1. Autism Spectrum Disorders: Intervention for High-functioning Students Rhea Paul, Ph.D., CCC-SLP Southern Connecticut State University Yale Child Study Center Feb. 11-15, 2008 rhea.paul@yale.edu

2. Goals of Treatment for High Functioning Students with ASD Social Interaction skills Social Interaction skills Peer relations Communication skills Communication skills Pragmatic and conversational skills Adaptive skills Self-help Self-regulation, emotional regulation Academic skills appropriate to developmental level Reading comprehension

3. Social Interaction: Intervention Methods

4. Social Stories Descriptive sentences: statements of fact Many children play on the playground during recess. Perspective sentences: refer to internal states Some children like to make a lot of noise. Affirmative sentences: express a common value One child goes down the slide at a time. This is a safe thing to do. Control sentences: identify personal strategies When I have to wait my turn on the slide, I can count the people in front of me to make the time go faster. Cooperative sentences: what others can do to help. The teacher can help me if I feel impatient. She can talk to me while I wait.

5. Comic Strip Conversations Use ‘think’ and ‘word’ bubble cartoons Sam, I saw a cowcatcher on an old-fashioned train yesterday. Do you know what that is? Sam doesn’t know as much as I do about trains. I will find out if he knows what the cowcatcher does before I tell him about the one I saw

6. Games Based on Special Interests Develop social games based on special interests of target child Involve target child in development of materials and rules Have target child teach game to peer Set up special opportunities to play game Take turns choosing games to play during interactive game time

7. Video Modeling Use commercial material such as My School Day Video tape peers conducting interactions such as greeting, negotiating, etc. Use video clips from TV shows to exemplify interactions (may use negative interaction)

8. Video Modeling View video, discuss reactions DESCRIBE VERBALLY Re-enact scene on video with clinician Re-enact with peer Improvise similar situation

9. Sample Video Models

11. Using Video Modeling Use video modeling and role playing to become aware of listener cues Looking at watch Taking a breath Looking toward door Yawning Use role playing to practice giving and perceiving these cues

12. Social Cognitive Skills Training (Timler et al., 2005) Role play social scripts in peer group Situation paragraph read to group 4-5 situations/ 2 hour session 6 weeks of 2 sessions/week Children guided during role play to use checklist to facility ability to identify what they know about situation from own and other’s perspective Further Qs helped identify a range of response strategies by selecting goal, stating alternative strategies to reach goal Evaluating consequences after response

15. Social Skills Groups Can use commercial curricula, such as Navigating the Social World (McAfee, 2001) Skillstreaming the Adolescent (Goldstein & McGinnis, 2000) Provide consistent group structure Check-in, greet Review last meeting’s skill Introduce new skill Model and role play new skill Snack, social time Activity that allows real-life practice of new skill Summary

16. Peer Support Networks Select 2-5 peers to serve as social support for student with ASD Assign each support peer a 20 minute period/day to structure activities for student with ASD, e.g.: Lunch: use Prompt and Praise to engage with others at table Recess: teacher creates scripts for entering games; peer support and target student practice in private, then on playground

17. Effective Adult Techniques: Social Skills Training (Timler, 2006) Teacher Redirects Prompting children to play with one another Rephrasing or restating one child’s statement for another Praising children for playing together Direct instruction in social language Modeling and practice with explicit cues Role play with prompting Corrective feedback Authentic contexts (peer involvement) Self-monitoring for older students

18. Pragmatics and Conversation

19. Video examples: ASD Conversational Behaviors

20. Pragmatic Domains Communicative functions Intents Frequency Discourse management Turns topics Register variation Politeness Social roles Presupposition Grice’s maxim of Quantity ‘mind-reading’

21. Pragmatic Assessment Children’s Communication Checklist (Bishop, 2003) Pragmatic Rating Scale (Landa et al., 1992) Pragmatic Rubric Pragmatic Protocol (Prutting & Kirchner, 1984) Social Skills Rating System (Gresham, 1990) Pragmatic Language Skills Inventory Gilliam & Miller, 2006)

