1. Kristin J. Szewczyk, M.S./CCC-SLP February 1, 2009

2. Communication is simply defined as “an exchange of information;” however, the process of communication is much more complex. (Hedge, 2001, p. 2)

3. Problems with Communication

4. Communication deficits are one of the primary characteristics of autism spectrum disorders (ASDs) (American Pyschiatric Association, 2000)

5. Common Problems with Communication Speech May Never Develop Speech 30% of individuals with ASD are Non-Verbal (Klin, 2006) Articulation Errors Difficulty understanding Prosody Inflection of Speech Oral Motor Difficulties Cannot imitate oral movements Drooling (American Speech-Language-Hearing Association [ASHA], 2009b; Prelock, 2006)

6. Common Problems with Communication Expressive Language Echolalia-Repeating what is said Immediate Delayed Difficulty expressing wants/needs Poor Vocabulary Difficulty with Pronouns Difficulty with non-literal aspects of language Reduced sentence length (ASHA, 2009b; Prelock, 2006)

7. Common Problems with Communication Receptive Language Difficulty following directions Difficulty answering questions Pragmatic Language Social Language Difficulty with Initiating and Maintaining a Conversation Difficulty understanding Facial Expressions/Body Language Poor Eye Contact (ASHA, 2009b; Prelock, 2006)

8. Functions of Communication

9. Three Primary Functions of Communication in Individuals with ASD Regulate Behavior Social Interaction Joint Attention (Wetherby & Prizant, 2005)

10. Functions of Communication Regulate Behavior First function to develop Making requests Objects Activities Expressing Wants/Needs Hunger/Thirst Asking for help (Prelock, 2006; Wetherby & Prizant, 2005)

11. Functions of Communication Social Interaction Play Activities Requesting involvement with Family/Friends Social Greetings “Hello”/ “Bye-Bye” Bring Attention to Self Showing Off (Prelock, 2006; Wetherby & Prizant, 2005)

12. Functions of Communication Joint Attention Shifting attention between individuals and objects Gaining an individual’s attention Directing an individual’s attention Make Comments Ask Questions Provide information (Prelock, 2006; Wetherby & Prizant, 2005)

13. Methods of Communication

14. Verbal Communication Augmentative and Alternative Communication (AAC)

15. Verbal Communication Using spoken words to express wants/needs, request items/activities, make comments, ask/answer questions, and engage in social interactions

16. AAC AAC is a combination of symbols and methods that are used to improve communication (Downey & Hurtig, 2003) Object Exchange Sign Language “Total Communication” Picture Exchange Communication System (PECS) Voice-Output Communication Aids (VOCAs)

17. Object Exchange Real Objects Child gives communicative partner an object to indicate what he/she wants Example: Child gives parent a book to indicate that he/she wants to read a story Child must have easy access to the objects in order to make wants/needs known (Strokes, 2006)

18. Sign Language Movements made with the hands to represent letters and words (National Institute on Deafness and Other Communication Disorders, 2008)

19. (Lifeprint.com, 2008)

20. Total Communication An AAC method that involves using verbalizations and sign language simultaneously (Goldstein, 2002; Prelock, 2006)

21. PECS Developed to improve the communication skills of preschool students diagnosed with ASD Child exchanges pictures with an individual to communicate Consists of six phases (Frost & Bondy, 1994, 2002)

22. PECS Phases Phase I – “How” to Communicate (Frost & Bondy, 2002, p. 67) Instructor presents the individual with a preferred item Individual chooses a picture that represents the preferred item Individual gives the picture to the instructor to request the item Instructor gives the individual the desired item

23. PECS Phases Phase II- Develops independent requesting Individual chooses a picture from his/her PECS book Individual finds the communicative partner and gives the picture to him/her Only one picture is used during this phase (Frost & Bondy, 1994; 2002)

24. PECS Phases Phase III-Continues to develop independent requesting Individual selects a picture from a larger field Individual independently selects a picture from his/her PECS book and finds a communicative partner in order to make the request Number of pictures increases as the individual gains accuracy and experience (Frost & Bondy, 1994; 2002)

