The case below illustrates how this might be done.
Individual example: Andrew
Three-year-old Andrew loved to be tickled and his parents loved to tickle him. During this time he squealed with delight, he looked into their faces, he allowed them to touch him – he was ‘with them’. When the activity stopped, Andrew ‘disappeared’ again. It was desperately frustrating for his parents to know that he could enjoy sharing space but that this was limited simply to being tickled. They had no idea how to move this on, yet were aware that somehow they needed to develop this pathway. First they increased the number of times they tickled and rough-and-tumbled. They had to let go of their idea that this is not how you would interact with a non-autistic child all the time.
Then they began to pair the tickling with another activity – blowing bubbles. Whilst Andrew was being tickled by his mum, his dad would start to blow bubbles. Andrew didn’t seem to notice at first but gradually he began to look intently at the bubbles. When he did this his mum would slow down the tickling game to let him focus on the bubbles. During the sessions, Andrew’s attention would flit between the two, and he began to touch a specific parent and seek out brief bursts of eye contact with them, depending on which activity he wanted, bubbles or tickles.
The bubbles were then moved to follow a bout of tickling (whilst Andrew was still very much with them and enjoying it). Andrew’s parents found that he was still receptive to the bubbles and amazed them by reaching out and laughing whilst he tried to pop them. During this time his mum and dad built in long pauses to allow Andrew to communicate that he wanted the game to go on. They were always responsive to whatever gestures and speech attempts he made by saying, ‘More bubbles? – yes!’ If they felt he was moving into his own solitary space again they would try a tickle, always responding to his lead. If he pulled away they would gradually tail off. If he responded they would keep going. Andrew was always left in control of the duration of the activity.
After a couple of weeks, Andrew responded to the bubbles without having to be tickled as well. Now Andrew’s parents had a second pathway to access their son; by associating new activities with the old pathways (tickles and bubbles), they continued to have positive results. The next thing they chose was a singing commentary. While Dad blew bubbles for Andrew to pop, Mum would begin a singing commentary (to a familiar tune such as ‘For he’s a jolly good fellow’) on what was happening. It went something like this:
‘Andrew’s on the sofa. Andrew’s popped a bubble…look, look, a big bubble… Andrew’s popped a bubble…Daddy’s blowing bubbles…more, more, more…Daddy’s blowing bubbles…pop, pop, pop…a bubble on the window, a bubble on the floor, look, Andrew bubbles more, more, more…’
Andrew’s mum sang the commentary using lots of repetition and rhymes where they were possible, all the time commenting on what Andrew was actually doing. It took a couple of sessions before she felt comfortable doing this, but soon found a style that worked and was fun.
Again Andrew originally appeared to ignore the commentary and only focused on the bubbles, but gradually he began to look at his mum to sing as soon as the bubble game commenced. Once it became clear that the commentary was as important to him as the bubbles, this was then moved on to singing commentaries about other things during the day, for example when Andrew just meandered about the room she would try a commentary on what he was doing:
‘Looking out of the window, what can you see? I can see a house, I can see a tree, touching the cushion, touching the floor, touching Mummy’s knee.’
Over a period of a few weeks, Andrew’s parents had created a collection of activities that not only gained Andrew’s attention and enabled him to attempt communication, but that were so enjoyable to him that he allowed them to share his space in the same way that only tickling would have done a few weeks previously.
I hope that this example illustrates that even if there is only one activity in which your child seems responsive, there are ways of associating this so closely with a new activity that the same enjoyable feelings allow him to extend the times when he is responsive to your attention and create opportunities for him to communicate.
Most of the parents who completed my survey stated that their children were often more receptive during rough-and-tumble play, and had worked out by trial and error that there are ways of using these periods to encourage even more interaction; other parents were stuck for ideas on how to move this on. At the time of my son’s diagnosis we were aware that he connected with us better and on many levels during this type of play, but were at a loss as to how to use this as a bridge to other activities. Once we eventually discovered how to associate it with new activities, we were able to introduce a range of things that could be used as tools to bring him back to us when he seemed less receptive and as rewards for more demanding activities such as speech therapy.
I would advise that it is counterproductive (and totally exhausting!) to attempt to gain your child’s attention most of his waking hours. In our early post-diagnosis days, I often panicked if I felt my son had drifted into his own world. I now feel he needs some time to do exactly this. You know your child best and can make the decision as to how intensive/relaxed your approach will be and what is right for your child.
As well as these play-based activities to encourage interaction you can also create opportunities for your child to communicate at other times:
Once you have discovered there are tools to gain your child’s attention and situations that you can create to encourage him to communicate, then some real playing can begin! Always hold on to your secret weapons – you never know when you might need them!
What is Intensive Interaction?
Intensive Interaction is a teaching method of exploring and using the very fundamentals of communication with children and adults who have severe communication challenges. During the first year of a typically developing baby’s life, a highly complex but very natural series of social responses and communicative exchanges happens between the baby and the adults around him. Intuitively, parents follow their baby’s cues to respond, they put the child in control of the type of engagement and the duration, it may be blowing raspberries, imitating vocalizations or pulling faces. Invariably these early interactions involve eye contact, sound making and turn-taking and lots of repetition