After deciding on the gesture and word you plan to use, ask your child to hand you things during a game by pointing and saying, “that, give me that.” You have just modeled what you want your child to learn. And when your child points to or reaches for something, before you give it, imitate your child by pointing to the object and say, “That? You want that?” Wait and see if your child will try to imitate the word “that” by saying “ah” or “da” before you give it. If she says anything at all, give the object. If she looks at the object but doesn’t say anything, give the object. Model this when your child makes requests every day. Pretty soon your child will probably begin to add a sound to the requesting gesture.
Add sounds or simple words to all your child’s gestures in the same way. In the gesture games you play, try to add a sound consistently—“boo” when your child uncovers his face during peekaboo, “bye” when your child waves bye-bye, “no no” when your child protests and pushes away an unwanted food or object. Follow the suggestions we have just laid out above to find a simple “word”—a sound to pair with your child’s gesture. Start modeling it and trying to get your child to imitate it. Your animal sound games and books, and your sound effects in your toy play routines, are other places to encourage your child to imitate your sounds with gestures.
Remember! The first time your child imitates your word and gesture, imitate your child’s word and gesture right back, give the toy to your child as quickly as possible, and keep the game going. Don’t ask your child to imitate you again right away. It’s really tempting, but it’s a brand-new skill, and it may be really hard for your child to do it twice in a row. Instead, go ahead and take your turn, and just model it again a couple of times. Then give your child another turn. She may model the sound as well as the gesture; she may not. But try it again the next day or the next time you do the routine. As it becomes easier for your child, you will expect more of these, and you can expect more imitations in a row. But baby steps are the way you will get there.
Add nouns or verbs to the simple sounds. Now, at this point, your child is vocalizing with his gestures and in your baby games and sound games, but he may be saying only an “ah” or a “da.” You are still playing your vocal games, right? So your child is likely increasing the number of sounds he is making, and can now imitate back and forth with you. So now, after your child gestures and vocalizes with his “ah” or “da” or other sound, imitate back and then model the correct word. For instance, if your child points to a cereal box and says “da,” you say, “That? Cereal! [emphasizing the “s”]. Cereal!” And hand it over. Add a real word to all your child’s gesture-plus-sound routines—ideally, a word that contains some sounds your child can already make and imitate in games with you. After you have done this for a few days, if your child is not starting to imitate the new word, get closer, look at him, say “Cereal? Cereal? Sss-cereal?”, and look expectantly, waiting for your child to imitate. Give the cereal regardless of what your child says or doesn’t say.
If you and your child have a number of vocal imitation games going, and if you have a number of sounds in them that your child can imitate, her ability to start imitating and adding sounds should come along. Accept any sound match your child makes. It’s a long way from “Sss” to “cereal,” but this is the way that all little children learn to speak. They say what they can, and over time—as their speech muscles and skills develop through practice, and as they learn to hear the sound differences more precisely—they come closer to saying the real word.
Summary of Steps 4–5
If you agree with most of the statements in the following checklist, you are now armed with important skills for helping your child build an initial vocabulary. These are skills you will use throughout your child’s language learning—building on what your child can already produce, offering new words in interesting contexts, and helping your child expand her utterances in meaningful activities. If you don’t feel secure in these skills, turn back to the start of this section and review. Consider asking your child’s speech–language therapist to observe your interactions and give you some feedback or coaching with these techniques.
Activity Checklist: Am I Building My Child’s Vocabulary?
____ I talk to my child throughout our activities together—both play and caregiving activities.
____ I speak in simple language to my child, using phrases that are just a word or two longer than my child produces on his or her own.
____ I routinely narrate my child’s activities as he or she does them, and I position myself for easy eye contact while doing so.
____ I frequently take turns with my child and label my actions as well as my child’s.
____ I add simple sounds to my child’s gestures (sounds I know my child can imitate), modeling them for my child and waiting expectantly for him or her to imitate me.
____ If my child easily imitates a simple sound with a gesture, I also model a single appropriate word and wait for my child to imitate it.
Caution! Does your child imitate, or echo, easily? If so, you may find it very tempting to provide the child with phrases and encourage him to echo every word, hoping that he will learn multiword speech more quickly. Don’t do this! It doesn’t help; we think it actually fosters more echoing. Instead, base your own word length on the length of your child’s spontaneous, meaningful, nonechoed utterances. Your child may be able to echo a whole sentence, but may produce only single words spontaneously. If this is the case, then base your sentence length on your child’s one-word spontaneous utterances. Hold your sentence length to two or three words (the one-up rule), and follow all our guidance above. For example, if your child spontaneously says “milk” to request it, don’t tell your child, “Say, ‘I want milk.’ ” Instead, just say something like “Here’s your milk,” or “Want more milk?” or “Yummy milk” as you hand over the milk. Focus on slowly building up your child’s spontaneous speech, and all should progress well.
