Expanding AAC Instruction for Children with Autism: Training Peer Partners

Transcription

1 Expanding AAC Instruction for Children with Autism: Training Peer Partners Kathy Thiemann Bourque, PhD, CCC SLP Juniper Gardens Children s Project University of Kansas November 15 th, 2013, ASHA Chicago 1

2 Disclosure Statement I have no relevant financial or nonfinancial relationship within the research described in this presentation. 2

3 Learning Objectives Rationale for peer partner instruction using AAC Review of two pilot studies and outcomes Teach children without disabilities how to communicate in play using AAC systems Monitor and evaluate children s social progress in specific social communication skills 3

4 What is AAC? Any nonspeech means to aid expressive and receptive communication is considered AAC, so this would include natural gestures, signs, PECS, picture selection, voice output communication aids, picture schedules, object cues, talking books... 4

5 Who are the PARTNERS in AAC Interventions? Parents Educational assistants Teachers Kent Walsh & Binger,

6 Monthly Survey Questions for Parents and Teachers: One Year Change Time 1 Time 2 Time 3 How many different children (brothers, sisters, friends) used your child's AAC system while communicating with your child today? How many different classmates used the child's AAC system while communicating with the child today? = 0 2 = = 3-4 4= 5-6 5= 7 or more

7 Why teach peers to use AAC systems? Preschool peer mediated social interventions are recommended as EBP (McConnell, 2002) Reciprocal communication depends on the communication skills of both communication partners Growth in comprehension over the preschool years is related to number of peers using AAC to interact with child (Barker, Akaba, Brady, & Thiemann Bourque, 2013) Initial studies showing positive communication gains for children with autism/dd with peer partners (Schwartz et al., 1998; Trembath et al., 2009; Thiemann Bourque, 2013) Peers represent an often untapped resource for augmented communication input

8 Video of Typical Child Peer Interaction 8

9 Nuts and Bolts of PM Instruction Recruit 3 to 4peers without disabilities Rotate in dyads with student with ASD Natural social learning opportunities every day, 5 to 10 min, integrated across the day Supportive social environment (e.g., game preferences, small groups, same peers) Systematic adult guided social skill instruction Structured and unstructured social times

10 PICS and PALS: Research Questions Pilot Study #1 (1) What are the effects of combining a buddy skills training program and PECS instruction on communicative exchanges between preschoolers with autism and their peers? (2) Does the intervention lead to collateral increases in receptive vocabulary? Funded by: Kansas Center for Autism Research and Training

11 PICS and PALS: Participants Pilot Study #1 Four preschoolers with autism (2;11 to 5;0) Moderate to severe autism Nonverbal or minimally verbal (less than 10 spontaneous, functional words; echoic) PLS 4 Standard Score range 51 to 70 Attend a center for children with autism integrated therapies (1:1, SLP, OT, PECS) Five preschool age peers from a neighborhood daycare center (age 3;4 to 4;11)

12 PICS and PALS: Design and Phases Pilot Study #1 Multiple baseline design across 4 dyads and across 2 social skills for 2 dyads 5 to 7 baseline observations STAY PLAY TALK buddy training (Goldstein et al., 1997; Goldstein & Thiemann Bourque, 2011) Staggered across two groups of 3 4 peers Then paired peers with focus children in classroom Intervention ranged from 12 to 18 sessions over 10 to 15 weeks

13 Buddy Training Stay Play Talk : Using PECS Six minute sessions with peers only 1. Sensitization Training: Video examples of different ways children communicate (e.g., sign, SGD, and PECS) 2. Stay: Sit close; move when buddy moves 3. Play: Take turns; share toys 4. Talk: Child taught to pick and put PECS symbol 5. Talk: Child taught to take, say, and give object 6. Talk: More ways to talk (gain attention, comment, etc.) Modified from English et al. (1997) published Buddy Skills Training Program 13

14 Changes in PECS and Speech with Peers: Child 3 10 Baseline Sensory and Centers Snack # of Behaviors/ 6 Min S-P-T Training Number of Sessions Total PECS PECS and SPEECH

15 Changes in Use of PECS and SPEECH: Child 4 12 Baseline Treatment Total PECS PECS and SPEECH # per 6 minute session Sessions

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17 SGD Social Play Project: Research Questions Pilot Study #2 (1) What are the effects of combining a buddy skills training program and SGD instruction on communicative exchanges between nonverbal preschoolers with autism and their peers? (2) Does the intervention lead to collateral increases in receptive vocabulary?

