Enhancing Communication for Individuals with Autism

A Guide to the Visual Immersion System™

by

Howard C. Shane, Ph.D. Emily Laubscher, M.S., CCC-SLP Ralf W. Schlosser, Ph.D. Holly L. Fadie, M.S., CCC-SLP James F. Sorce, Ph.D. Jennifer S. Abramson, M.S., CCC-SLP Suzanne Flynn, Ph.D., CCC-SLP and Kara Corley, M.S., CCC-SLP

Contents

1. An Overview of the Visual Immersion System™ . 1
2. Language Acquisition and Symbolic Competence . 21
3. Tools Used to Support Visual Language and Communication . 47
4. Principles of Assessment . 75
5. Principles of Intervention . 93
6. Protesting . 123
7. Organization and Transitions . 149
8. Requesting . 175
9. Directives . 195
10. Commenting . 223
11. Questions . 247
12. Social Pragmatics . 277
13. References . 303
14. Index . 311

About the Authors

Howard C. Shane, Ph.D.

Associate Professor of Otolaryngology at Harvard Medical School and Director of the Center for Communication Enhancement and the Autism Language Program at Boston Children’s Hospital.

Emily Laubscher, M.S., CCC-SLP

Speech-language pathologist in the Autism Language Program at Boston Children’s Hospital.

Ralf W. Schlosser, Ph.D.

Professor in the Department of Speech-Language Pathology and Audiology at Northeastern University, director of Clinical Research in the Center for Communication Enhancement at Boston Children’s Hospital.

Holly L. Fadie, M.S., CCC-SLP

Speech-language pathologist at Boston Children’s Hospital in the Augmentative Communication and Autism Language Programs.

James F. Sorce, Ph.D.

Director of Media Applications in the Autism Language Program at Boston Children’s Hospital.

Jennifer S. Abramson, M.S., CCC-SLP

Speech-language pathologist at Boston Children’s Hospital in the Autism Language Program and the Augmentative Communication Program.

Suzanne Flynn, Ph.D., CCC-SLP

Professor in the Department of Linguistics and Philosophy at MIT and researcher/clinician at Boston Children’s Hospital.

Kara Corley, M.S., CCC-SLP

Has 25 years of experience assessing and treating pediatric communication disorders, with a particular interest in social-pragmatic impairments.

An Overview of the Visual Immersion System™

Communication disturbance is a hallmark of autism spectrum disorder (ASD). The primary focus of this book is individuals with moderate-to-severe ASD who experience difficulty comprehending and expressing spoken language. This chapter describes the communication impairments and presents the rationale for a visually based approach to communication intervention, referred to as the Visual Immersion System™ (VIS™).

COMMUNICATION IMPAIRMENTS OF INDIVIDUALS WITH MODERATE-TO-SEVERE AUTISM SPECTRUM DISORDER

Individuals with moderate-to-severe ASD struggle to understand and express spoken words.

Spoken Language Difficulty: Comprehension

Many individuals with ASD struggle to understand spoken language. Common patterns of impairment include:

• Strong comprehension of nouns but difficulty understanding abstract concepts (verbs, adjectives).
• Difficulty understanding semantic relations and complex syntactic structures.

Although comprehension impairments may be masked by context clues, the reality is that language’s intended purpose often goes unfulfilled.

Spoken Language Difficulty: Expression

Approximately 50% of individuals with ASD do not use speech functionally. Their expression may include:

• Limited vocabulary, often heavily favoring nouns.
• Delayed and disordered knowledge of syntax.
• Use of scripted speech rather than generative speech.

A primary emphasis of this book is on facilitating language comprehension, which is crucial for effective communication.

THE VISUAL IMMERSION SYSTEM’S RATIONALE FOR EMPHASIZING VISUALS IN COMMUNICATION AND LANGUAGE

Focusing on the visual modality in communication intervention is promising for several reasons:

1. Children with ASD often have strong visual processing skills.
2. Visuals provide a sustained referent, allowing additional processing time.
3. Individuals with ASD may understand visual graphics better than spoken language.

As technology becomes more accessible, the implementation of personalized visual support systems for communication becomes both feasible and practical.

DEFINING COMMUNICATION

Communication is defined as the systematic exchange of information between a minimum of two people, encompassing verbal and nonverbal modalities.

FRAMEWORK FOR VISUAL LANGUAGE INTERVENTION

The VIS framework includes three modes of visual support:

1. Visual expressive mode
2. Visual instructional mode
3. Visual organizational mode

Despite the extensive use of visuals, current methods do not form a cohesive visual language system. The VIS provides a framework for teaching linguistic skill combinations to facilitate communication.

GENERAL PRINCIPLES OF THE VISUAL IMMERSION SYSTEM

1. Communication is used for multiple pragmatic functions.
2. Two tiers of communication: scenes and element strings.
3. Communicative competence flourishes in a visually immersive environment.
4. Spontaneous communication and language arts are essential.

This framework is aimed at enhancing communicative functions necessary for individuals with moderate-to-severe ASD.