25. PECS Phases Phase IV- Combining pictures to make requests Individual uses a sentence strip located at the front of his/her PECS book to build more complicated requests Individual must locate the “I want” picture as well as the picture of the item or activity he/she is requesting Individual then finds a communicative partner in order to make the request (Frost & Bondy, 1994; 2002)

26. PECS Phases Phase V- “What do you want?” Individual uses a sentence strip located at the front of his/her PECS book to build more complicated requests Individual must locate the “I want” picture as well as the picture of the item or activity he/she is requesting Individual then finds a communicative partner in order to make the request (Frost & Bondy, 1994; 2002)

27. PECS Phases Phase VI- Independent Communication Individual independently responds to a variety of questions and makes comments using his/her PECS book (Frost & Bondy, 1994; 2002)

28. PECS (Strokes, 2006)

29. VOCAs Electronic device Child pushes a button on device Pictures/printed words on the buttons represent messages Pre-recorded message plays Vary in complexity and cost (Nunes, 2008)

30. VOCAs (The Sensory Company®, 2003)

31. VOCAs (AdaptAble Minds, n.d.)

32. VOCAs (SuperDuper Publications, 2009)

33. VOCAs (DynaVox Technologies, 2008)

34. Benefits of AAC Beneficial for verbal/non-verbal children with ASD Increases number of vocalizations/verbalizations Improves functional communication skills Expressing wants/needs Requesting (Blischak, Lombardino, & Dyson, 2003; Charlop-Christy, Carpenter, Le, LeBlanc & Kellet, 2002; Dyches, Davis, Lucido, and Young, 2002 ; Goldstein, 2002; Mirenda, Wilk, and Carson; 2000; Nunes, 2008

35. Benefits of AAC Improves communicative initiations Responses Comments Improves social interactions Decreases problem behaviors (Blischak, Lombardino, & Dyson, 2003; Charlop-Christy, Carpenter, Le, LeBlanc & Kellet, 2002; Dyches, Davis, Lucido, and Young, 2002 ; Goldstein, 2002; Mirenda, Wilk, and Carson; 2000; Nunes, 2008

36. Selecting a Method of Communication

37. When selecting a method of communication, should consider the following: Communication needs of your child Physical capabilities of your child Child’s level of motivation Flexibility/Accessibility of the method of communication Consult with a speech-language pathologist (SLP) (ASHA, 2009a)

38. Communication Strategies

39. Strategies Naturalistic Language Teaching Joint Action Routines Visual Strategies (Goldstein, 2002; Prelock, 2006; Tissot & Evans, 2003)

40. Naturalistic Language Teaching Instruction and learning is provided during naturally occurring situations Uses child-preferred materials Learn and generalize skills at a faster rate Child is reinforced for appropriate initiations and responses to communication (Harris & Delmolino, 2002; Prelock, 2006)

41. Naturalistic Language Teaching Milieu language teaching Child-directed modeling Mand-modeling Time-delay Incidental teaching (Goldstein, 2002; Harris & Delmolino, 2002; Prelock, 2006)

42. Milieu Language Teaching Child-Directed Modeling Uses child’s interests Establishes joint attention Adult/Instructor provides verbal models Reinforce correct responses Repair incorrect responses (Harris & Delmolino, 2002; Prelock, 2006)

43. Example of Child-Directed Modeling Interest: Child enjoys going for rides in the car Adult/Instructor: “Say, ‘Open the door.’” Child responds: “Door.” Adult/Instructor: “Say, ‘Open the door.’” Child responds: “Open the door.” Adult/Instructor: “Nice talking!” Adult/Instructor then opens the door to the car.

