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Posts Tagged ‘language’

How can visual supports help children and adolescents with autism spectrum disorder?

December 2, 2011 1 comment

In a recent blog post on helping nonverbal children communicate, we let you know that our Autism Treatment Network (ATN) would soon publish a pamphlet on visual supports. Yesterday, we were pleased to release Visual Supports and Autism Spectrum Disorders, available for free download on our website. For perspective on its usefulness, today’s “Got Questions?” comes from the pamphlet’s authors:

 Clinical Psychologist Whitney Loring, PsyD, and

 

 

Behavior Analyst Mary Hamilton Morton, MEd, BCBA.  

Both work within the ATN at the Vanderbilt Kennedy Center’s Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), in Nashville.

While working with hundreds of families of children with autism spectrum disorders (ASD), we have seen firsthand the benefits of visual supports. For some families, these tools bring immediate improvements in how their child and family function on a daily basis. Others find they need a few weeks working with these supports to see clear benefits emerge. Either way, they report significant improvements in their children’s communication and understanding, as well as increased compliance, adaptive behaviors and independence, along with decreases in challenging behaviors.

We are definitely believers in the power of visual supports!

Yet many of the families who come to us have yet to be introduced to these valuable tools. Some parents have heard that they should use visual supports. But they admit to not exactly understanding the term, where to begin, or why visual supports are important in helping their children communicate and understand others.

Often, we find ourselves explaining visual supports in the midst of answering the many other questions and concerns a family brings to us. As a result, parents may leave our clinic with “visual supports” being just one of many things they’re trying to remember and implement on their own.

Ironically, we came to realize that part of the problem was that we were attempting to explain visual supports quickly and verbally without having a visual way to communicate their importance!

Our answer is the newly released Visual Supports and Autism Spectrum Disorders, a step-by-step, easy-to-understand introduction to visual supports and the ways that parents and other caregivers can begin using them.

The pamphlet provides practical examples of how to begin integrating visual supports into a child’s daily routines. We’ve also included a variety of actual visual supports for parents to print, cut out and use, along with links to resources that provide more detailed information for those who want to go further.

So far, the response from families “test driving” this tool has been overwhelmingly positive, and the enthusiasm is not just from those new to visual supports. Some parents tell us, for example, that the guide helps them explain visual supports to other important adults in their child’s life—from grandparents to teachers and doctors.

We hope this pamphlet will help empower parents in both how they use visual supports and how they expand use among others who care for and work with their children. And we hope you find this tool useful in ways that make a positive difference for your child and your family. Of course, we continue to learn from you, as well. Please let us know more about how your family uses visual supports by leaving a comment on this blog and/or sending us an email at atn@autismspeaks.org.

Development of this tool is the product of on-going ATN activities. To learn more about the ATN or find a site in your area, please visit www.autismspeaks.org/atn. For more tools for parents, grandparents and clinicians or to find resources in your area, also visit our ATN Tool Kits page and Autism Speaks Family Services

Webchat on Promoting Language, Learning and Engagement in Toddlers and Preschoolers

December 1, 2011 3 comments

Thanks to all who joined us for today’s “Office Hour” webchat with our Chief Science Officer, clinical psychologist Geri Dawson, PhD. Here’s the full transcript.

Thursday December 1, 2011

12:30
Hello everyone. This is Dr. Geri Dawson. Thanks so much for joining me today. I am looking forward to reading your questions.
12:33
From Melanie
I am curious as to the research base on the consultative model and its impact in providing services with the very young child/toddlers with the diagnosis of ASD. Can this question be answered? Thanks
12:34
Hi, Melanie. Providing consultation to birth-to-three providers is a frequently used strategy for helping those providers learn to use ASD-specific intervention approaches. However, I am not aware of any empirical studies that compare a consultative model to direct intervention by specialists. The currently recommendation is for young children with ASD to receive direct one-on-one intervention with highly trained and well-supervised therapists for a significant part of their overall intervention program.
12:34
Comment From Julie

Hi Dr. Dawson. My son is 6 and he is echolalic and scripts a lot. any thoughts on how to best address both of these communication issues?

