Use Of Electronic Media To Promote Acquisition of Action Verbs and Prepositions in Autism Language Program

1. Use Of Electronic Media To Promote Acquisition of Action Verbs and Prepositions Created in: Autism Language Program, Children’s Hospital Boston Howard Shane, Ph.D. howard.shane@childrens.harvard.edu

2. www.aac-rerc.com This work is funded by the National Institute on Disability and Rehabilitation Research of the U.S. Department of Education, under grant number H133E030018. The opinions contained in this presentation are those of the grantee and do not necessarily reflect those of the U.S. Department of Education.

3. Acknowledgement Contributors to this presentation • Patients and parents in the Autism Language Program • Monarch School students, parents, and staff • Model Autism Program, Boston Public Schools • Sharon Shaham, James Sorce, Meghan O’Brien, Marie Duggan & John Costello (Center for Communication Enhancement, Children’s Hospital Boston)

4. Today’s Agenda • Overview of Teaching Language Concepts Program (TLC) • Why is learning language concepts difficult for some persons with ASD? • Why are visuals needed? • Three Phases of Instruction • Dynamic Scene Cues • Static Scene Cues • Element Cues • Developing Effective and Efficient Implementation Procedures for Teaching Element Cues • Using typically developing children • Adapting and applying findings to individuals with autism

5. Overview of VIP Goal Utilize visual supports to teach learners on the autism spectrum how to better communicate during everyday home, school and community interactions. Key ingredients • Visual language for comprehension and expression • A ‘closed language’ with restricted pragmatic opportunity -- targeting basic communicative operations • Mentors and learners use the same visual symbols • Use of advanced computer and video technologies

6. What is Visual Immersion? A symbol-rich environment An environment where visual symbols clarify spoken language, support expressive communication, assist with transitions, and facilitate learning. • Used in home, school, and community • Easy access to • Non-electronic symbols • Electronic Screen Media (Monitors and TVs)

7. What Does VIP Target? • Seven concrete Communicative Operations: • Protests/Refusals • Requests • Directives • Comments • Questions • Social conventions • Transitions • VIP is not intended to teach advanced communicative operations: • Abstract concepts: “…with liberty and justice for all.” • Passive voice: “The book was read by the boy.” • Complex syntactic structures: “If he hadn’t checked the weather in the morning, then he would have forgotten to bring his umbrella.” • Figurative language: “She flew to the bookstore.” • Humor : “Why did the chicken cross the road?” • VIP provides foundation for more advanced language-based intervention programs

8. VIP: Three Instructional Settings • Natural setting: Familiar, everyday people,objects, actions, locations and events as opportunities to overlay language. Takes advantage of adding language to already learned behavioral skills: • Daily living/self-help routines • Operational knowledge • Preferred play routines • Tabletop setting: A controlled environment involving one-to-one instruction • Virtual setting: Electronic (television or computer) display for presentation of materials Setting selection varies as a function of child and the skill to be learned.

9. Overview of Teaching Language Concepts Program (TLC)

10. Why Teach Language Concepts? Autism Language Program (ALP): • Population: Moderate to severe autism (from initial diagnosis to adulthood) • Core deficit: Difficulties with language comprehension and expression, in addition to pragmatic language skills • Comprehension: • Children on the spectrum often experience difficulty comprehending spoken language and/or auditory processing impairment (Novick et al., 1980; Boddaert et al., 2003). • Many children are able to follow routine-based, familiar directives, but have not yet demonstrated comprehension of more abstract linguistic concepts (e.g., verbs, prepositions, attributes) • Expression: • 50% of individuals with autism spectrum disorders do not use speech functionally (Wetherby and Prizant, 2005; Lord & Paul, 1997; Rutter, 1978) • Many children are able to reliably use PECS to request and label, but have not yet developed the ability to describe, comment, or ask questions

11. Model of Language Comprehension(Typical Development) Short-Term Memory Language Processor Spoken Language Comprehension

