Welcome back to our SLP student chats!  Tonight, October 21, 2002,
is the first chat of our third year of on-line chats for SLP students. 
We are pleased to announce that this chat will be hosted by Robin Parker,
SLP.D., CCC,  who will address the topic of Autism: Communication Intervention.

Dr. Parker is currently Consulting Director of the University of Miami Center
for Autism and Related Disabilities (CARD), Nova Southeastern University (NSU)
Satellite.  She is also a Clinical Supervisor and Program Instructor in the
Communication Disorders Program at NSU.  She supervises and teaches graduate
students in speech-language pathology.  Dr. Parker has developed a variety of
graduate courses about communication and autism spectrum disorders (ASD).  She
also provides diagnostic and intervention programs for individuals with ASD. 
Dr. Parker regularly lectures locally, nationally, and internationally about
autism spectrum disorders.  She has written several book chapters about ASD. 
She has co-developed Workable Solutions, a career/employment program for
individuals with severe communication impairments.

<Robin>  Welcome!!! Tonight we are chatting with Robin Parker, SLP.D., CCC, about
          Autism Communication Intervention.
<AdrienneFSU>  I'm excited to be back!
<epoissant>  Good evening!!
<AdrienneFSU>  What's an SLP. D?
<RobinParker>  That is a clinical doctorate .
<RobinParker>  It is probably the first of it's kind in SLP.  It is offered at Nova Southeastern
          University but FSU is where I did undergrad and grad (masters).
<RobinParker>  Dr. Wetherby from FSU was one of my mentor's.
<AdrienneFSU>  wonderful lady!
<hawaii> Dr. Parker, where is Nova Southeastern located?
<RobinParker> hawaii, NSU is located in Fort Lauderdale, FLorida.
<RobinParker>  Should I begin with some basics on autism spectrum disorders?
<Tracy>  Yes, please do
<RobinParker>  o.k.  Autism Spectrum Disorders (ASD) refers to a group of disorders all with a
          triad of deficits-communication, social, and behavioral deficits.
<RobinParker>  Within ASD, you  can receive a diagnosis of Rett Syndrome, Autism, Pervasive
          Developmental Disorder-Not otherwise specified, Childhood Disintegrative Disorder,
       and Asperger Syndrome.
<Brooke>  How does Rett syndrome fall into the spectrum?
<RobinParker>  Rett often looks like ASD in early stages but now there is a genetic test
          to confirm.  A classic observable symptom of Rett Syndrome is hand wringing.
<Tracy>  Do you find that people have trouble understanding that it's a "spectrum" disorder?
<Tracy>  other professionals, that is?
<RobinParker> Tracy--Sometimes
<RobinParker>  However, as more and more (1:150 now) get diagnosed, I think people are
          understanding better.
<Tracy>  right..
<Erika-OU> 1:150 ???
<Erika-OU>  That's a lot higher than what I learned.
<Erika-OU>  It's becoming more and more common.
<RobinParker>  Yes, new numbers are coming out everyday (it seems) but there is a major increase
          over the past 10 years (in diagnosis).
<Tracy>  Which is great, actually.
<Tracy>  I feel this leads to better services.
<RobinParker>  Yes services are better and there is a lot of time and effort spent on
          intervention now.
<AdrienneFSU>  Because the definition is broadening or awareness increasing? or both??
<Erika-OU>  Do think that is because more children actually have it...or because there is more
          awareness of the disorder?
<RobinParker>  The answer is both. But there actually is a true increase at least according to
          the most recent info.
<Brooke>  What about the environmental factors? They have said in a new report since Friday
          where clusters are being found in the west?
<RobinParker>  Environmental factors are very controversial.  It seems there may be at least
          a genetic link that may be turned on sometimes by an environmental factor although
          there is much research into more pure environmental factors.  Results have been very
<AdrienneFSU>  Quick question about Dx before moving to those interventions- I have trouble
          recognizing/distinguishing autism as I don't have much normal/delayed child experience. 
          Any tips?
<RobinParker>  Yes, observe typical children as much as possible, use normative charts and
          consider one of the main areas of difficulty--joint attention.  A key early feature
          of an ASD is difficulty with gestures and joint attention.  A great website is
<AdrienneFSU>  thanks
<Tracy>  Is the "floor" open for questions or would you rather we wait?
<RobinParker>  Please ask questions.
<Erika-OU>  Do you notice that many children with autism have a parent or parents that have
          math-y typie degrees...like engineering?
<Tracy>  erika not my experience, definitely
<Erika-OU>  hmm
<Erika-OU>  alright !
<RobinParker>  Erika-This is somewhat of a myth, however we do see a variety of parent types.
<RobinParker>  There was once a study in Cambridge that identified Asperger Disorder in
          approximately 40% of Math professors.
<Erika-OU>  wow really!
<Brooke>  wow
<RobinParker>  I do not know this to be definitively true but I do know of a man with a PhD.
