Wednesday, June 12, 2019

Assistive Technology (AT) for Students with Autism

Assistive Technology
Assistive technology (AT) refers to a number of accommodations and adaptations which enable individuals with disabilities to function more independently. This includes any type of technology that provides students with disabilities greater access to the general education curriculum and increases the potential to master academic content, interact with others, and enhance functional independence and quality of life. While AT is not necessary or required for every student receiving special education services, schools are required to provide the appropriate assistive technology system when it supports the child’s access to a free and appropriate public education (FAPE). There are various types of technology ranging from "low" to "high" tech that might be incorporated into the educational setting to increase children’s independent functioning skills and reduce barriers that may prevent them from performing at a similar level as their peers. For example, students may use software with word prediction capabilities that allow them to have more success with written composition. Hardware such as portable keyboards, laptop computers, and tablets may lessen the physical demand of writing for students with weak fine motor skills or difficulty coordinating ideas with writing. Similarly, a speech-generating device or voice output communication aids may meet the needs of children with limited expressive language, by providing an effective means of verbal communication.
 Augmentative and Alternative Communication (AAC)
 Communication impairments can impact an individual’s ability to communicate with others (expressive communication) and/or receive communication from others (receptive communication). Augmentative and Alternative Communication (AAC) is a type of assistive technology that can help assist children with communication impairments to increase skills in this area and to become more competent communicators. Some autistic students who have difficulty with expressive communication may be successful in social interaction and expressing their wants and needs with a low technology AAC system such as the Picture Exchange Communication System (PECS©). PECS is considered an evidence-based practice that incorporates both behavioral and developmental-pragmatic principles to teach functional communication to children with limited verbal and/or communication skills. There are six phases of PECS instruction, with each phase building on the last. The phases are: (1) Teaching the physically assisted exchange, (2) Expanding spontaneity, (3) Simultaneous discrimination of pictures, (4) Building sentence structure, (5) Responding to, “What do you want?” and (6) Commenting in response to a question. PECS relies on the principles of applied behavior analysis (ABA) so that distinct prompting, reinforcement, and error correction strategies are specified at each training phase in order to teach spontaneous, functional communication. The research evidence suggests that PECS can be used in multiple settings, including schools, homes, and therapy settings to successfully improve functional communication, play, and behavioral skills.
It is important for educational teams to consider AAC for any student with autism. For some autistic students, AAC may act as the primary mode of communication. For others, it may be a secondary form. A referral to an assistive technology specialist or speech-language pathologist for an evaluation should be made for a student who may benefit from assistive technology and/or an augmentative communication system. As with all assessment and intervention procedures, a team approach is necessary to determine the child’s strengths and limitations, and the range and scope of potential assistive technology options to address their specific needs.
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.
Key References and Further Reading
Charlop-Christy, M. H., Carpenter, M., H., LeBlanc, L. A., & Kellet, K. (2002). Using the Picture Exchange Communication System (PECS) with children with autism: Assessment of PECS acquisition, speech, social-communicative behavior, and problem behavior. Journal of Applied Behavior Analysis, 35, 213–231.
Frost, L., & Bondy, A. (2002). The Picture Exchange Communication System Training Manual (2nd ed.). Cherry Hill, NJ: Pyramid Educational Consultants.
Ganz, J. B., Davis, J. L., Lund, E. M., Goodwyn, F. D., & Simpson, R. L. (2012). Meta-analysis of PECS with individuals with ASD: Investigation of targeted versus non-targeted outcomes, participant characteristics, and implementation phase. Research in Developmental Disorders, 33, 406-418. doi:10.1016/j.ridd.2011.09.023.
Hart, S. L., & Banda, D. R. (2010). Picture Exchange Communication System with individuals with developmental disabilities: A meta-analysis of single subject studies. Remedial and Special Education, 31, 476-488. doi: 10.1177/0741932509338354.
Individuals with Disabilities Education Improvement Act of 2004. Pub. L. No. 108-446, 108th Congress, 2nd Session. (2004).
Kabot, S., & Reeve, C. (2014). Curriculum and Program Structure. In L. A. Wilkinson (Ed.), Autism spectrum disorder in children and adolescents:  Evidence-based assessment and intervention in schools (pp. 195-218). Washington, DC: American Psychological Association.
National Autism Center (2015). Findings and conclusions: National standards project, phase 2. Randolph, MA: Author. Available from: http://www.nationalautismcenter.org/national-standards-project/phase-2/
Sulzer-Azaroff, B., Hoffman, A. O., Horton, C. B., Bondy, A., & Frost, L. (2009).
The Picture Exchange Communication System (PECS): What do the data say? Focus on Autism and Other Developmental Disabilities, 24, 89-103.
Twachtman-Cullen, D. & Twachtman-Bassett, J. (2014). Language and Social Communication. In L. A. Wilkinson (Ed.). Autism spectrum disorder in children and adolescents:  Evidence-based assessment and intervention in schools (pp. 101-124). Washington, DC: American Psychological Association.
Wilkinson, L. A. (Ed.) (2014). Autism spectrum disorder in children and adolescents: Evidence-based assessment and intervention in schools. Washington, DC: American Psychological Association.
Wilkinson, L. A. (2014). Introduction: Evidence-Based Practice for Autism Spectrum Disorder. In L. A. Wilkinson (Ed.). Autism spectrum disorder in children and adolescents: Evidence-based assessment and intervention in schools (pp 3-13). Washington, DC: American Psychological Association.
Wilkinson, L. A. (2017). Best Practice in Special Education. In A best practice guide to assessment and intervention for autism spectrum disorder in schools (pp. 157-200). London & Philadelphia: Jessica Kingsley Publishers.
Wilkinson, L. A. (2017). A best practice guide to assessment and intervention for autism spectrum disorder in schools. London & Philadelphia: Jessica Kingsley Publishers.
Wong, C., Odom, S. L., Hume, K. A., Cox, C. W., Fettig, A., Kurcharczyk…Schultz, T. R. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45, 1951-66. doi: 10.1007/s10803-014-2351-z
Lee A. Wilkinson, PhD, is a nationally certified and licensed 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. 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 CBT. He 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).

