Best Practices in the Evaluation of Autism Spectrum Disorders (Ages 0-3) WEBINAR

Date: Tuesday, April 26, 2011
Time: 3:00–4:30PM Eastern
Presenter: Amy Dilworth Gabel, PhD

Register here: https://cc.readytalk.com/cc/schedule/display.do?udc=an9g1u3nst4k
Putting together an appropriate battery to assess infants and toddlers with suspected Autism Spectrum Disorders can be challenging. Early intervention for children with Autism Spectrum Disorders leads to better outcomes. Good assessment data helps to promote effective intervention. During this session we will review some of the best practices as you consider which types of measures could be used to answer specific referral questions.

Amy Dilworth Gabel, PhD, is the Training and Client Consultation Director with Pearson Clinical Assessment. She earned her PhD and MS in school psychology from the Pennsylvania State University. Her undergraduate training is in psychology and elementary education from Gettysburg College. As a licensed school psychologist in Virginia, her specialty is the comprehensive evaluation of preschool and school-aged students.
Prior to joining PsychCorp, Dr. Gabel worked in the Fairfax County Public School system in Virginia. In Fairfax, she served in positions as a school psychologist, special education administrator, and due process specialist. She has provided training workshops on a wide range of topics, including linking assessments to effective teaching, AD/HD, reading disorders/literacy, executive function disorders, and a variety of assessment and intervention methodologies.

April is Autism Awareness Month

The United Nations declared the first official World Autism Awareness Day on April 2, 2008.

Since that time, April 2 has been the designated day to highlight the need to help improve the lives of children and adults who suffer from the disorder.

The State of Qatar and Autism Speaks spearheaded World Autism Awareness


10 ways to honor Autism Awareness Month
Posted by
Kathie Harrington, MA, CCC-SLP
Occupation: SLP, author, speaker, mother of a son with autism.
Setting: Las Vegas, NV

1.Brainstorm with other SLPs about one child in particular, not at school or in the clinic, but over a cup of coffee or a soda.

2.Find a new app on your iPad or iPhone that you can use with a client with ASD.

3.Take a client with ASD on a field trip and explore a new environment together.

4.Find three new motivators to use with students with ASD. I scavenger around in dollar stores myself.

5.Make a bulletin board for your room/office that announces April as Autism Awareness Month.

6.Call one or all of your clients with ASD on the telephone and have a conversation. I would suggest telling them ahead of time that you will call them tonight to talk about ___________.

7.Turn on some soft music, sit back for 10 minutes, close your eyes, and allow your mind to drift into the world of a person with autism. They are sensory people, so you must see, hear, feel, smell, and perceive the world as they would.

8.If you team in a school/clinic with teachers, PTs or OTs, call a 15-minute "Autism Awareness Chat." Hey, buy a dozen cookies and make it a friendly, mind-freeing experience for everyone. Fifteen minutes may lead to more, and a chat in April may lead to one in May and June.

9.Invite the parents/caregivers of your clients with ASD into the therapy setting. Demonstrate strategies and pick one or two that you want the parent to carry over in the home environment.

10.Number 10 is probably the most important of all: read something new about autism, such as a story, poem, research, therapy strategy, etc, etc. Always be informed because as SLPs we are #2 in line to help children/adults with ASD. Who is #1? You tell me.
"Speech pathologists make good things happen."

