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

by Rogers, Sally J.

  Closing/transition: As your child’s interest begins to wane, or the play is feeling too repetitive, suggest that it is time to finish and offer the cleanup box. If your child does not want to clean up, offer another choice of theme in the box, and see if your child will make another choice. If so, then put the new materials down and encourage your child to help clean up the pretend play set so she can move to something else.

  Here is a list of pretend themes and related actions, in case you need some ideas:

  Having characters go to bed: Take off clothes, put clothes in hamper, put on PJs, brush teeth, pick out book, sing lullaby, kiss/hug good night, turn off the light.

  Having characters wake up: Get dressed (take off PJs, put PJs in hamper, put on clean clothes), wash face, brush teeth, comb hair.

  Mealtime: Set table, pour juice, put food into plate/bowl, eat, drink, wipe face, clean up.

  Running errands: Pretend to get in the car and go to a post office, grocery store, toy store, or restaurant. Go through some steps, then go home (cardboard boxes make good “cars”).

  Going on an outing: Go to preschool, church, doctor/dentist appointment, play date, birthday party, Grandma’s house, zoo.

  Playing at park: Go on swings or slide, climb up–down, build sand castle.

  Giving/taking a bath: Fill up tub, pour bubbles, wash body parts, rinse off soap, dry body parts.

  Playing out stories: Act out the themes from your child’s favorite books, movies, and classic fairy tales after your child knows the stories well.

  Going to the doctor’s office: Go in the door, sign in, get weighed and measured, go into the exam room, sit on the table, have the doctor listen to heart and chest, look in ears and mouth, check reflexes in feet.

  Going to the dentist: Go in and sign in, go to the exam room, sit in the chair, put on the bib, tip back a little, open mouth, look in with a mirror, tap some teeth, rub the gums, squirt water in, sit back up, take bib off, get new toothbrush.

  Note: Not only can you and your child play out these themes yourself with props from home, but as your child becomes a more advanced player, you can play these themes out with small doll figures, houses, cars, and props. Now the little figures can go to the zoo, the doctor, camping, to the park, to the farm, and so on, using commercial toy sets for props. You and your child can act out themes from favorite books or movies this way. Helping your child learn to create these stories with doll figures is great preparation for thematic play with other children.

  Activity: Use Pretend Play to Help Your Child

  in Real-Life Experiences

  Amazingly, this process of playing out scenes from life will also help your child understand more aspects of real-life experiences. As you play these out, you may find that daily routines that are difficult for your child (toothbrushing, bedtime, haircuts, etc.) become easier as your child learns and practices the steps and narration in play. Pretend play offers a way to prepare your child for a new experience that has the potential for being difficult or scary! Creating a “script” for what your child can expect in a new experience is called priming and is a research-based strategy for familiarizing a child with the skills and behaviors to use inside a sequence of events.

  Here are suggestions for priming your child for a first trip to the dentist, using pretend play:

  Two weeks before a dentist visit, start to play out a dentist visit with Winnie-the-Pooh, Mickey Mouse, or another favorite figure of your child’s—preferably one that has teeth or at least a mouth that opens. Play out with your child on the character the main simple steps—the chair, the bib, opening the mouth, the dentist looking at teeth with a mirror and touching them with a stick, and getting down. Start very simply, with the chair, the light, a bib, and a tongue depressor. Call it “playing dentist.” Play it out several days in a row with the figure, having your child take a turn acting as the dentist with the doll or animal, and also with you.

  As this play theme becomes familiar, add a couple more steps, and also play it out with another person if possible. If Mom has been playing this out, Mom can recruit Dad or Grandma to be the patient. Be sure to cheer for the “patient” when the “exam” is finished. As the theme gets to be familiar, use turn taking to have your child be the “patient” sometimes—to sit, put his head back, put on the cloth, open his mouth, and let you touch a couple of teeth with the tongue depressor. Then take off the bib and cheer. Your child now has a “script” for the dentist’s office and is prepared for what will happen.

  A few days before your scheduled visit, ask the office if you can come in for a “preview visit,” with an assistant playing out the steps you have practiced on you and then on your child, so your child sees the familiar script in the new place and knows what to expect. Take your camera and your child’s favorite doll or other figure with you! When you go there, have the receptionist greet your child and your child’s toy, and take a picture of the receptionist. Then walk into a dental suite, look at the chair, and perhaps put the toy figure in the chair. Take a picture of the chair. Have the assistant show your child how the chair goes up and down with the figure in the chair; then take a ride on the chair yourself, holding your child and the toy if she is relaxed about it, or just with the toy if your child seems anxious. Then sit in the chair holding your child and the toy, lean back, and have the assistant look in the mouth of the figure with an instrument and then in your mouth. Get a picture of the assistant looking into the mouth of the toy. If your child is relaxed, you can encourage your child to let the assistant look in her mouth. Try to get a picture of this. Then be finished and cheer the child and the toy. Get a picture! If it is possible, get a picture of the dentist who will see your child. Then have the celebration that you have practiced in play. Take a picture!

  Print out the pictures that you have taken, and make a little book with the pictures in order. Read it with your child to your child daily before the real visit. Be sure to end the book with the celebration picture and story.

  After the event is over, continue to play it out in pretend play, that day and here and there in the days after that. You can add more and more props (mask, cup, light, etc.), and it can be a theme for your child to choose from for pretend playtime.

  As your child has new life experiences, they all become possible themes for pretend play, both for preparation and for review play afterward. Critical social events are important themes for pretend play: birthday parties; doctor and dentist visits; getting “owies” and having them washed and bandaged; playing circle games with others; sitting in restaurants; going to the library for story hour; family and holiday routines; going to religious services—whatever repeated events you do with your child or events that cause your child anxiety. As you expand the number of props, figures, and actions, you will also naturally expand your language, and your child will be learning both the actions to anticipate and the language that goes with each event.

  Summary of Step 5

  This step has focused on helping your child learn to create scenes from life by combining pretend play actions into logical sequences. You have been building up the number of combined acts in your child’s pretend play themes. At some point your child will know the whole “script” for each of these themes, from beginning to end, and will be able to participate in playing them out with you, with brothers and sisters, and with other children at preschool and at home. See if you agree with most of the statements in the following checklist. If so, you are now armed with all of the necessary skills for teaching different kinds of symbolic play to your child. If not, start experimenting during play and caregiving routines until you have found some methods that work for each statement.

  Activity Checklist: Can My Child Combine Symbolic Play Actions?

  ____ I have ideas for what real-life events and familiar stories my child and I can act out during play.

  ____ I have the necessary props, dolls/animals/figures, and other objects for my child and me to re-create the real-life event.


  ____ I know how to adapt the joint activity routine to help my child combine several pretend play actions in a sequence.

  ____ I know how to use other strategies (make a preparatory visit, create a storybook to build the script, act out the events with characters or ourselves) to help my child understand and carry out play actions inside real-life events.

  ____ My child can easily combine different play actions in my home and in at least two other community settings.

  What about Gracie? Gracie’s mom likes the idea of including dolls and animals inside other daily routines. Right now Mom is working on potty training with Gracie and thinks that having her Yo Gabba Gabba! dolls also use the potty might motivate her daughter to do the same. Since Gracie can already carry out the actions with the objects on her mother, herself, and her dolls, Mom moves straight to having a doll act as its own agent. She speaks for the doll as it walks into the bathroom (“I have to go potty”) and completes each step that’s part of the potty-training routine (“Pants off,” “Underwear down,” “Help me sit on potty, please,” “Go pee-pee,” “Wipe-wipe,” “Panties up,” “Flush toilet,” “Wash hands”). Mom congratulates and praises the doll for doing each step while Gracie watches. Mom even hands a little reward to the doll for cooperating—a ribbon to put in its hair (Gracie loves ribbons and barrettes in her hair). Next Mom has the doll say to Gracie, “Your turn,” and through Mom the doll helps Gracie move through the potty-training steps. The doll then offers Gracie a choice of which ribbon to put in her hair. Gracie is very excited to have a pretty new ribbon to wear, and happily gathers up her dolls at the end of the routine.

  Chapter Summary

  Pretend play is a crucial developmental skill for all young children. It fosters thinking skills, language skills, and social skills. In particular, pretend play helps all children understand social expectations and social roles; it helps them learn the “rules” that underlie social events. Pretend play can also be used to prepare children for real-life events. Once your child understands pretend play, has some language, and can spontaneously come up with pretend play actions, you can help your child use pretend play to practice upcoming events. Pretend play routines, including storyboards and storybooks, can be used to practice novel situations—a first airplane ride, a trip to the hospital, the first day of a new group program, a birthday party, going to church, a new baby in the family, adjusting to a new pet. They can help your child become less afraid of certain triggers: the wind, hair washing or haircuts, the vacuum cleaner, the lawn mower, the shower. Symbolic play can also be used to help your child practice the rules for group games and activities. Learning the rules for “Duck, Duck, Goose,” circle time at preschool, “Musical Chairs,” “Stop and Go,” and so on can be fun and extremely helpful for your child when you play these out with your child and also play them out with dolls.

  Practice birthday parties, dentist visits, greetings, and other routines between dolls, so your child can learn the social scripts that go with these routines. Practice what a child should do when a friend gets hurt while playing: what to say, what to do. This is how your child will learn how to respond appropriately to others. Your child will learn these from your using the imitation and language skills you are teaching (which is how all children—and adults!—learn social scripts). Thus pretend play is as useful for young children with autism as it is for children without autism: It helps them make sense of real life and play with other children.

