autism spectrum disorders: intervention for high-functioning students rhea paul, ph.d., ccc-slp...
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Autism Spectrum Disorders: Intervention for High-functioning
StudentsRhea Paul, Ph.D., CCC-SLP
Southern Connecticut State UniversityYale Child Study Center
Feb. 11-15, [email protected]
Goals of Treatment for High Functioning Students with ASD
Social Interaction skillsSocial Interaction skills Peer relations
Communication skillsCommunication skills Pragmatic and conversational skills
Adaptive skills Self-help
Self-regulation, emotional regulation Academic skills appropriate to
developmental level Reading comprehension
Social Interaction: Intervention Methods
Social Stories Descriptive sentences: statements of fact
Many children play on the playground during recess. Perspective sentences: refer to internal states
Some children like to make a lot of noise. Affirmative sentences: express a common value
One child goes down the slide at a time. This is a safe thing to do.
Control sentences: identify personal strategies When I have to wait my turn on the slide, I can count the
people in front of me to make the time go faster. Cooperative sentences: what others can do to
help. The teacher can help me if I feel impatient. She can talk
to me while I wait.
Comic Strip Conversations
Use ‘think’ and ‘word’ bubble cartoons
Sam, I saw a cowcatcher on an
old-fashioned train yesterday. Do you know what that is?
Sam doesn’t know as much as I do about
trains. I will find out if he knows
what the cowcatcher does before I tell him about the one I
saw
Games Based on Special Interests Develop social games based on
special interests of target child• Involve target child in development of
materials and rules• Have target child teach game to peer• Set up special opportunities to play game• Take turns choosing games to play during
interactive game time
Video Modeling Use commercial material such as
My School Day Video tape peers conducting
interactions such as greeting, negotiating, etc.
Use video clips from TV shows to exemplify interactions (may use negative interaction)
Video Modeling View video, discuss reactions DESCRIBE VERBALLY Re-enact scene on video with
clinician Re-enact with peer Improvise similar situation
Sample Video Models
Sample Video Models
Using Video Modeling Use video modeling and role playing
to become aware of listener cues Looking at watch Taking a breath Looking toward door Yawning
Use role playing to practice giving and perceiving these cues
Social Cognitive Skills Training (Timler et al., 2005) Role play social scripts in peer group
• Situation paragraph read to group• 4-5 situations/ 2 hour session• 6 weeks of 2 sessions/week
Children guided during role play to use checklist to facility ability to identify what they know about situation from own and other’s perspective
Further Qs helped identify a range of response strategies by • selecting goal, • stating alternative strategies to reach goal• Evaluating consequences after response
Social Skills Groups Can use commercial curricula, such as
• Navigating the Social World (McAfee, 2001)• Skillstreaming the Adolescent (Goldstein & McGinnis,
2000) Provide consistent group structure
• Check-in, greet• Review last meeting’s skill• Introduce new skill• Model and role play new skill• Snack, social time• Activity that allows real-life practice of new skill• Summary
Peer Support Networks
Select 2-5 peers to serve as social support for student with ASD
Assign each support peer a 20 minute period/day to structure activities for student with ASD, e.g.: Lunch: use Prompt and Praise to engage
with others at table Recess: teacher creates scripts for
entering games; peer support and target student practice in private, then on playground
Effective Adult Techniques: Social Skills Training (Timler, 2006) Teacher Redirects Prompting children to play with one another Rephrasing or restating one child’s statement
for another Praising children for playing together Direct instruction in social language Modeling and practice with explicit cues Role play with prompting Corrective feedback Authentic contexts (peer involvement) Self-monitoring for older students
Pragmatics and Conversation
Video examples: ASD Conversational Behaviors
Pragmatic Domains
Communicative functions Intents Frequency
Discourse management Turns topics
Register variation Politeness Social roles
Presupposition Grice’s maxim of Quantity ‘mind-reading’
Pragmatic Assessment
Children’s Communication Checklist (Bishop, 2003)
