FUNCTIONAL COMMUNICATION Evaluation and Support

1. FUNCTIONAL COMMUNICATION Evaluation and Support Geni Moots Plotnick, M.A., SLP / Regional Autism Specialist SOESD Geni_Moots-Plotnick@soesd.k12.or.us

2. Today • Defining Functional Communication • Evaluation Components • Characteristic of ASD? • Goal-Setting • Service

3. SLP Opportunities…. • Team collaboration to determine eligibility • IEP Crafting • Direct Service for Communication, Social Cognition and Behavior • Train, rehearse, facilitate generalization • Consultation to parents and staff and peers -analysis -modeling -graphic supports

4. ASHA SAYS: “ Due to the pervasive nature of social communication impairment, individuals with ASD should be eligible for services from a speech/language pathologist.” www.asha.org/docs/html/GL2006-0049.html

5. The ASD Story • Prevelance 1/150 or higher • Neurologic disorder of perception and thought • Etiology?? Genetic predisposition with biochemical insult triggers?? • Can reliably be diagnosed as early as 18 months by experienced diagnosticians

6. ASD • COMMUNICATION • SOCIAL • SENSORY PROCESSING • PATTENRS OF BEHAVIOR / INTEREST Social Competence, Independence, Self-Regulation

7. ELIGIBILITY COMPONENTS • Developmental history/ Parent interview • File Review • Observations • Direct Interaction • Medical Statement • Assessment of Educ • Impact • Behavioral Rating Scales

8. Adult reporting Checklists Student Interview Observations Rating Scales Standardized Assessments Orchestrated or Analog Interactions Peer Probes Developmental comparisons FBA Sampling/Analysis TOOLS

9. 1. Social Communication • Orienting • Shared focus and emotion • Reciprocity-initiating bids to interact/maintain • Considering partners’s communications • Rapid shifting of attention (can they do it?)

10. 2. Language and Cognition • Comprehension • Verbal skills • Nonverbal comprehension and expression • Symbolic play • Literacy • Executive Functioning (problem-solving, planning, organization, flexibility)

11. 3. Behavior and Emotion • Assist team in acknowledging relationship between challenging behavior and communication • Regulating self in midst of bombarding environment and/or social challenges • Express a variety of recognizable emotions • Recognize and respond to emotions of others

12. 4. Augmentative/Assistive Technology • Recognition of,response to, use of various tools and symbols (object, photo, drawing, print etc) • Potentially augment input / output

13. 5. Contextual Engineering • Visual support and structure -picture schedules and work systems -social stories and scripts Self-determination/advocacy tools; individuals w/ASD seem to have been taught to depend on excessive prompting from others.

14. What’s In Place? Find and describe the embedded supports that are in place…those that seem to be working for the individual. • Fitting adult communication style • Assistive Technology (high or low tech) • Augmentative Communication (high or low tech) • Contextual Engineering (organization, clarity of room, schedules)

15. Watch carefully!

16. Standardized Assessment Receptive / Expressive Levels usually based upon individual’s response to graphic stimuli or adult action. Tests assess knowledge better than performance which involves rapid, multi-modal processing and response. FORM appear adequate but socially-based USE (requiring inference and prediction) may be skewed.

17. Evaluating Communication Development *CHAT *PPVT/EOWPVT *PLS *CELF *Social Comm *Test of Narrative Language Questionnaire *Test of Lang Competence Evidenced-Based Assessment Studies by 1) Sally Ozonoff and 2) Geralyn Timler 3) ASHA report

18. LANGUAGE AND COMMUNICATION (How we take in or put out language) -Comprehension -Offering information -Reporting events -Use of body -Frequency of bids directed to others SOCIAL (what we do to stay connected) -Quality of rapport -Shared enjoyment -Joint attention -Shared gaze/focus -Balance -Repair ADOS (autism diagnostic observation schedule)

19. Social Development Ages 1-3 interactions with caregivers and proximal, parallel play with peers Ages 3-5 mutual engagement in play activities. Preschool play is an avenue for fantasy -lost/found -danger/rescue -death/rebirth Heavy demands on perspective-taking, negotiation, roles, agree, disagree etc.

20. Intermed.Great sensitivity. Need to avoid rejection. Use gossip, teasing, negative evaluation M.S. Need more than group exceptance; need close relationship with other(s) as transfer parent-child bond H.S. Desire personal intimacy, self-disclosure, trust, commitment

21. Social Competence Abilility to relate effectively to people Ability to be accepted by others (Guay ’93) • SKILLS • INTERACTIONS • RELATIONSHIPS and FRIENDSHIPS

22. Evaluating Social Competence • Test of Problem Solving? • Test of Pragmatic Language? • CELF-IV Pragmatic Language subtest? Must have additional venues to assess the demands of authentic, spontaneous (unscripted) interpersonal communication.

23. CONTEXTS Quiet simple space Free choice Playground /break Cafeteria As group member responding to teacher instruction New / unexpected / upsetting events PARTNERS 1-1 w/familiar adult 1-1 w/unfamiliar adult w/peer in familiar setting w/small group w/parent The ‘Album’ vs. the ‘Snapshot’

24. Differential Diagnosis Co-occurrence with other physical, learning and/or mental health disorders is common. Scattered ASD traits may be indicative of other disorders rather than fulfilling an ASD picture. As a team member specializing in communication and social development it is critical that SLPs be knowledgeable.

