The notes that follow were given to trainees as part of an intensive home based program for a 3 year old hyperlexic boy named Jack in 1994. The notes were supplied to the trainee therapists about 6 months into the programme and supplement the notes provided at the start of the home based programme.

THE L.I.T.T.L.E. PROGRAMME

We are very pleased with the success of the language exercises; all the hard work that has been put into them over the last six months has really shown results!

We would like to maintain the exercises we are already using, but also introduce a few new ones.

However we also want to emphasise that ALL the different activities Jack does with you are helpful and important. Just interacting with another person, and having to look and listen and respond, is very valuable for Jack. He still needs lots of practise on social skills such as eye contact and turn taking. Learning to play in a way that involves other people is also very important if he is going to begin to make friends with other children. We only describe the language exercises in a lot of detail because they often require some explanation.

Many of the language exercises can be done informally. Opportunities often arise when playing a game or looking at a book. This helps Jack to generalise what he is learning.

The aim is to teach Jack to group similar things together, such as animals, food, furniture, toys, things that are found in the garden, things that are found in the bathroom, etc. This helps to give him a grasp of how things are organised.

We have prepared sets of picture cards for the various categories, for example, a set of pictures of furniture, a set of pictures of clothing, etc.. To go with these pictures are word labels giving the name of the category.

These cards can be used in various ways.

1. Choose four pictures from one set and one picture from a different set.

For example, a monkey, a cat, an elephant, a tiger from the animal set, and a strawberry.

Mix up these pictures and put them out on the table.

As you lay each picture on the table, ask, ‘What’s this?’.

Jack should reply, ‘It’s a monkey’, ‘It’s a cat’, etc.

When all the cards are out on the table ask, ‘Which of these are animals?’

Hand him an ‘animal’ word label to put under one of the animal pictures.

If he places it correctly say, ’Yes, a monkey is an animal’ or ‘Yes, a cat is an animal’, etc.

Carry on giving him ‘animal’ labels until he has labelled all four animals.

Then ask ’Which one is not an animal?’ and hand him the label that says ‘not an animal’.

When he places the label correctly say, ‘Yes, a strawberry is not an animal’.

This exercise can be made harder by reducing the number of pictures of the same category. For example, use only three pictures, two animals and one ‘odd-man-out’.

2. Choose two categories to work on, for example furniture and clothing.

Take three pictures from each category.

Mix them up and put them out on the table, each time asking ‘What’s this?’.

When all six pictures are on the table ask ’Which of these are furniture?’, and hand him the three labels saying ‘furniture’.

When those are placed correctly ask ‘Which of these are clothing?’ and hand him the three labels saying ‘clothing’.

3. Choose two categories, for example ‘toys’ and ‘vehicles’.

Put a ‘toy’ word label on one side of the table and a ‘vehicle’ word label on the other side.

Mix up lots of toy and vehicle pictures, and put them in a pile.

The idea is to take it in turns to put a picture by the correct word. So you might start by picking up a picture and saying, ‘Balloon'. That’s a toy’ and putting it on the toy side of the table.

Then it’s Jack’s turn to pick up a picture and place it correctly.

At the end of the game all the pictures of toys should be on one side of the table, by the ‘toy’ label. All the pictures of vehicles should be on the other side around the ‘vehicle’ label.

At the moment Jack tends to just put each picture in the middle of the table, although he says ‘toy’ or ‘vehicle’ correctly. He needs to learn to physically group things in the same category together.

Categories are often easy to work on when looking at books. For example you could point out a mouse in a picture and ask, ‘What’s that?’. When Jack says ‘It’s a mouse’ say ‘Yes, it’s a mouse. A mouse is an .....?’ Hopefully he should be able to supply the word ‘animal’.

The aim is to get Jack to work out what different objects are used for. For example, a knife is for cutting with, a chair is for sitting on, a toothbrush is for cleaning teeth, etc..

This can be done either by matching labels to pictures or verbally, using just the pictures.

USING LABELS

Put a set of four pictures out on the table. As usual, each time you put a picture on the table ask, ‘What’s this?’. Jack should answer, ‘It’s a knife’, etc.

You could also ask, ‘What can you see’, and Jack might answer, ‘a knife, a chair, a hat and a spoon.’

Give Jack a label, such as ‘for cutting with’, or ‘for putting on my head’. He has to work out where each of the four labels should be placed.

VERBALLY

Take a set of four pictures from the ‘What’s it for?’ file.

Show Jack the first picture (for example an apple) and ask him ‘What is it?’.

When he has said ‘It’s an apple’ ask, ‘What’s it for?’.

He should reply ‘It’s for eating’. If he is unsure it sometimes helps to do a little mime.

Work through the other cards in the same way.

An easier method which Jack finds quite funny is to show Jack the picture and then suggest two alternative uses, one correct and one silly.

For example, if the picture was of a hat you might say

‘What’s it for? Is a hat for eating? Or is a hat for putting on your head?’.

If Jack says, ‘Putting on your head’ say, ‘Good boy! A hat is for putting on your head’.

