American Speech-Language-Hearing Association Conference November 18-20, 2010, Philadelphia, PA

Transcription

1 American Speech-Language-Hearing Association Conference November 18-20, 2010, Philadelphia, PA Successfully Treating Children with Autism: Collaboration Between ABA & AAC Session #1449 I. Presenter & Session Introductions: Richard Lytton, M.A., CCC-SLP Speech-Language Pathologist Coordinator, Assistive Technology Services A.I. DuPont Hospital for Children Wilmington, DE Heidi Light-Keppler, M. Ed., BCBA Board Certified Behavioral Analyst Home and Community Services, Pennsylvania Verbal Behavior Project Exton, PA Honey Rinicella Parent/ Co-Coordinator, TACA (Talk About Curing Autism) of Pennsylvania West Chester, PA II. Living with Autism (Ms. Rinicella) Some children with autism are unable to speak, but that does not mean they have nothing to say! There are a number of treatments available for nonverbal people with autism including medical and educational approaches. Medical approaches include diet and supplements; educational approaches include speech and behavioral therapies, as well as assisted technology devices and augmentative communication methods. Real Stress. Not being able to communicate is an unbelievable challenge for parents. It not only makes life constantly difficult, but it also breaks a parent s heart, often leaving a helpless feeling. Behavioral challenges. For an autistic child, not being able to communicate your needs to your friends, therapists and parents can cause insane behaviors! There are many reasons this communication breakdown can increase behaviors, such as frustration due to word retrieval issues, not being able to express a need like hunger, or often a child may exhibit behaviors when they cannot communicate a pain they are feeling. Raised expectations: If you do not raise the bar for our affected children, then they will continually trip over it! III. Profiles of children with Autism: Strengths and Challenges (Mr. Lytton)

2 Autism less smart Autism = thinking and learning differently Many children who have Autism and who have significant speech and language impairments are visual, multi-sensory, and/or experiential learners. o Many have specific weaknesses in processing and modulating sensory information (auditory, visual, proprioceptive, etc.) and in concomitant motor learning. IV. Goals of Applied Behavioral Analysis (ABA) (Ms. Light-Keppler) Choose improvement of behaviors that will Access reinforcement for the child, rather than punishment Help the client both temporarily and in the future Endure after instruction (and access reinforcement naturally vs. being dependent upon contrived forms of reinforcement) Be age-appropriate Be a desired alternative to a maladaptive behavior to decrease Consider training communicative behaviors that provide: Frequent practice opportunities Extended duration of need Increased access to Sr+ Efficient and effective access to Sr+ Greater independence per activity/less reliance on adults Increased access to reinforcement for significant others Always ask yourself when seeking to improve a behavior, will this behavior Help the child? Produce R+ when you are not present? Be similar to behaviors of their peers? Enable independent functioning in typical environments? Increase adaptive/appropriate behavior? Increase access to peers and less restrictive environments? V. Augmentative & Alternative Communication (AAC) (Mr. Lytton) Functional communication consists of more than one communication technique o Speech, signs, low-tech communication displays (including PECS), Speech Generating Devices o Different expressive language/communication techniques may be functional with different communication partners and for different pragmatic language purposes Functional expressive language and communication performance requires: o Ability to establish and maintain joint social/communication attention; exchange socially interactive and communicative turns

