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Autism Immersed podcast, episode 2

Our second episode is part 2 of an interview with Dr. Rebecca Morrison, the founder of Oakstone Academy in Westerville, OH. 

We will be discussing how the school started, its mission, and exploring their one of a kind “social immersion model” that puts students on the Autism spectrum in typical classrooms with typically developing peers. 

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INTERTWINED: How Therapies Work in an Academic and Social Immersion Model

Oakstone Academy and The Children’s Center for Developmental Enrichment (CCDE) offers a service delivery model that is unique in this inclusive school designed for students with Autism Spectrum Disorders and their peers.  Speech and Occupational Therapies are offered as classroom-based (push-in) and direct/private (pull-out). These types of service delivery models have been in existence in the schools, and though no single model is appropriate for all students, the ultimate goal is ensuring that the student’s needs are met in a variety of settings.   Service delivery models in the schools should be dynamic and fluid, allowing the Speech-Language Pathologist (SLP) to support the student by providing effective intervention in order to generalize skills.

Classroom-based service delivery allows the SLP to perform a variety of roles including working with the student individually, circulating around the room, or with small groups during an activity.  The natural environment provides an authentic setting tailored to the student’s needs. The classroom SLP can also provide “consultation” to the teachers in the use of strategies in the context of reading, writing, and speaking activities.  At Oakstone, the classroom SLP develops and writes measurable goals for the student’s Individualized Education Plan (IEP).  He/She may also administer testing to assess the student’s performance and/or skills for the Evaluation Team Report (ETR) to determine the student’s eligibility for special education services.  The SLP and classroom teacher work closely with the team (i.e., Occupational Therapist, Psych Services, administration) to create social narratives and visual supports and how to frame instruction for children with language impairments and provide positive behavioral support.  This partnership is critical to the classroom teacher and SLP as the student’s progress and changing needs evolve throughout the school year.

Direct/Private therapy or pull-out service delivery is provided in a separate room, which allows for individualized time with the student.  This type of intervention removes the child from the classroom curriculum for a specific amount of time.  Direct therapies are used for testing or screening; it may also be beneficial if the student has challenging behaviors and require a more restricted or quiet environment for learning or acquisition of skills.  SLP’s in this capacity determine each student’s goals and create treatment plans to target these goal areas. Often, therapists work closely with families by developing specific functional goals such as skills for daily living, self-help skills, or a visual schedule for routines at home.  While the classroom-based SLP provide support and strategies in the classroom, direct/private SLPs provide structured opportunities for increasing a particular skill or for teaching new behaviors. With fewer or less distractions, SLPs may take advantage of the space to create conversations and practice functional activities while working on specific language skills.  Direct/private therapy is ideal for practice drills and 1:1 instruction not necessarily possible in classroom-based services. While schools around the nation offer both direct and classroom-based therapies, the resources to implement pull-out therapy are becoming limited due to high SLP caseload and workload. As a result, students who need the individualized and focused therapy receive less therapy time.  Fortunately, Oakstone is able to provide and implement a combination of these models and the resources to sustain both therapies. Direct/Private therapy also allows for flexibility and creativity in creating small groups before/after school and during the school day (typically, at recess or lunch time). These groups are short, practical, and target specific goals for generalization. The benefit of direct/private therapy gives the parents or caregivers convenience in having the therapy before/after school or during the school day instead of traveling to another facility or private clinic for similar services.  Although some students receive additional therapies, this convenience is an attractive benefit to many families at Oakstone.

Collaboration, by definition, refers to working together to create a shared goal.  This unique alliance that happens between direct/private (pull-out) and classroom based (push-in) therapy not only benefits the student but ensures that his/her needs are met.  Combining these service delivery modes allows for a closer look on the educational relevance of Speech-Language services and the efficacy of treatment services in both the therapy room and the classroom.  Both capacities allow for expanded roles to address the needs of the student while affecting the student’s educational performance. Oakstone offers both types of therapies by fulfilling various roles to adopt a more comprehensive picture of speech services.  The weaving together of knowledge, expertise, experience, and passion of the SLPs and OTs at Oakstone can add power to the educational growth of the each student.

