Teaching, Training, and Living with Children

Who Have Autism: Recommendations 1-5

Teaching children with autism is different from teaching children without autism. Thankfully, we have the experience of many teachers, trainers, and parents who have found strategies and techniques that make this daunting task a little easier. The following ten recommendations for teaching, training, and living with children who have autism have been adapted from the works of Martin A. Kozloff, the Judevine Center for Autism, Applied Behavioral Analysis, and many parents, children, and teachers.

Recommendation 1:
Have high expectations. Do not assume the person cannot do something just because the person has autism. Do not be controlled by the person's IQ score. It is very difficult to accurately measure the IQ of a child who has autism. Expect the person to behave, to answer you when you ask a question, to come when you call, and to complete a task you assign. The person with autism may need more time than others to do these things and may need your help, but continue to expect good things from them. Above all, do not excuse bad behavior because you feel sorry for the person with autism. The first change many of us need to make when we work with those with autism is to stop thinking of persons with autism as helpless victims. Persons with autism are people. They are people with feelings, thoughts, desires, and needs. They respond to positive reinforcement, love, attention, punishment, and all the things we experience in life. However, they may respond in different ways.

Recommendation 2:
Use a positive approach. Stay positive at all times. Pay attention to and look for appropriate behaviors. When you see them, comment on them and reinforce them with specific verbal praise (e.g., "Carey, I like how you are sitting quietly."). To establish new behaviors, present other reinforcers along with the verbal praise, e.g., physical praise (a pat on the head, a "high five", etc.), a primary reinforcer (a bit of food or candy), or activity reinforcers (access to toys, time to play, etc.). Note: It is very important to find strong reinforcers (a reinforcer is anything that, when given after a behavior, strengthens the behavior). To find a strong reinforcer, talk to the parents, other teachers who work with the child, watch for those things the child chooses on his or her own, and try a million different things to see what is motivating for the child. Once you find a strong reinforcer, keep it under your control and do not allow the child access to it until the child has performed the behavior you are looking to strengthen. Unlimited access to reinforcers devalues them.
Ignore inappropriate behaviors. Destructive, abusive, or dangerous behaviors may require a consequence, but for most behaviors: start with ignoring. Commenting on, looking at, or paying attention to inappropriate behaviors in any way can be very reinforcing for many children with autism.
When you explain rules to the person, make sure they are stated in positive terms. That is, say, "Sit on the chair," rather than "Don't stand up." Tell the person what to do, rather than what not to do. If the person makes a mistake, say, "Good try," and have him or her try again. Also, never talk about the person's behavior problems or deficiencies in front of the person. It's rude to do with anyone; and may give the person with autism a list of things to do to get your attention! Be careful!

Recommendation 3:
Require a response. Never ask a person with autism to do anything! Always tell them. And never tell a person with autism to do something that you cannot make happen with your hands-on assistance. When you tell a person with autism to do something, give them a little more time to respond (about ten seconds). Many persons with autism have difficulty processing auditory information and/or visual cues and may need more time to decode what you have said and to decide upon a response. If after ten seconds, the person does not respond, prompt the answer. For example, if you have asked, "Kayla, are you happy today?" And got no response, prompt Kayla by saying, "I am ______." She may fill in the blank. If still no response, prompt again with "I am h_____." (assuming she looks happy). If still no response, prompt a "Yes" or "No" verbal or gestural response. Whatever response comes (even if you have to shake her head up and down for her) make sure you praise her for "Good answering" or "Good talking." Never allow a question to remain unanswered or an instruction to remain uncompleted. Do not drop it and move on to the next child. If you do this, the child with autism will learn that no response is ever required of them and that what they may have to say is unimportant. Make sure you get a response. Say what you mean, and mean what you say.

