My child can no longer attend school or therapies due to COVID-19, and we are staying home to avoid transmission of the virus. I’d like my child to remain connected to her grandparents and other family members during this uncertain time, but she isn’t great at talking on the phone. Her grandparents would be so happy to be able to talk with her. Is there anything I can do to help her learn to have phone conversations?

Answered by Chante Stoeckley, MEd, BCBA, LBA and David Celiberti, PhD, BCBA-D
Association for Science in Autism Treatment

Autism Telephone Skills

Yes! Maintaining social relationships while keeping physical distance is both incredibly important yet difficult. But by working on telephone skills with your child, you can both help her maintain important social and conversational skills and also help deepen her relationship with her grandparents and other family members. Since we don’t know your child, we can’t give specific advice, but we’ll share examples of skills that could be taught and a variety of teaching strategies you could use. Finally, we’ll share detailed examples of how you could put it all together.

Many social and pragmatic language skills go into a telephone conversation. You might know exactly which ones your daughter needs to work on based on your observations of her existing phone conversations. If not, you could watch for this during your next few phone calls to identify strengths and deficits.  You can also reach out to your child’s teacher, speech therapist, or behavior analyst, and get their input. Generally, consider starting with some emerging skills (ones that your child can already do to some extent but not really well or not consistently) instead of brand new and difficult skills. This may allow faster progress and more enjoyable phone conversations. Here are some skills that would lend themselves to phone practice. Some of them are skills in using the phone itself; others are general conversation skills that can be practiced on the phone. These examples cover skills for a range of ages and skill levels.

Specific Phone Skills

Skill Examples
Dialing the phone ●     Dialing a number
●     Finding and tapping a name
●     Finding and tapping a picture
●     Hanging up if there is no answer (see below for messages)
Beginning a conversation ●     Saying “hello” via voice or communication system (consider a video chat if your child uses sign or gestures)
●     Learning a sequence of identifying self, asking for conversation partner, checking if it’s a good time to talk, asking how they are
Answering a call ●     Picking up a ringing phone
●     Responding to partner’s questions (e.g., “Is this Annie?”)
●     Passing phone to requested person
Messages ●     Writing down a message
●     After hearing a message, walking to a parent and relaying the message
●     Leaving a message on a voicemail
Making calls for specific purposes ●     Ordering food
●     Asking for information (e.g., “Do you have any eggs?” or “What time do you close?”)
Ending a phone conversation ●     Saying goodbye
●     Explaining why you need to go (e.g., “My mom’s calling me for dinner…”)
●     Reciprocating expressions of affection (e.g., “I love you too.” “Me too.”)
●     Hanging up the phone/Disconnecting call
Safety Skills ●     Answering calls when other family members aren’t home (should she answer the phone, only answer calls from people she knows, or only answer calls from parents)?
●     Checking in with family members at designated times
●     Calling 911 or other emergency numbers
●     Responding to inappropriate questions (e.g., “Are you home alone?”) or marketing and spam calls

General Conversation Skills

Skill Examples
Answering questions ●     Answering yes/no questions “Did you go to school today?”
●     Answering WH questions about a tangible item shared via video conference “What did Grandma send you?” (while opening a gift)
●     Answering WH questions about past events “What did you have for breakfast?”
●     Answering WH questions about future events “What are you going to have for lunch?”
Trading Statements and Questions ●     Saying, “I’m having pizza” when a partner says, “I’m having spaghetti for dinner.”
●     When a partner says “What did you do today?”, answering “I played outside… What did you do today?
Asking Follow Up Questions ●     Asking “What?” when the partner says, “Guess what.”
●     Asking “What’s wrong?” when a partner says, “I am not feeling well.”
●     Asking “What did you have?” when the partner says, “I made a delicious breakfast.”
●     Asking “What did you watch?  when a partner says, “I watched a very funny thing on TV.”
Changing Topics ●     Introducing a new topic (e.g., “I want to tell you about what I saw outside.”)
●     Discussing the new topic that the conversational partner brings up.
●     Waiting for a break in conversation and politely changing the topic.
Repairing Conversations ●     Repeating self when asked “What did you say?”
●     Increasing volume when told “I can’t hear you.”
●     Asking a partner to repeat themself “What did you say? I couldn’t hear you…”
●     Asking clarifying questions “Did you say you are mad?…. Oh, sad.”
Reading Between the Lines ●     Identifying conversation partners’ emotion from their tone of voice.
●     Identifying meaning of indirect statements (e.g., responding to “Well, I’m kinda busy…” as meaning “I can’t talk right now”).

