BERNARDUS LARRYANT SONJA RONDESTVEDT VALERIE S. VARASTEH.
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Transcript of BERNARDUS LARRYANT SONJA RONDESTVEDT VALERIE S. VARASTEH.
BERNARDUS LARRYANTBERNARDUS LARRYANT
SONJA RONDESTVEDT SONJA RONDESTVEDT
VALERIE S. VARASTEHVALERIE S. VARASTEH
Mami Yamamoto 6 years old Kindergarten Enjoys playing with light toys, soft music, and
visual movements Does not enjoy loud noises Limited play skills Repeating both English & Japanese phrases
MAMI
Image taken from http://silveroses69.blogspot.com/2007_05_01_archive.html
Lives with Mother (Reiko) and Grandmother
(Akari)
FAMILY
Image taken from http://english.kimono-sakaeya.com/?eid=1440311Image taken from http://flickrhivemind.net/Tags/obasan/Interesting
The family wants Mami to:
Increase functional use of speech and other English language skills
Decrease her echolalia
GOALS
Echolalia is the repetition or echoing of verbal
utterances made by another person. Rydell & Prizant (1995) stated echolalia refers
“to a general class of speech repetition with few distinctions made regarding the degree of repetition or comprehension and intentionality underlying the production of echolalic utterance” (p. 106).
85% of verbal children with autism produce echolalic language (Rydell & Prizant, 1995).
DEFINITION
There is a need to consider the acceptance of echoic
behaviour. That is, how comprehensive is the child with autism’s utterance to the communicative partner? Rydell &Prizant (1995) suggest observing the following points :
1. Do the words used in the echoic utterance have an equivalent meaning to others?
2. Does it relates to the context in which it occurs?3. Is intention created in the utterance? 4. Does the utterance assist in maintaining a social interaction by
providing novel or needed information?5. Does the echoic utterance can evoke a response from another
person?6. Does the echolalia disrupt the child’s ability to partake
appropriately in a social interaction and/or an educational task?7. Does the echolalic behaviour isolate the child with autism?
ECHOLALIA IN CHILDREN WITH AUTISM
Echoic behaviour is displayed in interactive and
non-interactive forms (Prizant & Duchan, 1981): Interactive: degree of comprehension of the
model utterance by showing appropriate gaze; task attempt, and the use indicating behaviours (point, gesture, show, etc.).
Non-interactive: little comprehension of model utterance and lack the proper gaze, low in volume, and there is no observable change in behaviour.
ECHOLALIA IN CHILDREN WITH AUTISM
Bilingualism is not a hindrance for children
with developmental disabilities.
Children who are growing up in a bilingual home need to learn the spoken languages in order to partake wholly within the family system. It is important for their life context and for the children with autism to communicate with those who are important to them and play a large role in their life (Kay-Raining Bird, Lamond, and Holden, 2012).
AUTISM AND BILINGUALISM
Kay-Raining Bird, Lamond, and Holden (2012)
did a survey to investigate a range of questions around autism and bilingualism.
Mode of Communication Language Exposure Professional Advice
Family ratings display that bilingualism was of importance and a majority felt they were successful in raising their child in a bilingual home.
AUTISM AND BILINGUALISM
Echolalia has also been used to teach receptive
naming of Chinese characters (Leung & Wu, 1997):
o When children with autism echo the response before the matching task, the children display improved receptive language skills. In addition, the difficulty of the task affected the speed of acquisition.
o Echoic prompt may assist in reading the name of the character and guided attention to the matching symbol
ECHOLALIA AND BILINGUALISM
Two viewpoints in echolalia had been developed
around language acquisition:a. Echolalia is a pathological behaviour that needs to be
extinguished due to interference with the development of appropriate language skills; no functionality is observed in the echoic utterances
b. Echolalia is used with a functional purpose; furthermore, echolalia can be a tool to develop a more conventional application of the child with autism’s language repertoire.
Language development in children with autism is linked to the Gestalt and Interactionist approaches.
ECHOLALIA IN LANGUAGE DEVELOPMENT
Gestalt processor – develops language by
using memory and repeating multi-word utterances in chunks. The process aids in the comprehension of linguistic structures (albeit, in small amounts) (Bebko, 1990; Rydell & Prizant, 1995; Prizant & Rydell, 1993).
Memorization and chunking of the conventional linguistic structures also supports generalization and applyinh the chunks in other proper and appropriate ways (Prizant, 1983; Prizant& Rydell, 1993).
