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Early Intervention Strategies for individuals with
Autism
Sue E. McMillan, MClSc, SLP(C)
Introductions Speech-Language Pathologist=Speech-Language Therapist
Bachelor or Master’s degree in Human Communication Disorders
“Speech-Language Pathologists screen, assess, identifyand treat speech, language, voice, fluency (stuttering), swallowing and feeding problems for all age groups in addition to advocating for the prevention of these disorders.” Source: Speech-Language Audiology Canada
Role of SLP in AX & TXof Autism
Early identification of red flags for Autism
SLP frequently the earliest to identify red flags in children who demonstrate delayed communication, play and social skills development
Member of a multidisciplinary team (i.e., Developmental Paediatrician, SLP, OT, Behaviour Therapist, Early Childhood Educator, Art Therapist, etc.) to assess and/or treat children with Autism
RED FLAGS FOR AUTISMUNUSUAL WAYS OF PLAYING WITH TOYS
Turning toy cars upside down and spinning the wheels
Lying on the floor and staring at the wheels of toy cars as they roll
Spinning jars or lids of jars
Lining up toys
RED FLAGS FOR AUTISMSENSORY SEEKING OR SENSORY AVOIDANT BEHAVIOURS
Avoids eye contact with communicative partners
Frequently walking on tip toe
Flicking fingers in front of eyes or at side of eyes
Rocking
Spinning
Squeezing into tight spaces (e.g., between couch and wall)
Covering ears in response to loud noises
RED FLAGS FOR AUTISMUNUSUAL WAYS OF COMMUNICATING
Does not respond to own name
Leading a partner’s hand to an object/using a partner as a “tool”
Difficulty initiating conversation with others
Getting stuck on one toy or topic of conversation (e.g., only plays with or talks about Thomas the Tank Engine)
Does not notice where others are looking
Imitates exactly what others say
RED FLAGS FOR AUTISMCHALLENGING BEHAVIOURS
Has difficulty with making transitions from one activity to another
Gets very upset and cannot calm self or be calmed by familiar adult
Upset by small changes in routine like driving a different route or furniture location being changed in a familiar room
What is your role?TRUST YOUR “GUT”!
REMEMBER THAT YOU ARE THE EXPERT IN YOUR CHILD!
ADVOCATE FOR SERVICES: CONTACT OR MAKE REFERRALS TO PAEDIATRICIANS, NEUROLOGISTS, SLP’S, PSYCHOLOGISTS
CONTACT THE BARBADOS COUNCIL FOR THE DISABLED
EDUCATE THE BARBADIAN PUBLIC ABOUT AUTISM TO INCREASE AWARENESS AND TOLERANCE
What does “Autism” mean to me?
DEFINING AUTISMMy child has Autism. Autism is a complex disorder of brain
development. It makes it difficult for my child to understand what is said to them, express their wants and needs, play with others, and tolerate certain sensations. Sometimes my child becomes upset and has difficulty calming down. It is NOT because my child is “badly behaved”. It IS because he/she does not understand how to ask for help from others. Sometimes my child does things that you think are “strange”. My child simply sees the world in different ways than you and I. My child IS affectionate with people he/she knows. My child WANTS to communicate with others and is working hard to learn how.
What can YOU do to help my child?
BE PATIENT. BE TOLERANT. TELL OTHERS ABOUT AUTISM.
StatisticsCurrent Canadian statistics: 1/94 individuals
have a diagnosis of Autism
100,000 in my home province of Ontario, Canada
If we use comparable statistics for Barbados: Approximately 2,900 individuals with Autism
WHAT IS THE MORAL OF THE STATISTICAL STORY?
WE NEED TO…
BE PATIENT
ACCEPT INDIVIDUALS WITH AUTISM IN OUR COMMUNITY
LEARN HOW WE CAN HELP SUPPORT INDIVIDUALS IN OUR COMMUNITY WHO ARE AFFECTED BY AUTISM
Common MythsMYTH: Individuals with Autism DO NOT WANT TO
INTERACT with others
TRUTH: Individuals with Autism often don’t know HOW to interact
MYTH: Children with Autism have no interest in toys
TRUTH: Children with Autism have difficulty exploring toys to learn what to do with them
Common MythsMYTH: Individuals with Autism are not affectionate
TRUTH: Individuals with Autism are just as individual as you and I. Some like physical contact, others don’t
MYTH: Individuals with Autism are all like “Rainman”
TRUTH: Individuals with Autism have a range of individual cognitive abilities
EARLY INTERVENTIONDr. Amy Wetherby, SLP, Director, Autism
Institute in the College of Medicine, Florida State University
Estimated lifetime societal cost of $3.2 million dollars per child with Autism
Her research has come up with a list of “red flags” that can be seen between 12-24 months of age
Why Early InterventionDR. WETHERBY’S RESEARCH HAS DEMONSTRATED
Intervention has the greatest impact before 3 years of age because this is the time of greatest “brain plasticity”.
Believes early “symptoms” of Autism, difficulty in communication and social interaction, lead to behaviour problems which are actually secondary to these early symptoms
So, treating early symptoms can reduce severity of secondary “behaviour problems”, which are actually communication.
