phb-paul-03(p55-78).pdf

What Are the Social
Communication Symptoms of
Autism Spectrum Disorder, and

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@;9?;2%@41?;/5-8 /;99A:5/-@5;:-:0>1?@>5/@5B1 >1<1@5@5B1.14-B5;>?@4-@ Excerpted from Let’s Talk: Navigating Communication

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Box 3.1. Social Symptoms

Social symptoms are nonverbal behaviors that often lead parents to worry about their child’s development before the child starts talking. They include

Reduced tendency to look and smile at others
Reduced likelihood to imitate others’ actions, as in play with toys
Reduced participation and enjoyment in infant games, such as Peekaboo
Reduced babbling, especially back- and- forth babbling with others
Increased and long- lasting use of unusual sounds
Reduced use of gestures, especially pointing, to get others to pay attention or do something; also reduced ability to follow others’ gestures, such as difficulty looking toward where others point
Reduced interest in other people’s talk; delayed response to hearing name
Reduced interest in sharing things and experiences with others; lack of show- ing objects
Reduced ability to follow others’ attention to objects (responding to joint at- tention) or signal others to share attention to an object of interest to the child (initiating joint attention)
Limited initiation of communication, except to get things or help
Unusual social initiations, such as licking or smelling others
Using others as tools by grabbing their hand or arm to take them to something the child wants without looking at their face
Limited interest in sharing enjoyment with others by looking at them with warm facial expressions or finding pleasure in being with others; limited re- sponses to praise or attention from others
Failure to learn to play with toys as others do, in functional ways (e.g., lining up blocks in a row instead of building a tower)
Failure to develop pretend play (e.g., persisting in exploring objects’ shapes and textures rather than pretending the object is something else)
Preference for solitary activities; failure to notice other children Excerpted from Let’s Talk: Navigating Communication Services and Supports for Your Young Child with Autism by Rhea Paul, Ph.D., CCC-SLP, & Donia Fahim, Ph.D. Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 ' | All rights reserved

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Box 3.2. Language/Communication Symptoms

Language/communication symptoms are usually noticed when other children Tbegin talking; parents become concerned because the child appears delayed in acquiring speech.

Delayed acquisition of spoken language; slow to acquire first words and sentences
Inability to follow simple instructions or respond to name
Immediate or delayed echolalia
Unusual rhythm, melody, or intonation in speech
Reversing pronouns (“Pick you up” instead of “Pick me up”) for a long period of time
Verbal rituals; repeatedly having to say or hear the exact same words the same way
Speech that sounds too stiff and grown up for the young child, who may sound like a “little professor” <->@ 2>;9 418<5:3 9-71 - 05-3:;?5? ;2 % @41 -??1??91:@ ;2 ?;/5-8 /;99A:5/-@5;:?E9<@;9? 1?<1/5-88E 418<?@41@1-9501:@52EC41>1E;A>/4580 5??4;C5:3?@>1:3@4?5:5:@1>-/@5:3C5@4;@41>? 501:@52E@->31@? -:0<>5;>5@5F1 :110?5:-:5:@1>B1:@5;:<>;3>-91@p?8;;7-@@41?;/5-8 /;99A:5/-@5;:-? ?1??91:@5:9;>101@-58@;?4;C4;C5@418<?@41@1-9@;01B18;<-:10A/-@5;:-8 <8-:2;>-/4580C5@4%

What Does a Communication Assessment Look Like?

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Excerpted from Let’s Talk: Navigating Communication Services and Supports for Your Young Child with Autism by Rhea Paul, Ph.D., CCC-SLP, & Donia Fahim, Ph.D. Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 ' | All rights reserved

FOR MORE, go to http://www.brookespublishing.com/lets-talk

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When Lilly was 14 months old, her parents noticed that although she babbled, she made some funny sounds and often hummed the sounds of her favorite cartoons. She was observed to smile at her parents and grandparents, but she did not seem to be very interested when they would try to get her to imitate them or play games such as Peekaboo. When her parents called her name, she often would not look at them, and they also noticed that she used unusual means of communicating her needs; often pull- ing the adult’s hand to the item she wanted rather than looking at faces and pointing to the object. At about this time, one of Lilly’s cousins was diagnosed with ASD at the age of 2 1/2. Lilly’s parents began reading about ASD and found out that it tends to run in families. Still, they hesitated to get Lilly assessed. She was so little, what could the testers possibly do? Even if they decided something was wrong, what kind of treatment could there be for a 1- year- old child? They decided to wait and see how things went and hope for the best. By the time Lilly was 21 months old, all the other toddlers in her playgroup were talking and playing nicely with toys. Lilly still had only two or three words and preferred to be by herself, even during playgroup time. She spent as much time as she was al- lowed spinning tops or turning toy cars upside down and spinning their wheels around and around as she closely watched them. She did love music, though, and would sit down with the other children when one of the moms led them in a song. Her parents’ concern had not lessened, though, seeing her with other children her age, and they de- cided to schedule her 24- month checkup with her pediatrician early and ask him about her behavior. When they mentioned their concerns, he had them fill out a screening questionnaire for ASD, and they were told that Lilly’s score placed her at risk for the disorder. The doctor referred them to a local early assessment agency, and the family reluctantly decided to have Lilly assessed.

