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

by Rogers, Sally J.

  Here are three steps you can take:

  Step 1. Exaggerate your gestures.

  Step 2. Add predictable steps.

  Step 3. Provide needed help.

  Step 1. Exaggerate Your Gestures

  When you are playing with toys with your child, highlight your own gestures in your toy routines, along with your speech. Ask your child to give you pieces, to pick up pieces, or to put them in, by extending your hand for the pieces or pointing to where they go while you speak. Use your hands and body as well as your words to convey this, and then help your child follow through. Use hand and body gestures that are relatively easy for your child to imitate, such as reaches, points, open hands, and pushing away—gestures that can easily be incorporated into your joint activity and sensory social routines.

  • Object-based gestures: showing, pointing, giving, putting in/taking out, turning, pushing, crashing, rolling, banging

  • Sensory social gestures: showing, pointing, clapping, patting, jumping, creepy fingers, tickling, stomping

  Have your child help to set up or clean up an activity or to take the next turn, using your body to communicate this by showing her how, by handing pieces, pointing, using hand gestures. Ham it up! Help your child follow through; be sure your child achieves her goal as soon as she follows through; and give your child lots of praise for following through. All of your routines are vehicles for body language.

  Here are some ideas:

  When dressing, show and label each piece of clothing before you put it on. When you involve your child in helping or giving, use big gestures like holding your hand out for your child to give.

  When diapering, show the diaper and name it before you give it to your child to hold. When you ask for it back, use a big gesture to get it, and a give the child big “thank you” afterward.

  At mealtimes, give your child a few bits of food on the high chair tray, and then point to one for him to eat: “This one—get this one!” Help your child follow your point to get it. If he doesn’t, then next time, give just one and point to that one before your child gets it. That way, your child has to be following your point.

  At bath time, ask for a hand or foot to wash by pointing, asking, and holding your hand out. Ask for the bath toys at the end, and point to them to be put away, one at a time.

  During sensory social games, exaggerate the gestures for chase, tickle, swing, spin, “Itsy-Bitsy Spider,” and other songs and finger plays. Get down on eye level, face your child, make a big excited smile, position your hands dramatically, and then start the game with big energy. Help your child anticipate what is going to happen from your face and body posture, and build her excitement and anticipation.

  Step 2. Add Predictable Steps

  It will help your child a great deal to understand your gestures in routines if you add routine steps and sequences to the play and care routines, and then use a gesture or other nonverbal action to cue your child to take the next step. Carry out your activities or games in predictable steps, repeating the routine in step-like fashion a few times in a row, so that your child understands the steps of the routine and can anticipate what is next. Then the next time you repeat the sequence, pause at one of the steps, use an exaggerated gesture, and wait for a response.

  Lindee has built a very predictable routine around bubbles for her 18-month-old son, Anthony. The bubbles sit on a bookshelf above Anthony’s reach, along with other favorite toys.

  Setup: First (Step 1), Lindee says, “Want to play?” while she offers her hand. He takes it, and they walk together over to the bookshelf. Step 2: Then she turns to face him, and she waits for him to extend his arms and look at her for a pickup. If he does this, she says, “You want up,” and picks him up. If he doesn’t, she extends her arms and says, “Want up?” Then she waits for his arms and eyes before she lifts. Step 3: She lifts him toward the shelf, and he reaches towards the bubbles. Step 4: With her free hand she picks up the bubbles, saying, “You want bubbles! Here are the bubbles,” and hands them to him. She then puts him down. Step 5: He tries to open the bubbles but cannot, and she extends her hand: “Need help?” He looks at her and puts the bubbles in her hand. Step 6: “Open. Open bubbles,” she says as she opens them. She pulls out the wand and positions herself to blow.

  Theme: Lindee looks right at Anthony’s eyes, says, “Blow bubbles?”, and makes a little blowing gesture with her mouth. Step 7: Anthony looks directly at her, smiles, and blows. She immediately blows a stream of bubbles for him. He smiles, reaches for the bubbles, and bats them.

  Variation: Step 8: Lindee catches a big bubble with the wand, holds it out to Anthony, and says “Pop?” He points his finger and pops the bubble as she says “pop.” Step 9: She extends her finger and pops another as he watches, which he then imitates, poking while she says “pop.” Step 10: The bubbles are all done, and Anthony looks around, sees the bubble container right there, and picks it up. He hands it to Lindee with eye contact, and the process begins again.

