Preschoolers with ASD play the "Buddy Game"

What if there were a 15-minute peer-mediated intervention for toddlers and preschoolers with autism? What if we told you that same intervention required minimal training for teachers and no training for peers? Intrigued yet?

This study found that children with autism between 29 and 78 months old initiated significantly more social interactions with peers during the Buddy Game” than they did during unstructured play during recess. What’s more, these improvements carried over to a generalization free-play time following the intervention.

So, what is the “Buddy Game”? Children with autism were randomly paired with typically developing peers. Teachers led dyads in singing songs together for 15 minutes, incorporating gestures and movements during the daily structured intervention on the integrated preschool playground. The intervention includes activities that naturally occur in preschool settings—singing songs like “Head, Shoulders, Knees, and Toes” and “Wheels on the Bus” embedded within a natural context: recess.

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Keep in mind some limitations of the study: the sample size was small (10), and there were possible issues with baseline data, given that children were transitioning classrooms and/or schools around the time of the intervention.

This study helps us reconsider structuring recess or other “free play” time during the preschool academic day. It could be a win-win if by structuring 15 minutes of recess and using incidental teaching, kids with autism are exposed to a variety of peers and have increased opportunities for social initiations, both during and after the intervention. 

 

Morrier, M. J., & Ziegler, S. M. (2018). I Wanna Play Too: Factors Related to Changes in Social Behavior for Children With and Without Autism Spectrum Disorder After Implementation of a Structured Outdoor Play Curriculum. Journal of Autism and Developmental Disorders. Advance online publication. doi:10.1007/s10803-018-3523-z

Peer mentors and PEERS

These authors added a new spin to PEERS, a well-researched social skills and friendship curriculum, by including peer mentors. First, note that PEERS is designed for adolescents with autism who do not have intellectual disabilities. The curriculum manual contains 90-minute weekly interventions for 14 weeks, but there is also a version structured for school delivery. Targeted social skills include choosing appropriate friends, how to handle teasing, bullying, gossip, and more.

Participants in this study (high school students with verbal IQs of 70 or above) were placed in one of three groups:

  1. Followed the traditional PEERS curriculum (only included adolescents with autism)
  2. Followed PEERS and incorporated peer mentors (PEERS with Peers)
  3. Control group (Followed the traditional PEERS curriculum, with a delayed start)

Participants in groups 1 and 2 increased social skills knowledge and decreased loneliness. Students in group 1 increased get-togethers with peers compared with those in the control group. Students with autism in the PEERS with Peers group had significant improvements in social skills and problem behaviors, as reported by their parents, showing a “modest advantage” over the traditional model. Many of these skills were maintained four months later.

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The PEERS curriculum has a growing evidence base, but what’s really exciting about this study is that the researchers purposely had clinicians lead the intervention, paying attention to the research to practice gap in this area. Saving some of the best news for last, training to implement PEERS was manageable—staff participated in a 3-day initial training and 1-day refresher, and peer mentors received only 1 hour of training, along with their parents. All in all, this curriculum is worth checking out if you serve adolescents with autism who do not have ID.

 

Matthews, N. L., Orr, B. C., Warriner, K., DeCarlo, M., Sorensen, M., Laflin, J., & Smith, C. J. (2018). Exploring the Effectiveness of a Peer-Mediated Model of the PEERS Curriculum: A Pilot Randomized Control Trial. Journal of Autism and Developmental Disorders. Advance online publication. doi:10.1007/s10803-018-3504-2

Video prompting for vocational skills

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SLPs supporting high school students with autism and/or intellectual disabilities know the importance of vocational skills. We know, too, that it’s critical to fade our support so that these students can be as independent as possible at their jobs. This article shows one possible method for doing so.

The authors used tablets* to provide four high school students with ASD and/or ID video prompting to complete a job task (setting up the school conference room for meetings). Instead of presenting the entire skill sequence at once like with video modeling, video prompting breaks down the skill sequence so that the viewer can watch one skill, perform that skill, and then repeat the process with the next skill.

