Does this sound like something that would happen in a therapy session?
Child: Can we play with this toy today?
Therapist: First we’re going to play this game, then we have another activity. We can play with that toy later if we have time.
Many children on the autism spectrum struggle with flexibility. They tend to be rigid in in their routines, language, and overall thinking. In order for children to develop novel language that can be used in many ways, they have to be flexible thinkers.
Many of us speech-language pathologists (SLPs) don’t directly work on flexibility, but we should - because improved flexibility leads to increased use of novel language, abstract thinking skills, and emotional thinking. And aren’t these all areas that many kids on the spectrum struggle with?
So what’s wrong with that scenario above? When the child asks to play a game and the therapist says, “No, we’re going to do this first”?
1. The therapist in that situation is not modeling being flexible. Children need to see that us, the adults, can be flexible.
What you could do instead: Ask questions, negotiate, and come to a compromise. Time spent negotiating with the child is not wasted. The skill of negotiating is a higher level skill, and any practice with negotiating is going to improve the child's language and flexibility.
2. First-then routines promote rigidity, not flexibility. Most therapists believe that using first-then or a visual schedule helps children learn to accept or tolerate certain activities, so it sounds counterintuitive to say that these routines promote rigidity. But this is just what they are - routines. Routines are a series of steps done the same way every time. Having children do the same thing the same way every time, by definition, promotes repetition and not flexibility.
What you could do instead: Work on improving the child's ideation. I say that children who are rigid seem to have tunnel vision - they can only see one direction, one answer, or one way of doing something. To help the child become flexible, we need to get him to start looking in many directions, and we can do this by working on his ideation skills.
Remember my blog post, Why We Should Stop Over-Prompting Kids on the Spectrum? There is a major difference between planning and executing. Often times in therapy, the therapists do the planning and the child does the executing. This is why we may not see carryover. In order to generalize the skills a child demonstrates in the therapy room, he must be able to do the planning. So instead of creating a schedule for your therapy session, let the child come up with the plan. Having the child help determine which games you will play in therapy, and how to play them, gives the child many opportunities to generate ideas.
3. The therapist is dictating the activities and the order, which means that the child is NOT. Again, when we do all the planning, there are missed opportunities for the child to come up with ideas. Going into a therapy session without a plan can be scary, and being flexible in our therapy sessions is not easy - it’s hard work. It takes much less energy to choose activities in advance and follow a schedule. However, I believe there is a bigger argument that can be made for us knowing how to address each child’s goals no matter the activity.
What you could do instead: a) know the child, b) know the child's goals, and c) know how to address those goals in therapy no matter the activity. For instance, if you are working on WH-questions, do you really need to use WH-Questions Bingo today, or can you work on "where" questions while hiding animals around the room, or during pretend play with a house?
Jessie Ginsburg, M.S., CCC-SLP is a speech-language pathologist, autism expert, and owner of Pediatric Therapy Playhouse, a multidisciplinary clinic in Los Angeles.