Empowering parents is key to helping pre-school children with ASD develop their communication
The thing we hear most from parents of pre-school children who have social communication or ASD difficulties (diagnosed or suspected) is that they feel helpless. They know their child has a problem, but don’t know how to help. Their child may not have words, may have terrible temper outbursts because they can’t communicate and family life may be in tatters. Dads, in particular, usually want to feel they are doing something which will “fix it”.
It is important that parents are supported to work out the stage of their child’s communication and that they are taught strategies to help take their child through to the next stage.
There are four stages of communication for children with ASD.
Own agenda: these are the children who don’t really see the point of communication; they play alone and like to do things by themselves. Communication is usually pre-intentional.
Requester: these children have begun to realise that the adult can be useful; they may take a parent’s hand to lead them to what they want.
Early communicator: these children have started to use specific gestures, sounds, pictures or words to ask for things in motivating situations.
Partner: these children can take part in conversations.
Not all children will start as “own agenda” and they may have elements of more than one stage. Where they are depends on their interaction skills, understanding and how and why they communicate.
Using everyday routines
Instead of relying on worksheets or flashcards, it can be very effective to use simple everyday routines to promote communication. It is also the case that many children with ASD find it hard to generalise learning from one situation to another, so learning language in real life situations can be crucial.
An enormous amount of learning can take place when children are involved in daily routines such as bath-time, snack or meal times, nappy changing and going out in a car – things that parents do with their children every day. These daily events are so important because they provide opportunities for repetitive learning in a natural, yet structured way. Within the context of such daily routines, a young child begins to make sense of their world.
Since there are targets in all our daily routines, it is clear to the child what has to be done. For example, the target of getting dressed is for the child to end up wearing clothes, socks and shoes. The goal of going in the car is to be seated in the car seat. Each routine consists of a series of small steps, such as opening the car door, climbing into or being put into the seat, sitting on the seat and then being fastened in. Routines have language that go along with them and there are cues in each situation, such as, “Time to get dressed” or “Let’s go in the car.”
Use the child’s interests and follow their lead
By observing the child’s interests it is possible to use what really motivates the them. Giving the child a reason to communicate, then waiting, is a great start. The things that motivate each child will be different, but will generally include common themes, such as food and especially chocolate.
Alice, a child at the own agenda stage, loved chocolate buttons, so we discussed how we could use these to make her need to ask the adult for help to get them. A clear plastic box with a lockable lid served this purpose well. By the next session, Alice had learned to take the box to her mother for her mother to open for each individual button. This situation wasn’t without initial difficulties, as Alice hadn’t been happy about the new arrangement, but by week four Alice had moved to being a “requester”, as she now saw the point in interaction with adults. Although the interaction was geared to having her needs met, it was still a huge step in the right direction.
Another child liked to stim with pieces of paper she’d torn from a colouring book, so the parent copied this and was able to have some really useful interaction by getting the child to copy them and gain eye contact too. They were able to set targets and move on from there.
Hanen’s* “observe, wait and listen” strategy works well as it shows how to stand back, wait and see what will happen before jumping in. This approach can be a great help in getting to know how a child communicates.
Susie Shah, mother to Aisam (requester level), aged four years, says: “I found it so hard to stand back and wait to begin with, but it was the best thing I learned. I can now see that he was actually communicating even though he couldn’t talk”. She felt is was positive and a gave her a renewed impetus to want to help him.
Being face to face
This sounds so simple, but how you position yourself is important. You need to be level with the child’s eyes for maximum communication opportunities; so if the child is sitting on the floor, you have to lie on your tummy or on your side, level with the child. You can get a few doubters with this strategy but once they try it people report back very positively. Joshua’s Mum, Tori, found this very awkward to start with: “I felt I was the wrong shape to lie on the floor, but Josh loved it so much I persevered and it really works for him”, she says.
Making it work
Strategies such as those above can help to empower parents, making them feel they know more about what they can do to support their child’s communication development and what others, such as nursery staff, can do to help. The more everyone involved understands the process, the more their confidence grows and the better equipped they are to seek further support and try out new things.
Questions to ask yourself
Parents, in particular, need to understand how important their role is in helping children to develop communication. It can be very worthwhile to consider a few simple questions.
- where would you rate your child’s communication on a scale from one to ten?
- can you identify their communication level?
- do you know how to use everyday routines to help communication?
- do you know how to use books to help communication?
- do you know how to use songs/music to help communication?
- do you know how to use toys and games to help communication?
- how confident are you that you know what to do to support your child’s communication?
Libby Hill and Natasha Hallam are speech and language therapists at Small Talk SLT:
* Hanen’s More Than Words by Susan Feryhough.