churchill report helen bolton 2005 · helen bolton winston churchill trust fellow – 2005 -2- ......

The Winston Churchill Memorial Trust of Australia

Report by – Helen Bolton – 2005 Churchill Fellow

To study the use of PROMPT with low-verbal children with Autism I understand that the Churchill Trust may publish this Report, either in hard copy or on the internet or both, and consent to such publication. I indemnify the Churchill Trust against any loss, costs or damages it may suffer arising out of any claim or proceedings made against the Trust in respect of or arising out of the publication of any Report submitted to the Trust and which the trust places on a website for access over the internet. I also warrant that my Final Report is original and does not infringe the copyright of any person, or contain anything which is, or the incorporation of which into the Final Report is, actionable for defamation, a breach of any privacy law or obligation, breach of confidence, contempt of court, passing-off or contravention of any other private right or of any law. Signed Date

PROMPT with children with Autism

Helen Bolton Winston Churchill Trust Fellow – 2005 -2-

Table of content Table of content ....................................................................................................................... 2 Table of Figures ....................................................................................................................... 3 Introduction ............................................................................................................................. 4 Executive Summary .................................................................................................................. 5

Highlights ................................................................................................................................... 5 Recommendations ....................................................................................................................... 5 Implementation & Dissemination ..................................................................................................... 6

Background to project ............................................................................................................... 7 Programme, at a Glance............................................................................................................ 9

1. PROMPT course – Bridging PROMPT technique to Intervention......................................................... 9 2. Talk, Learn & Communicate– Seattle, Washington........................................................................... 9 3. PROMPT Institute – New York..................................................................................................... 9 4. From the Heart Therapy Services................................................................................................. 9 5. PROMPT Instructors’ camp......................................................................................................... 9 6. ASHA Convention ..................................................................................................................... 9

1. Bridging PROMPT Technique to Intervention............................................................................ 10 Key Concepts ................................................................................................................................ 10

Uses of PROMPT....................................................................................................................... 10 PROMPT tenets......................................................................................................................... 11 PROMPT Conceptual Framework.................................................................................................. 11 USE model ............................................................................................................................... 11 Core Elements in PROMPT treatment ............................................................................................ 12 What I have learnt & can share with others! ..................................................................................... 12

2. Talk, Learn & Communicate – Seattle, Washington.................................................................... 13 Overview of Talk, Learn & Communicate............................................................................................. 13

Speech, Language, Communication Services .................................................................................. 13 Occupational Therapy Services: .................................................................................................... 13

Client Observations ........................................................................................................................ 13 Literacy Programme Development ..................................................................................................... 14 Social Understanding Group............................................................................................................. 14 Viewing videos of NSSPS Clients ...................................................................................................... 15 Resources .................................................................................................................................... 15

Books: ..................................................................................................................................... 15 Activities observed ..................................................................................................................... 15 Games ..................................................................................................................................... 15 Equipment ................................................................................................................................ 15 Literacy Programmes .................................................................................................................. 15

3. PROMPT Institute - New York ............................................................................................... 16 PROMPT Instructors meeting ........................................................................................................... 16 Visit to Association for Metroarea Autistic Children (AMAC) .................................................................... 16

Special Needs Unit (SNU) ............................................................................................................ 16 Communication Acquisition Needs (CAN)........................................................................................ 16 Team Ten ................................................................................................................................. 16 Reward Store ............................................................................................................................ 16

Observation of clients...................................................................................................................... 17 Observation and participation in home-based programme of client ........................................................... 19

Angels (volunteer staff) & Parent meeting........................................................................................ 19 Intensive Therapy session............................................................................................................ 19 School visit ............................................................................................................................... 19

Son-Rise Programme...................................................................................................................... 20



4. From the Heart Therapy Services........................................................................................... 21 Individual Client observations ........................................................................................................... 21 Imaginative play sessions ................................................................................................................ 22

Specific Goals/Objectives ............................................................................................................ 22 Format of clients’ session:............................................................................................................ 23 Parent information session ........................................................................................................... 23

Equipment .................................................................................................................................... 23 Assessment tools ....................................................................................................................... 23 Games ..................................................................................................................................... 23 Computer cds: ........................................................................................................................... 23

5. PROMPT Instructors Camp................................................................................................... 24 Current & New Initiatives at The PROMPT Institute ............................................................................... 24 Phonetic transcriptions .................................................................................................................... 24 Smart Tools .................................................................................................................................. 25 Case Presentations ........................................................................................................................ 25

6. ASHA Convention ............................................................................................................... 26 Summaries of papers/sessions/workshops attended.............................................................................. 26

Children’s Play: The Roots of Language and Literacy Development...................................................... 26 Predictors of outcomes for children with Autism receiving early intervention ........................................... 27 AAC for communication & behaviour support with individuals with Autism .............................................. 27 Facilitating Phonological Awareness Development in Children with Speech Delay ................................... 28 Enhancing the Learning of Motor Skills - Application of Motor Learning Principles in Childhood Apraxia of Speech .................................................................................................................................... 29 Social Language Independence with Severely Impaired Using PROMPT and AAC .................................. 30

Conclusion............................................................................................................................ 31 Recommendations ................................................................................................................. 32 Implementation & Dissemination ............................................................................................... 33 References ........................................................................................................................... 34

Table of Figures Figure 1 Jackie using a complex PROMPT with 3 year old, Nathaniel. ............................................................ 7 Figure 2 Just starting out... here I am using PROMPT with Blair & Mark before going off on my Churchill

Fellowship... I had so much to learn! ................................................................................................. 8 Figure 3 Myra working with 4 year old, Madeline....................................................................................... 13 Figure 4 Nola with 6 year old, Maddie..................................................................................................... 14 Figure 5 Pinch bugs ............................................................................................................................ 15 Figure 6 The 'elusive' Tic Tac Tony! ....................................................................................................... 15 Figure 7 Straight Shot rollercoaster - great fun for young and old! ................................................................ 15 Figure 8 Jackie working with 3-year old Ben ............................................................................................ 17 Figure 9 Jackie working on semantic organisational activities with Matthew.................................................... 18 Figure 10 18-month old Rachel being prompted to use lip rounding .............................................................. 18 Figure 11 Jache working with Jackie & an ‘angel’...................................................................................... 19 Figure 12 Jache ‘PROMPTS’ Jackie....................................................................................................... 20 Figure 13 Helen with Martha Adams and Speech Therapy Assistants, Marcus & Yvette.................................... 21 Figure 14 Helen with PROMPT Instructors at San Diego Instructors' course ................................................... 25 Figure 15 Relaxing after her presentation at ASHA, Donna Gaines (3rd from left) with Helen, Deb Hayden, Martha

Adams, Meg Houghton & Olympia Avignon. ..................................................................................... 30



Introduction This project took place in October-November 2005 with a trip encompassing visits to three Speech Pathology clinics in the United States of America; attending a PROMPT workshop in Canada; participating in the PROMPT Instructors’ camp; and attending the American Speech & Hearing Association convention. As a managing partner of Northern Suburbs Speech Pathology – Therapy, Learning & Communication, a private practice, opportunities to develop one’s skills further are generally not only self-funded, but also result in no income during your studies. Without the financial support of the Churchill Trust, I would never have been able to realize this wonderful experience. I would like to acknowledge the following people for helping me to fuel my passion for learning and sharing that knowledge with my clients, their families and my colleagues: Whist on my travels:

• Dr Nola Mariner, from Talk, Learn & Communicate – Seattle, Washington my mentor from the age of 11, who not only inspired me to become a Speech Pathologist, but also introduced me to PROMPT and shared her home, knowledge and expertise with me;

• Jackie Dolson-Shewchuk, from PROMPT Institute – New York, New York (well it should be up and running soon!), an amazing Speech Pathologist & educator who opened her heart and home to me, instilling in me some of her passion for living and loving what you do!

• Martha Adams, from From the Heart Therapy Services – Austin, Texas, who shared her commitment, dreams and love of her clients and colleagues with me;

• Deborah Hayden, from The PROMPT Institute – Santa Fe, New Mexico, for developing PROMPT and, in her own words, … ‘PROMPT will teach you how to look, your hands will teach you how to know, your heart will teach you how to see’ (Hayden, 2003a) I still have so much to learn, but thank you for opening the door;

• PROMPT Instructors - Meg Houghton, Edwyna Alexander, Lisa Freeman, Olympia Avignone, Donna Gaines, Joanne Hinchman-Giuffre, Bob Kiernan, Kayle Shulenberger, Alice Stroutsos & all the other PROMPT instructors for welcoming me into the ‘PROMPT world’ and sharing your knowledge, skills, enthusiasm and commitment to PROMPT.

My referees, who had the confidence and belief in me: • Joy Tranter, Speech Pathologist – Cerebral Palsy Association, for supporting me both personally and

professionally over many years as a teacher, mentor and true friend; • Dr David Roberts, Paediatrician – Joondalup Paediatrics, my colleague, who supported this project,

knowing that it would make a difference to young children with Autism; • Cathy Rainey, Director – Perth Harmony Chorus, for helping me know that challenges and commitment can

take many different forms – you just have to go for it! Making it happen:

• Sandy Gray, my business partner from Northern Suburbs – Therapy, Learning & Communication, who shared a dream with me that one day we would open a private practice together … and continues to dream with me as we expand and develop into a unique and specialist family-focused service;

• Staff of Northern Suburbs Speech Pathology – Therapy, Learning & Communication, whose commitment to their clients, their own professional development and the practice epitomizes the belief ‘together we can do the impossible’! (Maxwell, 1999);

• Kali Caramia, my partner, whose belief in me inspired me to ‘have a go’ and has been there all along the journey supporting me with her wisdom and her love;

• My family - Poppy Bolton, my Mum, Ashlen & Callum Wolfenden, my children, Alan, Ross & Neil, my brothers, and their families for understanding and accepting my commitment & drive.