44. Milieu Language Teaching Mand-Modeling A mand is “a verbal instruction or request” (Prelock, 2006, p. 413) Teaches functional communication skills Utilizes child’s interests Establish joint attention (Harris & Delmolino, 2002; Prelock, 2006)

45. Mand-Modeling Adult/Instructor instructs the child to follow a command or complete a request Provides a verbal model Reinforce correct responses Repair incorrect responses (Harris & Delmolino, 2002; Prelock, 2006)

46. Example of Mand-Modeling Child approaches playdough, which is the child’s favorite activity Adult/Instructor: “Say, ‘I want playdough.’” Child says: “Dough.” Adult/Instructor: “Say, ‘I want playdough.’” Child says: “Want playdough.’” Adult/Instructor: “Say, ‘I want playdough.’” Child says: “I want playdough.” Adult says: “Nice talking!” Gives child the playdough

47. Milieu Language Teaching Time-Delay Using pauses between the mand and the provided model/cues Develops independent communication (Harris & Delmolino, 2002; Prelock, 2006)

48. Example of Time-Delay Child wants to watch a movie and stands in front of the TV Adult/Instructor waits until child makes the request Child says, “I want to watch a movie.” Adult/Instructor completes the request

49. Milieu Language Teaching Incidental Teaching Increase language/conversational skills Environment arranged to facilitate communication Utilizes child’s interests Child must interact with adult to make a request

50. Milieu Language Teaching Adult instructs child to make a request or answer a question using a more complex response Provides a model Provides correction Provides reinforcement (Harris & Delmolino, 2002; Prelock, 2006)

51. Example of Incidental Teaching Child wants a cookie and says, “Cookie.” Adult/Instructor: “What kind of cookie do you want?” Child: “I want a chocolate cookie.” Adult/Instructor: “Here is your cookie. You like chocolate cookies. I like chocolate cookies, too. Do you think Daddy likes chocolate cookies?” Child: “Yes. He eats chocolate cookies, too!”

52. Joint Action Routine Utilizes familiar routines Involves two or more individuals Provide some items for routine, but withhold others Child requests items needed to complete the routine Adult/Instructor asks child questions during the routine (Prelock, 2006)

53. Joint Action Routine Three types of joint attention routines Routines with a “specific product or outcome” (Prelock, 2006, p. 408) Routines planned around a theme or story Turn-taking routines (Prelock, 2006)

54. Example of Joint Action Routine Breakfast Adult/Instructor: “What do you want for breakfast?” Child: “Cereal.” Adult/Instructor: “What kind of cereal?” Child: “Lucky Charms.” Adult/Instructor gives child the box of cereal Child: “I need the milk.” Adult/Instructor gives the child the milk. Child: “I need a bowl and a spoon.” Adult/Instructor gives the child the bowl and spoon.

55. Why use visual strategies?

56. Visual Strategies Children with ASD are visual learners Makes concepts concrete Improves focus and attention Reduces anxiety Improves communication (Rao & Gagie, 2009; Tiss0t & Evans, 2003)

57. Visual Strategies Modeling Live Video Social Stories Scripts

58. Live Modeling Also known as “in vivo modeling” Child observes an individual demonstrating a desired behavior Parents, peers, other adults/children Goal is for child imitate and use the desired behavior in other situations (Charlop-Christy, Le, & Freeman, 2000; Prelock, 2006, p. 420)

59. Live Modeling Benefits Effective in improving social and communication skills Implemented by a variety of individuals Parents, siblings, teachers, etc. Used in a variety of settings and situations (Charlop-Christy, Le, & Freeman, 2000; Prelock, 2006

60. Video Modeling Child watches videos of an individual demonstrating a desired behavior Others Parents, peers, other adults/children Self Again, goal is for child imitate and use the desired behavior in other situations (Buggey, 2005; Delano, 2007; Hitchcock, Dowrick, & Prater, 2003; Sherer et al., 2001)

61. Video Modeling Benefits Effective in improving social and communication skills Ususally obtain quicker results than live modeling Can be used repeatedly in a variety settings and by different individuals (Baharav & Darling, 2008; Charlop-Christy, Le, & Freeman, 2000; Delano, 2007; McCoy & Hermensen, 2007)

62. Modeling Considerations First, choose a behavior to teach Examples Saying “hello”/ “bye” Answering questions Conversational skills Turn-taking (Charlop-Christy, 2004)

