You have accessThe ASHA Leader ArchiveMake it Work1 Mar 2020

Help Kids With Autism Plan, Not Just Execute

In our efforts to support them, sometimes we over-prompt clients with autism spectrum disorder. Here’s how we get them to practice skills, in addition to carrying them out.

    Think about when you were learning to ride a bike. You’ve graduated from your training wheels, and you’re ready to try this thing. “Don’t worry,” your dad reassures you. “I’m going to be holding on to the back of the seat. I’ve got you. I won’t let you fall.” Eventually you’re riding so straight and smooth that it’s time for Dad to let go. And you’re off!

    How did you learn to ride that bike in the first place? Was that the first day you got on the bike? Certainly not. You worked on that for months, maybe years. There are so many steps involved—maybe a tricycle first, then a two-wheeler with training wheels, then your dad holding on to the back of the seat, and finally riding on your own.

    What would happen if your dad tried to teach you how to ride a bike by putting you on it and giving it a shove? You would fall, no doubt, because you hadn’t yet developed the necessary skills to ride independently.

    So why do we sometimes assume that’s how kids with autism spectrum disorder (ASD) learn language and how to navigate social situations?

    Let the client do the work

    We clinicians are, all too often, the bike-shovers. We are the over-prompters. We want so badly for our clients to succeed that sometimes some of us may do all the work for them. We skip the tricycle and the training wheels, and we set them up on that bike. But without us there to hold them steady, they fall off. The child on that bike doesn’t have enough skills to ride off on his own.

    Let’s look at a typical situation of over-prompting:

    You enter a classroom with one of your clients, an 8-year-old named Charlie who has ASD.

    You: “Oh, Robert’s here today. Let’s go say ‘hi.’”

    You pull Charlie’s hand and walk over to Robert.

    You: “Here’s Robert! Charlie, say ‘Hi, Robert!’”

    Charlie: “Hi, Robert.”

    Here’s my question: The next time Charlie walks into that classroom without you or another adult, do you think he will be able to approach Robert and say hello? Most likely not. And it’s not because he doesn’t have the skills to execute. It’s because he hasn’t had the practice with the planning.

    In the bike analogy, the steps to riding the bike (tricycle, training wheels) represent planning. In Charlie’s situation, we’ve done all of the planning work for him. We’ve put him up on that bike. However, he won’t be able to ride without us holding on to the back of his seat and helping him pedal, because he hasn’t developed the skills he needs to do so.

    Planning and executing are very different, and both very important skills to develop. Sometimes we are so busy prompting children to execute that we forget about how important it is to give them practice planning.

    Three tips

    Say you and the child are playing with a toy farm. The cow falls off the roof and gets hurt. Let’s look at three ways you can promote planning and ideation in this instance.

    Ask open-ended questions

    Instead of telling the child your ideas, encourage the child to generate his own ideas by asking open-ended questions. The fewer cues you give the better.

    In the toy farm example, you can start with general questions, such as “What should we do?” If the child needs more support, you can ask more specific questions, such as “Where should we go for help?” or “Who can make the cow feel better?”

    Encourage the child to draw on past experiences

    Ask the child what he did the last time he was in this situation. For example, “When you get hurt, who do you go to for help?” or “When you’re hurt, what makes you feel better?”

    Be the child’s peer play partner

    When we ask lots of questions, it’s easy for kids to get overwhelmed or disinterested. Try talking to him as his peer to keep him excited about making the plan. You can do this simply by asking questions with “we,” rather than giving directions with “you.” For example, instead of saying “You need to help the cow,” you can ask, “How can we help the cow?”

    A better way

    Using these tips, let’s revisit the interaction with Charlie in a way that can be more effective and more meaningful:

    You walk into the classroom with Charlie.

    You: “Oh, look, Charlie. Who’s here today?”

    Charlie: “Robert’s here.”

    You: “Yeah, Robert’s here. What should we do?”

    Charlie: “Go say ‘hi.’”

    You: “Good idea! How should we say hi?”

    Charlie: [Comes up with an idea—say hi, give a high-five, ask him to play—as there are many ways to say hi!]

    I know this change seems simple, but it makes such a big difference. In this second scenario, the child is the one generating the ideas and making the plan. We are stimulating his brain by asking him questions so that he can come up with ways to interact in this situation. We are helping him with his ideation.

    So before you tell your young clients to say this or do that, see if they can come up with their own ideas. Don’t put the child on the bike and give him a shove. Instead, go through all the steps so that he can ride the bike on his own.

    Author Notes

    Jessie Ginsburg, MS, CCC-SLP, is the owner and director of clinical services at Pediatric Therapy Playhouse, a multidisciplinary clinic in Los Angeles.

    Additional Resources