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

by Rogers, Sally J.

  Step 3. Teach Your Child How to Point to Objects

  to Share Experiences

  Rationale. Pointing typically develops after giving and showing. It’s an important tool because your child can use it to share interest with you in objects and events that he is not touching—a bird in the sky, the lights overhead, a dog on a leash, a lion at the zoo. It is another means to comment about something your child sees, and therefore another route to a learning opportunity. As with the other gestures, it is easiest to teach your child first to comprehend pointing and then to produce it.

  Activity: Help Your Child Learn to Follow a Point

  Here are suggestions for teaching your child to follow your point:

  To teach your child what pointing is all about, use your finger to point to, tap, and draw your child’s attention to an object very near your child—something your child is looking for or may want. As you point, say something like “Jamie, look. A cookie!” For instance, point to pieces of food on the table in front of your child that she will want to pick up. Point to a puzzle piece that your child will want to pick up and put in the puzzle. Point to the place in the puzzle where the piece should go (“Jamie, it goes here!”). When your child follows your point to the object, help your child as needed to achieve her goal with the object (this is the reward for following your point). For an object your child wants, instead of giving it, put it down and point to it (“Here’s the car!”).

  If your child does not follow your point, reposition yourself, the child, or the object to help him complete the action. Point to something that is close by, between you and your child. Keep pointing while your child picks up the object, so that your child sees the relationship between your point and the object placement.

  Before using the give-to-me gesture (opening your hand while saying, “Give me”), point to the object you want your child to give you. Point, direct her attention to the object, and then turn your hand over into a “Give me” gesture and help your child give you the object. Give your child a lot of experience with following your points in all kinds of settings. Within a few days, you will probably see your child starting to follow your point and understanding what it means. When your child consistently follows your point, you know that she has learned its meaning.

  As your child learns to follow your point and touch, start to put more physical space between your point and the object you are pointing at, as you continue to say something like “Steffy, look! The baby!” Start by having 6 inches of space between your finger and the object. Later increase it to 12 inches, then 2 feet, then 3 feet (things on the floor, couch, or bed are appropriate for working on longer distances). Now you know that your child knows that pointing directs his attention to something important. Make sure your child gets the object after looking!

  Position objects or toys your child really likes out of reach and point to the objects, saying “Timmy, look! The jack-in-the-box,” waiting until your child looks at the object before getting it down and giving it over.

  There are many opportunities in your existing routines to help your child follow your point. During your turns, think about how you can vary the activity by pointing to different things your child might attend to.

  Here are some ideas for different ways to demonstrate pointing:

  During toy play, use toys that have multiple pieces, so that during play you can point to where the next item might go—the place for a puzzle piece, the top of the tower for block stacking, the hole for the peg or shape that matches. Or hide the last piece on the floor nearby, and when your child is looking for the last piece needed to complete it, say, “[Name], look” while pointing at the needed piece.

  Point to button-activated toys, so that when the button is pushed, the fun effect will happen.

  Use picture books with large, clear pictures (but not too many on a page), because there is something on each page to point to and show your child.

  Try toys that might be a little difficult for your child to use on her own, so that your pointing to show how to operate them will help your child succeed.

  Point to things you know your child will likely want in all kinds of settings—to cereal on his high chair tray, to the next ring that goes on the ring stacker, to bath toys.

  Activity: Teach Your Child to Point to Request Objects

  Now it’s time to teach your child to point! To learn pointing, your child needs to be able to reach with her hand consistently toward distant objects to request them—to indicate choices and desires without having to touch the objects. You have started working on this in Chapter 8.

  Here are suggestions for teaching your child to point:

  If your child can use a reach to communicate a request (rather than as a way to grab), hold the object slightly away from your child (e.g., “Do you want a drink?”) to elicit your child’s reach. Then very quickly mold your child’s hand into a point (“Point; point to cup”), and bring the tip of your child’s index finger over to touch the desired object. Then immediately give the object (“Here’s the cup!”). It works a little better at first if you hold the object in your less dominant hand and shape your child’s point with your dominant hand. Don’t worry about molding a perfect point. Just work toward extending your child’s index finger; with time and practice, you can help your child close the other fingers.

  Pointing is a challenge for children with ASD to learn, and you will want to help your child practice many times a day at times when your child really wants something (it’s the getting it after pointing that rewards your child’s point and builds the skill). Practice especially at meals, during object play, and during bath time. Try to practice it several times in each activity in which your child is “requesting” an object with her body. Once you give the object to your child, let her have it for a few minutes. You don’t want to take it away and ask for another point; that would be very frustrating for your child!

