Supporting children with Autism Spectrum Disorders

1. Supporting children with Autism Spectrum Disorders Julie Mullis Clinical Lead Specialist Speech & Language Therapist (ASD) Cardiff & Vale UHB Flying Start Conference 15/1/16

2. What is autism? • A neuro-developmental disorder • A medical diagnosis, made by a multi-disciplinary team, by observing a pattern of behaviours which affect: • social interaction • social communication • social imagination/flexible thinking • repetitive and restricted behaviours and interests • 90% also have sensory processing difficulties • A spectrum condition meaning there is a huge variety of presentation

3. Prevalence of ASD • Used to be thought of as a rare condition • Now thought to occur in about 1 in 100 • Broader defining characteristics • Better diagnosis • Better knowledge in the general public

4. Early identification • Early identification leads to early intervention • Record observations • Discuss your concerns with the parents • Do not use medical terminology • Gain consent to refer to other agencies as appropriate • Include comments about positive skills

5. Early support and intervention • You do not have to wait for a child to receive a diagnosis to start providing support • All pre-school children with ASD will have difficulties with communication • Visual strategies can be used to support them to understand us and to support them to communicate with us

6. What visual strategies do you use to help you in your daily life? • Calendar? • Diary? • To do lists? • Electronic devices/apps?

7. Why use visual communication systems with children with ASD? • Visual • Concrete • Repetitive • Predictable • Consistent • Processing • Unambiguous

8. Benefits of using visual systems • Develops symbolic understanding through a hierarchy • Objects • Photos • Symbols • Writing • Develops independence • Communication • Planning

9. So what about signing? • Signs are a visual means of communication but… • Like speech, signs are transient • Like speech, signs rely on recall rather than recognition • Motor difficulties • Difficulties with imitation • Echopraxia

10. Visual strategies that we can use to support our communication to children with ASD • Visual Schedules • Cue Cards • ‘Traffic Lights’ • Timers • Writing

11. Visual strategies that we can provide for children with ASD to communicate with us • Objects of Reference • Picture Exchange Communication System (PECS) • Communication Books • Voice Output Communication Aids • Writing

12. Visual Schedules • Aids independence • Represents the order of activities • Helps to organise our time • Reduces anxiety • De-personalises instructions • Ensures flexibility not rigidity

13. Where to start? • What is the level of the child’s symbolic understanding? • Can the child understand • Objects? • Photos? • Symbols? • Written words?

14. Length of schedule? • One at a time? • First X, then Y? • Longer schedule? • Half-day or whole day? • Weekly calendar ?

15. Objects of Reference (OORs) • Some children will not yet understand pictures • Label object if possible • Use single word consistently with the object • Later show OOR with photo or symbol

16. Labelling pictures • Ensures that everyone calls an item by the same label • Aids language development • Develops word recognition pre-literacy skills

17. OOR schedule

18. Using OOR to support the child’s communication • Ensure items are easily accessible – box or shelf • Present two objects as a choice • Say what is on the label as item is given

19. Visual Schedule – ‘First X, Then Y’

20. Engaging with the schedule • The child needs to engage with the schedule by removing the picture or ticking the item, etc, or at least looking at the item • ‘Finished’ box or pocket • Reflecting on activities at the end of the day • Copy to take home

21. ‘Flip down’ portable schedule

22. Within task visual schedule

23. Cue Cards • Simple ‘one message’ instructions or reminders about specific rules or behaviours to be remembered • Backs up verbal instructions that are not on the visual schedule • De-personalises • Asocial and removes emotional engagement • Reduces need for repeated verbal instructions

24. ‘Traffic Lights’ • A type of cue card • Can be used individually or with groups • Helps individuals to understand transitions • Prompts children to start and finish activities • Warns children that activities are going to finish

25. Green Traffic Light • “X activity is starting now” • “Go” • “Start X”

26. Amber Traffic Light • Teaches concept of waiting • “X activity is nearly finished” • “X activity is starting soon” • Can be paired with a verbal countdown or use of visual timer such as egg-timer

27. Red Traffic Light • “X activity is finished now” • “X items are finished/all gone now” • “Stop/Finish”

28. Timers • What kinds of timers are there? • Egg timers • Clocks and watches • Sundials • On computer • On phone • On TV

29. Timers Why do you use clocks or timers?

30. For cooking • To record a programme • To remind us to take medication • To know how long before the bus is coming • To get to an appointment on time • To know how long it is before we can have a break?

31. Use of timers • Help us to • plan and organise our time • be productive • be where we need to be when we need to be there • Represents an abstract concept in a more visual and concrete way – provides information that otherwise would be hard to explain • Reduces anxiety

32. PECS • Picture Exchange Communication System • A structured programme developed specifically for children with ASD • Develops communicative intent • Teaches that two people are needed for communication to be effective

33. PECS (contd) • Provides a functional appropriate means of communicating requests which reduces inappropriate behaviours • Uses pictures to request desired items • Builds up gradually to longer sentences and more functions (comments, responding to questions)

34. Communication Books • For children who • know how to get someone’s attention • have a large vocabulary (PECS no longer user-friendly) • can scan a selection of pictures • Photos, symbols or written words can be used • Child communicates by pointing to one or more pictures

35. Voice Output Communication Aids • VOCAs are high-tech battery powered AAC • Use symbols that are already familiar • Looks like PECS book

36. VOCAs - Advantages and disadvantages • Portable • Motivating • Easy to add new vocabulary • Can break down, run out of battery, get broken • Needs low-tech back-up • Technology developing fast – new apps cheaper and easier to individualise – iPads and iPods increasingly being used as communication aids

37. Writing • Writing is a visual means of communication • Can be used to communicate with individuals with ASD • Some individuals need longer to process verbal information • Some non-verbal individuals can read and write and can use written systems tocommunicate

38. Any questions? ?