Here’s how the prompting systems worked: Pictures and videos represented the tasks and “decision points” (i.e., Is the meeting today an IEP meeting—yes or no?). For each step in the sequence, students had the option to select a prompt or to complete the skill independently. Prompts could be pictures, text, sound clips, or videos, or a combination of these.

Students were briefly pre-trained on operating the tablets. All four students substantially increased their percentage of correct responses at the decision points. They also independently decreased their use of the prompts as they became more successful completing the skill sequence. Independently! What’s more, students and staff reported satisfaction with the devices and prompting systems.

Generalizing these findings is tough because of the small sample size, single skill addressed, and lack of information about skill maintenance. But, this study is worth checking out if you’re interested in trying a prompting system like this. Perhaps even more importantly, the authors designed the prompting systems with UDL in mind, and it definitely doesn’t hurt to increase our knowledge and skills in this area!

*iPads (Go Talk Now) and HP Slates (PowerPoint)

 

Laarhoven, T. V., Carreon, A., Bonneau, W., & Lagerhausen, A. (2018). Comparing Mobile Technologies for Teaching Vocational Skills to Individuals with Autism Spectrum Disorders and/or Intellectual Disabilities using Universally-Designed Prompting Systems. Journal of Autism and Developmental Disorders. Advance online publication. doi:10.1007/s10803-018-3512-2

Improving reading and comprehension skills in the middle grades—we’re in it for the long haul

When students reach the upper-elementary years (4th and 5th grades, or ages 9–11), the curricular demands for reading get harder, and it gets harder for us to help struggling readers keep up. To address this need, Vaughn et al. tested an intervention targeting both word reading (i.e., decoding text) and reading comprehension (i.e., understanding what you read) for upper-elementary students.

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Students in this study were 8–12 years old and were randomized to either the study intervention or to a control condition where they received whatever intervention their schools gave them. The study intervention was intense, with 30- to 45-minute group sessions, 5 days a week for the majority of the school year (October–April; almost 45 hours of intervention on average). The first phase of the intervention targeted word reading and reading fluency (sample lessons here). Then, students moved on to reading expository and narrative text, with comprehension practice (answering questions, summarizing, etc.; sample lessons here) and word practice (morphology instruction along with continued reading fluency practice).

Children in the intervention group improved significantly compared to control children on an experimenter-developed measure of word reading and on a measure of reading fluency. They did not improve significantly on measures of reading comprehension. Unfortunately, this is pretty typical; most reading comprehension intervention studies see mixed results or no improvement at all.

Improving word reading skills in upper-elementary students is hard, and improving comprehension is even harder. This is an all-hands-on-deck kind of problem, with intensive services needed to help students catch up. The authors conclude that “…students with significant reading difficulties require intensive reading instruction for many years. Students in fourth grade and beyond with intractable reading difficulties may require intensive interventions provided by highly qualified clinicians throughout their schooling.”

 

Vaughn, S., Roberts, G. J., Miciak, J., Taylor, P. & Fletcher, J. M. (2018). Efficacy of a word- and text-based intervention for students with significant reading difficulties. Journal of Learning Disabilities, Advance online publication. doi:10.1177/0022219418775113

Throwback (2014): Narrative intervention supports language skills

We review research on narratives a lot—probably because narrative skills are: (1) needed in both academic and everyday social interactions, (2) featured in common core standards, and (3) supported by evidence for both assessment and treatment of language skills. If you’re not convinced yet, here’s one more treatment study supporting their use—in an open access (WOO!) article from 2014.

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Adlof et al. tested their “Structured Narrative Retell Instruction” (SNRI) in a small feasibility study. A small group of preschool–1st grade children (ages 3–6) were recruited from a center serving low-income families. Children received either the SNRI or a control treatment of “code-focused literacy instruction” (identifying sounds and letters, pointing out rhymes, etc.) in small group sessions lasting 40 min, 2 times per week for 6 weeks. Both conditions used published children’s storybooks, and the children got to take them home.

