1. Developing an Intervention Program for the Verbal Child with Autism:

After considering the above questions, an intervention program can then be developed to address the child's verbal communicative needs.

  • Addressing Unconventional Verbal Behaviors (UVBs):

After determining if the child is using UVBs for non-communicative and/or communicative purposes, the following intervention strategies can then be tried:

Non-Communicative Purposes:

  • Modify situations that might be stressful or anxiety producing for the child, thus resulting in the occurrence of UVBs
    • Example: A child consistently exhibits an increase in UVBs during gym class, possibly because gym is a less structured environment with unclear expectations. The use of visual support strategies such as a gym class schedule, visual boundaries marked off with floor tape, etc., can increase the child's comprehension of this environment and thus reduce overall feelings of stress/anxiety. This may result in a decrease in the occurrence of UVBs.

  • Simplify verbal messages given to the child. It is easy to overestimate a child's language comprehension abilities when considering the length and complexity of some echolalic utterances used by the child. Although the child may echo 8-10-word grammatically complex sentences, this is not a true reflection of the child's overall language abilities. In fact, the child's ability to comprehend language may be significantly impaired. Without realizing it, many people may use language too complex for the child with autism to understand. As a result, some children may show an increase in the occurrence of UVBs due to stress/anxiety associated with auditory information overload. Avoiding excessive talking and using simple, concrete sentences can assist the child in more readily understanding verbal messages, and thus decrease the occurrence of UVBs.

Communicative purposes:

  • Replace the UVB with a more appropriate form to express the same language function.

    • This could be accomplished in two ways: through providing a more appropriate verbal model, and by using visual support strategies, such as pairing a visual symbol with written words that the child can use.

    Example: A child uses this echolalic utterance to request to go to the bathroom: "Do you have to go to the bathroom, Mark?". The teacher provides a more appropriate verbal model for the child to echo, such as "I have to go to the bathroom", in order to demonstrate a more appropriate phrase. For another child, a picture symbol of a toilet with the written words, "I have to go to the bathroom," is positioned in close proximity to the child. Initially the child is physically prompted to pick up this card and "read" the words/picture to assist in making an appropriate verbal request.

  • Always respond to UVBs which are produced with communicative intent; that is, when the child anticipates a response to his UVB utterance. If the communicative partner responds verbally, he should use language skills comparable to the child's true language level (i.e., a simplified verbal response) as well as emphasize a relationship between the child's UVB and environmental referents such as objects, actions people (9).
    • Example: A child uses the echolalic utterance, "Are you ready for some football?" (from the Monday Night Football theme song) to request to play football. The adult responds by saying, "Let's play football!" and hands the child a football.

    Sometimes the communicative partner may need to respond to the child, using a visual support strategy that the child readily understands, rather than using only a verbal response.

    Example: A child with autism goes to different locations after school. He perseverates, stating, "Go to Grandma's?" to ask about that day's location. The school staff develops a daily visual schedule representing the locations the child is scheduled to go to after school. When the child perseverates, "Go to Grandma?", he is referred to his visual schedule, which he readily comprehends.

  • Use alternative communication strategies to facilitate expressive communication. The use of alternative communication strategies, such as picture communication symbols or written words, may help the child, who primarily uses UVBs for expressive communication, to communicate in a more appropriate manner. These visual alternatives also provide a "backup" in more stressful, anxiety-producing situations (9).
    • Example: A child uses, "Want a snack?", throughout snacktime to indicate that he wants more to eat or drink. A picture exchange communication system is implemented to teach the child how to request specific snack items, rather than relying upon the generic echolalic utterance of, "Want a snack?".

  • Developing/Increasing nonverbal social communication (discourse) skills:

    The child's ability to both understand and use various nonverbal social communication (discourse) behaviors should be addressed (See previous listing of various nonverbal social communication behaviors). The following interventions strategies are suggested.
    • Understanding nonverbal social communication behaviors: Various strategies such as audio-taping, video-taping, role-playing, etc. can be used to increase the child's ability to understand nonverbal social communication behaviors. For example an audio-tape can be used to teach the child to initially recognize varied vocal volumes, rates of speech and inflectional patterns both in his own speech and in that of others. Once the child is able to recognize these vocal features auditorilly, a video-tape might be used as the next step to teach the child to understand what these vocal features might mean in different contexts. This would be helpful in teaching the child that he needs to use multiple cues to appropriately understand and respond to these behaviors. For instance a raised vocal volume can indicate anger, a warning for danger, a call for attention, etc. Additional contextual features, such as the immediate environment and the person's facial expression or body language, must also be taken into consideration to appropriately interpret the raised vocal volume.
    • Using nonverbal social communication skills: Strategies such as modeling, role playing audio-taping, video-taping, Social Stories (5), Comic Strip Stories (4), etc., can be used to teach the child to use nonverbal social communication behaviors.
      • Example: A child is taught to gesture, "come here", through modeling, role playing and video-taping. Another child is taught to identify and monitor different vocal inflections, both in his own speech and in others', through the use of an audio-tape. A Social Story (5) and video-taping can be used to teach a child to maintain acceptable physical space and exhibit appropriate body language when communicating with others.