GESTALT APPROACH
Children with autism take on a gestalt form of
language development. Most children with typical development develop language through an analytical process.
Analytic processors - develop language skills with acknowledgement of the basic structures in language. The meaning behind words and phrases are develops through linguistic stages toward more complex utterances (Prizant & Rydell, 1993).
GESTALT APPROACH
Children with autism are considered to
develop language through an extreme form of gestalt processing and can be correlated to characteristics linked to autism such as the degree of rigidity seen in individuals with autism, coping with unpredictability, lack flexibility, difficulty with producing generative and flexible language, and comprehending social-system rules (Prizant, 1983; Prizant & Rydell, 1993).
GESTALT APPROACH
Examines “the relationship among the fundamental
variables in the social-communicative interaction and the influence of these variables on an individual’s communicative performance” (Prizant and Rydell, 1993, p.275).
Prizant and Rydell (1993) suggest two factors are related to the interactionist approach:
1. Cognitive, social, socio-emotional, linguistic strength or weaknesses of the child may affect the nature of the interaction.
2. The partner’s interactive style may influence the response.
INTERACTIONIST APPROACH
Task Demand/ Unfamiliar Environmento Echolalia may occur more frequently when the child is
in a challenging social scenario, and/or demanding and novel setting (Prizant & Rydell, 1993).
Comprehensiono Echolalia is employed when there is difficulty in
comprehension during verbal interaction with a communicative partner (Bebko, 1990; Prizant & Rydell, 1993; Rydell & Prizant, 1995).
o Information-processing view: echolalia arises when the adult uses abstract language and it does not match the semantics that were previously used during the child’s turn in the conversation (Prizant, 1983; Prizant, Rydell, 1993; Rydell & Prizant, 1995 Schuler, 1979).
COGNITIVE AND SOCIAL FACTORS INFLUENCING ECHOLALIA
Transitions (Prizant, 1983; Prizant & Rydell,
1993; Schuler, 1979)o Children with autism display an increase use of
echolalia and agitation due to confusion from a change in the usual routine. In addition, fatigue and distraction linked to transitions also led to higher incidences of echolalia.
Adult influences (Rydell & Mirenda, 1994; Prizant & Rydell, 1993)
o The style of communication affects the level of echolalia produced in children with autism. The directive style increases echolalia while the facilitative style consists of natural turn-taking.
COGNITIVE AND SOCIAL FACTORS INFLUENCING ECHOLALIA
Adult influences (Rydell & Mirenda, 1994;
Prizant & Rydell, 1993) An association between the communicative style and
linguistic constraint. High constraint utterance: when the child is required to
respond to the adult’s utterance in a similar form of style in communication which has “specific syntactic-semantic structure or content” (Rydell & Mirenda, 1994, p.720).
Low utterance constraint: not required to meet the adult directive control, more natural conversational comments.
COGNITIVE AND SOCIAL FACTORS INFLUENCING ECHOLALIA
Is an utterance that is emitted immediately
following the original utterance, or a brief time following the utterance from the communication partner (usually within two comments) (Prizant & Duchan, 1981; Prizant and Rydell, 1993; Rydell & Prizant, 1995)
Retrieval of information from short term memory (Prizant, 1983).
The researchers determined that immediate echolalia often was used with clear evidence of purposeful communication (Prizant, 1983; Prizant & Duchan, 1981).
IMMEDIATE ECHOLALIA
Immediate echolalia may support the
development of more elaborate language skills and the frequency of echolalia depends on the level of language development (McEvoy et al., 1988).
Children with autism who display intermediate level of language acquisition will emit more echolalic utterances since it serves as a function to communicate with others and a way to continue acquisition (McEvoy et al., 1988).
IMMEDIATE ECHOLALIA
Delayed echolalia refers to utterances that are
repeated later on in time (Prizant & Rydell, 1984). Usually echoic utterances are derived from TV
commercials, movies, and repetition of parental reprimands.
Involves retrieval of information from the long term memory storage (Prizant, 1983).
It is easier for those familiar with the child with autism to decipher the meaning behind the delayed echolalia and how it may relate to the context in which it occurs (Prizant & Rydell, 1984).
DELAYED ECHOLALIA
Mitigated echolalia- when the child changes a word,
phrase, intonation, or feature of the utterance that is repeated (Bebko, 1990).
