Growing Up on the Spectrum

by Lynn Kern Koegel

  Finally, learning to read other people’s body cues can help. Is the other person looking away, smiling, looking uncomfortable? Individuals on the spectrum often have to be taught what these cues mean. We often start by exaggerating the cues, like yawning or looking in a completely different direction. It’s helpful sometimes to teach your child to ask if she’s getting the cue right. For example, she can say, “I see you’re looking at your watch—do you have to run?” or “Are you interested in Family Guy or would you rather talk about something else?” Improving all of these areas can help to get the timing right during conversation.

  Ask Relevant Questions

  We’ve noticed that many adolescents and adults on the spectrum really don’t ask enough questions. Well-timed and concerned questions are key to making and maintaining friendships, so teaching your child to ask appropriate questions will fill in the gaps, keep the conversation going, and ultimately help him socially.

  Earlier in this chapter we talked about initiating conversations with questions. That sometimes takes a lot more work because your child will have to dream up something to talk about. Asking a question within the conversation can be easier because your child can bounce a question off the previous statement.

  It’s important that your child show interest in what the other person is saying, and an appropriate question will make it clear he’s really listening. You can work on that. For example, if you say, “The food here is really bad,” you can practice having your child say, “What did you have?” so she can learn how a related question will keep the conversation going. You can also teach her that a great time to ask a question is when there are a few seconds of silence during a conversation.

  When we work with our adolescents and adults, we usually have them come up with about three questions they could have asked in a given context. If they can’t think of any, we give them suggestions. For example, if the conversation is about the weather and the adult on the spectrum can’t think of anything to ask, we may prompt her to ask if the other person likes snow, or what his/her favorite kind of weather is, or if he/she knows what the forecast is. With practice, and brain-storming, asking questions gets easier.

  We all want our friends to show that they care about our well-being and aren’t just wishing we would move on to another topic when we’re expressing some distress. To put it simply, what a worried or sad friend wants to hear is “Are you OK?” and not “He wasn’t right for you anyway,” “You’ll be fine,” or “It doesn’t sound like that big a deal.” You need to make sure that your child learns how to ask the kind of questions that show real concern about the other person and uses a tone of voice that sounds sincere.

  Reflecting the Response

  Not only does your child need to learn to wait for a response (after asking a question or giving the other person a chance to speak) but he also needs to learn to reflect that response in some way, to prove that he’s been listening and is interested. This can take the form of either a question or a comment. For example, if your child asks, “Did you see The Happening?” and the peer says, “No, I don’t like scary movies,” your child can reflect on this by asking another question: “Oh, you don’t like scary movies, what kind of movies do you like?” Or he might comment: “I don’t like them either, although the Scream movies were kind of fun.” Reflecting a response not only lets the other person know you’re a good listener but can also buy some time while you’re thinking up a question!

  Many of our kids answer questions as briefly as possible. For example, if someone asks, “Do you have any sisters or brothers?” they might simply say yes and nothing else. Or if someone asks what their favorite class is, they might just say, “Math.” We’ve had success overcoming this brevity by teaching our kids the strategy of (1) making a statement, (2) adding some information, and (3) sharing a feeling about it. Then we add that it’s time to let the other person respond.

  So if someone says, “Do you like math?” we teach them to say something like, “Yeah, I like math—we’re working on quadratic equations. Mrs. Berry explains them really well.” Or if a peer asks if they have any brothers or sisters, they might say, “Yeah, I have a brother; he’s two years younger than me, and he’s really into baseball.” The three rules are easy to remember and help to keep the conversation moving. We often practice by writing a little diagram of these three steps: topic➔more information➔feeling.

  Visual aids, like the above, can help provide a framework for practice and often facilitate the understanding of the process for kids on the spectrum. While these longer utterances may sound a little awkward initially, with enough practice your child will internalize the idea, and become a much better conversationalist.

  While many of our kids have trouble getting the conversation started, we also have some kids who go on and on and on and on. The strategy we discussed above—(1) making a statement, (2) adding some information, and (3) sharing a feeling, and then waiting for the other person to respond—works great for this group too. They often don’t pick up on the conversational partner’s clues that they are giving far too much information, but if we teach them to limit many of their responses to those three pieces of information, they can learn to maintain a much more even give-and-take.

  Stick to the Topic at Hand

  It’s important to teach your child to really listen to what others are saying and not just wait for a chance to talk about what interests her. Make sure your child’s responses in a conversation are related to what preceded them. For example, if a peer says, “My grandmother is in the hospital” and your child responds with “Do you like ancient Egyptian art?” that’s not likely to make her friend want to continue the conversation or seek her out in the future. In contrast, if your child responds with “That’s too bad; I’ll bet that’s really difficult for you” (or perhaps the more contextually appropriate “That totally sucks”), she will be considered an empathetic conversational partner.

