8. Social Communication/Pragmatics
at _________mo an infant Establishes joint reference, or the ability to focus attention on an event or object as directed by another person.
10-12mo
Define ASD
ASD is an umbrella term that encompasses a range of disorders that are characterized by core impairments in social communication and a restricted repertoire of interests and behaviors
How do I know if a client has ASD vs. a pragmatic/social communication disorder?
ASD is an umbrella term that encompasses a range of disorders that are characterized by core impairments in social communication and a restricted repertoire of interests and behaviors. SCD is a pragmatic language impairment that is typically not as severe as autism but has language difficulties that impact communication, social interaction and use of language in context. The main difference is that clients with ASD will show, or have a history or, restricted and repetitive patterns in behaviors, activities and interests.
Children with effective pragmatic skills display
Adequate cohesion: the ability to order and organize utterances in a message so that they build logically on one another As they get older, they distinguish between and appropriately use direct and indirect speech acts, or requests Direct → "Bring me the ball" Request → "Will you bring me the ball?" Indirect → "Wouldn't it be nice if I had the ball?" Appropriate knowledge of discourse: refers to how utterances are related to one another; it has to do with the connect flow of language. Narratives: a form of discourse where the speaker tells a story; the speaker talks about a logical sequence of events.Pragmatics are heavily influenced by culture. Pragmatic skills are increasingly recognized as important for social, academic, and vocational success. Effective pragmatic skills enable speakers to relate successfully to others within their linguistic and cultural milieus.
Treatment techniques for children w/ ASD
Applied behavioral analysis and discrete trial teaching, AAC, Floor time, peer and play mediation,PECS, social stories, assisting in Theory of mind, general behavior management
Assessment of pragmatic skills: Adolescents:
Assess the frequency with which the client asks you to repeat information; frequent requests suggest poor listening skills. Assess the use of correct register depending on the situation (i.e., use of slang register when with peers and more formal register with authority figures)., Note any inappropriate body language during conversation (i.e., standing too close, using inappropriate gestures)., Introduce various topics and evaluate the student's ability to maintain those topics over successive utterances., Ask the student to read a story and then retell it; ask the student to orally narrate a story; evaluate the student's ability to correctly sequence events in a manner that is understandable to the listener., Count the frequency of maze behaviors, such as false starts and repeated attempts to express the same idea., Note interruptions, irrelevant comments, and non sequiturs., Make some vague and nonspecific statements to the student, and evaluate whether the student makes requests for clarification.
general 10-12 mo pragmatic skills
Attempts to display independence (i.e., crawling for exploration or refusing food), May show fear around unfamiliar people and objects, Tries to get attention by repeating sounds and gestures, Enjoys imitating people, Child uses perlocutionary behavior, in which signals have an effect on the listener or observer but lack communicative intent, Children enter locutionary behaviors around 12 months, and begin to use words., Establishes joint reference, or the ability to focus attention on an event or object as directed by another person.
describe the relationship with AAC and ASD
Augmentative and Alternative Communication (AAC) to help the individual express thoughts, ideas, wants, needs, and feelings. AAC can be used to supplement existing expressive verbal communication or with individuals who are unsuccessful at learning expressive verbal communication.
general pragmatic skills at 6-7 y.o
Becomes aware of mistakes in other people's speech Is apt to use slang and mild profanity
general 0-3mo pragmatic skills
Begins to smile in response to their caregivers, also called social smile, Develops more facial and body expressions, Can briefly calm themselves (i.e., sucking on thumb), Recognizes they are having fun and may cry when playing stops, Makes eye contact and looks at people while interacting
Describe rx techniques for children with ASD: Applied behavioral analysis and discrete trial teaching
Behavior modification through operant conditioning, Teach skills through carefully sequenced steps of objectives, Intense focus on training with prompts and rewards , Teaching segment one on one with an antecedent (instruction or request for specific action), a behavior (response from the child), and a consequence (trainers reaction; reinforcement/praise)
list General behavior management techniques for ASD
Behavioral interventions and techniques, Applied Behavior Analysis (ABA), Discrete Trial Training (DTT), Functional Communication Training (FCT), Incidental Teaching, Milieu Therapy and Self-Management.
general pragmatic skills at 2-3 y.o
Copies others in more complex tasks (i.e., cleaning, cooking, self-care), Shows affection towards friends, Shows an increasing variety of emotions, Upset when there are major changes in routine, Seems concerned about personal needs and may even act "selfishly", Child's utterances generally have communicative intent, although occasionally egocentric, Child demands rapid topic shifts (3yo can sustain topic of conversation about 20% of the time), Communication includes criticism, commands, requests, threats, questions, and answers, Interpersonal communication expands; the child learns to adopt a role to express own opinions and personality.
