iSupports for Children with Autism: Cookie Doodle Language Therapy

Ten Ways to Teach Communication Skills Using Cookie Doodle iPad App.

I invite you to watch the video below first before reading about some of the learning objectives you might target while using this app. 

1)     Joint Attention

• With many young children who have autism, it is difficult to establish Joint Attention (JA is when two people are doing, looking at, feeling, intending the same thing at the same time--and know that they are both together in this enterprise).  iPads are visually riveting.  It is relatively easy to get most children with autism looking at things on the ipad.  The child knows that you are both looking at the same thing, in part, because you can easily both be interacting with the pictures on the program.  When you say Hmmm, what color?  Brown.  I choose brown  the child can see that you selected something that was brown and if the next time you name a different color and select it, the meaning of the color word becomes increasingly obvious.  If you say Cut, cut, cut while cutting the butter, the child sees what the word might mean.  These programs give the child practice in maintaining joint attention with another person because it is easy, and highly pleasurable for the child to maintain joint attention in this kind of an activity.

2)     Taking Turns

• It is relatively easy to move the iPad from one person's reach to another person's reach, allowing each person to take a turn.  You can create a turn taking activity easily.  If at the same time you announce Mommy's Turn and then David's Turn, you are making the act of turn-taking even more obvious.  When first taking turns, make Mommy's turn really quick and David's turn longer.  Eventually, make turns more evenly timed so that David can play with another child and not just mommy.

3)     Speech Sounds

• One of the ways that we teach a child new speech sounds is we let the child hear the sound repeatedly--often slowing the production of the word down to emphasize the target sound a little.  I might choose the Cookie Doodle app, for example, when I was helping a child use the "k" sound instead of the "t" sound in appropriate words.  This would be the child who pronounces the word cookie as "tootie".   There are so many opportunities to emphasize the "k" sound while playing this particular game. This therapy strategy would not even require that you ask the child to say the "k" sound, at least not at the beginning, but rather that you just find as many opportunities to say words with a "k" sound as you can while playing.  Here is a little sample of how one might talk while playing if the idea was to say as many "k" words as possible.  "Wow! You chose green.  Green Cookie?  Yuck! No Cookie for me!  I don't like green Cookies.  I can't eat green cookies! My turn.  I will make green cookies too but Yuck!  I won't eat them.  I will cut, cut, cut, cut my cookie and no one can eat it.  Cookie crumbs.  You can't eat cookie crumbs." 
•  While I might find another app for another sound, I would not need to. With a little thought, one could probably target any sound using the same app.  Write out a little script for yourself to help you think of how to say the same sound over and over in different words while playing the game together. If your child is working on sounds with a Speech Language Pathologist, ask this professional for help with choosing sounds to target in play.

4)     Vocabulary

•  It is easy to teach vocabulary with any activity where the child can see exactly what you mean as you say the word.  Some obvious vocabulary to teach with this game would be descriptive words (colors, shapes, sizes), space/location words (down, up, next to, beside, on top, on the edge, far away, close), action words (cut, sprinkle, stir, color, bite, eat, pour, shake),  politeness words (please, thank-you, your welcome), labels (bottle, egg, salt, bowl), time words (first, second, third, after, next time, last time, before).  You might want to look on your child's treatment plan or IEP to see what kind of vocabulary goals your child has or ask your child's Speech Language Pathologist to help you choose some words.

5)     Pretend versus Real  

•       Anything you teach in the two dimensional world of a computer screen or for that matter, a book, is pretend, not real in this presentation. You can make the concept of pretend versus real more clear if you use these words while doing the activity on the screen and then repeating the activity in the real world.  E.g.  Let's make pretend cookies versus Let's make real cookies.  Cookie Doodle is very easy to do in both worlds.  The concept of "pretend" versus "real" can be a useful concept to teach. It has long intrigued me that with typical children, we tend to throw pretend and real together and let children sort out what is pretend versus real eventually--as in the case of Santa Claus.  It is much more pervasive than the clearly deceptive manner in which we present Santa.  We do things like threaten to eat your little toes while changing a baby's diaper--what a horrible thing to say to a child but we smile as we say it and apparently, young children trust our smiles more than they trust our words.  That might, in fact, be what we are teaching as we say this.  Trust my facial expression, not my words when there is any doubt.  We give children books with stories where animals talk, dinosaurs walk the earth, and orphaned children live at Hogworts Magic Boarding School.   For children with autism, who tend to be very literal in their thinking, it can be useful to teach, from an early age, that some things are real and somethings are pretend.  We want all children to enjoy rich imaginative lives but there can be some distressing confusion in our cultural approach for children with autism.   
•       I want to make another point,under this heading of pretend versus real and slip it in here. A child is much more likely to use new communication skills that are taught in the two dimensional world of computers if these same skills are explicitly taught in the real world soon after. Don't expect a child to use the vocabulary, for example, that you teach with Cookie Doodle, unless you also teach that vocabulary in other real places--such as when cooking real cookies.

Next blog post will cover the following communication learning objectives.  If you can think of more learning objectives and strategies related to using Cookie Doodle--please put them in the comments section. 

6)     Planning and Sequencing

7)     Politeness  (Caring for the Needs of Others)

8)     Mental Flexiblity

9)     The Language and Concept of Gradation

10)  Beginning and Ending Activities Verbally

Discovery Toy Champion--Marble Works

One of my favorite toys is Marble Works.  This toy is sold by Discovery Toys and although parents have purchased  similar toys made by other companies, they are often disappointed and report that other similar toys are less sturdy and well-designed.  The reason for the blog post, however, is not to endorse this company nor is it even to endorse this toy so much as to use this toy to explain some important things to consider about toys. The right toy matters but the way you play the game is even more important.