Mitigation is used in both types of echolalia. Rydell and Mirenda (1994) suggest mitigated echolalia is
not derived from rote repetition. Mitigation demonstrates a control over the echolalic
utterances and utilization of rule-governed grammatical competence (Bebko, 1990; Prizant & Rydell, 1993; Roberts, 1989).
Bebko (1990) describes two basic capabilities of language are intact for children with autism who use mitigated echolalia: labeling and symbolic function. A third component in language that is seen with mitigated echolalia shows inference to one’s self (Bebko, 1990).
MITIGATED ECHOLALIA
Language Samples & Ecological Assessments Preferably videotaped samples in multiple
environments. If videotaping is not an option, audio taping or
written observations from an observer is advised. In Chapter 5 of Teaching Children with Autism:
Strategies to Enhance Communication and Socialization, Rydell and Prizant offer 18 different suggested activities for collecting language samples in different environments.
Data Collection
Eat a desired food item in front of the child without
offering any to him or her. Activate a wind-up toy, let it deactivate, and hand it
to the child. Give the child four blocks to drop in a box, one at a
time, then immediately give the child a small animal figure to drop in the box.
Look through a few books or magazines with the child.
Open a jar of bubbles, blow bubbles, and then close the jar tightly and give the closed jar to the child.
Some Suggested Activities for Language
Sample
Initiate a familiar social game with the child
until the child expresses pleasure, then stop the game and wait.
Blow up a balloon and slowly deflate it; then hand the deflated balloon to the child or hold the deflated balloon up to your mouth and wait.
Offer the child a food item or toy that he or she dislikes.
Place the child’s hands in a cold, wet, or sticky substance, such as Jell-O, pudding, or goo.
Suggested Activities for Language Sample
After you have the language sample, you can now
categorize the unconventional verbal behaviour.
Immediate echolalia-immediate repetition of words or phrases
Delayed echolalia-significantly delayed repetition of words or
phrases (hours, days, or weeks later)
Step 1
From Prizant and Rydell (1984)If it’s immediate echolalia there are two categories:1.Interactive functions Turn-taking Declarative Request
2. Noninteractive functions Nonfocused Rehearsal Self-regulatory
Step 2Determine the function of the echolalia
If it’s delayed echolalia there are also two categories:1. Interactive functions Turn-taking Verbal completion Providing Information Labeling (interactive) Request Calling Affirmation Directive
Step 2Determine the function of the echolalia
2. Noninteractive function Nonfocused Situation association Self-directive Rehearsal Labeling (noninteractive)
Step 2Determine the function of the echolalia
Possible AntecedentsEcholalia is more likely to occur in these
conditions:1. Specific situations2. Specific interactions3. Person-specific situations
Step 3When does it occur?
What is the communicative intent?From Wetherby and Prizant (1989) Is there no awareness of the goal? Is there awareness of the goal? Is there a plan to achieve the goal? Is there a coordinated plan to achieve the goal? Is there an alternative plan to achieve the goal? Is there metapragmatic awareness to achieve
the goal?
Step 4Communicative Intent
Determining the communicative function of the
echoic utterances are done by examining the communication partner’s interpretation of and reaction to the behavioural act.
Interviewing the home and school team members to gain greater information about their interpretation of and reaction to the unconventional verbal behaviour is suggested. A functional assessment interview could be used to gather this information.
Step 4.5 Communicative Function
Another factor to consider for echolalia is the
whether the unconventional verbal behaviour is challenging and who is it challenging for.
Does it add new or relevant information? Does it interfere with the person’s ability to have
conversations or be apart of conversations? Does it have stigmatizing effects on the person
in certain contexts?A functional behaviour assessment could be done
to assist with determining those factors.
Step 5Challenging behaviours
The last stage of assessment is looking at
whether direct intervention is needed and/or wanted.
Once the language samples have been analyzed and coded, suggestions for either direct or indirect intervention can be made if the family or school feel it is beneficial.
Step 6Intervention?
The Inventory of Potential Communicative Acts
(IPCA) by Jeff Sigafoos et al.
Social Networks: A Communication Inventory for Individuals with Complex Communication Needs and their Communication Partners by Sarah Blackstone and Mary Hunt Berg, Published in 2003.
