howard shane, phd, ccc‐slp

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HowardShane,PhD,CCC‐SLPEmilyLaubscher,M.S.,CCC‐SLP

JamesSorce,PhDRalfSchlosser,PhD

JenniferAbramson,M.S.,CCC‐SLPSuzanneFlynn,PhD,SLP

American Speech Language Hearing Association (ASHA) Convention November 18-20, 2010

Philadelphia, Pennsylvania

www.aac-rerc.com

This work is funded by the National Institute on Disability and Rehabilitation Research of the U.S. Department of Education, under grant number H133E030018. The opinions contained in

this presentation are those of the grantee and do not necessarily reflect those of the U.S. Department of Education.

IntroducEontotheVisualImmersionProgram(VIP)•  Development,ra.onale,coreprinciples,tools

IntroducEonofthefieldstudy•  `Goals,design,procedures,par.cipant

DiscussionofintervenEontechniquesandpreliminaryresults

DiscussionofconclusionsandimplicaEonsforclinicalpracEce

DocumenteddifficulEeswithspokenlanguage(Boddaertetal.2003;Wetherby&Prizant2000)

RelaEvenaturalstrengthsinvisualprocessing(Althaus,deSonneville,Minderaa,Hensen&Til1996)

Naturalpreferenceforvisualinput,especiallyelectronicscreenmedia(ESM)(Shane&Albert2008)

CurrentuseofvisualslimitedtoteachingofisolatedoperaEons

*TheVisualImmersionProgramrepresentsana^empttomovebeyondcurrentinstrucEonalnormsbyprovidingmaximumaccesstolanguagethroughthevisualmodality.

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EnvironmentisvisuallyimmersiveVisualssupportcomprehensionandexpression

Visualssupport7disEnctcommunicaEvefuncEons•  Protes.ng•  Organiza.on/Transi.ons•  Reques.ng•  Direc.ves•  Commen.ng

•  Ques.oning•  SocialPragma.cs

Scenecues•  Dynamicscenecues(videoclips)•  Sta.cscenecues(photographs)

MixeddisplaysElementcues•  GraphicsymbolsTopicDisplaysSobwareHardware

ActualizethecoreprinciplesExpandandrefineinstrucEonalprogram

•  Teachingtechniques•  Tools–roleoftechnology

EvaluateeffecEvenessofapproachonanongoingbasisTeachandtrainotherstoimplementtheprogram:TraintheTrainermodel•  Ini.alevalua.ondonebythefieldworker•  Fieldworkerprovidesmodelingandtraininginuseofvisualsupports

•  Fieldworker“stepsback”andmentors“stepup”

Casestudydesign(Yin2009)•  Two‐yearstudy•  Focusedononeprimarysubject(BC)

Implementedacrossallkeyenvironments•  Home•  School•  Community

TrainedmulEplementors•  Parents,homeaides,familyfriends•  Teachers,schoolaides,classmates

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Baselineassessment•  7func.ons•  Formaltes.ng,recordreview,observa.on,interview

DevelopedInstrucEonalProgram•  Determinedgoals•  Designaninstruc.onalapproach

Createdandimplementedvisualmaterials

Providedtraining

Evaluatedprogressandmodifiedgoals/materialsasneeded

Age:17years

Gender:FemaleDiagnosis:Au.sm

Medicalstatus:grossandfinemotordifficul.es

EducaEonalstatus:Substan.allyseparateclassroom;Voca.onaltransi.onalprogram

Preferences:electronicscreenmedia,art,reading…

GeneralCommunicaEonSkillsatBaseline

Overall

–  DifficultyestablishingandmaintainingjointaZen.on

–  Longprocessingdelays–  Echolalicspeech–  Abletodecode;reducedcomprehension

–  IncreasedaZen.onwithvisualsupports–photographs,videos,textComprehension

–  Difficultywithabstractlexicalconceptsencodedinverbs,preposi.ons,descriptors

–  Reliesheavilyoncontextcues,physicalandgesturalsupportExpression

–  Infrequent–  Primarilyphysical;occasionaluseofscriptedphrases

The Field Study: Intervention Techniques and Preliminary

Results DatafromYear1Presented:

–  Direc.ves–  Commen.ng

–  Ques.oning

3sourcesofdata:–  Videoanalysis–  Progressnotes–  Socialvalida.on

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Directives: Definition

•  Languageusedtocontrolthebehaviorofanother.

