Autism Spectrum Disorders: Intervention for High-functioning

StudentsRhea Paul, Ph.D., CCC-SLP

Southern Connecticut State UniversityYale Child Study Center

Feb. 11-15, 2008rhea.paul@yale.edu

Goals of Treatment for High Functioning Students with ASD

Social Interaction skillsSocial Interaction skills Peer relations

Communication skillsCommunication skills Pragmatic and conversational skills

Adaptive skills Self-help

Self-regulation, emotional regulation Academic skills appropriate to

developmental level Reading comprehension

Social Interaction: Intervention Methods

Social Stories Descriptive sentences: statements of fact

Many children play on the playground during recess. Perspective sentences: refer to internal states

Some children like to make a lot of noise. Affirmative sentences: express a common value

One child goes down the slide at a time. This is a safe thing to do.

Control sentences: identify personal strategies When I have to wait my turn on the slide, I can count the

people in front of me to make the time go faster. Cooperative sentences: what others can do to

help. The teacher can help me if I feel impatient. She can talk

to me while I wait.

Comic Strip Conversations

Use ‘think’ and ‘word’ bubble cartoons

Sam, I saw a cowcatcher on an

old-fashioned train yesterday. Do you know what that is?

Sam doesn’t know as much as I do about

trains. I will find out if he knows

what the cowcatcher does before I tell him about the one I

saw

Games Based on Special Interests Develop social games based on

special interests of target child• Involve target child in development of

materials and rules• Have target child teach game to peer• Set up special opportunities to play game• Take turns choosing games to play during

interactive game time

Video Modeling Use commercial material such as

My School Day Video tape peers conducting

interactions such as greeting, negotiating, etc.

Use video clips from TV shows to exemplify interactions (may use negative interaction)

Video Modeling View video, discuss reactions DESCRIBE VERBALLY Re-enact scene on video with

clinician Re-enact with peer Improvise similar situation

Sample Video Models

Sample Video Models

Using Video Modeling Use video modeling and role playing

to become aware of listener cues Looking at watch Taking a breath Looking toward door Yawning

Use role playing to practice giving and perceiving these cues

Social Cognitive Skills Training (Timler et al., 2005) Role play social scripts in peer group

• Situation paragraph read to group• 4-5 situations/ 2 hour session• 6 weeks of 2 sessions/week

Children guided during role play to use checklist to facility ability to identify what they know about situation from own and other’s perspective

Further Qs helped identify a range of response strategies by • selecting goal, • stating alternative strategies to reach goal• Evaluating consequences after response

Social Skills Groups Can use commercial curricula, such as

• Navigating the Social World (McAfee, 2001)• Skillstreaming the Adolescent (Goldstein & McGinnis,

2000) Provide consistent group structure

• Check-in, greet• Review last meeting’s skill• Introduce new skill• Model and role play new skill• Snack, social time• Activity that allows real-life practice of new skill• Summary

Peer Support Networks

Select 2-5 peers to serve as social support for student with ASD

Assign each support peer a 20 minute period/day to structure activities for student with ASD, e.g.: Lunch: use Prompt and Praise to engage

with others at table Recess: teacher creates scripts for

entering games; peer support and target student practice in private, then on playground

Effective Adult Techniques: Social Skills Training (Timler, 2006) Teacher Redirects Prompting children to play with one another Rephrasing or restating one child’s statement

for another Praising children for playing together Direct instruction in social language Modeling and practice with explicit cues Role play with prompting Corrective feedback Authentic contexts (peer involvement) Self-monitoring for older students

Pragmatics and Conversation

Video examples: ASD Conversational Behaviors

Pragmatic Domains

Communicative functions Intents Frequency

Discourse management Turns topics

Register variation Politeness Social roles

Presupposition Grice’s maxim of Quantity ‘mind-reading’

Pragmatic Assessment

Children’s Communication Checklist (Bishop, 2003)

Pragmatic Rating Scale (Landa et al., 1992)

