Kristin J. Szewczyk, M.S./CCC-SLP

February 1, 2009

Communication is simply defined as “an exchange of information;” however, the

process of communication is much more complex.

(Hedge, 2001, p. 2)

Problems with Communication

Communication deficits are one of the primary

characteristics of autism spectrum disorders

(ASDs)

(American Pyschiatric Association, 2000)

Common Problems with Communication

Common Problems with Communication

Expressive LanguageEcholalia-Repeating what is said

Immediate Delayed

Difficulty expressing wants/needsPoor VocabularyDifficulty with PronounsDifficulty with non-literal aspects of languageReduced sentence length

(ASHA, 2009b; Prelock, 2006)

Common Problems with Communication Receptive Language

Difficulty following directionsDifficulty answering questions

Pragmatic LanguageSocial Language

Difficulty with Initiating and Maintaining a Conversation Difficulty understanding Facial Expressions/Body

Language Poor Eye Contact

(ASHA, 2009b; Prelock, 2006)

Functions of Communication

Functions of CommunicationThree Primary Functions of Communication in

Individuals with ASD

Regulate Behavior

Social Interaction

Joint Attention

(Wetherby & Prizant, 2005)

Functions of Communication Regulate Behavior

First function to develop Making requests

Objects Activities

Expressing Wants/Needs Hunger/Thirst Asking for help

(Prelock, 2006; Wetherby & Prizant, 2005)

Functions of CommunicationSocial Interaction

Play Activities Requesting involvement with Family/Friends Social Greetings

“Hello”/ “Bye-Bye” Bring Attention to Self Showing Off

(Prelock, 2006; Wetherby & Prizant, 2005)

Functions of CommunicationJoint Attention

Shifting attention between individuals and objects Gaining an individual’s attention Directing an individual’s attention

Make Comments Ask Questions Provide information

(Prelock, 2006; Wetherby & Prizant, 2005)

Methods of Communication

Verbal Communication

Augmentative and Alternative Communication (AAC)

Verbal Communication

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

AACAAC is a combination of symbols and methods

that are used to improve communication (Downey & Hurtig, 2003)

Object Exchange

Sign Language

“Total Communication”

Picture Exchange Communication System (PECS)

Voice-Output Communication Aids (VOCAs)

Object ExchangeReal Objects

Child gives communicative partner an object to indicate what he/she wants Example: Child gives parent a book to indicate that

he/she wants to read a storyChild must have easy access to the objects in

order to make wants/needs known

(Strokes, 2006)

Sign Language

Movements made with the hands to represent letters and words

(National Institute on Deafness and Other Communication Disorders, 2008)

(Lifeprint.com, 2008)

Total Communication

An AAC method that involves using verbalizations and sign language

simultaneously

(Goldstein, 2002; Prelock, 2006)

PECS

PECS PhasesPhase I – “How” to Communicate (Frost &

Bondy, 2002, p. 67)Instructor presents the individual with a

preferred itemIndividual chooses a picture that represents

the preferred item Individual gives the picture to the instructor to

request the itemInstructor gives the individual the desired item

PECS PhasesPhase II- Develops independent requesting

Individual chooses a picture from his/her PECS book

Individual finds the communicative partner and gives the picture to him/her

Only one picture is used during this phase

(Frost & Bondy, 1994; 2002)

PECS PhasesPhase III-Continues to develop independent

requesting

Individual selects a picture from a larger field

Individual independently selects a picture from his/her PECS book and finds a communicative partner in order to make the request

Number of pictures increases as the individual gains accuracy and experience

(Frost & Bondy, 1994; 2002)

PECS PhasesPhase IV- Combining pictures to make requests

Individual uses a sentence strip located at the front of his/her PECS book to build more complicated requests

Individual must locate the “I want” picture as well as the picture of the item or activity he/she is requesting

Individual then finds a communicative partner in order to make the request

(Frost & Bondy, 1994; 2002)

PECS PhasesPhase V- “What do you want?”

Individual uses a sentence strip located at the front of his/her PECS book to build more complicated requests

Individual must locate the “I want” picture as well as the picture of the item or activity he/she is requesting

Individual then finds a communicative partner in order to make the request

(Frost & Bondy, 1994; 2002)

PECS PhasesPhase VI- Independent Communication

Individual independently responds to a variety of questions and makes comments using his/her PECS book

(Frost & Bondy, 1994; 2002)

PECS

(Strokes, 2006)

VOCAsElectronic device

Child pushes a button on device

Pictures/printed words on the buttons represent messages

Pre-recorded message plays

Vary in complexity and cost

(Nunes, 2008)

VOCAs

(The Sensory Company®, 2003)

VOCAs

(AdaptAble Minds, n.d.)

