As a team of speech and language therapists, we see many children who are diagnosed or at the early stages of diagnosis of an Autistic Spectrum Disorder. We also see young adults who are living with an Autistic Spectrum Disorder.At Integrated Treatment Services we have Speech and Language Therapists within our team who have a special interest in children and adults with Autistic Spectrum Disorders who can offer some extensive experience in supporting a therapy programme to support the individual.

As a Manager of the team, I too have a specialist interest within this group of children and young adults and take pride in striving to ensure we know about the latest approaches so our therapists are informed to use a personalised combination of these approaches to suit the child, young person and their family.

Autism is a life-long brain disorder that is normally diagnosed in early childhood.
People with autism have difficulties communicating, forming relationships with others and find it hard to make sense of the world around them.

Autism is a spectrum disorder varying in symptoms, severity and impact from person to person and ranging from those with no speech and limited cognitive ability to those of high IQ and typically highly-focused interests and abilities.
Repetitive behaviours are common across the spectrum, which includes Asperger Syndrome. This is a form of autism in which speech development and IQ are normal, but in which social disability can be compounded by depression or other mental health problems.

Some people with autism demonstrate significantly challenging behaviours.

A distinction is made in assessing the needs of people with autism between those who have an IQ of less than 70, who are described as low functioning and classified as having a learning disability, and those who have an IQ above 70 who are often described as high functioning.

Boys are four times more likely to be diagnosed with autism than girls.

In total more than half a million people in the UK have an autistic spectrum disorder.

Autism affects people of all racial, ethnic and socio-economic backgrounds.

There are estimated to be around 540,000 people with an autistic spectrum disorder in the UK.

TEACHH is an evidence-based service, training, and research program for individuals of all ages and skill levels with autism spectrum disorders. Founded in 1966 by Eric Schopler at the University of North Carolina at Chapel Hill, TEACCH provides training and services geared to helping autistic children and their families cope with the condition. With over 40 years of experience of working with autistic people, TEACCH methodology continues to evolve, refining its approach. TEACCH runs conferences in North Carolina and organises programs throughout the USA and in the UK. This approach is approved by the National Autistic Society.In its simplest format, TEACHH works by presenting the child/young person with an Autistic Spectrum Disorder, a very clear and structured working pattern. Start and finish trays are presented, encouraging the child/young person to select the work to be undertaken from one tray and to place it in the finished tray, once completed. It therefore makes it very clear what the demands are and when they will end. The child/young person works in a non distracting environment, clear from bright colours on the wall which may overwhelm them and out of reach of a range of classroom objects and other students. Behaviours are attempted to be understood and moulded to communicate needs for such behaviours in a more effective way.

PECS was developed in 1985, by Andy Bondy, PhD and Lori Frost, CCC/SLP, as a unique augmentative/ alternative communication (AAC) system that teaches children and adults with autistic spectrum Disorders and other communication deficits to initiate communication. First used at the Delaware Autistic Program, PECS has received worldwide recognition for focusing on the initiation component of communication. It was created with educators, resident care providers and families in mind.PECS is designed to teach functional communication with an initial focus on spontaneity. It has been and continues to be implemented in a variety of settings (home, school, community) so students have the skills to communicate their wants and needs. PECS does not require complex or expensive materials since it uses picture symbols as the modality. Research has shown that many preschoolers using PECS also begin developing speech.

The training protocol is based on B.F. Skinner’s book, Verbal Behaviour so that functional verbal operants are systematically taught using prompting and reinforcement strategies that will lead to independent communication. Verbal prompts are not used, thus building immediate initiation and avoiding prompt dependency. PECS begins with teaching a student to exchange a picture of a desired item with a “teacher”/communicative partner, who immediately honours the request. After the student learns to spontaneously request for a desired item, the system goes on to teach discrimination among symbols and then how construct a simple sentence. In the most advanced Phases, individuals are taught to respond to questions and to comment. Additionally, advanced language concepts such as size, shape, colour, number, etc are also taught so the student can make their message more specific. For example, I want big yellow ball.

Visual timetables are a way to present the child/young person, with visual information to help them better understand their day. Photos or symbols are used to break down parts of the day e.g. the morning until lunch, the afternoon and the evening. These timetables can help reduce anxiety for the child/young person, since they are more fully informed of when something will stop and what will happen next.

Understanding the concept of time can be difficult for any young person, but it is important for us as adults to provide the person with Autism a concept of what will happen throughout their day.Many people stop using visual timetables when a child or young person seems familiar with the routines of the week. However a visual timetable is crucial to keep in place so it can help to present changes of routine outside of the ‘normal’ patterns of the day. It is also in place to support the child/young person requesting a change in order of events by selecting the photo/symbol themselves; e.g I want swimming now, not after lunch.

Are an even smaller break down of the above approach. The now activity usually represents a work activity that needs completing, the next activity is usually the motivating activity that follows. As with elements of PECS, you aim to work on the child/young person’s motivation for a rewarding activity that will follow ‘work’, whilst presenting clear and concrete timescales for the client. You can build these board to represent now, now, next, so as to build up the number of pieces of consecutive work.

Social stories were introduced in 1993 as a method to help teach social skills to individuals with an autism spectrum disorder. Individuals with an ASD have significant impairments in the social domain as defined by the nature of the diagnosis. There is a great emphasis placed on the importance of teaching social skills to individuals with an Autistic Spectrum Disorder as it has been identified as one of the best indicators of positive long-term outcomes.[A social story is an individualised short story that describes social relevant cues in any given situation. It breaks down a challenging social situation into understandable steps by omitting irrelevant information and by being highly descriptive to help an individual with an Autistic Spectrum Disorder understand the entirety of a situation. It includes answers to questions such as who, what, when, where, and why in social situations through the use of visuals and written text. Social stories are used to teach particular social skills, such as identifying important cues in a given situation; taking another’s point of view; understanding rules, routines, situations, upcoming events or abstract concepts; and understanding expectations.

The goal of a social story is to reveal accurate social information in a clear and reassuring manner that is easily understood by the individual with an Autistic Spectrum Disorder. The improved understanding of the events and expectations may lead to a change in behaviour, although it is suggested that the goal of a social story should not be to change individual behaviour.

Social stories use a specifically defined style and format. In the initial version, four types of sentences were used (descriptive, perspective, directive, affirmative), along with a basic sentence type ratio. Control, co-operative and partial sentences types have been added to the model.

There are seven sentence types that may be used in a social story;

Descriptive sentences: are truthful and observable sentences (opinion- and assumption-free) that identify the most relevant factors in a social situation. They often answer “wh” questions.
Perspective sentences: refer to or describe the internal state of other people (their knowledge/thoughts, feelings, beliefs, opinions, motivation or physical condition) so that the individual can learn how others’ perceive various events.
Directive sentences: presents or suggests, in positive terms, a response or choice of responses to a situation or concept.
Affirmative sentences: enhances the meaning of statements and may express a commonly shared value or opinion. They can also stress the important points, refer to a law or rule to reassure the learner.
Control sentences: identifies personal strategies the individual will use to recall and apply information. They are written by the individual after reviewing the social story.
Cooperative sentences: describe what others will do to assist the individual. This helps to ensure consistent responses by a variety of people.
Partial sentences: encourages the individual to make guesses regarding the next step in a situation, the response of another individual, or his/her own response. Any of the above sentences can be written as a partial sentence with a portion of the sentence being a blank space to complete.
Social story ratio: Two to five cooperative, descriptive, perspective, and/or affirmative sentences for every directive or control sentence.

Hanen More Than Words is a family-focused program that gives parents of children with Autism Spectrum Disorder and related social communication difficulties, practical tools to help their children communicate.
More Than Words derives its theoretical basis from the same social interactionist perspective as It Takes Two to Talk, Hanen’s program for parents of pre-school children with language delays. Like this program, More Than Words emphasises the child’s everyday activities as the context for learning to communicate. In addition, More Than Words incorporates current best practice guidelines, highlighting the importance of affect, predictability, structure and the use of visual supports to enhance learning in children with an Autistic spectrum Disorder.

