Autism Spectrum Disorders: Strategies for
the School-Based SLP
Melanie W. Hudson, M.A., CCC-SLP
National Director
EBS Heal...
Understanding Asperger’s Syndrome and the SLP’s Role in
Assessment and Intervention
Defining Autism
• DSM- IV-TR, 2000
• Behavior Disorder
• Brain disorder with genetic basis
• Social interaction
• Verbal/n...
Prevalence of Autism
• 1970s: 2-5 per 1000
• 2000: 1/500 (DSM-IV-TR, 2000)
• 2003: 34-60 per 1000 (Fombonne)
• 2007: 1/150...
The Concept of Autism:
• Richard Grinker: Anthropological
Explanation
• Leo Kanner: Differential Diagnosis with
Schizophre...
1. Autism Disorder
2. Asperger’s Disorder
3. PDD - NOS
Autism Spectrum Disorder
Autism
4. Rett’s Disorder
5. Childhood Dis...
Asperger’s Disorder
• Qualitative impairment in social interaction in at least 2 of the
following:
– Marked impairment in ...
Asperger’s Disorder (cont’d)
• Restricted repetitive and stereotyped patterns of
behavior, interests, and activities as ma...
Early Diagnosis is Critical
• Early identification of children who are “at risk”
for ASD facilitates early intervention
• ...
Autism impacts:
• Social Interaction
• Communication
• Behavior
SLP Role in Assessment and Intervention
• Prioritize goals for achieving social
communication
• Honor and adapt to a famil...
Assessment Tools:
• Structured parent interviews
• Extensive observations of the child in a
variety of settings – with one...
Assessment for ASD Child with Higher
Skills
• More traditional tools do not get at underlying pragmatic
challenges
• Narra...
Other Tools
• “The Pragmatic Protocol”, Prutting and Kirchner
– Developed in 1982 to provide an overall
communication inde...
Pragmatic Protocol
• How Does it Work?
– Observation of individuals engaged in
spontaneous, unstructured conversation with...
Communication Acts
• Verbal Aspects:
– Speech Acts
– Topic Maintenance
– Turn-taking
– Lexical selection
– Stylistic Varia...
Communication Acts:
• Non-verbal Aspects:
–Kenesics
–Proxemics
Communication Acts
• Paralinguistic Aspects:
–Intelligibility of speech
–Prosodics
Conversational Effectiveness Profile-Revised
(Kowalski, T., 2010)
• Documents relative strengths and weaknesses in social-...
Understanding the Influence of Language and
Cognition in ASD
Language Impairments in ASD
• Difficulty with pragmatic aspects of language may be
present across the spectrum:
– Conversa...
Language Profiles and Cognitive Mechanisms:
The Links
• Theory of Mind: Ability to interpret mental
states in people and r...
Theory of Mind and Language
• Necessary to interpret others’ mental states to
communicate effectively
• Joint attention sk...
Findings Related to Theory of Mind
• After accounting for age, IQ, and general
language level:
– Theory of Mind was a sign...
Findings Related to Executive Functions
• Related to language and other co-morbid
symptoms (ex. ADHD)
• More significant i...
Clinical Implications: Assessment
• Language-Theory of Mind-Executive Functions:
Mutually influencing cognitive functions,...
EF and Social Adaptation Measures
• Standardized Assessment: NEPSY-2 (Korkman
et al., 2007) for ages 3-16
• BRIEF: Parent ...
Clinical Implications: Treatment
• Organizational Skills
• Reading Comprehension
• Asking and Responding to Questions
• Fo...
Service Delivery Models
Service Delivery Models:
A Continuum
SLP Role in Intervention
• Prioritize the goals for achieving social
communication
• Honor and adapt to a family’s individ...
SLP Role in Intervention
• Partner with families
• Collaborate with teams
• Engage in professional development
• Advance t...
Interventions with varying levels of evidence
(National Standards Project, 2009)
Established
• Joint Attention
Training
• ...
Continuum of Interventions:
Social Pragmatic Developmental (Prelock, 2010)
Emphasize initiation and
spontaneity
Follow chi...
Contemporary Behavioral Approaches
• Give children choices
• Share control of teaching opportunities
• Use preferred activ...
Service Delivery is Dynamic Process
• Change intervention models based on:
– Individual progress
– Changing communication ...
Planning Intervention
• Consider each of the following:
– Functional, spontaneous communication
– Social instruction in va...
Positive Behavior Support
• Teaching the child an appropriate way to communicate results in
reducing challenging behavior ...
Positive Behavior Support
• Review of single-subject intervention in more
than 100 studies demonstrated its effectiveness
...
Positive Behavior Support
Functional
Assessment
Features
Clear
description of
behavior
Events, times,
and situations
that ...
Positive Behavior Support
Intervention
Plan Focus
Proactive
environmental
changes
Teaching new
skills to
replace
problem
b...
Visual Strategies and Supports
• Things that are seen that enhance the
communication process (ex. body language,
calendars...
