Pragmatic Language Intervention for Adults with Autism

autism

 

A man enters the room, apparently comfortable with his surroundings and with those around him. Despite his large physique, he exudes a gentle demeanor and a genuine kindness as he approaches the other adults in the room. He curtly nods to a few people in the room, and then takes a seat in his usual spot. As he scans the papers in front of him, his face lights up and he points to a picture representing the day’s refreshments. He smiles at the woman sitting next to him and carefully produces the words, “Want…snack.” He nods again and smiles with noticeable satisfaction.

This man’s name is Jim, and he is an adult with autism. Jim attends one of the two Adult Language and Pragmatics Skills (ALPS) programs offered at Towson University’s Hussman Center for Adults with Autism. Like many other individuals on the autism spectrum, Jim struggles to communicate verbally and to engage in meaningful social relationships. These difficulties represent unique challenges for Jim and other adults on the spectrum. To address these challenges, Jim attends the ALPS group each week and participates in meaningful activities designed to explicitly address areas of need. The activities target communication in a variety of social contexts, and participants show subsequent improvements areas of need.

In addition to the positive changes observed with group participants, the ALPS programs also are gaining positive attention from families in the greater Baltimore community. Jim’s mother recently expressed her appreciation for the ALPS group and for the noticeable improvements she sees in her son’s communication. She wrote, “There are not enough words to express my gratitude to you and your team. Jim’s communication did significantly increase with the Fall session. I know that your program is critical to Jim’s continued progress.”

So what makes the ALPS programs at Towson University effective and attractive? Some would say the impressive amenities available at Towson University’s Institute for Well Being facilitate the programs’ success. Admittedly, the rooms equipped with multi-media technology and the fully furnished apartment in which adults can practice skills are indeed helpful. But the ALPS groups also offer experiences purposefully designed to incorporate evidence-based practice techniques for optimal success:

  1. Mentor/Peer Role Models – The use of peer role models is well-supported in the literature as an evidence-based practice intervention (Llaneza, DeLuke, Batista, Crawley & Frye, 2010; McGee, Almeida, Sulzer-Azaroff & Feldman, 1992; Orsmond, Krauss & Seltzer, 2004). Mentors from the ALPS groups include graduate student clinicians earning clinical hours in the speech-language pathology program, as well as undergraduate mentors earning service learning hours. Mentors plan the group sessions as well as individualized activities to target specific goals agreed upon by mentors and participants. The mentor-participant relationship emerges as a mutually-beneficial partnership in which each party experiences growth and personal satisfaction. Participants learn from the mentors through direct modeling experiences, and the mentors gain invaluable experience with adults on the spectrum. Often, the student mentors indicate that their perceptions of autism significantly change as a result.
  1. Relevant Topics – To foster meaningful learning experiences relevant to the unique challenges that adults with autism face, topics are selected that directly relate to participants’ everyday lives. Topics vary from semester to semester, but generally include practical themes such as nonverbal communication, managing emotions in moments of conflict, dating and relationships, self-advocacy, communication in the workplace, and increasing independence. Many participants suggest ideas for topics, and sessions are planned with the participants’ specific needs in mind.
  1. Universal Design for Learning Standards – To target specific strengths and needs of participants in the group and to incorporate learning style preferences, sessions are planned utilizing Universal Design for Learning (UDL) guidelines. The UDL approach asserts that to best meet the individual needs of diverse groups of learners, clinicians should offer (a) multiple means of presentation, (b) multiple means of response and (c) multiple means of engagement (Rose & Gravel, 2010). The ALPS groups at Towson University incorporate UDL standards in several specific ways:
    • Technology Tools – to increase engagement and to provide additional visual representation, ALPS groups routinely incorporate multi-media videos, interactive whiteboard activities, iPads, smartphones, and personal communication devices into learning experiences.
    • Response systems – to facilitate and maintain engagement of the group and to include nonverbal responders, discussions are often supplemented with systems that allow all participants to answer questions and express opinions simultaneously. Pinch cards, signs, color-coded paddles and gestures are all used to facilitate each participant’s communication of ideas and opinions.
    • Kinesthetic and tactile experiences – to include kinesthetic/tactile learning styles and to address participants’ need for movement for regulating sensory input, all sessions include activities requiring the participants to move. Sometimes the movement also serves as a mode of response (e.g., moving to a designated location in the room to indicate a choice), further integrating UDL guidelines.
    • Differentiated supports – to meet the needs of individual learners in a diverse group, activities are adapted specifically for each participant. Student mentors often create and implement visual supports, and provide hierarchical prompts to promote the highest levels of success and independence.
  1. Experiential Learning Opportunities – to address multiple learning styles and to provide hands-on practice, sessions often include functional activities that utilize social communication skills. Group members participate in role play activities, everything from acting out scripted dyadic communication to real-world experiences like ordering food in a restaurant. Participants do not simply listen to an instructor talking about strategies for successful communication; rather, participants engage in direct and relevant experiences that target effective communication and self-advocacy.
  1. Social Connection Opportunities – ALPS sessions are comprised of a variety of social experiences, encouraging participants to connect with others through structured practice. Whole group, small group and individual experiences are offered weekly as group members discuss ideas and opinions relevant to the session topic. Activities that foster partnership and cooperation are also utilized, encouraging participants to step out of their comfort zone as they practice social skills.
  1. Reflection and Review Experiences – All participants are encouraged to reflect on their experiences and to review important strategies. Each week, participants and mentors discuss progress and identify goals for the participant to consider in the week ahead.
  1. FUN – As one participant freely offered, “I don’t learn much when I’m bored. But I always remember the fun parts!” A preference for fun is certainly not unique to the autism population. Don’t we all remember the fun parts? To maintain an enjoyable and social atmosphere, sessions are planned using central themes. Activities, snacks, and even attire may revolve around the designated theme. Past selections include favorite movie, sport, travel and holiday themes. To further the fun, ALPS groups end each semester with a celebration party in which each group member is recognized for personal achievements.

