This Calls for an Intervention

Imagine the frustration of not being able to talk or understand the meaning or context of words. The world would be a lonely place, thoughts trapped inside, with no way to express them. Good communication is the back and forth between understanding and being able to express those thoughts. Communication is important because everyone longs to be heard, and everyone needs to be heard. If a child is suspected of having an autism spectrum disorder, early intervention is crucial. Children who have ASD (autism spectrum disorders) benefit greatly from early intervention, showing better brain function as well as advances in their abilities to communicate and behave like other children, according to a new study conducted by Yale School of Medicine Researchers and published in the Journal of Autism and Developmental Disorders. (Kearney, C. 2012) These first years of therapy can make a lifetime of difference.

There are many interventions that increase communication skills and promote independence in children on the autism spectrum. Brooke Ingersoll (2010) compares and contrast models…some of these models use an applied behavior analysis (ABA) approach, which incorporates explicit prompting strategies according to the child’s initiation and the developmental approach that does not use these strategies, instead choosing to focus on facilitative strategies such as adult responsiveness. (Hall, L.J. 2013) Each of these intervention strategies have seen success with the children that have used them. It truly is a matter of what the needs of the child are, as to which program might work best for him/her. The following list contains brief summaries of each intervention and how they work.

  • The DIR/Floortime Model- This floortime philosophy, developed by Stanley Greenspan, M.D, is an approach for parents and educators that fosters the development of the whole child by engaging and creating partnerships. (Hanna & Wilford, 1990) (Hall, L.J., 2013) The PLAY project is based on this intervention.
  • Responsive Teaching- This approach was developed by doctors, Gerald Mahoney, a clinical psychologist, and James McDonald, CCC-SLP. The responsive teaching method was developed to assist caregivers in maximizing the potential of each of the routine interactions with children (Mahoney & McDonald, 2007) (Hall, L.J, 2013) Joint activities between parent and child are used in this intervention.
  • The Hanen Program- This program was developedd in 1975 by Ayala Hanen Manolson, a Canadian speech and language pathologist. Her focus was on helping parents communicate with their severely language delayed children. More Than Words is based on the Hanen Program.
  • Relationship Development Intervention (RDI)- This intervention is a trademark of Gutstein, Sheely, and associates. (Gutstein & Sheely, 2004) Steven Gutstein (2009) describes RDI as an approach that uses methods that are continually evolving to address the information processing disability of individuals with autism spectrum disorders, by carefully building dynamic intelligence. (Hall, L.J, 2013) Spotlighting and framing are two strategies based on RDI concepts.
  • Enhanced Milieu Teaching- The Milieu Teaching focuses on increasing the number of opportunities for teaching new skills by “eliciting communication through environmental arrangement, the mand model, and time delay procedures” (Yoder and Warren, 1993 p.46) (Hall, L.J, 2013) Strategies based on this intervention are the mand model (verbal communication that functions as a request), and time delay.
  • The Denver Model/Early Start Denver Model- This model is multidisciplinary. It is used with young children that have autism. It started as a federally funded program in 1981. Almost all the therapies based on this intervention used play. Play is one of the most powerful cognitive and social learning tools (Rogers et al., 2001; Rogers & Lewis, 1989) (Hall, L.J, 2013)
  • Pivotal Response Treatment (PRT)- This treatment uses both applied behavior analysis and a developmental approach. Five pivotal areas are covered, motivation, responsivity to multiple cues, self-management, self-initiations, and empathy. (Koegel, Openden, et al., 2006) (Hall, L.J, 2013)
  • The SCERTS Model- This model is fairly new, and takes a multidisciplinary approach. This model covers three main areas. Social communication, emotional regulation, and transactional supports. (Prizant et al., 2006b) (Hall, L.J, 2013) This model takes into account the interaction styles and needs of the child, the family and professional team.

When working with these interventions, pull out (one on one/small group) language and speech sessions are helpful because of the focus on that individual child. Yet, pull out sessions should not be the only time these interventions are used. Pull out sessions are not enough. Children with autism spectrum disorders need to spend time with their peer group. Peer interaction would be considered an important component of social-emotional development. (Hall, L.J, 2013) Classmates are models for both communication and social interactions, which the child with ASD needs. It is appropriate and necessary that the speech and language pathologist work with the child in that child’s classroom among their peers.