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WHAT TESTS WILL BE USED TO ASSESS MY CHILD?

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Standardized Tests

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retardation.1/-A?1@41E-8?;501:@52E/4580>1:C4;?/;>1?53:5K/-:@8E45341> @4-::;>9-8I13 -.;B1UWTJ #@1?@?->1-8?;A?10-?<->@;2@41501:@5K/-@5;: <>;/1??2;>/4580>1:C4;->1352@10 #@1?@?A?10@;-??1??/4580>1:C5@4-A@5?9-:0;@41>05?-.585@51?;2@1:4-B1 ?1B1>-805J1>1:@?/-81?&419;?@/;99;:@E<1?->1?/-81?@4-@?1<->-@1B1>.-8 -.585@51?I13 .15:3-.81@;?-E-:0A:01>?@-:0C;>0?-:0B1>.-88E<>1?1:@10 9-@1>5-8J2>;9:;:B1>.-8I13 @41-.585@E@;>1/;3:5F1-:05:@1><>1@B5?A-8<-@ @1>:?C5@4;A@:-95:3;>01?/>5.5:3@419J9;@;>?/-815?;2@1:5:/8A0105: @41?1@1?@?2;>B1>EE;A:3/4580>1:.1/-A?1?;9A/41->8E01B18;<91:@5:B;8B1? 81->:5:34;C@;C-87 6A9< 0>-C -:0A?1A@1:?58?-:E/4580>1:C5@4% ?/;>19A/4C;>?15:B1>.-8->1-?@4-:@41E0;;::;:B1>.-8;>9;@;>?/-81? &41?105J1>1:/1?/-:.1-3;;0?53:.1/-A?1?1B1>-8?@A051?4-B12;A:0@4-@ /4580>1:C4;0;.1@@1>;::;:8-:3A-31@1?@5:35:@411->8EE1->?@1:0@;4-B1 -.1@@1><>;3:;?5?@4-:@4;?1C4;?/;>18;C;:-88?/-81?I-B1?; VTTXJ @5?59<;>@-:@@;>1919.1>@4-@9;?@?@-:0->05F10@1?@?;2@45?75:0->1:;@ /;:?501>10?@-.81A:@58-/45805?X;>YE1->?;80&4-@91-:?@4-@52/4580>1:->1 @1?@10-@V;>WE1->?;80 -?/4580>1:A:01>3;5:3-??1??91:@2;>%;2@1:->1 @41:@415>?/;>1?->185718E@;/4-:31;B1>@41:1D@?1B1>-8E1->?8;C?/;>1;: -@1?@;25:@1881/@A-8-.585@E5:@411->8EE1->?0;1?:;@:1/1??->58E91-:@41?/;>1 C588-8C-E?.1@4-@8;CA@5@0;1?91-:@4-@@41/45805?018-E105:@41@1?@10 area now -:05@5?59<;>@-:@@;<>;B501@41/4580C5@4418<@;81->:@41?7588? @4-@->18-335:3 :-005@5;:@;#@1?@? @1?@?;28-:3A-312A:/@5;:;2@1:->1A?105:01B18 ;<91:@-8-??1??91:@?;2/4580>1:C5@4%8@4;A34#@1?@?9-E/;:@-5: B1>.-8?/-81? @41?1?/-81?35B1;:8E-31:1>-8<5/@A>1;2@4181B18;2-/4580p?A?1 ;28-:3A-315:/;9<->5?;:C5@4@E<5/-88E01B18;<5:3/4580>1:;>101@-5810 5:2;>9-@5;:;2@1:5?:110105:;>01>@;01B18;<-:5:@1>B1:@5;:<>;3>-9@4-@

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5?05>1/@8E/;9<->10C5@4@41?/;>1?;2@E<5/-88E01B18;<5:3/4580>1::?@1-0 @41E;2@1:->1C4-@5?/-8810 criterion- referenced measures,91-:5:3@4-@@41E 501:@52E/1>@-5:/>5@1>5-I13 ;1?@41/4580 5:5@5-@16;5:@-@@1:@5;:;1?@41/45804-B1 Criterion- referenced language >1<1@5@5B1 .14-B5;>?J -:0 -??1?? C41@41> measures are often used to @41/4580911@?1-/4/>5@1>5;:&41!% assess the communication I;>01@-8 VTUVJ5?-:1D-9<81;2-/>5@1>5;:skills of children who are not yet >121>1:/1091-?A>1 talking.

