AAC and Autism Spectrum Disorder (ASD)

1. AAC and Autism Spectrum Disorder (ASD) Blair Ridgley Michelle Neumann Bianca Havel

2. Autism Spectrum Disorder (ASD) • A developmental disability • Children with autism, also known as autism spectrum disorder or ASD, have deficits in: • Social Skills • Communication • Language • They also have restricted and repetitive patterns of behavior, interests, or activities, such as flipping objects, echolalia, or excessive smelling or touching of objects. • ASD may be mild or severe. • All children with autism don't have the exact same problems.

3. Social Deficits in ASD • Sharing a common focus with another person about the same object or event-known as joint attention • Playing with others and sharing toys • Empathy • Difficulties in conversation: • Turn-taking, • Understanding social cues, • Sensing the feelings or reactions of others, • Interpreting another’s perspective., • Reduced sharing of interests • Deficits in nonverbal communication • Absence of interest in peers • Difficulty adjusting behavior to suit various social contexts • Difficulty with imaginative play • Difficulty making inferences and nonliteral or ambiguous meaning of language • making and keeping friends.

4. Communication Deficits in ASD • Children with ASD may have trouble with communication skills like understanding, talking with others, reading or writing. Sometimes, he or she might lose words or other skills that they used before. Children may have problems: • Understanding and using gestures, like pointing, waving, or showing objects to others • Following directions • Understanding and using words • Developing language skills • Communicating nonverbally • Using spoken language • Learning to read or write. Or she/he may read early but without understanding the meaning—called hyperlexia.

5. Communication Deficits in ASD • Trouble understanding that words relate to objects and activities • Abstract words are challenging • Often self-absorbed* • Unable to successfully communicate and interact with those around them

6. Communication Disorders Associated with ASD • Not every child with ASD will have a language problem… • Varies depending on intellectual and social development • Some may be nonverbal • Some may have rich vocabularies • Most have little or no problem pronouncing words • The majority has difficulty using language effectively • May have problems with the meaning and rhythm of words and sentences • May be unable to understand body language and vocal tones

7. NonverbalCommunication • They do not learn to use facial expressions to convey a message • Often have blank expressions/inappropriate expressions • Do not instinctively know that a smile communicates pleasure and a frown represents displeasure or sadness • In a normally developing child, they pick up meanings of facial expression spontaneously • For kids with ASD, any recognition of the meaning of nonverbal expressions must be explicitly taught

8. Repetitive or Restrictive Behaviors and Special Interests • …As manifested by at least 2 of the following: • 1. Repetitive motor movements, use of objects, or speech • Hand flapping, toe walking • Lining up objects • Watching the same scene of a movie • 2. Insist on sameness • Extreme distress at small changes; Difficulty with transitions • 3. Highly restricted, fixated interests • Strong attachment with unusual objects • 4. Hyper or hypo- reactivity to sensory input • Pain/temperature • Specific sounds or textures • Visual fascination with lights or movements

9. Other Deficits in ASD • Children may also: • Repeat words just heard or words heard days or weeks earlier-called echolalia • Talk with little expression or use a sing-song voice • Use tantrums to tell you what he does or does not want. • Get upset by certain sounds • Like only a few foods

10. Diagnosis of Autism • Parents typically first notice unusual behaviors • Failure to make eye contact, repetitive behaviors, not responding to his/her name • Medical diagnosis made by physician, according to the DSM-5 • Guides physicians according to a specific number of symptoms • Problems in at least one of the areas of communication, socialization, or restrictedbehavior must be present before the age of three • Behavioral assessments conducted • Some characteristic behaviors apparent in first few months or early years of the child’s life

11. Diagnosis (continued) • 2 stages of the diagnosis: • 1. A developmental screening during the child’s regular “checkups” • 2. A comprehensive evaluation by a multidisciplinary team • Pediatrician • Psychologist • Speech-language pathologist • Occupational therapist

12. Criteria to be met for diagnosis of ASD • 1. Deficits in social communication and interaction • 2. Repetitive or restrictive behaviors and special interests • 3. Language delays occurring in beginning stages of language development as well as in interactive conversation • 4. Symptoms must be present in early childhood

13. Possible Causes of ASD? ASD is a lifelong problem with a number of possible genetic and/or environmental causes, including but not limited to: • Genetic problems or syndromes • Severe infections that affect the brain (meningitis, celiac disease, encephalitis, etc.) • Exposure to toxins or illness during pregnancy (rubella, chemicals, etc.)

