A Developmental Framework for EBP for ASD Part 2

Emily Rubin Author

09/05/2016 Added

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Description

As a result of this activity, participants will be able identify critical priorities for educational outcomes for students with autism who are: 1. Before words and using gestures and facial expressions to communicate. 2. Using emerging language skills either via speech, pictures or other symbolic forms of communication. 3. Using conversational language to engage with a range of social partners.

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[00:00:02.548]So now I'm going to change the conversation a little bit
[00:00:05.160]and we're gonna talk specifically about how can we foster
[00:00:07.880]this social-emotional growth.
[00:00:09.771]This is one of my absolute favorite slides
[00:00:12.200]because what it does is simplify our role as educators,
[00:00:15.341]speech and language pathologists, therapist,
[00:00:17.547]behavior specialist.
[00:00:18.754]We need to make sure that we have our eye on the prize.
[00:00:21.972]If we're working with a child who is before words,
[00:00:24.553]what is gonna help that child shift
[00:00:26.353]into the next developmental stage, which is language,
[00:00:29.702]which we've got to all admit is one
[00:00:31.444]of the best predictors of positive outcome
[00:00:33.892]in the longer term.
[00:00:34.892]What gets a child from before words to language?
[00:00:37.490]I'll tell you the simple thing it is,
[00:00:39.191]they gotta like people.
[00:00:40.593]And liking people equals initiating spontaneous bids
[00:00:44.727]of non-verbal communication.
[00:00:46.622]The best predictor of language acquisition
[00:00:48.721]is a high rate of spontaneous, non-verbal communication.
[00:00:52.204]We need to be working on that in order
[00:00:53.753]to get our children at the emerging language stage.
[00:00:56.433]It's kind of an interesting concept,
[00:00:57.911]because we work with some large school districts now
[00:01:00.484]and I do have the chance to look sometimes
[00:01:02.252]at all of their IEPs and I look at, say,
[00:01:05.043]hundreds of children that are before words,
[00:01:07.302]and I scroll down the list of goals and objectives
[00:01:09.722]that we're working on, and a lot of them had to do
[00:01:12.071]with matching objects, sitting nicely at circle time,
[00:01:15.022]following directions, making a transition without duress.
[00:01:18.604]Not that these aren't good goals,
[00:01:20.153]but they're not the most utmost priority.
[00:01:22.612]That child needs to be working on initiating bids
[00:01:25.822]for communication with his teacher and with therapists
[00:01:29.084]and others around them.
[00:01:30.449]The more he's communicating, the more likely
[00:01:32.377]he will begin to use language, either in the form of speech,
[00:01:35.317]pictures, or sign language or other forms
[00:01:37.399]of assistive technology.
[00:01:39.048]We need to get our children communicating,
[00:01:41.050]and so that's keeping our eye on that prize.
[00:01:44.050]Next, as you see the emerging language stage child.
[00:01:46.408]How did we get him there?
[00:01:47.319]We convinced him that people were cool,
[00:01:49.370]and now that we did that, how do we get him
[00:01:52.008]to the conversational level stage?
[00:01:53.423]How do children become conversational,
[00:01:55.370]talking about the past, present, and the future?
[00:01:57.586]If they've got language skills, the way they do it is
[00:02:00.255]to use people's names and verbs, because prior to that,
[00:02:03.522]if they're just developing more vocabulary,
[00:02:05.613]and I have seen plenty of kids with autism
[00:02:07.251]who can say iPad, car, truck, ball, popcorn,
[00:02:10.621]but they don't know mom, teacher, Emily, Jason.
[00:02:15.093]They're not able to use people's names and verbs
[00:02:17.552]and we're not really targeting it.
[00:02:19.373]Again, I look at the IEP goals of hundreds of children,
[00:02:22.371]and what are we having them do but define the difference
[00:02:25.171]between hot and cold or point to red versus blue.
[00:02:28.421]They gotta learn their teachers' names
[00:02:30.272]and they've gotta learn, potentially, their peers' names
[00:02:32.440]and parents' names and other people's names paired
[00:02:34.792]with verbs to make requests, to make comments,
[00:02:37.260]to share routines, and so forth.
[00:02:39.039]Subject verb predicts conversational language.
[00:02:41.992]Next, we have the conversational stage.
[00:02:44.621]Children at this stage, very interestingly,
[00:02:46.451]have bought into the idea of people.