Criterion- Referenced Tests

5@1>5;: 121>1:/108-:3A-3191-?A>1?;2@1:->1A?10@;-??1??@41/;99A :5/-@5;:?7588?;2/4580>1:C4;->1:;@E1@@-875:3%;918-:3A-31@1?@?/-:.1 A?10C5@4<>1B1>.-8/4580>1:@;81->:4;C9-:EC;>0?@41EA:01>?@-:0I13 @41""(&J;>C41@41>@41E/-:2;88;C?59<815:?@>A/@5;:?I13 "%J.>5@1>5;: >121>1:/1091-?A>1?->19;>1A?12A8 4;C1B1> @;K:0;A@4;C;2@1:I2>1=A1:/EJ 2;>C4-@>1-?;:I2A:/@5;:J -:04;CI2;>9J-/4580-//;9<85?41?/;99A:5/- @5;:;>1D-9<81 @41>-@1;2/;99A:5/-@5B1-/@5;:?1D45.5@10.E-/4580?A? <1/@10C5@4%/-:.1;.?1>B10-:0/;9<->10C5@4@4;?1?11:5:@E<5/-88E 01B18;<5:3/4580>1:A:01>@41?-91/;:05@5;:? -:E@-?7?;:/>5@1>5;: 121>1:/1091-?A>1?2;>@45?<;?15:B;8B1@19< @-@5;:?;>1D-9<81 -:-@@>-/@5B1@;E9-E.1?4;C: @41:45001: -:0@41/85:5 /5-:@19<@?@41/4580@;-?72;>5@/45809-E.1;J1>10-.-3;2@;E?-:05:B5@10 @;<A88;:12>;9@41.-35:;>01>@;;.?1>B1C41@41>41;>?41C588?4->1@41 @;E;>5:5@5-@16;5:@-@@1:@5;:@;5@C5@4@41-0A8@?5:@41>;;9)41:/4580>1: ->1:;@E1@@-875:3 -??1??;>?8;;72;>;@41>91-:?;2/;99A:5/-@5;:%;919-E

.1-0-<@5B1 ?A/4-?A?5:3-31?@A>1@;>1=A1?@-45001:@;E 9-75:3-?;A:0@; /-88-:-0A8@p?-@@1:@5;:@;-@;E ;>8;;75:3-@@41-0A8@2;>418<C5@4-/8;?106-> %;91@591? @4;A34 /4580>1:C588A?181??-0-<@5B1C-E?@;/;99A:5/-@1@415> :110?85@@81.;E9-E.-:345?41-0;:@41@-.81C41:41/-::;@;.@-5:-@;E41 C-:@?85@@8135>89-E.135:@A>:5:3->;A:05:/5>/81?C41:?41/-::;@;<1:- 6->&41?1.14-B5;>?-8?;?1:0-91??-31-:0->1/;:?501>10/;99A:5/-@5B1 .A@ @41E0;?;5:-9-8-0-<@5B1 A:A?A-8C-E%@588 @41E->1-:59<;>@-:@<->@;2@41 -??1??91:@.1/-A?1@41E@188@41@1-94;C;2@1:@41?175:0?;2.14-B5;>?;//A> -:0C4-@@4;A34@?@41E/;99A:5/-@1 $1<8-/5:3@41?19-8-0-<@5B1.14-B5;>?C5@49;>1-<<>;<>5-@1C-E?@;/;9 9A:5/-@15?;:1;2@41K>?@3;-8?@41@1-99-E?1@&41-??1??91:@C588-8?;?4;C @41@1-9C4-@501-?@41/45805?@>E5:3@;31@-/>;??C5@491-:?;@41>@4-:?<11/4 ?A/4-?31?@A>1? 3-F1 -:0?;A:0?;>@41/;99A:5/-@5B1-/@?@41/45805?-8>1-0E 1D<>1??5:3C5@431?@A>1? 3-F1 -:0?;A:0? @41@1-99-E@->31@1->8EC;>0? ?53:? ;><5/@A>1?@;/;99A:5/-@1@41?1501-?5:-9;>19-@A>1C-E;>/;99A:5/-@5B1 2A:/@5;:?@4-@@41/45800;1?:;@E1@1D<>1??-@-88 ;>B1>E5:2>1=A1:@8E @41@->31@ 9-E.1@;31@@41/4580@;1D<>1??@41?1501-?:;:B1>.-88E C5@431?@A>1? 3-F1 -:0 ?;A:0?K>?@ .12;>19;B5:3;:@;9;>1?E9.;85/91-:?;21D<>1??5;: Excerpted from Let’s Talk: Navigating Communication Services and Supports for Your Young Child with Autism by Rhea Paul, Ph.D., CCC-SLP, & Donia Fahim, Ph.D. Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 ' | All rights reserved

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Play Assessment "8-E5?-:;@41>->1-@4-@;2@1:5?1D<8;>10C5@4/>5@1>5;:

