Communication Enhancement Education for Parents of Preschool Autistic Children

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Communication Enhancement Education for Parents
of Preschool Autistic Children

• Susan Longtin, PhD, CCC-SLP
• Brooklyn College, NY
• Annual Convention of the American
• Speech Language Hearing Association,
• November 22, 2008

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Acknowledgements

• Colleague
• Adrienne Rubinstein
• Students
• Jessica Antioco,Valerie Sirotnikova
• Malvina Granovskaya,Yuliya Khutoretskaya,
• Marina Zavulunov, Gloria Seruye,
• Pnina Wellerstein, Vanetta John
• Lynda Aboody

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Acknowledgements

• Participating families
• Quality Services for the Autistic Community
  (QSAC) Preschool
• Funding
• Several PSC-CUNY Awards
• Tow Faculty Travel Award

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Background Information

• Research supports involving parents of children
  with ASD in intervention
• Parent is childs first partner
• Increases intensity of treatment
• Parents can facilitate communication and language
  goals throughout the day
• (National Research Council, 2001)

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Purpose

• To describe a short-term, pilot education program
  for parents of preschool children with ASD.
• Present parent satisfaction data
• Describe coding systems for parents children
• Present preliminary results for parent child
  outcomes

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Developmental social pragmatic (DSP) principles

• Child centered
• Social interactionist
• Goals based on developmental sequences
• Naturalistic contexts everyday routines
• Acknowledge individual variation

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Participants

• Children enrolled in a preschool program children
  with ASD
• N4
• CA range 3-5 years
• Parents of preschool children with an autistic
  spectrum disorder (ASD)
• N4
• Diverse CLD backgrounds

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Current Perspective in DSM-IV-TR (2000)
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Child participant profiles
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Childrens available test data
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Parent participant profiles
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Procedures for Parent Participants

• attended 5 educational workshops about childrens
  social-communication and language development and
  problems
• learned DSP strategies to enhance their childs
  communication
• received support from small group format

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Procedures cont. When Where?

• Parents attended five workshops conducted at
  their childs preschool
• Parent-child dyads were visited at home following
  each workshop
• To receive feedback on parents use of the
  strategies and childs social communication
• Parents completed a satisfaction survey at end of
  the last workshop.

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Research Design

• Single subject multiple baseline across subjects
  design
• Pretreatment baseline observations
• Half subjects received 3 pretraining baselines
  and 5 home visits following training (8 sessions
  total)
• Half subjects received 5 pretraining baselines
  and 5 home visits following training (10 sessions
  total)

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Research Design Data Collection

• Preliminary review of records and parent
  interviews
• Establish goals for each child
• Parent home visits followed each workshop

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Overview of the Workshops

• Introduction
• Strategies
• Strategies cont.
• Visuals
• Integration Reflection

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Introductory workshop

• Theoretical/conceptual frameworks
• Communication language development stages
• Childrens learning sensory styles
• How why your child communicates
• Adapted from Sussman (1999)
• Enticing interaction
• Home practice plan
• Adapted from MacDonald (2004)

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Conceptual frameworks

• Developmental
• Individualized
• Social pragmatic
• Communication
• Family-centered relationship-based
• Responsive
• Positive
• Adapted from Greenspan Weider (1998), Sussman
  (1999), MacDonald (2004)

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Second Workshop

• Reporting back sharing
• Strategies to enhance social communication
  language
• Tuning in to the childs interests
• Following the childs attentional focus
• Intruding on childs unengaged, repetitive
  behavior
• Adapted from Sussman (1999)

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Third Workshop

• More strategies
• Balance
• Match
• Respond
• Share control
• Be emotionally playful
• Adapted from MacDonald (2004)
• Using routines repetition

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Fourth Workshop

• Range of visuals
• Rationale for using visuals
• How to use visuals to enhance understanding
• How to use visuals to enhance expression
• Adapted from Sussman (1999)

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Fifth Workshop

• Integrating the strategies
• Special concerns
• Relationship-based
• Reflection
• Parent Satisfaction Questionnaire

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Transcription

• Videotaped observations were transcribed using
  standard orthography
• 10 minute segments of parent-child interactions
• Included rich contextual detail
• Reliability of transcripts established
• 91.4 for children
• 92.1 for parents

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Childrens Data Codes

• The childrens behavior was coded for
• Affect
• Gaze
• Gestures
• Nonlinguistic vocalizations
• Words
• Communicative acts

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Parent Data Codes

• The parents behavior adjacent to their childs
  behavior was coded for
• Responsivity
• Nonresponsivity
• Attempts to encourage their unengaged child to
  participate

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Responsive Language

• What parent says is related to the childs focus
  of attention based on childs gaze, action,
  object manipulation, vocalization, or words.

