AAC with ABA for ASD: Easy as 1, 2, 3

Transcription

1 AAC with ABA for ASD: Easy as 1, 2, 3 Christina Martin, M.S., CCC-SLP, BCBA Lauren Rich, M.Ed., SLP-Assistant, BCBA Therapy and Beyond Handouts Updated handouts are available on our website at: /presentations

2 Disclosures Christina Martin, M.S., CCC-SLP, BCBA Relevant Financial Disclosures Receives salary for employment at Therapy and Beyond. This organization provides ABA and speech therapy to individuals with autism and other developmental disabilities. Relevant Non-Financial Disclosures Is dually credentialed as a Speech Language Pathologist and a Board Certified Behavior Analyst. Disclosures Lauren Rich, M.Ed., BCBA, SLP-Assistant Relevant Financial Disclosures Receives salary for employment at Therapy and Beyond. This organization provides ABA and speech therapy to individuals with autism and other developmental disabilities. Relevant Non-Financial Disclosures Is dually credentialed as an Speech Language Pathology Assistant and a Board Certified Behavior Analyst

3 Learning Objectives Describe the need for AAC and identify different AAC options Describe a method for determining which AAC to use Explain the potential benefits of AAC on the development of natural speech with individuals with ASD Recognize the myths about AAC and distinguish scientific from pseudoscientific treatment claims What is Autism? Autism, or autism spectrum disorder (ASD), refers to a range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication, as well as by unique strengths and differences. We now know that there is not one autism but many types, caused by different combinations of genetic and environmental influences. Autism Speaks. (2017). What is Autism? Retrieved from:

4 What is Autism? About 1 in 68 children has been identified with autism spectrum disorder (ASD). ASD is reported to occur in all racial, ethnic, and socioeconomic groups. ASD is about 4.5 times more common among boys (1 in 42) than among girls (1 in 189). About 1 in 6 children in the United States had a developmental disability in , ranging from mild disabilities such as speech and language impairments to serious developmental disabilities, such as intellectual disabilities, cerebral palsy, and autism. Centers for Disease Control. (2017). Autism Spectrum Disorder: Data and Statistics. Retrieved from: Need for AAC Approximately 33%-50% of individuals with autism present with little or no functional speech. These individuals may be candidates for AAC to replace or supplement natural speech. National Research Council. (2001). Educating children with autism. Washington, DC: National Academy Press

5 What is AAC? Augmentative and Alternative Communication includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. American Speech-Language-Hearing Association. (2002). Augmentative and alternative communication: knowledge and skills for service delivery [Knowledge and Skills]. Available from Augmentative vs. Alternative Supplement to current communication Replacement of current communication American Speech-Language-Hearing Association. (2004). Roles and responsibilities of speechlanguage pathologists with respect to augmentative and alternative communication: Technical report [Technical Report]. Available from

6 Key Terms Act of giving or receiving information in any form System of conveying thought with shared rules Communication by vocal production American Speech-Language-Hearing Association. (2004). Roles and responsibilities of speechlanguage pathologists with respect to augmentative and alternative communication: Technical report [Technical Report]. Available from AAC Forms Sign Language Communication Boards PECS And many, many more Speech Generating Devices Electronic Communication Systems

7 No Tech Example Low Tech Example

8 High Tech Examples AAC Selection

9 AAC Selection The best method supports the development of spontaneous, meaningful communication that generalizes to all environments. There is no such thing as one size fits all. AAC Selection Feature Matching an individual s available or potentially available augmentative and alternative communication Caron, J. (2013) Feature Match Table. Retrieved from

