Encouraging Connections Between Parents and Children With Autism During an April online conference, early intervention expert Juliann J. Woods chatted with participants about how to encourage interactions between parents and their children with autism spectrum disorder. The Leader was listening. Overheard
Overheard  |   June 01, 2014
Encouraging Connections Between Parents and Children With Autism
Author Notes
  • Juliann J. Woods, PhD, CCC-SLP, is director of the Communication and Early Childhood Research and Practice Center, professor in the School of Communication Science and Disorders, and associate dean of research in the College of Communication and Information at Florida State University, Tallahassee. She is an affiliate of ASHA Special Interest Groups 1, Language Learning and Education; and 16, School-Based Issues. jwoods@fsu.edu
    Juliann J. Woods, PhD, CCC-SLP, is director of the Communication and Early Childhood Research and Practice Center, professor in the School of Communication Science and Disorders, and associate dean of research in the College of Communication and Information at Florida State University, Tallahassee. She is an affiliate of ASHA Special Interest Groups 1, Language Learning and Education; and 16, School-Based Issues. jwoods@fsu.edu×
Article Information
Special Populations / Autism Spectrum / Early Identification & Intervention / School-Based Settings / Overheard
Overheard   |   June 01, 2014
Encouraging Connections Between Parents and Children With Autism
The ASHA Leader, June 2014, Vol. 19, online only. doi:10.1044/leader.OV.19062014.np
The ASHA Leader, June 2014, Vol. 19, online only. doi:10.1044/leader.OV.19062014.np
It’s crucial for parents to support their children’s communication development by engaging them in everyday routines and activities—and embedding interventions in them, Woods said in her conference session. She presented young “Nathan” and his family as a case study on how to help parents and children with autism better interact by incorporating coaching and feedback into treatment.
Juliann J. Woods: The Early Social Interaction project and our work at Florida State University have been with toddlers. I will share the work we have been doing with later preschool and kindergarten. It is very important to keep the parent involved through transitions. I think too often we take the kids to school and the parents are left out of the decision-making. Including them in the types of routines that they do at home and supporting them at school are very important. Think about Nathan and his family. They love the library and music—those are age-span activities and could be included in school-age interventions, too. Nathan’s older sister is working with our support now to use an iPad in the city library. I think if we look at what families want to do and support them there, it is a win-win. We can work on our goals and they get to benefit by not being isolated at home, as well as having generalization activities for the child in the community.
Beatrice Fargnoli: When is feedback given during collaborative coaching sessions? Is it given as the interactions are occurring or after?
Woods: We give feedback two different ways—within and after—depending on how well the interaction is going. We will give feedback within if it is needed to improve the opportunities for the child or to support the parent’s success immediately. However, if everything is going well, we try not to interrupt and offer feedback in the form of reflective questions or comments afterward to support a deeper understanding by the parent of what’s happening in the interaction.
Susan Cassell: How do you feel about siblings participating in home-based therapy?
Woods: Love those siblings. Some of the best and most cost-effective interventionists ever. Let’s be honest: They are there all the time—or at least most of it—and so supporting the parents to engage with them in certain routines and activities is only functional and meaningful. But there are times for specific acquisition of targets by the child with ASD that the sibling may interfere with, and then other options are important. Siblings may be able to learn a variety of simple strategies to use to support their brother or sister, so we look specifically for those and try to get them going—in addition to the individualized work with the parent(s). The child with ASD is likely to need focused attention to some targets.
Jennifer Kemp: Your ESI program is designed for toddlers. Are you planning to create a program for older children with ASD who were diagnosed later in life and need to work on joint attention and social communication?
Woods: Right now, the Classroom SCERTS Intervention project is undergoing a multi-site randomized control trial research study. It is not with parents but rather with teachers in school settings, but it uses many of the same principles. We were “grant opportunity” shopping today, looking for funds to support parents of older children, 3–8, to do an ESI-type approach, but so far haven’t found a funding agency. We want to.