VOCAs

(SuperDuper Publications, 2009)

VOCAs

(DynaVox Technologies, 2008)

Benefits of AACBeneficial for verbal/non-verbal children with

ASD

Increases number of vocalizations/verbalizations

Improves functional communication skills Expressing wants/needs Requesting

(Blischak, Lombardino, & Dyson, 2003; Charlop-Christy, Carpenter, Le, LeBlanc & Kellet, 2002; Dyches, Davis, Lucido,

and Young, 2002 ; Goldstein, 2002; Mirenda, Wilk, and Carson; 2000; Nunes, 2008

Benefits of AAC Improves communicative initiations

Responses Comments

Improves social interactions Decreases problem behaviors

(Blischak, Lombardino, & Dyson, 2003; Charlop-Christy, Carpenter, Le, LeBlanc & Kellet, 2002; Dyches, Davis, Lucido,

and Young, 2002 ; Goldstein, 2002; Mirenda, Wilk, and Carson; 2000; Nunes,

2008

Selecting a Method of Communication

When selecting a method of communication, should consider the following:Communication needs of your childPhysical capabilities of your child Child’s level of motivationFlexibility/Accessibility of the method of

communicationConsult with a speech-language pathologist (SLP)

(ASHA, 2009a)

Communication Strategies

StrategiesNaturalistic Language Teaching

Joint Action Routines

Visual Strategies

(Goldstein, 2002; Prelock, 2006; Tissot & Evans, 2003)

Naturalistic Language Teaching

Instruction and learning is provided during naturally occurring situations

Uses child-preferred materials Learn and generalize skills at a faster rate

Child is reinforced for appropriate initiations and responses to communication

(Harris & Delmolino, 2002; Prelock, 2006)

Naturalistic Language Teaching

Milieu language teachingChild-directed modelingMand-modelingTime-delayIncidental teaching

(Goldstein, 2002; Harris & Delmolino, 2002; Prelock, 2006)

Milieu Language TeachingChild-Directed Modeling

Uses child’s interests Establishes joint attention

Adult/Instructor provides verbal models Reinforce correct responses Repair incorrect responses

(Harris & Delmolino, 2002; Prelock, 2006)

Example of Child-Directed ModelingInterest: Child enjoys going for rides in the

carAdult/Instructor: “Say, ‘Open the door.’”Child responds: “Door.”Adult/Instructor: “Say, ‘Open the door.’”Child responds: “Open the door.”Adult/Instructor: “Nice talking!”

Adult/Instructor then opens the door to the car.

Milieu Language TeachingMand-Modeling

A mand is “a verbal instruction or request” (Prelock, 2006, p. 413)

Teaches functional communication skills

Utilizes child’s interests Establish joint attention

(Harris & Delmolino, 2002; Prelock, 2006)

Mand-ModelingAdult/Instructor instructs the child to follow a

command or complete a request

Provides a verbal model

Reinforce correct responses

Repair incorrect responses

(Harris & Delmolino, 2002; Prelock, 2006)

Example of Mand-ModelingChild approaches playdough, which is the

child’s favorite activityAdult/Instructor: “Say, ‘I want playdough.’”Child says: “Dough.”Adult/Instructor: “Say, ‘I want playdough.’”Child says: “Want playdough.’”Adult/Instructor: “Say, ‘I want playdough.’”Child says: “I want playdough.”Adult says: “Nice talking!”

Gives child the playdough

Milieu Language TeachingTime-Delay

Using pauses between the mand and the provided model/cues

Develops independent communication

(Harris & Delmolino, 2002; Prelock, 2006)

Example of Time-DelayChild wants to watch a movie and stands in

front of the TV

Adult/Instructor waits until child makes the requestChild says, “I want to watch a movie.”Adult/Instructor completes the request

Milieu Language TeachingIncidental Teaching

Increase language/conversational skills

Environment arranged to facilitate communication

Utilizes child’s interests

Child must interact with adult to make a request

Milieu Language TeachingAdult instructs child to make a request or

answer a question using a more complex response

Provides a model

Provides correction

Provides reinforcement

(Harris & Delmolino, 2002; Prelock, 2006)

Example of Incidental TeachingChild wants a cookie and says, “Cookie.”

Adult/Instructor: “What kind of cookie do you want?”

Child: “I want a chocolate cookie.”

Adult/Instructor: “Here is your cookie. You like chocolate cookies. I like chocolate cookies, too. Do you think Daddy likes chocolate cookies?”

Child: “Yes. He eats chocolate cookies, too!”

Joint Action RoutineUtilizes familiar routines

Involves two or more individuals

Provide some items for routine, but withhold others

Child requests items needed to complete the routine

Adult/Instructor asks child questions during the routine

(Prelock, 2006)

Joint Action RoutineThree types of joint attention routines

Routines with a “specific product or outcome” (Prelock, 2006, p. 408)

Routines planned around a theme or story

Turn-taking routines

(Prelock, 2006)

Example of Joint Action RoutineBreakfast

Adult/Instructor: “What do you want for breakfast?”

Child: “Cereal.”Adult/Instructor: “What kind of cereal?”Child: “Lucky Charms.”Adult/Instructor gives child the box of cerealChild: “I need the milk.”Adult/Instructor gives the child the milk.Child: “I need a bowl and a spoon.”Adult/Instructor gives the child the bowl and

spoon.