18 SGD Social Play Project: Participants Pilot Study #2 Three preschoolers with autism (4;5 to 4;7) Severe autism Nonverbal or minimally verbal (less than 10 spontaneous, functional words; echoic) PLS 4 Standard Score = 50 for all three All attended inclusive preschool classroom Three preschoolers (peers) from same classroom (age 3;6 to 3;9)

19 SGD Social Play Project: Design and Phases Pilot Study #1 Multiple baseline design across 3 dyads 5 to 7 baseline observations STAY PLAY TALK training SGD embedded within TALK phase Buddy training staggered across 3 peers Then paired peers with focus children in classroom Intervention ranged from 15 to 18 sessions over 8 to 9 weeks

20 Buddy Training Stay Play Talk : Using SGD (Go Talk) Three 30 minute sessions with each peer 1. Sensitization Training: Video examples of ways to communicate; how to be a buddy 2. Stay: Sit close; move when buddy moves 3. Play: Take turns; share toys 4. Talk: Talk with buttons, look and listen, and push and talk 5. Talk: More ways to talk 20

21 20 Year 2: Avge Communication Acts Over All BL and TX Sessions Avge # of Spont Acts per 6-min Sn Focus Child Comm Acts Focus Child VOCA use Peer Comm Acts Peer VOCA use BL Centers Switch Snack All Tx

22 Peer Recruitment 22

23 Teacher Recommendations Age appropriate social and language skills Not overly shy and quiet Socially responsive to others Follows simple directions Good school attendance 23

24 Group Set up for Social Success Recruit 3 4 peers Peers rotate in dyads Short and frequent activities 5 to 10 min across the day Preferred activities snacks, musical switch toys Routine settings centers, snack, art, table top activities Quick turns and responses 24

25 Peer Training: Instructional Strategies 25

26 Controlled Practice and Feedback Each peer has book with Buddy Steps (pictures and words) Adult instructs and models Adult child role play Child child role play Feedback and reinforcement ongoing, be SPECIFIC Model and ask questions to check comprehension until child is successful Visual reminders to use skills in classroom (e.g., flag with pictures of steps and words; posters of Buddy Skills) 26

27 Example Teacher Script: Introducing Steps Teacher: Child: Teacher: The first step to being a good buddy is to STAY with your buddy What s the first step to being a good buddy? STAY with your buddy That s right! STAY means you 1. Sit close and 2. If buddy moves, you move What does STAY mean? 27

28 Example Teacher Script: Review of Skill Steps Child: Teacher: Child: Sit close I move when he moves Very good! So if your buddy moves to play with blocks, what do you do? Go with him to the blocks 28

29 Example Teacher Script: Role Play Teacher: Let s practice, watch me Demonstrate STAYING and NOT STAYING, with adult helper Did I sit close? Did I move when my buddy moved? Child: Yes or no Yes or no Teacher: Nice job watching. Now it s your turn to practice. I want you to STAY with your buddy and I will watch and see Sit close and move if your buddy moves 29

30 Video of Peer Instruction: Stay and Play 30

31 Video of Peer Instruction: Talk with Buttons 31

32 After Peer Training Move to Classroom Three times per week (sometimes twice per day) Children paired up in dyads: focus child and one peer Adult instruction and peer review of Stay Play Talk for 3 5 min prior to free play (10 min) Adult observes and prompts nonverbal and verbal skills for successful social exchanges Activities motivating and fun for both child and peer be creative 32

