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

by Rogers, Sally J.

  Step 4. Teach Your Child to Understand Brand-New Words

  and Instructions

  So far, we’ve been talking about giving children instructions involving things they can actually do. They are capable of sitting, standing, giving, approaching you, and throwing things in a trash container. You give them the instruction and walk them through it, fading your supports as quickly as possible. Through this process, they learn what the instruction means. However, most of the instructions you will give your child a little later on will involve skills your child does not yet have. Now you will be teaching the skill and the language for it, all together. Putting on a coat, taking off shoes, bringing you her pajamas, sharing his toy with his brother—these all involve new skills your child will need to learn from you.

  The process will be the same: (1) You will figure out the reward—fun bath time follows undressing; taking off a coat or jacket and hanging it up on the hook is necessary before entering the preschool room; bringing you the pajamas is followed by a favorite storybook; sharing a toy involves getting it back very quickly and getting another one to play with. (2) Then you will give your child the instruction and help her follow it. (3) Finally, you will reward her for following the instruction.

  Over repeated practice opportunities (daily or several times a day), you will slowly decrease the amount of help you give (fade your prompts) to ensure that your child follows through. That is, you will be giving less and less help once you give the instruction, until you are just gesturing that your child should follow through. Then you will fade your gestures, and your child will follow your verbal instruction and use the skill independently.

  What about skills that have lots of steps? For multistep tasks like bathing, your child may need quite a while to learn them all. In this situation, it is often useful to begin to work toward independence by having your child learn the very last step independently, then the last two, then the last three. This is called backward chaining. For instance, you would help your child take off his clothes up until the very last step (shirt off head), which your child would do alone. Once that is mastered, you would focus on the next-to-last step as well (shirt off neck and head). This is the process we have discussed in Chapter 7, in which you are breaking down the skill into its various steps and teaching each step as its own skill—even while you have your child participate in all the steps, so he learns the chain.

  Caution! We recommend that you not use verbal instructions in the various steps of a chain. The instruction to “Wash hands” needs to mean all the steps of washing hands. Teach your child the intermediate steps through physical prompts and gestural prompts, but don’t use verbal instructions to prompt your child to do the individual steps; otherwise, you are in danger of having a child who waits to be told each step. You want each action to become the antecedent for the next action. So use physical prompts or gestures to keep the chain of steps going, and physical arrangement of materials if you need to, to help your child through a complex set of actions involving objects (e.g., laying out the clothes to be put on in order on the bed, or putting all the pieces for table setting on the table).

  Summary of Steps 1–4

  Your child’s intervention team will be able to help you figure out how to help your child learn all kinds of instructions. We are really just trying to give you a beginning point here (a place to start after diagnosis while you are waiting for your child’s services to get organized and get going) and a follow-through point (a way to work with your child at home and in daily life that augments other interventions your child will receive). To monitor your own learning, 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 build her understanding of speech. These are skills you will use throughout your child’s language learning—building on what your child can already do, offering new vocabulary words in their appropriate contexts, and helping your child follow through with instructions in meaningful, enjoyable 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 Up My Child’s

  Understanding of Speech?

  ____ I routinely put simple words and instructions into our play and caregiving routines.

  ____ I monitor myself and consistently help my child follow through with instructions.

  ____ I make sure there are rewarding consequences that follow my child’s successful cooperation with instructions.

  ____ I foster my child’s independence at following instructions by fading my help rapidly.

  ____ When teaching my child a new skill, I use simple, direct language to introduce the activity.

  ____ When working with my child, my instructions or directions are balanced by the many opportunities my child has to make choices and have fun with me; we are partners in the process.

  Summary: Building Receptive Language

  Chapter Summary

  Young children with autism often have significant difficulties using and understanding speech. However, they are capable of making enormous gains in these areas. We believe, and have demonstrated in our studies and clinical work, that the majority of young children with autism can learn functional, spontaneous, phrase speech. To promote their language development, children need to receive high-quality language experiences and intervention throughout the preschool years. Parents are in the best position by far to provide the greatest number of language-learning opportunities, regardless of the intensity of “outside” therapies.