121>1:/10-??1??91:@4580>1:C5@4%;2@1:0;:;@<8-E@41C-E;@41>/458 0>1:0; 2;/A?5:39;>1;:1D<8;>5:3;.61/@?-:0A?5:3@4195:>1<1@5@5B1C-E? I?114-<@1>VJ??1??91:@?;2<8-E2;>/4580>1:?A?<1/@10;2%A?A-88E/;: ?5?@;235B5:3@419;<<;>@A:5@51?@;A?1<8-EC5@4;.61/@?@4-@1:/;A>-312A:/ @5;:-8A?1-:0<>1@1:0 ;.?1>B5:34;C@41/4580>1:A?1@41;.61/@? <>;B505:3- 9;018;22A:/@5;:-8;><>1@1:0A?1 -:0;.?1>B5:3C41@41>@41/45802;88;C?@41 -0A8@p?1D-9<81 &45?75:0;2-??1??91:@4-?@C;<;?1?!:15??59<8E@;?114;C@41 /4580<8-E?-:0A?1?@;E?.1/-A?1/4580>1:C5@4%;2@1:A?1@;E?5:<->@5/A 8-> A:A?A-8C-E?&41;@41>5?.1/-A?1A?5:3;.61/@?5:<8-E5?>18-@10@;A?5:3 C;>0?@;/;99A:5/-@1$1?1->/41>?4-B17:;C:2;>E1->?@4-@@E<5/-88E01B18 ;<5:3/4580>1:C4;?4;C9;>1?E9.;85/;><>1@1:0<8-E@1:0@;4-B19;>1 ?<;71:8-:3A-31.1/-A?1 -?C1pB105?/A??10 A?5:3@;E?-??E9.;8?5:B;8B1? @41?-9191:@-8<>;/1??1?-?A?5:3-C;>0@;?@-:02;>-:501-;@4<>1@1:0 5:3-:0A?5:3C;>0?5:B;8B1?E9.;85/@4;A34@}@41-.585@E@;4;80-@4;A34@ 5:95:0-:01D<>1??5@;A@5:@;@41C;>80&41?1@C;75:0?;2.14-B5;>} <>1@1:05:3-:08-:3A-31}A?A-88E3;@;31@41>5:@E<5/-801B18;<91:@A@2;> ?;91/4580>1:C5@405?-.585@51? ;:12;>9;2?E9.;85/.14-B5;>9-E.1-41-0 ;2@41;@41>2@45?5?@>A12;>E;A>/4580 @41:@41-??1??91:@@1-9C588C-:@ @;7:;C.1/-A?152<8-E?7588?->1-41-0;2@41/4580p?8-:3A-3181B18 @41:5@ ?A331?@?@41/45805?9;>1>1-0E@;81->:8-:3A-31@4-:52.;@4->1?5958->8E 018-E10"8-E-??1??91:@C588:;@;:8E418<@41@1-901?/>5.1E;A>/4580p?81B18 ;22A:/@5;: .A@C588-8?;418<@;01/50152@41/45805?>1-0E@;81->:-?E9.;85/ /;99A:5/-@5;:?E?@19 ?A/4-??<11/4;>?53: ;>:110?@;?<1:09;>1@591 01B18;<5:3<8-E-:0<>1B1>.-8/;99A:5/-@5;:?7588?.12;>12;/A?5:3;:?E9

.;85//;99A:5/-@5;:&;?4;CE;A4;C@45?-??1??91:@5:2;>9-@5;:/-:.1 A?10 41>1->1?;91;2@41@45:3?@4-@4-<<1:10-@588Ep?-??1??91:@C41:?41 C-?:1->8EVE1->?;80 Lilly’s parents reported she was saying five or six different words and doing a lot of bab- bling. The team did an ADOS (Lord et al., 2012). They also used a Mullen Scales of Early Learning to assess her verbal, visual (nonverbal), and motor skills. They used the CSBS- DP (Wetherby & Prizant, 2003) to get a closer look at her communication. Lilly’s parents had informed the team that Lilly loves bubbles and the Moomins. They put a Moom- ins book in a clear box to tempt Lilly and see how she would respond. As soon as Lilly saw the box she shrieked with joy, “Moo- Meens piz!” Lilly also enjoys puzzles, and she completed an inset puzzle soon after she received it. She also likes banging the puzzle pieces together by her ear and spinning them. The team met with Lilly’s parents and reported that the ADOS (Lord et al., 2012) showed Lilly scored within the range seen in children with ASD. The Mullen showed her motor and visual skills were at age level, but her verbal skills were delayed in both expres- sion and comprehension. The CSBS- DP (Wetherby & Prizant, 2003) showed that Lilly was requesting things in almost all the temptation situations presented, using sounds and Excerpted from Let’s Talk: Navigating Communication Services and Supports for Your Young Child with Autism by Rhea Paul, Ph.D., CCC-SLP, & Donia Fahim, Ph.D. Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 ' | All rights reserved

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her few words, but she hardly ever communicated for reasons other than making requests. Her play skills were observed to consist mostly of turning toys over to look closely at their shape or banging them together to hear the sound they made. Even after modeling feeding a stuffed toy with a spoon, Lilly did not show any pretend feeding. The team recommended that she begin intervention and that one of her goals would be to learn more words for making re- quests; another to use gestures, gaze, and sounds to communicate for joint attention, as well as to work on imitating others and using toys in pretend ways.

WHY WOULD A CHILD WHO IS NOT TALKING NEED

TO SEE A SPEECH- LANGUAGE PATHOLOGIST (SLP)?

