Participant
S. is a 30 months old boy diagnosed with autism. He is receiving behavioural training for 3 months at a private association for children with autism, for an average of 10 hours/ week. At the beginning of the behaviour intervention he had been heard to spontaneously vocalise 6 sounds (4 vowels and 2 consonants), but had no ability to imitate any of them and also had not the ability to imitate motor movements.
The child does not make eye contact and does not use gestures to indicate the desire to obtain an object for which he has motivation. Most of the time, when he wants an object, he takes it directly from the adult or cries when he cannot get the object himself. Most of the time, he engages in self-stimulating behaviours and does not stay in contact with another person for more than 5 seconds.
Objective
An ESDM intervention session involves a series of joint activities each 5 to 10 minutes. In a 2 hour session, across the activities, all the child’s objectives can be addressed, including a review of masters skills, the maintenance skills, and multiple opportunities to practice the target skill.
Getting the most teaching into a session requires some planning and preparation. In this study, our objective is to create game activities in which we address as many of the child’s learning objectives as possible, included in the personalised intervention plan.
Among S.’s learning objectives, we find: the child uses eye contact and gestures consistently to request an item or continue the routine, the child follows pointing and imitates actions, he also follows simple instructions.
Procedure
Social communication occurs especially through eyes and faces. So, we need children to look at us, to make repeated eye contact, to have clear views of our face, expressions, gaze patterns and mouth movements as we speak. As much as possible, we want to position ourselves so that we are face-to-face with children, at their eye level, and with the materials between us and the child. We have to become part of the child’s focus of attention. Thus once we identify a child’s object or activity interests, the next step is to draw the child’s attention to our eyes and faces, our body actions, and our voices, sounds and words.
Watch the child with interest, nodding and smiling in a natural and approving fashion, while adding simple words and sound effect. Narrate the child’s actions using words or phrases that are appropriate for the child’s language level and add sound effects as much as possible. By describing the child’s actions and play without interrupting or changing the child’s focus can help to maintain the child’s attention to the activity while promoting language learning. In this way, we can end up building joint activity play.
Joint activity routines are the frames for teaching in the ESDM and the social element of a joint activity is the richest teaching tool. In joint activity, partners look at each other, share smiles and fun.
The activity in which the skills will be taught is created by the therapist during a joint activity routine developed from a child’s choice. Learning opportunities that target specific skills need to be created out of naturally play routines. For example, S. ‘s 1-hour session consists of 9 activity blocks. Each session began and ended with a geeting, with a snack somewhere in the middle, some book routines, alternating table and floor activities, and alternating object and sensory social joint activities routines. Each activity will last from 2 to 5 minutes, including time for clean-up and set-up and breaks.
Some examples of activities that were chosen for S. and in which he was taught the learning objectives are:
- Hello routine with song (and gestures) – An activity in which the child was taught to use eye contact and gesture consistently to request or continue the routine, to imitate and follow pointing
- Popping and stamping bubbles- in this activity the learning objectives related to imitation, communication and social were practiced
- Snack – we practiced the social, communication and imitation objectives
- Rolling the ball back and forth – we practiced the social, communication and imitation objectives
Objectives from several fields were set in each activity. Two or three different objectives were taught in each activity, among which, at least one objective related to communication.
Results and discussion
Joint activity routines, both those with objects and those without objects, provide the platform for learning in the ESDM intervention. A relationship is being developed during this step, in which you become a fun partner in the child’s play and play become more fun and more interesting because of your presence. The way you are positioned in relation to the child, the activity you have chosen and the way you describe his actions, draw the child’s attention to you. Joint activity routines depend on positive relationship.
It is very important to prepare interesting and motivating activities for the child, according to the learning objectives of the child’s personalized intervention plan, to alternate between object and sensory social routines and to constantly vary the place where we carry them out. Sometimes the activities take place on the floor, sometimes at the table.
Planning activities for a session ensure that materials are available to support the objectives and the development of the joint activity routines is the frame in which you teach objectives. The plan allows the therapist to think through activities that will target all the objectives from the Intervention Plan.
Following the intervention, by planning some activities in which the learning objectives are taught and by offering multiple learning opportunities, S. learned to ask for the objects for which he is motivated through visual contact and pointing. He also learned to imitate at least 10 actions with the objects in the game and to follow instructions like “Sit down”, “Come to me”, “Stand up”, “Wait!”, “Put in”, “Give it to me.”, etc.
