Early Start Denver Model (ESDM) – Exercises for parents of ASD children

During bathtime, give your child directions to help prepare for the bath: ”Get your towel.”, ”Get the soap”, ”Turn on water”. Then, you can teach your child body parts by telling him to give you a specific body part for you to wash: say ”Give me your foot” and point to it to help your child respond. Then reward the child’s response by washing the foot in a playful way. Then you can say ”Give me your hand”, point to it and reward the child’s response.

Be sure not to repeat your instruction over and over without following through with physical guidance, or your child may learn that he does not need to respond!

First, make sure that you are right in front of your child, and that your objects are positioned in front of her matching objects.

Begin by imitating your child’s actions with your own materials and labelling the objects and actions your child is using. For example, if your child is rolling a car back and forth, you will roll your car back and forth exactly as your child is doing.

After you have imitated your child’s actions for a while, introduce a variation on the action you are performing . For example, you could roll the car more quickly or slowly, or roll the car on your body instead of the floor, and so on. Then, change the action to a different one and show your child your new action. If your child is interested in what you are doing, wait expectantly and see if your child imitates the new action. If not, help him (prompt) by guiding him through the new movement with your hand over his hand.

Once the child has made the new action, praise your child enthusiastically and let him do what he wants to do for a minute with the toy and imitate your child’s actions a few times. Then, show the new action again, use prompt and praise.

Our goal is that the child will initiate giving for help, so the open hand is a prompt that we have to fade quickly. 

• Each time you repeat this, wait longer before you extend your hand (a time delay procedure) and minimise your hand gesture. 
• Increase the distance from the child’s hand to yours. 
• Each time do less and wait a little longer 
• Your goal is that the child will hand the object to you without you making any movement at all.
• When the child places the object in your hand, say, “Oh! you need help”, then open, hand it back by saying something like “Marker is open” or “Here’s the cracker”.

Sensory Social Routines are joint activity routines in which each partner’s attention is focused on the other person, rather than on objects, as in object-oriented joint activities and in which mutual pleasure and engagement dominate the play. 

A sensory social routine is a dyadic activity in which two persons are engaged in the same activity in a reciprocal way: taking turns, imitating each other, communicating with words, gestures or facial expressions, and building on each other’s activity. 

Examples of sensory social routines: Peekaboo, Here comes Mousey; songs routines with motions, like “Eensy Weensy Spider” and “The wheels on the Bus”; finger plays like “Creepy Fingers”; and movement routines like “Airplane”, “Swing”, “Chase” and “Hide and Seek”.

In a sensory social routine, the two partners should have many exchanges, or turns. Children need to be active social partners, taking many turns to request, continue, imitate or cue. The routine should look very reciprocal, with each partner acting in response to the other, and the child providing some social or communicative behaviour every 10 seconds or so.  

This is not a situation in which the adult is entertaining the child and the child is passively observing the adult. Adult and child are in back-and-forth communication throughout, via movements, gestures, eye contact, sounds, words, or other actions. The goal is for the child to focus on and communicate with the adult’s face and body to initiate, respond to, or continue the sensory social routine. 

The adult will start, pause, and wait often, to give the child a chance for his or her communicative turn.

In order to learn from people, children’s attention has to be on people. We have to be part of the child’s focus. Once we identify a child’s object of 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. 

Strategies to increase the child’s attention:

1. Eliminate the Competition – Put the toys that you are not using away or out of sight, in closed cabinets or under blankets. Ideally, the room should be able to be arranged with nothing in it except a table and chairs and a closed or covered cabinet. You need to be the source of everything interesting and desirable in the room.
2. Take Center Stage – we need children to look at us, make repeated eye contact, have clear views of our face, expressions, gaze patterns, and mouth movements as we speak. 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.
3. Watch and Comment – Narrate the child’s actions using words or phrases that are appropriate for the child’s language level and add sound effects.
4. Be Helpful- Offer one piece of the item that the child is reaching for or push it closer. Steady the object, move things closer, open containers, give materials, and help freely with any struggle the child is having. This establishes that your presence is actually helpful to the child.