Sunday, February 17, 2019

Pragmatic Language Skills and the Autism Spectrum


Pragmatic Language Skills

The diagnostic criteria for autism spectrum disorder (ASD) include persistent deficits in social communication and social interaction across multiple contexts. Problems with the pragmatic/social use of language or impairment in the ability to understand and use language in social-communicative contexts is a core feature of ASD. Pragmatic skills involve: (a) using language for different purposes; (b) changing language according to the needs of a listener or situation; (c) understanding non-literal language; and (d) following rules for conversations.  

There are many unwritten rules in society that govern our behavior. While most of us intuitively understand these rules, individuals with ASD have not automatically learned the conventions and nuances that make up their social environment. These unspoken or “hidden” social standards can make the world a confusing place and result in life-long challenges. For example, social expectations such as “it is not polite to interrupt others while they are talking,” “take turns in conversation” and “discuss other topics besides only those you are interested in” are not taught and are assumed to be known and understood. We seem to have an “unconscious” navigator that allows us to make intuitive sense of the unspoken rules in society and adjust to the social demands of our everyday lives.
Unspoken Rules

The unspoken rules of social engagement involve the use of the pragmatic, social communicative functions of language (e.g., turn taking, understanding of inferences and figurative expressions) as well as nonverbal skills needed to communicate and regulate interaction (e.g., eye contact, gesture, facial expression). This includes body language and idioms, metaphors, or slang – phrases and meanings that we intuitively assimilate or learn through observation or subtle cues. Individuals with ASD tend to interpret language literally and may be puzzled by the common everyday expressions used by a typical peer or adult. They may fail to use appropriate nonverbal communication skills, such as eye contact and have impairments in comprehension, or generally have difficulty communicating with others. As a result, peers often feel ineffective when engaged in social exchanges with a child on the autism spectrum and may avoid that person and/or react in a negative way (e.g., teasing or bullying), further impacting the development of appropriate social skills. 
Consider how idioms or figurative speech such as “how the cookie crumbles,” “curiosity killed the cat,” "kill two birds with one stone," "everything but the kitchen sink," and “when it rains, it pours” will have a totally different meaning and result in confusion if taken literally. In order to understand language, we must understand what the idioms in that language mean (there are well over 3,000 idioms in the English language). If you try to figure out the meaning of an idiom literally (word by word), you will be bewildered. While the typical individual might understand that the phrase “that’s the way the cookie crumbles,” and accompanying body language (e.g., voice, body) communicates to the listener that something unfortunate has happened, to someone with a pragmatic social-communication problem, this idiom will have a completely different meaning and be confusing.

Assessment

Because social communication deficits are among the core challenges of ASD, a best practice student assessment should include an evaluation of pragmatic competence and not be limited to the formal, structural aspects of language (i.e., articulation and receptive/ expressive language functioning). As a group, more capable students with ASD tend to demonstrate strength in formal language, but a weakness is pragmatic and social skills. As a result, they often fail to qualify for speech-language services because they present strong verbal skills and large vocabularies, and score well on formal language assessments. 
A variety of assessment strategies should be used, including direct assessment, naturalistic observation and interviewing significant others, including parents and educators, who are valuable sources of information. 

Assessments to identify pragmatic language deficits tend to be less well developed than tests of language fundamentals. There are fewer standard measures available to assess these skills in children with ASD. Valid norms for pragmatic development and objective criteria for pragmatic performance are also limited. Among the standardized instruments that focus on the social communicative functions of language are the Comprehensive Assessment of Spoken Language (CASL; Carrow-Woolfolk, 1999), Test of Pragmatic Language, 2nd Edition (TOPL-2; Phelps-Terasaki & Phelps-Gunn, 2007), Social Language Development Test-Elementary (SLDT-E; Bowers, Huisingh, & LoGiudice, 2008), Children's Communication Checklist, Second Edition (CCC-2; Bishop, 2006) and Pragmatic Language Skills Inventory (PLSI; Gilliam & Miller, 2006). 

It is imperative that speech/language services for children with ASD include particular attention to the pragmatic, social communicative functions of language (e.g., turn taking, understanding of inferences and figurative expressions) as well as to the nonverbal skills needed to communicate and regulate interaction (e.g., eye contact, gesture, facial expression, and body language). Significant and severe deficits in the ability to communicate and interact with others can limit participation in mainstream academic settings and community activities. Moreover, pragmatic deficits tend to become even more obvious and problematic as social and educational demands increase with age. Students with pragmatic language deficits who do not meet the DSM-5 ASD criteria for restricted, repetitive patterns of behavior should be evaluated for social (pragmatic) communication disorder (SCD).  