Summary: Building Expressive Speech and Language
What You Can Do to Help Your Child
Understand Speech
At the time they are diagnosed with autism, young children typically understand very few words that the people around them use. Some children might seem to understand more than they actually do, because they may learn to “read” the whole situation and make good guesses about what will happen next, based on their past experiences. For instance, you may say, “It’s time to go to preschool. Let’s get in the car,” and your child may head to the door. It looks as if your child has understood your words. But you have also picked up your keys and your jacket, as well as your child’s backpack and jacket, and these may be the nonverbal cues your child is using to interpret what is going on.
Sometimes young children with autism seem to ignore the speech that is being directed at them. You may be doing a terrific job of narrating play, using simple language, and providing language models, but the words may not “penetrate” your child’s attention. Your child may not have learned the importance of listening, or the need to follow through by responding to your words. But you can teach your child to listen and respond to words. It will come.
The best news about receptive language learning is that when you follow the guidelines we have given you for expressive language development, receptive language understanding will develop right alongside it. The techniques actually develop both sets of skills. Over time, as you follow the techniques we have already covered, your child will learn that speech is important, that she needs to listen and attend to what is being said, and that she is expected to respond when spoken to. If you’ve been helping your child make sounds with her gestures, you’ve already been expecting your child to listen to the word or sound you’ve modeled and imitate it back. You’ve waited to give your child the cereal until she responds with a sound. In this situation, you expect your child to listen to you and to respond. You make it clear that a response is required, and your child has learned this. This is how yo
ur child will learn to respond to other spoken requests you make or spoken instructions you give to your child.
In the previous chapters, you added labels to objects and actions throughout the day during your child’s activities. These techniques are powerful for building receptive language. Now we will address a different topic: understanding other’s instructions.
Continue using the previous steps and add these other steps, which focus precisely on understanding and responding to others’ speech:
Step 1. Expect a response, then get it.
Step 2. Be clear about the natural reinforcers of your child’s speech, and be sure to use them for responding to speech.
Step 3. Instruct less and follow through more.
Step 4. Teach your child to understand brand-new words and instructions.
Step 1. Expect a Response, Then Get It
Part of teaching your child to understand is raising your expectations for your child’s response.
Rationale. When a young child with autism does not speak or understand speech, over time you may stop expecting the child to respond. But a child who isn’t expected to respond won’t learn the importance of speech. So it’s critical to start requiring a response.
Activity: Follow Through on What You Say to Ensure a Response
When you are focused on teaching your child to understand speech, your expectations and follow-through are crucial. For this step, you need to get your child’s attention, give your child a simple instruction, and wait briefly for the child’s response. If there is none, quickly physically cue or prompt your child to follow through, and then follow with the reinforcer, whatever it may be. The turn-taking routines discussed in Chapter 6 are great examples. When it’s your turn, you can extend your hand, say, “Give me,” wait briefly for the child to give, and prompt your child to place the object in your hand if the child needs help completing this step. Then you take a very fast turn and give the object right back, so that the child ends up with the object he wanted in the first place. Making gentle and easy but frequent requests or instructions and requiring follow-through is a crucial teaching technique for developing children’s understanding of words and their attention and responsiveness to adult speech.
Step 2. Remember the Natural Reinforcers of Your Child’s Speech,
and Be Sure to Use Them for Responding to Speech
Step 2 may sound simple enough, but it’s important to choose the right reinforcers—the rewards for cooperating. You need to work with your child’s own goals and motivations. So the time to teach your child the instruction “Sit down” is when your child wants something that you have. Have your child sit down on a small chair or the floor before you hand over the glass of juice she is requesting, or “Come here” to go outside to play, or “Stand up” to transition from a sitting activity to a fun physical game. In all these examples, the instructions are followed by a powerful reinforcer. They are also physical skills your child already has—sitting, standing, walking to you. If you provide an instruction right before doing something that your child wants, your child will get used to hearing your instruction and the rewarding activity and words that follow. Inserting simple demands before delivering what your child wants is a very powerful part of teaching the child to follow simple instructions.
Two-year-old Alex plays happily alone, and he pretty much ignores his parents’ efforts to engage him. As he puts pegs into a little car, his mom says, “Put it here,” and points to a hole. He ignores her and puts it elsewhere. He reaches for a pompom, and Dad sees his goal, picks it up, and offers it to him. “Want the pompom?” says Dad, but Alex turns away from Dad and picks up the other pompom lying within reach. Dad hands him the other pompom, and he drops it on the floor. He turns back to the car, and Mom models driving it while making “vroom-vroom” noises. He blocks her and starts to put pegs in again.