33 Treatment Fidelity for PECS Intervention MATERIALS AND SET UP Buddy PECS Book with minimum 2 picture symbols on front Flag with Buddy Steps: STAY PLAY TALK 1 trained peer Star card and prize box or preferred activity list (as a reinforcer) Activity has pieces or parts (opportunities to request) TEACHER STEPS AND DIRECTIONS Always have peer sitting next to focus child Place Buddy PECS book between the two children Assign peer role of holding/being in charge of parts Say, Remember to STAY, PLAY, and, TALK; (name of peer) you can TAKE, SAY, AND GIVE if (name of focus child) gives you a picture to ask for (object). Show peer the STAY, PLAY, and TALK flag and say, If you forget to STAY, PLAY, and TALK, or TAKE, SAY, and GIVE I will wave this flag to help you remember. Once every 30 sec if there are no interactions prompt PEER using least to most hierarchy 1. Peer holds up object and looks expectantly 2. Peer asks, What do you want? 3. Peer points to picture symbol to cue focus child to request object 4. Adult assists if peer is unsuccessful in eliciting a response from focus child Prompt peer to respond to focus child s request TAKE, SAY and GIVE the item to the focus child. Provide specific reinforcement and feedback; at end of activity show Star Card and give prize

34 Child Peer after PECS Instruction: Session 14 34

35 Video of PECS Interaction: Session 20 35

36 Treatment Fidelity for SGD Intervention MATERIALS: Go Talk with 2 programmed squares for objects (e.g., goal to make requests) Flag with Buddy Steps: STAY PLAY TALK 1 trained peer Star card and prize box or preferred activity list (as a reinforcer) Activity has pieces or parts placed in plastic bin/container (opportunities to request) TEACHER STEPS AND DIRECTIONS Teacher aided model pairs objects with programmed button and says each phrase Peer aided model pushes each programmed button and says each phrase Teacher prompts focus child to push each button, says each phrase, and encourages imitation Teacher follows 4 direct instruction steps for exchanging toys 1. Teacher asks peer to push a button to request item from focus child 2. Teacher prompts focus child to respond (e.g., give toy, answer with Go Talk) 3. Teacher asks focus child to push a button to request item from peer 4. Teacher prompts peer to respond (e.g., give toy, answer with Go Talk) Teacher assigns peer role of holding/being in charge of parts Show peers the STAY, PLAY, and TALK flag to remind them Free play: Once every 30 sec if there are no interactions prompt PEER using least to most hierarchy Provide specific reinforcement and feedback; at end of activity show Star Card and give prize

37 Video of SGD Dyad Instruction 37

38 Video of AAC Interaction: Snack 38

39 Social Communication Goals 39

40 Selection of Skills Baseline child peer observations Survey of teacher and parent priorities Prelinguistic/nonverbal skills Linguistic/verbal skills AAC Use 40

41 Pre linguistic Communication Behaviors Joint Attention Eye gaze shift to peer Showing a toy Vocalizing and showing Gestures Giving or taking a toy Leading peer s hand for help Making choices pointing Protest Ending activity Refusing a toy Affect Sharing enjoyment, positive Frustration, negative 41

42 Communication Goals Range of Functional Skills Requests Protests Comments Ask for help Shares Turns Gain/seek attention 42

43 Social Communication Examples Social Communication Examples Requests I want ball; Cookie, please Protests All done; No more Comments It s a pig; It says oink Shares Here you go Turns My turn; Your turn Gain Attention Look; [child s name] 43

44 Monitor and Evaluate Social Progress 44

45 Tracking Social Communication Progress Focus child initiations and responses Peer initiations and responses Multiple turn interactions Adult prompts and peer prompts Decreases in inappropriate social skills Use of skills with untrained peers Use of skills in novel games and social contexts Quality of interactions (e.g., affect, enjoyment, smiles) Peer acceptance and friendship ratings 45

46 Communication Complexity Scale (CCS) Structured Communication Sample: Adult Partner Structured Communication Sample: Peer Partner 12 communication opportunities presented Assess changes in prelinguistic communication Assess changes in symbolic communication 46

47 Outcomes for PECS and SGD Peer Instruction Increased rates of peer initiations and responses per minute Increased rates of focus child initiations and responses per minute Changes in reciprocity greater with SGD vs. PECS Changes in receptive vocabulary for 5 of 7 participants Increased speech for 3 of 7 participants

48 Changes in Total Communication Acts

49 Changes in Communication using PECS or SGD

50 Moving forward Create brief, frequent, and successful AAC communication opportunities across the day Select and observe changes in rates of prelinguistic skills (e.g., eye gaze, gestures, vocalizations), social reciprocity, and peer acceptance Individualize AAC interventions based on child s communication needs and competencies Be choosy when selecting peer partners