Adapted from Wilkinson, L. A. (2017). A best practice guide to assessment and intervention for autism spectrum disorder in schools. London and Philadelphia: Jessica Kingsley Publishers.

Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, chartered psychologist, and certified cognitive-behavioral therapist. He provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorders. Dr. Wilkinson is author of the award-winning books,  A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a best-selling text in the APA School Psychology Book Series,  Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

© 2017 Lee A. Wilkinson, PhD

Monday, February 11, 2019

Positive Behavior Support in the classroom for Learners on the Autism Spectrum


Positive Behavior Support for Students with Autism

The problem behaviors of children on the autism spectrum (ASD) are among the most challenging and stressful issues faced by schools and parents. The current best practice in treating and preventing undesirable or challenging behaviors utilizes the principles and practices of positive behavior support (PBS). PBS is not a specific intervention per se, but rather a set of research-based strategies that are intended to decrease problem behaviors by designing effective environments and teaching students appropriate social and communication skills. PBS utilizes primary (school-wide), secondary (targeted group), and tertiary (individual) levels or tiers of intervention, with each tier providing an increasing level of intensity and support. 
 PBS Strategies in the Classroom

Other than families, teachers are the most influential resource for students with and without special needs. Although functional behavior assessment (FBA) and intensive individual support is recommended for students with serious and persistent challenging behaviors, teachers may prevent the possibility of problematic behavior through the implementation of class-wide and targeted group PBS strategies. For example, effective prevention of challenging social behavior can be addressed through arranging the classroom environment and/or by adapting instruction and the curriculum. Changing the classroom environment or instruction may lessen the triggers or events that set off the challenging behavior. Teaching effective social interaction and communication as replacements for challenging behavior is also a preventive strategy for improving little used student social interaction and communication skills. Teachers can model, demonstrate, coach, or role-play the appropriate interaction skills. They can teach students to ask for help during difficult activities or negotiate alternative times to finish work. Encouraging positive social interactions such as conversational skills will help students with challenging behavior to effectively obtain positive peer attention. The following are examples of PBS strategies for improving social skills and prosocial behaviors in the classroom (Vaughn, Duchnowski, Sheffield, & Kutash, 2005; Wilkinson, 2016). 
Initiating interactions. Teachers might notice that when a student with ASD enters the classroom, group activity, or other social interaction, he or she may have particular difficulty greeting others students or starting a conversation. For example, they may joke, call another student a name, laugh, or say something inappropriate. In this situation, the student may have trouble ini­tiating interactions or conversations. The teacher might talk to the student individually and offer suggestions for ways he or she can provide an appropriate greeting or introduce a topic of conversation. The student might then be asked to practice or role-play the desired behavior.
Example: “why don’t you ask students what they did last night, tell them about a TV show you watched, or ask if they finished their homework, rather than shouting or saying ‘Hey, Stupid.’ Other students in the class want to be your friend, but you make it difficult for them to talk with you. Let’s practice the next time the class begins a new group activity.”
Maintaining interactions. Many students with ASD struggle to maintain a conversation (e.g.., turn taking). Some may dominate the conversation and make others feel that they have nothing to contribute, while other students may experience difficulty keeping up with the flow of conversation and asking questions. Students may also have lim­ited topics of interest and discuss these topics repetitively.
Example: “I’ve noticed that other students cannot share their thoughts and ideas with you when you start a conversation because you do all the talking. It may seem to them that you don’t care what they have to say. Other students will be more willing to talk if you stop once you’ve stated your idea or opinion and allow them a turn to talk. When you stop, they know you are listening. You can say to them, “What do you think?” or “Has this ever happened to you?’”
Terminating interactions. Some students with ASD may not know how to appropriately end a conversation. They may abruptly walk away, start talking with another student, or bluntly tell a student they don’t know what they’re talking about. Other students may interpret this as rude and impolite behavior. Teachers might point out to the student some ac­ceptable ways of ending a conversation.
Example: “You just walked away from that student when they were talking. Rather than walk away, you might say “‘I have to go now,’ ‘It’s time for my next class,’ ‘Or ‘I’ll see you later and we can finish our talk.’”
Recognizing body language. The recognition of body language or nonverbal cues is critical to suc­cessful social interactions. Students with ASD typically have difficulty interpreting these cues from teachers or other students. Body language tells students when they violate a person’s personal space, a person needs to leave, or they need to change behavior. Teachers can incorporate these skills into their class time or school day.
Example: Before leaving the classroom, demonstrate  nonverbal cues by holding a finger to your lips and telling students that means “quiet,” a hand held up with palm fac­ing outward means “wait” or “stop,” and both hands pushing downward means “slow down.” You may need to demonstrate facial expressions you use to “deliver messages” and what they mean. Other students can demonstrate nonverbal cues they use. When students move through the halls, you may want to teach them the “arms length” rule for personal space.
Transitions. Many students with ASD have significant problems changing from one activity to the next or moving from one location to another. They may be easily upset by abrupt changes in routine and unable to estimate how much time is left to finish an activity and begin the next one. Poor executive function skills such as disorganization may also prevent them from putting materials away from the last activity or getting ready for the next activity. They may also need closure and preparation time for the transition. Problems arise if the teacher tries to push them to transition at the last minute.
Example: About 10 minutes prior to the transition, refer to the classroom schedule and announce when the bell will ring or when the next activity will begin. Provide a 5-minute and then a 1-minute warning. This countdown helps students finish assignments or end favorite activities. For students that have difficulty getting started after a transition, place assign­ment folders on their desks so that they have their assignments and don’t have to wait for instructions or materials. They can use the same folder to submit assignments (the folders can be left on their desks at the end of the period).
Conclusion 
Students on the autism spectrum often lack the social skills to communicate and interact effectively with peers and adults. They may use challenging or disruptive behavior to communicate their needs. These examples illustrate how PBS provides a proactive framework for assessing social interaction and communication needs and for teaching new, effective skills that replace the challenging behavior. When used consistently, these strategies fit within the framework of the classroom and can help promote positive student behavior.