14. How can ASD be treated? • Behavior and development programs • Education and learning programs • Medications • Other treatment and therapies

15. Behavior and Development Programs • Applied Behavior Analysis (ABA): Focuses on the principles that explain how learning takes place • When a behavior is followed by a reward, the behavior is more likely to be repeated • By assessing the relationship between a targeted behavior and the environment, ABA can be used to change that behavior • UCLA/Lovaas: Utilizes the principles of ABA • Typical therapy session: • Two or three hour sessions • Short periods of structured time devoted to a task (3-5 minutes) are followed by an equal amount of free play for the child • Longer breaks at the end of every hour (10-15 minutes) • Free play and breaks are used for incidental teaching or practicing learned skills in new environments

16. Education and Learning Programs • These programs are offered in schools or other learning centers. They focus on learning and reasoning skills and “whole life” approaches. • TEACCH Autism Program (University of North Carolina) is based on understanding the “culture of autism”Framework includes: • Physical organization • Individualized schedules • Activity systems • Visual structure of materials in tasks and activities

17. Education and Learning Programs Social Skills Development Interventions • The primary focus of Social Skills Development Programs is to help children with ASD develop improved awareness and understanding of other perspectives in order to improve conversation skills, develop relationships with peers, play cooperatively, mediate conflict, develop self regulation skills, and problem-solve. • The social skills sessions are highly structured and begin with an assessment and conclude with brief progress reports. • Methods such as role-playing and simulation are also used. • Activity-based lessons are often incorporated in order to focus on the teachable moments when real-life dilemmas occur.

18. Medications • Antipsychotic drugs: resperidone (Risperdal) and Aripirazole (Abilify) can help reduce emotional distress, aggression, hyperactivity, and self-injury. • Side effects include weight gain, sleepiness, tremors, and abnormal movements Serotonin-reuptake inhibitors (antidepressants) and hyperactivity medicines (Ritalin) have not been studied enough to know if it can help treat ASD symptoms

19. Other Treatment and Therapies • Speech and Language Therapy • Dietary interventions • Music Therapy • Occupational Therapy • Acupuncture • Sensory Integration Therapy • AAC

20. Autism and Augmentative and Alternative Communication (AAC) • Augmentative and alternative communication (AAC) strategies were first explored for individuals with autism spectrum disorders (ASD) in the 1980s and early 1990s. • Since that time, developments in technology have played a crucial role in improving the quality, affordability and accessibility of AAC strategies for members of this population. • As the use of AAC for persons with ASD became more widespread, it expanded beyond its traditional use for expressive communication alone, and was used to augment comprehension and to provide organization of time and sequences • AAC Systems (no tech, low tech and high tech)

21. No Tech and Low Tech Systems No Tech • Gestures • Signs Low Tech • Visual Aids • Calendars • Schedule Boards • Reminder Strips • Communication Boards • PECS

22. High Tech AAC • iPad • NovaChat 5,7, & 10 • Accent 800, 1000, & 1200

23. Using Visual Strategies to Improve Behavior for Children with ASD • It is important to recognize that students have different learning styles and that many students are VISUAL learners • The issue causing the behavior problem should first be recognized then strategies can be developed to prevent or lessen the behavior. • Many behavior situations and problems are related to communication; relating to understanding, expression, or other learning skills such as establishing attention and memory

24. Using Visual Strategies to Improve Behavior • Behavior-Communication-Visual Strategies Framework • Causes of behavior differences are frequently related to communication difficulties; problems in understanding and/or difficulty with expression • The remedy to improving behavior is improving communication • The method is using visual strategies to support communication

25. Using Visual Strategies to Improve Behavior • Managing behavior for any student requires insight, keen observation, patience, and lots of wisdom • Communication emerges as an integral part of the problem, or it evolves as an essential part of the solution.

26. Visuals Schedules Reminder Strips

27. Visuals Calendar Emotions Self Regulation

28. The SCERTS Model • A comprehensive, multidisciplinary approach to enhance communication and social-emotional abilities of individuals with ASD • Primary Developmental Dimensions • Social Communication • Emotional Regulation • Transactional Support

29. The SCERTS Model • Disciplines involved in team • General and Special Education • Speech-Language Pathologist • Occupational Therapist • Child Psychologist and Psychiatrist • Social Worker

30. The SCERTS Model • Social Communication • Addresses overriding goals of helping a child to be an increasingly competent, confident, and active participant in social activities. • To do so, children must acquire capacities in 2 major areas of functioning • Joint attention • Symbol use

31. The SCERTS Model • Social Communication • Joint Attention • Children must learn to share attention and emotion with a partner as well as to express intentions across communicative partners • Symbol Use • One aspect is communication means • Communication means may be presymbolic or symbolic

32. The SCERTS Model • Social Communication • Ultimate Goal: Support children in developing the foundational abilities in joint attention and symbol use that support communicative and social competence • Research as well as clinical experience has demonstrated that with increased social communicative abilities, behavioral difficulties may be prevented or lessened.

