10 months ago



William 93 sation and to

William 93 sation and to teach them linguistic devices to keep the conversation going. It’s important to first set the parameters of the conversation. Practicing has to be a natural part of everyday life, not seen as a time for “therapy.” The conversation must be fun so the child sees the value of engaging in social interchange through conversation, and it should not be coercive but part of the natural flow of the day’s routine. The conversation is best carried out by parents, teachers, or older siblings who can understand the new rules of the game or that the language game will have to be played at first by somebody else’s rules. It is essential, as my conversation with William demonstrates, that the context be front and center in any conversation with a child with ASD. Techniques to set the conversational context can be established by asking about common events, practicing conversations that might occur on a routine basis with typical children, and talking about a child’s special interests. This ensures that a common context is established that allows the speaker and listener to build shared meaning. Discussing common events like finding out what happened at school, how people were feeling, what somebody’s behavior was like are especially helpful. It’s also useful to make the conversations functional. What conversational abilities does one need to survive in the world, to use change to buy things at the store, to ask for directions, and so on? Practicing going to the store or using the bus can be excellent opportunities to teach these skills and to learn certain routines. Using visual aids can also be helpful—books, pictures, or the TV can be a useful way of facilitating communication and of initiating a conversation. It is also very effective to initiate a conversation on the child’s favorite topic. This will make the context abundantly clear and tends to elicit the most speech and the most appropriate social skills. I try to engage in the conversation on the child’s terms for a while but then steer it toward other, more appropriate topics like what happened at school, what it is about a sibling that bugs him the most, and so on. This redirection can be difficult, and it sometimes feels like setting up signposts that are ignored consistently. But persistence eventually pays off. The key to creating a common context is to realize that sometimes what’s being said by the child with ASD is not always what is meant. It’s that imaginative leap to the context that the child with ASD is operating from that is often required to make sure the conversation makes sense. I always try to clarify with the child an ambiguous context to make sure we’re speaking with a common frame of reference: “Are we talking

94 A MIND APART about subways here or what Pamela and John saw?” Repetitive questioning is a common problem in conversation and is a good example of the difficulty in inferring the context from which a child speaks. A child with autism or AS will often ask the same question over and over again, even after the appropriate answer is given. Usually there is another question that the child wants an answer to, but he or she cannot disengage from the first topic. The child asks a question arising from a context that’s hidden, but parents and teachers often answer from the context that’s visible. I remember one boy who repetitively asked what would happen if he got in trouble at school. Each time his parents tried to reassure him that he rarely gets in trouble anyway, he asked the same question right away. That led to all kinds of problems, sometimes even aggression and a sense of frustration on the part of both the child and his parents. But since that wasn’t really the child’s question, he had to ask it again and again, in the same way as before. I spent a lot of time trying to figure out what question he was really asking It turned out he was very concerned about other children teasing him at school and why they didn’t get in trouble for that behavior. Once we talked about that issue, the repetitive questions subsided. Another example is the little boy who over and over again asked whether it was time to bring out the Christmas tree, even though it was the middle of July. His parents would answer that it was much too early. In fact the little boy was not asking a question, but making a request to bring out the tree now, whatever the time of year. Once we realized this, he was taught to make the direct request instead, and as a reward the parents brought out the tree on the twenty-fifth of each month for a little party. It was a little extra work but paid off in other ways as he started to ask fewer repetitive questions in general. Teaching social skills also has a direct impact on conversational abilities. It may be useful, for example, to try to teach children with autism and AS a theory of mind, to expand their horizon of interests, to help them not get stuck in the details of a situation. Since those with autism are not intuitively aware that their behavior might have a negative impact on others, active feedback is required for them to understand that. I will tell them I have trouble following the train of the conversation or I’m a bit bored and we should talk about something else. I sometimes give the child a visual or verbal prompt to help him generate a novel response in the conversation or to help him switch topics. This helps get him “unstuck” and can break the chain of perseveration.

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