1 / 31

Enhancing Verbal Communication- Where to start?

Enhancing Verbal Communication- Where to start?. Jennifer Lozier M.S. CCC-SLP. Welcome activity. Different levels our children are on Non-verbal Starting to verbalize Fully functional?. What you will learn.

toan
Download Presentation

Enhancing Verbal Communication- Where to start?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Enhancing Verbal Communication- Where to start? Jennifer Lozier M.S. CCC-SLP

  2. Welcome activity • Different levels our children are on • Non-verbal • Starting to verbalize • Fully functional?

  3. What you will learn • Describe the characteristics and needs of a child with ASD and severe cognitive impairment • Choose goals and speech therapy intervention • List multiple strategies to employ in therapy sessions

  4. Characteristics • • Multiple repetitive behaviors • • Poor verbal skills or non-verbal • • Few opportunities to interact in a social context • • Low IQ scores • • Poor social skills • •Little to no academic gains • • Maladaptive behaviors such as self-injury, aggression, and/or property destruction

  5. Characteristics • • High rate of uneven cognitive development • • Indications of a dissociation between verbal and visual- perceptual skills among the older children. • • Specific association of discrepantly high nonverbal skills with increased social symptoms • • Suggestion that the nonverbal > verbal profile may index an etiologically significant subtype of autism.

  6. Characteristics • • Significant positive correlation between the presence of repetitive behaviors and the Hyperactivity scale of the ABC. • • Parent ratings of their stress levels and the presence of repetitive behaviors in their children were highly correlated.

  7. Characteristics • • Children with autism grow up to be adults with autism. • • If communication is poor as a child, it can be even poorer as an adult. • • If a child had access to an alternative communication system when they were in school , they have frequently lost that access as they transition to adult services.

  8. None of this matters – because you tailor the intervention to the needs of the child – not the description or the diagnosis!!! • Cookbook curriculums will not work! • Each child is unique and it is necessary to individually determine needs and design an intervention plan to meet those needs.

  9. Our Goal? • • Increase functional communication • • Improve quality of life • • Decrease maladaptive behaviors • • Ensure a basic human right

  10. Where to start? • • Always with an evaluation. • – Typical standardized tests will not help. • – Use some tests that are younger than age for skills assessment only. • – VB-MAPP – Verbal Behaviors Milestones Assessment and Placement Program • – ABLLS - The Assessment of Basic Language and Learning Skills - Revised • • Consult with psychology and behavior analysts.

  11. WHY the VB-MAPP? • • Breaks down skills such as communication intent: • – Makes eye contact (gaze shift) as a mand for attention or other reinforcer • – Moves close to a reinforcing time to indicate desire • – Pulls an adult to get access to a reinforcing item • – Points or gestures toward a reinforcer in order to obtain it

  12. WHY THE VB-MAPP? • • Tacts 3 body parts • • Tacts 2 auditory stimuli (ringing phone) • • Spontaneously emits a tact containing two words for 5 different tacts (baby crying) • • Tacts 40 different items when asked “What’s that?”

  13. BEHAVIOR & SPEECH

  14. CASE HISTORY #1 – Dax • • 9 year old male • • Non-verbal • • IQ tests unable to be administered due to lack of compliance. • • Severe self-injury • • Property destruction • • Unsuccessful with PECS for 3+ years • • Has a Vantage Lite • • Has seizures, Pica, and auto-immune disorder. • **Asked parents for their preferred items so you know how they can be reinforced.

  15. Dax • Results of evaluation: • • Very poor play skills • • Engages in simple initiating joint attention for highly preferred items • • Points to 3-D objects with verbal and gestural prompts

  16. Therapy • • Play–we have to teach him how to have fun. • – Loves deep pressure, tickles, rolling on a therapy ball • – Eye gaze to indicate want for more • – No verbal demands, no signs, no icons • • He is at a pre-linguistic level and has to learn that intent, motivation, and interaction.

