Teaser Tuesday-Social Interaction in Young Children with Autism Spectrum Disorder

The Early Identification of Autism Spectrum Disorders by Patricia O’Brien Towle is a unique visual guide aimed to equip readers with the skills to recognize autism spectrum disorders (ASD) in children as young as 15-18 months old. It provides a systematic framework for understanding theTowle_Early-Identific_978-1-84905-329-7_colourjpg-web complex nature of ASD. From social interaction to communication to restricted and repetitive behaviors, each chapter focuses on key symptoms and uses photographs to illustrate and enhance understanding of presenting or absent behaviors. It is written in an accessible style and covers all of the core aspects of ASD, giving readers everything they need to be able to successfully identify the behavioral indicators of autism.

Chapter 4-Social Interaction in Young Children with Autism Spectrum Disorder

Difference and delay in social development is at the absolute core of ASD. Some children show normal first-year social development and then start
to lose those skills in the second year, while other children evidence delays right from the start. The behaviors to be described and illustrated in this chapter fall into the following three general clusters:

  •  Social engagement and interest: How does the child show that he is interested in others and ready to be engaged? To this end, where does the child place himself physically so that he has the opportunity to get involved with others? How does the child use eye contact to signal interest in engagement, and monitor the faces of others to extract information about how the interaction may go? How does the child get social interaction going with others, and how does he respond when others initiate social interaction with him?
  • Emotional signaling: How does a child exchange purely emotional information with others, and signal her internal state?
  • Capacity for interaction: How easily does the child fall into a give-and take pattern across a variety of circumstances, from predictable and scripted routines to a free-flowing, reciprocal social interchange? Can he sustain an interaction once it is started?

Download the chapter 4 extract here.

Patricia O’Brien Towle, Ph.D., has 30 years’ experience with early childhood developmental disabilities and Autism Spectrum Disorders. She is a clinical child psychologist at the Westchester Institute for Human Development and assistant professor of psychiatry, pediatrics and public health at the New York Medical College. In addition to her extensive clinical experience, Dr. Towle carries out research on the prevalence and developmental course of ASD, supervises psychology interns and post-doctoral fellows, and gives presentations to professionals and parents nationally. She lives in Westchester County, New York.

“There is hope for all learners”: An interview with Paula Moraine on helping students take control of everyday functions

Paula Moraine, M.Ed. is Director of the Community Outreach Center for Literacy and Tutoring Program at The Highland School in Bel Air, Maryland, USA. She has also worked as a classroom teacher and a teacher training instructor, has taught academic courses on education at the University of Aberdeen, Scotland, UK, and was Editor of the Journal for Curative Education for five years.

In this interview, Paula talks about her new book, Helping Students Take Control of Everyday Executive Functions, and how, by understanding a student’s own way of learning, teachers and parents can help them succeed in and out of school, regardless of their skill or ability level.

How did you come to specialize in working with children with executive function difficulties, and what made you decide to write a book about it?

I have been a teacher and an educator my whole life. Teaching is natural for me and I enjoy teaching students of all ages. I taught teachers in teacher training settings for many years, and I tried to share what it meant to have an intuitive understanding of the students’ needs. It was always clear to me that every student learned differently, and I could see that every teacher taught out of their personal set of strengths and weaknesses. But my big question was: “Why?” My other big question was: “How can I communicate this with words?”

I have taught the whole gamut from special needs students to very gifted students, from the youngest students to adults. There was a “red thread” connecting all these experiences that did not have to do with the students’ ability level. Gradually, I realized that this thread was the individual’s executive function, the “how they learn” aspect of education. So I turned my attention to executive function, or EF as I call it, and a whole world of insight opened up for me. It no longer mattered what level of intelligence or skill the student had; if I could understand how their EF worked, then I could do something to help them become the best they could be.

The inspiration to write the book came from the students and their parents as much as it did from me. I wanted to make these ideas available, and I wanted to put these ideas into an objective format. The parents and students kept telling me that I needed to write a book, so as a kind of “thank you” gift to my students I decided to make this book available to anyone who was interested in how to strengthen their executive functions.

In the book, you advocate a salutogenic approach to teaching executive function skills, and say that skills should be built upon “from the inside out”. Can you tell us a bit more about this approach – what makes it unique, and why can it be so successful?

