Here, Carol and Vicki answer some questions about their new book, Rising to New Heights of Communication and Learning for Children with Autism: The Definitive Guide to Using Alternative-Augmentative Communication, Visual Strategies, and Learning Supports at Home and School.
Tell us about your experience working with children with autism?
[Carol:] I am a licensed Speech-Language Pathologist (SLP) with 28 years of experience in the profession with the Cleveland Metropolitan School District (Ohio, USA) and in private practice. I have experience in many areas of speech and language therapy, however, for the past 6 years, I have provided services exclusively to students with autism and other pervasive developmental disorders. I am proficient in the use of many low-tech and high-tech alternative communication methods, as well as in the use of alternative methods of teaching to address specific unique needs of the students.
The frustration I felt when the use of standard interventions methods produced limited improvement fueled my desire to expand my knowledge base, and to meet the challenge of addressing the unique needs students with autism, severe learning disorders and significant communication disorders exhibit. Pairing the individualized and varied needs of the students with distinctive, innovative, and at times, atypical intervention methods, captured my interest and spearheaded my effort and desire to work with students with autism and other pervasive developmental disorders.
[Vicki:] I have also spent most of my career as a school-based SLP, providing services to students with low incidence disabilities for a number of years. Beginning in the late 1980s I worked on several grant projects to provide adapted computer access to children with physical disabilities. My role evolved into using low- to high-assistive technology (AT) in the classroom and speech generating devices with this population of children with severe dysarthria, from cerebral palsy or other conditions resulting in nonverbal or unintelligible communication.
Becoming the first Assistive Technology-Alternative/Augmentative Communication SLP in our school district many years ago, it was a natural move for me to begin offering services to students with autism, who had difficulty communicating. They also benefitted from AAC and AT as communication and learning supports.
I’ve also managed a privately owned autism treatment center, the rehabilitation departments of skilled nursing facilities, and a vocational rehabilitation program for adults.
Carol and I are currently partners in a private practice that provides interventions for autism, PDD, AAC, visual strategies, and environmental design.
How did the book come about, and who did you write it for?
As consultants, we have encountered many interventionists and parents who are working hard and implementing many techniques to help the student yet, realizing little to no improvement in academics, socialization, communication, and behavior. Although their intent is genuine and commitment is strong, their understanding of evidence-based practices that have proven successful with students with autism and other pervasive disorders is often limited. Those working with these student are either unfamiliar, have limited knowledge, or possess inaccurate information about alternative strategies. We wrote the book as a user-friendly resource so anyone interested can learn alternative strategies that work. In writing the book, we recognized that many individuals presently in the trenches providing intervention services to the students often encounter the difficulty of time constraints. These time constraints prohibit the ability to engage in extensive research or decipher difficult reading materials. There are few user-friendly resources that offer comprehensive information about varied intervention strategies, such as, visual supports, PECS, speech generating devices, social stories, and structured environments under one cover. Consequently, in addition to writing the book so individuals may learn about alternative strategies, we wrote the book to offer a comprehensive resource that answers specific questions, offer examples, includes goals/objectives, in a consistent easy to use format.
The book is for interventionists, caregivers, families, and community members who look to educate and interact with individuals with autism or other pervasive developmental disorders. It is for anyone who desires to gain a better understanding of unique, nonstandard intervention methods that have been researched and found to be successful with the target population.
What makes it the “definitive guide”?
We certainly wanted to indicate how strongly we feel about the strategies we embrace, but also, the interventions described in Rising are definitive because they are grounded upon our decades of experience working with individuals with autism, AAC, PDDs, and other profound disorders, and just as significantly, because they are research-bound and evidence-based.
Carol and I are resolute in our application of specific interventions, because we’ve witnessed their success. For instance, in Rising and in our recent article for the JKP Blog, we discussed how physically structuring the environment increases the likelihood that a child’s appropriate behavior will increase and undesirable behaviors will lessen, if the setting is designed effectively. Within an organized environment, visual supports supply information, communicate expectations, and offer predictability, among other advantages.
