There are certain items that each SLP would not leave home without. Over all the years that I've worked with children on the autism spectrum, I find that a View Master is one of those treasures I always carry in my bag. As far as I know, it cannot be duplicated on an iPad or iPhone. It is not the same as flash cards or books. A View Master is unique.

Maybe I was allowing Doug to learn how to multi-task when he was 4 years old (see him at right viewing and eating simultaneously). I'm not sure that I had that concept in mind at the time, but he was focused on whatever characters were popping into his big blue eyes from his View Master and eating at the same time.  

View Master and its Reel Rules

When you use a View Master with children on or off the autism spectrum, always make sure it is a simple one. Select one that is light weight and easy to handle. The reels should be of the latest cartoon characters, favorites, new movies, or animals.

What Language Skills Does a View Master have to Offer?

A lot and first of all - make it exciting and fun to learn something new. The best way to do that is to provide a good, fun, animated, model. Make it something the child simply can't resist.

• Turn taking and sharing (between two or more people)
• Focus/attention
• Vocabulary
• Sequencing
• Visual awareness
• Expressive speechInitiating
• Answering (whatever level the child is at: yes/no or wh questions)
• Finding humor
• Social skills (talking about the scenes)

Benefits of using a View Master

• Release of tension/anxiety/calming
• Provides visual input in a focused manner
• Provides opportunity for a shared relationship
• Can be used as a reinforcer
• Can be used to make choices (which reel the child wants, where they want to sit to use it)
• Provides opportunities for new body positions (tipping head toward light, lying on back)
• Provides hand/eye coordination between the clicker and the picture
• (the above are in addition to the benefits of speech/language)

It is important the SLP or parent know the reel very well before the child sees it so the language of learning, excitement, fun, sequencing, and sharing can take place. Always insist on your turn. Just like I wrote about the we-Pad, this is a we-View Master.

The child with ASD might view the world from a different

set of eyes but the View Master grants them moments

of awareness in a world the SLP can share.

What's a favorite tool for children/adults on the spectrum in YOUR bag? Let me know and I just may write about that too.

I will be giving the Keynote Address at the Florida Speech/Language/Hearing Association Convention in Orlanda, FL, May 24-27, 2012 ~ Experience the Magic of FLASHA. The title of my address is The Magical Kingdom of Autism.                                    

It's important to keep up with the experts in the field of autism/ASD. One of the best ways to do so is to attend conferences. This has a three-fold benefit: to hear the speaker, network, and attain CEUs.

I recently attended a one-day conference sponsored by Future Horizons (largest publishing company for books on autism at www.FHautism.com) Dr. Temple Grandin was the featured speaker. The HBO movie of her life received Emmy, Golden Globe and SAG awards.                                             

Dr. Temple Grandin, Kathie/Temple

Kathie/Paula Aquilla, BSc,OT

Kathie/Jennifer Mcllwee Myers

Highlights from Dr. Temple Grandin:

I've heard Dr. Grandin speak several times before but I believe she was more relaxed and able to interact with the audience this time. She actually made several jokes and smiled a few times. A stiffness to her gait and speech, for sure those were present. Her inability to change was noted and bluntness to her delivery was the same. But I always enjoy Dr. Grandin's message. For those SLPs who don't know, Dr. Grandin is a very high functioning person with autism who shares her message from childhood through her career as an author, speaker, professor at Colorado State University and designer of livestock handling facilities. She is an exemplary person with or without a disability.

What I want to share with you is what Dr. Temple Grandin communicates to her audiences that are important for SLPs and their families with whom you work. These are important because they are life-long. Autism is life-long.

