ENHANCING COMMUNICATION SKILLS FOR STUDENTS WITH AUTISM SPECTRUM DISORDERS (ASD) IN THE GENERAL EDUCATION CLASSROOM Mod

1. ENHANCING COMMUNICATION SKILLS FOR STUDENTS WITH AUTISM SPECTRUM DISORDERS (ASD) IN THE GENERAL EDUCATION CLASSROOM Module 3 Lesson 2 Expressive Language

2. OUTLINE • Lesson 2 • Expressive Language • Characteristics • More Strategies for the Classroom

3. EXPRESSIVE LANGUAGE

4. Students with ASD often have substantial delays and differences in expressive language. (Paul, 2007; ASHA, 2006). • Students with ASD who develop speech typically use language that is sparse and repetitive. They often use expressive language for limited purposes, mostly to request or protest. • Potential classroom application: Acknowledge and respond to all communicative attempts. Use activities of interest that happen regularly (such as snack time, independent play, or favorite toys, books, or other items), to allow repeated opportunities for practice; include pauses to encourage the student to communicate and participate. Model vocabulary, simple sentence structures, and communicative intents (beyond requesting or protesting) such as to comment, get someone’s attention, initiate interaction, etc. Use pictured symbols to prompt the student to say target words or sentences. Encourage use of alternate modes of communication (augmentative communication), such as picture symbols with printed words and gestures.

5. Expressive vocabulary in students with ASD is often sparse and restricted to nouns or object labels . Students are also often delayed in combining words (such as saying “Cookie” instead of “more cookie’) (Paul, 2007; ASHA, 2006). • Potential classroom application: Acknowledge and verbally interpret the student’s intentional communication; model and stress key words and word combinations (e.g., student reaches for a cookie that is out of reach. Teacher points to the cookie and says “You want cookie. Cookie”). Expand the student’s verbal communication (e.g., student says, “Ball” to request the big ball. Teacher says, “Ball, big ball”). Teach words that the student may like, such as “jump” while jumping on a mini-trampoline. Use activities that will provide many opportunities for practice. Include picture symbols and printed words as prompts. Encourage use of augmentative communication to express new words.

6. Students with ASD show literalness in their expressive use of language (Paul, 2007; ASHA, 2006). • Students with ASD usually have difficulty using abstract concepts (such as related to time, direction, and math) and higher level expressive language skills (such as expressive problem-solving, reasoning, explanations, and creative and figurative language). • Potential classroom application: Teach and practice language in various situations and activities to promote generalization. Use visual depictions of words that are difficult for the student to understand and use. Use picture symbols with printed words to prompt verbal labeling, explanations, and other higher level language skills.

7. Many students with ASD exhibit echolalia, either immediate or delayed. They may also use unconventional or idiosyncratic words, phrases, or sentences, or undesirable behaviors to communicate (ASHA, 2006; Wetherby & Prizant, 2000). • Students may hear and repeat a word or “chunk” of language and associate this word or “borrowed” phrase with a specific experience or event. An echolalic utterance may be equivalent to a single word or may refer to a situation or event. • Potential classroom application: Try to interpret the communicative intent of echolalia or idiosyncratic words, and if this is possible, verbally acknowledge what the student is trying to communicate. Model conventional or more correct language. Teach language that expresses various communicative intents (e.g., words for commenting, asking, showing, expressing emotion, interacting, etc.). Continually expand expressive vocabulary and sentence structures in daily activities.

8. As for receptive language, expressive language may be limited in tasks requiring joint attention and interpersonal interaction (Paul, 2007; ASHA, 2006). • Potential classroom application: Encourage interactions even without speech. Use repetitive activities and modeling, giving many chances for practice and predictability. Encourage joint attention by involving a favorite activity; or plan for a favorite activity to naturally happen next (reinforcement); teach the student to call or get attention to initiate an interaction, such as to ask for help with something he likes. Include pictured cues as prompts for the student to know what to say or do; practice “scripts” of what to say in various situations. Encourage students to use alternate modes of communication, such as picture symbols with printed words (augmentative communication).

9. Students with ASD may have delayed or limited speech, with reduced intelligibility (ASHA, 2006; Paul, 2007; Landa, 2007). • Speech characteristics can include: • inconsistent articulation errors, limited consonant inventory, and simple syllable structures • fine and gross motor incoordination • vocal differences may also be present including monotone intonation, whispering, or using a quieter voice, abnormal pitch and rate. • Potential classroom application: Include alternate modes of communication, such as picture symbols with printed words (augmentative communication), along with repetitive predictable routines, to facilitate speech and language.

