Abby has significant motor delays. Her mother asks you some version of this question during every visit: “Is it my fault that Abby isn’t walking yet?” or “What did I do to cause this?” The question itself makes you uncomfortable, because you can’t really answer it well and because you feel like you’ve tried to answer it for the past several weeks. Each time Abby’s mother asks, you say that you don’t really know what is causing Abby’s delay but what’s important is that we keep supporting Abby’s development so that she can learn to move. You and Abby’s mother both recognize that this is the best one you’ve got…so why does she keep asking?

Emotional Questions Matter

It can be incredibly challenging to manage the emotions that pop up during EI visits – both with parents and within ourselves. When we see a parent struggling with guilt over her child’s developmental delay or disability, it can be difficult for us to know what to do or how to help. With a question like this about fault, it can be especially challenging because we really don’t have the answer. In most situations, the child will have a delay and we won’t know what caused it. It might be easy to think, well, it doesn’t really matter what caused it…what matters is what we do now. However, it probably matters ALOT to the parent.

When a parent asks a question like this, it’s important that we have an honest and appropriate answer. It’s also important to recognize (and say so) that sometimes we don’t have the answer but we can still acknowledge the emotions behind it. Abby’s mother is not hoping that her service provider will place the blame on her shoulders; instead, she may be hoping to share her anxiety and fear with someone she trusts. You may be the person she’s chosen to voice her fear to…what do you do then?

Answering this Tough Question

Here are a few things to consider when a parent asks you if it’s her fault:

Be honest and be kind

In most cases, the answer is that you really don’t know what caused the delay. Most likely, it wasn’t something the parent did, and you can say that too. If you DO think it was something that happened (or didn’t happen) in the child’s environment, like when a child has experienced neglect or there is a history of substance abuse, you can be gentle about this and redirect the focus of the conversation to what the parent is doing well now. I remember working with a parent who struggled to interact with her child during the day because she had so much else to do. Honestly, I felt that the lack of interaction had probably affected the child’s communication and interaction skills. Rather than answer “yes, not paying attention to him contributed to this delay” – which I would never say because how do I really know? – we talked about the changes she’d made since she found out that he needed more interaction and I praised her efforts. It was a tricky conversation because she did have a learning curve, but as she began to feel more like she was making a positive impact on her child’s development, the guilt she felt about the past seemed to lessen.

Acknowledge the parent’s feelings

I think it’s very appropriate to ask the parent to tell you more about how she’s feeling. You might invite it by saying something like “You’ve asked me that question several times on the last few visits. We can talk more about how you’re feeling about Abby’s development if you like.” You can open the door and see if she decides to share more. Inviting this discussion can also be tricky, though, because what comes through the door could be more than you can handle. Since most interventionists are not counselors, follow your instincts. If you suspect that the parent could benefit from more professional support, or maybe even another parent to talk to, offer to make that connection or see if the service coordinator can help. Sometimes, interventionists are afraid to have these conversations because they might distract from the “real” work of the visit. I would suggest to you that the real work might not be possible, or be unnecessarily challenging for the parent, if these feelings are left unacknowledged.

Acknowledge your own feelings & examine your own response

If a parent asks a question like this over and over, it could be because she is not getting an adequate answer. If you avoid answering, she may sense that and think you really do think it’s her fault. While we can’t be in control of how a parent interprets what we say, we can be mindful of the messages we send. Reflecting on your tone of voice, the words you choose, and your body language are important.

Follow your answer with encouragement

The question might really be a cry for hope and encouragement. A parent who asks this question may be very worried about the future. Follow your best answer by pointing out what the parent is doing well, how it’s a wonderful thing that she’s involved in early intervention, and that the child is making progress (if this is the case). Offer genuine reassurance and help the parent see that, regardless of why or what happened in the past, she has the opportunity now to make a big difference in her child’s life and you are there to help her do that.

There will be times when answering Abby’s mom’s question are easier than others. Just remember that this question is probably harder for the parent to ask than for you to answer. Answering it as best you can and following it with encouragement for what’s to come can be just what is needed.

How have you answered this question before?

What do you do when a parent expresses fear or anxiety over the child’s delay or disability?

Share your insights and suggestions below in chat.

The post Abby’s Mother Asks Again: “Is it my fault?” appeared first on Early Intervention Strategies for Success.

