Module 2: Autism Communication Differences PDF

Module 2: Autism: Communication Differences EDU774 What will we cover today? 1. Module 1: Review of Quiz Questions and Answers 2. Module 1: Statistics section completion Module 2: Communication deficits in ASD and Strategies to Address Them 1. Typical Communication Development 2. Communication Del...

Module 2: Autism: Communication Differences EDU774 What will we cover today? 1. Module 1: Review of Quiz Questions and Answers 2. Module 1: Statistics section completion Module 2: Communication deficits in ASD and Strategies to Address Them 1. Typical Communication Development 2. Communication Delays with Autism 3. ASD Communication Strength 4. ASD Cultural and Linguistic Considerations 5. Involving Caregivers in Planning for Goals 6. Enhancing Educator/Caregiver Skills 7. ABA techniques to Support Communication Development 8. Social Communication Differences for ASD Module 1 Follow up: Statistics ● Historical Prevalence: In the 1940s, the estimated prevalence of autism was around 4 or 5 in 10,000. ● Increase in the Mid-1990s: By the mid-1990s, the estimated prevalence increased to 10 per 10,000 (1 in 1,000) for autism and 22 per 10,000 for pervasive developmental disorder (PDD). ● Recent data: 1 in 36 children in the US were diagnosed with autism (CDC, 2020) ● Recent International Prevalence: A review of studies from 1966 to early 2013 across 23 countries found a mean international prevalence rate of 66 per 10,000, or 1 in 152. ● Underdiagnosis: Low socioeconomic status (SES), minority, and immigrant populations experience underdiagnosis of ASD. ● Regression in Children: Regression, or loss of skills, occurs in 1 in 4 children diagnosed with ASD and is associated with more severe symptoms. ● Co-Occurrence of Intellectual Disability: Approximately 69% of individuals with ASD have a co-occurring intellectual disability. ● Module 1 Follow up: Statistics ● Epilepsy: Epilepsy is 10 to 30 times more prevalent in individuals with ASD, particularly in those with moderate to severe intellectual disabilities. ● Prevalence in the United States (2012): The Autism and Developmental Disabilities Monitoring (ADDM) Network estimated the prevalence of ASD in the United States at 1 in 68, based on data from 11 states. ● State Variations: Prevalence rates vary among states, with New Jersey reporting the highest rate (1 in 41) and South Carolina the lowest (1 in 81). ● Ethnic Disparities: White non-Hispanic children are more likely to be identified with ASD compared to Black non-Hispanic and Hispanic children. ● Delayed Evaluation: Black and Hispanic children are less likely to be evaluated for concerns by age 3 compared to White children. ● Age of Diagnosis: The majority of children with ASD do not receive a diagnosis by a community provider until age 4. ● Module 1 Follow up: Statistics ● Role of Special Education: Special education systems play an important role in identifying children with ASD. ● Increase in Identification Over Time: There is increased identification of ASD over time, with higher prevalence rates in 8-year-olds compared to 4-year-olds. ● Factors Contributing to Prevalence Increase: Possible factors include increased awareness, broadening of classification criteria, different case-finding methods, and service availability. ● Cultural Phenomenon: Some epidemiologists argue that ASD is influenced by biological, cultural, and psychological factors, and its conceptualization affects diagnosis and treatment. ● Differences in Gender: ASD is about 4.5 times more common among boys than among girls. 1. Typical Communication Development 2. Communication Delays with Autism ● Individuals with autism spectrum disorders (ASD) show differences in communication development, especially in language acquisition timing and patterns (Tager-Flusberg et al., 2006). ● Early signs of impairment manifest in infancy, such as a lack of shared attention, where infants with ASD might not follow the caregiver's gaze or engage in coordinated joint attention (Adamson & Chance, 1998). ● By 18 months, typical children share attention with caregivers, but in ASD, deficits in sharing gaze and pointing are observed and used as identifying factors in ASD screenings (Baron-Cohen, Allen, & Gillberg, 1992). 2. Communication Delays with Autism ● Failure to attend to speech is an early predictor of ASD (Osterling & Dawson, 1994; Paul & Sutherland, 2005), and parents often express concerns about their children's communication and speech in the second year of life (Prelock, Paul, & Allen, 2011). ● Individuals with ASD exhibit reduced rates of communication (Paul & Sutherland, 2005) and may use speech idiosyncratically, such as in immediate or delayed echolalia (Bay, 1980b). ● Difficulties with pronouns are common in ASD, where individuals might misuse pronouns and struggle with gender distinctions (Tager-Flusberg et al., 2011). 