By: Tina Lee Cheng, M.D., M.P.H.
When I ask children with Aspergerís syndrome who have this characteristic to describe the range of aromas they experience when eating a ripe peach mysoline 250mg cheap medicine woman cast, for example cheap 250 mg mysoline free shipping medications keppra, they may respond with descriptions such as Ďit smells like urineí or Ďit smells as if it is rotten cheap 250mg mysoline amex medications 10325. An adult said to me that he perceived perfumes as having a similar smell to insecticides. A child with olfactory sensitivity may avoid the aromas of paints and art supplies at school, the school cafeteria or rooms where a cleaner has used a particular detergent or cleaning agent. I know of several adults with Aspergerís syndrome who have combined an acute sense of smell with a special interest in wines to become celebrated wine experts and connoisseurs. As Liane Holliday Willey walked to her table at a restaurant, her acute sense of smell enabled her to warn a diner at another table that her sea food was off and would make her very ill. She also uses the ability to smell sickness in her daughters by smelling their breath (personal communication). Strategies to increase dietary diversity It is important to avoid programs of force feeding or starvation to encourage a more varied diet. The child has an increased sensitivity to certain types of food: it is not a simple behaviour problem where the child is being deliberately defiant. Nevertheless, parents will have to ensure that the child eats an appropriate range of food, and a dieti cian may provide guidance on what is nutritious but tolerable to the child in terms of texture, aroma or taste. Gradually the sensitivity diminishes, but the fear and consequent avoidance may continue. When this occurs, a program of systematic desensitization can be introduced by a clinical psychologist. The child can first be encouraged to describe the sensory experience and identify foods that are rated as some of the least unpleasant and more likely to be tolerated with encouragement. When introducing a low prefer ence food, the child initially only has to lick and taste, rather than chew or swallow, the food. When trying specific food sensations, the child should be encouraged to be relaxed, with a supportive adult present, and achieve congratulations and perhaps an appropriate reward for being brave. Nevertheless, some adults with Aspergerís syndrome continue to have a very restricted diet consisting of the same essential ingredients, cooked and presented in the same way, throughout their lives. Such children and adults report being Ďblinded by brightnessí and avoid intense levels of illumination. Extra red was added to the colour making it look orange, and it blurred upwards making it look like it was on fire. When the child with Aspergerís syndrome has a natural talent at drawing, and this is combined with the special interest and considerable drawing practice, the result can be works of art that achieve an effect of photographic realism. For example, a young child who has an interest in trains can be precocious in learning to draw railway scenes in perspective, including almost every detail of the loco motive. In contrast, the people in the scene may be drawn at an age-appropriate level of representation. There are reports of visual distortion, as described by Darren: I used to hate small shops because my eyesight used to make them look as if they were even smaller than they actually were. Liane Holliday Willey described that: Bright lights, mid-day sun, reflected lights, flickering lights, fluorescent lights; each seemed to sear my eyes. Together, the sharp sounds and the bright lights were more than enough to overload my senses. My head would feel tight, my stomach would churn, and my pulse would run my heart ragged until I found a safety zone. It produces Ďshadowsí in my vision (which were very scary when I was young) and long exposure can lead to confusion and dizziness often resulting in migraine. There have been descriptions of not being able to see something that is clearly visible and that the person is searching for (Smith Myles et al. The child may be asked to find a particular book in his or her desk or cupboard, and despite the book being easy for others to see, the child does not recognize the book he or she is looking for. For the person with Aspergerís syndrome, there can be intense pleasure in examples of visual symmetry. For young children this can be the parallel lines and sleepers or ties of a railway track, a picket fence or electricity pylons in a rural landscape. Adults with Aspergerís syndrome may extend the interest in symmetry to an appreciation of architecture. Liane Holliday Willey has a remarkable knowledge and appreciation of architecture: To this day, architectural design remains one of my most favored subjects and now that I am older I indulge my interest, giving in to the joy it brings me. When I feel tangled and tense, I get out my history of architecture and design books and set my eyes on the kinds of spaces and arenas that make sense to me; the linear, the straight lined and the level buildings that paint pictures of strong balance.
