The practice of early intervention (EI) is always evolving and changing as new evidence comes to light about how to support children and families. This brief summarizes a research study that examined the behaviors of caregivers of young children with autism that were associated with higher levels of joint attention and language in children. It is followed by strategies you can use to evolve your practices based on the findings in the study.
Research: What Do We Know?
Siller, M., & Sigman, M. (2002). The behaviors of parents of children with autism predict the subsequent development of their children’s communication. Journal of Autism and Developmental Disabilities, 32(2), 77-89. (PDF, New Window)
Siller and Sigman examined whether or not particular caregiver communication behaviors would be associated with higher levels of language in children at later ages. Twenty-five children with autism were matched to samples of children with developmental delays or typical development in areas of mental age, language age, and years of maternal education. Each child’s social-communication was assessed at the beginning of the study and 1 year, 10 years, and 16 years later. Caregiver-child play interactions were observed and videotaped in a lab playroom. Specifically, the authors wanted to know: Will caregivers who spend a higher proportion of play engagement targeting objects that are already the focus of the child’s attention, trying to maintain the child’s ongoing activity, have children with more superior communication skills at later ages (p. 79)?
The strongest predictors of superior communication abilities in the children with autism were linked to caregiver’s verbal behaviors. Specifically, caregivers who synchronized what they said with the child’s focus of attention and used communication that was undemanding had children with the greatest gains in language development. Interestingly, how attentive children were to toys and how often caregivers talked with them was not predictive of communication gains; rather, it was how the caregiver communicated with the child that was more important.
Practice: How Can You Use What You Know?
These findings point to the importance of early interventionists helping families learn to communicate with their children in ways that are more naturalistic and less demanding (i.e., avoiding “say sand” or “what is this?” and instead “You’re poring the sand!” with emphasis on the important word “sand”). Interventionists can also help families synchronize what they say during play with what the child is doing – meaning that the caregiver talks about objects and activities that the child is already playing with or attending to.
This can be challenging when children have restricted interests or tend to play repetitively with toys or other objects (like opening and closing cabinet doors or spinning bowls on the floor). Rather than removing the child from the repetitive activity, the caregiver can join the child in the activity, narrating the play by giving words to what is happening and making the activity interactive. Using what the child is already doing can make it easier for him to engage, communicate and attend for longer periods of time. Learning in this manner is also interest-based, because the play context is one that the child has chosen.
I think that these findings are likely to be true for children who have language or other delays without having autism. Try out what you’ve learned on your next visit using these strategies:
Share these findings with parents – Talk about these key findings and help families reflect on them and think of ways to use them to help their children. Don’t assume that parents won’t understand.
Observe parent-child play and link what you see with these findings – Point out when play and communication are synchronized and when opportunities arise to do that. For example, if the child is spinning a bowl on the kitchen floor, coach the parent in how to take a turn spinning the bowl too and how to talk about it – “my turn!” or “ready, set, go!” when she or the child spins the bowl.
Use the child’s perseverative play rather than always discouraging it – We don’t want children to spin bowls all day long, but using that activity, which he enjoys, and turning it into an undemanding fun interaction can be a great context for learning.
Practice synchronization – This sounds complicated, but it’s really just about following the child’s lead, imitating what he does and says, taking turns, and building on his play. Keep the focus on what he’s doing, rather than on your own agenda, and use his play to help him learn what he needs to know.
Reflect on how you play with the child too – Listen to yourself and think about what you do. Practice implementing these findings too so that you can help families learn them. If you are modeling a more demanding approach, then step back and see how you can make changes as well.
What are your thoughts about these findings? How have you helped families be less demanding in their communication and be successful with engaging their children during play?
For more information and resources related to supporting infants and toddlers with autism spectrum disorders, visit the VA Early Intervention Professional Development Center’s topic page on Autism Spectrum Disorder or the free Autism 101: What Every Early Interventionist Needs to Know module.
What a great post! The research results are so interesting and really very much in line with evidence suggesting that we should be interacting with all children and families around their priorities, interests and routines.
Thanks Susan! This is one of my favorite research articles because the results are so powerful for our work! Since I know you work in professional development, like me, I’m wondering how you might be able to use this kind of brief in your work?
Great article to read. Following the child’s lead in what they like to do helps encourage development rather than pushing them to do/say something. This is something I like to focus on with parents more in the future and plan to observe how the family interacts which their child. This is a great opportunity then to coach them into new ways of interacting with their child.
Yes, Syndy, EI really is all about the parent-child interaction. When that’s going well and the parent understands what following the child’s lead really means (which seems simple but is often misunderstood), development moves along. How do you explain/demonstrate what following the child’s lead really looks like? I’d love to hear what words you use.
This post really is in tune with what we discussed at a team meeting this past week. A team member brought up concerns about how to get parent and child involved within an activity and encourage language development. The entire team all chimed in asking what the child’s interest was (spinning wheels), and then everyone encouraged using that activity to facilitate the child’s learning, even if it’s not something the parents want to do all day long. This is a great post to share with the team member asking for support, and reading this helps me feel that our team is really trying to head towards a more family supported and child interest focus early intervention.
I think this would be a great article to bring to a visit with you. I often discuss following interests and using language that are about observations, rather than demands, but this is easier said than done. When parents are in the habit of directing their child’s play and asking questions, expecting an answer, it can be a difficult habit to break. This blog may be good to refer back to and to provide parents with specific examples and evidence supporting this. Parents may be more open to allowing those perseverative play activities, knowing the way they use language during it can benefit their child’s development. Great read!
This summary of research is very useful to read. It contributes to growing evidence-based research with a variety of language delayed children by the Hanen Foundation, Ann Kaiser and her colleagues, James MacDonald, and others. I have personally found it very consistent with the research about the interactions with typically developing children and their parents as well. In my own experience, it is the most effective in natural environments in family routines, the model for early intervention. It changes a power struggle of “say this” to conversations about whatever is happening that enriches everyone’s lives. It supports parents noticing what their children can do and enjoy doing and build on that in natural exchanges. It no longer becomes a lesson but a communication that can happen at any time throughout the day.
I love how you describe this as changing from a power struggle to a conversation, Jean! I think it can feel like that for interventionists too!