PSY 3410

AUTISM SPECTRUM DISORDERS &

INTELLECTUAL DISABILITY
Unit 6 - Language & Communication:
Teaching Communication
Instructor: Dr. Lauren Moskowitz

Class #10-12 10/8, 10/11, & 10/15

Language and Speech
¨ Language is…
¤ Social
in nature (rules tell you what words mean
and how to put them together in context)
n Receptive language
n Expressive language

¨ Speech is…
¤ The verbal means of communicating. Consists of:
n Articulation
n Voice
n Fluency
 Areas of Linguistic Communication

1) Phonology – the sounds of a language system

2) Semantics – the meaning of words &
relationship between words
3) Syntax – rules that underlie word order,
sentence construction, & word combinations
4) Pragmatics – rules governing appropriate use
of language within social interactions
5) Prosody – patterns of speech including
intonation, rhythm, & stress
 Normal Language Development
(Expressive)
Age Typical Milestones
Birth Crying/physiological sounds
1 - 3 months Cooing
4 - 6 months Babbling, laughs, vocalizes excitement
9 -13 months Intentional communication
12-18 months Speaking first words
18 - 30 months Speaking first word combinations
30 months – 5 years Using sentence grammar
Discourse grammar; articulating all speech
4 - 8 years
sounds correctly
 Normal Language Development
(Hearing and Receptive)
Age Typical Milestones
Startles to loud noises, seems to recognize voice
Birth - 3 months and quiets if crying

Moves eyes in direction of sounds, notices toys

4 - 6 months that make sounds

Recognizes simple words, begins to respond to

7 months - 1 year requests
Points to pictures in a book, listens to simple
1 - 2 years stories
Understands differences in meaning, follows 2-
2 - 3 years step requests
Pays attention to short story and answers
4 - 5 years questions about it
 Nature of Communication Impairment
in ASD
¨ Children in the early stages show a limited range of
communicative functions
¤ Behavior regulation
¤ No communication for joint attention

¨ May develop idiosyncratic or unconventional means of

communicating
¤ Echolalia
¤ Challenging behavior

¨ Conversational skills: Children with autism less likely to

¤ Respond to questions & comments
¤ Offer new information
¤ Offer personal information
Assessing Communication

¨ Assess with meaningful people

¨ Assess in natural contexts
 Assessing Communication:
Assess Interaction Style
¨ Adult Facilitative Style
¤ Child controls focus & direction
¤ waiting for initiations

¤ Using comments, acknowledgments, reflections

¨ Adult Directive Style

¤ Adults controls focus & direction
¤ Initiating more than half the topics
¤ Using questioning for continuation (e.g., “What is that?”)

¤ Using directives (e.g., “Look at that.”)

Importance of Facilitating
Communication Skills in ASD

¨ outcome - especially in young children

¨ lack of skills as a source of family
stress
Teaching Communication: Overview

¨ Decide what social communicative goal is

important (e.g., joint attention)
¨ Decide what to teach to achieve the goal
(e.g., “What’s that?”)
¨ Decide what system to teach to achieve
the goal (e.g., verbal)
¨ Decide how you are going to teach it
(e.g., incidental teaching)
Deciding What to Teach
(e.g., Teaching Verbal Initiations)
¨ Teaching “What’s That?”
¤highly desired items
¤take item as reinforcer
¤intermittent schedule

L. K. Koegel et al., (1998)

Teaching Communication:
Selecting a System
¨ Speech or nonspeech systems
Requirements for Speech

¨ Use vocalizations intentionally to

communicate?
¨ Ability to imitate speech?

¨ Sensory abilities?

¨ Motor abilities?

¨ Motivation and interest?

Teaching Speech
¨ Basic Phonology
¤ Labial Sounds (air restricted by lips)
n /m/
n /p/
n /b/
n /w/
¤ Alveolar Sounds (air restricted by placing tongue
behind the top front teeth)
n /t/
n /d/
n /s/
n /z/
Nonspeech Systems

¨ Sign language
¨ Visual

¤photos, objects, drawings, picture

symbols, words
¤boards, books, devices
Sign Language
¨ Children with ASD strong visual learns
¨ Signs easier to prompt & often iconic

candy
Picture Exchange Communication
System (PECS) (Bondy & Frost)
¨ Children are taught to approach and
give a picture of a desired item to a
partner in exchange for the item
PECS Video
 Augmentative & Alternative
Communication (AAC) Devices

Voice Output Devices:

http://www.reallookautism.com/ot
her-videos/
Intervention Guidelines

¨ Goals should emphasize the functional use

of communication
Teaching Language and
Communication
¨ General Approaches:
¤ Discrete Trial Training (DTT)
n Phonology
n Semantics
n Syntax

