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.

Training natural communication partners how to model AAC

Model, model, model! We all know how important and effective AAC modeling can be (see here and here, for example)—however, modeling is only as good as the partners who are implementing it. If you’re working with kids who use AAC, chances are there are communication partners who need guidance in how to model, and that’s no simple task. If you’re thinking “I agree, but HOW do I teach the partners?”, this review is for you!

The authors of this study gathered 29 studies in which more than 250 communication partners (including peers, teachers, paraprofessionals, parents, and other adults) implemented modeling strategies across various settings. Although they looked at a handful of research questions, the most clinically relevant questions were: How were the communication partners trained and what did they have to say about the training they received?

The most common training strategies were:

  • orally sharing information

  • modeling the strategies, and

  • allowing the partners to practice in controlled settings (role plays), or with a child, while providing feedback

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Overall, partners rated instruction as worth the time, easy to understand, practical, and transferable to other children. Some additionally offered the suggestion to provide more direction on how to model during a child’s regularly occurring activities (something to consider when you are providing training).

Seems pretty straightforward, right? We train the partners using those strategies and then off they go? Not so fast. The authors found that most communication partners also benefited from simultaneous support while learning to model. So after you train the partners, it’s important that you stick around to offer coaching and consultation as necessary.

If this seems daunting (how can I possibly fit this into my already jam-packed day!?), it’s important to remember that teaching communication partners can drastically improve the reach of our interventions—the amount of time we spend with our students is so limited compared to their interactions with natural communication partners.

If partner instruction is something you’d like to improve, be sure to check out the full article (specifically Table 2) for a list of the included studies and the training strategies used in each.

 

Biggs, E. E., Carter, E. W., & Gilson, C. B. (2019). A scoping review of the involvement of children's communication partners in aided augmentative and alternative communication modeling interventions. American Journal of Speech–Language Pathology. doi: 10.1044/2018_AJSLP-18-0024

“I wish…I think…I wonder…”: Improving parents’ shared book readings

Shared book reading can be a sweet moment between parent and child—while also serving to improve a child’s literacy skills. The trick is figuring out how to help parents make the most of these interactions. This pilot study examined the effects of a short training on parent–child storybook readings. While this study focused on Deaf/Hard-of-Hearing preschoolers, most outcomes focused on the changes in the parents’ skills—meaning you can apply this across many populations.

Researchers recorded multiple shared book readings at each of three stages in the experiment: before training parents, in the “intervention period” (the two weeks following the parent training), and eight weeks after training. The training was only twenty minutes long (very do-able for real world clinicians!) and included a very short power point, a two-minute video model, and discussion with the parents. The authors focused on these topics for parent training:

  • Switching mindset from “education” to gaining insight into the child’s thoughts

  • No such thing as right or wrong

  • Increasing use of wait time

  • Increasing conversational turns

  • Making phonemic awareness fun and silly (like making up nonsense words by taking words in the text and changing one phoneme)

  • Using open ended prompts: “I wish…”  “I think…” “I wonder…” “What do you think?”

Parents were also given two booklets from the National Institute for Literacy and a few wordless picture books to add to their home collection.

When measuring parent interaction types, the authors split prompts into two categories:

Open-Ended Prompts

Questions that encourage open-ended discussion: “What do you think…

Indirect prompts such as “I think…” or “I hope…” paired with wait time

Closed-Ended or Right/Wrong Prompts

WH questions about the story text: “What is that?” “Where is her bone?

Questions about the story text that encourage one word answers

Yes/no questions or “how many” questions

For only spending twenty minutes on parent training, researchers saw some encouraging changes! Both the total number of parent–child exchanges and the percentage of open-ended prompts increased from baseline, through the intervention and retention stages. The percentage of words spoken by the child was also higher in the intervention and retention stages (though only the intervention stage showed a statistically significant difference from baseline levels). Because a dip was shown in all outcomes during the retention stage, eight weeks after training, it looks like clinicians will probably need to follow-up with parents periodically.

For more along these lines, check out our reviews about supporting parents to complete literacy programs, teaching vocabulary via shared readings, and improving the narrative comprehension of children with ASD.

