MAMI

1. MAMI BERNARDUS LARRYANT SONJA RONDESTVEDT VALERIE S. VARASTEH

2. OUTLINE • MAMI & FAMILY • BACKGROUND INFORMATION • ASSESSMENT • INTERVENTION • CONCLUSION

3. MAMI & FAMILY

4. MAMI • Mami Yamamoto • 6 years old • Kindergarten • Enjoys playing with light toys, soft music, and visual movements • Does not enjoy loud noises • Limited play skills • Repeating both English & Japanese phrases Image taken from http://silveroses69.blogspot.com/2007_05_01_archive.html

5. FAMILY • Lives with Mother (Reiko) and Grandmother (Akari) Image taken from http://english.kimono-sakaeya.com/?eid=1440311 Image taken from http://flickrhivemind.net/Tags/obasan/Interesting

6. GOALS • The family wants Mami to: • Increase functional use of speech and other English language skills • Decrease her echolalia

7. BACKGROUND INFORMATION

8. DEFINITION • Echolalia is the repetition or echoing of verbal utterances made by another person. • Rydell & Prizant (1995) stated echolalia refers “to a general class of speech repetition with few distinctions made regarding the degree of repetition or comprehension and intentionality underlying the production of echolalic utterance” (p. 106). • 85% of verbal children with autism produce echolalic language (Rydell & Prizant, 1995).

9. ECHOLALIA IN CHILDREN WITH AUTISM • There is a need to consider the acceptance of echoic behaviour. That is, how comprehensive is the child with autism’s utterance to the communicative partner? Rydell &Prizant (1995) suggest observing the following points : • Do the words used in the echoic utterance have an equivalent meaning to others? • Does it relates to the context in which it occurs? • Is intention created in the utterance? • Does the utterance assist in maintaining a social interaction by providing novel or needed information? • Does the echoic utterance can evoke a response from another person? • Does the echolalia disrupt the child’s ability to partake appropriately in a social interaction and/or an educational task? • Does the echolalic behaviour isolate the child with autism?

10. ECHOLALIA IN CHILDREN WITH AUTISM • Echoic behaviour is displayed in interactive and non-interactive forms (Prizant & Duchan, 1981): • Interactive:degree of comprehension of the model utterance by showing appropriate gaze; task attempt, and the use indicating behaviours (point, gesture, show, etc.). • Non-interactive:little comprehension of model utterance and lack the proper gaze, low in volume, and there is no observable change in behaviour.

11. AUTISM AND BILINGUALISM • Bilingualism is not a hindrance for children with developmental disabilities. • Children who are growing up in a bilingual home need to learn the spoken languages in order to partake wholly within the family system. It is important for their life context and for the children with autism to communicate with those who are important to them and play a large role in their life (Kay-Raining Bird, Lamond, and Holden, 2012).

12. AUTISM AND BILINGUALISM • Kay-Raining Bird, Lamond, and Holden (2012) did a survey to investigate a range of questions around autism and bilingualism. • Mode of Communication • Language Exposure • Professional Advice • Family ratings display that bilingualism was of importance and a majority felt they were successful in raising their child in a bilingual home.

13. ECHOLALIA AND BILINGUALISM • Echolalia has also been used to teach receptive naming of Chinese characters (Leung & Wu, 1997): • When children with autism echo the response before the matching task, the children display improved receptive language skills. In addition, the difficulty of the task affected the speed of acquisition. • Echoic prompt may assist in reading the name of the character and guided attention to the matching symbol

14. ECHOLALIA IN LANGUAGE DEVELOPMENT • Two viewpoints in echolalia had been developed around language acquisition: • Echolalia is a pathological behaviour that needs to be extinguished due to interference with the development of appropriate language skills; no functionality is observed in the echoic utterances • Echolalia is used with a functional purpose; furthermore, echolalia can be a tool to develop a more conventional application of the child with autism’s language repertoire. • Language development in children with autism is linked to the Gestalt and Interactionist approaches.

