Chapter 3

Keep Your Child Away from the Screen

Limiting screen time has become a tedious cliché, like watching your weight. Everyone is talking about it, and yet it gets worse every year. I will make it very simple: don’t limit your child’s screen time. Eliminate it altogether. With the exception of non-addictive learning tools, a child battling autism should never set eyes on a screen.

No TV. No Netflix. No YouTube. No Disney. No Cartoons. No little Einstein. No Sesame Street. If your child can find these programs on his own, delete them from the device. Use a dedicated device and lock it on the learning app. This will prevent your child from migrating to YouTube or other internet-based services.

Here’s how to lock your child’s device on the learning app. On an iPhone or iPad, launch Settings, tap Accessibility > Guided Access. Toggle Guided Access On. Tap on Set Passcode and choose a passcode that only you will know. Toggle Accessibility Shortcut to Off. Once Guided Access is enabled, if your child tries to leave the app, a banner message will appear telling him to triple-click the Home button to exit. If he doesn’t know the passcode, he won’t be able to exit Guided Access. On an Android smartphone and tablet, Launch Settings -> Search -> ‘Pin’. Turn ‘Screen Pinning’ (‘Pin Windows’) On. Set ‘Use Lock to unpin’ On. Specify a Pin. To start pining, Open the app, tap the Overview button (square), tap the app icon at the top of the screen -> Pin this app. On older devices, tap the Pushpin button in the lower right corner.

Wait! What about “everything in moderation?” Are these draconian measures truly necessary?

Remember, it’s not draconian if your child doesn’t know what he’s missing. We can all agree that avoiding a bad habit is infinitely easier than breaking one after it’s taken hold. Many young autistic children fall in love with watching videos at first sight. It’s amazing how quickly it can become a problem you wish you didn’t have. By contrast, I am yet to meet a parent who regrets taking too long to introduce her child to the magic of passive entertainment.

I emphatically recommend you wait to share your favorite kids’ shows with your child until he catches up to his age group. Here's why.

Watching Movies Undermines Therapy

None of the popular children’s programs, not even the educational ones, like Sesame Street, develop voluntary imagination. All the developmental activities we talked about in the previous chapter require that the child focus his mind on creating new mental images. Watching a video blocks this effort and replaces it with readily manufactured ones.

What’s worse, watching videos becomes an addictive habit with some children. They get used to the instant gratification of artificial imagery and refuse to do the mental work necessary to develop voluntary imagination.

The critical period for combinatorial language acquisition lasts approximately between the ages of two and five. That’s only three years or about 1000 days, and it can be shorter in some children. During this time, the brain is building neural pathways every second of every day. Language pathways compete for molecular building blocks with the pathways leading to nonverbal existence. The early signs of autism are proof that the nonverbal pathways are “winning,” and therapy is an attempt to reverse this process. Can an hour of screen time a day make a difference? It can and it does. It makes no sense to give the other side a break when we’re already behind.

To measure the impact of TV and video watching on voluntary imagination, we observed 3,227 children between the ages of two and five over a period of three years. All else being equal, the children who watched videos 40 minutes a day or less improved their MSEC scores on average by extra 40 percent, compared to the children who watched 2 hours a day or more.

Is 40 percent worth fighting for? When you recall that each MSEC point represents a critical milestone on your child’s way to combinatorial language, the answer is obvious. If we can shave off another point or two by eliminating the last half-hour of daily screen time, that’s the best bargain we will make in our lifetime.

What about the Benefits of TV?

Remarkably, our study didn’t find any. Aside from measuring combinatorial language and voluntary imagination through MSEC, our study tracked Autism Treatment Evaluation Checklist (ATEC) scores. ATEC measures your child’s progress in four areas: (1) Speech/Language/Communication, (2) Sociability, (3) Sensory/Cognitive Awareness, and (4) Physical/Health/Behavior. (The complete ATEC questionnaire is available free of charge [www.autism.org here]) All children in our study improved in all areas, but the high screen-time group did not statistically outperform the low screen-time group in any measure.