• The strongest piece of advice I can give to both teachers and parents is to develop the child's strengths and teach them from those.
• Drop the label and look at the kid.
• We are too hung up on autism. Autism is part of what I am but it is secondary to what I am.
• Don't worry if you are not doing evidence based therapy/strategies. See what works with each individual child and use it or drop it and try something new.
• Sort everything into categories (teach categorization).
• Teach by specific examples.
• People with autism get worse when they get tired. Sleep is important and many have sleep problems.
• Give children a lot of experiences. Get them out in the real world.
• Start teaching social rules in the real world - one specific explanation at a time.
• Sit kids by windows (natural light) in classrooms.
• Laptops and tablets are better than desktop computers. Desktops often flicker to people with autism.
• Children with autism do not hear hard consonant sounds. Use flashcards to teach and practice them.
• Echolia is output. It is not that they do not understand.
• Children with autism need three types of sensory integration: for sensory seeking, for picky eating habits and for low tone kids
• Anxiety is a part of all people with autism (many, including Temple, are on medications for anxiety - if so, these medications need to be increased in small increments)
• People with autism do not get enough exercise.
• People with autism build relationships through shared interests rather than emotions, but we do have many emotions.
• By the age of middle school, people with autism need to get a job outside the home.
• To person with autism, sell your skill, not yourself.
• It is important to teach good manners.
• For behaviors, make things consistent and constant with the consequences.

How the above information impacts speech/language therapy:

As I went over each of these bulleted statements by Dr. Temple Grandin, I asked myself these questions:

• Does this relate directly to speech/language therapy?
• Is it my responsibility, as an SLP, to assist this young child or adult with a goal such as this?
• Can I, as an SLP, do anything about this?

Most of these I answer with a resounding YES. Yes, I can, should, and will do something about each of these. I can't control the amount of sleep a child gets but I can discuss the importance of it if I know he/she falls asleep in the classroom. The same with medications but the SLP should know when medication is altered in any way.

So, SLPs get on your thinking caps. You don't need a recipe book. You don't need to know what a child cannot do. You can't cure autism but you can sure make it better.

I have already blogged about many of the bulleted points that Dr. Grandin finds important for people across the spectrum and you bet your booties I will be blogging about the others.

                                              Thank you, Dr. Grandin, for being who you are

                                                and for sharing your life so that we might all

learn from you.

                                         "Speech pathologists make good things happen."

This week, I have a special poem, "I Believe in Blue," that I wrote for my son on his 41st birthday, which happened to be the first day of April, the beginning of Autism Awareness Month. Light It Up Blue was part of the awareness sponsored by Autism Speaks.

I have not yet shown this poem to my son, Doug, because he told me once when I asked him if he would be part of a panel at the National Autism Society Annual Convention, "Mom, that's something you do." I honor that.

I did not punctuate I Believe in Blue in any way because autism never pauses

Enjoy

"Speech pathologists make good things happen."

Toby Keith sings about his Red Solo Cup, and most of his lyrics don't exactly fit in with the autism spectrum. There is one verse of this popular song that does, if I tweak it just a bit.

This is all in fun, of course, and autism, as we all know, is not fun, funny or amusing to professionals or families. When I was a young mother and in the midst of raising our son with autism, I was lucky because I had the wisdom of a very wonderful friend about three times my age. Grandma Marty, as we called her, was always there for me. I'd talk. I'd cry. I'd explain what had happened or what our family had to do next. Grandma Marty listened. She caught my tears on her heart. She told me to find the good in every day. She advised me to "swing on a gate," which meant to just ignore some things, relax, find humor, wait, and enjoy life. She told me that when I got off that swinging gate I would be energized and ready to once again learn and do what needed to be done. I would be ready to make the right choices for our son and for our family. Grandma Marty was right.

Autism was new in the world of diagnosis and rarely discussed or studied in the educational realm some 40 years ago. (Dr. Leo Kanner identified autism in 1943, and Dr. Hans Asperger characterized Asperger's syndrome in 1944.) I was lucky because I had the wisdom of many wonderful professors for myself and eager educators for our son. They all told me to find the good in every day. (The only programs for autism at that time were electric shock, cattle prods, and "The Cold Mother Theory." I burned those books.) We put ourselves around these good people. They were our advisors, mentors, teachers and friends.

My hope for you, as SLPs, is that you pass on Good and Hope to your clients and families as they deal with autism in their daily lives. Few people can accomplish that. I was very, very, very lucky to have these special people in our family's life when we so desperately needed them. I made a promise that I would always share what I know. You can be one of the few your families will etch in their memories of special people.

So now I have a Blue Solo Cup. I lift it high for Light It Up Blue Day and the month of April for autism awareness. Our family has been aware of autism for 40 years, and that's OK because we continue to find the good in every day. After all, there always is.

P.S. The name of my private practice in Las Vegas is Good Speech, Inc. That name comes with a reason.

In next week's Autism Spectrum Blog for the last week of April, Autism Awareness Month, I plan to share a special poem I wrote about my son, "I Believe in Blue." I hope you come back because it's special and I'd hate to have you miss it.

"Speech pathologists make good things happen."

The Autism Awareness Ribbon

The puzzle pattern reflects the mystery and complexity of the autism spectrum. The different colors and shapes represent the diversity of people and families living with the condition. The brightness of the ribbon signals hope - hope that through increased awareness of autism, and through early intervention and appropriate treatments, people with autism will lead fuller, more complete lives.

I like this symbol and its definition because it does not talk about a cure for autism/ASD. Rather, it portrays awareness, hope, and the mystery of life itself through the eyes of autism. The representation includes not only the person with autism but families and professionals as well. In other words, this little puzzled ribbon covers the autism spectrum.

A responsibility of every SLP is to be able to give parents and other professionals guidance and reliable information about where to find trustworthy websites for their needs. Many young parents are at the beginning of their "autism journey," as are many professionals. The Internet is a deep, dark hole of unreliable and depressing information concerning the autism spectrum. Your clients need to know where they can get the latest, best, most optimistic and dependable answers to their questions. They will respect you for knowing and directing them to the following sites.

• American Speech-Language-Hearing Association
• Autism Research Institute
• Autism Society of America
• Autism Speaks
• Kathie's World
• National Autism Association

It is also important that the SLP maintain a community list to share with parents and other professionals. Just be sure that in any discipline more than one name is given on your referral list.

Kathie's Pendant

"Speech pathologists make good things happen."

Autism Awareness Month began on Sunday, April 1. My son Doug's birthday is April 1.

The fifth annual World Autism Awareness Day was April 2. World Autism Awareness Day "aims to increase people's awareness about people, especially children, with autism. The day often features educational events for teachers, health care workers and parents, as well as exhibitions showcasing work created by children with autism."

14 Signs of Autism That All SLPs

Need to Recognize in Children and Adults

1. May avoid eye contact
2. May prefer to be alone
3. Echoes words/phrases
4. Difficulty interacting with others
5. Spins objects or self
6. Insistence on sameness
7. Inappropriate attachment to objects
8. Inappropriate laughing or giggling
9. May not want cuddling
10. Difficulty in expressing needs
11. Inappropriate response or no response to sound
12. No real fear of danger
13. Apparent insensitivity to pain
14. Sustained, unusual or repetitive play

Additional Characteristics Associated with ASD

There are many characteristics associated with ASD that are less observable because they are based on developmental histories or happen in the home environment. Thus, SLPs should interview the parent/caregiver in depth. Some of these characteristics are as follows:

• Picky eating habits
• Poor sleeping patterns
• Lack of a social smile and overall affect
• Had a skill but lost it
• Does not play appropriately with most toys
• Lack of visual and auditory tracking
• Does not reach out when reached for as a baby
• Does not respond to name when called
• Toe walking
• Flapping of hands or objects
• Does not follow simple commands
• Hypersensitive to sound (covers ears) or hyposensitive to sound (no startle response to loud sound)
• Mild to severe temper tantrums
• Hyper- or hyposensitivity to pain
• Stiff posture with an awkward gait
• Preservative, either physically or verbally
• Impulsive and will not wait for needs to be met
• Difficulty with toilet training
• High anxiety level
• Feels, smells, and/or tastes objects
• Ritualistic with certain objects (e.g., lines up cars)
• Stares into space
• If verbal, uses pronoun reversals
• If verbal, refers to self in third person
• If verbal, echoes speech from television or people
• If verbal, speech is monotone

Believe It or Not Characteristic

Even I don't know whether to believe this or not. I've been a reader of autism for about 40 years. That's a long time, and certainly a long time to remember where you might have read a particular fact. I've only read it once, and I've never seen it again, but I have found over the years that it seems to run true about 80 percent to 90 percent of the time: "People with autism have long, beautiful eyelashes."

I always make a quick, silent note in my observations about "long eyelashes" when I do an assessment. I never mention it to parents, nor do I bring it up during an IEP. It's just something I note to myself. Does my son, Doug, have long, beautiful eyelashes, you ask? Ahhh, any woman would kill for them!

"Speech pathologists make good things happen."

When do you elicit a language sample? Certainly when you first see a child you would want to take a language sample. However, if the child is not comfortable on the initial assessment, there is nothing written in stone that says that it has to be completed the first time around. That in itself should tell you something.

I feel that assessment is ongoing. Thus, language sampling is a good thing to do every few weeks, especially during rapid growth spurts. This is the most natural form of how a child is using his or her language across environments.

Where does an SLP take a language sample? Wherever the SLP and child are. This can be done in the therapy setting (individual/group), classroom, playground, home, on the job - in any environment because "live" is all around us.

What do you hope to attain from a language sample? Everything! Perhaps a better question is what can't an SLP attain from a language sample? Here is a laundry list of what I look for in a sample that is taken individually in the therapy setting: pragmatics (social language skills), expressive and receptive language skills, asking questions, answering questions, syntax, morphology, attention/focus, categorization, sequencing, counting, basic concepts, following directions, negation, appreciation of humor, and turn taking. I also look for topic maintenance, perseveration, left-to-right orientation. Of course, I base all of the above on age and cognitive appropriateness. I even make notes about articulation, fluency and voice (quality - loudness) and other behavioral patterns.

A Reminder About the Importance of Taking a Language Sample

Be sure to refresh yourself about what is necessary to look at when taking a language sample in my posts from February 2, 2012 and February 9, 2012.

Six Language Sample Collages

Because I received so many pictures, I put three collages in this post and three in my previous post. I would recommend using different collages as you assess any particular child.

• Print the collages
• Place each one in a protective transparent sleeve or laminate
• Either the SLP selects one for the language sample or the child selects between two
• Have fun!

Collage #1 Chuckles, Chunky, Copper, Goldie, Mr. Higbee, cartoon fish (I slipped in a cartoon to ask the child to show my which animal is NOT real), Lizzy, C.C.        

Collage #2 Chuckles, Coconut, Chunky, Sonny and Cher

Collage #3 His Majesty, Donkaroo, Little Peeps, Chuckles

 These are the Language Sample collages I made for you

I hope you'll use them, oh yes, I do.

Take a language sample whenever you get a chance.

It's an ongoing measure of what you can enhance.

"Speech pathologists make good things happen."

Because I received so many pictures, I divided the collages I made between this week's post and next week's. So look for your special friend and make them all your special friends.

(A reminder about the importance of taking a language sample: Be sure to refresh yourself about what is necessary to look at when taking a language sample in my Feb. 2 and Feb. 9 posts.)

• Print the following collages.
• Place each one in a protective transparent sleeve or laminate.
• Either the SLP selects one for the Language Sample or the child selects between two.
• Have fun!

Collage #1 features Bubba, Bugsy, Twist, Coconut the fish, and Perry.

Collage #2 features Sonny and Cher, Rocco and Saddle-Up.

Collage #3 features Lucky, Rocco, Foxie (I slipped in a cartoon to ask the child who is NOT real), Trixie, Kiki and Goldie.

 Three more collages are coming your way

to assist your kids who have so much to say.

Take a language sample, then figure it out,

you'll have children talking without a doubt.

"Speech pathologists make good things happen."

Blog Comment: "Please correct your meter from 'to loud' to 'too loud.'" - D.

To D: So sorry about the error. That tells me you are a close reader, and I appreciate the correction. I have made the change to the Loud Meter, as you can see below. Please feel free to print it off and use it with your clients.

Thanks so much for following my autism blog.

Please be sure to refer back to my recent posts, "A Lesson in Volume Control" and "Working with Hearing Sensitivity" for more information on loud voices and hearing sensitivity in individuals on the autism spectrum. This Loud Meter is another tool in the SLP's therapy bag.

Meter, Meter on the Wall

I'm thinking of all the other ways a meter such as this one can be used to modify various behaviors in people with autism. It is limitless. It can be personalized to individuals, or it can be modified for classrooms, therapy rooms, home environments, or even on-the-job training.

The various steps or degrees on the meter can be changed with Velcro® backing so that one meter can be used with a number of clients with different needs. Here are some ideas of behaviors that can be modified with the use of this meter:

• sitting in a chair
• not talking so much
• topic maintenance
• sharing objects
• grooming
• completing a task or assignment
• asking appropriate questions

Of course, you can use your imagination and customize the meter to particular clients and their needs.