Simone Reilly: How would you go about facilitating parent-child interaction in grade school? Any thoughts on how curriculum standards are changing and the impact on the parent-child dynamics?
Woods: First, we need to make sure parent-child interaction is a priority for all grades. Parents continue to need support for social communication outcomes. I do not believe the curriculum standards need to interfere with interactions. I worry that the stress of success in testing can add to the already complex life events for families. So all efforts to keep families communicating about routines and activities that are important and relevant to them will be helpful. I encourage you to read the Lucinda Bernheimer article I referenced (bit.ly/bernheimer) about adults of families and the importance of routines.
Judy Edberg: Most of the examples in your presentation seemed to address working with parents in an early intervention setting. Do you have some suggestions on how to get parents on board for school? The situation that we often encounter is the desire of the parents to have their child in class during academic time, even though their child is only acting as an observer due to the mismatch between the child’s skill level and the class content. When asked for examples of their child learning from other children, the parent cites examples of physical movement activities, an area we want to be able to spend more time on as part of this student’s program. There seems to be a disconnect between how they observe their child learning in social situations at home and their perspective [or] interpretation of how their child will learn from peers at school. Can you offer some suggestions?
Woods: I believe in listening to parents and hearing what they believe is important. Friends are key to life after school. I would approach this with one of my most preferred evidence-based interventions, peer-mediated intervention. Teach the competent peers to support the child with ASD’s learning. I realize that was a short answer for a complex and very important question. I do believe in families and their voice.
Linda Cummings: If a child is older—say 5 to 6 years old—and is non-verbal with object-oriented play skills and is interacting very little with the people around him, and the parent(s) expresses interest in wanting to work with their child at home … could I use this tack with mom, e.g. listening to what she wants and building communicative opportunities into those routines?
Woods: Absolutely! I would start with people-oriented routines and preferred play and social interactions. Get the objects out of the picture, at least to get started. Look at what they do in dressing, hair care, music in the car to school. The objects are not functional and meaningful but the routines without objects can be. They occur throughout the day and will benefit the student at home and school.
Risa Radeke: In my experience, some parents do not seem to have the motivation or state that they do not have the time to be active participants in a family-centered approach. Do you have a special technique or strategy to actively engage reluctant parents?
Woods: Risa, this approach is not for all families. With that said, I will argue it is for most! Parents are very often afraid of what they don’t know, and frankly they do not have master’s degrees as SLPs and years of experience! So they need more information that immediately helps them engage with their child. Engaging them in one simple routine—whether it is “Ring Around the Rosy” or feeding the cat—they can enjoy and be successful with can help them see they do have the skills. It is up to us to show them how these routines are “teaching” the child … most parents do not think of handwashing as anything more than handwashing. They do not see the social communication components built in.
Melissa Crowder: What are your suggestions for helping parents of school-age children when working directly with them is not an option?
Woods: There are so many strategies, thanks to technology! I love using social stories on iPads or iPhones, or even paper if the family is low-tech. So many of the routines and activities that are key at home also occur at school—such as clean-up, organizing materials or making requests for food items. Anything that happens at home and school can be a collaborative routine, and if it is one that helps the parent interact with their child, then you are doing double duty for the child and family. Starting with a routine or activity the parent identifies changes it from homework to activities that can work at home. The parent’s ability to identify the priorities is key.
Julia Mahon: Thank you for the follow-up example of the ongoing success of the mother-son interactions in their trip to the library and use of digital learning. Can you speak a bit to establishing social interaction interventions with the families of older children (elementary school age), especially if you are the first service provider to work with the family—or the first one for some time. Also, would you use the same approach if you were working with paraprofessionals not under your supervision who may work with the family, from agencies that do not have any training in developing speech-language intervention.
