One of the stories from class that really stuck with me was about a 4 year old boy who had just recently started putting words together in short sentences. By 5 1/2 he was walking up to strangers in grocery stores asking for help finding cereal. His mom said she was amazed and that she was even a little teary eyed when she retold the story to us. To his mom and to me it seemed like he had just climbed Mt. Everest.
While speaking is a crucial component to communication, it is far from the only aspect. Proximity, timing, eye contact, reading the room and a host of other variables can affect the way in which a child communicates. These mountains to climb can be difficult for many autistic children to overcome. But there is hope. Therapy can equip a child with the tools that they need to ascend the biggest of mountains.
What people get wrong about “communication goals”
I would like to begin by addressing a misconception that many people have regarding the communication goals of children with autism. For a long time, many have perceived the ultimate goal of a child’s communication goals to be to say one word, such as “hello” upon request. Many people even associate working on a child’s communication goals with teaching a child to say “hello” like a parrot. However, this outdated image is not fair to the children and families who are working so hard on communication goals. Most autism therapies start from the current communication level of a child and work from there. The goal of a child’s communication goals is to allow the child to effectively communicate his or her needs and wants. Typically, the goals for a child’s communication goals are for the child to make requests, to protest, to comment, and to understand others.
Most communication goals in therapy do not start with the typical hello or other greeting. The typical communication goal is what does this child want to say? What are this child’s frustrations that he or she cannot express with the words that he or she has? In the majority of cases, the communication goals in a child’s therapy start with what the child already can say and then we build from there.
That’s a much more interesting question. And the answers look wildly different from one child to the next, which is, of course, exactly the point.
Some kids have communication goals to request items or services, to express needs and make wants known, to comment on events going on around them, to understand others comments. Some kids need to work on reading facial expressions to ensure that conversations are smooth and not confusing. Other kids have the words but struggle with maintaining a typical conversation back and forth.
The confidence piece, and why it’s consistently underrated
In response to repeatedly being misunderstood, having no idea what others are thinking or feeling, not being given any help regarding social situations or social cues for appropriate or misappropriate behavior, kids with Autism will withdraw from social interaction. They will stop trying to initiate contact with their peers. Why would they?!
The child who withdraws from interactions with peers has consistently been failed by those around him in terms of being understood. Thus the child who does not approach another child on the playground has the capacity to do so but has not because he has not had success with interactions with other children in the past. Thus the child’s therapy needs to give him a sense of success with every session. Therefore in sessions with this child, we will help him to tolerate the proximity of another, then help him to initiate interactions with other children. And it is not until he is able to do these things that he will ask a stranger where the cereal is on the shelves.
Not magic. It’s the hard work of therapy of Repetition of Structured interaction of someone trying their best to pay attention and figure out what works.
What is Personalized for one child on the autism spectrum may not be Personalized for another child on the autism spectrum.
Most therapies today honor a child’s motivation and work within the context of the child’s interests and goals. Therefore, the therapist is able to rapidly switch focus in the session in order to follow the child’s motivation. For example, a child is engaged in a bubble activity within a session, however as the child begins to play with the bubbles, they become more interested in following a train around the room. The therapist then switches focus of the session to follow the child’s interest in the train. It is critical for the therapist to have a very solid understanding of the child’s life from day to day in order to personalize the therapy sessions. Therefore, prior to the sessions, the therapist checks in with the parents regarding what occurred the night before and how the child is doing that day. On days in which the child is having an extremely intense sensory day, the therapist will alter the level of demand of the tasks given to the child in order to meet the child halfway and be able to work effectively with them within that session. Most programs do not adhere to a strict protocol in working with children with autism and follow a more flexible, data-driven approach within the sessions.
All programs are marketed as individualized. That is, as programs for autism therapy they are delivered with a number of different components. These are listed out to potential families at the beginning of the intake process. In reality, very few programs are actually delivered that way. As a rule, a program is delivered in essentially the same way to every child. Therefore, it is very important to pay close attention to how a program is actually delivered from session to session. The beginning of the program is a great place to start to look for clues as to how a program will be delivered in the long run.
Here for Families: There is therapy that is data-driven and child-led. A therapy approach where every step of the way your child’s and your family’s needs are taken into account. Here for Families offers quality support for all families. See what effective autism therapy for your child looks like at therapy sessions offered by autism therapy bedford ma.
Individualized – As with communication goals, people tend to assume that all therapy programs are of the individualized variety. As with communication goals, the reality of individualized therapy can vary greatly. However, there are a few signs that a therapy program is individualized:
- Goals are updated regularly based on actual progress, not just reviewed at intake and then forgotten
- The child’s specific preferences and interests are woven into session activities, not treated as rewards dangled at the end
- Parent involvement is structured and meaningful, not optional or performative
- There’s a clear, honest explanation for why each skill is being targeted right now, at this stage
A quick look at what therapy can target
| Skill area | What it might look like before therapy | What progress can look like |
| Requesting | Meltdowns when needs aren’t met | Using words or devices to ask clearly |
| Social reciprocity | Parallel play, little peer interaction | Turn-taking, shared attention in games |
| Emotional regulation | Shutdowns or outbursts with little warning | Recognizing early signs of distress, using coping strategies |
| Independence | Needing adult prompts for daily tasks | Completing routines with fading support |
Independence isn’t the finish line
One of the biggest misconceptions, or misunderstandings, is that parents of children with Autism are trying to teach their children to behave “Typical” or “Normal” or even “Typical Neurotypical.” This is far from the truth. The reality is that many children with Autism are already Autistic, and will always be Autistic. What parents and clinicians want to do is to teach children with Autism to be as independent as possible, and to have as many ways to meet their needs as possible. This means that kids with Autism will have as many successful interactions as possible, in as many different situations as possible. I would love to see people celebrate a child with Autism approaching another kid in the playground, and having a successful interaction with that other kid. Because that is what we are trying to teach. We are trying to teach kids with Autism to be as independent as possible, and to have as many ways to meet their needs as possible, in our typically Autistic-unfriendly world.
A few weeks ago, in the cereal aisle of a local grocery store, a mother was frantically crying. She was clearly very upset. But then I realized that her son, who had Autism, had asked for the specific brand of cereal that this mother’s son wanted. He had gone to ask for it. He had found a stranger in the aisle and communicated with her to obtain the item that he wanted. And then he went back to his mother’s side with his arms loaded down with boxes of the cereal that he wanted. The mother was in tears. Not because her son was being “difficult” in the grocery store. But because her son had wanted something. And he had gone to get it. And he had done it all on his own. And in a completely new situation. He had been successful in a new situation. And that had made his mother very happy.
Confidence is normally quiet and practical and hard-won for the individual. The goal of building a child’s communication skills is to give them the tools that they need to successfully interact with other people. Then, give them the opportunity to use those communication skills in as many different situations as possible in order to give them confidence in their ability to use their communication skills in a variety of situations.
