As a teaching approach for nonverbal hard to reach children, Intensive Interaction builds on these principles of following the child’s lead in interactive rather than directive play. For children beyond baby years this type of playing can seem uncomfortable for parents to engage in at first. We are employing strategies that we inevitably used the first time round when our children were indeed babies. So why revisit this stage of development? There will be parents reading this book desperately hoping for ideas to connect with a child so withdrawn into autistic aloneness that activities such as structured learning and language building are out of reach – your child needs to connect with you first, even fleetingly. The natural processes of early communication have been altered by autism, but that is not to say that they have been damaged for good. By extending and intensifying the period of early pre-verbal parent/child interaction you are giving your child’s brain more time to respond – your child may be developmentally delayed so playing at this very early parent/baby level with your older child will be appropriate and right for him. Ultimately if Intensive Interaction has significant results with adults on the severe end of the autism spectrum (and it does), then a child can benefit even more from the ‘neural plasticity’ that young brains have.
The goal is to create some sense of meaning and enjoyment in just being with others, to ‘re-wire’ the processes that drive a child to resist and avoid relatedness at all costs by engaging in an activity that is intrinsically motivating and rewarding – this is the first and most important aim. Enjoyment comes from your child being calm and sharing control, feeling safe and having fun in the most basic form of interaction. This is sharing space at foundation level: enjoying being with another person. Intensive Interaction is not an overnight autism cure, it is one of many intervention strategies which with lots of effort, perseverance and repetition can increase your child’s motivation to relate.
You may wish to explore Intensive Interaction further, to attend training or watch it in process. For information, newsletters and training information, visit: www.intensiveinteraction.co.uk
Chapter 3
Structured Play
Why do children on the autism spectrum need structure?
Despite common communication impairments, children on the autism spectrum vary considerably, in fact autism may be seen as an ‘umbrella’ term in itself, like the description ‘learning disability’. As autism does not just affect the ability to learn and understand but affects processing by all the senses, the potential for its various subtypes is endless – different degrees of problems with speech, social communication, learning difficulties, sensory problems, physical problems…, and on top of this are the individual’s responses and ability to cope with his condition.
As much as we all hate labels, for most parents the diagnostic label should be the passport to relief, to being able to find the most appropriate services, the right professional help and the best approach for them and their child. Confusingly, however, for parents of children on the autism spectrum there doesn’t seem to be one best approach. There are a number of routes all with worldwide advocates who devoutly believe that this is the only way to help, if not ‘recover’, your child from autism. For parents of very young children, this diversity of advice is confusing, pressurizing and piles more stress on top of an already strained household.
Despite this barrage of what seems like contradictory advice there are some golden threads of agreement and one such element is that of structure. It would appear that those therapies and approaches to autism that have stood the test of time and demonstrated quantifiable results have a central theme of structure. In describing what structure is, it is probably easier to describe what structure isn’t, with all the contradictions that this encompasses!
It isn’t about providing a great deal of choice (though creating opportunities for choice is a part of structuring the environment).
It isn’t about ‘free’ play (though structured play is the first step to encouraging spontaneous play).
It isn’t about leaving a child to discover an activity, its limits and potentials by himself (though learning to discover these things together is a definite goal).
It isn’t about these things because, in a play context, choice, freedom and discovery are simply not the things that motivate children with autism to play in the way they motivate their non-autistic peers. Children with autism need structure because despite their many differences, in general they have impaired motivation to interact, learn and play. They have rigid and repetitive patterns of thinking and therefore of talking and playing, and are often motivated to preserve ‘sameness’. Coupled with a resistance to being directed and a need to take control of as many aspects of their immediate environment as possible, it is not difficult to appreciate how being part of a learning and playing environment that advocates spontaneity, free choice and independent discovery simply is not appropriate for a child with autism.
What does ‘structuring play’ actually mean and how does it work?
You might feel that this sounds fine in a therapeutic or educational environment, but how does this work in a busy home environment with a three-year-old? We shouldn’t feel that the only way to help our child is to follow a specific private programme executed by a therapist, not a mere mortal parent! As primary carers for our children we can learn how to structure their play – it’s about choosing an activity, looking at how your child already engages (or doesn’t) in the activity, whether he plays appropriately or inappropriately, how he interacts with you (or doesn’t) during these times and how you can make improvements. It’s about looking at his day and working out how you can steer him into constructive interaction and play for more hours than he currently does. Introducing structure is also about being aware of what makes him distressed and working out how communication can be improved to make him feel safer by making his day seem more predictable and less chaotic. It’s also about taking some control yourself; making your child aware that he is a part of a functioning family, with the comings and goings that this involves, and not always the nucleus that the rest of the family revolves around. Giving your child structure allows you to do this in the kindest way.
Structuring play works by systematically breaking a play activity into its component parts so that it is no longer a jumble of language, objects and actions that has no meaning for your child. By breaking it down into very simple elements you give your child a chance to work out what each element represents – you give him the chance to interpret the activity and give it meaning. Fundamentally you are giving his brain a chance to keep up with processing incoming information. I expect achievements will vary according to your child’s potential, but even the smallest of successes will justify the effort. This is how structuring an individual activity works. Throughout the book I also refer to structuring the day as a series of activities. These will not all be play activities – the day is represented in pictures showing the sequence in which they will happen, including the particular play activities that you have planned for that day.
Creating play opportunity – setting the stage
Each of the following chapters in turn draws your attention to sensory problems that may hinder playing with that particular activity and the importance of checking the play environment, so I won’t repeat this again here.
Remember to be responsive to your child’s level of tolerance to direct requests – if he is resistant, pull back; introduce the activity that you have planned into the day ‘indirectly’. Play alongside your child as if for your own pleasure, set up a duplicate activity within his reach and keep the session very short (one or two minutes at a