Language learning especially depends on brain plasticity. We are all amazed by the ability of very young children to learn languages—whatever languages are around them—and speak them like natives. In contrast, many of us have tried to learn a new language as adults and found it virtually impossible to sound like native speakers. This is one of the best examples of the special capacity for learning in the first 5 years of life. For young children with autism, beginning intervention as soon as we possibly can allows us to capitalize on the tremendous plasticity and learning ability during the infant and toddler years. The more progress made in the preschool years, the fewer disabilities children with autism have later.
Research shows that early intervention increases children’s play skills, their cognitive abilities (IQ), their speech and language, and their desire for social interaction. It increases their social abilities and decreases their ASD symptoms and their behavior problems. It helps them learn faster and participate better in all aspects of life—at home, at school, and in the community. Some studies have found that even the diagnosis changes for some children as a result of early intervention: Children who receive intervention may show lessening symptoms of autism. This allows many children to go on to a typical preschool, kindergarten, or first grade; develop greater conversational and play skills; and develop more complex peer relationships. Positive changes don’t just happen for a few children who get early intervention. All children who receive early intervention benefit, though the changes are faster and greater for some than for others.
HOW DOES EARLY INTERVENTION WORK?
Studies on infant learning have helped us understand why early intervention is so effective. Here are some facts about how babies and toddlers learn.
In the past 30 years, scientists have learned that even very young infants are highly engaged in learning and know much more than we believed. Young infants are like little scientists: They develop ideas of how the world around them works, and they test these ideas through their body actions and their senses. They take in information from all their experiences, and they use this information to improve their ideas about how the world works. For example, scientists have learned that infants have a rudimentary knowledge of physics, number, and other physical properties, and use this knowledge to experiment on the world around them. At birth, infants actually have the capacity to hear and produce all of the different speech sounds that make up all of the spoken languages in the world—a capacity that is lost over time for those languages a child is not exposed to (this explains why we have an accent when we learn new languages as adults). Right from birth, infants can recognize familiar voices and faces. They come into the world prepared to interact with things and people, and to discover and learn from the world around them. Because of the active nature of infant learning, it is important to consider the following:
• What opportunities for learning are available in the various daily activities of your young child with ASD?
• What kinds of activities does your child actively attend to and find rewarding?
• Does your child have the basic skills for learning from others, such as paying attention to others, imitating them, playing with them, and watching what they do?
• Does your child exhibit any problem behaviors that interfere with learning from others, such as frequent tantrums or overly repetitive behaviors?
The typical infant learns during every waking moment of the day. When she wakes up, she begins babbling and playing with her hands, or toes, or toys in the crib. She examines how they work, what happens when she throws the toys out of the crib, and how her parents respond when she coos or when the toys make a loud crashing sound on the floor. When she hears the crashing sound, she may call out, imitating the loudness of the sound. She remembers that the last time she made a loud sound, a parent arrived. Chances are that she notices the sound of Mom or Dad opening the bedroom door. She turns quickly toward that sound and focuses intently on her parents’ facial expressions and words as they approach her. She’s been awake for only 5 minutes, and she has already learned something about cause and effect, gravity, emotions, and words!
Now let’s compare this child to a young child with ASD. She wakes up and also begins to play in the crib, but her play is different. She may ignore the toys and instead be fascinated with the way the light is shining through the crack in the curtains. She may tilt her head back and forth to experiment with the light, noticing how it changes with her head movement, watching her hand and fingers move in the light. She may spend a long time rocking her head back and forth, watching the light. She is quiet, not making many sounds. When her parents come to get her up, she does not look to see their expressions or turn to their voices. The light patterns still hold her attention. She too is learning, but instead of learning about toys, speech sounds, faces, and people, she is learning about patterns of light and movement. She has missed important opportunities for learning how to communicate, socialize, and play, because she didn’t call for her parents or watch them come in and because the light was more interesting to her than the toys. Her long attention to the light and to the movements of her fingers and head has interfered with her attention to other learning opportunities available to her. Some of the key differences between most young children and those with autism are shown in the box below.