1. Piece-by-piece.  Any toy that allows the adult play partner to hand out the parts, one part at a time, provides many opportunities to communicate--so long as the child really wants the parts.  I often explain to my young play partner that I am the Parts Person and that the he or she is the Builder and so the Builder has to get parts from the Parts Person.  If a child is not able to understand the explanation, I still use the strategy. This explanation works very well, though, for many children and it is one that I learned from Dr. Gutstein.  It is ok to exchange roles if a child wants to but if you do, then the child hands out parts and the adult builds--the child does not get to have both roles.  Dr. Gutstein did not encourage this role reversal in that workshop, by-the-way but for teaching communication skills, exchanging roles is very helpful.  In this case, almost every child is going to want to be the Builder.  The most important point, is that if you ever just hand over all the parts to the child to play with, no significant language learning or communication will occur. 
2. Establish a game vocabulary.  This game lends itself to creating and using cool words both as names and as a description of what is going on as the marble races down and around and through all the parts of the toy.  All games seem to be more fun if there is a specific vocabulary and a vocabulary is needed if you are going to talk about what is going on.  I name the parts of  Marble Works with words like zigzag, wheel, whirly-bird, wiggle wiggle wiggle, jump, bump bump bump, funnel, connector, and foot--often teaching the words by showing the part and showing the child the physical properties of the part that inspired the name.  With specific parts named, the child can request the part he or she wants and I can provide a choice. E.g. Did you want connector or funnel?   We can also talk about how far marbles jumped or which marble won the race, or how upsetting it is when marbles get stuck.  This kind of language becomes rather like Marble Works Sports Talk and I use that manner of talking because it is exciting to talk about games in this dramatic way. You are also teaching a manner of using the words rather than just the words and this makes the vocabulary so much more fun to learn.
3. Many possible communication goals.  This toy allows for many different and increasingly complex communication goals.  In the beginning, we might use the toy to teach the child how to share control of a toy with an adult.  We might be helping the parent of the child learn how to retain control of the materials while remaining fun and playful (rather than directive and authoritarian). We might be teaching this Sports Talk manner of speaking about games.  We might be learning to request or tell another person what to do or express disappointment. Years later, we might be working on creating a written plan for the project prior to starting it or, by taking pictures of several different projects after completed, the goal might be to learn to evaluate the relative subjective value of different ways of putting Marble Works together.  On a scale of 1 to 5 with 5 being the most cool of all, rate each of your last three Marble Works projects for how cool the project was. There are seemingly endless learning objectives with a toy like this.
4. Flexibility and creativity. Any toy, like this one, that allows a great deal of flexibility and creativity is a good toy for a child with autism because there is a tendency for children with autism to want to find one way to do a thing and then repeat this one way over and over until the child gets bored and doesn't want to play with it anymore at all. By insisting on playing in a variety of different ways with the same materials, the adult can show a child that there are many different possible ways to do things and that finding new ways is fun. This one goal is worthy of many hours of play because when a child with ASD becomes more flexible and creative, life becomes far less anxious for that child. Toys with a single right way to play are not good toys for any child but they are really bad for a child with ASD who already tends to think like this and does not need to practice inflexibility in play.
5. Sensory Reinforcement.  This toy provides a great sensory reward because for people of any age, watching marbles fall, twirl, roll and jump is a visual treat.  For most children with autism, it is beyond exciting!  The trick is for the adult play partner to realize that dropping marbles down is the primary motivation that keeps a child willing to take turns, learn new vocabulary, share control of materials, verbally make a building plan--and so on.  Just like any other thing that you use as a reward, the adult needs to be smart about how the reward is used.  Let the child drop the marble after he or she does something that you want the child to do again and not, for example, after the child whines or demands or breaks something.  This might seems obvious, but there is a tendency for parents to want to avoid a meltdown and so give the child what he or she wants at the first sign of emotional dis-regulation in order to avoid a full blown melt-down.  Instead, a parent needs to model for the child the socially appropriate skill that the child should use but does not know how to use in that moment.  For example, the child wants to drop a marble and is starting to throw pieces because he or she is not getting the marble fast enough.  At this point, show the child what to say.  E.g.  Mom, can I have a marble? or It is hard to wait for marbles! or I wish it was my turn, my brother takes too long! or even showing a child how to hold out a hand to request a marble. If you identify the fact that dropping marbles is the primary reward in this activity, you can be careful to teach what you want to teach with this reward. 
6. Remember that rewards don't work forever  --although, honestly, dropping marbles is interesting for longer than most things.  Knowing that rewards don't continue to be rewarding forever, make sure you stretch out how often you provide this reward by just giving out a Test Marble from time to time at the beginning.  Gradually, suggest that perhaps it would be good to try two or three marbles if you sense that your child is losing interest.  You can also increase your child's interest in other ways--like showing him or her how to build the set in a new way.  At the very end, in the July 4th Fireworks strategy, give your child lots of marbles to send down in a short Grand Finale! Then quit while your child is still enjoying the game and pull it out at another time to play together. Meanwhile, try to teach your child to be rewarded by other aspects of Marble Works play. Help your child learn to enjoy sharing control (if this is what you are working on) by teaching the skill very gradually and without lecturing--the killer of all joy in play is a parent lecture. Mention aloud (for a child who would understand what you are saying) that it is so much fun to play together.  Later, talk about how much you want to play Marble Works again because it makes you happy to play together.  Do not hand over the toys at the end and let your child play alone because your child may actually like playing alone better than playing together!  Sell your child on the idea that cooperation is fun.  E.g.  Come help Mommy set the table. I will be the Parts Person and you will be the Table Setter.  We are good at doing things together!  or Help Daddy drop dirty clothes down the Laundry Chute--I will be the Part Man and you be the Clothes Dropper. We are a team!  Eventually, you want your child to cooperate because cooperation feels good not because it is fun to watch marbles fall down.  From the beginning you need to plan that the initial reward will not work forever.
7. Example of Marble Works Play

It is Hard to Keep a Secret

Here is the most delightful blog post ever on keeping a secret when you are a kid:

Cookie Keeps a Secret

New Autism Games Website Launched

Welcome Visitors!


Please Come In to see my new 
 Autism Games Website!

Still on Tahirih's Imagination Lane at www.autismgames.org

Capitalizing on Your Child’s Interest

Guest Post by Allison Norgard BS

Graduate Student

Each of us has a favorite thing that we love at almost any time on any given day.  Whether you have a sweet tooth or a special hobby, active involvement in that interest always sparks your attention.  Children with Autism also have specific interests--perhaps an interest in dinosaurs, or the presidents of the United States.  It could even be a favorite color that captures a child’s attention.  You can use a child’s passionate interests to help that child develop joint attention skills.

Even if it feels like your child has a very narrow interest, you can still use that interest in many everyday social routines.  For example, a child in this clinic showed a strong interest in the letter ‘w’.  We discovered this while playing with a simple frog toy that spits out letters. We quickly realized that ‘w’ in all contexts was way more interesting to this child than anything else in the room.

Once we identified the child’s interest, we had to find ways for ‘w’ to pop up in his daily life.  It seemed tricky at first, but once we started with one idea, it became much easier.

