Social-Pragmatic Skills and Autism Spectrum Disorders

December 17, 2012

Social pragmatic skills help individuals engage in social interaction with others. Many of us grasped the unwritten rules that govern our behavior in the social environment early on in our lives. However, individuals with Autism Spectrum Disorder (ASD) have difficulties learning these rules. In fact, social-pragmatics is often considered a core challenge for these children. The “hidden” social expectations can make social interaction a confusing experience. Therefore, many professionals and parents may want to help children with ASD develop a variety of skills that fall within the social-pragmatic realm. Nonetheless, before we start, we need to first sort out important conversational skills and find ways to assess children’s performance.

Social pragmatic skills involve not only one’s ability to communicate intent, but also knowledge of discourse management, register variation, presupposition, and other social skills. Discourse Management involves managing the conversation to keep it flowing and effective. Conversation partners need to agree on turn allocation, which involves identifying turn-taking opportunities and limiting one’s talking to one’s turn. They stay on the topic unless there is a signal by a communication partner that he/she is going to change the topic. Knowledge of topic maintenance includes knowing how to smoothly switch to a new topic. When conversation breakdown occurs, one needs to recognize it and use subsequent repair strategies such as repeat, rephrase, or adding information to aid communication. Register variation includes politeness/social role recognition, as people change their word choices, sentence forms, vocal tone and gestures/body posture to adjust to social roles in various discourse patterns. Presupposition, or perspective-taking, involves making assumptions about what other people know. People learn to understand everyone has different thoughts, feelings, and experiences, and take this into account during the conversation. Paralinguistics refers to the use of prosody, gaze, gestures, and physical proximity to show interest in the interaction, convey different layers of meanings and monitor the nonverbal communication of the partner. Social behaviors involve use of facial expressions, conventional gestures, and social actions that are expected in one’s culture, such as dressing appropriately for an occasion, offering to share something, assisting someone who needs help, patiently waiting for a turn in a game, etc.

Children with ASD may be able to fluently express their intention, but they often face difficulties in their social interaction with lack of proficiency of more than one skill listed above.

Assessing pragmatic skills can be a challenge since conversations are dynamic, and there is no easy way to measure one’s performance via standard tests. Formal assessment which involves static, often pictured situations can be used to establish a starting point, but information collected through observation, interview, and check lists helps us to detect if the individual lacks the knowledge to manage such conversations or is merely experiencing a performance issue. If needed, specific situations can be created to probe particular skills. Information from more than one source is necessary to establish goals and priorities for intervention.

Several key components need to be considered as we develop an individualized treatment program for children with ASD. These include the child’s knowledge about social communication, his/her ability to apply social knowledge in various situations, the cognitive/emotional cost to the child, the need to find right strategies to specific challenges, the co-occurring elements in the planning/implementation stages of social interaction, plans to generalize learned skills, self-monitoring skills that promote independence and flexibility, etc. Interventionists should also consider what skills are easiest/most important to teach, which skills can be paired together, and which skills will make the biggest impact in terms of improving social interaction. Many tools and programs have been developed for improving social interaction in this population. For example, social groups and social stories help children with ASD to experience different social roles and social situations, expand their knowledge of social skills, give them examples of strategies they can use, and offer them opportunities to practice social-pragmatic skills in a low-stress environment. While the SLP may lead intervention, family members and school teachers can also provide additional learning opportunities throughout the day to help children monitor their newly learned skills.

Information taken from:

http://www.autismsupportnetwork.com/news/meeting-challenge-social-pragmatics-students-autism-spectrum-887512

– Chloe Chenjie Gu, MA., Speech-Language Pathology Intern

– Kristina Elliott, MA, CCC-SLP

Advertisements

Sensory Integration Activities and Self-Regulation

December 13, 2012

Sensory Integration Activities promote self-regulation in children and are necessary for:

  • daily functioning
  • intellectual, social, and emotional development
  • the development of a positive self-esteem
  • a mind and body which is ready for learning
  • positive interactions in the world around him
  • the achievement of normal developmental milestones

The great news is… sensory integration activities are unbelievably fun and a necessary part of development for any child, whether they have a sensory processing disorder or not.
From the womb into adulthood, our neurological systems are developing
and processing an overwhelming amount of sensory information every day.
Our system must then interpret this information and make it ready to be
tolerated and used for specific purposes.

