Teaching Receptive Language Skills & Following Directions

You're listening to another episode of the Turn Autism Around podcast. I'm your host, Dr. Mary Barbara, and I'm thrilled that you are here. Today I am talking all about how to build receptive language abilities; how to assess comprehension; how to teach it; when to use visuals; how to fade prompts; and all the things that are so important to teaching kids to comprehend our language. So let's get to this special episode.

Welcome to the Turn Autism Around podcast for both parents and professionals in the autism world who want to turn things around, be less stressed and lead happier lives. And now your host, autism mom, behavior analyst and bestselling author, Dr. Mary Barbera.

Now we're going to talk about receptive language, or understanding of language, or following directions. They're all tied so importantly to language and language comprehension. People talk about reading comprehension, but a child can't have reading comprehension before they have language comprehension. So whether your child has a diagnosis or not, whether they are two years old... five, twelve, sixteen, twenty five, forty five years of age. When you're talking about a person, a child, or a person with autism, in addition to assessing and teaching them needed expressive language skills, it's probably even more important to assess and teach them their receptive language, their understanding of language. And I have so many examples of this, even with my own son, who's now 23, diagnosed our two decades ago.

I remember what he was really little. A photographer came to our house to take pictures of him and Spencer. I think Spencer was six months, excuse me. And Lucas was two-ish, but he wasn't diagnosed with autism. We weren't really even thinking autism at that point. I wasn't at least. And the photographer asked Lucas if... he was just giving Lucas something to do. He's like, he's two. He's like, hey, buddy, go throw this in the trash. And Lucas, like, took it and just dropped it. Like he had no idea what the photographer was talking about. And I think the photographer even said, like, how old is he? And I said, two. And he just like... he should be throwing out the trash.

And one of the big things that made my husband think that Lucas might have autism was his lack of reaction to the baby. When Spencer was born, Lucas was 18 months of age. And Lucas was not understanding anything. He wasn't understanding there's a baby in mommy's belly. There was no understanding that he was a brother. We could have brought home a fake doll for as much as Lucas was understanding the situation. So that's a really powerful, I think, example of like how kind of in his own world a child could be.

When we did start to get him evaluated, I remember them asking me that 3 to 5 age program that he was in, I remember filling out a form or name asking me, does he touch his body parts? And I was like, oh, yeah, yeah, he could do that, you know. And then they evaluated him and they said, well, we didn't see he could touch his body parts. Like, could you show us how you get him to touch his body parts? And I was like, oh yeah, I have to sing the Barney song. First we touch our head and then we touch our toes and then we touch our belly, you know, and I actually was showing him too and he was doing it with only with the song, not out of order. You couldn't say touch toes and then touch your head. It had to be had toes and then belly in that order with a visual prompt.

So you could see how it's confusing for parents... so badly you want your child to understand and to pass the test and to be okay. And a lot of people just really focus on that expressive language, that talking component, when really we need to really figure out where they're at with comprehension.

Just like I told you a little earlier, that with the whole Coronavirus thing, you know, there's all these visuals and social stories and all that stuff. But if children don't understand even basic language, they're not going to be able to understand, even with visuals, even with books, they're not going to understand really much of anything. So we need to assess and we need to assess if it's a language comprehension issue, or... Like, I can't understand what you're saying versus I won't do it, I know what you're saying, and I'm refusing.

Either way, whether it's a can't problem or a won't problem, we still need to address it. We need to address it with assessment planning, good teaching, the right level of reinforcement and maybe some data collection as well. I have found that with kids that aren't conversational 99 times out of 100, it's a language issue. It's a comprehension issue. There might be a component of can't or won't, but it's predominantly a comprehension issue. You're not saying it in the right way; you're not giving them a visual which they need in order to do it. But when you test it, just like when I was testing body parts, you can't show them and test them at the same time.

So if I say touch your head and the child touches their head, we don't know if we're assessing receptive language or assessing imitation skills. So when you assess you can't use your visuals; you can't get out the stop sign and say stop, because that's a visual prompt. So we're going to do better with visuals. You know, imagine yourself in a foreign country, you don't understand the language, but if somebody holds their hand up and gives you a stop signal, or somebody touches their head and says something, you might be like, okay, maybe I'm supposed to touch my head. But when we're assessing, we have to really kind of sit on our hands and say, touch your belly, touch your head, touch your elbow. And that's the way we're really going to assess whether the child can do it or not do it. We may be able to pull in and we may need to pull in visuals in order to teach it, but that involves careful planning to put in the prompt, to take out the prompt, but for assessment reasons, we want to make sure that we are not giving visual prompts as we're assessing.

