Social Communication and Interaction
Janine's Unusual Behavior
/anine is a 10-year-old elementary school student who receives supports pertaining to her diagnosis with ASD and intellectual disability. She is generally happy and responsive in school and at home. However, recently, she's begun to become agitated in class for [seemingly] no apparent reason. Last week she overturned a desk and stormed out of her classroom. The first response by her teacher was to make sure that lanine was feeling physically well. Once it was established that lanine was physically well, the teacher allowed some time for lanine to calm herself in a separate space with an assistant teacher with whom lanine has a trusting relationship. The next step was to have lanine replace the desk in its proper position and to clean and straighten-up the surrounding area, which had been disturbed. Now, the teacher needed to figure out what had caused the incident and how to enable lanine to communicate her discomfort before becoming dysregulated and out of control.
By reconstructing and reflecting on the classroom situations that preceded lanine's agitation, her teacher, Speech Language Pathologist (SLP), and assistant teacher identified some possible causes for lanine's recent unusual behaviors. These included (a) noises that another student in the classroom was making, (b) insufficient time to eat her entire sandwich in lunch, and (c) difficulty understanding a task request. Since these types of situations usually didn't result in acting out, they couldn't be certain if these were upsetting /anine. Nonetheless, because lanine was exhibiting an increased rate of disruptive behaviors, which were interfering with her in-class performance and were disturbing her classmates, they decided to perform a functional analysis of her behavior.
The functional behavior analysis (FBA), conducted over the following week, illuminated the effect on /anine of the echolalic self-talk of the student seated adjacent to her. Simply by moving lanine's desk to a quiet area in the room, the teacher was able to stabilize her behavior. Had /anine been able to articulate that she was uncomfortable with the noises made by the other student, her desk throwing and other disruptive behaviors would not have occurred. Her outbursts were the result of her inability to communicate her discomfort and frustration. Even though /anine is verbal (i.e., speaking student), her self-awareness, self-advocacy, and expressive skills were not sufficiently developed to make her needs known.
Social communication and interpersonal interaction difficulties are at the core of autism spectrum disorder. Learners with ASD tend to experience problems engaging in socially appropriate and effective communication interactions. Such language disorders place students at increased risk for difficulties with behavior, social interaction, and emotional health as they approach adolescence and adulthood (Conti-Ramsden, Mok, Pickles, & Durkin, 2013), often leading to serious difficulties developing peer relationships. These challenges may be present across all ages and stages of development, and may range from communicating basic wants and needs to engaging in complex conversations (Morrell, 2019). Educators need to be knowledgeable and skilled in a variety of interventions that address such diverse communication needs.
Research findings have illuminated the relationship between language acquisition and cognitive development. A particularly relevant study by Luyster, Kadlec, and Carter (2008) examined the relationship between language development and long-term outcomes in children with autism. They reported that receptive language gestures, along with nonverbal cognitive ability and joint attention were significant predictors of academic success. For expressive language development, the most significant predictors they found included nonverbal cognitive ability, gestures and imitation. Implications for designing intervention programs of these and similar findings are addressed in this chapter. Strategies discussed may be applicable to both speaking and nonspeaking students.
Communication Interventions for
Speaking and Non-Speaking Students
Positive outcomes from directed communication interventions to improve social language in children with ASD have been found, with the largest effects seen when treatment has been implemented consistently among providers (Hampton & Kaiser, 2016). Although spoken language is a universal means of communication, it is not the sole method of effective communication. While the ability to speak and be understood is a strong predictor of adult outcomes for individuals with autism spectrum disorder (Howlin, Goode, Hutton, & Rutter, 2004), many individuals with ASD do not communicate effectively vocally, and many require facilitation through alternative/augmentative communication modalities.
Approximately 30% of children with ASD do not develop functional spoken language by age 5 (Anderson et al., 2007). Individuals with developmental disabilities who have failed to acquire a means of effective communication face great challenges. Many children who do not speak verbally may develop a repertoire of unconventional behaviors that are meant to communicate, but are often deemed maladaptive or inappropriate. For instance, a student who has not learned an effective way to tell his teacher when he is overwhelmed may display disruptive behavior, such as tantrums. Or a student who attempts to bite his teacher may be trying to escape an unpleasant or painful situation, but is unable to express extreme distress. These students would likely be considered as having behavior problems, when in reality they are simply trying to express their needs.
