08/09/2011 | Lindsay Dutton, MA CCC-SLP
Special Needs and Autism
Technologically, we’ve evolved to where many people prefer to use technology as their main form of communication. I’d be lost without my iPhone for texting, e-mail, as well as access to Facebook and Skype to keep up with friends and family.
When working with children with autism and other special needs, it is important to remember all the different ways that we communicate effectively throughout our day. Our communication skills build and maintain relationships and help us meet our wants and needs. Therefore, we should apply the same idea when thinking about our students and their communication needs. By broadening our idea of effective communication from just “speech” to any means that appropriately, effectively and efficiently gets the desired message across we open up an array of modalities to try with these students. When we transition from a “must learn to speak” communication plan to a “must learn to communicate” plan, we often see frustration decrease, behaviors decrease, communication increase, and even verbal speech increase. Overall the child and those working with him become more successful.
For children with autism, verbal speech, social communication, initiating communication, and using compensatory communication strategies are often difficult to learn. Verbal speech in particular can elude him and cause great frustration and challenges for the child, family, and those working with him. One-third to one-half of children with autism spectrum disorders are functionally non-verbal, making communication a significant issue that many families and professionals are working to improve. Some families, therapists and teachers are hesitant to introduce a child to augmentative or alternative communication (AAC) systems because they worry the child will lose what speech he has or that he will not continue to expand his verbal repertoire. Research has demonstrated that this is not the case. In fact, many children’s verbal communication increases over time when they use an AAC system.
Children demonstrate a desire to gain access to things they like such as food, toys and attention from parents very early in life. They also begin to understand and seek the completion of an activity, or demonstrate avoidance of what is to come next in their day if it is not a preferred activity. Without a way to appropriately express themselves, these desires often manifest in the form of behaviors such as hitting themselves or others, screaming, crying, biting, destroying things around them, running away, etc. This is our indication that it is time to begin implementing a functional communication system. It also points to the diligence needed in pro-actively implementing communication systems prior to the escalation of behaviors.
In behavior literature, functional communication training examples often include implementing sign language or picture symbols as a form of communication for a child that is demonstrating behaviors. Taking a more holistic approach, functional communication can include any type of communication that the student can successfully use across people and environments. This might include objects, pictures, communication books, sign language or speech generating devices.
The first step to implementing a functional communication system is often the most difficult. To be most effective, it must successfully express the function of the behavior the child is exhibiting. For example, if a child is pulling an adult’s hair to get their attention, teaching them to express “finished” is not going to be an effective way to decrease this behavior. Teaching this child how to tap the adult on the shoulder, push a Big Mack switch that says “Look at me!,” or to hand the adult a picture that says “Hi,” would be much more effective. Before a successful communication plan can be implemented the child’s team (parents, therapists, teachers) must understand the function of the behavior. What is the child really trying to tell us when they are engaging in various behaviors? A functional behavior assessment (FBA) can be used to help answer this question.
After the FBA has been completed the team has a better understanding of what the child’s behaviors are really trying to communicate. Then it is time to implement some sort of functional communication. Often this starts as picture symbols. Picture symbols are easy to create and re-create as needed (many will get destroyed and lost during training) and are relatively inexpensive. The simplicity of using pictures makes them easy to implement which in turn addresses the behavior and begins the shaping process quickly. Teaching sessions are highly structured with high levels of repetition to ensure success for the child. This builds momentum, motor memory and facilitates a positive relationship with the individual implementing the training and the communication system. Once the child is able to independently communicate using the desired communication system in 80-90% of opportunities, quickly move the opportunities to natural settings. This is vital to the effectiveness of the process. Too often these sessions begin and end in highly structured environments and do not continue being facilitated and practiced in natural environments. Natural environments deliver a much more beneficial, functional and meaningful experience to the child and those surrounding him. The child should get a minimum of 30 opportunities throughout his day in the natural environment to practice his communication skills. This requires brainstorming with the child’s team to set up these opportunities throughout the day. Perhaps he can be offered choices of who he might want to greet in a different classroom, or greeting students coming in from recess. It takes creativity, training of staff and thinking outside of the box to make the opportunities occur, but it is well worth the time investment. Communication should be consistent, efficient and effective across people and environments, not just during activities such as group time, snack, or therapy.
Heartspring is a residential special education school that serves students ages five to 21 from all over the country with autism and other developmental disabilities. Most of our students enroll at Heartspring after their parents and/or school districts have determined that they are currently unable to provide a free and appropriate education for the child. Parents and school districts are seeking assistance in creating a strong program and IEP, which can then be transitioned back to their local school. Often these students do not have a functional communication system when they walk through our doors. For others communication systems have been trialed throughout the years, but for one reason or another have failed. During interviews some people can remember trying a system, but rarely are they able to articulate the pros and cons and integrity with which it was trialed. Therefore we start from scratch in our challenge to find, create and implement a functional communication system for our students.
An AAC evaluation is a specialized assessment focused on looking at the skills and preferences of the child and matching them to features and characteristics of various communication systems available. This assessment should be comprehensive, looking at the child’s cognition, writing and reading skills, behaviors, speech and language abilities, and mobility. The goal is to find the right system for the child, not fit a child to a system. At Heartspring we trial systems that we might not have in our library to make sure we are considering all options. During our AAC evaluations, we interview the student’s team using the Wisconsin Assistive Technology protocol as a guide to gather information. We then consider the SETT framework created by Joy Zabala. This framework asks the team to consider the Student, Environment, Task and Tools to help determine what assistive technology is most appropriate to trial. We try a minimum of three different communication systems (typically five to seven) over a period of two to three months. We set up trials in the classroom and home environments to get an idea of the student’s skills, preferences, use and potential growth using the chosen systems. Depending upon the student’s skills, the systems chosen for trials often include a variety of low- and high-tech systems. The evaluation results in a comprehensive report that discusses the student’s strengths and challenges in relation to each system trialed, as well as data collected throughout the assessment. A recommendation is made for a communication system, as well as short and long term goal suggestions.
Overall the goal is to find a communication system that meets the current needs of the student and will grow with their skills in the future. Ongoing assessment is necessary to make sure this occurs. In addition, all students that have high-tech devices should also have low-tech back-ups to use when their device is being programmed or being repaired. So the time spent early in the student’s programming teaching them to exchange pictures and use a low-tech system will not be in vain, even if they get a high-tech device.
We always work towards a student gaining verbal speech. However, in the end, having a functional means of communication that is effective and efficient across people and environments will have a bigger impact on their participation in their world. Effective communication, regardless of modality is priceless.