Types of Visual Strategies and Supports
• Schedules
• Calendars
• Choice Boards
• Environmental Organizers (labels on
shel...
Word Wall
• Acts as a reference and scaffold for written work;
reinforces theme vocabulary
• High-frequency words and most...
Priming (Pre-Teaching)
Diehl, 2008
• Previewing classroom assignments before being
presented in class
• Parents or special...
Priming
Benefits
of
Priming
Decrease in
problem
behavior
May provide
necessary
motivation to
complete
task
May
heighten
st...
Priming
Collaboration team
determines who will be
participating
Establish timely and
efficient communication
method for ex...
Examples of Priming
• Semantic Webbing
• Reading checklist
• SQ3R
Reading Checklist (Diehl, 2008)
Assignment
(Ex. Read
pages 15-22)
Things to look
for?
Where do
snow
leopards live?
What do...
SQ3R
• Survey: Chapter Headings, bold-faced
headings, pictures, captions; Guess what text is
about
• Question: Read search...
Social Stories
(Carol Gray)
• To bridge or scaffold social understanding gap
• Effective in enhancing perspective-taking
•...
Teaching Social Stories
(Gray,C.)
• Introduce story in quiet place
• Review daily before targeted situation
• Keep data on...
Comic Strip Conversations
• A conversation between 2 or more people using
simple drawings
• Use dry erase boards, chalk bo...
Comic Strip Conversations
Where are
you?
Who else is
here?
What are you
doing?
What
happened?
What did others
do?
What did...
Video Modeling
(Charlop-Christy, 2004)
• Watching a video of adults or children modeling
particular target behaviors
• Hel...
Steps for Video Modeling
• Select and define the targeted behavior (ex. asking a question
during class)
• Complete a task ...
Video Modeling
• Considerations (Charlop-Christy & Kelso, 1997):
– Consider a motivating theme in the conversation or play...
Video Modeling Considerations:
– Talk about possible variations of events so the
child has opportunities for flexible lear...
Self Management Strategies
(Koegel, R.L., Koegel, L.K., & Parks, D.R.,1995)
• Promote independence and responsibility for
...
Steps to Self-Management
• Discriminate between appropriate and
inappropriate behavior
• Evaluate behavior (ex. happy/sad ...
Choice Chart
Peer Mediated Intervention
• Peers used in variety of roles:
– Tutoring
– Buddy system
– Prompters
– Reinforcers
– Establi...
Peer Mediated Interventions
• Proximity: Placing typical peers who
are socially competent with children
with ASD, directin...
Peer Mediated Interventions
• Prompting and Reinforcing:
Combination strategy where socially
competent peers are trained t...
Peer Mediated Interventions
• Antecedent Prompting: Child with ASD is
paired with a socially competent peer who is
instruc...
Four Steps to Support Peer Mediated Intervention:
1. Introduce the skill to a typical peer, describing and
providing a rat...
Relationship Development Intervention
• Goal is to provide comprehensive program for
developing relationship skills
• Base...
Inclusion Strategies for ASD
(Diehl, 2008)
• Classroom Organization
– Use consistent routines
– Delineate spaces (labeling...
Inclusion Strategies
(cont’d.)
• Before Teaching Supports
– Establish signal words to get attention
– Give assignments in ...
Inclusion strategies
(cont’d.)
• During Teaching Supports
– Use signal words for stressing important
information
– Keep es...
Watch for attention, stress, fatigue and provide alternate
pleasurable assignments during that time
Inclusion Strategies
(cont’d.)
• Facilitating Independent Work
– Provide visual instructions
– Provide specific roles for ...
Inclusion Strategies
(cont’d.)
• Student Organizers
– Use daily planners and teach independent use
– Laminate daily schedu...
Collaboration and ASD
“I believe that you don’t make major input
with children with complex disabilities unless
it is coll...
Learning Spanish
(Diehl, 2010)
Attending
class 1 hour
per week for
6 weeks
Speaking
Spanish
with
classmate
who is also
lea...
Contextualized Learning
Language needs to be infused throughout a
child’s day in order for learning to occur.
Why Collaborate?
“ASHA recognizes that the provision of speech,
language, and hearing services in educational
settings is ...
Why Collaborate?
Federal Law tells us that we should focus on the
services we provide rather than “a place” where the
stud...
Why Collaborate?
Effective schools research indicates that
collaboration within the school staff increases
student achieve...
Principles of Learning are Supported in a Collaborative Model
• Learning that is meaningful to the learner is acquired mor...
The Classroom is a Natural Setting
Services delivered in a classroom provide:
• More opportunities to communicate
• More v...
Advantages of Classroom-Based Intervention
• No time wasted in transition (some behavior problems are
related to transitio...
Collaboration is not a Replacement for Isolated Intervention
• It is designed to assess and treat communication
impairment...
Why Use Pull-Out Model?
• Allows intensive 1:1 treatment
• Useful for some intervention approaches
• May be best environme...