63. Modeling Considerations Next, determine steps achieve desired behavior Examples Saying “hello” / “bye” first Asking question Beginning a conversation Helps to watch child’s peers Success Demonstrates behavior 75% to 80% of the time (Charlop-Christy, 2004)

64. Visual Strategies Social Stories Short stories that are written from the child’s point-of- view Provides information about a social situation and how to respond appropriately Individuals involved Order of events in the situation Feelings of other/self (Ivey, Heflin & Alberto, 2004; Sansosti & Powel-Smith, 2008)

65. Social Stories Benefits Reduces problem behaviors Improves social communication Increases appropriate social interactions (Crozier & Tincani, 2005; Thiemann & Goldstein, 2001; Ivey, Heflin & Alberto, 2004; Sansosti & Powel-Smith, 2008)

66. Example of Social Story http://www.frsd.k12.nj.us/autistic/Social%20Stories/P ages/asking_other_kids_to_play.htm. http://www.frsd.k12.nj.us/autistic/Social%20Stories/P ages/asking_other_kids_to_play.htm

67. Visual Strategies Scripts Used to teach social and conversational skills Taught using modeling, cues, and reinforcement Script is written on a cue card May include pictures or other symbols depending on individual’s reading level May be tape-recorded (Charlop-Christy & Kelso, 2003; Ganz, Kaylor, Bourgeous, & Hadden, 2008)

68. Scripts Scripting process: Adult asks a question Presents cue card to individual containing the response Individual is told to read the response out loud Adult then instructs the individual to read the response while maintaining eye contact Process is repeated until conversation is finished Provide reinforcement Verbal praise – “Great job!” Preferred food, toy, or activity (Charlop-Christy & Kelso, 2003; Ganz, Kaylor, Bourgeous, & Hadden, 2008)

69. Script Example Adult: Do you like to watch T.V.? Child: Yes. Do you like to watch T.V.? Adult: Yes. What’s your favorite show? Child: Power Rangers. What show do you like? Adult: Cheers. Do you watch videos? Child: Yes. Can we watch a video? Adult: Sure! (Charlop-Christy & Kelso, 2003, p. 125)

70. Scripts Benefits Improves conversational skills Improves social interactions Peers Adults Decreases echolalia and speech perseverations (Charlop-Christy & Kelso, 2003; Ganz, Kaylor, Bourgeouis, & Hadden, 2008)

71. Visual Strategies Resources Boardmaker http://www.mayer-johnson.com/MainBoardmaker.aspx Microsoft Clip Art Writing with Symbols http://www.mayer-johnson.com/ProdDesc.aspx?SKU=M165

72. Visual Strategies Resources PixWriter http://www.slatersoftware.com/pixwriter.html Digital Camera Google Images http://www.google.com

73. Conclusion Communication is a complex process Especially difficult for individuals with autism Three Functions of Communication Regulate Behavior Social Interactions Joint Attention (American Pyschiatric Association, 2000; Hedge, 2001; Prelock, 2006)

74. Conclusion Many available methods of communication Choose the one that best fits the communication needs of your child Communications Strategies for in the Home Naturalistic Language Teaching Joint Action Routines Visual Strategies (ASHA, 2009a; Charlop-Christy & Kelso, 2003; Goldstein, 2002; Harris & Delmolino, 2002; Ivey,Heflin & Alberto, 2004; Prelock, 2006; Sansosti & Powel-Smith, 2008; Tissot & Evans, 2003)

75. OPPORTUNITIES TO COMMUNICATE ARE EVERYWHERE!!!

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77. References American Speech-Language Hearing Association. (2009b). Autism (Autism spectrum disorders). Retrieved January 18, 2009, from http:// www.asha.org/public/speech/disorders/Autism.htm. Baharav, E., & Darling, R. (2008). Case report: Using an auditory trainer with caregiver video modeling to enhance communication and socialization behaviors in autism. Journal of Autism and Developmental Disorders, 38, 771-775. Retrieved January 19, 2009,from ERIC database.

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