Treatment Options
American Sign Language
Children with autism, especially low functioning autism have trouble expressing what they want to say through speech, writing, or gestures. When these children cannot express themselves in traditional ways, they often choose other forms of expression. They may use idiosyncratic and unconventional means to communicate such as self-injurious behavior and echolalia. The child may also attempt to communicate through facial expression, body movement, posture, vocalization, crying, tantrums, etc. This behavior indicates that autistic children may be motivated to communicate but are limited to their use of conventional signals and in their inability to consider what the listener needs to know to understand their message (Berkell, 1992). Sign language is useful for those individuals who have little or no verbal abilities or communication skills. Persons with a variety of functioning levels can be taught to use sign language. Many behaviors associated with autism and other developmental disabilities such as aggression, tantrums, self-injury, anxiety, and depression, are often attributed to an inability to communicate to others. Signed speech allows the person to communicate using signs. Learning to speak is usually accelerated by teaching sign language and speech at the same time teaching sign language to people with autism and other developmental disabilities does not interfere with learning to talk and evidence indicates that teaching sign language along with speech accelerates verbal communication. Sign language has been suggested as another alternative means of communication for the approximately 45,000 – 55,000 nonverbal autistic children in the untied States (National Society of Communication for Autistic Children, 1978).
This form of communication has been successful for many reasons:
- The idea that for some autistic children, the use of simultaneous communication (a procedure in which the therapist accompanies each sign with the corresponding spoken word) might trigger or facilitate speech development.
- It has been suggested that although many autistic children have difficulty understanding spoken words, they seem to better understand gestures.
- A third advantage to sign language is that a parent or teacher can easily help by molding the child’s hands into the correct sign for a given word.
- There is often a concrete relationship between the sign and its referent.
- It has been mentioned that even though these autistic children are not deaf, a child who has acquired sign language can potentially be placed in a classroom and /or community for the deaf thereby increasing opportunities for academic, vocational, and social development.
If, instead, the child’s attempt to communicate can be acknowledged and expanded, difficult behaviors may begin to decrease. One of the greatest advantages to sign language programs is that, through them, it is possible to teach the child how to express his needs and wishes. It is an enormous accomplishment when a child can simply sign "finished" rather then having a temper tantrum.
The use of signing with autistic children has been growing consistently since the early 70’s. The hope is that the ‘easier’ sign language will provide a structure from which English can develop as a second language. The reasons why signing is ‘easier’ are probably multiple. Sign language is also more iconic than speech; autistic children learn iconic signs faster and retain them more readily than non-iconic ones. Signs are promptable - they can be physically guided. It is easier to make individual signs distinct than to separate individual words from the stream of speech. In the light of the ‘failure’ of speech programs, signing may be presented as a new activity - free from association with that experience of failure. All the studies report an increase in social awareness and a decrease in tantrums following the development of a system of communication. It is hoped that the child will learn to code his or her experiences and thus build up cognitive structures, which are the basis for much later learning.
Picture Communication
Picture communication is done by teaching an individual to communicate with others by using pictures of items they want instead of having to use verbal language. This is beneficial to individuals with autism and other developmental disabilities because, it requires very few complex motor movements to use it, therefore it is a mode of communication that can be used with individuals who have deficits in their motor repertoire. This system does not require the listener to be familiar with any additional language like sign language the picture is the word. This system is also low in cost and is portable to any location or environment.
Picture communication is based on child initiation: the child must request preferred items and then they receive the requested items as a result of the communicative act; this system also benefits the child by having generalization procedures built into the program. A picture communication system can be taken anywhere it allows a child to request items in any location, achieving generalization more rapidly (Schwartz, Garfinkle, & Bauer, 1998). Also, this system has evidence from several case reports that it can be rapidly learned and may increase oral communication skills. Bondy and Fost (1994) showed positive outcomes for 85 children who learned to use picture communication. Charlop- Christy, Carpenter, Lee, LeBlanc, and Kellet (2002) taught three children with autism to use picture communication, and showed a dramatic increase in their verbal and communicative intent, increase in social functioning, and a decrease in disruptive behaviors. Schwartz, Garfinkle, & Bauer (1998) also reported that children who had limited vocalizations continued to have increased spontaneous language following the use of picture communication, and children with no picture communication training showed no change in their spontaneous communicative intent. The notion that the use of picture communication may increase spontaneous speech is very important in and of itself, knowing this may allow non verbal children to become verbal overtime with the implementation of picture communication. Picture communication has been empirically validated as a successful way to teach functional communication to children and adults with autism, and therefore should be incorporated into an individuals program with limited communicative abilities or for those children/adults who prefer to communicate visually rather than orally.