  Speech builds on gestures, imitation, shared attention, and vocal and object play. Functional communicative speech begins with these skills. The fundamental techniques that you as a parent can use involve simplifying your language; creating many, many opportunities for the child to engage with you and communicate throughout the day; using gestures, words, and sound effects in all your activities with your child; building up your child’s repertoire of speech sounds through vocal games involving imitation, sound effects, animal sounds, and song patterns in play; increasing your expectations for your child to vocalize along with his gestures; and increasing your expectations and follow-through to show your child how to listen and respond to your simple instructions. Let communication routines become part of all your caregiving routines and play routines with your child. Include your child in as many of your household activities as possible. Interacting with others who are speaking to them and doing shared activities is how children learn functional language skills. This is how every child learns to use and understand spoken language.

  ________________________

  1A small minority of children with autism do not learn to use spoken language. These children, however, can learn to communicate by using pictures and other visual devices. All children need to learn to communicate by using either speech or other communication methods.

  14

  Putting It All Together

  We are coming to the end of a long time spent together. You’ve accumulated a lot of strategies for directly addressing the learning challenges of early autism. All of these are based on the success we’ve had with the Early Start Denver Model, which helps young children learn naturally by building learning into everyday routines, and particularly by incorporating it into play. Children with autism need to discover the rewards of social interaction, because being engaged in activities with others and communicating with them are the routes to all learning, including learning to speak.

  We hope that by now, with practice, use of the strategies we’ve described comes naturally to you too. And we hope, as a result, that you’ve seen your child turn a corner toward becoming engaged, communicating, and learning, which will lead to success in the years to come.

  In this final chapter we’ll review the building blocks you’ve accumulated, to give you a picture of
how they all fit together in your daily interactions with your child and propel your child along a typical developmental path at this crucial early stage of life. We’ll also show you how these parent-delivered strategies can intersect with the early intervention efforts of the professionals who are assisting you and your child. Finally, we’ll help you keep the most important principles in mind as you continue to teach your child in the months and years ahead, and we’ll steer you to the appropriate chapters to review if you run into any problems with using the strategies you’ve learned in this book.

  But first, here are two important bits of advice if you’ve just gotten started and are worried that weaving these strategies into your already busy life will be too difficult:

  • Carve out moments to interact and play with your child. It’s a challenge to use teaching strategies, set up play activities, and arrange everyday activities so they can provide teaching moments. Things go slower; less gets done. It takes young children with autism time to learn new routines. Working them into these new routines takes time, and your child may protest changes in his or her routines. However, this will become more and more automatic, both for you and for your child. As you practice these routines, they will become like second nature to you. You will no longer have to think or plan or monitor yourself—it will be natural. The same will be true for your child. Young children are flexible and can learn new routines, and they enjoy interacting with parents (and the younger they are, the more flexible they are!). Whether it is dressing, mealtime, playtime on the floor, or reading books at bedtime, the important thing is to find interactive time throughout the day to engage your child face to face with you as you narrate your shared activities and elicit your child’s participation. That is how your child will learn.

  • Take baby steps. Go one little step at a time, making sure there are fun activities, things your child enjoys—rewards for participation—built into each activity. You will be rewarded by seeing your child become much more of a participant in family life, learning much more about language and about how the world of your family works. Remember, “slow and steady wins the race.” Take your time to adopt new routines. The routines are always going to be there. The strategies described in this book should offer pleasurable parenting experiences for you, as well as your child.

  Please share these techniques with your child’s circle of concerned others: your partner or spouse, grandparents, siblings, babysitters, preschool teacher, and other caregivers. That way, your child’s learning opportunities will increase; others will have more satisfying experiences with him or her; and you can share the responsibility for helping your child learn among the many people who care about your child. You will be able to talk to others about what is working well and what is not. Your child will learn how to use his or her new skills with many different people, not just one. And each person will bring to the learning situation his or her own style and ideas, which will enrich the learning experience.

  YOUR FOUNDATION FOR GIVING YOUR CHILD AN EARLY START

  At this point you are undoubtedly very aware of how many learning opportunities you can create for your little one in every one of your play and care routines. If you’ve started incorporating our suggestions into your day, you’re applying many critical principles for teaching a child with ASD.

  You are likely quite skilled now at gaining and holding your child’s attention. You know that learning cannot occur without attention, and if you have followed the guidelines for positioning yourself with your child, for rewarding attention, and for making sure you have your child’s attention before trying to teach anything new or reinforce anything already taught, your child probably pays much more attention to you now than when you started with this book. If you take away only one thing away from this book, take away this principle: the importance of gaining and holding your child’s attention for learning from you.

