3.1. Development of Speech, language and communication: Implications for across the spectrum of ASD
3.2. Alternative & Augmentative Communication (AAC) systems, communication aids & devices:
3.3. Sensory processing and development of motor skills in ASD
3.4. Developing Interpersonal Skills.Behaviour regulation & role of counselling for persons with ASD
3.5. Therapeutic recreation for students with ASD.
3.1 Development of Speech, language and communication: Implications for across the spectrum of ASD
The ability to communicate is important for daily living, including the development of social relationships. Children learn to communicate in stages, with articulation and language developing independently. To understand verbal communication development, it is important to understand the difference between speech (articulation) and language.
People with ASD have challenges with communication and social skills. They often find it hard to have conversations and may not pick up on social cues. Some people with ASD may not talk at all, and others may talk very well. But all will have some challenges making friends and communicating socially.
People with ASD also have some type of restricted interest or repetitive behaviors. They may focus on one topic, like cars or a television show, or they may be attached to a certain object or activity. A person with ASD may not like changes in their schedule or changes in the way they do something.
ASD can range on a spectrum from mild to severe, depending on how much these challenges affect everyday life.
Common characteristics of speech and language among children with ASD include:
When children with ASD are not able to respond when others speak to them, or to their own names, they are sometimes mistakenly thought to have a hearing problem.
Verbal skills are only one aspect of effective communication. Body language—such as hand gestures, body stance, and making eye contact—conveys to others whether someone is joking or being serious, for example, or angry or happy.
All of the skills involved with social communication presuppose an understanding of complex social expectations, coupled with an ability to self-modulate based on that understanding. People with autism commonly lack those abilities.
Sometimes people with high-functioning autism find themselves frustrated when their attempts to communicate are met with blank stares or laughter; they may also be mistaken as rude. This is due to:
Many people with autism are able to compensate for social communication deficits by learning rules and techniques for better social interaction. Most children (and some adults) participate in treatment programs aimed at improving social communication through a combination of speech-language therapy and social skills therapy.3
Speech-language therapy focuses not only on correct pronunciation, but also on intonation, back-and-forth conversation, and other aspects of pragmatic speech. Social skills therapy may involve role-playing exercises and group activities that require practicing collaboration, sharing, and related skills.
Ideally, treatment should begin during the preschool years, when language development occurs. Generally, children with autism respond well to highly-structured, specialized programs. Parents and those involved in the care of these children should integrate treatment strategies so they become part of the child’s daily life.
Children with severe (or level 3) autism may never develop oral speech and language skills, in which case treatment goals involve learning to communicate using gestures (such as sign language) or by means of a symbol system in which pictures are used to convey thoughts.
3.2 Alternative & Augmentative Communication (AAC) systems, communication aids & devices:
Communication devices, systems, strategies and tools that replace or support natural speech are known as augmentative and alternative communication (AAC). These tools support a person who has difficulties communicating using speech.
The first “A” in AAC stands for Augmentative Communication. When you augment something, you add to it or supplement. Augmentative communication is when you add something to your speech (eg. sign language, pictures, a letter board). This can make your message clearer to your listener.
The second “A” in AAC stands for Alternative Communication. This is when you are not able to speak. It is also when your speech is not understood by others. In this case, you need a different way to communicate.
Basically, AAC can be tools, systems, devices or strategies. These tools help a person communicate, when they cannot rely on speech. Perhaps your child has not started talking. Perhaps you have lost your ability to speak. Perhaps your speech comes and goes. Maybe speaking is harder than other ways to communicate. AAC can help.
Some examples of AAC include:
1. Unaided communication systems – Rely on the user's body to convey messages. Examples include gestures, body language, and/or sign language. One advantage of unaided communication communication systems is that it does not require any technology beyond the person's body.
2. Low-tech AAC - Any type of aid that does not require batteries or electricity. This includes things like a simple pen and paper to write messages on, as well as pictures boards, that can be carried to aid communication. On picture boards, users can point to images, words, pictures, drawings, or letters in order to communicate their message. The pointing might be done with the user's hands, other body parts, eye gaze, or a pointer held in the hands or mouth.
3. High-tech AAC - Any aid that requires electricity or batters. This includes specialized devices, software, smartphone applications, electronic communication boards, and keyboards. Many high-tech AAC devices are Speech Generating Devices, which means they can produce digitized speech when the user either types a message or presses on images, words, or letters.
Electronic Fluency Devices are devices intended to help improve the fluency of people with stutters. They do this by playing the sound of the user's own voice back into their ear, slightly altered.
There are two main types of Electronic Fluency Devices :
Delayed Auditory Feedback (DAF)- Delayed Auditory Feedback devices play the user's voice back delayed by a fraction of a second. DAF devices may resemble hearing aids or headphones with a microphone. There are also apps that can use DAF on phone calls.
Frequency Altered Feedback (FAF)- Frequency Altered Feedback devices are similar to DAF but rather than delaying the user hearing their own voice, they change the pitch at which the user hears their own voice.
Many people who cannot rely on speech, could benefit from AAC. And there are challenges when people do not have AAC.
These include:
There are often difficulties without AAC, when someone cannot talk reliably.
People who use AAC say that, prior to having a communication system, they experienced:
3.3 Sensory processing and development of motor skills in ASD
Autism spectrum disorders (ASDs) represent an extensive category of conditions that had a variety of deficits. Dysfunctions of perceptual and sensory processing as well as interaction and neurological functioning result in various functional behavior limitations.
Sensory processing disorders (SPD) include three main types of problems: sensory modulation disorder (ie, under-responsiveness, over-responsiveness, and sensory seeking), sensory-based motor disorder (ie, vestibular-bilateral functional problems), and sensory discrimination disorder (ie, dyspraxia). The new DSM-5 definition of autism as well indeed includes sensory issues as one of the four restricted and repetitive behavior features, and the sensory issues are defined as over- or under-responsivity to sensory stimulation or atypical attention on certain sensory elements in the environment. SPD are reported in a high proportion (92%) of ASD, and the levels of sensory dysfunction correlate to the autism severity and atypical behaviors but are not associated with cognitive levels (eg, intelligence quotient).
Sensory integration was defined as the complicated neurological processes that categorize, modulate, and coordinate sensations from an individual’s body and from the surrounding environment, the end products of the functional sensory integration process are adaptive behaviors. The primary sensory systems involved in the sensory integration process are vestibular, proprioceptive, and tactile systems. Different kinds and degrees of problems in development, information processing, and behavior might occur when the sensory inputs from these primary sensory systems are not integrated or organized appropriately at the cortical and subcortical levels. Children with ASD often have sensory integrative dysfunction caused by poor sensory registration, motor incoordination, sequencing deficits, and specific verbal-motor dyspraxia.
Sensory integration focuses primarily on three basic senses–tactile, vestibular, and proprioceptive. Their interconnections start forming before birth and continue to develop as the person matures and interacts with his/her environment. The three senses are not only interconnected but are also connected with other systems in the brain. Although these three sensory systems are less familiar than vision and audition, they are critical to our basic survival. The inter-relationship among these three senses is complex. Basically, they allow us to experience, interpret, and respond to different stimuli in our environment. The three sensory systems will be discussed below.
Tactile System
The tactile system includes nerves under the skin’s surface that send information to the brain. This information includes light touch, pain, temperature, and pressure. These play an important role in perceiving the environment as well as protective reactions for survival.
Dysfunction in the tactile system can be seen when an individual:
· withdraws from being touched
· refuses to eat certain ‘textured’ foods
· refuses to wear certain types of clothing
· complains about having one’s hair or face washed
· avoids getting one’s hands dirty (i.e., glue, sand, mud, finger-paint)
· uses one’s fingertips rather than whole hands to manipulate objects
A dysfunctional tactile system may lead to a misperception of touch and/or pain (hyper- or hypo-sensitive ) and may lead to self-imposed isolation, general irritability, distractibility, and hyperactivity.
Tactile defensiveness is a condition in which an individual is extremely sensitive to light touch. Theoretically, when the tactile system is immature and working improperly, abnormal neural signals are sent to the cortex in the brain which can interfere with other brain processes. This, in turn, causes the brain to be overly stimulated and may lead to excessive brain activity, which can neither be turned off nor organized. This type of over-stimulation in the brain can make it difficult for an individual to organize one’s behavior and concentrate and may lead to a negative emotional response to touch sensations.
Vestibular System
The vestibular system refers to structures within the inner ear (the semi-circular canals) that detect movement and changes in the position of the head. For example, the vestibular system tells you when your head is upright or tilted (even with your eyes closed). Dysfunction within this system may manifest itself in two different ways. Some children may be hypersensitive to vestibular stimulation and have fearful reactions to ordinary movement activities (e.g., swings, slides, ramps, inclines). They may also have trouble learning to climb or descend stairs or hills; and they may be apprehensive walking or crawling on uneven or unstable surfaces. As a result, they seem fearful in space. In general, these children appear clumsy. On the other extreme, the child may actively seek very intense sensory experiences such as excessive body whirling, jumping, and/or spinning. This type of child demonstrates signs of a hypo-reactive vestibular system; that is, they are trying continuously to stimulate their vestibular systems.
Proprioceptive System
The proprioceptive system refers to components of muscles, joints, and tendons that provide a person with a subconscious awareness of body position. When proprioception is functioning efficiently, an individual’s body position is automatically adjusted in different situations; for example, the proprioceptive system is responsible for providing the body with the necessary signals to allow us to sit properly in a chair and to step off a curb smoothly. It also allows us to manipulate objects using fine motor movements, such as writing with a pencil, using a spoon to drink soup, and buttoning one’s shirt.
Some common signs of proprioceptive dysfunction are:
· clumsiness
· a tendency to fall
· a lack of awareness of body position in space
· odd body posturing
· minimal crawling when young
· difficulty manipulating small objects (buttons, snaps)
· eating in a sloppy manner
· and resistance to new motor movement activities
Another dimension of proprioception is praxis or motor planning. This is the ability to plan and execute different motor tasks. In order for this system to work properly, it must rely on obtaining accurate information from the sensory systems and then organizing and interpreting this information efficiently and effectively.
Children with ASD demonstrate difficulties in performing daily tasks requiring various visual perception functions such as visual figure ground, visual form constancy, and visual sequencing memory abilities.13 Besides limitations in both essential social communication and adaptive behaviors, children with ASD also exhibit delayed motor development and deficient perceptual-motor functions that influence multiple sensory and neuromotor systems. Research results suggest that children with ASD usually have co-existing motor dysfunctions and motor programming deficits. Motor coordination deficits are considered as a cardinal feature of ASD in addition to their featured social and behavioral difficulties, and the large effects from meta-analysis research provide compelling support for the ASD group having significant deficits in performing motor coordination tasks. These perceptual-motor deficits in ASD have great adverse impact on their qualitative and quantitative participation in various activities across settings.
The International Classification of Functioning, Disability and Health (ICF) model defines participation as “engagement in life events and contexts” resulting from interaction of individuals with their environments. Participation in daily activities is crucial and essential for fostering development and enriching life experience, and through these, children will be able to obtain skills and capabilities, establish inter-personal connections, and find meaningful goals of life. The concept of participation and function has become increasingly important in the field of childhood rehabilitations.
The first study hypothesis is that children with ASD would have atypical or impaired sensory and perceptualmotor performances. On the basis of shifts of health paradigms, the second hypothesis is that body functions would have significant impacts on ASD children’s activity participations. The age and gender effects would be investigated as well. To address these study hypotheses, standardized instruments assessing different subdomains of body functions and activity participations were adopted. The results of a comprehensive assessment battery could provide thorough and in-depth understanding of the sensorimotor functions and activity participations in a wide age-ranged children with ASD.
3.4 Developing Interpersonal Skills. Behaviour regulation & role of counselling for persons with ASD
Supporting social interaction is an important piece of the student’s educational plan. Student’s with autism often have the desire to interact with others, but do not have the skills to engage appropriately or may be overwhelmed by the process. Some students are painfully aware of their social deficits and will avoid interactions even though they desperately want to connect with others. Others will engage in attention seeking behavior to connect with others until they build the skills they need to interact. Social development represents a range of skills, including timing and attention, sensory integration and communication, that can be built and layered to improve social competence. Building competence will result in further interest and interaction.
Social skills for children include:
Social skills help all children know how to act in different social situations – from talking to grandparents to playing with friends at school.
Social skills can help your child make friends, learn from others and develop hobbies and interests. These skills can also help with family relationships and give your child a sense of belonging.
Here are some strategies to support social skill development in your students with autism:
Behavioral regulation refers to your ability to resist using unhealthy behaviors to regulate emotion. Sometimes people use behaviors like eating, drinking alcohol, or self-harm to reduce negative emotions, but these types of behaviors end up doing more harm than good and don’t end up making these people any happier.
When you use unhealthy behaviors to change your emotions, you never learn how to change your emotions in healthy ways. You become reliant on that extra beer or chocolate dessert to make you feel better and you can even end up developing unhealthy addictions. But by learning behavioral regulation, you can reduce your reliance on these unhealthy behaviors.
Behaviour regulation, sometimes also known as “self-regulation”, refers to our ability to:
There is a strong connection between behaviour regulation and language. Studies show that:
In studies of children with language delays, researchers found that:
Due to the connection between behaviour regulation and language, it’s important for parents, and especially for parents of children with language difficulties, to learn ways to encourage their child’s ability to regulate his or her behaviour. This will help the child benefit from speech and language therapy, interact with family members and other children, and learn at school.
Emotion regulation (ER) refers to the handling and modifying of emotional reaction intensity and duration. Individuals who struggle with ER have issues with aggression, meltdowns, or other problem behaviors in response to an inability to regulate emotion. Generally, these problem behaviors are an attempt to alleviate distress from ER issues. ER treatments aim to develop a more adaptive and appropriate response to distressing situations via increased emotional awareness and understanding.
The presenter makes two critical distinctions:
1. ER issues occur when an individual does not have the regulatory capacity or skills to control emotional reactions. — these are not temper tantrums or manipulative behaviors.
2. ER is concerned with more than the “moment of meltdown”
Individuals on the spectrum are at high risk of ER issues as many core ASD symptoms and proven differences in brain function are understood to trigger challenges with emotional control. Further research has shown ER issues prove more reliable than ASD symptom severity in predicting increased anxiety and depression as well as hospitalizations and emergency room visits.
Clinical mental health counselors may use various treatments and therapies based on the severity of symptoms, the age of the child and the child’s placement on the spectrum. Here are a few useful therapies for children with ASD.
Clinical mental health counselors who work with autistic children are crucial to improving outcomes — both for those with the disorder and for their families.
Counseling is recommended for all family members in households with a child on the spectrum. To compliment this, parents and family members must prioritize self-care. Parents need time alone to decompress and time together to connect and siblings need one-on-one time with parents to feel seen and heard. It can be challenging to maintain self-care, and a schedule is useful to help keep these routines in place. As children with an ASD often responds well to routine, this practice helps everyone in the family.
Although there are several challenges to raising a child or with autism, the is also a bright side. As a counselor, you can help families focus on milestones, individual progress or funny moments. The unique, unforgettable moments are what make the journey of raising an individual on the spectrum well worth it.
The pandemic may have thrown us all a few curve balls, but we can still connect with and support one another. Working with individuals with autism and their families can be very rewarding. As a counselor, you can help parents feel hopeful and capable of helping their child. The autism community is known for its overwhelming strength and support. It is a place where families draw their strength and continue moving forward, blazing a path for those on the spectrum.
