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Preschool Shadow Aide
How to shadow my child with autism at a typical
preschool
Preschool
Shadow Aide
How to
shadow my child with autism at a typical preschool
Y.S. Brobst, M.A. – a parent. Copyright 2001- 2003. All Rights Reserved.
Please do not print, reproduce or transfer
this written work by any means. Refer the reader to the website (http://home.san.rr.com/autismnet/preshadow.html)
because this paper is updated occasionally.
Autism is a lifelong neuro-developmental disorder that
presents itself with a triad of behaviors: impaired communication, impaired
socialization, and repetitive or stereotyped behaviors.
A typical preschool is probably the best place for a 4
year-old child with autism to model the behaviors of typical peers. However, each child with autism presents
a unique array of symptoms that fall within the autistic spectrum. The higher-functioning child with autism
who presents no major disruptive behaviors will have the best outcome in the
typical preschool setting, however with the help of a qualified shadow aide.
Choosing a shadow aide for my child was hard. Our qualifications for the shadow aide
included:
1)
At least a bachelors degree in psychology, speech,
education, or special education.
2)
Knowledge, experience, and skilled in behavior
modification or applied behavior analysis
3)
Experience working with children with autism
4)
Ability to pretend to be a peer
5)
Ability to pretend to be a class aide
6)
Ability to implement the techniques used by the speech/language
therapist, occupational therapist, vision therapist, psychologist, and other
specialists involved in providing special education supplemental services.
With the above qualifications, the parent or supervisor,
nonetheless needs to train and communicate frequently with the shadow aide. A
less qualified individual is acceptable but may require high self-motivation
for this person to learn the behavior modification techniques and about
autism. Otherwise, the parent will
simply be wasting their child’s precious time with a less qualified shadow
aide.
The Interview
1)
The parent or supervisor provides the individual
with materials to read in order to be successful at being a shadow aide for a
child with autism.
2)
The goals and objectives are set up based on the
needs and overall functioning of the child.
3)
The data sheets are provided to track progress and
behaviors.
4)
There is a discussion of what the child is like -
the current behaviors and functioning.
5)
There is also a discussion of what is being done outside
of the school (ABA Therapy) and the plans to generalize at the typical
preschool setting the skills learned during the home therapy.
First 2 Days on the Job
1)
Get a notebook, observe the child’s behaviors, and
record everything – behaviors, actions, verbatim language, interactions, etc.
2)
Also, observe the typical children, record what is
typical behavior, typical social interaction, typical verbal and non-verbal
communication. Observe the
extroverted and introverted children and record observations.
3)
After 2 days, analyze the behavior of the child
with autism and do a plan of action.
Summary from the 2 days of observations:
1)
This child has the ability to parallel play.
2)
This child has immediate echolalia and some delayed
echolalia.
3)
This child can interact with adults better than his
peers.
4)
This child cannot respond to questions asked of him
by adults. He has to be prompted for answers
5)
When peers attempt to interact with this child, he
looks at the peer briefly, attempts to say something but instead walks away.
6)
He perseverates on activities such as puzzles.
7)
He does not communicate his needs. He attempts to do things himself.
8)
He talks to himself often.
9)
He mouths his shoelaces, pencil erasers, etc.
10)
He chooses not to run around with his peers.
11)
He has fleeting eye contact.
12)
He sometimes refuses to join his peers at circle
time.
13)
He does not like to share toys with anyone.
Analysis from observations
1)
This child needs intensive language therapy.
2)
This child needs to learn turn-taking
3)
This child needs to learn social play with peers
4)
This child has a lot of problems, let’s handle them
one-at-a-time.
The definition of “shadow” from the Random House
Dictionary is “to follow (a person) about secretly in order to keep watch
over his or her movements.” Likewise,
the definition of “aide” from the same dictionary is “an official
assistant.” From the above
definition, one can surmise that a shadow aide is a person who follows
another child about secretly in order to keep watch over his or her behavior
and assist this child in achieving age-appropriate behavior. With this in mind, the author defines the
"shadowing process" as an iteration of behavior analysis, planning,
implementation, and review of results.
Repeat this process again and again until you reach favorable results
in behavior. This definition follows
the “Y.S. Brobst Principles of Being a Preschool Shadow Aide” which is a
unique way of approaching shadowing.
Many shadow aides are there to merely assist children with autism when
they run into trouble. This shadowing
process requires a lot more work, analysis, trials, staging of real-life
scenarios and achieving realistic goals.