10 AAC Selection Feature Matching Table Caron, J. (2013) Feature Match Table. Retrieved from AAC Selection The Essential for Living (EFL) is: A communication, behavior, and functional skills curriculum, assessment, and skill-tracking instrument for children and adults with moderate-to-severe disabilities. Assesses and teaches functional skills as opposed to developmental skills Developed by Patrick McGreevy, Ph.D., BCBA-D, Troy A. Fry, M.S., BCBA, and Colleen Cornwall, Ed.D., BCBA. McGreevy, P., Fry, T. & Cornwall, C. (2014). Essential for living: A communication, behavior and functional skills curriculum, assessment and professional practitioner s handbook. Orlando, FL: Patrick McGreevy, Ph.D., P.A

11 AAC Selection Chapter 6 in the big grey book (Practitioner s Handbook) Co-authored by Janine Shapiro, M.S., CCC-SLP, BCBA Methods of Speaking is used similarly to AAC Defined as a way to communicate in a form other than Saying Words AAC Selection Identified 6 vocal profiles based on the extent of an individual s spoken-word repertoire Use vocal profiles to determine: Whether to select saying words (i.e. natural speech) as a primary method of speaking or to select an alternative method (i.e. AAC) Realistic goals A plan of action to meet those goals A recommended allocation of resources relative to the method of speaking

12 AAC Selection Identified 46 alternative methods of speaking Broken up into a list containing specific and nonspecific response forms Topography-based response forms (i.e. sign language, writing words, etc.) Selection-based response forms (i.e. picture exchange, SGDs, etc.) Non-specific response forms (i.e. reaching, pointing, gesturing, etc.) AAC Selection Selection is based on one or more of the following: The physical skills of the individual The size of the audience for specific methods The ease with which specific methods can be implemented by instructors and caregivers The potential of specific methods for advanced language

13 AAC Selection Selection is based on one or more of the following: Extent to which the individual s current sensory, skill, and behavioral repertoires correspond with those repertoires which tend to occur when specific methods under consideration are effective Extent to which methods under consideration retain advantages of saying words with respect to functioning as a speaker and being understood by an audience AAC Selection Compares an individual s sensory, skill, and behavioral repertoires with those repertoires that often occur when each of 46 alternative methods of speaking are effective An individual is matched with several methods of speaking that are often effective with learners with similar repertoires Methods which retain more of the 11 advantages of spoken words emerge as candidates Quickly determines candidates for an alternative method of speaking for a specific learner

14 Pseudoscientific Claims Pseudoscience refers to claims that appear to be based on the scientific method but are not. 1. Untested 2. Unchanged 3. Confirming evidence 4. Anecdotal evidence 5. Inadequate evidence 6. Avoiding peer review 7. Disconnected 8. New terms 9. Grandiose outcomes Russell s Orbiting Teapot 10. Holistic Finn, P., Bothe, A.K., & Bramlett, R.E. (2005). Science and Pseudoscience in Communication Disorders. American Journal of Speech-Language Pathology, 14, Scientific Claims Applied Behavior Analysis as an Evidence-Based Practice ASD is a medical/ neurodevelopmental condition with behavioral symptoms that are directly addressed by applied behavior analysis methods. ABA has proven effective in addressing the core symptoms of autism as well as developing skills and improving and enhancing functioning in numerous areas that affect the health and well-being of people with ASD. The effectiveness of ABA-based interventions in ASDs has been well documented through a long history of research in university and community settings. Children who receive early intensive behavioral treatment have been shown to make substantial gains in cognition, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups. ABA has both long-term empirical and research data to demonstrate its effectiveness in helping children who are diagnosed with ASD, and AAP has endorsed the use of ABA treatments when determined appropriate by physicians within a medical home, in close consultation with families. American Academy of Pediatrics. (2012) Statement on the Use of ABA to Treat Individuals with ASDs. Retrieved from

