Building Communication Around Routines by Susan Boswell

The WHY of Communication
There are a number of reasons why a child might use communication. Two very important and also very different reasons are:

  • to regulate others and get needs met
  • to share attention and experiences with others

For children with autism, while both of these communication functions may be difficult to learn, the second one is the most difficult. Our goals for communication training for children with autism include helping them increase both the regulatory function of communication and also increase their motivation and understanding of using communication in more purely social ways. We hope to help them realize that they can share experiences with others, that it is fun to do so, and that communication is a part of this sharing of experiences.

Why Use Routines?
Routines are of high interest to children with autism. Learning and using routines are learning strengths. They like the predictability of routines and, left to their own devices, often establish their own rigid routines and become very upset if they are disrupted. By establishing a positive routine, and then disrupting it, we create an incentive for the child to communicate in order to re-establish the familiar routine.

Joint Activity Routines
A joint activity routine is a powerful teaching tool for children with communication disorders. This term describes a routine in which the child and the adult engage in a meaningful activity together and communicative behaviors are taught within the routine of the activity.

Key elements of Joint Activity Routines

  • They occur in a meaningful and functional context (such as a play routine, a bathing routine, etc.)
  • They use the child's interests and strengths.
  • They are social (involve 2 people) at the child's level of understanding (ranging from parallel, to cooperative, to turn-taking, to interactive)
  • The adult role is to:
    1. set up the environment and introduce the activity
    2. add visual supports to the routine (such as pictures, objects, print words)
    3. repeat and establish the routine, and then
    4. wait -- and cue the child with the visual supports as needed to continue the routine

Settings / Activities Conducive to Interactive Routines

PLAY: social baby games play with toys motor games table games exercises music pets
SELF-CARE: dressing eating bathing hair care selecting clothes
SOCIAL SETTINGS: greetings delivering messages serving refreshments shopping
COMMUNITY LIVING: eating out travel in the car walking
DOMESTIC LIVING: putting away toys setting the table cooking (stirring, pouring, opening, cutting, etc.)

Examples of routines

1. Motor "sandwich" game:
This routine is built on the child's enjoyment of deep pressure. The "sandwich" is the child between 2 large pillows, with the adult providing deep massage pressure to the child's back or tummy. Visual supports to use include the pillows and/or a picture of the pillows. Paired language could include the child's name, such as "Johnny sandwich" or "Make a Johnny sandwich". If other children are included, photos of each child can be incorporated so that "Johnny sandwich" can be distinguished from "Susie sandwich".

This type of play routine, based on physical activity, is frequently very motivating to our beginning-level students. Other examples could be blowing a balloon or bubbles, pick up and swing routine, "airplane" on the adult's feet routine, or rolling/spinning objects. These are all simple routines (1-step) and appeal to the child at a sensory level.

2. Making juice routine:
This routine is built on a meaningful and motivating activity--snack! Practice steps daily over several days, using the same materials and sequence and allowing/ guiding the child to actively participate. Visual supports include the needed materials (juice mix, pitcher, spoon, etc.) and a picture array on a display board for 1 or more of the same objects/actions of the routine. If the child can only do 1 step of the activity, then only 1 picture would be displayed. The adult uses simple language for each step, paired with the objects and pictures. When the routine is well established, disrupt it by leaving out a needed material or pausing and waiting for the child to act (verbally, with the pictures, or with the objects). This format is useful for multiple step routines.

3. Swimming pool routine:
Look for activities that you can find a waterproof object to be a part of. For example, holding a toy boat, the routine could be the "Motor Boat" chant that goes slow and then fast, with the teacher/parent providing the speed through the water for the child. Another example could be the "Walk, walk, walk, and STOP" chant holding a toy stop sign and substituting different verbs, such as walk, jump, run, etc. Another could be the "Bunny Hop" holding a plastic bunny. These routines offer the child a chance for initiation either verbally or with the objects, while they also offer a fun way to pair meaningful action verbs with an activity. They also incorporate the use of music and rhythm, which is often both very interesting and helpful to children with autism. Pairing words with rhythmic movement or music is another strategy to develop motor activity routines.


Susan Boswell
TEACCH
Susan_Boswell@med.unc.edu