Julie Mullis Clinical Lead Specialist Speech & Language Therapist (ASD) Cardiff & Vale UHB Flying Start Conference 15/1/16

 A neuro-developmental disorder  A medical diagnosis, made by a multi- disciplinary team, by observing a pattern of behaviours which affect: ◦ social interaction ◦ social communication ◦ social imagination/flexible thinking ◦ repetitive and restricted behaviours and interests  90% also have sensory processing difficulties  A spectrum condition meaning there is a huge variety of presentation

 Used to be thought of as a rare condition  Now thought to occur in about 1 in 100  Broader defining characteristics  Better diagnosis  Better knowledge in the general public

 Early identification leads to early intervention  Record observations  Discuss your concerns with the parents  Do not use medical terminology  Gain consent to refer to other agencies as appropriate  Include comments about positive skills

 You do not have to wait for a child to receive a diagnosis to start providing support  All pre-school children with ASD will have difficulties with communication  Visual strategies can be used to support them to understand us and to support them to communicate with us

 Calendar?  Diary?  To do lists?  Electronic devices/apps?

 Visual  Concrete  Repetitive  Predictable  Consistent  Processing  Unambiguous

 Develops symbolic understanding through a hierarchy ◦ Objects ◦ Photos ◦ Symbols ◦ Writing  Develops independence ◦ Communication ◦ Planning

 Signs are a visual means of communication but…  Like speech, signs are transient  Like speech, signs rely on recall rather than recognition  Motor difficulties  Difficulties with imitation  Echopraxia

 Visual Schedules  Cue Cards  ‘Traffic Lights’  Timers  Writing

 Objects of Reference  Picture Exchange Communication System (PECS)  Communication Books  Voice Output Communication Aids  Writing

 Aids independence  Represents the order of activities  Helps to organise our time  Reduces anxiety  De-personalises instructions  Ensures flexibility not rigidity

 What is the level of the child’s symbolic understanding?  Can the child understand ◦ Objects? ◦ Photos? ◦ Symbols? ◦ Written words?

 One at a time?  First X, then Y?  Longer schedule?  Half-day or whole day?  Weekly calendar ?

 Some children will not yet understand pictures  Label object if possible  Use single word consistently with the object  Later show OOR with photo or symbol

 Ensures that everyone calls an item by the same label  Aids language development  Develops word recognition pre- literacy skills

 Ensure items are easily accessible – box or shelf  Present two objects as a choice  Say what is on the label as item is given

 The child needs to engage with the schedule by removing the picture or ticking the item, etc, or at least looking at the item  ‘Finished’ box or pocket  Reflecting on activities at the end of the day  Copy to take home

 Simple ‘one message’ instructions or reminders about specific rules or behaviours to be remembered  Backs up verbal instructions that are not on the visual schedule  De-personalises  Asocial and removes emotional engagement  Reduces need for repeated verbal instructions toilet no light

 A type of cue card  Can be used individually or with groups  Helps individuals to understand transitions  Prompts children to start and finish activities  Warns children that activities are going to finish

 “X activity is starting now”  “Go”  “Start X”

 Teaches concept of waiting  “X activity is nearly finished”  “X activity is starting soon”  Can be paired with a verbal countdown or use of visual timer such as egg- timer

 “X activity is finished now”  “X items are finished/all gone now”  “Stop/Finish”

 What kinds of timers are there? ◦ Egg timers ◦ Clocks and watches ◦ Sundials ◦ On computer ◦ On phone ◦ On TV

Why do you use clocks or timers?

 For cooking  To record a programme  To remind us to take medication  To know how long before the bus is coming  To get to an appointment on time  To know how long it is before we can have a break?

 Help us to ◦ plan and organise our time ◦ be productive ◦ be where we need to be when we need to be there  Represents an abstract concept in a more visual and concrete way – provides information that otherwise would be hard to explain  Reduces anxiety

 Picture Exchange Communication System  A structured programme developed specifically for children with ASD  Develops communicative intent  Teaches that two people are needed for communication to be effective

 Provides a functional appropriate means of communicating requests which reduces inappropriate behaviours  Uses pictures to request desired items  Builds up gradually to longer sentences and more functions (comments, responding to questions)

 For children who ◦ know how to get someone’s attention ◦ have a large vocabulary (PECS no longer user- friendly) ◦ can scan a selection of pictures  Photos, symbols or written words can be used  Child communicates by pointing to one or more pictures

 VOCAs are high- tech battery powered AAC  Use symbols that are already familiar  Looks like PECS book

 Portable  Motivating  Easy to add new vocabulary  Can break down, run out of battery, get broken  Needs low-tech back-up  Technology developing fast – new apps cheaper and easier to individualise – iPads and iPods increasingly being used as communication aids

 Writing is a visual means of communication  Can be used to communicate with individuals with ASD  Some individuals need longer to process verbal information  Some non-verbal individuals can read and write and can use written systems to communicate

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