When I talk to parents about screen time, they often point to new vocabulary as their best defense. It goes something like this: “My child is already behind his age group. Where in his daily life will he find everything that happens on his favorite shows?”

Hold that thought! We know from Chapter 2 that voluntary imagination must take priority over learning new words. That said, taking a break from the movies doesn’t mean depriving your child of great story time. Read to him. Listen to an audiobook together. Throw in a few questions and answers, and his brain gets a full workout in addition to his daily dose of vocabulary.

Finally, I suggest your child will get more out of an interactive and challenging learning game than from any passive screen time. A case in point is four-year old Rocco, who plays MITA with his father several times a day.

“One game in MITA is about a full and an empty glass. I know for a fact nobody taught him these words before. I started him on that game at the basic level and took him all the way up to the highest difficulty. Today, I was serving the juice. I poured the last drop, and he said: ‘It’s empty.’ Another game is matching cars. It’s his favorite. Sometimes when we walk down the street, he points to a car and says: ‘Same car.’ He can tell that the car is similar to mine.”

If you like the idea of learning apps, choose the ones that challenge your child’s thinking. The more effort it takes to complete each step, the less addictive the app. Once children run out of “cognitive energy” they lose interest in the game. This is one of the design principles we use to make MITA non-addictive. Another one is to keep sensory stimulation to a minimum, both to reduce distractions and to eliminate the risk of addictiveness.

To get the most out of your app, make sure your child doesn’t guess the answers. Encourage him to solve the puzzles in his mind and only then to press the buttons. Trial-and-error defeats the purpose of the game, which is to get your child to work out the solution in his mind’s eye.

Pay attention to the physical environment in which your child plays learning games. Choose a quiet spot with few visual distractions. This will help focus his attention on the game and speed up the learning process.

Bonding Is Therapy Autistic children often have no trouble entertaining themselves. The challenge is to get them to notice, connect, and enjoy the company of others. This is another reason to tread lightly on solitary entertainment, like TV, and to shift towards activities with more potential for shared play. Ten-year old Josh has caught up to his peers in school and has a strong interest in astronomy. His father, Alex, believes Josh is on his way to becoming an independent adult. The biggest success factor, according to Alex, is the emotional bond he has formed with his son since Josh was three years old.

“He loved Legos. He could spend eight hours a day building a fire truck or a rocket. It was easy to leave him alone. If you weren’t trying to spend time with him, he didn’t ask for it. Trying to connect was like digging a tunnel: you move slowly and feel your way through. But in the end, he was no different than other kids. He enjoyed feeling a live being by his side, someone who took an interest in him.

Once he opened up, we played games together. One was Treasure Hunt. I would hide a Lego piece and leave notes telling him where to find it. The first note said where the next note was, and so on. Another game was to draw his favorite characters and cut them out of paper. He used to obsess over Jack and the Beanstalk. We made paper dolls and role played. He was Jack and I was the evil giant. It became a turning point in the relationship: when you’re role-playing, you’re not hiding away.”

Bonding may be the key that unlocks your child’s desire to imitate and join other humans. According to the social motivation theory of autism, this desire is critical to the acquisition of language. Without it, brain development takes a different course and resulting in a lifelong combinatorial language deficit.

Usually, the bonding happens naturally as the child clings to the parent. In your case the roles may be reversed, and it’s up to you to break the ice. A 2013 study found fewer connections between the voice-processing and reward circuitry of the brain of autistic children compared to their peers.

The degree of underconnectivity in the study was proportionate to the severity of the symptoms. In other words, your child’s brain may not be able to emotionally connect to your voice or your presence. But if you changed that, his symptoms would also likely improve.

Can you help your child bridge the disconnect and grow a secure bond? That’s exactly what Alex did with Josh, and I encourage you to do the same. How you go about it will be unique to you, your child, and your family.