  If your child has especially restricted interests and difficulty talking about anything else, you’ll need to practice this empathetic listening quite a bit, because it’s an important piece of the making-friends puzzle. The other day I was working on conversation with an adult with Asperger’s syndrome who really has no friends. The first thing he said to me was, “Would you rather be a pilot on an aircraft or the captain of a submarine?” When I replied, “Probably neither, since I don’t like being too far above or below ground level,” he said, “What do I do if someone just doesn’t want to talk about the things that I want to talk about?” Anyway, we talked about how important it was when asking questions to make sure the other person is interested in the topic. Eventually, he asked enough questions that he hit on a topic of interest to both of us (specifically, the latest fiction books I had read).

  You can practice staying on topic and then give your child feedback, or use self-management or video modeling to work on these areas. Feedback and redirection can be helpful, but be sure not to criticize your child—he’s trying hard to socialize in the best way he can and needs support, not criticism. And it’s always more effective to point out the successful moments than the unsuccessful ones. It’s kind of like when someone tells you not to think about elephants and then that’s about all you can think about. So if you focus on strengths rather than weaknesses, your child will remember the pluses. Newly learned behaviors are more likely to be used if the person is working for something positive (like a compliment) rather than avoiding a punishment.

  Finding a Natural Rhythm of Speech

  Maintaining a dialogue isn’t just about the words exchanged, but also about tone and nuance. Using the right intonation, pausing at the appropriate times, speaking at varying speeds, and emphasizing certain words all contribute to making a person interesting and easy to listen to while adding to the emotion of any message. Most of us instinctively learn how to monitor our voices from feedback that friends and family have given us. In fact, certain people make a living from the manipulation of their v
oices—think of our favorite TV characters, such as the soft-spoken psychologist who asks all the questions or the fast-talking deal maker or breaker. Prosody conveys message, meaning, and feeling. Unfortunately, many of our kids have prosody problems. Some talk too quickly, some too slowly, some too loudly, some too softly, and some simply have very unusual intonation patterns.

  I have found that many individuals on the spectrum respond well to intervention in this area, but you have to devote a lot of time to practicing if they still persist in the teen and adult years, because—let’s face it—they’ve been talking that way for a long, long time. Basically your child will need to practice until the new speech patterns become a habit. We worked with one university student who had no pitch variation in her voice: she talked in a monotone. We started working on the rising and falling intonation people use when they ask a question, and she said it felt very awkward and exaggerated to her (although it sounded great to us). It took a lot of practice until she felt comfortable using the right voice modulation, but she did get it in time.

  Here’s an overview of some of the different types of prosody problems that are common with kids on the spectrum, with advice on how to work on improving them, and some real-life examples:

  1. Talks too quickly or slowly. Many people on the spectrum talk too slowly. It almost feels as if they start to say something and their mind just wanders, leading to really long pauses in the conversation. The intervention we use also works well for people who talk too quickly. Basically, we’re teaching them a good pace. Here’s how you do it.a. Gather materials. The first thing you’ll need to do is gather together some materials that will help the person you’re working with get ideas. They can be any combination of pictures from family albums, books, magazines, post-cards, and so on. Put them together in a pile for easy access. If your child needs a little extra incentive, decide on a specific number of points he needs (like twenty) to earn a little prize, which could be a break, a treat, or a fun activity you’ll do together when you finish—whatever appeals to him.

  b. Start small and easy. Now take those items, and pick out one word to say about each item. For example, if it’s a family photo album, you can say “Mom” for one picture, then “Dad” on the next picture, then “vacation” on the one that has the last family trip. Have your child repeat each word after you and tell her, “That sounded great” if she says it with the right pace. Do this until she can repeat twenty words in a row with a good-sounding pace. If it doesn’t sound right, ask her to try it again and repeat the word you want her to imitate.

  c. Do it alone. Now it’s his turn to say the words at the right pace by himself. Remember, you aren’t going to model the word for him this time through. Go through the pictures or cards again and praise him (“Wow! That sounded great!”) every time he says a word with a good pace. If he doesn’t sound so great, don’t criticize him or take points away, just matter-of-factly ask him to try again.

  d. Up the ante. Now you’re going to repeat steps b and c, but with two words. Instead of saying “Mom,” you’re going to add a word, for instance, “Mom’s shirt” or “my dad” or “family vacation.” Have her repeat the two words and when she does so at the right pace, praise her. After she says twenty in a row at the right pace, have her redo those twenty all by herself while you give feedback after every utterance.

  e. Move to phrases. Now it’s time to move up to very short phrases—no more than three or four words. You can add something to each two-word combination, for example, “Mom’s new shirt,” “my dad fishes,” or “our family vacation.” Again, first have him repeat after you then let him say the phrase by himself once he’s repeated twenty in a row at the right pace. Remember, compliment him on how great it sounds.

  f. Start sentences. After phrases, you can move to sentences. So this time you’re going to have her repeat your sentences, such as, “My mom has a new shirt,” “My dad fishes at the lake,” or “Our family vacation was fun.” Give her verbal rewards for nice-sounding sentences and have her try again if they’re too slow (or too fast). After she can repeat twenty sentences in a row with good pacing, have her say twenty sentences by herself.