  17. Therapy • • Once interaction is established– give it time! • • Introduce Total Communication • – Signs • – PECS • – Icon • – Device • •Take data on which method is most successful

  18. What worked for Dax? • PECS and Vantage Lite • PECS was used for everyday communication throughout the day

  19. Goals • Will use 1 word utterances to direct the course of an activity • Say “all done” to show that something is finished with gestural prompts and 70% accuracy. • Direct another person’s actions by saying the word “go” with gestural prompts and 70% accuracy. • Say the word “help” to request help with gestural prompts and 70% accuracy. • Say the word “stop” or “all done” to indicate that he is finished with an activity with gestural prompts and 70% accuracy. • Say the word “stop” to command someone else to stop something with gestural prompts and 70% accuracy.

  20. Goals • Use PECS to request a preferred item/activity. • Give PECS symbol to request the following items/activities: “cereal, cracker, chip, popcorn, cookie, candy, swing, book, movie” with gestural prompts with 90% accuracy over a 3 month treatment period.

  21. Case History #2- Bryan • 19 year old male • Minimal verbal expression • Severe aggression and self-injury • I.Q. = 79 • Significant weakness of the tongue • Severe excessive tone of the upper lip

  22. Bryan • Results of Evaluation • Vocabulary age equivalent 3.9 years • Inability to produce bilabials (sounds produced when lips are together- b, p, m) • Flips hand toward desired item • Highly motivated by edibles

  23. Therapy • Took a very long time to establish rapport • First several months of treatment focused on pairing • Playing games, using preferred items, and lots of gluten free pretzels and Hot Tamales • Building rapport- motivation- was critical and the focus for treatment to be successful!

  24. What worked for Bryan? • Slow and steady • Pairing • Initial goal of therapy focused on interaction and not language production of articulation precision • Employing different reinforcement schedules

  25. Goals • • Engage in cooperative and/or turn-taking activities • – Participate in non-verbal turn taking activities for an average of 3 minutes per activity for at least 4 activities during the therapy session. • – Complete 1 step directions with 70% compliance during the therapy session as averaged over a three month period.

  26. Goals • • Use functional expressive and receptive language skills. • – Use 3-5 word sentences to communicate basic wants and needs in 6/10 opportunities during a treatment session. • – Greet an adult and state how he is feeling in 3/4 opportunities during a treatment session given maximum cues. • – Identify and label facial expressions with 70% accuracy given moderate cues. • – Identify and label at least 10 items in simple, common categories with 80% accuracy.

  27. Goals • • Increase accurate production of bilabial consonants. • – Produce /p,b,m/ in the initial and final position of words with minimal prompts with 90% accuracy. • – Participate in oral-motor exercises to decrease facial tone and lip retraction 2-5 minutes per treatment session.

  28. What are your greatest challenges? • • Motivation • • Interaction • • Goal setting • • Reinforcement schedules

  29. Strategies • • Be functional– skills needed for a successful life • – Sorting – but sorting what? • – Categories – of what, for what? • – Social skills – greetings, closings, please and thank you • – Money – not just counting and value but the exchange • Reinforcement Schedules- Reinforce often, more often than you think.

  30. Useful resources • •Peer Play and the Autism Spectrum- Pamela Wolfberg • •VB-MAPP – Mark Sundberg, Ph.D. • •Functional Behavioral Assessment, Diagnosis, and Treatment – EnnioCipani and KevenSchock • •Teaching Language to Children with Autism or Other Developmental Disabilities – Mark Sundberg, Ph.D. and James Partington, Ph.D. • •Encyclopedia of Basic Employment and Daily Living Skills - Phillip Roy • •PrentkeRomich AAC Lab & Language Stages Chart

  31. References • Lynn M. Dudek, M.S. M.B.A., CCC-SLP, many of her slides were used in this presentation. • Gabriels, R., Cuccaro, M., Hill, D., Ivers, B., & Goldson, E. 2004. Repetitive behaviors in autism: relationships with associated clinical features. Research in Developmental Disabilities, 26 (2), 169-181. • Joseph, R., Tager-Flusberg, H., & Lord, C. 2002. Cognitive profiles and social-communicative functioning in children with autism spectrum disorder. Journal of Child Psychology and Psychiatry, 43 (6), 807-821. • Sundberg, M. & Partington, J. (1998). Teaching language to children with autism or other developmental disabilities. Concord, CA: AVB Press.

More Related