33. The SCERTS Model • Emotional Regulation • For a child to be optimally available, he or she must have the emotional regulatory capacities and skills to: • Seek assistance and/or respond to other’s attempts to provide support for emotional regulation when faced with stressful, overly stimulating, or emotionally dysregulating circumstances • Remain organized and well-regulated in the face of potentially stressful circumstances • Recover from being “pushed over the edge” into states extreme emotional dysregulation or shutdown, through mutual- and/or self regulatory strategies

34. The SCERTS Model • Emotional Regulation • Helping a child more effectively maintain optimal arousal, or at the very least, a well-regulated state • Frequent high states of arousal: anxiety, fear, distress, dysregulating positive emotional states of elation and giddiness • The child may also withdraw or shutdown • Low state of arousal: appear passive, disengaged, and inattentive • Ultimate goal: To support a child in adapting to and coping with the inevitable and uniquely individual daily challenges that he or she will face in maintaining a well-regulated state of arousal most conducive to learning and relating to others

35. The SCERTS Model • Transactional Supports • Interpersonal Supports • Learning Supports • Support to Families • Support among Professionals and Other Service Providers

36. The SCERTS Model • Transactional Support • Interpersonal Supports • Adjustments made by communication partners in language use, emotional expression, and interactive style that are effective in helping a child with ASD process language, participate in social interaction, experience social activities as emotionally satisfying, and maintaining well-regulated states. • Also includes Peer Support

37. The SCERTS Model • Transactional Support • Learning Supports • Environmental arrangement, or the ways typical settings and activities are set up or modified to foster communication and emotional regulation, visual supports for social communication and emotional regulation, which may be implemented in various settings

38. The SCERTS Model • Transactional Support • Support to Families • Mainly educational support: sharing helpful information and resources or direct instruction in facilitating a child’s social communication, emotional regulation, and daily living skills and implementations of learning supports for the child. • Emotional support is used necessary

39. The SCERTS Model • Transactional Support • Support among Professionals and Other Service Providers • Informal and planned opportunities for enhancing educational and therapeutic skills and for providing emotional support , whenever necessary, to cope with the challenges of working with children with ASD and to prevent burnout

40. The SCERTS Model • When a child’s development in social communication and emotional regulation is supported, with strategic implementation of transactional support, there is great potential for comprehensive, long term positive effects on a child’s development in educational and everyday activities.

41. What is the Picture Exchange Communication System • Low tech form of AAC • Originally designed for young children with autism in the late 1980s • Children are taught to approach a communication partner with a picture of a desired item in exchange for that item • The PECS protocol and training sequence (six phases) are based on the operants defined by Skinner’s work Verbal Behavior (1957)-mand, tact, and intraverbal • Each phase targets a different communication goal

42. How Does PECS Work? The 6 phases of PECS: • Teaches the child how to make a request • Requires the child to travel to their communicative partner (communication book + increased distance between child and communicative partner) • The child must chose between 2 items (highly desired vs. nondesired item to gradually multiple desired items) • Sentence structure is developed (A sentence starter “I want” + picture symbol) • Teaches the child how to answer “What do you want?” (verbal prompt, delay, and gestural prompt) • Child is taught to comment in response to their partner’s communication question (I.e. What do you see?)

43. Advantages of PECS • Children with relatively limited prerequisite skills (e.g. eye contact, gestures, and verbal imitation) can utilize PECS • Training for PECS is short, typically a 2-day workshop • It is motivating for children since they are immediately rewarded • Cost

44. Disadvantages of PECS Restricted range of communicative functions: • Phases I-V all target requests (no protests or refusals) • Phase VI targets comments • Comments are not spontaneous since they are responses to adult prompts • No opportunity to indicate that an item is not wanted • Preparation can be labor intensive for clinicians • Vocabulary is limited

45. Is PECS Effective? Research has shown that PECS is a promising, but not yet established evidence-based intervention for facilitating communication in children with ASD, but not for facilitating speech. • Small to moderate effects were demonstrated for the short-term efficacy of PECS in improving communicative outcomes for young children with ASD • PECS may also decrease problems behaviors (e.g. tantrums grabbing, etc.) in some children • Evidence for maintenance and generalization of communicative gains is limited and future research is needed

46. Language Acquisition through Motor Planning (LAMP) • LAMP was developed by utilizing motor learning principles along with the Unity language system for treatment of individuals who are nonverbal and use AAC to communicate.

47. Studies in AAC and Autism: The Impact of LAMP as a Therapy Intervention • LAMP • A therapeutic approach based on neurological and motor learning principles. • The goal is to give individuals who are nonverbal or have limited verbal abilities a method of independently and spontaneously expressing themselves in any setting. • It focuses on giving the individual independent access to vocabulary on voice output AAC devices that use consistent motor plans for accessing vocabulary. • Teaching of the vocabulary happens across environments, with multisensory input to enhance meaning. • The child's interests and desires help determine the vocabulary to be taught.

48. Studies in AAC and Autism: The Impact of LAMP as a Therapy Intervention • The LAMP approach includes 5 components • Readiness to learn • Shared Engagement • Consistent Motor Patterns • Auditory Signals • Natural Consequences

49. Studies in AAC and Autism: The Impact of LAMP as a Therapy Intervention • Methods • 7 children involved in study • Ranged from age 3 to 7 • Diagnosis of ASD or pervasive developmental disorder- not otherwise specified and complex communication needs • All 7 diagnosed with expressive-receptive language disorder • Each obtained a speech generating device (SGD) and received LAMP intervention • Each child was a patient of a private practice

50. Studies in AAC and Autism: The Impact of LAMP as a Therapy Intervention • Methods • It was clear from both baseline data and observation that each participant had complex communication needs • Limited Vocalizations • Low intelligibility • Severely limited expressive vocabulary • Difficult behaviors • Inability to maintain attention to tasks