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ASD and AAC: Making it Work

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Title: ASD and AAC: Making it Work


1
ASD and AAC Making it Work!
  • Maija Gulens, MS, CCC-SLP
  • Speech-Language Pathologist
  • Augmentative Communication and Learning
    Enhancement Program

2
Introduction
  • Background and experiences
  • Theoretical perspectives on autism
  • Overview of strategies
  • References and resources
  • Video Illustrations
  • Summary and Questions

3
Theoretical Perspectives on Autism
  • Joint Attention Deficits and Executive Function
    Deficits (Mundy Stella, 2000)
  • Deficits in social orienting early in
    development, certain neuroaffective motivation
    systems that prioritize social information
    processing are impaired
  • Deficits in executive function certain cognitive
    processes select appropriate goal directed
    actions from an array of competing action
    potential
  • It is possible that the early motivation system
    that prioritizes orienting to social stimuli
    primes the development of the capacity to select
    appropriate actions in the face of competing
    stimuli
  • This would give early practice (and neurological
    organization) associated with selecting an action
    given multiple distracters

4
Theoretical Perspectives on Autism
  • Deficits in Theory of Mind and gestalt
    perception (Bogdashina, 2005)
  • Perception of the whole scene as a single entity
    with all the details perceived (but not
    processed) simultaneously
  • Do not perceive wholes with out complete
    attention to the constituent parts
  • In order to recognize things, they must be
    exactly the same as previously experienced,
    otherwise the gestalt of the situation is
    different (causing fear, stress, frustration)
  • This might explain dislike of changes and
    preference for routines
  • Also leads to rigidity of thinking and lack of
    generalization

5
Overview of Strategies
  • Use AAC to Facilitate Speech and Language
  • Customize for Motivation
  • Increase Language Output for Functional
    Communication
  • Teach Generalization
  • Modify Challenging Behaviors

6
1) Use AAC to Facilitate Speech and Language!
  • Supported by ASHA position statement on best
    practices for ASD
  • Research Support none to suggest that AAC
    interventions have a negative impact on the
    development of speech
  • Supported by Clinical Experiences

7
2) Customize for Motivation
  • Do anything to help engage the child!
  • Follow the childs lead (Miller, 1981)
  • imitate, engage, try parallel play

8
Customize for Motivation
  • Consider the benefits and challenges of engaging
    the individual within his or her specific scope
    of interest (Prizant, Wetherby, Rydell, 2000)
  • stereotypical repetitive behaviors or stimming

9
Customize for Motivation
  • Recognize the importance of developing
    responsivity or ensuring balanced reciprocity
    between the individual and the communication
    partner (Harwood, Warren, and Yoder, 2002)
  • Via engagement through joint action routines
    (Snyder-McLean, Solomonson, McLean Sack, 1984)
  • A ritualized interaction pattern, involving join
    action, unified by a specific theme or goal,
    which follows a logical sequence, including a
    clear beginning point, and in which each
    participant plays a recognized role, with
    specific response expectancies, that is essential
    to the successful completion of that sequence.
  • Via introduction of symbolic communication
  • PECS (Bondy Frost, 1994)
  • modified picture exchange communication system

10
Customize for Motivation
  • WOW! - Follow the basic principles of assessment
    in AAC that include exploration of visual,
    auditory, access, and sensory needs, as well as
    cognitive and developmental level (Beukelman
    Mirenda, 1998) in choosing modalities
  • Gestures/Signs
  • Photos/PCS
  • Voice Output/Verbal
  • Text

11
3) Increase Language Output for Functional
Communication
  • Use Power Words
  • More ? for continuation of an activity
  • Expand to more object, more action
  • Expand to commenting Yay! I like that!
  • Help ? for engagement, to increase
    self-determination throughout daily activities,
    for replacement of frustration
  • All done ? for protesting/rejection, for task
    completion, for termination

12
Communication Temptations (Wetherby Prizant,
1989)
  • Eat desirable food in front of child without
    offering to him/her
  • Activate a wind-up toy, let it run down, hand it
    to the child
  • Initiate a familiar game, play it until child
    expresses pleasure, then wait
  • Open bubbles, blow bubbles, close jar tightly and
    hand to child
  • Blow up a balloon and let the air out hand it to
    the child
  • Hold an undesirable food to the childs mouth
  • Place a desired toy or food in a clear container
    with a tight lid that the child cant open give
    it to the child and wait
  • Put the childs hand in a cold/wet/sticky
    substance (and wait) (e.g. pudding, paste)
  • Roll a ball to the child after several rolls
    back and forth, change to a car or other wheeled
    toy
  • Put a toy that makes noise in an opaque bag, then
    shake the bag, and hold it up to the child

13
3) Increase Language Output for Functional
Communication
  • Increase range of Communicative Functions
  • WOW! Although some of the most well known and
    frequently used interventions, such as PECS
    (Bondy Frost, 1994), provide an important
    starting point for teaching communication
    behaviors, the range of communicative functions
    taught to children with autism needs to be
    expanded beyond requesting (Mirenda, 2003
    Wetherby Prizant, 1989 Loveland, Landry,
    Hughes, Hall, McEvoy, 1988).

