Abstract: Learning Objectives: Speaker Bio: Course Directions:

Size: px

Start display at page:

Download "Abstract: Learning Objectives: Speaker Bio: Course Directions:"

Bryan Osborne
5 years ago
Views:

1 Title of Course: Visuals for Autism: Beyond the Basic Symbols CE Credit: 2 Hours (0.2 CEUs) Learning Level: Introductory Speaker: Anna Fredman, MS, CCC-SLP Abstract: It is well-established by research that many learners on the autism spectrum benefit from the use of visuals. How can we go beyond a basic use of symbols to create and implement individualized visuals that will help our students learn and communicate more comprehensively? Participants will learn about considerations and strategies to take into account in order to put more effective visuals in place for their students on the autism spectrum. Topics covered include: broadening symbol selection, adding layers and additional components to visuals in order to make them more motivating and meaningful, providing visuals for a wide variety of expressive communicative functions, and using visuals for comprehension and organization as well as expression. Learning Objectives: 1. Summarize current research supporting the use of visuals for individuals on the autism spectrum 2. Explain the importance of using visuals for comprehension (and not only expression) 3. List the seven functions of communication that can be supported with visuals 4. Identify benefits and possible limitations of current practices such as PECS 5. Distinguish among visual schedules, visual rules, visual token boards, and visual topic boards and their uses 6. Name several strategies for facilitating generalization of visual supports throughout a child s environment Speaker Bio: Anna Fredman, M.S., CCC-SLP is a speech language pathologist at A+ Solutions in Beachwood, Ohio. She received her bachelor s degree in psychology from Brandeis University (Waltham, MA) and her master s degree in speech language pathology from the MGH Institute of Health Professions (Boston, MA), where she graduated with high honors. She previously worked at Monarch Center for Autism. She enjoys working with a wide range of school-aged students and has specialized in therapy for those on the autism spectrum, including high-functioning teenage students with a focus on social pragmatics and self-advocacy, and preschool-aged children learning basic communication and social skills. Course Directions: This online course provides instant access to the course materials (PDF download) and CE test. Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion. You can print the test (download test from My Courses tab of your account) and mark your answers on it while reading this course document. Then submit online when ready to receive credit. any questions to admin@pdresources.org we re here to help! Visuals for Autism: Beyond the Basic Symbols Page 1 of 36

2 References Duttlinger, C., Ayres, K. M., Bevill-Davis, A., & Douglas, K. H. (2013). The effects of a picture activity schedule for students with intellectual disability to complete a sequence of tasks following verbal directions. Focus on Autism and Other Developmental Disabilities, 28, DOI: / Droucker, D., Curtin, S., & Vouloumanos, A. (2013). Linking infant-directed speech and face preferences to language outcomes in infants at risk for autism spectrum disorder. Journal of Speech, Language, and Hearing Research, 56, Flippin, M., Reszka, S., & Watson, L.R. (2010). Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders: A meta-analysis. American Journal of Speech-Language Pathology, 19, Kana, R. K., Keller, T. A., Cherkassky, V. L., Minshew, N. J., & Just, M. A. (2006). Sentence comprehension in autism: Thinking in pictures with decreased functional connectivity. Brain: A Journal of Neurology, 129, Keehn, B., Shih, P., Brenner, L. A., Townsend, J., & Muller, R. A. (2013). Functional connectivity for an Island of sparing in autism spectrum disorder: An fmri study of visual search. Human Brain Mapping, 34, DOI: /hbm Kuhl, P., Coffey-Corina, S., Padden, D., & Dawson, G. (2005). Links between social and linguistic processing of speech in preschool children with autism: Behavioral and electrophysiological measures. Developmental Science, 8, Paul, R., Chawarska, K., Fowler, C., Cicchetti, D., & Volkmar, F. (2007). Listen my children and you shall hear: Auditory preferences in toddlers with autism spectrum disorders. Journal of Speech, Language, and Hearing Research, 50, Pierce, K., Conant, D., Hazin, R., Stoner, R., & Desmond, J. (2011). Preference for geometric patterns early in life as a risk factor for autism. Archives of General Psychiatry, 68, DOI: /archgenpsychiatry Samson, F., Mottron, L., Soulieres, I., & Zeffiro, T. A. (2012). Enhanced visual functioning in autism: An ALE meta-analysis. Human Brain Mapping, 33, DOI: /hbm Schlosser, R. W., Shane, H. C., Sorce, J., Koul, R., Bloomfield, E., & Hotz, L. (2011). Identifying performing and underperforming graphic symbols for verbs and prepositions in animated and static formats: a research note. Augmentative and Alternative Communication, 27, Shukla-Mehta, S., Miller, T., & Callahan, K. J. (2010). Evaluating the effectiveness of video instruction on social and communication skills training for children with autism spectrum disorders: A review of the literature. Focus on Autism and Other Developmental Disabilities, 25, Stevenson, R. A., Siemann, J. K., Schneider, B. C., Eberly, H. E., Woynaroski, T. G., Camarata, S. M., & Wallace, M. T. (2014). Multisensory temporal integration in autism spectrum disorders. The Journal of Neuroscience, 34, DOI: /jneurosci Wilson, K.P. (2013). Incorporating video modeling into a school-based intervention for students with autism spectrum Disorders. Language, Speech, and Hearing Services in Schools, 44, Visuals for Autism: Beyond the Basic Symbols Page 2 of 36