Alex’s lack of response discourages his parents, and they don’t know how to motivate him to engage with them. They decide to use identical cars in play activity and to imitate his actions with one of the cars with an identical one they are holding. As they begin to imitate his actions and narrate, he begins to look at what they are doing. After about 10 minutes, his father holds back for a minute, and Alex looks at him and makes a little emphatic noise, as if to say, “Come on, Dad, do it!” Dad does, and Alex smiles and looks up at Dad briefly. As they continue to imitate him, they now begin to add a piece to his car. He does not reject this, but rather looks up at Mom and then continues. After a couple more minutes, Mom hands him a peg and he puts it in his car. Then, as he reaches for the pompom, Dad hands it to him, saying “Here, Alex, pompom,” and he takes it. Dad picks up the other pompom, says “Alex, pompom,” and hands it to him. Alex takes it. He turns back to the car and puts another peg in, which Mom imitates. She then drives her car, making a “vroom-vroom” sound, but he places another peg. She picks up a peg and offers it: “Alex, peg.” He says “peg” and puts it in.
Mom and Dad have developed a very effective strategy in this play. They imitate him, narrating and helping him for several turns, and then they place an instruction (e.g., “Alex, peg”) inside the flow of activities. They make sure to follow through (either by handing it over or by placing the piece), but their play interactions with him are so rewarding that he follows through with the instructions, and this keeps the game going. After another few minutes, his father offers a choice: “Alex, peg or pompom?” as he holds both out. Alex says “peg” and selects the peg, which Dad then labels (“You chose peg”). Lo and behold, he is communicating, with gestures, gaze, and even a word imitation!
Alex is harder to engage than some young children with ASD, but his parents are persistent. They do not give up, and they find a way to join him in play. Like most children, he enjoys being imitated, quickly experiences the contingency, and comes to expect it—and that becomes the reward for this shared activity. His parents choose their words and actions carefully, fitting them into his preferred activity and being careful to space their instructions out so they follow several minutes of Alex-led activity. Their persistence, their ability to establish a powerfully reinforcing joint activity, and their wisdom at putting simple instructions into the play, directing him to do things he already wants to do—these techniques allow them to begin to work on receptive language, the names of the objects. Within 12 weeks, Alex is playing cooperatively in toddler-type toy activities with both parents, imitates single words easily, and uses about 25 words spontaneously.
But what if there is no built-in reinforcer in the play activity? In the example above, Alex’s parents find a reinforcer inside the activity—pegs and pompoms—and focus their language and expectations for Alex’s responses on these items. However, if there is no intrinsic reinforcer (a reward that relates to the child’s behavior) in a routine, you can create one. As you know from Chapter 9, learning happens only when behaviors are followed by reinforcers. How can you create reinforcers where there don’t seem to be any?
Sometimes you can use activities your child really likes and rearrange the order of household routines to capitalize on the reward power of the favorite activity. For instance, it is a struggle for many parents to motivate their children to get dressed for school in the morning, even when the children are perfectly capable of self-dressing. Think about the reward structure for getting dressed. Is there any? For children who are hungry in the morning and are motivated to eat breakfast, parents can establish a new rule—that the children have to be dressed before breakfast. Now breakfast, which would have happened anyway, gets repositioned to follow self-dressing and can reinforce the activity.
There has to be some reward for a child for following an instruction. This doesn’t mean you are spoiling or bribing your child, regardless of what others say. This is how children learn. You wouldn’t go to work if you were not receiving a paycheck, would you? It’s the same for your child. You need to find something your child is motivated to have: a favorite activity, an object that you
r child really loves to handle, an electronic toy, or even a little piece of a favorite cereal or a sip of juice. Some desired event must follow your child’s cooperation with the instruction, no matter how much you had to help, for your child to learn. If your child has a runny nose and you provide a tissue and help him wipe it, the natural thing to do then is “throw it away.” Say it and help your child do it. Once it is thrown way, clap and cheer for your child, pick him up and play a favorite game in the air, or go back to the very fun activity that was interrupted by the runny nose. All of these will provide rewards for throwing the tissue away.
Step 3. Instruct Less and Follow Through More
To teach your child that your words have meaning, you must follow through—happily, playfully, but consistently. So be careful what you say! Be ready to act. Giving instructions without following through actually teaches children to ignore their parents’ instructions. If you are not in a position to assure that your child follows through on an instruction by helping your child through it, don’t give the instruction in the first place. Fewer instructions, with more follow-through, often aids children’s learning of others’ speech.
An Early Start for Your Child with Autism: Using Everyday Activities to Help Kids Connect, Communicate, and Learn Page 36