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Dr. Chris’ Autism Journal » General Thoughts
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Archive for the 'General Thoughts' Category

The Hidden Curriculum and Unwritten Social Rules

Wednesday, November 5th, 2008
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photo_BrendaSmithMyles.jpgI attended the Geneva Centre for Autism conference last week and saw many interesting presentations and one that I found inspiring was a talk by Brenda Smith Myles.  She is the author of a book called The Hidden Curriculum: Practical Solutions for Understanding Rules in Social Situations.  There are a great deal of good books on autism and several with pracial information for intervention.  Few of these books, and few interventions, focus on what is not obvious but what might be extremely important. 

thomas and dash.jpg“The hidden curriculum refers to the set of rules or guidelines that are often not directly taught but are assumed to be known (Garnett, 1984; Hemmings, 2000; Jackson, 1968; Kanpol, 1989)” (from Brenda’s book on page 5).  This curriculum includes things like unspoken rules, slang, metaphors, body language, etc.  Most of us pick up on these things instinctively but it is often difficult for those with autism and other special needs to do this.   

In her talk, Brenda spoke of obscure social situations such as using087_040_Lara_Neighbor.jpg a public restroom or shower, using an elevator, and everyday conversations.  To many of us, these are situations that we have become accustomed to and we accept the social rules, even though we may not always think about them or discuss them.  She gives practical tips for teaching these hidden social rules to children and to adults and stresses the importance of making these a part of everyday life.

templeartpic.gifAnother good resource for learning about the hidden rules in social situations is a book that I have finally started reading by Dr. Temple Grandin and Sean Barron (click here for a very interesting podcast with Sean) called Unwritten Rules of Social Relationships: Decoding Social Mysteries Through the Unique Perspectives of Autism.  This insightful and intelligent book helps you see into the minds of people with Autism Spectrum Disorders and how they perceive these strange social situations and rules, and how they cope with these situations.  This book is helpful for professional, families, and those with a diagnosis themselves - fascinating book that I will probably recommend to many of my friends that are not in the field, it really demonstrates how different brains process information from various perspectives and that we can not take any knowledge for granted.000_51_Clark_reading.png

The only thing that is missing from this perspective is how to measure success, how to take data and assess what the child or adult has learned and what they have left to learn.  If anyone knows of a good hidden curriculum type of assessment or measurement, please post here, I would be very excited to take a look at something like that! 

B & E 3.JPGFrom looking at these 2 books and listenting to Brenda talk (and Temple on several occassions), I am reminded how important it is for us to look beyond the obvious in education.  This awareness of hidden information in our world can only advance the science of interventions and assist us with developing programs that result in real-world success.

Effectiveness = Accessibility + Implementation

Wednesday, October 8th, 2008
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B and Trish.jpgI have been in many discussions lately about what makes an intervention effective and was asked the difficult question: How do you narrow it down to just 1 or 2 words?  This is very tough because effectiveness of intervention is dependent on many things including the scientific integrity, social validity, usability, motivation for students, funding and resources, etc.  The 2 things that I felt were critical for real effectiveness for children were accessibility and implementation. No matter how many papers are published on it, no matter how many professionals insist you do it, and no matter how much you think it will help your child, if you do not have quick accessibility to it and are not able to appropriately implement it, the intervention will not be effective.

So, what makes an intervention accessible or not? 100_0152.JPG First, if the intervention can ONLY be implemented by a particular person or agency, it is not accessible to most people.  Interventions should be readily available in various parts of the country (or even in other countries) and the intervention should be one that can be replicated easily by people not associated with the agency.  Second, an intervention should not require extensive amounts of training.  Training is necessary and critical for success for any intervention, but some of the popular treatments require time-consuming and very expensive training programs in order to implement.  In addition, training sessions are not often available to many people who want it and waitlists for these trainings is way too common.  If you cannot get training, the intervention is not really accessible to you and so, obviously, it stj-158.jpgwon’t work.  The third barrier to accessibility is money.  If the intervention requires an immense amount of 1:1 time from a qualified professional, or requires a large amount of materials, it can get very costly and many people do not have access to these kinds of intervention.  If a parent or school cannot afford it and the government or insurance do not cover it, the intervention is not accessible to most people.  The final and perhaps biggest problem is lack of resources.  In an ideal situation where you have access to all of the above, you are most likely going to find yourself on long waiting list (which can be up to 2 years in some places).  This problem prevents many children from getting the necessary intervention that they need and is an even bigger problem in rural areas where there is a paucity of service providers.

If you do not experience problems with any of the000_86_Eric_catching.png above accessibility issues, you should consider yourself extremely fortunate.  However, you should always think about the quality of implementation.  I have seen many programs start out great and basically fall apart over time.  This is because of staff turnover, difficulty finding and training staff, and clinical drift (i.e. the therapist is either not keeping up with the science, losing interest, or in some way losing focus on moving the intervention forward).  Another common problem with implementation is that most children’s needs change as they develop.  Interventions should grow with the child or you should move on to something else when that intervention is no longer appropriate.  Another problem with implementation is keeping up with all of the materials, data collection, and reporting.  This is a huge burden on therapists, parents, and schools.

000_25_Abby_smiling2.pngReading this may make you feel a bit like there is not hope for a quality intervention, but there most certainly is hope!  Many clinics and school programs are well aware of these issues and are doing the necessary research and product development to help by increasing accessibility and developing plans for effective implementation over time.  Technology is one solution that may address many of these issues.  For instance, the use of video and the iJ computer.jpgnternet allows us to provide web-based training for providers.  This technology also allows for remote consultation for individual children.  Portable devices such as cell phones and iPods may allow for quicker access to video modeling, learning programs, and data collection and sharing.  Computers have opened the door to interventions that are not only accessible to most people, but that are also effective, motivating, and provide richer data and reports than other interventions.  The future of intervention must plan for accessibility and implementation, and technology may be the best road map for getting us there.

Narrative Language and Timo Stories

Saturday, July 19th, 2008
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S7300660.jpgVocabulary and text comprehension are critical skills for reading and academic success. The ability to understand and tell a familiar story forms a strong part of the foundation for these later skills. Between the ages of two and five, children’s narratives (i.e. ability to recount events or tell stories) progress from simple phrases about past events to telling more elaborate personal stories (like what happened at school or at the dentist that day) to retelling of familiar children’s books, and on to creating stories of their own.

Narrative skills are critical for school success and are often a strong predictor of kindergarten readiness and later academic success.  When children are asked “What did you do over the weekend?” by their teachers, children with Autism Spectrum Disorders (ASD) and other language difficulties often have trouble answering this question. Similarly, when asked “What did you do at school?” by the parents, the child demonstrated the same frustration in understanding the question, remembering, and verbally recounting the experience. Even children who have recovered from other language deficits often demonstrate difficulty with narrative language skills.

Types of narratives include recounting events, unsolicited accounts of events, event casts (i.e. “broadcasting” of ongoing actions), making up stories (i.e. fictional stories), and scripts (i.e. response to tell what is done in aS7300618.jpg certain situation) (Heath, 1986). These skills not only tell us about a child’s language and literacy development, they also give us insight into their social, emotional, and cognitive skills (Engel, 1995).

Research in speech-language pathology supports the significance of narrative language:

Bishop and Edmundson (1987), in a prospective, longitudinal study of language-impaired children, found that the best predictor of a positive outcome was the ability to tell back a simple story to pictures.

Botting, Faragher et al. (2001). McCabe and Rollins (1994), and Westby (1991), have similarly documented the importance of oral narrative skills for a child’s social and school success.

Loveland (1989) compared children with ASD to children with mental retardation and found that both groups were able to answer questions about a puppet show or video skit they observed, but that the ASD children produced more bizarre responses demonstrating their difficulties with grasping the story as a representation of meaningful events. When compared to typically developing peers, children with ASD lacked the complexity in responses compared to their peers (Losh & Capps, 2003). The children in this study also showed problems inferring, building on causal relationships in narrative contexts, and demonstrated deficits on emotional understanding measures.

Narrative Based Language Intervention (NBLI) is a hybrid language intervention approach that combines naturalistic activities (such as story telling) with skill-based activities to address children’s language and communication goals (Swanson, L. A., Fay, M. E., et al. 2005). The goal of NBLI is to help children develop skills for generating narratives while at the same time addressing their individual needs to develop crucial underlying language skills.

Some of the benefits of NBLI include the ability to target multiple language goals simultaneously (i.e. narrative skills, comprehension, morphosyntax and complex syntax, vocabulary, and social thinking); and the ability to target other goals simultaneously (e.g. memory, sequencing, pretend play, self-help skills, reading).

ABOUT TIMO STORIES

Animated Speech has incorporated NBLI with scaffolded (i.e. making implicit information more salient and gradually building complexity ) stories to improve the story retelling skills, products_stories_03-new.pngpersonal narratives, answering questions, following directions, imitation, reading comprehension, syntax, and vocabulary skills of young children with autism and/or significant language problems.

Animated Speech, with support from Dr. Lauren Franke (speech-language expert), has developed a computer based NBLI program called Timo Stories.