3 Visuals for Autism Beyond the Basic Symbols November 3, 2014 Anna Fredman, MS CCC-SLP Speech Language Pathologist Presenter Disclosures Financial Disclosures: Anna Fredman, MS, CCC-SLP, has no financial relationships to disclose. Autism: Beyond the Basic Symbols 1

4 Presenter Disclosures Non-Financial Disclosures: Anna Fredman, MS, CCC-SLP, is a past employee of Monarch Center for Autism at Bellefaire JCB and created many samples included in this presentation while an employee there. Philosophies endorsed by Monarch (and supported by evidencebased practice) are included in this presentation. Main Course Objective: Improve understanding of how to select, adapt, and implement more effective visuals, addressing a variety of communication functions, for learners on the autism spectrum. Autism: Beyond the Basic Symbols 2

5 Course Learning Outcomes Participants will be able to: Explain current research supporting the use of visuals for individuals on the autism spectrum Identify different types of visual representation beyond generic symbols List four considerations to use when customizing visual supports Explain the importance of visuals used for comprehension (and not only expression) Continued on next slide Course Learning Outcomes (cont d) Participants will be able to: List the seven functions of communication that can be supported with visuals Identify benefits and possible limitations of current practices such as PECS Distinguish between visual schedules, visual rules, visual token boards, and visual topic boards and explain the uses of each one Name several strategies for facilitating generalization of visual supports throughout a child s environment. Autism: Beyond the Basic Symbols 3

6 Defining Autism Autism Spectrum Disorders as defined by the DSM-5 (summarized): Persistent deficits in social communication and social interaction social-emotional reciprocity nonverbal communication relationships Restricted, repetitive patterns of behavior, interests, or activities Repetitive use of motions, objects, or speech Insistence on sameness; inflexibility with routines and rituals Abnormally restricted, fixated interests Abnormal reactivity to or interest in sensory input New DSM-5 diagnosis: Social Pragmatic Communication Disorder Research: Difficulty with spoken language Children with autism respond differently to spoken language¹ Differences as early as infancy in response to spoken language² Individuals with autism demonstrated less accurate temporal processing translates to difficulty with speech processing Toddlers with autism or at risk were more likely to focus on dynamic geometric images than dynamic social images 4 1: Paul, Chawarska, Fowler, Cicchetti & Volkmar (2007); Kuhl, Coffey-Corina, Padden, & Dawson (2005); 2: Droucker, Curtin & Vouloumanos (2013); 3: Stevenson et al. (2014); 4: Pierce, Conant, Hazin, Stoner & Desmond (2011) Autism: Beyond the Basic Symbols 4

Research: Strength in visual processing Self case-study: Temple Grandin Individuals with autism use brain areas for visual imagery (parietal and occipital) more than typical

brains likely enhanced visual skills² Strengths found in non-social visual processing in people with autism; may be connected to weaknesses in social communication³ 1.

