Lisa R. Audet , Ph.D., CCC-SLP Assistant Professor, Kent State University laudet@kent.edu

1. Let’s get them Communicating: Interactions and Children with Minimal Language__________________________________________ Lisa R. Audet, Ph.D., CCC-SLP Assistant Professor, Kent State University laudet@kent.edu

2. Our Time Together • Individuals with autism spectrum disorders (ASD) have complex communication needs. • Those with minimal language skills present us with our greatest challenge. • Today’s presentation will • increase your understanding of the core features of ASD; and • provide you with specific strategies to increase comprehension, production, and social interaction in children who have minimal language skills.

3. Core Deficits Problems with joint attention: eye gaze shifting for communication purposes Deficits in development of the Gestural Complex: giving, showing, distal pointing Gestural Complex: The greatest predictor of emerging language development-particularly distal pointing Deficits in combining non-verbal and verbal communication behaviors Deficits in adaptive solitary and social aspects of play Deficits in cognitive functional aspects of play

4. Core Deficits: Day to Day • Children with ASD who have minimal language • Reduced attempts to interact • Reduced readability of attempts to interact • Limited conventional exploratory play with problem solving involved • Short attention span • Engage in same old play…over and over and over again • Restricted social opportunities and success: the structure and evolution of conversation • Limited meaningful, context embedded opportunities to learn language-the deep meaning of words • Increased rigidity, isolation, and frustration

5. Joint Attention • Joint Attention: • Must understand the nature of eye gaze for communication: to identify and share a topic of interest with another • Requires rapid eye shifts and attention shift • Some children with ASD may be overwhelmed by the task, not comprehend or have the ability (at first) to demonstrate the skill

6. Joint Attention Strategies • Identify target behavior: Gaze to orient to the speaker vs. gaze to initiate interaction (make a request, comment, protest) • If to initiate: • Be in the child’s visual field • Reduce amount of talk • Limit amount of facial movement (pleasant neutral expression) • Hold object of interest to the child next to your eyes and • Wait……… • Reinforce even the slightest gaze shift between your eyes and the object with the object of interest • Label the object (no need for empty “good job!” reinforcer) • Allow the child to engage with the object of interest • Repeat within a natural flow of interaction. • In this context, do not say “look at me” as the focus needs to be on keeping the child as the initiator of the interaction.

7. Distal Point The ability to use the pointer finger to direct another person’s attention to an object, person, event of interest with the purpose of sharing that object, person, event with the partner

8. Distal Point: Strategy One Gently rub the tip of the pointer finger Verbally prompt, let’s get our hands read Avoid using hand over hand instruction/blocking the three remaining fingers Keep the emphasis on the finger that has “meaning” –the pointer Engage in shared book reading or other activities where together the adult and child point to different objects, pictures that are within reach of both individuals

9. Distal Point: Strategy Two Place desired objects out of reach When child reaches for the object gentle rub the child’s pointer finger and Once the point is approximated, obtain the object for the child Reinforce with words describing the event such as: “Jimmy said: Want X” so that the child begins to learn that his point has meaning

10. Reciprocity The ability to engage in turn taking within a social interaction: non-verbal, vocal, verbal Dyadic vs. Triadic Interactions Dyadic: person to person; person to object Triadic: person to person to person; person to person to object

11. Reciprocity Strategies • Begin with dyadic interactions using: • Joint action routines • Create a rhythm and routine • Imitate the child’s developmental, adaptive behaviors • Scaffold the routine, child behaviors by: • Adding vocalization • Adding an action • Withholding, wait to obtain social signal (gesture, eye gaze, vocalization, verbal approximation) • Use vocal intonation to signal expectancy

12. Reciprocity Strategies • Triadic Interactions • Remember if the child isn’t responding to the triadic interaction, shift back to the dyadic. The purpose is to build meaningful, social turn taking – that are pleasant to create a desire to have MORE • Within a dyadic interaction add an object • Use the object to build upon the dyadic (the object moves, engages in an action) that is part of a known routine. • Withhold the object to elicit social signally: giving object to the adult, gaze shift, verbal/vocal approximation, sign etc. • Use language to indicate that the object has stopped and/or the child’s desire: the bunny is not moving, I am sad, Jimmy wants the bunny to dance. • Model the desired behavior: give the child the object, point to it, use 1-2 words such as “you do,” “make go” etc. • Reinforce naturally with language: “yeah bunny dance,” “you made him go” and the action paired with positive facial expressions

13. Combined Means, Initiation & Readability • Core feature: • Children with ASD typically use one communication behavior vs. combining 3-5 (gesture + facial expression + vocal intonation + eye gaze + words) • Reduced combined behaviors decreases readability of a communication behavior • Decreased readability • Increases likelihood we will • Miss the act • Misunderstand the intent • And the child will become frustrated • More evident when the child is attempting to initiate vs. respond to an interaction

14. Combined Means and Initiations • Interventionists need to begin to observe more: • we take combined means for granted • it is so tacit to our functioning so; • Observe, interpret, and respond to single communication behaviors (with a reasonable guess/hypotheses); • Target the ability to combine 2 communication behaviors • Strategies: • strategic wait, withholding, modeling, linguistic mapping to elicit the behaviors; naturally reinforce child initiated acts

15. Combined Means & Initiation: Importance The Gestural Complex and Joint Attention Lead to Language Development So this is important to work on, especially with young children who have minimal skills before they develop less adaptive communication behaviors Humans communicate to initiate and respond to interactions; so intervention must include development of meaningful and readable initiated acts

16. Initiated Acts: The Context • Initiated communication acts • communication behaviors (verbal/non-verbal) where a child begins the interaction • Strategies: • Build upon child’s interest • Developmentally the child initiates at first to request actions, objects, recurrence, and protest • Create scenarios within natural routine for the child to use adaptive communicative behaviors for the above social purposes.

17. Enhancing Communication within Play Imitate child’s behavior: Label the action (parallel talk) Scaffold the behavior: Add a new object or event; One at a time Model a new behavior or action Use strategic and expectant wait: facial expression, vocalizations, verbalizations Label problems the child encounters and wait Respond to any/all social signals as meaningful to encourage reciprocity Sabotage the interaction to create real problems

18. Teaching Children with ASD how to Listen Never repeat a directive more than twice Least-to-most prompts Strategic wait Slow the pace Look at the person versus an object

19. Strategies to Increase Comprehension Consistent Follow-Through Integration of Multiple Modes of Representation Multiple Repeated Examples

20. Thank You Questions