[00:02:48.371]Usually their social motivation has grown
[00:02:50.640]along this path, so they do like people
[00:02:52.980]and they have creative language
[00:02:54.720]and they desperately want connections.
[00:02:57.170]But they have developed different neurological processing
[00:02:59.491]around people, and then what happens is they fail a lot.
[00:03:03.086]They don't understand social conventions.
[00:03:05.119]They are coming off as off-putting to their peers
[00:03:08.051]and to their teachers, and while they really desperately
[00:03:10.611]want those connections, they fail and fail and fail.
[00:03:13.341]What was the best predictor of a child
[00:03:14.990]at the conversational stage in terms of their success
[00:03:17.839]into young adulthood?
[00:03:19.191]It's mental health and self-esteem.
[00:03:21.811]We need to make sure they're successfully connecting
[00:03:24.039]with their peers and that they're learning
[00:03:25.771]those social conventions in very positive ways
[00:03:28.371]and we're giving them the support they need
[00:03:29.822]to be that successful.
[00:03:33.072]First let me talk about the before words child.
[00:03:35.861]At this stage children with autism are not yet convinced
[00:03:39.661]that people are amazing.
[00:03:41.360]We need to convince them people are just as cool
[00:03:43.872]as the sensory experiences that they're having
[00:03:46.051]and the objects that they're exploring
[00:03:48.112]in the physical world around them.
[00:03:52.371]What does the neuroscience tell us?
[00:03:55.131]What does research tell us about children
[00:03:56.971]who are not yet talking?
[00:03:58.799]And this is a really important place to start
[00:04:00.910]when we're thinking about what's evidence-based.
[00:04:03.141]We have learned that children before language,
[00:04:05.821]social stimuli may not be that intrinsically rewarding.
[00:04:08.930]They're looking toward us sometimes,
[00:04:10.691]but they're not getting the jazz in their brain.
[00:04:12.821]They may not get the same opioid and the dopamine
[00:04:14.959]and the oxytocin.
[00:04:16.448]So as a result their gestures toward us,
[00:04:18.541]their facial expressions, they're just delayed.
[00:04:20.731]They just don't often connect with us.
[00:04:22.651]And since a high rate of spontaneous communication
[00:04:25.280]is truly predictive of language acquisition,
[00:04:27.792]we really should be thinking
[00:04:29.320]about those evidence-based practices that are focused
[00:04:32.040]on getting that child to bid more for social engagement,
[00:04:35.130]approaching us through proximity,
[00:04:37.191]taking our hand and pulling us places.
[00:04:39.159]That's a great start.
[00:04:40.472]Pointing, gesturing, facial expressions,
[00:04:43.101]working on increasing that
[00:04:44.705]as spontaneous, non-verbal communication.
[00:04:46.858]It's those skills that are gonna predict
[00:04:48.576]whether the child is gonna progress.
[00:04:51.723]So let me share with you a possible sample
[00:04:54.479]for an IEP objective, 'cause that we want to get out here.
[00:04:57.760]And if you would love to write this down,
[00:04:59.409]and I'm speaking too fast, please know that you can download
[00:05:02.419]the handout and you can see an example written here.
[00:05:06.019]What I've tried to do is align this to the speaking
[00:05:08.539]and listening standards of our Common Core
[00:05:10.709]as well as many of our state standards as well.
[00:05:13.819]What would be a measurable goal for a before words child?
[00:05:17.320]First, let's embed some support.
[00:05:19.178]We've gotta entice, we've gotta give them choices
[00:05:21.619]of highly-engaging, not as soothing hands-on materials.
[00:05:25.086]This is what we would call naturalistic intervention.
[00:05:27.640]It's also very similar to the work
[00:05:29.611]of the pivotal response treatment.
[00:05:31.651]And we're giving them a time delay which is evidence-based
[00:05:34.389]to work on that initiation.
[00:05:36.520]And what do we do?
[00:05:37.651]We're gonna say, when provided with choices
[00:05:39.371]of highly-engaging and soothing, hands-on materials,
[00:05:42.345]the student will initiate non-verbally,
[00:05:44.659]either using a shared facial expression,
[00:05:46.779]a giving gesture, a point gesture,
[00:05:48.917]and X number of times per activity
[00:05:51.457]across X number of activities per school day.
