Increasing Language for Children with Autism

Impairment in communication is one of the main diagnostic criteria for a child with autism, specifically a delay in or total lack of spoken language.  Behavior analysts break down “language” into many reasons a child would communicate.  Based on these reasons, they identify where there are deficits and how they can increase these deficit areas.  We will outline some of them here in a very easy-to-understand manner and then give some advice on how to increase these forms of language every day.

The first form of language a child engages in is repeating.  This happens when a child repeats what another person says.  You may be thinking at this point that your child with autism does this a lot!  Many children with autism engage in this behavior although it is repetitive in nature and they do not do it to get attention from others (why typically developing children repeat language); they do it because it is fun for them. In order to learn other forms of language (which we will discuss below), a child should be able to repeat what an adult says on command. If your child does not do this regularly, give many opportunities for repetition, each day throughout the day.  Get your child’s full attention, say a simple sound or word very clearly to them (e.g., “ahhhh”) and continue to do this until they repeat or approximate what you are saying.  Provide lots of praise and even preferred items.

Another important form of language a child engages in is requesting.  Many children with autism engage in challenging behaviors as a form of requesting (e.g., crying to get a cookie and this results in them getting a cookie so they will quiet down), instead of using appropriate language (e.g., “mommy, can I have a cookie?”).  This form of language can be taught throughout the day, every day, if you know what your child wants.  Keep many of their preferred items out of reach, especially food items.  Whenever they show a desire for something, model what they should say or do to communicate (e.g., you say “cookie”, engage in the manual sign for cookie, or point to the cookie icon or picture for them to give you) and require them to engage in the same communicative behavior that you modeled before you give them the cookie.  Give them small pieces of food items, little sips of drinks, or a short amount of time to play with preferred toys so you can remove the item and practice requesting for the item again.  If you do this about three times each time they want varied things throughout the day, your child will begin to gain this requesting skill, and you may see a decrease in challenging behaviors.

Remember, to learn language your child must receive lots and lots of learning opportunities per day.  You can provide this by engaging in simple strategies such as the ones we discussed above.

What challenges have you faced? Please write us back and we will respond.

Using Structure and Scheduling for Your Child and Taking Much Needed Time for You

When you arrive home with the kids after school and work, the first thing you may want to do is relax!  Turning on the television for your child, letting her watch a movie, or allowing her to engage in her repetitive behaviors to her heart’s content is very tempting.  You have had a long day and rest is probably the first thing you would like to do.  Allowing these things just discussed though should be kept to a minimum and used as “earned” activities or used in emergency situations (i.e., when you just can’t take it anymore!).

So, what do you do instead?  When do you get “you” time?  First, focus on creating structure for your child during these down times.  Structure and routine are so important for children with autism. They are important for just about everyone but when it comes to children on the autism spectrum, they really thrive on routine and structure. You establish predictability with structure and routine and it can also help with meltdowns.

Create a visual schedule for your child for the evening routine using printed out photographs which you can Velcro in order to a piece of paper (a laminated paper is best).  A child can, by following clear pictures, recognize the order and importance of daily activities.  This reduces stress and anxiety because they know what to expect and what will be happening next. For example, you may allow 15 minutes of free play time, then homework, then dinner, then bath/shower, then bedtime routine activities, then bed.  It allows your child to see what to expect for the evening and also guides you as the parent, reminding you each evening what the structure should be.

What if your child does not follow visual schedules independently?  That’s okay!  It may take a few days, or even a few weeks, but after you guide them through the schedule each night, using a timer to signal the end of each activity, and guiding them to take off each picture as it is completed, they will learn to follow the schedule themselves and become independent before you know it.

Final tips: Be sure to include fun things that your child likes on the schedule, not just work activities and boring nightly activities.  Sometimes let them choose the activities during certain times (e.g., bedtime routine activities).  Lastly, be sure that when your child has successfully completed their schedule and is successfully in bed, do something good for you!  Enjoy that piece of cake that’s been sitting in the refrigerator or that glass of wine you’ve been waiting for all week.  Watch a movie with your partner.  Now it’s you time!

