What is Autism

Autism is a general term used to describe a group of complex neuro-

developmental disorders also known as Pervasive Developmental
Disorders (PDD) or Autism Spectrum Disorders (ASD). These
disorders are characterized, in varying degrees, by challenges related
to:

•Communication

•Social Interaction

•Restrictive or repetitive behaviours and interests

People with autism may also experience other difficulties including

medical issues, differences in coordination and muscle tone, sleep
disturbances, altered eating habits, anxiety or disordered sensory
perceptions. (2013 Autism Speaks inc).

What Causes Autism?

Not long ago, the answer to this question would have been “we have
no idea.” Research is now delivering the answers. We now know that
there is no one cause of autism just as there is no one type of autism.
Over the last five years, scientists have identified a number of rare
gene changes, or mutations, associated with autism. A small number
of these are sufficient to cause autism by themselves. Most cases of
autism, however, appear to be caused by a combination of autism risk
genes and environmental factors influencing early brain development.

Although autism appears to have its roots in very early brain

development, the most obvious signs and symptoms tend to emerge
between two and three years of age. Often parents are the first to
notice that their child is showing unusual behaviours such as failing to
make eye contact, not responding to his or her name or playing with
toys in unusual, repetitive ways. Sometimes an autism spectrum
disorder is diagnosed later in life, often in relation to learning, social
or emotional difficulties.

What’s Different About People with Autism?

Things that may make a person with autism different can also be seen
as exceptional abilities. It is important to think of him or her as
intelligent, even if language or behavioural difficulties do not reveal
this in the way you expect. Characteristics of someone with autism
can be seen as both challenges and strengths. For example, a child
who seems inflexible or rigid may also be the one who is the best at
following the rules of your program. People with autism may display
some or all of these characteristics:

•Difficulty understanding language, gestures and/or social cues

•Limited or no speech

•When there is speech, it can be repetitive or relate primarily to one

particular topic
•Limited or no eye contact

•Difficulty participating in back-and-forth conversations or

interactions

•Social awkwardness

•Intense interest in unusual topics or objects

•Repetitive behaviours, such as pacing or lining things up, spinning,

hand flapping or rocking.

•Sensitivity to light, sound, smell, taste or touch

•Abnormal fears and/or lack of appropriate fear for real dangers

•Difficulty managing transitions, changes in routine, stress and

frustration

•Strong visual skills

•Good rote learning and long-term memory skills (math facts, sports
statistics, etc.)

•Adherence to the rules

•Honesty

•Intense concentration or focus, especially on a favourite

•Ability to understand and retain concrete concepts and patterns

•Strong interest and/or ability in mathematics, technology, music and

art Tips for Communication with People with Autism

• Speak calmly.
• Use direct, concrete phrases.

• Instructions should contain no more than two steps.

• Allow extra time for the person to respond.

• Avoid using phrases that have more than one meaning, like “cut it
out.”

• Avoid touching. If necessary, gesture or gently guide the person.

• Be alert to the possibility of outbursts or unexplained behaviours. If

the person is not harming themselves or others, just wait for these
behaviours to subside.

(© 2013 Autism Speaks Inc. Autism Speaks and Autism Speaks It’s
Time To Listen & Design are trademarks owned by Autism Speaks
Inc)

According to Wiggins, Baio, Rice,( 2006) it is important to

understand the early development of children for one to understand
the reflags or challenges one may experience in terms of language
development. It is important to note that Babies start communicating
and relating to other people at birth. Thus, continued social-emotional
development is key to forming strong relationships and continued
learning

Stages of development to note include;

By the end of 3 months

• Begin to develop a social smile

• Enjoy playing with other people and may cry when playing stops

• Become more expressive and communicate more with face and body

• Imitate some movements and facial expressions

By the end of 7 months

• Smile back at another person

• Respond to sound with sounds

• Enjoy social play

Red Flags

• No big smiles or other warm, joyful expressions by six months or

thereafter

• No back-and-forth sharing of sounds, smiles, or other facial

expressions by nine months or thereafter

By the end of 12 months

• Use simple gestures

• Imitate actions in their play

• Respond when told “no”

Red Flags

• No back-and-forth gestures, such as pointing, showing, reaching, or

waving bye
 • Not answering to one’s name when called

• No babbling – mama, dada, baba

Joint Attention and Social Engagement

By the end of 18 months

• Do simple pretend play

• Point to interesting objects

• Use several single words unprompted

Red Flags

• No single words by 18 months

• No simple pretend play

By the end of 2 years (24 months)

• Use 2- to 4-word phrases

• Follow simple instructions

• Become more interested in other children

• Point to object or picture when named

Red Flags

• No two-word meaningful phrases (without imitating or repeating)

