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.

Developmental, naturalistic options for preschoolers with autism

There are many, many options for teaching pragmatic skills to children with autism, varying from structured discrete trial training (DTT) to more naturalistic, child-led interventions. Often we think of behavioral and naturalistic approaches to therapy as an either/or. In reality, though, the majority of the interventions available for young children with autism use a naturalistic approach, based on developmental principles, while also pulling in elements of behavioral theory (recently, autism researchers coined the term “naturalistic developmental behavioral intervention,” or NBDI, to reflect these nuances).

This systematic review focuses on developmental social pragmatic (DSP) interventions (similar to NBDIs, but not including any explicit prompting, which is a more behavioral strategy). The researchers carefully defined DSP interventions using a core set of criteria to make sure they pulled just the right group of studies. DSP interventions:

  • Are based on developmental principles (hence the name!)

  • Use natural/play-based settings in therapy

  • Follow the child’s lead

  • Emphasize environmental arrangement and natural communication opportunities, and

  • Avoid explicit prompting (“Say ‘More Blocks’!”)

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Although DSP interventions (like NDBIs) incorporate some behavioral principles, they are not DTT—we’re talking about less structured learning opportunities here. Need examples? Think SCERTS (social communication, emotional regulation, transactional support intervention), DIR (developmental, individual difference, relationship-based intervention), PACT (parent-mediated communication-focused treatment), and More Than Words.

There are a few ways you might use a review like this. Have an intervention in mind and want to see if it made the list? Want to learn more about the evidence base for the intervention your school or clinic is already using? Or maybe you want to look into a new and different intervention for preschoolers with ASD? Whatever your purposes, keep in mind that (as with many systematic reviews and meta analyses) it’s a bit apple-and-oranges to compare the kids’ language outcomes across studies— we need more research to be able to say which DSP interventions lead to the biggest language gains. The results show us, though, that these interventions in general had positive effects on attention, engagement in social interactions, and initiations for preschoolers with ASD. Parent interaction styles improved, too, becoming less directive and more responsive. We love seeing outcomes like that! Overall, this article is a nice place to start organizing your thoughts on the many developmental social pragmatic options available for treating preschoolers with autism. 

Binns, A. V., & Oram Cardy, J. (2019). Developmental social pragmatic interventions for preschoolers with autism spectrum disorder: A systematic review. Autism and Developmental Language Impairments. doi:10.1177/2396941518824497

Throwback (2013): Grammar intervention for… social & literacy skills?

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Children with language disorders often struggle with social skills and literacy. While their IEPs might reflect grammatical deficits, we must consider how language issues might impact other areas of student’s lives. Is there a way to sneakily incorporate social and literacy skills into our grammatical interventions in an evidence-based way? The short answer is... yes!

Washington (2013) hypothesized that expressive grammar intervention could naturally support preschoolers to improve their social interaction and print concepts. In this intervention, preschoolers were asked to engage in a sentence-building task aimed at forming subject-verb-object sentences given various prompts. However, in addition to typical language-related prompting, SLPs integrated social and print concept features throughout therapy. Some of the techniques included:  

  • Guidance for listening and turn taking

  • Modeling appropriate toy play

  • Facilitating interactions with peers

  • Use of visuals to highlight morphemes

  • Pointing to words and letters while turning pages of a book

  • Highlighting book conventions such as directionality and orientation

These are things that many of us probably do without thinking during various types of therapy. However, this study provided evidence that purposefully adding elements of social and literacy skills can lead to significant, broad-based enrichment of social skills and emergent literacy. Children even maintained these social and literacy improvements for three months post-intervention. Your students with language disorders can get a three-for-one deal, just by attending your therapy sessions!

 

Washington, K. N. (2013). The association between expressive grammar intervention and social emergency literacy outcomes for preschoolers with SLI. American Journal of Speech-Language Pathology, 22, 113–125.