McKenzie Centre speech language therapist Estelle Pretorius, provides strategies that will empower you as a parent or caregiver of a child with Autism, to support their communication and interaction using daily routines throughout the day.
22 November 2016 – FAMILY is the most important influence in your child’s life. You know more than anyone else, what makes your child happy, what he or she likes doing, how your child is likely to respond in any given situation, and the things he or she avoids. You are an important person in your child’s early learning and development. You are an equal partner in the team around your child, as you spend the most time together. Embrace the opportunity for your child to learn from, and with you.
Build a team around you
A family-centred approach is crucial to supporting your child’s learning and participation in the community. Wrap early intervention services around your family.
Ensure that your early intervention team who may include occupational therapists, physiotherapists, speech language therapists, psychologists, and early intervention teachers provide you with practical strategies and support for your child and family, helping you enjoy and use the time you spend together every day as learning opportunities. Collaboration between team members is important when setting goals and evaluating progress for your child. As a family, you will have natural supports as well e.g. family, friends, and carers. Encouraging and maintaining these, are an advantage to the wellbeing of your family.
Breathe and take perspective
Your child is first and foremost a child with behaviours and emotional challenges that you will find in any baby, toddler and pre-schooler growing up. Although Autism may affect functional skills and daily living in some children more than in others, it does not define, describe or explain your child’s temperament or personality!
Independence begins with predictability and routines
Children learn amazing skills, and thrive when their day is organised and predictable. Routines provide security, structure and expectations, which are foundational for learning to cope and being independent. Your child learns many social interaction and communication skills in naturally occurring daily situations, including meal times, bath and bed time, family activities, grooming and dressing activities. Your child will learn to pay attention to what you are saying, and what is happening around him or her, become more responsive to, and process spoken language, take turns, and learn the rules and boundaries of acceptable behaviour. Involving children in predictable daily routines provides them with regular patterns in activities and hearing language in a meaningful context.
Make your words stand out
Babies and toddlers learn what words mean when we see them in action and when they are used in a specific context e.g. when a mother changes her baby’s nappy, she uses words that belong in this routine. These words may be, ‘let’s put your nappy on’ while she shows the nappy to the child. In this illustration the mother used spoken language with contextual cues, i.e. this routine happens at the changing table and she uses visual cues, the nappy, to the child before she puts the nappy on. During the routine the baby will hear the word ‘nappy’ several times while she puts the nappy on her. This baby will also hear the word ‘nappy’ throughout the day used by a range of people, and she will relate it to the context she learnt the word. When children learn new words, it is important that we help them understand its meaning, or function, by showing them (using an object, gesture or sign). Using the word in the context it belongs i.e. it is being reinforced as part of a typical routine, and practiced over and over, makes the word ‘stand out’ and become meaningful to the child. Remember also that ‘less is more’, keep instructions and comments short and always wait for the child’s response before you continue.
Make information concrete
Visual communication supports can enhance the child’s ability to understand not only what is being said, but also what is happening and what they are expected to do. Frustration happens easily when expectations are not clear and the child is unable to understand or get their message across. Visual supports provide the child with the ability to make a choice, to express their needs/wants, to complete a simple task and to be included in activities. Visual supports take the form of real objects, pictures, photos or symbols, but can also involve actions, gestures or signs. Examples of visuals that support daily routines are;
- Activity schedules showing what happens, and when,
- Communication boards that provide the child with options and the means for requesting activities,
- Task schedules for helping a child learn a self-care task such as the steps of the toileting routine,
- Symbols/cue cards or gestures that help a child understand the rules and boundaries of behaviour e.g. stop/wait, and
- Social stories that describes a situation and how to respond.
Understand your child’s sensory profile
Sensory processing difficulties are common in children with Autism, and have an impact on how they take an interest, engage and participate in any setting. Your child is unique in the sense that he or she will avoid or seek out a combination of experiences that are significant. Children with Autism may have difficulties processing how they hear things, how they look at things, how they smell or taste things, and how their bodies respond in relation to the world around them. An occupational therapist will help you learn your child’s sensory profile. Some of your child’s behaviours, e.g. avoiding showers, may be strongly connected to their sensory preferences. You are also able to use your child’s sensory preferences as a starting point to connect. If your child enjoys jumping on the trampoline, because he or she seeks movement, it is an opportunity for you to join in and create an interactive game such as ‘stop and go’. Your child is more likely to stay and play if it involves their sensory interest.
Be a fun play partner and join in with their interests
Join in with what your child is doing; copy their actions, movements, sounds and words and talk about what he or she is doing. Use exaggerated expressions and fun words that will capture attention e.g. ‘uh oh!’, ‘wow’ or ‘yeah!’ and add sounds to actions e.g. using the word ‘bounce’ when you are bouncing the child on your knee. Involving yourself in your child’s play on a regular basis, builds your child’s capacity to include others’ ideas and provides foundation skills and imitating and learning from others.
There is a time and place for special interests
Your child may have a specific, intense and repetitive interest in an object or activity. The function of this interest for your child is pure delight and is often very calming and soothing. To be denied access to these activities will cause distress and anxiety. Plan access to these activities throughout the day and use them as motivators for tasks that are more challenging and less preferred. Keeping special interests for special times can be a great tool for your child to learn to wait, and to communicate directly towards you in any communication modality i.e. gestures, pictures, signs, words or the written word.
Create reasons for your child to communicate towards you
People games are great tools for building anticipation and functional communication skills. They are fun, physical games that are shared between adult and child, without involving a toy or object. People games that are popular are; tickle games, a game of chase, peek-a-boo and nursery rhymes/songs. They build valuable foundations in joint attention, functional communication and back and forth interactions and are a great way to re-connect with your child and build stronger relationships. When your child knows a game really well, choose a place in the game to pause i.e. waiting without saying or doing anything other than an expression of anticipation in your face. Your child will want to keep the game going, and will want to show you in some way that he or she wants ‘more’. Begin to respond to even the slightest attempts e.g. a look or a gesture, and later you can wait for your child to say the word ‘more’ before you continue the game.
Meaningful eye contact
The presence of meaningful eye contact for social purposes may be an important skill for a child with Autism to learn; however, this may be particularly difficult because it requires the child to ‘multi-task’ e.g. looking at a person while having to listen to them. You can begin to build foundations for this task while you are playing alongside or with your child. Learn the art of ‘talking with your face’ and creating reasons for your child to look directly towards you. An example of a game you can play, is when something happens expectantly e.g. the tower your child is building, is knocked over, you could come down to their level and show a surprised expression on your face, with a gasp of air or the word ‘uh oh!’ and wait for the child to look towards you, before assisting. You can also bring a toy close to your face before giving it to your child, which allows him or her to briefly acknowledge you before having the desired toy. Position yourself so you make it easy for your child to shift attention from the activity to look at you, try sitting opposite when reading a book or playing with a cause and effect toy. Add fun sounds and match a facial expression with this sound, when your child is facing you.
Research suggests that there are long term benefits of functional language acquisition through participation in daily routines. By creating learning opportunities within every routine, children have repeated practice of skills, and increased social competence.
About the author
Estelle Pretorius, B Logopedics (Communication Pathology), is on the professional expert team of Altogether Autism and works as a speech language therapist at McKenzie Centre Early Intervention Centre in Hamilton.
This article was first published in Altogether Autism Journal Issue 4, November 2016 read the latest edition.