Thanks to all who joined us for today’s “Office Hour” webchat with our Chief Science Officer, clinical psychologist Geri Dawson, PhD. Here’s the full transcript.
Thursday December 1, 2011
Hello everyone. This is Dr. Geri Dawson. Thanks so much for joining me today. I am looking forward to reading your questions.
I am curious as to the research base on the consultative model and its impact in providing services with the very young child/toddlers with the diagnosis of ASD. Can this question be answered? Thanks
Hi, Melanie. Providing consultation to birth-to-three providers is a frequently used strategy for helping those providers learn to use ASD-specific intervention approaches. However, I am not aware of any empirical studies that compare a consultative model to direct intervention by specialists. The currently recommendation is for young children with ASD to receive direct one-on-one intervention with highly trained and well-supervised therapists for a significant part of their overall intervention program.
Comment From Julie
Hi Dr. Dawson. My son is 6 and he is echolalic and scripts a lot. any thoughts on how to best address both of these communication issues?
Hi Julie, Echolalia is a common way for kids with ASD to learn to speak. When your child echos back a word or phrase, treat it as a real communication regardless of whether it seems to make sense or not. Use part of the echoed speech but modify it to be more appropriate. For example, if he says, “You want cookie” when he wants something to eat, say “Cookie – you can say ‘I want cookie’ – and then give him what he wants. Continue to model appropriate speech incorporating parts of his echoed speech. The important thing is for him to feel successful in his attempts to communicate as this will keep his motivation high.
Comment From Troy S.
I do, but not sure how to ask it. It’s very general. We have a 2 yr old who hasn’t spoken a word. He was diagnosed at Kennedy Kreiger as being on the s[ectrum. And we are wondering if there are any realistic expectations of when we can expect him to speak his first words….?
Hi Troy, Many two year olds with autism have not yet developed speech. Is your child making any sounds at all? Vocalizing? If so, build on this sounds by imitating them, playing with sounds and songs, and always responding to his sounds as if they are meaningful communication, while modeling the correct word for hiim. Likely, he will start to use words eventually.
Comment From April Costello
@ Julie, there is a wonderful article which further reinforces Dr. Dawson’s recommendation. It is called Finding the Words, To Tell the “Whole” Story by Marge Blanc. It was a tremendous help to me in understanding my Son’s speech patters! :)
Hi April, There are many strategies that parents can use at home to promote language. You’ll want to use these throughout the day during your regular activities, such as mealtime, bathtime, at the park, and so on. Lynn Koegal has written a book called “Overcoming Autism” which describes many strategies that parents can use at home at promote speech. I think you will find that they are very helpful. Here is the link:
Comment From Shane Lynch
Based on Dawson and Osterling (1997) and the National Research Council (2001), family involvement has been cited as an element of best practice. However, unlike the other elements, family involvement is less quantifiable. Have you any thoughts on what “quantity” of involvement is related to improved outcomes? Thanks.
Hi Shane, Family involvement in early intervention is essential. Parents should be at the helm of any intervention program. Although it is difficult to “quantify” as you point out, the key points are that (1) parents should be involved in setting goals for their child that they find meaningful and important, (2) sensitivity to the individual family – their values, beliefs, culture, and so on is needed, (3) parents should be taught strategies for promoting skills at home using similar approaches that are being used at school and in therapy so that these skills can generalize to the larger community environment. The good news is that research is showing that parents can learn these strategies and are effective at using them to help their child.
Comment From Julie
Thanks. as far as scripting. He scripts a lot of TV/ movies and at inappropriate times, like during library time at school. Any ideas on how to manage it when it’s not approproate but also encourage him as he is learning new words through this avenue. many thanks!
Hi again Julie, The key thing here is to determine why and how he is using his echolalia. Does it signal that he is getting overwhelmed? Is he using it in a self-stimulatory fashion? Is he using it to communicate? Depending on the function, you will want to respond in different ways. For example, if he is using it in a self-stimulatory fashion in inappropriate places like library time, his teacher can teach him the idea of “quiet voice” – i.e. he should be reinforced for keeping quiet during the times when that is appropriate.
Comment From Matissa
Hi Dr. Dawson. I teach 2 & 3 year olds at a preschool and we have a few children within our program who are on the spectrum. What tips can you give us as we work with these children alongside neuro-typical children? Esp. as it pertains to class structure and discipline.