  You understand the structure of a joint activity and its importance as the framework for teaching and engaging your child. In joint activities partners share control of the activity, at times leading and at other times following each other. They play together, building on each other’s actions by imitating, elaborating, or taking turns. It is through joint activities that young children learn in natural settings—at home and out, with you and the rest of your family—and ultimately with their friends and classmates too. Joint activities begin with your child’s attention, motivation, and interest in an activity. In a joint activity you and your child are face to face, so that both of you are attentive and involved with the materials and with each other. Together you develop a theme, and then variations to expand the theme. Finally, the two of you close it down and transition smoothly to another activity; you sustain your child’s attention through the transition and into the next activity, so there is no break in attention and learning.

  You have probably experimented a lot with the joint activity structure, using it at meals and in care interactions like bathing, dressing, changing, and bedtime, as well as in play routines. You and your child probably have a wide range of joint activity routines at this point. Some of your routines use toys and other objects. These object-oriented routines highlight cognitive, play, motor, and language growth. Other play routines occur without toys. These sensory social routines create emotional exchanges and shared attention, and especially foster language, imitation, and social learning. You are probably seeing some very big differences now in your child’s willingness to engage in joint activities with you and others—better attention, more motivation to engage, many more skills, more mature and sustained play with toys, much more communication. Take a deep breath, to remember and appreciate what you and your child have accomplished.

  You have learned a lot about how children learn. Now you understand that you’ve been applying the ABC’s of learning in all your routines with your child. The terms antecedent, behavior, consequence, and reinforcement have come alive for you. You know that your child’s behaviors occur in response to some stimulus or another (the antecedent), and that the teaching–learning process ties antecedent and behavior together by following them with a desirable consequence for your child—one that occurs right after the child uses the skill you are trying to develop. Understanding this ABC relationship will allow you not only to teach your child new skills, but also to replace unwanted behaviors that may crop up with more acceptable and more communicative ways for your child to achieve his or her goals. It will also help you develop plans to teach your child new skills and behaviors, by thinking through the ABC’s for yourself.

  If you have completed this book, you now know a great deal about the development of communication skills. The developmental skills young children use to learn from others—imitation, joint attention, gestural and verbal communication, speech, practice in play, and practice during daily activities—are part of your moment-to-moment awareness. You have learned how to embed imitation into all kinds of joint activities. Imitating actions on objects is particularly easy to target in open-ended joint activities with objects. Gestural imitation is particularly salient in sensory social routines, especially songs and finger plays. And verbal imitation to learn new language structures occurs during language-learning activities in all kinds of joint activities.

  You now know much more about how language develops—from meaningful gestures, from your child’s use of his or her voice, and from the ongoing process of learning how speech and gesture influence others. You know the importance of functional communication: helping your child develop the gestures and words needed to indicate what is already in your child’s mind. You are giving your child the gestures and words that label his or her desires, actions, interests, and feelings. You are putting the words in your child’s ears that you want to come out of the child’s mouth.

  The purpose of language is to coordinate and share information and experiences with other people. Language is primarily a social behavior. You are emphasizing the functional and social aspects of communication when yo
u respond to your child’s gestures and speech by following through on their meaning—that is, by saying back what your child has said with the body or with speech (with a little elaboration), to let the child know that you have heard and understood it, and to provide a model for a slightly more mature way to say it. This is the one-up rule. You are responding to communication with meaningful communication rather than praise. And you know how to embed all this into playful routines, both during play and during caregiving. You are an expert in play! You are likely to be a very fun play partner and to have all kinds of play routines involving toys, social games, pretend, physical games, and outdoor activities in your repertoire.

  Finally, you have learned how to make the most of the learning opportunities afforded by your everyday activities and routines with your child. Remember the big six types of activities introduced in Chapter 4: toy or other object play, social play, book activities, meals, caregiving (bathing/dressing/changing/bedtime), and household chores. Here is a review of the basic guidelines for making the most of these opportunities.

  Meals

  Does your child eat at the table, in either a booster seat or a high chair? If not, work to make that change and then sit down and eat with your child. Incorporate your child into family meals. Try to structure three meals and three snacks a day, all at the table and all involving others, while you decrease (or eliminate) eating on the run. Having a child sit down to eat or drink (even to sit down on the floor to drink from a cup) gives you the chance to work on many requesting skills, imitating skills, and communication skills centering around food and drink, which are usually very motivating for children.

  As you read this, you may realize that you had once successfully established organized mealtimes and snack times, but that now your child has gone back to eating and drinking whenever and wherever he or she wants. These patterns have probably evolved slowly over time, and you can slowly undo them, step by step: