Blending social cognitive interventions for children with autism

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If you’re supporting children with autism, odds are your priorities include building social communication and/or self-regulation skills. First and second graders with autism in this study made gains in both areas—and their parents improved their ability to support their kids in them, too! Group therapy combined elements from multiple evidence-based social cognitive interventions (TEAACH and Social Thinking, which now includes Zones of Regulation). And rather than teaching the child a series of discrete social skills (e.g., face communication partner, use eye contact, and nod while communication partner is talking), the idea here is to support children in becoming problem-solvers so they can use social skills across contexts.

Pulling therapy elements from multiple social cognitive interventions made sense for this particular group of kids, because they had average or above average intelligence, were included in the gen ed classroom at least 80% of the time, and read at a first grade level. What’s awesome is that the parents were introduced to the therapy approaches in two-parent-only sessions and then participated in all ten 90-minute intervention sessions. We get that this kind of parent involvement isn’t possible in the schools—maybe not in private practice either—still, it’s important that parents are introduced to the approaches we’re using in therapy, especially if they’re working for their kids.

So, a bit more on the interventions the researchers blended together. The TEAACH approach prioritizes structuring the environment and activities, including visual supports, and incorporating the participants’ unique interests. The Social Thinking umbrella includes a number of frameworks and teaching strategies; in this study, the Social Thinking side of the intervention included vocabulary from We Thinkers! Volume 1, like expected/unexpected behaviors and whole body listening, as well as Zones of Regulation strategies.

Want to look closely at the session activities and content? Table 2 has you covered. Also, we recommend checking out Table 3 for definitions of the strategies—some of which may be familiar to you and others that might be new—like visual countdowns, thinking with your eyes, and progressive relaxation. The authors in this study show us that two interventions may be better than one, particularly when we’re picking and choosing parts that play up students’ strengths and address their specific weaknesses. 

Nowell, S. W., Watson, L. R., Boyd, B., Klinger, L. G. (2019). Efficacy study of a social communication and self-regulation intervention for school-age children with autism spectrum disorder: A randomized controlled trial. Language, Speech, and Hearing Services in Schools. doi: 10.1044/2019_LSHSS-18-0093.

Throwback (2013): Connecting through commenting

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Conversation can be one of the most difficult tasks for students with co-morbid language and social communication impairments.

One of the most important parts of a conversation is validating social comments—statements or questions directed towards peers for the sole purpose of furthering the interaction. They might include expressing feelings, sharing information, asking a peer a question, or helping a peer with a task. Though they come naturally to typically-developing peers, kids with social communication deficits need explicit instruction and multiple opportunities to practice.

In 2013, Fujiki et al. implemented a 10-week intervention meant to increase students’ use of validating social comments. Students ages 6–9 participated in 15–30-minute sessions, 2–4 times per week with the following procedure: 

  1. Individual direct-instruction and practice sessions using social stories and role-playing

  2. Video-taped practice with typically-developing peers during a social game

  3. Video-review sessions with the SLP to provide feedback and highlight positive interactions

This intervention led to an increase in validating social comments in three out of the four children, and an increase in teacher’s perception of the student’s likeability and prosocial behavior. (In the fourth case, the student’s aggressive behaviors undermined his ability to participate effectively.) Although peer perceptions of students did not change, the authors note that a more intense and sustained intervention (i.e. longer than ten weeks) might be effective to foster peer friendships for these students.

For those school-based SLPs out there, this type of intervention might be perfect for your push-in sessions—that’s a win for both kids and therapists!

 

Fujiki, M., Brinton, B., McCleave, C. P., Anderson, V.W., & Chamberlain, J.P. (2013). A social communication intervention to increase validating comments by children with language impairment. Language, Speech, and Hearing Services in Schools. doi: 10.1044/0161-1461(2012/11-103).

Teaching grammar to kids with ASD—How explicit should we be?

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We know that the language skills of children with autism spectrum disorder (ASD) vary… a lot. While some children are impaired across all language domains, others have weaknesses in just a few. For example, one subgroup of children with ASD have a relative weakness in grammar compared to the other domains. For kids with impairments in grammar, it is common practice to use an implicit intervention approach.

Perhaps you use implicit strategies with your clients? Do you show them pictures, model, and provide corrective feedback and recasts (e.g., “That’s right! The dog is running!”)? These are all implicit (you’re basically bombarding the child with correct productions and hoping that it sticks). Sometimes, though, you might feel that implicit isn’t enough. With some of your clients, do you ever find it helpful to explicitly provide the grammatical rule that you’re working on (e.g., we add -ing because it’s an action word)?

The authors of this study wanted to see whether adding an explicit component to intervention would be advantageous for children with ASD*. Seventeen children with ASD (ages 4–10) were taught two novel grammatical forms by either a combined explicit–implicit approach or an implicit-only approach. The combined approach differed in one way—the rule was described to the kids during intervention, which ended up being advantageous. More children learned the rules and used the novel forms during the combined explicit–implicit approach compared to the implicit-only approach.  

So if you’re working with kids with ASD with grammatical weaknesses, should you present the rules during intervention? At this point, it’s worth a try. The authors did question the generalizability of the results because the sample in the study was not very diverse (all subjects were verbal with mild-moderate ASD); so while the explicit component could be helpful for some of your students, it’s important to keep this limitation in mind.

