Transcript KristinAutismCommunication - asdforum

Kristin J. Szewczyk, M.S./CCC-SLP
February 1, 2009
Communication is simply defined as
“an exchange of information;” however, the process
of communication is much more complex.
(Hedge, 2001, p. 2)
Problems with Communication
Communication deficits are one
of the primary characteristics
of autism spectrum disorders
(ASDs)
(American Pyschiatric Association, 2000)
Common Problems with Communication
 Speech
 May Never Develop Speech

30% of individuals with ASD are Non-Verbal (Klin, 2006)
 Articulation Errors
 Difficulty understanding Prosody
 Inflection of Speech
 Oral Motor Difficulties


Cannot imitate oral movements
Drooling
(American Speech-Language-Hearing
Association [ASHA], 2009b; Prelock, 2006)
Common Problems with Communication
 Expressive Language
 Echolalia-Repeating what is said


Immediate
Delayed
 Difficulty expressing wants/needs
 Poor Vocabulary
 Difficulty with Pronouns
 Difficulty with non-literal aspects of language
 Reduced sentence length
(ASHA, 2009b; Prelock, 2006)
Common Problems with Communication
 Receptive Language
 Difficulty following directions
 Difficulty answering questions
 Pragmatic Language
 Social Language



Difficulty with Initiating and Maintaining a Conversation
Difficulty understanding Facial Expressions/Body Language
Poor Eye Contact
(ASHA, 2009b; Prelock, 2006)
Functions of Communication
Functions of Communication
 Three Primary Functions of Communication in Individuals
with ASD
 Regulate Behavior
 Social Interaction
 Joint Attention
(Wetherby & Prizant, 2005)
Functions of Communication
 Regulate Behavior
 First function to develop


Making requests
 Objects
 Activities
Expressing Wants/Needs
 Hunger/Thirst
 Asking for help
(Prelock, 2006; Wetherby & Prizant,
2005)
Functions of Communication
 Social Interaction





Play Activities
Requesting involvement with Family/Friends
Social Greetings
 “Hello”/ “Bye-Bye”
Bring Attention to Self
Showing Off
(Prelock, 2006; Wetherby & Prizant,
2005)
Functions of Communication
 Joint Attention
 Shifting attention between individuals and objects
 Gaining an individual’s attention
 Directing an individual’s attention
 Make Comments
 Ask Questions
 Provide information
(Prelock, 2006; Wetherby & Prizant,
2005)
Methods of Communication
Verbal Communication
Augmentative and Alternative
Communication (AAC)
Verbal Communication
 Using spoken words to express wants/needs, request
items/activities, make comments, ask/answer
questions, and engage in social interactions
AAC
 AAC is a combination of symbols and methods that are
used to improve communication (Downey & Hurtig, 2003)
 Object Exchange
 Sign Language
 “Total Communication”
 Picture Exchange Communication System (PECS)
 Voice-Output Communication Aids (VOCAs)
Object Exchange
 Real Objects
 Child gives communicative partner an object to indicate
what he/she wants

Example: Child gives parent a book to indicate that he/she
wants to read a story
 Child must have easy access to the objects in order to
make wants/needs known
(Strokes, 2006)
Sign Language
Movements made with the hands to represent letters
and words
(National Institute on Deafness and Other Communication Disorders,
2008)
(Lifeprint.com, 2008)
Total Communication
An AAC method that involves using verbalizations and
sign language simultaneously
(Goldstein, 2002; Prelock, 2006)
PECS
 Developed to improve the communication skills of
preschool students diagnosed with ASD
 Child exchanges pictures with an individual to
communicate
 Consists of six phases
(Frost & Bondy, 1994, 2002)
PECS Phases
 Phase I – “How” to Communicate (Frost & Bondy,
2002, p. 67)
 Instructor presents the individual with a preferred item
 Individual chooses a picture that represents the
preferred item
 Individual gives the picture to the instructor to request
the item
 Instructor gives the individual the desired item
PECS Phases
 Phase II- Develops independent requesting
 Individual chooses a picture from his/her PECS book
 Individual finds the communicative partner and gives
the picture to him/her
 Only one picture is used during this phase
(Frost & Bondy, 1994; 2002)
PECS Phases
 Phase III-Continues to develop independent
requesting
 Individual selects a picture from a larger field
 Individual independently selects a picture from his/her PECS
book and finds a communicative partner in order to make the
request
 Number of pictures increases as the individual gains accuracy
and experience
(Frost & Bondy, 1994; 2002)
PECS Phases
 Phase IV- Combining pictures to make requests