7 Research: Strength in visual processing Self case-study: Temple Grandin Individuals with autism use brain areas for visual imagery (parietal and occipital) more than typical controls, to aid with comprehension of spoken language¹ fmri studies indicate brains of people with autism allocate more neurological resources to visual processing than typical brains likely enhanced visual skills² Strengths found in non-social visual processing in people with autism; may be connected to weaknesses in social communication³ 1. Kana, Keller, Cherkassky, Minshew & Just (2006) 2. Samson, Mottron, Soulieres,& Zeffiro (2012) 3. Keehn, Shih, Brenner, Townsend & Muller (2013) Visuals = Useful Tool Now What? Autism: Beyond the Basic Symbols 5

8 Does This Look Familiar? Getting Beyond the Basics Visuals are not one size fits all! We need to change the way we are thinking about visuals: A. What kind we use B. For what functions Autism: Beyond the Basic Symbols 6

A. What kinds of visuals are we using? All visuals are not created equal! We need to consider.

Shane) Visual Representation Level = the type of visual that a child understands to represent

9 A. What kinds of visuals are we using? All visuals are not created equal! We need to consider. 1. Visual Representation Level 2. Format (vertical, horizontal, clip board, ipad) 3. Size and colors 4. Motivational components Consideration #1: Visual Representation Levels (explained by Howard Shane) Visual Representation Level = the type of visual that a child understands to represent or stand for something - Objects - 3D Representations - Photographs - Color line drawings - Black and white line drawings Consider video models as well! Autism: Beyond the Basic Symbols 7

10 A Note About Video Modeling Dynamic visuals can be more meaningful and more easily understood by individuals with autism than static visuals¹ Video modeling (including video selfmodeling and point-of-view) can be used as teaching tool for ASD² Specific recommendations are supported by research on techniques for using video modeling in school-based therapy ³ 1. Schlosser, et al. (2011) 2. Shukla-Mehta, Miller, & Callahan (2010) 3. Wilson (2013) Consideration #2: Format Autism: Beyond the Basic Symbols 8

11 Consideration #3: Size and Colors Consideration #4: Motivational Components vs. Autism: Beyond the Basic Symbols 9

12 Customize Your Visuals!! B. What functions do our visuals address? What are we using visuals for? Are we thinking about comprehension as well as expression? Autism: Beyond the Basic Symbols 10

for speech/language tasks, but all concepts taught in school (math,

13 Visuals for Comprehension Visuals often focus on expression Comprehension needs to be the basic foundation of our therapy Not just for speech/language tasks, but all concepts taught in school (math, routines, gym, etc.) Learning Calculus in Swahili? Autism: Beyond the Basic Symbols 11

14 Teaching Concepts with Visuals Think about all areas of school day, and all levels of visual representation Examples: Teaching the concept of pointing (symbol) Teaching the routine of hand-washing (photos) Teaching gross motor skills (videos) Video modeling supported by new research Not just in the speech therapy room! A topic board that can also aid with comprehension Autism: Beyond the Basic Symbols 12

15 Visuals for Expression What functions are our visuals serving? Classrooms that use visuals usually focus on: Requesting Schedules Functions of Communication There are SEVEN! As defined by Shane & Weiss-Kapp (2007) and the Monarch Model¹ Requests Protests Directives Comments Questions Social Pragmatics Organization/Transitions 1. Compiled by Monarch Center for Autism in Cleveland, OH Autism: Beyond the Basic Symbols 13

Protests I don t like this activity! This is too hard for me. I don t want to do this.

16 Requesting I need the bathroom. Can I have the orange toy please? I want the book on the top shelf. I need help with this. Can I take a break now? Protests I don t like this activity! This is too hard for me. I don t want to do this. This is making me uncomfortable. You are too close to me. Stop making that noise! Autism: Beyond the Basic Symbols 14

It s rainy outside. This is boring. I see a squirrel on that tree!

17 Directives Give that to me, please. Come here. Look at this! Come with me. Comments This is fun! I like this game. It s rainy outside. This is boring. I see a squirrel on that tree! That girl is running fast. My doll is going to sleep. Autism: Beyond the Basic Symbols 15

Social Pragmatics It s nice to meet you! Excuse me. See you later!