  You should see, over time, that your child begins to extend the index finger without your having to shape it first. That’s great! Don’t expect a perfect point. It will evolve over time. A spontaneous approximation to a point, without your hand molding, is much more important than a perfect point.

  After your child is pointing spontaneously to objects within reach, you want to teach your child to point “through the air,” without having to touch the object. This is called a distal point, while the closer one is a proximal point. To teach a distal point, hold the object a little out of your child’s reach. As your child extends the point toward the object, give it to him without having your child’s pointing finger touch it. Start with a 4- to 6-inch gap. Once your child is pointing easily to things just out of reach, hold it back more—12 inches. Then farther—18 to 24 inches. Now your child has a distal point. Now present things from the side or above. Help your child point to things in all directions.

  Once your child has mastered the distal point, provide a choice of two objects while naming the objects (“Andrew, car or truck?”), so your child can point to choose. This works well for larger things—cereal boxes, shirts, milk or water bottles, bath toys, and so on. Pointing to choose is a very functional skill. Be sure to name the choices; this is a great vocabulary builder.

  As with the giving and showing gestures, we teach pointing first without expecting eye contact. But once your child is using pointing easily and consistently to request, start to expect eye contact after the point gesture before giving your child what she is requesting. This requires that you be in front of your child and offer things directly in front, so it is easy for your child to make eye contact. Once your child points, hold the object back and wait patiently for your child’s eye contact before you release the object. If you need to, call your child’s name or make a little sound to encourage her to look at you. Slowly increase expectations that eye contact will follow pointing to an object routinely.

  Here are some specific ideas for teaching pointing to request objects:

  You can provide your child with lo
ts of opportunities for practice by controlling multipiece materials, such as puzzle pieces, pieces for a shape sorter, pegs for a pegboard, or Legos, Tinkertoys. Have your child request several of them as you offer them by pointing.

  Putting little round dots or stickers on objects as “pointing targets” helps some children learn pointing more quickly. Each time, they will touch the dot with their point. After they learn to do this spontaneously and it is well established, you can peel off the dots, and they will continue to point.

  Activity: Teach Your Child to Point to Show or Comment

  Children can use pointing to express several meanings. It can mean “I want this” (requesting). It may mean “Do this” (regulating another person’s behavior). It may mean “Attend to this” or “I’m interested in this” (the showing or commenting function). The commenting function is really important for language and vocabulary, as well as social development. It is how typically developing children get parents to label objects of interest. We have already talked about teaching pointing for requesting and teaching giving to get help or to get someone to remove something. Now we shift to helping your child learn to use pointing and gaze as a way of showing or commenting.

  Here are suggestions for teaching your child pointing to show or comment:

  Pointing to show is a more complex way of showing. Your child needs to have mastered showing on request before you start to work on pointing to show. One of the best ways to encourage pointing to show or comment involves developing commenting routines around books that have several very clear pictures on a page, or picture albums, or puzzles with pictures. In any of these routines, while facing your child, point to each picture in turn. When your child looks at the picture (short pause), name the picture (you have done this earlier, in teaching your child to follow a point). When you do this, you are modeling pointing to show/comment. When your child looks, make interesting sound effects to add to your child’s engagement with the activity. Be sure your child is attending to each picture you point to. When your child’s interest wanes, the activity is finished. Do the same books in the same way for a week or so; it builds up your child’s learning about the routine, and your child’s interest and attention will likely expand.

  Once your child enjoys and really understands this activity as a pointing and naming activity, you will begin the variation. Be sure to be in front of your child. Begin the activity, point to the picture, but do not speak. Don’t name the picture. Just wait, ready to speak. Your child will likely look up to you to see why you are not naming. When your child looks at you, name the picture and make the sound effects. If your child doesn’t look, refer back to the ideas in the preceding section. Do a few more pictures in the regular way to establish a pattern or theme, and then do this waiting variation again. Continue this way for a few days. You will probably see your child learn to use looking to cue your speech. You have taught the child to use eye contact as a way to get someone to produce a label—that is, as a way to initiate commenting.

  The next step involves teaching your child to use her own point to get you to comment. Position yourself in front of your child. Now, rather than your pointing to the pictures, let your child do the pointing. If she already does that spontaneously, great. Otherwise, take your child’s hand and help your child point to each picture while you provide the word and sound effects right after the point, just as before. Once this becomes a set routine, provide less and less help with the point, until your child is leading the activity by pointing to each picture and you are responding to your child’s point with a word.