22. Improving Conversational Skills

23. Enhancing Pragmatic Skills Conversational participation and reciprocity Take turns w/o interrupting Responding appropriately to others’ speech Adding something new and relevant information to a topic Terminating/changing topics appropriately Initiating and maintaining peer interactions Entering peer play and conversation Maintaining and expanding play themes Terminating play appropriately Reduction of obsessive, perseverative topics Understanding and telling stories Understanding social sequences Understanding psychological motivation

24. Scripting Provide explicit written script of interaction, e.g., Walk up to a classmate Make eye contact Say, “Hi ____________” Practice script w/ adult Practice w/ peer Script Fading: Cut off increasingly large parts of script, until client can do the scene independently

25. Scripts and Script Fading Provide topic lists, guide students to write and fade their own scripts Use favored topics to bridge to new ones trains → dining car → food Have students choose a strip to talk with a teacher/clinician Fade scripts with adult Encourage student to repeat with peer partner

26. Scripting with Peer Training Peers taught 5 facilitative skills w/o target child present: 1. Look, wait, and listen 2. Answer questions 3. Start talking 4. Say something nice 5. Keep talking Target children given written scripts for social interaction (“Can I play checkers with you?”)

27. Direct Instruction Make conversation: Maintain topic: Change topic: Go up to person. Say ‘hello.’ Smile. Listen to what s/he says and respond. Listen. Think about what the person says. Talk about the same thing. Keep quiet and listen. Wait until the person pauses. Say, “Let’s talk about something else. Like…”

28. Direct Instruction: The “Conversation Can” (Brinton, Robinson & Fujiki, 2005): Brainstorm a list of topics classmates might want to discuss Write each on a slip of paper Put slips in can Take turns pulling out a topic Start conversation: Think first: What should I say Say two things about the topic Ask interlocutor a question about the topic Listen while interlocutor answers

29. Graphic Supports for Conversation Checklists When I had a conversation, did I Look at my friend? _____________ Stand one arm’s length away? _____________ Appear interested by asking questions and listening? ______ Talk about what my friend is interested in? ______ Posters Important Parts of Conversations: Topic: Pick something your friend wants to talk about Questions: Use these to keep the back-and-forth going Comments: Say something new that your friend doesn’t know, but would find interesting

30. Graphic Supports for Conversation Choice Boards Pick your conversation topic for today:

31. Graphic Supports for Conversation Choice lists  Yo, __________!  Hey, Pal!  High 5!  What’s up?  Hi, how ya doin’!

32. Principles of Pragmatic Intervention Strategies Students with ASD will not acquire social skills from exposure; they require mediated experiences Verbal, written and graphic supports are effective Peer involvement is an essential element Peers need training, but it is not extensive Encourage ‘mind reading’

33. Adaptive and Self-Regulatory Skills Same principles as with lower functioning. Visual supports Social Stories, Comic Strip Conversations ABA approaches Task analysis Functional Behavior Analysis Consequences-natural and contrived

34. Self-Management Skills Picture Schedules: visual supports

35. Self-management: Social Stories Recess * After lunch we go to recess. * Sometimes recess is on the playground. * A lot of the children play on the playground equipment. * It is fun to play on the playground equipment. * Everyone should play safely. * When the whistle blows that means it is time to line up and go inside. * I will try to line up as soon as the whistle blows. * This will make my teachers happy. * After I line up I will try to stay in line. * Everyone will be proud of me!

36. Academic Skills Reading can appear a strength May be early, precocious w/ keen interest in letters, numbers May show interest in words (read dictionary) BUT, difficulties in comprehension often occur. Narratives (stories) may be a good vehicle for improving reading comprehension

37. Narrative Intervention Understanding motives: make character motivation explicit Understanding intentions: discuss reasons for actions Understanding emotions: discuss how characters feel and why