15 Applied Behavior Analysis The in which procedures derived from the are systematically applied to improve behavior to a meaningful degree and to demonstrate experimentally that the procedures employed were responsible for the improvement in behavior." (p. 14) Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied Behavior Analysis, 2nd ed. Upper Saddle River, N.J.: Pearson Prentice Hall. Applied Behavior Analysis Some individuals may rely on socially inappropriate, or maladaptive behaviors (i.e. hitting) to communicate their needs to others. In these cases, can serve as an method of communication through. Danov, S.E., Hartmann, E., McComas, J.J., & Symons, F.J. (2010). Evaluation of two communicative response modalities for a child with autism and self-injury. The Journal of Speech and Language Pathology- Applied Behavior Analysis, 5(1), Wacker D. P, Berg W. K, Harding J. W, Derby K. M, Asmus J. M, & Healy A. (1998). Evaluation and long-term treatment of aberrant behavior displayed by young children with disabilities. Developmental and Behavioral Pediatrics, 19,

16 Functional Communication Training A differential reinforcement procedure in which an individual is taught an that results in the same class of reinforcement identified as maintaining problem behavior For example, instead of screaming for an orange, an individual is taught to exchange a picture to gain access. Carr, E.G. & Durand, V. (1985). Reducing behavior problems through functional communication training. Journal of Applied Behavior Analysis, 18, Functional Communication Training

17 AAC is speech intervention strategy. AAC is a last resort speech intervention strategy. AAC interventions on the failure to develop speech skills or considered a last resort because AAC can play many roles in early communication development. AAC devices and strategies are a tool, a means to an end language and communication skills. Romski, M. & Sevcik, R. (2005). Augmentative communication and early intervention: Myths and realities. Infants and Young Children, 18(3),

18 AAC is speech intervention strategy. There are skills needed for AAC

19 individuals are considered potential candidates for AAC. There is a policy with respect to determining individuals' eligibility for AAC services. There is arbitrary list of (i.e. match pictures, level of cognitive ability, etc.) There are pre-requisite skills needed for AAC. "... breathing is the only prerequisite that is relevant to communication. Breathing equals life, and life equals communication. It is that simple." American Speech-Language-Hearing Association. (2004). Roles and responsibilities of speechlanguage pathologists with respect to augmentative and alternative communication: Technical report [Technical Report]. Available from Kangas, K. & Lloyd, L. (1988). Early cognitive skills as prerequisites to augmentative and alternative communication use: What are we waiting for? Augmentative and Alternative Communication, 4(4), Mirenda, P. (1993). Bonding the uncertain mosaic. Augmentative and Alternative Communication, 9(1), 3-9. There are skills needed for AAC

20 Only from AAC. benefit Only certain ages benefit from AAC. The comprehensive study of AAC intervention by Millar, D., et. al, (2006) indicated that the positive effects of AAC intervention on speech production were observed across children and adults, ranging in age from. It is too early or too late to start teaching AAC. Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research, 49,

21 Only from AAC. benefit AAC will speech and language development

22 AAC will inhibit or impede speech and language development. There have been NO published studies that show decreased speech production as a result of AAC. Two articles reviewed all of the previouslypublished research that had investigated speech production before, during, and after AAC intervention. NONE of the individuals involved in any of the studies demonstrated decreases in speech production as a result of AAC intervention. The majority demonstrated at least modest gains in speech. Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research, 49, Schlosser, R., & Wendt, O. (2008). Effects of augmentative and alternative communication intervention on speech production in children with autism: A systematic review. American Journal of Speech-Language Pathology, 17(3), According to the study by Millar, D., et. al, (2006) investigating speech production before, during, and after AAC intervention, participants with: Decreases in speech production= 0% No change in speech production= 11% Increase in speech production= Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research, 49,

23 According to Mirenda (2003), if AAC (e.g., the manual sign or graphic symbol for cookie) is presented along with the spoken word (as is typically the case in AAC intervention), and these are followed by a reinforcer (e.g., a chocolate chip cookie), Mirenda, P. (2003). Toward functional augmentative and alternative communication for students with autism: Manual signs, graphic symbols, and voice output communication aids. Language, Speech, and Hearing Services in Schools AAC will speech and language development

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