Sometimes before a shadow aide can deal with the core of
the shadowing program (communication and socialization), she has to deal with
disruptive behaviors (or some stereotyped behaviors) such as:
1)
Hitting, screaming, crying, running away
2)
Making odd and inappropriate noises
3)
Making inappropriate body movements
4)
Not following directions
5)
Lack of self-help skills such as using the restroom
6)
Impulsive behavior such as running into the street,
leaving without telling anyone
7)
Not being able to sit still in circle or during
class
8)
Non-compliance, melt-down
If this is the case, it will benefit
the child to start out in a very structured and disciplined program to make
him aware of these disruptive behaviors and replace these behaviors with
acceptable ones such as use of appropriate language, etc. It is unfair to the typical class of children,
if a child is always disrupting learning in class. However, bear in mind that even though the child has mastered
appropriate behavior in a structured setting, the beginning days of typical
preschool inclusion may invoke disruptive behaviors. This is where the shadow
aide needs to analyze what is causing the disruptive behavior, determine what
happens after the behavior took place, and do a plan of action. Action may include some sensory
integration therapy, occupation therapy, behavior modification therapy, etc.
Once the disruptive behavior is
brought down to a minimum, start the communication and socialization
shadowing program at the typical preschool.
Please note that the role of the shadow aide at the typical preschool
is to teach the child with autism to independently socialize, communicate,
behave and perform in class at an age-appropriate level. Typical peers have disruptive
behaviors. What will differentiate the
child with autism from the typical peers are the behaviors due to the child’s
disability. The role of shadow aide
is not an easy job. If the sole role
of the shadow aide is to make the child behave, sit quietly in class, and
complete all the school work, then the aide’s work is completed in a few
days. There is more to sitting quietly,
doing the school work, and behaving nicely at a typical preschool. The child with autism needs intervention
for his impairment in socialization and communication, and
stereotyped/repetitive behaviors.
BEHAVIOR
ANALYSIS #1
My child’s first behaviors included sitting on the carpet
alone at the preschool classroom and playing with the same puzzles over and over again. There was no interaction with peers. A peer attempted interaction with him but he ignored the peer.
Based on the above behaviors, devise a plan of action and
implement. For example,
PLAN A- Have a
peer sit with the child with autism and play the puzzles with him.
Results of implementation: The child with autism screams obviously protesting to not want
to share the puzzles with the peer.
(FAILED implementation)
Based on the above behaviors, devise another plan of
action and implement.
PLAN B – Practice parallel play first with a peer
Results – A typical peer is prompted to parallel play with
the child with autism. This child
with autism stands up and walks away.
(FAILED implementation)
Based on the above behaviors, devise a plan of action and
implement.
PLAN C – Shadow aide sits with the child with autism and
parallel plays.
Results – The child with autism stands up and walks away.
(FAILED implementation)
PLAN D – Shadow walks around the child with autism who is
playing by himself. She sits down
with him for 5 seconds and parallel plays, after which the shadow stands up
and walks away.
Results – The child with autism parallel plays with the
shadow for 5 seconds. (SUCCESSFUL implementation)
PLAN E – Shadow walks around the child with autism who is
playing by himself. She sits down with him for 10 seconds and parallel plays,
after which the shadow stands up and walks away.
Results – The child with autism parallel plays with the
shadow for 10 seconds. (SUCCESSFUL implementation)
PLAN F – Shadow walks around the child with autism who is
playing by himself. She sits down
with him for 15 seconds and parallel plays, after which the shadow stands up
and walks away.
Results – The child with autism parallel plays with the
shadow for 15 seconds. (SUCCESSFUL implementation)
PLAN G – Shadow walks around the child with autism who is
playing by himself. She sits down
with him indefinitely and parallel plays.
Results – The child with autism parallel plays with the
shadow indefinitely. (SUCCESSFUL implementation)
SOCIALIZATION and PLAYING ALONE ANALYSIS:
Many people will argue as to why one would “force” a child
who would rather be alone to play or socialize with others. At what point will the shadow aide
determine that this child with autism wants to be left alone or that his lack
of socialization and play with peers is a result of his disability. Shadow aide analyzes the situation. The child with autism above prefers to
play with the puzzles over and over again because this is what his body and
brain can do comfortably. The child
with autism prefers to be alone because this is what his body and senses can
handle. Why not “teach” this child to
do something else? Socialization does
not come easy to this child with autism.
All the very basic aspects of socialization have to be taught
step-by-step. Just as math may come
easy to some children, others may have trouble with it and need to be tutored
step-by-step.
BLIND SHADOW AIDE OR NOT:
The question arises as to whether or not the shadow aide
should be blind to the child with autism.
