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Julie Mullis Clinical Lead Specialist Speech & Language Therapist (ASD) Cardiff & Vale UHB Flying Start Conference 15/1/16 A neuro-developmental disorder A medical diagnosis, made by a multidisciplinary team, by observing a pattern of behaviours which affect: ◦ ◦ ◦ ◦ social interaction social communication social imagination/flexible thinking repetitive and restricted behaviours and interests 90% also have sensory processing difficulties A spectrum condition meaning there is a huge variety of presentation Used to be thought of as a rare condition Now thought to occur in about 1 in 100 Broader defining characteristics Better diagnosis Better knowledge in the general public Early identification leads to early intervention Record observations Discuss your concerns with the parents Do not use medical terminology Gain consent to refer to other agencies as appropriate Include comments about positive skills You do not have to wait for a child to receive a diagnosis to start providing support All pre-school children with ASD will have difficulties with communication Visual strategies can be used to support them to understand us and to support them to communicate with us Calendar? Diary? To do lists? Electronic devices/apps? Visual Concrete Repetitive Predictable Consistent Processing Unambiguous Develops symbolic understanding through a hierarchy ◦ ◦ ◦ ◦ Objects Photos Symbols Writing Develops independence ◦ Communication ◦ Planning Signs are a visual means of communication but… Like speech, signs are transient Like speech, signs rely on recall rather than recognition Motor difficulties Difficulties with imitation Echopraxia Visual Cue Schedules Cards ‘Traffic Timers Writing Lights’ Objects of Reference Picture Exchange Communication System (PECS) Communication Voice Books Output Communication Aids Writing Aids independence Represents Helps the order of activities to organise our time Reduces anxiety De-personalises Ensures instructions flexibility not rigidity What is the level of the child’s symbolic understanding? Can the child understand ◦ Objects? ◦ Photos? ◦ Symbols? ◦ Written words? One at a time? First X, then Y? Longer schedule? Half-day or whole day? Weekly calendar ? Some children will not yet understand pictures Label object if possible Use single word consistently with the object Later show OOR with photo or symbol Ensures that everyone calls an item by the same label Aids language development Develops word recognition preliteracy skills Ensure items are easily accessible – box or shelf Present Say two objects as a choice what is on the label as item is given The child needs to engage with the schedule by removing the picture or ticking the item, etc, or at least looking at the item ‘Finished’ box or pocket Reflecting on activities at the end of the day Copy to take home Simple ‘one message’ instructions or reminders about specific rules or behaviours to be remembered Backs up verbal instructions that are not on the visual schedule toilet De-personalises Asocial and removes emotional engagement Reduces need for repeated verbal instructions no light A type of cue card Can be used individually or with groups Helps individuals to understand transitions Prompts children to start and finish activities Warns children that activities are going to finish “X activity is starting now” “Go” “Start X” Teaches concept of waiting “X activity is nearly finished” “X activity is starting soon” Can be paired with a verbal countdown or use of visual timer such as eggtimer “X activity is finished now” “X items are finished/all gone now” “Stop/Finish” What kinds of timers are there? ◦ Egg timers ◦ Clocks and watches ◦ Sundials ◦ On computer ◦ On phone ◦ On TV Why do you use clocks or timers? For cooking To record a programme To remind us to take medication To know how long before the bus is coming To get to an appointment on time To know how long it is before we can have a break? Help us to ◦ plan and organise our time ◦ be productive ◦ be where we need to be when we need to be there Represents an abstract concept in a more visual and concrete way – provides information that otherwise would be hard to explain Reduces anxiety Picture Exchange Communication System A structured programme developed specifically for children with ASD Develops communicative intent Teaches that two people are needed for communication to be effective Provides a functional appropriate means of communicating requests which reduces inappropriate behaviours Uses pictures to request desired items Builds up gradually to longer sentences and more functions (comments, responding to questions) For children who ◦ know how to get someone’s attention ◦ have a large vocabulary (PECS no longer userfriendly) ◦ can scan a selection of pictures Photos, symbols or written words can be used Child communicates by pointing to one or more pictures VOCAs are hightech battery powered AAC Use symbols that are already familiar Looks like PECS book Portable Motivating Easy to add new vocabulary Can break down, run out of battery, get broken Needs low-tech back-up Technology developing fast – new apps cheaper and easier to individualise – iPads and iPods increasingly being used as communication aids Writing is a visual means of communication Can be used to communicate with individuals with ASD Some individuals need longer to process verbal information Some non-verbal individuals can read and write and can use written systems to communicate ?
