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Based on your observations in the field experience, create a 1,000-1,250-word functional communication training plan for the student you observed:Complete an Antecedent-Behavior-Consequence chart to formally assess the targeted communication-related behavior of the student observed in Clinical Field Experience A Create a table that clearly identifies, by column:Target BehaviorDate/Time/Place of BehaviorAntecedent to the BehaviorFrequency/Duration/LatencyConsequences of the BehaviorAnalyze the data from the ABC chart and identify an intervention goal/outcome.Design specific steps to be implemented that will change the behavior and improve the student’s ability to communicate. Identify the following:Prerequisite component skill deficits and actions reducing the demands of the task.An appropriate AAC device to support the needs of the student in improving communication and staying engaged.Strategies to manage situations and consequences.Any obstacles that may be encountered and ideas on how to overcome these obstacles.Any rewards and reinforcements, with supporting schedules.Within your plan, include a rationale for your intervention goal/outcome as well as an explanation as to why assessment and data collection tools are vital when targeting communication skills and communication-related behaviors.Support your plan and rationale with 1-3 scholarly resources. Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.Read Chapter 1 and the Links.Links:Read “Augmentative and Alternative Communication,” located on The Nancy Lurie Marks Family Foundation website.URL:http://www.nlmfoundation.org/about_autism/communication.htmReview The Center for AAC & Autism website.URL:http://www.aacandautism.com/Read “Defining and Describing Augmentative and Alternative Communication,” by Sigafoos, Scholsser, and Sutherland, located on the Augmentative and Alternative Communication page of the International Encyclopedia of Rehabilitation website.URL:http://cirrie.buffalo.edu/encyclopedia/en/article/50/Review the Carly’s Voice website.URL:http://carlysvoice.com/home/Read “What is Functional Communication?” located on the Speech and Language Kids website.URL:https://www.speechandlanguagekids.com/functional-communication/
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Chapter 1 Overview of Autism Spectrum Disorders and Complex Communication Needs
Current estimates suggest that approximately 1 in 68 children has an autism spectrum disorder
(ASD; Centers for Disease Control and Prevention [CDC] 2014 ). Further, over one million
children in the USA have complex communication needs (CCN), meaning that they cannot
effectively use speech to communicate (Binger and Light 2006 ). Many people with ASD have
CCN as well. Recognizing that an individual with ASD has signifi cant problems communicating
well through speech is critical to ensuring that these communication needs are addressed early to
prevent a loss of educational and social opportunities (Horovitz and Matson 2010 ). Thus, this
chapter provides readers with a brief overview of characteristics of ASD, with a signifi cant
focus on people with ASD who also have CCN, laying the groundwork for later chapters that
address what can and should be done to address signifi cant communication needs in this
population.
Characteristics of ASDs
ASDs fall across a broad spectrum. That is, people who have ASD are a heteroge-neous group.
The range of functioning and skills may fall at any point on a wide scale. The key characteristics
that qualify someone for a diagnosis of an ASD are observable defi cits in social–
communication skills and the presence of restrictive, repetitive, and stereotypical interests and/or
behaviors. Each of these areas, and other defi cit and skill areas that are common in individuals
with ASD, is discussed below, with a focus on the subgroup of individuals with ASD for whom
augmenta-tive and alternative communication (AAC) may be most appropriate. The diagnostic
criteria for ASD in the Diagnostic and Statistical Manual (DSM- 5; American Psychiatric
Association [APA] 2013 ), which is the primary tool for diag-nosing ASD in the USA, have been
modifi ed signifi cantly from the prior edition.
Major changes include the combination of the social and communication factors into a single
category. To qualify as having an ASD, the DSM-5 states that individuals must meet the three
social–communication criteria and at least two of the four crite-ria related to restricted and
repetitive behaviors. Further, in the DSM-5, subcatego-ries of ASD [e.g., pervasive
developmental disorder, not otherwise specifi ed (PDD-NOS)] have been replaced with a
spectrum model involving severity in social communication and in restricted/repetitive behaviors
(APA 2013 ). Individuals who meet the criteria for ASD are now further categorized as having or
not having a lan-guage impairment; that is, previously, one of the possible qualifying criteria was
a lack of functional speech, or the preverbal communication phase (Tager- Flusberg et al. 2009 ),
which instead is now considered an “add on” specifi cation and would be considered as likely
qualifying an individual as having a “level 3” severity for social communication, or “requiring
very substantial supports” (APA 2013 ). The DSM-5 (APA 2013 ) changes have caused some
concern that the criteria are now more strict and will eliminate people with mild ASD and young
children who do not immediately demonstrate enough of the social–communication defi cits due
to age, decreasing the probability of early intervention (Barton et al. 2013 ). In fact, a number of
recent studies have reported that, under the new criteria, many high functioning individuals of all
ages, people with PDD-NOS, those with fewer chal-lenging behaviors, and young children with
ASD would no longer qualify (Barton et al. 2013 ; Gibbs et al. 2012 ; Mandy et al. 2012 ;
Matson et al. 2012a , b ; McPartland et al. 2012 ; Volkmar and Reichow 2013 ; Williams et al.
