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Communicating Through Play with your Pre-School Autistic Child
Reclamation and Tugging on his Mind through 'Live Company'

Autism Oxford Conference, 1999

Play Music with your face! - Mouth and Face Games

Better than any toy, the human face can be as exquisitely responsive and expressive as nothing else in the world. It is really the most amazing cause-and-effect toy ever invented: it has eyes that blink, that can shine and widen in surprise, in joy, with love, concern or worried urgency, they can narrow in a more pained or nasty expression, be that real or pretend. It has a mouth that can not only talk and sing, but also make funny, surprising, soothing, exciting shapes to watch and noises to hear; it can open and shut, purse and smile, blow raspberries or make plopping noises, with a tongue inside that can wiggle from side to side, go in and out. It has a nose that can crinkle or blow, that sticks out so one can grab it, to which mummy always says one of her frequent ‘no!’s (!). There are eye-brows which can frown or stretch in surprise, or mock-anger, teasingly provoking a laugh and fostering a beginning sense of humour.

What I call ‘Mouth-and-Face-Games’ are nothing more than larger-than-life elaborations of the earlier baby-babbling games of ‘pure interraction’, they aim to use whatever remnants of instinctive interest and responses there may be, to recreate face-to-face situations that are interactive, playful and fun. The baby’s earliest vocabulary includes grunts, gurgles, shrieks, coughs, smacking his tongue or his lips, blowing raspberries, making bubbling and lots of other sounds, impossible to describe in words, but happily echoed by any tuned-in adult. They require no tools or equipment, just looking, listening, copying and echoing each other’s sounds. All we need in our tool-kit is our face, eyes and voice, a thoughtful and feelingful mind, an interest in careful observation, some sensitive awareness of our own pre-verbal communicative potential, a willingness to wait, watch and respond rather than to teach and demand, and to keep our concentration tightly focussed on the child’s face and subtle communications.

Some of this is similar to how we instinctively help a tiny baby to focus. How do we attract and hold a baby's attention, or regain it, if he has turned his head away or disintegrated into crying? The answers are in watching the details of babies' communication, watching someone who is 'really good with babies', paying attention to what holds the baby's attention, makes him coo or laugh or turn away, and what the adult does to hold or regain it. Much of this relates to what the adult does with their face and head, with their voice, breath and body-movements, with lots of ‘making it bigger’.

A sensitive adult wanting to strike up a 'conversation' with a baby of about 3 months might first attract his attention with a sharp in-breath, which may be voiced with an 'as-if-alarmed' and super-surprised ''h-aa!?”. It may almost sound as if they just had a tiny version of the fright of their life (with some children, it may need to sound like a big version of the fright of his life!). The alarm in someone’s voice seems to provoke an innate compulsion to check their face: is there really an immediate threat to their life in it? The child looks up, but finds the alerting sounds embedded in a broadly smiling greeting-face, with wide beaming eyes, welcoming him with delight into a communication-game, claiming him as partner and into a human encounter.

The 3-year old autistic child has had almost 3 full years of, often insistent, practice in not focussing, not pulling his senses together, not paying attention, not studying mother's face, - a very long time when brain-growth is at a biological peak. Adults can easily succumb to his bizarre behaviours, losing all confidence in being able to claim his attention, to engage his interest in social activity. It is important to be aware of this, as such feelings need to find their match in our massive efforts to claim, or reclaim, his attention and interest. We have years of anti-developmental practice to counter! That is how much bigger we have to try to make all our overtures, all our gestures, all our communications! Make whatever you say, do, or show him about 3 or 4 years bigger! We need to make our presence unavoidable for him, but in such fun ways, as not to put him off, should he risk coming out of his shell.

Patrick wasn’t one for joining in. He had his own agenda. But finally he relented to sit down. Making the most peculiar noises with my mouth, he looked up with sudden interest. I did it again, all my attention focussed on him, trying to hold his interest through the expressivity of my own face. Then I paused mid-way, to encourage him to take over the sound-making himself, widening my eyes to show that my attention was still all on him, before offering a weaker version myself, anxious not to lose our hard-won ‘shared attention’. And indeed, he tried to copy my ‘raspberries’. I echoed him, and he did it again, this time with more ‘umph’. After a few rounds, I added a tongue-click, then waited for him to take his turn. He did. We were now having a dialogue-game of ‘raspberries - tongue-click - : your turn!’. I added a vocal sound at the end, and Patrick copied this too. And then it was my turn to be surprised! Patrick’s next turn went:“‘raspberries’ - tongue-click - vocal sound - punch air and shout!” He looked at me with a broad grin. It was wonderful! Patrick had not only understood the idea of copying vocal sounds, but also the idea of sequencing and adding new elements. This was creative! We continued for about 10 minutes, and only stopped because we had to. From then on, Patrick ‘asked’ daily for ‘mouth-and-face-games’!