12. Model of Language Comprehension(Moderate-Severe ASD) Short-Term Memory Language Processor Verbal Information Comprehension • = Clinical insight suggests these impairments are due to: • Attention to auditory stimuli • Not understanding language as meaningful/symbolic • Fleeting nature of spoken language • Language processor ‘broken’ • Combinationof these • Language comprehension is often compromised • Occasional comprehension of noun labels and familiar directives (in context) • Impaired comprehension of relational linguistic concepts (e.g., verbs, prepositions, • attributes)

13. ‘Teaching Language Concepts’ (TLC) Program • A visual instruction system for hard to learn language concepts (e.g., verbs, prepositions and attributes). • TLC is a closed visual language • Instruction in the virtual environment (video clips), tabletop environment (photographs, toy figurines and miniature objects), and natural environments (home, school and community)

14. Three Phases of TLC Instruction

15. TLC Instructional Phases: • Learner progresses through all/some of three phases of visual language symbols, from concrete to abstract representations: • Dynamic SceneCues:full-motion video clips of action scenes

16. Bypassing Spoken Language Comprehension Using Dynamic Scene Cues (Moderate-Severe ASD) Verbal Information Imitation (as inferred from dynamic scene cues) Short-Term Memory Visual Information (dynamic scene cues) *Note: No involvement of language processor required for comprehension of dynamicscene cues

17. TLC Instructional Phases: • Learner progresses through all/some of three phases of visual language symbols, from concrete to abstract representations: • Dynamic SceneCues:full-motion video clips of action scenes • StaticSceneCues:photographs that capture a prototypical moment in the action scene

18. Bypassing Spoken Language Comprehension Using Static Scene Cues (Moderate-Severe ASD) Verbal Information Imitation (as inferred from static scene cues) Short-Term Memory Visual Information (static scene cues) *Note: No involvement of language processor required for comprehension of staticscene cues

19. Implications of Static Scene Cue Mastery Use of dynamic and static cues bypasses language processor • Due to load on language processor when using elements, some children may use static scenes as their communication system Mastery of static scene cues is a significant accomplishment • Can be used to promote general understanding and communication related to: • Daily Living Skills • Play • Transitions • Requesting • Commenting • Clarifying • Directives

20. TLC Instructional Phases: • Learner progresses through all/some of three phases of visual language symbols, from concrete to abstract representations: • Dynamic SceneCues:full-motion video clips of action scenes • StaticSceneCues:photographs that capture a prototypical moment in the action scene • Language Element Cues: graphic icons representing each of the individual linguistic components that comprise an action scene (e.g., subject, object, verb, preposition, adjective, etc.)

21. TLC Phase 3: Element Cues

22. Symbolate: Language Comprehension? • Stringing symbols together does not automatically result in comprehension. • Learners must first have a knowledge of language elements and semantic relationships, as provided in VIP. • Paradoxically, stringing symbols together may actually interfere with comprehension.

23. Model of Visual and Spoken Language Comprehension(Moderate-Severe ASD) Comprehension of Verbal Representation Verbal Information Short-Term Memory Language Processor Visual Information (element cues) Comprehension of Visual Representation (element cues)

24. Clinical Observations About Element Understanding • Some label elements without meaning attached (echolalic-like) • Some comprehend agent and object elements -- struggle with relational elements • Some comprehend isolated elements -- difficulty interpreting element strings • What improves element comprehension? • Immersion in symbol-rich environment • Mass trials across multiple settings and communication partners • Computer-based instruction • Persistence over extended period Bottom line: A more effective, efficient way of teaching language elements must be developed.

25. TLC 3 Phases: Clinical Observations Progressing from Dynamic Scene Cues to Static Scene Cues -- is easy No involvement of language processor required Static Scene Cues to Element Cues -- is difficult Requires involvement of language processor But The payoff is worth it -- foundation for generative language Goal: Combine language element cue vocabulary with their understanding of semantic relationships to generate novel sentences for expressing requests, comments, replies, etc. in natural settings.

