ASD and AAC: Making it Work

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ASD and AAC Making it Work!

• Maija Gulens, MS, CCC-SLP
• Speech-Language Pathologist
• Augmentative Communication and Learning
  Enhancement Program

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Introduction

• Background and experiences
• Theoretical perspectives on autism
• Overview of strategies
• References and resources
• Video Illustrations
• Summary and Questions

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Theoretical Perspectives on Autism

• Joint Attention Deficits and Executive Function
  Deficits (Mundy Stella, 2000)
• Deficits in social orienting early in
  development, certain neuroaffective motivation
  systems that prioritize social information
  processing are impaired
• Deficits in executive function certain cognitive
  processes select appropriate goal directed
  actions from an array of competing action
  potential
• It is possible that the early motivation system
  that prioritizes orienting to social stimuli
  primes the development of the capacity to select
  appropriate actions in the face of competing
  stimuli
• This would give early practice (and neurological
  organization) associated with selecting an action
  given multiple distracters

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Theoretical Perspectives on Autism

• Deficits in Theory of Mind and gestalt
  perception (Bogdashina, 2005)
• Perception of the whole scene as a single entity
  with all the details perceived (but not
  processed) simultaneously
• Do not perceive wholes with out complete
  attention to the constituent parts
• In order to recognize things, they must be
  exactly the same as previously experienced,
  otherwise the gestalt of the situation is
  different (causing fear, stress, frustration)
• This might explain dislike of changes and
  preference for routines
• Also leads to rigidity of thinking and lack of
  generalization

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Overview of Strategies

• Use AAC to Facilitate Speech and Language
• Customize for Motivation
• Increase Language Output for Functional
  Communication
• Teach Generalization
• Modify Challenging Behaviors

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1) Use AAC to Facilitate Speech and Language!

• Supported by ASHA position statement on best
  practices for ASD
• Research Support none to suggest that AAC
  interventions have a negative impact on the
  development of speech
• Supported by Clinical Experiences

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2) Customize for Motivation

• Do anything to help engage the child!
• Follow the childs lead (Miller, 1981)
• imitate, engage, try parallel play

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Customize for Motivation

• Consider the benefits and challenges of engaging
  the individual within his or her specific scope
  of interest (Prizant, Wetherby, Rydell, 2000)
• stereotypical repetitive behaviors or stimming

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Customize for Motivation

• Recognize the importance of developing
  responsivity or ensuring balanced reciprocity
  between the individual and the communication
  partner (Harwood, Warren, and Yoder, 2002)
• Via engagement through joint action routines
  (Snyder-McLean, Solomonson, McLean Sack, 1984)
• A ritualized interaction pattern, involving join
  action, unified by a specific theme or goal,
  which follows a logical sequence, including a
  clear beginning point, and in which each
  participant plays a recognized role, with
  specific response expectancies, that is essential
  to the successful completion of that sequence.
• Via introduction of symbolic communication
• PECS (Bondy Frost, 1994)
• modified picture exchange communication system

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Customize for Motivation

• WOW! - Follow the basic principles of assessment
  in AAC that include exploration of visual,
  auditory, access, and sensory needs, as well as
  cognitive and developmental level (Beukelman
  Mirenda, 1998) in choosing modalities
• Gestures/Signs
• Photos/PCS
• Voice Output/Verbal
• Text

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3) Increase Language Output for Functional
Communication

• Use Power Words
• More ? for continuation of an activity
• Expand to more object, more action
• Expand to commenting Yay! I like that!
• Help ? for engagement, to increase
  self-determination throughout daily activities,
  for replacement of frustration
• All done ? for protesting/rejection, for task
  completion, for termination

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Communication Temptations (Wetherby Prizant,
1989)

• Eat desirable food in front of child without
  offering to him/her
• Activate a wind-up toy, let it run down, hand it
  to the child
• Initiate a familiar game, play it until child
  expresses pleasure, then wait
• Open bubbles, blow bubbles, close jar tightly and
  hand to child
• Blow up a balloon and let the air out hand it to
  the child
• Hold an undesirable food to the childs mouth
• Place a desired toy or food in a clear container
  with a tight lid that the child cant open give
  it to the child and wait
• Put the childs hand in a cold/wet/sticky
  substance (and wait) (e.g. pudding, paste)
• Roll a ball to the child after several rolls
  back and forth, change to a car or other wheeled
  toy
• Put a toy that makes noise in an opaque bag, then
  shake the bag, and hold it up to the child

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3) Increase Language Output for Functional
Communication

• Increase range of Communicative Functions
• WOW! Although some of the most well known and
  frequently used interventions, such as PECS
  (Bondy Frost, 1994), provide an important
  starting point for teaching communication
  behaviors, the range of communicative functions
  taught to children with autism needs to be
  expanded beyond requesting (Mirenda, 2003
  Wetherby Prizant, 1989 Loveland, Landry,
  Hughes, Hall, McEvoy, 1988).

