978-1572305441

Trevor 143
he was rewarded with a paper star that he could add to his mobile. We
also started with trials teaching him how to imitate actions with objects
and sounds. Then we progressed to imitation of mouth movements,
hand movements (touch your head, touch your elbow), then verbal imitation
(imitate vowel sounds, sounds of letters, etc.). We also worked
on understanding language using discrete trials to help him identify
pictures, objects, and colors and then to discriminate between objects
(point to the door when presented with a picture of a room). Then we
got him to follow one- and two-step commands and to find hidden objects.
We also designed a program to work on expressive language by
presenting him with two objects and asking him to label which one he
preferred. Once each skill was mastered, attempts were put in place to
teach him the same skill with his mother, his main teacher at day care,
and finally one of the other teachers with whom he was less familiar.
He now had some basic attention and compliance skills that would
allow him to benefit from more formal and structured attempts to facilitate
social and communication skills in the context of other typical children.
We also set up some guidelines for parenting and interaction that
were different from the way Alice usually interacted with him. First we
placed him in a community day care setting, and the school hired a
teaching assistant to work with him on a curriculum we provided based
on an assessment of his social, communication, and play skills. We
helped to set out a routine for his day so that it was highly structured
with play time at home with his mother included so that she could
work with him as well. With Trevor, Alice was taught to be intrusive
and take every opportunity to interact with him. She would hide things
or put them out of reach so that Trevor would have to come to his
mother and ask for them. Alice would set aside some time each day to
play with Trevor, to build things with his Lego pieces, do puzzles with
him. She would consistently and enthusiastically reward all attempts at
communication and social interaction or attempts by Trevor to use
more developmentally appropriate means to have his needs met. She
would be very sensitive to Trevor’s nonverbal signals for communicating
and look for subtle signs of distress that might indicate mounting anxiety.
She would then have to make a decision to either avoid the anxietyprovoking
situation or face it head on and be prepared.
At first we also had a therapist work with Trevor at home. She
would simply sit beside him while he played. Interactions would be initiated
by Trevor, but the therapist would watch and comment on his activities.
Trevor might turn away or move to another place in the room.