And if it wasn’t for: • My clients & their families - Liam, and his mum, Mellinda; Joshua, and his Mum Liz and Alex, and his

Mum, Kate… and all the other children with Autism and their families – those that I have known in the past and all those that I will meet in the future. I feel truly privileged that you have allowed me to become a part of your lives. Thank you for ‘giving’ me so much … with every word, smile & achievement … I am truly blessed.



Executive Summary Helen Bolton Manager/Consultant Speech Pathologist Northern Suburbs Speech Pathology Ph: 08 9301 1154 Therapy, Learning & Communication Fax: 08 9301 1150 10 Elcar Lane Joondalup WA 6027 Email: [email protected] The fellowship travel was undertaken in October-November 2005 encompassing visits to Speech Pathology service providers in the USA; attending a Bridging PROMPT to Intervention workshop in Canada; participating in the PROMPT Instructors’ camp; and attending the American Speech & Hearing Association convention in San Diego. The objective of the fellowship was to develop knowledge and skills in PROMPT – Prompts for Restructuring Oral Muscular Phonetic Targets and apply these to children with Autism and/or motor-speech disorders. Although my intention was to focus studies on PROMPT intervention with children with Autism, there were other opportunities to learn about techniques that could be used with children with a range of communication issues, including those with challenging behaviours & literacy difficulties.

Highlights • Participating in Bridging PROMPT Technique to Intervention integrating previous knowledge attained from the

introductory course with concepts demonstrating the ‘holistic’ nature of PROMPT; • Reinforcing my PROMPT learning with my visit to Dr Nola Mariner - Talk, Learn & Communicate (TLC) – Seattle

and participating in the Social Understanding Group at TLC from which a ‘pen-pal’ network between young boys with Autism in Seattle and Perth will be established;

• Observing Jackie Dolson-Shewchuk, Prompt Instructor, New York City; and working ‘hands-on’ with Jache, a 13 year-old boy who has only started speaking in the last year since the use of PROMPT;

• Observing Martha Adams – From the Heart Therapy Services – Austin, Texas and participating in the interdisciplinary Imaginative Play sessions created around a fairy tale, integrating many aspects of learning, particularly sensory-integration, into a group program;

• Attending the PROMPT Instructors’ camp in San Diego and establishing a network of Speech Pathologists who will be able to support and mentor my further education in PROMPT;

• Attending the American Speech & Hearing Association’s Convention in San Diego and hearing world authorities presenting on a diverse range of topics, related not only to PROMPT & Autism, but also, play, literacy development and challenging behaviour.

Recommendations • To provide appropriate intervention for children with Autism and/or complex motor-speech disorders, Speech

Pathologists would benefit from using PROMPT therapy; • Further opportunities for training in PROMPT need to be available in Western Australia and the PROMPT

Interest Group needs to meet on a monthly basis to support & mentor newly trained PROMPT therapists; • The use of therapy assistants and/or Speech Pathology students, in the development of resources and working

with therapists in group and individual programmes should be investigated further, allowing for therapists to have more ‘hands-on’ time with clients; and

• More sensory-motor activities can be integrated into Speech Therapy sessions and we could be working jointly with an Occupational Therapist and/or Physiotherapist with specialist skills in this area more.

Further recommendations for Speech Pathologists’ intervention arose from papers delivered at the ASHA convention: • In relation to children with challenging behaviour, integrate the use ;visual contingency maps’ and ‘wait’ signals

as another strategy to manage this; • In relation children ‘at risk’ of early literacy difficulties, place more emphasis on intervention at the phoneme

(sound) level;



• In relation to literacy development, provide children with a more solid foundation in comprehension of language, which can be taught through play (rather than focusing solely on phonological awareness skill development); and

• In relation to outcomes for children with Autism, focus on reducing their stereotypic behaviours because this is more likely to have a positive impact on their development of cognitive, language, social, and daily living skills; and

• In relation to intervention with children with Apraxia, apply the knowledge that we have on motor learning principles to intervention, including the use of dynamic temporal & tactile cueing, use of feedback and use of ‘external’ focus of attention.

Implementation & Dissemination The knowledge and skills that have been acquired during the fellowship will be directly applied in: • My own clinical practice with clients with: Autism and/or motor-speech disorders, particularly as I participate in

the next level of PROMPT education to become a Certified PROMPT therapist; Literacy difficulties – particularly integrating information about play/language and phonological awareness into literacy development programmes; and Challenging behaviours – expanding the use of AAC strategies to address these behaviours;

• Education of the staff of Northern Suburbs Speech Pathology – Therapy, Learning & Communication and other Speech Pathologists, specifically in encouraging them to participate in PROMPT training that will be available in Australia in 2006 and then supporting their development of these skills;

• Networking with other PROMPT trained Speech Pathologists through the PROMPT Interest Group that has been established in Perth, Western Australia and supporting the future training of PROMPT therapists by applying to be an ‘assistant’ in PROMPT courses;

• Informing other professionals and parents of the use of PROMPT through articles submitted to relevant newsletters and presentations at appropriate forums. With the release of the Parent Manual in 2006 there will be opportunities to provide specific training to these groups;

• Applying the information regarding Literacy Development to intervention groups held at Northern Suburbs Speech Pathology – Therapy, Learning & Communication and those that are developed and/or facilitated by our therapists in schools;

• Application of administrative functions of other practices than can be implemented to enhance Northern Suburbs Speech Pathology – Therapy, Learning & Communication and incorporate international standards of practice in our office; and

• Continuing to build communication and links with clinicians within our practice and within the Speech Pathology community in Perth to ensure that clients are receiving services that reflect best practice.



Background to project Teaching non- or low-verbal children to talk is a challenge. In Western Australia in 2003, 218 children were diagnosed with an Autism Spectrum Disorder. Of the 195 children with information presented on their language levels 23% were described as non-verbal, 9% as having echolalia or jargon, 11% as limited functional, 24% as having delayed language, 15% with atypical language, and 17% had normally-developing language at the time of diagnosis (Glasson E et al, 2005). Smith, Zaidman-Zait & Mirenda (2005) examined the change over time of 38 children with ASD who spoke 60 words or less prior to the initiation of early intervention. They found that predictors of vocabulary growth over 2 yrs included:

• IQ at 6 months (post-intervention commencing) • the number of words produced at baseline • vocal imitation skills at baseline • gestures to initiate joint attention at baseline • pretend play skills with objects at baseline

These results imply that early interventionists should focus on developing: • vocal imitation skills • gestures for initiating joint attention, and • pretend play skills

…toward the goal of maximizing vocabulary development over time. Consequently, it is imperative that Speech Pathologists employ methods that develop oral language skills as early as possible in young children. Children with Autism Spectrum Disorders may have normal peripheral motor control, but often they present with sensory integration difficulties consequently, establishing the link between the sensory-motor and cognitive-linguistic areas is a critical component of intervention (Hayden, 2004). PROMPT, is a dynamic sensory-motor approach, developed by Deborah Hayden from The PROMPT Institute, that uses ‘prompts for restructuring oral muscular phonetic targets’ (Hayden, 2004). The system uses ‘touch’ as the primary sensory modality, in addition to auditory and visual input, to:

• “develop or re-establish speech motor control; • provide a foundation for integrating sensory modalities (audition and vision) in developing concepts

and expressive language; and • enhance social-emotional interaction between clinician and child.” (Hayden, 2004 p 255).

PROMPT has evolved over 30 years and has integrated our theoretical and clinical knowledge from a range of disciplines on the development of physical, cognitive and social skills. Consequently, PROMPT has evolved into a ‘holistic’ model of intervention embracing three key aspects of communication – physical-sensory; cognitive-linguistic and social-emotional. What is particularly ‘unique’ about PROMPT is the use of tactile-kinesthetic input which is considered to be the critical modality for recognizing, developing/re-balancing and integrating cognitive-linguistic, social emotional & motor behaviour. This systematic input to the face and neck areas aims to establish new motor schema (Gaines, 2005) and creates new and more intact neuro-motor pathways (Kaas, 1991). Figure 1 Jackie using a complex PROMPT with 3 year old, Nathaniel.



Northern Suburbs – Therapy, Learning and Communication is a private Speech Pathology clinic that was established in Perth in 1995. The practice, lead by Helen Bolton & Sandy Gray, has a team of 10 Speech Pathologists, who provide specialist services to children and adults with a range of communication disorders. Some of the therapists specialize in diagnosis and intervention with children who have an Autism Spectrum Disorder, seeing approximately 50 new cases per year. In 2001, I visited Dr Nola Mariner at her Talk, Learn & Communicate clinic in Seattle, Washington, where I was introduced to the PROMPT technique of intervention. Despite being excited about applying this dynamic and innovative approach, I did not have the skills to be able to do so on returning to Perth. It was not until 2004, that the first ‘Introduction to PROMPT Technique’ course was presented by Meg Houghton in Western Australia. I was immediately motivated to use the technique with as many clients as possible and was fortunate to have Dr Mariner visit Northern Suburbs – Therapy, Learning & Communication in the following November to reinforce my knowledge and skills. However, I was still desperately under-skilled to provide the level of intervention required by my clients and did not have the skills to train the other therapists in the practice. At that stage, there had been no dates scheduled in Australia for the Bridging PROMPT Technique to Intervention course. Hence, my application to the Churchill Trust to not only visit Canada/USA to participate in this course, but to visit some of the leading therapists in the world applying this technique in their clinics. My long term goals are, following completion of the Bridging PROMPT Technique to Intervention, to have an opportunity to undertake the next level of training, PROMPT Certification (which I anticipate will happen during 2006-2007) and eventually to become a PROMPT Instructor (which is ‘by invitation’). My journey has only just begun!

Figure 2 Just starting out... here I am using PROMPT with Blair & Mark before going off on my Churchill Fellowship... I had so much to learn!



