Intervention for ASDs Using an Individuals Representational Capacity: Working Within the Zone of Pro

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Intervention for ASDs Using an Individuals
Representational Capacity Working Within the
Zone of Proximal Development

• Stacy Oller, M.S., CCC-SLP
• Driscoll Childrens Hospital
• and
• Stephen D. Oller, PhD
• Texas AM University-Kingsville

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The first encounter with a diagnosis of ASD

• SLPs and Audiologists
• first encounter (before or after the diagnosis)
• percentage of caseload
• Gathering a case history
• how the family has been affected by Autism
• the stage of acceptance

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The Initial Speech and Language Evaluation

• Assessments used according to normal developing
  children
• A good reference point to begin with
• Different wording
• Setting goals according to initial evaluation
• The Re-assessment
• Higher ceilings but same scores

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An Assessment based on the Theory of Abstraction

• 16 different levels of language development
  before the age of 5
• Non-verbal levels (level 0 to level 9)
• Goal Setting
• detailed and individualized for each patient
• easy explanation and understanding for a home
  carryover program
• measuring progression or a stand still
  (additional therapies or treatments)

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Collaboration is Key

• Working with OTs and PTs at a Childrens
  Hospital
• OTs as they provide sensory input
• Feeding Therapy
• texture aversions, gagging, swallowing, oral
  awareness
• Patient examples
• notice (Speech and OT)

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Building Bridges

• Therapy for Children with Autism and Other
  Pervasive Disorders (2002)
• Ellen Yack, B.Sc., M.Ed., O.T.
• Paula Aquilla, B.Sc., O.T.
• Shirley Sutton, B.Sc., O.T.
• Sensory Integration and Communication Strategies
• i.e. swinging on a platform swing while blowing
  bubbles

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Using the scale to guide goal writing

• Initial Assessment and Re-assessment
• Using the scale in conjunction with a published
  assessment to determine level of patient
• Therapy Sessions
• What activities/stimulation provides patient with
  higher levels of communication skills
• Home Carry-over
• Examples of Goals to achieve at each level

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Adjusting Goals as needed without a formal
Assessment

• Levels provide guidance when patient changes
  learning style
• When patient begins or discontinues
  medication/treatment
• Patient is placed on hold for a few weeks due
  to illness, change in home environment, or
  insurance

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Level 0(present before or at birth)

• Child is unresponsive to tactile, auditory, or
  visual cues, cannot discriminate any boundaries,
  Whats me, whats not me.
• Waking up after surgery
• Ethan and his mother
• ADD VIDEO HERE
• Goal In 1 month, Pt will respond to stimuli
  provided by SLP x8/10 via auditory, tactile, or
  visual cues across 4 sessions.

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Level 1(present before or at birth)

• Child notices objects. Behaviors to look for
  joint attention interested eye gaze
  responsiveness to visual, auditory, and/or
  tactile stimuli.
• Justus (OT and Speech)
• eating hair, biting, and mouthing all toys
• me vs. not me
• begin to understand, learn, and develop body
  awareness
• Goal In 2 months, Pt will participate in joint
  attention with SLP 8/10x during age appropriate
  play via oral tactile stimulation across 4
  sessions.

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Level 2(present before or at birth)

• Discriminates and follows a moving object,
  Behaviors to look for reaching grasping and/or
  avoidance behaviors.
• Ethan (OT and Speech)
• responded to auditory stimulus only, and would
  walk towards the sounds to retrieve the ball
• eye gaze when desired his comfort toy, a small
  ball, for oral input
• Goal In 2 months, Pt will reach or grab
  object(s) 10/10x during turn taking with SLP
  across 4 sessions.

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Level 3(present before or at birth)

• Child can represent an object that is not in the
  perceptual field
• Ethan (OT and Speech)
• Cries until he hears the sound of the ball
  bouncing
• Moms voice when she calling him outside the room
• Goal In 2 months, Pt will demonstrate
  familiarity with stimuli presented as evidenced
  by facial expressions/body orientation 3/3x of
  the time across 4 sessions.

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Level 4(4-8 weeks of age)

• Initiate an object search that may or may not be
  in the current perceptual field. Behavior to look
  for Continued searching for an object that has
  been removed from view.
• Justus (OT and Speech)
• Knocking over stackable cups to look for cereal
• Goal In 2 months, Pt will search for missing
  objects (e.g. toy, cup) presented then taken away
  during play 10/15x across 4 sessions.