3.5 Therapeutic recreation for students with ASD.
Participation in recreational programs has shown extensive benefits for children with Autism. It can reduce behavioral and emotional disorders, help develop social skills and build relationships, improve physical and mental health, and help children develop their interests. Many different types of therapeutic recreational activities exist today, all catering to the unique needs of participants. These therapeutic activities should be taken advantage of to encourage the short and long term well being of individuals with autism.
Music Therapy
Music therapy is a well-established professional health discipline that uses music as the therapeutic stimulus to achieve non-musical treatment goals. Research supports connections between speech and singing, rhythm and motor behavior, memory for song and memory for academic material, and overall ability of preferred music to enhance mood, attention, and behavior to optimize the student’s ability to learn and interact. Some of benefits of music therapy include:
Art Therapy
Arts and crafts can be a particularly effective therapy for people with autism. Because they tend to have difficulty processing sensory input and are often non-verbal, autistics respond well to visual, concrete, hands-on therapies. Art making is an effective, clinically sound treatment option for autism when supplemented with studies from the fields of art, art education, psychology, and other creative arts therapies. Some benefits of art therapy include:
Therapy Yoga & Gymnastics
Therapeutic yoga and gymnastics delivers pediatric occupational and physical therapy in a sensory rich environment that promotes growth, independence and balance of the mind and body. Some benefits of therapy yoga and gymnastics include improvements in:
Karate
The Karate for All is a unique program developed specifically for children and adults with special needs that will allow them to achieve their full potential and independence by enhancing their skills and abilities needed to be successful in their communities. KFA uses an occupational therapy approach to enhance the following skills:
Hockey
Created in 2000 for players with developmental disabilities, the American Special Hockey Association (ASHA) gives people of all ages and abilities a chance to learn and grow by playing hockey. Some of the goals of ASHA include:
Dance/ Movement Therapy
Dance/Movement therapy focuses on movement behavior as it emerges in the therapeutic relationship. Expressive, communicative, and adaptive behaviors are all considered in-group, individual, and family treatment formats. Dance/movement therapists’ unique facility for understanding, reflecting, and expanding nonverbal expressions can help those with autism to:
Aquatic Therapy
Aquatic therapy is treatment performed in the water by qualified physical and occupational therapists, to aid in the restoration, extension, and maintenance of an individual’s quality function. Benefits of aquatic therapy include:
Horseback Riding
Therapeutic horsemanship uses the pleasures and skills of horseback riding and horse knowledge to build developmental, emotional, social, and physical skills for each individual rider. Benefits of horsemanship therapy include improvements in:
Let’s look at the benefits of recreational therapy in the form of art therapy, drama therapy, aquatics, equine therapy or for that matter music therapy. To begin with, these sessions are focused with specific aims, plus they work toward a wide range of physical, social, and emotional goals enabling these children to indulge in their interests and capitalize on their strengths.
Communication - Therapeutic Recreation programs aid in skills required for communication through playing, sports, music etc where there is interaction with others of the same age group in a fun setting.
Motor skills - Various recreational activities such as swimming, horse riding, playing an instrument facilitate motor skills, coordination as well as endurance. Physical activities in particular promote a healthy lifestyle, overcoming certain challenges such as limited motor skills and provide the supply of crucial Vitamin D in our bodies.
Acquiring skills – A benefit is the acquisition of social skills such as sharing as well as sportsman spirit. Regular participation in such wonderful and relaxing programs will aid the inculcation over time of such much needed skills for life’s long journey.
Self-esteem – It’s noticed that children with Autism tend to become more confident in life and feel a sense of achievement with such forms of therapy which they enjoy and indulge. It also makes them happier individuals.
Recreation is about activities and experiences which produce feelings of enjoyment and satisfaction. They give all of us opportunities to express creativity, achieve and master new skills.
Recreation can be particularly important for people with autism, drawing on opportunities to practice social skills, physical aptitude and increase motivation. These activities can provide the basis for increased self-confidence for your child.
Participation in recreation and leisure activities allows individuals with autism to learn skills specific to a particular sport or activity. But more importantly, participation in these programs also helps improve more general skills that can be applied in settings like school and work. So progress can be seen not just in the specific programs, but in other areas of life as well.