Early Signs of Autism

ADVANCE Magazine
By Jason Mosheim

The barriers to diagnosing autism before age 2 threaten to keep children from receiving early intervention. However, now that clinicians are beginning to understand what to look for-and when-those barriers may crumble sooner rather than later.
Until the last few years, professionals didn't know what to look for in children who were only 9, 12 or 15 months old. They are gaining ground in this area, but the typical age for diagnosis remains between 2 and 3 and sometimes 4.
Clinicians may hesitate to make an early diagnosis or mention red flags to parents because of the variability in early child development. Although children may appear to have early delays, some will improve and go on to develop normally while others may fail to make gains or even regress. "You might see a 12-month-old and think everything's going great, but then things begin to look worse over the next six to eight months," said Elizabeth Crais, PhD, CCC-SLP, a professor at University of North Carolina-Chapel Hill.
One way to see what children with autism look like prior to a diagnosis is through the use of retrospective video analysis. When children are diagnosed, Dr. Crais and colleagues Grace Baranek, PhD, OTR/L; Linda Watson, EdD, CCC-SLP; and Steve Reznick, PhD, director of the Program in Developmental Psychology, ask parents to provide home videos of their children made before the diagnosis in order to review early behaviors. Currently, they are looking at videos of children in two age groups: 9-12 months and 15-18 months.
"If we can get videotapes of the kids between 9 and 12 or 15 and 18 months, it allows us to see them potentially before anybody has a suspicion and look at their characteristics or behaviors," Dr. Crais said. "Some children begin to look worse as time goes on."
According to the literature, repetitive and stereotypical behaviors appear later in development, but they can appear early on in some children. These children may turn to repetitive behaviors as a way to engage themselves because of a significant deficit in their social skills.
"We are trying to identify children early so we can prevent some of the repetitive behaviors," Dr. Crais told ADVANCE. "Opening up their social world at an early age also allows them to take advantage of all the social and? play interactions that come afterwards."
Many children also engage in sensory-seeking behaviors, she said. "We look for things like pushing themselves against you or demonstrating atypical behaviors with their hands, bodies and eyes."
Her team also looks at broad communication skills like eye gaze and vocalizations.
Videos contribute to the study of gesture development, she noted. "We look at the early gestures that kids produce or ones they don't produce. There are patterns of gesture use even at these early ages. For example, categories such as joint attention have fewer gestures. A pattern of use begins to exemplify kids even in the 9- to 12-month range."
One interesting finding, she reported, is that "gestures, or lack of them, in the 9- to 12-month range are highly predictive of later language skills at ages 3 and 4. That's pretty powerful." As a result, researchers now are paying more attention to gestures, specifically joint attention behaviors of showing, giving and pointing. Dr. Crais has seen many 2-year-olds over the years who aren't talking but are gesturing, smiling, and using other ways to communicate. In many cases these children are late talkers who probably will catch up with their typically developing peers.
"If one 2-year-old gestures, communicates, vocalizes, looks at you, and understands much of what you say and another has limited or no gestures, few vocalizations and limited comprehension, the one that has all these means of communicating is probably going to be more successful. The other child likely will continue to have language problems," she said.
Gestures can be a powerful, discriminating set of behaviors that can help clinicians decide if they need to see children in intervention or can wait, monitor them, and let them mature.
In joint attention behaviors an individual attempts to direct a person's attention to something. For example, a parent points out an airplane to a child; a child shows an object to someone; or a child gives a rattle to an adult, wants it back, and repeats the interaction. "Many little children who have something in their hand want to show it to you and will look at you to make sure you're seeing it, too, and enjoying it with them," said Dr. Crais. "Little kids with autism are less likely to engage in some of these social behaviors that represent joint attention."
The most well-known gesture is pointing. Typical children point to things with the intent of sharing the experience with someone else. Children with autism often use behavior regulation acts to try to get a person to do or not do something. "Even very young children with autism focus on those kinds of behaviors. They grab your hand to get something or take your hand and guide you to the refrigerator to get you to open the door," said Dr. Crais. There are fewer joint attention acts and less variation in social interactions but not a total absence of either type, the researchers have found.
