NATURALISTIC EARLY AUTISM INTERVENTION
Parents often feel at a loss when they attempt to implement behavioral intervention or teaching methods suggested by therapists or school personnel. Some Applied Behavior Analysis approaches seem contrived and even contradictory to their natural tendencies, such as conducting repeated learning trials in a discrete trial format, or ignoring crying and paying attention when the child is following directions and behaving cooperatively. They say, "It just doesn't feel right." Parents already have a full time job working outside the home or managing the household and caring for other children. Schlepping kids can be full time job in itself. Trying to find time for conducting additional therapy or teaching can seem daunting.
But parents often find it entirely possible to fit some therapy activities within normal daily routines, which they are going to be doing anyway. Naturalistic intervention or incidental teaching can be very effective for children who already have some basic skills of following directions, play skills, and who have participated in some of the following activities in a Discrete Trial Format either at school or home. Higher functioning children tend to do best with naturalistic interventions that occur in the context of normal daily routines and activities.
Children with extremely short attention span, or who do not follow one step instructions consistently or who bolt or elope from the area, are usually not good candidates for an incidental teaching approach. Typically, if a child begins to acquire skills in these contextually nested daily activities, they generalize with minimal additional specific teaching. This approach also encourages learning related vocabulary that fits within each context, and specific responses that are appropriate to those settings.
I can pretty well guarantee you, that if you decide to conduct incidental intervention while you are trying to teach your child and the neighbor youngster to play soccer, you are likely to conclude that incidental intervention doesn’t work. There are too many strongly competing distractions. Your child will be focused on kicking the ball and responding to the neighbor child’s yelling, and not the learning activities which are part of your teaching goals. It’s best to start by reviewing your child’s ITP or IEP goals. Suppose one of your child’s goals is increasing receptive vocabulary involving everyday objects and things. Another goal involves discriminating people’s emotions. A third involves using action verbs, such a walking, running, reading, laughing, clapping and so on. There are certain to be other goals, but be practical. Try not tackling too much at one time.
You are going to go to the library and pick up some books and return old ones, and then you promised your child you would take him to the park. Make a list of 3-6 objects or things your child is likely to see on his outing, at the library and then in the park. For example, the words, book, clock, CDs, and librarian are obvious. Think about action words that your child is likely to encounter in the park, such as running, jumping, swinging, laughing, throwing and so on. At the library you might say “Where is the clock?” “Give the librarian the book,” “Put the book in the bag,” and so on. At the park, you might say, “What is that boy doing?” (Running), “Which girl is throwing?”, “Point to swinging.” These questions and requests can be interpolated between climbing on the monkey bars, teeter tottering or riding the marry-go-round. They should definitely not be showered upon the child as a non-stop string of questions, which defeats the purpose. The child should see your queries as making sense in the context of what she or he is doing.
You can also use emotions expressed by others in outdoor settings, like the park, as a way of naturalistically teaching emotions. Point to a child who is laughing and ask, “How does that boy feel?” “Point to the sad girl,” referring to a child who is crying. The secret in making this work, is to plan in advance what teaching opportunities you are likely to encounter. If you prepare for them, it will be easy to use spontaneously arising events to teach important skills. If you hope to recognize opportunities arise on the fly without planning, you are likely to miss most of them. You can also prepare your child for such outings by showing her or him pictures of different facial expressions or various action verbs the night before the outing.
Household chores are great vehicles for teaching the names of things (such as silverware items, napkins and dishes), places (rooms in the house), prepositions (in, on, beside, on top of), relational works (bigger, shorter, taller), color names (receptive) and labeling. Here are simple examples: “Put the fork beside he plate,” “Put the towel in the bathroom,” “Get the small cup,” “Find the red one.” Action verbs, like pour, put, fold, dump, rinse, give, hand, and help, are part and parcel of many household chores. “Pour juice in Emma’s cup,” “Give Donnie the spoon,” or “Help Mom with the dishes.” These incorporate social goals with household chores.Such household routines are also useful for teaching sequencing skills, like the order in which objects and materials are accessed to achieve a goal, such as filling a cup with juice, which involves a series of specific steps, “What should we do next?” These are called executive function activities and are usually problematic in youngsters with autism.
One of the advantages of such daily routines is that they have to be done anyway, and will eventually become functional skills that will be helpful to the child and family. When a child does helpful things around the home, parents, older siblings and friends automatically make positive comments which helps reinforce and maintain the child’s activities. As the child becomes more competent in them, s/he will be able to complete many of them with minimal prompts.
A last advantage of these naturalistic household and other daily routines is that they are incompatible, to a large extent, with non-functional repetitive routines and will provide a much higher rate of positive parental contact than if the child is left to fend for her or himself. It is more likely the child will engage in some form of challenging behavior to achieve parental attention if they have nothing functional to do that gains parental attention more legitiamately.
See Chapter 6 in my book, "Straight Talk On Autism" published by Paul H. Brookes for more suggestions.
Return to Frequent Issues