Hi Matissa, Children with autism tend to thrive in an environment that is structured, provides routine, and visual supports (such as pictures that explain the sequence of activities). The neurotypical children can be taught to help the children with autism by teaching the neurotypical children to approach and involve them in play. There are a number of well-established curricula and program features that have been used effectively for children with ASD. Here is a link that describes the features of a good preschool program:
Comment From Tami
Is sign language an appropriate tool? It seemed to help our neural typical child and I am wondering how commonly it is used with non-verbal children on the spectrum
Tami, I am not sure how old youg child is, but sign language can help a child with autism communicate. Sign language still can be challenging, however, because it involves complex motor movements and has its own syntax, and so on. So, often the signs used are simple ones. Spoken language, and perhaps other augmentative language devices, such as pictures, should always be used along with sign language.
Advance question From Breiana
My 2.5 year old son was diagnosed with autism 4 weeks ago. We were told to get him in ABA/VB. Is this the most effective method of ABA? What interventions do you recommend we do at home? We are also looking at preschools for when he turns 3. Do you typically recommend an inclusion preschool or an autism only preschool? Thanks
Applied behavior analysis (ABA) is a well-established effective intervention method for young children with autism. Within the broad category of ABA interventions, there are many different models, and Verbal Behavior (VB) is one of those approaches. There is no evidence that VB is more effective than other approaches that are based on ABA. The choice of classroom depends on many factors and the individual child. There is no one size fits all answer.Here is a good website that discusses how to evaluate a preschool program http://www.eric.ed.gov/PDFS/ED486480.pdf . Here are some features you should look for in a preschool program:
-The intervention program should be individualized to each child, taking into account each child’s unique characteristics, strengths, and challenges, and utilized well-validated intervention methods, such as ABA.
-The intervention program should be designed and overseen by a trained, professional, interdisciplinary team.
-A curriculum that focuses on the specific areas of challenges in ASD should be used.
-The program should provide for ongoing data collection on the progress the child is making in each skill area, with adjustments to the program made when progress is not evident.
-The child should be engaged in the intervention activities and receive at least 25 hours of structured intervention each week.
-Parents should be closely involved in the intervention, setting goals and priorities, and be taught how to implement the intervention strategies at home.
Hi Terry – A good article describing the important elements of an intervention program can be found at this link:
Comment From Tracy
Hello Dr. Dawson. Are there national standards in early interventions that you see most frequently used or cited?
Hi Tracy, Here is a document that describes national standards for early intervention:
National Autism Center. National Standards Project – Addressing the Need for Evidence-Based Practice Guidelines for Autism Spectrum Disorders, 2009.http://www.nationalautismcenter.org/pdf/NAC%20Standards%20Report.pdf
Comment From Guest
My daughter is struggling to learn how to handle and care for her 6yr old autistic child. We have been looking for resources but keep coming up empty. Any advise?
Hello Guest at 12:46, Please check out the Resource Guide From Autism Speaks’ Family Services:
Resources Guide from Family Services:
Comment From Tami
My grandson is 6 and it seems as though his behavior changes weekly if not daily. When he does something wrong timeout did work, taking toys away did work, now it seems as though NOTHING works. Should an autistic child be punished? and if so what is the best form of punishment to use?
still typing …
Hi Tami, Children with autism often have behavioral challenges, such as tantrums and sometimes aggressive behavior. Often these behaviors are used to communicate a need or want. Given that children with autism have trouble with communicating with words, they use these behaviors instead. So, the first step is figuring out why the behavior is occuring and what your grandson is trying to communicate. Sometimes, the behavior occurs because the child is overwhelmed or frustrated. So reducing overwhelming situations and frustrations will help. But, ultimately, you will want to teach your grandson to communicate his needs in a more appropriate way. For example, if he tantrums when he wants something, you will want to make sure that you model for him how to ask for something appropriately (even if this is just helping shape his pointing toward an object) and then reinforcing that appropriate behavior by giving him what he is requesting. It is helpful to work with a trained professional who can help you use these strategies. I do not recommend punishment because these challenging behaviors are really the result of difficulties in communication.
