Autistic Disorder. Asperger s Disorder: Problems: Higher Functioning Autism Spectrum Disorders: Revealing Communication Deficits. Therefore, we must:

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1 Higher Functioning Autism Spectrum Disorders: Revealing Communication Deficits Glenis Benson, Ph.D. American Speech and Hearing Association Chicago, IL November 20, 2008 Problems: Assumption that language development in this population is essentially normal When these individuals have decent expressive language we tend to look no deeper In Aspergers we don t expect delays given the diagnostic criteria Many kids have a potpourri of diagnoses but not AS Dearth of tools to look at their primary deficits Autistic Disorder impairments in: socialization, communication, and behaviors / interests at least two signs from social, and one sign from each communicative, and behavior/interests must meet 6 or more criteria Qualitative impairment in communication in Pervasive Developmental Disorders (DSM IV) delay in, or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) in individuals with adequate speech, marked impairment in the ability to initiate or sustain conversation with others stereotyped and repetitive use of language or idiosyncratic language lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level Asperger s Disorder: impairments in: socialization, described as active, but odd one or more areas of narrow, circumscribed interest no, or only mild delays in language single words by 2 years of age, phrases by 3 no significant delay in cognitive development or adaptive behaviors Therefore, we must: take a second look at persons with ADHD, OCD, ODD, LD diagnoses investigate expressive and receptive abilities in PDDNOS, HFAs and AS be creative in our investigative techniques Please obtain permission from the author prior to copying handout/generating slides from this work. 1

2 Diagnostic/Screening Instruments: Social Responsiveness Scale SRS Constantino, 2005 Social Communication Questionnaire (SCQ: Rutter, Bailey, Berument, Le Couteur, Lord & Pickles, 2003) Asperger Syndrome Diagnostic Scale (ASDS; Myles, Bock, & Simpson, 2000) Autism Spectrum Screening Questionnaire (ASSQ; Ehlers, Gillberg, & Wing, 1999) Australian Scale for Asperger s Syndrome (ASAS; Garnett & Attwood, 1995) Therefore, we must: take a second look at persons with ADHD, OCD, ODD, LD diagnoses investigate expressive and receptive abilities in PDDNOS, HFAs and AS be creative in our investigative techniques Assessment Strategies Assessment Strategies, cont d Assessment challenges: most focus on language form and rely on elicited responses in ASDs the impairments are in socialcommunicative or pragmatic aspects of language formal instruments therefore assist with few aspects of ASD communication (Schuler et al., 1997, Prizant et al., 1997, Wetherby & Prizant, 1999) Limitations re: educational programming In ASDs we need to assess the following (Schuler et al, 1997; Wetherby et al., 2000): communicative functions, use of gestures, use of repair strategies, understanding conventional meanings as well as conversational skills Assessments should: Combine assessment strategies: Document natural communicative exchanges in addition to formal means, the systematic use of informal procedures is needed (Wetherby et al., 1997) be dynamic and ongoing (Twachtman-Cullen & Twachtman-Reilly, 2002) Direct assessment Interview significant others (I.e., parents, teachers) Observe in everyday settings (home, classroom, cafeteria) Review written work Please obtain permission from the author prior to copying handout/generating slides from this work. 2

3 Some language tests that tap areas of difficulty for ASD (Myles & Adreon, 2001: Paul & Wilson, 2009) CASL Comprehensive Assessment of Spoken Language (Carrow-Woolfolk, 1999) TLC Test of Language Competence- Expanded Edition-Level 2 (Wiig & Secord, 1989) TOPL (Phelps-Tarasaki & Phelps-Gunn, 1992) Test of Problem Solving (Zachman, Barrett, Huisingh, Orman & Blagden, 1994) PRS The Pragmatic Rating Scale (Landa et al, 1992) Be careful with your interpretations of findings... Often can talk the talk but not walk the walk Ace the TOPL but be terribly challenged in the application of that knowledge Expressive Echolalia How does the student use language? To convey information? (talking at people) To establish relationships? (talking with people) Usually they convey or talk at much easier than they can establish relationships Immediate, delayed EXPRESSIVE may exceed RECEPTIVE Communication: Standardized Communication: Standardized CCC-2: Children s Communication Checklist 2 nd edition by Dorothy Bishop WH Question Comprehension Test for Persons with Autism Spectrum Disorders by Beverly Vicker CCC-2: Children s Communication Checklist 2 nd edition by Dorothy Bishop WH Question Comprehension Test for Persons with Autism Spectrum Disorders by Beverly Vicker Please obtain permission from the author prior to copying handout/generating slides from this work. 3

4 Children s Communication Checklist (CCC-2) by Dorothy Bishop Ages: 4:0 16:11 70 questions Caregiver completes (5-10 minutes) Domains: Language (speech, syntax, semantics, coherence) Pragmatics (initiation, scripted language, context, nonverbal communication) Children s Communication Checklist Examples: #40 Confuses the sequence of events when trying to tell a story or describe a recent event #41 Is too literal (e.g., asked if it is hard to get up in the morning? Replies no, you just put one leg out of the bed and then the other and stand up or if told watch your hands when using scissors, proceeds to stare at his or her fingers) #45 Asks a question, even though he or she has been given an answer Communication: Standardized WH Question Comprehension Test: for students with Autism Spectrum Disorder CCC-2: Children s Communication Checklist 2 nd edition by Dorothy Bishop WH Question Comprehension Test for Persons with Autism Spectrum Disorders by Beverly Vicker Ages: 3 and up A reproducible 60 question (10 who, what, when, where, why and how) Intervention strategies at back Communication: Informal Communication: Informal ASCS: Assessment of Social and Communication Skills by Kathleen Quill (Brookes Publishing) Communication Assessment I & II by Kate Silver (Jessica Kingsley) Language samples, language samples, and more language samples! ASCS: Assessment of Social and Communication Skills by Kathleen Quill (Brookes Publishing) Communication Assessment I & II by Kate Silver (Jessica Kingsley) Language samples, language samples, and more language samples! Please obtain permission from the author prior to copying handout/generating slides from this work. 4