Programme, at a Glance 1. PROMPT course – Bridging PROMPT technique to Intervention 13-15 October, 2005 Presented by Jackie Dolson-Shewchuk

In Calgary Contact information from: PROMPT Institute 4001 Office Court Drive Santa Fe, New Mexico 87507 Ph: 505 466 7710 [email protected]

2. Talk, Learn & Communicate– Seattle, Washington 16-21 October 2005 Dr Nola Mariner

17535 – 15th Ave NE Seattle, WA 98155

Phone: (206) 440-9708 Fax: (206) 260-2414

[email protected]

3. PROMPT Institute – New York 27 October-3 November Jackie Dolson-Shewchuk 2005 c/- 78 west 85 Street, 5D

New York, NY 10024 Ph 1-917-582-6401 [email protected]

4. From the Heart Therapy Services 6-10 November 2005 Martha Adams 5524 Bee Caves

Austin, Texas 78746 Ph 512-306-1707 [email protected]

5. PROMPT Instructors’ camp 15-17 November 2005 Held at Bahai Resort Hotel, San Diego Contact: Deborah Hayden PROMPT Institute

4001 Office Court Drive Santa Fe, New Mexico 87507 Ph: 505 466 7710 [email protected]

6. ASHA Convention 18-20 November 2005 American Speech & Hearing Association

c/- 10801 Rockville Pike Rockville, Maryland 20852 Ph 1-800-498-2071 Fax 301-571-0457 www.asha.org



1. Bridging PROMPT Technique to Intervention 3-day course held in Calgary, Alberta 13-15 October 2005 Presented by Jackie Dolson, Speech Pathologist Starting the Churchill Fellowship with attending the Bridging PROMPT Technique to Intervention reinforced my prior knowledge and introduced me to other theoretical concepts on which the PROMPT model was developed. It would not be appropriate in this context to attempt to describe the content of the workshop, however some ‘key’ concepts that were taught and, which underlie the PROMPT technique, will be briefly described. This information is taken from the Bridging PROMPT Technique to Intervention manual (Hayden, 2003a). Information about PROMPT courses is available at www.promptinstitute.com, including those that will be held in Australia (April 2006 in Perth!) The Bridging PROMPT Technique to Intervention builds on the knowledge already acquired in the Introduction to PROMPT Technique course. The objectives of this level of training are to: • Describe & apply the PROMPT application principles & technique; • Differentiate and apply, alone or in conjunction, PROMPT Parameter, syllable, complex & surface prompts with

varying speech production disorders; • Describe and demonstrate three planes of movement using PROMPT; • Identify initial parameters and priorities to begin goal setting with various client exemplars; and • Develop motor-speech goals that bridge technique to language and social interaction.

Key Concepts PROMPT is a ‘philosophy’ that recognises that sensory-motor, cognitive-linguistic and social-emotional domains are interrelated in the development of communication and consequently the underlying ‘breakdown’ in communication should be analysed across these areas and child’s strengths should be used to optimize their development (Hayden, 2003b). It is an approach that provides a “systematic way to investigate various modalities, ie auditory, visual, and tactile across motor and sensory-motor domains to evaluate the integrity of global motor, oral motor, sequencing, language and speech characteristics” (Hayden, 2003b p 7). The PROMPT system enables the therapist to “plan and organise the direction and type of treatment needed for the specific type of speech production delay or disorder” (Hayden, 2003b, p 7). The technique of PROMPT incorporates neuromotor principles in the use of tactile-kinesthetic, auditory and visual input to provide the speech system with ‘feedback’. It is the area of ‘technique’ that specifically deals with the use of “parameter, syllable, complex & surface prompting, timing and transition between movements, and the motor equivalence to language” (Hayden, 2003b p 7).

Uses of PROMPT “The purpose of PROMPT is to enhance or significantly change, in those with speech production disorders, appropriate motoric, cognitive-linguist, social and pragmatically meaningful, communication with significant others “(Hayden, 2003a p 15) and it is used to:

1. To develop an interactive awareness/focus for oral communication; 2. To develop integrated multi-sensory (tactile-kinesthetic) associative mapping for cognitive or linguistic

concepts; 3. To develop, balance or restructure speech subsystems at the motor-phoneme word or phrase levels.



PROMPT tenets The philosophy underlying PROMPT is reflected in the following tenets:

1. That human beings are internally and externally driven by the physical, mental and social-emotional Domains;

2. That these Domains are full integrated and co-dependent in a functional human; 3. That communication represents the purest integration of all three domains; 4. That humans need to connect with other humans across all Domains; 5. That communication may be disrupted by a breakdown in any, or all three Domains; 6. That to strengthen the weakest domain, all Domains must be reintegrated in a systematic fashion; 7. That restructuring should alternate focus among all Domains, but the timing and order are individually

determined; 8. Finally, that no communication intervention can produce permanent change without involving all Domains.

(Hayden, 2003b p8)

PROMPT Conceptual Framework • The PROMPT technique is based on the contention that physical-sensory, cognitive-linguistic and social-

emotional domains are interdependent and develop along a continuum in normally developing children.

USE model The USE model was created to provide the social application framework for PROMPT and highlights that the relationship between the client and the therapist is critical:

o Understand strengths and weaknesses across all domains; o Support the client to develop in all three domains with consideration of the emotional, physical and

communication support and boundaries/strategies; and o Evaluate all areas of client functioning.

(Hayden, 2003a)



Core Elements in PROMPT treatment 1. “The use of tactile-kinesthetic information as a critical modality for recognising, developing/re-balancing

and integrating cognitive-linguistic social-emotional and motor behaviour; 2. Determining a communication focus, eg an aspect of development in which to embed and focus

communication intervention, eg self-help or activities of daily living, interactive communication routines, play skills or pre-linguistic, pre-academic or academic learning;

3. Developing goals and embedding objectives that embody the Communication Focus and work towards motor/language, cognitive and social function;

4. Analysing the global and speech-motor sub-systems to determine three priority areas fhat need immediate development or rebalancing and create an initial lexicon;

5. Deciding on the purpose of prompting and what types of prompts should be used to support and develop speech-motor control for speech and language and/or interaction and cognitive development;

6. Realisation of how chosen goals and objectives will directly affect resourcing and therefore, activity, toy/material choices;

7. Insuring that a high degree of motor/sound practice (using prompts for accuracy of production) and generalisation of these into novel syllables and words, within naturalistic activities, are used within each session;

8. The inclusion of reciprocal interaction and choice making in almost every turn; 9. Presentation of the same/similar activities over time to provide a structure in which increased motor-

language complexity and cognitive learning or events and sequences can be learned. (Hayden, 2003a)

What I have learnt & can share with others! Throughout the course Jackie interspersed wonderful ideas and reinforced concepts that are directly relevant to clinical practice, including:

• Children in structured predictable environments have longer MLUs (mean length of utterances) than in free play;

• Be an ‘honest broker’ – do what you say to build trust; • Children learn more when they don’t have to focus on too many different things – maintain same activity and

change the motor demands; • Therapist provides the structure (use schedules & predictable routines) so child can focus on motor

patterns; • Link all learning to meaningful, functional and predictable activities; • Work on SPEECH to develop SPEECH! • Should see change in 3-4 sessions or you are working too high on motor speech hierarchy or there is

another underlying issue; • Don’t forget ‘tone’ & phonatory control – working with Occupational Therapists and Physiotherapists to

provide appropriate sensory-motor input; • Coordinated Structure Theory – working on one area of the hierarchy impacts on areas both above and

below on hierarchy! Lip rounding will encourage posterior tongue contraction, so working on one will reinforce the other.

There was so much more involved in the course with opportunities to increase my knowledge of the underlying theory; practise my prompting skills; write appropriate long term goals and objectives integrating the three domains – physical-sensory; cognitive-linguistic and social emotional, selecting sounds and lexicon and using appropriate equipment. Jackie was an outstanding educator who used a variety of teaching techniques to maintain the group’s interest and enthusiasm for learning throughout the course. It was also invaluable to establish networks with Speech Pathologist working with PROMPT in Canada, whom I have been able to maintain contact with.



2. Talk, Learn & Communicate – Seattle, Washington Contact details Dr Nola Mariner

17535 - 15th Ave NE Seattle, WA 98155 Phone: (206) 440-9708 Fax: (206) 260-2414 Email: [email protected] Website: talklc.com

Overview of Talk, Learn & Communicate Talk, Learn & Communicate’s mission is “to provide the highest quality of therapeutic and educational services for individuals (and their families) with speech, language, communication, sensory processing, motor, self-care and learning difficulties. It is our intent that these services will assist people to speak, learn, communicate and live to their fullest potential.” (Talk, Learn & Communicate, 2003). The programme provides the following:

Speech, Language, Communication Services

• Speech & language, communication and learning evaluations for children adolescents and adults. • Consultation and training in the use of communication aids and strategies. • Speech and language therapy to implement our recommendations. • Intensive therapy programs. • Training for families, agencies and school staff. • Assistive technology & augmentative communication therapy and workshops. • Software based training for improving auditory processing and receptive language skills.

Occupational Therapy Services:

• Occupational therapy evaluations for children and adolescents focusing on gross motor skills, fine motor skills, visual-motor abilities, sensory integration, and self-care abilities.

• Individualized therapeutic intervention to improve gross and fine motor abilities, independence in self-care, sensory integration, and play skills.

• Group therapy using The Alert ProgramTM for Self-Regulation and interventions to improve handwriting skills. • Develop home programs to improve motor development and sensory integration. • Collaborate with other service providers for continuity of care.” (Talk, Learn & Communicate, 2003).