Notice how building a bond allowed Alex to steer Josh from watching his favorite cartoons to playing challenging interactive games with his dad. Here’s how it worked:

“I wondered why he stared at a close-up of a character on the screen but avoided eye contact with real humans. Why would he rather turn us off and turn on the cartoons? At the time, he was also obsessing over the Titanic. He sat for hours drawing one picture of a sinking ship after another. We had to take away the crayons to make him go to bed. The therapist said it was no good, an artificial world, we should drag him away from the TV and distract him from drawing too much. I thought, what if, instead of breaking up his world, I joined him there?

At first, I just stayed in the same room. He didn't want me to watch him, so I’d pick up a book and pretend I was reading. He saw that I wasn’t out to ruin his fun, and he relaxed. A few days later he let me sit on the couch with him. I sat three feet away, and at some point he moved a little closer, still with his back to me. The next day, a little closer. One day he leaned on me. That’s when I knew he liked being together. After that, we started playing. He’d let me help with the Legos or draw on the same piece of paper. From there, we moved on to all kinds of games.

It took weeks, maybe months to overcome his fear of contact. First he tolerates you, then he likes you. He feels joy from not being lonely. Then he accepts you into his world. Then he wants to communicate. When he wants to say something, he will find a way.“

Be patient and follow your child’s lead. When you make an opening gesture, like quietly watching your child play, give him a chance to accept or reject it. Let him set the boundaries and be in control of when and how the bonding happens. Wait for his response and enjoy the subtle intimacy as you and your child get to know each other.

Nothing brings us together as quickly as sharing a laugh. Anytime you can make your child giggle is a win. Alex’s favorite trick is to play forgetful.

“He likes to take care of others for a change. I pretend that I forget how to put on a shirt, and he shows me how to do it. At night, I’d say: ‘Let’s go brush hands.’ He laughs and corrects me. It makes him feel good about himself and helps him mature socially.”

While Alex built bonding rituals around his son’s hobbies and obsessions, Ricardo noticed that his son liked to help around the house and used the chores to interact with his child.

“He asks to sweep the floor after dinner, to feed the dog, to put the dishes in the dishwasher. He folds the clothes and puts them in his drawer. When he wants something, I tell him where to get it. He can follow rudimentary instructions. It's working. Today I increased the level of the game on these subjects in MITA.”

The bonding starts with your child feeling safe and relaxed in your presence. When he’s ready, join him in his favorite pastimes. It could be a creative activity like coloring, playing, or singing. It could be physical movement—running, jumping, dancing, or even house chores. It could be food. It could be anything he likes. Let him find out if he likes it better together.

Pretend Play is Therapy

Pretend play, also known as make-believe and symbolic play, is separated from other forms of daily activities by its creative aspect, its difference from habitual actions and those performed for the sake of necessity. Pretend play is exhibited by children universally across all cultures and begins unprompted between the 1.5 to 2 years of age. The absence of pretend play puts a child at high risk for autism and represents a key deficit used in the diagnosis of autism. Pretend play is an essential precursor for combinatorial language. In our research of 7,069 young children with ASD, engagement in pretend play was associated with 1.9-fold better combinatorial language score. The positive effect of pretend play was stronger than the combined effects of seizures and sleep problems.

How can parents enhance pretend play activities? Joining your child in his fantasy world is a great way to promote pretend play. Parents can also encourage pretend play with certain toys, like doctor's kits, play kitchen sets, and costumes. Here are a few examples of how you could assist your child developing pretend play.

