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Transcript of Autism Spectrum Disorders: Strategies for the School-Based SLP Melanie W. Hudson, M.A., CCC-SLP...
Autism Spectrum Disorders: Strategies for the School-Based SLP
Melanie W. Hudson, M.A., CCC-SLP
National Director
EBS Healthcare
Understanding Asperger’s Syndrome and the SLP’s Role in Assessment and Intervention
Defining Autism
• DSM- IV-TR, 2000• Behavior Disorder• Brain disorder with genetic basis• Social interaction• Verbal/non-verbal communication• Restricted range of interests and activities
Prevalence of Autism
• 1970s: 2-5 per 1000• 2000: 1/500 (DSM-IV-TR, 2000)• 2003: 34-60 per 1000 (Fombonne)• 2007: 1/150 births (CDC)• 2008: 1/91 (Kogan, Strickland, et.al)• 2009: 1/91 (Bloomberg, et.al)
(Prelock, 2010)
The Concept of Autism:
• Richard Grinker: Anthropological Explanation
• Leo Kanner: Differential Diagnosis with Schizophrenia
• Hans Asperger: Genetic and Biological Factors
• Lorna Wing: Spectrum Concept
1. Autism Disorder2. Asperger’s Disorder3. PDD - NOS
Autism Spectrum Disorder
Autism
4. Rett’s Disorder
5. Childhood Disintegrative Disorder
Asperger’s Disorder
• Qualitative impairment in social interaction in at least 2 of the following:– Marked impairment in the use of multiple nonverbal
behaviors such as eye contact, facial expression, body postures, and gestures to regulate social interaction;
– Failure to develop peer relationships appropriate to developmental level;
– Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people;
– Lack of social or emotional reciprocity
Asperger’s Disorder (cont’d)
• Restricted repetitive and stereotyped patterns of behavior, interests, and activities as manifested by at least 1 of the following:– Encompassing preoccupation with one or more
stereotyped and restricted patterns of interest that is abnormal either in intensity or focus;
– Apparently inflexible adherence to specific, nonfunctional routines or rituals;
– Stereotyped and repetitive motor mannerisms;– Persistent preoccupation with parts of objects
(Diehl, S., 2008)
Early Diagnosis is Critical
• Early identification of children who are “at risk” for ASD facilitates early intervention
• Early intervention is essential for better outcomes
(Diehl, 2008)
Autism impacts:
• Social Interaction• Communication• Behavior
SLP Role in Assessment and Intervention
• Prioritize goals for achieving social communication
• Honor and adapt to a family’s individual needs and cultural context
• Recognize evidence-based practice• Understand the communication demands of the
classroom
(ASHA, 2006c)
Assessment Tools:
• Structured parent interviews• Extensive observations of the child in a
variety of settings – with one preferably made in the home environment
• Observations by more than one evaluator, either separately or jointly conducted
• Observations made at different times
Assessment for ASD Child with Higher Skills
• More traditional tools do not get at underlying pragmatic challenges
• Narrative assessment allows for observation of breakdown in personal story-telling ability, use of internal responses and solutions to problems
• Also consider: Test of Language Competence, The Word Test, Test of Problem-Solving, and pragmatic subtests of CASL
• ADOS is “gold standard” for assessment; requires face-to-face training (videotaped training is available); based on DSM criteria
(Prelock, 2010, live chat on ASHA Web site)
Other Tools
• “The Pragmatic Protocol”, Prutting and Kirchner– Developed in 1982 to provide an overall
communication index for school-age children, adolescents and adults
– Consists of 30 pragmatic aspects of language – Considers role of each participant in structuring the
interaction and evaluate results accordingly
Pragmatic Protocol
• How Does it Work?– Observation of individuals engaged in
spontaneous, unstructured conversation with positive neutral partner
– 15 minutes of videotaped interaction– Each aspect is judged as appropriate,
inappropriate or not observed– Consider sociolinguistic background of the
individual being observed
Communication Acts
• Verbal Aspects:– Speech Acts– Topic Maintenance– Turn-taking– Lexical selection– Stylistic Variations
Communication Acts:
• Non-verbal Aspects:–Kenesics–Proxemics
Communication Acts
• Paralinguistic Aspects:–Intelligibility of speech–Prosodics
Conversational Effectiveness Profile-Revised(Kowalski, T., 2010)
• Documents relative strengths and weaknesses in social-pragmatic communication inherent in Asperger’s
• Comprised of 6 domains (social interaction, social communication, academic communication, perspective-taking, social-emotional)
• Diagnostician rates each area on 3-point scale (appropriate, somewhat appropriate, extremely inappropriate)
• May be used in a variety of settings
Understanding the Influence of Language and Cognition in ASD
Language Impairments in ASD
• Difficulty with pragmatic aspects of language may be present across the spectrum:– Conversational discourse– Understanding and telling stories– Nonverbal aspects of communication, including
