Therapy Techniques to Remediate Language Deficits

North Dakota Speech-Language Hearing
Association Fall 2008 Convention
By Lisa Roteliuk, M.S., CCC-SLP
Minot State University
[email protected]
Agenda
 Review three essential communication skills for students
with autism spectrum disorders (ASD)
 Review rationale for using visual support strategies for
individuals with ASD
 Discuss using visual schedules and transition helpers
 Discuss Therapy Ideas for five areas of language
 Phonology
 Semantics
 Morphology
 Syntax
 Pragmatics
Essential Communication Skills for
Individuals with ASD (Hodgdon, 2008).
 1. Establishing a Social Connection
 teach the students how to engage with others.
 2. Understanding others
 teach how to interpret social situations, understand
meaning of facial expressions and body language,
changes in routines or rules for behavior.
 3. Communicating wants and needs
 Teach many forms of communication to help reduce
frustration and get needs met
e.g., pointing, gestures, pictures, written language, etc.
Why do individuals with ASD
function better visually?
 1. They have difficulty shifting and
reestablishing attention.
 2. They have difficulty attending to
foreground sounds and blocking out
background noises. (Hodgdon, 1995).
Why do we use Visual Supports?
 They promote students’ strengths and give them a means
to overcome difficult areas (Hodgdon, 1995, p. 11).
 Questions for the skeptic teacher, principal, etc.
 Do you use a calendar to write down important dates?
 Do you use a “To Do” list at your desk or in your home?
 Do you point out advertisement pictures to show desired
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

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items?
Do you make up a shopping list before you go to the store?
Have you ever followed a recipe in a cookbook? Did you
return to the recipe the next time you cooked that item?
Do you ever attach notes to your bathroom mirror as a
reminder to do a task?
Do you scan the menu before ordering in a restaurant?
Why do we use Visual Supports?
(cont)
1. Help organize their environment
 Daily, weekly, or monthly schedules
2. Reduce anxiety felt by student
 Mini schedules to teach specific skill
3. Increase student’s learning efficiency
 Visual cues/prompts
Rationale for Visual Schedules
 Give students information about their life
 Help students gain order for their world
 Serve as a communication aid to discuss and share
daily events
 Improve vocabulary and language skills
 Assist in developing time concepts
 Teach sequence (before/after, first/then)
 Reduce or eliminate behavior problems related to
transitions (Hodgdon, 1995, p. 44).
Daily Schedule
Mini Schedule
Communicating “NO”
 General rule when giving students instructions about
their behavior is to state the expected behavior in a
positive manner.
 May need to clarify information for students by telling
them:
 What is not a choice
 What is not acceptable behavior
 What is not going to happen
 Universal “No” sign
placed over or beside a picture
will help the student know what they can or can’t
touch
Communicating “NO”
 Same universal “NO” sign can be used to communicate
to the student:
 changes in their daily schedule,
 changes in lunch choices,
 changes in personnel
 Having the change represented visually can be calming
for the student and provides them a way to deal with
the change without having to ask for reassurance from
adults (Hodgdon, 2000).
Transition Helpers
1.
Prepare students for transitions.
“You have 3 more turns before we stop.
b. “Only 30 more seconds and the time is out.”
c. Always let the students know before they start a game
how long the activity will last; as the transition time
approaches, give students a verbal or physical warning.
a.
1)
2)
Show ending time on clock or timer.
Create a natural ending by setting out last three cards.
2. Make transitions part of the routine by adding “clean
up” ritual to allow student to naturally shift gears.
Transition Helpers (cont)
3. Give information and cues to prepare students for
what comes next by having them carry the object or a
representative picture icon to the next activity.
4. Let students know when they can return to the
activity they don’t want to leave.
5. Let the student know what will be happening next if
you are moving to an undesired activity (Hodgdon,
1995).
Visual Support Reminders
 Use areas of interest as a motivator and as a
learning tool
 Think outside the box – what works for “typical”
student doesn’t always work for students with
ASD
 Most teachers use some visual supports, but
often not enough for students with ASD
 Everything the teacher says doesn’t need to be
put into a visual form, only the things that have
to be repeated often.
Visual supports for Phonology
 Use mouth puppet as a visual cue to teach placement
 Use mirror as a visual cue
 Use visual phonics or other signs to represent target
sound
 Use tactile cues
 Touch neck for /k/ sound
 Touch top of head for /r/, /k/, & /g/ sounds
 Draw finger down arm for /s/ sound and s-clusters
Phonology (cont)
 Intonation Patterns (Harrington, 2000, p. 71-72).
 When prosody issues appear in your students speech, use
these signs to help them understand how and when to make
your voice raise and lower.