I have made another, nearly blank, meter for you to use. Let me know who our creative SLPs are and just how you have developed this idea into a successful therapy technique. I'll be happy to share YOUR ideas in a future post.

"Speech pathologists make good things happen."

Dear Kathie: "Chad is 5 years old and ‘very' autistic and non-verbal. He covers his ears with his hands when there is a loud noise, such as a fire alarm, or even when he anticipates a loud noise, like a balloon that he thinks may pop. How can I help him, his classroom teacher, and his parents? - Payton, speech-language pathologist

My Response: Using the hands to cover one's ears is very common in children with autism spectrum disorder. Many people think it's just weird or that the child is being difficult because he or she will stop what they are doing and cover their ears immediately to a loud sound or if they think one might happen, like in the case of the balloon mentioned above. In actuality, these loud sounds often cause real pain to the person with autism. People with autism react to certain pitches and tones, but often not to others. They may not even react to people's voices. This can vary on a daily basis and across environments. It will also depend on whether something extremely loud has startled them in the past.

I have seen children with autism cover their ears well into their teens. I have seen parents keep their child away from family outings that they know will be full of loud sounds. I have seen children wear heavy sets of headphones and they still cover their ears with their hands. I have seen mothers stuff cotton plugs in their child's ears. I have seen children cover their ears and scream to loud sounds.

I do think there are some strategies we can implement to assist these individuals so that the volume of the sound will induce less fear and not startle them as much. We can even introduce some more socially acceptable reactions to the sound. One word of advice, though: never pull the child's hands away from his or her ears.

Strategies for Young Children

• I'm a huge believer in early intervention. So the first time this behavior is reported or observed, just know that it is going to reoccur.
• Ask this question at the Individualized Education Plan (IEP) meeting: "Does Chad cover his ears when he hears a loud noise?"
• Gradually desensitize the child by using a variety of sounds on an iPad, a tape recorder or a video. By using an iPad, the child can point and touch the sound, thus empowering the child to take control of the sound. (Please refer to the post "The iPad Becomes a wePad for Autism".)
• Make it fun and laugh at the sounds.
• Control the level of the sounds on the iPad or device from soft to louder.
• Use the images provided in the "A Lesson in Volume Control" post. (You can use the Loud Meter for children who are at that level of understanding.) 
• Use self and parallel talk such as:

• "The balloon might pop but it's OK."
• "I like the helicopter."
• "You hear a bear." (Say this after the child has selected a picture of a bear on the iPad)
• "I think thunder is fun."

• Practice in front of a mirror with the child covering and uncovering their ears with their hands and use soft and loud sounds and self and parallel talk to make it fun.

• Tell the school office to give the classroom a heads up in the case of a fire drill so that the teacher can let the child know about it ahead of time.
  

Again, never pull the child's hands away from his or her ears.

Strategies for Teens and Adults

• I hope by the time an individual becomes a teenager or adult that they have been lucky enough to have been given many of the strategies listed above. If so, they may have outgrown the need to cover their ears through desensitization, practice and simply by maturing.
• Shape their ear-covering behavior through the use of a mirror and let them see for themselves how they look to others
• Empower the individual by letting them select a headset that is smaller and more socially acceptable. Always check with the parents first.
• Show them and talk about appropriate ways to escape certain offensive sounds
• For individuals with high functioning autism or Asperger's syndrome, honesty is the best answer. For example, you can say "Covering your ears with your hands draws unnecessary attention." Let them know how it looks to others. ("Looking at you, looking at me.")
• Watch for bullying - it can be very subtle but very deadly. This true with younger children as well.

Behavioral Change

It takes persistence, consistency and a team to change this behavior. It may not be easy but it is certainly worth the time and expertise of the SLP.

"Speech pathologists make good things happen."

My Response: Great question, Ellen. In last week's Autism Spectrum Blog post, "Five Functions of Undesirable Behavior," one of the functions was avoidance. I believe avoidance is the purpose of Julie's negative behavior. She is avoiding the work and is successful at it. By letting Julie get by with doing nothing and sitting there with her head down on the desk, the teacher becomes the enabler.

