Basic Assumptions About Autism

1. Language in Infants, Toddlers and Preschoolers:Creative Solutions to Common Problems: Working With Children With ASD Joanne Gerenser Ph.D.Executive Director, Eden II Programs Mareile Koenig Ph.D.Associate Professor, West Chester U Arlene Kaye MSSpeech-Language Pathologist, Cheshire, CT Public Schools Tracy Vail MSDirector, Let's Talk Sp & Lang Svcs Inc 

2. Basic Assumptions About Autism • Stimulus Overselectivity • There is a large body of research that suggests children with autism may respond to an overly restrictive portion of complex stimuli(e.g., Lovaas, Koegel, & Schreibman, 1979; Koegel, Koegel, Freg, & Smith, 1995)

3. Purpose • To review basic literature on unique learning characteristics of learners with autism • To review how these learning characteristics can challenge learners in acquiring skills • To present a series of case studies that illustrate strategies for addressing the unique learning characteristics of learners with autism in acquiring skills ranging from basic receptive language to complex use of pronouns and asking questions

4. Autism • Stereotypic and Repetitive Behavior • Behavior identified as self-stimulatory appear to interfere with relationships, learning, and neurological development(Koegel,Valdez-Menchaca, & Koegel, 1994) • There appears to be an inverse relationship between stereotypy and appropriate behaviors(Kern, Koegel, & Dunlop, 1984)

5. Self-Stimulatory Behavior High stereotypy Continued absence of alternative behaviors Impaired learning Fewer skills acquired

6. Autism • Process Environment Differently • Difficulty processing transient input(Schuler, 1995) • Difficulty processing multiple cues(Lovaas, Schreibman, Koegel, & Rehm, 1971) • Reduced awareness of theory of mind(Baron-Cohen, Leslie, & Frith, 1985)

7. Autism • Issues with Motivation • Do not respond to social reinforcers in the beginning • Difficult to determine what child is responding to in the environment: may have limited reinforcement repertoire

8. Autism • Reduced Observational Learning • Children with autism typically have a great deal of difficulty with imitation • Children with autism have great difficulty “picking things up” from the environment

9. Autism • Disorder versus Delay • Scattered profile • Splinter skills

10. Implications • Children with autism present complex learning profiles • Many deficits unique to autism challenge our existing curricula, teaching skills, and traditional problem solving methods

11. Case Studies: Basic Receptive Language Joanne Gerenser, Ph.D., CCC-SLP The Eden II Programs www.eden2.org jgerenser@eden2.org

12. Case Study 1 • Child mastered one direction in isolation • Child mastered second direction in isolation • Breakdown occurred in discrimination

13. Case Study 1

14. Action Taken • Evaluate reinforcement • Evaluate intensity • Alter commands to maximize differences • Stand • Touch your feet • No changes in performance

15. Evaluation of Problem • Visual programs progressing well • Matching objects, pictures, shapes • Non verbal motor imitations • Excellent eye contact • Hypothesis • Failure to attend to relevant stimuli (verbal) • Overselecting on irrelevant stimuli (visual)

16. Solution • Must evaluate prompt to direct learner’s attention to relevant stimuli • Use of an intra-stimulus prompt would make the relevant stimuli (speech) more salient and strengthen SD – P – Response relationship

17. Intonation Prompts • Utilize suprasegmental (intonation) features as a cue to promote attending to segmental features (speech) • Select 3 commands and create three distinct corresponding intonational patterns • Programming must be consistent and fading must be systematic

18. Case Study 1 Wave bye bye • Program Step One: • Three one step commands introduced in discrimination: Touch feet Clap

19. Case Study 1 • Program Step Two: • Fade intonation when all three are mastered • Fade intonation one command at a time

20. Case Study 1

21. Case Study 2 • Mastered 10-12 one step commands • Unable to receptively discriminate objects • Begin with removal of carrier phrase • E.g., remove “give me” or “touch” and simply state object name (car, shoe, etc.)

22. Case Study 2 • If that fails, then try object related commands • Hypothesis: • The learner is unable to integrate the addition of a visual component to the receptive language task • Use existing skill to master novel skill

23. Object Related Commands • Select several highly familiar common objects that have clear functions (e.g., juice, car, book, hat) • Conduct typical one concept command program with mastered commands • Use an object with its function as the new one concept command

24. Object Related Commands • Phase 1 • Mastered commands: stand up touch head clap hands touch ears stomp feet etc. • New command: “eat pretzel”

25. Object Related Commands • May need to leave object in isolation on table but would be better to begin with several objects serving as distractors

26. Object Related Commands • Phase 2 • introduce new object related commands until approximately 7-10 object related commands are mastered in discrimination with each other as well as the mastered one concept commands

27. Object Related Commands • Phase 3 • Begin systematically fading the function or action stand up eat pretzel clap car jump drink juice

28. Object Related Commands • Phase 4 • Introduce the actual Sd after all objects are mastered without function or action carrier phrase stand up give me car clap give me cookie give me shoe jump

29. Receptive Object Identification • Phase 5 • Introduce all mastered objects from the object related commands without function or action carrier phrase in a receptive identification format give me car point to shoe give me cookie point to juice

30. Case StudyAbby Requesting Information Tracy Vail,MS,CCC/SLP Speech/Language Pathologist tlvail@mindspring.com

31. What’s the Problem? • Abby has been taught to formulate sentences but does not use them functionally or under the appropriate conditions in a wide variety of contexts.

32. Learner Characteristics of Abby • Reinforced by silly sounds and exaggerated facial expressions • Tends to become agitated when corrected • Diagnosed with severe Verbal Apraxia at 4- non-vocal till 6 years of age • Tends to respond to visual stimuli over verbal – difficulty responding to multiple stimuli

33. What’s Missing? • Stimulus conditions reflecting when people are motivated to ask questions. • Gaining information is not valuable to her (not paired with reinforcement)

34. What’s Missing? • Teaching multiple questions forms with the same set of stimuli. (requiring conditional discriminations of which question form is needed) • Teaching the same question forms under multiple conditions. (generalization)

35. Strategy • Clearly define the conditions under which people are motivated to ask questions. 2. Determine multiple reinforcing conditions for Abby 3. Pair gaining information with reinforcement.

36. Strategy 4. Teach multiple question forms using the same stimuli. 5. Teach under a wide variety of contexts (generalization)

37. Why Do People Ask Questions? • What- to gain information about the name of an object that is either unknown or unable to be discriminated. • Who- to gain information about a person who is either unknown or unable to be discriminated. • Whose- To gain information about the ownership of an item. • Where- to gain information about the location of an object, person or activity that is not visible.

38. Why Do People Ask Questions? • When- To gain information regarding some measurement of time. • Why- To gain information about the reason something is occurring or has occurred. • Which- To gain clarification about 2 or more items. • How – To gain information about a process or procedure

39. Reinforcing Conditions for Abby • Playing with pretend food • Playing with card games • Obtaining items needed for story kits • Obtaining primary reinforcers (candy) • Obtaining highly preferred activities when requested

40. Teaching Procedure • Contrive a situation designed to evoke a specific question form. • Fully prompt the use of the appropriate question form then fade the prompt. (most to least prompting) • Correct any errors by presenting the condition again, fully prompting, then fading the prompt. (error correction procedure)

41. Teaching Procedure • Deliver the information necessary to gain the reinforcer immediately after the question is asked. Reinforcement should initially be delivered within 30 seconds. • Criterion for mastery- contrived situation evokes question on the first opportunity over 3 consecutive sessions. • Immediately following mastery, add another question form to the same context.

42. Results • Abby is asking questions with minimal to no prompting in a wide variety of contrived contexts. • Abby is using question forms with no prompting when engaged in reinforcing activities with family and friends. • Abby is beginning to generalize the use of questions to untaught contexts such as pretend play with siblings and when engaged in conversations.

43. Teaching “Which?”

44. Where, Who, Which

45. What…color, kind, do…

46. Facilitation of conversational turn-taking and pronoun use with children who demonstrate echolalic behaviors. Arlene Dworkin Kaye, M.S., CCC Speech and Language Pathologist akaye36718@aol.com

47. A definition of “echolalia” The repetition of utterances heard in the immediate of distant past.” (Koegel &Koegel, 1975)

48. Echolalia has been identified as a feature prevalent in the utterances of 75% of verbal children with autism.(Rutter, 1968; Wing, 1971)

49. “Echolalia appears to serve important communicative and cognitive functions”(Prizant,Schuler, Wetherby & Rydell, 1977)

50. Interactive Fuctions of Immediate Echolalia (Prizant & Duchan, 1981) 1. TURN TAKING: turn fillers in alternating verbal exchange. 2. DECLARATIVE: providing labels for objects, locations or actions (may be paired with physical act)