Autism Spectrum Disorders:

Building connections and

relationships… practical

strategies in autism

treatment for toddlers to

teens and beyond

Amy Frisbie MA, CCC SLP

Autism Program Coordinator Amy.Frisbie@ChildrensColorado.org

2016 National

RiteCare

Conference October

13-15, 2016

Presenter Disclosures

Amy Frisbie MA, CCC-SLP has been working at

Children’s Hospital Colorado since 2001. Her areas

of specialty include augmentative and alternative

communication (AAC) and Autism Spectrum

Disorders (ASD). She currently serves as the

Autism Program Coordinator at CHCO.

Disclosures ~ Financial: Employed by CHCO

2

Presenter Disclosures

Amy Thrasher teaches in the Child Learning

Center at the Speech, Language, Hearing

Sciences Center at the University of Colorado,

Boulder (SLHC).

Disclosures ~ Financial: Employed by the University

of Colorado – Boulder

3

Session overview:

• The presenter will discuss evidence-based practice

and intervention for the youngest learners using the

Early Start Denver Model, and popular strategies

related to video modeling, iPads and cell phone

technology.

• Supports for building peer interactions and social

skills will be presented in various settings and

outcome measures related to social communication

coaching for adolescents will be shared.

• The changing perceptions of the strengths of people

with autism will be highlighted as we consider the

future for young adults in the workplace.

4

Session objectives:

1. List 3 evidence based intervention practices for

young children with autism

2. Describe why teaching pragmatic language skills

is vital for developing friendships

3. To discuss how the needs of teens and young

adults with autism are different than those of young

children and toddlers who are recently diagnosed

5

+

Diagnosis and features of

autism spectrum disorder

(ASD) About 1 in 68 or 1.5% of children were identified

with ASD based on tracking in 11 communities

across the United States in 2012. (CDC, 2014)

6

Often, a speech language pathologist is

the first professional to see a child with

autism spectrum disorder (ASD)

Because the core characteristics and challenges in

Autism Spectrum Disorders (ASD) are related to

communication and social interaction: our specialty

They include:

• Social Communication

• Language and Related Cognitive Skills

• Behavior and Emotional Regulation

• Sensory and Feeding Issues

Why does this matter….?

We have a very important

role in the lives of young

children and SLPs are

crucial for early detection

and referral for diagnosis--

and treatment-- of autism

spectrum disorders!

8

Core Challenges in ASD

• joint attention (e.g., social orienting, establishing shared

attention, monitoring emotional states, and considering

another's intentions)

• social reciprocity (e.g., initiating bids for interaction,

maintaining interactions by taking turns, and providing

contingent responses to bids for interaction initiated by

others)

• language and related cognitive skills (e.g., understanding

and using nonverbal and verbal communication, symbolic

play, literacy skills, and executive functioning—the ability

to problem solve and self-monitor future, goal-directed,

behavior)

• behavior and emotional regulation (e.g., effectively

regulating one's emotional state and behavior while

focusing attention to salient aspects of the environment

and engaging in social interaction).

9

Core challenges in ASD:

Typical infants

demonstrate a

predisposition to

social stimuli by

focusing on:

• caregiver's eyes

• direction of gaze,

• facial expressions,

• voice and gestures

This leads to

successful joint

attention, such as

• recognizing

another's visual

references,

• directing others

• determining their

intentions

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Joint attention

Core challenges in ASD:

Children who both

initiate and follow the

attentional focus of

their communication

partners, develop

strong social

communication and

language skills

However, difficulty

with this skill limits

opportunities to:

• initiate conventional

communication,

• respond to the

models of others &

• ability to acquire

more sophisticated

language.