  Look at this episode. It takes 2–3 minutes, and inside this routine are 10 different communicative steps. Anthony produces one or more nonverbal communications inside each step, several each minute. For a child who 3 weeks ago produced absolutely no communicative gestures, this is a huge transformation. And the set routine that Lindee uses to do this simple game helps Anthony anticipate each next action and cue her for it. He is now an active communicative partner, fully engaged and co-constructing each step of this simple routine. If a simple bubble routine can foster so many communications, imagine how much can be done with a more elaborate routine like a meal or a puzzle.

  Here are some examples of talking body signals you could use throughout your interactive routines during the six target activities (toy or other object play, social play, meals, caregiving, book activities, and household chores):

  Use a hand or body movement to “ask” whether your child would like to continue a song or game.

  Use eye contact and an expectant look to “ask” whether your child would like to receive or take an object, cup, or food item.

  Use a sound effect to cue the child that you are about to create an action with an object.

  Smile or laugh and wiggle your fingers to indicate that you are about to tickle your child.

  Extend your hand to indicate that you are about to play a physical game.

  Mimic the blow gesture to indicate that you are going to blow bubbles or blow up a balloon.

  The example with Lindee and Anthony illustrates one of the reasons we place such importance on using the structure of joint activities for play and for care routines. It is much easier for your child to understand what you are indicating and saying if she already knows what will happen next. So, as much as you can in all your daily child routines, think about a consistent setup, theme, variation, and closing. This is every bit as important for bathing, diapering, dressing, meals, and so forth as it is for object and social play. If you need a reminder, go back to Chapter 6 and review the section on joint activity routines.

  Step 3. Provide Needed Help

  An effective way to teach your child to “ask” for help, by giving materials to you or by looking at you for help, is to use something that is a little too difficult for your child to do alone. While you are providing the help your child needs, you will also be using different gestures to help your child learn to understand nonverbal communication.

  Here are some possibilities:

  For a child who likes puzzles, you could use a puzzle that’s a little too difficult for your child to complete alone. As you and your child are completing the puzzle together, point to the holes for each of the pieces, while saying “It goes here! Here!” When your child follows your point, then the pieces go in. Voilà—there is the reward for noticing and following your point!

  You might put the puzzle pieces for a favorite puzzle in a plastic container or bag that your child cannot open himself. Give him the puzzle and container of pieces, and wait for him to need your he
lp. When your child realizes he can’t open it by himself, ask if he needs help, using an open hand to request it along with words. Then, when he puts it in your hand, open it and give it right back. His reward for responding to your open hand and making the request is getting access to the pieces.

  You might start a windup toy that your child loves to watch. Don’t wind it up too much! When it runs out, wait to see what your child does. She may look at you or give it to you. If so, say, “You want more?” as you wind it up and do it again. If not, ask your child to give it to you by using an outstretched hand and words. Then, as soon as your child gives it to you (even if you need to help), wind it up fast and get it going again.

  In addition to these activities in which you are providing help, sensory social routines can be used to teach children the meaning of nonverbal communication. When you are playing games like chase/“I’m gonna get you,” airplane, “Ring-around-the-Rosy,” pattycake, or peekaboo, highlight your expressions, gestures, and body movements, so that your child learns the relationships between your movements and the game. Your movements and words will “label” the game for your child. Playing games and performing caregiving activities in a kind of ritualized way—the joint activity structure—with toys, with sensory social routines, with diapering/dressing/bathing/bedtime routines, and with mealtime routines will help your child learn to associate your gestures, facial expressions, and words with the routines. You are teaching your child how to read and interpret the meaning of your face, gestures, body movements, and words.

  Planning Activities to Increase

  Nonverbal Communication

  It might help you get into the swing of incorporating all the preceding steps into your daily routines if you use the two forms discussed in this section to plan. First, think of an object-focused joint activity and a sensory social routine that your child really enjoys doing with you. Imagine going through the steps and sequences of that routine. What gesture could your child use to request these preferred actions, movements, or consequences from you? Look at the two examples in the form on pages 160–161, and then try filling out a few more activities to practice with your child this week. Make extra copies of the form to record information about additional activities besides those listed on the left, if you like.

  For some parents, it is helpful to dissect the day into the six types of play and caregiving activities or routines that occur throughout the day, and then to break down the joint activity steps that each routine involves. When you do this, you have a framework for thinking through the different gestures, actions, facial expressions, and words that go with those steps. The form on pages 162–163 provides you with some examples that other parents have developed. Try one or more of these out, varying the steps to fit your own home and materials. Be sure to narrate each step, provide clear gesture cues, and cue your child to take some active role with every step. Next, try writing out a “script” for yourself for an activity in one of the form’s blank rows. Then try out the script during the activity, and see if it helps you break down the activity into simple steps that each contain a simple narration and a nonverbal communication for you and for your child (see the case example of Lindee, Anthony, and the bubbles, above). You may be surprised by how quickly your child begins to participate in each step and how much more your child begins to communicate with his or her body.

