An Early Start for Your Child with Autism: Using Everyday Activities to Help Kids Connect, Communicate, and Learn
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1. Begin by having your child sit down to eat. At the table is the best place, but if that is too far a stretch, begin by requiring the child to sit down wherever he or she is. Once seated, you can hand your child food or drink. If your child starts to get up while holding the food, consider taking the food away and encouraging your child to sit down again. Your child may well refuse to sit any longer after a few bites, at which time you will remove the food. However, if your child isn’t yet full, he or she will be hungry or thirsty again soon, and you can practice again. If you are warmly and gently persistent, you will likely teach this skill quickly.
2. Once your child sits, switch to having the child sit in the kitchen, near the high chair. Try to give your child as much as he or she can eat and drink at one time, and then put off the next snack or meal for an hour or two.
3. Once your child is sitting in the kitchen for all food and drink, move the eating place to the high chair or booster seat, where you can sit right across from your child at a corner and provide the food there.
4. Be sure to eat or drink a little something yourself—a cup of coffee, piece of fruit, something to make it a social time. If you typically have a TV or video running during meals, turn it off, either quickly (if your child tolerates it) or slowly if needed, by first muting the sound for a few meals, then dimming the picture for a few meals, then keeping it off. Instead, sit with your child; have your child’s food on the table (ideally, with you and the other family members); offer your child food and name the food; and wait for eyes, voice, or gesture to request. Don’t give very much in a portion, so that your child needs to request many times to end up full. Shifting your child to eating three meals and three snacks a day at the table will result in better nutrition, better eating habits, and much more communication. If you can’t do this for three meals, do it for one or two.
Caregiving Routines
Build social play routines into changing, bathing, dressing, washing hands, brushing teeth, and getting ready for bed. Add songs, social games, and object play routines to all your caregiving routines. Help your child do many of the steps of each routine him- or herself, instead of being passive (or resistant!) while you do it all. When you help your child participate in washing and drying, brushing teeth, washing hands, handing you a diaper, or giving you a sock or shoe, you will also be adding language and increasing communication during these activities—the building blocks of speech and language. You already spend time doing these things, and adding communication games and child expectations to those routines makes them richer learning experiences for your child. For example, if your child is watching a video while being dressed, little learning about dressing can take place. If the TV is off, you and your child are face to face, and you are helping your child complete each step of the routine (pull on each piece of clothing; hand you shoes, socks, or diaper; help pull zippers or button buttons), as you talk to your child in simple language about each step, narrating the activity, your child is learning language, self-care, social, and motor skills.
Bedtime is an especially important time for language learning. Does your child have a set bedtime routine? If not, can you begin one? Bathing your child and playing with bath toys nightly provide a very rich setting for language learning and social exchange. Following the bathing and drying routine with lotion and pajama-dressing routines that are language-rich and full of social exchanges provides two more learning-rich activities. Brushing teeth can be another language- and learning-rich activity. So, finally, are putting your child into bed and reading a book together (which for young children means naming and talking about the pictures and creating sound effects, not reading the script).
We have just walked you through close to an hour of a bedtime routine. It takes time, and parents with multiple small children and other demands will have many limitations on their time. However, this is a whole hour filled with language and social learning activities, and it is a routine that will also build better sleep habits. Even picking out one or two of these routines nightly will be very helpful for your child. Their consistency and repetition are what make these routines such powerful learning experiences.
Toy and Social Play
You have probably already increased your toy play routines and sensory social routines with your child, since we have been focusing on these so strongly throughout the book. Finding 15–30 minutes two or three times a day (morning, afternoon, and evening?), indoors and out, will help you continue to build the communication and learning value of these routines. The critical factor in play is the joint activity routine structure, with partners face to face, actively engaged with each other and the toys or social games, and communicating back and forth throughout. Try to help others who play with your child—parents, older siblings, grandparents, babysitters, and others—use these techniques as well.
Household Chores
Don’t forget about household chores! There are many ways young children can participate with you in chores. They can help you feed the dog, water the plants, pull the clothes out of the dryer, wash the tires on the car. They can play in the kitchen sink with water, scrubbers, and vegetables while you prepare a salad. They can play beside you in bubbles while you wash dishes. They can participate in making cookies or putting cut-up vegetables in a cooking pot or salad. They can help unload the dishwasher and put the silverware into the correct slots in the silverware drawer. In the grocery store, they can put objects into the cart. When you include your child in your everyday routines, you are automatically talking to your child about the task and helping your child do it. Your child is having new experiences, learning new skills, learning how the world works, learning new words, learning from you! Just participating with you in your chores increases your child’s learning opportunities enormously during daily life.