Here are some ‘w’ activity ideas:

• Use letter shaped cookie cutters.  The ‘w’ cookie cutter can be used in actual foods such as pancakes for breakfast, or for fun at the table with play-doh.
  
• Use ‘w’ during bath time by cutting one out of colorful foam. 
• Make ‘w’ magnets to put on the refrigerator, the filing cabinets, and other creative places around your home and then go out together to collect them.
• Many children love mirrors; use white board markers or shaving cream to write out ‘w’ on mirrors. 
  
• Take blankets or pillows and make a giant ‘w’ on the floor of the family room.  Than you can tickle and squish with the pillows and add some sensory fun. 

As you can see, ‘W’ can become part of any part of the day.

As you can see, ‘W’ can become part of any part of the day.

Although it might seem small and narrow to focus on an interest like ‘w’, you can use a focus like this to teach virtually anything. If you want to work on a language goal rather than joint attention, you can take the ‘w’ and mix and match it with other concepts to build language.  The “w” can come in different colors, sizes, textures.  The “w” can be hidden in various locations that you can name. You can use one simple interest, at many different levels to help a child with autism no matter what the child’s developmental level.  Following your child’s lead by noticing what interest him or her.  When you share in your child’s excitement and interests, it will become much more motivating and rewarding for him or her to play with you.

Here is a letter game with "w":

How Children Learn Vocabulary

Vocabulary is not filed away in the brain like it is in a dictionary, of course.  I don't have the foggiest idea how words are actually stored in the brain but I do know that children gradually come to learn the meaning of words through experiences that occur when the word is spoken.  Vocabulary knowledge is really a complex set of associations between the sound of a word and memories, related concepts, and even similar sounding words.  A new vocabulary word is not simply acquired one day with enough repetition; vocabulary associations are built gradually and the meaning of every word grows and changes.

A baby hears the word Daddy in the presence of one big hairy guy that grins and cuddles and threatens to eat her toes and the word Daddy gets connected neurologically to the feel of a beard, the sound of a deep male voice, a silly grin and the sense of being loved.  Every experience that this child has with her father becomes part of the meaning of Daddy. Gradually the word Daddy is understood as more than a label for a beloved man.  Daddy is the word this child can utter to call her dad when he is in a different room, to complain to him when he says it is bedtime, and eventually to bring him to mind sixty years later when her father has been gone from this earth for a decade.

We learn words within social experiences.  I was in The Netherlands in August for long enough that I began to understand some Dutch words.  The first time a store clerk asked me in Dutch if I needed a shopping bag, I did not understand and she switched to English and repeated herself.  By the time I left, three weeks later, I did understand and would shake my head no and pull out the bag I carried with me.  I learned the words in that particular social context but now, here, I have no idea what the word for shopping bag is in Dutch. If someone said the word to me here, I don't think I would understand it.

Children with autism often have unusual difficulty learning vocabulary but like all learners, they need to learn vocabulary in a variety of contexts in order to understand the varied and nuanced meaning of words.  In fact, it appears they learn new vocabulary like I learned the word for shopping bag in the Netherlands.  They tend to learn the word in one social situation and not even recognize it as the same word  in a different social situation.  If we want the child to understand the word in a variety of social situations, we need to teach the word in a variety of social situations.

Example of different social contexts for the words shopping bag:

Let's go buy a new toy and put it in this shopping bag.  

Help mommy take cans out of my shopping bag.  

I can't find my shopping bag--help me look for my lost shopping bag.  

The shopping bag is too full, we can't carry it.  

You carry the shopping bag, my hands are full.

I have a surprise for you in the shopping bag! 

Now if someone in The Netherlands had used the Dutch word  for shopping bag in all of these contexts, I would probably still know how to say it today.

A Ship's Captain

I remember reading a book, a long time ago, called The Ship Who Sang by Anne McCaffrey and ideas from this book took hold of my imagination and became a metaphor that I have revisited. In the book, Helva is a young captain of a spaceship. She is born with severe physical handicaps but is exceptionally intelligent so she is put on some kind of life support system and then encapsulated in a complex spaceship. She becomes the brains of this ship and the ship becomes her body.

The metaphor of being captain of a ship sailing across the wide expanse of life is not original, of course, but imagining that one is actually, physically hooked up to a complex machine like a spaceship takes the metaphor a little further. The book explores, in the story of Helva, how it is to be both the same as others and very, very different.

Over the years, I have imagined my own brain as Helva, in charge of a complex machine, me, and baffled by both mechanical problems and the complexity of sailing in ever changing galaxies. I have learned to be patient with myself, in part, by reflecting on this metaphor. When I am overwhelmed by large or small challenges, I am not hesitant to seek information from the accumulated knowledge and wisdom of others.

When I think about how we all begin, captains of ships that we don't know anything about, I think it is a strange process to grow-up. In the beginning, as newborn infants, we learn to use our eyes, ears, hands and mouths by trial and error. Luckily we can't sail far at the beginning. It is fortunate that we learn to talk and walk at about the same time. Even before we can talk, we have mastered the art of watching others and imitating their behaviors and even their attitudes toward the world around us. Once we are able to imitate and communicate, we develop navigation skills far beyond what we could learn by trial and error. As hard as it is to captain a powerful human ship, it is possible and we stand a good chance of having a grand adventure because we can learn from the accumulated knowledge and wisdom of so many who sail beside us and who have sailed before us. It is hard to imagine how terrifying it would be to sail through life without others guiding, instructing, and reassuring us all the way along.

The ship metaphor helps me understand and prioritize therapy goals for children with autism. I imagine the child with autism as captain of his or her own ship, trying to learn to navigate through life. I know that this child captains a ship that navigates differently from mine and differently from his parents' ship. In fact, this child's ship may be a thousand times more difficult to navigate and we who are in charge of guiding, instructing and reassuring must try as best we can to understand how this child's ship works.

Goal 1: Sharing what I know and listening to what parents know is the first objective of therapy. If all children who had autism were alike, it would be a little easier, but this is not the case. If I don't understand, and even worse, if the parent does not understand how the child's vessel works, how are we to guide, instruct, and reassure?

Goal 2: The second priority is to create an effective communication system between the parent and the child. The system does not have to be the same as the communication system that flows between other parents and children but it needs to be effective so that when the child is confused or lost there is someone there who will see this and will guide, instruct and reassure as needed.

I believe, as I must in my profession, that these two goals are possible. Sometimes it seems otherwise but it is always possible.