What makes it difficult to identify some children with autism earlier is that they may participate with others in games like peek-a-boo and communicate by smiling, laughing and looking when they are younger.
"If I raise the possibility of autism, some parents say, 'But he smiles, laughs, plays with us, and looks at us.' The notion that these children don't smile, laugh, or socially interact is incorrect," said Dr. Crais. "Some are very hard to reach, but even they have times where they can be reachable. The public has the idea that these children aren't social, and that's not the case in a number of situations."
At 12 months children should be demonstrating some behavior regulation, social interaction and joint attention acts. At 15 to 18 months, they should have a variety of behaviors in each area as they begin using words. "Words are coming in and begin to replace gestures," said Dr. Crais, "but there's a period of time where words and gestures are both used. The child will point and say 'airplane.' As words become more powerful and prominent to them, gestures begin to slide away."
Another important early behavior is play. The four common levels of play are exploratory, relational, functional and symbolic. Children with autism have an easier time with exploratory and relational play. They begin to falter when they encounter functional play, which is built on relational play. At this stage, for example, children put things together or line up blocks. In order to move on to functional play, they need to have a good sense of what other people are doing.
"Some activities require children to look around, see what everybody else is doing, and repeat the behaviors," she said. "Kids with autism traditionally are not that aware of peers around them and therefore don't learn ways to play functionally with toys."
Symbolic play also can be difficult for this population. "A child who blows on an empty cup and says 'hot!' is pretending to have a hot drink. Or they put scraps of paper on a plate and say, 'Do you want some chips?' They're symbolizing that something is there," explained Dr. Crais. "Those are very hard skills for children with autism. Many researchers feel the cause is a lack of social interaction."
Research has demonstrated that the development of play and language skills runs parallel at some point, she said. "We can look at both sets of behaviors and say, 'How is this child doing in both domains, and can we use that?' If their play is good but their language is poor, can we use play to enhance their language, or vice versa?"
Dr. Crais and her colleagues are conducting an intervention study using a parent report tool they developed.1If parents score their child high on the First Year Inventory (FYI), indicating many risk factors for a possible autism diagnosis, the researchers test the child. Those children who appear to have symptoms characteristic of autism are placed in a randomized control treatment trial, where they receive project-specific intervention or are referred for community services.
"Only a few children have finished the study, but already we're seeing really nice changes," Dr. Crais said.
A number of sources have identified effective components of intervention for children with autism.2Among the most important are enrolling them in intervention as early as possible and actively engaging them in intensive instructional programming for at least 25 hours. Also key is building spontaneous functional communication, as well as the amount of time spent in speech and language intervention.3-5"It's a pat on our backs to say that it's critical for children to get into speech-language therapy so they can begin to enhance their communication and social skills," she said. "It's affirming for us as speech-language pathologists to see that."
All children should receive a 12-month well baby check-up, which is a perfect time to begin looking at behavior, Dr. Crais said. The American Academy of Pediatrics recommends all children be screened for autism twice by age 2-at 18 and 24 months.6"We would like to see a tool like ours used even earlier, at 12 months, to see if there are any signs that might be a concern," she said. "Ultimately, we would like to get early identification down to 12, 15 or 18 months because these are critical periods for some children."
References
1. Baranek, G., Watson, L., Crais, E., et al. (2003). First-Year Inventory (FYI). Unpublished manuscript. University of North Carolina-Chapel Hill.
2. National Research Council. (2001). Educating Children with Autism. Washington, DC: National Academy Press.
3. Rogers, S. (1998). Empirically supported comprehensive treatments for young children with autism. Journal of Clinical Child Psychology, 27 (2): 168-79.
4. Rogers, S., Vismara, L. (2008). Evidence-based comprehensive treatments for early autism. Journal of Clinical Child & Adolescent Psychology, 37 (1): 8-38.
5. Turner, L., Stone, W., Podzol, S., et al. (2006). Follow-up of children with ?autism spectrum disorders from age 2 to age 9. Autism, 10 (3): 245-65.
6 Plauche Johnson, C., Myers, S.M., et al. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120 (5): 1183-1215.
For More Information
•???Elizabeth Crais, PhD, bcrais@med.unc.edu
Jason Mosheim is a Senior Associate Editor at ADVANCE. He can be contacted at jmosheim@advanceweb.com.

Early Signs of Autism

ADVANCE Magazine
By Jason Mosheim

The barriers to diagnosing autism before age 2 threaten to keep children from receiving early intervention. However, now that clinicians are beginning to understand what to look for-and when-those barriers may crumble sooner rather than later.
Until the last few years, professionals didn't know what to look for in children who were only 9, 12 or 15 months old. They are gaining ground in this area, but the typical age for diagnosis remains between 2 and 3 and sometimes 4.
Clinicians may hesitate to make an early diagnosis or mention red flags to parents because of the variability in early child development. Although children may appear to have early delays, some will improve and go on to develop normally while others may fail to make gains or even regress. "You might see a 12-month-old and think everything's going great, but then things begin to look worse over the next six to eight months," said Elizabeth Crais, PhD, CCC-SLP, a professor at University of North Carolina-Chapel Hill.
One way to see what children with autism look like prior to a diagnosis is through the use of retrospective video analysis. When children are diagnosed, Dr. Crais and colleagues Grace Baranek, PhD, OTR/L; Linda Watson, EdD, CCC-SLP; and Steve Reznick, PhD, director of the Program in Developmental Psychology, ask parents to provide home videos of their children made before the diagnosis in order to review early behaviors. Currently, they are looking at videos of children in two age groups: 9-12 months and 15-18 months.
"If we can get videotapes of the kids between 9 and 12 or 15 and 18 months, it allows us to see them potentially before anybody has a suspicion and look at their characteristics or behaviors," Dr. Crais said. "Some children begin to look worse as time goes on."
According to the literature, repetitive and stereotypical behaviors appear later in development, but they can appear early on in some children. These children may turn to repetitive behaviors as a way to engage themselves because of a significant deficit in their social skills.
"We are trying to identify children early so we can prevent some of the repetitive behaviors," Dr. Crais told ADVANCE. "Opening up their social world at an early age also allows them to take advantage of all the social and? play interactions that come afterwards."
Many children also engage in sensory-seeking behaviors, she said. "We look for things like pushing themselves against you or demonstrating atypical behaviors with their hands, bodies and eyes."
Her team also looks at broad communication skills like eye gaze and vocalizations.
Videos contribute to the study of gesture development, she noted. "We look at the early gestures that kids produce or ones they don't produce. There are patterns of gesture use even at these early ages. For example, categories such as joint attention have fewer gestures. A pattern of use begins to exemplify kids even in the 9- to 12-month range."
One interesting finding, she reported, is that "gestures, or lack of them, in the 9- to 12-month range are highly predictive of later language skills at ages 3 and 4. That's pretty powerful." As a result, researchers now are paying more attention to gestures, specifically joint attention behaviors of showing, giving and pointing. Dr. Crais has seen many 2-year-olds over the years who aren't talking but are gesturing, smiling, and using other ways to communicate. In many cases these children are late talkers who probably will catch up with their typically developing peers.
"If one 2-year-old gestures, communicates, vocalizes, looks at you, and understands much of what you say and another has limited or no gestures, few vocalizations and limited comprehension, the one that has all these means of communicating is probably going to be more successful. The other child likely will continue to have language problems," she said.
Gestures can be a powerful, discriminating set of behaviors that can help clinicians decide if they need to see children in intervention or can wait, monitor them, and let them mature.
In joint attention behaviors an individual attempts to direct a person's attention to something. For example, a parent points out an airplane to a child; a child shows an object to someone; or a child gives a rattle to an adult, wants it back, and repeats the interaction. "Many little children who have something in their hand want to show it to you and will look at you to make sure you're seeing it, too, and enjoying it with them," said Dr. Crais. "Little kids with autism are less likely to engage in some of these social behaviors that represent joint attention."
The most well-known gesture is pointing. Typical children point to things with the intent of sharing the experience with someone else. Children with autism often use behavior regulation acts to try to get a person to do or not do something. "Even very young children with autism focus on those kinds of behaviors. They grab your hand to get something or take your hand and guide you to the refrigerator to get you to open the door," said Dr. Crais. There are fewer joint attention acts and less variation in social interactions but not a total absence of either type, the researchers have found.