And not to just say, yeah, he knows most of his body parts, but to actually write them down. What body parts does he know? What doesn't he know? A lot of kids get mixed up between eyes and ears, for instance. They might get the big body parts like head and belly and toes. You also don't want to do it in the same order, like head, shoulders, knees and toes. Some kids then if you say touch your head, they might go next to shoulders because they remember the song. So it can get a little tricky. So make sure you're writing things down, not going in the same order when you're assessing.

So if you get problem behaviors while you're assessing, then the demands are probably too hard and or the reinforcement is too low. So if there's any component of I won't do it, I won't sit and listen to this book you're reading, is probably because you wouldn't sit and listen for 10 minutes to a book read in another language, would you? You know, so we have to really make sure we're assessing very easy things, making it fun, maybe not doing all the body parts at once, maybe making it a part of, you know, they really like to play the ball. So you're bouncing the ball back and forth. And while you're holding the ball, you're saying touch your knees and then, okay, that whether they do it or not, you throw the ball back. And so you might make it fun, make the assessment really fun. Don't make it like this is a big test and now I've got to get all nervous or I don't really want to do it.

So that's the assessment. The planning part is just like I said, we have to plan for when we're going to assess. We're gonna have to plan for how we're going to teach it. And we're going to also have to plan for reinforcement. And there does seem to be some confusion with many people about, you know, they might say they don't like ABA applied behavior analysis type of treatment because it uses reinforcement and I don't want to bribe my child. So there's a lot of confusion between bribery and reinforcement. And I did a video blog on bribery versus reinforcement you may want to check out. But basically bribery is when you respond to problem behaviors, like I went the blue one, you know, and then you're like, well, if you do this, then I'll give you a blue on our stop screaming and I'll give you the blue one. So they're arguing with you. Or even if they don't have the language to argue, they're having some kind of problem behavior. And then you're saying, okay, let's just get in the car. And if you get in the car, and they're in the middle of a problem behavior, get in the car, we will go get a donut. So you're basically dangling the carrot in the middle of problem behavior, which is bribery.

Reinforcement is planned. It's adult-led. It's not in reaction to problem behavior. It will actually do wonders to prevent problem behavior. And so it's a whole system of how much reinforcement you need really depends on the child. But you are going to need reinforcement in order to teach harder skills. And for many kids with autism, they're so far behind that we have to do what we can to catch them up. And so planning is certainly really important, and not just planning for what kind of visuals we might use, like we might teach touch head, and we show them. And then we might do a transfer procedure, which I've done video blogs and podcasts on. And then we may say touch head again without touching our own head. So we're doing an imitation and a receptive command, touch head with touching our head. They do the skill. Now we say touch head without showing them and see if we can transfer that skill and fade out the prompt.

After assessing and planning then is we're going to have to teach and we're going to have to probably teach in a systematic kind of way. We don't want to work on all the body parts, for instance, at the same time, we might want to just work on two or three because eyes and nose are so close and eyes and ears are so close, we probably don't want to teach them at the same time. We certainly don't want to teach like mouth and teeth at the same time because they're so close together. So we want to make that a part of our teaching plan to teach things that aren't too close in nature.

We want to make sure that the overall task in the session is fun and light with lots of reinforcement. And we want to make sure that harder tasks are sandwiched between easy tasks. So if you know about hand-washing is not a real preferred skill, then you would want to do the hand-washing practice, which I have a whole bonus video that I released a couple of weeks ago when the whole Coronavirus first came out on hand-washing. So you may want to check that out. But say hand-washing is not preferred, you're going to say, but going outside is preferred. So we're going to practice watching our hands before we go outside, then we're going to go outside. And then when we come back in... We can't go for more high preferred outside to washing our hands necessarily, but we might want to transition in for five minutes, then we wash our hands, we get a snack. So you could see how we do easy, hard, easy, hard. And that's taking advantage of the pre-mac principle, which is basically first eat your peas, then you get dessert. And that's what's known as the pre-mac principle, making harder things first and then following them with easy or more reinforcing things.