Today I want to share someone else’s blog post that just wow’ed me. Before you read what I write, read this short post by Lisa Reyes: Someone Asked My Son with Autism Why Eye Contact Is Hard. This Was His Answer.

As I read Phillip’s answer, I kept thinking what if we approached toddlers with this in mind? Often we, and parents, approach a toddler whom we suspect has autism spectrum disorder (ASD) as if he doesn’t like interaction or eye contact. We want to “teach” him to interact more, talk more, listen better (or at least show us he’s listening), and make better eye contact. I’m not suggesting that teaching social and communication skills are a bad thing. I just wonder if we focused more of our energy on getting to know the child as he is and changing OUR behavior to better interact with him, what the outcome might be?

Intervention Strategies for Changing Our Behavior

Here are a few strategies you might use to adapt your behavior to support a child’s abilities to interact. Remember, these strategies might be great for you but they could be even more useful when you share them with parents!

Be specific – When we want the child to focus, reduce the number of details/distractions and tell him what to look at or listen to.

Try sitting beside the child – Our tendency is to sit the toddler in our lap or across from us in the parent’s lap. Sitting beside him might reduce visual and tactile distractions and make it easier for him to focus his attention. Ty this while playing, having a snack at the table, or reading a book together.

Respect the child’s need to listen and process – Look for signs that he’s listening (other than eye contact) and respond to those. Give the child time to process what you’re saying, “erase some stimuli” and “access” his answers. Allowing for a little extra processing time can go along way and requires that WE be quiet while it’s happening. Try it and you’re likely to find that it’s hard for you to do. Adults have a tendency to want to fill up quiet spaces with our own voices. Resist that behavior and watch the child. You’re likely to see him respond in ways he could not when your voice provided too much background noise.

Talk TO the child…but not too much – It can be easy to talk “about” a child rather than “to” him when you don’t get an easy-to-read response. Change that behavior by intentionally developing the habit of talking to the toddler, using simple words, short phrases, and a calm but expressive voice. Be careful that you don’t overwhelm him, though, by providing too much background noise. I often found that when I was interacting with toddlers with characteristics of autism or other sensory differences, it worked best to give the instruction verbally, keeping it short, and provide a simple model. Then I’d say “you try” and I’d be quiet and wait. The child was often more successful when I didn’t continue to narrate his actions while he worked. As we learn from Phillip, continuing to talk probably distracted the child who was trying really hard to concentrate.

Allow him his need to move – Accepting the child’s need for movement, and working within it, rather than against it, may ease the stress a bit for everyone. Encourage parents to find ways to increase the child’s body awareness, for example, by giving deep pressure hugs or playing swinging games before the family goes out to a restaurant or sits down to read a story together.

Remember that he just might love people – The behaviors we see don’t always easily communicate this. Taking the point of view that the child may love people and want to interact with them, instead of thinking he just wants to be alone, can completely change interactions. It’s a positive, enabling perspective that draws you to the child. The trick is to figure how how to behave in ways that help the child show you he loves you right back.

Share what Phillip says with parents. Help them observe their children and coach parents to try these strategies. They are the people who most benefit from understanding their children better and most want to feel that their children love them. Helping them reflect on and adapt their own behavior can make a world of difference.

I don’t know if Lisa or Phillip will know I shared their post, but if they do, I want to send a big “thank you” to Phillip for sharing his experience. Embracing what he teaches us may just make us better early interventionists.

What are your thoughts about eye contact?

What did you learn from Phillip’s advice?

Leave your comment below!

The post Supporting Toddlers with Autism by Changing OUR Behavior appeared first on Early Intervention Strategies for Success.

Ben is joining Marissa and her mother during breakfast because Mrs. Smith asked for support with helping Marissa communicate at meals. At first, Ben just observes and chats with Mrs. Smith. He asks her what her goals are for Marissa during breakfast. She says that she really wants Marissa to say or sign “please” and “thank you” to get her food or after getting what she needs. It’s very important to Mrs. Smith that Marissa learns manners. Marissa is 24 months old and has three words: mama (which she says), more and cat (she signs both of these).

What should Ben do? Should he follow the parent’s request and help her teach these words?

