An Early Start for Your Child with Autism: Using Everyday Activities to Help Kids Connect, Communicate, and Learn
Page 8
Furthermore, parents were just as skilled as therapists in helping their children learn to use words and imitate. This shows that parents who learn to use intervention skills can be as effective as trained therapists in teaching their children critical new learning skills and scaffolding their children’s use of their new skills.
There are several different parent-delivered intervention programs available to the public, and several of these are currently being studied in ongoing research. Some examples include Hanen More than Words; the Early Start Denver Model; Pivotal Response Training; Responsive Teaching; and Social Communication, Emotional Regulation, and Transactional Support (SCERTS).
In this book, we describe a set of easy-to-use strategies that parents and other caregivers can use throughout their regular daily activities with their children to help their children engage, communicate, and learn. You can use these strategies during playtime, bathing, mealtimes—really any time you are with your child. This ensures that, like typical children, your child with autism is learning every minute of the day, not only while participating in an intervention program. The strategies we offer in this book are based on the Early Start Denver Model.4 They focus on helping children become actively engaged in learning and communicating by building up their core social learning abilities: imitation, sharing attention, initiating communication with gestures, using their voices and bodies to talk, and learning to play with other people in varied ways with toys. The strategies we offer in this book are ones that help parents and other caregivers (and therapists as well!) develop these skills by being play partners with their children during child-preferred play activities and during typical caregiving routines. Parents and their children develop joyful, back-and-forth play during these activities and routines. The strategies we will teach you will help you find fun play activities that both you and your child enjoy. We will teach you how to scaffold your child’s attention and learning during play and caregiving activities by following your child’s interests and helping your child experience more learning opportunities. In the remaining chapters of this book, we go through these intervention techniques, one by one, for you.
However, before we end this chapter, let’s review some of the key points that we have covered here:
• The brain is very plastic during early development and is shaped by learning experiences. As learning occurs, connections between brain cells are formed.
• Infants actively explore the world, develop ideas about how the world works, and test to see if their ideas are correct.
• Typical infants are learning during almost every waking moment and spend most of their time interacting with people. Children with autism tend to spend less time focusing on people and more time focusing on objects than other children do. This limits their opportunities for social learning and communication.
• Parents can help their child with ASD learn by drawing their child’s attention to important learning opportunities by exaggerating their actions and speech and providing appropriate toys, which is called scaffolding. This helps provide many learning opportunities.
• Early intervention with young children with autism can improve learning, play, communication, and social abilities. It can also help with problem behaviors, such as tantrums and aggression.
• Studies have shown that children with autism are emotionally attached to their parents and other members of their families but may demonstrate this in different ways than typical children.
• Children with autism have trouble talking and have difficulty using gestures and facial expressions to communicate their needs and wishes to their parents. They usually need to be taught how to use gestures such as pointing.
• Children with ASD don’t readily imitate others, but they can be taught to imitate, which opens the door to learning about others.
• Although children with autism are drawn to objects, they may not be adept at playing with toys in varied and appropriate ways. They may be very good at operating their toys, but their play with toys tends to be overly repetitive. Intervention helps them learn to play with lots of toys in functional, social, and creative ways.
• Parents can learn to use intervention strategies with their children; in fact, they are able to master the techniques as well as trained therapists.
• Children whose parents use intervention strategies at home tend to retain the skills they learned. When parents use intervention strategies at home, this reinforces their children’s learning in other intervention programs, so children are able to remember the skills they have learned and use them in many different settings.
• Parent-delivered interventions can help parents feel happier, less stressed, and more optimistic. When parents learn to use intervention strategies with their children, they have a more positive outlook, feel empowered, and are less likely to be depressed.
• Parent-delivered interventions don’t require special equipment and hours of special “teaching” time spent working with a child. The materials required for carrying out interventions at home are simple toys and other play materials. The strategies are carried out during everyday activities, such as bath time, meals, and indoor and outdoor play.
• Most parent-delivered interventions stress the importance of positive emotions and a happy relationship between parents and children for promoting learning. Studies have shown that the parent–child social relationship is the foundation for learning and communicating.
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1Osterling, J., and Dawson, G. Early recognition of children with autism: A study of first birthday home videotapes. Journal of Autism and Developmental Disorders, 24, 247–257, 1994. See also Palomo, R., et al. Autism and family home movies: A comprehensive review. Journal of Developmental and Behavioral Pediatrics, 25(2, Suppl.), S59–S68, 2006.