Once Patrick and I had developed a sequence of sounds and actions, we could each add bits for the other to copy. I also used two other ‘tricks’: often I would start, then pause suddenly, smiling expectantly. Or I might make as if I was going to click my tongue, but then freeze with my tongue visibly in my mouth, - which would invariably get him to finish or to put in the next bit of the sequence, like the tongue-click.

At other times, I would get it wrong: playful ‘messing up’ often motivates a young child into communicative action! I’d start off alright, but then leave a bit out, - and hesitate, e.g.:“‘raspberries’ - vocal sound - punch air with right fist and - tongue-click (instead of shout)”. Pretending to be surprised, when he ‘corrected’ me, I’d apologise (all in good humour!) and start again from the beginning, ...: it’s fun!

Mistakes have their place too. The stuff of human relationships and communication, they help to keep things alive. Balancing this is like a tight-rope walker. It requires much patient perseverance, great attention to detail and determination.

However, we must bear in mind throughout that although the autistic child may be able to, he is likely to be very unused to using his mind in such ways. His threshold for being over-stimulated by too much of anything, and to feel pushed over the edge, may be minute. Therefore, while one autistic child may need us to greet him with the broadest and warmest smile we have, another may need a much cooler version, like the faintest and most unobtrusive smile or look we have available! It is our responsibility as adults to remain sensitive to the level of stimulation and frustration each child can tolerate at any given moment, and to stop and tune down our efforts at the slightest sign of seeing him withdraw or get frightened.

After many years of working with autistic children, Anne Alvarez, a child-psychotherapist, suggested the term ‘reclamation’ for what we are trying to do, i.e. to claim, or reclaim, him as a fellow human being with all the human potential that belongs to being human.

The most important is to 'make it bigger!', i.e. to make a conscious effort to be dramatic, to exaggerate what we do or say, down to the smallest details. By over-acting our responses, we make our communications to the child ‘bigger’, and easier for him to attend to.

The 3-year old autistic child has had almost 3 full years of, often insistent, practice in not focussing, not pulling his senses together, not paying attention, not studying mother's face, - a very long time when brain-growth is at a biological peak. Adults can easily succumb to his bizarre behaviours, losing all confidence in being able to claim his attention, to engage his interest in social activity. It is important to be aware of this, as such feelings need to find their match in our massive efforts to claim, or reclaim, his attention and interest. We have years of anti-developmental practice to counter! That is how much bigger we have to try to make all our overtures, all our gestures, all our communications! Make whatever you say, do, or show him about 3 or 4 years bigger! We need to make our presence unavoidable for him, but in such fun ways, as not to put him off, should he risk coming out of his shell.

A word of warning may be due here: ‘making it bigger’ does not simply mean more, louder, faster. We want to exaggerate whatever will draw his attention to the feeling that is shared and expressed by the behaviour, rather than simply the behaviour itself.

One adult would approach Kofi by talking to him in a barrage of loud shrill noise. The more he withdrew, the louder and more persistent she got, the closer she would sit, hold his hand harder, whenever he wanted to run away.

While she may have used the idea of ‘make it bigger!’ she did so without sensitivity to the child. Her approaches lacked the element of playfulness, so essential to win his interest and willingness to cooperate. She forgot to observe her own behaviour, or Kofi’s likes and dislikes (he hated any loud, and especially shrill, noises!), and to tune in with him on his level of development. Sometimes ‘making it bigger’ may even have a paradoxical feel, like moving exaggeratedly more slowly, or more quietly, or more unexpectedly.

Approaching the autistic child with 'make it bigger!' in mind at all times provides the adult with a simple 'technique' of not falling prey to the sense of being rendered non-existent, so common and demoralising. If tuned precisely and sensitively to each child, this technique, intuitively familiar to all of us from talking to much younger babies, can achieve an enourmous increase in the success-rate of the autistic child’s responsiveness, his ability to pull his attention together and his motivation to focus.

Don’t go silent too: talk to him! Believe it or not, he may be listening!

It is not uncommon for the adults to become as mute, and even non-communicative, as the autistic child in their charge. When asked why, the response is often a helpless “but he doesn't understand”, “I don't know what to say” or “I don't understand what is going on”. Although understandable this is not necessarily logical, as not understanding does not need to make us unable to speak. By not responding in the usual human ways which we take for granted, the child behaves as if the adult was not there. Feeling baffled is a normal human response, and the adult's experience of utter puzzlement has perhaps resulted in something like a mental black-out that affects their usual common-sense and thinking-capacities, i.e. "I just can't get my head around it!". It is like a state of shock, - shock over the child's puzzling and humanly incomprehensible behaviour, one's own inability to make sense of it, to communicate or even to make contact, and the experience of apparently having lost one's own mental capacities, even though one thought they were usually working well enough.

I vividly remember the sense of bewilderment in Nancy’s support-worker sitting silently, and as if paralysed, by the computer while Nancy was involved with some marbles on the floor. When I spoke to the support-worker, she came ‘back to life’. Her intention had been to let Nancy play on the computer. When I suggested that it might not only be useful for Nancy, but also for herself, to put her thoughts, feelings and observations into words, she looked at me with amazement and a sense of relief. I added that I felt Nancy needed to be reminded that she was missing her computer-time.