Not being able to communicate would be frustrating and debilitating for both the individual with Autism Spectrum Disorder and his/her caregivers. The intervention therapies that have been mentioned in this post, can make a huge difference in the lives of children on the autism spectrum and their families. When intervention is successful, a whole new world is opened up for them and the future looks brighter.

References

Greenspan, S.I., & Wieder, S. (2006). Engaging autism: Using the floortime approach to help children relate, communicate, and think. Cambridge, MA: De Capo Lifelong Books.

This book explains the floortime philosophy, and how this helps foster development of the child.

Gutstein, S.E., & Sheely, R.K. (2002a). Relationship development intervention with young children: Social and emotional development activities for Asperger syndrome, autuism, PDD,and NLD. New York: Jessica Kingsley.

This book explains the RDI philosophy, and assists parents in developing a relationship with their child with ASD.

Hall, L.J. (2013). Autism Spectrum Disorder: From Theory to Practice, Second ed. Pearson.

A book that covers all the different aspects of Autism Spectrum Disorders.

icdl.com/dirFloortime.overview.index.shtml

The Interdisciplinary Council on Developmental and Learning Disorders with DIR®Floortime TM information

Ingersoll, B., & Dvortcsak, A. (2010b). Teaching social communication to children with autism: A practitioner’s guide to parent training. New York. Guilford.

This book discusses techniques that parents can use to help their child communicate. There are direct techniques such as prompting and reinforcing that are taught.

Kearney, C. (2012, November 7). Early Intervention for Autism Shows Major Brain Changes. website:http://www.medicalnewstoday.com/articles/252463.php

Children with ASD benefit greatly from early intervention. This article discusses Pivotal Response Treatment in children between the ages of two to five years old. Magnetic resonance imaging was taken of the children’s brains that were using this intervention therapy.

Koegel, R.L., & Koegal L.K. (2006). Pivotal response treatments for autism: Communication, social, and academic development. Baltimore. Brookes.

This book discusses Pivotal Response Treatment. This particular model uses both applied behavior analysis and the developmental approach.

Mahoney, G., & MacDonald, J. (2007). Autism and developmental delays in young children: The responsive teaching curriculum for parents and professionals. Austin, TX: Pro-ed.

Prizant, B.M., Wetherby, A.M., Rubin, E., Laurent, A. C., & Rydell, P.J. (2006b). The SCERTS model: A comprehensive educational approach for children with autism spectrum disorders: Volume II, Program planning and intervention. Baltimore, MD: Brookes.

This book explains the SCERTS model. The three main areas that this model covers are social-communication, emotional regulation, and transactional supports.

Rogers, S.J., & Dawson, G. (2010). Early Start Denver Model for young children with autism: Promoting language, learning and engagement. New York: Guilford.

This book explains the Early Start Denver Model. This intervention presents activities through play, and social games.

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Communication Interventions

Bolick, T. Ph.d, (n.d). The Growing Need for Psychologists in the Intervention for Autism Spectrum/Pervasive Developmental Disorders. NH Psychological Association Newsletter

The doctor discusses some statistics about autism. She goes on to discuss interventions that focus on communication skills, social awareness, daily living skills, play and coping skills. She believes effective intervention is possible if everyone works together. This includes, teachers, parents/family, therapists, physicians, and psychologists.

Corsello, C.M Ph.d, (2005). Early Intervention in Autism. Infants & Young Children, 18, 74-85

In this article the author discusses that early intervention of children with autism is critical. She believes that more research needs to be done on the interventions that are already in use. This article compares the interventions, especially looking at the birth to age three group.

Kearney, C. (2012, November 7). Early Intervention for Autism Shows Major Brain Changes. website:http://www.medicalnewstoday.com/articles/252463.php

Children with ASD benefit greatly from early intervention. This article discusses Pivotal Response Treatment in children between the ages of two to five years old. Magnetic resonance imaging was taken of the children’s brains that were using this intervention therapy.

Smith, T., (1999). Outcome of Early Intervention for Children With Autism. Clinical Psychology:Science and Practice, 6, 33-49

This article discusses whether or not the gain in IQ points with the use of early intervention techniques is accurate. The writer suggests that findings need to be interpreted cautiously. This article is over ten years old, and it is interesting reading this in light of some of the newer data that has been gathered concerning autism interventions and therapies.

The Autism Education Network. (2013). Autism Interventions. website:http://www.autismeducation.net/education/autism-interventions

This article discusses some of the more prevalent types of interventions that are used with individuals with autism spectrum disorders.

Walsh, N. (2009, November 30). Home-Based Early Intervention Benefits Autism Outcomes. website: http://www.medpagetoday.com/Neurology/Autism/17216

This article is about early intervention using the Early Start Denver Model. This model integrates applied behavior analysis with relationship-based approaches. After one year, it is claimed, that the children involved in this early intervention therapy increased their IQ by 15.4 points, as opposed to the control group which was only 4.4 points.

Broken

English: Final baked loaf

The Gypsy Mama

1. Write for 5 minutes flat on the prompt: “Broken” with no editing, no over thinking, no backtracking.
2. Link back here and invite others to join in.
3. And then absolutely, no ifs, ands or buts about it, you need to please visit the person who linked up before you & encourage them in their comments. Seriously. That is, like, the rule. And the fun. And the heart of this community.

OK, are you ready? Please give me your best five minutes on:::

Broken…

****************************************************************

The world’s definition of broken–beat down, ruined, unusable.

God’s definition of broken–love poured out.

The woman, broken. A sinner. She broke the jar and poured out the perfume on the Jesus.

36 When one of the Pharisees invited Jesus to have dinner with him, he went to the Pharisee’s house and reclined at the table. 37 A woman in that town who lived a sinful life learned that Jesus was eating at the Pharisee’s house, so she came there with an alabaster jar of perfume. 38 As she stood behind him at his feet weeping, she began to wet his feet with her tears. Then she wiped them with her hair, kissed them and poured perfume on them. Luke 7 NIV

Jesus broke the bread with His disciples. A breaking. A thanksgiving.

While they were eating, Jesus took bread, and when he had given thanks, he broke it and gave it to his disciples, saying, “Take and eat; this is my body.” Matthew 26:26 NIV

That same Jesus, body broken. He poured out His blood for us.

There has never been a greater love.

50 And when Jesus had cried out again in a loud voice, he gave up his spirit.

51 At that moment the curtain of the temple was torn in two from top to bottom. The earth shook, the rocks split 52 and the tombs broke open.  Matthew 27 NIV

Sin Sickness

Not Jesus' tomb, but a tomb none the less.

(Photo credit: callmetim)

Let’s face it.

For all the beauty that is in this world…

every gorgeous sunrise, every mountain peak, each newborn baby…

all those things that bring fleeting, tenuous, joy…

There is also pain.

This world spins crazy on its axis, and sometimes the spinning can make us sick.

Sick with worry, sick with sorrow, sick to death.

This is how the world was then, too.

When Christ came.

Sin sickness since the day the stench of it permeated the earth.

When the deceiver asked the woman and man to defy.

And their “yes”, bit hard into sin.

And ever since, mankind has known full well what sin feels like.

Roman soldiers, people crying, “Crucify Him!”, a governor who wanted no part of it.

Heavy wooden cross beam, splintered wood, and blood.

The sin of the world on His shoulders, separation from His Father……

and Jesus tasted darkness that day.

The bitterness of a world gone bad.

His perfect sacrifice, for a world that knew Him not.

Killed. Buried. Left in a dark and silent tomb.

Sin mocked. The deceiver lied. The world waited.

The disciples questioned, the women cried. The world waited.

On the third day, the tomb was empty.

Jesus was not there. Death could not keep Him. The tomb could not hold Him.

He is alive! He stands victorious.

We can face this world on days that are hard and uncertain

.Because our Savior lives!

11 Now Mary (Magdalene) stood outside the tomb crying. As she wept, she bent over to look into the tomb 12 and saw two angels in white, seated where Jesus’ body had been, one at the head and the other at the foot. 13 They asked her, “Woman, why are you crying?”“They have taken my Lord away,” she said, “and I don’t know where they have put him.” 14 At this, she turned around and saw Jesus standing there, but she did not realize that it was Jesus.15 He asked her, “Woman, why are you crying? Who is it you are looking for?”Thinking he was the gardener, she said, “Sir, if you have carried him away, tell me where you have put him, and I will get him.”16 Jesus said to her, “Mary.”She turned toward him and cried out in Aramaic, “Rabboni!” (which means “Teacher”).17 Jesus said, “Do not hold on to me, for I have not yet ascended to the Father. Go instead to my brothers and tell them, ‘I am ascending to my Father and your Father, to my God and your God.’”18 Mary Magdalene went to the disciples with the news: “I have seen the Lord!” And she told them that he had said these things to her.      —John 20 NIV

Characteristic Checklist/Autism

Is your child nonverbal? Or have you noticed that the language he/she does have, doesn’t sound quite “right”? Do you believe your child is not reaching age appropriate milestones? If this is the case, your child might have a language or communication disorder.

Kyla Boyse, a registered nurse at the University of Michigan Health System, says,If your child is not on track with the following speech/language development milestones, you should talk to your pediatrician.” (Boyse, K. R.N, University of Michigan Health System. 2012) Speech and language milestones for a typical child are as follows:

Age Language Level
Birth Cries
2-3 months Cries differently in different circumstances; coos in response to you
3-4 months Babbles randomly
5-6 months Babbles rhythmically
6-11 months Babbles in imitation of real speech, with expression
12 months Says 1-2 words; recognizes name; imitates familiar sounds; understands simple instructions
18 months Uses 5-20 words, including names
Between 1 and 2 years Says 2-word sentences; vocabulary is growing; waves goodbye; makes “sounds” of familiar animals; uses words (like “more”) to make wants known; understands “no”
Between 2 and 3 years Identifies body parts; calls self “me” instead of name; combines nouns and verbs; has a 450 word vocabulary; uses short sentences; matches 3-4 colors, knows big and little; likes to hear same story repeated; forms some plurals
Between 3 and 4 years Can tell a story; sentence length of 4-5 words; vocabulary of about 1000 words; knows last name, name of street, several nursery rhymes
Between 4 and 5 years Sentence length of 4-5 words; uses past tense; vocabulary of about 1500 words; identifies colors, shapes; asks many questions like “why?” and “who?”
Between 5 and 6 years Sentence length of 5-6 words; vocabulary of about 2000 words; can tell you what objects are made of; knows spatial relations (like “on top” and “far”); knows address; understands same and different; identifies a penny, nickel and dime; counts ten things; knows right and left hand; uses all types of sentences

(Boyse, K. R.N, University of Michigan Health System. 2012)

If you notice that your infant is not babbling or cooing, or your toddler is not imitating familiar sounds or is not beginning to build a vocabulary, it is possible that your child might need to be evaluated for a language disorder. If your two year old is not combining a noun and a verb in conversation, or is not interested in hearing stories, or can’t identify any of his/her body parts you should see about having them evaluated. By the ages of three and four a typical child is well on their way to a one thousand word vocabulary.

A language or communication disorder occurs when an individual either does not understand what someone is telling him/her, receptive language, or is unable to share their thoughts or feelings in words which is expressive language. (American Speech-Language-Hearing Association. n.d.) Communication is a constant back and forth of both understanding and expressing language.

Children with Autism Spectrum Disorders will, most likely, have language delays. Their delays will be in both receptive and expressive language.

This is a checklist of language delay characteristics to look for if you suspect your child might have a language disorder.

  1. Does the infant follow the gaze of his/her caregiver?

  2. Does the infant engage in a shared focus on objects or other people, coordinated joint attention? (Adamson & Chance, 1998)

  3. Does the child point at objects to show interest or desire for that object?

  4. Does the child attend to speech ( Osterling & Dawson, 1994; Paul & Sutherland, 2005) and is he/she communicating with others around him/her?

