An Early Start for Your Child with Autism: Using Everyday Activities to Help Kids Connect, Communicate, and Learn

by Rogers, Sally J.

  Later in the chapter, we discuss how, over time, you will begin to ask for more elaborate communications—such as using a point instead of just a reach, or using both gesture and a vocalization at the same time. For now, the goal is to help your child develop a talking body by learning to use simple nonverbal communications like eye contact, sounds, reaches, directed smiles, and other body gestures.

  Here are more ideas:

  Instead of plopping all the bath toys into the tub, offer one or two while naming each, and wait for your child to communicate the request before you hand it to him.

  Instead of having your child’s toys all out and available, organize some of them in clear shoeboxes (with snug lids) on a shelf, and have your child choose a box. Once she gets the closed box, wait for a nonverbal communication that your child needs help to open it. Offer your hand and ask if she needs help.

  Instead of dumping out the pieces of a puzzle all at once, keep the pieces and offer them to your child one at a time as you name each one, or as a choice between two (“Bear or horse?”). Elicit a reach, gaze, or another nonverbal communication for most of them. Name it as your child gets it: “Bear! You wanted bear!” Give a few here and there as freebies when your child looks at them (“Here’s pig!”) to keep motivation high. Do this when playing with any toys that have multiple pieces.

  When changing your child’s diaper, give her the diaper to hold and then ask for it when it’s time to put it on (hold out your hand and say, “Give me diaper!”). If she doesn’t give it to you, then take it: “Give me diaper. Thank you. Here’s diaper.” When putting your child’s shoes on to go outside, tell your child to sit down on the floor or couch in front of you. Put her shoes and socks between the two of you, and have her hand you each shoe and sock one at a time (help as needed) to put on as you ask for them (“Give me sock,” “Give me shoe”). Narrate as you put each item on, as described in Chapter 4. With dressing, have your child hand you each piece of clothing when you ask for it. Help as needed, and narrate as you go.

  When bathing, ask your child for each hand and each foot. Ask for the shampoo and washcloth. Offer each toy before you give it. For each, name objects as you go, offering choices or help as needed. Doing all these caregiving activities in this way gets your child actively engaged in the activities and gets your child attending and responding to you, rather than being a passive participant in the process.

  We have described many ways you can help your child develop a talking body and use her body to communicate, but how should you respond when she does it? With your body and your voice. Follow through on your child’s communication—do the action or give the object requested, and narrate! Add some words to describe what the child wanted, or what he or she was doing, or what was happening:

  • “You want cereal.”

  • “More juice.”

  • “Get the bubbles.”

  • “Bang bang” (when banging toys).

  • “No milk” (when your child refuses).

  • “Blow balloon.”

  • “Up.”

  • “More swing.”

  • “Pour water.”

  In Chapter 13 we discuss in much more detail how to choose your language.

  The ideas listed for this step show how many times an hour you can set up an opportunity for your child to communicate with you by using body language. You might find that your toddler can communicate with you as often as 60 times in an hour of play or caregiving activities—once a minute—if you really slow down and stop handing things over and doing things to your child, and instead involve your child in the activity and draw out nonverbal communication from your child.

  Activity: Choose Certain Gestures to Teach

  We have been discussing at length how and when you can encourage your child’s gestural communication. But which specific gestures are good choices to teach first? In choosing gestures, you will want to consider two issues: (1) what gestures you can easily prompt, shape, and elicit from your child during the teaching/learning phase and (2) what messages the gesture needs to convey.

  There are three main types of messages that very young children tend to deliver in the preverbal communication period: desires for social interaction, efforts to control other people’s behavior (called “behavior regulation”), and efforts to share attention with other people about interesting objects and events—joint attention. We will hold off discussing joint attention until Chapter 10 and focus now on gestures you can help your child learn to convey her desires for social interaction and behavior regulation.

  Young children communicate their desire for social interaction with all kinds of body language. They look intently and smile to invite an interaction or to respond to a fun game. They reach to people they want to play with. They make gestures to cue parents to sing favorite songs, to tickle them, to chase them. They reach for more when their parents start and then stop a social game. They use their voices to call, laugh, or chuckle. They come right up to parents to gain their attention and begin an interaction. They clap, wave bye-bye, give high fives, and make gestures for simple games like peekaboo at parents’ request.

  In Chapter 5, you worked on developing many of these gestures with your child during all kinds of social activities. You very likely have already helped your child develop gestures like looking, smiling, reaching, and carrying out some gestures as ways of beginning a social game with you or continuing these games when you pause. You have also been working on teaching your child the “arms up” gesture when requesting a pickup or hug. Other communications in this group that are often easy to teach young children with ASD are looking and waving during greetings and high five. We will briefly describe how to go about teaching your child each of these.