Choosing an aide who is blind to the child may be a good approach for
this child with autism. This means
that the child will not know that he has a personal aide. The aide will pretend to assist the other
children in class while keeping an eye on the child with autism. The only reason why his home therapists
would act as shadows at school is to give him the motivation and confidence
to transfer his newly acquired skills at the school setting. In this respect, the shadow aide is acting
as the child’s coach. Once he masters
the skill at school, then lean towards switching to a blind shadow aide for
the child to test his independence in using acquired skills.
BEHAVIOR
ANALYSIS #2
My child can now parallel play with the shadow aide. The shadow attempts to touch the puzzle he
is building. The child screams and protests “No!” The shadow analyzes this behavior. Why? She touches the
puzzle again which results in the same screaming and protesting
behavior. The shadow says to the
child, “Why? It’s okay, I am just touching it. See?” Child protests and cannot verbalize as to
why. The shadow puts herself in the
child’s position. Why would she not
want anybody to touch her puzzle? Oh,
because I am building it and I don’t want anybody to mess it up. The child perseverates on the puzzle all
day – building the puzzle, when done, shuffling it, then building it again
and again and again.
PLAN A – Shadow aide makes the puzzles inaccessible and
will observe what the child will do.
Please note that many preschool teachers exercise boundaries on their
students. For free play, they only
allow certain activities for children to do while other activities cannot be
accessed. This teaches the children
boundaries and following the rules. Please
coordinate with the preschool teacher if a certain activity will be inaccessible
to the class.
Results – The child with autism would not join the typical
peers in building the blocks nor would not play with the typical peers in the
pretend center. He just stands
around. Shadow tells the child to go
play with the blocks. The child
screams, “No! Leave me alone!” The
shadow holds his hand to walk him to the blocks. The child starts screaming and protesting. Everyone in the preschool room is
disrupted. (FAILED implementation)
PLAN B – Shadow still has all the puzzles inaccessible and
will observe what the child will do.
Then she brings the blocks to the child and attempts to parallel play
with him.
Results – The child plays with the blocks by himself. The shadow sits by him and watches, then
she starts to play with her own blocks.
The child continues to parallel play with the shadow aide. The shadow talks to the child. The child responds with echolalia and
continues to parallel play.
(SUCCESSFUL implementation)
BEHAVIOR
ANALYSIS #3
Shadow wants to find out if the child with autism chooses
to parallel play with typical peers.
Outside, there is a big sandbox.
She directs the child to sandbox and the child says, “No!” The child chooses to ride the tricycle.
PLAN A – Shadow tells the teacher to tell the class or the
child with autism next time that the tricycles are not available
outside. They can either go to the
sandbox or play ball.
Results – The child with autism chooses the sandbox and
parallel plays with the typical peers.
(SUCCESSFUL implementation)
DATA LOG RECORDING:
Shadow aide reports the following in the data log.
1)
Non-compliant – says “No!” all the time. Need additional intervention on this (i.e.
social stories)
2)
Has trouble with cooperative play. Need to model to him what cooperative play
is all about. This child seems to
have the receptive language skills to understand directions.
3)
Practice on parallel play more. Parallel play with an adult first, then
peer, then group of peers.
PLAY WITH PEERS ANALYSIS:
Shadow aide observes and analyzes the play skills of the
typical peers. Here are two
children. One has a language barrier
and can hardly speak English and the other one is quite shy. But yet, without too much language
exchange, these two children are playing and interacting with each
other. How can they do this? Why is it so easy for those two children
to socialize? Why is it so unattainable
for this child with autism to do what they can do? Shadow aide observes the typical children social behavior. One thing that she notices is that these
typical children use of their eye contact along with their facial expressions
to communicate messages to each other.
Looking somebody in the eye establishes a connection, an emotional
connection. Many psychologists today
who deal with autism argue that eye contact is not important as it used to be
because many adults talk without making eye contact, anyhow. The author disagrees because this child
with autism needs at least the very basic eye contact to establish an
emotional connection with others.
When someone walks by, a typical child would look up and look at that
person’s eyes. This may mean nothing
to typical people but it means a lot for this child with autism in order to
establish the connection with others.
What about the children who are blind? How can they establish a connection without the eye
contact? These blind children have
the functional language to socialize.
Their other senses and physical being are functioning properly to want
to be with others. Unfortunately,
this child with autism does not have the functional language to
socialize. There are also some
sensory integration issues in which his body cannot properly process the
environment around him. So how do you
teach this child with autism to establish eye contact? It is more than a “Look at me, look at my
eyes” program therapy. It’s about an
emotional connection and non-verbal communications therapy.
BEHAVIOR
ANALYSIS #4
Shadow aide steps back and observes the behavior of the
child with autism from behind the bushes.