What makes it difficult to identify some children with autism earlier is that they may participate with others in games like peek-a-boo and communicate by smiling, laughing and looking when they are younger.
"If I raise the possibility of autism, some parents say, 'But he smiles, laughs, plays with us, and looks at us.' The notion that these children don't smile, laugh, or socially interact is incorrect," said Dr. Crais. "Some are very hard to reach, but even they have times where they can be reachable. The public has the idea that these children aren't social, and that's not the case in a number of situations."
At 12 months children should be demonstrating some behavior regulation, social interaction and joint attention acts. At 15 to 18 months, they should have a variety of behaviors in each area as they begin using words. "Words are coming in and begin to replace gestures," said Dr. Crais, "but there's a period of time where words and gestures are both used. The child will point and say 'airplane.' As words become more powerful and prominent to them, gestures begin to slide away."
Another important early behavior is play. The four common levels of play are exploratory, relational, functional and symbolic. Children with autism have an easier time with exploratory and relational play. They begin to falter when they encounter functional play, which is built on relational play. At this stage, for example, children put things together or line up blocks. In order to move on to functional play, they need to have a good sense of what other people are doing.
"Some activities require children to look around, see what everybody else is doing, and repeat the behaviors," she said. "Kids with autism traditionally are not that aware of peers around them and therefore don't learn ways to play functionally with toys."
Symbolic play also can be difficult for this population. "A child who blows on an empty cup and says 'hot!' is pretending to have a hot drink. Or they put scraps of paper on a plate and say, 'Do you want some chips?' They're symbolizing that something is there," explained Dr. Crais. "Those are very hard skills for children with autism. Many researchers feel the cause is a lack of social interaction."
Research has demonstrated that the development of play and language skills runs parallel at some point, she said. "We can look at both sets of behaviors and say, 'How is this child doing in both domains, and can we use that?' If their play is good but their language is poor, can we use play to enhance their language, or vice versa?"
Dr. Crais and her colleagues are conducting an intervention study using a parent report tool they developed.1If parents score their child high on the First Year Inventory (FYI), indicating many risk factors for a possible autism diagnosis, the researchers test the child. Those children who appear to have symptoms characteristic of autism are placed in a randomized control treatment trial, where they receive project-specific intervention or are referred for community services.
"Only a few children have finished the study, but already we're seeing really nice changes," Dr. Crais said.
A number of sources have identified effective components of intervention for children with autism.2Among the most important are enrolling them in intervention as early as possible and actively engaging them in intensive instructional programming for at least 25 hours. Also key is building spontaneous functional communication, as well as the amount of time spent in speech and language intervention.3-5"It's a pat on our backs to say that it's critical for children to get into speech-language therapy so they can begin to enhance their communication and social skills," she said. "It's affirming for us as speech-language pathologists to see that."
All children should receive a 12-month well baby check-up, which is a perfect time to begin looking at behavior, Dr. Crais said. The American Academy of Pediatrics recommends all children be screened for autism twice by age 2-at 18 and 24 months.6"We would like to see a tool like ours used even earlier, at 12 months, to see if there are any signs that might be a concern," she said. "Ultimately, we would like to get early identification down to 12, 15 or 18 months because these are critical periods for some children."
References
1. Baranek, G., Watson, L., Crais, E., et al. (2003). First-Year Inventory (FYI). Unpublished manuscript. University of North Carolina-Chapel Hill.
2. National Research Council. (2001). Educating Children with Autism. Washington, DC: National Academy Press.
3. Rogers, S. (1998). Empirically supported comprehensive treatments for young children with autism. Journal of Clinical Child Psychology, 27 (2): 168-79.
4. Rogers, S., Vismara, L. (2008). Evidence-based comprehensive treatments for early autism. Journal of Clinical Child & Adolescent Psychology, 37 (1): 8-38.
5. Turner, L., Stone, W., Podzol, S., et al. (2006). Follow-up of children with ?autism spectrum disorders from age 2 to age 9. Autism, 10 (3): 245-65.
6 Plauche Johnson, C., Myers, S.M., et al. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120 (5): 1183-1215.
For More Information
•???Elizabeth Crais, PhD, bcrais@med.unc.edu
Jason Mosheim is a Senior Associate Editor at ADVANCE. He can be contacted at jmosheim@advanceweb.com.

