Early Intervention Strategies for individuals with Autism Sue E. McMillan, MClSc, SLP(C)

Early Intervention Strategies for individuals with

Autism

Sue E. McMillan, MClSc, SLP(C)

Introductions Speech-Language Pathologist=Speech-Language Therapist

Bachelor or Master’s degree in Human Communication Disorders

“Speech-Language Pathologists screen, assess, identifyand treat speech, language, voice, fluency (stuttering), swallowing and feeding problems for all age groups in addition to advocating for the prevention of these disorders.” Source: Speech-Language Audiology Canada

Role of SLP in AX & TXof Autism

Early identification of red flags for Autism

SLP frequently the earliest to identify red flags in children who demonstrate delayed communication, play and social skills development

Member of a multidisciplinary team (i.e., Developmental Paediatrician, SLP, OT, Behaviour Therapist, Early Childhood Educator, Art Therapist, etc.) to assess and/or treat children with Autism

RED FLAGS FOR AUTISMUNUSUAL WAYS OF PLAYING WITH TOYS

Turning toy cars upside down and spinning the wheels

Lying on the floor and staring at the wheels of toy cars as they roll

Spinning jars or lids of jars

Lining up toys

RED FLAGS FOR AUTISMSENSORY SEEKING OR SENSORY AVOIDANT BEHAVIOURS

Avoids eye contact with communicative partners

Frequently walking on tip toe

Flicking fingers in front of eyes or at side of eyes

Rocking

Spinning

Squeezing into tight spaces (e.g., between couch and wall)

Covering ears in response to loud noises

RED FLAGS FOR AUTISMUNUSUAL WAYS OF COMMUNICATING

Does not respond to own name

Leading a partner’s hand to an object/using a partner as a “tool”

Difficulty initiating conversation with others

Getting stuck on one toy or topic of conversation (e.g., only plays with or talks about Thomas the Tank Engine)

Does not notice where others are looking

Imitates exactly what others say

RED FLAGS FOR AUTISMCHALLENGING BEHAVIOURS

Has difficulty with making transitions from one activity to another

Gets very upset and cannot calm self or be calmed by familiar adult

Upset by small changes in routine like driving a different route or furniture location being changed in a familiar room

What is your role?TRUST YOUR “GUT”!

REMEMBER THAT YOU ARE THE EXPERT IN YOUR CHILD!

ADVOCATE FOR SERVICES: CONTACT OR MAKE REFERRALS TO PAEDIATRICIANS, NEUROLOGISTS, SLP’S, PSYCHOLOGISTS

CONTACT THE BARBADOS COUNCIL FOR THE DISABLED

EDUCATE THE BARBADIAN PUBLIC ABOUT AUTISM TO INCREASE AWARENESS AND TOLERANCE

What does “Autism” mean to me?

DEFINING AUTISMMy child has Autism. Autism is a complex disorder of brain

development. It makes it difficult for my child to understand what is said to them, express their wants and needs, play with others, and tolerate certain sensations. Sometimes my child becomes upset and has difficulty calming down. It is NOT because my child is “badly behaved”. It IS because he/she does not understand how to ask for help from others. Sometimes my child does things that you think are “strange”. My child simply sees the world in different ways than you and I. My child IS affectionate with people he/she knows. My child WANTS to communicate with others and is working hard to learn how.  

What can YOU do to help my child?

BE PATIENT. BE TOLERANT. TELL OTHERS ABOUT AUTISM.

StatisticsCurrent Canadian statistics: 1/94 individuals

have a diagnosis of Autism

100,000 in my home province of Ontario, Canada

If we use comparable statistics for Barbados: Approximately 2,900 individuals with Autism

WHAT IS THE MORAL OF THE STATISTICAL STORY?

WE NEED TO…

BE PATIENT

ACCEPT INDIVIDUALS WITH AUTISM IN OUR COMMUNITY

LEARN HOW WE CAN HELP SUPPORT INDIVIDUALS IN OUR COMMUNITY WHO ARE AFFECTED BY AUTISM

Common MythsMYTH: Individuals with Autism DO NOT WANT TO

INTERACT with others

TRUTH: Individuals with Autism often don’t know HOW to interact

MYTH: Children with Autism have no interest in toys

TRUTH: Children with Autism have difficulty exploring toys to learn what to do with them

Common MythsMYTH: Individuals with Autism are not affectionate

TRUTH: Individuals with Autism are just as individual as you and I. Some like physical contact, others don’t

MYTH: Individuals with Autism are all like “Rainman”

TRUTH: Individuals with Autism have a range of individual cognitive abilities

EARLY INTERVENTIONDr. Amy Wetherby, SLP, Director, Autism

Institute in the College of Medicine, Florida State University

Estimated lifetime societal cost of $3.2 million dollars per child with Autism

Her research has come up with a list of “red flags” that can be seen between 12-24 months of age

Why Early InterventionDR. WETHERBY’S RESEARCH HAS DEMONSTRATED

Intervention has the greatest impact before 3 years of age because this is the time of greatest “brain plasticity”.