PARTNERING WITH YOUR PROFESSIONAL TEAM
By this point you have likely enrolled your child in early intervention services (or are trying very hard to do so) and are working with professionals to continue to help your child progress. Your child’s therapists and educators have likely identified a number of developmental gains that your child is ready to make, written as a set of learning objectives. Everything we have covered so far will help you teach these skills to your child through your ongoing play, caregiving, and daily routines, at home and out and about. You will be working very closely with the professionals on your team, and you should never hesitate to ask for information, clarification, or advice when in doubt about anything involved with your child’s treatment.
• If you need your therapists to break down the learning goals they have developed into smaller steps so you can work them into your routines more easily, ask them to do it for you, so you can figure out where to start on each skill.
• If you do not have a copy of each professional’s treatment goals, ask each of your child’s team members for them.
• If you need help in figuring out how to work on those goals at home in your natural routines, ask your professional team members to show you and to write out a home program for you.
Watch how the different professionals work with your child. Identify what works and what doesn’t. Join in your child’s treatment sessions, so you can learn from the therapists and carry out their goals at home. This is how your child will benefit from their knowledge. Help your team members identify what is helpful and what is not for your child. They are the experts in their disciplines, but you are the expert in your child. You know what your child likes and does not like, how he or she learns best, what your child can and cannot do yet at home, what is working and what is not. Help your team understand all this about your child. If you see your child not progressing in his or her treatment with others, speak up! Lack of progress signals a problem in the teaching plan, not a limit in your child’s ability to learn. If your child is not progressing in one area, ask your team to come up with a different approach. You know your child can learn: Look at all the things you have taught your child over the pa
st weeks as you have worked your way through this book.
ABOVE ALL ELSE
• Every interaction you have with your child is an opportunity for your child to learn and for you to teach. Your child learns something in every one of these interactions, so ask yourself whether what is happening is what you want your child to learn. Maximize your child’s learning by using the incidental (already existing) experiences you have with your child—family routines, outings, chores, caregiving, time in the car. When you use these times to engage your child in the activity, rather than moving your child through routines without engaging him or her in the step-by-step process, your child can be receiving hundreds of learning opportunities every day.
• Try to teach your child the skill he or she needs in the setting in which your child will use it. Practice eating communication skills at the table where your family eats. Practice taking off a coat and putting it on a hook when your child comes in from outside, both at home and at preschool. Teach your child to dress and undress when and where it’s appropriate, and to name the objects used in each setting or activity in which the child encounters them in daily life. Children learn real-life skills more quickly and more deeply in real-life settings and situations, rather than through flash cards and computer games. Learning “sticks” when it occurs in daily life.
• Work toward age-appropriate initiative and spontaneity. Spontaneity and initiative indicate independence. You are not teaching your child simply to follow directions for everything your child needs to accomplish throughout the day. That’s the reason behind strategies that involve following your child’s attention, reading his or her cues to direct you to rewarding activities and materials that motivate your child to engage and participate. We’ve encouraged you to be alert for spontaneous performing of skills that you’re trying to instill. When your son makes a sound on his own (not just one elicited by you during a game), or your daughter takes the initiative to lead you to the refrigerator when she’s hungry instead of screaming, your quick response with a reward or reinforcer at the ready will solidify this skill. But be sure that demonstrations of independence are age-appropriate and are not substitutes for communication. Most 2-year-olds, for example, do not have unlimited access to the refrigerator, because it’s not age-appropriate behavior. So if your 2-year-old with ASD opens the fridge to get a drink, it may very well be because he or she does not have a way to request it from others or is not motivated to use the communication skill of requesting it from others. You have likely taught your child ways to participate in many, many new activities, both regular household routines and play routines. All of these together foster your child’s ability to initiate an activity and spontaneously begin communication, play, and social exchanges. Try to support your child’s initiation of age-appropriate play skills, personal skills, and language.
• Help your child regulate his or her arousal and activity levels to optimize availability for learning. We have discussed this idea in terms of the choice of joint activities. There is a rhythm to interactive play that you have likely already discovered. You probably now know how to optimize your child’s attention and energy for learning by alternating between quieter activities and livelier ones. As we’ve said before, it also helps to alternate between object-oriented joint activity routines and sensory social routines. Move from place to place as you create different joint activity routines. Children’s body movements and positions can tell you something about what they need. Quieter, more passive children may need to be energized for learning through lively, physical, sensory social routines that involve fast, quick movements. An active, busy child who has trouble attending for more than a few seconds needs periods of lively, physical, social play (think playing chase, running outside, climbing stairs or slide ladders, or other types of backyard play) to alternate with quieter, slower, rhythmic, sensory social activities that focus attention for learning (such as being rocked on a ball, chair, or lap as you sing a song together; walking and moving to rhythmic music; or being rocked in a rocking chair while you go through an interactive book). Organize the physical space for a busy child by putting away things that are out, by limiting the number of materials available at any one time, by using boxes and containers and shelves or closets for toys, and by being ready to transition smoothly from one activity to another to extend and maintain your child’s attention. Remember to use the structure of joint activity routines in the lively activities as well as the quiet ones, to take advantage of the learning opportunities that are already there. Helping your child stay in a well-regulated state for learning also helps markedly with behavior. It’s a “two-for-one” deal!
