Slide 1 An Update to the Great 8 For SLPs and ASDs Presented by Lynn M. Dudek M.S., CCC-SLP, MBA, BCBA [email protected]___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 2 Who am I? ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 3 Introduction Why am I so passionate about supporting SLPs treating ASDs? What will you leave with today? My Preservice Academic Course Content on ASD Adequately Prepared Me to Serve Individuals with this Disability 37% 44% 17% 2% 0 10 20 30 40 50 60 70 80 90 100 Strongly Agree Agree Disagree Strongly Disagree Opinion Ratings Percentage of Respondants Following Graduation, I Would Rate My Knowledge of ASD as: 5% 14% 29% 52% 0 10 20 30 40 50 60 70 80 90 100 Minimally Knowledgeable Somewhat Knowledgeable Knowledgeable Very Knowledgeable Opinion Ratings ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
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For SLPs and ASDs An Update to the Great 8 20 14% 20 … Update to the Great 8 For SLPs and ASDs ... of incorporating behavior -based strategies into treatment. ... An unscored Parent/Caregiver
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Slide 3 IntroductionWhy am I so passionate about supporting SLPs
treating ASDs?
What will you leave with today?
My Preservice Academic Course Content on ASD Adequately Prepared Me to
Serve Individuals with this Disability
37%
44%
17%
2%
0
10
20
30
40
50
60
70
80
90
100
Strongly Agree Agree Disagree Strongly Disagree
Opinion Ratings
Pe
rce
nta
ge
of
Re
sp
on
da
nts
Following Graduation, I Would Rate My Knowledge of ASD as:
5%
14%
29%
52%
0
10
20
30
40
50
60
70
80
90
100
Minimally Knowledgeable Somewhat Knowledgeable Knowledgeable Very Knowledgeable
Opinion Ratings
Perc
en
tag
e o
f R
esp
on
dan
ts
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Slide 5
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Slide 6 Learner Objectives
After this course, participants will be able to list the necessary
components of comprehensive treatment for individuals with ASD.
After this course, participants will be able to explain the importance
of incorporating behavior-based strategies into treatment.
After this course, participants will be able to list 3-5 different types of
visual supports.
After this course, participants will be able to describe pros and cons
of AAC devices and communication apps.
After this course, participants will be able to discuss the importance
of collaboration with other professionals.
After this course, participants will be able to implement strategies to
increase motivation and compliance with those they serve.
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Slide 7 What are the Great 8?
Assessment
AAC
Behavioral Principles:
Reinforcement
Structure (schedules, visual supports)
Data
Social Skills
Sensory
Teamwork
Train your colleagues
Comprehensive Planning
Humor
Flexibility
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Slide 8
ASSESSMENT
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Slide 9 ASSESSMENT
The content validity of 57 outcome measurement tools was strong; however, there was minimal evidence of the tools' capacity to track outcomes of an intervention or progress over time. There was limited evidence for the measurement properties of standardized assessments and questionnaires that were developed for the general population, but applied to young children with ASD.
The majority of the tools identified (75/132; 57%) had no evidence that met the inclusion criteria of this review so their applicability for children with ASD could not be determined.
McConachie et. al, 2015
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Slide 10 ASSESSMENT
12 tools with a preponderance of positive evidence for three or more measurement properties (e.g., reliability, validity, responsiveness)were identified
Modules 1 through 4 provide cutoff scores for autism and autism spectrum classifications.
Modules 1 through 3 provide a Comparison Score indicating level of autism spectrum-related symptoms compared to children with ASD who are the same age and have similar language skills.
Non-verbal to verbal
Special training required
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Slide 13 CARS-2
CARS-2 (Schopler &Van Bourgondien, 2010)
Two 15-item rating scales completed by the clinician (each designed for a different population)
An unscored Parent/Caregiver Questionnaire Structured interview
24 months of age and up
Cutoff scores, standard scores, and percentiles
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Slide 14 GARS-2
GARS-2 (Gilliam, 2013)Assists in identifying autism in and estimating its severity
3 through 22
56 items
6 subscales:
Restrictive/Repetitive Behaviors
Social Interaction
Social Communication
Emotional Responses
Cognitive Style
Maladaptive Speech.
Standard scores, percentile ranks, severity level, and probability of autism.
