Dr. Chris’ Autism Journal

Vocabulary 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 a 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, personal 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:

a) 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

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!

 There is no specific age that a child should start using the computer, but most people would agree that the child should be at least 2 years old. At this age, many children may be ready, but some will not, even at 3 or 4 years old. By the age of 5 years, most children are probably ready to start using the computer in one way or another. There is little research on when a child should begin using the computer, but there are a few signs that your child might be ready:

1. Your child is at least 2 years old
2. Your child is interested in visual stimuli such as the computer or television
3. Your child attends to visual stimuli for at least 5 minutes (with or without your help)
4. Your child is able to reach for items or point to desired items (so that they can touch the computer monitor or point to items on the screen) (not necessary for your child to use a computer mouse at first) (this one is not totally necessary as there are accommodations that can be made even for those children who cannot point to the screen)
5. Your child can attend to and follow brief, verbal instructions (e.g. “sit down”) (for this one, it is worth trying the computer briefly to see what happens, for some children, they respond better to the computer than to verbal instructions).

How can I get a child started using the computer?

The best way to get a child started on the computer is to introduce it gradually with little demand on the child. The focus at first should be on showing the child that the computer is fun!

1. Pick a stimulating program that your child is likely to love (this does NOT have to be educational – just fun for your child!) and have your child sit with you while you navigate through the program. If your child wants to grab the mouse or touch the monitor, let him, but do not give your child any instructions or place any demands on him or her.
2. Once your child begins to show interest (which could be the very first time!), start placing your child’s hand on the mouse occasionally and physically prompt them to move it around and click. If you have a touch screen monitor, you can have your child start touching the screen to see what will happen. For this step, you should again choose a program that is reinforcing for your child, not necessarily a learning program.
3. Now you can introduce a simple learning program (you will want to start with content that is relatively easy, but not boring, for the child). Begin with very short sessions such as 5 minutes and do several times throughout the day (2-3 times). Sit behind your child and provide extra reinforcement (e.g. praise, food, touch) to keep your child engaged. You may want to set a timer so the child knows how long they are expected to sit at the computer.
4. Increase the difficulty of the learning program and increase the time gradually that the child sits at the computer (no more than 20 minutes for a young child, up to an hour for an older child).
5. As your child gets more independent on the computer, you can fade your presence but it is recommended that you sit with your child for some of the computer sessions to work on expressive language and social interaction.
6. To make sure it is working, you should collect data on the skills you are trying to improve.

What should I look for in purchasing software for my child?

1. If only looking to entertain your child, not teach, pretty much anything will work – these kinds of programs are good rewards for your child to earn after using a learning program.
2. For teaching, look for programs that are specifically designed for your child’s needs. For instance, if you have a child with an Autism Spectrum Disorder, you may want to purchase a program that is designed specifically for this population. Also, be sure to look at the ages the program is designed to teach. If your child is older, you will want to choose a program with age ranges that match your child’s developmental level.
3. Look for programs that are based on science. Many programs claim to do this, so look at what “science” they are referring to.
4. Look for companies that have done and continue to do research on their products! This one is extremely important, claiming something is “evidence-based” or “effective” without any research is a false claim. At minimum, the companies should provide a scientific framework that their products are based on.
5. Identify programs that are visually interesting and have fun sounds – you will want your child to enjoy what they are doing! Most companies provide free demos of their products so that you can check out what the program looks and sounds like. Higher quality products are more engaging for most children.
6. Programs that claim to be effective should provide a data collection system in the software. Having frequent progress reports on how your child is doing will help you decide if the program is working or not.
7. One of the biggest issues with computer instruction is whether or not skills will generalize to off-computer activities. Programs that provide generalization solutions in the software and give suggestions for off-computer activities are ideal.
8. Last, but not least, try to identify programs that will grow with the child so that you are not replacing software every month or so (this gets costly, results in loss of data tracking, and can be frustrating for your child).

Written by:

Christina Whalen, PhD, BCBA

President and Chief Science Officer

TeachTown, Inc.

www.teachtown.com

Games such as Second Life may provide a great opportunity for opening social doors for people with Autism Spectrum Disorders (ASD).  This virtual world allows users to create characters and interact socially with others in an online world.  In a recent article, CNN reports on how this can be beneficial.  Created by an adult with Asperger’s Syndrome, Naughty Auties is a world where people with ASD can interact with one another in a more relaxed, less socially intimidating environment.  This sounds like a great solution for teaching social interaction and working on social skills.

This kind of solution for helping teens and adults with ASD may end up causing more harm than good.  In worlds such as Second Life, there are an unfortunate group of people called “griefers” whose sole purpose is to cause harm to others.  These people literally seek out vulnerable people in these online worlds and deliberately disrupt the world and cause harm, just because they can.  In worlds such as Second Life, there is no supervision, there are no limits, and anyone can get in and do whatever they want and say whatever they want.  This opens the doors for griefers and others will the wrong intentions.  For the ASD community, they are especially vulnerable due to their difficulties with understanding subtle social cues and often, language difficulties.

Although I support the idea of providing a virtual world for working on social skills and understanding, I am nervous about an open-ended world where people with disabilities are completely exposed and open to griefers.  Instead, I would like to see something similar that is not open to anyone wanting to join, and that operates in a more controlled space perhaps with computer players (like in the SIMS) or with invite-only people that have been screened.  The other issue to consider is how effective this kind of environment is for increasing skills, with no data collection or research on the effectiveness of doing this for someone with ASD, I would hesitate.  Research is clearly needed on this kind of program, particularly if it is described as an intervention or skill-building program.
In general, I think the idea is great, but people should be aware of the potential risks before jumping into a world with so many risks.

If you are a parent and are looking for a great opportunity to get involved in autism research, you should check out IAN, the Interactive Autism Network.  IAN was established in January 2006 at Kennedy Krieger Institute and is funded by a grant from Autism Speaks. IAN’s goal is to facilitate research that will lead to advancements in the prevention, treatment, and cure of autism spectrum disorders.  Joining IAN will help you better understand the research process, help you keep up with some of the latest and most cutting-edge research findings, better understand the value of research, and even influence the direction future research.

What is IAN Research?

IAN Research allows parents of children diagnosed with an Autism Spectrum Disorder (ASD) to participate in research over the Internet. Parents provide information about their child’s diagnosis, behavior, family, environment, and services received. Parents may also report on their child’s progress over time.

Who can participate in IAN Research?

To register and answer research questions in IAN Research, you must live in the United States and be a biological or adoptive parent of a child under the age of 18 who is diagnosed professionally with one of the following disorders:

• Autism Spectrum Disorder (ASD)
• Autism
• Asperger Syndrome
• Autistic Disorder
• Pervasive Developmental Disorder (PDD)
• Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)
• Childhood Disintegrative Disorder (CDD)

The child should not have a diagnosis of Rett Syndrome.

What are the benefits of joining?

You will be able to participate in important research on ASDs. IAN will provide tools that help you monitor your child’s progress over time and explore how your child is similar to (or different than) other children affected by this disorder.