My Child Has Autism, Now What?

My friend and colleague, Dr. Susan Larson Kidd, published her first book recently!  My Child Has Autism, Now What?  Ten Steps to Get You Started.  At the clinic, where I work, we were all happy for her and so we hosted a book signing event at a local art museum.  I had the opportunity to introduce Dr. Kidd and this meant thinking about her, her work, and our relationship.  I will say a few words on these three topics here--because all of these things are important to me.  

Let me tell you about Dr. Susan Larson Kidd.  First, don't you think she has a great last name?  I know that the kids she works with love calling her Doctor Kidd.  She is an Educational and Behavioral Consultant who works in private practice and lectures around the nation.  She is good at practically everything that I find difficult.  Like singing.  That is something that I admire that she is good at and I am not.  In addition, she organizes and plans and documents and remembers the details like what various parts of the brain are called and the names of various intervention strategies and who the important researchers are and what they have contributed to the field of autism. So, when she writes a guide book for parents of newly diagnosed children, you can be sure that it will be practical, organized, well-researched and useful. It is a shame you can't hear her sing in this book, though.

We do have some things in common, Dr. Kidd and I.  We both find great pleasure in spending time with children who have autism. We share a passion for educating parents.  We both believe in the capacity of parents to learn and grow well into the fascinating journey that they begin the moment they start to parent a child with autism.  We sincerely believe that with good information and the acquisition of some new parenting skills, it is realistic and possible for parents of children with autism to create happy family lives.  The book Dr. Kidd has written reflects one of our shared goals in life which is to guide children with autism and their families toward happy lives.

 I will take this opportunity to reflect on my friendship with Dr. Susan Larson Kidd as well and give you an insider scoop, because we have a meet every week at least once if we possibly can kind of friendship. Every way that she and I are different and each way that we are the same contributes to the richness of our friendship.  We cover more territory in life through our friendship because of our differences and yet it always feels like we are moving in the same direction.  Professionally, in the same way that parents of children with autism must seek out support, in order to parent their best, those of us who work in this field also need support.  We need to be able to talk about our successes, which might seem insignificant to someone unfamiliar with autism.  We need to be able to talk about our dreams for children and get a second opinion on whether these dreams are too small, too grandiose or reasonably ambitious. We need someone safe with whom we can share failures and insecurities. We need someone to remind us of things we used to know but have forgotten.  We need someone to motivate us to keep seeking out new knowledge even though learning about autism can feel like trying to drink out of a fire hose.   Susan is all these things for me and more.  I hope you will buy and read her book and share a little in the joy of knowing Dr. Susan Larson Kidd.

Lexi, who is pictured in the book, is signing books too.

The Disposition to Communicate

Communication is not simply a set of speech and language skills, it is a complex social behavior that occurs or does not occur based on a number of factors. I have been thinking about this lately and trying to sort out the important factors that keep me communicating with others or get in the way of communication.  Extrapolating from my experience, I am thinking also about what keeps children with autism communicating or not.

It is clearly not enough to have the skills of communication--we also need the disposition to communicate.  Can I say hello to my neighbor?  I have the skill but I might not always use the skill.  If my neighbor is friendly and talkative and I enjoy talking to the man, then I greet him when he and I both walk out of our door at the same time in the morning.  If he is not friendly or does not say much that is enjoyable for me to hear, or is downright unpleasant in some way, or if I am late to work or preoccupied with something pressing, I might actively avoid greeting him.  If, everyday, my neighbor and I have acquired the habit of just saying hello, and then waving--then this routine will hold despite a lack of time, real social interest in one another, or any other factors that might increase or decrease my desire to communicate with my neighbor.  Little communication routines keep social connections alive if not vibrant.  If I really, really enjoy talking to my neighbor, and it is clear he enjoys talking to me too, then I might start to gather topics of conversation throughout my day that would interest him in our regular morning conversation.  If he likes politics then I might scan the headlines in the paper over breakfast for political news and during the day, I will remember political comments that I hear at work to repeat to him the next morning.  I might do this even if I don't particularly like the topic of politics because the social relationship is what is really motivating me. It is useful to think of all these factors and how they influence how much and to whom we speak.

I got thinking about this because recently I have lost my disposition to blog. Daily blogging is not so different than having a daily conversation with a friend or neighbor.  I write blog posts with parents and other professionals in mind because these are the real people that I talk to all day.  My other conversational partners are the children that I see each week.  With my blog posts,  I rehearse and clarify the topics that I want to cover in real conversations.  I think about how and why communication and social interactions work or do not work by posting on these topics.  Sometimes, I use a blog post to say things that cannot be said to the real people that I talk to because it would not be wise or tactful yet I want to say these things.  I guess you could say that blogging is a form of talking with one's self but it improves my communication with others in my workplace.  As a bonus, I have actual readers of the blog (or at least I used to have when I used to write.)  So, why did I lose my disposition to engage in this form of communication?  Because my mind was largely occupied with other things than work in the last weeks and months.

My disposition to think about and communicate about autism has been superseded by my disposition to think about and communicate about weddings.  First my youngest daughter got married at the end of July and no sooner was that accomplished than my older daughter announced her engagement.  My mind seems to be preoccupied with things like guest lists, wedding dresses, flower choices, and reception menus.  You, dear readers, if there are any of you left, should be grateful that I spared you all of that.  But I have been and am enjoying it hugely.  Just one bit that I will share about the upcoming wedding--the next wedding will be in The Netherlands!  I just got back from a two week vacation there where we did some seriously focused wedding planning and some seriously fun recreating too.  I am a little more distant from the planning of this wedding, though, so perhaps I will recover my disposition to write blog posts.  Actually, I am certain that my disposition to write blog posts will return sooner or later.  Meanwhile, for any reader who is focused on teaching a child with autism to communicate, let these be the take home messages from this post:

1.  Spend as much time developing your child's disposition to communicate as you spend teaching your child new communication skills.

