain that the individual should not step towards a person who backs away from him or her. If unsure where to stand, it is always safer to keep more distance than one thinks is appropriate, and the other person will move closer if needed. 134

Follow-Up Discussion E Accidental Touches This section offers some ideas about how to assist the individual in understanding accidental touches. There may be times when someone may touch the individual or the individual may touch someone else in a way that is not acceptable according to the content of this book—but that was not purposeful. To prevent unnecessary conflict it is important to discuss the idea of accidental touches.

Discussion Explain that there may be times when the individual may accidentally touch someone else in a way that this book says is not OK; there may be times when another person may accidentally touch the individual in a way that this book says is not OK. Accidental touches may occur if one trips, stumbles, or moves suddenly without thinking or looking. Apologizing by saying “sorry” usually indicates that a person touched in a way that was accidental, and the individual does not need to report the incident to an adult. The individual can communicate that he or she is “sorry” to let a person know a touch was not purposeful.

Activity Instructions ▶▶ Model apologizing in a way that the individual can use to indicate to another person that a touch was accidental, ranging from a simple “sorry” to longer explanations for those who are capable. ▶▶ Prompt the individual to imitate.

Discussion Convey that if a person touches the individual in a way that this book says is not acceptable numerous times—even if apologizing afterwards—it may not be accidental. For example, if the individual is standing in line, and the peer behind the individual repeatedly pushes the individual down, it is likely not to be accidental, even if the peer is apologizing—that the apology may be sarcasm, meaning the individual should alert someone in charge of the peer.

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References

American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision). Washington, DC: American Psychiatric Association. Brown, D. (2012) The Aspie Girl’s Guide to Being Safe with Men: The Unwritten Safety Rules No-one is Telling You. London: Jessica Kingsley Publishers. Bruey, C.T. and Urban, M.B. (2009) The Autism Transition Guide: Planning the Journey from School to Adult Life. Bethseda, MD: Woodbine House Inc. Child Welfare Information Gateway (undated) Child Abuse Reporting Numbers by State. Available at www.nccafv.org/child_abuse_reporting_numbers_co.htm, accessed on 12 February 2015. Coulborn Faller, K. (1993) Child Sexual Abuse: Intervention and Treatment Issues. US Department of Health and Human Services, Administration for Children and Families. McLean, VA: The Circle, Inc. Available at http://centerforchildwelfare.fmhi.usf.edu/kb/trpi/Child%20Sexual%20 Abuse-%20Intervention-%20Investigation%20and%20Treatment%20Issues.pdf, accessed on 27 April 2015. Field, T., Lasko, D., Mundy, P., Henteleff, T., Talpins, S., and Dowling, M. (1997) “Autistic children’s attentiveness and responsivity improve after touch therapy.” Journal of Autism and Developmental Disorders 27, 333–338. Gammeltoft, L. and Nordenhof, M.S. (2007) Autism, Play, and Social Interaction. London: Jessica Kingsley Publishers. Gerhardt, P. (2012) Sexuality and sexuality education and the autism spectrum. Lecture presented at 5th Annual Pennsylvania Autism Training Conference, Lancaster, PA. Available at http://video3. tiu11.org/videos/video/13, accessed on 23 March 2015. Heller, S. (1997) The Vital Touch. New York: Henry Holt and Company. Koegel, L.K. and LaZebnik, C. (2004) Overcoming Autism: Finding the Answers, Strategies, and Hope that can Transform a Child’s Life. New York: Penguin Books. Ripley, K. (2014) Exploring Friendships, Puberty, and Relationships: A Programme to Help Children and Young People on the Autism Spectrum to Cope with the Challenges of Adolescence. London: Jessica Kingsley Publishers. Steinburg, L. (2011) “Talking to your teen about sex.” Psychology Today. Available at www. psychologytoday.com/blog/you-and-your-adolescent/201102/talking-your-teen-about-sex, accessed on 12 February 2015. Wehman, P., Smith, M.D., and Schall, C. (2009) Autism and the Transition to Adulthood: Success Beyond the Classroom. Baltimore, MD: Paul H. Brooks Publishing Co.

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