2. Communication Delays with Autism ● If individuals with ASD use speech, it might have atypical prosody or intonation and can lack understanding of word boundaries, answering wh- questions, or interpreting the context of words (Fay, 1980a; Koegel & Koegel, 1995; Krantz et al., 1981). ● Vocalizations in individuals with ASD might be self-stimulatory and repetitive, often focused on favorite topics and lacking the ability to generalize word meanings or forms (Schuler, 1980). ● Pragmatic challenges are common, where individuals with ASD may take language literally and struggle to understand the social context in which language is used (Tager-Flusberg et al., 2011; Bogdashina, 2005). ● Literal interpretations of phrases or instructions might occur, leading to responses that don't align with the intended meaning, such as literal hopping when told to "hop to it" (Bogdashina, 2005). 3. ASD: Communication Strengths ● Some individuals with autism spectrum disorder have strengths in communication, such as visual-spatial abilities and larger vocabularies (Charlop, Greenberg,& Chang. 2011). ● Certain individuals exhibit advanced text reading skills, enabling effective text-based communication (Kupperman, Bligh, & Barouski, 1992) ● Text based communication systems can be used to facilitate interactions with other when the learners who have strong ready and visual processing skills ● Proficiency in memorizing language chunks, like songs, can aid in communication through social scripts (Lue, Schlosser). ● Incorporating activities that engage individuals with ASD, such as hugs or swings, can enhance communication strategies (Lue). 4. ASD: Cultural and Linguistic Considerations ● Caregivers use language to support children's learning in language acquisition (Wilcox & Shannon, 1998). ● Different cultures have varying beliefs about language learning, speech value, and social interaction (Wilcox & Shannon, 1998). ● Mexican American and Anglo American interactions differ, with Mexican American culture involving more triadic interactions (van Kleeck, 1994). ● Inuit culture views talkative children differently from English-speaking cultures (Owens, 1996). ● Children learn cultural conventions as they acquire language, including status, gender roles, and expressions of affection (Rice, Grinker et al., 2011). 4. ASD: Cultural and Linguistic Considerations ● Samoan children make requests based on rank, and Korean language uses suffixes for respect (Grinker et al., 2011). ● Children are aware of different communication styles among peers and adapt based on context (Rice, 1993). ● Educators must acknowledge cultural differences in communication when working with children with ASD and their families. ● Nonverbal behaviors vary across cultures, with differences in nonverbal communication methods (Garcia-Coll, 1990). ● Understanding cultural nuances in communication is crucial when working with diverse families and designing intervention plans (Kayser, Mirenda & Bopp, 2003). 5. Involving Caregivers in Planning for Goals ● Speech-language pathologists play a role in the educational team's assessment and contribute to communication goals based on inputs from all team members, including family and educators (Kalyanpur & Harry, 1999). ● Collaborative work among all educators and family members is recommended for implementing the speech-language pathologist's recommendations for learners with ASD (Kalyanpur & Harry, 1999). ● Alternatives to traditional pull-out therapy sessions, like addressing language goals within the classroom, have been explored due to concerns regarding efficacy, generalization, and naturalness of pull-out sessions (Cirrin & Penner, 1995). 6. Enhancing Educator/Caregiver Skills ● Role of teaching effective strategies to communication partners is often underestimated but studies show that when communication partners are taught use of effective communication strategies for their learners, this leads to an increase in communication of the learners (Hall & Macvean, 1997) ○ How can caregivers/educators support communication development? ■ Provide frequent opportunities ■ Contrive learner motivations ■ Acknowledge communication attempts ■ Model and embed communication in the daily routines ■ Don’t be afraid to be playful and cheerful-research shows that when communication partners are playful and animated, the learners communication is enhanced (Mahoney & McDonald, 2007) 7. ABA techniques to support Language Development ● Applied Behavior Analysis techniques to enhance communication skills: ○ Discrete Trial Training (DTT) can be used to work on prerequisite skills such as: ■ Attending to instruction (helps with attending to communication of another person) ■ For non-vocal learners, they can begin with motor imitation tasks ● ABA techniques that incorporate learner’s motivation: ○ Naturalistic Environment Teaching (NET) ○ Incidental Teaching ○ Enhanced Milieu Teaching ○ Pivotal Response Treatment (PRT) ○ SCERTS model- combines ABA strategies and social interactionist theories 7. ABA Techniques to support Language Development ● How to support Language during play: ○ Macdonald and Mitchell (2002) note shared control in play along with ■ using comments and reflections that outnumber questions can help support development of vocabulary ■ use open ended questions: ● e.g. instead of saying “are they having fun?” , state “I wonder if they are having fun” Turn Taking in communication and play: ■ wait for learner to respond to comment on your comments/open ended questions ■ when the learners make a comment, make a related comment to increase length of communication ■ Take turns in picking activities/actions in pretend play 7a) Use Functional Communication to Replace Challenging Behaviors Functional Communication Training ● All behavior is communication and any behavior that develops (even the challenging behaviors serve a function for the learner) ● during the Functional behavioral assessments, identify the function of the challenging behaviors ● based on the function of the behavior, a functionally equivalent behavior can be identified and taught. ○ Let’s discuss an example ○ Can you give an example of a challenging behavior with a specific function? What would you propose as a goal for a replacement behavior? ● As the replacement behavior is taught via functional communication training, the frequency, intensity,and duration of challenging behaviors decreases (Carr & Durrand, 1985) 7b) Use Functional Communication to Replace Challenging Behaviors Other aspects of Functional Communication training: ● Replacement behaviors must be clear and recognizable to others to be effective (Durand & Merges, 2001). ● Consequences and success reinforcement are crucial for encouraging the use of the replacement behavior (Heflin & Alaimo, 2007). ● Systematic teaching of replacement behaviors involves evidence-based strategies like prompting, prompt fading, and differential reinforcement (Sigafoos, O'Reilly, & Lancioni, 2009). ● Common replacement behaviors taught include pointing, verbal expressions, and using visuals for requests and initiating social interaction (Martin, Drasgow, Halle, & Brucker, 2005). ● Data collection is essential to ensure the selected communication skill serves the same function and is helpful for the individual (Carr et al., 1994). ● Encouraging choice-making can influence communication success, reducing disruptive behaviors and enhancing individuals' participation in their daily routines (Durand, 2012; Sigafoos et al., 2009). 7c). Focus on Oral Language ● Strategies employing behavior analysis have been utilized extensively to teach speech and language skills to learners with autism spectrum disorders, including discrete trial teaching for communication skills (Brunner & Seung, 2009; Wong et al., 2015). ● Incidental teaching, another evidence-based intervention, has shown success in developing vocal language skills in children with ASD by following the child's lead and setting up communication opportunities (McGee & Morrier, 2005). ● Pivotal response treatment (PRT), similar to incidental teaching, focuses on child-initiated activities, varied tasks, and natural reinforcers, claiming significant success in acquiring words for young children with autism (Koegel & Koegel, 2006). ● Despite a scarcity of research, evidence suggests that teaching in a child's native language can be beneficial, leading to increased correct responses and reduced challenging behaviors for children with ASD (Kayser, Lang et al., 2011). ● Stimulus-equivalence procedures have demonstrated potential in teaching second-language skills to individuals with autism, indicating promising outcomes that could address second-language learning challenges for learners with ASD (Fragoso & Hall, 2006). 7d). Using AAC ● Augmentative systems are frequently used alongside speech goals for individuals with ASD to supplement or substitute language development delays (Wendt, Ogletree & Oren, 2006; Charlop et al., 2011). ● Research supports that augmentative systems don't hinder speech development if educators continue targeting vocal language (Schlosser et al., 2009; Charlop et al., 2011). ● There's no superior form of augmentative system identified for promoting spontaneous and generative communication in ASD individuals (Wendt, 2009). ● Some individuals with ASD may require intentional communication training to fulfill their needs, as they might have learned to communicate through nonverbal behaviors rather than using a formal communication system. 7e) Picture Exchange Communication System (PECS) ● The Picture Exchange Communication System (PECS) is an evidence-based practice for ASD individuals with minimal speech, focusing on picture or 3D item exchanges (Bondy & Frost, 2002; Wong et al., 2015). ● It involves initial phases of exchanging pictures for desired items and progresses to sentence requests and environmental observations (Bondy & Frost, 2009). ● PECS can lead to improved spontaneous speech, reduced problem behaviors, and enhanced social behaviors (Bondy & Frost, 2009; Greenberg, Erickson, Tomaino, & Charlop, 2014). ● Understanding the relationship between the symbol and its referent is crucial for learners (Quill, 2000). ● Environmental arrangements and motivation play a role in reinforcing and enhancing communication skills (Quill, 2000). 7f) Sign and Gestural Communication ● Sign language, such as Makaton and American Sign Language (ASL), is found to be effective for communication in individuals with ASD, aiding their language development (Wendt, 2009; Creedon, 1973). ● Creedon's early research showed that using sign systems increased vocabulary and language skills in nonverbal learners with ASD (Creedon, 1973). ● Makaton, used in England and Australia, facilitated increased sign use and enhanced enjoyment and interaction in communication sessions (Hooper & Walker, 2002). ● Introducing signs alongside music showed significantly more sign and word imitation compared to rhythm and sign alone, suggesting music enhances attention and recall (Buday, 1995). 