[00:05:54.157]This is where we get our baseline data.
[00:05:55.568]We find out how often they're doing it now
[00:05:57.528]and we up the ante.
[00:05:59.814]The research is telling us that we want
[00:06:01.427]to get children communicating at least two times a minute
[00:06:04.416]in really highly-motivating situations.
[00:06:06.536]And for some of our children that's a long way off,
[00:06:08.557]they're not quite so sold on people.
[00:06:10.747]So we really need to work toward that
[00:06:12.248]in our IEP objectives.
[00:06:13.997]And then as you can see, I added at the very end
[00:06:16.307]of that goal, in order to actively participate
[00:06:18.896]in communication exchanges with diverse partners,
[00:06:21.368]which is really the language of the Common Core
[00:06:23.248]essential element related to speaking and listening.
[00:06:26.665]The criteria for mastery would be data that you're taking
[00:06:29.528]about the number of non-verbal initiations,
[00:06:31.656]however way that child is doing it,
[00:06:33.272]through facial expressions and gestures,
[00:06:35.197]and how many activities over a course
[00:06:37.096]of a certain number of weeks.
[00:06:41.258]So really what we're talking about
[00:06:42.496]with our before words kids is shifting some priorities
[00:06:45.368]from outcomes related to things
[00:06:47.557]toward outcomes related to people.
[00:06:49.855]As you see here in the first example,
[00:06:51.808]I coached this particular teacher and this young boy.
[00:06:54.776]She was doing a lot of matching skills with him,
[00:06:57.934]and spending a lot of her one-on-one time teaching him
[00:07:00.645]about matching the objects to objects,
[00:07:02.503]objects to pictures, and I can tell you,
[00:07:04.765]he was finding it to be very uninteresting
[00:07:07.222]and struggled, and what was most concerning
[00:07:10.039]was not his concept knowledge about matching,
[00:07:13.029]but his feeling about his teacher.
[00:07:14.948]Because they had a good relationship,
[00:07:16.598]and I wanted that relationship to get even better.
[00:07:18.909]I wanted him to initiate more, to communicate more,
[00:07:21.890]and to connect, because that is the fuel
[00:07:23.539]for language acquisition.
[00:07:25.109]And so the shift was, let's do a little bit more
[00:07:27.199]of the social routines, and initiating request
[00:07:30.581]for songs, request for actions and so forth.
[00:07:33.461]And we can still work on matching,
[00:07:35.130]but let's make it really intrinsically rewarding.
[00:07:37.511]Let's make it hands-on and playful
[00:07:39.362]so that the person becomes a source
[00:07:41.181]of pleasure and engagement.
[00:07:45.234]Another priority shift is to really think
[00:07:47.202]about high rates of spontaneous communication
[00:07:49.761]using environmental arrangements, visual supports,
[00:07:52.167]and even technology-assisted instruction.
[00:07:54.439]We can put the child in the driver seat
[00:07:56.349]who's before words, and I mean that.
[00:07:58.366]As we often rely a lot on hand-over-hand prompting
[00:08:00.949]to help children engage, but there are many
[00:08:03.737]evidence-based strategies such as these
[00:08:05.767]that you've seen here that will help children initiate.
[00:08:08.938]Just environmental engineering here,
[00:08:11.189]what you have in the first image,
[00:08:12.949]there's two choices of snack items
[00:08:14.439]in see-through containers.
[00:08:15.949]If the child is at all interested,
[00:08:17.647]his eyes are gonna do the talking for us.
[00:08:19.549]He looks at the snack container and we might reach over
[00:08:21.578]and pick it up and hand it to him.
[00:08:23.578]Pretty soon he's gonna learn that our hand is really useful
[00:08:26.487]and start sliding it over to our hand,
[00:08:28.247]handing it to us, giving it to us, picking up.
[00:08:31.207]And then you see on the right-hand side a child
[00:08:32.989]who would open any see-through container on the planet.
[00:08:35.178]We might need to do a vacuum seal,
[00:08:37.086]use some technology-assisted instructed
[00:08:39.007]to help this child make a giving request to communicate.
[00:08:43.154]See-through containers are some of our best friends
[00:08:45.298]at this particular stage 'cause it allows the child's eyes
[00:08:47.759]to do the talking.
[00:08:48.778]We can see what they'd like,
[00:08:49.909]it's a temptation for them to communicate,
[00:08:52.246]and then we can see them initiating with us.
[00:08:54.954]The goal of these interventions is to really help
[00:08:58.458]that child fall in love with the social world,
[00:09:00.447]connect, and have a way to initiate with us.
[00:09:05.361]Now, at the emerging language stage,
[00:09:07.858]what do we do at this stage?
[00:09:09.199]How we got children there is they liked people.
[00:09:12.327]They saw us as useful.
[00:09:13.917]The children who saw us initially as vending machines
[00:09:16.319]'cause we're really good at offering them certain candies
[00:09:18.909]or treats or cookies or whatever they might
[00:09:20.578]be interested there or were, we are the iPad charging
[00:09:23.399]device that will go and retrieve the iPad and so forth,
[00:09:26.696]but really our goal at this stage is to become people
[00:09:29.046]who do lots of actions and lots of things for our children,
[00:09:31.978]and so they truly form those stronger relationships.
[00:09:34.589]That's children at the emerging language stage.
[00:09:38.612]What is the neuroscience teaching us about this stage?
[00:09:41.887]Neuroscience teaches us that children who are beginning
[00:09:44.117]to talk or using symbols to communicate
[00:09:46.817]are showing interest in people, but they still,
[00:09:49.229]with our eye-tracking research, they're just not looking
[00:09:51.378]at us and shifting gaze between people
[00:09:53.047]and objects nearly as much.
[00:09:55.126]And their eyes tend to be more focused
[00:09:56.747]on the non-social stimuli and the world around them.
[00:09:59.709]So what happens is their vocabulary
[00:10:01.559]becomes really biased toward nouns.
[00:10:04.527]I'm sure as you're listening to this,
[00:10:06.199]I see some nodding out there, that you're thinking,
[00:10:08.599]"My goodness, they know a lot of nouns."
[00:10:10.247]I knew some children that knew more nouns than I did,
[00:10:12.439]all the different types of fish in the ocean,
[00:10:14.287]all the different types of cars and trucks and vehicles.
[00:10:17.327]They're very good at focusing on that non-social stimuli.
[00:10:21.314]We need to make sure that our goals and objectives
[00:10:23.279]do not just enhance that skill and take something
[00:10:26.418]they're already on a path of becoming experts at,
[00:10:29.007]but instead balancing them a little bit,
[00:10:31.479]going after people's names and verbs,
[00:10:34.469]subject-verb word combinations,
[00:10:36.858]those are predictive of creative language acquisition
[00:10:40.152]and really should be a critical priority.
[00:10:42.149]So let's get our evidence-based strategies out there
[00:10:44.319]and figure out which of these are gonna help us
[00:10:46.459]develop this child's use of his teachers' names
[00:10:48.719]and verbs to talk about not only requesting
[00:10:51.189]but commenting, sharing, requesting comfort, and so forth.
[00:10:55.730]I referenced the ASHA practice portal,
[00:10:57.759]for those of you who are speech and language pathologists
[00:10:59.829]because ASHA practice portal does have a list of goals
[00:11:03.090]and objectives that are considered
[00:11:04.319]to be really research based for children
[00:11:06.479]along the autism spectrum in terms
[00:11:08.541]of key strategies and targets.
[00:11:13.053]Next I wanted to share with you just an example.
[00:11:16.461]This is an example of a subject-verb-noun word combination
[00:11:20.713]using picture communication symbols.
[00:11:22.977]And using color coding could be so helpful
[00:11:25.359]because our children are very good at matching.
[00:11:27.697]Their cognitive studies have shown that.
[00:11:30.268]And this will remind them that we're not just saying
[00:11:32.871]I want the yogurt, but instead I want Emily
[00:11:35.558]to open the yogurt.
[00:11:36.958]We may just leave the first two words on there for them
[00:11:39.417]as they put that object on there, but we're modeling
[00:11:41.897]and giving them that aided language stimulation
[00:11:44.016]for them to understand who I am
[00:11:45.947]and what action I'm providing for them.
[00:11:48.449]This is a powerful learning tool for children
[00:11:50.417]who need to connect with people more
[00:11:51.897]to develop that creative language.
[00:11:55.907]So similar to the before words example I wanted
[00:11:57.987]to give you a sample IEP objective
[00:12:00.489]to focus on what matters most.
[00:12:03.217]What is a goal that's going to be very research-based
[00:12:05.506]and it's gonna give you a lot of bang for your buck?
[00:12:07.918]And that at the emerging language stage.
[00:12:10.118]This one's also aligned to the speaking
[00:12:11.878]and listening standards of the Common Core,
[00:12:14.398]and the measurable annual goal might be,
[00:12:16.969]when provided with visuals or color-coded templates
[00:12:20.087]and highly-engaging materials, it's gotta be rewarding
[00:12:22.897]for our children, students will initiate greater
[00:12:25.547]than X number of people's names paired with verbs
[00:12:28.569]per activity, and at least X number of activities
[00:12:31.436]per school day in order to actively participate
[00:12:33.666]in communicative exchanges with diverse partners.
[00:12:36.918]Again, the number X represents what you would need
[00:12:39.736]to gather in baseline data.
[00:12:41.558]Where is that child at and is the child even ready
[00:12:44.049]to use these types of symbolic language forms?
[00:12:46.609]But how frequently would we target it?
[00:12:48.601]Would it be one time activity, two time, three time?
[00:12:52.163]If we compare it to more neurotypical children
[00:12:54.051]who are entering the emerging language stage,
[00:12:55.891]the sky's the limit.
[00:12:57.091]They're calling out people's names and verbs all the time.
[00:12:59.862]It is the basis for creative language.
[00:13:02.611]Next we need to look at the criteria for mastery,
[00:13:04.782]so it would be the number of targeted word combinations
[00:13:06.862]and the number of activities across a certain amount
[00:13:09.033]of time before we moved on
[00:13:10.342]to the next set of goals for that.
[00:13:13.636]When we apply that I think the rewards are quite remarkable.
[00:13:17.360]I recently saw this little boy in a video
[00:13:20.041]with his speech and language therapist
[00:13:21.673]in a preschool classroom.
[00:13:23.361]They were actually playing with the iPad.
[00:13:25.889]And when you pull out an iPad with an app on it,
[00:13:28.273]oftentimes the child's attention will focus,
[00:13:30.193]just go so hardcore right onto that iPad.
[00:13:33.430]And we lose them, right?
[00:13:34.750]We lose the child to that device.
[00:13:38.381]But this particular therapist, her name was Shelly,
[00:13:41.371]did such a fabulous job of picking an app
[00:13:44.051]that was silly and funny.
[00:13:45.371]It had real-life animals, it had monkeys and,
[00:13:50.201]sorry, turtles and so forth.
[00:13:52.310]And she would say, "Miss Shelly, turn on the turtle,"
[00:13:57.182]or, "Dominic, turn on the turtle."
[00:13:59.710]And they would take turns back and forth with this activity.
[00:14:04.341]And because it was a choice that this little boy liked
[00:14:07.561]to make was Miss Shelly, he was really learning her name
[00:14:10.721]and that whenever she turned it on,
[00:14:12.190]that silly stuff would happen on the iPad.
[00:14:14.449]And you start to see this, he's not looking at the iPad,
[00:14:17.102]he's looking at her.
[00:14:18.121]She's just as funny and just as silly
[00:14:20.241]as what he's seeing on the screen.
[00:14:22.091]And it was like using it as a remote control
[00:14:24.679]for social interaction.
[00:14:26.171]Just beautiful to see a child learning his teacher's name
[00:14:29.229]or his therapist's name and really connecting.
[00:14:34.940]Our goal is, then,
[00:14:36.490]our goal is to help our children develop that competence
[00:14:39.851]along the social-emotional-neuro-developmental path
[00:14:43.710]to get to the point where we would call them conversational.
[00:14:46.841]A child has gotten to this particular level
[00:14:49.942]because they went through the arduous task of falling
[00:14:53.182]in love with the social world despite possibly
[00:14:55.670]having genetic differences which didn't give them
[00:14:58.140]the advantage of that social-emotional juice
[00:15:00.601]of cocktails of the oxytocin-mix cocktail.
[00:15:03.251]Children with autism can certainly do that.
[00:15:05.091]We have all seen it,
[00:15:06.091]we've seen children with autism connect with people.
[00:15:09.521]All of them go at a difference pace, obviously,
[00:15:11.643]and they all have different developmental trajectories.
[00:15:14.435]But the possibility of them connecting with people is there.
[00:15:18.243]We've gotta work hard at building that relationship
[00:15:20.203]and that connection.
[00:15:21.722]Then we see some of the develop beyond
[00:15:23.355]into the emerging language stage
[00:15:25.174]to develop people's names and verbs and creative language
[00:15:28.091]and move into what we call the conversational stage,
[00:15:30.972]where now they can talk about the past,
[00:15:32.663]the present, and the future.
[00:15:34.275]And at this time I have seen all too often children
[00:15:36.848]who have truly fallen in love with the social world
[00:15:39.443]and want to have the friendships and peers,
[00:15:41.881]but they, time and time again, they fail.
[00:15:45.083]They're going up to peers and asking them to play
[00:15:47.774]and the peers are rejecting them.
[00:15:49.334]Because they don't understand
[00:15:50.435]what other people are thinking,
[00:15:52.322]they often don't use appropriate body proximity.
[00:15:55.195]They don't use appropriate tone of voice
[00:15:57.122]or talk about the right topics and so forth.
[00:15:59.875]And so they struggle in their self-esteem.
[00:16:02.185]Some of our kids get very angry when they are not successful
[00:16:05.355]and they are frustrated.
[00:16:06.963]What do we need to be thinking about at this stage?
[00:16:10.323]Neuroscience teaches us that children
[00:16:11.995]at the conversational language may have developed
[00:16:14.734]some social motivation now, but the neuroscience
[00:16:17.366]is showing us they have difficulty predicting intentions
[00:16:20.014]and social expectations.
[00:16:21.865]Functional MRI studies that we conducted years ago
[00:16:24.571]at the Yale Child Studies Center
[00:16:25.854]and have thus been replicated at many different institutions
[00:16:28.104]have shown us that children who are conversational level
[00:16:31.006]with autism often process social information
[00:16:33.766]in very different regions of the brain,
[00:16:35.694]regions of the brain that require you to intellectualize,
[00:16:39.195]what is this person thinking?
[00:16:40.694]What is this person feeling?
[00:16:42.115]It's not intuitive.
[00:16:43.401]And because it's not intuitive, they're often having
[00:16:45.883]to work really hard to figure out,
[00:16:47.603]did I just upset that kid?
[00:16:49.281]Is he being sarcastic, is it real?
[00:16:51.580]And they struggle and they fail so often.
[00:16:54.043]And so that's something that's happening quite significantly
[00:16:57.421]at this particular stage.
[00:16:59.568]What should our priorities be then?
[00:17:01.746]What should we be focusing on?
[00:17:03.061]Should we be focusing on simply telling them
[00:17:04.951]to not interrupt us, or telling them to talk quieter?
[00:17:08.290]Our priority first and foremost should be
[00:17:10.032]on their self-esteem.
[00:17:11.621]They need to feel good about themselves
[00:17:13.279]because if it takes that much work to figure out
[00:17:15.198]what we're thinking and feeling,
[00:17:16.301]they need loads of social motivation.
[00:17:18.520]And what we've seen all too often in the field
[00:17:20.781]is children who reach the conversational level stage
[00:17:23.832]and when they get there, they burn out.
[00:17:26.331]They get so frustrated with not being successful
[00:17:28.731]and they start to retreat.
[00:17:31.240]Children at the conversational stage are
[00:17:33.073]at much higher risks for co-morbid conditions
[00:17:35.499]such as mental health issues, anxiety, and depression.
[00:17:38.819]So if we don't have IEP goals about them feeling good
[00:17:41.568]about themselves, having effective and successful
[00:17:44.029]communication interactions, I believe we're failing them
[00:17:47.235]because we truly need to make sure that they're successful,
[00:17:50.388]and that if they don't feel it, they're gonna fall apart.
[00:17:52.806]And we need to help them there.
[00:17:54.520]And so we need to teach self-efficacy and in doing so,
[00:17:57.338]therefore, we need to teach them some social norms.
[00:17:59.789]But we never wanna do one without the other.
[00:18:01.640]We wanna make sure that we're not scolding them,
[00:18:03.400]for example, for using an inappropriate vocal volume.
[00:18:06.179]We wanna teach them things that involves some evidence-based
[00:18:08.960]practices, things called cognitive-based interventions
[00:18:11.807]such as the social thinking curriculum with Michelle Winner,
[00:18:14.976]Carol Gray's Comic Strip Conversations
[00:18:17.392]for social narratives and so forth.
