Therapy Techniques to Remediate Language Deficits in Individuals with Autism Spectrum Disorders

1. Therapy Techniques to Remediate Language Deficits in Individuals with Autism Spectrum Disorders North Dakota Speech-Language Hearing Association Fall 2008 Convention By Lisa Roteliuk, M.S., CCC-SLP Minot State University lisa.roteliuk@minotstateu.edu

2. Agenda • Review three essential communication skills for students with autism spectrum disorders (ASD) • Review rationale for using visual support strategies for individuals with ASD • Discuss using visual schedules and transition helpers • Discuss Therapy Ideas for five areas of language • Phonology • Semantics • Morphology • Syntax • Pragmatics

3. Essential Communication Skills for Individuals with ASD (Hodgdon, 2008). • 1. Establishing a Social Connection • teach the students how to engage with others. • 2. Understanding others • teach how to interpret social situations, understand meaning of facial expressions and body language, changes in routines or rules for behavior. • 3. Communicating wants and needs • Teach many forms of communication to help reduce frustration and get needs met e.g., pointing, gestures, pictures, written language, etc.

4. Why do individuals with ASD function better visually? • 1. They have difficulty shifting and reestablishing attention. • 2. They have difficulty attending to foreground sounds and blocking out background noises. (Hodgdon, 1995).

5. Why do we use Visual Supports? • They promote students’ strengths and give them a means to overcome difficult areas (Hodgdon, 1995, p. 11). • Questions for the skeptic teacher, principal, etc. • Do you use a calendar to write down important dates? • Do you use a “To Do” list at your desk or in your home? • Do you point out advertisement pictures to show desired items? • Do you make up a shopping list before you go to the store? • Have you ever followed a recipe in a cookbook? Did you return to the recipe the next time you cooked that item? • Do you ever attach notes to your bathroom mirror as a reminder to do a task? • Do you scan the menu before ordering in a restaurant?

6. Why do we use Visual Supports? (cont) • Help organize their environment • Daily, weekly, or monthly schedules • Reduce anxiety felt by student • Mini schedules to teach specific skill • Increase student’s learning efficiency • Visual cues/prompts

7. Rationale for Visual Schedules • Give students information about their life • Help students gain order for their world • Serve as a communication aid to discuss and share daily events • Improve vocabulary and language skills • Assist in developing time concepts • Teach sequence (before/after, first/then) • Reduce or eliminate behavior problems related to transitions (Hodgdon, 1995, p. 44).

8. Daily Schedule

9. Mini Schedule

10. Communicating “NO” • General rule when giving students instructions about their behavior is to state the expected behavior in a positive manner. • May need to clarify information for students by telling them: • What is not a choice • What is not acceptable behavior • What is not going to happen • Universal “No” sign placed over or beside a picture will help the student know what they can or can’t touch

11. Communicating “NO” • Same universal “NO” sign can be used to communicate to the student: • changes in their daily schedule, • changes in lunch choices, • changes in personnel • Having the change represented visually can be calming for the student and provides them a way to deal with the change without having to ask for reassurance from adults (Hodgdon, 2000).

12. Transition Helpers • Prepare students for transitions. • “You have 3 more turns before we stop. • “Only 30 more seconds and the time is out.” • Always let the students know before they start a game how long the activity will last; as the transition time approaches, give students a verbal or physical warning. • Show ending time on clock or timer. • Create a natural ending by setting out last three cards. • Make transitions part of the routine by adding “clean up” ritual to allow student to naturally shift gears.

13. Transition Helpers (cont) • Give information and cues to prepare students for what comes next by having them carry the object or a representative picture icon to the next activity. • Let students know when they can return to the activity they don’t want to leave. • Let the student know what will be happening next if you are moving to an undesired activity (Hodgdon, 1995).

14. Visual Support Reminders • Use areas of interest as a motivator and as a learning tool • Think outside the box – what works for “typical” student doesn’t always work for students with ASD • Most teachers use some visual supports, but often not enough for students with ASD • Everything the teacher says doesn’t need to be put into a visual form, only the things that have to be repeated often.

15. Visual supports for Phonology • Use mouth puppet as a visual cue to teach placement • Use mirror as a visual cue • Use visual phonics or other signs to represent target sound • Use tactile cues • Touch neck for /k/ sound • Touch top of head for /r/, /k/, & /g/ sounds • Draw finger down arm for /s/ sound and s-clusters

16. Phonology (cont) • Intonation Patterns (Harrington, 2000, p. 71-72). • When prosody issues appear in your students speech, use these signs to help them understand how and when to make your voice raise and lower. • Question – your voice will rise at the end of a question. • ? How was your day? • Statement – your voice will lower at the end of a statement. • . The sun is hot.

17. Therapy Ideas for Semantics • Categorization (Harrington, 2000, p. 73) • Cut circles out of construction paper. (diameter of circles - red = 6 inch, blue = 4 ½ inch, green = 3 inch, yellow = 1 ½ inch). • Show smallest circle (yellow) to student and write animal on it (e.g., “giraffe”). This circle stands for a specific animal. • Show next smallest circle (green) and place beneath yellow circle, stating it stands for “zoo animals,” the group giraffes belong to. • Add last two circles when the student begins to understand and identify first two categories well. The last two categories would encompass “all animals” and “living things.”