Individual uses a sentence strip located at the front of his/her
PECS book to build more complicated requests

Individual must locate the “I want” picture as well as the
picture of the item or activity he/she is requesting

Individual then finds a communicative partner in order to
make the request
(Frost & Bondy, 1994;
2002)
PECS Phases
 Phase V- “What do you want?”
 Individual uses a sentence strip located at the front of
his/her PECS book to build more complicated requests
 Individual must locate the “I want” picture as well as the
picture of the item or activity he/she is requesting
 Individual then finds a communicative partner in order
to make the request
(Frost & Bondy, 1994; 2002)
PECS Phases
 Phase VI- Independent Communication
 Individual independently responds to a variety of
questions and makes comments using his/her PECS
book
(Frost & Bondy, 1994; 2002)
PECS
(Strokes, 2006)
VOCAs
 Electronic device
 Child pushes a button on device
 Pictures/printed words on the buttons represent messages
 Pre-recorded message plays
 Vary in complexity and cost
(Nunes, 2008)
VOCAs
(The Sensory Company®, 2003)
VOCAs
(AdaptAble Minds, n.d.)
VOCAs
(SuperDuper Publications, 2009)
VOCAs
(DynaVox Technologies, 2008)
Benefits of AAC
 Beneficial for verbal/non-verbal children with ASD

Increases number of vocalizations/verbalizations

Improves functional communication skills
 Expressing wants/needs
 Requesting
(Blischak, Lombardino, & Dyson, 2003; Charlop-Christy, Carpenter, Le,
LeBlanc & Kellet, 2002; Dyches, Davis, Lucido, and Young,
2002 ; Goldstein, 2002; Mirenda, Wilk,
and Carson; 2000; Nunes, 2008
Benefits of AAC



Improves communicative initiations
 Responses
 Comments
Improves social interactions
Decreases problem behaviors
(Blischak, Lombardino, & Dyson, 2003; Charlop-Christy, Carpenter, Le,
LeBlanc & Kellet, 2002; Dyches, Davis, Lucido, and Young,
2002 ; Goldstein, 2002; Mirenda, Wilk,
and Carson; 2000; Nunes, 2008
Selecting a Method of Communication
 When selecting a method of communication, should
consider the following:
 Communication needs of your child
 Physical capabilities of your child
 Child’s level of motivation
 Flexibility/Accessibility of the method of
communication
 Consult with a speech-language pathologist (SLP)
(ASHA, 2009a)
Communication Strategies
Strategies
 Naturalistic Language Teaching
 Joint Action Routines
 Visual Strategies
(Goldstein, 2002; Prelock, 2006; Tissot & Evans, 2003)
Naturalistic Language Teaching
 Instruction and learning is provided during naturally
occurring situations
 Uses child-preferred materials
 Learn and generalize skills at a faster rate
 Child is reinforced for appropriate initiations and
responses to communication
(Harris & Delmolino, 2002; Prelock, 2006)
Naturalistic Language Teaching
 Milieu language teaching
 Child-directed modeling
 Mand-modeling
 Time-delay
 Incidental teaching
(Goldstein, 2002; Harris & Delmolino, 2002; Prelock, 2006)
Milieu Language Teaching
 Child-Directed Modeling
 Uses child’s interests

Establishes joint attention
 Adult/Instructor provides verbal models


Reinforce correct responses
Repair incorrect responses
(Harris & Delmolino, 2002; Prelock, 2006)
Example of Child-Directed Modeling
 Interest: Child enjoys going for rides in the car
 Adult/Instructor: “Say, ‘Open the door.’”
 Child responds: “Door.”
 Adult/Instructor: “Say, ‘Open the door.’”
 Child responds: “Open the door.”
 Adult/Instructor: “Nice talking!”