Myths About Service Delivery
• Individual therapy is always the best option
• Communication problems should only be addres...
Barriers to Collaboration
• Graduate students are taught medical model
• New SLPs are inexperienced in collaboration
• Par...
To facilitate collaboration among the educators
of preschool and school-age children in
developing functional social commu...
SLPs in the Classroom
Always look at academic and social issues
from a language perspective; trust teachers to
know curric...
Administrative Support
Administrators must be willing to:
• Provide meeting time for collaboration by all team
members
• M...
Breaking Down Barriers
• Work with university programs to teach collaboration strategies; teach a
“workload “ approach* to...
Planning
“A meeting to infuse goals is more
important than an individual session”
Sylvia Diehl
Team-Teaching/Co-Teaching
• Requires a significant amount of respect and trust
between teachers
• Avoid the same teacher a...
Benefits of Thematic Units
• Increase in student achievement
• Helps student to connect learning both within the
topic and...
Interventions with Case Studies
• Social interaction
• Communication
• Behavior
Ken
• 8 years old
• Talks constantly about video games
• Academically on grade level
• Other children play with him in sho...
Hunter
• 17-years old
• In regular HS academic program with
SpEd support
• Other students tolerate but do not seek
him out...
“The absence of evidence is not evidence of absence”
(Paula Kluth, 2010)
References
• American Speech-Language-Hearing Association. (2006c). Roles and responsibilities of speech-
language patholo...
References
• American Speech-Language-Hearing Association. (1996). Inclusive practices for children and
youths with commun...
References
• Montgomery, J. (1990). Effective Collaboration and Consultation Services for Speech and
Language Hearing Hand...
Autism Spectrum Disorders: Strategies for the School-Based SLP
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  • Geschwind, 2009: broad-based neurodevelopmmental or brain-based disorder result of genetic events occurring prior to birth
  • Kanner: 1943; Asperger: 1944; Wing: 2005; Grinker: “Unstrange Minds: Remapping the World of Autism”
  • Autism Diagnostic Observation Schedule; toddlers to adults; 30-45 min., developmental levels and language skills
  • Also: Asperger Syndrome Diagnostic Scale (Myles, Book, Simpson, 2003) Questionnaire, ages 5-18; SS and %iles; targets intervention goals
  • Impaired ability in formation of prototypes; organizing information into different categories; difficulty determining saliency, esp. in visual processing
  • Stanley Greenspan
  • Tom Buggey uses video modeling for PBS
  • Tom Buggey suggests putting stories on a PowerPoint, send to teachers and parents and hard-copy into student’s notebook
  • Major reason to promote with administration and teachers
  • Goal for Educators!
  • *Nancy Alarcon
  • Autism Spectrum Disorders: Strategies for the School-Based SLP

    1. 1. Autism Spectrum Disorders: Strategies for the School-Based SLP Melanie W. Hudson, M.A., CCC-SLP National Director EBS Healthcare
    2. 2. Understanding Asperger’s Syndrome and the SLP’s Role in Assessment and Intervention
    3. 3. Defining Autism • DSM- IV-TR, 2000 • Behavior Disorder • Brain disorder with genetic basis • Social interaction • Verbal/non-verbal communication • Restricted range of interests and activities
    4. 4. Prevalence of Autism • 1970s: 2-5 per 1000 • 2000: 1/500 (DSM-IV-TR, 2000) • 2003: 34-60 per 1000 (Fombonne) • 2007: 1/150 births (CDC) • 2008: 1/91 (Kogan, Strickland, et.al) • 2009: 1/91 (Bloomberg, et.al) (Prelock, 2010)
    5. 5. The Concept of Autism: • Richard Grinker: Anthropological Explanation • Leo Kanner: Differential Diagnosis with Schizophrenia • Hans Asperger: Genetic and Biological Factors • Lorna Wing: Spectrum Concept
    6. 6. 1. Autism Disorder 2. Asperger’s Disorder 3. PDD - NOS Autism Spectrum Disorder Autism 4. Rett’s Disorder 5. Childhood Disintegrative Disorder
    7. 7. Asperger’s Disorder • Qualitative impairment in social interaction in at least 2 of the following: – Marked impairment in the use of multiple nonverbal behaviors such as eye contact, facial expression, body postures, and gestures to regulate social interaction; – Failure to develop peer relationships appropriate to developmental level; – Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people; – Lack of social or emotional reciprocity
    8. 8. Asperger’s Disorder (cont’d) • Restricted repetitive and stereotyped patterns of behavior, interests, and activities as manifested by at least 1 of the following: – Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus; – Apparently inflexible adherence to specific, nonfunctional routines or rituals; – Stereotyped and repetitive motor mannerisms; – Persistent preoccupation with parts of objects (Diehl, S., 2008)
    9. 9. Early Diagnosis is Critical • Early identification of children who are “at risk” for ASD facilitates early intervention • Early intervention is essential for better outcomes (Diehl, 2008)
    10. 10. Autism impacts: • Social Interaction • Communication • Behavior
    11. 11. SLP Role in Assessment and Intervention • Prioritize goals for achieving social communication • Honor and adapt to a family’s individual needs and cultural context • Recognize evidence-based practice • Understand the communication demands of the classroom (ASHA, 2006c)
    12. 12. Assessment Tools: • Structured parent interviews • Extensive observations of the child in a variety of settings – with one preferably made in the home environment • Observations by more than one evaluator, either separately or jointly conducted • Observations made at different times
