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The goal of this section is to introduce the teaching tools portion of the success triangle: visual cues and structured teaching. It is important to understand that this is only an overview, a crash course, if you will. Please be sure to seek more information on teaching strategies as it applies to your situation.
Assistive technology can be used to help kids communicate more effectively or to jump-start learning. Technology can be low- or high-tech and may combine visual, auditory, or motor supports, helping a wide range of abilities. Basic visual cues, which are low-tech educational enhancements, and other technology can be used temporarily or as a way of life, augmenting any teaching methodology.
For us, visual cues have been invaluable. To clarify, visual cues can be manipulative objects, pictures, written words, or even gestures and body language. Visual cues can be used in conjunction with, or as a replacement of, verbal language to help convey messages more clearly.
Structured teaching involves breaking down tasks into manageable components and organizing them in a predictable way. Many instructional metrologies promote the use of pictures, but it is the TEACCH methodology that combines structure with visual cues to help individuals with autism. Structured teaching can be used to teach academics, self-help and social skills, team sports and games, and even free play and creative activities.
In The Beginning
In the beginning of life, most babies survive, and even thrive, on a basic food—milk. Then somewhere around the first year of life, at about the same time that we introduce table food, our special kids may not develop properly or they may begin to slip into developmental regression. Since you're reading this, you've undoubtedly heard about the many who have benefitted from dietary intervention. But feeding our kids the right foods is easier said than done. The basic human sensory system encourages and protects us to survive. Our taste buds send messages to our brain telling us instinctively that sweet is good and bitter is not. Further, gluten, casein, yeasts, and other foods can act as opiates and create cravings and addictions beyond our control. The combination of instinct with uncontrollable cravings creates a huge challenge for caregivers. So how can we feed our kids right?
Motivation
It is no secret that humans are motivated to survive and part of survival is communication. The earliest form of communication is to make noise (scream or grunt) or to use social expressions (eye contact or other gestural body language). Communication can occur in a variety of ways: sign language, verbal language, body language, art, music, and movement. Communication is meant (usually) for another being. But when one is socially impaired (and if auditory processing is impaired on top of a social disorder), language can be jumbled into a meaningless mess of sounds. In other words, there is no reason, no motivation, to communicate.
But people with autism, in general, can understand objects or pictures, making messages more easily conveyed using this less social, less audible, modality. The trick for educators and parents is to leverage this core understanding and then inspire—or motivate—our kids to communicate in a way that everyone can understand. To do this, we must go to the lowest common denominator: verbal words, written words, gestures, pictures, objects; whatever is most appropriate.
My non-verbal two-and-a-half-year-old son, no longer understood the need, or no longer had the motivation, to communicate. I was desperate to reconnect with my little boy. We first had to show him the need to communicate and then we had to teach him how to communicate. First objects, then pictures, then words taught him these lessons.
Reconnecting with Language:
Building Vocabulary With Pictures
The nutritional diet dramatically improved my son's ability to concentrate. But language did not come back automatically, nor did it come back quickly, at least not initially. Three months after my son was eating GFCF foods, speech therapy began. Our first speech therapist brought my son's world to a new level of understanding—she combined pictures and verbal language with favorite toys. Within six months, my son's vocabulary exploded to over 200 words and he was also combining two and three words together in meaningful ways.
Method to the Madness
At the time, it seemed like we were just winging-it, trying everything that would bring language back. But now as I reflect upon the last several years, we definitely approached language building in a methodical way: first technology, then pictures, then structure.
Because my son had completely lost interest in books and pictures, we needed a way to help him understand that pictures had meaning. Early in the process, we were introduced to a voice output device. This assistive technology device is set up by laying-out a grid of pictures. The caregiver then records her voice to associate the word or phrase with each picture. So, when the child pushes the picture, a (familiar) voice is heard.
We programmed our first board using a train theme and we kept it by the train table. Initially, I used the board and followed my son's play scheme. When he moved his train fast, I pushed the "Fast" button. He looked at me briefly. Next, when he crashed his trains together, I pushed the "Crash" and the "Uh-Oh" button. He smiled.
Within just a couple of minutes, my son wanted to incorporate the board with his play. Over the next couple of days, we set up several other picture boards to accompany play scenarios. My son enjoyed hearing the sounds and he continued to push the pictures when he played. Within days, my son understood that communication could be fun. He began to reconnect with pictures. He also understood that communication had a purpose: my son was motivated to communicate.
While the device was a great tool to jump start communication, it was not as flexible as we needed for our busy two-year-old. So, our next step was to incorporate pictures into our everyday lives. We adapted our home with pictures: picture play boards by favorite toys and games, a food board on the refrigerator, and choice boards on bins of toys were some ways that we reinforced our new way of communicating.