How to Make a Visit to the Grocery Store a Learning Opportunity for Your Child with Autism

A visit to the grocery store for parents with a child with autism can be quite stressful. On the other hand, it can also be a wonderful learning experience if parents take the time to follow a few simple strategies.

Before the shopping experience begins, it may be beneficial to state what is expected from your child, approximately how long it will take, and what can be expected afterwards. A method to increase motivation may be to state a clear if/then contingency. For example, “Johnny, if you stay next to mom/dad, help pick out your items, then after shopping we can get visit a nearby store you like.”

Make a list of items, either drawn out, printed out, or cut out from advertisements that your child can keep track of during the shopping trip. These can be items they prefer and would be interested in tracking and finding. Ask your child to cross out the items or put the picture in an envelope when you both find the item, signifying one step closer to being done with the shopping experience. Give your child a shortened list without all the items you need to get on it. Save the last item that you get for his list so that he can directly see when the last item is crossed out, you are done!

Have a back-up enjoyable activity that your child can engage in while you are completing the remaining part of the shopping trip that is not on his list. A small coloring book, games on your phone, a squishy toy, or some music through headphones may work to keep him engaged.

Use the experience to teach language skills. Grab a green and a red apple and ask your child to identify which one is red. Grab a big and a small can of tomatoes and ask your child to identify which one is bigger. Ask your child to label items that you grab from the shelves, especially preferable items. Based on how advanced your child’s speech is, tailor what you ask of them to their level.

Last, if your child has difficulties walking through an entire shopping experience, allow your child to catch a ride on the shopping cart only if he has walked and helped for a certain amount of time, or when all of his grocery list is completed. If you base it on time, be sure to have a visual chart (e.g., have 5 boxes, each representing 2 minutes) or timer for him to know how much time he has left of walking.

Hopefully these strategies will aid in creating a productive and enjoyable grocery shopping experience for you and your child!

How to Teach Children with Autism How to Play Independently

Do you ever wonder how you make it through each day, getting your child dressed and to school?  What about shopping, laundry, house cleaning, and dinner? Somehow you do it, and that is enough for anyone to be proud of.  We want to provide you with some additional techniques that may help with the time when your child with autism is home and needs to be looked after, but you also have things to accomplish.

Preparing dinner is a great scenario that many parents have difficulties with.  The solution for many parents is to put a movie on, give the child the iPad, or to allow the child to engage in whatever self-stimulatory behaviors they enjoy most (e.g., running around the house repeating phrases, flapping objects up and down, or rolling cars back and forth on the floor while lying down staring at them).  Although these may be activities that make your child happy and allow you to get dinner ready, there are additional techniques that foster appropriate independent engagement by your child with autism during times you cannot provide your full attention.

Activity schedules work wonders for this purpose. Activity schedules are visual guides that lead a person through a series of activities, leading to an ultimate prize.  Visual schedules help with transitioning from one activity to another with minimal prompting.

There are some pre-requisites to being able to utilize schedules although these can be worked on in the meantime if your child does not have them.  Your child should be able to independently play with some objects, even if the object is as simple as a peg board, or as complex as a 100-piece Lego structure.  Laminate pictures of these activities and velcro them to a vertical strip hanging on the wall.  At the bottom should be a picture of what your child really wants to do in the moment, even if it’s dinner!  If your child has never had experience with an activity schedule, guide them through the process of pointing to the first picture, finding the activity, playing with the activity, putting the activity away, taking that picture off the schedule, pointing to the next picture, and so on and so forth until the ultimate activity or item is achieved.