As children get older, they distinguish between and appropriately use direct and indirect speech acts, or requests. list examples
Direct → "Bring me the ball", Request → "Will you bring me the ball?", Indirect → "Wouldn't it be nice if I had the ball?"
Describe rx techniques for children with ASD: Floor time
Engage in spontaneous and interactive activity with child, Follow the child's interest while providing structured play, Natural learning situation tailored to developmental level
Describe rx techniques for children with ASD: PECS
Establish functional reciprocal picture communication system within social context, A picture of a desired item is exchanged with a communication partner, A form of AAC that incorporate ABA principles with focused teaching, motivation, and reinforcement
list Reciprocal Social Interaction Deficits assoc. w/ ASD
Eye contact is often averted/indirect, with a reliance on peripheral vision, Facial expression is minimal and incongruent with events occurring or with words spoken, Body posture is rigid and uncomfortable when engaged in interaction, Gestures accompanying verbalization may be absent or exaggerated/animated, Lack of initiation for interaction with people (i.e., avoids or ignores), Limited ability to relate to peers and an absence of friends, Failure to share interest or achievements with others, Lack of interest in activities, emotions or focus of others, Verbal and social interactions are egocentric (i.e., one sided monologue), Lack of joint attention on others
general pragmatic skills at 4-5 y.o
Has more developed friendships and maybe even a "best friend" More cooperative with rules Understands and is sensitive to others' feelings Understands the difference between real life and make believe Has changes in attitude (i.e., is demanding at times and cooperative at other times) Modifies speech as a function of listeners age (beginning at 4 years) Begins to judge grammatical correctness and appropriateness of sentences Can maintain topic over successive utterances Uses egocentric monologue about ⅓ of the time Uses indirect speech acts, softens speech ("I think that goes in there," rather than "put that in there") Begins to tell jokes and riddles (begins around 5 years)
Describe rx techniques for children with ASD: Augmentative and alternative communication (AAC)
Improvement noted in behavior and emotional regulation, speech, expressive language and social communication, receptive language development and comprehension , Low tech to high tech options
can Social comm. disorder be dx in conjunction with ASD?
In the case of autism spectrum disorder (ASD), social communication problems are a defining feature, along with restricted, repetitive patterns of behavior. Therefore, social communication disorder cannot be diagnosed in conjunction with ASD.
general pragmatic skills at 7-8 y.o
Initiates and maintains conversation in small groups Is able to role-play, to take the listener's point of view Determines and uses appropriate discourse codes and styles (i.e., informal with friends, formal with adults)
Goals target core challenges of ASD and focus on
Initiating spontaneous communication in functional activities, Engaging in reciprocal communication interactions and Generalizing skills across activities, environments, and communication partners.
Social communication disorder may be a distinct diagnosis or may co occur with other conditions, such as-
Intellectual disability, Developmental disabilities, Learning disabilities, Spoken and written language disorders, Attention-deficit/hyperactivity disorder (ADHD), TBI, Aphasia, Dementia, Right-hemisphere damage
general 4-6 mo pragmatic skills
Is usually happy when surrounded by cheerful caregivers, Responds to and copies some movements and facial expressions, Develops an awareness of their surroundings and expresses a desire to engage (i.e., banging objects or toys)
If you are working in EI and you are going to assess a 9month-old. What are some early possible signs to look for that might indicate some Social warning signs?
Lack of appropriate eye contact, lack of joint attention, not playing with toys appropriately (i.e., not using a car as a car, just banging it), lack of communicative intent or initiation , Lack of response to name, Lack of social smile, Poor mutual attention, Limited gestures, Poor imitation, Poor eye contact , Limited affective range , Extreme passivity , Poor visual orientation to stimuli
warning signs of ASD 9-12 mo
Lack of response to name Lack of a social smile Poor joint attention/ mutual attention Limited gestures Poor imitation Poor eye contact Limited affective range Extreme passivity Poor visual orientation to stimuli
warning signs of ASD at 18 mo/ 1.5
Lack of response to name Lack of shared joy Poor joint attention Minimal pointing/gesturing Unusual prosody to speech Lack of appropriate gaze Lack of shared interest Repetitive body movements Repetitive mvmt w/ objects
warning signs of ASD at 2 years
Lack of responsiveness Lack of shared enjoyment Lack of facial expression Lack of pointing to share interest Poor imitation, delated speech Abnormal eye contact Limited interest in shared games Over/under sensory reactions Unusual visual interest; unusual play w/ objects
general 7-9mo pragmatic skills
May show anxiety around strangers, Plays social games like peek-a-boo, Learns the meaning of word when they're used consistently, Enjoys looking at self in a mirror, Becomes more "clingy" when leaving caregivers (i.e., reaches for caregiver when being held by someone else), 9-10 months, illocutionary behavior, signalling to carry out some socially organized action, such as pointing/laughing; uses intentional communication.