prosody, facial expression, body language
Language Profiles and Cognitive Mechanisms: The Links
• Theory of Mind: Ability to interpret mental states in people and relate to their behavior, (put yourself in someone else’s shoes)
• Executive Functions: Skill set for planning, guiding problem-solving, and regulation of behavior
• Impairments in both found among range of children with ASD
(Tager-Flusberg, 2010)
Theory of Mind and Language
• Necessary to interpret others’ mental states to communicate effectively
• Joint attention skills at the root of Theory of Mind• Significantly impaired in ASD population
Findings Related to Theory of Mind
• After accounting for age, IQ, and general language level:– Theory of Mind was a significant predictor of
child’s ability to maintain discourse topic – Theory of Mind was significant predictor of
socialization scores on the Vineland– Theory of Mind was a significant predictor of
severity of autism symptoms
(Tager-Flusberg, 2003)
Findings Related to Executive Functions
• Related to language and other co-morbid symptoms (ex. ADHD)
• More significant impairments in children with ADHD symptoms
(Tager-Flusberg, 2010)
Clinical Implications: Assessment
• Language-Theory of Mind-Executive Functions: Mutually influencing cognitive functions, impaired to a different degree in each child
• Influences academic performance and peer relations
• Effective assessment will evaluate ALL aspects• Child can perform well on test but still have
everyday problems
(Tager-Flusberg, 2010)
EF and Social Adaptation Measures
• Standardized Assessment: NEPSY-2 (Korkman et al., 2007) for ages 3-16
• BRIEF: Parent report measure, 86 items, for ages 2-18
• Social Maturity Scale- Teacher rating, 7 items, correlates with Theory of Mind (Peterson et al., 2007)
(Tager-Flusberg, 2010)
Clinical Implications: Treatment
• Organizational Skills• Reading Comprehension• Asking and Responding to Questions• Following Directions• Conversational Skills• Peer Relationships
Service Delivery Models
Service Delivery Models:
A Continuum
SLP Role in Intervention
• Prioritize the goals for achieving social communication
• Honor and adapt to a family’s individual needs and cultural context
• Recognize evidence-based practice• Understand the communication demands
of the classroom
(ASHA, 2006c)
SLP Role in Intervention
• Partner with families• Collaborate with teams• Engage in professional development• Advance the knowledge base• Advocate to promote communication and
independence
(ASHA, 2006c)
Interventions with varying levels of evidence (National Standards Project, 2009)
Established
•Joint Attention Training•Modeling•Naturalistic Teaching•Pivotal Response•Peer Training
Emerging•AAC•Developmental-Relationship Based•Language Training•Sign•PECS
Unestablished
•Academic•Auditory Integration•Sensory Integration•Facilitated Communication•Gluten and casein-free diet
Continuum of Interventions: Social Pragmatic Developmental (Prelock, 2010)
Emphasize initiation and spontaneity
Follow child’s lead
Teach within the natural environment
Example: Floor Time
Contemporary Behavioral Approaches
• Give children choices• Share control of teaching opportunities• Use preferred activities and materials
(Prelock, 2010)
Service Delivery is Dynamic Process
• Change intervention models based on:– Individual progress– Changing communication demands– Response to treatment
(Prelock, 2010)
Planning Intervention
• Consider each of the following:– Functional, spontaneous communication– Social instruction in various settings throughout the day– New skill acquisition that then includes generalization and
maintenance (a skill remains a “trick” until it is performed across settings, people and materials)
– Play skills that include peer and peer interaction– Functional assessment and positive behavior support to address
problem behaviors– Functional academic skills
(Diehl, 2008)
Positive Behavior Support
• Teaching the child an appropriate way to communicate results in reducing challenging behavior and increases communication skills
• Created because of dissatisfaction with traditional methods for addressing severe behavior problems
• Directly targets the relationship between challenging behavior and communication
• Focuses on intervention in natural contexts• Shifts focus from restricting behavior with narrowly defined settings
and expectations • Increases quality and quantity of meaningful and positive
interchanges
(Diehl, 2008)
Positive Behavior Support
• Review of single-subject intervention in more than 100 studies demonstrated its effectiveness in reducing challenging behavior (Carr,1999)
• Average behavior reduction for single-subject studies for children with autism was 94.6% (Horner, 2000)
(Diehl, 2008)
Positive Behavior Support
Functional Assessment
Features
Positive Behavior Support
Intervention Plan Focus
Visual Strategies and Supports
• Things that are seen that enhance the communication process (ex. body language, calendars, maps, etc.)