[00:18:19.280]Some of these approaches have been very helpful
[00:18:21.211]to help children understand
[00:18:22.270]what another person's thinking and feeling
[00:18:24.312]and changing their behavior as a result.
[00:18:27.936]So let me give you an example of an IEP goal here.
[00:18:31.611]One of the goals we might consider for a child
[00:18:33.491]at the conversational stage, and this one's purely
[00:18:35.611]just an example, is that when provided with visuals,
[00:18:39.136]because that's gonna ease their mind of having
[00:18:41.051]to figure out what they're thinking and feeling
[00:18:42.541]all the time, and motivating materials,
[00:18:45.312]because they may not have as much motivation,
[00:18:47.932]the student will initiate conventional communication
[00:18:50.635]using effective vocal volume with peers and adults
[00:18:53.504]on this many occasions per activity on this many activities
[00:18:57.451]per school day in order to build on comments
[00:18:59.850]and topics initiated by adults and peers,
[00:19:02.668]which is an essential element for language skills
[00:19:04.659]in the Common Core.
[00:19:06.776]The criteria for mastery, of course,
[00:19:08.429]would be the number of initiations using conventional
[00:19:10.501]vocal volume in at least this many activities, of course,
[00:19:14.051]over six consecutive weeks or something along that nature.
[00:19:17.816]Again, these are just samples.
[00:19:19.901]And the idea of this is to give them the support they need
[00:19:23.061]to derive the social cues in the environment proactively
[00:19:26.149]to make sure they can understand how they're supposed
[00:19:28.581]to act, how they're supposed to wait for their turn
[00:19:31.501]in conversation and so forth.
[00:19:36.861]A couple of quick examples of this is this one here.
[00:19:40.651]And this is simplest of all simples, hand signals.
[00:19:44.958]But it really is about giving a visual support
[00:19:48.221]to help that child begin to think and process,
[00:19:51.552]how do I need to act in this situation?
[00:19:53.973]I tell you a quick story as I bring
[00:19:56.461]this visual support up.
[00:19:58.133]I once met a boy named James.
[00:19:59.928]He was a fourth-grader, and he was a very vibrant boy
[00:20:02.981]who was clearly quite intelligent,
[00:20:04.883]who had a special interest in helping the world
[00:20:07.920]develop more sustainable energy sources.
[00:20:10.341]And he was fervent about it.
[00:20:11.653]He would stand in the parking lot and he would argue
[00:20:14.802]with the parents as they came in about their Yukons
[00:20:17.100]and their GMCs, the big SUVs and explain
[00:20:19.601]that that's too much gas mileage for one family.
[00:20:22.618]But in the classroom he was relentless.
[00:20:24.800]He was constantly interrupting the teacher,
[00:20:27.120]and the teacher was very frustrated, understandably,
[00:20:29.910]and just simply kept saying, "That's first strike, James.
[00:20:33.111]"By the third strike you're going
[00:20:34.661]"to the principal's office."
[00:20:36.152]James spent many a time and a trip to the principal's office
[00:20:38.961]because of this challenge.
[00:20:41.763]I talked to her about why does she think
[00:20:43.880]he was interrupting her so much.
[00:20:45.813]And she said,
[00:20:46.813]"I think he's just trying to get my attention."
[00:20:49.021]And I said, "You know what?
[00:20:50.493]"Attention-seeking's gotten a bad reputation in autism."
[00:20:53.573]"For a child with autism to seek your attention,
[00:20:55.680]"that's pretty remarkable.
[00:20:56.784]"It means they've gone through this arduous task
[00:20:58.580]"of learning that people are worthwhile
[00:21:00.509]"and that people are interesting and that it's wonderful
[00:21:03.388]"that he's seeking your attention.
[00:21:04.969]"I think that, in and of itself, is not the key issue.
[00:21:07.654]"It's the timing of it and the form of it
[00:21:09.518]"that are bothering you right now.
[00:21:11.089]"It's not that he likes you
[00:21:12.137]"and he wants to connect with you."
[00:21:13.926]And she agreed with me on that.
[00:21:15.343]And I said, "So now, let's back it up.
[00:21:16.825]"Why is he seeking so much of your attention?
[00:21:19.065]"Why would a child need so much attention?"
[00:21:21.385]And she stopped and she realizes,
[00:21:23.261]"He doesn't have any friends.