The best part about sensory integration activities is the creative fun
you can have coming up with ideas, playing with your child using sensory
input, or purchasing unique toys and products anyone would love!

Children think they are having fun when they are actually working strenuously at building essential skills with their bodies and better neurological systems.

It takes a lot of hard work, dedication, consistency and persistence, but in the end, you will have a thriving child who can regulate sensory input much more effectively.

The variety of sensory integration activities is endless… only limited by your creativity and imagination!

 

1)   Tactile Play:

  • Shaving cream
  • Rice, lentils, beans, pasta
  • Water and sand
  • Playdoh
  • Silly string

 

2)   Vestibular Input:

  • Swing
  • Slide
  • Spinning in an office chair
  • Rocking chair
  • Sitting or rolling on a yoga ball
  • Scooter boards

 

3)   Proprioceptive Input:

  • Trampoline
  • Tunnel
  • Heavy work chores (pulling garbage bin, stomping on cans for recycling, wiping tables and windows, carrying groceries)
  • Wrestling
  • Tug of war
  • Animal walks
  • Chewy food (bagels, licorice, gum, beef jerky)
  • Crunchy food (chips, pretzels)
  • Thick liquids through straws (milk shakes, yogurt drinks)

 

Resources: http://www.sensory-processing-disorder.com/sensory-integration-activities.html

 

– Patricia Fasang, MS, OTR/L


Facilitating First Words

December 10, 2012

Imitation is an important skill when learning to talk. As speech therapists, we use imitation to teach our children to use new words and make new sounds. However, imitation is a learned skill and not all children get it right away. Parents get frustrated when their child is not talking and can be heard repeating over and over again, “Say…” However, we cannot force our children to speak. DeThorne, et al. (2009) discussed six methods to elicit speech development for children who are not imitating. All six methods are considered “evidenced-based practice,” meaning there is research that confirms that the method works. Below is a list of the six methods and ideas to help facilitate imitation:

 

1)      Provide access to Augmentative and Alternative Communication (AAC)

  • Simple sign language (i.e., the signs for “more” and “open”)
  • Pictures – in our EIC groups, we use pictures during snack so that our kids can request and pictures to help transition between rooms/activities (a picture of the gym to indicate gross motor play time)

 

2)      Minimize pressure to speak

  • Avoid direct requests to imitate
  •  Follow the child’s lead
  • Play with puppets

 

3)      Imitate the child

  • Imitate their sounds (babble) and non-verbal actions (anything from yawns to banging on the table)
  • Assign meaning to their vocalizations: as they say “bababa” show them a ball

 

4)      Utilize exaggerated intonation and slowed tempo

  • “More” can be modeled with a rising intonation to indicate a request
  • Use nursery rhymes with pauses so that your child can be tempted to fill in the words (“Row row row your…”)

 

5)      Augment auditory, visual, tactile, and proprioceptive feedback

  • Tap your top lip when using the sound for “t” to signify your tongue position or tap your throat for “k” and “g” sounds
  • Use echoes through a tube to amplify sounds or a mirror to emphasize mouth position

 

6)      Avoid emphasis on nonspeech-like articulator movements: focus on function

  • Use a kazoo to elicit the “m” sound, with closed lips and voice
  • Use fun sounds during play, like blowing raspberries as a car motor

 

DeThorne, L.S., Johnson, C.J., Walder, L., & Mahurin-Smith, J. (2009). When “simon says” doesn’t work: Alternatives to imitation for facilitating early speech development. American Journal of Speech-Language Pathology, 18, 133-145.

 

– Jenny Graham, MA, CCC-SLP


Leaving Early Intervention: Where Do We Go Now?

December 5, 2012

Many of our families with children 18-36 months make their way to CSLOT’s early intervention clinic or individual therapy through their local regional center. And unless the child fits one of the eligible conditions to continue regional center services, the early intervention services through their regional center end when the child turns three years old. But where do you go from there if your child continues to need services and does not qualify through the regional center.

Prior to the child’s birthday your service coordinator will put you in contact with someone from your local school district. They will begin a transition process with you that involves evaluating your child. The school district will review previous reports and evaluations done while in early intervention, but they also need to complete their own testing as they have different eligibility criteria for receiving services.