14
The Communication Matrix (Rowland, 2004)
  • A tool that represents 4 basic reasons for
    communicating, and 7 levels of competence, and
    was designed for individuals with severe
    communication impairments. It is useful to
    assess communication skills for
  • refusing
  • obtaining
  • engaging in social interactions
  • providing or seeking information
  • provides a useful framework for determining
    communication goals, by demonstrating strengths
    and needs in each area

15
Early Semantic Combinations (Brown, 1973)
  • attributeentity (e.g., big ball)
  • agentaction (e.g., monkey jump)
  • actionobject (e.g., help me)
  • actionlocation (e.g., hurt head)
  • possessorpossession (e.g., baby shoes)
  • recurrence (e.g., more cracker)
  • denial/rejection (e.g., no shoes)
  • disappearance (e.g., all done baby oh no
    shoes)

16
Grammatical Morphemes
  • Browns Stages
  • II -ing in plural
  • III on possessive
  • IV regular past irr past reg 3rd
    sing. articles copula be
  • V auxiliary be irreg 3rd sing.

17
4) Teach Generalization
  • Need to explicitly design strategies for
    generalization of skills into the instructional
    program
  • WOW! Need explicit teaching approach for symbol
    learning, access skills, and language skills
    (Angelo Goldstein, 1990 Kozleski, 1991
    Wilkinson McIlvane, 2002)
  • Across familiar partners, (including staff
    members, peers, family members), as well as
    unfamiliar partners (Basil, 1992 Rowland
    Schweigert, 1999)
  • Across settings (Prizant, Wetherby, Rydell,
    2000),
  • Across social networks (Blackstone Hunt Berg,
    2003)
  • Across communication contexts (Light Binger,
    1998)

18
4) Teach Generalization
  • Select Vocabulary for General Use
  • Use broad statements rather than narrow ones
  • (e.g., red crayon blue crayon vs red,
    blue, green)
  • (e.g., Dont hit me vs please dont do that)
  • Simplify language input to provide models for
    repetition (echolalia)
  • (e.g., Before we go you need to go over there,
    sit down, and get your shoes on vs first shoes,
    then go home)
  • Avoid pronouns when modeling speech
  • (e.g., I want to eat vs time to eat)
  • (e.g., Do you want more crackers to eat? vs
    more crackers)
  • Provide practice in multiple contexts with
    multiple partners

19
5) Modify Challenging Behaviors
  • Communication repertoires also need to be
    expanded to replace challenging behaviors with
    acceptable communication responses (Wacker, Berg,
    Harding, 2002)
  • Functional behavior analysis - Need to identify
    the function of the inappropriate communication
    behavior (i.e., biting self, throwing self down,
    running, screaming)
  • to escape an activity,
  • to avoid an event about to take place,
  • to request another action/item (Sigafoos,
    OReilly, Drasgow, Reichle, 2002)

20
5) Modify Challenging Behaviors
  • ABCs (antecedent behavior consequence)
  • Replacement behavior (communication strategy)
    needs to occur during the antecedent phase,
    before the behavior emerges, and before the child
    becomes agitated and or dysregulated
  • There are socially acceptable forms (saying no,
    or making gestures to avoid undesired
    objects/actions) to make these requests, but
    often children with autism need to be explicitly
    taught those forms
  • WOW! the replacement behavior needs to serve the
    same function, needs to be as efficient, and
    needs to be more reinforcing than the previous
    behavior for it to be replaced (Wacker, Berg,
    Harding, 2002)

21
Decrease Task Demands through Assistive Technology
  • Consider the impact of deficits on typical tasks
  • problems fine motor skills and organization
  • task analysis writing assignment
  • generate ideas -memory, vocabulary, semantic
    associations
  • write down ideas - hand writing
    encoding/spelling
  • expand ideas semantic syntactic organization
  • revise and edit content - monitor main idea
  • produce text

22
  • Explore the role of computers in intervention
  • motivation games, graphics, videos
  • multi-media learning environment
  • concept development First 1,000 Words
  • language development Laureate Software
  • literacy development Kid Phonics, Reader
    Rabbit, Jumpstart
  • organization Kidspiration, Inspiration

23
  • to break down tasks
  • note taking and outlining Word, Writing with
    Symbols
  • writing aids spell check feature
  • talking word processors WriteOutloud,
    SymWriter,
  • word prediction software EZKeys CoWriter
    SDPro
  • audio input and speech recognition software
    Dragon Naturally Speaking
  • alternative textbooks

