Communication and Autism Spectrum DIsorders

1. Communication and Autism Spectrum DIsorders Kristin J. Szewczyk, M.S./CCC-SLP February 1, 2009

2. Communication is simply defined as “an exchange of information;” however, the process of communication is much more complex. (Hedge, 2001, p. 2)

3. Problems with Communication

4. Communication deficits are one of the primary characteristics of autism spectrum disorders (ASDs) (American Pyschiatric Association, 2000)

5. Common Problems with Communication • Speech • May Never Develop Speech • 30% of individuals with ASD are Non-Verbal (Klin, 2006) • Articulation Errors • Difficulty understanding Prosody • Inflection of Speech • Oral Motor Difficulties • Cannot imitate oral movements • Drooling (American Speech-Language-Hearing Association [ASHA], 2009b; Prelock, 2006)

6. Common Problems with Communication • Expressive Language • Echolalia-Repeating what is said • Immediate • Delayed • Difficulty expressing wants/needs • Poor Vocabulary • Difficulty with Pronouns • Difficulty with non-literal aspects of language • Reduced sentence length (ASHA, 2009b; Prelock, 2006)

7. Common Problems with Communication • Receptive Language • Difficulty following directions • Difficulty answering questions • Pragmatic Language • Social Language • Difficulty with Initiating and Maintaining a Conversation • Difficulty understanding Facial Expressions/Body Language • Poor Eye Contact (ASHA, 2009b; Prelock, 2006)

8. Functions of Communication

9. Functions of Communication • Three Primary Functions of Communication in Individuals with ASD • Regulate Behavior • Social Interaction • Joint Attention (Wetherby & Prizant, 2005)

10. Functions of Communication • Regulate Behavior • First function to develop • Making requests • Objects • Activities • Expressing Wants/Needs • Hunger/Thirst • Asking for help (Prelock, 2006; Wetherby & Prizant, 2005)

11. Functions of Communication • Social Interaction • Play Activities • Requesting involvement with Family/Friends • Social Greetings • “Hello”/ “Bye-Bye” • Bring Attention to Self • Showing Off (Prelock, 2006; Wetherby & Prizant, 2005)

12. Functions of Communication • Joint Attention • Shifting attention between individuals and objects • Gaining an individual’s attention • Directing an individual’s attention • Make Comments • Ask Questions • Provide information (Prelock, 2006; Wetherby & Prizant, 2005)

13. Methods of Communication

14. Verbal Communication • Augmentative and Alternative Communication (AAC)

15. Verbal Communication • Using spoken words to express wants/needs, request items/activities, make comments, ask/answer questions, and engage in social interactions

16. AAC • AAC is a combination of symbols and methods that are used to improve communication (Downey & Hurtig, 2003) • Object Exchange • Sign Language • “Total Communication” • Picture Exchange Communication System (PECS) • Voice-Output Communication Aids (VOCAs)

17. Object Exchange • Real Objects • Child gives communicative partner an object to indicate what he/she wants • Example: Child gives parent a book to indicate that he/she wants to read a story • Child must have easy access to the objects in order to make wants/needs known (Strokes, 2006)

18. Sign Language Movements made with the hands to represent letters and words (National Institute on Deafness and Other Communication Disorders, 2008)

19. (Lifeprint.com, 2008)

20. Total Communication An AAC method that involves using verbalizations and sign language simultaneously (Goldstein, 2002; Prelock, 2006)

21. PECS • Developed to improve the communication skills of preschool students diagnosed with ASD • Child exchanges pictures with an individual to communicate • Consists of six phases (Frost & Bondy, 1994, 2002)

22. PECS Phases • Phase I – “How” to Communicate (Frost & Bondy, 2002, p. 67) • Instructor presents the individual with a preferred item • Individual chooses a picture that represents the preferred item • Individual gives the picture to the instructor to request the item • Instructor gives the individual the desired item

23. PECS Phases • Phase II- Develops independent requesting • Individual chooses a picture from his/her PECS book • Individual finds the communicative partner and gives the picture to him/her • Only one picture is used during this phase (Frost & Bondy, 1994; 2002)

24. PECS Phases • Phase III-Continues to develop independent requesting • Individual selects a picture from a larger field • Individual independently selects a picture from his/her PECS book and finds a communicative partner in order to make the request • Number of pictures increases as the individual gains accuracy and experience (Frost & Bondy, 1994; 2002)

25. PECS Phases • Phase IV- Combining pictures to make requests • Individual uses a sentence strip located at the front of his/her PECS book to build more complicated requests • Individual must locate the “I want” picture as well as the picture of the item or activity he/she is requesting • Individual then finds a communicative partner in order to make the request (Frost & Bondy, 1994; 2002)

26. PECS Phases • Phase V- “What do you want?” • Individual uses a sentence strip located at the front of his/her PECS book to build more complicated requests • Individual must locate the “I want” picture as well as the picture of the item or activity he/she is requesting • Individual then finds a communicative partner in order to make the request (Frost & Bondy, 1994; 2002)