Salutogenesis, a word that literally means “the origin of health”, is based on the concept of coherence, which for me is another way of saying “integrated”. The three areas that make up the experience of coherence are comprehensibility, meaningfulness, and manageability, and these can also be understood as our thinking, our feeling, and our actions or will. It is not a good idea to try to force change on another person, or to try to make them think, feel, or act out of demand or requirement. There is nothing more personal, individual, and sacred than how a person thinks, feels, and acts. Yet, as a teacher I am asked to bring about learning and change in the student. So the real question in education becomes: “How can we bring about learning and change in such a way that it happens internally, through the student’s own will?” It caused me pain when I saw teachers forcing, requiring, coercing, or demanding actions from their students. For myself, words that became fundamental in my teaching were lead, guide, inspire, and provide. This is what led me to the ideas that are foundational to the idea of salutogenesis; I wanted to be the kind of teacher who could make learning comprehensible, meaningful, and manageable.

How does the book reflect your general philosophy about teaching?

This book reflects my general philosophy about teaching in every way. I wanted to communicate that there is hope for all learners, that everyone can find a way to learn that is personal and successful. I wanted to share how to translate what a student is saying not just by listening to their words, but by listening to the essence of who they are as a learner. This is not something that can be communicated simply, and it is not a way of being that comes naturally to all teachers. But many teachers will understand that it is an attitude, a kind of “life-gesture” that makes this kind of listening in teaching possible. Teaching is generally considered an activity that one does “to” another. I think of teaching as something that I do “for” that other person. The learning is theirs, the experience of change is theirs, and for me the main thrill is when that student starts finding his or her “voice”.

Can you describe how you hope people will use it?

I hope people will read through this book and think: “I can do this! This makes sense and it is something that will help me, too.” Learning how to use our executive functions is a life-long task. Just because we might have arrived at that magic third decade when the part of our brain that directs executive function is mature, it doesn’t mean we also have the necessary skills and experience to use our executive brain perfectly. Any effort we make toward trying to understand someone else’s experience of executive function will help us toward better understanding our own. For me, it is more important that the reader has an opportunity to think about an aspect of learning that might not have been so clear before reading the book. I hope it is read creatively and individually – no two people need to read this book exactly the same way. I hope readers take what they need, and use what makes sense in their own experience.

If you could give teachers just one “golden rule” for promoting executive function skills in their students, what would it be?

If you follow the “Golden Rules”, you will give the students their voice. These rules transcend all educational approaches and educational systems. It doesn’t matter if you are in a private or public sector of education, and it doesn’t matter if you are a teacher or a parent. These “Golden Rules” will allow you to help the student replace fear and anxiety with hope and confidence. This approach still calls for hard work, but the goal of strengthening executive function becomes more attainable and available for everyone. This is why the ingredients are so important, since you can take them and find relevance in them for everyone.

Copyright © Jessica Kingsley Publishers 2012.

British Medical Association (BMA) Honours Three JKP Titles at 2011 Book Awards

We were so thrilled that three JKP titles were honoured at the prestigious
2011 BMA Medical Book Awards, which took place on Wednesday, 14th September
at BMA House in Tavistock Square, London.

JKP commissioning editor Steve Jones attended the awards ceremony and was joined by JKP authors Ilona Roth, Liz Hoggarth, Hilary Comfort and Tony White, whose books each received the distinction of “Highly Commended” and were nominated for first prize in their respective categories.

All nominated books were reviewed by a select group of doctors and educators. Here are some more details about the books, along with some comments from the judges:

A Practical Guide to Outcome Evaluation
Liz Hoggarth and Hilary Comfort
Highly Commended – Health and Social Care Category

‘This is an unusually successful book with one typically germane phrase in the introduction: “We hope that you will find some sections of this material that specifically answer the questions you are faced with in evaluating your work. Dip into the material for something you need or work through it systematically, Use it for reference, Make it work for you.”
It’s particularly relevant at an especially innovative time in health care.’

The Autism Spectrum in the 21st Century – Exploring Psychology, Biology and Practice
Ilona Roth with Chris Barson, Rosa Hoekstra and Greg Pasco and Terry Whatson
Highly Commended – Popular Medicine Category

‘This book is well-researched and provides clear, impartial and accurate knowledge of many facets of the autism spectrum. Its language is very accessible. The book was designed as a self-contained volume for a variety of readers, not necessarily with any scientific or specialist knowledge, either “as part of an education programme or for general interest and self-directed study” or as a module in the Open University. The book is written by Open University academic staff in association with a number of professional in the autism field and covers a wide range of topics, clearly showing the multidisciplinary nature of the field. To encourage active participation and adult learning, each chapter section has a summary of key points and at the end of each chapter is a list of learning outcomes and self-assessment question, and comments/suggested answers on these areas are nicely places at the end of the book. The important words and concepts are written in bold and this together with exercises, learning outcomes and questions, enhances the value of the book even for those pickling it up out of interest rather than as part of a study as it provides a useful summary and worked examples.’