• Lack of interest in other children

Red Flag:

• Any loss of speech or babbling or social skills

 • Regression at any age is cause for immediate referral
• Although toddlers & young children may not be speaking-
they can still demonstrate a variety of communicative and
social skills

• Choosing an appropriate intervention method can be linked

to the child’s skills, needs and interests  Important to target
the ‘whole picture’ of the child’s communication skills

Characteristics as described by CDC

CDC breaks down “red flags” or characteristics into several
categories:
Social skills
Communication
Unusual Interest or Behaviour
Other Symptoms
Characteristics re: Communication
 Delayed speech and language skills, or nonverbal
 Repeats words or phases over and over (echolalia)
 Reverses pronouns (e.g., “you” instead of “I)
 Gives unrelated answers to questions
 Does not point or respond to pointing
 Uses few or no gestures (e,g, dose not wave goodbye)
 Talks in a flat,-robot-like, sing-song voice
 Dose not pretend in play (e.g., dose not pretend to “feed” a doll)
 Dose not understand jokes, sarcasm or teasing
Characteristics re: social skills
 Dose not respond to name 12 months
 Avoids eye contect
 Prefers to play along
 Dose not share interest with others (joint attention)
 Only interacts to achieve a gaol or object
 Flats or inappropriate facial expressions
 Dose not understand personal space boundaries
 Is not comforted by others during distress
 Has trouble understanding emotions

Characteristics re: unusual Interests

 Lines up toys or objects
 Plays with toys the same way every time
 Has obsessive interests
 Has to follow certain routines
 Flaps hands, rocks body, or spines in circles

Characteristics re: Behaviour

 Over active
 Impulsive
 Short attention span
 Aggressive
 Injures self or others
 Excessive temper tantrums
 Unusual sleeping or eating habits
 Unusual mood or emotional reactions
 Gets upset by change
 Unusual reaction to way things sound, smell, taste, look or feel
Some of these characteristics can be seen in other disorders.
*remember to look for persistent deficits in social communication across a variety of contexts
and restrictive, repetitive behaviour
Social communication and Interaction:
Persistent deficits using and understanding social communication in social interaction across
multiple contexts (nonverbal, echolalia, reading body language, language content)
 Communication- can be range from nonverbal to echolalia to using grammatically
correct sentences in conversation but my use inappropriate context.
 Interaction-pay less attention to social stimli, have trouble reading nonverbal
cues/body language, have poor initiation with peers, conversational skills.

Restricted and Repetitive Behaviour

 Restricted range of interest, self stimming, follows rules and rituals rigidly, repeats
daily activities with minimal variation, fixated interests, hyper or hypo-sensitivity to
sensory stimuli

Speech, Language, Pragmatics

 Foral and informal testing
Language: MLU, spontaneous utterances, ability to request and comment, ability to
label, answer and ask Wh questions
Speech: speaking intelligibility, sound errors, fluency
Pragmatics: use of language, conversational content, verbal turn taking, eye content,
perspective taking
Assessing Young Children wth Autism: What to consider

i. Frequency
i. Functions
ii. What is your child communicating for? Requests? Social interaction?
iii. Means
iv. How is your child communicating? Gestures/speech/babbles

v. Reciprocity: responsiveness to others

Our roles as SLPs:
 Without diagnosis: observe red flags in behaviour, gross/fine motor development,
adaptive skills or other area of concerns.
  Refer parents to appropriate professionals
 We can’t diagnose, but we have a responsibility to tell parents what we see
and the next step
 With diagnosis: treat deficits, not disorder

What are the pivotal skills for speech development?

Joint Attention

Imitation

Symbolic Play

1. Joint attention
According to Inge-Marie Eigsti (2013) Joint Attention is the process of sharing one’s
experience of observing an object or event, by using & following gaze or pointing
gestures. It is critical for social development, language acquisition & cognitive
development…

In other words: Joint attention is a child’s way of pointing something out for the purpose
of sharing.

2. Symbolic play
• Communication goals should focus on play, in addition to communication

• Important to incorporate play into both therapy goals and home setting

• The use of symbols in pretend play and the understanding of words as symbols
is a key component of communication

Why is Play so important to target?

 Helps a child to learn about the people and objects around him .Pretend play is especially
important at early stages of language development because both pretend and language are
forms of symbolic functioning: using an object or a word to stand for an idea.

Play & Language Development

pretend play and language development develop in tandem and children with ASD frequently
have difficulty in this area. To add on play with motivating objects can be an enticing way to
both capture attention and build language. For children with deficits in both pretend play and
language, developing symbolic play will A child’s level of symbolic play skills predicts:
Later social relatedness (Sigman& Ruskin, 1999) as well as: response to language treatment
(Yoder & Stone, 2006)  Kasari et al., 2007: Play behaviors taught by:
• Discrete trial imitation

• Physical guidance

• Modeling and practice in

• using objects representationally,

• Referring to objects out of sight

• Attributing properties to objects (hot!)