Manners and Toddlers

Okay, first of all, these two words often really don’t go together. Research has shown that parents often have expectations for behavior that far exceed a toddler’s abilities for self-control (same goes for sharing but that’s another blog post). However, learning how to be kind, considerate, and polite can begin very early (we just can’t expect it yet). Probably the very best way for a parent to “teach” a toddler manners and consideration for others is by modeling these behaviors for the child – by saying “please” and “thank you ” to others and by replying to the child with these words when appropriate (like when the toddler gives her mother her empty juice cup or throws something in the trash). Insisting on these behaviors during toddlerhood, however, is likely to result in two frustrated people (the child and the parent).

Now add in a developmental delay in communication and you’ve just raised the frustration bar. When a toddler is demonstrating a delay in communication, it’s best to focus on teaching words/signs that have concrete meanings and relate to the child’s everyday life. “Please” and “thank you” really don’t mean anything to a toddler. These words don’t correspond to an object or activity that has meaning for the child; they are abstract concepts at this age. If the child learns them, they are likely to become generic requesting words, much like what “more” becomes for many children who learn this sign. While they give the child a way to request, don’t specify the need. If the child has a generic word/sign to use to make a request, the frustration could still be there because she is unable to be more specific, so the parent-child guessing game continues as the parent tries to guess what the child is saying “please” for.

So what should Ben do when Mrs. Smith asks for help teaching these words? Here are a few ideas.

Strategies for Managing the “Please” and “Thank You” Debate

Explain the pros and cons of teaching manner words – Ben could share with Mrs. Smith information like what you’ve just read here regarding “please” and “thank you” being difficult for toddlers to understand. Once Mrs. Smith has some more information, she can decide if this is still a priority.

Ask what specific situations occur when Mrs. Smith would like for Marissa to communicate – Ben could delve deeper into the request to find out what activities are important to Mrs. Smith related to Marissa’s communication.

Identify specific, concrete words (nouns and verbs) to focus on – In discussing specific situations, Ben could help Mrs. Smith reflect on what labeling words she would like for Ben to use. The focus would be on pragmatics – helping Marissa use a word or sign to get what she needs, rather than making a general request.

Plan to revisit manner words when Marissa has added more words to her vocabulary – If Mrs. Smith is comfortable with this plan, they could agree to teach manner words later once Marissa has a larger vocabulary. “Please” could be added later to expand a request, such as “cookie please” once she can use “cookie” to request and is ready to begin using two words phrases (which might be a while since she’d need about 50 words first). “Please” will still be pretty abstract, even at that point, but it might be a way to ensure that Mrs. Smith knows that Ben hears her priority and that it will be addressed later.

In the end, if the parent really wants the child to learn these words, then that’s okay as long as Ben has provided Mrs. Smith with information about early communication development. Ben can show Mrs. Smith and Marissa the signs and they can practice them during the week. Ben’s job is to share his knowledge so that Mrs. Smith has the tools and information she needs to make informed decisions and support Marissa’s development. Teaching manner words is not a deal-breaker; it just might not be the most effective place to spend time when encouraging early language development in a toddler with communication delays.

What are you thoughts about the “Please” and “Thank You” debate? How have you handled it when a parent focuses on these words?

Share your experiences in the comments below!

The post The “Please” and “Thank You” Debate appeared first on Early Intervention Strategies for Success.

Meet Chris – He and his family have moved 7 times since he was born and are now staying with friends. Chris was referred to your program by his mother at the suggestion of her friend’s mom. The referral said that Chris was 29 months old and not walking. When you arrive for the screening, you see that Chris’s legs are scissoring and he’s experiencing high muscle tone. Turns out that Chris hasn’t been to a doctor since he was 5 months old and living in another state.

Meet Aliyah – Aliyah was taken to the doctor regularly but saw a different medical professional each time, rotating through whoever was available. She is 33 months old and is using mostly “ah” sounds to mean many things. She makes great eye contact and is very social and very bright. Recently, her child care provider completed a screening at her mother’s request, which resulted in a referral to EI. Her mother was frustrated because she’s been worried for a while. Because Aliyah is so social and “so smart,” she’d been repeatedly told by many people that Aliyah would eventually talk so to just wait a little longer…

Sigh…Why’d It Take So Long to Find Chris and Aliyah?