12:37
Hi Julie, Echolalia is a common way for kids with ASD to learn to speak. When your child echos back a word or phrase, treat it as a real communication regardless of whether it seems to make sense or not. Use part of the echoed speech but modify it to be more appropriate. For example, if he says, “You want cookie” when he wants something to eat, say “Cookie – you can say ‘I want cookie’ – and then give him what he wants. Continue to model appropriate speech incorporating parts of his echoed speech. The important thing is for him to feel successful in his attempts to communicate as this will keep his motivation high.
12:39
Comment From Troy S.

I do, but not sure how to ask it. It’s very general. We have a 2 yr old who hasn’t spoken a word. He was diagnosed at Kennedy Kreiger as being on the s[ectrum. And we are wondering if there are any realistic expectations of when we can expect him to speak his first words….?

12:41
Hi Troy, Many two year olds with autism have not yet developed speech. Is your child making any sounds at all? Vocalizing? If so, build on this sounds by imitating them, playing with sounds and songs, and always responding to his sounds as if they are meaningful communication, while modeling the correct word for hiim. Likely, he will start to use words eventually.
12:42
Comment From April Costello

@ Julie, there is a wonderful article which further reinforces Dr. Dawson’s recommendation. It is called Finding the Words, To Tell the “Whole” Story by Marge Blanc. It was a tremendous help to me in understanding my Son’s speech patters! :)

12:43
Hi April, There are many strategies that parents can use at home to promote language. You’ll want to use these throughout the day during your regular activities, such as mealtime, bathtime, at the park, and so on. Lynn Koegal has written a book called “Overcoming Autism” which describes many strategies that parents can use at home at promote speech. I think you will find that they are very helpful. Here is the link:
12:44
Comment From Shane Lynch

Based on Dawson and Osterling (1997) and the National Research Council (2001), family involvement has been cited as an element of best practice. However, unlike the other elements, family involvement is less quantifiable. Have you any thoughts on what “quantity” of involvement is related to improved outcomes? Thanks.

12:47
Hi Shane, Family involvement in early intervention is essential. Parents should be at the helm of any intervention program. Although it is difficult to “quantify” as you point out, the key points are that (1) parents should be involved in setting goals for their child that they find meaningful and important, (2) sensitivity to the individual family – their values, beliefs, culture, and so on is needed, (3) parents should be taught strategies for promoting skills at home using similar approaches that are being used at school and in therapy so that these skills can generalize to the larger community environment. The good news is that research is showing that parents can learn these strategies and are effective at using them to help their child.
12:49
Comment From Julie

Thanks. as far as scripting. He scripts a lot of TV/ movies and at inappropriate times, like during library time at school. Any ideas on how to manage it when it’s not approproate but also encourage him as he is learning new words through this avenue. many thanks!

12:52
Hi again Julie, The key thing here is to determine why and how he is using his echolalia. Does it signal that he is getting overwhelmed? Is he using it in a self-stimulatory fashion? Is he using it to communicate? Depending on the function, you will want to respond in different ways. For example, if he is using it in a self-stimulatory fashion in inappropriate places like library time, his teacher can teach him the idea of “quiet voice” – i.e. he should be reinforced for keeping quiet during the times when that is appropriate.
12:52
Comment From Matissa

Hi Dr. Dawson. I teach 2 & 3 year olds at a preschool and we have a few children within our program who are on the spectrum. What tips can you give us as we work with these children alongside neuro-typical children? Esp. as it pertains to class structure and discipline.

12:56
Hi Matissa, Children with autism tend to thrive in an environment that is structured, provides routine, and visual supports (such as pictures that explain the sequence of activities). The neurotypical children can be taught to help the children with autism by teaching the neurotypical children to approach and involve them in play. There are a number of well-established curricula and program features that have been used effectively for children with ASD. Here is a link that describes the features of a good preschool program:
12:56
Comment From Tami

Is sign language an appropriate tool? It seemed to help our neural typical child and I am wondering how commonly it is used with non-verbal children on the spectrum