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Level 5(16 weeks of age)

• Represent an object across different inertial
  states, does not search the previous (stationary)
  location but continues to follow the object until
  interest is lost.
• Ethan (OT and Speech)
• Rolling ball, moving train, wind-up car or truck
• Goal In 1 month, Pt will follow moving object(s)
  presented (e.g. car, ball) from start to finish
  point 10/10x via eye movement during play x4
  sessions.

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Level 6(about 20 weeks of age)

• Behaviors to look for expectancies for sequences
  of events frustration in changes of routine
  and/or perturbed by unexpected events.
• Angel (OT and Speech)
• out of sequence day (new school or weather)
• Singing frustration
• Sliding doors swing in the gym
• Goal In 1 month, Pt will independently walk to
  therapy and sit down in anticipation of
  activities 100 of the time to indicate awareness
  of routine across 4 sessions.

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Level 7(5-7 months of age)

• Behaviors to look for orientation towards speech
  or visual symbols over other auditory or visual
  stimuli pointing increased non-distress
  vocalizations.
• Justus (OT and Speech)
• eye gaze while therapists talk
• no verbal response
• Goal In 1 month, Pt will point or move towards
  object(s) desired 9/10x when presented during
  play across 4 sessions.

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Level 8(6-9 months of age)

• Canonical babbling, any repetitive syllabic
  utterance, meaningless, persevarative utterances
  or repetitions.
• Angel (Speech and OT)
• Rote production of ABCDEFG.Z
• Recites song of interest from movie or cartoon
• Goal In 1 month, Pt will use CV combinations
  spontaneously 10/20x during vocalized/pretend
  play across 4 sessions.

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Level 9(7 to 12 months of age)

• Receptive vocabulary, looking at an object named,
  orienting towards speaker who said childs name.
• Aldo (PT, OT, and Speech)
• Bubbles!
• Block please while SLPs hand is open
• Goal In 1 month, Pt will respond to his name
  when called 5/5x via tactile cues x4 sessions.

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Level 10(10-15 months of age)

• first word, correctly produce a symbol
  recognizable to parent, gestural behaviors ASL
• Good Days vs. Bad Days
• mama, dada, or no
• papas for food or bottle
• Goal In 1 month, Pt will use greetings
  appropriately, hi or bye 3/5x via modeling of
  function x1 across 4 sessions.

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Level 11(18-24 months of age)

• Two word utterance, uses one word to modify
  another word, mama keys.
• Spontaneous speech during therapy
• a ball game, labeling puzzle pieces, identifying
  objects in a storybook, or answering what is
  this?
• Goal In 1 month, Pt will spontaneously use 2
  word utterances 10/15x during a turn taking
  activity across 4 sessions.

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Level 12(24 to 30 months of age)

• Utterances that include a subject verb object,
  but not sentences with an indirect object.
• Cow says moo, Cat says meow, Car goes vroom
• Goal In 1 month, Pt will use SVO phrases 5/10x
  during storybook reading or pretend play via
  verbal modeling across 4 sessions.

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Level 13(2.5 to 3 years of age)

• Child can correctly use the I, me, and you
  pronouns, identify their feelings, but not
  necessarily explain emotions or recognize
  emotions in others.
• I want gum, Me ride bike, You blow bubbles
• Goal In 1 month, Pt will use the I, me, and you
  pronouns 10/10x during reciprocal play or
  activities across 4 sessions.

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Level 14(3 to 5 years old)

• Identify feelings in others, but unable to
  explain why the other person feels that way.
  However, the individual seems isolated
  emotionally.
• Goal In 2 months, Pt will answer what and
  why regarding a sequence of events 8/10x within
  a situation during storybook reading across 4
  sessions.

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Level 15(3 to 5 years old)

• A sense of humor and feelings about feelings, I
  enjoy being happy, but unable to adjust their
  feelings according to others.
• Unable to connect the dots
• Goal In 1 month, Pt will answer questions
  requiring inferences to be made regarding a
  characters motivations 7/10x during a storybook
  or play given a model x1 across 4 sessions.

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Level 16(5 years of age)

• Child considered completely normal and capable of
  fully participating in the spoken language and
  social settings.
• Ethan after therapy and various treatments.

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Theory to Therapy

• Activities (lower levels vs. higher levels)
• Increases comprehension (tactile, visual, or
  auditory)
• Discharge or continue a goal
• Structured vs. Movement
• Home carryover