References

https://www.asha.org/slp/schools/school-based-service-delivery-in-speech-language-pathology/

https://www.iidc.indiana.edu/pages/The-21st-Century-Speech-Language-Pathologist-and-Integrated-Services-in-Classrooms

https://journals.sagepub.com/doi/full/10.1177/2396941516680369

https://www.asha.org/NJC/Types-of-Services/

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Immersed in theatre

Immersing students with autism spectrum disorder means having inclusive extracurricular opportunities.

“All the world’s a stage,

And all the men and women merely players;

They have their exits and their entrances;

And one man in his time plays many parts,”

-from As You Like It by WIlliam Shakespeare

When William Shakespeare wrote these words, he was commenting on the roles we play in our daily lives and the drama that surrounds us. For students with Autism Spectrum Disorder, theatre, whether on stage or behind the scenes, can be a powerful tool for membership in a community. Participating in a play not only develops a sense of confidence, competence, and self worth, but also can help students with ASD to feel that they belong and even can improve their interpersonal skills beyond the stage. Success comes from developing competence and earning a place in the group.

Kara Zimmerman helps a high school student prepare for his role in the production of A Midsummer Night’s Dream

Kara Zimmerman, a professional actor, currently teaches theatre and music at Oakstone Academy in the school’s Academic and Social Immersion Model. She was intrigued to have students of all abilities try out for theatre, as she was aware of many studies that show how well students with ASD do in the arts. However, she commented that it “blows my mind to see kids going far beyond what they are supposed to do”. Kara runs the theater program at Oakstone just as the rest of the school is run. Students with ASD are considered full members of the community and try out for theatre with their classmates, earning their roles. She does not cast per diagnosis, but by role, choosing the student who is best suited for the part. “Diagnosis doesn’t matter,” Kara commented, “I forget we are in an immersion setting because all the kids are just there to put on a great show.” As she has been more involved with casting and directing shows at Oakstone over the past few years, Kara has seen the benefits of theatre for her students with ASD. “Theatre fosters support and understanding. It teachers about emotion and empathy….it really helps connect the dots between emotions and actions.” Kara also commented that she sees her cast and crew without diagnoses benefit as well, as the team approach and supportive environment of theatre really reinforce the role of peer models and the idea that everyone is learning from one another.

Grant Carpenter oversees the backstage and technical crew of the Oakstone theatre department. As a lifelong theatre participant, Grant enjoys facilitating the camaraderie of theatre. “Theatre requires teamwork from every single person,” Grant added, “Any part can–and does–make a scene.” This message is reiterated in how he runs crew, focusing on each individual’s ability to help in a particular area as they prepare a vision for the staging of the show. “Some students are going to be better with detail work, while others are really fast and efficient spreading paint. We need people to work on the backdrop, the props, the costumes, the tech.  All those abilities are needed as we work towards one cohesive presentation.”

Mr. Grant coaching students as they build sets

Both Kara and Grant commented about the idea of watching students exceed expectations that society sets for them because of their diagnosis. “Parents will tell me,” Kara shared, “about being told their child will never talk or never have friends. Then, you see them on stage and it blows my mind to watch them going beyond what they were supposed to do.” Grant is constantly amazed to see kids “who don’t talk much outside of theatre get up on stage and drop an awesome monologue.” Kara may have said it best, when reflecting about the impact theatre has on her students: “I cry every time we do a show. Every time.”

Several members of the recent middle school play at Oakstone and their parents also talked about the impact that being a part of the theatre had on them. Because all three students have ASD, they will be referred to by pseudonyms: Alex, Betsy, and Diane. Alex and Betsy both had roles onstage, while Diane was a second year member of the crew.

Alex shared that he opted to do theatre to be with his friends. “I felt excited because I got to be with my friends. It feels good to go to school and be in plays and have friends.” He commented, “people with autism should try doing plays, so they aren’t left out.”  Betsy also felt students with ASD should participate in plays, commenting, “Even if you can’t talk, you can act it out. You can be in the group.” Both actors and Diane enjoyed being part of a group or team. Diane added, “I know a lot more students now. It helps give me social practice to be in theatr.e It also makes school more fun and positive. Theatre is the most fun thing I’ve joined.” The idea of being a member of a group and working towards a common goal is crucial for students with ASD, and theatre gives them first hand experience with that.