Quite often Jack chooses the silly alternative, which he thinks is very funny, particularly if you do a little mime to illustrate it.

Say, ‘No, a hat is not for eating'. Try again. A hat is for.......?’ He should then give the right answer.

Any silly alternatives can be used, such as throwing, sitting on, brushing your hair with, jumping on, putting on your feet, sleeping on, etc..

The nice thing about doing the exercise verbally is that it encourages him to listen. He tends to rely too much on reading labels.

This is another exercise that can easily be done when looking at pictures in books.

The aim is to help Jack understand a simple sequence of events. Autistic children often have very little grasp of how one thing naturally follows another This task works on that deficit.

We have several sets of pictures. Each set shows a very simple story.

For example,

Boy with banana on plate. Boy eating banana. Boy with banana skin on plate.

Show Jack the first picture and ask one or two questions.

For example, ‘What has the boy got?’ ‘A banana’. ‘Where is it?’ ’On the plate’.

Then ask, ‘What happens next?’.

Put the other two pictures out on the table.

Jack picks the correct picture (Boy eating banana) and puts it next to the first picture.

Ask a question to make sure Jack notices what is in the picture.

‘What’s the boy doing now?’. Jack should say ‘Eating’.

Ask ‘What happens next?’

Jack should place the last picture (Boy with banana skin) next to the other two.

Again, ask a question to make sure he knows what is happening in the picture.

‘Where’s the banana?’ ‘All gone’.

At the end summarise the story pointing at each picture and saying,

‘First the banana is on the plate.

Then the boy is eating the banana.

Last the banana is all gone’

One or two of the stories have four pictures rather than three. In that case, when you summarise the story at the end use the word ‘then’ twice, for example,

‘First....... Then...... Then ....... Last.......’

There are quite a few other areas of language that we are trying to work on with Jack, which are best done informally. We don’t expect you to remember all of them! Some might provide useful ideas for activities.

At the moment Jack tends to use quite a lot of odd, autistic-type speech. We want to target two phrases that Jack quite often uses and teach him to use something that sounds more normal.

1. If we ask Jack, ‘Do you want a drink?’ he tends to reply ‘Drink’.

We want him to say ‘Yes, please’.

This may crop up in sessions if you ask him if he wants to have a particular toy or game.

You say, ‘Do you want to do a jigsaw puzzle?’

Jack agrees ‘Jigsaw puzzle’

When this happens you immediately prompt him to use the correct phrase.

You say, ‘Say "Yes, please"’.

Jack copies ‘Yes, please’.

2. If we offer Jack something that he doesn’t want, for example a book, he says, ‘No book’. We want him to say ‘No, I don’t want a book’.

This would work out as follows:-

You ask, ‘Do you want to do a jigsaw puzzle’.

Jack replies ‘No jigsaw puzzle’

You prompt him with the correct phrase,

‘Say "No, I don’t want jigsaw puzzle"’.

Jack copies, ‘No, I don’t want jigsaw puzzle’.

Obviously, it’s even more normal to say ‘No, I don’t want to do a jigsaw puzzle’, but that makes the sentence a bit too long for Jack to remember easily.

It would be useful for Jack to learn to use this phrase appropriately. At the moment, if we ask him ‘What’s that?’ and he doesn’t know he tends to say nothing, although he does look at us expectantly, waiting for us to tell him. When he goes to a new school it will be helpful if he is able to say, ‘I don’t know’. Then the teacher will be able to tell whether he hasn’t heard or understood the question, or whether he has heard and understood the question but doesn’t know the answer.

We are hoping to put some pictures of objects that Jack doesn’t know the names of in with the category pictures and noun pictures. This will provide him with a bit of practise on ‘I don’t know’.

For example:-

You show Jack a picture of a coat hanger and ask, ‘What’s that?’.

Jack says nothing because he doesn’t know (he will probably look at you expectantly).

You prompt him, ‘Say "I don’t know"’.

Jack copies, ‘I don’t know’.

You say ‘It’s a coat hanger’.

This can work quite well when looking at books. Jack isn’t sure of the names of quite a few every-day objects (for example, vacuum cleaner, fridge, chimney, dustbin, cushion) so there should be quite a few opportunities.

PREPOSITIONS - BEHIND, IN FRONT, AND NEXT TO.

Jack seems to have got the idea of ‘in’, ‘on’, and ‘under’, so he’s ready to go on to these new prepositions.

This is a nice activity to do with soft toys or the plastic animals.

The easiest way to work on this with Jack is to choose just one preposition, such as ‘next to’.

First demonstrate the idea of ‘next to’ a few times.

For example:-

‘Look. Lion is next to the tiger. Off he goes. Now lion is next to the giraffe’.

Then ask Jack to put the lion in the correct place.

For example:-

‘Jack, put lion next to the crocodile. Good boy. The lion is next to the crocodile.

Now put the tiger next to the elephant. Yes! The tiger is next to the elephant’.

The hardest stage for Jack is actually saying where the animal is.

For example:-

‘Jack, where’s the gorilla?’

Jack has to say ,’Next to the snake’.