It is clear that often disruptive or aggressive behaviors can be reduced if students are able to communicate effectively. Building communication competence can ameliorate problematic behavior by teaching communication as a replacement and more effective means of advocating for desired objects or events, while simultaneously placing undesirable behaviors on an extinction path.
Selecting Well-Matched Intervention Plans
One of the first steps in teaching language is to assess each student and to select an appropriate pathway for intervention. If there are strong echolalic skills, providers should strive for vocal language; if there is minimal or no echolalic skill present, but imitative behaviors are good, sign language may be a better choice; for a learner with minimal or no echoic or imitative skills, but good matching skills, a picture exchange or augmentative device is likely the best route. While underlying abilities and preferences may not be apparent at first exposure, assessing and determining a path of instruction for each student, with consideration of the student's full picture of communication, intellectual, cognitive, social, and motor skills will yield useful information. Also, sensory, learning, and behavior challenges should be evaluated and considered in intervention plans.
It is critical that interventions be developed and implemented with fidelity and integrity. Developing effective programs requires educators to carefully plan and design the underpinnings or foundation, upon which the program will be based. Research and education in the areas of communication and language development have focused heavily on improving language in young children during periods of early development when language seems to be more easily acquired. In fact, it has been widely accepted that interventions to improve spoken language tend to be less effective if delivered outside this critical period. In addition to child age, a frequently debated question deals with whether it is beneficial or detrimental to use speech generating devices (SGD) to teach language. Informed by current research, this chapter addresses this question and provides a framework for understanding the potential of interventions targeting spoken language in students with ASD.
Methods presented in the chapter are described for use by teachers and related service providers. They are not intended to supplant the science of communication and the job of the speech language pathologist. Rather, they should be regarded as strategies to develop functional communication that will, in turn, promote productive social interaction, enhance self-determination competence, improve executive functioning, and help ameliorate behavior problems. Janine's story illustrates how behavioral challenges may be tied to limitations in (a) awareness of the thoughts and feelings of others (theory of mind), (b) self-awareness, and (c) expressive communication.
Understanding Behavior as a Form of Communication
Autism is a disorder of behavior and communication. In fact, communication is a form of behavior and behavior is a form of communication. As such, behaviors performed by individuals with ASD may be best understood of in terms of communicative intent. Autism education of necessity is centered around developing communication skills that will enable individuals to socially interact with others. Because pedagogy underlying communication and language development is at the core of education for individuals with autism, this chapter addresses strategies, which have been used successfully to develop communication competence, from the pragmatic lens of the special educator in classroom and community instruction.
The majority of interventions for communication development in individuals with ASD have focused on early childhood. Although fewer interventions have been developed for adolescent students, some approaches that are used for young children may be effective, with modifications, for older students. Although there is considerable variability in symptom presentation across individuals with ASD, problems with communication and social interaction are listed among the major characteristics that define this disorder (American Psychiatric Association, 2013).
In addition, there is a wide range of co-morbid conditions, ranging from cognitive impairment to medical and psychiatric conditions (Myers & Johnson, 2007). These co-occurring problems often lead to considerable functional impairment in and of themselves, exacerbating the effects of core symptoms on overall function. Speech and language delays have been shown to positively correlate with the occurrence of aggressive behaviors in children with autism (Dionne, Tremblay, Boivin, Laplante, & Perusse, 2003). Physical aggression appears to be particularly problematic, and has been associated with serious negative outcomes for adults on the spectrum.
What actually constitutes language can be a confusing question. Just as people from different countries may speak in different languages (e.g., English, Spanish, French), there are different forms of verbal behavior. Verbal behavior includes vocal language (spoken word), sign language, gestures, device output, and picture exchange. A common mistake when discussing someone's skill set would be by saying the person is nonverbal when, in reality, they are able to communicate via sign language, making them
nonvocal, or nonspeaking. Ultimately the purpose of language is simply to communicate with others.