Is the child able to parallel play without prompting? It looks miserable. The child stands at the perimeter of the
walls and is contented with walking around while touching the walls.
PLAN A – Shadow walks up to the child with autism and
says, “Hi, do you want to play?” If
he says yes, then great. If he says no, then shadow aide sits next to child
and pretends she is having fun with the toy, while tempting the child to play
with her.
Results – The child continues to walk around the perimeter
of the wall and ignores the shadow.
(FAILED implementation)
The shadow aide thinks hard. The wall is more reinforcing for him than this toy. She has to find something that is more
reinforcing than the wall.
PLAN B – Shadow aide picks up a few of the playground wood
chips, walks up to the child with autism and says, “Look, these little barks
are like puzzles. Puzzles. I’ll show you.” Shadow sits down and plays with the barks that looked like
little puzzle pieces.
Results – The child hears the word “puzzles” and becomes
curious. He sits down with the shadow
while they play with the barks.
(SUCCESSFUL implementation.)
BEHAVIOR
ANALYSIS #5
PLAN A - After a while, other typical peers are curious as
to what is going on and they wish to join in. The shadow aide gives them their own set of barks to play with
after which she stands up, moves away and observes the play.
Results – The child was able to tolerate the parallel
playing with the peers. (SUCCESSFUL implementation.)
The shadow notices that a peer tries to interact with the
child with autism. The peer says, “I
am making a building now, what are you making?” The child with autism looks quickly at the peer, attempts to
say something but decides to stand up and walk away as if he cannot handle
the interaction or does not know how to reply.
The shadow analyzes the situation. Is it sensory or is it the language
deficit? If he has the language, will
he be able to respond to him?
DATA LOG REPORT
1)
The child can parallel play with a typical
peer. When the peer starts talking,
he walks away. What happens when the
typical peer doesn’t talk and just does non-verbal communication
(gestures)? Will this child with
autism walk away?
OVERALL ANALYSIS:
1)
COMPLIANCE: Why is it so hard to have this child
comply with the shadow aide in a typical environment? First off, the regular preschool teacher
actually treats this child like any other typical child – meaning no “special”
treatment which is what we want. However, this means that he does not get any more attention than
any other child. Is this child
asserting his independence from the aide?
Or does the child with autism feel like this aide is just bugging him
all the time? Just leave him
alone? Compliance is never really a
problem in a special class setting or special program setting with special
needs kids. For one thing, the
special class setting and the special program setting are much more
structured and all the children given the behavior problems are cited by the
teacher and aides at some point. In the typical setting, he probably feels
that he is the only one who is required to do all these things. Exercise some informal and fun compliance
testing with the child. If the child
says no, then that might mean that he feels he is the only one being required
to follow all the instructions from the shadow aide. Shadow aide has to pretend that she is
aiding everyone.
2)
LANGUAGE:
This child obviously has delayed expressive language. He tries to talk but can’t. He tries to put words together but ends up
with delayed echolalia or out of context language – language that does not
relate to the situation. When asked a
question, he responds by repeating the last few words of the question. The ABA therapy home program needs to
increase one-on-one therapy on language development.
3)
PLAY: This
child seems to have the ability to play parallel with another peer as long as
there is no conversation (talking) involved in the play. He does not know how to initiate play nor
join in play.
4)
SOCIALIZATION:
This child has no clue on how to initiate socialization nor join in
socialization.
5)
STRESS:
This child has stress-related behaviors such as immediate echolalia,
mouthing objects, scratching body, and fidgeting in his seat.
6)
SENSORY: This child has sensory issues because of
poor eye contact. He chooses to walk
around the perimeter of the walls because of sensory overload. Possible auditory and visual sensory
issues.
The big question is:
Is this child ready for typical preschool inclusion? Examine the ABA
(applied behavior analysis) home therapy.
This child needs to master skills using child-to-adult therapy,
child-to-peer therapy, child-to-two peers therapy, child-to-small peer group
therapy, and child-to-large peer group therapy. All peers must be typical in order to model correct social
behavior.
NON-COMPLIANCE ANALYSIS:
Frequently, most ABA therapists and shadow aide therapists
will complain that the child with autism has non-compliance issues while the
parents or even the school teacher say otherwise. Most typical children have
non-compliance issues ranging from refusal to brush their teeth, do homework,
sit down to eat dinner, etc. Another example is when a mother requests (or
demands) a typical child to help clean up the mess. Most often the typical
child will either ignore the first request and it may take a good number of
repeating the request (or demand) for the child to comply. Some typical
children are furtive enough to think up of a number of excuses as to why they
could not possibly clean up the mess.