A central goal of early intervention is to help young children with ASD pay attention to key social learning opportunities like speech, faces, and gestures, and to “boost,” or make more salient, their attention to people—their actions, sounds, words, and faces—so that the children can more readily make sense of the information that is essential for typical language and social development. Developmental psychologists use the term scaffolding to describe the way parents aid their children’s learning by drawing their children’s attention to the most important learning opportunities in the environment. When parents scaffold their children’s attention in learning opportunities, parents increase or decrease stimulation as needed, provide appropriate toys, repeat and exaggerate certain actions, slow and simplify their speech, and so on, so that the children can learn more readily. When you, as a parent of a young child with ASD, use early intervention strategies to scaffold your child’s attention, you will use the same scaffolding strategies that other parents use, but you will build a stronger scaffold for your child—one that is tuned to your child’s individual learning characteristics (his favorite activities, experiences, and sensitivities), as well as the learning challenges that are seen in most young children with ASD.
When you begin using specific early intervention techniques with your child, like those described later in this book, you will learn techniques for doing these things:
1. Drawing his attention to the people in his environment
2. Making social play more enjoyable and rewarding
3. Teaching him the basic skills of learning:
• Attending to others’ faces, voices, and actions
• Imitating others
• Using his voice and body to communicate
• Sharing emotions, needs, and interests with others
• Understanding that others’ communications have meaning for him
• Playing with toys in typical ways
• Learning to use and understand speech
• Reducing any behaviors that interfere with learning
With these special intervention techniques, you will be able to open up a world of learning opportunities for your child during the period when your child’s brain is still developing very quickly, and this will maximize the impact of early intervention.
THE UNIQUE LEARNING CHALLENGES ASSOCIATED WITH ASD
Many studies have shown us the unique ways in which children with ASD interact with the world, and have thus helped us better understand some of the learning challenges associated with ASD. These challenges are what early intervention is designed to target. These are some of the common challenges to learning associated with ASD:
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Attention Rather than naturally paying attention to people, including their faces, gestures, and voices, children with ASD tend to pay a greater amount of attention to objects and other types of nonsocial information (lights, patterns, etc.).
Social motivation Rather than frequently seeking out others for interaction and being motivated to share experiences with others, children with ASD may prefer to spend time alone, or to play near but not with others.
Use of gesture When attempting to communicate, children with ASD often don’t use gestures to share their experiences with others, such as pointing and showing things to others. They tend not to understand or respond to other people’s communicative gestures, either.
Imitation and turn taking Instead of readily imitating the sounds and actions of others, children with ASD don’t often imitate others and don’t often engage in back-and-forth toy play. It doesn’t seem particularly enjoyable to them.
Toy play Rather than exploring lots of objects and using them in creative ways, children with autism can often be overly focused on a small set of objects and repeat the same action over and over. They may become distressed when this pattern of play is disrupted by others. They tend to play alone with toys, rather than with others.
Babble Rather than making lots of sounds and paying attention to other people’s sounds, young children with ASD may be unusually quiet. They may make only a small number of sounds. Their sounds may not sound much like speech, and they tend not to use their sounds to send messages to others.
Arousal and sensory sensitivities In contrast to other children, children with ASD may seem easily overstimulated or may seem underresponsive to various sensations. They may have unusual sensitivities to touch, sound, or light.
Why does a child with autism have these unique challenges? It has to do with how autism affects brain development. There are areas of the brain that are specialized for aspects of social learning, such as eye contact and emotional responses. When these areas are functioning properly, a child is naturally drawn to social experiences and easily learns language and social interactions. Research has shown that these key areas of the brain specialized for language and social interaction are underfunctioning in young children with autism. There also seem to be fewer connections than is usually the case between certain regions of the brain—such as between the sensory areas that are specialized for sound, vision, and touch, and the thinking areas that are specialized for comprehending and making sense of the sounds, sights, and touches we experience. This suggests that a child with autism experiences the people and objects in the environment but has difficulty making sense of those experiences, especially those related to social learning and communication.
