____ I know a number of toys or objects that my child likes to play with.
____ I know several social games (games without toys, like tickling or roughhousing) that make my child smile.
____ I know some outdoor activities my child likes (playing on swings, walking, etc.).
____ I know some objects and activities that help make my child happier when he or she is in a bad mood.
____ I know some songs or sounds that my child likes to listen to.
____ I know some activities or toys I can use while I am involved in meals or caregiving activities (meals, bathing/dressing/changing/bedtime) that can make my child smile or laugh.
____ I know what my child likes to do with books.
What about Pablo? As described above, Pablo’s only interest in objects was holding the remote control. Pablo’s mother initially offered a wide selection of toys to see whether he would trade the remote control for another item she offered, but he didn’t seem to care about the other objects. Instead, Mom started thinking about what effects or actions she might use to capture his attention herself. She had seen Pablo smile briefly when tickled by his older sister, so she tried that first. To her surprise, Pablo laughed. She didn’t worry at this point about taking the remote control out of his hands; instead, she held up her hands and wiggled her fingers each time she said the word “tickle.” Pablo didn’t pull away, but in fact leaned in toward his mother in anticipation of the next tickle. As Pablo relaxed into the game, he loosened his grip on the remote control and his mother was able to gently take it out of his hand while continuing to tickle him. Once out of his reach, she placed it behind her so it would remain out of sight and not distract him from the game.
Pablo’s mother also found other ways to tickle him, such as blowing raspberries on his neck and belly. She showed him how to pull up his shirt before tickling him on his belly, and she made sure to respond right away each time Pablo did this. When Pablo tired, she offered other objects he might want to hold and showed him how they operate, such as banging the wooden spoon on the table or pushing the buttons on a toy phone. With the remote control out of sight, Pablo was more open to exploring new things. He still tended to repeat the same action with the object, but now Mom knew she could get him away from the remote control and engage him in activities more appropriate for learning.
What about Matthias? Matthias was the child who had very little interest in objects. He preferred to lie on the back of the couch and look out the window most of the time. His dad could not figure out how to interest him in his toys, and after each attempt Matthias returned to the couch. So Matthias’s dad tried a different approach to interact with Matthias. The next time Matthias walked toward the couch, his dad lifted him up and dropped him onto the couch. He repeated this game a few times—helping Matthias climb off the couch, lifting out his arms to pick Matthias up, and dropping him onto the couch. Now Matthias started to understand the game, and, after falling, he walked over to Dad to be picked up and dropped again.
In trying to figure out what Matthias enjoyed, his dad realized that Matthias enjoyed more than just the couch, and smiled and came back for more when he was tossed into the air. So Dad experimented a little with some other “movement” games. He found that Matthias loved being flipped up onto his shoulder and “airplaned” around the room, loved being bounced actively on the big exercise ball; loved having his dad flip him onto the bed and push on his chest with a pillow; and loved being dried roughly after his bath with a big towel and a lot of action. During these kinds of activities, Matthias was much more likely to laugh, smile, look at Dad, and pull on Dad to repeat the game.
Matthias’s dad discovered that he could also bring a stuffed animal into these physical games on the bed and use the stuffed bear to tickle and push. Matthias would reach out to the bear for more play—the first interest he had shown in his stuffed animals. Matthias enjoyed it when Dad sang, “Head, shoulders, knees, and toes,” as he dried those body parts with a towel. And he enjoyed it when Dad stood in front of him, instead of behind, to swing him at the park, swinging him strongly and then catching him in his arms. Matthias would laugh, wiggle, and look at Dad expectantly for the next push. Dad’s detective work and experimenting have helped him identify many activities that Matthias enjoys.
Step 2. Step onto the Stage; Take Your Position
Rationale. Social communication occurs especially through eyes, faces, and bodies. We want children to look at us; to make repeated eye contact; and to have clear views of our faces, expressions, gaze patterns, and mouths as we talk. In general, having children sit down when we play with them helps us get in their spotlight or focus of attention. Sitting down helps focus your child’s attention, because the chair provides support and keeps your child from moving away easily. Sitting in front of your child to read a book or play with a toy may seem like an odd way to position yourself, but holding a child in your lap to read won’t allow you to engage in face-to-face interaction and limits social exchange. Once you get used to reading books and playing in front of your child, it will become a habit, and you won’t have to think about it any more. If you use a bean bag chair or any chair that has arms and provides support, your child will be more likely to stay focused on the interactive activity.
Activity: Find Positions That Put You in the Spotlight
When you are playing with or caring for your child, start to position yourself in such a way that your child has a very clear view of your face and eyes. As much as possible, try to be close up, on the same level, and face to face with your child during both play and caregiving activities. We can’t overemphasize the importance of positioning to increase your child’s attention to people and learning opportunities.
Here are some ideas for positioning yourself and your child so that learning occurs more easily:
Positions in which your child is lying down on his back and you are seated while leaning over him are wonderful for social games, finger plays, and little songs and routines. Diaper-changing time, whether on the changing table or on the floor, is a great time to be positioned face to face and to talk to your child and sing some little songs or finger games as part of the diaper change.