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The Communication Matrix (Rowland, 2004)

• A tool that represents 4 basic reasons for
  communicating, and 7 levels of competence, and
  was designed for individuals with severe
  communication impairments. It is useful to
  assess communication skills for
• refusing
• obtaining
• engaging in social interactions
• providing or seeking information
• provides a useful framework for determining
  communication goals, by demonstrating strengths
  and needs in each area

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Early Semantic Combinations (Brown, 1973)

• attributeentity (e.g., big ball)
• agentaction (e.g., monkey jump)
• actionobject (e.g., help me)
• actionlocation (e.g., hurt head)
• possessorpossession (e.g., baby shoes)
• recurrence (e.g., more cracker)
• denial/rejection (e.g., no shoes)
• disappearance (e.g., all done baby oh no
  shoes)

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Grammatical Morphemes

• Browns Stages
• II -ing in plural
• III on possessive
• IV regular past irr past reg 3rd
  sing. articles copula be
• V auxiliary be irreg 3rd sing.

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4) Teach Generalization

• Need to explicitly design strategies for
  generalization of skills into the instructional
  program
• WOW! Need explicit teaching approach for symbol
  learning, access skills, and language skills
  (Angelo Goldstein, 1990 Kozleski, 1991
  Wilkinson McIlvane, 2002)
• Across familiar partners, (including staff
  members, peers, family members), as well as
  unfamiliar partners (Basil, 1992 Rowland
  Schweigert, 1999)
• Across settings (Prizant, Wetherby, Rydell,
  2000),
• Across social networks (Blackstone Hunt Berg,
  2003)
• Across communication contexts (Light Binger,
  1998)

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4) Teach Generalization

• Select Vocabulary for General Use
• Use broad statements rather than narrow ones
• (e.g., red crayon blue crayon vs red,
  blue, green)
• (e.g., Dont hit me vs please dont do that)
• Simplify language input to provide models for
  repetition (echolalia)
• (e.g., Before we go you need to go over there,
  sit down, and get your shoes on vs first shoes,
  then go home)
• Avoid pronouns when modeling speech
• (e.g., I want to eat vs time to eat)
• (e.g., Do you want more crackers to eat? vs
  more crackers)
• Provide practice in multiple contexts with
  multiple partners

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5) Modify Challenging Behaviors

• Communication repertoires also need to be
  expanded to replace challenging behaviors with
  acceptable communication responses (Wacker, Berg,
  Harding, 2002)
• Functional behavior analysis - Need to identify
  the function of the inappropriate communication
  behavior (i.e., biting self, throwing self down,
  running, screaming)
• to escape an activity,
• to avoid an event about to take place,
• to request another action/item (Sigafoos,
  OReilly, Drasgow, Reichle, 2002)

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5) Modify Challenging Behaviors

• ABCs (antecedent behavior consequence)
• Replacement behavior (communication strategy)
  needs to occur during the antecedent phase,
  before the behavior emerges, and before the child
  becomes agitated and or dysregulated
• There are socially acceptable forms (saying no,
  or making gestures to avoid undesired
  objects/actions) to make these requests, but
  often children with autism need to be explicitly
  taught those forms
• WOW! the replacement behavior needs to serve the
  same function, needs to be as efficient, and
  needs to be more reinforcing than the previous
  behavior for it to be replaced (Wacker, Berg,
  Harding, 2002)

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Decrease Task Demands through Assistive Technology

• Consider the impact of deficits on typical tasks
• problems fine motor skills and organization
• task analysis writing assignment
• generate ideas -memory, vocabulary, semantic
  associations
• write down ideas - hand writing
  encoding/spelling
• expand ideas semantic syntactic organization
• revise and edit content - monitor main idea
• produce text

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• Explore the role of computers in intervention
• motivation games, graphics, videos
• multi-media learning environment
• concept development First 1,000 Words
• language development Laureate Software
• literacy development Kid Phonics, Reader
  Rabbit, Jumpstart
• organization Kidspiration, Inspiration

