Transcript ABA Therapy - Metro Parent

Improving ASD Treatment
Outcomes
Integrating Speech-Language Therapy and
Applied Behavior Analysis
Emily Graham, M.A., CCC-SLP
& Jason Majchrzak, M.S., L.L.P., B.C.B.A.
What is Applied Behavior
Analysis?
 Applied: Address socially important behaviors
 Behavioral: Focus on behaviors we can see and measure
 Analytic: Use data to show treatment had an effect
 Technological: Therapy can be explained and taught
 Conceptual: Based on what we know about human behavior
 Effective: Therapy gets strong, socially important results
 Generalizable: Newly trained behaviors can occur across a
variety of times and settings.
Goals of Applied Behavior
Analysis
 Teaching new behaviors/skills
 Talking, dressing, toileting, using utensils, Preacademic and academic
 Increasing current behaviors/skills
 Improve demonstration of a skill
 Reducing barriers
 Slow progress in school, language, social skills
 Reducing problem behaviors
 Tantrums, aggression, self-injurious behavior
ABA Therapy
 Assessment by BCBA
 Treatment plan created based on child’s
individual needs
 Goals established in partnership with parents
 Evidence based strategies to achieve goals
 1:1 center-based therapy sessions with ABA
Implementer
ABA and Communication – Use
Language Functionally
 Requests
 Asking for information
 Naming
 Reciprocal
conversation
 Responding to
questions
 Following
instructions
 Social skills
 Feelings identification
and expression
 Reducing problem behaviors
ABA: Parent Involvement
 Collaboration with therapy services
 Parents are experts on their kids!
 Participate in treatment development
 Learn therapy strategies and do therapy at home!
 Stay in touch and talk with your BCBA often!
Collect data at home.
What is Speech-Language Therapy?
 Start with assessment by an SLP,
who will give recommendations for
treatment
 Many methods of intervention to
achieve goals
 Improve communication skills,
understanding skills, social
language skills, non-verbal
communication, play skills,
articulation/phonological
development and suprasegmental
features of speech
 Focus on building skills for
functional communication and
social interaction
Speech-Language Therapy
Although children on the autism spectrum may share a similar
diagnosis, intervention methods and goals may vary widely based
on the communicative level of the child
Low-functional verbal: may repeats words (echolalia) and recites
scripts but and has delayed functional language
Non-verbal: limited to no spontaneous or imitated verbal language
Hyperverbal: talks non-stop about topics only he/she is interested
in without being able to read the social cues of others or take turns
in conversation
Verbal Language/Sign/AAC/PECS
Foundation Skills
For Functional Higher Level Language
Eye Contact
Joint Attention
Gestures
Give/Show
Reciprocal
Interaction
SLP Modalities of Communication
 Verbal language
 PECS (Picture Exchange
Communication System)
 Sign Language/Gesture
 AAC (Augmentative and
Alternative
Communication)
 Total communication
approach: using any
combination of the above
modalities
SLP Methods of Intervention
Shaping Imitative Speech:
Modeling Imitative Speech:
 Strengthening the effects of
reinforcement with the aim to
increase number of vocalizations
and verbalizations
 Provide a prompt for requesting,
commenting, responding,
describing, negating, etc., as you
would want the child to say it
 Gradually increase complexity of
the utterance
 Praise the imitative attempt with a
desired object or verbal praise and
reinforce with repetition
 “Buh” to “buh-buh” to “bubble”
Echo Expansion:
 Appropriate when child is using single words more consistently
 Add an additional word to a spontaneous production and praise when done
correctly
 “Bubble” to “bubble please” to “more bubble please”
SLP Methods of Intervention
Errorless Learning
 Goal is to replace echolalia with
functional speech
 Prompting, shaping and fading
 Yes/No: hold up a desired
item, ask “do you want ____?”
Prompt the child to say “yes,”
and give visual cues
 Prompt is then faded with less
volume and emphasis
Play-Based Therapy
 DIR (Developmental Individual
Difference Relationship-Based
Model)
 Greenspan Approach,
Floortime and PLAY
Project
 The Hanen Method
Structured Social Play
Visual Language Learning
 Turn taking, both verbally and
in play
 Social stories
 Peer play groups with
structured activities
 PECS sentences
 Visual schedules
ABA + Speech
Working Together for Best Outcomes
 Implementing best communication modality for the
patient across both therapies
 Sharing strategies and techniques and increasing
impact at home, school, and in the community
 Generalization of skills learned in speech therapy to
ABA and vice versa
 Encouraging consistency to prevent conflicting
recommendations and methods
 Using similar terminology or clarify unfamiliar
terminology (i.e., manding versus requesting)
Parent Involvement
 Be an active participant in your child’s therapies!
 Observe sessions, as appropriate, to carry-over skills
into the home environment
 You may request communication between your
child’s therapists (must use release forms)
 Sharing progress notes and treatment plans
 Be open about child’s successes and struggles within
other services and environments (school, daycare,
play groups, etc.)
