Increasing
Communication Skills in Students with Autism Spectrum Disorders:
The AAC Technology Solutions
It is only
in the recent 10 years that AAC has been implemented and made
available to individuals with autism. The course of research
in the areas of autism, language stimulation and special education
have brought focus on the viability of AAC use in natural environments
for individuals with autism. In addition, research in education,
behavioral psychology, neurology and physiology compel language
intervention to begin as soon as possible to insure the best
possible outcomes.
Early
Indicators of Autism and AAC Interventions
The early indicators of autism, including difficulties in maintaining
eye contact, gestural communication, protodeclarative pointing
and joint attention are behaviors which provide the scaffolding
for the development of language. Many specific AAC interventions
can target these early indicators and may provide effective
scaffolding for the development of symbolic communication. Autism
and Family Functioning
The behavioral,
communicative and social deficits in individuals with autism
are significant stressors on their families These stressors
negatively impact family functioning more than in any other
disability. In addition, parents' assessments of particular
characteristics of their pre-school children with autism indicate
language and communication to be the most serious and stressful
component of the disability. Research studies implementing Natural
Aided Language strategies through parent training have indicated
increases in parent-child communication and decreases in parent
perception of severity of their child's handicap as well as
concurrent parent stress (Cafiero, 1998, 1995).
Natural
Aided Language
Natural Aided Language is an augmentative communication strategy
in which visual symbols (either icons or words) are placed on
an environmentally specific language board or technology device
for the purpose of facilitating interaction and participation
in an activity. Communication partners touch key words on the
language board while saying those words so that receptive language
training is occurring naturally during the activity. Natural
Aided Language is an enhancement and expansion of Goosens',
Crain and Elder's (1992) Aided Language Stimulation, however
in Natural Aided Language, the visual language is viewed as
a legitimate and real language and every activity, environment
and potential communicative need is interfaced with a visual
language board with or without an AAC device. As a real and
legitimate language, every person in the child's environment
takes responsibility for using the language and implementing
the language board. The child with autism is exposed to this
language by his family, peers and professional helpers, thereby
receiving intense receptive language stimulation with the expectation,
without pressure, that expressive language(with or without AAC
support) will eventually occur. The symbols most commonly utilized
are the Mayer-Johnson Picture Communication Symbols. These symbols
can be accessed through the Mayer-Johnson catalogs as well as
a computer program, Boardmaker.
Naturalistic
Learning
Natural Aided Language utilizes the best practices of naturalistic
learning (documented to be most effective for youngsters with
autism), natural language strategies and AAC. Naturalistic learning
provides opportunities for children with autism to learn skills
in real and meaningful environments whereby the reinforcer is
contextually related to the activity itself.
Creating
Interactive Language Boards
Initially it is important to introduce Natural Aided Language
in a child preferred and reinforcing environment. Many families
and teachers choose snack or meal times. These times are generally
successful for youngsters with autism who enjoy meals and they
will generally remain seated for the activity.
A "placemat
board" can be created by taking an inventory of the verbs and
nouns required to interact during a meal activity. Vocabulary
is chosen which drives the activity, that is, gets it started,
moving and completed, as well as the objects required for the
actual activity and descriptors for giving the child expressive
options for commenting, acceptance or refusal.
| Pronouns |
Nouns |
Verbs |
Descriptors |
Misc. |
| I |
cup |
want |
yummy |
Thanks |
| You |
trash |
pour |
yucky |
Please |
|
plate |
eat |
more |
No |
|
straw |
put |
|
Yes |
|
napkin |
drink |
|
juice |
taste |
|
cookie |
finished |
|
chips |
open |
|
|
sit |
The vocabulary
in above is strategically placed on the perimeter of a heavy
piece of placemat sized poster board and laminated for durability.
The placemat board provides a readily available language stimulation
activity during the reinforcing time of snack. Caretakers interact
and "chat" with the youngster naturally while touching key words.
All communicative attempts on the part of the child are acknowledged
as valid and shaped by parent, teacher or caretaker imitating
and modeling child communication verbally and by touching the
picture symbols.
The Merging
of Autism "Best Practices" and AAC Interventions Interventions
for children with autism are many and may often represent what
is often called "trend of the year." While AAC interventions
are showing great promise in emerging research, AAC is not an
end, but a means to address goals and objectives which improve
quality of life for children with autism. As such, AAC can be
used to address methodologies across the educational and behavioral
spectrum: Applied Behavioral Analysis, Greenspan (Developmental
Therapies), Sensory Integration, Psychogenic Therapies, as well
as literacy learning and curricular adaptation. The use of VOCAs(voice
output communication devices), such as the BIG MAC, Voice in
a Box, and Talk Pad can enhance communication training by providing
auditory feedback for the responsive student. Requesting, commenting,
behavior management, as well as literacy and curricular adaptations
can be addressed with Natural Aided Language Strategies on VOCAS.
Strategies such as Modeling, Time Delay, environmental prompts
and faded physical prompts can provide the structure for teaching
AAC the student.
Literacy
Learning and Communication Skills Development
There was a time when the sequence of literacy development detailed
that a child first learns to listen, speak, read, and then write.
Unfortunately, this often meant that children with autism were
excluded from literacy learning experiences. In light of the
fact that these children have a scatter of strengths and needs,
and demonstrate strong visual processing skills, it is essential
to provide reading and writing/keyboarding experiences for them.
In addition, current, state of the art findings are detailing
hyperlexic children who, with support have been using their
literacy skills in interactive communication contexts. Picture
symbol adaptations of journalling programs, general curriculum
and literature (Dexter, 1998) can make communication and participation
more accessible for students with autism.
Accountability
and Data Collection Systems
AAC interventions, through the use of low tech symbol and alphabet
boards, VOCAS, lap top computers and the internet, are beginning
to show great promise for increasing communication, participation
and socialization for individuals with autism. It is imperative,
however, to interface every AAC intervention with a concurrent
system of identifying outcomes, systematic instruction to address
the outcomes, and practitioner-friendly methods of collecting
outcome data. Data then must be utilized to address appropriate,
individualized, program development. Data collection methods
include simple communication board collection tools, videotape
records, portfolios, as well as more complex or hierarchical
data collection instruments.
Where
do we go from here?
As families and practitioners struggle with the issue: "What
is best for this child? Which interventions will provide the
best outcome?" it is important to remember that autism is a
spectrum disorder. Every child is a unique collage of strengths
and needs. There is no "rubber stamp" best program for every
child. (Freeman, 1996). AAC technology is showing great promise
as a vehicle for implementing a variety of methodologies more
effectively. More importantly, though, providing a means to
communicate immediately, that is, at first diagnosis, is essential.
Functional communication training minimizes the development
of aberrant behaviors (Mirenda, 1998), and many researchers
believe it provides the scaffolding for the development of more
complex language and cognitive skills (Dexter, 1998; Cafiero,
1998, Kangas & Lloyd, 1988). Interaction, communication and
discourse between people are essential parts our humanness.
Individuals with autism are entitled to the tools necessary
to exercise this most basic human right.
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