Created in

1

Teaching Language Concepts (TLC) Language
Instruction For Persons on the Autism Spectrum

• Created in
• Autism Language Program,
• Childrens Hospital Boston
• Howard Shane, Ph.D.
• James Sorce, Ph.D.
• Meghan OBrien, M.S., CCC-SLP
• Marie Duggan
• Anna Hutt Fredman
• Sharon Weiss-Kapp, M.S., CCC-SLP

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 (Augmentative Communication
  Program, Childrens Hospital Boston)
• John Costello (Augmentative Communication
  Program, Childrens Hospital Boston)

4
Todays 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 Teaching Language Concepts Program
(TLC)
6
Why Teach Language Concepts?

• Autism Language Program (ALP)
• Population Primarily individuals with 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

7
Model of Language Comprehension(Typical
Development)
Short-Term Memory
Language Processor
Spoken Language
Comprehension
8
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
• Combination of 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)

9
Current Intervention Practices

• The importance of visuals
• Providing communication via an alternative
  modality/channel (visual) takes advantage of an
  area of relative strength -- visual processing --
  to extract the intended meaning (supported by
  research and considerable clinical observation)
• Sustained presence -- while spoken language is
  ephemeral, visual symbols remain present,
  providing an extended period of time for
  additional rehearsal and processing.

• However
• Many programs targeting individuals with ASD use
  visuals, yet the focus is typically on
• Developing expressive language skills
  (particularly requesting and labeling)
• Scheduling
• Few communication programs (spoken or visual)
  focus on developing language comprehension

10
Teaching Language Concepts (TLC) Program

• A visual instruction system for teaching language
  concepts that tend to be difficult for people
  with moderate to severe autism (e.g., verbs,
  prepositions and attributes).
• TLC is a closed visual language, limited to the
  essential vocabulary and syntax needed to support
  the comprehension and expression of practical,
  everyday communication exchanges.
• Instruction typically begins in the virtual
  environment (video clips) and the tabletop
  environment (photographs, toy figurines and
  miniature objects), then extends to the natural
  environment to enable functional communication at
  home, school and community.

11
Key Ingredients of TLC

• Visual language for both language comprehension
  and expression
• Both mentors and learners use the same visual
  symbols to communicate with each other
• Targets language comprehension viewed as
  foundation for expression
• Advanced computer and video technologies attract
  and maintain childrens attention, provide
  compelling multimedia language instruction, and
  enable the use of dynamic visual symbols

12
What TLC Does Not Target

• TLC 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 hadnt
  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?
• TLC provides a solid foundation for launching
  language-based intervention programs that target
  the more advanced communicative operations listed
  above.

13
Three Phases of TLC Instruction
14
TLC Instructional Phases

• Learner progresses through all/some of three
  phases of visual language symbols, from concrete
  to abstract representations
• Dynamic Scene Cues full-motion video clips of
  action scenes

15
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 dynamic scene cues
16
TLC Instructional Phases

• Learner progresses through all/some of three
  phases of visual language symbols, from concrete
  to abstract representations
• Dynamic Scene Cues full-motion video clips of
  action scenes
• Static Scene Cues photographs that capture a
  prototypical moment in the action scene

17
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 static scene cues
18
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

19
TLC Instructional Phases

• Learner progresses through all/some of three
  phases of visual language symbols, from concrete
  to abstract representations
• Dynamic Scene Cues full-motion video clips of
  action scenes
• Static Scene Cues 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.)

20
TLC Phase 3 Element Cues
21
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)
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
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.
24
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.

25
The Empirical Challenge

• Can we better understand the process?
• Can we expedite the process?

26
Developing Effective and Efficient
Implementation Procedures for Teaching Element
Cues
27
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

28
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!

29
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 climbs ladder rather than ladder on
  man)

30
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

31
Iteration 2 Visual Template
32
Iteration 2 Modified Top-Down Approach

• Outcome
• Initially learners did not appear to attend to
  the relational element -- verb or preposition
  (e.g., You dont 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

33
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

34
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

35
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

36
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

37
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

38
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

39
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