Elizabeth Field - Building Communication and Independence for Children Across the Autism Spectrum: Strategies to Address Minimal Language, Echolalia and Behavior

Building Communication and
Independence for Children
Across the Autism Spectrum

Strategies to Address Minimal
Language, Echolalia and Behavior

Elizabeth Ives Field

There is some controversy in the international autism community over the use of person-first or identity-first language. Should we refer to a child with autism (person-first) or an autistic child (identity-first)?

Some parents have a strong preference for person-first language and many professionals have been instructed to use it always.

Some adults with autism spectrum diagnoses strongly prefer to be known as autistic adults while others, like my friend Samuel, consider the controversy to be a distraction from more important issues.

Either way, we are discussing unique individuals with some shared challenges. I am comfortable with either terminology and you will find both person-first and identity-first language in this book. I hope this compromise will be acceptable to my readers.

The children and teens described in this book all have invented names and their characteristics are based on several people who have had similar needs and abilities.

I do not like to keep repeating he or she and I will bet that you dont like reading it either. Because four times as many boys as girls are diagnosed with autism (American Psychiatric Association 2013, p.57), I default to the male pronouns most often when describing characteristics of groups. However, there certainly are girls on the autism spectrum. They are important, and whole books have been written about them. Here, they and their female pronouns will be represented in two of the nine case descriptions.

References used or mentioned are listed at the end of the book. The content of the book is based heavily on my experience with many children, young adults and families, but I do want to recognize people and programs from whom I have drawn evidence, inspiration or support.

Parents everywhere want their children, including those on the autism spectrum, to grow up to be able to sail their own ships: to be Safe, Happy, Independent and Productive.

Many factors contribute to a successful adulthood, including natural talents, family support, education and other learned skills, personal effort and opportunities. Any individuals independence and productivity will differ with these and other variables, but ideally everyone should have the opportunity to maximize his or her own potential.

One very important skill needed throughout life is communication. It is also one of the key areas of difficulty for people on the autism spectrum. In fact, absent, limited or atypical speech and language often lead parents to seek help for their child even before an autism diagnosis is considered.

Communication affects safety, happiness, independence and productivity across domains. For example, if Jake learns to ask for a drink with words, signs or picture symbols instead of hitting or screaming, and Sarah learns to answer questions instead of echoing them, and Derek learns to express his opinion without using rude words and tone, they will have improved their cognition, behavior and social skills as well as their communication.

This book will help speech/language pathologists, teachers and parents of autistic children to teach functional communication skills which are developmentally attainable, immediately practical and of lifelong usefulness to the child and future adult. I will provide 11 chapters of consultation to maximize this progress.

Instead of focusing on diagnosis or new breakthroughs or particular treatment programs, this book is about common issues faced by professionals and families working with children who have different levels of development and varied degrees of autism severity. Mostly, it is about ways to move forward.

I believe we can maximize adult potential by individualizing childhood goals and therapies so that the skills addressed will be attainable, useful immediately and a solid basis for future progress for the child in front of you. Your son, daughter or student will be an autistic child for about 20 years but may then be an autistic adult for 60 years or more. It is essential to select and work on skills that will be important now and in the future.

In this book, I present nine children and teens, divided into three groups based on their communication development. These will include nonverbal children, those with moderately functional speech or atypical language such as echolalia, and the highly verbal individuals who until recently have been diagnosed with Asperger syndrome.

This book will focus mainly on specific ways to improve communication abilities for the children in these subgroups. Since communication does not occur in a vacuum, the selected goals will also impact behavior and social interaction.

I have been fascinated with, and marinating in, the field of autism for more than 40 years, through my career as a speech/language pathologist and autism consultant. I have known many dozens of individuals on the autism spectrum, and usually their families, while working in residential settings, schools and preschools, hospitals, a university and private practice. Often, these relationships have spanned 20 years or more. I have done a lot of speech and language evaluations and therapy, but the majority of my career has been as a consultant to many different public school teams and families working with children and young adults on the autism spectrum for the purpose of increasing communication, independence and appropriate behavior. I have done autism presentations at conferences, in-service events and short courses, distributed e-newsletters to professional colleagues and contributed articles to Autism Parenting Magazine .

This book is a compilation of some of the things I have learned along the way from the wonderful children and families I have been privileged to know. My experience includes children and youth of all ages and abilities, many of whom have shared their lives with me over several years or though their entire school years and into adulthood. The recommended goals and detailed teaching methods in this book are designed for speech/language pathologists and teachers to use in schools or clinics, for parents to use at home and for teams to consider in program planning.

My approach to intervention is rooted in the field of communication disorders with strong developmental and behaviorist influences. I value and draw inspiration and support from the research evidence and experiences of all these fields.

The American Speech-Language-Hearing Association (ASHA) is the national organization of speech/language pathologists and audiologists. In a position statement by the Joint Coordinating Committee on Evidence-Based Practice, ASHA describes evidence-based practice as an approach in which current, high-quality research evidence is integrated with practitioner expertise and client preferences and values into the process of making clinical decisions (ASHA 2005, p.1).

An extensive review by Wong et al . (2014) lists more than 20 therapeutic approaches that have sufficient research support to be considered evidence-based. These include approaches thickly woven through my intervention procedures in the chapters of this book such as: