Unit 3: Teaching strategies for individuals with ASD

 

3.1.  Structure and Visual Support (TEACCH, Structured Teaching)

3.2.  Behavioural Strategies and Approaches (e.g., Applied Behaviour Analysis (ABA), Verbal Behaviour Analysis (VBA), Cognitive Behaviour Therapy (CBT), Reinforcement

3.3.  Social Strategies and Approaches (e.g.,social stories, Comic strips, Peer-Mediated Programs)

3.4.  Strategies and Approaches (e.g., Learning Experiences and Alternate Program for Pre- schoolers and their Parents (LEAP), Early Start Denver Model (ESDM), The Joint Attention, Symbolic Play, Engagement & Regulation (JASPER), Floortime)

3.5.  Consideration for Learning and Teaching Methods in ASD

 

 

 

 

 

 

 

 

 

 

 

3.1         Structure and Visual Support (TEACCH, Structured Teaching)

 

 

Structured Teaching is a set of teaching techniques developed by Division TEACCH (Training and Education of Autistic and related Communication-handicapped Children), a state-wide program serving individuals with autism spectrum disorders (ASD) in North Carolina.

Division TEACCH is a comprehensive treatment model that serves individuals with autism across the lifespan. Along with the structured teaching strategies, the model emphasizes an extensive understanding of autism, partnering with families, individualized assessment when developing and implementing strategies, and the development of skills across curriculum areas (with attention to the development of communication and social skills).

Structured teaching strategies can be implemented across settings and across curriculum area, as they serve as a vehicle to teach skills, and/or as a framework for a classroom setting.

These teaching strategies are based on an understanding of how autism impacts the thinking, learning, and behavior of an individual with ASD. Differences in auditory processing, imitation, motivation, and organization can hinder the educational success of students with ASD, as most traditional teaching strategies rely heavily on verbal instructions, demonstration, social reinforcement, and sequencing chunks of information or directives.

Structured Teaching strategies, however, capitalize on the strengths of students with ASD. These include providing predictable and meaningful routines through the use of structure, adding visual/structural supports to classroom instruction and activities to increase engagement and independence, and clearly organizing classroom spaces and teaching materials to reduce anxiety and increase appropriate behavior.

There are five elements of Structured Teaching that build on one another, and all emphasize the importance of predictability and flexible routines in the classroom setting. Division TEACCH developed a visual to illustrate the Structured Teaching components — the Structured Teaching pyramid:

Physical structure in the school setting

Physical structure is the foundation of structured teaching and is helpful in ensuring that learning is occurring in the classroom.

Visual schedules in the school setting

A visual schedule communicates the sequence of upcoming activities or events through the use of objects, photographs, icons, words, or a combination of tangible supports.

Work systems in the school setting

A work system is an organizational system that gives a student with ASD information about what is expected when he/she arrives at a classroom location.

Visual structure in the school setting

Visual structure adds a physical or visual component to tasks to assist students in understanding HOW an activity should be completed. 

 

 

 

3.2         Behavioural Strategies and Approaches (e.g., Applied Behaviour Analysis (ABA), Verbal Behaviour Analysis (VBA), Cognitive Behaviour Therapy (CBT), Reinforcement

 

Problem Behaviours — like all behavior — serves a function, usually one of these:

Your child’s difficult behaviour might also have specific triggers, like the following.

·      Routines and rituals
Children with ASD often like predictable environments, and they can get very upset if their familiar routines are broken. For example, your child might be upset if you change the route you usually take home from school.

·      Transitions
Your child might not understand it’s time to move on from one activity to another. Or like typically developing children, your child just might not want to.

·      Sensory sensitivities
Children with ASD often have sensory sensitivities and might like feeling or touching particular surfaces or objects. Your child might get upset if they aren’t allowed to touch.

·      Sensory overload
Your child might get upset if too much is happening around them, if they find a particular noise overwhelming, or if the light is too bright.

·      Unrealistic expectations
Like all children, your child with ASD can get frustrated if they’re expected to do something they don’t have the skills for, like getting dressed independently.

·      Tiredness
Children with ASD can have sleep problems. If your child isn’t getting enough good-quality sleep, this can cause difficult daytime behaviour.

·      Discomfort
This could include things like the feeling of clothes against skin, a prickly label, wet pants, a bump or pain. Check with your GP if you suspect there could be a medical condition causing your child’s behaviour.

·      Other conditions
Your child might have other conditions as well as ASD, like epilepsy, mood disorder or ADHD. These can all cause difficult behaviour. A medical assessment will help you to identify and manage these conditions.

Behavioral interventions are now considered an “established” treatment for ASD children, although they should not be expected to lead to normal functioning. They may improve the core symptoms of ASD, mainly in the first 12 months of treatment. Behavioral interventions are those in which instrumental learning techniques constitute the predominant feature of the intervention approach, based on the principles of behavior modification.

Ivar Lovaas and colleagues pioneered one of these intensive behavioral interventions, Applied Behavioral Analysis (ABA) in the 1960s. It seeks to reinforce desirable behaviors and decrease undesirable behaviors, teaching new skills and generalizing them through repeated reward-based trials. It requires a low student-to-therapist ratio and very intensive intervention (at least 25 hours a week). At this time, this is the only evidence-based approach to intensive early intervention for children with autism.

Discrete trial training (DTT), originally developed by Ivar Lovaas, is the most structured form of intensive therapy. It consists of breaking down skills into more discrete components to be taught in a stepwise fashion: the therapist presents an instruction (stimulus), prompts a response, waits for the child’s response, and provides an appropriate consequence depending on the response. The original behavioral interventions, based almost exclusively on DTT techniques, were developed at the University of California, Los Angeles under the Young Autism Project, and although they have demonstrated benefits in attention, imitation, obedience and discrimination, they have been criticized because of the lack of generalization and because the structured setting does not represent more naturalistic interactions between adults and children.

For this reason, contemporary ABA programs have been developed, which are taught in more naturalistic settings, with methods like Pivotal Response Training (PRT), the Natural Language Teaching Paradigm  or Incidental Teaching, where the child initiates the interaction, improving the generalization of the skills. In the current literature, the term Early Intensive Behavioral Interventions (EIBI) has arisen to summarize all these approaches, and it is accepted that they promote changes in the intelligence quotient and positive changes in adaptive skills and expressive and receptive language skills. New trends in the Contemporary ABA techniques include Positive Behavioral Support, Functional Assessment  and Functional Communication Training, with its “errorless” teaching.

APPLIED BEHAVIOR ANALYSIS (ABA)

Applied Behavior Analysis (ABA) is a type of therapeutic intervention that can improve social, communication, and learning skills through reinforcement techniques. In addition to improving general adaptive behaviours, such as social skills, learning skills, it can focus on specific skill learning such as fine motor dexterity, hygiene, grooming, etc. Some also call it Autism Behavioural Therapy but it’s just one of ABA’s applications. ABA is effective for both children and adults with psychological conditions in a variety of settings, including schools, homes, and clinics. It has also been shown that consistent ABA therapy can significantly improve positive skills and behaviours and decrease the need for special services in the future

ABA therapy programs can help:

● Improve language and communication skills

● Increase attention, focus, social skills, memory, and academics

● Reduce the occurrence of behavioural problems

Applied Behavior Analysis (ABA) is a type of therapy based on the psychology of learning and behavioural trades. ABA therapy applies the understanding of how behaviour works in real-life situations, to increase behaviours that are helpful and decrease behaviours that are harmful or affect learning. Applied Behavior Analysis involves several techniques for understanding and changing behaviour. ABA is a form of flexible treatment that can be adapted to meet the needs of each unique person. It can also be provided in many different locations – at home, at school, and in the community. ABA therapy can involve one-to-one teaching or group instruction ABA therapy programs can help:

A qualified behavioural psychologist designs and directly oversees the program. They customize the ABA program to the child’s skills, needs, interests, preferences, and family circumstances. The ABA program is started with a detailed assessment of the child’s existing skills and preferences in order to formulate specific treatment goals. Treatment goals are decided after taking into consideration the age and ability level of the child with autism. Goals can include different skill areas, such as:

● Communication and language

● Social skills

● Self-care behaviours

● Play and leisure

● Motor skills

● Learning and academic skills

The instruction plan breaks down each of these skills into small, concrete steps. The therapist teaches each step one by one, from simple (e.g. imitating single sounds) to more complex (e.g. carrying on a conversation). Progress is measured by collecting data in each therapy session. Data helps to monitor the child’s progress toward goals on an ongoing basis.

The therapist egularly meets with family members to review information about progress in order to plan ahead and adjust teaching plans and goals accordingly.

5 Techniques Used in Applied Behaviour Analysis

Applied Behavior Analysis involves several techniques to produce desired results in children who can benefit from behaviour modification. Here are five of those valuable techniques:

Positive Reinforcement

A child with special needs who face difficulties in learning or social interaction may not know how to respond in certain situations. One way to encourage positive social behaviours involves using positive reinforcement immediately to encourage the behavior in the future.

Negative Reinforcement

When maladaptive behaviours occur, the behavior needs to be corrected immediately. A good way to correct bad behavior is to remove a desired object or activity from the child. This is a form of non-aversive punishment. More importantly, negative reinforcement should be consistent for the child to understand the relevance of the action and consequence.

Using prompts and cues

Prompts are visual or verbal cues used to encourage a particular behaviour. Verbal cues are gentle reminders while visual cues are even less direct and might be a gesture or a look of your eyes. The child will see this cue and be reminded to behave in a simple way. Examples could be taking their shoes off when walking into the house or washing their hands before a meal. The idea is to eventually fade out the prompts when the child no longer needs them. The prompts can be helpful because they are typically not intimidating or accusatory.

Task Analysis

This is an analysis model of current behavioural trends and actions to help learn about the child rather than correct or reinforce the behaviour. The child psychologist gives the child a task and observes how they perform it. This analysis is broken down into a number of categories :

● Physical actions

● Cognitive actions

● Repetition

● Allocation

● Environment

Once the therapist has analysed how the child performs tasks, this information is used to make other tasks easier for the particular child by breaking them down into steps that will be easily understood by the child.

Generalization

Through this model, the therapist takes what the child has learned in one instance and applies it to other instances. For example, If a child knows how to say the alphabet when singing it, the child psychologist can take their knowledge of the alphabet and try to apply it to teaching the child to spell out their name.

Children with special needs benefit the most from personalized and special assistance. Therapists who use applied behaviour analysis use these particular techniques and others that help make children who need a little more help independent, well adjusted and happy adults.

 

Applied Behavior Analysis involves many techniques for understanding and changing behavior. ABA is a flexible treatment:  

Positive Reinforcement

Positive reinforcement is one of the main strategies used in ABA.

When a behavior is followed by something that is valued (a reward), a person is more likely to repeat that behavior. Over time, this encourages positive behavior change.

First, the therapist identifies a goal behavior. Each time the person uses the behavior or skill successfully, they get a reward. The reward is meaningful to the individual – examples include praise, a toy or book, watching a video, access to playground or other location, and more.

Positive rewards encourage the person to continue using the skill. Over time this leads to meaningful behavior change. 

Antecedent, Behavior, Consequence

Understanding antecedents (what happens before a behavior occurs) and consequences (what happens after the behavior) is another important part of any ABA program.

The following three steps – the “A-B-Cs” – help us teach and understand behavior:

1.     An antecedent: this is what occurs right before the target behavior. It can be verbal, such as a command or request. It can also be physical, such a toy or object, or a light, sound, or something else in the environment. An antecedent may come from the environment, from another person, or be internal (such as a thought or feeling).

2.     A resulting behavior: this is the person’s response or lack of response to the antecedent. It can be an action, a verbal response, or something else.

3.     A consequence: this is what comes directly after the behavior. It can include positive reinforcement of the desired behavior, or no reaction for incorrect/inappropriate responses.

Looking at A-B-Cs helps us understand:

1.     Why a behavior may be happening

2.     How different consequences could affect whether the behavior is likely to happen again

EXAMPLE:

How could ABA help the student learn a more appropriate behavior in this situation?

With continued practice, the student will be able to replace the inappropriate behavior with one that is more helpful. This is an easier way for the student to satisfy the child’s needs!

Applied Behavior Analysis (ABA) is a type of therapy that focuses on improving specific behaviors, such as social skills, communication, reading, and academics as well as adaptive learning skills, such as fine motor dexterity, hygiene, grooming, domestic capabilities, punctuality, and job competence. ABA is effective for children and adults with psychological disorders in a variety of settings, including schools, workplaces, homes, and clinics. It has also been shown that consistent ABA can significantly improve behaviors and skills and decrease the need for special services.

VERBAL BEHAVIOUR ANALYSIS (VBA)

Based on the principles of B. F. Skinner's book called Verbal Behavior, this therapy is designed to teach communication skills. What makes it different from conventional speech therapy is that it is designed to connect the child's motivation to speak with the function or purpose of the word. The child learns the purpose of language is to ask for things, label items, understand verbal directions, answer questions and use phrases to communicate.

This approach encourages people with autism to learn language by connecting words with their purposes. The student learns that words can help them get desired objects or results.

Verbal Behavior therapy does not focus on words as labels only (cat, car, etc.). Rather, it teaches why we use words and how they are useful in making requests and communicating ideas.

Language is classified into types, called “operants.” Each operant has a different function. Verbal Behavior therapy focuses on four word types:

VB and classic ABA use similar techniques to work with children. VB methods may be combined with an ABA program to work towards communication goals.

How is this therapy different from ABA or Speech Therapy?

Most Discrete Trial Testing and ABA programs originate from a more traditional language system which focuses on receptive(interpret information) and expressive (spoken language) skills.Verbal Behavior Therapy begins with teaching "mands" or requests for desired items like a cookie or candy. The child

quickly learns that asking for someone is meaningful because they get what they want.  Pointing is especially encouraged in the beginning. A child doesn't need to speak to be referred to as verbal. He/she simply needs to be able to communicate. This can involve gestures like pointing, sign language, picture exchange and AT. VBA isn't as structured as ABA and emphasizes mixing and varying what is being taught. It requires less documentation during the actual teaching session.

 

How does it work? 

Verbal Behavior therapy begins by teaching mands (requests) as the most basic type of language. For example, the individual with autism learns that saying “cookie” can produce a cookie.

As soon as the student makes a request, the therapist repeats the word and presents the requested item. The therapist then uses the word again in the same context to reinforce the meaning.

The person does not have to say the actual word to receive the desired item. At first, he or she simply needs to make a request by any means (such as pointing). The person learns that communicating produces positive results.

The therapist then helps the student shape communication over time toward saying or signing the actual word. 

In a typical session, the teacher asks a series of questions that combine easy and hard requests. This allows the student to be successful more often and reduces frustration. The teacher should vary the situations and instructions in ways that keep the student interested.

Errorless Learning

Verbal Behavior therapy uses a technique called “errorless learning.”

Errorless teaching means using immediate and frequent prompts to ensure the student provides the correct response each time. Over time, these prompts are reduced. Eventually the student no longer needs prompting to provide the correct response.

EXAMPLE

Step 1: The therapist holds a cookie in front of the student and says “cookie” to prompt a response from the child.

Step 2: The therapist holds the cookie and make a “c” sound to prompt the response.

Step 3: The therapist holds the cookie in the child’s line of sight and waits for the request with no cue.

The ultimate goal is for the child to say “cookie” when he or she wants a cookie – without any prompting.

What is the intensity of most VB programs?

Most programs involve at least one to three hours of therapy per week. More intensive programs can involve many more hours.

Instructors train parents and other caregivers to use verbal-behavior strategies in their daily life.

Who can benefit from Verbal Behavior therapy?

Verbal Behavior Therapy can help:

 

COGNITIVE BEHAVIOR TECHNIQUES

v Cognitive behavioral therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave.

v Therapists or computer-based programs use CBT techniques to help individuals challenge their patterns and beliefs and replace "errors in thinking such as over generalizing, magnifying negatives, minimizing positives "with "more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior.

v The origins of Cognitive Behavioral Therapy (CBT) dates back to the Behavioral Therapies and their development in the early 20th century, and correlate with the development of Cognitive therapy in 1960, and consequently resulted in their fusion. Their effectiveness has been demonstrated by numerous clinical studies in the treatment of various psychiatric disorders. Aaron Beck is considered to be the father of Cognitive Therapy, and his focus was initially on targeted treatment of depression. He thought that in depression there is a distortion of thoughts that is mainly focused on the negative perception of themselves, negative interpretation of the environment and the negative expectations in the future [1]. High efficacy of Cognitive Bihevioral Therapy is demostrated in the treatment of depression, generalized anxiety disorder, social phobia, posttraumatic stress disorder, and depressive and anxiety disorders in children.

v Basic principles of Cognitive Behavioral Therapy include cognitive restructuring, in which therapist and patient work together to change disruptive thinking patterns. It includes behavioral activation, in which patients learn to overcome obstacles to participating in enjoyable activities. Also, it focuses on specific, present problems and it is time-limited, economic and goal oriented. In individual or group sessions, problems (in terms of behaviors, emotions and thinking) are identified. Approach is educational. The therapist uses structured learning experiences that teach patients to monitor and write down their negative thoughts and mental images. The goal is to recognize how those ideas affect their mood, behavior, and physical condition. Therapists also teach important coping skills, such as problem solving and scheduling pleasurable experiences. Patients are expected to take an active role in their learning, and that is why they are given homework assignments at each session which is one of the main basics in cognitive-bihevioral therapy. If you had learned in school multiplication table for only an hour a week, you would probably still wondering how much is 6x7. Same is with psychotherapy; achieving the goal would take a very long time if all what person is doing is thinking about techniques and topics taught only one hour a week. Therefore, Cognitive Behavioral therapists assign patients homework and encourage them to practice techniques that they are taught.

STEPS IN CBT

Step 1: Identify critical behaviors

Step 2: Determine whether critical behaviors are excesses or deficits

Step 3: Evaluate critical behaviors for frequency, duration, or intensity (obtain a baseline)

Step 4: If excess, attempt to decrease frequency, duration, or intensity of behaviors; if deficits, attempt to increase behaviors.

HOW CBT WORKS?

v CBT is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle

In CBT, problems are broken down into five main areas:

Situations, thoughts, emotions, physical feelings, actions.

v CBT is based on the concept of these five areas being interconnected and affecting each other. For example, your thoughts about a certain situation can often affect how you feel both physically and emotionally, as well as how you act in response

WHAT HAPPENS DURING CBT SESSIONS

v If CBT is recommended, you'll usually have a session with a therapist once a week or once every two weeks. The course of treatment usually lasts for between five and 20 sessions, with each session lasting 30-60 minutes.

v During the sessions, you'll work with your therapist to break down your problems into their separate parts – such as your thoughts, physical feelings and actions

v You and your therapist will analyse these areas to work out if they're unrealistic or unhelpful and to determine the effect they have on each other and on you. Your therapist will then be able to help you work out how to change unhelpful thoughts and behaviors.

v After working out what you can change, your therapist will ask you to practice these changes.

v This should help you manage your problems and stop them having a negative impact on your life.

HOW CBT IS DIFFERENT?

v Pragmatic – it helps identify specific problems and tries to solve them

v Highly structured – rather than talking freely about your life, you and your therapist discuss specific problems and set goals for you to achieve

v Focused on current problems – it's mainly concerned with how you think and act now rather than attempting to resolve past issues

v Collaborative – your therapist won't tell you what to do; they'll work with you to find solutions to your current difficulties

USES OF CBT

CBT has been shown to be an effective way of treating a number of different mental health conditions. In addition to depression or anxiety disorders, CBT can also help people with:

v obsessive compulsive disorder (OCD) 

v panic disorder

v post-traumatic stress disorder (PTSD)

v phobias

v eating disorders – such       as anorexia and bulimia

v sleep problems – such as insomnia problems related to alcohol misuse

PRONS AND CONS OF CBT

v It may be helpful in cases where medication alone hasn't worked

v it can be completed in a relatively short period of time compared to other talking therapies

v The highly structured nature of CBT means it can be provided in different formats, including in groups, self-help books and computer programs

v It teaches you useful and practical strategies that can be used in everyday life – even after the treatment has finished

DISADVANTAGES

v You need to commit yourself to the process to get the most from it

v Attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time

v It may not be suitable for people with more complex mental health needs or learning difficulties – as it requires structured sessions

v It involves confronting your emotions and anxieties – you may experience initial periods where you're anxious or emotionally uncomfortable

v It focuses on the individual’s capacity to change themselves (their thoughts, feelings and behaviors) – which doesn't address any wider problems in systems or families that often have a significant impact on an individual’s health and wellbeing

v Some critics also argue that because CBT only addresses current problems and focuses on specific issues, it doesn't address the possible underlying causes of mental health conditions, such as an unhappy childhood

 

 

3.3         Social Strategies and Approaches (e.g.,social stories, Comic strips, Peer-Mediated Programs)

 

 

Provisions to meet the educational needs of individuals with autism are geared to enabling them to lead as independent a life as possible in adulthood. This implies that education would provide the individuals with work skills that would make them eligible for seeking employment, obtain employment, retain their jobs, be able to live independently, and have adequate leisure skills. Yet the few educational opportunities that currently exist are more focused on the development of cognitive skills and on ‘academics’ and pay little attention to the needs of individuals for when they become adults with autism. This near-absence of appropriate educational opportunities severely limits the possibility for employment—and therefore, the opportunities for independent living— for the vast majority of individuals with autism. In order to maximize the options for adults with autism to be independent as adults, current services and planning must also take into consideration the need for training in vocational skills, job opportunities, living options, and recreational opportunities.

Communication Skills

Using language and communicating with other people can be a challenge for many children with autism spectrum disorder (ASD). But with help and understanding, these children can develop communication skills.

In order to provide the best, most targeted communication treatment program for a child with autism, a comprehensive communication evaluation needs to be conducted by a speech-language pathologist (SLP). This assessment needs to evaluate pragmatic language skills (functional and social communication) as well as semantic language skills (the meaning of language­—including content and context). Because of the unique nature of autism, the assessment requires a team effort, involving family, teachers, and others who know the child well, and it should include more than standardized testing. A complete picture of the child is needed to make treatment decisions and to provide a baseline by which progress can be measured.

That’s where functional communication training (FCT) comes in. FCT involves teaching an individual a reliable way of conveying information with language, signs, and/or images to achieve a desired end. It’s called “functional” because it doesn’t just teach kids to label an item (ie associating the word RED to a picture of an apple) but focuses on using words or signs to get something needed or desired — a food, a toy, an activity, a trip to the bathroom, a break from something.

FCT involves the use of positive reinforcement to teach children about language and communication, to increase their ability to interact effectively with others to get their needs met.

Social Stories

Social stories were created by Carol Gray, a teacher, and consultant. In 1990, she began experimenting with the idea of creating "social stories" to help her autistic students prepare for a range of school-based situations. Over the course of several decades, she perfected a system and approach which she has patented. While many people create their own social stories, Gray holds the trademark for the term.

Since 1990, quite a few researchers have explored the efficacy of social stories. Most have found the approach to be useful, though there are some mixed results. Clearly, social stories can only be useful when the audience is engaged, interested, and able to understand and act on the content.

Social stories explain social situations to autistic children and help them learn socially appropriate behaviour and responses. These stories are sometimes called social scripts, social narratives or story-based interventions.

According to Carol Gray, the criteria for a good social story, in summary, are as follows:

1.     Share accurate information in a supportive, meaningful, descriptive manner.

2.     Understand your audience (the individual with autism) and his/her attitude toward the skill, concept or situation being described.

3.     Include a title, introduction, body, and summarizing conclusion in each social story.

4.     When writing, use a first or third-person voice, have a positive tone, be absolutely literal and accurate.

5.     Answer the key questions who, what, where, why, when, and how.

6.     Include descriptive sentences as well as coaching sentences.

7.     Describe more than you direct.

8.     Review and refine your social stories before presenting them.

9.     Plan before you write, monitor outcomes, mix and match as needed, provide both instruction and applause.

10.Include at least 50% "applause" (affirmation) for the audience.

Common Uses of Social Stories

Misuse of Social Stories

Because Social Stories are simple, it's easy to misuse them or create them incorrectly. Social Stories are not narratives about children behaving properly, and they are not a set of directives for completing tasks or behaving appropriately. When creating social stories, writers should avoid:

Another common error in the creation of Social Studies is the misuse of visuals. Images are intended to be as realistic, accurate, and meaningful as possible. Nevertheless, many creators of Social Stories litter their work with clip art, emojis, and other items which "decorate" the story but convey no meaning to the person reading it.

Comic strips

Comic strip conversations, created by Carol Gray, are simple visual representations of conversation. They can show: 

·       the things that are actually said in a conversation 

·       how people might be feeling 

·       what people's intentions might be. 

Comic strip conversations use stick figures and symbols to represent social interactions and abstract aspects of conversation, and colour to represent the emotional content of a statement or message.

From Carol Gray's Comic strip conversations, 1994 

By seeing the different elements of a conversation presented visually, some of the more abstract aspects of social communication (such as recognising the feelings of others) are made more 'concrete' and are therefore easier to understand. 

Comic strip conversations can also offer an insight into how an autistic person perceives a situation. 

Comic strip conversations can help autistic people understand concepts that they find particularly difficult. People draw as they talk and use these drawings to learn about different social situations. 

In a comic strip conversation, the autistic person takes the lead role, with parents, carers or teachers offering support and guidance. 

·       Start with small talk (for example, talking about the weather) to get the person you are supporting familiar with drawing while talking and to mimic ordinary social interactions. 

·       Ask a range of questions about a specific situation or type of social interaction. The autistic person answers by speaking and drawing their response. 

·       Summarise the event or situation you've discussed using the drawings as a guide. 

·       Think about how you can address any problems or concerns that have been identified. 

·       Develop an action plan for similar situations in the future. This will be a helpful guide for the autistic person. 

·      For complex situations, or for people who have difficulty reporting events in sequence, comic strip boxes may be used, or drawings can be numbered in the sequence in which they occur. 

Comic strip conversations can be used to plan for a situation in the future that may be causing anxiety or concern, for example an exam or a social event. However, remember that plans can sometimes change. It's important to present the information in a way which allows for unexpected changes to a situation. 

Peer-Mediated Programs

Peer-mediated instruction and interventions (PMII)—or any instruction or intervention implemented with another child without disabilities—can be applied in a variety of different ways. Rather than involving just a teacher or therapist and the child, PMII involves one or more peers who take on a role in the teaching.  PMII works in dyads or ‘the buddy system,’ in small groups, and classroom-wide intervention programs.

Some of the goals of implementing a peer-mediated program are to:

1.     Teach peers strategies for talking and playing with students with ASD

2.     Increase interactions between students with ASD and their typically developing peers

3.     Minimize adult support

PMII describes not just one intervention but a group of different methods. PMII has shown to be effective in classwide formats, using peers as natural models, using peers as instructors, and in social skills training.  Below are some examples of how PMII can be customized to meet the goals of different learners with ASD.

Classwide PMII Interventions

Peer-Mediated Instruction and Interventions may be implemented not just with the individual learner and one peer, but instead with all the children in a classroom.  Sometimes known as group-oriented contingencies, these interventions involve systems of reward or motivation for all peers that help foster interactions and appropriate behaviors for the individual learner.   It can also include changing the physical characteristics of a classroom or clinic environment to promote interactions between children.

Peer Modeling Interventions

Some PMII methods capitalize on the peer as a natural model of appropriate behavior.  Sometimes known as observational learning, the technique focuses on having a child with autism observe the peer and subsequently imitate the model.  Research shows that having a peer model a behavior is just as effective for children with ASD as adult models.  Peer-modeling can also be used to help a child with ASD learn to initiate and respond to natural social cues from a peer.

Peer Tutoring Interventions

Peer tutoring interventions describe a myriad of PMII methods where the peer without disabilities assumes the role of the instructor.  During peer tutoring interactions, the peer may provide the instruction, provide the reward or positive reinforcement for good behavior, or may provide corrective feedback.  In most peer-tutoring interventions, the peer undergoes training beforehand but then can independently implement the intervention.  Some peer-tutoring interventions involve the reverse, where the child with autism acts as the tutor, delivering appropriate instructions and corrective feedback to a peer.

Social Skills Training

For learners with goals related to developing social skills, PMII interventions may involve social skills training.  Sometimes known as peer networks, these social skills training groups practice a specific social skill in small groups.  The group might focus on one response, like taking turns or having conversations, or it might have a broader focus on modeling appropriate social behaviors or developing friendships.

 

Frequent monitoring of child progress will be an important component to determine the effects of the intervention strategies on social interactions. Direct observation will allow educators to assess both the quality and quantity of the children’s social engagement. For example, educators should evaluate:

 

 

3.4         Strategies and Approaches (e.g., Learning Experiences and Alternate Program for Pre- schoolers and their Parents (LEAP), Early Start Denver Model (ESDM), The Joint Attention, Symbolic Play, Engagement & Regulation (JASPER), Floortime)

 

 

JASPER

The Joint Attention, Symbolic Play, Engagement & Regulation (JASPER) approach was developed at the center for Autism Research and Treatment by Dr. Connie Kasari. It is a treatment approach based on the integration of developmental and behavioral principles. The model uses naturalistic strategies to target the foundations of social-communication in terms of joint attention, imitation and play. Primary implementers of the intervention include parents and teachers whose ultimate goal is to promote generalization across environments and activities and maintain progress over time.