3 o Vocabulary from different parts of speech and different semantic categories. (example: one cannot achieve fluent language expression without verbs) o Syntax in sentences as well as in communication turn-taking across sentences. o Pragmatic language skill such as initiation; topic initiation and maintenance; requesting; predicting and anticipating; telling personal information, active participation through communication interaction in activities that occur throughout one s day, week, and life. o Portability and generalization across all domains of one s life (home, school, and community) and across communication partners. Functional communication performance is matched to contextual language and social needs Importance of raising the bar of expectations VI. Designing Collaborative Assessment Processes & Treatment Plans (Mr. Lytton) In accord with ASHA s Technical Reports and Guidelines See below VII. A Case Study of Functional Outcomes (Ms. Light-Keppler & Ms. Rinicella) What makes a behavior functional (including a communication behavior) is that: 1) it works in social situations; 2) it works in naturally-occurring environments; and 3) society accepts it. Always keep data to support where the greatest need lies. This will allow you to track the progress and allow you to plan and therefore move ahead, to the child s next steps. Example: The ABBLS VI. Designing Collaborative Assessment Processes & Treatment Plans In accord with ASHA s Technical Reports and Guidelines (see below) 1. Family members of individuals with autism fulfill multiple roles beyond those inherent in being a member of any family. (1) 2. A philosophical mandate for family-centered practices has permeated both health care and educational fields. This philosophy offers a foundation for effective family professional collaborations in assessment, diagnosis, and treatment of individuals with ASD. (1) 3. Inter-disciplinary assessment and treatment teams: Given the importance of social communication in the diagnosis of ASD, the SLP can play an important role in both screening and diagnosis The SLP plays a critical role in referring children suspected of possible ASD to an audiologist to confirm or rule out a hearing loss. Furthermore, the SLP should play a primary role in the diagnosis of speech and language impairments that can co-occur with ASD, including, but not limited to, features of specific language impairment, apraxia, and dysarthria. (1)

4 4. Ingredients of Effective Programs (1) o The NRC** recognized the need for more meaningful outcome measures and recommended measures that include (a) gains in initiation of spontaneous communication in functional activities and (b) generalization of gains across activities, interactants, and environments. The broad impact of the social communication challenges and problems with generalization for individuals with ASD underscores the critical importance of ecologically meaningful outcome measures. The NRC concluded that learning in natural learning environments appears to be the most effective intervention approach. Not only do such environments invite higher rates of initiation and generalization, they also enhance the ecological validity of the intervention because the behaviors involved are more likely to translate into a better quality of life and increase social acceptance. *** National Research Council (NRC) of the National Academies (National Academy of Sciences, National Academy of Engineering, Institute of Medicine, & National Research Council 5. Many issues should be considered in order to make informed decisions about specific instructional strategies. Clinicians need to ask themselves whether the interventions under consideration: focus on core characteristics and challenges as essential outcomes; incorporate empirically supported strategies to support initiation and generalization; assess the link between behavior and communication and use of positive behavior support; use strategies that support learning style, developmental framework, and self-determination; incorporate AAC; consider peer and peer-mediated learning as a context. Each of these considerations is discussed in the Guidelines in relation to available evidencebased practice. (1) 6. Current best practices reflect an awareness that not only persons with severe disabilities, but also their environments, need to be assessed. Environmental assessments are designed to ascertain the degree to which different environments invite, accept, and respond to communication acts by persons with severe disabilities. (3) 7. The consistent use of meaningful interactive contexts is the hallmark of current intervention practices. Teaching communication in these more natural contexts appears more likely to foster the maintenance and generalization of newly learned communicative behavior to all similar contexts in the individual's natural environment. (3) When considered together, all of the assessment and intervention practices discussed above have important implications for service delivery practices. Communication intervention must involve significant people and significant contexts across multiple environments. The delivery of intervention services of this scope requires the collaboration and competence of families and of professionals and paraprofessionals from many disciplines. (3) (1) Guidelines for Speech-Language Pathologists in Diagnosis, Assessment, and Treatment of Autism Spectrum Disorders: Across the Life Span, ASHA, 2006 (2) Technical Report: Principles for Speech-Language Pathologists in Diagnosis, Assessment, and Treatment of Autism Spectrum Disorders: Across the Life Span, ASHA, 2006

5 (3) Guidelines for Meeting the Communication Needs of Persons with Severe Disabilities: National Joint Commission for the Communication Needs of Persons with Severe Disabilities, ASHA, 1992