• This means making sure that there are interesting, responsive, frequently available communication partners for your child--including you, of course.  Try to see communication situations from your child's point of view in order to become a more interesting communication partner.
• This also means making sure that people are not doing things that would make your child actively avoid communication-including you doing these things, of course.  See all communication situations from your child's point of view and you may see why your child actively avoids becoming engaged at times.

2.  Parents often say "My child communicates when he/she wants to." with the implication being that the child inexplicably does not want to communicate very often.   There is always a reason why someone is not communicating.  What is your child preoccupied with that gets in the way of social communication?  The wedding season will soon be over at my house but you may want to look at some of the socially isolating things that preoccupy your child and decide if these are temporary interference or if these things will permanently interfere with your child developing a disposition to communicate.

3.  Little routines of communication, which don't take a lot of time or mental effort, can keep a child connected socially even when things like exhaustion from starting a new school year, preoccupation with anxiety about something new, or a new passionate interest seem to be getting in the way of more active communication.

4.  The complex system that keeps us communicating or inhibits us can be altered intentionally.  You can alter the social world around your child and increase his or her disposition to communicate. 

All Blue, Only Blue, No Other Color Will Do

We have a new Smart Board at the clinic, and I am starting to use it in therapy.  Basically, it is like having a very large touch screen computer monitor.  I have been using it with some children as though it were a large white paper and we have been coloring and drawing on it. There are many cool ways one can draw and create art on a Smart Board but trying to create a structure that allows a child with autism to draw in a socially interactive way can be a challenge.  This post is about one of the autism challenges that I have encountered as I started using a Smart Board.

For some children, the activity of coloring is like a cognitive pothole where the child becomes stuck in a single colored neurological loop.  The child becomes consumed with the desire to use one and only one color.  If I was not trying to hold a conversation with the child, I am sure I could be cool with the one color thing--at least for a while.  I am not cool with it, though, because there is very little one can or wants to say while trying to cover a large white surface with a single color.

Three children that I saw this week insisted on the color with one and only one color thing and wanted to fill the entire white surface of the Smart Board with one color.  I used a shapes program on the Smart Board and filled much of the board with circles. The child was then able to pick a color and fill these circles with that color by tapping on the circle.  Two of the three children would only choose blue.  The third would start with one color and then she stuck with that color, period, end of discussion.  I know the drill with her because we have done some coloring on paper and she does the same thing. When I tried to talk these children into using other colors, I got ignored--which served me right because talking is almost never useful in this kind of situation.  If I pushed the issue by taking a turn and coloring with a different color on the board, the child got upset and tried frantically to repair the damage that I had done.  If I pushed too long, the child lost interest in the Smart Board activity suddenly, completely and absolutely.  So.... what to do?

First, I know that some of you have some good strategies and now, as I think about it, a lot more strategies are coming to mind. Feel free to comment below with what you would have done or have done in a similar situation. I missed several of the likely to succeed strategies.

Child 1.  I gave up on talking and took a turn, thus ruining her art by adding a second color.  She moved away from the Smart Board and requested that we go to a different room to play. I took her to a different room when she said We gotta get outta here, Tahirih!

Child 2.  This child filled every circle with blue.  I took a turn and filled a circle with red.  He protested angrily and I decided to take an indirect approach to showing him all the color opportunities on a Smart Board.  I offered Child 2 a different activity which I set up across the room.   While Child 2 was busy putting together a letter puzzle on the other side of the room with his mom, I had mom call out letters across the room to me.  When she called out a letter, I wrote the letter on the Smart Board.  Child 2 likes letters and he started looking up to see me write the letter.  I changed colors often and called back what I was doing. Red B. I said while writing a B in red.  Blue T.  Purple X.  The child began to call out letters with prompting from mom.  I wrote the letter in different colors.  I hope we will be able to do a letter writing game on the Smart Board next time he comes so that we will not be stuck with blue, blue, nothing but blue every time he draws on the Smart Board.  Once we have the colored letter game down, we will try to play the colored circle game the same way--with lots of different colors.

Child 3.  We started by making circles and Child 3 helped me and then I suggested that we paint the circles.  he agreed but then "painted" them with blue, blue, and more blue adding circles and then painting them until the whole white board was covered in blue. I sometimes changed the color of a circle quickly but my co-artist quickly changed circles back to blue and after a few times he asked me politely to leave the circles alone.  The words were polite but the voice sounded a note of panic. I became aware that every time I changed the color of a circle, this child was learning that asking politely does not work and he was moving closer to having a melt down. I stopped changing the colors. I then talked about how "boring" all blue circles were and he told me he liked boring.  Never argue with a child who has autism. You can disagree but there is no point engaging in an argument. I know this rule and I didn't pursue this discussion because it was likely to become an argument.  We talked about it being my turn to choose a color and that it would be fair if I got to choose my own favorite color.  He told me that I could take a turn but my favorite color was blue. I soon realized that we were not making progress even though this little guy is very verbal and wants to be cooperative.