Some tips: start with only one or two activities until your child can independently utilize the schedule and transition from activity to activity.  Also, remember that the activities should be somewhat preferred by your child, as this is their independent time and we want to increase the success of them playing independently.  If they dislike activities, this increases the chance of challenging behaviors and the need for more of your attention.  It may take a few days, or even weeks to develop this skill. Over time, your child will be able to complete this task with increasing independence, practice decision making and pursue the activities that interest him or her and it will give you some much needed time to get things done while at the same time knowing that your child is being productive.

Some Simple Strategies to Help You Go to the Park with Your Child with Autism

Many parents of children with autism run into barriers when taking their children out into the community. The park is one place where children typically enjoy their freedom and thrive, which can be a nice relief for many parents. Although, for parents of children with autism, this can be a stressful situation for many reasons. Children with autism may not have the social skills to play with other children and they may not interact in ways that are socially appropriate. Many children with autism also engage in observable self-stimulatory behaviors that may seem awkward to uninformed people. Other children may have difficulties with transitions and therefore, leaving the park is always a struggle for the parent of a child with autism, more so than that of a parent of a typically developing child.

Nevertheless, there are some strategies for parents of children with autism to practice to help relieve some of these stressors and make the park a more enjoyable experience for everyone.

First, if your child is not interested in other children but rather enjoys playing on or around the apparatus, be present if other children are around. Always be within a close distance so that any pushing or bumping can be easily and quickly dealt with. Attempt to block your child from running away and assist him with saying “sorry” or “hi” to the other child. Allow your child to leave and in a friendly manner, engage in a simple conversation with the other child such as “are you having fun at the park today?!” This way, the experience ends on a positive note instead of the memory of your child engaging in an aggressive behavior towards the other child.

Consider sparking interest in your child for other people, activities, toys, and conversations by pointing  these out in his or her environment: “Wow, those kids are going down the slide really fast, that looks fun!” or “That boy has a really cool race car, maybe you can ask to see it?” These are minimally intrusive ways to promote engagement with surrounding people, objects, and activities. With repeated exposure and positive interactions with people and activities at the park, your child’s positive engagement at the park may be reinforced over time. In other words, it may get stronger, more frequent, and trips to the park can turn into something he looks forward to.

Second, if your child engages in many self-stimulatory behaviors and they are difficult to avoid at parks, go to parks during less crowded times so you can allow your child to have fun without having to always remind him about keeping his “hands down”. If you can only go during highly crowded times, be sure to be present with your child, prompting him to engage in appropriate activities at the park such as monkey bars, swings, and slides to decrease the chances of him engaging in self-stimulatory behaviors. Keep your child “busy” with these alternative, appropriate behaviors so that engaging in undesirable or self-stimulatory behaviors becomes incompatible. It is difficult for a child to engage in self-stimulatory behaviors when he or she is having fun climbing a monkey bar, going down a slide, or playing with shovels and buckets in the sand.

Last, if transitions are difficult, let your child know from the time of arrival how much time he or she will have at the park. Have a visual countdown (e.g., boxes that are crossed off every 5 minutes) until it is time to leave. If your child prefers electronics and timers, start a timer on a phone or electronic device instead. Provide reminders when time is almost up, so your child is not “surprised” when it is time to transition. When time is up, it helps to have something positive that your child can look forward to after the park (e.g., frozen yogurt, pick up brother, dinner, or treat in the car).

We hope that these strategies may help relieve some of the stress associated with going to parks and both you and your child can enjoy and have fun!

What should you do IN RESPONSE to your child engaging in challenging behavior?

Remember those four reasons why people may engage in challenging behaviors discussed in the previous post?  People may want attention from other people, may want something, may want to get out of something, or may enjoy how the behavior feels.  If you haven’t already read it, we suggest reading the prior post so the information below is as useful as possible.

This post will focus on reactive strategies, based on the reason your child is engaging in the particular challenging behavior.  In other words, what should you do in response to your child engaging in the behavior?  This is probably the most stressful for parents as they may wonder if what they are doing is right.  They may wonder if they are hindering or helping their child.  Hopefully we can provide some guidance.