Adult/Instructor then opens the door to the car.
Milieu Language Teaching
 Mand-Modeling
 A mand is “a verbal instruction or request” (Prelock,
2006, p. 413)
 Teaches functional communication skills
 Utilizes child’s interests
 Establish joint attention
(Harris & Delmolino, 2002; Prelock, 2006)
Mand-Modeling
 Adult/Instructor instructs the child to follow a
command or complete a request

Provides a verbal model

Reinforce correct responses

Repair incorrect responses
(Harris & Delmolino, 2002; Prelock, 2006)
Example of Mand-Modeling
 Child approaches playdough, which is the child’s
favorite activity
 Adult/Instructor: “Say, ‘I want playdough.’”
 Child says: “Dough.”
 Adult/Instructor: “Say, ‘I want playdough.’”
 Child says: “Want playdough.’”
 Adult/Instructor: “Say, ‘I want playdough.’”
 Child says: “I want playdough.”
 Adult says: “Nice talking!”

Gives child the playdough
Milieu Language Teaching
 Time-Delay
 Using pauses between the mand and the provided
model/cues
 Develops independent communication
(Harris & Delmolino, 2002; Prelock, 2006)
Example of Time-Delay
 Child wants to watch a movie and stands in front of
the TV
 Adult/Instructor waits until child makes the request
 Child says, “I want to watch a movie.”
 Adult/Instructor completes the request
Milieu Language Teaching
 Incidental Teaching
 Increase language/conversational skills
 Environment arranged to facilitate communication
 Utilizes child’s interests
 Child must interact with adult to make a request
Milieu Language Teaching
 Adult instructs child to make a request or answer a
question using a more complex response

Provides a model

Provides correction

Provides reinforcement
(Harris & Delmolino, 2002; Prelock, 2006)
Example of Incidental Teaching
 Child wants a cookie and says, “Cookie.”
 Adult/Instructor: “What kind of cookie do you want?”
 Child: “I want a chocolate cookie.”
 Adult/Instructor: “Here is your cookie. You like chocolate
cookies. I like chocolate cookies, too. Do you think Daddy likes
chocolate cookies?”
 Child: “Yes. He eats chocolate cookies, too!”
Joint Action Routine
 Utilizes familiar routines
 Involves two or more individuals
 Provide some items for routine, but withhold others
 Child requests items needed to complete the routine
 Adult/Instructor asks child questions during the routine
(Prelock, 2006)
Joint Action Routine
 Three types of joint attention routines
 Routines with a “specific product or outcome” (Prelock, 2006, p.
408)
 Routines planned around a theme or story
 Turn-taking routines
(Prelock, 2006)
Example of Joint Action Routine
 Breakfast
 Adult/Instructor: “What do you want for breakfast?”
 Child: “Cereal.”
 Adult/Instructor: “What kind of cereal?”
 Child: “Lucky Charms.”
 Adult/Instructor gives child the box of cereal
 Child: “I need the milk.”
 Adult/Instructor gives the child the milk.
 Child: “I need a bowl and a spoon.”
 Adult/Instructor gives the child the bowl and spoon.
Why use visual strategies?
Visual Strategies
 Children with ASD are visual learners
 Makes concepts concrete
 Improves focus and attention
 Reduces anxiety
 Improves communication
(Rao & Gagie, 2009; Tiss0t & Evans, 2003)
Visual Strategies
 Modeling
 Live
 Video
 Social Stories
 Scripts
Live Modeling
 Also known as “in vivo modeling”
 Child observes an individual demonstrating a desired
behavior
 Parents, peers, other adults/children
 Goal is for child imitate and use the desired behavior in
other situations
(Charlop-Christy, Le, & Freeman, 2000;
Prelock, 2006, p. 420)
Live Modeling
 Benefits
 Effective in improving social and communication skills
 Implemented by a variety of individuals
 Parents, siblings, teachers, etc.
 Used in a variety of settings and situations
(Charlop-Christy, Le, & Freeman, 2000;
Prelock, 2006
Video Modeling
 Child watches videos of an individual demonstrating a desired
behavior
 Others
 Parents, peers, other adults/children
 Self
 Again, goal is for child imitate and use the desired behavior in other
situations
(Buggey, 2005; Delano, 2007; Hitchcock, Dowrick, & Prater, 2003;
Sherer et al., 2001)
Video Modeling
 Benefits
 Effective in improving social and communication skills
 Ususally obtain quicker results than live modeling
 Can be used repeatedly in a variety settings and by different
individuals
(Baharav & Darling, 2008; Charlop-Christy, Le, &
Freeman, 2000; Delano, 2007; McCoy &
Hermensen, 2007)
Modeling Considerations
 First, choose a behavior to teach
 Examples
 Saying “hello”/ “bye”
 Answering questions
 Conversational skills
 Turn-taking
(Charlop-Christy, 2004)
Modeling Considerations
 Next, determine steps achieve desired behavior
 Examples