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Juan is a 3- year- old boy who was diagnosed with autism at the age of 28 months. He has been receiving home- based intervention since then. Juan occasionally echoed parts of words after an adult but did not use words to ask for things or interact with others. His mother, Maria, tried very hard to understand his nonverbal ways of communicating, but, more often than not, this resulted in a guessing game that ended in frustration and tears for both. If Juan wanted something and could not reach it himself, then he either pulled an adult by the hand toward what he wanted or he screamed and cried until someone figured out what he was after. Maria spoke with their SLP to explain how she had repeatedly tried to teach Juan spoken words. For example, when she knew Juan wanted to drink water, she asked him to repeat the word water, but he didn’t say anything and just became more upset; this often ended with a tantrum. Maria reported that she felt frustrated and sad about the difficulty communicating with her son. The SLP explained that talking

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%;/5-8 ;99A:5/-@5;:%E9<@;9?;2% ZY

can be difficult for children with autism and asking Juan to repeat words at this stage can be frustrating for everyone. Juan may only learn from it that no one can meet his needs unless he screams, and screaming will eventually get him what he wants. The SLP recommended teaching Juan a few signs as a stepping stone toward acquir- ing verbal language. Although Maria was willing to try this strategy, she’s worried— “Aren’t signs or gestures only used with children who are deaf? Does deciding to teach Juan signs mean the SLP thinks Juan will never speak? Will using signs discourage him from learning to talk?”

;?@/4580>1:C5@4%0;01B18;1Y;>ZE1->?;80@/-:.1418<2A8@;4-B1-:-8@1>:-@5B1C-E@; /;99A:5/-@1@4-@-88;C?@41/4580@;1D<>1??C-:@?-:0:110?0A>5:3@41@591 C41:?<11/45?8595@10Augmentative or alternative communicationIJ5?@41@1>9 A?10@;01?/>5.1@41?191@4;0?A?@-?@41>1 ->19-:EC-E?@;31@2>;9;:1<8-/1@;-:;@41> ost children with ASD I13 ;:2;;@ .E.571 /-> @>-5: ;><8-:1J @41>1 do develop spoken 5?9;>1@4-:;:1C-E2;>-/4580@;/;99A:5M language, although it /-@1&41@1-9p?6;.5?@;K:0@419;?@1Q/51:@ may take them until they are 5 or 91-:?;2-88;C5:3@41/4580@;?A//1??2A88E1D6 years old. It can be helpful to have <>1??:110?:;C5:;>01>@;81->:@4-@@41>15?an alternative way to communicate -:-0-<@5B1C-E@;31@91??-31?-/>;??&4-@ that allows children with ASD to A:01>?@-:05:39-E.1418<2A85:-/=A5>5:3 express wants and needs during ?<11/4the time they have very limited @5?A?A-88E-:%"C4;1B-8A-@1?@41speech. Augmentative or alternative /4580p?>1-05:1??-:0:1102;>-:?E? communication (AAC) is the term @19 /4;;?1? @41 9;?@ -<<>;<>5-@1 used to describe these methods.

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.812;>E;A:3/4580>1: 4;C1B1> -:0-8?;9-E.1418<2A8&41 9-5:<;5:@;2-:?E?@195? :;@C4-@@E<15?A?10 .A@@4-@ @41?E?@19<>;B501?-9;>1L1D 5.81 /;:B1:@5;:-8C-E@;1D<>1?? C-:@?-:0:110?2;>@41/4580: @45?C-E /-:.A580@;C->0 @41 -.585@E @; /;99A:5/-@1 - C501>>-:31;291-:5:3?@4-: Excerpted from Let’s Talk: Navigating Communication Services and Supports for Your Young Child with Autism by Rhea Paul, Ph.D., CCC-SLP, & Donia Fahim, Ph.D. Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 ' | All rights reserved

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ZZ "-A8-:0-459

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Box 3.3. Five Steps in the SET GO Program for

Teaching Signs (Fahim, 2011)

S: Select activities and items the child enjoys.

E: Establish a positive rapport.

T: Teach the child to request.

G: Give reasons to use targeted signs by contriving situations.

O: Omit and reduce prompts as child becomes more independent.

Step 1: Select targeted activities or items. Create a short list of targeted activities and items the child enjoys. Identify three or four activities and items for which the child will learn the signs.

Step 2: Establish positive rapport. Help the child understand that other people can make fun things happen. Engage in activities the child enjoys and find ways to share them. For example, hold the child’s hands and sing in rhythm as he or she jumps on a toy trampoline.

Step 3: Teach how to request using signs. Use consistent, simple verbal prompt phrases (“What do you want?”) as well as physical prompts, and then name the item or action with a sign. For example, provide a closed jar with a treat in it, model the sign for OPEN, physically guide the child to produce the sign OPEN, then open the jar and provide the treat.

Step 4: Give reasons to sign. Set up situations in which the child can practice the signs throughout the day; have items from each meal and snack in closed con- tainers so the child must use a sign to request that adults open the container.