Question – your voice will rise at the end of a question.
?

How was your day?
Statement – your voice will lower at the end of a statement.
.
The sun is hot.
Therapy Ideas for Semantics
 Categorization (Harrington, 2000, p. 73)
 Cut circles out of construction paper. (diameter of circles red = 6 inch, blue = 4 ½ inch, green = 3 inch, yellow = 1 ½
inch).
 Show smallest circle (yellow) to student and write animal on
it (e.g., “giraffe”). This circle stands for a specific animal.
 Show next smallest circle (green) and place beneath yellow
circle, stating it stands for “zoo animals,” the group giraffes
belong to.
 Add last two circles when the student begins to understand
and identify first two categories well. The last two categories
would encompass “all animals” and “living things.”
Giraffe
Zoo
Animal
All Animals
Living Things
Semantics (cont)
 Figurative language
 Learning Idioms
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Focus on 2-3 idioms at a time.
Have the students draw what they think the idiom means on
half of the paper.
Discuss actual meaning of idiom and have student draw the
actual meaning on the other half.
Review the actual meaning of all three idioms and have the
students share their drawings and the meanings with a peer,
teacher, etc.
Semantics (cont)
 Things I Can Say and Do by Michelle Zucker Saunders
 Uses visual organizers to help students understand and
use functional vocabulary.

E.g., Things I Can Do: Shirts
 Tell someone what I do with a shirt.
 Describe my shirt.
 Tell someone where I keep my shirts.
 Ask someone to tell me about a favorite shirt.
shirts
Visual Supports for Morphology
 Verb Bingo game to teach verb tense using visual prompts:
Verb
Bingo
Morphology (cont.)
 Verb tense (Past, Present, Future)
 Use tape to divide room and signs with “today, yesterday, tomorrow”
 Use Starter Phrase Cards “Today we ____.”, “Yesterday we ____.”
 Use backward chaining to gradually fade cues
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1. Student imitates whole phrase said by clinician (e.g., “Yesterday, we
went to town.”
2. Student imitates phrase stated by clinician and fills in the last word
independently. (e.g., “Yesterday, we went to ____.”)
3. Student imitates phrase stated by clinician and fills in the last two
words independently. (e.g., “Yesterday, we went ___ ______.”)
4. Fading continues until the student completes whole sentence
independently.
**You may have to provide two written verb tense choices for the client
to choose from and then gradually fade choices once they are able to
independently fill in the verb.
Visual supports for Syntax
Increase sentence length
Syntax (cont)
Increase sentence length
Syntax (cont)
Increase sentence complexity by
adding prepositions
Visual supports for Pragmatics
 Initiating & Maintaining a Topic
 Use communication journal between home and school
 Autism and PDD Tell Me About It by Michelle Zucker
Saunders
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Provides students with fill-in-blank worksheets that the
student completes at school or home to help them increase
conversational skills.
Helps students:
 Give Details
 Talk about something that happened
 Describe routines
 Problem solve language needed for difficult situations.
Pragmatics (cont)
 Topic Initiation and Topic Maintenance
 Topic Talk Conversation Card Game by Susan Pike (Super
Duper)
 Targets topic initiation, asking and answering questions,
making comments, and maintaining a topic.
 All About You, All About Me Fun Deck by Molly DeShong
(Super Duper)
 E.g., Tell me about your favorite flavor of ice cream.
 Turn Taking
 Use microphone to designate whose turn it is to speak
 Have chip or other object that is passed back and forth
between the speakers/listeners
Pragmatics (cont)
 Conversational Skills
 Comic Strip Conversations by Carol Gray

http://www.thegraycenter.org/store/index.cfm?fuseaction=product.disp
lay&product_id=41
 Uses simple drawings to illustrate a conversation between two or
more people
 Colors may be used to represent emotions felt during conversation