Client Observations Much of the visit was spent in client observation, integrating the information from the Bridging PROMPT technique to Intervention. Although I made detailed observations of individual clients these are of more particular interest to Speech Pathologists who are using PROMPT with their caseload and are not included in this report. However, more general concepts that were reinforced during the observations follow: Figure 3 Myra working with 4 year old, Madeline



• Easier to work on attractor state of excessive opening then attractor state of retraction; • ‘Body break’ – giving children a break for physical/free play time and the ‘Straight Shot’ rollercoaster was great

for this along with the other sensory-motor equipment (see description/photo on page 14); • When there is fronting, ie saying ‘t/d’ for ‘k/g’, target back tongue +

rounding, then mid-tongue to consolidate these areas before working on anterior tongue;

• Need for mass practice, particularly with children with sequencing issues, prior to distributed practice;

• Inserting ‘schwa’ is related to poor jaw control – dropping to 4+ position! • Use mental imaging to match target – use visual feedback with pictures

of mouth positions for different sounds and match to letter for phoneme-grapheme association (Used Lindamood pix);

• Need to use Vineland II for developmental profile which gives standardized scores for PROMPT domains – computer scored with reported generated;

Figure 4 Nola with 6 year old, Maddie

Literacy Programme Development Dr Mariner was providing supervision to a staff member who was going to be providing an intensive literacy programme for a client. This was based on a similar programme that Dr Mariner had run in Sandpoint, Idaho to high school-aged boys with literacy difficulties. Underlying the intervention programme is the need to establish what constitutes the underlying issue, ie phonological issue – unable to make the sound-symbol association; Conceptualization – unable to ‘hold’ the image in the mid; or Comprehension difficulties. Specific programmes developed by the Lindamood-Bell Learning processes were explored. “This sensory-cognitive instruction focuses on individual needs, requiring individual diagnosis to determine strengths and weaknesses in reading, spelling and language comprehension – vocabulary; phoneme awareness (symbol and gestalt imagery); word attack (phonological processing); word recognition (orthographic processing) spelling; paragraph reading (both accuracy & fluency) and oral and written language comprehension. This instruction is:

• Diagnostically driven to meet the needs of an individual child; • Customised to ensure sensory processing is developed and applied to reading, spelling, language

comprehension and critical thinking, and • Delivered in one-to-one, small group and classroom environments.” (Bell & Lindamood, 2005).

The developers of this programme have developed a range of resources (listed below), that integrate well with the tactile sensory input that is used with PROMPT.

Social Understanding Group Talk, Learn and Communicate run a Social Understanding Group (SUG) for 7-year old boys who have an Autism Spectrum Disorder, facilitated by Myra Tishkoff, Speech & Language Pathologist. I was able to participate in one of these sessions, ‘introducing’ the boys to boys in Australia who also have an Autism Spectrum Disorder. We shared pictures of Australia and the boys… and it was quite delightful when these young children in Seattle pointed out the Australian boys commenting which one was ‘just like me’! The objectives of the group are to increase nonverbal communication; increase ability to develop friendships/relations – building social interaction & communication skills; develop higher order critical thinking; and increasing self-awareness through movement and language. Myra & I will be establishing a ‘pen-pal’ network via the internet in which the children in both countries will correspond with each other, sharing their experiences and activities.



Viewing videos of NSSPS Clients Video recordings of several clients from Northern Suburbs Speech Pathology were taken to be analysed by Dr Marriner. Specific feedback on each of these clients was given and will enable their intervention to be more specifically tailored to meet their needs.

Resources One of the highlights of the visit to Talk, Learn and Communicate was an opportunity to explore many of the resources, including games and activities, that are appropriate for intervention. This included a visit to a local toy store and two box loads of fabulous resources being sent back to NSSPS. Some of the resources/games that were particularly valuable are included below:

Books: Anthony J. Caruso Edythe A. Strand. (1999). Clinical Management of Motor Speech Disorders in Children. New York, New York, U.S.A. : Thieme Medical Pub. Gutstein, S & Sheely, R. (2002). Relationship Development Intervention with Young Children: Intervention with infants & preschoolers. Kingsley Publishing. Figure 5 Pinch bugs

Activities observed Pinch bugs - make ‘bugs’ using wooden pegs, felt and eyes! Stick magnets on the back! (photo) Popcorn making – target vocabulary: pop, up, melt, butter, bowl, top on;

Games Animal match-ups (Ravensburger) Don’t Break the Ice, Cootee & Ants in the Pants – Hasbro games/Milton-Bradley Ball Popper – Play School Balloon Lagoon – Cranium toys TicTac Tony – Fischer-Price (a discontinued toy which may be available through e-bay) Pop-up Pirate - Tomy

Figure 6 The 'elusive' Tic Tac Tony!

Equipment Straight Shot rollercoaster (Step 2) – a great physical activity that creates many communicative opportunities as well as providing sensory stimulation!

Figure 7 Straight Shot rollercoaster - great fun for young and old!

Literacy Programmes The following are available from Lindamood-Bell Learning Resources, www.lblp.com:

• Lindamood Phonemic Sequencing (LiPS)- targeting phonemic awareness; • Seeing Stars: Symbol Imagery for Phonemic Awareness & Spelling program – develops symbol imagery

and directly applies that sensory-cognitive function to sight word development, contextual fluency, spelling and increasing the speed and stability of phonemic awareness;

• Visualizing and Verbalizing for Language Comprehension and Thinking stimulates concept imagery. Individuals become able to image gestalts which include color, and even movement. This improves their language comprehension, reasoning for critical thinking, and expressive language skills.

Simon Sounds it Out – stages 1 & 2, available from Don Johnson. Away We Go – Scientific Learning



3. PROMPT Institute - New York Contact details Jackie Dolson-Shewchuk c/- 78 west 85 Street, 5D

New York, NY 10024 Ph 1-917-582-6401 [email protected]

Jackie is currently employed at YAI Lifestart which is a private agency that is government funded through the birth-to-three initiative in New York state. The children are parent referred via a pediatrician and she works with these clients in their own homes. Jackie is also in the process of establishing a New York office for the PROMPT Institute and she spends a significant amount of time teaching PROMPT courses frequently in the USA & Canada.

PROMPT Instructors meeting Having arrived in New York City after spending all day on a plane from Vancouver, Canada, I went immediately to a meeting with many of the PROMPT Instructors from New York City. This created opportunities to visit some of these practitioners during my visit to NYC over the following week and establish contact with some of the instructors who would be at the Instructors’ camp in San Diego later in my trip.

Visit to Association for Metroarea Autistic Children (AMAC) 25 West 17th St New York, NY 10011 www.amac.org Meredith Needleman, a recently trained PROMPT Instructor, works at the Association for Metroarea Autistic Children (AMAC). This facility provides a range of services including: school services, summer sleepaway camp, after school & Saturday programmes, adult day services and individual residential alternatives. The following information was provided through their information pamphlets. AMAC school services were established in 1961 and provide services to children using Applied Behaviour Analysis (ABA) for children aged 2-16 years of age. Preschool services (2-5 years) provide one-to-one and small group instruction to help children enter maintstream settings on graduation. School aged children are provided with intense instruction at appropriate levels depending on the child’s needs:

Special Needs Unit (SNU) These children require the most intensive level of services to build skills and work in classes of 6 children with one special education teacher and three assistant teachers. ABA is used to promote communication, self-help and early academic skills. The majority of instruction is one-to-one, with children spending most of their day in discrete trial teaching that will allow them to successfully transition to more traditional educational settings. This instruction is supplemented with group instruction to encourage systematic generalization of skills and social development.

Communication Acquisition Needs (CAN) Teaching is primarily in small groups of up to four students with one-to-one discrete trial training only being used to teach new skills and those that are not developing at the expected rate. The focus in this stage is developing the child’s language skills and social awareness.

Team Ten At this level, all teaching is conducted in the group setting in classes of 10 students and from here students can successfully transition into less restrictive classes in their community schools.

Reward Store This is an innovative program which both encourages appropriate behaviour and teaches students money skills. Children are reinforced every 30 minutes for appropriate behaviour and can ‘cash in’ their rewards at the end of the week for items in the ‘store’.



Observation of clients Over this two day period, Jackie Dolson-Shewchuk was observed working with several children at home and in a school setting; in individual and paired sessions. Notes of significance were made on some of those clients. It was positive to see that many of the areas that I identified as requiring intervention were included in the children’s programme. Many of the highlights of my observations of Jackie working with these clients are specifically relevant to Speech Pathologists who are ‘PROMPT’ trained, however there were some general concepts that are of relevance that will be included in this report: Ben, was almost 3 years of age and had a history of significant neurological dysfunction. He needed to learn how to make movements across 2 planes of movement, ie up and down and backwards and forwards. Many of the children I saw, including Ben, needed to establish more consistent mouth closure, including keeping their mouth in a neutral position with the lips together, rather than with an open mouth posture. Ben also demonstrated retraction of his lips, ie he tended to have a ‘smiling’ mouth and had difficulty with sounds that required ‘rounded’ mouth movements, ie ‘oo’ and ‘sh’ sounds. Jackie worked specifically with vocabulary that targeted the above issues, including: give me...; off; me+sign; on; all done; more; open; help; again; up; you; boo; cup; bubbles – ppp; bye bye; pop; bee. She frequently used songs, including Monkeys on the bed; Where is monkey; We are popping bubbles and Wheels on the bus. Given that Jackie carries all of her equipment in a backpack as she walks from client to client in Manhattan, her equipment needs to be easily portable. Ben delighted in playing with toy monkeys and a crocodile; catching bubbles with a bee bubble blower, making ‘critters’ with play dough and reading ‘Spot’ books. Each of the pieces of equipment was chosen to elicit the target vocabulary that had been selected. Figure 8 Jackie working with 3-year old Ben

Jakson, another almost 3 year old child, had a diagnosis of Pervasive Developmental Disorder (Not Otherwise Specified) – one of the Autism Spectrum Disorders. He also has a history of feeding difficulties and Jackie’s visit to Jakson coincided with breakfast so that she could have some input into this area as well. Jakson is currently receiving services from the Son-Rise Programme (see details on page 19) and consequently Jackie integrated her PROMPT goals with this. His PROMPT oral-motor goals were specifically targeting lip rounding and use of the tongue tip. The therapist was frequently ‘mapping in’ phrases, ie giving the child the tactile-kinesthetic input for words/phrases that the child is not yet able to use.

