They may seem unrelated to the acquisition of literacy skills, but the joint attention, imitation and play skills that children develop by interacting with others establish the groundwork for preliteracy gains. Without these crucial skill sets children cannot move on to successful learning at the phonics level.
While typically developing children absorb these skills naturally, it's a different story for children with autism. A lack of interest in social interaction often compromises their ability to gain value in shared activities. As a result, they need explicit coaching on joint attention, imitation and play skills.
"Because the skills are developed in play and interaction, our students with autism actually have to be taught how to play," said Cathy Smith Batchelor, MA, CCC-SLP, on staff at the Southeastern Cooperative Education Program (SECEP) in Norfolk, VA.
Joint attention is the ability to attend to the same object as another person and acknowledge "sharing a moment." It affects nearly every other skill area in children, according to Amy Brillhart, MS, also on staff at SECEP.
"For a child to begin to attend to literacy and even realize that it is something they can attend to, they have to be able to show joint attention to people, objects and activities," she told ADVANCE. "The capacity to coordinate and share attention and interest with another person is a pivotal skill that a child needs in order to have a basis for literacy learning."
To develop preliteracy skills children with autism must be able to find meaning in everyday interactions. They often imitate sounds or actions but typically don't attach any significance to them. Teaching children how to read, write and even listen will be a challenge if they find activities meaningless. "If there is no meaning attached, it's not going to stay in their heads, and they're not going to learn," said Batchelor.
Much to the dismay of parents, reading books to children with autism may turn into a fruitless, frustrating endeavor. "It's very difficult to get them involved with literacy materials or even see that literacy can be interactive or rewarding," said Brillhart. In many cases they simply will avoid the activities that they deem insignificant. "You have to overcome the social deficits as they impact interaction and engagement before you can help the child learn phonics."
One problem that speech-language pathologists face is that a good portion of the research in this area focuses on beginning instruction at the phonics level. "The conventional definition of early literacy doesn't cover a large number of our students," she said. "We have many students who are severely disabled, and we're looking at getting them to phonics, not starting at phonics."
"We consider that early literacy but not emergent literacy, and we have to deal with emergent," noted Batchelor. "In our opinion we're looking at an [autism] epidemic. This is something that we all need to be thinking about now."
Speech-language pathologists should not rely solely on commercially-based materials to help children with autism learn to assign meaning and value to activities. They should tailor material to each individual child, such as making books out of digital photos showing the child's daily routine or a favorite topic. Another approach is to create books showing students re-enacting stories or nursery rhymes.
"Taking digital pictures and making books will grab their interest and have specific meaning for them," Brillhart said. "They get to see their face in the book, their friends and their classmates-people they know. It has more reference for them."
Classroom teachers often are trained to work with children who have disabilities, but they may not be familiar with the skills that a child needs prior to learning verbal language or early literacy skills. The speech-language pathologist's role is to help teachers reframe their definition of preliteracy skills to include teaching joint attention, play skills and imitation skills.
"Not only can we serve on a consultation basis to help them understand the skills a student needs to be taught, but we can model the strategies and help them become familiar with the typical developmental sequence," she said. Teachers usually are not aware of what to do with students who are not ready for instruction at the phonics level. While many of them are familiar with commercial literacy materials, they often don't know how to reach a student who "couldn't care less about a hungry caterpillar."
Teachers also might not know how to adjust and individualize their instruction in order to reach as many students as possible.
"That's where speech-language pathologists can do the most good and give the most support in helping to educate teachers about those skills that come before the child even speaks," said Brillhart. Teachers need to understand the pivotal role of play, imitation and joint attention skills in terms of learning early literacy skills. "Sometimes they don't see how those early skills are connected to reading a book."
"It also falls into our role as speech-language pathologists to look at reading, writing, listening and talking-the four modalities of communication," said Batchelor. "It's within our scope of practice to do that."
Speech-language pathologists should be involved in the reading process because it's a way to increase a student's communicative opportunities. Students need to be able to receive and give information. If they can't do so verbally, the modality that often is left to them is reading. "Our students need to have every advantage possible," said Batchelor.
Clinicians need to consider how play, joint attention and imitation skills develop over time.
Play involves repetition and novelty. Imitation games help children begin to associate objects with words. For example, a clinician can roll a ball back and forth with a student, prompting the child when to roll or catch the ball.
"This isn't about using any kind of language yet. This is just simply looking at the same object at the same time and doing something with it. Once the child becomes engaged, you add language, even it it's just the words 'go,' 'ball' and 'you,'" said Batchelor. Changing facial expressions during the game encourages children with autism to look at faces.
Clinicians can use tangible objects to address joint attention skills, such as holding one object next to another, moving it back to the face, and then moving the tangible back to the object. The goal is to get the child to look at the tangible object and then back at the clinician, who should always use positive reinforcement when the child is successful.
Speech-language pathologists should use objects that excite the child, even if it's a straw or a piece of candy. This is critical for children wih autism, who need to be emotionally and internally regulated before they can communicate.
"Their attention is something we have to grab when they're ready to give it, so you have to follow the child's lead," said Brillhart. "Maybe a child plays with a string for stimulation. That would be the object I would use because it's highly engaging for them and it's something they're interested in."
Once the child masters this skill, the speech-language pathologist should work on gaze alternation. The child looks at the tangible object, then to the clinician, and then back at the tangible again.
The next step is to help the child learn a pointing response, which is an important skill in both educational and assessment activities. Clinicians can achieve this by hiding an object in a container and encouraging the child to point to the container as a way to retrieve the object. It's important to change objects frequently so the child doesn't get bored.
"If you have a box full of objects that you know are highly reinforcing to the child, you have to switch out these objects to keep them novel," said Brillhart. "If you use the same thing over and over, the child is going to lose interest, and you've lost them."
A teacher's arsenal of objects should stimulate the senses and include things that are sparkly, rough, smooth or noisy. Activities such as swinging, twirling, blowing bubbles, playing with water, and pouring sand or powder over the hands and feet while adding funny sounds or facial expressions will stimulate their minds and capture their interest.
However, it's sometimes difficult to predict what a child will enjoy. "I can't say how many times I bought a new toy that I thought the kids would love, and they want to play with the bag or box instead," she said.
When teachers interact with students, they're not always aware that they're teaching an early skill. As an extra set of eyes and ears, speech-language pathologists should take the opportunity to give them positive feedback when it's apparent that the child has picked up on certain skills.
"If I see the teacher doing something that shows the child is learning an early skill, I try to say to her, 'Wow, that's awesome the way you're using that song. The opportunity you're giving him to learn through repetition is great,'" said Brillhart. If the teacher uses a reinforcer to get the child's attention, she'll compliment her and explain that the child showed a gaze alternation because she was using an object that was interesting to the child.
"I find it more effective if I give them positive feedback as they're working with the child because they often don't even realize they've done something that is helping the child with his or her skills," she said.
By helping teachers understand where their students are symbolically, speech-language pathologists can assist them in providing parents with strategies and materials that they can use with their children to facilitate positive literacy experiences at home.
No matter how cognitively young a child may be, clinicians and teachers cannot assume that the child doesn't have the capacity to acquire literacy skills. If professionals give up on the opportunity to present literacy information to children despite their skill level, they're counting them out of a world that is based on literacy, said Brillhart. "We have to continue to help teachers understand that every student with autism has the potential to engage in successful and enriching literacy experiences."
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Jason Mosheim is an Associate Editor for ADVANCE. He can be contacted at firstname.lastname@example.org.