E.g., red = anger; green = happy; blue = sad, etc.
 Defines different parts of a conversation for students

“Talk” bubble, “thought” bubble, listening, etc.
 Students may start out making a comic strip for a conversation
previously taped or drawing as they talk with their teacher
 Eventually they may be used to help the students problem solve an
area of difficulty, such as “topic initiation”
Pragmatics (cont)
 Answering “Wh” and “Yes/No” Questions
 Ask and Answer by Sharon Webber (Super Duper) work well
to provide visual cue to get students started in asking and
answering questions.
 Typically start with more concrete “Wh” forms (What, Where,
Who) and then add more abstract forms (When, Why, How)
 Yes/No Questions - Want to ensure the questions you develop
are ones where you know if the student answers correctly

E.g., Do you have a brother? Is this a book?
 Typically practice these questions individually until the
student shows mastery; then, develop a game board and
practice asking and answering questions within our social
skills group.
Pragmatics (cont)
 References for Asking/Answering Questions
 LinguiSystems
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Autism and PDD Answering Questions
The Basic Reading Comprehension Kit for Hyperlexia and
Autism
Autism and PDD Photo Cards Wh-Question and Interactive
Software
Autism and PDD Buddy Bear and Becca Bunny Book Sets and
Interactive Software
Pragmatics (cont)
 Identifying Emotions of Others
 Student watches video clips of familiar people or use
picture cards with people displaying various emotions
 Student looks at various facial features and answers
questions on a checklist about the features
 Once student completes the checklist for each emotion,
they make a master list stating what the facial features
do for each emotion (Sussman, 2006, p. 21).
 Other resources for Emotions [LinguiSystems – The
Nonverbal Language Kit; Room 14: A Social Language
Program (age 6-10); Room 28: A Social Language
Program (age 11-18)]
Are corners of mouth turned up to a
smile?
Are corners of mouth turned
downward?
Are lips narrowed to a thin line?
Does lower lip sticks out over upper
lip?
Is mouth slightly open?
Are lips pulled tight?
Is upper lip raised?
Is the nose wrinkled?
Are the eyebrows lowered in a
frown and forehead creased?
Are the eyebrows raised?
Do the eyes look down?
Are the eyes filling with tears?
Are the eyes narrow?
Are the eyes open wide?
Are the eyes blinking fast?
Are the eyes crinkled at outer corners?
Do the eyes appear smaller or narrow?
Feeling
What the Eye
Area May Look
Like
What the Mouth
and Nose May
Look Like
Happy
*Eyes crinkled at
outer corners
*Eyes are open
*Mouth corners
turned up to smile
Sad
*Eyebrows lowered
in a frown
*Eyes look smaller
*Eyes look down
*Eyes filling with
tears
*Mouth corners
turned downward
*Lips narrow to
thin line
*Lower lip sticks
out over upper lip
I hear and I forget.
I see and I remember.
I do and I understand.
Chinese Proverb
References
 Boardmaker, Version Six (2008). Solana Beach, CA: Mayer-Johnson
 Gray, C. (1994). Comic strip conversations. Arlington, TX: Future
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Horizons, Inc.
Harrington, K. (2000). For parents and professionals: Autism in
Adolescents and Adults. East Moline, IL: LinguiSystems.
Hodgdon, L.A. (1995). Visual strategies for improving communication :
Practical supports for school and home. Troy, MI: Quirk Roberts
Publishing.
Hodgdon, L. A. (2008). Three essential communication skills for
students with autism spectrum disorders. Retrieved from
http://lindahodgdon.com/newsletter/welcome_issue.html#article2
Sussman, F. (2006). TalkAbility: People Skills for verbal children on the
autism spectrum – A guide for parents. Toronto, ON: The Hanen
Center.

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