Nelson, L. H., Stoddard, S. M., Fryer, S. L., & Muñoz, K. (2019). Increasing Engagement of Children Who Are DHH During Parent–Child Storybook Reading. Communication Disorders Quarterly. doi:10.1177/1525740118819662

Speech homework: The parents’ perspective

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If you are an SLP who works with children with speech sound disorders (SSD), you are aware of: (1) how important home practice is, and (2) how difficult it is to ensure it happens. You send home cute activities and worksheets only to find out they’re never being done. You email parents with suggestions but wonder how much parents actually use them.

Some researchers decided to interview parents about their experiences with home practice in order to better understand their perspective. They wanted to hear from parents how SLPs could better support and encourage their attempts!

The researchers interviewed six parents of children aged 3–6 who had participated in speech–language therapy for an SSD. Several themes emerged throughout the conversations. They boiled them down these: 

Evolution over time

Parents expressed that their experiences with home practice changed over time. At the beginning, parents often felt confused, overwhelmed, and unsure of how to complete the activities. Over time, parents felt increasingly confident in the activities and what was expected of them.

Different roles

Parents saw the SLP as the expert who could provide materials and instruction, but saw themselves as ultimately responsible for supporting their child’s speech and language.

Importance

Parents stressed the importance of several things to them: their child’s speech and communication growth, their own role and involvement in therapy, consistent home practice, and rapport with the SLP. They felt that when there was rapport, they and their child were more motivated to do home practice and they saw more progress.

Managing the practicalities of home practice

Parents expressed difficulty with the logistics of home practice. All parents reported that it was challenging to find the time to do the activities and most admitted that they did not complete the full amount of time suggested by the SLP. Parents described receiving activities that were not motivating to their child or did not suit them as a family. They were often also unsure of how to complete the activities or how to do the technical components of therapy.

Taken together, these findings leave us SLPs with some helpful takeaways. First, it’s important for parents and SLPs to have a clear discussion about both of their expectations at the beginning of therapy. These parents spoke about how their expectations did not always match the realities of what therapy looked like and it took a while for them to adjust and figure out the ropes. Second, it may be beneficial to regularly share data about the child’s progress, as parents found that when their child made progress, they were more motivated to continue home practice. Last, SLPs should work with the family to provide family-appropriate materials as well as sufficient training and clear instructions for how to complete them.

 

Sugden, E., Munro, N., Trivette, C.M., Baker, E., Williams, A.L. (2019) Parents’ experiences of completing home practice for speech sound disorders. Journal of Early Intervention. doi: 10.1177/1053815119828409.

Survivor: Home-based early literacy edition

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Early literacy skills are crucial to set the stage for learning to read. We know that kids with Developmental Language Disorder (DLD) are likely to struggle with skills like print knowledge. There are only so many hours in the (preschool) day, so some early literacy programs are designed to be completed by caregivers at home. However, experience tells us that not all caregivers will complete home literacy activities. In this study, Justice and colleagues wanted to find out which caregivers might finish or not finish a home program. 

The researchers used a technique called survival analysis, which sounds dramatic, but “survival” in this case just means finishing the book reading program (phew). They looked at results from a previous study on the effect of different incentives on caregivers’ participation. Caregivers of 4- to 5-year-old children with DLD were asked to complete the (free!) Sit Together and Read (STAR) program. The program includes 15 books paired with print-focused activities that are completed in 4 sessions per week over 15 weeks. Caregivers recorded their reading sessions and reported back to the researchers regularly. The main findings included:

  • Only 55% of caregivers completed the program

  • Of families who dropped out, a third never started the program at all

  • Families were less likely to drop out early if they received incentives of money ($.50 per session) or encouragement (positive text messages)

  • Higher-SES caregivers were more likely to complete the program than lower-SES caregivers

  • Caregivers of children with higher print knowledge skills were more likely to complete the program than caregivers of children with lower print knowledge skills. 

So what can we do with these findings? When asking caregivers to complete home literacy activities, we need to have realistic expectations for their participation. The biggest barrier seems to be getting started, so we can focus our efforts on supporting caregivers early in the program. While most of us probably can’t pay families for completing a program, sending encouraging texts or notes to remind them how important reading is might help increase participation. And lower-SES caregivers or caregivers of children with low print knowledge skills are likely to need the most support of all.

 

Justice, L. M., Chen, J., Jiang, H., Tambyraja, S., & Logan, J. (2019). Early-literacy intervention conducted by caregivers of children with language impairment: Implementation patterns using survival analysis. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-03925-1