• Compliment the learning style of the child with ASD
• Not transient such as oral or picture language• Much evidence to support
(Diehl, 2008)
Types of Visual Strategies and Supports
• Schedules• Calendars• Choice Boards• Environmental Organizers (labels on
shelves, bins, etc.)• Visual sorting tasks (ex. categorization)• Word Wall
(Diehl, 2008)
Word Wall
• Acts as a reference and scaffold for written work; reinforces theme vocabulary
• High-frequency words and most commonly misspelled words on permanent wall for child to see
• Theme or unit words should be available for more interactive activities (ex. key rings)
(Diehl, 2008)
Priming (Pre-Teaching)Diehl, 2008
• Previewing classroom assignments before being presented in class
• Parents or special educators can implement• Use on daily basis• Done as pull-out session the day before or at home
the night before• Familiarize student with material in relaxed, non-
threatening manner• High reinforcement for learning• Evidence-supported
(Wilde, L.D., Koegel, L.K., & Koegel, R.L., 1992)
Priming
Benefits of Priming
Decrease in problem behavior
May provide necessary
motivation to complete task
May heighten student
confidence
Enables enhanced performance on similar activities
Priming
Collaboration team determines who
will be participating
Establish timely and efficient communication method for exchanges
between not primed and when it is
Feedback forms designed, making sure assignments are clear, primed vs. unprimed,
documentation of communication between team
members
If child resists, begin with short
sessions and gradually build up
Begin with limited response
requirements on part of child and build up
Examples of Priming
• Semantic Webbing
• Reading checklist
• SQ3R
Reading Checklist (Diehl, 2008)
Assignment (Ex. Read pages 15-22)
Things to look for?
Where do snow leopards live?
What do they eat?
Word to find in dictionary
Habitat; mammal;
SQ3R
• Survey: Chapter Headings, bold-faced headings, pictures, captions; Guess what text is about
• Question: Read search questions or comprehension questions at end of chapter
• Read: Read to answer questions• Recite: Try to answer questions from memory• Review: Verify and support answers by
rereading
Social Stories (Carol Gray)
• To bridge or scaffold social understanding gap• Effective in enhancing perspective-taking• Allow parents and professionals to better
understand child’s perspective• May be used to address broad range of situations• Evidence-supported
Available from: http://www.thegraycenter.org/Social_Stories.html
Teaching Social Stories(Gray,C.)
• Introduce story in quiet place• Review daily before targeted situation• Keep data on student responses during story
and targeted situation• Revise or add to story as needed• Revise the review schedule as student shows it
can be faded. Decrease verbal support• Keep stories available to student
(Diehl, 2008)
Comic Strip Conversations
• A conversation between 2 or more people using simple drawings
• Use dry erase boards, chalk boards, paper• Depicts ideas such as everyone talking at once,
listening as part of a group, interrupting, LOUD or quiet words, who is saying what, who is listening, thoughts
• Beginning evidence-supported
(Diehl, 2008)
Comic Strip Conversations
Where are you?
Who else is here?
What are you doing?
What happened?
What did others do?
What did you say?
What did others say?
What did you think when you
said that?
What did others think when you
said that?