10. SummaryWays to adapt activities to promote expressive language • Provide instruction in activities of interest that happen regularly and with favorite items -- This allows repeated opportunities for practice. In these activities, teach words that the student may like, such as “jump” while jumping on a mini-trampoline. Include visuals and pauses to encourage the student to communicate and participate. • Acknowledge and respond to all communicative attempts -- Recognize even subtle communication signals, and verbally interpret all communication attempts. Stress, model, and expand key words or vocabulary, word combinations, and communicative intents (beyond requesting or protesting). Try to interpret the communicative intent of echolalia or idiosyncratic words; if this is possible, verbally acknowledge what the student is trying to communicate, and model conventional or more correct language. continued on next slide

11. SummaryWays to adapt activities to promote expressive language • Encourage use of alternate modes of communication, such as picture symbols with printed words (augmentative communication, or AAC) to facilitate speech and language -- AAC can be used as prompts to help students know what to say and how to say it, and as a way to develop language and communicate. AAC can be used to teach new words and concepts, to expand expressive vocabulary, sentence structures, and communicative intents, including to promote interactions. See more about AAC in Lesson 3. • Specific teaching strategies may depend on the student’s language level and other needs – Collaborate with your speech-language therapist and other team members to individualize instruction that addresses students’ specific expressive language needs.

12. MORE STRATEGIES FOR THE CLASSROOM

13. As noted in Lesson 1, effective systematic instruction in the general education classroom includes “naturalistic instruction.” The next few slides describe some of the naturalistic instructional strategies that can be used to promote expressive language skills. Refer to Lesson 1, Slide 21, for more information about naturalistic instruction. • As for receptive language, naturalistic instruction to promote expressive language skills and participation involves: • structuring the environment, and • adapting methods and activities to promote receptive language skills and increase participation.

14. Responsive interaction strategies (following the student’s lead) – refer to Lesson 1, slide 22, for more information on these strategies. • Example: Cathy communicates mostly to request items using occasional words, changes in body posture, screaming, and repeated phrases. To expand effective communicative intents, the teacher has targeted expressive communication for social interaction (i.e., to show) using this strategy. continued on next slide

15. Responsive interaction strategies (continued) • Example continued: Students in class were instructed to bring a photo of favorite things at home to share with the class. Cathy is looking at her picture of favorite things at home-- her mom, cat, and herself holding a favorite toy. The teacher sits down and sees that Cathy is looking at and touching the picture of her mom. The teacher does the same, looks at Cathy, and says, “You see Mom. Mom.” Cathy touches the picture of her mom again. The teacher again touches mom, looks at Cathy, and says, “You see Mom. That’s Mom,” hoping to facilitate the student saying or doing the same. Cathy then touches the picture and says, “Mom.” • Imitation acknowledges the student’s act and “invites” a response from her.

16. Environmental arrangement strategies – See Lesson 1, slide 24, for more information about these strategies which can also be used to promote expressive language. • Example: Mary says one to two-word combinations, usually in response to questions. During lunch, to promote initiations of communication, the teacher gives her a little bit to drink and a quarter of a sandwich, instead of a full glass and half a sandwich. Mary cries and holds out her glass. The teacher, says, “More drink. More drink please” and gives her a little more to drink. The teacher moves away and Mary raises her cup and says, “More.” The teacher asks and points to each one, “More drink? Or more sandwich?” Mary says, “Drink.” The teacher, says, “More drink, please” and gives her a little bit more. • In this case, including materials of interest, offering small portions at a time, and a choice making setup encourage Mary to initiate communication.

17. Modeling – See Lesson 1, slide 26, for more information on modeling. In the example below, Sam wants play dough but can’t open the box. Step 1: Establish joint attention – Sam is in his seat, looking at his play dough box. The teacher gets beside Sam, and also looks at it. Step 2: Present a verbal model that labels or describes the focus of interest - The teacher says, “Open” to show Sam how to ask for help. Step 3: When the student imitates the model, acknowledge and expand his/her response and provide access to the material or activity – Sam says, “Open.” The teacher says, “Yes, open box,” opens it, and gives it to Sam. Step 4: If the student does not imitate or respond appropriately, repeat the model. If the student again does not respond correctly, provide corrective feedback and help him access the material or activity - In this case, the teacher could say, “Open box” as she opens the box lid partially and gives it to Sam saying,” Here, open box.”

18. Incidental Teaching – See Lesson 1, slide 28, for more information on this. • Example: Mandy likes to say or imitate student’s names during roll call. When the teacher calls out a name, Mandy says it too. The teacher decides to use that activity for Mandy to practice using communication to interact with others and to combine words. Mandy first gets to call out each student’s name during roll call (this takes place at the bulletin board that has a picture of each child and first name). The next step is for Mandy to ask, “Where is” plus the student’s name; or say the student’s name and direct them to “raise hand.” • Any naturalistic or other instructional technique could be used here to expand Mandy’s expressive language.

19. Embed instructional episodes for classroom goals in regularly occurring activities. See Lesson 1, slide 29 for the steps involved. The next two slides include more information and examples about each step.