May is better Hearing and Speech Month

This annual event provides opportunities to raise awareness about communication disorders and to promote treatment that can improve the quality of life for those who experience problems with speaking, understanding, or hearing. ASHA have many resources to help you celebrate BHSM every day.


Even though this is mainly celebrated in large scale in the U.S, what can we in Europe doing to raise awareness among professionals, parents and schools.

Being in the Netherlands, with a wide population of expats, families find it difficult to find a native speaking English Speech therapist for their child. Parents feel helpless and not being able to provide help for their child.

Online Speech Therapy can be the answer.Your child can continue to receive Speech Therapy from the same therapist from back home, or find other English speaking therapists in the country. Being in the comforts of your home(both you and the child) with games to practice on their own, TinyEYE Speech Therapy Services opens a whole new magical world for you and your child.

TinyEYE has goal focussed games and you as the therapist is able to provide structured therapy, while the child plays and has fun. A tinyEYE session is usually 20 minutes filled with adventure going to Mars and swimming under water.The fun and excitement is new everytime!

Reconnect

Its been a long time.. so I wish to reconnect!
Whats been happening in the last year?
1.Our second son was born.
2. We kick started TinyEYE Netherlands and started training Dutch speech therapists to use TinyEYE
3. More clients at the Higher secondary and primary international school.
4. I joined a EAL course at the International school with the teachers.

Well, thats what has been happening and its only getting more exciting and busier.
Stay tuned for some new articles and information.

Play in Autism To improve social interaction and comprehension.

Advance for Speech and Language
By Jason Mosheim
Posted on: July 19, 2010

Restricted play skills are one of the hallmarks of autism. Among the handful of reasons that children on the spectrum have trouble branching out in their play is that many lack ideation, which is necessary for understanding how to interact with new objects.

"Many kids with autism reject novelty," said Lisa Audet, PhD, CCC-SLP, assistant professor in the Department of Speech Pathology and Audiology at Kent State University in Kent, OH. "When something is new and they don't have a mental template or schema in their heads for how to engage with the object, they reject it." They prefer to play with only a handful of predictable items.

"Limited ideation results in them doing 'same old'-playing with the same thing all the time," she told ADVANCE. Comfortably stuck in one mode, they don't accumulate a well-rounded knowledge of basic concepts over time.

Many children with autism have motor planning deficits. They have difficulty using their hands to operate and explore toys in a way that most parents expect.

One boy who lacked fine motor skills and had difficulty using his fingers to operate cause-and-effect toys, like a See 'n Say®, only wanted to dump and throw objects, Dr. Audet recalled. His play skills did not evolve much beyond those motions because he didn't have good hand use. "As he got older, it looked more aberrant because you have a 10-year-old who's dumping and throwing like a 2-year-old," she said.

Older children with autism often display play skills that are similar to those of much younger, typically developing children. For example, 18-month-olds often derive great pleasure from filling containers or rolling a ball. Older children whose play skills closely match this age group may have language skills at about the same level.

Restrictive play also could be caused by anxiety. Children with autism often feel uneasy when they are presented with novel objects because they are forced out of their comfort zone. "They play with particular objects as a way of calming themselves, to self-regulate," Dr. Audet said. "Kids with limited ideation don't move to pretend play, where it becomes symbolic, and that parallels the absence of language, which is also a symbolic act."

Many children with autism also have trouble with turn-taking. The two types of reciprocal interactions to be on the look-out for are dyadic, between two people, and triadic, which involve two people and an object. Adults can teach dyadic interactions by singing a song that contains gaps for the child to fill with lyrics or sounds.

"We use strategic wait time and a lot of rhythmic information and melodic intonation to create predictability, which can be helpful in getting reciprocity around something dyadic," said Dr. Audet.

When children are engaged in sensorimotor activities that provide them with movement, such as bouncing or swinging, speech-language pathologists can seize the opportunity to assist them in maintaining the dyadic interaction and reinforce the predictability of a routine.