Step 5: Omit or reduce prompts. Wait before prompt- ing, allowing the child time to produce the sign him- or herself. If he or she doesn’t produce the sign, then provide a very small prompt, such as touching his or her hands instead of shaping them fully into the sign for OPEN.

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Initial attempts to get Juan to use signs to ask for things he wanted resulted in his run- ning away. For example, when presented with a bubble jar, he showed that he want- ed bubbles blown for him, but when the SLP demanded he make a sign for BUBBLE, he would look for something else he could get without having to do anything to get it. Maria was concerned, “Is this going to work? He’s all over the place and doesn’t stay still for a second.” The SLP started off by playing with Juan on the trampoline to establish positive rapport with him. She held his hands, and while he jumped, she simultaneously labeled his action, “Juan’s jumping. Jump, Jump, Jump.” After 1– 2 minutes of jumping, the SLP then started to use sentence completion, “Ready, set . . . ,” pausing and waiting for Juan to look at her before she would say “go.” The SLP introduced the bubbles after she had Juan’s interest. She blew bubbles and simultaneously said and signed BUBBLES in between jumping, which made Juan laugh as he tried catching the bubbles. After doing this a few times, the SLP paused the bubble blowing and said, “Give me five,” and then placed her palm out in front of Juan’s to give him the opportunity to slap her palm with his palm. As soon as Juan tapped her palm with his hand, she immediately blew the bubbles again. The SLP showed Maria how to teach Juan the sign for OPEN, which was selected because it can be used for many different requests and situations (e.g., open door, open cookies, open box). Maria held the bubbles in front of Juan and said, “What do you want? Open!” Maria then took Juan’s hands, helped him make the sign for OPEN, and then immediately opened the bubble jar and blew bubbles. Because Maria reported that Juan also enjoyed music, the SLP showed her how to prompt Juan to use the sign for MUSIC. Maria first held Juan’s hands while he jumped on the trampoline, then, just as the SLP had done, they sat down in between jumping, and Maria gave Juan the musical toy and started to sing a song. Maria then used the same physical and verbal prompts as the SLP. “What do you want? Music!” Juan was willing to allow his mother to help him, and he signed MUSIC. Together, Maria and the SLP selected four signs representing things Juan most fre- quently wanted, which included EAT, MUSIC, BUBBLES, and OPEN. The SLP helped Maria think of ways to encourage Juan to use the signs to have his needs met throughout the day. For example, Juan was asked to use the sign for EAT any time he wanted to eat. Juan was asked to use the sign for JUMP whenever he wanted to jump. Maria and the SLP practiced using the signs for the next 2 weeks. By the end of that time, Juan used the sign for EAT three times, with an imitative prompt and echoed part of the word ee. He used the sign for MUSIC with both a partial physical and verbal prompt, and he used the sign for OPEN with a physical and verbal prompt. Maria told the team, “I was skeptical when the SLP wanted to try signs, but get- ting him to use them has really helped his behavior. He’s calmer and doesn’t get upset when he has to wait. He uses the signs for EAT, MUSIC, and sometimes OPEN now. He has also started to make sounds when he signs for EAT. My aunt and his older sister have also learned the signs. Even the man in our local shop has started to sign THANK YOU with Juan.”

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HOW DO CHILDREN MAKE THE TRANSITION FROM

COMMUNICATION TO LANGUAGE?