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Responsive Action /or Affect

• What parent does is related to the childs focus
  of attention based on childs gaze, action,
  object manipulation, vocalization, or words.

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Nonresponsivity

• Nonresponsive language
• Parent utterance is not attuned to childs focus
  of attention, activity, or affect.
• Nonresponsive action /or affect
• Parent nonlinguistic behavior is not attuned to
  the childs focus of attention, activity, or
  affect.

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Facilitating the unengaged child

• Parents attempt to engage his/her unengaged
  child through words.
• Parents attempt to engage his/her unengaged
  child through gestures, physical contact, /or
  affect.

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Data Analysis

• Data was analyzed for frequency of use of
• Childrens codes
• Forms nonverbal verbal form
• Communicative functions
• Parents codes
• Responsivity
• Nonresponsivity
• Facilitative linguistic nonlinguistic behaviors

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Preliminary Results of Videotaped Observations

• Frequency of childrens codes
• Reliability
• Frequency of parents codes
• Reliability

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Parent Satisfaction Questionnaire

• Twelve items
• Surveyed various program components
• 5 point Likert Scale
• 1 not helpful
• 2 helped a bit
• 3 neutral
• 4 helpful
• 5 very helpful

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Program Components Surveyed by Questionnaire

• Improved communication between parent child
• Learning about communication in ASD
• Workshop content including strategies
• Group support
• Home visits

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Results

• Average ratings analyzed for each of 12 items for
  all parents
• Average ratings analyzed for each parent
• Results indicated that parents found
  participation in the program helpful to
  themselves and their child with ASD.

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Results of Parent Satisfaction Questionnaire
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Results cont.

• Results indicated that parents found
  participation in the program helpful to
  themselves and their child with ASD.
• Marks mother 4.42 early semantic-syntactic
  complexity
• Adams mother 4.29 intentional prelinguistic
• Johns father 4.17 first words
• Brians mother 3.17 preintentional

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Reflections from a clinician/observer

• Parents
• Siblings
• Parental Education Level
• Capacity for Change
• Expect the Unexpected
• Beyond Cultural Variation
• Follow Up, Carryover, Home Practice
• Magical Moments

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Summary Conclusions

• The parents felt they learned a lot and that
  their communication with their child was
  enhanced.
• Educator, mentor, observer, coach the SLP can
  embrace these additional roles.

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Suggested Readings

• Greenspan, S.I Weider, S. (1998) The child
  with special needs Intellectual and emotional
  growth. Reading, MA Addison Wesley Longman.
• Longtin, S. Gerber, S. (2008) Contemporary
  perspectives on facilitating language acquisition
  for children with Autistic Spectrum Disorders
  Engaging the parent and child. Journal of
  Developmental Processes, 3 (1), 38-51.
• MacDonald, J. (2004). Communicating partners.
  London Jessica Kingsley Publishers.
• National Research Council (2001). Educating
  children with autism (Committee on Educational
  Interventions for Children with Autism,
  Commission on Behavioral and Social Sciences and
  Education). Lord, C. McGee, J.P. (Eds.)
  Washington DC National Academy Press.

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Suggested Reading

• National Scientific Council on the Developing
  Child. (2004). Young children develop in an
  environment of relationships, Working Paper No.
  1. Cambridge, MA Center on the Developing Child
  at Harvard University.
• Prizant, B.M. Wetherby, A.M. (1998)
  Understanding the continuum of discrete trial
  traditional behavioral to social-pragmatic
  developmental approaches in communication
  enhancement for young children with autism/PDD.
  Seminars in Speech and Language, 19, 329-352.
• Sussman, F. (1999). More than words Helping
  parents promote communication and social skills
  in children with autism spectrum disorders.
  Toronto The Hanen Center.