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Answer the following question:Why is assessment important when determining the communication needs of an individual with ASD? What might happen if an appropriate assessment was not conducted prior to selecting the AAC? Why is this a concern?Respond to student discussion board. Do NOT mix student discussion with the question:Response#1:(Laura) An Augmentative and Alternative Communication AAC assessment is important to help determine which aided or unaided devices to use, strategies, and techniques recommended to make the best use of the communication device that match the fit for that students’ communicative needs. By the same token, one way of determining the desired outcome of an assistive device is to conduct a needs assessment. The needs identification process will determine the individual’s needs and goals and will provide a basis for the assistive technology intervention. Identifying the needs of the consumer is the most critical component of the service delivery process and is completed at the onset of the evaluation. The information collected during the need’s identification is the cornerstone for measuring the effectiveness of the final outcome. (Conference Proceeding, 1997) Therefore, a concern for not having an appropriate assessment conducted prior to selecting the AAC could be an individual might not understand how the device works.ReferenceFactors to consider when evaluating and implementing a computer based AAC integrated system with the active adult, 1997 Retrieved fromhttp://www.csun.edu/~hfdss006/conf/1997/proceedings/csun97_123.htmResponse#2:(Jo)Assessment is essential when determining the communication needs of an individual with ASD as it concludes comprehensive data that is necessary in order to develop an appropriate program. Prior to formal assessments, the team of professionals should gather information related to the clients/student’s educational, family, and social history, and the student’s communication needs and motivators (Gantz, 2014). Additionally, information on the student’s motor, cognitive, literacy, and communication skills are all critical to gather for the evaluator to determine an appropriate assessment tool (Gantz, 2014). If an assessment is incomplete, the individual with ASD may not receive an appropriate AAC device. Not receiving an appropriate AAC device is a concern as it will inhibit the student from being successful in all their environments. The student may become frustrated, which can lead to challenging behaviors or become isolated. It is vital to assess a student accurately in order to provide that student with a form of communication that will foster success in all environments.ReferenceGantz, J.B. (2014). Aided augmentative communication for individuals with autism spectrum disorder. New York, NY: Springer Publishing.Response#3:(ZH) Assessments are very important in order for the student to gain access to the right communication device. Assessments also give the team information on strategies and techniques that the student would benefit from. We want our students to be able to communicate in a functional way that will create independency and success in their post-secondary lives. All of the practice and skills taught up to that point are just preparation for the student’s abilities and success later in life. Assessments are important because they can create a more accurate plan in order for the student to use an AAC device.If an assessment that should have been conducted was not used, this could be a detriment for the student. Using an ineffective AAC does not help the student to functionally communicate. It could also end up being a waste of time for the student’s team and the students themselves because continual, unsuccessful trials will have to be made with new devices.Ganz, J. B. (2014). Aided augmentative communication for individuals with autism spectrum disorders.New York, NY: Springer Publishing.* I have inceluded some articles for the assignment. Thanks.Read “Interventions to Improve Communication in Autism,” by Paul, from Child and Adolescents Psychiatric Clinics of North America (2008).URL:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2635569/Read “Communication Services and Supports for Individuals with Severe Disabilities: FAQs and Discussion,” located on the American Speech-Language-Hearing Association website.URL:http://www.asha.org/uploadedFiles/Communication-Services-Severe-Disabilities.pdfad “Augmentative Communication Assessment Protocol for Symbolic Augmentative Systems,” by Gamel-McCormick and Dymond, located on the Virginia Department of Education’s Training and Technical Assistance Center at Old Dominion University website.URL:https://www.hved.org/web-content/PDFS/aug%20com%20protocol.pdfRead “Steps for Implementation: Functional Communication Training,” by Franzone, located on The National Professional Development Center on Autism Spectrum Disorders website.URL:http://autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/files/FCT_Steps_0.pdf
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Author Manuscript
Child Adolesc Psychiatr Clin N Am. Author manuscript; available in PMC 2009 October 1.
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Published in final edited form as:
Child Adolesc Psychiatr Clin N Am. 2008 October ; 17(4): 835–x. doi:10.1016/j.chc.2008.06.011.