Sitting on the floor with your legs out in front of you, with your child on her back on top of your legs or between them, is also a great position for tummy tickles or creepy fingers and for playing social games like “This Little Piggy,” peekaboo, pattycake, “Round and Round the Garden,” and “Where Is Thumbkin?”
Physical play routines on your bed or a couch provide excellent face-to-face positioning, both when the child is lying down and when the child is standing.
Seat your child on your lap, facing you, or on a small chair, bean bag chair, high chair, or corner of a living room chair or couch while you are sitting on the floor in front of him. This is a terrific face-to-face position for songs, finger plays, toy play, and reading books, as well as for dressing routines (shirts, pants, socks, and shoes). Keeping a face-to-face position is easier when you use some supports—a bean bag chair or pillow for your child to lean on or sit against; a couch, chair, or your knees for your child to lean against; a small table or chair for sitting or standing play. Social games and even book activities can be carried out face to face, with the book held in front of your child, your hands pointing to pictures, and your eyes and face in front of and close to your child’s face, ready to make eye contact, facial expressions, key words, and sound effects.
When seating your child, make sure her back and feet are well supported, so your child is comfortable and can attend to you rather than in an uncomfortable position. Her back should be against the back of the chair, her feet flat on the floor. Think about right angles. In a chair that fits your child, your child’s hips, knees, and ankles should all be at approximately 90 degrees. Feet should not be dangling in the air. For toddlers, a little stepstool is often a perfect height, and if you push it against the wall, there is also back support. Children (and adults, t
oo, as you know from experience!) are more comfortable when a chair fits them well, and they will stay in it longer.
Bean bag chairs are very helpful. We recommend them for all families. They allow you to seat your child in front of you with good support. Children also like to lie in them, and you can play many social games in that position.
Some young children want to move so much that they do not want to sit for very long. However, standing can also be a good face-to-face position, and for this a coffee table or child table is a great asset. Many youngsters like to stand at a table and play with toys, and it is easy for you to go to the other side of the table and be there, face to face, to join in. It will help if the table is heavy, so it will not slide when your child leans on it, and it should be low enough that your child can lean against it at the waist and have arms free to handle objects and reach to you. Your position can be across from your child or at the corner, where the two of you can face each other across the corner of the table. Avoid playing with your child side by side; it’s too hard for your child to see your face that way.
Activity: Take Advantage of Mealtimes
Mealtimes in a high chair or toddler seat provide easy opportunities for a face-to-face position at the kitchen table, especially if they are set up as social times. It’s tempting to have young children feed themselves while parents finish preparing food, rather than having a social meal. However, for children with autism, each mealtime and snack time at the table presents a rich opportunity to work on social attention and interaction.
Here are some ideas for increasing your child’s attention to you during meals:
Instead of giving your child the finger food on his tray, pull the high chair right up to one end of the dinner table and orient your chair so it is facing the high chair tray, so you can easily face your child and have a meal or snack with him. Place your child’s food on the table, and provide a little on a plate for your child and a little on your plate for you. Have fun talking about the food.
When your child has finished the small portion you gave her, offer more, but don’t hand it to her until your child has signaled in some way that she wants it. It can be any subtle behavior—a brief look to you, a reach toward the food, a point, or a sound or word—but wait for your child to do something, and then treat that behavior as an attempt to communicate with you. Once you hear or see it, quickly hand over the food while saying something like this: “More? Sure, you can have more.”
Offer your child a bite, and then encourage your child to give you a bite by leaning toward your child with your mouth open.
Place your child’s cup on the table out of reach but within sight, hold it up in front of your child, and ask if he wants it before handing it to him. Put just a little in the cup, so he will quickly finish and need more. Then, when your child has finished it and wants more, offer another pour, but wait for that communication before you provide it.
As the meal is ending, sing a little song or two with finger plays before you finish; help your child make a gesture that goes with the song by moving her hands through the motion. Songs are great language builders. Sitting face to face like this at the table is a great position for gaining social attention, and managing the food for the child brings your child’s “beam of attention” to you.
Summary of Step 2
If you have followed along and carried out the preceding activities, you will have found a number of ways to step into the spotlight of 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 skills for stepping into your child’s attentional focus. You will use this knowledge for Step 3. If you have not quite mastered using these skills, start experimenting with each of these, one at a time, during play with your child until you have found some ways to accomplish them.
Activity Checklist: Am I in the Spotlight during Activities
with My Child?
____ When we are interacting, my child can easily see my eyes, face, body actions, and movements.
____ My child is looking at me sometimes when we engage in activities together.
____ I am in front of my child, at the child’s level, and face to face (not towering over my child).
____ I have figured out ways to rearrange things a little to be face to face with my child during play and caregiving activities.
____ My child is in front of me and sitting or standing comfortably—sitting on the floor, sitting in a chair that fits, or standing at a table that is a good height for playing.