18. Giraffe Zoo Animal All Animals Living Things

19. Semantics (cont) • Figurative language • Learning Idioms • Focus on 2-3 idioms at a time. • Have the students draw what they think the idiom means on half of the paper. • Discuss actual meaning of idiom and have student draw the actual meaning on the other half. • Review the actual meaning of all three idioms and have the students share their drawings and the meanings with a peer, teacher, etc.

20. Semantics (cont) • Things I Can Say and Do by Michelle Zucker Saunders • Uses visual organizers to help students understand and use functional vocabulary. • E.g., Things I Can Do: Shirts • Tell someone what I do with a shirt. • Describe my shirt. • Tell someone where I keep my shirts. • Ask someone to tell me about a favorite shirt. shirts

21. Visual Supports for Morphology • Verb Bingo game to teach verb tense using visual prompts:

22. Verb Bingo

23. Morphology (cont.) • Verb tense (Past, Present, Future) • Use tape to divide room and signs with “today, yesterday, tomorrow” • Use Starter Phrase Cards “Today we ____.”, “Yesterday we ____.” • Use backward chaining to gradually fade cues • 1. Student imitates whole phrase said by clinician (e.g., “Yesterday, we went to town.” • 2. Student imitates phrase stated by clinician and fills in the last word independently. (e.g., “Yesterday, we went to ____.”) • 3. Student imitates phrase stated by clinician and fills in the last two words independently. (e.g., “Yesterday, we went ___ ______.”) • 4. Fading continues until the student completes whole sentence independently. • **You may have to provide two written verb tense choices for the client to choose from and then gradually fade choices once they are able to independently fill in the verb.

24. Visual supports for Syntax Increase sentence length

25. Syntax (cont) Increase sentence length

26. Syntax (cont) Increase sentence complexity by adding prepositions

27. Visual supports for Pragmatics • Initiating & Maintaining a Topic • Use communication journal between home and school • Autism and PDD Tell Me About It by Michelle Zucker Saunders • Provides students with fill-in-blank worksheets that the student completes at school or home to help them increase conversational skills. • Helps students: • Give Details • Talk about something that happened • Describe routines • Problem solve language needed for difficult situations.

28. Pragmatics (cont) • Topic Initiation and Topic Maintenance • Topic Talk Conversation Card Game by Susan Pike (Super Duper) • Targets topic initiation, asking and answering questions, making comments, and maintaining a topic. • All About You, All About Me Fun Deck by Molly DeShong (Super Duper) • E.g., Tell me about your favorite flavor of ice cream. • Turn Taking • Use microphone to designate whose turn it is to speak • Have chip or other object that is passed back and forth between the speakers/listeners

29. Pragmatics (cont) • Conversational Skills • Comic Strip Conversations by Carol Gray • http://www.thegraycenter.org/store/index.cfm?fuseaction=product.display&product_id=41 • Uses simple drawings to illustrate a conversation between two or more people • Colors may be used to represent emotions felt during conversation • E.g., red = anger; green = happy; blue = sad, etc. • Defines different parts of a conversation for students • “Talk” bubble, “thought” bubble, listening, etc. • Students may start out making a comic strip for a conversation previously taped or drawing as they talk with their teacher • Eventually they may be used to help the students problem solve an area of difficulty, such as “topic initiation”

30. Pragmatics (cont) • Answering “Wh” and “Yes/No” Questions • Ask and Answer by Sharon Webber (Super Duper) work well to provide visual cue to get students started in asking and answering questions. • Typically start with more concrete “Wh” forms (What, Where, Who) and then add more abstract forms (When, Why, How) • Yes/No Questions - Want to ensure the questions you develop are ones where you know if the student answers correctly • E.g., Do you have a brother? Is this a book? • Typically practice these questions individually until the student shows mastery; then, develop a game board and practice asking and answering questions within our social skills group.

31. Pragmatics (cont) • References for Asking/Answering Questions • LinguiSystems • Autism and PDD Answering Questions • The Basic Reading Comprehension Kit for Hyperlexia and Autism • Autism and PDD Photo Cards Wh-Question and Interactive Software • Autism and PDD Buddy Bear and Becca Bunny Book Sets and Interactive Software

32. Pragmatics (cont) • Identifying Emotions of Others • Student watches video clips of familiar people or use picture cards with people displaying various emotions • Student looks at various facial features and answers questions on a checklist about the features • Once student completes the checklist for each emotion, they make a master list stating what the facial features do for each emotion (Sussman, 2006, p. 21). • Other resources for Emotions [LinguiSystems – The Nonverbal Language Kit; Room 14: A Social Language Program (age 6-10); Room 28: A Social Language Program (age 11-18)]

37. I hear and I forget. I see and I remember. I do and I understand. Chinese Proverb

38. References • Boardmaker, Version Six (2008). Solana Beach, CA: Mayer-Johnson • Gray, C. (1994). Comic strip conversations. Arlington, TX: Future Horizons, Inc. • Harrington, K. (2000). For parents and professionals: Autism in Adolescents and Adults. East Moline, IL: LinguiSystems. • Hodgdon, L.A. (1995). Visual strategies for improving communication : Practical supports for school and home. Troy, MI: Quirk Roberts Publishing. • Hodgdon, L. A. (2008). Three essential communication skills for students with autism spectrum disorders. Retrieved from http://lindahodgdon.com/newsletter/welcome_issue.html#article2 • Sussman, F. (2006). TalkAbility: People Skills for verbal children on the autism spectrum – A guide for parents. Toronto, ON: The Hanen Center.