Some say that if you have met one child with autism, then you have met only one child with autism. That is because every child who is on the spectrum has an entirely different diagnosis and therefore has a unique set of needs and strengths. Consequently, it's impossible to design a uniform teletherapy plan for the autistic child.
At the same time, there are three fundamental principles that can serve as a general framework and guide an effective treatment plan for the autistic child to whom you are delivering teletherapy.
1. Establish Communication That Is Spontaneous and Functional
You must deal with first things first. Your initial goal in the teletherapy session with an autistic child is to assure that her communication is both functional and spontaneous. In other words, the child must have the capacity to communicate her basic needs and desires to those surrounding her independently, without being prompted regularly.
Sometimes the child's speech is so dysfunctional that introducing some form of augmentative-alternative communication (AAC) is necessary until a more organic method can be found. And even here, you need to be flexible as different forms of AAC work more effectively for different children. Some of the options available are:
Voice-Output AAC Device: When the child hits a switch or pushes a button, the device delivers an auditory message. These devices are often straightforward, easy to use, and quite effective in allowing the child to communicate.
Picture Communication System: For some children, communicating through pictures or object exchange is more concrete, and are therefore the methods of choice. Another phase in the system is introducing a simple communication board and teaching the child to point to the picture that conveys what she wants. A next can be incorporating the board into a voice-output device as mentioned above.
Sign Language: For some autistic children, sign language has proven to be very useful. Using their body to communicate the message has another significant benefit as well. It has been shown that many of these children become verbal quicker than they would have without sign language.
The Importance of Helping Children become Spontaneous
Many autistic children suffer from the deficit of being unable to speak spontaneously. They won't initiate dialogue, even in expressing their own needs, but will merely respond to another's initiation.
This being the case, it is imperative to gradually fade cues that prompt the child to speak, and thereby cultivate the child's facility to speak independently. There are many ways to fade cues for the child. And it is often the synthesis of the particular child's challenges and the SLP's creativity that will yield the most effective approach.
Another approach that has been effective for some therapists is first to teach the autistic child basic requests for those things that will be the most motivating to the child. And then gradually move on to more abstract interactions such as greeting, or commenting. Sometimes just opening that verbal door will lead to unexpected results!
2. Weave Social Communications into Daily Life
Once the autistic child's communication has become both functional and spontaneous, it is time to move on to the social realm. In this area as well, autistic children require direct instruction; if for no other reason, but the fact that understanding someone else’s behavior is difficult for autistic children.
What most children pick up naturally in their social interactions beginning in playgroups or daycare, and continuing into Elementary School, doesn't often happen for autistic children. These children demonstrate poor understanding of how to behave or act appropriately in social situations. This deficit if not resolved will invariably carry beyond the social dimension of school and negatively impact learning.
Socially Acceptable Behaviors Require Direct Instruction
It is imperative to explicitly teach autistic children what is both appropriate and inappropriate in various social environments. This goes beyond instructing the child as to what can and what cannot be said, but includes how the child should listen and react to others as well.
Regarding younger children, the focus will be on necessary skills such as listening when the teacher is speaking, following directions and answering the teacher's questions. As the children become older, the lessons will focus on communicating with a friend and participating in group conversations.
Social instruction strategies that have proven effective for autistic children include:
Visual Supports: Strategically planting visual reminders in the classroom to assist the child in remembering expectations for different situations.
Social Stories by Carol Gray: Reading stories that will teach the child what behavior is expected in various situations.
Video Modeling: Showing the child videos that demonstrate expected behaviors.
3. Peer Interactions Need to be Targeted
While teaching autistic children the basics of social communication is necessary, it is in no way sufficient. Think about it, just learning what to say on the one hand will help the autistic child to be appropriate. On the other hand, it may leave the conversation with a peer stilted and lifeless. Much more needs to be done to help these children have healthy social interactions and relationships.
The more subtle art of communication can be taught to autistic children. However, it is critical to remember that the skills to impart must be developmentally appropriate.
Peer Interaction Skills for Younger Children
Play skills: Young children need to graduate from parallel play and be taught how to play with others, taking turns and getting along without fighting.
Responding to Name: Show these children how to react when someone says their name.
Developing Attention Skills: Help autistic children to become tuned in to other children's reactions and feelings.
Peer Interaction Skills for Older Children
Targeting Conversational: Observe the autistic child's conversations to determine which social skills are lacking in regular dialogues and interactions with other kids and adults. Focus on these specific skills in the session.
Learning How to See Other Perspectives: An autistic child is often “trapped” inside his world. Consequently, the notion that there is such a thing as another's perspective is entirely beyond his grasp. Therefore the concept of another perspective needs to be introduced and explained, so the autistic child begins to realize that there is an "other."