In this light, the role of the shadow aide in analyzing non-compliance
behavior is to determine if this behavior is merely typical child
non-compliance behavior such as refusal to do the task because of being lazy,
putting the task at low priority, etc. or if non-compliance is the resulting
effect of his disability in which the child with autism may not possess the
skill, confidence and motivation to follow the request. An example of a non-compliance behavior
for a child with autism is as follows.
The shadow aide requests the child to “Go find a friend and
play.” The child either ignores the
shadow aide or screams “No!” Before
the shadow aide can conclude that this child is disobedient, the shadow has
to analyze why playing alone is much more motivating for this child than
playing with a friend. More often
than the author sees, shadow aides and therapists dismiss the resulting
non-compliance as the child being undisciplined and manipulative. With this,
the child’s behavior then progress into a power struggle with the shadow
aide. Yes, this particular child with
autism can recognize the methods of manipulating himself out of the situation
that he cannot carry out. And this is
what makes it hard for the shadow aide to analyze non-compliance behavior.
The resulting negative consequences given to a non-compliant child with
autism are usually time-out, withholding a preferred item, extinction, etc.,
or yet ignoring that the non-compliance behavior ever took place. The shadow
aide may not realize that when the parent or teacher requests this child with
autism to “Get the pencil at that table.” “Throw this paper in the trash
can.” “Put that book away.”, this
child is remarkably compliant because he can do these things with very little
effort. A better approach is for the
shadow aide to analyze why this child with autism prefers not to play with a
peer. Perhaps, this child has no skills
in initiating play with a peer and needs to be taught. Perhaps, this child has
sensory issues and has difficulty processing the environment considering the
surrounding noise of other children when he approaches a peer. Perhaps, this child is afraid of failure
because he understands that he can’t keep up with the peer once play has
started. Before dragging this child
by his hand so he can play or before presenting him with negative
consequences, the shadow aide has to determine how to present playing with a
peer to be more motivating than playing by himself. One intervention is to teach this child the “prerequisite”
skills needed to play with a peer after which the learned or mastered skills
are generalized in the school environment.
If the child has learned and mastered the play skills in a controlled
environment and is still non-compliant in the school setting, then this may
simply indicate that he may not have the confidence and motivation to
transfer them to this environment or perhaps there are unknown sensory issues
affecting the generalization of skills. In this light, continue to analyze
the child’s behavior. The key is to
make each small step towards play with a peer a success for the child. Gradual success can propagate into one big
success.
MOTIVATION:
Motivation is a problem for this child with autism. How
does the shadow aide give this child the motivation to interact or socialize
with other children? For most days,
the aide may feel like this child with autism is a hopeless case. This child will never socialize and does
not have any “will” to socialize at all. He is in his own world – period and
he wants to be. The last thing that
is needed is a shadow aide who rolls up her eyes and dismisses herself to
whatever the child wishes to do.
First of all, the shadow aide has to study the art of motivating. What motivates a person to do
something? Reinforcement - positive
or negative, prizes, rewards, high-fives, social reinforcers, etc., no doubt
may play as a solution to the problem.
The difficult part may be finding the right reinforcer in order for
the child to perform the requested task.
The key again is to start slow and to reinforce each minute
success. For example, if the child
with autism said “Bah!”, the shadow aide should reinforce him by saying,
“Hey, thanks for trying to say something. Tell me more. Give me five.”
instead of “Yes, what are you trying
to say? I can’t understand you.”
LANGUAGE ANALYSIS:
During the home therapy, the child with autism is able to
speak 3-4 word sentences with the ABA therapist. The child is also able to communicate with his parents.
However, he can barely communicate with his siblings, a playdate or
playmate. His language is out of
context when he is exposed to a group a children and echolalic when exposed
with adults. At the typical
preschool, this child with autism is almost mute or non-verbal. Analysis suggests that he has not
generalized his language skills beyond the home nor beyond the
therapists. He needs the
self-confidence and motivation to respond to the adults at the typical
preschool. He is, however able to
respond fairly to his shadow aide at the typical preschool. Shadow aide has to devise some means to
generalize at the typical preschool the learned skills from the home therapy.
ECHOLALIA:
Echolalia is a behavior in which a child with autism
repeats (echoes) what the other person says. For example, this special child
is asked by an adult, “Where should these toys go?” Rather than answering the question, the child responds with
“Where should these toys go?” or he
responds by repeating the last part of the question, “These toys go.” To a parent, this is an extremely baffling
behavior. And as one can see, this
special child often displays echolalic tendencies at the preschool. The shadow aide analyzes this behavior as
to when it occurs the most. It
appears to occur the most when the child is under stress of being questioned
or during novel situations. For the
most part, the home therapy is pursuing the child’s goal to achieve
“functional” language which will
eventually replace echolalia. At
this point, this special child’s language is mostly declarative such as
“You’re a man.” “Lettuce is a vegetable.”
