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Autism Spectrum Disorders: Strategies for the School-Based SLP

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Presentation on theme: "Autism Spectrum Disorders: Strategies for the School-Based SLP"— Presentation transcript:

1 Autism Spectrum Disorders: Strategies for the School-Based SLP
Melanie W. Hudson, M.A., CCC-SLP National Director EBS Healthcare

2 Understanding Asperger’s Syndrome and the SLP’s Role in Assessment and Intervention

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 Geschwind, 2009: broad-based neurodevelopmmental or brain-based disorder result of genetic events occurring prior to birth

4 Prevalence of Autism 1970s: 2-5 per 1000 2000: 1/500 (DSM-IV-TR, 2000)
2003: per 1000 (Fombonne) 2007: 1/150 births (CDC) 2008: 1/91 (Kogan, Strickland, 2009: 1/91 (Bloomberg, (Prelock, 2010)

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 Kanner: 1943; Asperger: 1944; Wing: 2005; Grinker: “Unstrange Minds: Remapping the World of Autism”

6 4. Rett’s Disorder 5. Childhood Disintegrative Disorder Autism Disorder Asperger’s Disorder PDD - NOS Autism Spectrum Disorder Autism

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 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 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 Autism impacts: Social Interaction Communication Behavior

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 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 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 Autism Diagnostic Observation Schedule; toddlers to adults; min., developmental levels and language skills (Prelock, 2010, live chat on ASHA Web site) 13

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 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 Communication Acts Verbal Aspects: Speech Acts Topic Maintenance
Turn-taking Lexical selection Stylistic Variations

17 Communication Acts: Non-verbal Aspects: Kenesics Proxemics

18 Paralinguistic Aspects: Intelligibility of speech Prosodics
Communication Acts Paralinguistic Aspects: Intelligibility of speech Prosodics

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 Also: Asperger Syndrome Diagnostic Scale (Myles, Book, Simpson, 2003) Questionnaire, ages 5-18; SS and %iles; targets intervention goals 19

20 Understanding the Influence of Language and Cognition in ASD

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 Impaired ability in formation of prototypes; organizing information into different categories; difficulty determining saliency, esp. in visual processing 21

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) 22

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 23

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) 24

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) 25

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) 26

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) 27

28 Clinical Implications: Treatment
Organizational Skills Reading Comprehension Asking and Responding to Questions Following Directions Conversational Skills Peer Relationships 28

29 Service Delivery Models
Service Delivery Models: A Continuum 29

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) 30

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) 31

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 32

33 Continuum of Interventions: Social Pragmatic Developmental (Prelock, 2010)
Floor Time Example: Emphasize initiation and spontaneity Follow child’s lead Consider related responses Teach within the natural environment Stanley Greenspan 33

34 Contemporary Behavioral Approaches
Give children choices Share control of teaching opportunities Use preferred activities and materials (Prelock, 2010) 34

35 Service Delivery is Dynamic Process
Change intervention models based on: Individual progress Changing communication demands Response to treatment (Prelock, 2010) 35

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) 36

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 Tom Buggey uses video modeling for PBS (Diehl, 2008) 37

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) 38

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 39

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 40

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) 41

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) 42

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) 43

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) 44

45 Priming 45 Benefits of Priming Decrease in problem behavior
May provide necessary motivation to complete task May heighten student confidence Enables enhanced performance on similar activities 45

46 Priming 46 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 46

47 Examples of Priming Semantic Webbing Reading checklist SQ3R 47

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; 48

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 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: 50

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 Tom Buggey suggests putting stories on a PowerPoint, send to teachers and parents and hard-copy into student’s notebook (Diehl, 2008) 51

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) 52

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? 53

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) 54

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) 55

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 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 Promote independence and responsibility for behavior
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) 58

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) 59

60 Choice Chart

61 Peer Mediated Intervention
Peers used in variety of roles: Tutoring Buddy system Prompters Reinforcers Established evidence (Diehl, 2008) 61

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 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 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 Four Steps to Support Peer Mediated Intervention:
Introduce the skill to a typical peer, describing and providing a rationale (describe the skill) Demonstrate the skill for the typical peer (demonstration) Rehearse skill with the interventionist Typical peer practices/rehearses the skill with another child, then works with the child with ASD after interventionist is certain he is ready

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) 66

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 67

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) 68

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) 69

70 Watch for attention, stress, fatigue and provide alternate pleasurable assignments during that time

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 71

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 72

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) 73

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 74

75 Contextualized Learning
Language needs to be infused throughout a child’s day in order for learning to occur.

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) 76

77 Why Collaborate? Federal Law tells us that we should focus on the services we provide rather than “a place” where the students go. Major reason to promote with administration and teachers (IDEA, 2004 [118 Stat. 2649]) 77

78 Why Collaborate? Effective schools research indicates that collaboration within the school staff increases student achievement. (Thompson, 2002) 78

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) 79

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) 80

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) 81

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) 82

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) 83

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) 84

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 85

86 To facilitate collaboration among the educators of preschool and school-age children in developing functional social communication skills within the classroom context Goal for Educators! (Frassinelli, Superior, & Meyers, 1983) 86

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. 87

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) 88

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 *Nancy Alarcon 89

90 Planning “A meeting to infuse goals is more important than an individual session” Sylvia Diehl

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) 91

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) 92

93 Interventions with Case Studies
Social interaction Communication Behavior 93

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 94

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 95

96 “The absence of evidence is not evidence of absence” (Paula Kluth, 2010)

97 97

98 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 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 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 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 98

99 References American Speech-Language-Hearing Association. (1996). Inclusive practices for children and youths with communication disorders [Position Statement]. Retrieved March 1, 2010 from 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 Retrieved March 1, 2010, from 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

100 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. 100

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