We left the Smart Board to go and spin tops on the other side of the room.  But before we started, I quickly put a bunch of square shapes up on the Smart Board.  My plan was to fill these with color. The first top we wound up for spinning was blue.  I suggested that my friend go across the room and paint one square on the Smart Board blue.  He did this, because he really does try to do things that I ask him to do--as long as I am not asking him to do something that is terribly wrong. He came back as I wound up the top and we watched the blue top spin.  The second top we wound up to spin was orange and purple.  I went over to the Smart Board and colored a square with orange and purple.  Then I went back to where my co-spinner was waiting and let the orange and purple top spin.  We watched the top spin across the floor. The third top that I pulled out was green.  I guess you better color the next square green  I said.  Why?  he asked.  Well, because this top is green.  I answered.  I don't think that Child 3 understood my logic exactly but with a furrowed brow, he did it anyway.  We continued this way until all the squares were colored and he did grasp the pattern of making squares on the board match the color of the top.  All the different colors look good to me.  I said, as we finished spinning all the tops.  Not boring.  My friend did not say a word on this topic.  All I can claim at this point is that this one time, Child 3 used a variety of colors even though he typically tries to use all blue, not just on the Smart Board but where ever possible.  He used different colors without signs of anxiety or sounds of protest.  Maybe that was progress.

But maybe he is at home right now reflecting on how much nicer those squares would have looked if he had done them all in blue.

Google SketchUp

Every year, at least a few of the kids that I work with show serious talent in drawing.  Here is a wonderful tool if you have a child who "thinks in pictures."

Autism and Spinning

I want to open up the topic of why children with autism  love to spin objects and whether one should limit the time that a child with autism spends spinning things.  I will offer a few thoughts along with links to very interesting discussions on this topic that I found. Please offer your thoughts and experiences in the comments section because the discussion is--like so many topics in autism, both challenging and fascinating.

First, I typically have a few spinning tops with me if I go to visit a child with autism for the first time because I know that I can use those tops to entice most children into playing with me with these "Gizmoz" as my friend Sheila Merzer (Autism Guru Extraordinaire) likes to call all fail-proof little toys. She and I both keep Gizmoz in our pockets in order to make our jobs easier and make us look like we know what we are doing.   The picture above, by-the-way, is from a website called Meet Mrs. Haugland's Class where they put together these cool homemade spinners.  While acknowledging that spinners are useful as therapy tools, I have also experienced the frustration of having a child who wants to do nothing but spin things or watch spinning things all day long.  Here is a blog post where a mother talks about her son, Zachary who went through an intense period of spinning.  I loved hearing her thoughts and discoveries about the behavior.  I also used her strategy of limiting the amount of time that a child spends spinning because I, too, have seen spinning start out as interest and become so intense as to be oppressive both to the family and to the child.  I have known parents who removed ceiling fans, tops, and other obvious spinning possibilities from their child's environment. I found this mother's insight on how a behavior like this may feed the tendency toward obsessive compulsive disorder.  I'd like to know more about that.

In the clinic, I might limit spinning this way:  I say First we will (whatever activity we are doing together) then we will Spin!  With a dedicated spinner, I might start with short activities that are followed by periods of spinning but soon I am saying things like Time for spinning.  We will spin three tops.  One (and I spin the top) Two  (and I spin the top) Three (and I spin the top)  All Done Spinning,  Time for (whatever). Whatever gets to be longer and longer and spinning gets to be shorter and shorter and we might forget all about spinning on many days.  We limit the spinning by deciding how many times we will spin and then move on calmly but firmly.  The goal is to teach a child to leave a highly desirable activity calmly and to learn to enjoy many other activities so much that spinning does not seem like the most desirable activity all the time.

I do worry that the child who spends a lot of time spinning objects is learning to feed the brain's need for activity with an activity that does not help a child learn.  Sheila Merzer talks about how children get stuck in these little mental loops and by doing them over and over again the child finds it harder and harder to do anything else. It becomes the only thing the child's brain wants to do.  I think this can happen to any of us and we end up spending a lot of our life doing things that don't really make us happy.  If this happens to me, I want people who love me to say "Enough already, Tahirih!  Let's get out and take a walk--you are spending all day reading!"  

Children with autism are not always appreciative when we want them to learn to do other things, though.  Sheila's solution to this if a child is really stuck and gets really upset when we encourage new or different activities is to expand the loop gradually.  We also expand the look in a variety of ways with the aim being to bring an activity like spinning more under the child's own ability to control.

Here are some ways that we might try to expand a little look like spinning into a more complex and mentally challenging behavior. First of all, we stay calm and relaxed as we proceed.  I say this because if we get anxious about the fact that a child is spinning, it seems to feel the child's anxiety and the spinning becomes more compulsive. But, it is perfectly possible for adults to take the lead in play and calmly insist that we are going to spin but first we need to make some decisions.  (I think of this step as helping the child access a different area of the brain from whatever area is involved in spinning.)  We don't spin a top until we decide together Who will spin? On what surface we will spin? What we will spin? The way I offer these choices varies depending upon the language level of the child and I might use visual supports to help some children understand the new and more complicated game of spinning.  With this last pre-meditated spinning decision, What are we going to spin?  I would offer pictures of spinning options and after each choice, the one chosen is no longer an option. I am expecting the child  to spin a variety of things and not just one favorite top.  Over time, the game might become a Hide-and-Find game with clues and treasure maps that help us find each top and pretty soon there would be other interesting hidden objects for us to find together.


I don't favor trying to altogether stop a child from spinning or doing any other behavior that helps a child stay calm or escape overwhelming situations (except those that are really dangerous or terribly socially unacceptable).  The reason I think this is inadvisable is that you end up chasing one behavior after another until the child eventually lands on one that you really can't do anything about.  I do, however, often suggest that parents turn off and unplug or take out TV's, computers and video game players if children become too addicted to these because these are so clearly associated with very poor language and social development and brain studies are making it clear that we are providing a kind of opium-like stimulant.  If carefully controlled, all of these technologies can be educational but many children with autism will become addicted so quickly that parents need to remove the option.  You really don't have the option of removing everything that can be a spinning object nor all the things one can line up nor hands that flap.  If you do insist the child stop one of these behaviors, the behavior that replaces the one you eliminated is often worse.  Here is a good article on this subject.  