15. GESTALT APPROACH • Gestalt processor – develops language by using memory and repeating multi-word utterances in chunks. The process aids in the comprehension of linguistic structures (albeit, in small amounts) (Bebko, 1990; Rydell & Prizant, 1995; Prizant & Rydell, 1993). • Memorization and chunking of the conventional linguistic structures also supports generalization and applyinh the chunks in other proper and appropriate ways (Prizant, 1983; Prizant& Rydell, 1993).

16. GESTALT APPROACH • Children with autism take on a gestalt form of language development. Most children with typical development develop language through an analytical process. • Analytic processors - develop language skills with acknowledgement of the basic structures in language. The meaning behind words and phrases are develops through linguistic stages toward more complex utterances (Prizant & Rydell, 1993).

17. GESTALT APPROACH • Children with autism are considered to develop language through an extreme form of gestalt processing and can be correlated to characteristics linked to autism such as the degree of rigidity seen in individuals with autism, coping with unpredictability, lack flexibility, difficulty with producing generative and flexible language, and comprehending social-system rules (Prizant, 1983; Prizant & Rydell, 1993).

18. INTERACTIONIST APPROACH • Examines “the relationship among the fundamental variables in the social-communicative interaction and the influence of these variables on an individual’s communicative performance” (Prizant and Rydell, 1993, p.275). • Prizant and Rydell (1993) suggest two factors are related to the interactionist approach: • 1. Cognitive, social, socio-emotional, linguistic strength or weaknesses of the child may affect the nature of the interaction. • 2. The partner’s interactive style may influence the response.

19. COGNITIVE AND SOCIAL FACTORS INFLUENCING ECHOLALIA • Task Demand/ Unfamiliar Environment • Echolalia may occur more frequently when the child is in a challenging social scenario, and/or demanding and novel setting (Prizant & Rydell, 1993). • Comprehension • Echolalia is employed when there is difficulty in comprehension during verbal interaction with a communicative partner (Bebko, 1990; Prizant & Rydell, 1993; Rydell & Prizant, 1995). • Information-processing view: echolalia arises when the adult uses abstract language and it does not match the semantics that were previously used during the child’s turn in the conversation (Prizant, 1983; Prizant, Rydell, 1993; Rydell & Prizant, 1995 Schuler, 1979).

20. COGNITIVE AND SOCIAL FACTORS INFLUENCING ECHOLALIA • Transitions (Prizant, 1983; Prizant & Rydell, 1993; Schuler, 1979) • Children with autism display an increase use of echolalia and agitation due to confusion from a change in the usual routine. In addition, fatigue and distraction linked to transitions also led to higher incidences of echolalia. • Adult influences (Rydell & Mirenda, 1994; Prizant & Rydell, 1993) • The style of communication affects the level of echolalia produced in children with autism. The directive style increases echolalia while the facilitative style consists of natural turn-taking.

21. COGNITIVE AND SOCIAL FACTORS INFLUENCING ECHOLALIA • Adult influences (Rydell & Mirenda, 1994; Prizant & Rydell, 1993) • An association between the communicative style and linguistic constraint. • High constraint utterance: when the child is required to respond to the adult’s utterance in a similar form of style in communication which has “specific syntactic-semantic structure or content” (Rydell & Mirenda, 1994, p.720). • Low utterance constraint: not required to meet the adult directive control, more natural conversational comments.

22. IMMEDIATE ECHOLALIA • Is an utterance that is emitted immediately following the original utterance, or a brief time following the utterance from the communication partner (usually within two comments) (Prizant & Duchan, 1981; Prizant and Rydell, 1993; Rydell & Prizant, 1995) • Retrieval of information from short term memory (Prizant, 1983). • The researchers determined that immediate echolalia often was used with clear evidence of purposeful communication (Prizant, 1983; Prizant & Duchan, 1981).

23. IMMEDIATE ECHOLALIA • Immediate echolalia may support the development of more elaborate language skills and the frequency of echolalia depends on the level of language development (McEvoy et al., 1988). • Children with autism who display intermediate level of language acquisition will emit more echolalic utterances since it serves as a function to communicate with others and a way to continue acquisition (McEvoy et al., 1988).