Why use visual strategies?

Visual StrategiesChildren with ASD are visual learners

Makes concepts concrete

Improves focus and attention

Reduces anxiety

Improves communication

(Rao & Gagie, 2009; Tiss0t & Evans, 2003)

Visual StrategiesModeling

LiveVideo

Social Stories

Scripts

Live ModelingAlso known as “in vivo modeling”

Child observes an individual demonstrating a desired behaviorParents, peers, other adults/children

Goal is for child imitate and use the desired behavior in other situations

(Charlop-Christy, Le, & Freeman, 2000;

Prelock, 2006, p. 420)

Live ModelingBenefits

Effective in improving social and communication skills

Implemented by a variety of individuals Parents, siblings, teachers, etc.

Used in a variety of settings and situations

(Charlop-Christy, Le, & Freeman, 2000;

Prelock, 2006

Video ModelingChild watches videos of an individual demonstrating a

desired behavior

Others Parents, peers, other adults/children

Self

Again, goal is for child imitate and use the desired behavior in other situations

(Buggey, 2005; Delano, 2007; Hitchcock, Dowrick, & Prater, 2003; Sherer

et al., 2001)

Video ModelingBenefits

Effective in improving social and communication skills

Ususally obtain quicker results than live modeling

Can be used repeatedly in a variety settings and by different individuals

(Baharav & Darling, 2008; Charlop-Christy, Le, & Freeman, 2000;

Delano, 2007; McCoy & Hermensen, 2007)

Modeling ConsiderationsFirst, choose a behavior to teach

Examples Saying “hello”/ “bye” Answering questions Conversational skills

Turn-taking

(Charlop-Christy, 2004)

Modeling Considerations

Visual StrategiesSocial Stories

Short stories that are written from the child’s point-of-view

Provides information about a social situation and how to respond appropriately Individuals involved Order of events in the situation Feelings of other/self

(Ivey, Heflin & Alberto, 2004; Sansosti & Powel-Smith, 2008)

Social StoriesBenefits

Reduces problem behaviors

Improves social communication

Increases appropriate social interactions

(Crozier & Tincani, 2005; Thiemann & Goldstein, 2001; Ivey, Heflin & Alberto, 2004; Sansosti & Powel-Smith,

2008)

Example of Social Story

http://www.frsd.k12.nj.us/autistic/Social%20Stories/Pages/asking_other_kids_to_play.htm.

Visual StrategiesScripts

Used to teach social and conversational skillsTaught using modeling, cues, and reinforcementScript is written on a cue card

May include pictures or other symbols depending on individual’s reading level

May be tape-recorded

(Charlop-Christy & Kelso, 2003;

Ganz, Kaylor, Bourgeous, & Hadden, 2008)

ScriptsScripting process:

Adult asks a question Presents cue card to individual containing the responseIndividual is told to read the response out loudAdult then instructs the individual to read the response

while maintaining eye contactProcess is repeated until conversation is finishedProvide reinforcement

Verbal praise – “Great job!” Preferred food, toy, or activity

(Charlop-Christy & Kelso, 2003; Ganz, Kaylor, Bourgeous, & Hadden,

2008)

Script ExampleAdult: Do you like to watch T.V.?Child: Yes. Do you like to watch T.V.?Adult: Yes. What’s your favorite show?Child: Power Rangers. What show do you

like?Adult: Cheers. Do you watch videos?Child: Yes. Can we watch a video?Adult: Sure!

(Charlop-Christy & Kelso, 2003, p. 125)

ScriptsBenefits

Improves conversational skillsImproves social interactions

Peers Adults

Decreases echolalia and speech perseverations

(Charlop-Christy & Kelso, 2003; Ganz, Kaylor, Bourgeouis, & Hadden, 2008)

Visual StrategiesResources

Boardmaker http://www.mayer-johnson.com/

MainBoardmaker.aspx

Microsoft Clip Art

Writing with Symbols http://www.mayer-johnson.com/ProdDesc.aspx?

SKU=M165

Visual StrategiesResources

PixWriter http://www.slatersoftware.com/pixwriter.html

Digital Camera

Google Images http://www.google.com

ConclusionCommunication is a complex process

Especially difficult for individuals with autism

Three Functions of CommunicationRegulate BehaviorSocial InteractionsJoint Attention

(American Pyschiatric Association, 2000; Hedge, 2001; Prelock, 2006)

ConclusionMany available methods of communication

Choose the one that best fits the communication needs of your child

Communications Strategies for in the HomeNaturalistic Language TeachingJoint Action RoutinesVisual Strategies

(ASHA, 2009a; Charlop-Christy & Kelso, 2003; Goldstein, 2002; Harris & Delmolino, 2002; Ivey,Heflin & Alberto,

2004; Prelock, 2006; Sansosti & Powel-Smith, 2008; Tissot & Evans,

2003)

OPPORTUNITIES TO COMMUNICATE ARE

EVERYWHERE!!!

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