What about Pablo? After completing the checklist for Step 2, Pablo’s mom realized that she spent a lot of energy following after Pablo, rather than creating the right social zones for play. One of her habits was offering Pablo objects when he was walking away from her or not looking at her. She decided that an important step to help Pablo learn was rearranging the play area to make it a better fit for Pablo’s size and focus of attention. She pulled the coffee table closer to the couch, so that when Pablo stood at it, his body was more supported by the couch. It was also an easy way to “wrangle” him in without forcing him to sit in a chair—a task that was difficult for Pablo except during mealtimes. Pablo also liked pillows, so she brought in some from the bedroom and propped them against the wall to create a soft, plush seating area without having to buy a bean bag chair.
Finally, Mom thought about other opportunities throughout the day at home where she could create a better spotlight of attention. During dinner, it was difficult for her to remain seated, because her other children always needed things from the fridge or help with cutting their food. During the day at snack time, though, when she and Pablo were alone, staying seated was more manageable. Mom decided that she would seat Pablo facing her while she drank her morning coffee as a way to interact and engage with him.
She also realized that when Pablo became tired, he usually wanted to be held. She decided to hold him in her arms with his face looking up at hers, rather than seated with his back to her and maximize this face-to-face time by singing his favorite songs.
What about Matthias? After completing the Step 2 checklist, Dad thought of more ways to enter Matthias’s spotlight of attention. Since Matthias already enjoyed lying on the couch, Dad was able to lean over him and establish face-to-face contact as he started and continued more active games. Dad created other games to do on the couch that required Matthias to sit upright, such as bouncing on the couch, being lifted up for “blastoff” like a rocket ship, and falling forward and into Dad’s arms.
As Matthias sought out these games, his tolerance for sitting improved, and Dad introduced books to Matthias and encouraged him to look at books with Dad while seated on the couch. He made sure to add fun sound effects and exaggerated motions to keep Matthias amused. Dad also brought a child-sized table and chair into the family room, and gradually started placing a few books and other toys he thought Matthias might enjoy on the table. The two started transitioning to the table and chair when coming into the family room and before going to the couch. Over a few weeks, Dad was able to increase their time interacting together at the table.
Also, any time Matthias needed help that involved an object (taking something out of a container, opening a snack item), Dad took Matthias over to the family room or kitchen table and had him sit down before helping. Matthias started to learn about other locations in the house besides the couch where fun and enjoyable things could happen.
Step 3. Eliminate the Competition
Rationale. The physical environment can be a powerful pull for your child’s attention. Observing your child will tell you what the attentional magnets are in a particular space. Video or computer images, mechanical toys, and moving objects can compete strongly with parents who are trying to capture their children’s attention. You may need to control and engineer the environment so that you have less competition for your child’s attention.
Activity: Notice Distractors and Manage Them
As you join
your child for a face-to-face play or caregiving activity, observe your child’s attention and identify the objects in the environment that take your child’s attention away from you. Once you notice one, take steps to minimize it.
Here are some ideas for managing distractors:
During toy play, put loose toys away on shelves or out of sight, so that toys you are not using are not attracting your child’s attention. Toys can go into cabinets with doors, into toy boxes, or even on open shelves covered with a blanket.
Turn off the TV unless someone is actively watching it. Keeping a TV running is a powerful attention magnet for little children with autism.
During playtime, try to turn off the computer and TV screens.
During social play, if the environment is busy and keeps distracting your child, go into another room. A big bed is often a great place for social play.
During bath time, give your child with autism a bath without others in the room (if it’s possible), so you can engage more with him.
During mealtimes, if several children are having meals at once, see if you can intersperse the food routines for your child with ASD (described earlier) with mealtime chat with your other children and adults at the table. However, don’t feel that you need to feed your child alone. The social mix of a family table is a very important experience for your child, as long as she is attending to others as well as to food.
What about Other People?
When your child with autism is just beginning to learn how to interact and pay attention to others, having several people try to interact with your child at the same time you are trying to can be distracting. It’s wonderful when several family members want to play together, but it’s also important to think about your child’s attentional spotlight. Children without ASD are highly skilled at switching back and forth between different people and activities, but children with ASD have difficulty attending to even one person, and you are actively working to build that capacity to help your child learn. Social interactions are the most important teaching tools you have, and you need to protect and increase your child’s interactions and attention to parents, siblings, and important others. In the beginning, it will be helpful to keep the spotlight on one person at a time. If other people are trying to interact with your child at the same time you are, your child’s attention will be diverted from you. When no one commands the spotlight, no learning can occur. So try to encourage everyone to interact one at a time with your child and not to interrupt your child’s attention and interaction with another person in the group. Later, as your child’s ability to pay attention to others improves, you should check to see if he can switch attention from one person to another and interact with both. This is an important skill too; it’s how families interact as a group.
An Early Start for Your Child with Autism: Using Everyday Activities to Help Kids Connect, Communicate, and Learn Page 9