TLC: A Comprehensive Approach to Teaching Communication Julie Martin M.A. CCC-SLP/L Kathryn Anthony M.S. CFY-SLP/L Elim Christian Services ACE Program

K. Anthony, J. Martin Elim Christian Services What to expect Communication philosophy What is TLC? How does it work for me? The concept of written language as a viable form of communication Questions and answers

K. Anthony, J. Martin Elim Christian Services Three cornerstones of communication The ability to attend to another individual The ability to understand another individual The ability to produce an effective message

K. Anthony, J. Martin Elim Christian Services Cornerstone of Communication Ability to attend to another individual Autism Spectrum Disorder is defined as (DSM IV Classification) Qualitative impairment in social interaction, as manifested by at least two of the following: a. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures, to regulate social interaction b. failure to develop peer relationships appropriate to developmental level c. a lack of spontaneous seeking to share enjoyment, interests or achievements with other people e.g., by a lack of showing, bringing or pointing out objects of interest d. lack of social or emotional reciprocity

K. Anthony, J. Martin Elim Christian Services Cornerstone of Communication Ability to produce an effective message Autism Spectrum Disorder is defined as (DSM IV Classification) Qualitative impairments in communication as manifested by at least one of the following: a. delay in, or total lack of, the development of spoken language not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime b. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others c. lack of varied, spontaneous, make-believe play or social imitative play appropriate to developmental level

K. Anthony, J. Martin Elim Christian Services Cornerstone of Communication: Ability to understand another individual Autism Spectrum Disorder is defined as (DSM IV Classification) Restricted, repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following: a. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus. b. apparently inflexible adherence to specific nonfunctional routines or rituals. c. stereotyped and repetitive motor mannerisms, e.g.: hand or finger flapping or twisting, or complex whole-body movements. d. persistent preoccupation with parts of objects. Receptive language skills tend to commiserate with cognitive level Deficits in receptive language skills are not part of defining characteristics of Autism Receptive skills tend to splinter Presence of echolalia may be perceived as higher receptive skills

K. Anthony, J. Martin Elim Christian Services Communication Brings order to an otherwise chaotic world Is the foundation of building relationships Is the tool used to effect ones own well-being

K. Anthony, J. Martin Elim Christian Services Communication bringing order to an otherwise chaotic world O R R D E

K. Anthony, J. Martin Elim Christian Services Communication bringing order to an otherwise chaotic world ORDER

K. Anthony, J. Martin Elim Christian Services Communication bringing order to an otherwise chaotic world What does chaos look like? What am I trying to communicate? Video clip – student is expecting go home to be the next thing on his schedule. He is trying to find out why this is not happening and when he is going home. What does order look like? I can communicate my message effectively! Video clip – the same student (2 years later) wants to go home and is asking when is it time to go home?

K. Anthony, J. Martin Elim Christian Services Communication the foundation of building relationships You cannot build a relationship without some form of communication.

K. Anthony, J. Martin Elim Christian Services Communication Is the tool used to effect my own well-being. This is how I … ask for things I want initiate conversations with people ask questions for clarification express feelings learn new things

K. Anthony, J. Martin Elim Christian Services So what do we do ? What is the best way to teach communication ?

K. Anthony, J. Martin Elim Christian Services Lets go back to the basics Bringing order A room designated to learning language and building communication skills in an autism friendly environment Building relationships A method that focuses on building the students, not just the skills Find out whats important to the student and whats important for them to be able to communicate to others Dont just teach skills for the sake of teaching skills or filling in milestones

K. Anthony, J. Martin Elim Christian Services Bringing Order TLC structure Space built with three adjoining rooms Group room Play/social communication room Reading room Students come as a class (6 students) 2 students per room (some exceptions are made if warranted for behavior reasons) Rotate around the rooms approximately every 10 minutes (picture of schedule)

K. Anthony, J. Martin Elim Christian Services Bringing Order TLC frequency and duration Students come for 1 hour, 3 times a week 2 sessions are devoted to IEP goals 1 session is devoted to reading skills

K. Anthony, J. Martin Elim Christian Services TLC Themes lessons are taught following a yearly theme schedule These themes are carried out throughout the entire program Students are focused on vocabulary in a variety of settings: various academic activities books field trips Allows students to experience vocabulary in a variety of forms Back to school Around the house Fall Thanksgiving Clothing Christmas Winter Food Animals Around town Community helpers Transportation Spring/nature/Mothers Day Health/hygiene Safety awareness Fun and games

K. Anthony, J. Martin Elim Christian Services Group Room Follows principles of ABA Works directly on IEP goals Allows for peer modeling opportunities Video clip – students working at group table

K. Anthony, J. Martin Elim Christian Services Play/Social Communication Room Follows floor time model Teach students Joint attention Parallel play Interactive play Teach students to talk to and listen to one another Video clip – students at snack time, requesting from each other Picture of room and video of working in room

K. Anthony, J. Martin Elim Christian Services Reading Room Immerse students in language through books Deliberate bombardment of language through structure of books Shared book reading (targeting joint attention) like a parent might read with their child Video clip – student and staff reading adapted book

K. Anthony, J. Martin Elim Christian Services Building Relationships creating a safe place There is a different set of rules in TLC The rules we always stick to: number one priority is keeping students and staff safe consistent with student behavior plans students are being productive at all times As for all of the other rules ……

