autism and other developmental disabilities 10/03/2013 · •peer-mediated instruction and...

Autism and Other Developmental Disabilities Programs Division

10/03/2013

A University Center of Excellence in Developmental Disabilities Education, Research and Services (UCEDD) 1

Communication and ASD:

Key Concepts for Educational Teams

Marci Laurel, MA, CCC-SLP

[email protected]

Training Objectives

Participants will:

1. Name at least three communication characteristics of ASD and state relevance for classroom practice.

2. Name two core communication challenges for students with ASD related to the development of academic skills.

3. Link at least two communication challenges to an evidence-based practice for intervention.

Thinking about the year just finished and the one to come…

• What are your two top challenges in the classroom?

• What might be the relationship to communication skills?

mailto:[email protected]


10/03/2013


Why are we talking about communication – AGAIN!

Crux of ASHA Position on Providing Services to Students with ASD

“Problems in the use of language and communication are overarching because ASD is primarily a social communication disability.”

Diane Twachtman-Cullen, Ph.D.

Editor-In-Chief, Autism Spectrum Quarterly

ASHA Position Continued

“These challenges result in far reaching problems, including difficulties with joint attention, shared enjoyment, social reciprocity in nonverbal as well as verbal interactions, mutually satisfying play and peer interactions, comprehension of others’ intentions, and emotional regulation.” (Twachtman-Cullen, 2007)


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What Type of Services Does ASHA Recommend?

Services should be connected to FUNCTIONAL and MEANINGFUL outcomes.

Preference is in favor of therapy in the natural environment.

Common Reasons for Denying Services to Students with ASD

He speaks in full sentences

Grammar and syntax are intact

She did very well on all of the language tests

Language skills are commensurate with chronological age

Cognitive ability is commensurate with communication skills

DSM 5: Autism Spectrum Disorder

• Social-emotional reciprocity

• Nonverbal communication

• Developing and maintaining relationships

Persistent deficits in social communication and social interaction across contexts

• Stereotyped or repetitive speech, movements, use of objects

• Excessive adherence to routines

• Highly restricted, fixated interests

• Unusual reactions to sensory input or interest in sensory aspects of the environment

Restricted, repetitive patterns of behavior, interests, or activities


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Autism Spectrum Disorder: Communication Characteristics

Deficits in Nonverbal Social Communication

• Eye contact

• Gestures

• Facial expressions

• Proxemics

• Prosody

How does nonverbal communication impact school success?

What strategies can support the development of nonverbal social communication?

Evidence Based PracticesSupporting Communication

• Practices from Applied Behavior Analysis including…• Task Analysis • Discrete Trial Training• Prompting• Reinforcement

• Functional Communication Training

• Visual Supports

• Picture Exchange Communication System

• Speech Generating Devices

• Naturalistic Interventions

• Peer-Mediated Instruction and Intervention

• Video Modeling

• Social Narratives

• Social Skills Training

• Visual Supports

http://autismpdc.fpg.unc.edu/evidence-based-practices



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Evidence Based PracticesNonverbal Communication

• Discrete Trial Training

• Visual Supports

• Video Modeling



Delays in Developing Language

• Difficulty with joint attention and symbol use • Does not direct behavior to another person for the

purpose of communication

• Difficulty expressing wants and needs • Difficulty asking for help

• May use little or no speech• Idiosyncratic ways of communicating, only some can

understand• Communicates needs through behaviors

What are specific strategies for working with students with ASD in these areas?

Evidence Based PracticesLanguage



• Visual Supports






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Difficulty Initiating and Sustaining Conversation

• Difficulty following rules for conversation (turn-taking, topic maintenance)

• Difficulty joining or ending conversation

• Fail to respond to comments– only responds to direct questions

• Conversations limited to preferred topics, interests

How do skills for social conversation impact school success? Is this a priority?

Lack of “Social-Emotional Reciprocity”

• Fail to initiate or respond to greetings, social routines

• Mind-blindness (Baron-Cohen)

• Difficulty understanding inferences

• Difficulty recognizing other’s thoughts, feelings, beliefs

• Difficulty expressing empathy

How does the team understand these challenges? What is your role in intervention?

Evidence Based PracticesConversation/Reciprocity

• Task Analysis


• Video Modeling

• Social Stories




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Lack of Symbolic, Social Imitative Play

• Unusual use of objects

• Difficulty using objects to represent other objects (e.g. pretending a block is a phone or a cup)

• Less likely to combine actions in novel play themes

• Difficulty cooperating

Does teaching “play” have a place at school?

Evidence Based PracticesPlay

• Practices from Applied Behavior Analysis including…• Task Analysis

• Discrete Trial Training

• Prompting

• Reinforcement

• Video Modeling


• Peer Mediated Instruction and Intervention

Repetitive, Stereotyped Speech

• Immediate Echolalia

• Repeats other speakers previous utterance

• Delayed Echolalia

• Recites lines from movies, TV

• Repeats words or phrases from previous situations


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Repetitive, Stereotyped Speech

• Idiosyncratic use of language

• Unconventional verbal behaviors

• Repeats sounds, words, phrases

• Makes up new words

• Uses highly specific meanings for words, phrases

• Asks repetitive questions

How does the team respond to language that is not directed for a social purpose?

• Nonverbal prompting

• Strong use of nonverbal communication

• Visual supports

• Limit adult language – one up rule

• Avoid repeating

• One communication partner at a time

• Slow the pace

• Wait and signal

• Avoid “jumping in”

So…

• Autism Spectrum Disorder is a disorder of social communication and skill deficits are appropriately addressed by members of the school team throughout the school day.


10/03/2013


Communication

• Children may learn to talk or use alternative methods of communication

• But these have little value if social interaction skills are not developed to provide opportunities to use those skills for meaningful communication with another person (Frea, 2015)

Communication

In order to achieve communication you have to have…

1. A sender

2. A receiver

3. A topic of joint focus

4. A method of communication

(Schweigert, 2016)

Without the first three, the fourth has no purpose


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“The ability to speak, sign or label and point to a picture does not ensure that communication will occur” (Janzen, 2012)

Has Communication Occurred?

• Is there an exchange of information?

• Is a message either directed to or received from another person?

Nine Critical Communication SkillsFrost and Bondy, 2002

1. Asking for desired item

2. Asking for help

3. Asking for a break

4. Rejecting

5. Affirming

6. Responding to wait

7. Responding to functional directions

8. Responding to transitional cues

9. Following a schedule


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Social Communication Skills

Early Skills

• Imitate

• Initiate

• Respond

• Take turns

• Persist

• Ask for help

• Shift attention


Conversation

• Respond to questions

• Respond to comments

• Suggest or negotiate a topic

• Maintain a topic –preferred and not!

• End a conversation

Perspective Taking

• Recognize thoughts and feelings of others

• Recognize effect of behavior on others

• Adjust communication based on reaction of others

• Adjust based on social situation


Meaning

• Non-literal language

• Fact vs. opinion

Peer Group

• Get attention

• Share/cooperate

• Follow group directions

• Negotiate


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Core Deficits in the Communication of Students with Autism

• Joint Attention: coordination of attention between people and objects

• Symbol Use: learning conventional or shared meaning symbols

Joint Attention

• Orienting and attending to a social partner

• Shifting gaze between people and objects

• Sharing affect (emotional states) with another person

• Drawing another person’s attention to objects or events in order to share an experience

What might be the impact of challenges with these skills at school?

Symbol Use

• Use of conventional gestures

• Learning conventional meanings for words

• Using objects functionally

• Symbolic play

What is the impact on academic skills?

“Dog”


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Symbols and Meaning

• What are some of the objects and symbols that your students enjoy?

• What stands in the way of connecting these to function and meaning?

“…the brain develops as a network of interconnected pathways, and teaching babies these isolated facts, these separate chunks of disparate information, devoid of context, only creates little no-exit cul-de-sacs.” (Roots of Empathy, Gordon, 2009)

What about Reading?

• There’s decoding…

• The rest is LANGUAGE!!

• How do we make sure one is connected with the other?!!?

Challenges in Reading Comprehension

• Understanding that symbols have meaning

• Integration of language, social understanding and emotional understanding

• Vocabulary, story structure, character motivation and goals

“Everything you read you relate back to a social event in your life, a social event that happened to you!”

Felicia Nevarez


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Or Math??

“I need a new coat!!!”

Intervention


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Priorities for Intervention

Engagement and Reciprocity

• At any age or stage

• Build around a preferred topic or activity

• Face to face interaction

• Less is more

• Be sure to carefully assess

• Do not presume

• Visuals, visuals, visuals!!

• Wait

• Less is still more

• Pay attention to nonliteral language

• Teach compensatory strategies

• Plan ahead

Increase Comprehension


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Developing Expressive Skills

• Functional in the context

• Provide multiple opportunities

• One up rule

• Immediate and powerful reinforcement

• Adjust for social context

• Practice in a variety of settings

Understanding and Using Gestures for Communication

• Use exaggerated face and body expressions

• Hold expressions longer

• Model conventional and descriptive gestures

• Practice

• Practice some more!

Using Communication For A Variety of Purposes

• Move beyond protest and request

• Include:• show

• share

• comment

• respond to questions

• respond to comments

• ask for information

• offer information…


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Communicating Across Contexts

• Functional means in all places

• Practice learned skills in a variety of settings

• Priming for context

• Class to class

Link Symbols to Meaning

• Understanding that symbols have meaning can be challenging at all levels

• Always link symbol to visual when learning

• Assess and teach in all subjects and throughout the school day

PUPPY =

General Concepts for Intervention


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Multiple Opportunities for Practice

Teach Communication Explicitly

Teach for Generalization Teach for Initiation of Communication

Teach Within the Context of Reciprocity

Use Visual Supports for Comprehension and

Expression


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Evidence Based PracticesSupporting Communication



• Visual Supports





• Video Modeling



• Visual Supports


How Did We Do?

Participants will:

1. Name at least three communication characteristics of ASD and state relevance for classroom practice.

2. Name two core communication challenges for students with ASD related to the development of academic skills.

3. Link at least two communication challenges to an evidence-based practice for intervention.


autism and other developmental disabilities 10/03/2013 · •peer-mediated instruction and...

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