Alex commented that he “didn’t feel nervous because I was prepared. Sometimes people get stage fright. I didn’t but some people did. I was kind to people who were nervous.” Alex had the opportunity to coach and support his peers, both with and without ASD, allowing him to be a leader.  Betsy, on the other hand, did feel a little nervous about remembering her lines, but was reassured by Kara’s direction. “Acting is reacting, that’s what Ms. Kara told us,” Betsy commented. “That means just pay attention and try your best.” Diane is not as interested in being on stage, but plans on continuing theatre in high school as well. “I like crew, not being seen, hiding, but having fun. It is better for my insecurities, but I still am participating in something.” Diane felt like participating in crew made some of her social anxiety less noticeable, as she was working with a team of students, with and without ASD, who all prefer to be behind the scenes. “Crew is still a lot of fun and you all help each other. We joke around  and even taught some kids about making jokes so they could laugh along with us.”

Diane’s mother has seen her self-worth grow since she began participating in theatre. “She finds real pride in being in crew. It builds on her interest in the arts, uses her talent. She is always excited to show me her work.” She has also seen Diane come out of her shell and be more willing to take risks related to social activities and feel the payoff. “Theatre is a place that she feels she fits in. (Diane) is excited to show others that crew is not a consolation prize; it’s just as fulfilling as being on stage.” Alex’s mom has also seen theatre as a vehicle to help Alex build his confidence. “Theatre gives him full membership in the group, not charity inclusion. He earned it.” For Alex, theatre is a place to put his phenomenal memory to use, and a place to allow others to see his personality and humor, which his mom feels he keeps hidden 95% of the time. “His past teachers saw him at the show and were wowed that he was so funny and brave onstage.” She elaborated, “This is a kid who at age 3 had maybe 10 words he spoke. At age 9, he whisper-talked in every class. Now, he is on stage, projecting, being funny!”

The most rewarding part of offering immersive experiences in theatre is seeing the ways it impacts students’ confidence and skills in other areas. Parents and staff alike see this happen time and again among students with ASD who participate in theatre. “Theatre was a spark for (Alex). He wants to go see the high school play now. He is doing more social planning–asking kids if they are participating in other activities and clubs. He is leaving our family in social situations to go be silly with friends. He makes friends outside of his classroom social group. He makes comments about what others are doing and wanting to do those things too–benefitting from positive peer pressure.” Betsy made the connection between studying her lines and studying her school work: “Learning lines makes you feel better at knowing what to do. It’s the same as studying for class.” Diane added, “theatre keeps you flexible. Things will go wrong along the way. You have to go with it, not lose it.”

In Academic and Social Immersion, participating in extracurriculars has power because participation is earned. No one is there as a mascot or to meet a quota. No one is there with an adult helper or aide. Everyone who participates is there because they have promise and potential. All students are expected to participate, to carry their weight, and ultimately to play their part.


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Using AAC When the SLP is Not Around

A summary of a presentation from the Ohio Speech Language Hearing Association 2019 convention by Oakstone staff Jennifer Hesseling and Kathy Wilson

With an emphasis on the benefits of social immersion and inclusion, parents and educators of children with Autism Spectrum Disorder (ASD) are seeking effective ways for their children to continue skill and language acquisition and enhancement, while also exposing their children to typically developing peers.  It may feel daunting to implement the use of an Augmentative and Alternative Communication (AAC) modality, but we believe strongly in the importance of every child having a voice and a way to communicate.

We first must identify barriers to our use of AAC consistently in our young person’s everyday life.  Many barriers require a change of perspective or a mental shift in order to overcome them. The first identified barrier is the fact that the use of AAC takes more time than verbal speech.  The perspective or mental shift taken into consideration here should be that speech-generating devices (SGDs) and picture based systems may take more time, but they are still the young person’s “voice.”  Be patient just as you would with a little one when they are learning words for the first time.

Another barrier to using AAC consistently and regularly is that we may have previously been used to the non-verbal child responding only receptively, with gestures, pulling, pointing, or grunting.  It is quick and easy to give the non-verbal student a choice of 2 pictures to respond and participate. The perspective to consider here is that children who do not speak still have plenty to say and can still participate in the classroom expressively.