Okay, I know I’m preaching to the choir. We’re early interventionists…early screening and identification are what we DO. Yes, we know all about it, but do others? I think an important job of every early interventionist is to help spread the word about the importance of early screening to our community partners. We want our choir to grow to include more home visiting program staff, medical partners, child care providers, social services folks, and of course families!

The reality is that no early identification system is perfect. There are so many variables that influence whether or not a child is identified early and appropriately referred for evaluation. Family preferences or instability, screener error, the “wait and see” approach, follow-through after the referral is made (by the family and the receiving program) – so many cracks in the system. We can’t fix all of the cracks but we can do our best to be sure that the information is available to those who are helping us find children who may benefit from early intervention.

Spread the Word about these Early Identification Resources!

Rather than going on about the importance of finding children and families early, I thought I’d highlight some wonderful resources. Check out these links and please, share them with your community partners!

Birth to 5: Watch Me Thrive – A federal effort to support families and providers in celebrating milestones, accessing universal developmental and behavioral screenings, increasing early identification of delays and concerns, and enhancing developmental supports.

Centers for Disease Control and Prevention (CDC) Resources – The CDC website has a plethora (love that word!) of resources for early developmental screening, too many to list, really. Check out these pages for a start:

• Child Development – Tons of resources about screening tools, research, recommendations, etc. Includes info for medical providers about how to manage screenings in their practices. You can also order lots of free materials to support your screening efforts! One interesting fact – according to the CDC site, did you know that only 1 in 5 parents report that their child has received a developmental screening??
• Learn the Signs. Act Early. – Great resources for early screening and identification of children with autism spectrum disorder.
• Hearing Loss – This is one example of a topic page that’s full of info about screening and diagnosis. Be sure to search for other similar topics too.
• Facts about Vision Loss (PDF, New Window) – This is one example of a fact sheet that community partners can use during screenings. The CDC site has lots of other fact sheets so search the site for other topics.

Identifying Infants and Young Children with Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening (AAP) – Share this resource with your local medical partners to get a conversation started about how to support screening and referral.

Developmental Screening and Assessment Instruments with an Emphasis on Social and Emotional Development for Young Children Ages Birth through Five (NECTAC) (PDF, New Window) – This booklet includes info about many screening tools, including a description, age range, time frame, scoring, psychometric info, and who may administer. A great place to start if you’re looking for good tools.

Infant/Toddler Development, Screening,and Assessment (Zero to Three)(PDF, New Window) – This training module/booklet is designed to be used with child care providers to support their knowledge.

Talking to Families of Infants and Toddlers about Developmental Delays (NAEYC) – This handout is another resource to help community partners start that conversation with families when there is a developmental concern. (The link I have for this doc is acting a little funny today but I wanted to include the handout anyhow. Try searching by the title another day to get to the handout. It’s a great one.)

There are tons of other screening resources out there. Even though we know about them, we need to continue the effort to get the word out in our communities. Let’s grow our choir and help others know about the benefits of early screening for children and families. Let’s help our community partners make sure children like Chris and Aliyah get what they need as early as possible!

Share your favorite screening and early identification resource in the comments below and let’s see if we can add to this list! Share your experiences and struggles with early screening and identification – have you met a child like Chris or Aliyah? I know I have…

You can also find more info about Screening and Assessment on the Virginia Early Intervention Professional Development Center website.

The post Preaching to the Choir about Early Screening Resources – Spread the Word! appeared first on Early Intervention Strategies for Success.

On your first visit you ask, “Is Tyler saying any words?” 

“Oh sure, Tyler has lots of words! He can say ball, mama, doggie, outside. He probably says 20-30 words!” his mother replies.

When you ask for more information, you realize that Tyler’s words are almost exclusively said in imitation after his mom prompts him. He only has 2 words that he actually uses: mama and doggie. Tyler is 18 months old.

Have you ever been in this situation? Families don’t always understand that when we (or the pediatrician) ask about how many words a toddler has, that we mean how many words the child spontaneously USES to communicate, comment, get his needs met. There is a huge difference!

Why the Answer Matters

For Tyler, if we use his mother’s estimate without gathering more information, we might conclude that Tyler is on target for his communication development. However, if we dig deeper, we will see that he actually only uses 2 words, which would be considered a developmental delay. This distinction isn’t always made during well-child check-ups at the pediatrician’s office either where the screening often relies on parent report. Relying on parent report can be a great thing; in fact, some studies have found that parent report is typically pretty accurate. The key here is asking the right question to help the parent understand what we are asking so that he or she can give us accurate information.