  If you have followed along and carried out the preceding activities, you will have found a number of ways to increase your child’s awareness and understanding of your nonverbal communication—your use of gestures, gaze, and expressions. You will see your child’s understanding in the gestures, sounds, and looks he uses to respond to you. 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 learn to understand nonverbal communication—knowledge that will also help your child learn to understand and develop speech and language. If you do not feel successful yet, 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 Helping My Child Learn to Read

  My Body Language?

  ____ I have found many opportunities during the day to highlight my body language for my child.

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

  ____ When my child uses a nonverbal cue (no matter how small), I try to follow through, so my child will learn that he or she can talk with the body to get what’s desired.

  ____ I have figured out ways of using my own body to communicate during play, and I exaggerate my expressions and gestures so my child will notice them.

  ____ When I communicate to my child by using body language and simple words, I know how to persist and to help my child respond 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 see my communications.

  ____ My child is learning how to “read” my body language in many more situations at home then he or she used to.

  What if your child doesn’t start signaling you in desirable ways? Bethany’s mother came into a parent coaching session with this concern: “The only messages Bethany communicates to me when I try to wait for a signal are crying and screaming. She tries to grab an object as soon as it is visible, so I can’t figure out how to hold it back so she can provide me with a gesture. What should I do?”

  The therapist knew Bethany well enough to know that she did not like change. The therapist suggested that, rather than holding objects back, the mother try giving her daughter items in containers, plastic zipper bags, or jars that she can hold on to but cannot open. This way Bethany could have some control over the object, but would still have to signal that she needed help. To help Bethany request help with a gesture rather than by crying, her mother needed to have her hands right in front of Bethany’s so she could quickly ask her if she needed help, and then open it quickly for Bethany and give the bag right back to her before Bethany would have a chance to start crying.

  A second strategy the mother began to use was to use lots of baggies—just two or three crackers in each (for snacks), one toy in each (for toy play with little objects), one color in each (for crayons)—in activities when there were lots of chances to practice. Having this happen frequently also helped Bethany get used to the new demand and get over crying. This took some time, but her mother knew from experience that Bethany did best at learning new things when they were repeated frequently. Practice over time developed the skill into an automatic, independent behavior. And there was little frustration, since Bethany reached her goal quickly and easily—getting the item out of the container/baggie when she handed it to her mother.

  The mother also tried a suggestion we have discussed above: She offered Bethany something she liked before she started to fuss. She held out a preferred toy, as well as a nonpreferred toy, slightly out of reach. When Bethany reached for the preferred toy, her mom quickly gave it to her, so she could learn that she could reach for things instead of only fussing when she wanted something.

  From An Early Start for Your Child with Autism. Copyright 2012 by The Guilford Press.

  From An Early Start for Your Child with Autism. Copyright 2012 by The Guilford Press.

  How do you build on success? For Robert, who learned how to gesture to get items from a bag very quickly, his dad “upped the ante” and used the same format to teach additional gestures. Robert’s father added a second expectation: When he opened the bag upon Robert’s physical request, he held up the two objects inside and offered them to Robert, who needed to point to the one he wanted. Robert reached for the desired object, and his dad said, “Point,” while modeling a point and then shaping Robert’s hand to a point as he touched the object. As soon as Robert touched the object with his point, his father gave it to him.

>   Chapter Summary

  Our first way of communicating is with our bodies and facial expressions. Long before speech emerges, most young children learn that people use body signals to send messages back and forth. They become quite skilled at communicating many kinds of messages nonverbally, before they can say their first words. Speech develops later, out of an elaborate nonverbal communication system. As you help your child with autism learn to use his or her body, eyes, and voice to send and understand simple communications, you will gradually continue to add expectations and opportunities for gestural communication, starting with easy or familiar gestures for your child to use and slowly teaching some new ones. You are teaching your child a critical life lesson about how we communicate and interact with one another, which is not by grabbing, screaming, crying, or manipulating bodies until a need is met. Instead, we send messages to others about what we want, feel, and want to share, and we attend to their messages as well. Our messages are about the thoughts, feelings, desires, and needs that motivate us to approach, engage, and converse with others, and we do this through our facial expressions, gestures, postures, eye contact, and finally words. Your child’s spoken language will develop out of this framework.

  8

  “Do What I Do!”

  Helping Your Child Learn by Imitating

  Chapter goal: To encourage you to imitate your child’s sounds, gestures, facial expressions, actions, and words, and to teach your child to imitate yours. Children learn by watching others and doing what they do.