•  DirecEvesarebothrecepEveandexpressiveinnature

Directives: Assessment and Baseline for BC

•  ComprehensionbestwithinrouEnes

•  DifficultywithcomprehensionofnoveldirecEves

•  Didnotdirectothers

Directives: Goals and Strategies

Goal:IncreaseknowledgeofconceptsandsyntaxthroughdirectinstrucEon–  Teachtheconcept

•  Conceptinplausibledirec.ve•  Conceptinnonsensedirec.ve•  Contrastwithotherconcepts

–  Integrateintorou.nes–  Graphicsymbolsforopportuni.eswherepersonalizedsupportsnotavailable


Goal:PromoteparEcipaEonincommonrouEnes*–  Improvecomprehension

•  Example:preparingtogotothebeach

–  ImproveaZen.on•  Example:dressing

*ProgressionfromscenecuestoelementcuesmirrorsinstrucEonalformatasdetailedpreviously

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Goal:Promoteabilitytodirectothers–  Usingsingleconcepts

•  Iden.fyopportuni.es(open,drive)•  Placevisualsandmodel

•  Visualsremainavailabletosupportword‐finding

–  Graduallyincreasecomplexityofdirec.vesexpressed•  UsingTLC(Example:Openthewater)

•  UsingTopicdisplays(Example:Drivefast)

Directives: Preliminary Results

Evidencefromvideoanalysis–  Increasedaccuracyinfollowingdirec.vesdeliveredusinglanguage

•  Data–  Increasedfrequencyofexpression

•  Increaseinrateofdirec.vesgivenbylearnerfrom0/hourto1/hourinrandomvideosample


Evidencefromprogressnotes–  Demonstratedincreaseincomprehensionofconceptstaught

•  Selecteddatasample

–  BCnowanac.vepar.cipantinmorecommonrou.nes

–  Expressiveuseofcombinatorialseman.crela.onsemerging

•  Example:TLCdata


SocialValidaEon–  “BCisdefinitelyrespondingbeZertolanguage/commands.Sheknows

muchsoonerwhatisbeingaskedofherthanshedidpreviously.Theeffectisveryno.ceable,maybemoresofor[hersister]andmebecauseweseethedrama.candnotgradualchanges.”–BC’sbrotherinlaw

–  “KnowinghowtobestteachBChasallowedustoaskmoreofBCandincreaseherageappropriateabili.esandindependence.Asanexample,BCnowclearsherplacefromdinnerindependently,witheithernoor1prompt.”–BC’sstepmother

–  “Shelearnedfromthevisuals”–BC’smother

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Commenting: Definitions

ObjecEvecomment‐exchanginginformaEonthatdescribessomeoneorsomethingbyincludingsomeorallofitsrelevantcharacterisEcsorqualiEesthatarealsoperceivablebyothers(e.g.,who,what,where,when,etc.).

SubjecEvecomment‐aremarkintendedtoshareone’sinternalstatee.g.,thoughts,feelings,opinions,orreacEonstoanevent,acEvity,objectorperson.

Commenting: Assessment and Baseline for BC

ObjecEveCommenEng–  Abletolabelpeople,objects,someac.onswhenprompted–  Nospontaneouslabelingnoted

SubjecEveCommenEng–  Useofbehaviorandfacialexpressions–  Occasionaluseofscriptedphrases

Nospecificsupportsinplace

Commenting: Goals and Strategies

Goal:IncreaseoverallcommenEng(frequency,spontaneity,variety,complexity)–  Iden.fyinterests–  Providevisualsandmodeluse

•  Individualsymbols(lowtech,hightech)•  Topicdisplays

–  Includevariedvocabulary(descriptors,phrases)

Commenting: Preliminary Results

Evidencefromvideoanalysis–  increaseinfrequencyofcommen.ngfrom3atbaselineto7atfollow‐up

–  Increaseinuseofgenera.ve(unscripted)language

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Commenting: Preliminary Results

Evidencefromprogressnotes–  Spontaneoususeofcombinatorialseman.crela.onsemerging–video

–  Increasedmodelingofcommentsonthepartofmentorsobserved

•  Increaseininstancesofimmediateecholaliawithsimultaneouspoin.ngtothevisualsobservedinmanyinstance–processing/prac.cing/aZending

Questioning: Definition

InterrogaEvesentences,phrases,orgesturesthatarespokenorwri^en

QuesEonsaredirectedtosomeoneinordertoreceiveinformaEoninreply.