    13. 13. Assessment for ASD Child with Higher Skills • More traditional tools do not get at underlying pragmatic challenges • Narrative assessment allows for observation of breakdown in personal story-telling ability, use of internal responses and solutions to problems • Also consider: Test of Language Competence, The Word Test, Test of Problem-Solving, and pragmatic subtests of CASL • ADOS is “gold standard” for assessment; requires face-to- face training (videotaped training is available); based on DSM criteria (Prelock, 2010, live chat on ASHA Web site)
    14. 14. Other Tools • “The Pragmatic Protocol”, Prutting and Kirchner – Developed in 1982 to provide an overall communication index for school-age children, adolescents and adults – Consists of 30 pragmatic aspects of language – Considers role of each participant in structuring the interaction and evaluate results accordingly
    15. 15. Pragmatic Protocol • How Does it Work? – Observation of individuals engaged in spontaneous, unstructured conversation with positive neutral partner – 15 minutes of videotaped interaction – Each aspect is judged as appropriate, inappropriate or not observed – Consider sociolinguistic background of the individual being observed
    16. 16. Communication Acts • Verbal Aspects: – Speech Acts – Topic Maintenance – Turn-taking – Lexical selection – Stylistic Variations
    17. 17. Communication Acts: • Non-verbal Aspects: –Kenesics –Proxemics
    18. 18. Communication Acts • Paralinguistic Aspects: –Intelligibility of speech –Prosodics
    19. 19. Conversational Effectiveness Profile-Revised (Kowalski, T., 2010) • Documents relative strengths and weaknesses in social- pragmatic communication inherent in Asperger’s • Comprised of 6 domains (social interaction, social communication, academic communication, perspective- taking, social-emotional) • Diagnostician rates each area on 3-point scale (appropriate, somewhat appropriate, extremely inappropriate) • May be used in a variety of settings
    20. 20. Understanding the Influence of Language and Cognition in ASD
    21. 21. Language Impairments in ASD • Difficulty with pragmatic aspects of language may be present across the spectrum: – Conversational discourse – Understanding and telling stories – Nonverbal aspects of communication, including prosody, facial expression, body language
    22. 22. Language Profiles and Cognitive Mechanisms: The Links • Theory of Mind: Ability to interpret mental states in people and relate to their behavior, (put yourself in someone else’s shoes) • Executive Functions: Skill set for planning, guiding problem-solving, and regulation of behavior • Impairments in both found among range of children with ASD (Tager-Flusberg, 2010)
    23. 23. Theory of Mind and Language • Necessary to interpret others’ mental states to communicate effectively • Joint attention skills at the root of Theory of Mind • Significantly impaired in ASD population
    24. 24. Findings Related to Theory of Mind • After accounting for age, IQ, and general language level: – Theory of Mind was a significant predictor of child’s ability to maintain discourse topic – Theory of Mind was significant predictor of socialization scores on the Vineland – Theory of Mind was a significant predictor of severity of autism symptoms (Tager-Flusberg, 2003)
    25. 25. Findings Related to Executive Functions • Related to language and other co-morbid symptoms (ex. ADHD) • More significant impairments in children with ADHD symptoms (Tager-Flusberg, 2010)
    26. 26. Clinical Implications: Assessment • Language-Theory of Mind-Executive Functions: Mutually influencing cognitive functions, impaired to a different degree in each child • Influences academic performance and peer relations • Effective assessment will evaluate ALL aspects • Child can perform well on test but still have everyday problems (Tager-Flusberg, 2010)
    27. 27. EF and Social Adaptation Measures • Standardized Assessment: NEPSY-2 (Korkman et al., 2007) for ages 3-16 • BRIEF: Parent report measure, 86 items, for ages 2-18 • Social Maturity Scale- Teacher rating, 7 items, correlates with Theory of Mind (Peterson et al., 2007) (Tager-Flusberg, 2010)
    28. 28. Clinical Implications: Treatment • Organizational Skills • Reading Comprehension • Asking and Responding to Questions • Following Directions • Conversational Skills • Peer Relationships
    29. 29. Service Delivery Models Service Delivery Models: A Continuum
    30. 30. SLP Role in Intervention • Prioritize the goals for achieving social communication • Honor and adapt to a family’s individual needs and cultural context • Recognize evidence-based practice • Understand the communication demands of the classroom (ASHA, 2006c)
    31. 31. SLP Role in Intervention • Partner with families • Collaborate with teams • Engage in professional development • Advance the knowledge base • Advocate to promote communication and independence (ASHA, 2006c)
    32. 32. Interventions with varying levels of evidence (National Standards Project, 2009) Established • Joint Attention Training • Modeling • Naturalistic Teaching • Pivotal Response • Peer Training Emerging • AAC • Developmental- Relationship Based • Language Training • Sign • PECS Unestablished • Academic • Auditory Integration • Sensory Integration • Facilitated Communication • Gluten and casein-free diet
    33. 33. Continuum of Interventions: Social Pragmatic Developmental (Prelock, 2010) Emphasize initiation and spontaneity Follow child’s lead Consider related responses Teach within the natural environment Example: Floor Time
    34. 34. Contemporary Behavioral Approaches • Give children choices • Share control of teaching opportunities • Use preferred activities and materials (Prelock, 2010)