12:59
Tami, I am not sure how old youg child is, but sign language can help a child with autism communicate. Sign language still can be challenging, however, because it involves complex motor movements and has its own syntax, and so on. So, often the signs used are simple ones. Spoken language, and perhaps other augmentative language devices, such as pictures, should always be used along with sign language.
1:02
Advance question From Breiana
My 2.5 year old son was diagnosed with autism 4 weeks ago. We were told to get him in ABA/VB. Is this the most effective method of ABA? What interventions do you recommend we do at home? We are also looking at preschools for when he turns 3. Do you typically recommend an inclusion preschool or an autism only preschool? Thanks
1:03
Applied behavior analysis (ABA) is a well-established effective intervention method for young children with autism. Within the broad category of ABA interventions, there are many different models, and Verbal Behavior (VB) is one of those approaches. There is no evidence that VB is more effective than other approaches that are based on ABA. The choice of classroom depends on many factors and the individual child. There is no one size fits all answer.Here is a good website that discusses how to evaluate a preschool program http://www.eric.ed.gov/PDFS/ED486480.pdf . Here are some features you should look for in a preschool program:
-The intervention program should be individualized to each child, taking into account each child’s unique characteristics, strengths, and challenges, and utilized well-validated intervention methods, such as ABA.
-The intervention program should be designed and overseen by a trained, professional, interdisciplinary team.
-A curriculum that focuses on the specific areas of challenges in ASD should be used.
-The program should provide for ongoing data collection on the progress the child is making in each skill area, with adjustments to the program made when progress is not evident.
-The child should be engaged in the intervention activities and receive at least 25 hours of structured intervention each week.
-Parents should be closely involved in the intervention, setting goals and priorities, and be taught how to implement the intervention strategies at home.
1:04
Hi Terry – A good article describing the important elements of an intervention program can be found at this link:
1:05
Comment From Tracy

Hello Dr. Dawson. Are there national standards in early interventions that you see most frequently used or cited?

1:06
Hi Tracy, Here is a document that describes national standards for early intervention:
1:07
National Autism Center. National Standards Project – Addressing the Need for Evidence-Based Practice Guidelines for Autism Spectrum Disorders, 2009.http://www.nationalautismcenter.org/pdf/NAC%20Standards%20Report.pdf
1:08
Comment From Guest

My daughter is struggling to learn how to handle and care for her 6yr old autistic child. We have been looking for resources but keep coming up empty. Any advise?

1:09
Hello Guest at 12:46, Please check out the Resource Guide From Autism Speaks’ Family Services:
1:09
Resources Guide from Family Services:
http://www.autismspeaks.org/family-services/resource-guide
1:10
Comment From Tami

My grandson is 6 and it seems as though his behavior changes weekly if not daily. When he does something wrong timeout did work, taking toys away did work, now it seems as though NOTHING works. Should an autistic child be punished? and if so what is the best form of punishment to use?

1:14
still typing …
1:14
Hi Tami, Children with autism often have behavioral challenges, such as tantrums and sometimes aggressive behavior. Often these behaviors are used to communicate a need or want. Given that children with autism have trouble with communicating with words, they use these behaviors instead. So, the first step is figuring out why the behavior is occuring and what your grandson is trying to communicate. Sometimes, the behavior occurs because the child is overwhelmed or frustrated. So reducing overwhelming situations and frustrations will help. But, ultimately, you will want to teach your grandson to communicate his needs in a more appropriate way. For example, if he tantrums when he wants something, you will want to make sure that you model for him how to ask for something appropriately (even if this is just helping shape his pointing toward an object) and then reinforcing that appropriate behavior by giving him what he is requesting. It is helpful to work with a trained professional who can help you use these strategies. I do not recommend punishment because these challenging behaviors are really the result of difficulties in communication.
1:15
Comment From Kristen

I wanted to add about Gabe that he has started to babble A LOT in the last month. He runs up to one of us and screetches AH or EE wanting us to mimic him. Can this lead to eventual speech? He is even making eye contact for periods of 3 to 5 seconds when we are doing this. Is there a way to mold this into more sounds. Right now he does not want to deviate from the 3 or 4 sounds he is comfortable with.