11

Social reciprocity

Core challenges in ASD:

Individuals with ASD

often use limited

conventional

gestures in favor of

leading, pulling, or

manipulating

another's hand:

“HAND AS TOOL”

The use of

conventional

gestures (showing,

waving, pointing,

nodding, shaking

one's head) are

often delayed, or

absent, in people

with ASD

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language and related

cognitive skills

Core challenges in ASD:

The lack of varied,

spontaneous make-

believe and

functional play is a

characteristic of ASD

Individuals with ASD

may demonstrate:

• limited functional

use of objects,

• difficulty orienting

toward caregivers

and

• Difficult imitating

the actions of

others

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language and related

cognitive skills

Core challenges in ASD:

Up to half of

individuals with ASD

have significant

difficulty using

speech as a

functional and

effective means of

communication

Therefore, the use

of augmentative

and alternative

communication

(AAC) for ASD

intervention is

showing “growing

evidence” of

success (Iacono, T,

Trembath, D, et al, 2016)

14

language and related

cognitive skills

Core challenges in ASD:

Individuals with ASD

may learn

phonological rules and

detect patterns in

words (decode), but

often without

comprehension of

what they read

This pattern is called

hyperlexia and can

occur with other

disabilities, but is

most commonly

observed in

individuals with ASD

15

Literacy

Diagnostic Criteria of Autism Spectrum

Disorder 299.00 (F84.0)

A. Persistent deficits in social

communication and social interaction across

multiple contexts

B. Restricted, repetitive patterns of

behavior, interests, or activities

C. Symptoms must be present in the early

developmental period

D. Symptoms cause clinically significant

impairment in social, occupational, or other

important areas of current functioning.

16

What to look for in the

youngest children:

http://resources.autismnavigator.com/about

Autism/player/about_autism_presentation.h

tml

http://resources.autismnavigator.com/asdgl

ossary

17

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Early Intervention and

evidence based practice

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Early Intervention in ASD

What are Evidence-Based Practices?

• “Many interventions exist for autism spectrum

disorder (ASD). Yet, scientific research has found

only some of these interventions to be effective.

The interventions that researchers have shown to

be effective are called evidence-based practices

(EBPs). One reason for using EBPs is

because, by law, teaching practices must be

based on evidence of effectiveness.” (NPDC) http://autismpdc.fpg.unc.edu/evidence-based-practices

19

National Professional Development Center on

Autism Spectrum Disorder (NPDC)

Funded by the Office of Special Education

Programs in the US Department of Education

from 2007-2014.

A collaboration among three universities—the

University of North Carolina at Chapel Hill, the

University of Wisconsin at Madison, and the MIND

Institute, University of California-Davis.

The goal of the NPDC was to promote the use of

evidence-based practices (EBPs) for children and

youth with ASD, birth to 22 years of age. 20

National Professional Development Center on

Autism Spectrum Disorder (NPDC)

The NPDC used a rigorous criteria to identify EBPs

that have been shown through scientific research to

be effective with students with ASD, including:

Picture Exchange Communication System

(PECS)*

Technology-aided Instruction and Intervention

(TAII)/ Speech Generating Devices

Video Modeling (VM)

Visual Support (VS)

Social Narratives (SN)

Social Skills Training (SST)

Parent Implemented Intervention (PII)

21

+ How are we applying EBP

intervention at CHCO?

Use of augmentative and

alternative communication

strategies (AAC)

Speech generating

Devices (SGDs)

Picture Exchange Communication

System (PECS) 22

How are we applying EBP

intervention at CHCO?

Video Modeling

(VM)

https://www.youtube.

com/watch?v=zT6IT

DwPi0w&list=PLDCA

ACE2C2BF5733F&in

dex=5

Visual Supports

(VS)

23

How are we applying EBP

intervention at CHCO?

Social Narratives (SN)

Often called “Social

Stories”, by Carol Grey

24

How are we applying EBP

intervention at CHCO?

Social Skills Groups

• Groups are offered for preschool, school

age and teens; 33 groups a year!

• The model of care includes on campus

teaching and off campus outings for

generalization

• Parent education is provided weekly

• Home practice is required

• Individual goals are developed for each

child and outcomes are measured over

time

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How are we applying EBP

intervention at CHCO?

Social Skills Groups outcome measures:

Bellini/IRCA/Social Profile/2003

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How are we applying EBP

intervention at CHCO?

Social Skills Groups

• Based on the work of Michelle Garcia

Winner and “Social Thinking”

• We all need social thinking all day long,

but we take it for granted if we are good at

it…

• We use social thinking to consider the

perspective of another person.

For example…

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Social Skills Groups at CHCO? https://www.socialthinking.com/LandingPages/Mission

• At work – when we become aware that by

loudly sipping our coffee we may be

bothering our coworkers.

