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Communication deficits often mimic behavioral problems

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Echolalia. should be encouraged initially as legitimate communicative acts ... Echolalia, continued. use facilitative style, use positive responses ... – PowerPoint PPT presentation

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Title: Communication deficits often mimic behavioral problems


1
Communication deficits often mimic behavioral
problems
2
Problem behaviorBehavior problem
3
Must look at the function of the behavior and
teach a more conventional means (replacement
behaviors)
4
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

5
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

6
Stimulus Overselectivity
  • child attends too narrowly to stimuli
  • impedes generalization
  • salience
  • children respond only to an overly restricted
    range of environmental stimuli

7
Information processing duration
  • May process information more slowly than non
    spectrum persons
  • May process some kinds of information better than
    others

8
Poor generalization and they process information
spatially, not sequentially
9
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

10
Cognition
  • attention
  • memory
  • executive functions, problem solving, reasoning

11
Cognition Attention
  • difficulty with selective attention
  • difficulty with shifting attention
  • deficits more frequent if MR is present

12
Cognition Memory
  • compromised working memory
  • adequate short-term memory
  • good rote memory
  • difficulty encoding/remembering complex
    information
  • difficulty with sequential/abstract information

13
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

14
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

15
You must
  • Understand both the disability and the person who
    manifests it!

16
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

17
When teaching/coaching we typically
  • tell someone what to do, or
  • show them, model it,
  • reward spontaneous occurrences
  • provide social reinforcements

18
Disability Awareness / Sensitivity Training
  • Goal - to improve student understanding and
    support of classmates with ASDs
  • e.g., Carol Grays Sixth Sense

19
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)

20
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

21
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)

22
What do people with ASDs do that shows us they
are visual?
  • Puzzles
  • maps/routes
  • artistic
  • letters/numbers

23
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.

24
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.

25
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
26
Why are visuals better for persons with ASDs?
  • Difficulty shifting/reestablishing attention
  • Sensory differences (unable to block out
    competing noises)
  • Processing delays

27
But do we need to use visuals for all persons
with ASDs? My student speaks.
  • Yes, and yes, again and again!

28
The use of visual tools is not determined by a
persons ability to talk or use language
29
What about Sign Language
  • Pros
  • availability
  • visual
  • Cons
  • typically, small audience
  • visual but fleeting, transient cue
  • limited motor ability of some

30
But this is an equal opportunity strategy
  • Strategies that work for children with Autism
    Spectrum Disorders work for many other students

31
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

32
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

33
Left to right sequence to parallel the way the
world works is preferableColor isnt always
good!
34
Transitions
  • are tough
  • provide as much predictability as possible
  • forewarning, provided visually

Why are transitions tough? Think back to
DIFFICULTIES SHIFTING ATTENTION
35
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!

36
But my students know their schedules. Do I
still need to use it?
  • YES

37
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

38
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

39
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

40
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

41
What are the long-term effects of using visual
strategies?
  • Do you gradually try to eliminate the use of
    visual tools?

42
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

43
Strategies to use and NOT use
  • concrete
  • stable
  • spatial
  • visual
  • gestalt
  • abstract
  • transient
  • temporal
  • verbal reasoning
  • analytical

44
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)

45
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

46
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

47
Communication strategy should
  • incorporate visual cues into the communication
    system
  • establish and utilize routines
  • build in generalization

48
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
49
Avoid
  • use your words
  • full-sentence press (Twachtman-Cullen)

50
Request repertoire
  • cookie
  • want cookie
  • I want cookie
  • I want cookie please

Only one function!!!
51
Various functions
  • Request puzzle
  • Refusal no
  • Comment points to things

Increases social/communicative competence,
decreases likelihood of challenging behaviors
52
Strategies for the Nonverbal Child
  • highly structured environment -utilize routines
  • routines are a powerful means of promoting
    communication
  • can violate or sabotage routines

53
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

54
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
55
Utilize a giving gesture
  • Pointing and showing are difficult
  • Manipulating the communication card is more
    successful than simple pointing or showing

56
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

57
Most preschoolers introduced to PECS took more
than one year to demonstrate independent speech
58
Speech tended to develop after the children had a
lexicon of 30-100 symbols(Frost Bondy, 1994)
59
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

60
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.
61
Efficacy of communication intervention
  • Should be determined by meaningful outcome
    measures in social communicative parameters, not
    just the acquisition of verbal behaviors

62
Communication system
  • Available and integrated into home/ school/
    community
  • Manipulation, not just pointing

63
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)

64
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

65
Avoid long strings of verbal instructions
  • gt3 steps are tough (Grandin)
  • written directions are preferable, for those who
    read

66
Communicative Interventions
  • converting behavior to conventional communication

67
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

68
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

69
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

70
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

71
Strategies to use and NOT use
  • concrete
  • stable
  • spatial
  • visual
  • gestalt
  • abstract
  • transient
  • temporal
  • verbal reasoning
  • analytical

72
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!
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