Saying “hello” / “bye” first
Asking question
Beginning a conversation
 Helps to watch child’s peers
 Success

Demonstrates behavior 75% to 80% of the time
(Charlop-Christy, 2004)
Visual Strategies
 Social Stories
 Short stories that are written from the child’s point-ofview
 Provides information about a social situation and how to
respond appropriately



Individuals involved
Order of events in the situation
Feelings of other/self
(Ivey, Heflin & Alberto, 2004;
Sansosti & Powel-Smith, 2008)
Social Stories
 Benefits
 Reduces problem behaviors
 Improves social communication
 Increases appropriate social interactions
(Crozier & Tincani, 2005; Thiemann & Goldstein, 2001;
Ivey, Heflin & Alberto, 2004; Sansosti & Powel-Smith, 2008)
Example of Social Story
http://www.frsd.k12.nj.us/autistic/Social%20Stories/P
ages/asking_other_kids_to_play.htm.
Visual Strategies
 Scripts
 Used to teach social and conversational skills
 Taught using modeling, cues, and reinforcement
 Script is written on a cue card
 May include pictures or other symbols depending on individual’s
reading level
 May be tape-recorded
(Charlop-Christy & Kelso, 2003;
Ganz, Kaylor, Bourgeous, & Hadden,
2008)
Scripts
 Scripting process:
 Adult asks a question
 Presents cue card to individual containing the response
 Individual is told to read the response out loud
 Adult then instructs the individual to read the response while
maintaining eye contact
 Process is repeated until conversation is finished
 Provide reinforcement


Verbal praise – “Great job!”
Preferred food, toy, or activity
(Charlop-Christy & Kelso, 2003;
Ganz, Kaylor, Bourgeous, & Hadden, 2008)
Script Example







Adult:
Child:
Adult:
Child:
Adult:
Child:
Adult:
Do you like to watch T.V.?
Yes. Do you like to watch T.V.?
Yes. What’s your favorite show?
Power Rangers. What show do you like?
Cheers. Do you watch videos?
Yes. Can we watch a video?
Sure!
(Charlop-Christy & Kelso, 2003, p. 125)
Scripts
 Benefits
 Improves conversational skills
 Improves social interactions


Peers
Adults
 Decreases echolalia and speech perseverations
(Charlop-Christy & Kelso, 2003; Ganz, Kaylor, Bourgeouis,
& Hadden, 2008)
Visual Strategies
 Resources
 Boardmaker

http://www.mayer-johnson.com/MainBoardmaker.aspx
 Microsoft Clip Art
 Writing with Symbols

http://www.mayer-johnson.com/ProdDesc.aspx?SKU=M165
Visual Strategies
 Resources
 PixWriter

http://www.slatersoftware.com/pixwriter.html
 Digital Camera
 Google Images

http://www.google.com
Conclusion
 Communication is a complex process
 Especially difficult for individuals with autism
 Three Functions of Communication
 Regulate Behavior
 Social Interactions
 Joint Attention
(American Pyschiatric Association, 2000; Hedge, 2001; Prelock, 2006)
Conclusion
 Many available methods of communication
 Choose the one that best fits the communication needs of
your child
 Communications Strategies for in the Home
 Naturalistic Language Teaching
 Joint Action Routines
 Visual Strategies
(ASHA, 2009a; Charlop-Christy & Kelso, 2003; Goldstein, 2002; Harris
& Delmolino, 2002; Ivey,Heflin & Alberto, 2004;
Prelock, 2006; Sansosti & Powel-Smith, 2008; Tissot & Evans, 2003)
OPPORTUNITIES TO
COMMUNICATE ARE
EVERYWHERE!!!
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