1:17
Hi Kristen, Wonderful!! It is such a good sign that Gabe is babbling a lot. Make sure to respond by imitating his babbling and, when appropriate, modeling a word that is simple and builds on the babbling sound. For example, “AH” can eventually become “BAH” and then “BALL”.
1:18
Comment From Bill

Dr Dawson, can you comment on how we could do a better job at individualizing the learning and communication for various ‘colors’ of the spectrum. many school districts, doctors and academics have a tendency to lump all of our kids into one ‘autism’ bucket (The DSM V may exacerbate this). How can WE better communicate these more individualized needs of the autistic children to the general population? What do you see us as the autism community need to do better?

1:20
Hi Bill,I couldn’t agree more. Kids with autism are each unique and each have their own ways of learning, strengths, and challenges. Although there are some general principles that are helpful for most kids, it is important to individualize each child’s program. Some children learn best through the visual modality and need lots of support to develop speech. Others are talking up a storm but are focusing on only one topic and need to learn how to engage in a conversation. A good educator or therapist should be identifying each child’s learning style and objectives and then developing an indivualized plan for that child.
1:22
Comment From Guest

Tami, sign language has been very helpful to my twin sons who are on the spectrum. It seems to have lead to words for one of my boys and it lessens frustration for the other.

1:22
Comment From Julie

We’re trying to integrate our son into the typical kindergarten classroom. Any advice to give on how to successful to this. His current classroom is 8 children all on the spectrum. The typical kindergarten classroom is 20 – 25 children. Thus far we’ve agreed to do it one subject at time, starting with library time, moving into music as these are the activities he enjoys the most.

1:24
Hi Julie, A good strategy is to familiarize your child with the teacher and classroom ahead of time, teaching him about the layout, routine, and so on. While he is in the classroom with other kids on the spectrum, identify the specific skills that he will need to be successful in the typical kindergarten classroom. Will he need to stand in a line, raise his hand, sit for long periods of time, and so on. Teach and practice those skills ahead of time and then help him generalize those skills to the typical classroom. In addition, start with short periods of time in the typical classroom during periods that are least challenging and then extend the amount of time he is there. Good luck!
1:26
Comment From Matissa

Will the transcript from this live chat be available for print after the chat is over? Would love to share this information and links with my fellow teachers.

1:26
Yes, we’ll be posting the transcript on our science blog. Here’s the linkhttp://blog.autismspeaks.org/category/science/
1:27
Comment From zenaida

My son is 6. I’m trying so hard to teach him to do the right thing. What he does is he takes his poop and puts it all over himself, the sink, door and towel. I don’t know how to stop this. I need help

1:29
Zenaida, I know this must be very challenging for you. I think it would be best if you could work with a behavior specialist who can help you get this behavior under control. Here is a link to resources in your area: If you can’t find someone, please contact us at Autism Response Team and we will help you sort this out. Here is the link:
1:31
Comment From Tiffany

My non-verbal 4 year-old has just been diagnosed on the spectrum and has been in early intervention programs and speech therapy since she was 2. It seems like she has been on the verge of of communicating vrbally for the last year, she says words here and there, just not consistently. We have been advised to get her in an ABA program, but our insurance won’t cover it. What other resources do you suggest to get our little girl consistently communicating?

1:33
Hi Tiffany, Your local school is obligated to provide preschool programming for your child, so be sure to take advantage of that. You can also use strategies at home. Lynn Koegal’s book “Overcoming Autism” describes many strategies for promoting speech and language that parents can use at home. The fact that your daughter is saying words here and there is a very positive sign. Be sure to imitate those words and reinforce them by responding to them.
1:35
Dear everyone, I am sorry that the hour is over and went so quickly. I wish I had more time to respond to each one of your questions. Please visit Autism Speaks’ website, especially the Family Services section, to find many resources and tool kits for families. I will be holding another chat in the future so I hope we will have a chance to communicate again. Best wishes, Dr. Dawson
1:36
Transcript coming on our science blog:http://blog.autismspeaks.org/category/science/

The Emerging Neuroscience of Autism: an Opportunity to Learn and to Share

November 22, 2010 9 comments

Autism is a complex disorder.  Answers will be found by taking multi-disciplinary approaches. A broad vision of autism spectrum disorder (ASD) considers how the brain develops and affects cognition, what treatments work for core symptoms, and how ASD changes over the lifespan. However, opportunities for scientists to appreciate the broad vision and diversity of approaches are unfortunately few.