In this video clip, you will see a beautiful little Ship Who Sings. Be sure to watch it as you will be moved and inspired, I promise.

Can a Child Overcome Echolalia?

I was asked this by a parent recently. Worded this way, the question is a little hard to answer. The answer is mostly yes. Yes, many children with autism go through a period of echolalia and use less and less echolalia as they learn more language skills. Many children continue to use rote, memorized language even after the immediate echolalia is gone. It is a long haul for children with autism to learn how to use original, self-generated language to convey original self-generated ideas. Every step of the way is a cause for celebration.

It is not so much that the child overcomes echolalia; it is like if there were 1000 skills that a child would need to talk in complete self-generated, original sentences, a child with echolalia has learned 287 of those skills. I am entirely making up those numbers but my point is, if a child is echolalic, that child knows some important things about communicating--but still needs to acquire many more communication skills. We can systematically teach the child the skills he is missing but meanwhile, echolalia is wonderful because it indicates that the child wants to communicate, is learning to communicate and is trying to communicate with what he knows so far.

The very first thing that I ever read about language development in children with autism was an article by Dr. Barry Prizant on echolalia. I am not even sure if he was a Doctor when he wrote it, it was so long ago. Like many aspects of language development, typical or atypical, it turns out that echolalia is a lot more complicated than one would imagine. I remember the article because it was so unexpectedly complicated that I kept thinking about it even though I had never met a child with autism in my life.

Some reasons why children use echolalia and what to do to help:

1. The child hears people talking as though listening to a song in a foreign language. The child may not have any idea that there are individual words in the long streams of sound that he hears. I hear French this way--like it is a song with a melody that I can imitate even though I don't know what the words mean. I can sound kind of French but not know what I am saying as I imitate someone speaking French. The thing is, I want to imitate that interesting French sound that I hear just like I want to hum a catchy tune. I don't even try to figure out what the speaker is saying. Trying to decode the French is too hard for me but I really like how French sounds so I imitate it. If a child is doing this empty imitation, you needs to help the child understand the meaning of words and phrases. Shorten your sentences. Use less language. Use visuals. Demonstrate meaning. Echolalia is an important sign that you need to do more to help your child with language comprehension.
2. The child repeats what you say because the child wants to take a conversational turn but does not yet have the necessary expressive language skills. The good news is that a child using echolalia for this reason understands that conversation goes back and forth between two people. This back and forth can be hard to teach so it is cool if a child understand this aspect of conversation. A chatty child with autism is much easier to teach than a silent child. But this child still needs to learn how to put his or her ideas into words. You can help a child who uses echolalia in this way by watching for clues as to what the child would say, if he could express ideas, feelings, and intentions in words. Try to read any and all of this child's behavior and translate his behavior it into words. If the child pushes, you say Move, Mommy and the child may then repeat Move, Mommy particularly if you guessed correctly about why you were being pushed. In this case, you use echolalia to help a child learn expressive language skills. It is good that the child repeats because repeating your words will help your child develop expressive language skills.
3. The child does not entirely understand what he hears and repeats it so as to give himself a second go at hearing and understanding. Sometimes the child repeats what he hears under his breath even. Use plenty of wait time after you say things to give this child time to process the meaning of what you say. Add visual supports and demonstrations (as in the previous situations) to increase the child's comprehension of language. It is good that your child repeats language to help himself comprehend better because without doing this, your child would understand less of what you say.
4. Some children are able to use self-generated original language but it still requires more mental effort than repeating what others have said. Echolalia is habitual and easier. For this child, you may need to help the child focus by getting down at the child's level, saying things that alert the child to your genuine interest in his or her thoughts, and in a variety of ways support the child's hard mental work of composing original language. Today, for example, I put a child in a swing, pushed him several times, then stopped the swing and asked him to compose an original sentence, Tell mom what we saw on our field trip. He repeated some of what I said, what we saw.. I gave him a couple more swings and stopped him and said Mom, we saw____ . He said a balcony. I gave him two more swings, stopped the swing and held up one finger and said, Mom, we saw a cool balcony. I held up another finger and and looked at Jacob. He said And there was no one in the audience. I nodded and said, We were the only people in the theater, no one was in the audience. Jacob was on to my topic now and mom, of course, responded with interest to everything he said. Jacob's sentences became increasingly complete and interesting. However, he went back to using more rote, memorized language as soon as we stopped providing that level of support. In this case, it is good that your child uses echolalia because it alerts you to the fact that you need to provide more language support in order for your child to successfully generate original thoughts and express these thoughts in words and sentences.

The main point that I remember from that long ago article by Barry Prizant is that echolalia is a good thing, not a bad thing. Kids with autism learn language differently than other children and echolalia is a tool of that learning process. There are many reasons why a child might use echolalia and if you can figure out the reason, you are better able to teach the child the next important language skill.

The Big Book of Exclamations

Brandon likes books but he does not like to have his mom read books to him. Perhaps it is because she interrupts his careful page turning or because her talking makes it hard for him to focus on the details that he loves in pictures. Whatever the reason, it was frustrating for Brandon's mom because reading together was something that she wanted to do with him. She was so excited when she found that Brandon would willingly become engaged in reading The Big Book of Exclamations with her.

Brandon is not saying many words and his understanding of words is limited and inconsistent. When his Speech Pathologist, David Harper M.S. CCC, suggested that mom read The Big Book of Exclamations with Brandon, she was surprised at how many exclamation words Brandon recognized and how much he loved hearing these words. Ah Oh! BEEP BEEP! Weeeeee! He studied the milk spilling, the car honking and the child sliding down a slide with great interest as mom read these highly expressive words.

Speech Pathologists really do have some good tricks for getting young kids using and listening to words, as you will soon discover if you read The Big Book of Exclamations to your child. Teri Kaminski-Peterson, M.S. CCC, the author has provided strategies for reading the book that are every bit as important as the lovely pictures and perfect word selection. This book is appropriate for toddlers and preschoolers who are just starting to talk and even pre-readers who like to memorize the text in a book and then read it to an appreciative listener.

Willing Little Warrior

I took Brent with me to pick a toy from our toy closet this morning. I said, Hold my hand, let's get a toy. This is not part of our routine. He lifted a limp hand to put in mine and I turned back and leaned down beside Brent to say We will be right back, Mommy. Brent's beautiful blue eyes were somber through this exchange looking at me in his quiet, serious way. I was pretty sure he had no idea where we were going, or why, and he had no idea what I had said to his mom. Still, he came with me, willing to take on so many unknowns just because I asked.