Jack usually loves lining things up, and this is a very good opportunity for working on these particular prepositions. For example, ‘Let’s put teddy behind Piglet. Tigger goes behind teddy. Winnie-the-Pooh goes behind Tigger’, etc..

Jack tends to find work on prepositions easier if you use people or animals rather than objects. For example, if you put a ball behind the door, and asked, ‘Where’s the ball?’, he might have problems, but it you put a teddy behind the door and asked ‘Where’s the teddy?’, he would find this easier.

Jack needs to get a grasp of these words to help him understand the order in which things happen. We try to use them in every-day situations.

For example,

‘First we put our coats on, then we get in the car, last we go to the park’,

‘First we eat our dinner, then Mummy gets the toys’

‘Medicine first, then sweet’.

He needs more work on this, so if you get an opportunity have a go during the sessions, please do.

For example, if you want Jack to work with the bricks and he wants to play with the animals, say

‘First bricks, then animals’. (It may not work!)

Often pretend play provides some opportunities.

For example, with toys on the slide, line them up behind it and say,

’Pussycat goes first, then teddy, and last parrot’.

Or if you were pretending to wash a teddy,

‘First we wash his face......, then his hands......, and last his feet.’

(See also ‘What Happens Next’ in the language exercises).

The aim is to encourage Jack to listen more closely to what is being said, and to follow more detailed instructions.

For example if you put a pig and a box on the table, and said to Jack, ‘Put the pig in the box’, that would be a simple instruction to follow.

If you put two or three pigs of different sizes on the table, and a box, and said to Jack, ‘Put the little pig in the box’, that would be a more detailed instruction. He would have to choose the correct pig and put it in the box.

If you put two or three pigs on the table, and two boxes of different colours, and said, ’Put the big pig in the red box’, that would be a very detailed instruction. Jack would have to choose the correctly sized pig and put it in the box of the correct colour.

One way of doing this is to get half a dozen soft toys and say, for example,

‘Put the green bird on the bed’.

‘Put the animal with stripes under the table’.

‘Make the little teddy jump’.

‘Give the animal that says "Miaow" a cuddle’.

Each time Jack has to select the correct animal. He then has to put it in the correct place, or do the right thing with it. If Jack finds this too complicated try simplifying it a little, for example by asking him to put each animal in the same place, such as on the bed.

More detailed instructions can also be used when looking at pictures in books, particularly if there are lots of similar things in the picture. For example, you could say ‘Point to the house that has a green door’(presuming there are several houses in the picture) or ‘Point to the square window’, or ‘Point to the animal with a long neck’, etc..

This is a useful activity to do with Jack because it provides a different way of practising the vocabulary he has learnt so far, and also helps him to learn new words. You will probably find that you have to do most of the drawing, as Jack finds drawing even very simple pictures difficult. He will happily draw letters and shapes but is completely stumped if you ask him to draw a cat or a man or a tree. He likes watching other people drawing things and will happily add a feature, such as the eyes in a face or the tail of an animal, if asked.

Drawing provides a good opportunity to teach Jack the names of parts of things.

For example, if you were drawing of a flower you could say, ‘Look, Jack, here’s the petals (draw the petals)....., here’s the stem......, and here are the leaves. Jack, you colour the petals’.

Or if you were drawing a house, you could ask Jack questions as you drew, such as,

‘These are the ......?’ (windows),

‘Here’s the ......?’ (roof),

‘What’s this?’ ‘It’s the chimney’.

‘Jack, you draw the door’

Jack grasps new words easily if he can see them written down, so it may be helpful to actually write labels on the picture.

Animals, birds and fish are always a favourite with Jack, and introduce words such as beak, claws, whiskers, feathers, fins, trunk, horns, etc..

Drawing also provides a good way of working on words such as long and short, fat and thin, big and little. Of course it’s also possible to have actions in the picture, such as running, eating, crying, swimming, etc., and prepositions, for example, ‘The cat is next to the mouse’, or ‘The chimney is on the roof’.

Pretend play is still an area that Jack finds quite difficult, although he has certainly improved. He usually understands toys doing very basic actions such as eating, drinking, dancing, running, jumping, etc.. He also understands a few slightly more complicated ideas, such as chasing, falling over and hurting themselves, crying, bathing, and hiding. These may provide a useful starting point.

A different approach is to ask Jack to pretend to be something, for example a train, or an aeroplane or a particular animal. We haven’t done this much with Jack yet, so we don’t know how well it will work. However he can certainly do a chimpanzee with remarkable accuracy! At first it might be necessary to demonstrate to Jack what you want him to do so that he gets the idea.

A new timetable of sessions for the Summer term is enclosed. This may well be the last term of the programme, since Jack will be probably be attending school full-time from September. It would be nice to arrange some kind of event to celebrate the completion of the programme, so we shall be looking at ways we can do this.

Please don’t worry if we have booked you for a session that you cannot attend. Just let us know at some point before the date. And as always we would like to remind you that you should feel free to let us know if you want a break, or no longer wish to take part in the programme. People’s circumstances and commitments change over time, so if for any reason, you find that you no longer have the time to give, please do let us know.

Thank you again for your help in the programme.