In SNRI sessions, clinicians read the books and: (1) led children in think-alouds, (2) pointed out story grammar elements (setting, characters, problem, etc.), and (3) defined and discussed challenging vocabulary words. Then, clinicians led the group in answering comprehension questions and assisted children in retelling the story. See the article’s supplemental materials for an example lesson.

After the intervention, children in the SNRI group showed large gains on measures of vocabulary, narrative skill, and grammar, while children in the control group showed gains on fewer measures. This is a small, initial study, so we have to interpret the results with caution. However, the results were promising and add to the evidence showing narrative intervention improves children’s language skills.

 

Adlof, S. M., McLeod, A., & Leftwich, B. (2014). Structured narrative retell instruction for young children from low socioeconomic backgrounds: A preliminary study of feasibility. Frontiers in Psychology, 5, 391. doi:10.3389/fpsyg.2014.00391

Just say "yes" to narrative assessment for ASD

We all have those high-functioning kids with ASD who score in the average range on the CELF but so clearly have language issues. It can be hard to justify services for students like this, especially in school districts where test scores are the main criteria for eligibility. King & Palikara sought a solution to this frequent dilemma by using a variety of different assessment tools.

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Using groups of adolescents both with and without high-functioning ASD, the researchers tested each child using the CELF-4, a standardized vocabulary test, a variety of narrative analysis tasks, and the Children’s Communication Checklist (CCC-2), completed by parents and teachers.

Not surprisingly, the adolescents with ASD scored similarly to typically developing peers on the CELF-4 and vocabulary measure. However, students with ASD scored significantly lower on a variety of narrative tasks.

Compared to peers, adolescents with ASD produced narratives that:

  • Were shorter and less grammatically complex
  • Used more limited vocabulary
  • Included less reasoning and fewer explanations
  • Made fewer references to emotion and thoughts
  • Made use of fewer linguistic enrichment devices
  • Contained less conflict resolution and reduced character development
  • Were overall less coherent

Did you get all that?

Basically, when assessing high-functioning students with ASD, especially those on the verge of qualifying, do yourself a favor and include some kind of narrative measure. I know, I know—narrative analysis can be complex and time-consuming, and the authors note this as well. But using narratives in assessment can give us great information about specific areas of difficulty that the CELF just doesn’t address. Besides, narrative assessment results translate so easily into IEP goals, so it will be worth your while. Check out the original article for more details on how they used and analyzed narrative assessment!

 

King, D., & Palikara, O. (2018). Assessing language skills in adolescents with autism spectrum disorder. Child Language Teaching and Therapy, 34(2), 101–113.

Problem behavior sending a message? Replace it with communication

We know that behavior is a form of communication, and that inadequate communication skills and problem behavior go hand-in-hand. This holds true for typically-developing toddlers (just ask any parent!) and also for individuals with communication disabilities, who may have had years (or decades) to develop disruptive, destructive, or dangerous behavior patterns. These are tough students, and tough situations, but also can be some of the most rewarding— when we can help a client learn a new way to communicate what they could only say through behavior.

A well-known intervention for doing just this is Functional Communication Training—an approach where you study the behavior to learn its function (generally by doing a functional behavioral assessment, or FBA; you may call these ABCs or some other fun acronym), and systematically teach a new, more socially-acceptable way to communicate that message. Instead of head-banging to escape challenging academic tasks, maybe the student can ask for help or a break instead. Sounds obvious, but the trick is in getting everyone to recognize the communication behind the behaviors and follow through with prompting and reinforcing the replacement. This is why we advocate!

