Communication deficits often mimic behavioral problems

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Communication deficits often mimic behavioral
problems
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Problem behaviorBehavior problem
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Must look at the function of the behavior and
teach a more conventional means (replacement
behaviors)
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Cognition.the mind of the person with ASDs

• Information processing
• salience
• duration
• Stable, not transient/fleeting
• Visual, not auditory
• Spatial, not temporal
• Concrete, not abstract
• Gestalt, not analytical processors

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Salience for the person with the ASD Stimulus
Overselectivity

• child attends too narrowly to stimuli
• impedes generalization
• children respond only to an overly restricted
  range of environmental stimuli

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Stimulus Overselectivity

• child attends too narrowly to stimuli
• impedes generalization
• salience
• children respond only to an overly restricted
  range of environmental stimuli

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Information processing duration

• May process information more slowly than non
  spectrum persons
• May process some kinds of information better than
  others

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Poor generalization and they process information
spatially, not sequentially
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Cognition

• Attention
• shifting, sustaining
• memory
• compromised working memory
• adequate short-term memory
• good rote memory
• difficulty encoding/remembering complex
  information
• difficulty with sequential/abstract information

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Cognition

• attention
• memory
• executive functions, problem solving, reasoning

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Cognition Attention

• difficulty with selective attention
• difficulty with shifting attention
• deficits more frequent if MR is present

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Cognition Memory

• compromised working memory
• adequate short-term memory
• good rote memory
• difficulty encoding/remembering complex
  information
• difficulty with sequential/abstract information

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Cognition Executive functions, problem solving,
reasoning

• these require working memory, planning/organizatio
  n, flexibility and inhibition, ALL TOUGH FOR
  SOMEONE WITH AUTISM
• difficulty alternating or shifting cues
• adapting to changes
• formulating plans/strategies

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There is no generalized concept of nouns

• for cats Grandin needs to access her series of
  videos of cats
• she needs to replay the video to comprehend the
  concept

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You must

• Understand both the disability and the person who
  manifests it!

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Fragile - Handle with Care

• Even though there are many things about me that
  are unique, in the ways that really matter I am
  just like other children. I learn best from
  people I trust, and I learn to trust when I sense
  that people like me. Please try to see the world
  through my eyes, for I cant see it through
  yours. And please know that even though it may
  not seem so, I really am trying to adapt to a
  world that my neurological challenges prevent me
  from understanding without your help.
• If you keep these things clearly in mind, you
  will be less apt to label me a behavior problem
  and more likely to teach me the things I need to
  know so that I can function with greater
  understanding and competence in a world that is
  often inhospitable to my needs. -Twachtman-Cullen

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When teaching/coaching we typically

• tell someone what to do, or
• show them, model it,
• reward spontaneous occurrences
• provide social reinforcements

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Disability Awareness / Sensitivity Training

• Goal - to improve student understanding and
  support of classmates with ASDs
• e.g., Carol Grays Sixth Sense

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Curriculum ideas

• to use the A word or not
• discuss how children are different (hair color,
  prosthetics, academic/motor prowess, ability to
  make friends, how to play
• discuss how children are same (smile, cry)

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Then, you need to determine the following

• How you are going to teach the child with the ASD
• What you are going to teach the child with the ASD

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How you teach

• maximize their strengths
• use VISUALS, STABLE CUES TOO!
• (even after they understand verbal language)
• be CONCRETE
• provide opportunities for communication
• (temptations/sabotage)
• use routines, predictability
• (structured teaching is a must)

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What do people with ASDs do that shows us they
are visual?

• Puzzles
• maps/routes
• artistic
• letters/numbers

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What do teachers and caregivers often say about
people with ASDs?

• He is really inconsistent.
• She just does what she wants.
• He manipulates everyone.
• She doesnt pay attention.
• He tunes out all the time.
• He is so rigid that he follows the routine, even
  when things change.
• She cant handle change.
• He really has behavior problems when we do
  something new.

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Similarly, teachers and caregivers may describe

• He understands everything I say but he is just
  being bad.
• He knows exactly what I want.
• He understands me. He is just being stubborn.
  Hell do it when he wants to.