Recommendation 4:
Ignore irrelevant speech, vocalizations, giggling, laughing, and actions. Check this scene out: All of a sudden, Andrew, a child with autism, breaks out in loud and animated giggling. The teacher spends the next 15 minutes asking Andrew what is so funny, she laughs with him, and goes around the room pointing out several objects and asking, "Is this what you are laughing at?" The giggling stops as abruptly as it started. The teacher is puzzled and has no idea what triggered the giggling. She was hoping for a breakthrough moment of connection with Andrew.
Rather than achieve a "breakthrough," the teacher has just reinforced an inappropriate behavior for 15 minutes! Remember, pay attention to behaviors you want to see repeated and ignore behaviors you want to stop. What's so inappropriate about giggling, you may ask? Nothing, if it is related to what is going on at the time. However, if you see no clear connection with what has just happened or is happening, then ignore it. You need to teach the child with autism what is relevant speech and actions and what is irrelevant. This goes for self-stimulating behaviors, echolalia, out-of-context words and phrases, screaming, odd actions, and any other behavior that is not related to what is going on. One of the traps teachers and parents get into with children with autism is that we want to encourage all communication, because we so rarely get it from the child. However, make sure you differentially reinforce and respond to relevant and irrelevant communication. Otherwise, you will get more and more irrelevant speech and actions because the child sees that it gets your attention. When the child's response or actions are relevant, give lavish praise and point out the connection between what the child said (or did) and the relevant event (for example: "Yes, Andrew, it is funny when Barney giggles!").

Recommendation 5:
Speak slowly, clearly, and specifically. Remember, persons with autism may have difficulty processing what you say. At first, speak slowly and clearly so the child receives all to most of your verbal cues. (Later you will want to make your speech as normal as possible so the child will understand anyone, not just you.). Make sure the child is looking at your face (more on this later) to assure he or she also picks up on your nonverbal cues. Be specific in your language. Until you know the child understands colloquialisms or abstractions, do not use them. For example, rather than say, "Take a seat," say, "Sit on the chair." Many children with autism are very literal and may misunderstand your nonliteral phrases - no matter how common they seem to be. For example, a parent once told me that she was puzzled when her child kept holding his worksheets up to his face, until she realized that she had told him, "Keep your eyes on the paper." Watch your nonliteral speech - it can have unforeseen consequences! Use nouns as nouns, verbs as verbs, and adjectives as adjectives. For example, if you are teaching colors by showing different color blocks, do not say, "This is blue," rather say, "This is a blue block." Do not say, "This is a cow," if showing a picture of a cow. Instead, say,"This is a picture of a cow." Also avoid inadvertently asking questions when you intend to give a command. We all do this when we tell a child to do something but add the polite phrase, "Okay?" This changes the command to a request and the child can say, "No." And, since we want to always reinforce appropriate communication, we would have to honor their "no" and stop the activity. Also avoid outright questions, like: "Will you do this?" or "Are you ready to work?" Other statements to avoid: "Do this for me." (School work is not done for someone else, it is the child's duty). "Let's put on our coat." (Unless that is a very big coat, avoid this "we" talk). Also avoid "Please" and "Thank you" when giving commands or instructions, these are polite words but not needed for expected behavior.

Recommendation 6:
Use a schedule and other methods to predict upcoming events and changes for the child with autism. Most children with autism resist change and prefer sameness. Rather than just a stubborn habit, this is probably due to the child's inability to fully comprehend and pay attention to all the cues from their environment that announce a change is upcoming. Many children with autism focus on only a small part of the situation rather than the whole. For example, most us us can look around the room and see people getting ready to go home, we hear the rustling papers, see the clock moving, hear the teacher say the "end of the day phrases," etc. Children with autism may miss all of this and only be focused on the puzzle he or she is completing. Children with autism need to know what activity is first, next, and last. Children with autism should be warned when an activity is about to change (e.g., "In five minutes it will be time to put the puzzle away.") and another is about to start (e.g., "When you are finished with the puzzle, it will be time for math worksheets."). Children with autism should be warned about visitors coming into the classroom and home. They need to be warned about odd or scary things that are about to happen (e.g., "Kayla, in five minutes the school bell/fire alarm will ring. It will be loud!"). "Social stories" are stories that explain the reason for things to children with autism, explain the perspective of others, and talk about expected behaviors from others and the child with autism. Social stories can be a great way to prepare children for changes and new situations.

Recommendation 7:
Do not raise your voice, grab, or threaten the child with consequences. Raising your voice seems like the natural thing to do to get compliance. (It works at home, right?). However, many children with autism may be sound-sensitive. They may just avoid you. Also, when we raise our voice to a child, we have probably already gave the command four or five times. What we have taught the child is that the only time we really mean business is when we raise our voice. The child with autism knows we don't really expect them to obey us until we are shouting. To get around this, tell the child to do something once or twice, if the child does not comply, assist them in the least intrusive method needed to get the child to comply. For example, if you have calmly told the child to sit down twice and the child is still standing, place your hand on the child's shoulder and guide the child into the seat. Once the child is seated, say, "Good sitting. I like how you follow directions." The child learns from this encounter that you mean business.
Rather than chase after or grab a child who is running away from you (unless the child is facing obvious danger), tell the child what he or she should be doing ("You need to come back here.") and offer the child a contingency for returning on their own. For example, "As soon as you come back and finish the activity, it will be time for snack (etc.)." Do not threaten negative consequences (e.g., "If you don't get back here you can't go outside all day!"). This will lead to a power struggle and/or more avoidance. Stay calm and keep it positive. Teach the child to ask or tell where he or she is going by anticipating their escape behavior and saying, "It looks like you want to go outside. Use your words." And then reward this appropratebehavior with a trip outside (if possible - if not, tell the child when going outside is an option.).

