Teaching how to point
Pointing. It seems so simple and straightforward that most people probably don’t even think about it. It is certainly one of the world’s foremost gestures – and it is quite a universal one at that (although pointing can be rude in some countries). Yet there are some autistic people, especially children, who don’t point, and who do not know to follow the direction of a pointed hand to locate what their communication partner is trying to highlight. Rather than pointing, it is more common to see autistic children taking an adult’s hand and placing it or “throwing” it towards the desired item.
Teaching how to point is generally done through a combination of modelling and physical prompting. If your student is tactile defensive then you may have to rely solely on modelling if they dislike even firm touch.
Teaching pointing is based on the same premise that a lot of Speech and Language goals are based on: sabotage. Sabotage is going to show up a lot during the Communication Series so it’s probably best to address a few things here. I have come across a small handful of people who claim that sabotage with the intention to further communication is a terrible thing to do – that any and all communication should be accepted at all times. I do agree that there needs to be acceptance of AAC; but the reality is that there are limitations to this. Communication needs to be able to be interpreted by a variety of people – not just those who know the individual’s every gesture well, because those people might not always be there.
That said, some people might take sabotage too far. Not every requesting opportunity should be sabotaged. Most people do not force their non-autistic family members, friends or students to communicate in full and grammatically correct sentences at all times, or lock away everything the individual likes until they ask for it, and the same principle applies to any development of speech and language. There needs to be a careful balance between sabotaging to develop skills, opportunities to be independent, and just general day-to-day life.
Additionally, the student should not be left failed in their attempt to communicate. Modelling, prompting, or stepping backwards to a level of communication in which they can be successful are much preferable to deciding that because they did not respond correctly to the sabotage, they can miss out on what they were meant to communicate for. There are two main reasons for this: firstly forcing them to go through failure for communication might lead to damage to confidence and self-esteem, and secondly it might lead to them attempting to access the item themselves when you’re not looking and risk hurting themselves (for example if they climb onto a work surface and fall). Far better to alter the situation to allow successful communication.
With that aside, back to pointing.
The first step to this is to identify something that the student is motivate to communicate over. This might be a physical object, food, or an experience such as a bubble tube or music being played. A motivator worksheet is attached at the bottom of this post to help you to identify things that are possible motivators for communication.
With a motivator in mind you can take one of two approaches. The first is simply placing the item in a place that is visible to the student but just out of reach, and the second is the same approach as PECS, with ‘The first one’s free’ where the student is given the item or a piece of the food – and then it is taken back (or the rest in the case of food) is then placed in view but out of reach. As long as the item is not too high, what you should get is some sort of indication that the student wants more of that item. This might be eye gaze, it might be walking over and standing beneath the item, or it might be vocal protests or crying.
Before the student becomes distressed model pointing to the item and state it’s name, then quickly take the item and hand it to the student. You can repeat this a few times, but make sure to stop before overdoing it. Learning communication should be useful and functional, not completely stressful.
After some successful modelling, you can try physically prompting the student to point to the item themselves. Sometimes this will entail the entire process of curling the other fingers in and leaving the pointer extended. Again, once they have pointed with your assistance, label and provide the requested item.
It doesn’t have to be this rigid all the time, and teaching opportunities will hopefully arise when the student indicates they want something in their usual method (by “throwing” the communicator’s hand for example), and then the same modelling and physical prompting can be carried out then. You may decided that your student doesn’t have the fine motor skills yet to extend their pointer finger, in which case you might choose to start with whole hand pointing.
Once they are confident pointing to an item relatively near to them, you can begin to move the item further distances. Don’t go too far at once, but increase the distance in small increments to encourage the student to seek out the item they want.
Once this is successful you could begin to put the item into things – such as cupboards or tins on the work surface. This typically might be started by placing the item in a cupboard with the door wide open and then slowly close the door until it is shut. You may want to provide visual guides in the form of photos or symbols on cupboard doors to help the student determine what is in the cupboard you are teaching them to point at.
You will find that you need to be quick in responding to communication attempts, and you will need to watch the student closely as well whilst working on it. Some students find communication so difficult they will simply try and find an alternative way to retrieve the item themselves (which could be dangerous), or simply give up on the item. So be quick, be prepared, and reinforce immediately. Also, as I said earlier, don’t force the student to point to get absolutely everything they need or want. Include it in day-to-day life but don’t stress the student out with it.
Until next time.
Disclaimer: The opinions and information provided in this post are my own, and based on personal, educational, and work-based experience. They do not reflect the opinions of any of the authors of the content referenced in this post. I am not affiliated or supported by any organisation, and this is meant to be an educational series of posts. The information posted here is not a substitute for advice and information provided by your own GP, speech and language therapist, occupational therapist or other professional in the field of autism, and should not be taken as such.