Strategies for supporting children with autism in an early childhood setting

Children with autism are more than capable of learning new skills and of interacting successfully with peers and adults. In some cases, they may need more support or different types of support to thrive in a busy, and sometimes overwhelming, early childhood environment. This resource provides some simple strategies for supporting children with autism in an early childhood setting. Specifically, it covers strategies for increasing engagement and participation, teaching new skills, supporting communication and understanding, and addressing challenging behaviours. The value of including parents is also discussed.

It is important to remember that every child with autism is different, and that none of these strategies will work for every child. Teachers should select strategies based on their knowledge of the needs and interests of the child and the desires of his or her family/whānau. As most ECE centres have high child to teacher ratios, there may only be limited opportunities for teachers to interact one-on-one with the child. If the child has an Education Support Worker (ESW), they can be used to free up additional time for the teacher to interact with the child. Therefore, it is recommended that teachers identify key times throughout the day that they could use these strategies.

All the strategies listed here are considered to be ‘evidence-based’ practices or are used in evidence-based treatment packages. This means that several high-quality studies have found that each strategy generally leads to positive outcomes for young children with autism.[i] These strategies are based on Applied Behaviour Analysis[ii] and/or evidence-based intervention programmes such as the Early Start Denver Model[iii] and Pivotal Response Treatment.[iv]

Throughout this resource ‘Sally’ will be used as an example. She is a fictitious three-year-old girl with a diagnosis of autism who does not yet speak.

Increasing engagement and participation

Motivation
Children with autism are more likely to be engaged and participate when they enjoy what they are doing. Try to make a list of the child’s favourite toys, books, social games (e.g. tickles, songs), and foods and allow them to do these things as much as possible (within reason). Try to give the child many opportunities to choose activities or toys, such as:

• Joining the child in an activity that they are already doing
• Holding two favourite things, one in each hand, and allowing the child to verbally choose, or to point or reach for the object that they want
• Creating a box of the child’s favourite toys and allowing the child verbally choose, or to point or reach for the object that they want

Positioning
Try to maximise the time that the child spends facing you. For example, you can:

• Hold toys, books, and desired objects near your face
• Sit facing the child at a table or on the floor
• Make sure you are facing the child when they use outdoor play (e.g. swings, slide) rather than standing behind them

Managing distractions
Children with autism can find it difficult to focus when there are lots of toys or other children around. Although it can be difficult to manage distractions in an ECE centre, you could try to:

• Try to bring out one favourite toy at a time. For example, you could place a few favourite toys on shelves or out of reach, to bring down individually when needed. You could also collect a few favourite toys, place them in a plastic container, and allow the child to choose one.
• Find quieter areas without too many toys or other children, where you can play social games with the child
• For toys that have many parts (e.g. blocks, trains, dolls’ houses etc.), try to bring out just a few pieces at a time

Following the child’s lead
Take time to observe the child and notice his or her goals and interests. You can then join in the child’s play in the following ways:

• Imitating – Try to copy the child’s actions. For example, if they are banging on a drum, you start banging on the drum too
• Narrating – Find simple words, phrases, or sound effects for each of the child’s actions. For example, ‘roll’ if the child is rolling a ball, and ‘bang bang bang’ if the child is using a hammer and pegs
• Helping – Find as many opportunities to help the child as possible. This could include handing the child objects which are out of reach, opening containers/packets that the child cannot open, and operating trickier toys (e.g. wind-up toys, bubbles)

Engaging with peers
It can be helpful to encourage peers to join in with the child with autism. Both the peers and the child may need a bit of help to ensure that the interaction is successful. These are a few strategies for promoting positive interactions with peers:

• In social games, give peers a ‘turn’ too. For example, during a game of chase, let a peer take a turn at chasing. Just be aware that the peer may need some help to learn the ‘rules’ of the game.
• Help the child with autism to notice what peers are doing and to copy. Draw attention to interesting actions (e.g. someone doing a big jump) and help the child with autism to copy. If peers find an interesting object, encourage them to show it to the child with autism. Also, help the child with autism to practice showing interesting objects to peers.
• When the child with autism is interacting with peers, try to take yourself out of the interaction and position yourself behind the child with autism so you can provide ‘invisible support’ as needed.