Recommendation 8:
Do not allow behavior problems to succeed in escaping demands. If you give the child an instruction and the child has a tantrum, ignores you, engages in self-stimulatory behavior, walks away, or refuses to comply with your instruction, you must continue to insist that the instruction is completed. Wait the child out, when he or she is calm, make sure the task is completed. Use a contingency statement to improve the child's motivation. For example, "I know you do not like making the bed, but when you are finished, it will be time to ride your bike (or something else pleasant to the child)." This results in a win-win situation, which is what we are always seeking with our children. Allowing a child to escape demands is a very powerful reinforcer for their escape behavior (tantrum, etc.) and this will be a very difficult habit to break once it is established.

Recommendation 9:
Do not give in to rigid routines or fixations. Children with autism often have rituals or routines that they feel compelled to perform. Often, the child will demand that others comply with his or her routines as well. For example, I know a young child who must count ten steps as he walks up the steps. If he miscounts or the steps do not add up, the child insists that Mom and he start all over again at the bottom. This is probably similar to obsessive-compulsive disorder behavior. It's as if the child believes something bad will happen if the correct number of steps is not counted or some other routine or ritual is not followed. This actually becomes a self-fulfilling prophecy. Once the routine is completed, there is a sense of relief and the "bad thing" doesn't happen. Stopping the child from performing the routine (or ritual) may result in a severe tantrum. Giving in to the routine (or ritual) after this, reinforces the routine (or ritual) and the tantrum - not a good thing! Don't go out of your way to stop all routines and rituals. The ones that are harmless and do not infringe on other's rights (e.g., lining up cars in the toy room), you can simply ignore and not play along. But do not allow the child to demand that others comply with their routine or ritual and do not allow it to take over the entire house or school. Tantrums are sure to come, but tantrums are always ignored (unless the child is in physical danger). When ignoring a behavior that previously received a lot of attention, the behavior will probably get worse before it gets better. Be patient and ignore consistently for at least three weeks (the time it takes to develop a new habit). If the behavior has not decreased, another strategy may be required (perhaps attention is not the motivation for this behavior).

Recommendation 10:
Establish, reinforce, and expect the basic "learning/ attending protocol." Persons with autism have difficulty attending to what is important. Frequently they are paying attention to irrelevant aspects of what we are saying or doing or distracted by their own interests, actions, or sensory needs. In order to effectively teach the person with autism, we must first gain their attention. My first few exposures to autism came when I was assigned to assess children for eligibility for an early intervention program. My attempts to assess the children with autism would be comical if it weren't for the serious nature of their condition. I would pull out my blocks and puzzles and the chase was on! My report went something like this: "The child stacked two blocks on the couch, three blocks on the table, and stacked four blocks inside the refrigerator." This may be okay for testing purposes, but teaching is something different. In order to teach a child, you must have their attention. That means they are in one spot in the room, preferably sitting down, and looking at you. The child's hands are not waving in the air, playing with something, or rubbing their body. Their hands are ready to work. That is exactly what the "learning/ attending protocol" is.

The Learning/ Attending Protocol
a. Give the command: "Sit on the chair." If the child does not sit, make it happen and praise the child for "Good sitting."
b. Give the command: "Hands on the table." or "Hands ready." If the child does not place hands on the table, make it happen and praise the child for "Good hands ready." or "Good following directions."
c. Give the command: "Look at me." If the child does not look at you, wait him or her out, and when you get even a brief eye contact, praise the child for "Good looking" and present a pleasant activity or food reward. Occasionally it is necessary to hold a bit of food or a desired toy up near your eyes to get eye contact. Once eye contact is more regular, fade from holding the desired item near your eye.
Make sure you get these three things to occur before presenting an instruction, activity, or reward. This prepares the child to learn, helps to control extraneous stimuli, and teaches the child the habit of learning and what teaching is all about.