In Young Children with ASD Kristy Benefield Speech-Language Pathologist St. Tammany Parish School System

Transcription

1 DEVELOPING COMMUNICATION SKILLS In Young Children with ASD By Kristy Benefield Speech-Language Pathologist St. Tammany Parish School System

2 Today we will learn.. OVERVIEW The definition of communication The functions of communication Assessing communication skills Developing a communication system Incorporating a communication system in the home

3 WHAT IS COMMUNICATION Speech becomes communication when there is an intent to convey a message to someone else. When we communicate we are connecting with others by sharing ideas, letting others know how we feel and making our wants known. Functional communication is behavior directed to another person who in turn provides related direct or social rewards. Involves a speaker and a listener

4 WHAT ARE THE FUNCTIONS OF COMMUNICATION 1. Seeking attention 2. Greeting 3. Requesting 4. Choice Making 5. Commenting 6. Recurrence 7. Rejecting/Protesting

5 HOW IS COMMUNICATION AFFECTED IN STUDENTS WITH AUTISM Deficits in speech and language contribute to challenging behaviors which becomes the primary communication mode. Frequently, these behaviors tend to be aggressive. Examples: hitting, kicking, spitting, biting self, head banging Behavior is communication. Some of the student s behavior may be as a result of failed communication. (NIH, 1991)

6 ASSESSMENT Our goal of assessment is to determine... what the child does to communicate and what is missing when the communication is unsuccessful How do we achieve that?... By looking at the key questions What motivates the child?... Preference assessments, family input

7 DEVELOPING COMMUNICATION SKILLS KEY QUESTIONS TO CONSIDER 1. Does the child exhibit intentional communication? 2. In what way does the child communicate? 3. How does the child use language to communicate? 4. Is there a reason to communicate? 5. Does the child initiate and/or respond to communicative interactions?

8 KEY QUESTIONS (CONTINUED) Does the child exhibit intentional communication? When a child anticipates an outcome from his form of communication, he demonstrates intent. Intentional communication is indicative of a desire to communicate Children with autism Communicative intent is difficult. do not understand that they can use communication to get a need met may exhibit distress when unable to get needs met successfully

9 KEY QUESTIONS (CONTINUED) In what way does the child communicate? Motoric: is the child using physical manipulation of a person. For example, is he bringing his parent towards a desired item, like to a door to go outside. Gestural: pointing, signing or gazing toward a desired item. Vocalization: using sounds to communicate. For example, vocalizing ah-ah-ah to get a parent s attention. Pictorial: is the child using pictures of various objects Objects: the child brings a specific object to a parent to communicate. For example, does he bring a cup to indicate drink.

10 KEY QUESTIONS (CONT D) How does the child use his language to communicate? 3 purposes of language: 1. Behavioral Regulation: the child uses communication to request, protest or to satisfy immediate physical needs. This is the easiest /earliest emerging communicative function. (requesting objects, actions, assistance; protesting/rejecting object or action) 2. Social Interaction: communicative behaviors used to initiate, respond to, maintain or to stop social interactions. (requesting social routines, comfort, greetings, calling attention, showing off) 3. Joint Attention: used to direct another person s attention to an object, event or topic of a communicative act; very difficult for children with autism. (commenting, requesting information from others, giving information to others) Written by Susan Stokes under a contract with CESA 7 and funded by a discretionary grant from the Wisconsin Department of Public Instruction.

11 KEY QUESTIONS (CONT D) Is there a reason for the child to communicate? Does the child initiate or respond to communicative interactions? Need to determine what motivates the child. These motivators will be key in developing an intervention plan. Does the child understand and participate in both roles of communicative interactions? This is difficult for children with autism. They tend to do better with learning to respond.