¤ Naturalistic Behavioral Interventions (e.g., Incidental

Teaching (IT) or Natural Language Paradigm (NLP))
n Pragmatics
 Discrete Trial Teaching (DTT)

¨ Goal: to teach by frequently reinforcing correct

responses

¨ Five elements:
1. Presentation of cue or discriminative stimulus (SD)
2. Deliver a prompt (if necessary)
3. Child makes a response
4. Consequence (reinforce for correct response, or correct)
5. Intertrial interval (pause, then repeat above steps)
1) Cue/Discriminative Stimulus D
(S )
¨ A stimulus that is discriminative for reinforcement.
¨ Should be:
¤ Clear
¤ East to discriminate

¤ Consistent

¨ Examples:
¤ “What is this?”
¤ “Touch apple”
2) Prompt
¨ Prompt is an additional stimulus that is presented in
order to ensure that the child responds correctly to
the discriminative stimulus (SD)
¨ Types of Prompts:
¤ Physical
¤ Position

¤ Nonspecific

¤ Recency Prompt-Fading:
¤ Modeling prompt must be faded so that child
does not become prompt-dependent
(e.g., volume fading)
3) Response
¨ Desired behavior (i.e., what we want the child to say
or do).
¨ The child gives a response after the SD (or prompt if
necessary).
¨ Should be within 1-3 seconds of the SD.
¨ Right/Wrong should be consistent across caregivers.
¨ Shaping: start easy and work toward harder tasks
by slowly raising expectations for what is a right
answer (i.e., successive approximations).
4) Consequence
¨ Right Answer:
¤ Reinforcing Stimulus (SR).
n Praise, hugs, high five, food, toys, music, etc.
n Given immediately after correct response.

¨ Wrong Answer:
¤ Remove reinforcers (time-out)
¤ Give correction such as “no” (optional)

¤ Wait 1-2 seconds

¤ Repeat instruction
5) Intertrial Interval (ITI)
¨ Short break or pause before repeating the
entire DTT sequence
¨ Wait several seconds before beginning the
next trial
 Summary of DTT

SD Prompt Response SR ITI

“What’s this?” Child Give child

“Say: states piece of Wait &
while holding up Apple” repeat
an apple “Apple” apple
 Examples of DTT
¨ Teaching child to make a sound
¤ hold child’s lips and tickle child to get “mmm” sound
¤ physical manipulation of child must be faded

¨ Receptive labeling (understanding words)

¤ e.g., teacher: “point to apple” and child points to apple

¨ Expressive labeling (producing words)

¤ e.g., teacher: “What is this object?”, Child : “Apple”.

Apple
Video of Discrete Trial Instruction
 DTT Sequence
¨ Discrete-trial programs generally begin with general
compliance training (sit in a chair, look at clinician, imitate
nonverbal behavior in response to verbal commands)
¨ Speech is taught as a verbal behavior
¨ Objectives are targeted beginning with
¤ Verbal imitation
¤ Following one-step commands
¤ Receptive discrimination of body parts, objects, person names and
pictures
¤ Expressive labeling in response to questions
¨ Later, language objectives include prepositions, pronouns,
same/different and yes/no
NRC (2001)
Time Frame of DTT
¨ Each discrete trial lasts 5-20 seconds with brief
pause between trials.
¤ 1 - 2 minute breaks between sessions.
¤ 15 minute break every hour.

¤ 1 - 2 hour break in the middle of the day.

¨ Recommended amount for 2 - 3 year old children

varies from 10 - 40 hours/week.
 Best Practices in DTT
¨ Errorless learning
¤ Practice doing something right!
¨ Error correction
¨ If a mistake is made, prompt the correct response
¨ Physical control
¨ Functional curriculum (at least at first)
¨ Functional reinforcers (when possible)
¤ If not possible, is your curriculum functional?
¨ Mix a lot of easy tasks with a few hard tasks
¤ What motivational principle is this?
¨ Stimulus Rotation/Discrimination Training
¤ For learning to occur, intermix stimuli randomly (rotate 2 or more
SD‘s randomly) to ensure appropriate stimulus control
Uses for DTT
¨ New Behavior
¤ New speech/communication
¨ New Discriminations
¤ Imitation
¤ Receptive Language
¤ Expressive Language
¤ Conversation
¤ Sentence, grammar, and syntax

¨ Reducing Problem Behavior

¤ Escape motivated problem behavior
¤ Alternative to problem behavior
Advantages/Limitations of DTT
¨ Advantages
¤ A lot of short trials means a lot of opportunities to
learn.
¤ Highly individualized to each child’s skills.

¤ Precise, simple format.