And then, something amazing happened. Mealtime, the once dreaded part of the day because we never seemed to have the right food in front of my opinionated little boy, became a game of choice and communication. Picture choices, reinforced with verbalizations during every meal, became a language-rich practice session. We talked a lot about our food: temperature, color, texture, and taste preferences. It was so much fun to get to know my little boy once again!
By the time my daughter began to receive speech therapy, our therapist had figured out a way to make pictures portable and dynamic, fitting communication more naturally into our busy life. Our boards now went everywhere with us. And, of course, we had a picture board of acceptable foods, making it easier to communicate important dietary restrictions with unfamiliar caregivers. The more I made our world visual, the better my kids understood it. Life was becoming easier. Life was becoming happier.
Now on a mission, I added pictures to everything: timers, toys, transitions, and trains—you name it, we had a picture for it. And when things got tough, I always relied on this fundamental principle: make it visual.
Imagine Brother and Sister wrapped-up in their own worlds, interacting with their own special interest toys. Then, Brother decides he wants to play with Sister's toy, so he takes it. Sister is angry, she hits Brother then she bites him. Then start the screams. Brother screams louder, hits Sister back, and pulls Sister's hair. And so on, ad nauseam. Now you know what it was like in my house every day after school.
In a desperate attempt to help work through emotions, I developed portable emotion cards. On one side of the card, I put an emotion picture: happy, mad, sad, sleepy, and so forth, and on the other side, I put a picture of the kids while they were acting out these emotions.
During a heated moment, I would bring the cards with me and say, "Are you sad?" and show the sad picture card. Then, I would say, "How can I help you be happy again?" and show the happy card. Our cool-down time went from being an ear-piercing scream session that lasted thirty minutes or more to less than one minute. Not only did the emotion cards save my eardrums (and blood pressure) but you can bet this type of nurturing helped my kids build stronger self esteem while still giving them the tools and building blocks to succeed in typical environments.
Picture supports can jump-start and build communication. Picture supports can also build confidence, self-esteem, and independence. Implementing visual supports is well-worth the investment of time and money. And with just a little more effort, structuring tasks can help kids succeed in many other ways.
Regulating the Mind:
Visual Structure in the Natural Environment
Even though it was heartbreaking that my children could not talk, tantrums debilitated our every day living. One of the most poignant lessons that I've learned over the last several years is that my kids organize their worlds differently than others. TEACCH suggests that we structure work and play to help people with autism function at a deeper, more connected level. But, what does that mean exactly, especially for a preschooler?
Typically children dream-up play schemes which help them to understand the world better. However, kids with autism may have difficulty thinking about, starting, and even finishing a routine. Structure for non-verbal children and pre-readers can mean putting tasks in order. This may sound unusual as you may be thinking that kids learn through play. But, when a child cannot dream-up play schemes, learning is impaired and stagnated.
So what happened when we implemented structured routines in our house? Wow! What a difference! Organizing and communicating the sequence of events helped regulate, or calm, the sensory system by giving clear expectations. We structured everything from daily living skills, to school work, to play and social skills.
Implementing structure was a learning process for us and it is important to remember, that like the nutritional diet, no child is the same and structure must be implemented according to the child's needs. Understandably, TEACCH does not offer a prescription for all people across the spectrum. But the fundamental principles can be incorporated in many ways, beginning with the most basic and blossoming into a world full of learning.
Staying on Task
When both of my kids began to regress, the first behavior to surface was the lack of attention and lack of willingness to stay on task, whatever the task: eating, playing, learning. So, we first set up "work" baskets that were simple tasks for them to complete, such as shape sorters, stringing beads, or hammering golf tees into styrofoam. The overall "work" session was coupled with a picture-based task list or schedule. They had to finish the first task before they could move onto the next.
When we started, we initially set aside five minutes, building up to thirty minutes of "work time," each day. The kids loved it and they felt so proud when they finished their work. In the beginning, they were learning two important concepts: sequencing a task and finishing a task; critical skills for school (and life) success. Within two weeks, my son could "work" for twenty minutes, engaged in his tasks.
Once you get started with structuring activities, you can find learning opportunities in so many ways. To get started more quickly, tasksgalore.com sells books full of ideas and premade kits can be purchased from shoeboxtasks.com and blueridgebagsandmore.com.
Integrating Visual Structure into Daily Routines
The next step was to implement structure into our daily lives. Some of our activities were to create "work" scenarios in the kitchen, such as setting the table. We also created a simple picture board for the bathtub. It listed body parts, soap, and wash cloth, and the "work" was to wash each body part pictured. Only when they finished washing all of the pictured body parts were they allowed to be "finished" with bath time.
Unfortunately, some people believe that structured teaching is limited to classroom use. However, daily routines and everyday living can be made much easier by adding structure. In addition to academics, we've used structure to help us with potty training, morning and nighttime routines, playground skills, turn-taking, chores, grocery shopping, and even safety procedures, eating vegetables, and spontaneous play. The lesson is, if something is challenging, make it visual and structure it!