At the toy closet, Brent looked over the toys and games carefully but stayed very serious given the riches I had set before him. He did not reach out to select anything. I encouraged him to desire something saying, Brent wants..... No response for a while so I waited while he looked longer. Brent finally saw a toy stoplight and looked suddenly alert. He did not look at me but he said, Do you see Stoplight? He was not asking me if I saw the stoplight but rather was imitating what others say when they notice his interest in something--he was tentitively requesting the stoplight. I said Brent wants stoplight. OK and handed the box to him.

Brent dropped to the floor immediately and opened the box to pull the stoplight out. Wait. I said, gently as I took the box from his hands. We will play in Tahirih's room. Since I had picked a second toy to take back with us, my hands were full and the lid to the stoplight box was on the floor. Get the lid. I said. No response. Pick the lid up. I tried. No response. I touched the lid with my foot and said Brent, pick up the lid. Brent immediately put his foot on the lid too. Brent did not understand a word I had said but, sweet boy, he was quite willing to do what he thought I wanted him to do.

I don't know why, exactly, but this moment made my heart feel--I don't know what to call it. When a child is so willing and so brave, I feel some constellation of admiration, sadness, and love.

Getting All My Ducks in a Row

Much to my husband's amusement, I am writing still another post on rubber ducks. In a previous post on Ducks and Duck games, I suggested buying ducks in pairs but apparently failed to make it clear enough why matching pairs of ducks are better than single ducks. A reader suggested I clarify this so I am using this suggestion as an excuse to take more duck pictures and write more on playing with rubber ducks. This is my third post on ducks and if I continue on this track, I may have to make a new blog, just for rubber ducks. Regardless of the toys you use, it is my hope that thinking about the play ideas I suggest here will help you create more imaginative and engaging games for your child. I am moving the three posts on ducks so that they are all in a row and thus easier to read one after another if you are so inclined.

Setting Up A Visual Pattern
I engage children with autism in games with a number of strategies but none is so fail-proof as creating an obvious visual pattern. Repeating this visual pattern a few times and then inviting the child to help me continue is so successful that I use this play principle in dozens of games.

It is easy to set up visually obvious patterns with rubber ducks. Rubber ducks are bright colored. They all have the same unique but obvious ducky shape. If the rubber ducks vary just a little, but they come in matching pairs, matching rubber duck pairs is a still more obvious visual pattern.

Simply matching duck pairs is enough of a game to get some children involved. If you have enough duck pairs, you can just keep setting out one of a pair, hand your child the second in the pair, and your child will add the matching duck to a simple duck parade. This can happen on the edge of the tub or under the kitchen table or pair-by-pair up the steps to the second floor of your house.

Simple language is easy to add to a game of pairing up ducks and language both complicates the game in some delightful ways and teaches your child new words and new pretend play ideas. You might quack each duck up to the parade and that would be fun for a while. You might up the drama with simple pretend play ideas like knocking ducks over, kissing bruised feathers, and putting on bandages. After an exhausting set of mishaps, you might put pairs of ducks to bed for the night under a tissue blanket saying Night, Night, go to sleep. These are simple play frames and just right for some children.

Other children will enjoy much more complex language and more complex play ideas. A duck story is easy to weave with these versatile actors, since they can say or do almost anything that your child and you can imagine. If your child is ready for more complex duck tales, weave stories of high crime and drama. Remember the world from your child's perspective and you might be inspired to create stories of ducks that are naughty and won't go to bed. Ducks that are hungry but will only eat green worms. Ducks that are angry because sibling ducks get to sit next to Mommy duck in the front seat of the car. Ducks that are scared of loud noises or get lost from the pond because they wander off alone. In duck world, retell the story of your child's life. Telling such stories with ducks makes the story more concrete and the use of duck re-enactment can help a child listen, comprehend and enjoy whatever story you might tell.

Ducks Get Lost

All the ducks are in the pond. Oh No! One Flower Duck left the pond. Flower Duck is lost! Flower Duck, where are you? Everybody, look for Flower Duck! Flower Duck is in the house! Yeah! We found Flower Duck. Come down Flower Duck. Come back to the pond. Now Two Flower Ducks are together! Yeah!

Oh No! Now One Birthday Duck is lost! Birthday Duck, where are you? Look for Birthday Duck! Birthday Duck is in the house! Come out Birthday Duck. Come back to the Pond. Now two Birthday Ducks are together--that is happy.

All the ducks are in the Pond. Don't go away ducks, you might get lost!

Having matching ducks is motivating to many young children with autism--simply because it is a visual pattern that is easy to see. Matching ducks may still be motivating for older children with autism who might be ready to start enjoying longer pretend play stories but still find it hard to listen to that much language. One duck missing from a pair is visually easy to understand and is a pretend problem that will matter to most children. The rest of the story, if it resonates in a child's life or delights a child's sensibilities can gradually make sense. Putting together duck pairs works to sustain attention so that play and language skills can grow.

Rubber Duck Games

There are as many games to play with Rubber Ducks as there are variations on Rubber Ducks. Start by getting a cool collection of say, 10 or more ducks. The more the better--up to a point. Click here for one extensive duck collection or visit any toy store--but get identical pairs of ducks and make sure each pair is distinctively different from the others. Let's start with a traditional play idea:

Bath Game 1
(good if your child is not yet talking)

Put the ducks up on a high shelf or on the other side of the room from the bathtub then call the ducks, one-by-one Du-uck, Come here! and bring a duck over to put it in the tub. Gesture for the duck to come with your hand as you call it.

Take the ducks out of the tub, one-by-one saying Bye Bye Duck and put it back where it was on the other side of the room.

Bath Game 2

(good if your child is starting to say words or use pictures to communicate)

Take a photo of each kind of duck and laminate it--leaving a little edge of plastic around the photo so no water can get in. Play the game the same as the previous game except that you should call each duck by name while looking at the duck you intend to get for your child. Pirate Duck, Come here! Let your child pick ducks by looking at, touching, or handing you a photo of the duck--or by calling the duck. Since your child takes a bath pretty often, don't worry if he or she actually says the names of the duck or uses the pictures to choose--just keep playing the game every bathtime.

Bath Game 3

(Good for if your child is talking and you are working on conversation)

Play as in previous games, only after you and your child have settled on names for all the ducks, use clues to get the ducks. For example, you say: A duck that has a red hat. Your child says Fireman Duck!