    35. 35. Service Delivery is Dynamic Process • Change intervention models based on: – Individual progress – Changing communication demands – Response to treatment (Prelock, 2010)
    36. 36. Planning Intervention • Consider each of the following: – Functional, spontaneous communication – Social instruction in various settings throughout the day – New skill acquisition that then includes generalization and maintenance (a skill remains a “trick” until it is performed across settings, people and materials) – Play skills that include peer and peer interaction – Functional assessment and positive behavior support to address problem behaviors – Functional academic skills (Diehl, 2008)
    37. 37. Positive Behavior Support • Teaching the child an appropriate way to communicate results in reducing challenging behavior and increases communication skills • Created because of dissatisfaction with traditional methods for addressing severe behavior problems • Directly targets the relationship between challenging behavior and communication • Focuses on intervention in natural contexts • Shifts focus from restricting behavior with narrowly defined settings and expectations • Increases quality and quantity of meaningful and positive interchanges (Diehl, 2008)
    38. 38. Positive Behavior Support • Review of single-subject intervention in more than 100 studies demonstrated its effectiveness in reducing challenging behavior (Carr,1999) • Average behavior reduction for single-subject studies for children with autism was 94.6% (Horner, 2000) (Diehl, 2008)
    39. 39. Positive Behavior Support Functional Assessment Features Clear description of behavior Events, times, and situations that are predictive Describes consequences that may maintain the behavior Formulates a hypothesis
    40. 40. Positive Behavior Support Intervention Plan Focus Proactive environmental changes Teaching new skills to replace problem behaviors Eliminating natural rewards for problem behavior Maximizing clear rewards for appropriate behavior
    41. 41. Visual Strategies and Supports • Things that are seen that enhance the communication process (ex. body language, calendars, maps, etc.) • Compliment the learning style of the child with ASD • Not transient such as oral or picture language • Much evidence to support (Diehl, 2008)
    42. 42. Types of Visual Strategies and Supports • Schedules • Calendars • Choice Boards • Environmental Organizers (labels on shelves, bins, etc.) • Visual sorting tasks (ex. categorization) • Word Wall (Diehl, 2008)
    43. 43. Word Wall • Acts as a reference and scaffold for written work; reinforces theme vocabulary • High-frequency words and most commonly misspelled words on permanent wall for child to see • Theme or unit words should be available for more interactive activities (ex. key rings) (Diehl, 2008)
    44. 44. Priming (Pre-Teaching) Diehl, 2008 • Previewing classroom assignments before being presented in class • Parents or special educators can implement • Use on daily basis • Done as pull-out session the day before or at home the night before • Familiarize student with material in relaxed, non- threatening manner • High reinforcement for learning • Evidence-supported (Wilde, L.D., Koegel, L.K., & Koegel, R.L., 1992)
    45. 45. Priming Benefits of Priming Decrease in problem behavior May provide necessary motivation to complete task May heighten student confidence Enables enhanced performance on similar activities
    46. 46. Priming Collaboration team determines who will be participating Establish timely and efficient communication method for exchanges between not primed and when it is Feedback forms designed, making sure assignments are clear, primed vs. unprimed, documentation of communication between team members If child resists, begin with short sessions and gradually build up Begin with limited response requirements on part of child and build up
    47. 47. Examples of Priming • Semantic Webbing • Reading checklist • SQ3R
    48. 48. Reading Checklist (Diehl, 2008) Assignment (Ex. Read pages 15-22) Things to look for? Where do snow leopards live? What do they eat? Word to find in dictionary Habitat; mammal;
    49. 49. SQ3R • Survey: Chapter Headings, bold-faced headings, pictures, captions; Guess what text is about • Question: Read search questions or comprehension questions at end of chapter • Read: Read to answer questions • Recite: Try to answer questions from memory • Review: Verify and support answers by rereading
    50. 50. Social Stories (Carol Gray) • To bridge or scaffold social understanding gap • Effective in enhancing perspective-taking • Allow parents and professionals to better understand child’s perspective • May be used to address broad range of situations • Evidence-supported Available from: http://www.thegraycenter.org/Social_Stories.html
    51. 51. Teaching Social Stories (Gray,C.) • Introduce story in quiet place • Review daily before targeted situation • Keep data on student responses during story and targeted situation • Revise or add to story as needed • Revise the review schedule as student shows it can be faded. Decrease verbal support • Keep stories available to student (Diehl, 2008)
    52. 52. Comic Strip Conversations • A conversation between 2 or more people using simple drawings • Use dry erase boards, chalk boards, paper • Depicts ideas such as everyone talking at once, listening as part of a group, interrupting, LOUD or quiet words, who is saying what, who is listening, thoughts • Beginning evidence-supported (Diehl, 2008)
    53. 53. Comic Strip Conversations Where are you? Who else is here? What are you doing? What happened? What did others do? What did you say? What did others say? What did you think when you said that? What did others think when you said that?