This year a special 2-day conference on autism was held prior to the annual Society for Neuroscience meeting in San Diego, giving scientists an opportunity to focus on ASD and share ideas. The conference, called The Emerging Neuroscience of Autism Spectrum Disorders: Etiologic Insights; Treatment Opportunities, offered an overview of current autism research from many of the world’s leading autism researchers.

There were two strong themes in the meeting. The first was that autism research has historically studied different groups of children at specific time points. This kind of study is known as cross-sectional research. There has been comparatively little research on how children change over time, known as longitudinal research. Given that ASD is a developmental disorder which changes over the lifespan, more longitudinal research is needed. The second theme highlighted what we can learn from the incredible diversity of symptom and subtypes of ASD.  Future ASD research demands a greater focus on individual differences instead of the common comparisons between averages derived from groups of individuals with ASD and typically-developed individuals.

Biological mechanisms

The first session of the meeting included a review of what is known about autism risk genes. Steve Scherer, M.D. (University of Toronto) described how small variations in the number of copies of a piece of genetic code (copy number variations, CNVs) can be risk factors for ASD. These CNVs may be inherited or occur for the first time in the individual with ASD  (de novo). Similar CNVs have also been identified in ADHD, schizophrenia and bipolar disorder, suggesting that there may be some common pathways underlying related developmental and psychiatric disorders. The incredible advances in genetic research, in no small part from Dr. Scherer and the Autism Genome Project, enable scientists to explore how these genetic variations affect brain development in animal models and provide clues into the underlying biology of ASD.

Declan Murphy, M.D. (Institute of Psychiatry, UK) impressed the audience with his proposal that brain imaging could be used to assist future clinicians in the diagnosis of ASD. The high costs of diagnosing individuals with ASD in Dr. Murphy’s South London community clinic motivated him to explore new methods.  He used statistical methods combined with functional brain imaging to identify brain networks that may be different in adults with ASD. The use of brain scans may one day make the diagnosing ASD cheaper, quicker and potentially more accurate.

Cognition and new treatments

Day 2 of the meeting shifted focus away from biology to cognitive development and the evaluation of behavioral interventions. Tony Charman, Ph.D., (Institute of Education, London) described his study of cognitive strengths and weaknesses in a large sample of children with ASD. He argued for the importance of understanding the unique pattern of cognitive skills found in ASD to guide neuroimaging research and developing assessments of skills for early intervention programs. Dr. Charman also identified challenges in this area of research, noting that the field must address issues, such as small sample sizes and reliance on group comparisons if we are to progress.

Cathy Lord, Ph.D., (University of Michigan) showed longitudinal data collected using the Autism Diagnostic Observation Schedule (ADOS)—a tool to identify and quantify features of ASD. Her data revealed individual differences in the development of particular skills, such as eye contact, and joint attention skills, even though overall ADOS scores remain mostly constant. Language IQ remains an important predictor of children’s expected progress. Perhaps in the future, the ADOS diagnostic tool can also be used to monitor the long-term benefits of interventions.

The final two sessions focused on interventions. Fred Frankel, Ph.D. (UCLA) presented data from new interventions in friendship training.  Judith Reaven, Ph.D., (University of Colorado School of Medicine) showed her data on cognitive behavioral therapy for anxiety in ASD. Aubyn Stahmer, Ph.D., (Rady Children’s Hospital, San Diego) evaluated the use of an integrated intervention model in community settings. Sally Rogers, Ph.D. (MIND Institute) concluded this session with a summary of the challenges in developing good outcome measures for intervention studies.

The last session summarized the evidence behind pharmacological treatments for ASD. One of the real challenges for behavioral pharmacologists is how to identify drug treatments for core social and communication skills. Currently only two drugs are approved for treating irritability in ASD. Several other drug treatments have been tested in clinical trials with minimal or no evidence for their effectiveness. Individual differences and variation in symptoms over time make finding treatments for the core symptoms of ASD like trying to hit a moving target.

