proportion of nonverbal children with autismidahotc.com/portals/0/webinar documents/autism spectrum...

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Webinar- Beginning an aided AAC system with persons who experience ASD

Joe Reichle, Ph.D.

Reichle (2009)Press *6 to mute your line.Press #6 to unmute.

Proportion of Nonverbal Children with Autism

- 33% to 50% of children with autism have b t d b lbeen reported as nonverbal

(Bryson, 1996; Lord and Paul, 1997)

-14-20% of children diagnosed with ASD at 2 receiving intensive early intervention

Reichle (2009)

remain nonverbal

(Lord, Risi and Pickles, 2004)

Press *6 to mute your line.Press #6 to unmute.

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Gestural Communication Mode

Gestural-

-contact gestures

-distal gestures

-sign languages

-sign systems

Reichle (2009)

-finger spelling


Contact Gesture- The child’s hand touches another person or object

Distal Gesture- The child’s hand does not touch a person or object (e.g., open-h d d h i ti t di t

Reichle (2009)

handed reach, pointing at a distance, waving)


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Communication Development

1st wordsContact DistalPre-Intentional


Early Exchanges Between Children and Caregivers

• 5 months: TAKE (receive object from reach)• 6-8 months: GIVE (extend to another and relinquish)( q )• 7-8 months: BID FOR RETURN OF OBJECT

(open and close hand)• 8-11 months: GIVE• 8-13 months: SHOW• 8-10 months: CONVENTIONAL BID FOR RETURN

(e.g., pound fist)

Reichle (2009)

• 10-11 months: VOCALIZATIONS EMBEDDED INTOGAME

• 9-14 months: POINT

(Bates et al., 1975; Carpenter,Nagell, Tomasello, 1998; Crais, Douglas, & Campbell, 2004; Masur, 1983)


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Children with ASD Tend to Rely on More Primitive Gestures

• Leading

• Pulling

• Manipulating partner’s hand


Gestural UseAmong Persons with Autism

-Fewer gestures are combined with vocalizations than occur in typicallyvocalizations than occur in typically developing children

-Less pointing-Fewer conventional gestures-Use of Unconventional Behavior to

Reichle (2009)

Communicate (both verbal and non-verbal)

Wetherby et. al. (2000)Press *6 to mute your line.Press #6 to unmute.

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Development of Gestures:Why Are They Important?

• Early means to communicate

• One of the first signs of intentionality

• Can be helpful in identifying delays

• Important to intervention planning

Reichle (2009)

p p g


Augmentative Communication and Autism (Mirenda & Erickson, 2000)

1970s and 1980s manual signing1970s and 1980s- manual signing combined with speech = most frequent AAC technique

– (Kiernan, 1983; Matas, Mathy-Laikko,

Reichle (2009)

( , ; , y ,Beukelman, & Legresley, 1985; Iacono & Parsons, 1986)


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Graphic Symbols- Two- and/or three-dimensional symbols used to represent objects/events and related concepts to produce or receive messages

Two Dimensional• Product Logos

• Photographs• Line Drawings• Traditional Orthography

• Arbitrary symbols

Three Dimensional

Reichle (2009)

-Parts of Objects

-Laminated Real Objects

-Packaging


DO NONVERBAL CHILDREN LEARN SPEECH FROM INTRODUCING GESTURAL OR GRAPHIC COMMUNICATION?-

Yoder , Layton, and colleagues -described:

good and poor verbal imitators

– good verbal imitators made greater receptive and

Reichle (2009)

g g pexpressive language gains with manual signing than poor imitators

– speech development concurrent with signing was much more likely in good verbal imitators


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Speech Production

Best recent evidence from Picture Exchange i ticommunication program


THE IMPACT OF AIDED LANGUAGE STIMULATION ON COMPREHENSIONAND PRODUCTION

• 3 nonspeaking preschool children with moderate cognitive disabilities

• Children taught to use graphic symbols to request materials needed to participate in desirable activities

• Elicited probes were used to determine whether the children increased their comprehension and production of graphic symbols.

• Results indicated that all three children displayed increased symbol comprehension and production following the implementation of aided language stimulation.