Pragmatics are heavily influenced by __________
Pragmatics are heavily influenced by culture.
Functional Communication Training (FCT)
Problem behaviors can be eliminated through extinction and replaced with alternate, more appropriate ways of communicating needs or wants.
Describe rx techniques for children with ASD: Peer and play mediation
Promote natural interaction and carryover, Peers provide a model to imitatE, Social interaction opportunities increase, Incorporate items of interest to motivate social engagement
Define pragmatic/social communication disorder (SCD)
SCD is a pragmatic language impairment that is typically not as severe as autism but has language difficulties that impact communication, social interaction and use of language in context.
examples of Restricted, Repetitive Patterns of Behaviors in ASD
Self-stimulatory behaviors: Rhythmic, repetitive motor movements such as hand flapping, twirling or finger tapping, Repetitive, ritualistic interaction with objects (lining items up or spinning the wheels on a toy car), Motor preservation: Doing a motor activity over and over (doing a puzzle or climbing up and down a side), Inflexible reliance on routines/rituals, such as adhering to a specific order of activities to get dressed in the morning, walking a specific path in the backyard or putting toys away a certain way , Fascination with mechanical movement & objects (ceiling fan, toilet flushing, turning lights on/off), Obsessive preoccupation with particular interests or items (dinosaurs, insects, the weather, maps, etc.) , Excessive sustained attachment to certain objects (stuffed animals, legos, clothes), Perimeter walking: Moving to the outer edge of a room or environment to avoid interaction
general pragmatic skills at 1-2 y.o
Shows defiant behaviors to establish independence (i.e., having tantrums), Does not understand what other think or feel and believes everyone thinks as they do (i.e., gets upset when no longer the center of attention), Enjoys being around other children, but not yet able to share easily, Can play independently for brief periods of time, Presuppositions emerge. The child uses expressions that have shared meaning for the listener and speaker. Child begins to understand rules of dialogue (i.e., when someone talks, you need to listen). The child is able to take the role of both listener and speaker, Child uses nonverbal as well as verbal communication to signal intent
list Communication Deficits assoc. w/ ASD
Significant delays in acquisition of spoken language skills, Childhood apraxia of speech, Echolalia: repetition of utterances spoken by others; can be immediate or delayed, Verbal perseveration: continuous repetition of a sound, word, or phrase, Monotone, robotic vocal prosody in expressive lang., Jargon production that is meaningful to others, Lack of discourse skills to initiate, maintain, or terminate conversation with others in appropriate manner, Lack of imaginative play or social imitative play with tendency to demonstrate parallel or repetitive play, Failure to develop abstract language and remain very literal/concrete in language interpretation, Failure to comprehend or express nonverbal aspect of communication, such as gestures, body language, humor, sarcasm or teasing
What are some of the warning signs to look for with Autism Spectrum Disorder?
Some warning signs could be if a child has difficulty understanding gestures, using words, following directions and learning to read or write, echolalia, talking very little or not at all, using challenging behaviors instead of words or gestures, difficulty maintaining eye contact, difficulty sharing attention with someone else and focusing on the same object, difficulty joining in play or sharing toys and/or taking turns in play and conversation. A child may present with stims such as arm or hand flapping or having various sensory needs
general pragmatic skills at 3-4 y.o
Starts cooperating more with others during play (i.e., sharing toys), Can sometimes work out conflicts with other children (i.e., taking turns in small groups), Uses words to communicate needs instead of screaming, grabbing, or whining, Becomes more independent in daily activities (i.e., may choose own clothes to wear), Can maintain conversation without losing track of topic, Begins to modify speech to listener (uses simplified language with younger children), Begins to produce indirectives ("Are the cookies done?" meaning "Can I have a cookie?"), Uses requesting (yes/no questions, wh- questions), Responds with structures (yes, no, because); expresses agreement/denial, compliance/refusal , Uses conversation devices (hi, bye, calls such as "hey mommy", accompaniments "here you are", please and thanks), Uses communicative functions: Role-playing, fantasies, protests/objections ("Don't touch that!"), Jokes, Game markers ("you have to catch me!"), Claims ("I'm first!"), Warnings ("Look out, or you'll fall!"), Teasing ("You can't have this!")
