By Tracy Vail,MS,CCC/SLP

Letstalksls.com

What Are Important Skills to Teach Young Children with Autism?

Communication skills: allow the child to get their needs met and replace maladaptive behaviors and engage in social interactions.

Non-verbal communication: Teaches the child that people’s faces/bodies carry important information.

Interactive Play Skills: teaches flexibility, improves relationships, replaces self-stimulatory behaviors

Imitation Skills: Allows the child to learn from the environment.

Ask and ObserveAsk the parents! What are their priorities?Observe the child- What areas are causing the

child the most difficulty in life right now?Look at where the child is currently

functioning and determine the necessary component behaviors/skills to meet the goals of the parents and child.

What are the goals of the family in 1 yr? 5 yrs? 10 yrs?

Most Common Approaches UsedBehavioral Approaches- ABA- Applied

Behavior Analysis and Applied Verbal Behavior, TEACCH

Developmental Approaches- SCERTS, Floortime/DIR, RDI

Developmental, Individual Differences, Relationship Based Intervention,

DIR/Floortime

A warm and intimate way of relating to a child. A floor time philosophy means engaging, respecting and getting in tune with the child in order to help the child elaborate through gestures, words and pretend play what is on the child’s mind. As a technique it is a process that is used to support the emotional and social development of the child. (Greenspan, 2002)

This model serves as the context or “container” of the therapy we do. But what does it mean?

Relationship Development Intervention (RDI)

A cognitive- developmental approach designed to remediate Autism.

Deals with autism as a neurologically based, information processing disorder.

Proposes to remediate the “Core Deficits” in Autism including motivation, communication, emotional regulation, episodic memory, rapid attention shifting, self-awareness, appraisal, executive functioning, flexible thinking, and creative problem solving.

Great stuff based on research by many in the field of psychology but what do these “core deficits” mean? How do we know when these skills have improved? What is the child doing? How can we measure it? AND, is it really necessary to spend thousands of dollars being trained to address these issues?

Hanen MethodTeaching communication and play skills

through adult- child interactions. Parents/therapists are to:

Observe, Wait and Listen (OWL)This approach is very similar to DIR in that the

child leads and teaching is conducted based on the interests of the child.

Behavioral ApproachesScientifically validated based on many

years of research.Based on measurable behaviors either

internal or observable.Based on the “laws of learning”Places the responsibility of learning on the

“teacher” rather than the studentMany “faces” to behavioral interventions.

Not all programs look alikeData driven program decisions

Applied Verbal BehaviorBased on the research of BF Skinner on

“why” people communicateLanguage is categorized into verbal

operants or functions: Mand, Tact, Echoic, Intraverbal (as well as “listener” behaviors)

There’s a strong focus on developing “intraverbal links” or relationships between words.

Language is taught as a behavior with specific teaching procedures used

Both natural environment teaching and intensive teaching are used based on the age and skills of the child

TEACCHThe long-term goals of the TEACCH approach are both skill

development and fulfillment of fundamental human needs such as dignity, engagement in productive and personally meaningful activities, and feelings of security, self-efficacy, and self-confidence.  To accomplish these goals, TEACCH developed the intervention approach called “Structured Teaching.”  

The principles of Structured Teaching include:Understanding the culture of autism. Developing an individualized person- and family-centered

plan for each client or student, rather than using a standard curriculum.

Structuring the physical environment. Using visual supports to make the sequence of daily

activities predictable and understandable . Using visual supports to make individual tasks

understandable(TEACCH Website)

Can We Combine Behavioral and Developmental Approaches?

YES!!!

Factors to ConsiderNo single “program” works for all children to

address all their needs.Every human being’s learning is a combination

of internal and external factors.Motivation of the child is the most important

factor to consider when making treatment decisions.

Parents often have preferences and skill sets that should be respected.

Different children respond better to different approaches.

Relevant Information About Learners with AutismThey tend to have very analytical mindsThey tend to have unusual motivations and

consequently unusual reinforcersThey tend to be “rule based” learnersTheir bodies experience the world in an unusual

waySome are quite rigid and anxiousThey often have difficulty understanding the

“rules” of social interaction and communicationSo what…..Now what?

Use Whatever Works to Teach the Most Important Skills to each Individual child at the Given Time

The Language We UseOften it isn’t what we do but how we talk

about what we do that makes approaches seem so different.

The language we use to talk about what we do should be precise, agreed upon and based on “observable” or “measurable” change.

As professionals we are charged to provide “evidenced based practices”. Show me the data!!

What do you see happening?

A Few Possible Observations

He interacted with the instructor for 3.5 minutes.

He requested using gestures 4 times with no prompting.

He imitated body movements twice with no prompting.

He looked at the instructor twice and smiled.

He laughed in response to the instructors actions twice.

He initiated a social game twice with no prompting.

He shared affectHe shared attentionHe both opened and closed

5 circles of communicationThe instructor followed the

child’s lead

He demonstrated a preference to engage in a regulatory pattern with ongoing variations

He regulated his actions to maintain social coordination

He responded to guides role actions to maintain the regulatory status of the pair.

Children are Complete Human Beings

They have a right to communicate to get their needs met

They want and need successful relationships in their lives

While they have some similarities, they all have unique needs that should be addressed

Each family structure is different and has unique priorities and needs

Child and family needs will change over time and programs need to reflect that

General Language CategoriesLanguage used to meet the needs of the

individualLanguage used for social interactions and

building relationshipsLanguage used for “learning” or academic

settings

Verbal Operants

Mand Motivation Says “car” gets car

Echoic “Say car” Says “car” social/secondary

Tact Car present Says “car” social/secondary

Intraverbal “We ride in the ..”Says “car” social/sec.