Key References and Further Reading 
Alberto, P., & Troutman, A. (2006). Applied behavior analysis for teachers (7th edition). New York, NY: Prentice-Hall.
Crone, D. A., Horner, R. H., & Hawken, L. S. (2004). Responding to problem behavior in schools: The behavior education program. New York: Guilford Press.
Crone, D. A., & Horner, R. H. (2003). Building positive behavior support systems in schools: Functional behavioral assessment. New York: Guilford.
Dunlap, G., Iovannone, R., Kincaid, D., Wilson, K., Christiansen, K., Strain, P., & English, C., (2010). Prevent-Teach-Reinforce: A school-based model of positive behavior support. Baltimore: Brookes.
Horner, R. H., Sugai, G., Todd, A. W., & Lewis-Palmer, T. (2005). School-wide positive behavior support. In L. Bambara & L. Kern (Eds.), Individualized supports for students with problem behaviors: Designing positive behavior plans (pp. 359-390). New York: Guilford Press.
Martella, R. C., Nelson, J. R., & Marchand-Martella, N. E. (2003). Managing disruptive behaviors in the schools: A schoolwide, classroom, and individualized social learning approach. Boston, MA: Allyn and Bacon, Inc.
OSEP Technical Assistance Center on Positive Behavioral Interventions and Supports. http://www.pbis.org/default.aspx 
Sprague, J. R., & Walker, H. M. (2005). Safe and healthy schools: Practical prevention strategies. New York, NY: Guilford.
Sprick, R.S., & Garrison, M. (2008). Interventions: Evidence-based behavioral strategies for individual students. Eugene, OR: Pacific Northwest Publishing.
Vaughn, B., Duchnowski, A., Sheffield, S., & Kutash, K., (2005). Positive behavior support: A classroom-wide approach to successful student achievement and interactions. Department of Child and Family Studies, Louis de la Parte Florida Mental Health Institute. Tampa, FL: University of South Florida.
Wilkinson, L. A. (2017). A best practice guide to assessment and intervention for autism spectrum disorder in schools. London: Jessica Kingsley Publishers.
Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, chartered psychologist, and certified cognitive-behavioral therapist. He provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorders. Dr. Wilkinson is author of the award-winning books,  A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a best-selling text in the APA School Psychology Book Series,  Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

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