• At the grocery store - when we move our

cart away from the middle of the isle so

other shoppers can pass by.

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Social Skills Groups at CHCO? https://www.socialthinking.com/LandingPages/Mission

• Watching TV – when we follow the story

by understanding how the characters

interpret and then influence each other.

• While driving - when we slow down upon

sensing that another car will cut in front of

us.

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Social Skills Groups at CHCO? https://www.socialthinking.com/LandingPages/Mission

• When we’re on social media – to

understand the intention of a message and

its sender; for example whether it is to be

friendly, sarcastic, flirty, compassionate,

etc.

• In conversation – when we attempt to read

the thoughts, beliefs, intentions, emotions,

knowledge and actions of our conversation

partner(s) and adapt our behavior to affect

the thoughts they have about us.

•

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Parent Implemented Intervention (PII)

http://www.hanen.org/Home.aspx

31

More Than Words® is

for parents of children

under 5 with ASD.

The goal is to improve

social communication,

play skills and

imitation

Hanen Programs: TalkAbility & More Than Words

Developed by Sally Rogers &

Geraldine Dawson at UC Davis

Mind Institute

32

EARLY START DENVER MODEL

* Naturalistic applied behavioral analytic

strategies

* Sensitive to normal developmental

sequence

* Deep parental involvement

* Focus on interpersonal exchange and

positive affect

* Shared engagement with joint activities

* Language and communication taught inside

a positive, affect-based relationship

33

What does it look like ?

https://onedrive.live.com/?cid=8AD2C480

E794039C&id=8AD2C480E794039C%21

114&parId=8AD2C480E794039C%21116

&o=OneUp

https://www.youtube.com/watch?v=wAoo8

pDLL3A

ESDM is a behavioral and

developmental hybrid

• Autism is a

developmental

disorder

• The curriculum

follows

developmental

sequences of

typicals

• All developmental

areas affected in

children with autism

are targeted in ESDM

• It includes task

analysis and

• data collection, which

is key for measuring

outcomes

In ESDM parents are key

• Supporting relationships =

supporting families

• Parents’ preferences and priorities

guide the team/goals

• Prepares parents for a lifetime of

decision-making and advocacy for

their child with autism

• Autism is a social disorder:

Relationships with family must be at

the heart of intervention

ESDM Curriculum Checklist

• A criterion-referenced tool that

provides developmental sequences of

skills in 8 domains

• 480 items organized into 4 levels

• Placement of items across levels

reflects typical child development

research and clinical experience

• Provides outcome data every 12

weeks

ESDM Curriculum Checklist

Step one: Complete the

ESDM Curriculum Checklist

Levels 1-4:

Receptive Language

Expressive Language

Social Interaction

Fine/Gross Motor

Imitation

Cognition

Play Skills

Adaptive

Behavior/Personal

Independence

Correspond to

developmental age

periods:

1. 9/12-18 months

2. 18-24 months

3. 24-36 months

4. 36-48 months

Domains:

Areas targeted during natural

environments and play

Imitation

Social Orientation

Joint attention

Positive Emotions

Communication

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• The more fun the child is having, the longer they are attending and interacting, and the more learning opportunities you can provide

• Work to increase the “fun quotient”

• Model assumes that one of the basic biological differences in ASD is a decreased internal reward from social interactions and engagement- in ESDM, use enjoyable play experiences to increase child’s experience of pleasure in social interactions and internal motivation to seek out social engagement

Sensory Social Routines (SSRs):

• Patty cake

• Peekaboo

• Chase

• Swinging

• Airplane

• So Big

• Open Shut Them

• Ring around the Rosie

• London Bridge

• Tickle games

Joint Activity Routines 1) Getting Ready/Set up

Child chooses the activity 2) Develop Theme

Get going with the activity and work on objectives

3) Elaboration

-Share the activity -Elaborate on or vary the activity (e.g.,

peek-a-boo with feet and hands) -add new materials, vary the actions, add

more steps to the actions 4) Closing-Transition

-Clean up & start new activity that is child’s choice

Activities are designed to target multiple objectives simultaneously- e.g., functional object use, pointing, eye contact, showing, imitation, etc.

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Transitions into adulthood

44

“If you have

met one

child with

autism, then

you have

met one

child with

autism.”