• Don’t forget to take care of yourself emotionally. When you feel emotionally spent or discouraged, don’t forget to rely on your social support network, as we have talked about earlier in the book (see especially Chapter 2). Call a friend, touch base with other parents by email or on Facebook, or talk to your partner or other family member. Talk to your physician if you feel down or blue most days. Get the help and support you need, so you can enjoy life and continue to help your child succeed and grow.
REVIEWING WHEN YOU HIT A SNAG
Here are some questions to consider if you run into difficulties along the way. If you answer no to one or more of the questions, think about the strategies you are using by revisiting relevant chapters:
Am I using simple words and phrases (the one-up rule) to communicate with my child? (If you might not be, review Chapter 13.)
Am I waiting first to see if my child can do a new skill without my help? (If you’re not sure you’ve been doing this, see Chapter 12.)
If my child needs help, am I giving as little help as needed for my child to demonstrate the new behavior or skill? (If you think you might have gone astray here, review Chapter 12.)
Do I have my child’s attention before communicating with him or her? (If not, review Chapter 4.)
Is the activity fun for my child? (If the child doesn’t show signs of enjoying the activity, go back to Chapter 5.)
Is the activity fun for me? (No? See Chapter 5.)
Does my child experience the “reward” of the routine as soon as he or she tries to use the target skills I am trying to teach? (Not sure? Review Chapter 9.)
Do I see and respond to my child’s efforts to interact and communicate with me (even if they’re not perfect)? (To be sure, see Chapter 7.)
Is my child getting enough practice to master the new behavior or skill? (See whatever chapters address the skills you’re working on. They all discuss practicing to cement the skills.)
In closing, we have written this book for you parents, your child’s first and most important teachers. Parents are the most influential teachers children will ever have. We hope the tools we have passed on to you will help you and your child continue to learn from and teach each other for many years to come. We hope we have helped you experience the pleasure of watching your child master new skills, step by step. Know that all of those little steps are adding up to big gains as your child engages, communicates, and learns from others. As you watch your child develop and engage with others, we hope that your confidence in your child’s future—in his or her ability to have a fulfilling, meaningful, joyful, and productive life—will also grow.
Appendix
Toys, Materials, and Books
for Your Young Child with Autism
AGE-APPROPRIATE TOYS FOR CHILDREN THROUGH PREKINDERGARTEN
Playthings in Your Cupboard
Tupperware; measuring cups; rolling pins and dough; clothespins; jelly jars; silverware tray; plastic cups, bowls, spoons, forks, and knives; child scissors; crayons and markers; shelf paper or printer paper; magazines and photos of people in the family; pictures of various objects, animals, and people that you take and store on your cell phone; empty cereal boxes; oatmeal containers; magazines; dishwashing soap (for bubbles); laundry basket; trowels from the yard; and many more.
Playthings You or Others Can Purchase
This list is meant just to give you a wealth of ideas to choose from; it is not a shopping list.
• Board books with large pictures, simple stories (see “Age-Appropriate Books for Young Children,” below)
• Books with photographs of babies
• Blocks
• 1-inch wooden blocks with letters or pictures
• Multicolor, multishape block set
• Nesting toys
• Cups, boxes
• Simple shape sorters
• Legos/Duplos
• Magna Doodle
• Pegboards with pegs
• Puzzles
• Wooden inset puzzles with knobs
• Wooden inset puzzles with matching pictures
• Noninterlocking puzzles of up to five pieces
• Simple interlocking puzzles of three to six pieces
• Toys that encourage makebelieve play (toy lawn mower, kitchen sets, brooms, etc.)
• Digging toys (bucket, shovel, rake)
• Dolls of all sizes
• Cars, trucks, trains
• Unbreakable containers of all shapes and sizes
• Bath toys (boats, containers, floating squeak toys)
• Balls of all shapes and sizes
• Push and pull toys
• Outdoor toys (slides, swings, sandbox)
• Beginner’s tricycle
• Connecting toys (links, large stringing beads, S shapes)
• Stuffed animals
• Farm set with barn and animals
• Little dollhouse set with small plastic people
• Zoo animals
• Child keyboard and other musical instruments
• Art supplies