All of these techniques are integrated into meaningful ALPS sessions for the advancement of pragmatic language and social skills. Future projects at the center include studies to objectively evaluate treatment efficacy and functional outcomes of the participants and mentors. While the ALPS groups continue to adapt and improve, the current success of the programs remains readily apparent. As we work to document improvements and successes, we are continually inspired by the adults who come to our center. Adults like Jim, entering our rooms with nods and smiles, looking for fun and friendly faces. Our hope is that these special adults feel equally inspired, and that they leave our rooms feeling successfully connected.

 

Lisa Geary, M.S., CCC-SLP, serves as Clinical Assistant Professor in the Department of Audiology, Speech-Language Pathology and Deaf Studies at Towson University. In addition to teaching and supervising graduate students in the on-campus Speech-Language Center, Lisa serves as program facilitator for the Adult Language and Pragmatic Skills Groups at Towson’s Hussman Center for Adults with Autism. Her teaching and research interests include Universal Design for Learning, Autism through the Lifespan, Augmentative and Alternative Communication (AAC), and Instructional Technology. Lisa can be reached at lgeary@towson.edu

 

References

Orsmond GI, Krauss MW, Seltzer MM. Peer relationships and social and recreational activities among adolescents and adults with autism. Journal of Autism Dev elopmental Disorders, 2004; 34:245–256.

LLaneza DC, DeLuke SV, Batista M, Crawley JN, Christodulu KV, Frye CA. Communications, interventions and scientific advances in autism: a commentary. Physiol Behav. 2010;100:268–276.

McGee, G. G., Almeida, M. C., Sulzer-Azaroff, B., Feldman, R. S. (1992). Promoting reciprocal interactions via peer incidental teaching. Journal of Applied Behavioral Analysis. 25 117–126.

Rose, D.H. & Gravel, J.W. (2010). Universal design for learning. In E. Baker, P. Peterson, & B. McGaw (Eds.). International Encyclopedia of Education, 3rd Ed. Oxford: Elsevier.

 

 

 

Making the Most of Summer Fun: Language-Based Activities for Children & Their Families

With summer just around the corner, many parents and teachers are already making plans for summer fun. Do you need ideas for speech-language activities during the summer break? Read on!  Here are my top suggestions for fun, language-based activities that target communication skills in memorable ways.

