Your child with autism has just initiated something verbal (with words) and/or nonverbal (body language, tone of voice, facial expressions, etc.). These initiations are totally precious because they are rare and generated by your child after much effort orchestrating multiple requirements for communication. So valuable are your child’s initiations, they deserve productive adult responses as models to further grow their language skills and continue the conversation. These techniques can help!
1. Acknowledge: Regardless of how incorrect her initiated sentences might be, whenever naturally appropriate, acknowledge verbally whatever she has said:
Along with your verbal input, make your nonverbal body language match your words like nodding ‘yes’, tone of voice, and facial expressions.
2. Emphasize: Use interjections to add emphasis and animation to your acknowledgment when appropriate:
Children learn by watching and listening to the various models of others, especially when you incorporate what your child has just said. Your child will naturally imitate your words if he or she chooses. Respond with short sentences or phrases presented slowly in an audible, clear voice.
After acknowledging and emphasizing, model through incorporation of these three strategies:
3. Expand: Restate whatever your child says using proper grammar to form a complete sentence.”
Child: “Car go.”
Adult: “Yes, the car is going.”
Child: “Her hungry?”
Adult: “Hmm…is she hungry?”
4. Extend: After applying the expansion technique above, add new information.
Child: “Car go.”
Adult: “Yes, the car is going. It’s a fast car!”
Child: “Baby cry.”
Adult: “Aw, yeah…the baby is crying. He’s hungry.”
5. Request imitation: If your child does not choose to imitate your words on his own, at times you may request his imitation. Since imitation cannot always be demanded or expected or performed flawlessly by your child, discretion should be used. Insert pauses in order to make it easier for your child to repeat:
Child: “Mommy, truck going!”
Adult: “Oh my goodness, yes! That truck is going too fast! Johnny, say, ‘Mommy,’ [pause for your child to repeat] ‘that truck’ [pause] ‘is going’ [pause] ‘too fast!’”
(Immediately following, try to have your child imitate the whole sentence without pausing.)
Adult: “Ok…Sarah, say, ‘Can I have milk, Mom?’” or “Yes…Sarah, say, ‘Mom, I want milk.’”
In situations where your child initiates something vague or inadequate, you can respond to what you think his intention was with these two strategies:
6. Paraphrase: To achieve greater clarity using different words, paraphrasing provides rich input for your child to hear and imprint into his repertoire.
Adult: “Oh! You want milk. Ok, here’s a glass of milk.”
Child: “My shoes?”
Adult: “Hmm…you are looking for your shoes. Where are your shoes? Let’s try to find your shoes.”
7. Evoke clarification: When your child initiates a vague or inadequate request or demand, respond with something factual. This might influence your child to consider using other words to clarify:
Child (as a request for milk): “Milk?”
Adult: “Yes, that is milk.” Or “M-hmm. The milk is white.”
Desired clarification from your child: “May I have milk?”
Child (as a demand to turn the TV back on): “TV on!”
Adult: “No, the TV is not on. I turned the TV off.”
Desired clarification from your child: “Turn the TV on.”
If your child does not spontaneously produce other words to clarify, you can provide the correct model for imitation (e.g., “Sarah, say, ‘Mom, I want milk.’”), or paraphrase with a request for imitation (e.g., “You want me to turn the TV back on. Sarah, say, ‘Mom, please turn the TV back on.’”).
With these seven strategies, your child’s priceless initiations can be further developed and reinforced to create more natural, meaningful communication. Feel free to Email me using the form below to share your experiences and to ask questions.
Imagine this: You begin to notice symptoms of pain and sensitivity in one of your teeth. You might give it some time until you notice that these symptoms don’t go away. Eventually, you notice that more teeth are affected along with some bleeding upon brushing your teeth. You have a reasonable suspicion that there might be an issue, and you don’t want it to continue to get worse. You’re not sure if it is just a case of simple toothaches or cavities or maybe neither, but more than likely, you will very soon visit the dentist and report your symptoms for the proper diagnosis and treatment.
