Foundational Skills for Autistic Learners Every OT Should Know

Foundational Skills for Autistic Learners

Working with autistic toddlers and preschoolers is incredibly rewarding, but it can also present unique challenges. You might encounter students like Hank, a 4-year-old client who wasn't yet speaking and clearly communicated his dislike for therapy sessions through his behavior. If you’ve ever felt unsure of where to start with a learner who isn't responding to traditional methods, you aren't alone.

The key often lies in stepping back and focusing on the basics. By establishing a strong base of foundational skills, you can help students find their voice and become more independent communicators. This guide explores eight essential skills and practical strategies to help you support your autistic learners effectively.

Related CE course for OT professionals: Foundational Skills for Autistic Learners

1. Joint attention

Joint attention is the shared focus of two individuals on an object. It’s defined as shared attention between at least two people on an object or event, where both people know they are attending to the same entity. This skill is critical because there’s a strong relationship between joint attention and both receptive and expressive language skills.

To work on this, try engaging in a shared activity without demanding language immediately.

• Use high-interest items: Incorporate toys, books, or music that the child already loves.
• Follow their lead: If a student is playing with a car, grab another car and play alongside them (parallel play).
• Be a play partner: Focus on the interaction rather than the outcome.

Goal example: Joe will increase his overall joint attention skills by engaging in a shared activity for a duration of 3 minutes, without prompts, over 2 consecutive sessions.

2. Requesting (manding)

Requesting is often the first language skill children learn because it helps them get what they want. Teaching a student to request helps them understand that their communication is powerful. Whether the student uses verbalizations, pictures, sign language, or an AAC device, the goal is to make communication functional and rewarding.

Strategies for success:

• Identify what items or actions the student enjoys.
• Provide prompts as needed but fade them over time.
• Embed opportunities for requesting throughout the day (e.g., during snack time or play).

Goal example: The student will request 10 preferred items or actions without prompting, over 3 consecutive sessions.

3. Imitation

Imitation is a stepping stone to more advanced communication. It involves copying behaviors, gestures, or sounds. Reciprocal imitation training (RIT) is a naturalistic intervention that teaches imitation within a social context and has been shown to improve spontaneous language.

You can break this down into three types:

• Object imitation: Rolling a car or banging a drum.
• Gesture imitation: Clapping hands or waving.
• Verbal imitation: Copying simple sounds or words.

Start by imitating the child's behavior first. If they bang a drum, you bang a drum. This builds rapport and shows them that imitation is a two-way street.

Goal example: The student will imitate actions with a variety of objects without prompts, over 2 consecutive sessions.

4. Matching

Matching is an early learner skill that helps students organize their world. It involves pairing identical items or pictures. This skill is essential across various environments and people.

Start simple with identical objects (e.g., two identical apples). Once that is mastered, move to matching identical pictures. Keep it functional by incorporating matching into daily routines, like matching shoes or cleaning up toys.

Goal example: The student will match identical pictures when presented with a field of 3 pictures, without prompts, over 2 consecutive sessions.

5. Following one-step directions

Following directions is vital for safety and participation in daily activities. However, it’s crucial to keep these directions functional and relevant to the context.

Avoid generic drills. Instead, use directions that make sense in the moment, such as "Throw this away," "Get your shoes," or "Come here."

Goal example: The student will follow functional one-step directions (a total of 5) with 90% accuracy, over 2 consecutive sessions.

6. Play skills

Play is how children learn, but autistic learners may need support to develop these skills. Be a flexible play partner and observe what the student enjoys.

Modified activities:

• Movement-based play: Incorporate yoga or obstacle courses.
• Modified games: Adapt games like "Simon Says" or "Musical Chairs" to fit the student's processing speed and sensory needs.
• Parallel play: Simply playing next to the student with similar materials can be a great starting point.

Goal example: Lee will increase her independent play skills by engaging with a variety of novel toys for a duration of 5 minutes, without prompts.

7. Fill-ins

Using "fill-ins" creates an opportunity for the student to complete a familiar phrase. This is often easier than generating language from scratch because the structure is already provided.

You can use familiar songs or common phrases. For example, sing "Twinkle, Twinkle, Little..." and pause to let the student say "Star."

Goal Example: When presented with a fill-in-the-blank phrase, the student will fill in the blank with a logical answer, with 90% accuracy.

8. Labeling (tacting)

Labeling allows students to identify and name items in their environment. Start by focusing on preferred items—things the student actually likes and wants to talk about.

Use pictures or real objects. If a student loves elephants, use pictures of elephants to work on labeling. You can also add actions (e.g., "The elephant is eating") to build phrase construction.

Goal example: When shown a picture, the student will label preferred items with 90% accuracy, over 2 consecutive sessions.

Putting it into practice

When working with autistic learners, building rapport is the most critical first step. Before you place any demands, observe the student. Find out what they love. Be playful, upbeat, and flexible. If a session isn't going as planned, don't be afraid to pivot. The goal is not compliance; it is communication. By focusing on these foundational skills, you provide a roadmap for your students to express themselves and participate more fully in the world around them.