If your child engages in a particular challenging behavior to get something that he/she wants, it is important for him to learn that his behaviors do not lead to getting what he/she wants.  You should avoid giving them what they want when engaging in the problem behavior, and even after the behavior ends.  The child should only be allowed to get what they want if he engages in a more appropriate behavior, which we will discuss in a future post. This can be difficult for parents as giving the child what they want quiets them down and relieves much of the stress in the home or community setting.  The problem is that your child will learn this connection and continue to engage in this behavior in the future when they want to same thing. It will become a repeated cycle.

If your child engages in a particular challenging behavior to get out of something, such as homework or eating dinner, it is important to not allow him to get out of the situation until they engage in a more appropriate behavior.  If the child hits and screams while doing homework, it is important to follow through, require them to complete a few more problems without hitting and screaming, and then they can leave.  More appropriate behaviors to get out of doing things they don’t want to do will be discussed in future posts.

If your child engages in a particular challenging behavior to get attention, you should avoid providing attention to them until the behavior is not occurring or he engages in a more appropriate behavior to get your attention.  Providing attention only teaches them that this bad behavior leads to what they want.  This connection needs to be disconnected and the child needs to be taught more appropriate ways to get attention.

Last, if your child engages in some challenging behavior because it feels good, such as head banging, it is important to block this behavior so that this particular behavior does not provide the sensory satisfaction that your child is receiving (in addition to preventing them from doing harm to themselves).  You can physically block the behavior or there are many devices created for this purpose.

Stay tuned for a future post providing suggestions for what to teach your child to do instead of engaging in the bad behaviors they currently know will get them what they want.  Just reacting how we have described above will not teach new, appropriate ways to get what they want.  Teaching a new, more appropriate behavior is the key to decreasing challenging behaviors.

Was this helpful?

Using Language in a Clear Way for Children with Autism

If you’ve ever heard behavioral therapists speaking with children with autism, you may have noticed that they speak with very clear and minimalistic language. Some people may even think it’s too robotic. So, why do they do it?

A language impairment is one of the main criteria to receive a diagnosis of autism. Many children may have difficulties not only expressing themselves but also understanding what other people say. Adults may think that the child is just ignoring them but in reality, the child may not understand what the adult is saying. Imagine going to a foreign country with people speaking a language that you do not understand and having no means of figuring out what the people are saying. If someone says, “Hey you, come here” in their language, would you respond?  If you don’t understand what they are saying you probably would not respond. This is how your child might be feeling.

The next time you try to give instructions to your child, think about this, and try some of the techniques we’ve outlined below.

First, use clear and minimalistic language. Say, “come here” instead of “hey Johnny, will you please come here now?!”

Second, to increase the likelihood that your child will pay attention to you and hear what you are saying, try the following strategies:

  • Give your instruction while you are physically near your child (i.e., next to them).
  • Crouch down close to your child so your voice and face are closer to him, increasing the chance of him looking at you.
  • Physically touch your child to bring his attention to you.
  • Talk to him about what he is engaged in before giving your instruction. For example, if your child is playing with Legos, you can first make a comment about the activity such as, “I really like what you built!”
  • If needed, interrupt his play if he is engaged in a highly preferred toy or activity before giving your instruction.

When these strategies are combined, they may help increase the likelihood that your child will understand you and follow through with what you instructed them to do.

Teaching alternative behaviors to decrease or stop inappropriate challenging behaviors

Implementing a behavior intervention plan to decrease or stop a challenging behavior is one thing.  Teaching an alternative to the challenging behavior is another.  Imagine this: your child climbs on the kitchen counter to reach for a jar of cookies way up in a cabinet.  Can you implement a plan to decrease or eliminate the behavior of climbing on the counter?  Yes, but there is also a chance that your child will just learn another challenging behavior to get him the same result.  In practice, it is always best to teach and alternative behavior.  Teaching the alternative behavior, in a way, can make the “unlearning” of the challenging behavior much faster.