Putting it all together

David Amaral, Ph.D. of the MIND Institute and current president of the International Society for Autism Research, summarized the meeting by focusing on autism research ‘Promises and Pitfalls’. On the positive side, he noted a dramatic rise in research, supported by increases in public and private funding, such as the major contribution by Autism Speaks.  As for pitfalls, Dr. Amaral underscored the significant variability among individuals with autism that must be recognized if research results are to be meaningful. He also encouraged the continuation of brain research across the lifespan acknowledging age-related changes in brain development and behavior over time.

Progress in the field of brain research will require an on-going partnership among people with autism, families and researchers.  We are both optimistic about progress and impatient to find answers.  We all look forward to IMFAR 2011 in May when autism researchers return to San Diego with a broader perspective and new insights.

5|25: Celebrating Five Years of Autism Science Day 20: Later Language Acquisition in Nonverbal Individuals with Autism

February 20, 2010 Leave a comment

In honor of the anniversary of Autism Speaks’ founding on Feb 25, for the next 25 days we will be sharing stories about the many significant scientific advances that have occurred during our first five years together. Our 20th item, Later Language Acquisition in Nonverbal Individuals with Autism, is from Autism Speaks’ Top 10 Autism Research Events of 2009.

A common belief of many parents and clinicians is that, if a child with ASD has not developed communicative speech by 5 years of age, the prognosis for future development of speech is extremely poor. In 2009 scientists challenged this belief by conducting a comprehensive review of the research literature to search for reports of individuals who were reported to have acquired speech at age 5 or older. Remarkably, one-hundred sixty-seven such cases were identified, changing the way in which we view language development in individuals with ASD.Early theories of brain development held that the period before age 5 represents a unique time in development during which language acquisition is possible, a critical period for language. Yet, recent longitudinal neuroimaging research has shown that the brain has a prolonged development, with major changes occurring during adolescence, and we now know that the capacity for neural generation extends even into adulthood. While the field of neuroscience has revised its notions of neuroplasticity and development accordingly, the field of ASD has held onto the notion of an early critical period for language acquisition. This paper published in the Journal of Cognitive and Behavioral Neurology, however, provides a very different perspective.

The authors identified in the published literature 167 individuals with ASD who used speech for the first time after age 5. Many of these children had been offered language intervention based on either traditional or naturalistic applied behavior analysis during the elementary school years, with the intensity of intervention ranging from 30 minutes/week to 30 hour/week. Others had been taught sign language or provided with Picture Exchange Communication System (PECS) training, computer-based training, or speech-language therapy. Children who developed phrase speech were found to have been in treatment longer than those who only achieved single word speech. In virtually all cases, significant time and effort put into treatment was necessary for speech to develop. According to their records, many of these children learned to “use phrases,” “answer simple questions,” “make spontaneous requests,” use “complete sentences,” and “speak in spontaneous, complex sentences.”

Although the age at which speech developed was variable (ranging from 6-12 years), once the child began speaking, subsequent improvement was often quite rapid. This suggests that achieving initial sound production and words can provide an important springboard for the development of subsequent speech. This important paper offers hope for the many children who have not yet developed speech by age 5, dispelling the belief that older individuals with ASD cannot respond well to speech interventions and providing a much more positive prognosis for individuals with ASD.

Did you know?: Autism Speaks’ High Risk High Impact Initiative chose “non-verbal” autism as one of its high priority research areas and has funded several grants in the area, including a novel treatment intervention to develop communication skills in non-verbal children over the age of five (to read more, please click here).  Autism Speaks also partnered with the National Institute of Child Health and Human Development to assemble a group of experts focusing on language, development, and autism to evaluate the efficacy of treatment interventions that target acquisition of spoken language.  This resulted in a consensus set of recommended measures published in the Journal of Speech-Language-Hearing Research.  These measures define benchmarks for determining a child’s language level and will be used to establish a framework for comparing outcomes across intervention studies.

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