Working with Suicidal Individuals – A Guide to Providing Understanding, Assessment and Support
Tony White
Highly Commended – Psychiatry Category

‘This is “must” reading for the different practitioners who work with person who do self harm. Provide an theoretical and practical introduction to the type of personality who do self harm or are suicidal … This book presents and comprehensive quantitative and qualitative suicidal risk assessment and describes valuable management strategies both in how to manage people with suicidal and pseudo-suicidal behaviour. It’s easy-to-read and understand provided with illustrations and case studies for better understanding. In my opinion this book fills the gap in the current literature addressing suicide and self-harm behaviour.’

It’s always a pleasure to attend the BMA Awards, partly as an opportunity to catch up with authors in the illustrious interior of BMA House, but also to hear about new outstanding medical books being published and to enjoy the buffet which never fails to impress (white chocolate, cherry and lavender tart was a particular hit this year)!

Another highlight of the night was the keynote address from President of the Royal College of Pathologists Dr Suzy Lishman, FRCPath who – as well as gamely posing for all of the award photographs – gave a compelling keynote laying out the case for public understanding of medical science in general and particularly the work of pathologists. Contrary to public opinion, not all pathologists are “CSI-style” forensics but form the backbone of health care, carrying out tests on blood samples, pregnancy tests and so on – over 70% of all diagnoses made in the NHS.

We’d like to offer our congratulations and thanks to all nominated authors who worked so hard to write the books – I know we’re already looking forward to next year’s BMA Awards!

Copyright © Jessica Kingsley Publishers 2011.

JKP Authors Andrew Nelson and Cindy Schneider share Autism-Theatre Techniques with specialists from Hong Kong

By Andrew Nelson, author of Foundation Role Plays for Autism: Role Plays for Working with Individuals with Autism Spectrum Disorders, Parents, Peers, Teachers, and Other Professionals

Fellow JKP author Cindy Schneider (Acting Antics: A Theatrical Approach to Teaching Social Understanding to Kids and Teens with Asperger Syndrome) and I have been colleagues and friends for over three years now. We met at the Autism Society of America (ASA) Conference in 2008 and immediately began collaborating on national autism-theatre projects along with other specialists from around the world.

Very early on in our friendship and collaboration we identified a mutual interest in training other autism-theatre practitioners in a “summer institute” style workshop. We wanted to offer thorough training in the theories and techniques used by autism-theatre artists and educators, and to give participants hands-on experience applying new skills with actors on the autism spectrum. This summer, in late July, our dream was realized.

One year ago, a mutual friend of ours contacted me about autism-theatre training for a group of autism specialists from Hong Kong. Mandu James YC Cheung and his wife, Dr. Eva Lai, had previously collaborated with Cindy and me on a project called “Actors in Action” at the ASA Conference. Mandu and Eva asked if I could arrange for a group of six autism professionals from the Caritas organization to come study somewhere in the US. I immediately contacted Cindy and plans were soon underway.

Our new friends from Hong Kong arrived on a Friday afternoon and we immediately dove into an intensive autism-theatre training.

For three days Cindy, myself, and our new partner Chris Nealy demonstrated a variety of activities from books and from our work over the years.

One of my favorite theatrical tools is the mask. Masks can be used in a wide variety of ways to teach emotion recognition, body awareness, emotional expression, subtle social cues and postures, etc. This particular set of masks was designed and created for me by my friend Doug Berky, an actor and mask maker from Indiana. In the photo (below) we are conducting a role play and using masks to depict the emotions often seen in bullying situations, and how different outcomes can change the mask from happy to sad, etc.

We also began to help the trainees develop an action plan for when they returned to Hong Kong. The trainees then spent three and a half days in the field observing many of Cindy’s ongoing “Acting Antics” programs in a variety of settings around her home base in Pennsylvania. They were also given the opportunity to work directly with actors on the spectrum, implementing new techniques learned in the previous days’ trainings.

By the end of the seven day intensive, we group of trainers had developed a very lovely friendship with our six new friends from Hong Kong. We laughed together and spent time discussing how the experience was going to be put into action in their communities.

Overall, I believed we learned as much as trainers as they did as trainees. We were especially honoured when the participants presented us with original art created by artists with developmental disabilities in Hong Kong (pictured left).

Cindy, Chris and myself hope to stay in close contact with our friends to learn about their experiences in the months to come. We also hope to be able to offer similar experiences to others with an interest in autism and theatre in the future.

Copyright © Jessica Kingsley Publishers 2011

JKP attends the NAS ‘Understanding and Managing Challenging Behaviour’ Conference in London

JKP attended The National Autistic Society’s conference on Understanding and Managing Challenging Behaviour held at Kensington Town Hall in London on the 6th July.