Functional language is needed to make this child communicate with
others effectively. The role of the shadow
aide is to let the home therapists know that echolalia is a problem in the
school setting at various scenarios.
The child may not exhibit echolalia at home at all, however the
therapists need to employ some interventions to move this new skill (functional
language) beyond the home by exposing the child to novel environments such as
a public playground, etc. Role-modeling and practice in answering questions
outside of the preschool will help the child prepare for novel situations
(questions and iteractions) at the preschool. Also, stress-management techniques need to be employed to
reduce echolalia. There is one
technique that could replace echolalia temporarily. Taken from Koegel’s
method of saying “I don’t know.” instead of repeating the question is a more
acceptable social response until the child achieves functional language and
stress-management techniques to respond appropriately in novel situations.
TEACHER SURVEY
This PDD School Survey can be administered to the
teacher(s) or teacher aides who work with the child in order to pinpoint the
symptoms of the disorder (from a casual observer’s point of view) and to
prepare a game plan for reducing or possibly eliminating the autistic
tendencies. This survey must be
administered at least after one month of school or whenever the teacher is
comfortable with rating the child with autism.
PDD SCHOOL SURVEY - CONFIDENTIAL –
Survey Adapted from the DSM-IV Criteria, PDD --- Survey Copyright 2000 Y.S. Brobst
STUDENT:
____________________________________ SCHOOL: _________________________
TEACHER:
____________________________________ DATE TODAY:
_____________________
Please answer with Y (Yes) or N (No) on the following
survey of this student. Additional
comments can be written at the back of this page. Thank you so much for your time.
______ 1) Qualitative impairment in social
interaction
_____ (a) marked impairment in the use of
multiple nonverbal behaviors
(Please check the
impairment below)
_____ eye-to- eye gaze
_____ facial expression
_____ body postures
_____ gestures to regulate social interaction
_____ (b) failure to develop peer
relationships appropriate to developmental level
_____ (c) a lack of spontaneous seeking to
share enjoyment, interests, or achievements with other people
Please check the following
that applies:
_____ lack of showing objects of interest to you
_____ lack of bringing objects of interest to you
_____ lack of pointing out objects of interest to you
_____ (d) lack of
social or emotional reciprocity
Please check the following that applies:
_____ lack of reciprocating
greetings
_____ lack of reciprocating
joy
_____ lack of reciprocating
other emotions such as ______________
______ (2) Qualitative impairments in communication
______ (a) delay in,
or total lack of, the development of spoken language (not accompanied by an
attempt to compensate through alternative modes of communication such as
gesture or mime) - Spoken language is
estimated at the level of a ________ year old.
______ (b) marked
impairment in the ability to initiate or sustain a conversation with others
______ (c) stereotyped
and repetitive use of language or idiosyncratic language
Please check the following that applies:
_____ Echoing the words of
others (all or last few words of the sentence)
_____ Use of language that
is out of context
______ (d) lack of
varied, spontaneous make-believe play or social imitative play appropriate to
developmental level - (Examples if
any _____________________________________________)
______ (3) restricted, repetitive, and stereotyped
patterns of behavior, interests, and activities
_______ (a)
encompassing preoccupation with one or more stereotyped and restricted
patterns of interest that is abnormal either in intensity or focus
Please check the following that applies:
______ Abnormal intensity of
focus on art projects
______ Abnormal intensity of
focus on other interests such as _____________
_______ (b) apparently inflexible adherence to
specific, nonfunctional routines or rituals
Please check the following that applies:
______ Inflexible to change
in routines (ex. Go this way, etc.,)
______
Inflexible to change in routines (other examples __________________)
_______ (c) stereotyped
and repetitive motor mannerisms (e.g., hand or finger flapping or twisting or
complex whole-body movements)
_______ (d) persistent
precoccupation with parts of objects
Please check the following that applies:
______ Persistent
pre-occupation with parts of cars, etc. ___________
______ Persistent
pre-occupation with parts of other objects such as _________
BASIC ASPECTS OF SOCIALIZATION
One might wonder why it is essential for the shadow aide
to observe typical children and record typical behavior, typical social
interaction, typical verbal and non-verbal communication. This is because it is crucial to have a
basis for coaching socialization and communication.