Why Early InterventionResearch proves that the brain is most “plastic”
before the age of 5 years
EI can prevent restricted interests from becoming so deeply ingrained
Help children with Autism develop social relationships that they would not otherwise develop
Help child develop core skills in communication, play, behaviour and social interaction that are needed for school success
INTERVENTIONS FOR AUTISM
MANY DIFFERENT INTERVENTIONS PROVIDED BY DIFFERENT PROFESSIONALS
WIDE VARIETY OF THEORETICAL BACKGROUNDS
DIRECT THERAPIES WITH CHILD
PARENT TRAINING
EDUCATOR TRAINING
BIOMEDICAL INTERVENTIONS
OCCUPATIONAL THERAPYGROSS AND FINE MOTOR SKILLS
SENSORY INTEGRATION
PLAY
COGNITIVE SKILLS
ACTIVITIES OF DAILY LIVING
FEEDING
BEHAVIOURAL THERAPIESAPPLIED BEHAVIOUR ANALYSIS
Based on work of Dr. O. Ivar Lovaas
Focuses on principles that explain how learning takes place such as “Positive reinforcement”: When a behavior is followed by some sort of reward, the behavior is more likely to be repeated.
Team supervised by Psychologist specializing in behaviour
Direct intervention provided by Behaviour Therapists/Behaviour Analysts (sometimes SLP’s)
BCBA (Board Certified Behaviour Analyst)
BEHAVIOURAL THERAPIESVERBAL BEHAVIOUR
Uses principles of ABA and theories of B.F. Skinner
Usually delivered by Behaviour Therapists/Analysts
Focuses on WHY we use words
Motivate individual with Autism to learn language by connecting language with its purpose: imitating, requesting, commenting, communicating ideas
Goal to help individual to learn that words can obtain desired objects, attention, etc.
BEHAVIOURAL THERAPIESPIVOTAL RESPONSE TREATMENT
Developed by Dr.’s Robert and Lynn Koegel. Derived from ABA.
Delivered by SLP’s, Psychologists, Special Education Teachers
Play based and child initiated
Significant parent training and involvement in delivery of intervention
Goals to develop communication, language and positive social behaviours as well as relief from disruptive self-stimulatory behaviours
Targets “pivotal” areas of child development: motivation, response to multiple cues, self-management and the initiation of social interactions.
TEACCH BASED ON WORK OF DR. ERIC SCHOPLER
A FRAMEWORK FOR TEACHING THAT INCLUDES THE INDIVIDUAL’S STRENGTHS IN VISUAL INFORMATION PROCESSING AND DIFFICULTY IN SOCIAL, COMMUNICATION, ATTENTION AND EXECUTIVE FUNCTION
INCLUDES:
EXTERNAL ORGANIZATIONAL SUPPORTS TO SUPPORT CHALLENGES WITH ATTENTION AND EXECUTIVE FUNCTION
VISUAL AND/OR WRITTEN INFORMATION TO SUPPLEMENT VERBAL COMMUNICATION
STRUCTURED SUPPORT FOR SOCIAL COMMUNICATION
RELATIONSHIP DEVELOPMENT INTERVENTION
DEVELOPED BY PSYCHOLOGIST, DR. STEVEN GUTSTEIN
BEHAVIOURAL TREATMENT
PARENTS TRAINED IN RDI AND PROVIDE INTERVENTION UNDER GUIDANCE OF AN RDI CERTIFIED PROFESSIONAL
GOAL TO TEACH INDIVIDUALS WITH AUTISM TO BE “FLEXIBLE THINKERS”
KEY SKILLS TAUGHT INCLUDE:
APPRECIATION FOR DIFFERENT PERSPECTIVES
COPING WITH CHANGE
INTEGRATION OF INFORMATION FROM MULTIPLE SOURCES (E.G. SIGHTS AND SOUNDS)
FORM PERSONAL RELATIONSHIPS
THE GREENSPAN FLOORTIME APPROACH™
CREATED BY DR. STANLEY GREENSPAN
FOLLOW CHILD’S LEAD AND USE THEIR INTERESTS
BUILD RELATIONSHIP WITH THE CHILD
HELP CHILD PRACTICE BASIC THINKING SKILLS: ENGAGEMENT, INTERACTION, SYMBOLIC THINKING AND LOGICAL THINKING
DELIVERED BY VARIETY OF PROFESSIONALS
TRAINING PARENTS
PICTURE EXCHANGE COMMUNICATION SYSTEM
PECS: A PICTURE-BASED COMMUNICATION SYSTEM TO PROVIDE NON-VERBAL CHILDREN WITH A MEANS TO COMMUNICATE AND SUPPORT CHILDREN WHO HAVE LIMITED VERBAL COMMUNICATION
TRAINING CAREGIVERS TO USE IT WITH CHILDREN WITH AUTISM
ANYONE CAN ACCESS TRAINING
FREQUENTLY INTRODUCED BY SLP’S AND BEHAVIOUR THERAPISTS
MORE THAN WORDS®HANEN® PROGRAM FOR PARENTS OF CHILDREN WITH
AUTISM SPECTRUM DISORDERS CREATED BY SLP’s FERN SUSSMAN AND SUSAN HONEYMAN
DELIVERED BY HANEN® CERTIFIED SLP
TEACHES PARENTS AND CAREGIVERS TO USE DAILY ACTIVITES TO HELP CHILDREN:
IMPROVE SOCIAL SKILLS
ENGAGE IN BACK-AND-FORTH INTERACTIONS USING VERBAL AND NONVERBAL COMMUNICATION
IMPROVE UNDERSTANDING OF LANGUAGE
MORE THAN WORDS®TEACHES PARENTS AND CAREGIVERS:
How your child learns best and what motivates him to communicate
Why your child behaves in certain ways, and what you can do to increase or reduce those behaviours
How to use knowledge about your child to set realistic goals
How to make interactions with your child longer and more meaningful
Tips for using pictures and print to help your child understand
Tips on how to talk so that your child understands you
Strategies for developing play skills and making friends
MORE THAN WORDS®PARTICIPANT COMMENTS
“Every aspect of the training was extremely helpful.“
“I would recommend MTW to any parent who has a child with Autism.”
