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A number of individuals with Autism Spectrum Disorders (ASD) do not develop functional speech, while many will have sizable communicative repertoires. Their language may include a number of commonly reported characteristics such as echolalia (excessive delayed and/or immediate imitation), incessant questioning, and significant challenges taking the social perspectives of their listeners. Additionally, persons with ASD tend to have difficulty understanding some aspects of language. Fortunately, during the past decade, social/communication skill intervention has resulted in significant forward strides.
Early childhood educators, parents, and other caregivers can play a significant role in the emergence of young children’s early communicative acts. In examining the evidence-based practice literature describing successful intervention strategies, a number of straight-forward actions appear to enhance beginning communication skills in children who have ASD. The remainder of this article will summarize those actions.
Increasingly, evidence supports the importance of adults who are diligent in attending to the focus of a child’s attention and are immediately responsive to the child’s communicative overtures. By interacting with the child in relation to his or her focus of attention, adults can insure that the child’s motivation to learn is as great as possible. Children whose caregivers named objects that were already the focus of the child’s attention have been shown to have significantly larger language repertoires than children with whom this happened less often (Tomasello & Todd, 1983).
It is becoming increasingly clear that responding to children’s behavior facilitates their communicative production. Hart & Risley (1995) found that children whose caregivers were most responsive to their communicative attempts developed larger vocabularies. Although talking to children is important, responding to their communicative attempts (which may be gestures or looking at/touching objects) appears to be very important in creating highly motivating communicative contexts.
Joint activity routines are social games that adults play often with children. For example, with very young children these include games such as “peek-a-boo,” and with older children these may include activities such as tossing a ball. Joint activity routines offer a number of components that facilitate social communication: (1) they have a very simple purpose; (2) the parts of the routine can be easily used by either participant; (3) they allow slight variations to facilitate generalized use (for example, “peek-a-boo” can be played with a washcloth at bath time or behind a paper plate at a picnic); and (4) they allow a large number of repeated intervention opportunities. Taken together, these characteristics permit their use to support communication across a range of motivating situations.
Some have expressed the point of view that augmentative communication systems should not be implemented concurrently with attempts to establish spoken communication in children with ASD or at-risk. However, there is little scientific support for this belief. In a recent review, Millar, Light & Schlosser (2006) found no evidence that augmentative communication implementation had an impeding influence on the development of speech. In a recent study, Harris & Reichle (2004) reported that implementing graphic communication symbols paired with the interventionist’s labeling of the symbol had increased the vocabulary comprehension skills of several learners with significant developmental disabilities. It is reasonable to speculate that this phenomenon holds for children with ASD. Additionally, some emerging literature suggests that augmentative communication applications may positively influence some children’s communicative production (e.g., Bondy & Frost, 1994). Yoder & Layton (1988) reported that children who were likely to acquire speech after the implementation of sign instruction were those who were able to imitate speech.
An important misinterpretation of the literature is that children with ASD who require augmentative communication support will benefit more from gestural symbols (signs) than from graphic symbols (pictures, line drawings, printed words). The relative benefit of each of these appears to be somewhat learner specific (Mirenda, 2005).
Among typically-developing children, communicative acts are used to behaviorally regulate others (e.g., request and protest), to establish joint attention in directing another’s attention to events (e.g., commenting on events), and to further social interaction (e.g., calling, greeting, communication associated with social games). Children with ASD often have communicative acts skewed more at behavior regulation. Communicative acts such as commenting may be more challenging because children with ASD tend to be less proficient in calling the attention of others to events in their environment. It is also possible that the extensive focus of many interventionists on requesting as an early skill may further skew this propensity. Recent intervention programs (Prizant, Wetherby, Rubin, Laurent & Rydell, 2005) emphasize the introduction of different communicative functions matched to particular regularly occurring situations as a means to enhance communication.
Once a new communicative skill has been taught there is a possibility of over- use (over-generalization). For example, once a child learns that he or she can request assistance, the child may discover that it requires less effort to request assistance than to independently complete work that does not require help. In the past several years, successful strategies have emerged (Reichle & McComas, 2004) to reduce over-use. Using the example above for instance, the child can be taught that reinforcement is greatest for working independently, the next greatest reinforcement is available by requesting assistance, and no reinforcement is available if the task is abandoned.
