Schedule 1.! What is Autism and How is it treated? Intervention and Outcomes, New views on Research and Possibilities 2.! How do typical children develop Referencing, Regulation, Play and Peer Relationships? What are the R&R Stages for children with ASD? 3.!!Break Introductory Workshop David Loyst, M.Sc., SLP Autism Consultant 4.! What is R&R Intervention? - Case Studies, before and after treatment videos 5.! How is it working? - Initial R&R Research results 6.!!Questions National Autistic Society Study - UK (Barnard, et. al, 2001). Only 3% of adults at the higher end of the spectrum were living independently Only 12% of higher functioning adults were in full time paid employment 65% had difficulty making friends and 31% were involved in no social activities at all Effects on Families were devastating - social lives were destroyed, including holidays, marriages torn apart... Case Study - William - high school student Research What is Autism? Core Deficits in Behaviour Referencing persons with ASD do not constantly monitor their own and other s behaviour and continue or alter their behaviour according to its effect joint attention/social referencing (Baron-Cohen, 1987, 1989, 1993, 1996, 1997; Dawson, 1998, 2000, 2002, 2004; Charman, 1997, 1998, 2000, 2003; Kasari, 1990, 2001, 2006, Mundy 1990, 1995, 1997, 2002, 2003;Whalen, 2003)
Referencing a Foundation for Learning Referencing facilitates Communication joint attention...provides the foundation for all subsequent communication and cultural learning... (p.2, Carpenter, et. al., 1998) Paul Bloom (2000) How Children Learn the Meanings of Words Here is how they do it: Young children can parse adult speech (or sign) into distinct words... They know enough about the minds of others to figure out what they are intending to refer to when they use words... Paul Bloom (2000) How Children Learn the Meanings of Words These capacities improve in the course of development. Children become better at parsing utterances into words... and at figuring out what other people are thinking about when they speak... Sabbagh & Baldwin (2001) noted that 3-4 year olds showed better word learning when the speaker appeared knowledgeable rather than ignorant of the word s referent Joint attention - correct word mapping Dare Baldwin (1991) When a child was staring at a novel object, a speaker said "Toma! There s a toma!". It was expected that the child would associate the word with the object she was looking at. The child only made the association if the speaker was looking at that object. If the speaker was gazing at another object, the child would follow the speakers gaze and assume that this different object was the referent of the word. Simon Baron-Cohen (1997) replicated this study and noted that children with Autism made significantly more mapping errors than language and mental aged matched typical children and children with mental handicap
Referencing facilitates Communication Children with ASD!joint attention ability was positively associated with language gains and social and communication symptoms...triadic gaze switching predicted language and symptom severity" #Charman, 2003$ Mundy et al. #1990$ found that joint attention behaviours #alternating gaze, pointing, showing and gaze following$ measured at 45 months were associated with language ability 12 months later. Kasari et al (2008) Language Outcomes after Joint Attention intervention Randomized controlled trial aimed at improving joint attention (JA) and symbolic play (SP) in preschool children with autism. Participants were 58 children (46 boys) with autism between 3 and 4 years of age who were attending ABA program, 30 hours per week. Children were randomized to a JA intervention, a SP intervention, or control group. Interventions were conducted 30 min daily for 5 6 weeks. Results indicate that expressive language gains were greater for both treatment groups 12 months after the intervention compared with the control group Case Study - Dustin - discrete trial vocabulary training Joint Attention predicts Play Children with ASD Rutherford et al (2007) found joint attention was the only factor which successfully predicted the development of children's play. Other factors such as developmental level, executive function, and imitation skills had no predictive value JA reflects a child s ability to coordinate mind and attention with that of a social partner, and allows the child to take in information from other people Case Study - Jason mediated play, scripts Referencing a Foundation for Regulation children who, at 6 months of age, were better able to follow the direction of their mother s gaze, demonstrated more independent active play or self-directed emotion regulation behaviour, and less comfort-seeking behaviour at 2 years of age when frustrated ( Morales et al., 2005)
Development of Referencing if referencing is a core deficit in ASD, how do you develop these skills? if the basis of remedial programming is to reintroduce developmental levels missed, then how is referencing developed in typical children? Overview Social referencing and joint attention skills acquired by typical children in their first 2 years Discuss how this translates to the acquisition of new skills in learning, regulating and relating to others R&R Stage 1 R&R Stage 2 Neonates: Quickly prefer faces over other visual stimuli 2 months: Engage in exchanges of facial expressions - Scan eye region of faces preferentially 4 months: Discriminate gaze direction 0 1 2 3 6-9 Months: Point Following mastered 6-10 month olds prefer those who help over a hindering individual 9-12 Months: Point and gaze following skills mastered - joint engagement with adult and object emerges - begin to show objects - alternate gaze between object and parent instead of pulling to request Point Following Gaze Following Own Objects 0 5 10 15
12 months: - begin to imitate novel actions - take other s perspective (unwilling/ unable) 18 months: Take other s perspective (know what is novel to adult - imitate intentional actions more than accidental, imitate goal oriented action even when model fails) Point Following Gaze Following Own Objects Recognize Respond Adapt R&R Stage 3 0 5 10 15 Development of Regulation in 3 months: Can match happy or sad affect on mother s face with appropriate voice (can match unfamiliar women before can match their father). 12 months: Visual cliff experiment - babies asked to crawl across a glass table and reference their mother to decide whether to cross the perceived cliff - if mother has a happy affect, 90% crossed - if mother has an anxious or worried affect 100% turned back (Sorce, 1985) Play and Language Development in Typical Children Peer Relationships & Play in Typical Children 6 month-14 months - cause and effect play 14 months: Symbolic Play emerges (corresponds with other s perspective 24 months: Sequential pretend play - cooperative play with mediation of adult - sharing is extremely difficult 36 months: narrative quality in play - motives, feelings of characters 2 years - no collaboration, need adult support and supervision 3 years - cooperative play without mediation - attempt to negotiate sharing (temperament influences outcome) - play takes on a narrative quality with motives and feelings of characters R&R Stage 5 - Social Dyads - Playdates R&R Stage 6 - Multiple Play Partners - Mainstreaming