    54. 54. Video Modeling (Charlop-Christy, 2004) • Watching a video of adults or children modeling particular target behaviors • Helps focus child’s attention on relevant stimuli in video • With practice and rehearsing, child begins to retain and display targeted language and behavior • Fosters generalization of behaviors • Established evidence-supported (Diehl, 2008)
    55. 55. Steps for Video Modeling • Select and define the targeted behavior (ex. asking a question during class) • Complete a task analysis to itemize the steps • Observe target script for typically-developing children • Present each step slowly with exaggerated acting • Provide at least 2 observations before assessing learning • Create short scripts allowing for reciprocal communication exchange • Gather input from parents, teachers and child to guide development of the video model (Courtesy, M. Mount, 2009)
    56. 56. Video Modeling • Considerations (Charlop-Christy & Kelso, 1997): – Consider a motivating theme in the conversation or play being modeled – Camera is strategically located to present facial expression or show hands carrying out a particular task – Pause the video to highlight target expressions – Prompt child’s attention as needed by saying something like “watch the T. V.” or “Look” – Immediately following the video viewing, ask the child to do what they watched – Debrief the child reviewing what was seen and heard, identifying any new language heard as well as noting prosody and emotional expression of the “models”
    57. 57. Video Modeling Considerations: – Talk about possible variations of events so the child has opportunities for flexible learning and thinking – Encourage and reinforce attempts to demonstrate the modeled behavior – Rewind to review important parts
    58. 58. Self Management Strategies (Koegel, R.L., Koegel, L.K., & Parks, D.R.,1995) • Promote independence and responsibility for behavior • Improve social interactions • External control does not result in lasting change (Diehl, 2008)
    59. 59. Steps to Self-Management • Discriminate between appropriate and inappropriate behavior • Evaluate behavior (ex. happy/sad face) • Monitor behavior over time (checking in at various times of the day, etc.) • Self-reinforce behavior when expected behavior met (ex. earning points) (Diehl, 2008)
    60. 60. Choice Chart
    61. 61. Peer Mediated Intervention • Peers used in variety of roles: – Tutoring – Buddy system – Prompters – Reinforcers – Established evidence (Diehl, 2008)
    62. 62. Peer Mediated Interventions • Proximity: Placing typical peers who are socially competent with children with ASD, directing them to play with their peers without specific training – Biggest outcome here is that children will be actively engaged with someone and they will stop or limit the stereotyped behaviors you often see
    63. 63. Peer Mediated Interventions • Prompting and Reinforcing: Combination strategy where socially competent peers are trained to prompt a child with disabilities to play and then to reinforce the child’s responses
    64. 64. Peer Mediated Interventions • Antecedent Prompting: Child with ASD is paired with a socially competent peer who is instructed to remain in proximity to the child with ASD; teacher provides periodic prompts to the child with ASD to engage in social interaction (Simpson et al., 1997)
    65. 65. Four Steps to Support Peer Mediated Intervention: 1. Introduce the skill to a typical peer, describing and providing a rationale (describe the skill) 2. Demonstrate the skill for the typical peer (demonstration) 3. Rehearse skill with the interventionist 4. Typical peer practices/rehearses the skill with another child, then works with the child with ASD after interventionist is certain he is ready
    66. 66. Relationship Development Intervention • Goal is to provide comprehensive program for developing relationship skills • Based on developmental model that begins with basic relationship exercises • Uses 10 skill areas that encompass the qualities of children who are successful in developing and maintaining friendships • Uses 6 stages from novice to Partner • Developed by Steven Gutstein and later collaboration with Rachelle Sheely • Evidence-supported (Diehl, 2008)
    67. 67. Inclusion Strategies for ASD (Diehl, 2008) • Classroom Organization – Use consistent routines – Delineate spaces (labeling) – Use abundance of visual supports – Prepare for transitions – Specify endings and new starts to activities
    68. 68. Inclusion Strategies (cont’d.) • Before Teaching Supports – Establish signal words to get attention – Give assignments in written form – Use priming strategies – Pair strong interests as motivators (ex. put dinosaur sticker on top of worksheet)
    69. 69. Inclusion strategies (cont’d.) • During Teaching Supports – Use signal words for stressing important information – Keep essential questions and concepts in the forefront – Avoid lengthy verbal instructions – Use visual supports (daily schedules, choice boards, etc.) – Provide models (work first math problem together)
    70. 70. Watch for attention, stress, fatigue and provide alternate pleasurable assignments during that time