The themes will be presented according to the research questions for this study discount 250 mg mysoline amex medicine 6 year, and additional illustrative data for each theme can be found in Appendices 40-43 buy mysoline 250 mg without prescription medicine clipart. W hich aspectsofLego therapy did children perceive to be interesting and enjoyable Table 10:Key them es buy 250mg mysoline free shipping medicine cabinet,definitions and illustrative data:factors associated w ith enjoym entin Lego therapy Key Them e D efinition Illustrative data Positive social Children described w orking w ith others Itísnotjustaboutm e building,itísabouteveryone building. Page | 117 Interestand ability in Children w ere inherently draw n to Lego Because itisso fun and Ican play w ith itallday. Icould Children perceived them selvesto be build a candy m achine thatw orks,like you putcandy in the top good atbuilding Lego,and betteratLego and then you putm oney inĒ than otherchildren. Page | 118 Inherent interest and ability in Lego There was a sense of passion and enthusiasm conveyed when children spoke about Lego. Comments made suggested that children were inherently interested in Lego as a medium and it was an activity that they felt they were successful in. Many children spoke about spending time building Lego at home, suggesting that it is an activity that they engage in out of choice in their free time. And Iím going to need a lot of the redĒ Children enjoyed the flexibility of Lego as a medium and there was the sense that Lego was perceived to be enjoyable because of the infinite building opportunities it affords. Many children spoke about enjoying being able to build lots of different things with Lego and enjoyed the creative aspect of Lego building. Itís like you can build anything you want with it because thereís just so much piecesĒ Children also described themselves as being good at building Lego, and they alluded to the fact that they perceived themselves to be better at building Lego than other children. So they were very stable, but I think the skyscrapers could fall over just by being touched. No children spoke negatively about Lego as either a medium or in relation to their abilities. Comments from this theme suggest that Lego is an area of perceived strength and interest, and thus is an appropriate medium through which to facilitate social interaction. Positive social opportunities Comments made by the children suggest that they experienced positive social interactions when working together in Lego therapy, and they enjoyed belonging to a team. Many children related their experiences in Lego therapy sessions to team membership. Children felt like they were part of a team, suggesting that they understood and accepted that Lego therapy session required group work and a division of labour. There was a sense that children enjoyed the feeling of belonging to a team Building together is fun because youíre not alone. Page | 120 Itís because I think Iím actually, cos when youíre doing it by your own youíre quite bored arenít you but when youíre together itís quite fun because when youíre building you can do funny things like Jamie did really fun things. It is possible that children enjoyed the social aspects of Lego therapy because interactions were centred on a shared task focus and children had similar interests. However, it is also possible that children enjoyed interactions because others in the group placed lower social demands on the children than interactions with typically developing peers. It is positive that children enjoyed interactions through the medium of Lego, but interactions with typically developing peers may provide greater opportunities for modelling positive social behaviour. Freestyle building All of the children interviewed spoke positively about freestyle building, and the majority of the children rated freestyle building as their favourite aspect of Lego Therapy. Children enjoyed both the opportunity for solitary play and the creative freedom that freestyle building provided. Page | 121 There was a sense that children preferred building in freestyle building because they had the freedom to build whatever they wanted, without being constrained by sets with specific instructions. Children were expected to devise a joint project to work on together in free style building. This required children to incorporate each otherís views and come to a compromise, so provided the opportunity to practice some important social skills. However, children often built individual models once the group had made a decision about what to build.
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Street clothes must not be worn for high risk activitieshigh risk activities under disposable coveralls purchase mysoline 250mg on line medicine 524. Workers who launder the clothes must be informed of the hazards of asbestos and the precautions required when handling contaminated clothing discount mysoline 250 mg amex symptoms graves disease. Positive pressure supplied air respirators may be required if wet removal is impossible discount mysoline 250mg amex symptoms of hiv. In some cases, dual cartridge half and full-face respirators with high efficiency filters are acceptable. The appropriate level of respiratory protection can only be determined by conducting air monitoring tests and calculating the protection factor needed. If fibre concentrations increase, workers will need to switch to respiratory protective equipment with a higher protection factor. October 2012 61 Alberta Asbestos Abatement Manual Chapter 5 (6) Workers must use body protection and safety equipment appropriate to other hazards present at the work site. Workers must have successfully completed a course of instruction approved by a Director of Occupational Hygiene and have a valid Asbestos Worker Card. October 2012 62 Alberta Asbestos Abatement Manual Chapter 5 (8) Procedures to deal with emergencies such as a fire or injury must be developed and in place prior to work starting. One worker, who is appropriately trained, must be stationed outside the containment to respond to emergencies and contact rescue personnel if required. Workers inside the containment should have some form of communication with the worker outside the containment. Emergency exits should be clearly marked, both inside and outside of the containment. The signs should read as follows and also include the name of a contact person on-site. Caution Asbestos Dust Hazard Avoid Breathing Dust Wear Protective Equipment Breathing Asbestos Dust May Cause Cancer Entry is Prohibited Except to Authorized Persons Eating, Drinking and Smoking are Prohibited in this Area (2) Clearly mark the boundary of the work area by placing barricades, fencing or similar structures around it. Use polyethylene sheeting at least six mil thick, or a similar impervious material, held in place with appropriate tape and adhesive. It may be necessary to erect a temporary wooden or metal frame to which the plastic barrier can be attached. All joints must overlap by approximately 30 cm and be double-taped to ensure the area is completely sealed off. In this arrangement, the major and usually only route of air into the removal area is through the decontamination unit. Negative pressure must be maintained in the enclosed space until site decontamination work is complete and air monitoring tests confirm fibre levels are low enough to permit dismantling of the enclosure. The airflow pattern in the work area must ensure that the clean room and shower room of the decontamination facility are safe for workers who are not wearing respirators. Where it is not possible to change the filter while within the removal area, a temporary enclosure should be constructed around the unit during filter replacement. Where practical, the discharge point for any exhaust unit should be to the outside air, away from other work areas, air-conditioning inlets or breathing air compressors. The best way to inspect the filter and seal fittings is by using a static pressure alarm which indicates a failure in the system. October 2012 64 Alberta Asbestos Abatement Manual Chapter 5 (9) If a complete enclosure cannot be constructed, cover any windows and doors leading into the area with a plastic sheeting barrier. Cut the plastic sheeting so it overlaps the framework of the window or door by 10 to 15 cm. Ensure a good seal by wiping the area around the window or door with a moist cloth so that the tape sticks. Where asbestos is removed from an entire floor of a multi-storey building, all passenger elevators must be prevented from stopping at that floor. Removal workers may gain access to the floor via the fire staircase or from an elevator dedicated for this purpose. Aside from specific asbestos exhaust units, all ventilation and air conditioning equipment that services the removal area must be shut down for the duration of the removal job, if possible. All vents must be sealed to prevent asbestos dust from getting into the duct network. Upon completion, and after final cleaning of the removal area, all mechanical ventilation filters for recirculated air should be replaced if possible. Sheeting covering the walls should overlap the turn-ups on the inside of the containment to prevent leaks of asbestos-contaminated water running outside of the containment.
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