¨ Limitations
¤ Very time intensive
¤ May not generalize to other settings or situations.
Naturalistic Interventions
(e.g., Incidental Teaching)
¨ Focus is on pragmatics (communication)
¨ Interaction which arises naturally in an unstructured
situation such as free play
¤ Used by adult to transmit information or give child
practice in developing the skill
¨ Includes:
¤ Careful observation of the child’s behavior – follow
lead of the child.
¤ Searching for “teachable moments”
¤ Waiting for child to initiate communication/interest.
n Initiating may include: eye gaze, leading, pointing, increase
vocalization
Incidental Teaching

¨ Child choice
¨ Multiple, natural examples

¨ Interaction rather than clinician control -

turn taking
¨ Natural reinforcers

¨ Teaching embedded into day

¨ Fewer “trials”
 Naturalistic Interventions
¨ Types of Naturalistic Language Interventions
¤ Natural language paradigms (Koegel et al., 1987)
¤ Incidental teaching (Hart, 1985; McGee et al., 1985, 1999)
¤ Milieu Intervention (Charlop et al., 1985; Kaiser et al., 1992)
¤ Pivotal Response Training (Koegel, 1995; Koegel et al., 1998)

¨ What they have in common

¤ Focus is on pragmatic aspect of language (social communication)
¤ Interspersed & embedded in natural environment
¤ Use natural reinforcers that follow what the child is trying to
communicate
§ Initiated by the child & focus on child’s interests; waiting for child to
initiate communication of interest
§ Careful observation of the child’s behavior searching for “teachable
moments”
 Examples of Using
Naturalistic Intervention
¨ Community Outings
¤ “Give the librarian the book”, “where is the clock?”
¤ “What is the boy doing?”, “Which girl is throwing?”
¤ e.g., Park; intersperse with climbing on monkey bars

¨ Naturalistically teach emotions

¤ e.g., “How does that boy feel?” (laughing) “point to the sad
girl”

¨ Household chores
¤ e.g., “Put the plate on the table”, “find the red cup”, “give
Don the spoon”, “help mom with the dishes”
See Chapter 6 in “Straight Talk on Autism” by Travis Thompson for more suggestions.
http://travis-thompson.net/#/naturalistic-intervention/4534150129
Watch Video of Dr. Lynn Koegel

https://www.youtube.com/watch?v=oYQ0R
6pSFGE
 DTT versus
Naturalistic Interventions (such as IT)
Discrete Trial Training Naturalistic
(DTT)
Stimulus Items Chosen by clinician Chosen by child
Repeated until correct Varies
Easy to say Natural environment
and functional
Prompts Varied Modeling
Responses Correct responses Attempts are also
reinforced reinforced
Consequences Edibles, praise, toys, etc. Natural reinforcers
 Naturalistic Interventions vs. DTT
¨ “Normalized” interventions (naturalistic): loosely
structured sessions of indirect teaching with everyday
situation, child initiation, natural reinforcers, liberal criteria
for presentation of reinforcers
¨ Discrete-trial training: highly structured direct teaching
sessions of discrete trials, teacher initiation, artificial
reinforcers, response shaping
¨ Review of 8 studies found that normalized language
training was more effective than discrete-trial training
¤ Functional use
¤ Parental affect
Delprato, D.J. (2001). Comparisons of discrete-trial and normalized behavioral language
intervention for young children with autism. Journal of Autism and Developmental Disorders.
Advantages/Limitations of
Naturalistic Behavioral Interventions
¨ Advantages:
¤ Many different opportunities to learn
¤ Child has motivation – natural reinforcement makes in
meaningful and enjoyable.
¤ Promotes generalization (across stimuli, settings)
¤ Less cue dependency
¤ Can be incorporated into everyday activities

¨ Limitations:
¤Not as precise as DTT
¤ Because stimuli may always change, it may not be good for
initial skill acquisition.
Teaching Methods

Initial Acquisition Massed Practice in

Natural Contexts

Promoting “Use” Incidental Teaching

 Comparison of Naturalistic Behavioral
& DSP
Naturalistic Behavioral Developmental, Social-Pragmatic (DSP)
Setting Natural Natural
Teaching episodes Child-initiated Child-initiated

Materials & activities Child-selected Child-selected

Target skills Specific social communication skills (e.g., General social-communication skills (e.g.,
two word phrases, pointing, pretend play social engagement, nonverbal
schemes) communication)
Elicitation strategies Environmental arrangement (i.e., in-sight, Environmental arragenement (i.e.,
out-of-reach, controlling access) communicative temptations, playful
obstruction, wait time)
Prompt strategies Varied according to child’s initiation (i.e., Not a defined component
physical guidance, modeling, explicit
instruction)
Reinforcement properties Natural Natural
Reinforcement Loose shaping, reinforce attempts toward Reinforce all communicative behaviors
contingencies target

Adapted from: Ingersoll, B. R. (2010). Teaching social communication. JPBI, 12(1), 33-43.