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My response to what people said to me would
often be delayed as my mind had to take time to
sort out what they had said. The more stress I
was under, the worse it became.Donna
WilliamsNobody Nowhere
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Why are visuals better for persons with ASDs?

• Difficulty shifting/reestablishing attention
• Sensory differences (unable to block out
  competing noises)
• Processing delays

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But do we need to use visuals for all persons
with ASDs? My student speaks.

• Yes, and yes, again and again!

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The use of visual tools is not determined by a
persons ability to talk or use language
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What about Sign Language

• Pros
• availability
• visual
• Cons
• typically, small audience
• visual but fleeting, transient cue
• limited motor ability of some

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But this is an equal opportunity strategy

• Strategies that work for children with Autism
  Spectrum Disorders work for many other students

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Pay attention to students who are described like
this

• He is just manipulative
• He acts like hes deaf
• Shes inconsistent
• He is very distractible
• She is off in another world
• She doesnt pay attention
• She doesnt like to listen

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Schedules

• What is happening on a normal day
• What is happening that is new or different
• What is the sequence of events
• what is changing

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Left to right sequence to parallel the way the
world works is preferableColor isnt always
good!
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Transitions

• are tough
• provide as much predictability as possible
• forewarning, provided visually

Why are transitions tough? Think back to
DIFFICULTIES SHIFTING ATTENTION
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WARNING, WARNING...

• Do not put times on your kid schedules unless
  you are sure you can ALWAYS meet these timelines
  PERFECTLY
• Rememberthese kids are rigid!

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But my students know their schedules. Do I
still need to use it?

• YES

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Calendars

• Give information about routine events
• Give information about new experiences
• What is changing or different
• A good communication tool about past present and
  future

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Make abstract concepts CONCRETE
Passage of time. Smaller scale

• Passage of time is difficult to explain
• use schedules
• use calendars
• use timers, hour glass
• use individualized pictures
• Zaboos

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Creating visual tools

• Do
• use what the student understands quickly and
  easily
• use a variety of resources
• observe how students respond to what you create
• create tools that are universally understood

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Creating visual tools

• Do not
• make tools that are too complicated or too
  difficult for students to understand
• create arbitrary rules about how visual tools
  must look

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What are the long-term effects of using visual
strategies?

• Do you gradually try to eliminate the use of
  visual tools?

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I want my child to talk!!!

• Visual tools do not prevent students from talking
• Visual tools improve communication
• Visual tools reduce frustration
• Visual tools reduce behavior situations

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Strategies to use and NOT use

• concrete
• stable
• spatial
• visual
• gestalt

• abstract
• transient
• temporal
• verbal reasoning
• analytical

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What you teach

• emphasize the functional use of language and
  communication across settings
• NOT just vocabulary or grammar, NOT just verbal
  behaviors, or articulation!
• communication for a variety of functions
• requesting, rejecting, commenting
• emphasize social interaction, playing with toys
• attack the social cognitive deficits
• goals identified by the family (e.g., toileting)

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Communication intervention needs to

• increase their communicative intent
• help to use interpretable NOT idiosyncratic means
• communicate what is important for the child
• observe the child to determine what is important
  to him to communicate about
• build a vocabulary list starting with what the
  child knows and build on that

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Communication intervention needs to

• first words should express a variety of concepts
• e.g., more, help, want, eat, stop, dont like,
  break
• communicate wants, needs, thoughts, feelings
• communicate across a variety of settings, persons
  and tasks
• be as independent as possible
• encourage and support self-initiated
• spontaneous communication

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Communication strategy should

• incorporate visual cues into the communication
  system
• establish and utilize routines
• build in generalization

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Communication

• precedes language, yes, even for those with ASDs
• do not try to reverse the process use your
  words
• map language onto the nonverbal request

X
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Avoid

• use your words
• full-sentence press (Twachtman-Cullen)

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Request repertoire

• cookie
• want cookie
• I want cookie
• I want cookie please

Only one function!!!
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Various functions

• Request puzzle
• Refusal no
• Comment points to things

Increases social/communicative competence,
decreases likelihood of challenging behaviors
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Strategies for the Nonverbal Child

• highly structured environment -utilize routines
• routines are a powerful means of promoting
  communication
• can violate or sabotage routines