Joshua was a delightful 2 year old with Periventricular Leukomalacia (PVL), a brain injury that results in death of small areas of brain tissue around the ventricles (fluid-filled spaces of the brain that hold spinal fluid). Despite having severe gross and fine motor involvement, Josh’s receptive and expressive language skills are age appropriate. However his physical issues impact on his phonatory (breath) control for speech and this, along with reinforcing the Physiotherapy and Occupational Therapy, were primary targets of intervention. Figure 9 Jackie working with 2 year old, Joshua



Matthew, another almost 3 year old child presented at 2 years of age with delayed expressive language skills and an underlying motor-speech disorder. He also had problems with ear infections which were treated. Currently, he presents with age appropriate motor-speech and receptive/ expressive language skills, but has residual word-finding difficulties. Often children who have had a history of speech delay and present with word-retrieval difficulties are at risk of early literacy difficulties; consequently it is important to provide intervention in these areas as early as possible (Catts, 1998). Working with Matthew provided me with a great opportunity to share some of my knowledge and skills in working with children who are ‘at risk’ early literacy difficulties, specifically on activities to develop semantic organisational skills. Figure 9 Jackie working on semantic organisational activities with Matthew

Rachel, an 18 month-old, has just started talking and is now using about 25-50 words. She has had a history of a gross motor delay. Rachel was ‘fixing’ at her jaw for stability (ie holding her jaw tight). The Occupational Therapist and Speech Pathologist worked on her tolerating more oral stimulation to reduce this tension and, as a consequence, she started walking and her speech started to dvelop. Currently Jackie is focusing on establishing more lip rounding with words such as ‘shoe; toe; go; juice; and more’; closing syllables (ie putting the ‘ends’ on words) with ‘off; on; top; up; eat’. She is also ‘mapping in’ sounds made with the back of the tongue ie 'go' ‘all gone’ – working on this area will also encourage lip rounding (coordinated structure theory, Hayden 2004). Other target words that were focused on during the session included: off, bye, up, baby, erma /mermu/, rachel /rei rei/, up/down, nigh night, boo boo, hi, daddy/papa chosen, not only for their oral-motor significance, but also words that are functional within Rachel’s environment. Figure 10 18-month old Rachel being prompted to use lip rounding



Observation and participation in home-based programme of client Jache, a 13 year old boy with Autism, has been receiving services from the Son Rise-Options Institute programme (see page 19) for 10 years. His family moved from Texas to Massachusetts to access the program (see details on following page). Jache was initially seen about a year ago by Deborah Hayden, Director of the PROMPT Institution at which time he was non-verbal. He has subsequently started speaking and can use some short familiar phrases to make his needs known.

Angels (volunteer staff) & Parent meeting This was held on the evening prior to the observations; Angels presented feedback on Jache’s achievement of goals to date and set new goals with the parents as facilitators. Of concern to the parents was that angels are not really using communicative functions in the program – which appears in some ways contrary to their Son Rise program (see page 19). A priority of the feedback session with the Angels and the subsequent work with Jache was to demonstrate how to expand Jache’s functional communication. Figure 11 Jache working with Jackie & an ‘angel’

Intensive Therapy session Jache works intensively with therapists and his mother over an 8-10 hour day in a purpose built room in the family home. During the day Jackie and I visited him, we worked with his primary ‘Angel’ and his mother for the entire day. From a physical-sensory perspective, Jache needed to focus on maintaining neutral mouth position with jaw at 1 (ie closed) when at rest; establishing more lip rounding; and closing syllables with lips together or tongue tip sounds. However, he also has significant needs in the social-emotional domain, to use his verbal language to request and turn-take, and in the cognitive-linguistic domain, to follow single-step commands. One of the most rewarding experiences that I had during my Churchill Fellowship was when Jache ‘chose’ to work with me and then jointly with Jackie. There were periods during the day when Jache became extremely agitated, however he ended the day engaging both therapists in an interactive activity in which he requested one of the therapists to turn on music, then the other therapist to make a toy dog dance. When the dog was then thrown away, he even directed the therapist to retrieve it for him. Jache, who had been nonverbal a year ago, was using short sentences to make his needs known – what an amazing achievement!

School visit On the following day we observed a school-based Speech Pathologist working with Jache and discussed further opportunities for use of PROMPT and other language extension strategies, ie:

• Provide increased opportunities to use functional language during activities – introduce craft/cooking activities;

• Introduce books that are made of digital photos of Jache performing activities. Can also use the sessions to make the books, developing visual sequencing skills as well;

• Utlize cognitive teaching opportunities that are more functional, ie identify picture of item that is required in a specific activity – eg present pictures of knife and chair and ask ‘give me the knife/one for cutting’ when making fruit salad;

• Reduce intensity of tangible reinforcers; • Use symbols system (either photos or line drawings) for choice-making; • Vary reinforcers using choice-making board – not having objects in view and putting symbol and activity in a

‘finished’ box when this has been used.



Son-Rise Programme The Son-Rise Programme was established at the Autism Treatment Center of America in 1983 and is based on the following principles:

• “Joining in a child’s receptive & ritualistic behaviours supplies the key to unlocking the mystery of these behaviours and facilitates eye contact, social development & the inclusion of others in play;

• Utilising a child’s own motivation advances learning & builds the foundation for education & skill acquisition;

• Teaching through interactive play results in effective and meaningful socialisation & communication; • Using energy, excitement & enthusiasm engages the child & inspires a continuous love of learning &

interaction; • Employing a non-judgemental & optimistic attitude maximizes the child’s enjoyment, attention and

desire throughout their Son-Rise Programme; • Placing the parent as the child’s most important and lasting resources provides a consistent and

completing focus for training, education & inspiration; • Creating a safe, distraction-free work/play area facilitates the optimal environment for learning and

growth.” (The Options Institute, 1999-2004). The centre provides a range of services, including a ‘Start-up’ programme that trains parents and professionals in the fundamental skills and techniques necessary to design and implement a home-based child-centred Son-Rise Program. There are also advanced training programmes, including an ‘Intensive’ 5-day residential program for the child and his/her family. During our visit to the Options Institute, we were fortunate enough to observe two children and their families working on an ‘Intensive’ program. Jackie and I also had an opportunity to meet with Kate Wilde, the Assistant Director, of the Son-Rise program. We were given a copy of the program’s Developmental Model & Social Curriculum and discussed how PROMPT could be integrated into children’s programs within this theoretical framework. Figure 12 Jache ‘PROMPTS’ Jackie



4. From the Heart Therapy Services Contact details: Martha Adams 5524 Bee Caves Austin, Texas 78746

Ph 512-306-1707 [email protected]

From the Heart Therapy Services provide Occupational, Speech-Language and Physical Therapy Services. Their ‘quest is just the right challenge’ refers to “activities that prompt clients to stretch just a little beyond their current abilities, but that are not so difficult as to generate frustration or poor quality of response.” The facility uses both Speech Pathology assistants and Occupational Therapy technicians to undertake much of the preparation, equipment development and working in groups with the clients.

Figure 13 Helen with Martha Adams and Speech Therapy Assistants, Marcus & Yvette

This clinic provides an interdisciplinary approach which particularly focuses on the use of sensory-motor integration with PROMPT. Frequently individual Speech Pathology sessions commenced with the child in one of the gyms – some sessions were entirely based in the gym or joint session with the Occupational Therapist. Unfortunately, because of privacy legislation in the state of Texas, videos and photographs of sessions were not permitted. From the Heart Therapy Services also provide a range of group programmes, that are advertised to parents in their regular newsletter, including:

• Kid skills camp – an interdisciplinary group focusing on the development of interpersonal relationships, improving language & communication and sensory-motor skills;

• Hands-on handwriting camp – from pre-writing to beginning hand-writing groups, including an in-service for parents;

• Written expression camp – integrating both fine-motor and language aspects into written expression; and • ‘Date Nights’, held on a monthly basis and facilitated by technicians (Occupational Therapy assistants) to

entertain children and their siblings, enabling parents a 5-hour period of ‘reliable, trustworthy babysitting’.

Individual Client observations There were opportunities to observe and participate in therapy sessions with several different therapists, giving me an opportunity to apply some of the knowledge and skills that I had attained during the previous weeks. There were some particular techniques/activities that were observed that would be appropriate to integrate into therapy practises, including:

• Setting up visual schedule – these are drawn or written jointly with the child when s/he arrives, rather than set up prior to the child arriving, allowing for the child to have more ‘control’ and ‘power’ in the therapy session;

• Use of ‘brushing’ and sensory input, including use of ‘chewy tubes’ and bubble gum; • Clifford playdough – excellent for a range of PROMPT targets. Used ‘birthday’ theme – wrapping up

presents for Clifford and inviting ‘people’ to the party; • Trampoline -jumping on pix + words, ie bone, home, moon, sunny-then practise saying the word by

describing what she had jumped on. Therapist gave instructions of increasing length also working on auditory memory skills;

• Nesting eggs or cups – hiding objects of target words under cupping eggs, ie bone/shoe; • Books - Mayer-Johnson - transport match vehicle with use. Great book! • Foam puzzles great for 'push, in, out'- Pooh one with counting;



• Pooh colouring books - target horizontal plane rounding + Pooh imaginative play • Monster toast - this was a great cooking activity which could used as a procedural narrative activity. Instructions: 1. pour milk

2. Add food colouring 3. Paint a monster 4. Toast 5. Butter lightly 6. Sprinkle with cinnamon sugar 7. Munch your monster

Imaginative play sessions These are held over a 6-8 week period with children attending in groups of 2-3, facilitated by a Speech Pathologist & Occupational Therapist with two Speech Assistants included. During my visit, two groups were using this program, based on the story Jack & the Beanpole (the title of the traditional fairy tale being modified to accommodate specific PROMPT targets). The primary objective is to develop imaginative play skills, however additional specific goals/objectives set for each transition include:

Specific Goals/Objectives Greeting/farewell Increase abilities to offer spontaneous greetings; eye contact and motor speech at syllable & single word level; Brushing/Dressing Increase independence for dressing; focus to experience; in-hand manipulation and weight bearing on one foot – balance; Use of Melody/Therapeutic Listening Increase attention/focus; verbal awareness; auditory awareness; expectation of verbal interactions; organization of sequences within (story, events, actions); ability to wait and listen for the roles & interactions; awareness of emotions; modulation for unfamiliar or aversive activities (handwriting/colouring); Making choices/naming Increase cognitive-linguistic skills for naming objects, making associations and descriptors; motor speech at carrier phrase level; and memory skills to include memory sequencing; Repetition of the routine & weekly progression Provided proprioceptive input from climbing as well as building body strength; Multiple repetitions allowed for increase ability for sequencing our event; Trunk control. Reciprocal upper & lower extremities up ladder Snack Time Increase 2-4 step completion with improved motor planning; use of motor speech carrier phrases; awareness of social routine: passing & sharing; isolated index finger – in-hand manipulation; and increasing oral input variety; Fine motor Reiterate sequence from activities in movement; increase hand strength and use of digital manipulation for cutting and perseverance for handwriting; Transitions These were addressed throughout the social interactive routine and there were 11 transitions during the session Language Routine was set with verbal interactive models based on their motor speech –language systems; experiences with the environment using their bodies and with each other in this environment; Increased intelligibility, use of language to retell an event.