Possible Reasons

• Julie is bored
• Julie already knows the information
• Or, Julie knows she does NOT know the information
• Julie needs more of a challenge
• Or, Julie needs less of a challenge
• Julie is being reinforced by something the professionals are not observing (i.e. bullying could be going on behind the scenes)
• Julie feels powerless and this is one way of gaining power
• Julie might resist doing the work in a group

Power means to EMPOWER

Praise means to say something good about each small step

Positive means that the person finds success and builds on it

Plausible Solutions

• Shape Julie's behavior by first letting her read the assignment for a given period of time - maybe the first two days - then raise the expectation level by asking her to complete the first line on the page, or first five questions, etc.

• Empower Julie by giving her choices
• Choices between what kind of a writing tool to use to complete her work
• The choice of whether to complete the work does not exist

• Empower Julie by letting her choose between two assignments
• One assignment is easy and one is more of a challenge

• Give Julie an option of moving her desk - once

• Praise Julie for each small step along the way
  

• Tell Julie how good she feels about herself when she has completed something - constantly. Don't ask her - TELL her

• Watch for bullying - it can be very subtle but very deadly

• Take Julie and one peer into a quiet room and let her experience doing the written work with another student. Keep the environment as close to the classroom setting as possible and expect that the work will be completed.

• Give Julie work where she can excel on her own to begin with. She will most likely not initiate raising her hand if she has questions. Success build success.

As an autism mentor, I was called into a classroom for this very reason. I had a limited amount of time to work with this student with ASD, who would not complete an assignment for the regular classroom teacher.

The student did not know me, and I did not know him. I took two markers over to him, one black and one blue. His math paper lay flat on his desk.

I held one marker up by each side of my face and said, "Do you want to do the first line of numbers in black or in blue?" (NOTE: It was not a choice of doing the page, but rather what color marker he wanted to use)

He grabbed the blue marker out of my right hand and proceeded to complete the first line.

 "That makes us both feel good," I said. "Now, do you want a red or a green marker for line number two?" He selected the green one with a little less force.

• I never asked any questions (except for the one about the markers) or gave any commands.
• I only gave choices between two colored markers at a time.
• I knew the assignment was at a level he could accomplish on his own.
• Before he knew it, the math sheet was completed.
• We smiled at each other and gave high fives.
• My name didn't matter to him, but that success most certainly did.

Behavioral Change

In this scenario, the change didn't happen with just my one intervention. It takes persistence, consistence, and at least two weeks for change to occur.

"Speech pathologists make good things happen."

All behavior has a function and purpose. There are five main functions of undesirable behavior, and four of them go hand-in-hand with autism. It is important for the speech-language pathologist and the entire team to recognize how any particular behavior is reinforced and enabled.

Avoidance

Do children and adults with autism exhibit negative behaviors due to avoidance? Do they ever pretend not to hear? Do they ask unrelated questions in order to evade a topic? Yes, yes and yes.

The Asperger's population is especially clever at avoiding verbal and non-verbal cues in social situations. Many of these are intentional and many are not. Topic maintenance is a language skill that comes to my mind right away that is often lacking in individuals with autism spectrum disorder. It is certainly not always deliberate and there are many strategies for dealing with this behavior and area of language deficit.

Attention

Communication

The lack of ability to communicate successfully is a paramount reason for undesirable behavior. Children and adults with ASD have documented issues with their receptive, expressive and pragmatic speech and language skills. When a person cannot understand and/or be understood, behaviors take center stage. Social communication with this population is awkward, misunderstood and misleading to the person with ASD as well as to the listener. From childhood through adulthood, communication is a major cause of negative behavior. This can be exhibited through non-verbal and verbal behaviors.

Self-stimulation

Self-stimulating behaviors, such as hand flapping, head banging, self-mutilation, tapping, running back and forth, jumping up and down, and compulsive behaviors all serve a purpose for the person with autism. Of course, they are undesirable behaviors. Although these behaviors are difficult to change they are not impossible to alter. Many of them need gradual, step-by-step shaping over long periods of time. It is important for the team to determine more socially acceptable behaviors to replace the unacceptable ones.

Stress Reduction

My post "Autism in One Word" describes the stress level of children and adults with ASD. Stress is enormous. The fear of communication alone is like climbing a mountain each day. Add in the bullying and their misinterpretation of the world and it is understandable why these individuals engage in behaviors to reduce stress and anxiety. It is the goal of the team to explore and find acceptable and socially appropriate behaviors to reduce the stress level.