Knowing a child’s word count really isn’t all that helpful by itself, though. Sure, it can inform us about sounds the child is able to make and maybe even words he can understand. It also helps us identify whether or not the child has a variety of words that include nouns, verbs, and adjectives which are needed before the child begins combining words into phrases. In addition to knowing which words a child SAYS, we really need to know which words a child USES.

How Do You Help Families Understand the Difference?

Here are a few ideas:

Use specific language – Rather than asking the vague question above about whether Tyler is saying many words, a better, more specific question might be “What words does Tyler use to tell you what he wants?” Think about how you phrase questions so that your intent is clear.

Ask the next question – You might ask Tyler’s mother to tell you how he uses his words. You could ask a clarifying question like “How does Tyler use his words to talk to you?” or “Are these words that Tyler repeats or do you hear him use them on his own?”

Ask for an example – Ask Tyler’s mother for an example of when she hears Tyler use his words, like during a daily routine or activity. You can also ask about routines or activities that are a source of frustration for Tyler or his mother because he is not able to use his words.

Give pragmatic examples – You might provide Tyler’s mother with a specific example to put using words in context, like asking if Tyler uses “outside” to say that he wants to go outside to play. You could ask if he calls their family pet by saying “doggie” or says the word when he sees a picture of a dog.

Observe – Observation is always a good option when you have a child who is comfortable talking in front of or to you. We all know, though, that many toddlers are quiet when they first meet us. In that case, we must rely on what the parent tells us.

Specifically explain the difference and why it’s important – Be specific and talk about how developmentally, we want toddlers to move from imitating words to using them. Once a child can spontaneously use a word to get a need met, label something or make a comment, he or she really “has” that word. Imitating is the first step. This is especially important for children with echolalia, who often need extra help to get past the imitation stage.

Ask the parent to make a two-column list – Work with the parent to make a list of the child’s words. Divide the paper in half and list the imitated words on the left and the spontaneously used words on the right. Explain to the parent that the goal is for the words on the left to eventually move to the right. This list provides a visual example of the difference between the types of words. It’s also a great way to track progress.

What are other ways you help families understand the difference between imitated and spontaneously used words? How do you gather this information at intake and assessment?

Share your insights by leaving a comment below!

For more information about expressive and receptive communication development, visit the VA Early Intervention Professional Development Center to find these resources:

Speech and Language Resource Landing Pad (PDF, New Window)

Communication Delays & Disabilities topic page (articles, handouts, archived webinars and more)

If you know of other great resources, please share them in the comments too!

The post Does Tyler Imitate or USE his Words? – Why the Answer Matters appeared first on Early Intervention Strategies for Success.

Meet Jesse and his Mother

Jesse is 22 months old and often plays by himself. When his mother tries to play with him, she says that he ignores her or will move to another activity. When you observe their play, you notice that she tries very hard to join in what Jesse’s doing, but in doing so she changes the activity right away. You suspect that this is stressful for Jesse, which is why he moves away. You share your observations with his mother and talk with her about how she might ease herself into this space before jumping into playing with “his stuff.” Together, you and Jesse’s mother come up with these steps to go from sitting nearby to actually playing together:

Steps to Build Turn-Taking & Engagement

Step 1: Jesse’s mother first sits beside the table where Jesse likes to play. She keeps her hands in her lap and talks softly about what Jesse is doing. She doesn’t join the play yet. She is just getting him comfortable with her presence.

Step 2: Once he’s comfortable and doesn’t leave the area, she moves closer and takes a car. She imitates what Jesse is doing without touching his favorite cars or interfering in his activity. When Jesse drives his car along the edge of the table, she does the same thing with her car. When he stops his car, she stops hers. Again, she’s just passively involving herself and helping Jesse see that her play won’t interfere with his routine (yet!).

Step 3: After imitating Jesse for a while, his mother gently embeds herself in his play. One of his favorite games is pushing his cars off the edge of the table, then putting them back at the end of the line. His mother introduces turn-taking by pushing her car off after Jesse has pushed one of his. Taking this step slowly and quietly, with a gentle warning like “here comes my car” works well. She says “my turn” when her car goes off the edge, then “Jesse’s turn” or “your turn” when he pushes his car. They play this game for a while to establish this new routine. It’s not really “turn-taking” yet but Jesse is staying at the table so that’s a good sign.