More duck games to come.....

Why You Need Flocks, Herds and Collections of all Kinds

I use flocks and herds and collections to entice young children to play with me. One reason is that collections are intrinsically interesting. There must be some kind of a collector gene in our DNA because we are all drawn to collections. Even more importantly, once you have a child’s attention with your collection, there are so many ways you can play with a group of—well, anything.

The gaggle of geese or menagerie of Beanie Baby animals or set of colored markers works better for conversation if they vary in some interesting ways. Below is a set similar to the collection I use:

(Photo from here)

I often set Beanie Baby Animals all in a row because it is easier for a child to see that there is a collection this way in the same way that you might line up a collection of photos on the wall for visual effect. But groups are interesting too. Sometimes I can’t put the whole collection out at all because for some children a group of inviting things leads to a strong hoarding instinct and the child will need to gather and hold the collection. Once your child has the collection in his or her possession, the possibility for playing together with the collection is often over as you will have to wrestle them away to do anything else and the fun factor has gone to negative ten. Sometimes I use a high shelf on the wall to set the collection on so the child can see it but not get it all at once. This is such a good strategy that I suggest all families put a high shelf on the wall in the room where they play. Sometimes I take pictures of all the items in the collections and keep the real collection hidden away until needed allowing us to discuss and assemble the collection using the photos as a point of reference.

Many games that can be played with a collection are based upon 1) getting the collection to your child item by item in some interesting way, 2) doing something interesting with each item, 3) taking each item away in some interesting way. One child that I knew (and whose mom reads this blog so it will be interesting if she remembers this) loved long skinny things so I started collecting pens. He would pick up a picture of a cool pen and then I would get it for him. We would draw something quick with each pen and then he would hold it and study it, which is what he really wanted to do. I would say Bye Bye to the pen, naming it again, then putting it away. We had a little trouble with this last part for several days as giving each one up was hard but it got to be fun because he knew what was next. I quickly offered pictures of other cool pens and he selected the next one and we did it all again. I saved his favorite pen for last as he would never have given that one up quickly enough to make the game move forward at a good pace.

With a child who had more language, we might have drawn together for much longer, talking about what we were drawing and I might have set each pen upright after we were finished in a long snake of play doh so that he or she could see the collection growing pen by pen.

We can gather a collection with hide and find games or collect them by asking family members for items in the collection or send each one under a door to the child—there are endless ways to get the collection to the child in an interesting way. The items can be called, named, scolded, used, analyzed, rated, sorted, washed, displayed, photographed, lost, found, altered, wrapped, given, or hidden. The only limitation on what you do with a collection is the scope of your imagination.

March, 2009 Posts will include a Duck Collection Set of Games.

Eric and I Look for Mommy

Previously posted on Autism Games: Moving Together, where you will find a collection of games that are all based on Moving Together.

Eric and I Look for Mommy

Long ago, I worked with a three year old who had a diagnosis of autism. He was my first preschool student with ASD and I did not know how to get his attention--let alone engage him in any kind of language therapy.

He ignored me studiously and did not glance at my toys. He kept himself busy moving--pacing around my therapy room. He sometimes went to the door and cried and was more upset when I tried to console him. He ran away whenever I approached. But he looked at me when I said, You want Mommy.

So I picked him up, (flailing at first) and walked with him up and down the halls of the school where I worked, calling out, Mommy! Where are you? We would stop and look in each of the tiny windows in the doors to various classrooms and I would say Oh No! No mommy here!

It would be a few years before I hit upon the idea of keeping parents with me in the therapy room but this little boy might have set the seeds of that idea with his rapt attention to the task of finding his mom. Once he understood that he and I shared the goal of finding mommy, he was content to let me carry him around and he looked with me for his mom and soon he looked with me at everything, up and down the halls.

With this little boy, I created a moving together game that became our first game of every therapy session for months. I started each session with a marching game, saying March, March, March, Stop! If Eric looked right, I marched to the right. If he looked left, I turned left. Ready… Set… Go! I would say as I started from a stop. Run I would say as I ran. Stop I would say as I stopped again.

Our halls were full of interesting people, like babies from the daycare in their six pack stroller cart. Hi Babies! I would say. Hi Babies! Eric would repeat. Hi Marty! I would say as I walked past one of the other Speech Pathologist in the hall. Hi Marty! he would repeat. Hi Eric! she would answer.

I imagine that children have been learning to talk while being carried around by adults. They are a captive and happy audience to our chatter.

Following a Child's Lead

Some of the best games are games that you make up, on the spot, when a child seems to be interested in other things and not playing with you. Such was the case today. I had a game in mind with a set of puzzles but Michael took one puzzle over to the corner wall, took a few pieces out of it and studied each piece by himself. With his back to me, he could not have said more clearly, Leave me alone, I am busy. So the challenge was, how do I find a way to help Michael want to play with me?

Let me lay this challenge out a little more clearly:

1. I don't want to grab puzzle pieces out of Michael's hands (this is not only rude and undignified--it also encourages Michael to grab).


2. I don't want to give up on puzzles, since he is clearly interested in them (although I could have pulled something more interesting out and made sure I kept control of the materials this time).


3. Michael has told me that he sees me as an unnessary complication in regards to this puzzle play and I want him to see me as an important and interesting part of his play.


I give Michael a little time to study the puzzle pieces--which are signs, like road signs and such. While he studies the pieces, I study what he is doing with each one. He takes each one and puts it up against the wall--often trying to place two or three above and below each other--but they fall out of his hands if he lines up too many. I can't figure out why exactly but I try it and line up puzzle piece against the wall beside him. I don't get much of a sensory buzz out of this and I can't remember seeing signs lined up this way in the real world, so I don't know what he is doing or why. He is aware that I am doing something with puzzles next to him but I am probably not doing the thing that Michael was trying to accomplish so Michael is not interested.



Plan B. I think about other things that Michael is interested in that might explain his interest in these particular puzzle pieces--since he actually likes to put inset puzzles into their appropriate spots on the puzzle, what he is doing seems curious. Two of the pieces in his hands have words written on them. STOP and First Aid and the third depicts a stoplight. I know he likes to spell words. I pick up a pencil and trace a sign and then write the words on it as I spell it out. C A U T I O N spells Caution I say. Now Michael is looking at what I am doing with interest. I continue to write and spell words and he hands me puzzle pieces now when I hold out my hand for another one to spell. I hand back each puzzle piece as soon as I am done so he does not think I have devised a tricky way to get them away from him. I think to myself that I could line them up, in written form, one on top of the other and I do that on the paper. Michael clearly likes this idea. We are in business, he is completely hooked on this new game. By including me in his play, Michael is able to accomplish exactly what he intended.