The JKP stand was extremely popular and received many visitors particularly at lunchtime when John Clements signed copies of his JKP books, including People with Autism Behaving Badly: Helping People with ASD Move On from Behavioral and Emotional Challenges

In his keynote speech to the conference, John discussed ways that ‘neurotypicals’ can try to understand the root causes of behaviours of those on the spectrum in order to be able to facilitate real change. Afterwards delegates queued up to chat with him, share their experiences of challenging behaviour and buy copies of his four JKP books (see below). 

Deborah Lipsky’s new title, From Anxiety to Meltdown: How Individuals on the Autism Spectrum Deal with Anxiety, Experience Meltdowns, Manifest Tantrums, and How You Can Intervene Effectively, was also a big hit with the delegates.

In the afternoon there were talks by occupational and speech therapists working at the Helen Allison School for children with autism, who handed out practical tools for reducing anxiety for children with autism, such as weighted clothes, special cushions, pliable bracelets and stress balls! They also recommended JKP author Olga Bogdashina’s books as great explanatory guides about the sensory overload, desensitisation and the communication difficulties experienced by individuals with autism.

The day was a great success and ended with a thought-provoking talk by Professor Jim Mansell who discussed how services for people with autism could be run more effectively in the future. He is currently writing a book for JKP about actively supporting people with intellectual disabilities and helping them to live as full a life as possible, due to be published in April 2012.

Many thanks to the organisers, to our authors and of course to everyone who stopped by the stand!

Copyright © Jessica Kingsley Publishers 2011.

From Anxiety to Meltdown – An Interview with Deborah Lipsky

Deborah Lipsky is a high-functioning autistic individual with substantial experience in emergency and trauma management, having formerly worked as a firefighter, emergency medical technician, and reserve police officer. She is now a public speaker and consultant for schools, agencies, and private parties, specialising in meltdown management plans.

Here, Deborah answers some questions about her new book, From Anxiety to Meltdown: How Individuals on the Autism Spectrum Deal with Anxiety, Experience Meltdowns, Manifest Tantrums, and How You Can Intervene Effectively.

How and when were you diagnosed with high functioning autism?

I was diagnosed in 2005 as an adult. It came about because, after working with a state agency called Vocational Rehab that helps people who have difficulty become employed, they became frustrated with me because there were too many communication issues to work through, even with my counselor, that I decided independently to be tested for any mental illnesses to see what was wrong with me and why I had such difficulty with communication and social skills. I never expected the diagnosis but was relieved that it wasn’t mental illness.

How has this diagnosis affected your life, especially with regard to anxiety?

At first it was a relief as it explained why I had such difficulty relating to people and that I wasn’t “crazy” or mentally unbalanced as some people thought. After the initial euphoria I ended up going through the 5 stages of grief because I then looked back at my childhood and all the wrongs that were done to me because no one knew I was autistic. There was the usual denial, bargaining, and all the emotions right down to acceptance where I am at now. I am anxious now and have been all my life so a diagnosis really doesn’t change or affect the level of anxiety I felt and feel. It is part of who I am and I knew that before I was diagnosed.

Can you talk about the work you do?

My primary job is that I work for a seminar company doing seminars on understanding autism. Then on the side I do many consultations for individuals and agencies regarding clients with behavioral issues. I also do numerous keynote presentations, and private speaking and or training workshops for various agencies that contact me all through out the United States.

Both of your JKP books are about meltdowns – how did you become interested in this particular topic?

Meltdowns became my specialty because I would have so many and all the books I read on the subject at the time attributed the cause to willful behavior when I knew they occured not as a choice but as a reaction to overwhelming stressors I couldn’t control. I initially created a training program for hospital emergency rooms for the autism society of Maine to help professionals recognize the warning signs of impending meltdowns and how to avoid them in the first place if possible. Word quickly spread of this program and I began to expand that to doing private trainings for various agencies and then it became the focal point of the seminar I do for this company I work for now. I was also horrified at the fact that tantrum and meltdowns were considered one in the same when they were not and so I had to clarify the difference and give strategies to handle them both.

How did this book come about?

This book came about because my first book left a lot of unanswered questions about meltdowns and the confusion over tantrums and meltdowns. My first book was designed to be used in real-time to de-escalate a meltdown but obviously was ineffective in controlling a tantrum. I received many emails from people asking me to elaborate on the topic of meltdowns and tantrums because as an autistic person who experiences them both, my insights would be very helpful.