          in mathmatics.
<RobinParker>  He has high functioning autism.
<Tracy>  I have a question, for when you have a moment. Do you follow the dietary studies and
          allergy studies of recent years, as they apply to autism?
<Tracy>  and if so, what is your opinion?
<RobinParker>  Yes, I try to but my main focus is communication intervention.
<Tracy>  Right...do you have many families that pursue this angle in ADDITION to therapy?
<RobinParker>  My opinion is that I have not seen major differences over the long term with my
<RobinParker>  Yes, many of my families try these interventions in addition to traditional
<Tracy>  Thank you. we saw varying effects when I was in school...my mentor is involved in that
          research in addition to communication therapy.
<hawaii>  How do you teach semantics and pragmatics to the child with autism?
<hawaii>  My father asked me this question. He is a pediatric neurologist.
<hawaii>  And I'm trying to answer as best I can being a lowly grad student!
<AdrienneFSU>  Good question, hawaii. I'm also wondering if you start pragmatic tx with smaller
          bits- like eye contact? or jump into simulating daily activities?
<hawaii>  Thanks
<RobinParker>  I teach semantics and pragmatics in a variety of ways.
<RobinParker>  I always start with teaching children to communicate for social and less social
<RobinParker>  What I mean is that many chilren with ASD communicate intentionally to request
          and protest.
<RobinParker>  I work to increase the complexity of this, but then I start at the gestural level
          to teach more social communication functions.
<RobinParker>  Such as greet, show off and comment.  At young ages, we add eye contact,
          responding to joint attention, initiating joint attention, as well as working on
          keeping appropriate proximity when interacting, etc.  We also work on communicating
          with peers.  This is usually done through small groups and individual therapy.  For
          school age children, we do more traditional pragmatic groups.  I also really like
          involving typical peers and teaching them to get responses.  Circle of friends is
          another way to encourage friendships.
<RobinParker>  I use a variety of visual supports to do this as well as traditional language
          facilitation techniques.
<Tracy>  Visual supports?
<Erika-OU>  Like a schedule?
<RobinParker>  Visual supports are picture based additions to language.  Schedules are used for
          organization which are often helpful.
<Tracy>  Not like PECS, but just an addition, right?
<AdrienneFSU>  I had one client with Autism who showed signs of hyperlexia, we added single
          words, then phrases,  to the pictures... he began to use the phrases!
<RobinParker>  I am not speaking of PECS now but may use this augmentative approach is appropriate.
<Tracy>  right
<Robin>  Does everyone know what PECS is?
<hawaii>  yes
<jenniferseitz>  not familiar with PECS
<epoissant>  yes
<lafsa>  I have used PECS.
<charmaine>  somewhat
<RobinParker>  PECS is the picture exchange communication system develped by Lori Frost and
          Andy Bondy.
<RobinParker>  Picture exchange communication system is where children are taught to hand a
          picture to an adult to communicate.
<jenniferseitz>  Oh, right
<Tracy>  PECS is really for lower functioning/or lower language functioning children, though
          you can use it and expand later for spoken language.
<RobinParker>  Not necessarily true. I will explain.
<RobinParker>  PECS is an AAC system that teaches children or adults to give an interactor a
          picture or pictures to communicate.
<AM>  I just observed and autism classroom today, it was overwhelming.
<AM>  I have seen wonderful things happen with the PECS system and communication boards.
<RobinParker>  The exchange is important because some individuals with ASD do not understand
          that a person must be present for communication to work.  PECS also goes from
          simple requests to sentence length requests and comments.  Many children who learn
          this system also learn to speak, of those who do not, they do learn to communicate.
          But remember, this is just one method of augmentative and alternative communication.
          An individual should have his/her own assessment to determine what is best.
<RobinParker>  Individuals with ASD are often visual learners.
<RobinParker>  Using a picture symbol support for language helps because the message is static
          and more concrete than just spoken language but..
<RobinParker>  Symbols are not used to substitute for oral language but to enhance.
<RobinParker>  AM, I agree even in my clients who speak quite well...Don't we all use day
<Adrienne>  You're so right
<Tracy>  Dr. Parker, what are your opinions on ABA? I know I'm big into finding out what other
          professionals think!
<AdrienneFSU>  ABA? Apraxia Battery???
<Tracy>  applied behavioral analysis
<AdrienneFSU>  gotcha
<RobinParker>  I am a proponent of modern ABA programs who take pragmatics into account. 
          I work with an excellent ABA therapist.

