Intervention with individuals with ASD 11/12/14

Overview What intervention strategies are effective for supporting communication skills of individuals with ASD and limited verbal skills? What intervention strategies are effective for supporting communication skills of verbal individuals with ASD? How is unconventional verbal behavior addressed? What strategies might be used to expand on the conversational skills of individuals with ASD?

Interventions for supporting limited skills Substitute undesirable behaviors to communicate (ex: bored, activity is too difficult, self-stimulating behavior, etc.) AAC and visual supports Joint action routines Minimal speech and proximal communications

AAC and visual strategies Used to promote Joint attention Promote recall Enhance attention to and understanding of social communication Increase comprehension of language concepts Facilitate social initiation Facilitate communicative intent

AAC and visual strategies AAC and speech (AAC alwaysssss promotes speech) Aided (any communication system that is tangible) and unaided (gestures, pointing, etc.) communication systems Total communication (present with all communication systems) Decreasing the child’s communication, social and behavioral difficulties Capitalize on the visual strengths First goal is for expression Second goal is to increase receptive language skills, give information, provide structure Third goal is to manage transitions, make choices, and accept changes to routines

AAC and visual strategies Builds on the strengths in visual-spatial organization and the ability to learn language in gestalts Repeated opportunities to see the stimuli (speech is transient) Helps to organize information Literacy component (hyperlexic, can read at an early rate) Predictable, can be learned in steps

What are visual strategies? video Objects Photographs Icons Text

Why visual strategies…….? Easily understood Easily recognized Provide motivation

Visually Supported Communication When I see it ……… it clicks

How does it work? Helps with processing language Organize thinking Remembering information

Visually supported communication Leads to increased comprehension Participationgreater involvement in task Effective communicationdecreased behavior problems Hogden, L. Visual Strategies for Improving Communication. QuirkRoberts Publishing, Troy, MI.

Where can they be used? Follow directionsMaintain behavior Understand speechunderstand curriculum Sequence eventsanswer questions & comment

Therapy Schedule Divide the school day into segments/activities Give each segment/activity a name Select a representation system Consider photographs, line drawings or written words Select a format Is it for a whole group or for an individual? Where will you keep it? On a wall On a desk Therapist carries it in a book Student carries it in his pocket

Therapy schedule Decide when and how the student will use it throughout the day. Show or point to picture/object before the event takes place Peel off the picture/object and place on desk Turn each picture/object when the event is finished Put picture/object in the pocket when the event is finished

Therapy schedule Teach the student how to use the schedule. Before activity Model using an adult or peer Physically get the student to point/object to the picture Remove the picture/object and put on desk After the activity Model using an adult of peer Physically turn over the picture/remove the object Replace the picture/object into the finished pocket

Daily schedule Use the schedule to give the student information about what is happening How long to break time How long to a preferred activity How long to end of the activity How long to “going home” what is changing No playground activity Different room Different routine anything else he needs to know When is mom coming When am I going home

Daily schedule Is the schedule clearly outlined so that you as a therapist know all daily responsibilities? Is there a balance of interesting, difficult, easy activities and break times incorporated daily? Do individual student schedules consider student needs for break times, reinforcement, non-preferred activities followed by preferred activities? Does the schedule help a student with transitions – how to prepare for next activity? Does the schedule help a student know where and when to begin and end a task? How are transitions and changes in activity signaled? timer rings? teacher direction? student monitors clock? Is the schedule represented in a form that is easily comprehended by the student?

Task Organizers Mini schedule for individual activities Steps in a task Environmental inventory Look at schedule and select an activity Write down all the steps in the task Find pictures for the steps or take photographs of student performing the steps Laminate using contact paper and place Velcro at the back of each picture

Examples of different mini schedules/task organizers

AAC Gestures Gesture dictionary Photo and explanation of the gesture Establish routines and violate them Less transient and can be prompted Limb apraxia Not easily understood by all communication partners

SGDs (speech generating device) LAMP XOVy0 (language acquisition through motor planning) XOVy0 Teaches a motor movement Joint attention to symbols Promotes speech Easily understood by communication partners

Strategies to teach AAC Essentially similar to good language therapy Establishing communication Modeling by teacher and/or peer Use of light cues Expansion Use least to most prompt strategies Natural consequences for correct responses

PECS ( picture exchange comm system ) Developed by Bondy and Frost Video Teach functional communication within a social context (e.g., request) Using nonsocial rewards (getting the desired object) Direct a behavior towards a communication partner who provides a direct or social reward Prior to implementation a reinforcement assessment is completed Determine highly preferred, preferred and unpreferred items

PECS Phase 1 (two people process) Students learn to exchange single pictures for items or activities they really want Phase 2 Distance and Persistence, still using single pictures, students learn to generalize this new skill by using it in different places, with different people and across distances They are also taught to be more persistent communicators. Comm partner turns away so that the client will have to get the partners attn

PECS Phase III Picture Discrimination Students learn to select from two or more pictures to ask for their favorite things. These are placed in a communication book—a ring binder with Velcro® strips where pictures are stored and easily removed for communication. Phase IV Sentence Structure Students learn to construct simple sentences on a detachable sentence strip using an “I want” picture followed by a picture of the item being requested Attributes and Language Expansion Students learn to expand their sentences by adding adjectives, verbs and prepositions

PECS PHASE V Answering Questions Students learn to use PECS to answer the question, “What do you want?” Phase VI Commenting Now students are taught to comment in response to questions such as, “What do you see?”, “What do you hear?” and “What is it?”. They learn to make up sentences starting with “I see”, “I hear”, “I feel”, “It is a”, etc.