Remember:

• Behavior changes are slow
• Persistence is necessary
• Consistency is paramount
• Change must be made across environments
• Many changes are best made in small steps and shaped into a desirable behavior
• Under times of stress, people always return to familiar (old and comfortable) behavior

 How to Change Behaviors

Join me next week as I explore strategies for changing undesirable behaviors.

 "Speech pathologists make good things happen."

Dear Kathie: "Larry speaks so loudly. I can hear him coming from way down the hall in school. No one wants to sit by him in the lunchroom and his teacher is pulling her hair out. I've talked to Larry's mother and it's the same at home, in the library and at McDonald's. Any suggestions? And is this really in the realm of speech therapy for a child with ASD?" - Sonia, speech-language pathologist

My Response: Larry is not alone, Sonia. Many children and adults with ASD have loud voices and do not monitor themselves or their environments. To answer your last question first - YES, vocal loudness, awareness and the social aspects that go along with it are in the realm of speech therapy. This directly impacts communication with all children and adults with ASD across ages and environments.

Does Larry Know He's Loud?

The answer to this question is maybe...and maybe not. Assuming that his hearing is within normal limits (always have that checked out first) perhaps no one has ever told him just how offensive his loudness is. As we know, people on the autism spectrum can become defensive and even throw a tantrum if they are given commands to change a behavior, such as "speaker softer." Also, what does "speak softer" really mean to Larry? He's not thinking about how the other person perceives his vocal intensity. That's autism for you.

What Larry Is and Isn't Doing

• Since Larry is speaking, we know that he is intelligent and can speak (I'm not dealing with what he is speaking about, perseveration, and communicative intent in this post). He has something to say and wants somebody to hear it.
• Larry is not monitoring himself.
• Larry is not monitoring the reactions of others.
• Larry is not monitoring his speech in various environments.
• Larry is probably being Larry.

What the SLP Can Do

• Know from the start that a great deal of practice will be necessary because you are changing a behavior.
• Self-monitoring needs to come first.
• Monitoring the reactions of others comes second.
• Monitoring his speech in various environments comes third.

The three pictures above are provided for visual monitoring. The SLP should enlarge, cut, paste, laminate and share them with the classroom teacher, lunchroom monitor, the parent/caregiver and other professionals. They can be placed on a bulletin board, in a photo page or on a desk. Use your imagination and find out what works best for the child or adult in a variety of environments.

• The SLP will monitor the child/adult by using the Loud Meter or Thumbs Up/Thumbs Down method by visually showing the individual how he or she is perceived.

• Once the individual understands the strategy, they should take over and monitor their own loudness level by visually pointing to the Loud Meter or the Thumbs Up/Thumbs Down pictures. It should not take long to get to this point but it will take a lot of practice.

• Tape record and video tape "loud" scenes, "soft" scenes and "just right" scenes. Role play a variety of environments and go to specific places if possible.

• You, the SLP, vary your voice from loud to soft and have the individual monitor the Loud Meter or Thumbs Up/Thumbs Down pictures.

• Teamwork across environments is essential for this to become effective. It is up to the SLP to initiate a program like this, to demonstrate it to all appropriate team members, and to write it into the child's Individualized Education Plan if it is a communication concern for the student. Let's give "Loud, Loud Larry" what he needs, which is to learn how to monitor his own vocal volume.

"Speech pathologists make good things happen."

In "What to Include in a Language Sample, Pt. I," I expressed how important I feel a language sample is to complete an assessment for a verbal child or adult on the autism spectrum. I told you what to look for during a language sample and gave you an example of how I utilize a puzzle to elicit conversation with young children. When taking a language sample from an adult, I use a book or postcards that are of high interest to that individual.

Here is my second and favorite part of a Kathie Language Sample. (I told you it would make you bark.)

These are my two little dogs. Mr. Higbee is on top, and Diamond is on the bottom.

Preparation - before I present the picture

• Ask the child if they have pets at home (some do - some do not).
• Ask the child what kind(s) of pet(s) he or she has.
  
• Ask for the name(s) of the pet or pets (or a neighbor's pet, grandma's pet or an animal they've seen).
• Ask about the color and size of the animal.
  
• Ask what the pet does, eats, etc.