Believes early “symptoms” of Autism, difficulty in communication and social interaction, lead to behaviour problems which are actually secondary to these early symptoms

So, treating early symptoms can reduce severity of secondary “behaviour problems”, which are actually communication.

Why Early InterventionResearch proves that the brain is most “plastic”

before the age of 5 years

EI can prevent restricted interests from becoming so deeply ingrained

Help children with Autism develop social relationships that they would not otherwise develop

Help child develop core skills in communication, play, behaviour and social interaction that are needed for school success

INTERVENTIONS FOR AUTISM

MANY DIFFERENT INTERVENTIONS PROVIDED BY DIFFERENT PROFESSIONALS

WIDE VARIETY OF THEORETICAL BACKGROUNDS

DIRECT THERAPIES WITH CHILD

PARENT TRAINING

EDUCATOR TRAINING

BIOMEDICAL INTERVENTIONS

OCCUPATIONAL THERAPYGROSS AND FINE MOTOR SKILLS

SENSORY INTEGRATION

PLAY

COGNITIVE SKILLS

ACTIVITIES OF DAILY LIVING

FEEDING

BEHAVIOURAL THERAPIESAPPLIED BEHAVIOUR ANALYSIS

Based on work of Dr. O. Ivar Lovaas

Focuses on principles that explain how learning takes place such as “Positive reinforcement”: When a behavior is followed by some sort of reward, the behavior is more likely to be repeated.

Team supervised by Psychologist specializing in behaviour

Direct intervention provided by Behaviour Therapists/Behaviour Analysts (sometimes SLP’s)

BCBA (Board Certified Behaviour Analyst)

BEHAVIOURAL THERAPIESVERBAL BEHAVIOUR

Uses principles of ABA and theories of B.F. Skinner

Usually delivered by Behaviour Therapists/Analysts

Focuses on WHY we use words

Motivate individual with Autism to learn language by connecting language with its purpose: imitating, requesting, commenting, communicating ideas

Goal to help individual to learn that words can obtain desired objects, attention, etc.

BEHAVIOURAL THERAPIESPIVOTAL RESPONSE TREATMENT

Developed by Dr.’s Robert and Lynn Koegel. Derived from ABA.

Delivered by SLP’s, Psychologists, Special Education Teachers

Play based and child initiated

Significant parent training and involvement in delivery of intervention

Goals to develop communication, language and positive social behaviours as well as relief from disruptive self-stimulatory behaviours

Targets “pivotal” areas of child development: motivation, response to multiple cues, self-management and the initiation of social interactions.

TEACCH BASED ON WORK OF DR. ERIC SCHOPLER

A FRAMEWORK FOR TEACHING THAT INCLUDES THE INDIVIDUAL’S STRENGTHS IN VISUAL INFORMATION PROCESSING AND DIFFICULTY IN SOCIAL, COMMUNICATION, ATTENTION AND EXECUTIVE FUNCTION

INCLUDES:

EXTERNAL ORGANIZATIONAL SUPPORTS TO SUPPORT CHALLENGES WITH ATTENTION AND EXECUTIVE FUNCTION

VISUAL AND/OR WRITTEN INFORMATION TO SUPPLEMENT VERBAL COMMUNICATION

STRUCTURED SUPPORT FOR SOCIAL COMMUNICATION

RELATIONSHIP DEVELOPMENT INTERVENTION

DEVELOPED BY PSYCHOLOGIST, DR. STEVEN GUTSTEIN

BEHAVIOURAL TREATMENT

PARENTS TRAINED IN RDI AND PROVIDE INTERVENTION UNDER GUIDANCE OF AN RDI CERTIFIED PROFESSIONAL

GOAL TO TEACH INDIVIDUALS WITH AUTISM TO BE “FLEXIBLE THINKERS”

KEY SKILLS TAUGHT INCLUDE:

APPRECIATION FOR DIFFERENT PERSPECTIVES

COPING WITH CHANGE

INTEGRATION OF INFORMATION FROM MULTIPLE SOURCES (E.G. SIGHTS AND SOUNDS)

FORM PERSONAL RELATIONSHIPS

THE GREENSPAN FLOORTIME APPROACH™

CREATED BY DR. STANLEY GREENSPAN

FOLLOW CHILD’S LEAD AND USE THEIR INTERESTS

BUILD RELATIONSHIP WITH THE CHILD

HELP CHILD PRACTICE BASIC THINKING SKILLS: ENGAGEMENT, INTERACTION, SYMBOLIC THINKING AND LOGICAL THINKING

DELIVERED BY VARIETY OF PROFESSIONALS

TRAINING PARENTS

PICTURE EXCHANGE COMMUNICATION SYSTEM

PECS: A PICTURE-BASED COMMUNICATION SYSTEM TO PROVIDE NON-VERBAL CHILDREN WITH A MEANS TO COMMUNICATE AND SUPPORT CHILDREN WHO HAVE LIMITED VERBAL COMMUNICATION