<hawaii>  what about for older clients with autism?
<RobinParker>  There are many programs and curriculms designed for individuals with ASD

<Tracy>  Dr. Parker, which level of ASD functioning would you recommend ABA for?
<Robin>  Please tell us more about ABA
<AdrienneFSU>  Is that along the same lines as ecological assessments?
<RobinParker>  Ok I will answer.
<RobinParker>  First, applied behavioral analysis can be used with all of us...but discrete
          trial teaching should be modified depending upon the client.  If you are interested
          in ABA there are several good sources.  Check out Behavioral Intervention For Young
          Children With Autism by Pro-Ed.  Also check out info from Princeton Child
          Development Institute.  A pioneering study by Ivar Lovaas in the AROUND 1986 reported
          some very good results.  With this study many of our families and schools have
          developed programs.  Again, this is only one type of therapy, but with some good
          efficacy studies. 
<rebeccasloat>  I had a low functioning child with autism and the parents requested a
          behavorist.  What a difference it made. It helped me so much. I didn't really need his
          aid to come to speech class with him.

<AM>  Hmm, do you do social stories for them also?
<RobinParker>  Social Stories are from Carol Gray and are stories that help a child/adult
          understand a social situation.
<RobinParker>  I use a modified Social Story format as traditional social stories are for more
          higher functioning clients
<Robinslu> modified social story format?
<RobinParker>  I call them personal planning stories--They allow individuals to know what to
          expect in asituation because telling is not always enough.
<AM>  Thanks for clearing that up Dr. Parker.

<Tracy>  On the other hand, I had a child who was progressing GREAT in therapy, his parents
          had  different 8 evals.. 7 said to continue, 1 said to begin ABA.
<Tracy>  and now he talks like a robot
<RobinParker>  Talking like a robot is good if there was no talking before.  We can easily work
          on prosody.
<RobinParker>  However, ABA programming is not over if prosody is still monotone.
<Erika-OU>  8 evals?  How excessive!
<Tracy>  Erika it was excessive, they wanted someone to FIX their son, and ABA is what they
          wanted no matter the recommendations.
RobinParker>  8 evals seems like a lot but if it is your child you may do it too.
<RobinParker>  ABA is helpful if used appropriately.
<Tracy>  I think ABA would be GREAT and effective for some...but the way we were taught it's
          like training a dog with treats.
<RobinParker>  Again-this is a difficult area...
<AM>  Kind of like operant conditioning?
<Tracy>  AM right...you say "blue" he says "blue" he gets candy.
<RobinParker>  Yes, but geared and modified over the years.
<RobinParker>  That is old ABA. A more modern version would fade out tangible reinforcers
          fairly quickly.
<Tracy>  Right...that's what the trainers taught us to do. I can't remember the agency they
          were from..but our school system paid for them to come train.

<Robin>  Dr. Parker, at what age can autism be diagnosed?
<Robin>  and who makes the diagnosis?
<RobinParker>  The diagnosis of ASD is made by a psychologist or pediatric neurologist usually.