Saturday, June 1, 2019

Affective and Cognitive Empathy in Autism


Affective and Cognitive Empathy in Autism

One of the most common myths about autistic individuals is that they don’t feel empathy towards others. There are two interrelated types of empathy: affective or emotional empathy, which involves feeling an appropriate emotional response to another person’s emotion, and cognitive empathy, or Theory of Mind (ToM), which involves understanding or predicting another person’s perspective. The affective component of empathizing involves feeling an appropriate emotion triggered by seeing/learning of another’s emotion. When engaged in affective empathy, we vicariously experience the emotional states of others, understanding that our feelings are not ours, but rather those of the other person. Sympathy is also considered an affective component of empathy. It is the feeling or emotion triggered by seeing or learning of someone else’s distress which moves you to want to take an action that will help ease their suffering.

The cognitive or ToM component of empathy involves the understanding and/or predicting what someone else might think, feel, or do. It is the ability to identify cues that indicate the thoughts and feelings of others and “to put oneself into another person’s shoes.” It is also referred to as “mentalizing,” “mindreading,” and “perspective taking.” The ability to reflect on one’s own and other people’s minds (beliefs, desires, intentions, imagination and emotions) allows us to interact effectively with others in the social world. ToM may also be thought of existing on a continuum with some individuals able to “mindread” relatively easily and intuitively, while others experience varying degrees of problems interpreting and predicting another person’s behavior. Most (but not all) typical individuals are able to mindread relatively easily and intuitively. They can read another person’s facial expression and body language, and tone of voice and recognize his or her thoughts and feelings, and the likely course of their behavior. In other words, they interpret, predict, and participate in social interaction automatically, and for the most part, intuitively. Often referred to as "mindblindness," it is this cognitive component of empathy that is delayed in autism.
Unfortunately, the failure to understand the difference between affective empathy and cognitive empathy has led to a persistent myth and stereotype that people with autism are individuals who lack empathy and cannot understand emotion. It’s critically important to recognize that autism is characterized by challenges associated with cognitive empathy (ToM), not emotional empathy which is intact. Although autistic individuals may have difficulty with social cues and understanding and predicting another’s thoughts, motives and intentions, they have the ability to care and be concerned about other people’s feelings. Autism does not deprive someone of emotional empathy! Autistic people can and do experience feelings and emotions intensely as everyone else, even though it may not always be obvious to others in a "typical" way. 
Key References and Further Reading
Baron-Cohen, S. (1991). The theory of mind deficit in autism: how specific is it? British Journal of Developmental Psychology, 9. 301-314.
Baron-Cohen, S., Jolliffe, T., Mortimore, C., & Robertson, M. (1997). Another advanced test of theory of mind: evidence from very high functioning adults with autism or Asperger Syndrome. Journal of Child Psychology and Psychiatry, 38. 813-822.