QuesEonshavebotharecepEveandanexpressivecomponent

Questioning: Assessment and Baseline for BC

  ResponsetoYes/NoquesEonsunreliable  Abletoanswer:

  “who”ques.ons(labeling)  “what+be”ques.ons(labeling)

  Unabletoanswer:  What+doques.ons  Whereques.ons  Open‐endedques.ons  Otherques.onforms(e.g.,How,Why)

  DoesnotcurrentlyusesymbolicmeanstoaskquesEons  Yes/NoquesEonsandopen‐endedquesEonsaskedfrequently;nosupportsorinstrucEoncurrentlyinplace

Questions: Goals and Strategies

Goal:IncreaseabilitytorespondintenEonallytoyes/noquesEons–  Directinstruc.on–  Transi.ontodailyinterac.ons

•  Preferences•  Basicneeds

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Goal:Providesupportforresponsestoopen‐endedquesEons–  Visualchoicedisplays–  Useofdistracter


Goal:Teachuseof“Idon’tknow”–  Videomodeling

Questions: Preliminary Results

Evidencefromvideoanalysis–  Abilitytorespondcorrectly/inten.onallytoagreatervarietyof

ques.ontypesduringongoinginterac.ons•  Chart

–  Mentorsnowaskingques.onstogainrealinforma.on•  chart


Evidencefromprogressnotes–  Consistentresponsetoyes/noques.ons

•  Atthetabletop•  Duringreal.meinterac.ons

–  Generaliza.ontoyes/noques.onspertainingtoopinions•  video

–  Emerginguseof“Idon’tknow”asaresponse

•  Graph–  Abilitytorespondtoopen‐endedques.onspertainingtopreferences

•  Baselineandcurrentperformance

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SocialValidaEon–  Weusedtheyes/nosymbolsalotthisweekend–sheisreallygood

withthem!Ireallytrustheranswers!”‐BC’smother

Conclusions

Intensityofanimmersiveenvironmentmaycontributetobe^erresults•  Mul.pleenvironments

•  Mul.plementors

Technologycrucial•  Accesstomaterials

•  Moreeffec.vematerials

Confirmeda^racEontomedia(ShaneandAlbert2008)

Conclusions cont.

TraintheTrainermodeloffersnewopportuniEes‐progressioninnatureofparEcipaEon:•  Acceptance•  Jointownership•  Jointgoaldevelopment

•  Crea.onandprogrammingofdevices

ConEnueddevelopmentneeded•  Instruc.onalstrategies•  Tools

Implications

Currentservicedeliverymodelmayneedtobeexpanded–howtomakethisareality?

•  Mul.plementorsinvolved

•  Mul.pleenvironmentsinvolved•  Needforapoint‐person(SLP)

•  Establishgoals•  Modelinstruc.on•  Monitorlearner’sprogress

•  Coordinatethe“team”

•  Needforintui.ve,affordabletools

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QuesEons?

Thankyou!

Dynamic scene cue targeting the concept “push”

Static scene cue targeting the concept “push”

Mixed Display Targeting the Concept “Push”

Language Elements: Graphic icons representing the individual linguistic components comprised in the action scene (e.g., subject, verb, object, preposition, etc.).