When I put spinning and autism in the Google Search Engine, there were thousands of articles--many of these article explaining that spinning objects, lining up objects, and flapping one's hands are all symptom of autism. All of these behaviors along with echolalia (repeating things that others say without fully understanding the meaning of the words) are very distressing to parents because the behaviors are perceived as symptoms (a very medical term) of a disease (also a very controversial way of viewing autism).  While this view is one way to view the story of a child's unusual developmental path, I think there are much more useful, and less distressing ways to understand all of these behaviors and hundreds of others that are associated with autism. I don't get too attached to any one theory regarding anything to do with autism because after so many years of learning about autism, I have had to change my theory too many times.

I do, however, have a steadily growing respect for children who have autism and for the complexity of the brain differences that these children have.  There is always a reason why children do the things they do and the way we understand what they do shapes how we respond to these behaviors.  I understand the most about echolalia (being that language is my field) and far from feeling upset when a child starts to repeat what others say in a way that would be described as echolalic, I am very happy to hear the child doing this because I know that the child is trying to find a way to communicate.  See Can a Child Overcome Echolalia?  I am able to show that child more than he or she can discover alone about communication and I can help that child learn to communicate in a way that is more effective but when a child moves from not talking to echolalia I know we are moving forward!  Although I don't know all the answers regarding why children spin, I know I need to respect both the child and the behavior and work through with the child so that the child is able to spin things but not be stuck in such a rut with spinning that the child does not move forward developmentally.

Again, I will be happy to hear your comments and please offer links to interesting articles on the subject that you have found online.

Power Teaching

Here is a video demonstration of a way of teaching which could be modified somewhat and work with children who have ASD.  I use the strategies of movement, emotion and Key Phrases already.  I think the speed might be hard on some kids with ASD but there is virtually no time for a child to lose attention.  I think I will give this idea a bit of a try.  Watch this video and let me know your thoughts on this.

Authentic Chinese Food

When I was in New York one time, the menu at the Chinese Restaurant that we visited was not the same as any I had ever seen before.  I love Chinese Food--at least the version of it that I know.  In this restaurant, however, we were the only non-Chinese looking people in the building and that seemed like a good thing until we saw the menu.  It was in Chinese. We asked the waiter to translate menu items--which he did but way too rapidly for me to comprehend. At that point, each of us moved on to choose one of the  two or three items that sounded vaguely familiar or we randomly ordered by pointing at something on the page.  I am adventurous and ordered pretty randomly.  Others in my family went for more familiar sounding stuff.  Even these items were nothing like food that they had had before.  I did not actually like my meal very much nor did anyone in my family. The new tastes were too unfamiliar to my palate and visually things looked strange to me.  I assume that if I were to live in China for a while and the dish that I tried was frequently served, I might have come to like it. What is it, something like twelve times that you need to taste something before you learn to like new things?  I remember this experience when kids back quickly away from new games and activities that I introduce. I think of this as an Authentic Chinese Food event.

The more unfamiliar elements in a game that I introduce, the faster kids reject my bid to play together.  If I manage to sandwich new elements of play into familiar games, this makes it easier for children to try new things--so I do this quite often.  I use video models (video clips that show a child the new game) to introduce some new games because this really helps us get to that point that is like tasting a new food for the tenth time and you are at least able to tolerate it. If I put things that a child loves into new games--well this can go either way--sometimes it help a child enjoy the new game and sometimes the child reacts the way I would if you put an unfamiliar Chinese ingredient into my favorite desert.  Covering new ground with a child who has autism, (which is usually the point in a therapy session), is quite a tricky proposition.

Helping Children with Autism Through the Holidays

During the holiday season, we at the Scottish Rite Clinic for Childhood Language Disorder use the holidays to facilitate language development by teaching holiday vocabulary appropriate to each families cultural traditions. Our therapists do things like cooking with kids using visual recipes, writing letters to Santa with kids using Writing with Symbols,  planning with children what they could pack in a suitcase on a holiday trip, and so on.  This is a rich time of year for teaching new language because language is learned as it is needed in a child's real life experiences and there are so many exciting new experiences that come up during this time of year. At the same time, we know that the holidays are often particularly challenging for children with autism and perhaps more so for their families.


We try to be prepared with strategies that will help our young friends with autism cope with holiday changes at the clinic but still end up needing to deal with unexpected issues.  For example, we have a tree up in our clinic waiting room and one six year old that I see was upset that there was no star on the top of the tree.  We spent quite a bit of our session creating a star. This ended up being a rich language activity because we were able to help him communicate the problem, communicate his ideas for a solution, carry out his ideas, and even take a picture of his star on the tree to show mom.  But we had a dedicated hour in which to accomplish this and time can be in short supply for parents during the holiday season.  Using the holidays to support language development, social learning, and emotional coping skills is a challenge for parents both because of time constraints and because parents may not have a set of strategies ready to implement as needed.  As I was thinking about this, and talking to my colleague, Tamara Pogin, she mentioned that Linda Hodgdon has recently published a great newsletter on this topic.  Tamara and I are both faithful readers of Linda Hodgdon's Online Newsletters because they are consistently filled with useful information on how to use Visual Supports with children who have Autism Spectrum Disorders.  Visual Supports are the single closest strategy that we have to magic when it comes to helping kids with autism through difficulties of all kinds.  