Treatment techniques for children w/ ASD: General behavior management techniques
Teach compliance, attending and imitating, Use 1:1, trail by trail teaching, Reinforce correct responding, Use promoting techniques, Provide intensive, teacher directed instruction, Train functional skills, train to generalize, Data based instruction
Theory of mind:
Teach individual to understand mental states- how others think and feel
Describe rx techniques for children with ASD: Theory of mind
Teach individual to understand mental states=how others think and feel, Mindblindness: inability to understand others perceptions and beliefs from another persons perspective, Associated with executive function deficit
Describe rx techniques for children with ASD: Social stories
Teach social skills through story format, Specific to the child and problem, Story sequence describes relevant aspects of situation and appropriate social responses, Introduce story repetitively until it becomes a routine social response
Incidental Teaching
The clinician provides naturally occurring teaching opportunities that are based on the child's interests. The clinician follows the child's lead and reinforces communication attempts as these attempts get closer to the desired communication behavior
main difference bw ASD and pragmatic/social communication disorder (SCD)
The main difference is that clients with ASD will show, or have a history or, restricted and repetitive patterns in behaviors, activities and interests.
general pragmatic skills at 5-6 y.o
Understand humor, surprise Corrects potential errors by modifying the message Can recognize a socially offensive message and reword it in polite form Modifies speech according to listeners needs Begins to use and understand formal levels of address (Mr. and Mrs.) Gains greater facility with indirect requests ("I would like a sticker" instead of "Gimme a sticker") Can differentiate 80% of the time between polite and impolite utterances Uses expressions, such as "Thank you" and "I'm sorry" Often asks permission to use objects belonging to others Contributes to adult conversation
Language context involves
Where the utterance takes place, To whom the utterance is directed, What and who is present at the time
Applied Behavior Analysis (ABA)
a behavioral intervention that focuses on bringing about meaningful and positive change in behavior. ABA techniques have been developed for individuals with autism to help build a variety of skills (e.g., communication, social skills, self-control, and self-monitoring) and to help generalize these skills to other situations. The techniques can be used in both structured and everyday settings and in one-on-one or group instruction.
define Narrative discourse:
a form of discourse where the speaker tells a story; the speaker talks about a logical sequence of events. the knowledge of discourse refers to how utterances are related to one another; it has to do with the connect flow of language.
define Narratives:
a form of discourse where the speaker tells a story; the speaker talks about a logical sequence of events. the knowledge of discourse refers to how utterances are related to one another; it has to do with the connect flow of language.
define Social Stories™
a highly structured intervention that uses customized and carefully constructed stories to explain social situations to children and to help them learn socially appropriate behaviors and responses
define social Scripts
a prompting strategy that teaches children to use a variety of language skills during social interactions. Scripted prompts (visual and or verbal) are gradually faded out as children use new language skills more spontaneously
Milieu Therapy
a range of methods that are integrated into a child's natural environment. This includes training in everyday environments and during activities that take place throughout the day rather than only at "therapy time"
Exploring Feelings
a structured Cognitive Behavior Treatment program designed to encourage the cognitive control of emotions. Sessions include activities to explore specific feelings (e.g., being happy, relaxed, anxious or angry)
Rational Emotive Behavioral Therapy
a therapy approach that focuses on helping the individual acknowledge the problems that are upsetting them, accept emotional responsibility for these problems, and be empowered to change.
Self-Management approach and ASD
an approach aimed at helping individuals learn to independently regulate their behaviors and behave appropriately in a variety of contexts. Individuals are taught to discriminate the difference between appropriate and inappropriate behaviors, evaluate and record their behaviors, and reward themselves for using appropriate behaviors.
Verbal perseveration:
continuous repetition of a sound, word, or phrase
define Commenting
describing or identifying objects; i.e., "that's a cookie."
Social Communication Disorder is characterized by
difficulties with the use of verbal and nonverbal language for social purposes.
define Social Skills Groups
groups in which appropriate ways of interacting with typically developing peers are taught through direct instruction, role playing, and feedback. Groups typically consist of two to eight individuals with social communication disorders and a teacher or adult facilitator.
