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. He has designed more than a dozen computer applications used widely by people with disabilities and holds two U.S. patents.

Emily Laubscher, M.S., CCC-SLP

Speech-language pathologist in the Autism Language Program at Boston Children’s Hospital, working primarily in home, school, and community settings.

Ralf W. Schlosser, Ph.D.

Professor in the Department of Speech-Language Pathology and Audiology at Northeastern University and the director of Clinical Research in the Center for Communication Enhancement, Department of Otolaryngology and Communication Enhancement, 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 working 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 Massachusetts Institute of Technology and a researcher and clinician at Boston Children’s Hospital at Waltham.

Kara Corley, M.S., CCC-SLP

Has extensive experience assessing and treating pediatric communication disorders, especially 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 considerable difficulty comprehending and expressing spoken language. This chapter describes the communication impairments, presents the rationale for a visually based approach to communication intervention, and outlines the general principles of 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. Common issues include:

• Strong comprehension of nouns but difficulty with abstract concepts (verbs, prepositions, adjectives, adverbs).
• Challenges in comprehending semantic relations and complex syntactic structures.

Spoken Language Difficulty: Comprehension

Many individuals with ASD show considerable difficulty understanding spoken language, often relying on context clues to glean meaning. Their conversations with caregivers or teachers may tend to be incomplete or disjointed, leading to misunderstandings and maladaptive behaviors.

Spoken Language Difficulty: Expression

Individuals with moderate-to-severe ASD may have trouble using spoken language expressively. About 50% do not use speech functionally, and those who do may show several impairments:

• Limited vocabulary, primarily nouns.
• Delays in syntax and frequent use of scripted speech.
• Often restricted to requests, rather than generative language.

The Visual Immersion System’s Rationale for Emphasizing Visuals in Communication and Language

Focusing on visual modalities is aligned with the strengths of individuals with ASD, who often process visual information more effectively than auditory. This book emphasizes visual strategies to promote language growth and comprehension.

Defining Communication

Communication encompasses various modalities, including both verbal and non-verbal forms. The objective is to foster progress from non-symbolic to symbolic communication.

Framework for Visual Language Intervention

The VIS comprises three modes of visual support:

1. Visual expressive mode – used for expressive communication.
2. Visual instructional mode – supports comprehension.
3. Visual organizational mode – represents activity organization.

General Principles of the Visual Immersion System

The VIS aims to enhance communication skills in children with moderate-to-severe ASD through:

1. Acknowledging multiple pragmatic functions of communication.
2. Utilizing two tiers of communication: scenes and element strings.
3. Emphasizing a visually immersive environment for fostering communicative competence.
4. Supporting spontaneous communication and language arts.

Communication should fulfill multiple functions, addressing behavioral organization (protesting and transitions) and interactive communication (requesting, commenting, questioning).

Conclusion

The VIS provides a comprehensive framework for understanding and enhancing communication for individuals with ASD, supporting them in achieving effective communicative competence through a structured approach.