2013 ; Wilson et al. 2013 ). It has also been suggested that young children who previously met
the criteria, but would no longer under the current edition, have signifi cant impairments when
com-pared to typically developing peers, particularly in expressive communication (Beighley et
al. 2014 ). Researchers have recommended that the DSM-5 ASD crite-ria be adjusted to improve
sensitivity (i.e., reduction of false negatives, or failure to diagnose a child with ASD who does
have it) and specifi city (i.e., reduction in false positive diagnoses) by reducing the number of
social-communication and restricted and repetitive behaviors criteria necessary for a diagnosis
(Frazier et al. 2012 ; Kent et al. 2013 ; Lohr and Tanguay 2013 ).
Social–Communication Skills
Social and communication differences often become more apparent as people with ASD age and
social interactions and expectations become more complex (Tantam 2003 ). To qualify as having
ASD, the individual being evaluated must have the following three characteristics in social
interaction and communication (APA 2013 ). First, he or she must have defi cits in emotional
reciprocity. For example, people with ASD typically have diffi culties understanding and
perceiving others’ feelings and thoughts ( Kuo et al. 2013 ). They may be less oriented toward
other people than their peers are, such that the quality and quantity of their interactions 1
Overview of Autism Spectrum Disorders and Complex Communication Needs.
may appear signifi cantly different (Kuo et al. 2013 ). Children with ASD often have less
awareness of the need to share interests and take turns (Rowley et al. 2012 ). Second, he or she
must have diffi culty appropriately using and interpreting non-verbal communication (APA 2013
). For example, people with ASD may have dif-fi culty interpreting facial expressions or
combining messages given through tone of voice, body posture, and facial expression, causing
incorrect interpretations. People with ASD are likely to avoid making eye contact to the degree
others do (Matson et al. 2009b ). Some speak in monotone or have unusual pitch or use of
stresses in speech (Kanner 1971 ). Further, it may be diffi cult for them to match tone and facial
expressions to emotions (Shriberg et al. 2001 ). Third, he or she must have diffi culties forming
and sustaining relationships with others to a signifi cant degree. For example, people with ASD
often have diffi culty demonstrating interest in others and maintaining contact to a degree
expected by others their age (APA 2013 ). Although many do report that they have some friends
(Kuo et al. 2013 ), they have fewer friendships and are more likely to have no friends than peers
(Rowley et al. 2012 ). Their perceptions of friendships tend to indicate less intimacy or closeness
than their peers do in relationships with other typically developing peers (Solomon et al. 2011 ).
Further, adolescents with ASD have been found to spend more time with paid professionals and
other adults and to socialize with adults more than their peers do (Orsmond and Kou 2011 ;
Solish et al. 2010 ). Adolescents with ASD also report fewer opposite- gender friends than do
their peers, which could lead to less likelihood of romantic relationships (Kuo et al. 2013 ).
Relatedly, students with ASD are more frequently the targets of bullying than peers with other
disabilities (Humphrey and Symes 2010 ) and typically devel-oping peers (Rowley et al. 2012 ).