• Symbolic play behaviors increased

3. Imitation
• Consider both motor imitation and vocal imitation
• Important skill to both promote attention to others, and language
and sound development

Apart from the above other programs have been assocaited with induction of preverbal skills
of children with autism thes in clude

1 Behavioural Programs: Discrete Trial Instruction (DTI)

• Also known as a highly structured form teaching, focusing on repeated,

single trials to elicit new skills
• Uses prompting, reinforcement, and intervals to teach
2 The Picture Exchange Communication System (PECS)

PECS is a behaviorally based pictorial communication system designed for children with
social-communicative deficits. Using PECS, expressive communication skills are targeted
through the training of requests and, later, comments. As Bondy and Frost (1994, p. 3)
describe, “Children using PECS are taught to approach and give a picture of a desired item to
a communicative partner in exchange for that item. By doing so, the child initiates a
communicative act for a concrete item within a social context.” It is important to note that the
term PECS does not refer generally to all exchange-based pictorial communication
interventions (i.e., exchanging a photograph or line drawing for a corresponding real item);
rather, PECS is a specific, manualized intervention protocol.
In the PECS program, a child’s expressive communication abilities are shaped via the use of
reinforcement, delay, and generalization across trainers and settings. PECS training consists
of six phases (see Table 1). In Phase I: The Physical Exchange, two trainers physically
prompt the child to exchange a single picture for a preferred item, without distractor pictures.
In Phase II: Expanding Spontaneity, a communication book is introduced, and increased
distance is placed between the child and communicative partner. The child is required to get
a picture symbol from his or her communication book and travel to the communicative
partner to request an item. Placement of picture symbols is varied in the book, and
generalization is targeted across a variety of trainers and contexts. In Phase III: Picture
Discrimination, the child discriminates between two picture symbols (first between a highly
desired andanondesireditemandthenbetweentwodesired items).In Phase IV: Sentence
Structure, the child makes a request by building and exchanging a two-picture-sequence
sentence strip with an “I want” symbol plus the picture symbol for the preferred item. In
Phase IV, after the child has requested by giving the sentence strip, the communication
partner provides the verbal model “I wantI” and uses a time delay before labeling the
requested item and handing the sentence strip and requested item back to the child. In Phase
V: Responding to “What Do You Want?” the communicative partner introduces the verbal
prompt “What do you want?” As Phase V intervention continues, a time delay is inserted
between the verbal prompt and an additional gestural prompt toward the “I want” picture
symbol. Eventually, the child begins answering the question before his or her communicative
partner uses the gestural prompt. Finally, in Phase VI: Responsive and Spontaneous
Commenting, comments are trained via the exchange of a sentence strip in response to the
communicative partner’s questions (i.e., “What do you see?” and “What do you have?”
contrasted with the request cue “What do you want?”).

Ease of implementation for both children and interventionists is one of the features that
helped PECS to become a widely popular social-communication-training system for children
with ASD. For example, children do not need to master prerequisite skills (e.g., eye contact,
gestures, and verbal imitation) prior to beginning PECS training. Rather, children with
relatively limited skills begin exchanging picture symbols to

TABLE 1.Six phases of Picture Exchange Communication System (PECS) training.

Description

Training begins on a single picture of highly desired item. Student picks up picture of desired
item and releases into communicative partner’s hand in exchange for desired item.
Communicative partner gives the item to the child while naming the item (e.g., “car”). Two
adults (i.e., the communicative partner and a physical prompter) are used during this phase.
A communication book is introduced, and increased distance is placed between the child and
communicative partner. Child is required to get picture from her communication book and
travel to communicative partner to request item. To increase spontaneity and persistence,
placement of picture symbol is varied in the book. Also, generalization across a variety of
trainers, contexts, and reinforcers is introduced at this phase.
Child is required to discriminate between two picture symbols (highly desired vs. nondesired
item to gradually multiple desired items). Correspondence checks are done to ensure that child
is truly requesting preferred item.
Child uses a sentence starter (“I want”) to make a request by building and exchanging a 2-
picture-sequence sentence strip with “I want” symbol plus picture symbol for preferred item.
Communicative partner provides verbal model “I wantI” and pauses before labeling the
requested item and handing sentence strip and requested item back to child. Communicative
partner differentially reinforces any vocal attempt.

Activity 6.2
1. Read the attached article. The DSM-5 guidelines are attached as an additional reference.
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