Baron-Cohen, S., Ring, H. A., Bullmore, E. T., Wheelwright, S., Ashwin, C., & Williams, S. C. R. (2000). The amygdala theory of autism. Neuroscience & Biobehavioral Reviews, 24(3), 355-364.
Baron-Cohen, S., & Swettenham, J. (1997). Theory of mind in autism: Its relationship to executive function and central coherence. Handbook of autism and pervasive developmental disorders, 880-893.
Baron-Cohen, S. (2000). Theory of mind in autism: A fifteen year review. In S. Baron-Cohen, H. TagerFlusberg, & D. J. Cohen (Eds.), Understanding other minds: Perspectives from developmental cognitive neuroscience (pp. 3–20). New York: Oxford University Press
Fletcher-Watson, S, McConnell, F, Manola, E & McConachie, H 2014, 'Interventions based on the Theory of Mind cognitive model for autism spectrum disorder (ASD)' Cochrane database of systematic reviews. DOI: 10.1002/14651858.CD008785.p
Begeer S. Theory of mind interventions can be effective in treating autism, although long-term success remains unproven Evidence-Based Mental Health 2014;17:120.
Fletcher-Watson S, McConnell F, Manola E, McConachie H. Interventions based on the Theory of Mind cognitive model for autism spectrum disorder (ASD). Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD008785. DOI: 10.1002/14651858.CD008785.pub2
Gray, C. A. (1998). Social stories and comic strip conversations with students with Asperger Syndrome and high-functioning Autism. In E. Schopler, G. B. Mesibov, & L. J. Kunce (Eds.), Asperger syndrome or high functioning autism? (pp. 167-194). NY: Plenum Press.
Hutchins, T., & Prelock, P. A. (2008). Supporting theory of mind development: Considerations and recommendations for professionals providing services to individuals with ASD. Topics in Language Disorders, 28 (4), 340-364.
O’Brien, K., Slaughter, V. & Peterson, C.C. (2011). Sibling influences on theory of mind development for children with ASD. J Child Psychology & Psychiatry, 52(6), 713-719.
O’Hare, A.E., Bremner, L., Nash, M., Happe, F., Pettigrew, L.M. (2009). A clinical assessment tool for advanced theory of mind performance in 5 to 12 year olds. JADD, 39(6), 916-928.
Sprung, M. (2010). Clinically relevant measures of children’s theory of mind and knowledge about thinking: Non-standard and advanced measures. Child and Adolescent Mental Health, 15(4), 204-216.
Tager-Flusberg, H. (2001). A reexamination of the theory of mind hypothesis of Autism. In J. A. Burack, T. Charman., N. Yirmiya., & P. R. Zelazo (Eds.), The development of autism: Perspectives from theory and research (pp.173-193). Mahwah, NJ: Lawrence Erlbaum.
Wellman, H. M., Baron-Cohen, S., Caswell, R., Gomez, J. C., Swettenham, J., Toye, E., & Lagattuta, K. (2002). Thought-bubbles help children with autism acquire an alternative to a theory of mind. Autism, 6(4), 343-363.
Wilkinson, L. A. (2011). Mindblindness in Encyclopedia of Child Behavior and Development, Part 13, 955-956, DOI: 10.1007/978-0-387-79061-9_1795
Wilkinson, L. A. (2015). Overcoming Anxiety on the Autism Spectrum: A Self-Help Guide Using CBTLondon and Philadelphia: Jessica Kingsley Publishers.
Wilkinson, L. A. (2017). A best practice guide to assessment and intervention for autism spectrum disorder in schools. Jessica Kingsley Publishers. London and Philadelphia.
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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