Video Modeling(Charlop-Christy, 2004)
• Watching a video of adults or children modeling particular target behaviors
• Helps focus child’s attention on relevant stimuli in video
• With practice and rehearsing, child begins to retain and display targeted language and behavior
• Fosters generalization of behaviors• Established evidence-supported
(Diehl, 2008)
Steps for Video Modeling
• Select and define the targeted behavior (ex. asking a question during class)
• Complete a task analysis to itemize the steps• Observe target script for typically-developing children• Present each step slowly with exaggerated acting• Provide at least 2 observations before assessing learning• Create short scripts allowing for reciprocal communication
exchange• Gather input from parents, teachers and child to guide
development of the video model(Courtesy, M. Mount, 2009)
Video Modeling
• Considerations (Charlop-Christy & Kelso, 1997):– Consider a motivating theme in the conversation or play
being modeled– Camera is strategically located to present facial expression
or show hands carrying out a particular task– Pause the video to highlight target expressions– Prompt child’s attention as needed by saying something like “watch the T. V.” or “Look”
– Immediately following the video viewing, ask the child to do what they watched
– Debrief the child reviewing what was seen and heard, identifying any new language heard as well as noting prosody and emotional expression of the “models”
Video Modeling Considerations:
– Talk about possible variations of events so the child has opportunities for flexible learning and thinking
– Encourage and reinforce attempts to demonstrate the modeled behavior
– Rewind to review important parts
Self Management Strategies(Koegel, R.L., Koegel, L.K., & Parks, D.R.,1995)
• Promote independence and responsibility for behavior
• Improve social interactions• External control does not result in lasting change
(Diehl, 2008)
Steps to Self-Management
• Discriminate between appropriate and inappropriate behavior
• Evaluate behavior (ex. happy/sad face)• Monitor behavior over time (checking in at
various times of the day, etc.)• Self-reinforce behavior when expected behavior
met (ex. earning points)
(Diehl, 2008)
Choice Chart
Peer Mediated Intervention
• Peers used in variety of roles:– Tutoring– Buddy system– Prompters– Reinforcers
– Established evidence
(Diehl, 2008)
Peer Mediated Interventions
• Proximity: Placing typical peers who are socially competent with children with ASD, directing them to play with their peers without specific training– Biggest outcome here is that
children will be actively engaged with someone and they will stop or limit the stereotyped behaviors you often see
Peer Mediated Interventions
• Prompting and Reinforcing: Combination strategy where socially competent peers are trained to prompt a child with disabilities to play and then to reinforce the child’s responses
Peer Mediated Interventions
• Antecedent Prompting: Child with ASD is paired with a socially competent peer who is instructed to remain in proximity to the child with ASD; teacher provides periodic prompts to the child with ASD to engage in social interaction
(Simpson et al., 1997)
Four Steps to Support Peer Mediated Intervention:
1. Introduce the skill to a typical peer, describing and providing a rationale (describe the skill)
2. Demonstrate the skill for the typical peer (demonstration)
3. Rehearse skill with the interventionist
4. Typical peer practices/rehearses the skill with another child, then works with the child with ASD after interventionist is certain he is ready
Relationship Development Intervention
• Goal is to provide comprehensive program for developing relationship skills
• Based on developmental model that begins with basic relationship exercises
• Uses 10 skill areas that encompass the qualities of children who are successful in developing and maintaining friendships
• Uses 6 stages from novice to Partner• Developed by Steven Gutstein and later collaboration
with Rachelle Sheely• Evidence-supported
(Diehl, 2008)
Inclusion Strategies for ASD (Diehl, 2008)
• Classroom Organization– Use consistent routines– Delineate spaces (labeling)– Use abundance of visual supports– Prepare for transitions– Specify endings and new starts to activities
Inclusion Strategies (cont’d.)
• Before Teaching Supports– Establish signal words to get attention– Give assignments in written form– Use priming strategies– Pair strong interests as motivators (ex. put
dinosaur sticker on top of worksheet)
Inclusion strategies (cont’d.)
• During Teaching Supports– Use signal words for stressing important
information– Keep essential questions and concepts in the
forefront– Avoid lengthy verbal instructions– Use visual supports (daily schedules, choice
boards, etc.) – Provide models (work first math problem
together)
Watch for attention, stress, fatigue and provide alternate pleasurable assignments during that time
Inclusion Strategies (cont’d.)
• Facilitating Independent Work– Provide visual instructions– Provide specific roles for collaborative work– Assign peer buddies– Avoid burning out one student– Use timer, or something to delineate time/amount
– Allow keyboard for writing assignments
Inclusion Strategies (cont’d.)