  5. Does the child repeat language, echolalia, (Fay, 1980b) in unusual ways?

  6. Does the child have a one thousand word vocabulary between the ages of three and four?

  7. Is the child having a difficult time understanding and correctly using pronouns? (Fay, 1980b) Is he/she confused by gender?

  8. Is the child talking in a mechanical or wooden sounding, voice? (Fay, 1980b; Tager-Flusberg et al., 2011)

  9. Does the child perseverate on a favorite topic, not appearing to care if others lose interest in the topic?

  10. Does the child understand pragmatics knowing the context of language? (Tager-Flusberg et al., 2011) Does he/she understand the nuances of language ? Does he/she understand jokes, sarcasm, or social cues? Is he/she very literal with his/her language?

The language characteristics that are mentioned above are predictors of a language disorder. If any of these issues describe your child, he/she should be evaluated by a professional. Early intervention is extremely beneficial to those children with language disorders.

References:

Adamson, L. B., & Chance, S. E. (1998). Coordinating attention to people, objects, and language. In A. M. Wetherby, S. F. Warren, & J. Reichle (Eds.), Transitions in prelinguistic communication  (pp. 15-38). Baltimore, MD: Paul H. Brookes

What Is Language? What Is Speech?
http://www.asha.org/public/speech/development/language_speech.htm

American Speech-Language-Hearing Association. (n.d). What is Language? What is Speech?. website:http://www.asha.org/public/speech/development/language_speech.htm

This article helps to explain the difference between speech and language disorders.

Speech and Language Delay and Disorder: Your Child: University of Michigan Health System
http://www.med.umich.edu/yourchild/topics/speech.htm

Boyse, K, R.N. for the University of Michigan Health System. (2012, November). Speech and Language Delay and Disorder. website: http://www.med.umich.edu/yourchild/topics/speech.htm

Ms. Boyse discusses the milestones in child speech and language development.

Dawson et al 2004 Dev PSychology.pdf
http://infantlab.fiu.edu/articles/Dawson%20et%20al%202004%20Dev%20PSychology.pdf

Dawson,G., Toth, K., Abbott, R., Osterling, J., Munson, J. Estes, A., Liaw, J.(2004). Early Social Attention Impairments in Autism: Social Orienting, Joint Attention, and Attention to Distress. Developmental Psychology, 40, 271-283

Failure to attend to speech is a strong predictor of autism.

Hall, Laura J., (2013). Autism Spectrum Disorder: From Theory to Practice. Pearson Education, Inc.

References to Paul & Sutherland, 2005, Fay 1980b, and Tager-Flusberg, 2011 were found on page 174 in chapter eight, Focus on Communication. These references were used when discussing language delay characteristics.

Looking Toward Easter

The Crosses on Good Friday

The Crosses on Good Friday (Photo credit: 50%ChanceofRain)

It’s not about the bunny, it’s about the Lamb.

Christmas is wonderful, but Easter is the real reason that Christ came.

The Son of God was the perfect, blameless lamb.

It was the cross that formed the bridge. It was His blood that cleansed.

It was His resurrection that brought life.

Jesus Christ, the Lamb of God.

*************************************************************

Today I am thankful for:

* Springtime snow

* safe travel for my husband

* a phone call and husband’s voice

* sleeping in

* lots of leftovers in the fridge

* quiet stillness

* laughter

* kids getting along

* good grades

* taking a break

* orange juice that I don’t often get to have…

* Jesus, my Savior

* God’s perfect Lamb






Interesting Articles and Studies/ Autism Spectrum Disorder

Factsheet for autism therapy: picture exchange communication system (PECS) | Healing Thresholds
http://autism.healingthresholds.com/therapy/picture-exchange-communication-system-pecs

Healing Thresholds. (n.d) Fact sheet for autism therapy:picture exchange communication system (PECS). website: http://autism.healingthresholds.com/therapy/picture-exchange-communication-system-pecs

This site gives a basic explanation of PECS as an augmentative and alternative communication system.