25. PLAY ANYONE?? Research supports that ASD-to-NTD children displayed comparable use of communication to -request -protest -engage in constructive play -engage in nonsocial constructive play (puzzles) LESS use of social gaze, social responsiveness, shared affect, gestures, joint attention, symbolic/make-believe play

26. SHARING SPACE TURNS JOINT ATTENTION EMOTION/AFFECT -JOY -ANTICIPATION -DISAPPOINTMENT ACTIVITY/MOVEMENT OBJECTS TALK

27. MOST CRITICALGeralyn Timler, U Baltimore • PEER ENTRY -persistance (typical average=10 tries) -flexibility (need 3 strategies/alernates) -relevance (‘off-topic’=penalty) • Sustaining and maintaining collaboration • Conflict Resolution • Replace penalizing behaviors

28. NEGLECT = -solitary play -hover and wait -non-responsiveness -irrelevant behavior or talk -adult dependency REJECTION = -Hostility -Aggressiveness -Self-focused -Superiority -Defensiveness Atypical Social Behaviors Lead to…….

29. SAMPLES AND ANALYSIS

30. Most Common Communicative FUNCTIONS for • To obtain desired objects • To obtain desired actions -do this -go away -stop this • Verify facts (encyclopedia/dictionary/rules) • Complete scripted loops (reduce anxiety)

31. Two? Reciprocity and Balance Referencing Persistence/Repair Proximity and Orientation One is the loneliest #... Self-guidance Script stimming Rule review Intent of Vocal/Verbalizations?

32. Talk is Overrated We can teach and learn articulation, grammar and expression However……. Words are neither social nor communicative without a partner.

33. How does Student …….. -use peers as teaching/learning bud? -as a source of pleasure? -initiate / enter ? -maintain and repair? Student Output = Freq of Initiations Rate of Responses Verbal Nonverbal (action, gesture, expression) Key Probes for FC Evals:

34. PEERS 1-1, Small/ Large Group Sibling(s) Familiar Routine Setting Initiations Responses Balance ADULTS Parent(s) Teacher Paraeducator The Student’s Partners

35. HOW WE TALK Considering how adult communication influences atypical language and thought

36. Interaction / Interview Younger / More Fragile Give some time w/objects alone first Use Communicative Temptations Engage in imaginative 2-role skits w/props Have class photos Play w/ only two (identical) objects Play with only two (lock-key) objects Use of more phatives may encourage more S talk

37. Communicative TemptationsWetherby, Prutting, Prizant Ways to engage a reluctant communicator – 1.Create a problem that requires comm 2.Make a statement (non-confrontational) 3.Set forth a complaint or puzzle (to self) 4. Request information (“I want to hear..”) 4.Ask a question (last resort)

38. Older / More Competent • Sit side-by-side vs. across table • Avoid question strings • Watch at lunch/break • Leave pauses and voids • Disagree or surprise at least once (act like a peer!) • Peruse yearbook • Refer to ADOS / RDI interview ideas • Seek assistance “I don’t know where the library is” • May bring a peer (part-time?)

39. Input from General Educators • Teacher Survey: “__is being evaluated for ASD. We are looking as strengths and challenges in the areas of social/communication skills, unusual behaviors and interests. Given this focus, please send a brief description of this student from your perspective. Specific events you recall will be helpful but are not necessary. Thank you!”

40. INSTRUMENTAL -getting needs met vs SOCIAL -pleasurable interaction Student as RESPONDENT -passivity -compliance -focus on performance Vs. RECIPRICAL PARTNER -interactive -connected -initiating Potential Inhibitors

41. So, we will need to answer…………… are the social and communication behaviors characteristic of ASD ??

42. Comprehension -vocab -following directions -of verbal/nonverbal Processing -Orientation -Shifting attention/thought -Cognitive Flexibility Expression -intelligibility and prosody -relevance and range -clarity and repair -use of body/face -quantity and organization Connection w/Peers as -playmates/buddies -learning partners IMPACT ON EDUCATION

43. The SLP, The FCE and Curriculum Advocate for careful evaluation and ‘filling the gaps.’ As splinter skills are so prevalent in the neuro-atypical population, make sure core understanding is present. As these individuals often ‘learn’ structured, visual skills such as reading/math it is easy to move forth using grade-level benchmarks. Math (BOEHM space/quantity/time using realia,reality) Reading: Comp=MORE than recall! Check social savvy of inference and prediction.Don’t let fluency go beyond authentic comp! Vary genres at all levels.

44. Impact=Access and Participation • Orienting and Attending to environment and • main event or speaker(s) • Executive Functioning/goal-directed behavior • -Problem solving /self planning (variables/options/persistence) • -Initiation and Momentum (stop/start/inhibit) • Self-Organization

45. If eligible, then the goals… Should reflect: 1) The child 2) The core of the disability -present impact -projected impact SLP can assist casemanager in crafting these

46. Key Considerations • Language Processing and Comprehension • Functional, spontaneous communication • Play and Leisure • Social Interaction and Relationships across settings • Self-Regulation / Self-Advocacy • Functional academic skills

47. NCLB/Evidenced-Based Practicefocus on Autism and other DD Vol 20#3 *Individualizes supports and services – intensity and level based upon strengths/weaknesses *Systematic Instruction-desirable outcomes *Specific Content –must include and emphasizelanguage and social interaction (as primary) *Functional Approach to Problem Behavior-away from punishment/compliance to useful skill development

48. Getting Started • Replace most penalizing behaviors • Start and maintaing interaction • To support: -remain aware of own difficulties -practice ways to overcome these -apply to activities w/peers

49. Goal Priorities for ASD • Socio-Relational Communication/reciprocity • Independence; freedom from constant verbal prompting by adults • Cognitive Flexibility • Self-Regulation and Self-Advocacy: (know self and use support systems/communicate) • Problem Solving (beyond math!) • Literacy (Functional! Comprehension!)

50. ADJUSTING THE IMAGE • Great planning and support tool. Willamette ESD and Columbia Regional Programs gford@pps.k12.or.us • Beg / Inter /Adv: • Play and Leisure • Self-Advocacy • Relationships