Antecedent/Stimulus BehaviorConsequence

Motivation and Reinforcement

Motivation-

1. Temporarily increases the value of a reinforcer

2. Temporarily increases the behaviors that have been followed by that reinforcer in the past

Reinforcer- increases the likelihood that a behavior will happen again in the future

If a behavior is increasing in frequency, it is being reinforced!

Communication To Meet NeedsMands/requestsUse an augmentative system if the child is not

yet vocal: signs, PECS, voice output devicesTeach “errorlessly”- full prompts then fade

your promptsMake sure you have motivation before

teaching the requestTarget 3-4 words at any given time.

Conditions to TeachFill-ins: choo choo little …R= trainEchoic- shape articulation Choices- Block? Car? – Do you want

block or car?What do you want? What should I do?Noting said- object presentNothing said- object absent (pure

mand)

Choose a Response FormIf child is non-vocal, must use an

alternative/augmentative systemAugmentative communication encourages rather

than discourages vocal productionsExperiment to determine how the child responds

to various formsPicture/object exchangeSignsCommunication BoardsVocalVoice output devices

Teaching SignsMake sure the signs you teach can be

immediately reinforced.Choose iconic signs to begin teaching (look

like the object)Make sure all those in the child’s environment

know the child’s signs so they can be reinforced.

Early signs to avoid: more, yes/no, potty, open

Think: Objects, then actions, then adjectives

Introducing Signs

Signing Block

Picture Exchange Communication System

Communication Boards

Shaping SpeechBegin with vowels since they carry the most

meaningShape the syllable structure to increase

intelligibilityAvoid teaching simplification patterns typical in

young children as they tend to be VERY hard to correct in children with Autism.

Continue reinforcing requests with augmentative systems until vocals are intelligible to most people

Always say the word correctly before delivering the reinforcer

Avoid Dropping Sounds too Early

Watch for Sign/Vocal Confusion

Reinforce All Vocal Attempts

Use Imitation

Shape Speech in the Context of Requesting

Use Music

Use Books

Avoid reinforcing extra sounds

Interactive PlayBuild trust/relationship by being

predictableTeach flexibility by slowly

introducing changeFocus on engagement, shared affect,

joint attentionSocial imitation, social smilesnon-verbal communication

Move In and Out of the Comfort Zone

Beginning PatternsStart a pattern based on what the child is doing or

introduce your own patternMake sure the child has a role in the interaction.

You can be doing the same things or different things.As soon as the child is taking a role consistently,

vary the pattern. If the child withdrawals from the interaction, make the change more gradual next time.

Use silly sounds, breath intake, pauses right before the change will occur.

Reinforce behaviors you want to see more of!

Follow the Child’s Lead

Facial gazing, social imitation, pattern

Use the child’s interests

Expand Language and Play Skills

Advanced Pretend Play

Negotiating/Problem Solving

Non-Verbal CommunicationPairing Experience – pairing people with

reinforcement/establish social reciprocity/engagement- non-verbal behaviors exhibited by 2 people for the function of sharing reinforcing interactions. (many may be considered requests for the interaction to continue- imitate as a mand for the “listener” to repeat the behavior.)

Affect Sharing/Social Smiles

Imitation/Shared AffectMirroring Behaviors:Shared affect- Reinforced by adult

imitating the child’s affect in an exaggerated manner.

Social imitation- reinforced by continued presence of adult/child who’s attention has been established as a conditioned reinforcer.

Use Sounds and Pauses to Increase Facial Gazing and Shared Affect

Non-vocal RequestsMands/Requests= non-vocal behaviors exhibited by the

child that serve the function of obtain an item or action Look- reinforced by obtaining access to the item being

looked at.Reach (+ look)- reinforced by obtaining access to the

item being reached for.Point (+look)- reinforced by obtaining access to the

item at which the child pointedGive to activate (+look)- reinforced by activation of the

object/toy.Action to sustain (+look)- reinforced by repetition of

the action. 

Following Non-Verbal DirectionsGestural Listener= responding to gestural

mands/requests of others to exhibit a behavior.

Follow point – reinforced by adult attention or other conditioned reinforcer

Follow gaze- reinforced by adult attention or other conditioned reinforcer

Follow yes/no- reinforced by adult attention or other conditioned reinforce.

 

Following Point

Chains of BehaviorsCombined- chains of behaviors that involve

looking to request information then following a non-verbal receptive instruction.

Look + follow point- look is reinforced by having information provided and follow point is reinforced by conditioned reinforcement

Look + follow gaze- look is reinforced by having information provided and follow gaze is reinforced by conditioned reinforcement

Moving from Point to Gaze

Combined ContinuedLook + respond to head nod/shake (yes/no)-

look is reinforced by obtaining information and response to yes/no reinforced by conditioned reinforcement

Point and look + respond to head nod/shake (yes/no)- point and look reinforced by obtaining information and response to yes/no reinforced by conditioned reinforcement

Joint AttentionGestural Bid for Joint Attention = child

exhibits non-verbal behaviors for the function of drawing another’s attention to an object, event, or other environmental stimulus. The attention of the adult must be established as a conditioned reinforcer. (True Joint Attention as defined in behavioral literature)

Show object (+look)- reinforced by affective response/attention of adult/child

Joint Attention Cont.Look at object (+ look at person) reinforced

by affective response/attention of adult/childGive object (+look)- reinforced by affective

response/attention of adult/childPoint at object (+ look)- reinforced by

affective response/attention of adult/child

Thanks for All You Give to Children!