-:E<->1:@?->1/;:/1>:10@4-@52-:-8@1>:-@5B1?E?@19 ?A/4-??53:?;> /;9<A@1> 31:1>-@10?<11/4 5?5:@>;0A/10 @41:@41/4580C588>18E@;;41-B58E ;:@41-8@1>:-@5B191@4;0-:0:1B1>81->:@;?<1-78;@;2>1?1->/48;;7105:@; @45?=A1?@5;:-:031:1>-88E2;A:0@4-@A?5:3-:-8@1>:-@5B1?E?@190;1?:;@?119 @;711</4580>1:2>;981->:5:3@;@-87%;91?@A051??4;C10@4-@/4580>1:C4; ->1<>1B1>.-8C4;.135:A?5:3?E?@19?4-B1?;91-0B-:@-315:-/=A5>5:3 ?<11/4I-?->51@-8 VTUXJ@p?@4;A34@@4-@@41?E?@194181:C5@4 %A:01>?@-:0-.-?5//;:/1<@-.;A@/;99A:5/-@5;:@4-@@415>-A@5?971<@ @4192>;9A:01>?@-:05:3.12;>1}@4-@5@5? <;??5.81@;5:ŌA1:/1;@41>?-:031@C4-@C1 n alternative system does C-:@.EA?5:3?E9.;8?-:0?1:05:391??-31? not seem to keep children 5:?@1-0;2.E<4E?5/-88E9-:51:C5@4 %@;@41r4-s9;91:@C41:@41E>1-85F1 r2?-EI;>1D<>1??5:?;91C-EJ ?;91@45:3 @41:;@41>?0;?;91@45:30;:p@:110@;0>-3@419.E@414-:0@; C4-@C-:@-:04;<1@41E31@C4-@:110@419@;0;C5@45@/-:A?1@45?C;>0N ?53:N<5/@A>1@;31@C4-@C-:@-:0@41E31@@4191??-31%;@4-@p?C4E1B1>E.;0E 4-?.11:9-75:3@4;?1:;5?1?C5@4@415>9;A@4?-88@45?@591s!:/1@45?9; 91:@5?>1-/410 /4580>1:4-B1-9;>1<;C1>2A8>1-?;:@;81->:@;?<1-7@4-: 6A?@0;5:3C4-@;@41>?->10;5:3 &E<5/-88E01B18;<5:3/4580>1:?119@;4-B1-?@>;:30>5B1@;.1/;91-:0 -/@8571;@41>?->;A:0@419&4-@p?C4E@415><8-E;2@1:5:B;8B1?595@-@5:3C4-@ ;@41>?0; -:05@p?;:1;2@415>9;@5B-@5;:?2;>-/=A5>5:3?<11/4A@<->@;24-B 5:3%5?4-B5:381??9;@5B-@5;:5:@45?05>1/@5;:1->:5:3@;@-876A?@@;.1 8571;@41>?5?:;@-<;C1>2A81:;A34>1-?;:2;>/4580>1:C5@4%@;3;@;@41 @>;A.81;2-/=A5>5:3?<11/4/=A5>5:3?<11/45?4->0+;A4-B1@;85?@1:/->1 2A88E@;C4-@;@41>??-E 2;88;CC4-@@41E8;;7 -@C4581@41E?-E5@@;ŋ3A>1;A@4;C@41C;>0? Typically developing children >18-@1@;@45:3?5:@41C;>80 /4;<A<@41seem to have a strong ?@>1-9;2?;A:0?5:@;?1<->-@1C;>0? />1-@1 drive to become and act ?;9175:0;291:@-8>1<>1?1:@-@5;:;>@>-/1 like others around them. That’s why ;2@41C;>0?@;?1>B1-?-@->31@2;>C4-@E;A their play often involves imitating C-:@@;?-E ?;914;C?@;>1@45?919;>E5:what others do, and it’s one of their E;A>95:0?;E;A/-:K:05@-3-5:C41:E;Amotivations for acquiring speech. C-:@5@ 9-71B1>EK:19;@;>9;B191:@?5: But part of having ASD is having less ;>01>@;>1/>1-@1@41?;A:0?E;ApB1?@;>105: motivation in this direction.

E;A>95:0 -:0-06A?@@4;?19;B191:@?95 :A@18E@;9-71E;A>?;A:0?9-@/4@41?<11/4;2;@41>?<1-71>?5:E;A>1:B5>;: 91:@5:-88@41?A.@81C-E?@4-@9-71?<11/4?;A:0>534@ 2E;A1B1>@-A34@.-.E?53:?@;-:E;2E;A>@E<5/-88E01B18;<5:3/4580>1: @41:E;A9-E4-B1:;@5/10@4-@@41EC1>1-.81@;<>;0A/1=A5@1-21C.-.E?53:?

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.14-B5;>@4-@4-?@;.181->:10@4>;A34<>-/@5/1 6A?@8571;@41>9;@;>.14-B5;>? ?A/4-?81->:5:3@;?75 ?7-@1 ;><8-E-:5:?@>A91:@);>0?:110@;.1/;::1/@10 @;91-:5:3 ?;@412;/A?;25:@1>B1:@5;:?4;A80:;@.1?;818E;:0>5885:39;@;> <-@@1>:?1-:5:32A8;<<;>@A:5@51?:110@;.1<>;B5010?;/4580>1:C5@4% /-:<>-/@5/1<>;0A/5:3C;>0?-:0?;A:0?5:?1@@5:3?C41>1599105-@1>1C->0? ->1>1/15B10 Excerpted from Let’s Talk: Navigating Communication Services and Supports for Your Young Child with Autism by Rhea Paul, Ph.D., CCC-SLP, & Donia Fahim, Ph.D. Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 ' | All rights reserved

FOR MORE, go to http://www.brookespublishing.com/lets-talk

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WHAT CAN PARENTS DO TO SUPPORT COMMUNICA-

TION DEVELOPMENT IN YOUNG CHILDREN WITH ASD?