K. Anthony, J. Martin Elim Christian Services Building Relationships as for the other rules …. The goal is for students to feel safe and comfortable communicating Given opportunity to talk about what interests them might be plungers might be dinosaurs Opportunity to communicate how they want to might be on a chair might be on their head Remember: If youre happy, youll want to come – Make it a positive place and experience Video clip – students arriving in TLC

K. Anthony, J. Martin Elim Christian Services Building Relationships relationships with staff are just as important Close relationship with OT: proper positioning (tables and chairs) alternative work environments/approaches (ball chairs, standing, wheelbarrow walks, student positioned over ball) Sensory suggestions for transitions, needed breaks and play Video clip – students working in different rooms with various accommodations Paraeducators attend TLC with students allows for modeling and generalization to classroom behavior management

K. Anthony, J. Martin Elim Christian Services TLC was NOT created to be implemented ALONE It WAS created to be a TEAM approach

K. Anthony, J. Martin Elim Christian Services Building Relationships creating a safe place Open the door and let them come in It is our job to listen to interpret to respond to encourage to provide a communication path that they can follow to teach the most effective and appropriate way that allows them to be true to who they are It is NOT our job to teach them words for the sake of words to strip them of who they are by making their communication generic to silence their voice when it sounds like nonsense – they are always saying something - figure it out

K. Anthony, J. Martin Elim Christian Services Building Relationships it is our job to listen Communication is an innate urge People will find the most effective and quickest way to communicate A baby learns that if he cries, a parent comes. Once a child learns to talk, they discover that words are more effective to meet specific needs. If a child does not have the words they will revert to what is most effective. scream (video clip - student screaming vs saying bugging me) hit (video clip – student hitting vs saying I dont want to) familiar phrases/scripts (video clip - student saying whats so funny vs Hi)

K. Anthony, J. Martin Elim Christian Services Building Relationships it is our job to interpret If you think they said it, they probably did If you think there is a reason, there probably is They are trying to tell you something – what is it? Interpreting can only be done by focusing on the student and not the goals If you are so focused on what you want them to say – you will miss what they are trying to say !! Let me say it in a song Video clip – description of student below 14 year old student No purposeful verbilizations Loved to listen to music randomly sing parts of songs Songs were NOT random Greetings Specific songs for different people

K. Anthony, J. Martin Elim Christian Services Building Relationships it is our job to respond The best way to continue communication is to respond to the first attempt A correction is not an effective response If I attempt to communicate and no one responds I will stop communicating and may try something else (negative behaviors) If I attempt to communicate and I am wrong I will stop communicating and may try something else (negative behaviors) If I attempt to communicate and you hear me I will keep communicating

K. Anthony, J. Martin Elim Christian Services Building Relationship it is our job to encourage Some students are so content with their worlds that they really have no need to communicate with others outside So it is our job to invite students into conversations about what is interesting to them Video clip – student being engaged in conversation

K. Anthony, J. Martin Elim Christian Services Building Relationships to teach the most effective and appropriate way that allows them to be true to who they are How Corey says hi Video clip – student using personal approach to communicate Pairing hand gesture with saying hi on device How we say things reflects who we are We do not want communication to become so regimented and structured that there is no room for our students to express who they are

K. Anthony, J. Martin Elim Christian Services Building Relationships to provide a communication path they can follow Providing multiple forms of communication Teaching students to become proficient with different ways to communicate We want students to have a personal communication toolbox at their disposal what works in one situation wont necessarily work in the next… each student may practice multiple types of communication in TLC (e.g., verbal, pictures, device, print)

K. Anthony, J. Martin Elim Christian Services TLC and Reading Speech therapy team has committed time and effort teaching reading skills Reading is taught in an effort to provide students with the ability to use print as a viable form of communication Students do not follow typical pattern of development learn to talk learn to read learn to write All students have some reading ability to be expanded upon Many students have been exposed to pictures paired with words throughout their lives (Boardmaker pictures)

K. Anthony, J. Martin Elim Christian Services TLC and Reading Print as a viable form of communication looks something like this… Do you want to go to Grandmas or McDonalds? no speech no pictures How do you tell me ?

K. Anthony, J. Martin Elim Christian Services TLC and Reading But if you can read – then I can write it down Most accessible form of communication other than speech Theres always pen and paper around GrandmasMcDonalds

K. Anthony, J. Martin Elim Christian Services Traditional therapy Was it tried and did it work ? Yes, it was tried students were pulled out in one-one sessions 30 minute sessions (twice a week) therapy focused only on specific goals No, it did not work improved splinter skills but did not address underlying communication skills behaviors caused by communication deficits did not improve no noticeable changes in communication skills or strategies

K. Anthony, J. Martin Elim Christian Services TLC – things weve tried We definitely didnt get it right the first time break area computer station one-one station All were too independent and did not promote communication growth Remember: Students should be doing something productive for their personal communication growth at all times This looks different for every student

K. Anthony, J. Martin Elim Christian Services How does it work for me? Can be implemented in a classroom through stations may be a temporary set-up Does not need to be implemented by a speech therapist teachers, para-educators, and other therapists can do this too language arts goals can be addressed at group station/room The communication philosophy is not only for structured teaching but should be embraced throughout the day