So, as we approach this holiday season, I want to take this time to introduce any of you who do not yet know her, to Linda Hodgdon.   A good way to start your relationship with the wise and wonderful Linda Hodgdon would be to read her current newsletter in preparation for your holiday season.  Ideas from this particular newsletter may save you and your child a great deal of holiday stress and anxiety.  Her ideas include things as simple as showing your child the date on the calendar when you plan to take down the Christmas Tree but ideas like that are brilliant and invaluable. Click Here.

New Autism Games Website Launched

Welcome Visitors!


Please Come In to see my new 
 Autism Games Website!

Still on Tahirih's Imagination Lane at www.autismgames.org

Can a Child Overcome Echolalia?

I was asked this by a parent recently. Worded this way, the question is a little hard to answer. The answer is mostly yes. Yes, many children with autism go through a period of echolalia and use less and less echolalia as they learn more language skills. Many children continue to use rote, memorized language even after the immediate echolalia is gone. It is a long haul for children with autism to learn how to use original, self-generated language to convey original self-generated ideas. Every step of the way is a cause for celebration.

It is not so much that the child overcomes echolalia; it is like if there were 1000 skills that a child would need to talk in complete self-generated, original sentences, a child with echolalia has learned 287 of those skills. I am entirely making up those numbers but my point is, if a child is echolalic, that child knows some important things about communicating--but still needs to acquire many more communication skills. We can systematically teach the child the skills he is missing but meanwhile, echolalia is wonderful because it indicates that the child wants to communicate, is learning to communicate and is trying to communicate with what he knows so far.

The very first thing that I ever read about language development in children with autism was an article by Dr. Barry Prizant on echolalia. I am not even sure if he was a Doctor when he wrote it, it was so long ago. Like many aspects of language development, typical or atypical, it turns out that echolalia is a lot more complicated than one would imagine. I remember the article because it was so unexpectedly complicated that I kept thinking about it even though I had never met a child with autism in my life.

Some reasons why children use echolalia and what to do to help:

1. The child hears people talking as though listening to a song in a foreign language. The child may not have any idea that there are individual words in the long streams of sound that he hears. I hear French this way--like it is a song with a melody that I can imitate even though I don't know what the words mean. I can sound kind of French but not know what I am saying as I imitate someone speaking French. The thing is, I want to imitate that interesting French sound that I hear just like I want to hum a catchy tune. I don't even try to figure out what the speaker is saying. Trying to decode the French is too hard for me but I really like how French sounds so I imitate it. If a child is doing this empty imitation, you needs to help the child understand the meaning of words and phrases. Shorten your sentences. Use less language. Use visuals. Demonstrate meaning. Echolalia is an important sign that you need to do more to help your child with language comprehension.
2. The child repeats what you say because the child wants to take a conversational turn but does not yet have the necessary expressive language skills. The good news is that a child using echolalia for this reason understands that conversation goes back and forth between two people. This back and forth can be hard to teach so it is cool if a child understand this aspect of conversation. A chatty child with autism is much easier to teach than a silent child. But this child still needs to learn how to put his or her ideas into words. You can help a child who uses echolalia in this way by watching for clues as to what the child would say, if he could express ideas, feelings, and intentions in words. Try to read any and all of this child's behavior and translate his behavior it into words. If the child pushes, you say Move, Mommy and the child may then repeat Move, Mommy particularly if you guessed correctly about why you were being pushed. In this case, you use echolalia to help a child learn expressive language skills. It is good that the child repeats because repeating your words will help your child develop expressive language skills.
3. The child does not entirely understand what he hears and repeats it so as to give himself a second go at hearing and understanding. Sometimes the child repeats what he hears under his breath even. Use plenty of wait time after you say things to give this child time to process the meaning of what you say. Add visual supports and demonstrations (as in the previous situations) to increase the child's comprehension of language. It is good that your child repeats language to help himself comprehend better because without doing this, your child would understand less of what you say.
4. Some children are able to use self-generated original language but it still requires more mental effort than repeating what others have said. Echolalia is habitual and easier. For this child, you may need to help the child focus by getting down at the child's level, saying things that alert the child to your genuine interest in his or her thoughts, and in a variety of ways support the child's hard mental work of composing original language. Today, for example, I put a child in a swing, pushed him several times, then stopped the swing and asked him to compose an original sentence, Tell mom what we saw on our field trip. He repeated some of what I said, what we saw.. I gave him a couple more swings and stopped him and said Mom, we saw____ . He said a balcony. I gave him two more swings, stopped the swing and held up one finger and said, Mom, we saw a cool balcony. I held up another finger and and looked at Jacob. He said And there was no one in the audience. I nodded and said, We were the only people in the theater, no one was in the audience. Jacob was on to my topic now and mom, of course, responded with interest to everything he said. Jacob's sentences became increasingly complete and interesting. However, he went back to using more rote, memorized language as soon as we stopped providing that level of support. In this case, it is good that your child uses echolalia because it alerts you to the fact that you need to provide more language support in order for your child to successfully generate original thoughts and express these thoughts in words and sentences.

The main point that I remember from that long ago article by Barry Prizant is that echolalia is a good thing, not a bad thing. Kids with autism learn language differently than other children and echolalia is a tool of that learning process. There are many reasons why a child might use echolalia and if you can figure out the reason, you are better able to teach the child the next important language skill.

Musical Games

Most of us know that play is more difficult for a child with autism and that it is important to the child's development but what is it, exactly, about play that makes it important? How important is it as opposed to, say, direct instruction in language skills, social skills, or daily living skills?