“He is able to communicate a lot more because he is speaking and interacting.”
“I am now more confident and equipped to work with the children in my class.”
“Allowing time for R. to respond or initiate has helped enormously.”
“I found that with M. he is speaking a lot more and seems a lot more settled when it comes to working.”
So, how do I “do” early intervention
USE EVERYDAY ACTIVITIES IN EVERYDAY ENVIRONMENTS TO CREATE LEARNING OPPORTUNITIES
MEALTIME
GETTING READY FOR SCHOOL
RIDING THE BUS
NAPTIME
BATHTIME
BEDTIME
So, how do I “do” early intervention
FAMILY CHORES
GROCERY STORE
PLAYGROUND
STORYTIME
HOMEWORK TIME
So, how do I “do” early intervention
MAKE LANGUAGE “COME ALIVE”
TALK ABOUT WHAT YOU DO AS YOU DO IT
LABEL OBJECTS, ACTIONS, USE DESCRIPTORS
So, how do I “do” early intervention
COMMUNICATIVE MEANS:
THE “HOW’S” OF COMMUNICATION
Watch the child and observe how they communicate
Looks at objects
Looks at a communicative partner
Leads a communicative partner by the hand
Gives objects to a partner
Combines any of these
So, how do I “do” early intervention
COMMUNICATIVE FUNCTIONS:
THE “WHY’S” OF COMMUNICATION
Watch the child and observe why they communicate:
To request
To protest
To ask for help
To establish joint attention so they can share information with a partner
To comment
To initiate play
So, how do I “do” early intervention
3 L’sLOOK AT YOUR CHILD
LISTEN TO YOUR CHILD
LEARN TO LOVE WHAT YOUR CHILD LOVES
So, how do I “do” early intervention
“3 L’S”ALLOWS YOU TO MAKE A CONNECTION WITH
THE CHILD
CONNECTION IS KEY TO BUILDING A BRIDGE TO COMMUNICATION
MEET THE CHILD WHERE THEY ARE
VIDEO CLIP OF LEARNING TO LOVE WHAT YOUR CHILD LOVES
So, how do I “do” early intervention
CREATE OPPORTUNITIES FOR THE CHILD TO COMMUNICATE
BE “THE KEEPER” OF THE GOODIES: INTRUDE A BIT
WAIT FOR THE CHILD TO INITIATE
BE FACE-TO-FACE
USE THE 3 L’s
So, how do I “do” early intervention
HOW CAN I HELP MY CHILD UNDERSTAND
Use JUST ENOUGH words: children with Autism frequently have difficulty processing oral language so we need to keep it simple for them
Be ANIMATED when you speak: children with Autism frequently have difficulty sorting out what information they need to pay attention to so we need to make the important information STAND OUT for them
Go SLOW: remember that your child is like a foreign language learner and will benefit from extra time to process information
Use VISUAL INFORMATION such as GESTURES, OBJECTS and PICTURES
Children with Autism learn best through their VISUAL CHANNEL
So, how do I “do” early intervention
VISUAL COMMUNICATION AIDS
GESTURES
3D OBJECTS
PICTURES OF REAL OBJECTS
PRODUCT WRAPPERS/LOGOS
PCS SYMBOLS/BOARDMAKER SYMBOLS
So, how do I “do” early intervention
VISUAL COMMUNICATION AIDS
FIRST-THEN BOARD
CHOICE BOARD
VISUAL SCHEDULE
SOCIAL STORY
PECS
RESOURCESThe Hanen Centre www.hanen.org
Autism Speaks www.autismspeaks.org
Autism Navigator www.autismnavigator.com
Geneva Centre for Autism www.autism.net
Speech-Language and Audiology Canada www.sac-oac.ca
Friend2Friend Learning Society www.friend2friendsociety.org
Barbados Council for the Disabled 427-8136
Sue McMillan, SLP [email protected]