Interventions to Improve Communication
Rhea Paul, Ph.D., Prof. Yale Child Study Center
Prof., Communication Disorders, Southern Conn. State University And Lecturer, Yale Child Study
Center, 230 S. Frontage Rd., New Haven, CT 06520-7900
SYNOPSIS
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It is clear that children with autism benefit from intensive, early intervention that focuses on
increasing the frequency, form, and function of communicative acts. Intervention methods that draw
from a range of philosophies and make use of varying degrees of adult direction have been shown
to be effective in increasing language and communicative behaviors, although direct comparisons
among methods, controlled studies with random assignment to treatments, and long-term outcome
studies are, as yet, lacking. Available evidence shows that highly structured behavioral methods have
important positive consequences for these children, particularly in eliciting first words. However,
the limitation of these methods in maintenance and generalization of skills suggests that many
children with autism will need to have these methods supplemented with less adult-directed activities
to increase communicative initiation and to carry over learned skills to new settings and
communication partners. A review of programs aimed at language development in high functioning
children with ASD points out the importance of thinking beyond words and sentences to the social
functions of communication and language use when developing interventions. Although a range of
adult-mediated programs are reviewed here, providing opportunities for mediated peer interactions
with trained peers in natural settings appears to be especially important in maximizing the effects of
this intervention.
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Communication deficits are one of the core symptoms of Autism Spectrum Disorders (ASD).
People with ASD can be slow to begin talking, or may not learn to talk at all; others may learn
to produce words and sentences but have difficulty using them effectively to accomplish social
interactive goals. Milestones in language and communication play major roles at almost every
point in development for diagnosing and understanding autism. Most parents of autistic
children first begin to be concerned about their child’s development because of early delays or
regressions in the development of speech [1]. Functional language use by school age has been
shown to be related to better long-term outcomes in autism [2], [3]. Fluency and flexibility of
expressive language are key components of the distinction between “high-functioning” and
“low functioning” autism in school age or adolescence [4]. A history of language delay can be
particularly crucial in differentiating autism from other psychiatric disorders in highfunctioning adults[5].
Because of the centrality of communicative deficits in the expression of ASD, the amelioration
of communication problems in children with this syndrome is one of the most important areas
of educational service. The present discussion of intervention for communication disorders in
ASD will be divided into two broad sections; one will discuss the development of early,
Telephone 203 785 3388, Fax 203 737 4197, E-mail: rhea.paul@yale.edu.
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Paul
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prelinguistic communicative behaviors that lead to the emergence of language, the second will
examine intervention for children who produce language, but have difficulty using it
appropriately for social interaction. Communication Intervention for Children with
Prelinguistic Communication and Emerging Language
Characteristics of Early Communication in ASD
A wide variety of studies have discussed the communicative characteristics of prelinguistic
children with ASD. Chawarska and Volkmar [6,7] reviewed this literature, and identified
several key characteristics of this group. These include:
• limited attention to speech, including failure to respond to name [8], [9].



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deficits in joint attention skills [10], [11], [12], [13], [14], including coordinating
attention between people and objects, drawing others’ attention to objects or events
for the purpose of sharing experiences, following the gaze and point gestures of others,
shifting gaze between people and objects for the purpose of directing another’s
attention, and directing affects to others through gaze.
reduced rates of communication [14]
limitation in range of communicative intentions to those whose function is to get
others to do or not do things for them (requests and protests), [15], [14].
Failure to compensate for lack of language with other forms of communication,
particularly the more conventional forms, such as pointing or showing [16], [14],
[17–19].
deficits in symbolic behaviors apart from language [20],. [21], [22], and in imitation
of vocal and other behaviors [23], both of which are closely related to language
development in typical children. Intervention for communication in young children.
Intervention for communication in young children with ASD, then attempts to address this
range of difficulties.
Intervention Methods for Children with Prelinguistic Communication and
Emerging Language
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Goldstein [24], Paul & Sutherland [25], Rogers [26], and Wetherby and Woods [27] have
reviewed interventions for early communication in autism, which are generally divided into
three major categories. The first are often referred to as didactic. Didactic methods are based
on behaviorist theory and take advantage of behavioral technologies such as massed trials,
operant conditioning, shaping, prompting, and chaining. Reinforcement is used to increase the
frequency of desired target behaviors. Teaching sessions using these approaches involve high
levels of adult control, repetitive periods of drill and practice, precise antecedent and
consequent sequences, and a passive responder role for the client. The adult directs and controls
all aspects of the interaction.
A second category of approaches identified is frequently called naturalistic. These approaches
attempt to incorporate behaviorist principles in more natural environments using functional,
pragmatically appropriate social interactions, instead of stimulus-response-reinforcement
sequences. Naturalistic approaches focus on the use of “intrinsic,” rather than tangible or edible
reinforcers. Intrinsic reinforces include the satisfaction of achieving a desired goal through
communication (the client says, “I want juice” and gets juice), rather than more contrived,
extrinsic reinforcers such as getting a token or being told “good talking.” Finally, and perhaps
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most important, naturalistic approaches attempt to get clients to initiate communication, rather
than casting them always in a responder role.