Other Assessments continued
Focus on modifying the environment Based on information gathered from
Functional Assessment
INDIRECT INTERVENTIONS
Lack of appropriate play skills
Introduce different activities and toys in order to expand her repertoire of preferred activities and toys – increase choices for her reinforcer menu
SETTING EVENT INTERVENTIONS
Environment is too loud/noisy
Gradual exposure to loud and noisy environment Short period of exposures (5 minutes) Removal upon request using AAC or speech Gradually increase the amount of exposure in small
increments Provide safety signal for Mami to make it through the session Use a timer to provide a visual support for Mami
Pre-correct Mami to use her AAC or speech to ask for break “Remember, if you want to leave, you can ask for a break.”
ANTECEDENT INTERVENTIONS
Echolalic speech – minimal functional speech
Teach Mami to use her AAC to request for a break from the loud and noisy environment Every request made using AAC should be
followed by vocal approximation in order to encourage speech
Echolalia replacement strategy
TEACHING INTERVENTIONS
Response training - getting the subject to correctly label
picture symbols that will be used Cue-pause-point procedure
Deliver the instruction (CUE) Holding up a finger to signal silence and say “shh” or
“no” whenever silence is desired (i.e. during instruction). (PAUSE)
Move your finger so that it touch the picture card about 2 seconds after the instruction was delivered. (POINT)
Prompt to ensure the correct labelling occurs Intermittently reinforce correct responding
FOXX (2004)
To fade the prompts, cover the picture card
with a folder and touch the folder during the POINT phase
Eventually, fade the prompts all the way to simply PAUSE after delivering the instruction
FOXX (2004)
Practice with Mami so she can correctly label the
“break” card- “I want a break” In a loud and noisy environment:
Ask her, “What do you want?” Holding up a finger and saying “shh” whenever her
echolalia starts Touch the “break” card approximately 2 seconds
after If no response, prompt her to say “I want a break” Immediately, let Mami leave the noisy environment
upon asking
MAMI’S CASE
Eventually, cover the “break” card with your
hand and simply point to the hand Finally, simply pause 2 seconds after delivering
the question for Mami to respond correctly
GENERALIZATIONThe same procedure can be used in other situations as well, such as requesting for items, asking for attention, and others.
MAMI’S CASE
Has been shown to help children with autism make
gains in speech production (Schlosser & Wendt, 2008; Millar, Light, & Schlosser, 2006)
Comes in a number of different modes: manual signs, picture symbols, or voice output devices (Mirenda, 2003)
Use it in the early part of Mami’s intervention in order to give Mami an appropriate mean of communication
Gradually fade it out as her functional speech increases
AUGMENTATIVE AND ALTERNATIVE COMMUNICATION (AAC) DEVICES
Augmentative and Alternative Communication application for
iPad, iPhone/iPod Touch Consists of picture symbols as well as voice output
capabilities Chosen because of its functionality & cost Costs:
App: $189.99 iPad 2: $419.00 iPhone: $375.00 iPod Touch: $199.00
http://www.youtube.com/watch?v=vomkNSluWW4
PROLOQUO2GO
Total Cost $400.00 – $650.00
Images are taken from http://www.proloquo2go.com/About/
Main function is ESCAPE
Let Mami have a break when she uses her AAC to ask for one
Reinforce Mami with a preferred activity or toy when she uses appropriate and functional speech Create a reinforcer menu for Mami to choose
from Prompt Mami to use appropriate speech
CONSEQUENCE INTERVENTIONS
Risley and Wolf (1967) – replace echolalia with
stimulus specific responses
Schreibman and Carr (1978) – replace echolalia with a generalized verbal response
Foxx (2004) – replace echolalia with functional use of verbal labelling
REPLACING ECHOLALIA
Believe that the function of her echolalia is, for
the most part, escape Functional communication training
Cue-pause-point method to teach her appropriate speech
AAC to help Mami use appropriate language at the beginning of the intervention Proloquo2Go is the choice due to its
functionality and cost
CONCLUSION
Questions?
Image is taken from http://therealkenjones.wordpress.com/2012/02/08/capitalism-and-socialism-making-sweet-love-for-over-200-st-valentines-days/
ABCNews. (2010). The Conversation: iPad Gives Voice to the Autistic. Retrieved from http://www.youtube.com/watch?v=vomkNSluWW4
AssistiveWare. (2012). What is Proloquo2Go? Retrieved from http://www.proloquo2go.com/About/article/what-is-proloquo2go
Augmentative Communication Inc. (2012). Social Networks. Retrieved from http://www.augcominc.com/index.cfm/social_networks.htm
Bebko, J.M. (1990). Echolalia, mitigation and autism: Indicators from child characteristics for the use of sign language and other augmentative language systems. Sign Language Studies, 66, 61-78.
