Early Intervention Strategies
for individuals with
Autism
Sue E. McMillan, MClSc, SLP(C)
Introductions
 Speech-Language Pathologist=Speech-Language Therapist
 Bachelor or Master’s degree in Human Communication Disorders
 “Speech-Language Pathologists screen, assess, identify
and treat speech, language, voice, fluency (stuttering), swallowing and
feeding problems for all age groups in addition to advocating for the
prevention of these disorders.” Source: Speech-Language Audiology
Canada
Role of SLP in AX & TX
of Autism
 Early identification of red flags for Autism
 SLP frequently the earliest to identify red flags in
children who demonstrate delayed communication,
play and social skills development
 Member of a multidisciplinary team (i.e.,
Developmental Paediatrician, SLP, OT, Behaviour
Therapist, Early Childhood Educator, Art Therapist,
etc.) to assess and/or treat children with Autism
RED FLAGS FOR AUTISM
UNUSUAL WAYS OF PLAYING WITH TOYS
 Turning toy cars upside down and spinning the wheels
 Lying on the floor and staring at the wheels of toy cars
as they roll
 Spinning jars or lids of jars
 Lining up toys
RED FLAGS FOR AUTISM
SENSORY SEEKING OR SENSORY AVOIDANT BEHAVIOURS
 Avoids eye contact with communicative partners
 Frequently walking on tip toe
 Flicking fingers in front of eyes or at side of eyes
 Rocking
 Spinning
 Squeezing into tight spaces (e.g., between couch and wall)
 Covering ears in response to loud noises
RED FLAGS FOR AUTISM
UNUSUAL WAYS OF COMMUNICATING
 Does not respond to own name
 Leading a partner’s hand to an object/using a partner
as a “tool”
 Difficulty initiating conversation with others
 Getting stuck on one toy or topic of conversation (e.g.,
only plays with or talks about Thomas the Tank Engine)
 Does not notice where others are looking
 Imitates exactly what others say
RED FLAGS FOR AUTISM
CHALLENGING BEHAVIOURS
 Has difficulty with making transitions from one activity
to another
 Gets very upset and cannot calm self or be calmed by
familiar adult
 Upset by small changes in routine like driving a
different route or furniture location being changed in a
familiar room
What is your role?
 TRUST YOUR “GUT”!
 REMEMBER THAT YOU ARE THE EXPERT IN YOUR
CHILD!
 ADVOCATE FOR SERVICES: CONTACT OR MAKE
REFERRALS TO PAEDIATRICIANS, NEUROLOGISTS,
SLP’S, PSYCHOLOGISTS
 CONTACT THE BARBADOS COUNCIL FOR THE
DISABLED
 EDUCATE THE BARBADIAN PUBLIC ABOUT AUTISM TO
INCREASE AWARENESS AND TOLERANCE
What does “Autism” mean to
me?
DEFINING AUTISM
 My child has Autism. Autism is a complex disorder of brain
development. It makes it difficult for my child to understand what is
said to them, express their wants and needs, play with others, and
tolerate certain sensations. Sometimes my child becomes upset
and has difficulty calming down. It is NOT because my child is
“badly behaved”. It IS because he/she does not understand how to
ask for help from others. Sometimes my child does things that
you think are “strange”. My child simply sees the world in different
ways than you and I. My child IS affectionate with people he/she
knows. My child WANTS to communicate with others and is
working hard to learn how.
 What can YOU do to help my child?
 BE PATIENT. BE TOLERANT. TELL OTHERS ABOUT AUTISM.
Statistics
 Current Canadian statistics: 1/94 individuals have a
diagnosis of Autism
 100,000 in my home province of Ontario, Canada
 If we use comparable statistics for Barbados:
Approximately 2,900 individuals with Autism
WHAT IS THE MORAL OF THE
STATISTICAL STORY?