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This new systematic review of FCT intervention studies specifically targeted situations where FCT was used in schools, with AAC in the mix. They found 17 studies that met the eligibility and quality guidelines. Subjects were school-aged and had a range of disabilities. Overall, FCT resulted in less problem behavior and more AAC use, with large effect sizes*. The authors found that larger effects were seen with less intense behavior, and that destructive behaviors may simply take more time to eliminate. They also noticed that FCT tended to be more effective in inclusive school settings (more integration with students without disabilities) and that interventions informed by descriptive, rather than experimental, FBAs had better results. This last point is interesting; less-rigorous FBAs carried out by regular school personnel may be as good, or better, in these situations than the type you might hire an outside specialist to perform.

A range of different specific strategies (how communication was prompted and reinforced, etc.) seemed to be effective, so a student-centered approach, where you develop the intervention protocol with the individual in mind, looks like the way to go. The authors also include some helpful references for readers who need specifics on implementing FCT.

*This is great, but remember publication bias. It’s less likely that someone would write up and publish a case study of an intervention that didn’t do anything.

 

Walker, V.L., Lyon, K.J., Loman, S.L.  & Sennott, S. (2018). A systematic review of Functional Communication Training (FCT) interventions involving augmentative and alternative communication in school settings. Augmentative and Alternative Communication, 34(2), 118–129.

Perspectives & Tutorials

If you follow SLP groups on social media, you’ll know there are a lot of conversations about conflicts between professionals with different backgrounds and points of view. ASHA SIG Perspectives published a few pieces with helpful thoughts on these issues (marked below with *). We’ll call this collection “Playing well with others, or, Learning to Love a BCBA.”

Augmentative and Alternative Communication Intervention in Public Schools: Achieving Meaningful Outcomes Through Collaboration*

Conceptualising “dose” in paediatric language interventions: Current findings and future directions

This is a really good article regarding the issue of how much therapy is "enough" (scheduling, treatment intensity, etc.) We discuss it, here.

Cross-Age Peer E-Mentoring to Support Social Media Use: A New Focus for Intervention Research

Enhancing the Reading Development of Learners with Autism Spectrum Disorder

Fostering Communication in Elementary School Children on the Autism Spectrum Who Are Minimally Verbal

This is a great read if you are transitioning to this population or just feeling uncertain about your practice with these types of kids. It reviews the foundational skills (like joint attention) that we need to address and describes interventions that WORK.

A Glossary of Behavior Analytic Terms for Speech-Language Pathologists’ Considerations for Augmentative and Alternative Communication*

This is an important article to keep handy if you work in an ABA program or share clients with a BCBA. Not only does it demystify that profession’s particular jargon (if it’s unknown to you), it helps point out the places where SLPs have parallel terms and practices. Knowledge is power, and shared language can set the stage for good collaboration.

Guidelines for Feature Matching Assessment of Brain–Computer Interfaces for Augmentative and Alternative Communication

Not sure many of us are actually in a position to do this right now, but it’s SO COOL.

The Impact of Language Experience on Language and Reading: A Statistical Learning Approach

Interprofessionalism on the Augmentative and Alternative Communication Team: Mending the Divide*

Morphological Awareness and Literacy in Second Language Learners: A Cross-Language Perspective

Same or Different: How Bilingual Readers Can Help Us Understand Bidialectal Readers

Speech-Language Pathologists Engaging in Interprofessional Practice: The Whole Is Greater Than the Sum of Its Parts*

 

And more

Bent & Holt found that 5- to 7-year-olds’ ability to recognize words was significantly lower when the speaker had a nonnative accent (Japanese). When background noise was added, the children struggled to understand both the native Japanese speaker and a British English speaker, compared to an American English speaker.

Girbau found that bilingual (Spanish/English) children with language disorders and normal nonverbal intelligence had difficulty understanding long distance animate direct object pronoun sentences. What the heck is that, you ask? A sentence like this: “The ant explains that the snakes from the green jungle are scaring her with the strong hissing.” It might be useful to include “long distance” pronouns like this in therapy.

Klein-Tasman et al. administered the Autism Diagnostic Observation Schedule (ADOS) to children with Williams Syndrome who spoke at least in three-word phrases. They found a high risk (about 1 in 3) for ASD in this population. They also identify which particular social and repetitive behaviors are common in Williams Syndrome generally and which may point to a comorbid ASD diagnosis.

