Literature
Review: Evaluation of the Efficacy of
Communication-Based Treatments for Autism Spectrum Disorders. Brunner, D.,
& Seung, H.
This
review covers 36 studies from 2003-2007 in support of communication based
treatments for children with autistic spectrum disorders. It explores evidence
presented in seven treatment categories: applied behaviour analysis,
naturalistic behavioural, developmental, classroom-based, video modeling,
social skills and augmentative and alternate communication.
Back
in 2002 there was considerable evidence collected to support the effectiveness
of communication based interventions or ABA (Applied Behavioural Analysis) such
as discrete trial training, natural milieu and sign language. During this time
there was evidence that PECS, self-monitoring and family/parent based
interventions were effective for non-verbal children with ASD.
In
2006, there was a greater focus on functional communication training when
addressing challenging behaviours in non-verbal children. This included
discovering the root of the behaviour and replacing it with more appropriate
behaviour, using highly motivating objects or activities. It was found that the
training had more effect if it was consistent in the natural environment as
well as in school/daycare.
Sample PECS training session- Phase 1
Developmental
interventions assume that language is based on strong, positive adult-child
interactions. This relies heavily on parental and adult training and
involvement. Adults must assume that all verbal productions are deliberate and
purposeful. Because of this the adults must be extremely aware and in tune with
the child and this increases the social interactions, thereby increasing the
developmental opportunities for the child.
Classroom
based interventions are considered natural environments for providing
communication training. It can use several approaches as listed above and
tailor training for each individual child. Assistive and augmentative tools may
also be utilized and data collected to monitor ongoing success with the
communication goals.
By 2007,
video modeling showed evidence that motivation increased with attaining
communication goals by targeting a behaviour or skill using peers
(point-of-view modeling) or themselves (self-modeling). To date, Bellini, Akullian, et al.
(2007), state that there is
stronger evidence appearing to support video modeling as a strategy to increase
social engagement and behaviours.
Sample Video-Modeling A Haircut
Social
stories, a written narrative designed to improve social understanding and
behaviours/responses, are often less intimidating than role playing which were
the more traditional social skills training used prior to 2006. However,
despite their wide-spread use, there doesn’t seem to be clear evidence that
support the efficiency of using social stories.
Using Social Stories to Improve Behaviour:
According
to Simpson et al. (2005), 50% of all children with ASD will remain non-verbal
which highlights the importance of using non-speech communication strategies.
Augmentative and alternative communication methods (AAC) are effective for ASD
students of all ages and developmental stages. This study focused on four areas
of AAC: augmented input (visual schedules, choice boards), augmented input and
output (system for augmenting communication), augmented output only (PECS), and
assistive technology (speech generated devices, mobile devices).
In
conclusion, this literature review suggests that with any treatment or method,
it should not be used in isolation; that a combination of approaches can be
very helpful for non-verbal children. For example, PECS training can be
combined with video modeling to improve communication skills. Video modeling
can be combined with social stories is another example. With the ever increasing
availability of new applications in AAC, the possibilities are endless for
reaching all of our non-verbal students.
References:
Bellini, S., & Akullian, J.
(n.d.). A Meta-Analysis of Video Modeling and Video
Self-Modeling Interventions for Children and Adolescents With Autism Spectrum
Disorders. ASHA's Evidence Maps. Retrieved March 23, 2013, from http://www.ncepmaps.org/Review-534.php
Brunner, D., & Seung, H. (2009). Evaluation
of the Efficacy of Communication-Based Treatments for Autism Spectrum Disorders
. Communication Disorders Quarterly . Retrieved March 23, 2013, from http://cdq.sagepub.com/content/31/1/15
Simpson, R., deBoer-Ott, S., Griswold, D.,
Myles, B., Byrd, S., & Gantz, J. (n.d.). Evidence-Based Practices and
Students With Autism Spectrum Disorders . Focus on Autism and Other
Developmental Disabilities . Retrieved March 23, 2013, from http://foa.sagepub.com/content/20/3/140.short
Article
2:
Teaching Functional
Communication Skills Using Augmentative and Alternative Communication in
Inclusive Settings. S. Johnston, A. McDonnell,
C. Nelson, A. Magnavito
This was
a case study of three pre-school children with significant disabilities who
were taught functional communication behaviours using augmentative and
alternative communication (AAC) devices. After reading many similar articles,
this one stood out because of its sensitivity in keeping the child at the heart
of the study. There seemed to be a great deal of thought invested in gathering
as much information on the child as a whole person, their environment, their
background, their abilities and needs, and the suitability or fit for the AAC
device to be most appropriate, rather than the child for research purposes.
A great
deal of time was spent on creating an accurate baseline, documenting the
intervention along with the maintenance conditions. At the onset, the authors were
quick to point out that AAC systems alone do not ensure functional use of AAC
but that it requires effective interventions in order to acquisition of AAC
skills. They strove to embed intervention opportunities where children were
given opportunities to practice specific goals that are included within an
activity or event that expands, modifies or adapts the activity while still be
meaningful and interesting to the child. In other words, the teaching
strategies must remain authentic and interesting to the child. This requires a
thorough knowledge of the child and careful planned use of intervention
strategies that appear as normal as possible. The use of communication boards
using visuals the child easily recognizes, and electronic communication aides in
the learning environment would be an example of this.
They
stress that ensuring any AAC device is socially valid is another interesting
point in this study. Social validation or the assessing the impact of social
significance on the goals, methods and outcomes from the point of view of the
child, teachers and parents is considered very important.
The data
also looked into rating how the teachers viewed these interventions. This seems
very important because teachers need to understand, and buy into the effectiveness
of using AAC devices in order for strategies to be sustainable. A detailed survey was used by teachers to
assess the acceptability and perceived effectiveness of the intervention
strategy. It included opinions from teachers in each step of the intervention
as well as whether or not they saw the impact on the classroom environment
disruptive to classroom routines and whether or not it would be difficult to
maintain the strategy while still meeting the needs of the rest of the class.
This factor made this study very interesting as most research articles focused
on the effects of the student themselves and/or families.
In
summary, this case study recommends that future studies need to be carried out
to look into the validity of using AAC in supporting students with
communication challenges. In particular, they suggest that social validation as
viewed by teachers implementing AAC devices, an important piece in determining
whether or not strategies will be effective and sustainable.
References
Johnston, S., MacDonnell, A., Nelson, C., &
Magnavito, A. (n.d.). Teaching Functional Communication Skills Using
Augmentative and Alternative Communication in Inclusive Settings . Journal
of Early Intervention . Retrieved March 23, 2013, from http://jei.sagepub.com/content/25/4/263
Additional links:
Additional links:
Autism Canada- about autism, characteristics, early signs, screening tools and diagnosis.http://autismcanada.org/aboutautism/diagnoses.html?gclid=CJXUrq3rk7YCFaZFMgodq3YA9w
What is non-verbal autism?http://autism.about.com/od/autismterms/f/nonverbal.htm
Toronto Star: The Autism Project: iPads ‘speak’ for non-verbal, autistic kidshttp://www.thestar.com/news/investigations/2012/11/12/the_autism_project_ipads_speak_for_nonverbal_autistic_kids.html
Autism: How Do You Communicate With a Non-Verbal Child?: http://www.comeunity.com/disability/autism/autismnonverbal.html
