Autism and taking turns

By Janine Stichter Ph.D

How can I teach our son the crucial life skill of taking turns?

This week’s “Got Questions?” response is by Janine Stichter, professor of special education and an applied behavioral analyst at the University of Missouri’s Thompson Center for Autism and Neurodevelopmental Disorders, in Columbia. The university and its autism center are among the 13 sites in the Autism Speaks Autism Treatment Network (ATN).

Editor’s note: The following information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or behavioral therapist.

Autism and taking turns

I often hear this question about a pivotal life skill that challenges many children and adults on the autism spectrum.

Most people agree that learning to take turns is crucial to success in social situations. What often goes unappreciated is how turn taking involves the mastery of several related skills that are likewise important throughout life.

The ability and willingness to take turns involves

the skill of waiting (impulse control),
the ability to read facial expressions and body language (social perception) and
the twin skills of sharing and conversational reciprocity (the dance of interactions).

How we teach turn taking depends on a person’s developmental level. For example, young children and those with intellectual disability or limited language skills may not be able to process a lot of verbal instruction. In these situations, it’s important to create an environment that encourages and supports turn taking. (More about that below.)

Explaining how and why to take turns can work well with many older children and those on the less-severely affected end of the autism spectrum. With these groups, we can also teach higher-level turn taking skills. (Also described below.)

To put it another way, learning how to take turns along with its related skills is a lot like learning to read. As the child masters each level, we want to build on the skill while practicing it in different situations.

Here are some strategies we’ve found helpful working with children of different ages and developmental levels.

Taking turns in games

Many games and other fun activities lend themselves to learning how to take turns. I recommend games that have a clear turn taking structure combined with a strong visual element. Good examples include games with turns that involve rolling dice, spinning a wheel, picking up a card and so on.

You may find it helps to use visual supports as a reminder or signal for when it’s someone’s turn. For example, consider giving each player a card that’s red on one side and green on the other. You might explain that players keep their cards with the red side up while waiting, then flip it to green when it’s their turn.

At first, the person learning to take turns may need some assistance. For instance, if your son reaches for the spinner out of turn, you can point to the red card and say “Wait” or ask “Whose turn?”

Remember to praise your son for waiting his turn. Depending on the situation, you might also give a sticker or other small reward.

A turn taking project

At our center, we’ve had success with a Legos® building game involving two partners. We provide a picture of a completed structure built from blocks of two different colors. (See example at right.) The structure can be as simple or complex as you judge appropriate. Give one partner all the blocks of one color – let’s say red. Give the other color – let’s say blue – to the other partner. Now invite them to build the structure by taking turns.

Structured sharing

Classroom teachers can be powerful allies in helping children learn how to take turns. In kindergarten and the early grade school years, for example, it’s common to have a daily time for sharing or “show and tell.” Often, the students sit in a circle, each holding something to talk about or show to the group. This is a wonderful opportunity to learn the routine of turn taking, as each child learns to not only wait but also to focus on others. The key to success is repetition as part of the child’s daily schedule.

As in game playing, the teacher can use red- and green-sided cue cards as visual supports to help students remember to wait their turns. To signal when a student’s turn is over, the teacher might use a timer or give a verbal or visual cue. For example, hold up a yellow card, followed by a red card.

Conversational turn taking

Families can use a similar strategy to practice taking turns sharing about each person’s day at the dinner table. Consider putting out a line-up of topic cards (with pictures and/or words) in the center of the table, along with a red/green card for each person. To start, all of the cards should be flipped to red.

One person starts by choosing a topic and perhaps a conversation partner. For instance, one child may choose to talk to his dad about the topic “school.” Child and dad flip their cards to green. Meanwhile, mom and another child are listening with their cards showing red. Once the conversation about school ends, the second child can choose a topic and conversation partner, and so on.

If your son isn’t ready for this sort of planned conversation, I suggest using the cards slightly differently. Choose a topic card and give it to the first speaker. The person can say whatever he or she would like about the topic, while everyone else listens. The speaker then passes the card to the next person, who then takes a turn sharing.

You can adapt all these strategies to support your son as his skills improve.

Strengthening other social skills

As your son masters simple conversational turn taking, I encourage you to add opportunities to strengthen associated social skills. For instance, let’s say that one person at the table shares that she had a bad day. Instead of moving immediately on to the next person, model empathy and reciprocity by expressing how sorry you are that she had a bad day and/or asking a follow-up question. By reciprocity, I mean an exchange that reflects the perspectives of both the speaker and the listener.

Turn taking and table manners

Of course, turn taking is also important when it comes to serving food. Here again, you can use the red- and green-sided cards. Everyone starts with the red side up. Then one at a time, each person turns the card to green when the cook signals it’s their turn to serve themselves.

Again, be ready to remind your son if he starts to go out of turn, pointing to the red card and calmly asking, “Whose turn?” or saying, “Wait, please.” Likewise, remember to use lots of positive reinforcement such as immediate praise for waiting and perhaps a sticker or small prize.

As these examples illustrate, it’s helpful to use the same or similar cues across different activities and settings. The consistency can speed learning and help a child apply the skill in new and unanticipated situations.

You might even keep a couple of those green- and red-sided cards in a pocket or purse for situations like waiting in line at a store or for a server to take your order at a restaurant. Certainly, they can come in handy during a play-date that involves taking turns with a toy.

Teens and turn taking

As a child advances developmentally, I recommend activities that introduce more-advanced turn taking skills.

Take, for example, a high schooler who gets impatient while waiting his turn at Jenga. This is a good opportunity for some pre-game coaching.

First, encourage the teen to look at the friend whose turn it is and see if he can tell if the friend is aware that it’s his or her turn. You might suggest looking for telltale signs of concentration such as furrowed eyebrows and a slightly clenched mouth. Clearly, reading facial expressions and body language are important social as well as turn taking skills.

In addition, I encourage teaching the teen how to express a polite prompt such as “Sorry I’m impatient; do you think you’ll be much longer?”

I hope these strategies are helpful.