• Student Organizers– Use daily planners and teach independent use– Laminate daily schedule to use with soluble markers– Color-code folders for each subject– Label sections in folder for homework, completed work, etc.– Keep “obsessive” stuff in one place with written instructions on
when to use it– “Post-its” help with things that pop up during the day– Keep 2 sets of texts, one each for home and school– Keep written rules consistent– Use technology whenever possible
Collaboration and ASD
“I believe that you don’t make major input with children with complex disabilities unless it is collaborative”
(Sylvia Diehl, 2010)
Learning Spanish (Diehl, 2010)
Attending class 1 hour per week for 6 weeks
Speaking Spanish with classmate who is also learning Spanish
Living in Spain and using language daily in variety of contexts
Contextualized Learning
Language needs to be infused throughout a child’s day in order for learning to occur.
Why Collaborate?
“ASHA recognizes that the provision of speech, language, and hearing services in educational settings is moving toward service-delivery models that integrate intervention with general education programming, often termed inclusion.”
(American Speech-Language-Hearing Association [ASHA], 1996)
Why Collaborate?
Federal Law tells us that we should focus on the services we provide rather than “a place” where the students go.
(IDEA, 2004 [118 Stat. 2649])
Why Collaborate?
Effective schools research indicates that collaboration within the school staff increases student achievement.
(Thompson, 2002)
Principles of Learning are Supported in a Collaborative Model
• Learning that is meaningful to the learner is acquired more readily and is retained longer
• Learning is influenced by the frequency with which the stimuli are encountered and the same or similar response is made
• In general, practice in varied contexts can both increase retention of learning and extend its range of utility
• Transfer is facilitated where the learning situation resembles the application situation, or where the learning is practiced in various “realistic” contexts
• Observing the actions of another person can lead to the acquisition of new learning or the facilitation or inhibition of prior learning
• Group discussion and decision can facilitate change
(Ehren and Ehren, 2004)
The Classroom is a Natural Setting
Services delivered in a classroom provide:• More opportunities to communicate• More variety of communication opportunities• More variety of communication partners• More resemblance to real life• Less disruption in a student’s day that is disruptive to
learning• Models for teachers • Seamless transfer (carryover) of skills
(adapted from Ehren and Ehren, 2004)
Advantages of Classroom-Based Intervention
• No time wasted in transition (some behavior problems are related to transition)
• Child stays in LRE• Teachers have more frequent opportunities for planned
teaching• Classroom offers many opportunities to interact with and learn
from peers
(Hadley & Schuele, 1998; Garfinkle & Schwartz, 2002; Brinton & Frijiki, 2004; Case-Smith & Holland, 2009)
Collaboration is not a Replacement for Isolated Intervention
• It is designed to assess and treat communication impairments within natural settings
• It can supplement or extend services offered in a traditional pull-out model
(ASHA Relevant Paper, 1990)
Why Use Pull-Out Model?
• Allows intensive 1:1 treatment• Useful for some intervention approaches• May be best environment to establish new behaviors
(ex. discrete trial training)• Should be purposeful, planned and short-term
(Case-Smith & Holland, 2009; Moore & Montgomery, 2008)
Myths About Service Delivery
• Individual therapy is always the best option• Communication problems should only be addressed
by the “expert”• SLPs need to protect their territory• People who advocate a collaborative model are
trying to get out of work
(Haynes, Moran & Pindzola, 2006)
Barriers to Collaboration
• Graduate students are taught medical model• New SLPs are inexperienced in collaboration• Parents expect medical/clinical model• Teachers/Administrators expect pull-out model• Team planning is time-consuming• Turf Conflicts• Teachers don’t want to/know how to collect data
To facilitate collaboration among the educators of preschool and school-age children in developing functional social communication skills within the classroom context
(Frassinelli, Superior, & Meyers, 1983)
SLPs in the Classroom
Always look at academic and social issues from a language perspective; trust teachers to know curriculum and standards; SLPs role is to facilitate interactions and learning.