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Slide 15 MacArthur-Bates Communicative
Development Inventory - 3
MacArthur-Bates CDI-3 (Dale, 2007)
Long & Short form Parent Questionnaire
8 to 37 months (older if they have a developmental delay)
CDI: Words and Gestures (for use with children 8–18 months)
CDI: Words and Sentences (for use with children 16–30 months)
CDI-III (for use with children 30–37 months)
Standardized assessment
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Slide 16 Social Responsiveness Scale - 2
SRS-2, (Constantino,2012)
Identifies the presence and severity of social impairment within the autism spectrum and differentiates it from other disorders
2.5 years through adulthood
5 Subtests
Social Awareness
Social Cognition
Social Communication
Social Motivation
Restricted Interests and Repetitive Behavior
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Slide 17 Assessment of Basic Language and
Learning Skills-Revised
ABLLS-R (Partington, 2006)
Birth to 12 years
Criterion-referenced
Leads right to goal development
Identify deficiencies in language, academic, self-help, and motor skills
Time consuming
Specific items to be used for assessment
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Slide 18 VB-MAPP-2
The Verbal Behavior Milestones Assessment and
Placement Program-2 (Sundberg, 2008)
170 Milestones are assessed and Barriers
Transition Assessment and Task Analysis and Skills
Tracking
Mand, Tacts, Early Echoics
Listener Responding, Visual Perceptual
Independent Play, Spontaneous Vocal
Classroom Routines, Group Skills
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Slide 19 Assessment
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Slide 20 Assessment
What about the kids with higher functioning skills???
Language tests for form and function
Pragmatic assessments for use
Observe across many settings
Use standardized assessments
Interview parents and teachers
1:1 formal settings WILL NOT work!
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Slide 21 Assessment
Pragmatic Assessment
Using language for different purposes
Changing language according to the needs of a listener or situation
Following rules for conversations and storytelling
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Slide 22 Assessment
Pragmatic Assessment
Using language for different purposes
greeting (e.g., hello, goodbye)
informing (e.g., I'm going to get a cookie)
demanding (e.g., Give me a cookie)
promising (e.g., I'm going to get you a cookie)
requesting (e.g., I would like a cookie, please)
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Slide 23 Assessment
Pragmatic Assessment
Changing language according to the
needs of a listener or situation, such as
talking differently to a baby than to an adult
giving background information to an unfamiliar listener
speaking differently in a classroom than on a playground
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Slide 24 Assessment
Pragmatic Assessment
Following rules for conversations and storytelling, such as
taking turns in conversation
introducing topics of conversation
staying on topic
rephrasing when misunderstood
how to use verbal and nonverbal signals
how close to stand to someone when speaking
how to use facial expressions and eye contact
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Slide 25 Assessment - Play
Absence of play skills
Play does not vary
Lack of spontaneous play
No social or “make believe” play
Elaborate or intricate building
THINK ABOUT THE SKILLS YOU NEED TO PLAY…
Early Social (1st six months of
life)
Peek-a-boo, early turn
taking, smiles.
Simple Pretend (18-24/36
months)
Realistic use of objects.
Advanced Pretend (2-4 years)
Pretend play, play out
scripts.
Over 4 years old
More complex, use
language to narrate and
plan play.
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Slide 26
AAC
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Slide 27 AAC
“The currently accepted evidence in the literature suggests that no
specific skills are prerequisite for successful use of AAC in the broadest
sense. AAC is an intervention approach that can be the beginning of
communication development for an individual. A number of AAC
options are available to begin the intervention process.”
“AAC is probably right for an individual when he or she presents with a
severe expressive communication impairment that interferes with or
prevents development and use of oral language.”
“AAC interventions are used whenever individuals are unable to rely
on speech to meet all of their daily communication needs.”
ASHA
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Slide 28
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Slide 29 APPS
iCommunicate
4x10 grid or task
completion picture
10,000 included SymbolStix, reap
pictures, or online image
Dynamic visual schedules,
storyboards, communication
boards, routines, flash cards,
choice boards, speech cards
Record voice
$49.99 iPad only
My Choice Board
Up to 6 picture choices with
phrase “I want”.
Icons from app library, web
searches, personal photo library
Ability to show a picture is not
available
Record voice
$9.99 iPad only
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Slide 30 APPS
iComm
Free version has 9 categories of
pictures, paid version has 20
Add own pictures
Record short voice messages
Confirm picture choice with
YES/NO option
Paid version is $7.99 iPad only
My Talk Tools Mac, Windows, Tablets,
Smartphones
12,000 Symbolstix and 1000 Public Library, plus own pictures
Mac, Windows, Tablets (iPad), Smartphones
Backup and save work
Quick Words folders for social interaction
Extreme customization
$39.99
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Slide 31 APPS
LAMP
1-Hit, Transition, and Full
vocabularies (83 to 3000+ words)
Language Acquisition through
Motor Planning
Vocabulary builder
Built on motor planning
Word Finder feature
iShare for SGD and iPads
$299 iPad and PRC devices
Tap Speak Choice
Text to speech or voice recording
Direct access or scanning
Pixon® symbol set, designed by
Gail Van Tatenhove
Anti-Stimming mode
Backup service available
Customize board sizes (4, 6, to 24
icons) with 101 pages and 1700
buttons
$49.99 iPad only
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Slide 32 APPS
COMPASS Screen is split into toolbar,
navigation bar, and page area (where communication happens)
Pages can be organized by Core Words, Quick Fires, customizable pages
Visual Scene Layout or Grid Layout
Levels Questionnaire for assist in set up (concepts, literacy, page organization)
Mayer-Johnson LLC - P.O. Box 1579, Solana Beach, CA 92075 U.S.A.