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The final orientation in this classification scheme is called developmental or pragmatic. These
approaches emphasize functional communication, rather than speech, as a goal. As such, they
encourage the development of multiple aspects of communication, such as the use of gestures,
gaze, affect, and vocalization, and hold these behaviors to be necessary precursors to speech
production. Activities provide multiple opportunities and temptations to communicate; the
adult responds to any child initiation by providing rewarding activities. Thus the child directs
the interaction and chooses the topics and materials from among a range that the adult provides.
Teachers strive to create an affectively positive environment by following the child’s lead, and
react supportively to any behavior that can be interpreted as communicative (even if it was not
intended in that way).
In the following sections, examples of each of these three types of intervention approaches, as
applied to the prelinguistic and early language stages of communication in ASD, will be
presented.
Didactic Approaches
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A large body of research has demonstrated that didactic approaches are an effective means of
initially developing attention to and understanding of language, as well as initiating speech
production in preverbal children with ASD. Discrete Trial Instruction (DTI) entails dividing
the chosen skill into components and training each component individually, using highly
structured, drill-like procedures. Intensive training utilizes shaping, prompting, prompt fading,
and reinforcement strategies. Trials continue until the child produces the target response with
minimal prompting; at which point the next step in the hierarchy of behaviors (such as correctly
pointing to the named picture from among two pictures) is presented and trained.
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Several group studies have shown that structured intervention based on behavioral principles
is useful in improving expressive language in children with ASD [28–30]. A relatively large
literature based on single case studies has also demonstrated the efficacy of these approaches
in eliciting vocal imitation [31], and speech from nonverbal children [32], [33], [30]. However,
these approaches rely heavily on teacher direction, prompted responses and contrived forms
of reinforcement. An inherent weakness in didactic approaches lies in the fact that they often
lead to a passive style of communication, in which children respond to prompts to communicate
but do not initiate communication or transfer the behaviors acquired to situations outside the
teaching context [34]. These difficulties in generalizing and maintaining behaviors taught
through didactic approaches, along with changes in theoretical views of language learning that
emphasized the central role of social exchanges in the acquisition of language, led to the
introduction of more naturalistic methods of intervention.
Contemporary Applied Behavior Analysis (ABA)
A variety of practitioners of applied behavior analysis [35–37] have confronted the major
shortcoming of classic behavioral approaches: the lack of generalization. Hart & Risley [38]
were the first to attempt to apply operant principles to more functional communicative
situations. Their major insight concerned the importance of making access to the object of the
child’s interest contingent on the child’s initiating some communicative exchange about it.
These contemporary ABA, or naturalistic methods share some aspects of the didactic
approaches from which they are an outgrowth. They are moderately teacher-directed, address
goals specified by the adult, and rely on reinforcement, although the reinforcement is more
intrinsic (the attainment of the child’s desire, or a social reinforcement) than the tangible
rewards used in more traditional DTI methods. The effectiveness of these methods has been
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amply documented in the literature, at least in single case studies, both for initiating speech in
previously nonverbal children [39], as well as for increasing the complexity of spoken language
[40]. Direct comparisons of TD and naturalistic approaches have shown some advantage for
the more natural techniques, including maintenance and generalization of new behaviors
[41], although not all investigators accept this [42].
Several techniques that fall within the category of contemporary ABA approaches to
communication intervention include prompt-free training [43], incidental teaching [38,44], and
mand-modeling in which the caregiver requests a response from the child [45]. Milieu
teaching is an umbrella term that refers to this range of methods that are integrated into a child’s
natural environment [24]. The early language skills of children with a range of developmental
disorders, including autism, have been shown to be enhanced through Milieu teaching methods
[46], [35], [47,48]). Milieu teaching approaches include:
• Training in everyday environments



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Activities that take place throughout the day, rather than only at “therapy time.”
Preferred toys and activities are included so that participation in activities is selfreinforcing.
Encouragement of spontaneous communication by using “expectant waiting” and
refraining from prompting.
Waiting for the child to initiate teaching episodes by gesturing or indicating interest
in a desired object or activity.

Providing prompts and for expansion of the child’s initiation.

Rewarding child responses with access to a desired object or activity.