12 DEVELOPING COMMUNICATION Important factors in Developing Communication 1. Including parents, caregivers, and other family. 2. Early intervention 3. Incorporating everyday activities Establishing a Functional Mode of Communication 1. Speech: direct speech training 2. Sign language 3. Voice Output picture point systems (hi vs. low tech) 4. Picture Exchange Communication System Which function to teach first? Requesting

13 DEVELOPMENT OF COMMUNICATION (CONT D) Examples of the different modes of communication

14 ALTERNATIVE/AUGMENTATIVE COMMUNICATION There are many communication approaches available. Approaches should be made on an individual basis using evidence-based practices including: Consideration of family perspective Professional expertise Available evidence AAC choices should be based on: Student s strengths and weaknesses Level of social communication skills Motor abilities

15 RESEARCH SHOWS The positive impact of AAC on speech, expressive language and social communication: many devices enhance the use of speech, increase improvement in expressive language and foster increased social communication (Mirenda 2003; NRC 2001). Using combination of speech paired with sign language: this approach results in more efficient and broad receptive/expressive vocabulary development than speech alone for many children with autism (Barrera, Lobatos-Barrera & Sulzer-Azaroff 1980). it is uncommon for this mode of communication to increase combinations of words and sentences (NRC, 2001).

16 RESEARCH SHOWS (CONT D) Picture systems Using picture systems, like the Picture Exchange Communication System, shows an increase in communication initiations. Family involvement The greatest effects of any direct treatment are reflected in the generalization of learning achieved by working with parents and classroom personnel (NRC, 2001).

17 USING EVERYDAY ROUTINES Children learn from everyday routines 1. They learn how their world is organized 2. the words that people say in relation to each routine 3. social roles 4. how to participate with others in conversation

18 USING EVERYDAY ROUTINES (CONT D) Why use everyday routines? Routines are of high interest to children with ASD By manipulating an established routine, we create an incentive for the child to communicate Activities/Settings: PLAY: playing with toys, table games, pets SELF CARE: dressing, eating, bathing, selecting clothes Examples of ways to incorporate communication into the home environment

19 COMMUNICATIVE TEMPTATIONS Communication Temptations (Wetherby & Prizant, 1989) 1. Eat a desired food item in front of the child without offering any to the child. 2. Activate a wind-up toy, let it deactivate, and hand it to the child. 3. Give the child four blocks to keep in a box, one at a time (or use some other action that the child will repeat, such as stacking the blocks or dropping the blocks on the floor). Then immediately give the child a small animal figure to drop in the box. 4. Look through a few books with the child. 5. Initiate a familiar and unfamiliar social game with the child until the child expresses pleasure, then stop the game and wait. 6. Open a jar of bubbles, then close the jar tightly. Hand the closed jar to the child. 7. Blowup a balloon and slowly deflate it. Hand the deflated balloon to the child or hold the deflated balloon up to your mouth and wait. 8. Hold a food item or toy that the child dislikes out near the child to offer it. 9. Place a desired food item or toy in a clear container that the child cannot open while the child is watching. Put the container in front of the child and wait. 10. Place the child s hand in a cold, wet, or sticky substance, such as jello, pudding, or paste. 11. Roll a ball to the child. After the child returns the ball three times, immediately roll a rattle or a toy on wheels to the child. 12. Wave and say bye-bye to a toy upon removing it from the play area. Repeat this for a second and third toy, and do nothing when removing a fourth goy. These four trials should be interspersed through the other temptations, rather than be presented in a series. 13. Have the animal greet the child the first time. Repeat this for a second time and third time, and do nothing when bringing out the animal for the fourth time. These four trials should be interspersed when presented. 14. Put an object that makes noise in an opaque bag and shake the bag. Hold up the bag and wait. 15. Engage the child in an activity of interest that necessitates the use of an instrument for completion (e.g., crayon for drawing, spoon for eating, or wand for blowing bubbles). Have a third person come over and take the instrument, go sit on the distant side of the room, while holding the instrument within the child' sight and wait.

20 Questions Share time

21 REFERENCES National Institutes of Health (NIH) (1991). Treatment of destructive behaviors in persons with developmental disabilities. Washington, DC: Author. Bondy & Frost, L. (1994). The Picture Exchange Communication System. Focus on Autistic Behavior, 9,