<RobinParker>  I am not saying that ABA is necessarily good.  However, I have worked with
          clients who it has been a wonderful addition to a comprehensive educational program.
<AM> That is why it is so important to individualize our therapy, what works well for one may
          not work well for others.
<RobinParker>  I work with communication.  We try and make therapeutic tasks as functional as
<RobinParker>  This helps because individuals with ASD tend to learn through a strong memory
<Rob> That is very true Dr. Parker!
<AdrienneFSU>  I think it's also important to consider the family and what they are willing to do. 
          The big goal is for the child to communicate with them too, not just the SLP.
<hawaii>  Dr. Parker, what age range of this population do you work with?
<RobinParker>  young children through adults
<AdrienneFSU>  Dr. Parker, can you talk about transition activities?  I know transtion times are
          often most difficult- behavior and compliance-wise.
<RobinParker>  Yes
<RobinParker>  Schedules and letting the individual know that the transition is coming in terms
          they can understand.
<RobinParker>  Also having a static reminder
<AdrienneFSU>  routine is important?
<RobinParker>  There are some great books.
<RobinParker>  Books--Visual Strategies for Improving Communication by Linda Hodgsdon
<RobinParker>  Also Activity Schedules by Lynn McClannanhan and Patrica Krantz
<RobinParker>  Routine or teaching change in routines are important.
<RobinParker>  I have wild cards that I teach my kids because change is part of life.
<AdrienneFSU>  great
<RobinParker>  It is very important to make language concrete for some individuals.
<RobinParker>  However I use many of these techniques for all (not just ASD) clients.
<RobinParker>  It prevents a lot of behavior difficulties.
<AdrienneFSU>  "prevents" being key,  much easier than "handle"
<AdrienneFSU>  post problem
<RobinParker>  Yes, I agree
<RobinParker>  Post problems can also be dealt with.
<Tracy>  functional choices
<RobinParker>  For a school age children..Good Tracy
<RobinParker>  We may have acceptable behavior rules to follow---When I get mad I can ..
<RobinParker>  take a drink, ask for a break etc...
<Tracy>  We like the "walk or I will help you" approach also! for limp noodle kids
<RobinParker>  These routines and supports must be used over time they need to be taught.
<RobinParker>  Example--Having a piano does not make you a musician  ..anymore than having
          visual supports make you a good communicator without being taught.
<Brooke>  I have to get going, but thank you for your time and information Dr. Parker.
<Robinslu> Can you comment a little on echolalia?
<RobinParker>  Echolalia is often used for communication.
<RobinParker>  Need to assess and determine more conventional communication. Barry Prizant has
          some great articles.
<RobinParker>  There are 3 types of echolalia.
<RobinParker>  Immediate, delayed, and mitigated echolalia
<RobinParker>  Immediate echolalia is often a positive prognostic indicator.
<Tracy>  We would "scaffold" the existing echolalia at times...
<RobinParker>  Yes, we may simplify our model if we think our utterance was too long for child
          to process or use creatively.
<Tracy>  yes!
<RobinParker>  It may be the way for child to take a turn --these kids often want to communicate
          but do not understand how.
<Tracy>  great for play skills too
<hawaii>  What criteria do you use for termination of therapy?
<RobinParker>  When I use children it may also apply to adults.
<RobinParker>  Termination for therapy is when the individual does not need to make more
          functional improvements.
<hawaii>  I ask because my brother will not be receiving services soon.
<RobinParker>  This is a tough question
<Tracy>  That is tough.
<hawaii>  He is above the age for public education.
<RobinParker>  Do you think he can still make progress and improve communication?
<hawaii>  I think so, but I'm a sister.
<Robinslu> Does one with ASD ever really get to that point?
<RobinParker>  Well I often tend to agree because we all still learn throughout life.
<RobinParker>  It may be an issue of payment.
<hawaii>  The main issue that my family faces is that he has graduated from high school.
<RobinParker>  Are there adult programs in your area?
<hawaii>  They just moved to Maryland.
<hawaii>  North Potomac
<RobinParker>  He needs to be taught job skills--I work with individuals from lower functioning
          to high functioning.
<RobinParker>  We teach communication to help in the workplace and at home.
<hawaii>  Ok, my dad and mom will be getting a copy of this chat.
