from Clinical Practice Guidelines from the ICDL

Valley CoPA (Community of Practice in Autism) – June 2008

Following The Child’s Lead The caregiver should follow the child’s emotional interests to engage him at his functional developmental level and challenge him to move to the next level. These spontaneous interactions in which the caregiver follows the child’s lead will often take on two qualities. First, the caregiver helps the child move in the direction that interests him by, for example, putting the ball the child is interested in on her head. The child may then take the ball off the caregiver’s head, thus being drawn into focusing on the caregiver and engaging in pleasurable relating and purposeful, two way communication.

Second, the caregiver can become playfully obstructive. For example, if the child perseveratively opens and closes doors, the caregiver could get “stuck” behind the door. This action leads the child to focus on the caregiver as he tries to push her away from the door, giggling as he succeeds— only to have the caregiver run back to the door again to resume the game. In this way, the caregiver facilitates focus and engagement. As the child purposefully tries to engineer moving the caregiver away from the door, intentional, two-way communication is facilitated. Eventually, complex problem-solving behaviors and even the use of words, such as “go” or “away” can be elaborated off of the child’s spontaneous, emotional interest in the door.

Semistructured, Problem-Solving Interactions

The caregiver should create learning challenges for the child to master. These may involve social, motor, sensory, spatial reasoning, language, and other cognitive skills. For example, if the goal is to help a child learn a new word, such as “open,” the caregiver might put the child’s favorite toy outside the door so that she would want to open it. The caregiver may then help the child imitate the word “open.” The child, in this way, is practicing gesturing and using words together. Imitating the sounds “ope” for “open” while opening the door also provides the child with immediate meaning. Tying the word to affect or intent (and meaning) facilitates generalization. This approach is in contrast, for example, to the child saying the word “open” in response to a picture card and only later trying to use the word in real life to solve a problem.

In addition to working on language and cognitive and social capacities, semistructured problem-solving interactions should focus on activities that enable the child to engage in (1) sensory modulation and motor - planning exercises, such as jumping on a trampoline or mattress, running, spinning, appropriate roughhousing with deep tactile pressure, and obstacle courses; (2) perceptualmotor exercises and looking and doing games, such as throwing and catching a big Nerf ball, kicking, and reaching for moving objects; and (3) visual-spatial exercises, such as treasure hunt games, hide-and-seek, and building complex structures from visual cues.

Semistructured, problem-solving activities also need to be geared to each child’s unique profile. When put into a problem-solving context with emotional intent, the following types of activities may also be included:

Peer Interaction

Peer play is especially important once the child has mastered preverbal problem-solving skills and is moving into the early stages of using ideas in a functional and spontaneous manner. The now-engaged, intentional, partially verbal, and imaginative child needs to practice his emerging skills not only with adults but also with other children who are at a similar or higher developmental age (i.e., the other children need to be interactive, somewhat verbal, and imaginative). However, the playmates need not be the same age as the child. For example, if the child is 4 1/2 years old, but has a functional, emotional developmental capacity of 3 years, he might prefer the company (and vice versa) of 3- year-old playmates.

At this point, individual, one-on-one play dates should occur four or more times per week for one hour or more. Initially, an adult may have to facilitate the interactions to help deter the children from drifting into parallel play. The adult may create a game to help the children work jointly, such as having both children hide together while the adult tries to find them. While following the children’s lead, the caregiver is also free to create games that facilitate interactions among the children. The goal is to help the children “rub shoulders” with each other and to communicate with gestures and words. The need for peer play occurs at about the same time that a child needs to be integrated, often with an aide, into a regular preschool program or into an ongoing inclusion or integrated program.