Even experienced babysitters may feel a little intimidated at the thought of looking after a child with special needs. Relax! Knowing what to expect gives you the confidence to do a good job, just as it does when you care for any child.

Here's what you need to know about three common conditions:

Autism

Autism is a developmental disorder that makes it hard to communicate or interact with other people. Some kids have autism that is mild; others have autism that is severe.

Children with autism can have trouble understanding subtle directions and requests. They may become overwhelmed by busy and noisy environments. And, sometimes, they do not enjoy being touched.

Because every kid is different, ask the child's parents what to expect and what kinds of things the child enjoys doing.

Here are some things to know:

• Follow the child's routine, especially at bedtime or mealtime. Kids with autism prefer structure and can get upset if routines are different from what they're used to.
• Ask the parents about the child's favorite toys so you can play with them. Go slowly. One tactic is to sit alongside the child and mimic his play. That might attract his attention and lead him to join you.
• Special toys can help you encourage the child to cooperate. For example, you might say, "If you brush your teeth, you can play with your toy car."
• Don't be offended if the child decides to play alone or limits interactions with you. This is part of the disorder.
• Maintain a calm environment. For example, skip a trip to the playground when you know a neighborhood gathering is likely there. Avoid bringing your friends or other people the child may not know into the home.
• Go slowly when it comes to physical contact. Find out from the parents how their child reacts to affection. A quick hug or light tickle could set off a child with autism.

Know how to deal with difficulties: Ask the parents how to handle it if the child becomes upset or agitated. In general, as long as the child isn't hurting himself or anyone else, it's best to roll with the tantrum. Keep the child safe and close to you. If the child starts to settle down, you might bring out a favorite toy and start playing with it to create a distraction.

Some children with autism might calm down when cuddling a special stuffed animal. Others might respond well to sitting in a rocking chair with you or swinging on the backyard swing set.

Down Syndrome

Down syndrome is a condition in which extra genetic material causes delays in the way a child develops, both mentally and physically.

Like other children with developmental delays, kids with Down syndrome often seem younger than they are. Their skills are often behind those of other kids, but they may enjoy the same types of toys and games. You might need to adapt to play at their level of understanding.

Here are some things to know:

• Find something the child enjoys. Just like other kids, babies with Down syndrome enjoy brightly colored toys and toys that make noise or play music. Toddlers can work on building blocks or play pretend. School-aged children like playing games, crafting, and playing outside.
• Children with Down syndrome may have lower muscle tone. It might be difficult for them to move quickly and maintain coordination. Nevertheless, kids with Down syndrome can still be strong and physical. Playing outside is a great way to exercise their muscles.
• Babies with Down syndrome may have weak neck muscles. Make sure you support the baby's neck extra carefully when holding him or her.
• Children with Down syndrome sometimes have difficulty picking up small objects. Be patient and let the child try again.
• Help the child learn how to do new things. For example, if the child has a hard time stacking blocks, find a way to make her successful. You might hold the blocks on the bottom, while she adds more to the top.
• Keep rules simple. It can be tough for children with Down syndrome to follow directions.
• Children with Down syndrome might have trouble speaking. Ask the parents how their child expresses herself. For example, does she use pictures or sign language to communicate? Sometimes, all that kids with Down syndrome need is for someone to listen carefully.

Know how to deal with difficulties: To keep things consistent for the child, ask the parents about family rules and stick to them.

Attention Deficit Hyperactivity Disorder (ADHD)

Children with ADHD often have lots of energy and can get wound up quickly. Their attention span for activities might be shorter than that of other children, so plan many activities and use them as needed.

Here are some things to know:

• Children with ADHD are often quite creative. They may enjoy drawing pictures or building with blocks.
• Active, outdoor games can be fun for children with ADHD. Try hopscotch, swinging, and jumping rope. But skip the playground if it's close to bedtime.
• Wind down with quiet time at bedtime. Low-key activities, including watching a movie or sitting in a rocking chair and reading a book, can help all kids calm down for the night.
• If the child needs to take medication while you're babysitting, make sure the parents explain the dosage to you. If it's possible, ask parents if you can watch them giving the medication a couple of times. Find out what time you should be giving the medication (or helping the child take it).
• Be specific with your directions. To make sure kids with ADHD have listened and understood you, ask them to repeat the directions back to you.

Know how to deal with difficulties: It might help to provide the child with a schedule of what you'll be doing, especially if your visit is lengthy. Children with ADHD sometimes have trouble switching gears. That means playing a boisterous game of tag right before naptime might not work. If you know some calming strategies and have activities prepared for your visit, you and the child can relax and enjoy yourselves.

Children with special needs can be very sweet and loving. And it's great babysitting experience to learn how to care for kids who have different abilities. Seeing the world through a special child's eyes can change the way you look at life!

Reviewed by: Wendy Harron, BS, OTR/L, and Kate M. Cronan, MD
Date reviewed: August 2011