      Visual support strategies can also be effective in teaching the child to use appropriate nonverbal social communication skills. One such strategy is to print nonverbal social rules on a card the size of a business card. The child keeps the card in his pocket for an easy visual-rompt reference in social situations: "Look at the person who I am communicating with"; "Stand about 2 feet away from the person"; "Am I talking too loudly or not loudly enough? ", etc.

  • Developing/Increasing verbal social communication (discourse) skills:

    • Typically children develop social communication skills with relative ease. However children with autism need specific and direct instructions in this area, as they do not usually exhibit a natural tendency to engage in social communicative interactions (11). Strategies to focus on increasing a child's verbal discourse skills should be implemented through specially designed activities, particularly those which are highly motivating to the child, as well as through feedback during naturally occurring conversational exchanges (9) & (11). For example if the child is highly interested in "Pokeman", set up activities to focus on social communicative interactions revolving around this theme. When teaching verbal social communication skills, it is important to consider the discourse skills of, and interests of typically developing peers, including topics of discussion. While " Pokeman" might be a high interest topic for a middle school student with autism, this would not be an appropriate theme to use to teach social communication skills with middle school peers. The following strategies can be used to address various verbal social communication (discourse) skills:

    • Develop dialogue scripts (11): Dialogue scripts are used to visually script for the child each communicative partner's "lines" for a communicative exchange
      • Example: Partner 1: "Did you see the movie Chicken Run?" Partner 2: "Yeah, it was really funny. I liked the part when the chickens got in a big fight. What part did you like?" Partner 1: "I liked the part where the chickens were trying to learn how to fly".

      Depending on the individual child, dialogue scripts can be visually represented by written words, pictures, picture symbols, etc.. Dialogue scripts can be used regarding normally occurring routines/activities, as well as in contrived situations designed to increase the child's social communication skills in a structured context (11).

    • Engage in joint activity routines: Joint activity routines are familiar, highly predictable routines established with the child through repetition. These may include food-making routines, such as making Kool-Aid or chocolate milk; symbolic play routines involving play themes, such as eating in a restaurant, sports activities, etc. These routines also incorporate familiar, repetitive communicative interactions, providing an effective language learning strategy for children with autism (a strength feature of autism is a preference for routines (11)). Joint activity routines allow for the child and adult to engage in meaningful, natural social communicative interactions within the routine of an activity. An additional positive outcome in using joint activity routines is that they teach the child that he can share experiences with others through communication (2).
    • Use of visual support strategies: Various visual support strategies can be used to teach the child verbal social communication skills, as exemplified by the following:

"Turn-taking Card"

Turn-taking cards: A visual turn-taking card is a card with "my turn" printed on it (a graphic symbol can also be used depending on the child's ability to understand various visual representation systems). The turn-taking card is passed back and forth between communication partners to visually represent each conversational partner's turn in the conversation.

    Games: Social communication games can be created involving various social communicative directives printed on cards, such as, "Initiate a new topic", "End the current topic", "Ask someone a question related to the current topic", etc. The cards are then placed face down on the table and the students take turns drawing cards and following the communicative direction.

    Topic ring: Various appropriate topics to initiate are printed with either graphics, or written words, on a collection of cards (approximately 3" by 2") attached by a metal ring (e.g., "What have you been doing this summer?"; "Have you seen any good movies lately?"). The child can keep these cards in his pocket or attached to his belt loop for a visual prompt regarding appropriate topics to initiate with others. Typically these topics have first been taught in a small group setting, prior to having the child use this visual support strategy in less structured settings.

    "Conversational rules" business cards: Conversational rules, such as "Get the person's attention before speaking to him"; "Let the other person have a turn to talk", etc., can be written on small cards for the child to keep in his pocket. These cards serve as visual prompts to help the child engage in appropriate verbal social interactions.

  • Act out children's stories (11): Familiar stories can be acted out using manipulatives such as puppets, flannel board props, etc.. Initially the adult can teach the familiar story, using the props. The child can then be encouraged to "act out" certain characters of the story beginning with a character that has repetitive lines, if possible, such as the Big Bad Wolf in the "Three Little Pigs". Use of this strategy teaches the child verbal conversational turn-taking skills through an easily understood, visually motivating activity.
  • Encourage replica play (11): Miniature toys such as dollhouses, farm sets, airport sets, etc. can be used to act out social communicative interactions. Initially repetitive and familiar communicative routines are taught. Gradually the familiar routine dialogues can be altered, to allow for more spontaneous, generative communicative interactions to occur.
  • Use of videos: Videotaping social communicative interactions can be a very effective strategy to address social communication difficulties. The child can view videos of peers or others engaging in appropriate social communicative interactions as well as videos of himself in similar situations. Videos of the child with autism engaging in social communicative interactions, are beneficial for increasing the child's self-awareness and self-monitoring skills.