WE NEED TO…
 BE PATIENT
 ACCEPT INDIVIDUALS WITH AUTISM IN OUR
COMMUNITY
 LEARN HOW WE CAN HELP SUPPORT INDIVIDUALS IN
OUR COMMUNITY WHO ARE AFFECTED BY AUTISM
Common Myths
 MYTH: Individuals with Autism DO NOT WANT TO
INTERACT with others
 TRUTH: Individuals with Autism often don’t know HOW
to interact
 MYTH: Children with Autism have no interest in toys
 TRUTH: Children with Autism have difficulty exploring
toys to learn what to do with them
Common Myths
 MYTH: Individuals with Autism are not affectionate
 TRUTH: Individuals with Autism are just as individual
as you and I. Some like physical contact, others don’t
 MYTH: Individuals with Autism are all like “Rainman”
 TRUTH: Individuals with Autism have a range of
individual cognitive abilities
EARLY INTERVENTION
 Dr. Amy Wetherby, SLP, Director, Autism Institute in the
College of Medicine, Florida State University
 Estimated lifetime societal cost of $3.2 million dollars
per child with Autism
 Her research has come up with a list of “red flags” that
can be seen between 12-24 months of age
Why Early Intervention
DR. WETHERBY’S RESEARCH HAS DEMONSTRATED
 Intervention has the greatest impact before 3 years of age
because this is the time of greatest “brain plasticity”.
 Believes early “symptoms” of Autism, difficulty in
communication and social interaction, lead to behaviour
problems which are actually secondary to these early
symptoms
 So, treating early symptoms can reduce severity of
secondary “behaviour problems”, which are actually
communication.
Why Early Intervention
 Research proves that the brain is most “plastic” before
the age of 5 years
 EI can prevent restricted interests from becoming so
deeply ingrained
 Help children with Autism develop social relationships
that they would not otherwise develop
 Help child develop core skills in communication, play,
behaviour and social interaction that are needed for
school success
INTERVENTIONS FOR
AUTISM
 MANY DIFFERENT INTERVENTIONS PROVIDED BY
DIFFERENT PROFESSIONALS
 WIDE VARIETY OF THEORETICAL BACKGROUNDS
 DIRECT THERAPIES WITH CHILD
 PARENT TRAINING
 EDUCATOR TRAINING
 BIOMEDICAL INTERVENTIONS
OCCUPATIONAL THERAPY
 GROSS AND FINE MOTOR SKILLS
 SENSORY INTEGRATION
 PLAY
 COGNITIVE SKILLS
 ACTIVITIES OF DAILY LIVING
 FEEDING
BEHAVIOURAL THERAPIES
APPLIED BEHAVIOUR ANALYSIS
 Based on work of Dr. O. Ivar Lovaas
 Focuses on principles that explain how learning takes place
such as “Positive reinforcement”: When a behavior is
followed by some sort of reward, the behavior is more likely
to be repeated.
 Team supervised by Psychologist specializing in behaviour
 Direct intervention provided by Behaviour
Therapists/Behaviour Analysts (sometimes SLP’s)
 BCBA (Board Certified Behaviour Analyst)
BEHAVIOURAL THERAPIES
VERBAL BEHAVIOUR
 Uses principles of ABA and theories of B.F. Skinner
 Usually delivered by Behaviour Therapists/Analysts
 Focuses on WHY we use words
 Motivate individual with Autism to learn language by
connecting language with its purpose: imitating,
requesting, commenting, communicating ideas
 Goal to help individual to learn that words can obtain
desired objects, attention, etc.
BEHAVIOURAL THERAPIES
PIVOTAL RESPONSE TREATMENT
 Developed by Dr.’s Robert and Lynn Koegel. Derived from ABA.
 Delivered by SLP’s, Psychologists, Special Education Teachers
 Play based and child initiated
 Significant parent training and involvement in delivery of
intervention
 Goals to develop communication, language and positive social
behaviours as well as relief from disruptive self-stimulatory
behaviours
 Targets “pivotal” areas of child development: motivation, response
to multiple cues, self-management and the initiation of social
interactions.