  ________________________

  1Kasari, C., et al. Language outcome in autism: Randomized comparison of joint attention and play interventions. Journal of Consulting and Clinical Psychology, 76(1), 125–137, 2008.

  13

  Moving into Speech

  Chapter goal: To help you support your child to use and understand speech through active social interaction with people, their facial expressions, and their gestures.

  WHY SPEECH DEVELOPMENT IS SO IMPORTANT

  Speech is our main mode of self-expression and of social interaction. It is the skill that parents of young children with ASD are typically most worried about. You may very well have turned to this chapter before reading the rest of the book. Or you may wonder why we’ve waited so long to discuss this critical topic. It’s because everything else we have discussed so far is part of the foundation for speech development in young children. Just as children have to sit up and stand before they can walk, they have to be able to attend to parents, imitate their sounds, communicate with gestures, and shift their attention from objects to people and back again before they can learn the meaning and use of speech. So if you have not yet read Chapters 4–12, please do so before trying to apply the strategies in this chapter.

  Learning to talk involves two skills: using words to convey desires, experiences, feelings, and thoughts to other people, which is called expressive language; and understanding what others are saying, which is called receptive language. Young children with ASD often have much difficulty learning to understand and use speech, but most are quite capable of learning to communicate with words, with the help of their parents and professionals.1

  What’s Happening in Autism?

  Although not all children with ASD are delayed in developing language, most are. Many children struggle with learning to use speech, but all are helped by the strategies we discuss in this chapter. Many children with autism have overall slower rates of development in all areas (cognitive, social, communication), and this means that they will also learn language at a slower rate. In addition, as discussed in Chapter 4, autism is associated with a very specific difficulty in paying attention to other people. Finally, some children with autism have a specific difficulty with speech above and beyond their other problems. However, most children with autism can learn to use speech, provided they have enough support and the right kind of support.

  Why Is It a Problem?

  Autism’s effect on children’s social attention to others—their decreased social initiative, social responsiveness, and social engagement—results in fewer opportunities for these children to listen, learn, and respond to language. Therefore, we need to increase their opportunities for social interaction, as this will help promote language development. We have spent most of this book discussing ways to decrease the amount of time your child spends playing alone, wandering about the house, watching movies, and spending time relatively unengaged with others. You have already put many changes in place to help your child learn to talk by increasing the amount of time the child participates in meaningful social activities with others throughout the day.

  You already know that helping your child learn language means helping your child interact face to face with you and others in the family whenever possible. Watching movies or playing with electronic “educational” toys or computer games may be entertaining, but children learn to communicate by interacting with other people. Words they may pick up by imitating a movie script or an electronic program are often not used to communicate with others. Children learn communicative language from their interactions with other people.

  Given the demands of running a household, working outside the home in some instances, and caring for other family members, it simply isn’t possible to spend most of your day on the floor playing with your child. However, during the moments you are naturally with your child—such as during meals, bath time, or at the playground—you can drastically increase the number of language-learning opportunities you provide for your child by using the strategies discussed in this chapter. By including your child with autism in more household activities, and by making the care and play routines you already have with your child more interactive and language-focused, you can help your child’s language abilities grow. So let’s discuss the specific strategies for promoting speech and language development. We discuss expressive language first, followed by receptive language.

  What You Can Do to Build Your Child’s Expressive

  Speech and Language

  Does your child make many
sounds? Does your child use his voice as a way of communicating, even though he has not yet learned to talk? Can your child imitate any simple sounds you make, like animal sounds, or car sounds during car play? Can you and your child make noises back and forth to each other? Developing these skills paves the road to speech. Here are the steps to building expressive speech and language:

  Step 1. Build up your child’s vocabulary of sounds.

  Step 2. Develop vocal games with your child’s sounds.

  Step 3. Increase opportunities for listening and responding to sounds made by others.

  Step 4. Talk to your child in a way that promotes language development.

  Step 5. Add sounds to gestures.

  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. We have had an extremely high rate of success in teaching young children with autism to speak by using these techniques. Most develop first words within a year.

  Step 1. Build Up Your Child’s Vocabulary of Sounds

  To develop speech, your child needs to be able to make a lot of sounds, and to make them frequently and in response to you.

  Rationale. Often very young children with autism produce very few sounds, especially consonants. Vowel sounds, like “ah,” “ee,” and “oh,” are easier for children than consonant—vowel combinations, like “ba,” “da,” and “ta.” The first step is for your child to make a lot of simple vowel sounds and to make them frequently, in response to your making similar or other sounds. If your child does not yet do this, this is where you will start to focus—on increasing the frequency with which your child makes sounds, and also the number of different sounds your child can make.