For example in this first scenario, here are two typical
children sitting next to each other in the sandy playground. No activity nor
socialization between the two children are taking place. A few moments later,
Child A starts to scoop up sand and builds a small hill of sand. Child B looks over, grabs a shovel, picks
up sand with the shovel and pours it over on the small hill that Child A
created. Child B glances at Child A
and vice-versa. Then Child A proceeds
to pour more sand on the same hill after which Child B takes his turn. They do this activity without fighting and
without words, merely actions. This is called cooperative play. The two typical children are
turn-taking. It is an amazing sight
to see when these children play cooperatively without words.
Now, let’s look at the second scenario of our special
child with autism and the typical Child sitting next to each other in the
sandy playground. Typical child
starts to scoop up sand and builds a small hill. This introduces an opportunity for the special child to join in
play by pouring sand over the small hill that typical child built. After prompting, special child pours his
sand on the small hill exactly like Child B in the first scenario above. Seconds later, typical child gets very
upset at the special child. Why? The shadow aide is baffled. The two groups of children did exactly the
same thing- they both poured sand on the hill with the same amount of
sand. What was different?
As one can see, in the first scenario, when typical Child
A and typical Child B were busy taking turns during the sand activity, subtle
social cues were being communicated with each other. When Child B poured the sand on the small
hill, he quickly glanced at Child A for his reaction, while letting out a shy
smile. Child A smiled back and read the
cues of Child B, after which Child A took his turn to pour his sand on the shared
hill. Afterwards, Child A paused for
a moment and made eye contact with Child B as cue that it was Child B’s turn
to pour sand over the hill.
In the second scenario, special child with autism poured
the sand on the small hill without making eye contact and with zero social
cues. The typical child was
desperately trying to read the cues of the special child to determine his
intentions for pouring the sand on the typical child’s hill. Because the typical child could not read
special child’s intentions as he looked at him, he thought that special child
did not ask for permission first to pour over sand on the hill. The typical
child rightfully became upset. Isn’t it beyond belief that typical children
can ask for permission to join in play using merely their actions and eye
contact?
How do you teach a special child with autism to do such a
complex task? Luckily, this child
with autism responds to modeling and role-playing techniques of
teaching. The same scenario was
recreated over and over again to the child outside of the preschool, while
painstakingly teaching him the very basic aspects of socialization and
relationship development. It is not
an easy task because before one can recreate the scenario, there are several
prerequisites. The very basic eye
contact needs to be taught. The
development of relationships and emotions need to be taught. The awareness of
environment and non-verbal cues need to be taught. This exercise becomes a process of taking the top level of
social activity then breaking it down to several branches, and those branches
are then broken down to other branches, until a number of discrete activities
at the lowest level of the branches are reached. Subsequently, the branches in the lowest level can no longer be
broken down further. Therefore, the
activities at the lowest level are where one can begin coaching the
child. Breaking down these tasks to
their lowest level is also quite complicated. Furthermore, mastering one
discrete task may require different types of exercises that match the unique
needs of the child.
For example, to achieve the very basic eye contact one may
have to perform several exercises to achieve this. Establishing the very basic eye contact continues to be an
ongoing exercise for this child with autism.
This is because his hypotonia or low muscle tone is affecting the
ability of the eyes to move, track and focus. Examples of eye contact drills are as follows:
1)
Classic “Look at me” program
2)
Peekaboo program
3)
Follow the picture at the end of the moving
Popsicle stick for eye tracking exercises and other eye tracking exercises.
4)
Look at my eyes while the child moves his head from
left to right, right to left, up and down, down and up, etc.
5)
Look at my eyes while I slowly move around.
6)
“Look at my eyes because you care where I am at”
program
7)
“Look at my eyes because you are making sure I am
paying attention” program
8)
Emotions program, after which look at my eyes and
determine my emotions
9)
Staring contest
10)
“I am being funny and silly, so look at me” program
11)
And several
others
Sample Role-Playing of the sand scenario:
1)
First exercise:
Adult pours sand on a hill.
Then prompt by asking the child with autism to pour his sand on the
same hill. After that, the adult
takes a turn. Then child takes his
turn. Repeat this until child masters
this type of turn-taking. Note that
the child may not make eye contact or read the cues of the adult. The only cue that he is reading is that
the adult finished pouring the sand and that it was his turn. In this exercise, the child is learning
turn-taking.
2)
Second exercise.
Instruct the child that he needs to watch the adult pour the sand
first on the hill, after which he takes a turn, then adult takes a turn. In other words, the adult will not prompt
the child to take a turn. In this
exercise, the child does not make eye contact, however concentrates on the
cue of the adult pouring the sand on the hill “for the very first time”. At that time, he joins in and takes a
turn. In this exercise, the child is learning joining in play and taking
turns.