When the school district completes their evaluation, they will complete a report and hold an IEP (Individual Education Plan) meeting with you. Similar to the IFSP (Individualized Family Service Plan), the IEP meeting will involve a report explaining the results of testing, measurable annual goals, determination how progress will be measured, special education and supports available to your child, the extent to which you child will not participate in regular classes, individual accommodations needed for your child, and the date for services to begin, frequency, location and duration.

Another option is to continue at a private clinic, similar to CSLOT. However, beyond age three, the regional center will no longer pay for the services. Parents are sometimes able to access their health insurance in order to pay for services. If not, then parents do pay privately.

Sometimes it can be more intimidating for parents than the children, to leave familiar services behind. However, it is important to stay informed about available services and rights so that you can continue to be an advocate for your child.

 

Alana Garcia-Chavez, M.S., CCC-SLP


Sensory Strategies to Alert or to Calm Yourself or Your Child

December 3, 2012

Did you know that you can use sensory strategies to alert or to calm yourself or your child?

You may have heard of relaxation techniques to calm oneself by using soothing music or deep breathing. What about techniques to alert oneself when experiencing low energy? When addressing sensory strategies we often think of the sense of smell, sight, hearing, touch, and taste. From a sensory integration perspective, we also have the vestibular (balance) and proprioceptive (body awareness) systems. Based on personal responses and preferences, we can change or “regulate” the level of arousal through the use of these sensory systems.

There are some activities that tend to be calming in nature and some activities that tend to be alerting. You may notice that you have already used these strategies without realizing. For example, you may have used calming strategies with a young baby by dimming lights, playing soft music, swaddling and gently rocking him/her. These strategies address the vestibular, tactile, visual, and auditory input. Or you may have used alerting strategies when staying up late working or studying by removing clutter from your desk beforehand to prevent distractions, talking to yourself or reading aloud, fidgeting with your pencil, tapping your foot and eating a crunchy snack. These strategies address the visual, auditory, tactile, vestibular, and oral motor input.

Think about what you do or what your child does in a small subtle manner in order to maintain appropriate levels of arousal. This may help you select appropriate types of sensory input. Remember that each individual responds differently to different types of sensory input. Individuals need to reflect on their response to different types of input.

If you have any questions, please contact an occupational therapist who can assist you with using environmental/sensory strategies to support you or your child.

 

-Felicia M. Hashimoto, M.A.T., M.S., OTR/L

 

TYPE of INPUT ALERTING QUALITIES CALMING QUALITIES
VESTIBULAR (movement of head through space =>   contributes to balance) fast, jerky, changes directions, moving in suspended   equipment slow, rhythmic, movement in one direction,  using grounded equipment
PROPRIOCEPTIVE (on joints => contributes to body   awareness and coordination) fast paced, quick changes, jarring, jerking, starts or   stops abruptly joint compression, slow stretch, heavy resistance, (e.g.   push ups, heavy work, weighted blankets, backpacks, vests, or lap pad)
TACTILE light touch, unexpected touch, cold, rough, cool   environment pressure touch, tight wrap, firm stroking over large area,   predicted touch, warm environment
VISUAL bright colors, unexpected visual stimuli, bright lights,   red-yellow shades, changing/moving stimulus dark colors, predictable rhythmic pattern, dim lights, blue-green   shades, stimulus remaining constant
AUDITORY unexpected, loud, complex or mixed, pronounced expected, quiet, gentle rhythm, simple, melodic or   sing-song
OLFACTORY all odors tend to be alerting familiar odors associated with pleasurable & comforting   experiences, interactions or people
ORAL MOTOR Crunchy textures (e.g. pretzels, chips, raw veggies), cold   temperatures (ice chips, ice-cold drinks)) Deep breathing, resistive biting and chewing (e.g. fruit   leather, non-food items like Chewelry or Chewy tubes), sucking on hard candy,   thumb, or pacifier)

 

 

ALERT program from Therapy Works, Inc.: www.alertprogram.com

Ayres, J. (2005). Sensory Integration and the Child. Western Psychological Services.

Biel, L. & Peske, N. (2009). Raising a sensory smart child. London, England: Penguin Books.

Cohn, E., Miller, L. J., & Tickle-Degnen, L. (2000). Parental hopes for therapy outcomes: Children with sensory modulation disorders. American Journal of Occupational Therapy, 54, 36–43.

Kranowitz, C. (2006). The out of sync child: Recognizing and coping with sensory processing disorder. New York, NY: Perigree Trade.

Sensational Brain: www.sensationalbrain.com