[00:21:24.785]"He doesn't think he's smart, and yet I know he is.
[00:21:27.785]"And so we need to consider a new way of going about it."
[00:21:30.684]She was willing to give it a try.
[00:21:32.177]We put this chart up here,
[00:21:33.316]I can talk about it later, I can talk about it in a minute,
[00:21:35.974]this is a good time to talk.
[00:21:37.836]And came up with a very clear visual support to help James
[00:21:41.406]know this is not a great time.
[00:21:43.881]I can talk about it later, I can talk a minute,
[00:21:46.316]and so forth.
[00:21:47.149]She learned she had to give him actual appointment cards,
[00:21:49.316]they would schedule it a little bit,
[00:21:50.685]but it really helped smooth over that particular situation
[00:21:54.534]that was causing so much duress.
[00:21:57.782]Clearly providing visuals for social expectations
[00:22:00.494]is a clear evidence-based strategy
[00:22:03.077]for the use of visual supports.
[00:22:04.365]It's also tied in to some
[00:22:05.385]of the cognitive-based interventions
[00:22:07.175]that we can see out there in our field.
[00:22:10.825]Finally, another example, one that I've given you
[00:22:13.366]the access point there to Amy Laurent's website,
[00:22:16.115]one of my co-authors of the SCERTS Assessment Process.
[00:22:18.824]This is www.amy-laurent.com.
[00:22:22.065]You can download something called the vocal volume meter,
[00:22:24.935]and the vocal volume meter very clearly shows
[00:22:27.417]where the expected vocal volume is,
[00:22:29.715]and on the blue side where the actual vocal volume is.
[00:22:32.756]It's just literal, it's just scientific.
[00:22:35.617]There's no carried emotion with it,
[00:22:38.177]'cause I see all too often children are being scolded,
[00:22:40.817]and yet they just don't understand
[00:22:42.577]because they don't understand what other people
[00:22:43.917]are thinking intuitively, why it is that we are
[00:22:46.657]so sensitive to different vocal volumes.
[00:22:48.798]But teaching them explicitly, in this environment
[00:22:51.257]we need it at a two and I'm hearing a three,
[00:22:53.825]how do I bring our threes down to a two?
[00:22:56.117]A very simple tool that will allow us to achieve
[00:23:00.659]the goal that I've put out in front of you,
[00:23:02.359]appropriate vocal volume in different situations
[00:23:04.679]and so forth.
[00:23:08.998]So in conclusion, what I hope you took away from today's
[00:23:13.327]meeting is that
[00:23:16.035]we can't just pick evidence-based strategies
[00:23:18.297]because simply a child has autism.
[00:23:20.137]We need to do that developmental assessment to determine,
[00:23:22.905]is this child before words?
[00:23:24.457]Is this child emerging language
[00:23:25.795]or is this child conversational language?
[00:23:28.057]And if so, what are the highest priorities of goals,
[00:23:31.275]objectives, outcomes, that I need to be looking for
[00:23:33.897]so I can be a better consumer of the evidence-based
[00:23:36.257]practices that are available to me now?
[00:23:38.505]There's some great research out there
[00:23:39.817]and some great strategies that have been tried and proven,
[00:23:42.377]however we can't just apply them randomly.
[00:23:44.885]We have to be thinking, is this child actually in need
[00:23:47.865]of those particular skills and how much time
[00:23:49.945]am I spending on it given the most important skills
[00:23:52.353]of their developmental stage?
[00:23:54.494]Next week we're gonna talk about social-emotional
[00:23:57.005]engagement in classroom settings
[00:23:58.583]for students on the autism spectrum,
[00:24:00.485]and I'm gonna share with you a tool
[00:24:02.040]in which you can measure student engagement levels.
[00:24:04.824]And that's another wonderful tool to base our IEP
[00:24:07.605]objectives on because we can determine that if a child
[00:24:09.915]is actively engaging in the environment around them
[00:24:13.085]that they're probably connecting with people,
[00:24:14.784]using people's names and verbs, and also effectively
[00:24:17.493]communicating with their teachers and peers
[00:24:19.125]at the conversational stage as well.
[00:24:21.204]So thank you so much for tuning in today
[00:24:23.435]and I look forward to seeing you possibly next week
[00:24:25.184]for part two of this series.

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A Developmental Framework for EBP for ASD Part 2

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