18 Questions Who is that? When will this be done? What is that noise? Where did my mom go? Why do I have to do this? Social Pragmatics It s nice to meet you! Excuse me. See you later! Thanks. Are you okay? Turn-taking Higher level concepts Autism: Beyond the Basic Symbols 16

Organizations/Transitions Daily Schedule Session Schedule Rules/Expectations What are we Missing? Functions of Communication Requests Protests?? Directives?

19 Organizations/Transitions Daily Schedule Session Schedule Rules/Expectations What are we Missing? Functions of Communication Requests Protests?? Directives?? Comments?? Questions?? Social Pragmatics?? Organization/Transitions Addressed in Most Autism Classrooms Requesting Schedules Autism: Beyond the Basic Symbols 17

20 Visuals for Expression Requesting and Protesting Visual Choice Boards Picture Exchange Communication System (PECS) Benefits and limitations of PECS in the research¹ 1. Flippin, Reszka, & Watson (2010) Expression: Beyond Requesting. Think about the other functions of communication Use Topic Boards! Commenting Asking questions Conversation Exchange Autism: Beyond the Basic Symbols 18

21 Example: Commenting (Objective) Example: Commenting (Subjective) Autism: Beyond the Basic Symbols 19

22 Example: Asking Questions Example: Conversation Flow Autism: Beyond the Basic Symbols 20

23 Example: Conversation Example: Conversation Autism: Beyond the Basic Symbols 21

Visuals for Social Pragmatics Basic Level:

24 Visuals for Social Pragmatics Basic Level: Greeting My turn/wait Mid-Level: Ask me a question! Advanced: Improving Conversation Skills Conversation Repair Identifying Friends Problem solving Self-advocacy Example: Social Pragmatics Autism: Beyond the Basic Symbols 22

25 Example: Social Pragmatics Example: Social Pragmatics Autism: Beyond the Basic Symbols 23

Visuals for Organization/Transitions Visual Schedules Visual Rules/Expectations Token Boards Visual Schedules Give information such as: Activities of the day or session

26 Visuals for Organization/Transitions Visual Schedules Visual Rules/Expectations Token Boards Visual Schedules Give information such as: Activities of the day or session Sequence of events Changes from the regular routine Alerts for transitions (when is it time to stop one activity and move to the next) Autism: Beyond the Basic Symbols 24

For Example A visual schedule can look like any of these!

and help child anticipate what is next Increase cooperation Promote independence

activities Provide structure to notify and prepare students for change in regular

27 For Example A visual schedule can look like any of these! Benefits of Visual Schedules Reduce anxiety Improve comprehension of expectations and help child anticipate what is next Increase cooperation Promote independence Reduce need for repetitive verbal prompting Support transitions between activities Provide structure to notify and prepare students for change in regular routine Research Support¹ 1. Duttlinger, Ayres, Bevill-Davis & Douglas (2013) Autism: Beyond the Basic Symbols 25

28 Example: Visual Schedules for Changes in Routine Macro schedule for going to the doctor Micro schedule for getting a shot Adding layers to a visual schedule Autism: Beyond the Basic Symbols 26

Example: Schedule with Time/Duration Information Leisure Time Schedule Visual Rules/Expectations Think about what kind of symbols to use: BoardMaker/other

29 Example: Schedule with Time/Duration Information Leisure Time Schedule Visual Rules/Expectations Think about what kind of symbols to use: BoardMaker/other symbols Photographs Photos of student himself Increases comprehension Reduces need for verbal prompting Can pair with token board Autism: Beyond the Basic Symbols 27

30 Visual Rules/Expectations Example: Julia s quiet mouth visual Example: Ray s visual rules (Psyeudonyms used) Visual Token Boards Improve comprehension of rules Increase compliance Provide motivation Promote independence Autism: Beyond the Basic Symbols 28

31 Visual Token Boards May include visual rules or time/duration information First-Then Format Token Format Combination: Visual Schedule + Token Board Autism: Beyond the Basic Symbols 29

32 Summary Functions of Communication Requests Protests Directives Comments Questions Social Pragmatics Organization/Transitions Examples of Visual Supports PECS, choice boards, etc. Photos or icons symbolizing no Visuals to teach pointing, etc. Objective and Subjective commenting topic boards Topic Boards (for comprehension and expression) Low, Middle, & High level supports Schedules, Rules, Token Boards Visuals evolve with student progress Autism: Beyond the Basic Symbols 30