There are four reasons why children may engage in challenging behaviors: either to get something she or he wants (access), to get out of doing something they don’t want (escape), to get attention, or because the behavior itself feels good or pleases them (self-stimulatory/automatic).  The general theme that you will see throughout this article is that the alternative behavior that you should teach your child should still lead to your child getting what they want (i.e., one of the four reasons).

Let’s say your child screams and throws objects when they are done with their dinner.  Your child is trying to get out of something—the dinner table.  What might you teach your child to do instead of throwing and screaming?  You can possibly teach your child to “properly” communicate when they are done whether it be signing “all done” with their hands, saying “all done,” giving an “all done” laminated picture to an adult at the table, or some other mode of communication based on your child’s repertoire of skills.  At first, assist your child when you begin to see the signs of them being all done by guiding them through the physical movements of communicating (i.e., exchanging a picture or signing), or modeling the words they should use.  Gradually fade this assistance until they are doing it on their own, without engaging in the challenging behaviors.

The same strategies should be utilized for the other “functions” of behaviors, or when your child engages in challenging behaviors for other reasons.  When they want a cookie that is out of reach in the kitchen, teach your child to ask for the cookies using whatever mode of communication is appropriate for your child to replace the climbing on the counters.  It is important to give your child cookies every time they ask when they are first learning as this will be the key to decreasing the challenging behavior of climbing on the counter.  As your child gets used to this process, you can start giving him what he wants once in a while—this is a way to guarantee that the new behavior becomes stronger over time.

For attention-based challenging behaviors, one way to tackle this is to figure out what you think your child should be doing instead of the inappropriate behavior.  Of course, considering your child’s repertoire of skills first is important when figuring out what replacement behavior to teach.  Let’s say your child somehow finds the time you spend with him getting a “lecture” from you reinforcing, maybe one thing that you can do is stop or at least minimize the amount of time that you spend lecturing him and spend more time with him when he is behaving appropriately.  While doing that, also you can also do your best to spend more time with your child when he or she is behaving well (e.g., spending some time to play a favorite game, watching a favorite tv show, about talking about school/anything).

Lastly, when your child engages in challenging behaviors because it feels good, a little more thought has to be put into the alternative behavior.  It should be something that is not harmful and something, preferably, that you can control.  For example, if your child engages in repeating words/phrases or just vocalizing sounds that are not socially appropriate, allowing your child to engage in these behaviors in a particular environment (e.g., their bedroom) and teaching them to ask for “talking in my room” or something similar may help to gain control of where they may engage in this behavior.  When your child engages in this behavior anywhere else, he should be required to use the communication phrase and then go to the specified location.  Self-stimulatory behaviors can be very difficult to address on your own—more so if the behavior is also self-injurious in nature.

It will help you as a parent to practice on these concepts; however, should you continue having difficulties as to how to address you child’s most challenging behaviors, it is a good idea to reach out to a trained professional such as a BCBA as soon as possible.

What approach should caregivers take with challenging behaviors?

Managing challenging behaviors can be quite stressful.  Most of the time, parents just do what they can to get through the situation with as little fuss and fighting as possible.  Unfortunately, this often times involves strategies that may be counterproductive, increasing the chance of these behaviors occurring in the future.  If the goal is to decrease these behaviors in the long run, there are specific strategies to use based on why the behavior is occurring.  Not all behaviors should be treated the same.  These strategies that we will discuss below and in future posts may not always be the first strategy a parent would think of, we do recommend consultation with a behavior analyst who can provide a treatment plan and provide support for you and your family along the way.

In general, it is important to plan for a) alternative behaviors to teach your child to engage in instead of the behaviors they currently engage in during specific situations, as well as b) how to handle behaviors in the moment when they are occurring.  When planning for these strategies, it is crucial to always think about why your child is exhibiting the particular challenging behavior.  There are four reasons that people engage in maladaptive behaviors, to get something they want, to get attention from someone, to get out of a situation, and to get sensory feedback from the behavior itself.  We will briefly review these four reasons in this post.

