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THE ADVANCE
 
Reinforcement Board for Behavior, Motivation
By Aileen Montag, MA, CCC-SLP

 

Speech-language pathologists who work with children often have to deal with many problematic behaviors that make progress in therapy difficult. While we are trained in the speech aspect of therapy, we receive little training in other aspects that can be very challenging.

I have found that children sometimes demonstrate more problematic behaviors during speech therapy than at other times because communication is very hard for them. For therapists working with young children, it can be challenging to work on speech and language goals when they engage in so many interfering behaviors and have limited motivation and/or attendance.

Before speech or language intervention is implemented, the therapist should develop a way to deal with problematic behaviors such as hitting, kicking, biting, being self-directed, having difficulty attending, and being non-compliant. Speaking with the school psychologist or social worker is beneficial.

One technique that I have found helpful on many occasions is the use of a reinforcement board. The board helps motivate children by providing a preferred reward while helping them visualize their progress toward that reward. A sample board is featured on this page.

To implement this technique, pick something that motivates the child, such as playing with bubbles. Have the child work for this reward by doing what is asked.

Put a picture of bubbles at the end of a piece of cardboard or other sturdy backdrop. Using Velcro®, attach happy face images or something the child enjoys, such as cars, consecutively, with the picture of the bubbles last. When a required task is completed, the child gets to remove one happy face.

Happy faces are removed one at a time as the child does each required task until there are no happy faces left on the board. The only remaining image will be the picture of the bubbles. The child then gets to play with the bubbles as a reward for completing the required tasks.

Therapists also can use the board to stimulate more language by having the child choose a reward from several pictures. For example, a child who enjoys bubbles, pretzels and toy trains may choose a reward from among these three items. The child's choice is the picture you place at the end of the board.

For children who are able, it may be helpful to have them count the happy faces as they are removed so they can see their progress toward the reward. Therapists can substitute actual objects at the end of the board for children who are not able to use pictures
 


Visual Cueing in Autism
By Aileen Montag, MA, CCC-SLP


Children with autism spectrum disorders (ASD) often present with difficulties in the realms of communication, socialization, sensory integration and behavior. In order to maximize their potential, certain strategies must be implemented to make tasks more concrete, specific and manageable.
The use of visual cueing has been helpful for many of my students. Visual cues, which are often used to help with both independent and therapy-based tasks, can be used in a variety of ways depending on a child's cognitive and academic abilities.

Use of a first/then board is helpful in getting children to perform a less desirable task by rewarding them with a desired outcome. The clinician can create a small chart that says "First" on the top with a picture of the task and "Then" on the bottom with a picture of the reward. They are shown that by doing A, they will get B. For example, a child may have to complete a puzzle in order to use the computer.

Another helpful tool is a reinforcement board. Children earn tokens (i.e., happy faces) and place them in the designated spots as they work toward a desired outcome.

Visual cues can be helpful for reducing verbal load. Many children with autism have difficulty blocking out excessive stimuli. Simply showing a picture of a written word may be all that is necessary to cue a child toward a desired task or rule. For instance, a written cue that says "quiet hands" may be more effective than continually verbalizing to a child to keep his or her hands "quiet."

Cues should be phrased in what the child should do rather than the negative behavior (i.e., "quiet hands" vs. "stop touching your friends"). In my program therapists and teachers wear necklaces with pictures of various social rules depicted on them. This enables the teacher to quickly flip to the desired picture and cue the child on the spot.

This approach also can be used in the form of sign language to improve both expressive and receptive language skills. Children often learn to pair commands with a sign to help them remember directives and questions. When using signs, teachers and therapists should model continually for the children. Some children with autism need more explicit instruction with signing if they have motor planning problems.

Visual cues can be used to cue children for language targets as well. Use pictures to cue verb use, "wh" questions and other grammatical targets. Pictures also can be put together as cues for forming sentences.

The use of social stories and/or written cueing may be helpful when geared toward specific activities. For example, if a child has difficulty with waiting, a strip of written cues can be placed on the child's desk. The strip can consist of rules for waiting time, such as "When I wait, I keep my pencil on my desk" (rather than "I don't flick it at others") or "I wait for the teacher to call on me before I give my answer" (instead of "I don't call out").

Visual cues can be used in a variety of ways to help children with ASD. It's important that clinicians begin to fade out the use of cues as soon as the child can handle the stimuli. In some cases, however, cueing may always be needed. After all, people in general often use visual cues like reminders and schedules to help organize daily tasks. With effective strategies children with autism can function to their fullest potential.
 



Team Approach to ASD
By Aileen Montag, MA, CCC-SLP


Working in an autism cluster at an elementary school presents numerous challenges for the speech-language pathologist. The program I work in consists of several self-contained classes with various levels of inclusion in the regular education population depending on each child's needs and level of function.