  To teach your child to look and wave during greetings, begin by developing a very clear routine with your child for “hi” and “bye.” When you go into his room for the first time each morning, and every time you return to him from being away—in another room, on an errand, after a nap—say “Hi!” with a big smile and an exaggerated wave as soon as you see him. Then walk right up to your child and repeat the “hi,” smile, and give a big wave when you are right in front of him and face to face (you’ll have to squat down if your child is standing on the floor). Then take your child’s arm at the wrist or below and help your child wave as you say, “Hi, Mommy.” Do the same thing whenever you are leaving, “Bye-bye.” Say, “Bye-bye!” and wave when you are close to and right in front of your child so you can prompt him, and then, as you walk away, turn back and repeat it just before you walk out. Try to find multiple times each day to repeat these greeting routines when you are approaching or leaving your child. You can also cue other people to use the same greeting routines, and even make stuffed animals do these greeting routines. Always help your child respond, with a wave and with your words, “hi” or “bye-bye.” After a few days of this, continue your routine, but try to provide less of a prompt when you cue your child to respond. Instead of taking your child’s hand and prompting the full wave, try waiting a few seconds and then prompting more from the elbow than from the wrist. Be very consistent with this, offering many practice opportunities a day. It is quite likely that within a month your child will begin to respond to your greetings with a wave, eye contact, and perhaps even the words.

  High five is another gesture that is a good early choice. To teach it, choose a time when your child is sitting facing you and you are at eye level. Offer your open hand to your child, aimed toward one of her hands, saying, “Give me five,” and then with your other hand, take your child’s hand and slap it gently against your palm. Follow with a tickle and then practice it again a few times. Practice every day, multiple times, providing less help each day than the day before: Instead of operating your child’s hand, drop back to her wrist, and then in the next few days drop farther back, to her lower arm. In a week or two you will likely see her responding to your offer of your open hand and your verbal request for “high five”
by placing her hand on yours. Once she places her hand on yours without any help, start to practice the gentle slap that goes with high five by playing a kind of two-handed pattycake. This will very likely evolve into a full high five in the next few weeks.

  Young child’s behavior regulation communications generally have two meanings: requests (“Do this for me”) and protests (“I don’t want that; no”). You have been focusing on developing clear requests for desired objects and interactions through communicative reaching for several chapters now. A second important request that young children need to communicate is to ask for help.

  You can teach your child to hand you things and look at you to request help. We have already discussed the use of baggies, plastic containers, and other barriers you can place around desired objects, so that your child needs to hand them to you, and look, to request help in opening them. Other objects that easily support requests for help are windup toys, flashlights with difficult switches, bubbles with tight lids, juice boxes and food containers that need to be opened, and so forth.

  In all of these situations, you can offer your child the closed, familiar container, which your child will take but will be unable to open. You then offer your open hand (the “give me” gesture), while you ask, “Help?/Need help? Sure, I’ll help you!” Help your child give it to you and then open it fast and give the object back right away (this is the reinforcer for his gesture). Practice this often, with many materials. As your child becomes skilled at putting the object in your open hand, close your hand so your child has to do more to get your help, by putting it against your closed hand. The next step is to have your hand available but on your lap, so your child has to do more to put the object in your hand. As the last step, hold something else in your hands so your child has to do a full approach and offer to you to request your help. Every time your child makes a help request you say, “Help?/Need help? Sure, I’ll help you!” (or the like) and give help right away. Over the course of this procedure, your child may very well begin to imitate your word “help” while she gives you the object with which she needs help.

  All children need to have some way to communicate “no.” Providing a gesture for “no” may replace crying, throwing, or other unwanted behavior that your child currently uses. Teaching children to shake their head “no” is a rather difficult task until they have mastered facial and gestural imitations. The first protest gesture that most toddlers use is to push unwanted things away. You can easily teach this to your child once your child has a clear requesting gesture for desired objects. Pushing away for “no” is easiest to teach during a meal. The meal should be made up of at least one finger food your child likes a lot and one that she does not like (raw carrots, celery sticks, or green pepper slices work well). Begin by offering your child several bites, one at a time, of a preferred food, like a cracker. (“Want cracker? Yes, you want cracker.”) Wait each time for the reach request before you hand it over. Then, after three or four bites, offer the unwanted food instead of the cracker, in the same way you offered the desired food (“Want carrot?”), moving it toward your child. If your child takes it, wait until she starts to put it down or get rid of it. Then take it back, saying, “No, you don’t want carrot. You want cracker.” And freely give a cracker (“Here’s your cracker”). After a few more bites of the preferred food, offer the carrot again. After enough repetitions of this routine, your child will start to push away the carrot before it gets too close—that is the behavior you are trying to teach. As soon as she starts to push it away, pull it back while saying, “No, you don’t want carrot; you want cracker,” and then freely give the desired food.