We understand that all individuals are unique and each strategy is not suited for every child. But some themes are universal, like the need for consistency or to know the response to questions such as, “Where do I need to be; what do I need to do; how much is work is there to do; where do I put my finished work; and what comes next?”
In Part I of Rising, we provide comprehensive information on AAC, discussing speech generating devices, PECS, and symbolic language systems. Again, we recognize that the appropriate communication system must be selected, customized, modified, or created for the individual. Perhaps the most important tool in one’s toolkit is information. Rising provides that information…it’s the definitive resource for home and school!
In the book you talk about fear on the part of adults and teachers. Where does this fear come from, and how does it impact communication?
After speaking with a number of families and interventionists, we’ve come to recognize that learning of a diagnosis, especially one such as autism, is laden with strong emotions. Among those emotions, fear is often present, ranging from (and this could be fleeting to long-term) dread, anxiety, distress, concern, worry, panic, to horror. All that families once had in mind and in store for their children is now in flux. Questions replace hopes, and in creeps fear. Educators unfamiliar with autism or other PDDs might feel ill-equipped to meet the educational, social, or communication needs of this population.
People manage differently, but for those experiencing difficulty coping, we’ve provided introductory information on autism. We believe this allows families, educators and interventionists to rise above the fear factor and poke through the cloud that surrounds the diagnosis or label of autism, once equipped with sufficient knowledge. Next, we offer proven solutions. We devote three chapters of Rising to improving the communication abilities of children with autism or other PDDs. We describe the use of speech generating devices, PECS, and Symbolic Language Systems such as communication pages, boards, or binders. In Part II we share strategies to support learning, including the use of visual supports, social stories, and structuring the environment.
We compare our book to a hot air balloon. While fear might fill the balloon with hot air initially; our book, with its information, strategies, and resources guides the reader to rise above the fear to new heights for the child with autism or other PDDs.
What are some general DOs and DON’Ts when implementing the strategies in the book?
- Consider the cognitive, physical, social needs when selecting a strategy.
- Consider the individual’s interests, abilities, skills, and preferences.
- Use team approach with commitment and input from all team members.
- Plan for the use of the support, who will create it, know purpose, and expected outcome.
- Expect improved social skills, communication, learning, and behaviors.
- Determine type of representation (photos, symbols, objects, words).
- Work in well organized, clearly defined areas.
- Provide a strategy/device without training the individual and team members.
- Give up if it doesn’t work immediately.
- Use visual supports/work areas that are cluttered.
- Be inconsistent with the use of the strategy/device.
- Neglect to continuously collaborate and communicate with other members of the team especially families.
- Neglect to reassess the success of the intervention continuously.
When do parents and teacher know when communication therapies are working?
Just as the abilities of students are often unique and sporadic, progress noted, is likewise often unpredictable and intermittent. A comparison of pre- and post-data collected about level of competency is the best measurement of “success”/progress. Therapy is working, therefore, if students indicate by their actions and behaviors that they have a better understanding of their environment and what is expected of them throughout the day. The students demonstrate they understand, where they need to be, what they need to do, how much to do, and what comes next. Some examples of an understanding of these routines include, but are not limited to the following observable behaviors:
- There is a decrease in the number, and intensity of targeted or undesired behavior,
- There is a decrease in instances of awkward, inappropriate, and disruptive interactions during typical social situations,
- There is a decrease in inappropriate, disruptive behaviors during transitions,
- There is an increase in the number of structured tasks the student is able to independently and accurately complete,
- There is an increase in the student’s ability to follow rules and routines at home and school,
- There is increased compliance to questions and requests,
- There is an increase in the ability to relay simple requests.
In essence, success is not a single state of being, rather, a continuum of instances where students demonstrate a greater understanding of their surroundings and expectations by initiating and responding to routines, requests, and interactions with appropriate, low anxiety responses.
Copyright © Jessica Kingsley Publishers 2010.