Phone 800-588-4548 or 858-550-0084.
www.mayer-johnson.com
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Slide 79 VISUAL SUPPORTS
Cartooning
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Slide 80 VISUAL SUPPORTS
Structured Teaching
RED
(place objects here)
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Slide 81
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Slide 82 VISUAL SUPPORTS
Other supports
Social Stories TM (Carol Gray)
Power Cards (Elisa Gagnon)
Incredible 5 Point Scale (Kari Dunn Buron)
Timers
Charts
Checklists
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Slide 83 VISUAL SUPPORTS
Other supportsSocial Stories TM (Carol Gray, 2000)
I am at school and it is Circle Time. The teacher will like it if I listen to her. I will try to sit, listen, and pay attention to the teacher. If I need to leave the circle I may sit in my beanbag chair or sit on my big pillow. These are good choices. My teacher or my aide will help me stay in circle or sit on my beanbag or pillow.
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Slide 84 SOCIAL STORIES There are three types of sentences used in writing social stories:
Descriptive sentences: objectively define anticipated events where a situation occurs, who is involved, what they are doing, and why. (e.g., When people are inside, they walk.)
Perspective sentences: describe the internal status of the person or persons involved, their thoughts, feelings, or moods. (e.g., Running inside could hurt me or other people.)
Directive sentences: are individualized statements of desired responses stated in a positive manner. They may begin “I can try…” or “I will work on…” Try to avoid sentences starting with “do not” or definitive statements. (e.g., I will try to walk in inside.)
A social story should have 3 to 5 descriptive and perspective sentences for each directive sentence.
Avoid using too many directive sentences. They will be lost without adequate contextualization.
Write in first person and on the child’s developmental skill level. Remember to use pictures that fit within the child’s developmental skill level to supplement text.
Broek, E., Cain, S.L., Dutkiewicz, M., Fleck, L., Grey, B., Grey, C., et al. (1994). The
Original Social Story Book. Arlington, TX: Future Education. www.thegraycenter.org
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Slide 85 VISUAL SUPPORTS
Power Cards (Elisa Gagnon, 2001)
Monkey wants everyone to know that it is very important to be able to handle anger appropriately. Monkey started working on controlling his temper when he was a very small chimp and he has advice for all little boys who feel angry.
The next time you feel angry, try doing these things that helped Monkey:
1. Ask an adult if you can go to a quiet spot and calm down for a few minutes.
2. Get a piece of paper and pencil and draw for a few minutes to calm down.
3. Talk to an adult, like mom or Ms. Lynn, and work on a solution.
Practice these things and you’ll be swinging just like Monkey.
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Slide 86 VISUAL SUPPORTS
1. Ask an adult if you can go to a quiet spot and calm down for a few minutes.
•Clasp hands at mid-line -- squeeze or rub them or push and pull.
•Make small rhythmic arm or leg movements.
•"Steamroller" or "sandwich" student (rolling therapy ball over student with firm,
steady pressure).
•Perform slow wall, table, chair or hand to hand push-ups.
•Provide more variety in seatwork.
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Slide 118 SENSORY
Fidgeting
•Provide frequent breaks in seatwork; reinforce student for completing each segment of work.
•Provide more variety in seatwork.
•Allow opportunities for movement in the class, e.g., Brain Gym.
•Allow students to kneel, stand, or lie on floor to do work.
•Put a non-slip surface or mat on the chair.
•Try a seat cushion or "Move 'N Sit".
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Slide 119 SENSORY
Fidgeting
•Redirect student. Hand child an object or book, redirecting the movements to a constructive task.
•Allow student to straddle chair (less likely to tip over).
•Have a "fidget box" available or allow student(s) to keep a small object in desk (small Koosh, rubber ball, sticky toy, pipe cleaner, sandpaper square, etc.).