  Once your child begins to push away unwanted food at mealtimes, you can practice this in toy play as well, occasionally offering an unwanted object (a tissue, an empty small box, etc.) when you are handing toys over one at a time—as you might during a puzzle routine, building block towers, or putting shapes in a shaper sorter—at your child’s reaching request. Teach your child to protest by pushing things away and giving things back to you, always using the “no” script.

  The gestures just described are the first ones that we teach in our intervention work, and they provide a very strong initial foundation for communication.

  Step 4. Persist

  Rationale. With all of these new routines, your child will likely not understand at first what you want, and may fuss or resist because you have changed the way you are doing things. You will help things go smoothly by making it easy for your child to communicate and get what she wants. But persist so that learning occurs.

  Activity: Keep It Very Easy for Your Child

  Here are some ideas for keeping these new routines easy for your child:

  Look for communications (gaze, reach, sounds) you know your child can easily produce.

  Help your child do what you want him to do (reach, point, raise arms).

  Hand over the desired object or activity really fast after your child communicates, so your child quickly learns that this communication—no matter how small—is powerful. It has big effects and brings rewards.

  Be sure that each of these new routines is leading up to something your child wants, so there is a reward at the end. High chair choices mean food! Pointing to toys on the shelf gets toys! Maybe handing over a diaper at the changing table is followed by a favorite tickle game or by a moving mobile or music to see and hear, or by a favorite toy to hold for a few minutes while the diaper is changed. Get a hands-up at the end of diapering before you lift your child down from the table or up from the floor.

  Once you have had a success, keep repeating the new routines. You are likely to see your child learn your new way pretty quickly, and your child will begin to anticipate the routine, your expectations, and your cues. Over time, you will see your child use more and more nonverbal communications in your routines.

  Step 5. Position Yourself

  Rationale. When people communicate, they face each other. Especially for fostering eye contact, you must be facing your child, and your face should not be too far away from the child’s face. Communicating with your child face to face also makes it much easier for your child to get the idea of directing her eyes, voice, and gestures to you, not just out into space somewhere.

  Activity: Find Ways to Position Yourself Face to Face with Your Child and Put the Desired Objects between You

  All the ways we have suggested in Chapter 4 for positioning yourself to promote your child’s attention to you can be used here. Even for a book activity, try to position yourself in front of your child on the couch, on a bed, or on the floor (with the child in a bean bag chair or sitting with his back against a chair or couch) so that you are an active and communicating partner in the activity, not a faceless book-reading machine. When you are in front of your child with books, and draw your child’s attention to pictures with your pointing, words, and sound effects, your child has much more experience of you as the partner in the book activity, rather than being a voice from behind and a hand on the book. Your child sees you form the words and sees you gesture, and begins to understand reading as a social rather than a visual activity.

  Summary of Steps 1 through 5

  If you have followed along and carried out the preceding activities, you will have found a number of ways to increase your child’s nonverbal communication—use of gestures, gaze, and expressions—to communicate his wants, feelings, and thoughts. You will find yourself doing more with your child, and less to or for your child. As a result, you are probably beginning to see your child use much more body language to communicate spontaneously. See if you agree with most of the statements in the following checklist. If so, you are now armed with important skills for helping your child develop nonverbal communication—knowledge that will also help your child develop speech and language. If not, try to experiment with the preceding activities until you have experienced some success with each of the statements in the checklist.

  Activity Checklist: Am I Doing Less So My Ch
ild

  Is Doing More?

  ____ I know how to wait for my child to communicate; I do this many times a day.

  ____ I have found many opportunities during the day for my child to communicate.

  ____ I have made communication opportunities for my child during many different play and caregiving routines, and we do these most days.

  ____ Once I expect my child to communicate, I know how to persist and to help my child so we usually have success.

  ____ I routinely position myself in front of my child, and close to eye level, so it is easy for my child to direct communications to me.

  ____ My child is learning how to use his or her body to communicate in many more situations at home then he or she used to.

  What You Can Do to Increase Your Child’s

  Understanding of Others’ Nonverbal Communication

  Children with autism are often remarkably unaware of the meaning of other people’s nonverbal communications. It is not unusual to see a young child with ASD who does not understand the “give me” gesture of an open hand or the meaning of a point. Your child may not understand the significance of an angry or sad facial expression on another person. Sometimes people interpret the child’s lack of interest or response to others’ expressions as a lack of cooperation, but many children with ASD just do not understand what is being asked. We need to teach young children with autism to pay attention to people and what they are doing and help them understand what others’ body language means. Children without communication problems seem to learn this effortlessly. For children with autism, however, we need to throw a spotlight onto other people’s body language so it really stands out for them. How can you do that?