Once you’ve identified a skill or two, plan out how to practice it. Consider the format and timing of the calls, how you can prepare up front for success, and how to actually teach the skill before and during the call. Since your child will be practicing with a familiar family member, you might even consider redoing the call immediately so that prompted skills can be practiced independently. Here are some ideas in each of those categories. As stated above, keep in mind that since we don’t know your child and can’t give specific advice, it’s up to you and your team to choose which strategies you believe will work best.

Format & Timing

Conversation Partner ●     Start with someone your child knows well and enjoys spending time with.
●     Start with someone who communicates easily with your child.
●     Only after a few successful conversations, move onto other people.
●     If your child has been receiving ABA or SLP services, check if they are providing telehealth services. Calling with them would be a great way to practice the first couple calls.
Length and Time ●     Set up regular, ongoing scheduled calls, so you don’t have to plan each one separately. The calls are more likely to happen this way with less effort.
●     Call frequently! This is both good for skill building and for keeping social relationships close.
●     Keep the calls short initially. End on a positive note, leaving both parties looking forward to the next call.
●     If desired, increase the duration of the call over time. One strategy to increase the length of the call is to have you or the conversation partner ask “What are some things you might want to talk about right now?”  These can even be written down initially.
Format of Call ●     Use a speaker phone. By hearing both sides of the conversation, you’ll be better able to help your child be successful.
●     For some learners, a video chat may be more effective than an audio-only call. It’s also more personal and family members may appreciate the face to face interaction. Try Facetime on an iPhone, Duo on Android, or Skype on a computer.
●     If getting a family member set up with an app or account is daunting, there are web-based alternatives such as Linkello that don’t require any sign up or downloads.
●     Check out Marco Polo. It’s a video chat app that can be used asynchronously. Whenever you are available, you record a video call. When your conversation partner is available, they watch the video and reply. This has the benefit of not having to schedule specific times for phone calls. It has an added educational benefit of being able to listen to the video message multiple times and have your child practice their reply before recording it. There are some special features with which you child can experiment such as filters, voice effect, and doodles which can be accessed to make the practice more reinforcing (more fun!).

Planning & Preparation

Break Down the Skill ●     Before starting, break down the skill into the details of exactly what you want your child to do, how well, and when.
●     Write down the steps of the skill in as much detail as you can. For example, if you want to teach your child to “not end the conversation abruptly” you might decide that means they should do the following steps: 1. Say, “I need to go now”, 2. Wait for a reply, 3. Say “goodbye”, 4. Wait for a reply, 5. Hang up the phone.
●     Write down “how well” you expect it to be done. For example, if you want your child to have longer conversations, decide how long of a conversation you expect. If you want your child to answer questions that grandma asks, decide whether you expect complete sentences or single word answers, and correct answers or just their best attempt.
●     Write down when the skill should be done, being as specific as possible. If the skill is changing the topic of conversation, you might decide that the child should change the topic when there has been a lull of 3-5 seconds in the conversation.
Make a Visual Cue ●     Put the key information from your break down of the skill, and create a visual for your child. This can be used to prompt them during a call or to review how they did afterwards.
●     If the skill is a long series of steps, the visual could be a list of steps to follow, either in words or images.
●     If the skill should be repeated throughout the conversation, the visual could be a reminder of what to do, and check boxes to mark each time it is done.
Plan Some Content ●     Think of a number of interesting conversation topics you can introduce if needed to keep the call going. Better yet, let your child help make this list.
●     If your child’s conversation skills are just beginning or if they dislike the phone, find some preferred activities that could be done over the phone or video chat. If your child and a grandparent like to read books or sing songs together, consider doing that for a portion of the call.
Enlist the Conversation Partner’s Help ●     Let the person you’ll be calling know what skills the child will be working on
●     Tell them how they can help provide opportunities for practice such as asking a lot of questions, giving the child adequate time to answer.
●     Tell them how they can reward the child for using their new skills such as praising their efforts.