Pragmatic Rubric Pragmatic Protocol (Prutting & Kirchner,

1984) Social Skills Rating System (Gresham,

1990) Pragmatic Language Skills Inventory

Gilliam & Miller, 2006)

  

Improving Conversational Skills

Enhancing Pragmatic Skills Conversational participation and reciprocity

Take turns w/o interrupting Responding appropriately to others’ speech Adding something new and relevant information to a

topic Terminating/changing topics appropriately

Initiating and maintaining peer interactions Entering peer play and conversation Maintaining and expanding play themes Terminating play appropriately

Reduction of obsessive, perseverative topics Understanding and telling stories

Understanding social sequences Understanding psychological motivation

Scripting Provide explicit written script of interaction, e.g.,

Walk up to a classmate

Make eye contact

Say, “Hi ____________”

Practice script w/ adult Practice w/ peer Script Fading: Cut off increasingly large parts of

script, until client can do the scene independently

Scripts and Script Fading

Provide topic lists, guide students to write and fade their own scripts

Use favored topics to bridge to new ones• trains→dining car →food

Have students choose a strip to talk with a teacher/clinician

Fade scripts with adult Encourage student to repeat with

peer partner

Scripting with Peer TrainingPeers taught 5 facilitative skills w/o target

child present:1. Look, wait, and listen2. Answer questions3. Start talking4. Say something nice5. Keep talking

Target children given written scripts for social interaction (“Can I play checkers with you?”)

Direct Instruction Make

conversation:

Maintain topic:

Change topic:

Go up to person.Say ‘hello.’Smile.Listen to what s/he says and

respond.

Listen.Think about what the person says.Talk about the same thing.

Keep quiet and listen.Wait until the person pauses.Say, “Let’s talk about something

else. Like…”

Direct Instruction: The “Conversation Can” (Brinton, Robinson & Fujiki, 2005):

Brainstorm a list of topics classmates might want to discuss

Write each on a slip of paper Put slips in can Take turns pulling out a topic Start conversation:

Think first: What should I say Say two things about the topic Ask interlocutor a question about the

topic Listen while interlocutor answers

Graphic Supports for Conversation ChecklistsWhen I had a conversation, did I

Look at my friend? _____________

Stand one arm’s length away? _____________

Appear interested by asking questions and listening? ______ Talk about what my friend is interested in? ______

PostersImportant Parts of Conversations:•Topic: Pick something your friend wants to talk about•Questions: Use these to keep the back-and-forth going•Comments: Say something new that your friend doesn’t know, but would find interesting

Graphic Supports for Conversation Choice BoardsPick your conversation topic for today:

Graphic Supports for Conversation Choice lists

Yo, __________!

Hey, Pal!

High 5!

� What’s up?

� Hi, how ya doin’!

Principles of Pragmatic Intervention Strategies

Students with ASD will not acquire social skills from exposure; they require mediated experiences

Verbal, written and graphic supports are effective

Peer involvement is an essential element Peers need training, but it is not extensive

Encourage ‘mind reading’

Adaptive and Self-Regulatory Skills Same principles as with lower

functioning. Visual supports Social Stories, Comic Strip Conversations ABA approaches

Task analysis Functional Behavior Analysis Consequences-natural and contrived

Self-Management Skills Picture Schedules: visual supports

Self-management: Social Stories

Recess* After lunch we go to recess.* Sometimes recess is on the playground.* A lot of the children play on the playground

equipment.* It is fun to play on the playground equipment.* Everyone should play safely.* When the whistle blows that means it is time to line

up and go inside.* I will try to line up as soon as the whistle blows.* This will make my teachers happy.* After I line up I will try to stay in line.* Everyone will be proud of me!

Academic Skills Reading can appear a strength

May be early, precocious w/ keen interest in letters, numbers

May show interest in words (read dictionary) BUT, difficulties in comprehension often

occur. Narratives (stories) may be a good

vehicle for improving reading comprehension

Narrative Intervention Understanding motives: make

character motivation explicit Understanding intentions: discuss

reasons for actions Understanding emotions: discuss how

characters feel and why