Only when a child is able to engage in one-on-one joint interactions can clinicians begin to facilitate triadic interactions. Unfortunately, many clinicians start with the triadic events when attempting to increase joint attention and reciprocity. "The triadic interaction can be difficult for kids with autism," she said, "yet so often we start there, especially if the child is older, and doesn't yet understand reciprocity."

To qualify for kindergarten, children need to be able to occupy themselves with a solitary, adaptive activity for at least seven minutes. When working with a child prior to school enrollment, speech-language pathologists and parents must keep this in mind in addition to other social aspects of play, including parallel play, trading and sharing, and cooperative play.

"If we're working on parallel play, we know that imitation is difficult for kids with autism," said Dr. Audet. One way to facilitate imitation is to imitate a child's natural play behavior. For example, a speech-language pathologist can join a child in the activity of filling and dumping when trying to introduce a new tool.

"If a child is putting corn in a bucket and then dumping it, we begin to model so he knows he has a partner," she explained. "In addition to imitating, we work on parallel play by modeling with our own shovel. We then offer the shovel to the child and wait expectantly. The child may pick up the shovel and imitate us. If they don't, we continue to present an exaggerated model of the behavior and continue to present the shovel to the child."

The speech-language pathologist is building on the natural play of filling and dumping and modeling the next level of play.

The first cooperative play skill to teach is sharing. The child has to relinquish control of an object, probably a highly preferred one.

Most children learn to trade before they learn to share. This is important to keep in mind when working with children with autism because they must never be left without anything to keep them occupied as they wait for their play partner to return a toy. Otherwise, they are likely to succumb to frustration and act out.

Clinicians can teach trading by having children play with cause-and-effect toys such as cars or tops. "Give the kids different ones so they trade," she said. "They will get something similar but not exactly the same. Trading becomes important as a steppingstone to learning how to share."

Speech-language pathologists should be supportive so children will request help when needed. Nonverbal cues are a good place to start in providing children with the means to ask for help. Don't rush in to provide assistance whenever a problem arises, however. "Provide a mechanism for them to ask for help, whether it's a picture icon, a voice-output device, a hand-over-hand movement or signing," she said. "We let them know before they get too frustrated with an event that we're there to help. It's really important to read the nonverbal cues that are really subtle."

To spark spontaneous language in children with autism, speech-language pathologists can tap into their knowledge of normal childhood development. For example, typically developing children begin to speak in two-word combinations when they have approximately 75 words in their repertoire. Before attempting to elicit spontaneous speech and to get a sense of what expectations to set, clinicians need to ask themselves how many words are in the child's repertoire, if they are spontaneous words, and whether the words are approximations, imitative or echolalic.

Clinicians often advance too far ahead in treatment. "If children have 25 words in their repertoire and are echolalic, using a five-word sentence like 'I want more cookie, please' is a big jump if we expect that utterance to have true linguistic meaning," said Dr. Audet.

After determining the level of spontaneous language, speech-language pathologists can start building single-word vocabulary to help children reach the 75-word mark. "Begin to work on semantic relations, then reinforce those two-word combinations. When the child says, 'My cookie,' we say, 'Yes, Jimmy's cookie,' versus 'Tell me, 'I want more cookie, please,' and jumping to that rote utterance, which the child is going to comply with if he is echolalic," she said. "We sabotage ourselves if we reinforce echolalia vs. spontaneous language."

A child may need some echolalic chunks to ask for help, protest, or engage in adaptive behaviors, but that's only one prong, Dr. Audet said. The other prong is building up spontaneous vocabulary by reinforcing the use of single words and two-word combinations without making the child produce a complete sentence. "That's like a three-year developmental leap for a child who has a disability," she said. "We wouldn't expect that from a typically developing child."



For More Information

*
Lisa Audet, PhD, laudet@kent.edu

Jason Mosheim is a Senior Associate Editor for ADVANCE. He can be contacted at jmosheim@advanceweb.com.