Parents will often ask a question like, With a limited amount of time, are you really sure I should spend time playing with my child? I keep searching for ways to explain why play is so important. I saw the possibility of another way to explain this as I watched a video on Erica Smith's Blog.

On this video, Erica is demonstrating a kind of social musical play for young children created by a German composer, Carl Orff. The activity is highly structured but, by my definition, it is social play because the four year old girl, Morgan, has the choice of what notes to strike, she is enjoying herself and Morgan and Erica are clearly playing music together--each aware of and responding to what the other is doing. This game has all the elements that I look for in games for children with autism.

1. Social reciprocity--an activity where both players are important to the fun and success of the game.
2. Structure--enough structure that the child knows what to do and does not feel confused or anxious while playing.
3. Choices--opportunities for the child to make choices from among two or more possibilities, thus allowing the the child to develop more and more ability to observe, analyze, and choose what to do moment-by-moment.
4. Playfulness so that the child can enjoy and learn from the process regardless of the outcome.
   

Most musical training seems to be about teaching a child to play a predetermined set of notes at the exact right time in order to re-create a composition created by someone else. There is great value in this kind of training--in music and in all fields of knowledge. But this kind of training is not enough--particularly for a child with autism because playing an original composition is the real goal. Whether it is when a child combines two words in a novel way to create an original sentence, responds to a question with an original answer, or co-creates an original scene for a puppet show--anyone who loves a child with autism knows that these are the most cherished moments of all. Playing with a child in a multitude of ways offers the child with autism the opportunity to learn the art of original composition.

The Therapy Room

Yesterday, the parent of a child that I see, told me that my room was not comfortable for him, visually. He has a form of autism, himself, and has become an invaluable consultant to me on many things. I thought that I had made our therapy room visually comfortable for children with autism by choosing a soft light color for the walls and carpet, choosing solid and cool colors for the mats and avoiding florescent lights. But, apparently, there is more that I need to do.

Here is one source of information that I found as I have renewed my study of autism friendly room design: http://www.designautism.com/10tips/10tips.html

Don't Go Green When Potty Training

I get asked regularly about how to potty train a child with autism. This is a hard question for me to field with any confidence. I am a Speech Language Pathologist. I don't try to keep my work narrow in scope but I will often mention that I work at the other end.

OK. I do help parents create visual schedules, write social stories and I have even talked to a shy dad or two about taking his son into the bathroom for a demonstration. However, since I, personally, have never potty trained a child with autism, I feel like a fraud if I give too much advice. Better to ask other parents who have successfully done this is what I often tell parents. I found this blog review of a potty training book recently and apparently it worked for at least one child. If anyone out there wants to add links or suggestions, I'd be happy to have more references to give out.

I do have one bit of advice, though, and that is: Don't teach your son to use a tree in your yard. This might seem like a good idea at the time but the tree in your yard looks a lot like other trees. Once again, this week, one of my young friends thought that the little apple tree in our clinic play yard looked like the tree in his yard and he had his pants down before his dad could say a word. His red-faced dad mumbled something about the fact that they lived way out in the country.



Another good link on potty training on a blog full of good parenting tips that may or may not work but are worth considering: Moms with Marbles

Willing Little Warrior

I took Brent with me to pick a toy from our toy closet this morning. I said, Hold my hand, let's get a toy. This is not part of our routine. He lifted a limp hand to put in mine and I turned back and leaned down beside Brent to say We will be right back, Mommy. Brent's beautiful blue eyes were somber through this exchange looking at me in his quiet, serious way. I was pretty sure he had no idea where we were going, or why, and he had no idea what I had said to his mom. Still, he came with me, willing to take on so many unknowns just because I asked.

At the toy closet, Brent looked over the toys and games carefully but stayed very serious given the riches I had set before him. He did not reach out to select anything. I encouraged him to desire something saying, Brent wants..... No response for a while so I waited while he looked longer. Brent finally saw a toy stoplight and looked suddenly alert. He did not look at me but he said, Do you see Stoplight? He was not asking me if I saw the stoplight but rather was imitating what others say when they notice his interest in something--he was tentitively requesting the stoplight. I said Brent wants stoplight. OK and handed the box to him.

Brent dropped to the floor immediately and opened the box to pull the stoplight out. Wait. I said, gently as I took the box from his hands. We will play in Tahirih's room. Since I had picked a second toy to take back with us, my hands were full and the lid to the stoplight box was on the floor. Get the lid. I said. No response. Pick the lid up. I tried. No response. I touched the lid with my foot and said Brent, pick up the lid. Brent immediately put his foot on the lid too. Brent did not understand a word I had said but, sweet boy, he was quite willing to do what he thought I wanted him to do.

I don't know why, exactly, but this moment made my heart feel--I don't know what to call it. When a child is so willing and so brave, I feel some constellation of admiration, sadness, and love.

Teaching is not Telling

I have done taped interviews with parents from time to time, asking them after a year or so, what they have learned. I learn a great deal from these interviews. This morning, in our clinic waiting room, I was reminded of a particular interview. It was an interview where a mother told me that the most important thing she had learned was that teaching is not telling. I had not said this, at least not in these words so I was glad she went on to explain what she meant. She said that in her childhood, she saw adults tell kids what to do. She had learned that good kids did what their parents said. Good parents told their kids how to behave. Her intention was to be a good parent and to have good kids and her husband was right on board with this. So, they were nearly in despair when I first met them because their seven year old son ignored, disobeyed, and argued with them about nearly everything. They felt like bad parents with a bad child (whom they adored none-the-less.)