  g. Move it into conversation. Now you’ll need to practice with very controlled conversation. Start by letting him know you’re going to be working on the pace, or “how he sounds” (use whatever key words you feel comfortable with to describe it), while you just chat. Feel free to use the pictures and ask him to just say a couple of things about the picture or to use a sentence or two to answer your questions. If he has a problem with the pace, have him stop and repeat the sentence he had trouble with after you. So, for example, if he says, “We always have (long pause) fun on our family vacations,” you can say, “Honey, can you try it like this? ‘We always have fun on our family vacations.’ ” Then have him repeat the sentence. Practice this until you can have a nice conversation where he’s using the right pace.

  h. Move it to different locations. One thing that often causes a problem for kids on the spectrum is using the newly learned speech rhythm in everyday contexts—they may be used to speaking at the right pace in the one room where you’ve been practicing, but take them to the store or a restaurant and their newly acquired ability may disappear. So you’ll need to continue practicing in lots of different places.

  i. Practice with different people. You’ll also need to practice with lots of different people. You can do this from the get-go or you can do it after your child is speaking at a good pace. You can get your child’s relatives and friends involved if that’s comfortable. Anyone other than the person who did the original teaching will work.

  j. Continue to check for good pacing. If your child is talking at the right rate in all of her settings, you’re finished. And remember, the most important time to check is when she’s with her peers. Adults can be a lot more forgiving and patient. If the good pacing only happens when the setting is somewhat controlled, she may need to self-monitor her pace. Check Section I, Chapter 2 for the specific procedures, but she’ll probably need to use a wrist counter to monitor every sentence or few sentences. Simply being aware of the rate throughout the day will improve her speed until the right pace eventually becomes unconscious. Once she’s self-managing, keep monitoring to make sure the rate is right in all kinds of places with all kinds of people.

  2. Disfluencies. Disfluencies are a close cousin to rate problems, so the interventions that work are very similar. A disfluency is any repetition, whether word (“I want to go go go to the store”), phrase (“I wanna go, I wanna go”), insertion (“I want to um, um, um, go”), break, or other irregularity that interrupts the flow of a sentence. While virtually everyone has some disfluencies, when there are too many, you may need to intervene. It’s also important to note that many children, especially boys, tend to go through a period of time (usually in the preschool years) when they have more disfluencies, which they often outgrow. However, most of the children on the spectrum I have worked with seem to have disfluencies because their mind wanders midsentence. They may have a perfectly logical thought, but while trying to express it, they think about something else, and the sentence just doesn’t come out right. The intervention for rate works well with disfluencies for kids on the spectrum. Go through each step listed above, then, if necessary, have them self-manage each sentence with a wrist counter.

  3. Talks too loudly or softly. A small percentage of kids on the spectrum habitually speak at the wrong volume. I had dinner once with an adult with Asperger’s syndrome, and he told me more details than I wanted to know about his previous girlfriend in such a loud voice that I swear everyone in the whole restaurant knew all about his love life by the end of the evening. Since modulating how loudly or quietly you speak isn’t related to breaking up the speech into smaller parts, like rate and fluency problems, you can usually start at the sentence level. Here are some suggested steps:a. Repeat it: Have your child repeat sentences at an appropriate volume level. You can start with sentences or a
few sentences that your child can remember well enough to repeat back. Do this in a variety of settings, where there are different amounts of background noise: the car, a restaurant, a coffee shop, a classroom, a party, and so on. Give him feedback after every sentence: “That sounded great; you were talking at just the right volume” or “I couldn’t hear that one—could you say it a little louder?” Do this until he can repeat at least twenty sentences in a row at a perfect volume.

  b. Say it alone: Repeat step a, above, but this time have your child say the sentences by herself. They can be comments, questions, or statements. This is just to give her a chance to practice without the direct model. Remember to give feedback after each sentence, telling her whether it was the right volume or if she should try again. Do this in a variety of places, just like the last step.

  c. Self-manage: Now give your child a wrist counter and have him monitor the volume of each sentence or phrase. Practice by engaging him in conversation. Ask questions and have him monitor each sentence for the right loudness level. Do this in a variety of settings.

  d. Use it everywhere: Have your child use the wrist counter in other settings when you aren’t there. Read Section I, Chapter 2 for details about how to set up a reward system and check for success in these everyday settings. And make sure you check with people in those everyday settings to make sure she’s actually continuing to monitor the right volume you’ve worked on.

  e. Troubleshooting: If your child still continues to have trouble with volume, you may want to use some prompts. You can verbally or visually prompt him, but don’t forget about prompt fading (described in Section I, Chapter 2). For example, a 1 can be an indoor voice when it’s nice and calm and quiet, and a 5 can be the outdoor voice when he’s trying to get everyone’s attention on the baseball field or basketball court. A 3 can be halfway in between. Then you can quietly let him know ahead of time (or during an event, if necessary) which level he should be using. You can also come up with some hand signals so it’s discreet and doesn’t attract attention. The right signal between you and your child can help him with the ever-changing appropriate volume levels whatever situation he’s in.