Design to Learn at Oregon Health & Science University. (2012). The Communication Matrix. Retrieved from http://www.communicationmatrix.org/
REFERENCES
Foxx, R. M., Schreck, K. A., Garito, J., Smith, A., & Weisenberger, S. (2004). Replacing the
echolalia of children with autism with functional use of verbal labeling. Journal of Developmental and Physical Disabilities, 16(4), 307-320
Kay-Raining Bird, E., Lamond, E., & Holden, Jeanette. (2012). Survey of bilingualism in autism spectrum disorders. International Journal of Language and Communication Disorders, 47, 52-64.
Leung, J-P., & Wu, K-I. (1997). Teaching receptive naming of Chinese characters to children with autism by incorporating echolalia. Journal of Applied Behaviour Analysis, 30,
59- 68.
Loddo, S. (2003). Echo and savant abilities versus central coherence in autism. The National Autistic Society, 7, 226-229. doi: 10.1177/1362361303007002009
McEvoy, R. E., Loveland, K. A., & Landry, S. H. (1988). The functions of immediate echolalia in autistic children: A developmental perspective. Journal of Autism and Developmental Disorders, 18, 657-669. doi: 10.1007/BF02211883
REFERENCES
Millar, D.C., Light, J. C., & Schlosser, R.W. (2006). The impact of augmentative and alternative
communication intervention on the speech production of individuals with developmental disabilities. Journal of Speech, Language, and Hearing Research, 49, 248-264.
Mirenda, P. (2001). Autism, augmentative communication, and assistive technology: What do we really know? Focus on Autism and Other Developmental Disabilities, 16, 141-
151.
Mirenda, P. (2003). Toward functional augmentative and alternative communication for students with autism: Manual signs, graphic symbols, and voice output communication aids. Language, Speech, and Hearing Services in School, 34, 203-216
Prizant, B. M. (1983). Language Acquisition and communicative behaviour in autism: Toward an understanding of the “whole” of it. Journal of Speech and Hearing Disorders, 48, 296-307.
Prizant, B. M., & Duchan, J. F. (1981). The functions of immediate echolalia in autistic children. Journal of Speech and Hearing Disorders, 46, 241-249.
REFERENCES
Prizant, B. M., & Rydell, P. J. (1984). Analysis of function of delayed echolalia in autistic
children. Journal of Speech and Hearing Research, 27, 183-192.
Prizant, B. M., & Rydell, P. J. (1993). Assessment and intervention consideration for unconventional verbal behaviour. In J. Reichle & D. P. Wacker (Eds.),
Communication alternatives to challenging behaviour: Integrating functional assessment and intervention strategies (pp. 263-297). Baltimore, MD: Paul H. Brookes Publishing Co.
Risley, T., & Wolf, M. (1967). Establishing functional speech in echolalic children. Behaviour Research & Therapy, 5, 73-88
Roberts, M. A. J. (1989). Echolalia and comprehension in autistic children. Journal of Autism and Developmental Disorders, 19, 271-281. doi: 10.1007/BF02211846
Rydell, P. J., & Mirenda, P. (1994). Efects of high and low constraint utterances on the production of immediate and delayed echolalia in children with autism. Jounral
of Autism and Developmental Disorders, 24, 719-735. doi: 10.1007/BF02172282.
REFERENCES
Rydell, P. J., & Prizant, B. M. (1995). Assessment and Intervention Strategies for Children Who Use Echolalia. In Quill, K. A. (Ed.), Teaching children with autism: Strategies to enhance communication and socialization (pp. 105-132). New York, NY: Delmar Publishers.
Schlosser, R. W., & Wendt, O. (2008). Effects of augmentative and alternative communication I ntervention on speech production in children with autism: A systematic review. American Journal of Speech-Language Pathology, 17, 212-230
Schreibman, L., & Carr, E. G. (1978). Elimination of echolalic responding to questions through the training of a generalized verbal response. Journal of Applied Behavior Analysis, 11, 453-463
Schuler, A. L. (1979). Echolalia: Issues and clinical applications . The Journal of Speech and Hearing Disorders, 44, 411-434.
Seung, H., Siddiql, S., Elder, J. H. (2006). Intervention outcomes of a bilingual child with autism. Journal of Medical Speech-Language Pathology, 14, 53-63.
REFERENCES