The other thing you want to keep in mind when you're teaching kids to follow directions is try to focus on tasks and directions where you can prompt. So a lot of parents with babies and young children with or without autism, they're like, say hi, say hi. And the child, you can't make a child say hi. Even if they're fully verbal, you can't make the child say hi. So in the case where your child may not be verbal or vocal or conversational, limit your commands like, wave high so that you're not saying say hi, say hi. And then you realize, well, that's not going anywhere. Wave hi. Also, give directions that you want to follow through on. So if you're lying on the sofa and you're like, give me the remote, give me the remote and you're pointing to the remote and the child's not attending. And you just go get it yourself or your ask one of your other kids to get it for you then you're not following through with the test. So give directions which you can prompt and you can follow through on and you're willing to follow through on to teach.

Like I said before, you don't want to take a child from a 10 to 2 on the reinforcement scale from outside to potty, which they don't like to do. And we have to constantly be working on pairing up potty, pairing up hand-washing, pairing up anything that child doesn't like to do because we don't want a child crying for anything. If the child is not happily doing something thatmeans our reinforcement system is probably not where it needs to be. You also may want to check out my transitioning from high preferred to low preferred. I have a cheat sheet. I have a video blog that we can link that all below.

We also want to whatever we're teaching, especially if we're teaching receptive language and comprehension skills, is we want to simplify the language whenever possible. So instead of Johnny, go upstairs and get your shoes and put them on and then we're going to go in the car... That's a lot. That's multiple step directions. So you want to make it where the child is ninety five percent going to get it right. You know, whether the shoes have to be in sight, whether you have to point to them, get your shoes or without a point. Get your shoes if they're in the same place all the time. And if he doesn't get the shoes then you're gonna have to gently prompt him to go find the shoes, get the shoes and bring them back. So you want to simplify the language all always and try not to use a whole lot of words.

And then also, we want to always focus on trying to get five to eight positives for every negative. So it's like, you know, get the shoes. Nice job. Get the shoes. Let me help you put them on. You're such a good boy. Help him put them on. Now, you know, you give the child direction, to... Let's go get your jacket, or go get your jacket, or whatever the next step is. We constantly want to have an environment where we're giving praise. We're giving thumbs up and smiles. And if you find yourself resorting to no, stop, that's not right, I told you once I told you four times, let's do it. Those are all negative, negative, negative, negative. We want to create positive environments at school, at home. The community, wherever your child or client is at.

So in summary, when we're teaching receptive language skills, comprehension skills, following directions, we want to make sure we assess and we assess without visuals so you really see what the child knows of what they don't know. We want to plan for reinforcement and plan what kind of materials we're going to need to teach direction following. We're going to use simplified language and we're always going to try to use eight positives to every negative.

You also may want to always make sure you're as close to the child as possible when you're giving the directions. Maybe if they're very young and very little, small, you want to get down to their level, give the direction calmly versus, you know, across the room. And we really want to give directions in a very nice, friendly tone. It might have to be simplified and more exaggerated and more fun, the more fun and positive the better. And we do want to pull in visuals to teach. We're just gonna have to make sure we fade out those prompts. So we might want to... Like I said, touch your head while you're giving the direction to touch head. You might want to pull out a stop sign to teach children to stop at the end of a street. We may want to use visual tokens systems like my bear tokens system that I talk about in my online courses. So we do want to provide visuals. Most of us, including typically developing adults, learn best with visuals. We just want to be able to systematically fade out those visuals so the child really can function as well as possible in the world. And if you think about everything that kids are exposed to, especially in school settings, it involves a lot of comprehension abilities.

And so don't just think of language as speaking, think of language as understanding the world around you. Understanding the language. Understanding the safety. Understanding game rules. Understanding everything that's happening. And that is a process. And for many kids, it's just an ongoing thing that we have to constantly be assessing and teaching based on where the child is at.

Thanks for joining me today. I hope you liked that podcast on teaching comprehension issues. And if you did, I would love it if you would lead me a review or a rating and share it with friends. Tell everyone, you know, parents or professionals to tune in to the Turn Autism Around podcast anywhere you listen to podcasts.

If you're a parent or an autism professional and enjoy listening to this podcast, you have to come check out my online course and community where we take all of this material and we apply it. You'll learn life-changing strategies to get your child or clients to reach their fullest potential. Join me for a free online workshop at MaryBarbera.com/workshop, where you can learn how to avoid common mistakes. You can see videos of me working with kids with and without autism. And you can learn more about joining my online course and community at a very special discount. Once again, go to MaryBarbera.com/workshop for all the details. I hope to see you there.