Sequence of my dog picture

• First, I tell the child I have something special to show them: my doggies.
• I then silently lay the picture on the table and watch what the child does.
• Some pick the picture up.
• Some just look at it.
• Few children with ASD spontaneously ask a question about my dogs.

• I prompt questions and answers      
• "Is there anything you'd like to know about my dogs?" (Keep in mind I have already asked the child questions about his or her pets or a friend's or neighbor's pet - an animal they know.)
• "Would you like to ask me their names?"
• "How can I tell who is outside or inside?"
• "Who is going to go to sleep?" (Recently one little girl surprised me and asked if the pictures were taken at my house.)

• I use negative practice to get the child to defend him/herself, think and communicate.
• "Mr. Higbee thinks he's a lion. What do you think?"
• "Diamond wants to fly. Can she?"
• This should also provoke shared laughter and fun

Expanding into therapy

• Have the child bring pictures of his or her own pets. If the child does not have a pet, let them select one from a picture so he or she can pretend to have one.
• Make a bulletin board, scrapbook page or picture page with their pet and yours.
• Implement all of the wonderful strategies that were used during the assessment by turning them into therapy benchmarks
• Be sure to analyze the child's strengths and weaknesses.
• This activity can be utilized for your entire caseload.

-A Request-

►Send some pictures of YOUR pets to me at kathieh2@cox.net.

I'll compile them for all of us and make a collage that we can all use for assessment, therapy, and a bulletin board.

Please identify your picture in the subject line on the email as "Autism Spectrum Blog Picture."

"Speech pathologists make good things happen."

Dear Kathie: "Do you always take a language sample as part of an assessment with a verbal child or adult with ASD? If so, what do you look for and how do you elicit the conversation?" - Adrian, speech-language pathologist

I hear all too often - and to my disappointment - the following: "This child does not qualify for speech or language therapy because he or she is passing all academics, scored well on formal tests, and does not cause behavioral problems in the school setting."

Yet he or she is diagnosed as being on the autism spectrum. The child has no friends, cannot ask questions, does not initiate, does not use greetings or salutations, and does not maintain topics in a conversation, or the conversation is very tangential in nature. Laughter may or may not be present, but it is often not appropriate. This student may understand "yes" and "no," but the maybes of life are over his or her head. Predicting is, at best, unpredictable. Anxiety is off the scales (please refer to these posts). This child may be on medication for anxiety and seeing a psychologist or psychiatrist.

Here's HOW to elicit a language sample:

• I'm a believer in a VERBATIM sample of what a child/adult says (I used to tape record but today I use the note pad on my iPad and type it as we go)

• I'm a believer in always using something FAMILIAR and EASY for the child/adult. (I use the nine-piece farm animal puzzle below or a Disney picture book with children, and a book of high interest with adults. Simply ask the adult or their parent about his or her interests.)

In the animal puzzle, I obtain a mean-length of utterance and evaluate the individual's grasp on vocabulary; the singular/plural; who, what and where; answering and asking questions; selecting one item at a time as opposed to a handful (when taking the pieces out of a special bag); part vs. whole; left-to-right orientation (when asked to count); answering yes, no or maybe; topic maintenance; when it's appropriate to laugh; and other basic concepts. These are all for expressive and pragmatic skills.

When it comes time to put the animal puzzle pieces back in the bag, I see how far I can go with a child's knowledge. I ask for one piece at a time by making statements like: "Give Ms. Kathie the one who is standing in the mud," or "Put the one who gives us milk back in the bag." (I make sure my statements are as abstract as possible.) When parents observe the assessment, many of them have been surprised at how much their child knows during this phase. This is for assessing receptive skills in an informal manner.

Other aspects gleaned from this language sample:

• Does the child know what each animal says?
• After six pieces are in place, does the child know how many are missing?
• Can the child count and point to nearby objects? (I had a five-year-old who counted 29 animals!)
• Does the child have left-to-right orientation?
• Does the child know colors?
• Does the child find it funny when YOU place the dog piece in the cat's place? (Please see the post "Laughing at Language".)
  
• Does the child correct YOUR dog mistake? (Please see the post "What's Silly About That?")

I can't wait until next week when I show you how I complete my language sample. It will make you BARK.

"Speech pathologists make good things happen."