Stage 1: Joining in with the child

Children with ASD are often very content to play alone. This does not help them build important social skills.

What parents can try: Observe what your child is playing with, then join in by pointing at the object. Make comments about the object or what your child is doing with it. If your child looks up at you, reinforce the action with a smile and encouraging words and attempt to foster engagement and back-and-forth interaction by building on this interest. Next, gradually attempt to challenge your child to solve problems. For example, if your child is moving a toy car back and forth, you can pretend her hand is a hill the car needs to drive over and can engage her by saying, “Oh no, there’s a hill. Can you drive your car up the hill? Great job! Can you drive your car down the hill? You’re a very good driver.” Try to keep the back-and-forth interaction going.

Stage 2: Following a point

At around 10 months of age, typically developing children spontaneously begin looking in the direction of a parent’s gaze or point as the parent points to a distant object or event. Children with ASD lacking this skill can often be taught.

What parents can try: Throughout the day, you might point at objects or events in an effort to get your child to look at them. At first, you can point to objects that interest your child to promote early successes. If your child simply won’t follow what you are pointing to, you may have to prompt him by tapping on his shoulder or even manually turning his head in the direction of pointing. When your child is successful, you can start pointing to new objects or events that your child has not noticed in the past. Praise your child’s efforts, especially if after looking at the target, your child makes good eye contact with you and shows appropriate facial expression. Examples include joy at the sight of a new toy, eagerness at the sight of the ice cream truck, and fear at the sight of something scary. Training opportunities can occur during normal activities such as eating, dressing, and toileting. For example, you can say, “Look! The toast is done cooking!” as it pops out of the toaster. Car rides, when a child is a captive audience, may be especially fruitful. Say, “Look! See the…,” and point to pictures on billboards, objects or animals along the roadside, or other vehicles of various colors and shapes.

Stage 3: Pointing to request

At about 12 months, children begin to point to let others know what they want or need. Children with ASD will often just cry or lead an adult by hand to the desired object.

What parents can try: If your child leads you to the refrigerator, you can encourage her to point to the object first, before giving her anything. You might do this by pushing the desired object way back so that your child can’t quite reach it and then acting confused so that she needs to gesture with her hand or finger. If your child will not point, you can take her hand and form it into a point and then point to items that you are quite sure she does not want. This will provide your child opportunities to make decisions by frowning, shaking her head, or saying no. Then you can help your child point to the item that you think your child does want. Before giving it to her, you can say, “Oh, so this is what you want! Thank you for showing me.” As practice continues, you can try to fade out the hand-over-hand prompts so that your child will point spontaneously to desired objects.

If your child is standing by the door to go outside, you might pretend to be confused so that your child has to point to the doorknob that she wants turned. If she does, you might try to turn it but fail. Then you can say, for example, “We need Daddy to help us.” If your child doesn’t understand, you might gesture for your child to get Daddy. Your child might then walk over and pull Daddy to the door. Try once again to get her to point.

Stage 4: Pointing to show or comment

Most children point to get their parents to look at something interesting at about 14 to 16 months of age. Children with ASD do not usually try to engage their parents at this age.

What parents can try: Once pointing skills are mastered, try to teach your child to point to objects or events that interest him to get adult attention so that the experience can be shared. Teaching this skill is a bit more challenging. At first, this might involve catching him doing quasi-showing acts. For example, if your child brings you a box of cookies to open, do not open it right away. Instead, you might comment about the box, point out some of the pictures on it, talk about its contents, or do anything to keep the back-and-forth social interaction going. Then you can say something like “Thanks for sharing this with me. That was very nice of you.”

When your child persists, you can then say, “Oh, so you want me to open this for you. OK, I will, but thanks again for showing me the box.” At other times, you may observe your child looking at something of interest, such as a helicopter in the sky, but he does not point to get you to look at it. You could take his hand, form it into a point, and point at the object, and then say something like, “Oh, now I understand, you want me to look at the helicopter! Yes, that is a big helicopter. I wonder where it is going. Do you think it is flying home?” You may need to prompt your child by turning his head back and forth between the object and your face. Always reward even small attempts to get your attention, especially when your child makes good eye contact.

In summary, try to connect with your child throughout the day with gestures, pointing, and words (using most, if not all, of these at the same time). Use naturally occurring objects or events as targets for joint attention and ongoing social interaction. Even though your child may be happy playing alone, you should join in with him at regular times. You should not be concerned about using gentle physical prompts such as forming his hand into a point, tapping his shoulder, or physically turning his face from the object to your face and back again. Also, you should not be concerned about playing dumb to encourage your child to explain to you what he wants. You need to literally get face-to-face with your child with ASD when trying to teach him joint attention and social interactions.