3)
Third exercise:
Instruct the child that he needs to look at the adult’s eyes first
before he takes a turn to pour the sand on the hill. In other words, the adult will pour the
sand on the hill, the child will look at the adult, after which she will
allow him to join in. Role-playing:
Adult pours sand on the hill. The child attempts to join in without eye
contact and the adult pretends to get mad.
Adult pours sand on the hill again.
Child tries again with eye contact after which the adult lets him join
in play and they take turns. The
child is learning that he has to make eye contact as a gesture to ask for
permission from adult to join in play.
4)
Fourth exercise:
Instruct the child that he needs to read the face of the adult first
before he takes a turn to pour the sand on the hill. Role-playing 1: Adult pours sand on the hill. Child makes eye contact with
adult. Adult makes a mad face. Child does not join in. Role-Playing 2: Adult pours sand on the
hill. Child makes eye contact with adult.
Adult smiles. Child joins in
and they take turns. In this
exercise, the child is learning to read emotions as cue to determine if he
has permission to join in play.
Reading social cues is the most difficult part of the exercise and the
hardest to generalize. After
successfully implementing this exercise, the adult and child may role-play
several variations of this scenario by adding other types of social cues.
As one can see, the techniques used here are practically
similar to learning to play a sport
or a musical instrument for the very first time. When an individual learns to play a sport or a musical
instrument for the first time, the person has to initially learn the basic
skills of the sport or playing the instrument through simple drill exercises
and repetition until mastery.
JOINT ATTENTION
Joint attention is the ability of the child with autism to
have shared attention with others.
For example, if a typical child riding in a car sees a tractor out in
the road, the normal response would be, “Look, Mom! A tractor! Look!”
This means that the child is seeing something and that he wants to
share what he sees with another person.
As one can guess, this child with autism does not do this at all. He may see a million interesting things
but will never share what he sees with any person. However, there is one thing that this child will share with an
adult. His finished art projects and
completed desk work are important enough to warrant some adult’s attention. This is a good start because this means
that this child has the ability to share attention, he merely needs to be
taught how to do it in various settings.
Interesting enough, when the shadow aide pretends to be a
class aide, she may find that many children come up to her and say, “Watch
me!” or “Look at what I can do!”
These typical children are yearning for the attention of others
because of what they can perform physically.
They do this with fellow peers almost all the time. As one can deduce
again, the child with autism does not have the ability to show off his
physical abilities. “Why is that?”,
the shadow aide may ask. Perhaps, the
child with autism thinks that nobody cares even though he tried to share his
attention with others. Or perhaps,
the child with autism never thought that someone will actually think that it
is “neat” to see what he can see, or see what he can physically do. And perhaps, the child with autism does
not know that people actually do this – show off.
Consequently, how will the shadow aide teach this child
joint attention. The techniques are
very similar to the one described above for the very basic aspects of
socialization. Joint attention may be modeled, role-played and taught outside
of the preschool first. But one may wonder why this is very important to
teach. This is because joint
attention is part of the emotional connection and the development of
relationships. One technique used to
teach the joint attention drill for “Look at what I can do” is by modeling,
coaching, and role-playing.
Example: Shadow aide kicks her leg up.
She says to the child with autism, “Look at what I can do!” Child with autism watches the aide. The shadow then prompts the child, “What
can you do? I bet you can do this,
too?” The child with autism attempts
to kick his leg up. Shadow then
prompts him to say, “Watch me!” while
he kicks his leg up. Subsequently, she gives the child a short lecture that
whenever he can do something, it is okay to show it to somebody and say “Hey,
<peer>. Watch me!” Shadow then
proceeds to role-play with him by saying, “Okay, let’s pretend I am standing
here and you want to show me what you can do. What do you do?” Child
with autism says, “Watch me! I can do this!” then proceeds to jump from the
stool. This is a successful
implementation for the shadow aide.
However, another problem surfaced.
What if the shadow aide is not paying attention. How can the child with autism assure that
the other person is paying attention?
Another modeling, coaching, and role-playing for this drill need to be
implemented. As one can see, each
minute aspect of socialization has to be taught for this child with autism. This takes a great deal of effort and time
but the results are certainly rewarding even if it takes years to teach
these. Unfortunately for this child
with autism, simply having him around typical children or having typical
children reverse mainstreamed into his environment does not totally teach him
the subtleties of socialization. It
may teach him good behavior through modeling, however every aspect of the
socialization still needed to be taught.
It is unfortunate that for this child with autism, there are no
short-cuts such as putting him in a roomful of typical children and letting
him go and figure out socialization by himself with a few pull-outs for
speech therapy. | 