•For students who are continually tapping a pencil on the desk, model tapping on arm shoulder or thigh - and smile. Now you have quiet tapping.
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Slide 120 SENSORY
Alerting/Focusing•(THINK: bright colors, high contrast, loud, dysrhythmic, light touch, vibration,
bouncy activities, contact sports, rough play, rotation movements, wide open
spaces.)
•Use bright lighting.
•Use lots of visual cues: prompts photographs, illustrations.
•Clear auditory cues ("eyes here"). Avoid verbal cues when student is confused.
•Play loud, fast-paced music before a lesson.
•Play music with a rapid or dysrhythmic beat.
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Slide 121 SENSORY
Alerting/Focusing•Have student put cool water on face.
•Hand play in tactile media.
•Explore different textures.
•Use hand-held vibrators (never over the neck or behind the ears).
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Slide 122
TEAMWORK
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Slide 123 TRAININGS
Basic Trainings
IT Training
Clinical Documentation
Principles of Applied Behavior Analysis
AAC and Devices
Second Stage Training
Positive Reinforcement Strategies
Meet with Behavioral Consultants
Clinical Mentorship – weekly trainings based on staff feedback (evaluation, social assessments, goal setting)
Specialty Trainings
Device Training with PRC
representative
Funding source training to
obtain devices
HBS/CPI Training
Out of Department Training
BCBAs
CPST/Behavioral Health Team
Behavior Support
Teachers, Aides, Floaters
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Slide 124
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Slide 125 Sensory and Biological
Provide a sensory diet
Monitor and address environmental stressors:
Sound, light, proximity/personal space, textures
Movement needs
Monitor and address:
Appetite/hunger
Activity level (e.g., fatigue, hyper)
Posture and movement
Medical needs
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Slide 126 Reinforcement
Provide reinforcement
Contingent on expected behavior
Frequent and consistent
Self-selected
Gradually decrease use
Provide range of reinforcers
Concrete, activities, privileges
Use restricted interests
Pair social with tangible reinforcement
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Slide 127 Structure and Visual/Tactile Supports
Create predictability
Prepare for change
Provide routine
Walk through new activities
Use visual supports to hold information still
Video
Stories and cartoons
Schedules and checklists
Graphic/tactile organizers
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Slide 128 Task Demands
Remove obstacles
Social
Sensory
Restricted patterns
Cognitive
Communication
Motor
Emotional
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Slide 129 Skills to Teach
Address skill deficits
Social
Sensory
Restricted patterns
Cognitive
Communication
Motor
Emotional
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Slide 130
HUMOR &
FLEXIBILITY
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Slide 131
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Slide 132
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Slide 133
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Slide 134 Resources
Kasari, C., Kaiser, A., Goods, K., Nietfeld, J., Mathy, P., Landa, R., . . . Almirall, D. (2014).
Communication interventions for minimally verbal children with autism: A sequential
multiple assignment randomized trial. Journal of the American Academy of Child and
Adolescent Psychiatry, 53, 635–646.
Carr, E., & Durand, M. (1985). Reducing behavior problems through functional
communication training. Journal of Applied Behavior Analysis, 18, 111–126.
Drager, K. D. R., Light, J., & McNaughton, D. (2010). Effects of AAC interventions on
communication and language for young children with complex communication
needs. Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach, 3, 303–
310.
Mirenda, P. (1997). Supporting individuals with challenging behavior through functional
communication training and AAC: Research review. Augmentative and Alternative
Communication, 13, 207–225.
Robinson, L., & Owens, R. (1995). Functional augmentative communication and
behavioral change. Augmentative and Alternative Communication, 11, 207–211.
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Slide 135 Resources
McConachie H, Parr JR, Glod M, Hanratty J, Livingstone N, Oono IP, et al. Systematic
review of tools to measure outcomes for young children with autism spectrum
disorder. Health Technol Assess 2015;19(41)
AHSAWeb. “Augmentative and Alternative Communication.” Augmentative and
Alternative Communication. Accessed September 23, 2017.
http://www.asha.org/NJC/AAC/
PracticalAAC. “AAC101Handout.” PracticalAAC. Accessed September 23, 2017.
http://praacticalaac.org
Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The impact of augmentative and
alternative communication intervention on the speech production of individuals with
developmental disabilities: A research review. Journal of Speech, Language, and Hearing
Research, 49, 248–264.
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Slide 136 Resources
Cohen, S. (2004). Social Relationships and Health. American Psychologist, 59(8), 676-684.
http://dx.doi.org/10.1037/0003-066X.59.8.676.
Quill, K. (1995). Teaching Children with autism: Strategies to enhance communication and