What makes this book stand out is the fact that it explains in simple, easy-to-understand terms how, why and what we are thinking; how being anxious is core to being autistic; and it looks at autism from our vantage point. It offers so many valuable “ah ha” moments throughout that it will help those on all ends of the spectrum and those inbetween.

What is the difference between a tantrum and a meltdown?

A meltdown is an involuntary reaction to overwhelming stressor(s) either from cognitive or sensory overload. A tantrum is a choice of willful behavior with the intent of manipulating someone else’s response to meet their demand.

What are some causes of meltdowns that ‘neurotypical’ people often don’t pick up on?

Meltdown triggers vary from individual to individual. Some big ones include sudden changes, vague questions or commands, not getting understandable answers to questions the autistic person asks, and being stopped from stimming when they are trying to stay calm.

What is the worst thing for a family member or other caregiver to do or say when an autistic person has a meltdown?

By far the worst thing a person can do when someone is escalating into a meltdown is to ask questions like, “What have you been taught to do in these circumstances?”, or to offer vague, non-concrete choices to diffuse a meltdown like, “Do you want to go out and play?”

What should they do or say instead?

Always use the person’s name repeatedly. Use short phrases that convey that you are there and will help them: “Deborah, it’s OK. I’m here to help.” Nothing wordy or complex as the cognitive functioning is decreasing by the second and they can barely process what is being said. Repeating these phrases acts like an echolalia that also helps in calming them down if used in a calming tone. Again what to do is covered in my first book in detail so I recommend anyone who is involved with autism to read that book.

How can understanding why meltdowns happen improve the lives of people with autism?

Mainly once people understand meltdown triggers and why they occur the enviroment can be modified to help reduce the number of meltdowns. And more compassion instead of critism can be offered to us because we feel awful afterwards; feelings of remorse and regret are common because we didn’t want it to occur. It isn’t like we have a “quota” of so many meltdowns we need to have in a day. It just happens due to overwhelming factors beyond our (the autistic person’s) control.

Copyright © Jessica Kingsley Publishers 2011.

JKP author Mary Mountstephen meets with educators and students in Kuala Lumpur

This Spring, JKP author Mary Mountstephen was invited to Singapore and Malaysia to give a presentation based on her book, How to Detect Developmental Delay and What to Do Next: Practical Interventions for Home and School. Here, she talks a bit about her trip.

Twice before I’ve visited Singapore to build relationships with schools and organisations, and to deliver training around early interventions with children with developmental delay.

On my third trip there this Spring, I was was also invited to Kuala Lumpur by a woman called Joyce Moi who is a parent of a child with learning delays, and who has become involved in this field as a result of her daughter. Joyce knew of my work with children in the UK and my articles and book, How to Detect Developmental Delay and What to Do Next. She has close contacts with several schools and, given my success with children who are underachieving, knew that they would be interested in my approach and the Assessment Toolkit I have been developing.

During my stay, we held meetings with parents and schools and I also had the opportunity to assess five children for developmental delay. It was amazing to see how much interest there was in learning about the causes of underachievement and supporting the children in their care. I am grateful to Joyce, her colleagues and the students I worked with for a rewarding experience!

Mary Mountstephen leads a large specialist support centre at a major international independent school, and is an educational and neuro-developmental delay specialist in private practice, as well as being an international consultant to schools and organizations. She has an MA in Special Education and many years’ experience teaching in mainstream, independent and special schools. Mary lives in Glastonbury, UK.

Mary will travel back to Singapore in July to meet with other professionals. Her new website – www.kidscansucceed.com – will be running from early June 2011.

Copyright © Jessica Kingsley Publishers 2011.

Social Skills, Emotional Growth and Drama Therapy – An Interview with Dr Lee Chasen

Lee R. Chasen, PhD, RDT, LCAT, is the Founding Director of Kid Esteem Inc., a ground-breaking non-profit organisation dedicated to the social and emotional vitality and empowerment of children, families, schools, and communities. A drama therapist in private practice, Lee is based in Long Island, New York, USA.

Here Dr Chasen answers some questions about his new book, Social Skills, Emotional Growth and Drama Therapy: Inspiring Connection on the Autism Spectrum.

Tell us about your work with children on the autism spectrum.

I am a drama therapist with over 25 years experience working in public agencies and private practice. I have always been deeply concerned with the negative psychological impact on children and families brought about by the encroachment of commercial and corporate culture into the otherwise sacred intimacy of our personal lives and relationships. With this in mind, my wife and I founded Kid Esteem, a nonprofit educational organization dedicated to the social and emotional empowerment of children, families, schools and communities, in 1997. We noticed many children on the spectrum joining our groups structured for typical children, so we created programs to meet the specific and unique social and emotional needs of children on the autism spectrum.