Frequently people with ASD prefer to be alone when compared to people with intellectual
disabilities who do not have ASD (Matson et al. 2009b ). Play defi cits are common in younger
children with ASD (Barrett et al. 2004 ). ASD and CCN . Although severe speech defi cits are no
longer among the defi ning criteria for ASD (APA 2013 ), people with ASD have a wide range of
language abili-ties, from those who are able to use complex and fl uent sentences to those who
can-not speak (Matson et al. 2010b ; Grzadzinski et al. 2013 ). Humans use language to fulfi ll
varied purposes, including interacting socially, communicating needs, protest-ing, and learning
(Sigafoos et al. 2006 ); the lack of ability to effectively communicate may negatively impact
communicative, social, behavioral, and academic outcomes (Branson and Demchak 2009 ),
particularly post-secondary outcomes (Hamm and Mirenda 2006 ). Individuals with ASD who
require adult services are particularly unlikely to use speech as a primary means of
communicating; that is, approximately half of adults receiving developmental disability services
use speech as a primary means of communication (Hewitt et al. 2012 ). Further, ASD with CCN
is often asso-ciated with intellectual disabilities (Luyster et al. 2008 ) and oral-motor diffi culties
(Gernsbacher et al. 2008 ). Thus, those who have ASD and CCN require special considerations
when developing interventions, particularly AAC interventions. 6 Restrictive, Repetitive, and
Stereotypical Interests and Behaviors According to the current DSM-5 (APA 2013 ), to qualify
as having an ASD, in addition to the abovementioned social–communication defi cits, the
individual must meet at least two of the following four criteria. One, he or she may engage in
speech or motor movements that are repetitive or stereotyped (APA 2013 ). This can include
unusual motor movements, seeking sensory stimulation, and using items in a repeti-tive,
typically not functional, manner (Cuccaro et al. 2003 ). Repetitive motor move-ments are
particularly common in younger children with ASD and those with more signifi cant intellectual
impairments (Fombonne 2003 ), while repetitive speech is more common in people with ASD
who are older and have higher intellectual func-tioning (Bishop et al. 2006 ). Two, he or she may
be particularly drawn to routines and rituals involving verbal and/or nonverbal behaviors or be
particularly resistant to change (APA 2013 ). For example, people with ASD may display
compulsive behavior related to repetitive routines and display challenging behavior or otherwise
resist change in routines or the environment (Cuccaro et al. 2003 ). Insistence on sameness has
been demon-strated to be linked to structural brain differences (Bishop et al. 2013 ). Three, he or
she may have intensely focused restricted interests compared to others (APA 2013 ). For
instance, a person with ASD may have a strong interest in automatic sprinkler systems and
repetitively discuss types of systems and accesso-ries in great detail. This characteristic is more
common in people with ASD who are older and higher functioning (Bishop et al. 2006 ; CarcaniRathwell et al. 2006 ). Four, he or she may be over- or under-sensitive to sensory stimuli or be
intensely interested in sensory stimuli (APA 2013 ). For example, he or she might sniff peo-ple’s
hair or fl ick lights on and off. Challenging Behaviors and ASD Although challenging behavior,
or behavior that is problematic given a particular context [i.e., socially unacceptable, harmful,
and reduces quality of life (Matson et al. 2010a )], is not a core or defi ning characteristic of ASD
(DSM citation), indi-viduals with ASD often display such diffi culties (Hill and Furniss 2006 ;
Mandy et al. 2012 ). More specifi cally, some people with ASD have been described as engaging
in tantrums, aggressive, oppositional, and noncompliant behaviors (Kaat and Lecavalier 2013 )
and have been found to engage in such behaviors more often than typically developing peers and
peers with other disabilities such as attention defi cit hyperactivity disorder (Konst et al. 2013 ;
Mayes et al. 2012 ). Some people with ASD engage in self-injurious behaviors, such as banging
their heads against hard surfaces or biting themselves (Katt and Lecavalier). Challenging
behaviors tend to be more severe in individuals with more signifi cant intellectual impairments
(Gray et al. 2012 ). With age, however, behaviors tend to improve for most people with ASD,
although for individuals with severe intellectual disabilities, behaviors tend to increase (Gray et
al. 2012 ). 1 Overview of Autism Spectrum Disorders and Complex Communication Needs
Restrictive, Repetitive, and Stereotypical Interests and Behaviors
According to the current DSM-5 (APA 2013 ), to qualify as having an ASD, in addition to the
abovementioned social–communication defi cits, the individual must meet at least two of the
following four criteria. One, he or she may engage in speech or motor movements that are
repetitive or stereotyped (APA 2013 ). This can include unusual motor movements, seeking
sensory stimulation, and using items in a repeti-tive, typically not functional, manner (Cuccaro et
al. 2003 ). Repetitive motor move-ments are particularly common in younger children with ASD
and those with more signifi cant intellectual impairments (Fombonne 2003 ), while repetitive
speech is more common in people with ASD who are older and have higher intellectual functioning (Bishop et al. 2006 ). Two, he or she may be particularly drawn to routines and rituals
involving verbal and/or nonverbal behaviors or be particularly resistant to change (APA 2013 ).
For example, people with ASD may display compulsive behavior related to repetitive routines
and display challenging behavior or otherwise resist change in routines or the environment
(Cuccaro et al. 2003 ). Insistence on sameness has been demon-strated to be linked to structural
brain differences (Bishop et al. 2013 ). Three, he or she may have intensely focused restricted
interests compared to others (APA 2013 ). For instance, a person with ASD may have a strong
interest in automatic sprinkler systems and repetitively discuss types of systems and accesso-ries
in great detail. This characteristic is more common in people with ASD who are older and higher
functioning (Bishop et al. 2006 ; Carcani-Rathwell et al. 2006 ). Four, he or she may be over- or
under-sensitive to sensory stimuli or be intensely interested in sensory stimuli (APA 2013 ). For
example, he or she might sniff peo-ple’s hair or fl ick lights on and off.