27. PECS Phases • Phase VI- Independent Communication • Individual independently responds to a variety of questions and makes comments using his/her PECS book (Frost & Bondy, 1994; 2002)

28. PECS (Strokes, 2006)

29. VOCAs • Electronic device • Child pushes a button on device • Pictures/printed words on the buttons represent messages • Pre-recorded message plays • Vary in complexity and cost (Nunes, 2008)

30. VOCAs (The Sensory Company®, 2003)

31. VOCAs (AdaptAble Minds, n.d.)

32. VOCAs (SuperDuper Publications, 2009)

33. VOCAs (DynaVox Technologies, 2008)

34. Benefits of AAC • Beneficial for verbal/non-verbal children with ASD • Increases number of vocalizations/verbalizations • Improves functional communication skills • Expressing wants/needs • Requesting (Blischak, Lombardino, & Dyson, 2003; Charlop-Christy, Carpenter, Le, LeBlanc & Kellet, 2002; Dyches, Davis, Lucido, and Young, 2002 ; Goldstein, 2002; Mirenda, Wilk, and Carson; 2000; Nunes, 2008

35. Benefits of AAC • Improves communicative initiations • Responses • Comments • Improves social interactions • Decreases problem behaviors (Blischak, Lombardino, & Dyson, 2003; Charlop-Christy, Carpenter, Le, LeBlanc & Kellet, 2002; Dyches, Davis, Lucido, and Young, 2002 ; Goldstein, 2002; Mirenda, Wilk, and Carson; 2000; Nunes, 2008

36. Selecting a Method of Communication

37. When selecting a method of communication, should consider the following: • Communication needs of your child • Physical capabilities of your child • Child’s level of motivation • Flexibility/Accessibility of the method of communication • Consult with a speech-language pathologist (SLP) (ASHA, 2009a)

38. Communication Strategies

39. Strategies • Naturalistic Language Teaching • Joint Action Routines • Visual Strategies (Goldstein, 2002; Prelock, 2006; Tissot & Evans, 2003)

40. Naturalistic Language Teaching • Instruction and learning is provided during naturally occurring situations • Uses child-preferred materials • Learn and generalize skills at a faster rate • Child is reinforced for appropriate initiations and responses to communication (Harris & Delmolino, 2002; Prelock, 2006)

41. Naturalistic Language Teaching • Milieu language teaching • Child-directed modeling • Mand-modeling • Time-delay • Incidental teaching (Goldstein, 2002; Harris & Delmolino, 2002; Prelock, 2006)

42. Milieu Language Teaching • Child-Directed Modeling • Uses child’s interests • Establishes joint attention • Adult/Instructor provides verbal models • Reinforce correct responses • Repair incorrect responses (Harris & Delmolino, 2002; Prelock, 2006)

43. Example of Child-Directed Modeling • Interest: Child enjoys going for rides in the car • Adult/Instructor: “Say, ‘Open the door.’” • Child responds: “Door.” • Adult/Instructor: “Say, ‘Open the door.’” • Child responds: “Open the door.” • Adult/Instructor: “Nice talking!” • Adult/Instructor then opens the door to the car.

44. Milieu Language Teaching • Mand-Modeling • A mand is “a verbal instruction or request” (Prelock, 2006, p. 413) • Teaches functional communication skills • Utilizes child’s interests • Establish joint attention (Harris & Delmolino, 2002; Prelock, 2006)

45. Mand-Modeling • Adult/Instructor instructs the child to follow a command or complete a request • Provides a verbal model • Reinforce correct responses • Repair incorrect responses (Harris & Delmolino, 2002; Prelock, 2006)

46. Example of Mand-Modeling • Child approaches playdough, which is the child’s favorite activity • Adult/Instructor: “Say, ‘I want playdough.’” • Child says: “Dough.” • Adult/Instructor: “Say, ‘I want playdough.’” • Child says: “Want playdough.’” • Adult/Instructor: “Say, ‘I want playdough.’” • Child says: “I want playdough.” • Adult says: “Nice talking!” • Gives child the playdough

47. Milieu Language Teaching • Time-Delay • Using pauses between the mand and the provided model/cues • Develops independent communication (Harris & Delmolino, 2002; Prelock, 2006)

48. Example of Time-Delay • Child wants to watch a movie and stands in front of the TV • Adult/Instructor waits until child makes the request • Child says, “I want to watch a movie.” • Adult/Instructor completes the request

49. Milieu Language Teaching • Incidental Teaching • Increase language/conversational skills • Environment arranged to facilitate communication • Utilizes child’s interests • Child must interact with adult to make a request

50. Milieu Language Teaching • Adult instructs child to make a request or answer a question using a more complex response • Provides a model • Provides correction • Provides reinforcement (Harris & Delmolino, 2002; Prelock, 2006)