5 Assessment of Social and Communicative Skills (ASCS) Communication: Informal In Quill s book DO WATCH LISTEN SAY Interview (all players) Presence of skill, generalization of skill Prioritizes for IEP goals ASCS: Assessment of Social and Communication Skills by Kathleen Quill (Brookes Publishing) Communication Assessment I & II by Kate Silver (Jessica Kingsley) Language samples, language samples, and more language samples! Communication Assessment Record Communication Assessment Record (CAR) Descriptive summary of the persons communicative skills Devised to record a description of: How a learner is communicating What he uses his communication for What level of language he understands How he interacts in a social context Measures communication E.g., even if MLU doesn t change over time, but the student uses his communication skills in more settings and with more people THIS WILL CAPTURE THAT GROWH Provides a Communication Curriculum to correspond to the CAR Communication Assessment Record (CAR) Communication Assessment Record (CAR) Expressive communication Functional Use of Communication 1 Understanding Communication 1 Social Interaction 1 Example questions from Functional Communication I: How is no or I don t want to indicated? How does he make requests? How does he gain attention? Please obtain permission from the author prior to copying handout/generating slides from this work. 5

6 Communication Assessment Record (CAR) Communication: Informal Example questions from Understanding of Communication II Can he grasp the overview (i.e., can he recognize what something is all about and complete the sentence it s all about ) relating to an activity? Can he understand how questions (e.g., How did you make that? Or How did he hurt his leg?) ASCS: Assessment of Social and Communication Skills by Kathleen Quill (Brookes Publishing) Communication Assessment I & II by Kate Silver (Jessica Kingsley) Language samples, language samples, and more language samples! Writing: (Myles & Adreon, 2001) Expressive Language Generally these students will have difficulty with: organizing their thoughts providing sufficient background and description to ensure reader understanding creativity You must assess: these skills using both written and oral samples, with and without opportunities for brainstorming Collection of a language sample (narrative and conversational) Look at initiation, maintenance and termination of conversations, as well as topics and perspective taking Pragmatics is greatest area of difficulty for students with ASDs In ASDs the pragmatic functions of communication develop according to the following sequence (Wetherby & Prutting, 1984): behavioral regulation (requesting, protesting) social interaction (obtaining attention, turntaking) joint attention (e.g., commenting) Bottomline. How does your student request something? protest that he does not like/want/to do something? Please obtain permission from the author prior to copying handout/generating slides from this work. 6

7 Pragmatics is greatest area of difficulty for students with ASDs Understanding In higher functioning ASDs have difficulty with the more sophisticated pragmatic skills (Gillberg & Ehlers, 1998): use of repair strategies negotiating dealing with sarcasm/irony, etc. presuppositional knowledge conversation/discourse(e.g., Gricean Maxims) narrative discourse skills (due to deficits in critical thinking - Minshew, Goldstein, Taylor & Siegel, 1994) Never assume comprehension simply because the person used the word, remember echolalia! Receptive language is the least well understood deficit in people with ASDs Thinking in Pictures - Temple Grandin, 1995 Receptive if you can t make a picture in your head the child with ASD will have difficulty comprehending it more than 3 directives are impossible to follow expressive often exceeds receptive ability (this is not a typo)! better with factual information than emotionally-based information problems answering questions difficulty following directions appear noncompliant Receptive Language Receptive Language Difficulty with language comprehension has been documented in even the most able students with Autism Spectrum Disorders they tend to interpret language literally and have difficulty understanding figurative language and speaker intent (Peeters & Gillberg, 1999) in addition, they have difficulty comprehending nonverbal cues and signals (Landa, 2000; Mundy & Sigman, 1989; Tantum, 2000) WH question comprehension performance in persons with ASDs is unique (Vicker, 2002) order of acquisition similar to NTs (Who, What, Where - why and how were most difficult) ASDs error pattern was different from NTs; ASDs gave a different WH class answer, whereas NTs were vague or ambiguous WH Question Comprehension Test (Vicker, 2002) Please obtain permission from the author prior to copying handout/generating slides from this work. 7

8 Reading: (Myles & Adreon, 2001) Reading cont d: (Myles & Adreon, 2001) Tests that measure number of: words read correctly factual questions answered correctly, will NOT accurately reflect the abilities of the child with the ASD Need to assess the ability to: make inferences predict outcomes understand motivation of characters, intentions name main idea draw conclusions vocabulary (discrepancy between memorized definitions and understanding) sequencing recall of story events without prompts or additional processing time Problems may change with: subject matter classroom setting (whole group vs. individual setting) stress level Bottomline: Do NOT confuse often precocious decoding with reading comprehension Assess by using the curriculum the student will be using Receptive Language Receptive Language Caregivers and professionals often assume these children understand far more than they do document response to and use of communicative gestures/vocalizations with and without situational cues True linguistic comprehension is evidenced when children can comprehend words without situational or nonverbal cues In higher ability levels assess: simple and complex sentence types (e.g., negatives, questions, causal, conditional) ongoing discourse (e.g., understand a story or sequence of events) literal language (e.g., idioms, sarcasm, metaphors) Assessing persons with ASD Do it! Be creative! Please obtain permission from the author prior to copying handout/generating slides from this work. 8