Autism Spectrum Disorder Behavioural Education

How to teach children with special needs to engage themselves meaningfully?

We commonly hear experts in the field of disability tell the parents, “You should keep your child occupied throughout the day”. While we all know that an idle mind is a devil’s workshop, it is not easy, by any means, to engage a child throughout the day. Many children are able to exhibit a very good attention span while doing an activity, but the moment the activity is over, they are all over the place. Our focus is more on teaching them how to do a particular skill than teaching organizational skills. The result, parents (more often, it’s the mother) are an exhausted lot.

Engaging the child throughout the day is almost impossible because the parent has other things to do – taking care of siblings, elderly parents or doing various household chores. So what is the solution?

The child must be taught how to engage himself/herself meaningfully. This is easier said than done. Given the limitations of the child in terms of understanding, communication as well as impulsive behaviours, it requires a structured approach.

Visual Interactive Schedule helps the child to overcome the hurdles mentioned above. As the name indicates, it is

Visual – A picture (or object), representing an activity is shown to the child and the child is then asked to do that activity.

Interactive – Once the activity is done, the child removes the picture/object and drops it in a ‘FINISHEDBOX

Schedule – The pictures are arranged in a sequence. The child is taught that when he is done with one activity, he has a few more activities lined up to do. In other words, he is not ‘free’ after an activity. In short, the child is taught ‘what next!’

The pictures are usually displayed at a height, the child can read, reach, pluck and discard them in the ‘Finished’ Box. One can display it in many ways, such as drilling nails and tying a rope between them and the pictures are suspended with the help of clothespins (clips), or in notice boards, or transparent pockets.

A sample morning routine

About the Picture

Only the object’s picture should be taken. One should not take the picture of the child doing that activity. We are not sure what the child is looking into the picture. He may be distracted by his dress or the buttons on his shirt.

The object must be placed on a plain contrast background (e.g. black dupatta for light coloured objects) while taking pictures. This improves picture clarity. It also avoids pictures of unintended objects that are present in the background at the time of taking the picture, which can serve as a distraction or misinterpretation.

Laminate the pictures to make them durable. Always have 10 pictures (in stock) if you want to give 5 activities (double). So that you can rotate the activities to avoid boredom. I would recommend that we have two activities as constant so that we can gauge the progress of the child and change 3 activities to provide novelty.

About the Interaction

Now that you have displayed the pictures, let’s say 5 pictures, horizontally, one after the other, we take the child to the first picture. It shows a swing (for example). The child is then taken to the swing. After swinging, the child is brought back to the display area and with assistance, he picks up the picture of the swing and drops it in the ‘Finished’ Box, placed at the end of the sequence. This indicates that the activity is over.

Now the child is taken to the second picture and the entire sequence is repeated. This is done for all the 5 pictures. Each picture shown is followed by a related activity. The child with daily repetition understands the concept. You can gradually reduce your input and wait for the child to take the lead. You will be pleasantly surprised!

About the Schedule

The schedule is a sequence of activities. Choose odd numbers only. I would suggest starting with 3 then extend it to 5, then 7 and so on.

Choose the schedule at the same time every day. It can be for just 15 minutes every day. However, I would recommend, plan for 30 minutes. It can be at 5 -5.30 pm or 9- 9.30 pm, doesn’t make a difference. Ideally, if you have a helping hand, it makes the job easier. So you can plan it when both the parents are available at home. Just make sure that you choose a time when the child is not hungry or sleepy.

We will proceed at two levels.

Level I – All 5 activities are child preferred activities. It means he likes the swing, puzzles, jumping on the trampoline, playing with the drum and catching the ball, etc. So that you do not have ‘starting’ trouble with your new system. Once the child starts doing it on his own, let’s say after 15 days, you can move on to Level II.

Level II – The activities are given in the sequence of preferred-non preferred- preferred-non preferred…. alternately. You start with preferred activity and then move on to the non-preferred activity. It serves two purposes

  • Only when the child completes the non-preferred activity, he gets to do the preferred activity. This serves as a positive reinforcement
  • The child understands that even if it is not preferred by him, he still has to do it. This develops tolerance.