The Joint Attention, Symbolic Play, Engagement & Regulation (JASPER) approach identifies and treats core deficit areas for children with autism. These core deficit areas consist of joint attention, symbolic play, engagement and regulation and are considered the four main targets of the JASPER treatment. Basic JASPER strategies are integrated into naturalistic symbolic play sessions with a balance of structure and flexibility to improve these target areas. Strategies include; modeling, promoting hierarchies, imitating and expanding joint attention, language and play acts as well as pacing language to match the child’s language and adjusting play based on the interests of the child.  

Joint Attention, Symbolic Play, Engagement & Regulation (JASPER)strategies have been tested with children ages 12 months to 8 years old and have been shown to work well with other behavioral based interventions. Once initial assessments are completed an intervention plan is put into place and adults are trained twice per week for a series of sessions to learn the treatment strategies. The JASPER approach can be incorporated naturally into settings such as special education classrooms, inclusion and the child’s home.

Core values include:

·       Modeling and teaching joint attention skills directly

·       Increase the ability to coordinate attention

·       Increasing diversity and flexibility in play skills

·       Increase functional play and reach higher levels of symbolic play

·       Improve children’s state of engagement

·       Increasing engagement to increase opportunities for learning and social communication

·       Increase emotional and behavioral regulation

·       Decrease self-stimulatory behaviors

JASPER has been empirically tested with many children, ranging in age from 12 months to 8 years, with a wide range of developmental abilities. It has application for parents, teachers, paraprofessionals and clinicians. JASPER works well in conjunction with other behavioral-based therapies and can be naturally incorporated into inclusion and special education classrooms and every day activities in the home. The only required materials are developmentally-appropriate toys or activities.

 

Learning Experiences and Alternate Program for Pre- schoolers and their Parents (LEAP)

LEAP is an acronym for: Learning Experiences: an Alternative Program for Preschoolers and Parents. Our special education LEAP Preschool provides high quality early intervention services to preschool children diagnosed with an Autism Spectrum Disorder and their typically-developing peers.

LEAP reflects a naturalistic, inclusive developmental approach for teaching children with autism spectrum disorders in an early childhood environment. This approach focuses on enhancing the skills of children with autism through interaction and play with typically-developing peers. The LEAP model is one of the most extensively validated intervention programs in early childhood special education history.

Family Support

Family involvement is essential for the success of the children who participate in the LEAP Preschool program. To help families better understand and reinforce the skills their child is learning, LEAP Preschool offers basic behavior management training for parents. This training provides parents with the necessary knowledge to teach their children new skills at home.

LEAP is a multi-faceted program for young children on the austistic spectrum. It combined a variety of strategies such as Applied Behavior Analysis, peer-mediated instruction, incidental teaching, self-management training, prompting strategies, and systematic parent training. It was developed by Phillip Strain in Pennsylvania for both children with autism and typically developing children. LEAP has the components of an integrated preschool program and a behavior skills training program for parents. Services include parent involvement and training. The program does not provide one-to-one intervention; instead, services consist of 15 hours per week of classroom instruction provided by a teacher and an assistant who implement the program with 10 typically developing children and 3 to 4 children with autism. A full time speech therapist and contracted occupational and physical therapists also work with the children in specially arranged classrooms designed to support child-directed play. The primary goals of the curriculum are to expose children with autism to typical preschool activities and to adapt the typical curriculum for the children with autism only when necessary. Independent play skills are facilitated by using peer models and by prompting, fading, and reinforcing target behaviors (Strain & Hoyson, 2000).

 

Early Start Denver Model (ESDM)

The Early Start Denver Model (ESDM) is a behavioral therapy for children with autism between the ages of 12-48 months. It is based on the methods of applied behavior analysis (ABA).

Parents and therapists use play to build positive and fun relationships. Through play and joint activities, the child is encouraged to boost language, social and cognitive skills.

ESDM therapy can be used in many settings, including at home, at a clinic, or in school. Therapy is provided in both group settings and one-on-one.

It has been found to be effective for children with a wide range of learning styles and abilities. ESDM can help children make progress in their social skills, language skills, and cognitive skills. Children who have significant learning challenges can benefit just as much as those without learning challenges.

Parent involvement is a key part of the ESDM program. Therapists should explain and model the strategies they use so that families can practice them at home.  

The ESDM is based on the Denver Model, which is normally applied to older children with ASD. The early version of the ESDM was developed by Geraldine Dawson, Ph.D. and Sally Rogers, Ph.D. as an early behavioral therapy approach for children with some form of ASD. As mentioned, it focuses on the age group between 12-48 months and it is based on the methods of applied behavioral analysis (ABA).

The ESDM has been created in such a way that the lessons/therapy can take place in a variety of settings. Parents and therapists can both use play-based therapy, wherever they are, to work towards the development of positive relationships and associated relational skills. This play ‘learning’ therapy is based on knowledge of where a ‘normal’ child should be developmentally. Using the knowledge of ‘normal’ development, ESDM curriculum specifically targets the areas in which children with ASD may have extra difficulty. These specific areas commonly include social interaction skills, the ability to integrate skill sets, and the ability to both form and maintain relationships. 

The ESDM relies on intensively tested and empirically verified teaching techniques that draw on ABA methods and field-vetted teaching practices. Above all, it strives to be a relationship-focused curriculum (with both therapists and parents/caregivers). 

Some of the key features of the Early Start Denver Model are:

– Deep parental interaction

– Play-based therapy

– Language and communication lessons delivered within an affect-based and positive relationship

– Emphasis on positive affect and interpersonal dynamics

– Naturalistic strategies drawn from ABA

– Joint activities that reinforce shared involvement

– A sensitivity to ‘normal’ childhood development goals

The ESDM prepares children with ASDs and their parents for the educational and developmental programs that will likely be suggested or encouraged later in life (like the Denver Model). Proponents of the ESDM believe that it does the essential and important work of establishing relationship-focused behaviors in children at an early age, which will prove integral to their integration into larger social groups (like school environments) later in life. Today, the ESDM has become an indispensable tool to aid ASD children who struggle to connect with other members of their social context and who experience difficulty learning other related tasks.