Static Scene Cue: Still frame photographic images that capture a prototypical moment in the full-motion dynamic scene

Sentence Strip: Directives may be constructed here by affixing Corresponding language elements to the sentence Strip through the use of Velcro

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Element cues targeting the concept “push”

Graphic symbols

Teaching Language Concepts (TLC) Software

Directives: Plausible Directive

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Directives: Nonsense Directive

Directives: Contrast with Other Concepts

Directives: Integrate into Routines

Directives: Aided Language Stimulation

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Directives: Support for Comprehension Directives: Support for Comprehension

Directives: Support for Comprehension Directives: Support for Attention

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Concept Mostabstractlevelofsupportusedsuccessfullybymentorstosupplementspeech(quiet,non‐distracEng

environment)

Baseline 6Months 12Months

Wipe(Ac.on+ObjectPhrase)

PhysicalorGestural

VisualElementCues

None

Hangup(Ac.on+Object+Loca.onphrase)

Gestural DynamicSceneCues

VisualElementCues

On(Agent+Preposi.on+ObjectPhrase)

Gestural Sta.cSceneCues Sta.cSceneCues/MixedDisplays

%DirecEvesFollowedAccuratelyDuringaRandom1‐HourPeriod

Baseline 1‐Year

Rou.ne 18% 51%

Novel N/A 29%

Comprehension of Directives

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Percen

tofrespo

nsesintenE

onal

Date

IntenEonalresponsestoyes/noquesEonsregardingpreferences‐structuredacEvity

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20

40

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80

100

120

7/13/10 7/20/10 7/27/10 8/3/10 8/10/10 8/17/10 8/24/10 8/31/10 9/7/10 9/14/10 9/21/10 9/28/10 10/5/10

Percen

tofrespo

nsesintenE

onal

Date

IntenEonalresponsestoyes/noquesEonsregardingpreferencesinongoinginteracEons

NumberofIntenEonalorCorrectResponsesDuringRandomVideoSampleofDaily

InteracEonBaseline 1year

Yes/NoquesEons 0/10 1/7

Open‐endedquesEons 0/1 1/3

What+bequesEons 0/1 1/1

NumberofCorrect/IntenEonalResponsesProvidingNewInformaEonComparedtoTotalNumberof

Correct/IntenEonalResponses

Baseline 1year

0/2 2/3

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%correct

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%"What+do"quesEonsansweredcorrectlywithvisualsupport

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%opp

ortuniEesinwhich"Id

on'tkno

w"used

correctly

Date

Useof"Idon'tknow"inresponseto"wh"quesEons

Performancesummary:VideodescripEontaskusedtoteachcombinatorialsemanEcrelaEons

usedwithincommondirecEves

1/21/2010 5/13/2010

“(BC)requiredhand‐over‐handassistanceinordertoselectelementscorrespondingtothesceneshowninthemediawindow.”

“(BC)wasabletosuccessfullyandindependentlydescribe16/18dynamicscenecues(containingtheconcepts“open”and“dance”)byselec.ng‘agent+ac.on’or‘ac.on+object’elements.”

References Althaus,M.,deSonneville,L.M.,Minderaa,R.B.,Hensen,L.G.,&Til,R.B.(1996).InformaEon

processingandaspectsofvisuala^enEoninchildrenwiththeDSM‐III‐Rdiagnosis“PervasiveDevelopmentalDisorderNotOtherwiseSpecified”(PDDNOS):II.ChildNeuropsychology,2(1),17‐29.

Boddaert,N.,Belin,P.,Chabane,N.,Poline,J‐B.,Barthelemy,C.,Mouren‐Simeoni,M‐C.,Brunelle,F.,Samson,Y.,&Zilbovicius,M.(2003).PercepEonofcomplexsounds:Abnormalpa^ernofcorEcalacEvaEoninauEsm.AmericanJournalofPsychiatry,160,2057‐2060.

Shane,H.C.,&Albert,P.D.(2008).ElectronicscreenmediaforpersonswithauEsmspectrumdisorders:resultsofasurvey.JournalofAu=smandDevelopmentalDisorders,38(8)1499‐1508.

Wetherby,A.M.&Prizant,B.M.(2000).AuEsmspectrumdisorders:AtransacEonaldevelopmentalperspecEve.BalEmore,MD:PaulBrooksPublishingCompany.

Yin,R.(2009).Casestudyresearch:Designandmethods(4thed.).ThousandOaks:CA:SagePublicaEons.

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Example: Directing Others Example: Directing others

Example: Symbols for Commenting

howard shane, phd, ccc‐slp

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