24. DELAYED ECHOLALIA • Delayed echolalia refers to utterances that are repeated later on in time (Prizant & Rydell, 1984). • Usually echoic utterances are derived from TV commercials, movies, and repetition of parental reprimands. • Involves retrieval of information from the long term memory storage (Prizant, 1983). • It is easier for those familiar with the child with autism to decipher the meaning behind the delayed echolalia and how it may relate to the context in which it occurs (Prizant & Rydell, 1984).

25. MITIGATED ECHOLALIA • Mitigated echolalia- when the child changes a word, phrase, intonation, or feature of the utterance that is repeated (Bebko, 1990). • Mitigation is used in both types of echolalia. • Rydell and Mirenda (1994) suggest mitigated echolalia is not derived from rote repetition. • Mitigation demonstrates a control over the echolalic utterances and utilization of rule-governed grammatical competence (Bebko, 1990; Prizant & Rydell, 1993; Roberts, 1989). • Bebko (1990) describes two basic capabilities of language are intact for children with autism who use mitigated echolalia: labeling and symbolic function. A third component in language that is seen with mitigated echolalia shows inference to one’s self (Bebko, 1990).

26. ASSESSMENT

27. Data Collection Language Samples & Ecological Assessments • Preferably videotaped samples in multiple environments. • If videotaping is not an option, audio taping or written observations from an observer is advised. • In Chapter 5 of Teaching Children with Autism: Strategies to Enhance Communication and Socialization, Rydell and Prizant offer 18 different suggested activities for collecting language samples in different environments.

28. Some Suggested Activities for Language Sample • Eat a desired food item in front of the child without offering any to him or her. • Activate a wind-up toy, let it deactivate, and hand it to the child. • Give the child four blocks to drop in a box, one at a time, then immediately give the child a small animal figure to drop in the box. • Look through a few books or magazines with the child. • Open a jar of bubbles, blow bubbles, and then close the jar tightly and give the closed jar to the child.

29. Suggested Activities for Language Sample • Initiate a familiar social game with the child until the child expresses pleasure, then stop the game and wait. • Blow up a balloon and slowly deflate it; then hand the deflated balloon to the child or hold the deflated balloon up to your mouth and wait. • Offer the child a food item or toy that he or she dislikes. • Place the child’s hands in a cold, wet, or sticky substance, such as Jell-O, pudding, or goo.

30. Step 1 After you have the language sample, you can now categorize the unconventional verbal behaviour. • Immediate echolalia -immediate repetition of words or phrases • Delayed echolalia -significantly delayed repetition of words or phrases (hours, days, or weeks later)

31. Step 2Determine the function of the echolalia From Prizant and Rydell (1984) If it’s immediate echolalia there are two categories: 1.Interactive functions • Turn-taking • Declarative • Request 2. Noninteractive functions • Nonfocused • Rehearsal • Self-regulatory

32. Step 2Determine the function of the echolalia If it’s delayed echolalia there are also two categories: 1. Interactive functions • Turn-taking • Verbal completion • Providing Information • Labeling (interactive) • Request • Calling • Affirmation • Directive

33. Step 2Determine the function of the echolalia 2. Noninteractive function • Nonfocused • Situation association • Self-directive • Rehearsal • Labeling (noninteractive)

34. Step 3When does it occur? Possible Antecedents Echolalia is more likely to occur in these conditions: • Specific situations • Specific interactions • Person-specific situations

35. Step 4Communicative Intent What is the communicative intent? From Wetherby and Prizant (1989) • Is there no awareness of the goal? • Is there awareness of the goal? • Is there a plan to achieve the goal? • Is there a coordinated plan to achieve the goal? • Is there an alternative plan to achieve the goal? • Is there metapragmatic awareness to achieve the goal?

36. Step 4.5 Communicative Function Determining the communicative function of the echoic utterances are done by examining the communication partner’s interpretation of and reaction to the behavioural act. Interviewing the home and school team members to gain greater information about their interpretation of and reaction to the unconventional verbal behaviour is suggested. A functional assessment interview could be used to gather this information.