Interventions supporting verbal skills Discrete trial training video Natural language paradigm and milieu teaching Discrete trial training programs help to develop skills quickly They do not help with generalization Natural language training helps with generalization but it takes longer to learn the skills Onlooker should not be able to see anything special is being done Systematic approach is used Use of child preferred materials Stimulus control Natural consequences Motivation Context (environment and communicati on partners) Structure (one on one, small or large group)

Natural language paradigm & milieu teaching (video – pivot training) Incorporate naturally occurring examples or targets into the environment Language targets are explicitly prompted after a brief delay Direct natural consequences are used (object in a jar) Language is taught within the natural interventions (e.g., turn taking, shared control of conversations, choosing objects and activities that are used in play or learning tasks)

Milieu training Incorporates the principles of natural language paradigm video Child directed modeling (focusing on child’s interest to establish joint attention, providing a mand/request, expanding on the request, correction of incorrect response) Mand modeling (Tell me what you see) Time delay (assists in the child learning from the environment – wait to open the door to encourage a request) Incidental teaching (arrangement of the environment to encourage child’s requests for interesting materials as well as engaging in a desired activity)

Basic behavioral techniques Shaping Prompting Fading Differential reinforcement Data collection and evaluation to determine effectiveness

Video modeling Watch the behavior of another and then using what they observed in their own interactions, language use, play, daily self care routines Watch a video of a person modeling target behavior With practice and rehearsal, the child retains and displays the target behavior Begin to understand roles of people in particular situations Good technique for abating anxiety-producing situations development/social-skillshttp:// development/social-skills

Video-modeling Points to consider Motivating situation Photograph facial expressions Pause the video Direct attention to the video Request child to repeat (your turn)

TEACCH Language and communication curriculum Treatment and education of autistic and related children with complex communication needs (video 2) North Carolina 5 components Functions or purposes of communication Contexts or setting Semantic categories or meanings child expresses Words or units of communication child uses Communication forms and modes

TEACCH Communicative functions Getting attention Requesting Rejecting or refusing Commenting Seeking information Expressing feelings

TEACCH Contexts Several people and places School, home, grocery store, departmental store, Sunday school, restaurants Teachers, parents, other relatives, friends, peers, store clerks, strangers, employers Semantic categories Word meanings used to communicate an idea or concept

TEACCH Words components Broader than just spoken words, signs, gestures, pictures etc Expanding on the child’s vocabulary Quantity vs. quality Form Presymbolic communication – motor act Gestures Picture communication boards Sign language, spoken language, word boards

TEACCH Treatment strategies include: Incidental teaching Engineering the environment Shaping the child’s behavior Providing natural consequences

Managing unconventional verbal behaviors Echolalia Socially motivated and functional Represents a transitional language phase Simplify language input Respond to the child’s presumed intent Relate the child’s utterances to actions or objects of interest Support correct use of pronouns Modify situation that might cause anxiety New tasks create anxiety must be broken down into simpler steps or use visual supports for transitions Provide language opportunities as frequently as possible (e.g., choices)

Expanding conversational abilities Barrier games Learn to use language to direct another’s actions Offer meaningful repair strategies Increased knowledge of a variety of language concepts Expand conversational skills in the context of communicative interactions with a peer

Expanding conversational abilities Scripting Identify topics Providing expansion using probes Maintain turn taking Producing comments Encouraging elaborations Spinner game with comments and questions (who, what, where, when and why)

SCERTS Social communication (development of spontaneous, functional communication, emotional expression, and secure, trusting relationships with children and adults) Emotional regulation (development of ability to maintain a well-regulated emotional state to cope with everyday stress) Transactional support (development & implementation of supports modify and adapt the environment, and provide tools to enhance learning (e.g., picture communication, written schedules, and sensory supports) Video 3

More Than Just Words – Hanen program Helps families support communication (video) Child’s ability to communicate depends upon being able to pay attention Find enjoyment in two way communication Understand and imitate what others say and do Interact with others and have fun doing it Practice what they learn Have structure repetition and predictability in their lives

More than Just Words 4 goals First goal Help children learn to interact with their parents & others Parents learn that their children can find enjoyment in doing things with them and that communication is a two way process Second goal Parents find ways to help their children communicate in new ways (e.g, via signs, pictures, pointing, etc.) Third goal Parents teach their children to communicate for new reasons Set up situations to teach requesting etc. Fourth goal Help their children understand the relationship between what is being said and what is happening