Please note that we do not have to give equal weightage or duration to preferred and non-preferred activities. The preferred activities can be for 5-8 minutes whereas non-preferred activities can be for 10 seconds. But it cannot be skipped. Moreover, by displaying it we have made it predictable. So the child knows what he has to do and what is next. There are no surprises.

Choose ‘odd’ numbers, because the schedule should start with a preferred activity and end with a preferred activity.

In this method, children with language and communication delays also learn the system. The half an hour schedule can gradually be increased to one hour, two and eventually for an entire day. Gradually the child’s routine is incorporated in the system, including OT or speech sessions, school, music class, lunch or bath time, etc. This system is basically an ‘organizing’ tool, just like our diary of appointments or outlook calendar. So there is nothing wrong with continuing this throughout life.

As the child is able to read and write, words can replace pictures, wall display can be replaced by a file and so on.

This schedule is followed for an entire day. This way it can be customized according to the day. As the child understands the days of the week, we can have a time table for an entire week as well. As the child learns how to move on from one task to another, the parent can spare time for other work.

The Visual Schedule also helps in overcoming behaviour problems as most of the behaviours result out of either insecurity of what is going to happen next or due to unwanted surprises.

For children who do not identify pictures, real objects can be used. They then have two sets of objects – one is for display and the other one is for use. For example, they have a toothbrush for display and the same toothbrush is available for brushing teeth, remember the same colour, and same model.

Use task completion parameters to teach the child when to move from one task to another. If you have not read my other blog on ‘Task Completion’, I have attached it here…

 

Task Completion

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 ‘satisfaction’ 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 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.

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 that 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.

  

Types of Tasks

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 the 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 convert into ‘Non-Ending’.  Any  task which requires practice and repetition  fall in this category

  • 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 for 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-wheeler with a flat tyre 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’ just like having a finish line for an athlete.

Quality of Work

We have heard the proverb, Practice Makes a Man Perfect!… This proverb needs an extension, Practice Makes a Man (or a Woman) Perfect only when it is Practiced Perfectly! Many times we find children do activities for namesake. They rush through the activities since their focus is only on completing the task with scant regard to quality or accuracy of work. Hence it is important that every activity has a QC, you’re right – A QUALITY CHECK. Every task, be it throwing a ball on the target or eating food without spilling should have a quality check. For target throw, when the target is ‘hit’ then the quality is achieved; For eating without spilling the food, you can place one plate inside the other plate to show the child how much he has spilled the food.

 

Now comes the CHECK! If the performance does not meet the required standard, the activity is not considered completed. The child is asked to re-do the activity again. This will ensure that the child is focussed on the task at hand and learns to do things the right way. A point to note, the child should be able to understand the criteria on which we decide whether the quality is met or not. If not, you’ll have to simplify the way in which you measure quality. If the child understands the quality criteria, he will not depend on you for feedback. He will be able to correct himself whenever there is an error. This leads to independent work practice. Too many times we see parents complaining that the child performs an activity only in their presence… Just think about it…

To be fair on the child, just make sure that the quantity of tasks (the number of times or the duration that he has to do) is minimal. So that the focus shifts on quality of work and not the quantity.

The Task Completion Parameter feeds into the Visual Interactive Schedule. In other words, every task in the visual schedule has a definite endpoint. This is explicitly told to the child before each activity.

Summary

  • Choose to implement the Visual Schedule when both the parents are available (wherever possible)
  • Choose the same time of the day, every
  • Start small. 15 minutes every day is more beneficial than one hour twice a week.
  • Include Task Completion parameters for each and every activity. The child should know when the activity ‘ends’ even before he ‘starts’
  • Be regular. Including weekends…

With repetition and practice, the child will start engaging himself meaningfully as he now knows what he has to do next!

You may ask, what will happen when things do not go as per plan? There might be electricity failure, unexpected guests or medical emergencies. But if we reflect back, how frequent do these things happen? What is better – 30 days of uncertainty or 28 days of structure and 2 days of uncertainty?

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