What is the book about, and what is the significance of the mirror?

The book provides a theoretical foundation as well as a comprehensive thirty-session protocol for treating social deficits of autism with drama therapy. It tells the stories of children in the social skills program over the course of a year, illustrating their process and progress while describing specific drama therapy techniques and contexts for treatment. The mirror signifies an important intersect between drama therapy and emerging concepts in neuroscience. Recently discovered mirror neurons have been found to play a key role in developing self-awareness and social connection. Drama and theatre has historically been portrayed as a mirror to the human condition, raising questions and reflecting aspects of how we understand and relate to ourselves and each other. By holding the mirror of drama up to the mirror of social skills building neuron activity, we illuminate previously obscured angles, empowering a practical as well as metaphorical peripheral vision of sorts.

How did you develop the methods in the book, and why are they effective?

The original methods and techniques presented in the book were developed over a number of years by trial and error, based on a foundation of training and experience. The most obvious positive effects have been observed in the joyous and playful spirit of connection and interaction generated by the activities of the program that carry over to increased social activity and mastery at school, family functions and social occasions, as reported by parents and teachers. Plain and simple, the techniques are effective because they are fun, catching the attention and imagination of the participants.

The book is filled with examples and stories of how techniques like Video-modeling, costume, puppetry, improvisation, Power lines scripting and Director’s Chair transform the child’s experience, prompting a deeper awareness and understanding of self and practical application of behavior toward meaningful and sustained connection with another.

For practitioners, what are some important guidelines for using drama therapy with children on the autism spectrum?

  1. Enter the encounter with the utmost respect for the child, with awareness that on the most important level of functioning, we are all equals.
  2. Create an exciting and creative context for playful, free-spirited interaction that accepts a range of joyful expression, while at the same time maintains clear boundaries, appropriate expectations and a methodical, supportive approach toward meeting those expectations.
  3. Use the drama techniques to facilitate and reinforce the language of emotionally intelligent expression in all interactions.
  4. Provide parents with weekly skills sheets to follow up with at home, constantly reiterating that behavioral change and neurological adaptation will only come with consistent application over time.
  5. Engage social skills that are process-oriented, and be wary of skills that pressure children to superficially ‘fit in’.

Copyright © Jessica Kingsley Publishers 2011.

Rising to New Heights of Communication and Learning for Children with Autism – An Interview with Carol Spears and Vicki Turner

Carol L. Spears and Dr. Vicki L. Turner are Speech Language Pathologists, Assistive Technologists, and Alternative/ Augmentative Communication Specialists.

Here, Carol and Vicki answer some questions about their new book, Rising to New Heights of Communication and Learning for Children with Autism: The Definitive Guide to Using Alternative-Augmentative Communication, Visual Strategies, and Learning Supports at Home and School.

Tell us about your experience working with children with autism?

[Carol:] I am a licensed Speech-Language Pathologist (SLP) with 28 years of experience in the profession with the Cleveland Metropolitan School District (Ohio, USA) and in private practice. I have experience in many areas of speech and language therapy, however, for the past 6 years, I have provided services exclusively to students with autism and other pervasive developmental disorders. I am proficient in the use of many low-tech and high-tech alternative communication methods, as well as in the use of alternative methods of teaching to address specific unique needs of the students.

The frustration I felt when the use of standard interventions methods produced limited improvement fueled my desire to expand my knowledge base, and to meet the challenge of addressing the unique needs students with autism, severe learning disorders and significant communication disorders exhibit. Pairing the individualized and varied needs of the students with distinctive, innovative, and at times, atypical intervention methods, captured my interest and spearheaded my effort and desire to work with students with autism and other pervasive developmental disorders.

[Vicki:] I have also spent most of my career as a school-based SLP, providing services to students with low incidence disabilities for a number of years. Beginning in the late 1980s I worked on several grant projects to provide adapted computer access to children with physical disabilities. My role evolved into using low- to high-assistive technology (AT) in the classroom and speech generating devices with this population of children with severe dysarthria, from cerebral palsy or other conditions resulting in nonverbal or unintelligible communication.

Becoming the first Assistive Technology-Alternative/Augmentative Communication SLP in our school district many years ago, it was a natural move for me to begin offering services to students with autism, who had difficulty communicating. They also benefitted from AAC and AT as communication and learning supports.

I’ve also managed a privately owned autism treatment center, the rehabilitation departments of skilled nursing facilities, and a vocational rehabilitation program for adults.

Carol and I are currently partners in a private practice that provides interventions for autism, PDD, AAC, visual strategies, and environmental design.