Take a walk – A walk that incorporates language skills can be as simple as a stroll around the block, or as complex as an afternoon hike to a scenic destination. As you walk, encourage conversation by asking open-ended questions or observations like, “I wonder what this is!”  Take note (out loud) of things that you see, hear, discover and enjoy, encouraging your child to do the same. You could also create a game or scavenger hunt for your walk, prompting your child to search for and label objects using a picture checklist:

Plan Day Trips – Take trips to local beaches, parks, museums or amusement parks. These excursions are not only fun, but they give your child the gift of developing background knowledge, or schema – an important database of personal experiences that become essential for reading comprehension. Providing your child with a variety of life experiences gives them a broader vocabulary base and fosters personal connections to text and stories. These connections will prepare children for higher level skills as they are introduced to new reading material and participate in group discussions. Day trips are also good practice for language formulation, planning and organization skills, and they offer many opportunities to reinforce conversational behaviors, language use and comprehension. Here are some select visuals that target these skills:

Take a Road Trip – If you are planning a vacation this summer, take advantage of the many built-in opportunities to develop communication skills. Trapped in the car for hours? Resist the urge to “autoplay” your ride with DVDs or handheld electronic devices. Why not target speech-language skills with games that kids love and will very likely remember for years? “I Spy,” license plate games or find-the-alphabet contests all target verbal skills and a variety of language concepts. You could also create a Seek-and-Find activity for your trip, like this downloadable version:

 Make a Treat – What activity is more rewarding than one that ends in a fun treat to eat? Simple recipes can target a variety of language skills and are a favorite with kids. Practice following directions, using descriptive concepts, sequential vocabulary and more with real tools and materials.  Here is a super easy treat I’ve made with my own children and students, with visual directions that allow for review after you are done:Go to the Movies – ‘The movies’ are not exactly the first thing that comes to mind when one thinks about fostering communication skills. How can sitting passively in a dark theater target speech-language goals? But let’s face it – many parents can become desperate to find an enjoyable activity for the kids on those stifling hot, lazy days of summer. Enjoying an air-conditioned theater for a two hour respite can be just what you and your child need. (For children with sensory issues that make trips to movie theaters a challenge, look for sensory-friendly movie times, like those offered in AMC theaters.) In addition to creating motivating content for future discussions and activities, movies also generate opportunities for language before and after your excursion. Decide with your child what you will seewhere and when you will see it. After the show, review with your child the movie plot, characters and sequential events. Ask questions like, “What was your favorite part? Why?” to help your child formulate and support their opinions. Offer your own opinion, too! Encourage critical thinking skills by asking “why”  “how” and “what if” questions. Some families I know even keep a log of movies they see throughout the year, giving each movie a rating after a family movie discussion.

Schedule Playdates – Effective speech-language therapy often includes group sessions to promote socials skills and to create opportunities that reinforce generalization of skills. Foster peer interaction, interactive play, functional communication and other skills by arranging a short playdate. Around two hours is a good length of time for a get-together, allowing ample opportunities for play, exploration and a small snack. Offer a few summer activities (bubbles, balls, sand toys, etc) and encourage conversation/interaction, but do resist the urge to organize their activities. Children need time to develop play with each other and discover what is motivating or fun in the moment.

Read, Read, Read – Reading with your child is one of the best activities you can do to promote language and literacy skills. Studies show that time spent reading with your child is the best predictor of overall academic success. The AmericanAssociation of School Librarians reported a study, (Wells, 1988) where researchers found that “the amount of experience that five-year-old children had with books was directly related to their reading comprehension at seven and eleven years old. Wells stated that of all the activities considered possibly helpful for the acquisition of literacy, only one—listening to stories—was significantly associated with later test scores.” Read more.

Not sure how to incorporate language into reading? The U.S. Department of Education outlines things you can do to help your child develop language and literacy skills. Read more.

Whatever your plans this summer, do take time to engage with your child in real ways using everyday activities. For more ideas/activities that target communication skills, please visit my speech-language blog at LiveSpeakLove.

(This post originally appeared on LiveSpeakLove)

 

Lisa Geary, MS,CCC-SLP, is an SLP working in the Baltimore County Public Schools in Baltimore, MD. She also recently establishing her own private practice to supplement her school-based position. Lisa enjoys a diverse student caseload, servicing preschool and elementary school students in general and special education settings. Lisa especially enjoys working with students on the Autism spectrum and with students using low-tech communication supports and/or AAC/AT devices. With personal interests in the application of technology and in the creation of speech-language resources, Lisa maintains a blog highlighting these efforts.