 

The Joint Attention

 The strategies in JASPER promote joint attention skills – coordinating attention between objects and people for purposes of sharing. Examples include looking between people and objects, showing, and pointing to show. While joint attention develops naturally in typical children, those with autism must actively learn these skills. Our studies show that when joint attention skills are modeled and taught directly, children with autism use more joint attention. This leads to increased engagement and learning.

Joint attention is a behaviour in which two people focus on an object or event, for the purpose of interacting with each other. It is a form of early social and communicative behaviour.

Joint attention involves sharing a common focus on something (such as other people, objects, a concept, or an event) with someone else. It requires the ability to gain, maintain, and shift attention. For example, a parent and child may both look at a toy they’re playing with or observe a train passing by. Joint attention (also known as ‘shared attention’) may be gained by using eye contact, gestures (eg pointing using the index finger) and/or vocalisations, including spoken words (eg “look over there”).

When one person purposefully coordinates his or her focus of attention with that of another person, we refer to the behavior as  “joint  attention.” Joint   attention   involves   two   people paying  attention  to  the  same  thing,   intentionally   and   for   social reasons. Imagine, for example, that a teacher points to her desk and says to a child, “Look at that big apple.” The child looks at the place the teacher has pointed and sees the apple. In this situation, the teacher and the child have engaged in joint attention—that is, they shared attention to the apple on purpose.

Early joint attention skills may include a child reaching out to be picked up by an adult or looking at the same page of a book with another person. Further developed skills may include focusing on a game or requesting items, such as a favourite toy or food.

There are two ways joint attention can occur:

1. Initiating joint attention

In this case, the child initiates the social interaction. For example, the child may point to a toy, and gaze at their parent to get them to look at it, too. Older children may use vocalisations to gain attention (eg “look here mum”). Initiating joint attention could indicate that a child is socially motivated.

2. Responding to joint attention

In this scenario, the child responds to someone else’s efforts to gain joint attention. For example, a parent points to a ball and says, “look at the ball!”. The child responds by following the parent’s gaze and gesture (eg pointing using the index finger) to look at the ball. Responding to, is easier than initiating, joint attention.

Being able to establish joint attention is vital for developing social-communication and cognitive skills. In typically developing children, joint attention skills start to develop soon after birth and by the age of three, children are usually competent at gaining and maintaining joint attention from adults and peers.

Without joint attention skills, it could be difficult for children to interact and develop relationships with their caregivers and peers. Joint attention helps develop important social skills such as bonding and seeing another’s point of view.

Children with autism may have difficulties with joint attention, as they may find it difficult to interact while paying attention to an object and a person.

This could result in missed opportunities to interact and communicate with others. Also, it may make it difficult for a person with autism to get their wants and needs met.

The skills needed for joint attention include:

·       Orienting and attending to a social partner (that is, the person you are interacting with)

·       Shifting of gaze between people and objects

·       Sharing emotional states with another person

·       Following the gaze and point of another person

·       Being able to draw another person’s attention to objects or events for the purpose of sharing experiences.

 

Symbolic Play

A primary target of JASPER is to increase the diversity of children's play skills. Appropriate play acts are modeled, joint attention is facilitated within play routines, and greater diversity in types of play are encouraged. The overall goal is to help the child increase their diversity and flexibility in play and reach higher levels of play. Although reaching levels of symbolic play is an ultimate goal, functional play is also targeted depending on the child's developmental level.

Play provides some of a child’s first opportunities to rehearse social interactions, generate novel ideas, toy with symbolism and develop narratives — skills that serve us later in life, particularly in our highly social world. Indeed, children who engage in more complex play early in development show greater social competence at later ages1. Add the opportunity to invite another person to play, or to follow another’s lead, and the foundation for working with others is set.

For children with autism, however, these opportunities do not present themselves so easily. Yet play is still an important developmental tool for these children. For clinicians, it represents a key arena for delivering therapies that could improve a child’s social skills, language and certain cognitive capacities.

In assessing children with autism, clinicians look at several different types of play. Symbolic play includes the use of objects or actions to represent other objects or actions. In autism, symbolic play is often delayed, and spontaneous play is less frequent, less complex and lacks the novelty that typically developing children demonstrate.

Symbolic play is just another term for pretend play. By the age of 3, most children have developed fairly sophisticated tools for pretend play, both alone and with others.

They may use toys exactly as they're designed—playing "house" with a pretend kitchen and eating plastic food. Or they may make up their own pretend play, such as turning a box into a fortress.

Children with autism rarely develop pretend play skills without help. They may enjoy placing toy trains on a track. But they're unlikely to enact scenes or make sound effects unless they are actively taught and encouraged to do so.

Arranging play activities with missing items increased opportunities for children to engage in symbolic play. The training procedure can be used in clinical and educational settings as an initial step to establish and improve complex play behavior in children with autism spectrum disorder who lack such skills.

 

Engagement & Regulation

Engagement – JASPER utilizes a number of strategies to improve the child's state of engagement with others during intervention. The goal is to scaffold the child from being unengaged or solely focused on objects to higher states of joint engagement with others, and increase their diversity and flexibility enabling them to reach higher levels of play. Increases in engagement lead to increased opportunities for social communication and learning.

Regulation – This approach stresses the importance of emotion and behavior regulation. A series of strategies are employed to handle self-stimulatory behaviors that interfere with learning, lack of engagement, and disregulation.

 

Floortime

Floortime is a relationship-based therapy for children with autism. The intervention is called Floortime because the parent gets down on the floor with the child to play and interact with the child at their level.

Floortime is an alternative to ABA and is sometimes used in combination with ABA therapies.

The goal is for adults to help children expand their “circles of communication.” They meet the child at their developmental level and build on their strengths.

Therapists and parents engage children through the activities each child enjoys. They enter the child's games. They follow the child's lead.

Floortime aims to help the child reach six key milestones that contribute to emotional and intellectual growth:

Therapists teach parents how to direct their children into more and more complex interactions. This process, called “opening and closing circles of communication,” is central to the Floortime approach.

Floortime does not work on speech, motor or cognitive skills in isolation. It addresses these areas through its focus on emotional development.

Overall, this method encourages children with autism to push themselves to their full potential. It develops “who they are,” rather than “what their diagnosis says.”