Comment From Kristen
I wanted to add about Gabe that he has started to babble A LOT in the last month. He runs up to one of us and screetches AH or EE wanting us to mimic him. Can this lead to eventual speech? He is even making eye contact for periods of 3 to 5 seconds when we are doing this. Is there a way to mold this into more sounds. Right now he does not want to deviate from the 3 or 4 sounds he is comfortable with.
Hi Kristen, Wonderful!! It is such a good sign that Gabe is babbling a lot. Make sure to respond by imitating his babbling and, when appropriate, modeling a word that is simple and builds on the babbling sound. For example, “AH” can eventually become “BAH” and then “BALL”.
Comment From Bill
Dr Dawson, can you comment on how we could do a better job at individualizing the learning and communication for various ‘colors’ of the spectrum. many school districts, doctors and academics have a tendency to lump all of our kids into one ‘autism’ bucket (The DSM V may exacerbate this). How can WE better communicate these more individualized needs of the autistic children to the general population? What do you see us as the autism community need to do better?
Hi Bill,I couldn’t agree more. Kids with autism are each unique and each have their own ways of learning, strengths, and challenges. Although there are some general principles that are helpful for most kids, it is important to individualize each child’s program. Some children learn best through the visual modality and need lots of support to develop speech. Others are talking up a storm but are focusing on only one topic and need to learn how to engage in a conversation. A good educator or therapist should be identifying each child’s learning style and objectives and then developing an indivualized plan for that child.
Comment From Guest
Tami, sign language has been very helpful to my twin sons who are on the spectrum. It seems to have lead to words for one of my boys and it lessens frustration for the other.
Comment From Julie
We’re trying to integrate our son into the typical kindergarten classroom. Any advice to give on how to successful to this. His current classroom is 8 children all on the spectrum. The typical kindergarten classroom is 20 – 25 children. Thus far we’ve agreed to do it one subject at time, starting with library time, moving into music as these are the activities he enjoys the most.
Hi Julie, A good strategy is to familiarize your child with the teacher and classroom ahead of time, teaching him about the layout, routine, and so on. While he is in the classroom with other kids on the spectrum, identify the specific skills that he will need to be successful in the typical kindergarten classroom. Will he need to stand in a line, raise his hand, sit for long periods of time, and so on. Teach and practice those skills ahead of time and then help him generalize those skills to the typical classroom. In addition, start with short periods of time in the typical classroom during periods that are least challenging and then extend the amount of time he is there. Good luck!
Comment From Matissa
Will the transcript from this live chat be available for print after the chat is over? Would love to share this information and links with my fellow teachers.
Yes, we’ll be posting the transcript on our science blog. Here’s the linkhttp://blog.autismspeaks.org/category/science/
Comment From zenaida
My son is 6. I’m trying so hard to teach him to do the right thing. What he does is he takes his poop and puts it all over himself, the sink, door and towel. I don’t know how to stop this. I need help
Zenaida, I know this must be very challenging for you. I think it would be best if you could work with a behavior specialist who can help you get this behavior under control. Here is a link to resources in your area: If you can’t find someone, please contact us at Autism Response Team and we will help you sort this out. Here is the link:
Comment From Tiffany
My non-verbal 4 year-old has just been diagnosed on the spectrum and has been in early intervention programs and speech therapy since she was 2. It seems like she has been on the verge of of communicating vrbally for the last year, she says words here and there, just not consistently. We have been advised to get her in an ABA program, but our insurance won’t cover it. What other resources do you suggest to get our little girl consistently communicating?
Hi Tiffany, Your local school is obligated to provide preschool programming for your child, so be sure to take advantage of that. You can also use strategies at home. Lynn Koegal’s book “Overcoming Autism” describes many strategies for promoting speech and language that parents can use at home. The fact that your daughter is saying words here and there is a very positive sign. Be sure to imitate those words and reinforce them by responding to them.
Our Family Services resource guide:/family-services/resource-guideThat helpful book! http://www.amazon.com/Overcoming-Autism-Finding-Strategies-Transform/dp/0670032948
Dear everyone, I am sorry that the hour is over and went so quickly. I wish I had more time to respond to each one of your questions. Please visit Autism Speaks’ website, especially the Family Services section, to find many resources and tool kits for families. I will be holding another chat in the future so I hope we will have a chance to communicate again. Best wishes, Dr. Dawson
Transcript coming on our science blog:http://blog.autismspeaks.org/category/science/