37. Step 5Challenging behaviours Another factor to consider for echolalia is the whether the unconventional verbal behaviour is challenging and who is it challenging for. • Does it add new or relevant information? • Does it interfere with the person’s ability to have conversations or be apart of conversations? • Does it have stigmatizing effects on the person in certain contexts? A functional behaviour assessment could be done to assist with determining those factors.

38. Step 6Intervention? The last stage of assessment is looking at whether direct intervention is needed and/or wanted. Once the language samples have been analyzed and coded, suggestions for either direct or indirect intervention can be made if the family or school feel it is beneficial.

39. Other Assessments continued • The Inventory of Potential Communicative Acts (IPCA) by Jeff Sigafoos et al. • Social Networks: A Communication Inventory for Individuals with Complex Communication Needs and their Communication Partners by Sarah Blackstone and Mary Hunt Berg, Published in 2003.

40. INTERVENTION

41. INDIRECT INTERVENTIONS • Focus on modifying the environment • Based on information gathered from Functional Assessment

42. SETTING EVENT INTERVENTIONS • Lack of appropriate play skills • Introduce different activities and toys in order to expand her repertoire of preferred activities and toys – increase choices for her reinforcer menu

43. ANTECEDENT INTERVENTIONS • Environment is too loud/noisy • Gradual exposure to loud and noisy environment • Short period of exposures (5 minutes) • Removal upon request using AAC or speech • Gradually increase the amount of exposure in small increments • Provide safety signal for Mami to make it through the session • Use a timer to provide a visual support for Mami • Pre-correct Mami to use her AAC or speech to ask for break • “Remember, if you want to leave, you can ask for a break.”

44. TEACHING INTERVENTIONS • Echolalic speech – minimal functional speech • Teach Mami to use her AAC to request for a break from the loud and noisy environment • Every request made using AAC should be followed by vocal approximation in order to encourage speech • Echolalia replacement strategy

45. FOXX (2004) • Response training - getting the subject to correctly label picture symbols that will be used • Cue-pause-point procedure • Deliver the instruction (CUE) • Holding up a finger to signal silence and say “shh” or “no” whenever silence is desired (i.e. during instruction). (PAUSE) • Move your finger so that it touch the picture card about 2 seconds after the instruction was delivered. (POINT) • Prompt to ensure the correct labelling occurs • Intermittently reinforce correct responding

46. FOXX (2004) • To fade the prompts, cover the picture card with a folder and touch the folder during the POINT phase • Eventually, fade the prompts all the way to simply PAUSE after delivering the instruction

47. MAMI’S CASE • Practice with Mami so she can correctly label the “break” card- “I want a break” • In a loud and noisy environment: • Ask her, “What do you want?” • Holding up a finger and saying “shh” whenever her echolalia starts • Touch the “break” card approximately 2 seconds after • If no response, prompt her to say “I want a break” • Immediately, let Mami leave the noisy environment upon asking

48. MAMI’S CASE • Eventually, cover the “break” card with your hand and simply point to the hand • Finally, simply pause 2 seconds after delivering the question for Mami to respond correctly GENERALIZATION The same procedure can be used in other situations as well, such as requesting for items, asking for attention, and others.

49. AUGMENTATIVE AND ALTERNATIVE COMMUNICATION (AAC) DEVICES • Has been shown to help children with autism make gains in speech production (Schlosser & Wendt, 2008; Millar, Light, & Schlosser, 2006) • Comes in a number of different modes: manual signs, picture symbols, or voice output devices (Mirenda, 2003) • Use it in the early part of Mami’s intervention in order to give Mami an appropriate mean of communication • Gradually fade it out as her functional speech increases

50. PROLOQUO2GO • Augmentative and Alternative Communication application for iPad, iPhone/iPod Touch • Consists of picture symbols as well as voice output capabilities • Chosen because of its functionality & cost • Costs: • App: $189.99 • iPad 2: $419.00 • iPhone: $375.00 • iPod Touch: $199.00 http://www.youtube.com/watch?v=vomkNSluWW4 Total Cost $400.00 – $650.00 Images are taken from http://www.proloquo2go.com/About/