This mom was shocked when she truly began to understand that in order to teach her son to behave more appropriately, she had to show him, step-by-step how to behave. Likewise, she had to show him any new skill because he never learned new skills without visual demonstrations or some kind of visual support. She said her parents had never done this with her, rather they had just told her what to do and she had done it. Spanking might have been mentioned occasionally. She was shocked that she could not parent in the same way with her son and expect the same results. But she came to believe that her son really could not do what she told him to do, simply because she told him. This is the nature of the receptive language disorder most common in Autism Spectrum Disorders and in my experience, it is a very hard thing for parents to believe. It is really hard to believe, this mother said, when your child appears to understand language. Her son could talk, although when you listened closely, he was restricted in what he said, mostly to memorized language from books or movies but also many memorized argument phrases. Their son, like most the kids I see, used his memory to guide his behavior. He did what he had done before or what he saw done, not what he was told to do.

As she looked back on our year together, this mother remembered how hard it was to ignore the arguing routine that their son had perfected and respond to him with, Let me show you, just watch. They learned to move across the room to stand next to their son and demonstrate what they wanted him to do without saying a word in some cases. They also made lists for him (he could read and used written language quite well to guide his own behavior). They wrote stories and showed him pictures of what they wanted. If I had known how well video modeling worked, they would have made videos to teach him new behavior and new skills. These strategies were successful enough to be convincing but nothing was a quick miracle solution. Their son had seven years of coping by refusal under his belt. Over time, their willingness to show as a teaching strategy rather than tell as a teaching strategy resulted in less refusal and less arguments and more and more learning. Their understanding of their son changed dramatically. Their understanding of themselves as inexplicably bad parents changed as well.

As this mom, explained, we learn our parenting strategies early and usually by watching our own parents. In fact, we unconsciously imitate parenting behaviors even if we don't intend to do so, as when I say things that sound exactly like things my mother said--same words, same tone, probably the same knowing look on my face that drove me nuts when I was sixteen. I don't have autism, so I understood social hierarchies as a teenager and waited until I was a mother and had a teenage daughter before I imitated my mother's adult lecturing a teenager tone of voice and words. Kids with autism are much more likely to imitate the dramatic and powerful sounding language as soon as they hear it. Thus explains, the little girl in my clinic this week, who, when her brother told her he'd be right back, replied like a little queen ordering her servant around You will say, I will be right back, ma'am. Her brother grinned and told us that Mom's trying to teach her to be polite. Demonstrating behavior to a child with autism works even when you don't want it to.

The most effective teaching really is demonstrating, showing, modeling. Children, all children, but especially children with Autism Spectrum Disorders, will learn best by watching and imitating. At one level, parents know this but they don't always know how to use this principle. I work in a play-based clinic and parents watch or participate in every session. We play with kids in order to teach them new communication skills and it clearly works. Yet, I watch parents come into our waiting room, where we put out new and interesting toys every week and rarely do they play with their child while waiting for a therapy session. Most parents, if they interact at all with their child and the toys will slip into the role of director or corrector or tester. They do not sit on the floor with the toys and play but rather watch from the side to see that their child does not make too big a mess or get hurt or behave selfishly with another child. They might tell their child a few things about the toys and test vocabulary knowledge by asking things like What is this called? and What color is this? Parents behave this way because they long to be good parents and have good children. Telling is teaching in the minds of many adults because they saw their own parents fulfilling the teaching role in this way.

I was watching a new parent in our clinic interact with her daughter in the waiting room and starting to form an intervention plan this morning. This is when I remembered that parent interview where the mom said Teaching is not Telling. I knew that this would be an important new concept as I watched mother and daughter together. The mother had told me last week that the goals for her daughter were to 1) learn to play with other children 2) not be so bossy with everyone. This morning, the mother was sitting off to the side and asking her daughter questions about each toy or telling her daughter where to put each toy. Her tone was socially appropriate for a mother but would sound very bossy if her daughter imitated the tone with another child. Her daughter, although reluctantly compliant with the activity was not learning to play because what they were doing together was not playful. I knew, as I watched, that I will be gently asking this mom to rethink her role as parent, at least in regard to play and get on the floor and show her daughter how to play, how to be cooperative, how to share control--all the things she wants her daughter to learn. She has been telling her daughter long enough, now it is time for her to teach her daughter. Wish me luck. This is always a hard sell.

Slow Down When You Communicate

Here is another post about something you, as a parent could do that would help your child learn new communication skills faster than anything a Speech & Language Pathologist could do in a weekly therapy sessions. Slow Down when you communicate.

Take the time to move closer to your child and get down on his or her level as you communicate. Pause after phrases and sentences. Say one idea. Then be quiet.

Take the time to articulate words clearly. Use an interesting voice with lots of animation and drama but still say the words clearly.

Substitute hand gestures or facial expressions or head nods or shoulder shrugs for chatter. Tap your head as you think. Slap your forehead when you do something silly. Even as you use non-verbal communication, hold your gestures and expressions for longer since this is the nonverbal equivalent of slowing down.

Hold your child's hand or with eye-gaze demonstrate that you are waiting and listening. Don't be in a hurry to fill in answers when it is your child's turn to talk. Waiting longer is the way you slow down while listening.

Be quick to show your child what you mean when you sense confusion. Draw a picture. Demonstrate. Interpret any behavior that looks like lack of attention as confusion. Interpret any behavior that looks oppositional as confusion. Stay calm. Stay focused. Say Watch, I will show you.

All this takes time but your child will learn more communication skills with you, if you will take this kind of time while you communicate, than he or she will learn with anyone else.