NoKay

I love to help a child find words that he or she really wants to say. Sometimes--well often, I create situations where a child really wants to say something.

One little guy who was nearly nonverbal a few months ago loves lights so much. I would turn the lights off with one set of light switches and he would start to wail. I would say Daddy help! Light on! and he would stop crying long enough to say Light on! and run to the other set of light switches where daddy stood, and hold his arms up frantically. After all the lights were back on, he would walk away, fussing a bit and watching me warily in case I turned the light off again from the other set of switches. This was not his favorite activity but he was highly motivated to get the lights all on and would say the words necessary to make this happen. If I moved anywhere near the light switches, he would run to grab my hands and pull me back. If I asked him first Can I turn light off? he would reply NoKay which is the opposite of OK. We have been discussing lights and arguing about lights for many sessions. Yesterday, he gazed out the window in our clinic as street lights began to turn on and said light on. I replied Yes. Light on outside. We sat together on a step, playing with a balloon and every once in a while he would comment again about the lights on outside. We went back to the window to gaze at them again several more times before the session was over. He went home and told mom, Light on outside!

I think of it as a sales job, when I set out to demonstrate to a child why he or she should say words. If a child cares about something deeply, this is the topic to talk about, one way or another. If a child hates my ugly bug puppet, I pull it our regularly so the child can protest and then I can yell Go Away Bug! and throw it out the door. It is not long before the bug hater, if he can possibly do so, will be yelling Go Away Bug! And often yelling this with glee. I have had children request the bug that at first was genuinely frightening, just so he or she could yell at it. This is an easy sale because the child is already sold on the idea of the bug being banished, I just need to sell the idea of using words to do it.

I think that often we are not observant enough to figure out what would actually be an interesting set of words for a child with autism. We want the child to say things that are not interesting at all like to say the names of farm animals and colors. How may conversations about farm animals or colors have you had recently? We also want a child to say please, say hello, or answer questions like Why are you so upset? (which, I'd like to point out, grown men find hard to answer).

Talk about what a child cares about. If, for example, a child likes pencils and pens then discuss these. I once had quite a large collection of writing instruments that had names (light pen, bunny pen, Santa Pen, tiny pencil, tall pencil, wiggle pen, spinner pen, and so on.) I used these every session for weeks with a child who loved, as it turned out, all tall skinny things--even brooms and magic wands. I took pictures of every pen and pencil and we discussed each one, one by one, gazing at the picture as we talked, until the entire missing collection was found and collected again. Oh No! Skinny Pen is All Gone! Yikes! Skinny Pen where are you? Mom, where is Skinny Pen?

It is OK to use emotions to motivate language development. We all talk about what we are scared of, angry about, longing for, worried about, annoyed about, disappointed in, passionate about, in love with, fascinated by, curious about, revolted by, disgusted with and so on, and so on. If you are going to be putting words into a child's mouth, put the words in that the child really wants to say. A boring vocabulary lesson is NoKay.

Note: The emotion pens shown above are from here.

Words Every Child Should Be Able To Say

Picking out good first vocabulary words is often confusing for parents. Here is what I have come to believe:

• When your child wants to end something, he or she should be able to say all done, stop, or bye bye. The bye bye should be a way that your child can end an interaction if he or she does not want to hang out with someone. Don't worry about politeness until your child has a core vocabulary. Link to Sharing Emotions Games.
  


• When your child wants to begin an activity, he or she should be able to say go to get things started.


• In some way or another, your child should be able to say that he or she is mad or hurt or scared. And when your child communicates this, in any way at all, he or she needs to be acknowledged. Link to Sharing Emotions Games.
  


• If your child does not like something that you do or someone else does, he or she should be able to say don't, I don't like that! go away, or no! This is a time to acknowledge your child’s feelings and respect them if at all possible. Link to Sharing Emotions Games.
  

• A child needs a way to agree or disagree in a lot of different situations knowing how to say yes or no is very helpful--although most of my young friends learn the no early and the yes much later. Link to Yes/No Games.
  


• If your child wants to get your attention, your child should be able to call you with Mama, Daddy, or say come, or play. Link to Calling and Greeting Games.
  

• If your child misses you when you are not there, your child should be able to ask about you or talk about you with your name-- Mama, or Daddy. Missing a parent is a topic that should be discussed rather than brushed aside. Link to Calling and Greeting Games.
  


• If your child is hungry or thirsty or needs to use the bathroom, he or she should have a way to say eat and drink and potty.

• If something breaks or falls or does not act the way it should, your child needs a word to express surprise or dismay; something like Uh Oh! Oh No! Yikes! or Oh Man!
  

• If someone takes your child's stuff, he or she needs to be able to say mine!
  

• If your child wants a turn, he or she should be able to say my turn. Link Turn Games.
  

These are some of the first words that I teach children to say--focusing one by one on these important words. Because these words are so important, I really like the Springboard Lite and the other speech generating devices from Prentke Romich for children who are not able to rapidly acquire verbal skills. Prentke Romich got the words right on their devices. Even if you use another augmentative communication device, and there are now several good ones on the market, these are some of the most powerful words to make available to a child. Some of these words can be represented in pictures in a PEC's system but I have to say that children tend to use these words faster and more frequently if the words are available with a voice.

I teach these most powerful words in a variety of ways as I begin to help children learn to use words to communicate--a goal that I typically get to right after establishing some basic joint attention and a desire for social interaction. I model the words, of course, and demonstrate in every way I can how these words might work to meet each child's needs. I highlight the words and make them available to children even before the child can say the words by using augmentative communication systems including Mayor Johnson Boardmaker pictures, and Talking buttons, the Go Talk 20+ and a Springboard Lite. Even for verbal children, I often make the words available visually or on an augmentative speech device. Why? Because children learn words faster this way.

When it works, it is addictive to communicate. Every communication success speeds up a child's motivation to talk. The goal of early language therapy is to make communicating with language as easy as possible. We know that if kids try it, they will like it. But most of all, I make these words available because every child should be able to say these words.

Below is a picture of the layout of communication buttons on the Springboard Lite. You can see this better at their website where you can download a trial version of their program onto your computer. I never teach this whole array all at once to children but rather present and teach the buttons one or two at a time--but most the important words listed above are on the home page of the this device.