Step 4: Since this routine is going well, Jesse’s mom tries to make herself more necessary to the routine. When her car rolls off the table, she catches it instead of letting it hit the floor. When Jesse rolls his car off, this time she catches his car too. She immediately gives him his car. When he pushes the next car off the table, she catches it and gives it to him. She uses the “my turn/your turn” cues and adds simple, fun words such as “ready, set go!” as the car moves towards the edge, “uh-oh” when the car falls and “got it!” when she catches it.

Step 5: To build some interaction, Jesse’s mom catches his car then closes her hand around the car, asks Jesse “where’s the car?” then opens her hand for him to see. After repeating this a few times, she keeps her hand closed and prompts Jesse to approximate “open” to get his car. She accepts any sound he makes or eye contact as his way of taking his turn and opens her hand. This activity is quick so Jesse doesn’t become too frustrated or lose interest. If he does, she moves back a step or two to re-establish the game. After repeating this activity a few times, Jesse says “op-” to get his car!

They continue these games, alternating between interaction and allowing Jesse to play by himself so that he has a break. Jesse’s mom is trying to establish herself as part of his play routine without stressing him too much. She wants to connect with him and encourage his engagement and communication while having fun. In going through this sequence, Jesse is learning that interaction can be fun and his mother is learning how to gently make herself a part of his play. After the game is over, the two of you plan for how she can use strategies like these in other routines.

Using these Steps in Other Routines

These steps are just some examples of how to encourage turn-taking and engagement, which are pivotal skills for communication, learning, and social interaction. Parents can use a my turn/your turn routine like this for other activities such as:

• swinging in the parent’s arms or on a swing – the parent’s turn is one swing, the child’s turn is indicating that he wants more swinging
• popping bubbles – the parent’s turn is blowing the bubbles, the child’s turn is popping or looking at the parent to get more or saying “pop”
• going outside to get the mail – the child’s turn is knocking on the door, the parent’s turn is opening it; the child’s turn is saying “up” and the parent’s turn is lifting the child to retrieve the mail from the box

What are some strategies you use to help parents build early turn-taking skills in their children? Let’s think beyond play – how do you help them embed turn-taking in caregiving routines?

The post Teaching Early Turn-Taking & Engagement Skills – An Example appeared first on Early Intervention Strategies for Success.

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)?

Findings

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.

Practical Strategies

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.

The post EI Research to Practice Brief #2: Linking Parents’ Verbal Behaviors with Children’s Communication Development appeared first on Early Intervention Strategies for Success.

Examples of using pausing to encourage development are more powerful than me describing why this technique works so let’s start with a few examples from real intervention visits:

Sandy

One day on a visit with Sandy and her nurse, we played with Sandy’s favorite toy and assisted her as she activated it.  Sandy had multiple disabilities and difficulty with communication. After she played a little by touching buttons to turn on music, I turned Sandy’s toy off and asked her if she wanted to play again. She sat there, unmoving, so I asked her to show me that she wanted to play. After pausing longer than I ever had before, and watching her entire body for clues that she was communicating, she raised her left arm up off of her wheelchair tray. I instantly turned on her toy and praised her, asking if she was saying she wanted to play. After a short play period, I turned of the toy again. By now her nurse thought I was just being mean but I explained how I thought Sandy was communicating by raising her arm. I asked Sandy to tell me again if she wanted to play more and I waited. Within a few seconds, she lifted her arm again. This was her first “word.” When I showed her mother on the next visit, her mother cried and said that she’d never had a way to communicate with her daughter until now.

Alex

Alex had cerebral palsy and found coordinating purposeful movement extremely difficult. This led to people (including me) either doing things for him or using hand over hand support to “help” him with everything. One visit, I was amazed that he was able to put a shape into his puzzle with the piece placed in his hand and his mother providing support at his elbow. It took him easily a long 30-40 seconds to coordinate the movement but he was able to do it. If his mother hadn’t tried waiting him out, we would have taken his hand and “helped” him do it like we usually did. When we waited, we learned that he could do it himself. He knew more than we had given him credit for, and with waiting, he was able to show us what he knew.

