One of the most valuable skills for children and adults with autism is the ability to follow instructions. When people with autism can follow instructions, this opens up more options for learning, making friends, options for school, and options for life after school.
If your child can follow most one step instructions with just one reminder, then they will need less support at preschool. If your child can follow 2 step instructions, then they can have a much higher chance of managing in a mainstream school. If your teenager can follow instructions at home to complete regular daily routines independently or with minimal help, then they have more opportunity for work placement after school. When children and adults with autism follow instructions, to the best of their ability and with the least amount of help, it is easier for the people who are caring for them – parents, grandparents, teachers, group home staff, and the boss at work!
Why are following instructions difficult?
Following instructions requires a lot of underlying skills including the ability to:
- Pay attention to the verbal instruction
- Understand what the instruction means
- Remember the instruction
- Physically follow the instruction
For the purposes of this article we are talking about a child’s ability to follow a direction. Don’t confuse the ability to follow instructions with co-operation. If you tell your child to turn off the TV and they have a tantrum, it is unlikely that they can’t follow the instruction. They simply don’t want to. If your child frequently refuses to follow instructions and/or has tantrums when you give instructions, then it is a behavioural issue. This is different from teaching your child to follow instructions and requires a different set of strategies. Speak to your child’s therapist if your child is doing this.
These are the 5 steps you use to teach your child to follow instructions:
- Collect some data
You need to look at where your child is now so that you can choose the right level of instructions to teach. I have attached the ‘Following Instruction Form’ that can be used for collecting this information.
There is a hierarchy for learning to follow instructions. In this article, we will go as far as 2-step instructions:
- One step at home e.g. “sit down” “come here” “give”
- One step familiar instruction in other environments
- One step novel instruction at home. This means that you change a familiar instruction very slightly so that you know your child is listening and following the instruction, rather than rote learning an instruction e.g. If you tell your child to put their cup on the kitchen bench after a drink, make it a novel instruction by saying “Put your cup in the sink”
- One step novel instruction in other environments
- Two step instructions at home e.g. “Get your hat and put it in your bag”
- Two step familiar routines in other environments
You will notice that each level of instruction is separated out into following the instructions “at home’ and following the instructions “in other environments”. It is important that children follow instructions with different people and in different environments. Ask other people and collect information about other environments.
Choose the right level to teach your child instructions. This is usually the level at which they can follow instructions some of the time with your help. If your child isn’t following nay instructions, then start at the beginning. If your child follows most one-step instructions at home without help, then choose one-step novel instructions at home. Start in familiar routines, especially at home.
Teaching your child has 4 steps:
- Give the instruction
- Support the child to follow the instruction
- Reinforce the child for following the instruction – EVEN if you had to help them
- Generalise the ability to follow instructions to more people and more situations
Let’s look at each step individually.
- Decide what instruction you are going to give
Choose an instruction that is at the correct level. Use your ‘Following Instructions’ form to get the right level. Keep your instructions clear and at the right length. Eliminate unnecessary words. Instead of ‘Can you go over there and get your bag because we need to get ready for school’ say:
- ‘get bag’ (one step)
- ‘get your pack and give it to me’ (two step)
Match your instruction to your child’s communication level.
Why is it important to use the right level of language? Children with autism need to hear the most important part of the instruction. We want to set the child up for success when we give them an instruction. When you use too much language, your child may not understand what you said and they ignore the instruction.
Here are some examples for a parent who wants to teach their child to ‘sit down’:
- For a non-verbal child, the parent says “Sit”
- For a child who uses single words, the parent says “Sit down”
- For a child who says 2-3 words, the parent says “Sit on the chair”
Give the direction in a positive way – not a negative way. Eg. Instead of giving the instruction “Don’t put it on the floor”, say “Put it on the table”.
Tell your child to follow an instruction, don’t ask them to follow an instruction. Say “go to the toilet now”, don’t say “Can you go to the toilet now?”. The second example is a question not an instruction.
- Support and teach your child to follow the instruction
If your child doesn’t follow the instruction, then you start adding a bit of help or more cues to make sure they follow the instruction. You keep adding more help and cues until the child follows the instructions.
Let’s look at some of the cues or support you can start adding. We will use the example of a parent wanting to teach the child to pack away a toy:
- Parent gives the instruction “Pack away”. We always recommend that give you an instruction the first time without any cues or help because this is our final goal. Pick a good opportunity to give an instruction and stand in front of them (where possible).
- Cue 1: Come closer to the child and repeat the instruction again using a slower and slightly louder voice
- Cue 2: Touch the child on the arm and repeat the instruction
- Cue 3: Put your hands on your child’s hands and start using their hands to pack the toy away as you say, ‘Pack away”.