*Got deja vu? We’ve reviewed another study from this lab on explicit grammar intervention before, but that one looked at children with developmental language disorders (DLD).  This study extends those findings to a new population!

 

Bangert, K. J., Halverson, D. M., & Finestack, L. H. (2019). Evaluation of an explicit instructional approach to teach grammatical forms to children with low-symptom severity Autism Spectrum Disorder. American Journal of Speech–Language Pathology. doi:10.1044/2018_AJSLP-18-0016

AAC carryover: Buy-in is only the beginning

One of the biggest frustrations for clinicians who support AAC are the devices that don’t get used. You know, the ones that sit in the cabinet unless you’re in the room, or the ones that parents ask you not to send home. There are a lot of factors that contribute to this kind of device abandonment (can’t you just picture a lonely device feeling sorry for itself?). We need to understand these factors, so we can focus our work on the key ingredients that will promote AAC device use and help students—and their support teams—be successful.  

You won’t be surprised by two of the most common caregiver-related barriers to device success: 

1)    The adults don’t know how to use the device (or, they lack operational competency).

This includes finding words, programming, troubleshooting, and navigating the device settings. Parents and teachers often report that they don’t get enough training in this stuff.

2)    The adults don’t have positive attitudes about the device (or, they lack buy-in).  

Specific aspects of buy-in can include considering the device the child’s voice and believing that it should be available at all times.

These two barriers are important, for sure, but how important? And what else are we missing? This study delved into this issue, focusing on the operational competency and buy-in of parents and teachers of school-aged (3–16 years) children with autism, and whether they related to how frequently the children’s AAC devices were used. The 33 children in the study all used a personally-owned PRC device or the related LAMP Words for Life app as their main method of communication at both home and school. To measure how much devices were used, the researchers analyzed data from PRC’s Realize Language feature across three school days and one weekend. Parent and teacher surveys were used to measure operational competency and buy-in.

The good news? Overall, buy-in and operational competency was high for everyone. The bad news? No one was using devices that much. In this group, teachers reported greater buy-in (or at least answered their surveys that way, but that’s a whole different topic...), but parents and teachers were equally comfortable operating the devices. The devices were used more frequently at school vs. home (over half of the kids didn’t use the devices at home at all). 

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A big grain of salt here: the study looked at really a pretty small window in time (Is one weekend at your house representative of how your family works?), and only one device company—that uses a relatively complex language system—was in the mix. We also don’t know if looking at students with diagnoses other than autism would make a difference. Even so, it’s clear that something’s going on here. We can see that good intentions, valuing the device, and being trained in its use just isn’t enough. It looks like we need a broader conversation about barriers, including the practicalities of incorporating a device into daily activities and routines, especially at home. We definitely need to address operational competency and buy-in, but our families and other stakeholders are likely to need more support than that. The authors remind us to keep communication at the center of the conversation, rather than the technology. After all, the device is only the tool—communication is the point.

 

DeCarlo, J., Bean, A., Lyle, S., & Cargill, L. P. M. (2019). The Relationship Between Operational Competency, Buy-In, and Augmentative and Alternative Communication Use in School-Age Children With Autism. American Journal of Speech-Language Pathology. doi:10.1044/2018_AJSLP-17-0175

Human vs. machine: What’s better for prompting work tasks?

We’ve talked before about video prompting as an intriguing way to help older students with autism and/or intellectual disabilities learn new job tasks. To remind you, video prompts are similar to video modeling, except broken down into individual steps. So the student watches a video of the first part of the task, completes that step, watches the second step, and so on. This month, a new study compares video prompting directly to more traditional least-to-most prompting from a live person. Previous research on video prompting has often included least-to-most prompts in the intervention package as well, to increase the chances of success, and other studies comparing the approaches have had important limitations. Ideally, we want to prompt our students as little as possible, so it’s important to know what methods are most effective (result in the most learning) and most efficient (work faster, with fewer errors along the way).

Here, the researchers taught three middle-schoolers (12–15 years) with autism and moderate intellectual impairments* three office tasks: making a copy, sending a fax (old school!), and making a label for a file folder. For each student, one task was taught with video prompting, one with least-to-most prompting, and one was a control. For the video prompts, a series of brief clips (13–22 seconds), demonstrating each step in a task analysis, were pre-recorded and presented on an iPad. The videos showed someone’s hands doing each step of the tasks. Each clip ended with the instruction: “Now you do it.”

Based on a comparison of the two prompted tasks (and each student’s better method being introduced to the control tasks after an extended baseline), video prompting was both more efficient and more effective for 2 of the 3 students. For the other, least-to-most prompting worked better, but was still less efficient. Two of the students also preferred the videos to the least-to-most prompting. Interestingly, the teachers involved didn’t have a preference for video prompting, even though it worked well.

Now, let’s face it: video prompting is promising, but it takes more effort to prep than regular face-to-face prompting. Videos might be a good fit for job tasks that are likely to be taught many times, to many students, over months or years, since the videos can be reused—once they’re made, the workload is minimized. Also, for individual students who don’t react well to typical prompting procedures, the work up front could be worth the payoff.

*Two of the three were dually-diagnosed with Down Syndrome and ASD.

Aljehany, M. S., & Bennett, K. D. (2019). A Comparison of Video Prompting to Least-to-Most Prompting among Children with Autism and Intellectual Disability. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03929-x