1. Build the block house together, put people figures or animal toys near your child. Name a person figure: “This is John. He lives in the house.” Encourage your child to pick John up and put the figure inside the house. Always smile and encourage your child to come up with his own ideas. Your child could say “John” and “house.” Carry on your child’s story, say “John lives and in the house,” as he puts John inside the house. Continue taking turns with your child putting people into the house. If your child’s engagement wanes, bring in a new toy, e.g. a lion. Say “the lion also lives in the house.” Move a few new blocks closer to your child and invite your child to build a second story for the house. Continue commenting joyfully on your child’s achievements. Do not rush your child, just encourage his every move with a smile and a cheerful comment. Remember that play is therapy!
2. Introduce a toy cup, take a sip, and let your child take a sip from the cup. Show how you enjoy the sip. Smile and say “yummy.” Introduce a doll: Olivia. Say “Olivia wants to drink.” Show Olivia drinking from the cup. Take turns with your child.
3. Introduce a toy food item, take a bite, and let your child take a bite. Smile and say “yummy.” Say “Olivia is hungry.” Show how to feed Olivia. Take turns with your child feeding Olivia. Pretend that Olivia reaches for the spoon and feeds herself.
4. Say “Olivia wants to sleep. Olivia wants to go to bed.” Put Olivia into a toy bed, cover her with a blanket and sing a lullaby. Let your child imitate. Take turns covering Olivia with a blanket.
5. Pretend that Olivia is feeling sad, happy, or hurt. Take turns calming Olivia down.
6. Take Olivia to a doctor and let your child treat Olivia.
7. Introduce Olivia’s family: a doll’s father, mother, and siblings. Play out a family story and let your child imitate. Take turns with your child.
8. Take a fairy tale book and play out its story with toy animals. Let your child imitate the story. Take turns with your child.

A shipping container can become a shopping trolley or a bed for a sleeping doll. A banana can become a telephone. Some chairs and a blanket can be transformed into a tent. A wooden stick can become a horse. Pretend play toys can take any form and be constructed of any kind of object. Make use of items around you.

Stick to the toys and topics that your child enjoys most. Continue an activity as long as your child enjoys it. Slowly introduce new words, figures, and actions, while paying attention to what your child likes. Remember that play is therapy! Being an actor in your child’s fantasy world is one of the best ways to encourage and motivate him to engage in pretend play. Use pretend play as an opportunity to connect with your child. Smile and thoroughly enjoy the soup he makes you by mixing plastic vegetables in a toy bowl. Do utmost to delight your child. Give your child as much time as he needs. Smile and encourage. Play is therapy!

Hands-on Parenting Wins the Race

The idea is to custom-fit every aspect of your child’s life to serve his very unique needs. To that end, even a learning app, like MITA, needs your constant involvement.

Ricardo plays computerized learning games with his son:

“I never use the game as a babysitter. I make sure I am always there. When my son gets stuck, I mute the game and explain the question myself.”

Ricardo tried many games before he found the ones he liked. He is always on the lookout for a great game, and he has programmed a few himself. When Ricardo found MITA, it was not available in his native Brazilian Portuguese. He called us and offered to do the translation. That’s how MITA came to Brazil.

In the early days of searching for a game app, Ricardo learned that he had to watch the game closely to make sure it works as described.

“We were in the potty-training stage. I used games to make him stay on the potty. I found a Portuguese-language game on Google Play, but I realized there was something wrong with it. He was pressing the buttons before he heard the questions. It turned out the questions were not in random order. I was going to fix it myself, but there was no open source code available. I was furious. I dropped all my research in molecular biology and switched to games. I changed the focus of my research, because I saw the power of games.”

Not ready to write your own games? No problem. Look for ways to adapt the games already on the market to your child’s needs. This is Amber’s key to success with MITA:

“I’ve learned more over the years about how to optimize the program for my children which I think is an amazing option for caregivers! You can choose everything from which program to work on to how many of each puzzle should be given, as well as adjusting the difficulty yourself. This helps you as a caregiver to target the skills you are working on and is invaluable.”

As you see, these parents have used vastly different means to help their children succeed. If they agree on one thing, it is, perhaps, this. Don’t leave your child to his own devices. Don’t let him hide inside his world. Take your time to make contact and build a supportive relationship with your child. Don’t leave him at the mercy of a video—or even a learning app. Work and play with your child. Join him at his favorite games and teach him new ones. His brain has a lot to overcome, but with your patience, diligence, and creative touch, nothing is out of reach.

Reference

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