The degree to which the newly taught communicative behavior is efficient for the child can have a significant effect on the degree to which use in other contexts will occur. Drasgow, Halle and Ostrosky (1998) reported findings for three preschool-aged children with Autism/Pervasive Developmental Disorder and severe language delays. Baseline showed that children requested using marginally acceptable to unacceptable means (reaching, grabbing, leading). Each child was taught a replacement request (signing “please”) in school, but rarely used it at home. As soon as the children’s old behavior was no longer reinforced at home, two of the three learners very quickly began using the newly taught communicative alternative. Failure to generalize new behavior to other settings may actually be a decision not to use a new behavior until it is made more efficient than an old behavior.
Among the continuum of available intervention approaches are behavioral (Discrete Trial) and social-pragmatic strategies. Characteristics associated with Discrete Trial approaches include: (1) one-to-one instruction, (2) a highly prescriptive curriculum, (3) an initial emphasis on responding to interventionist-delivered cues/prompts, (4) a tendency to minimize context not directly related to the skill or discrimination being taught, and (5) a sequential introduction of intervention objectives. On the other hand, components of a social-pragmatic approach tend to emphasize (1) an initial focus on turn-taking and interactive exchanges, (2) a limited amount of interventionist directiveness, (3) concurrent consideration of gestural graphic and vocal mode communication, (4) teaching new behavior in the situation in which it is expected to be used, and (5) a concurrent implementation of multiple intervention targets. Both approaches for addressing the communication delays and deficits common in children with ASD have been recognized by many as among the most effective treatment methods to date (Dawson & Osterling, 1997). Regardless of the intervention strategy chosen, being consistent and precise in its implementation repeatedly has been demonstrated to be important.
Regardless of a child’s primary communicative mode, or the intervention approach emphasized, the general considerations presented in this article have been validated in evidence-based practice. There are promising strategies that are available to those responsible for meeting the communicative needs of young children with ASD regardless of their communicative limitations.
Bondy, A. & Frost, L. (1994). The picture exchange communication system. Focus on Autistic Behavior, 9, 1-19.
Dawson, G., & Osterling, J. (1997). Early intervention in Autism: Effectiveness and common elements of current approaches. In Guralnick (Ed.) The effectiveness of early intervention: Second generation research (pp. 307-326) Baltimore: Paul H. Brookes Publishing.
Drasgow, E., Halle, J. W., & Ostrosky, M. M. (1998). Effects of differential reinforcement on the generalization of a replacement mand in three children with severe language delays. Journal of Applied Behavior Analysis, 31, 357-374.
Hart, B., & Risley, T. (1995) Meaningful differences in the everyday experience of young American children. Baltimore: Paul H. Brookes Publishing.
Harris, M., & Reichle, J. (2004). The impact of aided language stimulation on symbol comprehension and production in nonverbal children with moderate cognitive disabilities. American Journal of Speech-Language Pathology, 13, 155-167.
Millar, D., Light, J., & Schlosser, R. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, Hearing Research, 49, 248-264.
Mirenda, P. (2005). AAC for communication and behavior support with individuals with Autism. Presentation at the annual convention of the American Speech, Language and Hearing Association. San Diego, CA. November.
Prizant, B., Wetherby, A., Rubin, E., Laurent, A., & Rydell, P. (2005). SCERTS model. Baltimore: Paul H. Brookes Publishing.
Reichle, J., & McComas, J. (2004). Conditional use of a request for assistance. Disability and Rehabilitation, 26, 1255-1262.
Tomasello, M., & Todd, J., (1983). Joint attention and early language. Child Development, 4, 197-212.
Yoder, P., & Layton, T. (1988). Speech following sign language training in autistic children with minimal verbal language. Journal of Autism & Developmental Disorders, 18, 217-229.
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Retrieved from the Web site of the Institute on Community Integration, University of Minnesota (http://ici.umn.edu/products/impact/193/default.html). Citation: Cadigan, K., Craig-Unkefer, L., Reichle, J., Sievers, P., & Gaylord, V. (Eds.). (Fall/Winter 2006/07). Impact: Feature Issue on Supporting Success in School and Beyond for Students with Autism Spectrum Disorders, 19(3). [Minneapolis: University of Minnesota, Institute on Community Integration].
The PDF version of this Impact, with photos and graphics, is also online at http://ici.umn.edu/products/impact/193/193.pdf.
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