7g) Speech Generating Devices (SGDs) ● Speech-generating devices (SGDs) are effective augmentative systems for ASD students lacking functional speech or with limited articulation and vocabulary (Ogletree & Oren, 2006). ● Most studies on SGD use in ASD focused on requesting behaviors and yielded positive results (Charlop et al., 2011; Gevarter et al., 2016; Strasberger & Ferreri, 2014). ● The AAC system choice should suit the individual, with PECS and SGDs emerging as effective choices in various settings (Ganz, Rispoli, Mason, & Hong, 2014; Mirenda, 2001). ● Transition from PECS to an SGD should occur once the learner is proficient with PECS and the selected device supports further growth (Frost & McGowan, 2011, 2012). ● It's important to differentiate between an SGD used for communication and one used as a toy, emphasizing the necessity of proper usage for effective communication (Bondy, 2016). 7h)Teaching Non-Verbal Communication ● Educators aim to model nonverbal behaviors, but direct teaching might be necessary for effective learning in individuals with autism (Prizant et al, 2006b; Taylor & McDonough, 1996). ● Teaching functional gestures like pointing has been successful using prompting and reinforcement techniques (McClannahan & Krantz, 1999; Buffington, Krantz, McClannahan, & Poulson, 1998). ● Children with ASD might display facial expressions unrelated to context, such as laughing when a peer is hurt (Feldman, McGee, & Mann, 1993). ● Teaching programs using behavioral analysis strategies enabled students to match facial expressions to emotions depicted in videos, and this skill generalized to recognizing emotions in their teachers (Hall & Russell, 2000). ● While research has shown individuals with autism can discern vocal prosody, dedicated studies focused on teaching appropriate vocal tones were not found (Lamers & Hall, 2003). 7i) Strategies to teach non-verbal language ● Applied behavior analysis is effective in teaching complex language to children with autism. ● Studies showcase success in teaching adjectives as descriptors and improving language skills. ● Home-school communication programs can enhance children's linguistic abilities and recall. ● Case studies illustrate improvement in recalling past events and using complex sentences. ● ABA strategies aid in conversation skills, topic management, and assertive responses. 8. Social Communication Differences ● Individuals with autism spectrum disorder (ASD) often experience various challenges in social communication. Some key differences include: 1. Difficulty in Social Interaction: Challenges in understanding and interpreting social cues, which can involve facial expressions, gestures, tone of voice, and body language. This difficulty can make it hard to engage in reciprocal conversations or understand social nuances. 2. Impaired Social-Emotional Reciprocity: Difficulty in developing and maintaining relationships, sharing interests or emotions, and engaging in back-and-forth interactions. This might lead to challenges in making friends or establishing connections. 8. Social Communication Differences 3. Nonverbal Communication Challenges: Difficulty in using and understanding nonverbal communication such as gestures, facial expressions, and body language, which can lead to misinterpretations or communication breakdowns. 4. Literal Understanding: A tendency to process language literally, which can cause challenges in understanding sarcasm, idioms, or abstract meanings in conversation. 5. Repetitive Behaviors and Routines: Engaging in repetitive behaviors or adherence to specific routines might hinder social communication by limiting flexibility in social situations. These differences can vary significantly among individuals with ASD, impacting their social interactions, relationships, and overall communication experiences. Understanding and accommodating these differences are vital for effectively supporting individuals with ASD in social settings. 8. Social Communication Differences 3. Nonverbal Communication Challenges: Difficulty in using and understanding nonverbal communication such as gestures, facial expressions, and body language, which can lead to misinterpretations or communication breakdowns. 4. Literal Understanding: A tendency to process language literally, which can cause challenges in understanding sarcasm, idioms, or abstract meanings in conversation. 5. Repetitive Behaviors and Routines: Engaging in repetitive behaviors or adherence to specific routines might hinder social communication by limiting flexibility in social situations. These differences can vary significantly among individuals with ASD, impacting their social interactions, relationships, and overall communication experiences. Understanding and accommodating these differences are vital for effectively supporting individuals with ASD in social settings. Any Questions?