The next barrier particularly applies to using AAC consistently in the community.  Sometimes the young person or caregivers may be a bit embarrassed of the social stigma of using a SGD.  Instead of being embarrassed, consider yourself an advocate raising awareness of all kinds of ways people can communicate.  With that, we must also allow others to be gracious in the acceptance of the less familiar form of communication.

The last barrier would be expecting the child to use AAC independently.  We must remember that communication and fluent AAC use does not happen overnight.  We must first devote time to becoming proficient with the system ourselves so we then can teach the young learner to become proficient.  We must also provide enough teaching and prompting to make the child successful in their communication attempts.

Now that you have changed your perspective and want to use AAC more in you classroom, home or community, here are some easy ways to incorporate AAC use in your everyday life!

If a young person has no mode of communication, we often look to Picture Exchange Communication System (PECS) as a first mode to trial.  We do this because PECS teaches the power of communication and the very important word: initiation! PECS teaches a child to communicate with a partner and that they have to initiate communication.  It also teaches that communication will not always be prompted.

If you are an educator or working in a school and looking for more ideas to incorporate AAC use in your school day this list is for you!  It is common for students who are non-verbal to engage in problem behavior due to lack of expressive communication. Research shows that as opportunities to respond increase, problem behaviors decrease.  Teachers need to allow students to actively participate in all areas to decrease behavior and increase independence.

Start with communicating basic wants and needs.  We start here because it is immediately rewarding and reinforcing for the young person.  We want to immediately replace non-preferred behaviors with appropriate communication. For example, if a student is having a tantrum over not getting a turn with a toy, we teach them to request “my turn” so they can appropriately use communication rather than unwanted behaviors.  Some basic wants and needs you might request are

o   bathroom

o   help

o   open, open juice, open crackers, open door, etc.…

o   more

o   a break

o   all done

o   specific items – toys, books, songs

o   food choices (specific foods, utensils, help, more, all done, etc.…)

o   people (Mommy, Daddy, siblings, teachers, peers)

o   school supplies (scissors, lunch box, snack, glue, color of paint/markers, etc.…)

o   help zipping coats

o   feelings

o   yes/no

Morning Circle – This is a great time to incorporate a lot of language into your everyday routine.  Do what works for your classroom routine and flow. You may use a classroom communication book, calendar communication book, greeting board, individual PECS books, or SGD.  You may only target one concept at a time until mastery. Modify to the needs of the student by having them match, select a response for a field of 1-2 choices.

o   start with greeting teachers and peers.  You can even make it into a fun song (Hello [name]. Hello [name]. Hello [name]. We’re glad you came today! Woo!)

o   calendar – month, day of the week, year, date

o   counting when finding the date on the calendar

o   talking about the weather – Include weather helpers is promote peer to peer communication (i.e. “[Peer], is it cloudy?” yes or no. “Is it sunny?” yes or no.  “The weather is ____.”)

Social Commenting – Social commenting is a critical element that must not be forgotten.  It is more difficult to work on due to the less reinforcement received for social comments, but still a vital aspect of language and communication.  Here are some ideas to target and increase social commenting:

requesting a turn – “my turn”

giving a turn – “here you go!”

manners – thank you, please, no thank you, you’re welcome

greetings/farewells

express likes/dislikes

recess time

making a play choice (i.e. blocks and trucks, puzzles, specific toys, etc.…)

choosing a peer to play with

choosing play equipment

choosing how to move on play equipment (i.e. swing fast/slow/side-to-side/spin)

Group Activities

o   Shape Monster – a popular circle time activity in which students use AAC to tell the puppet monster what shape to eat.  Fun and easy way to incorporate themed language and AAC use into whole group activities!

o   song circle – students take turns requesting song to listen and dance to!

o   checking behavior – students take turns identifying what color their behavior card was on that day.