Solving the Elephant Word Problem

The most effective intervention for children who use jargon or who use echolalia is to help these children understand the language you use and understand the social dynamics of each situation. Please see previous post. There are many strategies for accomplishing this but in this post, I want to talk about helping children comprehend words and word combinations. Some children talk in what sounds like meaningless gibberish but may actually be speaking in a kind of word that I have heard described as an elephant word.

An Elephant Word is something that the child thinks of as a word but which is actually a phrase or sentence that the child has heard. For example, in a preschool classroom each day at 10:00 am, the teacher says, Time to put the toys away. Then he sings a clean up song and helps the children put all the toys in boxes and on shelves. He then says Come to circle-time, sit on your carpet squares. A child with autism may begin to understand this routine and even have noted the words that the teacher says each day because the teacher tends to say this the same way every time (which is a good thing). To the child with autism, these three utterances sounded like three long, hard to pronounce words 1) timetoputyourtoysaway 2)cometocircletime and 3) sitonyourcarpetsquares. A word this long is not easy to repeat, though, and even if the child is trying to do so, it might not sound like anything intelligible. Try this six syllable word: saimnaywonkameemtak. Now close your eyes and try to repeat it. Even if I tell you that this means Let's eat applesauce for dinner, you'd have a hard time learning to say it because you don't know what part says applesauce or what part says dinner or any of the individual words. Only a passionate love for applesauce or a million repetitions (or the word in a song) could make you learn a word that big. It would be a lot easier to learn if you could hear the long string of sounds as meaningful words.

So that is the problem--the Elephant Word Problem.

Here is how I help children with autism to hear words as words.


I take the utterance apart for children and demonstrate the meaning of the words within the utterance. I might teach a child to hear sit and carpetsquare this way. Assuming the child, Amy, knows the phrase Amy's turn, I might bring her brother in to help with the game and say: David's turn. David sit on carpet square. Then, turning to Amy, I might say, Amy's turn. Amy sit on carpet square. And after I help Amy sit, I might begin to demonstrate the meaning of sit by contrasting it with stand. David's turn. Stand on carpet square. Amy's turn. Stand on carpet square. Because I know that Amy loves to play a game we call Go to Sleep/Wake up! I say David's turn. Sleep on carpet square. I would help David make this dramatic by snoring and then say Wake Up! and have David leap off the carpet square. Amy's turn. Sleep on carpet square. After this sleeping game, I need to clarify carpet square. I know Amy knows color words so I use them in the next part. All done. Bye bye red carpet square. Bye bye green carpet square. I put the carpet squares away with some procedure or another. Then, I announce, Time for blankets. David's turn. Sit on red blanket. Amy's turn. Sit on Green blanket. And so on.

This game might work with Amy but for a different child, say a child who loves trains and can think about little else, I might have to add a little presentation of train cars between each step of this game. In other words, I need to find a way to capture the child's attention or all this talking will be water off a duck's back. I don't need to break up all the sentences that Amy hears in order to help Amy hear words within sentences, but I might need to do several months of this kind of therapy in one way or another. I would certainly teach Amy's parents to break up and demonstrate the meaning of frequently used phrases so that they could help me speed up the process of breaking up Amy's Elephant words.

Note: A parent recently told me that where she sees one step between A and B in teaching her child to communicate, she often learns that there is A1, A2, A3......A9, and then B. That is true. We know there are two dozen steps or more to helping a child learn to read, but if a child does not learn to speak and use language spontaneously, we often find it hard to imagine all the steps to learning that are involved. Breaking it down into learnable parts is the challenge. You know that you have, indeed, broken the skill down far enough when a child begins to show an interest and learn.

Aaron's Story, The Beginning

My colleague, Angela Fellman M.A., a newly graduated Speech Language Pathologist, has just started working with a little guy, Aaron. Aaron is a young child with autism. He is not yet talking nor intentionally communicating beyond crying when he is upset and running when something does not appeal. He moves rapidly and constantly. He dashes from one side of a room to the other, switches on and off lights, ducks when Angela reaches for him even to save him from falling and bolts out the door if she stops being vigilant for even a moment. Aaron may be making Angela re-consider her chosen profession. After an hour, she looks sweaty and discouraged. But, she keeps trying to find activities that will win him over. Are there any activities that would win Aaron over? He seems unwilling to meet her half-way. But if he could talk and explain his position, I think the conversation might go like this: Angela would say, Aaron come play with me. Aaron would replay, I don't understand what you want me to do.



The games seem appropriate; Angela wants Aaron to pop bubbles with her, knock down blocks, swing in a swing, drop balls down a length of gutter. Aaron has shown the ability to do all of these things. He pops a couple bubbles but then tries to mouth the bubble wand and she ends up wrestling it away from him. He knocks down one block but then lobs the next one across the room. He drops one ball down the gutter and then runs toward the unguarded exit door. He swings for a moment and then wants down. If Angela starts to direct him toward another activity, he instantly melts to the floor, morphing into a thousand pound puddle. He is doing these activities for an instant but never for long and never with any apparent enjoyment. He seems unable to sustain any activity for long enough for it to become social, playful, or pleasurable.

I often wonder, with a child like Aaron, if he understands any activity as an Event. Does he perceive any time frames in his life as having a beginning, a sequence, an end. It is a trick of the mind to slice up the continuous stream of life into events. Children learn this trick over time with more and more complex sequences coming to feel like distinct events. Children learn to call one period of time, taking a walk and another period of time, eating, and still another period of time driving to the store. Children learn to see one moment as the beginning of an event and a series of moments as part of the event and a distinct moment as the end of the event. Maybe with driving, for example, it is opening the car door and getting in or getting out that defines the driving event. But what if a child never mentally grouped moments into events? What if the child just bumped into one moment after another without ever having a sense of starting, being part way done, or ending--well, anything? Well, then a child would behave just like Aaron does.



How could we tie a series of moments together in Aaron's mind so that he could begin to perceive a group of moments as an Event?

The way we usually write this goal is: Aaron will willingly engage for three to five turns in a variety of games with an adult.

We write goals so that they are measurable but it often helps to try to imagine the way a child understands what he or she is doing (even though we can't directly measure this) and so Angela will try to help Aaron understand each game as an Event with a beginning, a middle and an end. As Angela finds a way to engage Aaron in several new games, as I am sure she will, I will let you know how she does it. To be continued.