1. Lisa R. Audet, Ph.D., CCC-SLP
Let’s get them Communicating: Interactions and Children with Minimal Language __________________________________________   
Lisa R. Audet, Ph.D., CCC-SLP
Assistant Professor, Kent State University

2. Our Time Together
Individuals with autism spectrum disorders (ASD) have complex communication needs.
Those with minimal language skills present us with our greatest challenge.
Today’s presentation will
increase your understanding of the core features of ASD; and
provide you with specific strategies to increase comprehension, production, and social interaction in children who have minimal language skills.

3. Core Deficits
Problems with joint attention: eye gaze shifting for communication purposes
Deficits in development of the Gestural Complex: giving, showing, distal pointing
Gestural Complex: The greatest predictor of emerging language development-particularly distal pointing
Deficits in combining non-verbal and verbal communication behaviors
Deficits in adaptive solitary and social aspects of play
Deficits in cognitive functional aspects of play

4. Core Deficits: Day to Day
Children with ASD who have minimal language
Reduced attempts to interact
Reduced readability of attempts to interact
Limited conventional exploratory play with problem solving involved
Short attention span
Engage in same old play…over and over and over again
Restricted social opportunities and success: the structure and evolution of conversation
Limited meaningful, context embedded opportunities to learn language-the deep meaning of words
Increased rigidity, isolation, and frustration

5. Joint Attention Joint Attention:
Must understand the nature of eye gaze for communication: to identify and share a topic of interest with another
Requires rapid eye shifts and attention shift
Some children with ASD may be overwhelmed by the task, not comprehend or have the ability (at first) to demonstrate the skill

6. Joint Attention Strategies
Identify target behavior: Gaze to orient to the speaker vs. gaze to initiate interaction (make a request, comment, protest)
If to initiate:
Be in the child’s visual field
Reduce amount of talk
Limit amount of facial movement (pleasant neutral expression)
Hold object of interest to the child next to your eyes and
Wait………
Reinforce even the slightest gaze shift between your eyes and the object with the object of interest
Label the object (no need for empty “good job!” reinforcer)
Allow the child to engage with the object of interest
Repeat within a natural flow of interaction.
In this context, do not say “look at me” as the focus needs to be on keeping the child as the initiator of the interaction.

7. Distal Point
The ability to use the pointer finger to direct another person’s attention to an object, person, event of interest with the purpose of sharing that object, person, event with the partner

8. Distal Point: Strategy One
Gently rub the tip of the pointer finger
Verbally prompt, let’s get our hands read
Avoid using hand over hand instruction/blocking the three remaining fingers
Keep the emphasis on the finger that has “meaning” –the pointer
Engage in shared book reading or other activities where together the adult and child point to different objects, pictures that are within reach of both individuals

9. Distal Point: Strategy Two
Place desired objects out of reach
When child reaches for the object gentle rub the child’s pointer finger and
Once the point is approximated, obtain the object for the child
Reinforce with words describing the event such as: “Jimmy said: Want X” so that the child begins to learn that his point has meaning

10. Reciprocity
The ability to engage in turn taking within a social interaction: non-verbal, vocal, verbal
Dyadic vs. Triadic Interactions
Dyadic: person to person; person to object
Triadic: person to person to person; person to person to object

11. Reciprocity Strategies
Begin with dyadic interactions using:
Joint action routines
Create a rhythm and routine
Imitate the child’s developmental, adaptive behaviors
Scaffold the routine, child behaviors by:
Adding vocalization
Adding an action
Withholding, wait to obtain social signal (gesture, eye gaze, vocalization, verbal approximation)
Use vocal intonation to signal expectancy

12. Reciprocity Strategies
Triadic Interactions
Remember if the child isn’t responding to the triadic interaction, shift back to the dyadic. The purpose is to build meaningful, social turn taking – that are pleasant to create a desire to have MORE
Within a dyadic interaction add an object
Use the object to build upon the dyadic (the object moves, engages in an action) that is part of a known routine.
Withhold the object to elicit social signally: giving object to the adult, gaze shift, verbal/vocal approximation, sign etc.
Use language to indicate that the object has stopped and/or the child’s desire: the bunny is not moving, I am sad, Jimmy wants the bunny to dance.
Model the desired behavior: give the child the object, point to it, use 1-2 words such as “you do,” “make go” etc.
Reinforce naturally with language: “yeah bunny dance,” “you made him go” and the action paired with positive facial expressions

13. Combined Means, Initiation & Readability
Core feature:
Children with ASD typically use one communication behavior vs. combining 3-5 (gesture + facial expression + vocal intonation + eye gaze + words)
Reduced combined behaviors decreases readability of a communication behavior
Decreased readability
Increases likelihood we will
Miss the act
Misunderstand the intent
And the child will become frustrated
More evident when the child is attempting to initiate vs. respond to an interaction

14. Combined Means and Initiations
Interventionists need to begin to observe more:
we take combined means for granted
it is so tacit to our functioning so;
Observe, interpret, and respond to single communication behaviors (with a reasonable guess/hypotheses);
Target the ability to combine 2 communication behaviors
Strategies:
strategic wait, withholding, modeling, linguistic mapping to elicit the behaviors; naturally reinforce child initiated acts

15. Combined Means & Initiation: Importance
The Gestural Complex and Joint Attention Lead to Language Development
So this is important to work on, especially with young children who have minimal skills before they develop less adaptive communication behaviors
Humans communicate to initiate and respond to interactions; so intervention must include development of meaningful and readable initiated acts

16. Initiated Acts: The Context
Initiated communication acts
communication behaviors (verbal/non-verbal) where a child begins the interaction
Strategies:
Build upon child’s interest
Developmentally the child initiates at first to request actions, objects, recurrence, and protest
Create scenarios within natural routine for the child to use adaptive communicative behaviors for the above social purposes.

17. Enhancing Communication within Play
Imitate child’s behavior: Label the action (parallel talk)
Scaffold the behavior: Add a new object or event; One at a time
Model a new behavior or action
Use strategic and expectant wait: facial expression, vocalizations, verbalizations
Label problems the child encounters and wait
Respond to any/all social signals as meaningful to encourage reciprocity
Sabotage the interaction to create real problems

18. Teaching Children with ASD how to Listen
Never repeat a directive more than twice
Least-to-most prompts
Strategic wait
Slow the pace
Look at the person versus an object

19. Strategies to Increase Comprehension
Consistent Follow-Through
Integration of Multiple Modes of Representation
Multiple Repeated Examples

20. Thank You
Questions