The Program is organised around four major goals:

• Improved two-way interaction
• More mature and conventional ways of communicating
• Better skills in communicating for social purposes
• An improved understanding of language

Intensive interaction is an approach to teaching the pre-speech fundamentals of communication to children and adults who have severe learning difficulties and/or an autisic Spectrum disorder and who are still at an early stage of communication development. The approach was developed during the nineteen-eighties by the team of staff working at Harperbury Hospital School Herfordshire.

Dave Hewett Ph.D and Melanie Nind Ph.D, were teachers at Harperbury School, and they carried out Intensive Interaction research projects at the school as part of the development work. They have published three books on the approach (e.g. ‘Access to Communication’ London: David Fulton 1994) and extensive other publications.

Intensive Interaction is highly practical. The only equipment needed is a sensitive person to be the interaction partner. The approach works by progressively developing enjoyable and relaxed interaction sequences between the interaction partner and the person doing the learning. These interaction sequences are repeated frequently and gradually grow in duration, complexity and sophistication. As this happens, the fundamentals of communication are gradually rehearsed and learnt in a free-flowing manner. The style of the teacher person is relaxed, non-directive and responsive. In fact, a central principle is that the teacher person builds the content and the flow of the activity by allowing the learner basically to lead and direct, with the teacher responding to and joining-in with the behaviour of the learner. This simple principle is the one used by adults in interaction with babies during the first year. The first year is the period of development when a baby carries out intense and very rapid learning of the fundamentals of communication. Much of the development of Intensive interaction was based on reading of the scientific research on the way in which human beings learn to communicate during the first year.

The teaching sessions are therefore frequent, quite intense, but also fun-filled, playful and enjoyable. Both participants should be at ease with enjoyment of the activity as the main motivation. A session could be highly dynamic, with a great deal of vocalisation, sometimes with fun-filled physical contacts. A session could also be peaceful, slow and quiet.
First and foremost, Intensive Interaction is highly practical. The only equipment needed is a sensitive person to be the interaction partner. The approach works by progressively developing enjoyable and relaxed interaction sequences between the interaction partner and the person doing the learning. These interaction sequences are repeated frequently and gradually grow in duration, complexity and sophistication. As this happens, the fundamentals of communication are gradually rehearsed and learnt in a free-flowing manner. The style of the teacher person is relaxed, non-directive and responsive. In fact, a central principle is that the teacher person builds the content and the flow of the activity by allowing the learner basically to lead and direct, with the teacher responding to and joining-in with the behaviour of the learner. This simple principle is the one used by adults in interaction with babies during the first year. The first year is the period of development when a baby carries out intense and very rapid learning of the fundamentals of communication. Much of the development of Intensive interaction was based on reading of the scientific research on the way in which human beings learn to communicate during the first year.

The most important apect for us at Integrated Treatment Services is supporting our families and schools to be fully aware of the range of therapy options avavilable for children and young people with Autistic Spectrum Disorders.
It is thoroughly imporatnt for the therapist to spend time with the family/education settings, making observations and assessment of the child/young person as well as looking back over the developmental history. It is crucial that the therapist builds a good rapport with the family and education settings, so that we can understand the daily routines and pressures on the family/teaching staff, so as to advise on the best approaches that fit best with the family and settings needs .

www.nas.org.uk/
www.autismspeaks.org.uk
www.aboutautism.org.uk
www.autismuk.com/
http://www.paains.org.uk/
http://hcd2.bupa.co.uk/fact_sheets/html/autism.html
www.autismresearchcentre.com

Our team contiunes to provide support into two Independant specialist settings for children and young people with Autistic Specturm Disorders
www.theshires.org.uk
www.regard.co.uk

We are happy to talk through the needs of any family/school/care setting who are looking for therapy support for their child or young person with an Autistic Spectrum Disorder.