2Warren, Z., et al. A systematic review of early intensive intervention for autism spectrum disorders. Pediatrics, 127, e1303–e1311, 2011.
3Vismara, L. A., et al. Can one hour per week of therapy lead to lasting changes in young children with autism? Autism, 13, 93–115, 2009.
4Rogers, S. J., and Dawson, G. Early Start Denver Model for young children with autism. New York: Guilford Press, 2010.
Part II
Everyday Strategies
to Help Your Child Engage,
Communicate, and Learn
4
Step into the Spotlight
Capturing Your Child’s Attention
Chapter goal: To teach you how to increase your child’s attention to you, so that your child’s opportunities to learn from you will increase. Learning requires paying attention to people.
WHY YOUR CHILD’S ATTENTION TO OTHERS IS SO IMPORTANT
There are many things that young children cannot do yet, but one thing they do very well is pay attention to their environment and learn from what they see. Babies see fairly well very soon after birth, and they learn a lot about the world, people, and objects around them by watching objects and people in action. They are also surprisingly good at seeing patterns in the actions of people and objects around them. They learn to expect people to move and act in typical ways and are surprised and intrigued by unexpected events. In fact, they pay more attention to the unexpected than to the routine and predictable so that they can figure out new things.
Watching and listening to people are very important learning activities for young children—perhaps the most important learning activities, because they learn so much from interacting with other people. Most babies and toddlers prefer watching people and interacting with them over any other activity. Their brains are wired in such a way that looking at and interacting with other people are the most pleasurable activities of all (assuming that they are not hungry, fatigued, or uncomfortable).
What’s Happening in Autism?
However, young children with autism spectrum disorders (ASD) do not show as strong an interest in watching and interacting with people as other children do. Why would that be? T
here are two different possible explanations that you may read about. One suggests that children with autism have more difficulty than others understanding complex and unpredictable sights and sounds. Social interactions are certainly complex and sometimes unpredictable: They require a young child to make sense of facial expressions, speech, sounds, and gestures. Objects, on the other hand, are more predictable and generally less complex than people. When a young child acts on an object, it tends to respond in a reliable and predictable way. The child can make the object repeat the same action over and over. People act spontaneously and more variably than objects; they do not respond the same way every time. People who are trying to engage a young child can sometimes be very stimulating. They may speak very quickly and with a lot of emotion, creating a lot of sounds for the child to process at once. People may also move and gesture during interactions, talking with their hands and changing their facial expressions quickly to fit the mode and tone of the conversation. All of this information may be at times too stimulating for the child, whose response in such instances may be to fuss or to withdraw. This used to be a very popular way of understanding autism, but research suggests that this view is not the most accurate way to understand young children’s decreased attention to others.
The other line of thinking suggests that young children with autism are less tuned in to others from the start. This line of reasoning begins with the finding from scientists that children typically come into the world built to favor watching and interacting with people over anything else. As with any other trait, some children have less of this built-in “attraction” than others. In autism, this innate preference for people seems to be lessened. Because people are not so interesting, the physical world may compete more strongly for their attention than it would in a child who has a very strong built-in attraction for people. Notice that the end result of both of these theories is that children with autism find interacting with objects somewhat more interesting, and interacting with people somewhat less interesting, than most children do.
Why Is It a Problem?
When young children don’t pay much attention to the people caring for them, they miss out on very important learning opportunities. Children need to attend to everything that other people do—their physical movements, body language, facial expressions, and words—in order to learn. What very young children learn about communication, emotions, language, and social interaction comes from having lots of individual experiences with watching, imitating, and interacting with people. If they’re not spending much time tuned in to their parents or others—that is, if they’re not spending a lot of time focused on others’ faces, voices, and actions—their learning may be slowed, especially their learning about social communication and play. To increase their rate of learning, their attention to other people has to increase. Attention throws a spotlight on others that lights them up and highlights their actions, speech, and emotions, which are so critical for social learning. In short, more attention to others equals more opportunities to learn from them.
What You Can Do to Increase Your Child’s Attention
to People
How can you as a caregiver step into your child’s attentional spotlight? There are five specific steps you can carry out to increase your child’s attention to you:
Step 1. Identify what is in the spotlight of your child’s attention.
Step 2. Step onto the “stage”; take your position.
Step 3. Eliminate the competition.
Step 4. Identify your child’s social comfort zone.
Step 5. Join in by following your child’s lead.