  • Accommodated Books

o   Icon pages to match the vocabulary of a specific book that you can pull out to make sentences (i.e. “I see ____.”  “It’s a _____.”), answer questions (i.e. Who ate the cookie? “mouse”), or comment (i.e. “I like _____!”).

o   involves a child using AAC in “reading” a book

o   maintains attention and gives all children a way to participate actively in reading

  • Communication in Courses – Try to use vocabulary already programmed into SGDs by using daily vocabulary to label or answer questions.  Consider not adding vocabulary to a device if it is not functional to the individual’s everyday life, however, if not exposed they may not know the language exists.  Students can label vocabulary, request supplies needed, or answer WH questions related to course content.

o   social studies – transportation, community signs, maps

o   science – adjectives

o   math – counting, shapes, more/less

o   writing – typing name, common phrases, sight words

o   reading – read aloud, sounds

o   specials – art, music, gym

Prompting AAC whether it is a picture based system or SGD can be accomplished in many ways.  Remember to start with least invasive to most invasive prompts. A direct prompt, such as hand-over-hand assistance, is the most invasive and the hardest prompt to fade.  Indirect prompts, such as gestural or proximity cues, are less invasive and easier to fade. Do not forget the power of wait time which allows for the young person to have processing time.  Another great way to prompt fluent navigation is to use visuals of the navigation pathways or for category folders.

When confronting behavior and resistance, remember these tips:

·         Have the child start over and try the exchange again (i.e. “You’re not ready”).  They will not like having to do the work all over again and may comply with expectations.

·         Have a peer model the correct response

·         use high 5’s, tickles, squeezes, etc…

·         “skip” the child

Tracking a student’s AAC use is critical to avoid non-progress, plateaus in progress, and helps guide decision making in “what’s next” to learn or target.  When tracking AAC use it is important to track the functions of language that AAC is being used for such as requests, protests, greetings, etc.…). Also track the context and communication partners AAC is being used with so that you can evaluate if a student is generalizing the use of their device with multiple people in multiple environments and not only using it with their SLP.  It is also important to track the level of prompting required and the validity of communication with correspondence checks.

In summation, we challenge you to think about the following questions:

·         In what situations do you want to use AAC more?

·         Why do you think you do not currently use AAC?

·         What are barriers in your use to AAC?

·         What changes can you make today to start using AAC more with your young person?

If you want more information, please contact us at AutismImmersedSLP@ccde.org.  Follow us on Facebook and Instagram @AutismImmersedSLP for more information!

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PLAY PICS: Building play skills

With an emphasis on the benefits of inclusion and social immersion, parents and educators of students with autism are seeking effective ways for their children to continue skill acquisition and enhancement, while also exposing their children to typically developing peers.  But what does one do if a child who has access to an immersion environment doesn’t know how to play?

For most children, play is a naturally occurring phenomena that promotes their engagement and learning, independent performance, and social inclusion.  Children who are unable to participate in play experiences are at risk for future deficits and have greater difficulty adjusting to preschool environments where individual instruction is limited.  For children with autism, absent or restricted play skills might prevent opportunities for learning and successful participation in inclusive, general education classrooms.  Play Pics is a teaching tool to help students with autism spectrum disorder learn various basic play actions, expand their play repertoire, learn to self-monitor and recall play skills practiced, to improve initiation, play choice selection, and play variability.

Play Pics uses a research based strategy  formulated from Dr. Rebecca Morrison et al’s study, “Increasing Play Skills of Child With Autism Using Activity Schedules and Correspondence Training.”  (For full citation, see our PUBLICATIONS tab.) In this study, it was found that children with autism spectrum disorders benefit greatly from using picture schedules and visuals to promote independent performance and positive behavior changes when playing with toys.  Play Pics will help children develop play skills, make play choices, access more play areas in a classroom setting, increase their independent performance during playtime, and promote peer engagement. Play Pics also incorporates a self-monitoring card which promotes communication and language skills connected to play.

Play Pics are currently available for 5 common preschool toys: baby doll, ball, blocks, bus, and rocket. This dynamic and engaging strategy has been field tested, both in immersion preschool classrooms and at home. Our teachers and therapists find Play Pics to be a valuable tool to teach play skills. Our parents are experiencing success as well. Check out what a few parents have said about Play Pics:

“My son loves Play Pics [with a Ball]!  He has even started using the skills with his cousins and kids in our community!”

“I am so grateful for Play Pics [with a Bus]! Thank you guys for giving that to me to use with my son.  I have seen it help in many areas. He cleans up better now and follows directions more.”