What can be done?
1. Identify the time of the day when your child is at his ‘best’ in terms of mood, activity level and free from the influence of medications. Some children are active in the morning while others may be active in the night as late as 11 pm. This is the best time to teach them.
2. Establish a Routine. Routine is the most basic way of understanding for the child, despite many challenges the child may have. Example of a routine: Wear uniform while going to school in the morning. Doesn’t your child recognize when you are going out when he sees that you have changed your clothes or worn your footwear Doesn’t your child run to watch his favorite Ad in TV or waits for his brother to return from school? These are instances which tell us that the child understands routine.
A routine is a combination of time, activity and place that happens again and again (see insert) and is fixed.
This means that bed is only for sleeping in the night, jumping on the bed is not allowed. When a routine is established, the child knows why he is there in a particular place and what is expected of him… just like we know what to do when we go to a library compared to a cinema theatre.
3. Insist on Task Completion. I see this as a very important step towards developing attention. We often see children shifting from one task to another, one game to another without completing it. Such experiences become the norm and the child develops this as a habit. The result, the child does not have the ‘high’ of having achieved something. This affects their confidence levels as they grow up. As their confidence levels go down, the get stuck with familiar activities, familiar people and familiar routine and are scared to do new things in life. Sometimes, we mistakenly name them as ‘stereotypes’ of autism whereas in fact, it is just that the child does not know how to play with other toys!
If we dig further into the concept, let us reflect on what do we do as adults? Do we engage in activities in which we do not know the ‘End’? We go to the office and know when we will return. We go for vacations and book the return tickets even before we start. We know when the episode of a mega serial will get over or when the household chores are done with. In short, if we don’t know when an activity will end we would never start it.
Do our children know when the task will get over? The answer is a big NOOOO – given the limitations, they have with language, comprehension, and motivation. How can we expect their co-operation when they don’t know when a particular task or a particular visit is going to end?
So the key is to make the child understand when a given task will end ‘even before they start’.
Let’s understand a Task. A Task is an activity which has a beginning, a process, and an end. All tasks should move towards completion the moment they start. It should be a one-way thoroughfare. As I see it, there are 3 types of tasks in this world – Ending, Non-Ending and Repetitive.
Task completion parameter is important to develop attention and sitting tolerance.
Ending Tasks: These are tasks that have a natural completion. e.g. clean up or fixing a jigsaw puzzle. Children understand this easily as they can see when this task is going to complete. Non-Ending Tasks: These are tasks in which there is no definite ‘end’. e.g. swinging, playing a slide, jumping on a trampoline, etc.. You can play for 2 minutes or 2 hours. A timer or alarm can be used to signify completion of this task. To make it easier to understand, you set the alarm for 30 seconds and once the alarm rings, the child is asked to come out of the swing and switch it off. He is then asked to do something else (an ending task is preferred) and then he goes back to the swing. By repetition, the child understands that he has to come out of the swing at the sound of the alarm. The duration can be gradually increased to suit the child’s needs. By the way, playing catch and throw with a ball is also ‘Non-Ending’ unless you start counting. I always recommend playing target throw. You can ask the child to throw at a water bottle or any other target. By having 5 or even 10 of those, you make it an Ending task. You can always throw the ball back to the child to focus on ‘catching’
Repetitive Tasks: These are tasks that are inherently ‘Ending’ which we (adults) convert into ‘Non-Ending’. Any task which requires practice and repetition fall in this category e.g. handwriting. The same jigsaw puzzle which we discussed as an Ending Task can be made Repetitive when you ask the child to do it again and again. Now the problem is that the child cannot ‘See’ the end. He has laboriously completed the puzzle (more likely with your help) and then you just dis-assemble it and ask him to do it again. When this is done for the second time, the child is clearly frustrated as he thinks there is no end to this ordeal. It is easy to tell the child that he has to practice 5 times but what if the child does not understand numbers… I recommend that you use plastic tokens and a piggy bank.
Piggy Bank with tokens
You spread out 5 tokens on the table and ask the child to fix the puzzle. As soon as the child has finished it once, you ask the child to take one token and put it inside the piggy bank simultaneously mentioning ‘One Time Over’. Now there are 4 more tokens on the table, you undo the puzzle and ask him to do it again, and subsequently, it is ‘Two Times Over’. Now the task completion parameter shifts to the number of tokens remaining on the table. With a few repetitions, the child understands this logic. You can always start teaching this concept with a task familiar to the child to avoid melt-downs in the first place.
An explicit ‘Task Completion Parameter’ helps in two ways.
If the task is to the child’s liking, it will sustain interest for future interactions. Since children always live for the moment, this practice of completing the task at a pre-determined period helps the development of emotional regulation as they have to delay the gratification. He understands that he cannot have all at one go.
If the child dislikes the task, it improves tolerance. Since the child understands that there is a definite end to his ‘misery’ and that it is not going to last forever, the child makes up his mind to go through the process and finish it. Don’t we develop tolerance when we know that our ‘unwelcome guest’ will leave the next day or we develop the courage to push our two-wheelers with a flat tire when we know that the mechanic is nearby?
Only when the child knows the ‘end’ you can expect them to give sustained effort ‘to last the distance’. All this while, we have been asking our children to run a race without telling them where the finish line is…. Is it fair then to comment that the child has a poor attention span?
– Karthik R. Rao
Developmental Physiotherapist, Chennai