Here is a question that I was recently asked:
Tahirih, I have a question please. I am working at a clinic and we have a classroom that has several autistic children in it and once a week we try and take a group of around 10 children and we have several adults (2 teachers, 3 SLPs, 1 PT). When you have an autistic child (who is typically a roamer) should you insist he/she participate in group activity? For example today we read the “going on a bear hunt” story in their classroom, sang songs and did finger plays and then brought the children into the motor room where we acted out the story. We walked over the mountain, through the forest, under the bridge. You get the idea. Well the 2 “roamers” had a very difficult time w/ this and we need to know if we are correct in insisting they participate (w/ our help of course). Thanks for your input.
It is truly not possible to answer a question like this about specific children that one has never met doing specific things in an environment that one has never seen with people who have or don't have skills that would be important in determining the likely success. But I don't want to turn down what is a good question so I will answer generally and not for your little roamers in particular. The ideas that I will talk about are elaborated in the SCERTS manuals under the headings that they discuss as Emotional Supports and Transactional Supports. I refer you to these books for more information and your team will, no doubt, come away with many new strategies and ways of understanding group intervention if you can spend time studying SCERTS.
In my practice, I prioritize emotional regulation for children with ASD meaning that I don't want a child with ASD feeling highly anxious or stressed for long periods of time or at regular times every day or every week so I don't continue, unaltered, anything that proves to be highly upsetting or causes children to "leave" physically or cognitively. That said, I also want kids with ASD to experience as many social environments as possible and enjoy time with peers in different settings, doing different things. So I don't believe it is a good idea to isolate children with ASD from peers until they are "ready" as there are no readiness skills that are an absolute barrier to social inclusion except maybe danger to self or others.
There are many ways to help a child with ASD feel safe and not confused in activities such as you describe but some reluctant participators may respond to an additional element of support in one day and others might need to be taught how to use a learning support over a period of weeks or months. For example, some children might participate in the Bear Hunt activity easily with just the addition of a visual schedule. Some might enjoy being physically supported and physically moved from one place to another and find it easier to listen and learn if taken by hand or placed in a lap. Some children might enjoy this activity if the Bear Hunt was pre-taught by going on the hunt the day before with just one person or by showing the child a video model of this story or the activity before participating in the group event. One of those relatively simple learning supports might just do it assuming the child enjoys and understands something about what is going on in the activity. This is a big assumption, by-the-way. Other children might not respond to one or another of these supports, period. For example, a child might be so upset about being touched and restrained that the activity becomes nothing but a wrestling match and as a learning activity it fails entirely. Some children might be able to use one of these or a different learning support in order to stay emotionally regulated during the activity and learn but not until the learning support is taught in a much simpler context. If a child has never used a visual schedule, for example, the child might need to learn how to follow a visual schedule first. It might be wise to teach the schedule in a context where all the activities on the schedule are understood and enjoyed. Yesterday, I started a child on learning visual schedules by making a picture list of:
1) Kiss mom
2) Eat chips
3) Hug dad
4) Eat French Fries
For this child, kissing, hugging, eating chips and French Fries are all really good things so the child will just be learning that lists have numbers, go down the page, and whatever is in the picture represents what will happen in the real world in a certain order. I want to use visual schedules to teach some other much more challenging skills, like participating in activities with others, but we will scaffhold one skill on another until the child learns and uses visual schedules to understand group activities. Learning supports might eventually work well but may need to be taught incrementally.
The other issue, hinted at above, is whether the child understands the activity in any meaningful way. Going on a Bear Hunt is not something that a young child has ever experienced so he or she can only grasp the idea of it through imagining what it might mean. This is developmentally a very advanced skill for many young children with ASD. I often ask myself some specific developmental questions when I consider an unsuccessful therapy activity like this. Are this child's language skills such that he or she could understand the words? Does this child have any pretend play skills? Are this child's pretend play skills such that he or she could pretend something he or she has never seen? Does this child have the ability to engage in brief social interactions of this kind? If the child lives entirely in the present moment moving from one sensory experience to another, does not show evidence of comprehending narrative language, cannot engage in brief social interaction activities and is made highly anxious in busy changing social environments, then the Bear Hunt activity is developmentally way above the child's comprehension and ability. The experience still might be pleasurable and an opportunity for social learning if it were presented to this child so that every part was really a sensory experience with elements of chant or music, exaggerated facial expressions, stomping, running, and so on but this would require more preteaching because the thing that holds all those sensory elements together for most children is the story. One has to imagine the whole experience with no story and see if it works as a sensory routine. In the You Tube clip that I have embedded above, the story teller is using sensory elements well enough that it might be captivating to a child regardless of the incomprehensible story content and/or an inability to comprehend the language. The goal for the child with ASD might be to increase his or her attention to faces, move together with others, or stay longer in a group of children. Pre-teaching elements of the activity might make this possible and even engaging for the child. The child might be given homework the week before of watching this and some of the other great You Tube videos of The Bear Hunt story prior to the activity in a group. Perhaps the child would not make it through the entire group activity but still use the Bear Hunt materials with parents and a single therapist in the same week as the other children are doing it and just watch the other children from a distance on the day of the event.
The learning goal for the particular child would determine whether or not it was appropriate to ask the child to participate in the group activity and to what extent. The outcome of each session would determine what happens the next week. If the child becomes increasingly skilled at tuning out the teachers, escaping the group activity or disrupting the group activity then rethink your learning goal and learning strategy. If the child becomes increasingly willing to participate and learns more and more while participating then you're on the right track.
The fun for me as a therapist is trying to find a way to make things work regardless of how many steps it takes. There is no single solution for all kids with ASD but instead there are many great solutions that make social interaction and communication possible. You must Go On A Solution Hunt and come back with a good one.