In general, the Milieu approaches like these have been shown to be associated with increased
ability to initiate communication in children who did not show this ability previously [49],
[50]. Nonverbal children have developed speech using these methods [51], and increases in
the frequency, spontaneity and elaboration of language have also been documented [41],
[24], [52]. Yoder and Stone [48] showed that children with autism who had some
communicative behavior prior to intervention were more likely to develop speech in this
program than were children with fewer communication behaviors at baseline.
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In addition to the specific techniques described here, several comprehensive intervention
programs have been designed within the contemporary ABA format. Some examples are listed
in Table 1. A few studies [28,29] have shown these programs to be more effective in improving
language and cognitive outcomes, both short-term and over the course of two years, than
eclectic community interventions.
There is one significant problem with all the naturalistic ABA methods, however. Because of
their reliance on allowing children to initiate, requiring interventionists to make more on-line
decisions, they involve a significant level of training for interventionists, and rely to some
degree on clinician sensitivity and skill. Although it has been demonstrated that both parents
and peers can be taught to deliver naturalistic interventions successfully [32], [53], [54], these
methods, nevertheless, require more moment-to-moment decision-making than didactic
programs in which adult actions are clearly specified, unambiguous, and easily trained.
Moreover, unlike didactic approaches, there are few materials available that outline
comprehensive curricula; nor are there training opportunities that make it possible to master
the approach from independent study of published manuals or through inservice training.
Currently, then, it is difficult to disseminate these methods faithfully and efficiently to
interventionists beyond those who created the approaches and their direct trainees.
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Developmentally-Based, Social-Pragmatic Strategies
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This approach is based on the assumption that children with autism develop language in the
same way and following the same sequence as do typically speaking children. This means that
children who do not speak will first be encouraged to use other means of communicating to
get intentions across, in order to discover the value of communication in the ability to regulate
others’ behavior and control interactions. Proponents of this approach, then, advocate the use
of a variety of nonverbal forms of communication being used as a “stepping stone” to speech.
The central tenets of this group of approaches include:
• Following the child’s attentional lead; allowing the child to choose the course of the
interaction and use of materials;



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using the normal sequence of communicative development provides the best
guidelines for determining intervention goals;
providing intensified opportunities for children with ASD to engage in activities that
are similar to those in which typically developing peers engage, in the belief that these
are the most effective contexts for learning social and communication skills;
learning opportunities (“teachable moments”) that naturally arise in the course of
interactions should be exploited, rather than relying on a predetermined curriculum.
Intervention is carried out in the context of natural daily routines, such as bathing,
dressing, and feeding.
targeting functional goals for intervention; that is, targeted behaviors should be
applicable to daily, meaningful activities in a variety of contexts apart from the one
in which they were originally learned;
assuming the “prerequisite” role of nonverbal communication, including gestures,
gaze, vocalization, and other nonvocal means, in the development of language.
Floor Time—The developmental, individual-difference, relationship-based model (DIR;
[55]), often referred to as “floor time” aims to develop symbolic, interactive communication
through shared play and affect. Parents are trained to provide multiple, daily ‘floor time’
sessions in which the adult follows the child’s lead, comments on the child’s actions, providing
many opportunities for reciprocal action as well as challenges and obstacles to ‘stretch’ the
child’s capacities. The method employs ‘circles of communication’ in which the adult follows
the child lead in attending to objects the child shows interest in, then invites the child to interact
in increasing complex and challenging ways with the chosen object. Few empirical reports of
results of this intervention have appeared in the literature, although the authors give anecdotal
reports of improvement [56,57].
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Relationship Development Intervention—Gutstein and Sheeley [58] also present a
program in which parents are trained to deliver intervention. In RDI, parents are taught a variety
of strategies to use in providing scaffolded opportunities for their child to respond in more
flexible ways to challenging and increasingly unpredictable activities throughout daily
routines. The approach’s authors, Gutstein, Burgess, and Montfort [59], reported reductions in
autistic symptoms and increased mainstream school placements in an uncontrolled study of 16
children between 3 and 9 years who received this intervention and were followed for two years.
More Than Words—Another child-centered program was developed by Sussman [60]. It is
derived from approaches developed by The Hanen Centre® for training parents and teachers
to facilitate language development by providing enriched, contingent, and stimulating input to
children with a range of disabilities. The focus of More Than Words, and the Hanen approach
to autism in general, is on training the parents and teachers of pre-school children with ASD
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to promote communication and social skills within ordinary interactions throughout the child’s
day.
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Although there is a good deal of research to support the use of the Hanen approach in
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