  Once your child is initiating pointing to pictures for you to name, begin the activity, and when your child points to the picture, do not speak. Just wait, ready to speak. Your child will likely look up to you to see why you are not naming, and when your child looks at you, you name the picture and make the sound effects. Do a few more pictures for your child in response to pointing without requiring eye contact, and then do this waiting variation again. Continue this way for a few days. You will likely see your child learn to use pointing and looking to cue your speech. You have taught the child to use point and gaze as ways to get someone to produce a label—that is, as ways to initiate commenting. Your child is now combining pointing and gaze both to initiate and to comprehend commenting, just as it occurs in typical development.

  Generalize this skill by playing the point-and-name game in many situations. Bathtub toys allow for the point-and-name game. Crackers in the high chair work fine if you line them up and point and count. You can also do this with blocks in a line on the floor, with little cars, with objects on the coffee table, or with utensils at the table.

  Show your child objects outside by pointing and naming. Help your child show you interesting things outside—a flower, a dog, a bird, a sprinkler running—with the point-and-name game. (Remember, the showing routine is also a naming routine.) As you do pointing and showing in more and more situations, you will start to see your child spontaneously point to something, in order to show you something for you to name. This is a huge step and opens up a world of sharing thoughts, feelings, and words for your child.

  Summary of Step 3

  If you have followed along and carried out the preceding activities, you will have taught your child how to give, show, and now point to objects across different communicative functions (to request an object, to ask for help, to make a comment, to share an experience). See if you agree with most of the statements in the following checklist. If so, you are now armed with important skills for expanding your child’s joint attention skills. If not, start experimenting during play and caregiving routines until you have found some methods that work for each statement.

  Activity Checklist: Am I Teaching My Child to Follow My Point

  and to Point to Objects?

  ____ My child is able to follow my point to attend to, place, and pick up toys, food items, or other objects.

  ____ My child is able to make a point (with my help, if needed) when I offer an item or a choice between objects.

  ____ My child is able to follow my point to pictures during book routines.

  ____ When I point to a picture and pause, my child looks up at me during book routines.

  ____ My child points to pictures and looks at me during book routines.

  ____ I feel confident that my child and I have the tools to share activities with each other.

  What about Andrew? Andrew loves balloons, so his parents think of several ways to work on pointing during this activity. First they start the usual routine or theme in which Andrew communicates to them (by blowing) to blow up the balloon and let it go flying around the room. After a few instances of this, his parents vary the game by kneeling next to Andrew so that he won’t see where the balloon lands right away. Since his parents know where the balloon is, they are able to point to its location and help Andrew follow their gesture to pick up the balloon. They make sure he doesn’t put it in his mouth (to prevent choking) by being right by his side. Instead, they point to the balloon in his hand and ask him to give it to them. Since his parents have been teaching Andrew to give objects, he doesn’t need to see their outreached hand to understand their request and is able to give the balloon. His parents repeat the new game of Andrew asking them to blow up and let go of the balloon, waiting by his side for the balloon to land, and then pointing to its location. It works so well that Andrew starts looking at his parents before the balloon even lands for their cue.

  Next, his parents move on to teaching Andrew how to point. His mom blows a little air into the balloon and then points to the slightly inflated balloon, asking Andrew, “More blow?” Andrew makes a sound in response, so his mom blows a little more and then stops. This time she helps him point while making a sound, and then she blows two more times into the balloon before stopping. Again she points to the balloon, asking Andrew, “Blow?”, and then takes his hand to point to the balloon before continuing to blow. She does this several more times until the balloon i
s large enough to let go. She releases the balloon, and Dad points once Andrew looks at him for where the balloon has landed. When Andrew gives her the balloon, Mom goes through the routine of blowing a little air into the balloon at one time before having Andrew request more by pointing to it. Although he doesn’t point perfectly, Andrew does tap the balloon with his finger, and that’s good enough for Mom and Dad!

  What about Joshua? Joshua has several train books that he and Mom usually look at when Mom is getting him ready for bed. Mom places the book between them on the bed and points to pictures that she notices Joshua looking at—“You see the caboose,” or “Yeah, there’s the smoke.” After a few more pages of commenting on what Joshua sees, Mom points to a different picture on the page and says, “Joshua, look! There’s the black train,” and makes a train whistle noise to add effect. He looks up at her, so she points to the train on the next page and makes the whistle noise again. She continues pointing to the pictures Joshua sees, as well as those she wants to show him.