Format of clients’ session: • Brushed when they first arrived • Greeting song • Role-played dressing up (including staff); went throughout building and to gym to enact story • Jack and the Bean pole story enacting - targeted where, who and why questions • Fine-motor activity - Children made invitation for parents (listening to music while colouring) • Practice retelling story using tv with cardboard rolls and tissue box making a moving picture - Story telling

vest with weights in it or tightly wrapped velcro strip. Other activities including during the programme: planting and growing bean poles (checking these each week); making a movie book for retelling story; making a movie of the last visit to the giant’s palace.

Parent information session I was fortunate to observe the parent information session, provided to parents at the end of the 6-8 week programme in which they were given written feedback on the child’s progress and viewed a video of the children participating in the session.

Equipment Yet again, one of the highlights of this clinic visit was observing a wide range of equipment being used, including:

Assessment tools ASDS-Aspergers syndrome diagnostic scale-Pro-Ed GADS-Giloiam Asperger's Disorder Scale -Pro-ed

Games Stacrobats-Ravenburger Wheels on bus-MB-sings song then match pix to verbal Lucky ducks-MB-match colour; Princess jewellery Wee little piggies - MB my first games Teddy grahams game - Fischer-Price I Spy in Common - Scholastic-Briarpatch - school-age categorisation Tribond Jnr - Mattell-what do these have in common-7yrs + Zingo Bingo with a Zing-Think Fun Pizza Pile Up - Super Duper Nursery rhyme games MB - baa, baa black sheep; itsy spider; row, row. Wee little piggies - My first game Hasbro Rumble in the Jungle - Tomy

Computer cds: Thinking thing Toony the Loon Lagoon Edmark - good for auditory memory and processing Revenge of the riddle spider - www.BrightMinds.us A range of software programmes are available through www.CriticalThinking.com Cd-emotions - Windsor publishing



5. PROMPT Instructors Camp Held at Bahai resort in San Diego Contact details PROMPT Institute

4001 Office Court Drive Santa Fe New Mexico 87507 Ph: 505 466 7710

Bi-annually the PROMPT Instructors come together for a 2-day camp. As the organization expands further worldwide, there is a need to ensure that more policies/procedures are developed and implemented to maintain standards. I was fortunate this year to be included in this camp, generally only available to qualified instructors, and took on the role of minute-taker for duration of the camp!

Current & New Initiatives at The PROMPT Institute There was a significant amount of ‘in-house’ discussion during the camp, however the following information related to current and new initiatives was of particular interest:

• Workshop presentation – there were many ideas presented to the group on how to improve presentation of PROMPT workshops including the use of PowerPoint, overheads and other equipment, including LCD projectors – this was a particularly informative session with demonstrations included;

• Mentoring programme - Twelve new instructors have just been trained and the PROMPT Institute have established a ‘mentoring’ programme. Integrated into this concept are new ‘levels’ of instructors which are related to not only the instructor’s competence and experience, but also the number of workshops that they are presenting in a year. The organisation has also established a process whereby instructors’ certificates will be renewed and reissued every 2 years, to ensure that standards are maintained.

• Parent Manual – the PROMPT Institute are developing a Parent Manual that will be available to therapists who have completed the Bridging course to enable them to deliver programs to parents and other professionals/paraprofessionals who have an interest in the technique;

• Bulletin Board – the PROMPT website has a bulletin board which allows for Speech Pathologists and/or parents to post questions/information and the Instructors are rostered to respond to these;

• Motor & Action in Learning & Development course – this 12-week post-graduate course was presented by Deborah Hayden at the Florida State University for the first time in 2005; and

• PROMPT Skills Inventory has recently been developed which can be used with parents/teachers to give them feedback on treatment change. In the long term, if may be a tool by which normative data could be collected for research purposes.

Phonetic transcriptions Dr Roberta Chapey, a Speech Pathologist from New York City, presented a session describing her recently written book, “Mastering phonetic transcriptions for successful linear and nonlinear analysis with ‘Click ‘n type’ IPA Fonts’” and the “Click ‘n type” computer programme to make learning phonetics more fun to learn. The software enables samples to be more easily transcribed into phonetics. The text includes humor and interesting transcripts from or about famous people, that are interesting for young people to read, to teach phonetics – we had many laughs at some of the samples. Roberta would like to include a chapter in her book on the application of phonetics to PROMPT therapy, ie ‘How would you use the ‘Click ‘n type’ in PROMPT?’ A possible extension of this program would be to develop diacritics to notate PROMPT motor differences. This would require the creation of ‘new’ diacritics for motor movements such as lip rounding/retraction, jaw sliding, lip contact – what an exciting opportunity! Contact details: Dr Roberta Chapey [email protected] or [email protected] at Divergent Press



Smart Tools Smart Tools are resources, a software programme and therapy cards developed by Kayle Shulenberger and Alice Stroutsos to be used in PROMPT therapy. These resources were developed to enable therapists to assess clients, set appropriate goals and find words and functional activities based on PROMPT’s Motor Speech Treatment Hierarchy (Hayden, 1994). Kayle & Alice presented an update on the development of their resources and described how these could be integrated into the introductory workshop. They are currently developing an articulation screening/placement test and a report writing module. In the future Kayle & Alice are planning on including lists of children’s books and toys that are related to each PROMPT stage. There will then be a direct link to appropriate sources to purchase these. Contact details: Kayle Shulenberger, Alice Stroutsos www.smartalk.info

Case Presentations Certainly another highlight of the PROMPT Instructors’ camp was the case presentations. I had the opportunity to see each of the clients who were presented to the group during my clinic visits with Dr Nola Mariner, Jackie Dolson-Shewchuk and Martha Adams. Deb Hayden also presented a video-tape of a client from Australia who she is writing an intervention strategy for that will be published in the Speech Pathology Australia journal. Each instructor presented information on the client, as is required in the ‘Certification’ project, including:

• Completion of the Global Domain Evaluation to determine the Global Focus for Intervention and appropriate long term goals;

• Observation using the System Analysis Observation to complete the Motor-speech Hierarchy, analyse of the Speech Motor System and selecting PROMPTS to support the motor to language connection; and choose motor-phoneme links, words and phrases for intervention;

• Identification of support strategies and caregivers; • Development & integration of all areas into a treatment plan.

Videos of each of the clients were shown and the participants then discussed each aspect of the evaluation and treatment plan, providing suggestions and recommendations with regard to these. Given that I am undertaking the Certification project in 2006, it was valuable to see how experienced clinicians demonstrated the skills required at this level, ie to critically think & analyse, embed goals into appropriate activities and measure change.

Figure 14 Helen with PROMPT Instructors at San Diego Instructors' course



6. ASHA Convention Held at the San Diego Convention Centre Contact details: American Speech & Hearing Association

c/- 10801 Rockville Pike Rockville, Maryland 20852 Ph 1-800-498-2071 Fax 301-571-0457

What an amazing end to my Churchill fellowship, to attend the American Speech & Hearing Association convention! This convention is held annually and the San Diego convention with over 10 500 attendees, 3 600 presenters and 1 600 sessions available to attend. Clearly it was challenging to decide just ‘which’ sessions were going to give me the best ‘bang for my buck’. This term I heard frequently during my fellowship and in these days of trying to provide services that are cost-effective and efficient it really impacted on me. There was only one session that specifically targeted use of PROMPT, so I made a decision to go to sessions covering a broad range of topics that I could then disseminate information on to my colleagues on my return. Consequently, for the purposes of this report, in addition to a report on the PROMPT paper, there is feedback on papers presented in the area of language & play; outcomes of intervention in children with Autism; using AAC (Alternative-Augmentative Communication) with children with Autism; and Phonological Awareness & Early Literacy Development.

Summaries of papers/sessions/workshops attended Children’s Play: The Roots of Language and Literacy Development Carol Westby & Deb Wilson [email protected] (ASHA session 1082) This was a very entertaining presentation by Carol Westby, who developed the Westby Play Scale 25 years ago and Deb Wilson who is principal of a school for ‘deaf/hearing impaired’. , Carol reported that we are seeing less play happening and people were losing information about child development. The presenters framed information using the character ‘Pooh’, emphasising that ‘play is about learning to help each other’ The presenters discussed the development of play in children from infancy though to early high school who were developing typically and atypically, particularly those with a hearing impairment. The focus was on the use of play in the ecological assessment of children with disabilities and the development of comprehensive intervention programs to facilitate children’s social, cognitive, language skills and emergent literacy skills. Video presentations demonstrated the use of play in early childhood programs, classroom arrangement, play materials and teacher-child interactions in play that facilitate language and pre-literacy skills. Their concluding comment was…’Back to the days of Pooh and play to facilitate authentic language and literacy… phonological awareness is not going to teach children to comprehend stories!’ (Westby & Wilson, 2005).