How did the book come about, and who did you write it for?

As consultants, we have encountered many interventionists and parents who are working hard and implementing many techniques to help the student yet, realizing little to no improvement in academics, socialization, communication, and behavior. Although their intent is genuine and commitment is strong, their understanding of evidence-based practices that have proven successful with students with autism and other pervasive disorders is often limited. Those working with these student are either unfamiliar, have limited knowledge, or possess inaccurate information about alternative strategies. We wrote the book as a user-friendly resource so anyone interested can learn alternative strategies that work. In writing the book, we recognized that many individuals presently in the trenches providing intervention services to the students often encounter the difficulty of time constraints. These time constraints prohibit the ability to engage in extensive research or decipher difficult reading materials. There are few user-friendly resources that offer comprehensive information about varied intervention strategies, such as, visual supports, PECS, speech generating devices, social stories, and structured environments under one cover. Consequently, in addition to writing the book so individuals may learn about alternative strategies, we wrote the book to offer a comprehensive resource that answers specific questions, offer examples, includes goals/objectives, in a consistent easy to use format.

The book is for interventionists, caregivers, families, and community members who look to educate and interact with individuals with autism or other pervasive developmental disorders. It is for anyone who desires to gain a better understanding of unique, nonstandard intervention methods that have been researched and found to be successful with the target population.

What makes it the “definitive guide”?

We certainly wanted to indicate how strongly we feel about the strategies we embrace, but also, the interventions described in Rising are definitive because they are grounded upon our decades of experience working with individuals with autism, AAC, PDDs, and other profound disorders, and just as significantly, because they are research-bound and evidence-based.

Carol and I are resolute in our application of specific interventions, because we’ve witnessed their success. For instance, in Rising and in our recent article for the JKP Blog, we discussed how physically structuring the environment increases the likelihood that a child’s appropriate behavior will increase and undesirable behaviors will lessen, if the setting is designed effectively. Within an organized environment, visual supports supply information, communicate expectations, and offer predictability, among other advantages.

We understand that all individuals are unique and each strategy is not suited for every child. But some themes are universal, like the need for consistency or to know the response to questions such as, “Where do I need to be; what do I need to do; how much is work is there to do; where do I put my finished work; and what comes next?”

In Part I of Rising, we provide comprehensive information on AAC, discussing speech generating devices, PECS, and symbolic language systems. Again, we recognize that the appropriate communication system must be selected, customized, modified, or created for the individual. Perhaps the most important tool in one’s toolkit is information. Rising provides that information…it’s the definitive resource for home and school!

In the book you talk about fear on the part of adults and teachers. Where does this fear come from, and how does it impact communication?

After speaking with a number of families and interventionists, we’ve come to recognize that learning of a diagnosis, especially one such as autism, is laden with strong emotions. Among those emotions, fear is often present, ranging from (and this could be fleeting to long-term) dread, anxiety, distress, concern, worry, panic, to horror. All that families once had in mind and in store for their children is now in flux. Questions replace hopes, and in creeps fear. Educators unfamiliar with autism or other PDDs might feel ill-equipped to meet the educational, social, or communication needs of this population.

People manage differently, but for those experiencing difficulty coping, we’ve provided introductory information on autism. We believe this allows families, educators and interventionists to rise above the fear factor and poke through the cloud that surrounds the diagnosis or label of autism, once equipped with sufficient knowledge. Next, we offer proven solutions. We devote three chapters of Rising to improving the communication abilities of children with autism or other PDDs. We describe the use of speech generating devices, PECS, and Symbolic Language Systems such as communication pages, boards, or binders. In Part II we share strategies to support learning, including the use of visual supports, social stories, and structuring the environment.

We compare our book to a hot air balloon. While fear might fill the balloon with hot air initially; our book, with its information, strategies, and resources guides the reader to rise above the fear to new heights for the child with autism or other PDDs.

What are some general DOs and DON’Ts when implementing the strategies in the book?


  • Consider the cognitive, physical, social needs when selecting a strategy.
  • Consider the individual’s interests, abilities, skills, and preferences.
  • Use team approach with commitment and input from all team members.
  • Plan for the use of the support, who will create it, know purpose, and expected outcome.
  • Expect improved social skills, communication, learning, and behaviors.
  • Determine type of representation (photos, symbols, objects, words).
  • Work in well organized, clearly defined areas.


  • Provide a strategy/device without training the individual and team members.
  • Give up if it doesn’t work immediately.
  • Use visual supports/work areas that are cluttered.
  • Be inconsistent with the use of the strategy/device.
  • Neglect to continuously collaborate and communicate with other members of the team especially families.
  • Neglect to reassess the success of the intervention continuously.