In the following pages, we describe how to carry out each of these steps, give you some ideas for activities to try, and suggest what you can do to solve problems that may come up.
Step 1. Identify What Is in the Spotlight of Your Child’s Attention
Most young children with ASD are interested in objects and toys, and spend much of their time manipulating and playing with them. If this is true for your child, then it will probably be easy for you to find interesting materials for play. Young children are often very motivated to obtain objects, to handle favorite objects, to create interesting effects with objects, and to get help with objects they enjoy. Most also enjoy lively physical games their parents create—roughhousing, moving in time to music, running, bouncing, and swinging. By including materials that relate to your child’s interests and preferences (whether it be a favorite toy such as trains, a favorite cartoon character, or a preferred activity such as tickling), you can create learning situations in which your child is likely to attend to you and interact with you, thus learning from you. In addition, building social interactions into your child’s interest in specific objects will allow you to increase your child’s social skills. Social interactions will become linked with favorite activities and become more rewarding for your child.
Rationale. Highly appealing materials and play activities motivate children to interact with their parents. A motivated child is a happy child, attentive to his parents and ready to learn. Strong motivation supports active learners rather than passive observers, and active learners show initiative and spontaneity—two important characteristics to nurture in young children with autism. A motivated child also wants to continue an activity, which gives you as the parent the chance to embed many learning opportunities into the activity. The longer the activity goes on, the more learning opportunities you can create. This is why you want to know what objects and activities your child really enjoys—so you can create learning opportunities for your child. The following activity will give you tools for identifying your child’s preferred activities and materials. The questions will help you focus your own attention on your child’s attentional spotlight.
Activity: Figure Out What Your Child Likes
Spend time over the next few days really observing your child during the following six types of activities:
1. Toy or other object play
2. Social play
3. Meals
4. Caregiving (bathing/changing/dressing/bedtime)
5. Book activities
6. Household chores
Here are some ideas for learning about what your child is interested in and paying attention to:
In each of the six types of activities just listed, notice what your child is interested in and pays attention to. For each one, make a list of the objects, materials, toys, or physical games that your child seems to seek out and enjoy. (We have provided a form for you to keep your list right in this book, if you want to. It’s on page 89.) If your child does not naturally seek out objects or physical games, set out a few materials or toys, and encourage your child to manipulate or play with them to see what your child might like.
Next, answer these questions from your observations of your child when he is engaging in the activities listed above. For each of the six activities:
• What objects or activities does my child search for?
• What objects does my child like to watch, grasp, or hold?
• What activities does my child come to me or another family member for help with or to do?
• What makes my child smile and laugh?
• What calms my child when upset or cheers my child when cranky?
If your child does not have much interest in traditional play objects, then focus on your child’s response to other daily activities. There are very few young children who do not approach anything or anyone or who do not act on any objects without being guided. It happens, but it’s very rare. When your child moves independently, what is she moving toward or away from? When your child touches or holds anything, or watches anything, what is it? When you physically play with your child—tickle, cuddle, squeeze, spin around, whatever games you play—what are your child’s reactions? What does she seem to enjoy?
Sometimes children’s favorite objects are rather unusual for their age or are used in a repetitive, limited manner.
For instance, 26-month
-old Pablo spends his day with the TV remote in his hand. He keeps the TV on and switches channels as he stands in front of the TV or lies on the couch. Most of his awake time is spent in front of the TV, and efforts to turn it off or to take the remote away from him lead to big tantrums.
Three-year-old Matthias likes to lie on the back of the couch and watch out the window, for hours at a time. He shows very little interest in toys, people, or any activities going on in his household, even though there are toys and interesting activities around, thanks to his 4-year-old sister and the family pets.
Even if your child’s interests are unusual, they are interests, and you can add them to your list. There are a few young children who are not very interested in any objects or activities. For these children, we will teach you how to create more social games (also called sensory social routines) or other types of face-to-face routines, and, later, how to build your child’s interest in playing with toys. We describe strategies for creating those types of activities with your child in Chapter 5.
Summary of Step 1
If you have followed along and carried out the preceding activities, you will have learned quite a lot about your child’s interests, preferences, and the objects and activities that capture your child’s attention. See if you agree with most of the statements in the following checklist. If so, you are now armed with important knowledge about your child’s attention—knowledge you will use for Step 2. If not, start experimenting to find out what your child likes in each of these categories.
Activity Checklist: What Does My Child Like to Do?