Social Stories
A social story is a short story that describes a situation in terms of social cues and common responses (Gut & Safran, 2002). This provides individuals with impairment in social skills the opportunity to learn the correct responses and information regarding social situations. These stories are specifically developed for the individual and can be modified with pictures for individuals who do not yet read. The guidelines are those based on the research of Gray & Gray and have been proven effective for individual with autism in learning about new situations, transitions and changes in daily routines, situations that may invoke anxiety, social interactions, and a variety of academic, cognitive, and self help skills. The social story should be based on the individuals needs. The social story prepares the individual for upcoming events or new skills by providing the individual with information regarding the people and the setting, and the actual behavior responses he/she will need to emit in order to be successful in the situation (Gut & Safran, 2002). Remember when writing a social story to place yourself in that individuals shoes, observe the situation you are writing about and determine what elements of this situation may be causing the individual troubles. Contained within the social story one needs to include the purpose of the story, the people involved, describe the setting, describe what happens in sequence, give the reasons for why things are happening, give the responses required by the individual, and note what their personal feelings would be and reactions from others( Gut & Safran , 2002). To support individual with Autism Spectrum Disorder (ASD) would be with the use of social stories. Social stories have been used in numerous ways over the years to teach individual’s new skills with auditory comprehension and social skills deficits. Social stories are important because they help explain what is occurring and why (Gut & Safran, 2002). This is essentially important because people lacking social skills do not understand why certain things are important and why they need to be learned, Social stories put words and pictures together broken down into individual steps to stimulate the visual learner and allow them to comprehend material that was once thought of as only being able to be taught verbally (Barry & Burlew, 2004). According to the research of Kuoch & Mirenda, (2003) the three participants in their study diagnosed with autism were able to decrease the rate of problem behavior when social stories were implemented. Also, in a similar study by Hagiwara & Myles, (1999), the use of social story intervention with children diagnosed with autism was able to increase each child’s skill levels of on-task behavior and decrease problematic behavior. Research supports the use of social stories to teach a variety of skills and to decrease inappropriate behavior while replacing it with appropriate behavior.
Visual Schedules
Individuals with Autism Spectrum Disorder or other pervasive developmental disabilities often experience difficulties understanding, recalling, and using verbal information (Hodgdon 1995). This difficulty in processing verbal information can lead to a plethora of difficult situations for an individual with ASD i.e. social and behavioral. One way of aiding individuals with ASD to comprehend auditory information is with the use of visual supports. Visual supports are used to aide individuals with ASD to maintain attention, understand spoken language, and sequence and organize their environments (Hodogon 1995). This environmental support assists people with autism to organize their world, predict scheduled events, understand expectations, anticipate change in routine, make choices, and function more independently ( Heflin& Simpson 1998) Most individuals with ASD have difficulty following verbal information, the use of visual aides should be incorporated into their curriculum to learn new skills; self-help, social interaction; sharing, turn-taking, and academic situations Visual schedules are based on the “ First – then “ strategy; first you do ____, then you do ______. This allows the first expectation to be modified, as needed. The modification could occur in the amount of prompting provided to the individual to complete an activity or in order to accommodate the student’s daily fluctuations in their ability to process in-coming information, the Then part allows for consistency in terms of what activity is scheduled to come next (Structured teaching strategies 2005) . The use of visual Schedules makes the concept of time and activities more concrete to individuals with autism.
There are several important components of a visual schedule, which include, visual symbols, something on which to present the visual symbols (card board, laminated paper, chalkboard), and A means of indicating the activity is complete (finished box/ finished folder/ pocket). There are several reasons visual schedules benefit non-verbal individuals, especially individuals diagnosed with ASD. Visual schedules can be a way to introduce symbols that the individual can eventually use as an alternate form of communication. With consistent use of the schedule client begins to pair the symbols presented with the activities that are occurring, and using a visual schedule also helps in teaching the client to begin making choices. A visual schedule must be taught directly and consistently used. Visual schedules should not be seen as a support for individuals with autism which will eventually need to be faded from use or removed altogether; it should be seen as an assistive technology device that with its consistent use can increase independent functioning (Structured teaching strategies 2005).
The use of visual schedules is supported by both personal testimonials from parents, teachers, and caregivers, and by research supporting the effectiveness of graphic systems. Visual schedules are seen to be beneficial because they capitalize on the need fro predictability for those with autism on individuals with autism visual strength. The use of Visual supports seems to be beneficial, but there needs to be more research backing up the empirical validity for how it is used and what forms of visual representation are most beneficial to use with children with autism.
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