Administrative Support
Administrators must be willing to:• Provide meeting time for collaboration by all team
members• Maintain sufficient number of support staff• Understand that collaboration is efficient use of
educational resources but not a method to reduce amount or expense of special services
• Understand that SLP caseloads may need to be reduced
(ASHA Relevant Paper, 1990)
Breaking Down Barriers
• Work with university programs to teach collaboration strategies; teach a “workload “ approach* to service delivery
• Learn about collaboration and try it gradually
• Explain benefits of collaboration to parents; have parents tell other parents their child’s success stories
• Explain to teachers that collaboration meets the student’s needs; we are there to meet their needs and not our own
Planning
“A meeting to infuse goals is more important than an individual session”
Sylvia Diehl
Team-Teaching/Co-Teaching
• Requires a significant amount of respect and trust between teachers
• Avoid the same teacher always taking the lead instructional role
• Take turns “leading” the lessons and instructional units• Requires long-range planning• Requires commitment of classroom teacher to always be
present
(adapted from Green, 2008)
Benefits of Thematic Units
• Increase in student achievement• Helps student to connect learning both within the
topic and across other subjects (generalization)• Enables student to understand big concepts of
curriculum and apply them in many ways• Promotes depth of learning
(Thompson, 2002; Marzano, 2001)
Interventions with Case Studies
• Social interaction• Communication• Behavior
Ken
• 8 years old• Talks constantly about video games• Academically on grade level• Other children play with him in short spurts
until they tire of his bossy behavior• Needs personal assistant to move from
one activity to another• Disruptive when routine changes
Hunter
• 17-years old• In regular HS academic program with
SpEd support• Other students tolerate but do not seek
him out• Pleasant appearance and no behavior
issues except during fire drill
“The absence of evidence is not evidence of absence” (Paula Kluth, 2010)
References
• American Speech-Language-Hearing Association. (2006c). Roles and responsibilities of speech-language pathologists in diagnosis, assessment, and treatment of autism spectrum disorders across the life span: Position statement. Available from http://www.asha.org/policy.
• American Speech-Language-Hearing Association. (2006b). Knowledge and skills needed by speech-language pathologists for diagnosis, assessment, and treatment for autism spectrum disorders across the life span. Available from http://www.asha.org/policy.
• American Speech-Language-Hearing Association. (2006a). Guidelines for speech-language pathologists in diagnosis, assessment, and treatment of autism spectrum disorders across the life span. Available from http://www.asha.org/policy.
• American Speech-Language-Hearing Association. (1990). A Model for Collaborative Service delivery for Students With Language-Learning Disorders in the Public Schools [Relevant Paper]. Available from www.asha.org/docs/html/RP1991-00123.html
References
• American Speech-Language-Hearing Association. (1996). Inclusive practices for children and youths with communication disorders [Position Statement]. Retrieved March 1, 2010 from http://www.asha.org/docs/html/PS1996-00223.html
• Bondy, A., & Frost, L. (1998). Picture Exchange Communication System. Topics in Language Disorders, 19, 373–390.
• Diehl, S. (2008). Working with children with autism: Resource manual. ASHA Autism online web event, March 2010.
• Ehren, T. & Ehren, B. (2004). Therapy Services in the Classroom: Creating Students Success. ASHA Telephone Seminar, September 14, 2004.
• Green, Charlette. (2008). SLPs Collaborating in General Education: Practicing Seamless Education. Presentation to North Carolina Public Schools.
• Individuals with Disabilities Education Act. (2004). Public Law 108-446. Retrieved March 1, 2010, from http://www.copyright.gov/legislation/pll08-446.pdf
• Kowalski, T. (2010) Social-pragmatic success for asperger syndrome and other related disorders. Orlando, FL: Professional Communication Services.
• Marzano, R.J., Pickering, D.J., & Pollock, J.E. (2001). Classroom instruction that works. Alexandria, VA: Association for Supervision and Curriculum Development.
References
• Montgomery, J. (1990). Effective Collaboration and Consultation Services for Speech and Language Hearing Handicapped Children. Short Course at California Speech Language Hearing Association Annual Conference, Monterey, CA.
• Moore-Brown, B. (1989). The Speech/Language Specialist-Critical Support for Teaching Literacy. Presentation at the California State Federation/Council for Exceptional Children Annual Conference, Costa Mesa, CA.
• Paul, R. (2010). Communication Intervention Programs. ASHA Autism Online Web event.• Prelock, P. (2010). Assessment and Intervention in Autism Spectrum Disorders: The role
of the SLP. ASHA Autism online web event• Sancibrian, C. (2010). Navigating the service delivery continuum. ASHA Autism Online
web event.• Tager-Flusberg, H. (2010). Language and Cognition in Autism Spectrum Disorders. ASHA
Autism Online web event.• Thompson, M., & Thomason, J. (2002). Leadership, achievement, and accountability.
Boone, NC: Learning Concepts.• Wiig, E.. (1992) Language intevention with school-age children: Models and procedures
that work. Chicago, IL: Riverside Publishing Co.