Here is an example of a parent teaching the child to “get your hat and put it in your bag”
- Parent gives the instruction “get your hat and put it in your bag”
- Cue 1: Point to the hat and give the instruction again.
- Cue 2: Parent gets the hat and outs it in the bag while they say, “get your hat and put it in your bag”. The parent puts the hat back and repeat the instruction.
- Cue 3: Parent takes the child to the hat, puts the child’s hands on the hat, helps child carry the hat to put it in the bag. As the parent does this, they say the instruction “get your hat and put it in your bag” as they do it.
There are lots of different ways you can help or prompt a child to follow an instruction. The prompts that you use should be individualised for your child. The goal is to give your child help but give them the least amount of help. We do know that when you give children with autism a lot of help every time you want them to follow an instruction, they expect you to help them every time. They are less likely to learn to independently follow instructions if you always give too much help. Some children will always need help to follow instructions, but we still want to give the least amount of help when teaching them to follow instructions.
If you need help understanding the best prompts for your child, speak to your child’s Speech Pathologist or therapist.
The prompts that can be used to teach your child to follow instructions include:
- Repeat the instruction slowly and with a bit more animation in your voice
- Touch the child or the shoulder or arm as you repeat the instruction
- Use a gesture (eg a point) as you repeat the instruction
- Model the instruction by doing the instruction as you repeat the instruction. Always put the object back, if the instruction needs one, so the child still has the opportunity to follow the instruction
- Move your child’s arm or body to start following the instruction as you repeat the instruction
- Physically help our child start following the instruction as you repeat the instruction. In this prompt, you don’t physically help the child all the way through. You physically help them start following the instruction and you see if they can finish the instruction by themselves.
- Physically help them follow all of the instruction as you repeat the instruction while you help them.
Don’t use all of these prompts for every instruction. We recommend that parents use a maximum of 3 prompts. By the third prompt, we want the child to have followed the instruction with your help. The choice of prompts depends on each child’s ability.
Let’s look at the earlier example of “pack away”. The following table gives 3 options for 3 different children. The prompts are based on the child’s developmental level:
- Reinforce the child for following the instruction – EVEN if you had to help the
Everyone learns best when there is a positive outcome to what they do. This is exactly the same for children with autism. The difference is, children with autism learn best when there is an immediate, positive and meaningful outcome after they follow an instruction.
We also know that your child will be more likely to follow instructions in the future if you provide a positive consequence or reinforcement. What reinforcers can you use?
- Social reinforcers should be used every time your child follows the instruction – even if you had to help them. Smile and use a very animated voice as you say,
- “You did it!”
- “Great, you got your bag”
- “I love the way you found your bag”
- If you use an object or reinforcer, it should be natural where possible. When you teach your child to “sit down” at dinner then they get their food. When you teach your child to “sit down” before you turn the TV on, then they get to watch their TV show. When you teach your child to “get your hat” before they go outside, then they get to go outside and play. When you hold up 2 foods to your child and say, “Point to the one you want?” then they get the food.
- The other way to provide a positive reinforcement is to do something pleasant after your child follows the instruction that is not directly related to the instruction. This approach should be used with children who have more language and/or the ability to learn when a reinforcer is not immediate. If a parent is teaching a child to “pack away your toys”, after the child has followed the instruction the parent says, “Let’s go and have a snack now”.
ALWAYS reinforce your child regardless of the level of help you gave them. Reinforce them if they followed the instruction independently, but also reinforce them even if you had to physically help them to follow the whole instruction
If you can’t teach your child to follow an instruction at a particular point in time, then don’t give the instruction. If you are running late for preschool, only give the instruction “get your hat and put it in your bag” if you have the time to help them follow the instruction. If you don’t have time, then just get the hat yourself this time.
- Generalise the ability to follow instructions to more people and more situations
Once your child can follow instructions at home most of the time without help, then we need to make sure they can do the same thing with other people and in other situations. We do know that children with autism don’t always naturally generalise skills. They may only follow instructions the person who normally gives them or they may only follow them in the situation where it normally occurs.
Check that your child can follow the instructions in different situations:
- At home, what happens if the instruction is given by a different person?
- If your child can follow an instruction at home without help, what happens when you give the same instruction at grandma’s house or at the park?
- If your child can follow an instruction at home without help, what happens when the preschool teacher gives the same instruction?
Make sure that instructions are mastered properly across different situations before moving on to more complex instructions.
Repeat, repeat, and repeat–make following instructions a habit or routine. Habits are easier for all children, especially for children with autism. We know they do best when things are familiar. If following instructions is a familiar habit for your child, they will do it!
One on One Children’s Therapy
Certified Early Start Denver Model Therapist