20. Step 1: As for Lesson 1, select activities and arrange the environment (adapted from Noonan & McCormick, 2006 from Bricker & Norstad, 1990; Landa, 2007): • Select activities that group similar objects for different students.Example: telling stories with props is an activity that lends itself to teaching “identifying objects by their function” (using expressive language to label functions). • Select activities that group different goals/objectives for the same student.Example: Joe has three objectives that can be taught in the context of snack preparation: a language objective (“naming adjectives”), a cognitive or pre-linguistic objective (“labeling colors and shapes”), and a fine motor/self-care objective (labeling or requesting “pour”). • Select activities that can be adapted for varying age and skill levels.Example: see Lesson 1, slide 30, for information. continued on next slide

21. Select activities that require minimal adult direction and assistance. Example: see Lesson 1, slide 31, for more information. • Select activities that provide many opportunities for student initiations.Example: the activity “Up, up, and away” requires children to name a peer and then pass a balloon to that peer; each game provides many opportunities for children to initiate communication with peers. • Select activities that are motivating and interesting. See Lesson 1, slide 31, for more information. continued on next slide

22. Select activities that involve play. See Lesson 1, slide 32, for more information. • Design activities in which modeling can be used and the student’s imitation skills can be facilitated and practiced. Example: Students are to request colored pencils for a task but Tom needs help. The teacher has Tom choose the colors he wants, models each color name for him to imitate (to request) and get the pencils he wants. • Arrange physical space in the classroom to promote student learning.Examples: To promote use of adjectives, the classroom may have adjective words and pictures in the room that can be used as cues. If teaching math principles, the room can have a grocery store configuration to make the activity more interesting, etc. Also see slide 14 in this lesson. continued on next slide

23. Step 2: Decide how targeted skills will be taught. See Lesson 1, slide 33, for more information. • The instructional plan or matrix can be organized to include: • Activity or occasion for instruction – e.g., art class-- student likes to color • Schedule-e.g., 2:00 art class, possibly 1:00 free play • Physical positioning or materials- e.g., materials will be kept in a bin labeled “art” with picture symbol for art; have word and picture prompts nearby • Intervention strategies- e.g., for student objective: to say three action verbs (color, cut, and paste), always ensure joint attention, student must request item to use, based on choices of preferred and non-preferred items; include visuals and modeling as needed Continued on next slide

24. Student Response – e.g., student will describe what he did: color, cut, and paste, using speech and picture symbols as needed • Consequence for correct response- e.g., verbal acknowledgement and reinforcement (“Cut, you cut paper”); student may get to color longer when finished with project. • Consequence for incorrect response- e.g., teacher will model correct words, include augmentative communication to express the verbs, and use visuals as prompts

25. SUMMARYWays to promote expressive language across everyday classroom activities, using naturalistic instruction • Follow the student’s lead • Make environmental arrangements • Model communication skills and request that the student imitate • Continually expand the student’s communication skills by elaborating on what they say and asking elaboration questions • Plan learning opportunities in regularly occurring activities-- create a matrix or a list of the student’s communication goals and the classroom activities to show where and how instruction can be implemented • Collaborate with team members, including speech-language therapist, to address students’ specific language needs • Use naturalistic strategies above, with other teaching techniques, to promote language. Examples: • Use time delay or pause, and then model and request imitation • Include extra prompts or cues to help students expand language and know what to say; gradually reduce prompts and cues over time

26. Module 3 Lesson 2 Activity • Create an instructional matrix for three different students in your classroom, based on information in slides 21 and 22. Plan how and where instruction is to occur to promote expressive language objectives in your classroom activities. • Create one matrix for one activity, such as art • On the matrix, list the objectives for 3 different students, and the materials, strategies to include naturalistic instruction, response, and consequences for each student • Explain why you selected the targeted activity for the students • Explain why you selected the instructional strategies for each student

27. References American Speech-Language-Hearing Association. (2006). Principles for Speech-Language Pathologists in Diagnosis, Assessment, and Treatment of Autism Spectrum Disorders Across the Life Span [Technical Report]. Available from 222.asha.org/policy. Beukelman, D.R., & Mirenda, P. (2005). Augmentative and Alternative Communication: Supporting children & adults with complex communication needs (3rd ed.). Baltimore, MD: Brookes Publishing. Landa, R. (2007). Early communication development and intervention for children with autism. Mental Retardation and Developmental Disabilities Research Reviews, 13, 16-25. Noonan, M.J., & McCormick, L. (2006). Young children with disabilities in natural environments. Baltimore, MD: Brookes Publishing. Paul, R. (2007). Language disorders from infancy through adolescence (3rd ed.). St. Louis, Missouri: Mosby Elsevier. Wetherby, A.M., & Prizant, B.M. (Eds.). (2000). Autism spectrum disorders: A transactional developmental perspective (Vol. 9). Baltimore, MD: Brookes Publishing. Woods, J.J., & Wetherby, A.M. (2003). Early identification of and intervention for infants and toddlers who are at risk for autism spectrum disorder. Language, Speech, and Hearing Services in Schools, 34, 180-193.