Practice & Call

Practice Prior to the Call ●     Practice the skill in person without a phone.
●     Practice it on the phone with a family member in a different room.
●     Practice it in a role play, taking turns in different roles.
●     During practice, use the visual you created to prepare the child for what to do before starting, remind the child of what to do during the practice, and review how they did after the practice.
Prompt During the Call ●     Place initial calls on speaker phone so you can prompt (assist your child in trying the new skill).
●     Model the exact thing you want your child to do and let them imitate it.  (e.g., “Say, ‘Are you busy?’”. Modeling is most helpful in the early stages of learning a skill.
●     Use the visual cue you created and/or, for children who read, write out prompts on the fly (e.g., point to card that says “Ask what Grandpa is doing”).
●     For a child with more advanced language skills, try a low level verbal cue, or hint (e.g. you say, “I wonder if the snow melted at Grandma’s house.” to prompt your child to ask Grandma if it melted.).
Provide Feedback ●     During the call, find a way to celebrate when your child uses a skill successfully that doesn’t completely interrupt the call. This might be a gesture (thumbs up), a physical interaction (a high five) or a star on a chart or token board.
●     After the call, provide your child feedback. Provide praise for skills done correctly, and additional practice where mistakes were made.
●     Consider whether your child is adequately motivated to do their best on the call. If not, you might add an extra incentive in addition to the praise.

Putting it Together – Early Language Skills

Here’s an example of how you could put a number of these recommendations together. Let’s imagine that your child is an early learner and you want her to learn to dial the phone, and ask and answer some easy questions.

Format & Timing: She usually sees her grandfather a few times a week and she loves making silly faces with him, so you start by calling him. Since seeing her face is important to her, you choose to use Skype on a table for a bi-weekly call that is scheduled right after dinner on Mondays and Thursdays.

Planning & Preparation: For the skill of dialing, you add pictures of people in her life to your Skype account, so she can tap on the picture of the person she wants to call. For the skill of answering questions, you know that she sometimes, but not always, answers “who” and “what” questions about things and people in her immediate environment like answering, “Who is that?” when a sibling walks in or “What is it?” when she has something interesting. You decide to practice these questions on the phone. You aren’t sure how to teach her to ask questions, so you reach out to her teacher, who suggests that her grandfather put some fun items in a box, and you prompt her to ask, “What’s that?”, so her grandfather will answer and pull the surprise item from the box. Then you talk to her grandfather, and set up a plan for him to have a box with several interesting items in it to talk about.

Practice & Call: During the call, grandfather occasionally brings the box on screen and makes a leading statement like, “Ohh… look what I have!” and waits for her to ask “what is it?” before pulling out the item dramatically. You also ask him to engage in silly faces with her during the call, especially right after she asks or answers a question, in order to reinforce it. You’ve arranged for other household members to walk through the room or make funny noises occasionally, to provide her grandfather the opportunity to ask questions like “Who is that?”.

Putting it Together – Advanced Social Skills

Here’s another example for an older child learning more advanced social skills.

Format & Timing: When she makes a call, she typically starts talking about her interests immediately, so you decide to teach her to start a conversation using the following steps: identify self (e.g., “Hi this is Sarah”), check if it’s a good time to talk (e.g., “Do you have time to chat?”), and ask the conversational partner a small talk question (e.g., “How are you?” or “What are you doing?”). You also have observed that she doesn’t respond to indirect statements or someone’s tone of voice. You noticed this last week, when she asked her brother if he wanted to play a game, and after he sighed heavily and said “oh, fine”, she seemed unaware of his disinterest and started the game enthusiastically.

Planning & Preparation: You sit down with her to develop visual cues for both skills. For the first one of starting a call, you make a list of the steps, and let her write in the examples. You also put a checkbox next to each step so you can mark it off as she does it. For the second skill, you and she make a list together of examples of what someone might say/do in response to an idea or request, what it really means, and how to respond.

Practice & Call: Then you decide to role play together. With the visuals right in front of her, you take turns pretending to be different family members and friends on a call. When the opportunities to use the skills come up, you pause the call immediately after each one to give her feedback on what she did well and what she could do differently. Before the first call with a family member, you share with them the fact that she’s working on reading between the lines, and coach them on providing opportunities for her to practice. You have her put the conversation partner on speakerphone, so that you can prompt by pointing the appropriate part of the visual cue as needed.

As shown above, telephone skills are complex and multifaceted so there are plenty of opportunities for new skill development. As you consider new skills to teach, revisit the suggestions above and think about what types of teaching strategies are best suited for that new target. If your child struggles, consider whether there are perquisite skills that should be targeted first. As always, reach out to the relevant providers on your team for guidance. We hope that, while remaining physically distant, these ideas will help to continue to build your child’s social communication skills and help the family stay socially connected.

Citation for this article:

Stoeckley, C., & Celiberti, D. (2020).  Clinical Corner: How can I teach telephone skills at home?  Science in Autism Treatment, 17(4).

 

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