Children with autism require intensive intervention and will rarely initiate interaction on their own unless they need something. To encourage interaction and a shared world, floortime can occur anywhere, such as:

·      Inside the home.

·      In the backyard.

·      In a therapy office.

·      In elementary school.

·      At preschool or daycare.

·      At a playground.

·      In a supermarket. 

·      In the car.

·      In the bathtub.

Floortime can be done at any time of day and with anyone, such as parents, peers, and siblings. The key to floortime is that the people who participate in it enjoy it.

Floortime may be a good treatment option for a child with autism. It’s usually used as part of a comprehensive treatment plan that also includes ABA therapy, speech therapy, and occupational therapy, as appropriate for the specific child. The progress made in floortime therapy will transfer into other therapy areas as well. Ultimately, incorporating floortime techniques into daily life can be a great opportunity for you and your child to play and bond. Throughout the process, you can help to develop your child’s communication skills to their fullest potential.

 

 

 

3.5         Consideration for Learning and Teaching Methods in ASD

 

Teaching Children with ASD

When selecting teaching strategies, we are all aware that ‘one size fits all’ does not apply. It is important to acknowledge the individuality of each child. But there is another aspect beyond this that must be kept in mind when teaching children with autism.

Autism is a population that takes a uniquely different developmental path. While each child has his own specific style, a large number of children with autism have certain unique commonalities. These, in addition to their uneven patterns of strengths and weaknesses, are some unique learning characteristics that must be considered for their educational implications.

Generalisation: The ability to apply a skill in different situations is known as generalisation. Opportunities to generalise a skill learnt across situations, time and people must be given.

Concrete to abstract: Due to difficulties with imagination children with autism may find understanding of abstract concepts difficult. Because they focus concretely they often have difficulty with remembering the precise order of tasks. Here again visuals help. In addition, while teaching always starts with concrete objects and then moves to abstract concepts. Learning needs to be experiential and related to real life situations.

Rote learners: Children with autism have excellent rote memory and they may use this to compensate for their difficulties in comprehension. It is therefore imperative to work on language skills.

Literal understanding: As children with autism are literal interpreters it is essential to be clear and concrete in communication. It is best to avoid irony, sarcasm and metaphors. Children with autism may have difficulty with shared attention tasks which involves understanding what another person may be thinking. This is a skill which is vital in any teaching situation and highlights one of the main areas of learning difficulty in people with autism.

Curriculum

Reading: Many students with ASD have strong visual skills and are often more successful in learning to read through a whole word sight recognition approach than through a more traditional phonics program. Whole words that are meaningful are usually easier for students to learn to read than words for which students have no basis of experience or knowledge. In the beginning stages of learning to read, it is critical to enable students to develop a sense of confidence.

While knowing the alphabet and knowing the sound symbol associations are usually regarded as prerequisite skills for learning to read, many students with ASD often have difficulty acquiring these prerequisite skills. Some students are able to recite alphabet letters and letter sounds by rote, but may be unable to apply this to decoding words in a fluent manner. The rate of reading fluency will affect a student’s ability to comprehend the message of the words. If a student needs to give more cognitive attention to a difficult decoding process, then it is likely that the student’s understanding of what the words are saying will decrease.

Some students may be better able to understand and learn the phonetic components of words after they have learned to read them through a whole word sight recognition approach, working backwards within a top-down framework from the whole to the parts. It is important to consider that, although some students may be unable to manipulate the symbolic representations of sounds, they may still be able to recognize and comprehend words and acquire skills in phonics.

As the student acquires more words, it is essential to provide activities in which these words are used in meaningful contexts. Ongoing practice in sentence construction enables the student to understand how words are organized to express thoughts and needs, as well as how pronouns, articles, and prepositions are used in context. Daily practice in sentence construction provides students with the opportunity to develop an understanding of grammar and to learn a framework for using language. This practice also reinforces that repetition and rehearsal of language construction are ongoing expectations of daily task performance.

Writing: While some students with ASD are proficient in printing and handwriting, many others have difficulty with written tasks because of difficulties with fine motor skills. The visual-motor coordination and fine motor movements that are required in written activities may be extremely frustrating and divert the student’s attention from the content of what he is writing to the physical process of print production. Difficulties with handwriting have been identified as one of the most significant barriers to academic participation for students with ASD in schools today.

There are many ways in which technology can be used to enhance and compensate for the limitations that students have in their writing skills. If fine motor skills are a barrier to participation and academic function, then seek the alternative of assistive technology.

The use of keyboards, word processors, and writing software has facilitated the writing process for many students with ASD. Learning to use a keyboard is a valuable skill for students to acquire. For many students with ASD, using a computer is a highly preferred activity. Teach and encourage the student to learn to use the keyboard as a writing instrument. This is a reasonable accommodation to the motor planning difficulties often associated with ASD. While learning to print can be a useful exercise for many, when students’ difficulties with penmanship inhibit their ability to demonstrate their knowledge and spark behavioural upsets, the use of the keyboard is a viable alternative.

In many cases, OTs are involved with students with ASD and provide assessments and information on a student’s fine motor and writing skills. OTs can provide recommendations about the strategies, resources, and accommodations that will be appropriate to assist students with fine motor and writing difficulties. As with other skills, it is essential to focus on the students’ strengths and determine the skills and methods that will be most functional for the students in the future.

Mathematics For many students with ASD, participation in mathematics can be a challenging aspect of the academic curriculum. There are several reasons for this:

•       Although many mathematical concepts can be demonstrated through visual examples, they are often accompanied by sophisticated verbal instruction.

•       The language of mathematics instruction has its own vocabulary, and the precision of instruction and usage of terms can vary from one instructor to another.

•       Mathematical terminology can be very complex and is challenging for students who struggle with processing the language of everyday interactions.

•       Along with the verbal, orthographic, and representational expressions of number, there is also the symbolic representation in the form of numerals.

•       Mathematical operations are usually performed with a pencil. Many students with ASD have fine motor difficulties and learning to form numerals and manipulate them on paper may be challenging.