Motivation
Sally spends a lot of her time at kindy on the swings. Sally’s teachers decide that this must be one of her favourite activities, so they try to play with Sally when she’s on the swings.
Positioning
Instead of standing behind Sally to push her on the swings, the teachers now stand in front of her. They also crouch down so their faces are in line with her face.
Managing distractions
The swings are a good place for managing distractions as there are no toys within reach and there are few other children nearby.
Following the child’s lead
Imitating – Sally often makes an ‘oooh’ noise on the swing so the teachers copy that. When the teachers give Sally a big push, she smiles and laughs, so they smile and laugh too.
Narrating – When the teachers push Sally they say ‘push’, when she is swinging they say ‘up and down’ or ‘weee!’.
Helping – Sally prefers to be pushed on the swings, rather than pushing herself. The teachers wait until she lets them know she wants a push (e.g. eye contact, a smile, a noise) before giving her one.
Engaging with Peers
The teachers encourage older peers to take turns pushing Sally on the swing. They instruct the peers to stand in front of the swing to push. The teachers stand nearby, behind the peer, so they can provide support if needed.

Teaching new skills

Providing clear cues
Children with autism are more likely to learn new skills when there are clear and consistent cues for the expected behaviour. This can include words, gestures, actions, long pauses, and visuals. When deciding an appropriate cue for a behaviour, it is best to start by thinking of what works for other children the same age.

Prompting/modelling new skills
You may need to prompt or model a new skill for a child before they are able to do it themselves. Try to give as little help as possible – otherwise the child may not learn to do the skill independently. Examples of prompts/models include:

• Spoken instructions (e.g., saying ‘wash your hands’)
• Gestures (e.g., pointing at the sink)
• Models (e.g., washing your own hands)
• Physical prompts (e.g., taking the child’s hands and placing them under the tap)
  Note: this is the most intrusive prompt

Rewarding new skills
Everyone is more likely to repeat a new skill when it is followed by a reward. The best rewards are related to the behaviour (e.g. rewarding a child’s reach by giving them the toy they reached for). Each time a child uses a new skill, either independently or with prompting, make sure that it is rewarded!

Increasing teaching opportunities
Everyone learns faster when there are more opportunities to practise a skill. This could include practising the skill several times in a row or increasing the number of opportunities throughout the day.

When Sally arrives at kindy, she runs straight to the swings without saying hi to the teachers or bye to her mother. Sally’s parents and the teachers think it would be helpful to teach Sally to wave to say hi and bye.

Providing clear cues
To let Sally know that it is time to wave, her parents and teachers decide on a clear and consistent cue. They will all crouch in front of Sally, wave, say ‘Hi/bye Sally’ and wait for a response.
Prompting/modelling new skills
If Sally doesn’t wave after her parents or the teachers have waited for several seconds, they will say ‘Sally wave’. If she still does not wave, they will tap her hand, and, if she still does not wave, they will gently take her hand and help her to wave.
Rewarding new skills
When Sally waves, either independently or prompted, everyone will wave back enthusiastically and say ‘Hi/bye Sally!’ After she waves she will be allowed to go straight to the swing or into the car to go home. These are both rewards for Sally.
Increasing teaching opportunities
To increase the number of opportunities for Sally to wave throughout the day, each teacher will greet Sally when they arrive. They will also add a hello and goodbye song, which includes waving, into the daily routine.

Supporting communication and understanding

Some children with autism are very good at communicating their needs and understanding others’ communication, while others may need additional support in this area. The two strategies below are examples of evidence-based practices for supporting communication and understanding for children with autism.

Picture exchange
Some children with autism who do not yet communicate using spoken language may benefit from learning an alternative form of communication that can be easily understood. One option would be to teach the child to exchange laminated pictures with adults and peers to communicate their wants and needs.[v] Generally, it is best to start by teaching the child to request their favourite toys, foods, and activities using these pictures because they are likely to be very motivated to do so. For example, it might be helpful to practise this skill at snack-time or lunchtime, when there are lots of natural opportunities to ask for food. Teach the child to request with pictures using the following steps:

1. Sit opposite the child at a table
2. Place the target picture in front of the child
3. Hold up the desired item (e.g. a cracker) and wait
4. If the child does not hand you the picture, prompt them to do so (see Prompting/modelling new skills above)
5. When the child has given you the picture, either independently or prompted, give them the desired item and enthusiastically label it (e.g. ‘cracker!’)