Where do these differences in brain function come from? Science has shown that these differences in autism as a whole appear to be caused by a combination of genetic and environmental factors that influence very early brain development. The evidence for a genetic influence is based partly on studies of identical versus fraternal twins. Identical twins share all of their genetic makeup, whereas fraternal twins (and nontwin siblings) share half of their genetic makeup. If one identical twin has autism, the chance that the second twin also has autism is about 70%. In contrast, for fraternal twins, the chance is only 35%. So, clearly, genetic risk factors are influencing the cause of ASD. However, given that only 70% of identical twins (who share 100% of their genes) both have autism, other factors must also be playing a role. Research on environmental risk factors is still in its early stages, but studies thus far point to factors that influence fetal development during the prenatal period and around the time of birth. Such factors include older parental age at conception, maternal infections (especially flu) during pregnancy, birth complications (such as respiratory distress), and premature and/or underweight birth. These factors, by themselves, do not cause autism; they are related to higher risk of many kinds of developmental problems. However, autism may be more likely if there is already some genetic risk. For more information about the causes and other research on autism, we encourage you to visit the Autism Speaks Official Blog (http://autismspeaks.org/blog) and click on “Science.”
Fortunately, as mentioned earlier in this chapter, the brain has great plasticity early in life. A great deal of brain development is still in the future for a young child, so by providing specialized experiences that stimulate social and communication development (like those described in this book) and using other kinds of early intervention, it seems possible to steer your child’s brain development back onto a more typical path.
Young children with ASD are highly capable of learning. They form social attachments to their family members, and they respond well to teaching strategies that take into account their unique learning styles. Young children with ASD can overcome many of their challenges and become socially engaged, motivated, and creative learners. The remaining chapters in this book will show you how to help this happen for your child.
PARENT-DELIVERED INTERVENTION FOR YOUNG CHILDREN
WITH ASD: WHAT IS THE EVIDENCE?
Over the past 20 years or so, many, many studies have shown the benefits of early intervention for young children with ASD when the intervention is delivered by trained therapists. For example, in 2011, the federal agency that evaluates the evidence base for treatments (the Agency for Healthcare Research and Quality) published a systematic review of early intensive intervention for ASD.2 It included 34 clinical trials of early intervention in its review. The agency concluded that the evidence shows that early intensive behavioral intervention results in improved cognitive and language outcomes. One finding from many of these studies is that children had better outcomes if their parents learned to use strategies at home with the children that were similar to those their therapists were using in early intervention.
This makes perfect sense. Parents know their children better than anyone else; they are strongly motivated to help their children; and they spend more hours with their children than anyone else. Parents who scaffold their children’s learning by using specific teaching strategies, in addition to the hours their children are receiving other interventions, are adding many more learning experiences for their children every single day. This should help their children learn more!
Lately, research has begun to look more deeply into the effects of parent-delivered intervention. Various studies show that parent-delivered interventions can increase children’s communication and play skills, and can increase the amount of success and fun that both parents and children have interacting with each other. When parents learn to use intervention techniques at home, young children with ASD are more likely to remember and use the skills they have been taught by teachers or therapists. Furthermore, parents who use intervention strategies report feeling happier, less stressed, and more optimistic and empowered.
A recent study conducted by two of us with a coworker3 looked at how parents learned the intervention techniques included in this book and how their children benefited from them. The study involved eight families of 1- and 2-year-olds with ASD who had just been diagnosed. The families volunteered for a parent intervention program of 12 weekly sessions lasting 1 hour each. Parents learned to use a number of teaching techniques that focused on building their children’s attention, communication, social interactions, and play. The parents learned to do these things:
1. Create fun and satisfying exchanges between their children and themselves
2. Help their children’s language develop by emphasizing the social power of the early sounds that children make
3. Increase their children’s nonverbal communication and imitation skills
4. Build up their children’s interest in a wide range of toys, and skills in social toy play
Parents learned to use these intervention techniques during their typical playtimes at home and during their typical caregiving routines. Parents did not create hours of special teaching time. These were working parents who already spent as much time as they had ta
king care of their children and playing with them. They learned to use their existing time with their child in a more focused way.
Were parents able to learn the intervention techniques? Yes! The study actually found that even before they were taught the techniques, parents naturally used many of these techniques between 40% and 60% of the time during their typical play activities with their children. However, after only a few hours of coaching and a few weeks of using the techniques at home, most of the parents were using the techniques over 90% of the time.
The study then examined how parents’ use of the techniques affected the children. Before parents began to learn the techniques, the children in the study were using almost no word-like sounds. However, once the parents started to use the intervention techniques regularly at home, most of the children began to try to say words to communicate, not just to imitate or echo. The same thing was found for children’s imitation. It increased steadily once parents started to use the intervention techniques at home.
An Early Start for Your Child with Autism: Using Everyday Activities to Help Kids Connect, Communicate, and Learn Page 7