Who benefits most from pragmatic language intervention?

Not all children respond the same to various interventions. Parsons et al. helps us with this problem by identifying which school-aged children with autism respond best to a peer-mediated play-based pragmatic language intervention.

The intervention consisted of ten weekly 50-minute sessions for students with ASD (ages 6–11, without intellectual disability) paired with typically developing peers. During each session, SLPs and OTs targeted individualized pragmatic language skills through:

  • Self video-modeling

  • “Feedforward” discussions of target skills (where you focus on what to do next time, vs. feedback.)

  • Child-led play

  • Peer and therapist modeling

Parents were encouraged to carry over targeted skills at home by reviewing videos, holding playdates, and reading a provided parent manual. See the original article and this article for even more details about this intervention.

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So which children benefited most? The results might surprise you.

  1. Children with higher separation anxiety, possibly because this intervention created a safe space with positive social interactions.

  2. Children with greater ability to use and interpret communicative intent, suggesting that this skill may be an important prerequisite for this type of pragmatic intervention.

  3. Children with lower nonverbal communication skills had better pragmatic outcomes, likely because the intervention targeted these exact skills.

As a school-based SLP, you might consider these results when determining which students would be appropriate for various intervention types. For instance, if a child has significant difficulty using and interpreting communicative intent, the type of intervention used here might not be your first line of treatment. When working with a high-anxiety student, you might consider a more structured session with one peer rather than pushing in to a classroom with 10 other students.

 

Parsons, L., Cordier, R., Munro, N., & Joosten, A. (2019). A play-based, peer-mediated pragmatic language intervention for school-aged children on the autism spectrum: Predicting who benefits most. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-04137-3

Using animal filters to help kids with ASD identify emotions

This study looked at whether the use of animal filters—or “anthropomorphic” stimuli—could help adolescents (12–17) with autism recognize and interpret emotions. The participants matched emotion words (angry, sad, afraid, happy, or surprised) to either photos of faces or the same photos with animal filters over them, like, this:

 
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Fun! And, the best part is, the animal filters made a big difference: the kids were significantly more accurate in matching when the animal filter was present (specifically, for “happy” and “angry”). Based on findings from previous research, the authors speculated that the animal filters may have increased the kids’ social interest and motivation, making it easier for them to focus on and correctly identify emotions. And, note, most of the participants also had an intellectual disability. The variability in cognitive and social functioning among kids with ASD makes finding appropriate evidence-based interventions challenging, so it’s great that this activity could theoretically work for a whole range of clients.

The researchers make it really easy to replicate this activity for your clients, too. The images they used are freely available for research purposes, but it would be just as easy to use your own photos or stock photos that you find online. And this free website was used to make the animal filters. Happy animal filter-making!

 

Cross, L., Farha, M., & Atherton, G. (2019). The animal in me: Enhancing emotion recognition in adolescents with autism using animal filters. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-04179-7

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).

Girls vs. Boys: Communication differences in autism

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If you work with students with autism, chances are you’ve noticed some communication differences between the boys and girls on your caseload. But how do you quantify these differences? Do they impact treatment? Are they even real?

We’ve touched on this topic before, but there isn’t loads of research on it at the moment. This preliminary study by Sturrock et al. takes a deeper dive into examining the language and communication profiles of females and males with autism.

The study explored the language and communication skills of 9–11-year-old children with ASD and IQ scores in the average range*, compared to age and gender matched peers with typical development (TD). Within both groups, female and male performance were examined separately. Note that each of the four groups was relatively small (13 children per group). Overall, though, they found some surprising (and not so surprising) differences among the groups.

The ASD group as a whole scored about the same as the TD group on measures of expressive and receptive language. However, the authors did see a subtle deficit in the ASD group when it came to narrative language tasks (an issue we’ve discussed before).

But what about those gender-related differences? Well, it turns out that within the ASD group, females outperformed males in pragmatic language and semantic language tasks. However, females with ASD still lagged behind matched females with TD. Another interesting difference? Girls in general consistently scored better than boys on “language of emotion” tasks (like listing as many feeling/emotion words as possible in one minute).

So what we do with these preliminary findings? Primarily, this study can help you consider potential areas of strength and weakness to look out for during evaluation and treatment of children with ASD. Young females with ASD may need some pretty high-end support with pragmatic and narrative skills to communicate effectively with peers (and that support may further require careful attention to that child’s social group— hello, individualization!)

Additionally, the authors make the case that by increasing our awareness of the female ASD profile, a historically under-diagnosed and misdiagnosed condition, we may be able to help these girls get identified and get access to services sooner rather than later.

*The authors refer to this as High-Functioning Autism.

 

Sturrock, A., Yau, N., Freed, J., Adams, C. Speaking the same language? A preliminary investigation comparing the language and communication skills of females and males with High-Functioning Autism. Journal of Autism and Developmental Disorders. doi: 10.1007/s10803-019-03920-6.