Predictors of outcomes for children with Autism receiving early intervention Karen Bopp & Pat Mirenda University of British Columbia [email protected] (ASHA session 1077) The goal of this research was to determine the influence of six clusters of child behaviours: acting-out behaviours, sleeping disturbances, eating disturbances, stereotypic behaviours, social unresponsiveness and inattentiveness on outcomes (ie measures of language, adaptive behaviour, cognitive development and Autism rating) in young children with Autism. The results indicated those children with more problems with acting-out behaviour made more progress in language and social skills; children with fewer problems with stereotypic and inattentive behaviours made more progress on language, social and daily living skills. Consequently the researches recommend early intervention should:

• focus on improving inattentive behaviours in order to get the best “bang for our buck” (i.e., improve a wide variety of outcomes); and

• target the reduction of stereotypic behaviours to improve language and social outcomes over time. In fact, reducing stereotypic behaviours may be considered more “pivotal” to language and social outcomes than previously believed. In addition to promoting traditional non-verbal communicative skills, consider targeting specific behaviours such as stereotypies, since these behaviours appear to be related to the development of cognitive, language, social, and daily living skills over time for young children with autism.

(Bopp & Mirenda, 2005)

AAC for communication & behaviour support with individuals with Autism Pat Mirenda University of British Columbia [email protected] (ASHA session SC14) This presentation was a 3-hour short course, incurring a cost in addition to the registration fee. However, given Pat Mirenda is one of the leaders in the world in the use of Alternative/Augmentative Communication (AAC) with people with Autism who have challenging behaviours, the expense was certainly worthwhile. The seminar included video presentations of different types of intervention strategies focusing predominantly on adults. Challenging behaviour was defined as behaviour that may result in exclusion from typical school, home, and community settings; often impedes social relationships and/or learning; results in reduced quality of life for the person and his/her family and requires multi-element assessment and intervention supports that reflect current research. • There is a clear relationship between problem behavior and communication:

o people communicate in the most efficient and effective manner available to them at any given point in time;

• Some people have no way to communicate except through problem behavior: o individuals with limited or no functional speech who use AAC;

• Some people have other ways to communicate, but don’t know how or are unable to access those other ways in some situations:

o individuals whose problem behavior is triggered by situations that are frustrating, stressful, or anxiety-provoking; AAC may act as a bridge to communication

• Some people have other ways to communicate, but no one really "listens" until they use problem behavior: o individuals whose usual communication behaviors are subtle or otherwise difficult to interpret.



The presenter described different types of AAC to facilitate both comprehension and expression: • Augmented input supports to aid comprehension

o Visual schedules o Visual contingency maps and wait signals

• Augmented output supports to aid expression o Functional communication training o Choice-making supports

(Mirenda, 2005) Although I had previously used some of these techniques, there were others that I learnt and will now be integrating into therapy with some clients that I work with who have challenging behaviours. This will have an impact on my skills and subsequently practices of our staff.

Facilitating Phonological Awareness Development in Children with Speech Delay Susan Rvachew & Gail Gillon Website: cmds.canterbury.ac.nz [email protected] (ASHA session 1183) This session high-lighted the risk of children who have average or below average vocabulary and poor speech perception skills, being ‘at risk’ of poor Phonological Awareness and consequently difficulties in early literacy. The presenters stressed that speech perception, language and phonological awareness skills need to be within normal limits when kids START school to avoid long-term literacy difficulties! Gillon presented a longitudinal research study, monitoring literacy development in children from 3-8 years. They were provided with 25 hours of therapy -1 group and 1 individual per week administered in 6-8 week blocks, aiming to: • Improve speech intelligibility • Facilitate phoneme awareness – identify, categorization, matching • Teach letter name & letter sound knowledge The results of word recognition (tested at 6 years) was that the majority were above average, whilst for those without intervention, the majority were in the below average range. This was maintained when these children were re-tested at 8 years of age. By 8 years of age their spelling was slightly better than typically developing peers and their speech had improved to that of their peers. Intervention Activities A range of intervention activities were presented highlighting the need to:

• Focus at the phoneme level; • Integrate letter sound knowledge decoding encoding; • Model of service delivery ; • Time intensity – those children who only had 12 hours of group work, didn’t achieve at the same level; • Be aware that input on rhyme may have impact on spelling, but not as much on reading… need to focus

more at phoneme level; • Selected sounds that were associated with their speech sound difficulties; • Speech targets were very clearly written under the word to bring children’s attention to the print! • Identifying letters using large letters on the floor! • Used contrasts both visually and phonologically – ie ‘s’ and ‘m’; • I’m going to say a word, find the one I am talking about – which one starts with ‘s’? Can you tell me which

one starts with ‘s’? (Rvachew & Gillon, 2005)



Enhancing the Learning of Motor Skills - Application of Motor Learning Principles in Childhood Apraxia of Speech Edythe Strand Mayo Clinic www.mayoclinic.com (ASHA session 1542) Several presenters, including Edythe Strand from the renowned Mayo Clinic, came together to discuss the motor learning. This particular presentation was very insightful, applying information from previous presenters including Dr Wulf, who studies motor learning in a range of different contexts, Don Robbin & Geralyn Schultz. For the purposes of this feedback, only the information presented by Strand is included. Strand presented information specifically related to Apraxia, a speech disorder resulting in: difficulty with the ability to carry out purposeful voluntary movements for speech in the absence of a paralysis or weakness of speech; problems with sequencing of movement; difficulty reaching & maintaining specific articulatory configurations; and no difficulty moving muscles for non-speech activity. Treatment should allow the child the opportunity to take increasing responsibility for assembling, retrieving and executing motor plans with progressively less cueing – this is MOTOR LEARNING, which is a process of acquiring the capability for producing skilled action which occurs as a result of experience and practice Dynamic Temporal & Tactile Cueing (DTTC) for Speech Motor Learning (as used in PROMPT) allows the child to take increasing responsibility for assembling, retrieving and executing motor plans with progressively less cueing. Clinical experience has shown that children who have motor planning systems that are inefficient and no experience with correct speech movements require frequent, even concurrent visual/tactile feedback, to shape accurate movements. This supported the data Dr Wulf presented suggesting more frequent feedback might be required for the learning of complex skills. If task is relatively complex, more feedback seems to be needed and the learning is less likely to develop a dependency on it. DTTC builds in frequent, concurrent & immediate feedback at first then fades the specificity of feedback; frequency of feedback and lengthens the delay between response and feedback. As speech movement gestures become more accurate, the clinician may then begin to reduce the frequency of feedback, providing more summary feedback. Strand highlighted the importance of using ‘external’ rather than ‘internal’ focus of attention to change motor patterns, ie Internal – eg move your jaw less vs External – show me a smile, make your face look like mine. She highlighted that instructions & feedback are more effective if they direct attention to the movement effect than to the actual movement. Strand concluded that there are many principles of motor learning that can be applied to apraxic kids. Random vs blocked practice helps us decide how to organise practice within a session. The intervention programme at Mayo Clinic is for nonverbal 5 year olds who have had at least 3 years of prior Speech Therapy. The students attend the clinic for 6-weeks, with twice a day therapy… then return for reviews…INTENSITY MATTERS!!!!! This session really made me reflect on many aspects of motor-learning theory that we apply when working with children with complex speech disorders… and agonise over the lack of intensity of intervention that is available even to those with the most complex conditions!

(Strand, 2006)



Social Language Independence with Severely Impaired Using PROMPT and AAC Donna Gaines Children’s Speech & Language Services Virginia [email protected] (ASHA session 1906) What a wonderful end to the convention to have the last paper I attended being delivered by a PROMPT Instructor, whom I had the opportunity to get to know over my time in San Diego. Donna presented a case study of Ben, a severely impaired boy from age 9 to 13½ years, who progressed from being non-verbal to being able to produce intelligible and functional words and phrases. Donna discussed how through the systematic use of PROMPT, the choice of phonemes and lexicon use in predictable scripts for daily routines, allowed Ben to develop social language independence. She also demonstrated how PROMPT was used in conjunction with his AAC device, to best meet both the academic and social needs of this severely impaired individual. The video footage that Donna used to demonstrate his progress was amazing and really inspired me! Donna concluded with a wonderful comment…which I think encapsulates why I am so passionate about working in this area…

“Communication allows us to touch the lives of others and to be touched by others.” (Light, 1988)

Figure 15 Relaxing after her presentation at ASHA, Donna Gaines (3rd from left) with Helen, Deb Hayden, Martha Adams, Meg Houghton & Olympia Avignon.