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Augmentative Alternative Communication

• low tech is preferable to high tech
• object or picture swap
• (e.g., PECS- Frost Bondy, 1994 )
• sign language
• print, written words

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PECS - Picture Exchange Communication System

• identify what the person wants (item or activity)
• child spontaneously exchanges picture for reward
  (with prompting)
• discrimination between pictures of items
• child spontaneously exchanges specific picture
  for reward

Juice
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Utilize a giving gesture

• Pointing and showing are difficult
• Manipulating the communication card is more
  successful than simple pointing or showing

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Preschoolers taught with PECSBondy Frost, 1994

• Of 19 children who used PECS for lt1 year
• only 10 (2) acquired independent speech
• 5 used speech with PECS
• 12 used PECS as their sole communication
• of 66 children using PECS for 2 years
• 39 (59) developed independent speech
• 20 developed speech as they used PECS
• 7 used PECS only

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Most preschoolers introduced to PECS took more
than one year to demonstrate independent speech
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Speech tended to develop after the children had a
lexicon of 30-100 symbols(Frost Bondy, 1994)
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Speech tended to develop after the children had a
lexicon of 30-100 symbols(Frost Bondy, 1994)

• The overall communication development of children
  was strongly related to their overall level of
  intellectual functioning

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Effectiveness of communication and language
intervention programs needs to be documented
relative to the core deficits of joint attention
and symbolic capacity and relative to the target
goal of communicative competence in natural
language learning environments, with the emphasis
on acquisition of functional skills that support
successful communicative interactions.
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Efficacy of communication intervention

• Should be determined by meaningful outcome
  measures in social communicative parameters, not
  just the acquisition of verbal behaviors

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Communication system

• Available and integrated into home/ school/
  community
• Manipulation, not just pointing

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Echolalia

• should be encouraged initially as legitimate
  communicative acts
• should be replaced eventually by generative
  utterances for a variety of purposes in a variety
  of contexts
• simplify input, echoing increases with increased
  cognitive demand
• reduce directive style (wh questions, yes/no
  questions increase echoing)

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Echolalia, continued

• use facilitative style, use positive responses
• model conventional responses
• match the childs level of linguistic complexity
• (Im thirsty rather than are you thirsty?)
• disregard echoed utterances when calculating MLU
• modify the environment
• confusion contributes to echoing
• help anticipate transitions, use visual cues,
  pictorial calendars, daily schedules

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Avoid long strings of verbal instructions

• gt3 steps are tough (Grandin)
• written directions are preferable, for those who
  read

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Communicative Interventions

• converting behavior to conventional communication

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Strategies for comprehension/organization for
more able individual (Twachtman, 1996)

• story comprehension, report writing
• Storyline Organizational Support-SOS
• title, author, location, overview, characters,
  storyline, synthesis

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Capitalizing on literacy skills

• use visual schedules and sequences eliminate
  picture cues if child recognizes print
• use print to cue verbal responses
• use print to cue social responses
• create a whole language environment
• pair printed and verbal directions fade verbal
  and encourage following of printed directions

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In designing interventions, keep in mind

• unusual perception
• preference for inanimate/physical properties
• spatial arrangements work best
• cues that are concrete/nontransient
• lack of people knowledge
• poor perspective-taking ability

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All interventions need to

• reduce confusion, generate predictability
• establish an effective means of communication
• use visual-spatial modes of presentation
• adopt modes of instruction that are not dependent
  on spoken language, but that capitalize on
  strengths
• be built around the child interests, even
  fascinations
• have adults who can give up control to the child

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Strategies to use and NOT use

• concrete
• stable
• spatial
• visual
• gestalt

• abstract
• transient
• temporal
• verbal reasoning
• analytical

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10 Credos for people supporting persons with ASDs

• know the disability and the student
• take their perspective and understand that they
  have difficulty taking yours
• look at the functions of behaviors
• dont be blinded by their strengths, nor hold
  them to standards beyond their abilities
• provide support appropriate to students level
• fade prompts and promote independence
• seek information to help them and provide
  supports
• leave your egos elsewhere!
• Perform your duties mindfully, responsibly and
  respectfully
• Parents know their child better than anyone
  listen to them!