<RobinParker>  I think all indivduals can make an important contribution if given the right
          supports.  It is important that all individuals have the opportunity to learn a job
          even if teaching takes a long time.  We have a program at our clinic called Workable
          Solutions.  Employees do anything from filing and computer work, to inventory. 
          These are all real needs of the clinic.  We have employees start for a semester of
          volunteer work, then they can move to a paid position.
<Robinslu> Job skills do not seem to be a priority before one graduates from high school.
<hawaii>  exactly
<AdrienneFSU>  That's a shame.
<RobinParker>  I hope that is changing and you all can help.
<Tracy>  They should, shouldn't they. that is a shame.
<Robinslu> for any disability, in fact
<RobinParker>  I start around age 10 but work on it age appropriately for example..
<RobinParker>  Example..
<RobinParker>  One young man he is 12 now takes surveys around our clinic.
<RobinParker>  This is to help him in possible jobs for inventory, taking lunch orders, etc.
<hawaii>  very functional
<Robin>  great idea
<Robinslu> cool
<RobinParker>  This goal was developed with family.
<RobinParker>  My kids do a lot of photography and computer work because a talking job may not
          be optimal for MY clients
<hawaii>  right
<Robin>  hi bostonslp!  We are just finishing up our chat about autism....do you have a
          question for Dr. Robin Parker?
<bostonslp>  Yes! Glad I can squeeze one in. Thanx. I'm seeing k-5 kids on the spectrum right
          now, and all of their parents are clamoring for a specific social skills curriculum.
<bostonslp>  While I favor an eclectic approach. What is your opinion, Dr. Parker?
<RobinParker>  I agree but I always keep communication at the forefront.
<RobinParker>  Social skills need to be taught functionally and according to your setting.
<RobinParker>  Carol Gray offers some great ideas.  So does Sally Ozonoff.
<bostonslp>  to the individual needs of the kiddos. What do you suggest?
<bostonslp>  We do lots of social stories and role plays.
<bostonslp>  So in your opinion its not vital to adopt a specific curriculum?
<Tracy>  Boston, the parents are worried more about social skills than basic communication?
          Is that what you're saying?
<bostonslp>  No, these kids have basic communication skills.
<RobinParker>  I help them learn to communicate with peers and get needs met as well as
          communicate appropriately with teachers and parents.
<bostonslp>  But they are very needy in terms of expression and interaction.
<RobinParker>  If they are doing better, we do pragmatic groups and circle of friends.
<bostonslp>  And for these circles and groups, do you plan it week to week or have a set
<bostonslp>  I guess that's what I'm getting at.
<bostonslp>  The parents all have specific programs they want me to adopt.
<bostonslp>  But I'm reluctant to do so exclusively.
<RobinParker>  I usually do a 10-12 week curriculum that I prepare based on the needs of
          the group and classroom.  For example, one week might be friendship, another
          might be sharing, etc.  The form of the group is consistent.  We always have a
          group prepared snack.  We also have adopted spotlight on a particular child where
          he brings in something for show and tell, and a friend is paired.  Then they talk
          to the group together.
<bostonslp>  That sounds great
<RobinParker>  You need to have a rationale for the procedures that you decide.
<bostonslp>  10-12 weeks is enough time to address things, but doesn't tie you into a program
RobinParker>  Also, then work with the families for involvement because they will be more vested
          in the process... offer choices.
<bostonslp>  makes sense!
<AdrienneFSU>  An hour has gone by so quickly!  Thanks for sharing your time and expertise
          Dr. Parker.  I enjoyed it ~)
<Robin>  Dr. Parker, it is getting late......thank you so much for joining us!
<bostonslp>  Thank you!
<RobinParker>  Thanks for your great questions.
<bostonslp>  Thank you!
<Tracy>  thank you so much!!!
<charmaine> Bye
<RobinParker>  Wow it has gone quick!
<Robin>  Thank you all for joining us tonight!
<hawaii>  Mahalo from Hawaii !  Looking forward to the next chat session.
<sunny>  Good night!
<rebeccasloat> You are so kind to speak to us. Thank you and goodnite.
<hawaii>  Thanks Dr. Parker
<jenniferseitz>  Thanks, signing out now.
<Tracy>  Thanks for letting me join in! What's the next chat topic?
<Robin>  Our calendar has the updated schedule posted
<Tracy>  ok thanks
<Robin>  Good night all.

Selected Bibliography
Autism Spectrum disorders
Click Here