structured time to the three different activities, even though the activities eventually support each other. Activities specifically designed to aid communication (speech and language therapy) should be provided at your child’s individual level of ability. Make the most of your speech and language therapist for this. Structured learning can be done as a daily session at home, taking the form of a slightly more formal version of the structured play activities. Try creating a ‘workbox’ that is brought out every day, preferably at the same time of day. Keep it out of your child’s reach and rotate and change the materials often to keep his interest. To start with, keep the session very short with two or three two-minute activities, and gradually try to build up the time to a longer session. Use activities that can be done at a table top – you might like to sit opposite your child so that he can see your face, but if this is too intrusive for him at first, sit at his side.
For ideas of what items to put in your workbox and how to introduce them, see Chapter 6 (‘Table-Top Games and Puzzles’). Mix these with exercises provided by your speech and language therapist, and some pen control exercises (see Chapter 13, ‘Being Creative: Art and Craft’).
Individual example: Sam
Sam was three years old and recently diagnosed with an autism spectrum disorder. Since the diagnosis, Sam’s parents had been working on increasing his eye contact and generally gaining his attention with some simple play activities. Sam had very few words that he used consistently, but his parents felt he was actually quite bright and able. They believed that it was his hyperactivity and rigid routines which were preventing him from learning. They had started to help him communicate with a picture diary and had created a box containing a variety of learning activities that was to be brought out after breakfast (a time when Sam seemed to be at his best) every day. They took a photo of the box and gave it the label ‘workbox’. They also had a picture card for television, which they were using as a reward (Sam liked to watch a particular video over and over). At first Sam resisted having to sit, but when he realized the first session was for only one minute he became compliant enough to sit for ten minutes by the end of the first week.
In the box were:
a shape-matching puzzle
four photos of familiar people and animals (his brother Tom, Daddy, Grandma, Fluffy) – Sam was asked to ‘give Mummy Fluffy’, etc.
a furry toy dog and a brush – Sam was asked to brush dog’s nose, ears, feet, tail, etc.
After he had completed each activity, Sam put the item(s) back in the box. After the final one he was ‘rewarded’ with his video. Sam always resisted spontaneously being directed in this way outside the workbox session, but actually looked forward to the sessions (and their rewards!) when he knew it was going to happen. For two years, until Sam started school, he continued the daily sessions. By the time he was five he was completing two twenty-minute sessions a day in which he was recognizing written words, making story sequences with sequencing picture cards, categorizing objects and building on reasoning skills. During this period they went through times when he occasionally refused to comply; if this happened then the reward was changed and the activities rethought, or sometimes Sam just needed a couple of days off !
These structured learning sessions are not the only times for learning. Modelling correct behaviour and language and creating opportunities to communicate should be done throughout the day, but often it is difficult for a child with autism to spontaneously attend to what you are saying in order to listen and learn. At the table you have a few minutes when you really ‘have him’, and the structure and predictability of this connection feels less stressful for him than being randomly invaded. Always be responsive when your child initiates an interaction (verbal or otherwise) at other times during the day.
Structuring the day – creating a visual diary
Throughout the book I make reference to using ‘picture prompts’ to communicate to your child which play activity you have planned. There are some for you to photocopy and use at the back of this book. Using picture prompts in this way is an idea from TEACCH (Treatment and Education of Autistic and related Communicationhandicapped Children) – for more information, see the references at the back of the book. It makes sense to use these prompt cards as part of a picture diary to communicate the course of the day’s events to your child. How you display and use the cards is a personal choice – you may display them left to right, horizontally or in a vertical strip, top to bottom. Make them durable enough to withstand a fair amount of use; either invest in a laminator, or stick them to card and cover them with sticky-backed plastic. You could use a piece of ‘hook and loop’ so that they can be peeled off and reused.
How many cards you use is up to you and your child. Some children may need prompts for getting dressed and using the toilet; others may only need them for outings and activities. You might find the prompts relieve a long-standing problem caused by the frustrations of poor communication. For a number of months we had a problem if we went out and our son didn’t know which car (Mummy’s or Daddy’s) or which parent he was going with. After I had made cards for all the permutations – both parents in Dad’s car, both in Mum’s car, Dad in Mum’s car, etc. – the problem suddenly lifted. I used simple stick ‘men’ and ‘women’ drawings (plus a stick child) and luckily the cars are different colours! Picture representations can be made for anything, including a sequenced set of cards to depict the order in which to dress, wash hands, etc.
The website www.do2learn.com has a great selection of copyright-free pictures that you can simply print off and use. Also see Chapter 4 for lots of ideas on making the most of your computer to access and make visual supports.
A morning in pictures might look something like this:
After an activity is complete, have a posting box or envelope for your child to put the picture card in to indicate that is the end, then return to the board for the next activity.
Introducing choice and flexibility
Even though choice and flexibility are difficult areas for children with autism, after your child is used to using picture prompts you can also use them to help him make choices. His first choice may be which reward to have, for example ‘biscuit’ or ‘video’. You might also use them to help him choose an activity for ‘free play’, for example ‘trampoline’ or ‘cars’. Don’t put all the choices on the board; provide two, from which he can choose one and give it to you. Physically giving the card to you and gaining a response demonstrates to him that communication not only involves others, but that it works.
Using pictures to aid communication appeals to the ‘visual learner’ – children with autism often think and learn visually. Pictures are easier to decode than words, they make a direct and concrete link to the activity.
Pictures help to prepare him mentally for the next task and allow him to ‘shift gear’, reducing anxiety and confusion.
Pictures are excellent communication aids; their motivating and ‘attention-grabbing’ qualities make them suitable not only for nonverbal children but for all children on the autism spectrum.
Pictures are a physical aid to help your child exercise choice and control.