Challenging Behaviors and ASD
Although challenging behavior, or behavior that is problematic given a particular context [i.e.,
socially unacceptable, harmful, and reduces quality of life (Matson et al. 2010a )], is not a core
or defi ning characteristic of ASD (DSM citation), indi-viduals with ASD often display such diffi
culties (Hill and Furniss 2006 ; Mandy et al. 2012 ). More specifi cally, some people with ASD
have been described as engaging in tantrums, aggressive, oppositional, and noncompliant
behaviors (Kaat and Lecavalier 2013 ) and have been found to engage in such behaviors more
often than typically developing peers and peers with other disabilities such as attention defi cit
hyperactivity disorder (Konst et al. 2013 ; Mayes et al. 2012 ). Some people with ASD engage in
self-injurious behaviors, such as banging their heads against hard surfaces or biting themselves
(Katt and Lecavalier). Challenging behaviors tend to be more severe in individuals with more
signifi cant intellectual impairments (Gray et al. 2012 ). With age, however, behaviors tend to
improve for most people with ASD, although for individuals with severe intellectual disabilities,
behaviors tend to increase (Gray et al. 2012 ).
It is thought that individuals with ASD often engage in challenging behavior to communicate
needs, particularly when they cannot effectively communicate ver-bally (Chiang 2008 ; Kaat and
Lecavalier 2013 ). People with ASD and CCN may resort to challenging behaviors (e.g., selfinjurious behaviors, aggression, prop-erty damage) if unable to effectively communicate (Ganz
et al. 2009 ). Research has revealed that people with ASD frequently engage in challenging
behaviors to communicate a desire to escape demands or gain access to preferred items and
activities, including those related to their preferred repetitive motor movements (Matson et al.
2011 ; Reese et al. 2005 ). Further, more severe communication and social skill defi cits are
associated with higher rates of challenging behavior (Konst et al. 2013 ; Matson et al. 2009a ;
Sigafoos 2000 ) and higher rates of restricted and repetitive behaviors (Ray-Subramanian and
Ellis Weismer 2012 ). Thus, providing people with ASD and CCN with a reliable means of
communicating may address challenging behaviors while addressing communication defi cits.
Commonly Co-occurring Conditions and Characteristics
Often, ASD is diagnosed concomitantly with other disabilities, and features of ASD are similar
to characteristics of some other disabilities. For example, individuals with deafblindness and
signifi cant intellectual impairments have similar impair-ments in communication and social
interaction, as well as stereotypy (Hoevenaars- van den Boom et al. 2009 ). Characteristics
prevalent in people with ASD have been found to be more common in people with Down
syndrome (Moss et al. 2013 ) and Prader-Willi syndrome than in the general population (Buono
et al. 2010 ). Further, people with ASD are at an increased risk of having a number of cooccurring disabilities. High rates of psychiatric diagnoses have been found in adoles-cents and
adults with ASD (Mandy et al. 2014 ). For example, people with ASD have been diagnosed with
attention defi cit hyperactivity disorder, anxiety disorder, and oppositional defi ant disorder at
higher rates than found in the general population (Gadow et al. 2005 ; Mandy et al. 2012 ;
Simonoff et al. 2008 ; Ung et al. 2013 ). An estimated 25–40 % of children with ASD meet the
diagnostic criteria for either con-duct disorder or oppositional defi ant disorder (Kaat and
Lecavalier 2013 ; Mayes et al. 2012 ). Symptoms of depression are common in people with
ASD, particularly those who are higher functioning (Sterling et al. 2008 ). Approximately 38 %
of children with ASD have IQs in the range of intellectual disability (≤70; CDC 2014 ), which is
correlated with a higher risk for lacking the ability to speak (Hewitt et al. 2012 ).
Augmentative and Alternative Communication
The purpose of AAC is to improve the communicative competence of people who have CCN
(Light 1997a , b ; Lund and Light 2006 ). In a nutshell, communicative competence for people
who use AAC involves improving the quality and quantity 8of communicative interactions in
daily life, not in clinical treatment settings (Light 1989 , 1997a ; Sutton 1989 ; Teachman and
Gibson 2014 ). As noted above, AAC may provide a socially acceptable means for individuals
with ASD and CCN to communicate, resulting in a decrease in the need to engage in challenging
behav-iors along with enhanced communication and interaction (Ganz et al. 2009 ). Further,
aided AAC, or high- or low-tech devices such as picture communication boards and
computerized devices, is thought to be well suited to individuals with ASD because it is
primarily visually based, provides concrete representations of abstract con-cepts, does not
require advanced motor skills, and serves as a tool through which people with CCN can
communicate and engage in social activities (Cafi ero and Meyer 2008 ). The remaining chapters
in this book will provide suggestions for practitioners and parents regarding assessment for and
selection of aided AAC systems, collaborating with others to implement AAC, AAC-based
interventions, and controversial issues related to AAC for people with ASD and CCN.

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