When do parents and teacher know when communication therapies are working?

Just as the abilities of students are often unique and sporadic, progress noted, is likewise often unpredictable and intermittent. A comparison of pre- and post-data collected about level of competency is the best measurement of “success”/progress. Therapy is working, therefore, if students indicate by their actions and behaviors that they have a better understanding of their environment and what is expected of them throughout the day. The students demonstrate they understand, where they need to be, what they need to do, how much to do, and what comes next. Some examples of an understanding of these routines include, but are not limited to the following observable behaviors:

  • There is a decrease in the number, and intensity of targeted or undesired behavior,
  • There is a decrease in instances of awkward, inappropriate, and disruptive interactions during typical social situations,
  • There is a decrease in inappropriate, disruptive behaviors during transitions,
  • There is an increase in the number of structured tasks the student is able to independently and accurately complete,
  • There is an increase in the student’s ability to follow rules and routines at home and school,
  • There is increased compliance to questions and requests,
  • There is an increase in the ability to relay simple requests.

In essence, success is not a single state of being, rather, a continuum of instances where students demonstrate a greater understanding of their surroundings and expectations by initiating and responding to routines, requests, and interactions with appropriate, low anxiety responses.

Copyright © Jessica Kingsley Publishers 2010.

How Social Enjoyment Groups Work: An Interview with John Merges

In December, JKP author John Merges shared some thoughts about his passion: helping young people on the autism spectrum enjoy social interactions – an important skill they’ll need later in life and in work.

Here, he answers some more practical questions about how social enjoyment groups work, and about his new book, Social Enjoyment Groups for Children, Teens and Young Adults with Autism Spectrum Disorders.

What are Social Enjoyment groups, and who are they for?

Social Enjoyment groups are weekly experiences – in school and/or in he community — that provide individuals with ASD the opportunity to practice their skills at enjoying common social experiences. The groups provide positive goals, enjoyable experiences, coaching from professionals, and enough routine to make everything feel safe. School groups are for young people from age five though eighteen. Community groups are for twelve year olds through young adults.

What are the goals of Social Enjoyment groups?

The goals of Social Enjoyment groups are simple:

  1. Provide a safe, structure environment for the individuals.
  2. Provide exciting games and activities.
  3. Promote social interaction that simulates the social interaction that occurs at work.
    • Work with in partnerships and teams.
    • Tolerate/enjoy everyone in the room.
    • Learn to compromise and cooperate.
    • Learn new games and activities (simulating learning new job responsibilities).
    • Learn to evaluate – focus on the positive.
    • Learn to switch tasks without finishing a task.
    • Make friends.
  4. Focus on positive goals – give positive feedback.
  5. Provide extended time for participants to practice and then incorporate these skills.

What do Social Enjoyment groups look like in practice?

At their best, social groups look like a group of young people having fun — with the adults acting like coaches. There is a lot of laughter and a lot of smiles.

How is the Social Enjoyment group context different from general/inclusive community activities? How does this benefit young people with ASD?

In general, the inclusive activities in communities are dominated by “neuro-typical” individuals. The pace of learning and the number of skills needed are both high. Often individuals with ASD participate with adaptations, and/or with a paraprofessional helping. The typical youngsters often do not have a grasp of what the person with ASD is trying to accomplish, and are focused on developing their own skills/enjoying themselves.

Games and activities are learned at a slower pace in the FunJoyment groups that I’ve developed. Support and repetition insure that the young people have fun. The ritual of the group supports them and meets their need for security.

My greatest joy is “losing” one of my participants to a community-based activity when she/he is ready to do so.

What are some ‘hurdles’ that group leaders might face in running a Social Enjoyment group, and how can your book help?

My book is designed to identify all the hurdles that group leaders will encounter, and provide clear strategies and solutions. In brief, leaders need to:

  • Prepare by learning 6-8 activities
  • Remember that beginning is hardest. Group gets easier when you know most of the participants, and they know you. Start small, and build numbers as you become successful and comfortable.
  • Start with easier youngsters. You need to develop your skills at teaching enjoyment skills, managing time, focusing on coaching, and keeping things positive before bringing in your most challenging youngsters.

In general, leaders should look at themselves as TV game show hosts – it is their job to manage all the elements of the group so that the participants are successful, and then to praise the participants for doing all the work themselves.

John Merges is a Licensed Independent Clinical Social Worker who provides services to clients who are dealing with Autism Spectrum Disabilities. For more info about John and his practice, visit www.johnmerges.com.

Copyright © Jessica Kingsley Publishers 2011.