The first step for children who lack joint attention or awareness skills is to initiate a greeting with a brief hand-to-hand touch. Some children will prefer light touches, some children will prefer high fives. You will have to determine the tactile and sensory preferences of the child and determine what type of touch is most appropriate for him/her. In addition, this will not be an appropriate activity for children with significant motor limitations; however you could consult or cotreat with your PT/OT for an activity like this.

1. Model the activity for the child. Choose an adult or peer model. Touch his/her hand and greet them by saying “hi, _______.”
2. Give adequate prompting to help a child tolerate a greeting. (Not all children will need this step, but it’s a helpful one for some.)
   • If a child struggles with joint attention, you can put his/her favorite toy near your face and give the child the toy when he/she tolerates your hand-to-hand touch + verbal greeting “hi, _____.”
   • If a child struggles with initiation of the motor movement, you can have another adult provide a hand over hand over hand touch while you verbally greet the child “hi, ______.”
   • If the child struggles with maintaining proximity, make sure you meet them at their initial transition into the classroom or therapy space.
   • You may need to put the greeting on a child’s visual schedule as an additional “task” to complete.”

Once a child can independently tolerate a touch + verbal greeting, give adequate prompting to help a child reciprocate or even initiate the greeting.

• You can provide a visual cue of holding your hand up with an expectant wait.
• You can provide a visual + verbal cue of a picture icon or low-tech AAC option (e.g. a talking brick or GoTalk)
• If you are using PECS or another picture exchange system for a primary means of communication, you can practice the physical touch paired with the exchange of the picture
• If you’re using an AAC device, you can practice the physical touch paired with the selection of the greeting on the device.

Once the student is consistently reciprocating the greeting, begin to fade the prompts until he/she is initiating the greeting.

Begin to put some physical distance between you and the child so he/she can practice persisting in the greeting when you are not right in front of him/her

Practice this skill in some unstructured tasks/environments.

It is important to note: the end goal is not necessarily a verbal/spoken greeting, but rather independently using the pragmatic function of greeting another person. So when fading prompts, try to focus on the pragmatic function versus the verbal output of a child. This is a different skill.