The same urgency to seek a professional should be the case if you notice signs of developmental issues in your child. Children with developmental disabilities naturally rely on others to report the signs because they cannot report their own symptoms of the problems that they are experiencing. Of course, you are not a doctor or an expert of child development, but just like in the case of the toothache, you are an observer, a reporter, and a bit of a detective which requires some self-education. Because the visit to a medical professional usually lasts for a short period of time, it tends to allow only for a snapshot view of your child. As such, there is great importance on parental involvement in the evaluation process to receive a proper “differential diagnosis” which is essentially a process of elimination, thereby narrowing down the field of possibilities for what the specific condition may be.
Any evaluation is an ongoing process to gather and analyze information. Although your child’s pediatrician is often the “gateway” doctor who opens up the door to begin the evaluation process, more than one professional’s opinion may be warranted. As of today, the diagnosis of autism relies on observation, or “opinion”, so it is crucial that you are involved to help the professionals to make the proper diagnosis. Therefore, it is wise to keep an organized journal of all questions, concerns, and observations gathered by you and everyone who plays a meaningful role in the child’s life, such as caregivers, friends, family, teaching staff, and community members. Additionally, of great benefit would be videos of your child’s typical interactions to provide real-life examples (so keep your smartphone’s video app handy).
You will know when you have arrived at a proper and differential diagnosis of your child when the professional(s) have provided you sufficiently with specific answers to your specific questions. The differential diagnosis might not be autism but rather another developmental or learning disability. In other cases, it may be an issue requiring something like a change in diet, behavior management, or counseling. If your questions or concerns have not been addressed to your satisfaction, further documentation of any features should continue to be sought through other professional consultation which may be within a different field of study, such as a developmental psychologist, speech-language specialist, occupational therapist, and/or neurologist.
Still, if your self-education and ‘gut’ indicates that the issue goes beyond an attention and/or a language disability, then you need to proactively push for the evaluation process to continue. Otherwise, subsequent treatment services and education programs may be improper or insufficient. Consider the outcome of the toothache scenario presented earlier if an underlying gum problem were to have been treated with a simple cavity filling because a different specialist, like a periodontist, wasn’t consulted.
The diagnosis of Autism Spectrum Disorder (ASD) can take time because it is a very complex disorder to diagnose appropriately. It has been well documented that the earlier identification of autism is critical to steer the course of development and shape the child’s life. The sooner a diagnosis is made, the sooner the child can receive appropriate services. Then, at last, all of the meaningful people in the child’s life can better understand and help meet his or her needs.
Refer to the links below for signs and characteristics if an Autism Spectrum Disorder (ASD) is suspected.
According to the Centers for Disease Control and Prevention (CDC) in March 2014, 1 in 68 US children has an Autism Spectrum Disorder (ASD) which is a 30% increase from 1 in 88 two years ago. With the increase in statistics, naturally intensified concern has been directed towards autism.
The seventh annual World Autism Awareness Day is April 2, 2014. Since 2007, autism organizations around the world celebrate the day with fund-raising and awareness-raising events. It is long-awaited that literally the “world” is becoming “aware” of autism, and, at the same time, it is of the utmost importance to make this awareness both practical and significant. I propose “Five A’s for autism”:
- AWARENESS: We have become aware that the diagnoses of autism are on the rise.
Practicality and significance: More and more people of all ages and backgrounds are affected by this disorder, so it is more likely to touch someone you know.
- ATTENTION: Now that we have become aware, we can pay attention to the signs of autism.
Practicality and significance: Autism can only be diagnosed by observation, so it is up to everyone in the child’s life to be watchful.
- ACTION: Once we are aware, we can report what we see and hear to the child’s caregivers, educators, doctors, and family and friends.
Practicality and significance: The earlier a diagnosis of autism is established, the sooner treatment which involves the help of all of the significant people in the child’s life can begin for the best quality of life.
- ACCEPTANCE: While treatment helps the child progress through life, autism presents challenges throughout the lifespan. We need to be sensitive to the differences that people with autism have.
Practicality and significance: Our focus is on the person, not the disability.
- ADVOCACY: When we have become fully aware, attentive, action-oriented, and accepting of the person with autism, we must advocate for them.
Practicality and significance: At the heart of autism is difficulty relating to other people in society and trouble communicating. Therefore, people with autism rely on us to be their voices and their supporters.
Awareness is absolutely an important first step. Let’s go beyond and keep in mind the “Five A’s” on Autism Awareness Day. And everyday.