Timo’s Library has 6 colorful stories at 2 levels about everyday events and problems and includes 2 levels of materials:

Timo Stories Pic.pnga) Level 1: Mostly simple sentence patterns and concrete concepts

b) Level 2: Incorporates complex sentence patterns and more complex sentence patterns

Timo Stories includes the following key features:

· Stories depicit predictable events, in language that is simple, yet complex enough to cover a range of topics

· Addresses comprehension, story-retelling, vocabulary, turn-taking, verbal reasoning & more using stories about common events and problems

· Combines a naturalistic linguistic environment and direct teaching

· Timo’s Think Tank features 6 activities to practice vocabulary in multiple contexts

· Story Scramble reinforces sequencing and retelling each story

· Tracks student progress

· Based on Narrative Based Language Intervention (Swanson et. al. 2005)

· Engages and motivating stories and Timo engages child through dialogue and calling the child by name

· Offers intensive opportunities to learn via books and reinforcing games

· Stories written in an explicit style as a processing aid

· Provides Ideas for activities away from the computer for generalization

Timo Stories has many benefits for the student including:

· Supports and promotes social interaction with Timo rather the just working on the computer.

· Offers numerous opportunities for children to build their comprehension, syntax, and story retelling skills.

· Emphasizes earlier development of mental state vocabulary.

· Teaches child to grasp and remember information – retelling stories with increasingly complex syntax and concepts.

· May help with the development of early theory of mind skills.

· Opportunities to learn & practice vocabulary in multiple contexts of increasing complexity.

· Stories & activities designed to help students develop background knowledge of every day events & problem solving

Summer Strategies

Tuesday, July 15th, 2008
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One of the most difficult things facing families is what to do every year when summer comes!

Here are some useful sights to help you with the process:

1) This article gives practical advice for finding a summer program.

2) This article, written by a parent, is extremely helpful and talks about the importance of keeping up home programs over the summer.

3) This blog talks about ESY (Extended School Year) and your legal rights. In fact, this whole blog is about Law & Education and it written by an experienced lawyer - it is well done - I recommend checking it out!

4) Research often shows that children with autism are likely to lose skills when there is treatment is removed - typically developing children do not show as dramatic of a drop in their abilities with breaks in education. This finding has been shown in many studies in which a treatment is shown to be effective and generalizes to the natural environment - but at follow-up - skills are no longer present. Here is an example of a study with these kinds of findings (you may have to to order the original article if you are interested in reading the whole thing).

5) Many parent organizations (e.g. FEAT), clinics (e.g. New Horizons), and even summer camps (e.g. MySummerPrograms) are also available!

6) If you are not able to obtain services for summer or if you are getting limited services and think your child would benefit from more - TeachTown: Basics is an excellent gap-filler for your home or school program. In addition, Animated Speech Company offers software programs suitable for older children needing additional help with language.

Best of luck with your summer programs and stay tuned for tips for going back to school!

Discrete Trial Training - New Findings

Monday, June 30th, 2008
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Over the Memorial Day weekend, Dr. Chris Whalen and Dr. Shannon Cernich attended the Applied Behavior Analysis International conference in Chicago.  There were many exciting presentations and new developments in the field of ABA related to autism.

Of particular interest was a poster presentation entitled “An Analysis of Instructor Errors in Discrete-Trial Teaching of Children with Autism” by Daniel Mruzek, Tristram Smith, and colleagues at the University of Rochester.  They found that the largest proportion of instructor errors when delivering discrete trial training (DTT) occurred when delivering reinforcement.

These errors were of two types:  The instructor reinforced an incorrect child response or the instructor failed to reinforce a correct child response.  For example, instructor says “Show me the big one.”   Child points at small item but instructor thinks the child pointed at big item and says, Great job!”  Or the child points at the big item but the instructor is looking at her data sheet and thinks the child did not respond and says, “Try again.”  As reinforcement (often colloquially known as reward) is what increases the rate of a response, DTT can result in the wrong responses being increased, even with a trained instructor.

This is not to suggest that DTT is a flawed methodology.  All training methods as well as life often result in the wrong responses being reinforced.  Imagine the following scenario:  You meet someone new named Shelly; you mishear her name and call her Sally.  She responds when you call her Sally and does not correct you.  Your behavior of calling her by the wrong name is reinforced.

So the point is not to end your child’s DTT program in place of some other methodology, but to make sure it is being properly supervised.  Trained, good ABA therapists will regularly make the errors describe above (they’re only human), but a good supervisor will detect and correct these errors while supervising your child’s session.

More highlights from the ABA conference will follow in future blogs, but in conclusion, Dr. Chris and Dr. Shannon gave presentations at the conference on the use of TeachTown: Basics, a computer-assisted program that delivers concepts during the computer sessions in a DTT format.  Although computerized instruction is meant to supplement human instruction, not replace it, we are proud to state that TeachTown: Basics delivers errorless reinforcement.  There are some things that computers can do better than people.  If only your computer would help you the next time your child tantrums!

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