Structuring Academics
Visual reinforcements at school are invaluable and, if incorporated properly, they can make any classroom more fun! Based on structured teaching philosophy, my children's teachers created a picture schedule for circle and center time. As the kids began to understand the routine, the teachers would make choice boards, allowing them to build their own schedule. Ultimately, this empowered the children while still offering the structure and allowing more flexibility. Visual structure can engage all young children. Visual structure can enhance classrooms by providing a predictable environment, which kids, all kids, seek during this exciting time of life. Building in choices, empowering the child to make their own schedule is critical to building a strong self esteem.
I can't tell you how many times I've been given that "I'm sorry" look from educators about my kids' academic ability. There is absolutely nothing to be sorry about because my kids are smart. Always remember to make academics visual and to decompose broad concepts into manageable, manipulative, and visual components.
It took me about half an hour to set up an activity for my son to understand kindergarten patterning concepts. In less than ten minutes, he understood the math requirements for the entire kindergarten year!
My kids have benefitted from structuring reading, writing, science, and social studies tasks. The teachers set the curriculum and I support their effort by working with the kids on weekends and in the summers presenting topics in our different, structured way. I am convinced that these simple modifications can enhance any environment, including inclusive settings. Structure is an invaluable tool, limited only by the imagination, and collaboration between home and school is critical to its success.
Structuring Play
Structuring play may seem to take the fun out of pretending. But when a child doesn't have the skills to develop play scenarios, you have to intervene because kids learn through play. Adding simple structure to play schemes did not limit my children to "scripting." Instead, structure gave them a foundation from which they could initiate play with their friends and family. As an example, I created a dynamic play board which helped my kids become interested in a play carpet, something they had no interest in before the visual structure.
Using Visuals to Implement Dietary Changes
Implementing visual cues and structure is malleable, fitting a child's needs according to their interests and ability. It also can be quite overwhelming. The best thing to do when beginning this intervention is to follow similar guidelines as implementing the nutritional diet changes:
Start simple. Use the pictures at the end of this chapter to tailor a menu for your child. Copy the pages and put them on your refrigerator. Or create a book that the child can carry around, always returning it to a familiar spot, likely labeled with a picture as a reminder. Your refrigerator can become your command center, at least initially. When your child is hungry or thirsty, bring him to the refrigerator and point to the picture. Also help your child to point to the picture. Use simple, slow language. Ask your child to try to use words and wait until he complies. You can also create a picture exchange system for more concrete visual support, if needed. Build vocabulary, model language, and string words together, again reinforcing by pointing to picture cues and modeling language appropriately. Eventually, you can reinforce social conventions (eye contact, gestures, voice pitch, and tone) to the language routines.
Be diligent. If you have a steel refrigerator that doesn't hold magnets or your refrigerator is not an appropriate logistical area, try your garage door. It is likely to be metal and magnets will work there too! Or create a flip system . . . or, use this book. There are ways to reinforce language with pictures, reinforcing a multisensory approach to learning.
Be flexible. Once your home is engineered with visual supports and you're redirecting grunts and screams to picture points and basic sounds, you can more easily implement dietary changes. As your child grasps more language, raise the bar. Accommodate higher level learning whenever you can. Be sure to follow though with expectations and see how far your child can go.
Dispelling the Myths
Pictures: If I use pictures, my child will never develop verbal language.
Not true. Pictures can be a window to communication and behavior regulation. Humans will talk if and when they can. Similar to teaching infants sign language, pictures and signs can be a way to communicate, despite the lack of ability to talk. When your child can physically talk, he will choose that modality. Our job as caregivers is to open the door to communication. To learn more about how technology can help nonverbal kids, search for "ATRC" or the "assistive technology resource center" in your home state.
Verbal Language: If I keep talking to my child, he will get it.
Maybe . . . but keep in mind that many of our kids have sensitive auditory systems. Words may sound jumbled. Too many sounds, sounds that are background noises for most of us, may be irritating or confusing to our little guys. Especially in the beginning, during hard transitions, and in safety situations use simple words, use less words. Let pictures do the talking.
Structure: Structure will make my child rigid and inflexible.
On the contrary, structure, when implemented correctly, will instill predictability, calming an overloaded sensory system. The appropriate use of structure must be balanced with the ability of the child. More information about structured teaching can be found at teacch.com.
© 2006 Inga J. Smith. All Rights Reserved. Reprinted with permission.
As found in Special Foods and Teaching Tools by Inga J Smith |
Abstract Patterns--Beginning (
PlayPal was developed to help children improve play skills. It combines structure with visual cues to help children broaden imaginative play, all wrapped up in a portable package.