Pragmatic Rating Scale (Landa et al., 1992)
Pragmatic Rubric Pragmatic Protocol (Prutting & Kirchner,
1984) Social Skills Rating System (Gresham,
1990) Pragmatic Language Skills Inventory
Gilliam & Miller, 2006)
Improving Conversational Skills
Enhancing Pragmatic Skills Conversational participation and reciprocity
Take turns w/o interrupting Responding appropriately to others’ speech Adding something new and relevant information to a
topic Terminating/changing topics appropriately
Initiating and maintaining peer interactions Entering peer play and conversation Maintaining and expanding play themes Terminating play appropriately
Reduction of obsessive, perseverative topics Understanding and telling stories
Understanding social sequences Understanding psychological motivation
Scripting Provide explicit written script of interaction, e.g.,
Walk up to a classmate
Make eye contact
Say, “Hi ____________”
Practice script w/ adult Practice w/ peer Script Fading: Cut off increasingly large parts of
script, until client can do the scene independently
Scripts and Script Fading
Provide topic lists, guide students to write and fade their own scripts
Use favored topics to bridge to new ones• trains→dining car →food
Have students choose a strip to talk with a teacher/clinician
Fade scripts with adult Encourage student to repeat with
peer partner
Scripting with Peer TrainingPeers taught 5 facilitative skills w/o target
child present:1. Look, wait, and listen2. Answer questions3. Start talking4. Say something nice5. Keep talking
Target children given written scripts for social interaction (“Can I play checkers with you?”)
Direct Instruction Make
conversation:
Maintain topic:
Change topic:
Go up to person.Say ‘hello.’Smile.Listen to what s/he says and
respond.
Listen.Think about what the person says.Talk about the same thing.
Keep quiet and listen.Wait until the person pauses.Say, “Let’s talk about something
else. Like…”
Direct Instruction: The “Conversation Can” (Brinton, Robinson & Fujiki, 2005):
Brainstorm a list of topics classmates might want to discuss
Write each on a slip of paper Put slips in can Take turns pulling out a topic Start conversation:
Think first: What should I say Say two things about the topic Ask interlocutor a question about the
topic Listen while interlocutor answers
Graphic Supports for Conversation ChecklistsWhen I had a conversation, did I
Look at my friend? _____________
Stand one arm’s length away? _____________
Appear interested by asking questions and listening? ______ Talk about what my friend is interested in? ______
PostersImportant Parts of Conversations:•Topic: Pick something your friend wants to talk about•Questions: Use these to keep the back-and-forth going•Comments: Say something new that your friend doesn’t know, but would find interesting
Graphic Supports for Conversation Choice BoardsPick your conversation topic for today:
Graphic Supports for Conversation Choice lists
Yo, __________!
Hey, Pal!
High 5!
� What’s up?
� Hi, how ya doin’!
Principles of Pragmatic Intervention Strategies
Students with ASD will not acquire social skills from exposure; they require mediated experiences
Verbal, written and graphic supports are effective
Peer involvement is an essential element Peers need training, but it is not extensive
Encourage ‘mind reading’
Adaptive and Self-Regulatory Skills Same principles as with lower
functioning. Visual supports Social Stories, Comic Strip Conversations ABA approaches
Task analysis Functional Behavior Analysis Consequences-natural and contrived
Self-Management Skills Picture Schedules: visual supports
Self-management: Social Stories
Recess* After lunch we go to recess.* Sometimes recess is on the playground.* A lot of the children play on the playground
equipment.* It is fun to play on the playground equipment.* Everyone should play safely.* When the whistle blows that means it is time to line
up and go inside.* I will try to line up as soon as the whistle blows.* This will make my teachers happy.* After I line up I will try to stay in line.* Everyone will be proud of me!
Academic Skills Reading can appear a strength
May be early, precocious w/ keen interest in letters, numbers
May show interest in words (read dictionary) BUT, difficulties in comprehension often
occur. Narratives (stories) may be a good
vehicle for improving reading comprehension
Narrative Intervention Understanding motives: make
character motivation explicit Understanding intentions: discuss
reasons for actions Understanding emotions: discuss how
characters feel and why