Jackson

Jackson was trying out his new gait trainer in his mother’s kitchen. He was smiling and happy to be upright but struggling to move his legs. After practicing moving his legs with the PT’s help, we decided to wait him out to see what he could do. After looking at us like “why aren’t you helping me?” and watching as we encouraged him, Jackson dragged one toe forward, clearly attempting to walk. This step was the first of many.

One more example:

Devon

When Devon wanted to go outside, he would go to the door that led to the backyard and whine. He did this one day during a visit and his mother automatically got up to open the door. I hopped up too and we decided to use this as an opportunity to help Devon learn a word. Devon’s mother and I talked and she decided to teach him to say “out.” I suggested she move down to his eye level, prompt him for “out” by enunciating the word, pointing to her mouth, and pause with an expectant look on her face for him to imitate. She prompted him a few more times before he made an “o” with his mouth which we happily took as his attempt to say “out.” By the next visit, his mother had taught him to say “ow” instead of whining to go outside to play.

How to Use Pausing

Using pausing requires two things: patience and respect for a child’s efforts, whatever they look like. Pausing doesn’t always work the first time you try it. It usually requires that you teach the child what you expect him to do by repeating the routine, maybe using hand over hand prompting or verbal prompting, then fading out that support. Using the same 1-3 word prompts helps too so that the child associates your direction with what he’s learning to do. Some children can take up to 45 seconds to process what you say and respond so be patient. I don’t remember where I learned about waiting this long, but it worked well over the years, especially with children with more significant developmental needs. Some children will have shorter wait times, and you have to figure how how long to wait before they lose interest or become too frustrated, and before you or the parent provides help. Waiting until the child is completely upset is never effective, but pausing long enough that the child is motivate to act can work well. It’s a balance that you’ll figure out through trial and error.

Teach parents about pausing. It’s often easy to forget to pause and wait for the child to show you what he can do, especially in the busy-ness of everyday life. Learning to pause helps the parent create the expectation that the child will do something, whether it be look, make a sound, approximate a word, or move a body part. This expectation is critical to the development of independence, self-confidence, and communication. A simple pause can make a world of difference!

Do you have more examples of how you’ve used pausing with children? How do you teach parents about pausing? Share your ideas and examples by leaving a comment below. Be sure to follow the comments so you don’t miss out on other’s ideas!

The post Using Pausing to Encourage Development: Examples from Real Visits appeared first on Early Intervention Strategies for Success.

Early interventionists, physicians and nurses, child care providers, preschool teachers, home visitors, playgroup leaders, family members – you all have the power to help with early identification of autism spectrum disorder. Earlier identification is associated with earlier, appropriate intervention and better long-term positive outcomes for children. It is not an easy topic to discuss with families, and most of you are not able to make a diagnosis.

However, you can have the conversation. Here’s how:

Know the signs – Educate yourself on the early signs of autism spectrum disorder in infants and toddlers. Some early signs include: delays with social smiling; not responding when name is called; delays in communication (ie., delayed vocabulary, lack of joint attention, not using gestures, lack of turn-taking); repetitive behaviors; limited interests and play skills, etc. Read this article for a fantastic overview of prevalence, early signs, and evidence-based practices: Infants and Toddlers with Autism Spectrum Disorder: Early Identification and Early Intervention (PDF, New Window) (Boyd, Odom, Humphreys, & Sam, 2010).

Be honest and supportive – When a parent asks you the question “do you think my child has autism?” recognize this as an opening. While you may be wary to say “yes” because maybe you aren’t sure or maybe you are afraid, you can have an open, honest discussion with the parent. You can ask the parent what she knows about autism and why she is concerned about it. You can discuss the characteristics of ASD and reflect together on whether or not you and the parent seen similar behaviors in the child. You can talk about next steps – screening, a visit to the pediatrician, etc. You can talk about emotions and fears and help link the parent to people who can help. The video, Talking to Parents about Autism, from Autism Speaks, is a great resource to help you with the conversation.

Talk about the impact of early diagnosis and intervention – You can talk with the parent the significant link between early diagnosis and early, appropriate intervention. Talk about the link between early intervention and better long-term positive outcomes for academic and social-communication success. Do not pressure the parent; instead, share information and resources so that she can make the informed decision that is best for her child and her family.