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• to break down tasks
• note taking and outlining Word, Writing with
  Symbols
• writing aids spell check feature
• talking word processors WriteOutloud,
  SymWriter,
• word prediction software EZKeys CoWriter
  SDPro
• audio input and speech recognition software
  Dragon Naturally Speaking
• alternative textbooks

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Increase Positive Behavioral Supports

• Provide visual supports
• Visual schedules
• objects, photos, pictures, text
• aid comprehension of what is to come
• WOW! Schedules need to be flexible/changeable
  to accommodate changes in routines

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• Task schedules
• identify of steps for completion (e.g., feeding
  task)
• reinforce good behavior with a reward (e.g.,
  swing puzzle)
• break down the task into meaningful steps (e.g.,
  potty training)
• Visual Timers
• Aid concept of beginning, middle, end of activity

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Provide free choice time

• for preferred activities, for sensory-motor
  breaks, for self-expression and
  self-determination
• WOW! Schedules need to be functionally and
  visually distinct from choice boards/devices
• Following a schedule is receptive task this is
  what is next
• Making a choice of activity is an expressive task
  I want to
• Be sure the child has the power of communicating

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Use Technology

• to increase independence, decrease reliance on
  people for prompting

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6) Summary Words of Wisdom

• To facilitate engagement and motivation Follow
  the basic principles of assessment in AAC that
  include exploration of visual, auditory, access,
  and sensory needs, as well as cognitive and
  developmental level
• To increase functional communication The range
  of communicative functions taught to children
  with autism needs to be expanded beyond
  requesting
• To ensure generalization of skills Need explicit
  teaching plan to help generalize use of symbols,
  access skills, and language skills
• To modify challenging behaviors with
  communication alternatives The replacement
  behavior needs to serve the same function, needs
  to be as efficient, and needs to be more
  reinforcing than the previous behavior for it to
  be replaced
• To maximize the use of visual supports (a)
  schedules need to be flexible/changeable to
  accommodate changes in routines (b) schedules
  need to be functionally and visually distinct
  from choice boards/devices

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7) Resources

• Audiology, Speech Pathology and Learning Services
• 720-777-6800 - Appointments
• Augmentative Communication Learning Enhancement
  Program
• 720-777-6250 Appointments
• Neuropsychiatric Special Care Program (families
  in crisis ages 4-17 ASD or low IQ)
• 720-777-8240 Appointments
• http//www.thechildrenshospital.org/conditions/psy
  ch/neuropsych.aspx
• Child Development Unit (multidisciplinary
  evaluations)
• 720-777-6630 Appointments
• http//www.thechildrenshospital.org/news/publicati
  ons/tchnews/2006/patient_care.aspx

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8) References

• Angelo, D., and Goldstein, H. (1990). Effects of
  a pragmatic teaching strategy for requesting
  information by communication board users. Journal
  of Speech and Hearing Disorders, 55, 231-243.
• Basil, C. (1992) Social interaction and learned
  helplessness in severely disabled children.
  Augmentative and Alternative Communication, 8,
  188-199.
• Beukelman, D. and Mirenda, P. (Eds.) (1998).
  Augmentative and alternative communication
  Management of severe communication disorders in
  children and adults. (2nd ed.). Baltimore, MD
  Brookes.
• Blackstone, S. Hunt Berg, M. (2003). Social
  Networks A communication inventory for
  individuals with severe communication challenges
  and their communication partners. Monterey, CA
  Augmentative Communication, Inc.
• Bogdashina, O. (2005). Theory of mind and the
  triad of perspectives on autism and asperger
  syndrome A view from the bridge. London Jessica
  Kingsley Publishers
• Bondy, A., Frost, L. (1994). The Picture
  Exchange Communication System. Focus on Autistic
  Behavior, 9, 1-19.
• Harwood, K., Warren, S., Yoder, P. (2002). The
  importance of responsivity in developing
  contingent exchanges with beginning
  communicators. In J. Reichle, D. Beukelman, and
  J. Light (Eds.) Exemplary practices for beginning
  communicators. (pp. 59-96). Baltimore, MD
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• Kozleski, E. (1991). Visual symbol acquisition
  by students with autism. Exceptionality, 2,
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• Light, J., and Binger, C. (1998). General
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• Loveland, K., Landry, S., Hughes, S., Hall, S.,
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• Rowland, C. (2004). Communication Matrix A
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• Rowland, C., Schweigert, P. (1999). Its
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