Anna, Jason, and Leslie are three different children from different families. I took on each case, respectively, at different times over the past year. Anna was from a middle class suburban family, Jason and Leslie were part of inner-city, low-income families. Upon meeting them for the fist time and interviewing the families, I learned that Anna, Jason and Leslie had very similar profiles, all demonstrating problems in the following areas:
- Always on the go
- Play with a toy for a brief period of time before abandoning it
- Low frustration tolerance (tantrums if s/he doesn’t immediately get what s/he wants)
- Babbling and making sounds, but not saying words
- Not responding to verbal instructions
- Poor eye contact
- Little or no response to an adult talking, singing, or initiating play interactions
In two of the cases I mentioned, the parent was very concerned that these symptoms indicated that their child had autism. I agreed that weak interactive play skills and poor eye contact are “red flags” that may indicate autism. I also agreed that language delays and seeming to be “in his own world” can be a red flag as well.
However, in all of the above cases, the children didn’t seem to fit the autism profile in any other way. Instead, they seemed to present delays based on the short attention span, hyperactivity, and difficulty focusing on an activity. When a child has difficulty focusing, they are not likely to pick up language, imitate words spoken by a caretaker, or develop the ability to engage in sustained constructive play (i.e. building with Duplo, pretend play, look at a book, stack items).
In these cases, I found high chair intervention to be very helpful. Using the high chair simply means having the child sit restrained in his or her high chair for a brief period of time (five to forty minutes, depending on the child’s age, and how well s/he is responding).
During this time, given the child is happy and at ease in the high chair, the therapist or parent sits facing the child and engages him or her in focused play interactions. The reason this strategy is effective is simply because the over-active child is able to focus on the activity and the adult, due to the restraints of the high chair.
It may sound strange, but many hyperactive children love getting into their high chairs to do an activity, and can perform much better both at language and play, while restrained in this way. One child I worked with began to imitate words for the first time while seated in his high chair. During that first high chair session, he imitated four new words!
Here’s a simple how-to for a successful high chair interaction:
- Chose a fun and engaging activity and show it to the child. This should be a toy or puzzle with several pieces (i.e. blocks, wooden puzzle, picture cards, animal figures). For the sake of explanation, I will use a puzzle as our example. The adult hands the child the wooden board, and maintains control of all the pieces. Don’t just dump them onto his high chair tray! We want to facilitate communication, so keep it as interactive as possible.
- Hold one piece near your mouth. Model the word “boat”. Make eye contact with the child. Encourage him/her to imitate. Accept any response, even imperfect ones (the child makes a sound, grunts, or imitates the word), praise the child and hand him the piece.
- Allow the child to struggle with the piece. Wait until he or she communicates that he or she needs help. This can be done by making eye contact, making a sound, or saying a word. If your child does any of the above, model the word “help”, and immediately help him or her.
- Use brief phrases to describe what your child is doing. In case of the puzzle, repeat the words “put in” with each piece.
- Repeat with the next piece. Encourage as much imitation as possible. Always wait for or request eye contact before handing a desired item. Provide as much praise and encouragement as you can; your child is working very, very hard.
- End the activity on a pleasant note, before the child loses focus or reaches max frustration. Follow the high chair session with an active activity like outdoor play, or ball play.
*Please note that this strategy is most effective for the highly active profile as described above. Children with autism will not respond as well. Children with autism have difficulty making eye contact even while restrained in a high chair. While high chair interactions may be helpful, children with autism will require more intense intervention than the strategies described above.