    71. 71. Inclusion Strategies (cont’d.) • Facilitating Independent Work – Provide visual instructions – Provide specific roles for collaborative work – Assign peer buddies – Avoid burning out one student – Use timer, or something to delineate time/amount – Allow keyboard for writing assignments
    72. 72. Inclusion Strategies (cont’d.) • Student Organizers – Use daily planners and teach independent use – Laminate daily schedule to use with soluble markers – Color-code folders for each subject – Label sections in folder for homework, completed work, etc. – Keep “obsessive” stuff in one place with written instructions on when to use it – “Post-its” help with things that pop up during the day – Keep 2 sets of texts, one each for home and school – Keep written rules consistent – Use technology whenever possible
    73. 73. Collaboration and ASD “I believe that you don’t make major input with children with complex disabilities unless it is collaborative” (Sylvia Diehl, 2010)
    74. 74. Learning Spanish (Diehl, 2010) Attending class 1 hour per week for 6 weeks Speaking Spanish with classmate who is also learning Spanish Living in Spain and using language daily in variety of contexts
    75. 75. Contextualized Learning Language needs to be infused throughout a child’s day in order for learning to occur.
    76. 76. Why Collaborate? “ASHA recognizes that the provision of speech, language, and hearing services in educational settings is moving toward service-delivery models that integrate intervention with general education programming, often termed inclusion.” (American Speech-Language-Hearing Association [ASHA], 1996)
    77. 77. Why Collaborate? Federal Law tells us that we should focus on the services we provide rather than “a place” where the students go. (IDEA, 2004 [118 Stat. 2649])
    78. 78. Why Collaborate? Effective schools research indicates that collaboration within the school staff increases student achievement. (Thompson, 2002)
    79. 79. Principles of Learning are Supported in a Collaborative Model • Learning that is meaningful to the learner is acquired more readily and is retained longer • Learning is influenced by the frequency with which the stimuli are encountered and the same or similar response is made • In general, practice in varied contexts can both increase retention of learning and extend its range of utility • Transfer is facilitated where the learning situation resembles the application situation, or where the learning is practiced in various “realistic” contexts • Observing the actions of another person can lead to the acquisition of new learning or the facilitation or inhibition of prior learning • Group discussion and decision can facilitate change (Ehren and Ehren, 2004)
    80. 80. The Classroom is a Natural Setting Services delivered in a classroom provide: • More opportunities to communicate • More variety of communication opportunities • More variety of communication partners • More resemblance to real life • Less disruption in a student’s day that is disruptive to learning • Models for teachers • Seamless transfer (carryover) of skills (adapted from Ehren and Ehren, 2004)
    81. 81. Advantages of Classroom-Based Intervention • No time wasted in transition (some behavior problems are related to transition) • Child stays in LRE • Teachers have more frequent opportunities for planned teaching • Classroom offers many opportunities to interact with and learn from peers (Hadley & Schuele, 1998; Garfinkle & Schwartz, 2002; Brinton & Frijiki, 2004; Case-Smith & Holland, 2009)
    82. 82. Collaboration is not a Replacement for Isolated Intervention • It is designed to assess and treat communication impairments within natural settings • It can supplement or extend services offered in a traditional pull-out model (ASHA Relevant Paper, 1990)
    83. 83. Why Use Pull-Out Model? • Allows intensive 1:1 treatment • Useful for some intervention approaches • May be best environment to establish new behaviors (ex. discrete trial training) • Should be purposeful, planned and short-term (Case-Smith & Holland, 2009; Moore & Montgomery, 2008)
    84. 84. Myths About Service Delivery • Individual therapy is always the best option • Communication problems should only be addressed by the “expert” • SLPs need to protect their territory • People who advocate a collaborative model are trying to get out of work (Haynes, Moran & Pindzola, 2006)
    85. 85. Barriers to Collaboration • Graduate students are taught medical model • New SLPs are inexperienced in collaboration • Parents expect medical/clinical model • Teachers/Administrators expect pull-out model • Team planning is time-consuming • Turf Conflicts • Teachers don’t want to/know how to collect data
    86. 86. To facilitate collaboration among the educators of preschool and school-age children in developing functional social communication skills within the classroom context (Frassinelli, Superior, & Meyers, 1983)
    87. 87. SLPs in the Classroom Always look at academic and social issues from a language perspective; trust teachers to know curriculum and standards; SLPs role is to facilitate interactions and learning.