TEACCH
 BASED ON WORK OF DR. ERIC SCHOPLER
 A FRAMEWORK FOR TEACHING THAT INCLUDES THE
INDIVIDUAL’S STRENGTHS IN VISUAL INFORMATION
PROCESSING AND DIFFICULTY IN SOCIAL,
COMMUNICATION, ATTENTION AND EXECUTIVE FUNCTION
 INCLUDES:
 EXTERNAL ORGANIZATIONAL SUPPORTS TO SUPPORT
CHALLENGES WITH ATTENTION AND EXECUTIVE FUNCTION
 VISUAL AND/OR WRITTEN INFORMATION TO SUPPLEMENT
VERBAL COMMUNICATION
 STRUCTURED SUPPORT FOR SOCIAL COMMUNICATION
RELATIONSHIP DEVELOPMENT
INTERVENTION
 DEVELOPED BY PSYCHOLOGIST, DR. STEVEN GUTSTEIN
 BEHAVIOURAL TREATMENT
 PARENTS TRAINED IN RDI AND PROVIDE INTERVENTION UNDER GUIDANCE OF
AN RDI CERTIFIED PROFESSIONAL
 GOAL TO TEACH INDIVIDUALS WITH AUTISM TO BE “FLEXIBLE THINKERS”
 KEY SKILLS TAUGHT INCLUDE:
 APPRECIATION FOR DIFFERENT PERSPECTIVES
 COPING WITH CHANGE
 INTEGRATION OF INFORMATION FROM MULTIPLE SOURCES (E.G. SIGHTS AND
SOUNDS)
 FORM PERSONAL RELATIONSHIPS
THE GREENSPAN FLOORTIME
APPROACH™
 CREATED BY DR. STANLEY GREENSPAN
 FOLLOW CHILD’S LEAD AND USE THEIR
INTERESTS
 BUILD RELATIONSHIP WITH THE CHILD
 HELP CHILD PRACTICE BASIC THINKING SKILLS:
ENGAGEMENT, INTERACTION, SYMBOLIC
THINKING AND LOGICAL THINKING
 DELIVERED BY VARIETY OF PROFESSIONALS
 TRAINING PARENTS
PICTURE EXCHANGE
COMMUNICATION SYSTEM
 PECS: A PICTURE-BASED COMMUNICATION
SYSTEM TO PROVIDE NON-VERBAL CHILDREN
WITH A MEANS TO COMMUNICATE AND SUPPORT
CHILDREN WHO HAVE LIMITED VERBAL
COMMUNICATION
 TRAINING CAREGIVERS TO USE IT WITH
CHILDREN WITH AUTISM
 ANYONE CAN ACCESS TRAINING
 FREQUENTLY INTRODUCED BY SLP’S AND
BEHAVIOUR THERAPISTS
MORE THAN WORDS®
 HANEN® PROGRAM FOR PARENTS OF CHILDREN
WITH AUTISM SPECTRUM DISORDERS CREATED BY
SLP’s FERN SUSSMAN AND SUSAN HONEYMAN
 DELIVERED BY HANEN® CERTIFIED SLP
 TEACHES PARENTS AND CAREGIVERS TO USE DAILY
ACTIVITES TO HELP CHILDREN:
 IMPROVE SOCIAL SKILLS
 ENGAGE IN BACK-AND-FORTH INTERACTIONS USING
VERBAL AND NONVERBAL COMMUNICATION
 IMPROVE UNDERSTANDING OF LANGUAGE
MORE THAN WORDS®
TEACHES PARENTS AND CAREGIVERS:
 How your child learns best and what motivates him to communicate
 Why your child behaves in certain ways, and what you can do to
increase or reduce those behaviours
 How to use knowledge about your child to set realistic goals
 How to make interactions with your child longer and more meaningful
 Tips for using pictures and print to help your child understand
 Tips on how to talk so that your child understands you
 Strategies for developing play skills and making friends
MORE THAN WORDS®
PARTICIPANT COMMENTS
 “Every aspect of the training was extremely helpful.“
 “I would recommend MTW to any parent who has a child with Autism.”
 “He is able to communicate a lot more because he is speaking and
interacting.”