Conclusion What started out as a study trip to investigate the use of PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) with young children with Autism developed into an opportunity to learn much more about the application of PROMPT to a wide range of clients; understand the holistic nature of PROMPT; and to observe and investigate other forms of intervention for clients with diverse disabilities. There appears to be a perception by those who are not very familiar with PROMPT that it is only about the use of tactile-kinesthetic cues to develop speech, however this is only the ‘technique’ aspect. PROMPT is based on the underlying philosophy that communication (and ‘breakdowns’ in communication) can be viewed as inter-related domains of development, ie sensory-motor, linguistic-cognitive and socio-emotional. Difficulties in any one area will impact on the development in another. Similarly, strengths in a particular domain should be utilized to optimize the child’s communication potential. PROMPT uses a comprehensive approach to analysing the modalities (auditory, visual & tactile) across the motor and sensory-motor domains to evaluate a range of characteristics – global motor, oral motor, sequencing, language & speech. It then enables the clinician to develop goals to develop ‘functional, interactive and verbal communication’ (Hayden, 2003b p7), by planning & organizing the direction and type of therapy that specifically addresses the nature of the speech delay or disorder (Hayden, 2003b). Whenever one is introduced to a ‘new’ approach/technique, we are at risk of not understanding the ‘whole’ – how it has evolved, how it can be applied in a broad range of contexts with diverse clients, how each therapist brings ‘her/himself’ to the intervention. Speech Pathologists in Australia can be introduced to a system through professional education and then do not necessarily have an opportunity for ongoing support to apply the technique – consequently what was initially taught becomes ‘watered-down’ or blended with other techniques and loses it’s uniqueness. The PROMPT Institute provides ongoing training for Speech Pathologists to increase their knowledge and skills (ie Introduction to PROMPT, Bridging PROMPT Technique to Intervention, Certification in PROMPT and Instructors’ training and encourages the establishment of PROMPT Interest Groups to enable peers to support each other, which is essential when you are geographically isolated. I found it invaluable to have an opportunity to observe and learn from some of the leading PROMPT instructors in the world and would recommend this type of professional education to anybody to further develop their knowledge and skills in a particular field that they are choosing to develop as an area of ‘specialization’. Not only did I expand my knowledge, understanding and use of PROMPT, but I also had an opportunity to work with clinicians using a wide range of intervention programmes and strategies with children with different disorders, including: the Social Understanding Group held for young boys with Autism and the literacy programme integrating the Lindamood-Bell model (Bell & Lindamood, 2005) and exploring (and purchasing!!!) the amazing range of therapeutic materials and toys at Talk, Learn & Communicate in Seattle; the Son-Rise Programme at the Options Institute in Massachusetts; the Association for Metroarea Autistic Children in New York City; and the Imaginative Play sessions developed by the From the Heart Therapy Service in Austin. In both Seattle & Austin, the integration of sensory-motor input into Speech Therapy sessions, and working closely with Occupational Therapists was highlighted, as was the use of Speech Therapy assistants who develop so many resources and provide additional support during both individual and group work. To conclude my Churchill Fellowship attending the American Speech & Hearing Associations annual convention reinforced to me the great learning experience that such events hold. Leading authorities from throughout the world report of their findings and these can have a direct impact on our intervention. The papers that I attended, specifically targeting the relationship between language & play development and literacy; predictors of outcomes for young children with autism; use of Alternative & Augmentative Communication (AAC) with people with Autism; developing phonological awareness skills in children with a speech delay; applying motor learning principles in intervention with children with Apraxia and integrating PROMPT and AAC to develop social language independence, all have given me specific strategies and techniques that I will be able to apply to my own clinical practice and share with other Speech Pathologists, parents and educators.



Recommendations It has been rewarding and exciting to see some of the recommendations that have come out of my fellowship studies have already been implemented by Northern Suburbs Speech Pathology – Therapy, Learning & Communication. I look forward to supporting other Speech Pathologists and organisations in their endeavours to ensure that children with Autism and severe communication impairment have optimal opportunities to develop oral language. To this end, the following recommendations are made: • To provide appropriate intervention for children with Autism and/or complex motor-speech disorders, Speech

Pathologists would benefit from using PROMPT which: o Recognises the need to develop all aspects of communication, ie physical-sensory, cognitive-linguistic

and social-emotional; o Develops skills in using tactile-kinesthetic input, in addition to the use of auditory and visual cues, to

develop speech; and o Integrates more sensory-motor activities into therapy sessions;

• Further opportunities for training in PROMPT need to be available in Western Australia. Whilst I was away, two

further courses to be held in Perth were announced (Note: An ‘Introduction to PROMPT’ and ‘Bridging PROMPT technique to intervention’ will be held in April, 2006) and the PROMPT Interest Group needs to meet on a monthly basis to support & mentor newly trained PROMPT therapists. (A meeting schedule has been planned for 2006 – thank you Roslyn Ward);

• The use of therapy assistants and/or Speech Pathology students, in the development of resources and working

with therapists in group and individual programmes should be investigated further, allowing for therapists to have more ‘hands-on’ time with clients;

• More sensory-motor activities can be integrated into Speech Therapy sessions and we could be working jointly

with an Occupational Therapist and/or Physiotherapist with specialist skills in this area more (Note: Since returning to Perth, NSSP-TLC have contracted an Occupational Therapist who specialises in this area to work within the practice); and

• Establish a ‘pen pal’ network with young boys with Autism from our clinic with the Social Understanding Group in

Seattle. This process has commenced and we are looking forward to receiving our first letters from our ‘pen pals’!

Further recommendations for Speech Pathologists’ intervention arose from papers delivered at the ASHA convention: • In relation to children with challenging behaviour, integrate the use ;visual contingency maps’ and ‘wait’ signals

as another strategy to manage this; • In relation children ‘at risk’ of early literacy difficulties, place more emphasis on intervention at the phoneme

(sound) level; • In relation to literacy development, provide children with a more solid foundation in comprehension of language,

which can be taught through play (rather than focusing solely on phonological awareness skill development); and • In relation to outcomes for children with Autism, focus on reducing their stereotypic behaviours because this is

more likely to have a positive impact on their development of cognitive, language, social, and daily living skills; and

• In relation to intervention with children with Apraxia, apply the knowledge that we have on motor learning

principles to intervention, including the use of dynamic temporal & tactile cueing, use of feedback and use of ‘external’ focus of attention.



Implementation & Dissemination The knowledge and skills that have been acquired during the fellowship will be directly applied in: • My own clinical practice with clients with: Autism and/or motor-speech disorders, particularly as I participate in

the next level of PROMPT education to become a Certified PROMPT therapist; Literacy difficulties – particularly integrating information about play/language and phonological awareness into literacy development programmes; and Challenging behaviours – expanding the use of AAC strategies to address these behaviours;

• Education of the staff of Northern Suburbs Speech Pathology – Therapy, Learning & Communication and other

Speech Pathologists, specifically in encouraging them to participate in PROMPT training that will be available in Australia in 2006 and then supporting their development of these skills;

• Networking with other PROMPT trained Speech Pathologists through the PROMPT Interest Group that has been

established in Perth, Western Australia; • Supporting the future training of PROMPT therapists by applying to be an ‘assistant’ in PROMPT courses; • Informing other professionals and parents of the use of PROMPT through articles submitted to relevant

newsletters and presentations at appropriate forums. With the release of the Parent Manual in 2006 there will be opportunities to provide specific training to these groups;

• Applying the information regarding Literacy Development to intervention groups held at Northern Suburbs

Speech Pathology – Therapy, Learning & Communication and those that are developed and/or facilitated by our therapists in schools;

• Application of administrative functions of other practices than can be implemented to enhance Northern Suburbs

Speech Pathology – Therapy, Learning & Communication and incorporate international standards of practice in our office; and

• Continuing to build communication and links with clinicians within our practice and within the Speech Pathology

community in Perth to ensure that clients are receiving services that reflect best practice..

I believe my passion for learning has been fuelled even further this year by the opportunities made available to me by my Churchill Fellowship. I look forward to sharing the new techniques I have learnt with my staff at Northern Suburbs Speech Pathology and also by any other opportunities that may present themselves to me. I intend to persevere with my goal of becoming a PROMPT Instructor and would like to formally recognise and thank the Winston Churchill Memorial Trust for their part in this incredible learning experience.

Helen Bolton, January 2006



References Bell, N. ,Lindamood, P. & Lindamood P. (2005) Lindamood-Bell Learning Processes. www.lblp.com. Bopp. K & Mirenda, P. (2005). Predictors of outcomes for children with Autism receiving early intervention. Paper presented at the ASHA Convention, San Diego. Catts, H. & Kamhi, A (1998). Language and Reading Disabilities. Needham Heights: Allyn & Bacon. Gaines, D. (2005). Social language independence with severely impaired using PROMPT and AAC. Paper presented at ASHA Convention - 2005, San Diego. Glasson E, Bolton H, Chauvel P, Cohen D, Cook H, Dixon G, Klinken J, McMullin B, Tender J, Wray J (2005). WA Register for Autism Spectrum Disorders - 2003 Report. Perth, Western Australia. Hayden, D. (2003a). Bridging PROMPT Technique to Intervention. Santa Fe: The PROMPT Institute. Hayden, D. (2003b). Introduction to PROMPT Technique. Santa Fe: The PROMPT Institute. Hayden, D. (2004). PROMPT: A tactually grounded treatment approach to speech production disorders. In Stockman, I. (Ed.) Movement and Action in Learning and Development: Clinical Implications for Pervasive Developmental Disorders. San Diego: Elsevier-Academic Press. Kaas, J. (1991). Plasticity of sensory and motor maps in adult mammals. Annual Review Neuroscience, 14, 137-167. Light, J. (1988). Interaction involving individual using augmentative and alternative communication systems: State of the art and future directions. Augmentative and Alternative Communication, 4, 66-82. Maxwell, J. (1999) Teamwork makes the dream work. Nashville: Thomas Nelson. Mirenda, P. (2005). AAC for Communication and behaviour support with individuals with Autism. Paper presented at the ASHA Convention, San Diego. Rvachew, S. & Gillon, G. (2005). Facilitating phonological awareness for children with a speech delay. Paper presented at the ASAH Convention San Diego. Smith, V., Zaidman-Zait, A., & Mirenda. P. (2005). Cluster analysis of predictors of early intervention in children with autism. Manuscript submitted for publication. Strand, E. (2005). Enhancing the learning of Motor Skills - Application of Motor Learning Principles in Childhood Apraxia of speech. Paper presented at the ASHA Convention, San Diego.

Talk, Learn & Communicate (2003) Talk, Learn & Communicate. www.talklc.com.

The Options Institute (1999-2004). Autism Treatment Centre of America. www.autismtreatmentcenter.org.

Westby, C & Wilson, D. (2005). Children’s Play: The Roots of Language and Literacy Development. Paper presented at the ASHA Convention, San Diego.

churchill report helen bolton 2005 · helen bolton winston churchill trust fellow – 2005 -2- ......

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