Woods: Interesting questions … you are all making me think about things I love to do! Building on the last statement, I would start where the parent is and with something they like to do—or would like to do, but can’t because of social or behavioral challenges. Then I would systematically support them to be able to increase the child’s participation in a meaningful and functional manner. Using Nathan as an example: He is very verbal and doing well academically and not quite so well socially … but OK. His older sister “Selena” is much more severe and often limits what they can do as a family. Believe it or not, the family decided they wanted to bowl as a family activity. I am not a bowler but gave it my best shot. We went to the quietest bowling alley and I observed the environment with them and Selena in the environment, and then we brainstormed what to do. I am not sure if your school has bowling as an activity option but ours does, and so this was such a great home-school connection. It takes looking at each family and trying to support their interests and work with them on their challenges. And if you knew me, you would be laughing out loud at the image of me in the bowling alley!
Jan Rowland: As a contractor with early intervention through the Babies Can’t Wait program, I occasionally meet moms who feel that the time I am there working with their child is a time they can leave the room, start lunch, etc. How would you handle a mom that did not want to be an active participant in therapy?
Woods: Jan, this is a common problem. We start by discussing the importance of the parent in the early intervention program and what our role is, to help them as parents build their child’s capacity. So that means we work together. Parents often need to have a role—to know what to do—as they worry they are interfering with our magic! They may feel like we are the experts and need us to build their confidence in what they can do. This can take time, so I try to join them in the activities the parent is an expert in—and keep out of the play area. Moms and dads are experts at caregiving activities, so we can start with these activities. I also look for ways the child can play with them as people partners, such as social games. They can’t leave if they are playing peek-a-boo or unloading the dishwasher with the child! This stage can take time. Adults learn best through participation, but often avoid doing something they fear they may fail at. Parents also need to know what are the expectations of the program. Too often their idea of therapy is based on a medical model and their role was to let the expert conduct the therapy. Often our biggest job is to inform them and help them see what they can do!
Simone Reilly: I have no idea how to use social stories on iPads. Could you explain?
Woods: My favorite iPad app is Pictello. It is so simple, you can make a story that illustrates a routine in just a few minutes while the parent completes the routine with the child. For example, using an iPad with Pictello during a trip to the mailbox, the SLP would take pics of the mom and child at the door going outside, going down the sidewalk, at the mailbox, when the child opens the door and pulls out mail, etc.—whatever the key points for communication could be, or for behavior like no running, stop at the street. Once the photos are taken you insert them into the story on the iPad. Pictello allows two sets of text, and one can be audio recorded. We use the audio text line for the child, and the other text line at the top of the picture to tell the parent what to do. The concept is easy and effective. The parent can get the story and practice before the routine. The child hears what is expected of him, and the other words prompt the parent to use specific strategies, like wait at the door for him [the child] to request you to open it, [or] wait at the mailbox until he [the child] says “open.” Parents really benefit from the simple prompts but don’t feel like it is condescending—it is just a reminder. Learning in the moment is helpful for all of us. I hope that makes a little bit of sense, but Pictello is amazing for families, kids and SLPs, too.
Lauren Minta: I also enjoyed your presentation. I work in early intervention with the birth-to-3 population. What do you suggest for the child who is not interested in anything that the parent tries to engage the child in? Often the child who shows little interest in people, objects and activities.
Woods: I often think the biggest challenge is with children who are less engaged. I am thinking of a little guy, “James,” as I type. He spent way too much time at child care hugging a tree by the swing, and at home just sitting on the floor. We started with physical games—nothing too scary—but some contact to join with him and a specific role for him to play. We would sit in front of him and do a rocking-boat game (I am sure there is better name for it) but we would sing “row, row, row your boat.” We used quite a bit of music. We used mild tickle games and some hide-the-stuffed-animal activities to get his attention and interest. In the bathroom, for caregiving we used the mirror so he could see his mom from behind or when she was beside him. We had to get him to engage with us. After we began to get a bit of engagement, we worked next to increase frequency of communication and then started to increase the level of response we wanted from him. I think frequency for low responders is more important than the level of response. We need opportunities for practice.
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June 2014
Volume 19, Issue 6