Once the child learns to ask for items when the single picture is right in front of them, they can be taught to do more difficult tasks including:

• Going to get the picture when it is further away
• Finding the correct picture from a selection of four different pictures
• Communicating other things including rejecting items or activities they don’t want and commenting on the world around them

Visual supports
Some children with autism have trouble understanding other’s spoken communication and may benefit from visual supports throughout the ECE environment. These visual supports can take many forms including:

• Visual schedules which show each activity that will take place that day or during a particular time of day
• Visual activity schedules which show each step of a given activity, for example, getting dressed or washing hands
• ‘First then’ schedules which show how a less desired activity is followed by a more desired activity
• Visual timers which visually represent the amount of time that is left for a given activity

Addressing challenging/difficult behaviours

Young children, including young children with autism, sometimes use challenging behaviours to communicate their wants and needs. This could include hitting, screaming, biting, destroying property, or running away. There are two main reasons why a child may be using challenging behaviour:

1. To get something they want, such as access to items and activities that they like
2. To get rid of something they don’t want, such as escaping from activities they don’t like or getting rid of items they don’t like

We can teach children appropriate ways to get things, or to get rid of things, as a replacement for challenging behaviour. This is called functional communication training. The behaviours which are used as a replacement could include words, gestures, or the use of alternative forms of communication such as picture exchange (see Supporting communication above). We need to ask ourselves:

1. What is cueing the behaviour?
2. What is the purpose of the behaviour?
3. What behaviour is easy for the child to use instead?
4. How can I help the child to use this replacement behaviour?

Sally gets very upset when other children are using the swings. She often pushes other children off the swings and then gets on them herself.

1. What is cuing the behaviour?
   The fact that all the swings are being used by other children is likely to be the cue for Sally to push them off.
2. What is the purpose of the behaviour?
   The purpose of the behaviour is probably to gain access to the swings. In other words, Sally cannot use the swings because other children are using them, so she is pushing children off to get her turn.
3. What behaviour is easy for the child to use instead?
   Because Sally does not talk she could use a gesture like pointing at the swing or she could exchange a picture of the swing to ask for a turn. If/when Sally learns to talk, she could say ‘swing’ to ask for a turn.
4. How can I help Sally to use this replacement behaviour?
   See Prompting new skills above

Including parents

Research suggests that parents can effectively use strategies to help their young children with autism.[vi] Therefore, it could be helpful to share these strategies with the parents of any children with autism whom you support. It could also be helpful to have regular (e.g. termly) goal setting or Individual Planning (IP) meetings, to make sure everyone is on the same page.

References

This resource provides a very brief overview of strategies that teachers can use to support children with autism in an early childhood setting. The resources below contain more in-depth information about each of these strategies.

Ministries of Health and Education (2008). New Zealand Autism Spectrum Disorder Guideline. Wellington: Ministry of Health.

Rogers, S.J., Dawson, G., & Vismara, L.A. (2012). An early start for your child with autism: Using everyday activities to help kids connect, communicate and learn. New York, NY: Guilford.

Wong, C., Odom, S.L., Hume, K.A., Cox, A.W., Fettig, A., Kucharczyk, S., … & Schultz, T.R. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45(7), 1951-1966.

[i] Lang, R., Hancock, T.B., & Singh, N.N. (Eds.). (2016). Early intervention for young children with autism spectrum disorder. New York, NY: Springer.

Ministries of Health and Education (2008). New Zealand Autism Spectrum Disorder Guideline. Wellington: Ministry of Health.

Wong, C., Odom, S.L., Hume, K.A., Cox, A.W., Fettig, A., Kucharczyk, S., … & Schultz, T.R. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45(7), 1951-1966.

[ii] Lovaas, O.I., & Smith, T. (1989). A comprehensive behavioural theory of autistic children: Paradigm for research and treatment. Journal of Behavior Therapy and Experimental Psychiatry, 20(1), 17-29.

[iii] Rogers, S.J., Dawson, G., & Vismara, L.A. (2012). An early start for your child with autism: Using everyday activities to help kids connect, communicate and learn. New York, NY: Guilford.

[iv] Koegel, L.K., Ashbaugh, K., & Koegel, R.L. (2016). Pivotal response treatment. In R. Lang et al. (Eds.), Early intervention for young children with autism spectrum disorder (pp. 85-112). New York, NY: Springer.

[v] Bondy, A.S., & Frost, L.A. (1994). The picture exchange communication system. Focus on Autistic Behavior, 9(3), 1-19.

[vi] Wong et al., 2015

PREPARED FOR THE EDUCATION HUB BY

Dr Hannah Waddington

Hannah is a lecturer at Victoria University of Wellington, and is also a practicing educational psychologist and certified early start Denver model therapist. Her research focusses on the evaluation of early intervention approaches for young children with autism which are effective and feasible in a New Zealand context.