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Prompting students with autism, in and out of the classroom

Autism Immersed Podcast, Season 2, episode 2

On the 2nd episode of our 2nd season, Laura Davis enlightens us on the use of Speech & Language therapies in Socially Immersed classrooms, the importance of soft skills on day to day life, and how AAC devices and PECs should be treated as the student’s actual voice.

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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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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!