24
Increase Positive Behavioral Supports
  • Provide visual supports
  • Visual schedules
  • objects, photos, pictures, text
  • aid comprehension of what is to come
  • WOW! Schedules need to be flexible/changeable
    to accommodate changes in routines

25
  • Task schedules
  • identify of steps for completion (e.g., feeding
    task)
  • reinforce good behavior with a reward (e.g.,
    swing puzzle)
  • break down the task into meaningful steps (e.g.,
    potty training)
  • Visual Timers
  • Aid concept of beginning, middle, end of activity

26
Provide free choice time
  • for preferred activities, for sensory-motor
    breaks, for self-expression and
    self-determination
  • WOW! Schedules need to be functionally and
    visually distinct from choice boards/devices
  • Following a schedule is receptive task this is
    what is next
  • Making a choice of activity is an expressive task
    I want to
  • Be sure the child has the power of communicating

27
Use Technology
  • to increase independence, decrease reliance on
    people for prompting

28
6) Summary Words of Wisdom
  • To facilitate engagement and motivation Follow
    the basic principles of assessment in AAC that
    include exploration of visual, auditory, access,
    and sensory needs, as well as cognitive and
    developmental level
  • To increase functional communication The range
    of communicative functions taught to children
    with autism needs to be expanded beyond
    requesting
  • To ensure generalization of skills Need explicit
    teaching plan to help generalize use of symbols,
    access skills, and language skills
  • To modify challenging behaviors with
    communication alternatives The replacement
    behavior needs to serve the same function, needs
    to be as efficient, and needs to be more
    reinforcing than the previous behavior for it to
    be replaced
  • To maximize the use of visual supports (a)
    schedules need to be flexible/changeable to
    accommodate changes in routines (b) schedules
    need to be functionally and visually distinct
    from choice boards/devices

29
7) Resources
  • Audiology, Speech Pathology and Learning Services
  • 720-777-6800 - Appointments
  • Augmentative Communication Learning Enhancement
    Program
  • 720-777-6250 Appointments
  • Neuropsychiatric Special Care Program (families
    in crisis ages 4-17 ASD or low IQ)
  • 720-777-8240 Appointments
  • http//www.thechildrenshospital.org/conditions/psy
    ch/neuropsych.aspx
  • Child Development Unit (multidisciplinary
    evaluations)
  • 720-777-6630 Appointments
  • http//www.thechildrenshospital.org/news/publicati
    ons/tchnews/2006/patient_care.aspx

30
8) References
  • Angelo, D., and Goldstein, H. (1990). Effects of
    a pragmatic teaching strategy for requesting
    information by communication board users. Journal
    of Speech and Hearing Disorders, 55, 231-243.
  • Basil, C. (1992) Social interaction and learned
    helplessness in severely disabled children.
    Augmentative and Alternative Communication, 8,
    188-199.
  • Beukelman, D. and Mirenda, P. (Eds.) (1998).
    Augmentative and alternative communication
    Management of severe communication disorders in
    children and adults. (2nd ed.). Baltimore, MD
    Brookes.
  • Blackstone, S. Hunt Berg, M. (2003). Social
    Networks A communication inventory for
    individuals with severe communication challenges
    and their communication partners. Monterey, CA
    Augmentative Communication, Inc.
  • Bogdashina, O. (2005). Theory of mind and the
    triad of perspectives on autism and asperger
    syndrome A view from the bridge. London Jessica
    Kingsley Publishers
  • Bondy, A., Frost, L. (1994). The Picture
    Exchange Communication System. Focus on Autistic
    Behavior, 9, 1-19.
  • Harwood, K., Warren, S., Yoder, P. (2002). The
    importance of responsivity in developing
    contingent exchanges with beginning
    communicators. In J. Reichle, D. Beukelman, and
    J. Light (Eds.) Exemplary practices for beginning
    communicators. (pp. 59-96). Baltimore, MD
    Brookes.

31
  • Kozleski, E. (1991). Visual symbol acquisition
    by students with autism. Exceptionality, 2,
    173-194.
  • Light, J., and Binger, C. (1998). General
    instructional procedures for building
    communicative competence. In Building
    communicative dompetence with individuals who use
    augmentative and alternative communication, (pp.
    7-26). Baltimore, MD Brookes.
  • Loveland, K., Landry, S., Hughes, S., Hall, S.,
    McEvoy, R. (1988). Speech acts and the pragmatic
    deficits of autism. Journal of Speech and
    Hearing Research, 31, 593-604.
  • Miller, J. (1981). Assessing language production
    in children Experimental procedures. Needham
    Heights, MA Allyn and Bacon.
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  • Mundy, P. Stella, J. (2000). Joint attention,
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  • Prizant, B., Wetherby, A., Rydell, P. (2000).
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