33 Bringing it Home: Generalization Consistency Individualization In a classroom: key rings, velcro boards around room, electronic devices In other settings: gym, art, other teachers At home: getting parents on board Example: Generalization in Art Class Autism: Beyond the Basic Symbols 31

34 Conclusions Visuals should be customized and individualized Visuals should be used for comprehension as well as expression! Visuals should be provided and taught for many functions of communication Generalization and immersion are key! Visuals change with the student Suggested Reading Visual Language in Autism by Howard Shane & Sharon Weiss-Kapp (2007) Visual Strategies for Improving Communication by Linda Hodgdon (Revised Edition: 2011) Thinking in Pictures: My Life with Autism by Temple Grandin (Expanded Edition: 2006) Autism: Beyond the Basic Symbols 32

35 References Duttlinger, C., Ayres, K. M., Bevill-Davis, A., Douglas, K. H. (2013). The effects of a picture activity schedule for students with intellectual disability to complete a sequence of tasks following verbal directions. Focus on Autism and Other Developmental Disabilities, 28, DOI: / Droucker, D., Curtin, S., & Vouloumanos, A. (2013). Linking infant-directed speech and face preferences to language outcomes in infants at risk for autism spectrum disorder. Journal of Speech, Language, and Hearing Research, 56, Flippin, M., Reszka, S., & Watson, L.R. (2010). Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders: A meta-analysis. American Journal of Speech-Language Pathology, 19, Kana, R. K., Keller, T. A., Cherkassky, V. L., Minshew, N. J., & Just, M. A. (2006). Sentence comprehension in autism: Thinking in pictures with decreased functional connectivity. Brain: A Journal of Neurology, 129, References Keehn, B., Shih, P., Brenner, L. A., Townsend, J., & Muller, R. A. (2013). Functional connectivity for an Island of sparing in autism spectrum disorder: An fmri study of visual search. Human Brain Mapping, 34, DOI: /hbm Kuhl, P., Coffey-Corina, S., Padden, D., & Dawson, G. (2005). Links between social and linguistic processing of speech in preschool children with autism: Behavioral and electrophysiological measures. Developmental Science, 8, Paul, R., Chawarska, K., Fowler, C., Cicchetti, D., & Volkmar, F. (2007). Listen my children and you shall hear: Auditory preferences in toddlers with autism spectrum disorders. Journal of Speech, Language, and Hearing Research, 50, Pierce, K., Conant, D., Hazin, R., Stoner, R., Desmond, J. (2011). Preference for geometric patterns early in life as a risk factor for autism. Archives of General Psychiatry, 68, DOI: /archgenpsychiatry Autism: Beyond the Basic Symbols 33

36 References Samson, F., Mottron, L., Soulieres, I., & Zeffiro, T. A. (2012). Enhanced visual functioning in autism: An ALE meta-analysis. Human Brain Mapping, 33, DOI: /hbm Schlosser, R. W., Shane, H. C., Sorce, J., Koul, R., Bloomfield, E., & Hotz, L. (2011). Identifying performing and underperforming graphic symbols for verbs and prepositions in animated and static formats: a research note. Augmentative and Alternative Communication, 27, Shukla-Mehta, S., Miller, T., & Callahan, K. J. (2010). Evaluating the effectiveness of video instruction on social and communication skills training for children with autism spectrum disorders: A review of the literature. Focus on Autism and Other Developmental Disabilities, 25, Stevenson, R. A., Siemann, J. K., Schneider, B. C., Eberly, H. E., Woynaroski, T. G., Camarata, S. M., & Wallace, M. T. (2014). Multisensory temporal integration in autism spectrum disorders. The Journal of Neuroscience, 34, DOI: /jneurosci Wilson, K.P. (2013). Incorporating video modeling into a school-based intervention for students with autism spectrum disorders. Language, Speech, and Hearing Services in Schools,44, Autism: Beyond the Basic Symbols 34

Instructional Practices for Students with Autism A.. Kimberly Howard M.Ed.

Instructional Practices for Students with Autism A. Kimberly Howard M.Ed. The mission of the Kentucky Autism Training Center is to strengthen our state's systems of support for persons affected by autism