 “I am now more confident and equipped to work with the children in
my class.”
 “Allowing time for R. to respond or initiate has helped enormously.”
 “I found that with M. he is speaking a lot more and seems a lot more
settled when it comes to working.”
So, how do I “do” early
intervention
USE EVERYDAY ACTIVITIES IN EVERYDAY
ENVIRONMENTS TO CREATE LEARNING OPPORTUNITIES
 MEALTIME
 GETTING READY FOR SCHOOL
 RIDING THE BUS
 NAPTIME
 BATHTIME
 BEDTIME
So, how do I “do” early
intervention
 FAMILY CHORES
 GROCERY STORE
 PLAYGROUND
 STORYTIME
 HOMEWORK TIME
So, how do I “do” early
intervention
MAKE LANGUAGE “COME ALIVE”
 TALK ABOUT WHAT YOU DO AS YOU DO IT
 LABEL OBJECTS, ACTIONS, USE DESCRIPTORS
So, how do I “do” early
intervention
COMMUNICATIVE MEANS:
THE “HOW’S” OF COMMUNICATION
Watch the child and observe how they communicate
 Looks at objects
 Looks at a communicative partner
 Leads a communicative partner by the hand
 Gives objects to a partner
 Combines any of these
So, how do I “do” early
intervention
COMMUNICATIVE FUNCTIONS:
THE “WHY’S” OF COMMUNICATION
Watch the child and observe why they communicate:
 To request
 To protest
 To ask for help
 To establish joint attention so they can share information
with a partner
 To comment
 To initiate play
So, how do I “do” early
intervention
3 L’s
 LOOK AT YOUR CHILD
 LISTEN TO YOUR CHILD
 LEARN TO LOVE WHAT YOUR CHILD LOVES
So, how do I “do” early
intervention
“3 L’S”
 ALLOWS YOU TO MAKE A CONNECTION WITH THE
CHILD
 CONNECTION IS KEY TO BUILDING A BRIDGE TO
COMMUNICATION
 MEET THE CHILD WHERE THEY ARE
 VIDEO CLIP OF LEARNING TO LOVE WHAT YOUR
CHILD LOVES
So, how do I “do” early
intervention
CREATE OPPORTUNITIES FOR THE CHILD TO
COMMUNICATE
 BE “THE KEEPER” OF THE GOODIES: INTRUDE A
BIT
 WAIT FOR THE CHILD TO INITIATE
 BE FACE-TO-FACE
 USE THE 3 L’s
So, how do I “do” early
intervention
HOW CAN I HELP MY CHILD UNDERSTAND
 Use JUST ENOUGH words: children with Autism frequently have difficulty
processing oral language so we need to keep it simple for them
 Be ANIMATED when you speak: children with Autism frequently have difficulty
sorting out what information they need to pay attention to so we need to make the
important information STAND OUT for them
 Go SLOW: remember that your child is like a foreign language learner and will
benefit from extra time to process information
 Use VISUAL INFORMATION such as GESTURES, OBJECTS and PICTURES
 Children with Autism learn best through their VISUAL CHANNEL
So, how do I “do” early
intervention
VISUAL COMMUNICATION AIDS
 GESTURES
 3D OBJECTS
 PICTURES OF REAL OBJECTS
 PRODUCT WRAPPERS/LOGOS
 PCS SYMBOLS/BOARDMAKER SYMBOLS
So, how do I “do” early
intervention
VISUAL COMMUNICATION AIDS
 FIRST-THEN BOARD
 CHOICE BOARD
 VISUAL SCHEDULE
 SOCIAL STORY
 PECS
RESOURCES
 The Hanen Centre www.hanen.org
 Autism Speaks www.autismspeaks.org
 Autism Navigator www.autismnavigator.com
 Geneva Centre for Autism www.autism.net
 Speech-Language and Audiology Canada www.sac-oac.ca
 Friend2Friend Learning Society www.friend2friendsociety.org
 Barbados Council for the Disabled 427-8136
 Sue McMillan, SLP encouragingexpressionslp@gmail.com