Tools of the Mind

The other morning, I heard a discussion on Public Radio about a NIH study of a preschool curriculum called Tools of the Mind. This curriculum included using pretend play as a means for teaching young children self-regulation skills and executive function skills. The results of the study were impressive with youngsters showing more pro-social behaviors of the kind and quality that, coincidently, we are constantly targeting as we teach children with Autism Spectrum Disorders. I was convinced (re-convinced) that social pretend play is a near perfect system of social learning and children who have autism need more support so that they, too can engage in pretend play learning.

Pretend play is highly rule bound. When a child is pretending to be the mother of a sick infant, for example, the rules of being a mother are demanding. One has to act like a mother and not like a puppy or even get distracted by something that is mother-like but socially off task. Whatever the child knows about being a mother, the child must call to mind and portray these characteristics as appropriate in an evolving social situation. The combination of restricted role and dynamic social play are what hones mental skills that we call executive function skills. The child playing opposite our pretend mother, a youngster playing the mother's sick baby, may first pretend to cry and then fall asleep and then to crawl away and the pretend mother must decide how a mother would react to each of these situations. Other children are likely to lobby for their ideas about being mother and refine or expand the general knowledge about what a mother can or can't do. You get the baby some milk the sick baby actor may instruct. No, no, the mother has to stay with the baby all the time! another child may scold as she grabs a stethoscope and prepares to be the baby's doctor. There is planning and analyzing and choosing from among all the options that the group of players have experienced or witnessed. Learning could not be any more focused or intense than it is during extended pretend play. Pretend play is potent learning magic.

In a Tools of the Mind based curriculum, many hours a week are devoted to pretend play. Time for pretend play is what I hear preschool and kindergarten teachers lament giving up in favor of a more drill based curriculum prescribed to insure that children learn reading and math skills early. The practice of throwing out pretend play for a more adult directed education of preschoolers is like when we decided to throw out breast feeding babies in favor of baby formula. The Tools of the Mind study indicate we should re-think throwing out pretend play in school. Likewise, many serious programs for children with autism are drill heavy and pretend play lite. Many programs devote no serious effort toward teaching young children with autism to engage in pretend play--certainly not the hours a week it would require. If we believe that a typical child will need to have hundreds of hours of pretend play to master self-regulation and executive function skills "or cognitive control skills, including the ability to hold information in your mind; to resist habits, temptations or distractions; and to adjust to change" then how much more so do children with autism need the opportunity to do so and then the opportunity to get those hundreds of hour of play in. All this is sounding like a Floortime promotion, isn't it? I've gotta go back and re-read those Floortime books.

Game Level--Not Too Easy & Not Too Hard

Picking the right game or activity for your child is both easy and complex. It is easy if you show your child a new game and he or she jumps right in and can't wait to play. Ok. This is the right game! you say to yourself. It is complex if you are trying to judge the activity based upon the developmental level of your child because children with ASD are notably uneven in development. Systems for evaluating your child's developmental level may or may not be helpful. I want to help you have a general sense of whether a game is likely to be at the right level of complexity for your child. Your child will have fun playing a game if it is not too easy and not too hard.

I use the "my gut tells me this might work" system most often and my gut is pretty accurate after years of intense one-on-one child training. I also read about the systems that others in my field use to sort children into developmental levels or stages and find that reading makes my gut even more accurate. Many systems that I read about are complex and theory steeped so I can't just refer to these and expect everyone one to know what I am talking about without some serious background reading. SCERTS, which is also very theory steeped, none-the-less has a relatively simple system for putting children into one of three developmental levels. I spend a lot of time explaining this system to parents because I use the SCERTS system for tracking progress. I will try to explain these levels in a very simple way here for the purpose of helping you choose a game for your child. (My explanation here is downright simplistic but adequate, I hope, for this purpose). For more detail and a great system for organizing your child's intervention program, see the SCERTS Assessement and Intervention Guide Books.

Level 1: Social Partner Stage
These are children who are not really talking yet and have a hard time interacting socially at all, even for short periods of time. They are in the process of becoming Social Partners by learning skills like Joint Attention and Reciprocity and the tools of intentional communication such as words and gestures.

Games for the Social Partner usually employ the child's more well-developed interest in sensory experiences to pull a child into a social interaction. The previous post, Creating Common Ground is about how one starts to pull a child at this stage of development into social interaction. The page on Autism Games that is most associated with this level of play is Come Be With Me.
Joint Attention, reciprocity, and meaningful first words are the goals that should be the natural outcome of play with a child at this stage.

Level 2: The Language Partner Stage
These are the children who intentionally communicate but are still working out the basic systems. They are learning to stay socially engaged for longer periods of time. They are learning how and why and when to communicate. They have a vocabulary of under 100 words.

Most of the games on Autism Games are appropriate for children at this level of development. Still games may need to be modified so that there are less steps, or so that attention need not be shifted as often. The games may need to be modified so they include materials that are of more interest...and so on.

The natural outcome of play with a child at this stage of development should be longer periods of social engagement and the spontaneous use of new communication behaviors. During play, children should experience what it is like to communicate for new reasons, with new people, about new topics.

Level 3: Conversation Partner Stage
These are the children who can generate an original sentence and who can communicate for all the basic social purposes but are working on learning how to stay in a conversation. These are children who are learning how to tell a story about something that happened to them or something imagined. These children are often working hard on the mental flexibility that it takes to be a good conversation or play partner.

Many of the games on Autism Games are still appropriate for children at this level but I often increase the complexity of games for these children to include peer social partners. I may also increase complexity by including more pretend play elements. I spend more time with these children planning play and afterwards, discussing what happened. We also analyze together how we felt about it. I certainly require more variation during each play session and across play sessions.