Offer a screening – When a parent is concerned, any of you can offer to help the parent complete the M-CHAT. You can provide the parent with the url to the M-CHAT website where the parent can complete the screening online and review the results in private. You can link the parent to a local specialist for screening or further testing if she is ready for this step.

Coach the parent in how to use intervention strategies – Be sure that your sessions focus on what she can do to help her child learn to communicate and interact during daily routines when you are not in the home. Help her learn how she can make a difference in her child’s development. Autism is not hopeless. Help her see the impact she can have.

Link the parent to resources – Provide information about websites, books, support networks, professionals, and other parents who might be resources.  Find out about local community resources for autism interventions within and outside of the Part C system. Explore her family’s insurance to find out if it will pay for autism interventions. Share information in written form too so that the parent has it when she needs it.

Perhaps the hardest question is, “what if I am concerned but the parent hasn’t mentioned autism?” How do you bring it up? Look for that opening when discussing the child’s development. A parent of an older child with ASD once told me that the first person to bring up autism is never going to be someone you will like, meaning that it is natural to be angry with that first person. If you are going to be that first person, be sure to be sensitive and understand that talking about autism is an emotional experience. You can check out this handout, Concerns about Autism: Talking with Families (PDF, New Window), developed by the VA Community of Practice in Autism (CoPA) , that provides guidance on how to talk about autism with families when you have concerns.

Visit our Autism Spectrum Disorder page on the VA Early Intervention Professional Development Center site for links to online learning modules, free articles, and other resources that you and families can access.

Today is World Autism Awareness Day. Think about the role you can play in early identification.

How do you talk with families when you or they have a concern about autism? What do you say? What resources do you share?

The post Your Role in the Early Identification of Autism appeared first on Early Intervention Strategies for Success.

You’re on a first visit with the family of a toddler who is suspected of having an autism spectrum disorder (ASD). You greet the mother and try to say “hi” to the child, but he wanders away to continue his circuit around the room.  As you watch, he picks up toys and drops them, dances in front of the TV when a commercial comes on, then picks up his favorite car and drives it along the back of the couch. All the while he never responds to you and fleetingly looks at his mother who tells you that he loves his car game. So what do you do? How do you get him engaged?

Toddlers with ASD can have amazing strengths at entertaining themselves but find interacting with others very difficult. With a few tricks of the trade, you can pull the child in and help him learn that interacting is fun and useful. Sometimes it helps to out a strategy yourself, but always remember that the goal is to help him interact with his parents because they will be his partners during the week when you are not there!

Here are a few strategies to try:

Find Out What the Mother Would Do First

Ask the mother to tell you more about how the child plays and spends his time. Ask if she ever joins him in this game. Ask if she’ll show you how she would play with him. She might already know some great tricks to get him engaged so ask her before you jump in!

Start with Imitation

Pick up another car and drive it along the same path on the back of the couch. Just imitate him without demanding that he do anything. At first, you just want to help him get comfortable with you in his space.

Introduce “My Turn, Your Turn”

After he’s comfortable, introduce simple turn-taking by just using the words and pausing every so often for him to take a turn. He might not realize he’s taking a turn at first but that’s okay because you are teaching him. Put your hand in his path for your turn and say “my turn.” When he moves your hand or bumps you with his car, say “your turn” them move your hand. If he pushes his car off of the edge of the couch, you do the same thing to take your turn. You might catch his car as your turn then give it back to him so he can take his turn.

Keep It Going As Long As You Can

Keep the engagement and turn-taking going as long as you can to help him expand his abilities to interact and communicate. Be careful not to push him to becoming too upset and back off when you need to.  Let him take short breaks where you don’t interfere in his play. You won’t want engagement to be too stressful or he will avoid you or leave the area. Always try to bring him back to the game after a break or if needed, switch to another activity if you sense that he’s had enough of this one. Take it slow and try to make it fun!

Coach the Parent to Try the Strategies

If you can, START by explaining the strategies then ask the parent if she would like to try them out with your help. Gently coach her through what to do and praise her efforts. Point out when you see the child become engaged. Afterwards, ask the parent what she thought and which strategies she thinks she can use when you are not there.

What else would you do in this situation? What are your tricks of the trade for getting children engaged?  Share your best strategies!

The post Get Him Engaged! – 5 Strategies for Engaging Toddlers with ASD appeared first on Early Intervention Strategies for Success.