26. The Empirical Challenge • Can we better understand the process? • Can we expedite the process?

27. Developing Effective and Efficient Implementation Procedures for Teaching Element Cues

28. Top Down Approach

29. Example of Mixed Display - with Referencing

30. The TLC Approach Strategy: First study typical children, then apply findings to children with autism Rationale: • Not yet literate • Able to verbalize thought process • Compliance Subjects: Ages 3 yrs, 11 mos to 6 yrs, 4 mos • Procedure: General task - sequence three linguistic elements: left-to-right reading order • agent + action + object • agent + preposition + object • Experimenter provides no spoken language to label elements • Learner demonstrates comprehension of element string by acting out directives • Multiple design-prototype-test cycles to refine TLC instructional approach

31. Iteration 1: Top-Down Approach - Sequentially Through Three Instructional Phases Iteration 1 Procedure • Learner presented with • Dynamic scene cues; imitate action • Static scene cues; imitate action • Element cues; demonstrate comprehension by acting out directives • For each instructional phase, learner viewed the visual cues and was provided with spoken prompt, “Now you do it!”

32. Iteration 1: Top-Down Approach Sequentially Through Three Instructional Phases Outcome: • Able to accurately imitate dynamic and static cues • Difficulty understanding task when presented with element cues (often attempted to match objects to elements rather than carry out directive) • Difficulty comprehending left-to-right sequence of ‘reading’ elements • Difficulty understanding meaning of verb/preposition (abstract) symbols • Difficulty comprehending de-contextualized element strings. • Tendency to act on objects in a familiar manner (e.g., ‘man on ladder’ rather than ‘man climbs ladder’)

33. Iteration 2: Modified Top-Down Approach Modifications to Iteration 1 Procedure: • Introduced visual template to focus attention on left-to-right order of elements, and presented elements in left-to-right sequence • Introduced Mixed Display (Static scene cue along with Element cues) and demonstrated association between scene cue and its elements • To enhance understanding of task expectation: • Presented task as ‘game’ to discover meaning of the relational (verb or preposition) symbol • Experimenter modeled the task

34. Iteration 2: Visual Template

35. Iteration 2: Modified Top-Down Approach Outcome: • Initially learners did not appear to attend to the relational element -- verb or preposition (e.g., “You don’t need that one”) • Still initially attempted to match the agent and object elements to their physical objects • Given repeated trials, demonstrated comprehension of the individual elements, but continued to experience difficulty with the left-to-right ‘reading’ order for elements

36. Iteration 3: Bottom-Up Approach Modifications to Iteration 2 Procedure Instruction started at element rather than dynamic phase • Presented elements on computer monitor • Experimenter modeled the task • Guided discovery to select combination of element strings to play corresponding video clip • Then moved to tabletop • Presented non-electronic task with identical element cues and physical objects; • Experimenter modeled the task • Learner encouraged to create element strings to direct the actions of communication partners

37. Software Applications Puddingstone Place Learning Together with Music

39. Iteration 3: Bottom-Up Approach

40. Iteration 3: Bottom-Up Approach Outcome: • Older learners were able to execute each directive presented and label each element • Younger learners had difficulty attending to screen and task; more likely to engage in their own independent play with the materials

41. Iteration 4: Modified Bottom-Up Approach with Compelling Scenes • Modifications to Iteration 3 Procedure: • Created ‘fun’ scenes depicting engaging, motivating activities using human models and life-sized objects • Clicked on message window to activate video clip of corresponding element string (in hopes of enhancing attention to relational element) • Presented learner with an ‘agent’ element cue representing him/herself • Encouraged learner to use elements to direct his/her own play and actions of communication partners

42. Iteration 4: Modified Bottom-Up Approach

43. Iteration 4: Modified Bottom-Up Approach with Compelling Scenes Outcome: • Actively engaged • Successfully combined elements - although still initial tendency not to attend to relational element (verb or preposition) • Prepositions more difficult than verbs

44. Iteration 5 Modifications to Iteration 4 Procedure: • Focus attention to relational element (verb or preposition): • Animated relational element • Click on relational element to play video

45. Key Ingredients to Teaching Element Cues • Present elements electronically • Guided discovery with element combinations (to play video) • Provide children with symbols representing themselves and familiar communication partners to allow them to direct the activity • Begin instruction with fun, motivating tasks. Gradually expand to language-arts activities. • Animate center elements to direct attention to element and enhance likelihood of comprehension

46. Directions for future TLC research • Improve symbols • Animated symbols (verbs, preposition, attributes) • Generalization of language skills targeted in TLC to natural setting • Facilitating generative language