Analysing play activities in this way takes some practice, but very quickly becomes simply your way of playing with your own child. You may already have been doing this to an extent without even realizing exactly what you were doing!
Applied behavioural analysis (ABA)
Many readers have probably heard of Lovaas or ABA training. This is one of the long-standing therapies that have a central theme of structure which has proved positive for many children. We ourselves considered the programme but decided that for us and our little boy this was not going to be the right decision. We were, however, in a good position to offer a high level of structure and one-to-one attention, at his crucial stage of early development and felt strongly that we also had to create a learning and playing environment that accommodated his autism to some extent. The choice to go down this route is highly individual, but any parent who hasn’t heard of the therapy should at least research it. In brief, the home-based programme consists of teaching sessions conducted by a team of helpers trained by an ABA supervisor. The therapy can be intensive – up to 40 hours a week – and costly (though there are ways of trying to get help with this). Children are taught skills in a similar way to some of the techniques that I describe in this book – breaking them down into smaller tasks and using reinforcers to motivate. Many programmes are ‘play’-orientated and have come a long way since the older style ‘behaviour’-orientated programmes which have received negative publicity in the past. ABA is a big commitment emotionally, physically and financially, but for some families it is the preferred route. Those with children on the programme are usually more than willing to let you see how it works and to share their experiences. Like all therapeutic routes, parents need to explore all the possible ramifications and make an informed decision whilst trying not to get bogged down by the latest ‘recovery’ programme. This book is about demonstrating that as parents we have the power to help ourselves to knowledge and information in order to help our children.
For more information on ABA and other therapeutic options see the resources at the back of the book.
Structuring early learning
Non-autistic children have a curiosity and motivation to understand as much of the world around them as possible. Their developing brains cope with new concepts and levels of understanding as soon as they are physically ready. Their ability to think and reason is aided by a stimulating and attentive environment as well as their own biological make-up.
If, however, that very biological make-up is impaired in a way that takes away the motivation to understand and make sense of the child’s surrounding world (the way an autism spectrum disorder does) then the process of learning is disabled, regardless of whether the child’s intellectual reasoning is intact.
This makes the prospect of creating an environment to support learning much more of a challenge. Most parents of children with autism are in agreement that their child needs to have proactive input into helping him learn and play and communicate as early as possible. Even though these three elements of development are very much entwined, we might see them also as separate arenas that need equal attention. From the outside, activities aimed at developing play skills may also look like activities to aid learning and communication and vice versa. For parents, however, it may help to allocate 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;