TRAINING CAREGIVERS TO USE IT WITH CHILDREN WITH AUTISM

ANYONE CAN ACCESS TRAINING

FREQUENTLY INTRODUCED BY SLP’S AND BEHAVIOUR THERAPISTS

MORE THAN WORDS®HANEN® PROGRAM FOR PARENTS OF CHILDREN WITH

AUTISM SPECTRUM DISORDERS CREATED BY SLP’s FERN SUSSMAN AND SUSAN HONEYMAN

DELIVERED BY HANEN® CERTIFIED SLP

TEACHES PARENTS AND CAREGIVERS TO USE DAILY ACTIVITES TO HELP CHILDREN:

IMPROVE SOCIAL SKILLS

ENGAGE IN BACK-AND-FORTH INTERACTIONS USING VERBAL AND NONVERBAL COMMUNICATION

IMPROVE UNDERSTANDING OF LANGUAGE

MORE THAN WORDS®TEACHES PARENTS AND CAREGIVERS:

How your child learns best and what motivates him to communicate

Why your child behaves in certain ways, and what you can do to increase or reduce those behaviours

How to use knowledge about your child to set realistic goals

How to make interactions with your child longer and more meaningful

Tips for using pictures and print to help your child understand

Tips on how to talk so that your child understands you

Strategies for developing play skills and making friends

MORE THAN WORDS®PARTICIPANT COMMENTS

“Every aspect of the training was extremely helpful.“

“I would recommend MTW to any parent who has a child with Autism.”

“He is able to communicate a lot more because he is speaking and interacting.”

“I am now more confident and equipped to work with the children in my class.”

“Allowing time for R. to respond or initiate has helped enormously.”

“I found that with M. he is speaking a lot more and seems a lot more settled when it comes to working.”

So, how do I “do” early intervention

USE EVERYDAY ACTIVITIES IN EVERYDAY ENVIRONMENTS TO CREATE LEARNING OPPORTUNITIES

MEALTIME

GETTING READY FOR SCHOOL

RIDING THE BUS

NAPTIME

BATHTIME

BEDTIME

So, how do I “do” early intervention

FAMILY CHORES

GROCERY STORE

PLAYGROUND

STORYTIME

HOMEWORK TIME

So, how do I “do” early intervention

MAKE LANGUAGE “COME ALIVE”

TALK ABOUT WHAT YOU DO AS YOU DO IT

LABEL OBJECTS, ACTIONS, USE DESCRIPTORS

So, how do I “do” early intervention

COMMUNICATIVE MEANS:

THE “HOW’S” OF COMMUNICATION

Watch the child and observe how they communicate

Looks at objects

Looks at a communicative partner

Leads a communicative partner by the hand

Gives objects to a partner

Combines any of these

So, how do I “do” early intervention

COMMUNICATIVE FUNCTIONS:

THE “WHY’S” OF COMMUNICATION

Watch the child and observe why they communicate:

To request

To protest

To ask for help

To establish joint attention so they can share information with a partner

To comment

To initiate play

So, how do I “do” early intervention

3 L’sLOOK AT YOUR CHILD

LISTEN TO YOUR CHILD

LEARN TO LOVE WHAT YOUR CHILD LOVES

So, how do I “do” early intervention

“3 L’S”ALLOWS YOU TO MAKE A CONNECTION WITH

THE CHILD

CONNECTION IS KEY TO BUILDING A BRIDGE TO COMMUNICATION

MEET THE CHILD WHERE THEY ARE

VIDEO CLIP OF LEARNING TO LOVE WHAT YOUR CHILD LOVES

So, how do I “do” early intervention

CREATE OPPORTUNITIES FOR THE CHILD TO COMMUNICATE

BE “THE KEEPER” OF THE GOODIES: INTRUDE A BIT

WAIT FOR THE CHILD TO INITIATE

BE FACE-TO-FACE

USE THE 3 L’s

So, how do I “do” early intervention

HOW CAN I HELP MY CHILD UNDERSTAND

Use JUST ENOUGH words: children with Autism frequently have difficulty processing oral language so we need to keep it simple for them

Be ANIMATED when you speak: children with Autism frequently have difficulty sorting out what information they need to pay attention to so we need to make the important information STAND OUT for them

Go SLOW: remember that your child is like a foreign language learner and will benefit from extra time to process information

Use VISUAL INFORMATION such as GESTURES, OBJECTS and PICTURES

Children with Autism learn best through their VISUAL CHANNEL

So, how do I “do” early intervention

VISUAL COMMUNICATION AIDS

GESTURES

3D OBJECTS

PICTURES OF REAL OBJECTS

PRODUCT WRAPPERS/LOGOS

PCS SYMBOLS/BOARDMAKER SYMBOLS

So, how do I “do” early intervention

VISUAL COMMUNICATION AIDS

FIRST-THEN BOARD

CHOICE BOARD

VISUAL SCHEDULE

SOCIAL STORY

PECS

RESOURCESThe Hanen Centre www.hanen.org

Autism Speaks www.autismspeaks.org

Autism Navigator www.autismnavigator.com

Geneva Centre for Autism www.autism.net

Speech-Language and Audiology Canada www.sac-oac.ca

Friend2Friend Learning Society www.friend2friendsociety.org

Barbados Council for the Disabled 427-8136

Sue McMillan, SLP encouragingexpressionslp@gmail.com