Due to the complex nature of autism spectrum disorders (ASD), it is vital that speech-language pathologists provide treatment in conjunction with other professionals. Behavior specialists can help with challenges that arise from communication difficulties, sensory overload and other causes. An occupational therapist can assist with sensory issues by offering ideas such as sensory diets and activities to calm or alert the child.

Working on speech and language goals with a child whose senses are overloaded or understimulated is a tremendous task. Children who demonstrate more organization with their bodies and minds are in a better position to learn.

In return, speech-language pathologists can provide a great deal of information to other professionals. When behavioral challenges are caused by the environment, students should be in a highly structured classroom that allows them to know what is happening, with whom, where and when.

Visual cuing helps children understand and express themselves. Speech-language pathologists can assist teachers in developing a picture system that takes into account a child's language level. I often discuss language levels with teachers and aides to ensure children understand and express themselves to the best of their ability.

Children are who distracted and have difficulty attending to tasks for long periods benefit from a combination of active and table work, with appropriate breaks. For example, when working on prepositions, children appear to do best when they are part of the action. Having them go under a table or behind a chair keeps them active and helps with body awareness. Table work then reinforces the concepts of active work.

Working with parents is essential, no matter what speech and language difficulty a child has. Consistency is particularly important with the autism population, but school demands can make this difficult. Motivators can help children work toward desired goals. Parents are usually the best people to ask what motivates their child.

Children may be involved in various structured programs for different skill areas. Knowing what these areas are helps to plan treatment. If a teacher is working on skills in the classroom in a discrete trial-type format, the speech-language pathologist can work on the same or similar skills in both structured and less structured environments.

The same goals can be used in a more functional manner to help with carry-over. For example, if a child is learning body parts in a structured approach, the speech-language pathologist can include body parts in a vocabulary session by doing structured and less structured activities, such as bathing a doll while using the vocabulary.

Speech-language pathologists can be an important source of support for mainstreamed students. Some children on the spectrum excel in regular education and function close to or even above their peers academically. However, many children with autism have difficulty with abstract language and activities that require thinking "out of the box." They may need support to complete an activity that asks them to relate past events, such as writing about their weekend. Many children also need help with peer language and socializing. Knowing a child's difficulties helps a teacher pair the student with appropriate peers.

Working as a team is the best approach to help children with autism cope with their environment, behave appropriately, and communicate to their fullest potential. The speech-language pathologist is an important part of the team. The information we share can have a major impact on a child's functioning. While there are many challenges when working with this population, the rewards are unimaginable.
 



as seen in

HELIUM
 
What To Look For In A School For An Autistic Child
By Aileen Montag, MA, CCC-SLP


Children with Autism Spectrum Disorders often require specialized school environments. An environment that fosters sensory, communication, and behavioral supports is essential. Children with Autism tend to do better in schools with structured learning, where the child is given numerous opportunities to communicate using any modality that is effective. Many school environments for Autistic children center the child's day around a daily schedule, where the child is able to see the schedule, and know what to expect for the day. In addition to these schedules (which are often depicted by pictures), schools should provide supports to enable the children to learn to their fullest potential. Many of these supports are based on pictures depicting choices, first/then boards, and cues to help the child with things such as social rules. Since children with Autism often have sensory difficulties and behavioral challenges, school environments need to have plans in place to address these issues. Picture cues of rules for school are often helpful. Examples of this would be pictures or written text depicting such things as "quiet hands", "time to listen", "sit down", etc.

Supports for behavior are well needed and often involve behavior plans, where members of the school team work together on plans to control problematic behaviors. Since many children with Autism Spectrum disorders tend to have sensory challenges, a school environment needs to address these issues. Consultation with an occupational therapist is one suggestion. Other suggestions are to engage the child in activities which may be calming or which may help the child with sensory overload. An example might be taking the child for a walk when the child appears over stimulated. For children entering higher grades, and, or, being mainstreamed into regular education, communication with the special ed team and the regular education team is essential.

Many children with Autism Spectrum disorders have difficulty with both social skills and with communication skills. A Speech Language Pathologist should be on staff, and should work closely with the education team to help the child communicate and understand vocabulary, curriculum, etc. Many children with Autism need help with assignments such as writing, reading, and language. Since language difficulties are seen in most Autistic children, these difficulties often lead to further difficulty with academics. This is especially true for subjects where the child has to be creative with their language, such as with writing a story, drawing a picture, comprehending a story,etc. Activities which require the child to be more creative and "think out of the box" tend to be more difficult. It is essential that the school curriculum be adapted by using cues, prompts, and models to make things more literal for the child and less abstract. Once the child becomes more competent with material, these cues can be faded. With the necessary supports in place for behaviors, sensory integration, socialization, and communication, children with Autism can develop their skills to their fullest potential.

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