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.A@@45?/-:81-0@;95??5:3;<<;>@A:5@51?@;4-B1/4580>1:<>-/@5/11D<>1??5:3 @4;A34@?5:-/;:B1:@5;:-8C-E;>1D-9<81 C41:E;A>/4580?11?E;A<A885:3 E;A>@181<4;:1;A@;2E;A>.-3-:0599105-@18E>A:?@;C->0E;A-:08;;7? -@@41@181<4;:1 E;A9-E7:;C41;>?41C-:@?@41@181<4;:1@;<8-E:3>E 5>0?A@5:?@1-0;26A?@4-:05:3;B1>@41@181<4;:1 E;A9534@?-E r!4 0; E;AC-:@?;91@45:3s-:0<-A?1-:0C-5@2;>@41/4580@;>1?<;:05:?;91C-E 2E;A31@-8;;7-:0<1>4--?53: @41:E;A/-:@A>:;B1>@41@181 <4;:1 7:;C5:3E;A>/45804-? 9-01-/;::1/@5;:.1@C11:1D <>1??5:3-/;99A:5/-@5;:-:0 5@?>1?A8@2E;A/-:p@185/5@->1 =A1?@ -:0@41/458091>18E/;: @5:A1?@;8;;7-@@41@181<4;:1;> 3>-.?-@5@ @41:E;A/;A80@-71 45?;>41>4-:0 ?4-<15@5:@;

<;5:@ @;C->0 @41 @181<4;:1 9-71@41?53:2;>@181<4;:1 ;> ;J1> - ?<;71: <>;9<@ Ir&181 <4;:1 <81-?1sJ 01<1:05:3;: E;A>/4580p?/A>>1:@81B18;21D <>1??5;: +;A 9534@ 35B1 @4>11 /4-:/1? @; @-71 E;A> /A1 -:0 <>;0A/1-/;:B1:@5;:-8>1=A1?@ 2E;A0;:p@31@->1=A1?@-2@1> Excerpted from Let’s Talk: Navigating Communication Services and Supports for Your Young Child with Autism by Rhea Paul, Ph.D., CCC-SLP, & Donia Fahim, Ph.D. Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 ' | All rights reserved

FOR MORE, go to http://www.brookespublishing.com/lets-talk

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Reading

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.1/-A?15@@1-/41?@419-.;A@4;C.;;7?C;>7 C45/44181-0E @;>1-0 -:0<>;B501?>1<1@5@5B18-:3A-31@4-@3;1?C5@4-@@>-/@5B1<5/@A>1? C45/4418<?@41981->:C4-@C;>0?-:0?1:@1:/1?91-:@418<?/4580>1: -@?;91C4-@45341>81B18?;201B18;<91:@81->:@;>1919.1>-:0A:01> ?@-:0?1=A1:/1?;21B1:@?5:?@;>51?-:0@-87-.;A@/4->-/@1>?p21185:3?-:0 Excerpted from Let’s Talk: Navigating Communication Services and Supports for Your Young Child with Autism by Rhea Paul, Ph.D., CCC-SLP, & Donia Fahim, Ph.D. Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 ' | All rights reserved

FOR MORE, go to http://www.brookespublishing.com/lets-talk

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How to Play with Your Child with ASD

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.A@5:?5?@;:@-75:3@A>:?1@@41/4580L5/7@41?C5@/4 L5/75@;:/1E;A>?182 Excerpted from Let’s Talk: Navigating Communication Services and Supports for Your Young Child with Autism by Rhea Paul, Ph.D., CCC-SLP, & Donia Fahim, Ph.D. Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 ' | All rights reserved

FOR MORE, go to http://www.brookespublishing.com/lets-talk

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Playing with Your Child with ASD

Box 3.4. Playing with Your Child with ASD • Try to have 5– 10 minutes each day set aside for play. Your child doesn’t have

(continued)

to have the same playmate each time (e.g., mom, dad, brother, sister, cousin, grandma).

• Do not expect your child to repeat what you say. • Tell your child the names of objects instead of ask-

way. Or just pick a tune and sing whatever you say. • Talk about what your child is doing in short and

• Imitate what your child does by doing the same thing next to him or her and take turns (e.g., he or she pushes the car once, then take it from him or her, do the same action, and hand it back).

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BOX 3.4 (continued)

Use the child’s name at the end of a sentence, especially when praising him or her (e.g., “Well done, Ahmed!”).
Allow silent times.
Wait for your child to begin interactions.
Understand and respond to any form of communication, even a simple quick look at you while he or she is playing. Respond with, “Yes, I see you playing with the car!”
Treat behavior as if it were communication, even if the child may not have meant it that way. If the child accidentally rolls a car in your direction, then take it and say, “Oh my turn! Thank you! You gave me a turn!”
Imitate and praise any sounds the child makes, especially those that sound like speech. Don’t worry if you don’t understand what the child meant or if he or she meant anything. Respond to his or her sounds with excitement and your own vocalization.
If the child says a word, then repeat it back with correct pronunciation, but continue to respond to his or her immature form with your mature form.
Praise your child lavishly, using facial expressions, hugs, tickles, or anything else he or she likes.
Ignore any inconsequential behaviors while playing (e.g., if he or she screams when blocks fall apart). If you give attention to these behaviors, even by trying to calm him or her down, then they may actually be strengthened. Simply help him or her fix it without any comment or facial expression.
Keep it happy. If your child becomes upset at something you try, then ignore the outburst and go back to the previous form of play. Don’t give up; try again later.
Set the scene for some messy play. Cover the table with plastic and let the child fingerpaint with pudding, shaving cream, or cornstarch paste. This is a great chance to use words for how things feel— slippery, gooey, yucky, cold, sticky, and so forth. CONCLUSION

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