Working With Non-verbal Children On The Autism Spectrum

Working With Non-verbal Children On The Autism Spectrum

PlayI am going to describe how I work with non-verbal children or children with severely delayed language skills, who are on the autism spectrum. I will share what I have found to be effective and what I have been able to build on in order to develop interactions. Every child is unique, but there are core features of Autism and a lot of research has been carried out to find strategies and approaches that support these.

Every practitioner is different; clinicians have preferred ways of working and approaches they feel comfortable and confident using, and approaches that they don’t feel are right for them. For example, Applied Behaviour Analysis has a lot of evidence behind it that it works, and it is a popular approach, but I personally do not feel comfortable with this approach and it is not for me.map

I am interested in connecting with the child, joining them in their inner world and helping them to venture into the outer world. I am interested in communication and interaction, reducing demands in order to help the child develop these skills. I tailor what I do to the individual, but I carry a broad map in my head that I plot the intervention around.

Approaches and Strategies

I often start our therapeutic journey with the following overarching aim:

To reduce stress on the child and join them in their inner world.

To achieve this, I use the following approaches and strategies:

Responsive Communication

The Caldwell Foundation uses this term to replace Intensive Interaction. Watch the child to see what they are interested in and what they like doing. Mirror what they do / say – wait for the child to realise you are doing this and then your interaction becomes intentional communication.

Example:

Ball Cars RunningAlex is nearly 3. He finds interactions very difficult. Alex is non verbal and has a narrow range of interests. He likes to throw balls. He walks away or turns his back to the others when they try to interact with him. He finds it hard to tolerate others. The therapist watched him closely and then copied his actions and vocalisations. Alex quickly realised what the therapist was doing and he paused after an action / vocalisation, looked at her and smiled, waiting for the therapist to mirror him. The interaction was predictable; he knew that the therapist would do whatever he did. This reduced stress and made the interaction manageable for Alex.

Follow the child’s lead:

Many children on the spectrum find it hard to be directed in play. They tend to have restricted interests, and introducing what you want them to do can be very stressful. Children on the spectrum often prefer predictable play routines, and they like to know what is going to happen. Watch the child carefully to see what they are doing. This might be running up and down a room, it might be pushing a toy across the floor with their head near it so that they can watch it closely, or it might be throwing something again and again, or lining up toys, etc.

Open window reduce anxietyWatch closely and see if there is any opportunity for you to connect with the child and enter their world, even if it is for a few seconds. Position yourself so that it is easy for the child to look at you and involve you, e.g. if they are lying down lining up cars, lie down too, opposite the child. If they look up at you and vocalise or say a word, re-enforce it by repeating it. This shows you heard it, and that you are interested. Avoid asking questions, as this will put pressure on the child. We want to reduce stress, we want to join them in their inner world and share the experience. I think of it as watching and waiting for the child to open a window into their inner world.

Reducing Adult Language

Mirror what the child says and model language at their level in context, naming items and actions they are interested in. For example, name what they are playing with: “Ball!” “Bus! Here comes bus!” “Tickle!” “I, 2, 3, Up!” 

Example:

Sophie’s special interest is the alphabet, reading and writing. She taught herself to read and write at around the age of 3. She loves to write words with alphabet bricks. In a speech and language therapy session, she sat on the floor spelling words with the bricks, saying the letters and then the words, e.g. “T-r-a-m-p-o-l-i-n-e spells trampoline.” This was a solitary activity, and her attention was on the bricks. The therapist sat opposite her, at the same level, making sure it was easy for Sophie to look her. After a while, Sophie said a word, and looked up: “B-a-l-l spells ball.” This was the window opening! The therapist smiled and said, “B-a-l-l spells ball!” and added a comment, “Bouncy ball!”

Sophie continued spelling words, but each time she looked up and directed what she was saying to the therapist, who repeated it and added a comment. This became a predictable routine, which made it safe and manageable and enabled us to interact.

I move on from this to the following overarching goal:

To develop interactions through mirroring what the child is doing, and adding to this very gradually

Using Early Play Skills

Use physical play and non-directive play, following the child’s lead. 

Many children on the spectrum enjoy physical, rough and tumble play. Through physical play you can show them that sharing experiences with another person can be enjoyable, more enjoyable than experiences with objects. You can motivate them to want to share these experiences for you.

Examples of play:

TickleTickle: Tickle the child, then stop, pause, hold out your hands to show that you are about to tickle, say, “Ready, steady…….” Wait for the child to look at you and then say, “Tickle!” and tickle them. Repeat this – stopping, using your hands to show you are going to tickle them and to increase anticipation, waiting for the child to look at you to signal they want you to do this.

Add to this routine: Ask the child, “More?” and use the Makaton sign for more. From this you can move on to modelling and using “I want more.”

ChaseChasing: Chase the child, catch them and tickle, throw them on the sofa – do whatever you usually do when you catch them. Then hold out your arms to show you are going to chase the child, say, “Ready? Steady……” pause, wait for eye contact. When the child looks at you, even if it is fleeting, say, “Chase!” and chase them! Use the same procedure outlined above to turn this into an interactive routine. 

Add to this routine: Ask the child, “More?” and use the makaton sign for more. From this you can move on to modelling and using “I want more.”

hideHiding: Many children on the spectrum enjoy playing hiding games, e.g. hiding behind a blanket or a curtain. When they are hidden, say, “Where’s (+child’s name)?” You can increase anticipation by looking in other places, e.g. “Is he under the chair? No, he’s not here. Is he behind the sofa? No, he ‘s not here. Where is he? Maybe he’s behind the curtain! Let’s look! 1, 2, 3, here he is!” Lift the curtain to see the child. Repeat this to turn it into a predictable routine that you are doing together. 

Add to this routine: Ask the child, “More?” and use the makaton sign for more. From this you can move on to modelling and using “I want more.”

swingSwinging: swinging is used by Occupational Therapists to regulate sensory information in children. It is pleasurable and it has a purpose. Put a blanket on the floor, the child lies on their back so that they will be able to make eye contact with the person facing them. Say, “Ready, steady ….” Pause for the child to look at you and say, “Go!” then lift the blanket up with the child in it and swing the child back and forth. I sing Ring a ring a roses as I do this, and when I get to the last line, I pause, e.g. “We all fall …..” for child to look at me and complete the line, e.g. “Down!” Then lower the child to the floor. Wait for them to show you/tell you they want more and repeat this routine.

These activities are building blocks for me, they help lay the foundations to work on more targeted areas, e.g. understanding language, taking turns, requesting, etc. There will be another blog entry coming soon, describing what I do next.

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