Case Study #1
Layla is a 3-year-old with ASD and a moderate-severe receptive and
expressive language delay. She is verbal, with an approximately 100, singleword vocabulary and occasional 2-3 phrases, some of which are repetitive
scripts from TV shows or nursery rhymes. She often perseverates on labeling
numbers, colors and letters. She repeats questions that are asked of her. She
follows only 1-step directions some of the time. Symbolic play is a relative
strength, but she will not take turns in play. She is not yet toilet trained. Poor
behaviors are frequent and include hitting, throwing, and severe tantrums
when she does not get her way. Parents would often give Layla what she
wanted as soon as she started tantruming to avoid a bad behavior.
Tantruming behaviors often lead to hugs and coddling to try to get her to
calm down.
Interventions
Speech Therapy: Initiate PECS to supplement verbal language, errorless
learning, echo expansion, structured social play and play-based language
learning play. Have the child take the lead in therapy session to find a toy of
interest, model appropriate request. One toy at a time to work on requesting,
waiting and cessation. Work on following directions with visual cues and
slowing fading them. Visual schedules put into place to help her understand
what came next in therapy sessions.
ABA Therapy: ABA recommended the use of social stories to help Layla
understand expectations. ABA worked with the family in order to identify
that Layla often acted out to get attention or access to things that she wants.
Parent attention could then be focused on ignoring poor choices by Layla
and engage her when she was doing well. A behavior plan was also set to
remove and restrict access to desired things when Layla didn’t follow
directions. A behavior plan also included a strategy, asking Layla a series of
3 questions, unrelated to her scripting, when scripting started, as a way of
redirecting continued scripting.
Case Study #2
Jake is a 2-year-old non-verbal male. He is able to combine vowel and
consonant sounds spontaneously but does not produce sounds in
imitation. Jake sometimes has tantrums (crying, falling to the floor, runs
away) when he does not get something he wants or when it is not given
quickly enough. He has very poor eye contact. Play skills are very
decreased for his age, as he often lines up toys, stacks toys or visually
inspects parts of toys rather than playing appropriately with them. He
does not take turns in play or give objects on request.
Interventions
 Speech Therapy: Implement PECS and sign language for building
functional language and requiring eye contact be given with each
exchange. Shaping imitative speech for turning vowel and consonant
sounds into closer approximations of words. Modeling appropriate
play with verbal narration. Speech implemented ABA goal for waiting
for something after a request, which was part of his behavior plan.
 ABA Therapy: Implement PECS and sign language during Jake’s ABA
therapy session. PECS is used with different people and to request
things he wants, ask for help. When the ability to imitate speech
sounds was achieved, this skill was practiced in ABA, requiring
approximations of things he can say to get a desired reward. Behavior
therapy helped at home and in speech therapy to teach Jake to wait to
get things he wants and also limit how long he gets with his highest
preferred activities, setting up opportunities for him to then request
again in the future.
Case Study #3
Simon is a 5-year-old male, who is very verbal, but has some
grammatical errors in his speech as well as an articulation
delay. He likes to talk about airplanes and Thomas the train.
Simon will bring up these topics of interest all of the time and
has a hard time talking about anything else in a conversation.
He has poor eye contact and limited attention to tasks that do
not interest him. Simon has difficulty following others in group
and social tasks, often refusing to go along with things his
parents and other caretakers suggest or say. Simon has
demonstrated the ability to follow directions but often chooses
not to, arguing and refusing most instructions. A strength has
been Simon’s ability to regulate his own behavior based on
instructed rules.
Interventions
Speech Therapy: Enroll the patient into a structured social play group to
work on reciprocal communication, verbal turn taking in conversation
and topic maintenance. Grammatical errors would be targeted through
play-based language tasks and story cards in a 1:1 setting. Articulatory
errors would be evaluated and approached in drill play. Eye contact
would be requested during all verbal and gestural exchanges.
ABA Therapy: During social skills group, Simon would learn some basic
social rules about participation and cooperating with others. These rules
would then be practiced and enforced during social time. Use of
language during social skills time would work to enforce grammatical
error corrections. Simon would communicate with others, using full
sentences during group. Carry-over of articulation goals from SLP would
be offered in ABA sessions. Eye contact would also be required when
speaking with repeated drilling until eye contact was attained.
References
Koenig, M. & Gerenser, J. (2006) SLP-ABA: Collaborating to support individuals
with communication impairments. Journal of Speech and Language PathologyApplied Behavior Analysis. 1, 2-9.
Koenig, M. & Gerenser, J. (2011). Powerpoint from ASHA Convention ‘11: SLP-ABA
Collaboration on Autism Support Teams. San Diego, CA
Parker, Robin. "Incorporating Speech-Language Therapy Into an Applied Behavior
Analysis Program." Behavioral Intervention for Young Children with Autism.
Austin: Pro-Ed, Inc., 1996. 297-306.
Questions?
Thank you!