Stokes – SLP Institute
http://slpinstitute.cesa5.org/presenters/stokes

Stokes, S., K.L. (2006) Practical Instructional Strategies & Behavior Management for Students with Autism Spectrum Disorder. PESI website: http://www.pesi.com

I have a copy of Ms. Stokes notes that she used in a conference that I attended on ASD. It was one of the best conferences I have had the privilege to attend. These notes are bound, but technically not a book. She was a speaker for PESI at this conference.

With Autism Spectrum Disorders in… preview & related info | Mendeley
http://www.mendeley.com/research/red-flags-autism-spectrum-disorders-second-year/

Shumway, S., & Wetherby, A. M. (2009). With Autism Spectrum Disorders in the Second Year of Life. October, 52(October), 1139-1157. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2756334&tool=pmcentrez&rendertype=abstract

This is a study that examines the communication profiles of young children with Autism Spectrum Disorders.

Using Computer-Presented Social S… preview & related info | Mendeley
http://www.mendeley.com/catalog/using-computer-presented-social-stories-video-models-increase-social-communication-skills-children-h/

Sansosti, F. J., & Powell-Smith, K. A. (2008). Using Computer-Presented Social Stories and Video Models to Increase the Social Communication Skills of Children With High-Functioning Autism Spectrum Disorders. Journal of Positive Behavior Interventions, 10(3), 162-178. SAGE Publications. Retrieved from http://pbi.sagepub.com/cgi/doi/10.1177/1098300708316259

This study investigated the effect of using social stories on the computer. The children in the study were high functioning Asperger’s students.

Social Skills Interventions for C… preview & related info | Mendeley
http://www.mendeley.com/catalog/social-skills-interventions-children-high-functioning-autism-spectrum-disorders/

Schreiber, C. (2010). Social Skills Interventions for Children With High-Functioning Autism Spectrum Disorders. Journal of Positive Behavior Interventions, 13(1), 49-62. Retrieved from http://pbi.sagepub.com/cgi/doi/10.1177/1098300709359027

This article discusses social strategies/interventions to use with school age children and teens with Autism Spectrum Disorder.

Social stories, written text cues… preview & related info | Mendeley
http://www.mendeley.com/catalog/social-stories-written-text-cues-video-feedback-effects-social-communication-children-autism/

Thiemann, K. S., & Goldstein, H. (2001). Social stories, written text cues, and video feedback: effects on social communication of children with autism. Journal of Applied Behavior Analysis, 34(4), 425-446. Society for the Experimental Analysis of Behavior. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1284338&tool=pmcentrez&rendertype=abstract

This study is about teaching communication skills to children with ASD as they communicate with typical peers.

Assistive Technology for Children with Autism
http://www.specialed.us/autism/assist/asst10.htm

Stokes,S. (n.d) Assistive Technology for Children with Autism. website: http://www.specialed.us/autism/assist/asst10.htm

“Written by Susan Stokes under a contract with CESA 7 and funded by a discretionary grant from the Wisconsin Department of Public Instruction. ”

Ms. Stokes discusses various types of assistive technology that can be used with children that have autism.

Is the iPad a ‘Miracle Device’ for Autism? | Fox News
http://www.foxnews.com/tech/2011/03/09/can-apple-ipad-cure-autism/

Brandon, J. (2011, March 9). Is the iPad a ‘Miracle Device’ for Autism?. website: http://www.foxnews.com/tech/2011/03/09/can-apple-ipad-cure-autism/

This article discusses the benefits of children with autism being able to use iPads on a regular basis. iPads have been a miracle for some ASD children.

Language Development: Receptive, Expressive, Pragmatic, Oh my!
http://www.lewisandlewis.com.au/uncategorized/language-development-receptive-expressive-pragmatic-oh-my/

Fish, J. (2012, September 24) Language Development: Receptive, Expressive, Pragmatic, Oh my! . Lewis & Lewis. website: http://www.lewisandlewis.com.au/uncategorized/language-development-receptive-expressive-pragmatic-oh-my/

This is a business site. A speech/ language pathologist gives definitions of receptive, expressive, and pragmatic communication..