A common concern among parents of children with autism who have significant language deficits is that they won’t be able to express when something is wrong. For example, if they have a sore throat, ear infection, sprained ankle, or other health issue, they may not have the skills needed to communicate that something is wrong. These types of issues can make problem behaviors, social skills, or school difficulties more difficult.
This creates a major teaching challenge. It is much easier to teach children to talk about things happening inside of other people. That’s because the teacher can be sure of what’s happening in pre-planned pictures, videos, or live models. So, it is usually relatively easy to teach children to label pictures or videos as happy, sad, angry, or even hurt. But teaching them to talk about things inside themselves is much harder. The teacher doesn’t really know what is happening inside the child, so it is hard to provide the prompting and feedback needed to teach children to talk about those things.
The standard answer to what to do in this situation is to wait for opportunities when you do know what happened. This is probably how typically developing children learn to talk about these types of internal events. For example, if the child accidentally bumps his or her knee and starts crying the parent can immediately start talking about that. Oh no! You hurt your knee! Pointing to it, talking about it, etc. While I think that advice is fine, it is rather unsatisfying. First, the child is not getting hurt frequently (hopefully). Second, when a rare situation occurs when the child does gets hurt, it doesn’t mean the parent observed it and is able to take the necessary actions. Third, children with delayed language need many opportunities to learn new, difficult language skills. This procedure usually will simply not deliver enough learning opportunities.
As far as I am aware, there is not a published solution to this problem available in the research literature. But having to deal with this frequent concern from parents, I have improvised a solution that seems to work; and even if it doesn’t work, will likely lead to the child learning some useful language skills.
My suggested procedure is based on clinical experience and interpretation of the basic principles, not actual published studies. It is a relatively simple idea. Teach the child to talk about how things feel on different parts of the body so that when a critical situation occurs, they might be able to generalize to talking about an injury.
Here is how to do it:
- Teach the child the names of body parts without looking (e.g., cheek, elbow, knee, ear, etc). This can often be made into a game that many children enjoy (e.g., cover your eyes, blindfold, etc)
- Teach the child to label various sensory stimulation without looking (e.g., warm, cold, rough, smooth, tap, squeeze, soft, hard, etc).
- Teach the child to combine both without looking. The teacher asks, “What do you feel?” and the child makes responses like “Warm ear,” “Rough elbow,” “Squeeze hand,” “Soft knee.”
- Keep teaching this skill until the child starts making correct responses on novel, untaught examples, and thus demonstrating that they have generalized use of the skill.
I have used this program several times, and on at least two occasions, I have heard from parents that the child spontaneously used the skill when they actually got hurt. The program is generally well liked by children, teachers, and parents. It also has the potential to solve a huge problem for families.
Of course, it would be quite challenging to prove in a controlled research study that the two-component language skill program is why the children were able to respond accurately in the novel injury situation. But it certainly looks plausible.