    88. 88. Administrative Support Administrators must be willing to: • Provide meeting time for collaboration by all team members • Maintain sufficient number of support staff • Understand that collaboration is efficient use of educational resources but not a method to reduce amount or expense of special services • Understand that SLP caseloads may need to be reduced (ASHA Relevant Paper, 1990)
    89. 89. Breaking Down Barriers • Work with university programs to teach collaboration strategies; teach a “workload “ approach* to service delivery • Learn about collaboration and try it gradually • Explain benefits of collaboration to parents; have parents tell other parents their child’s success stories • Explain to teachers that collaboration meets the student’s needs; we are there to meet their needs and not our own
    90. 90. Planning “A meeting to infuse goals is more important than an individual session” Sylvia Diehl
    91. 91. Team-Teaching/Co-Teaching • Requires a significant amount of respect and trust between teachers • Avoid the same teacher always taking the lead instructional role • Take turns “leading” the lessons and instructional units • Requires long-range planning • Requires commitment of classroom teacher to always be present (adapted from Green, 2008)
    92. 92. Benefits of Thematic Units • Increase in student achievement • Helps student to connect learning both within the topic and across other subjects (generalization) • Enables student to understand big concepts of curriculum and apply them in many ways • Promotes depth of learning (Thompson, 2002; Marzano, 2001)
    93. 93. Interventions with Case Studies • Social interaction • Communication • Behavior
    94. 94. Ken • 8 years old • Talks constantly about video games • Academically on grade level • Other children play with him in short spurts until they tire of his bossy behavior • Needs personal assistant to move from one activity to another • Disruptive when routine changes
    95. 95. Hunter • 17-years old • In regular HS academic program with SpEd support • Other students tolerate but do not seek him out • Pleasant appearance and no behavior issues except during fire drill
    96. 96. “The absence of evidence is not evidence of absence” (Paula Kluth, 2010)
    97. 97. References • American Speech-Language-Hearing Association. (2006c). Roles and responsibilities of speech- language pathologists in diagnosis, assessment, and treatment of autism spectrum disorders across the life span: Position statement. Available from http://www.asha.org/policy. • American Speech-Language-Hearing Association. (2006b). Knowledge and skills needed by speech-language pathologists for diagnosis, assessment, and treatment for autism spectrum disorders across the life span. Available from http://www.asha.org/policy. • American Speech-Language-Hearing Association. (2006a). Guidelines for speech-language pathologists in diagnosis, assessment, and treatment of autism spectrum disorders across the life span. Available from http://www.asha.org/policy. • American Speech-Language-Hearing Association. (1990). A Model for Collaborative Service delivery for Students With Language-Learning Disorders in the Public Schools [Relevant Paper]. Available from www.asha.org/docs/html/RP1991-00123.html
    98. 98. References • American Speech-Language-Hearing Association. (1996). Inclusive practices for children and youths with communication disorders [Position Statement]. Retrieved March 1, 2010 from http://www.asha.org/docs/html/PS1996-00223.html • Bondy, A., & Frost, L. (1998). Picture Exchange Communication System. Topics in Language Disorders, 19, 373–390. • Diehl, S. (2008). Working with children with autism: Resource manual. ASHA Autism online web event, March 2010. • Ehren, T. & Ehren, B. (2004). Therapy Services in the Classroom: Creating Students Success. ASHA Telephone Seminar, September 14, 2004. • Green, Charlette. (2008). SLPs Collaborating in General Education: Practicing Seamless Education. Presentation to North Carolina Public Schools. • Individuals with Disabilities Education Act. (2004). Public Law 108-446. Retrieved March 1, 2010, from http://www.copyright.gov/legislation/pll08-446.pdf • Kowalski, T. (2010) Social-pragmatic success for asperger syndrome and other related disorders. Orlando, FL: Professional Communication Services. • Marzano, R.J., Pickering, D.J., & Pollock, J.E. (2001). Classroom instruction that works. Alexandria, VA: Association for Supervision and Curriculum Development.
    99. 99. References • Montgomery, J. (1990). Effective Collaboration and Consultation Services for Speech and Language Hearing Handicapped Children. Short Course at California Speech Language Hearing Association Annual Conference, Monterey, CA. • Moore-Brown, B. (1989). The Speech/Language Specialist-Critical Support for Teaching Literacy. Presentation at the California State Federation/Council for Exceptional Children Annual Conference, Costa Mesa, CA. • Paul, R. (2010). Communication Intervention Programs. ASHA Autism Online Web event. • Prelock, P. (2010). Assessment and Intervention in Autism Spectrum Disorders: The role of the SLP. ASHA Autism online web event • Sancibrian, C. (2010). Navigating the service delivery continuum. ASHA Autism Online web event. • Tager-Flusberg, H. (2010). Language and Cognition in Autism Spectrum Disorders. ASHA Autism Online web event. • Thompson, M., & Thomason, J. (2002). Leadership, achievement, and accountability. Boone, NC: Learning Concepts. • Wiig, E.. (1992) Language intevention with school-age children: Models and procedures that work. Chicago, IL: Riverside Publishing Co.
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