Harris & Reichle (2004)

Reichle (2009)

Harris & Reichle (2004)


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Jennie: Body Parts Component Analysis

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Comprehension of GraphicSymbols

Comprehension of SpokenSymbols

Reichle (2009)

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Displaying Graphic Symbols


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Traditional Grid Layout

• Vocabulary represented by separate AAC symbols in “boxes”AAC symbols in boxes – Language is taken out of context– “Decontextualized”

• Concepts are presented separately and out of an environmental context

Reichle (2009)

out of an environmental context

• May impose cognitive demands


Types of Low Tech Communication Aids

• Board Math Science Reading Lunch

• Book

• Wallet

Reichle (2009)

Frequently used words/symbols


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WalletsAccordion Wallet

Reichle (2009)

Book Wallets

Visual Scene Layout• Originally referred to as a “Graphic metaphor”

(Shane, 1998)(Shane, 1998)

• Vocabulary embedded under “hot spot” in visual scene– Digital photo of child’s experiences

• Vocabulary presented in meaningful context– Concepts related visually and conceptually as in life

Reichle (2009)

Concepts related visually and conceptually as in life


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Reichle (2009)

Navigating Arrays Containing Numerous Symbols

FIXEDFIXED-symbols and items on the board are stationary in a

permanent location

DYNAMIC

-Once a symbol is selected the device a tomaticall displa s a ne page of s mbols a

Reichle (2009)

automatically displays a new page of symbols-a symbol can be directly linked to another page (eg. much like a windows operating system).


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L l 1

Multiple Sheets

Level 2

L l 3

Level 1

I’m finished.

I need help!

Reichle (2009)

Level 3

This is fun.DEMO

Why Choose Sign

• Doesn’t require imitation skills (Reichle t l 1991 S db 1993)et.al., 1991; Sundberg, 1993)

• Signs are less transient than words (Fulwiler & Fouts, 1976)

• May overcome negative history associated with speech ( Sundberg & Partington

Reichle (2009)

with speech ( Sundberg & Partington, 1998).


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Wendt Systematic Review-Sign (2009)N=21 studies with evidence better than inconclusive

(primarily single subject design)

-highly effective in targeting receptive speech-highly effective in targeting receptive speech.

-strong evidence supporting speech gains (given imitative skills).

-Sign places greater communicative burden on partners of signer

Wendt Systematic Review-Graphic Symbols

Reichle (2009)

y p y(2009)

-Essentially same results although on a smaller number of investigations (N=15)


Efficiency from the interventionist’s perspective

• How difficult is it going to be to implement th i t ti ?the intervention?

• How easy is the response to prompt?• How quickly will the challenging behavior

diminish?• To what extent will the child’s new

Reichle (2009)

response be maintained?• To what extent will the response be

generalized and not over-generalized?Press *6 to mute your line.Press #6 to unmute.

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The Picture Exchange Communication System (PECS)• Bondy and Frost

E h i I iti t d C i ti U i• Emphasizes Initiated Communication Using Graphic Symbols

• Does Not Require Expensive or Complex Materials (low tech)

• Determine what the child persistently wants.

SLHS 5606 Topic 3 Press *6 to mute your line.Press #6 to unmute.

• NO VERBAL PROMPTS!

• The desired object is given to the learner every time it is requested.

• Phase 1: The Physical Exchange

Procedures for PECS

– Teacher physically guides the learner to release the picture in to the teacher’s hand.

– As soon as the learner releases the picture, the teacher gives her or him the desired object.

SLHS 5606 Topic 3

– Fade physical guidance to release, but keep open hand cue.

– Fade open hand cue.


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• Phase 2: Increasing spontaneity

Procedures for PECS (cont.)

– Learner produces picture exchange using a variety of pictures.

– Pictures are available one at a time. Continue environmental manipulation.

– Fade teacher proximity.

SLHS 5606 Topic 3

– Move communication board farther away from learner.


• Phase 3: Simultaneous discrimination


– The communication board is presented with 2 pictures: 1 of a preferred object; 1 of a nonpreferred or neutral object.


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• Phase 4: Building sentence structure


– The learner is taught to request using the phrase “I want ___________.”

I want

SLHS 5606 Topic 3

I WANT


Why is Matching Important?

When a person produces a communicative act using a graphic symbol they are matching that symbol to a real object or event in the environment


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Identity Match to Sample

• Pointing to a choice that is identical the l A t iti d isample . Across opportunities randomize

choices Sample

Reichle (2009)ChoicesPress *6 to mute your line.

Press #6 to unmute.



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• Randomly swap samples



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• Some beginning communicators have diffi lt l i t t h t ldifficulty learning to match-to-sample

• Fortunately, there is a range of strategies for teaching a person to match-to-sample (correspond symbols to

Reichle (2009)

(correspond symbols to items/events/actions)


Testing Simple Discrimination

Test Procedure:

1) Designate one symbol as correct 2) Present two –three symbols to child 3) Provide reinforcement if child chooses either 4) Shuffle symbols 5) Represent the symbols

Reichle (2009)

5) Represent the symbols 6) Continue to reinforce selection of same item

during each opportunity


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Opportunity #1

• Child can select either

• Child picks dog

• Child gets reinforced


Opportunity #2

• Correct choice is still dog

• Child picks car

• Child gets no reinforcement


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Collecting Data

Trial Left Choice Right Choice

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Data with Sample Indicated

Trial Left Choice Right Choice

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Visual Matching

• Identity matching - the learner matches a choice to a sample with exactly the samechoice to a sample with exactly the same perceptual features– e.g. matches a photo of a dog to another

identical photo of the dog

• Nonidentity matching - the learner matches a sample to a perceptually

Reichle (2009)

matches a sample to a perceptually different choice– e.g. matching a photo of a ball to a real object

(ball)Press *6 to mute your line.Press #6 to unmute.

