Communication & Behavioral Intervention for Young Children: Integrating Therapies Sherry Casper, Ph.D. Behavioral & Developmental Psychologist Karyn Lewis Searcy, M.A. CCC-slp CRIMSON Center for Speech & Language San Diego, CA
Child s behavior interferes with participation in speech and language therapy Child cannot communicate needs or emotions clearly enough to participate in traditional psychotherapy Child does not engage in age-appropriate play Who Will Treat This Child?
Parent Training Groups versus Parent-Therapist Reciprocal Coaching (Searcy, 2012)
Hanen model Promotes group support network Can be less stressful to parents to initially talk rather than do Relatively static approach Therapist as expert
Project ImPact Model Parent and therapist exchange knowledge Therapist-Parent: developmental issues Parent to Therapist: issues specific to child and family structure Can be group or individual Relatively dynamic: probe, trial, and adjust in real time (parent & child together with therapist)
Typical Parent-Child Interaction Parent nurtures structures Child responds seeks out comfort Attuned Parent-Child Interaction babble to child imitate vocal play coo/gurgle imitate model Communication Interaction Searcy, 1984
Fragmented Parent-Child Interaction Parent cannot nurture cannot structure Child non-responsive rejects comforting Disrupted Relationship withdraws or over-stimulates over-indulgent or unreasonable demands Communication under or over-reactive to stimulation self-stimulating or anxious Interaction Searcy,1984
Collaboration between Researchers and Clinicians Allied Professionals Parents and Therapists Blending Therapies Behavioral and Relationship-Based Direct and Indirect Approaches
Do you have a theory of learning? Do you apply your theory of learning when working with children or families? How does your concept of how people learn or change impact your work?
An empirically-based theory of how people learn and how to improve the techniques we use to teach It is NOT an intervention It IS a systematic attempt to alter the events prior to and events after a behavior occurs to either increase or decrease the likelihood of the behavior occurring again
Discrete Trial Training Pivotal Response Training Picture Exchange Communication System Verbal Behavior
Instructor using: Pivotal Response Training
Parent Consultation: Pivotal Response Training
Examples of Relationship- Based/Developmental Therapies
Comparative Treatment Theory (Ingersoll, 2010 ) Naturalistic Behavioral Approach Naturalistic Behavioral Approaches Based on: Learning theory Basic elements: between child and adult in natural environment child initiated adult prompts and shapes target behavior Specific techniques: incidental teaching mand model milieu teaching PRT PECS Developmental Social Pragmatic Approach Developmental Social Pragmatic Approaches Based on: Blend of Piagetian developmental psychology & social-pragmatic model Basic elements: Follow child s lead & respond to unconventional communication (e.g., jargon, echolalia) pre-intentional communication (e.g., grabbing, crying, expression) Specific techniques: DIR/Floortime Denver Model Responsive Teaching Hanen SCERTS
SLPs Need Strong Foundation in Behavioral Techniques and Theory
Every behavior serves a function Keeping focusing on ABCs to identify function of a maladaptive behavior AND plan or improve instruction
Behavior Generally Serves the Following Communicative Functions
A Antecedent (Discriminative Stimulus: S D) What elicits child s behavior? Example: Hold up a bottle of bubbles B Behavior (Response) C Consequence (Reinforcement) What the child does? Action or object that maintains or shapes the behavior Example: Child says Bubbles or Does not speak or gesture Example: Blow bubbles or Help the child point to bubbles to request
Understanding Time Out, it s more complicated than you may think How to use Time OUT & Time IN Effectively in Therapy
Critical Focus of ANY Treatment
Provide them Guidelines and SHOW Them How it Works
House rules and environmental structure Objects to help with self-soothing Reinforcement systems
Don t ASK child to do something make statements Never tell child to do something you cannot help them do Push one step beyond child s desire to stop Make engagement enticing and rewarding Three tries rule: if you do not understand child s request by third attempt, distract and move on
Don t Lock Parents and Other Professionals OUT--!
Views Language as Behavior The Secret Verbiage of the Behavior Analyst Manding Tacting Reason for Jargon
One Size NOT Fit all
Special Considerations Parents with Special Needs or MH challenges Very young children Families expecting or with newborns More than one child on the spectrum Children late to enter Early Start
Effective early intervention requires close collaboration with parents and allied professionals Parents are as much of an expert on their child as you are about your profession; support them as primary educators of their children Although communication is primary concern of SLPs, all others have a focus and impact on that skill, perhaps in a different, but equally important manner the key is to establish a strong collaborative alliance Make sure everyone understands and can apply the interventions you put in place and incorporate the techniques to expand the scope of your therapy
Ingersoll B, Dvortcsak A. Teaching Social Communication to Children with Autism. The Guilford Press. 2010 Landa RJ, Holman KC, Garrett-Mayer E. Social and communication development in toddlers with early and later diagnosis of autism spectrum disorders. Arch Gen Psychiatry. 2007;64(7):853-864. Searcy, K.L., Early Intervention for Speech & Language: Empowering Parentts. Plural Publishing, Inc., San Diego, CA., 2012. Stahmer AC, et al., PRT for the Classroom (2011)