Children often engage in maladaptive behaviors to get something they want.  For example, a child may want a cookie out of reach in the kitchen, so he screams in the kitchen, hitting his head until someone comes in the kitchen and offers what they can until he or she gets what they want.  The child learned that screaming and hitting his head is an effective way to get a cookie.

Children also engage in maladaptive behaviors to get attention from others.  Have you ever been talking with your partner and your child starts screaming or engaging in other bad behaviors?  This may be because he or she wants your attention, for you to pay attention.

A very common reason why children engage in challenging behaviors is to get out of things.  Imagine a child eating dinner and he starts throwing his food and hitting their caregiver.  The caregiver says, “okay, okay, all done,” and allows the child to leave.  The child learned that throwing and hitting is an effective way to get out of eating.

Lastly, children diagnosed with autism engage in challenging behaviors sometimes because they like how the challenging behavior feels.  Screaming, pinching their bodies, pulling their hair, banging their heads on hard surfaces are all behaviors that may serve some sensory need.  It is important to distinguish this from any of the other reasons previously discussed before determining how to react and what to teach instead.

Take some time to think about your child’s challenging behaviors and why he or she may be engaging in them.  Stay posted for future posts outlining strategies for how to react to these behaviors and what to teach your child instead, based on why they are engaging in the behavior.

What have been your specific challenges?

Why Is Following Through Important When Giving Instructions

One of the biggest concerns that parents have when raising children living with autism is that “their children just don’t listen.” Besides making instructions very clear and giving instructions only when the child is paying attention, the biggest most important thing a parent must do is follow through when the child does not respond.  Not following through when your child does not respond only teaches your child that there is no need to follow your instructions in the future.  This pattern, if not addressed, can be very frustrating and stressful.

Following through; however, can be difficult because many times parents are multitasking on a daily basis: cooking dinner, cleaning up the house, talking on the phone, and telling their kids to clean up in the other room et cetera.  Think about this before giving instructions: make sure you have your child’s full attention before giving your instruction and once you give your instruction, make sure you can immediately assist your child with completing the instruction you just gave.

Imagine this situation.  Mom gives Sally her clothes in the morning and tells her to get dressed.  Mom then leaves the room and tries to get lunches and other kids ready as well.  She comes back and Sally is still in her jammies playing with her dolls.  Mom tells Sally again that she really needs her to get dressed, this time making sure Sally is looking at her while she gives her instruction, points to the clothes, and then leaves again to finish getting things ready for school.  When she comes back five minutes later, Sally is still in her jammies playing with her dolls.  When Sally’s mom tells her to put her jammies on in the future, do you think Sally will comply?  Probably not.

Try this instead.  Mom tells Sally she has three more minutes to play with her dolls then it’s time to get dressed.  She sets a timer so the beep becomes a signal to transition to another activity (dressing).  When the timer goes off, mom is right there to take the dolls and give Sally her clothes.  She tells her “get dressed.”  Instead of leaving the room, mom stays to make sure Sally starts getting dressed.  If Sally just sits there, within about 10 seconds mom tells Sally again to get dressed but this time mom helps Sally start taking off her jammies, gradually backing away as Sally does more and more of the task herself.  Mom does not leave the room and does not repeatedly tell Sally “get dressed” without helping and making sure Sally does get dressed.  Once Sally is done getting dressed, Sally’s mom gives her the dolls back for 5 more minutes of play before school as a reward for getting dressed.  Here, Sally will learn, over repeated times of Sally’s mom following through, that when her mom tells her to get dressed, she cannot continue playing with her toys unless she does what her mom says.

Again, one of the most important factors when increasing your child’s compliance is follow through! How easy is this for you to do?