Mandak et al. found evidence through systematic review that literacy interventions (sight-word based, phonological, or combined) are effective at helping individuals who use aided AAC improve their word-reading abilities. They encourage clinicians to consider a combined approach, incorporate evidence-based prompting strategies such as time delay, and to be mindful of the tasks used to measure word knowledge.

O’Neill et al.’s meta-analysis reminds us that interventions that include aided input have been highly effective in improving expression and comprehension among people who use AAC. The majority of participants in studies included in the meta-analysis were preschool- or elementary-aged children with developmental disabilities.

Thistle et al. found that preschoolers without disabilities selected symbols on AAC display more quickly when the locations were consistent, rather than variable. The authors remind us that we need to replicate these findings with children with disabilities, but in the meantime the study provides evidence we can use to remind our co-workers about the importance of consistency in motor learning.

Reeves et al. studied the effect of Early Talk Boost (ETB) intervention on language scores in 3-year-olds, and found that children who received ETB intervention (in 20 minute group sessions 3 times/week for 9 weeks, delivered by teachers) improved significantly compared to children in a control group. Note: this article wasn't fully reviewed because it's not available to the majority of our audience, with training only provided in the UK. We hope to see further research and expanded training opportunities in the future!

Stark found that anxiety is the strongest predictor of the development of selective mutism in bilingual children. Bilingual status itself did not predict selective mutism. However, the family’s orientation to the mainstream culture was positively associated with children’s speaking behavior in preschool. 

Zemlock et al. found that practice with any kind of handwriting (letters OR numbers!) led to improvements in letter recognition in preschool- and kindergarten-aged children.

 

Bent, T., & Holt, R. F. (2018). Shhh… I Need Quiet! Children’s Understanding of American, British, and Japanese-accented English Speakers. Language and Speech. Advance online publication. doi: 10.1177/0023830918754598

Girbau, D. (2018). Direct object pronoun sentences processing in Spanish-English children with/without Specific Language Impairment and adults: a cross-modal priming study. Journal of Communication Disorders, 72, 91–110. doi: 10.1016/j.jcomdis.2018.01.003

Klein-Tasman, B.P., van der Fluit, F. & Mervis, C.B. (2018). Autism Spectrum Symptomatology in Children with Williams Syndrome who have Phrase Speech or Fluent Language. Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s10803-018-3555-4

Mandak, K., Light, J., & Boyle, S. (2018). The effects of literacy interventions on single-word reading for individuals who use aided AAC: a systematic review. Augmentative and Alternative Communication, 1–13. Advance online publication. doi: 10.1080/07434618.2018.1470668

O’Neill, T., Light, J., & Pope, L. (2018). Effects of Interventions That Include Aided Augmentative and Alternative Communication Input on the Communication of Individuals with Complex Communication Needs: A Meta-Analysis. Journal of Speech, Language, and Hearing Research. doi: 10.1044/2018_JSLHR-L-17-0132

Reeves, L., Hartshorne, M., Black, R., Atkinson, J. Baxter, A., & Pring, T. (2018). Early talk boost: A targeted intervention for three year old children with delayed language development. Child Language Teaching and Therapy, 34(1), 53–62.

Stark, A. (2018). Effects of anxiety, language skills, and cultural adaptation on the development of selective mutism. 74, 45–60.

Thistle, J. J., Holmes, S. A., Horn, M. M., & Reum, A. M. (2018). Consistent Symbol Location Affects Motor Learning in Preschoolers Without Disabilities: Implications for Designing Augmentative and Alternative Communication Displays. American Journal of Speech-Language Pathology. Advance online publication. doi:10.1044/2018_AJSLP-17-0129

Zemlock, D., Vinci-Booher, S., & James, K. H. (2018). Visual–motor symbol production facilitates letter recognition in young children. Reading and Writing, 31(6), 1255–1271.