Primary difficulties of Social Communication Disorder are
in social interaction, social cognition, and pragmatics. Specific deficits are evident in the individual's ability to: communicate for social purposes in ways that are appropriate for the particular social context, change communication to match the context or needs of the listener, follow rules for conversation and storytelling, understand nonliterate or ambiguous language, understand what is not explicitly stated.
Mindblindness
inability to understand others perceptions and beliefs from another persons perspective
Mindblindness
inability to understand others perceptions and beliefs from another persons perspective, Associated with executive function deficit
describe Activity schedules and visual supports
include objects, photographs, drawings, or written words that act as cues or prompts to help individuals complete a sequence of tasks or activities, attend to tasks, transition from one task to another, or maintain emotional regulation in various settings. Written and/or visual prompts that initiate or sustain interaction are called scripts. Scripts are often used to promote social interaction but can also be used in a classroom setting to facilitate academic interactions and to promote academic engagement
describe the Restricted, repetitive behaviors in ASD
interests, or activities are manifested by stereotyped, repetitive speech, motor movement, or use of objects; inflexible adherence to routines; restricted interests; and hyper and/or hyposensitivity to sensory input.
describe Computer-based instruction
involves the use of computer technology (e.g., iPads) and/or computerized programs for teaching language skills, including vocabulary, social skills, social understanding, and social problem solving
Autism Spectrum Disorder (ASD)
is a neurodevelopmental disorder characterized by deficits in social communication and social interaction and the presence of restricted, repetitive behaviors.
define Pragmatics
is the study of rules that govern the use of language in social situations; one focuses on the use of language in social context; pragmatics places greater emphasis on functions, or uses of language, rather than structure.. Pragmatics considers the context and function of the utterance
3 Functions of language
labeling, protesting & commenting
3 levels of severity for ASD
level 1 requiring support level 2 requiring substantial support level 3 requiring very substantial support.
define Labeling
naming something; i.e., child is playing with a puppy and says "tail"
define Protesting
objecting to something; i.e., "don't do that!"
Assessment of pragmatic skills: Elementary age children
observe the child's eye contact and other nonverbal behaviors, topic initiation and maintenance, turn-taking (including not interrupting)m and the ability to remain on topic.
Definition of ASD
persistent deficits in social communication and social interaction across multiple contexts. Deficits in social-emotional reciprocity (e.g., fail to initiate or respond to social interactions. Deficits in nonverbal communication behaviors used for social interaction (i.e., abnormalities in eye contact, body posture, lack of facial expressions). Deficits in developing, maintaining and understanding relationships (e.g., difficulty adjusting social behavior in various context, reduced interest in peer relationships
describe the Social communication deficits in ASD
present in various ways, can include impairments in joint attention and social reciprocity as well as challenges using verbal and nonverbal communication behaviors for social interaction.
define Appropriate knowledge of discourse:
refers to how utterances are related to one another; it has to do with the connect flow of language. ex: Narratives
other know characteristics that occur with ASD outside of social comm. and restrictive repetitive behaviors: Cognitive or intellectual deficits, Sensory integration disorder or dysfunction, Problems with self
regulation in response to sensory stimuli, Hyperlexia, Motor deficits
Effective pragmatic skills enable speakers to
relate successfully to others within their linguistic and cultural milieus (environment).
Echolalia:
repetition of utterances spoken by others; can be immediate or delayed
ASD consists of deficits in ________ and _____________.
social communication and restricted repetitive behaviors.
Pragmatic skills are increasingly recognized as important for
social, academic, and vocational success.
Adequate cohesion
the ability to order and organize utterances in a message so that they build logically on one another
What are the assessment options and therapy options for ASD?
the school psychologist will be responsible for assessment to determine a diagnosis of ASD. We can help with social skills, like turn-taking, eye contact, social stories, visual schedules, AAC devices when needed, expressive & receptive language, pragmatic language, etc.
true or false: Pragmatics considers the context and function of the utterance
true. pragmatics places greater emphasis on functions, or uses of language, rather than structure.
Some examples of behaviors affected by social communication disorder (SCD) include
using appropriate greetings; changing language and communication style based on setting or partner;telling and understanding stories; engaging in conversation (e.g., initiating or entering a conversation, maintaining the topic, taking turns); repairing communication breakdowns (e.g., rephrasing when misunderstood); using appropriate verbal (e.g., prosodic) and nonverbal (e.g., gestures) signals to regulate an interaction; interpreting the verbal and nonverbal signals of others during an interaction understanding ambiguous or figurative language; understanding information not explicitly stated (inferring); and making and keeping close friendships. Variations across all areas of social communication occur within and across cultures. Differences related to cultural norms are not considered disorders.