Suppose a learner can discriminate but not match

• Stimulus building/shaping

Across successful opportunities, gradually build a distracter so the learner continues to choose the target symbol under more

Reichle (2009)

to choose the target symbol under more difficult circumstances.


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Oddity (Stimulus Fading)

.See Wilkinson et.al (2002)

• five individuals with severe mental retardation

• They failed the identity matching task

• They succeeded in an oddity task

Reichle (2009)

• This in turn helped improve their identity matching performance


Oddity

• Have the student identify the one object th t i diff t f th th h ithat is different from the other choices

• Across successful opportunities, reduce the number of choices in the array until only 2 remain a correct and an incorrect

Reichle (2009)

only 2 remain a correct and an incorrect choice


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Oddity Example (1 of 8)




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COFFEE


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General Rules in Implementing Communicative Replacement

• Don’t continue to reinforce the challenging behavior.

• Try to minimize the probability that a challenging/more• Try to minimize the probability that a challenging/more informal behavior is emitted prior to the emission of a socially acceptable communicative alternative.

• If possible, select a communicative alternative that is already part of the learner’s existing communicative repertoire.

Determine how discriminable the use of the new

SLHS 5606 Topic 3

• Determine how discriminable the use of the new communicative alternative needs to be.

• Consider the natural maintaining contingencies offered by the natural environment.


Request Assistance

• A socially acceptable request for i t ith diffi lt it ti itassistance with a difficult item or activity

– Upon encountering a difficult puzzle, Matt says “Help.”


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Request Assistance (cont.)

• This strategy can be implemented when theThis strategy can be implemented when the interventionist is certain that providing unsolicited assistance reduces emission of challenging behavior

• It can be implemented to gain access to desired items/activities

and

SLHS 5606 Topic 3

• To escape more aversive items and activities


Request Assistance (cont.)

Nonpreferred/Difficult Tasks

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Teaching “Requesting Assistance”

• Provide unsolicited assistance in presence of provoking activityprovoking activity

-but-• in the absence of challenging behavior.• Just prior to delivering unsolicited assistance,

prompt a request.• Gradually fade prompts

SLHS 5606 Topic 3

Gradually fade prompts• Ensure that requests for assistance are used

conditionally


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Request Assistance

Challenging Behavior

ES

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Baseline

Request Assistance

+ Escape Extinction MaintenanceRequest Assistance +

Prespecified Reinforcer

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Problem Attempted

Problem Completed Independently

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Teaching Explicit Requesting(less discrete trial approach)

• Identify a variety of different situations t d b l i th fencountered by a learner in the course of

a day.

• For each situation, select a “key” symbol to be introduced.

• Just prior to presenting the item/activity

SLHS 5606 Topic 3

• Just prior to presenting the item/activity, prompt the learner to select a single corresponding symbol.


Freeplay

ACTIVITY SYMBOL

play

Storytimestory

SLHS 5606 Topic 3

Snacksnack


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Discriminating Between Explicit Symbols

• Begin combining two of the target symbols in a choice array at a time that is typically associatedchoice array at a time that is typically associated with participation in either activity

SNACK PLAY

SLHS 5606 Topic 3

• In this array, either symbol selection could be considered correct


• Once a symbol has been selected, offer both of the items corresponding to the symbol choicesthe items corresponding to the symbol choices.

• To be correct, the learner must select the activity that corresponds to the symbol selected.

• In this step, the learner actually specifies the sample by selecting the symbol. If he selects the item corresponding to the symbol, he has

SLHS 5606 Topic 3

p g ydiscriminatively used the symbol.

• Increase the size of the array of available symbols in the choice array.


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- ALTERNATIVELY -

Explicit Requesting (cont.)

• Engage the learner in the activity

• Interrupt the activity

• Deliver the prompt in order for the learner to re-establish the activity (interrupted behavior chain)

SLHS 5606 Topic 3

behavior chain).


INTERRUPTED BEHAVIOR CHAINS

1. Select graphic symbols or manual signs for the target requests.

2 Begin the routine2. Begin the routine.3. Interrupt the routine at the predetermined points

using strategies in Assessment Step 4. Do not use verbal cues.

4.Opportunity 1.a. Wait 5-15 seconds for the individual to initiate

communication.b. If the individual initiates, continue the chain.c. If the individual does not initiate, model or

SLHS 5606 Topic 3

,physically prompt the desired communicationbehavior.

d. Wait 5-15 seconds.


proportion of nonverbal children with autismidahotc.com/portals/0/webinar documents/autism spectrum...

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