Nancy’s worker explained that, because she was unable to make sense of what Nancy was doing, she could not say anything until she understood. She seemed to be ‘hiding’ herself, as if pretending not to be there either, as if then nobody would find out (not even herself) how ‘incompetent’ and ‘stupid’ she felt she was. I said that this is a very common and ‘normal’ experience when with an autistic child, - virtually the other side of the coin: the child takes no notice you, so you feel rendered incompetent with nothing worth noticing to offer. But we can detach our ability to think, and to talk, from our sense of helplessness and meaninglessness created by the autistic state of mind. Although hard, it requires no more than keeping in mind that our ability to speak enables us to catch in words our sense of bewilderment, our feelings, thoughts and observations, - like butterflies in a net. All we have to do is get the net out!

There is something in some autistic children that seems to exert a deadly pull on the adult's mind into an apparently inescapable state of mindlessness. There is something catching, something contagious, in the way in which he does not respond to us, and it may feel pointless to talk to someone who seems not to even notice you, which is, of course, precisely the reason why we should make the continual heroic effort to speak to him. The last thing we want is to collude with his denial of our presence, his refusal to take notice of us as fellow human beings and the possibility of meaningful human contact. Not being able to get an ordinary response from a child may make us feel like a hopeless case ourselves: why are we unable to get through to this child and make contact, why can't we make sense of what is going on, why don't we understand? Putting exactly this into words can be a powerful way out of this hopeless helplessness-dilemma. Talk to him, if only because it keeps you alive and thinking! As with a much younger child, it is a good idea to alternate between using ‘you’ and the child’s name. Nancy’s support-worker’s commentary may have gone something like this:

“I am not sure what to do now, Nancy! I thought you might like to play at the computer. .... (watching quietly) .... But I feel that you don’t want to know that I am here with you. It’s as if Nancy is saying: ‘No-one here but Nancy! Nancy and her marbles! Only Nancy and her marbles here!’ ... (watching quietly, then with some friendly urgency in her voice): But I can see you: Nancy is playing a marble-game. But I am not quite sure how it works. ... I am really sorry I don’t understand. I feel I am no good, that there is nothing I can do to help you. It actually makes me feel quite useless and depressed. ... (acknowledging those feelings to herself allows her to let go of their paralysing effect, and to return to Nancy): I can see that you are arranging your marbles in different patterns, this one and that one and another one. (speaking in a larger-than-life manner): Where is that one going? Oh, it’s going over there with the big marbles. Lots of big ones. I think Nancy says: where does the little one go? - Oh, that’s where it goes, the little one goes over there, all by itself. ... (then, in a more puroseful tone and with some urgency): Listen, Nancy! I think it’s time to do something different. Time to put the marbles away. Play with the marbles again later! - Let’s play on the computer now! ....”

The process of spelling out what one is seeing, feeling and thinking has life-saving potential for the adult, allowing us to keep a grip on our own mind, it gives us something to hold on to, helping us sort out what we do or do not understand, whether there is anything to understand at all, what we may need to know in order to understand more, and how we could perhaps find out. It also helps the child to be aware that there is someone friendly there who is making an effort to understand. There is no way of knowing whether Nancy was really not aware of her support-worker’s attention on her, or whether she just did not show it. The adult’s mental effort of focussing on the child, of watching and describing, also acts as a model of how the child himself could focus his attention and use his own mind. He may hear, even if only now and again, when your words correspond with what he is doing, looking at, thinking or feeling. Hearing the words that correspond exactly to what a child is doing or experiencing is one of the most important building-blocks in the development of early language-skills (‘shared attention’).

Don't muddy the water by being too active, talking too much, suggesting other things. Make your comment, with the appropriately expectant urgency, and wait. You don’t need to do much for a sense of suspense and expectation to build up. In fact, the less you do, the more it does! If you have created an expectant atmosphere but nothing is happening (because you are just waiting, without moving or speaking, just keeping your attention firmly focussed on him), it is as if you are almost 'willing' his mind and memory into gear. Almost invaribly he will have to notice, to wonder, to wake up into some grating sense that "something must be up". He will have to look at you to find out.

However, some people think that not only does the autistic child not understand language, but that one should not talk to him too much because it confuses him, - and there certainly appear to be times when the autistic child does not understand. But how do we know? It seems to vary so much from child to child, from moment to moment, from week to week, as development goes on or not. The trouble is that we can never be sure whether he does, at this moment, understand or not, which raises the question, whether it is better to err on the side of silence, underestimating his abilities to understand, hear and take in what we are saying, or of speaking too much, perhaps overestimating his mental capacities. But if talking keeps the adult’s ability to use her common sense alive and functioning, if it enables her to think of ways of enlivening him and making some tenuous contact, then it may serve a purpose that is worth-while and in the service of his mental growth.