ABA for SLPs

Interprofessional Collaboration for Autism Support Teams

Joanne E. Gerenser, Mareile A. Koenig, Joanne E. Gerenser, Mareile A. Koenig

• Publisher: Brookes Publishing
• Year: 2019
• ISBN:
  9781681253480
• Topic: Éducation
• Subtopic: Éducation inclusive

To help ensure the best outcomes for learners with autism spectrum disorder, speech-language pathologists (SLPs) and behavior analysts (Bas) need to work together to support positive behavior and effective communication. This book provides SLPs with a clearer understanding of applied behavior analysis (ABA)—and bridges the gap between the two fields with a comprehensive plan for collaboration.

An important new addition to courses in speech-language pathology, this textbook clears up the myths and misconceptions surrounding ABA and builds a clear path to interprofessional practice between SLPs and Bas. Through chapters co-authored by practitioners from both disciplines, speech-language pathologists will learn how to move past ABA stereotypes and controversies, incorporate the best ABA-based practices into their work- and break down the barriers to productive collaboration with Bas.

An essential part of every future SLP's education—and an eye-opening guide for practicing professionals—this timely text shows how experts from two vital fields can learn from each other and work as a seamless team to support better lives for people with autism.

READ THIS BOOK TO:

• Discover the benefits of collaborating with Bas, including practical strategies for connecting with them and for learning from their expertise
• Learn fundamental features of ABA, including its key terminology, core behavioral teaching components, and data collection methods
• Receive recommendations for applying the interprofessional education and interprofessional practice model (IPE/IPP)
• Learn about proven ABA-based interventions, including the analysis of verbal behavior, Pivotal Response Treatment, Incidental Teaching, and the Picture Exchange Communication System
• Learn how to integrate ABA with speech-language pathology in critical areas, including assessment, goal-setting, and behavior intervention

STUDENT-FRIENDLY FEATURES: Learning objectives, reflection questions, vignettes, and a helpful glossary make it easy for SLPs to absorb and apply new terminology and strategies.

1

Interprofessional Collaboration

Mareile A. Koenig and Joanne E. Gerenser

LEARNING OBJECTIVES

After completing this chapter, the reader will be able to

•Describe and distinguish between the services provided by both speech-language pathologists (SLPs) and behavior analysts (BAs)

•Discuss the ways that both SLP and BA services support individuals with autism spectrum disorder (ASD)

•Explain why it is important for SLPs and BAs to understand the foundations of both disciplines and collaborate together effectively

•Understand historical barriers to collaboration between SLPs and BAs

•Understand guidelines for effective SLP–BA collaboration and list ways to apply these guidelines in practice

Children with ASD present with a complex range of needs, and it takes a village to support those needs. The family is at the center of the village, and professionals who support the family typically include educators, SLPs, BAs, and many others, depending on a child’s specific profile. The strength of this support system rests not only on the expertise of individual professionals but also on the degree to which professionals from different disciplines collaborate with each other. This chapter focuses specifically on collaboration between SLPs and BAs in the service of children with ASD. It 1) briefly highlights selected symptoms of ASD that can be supported by the overlapping services of SLPs and BAs, 2) summarizes the range of services provided by SLPs and BAs, 3) discusses the importance of SLP–BA collaboration, 4) addresses barriers to collaboration, and 5) introduces guidelines for supporting the collaboration process.

WHY CHILDREN WITH ASD NEED SLP AND ABA SUPPORT SERVICES

Consider the example of Katrina as an illustration of how and why SLPs and BAs need to work together to support children with ASD.

Managing Katrina’s Behavior: SLP–BA Collaboration

Katrina is a 4-year-old with ASD who receives center-based early intervention in a small classroom, five mornings per week. The SLP’s role within Katrina’s classroom is to engage small groups of students in a routine circle activity. Whenever Katrina is present, however, she kicks and scratches the students sitting on either side, which disrupts the small-group activity and is a safety hazard. The SLP attempts to manage Katrina’s behavior by increasing the space between children, grouping her with different children, redirecting her attention, and blocking her challenging behaviors. Regardless of the intervention, Katrina’s behaviors always escalate, however, until the SLP sends her to time out.

When the SLP consults with a resident BA for advice on managing Katrina’s behavior, the BA conducts a functional behavior assessment (FBA). The FBA results indicate that Katrina’s kicking and scratching function as a means of allowing her to escape the group activity. The BA recommends functional communication training (FCT) for teaching Katrina an appropriate way to request a break. The SLP assists by recommending the appropriate communication modality (in this case, a visual “break” card). The BA assists in follow-up by designing a behavioral program for gradually increasing the length of Katrina’s circle participation time once she has learned to request breaks consistently without kicking or scratching. Katrina learns to participate in the complete group circle event without incident within 3 weeks.

ASD is characterized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association [APA], 2013) by “a persistent deficit in social communication and social interaction” (p. 50) and by the presence of “restricted, repetitive patterns of behavior, interests, or activities” (p. 50). Clearly, deficits in social-communication are a central feature of this disability. The profiles of individual children with ASD vary widely depending on 1) the number and severity of symptoms associated with each of these deficit areas and 2) the presence or absence of disabilities that may accompany ASD, such as intellectual impairments, atypical responses to sensory stimulation, sleep disturbances, and obsessive compulsive behavior. An exhaustive description of ASD is beyond the scope of this chapter. A brief consideration of selected communication deficits is provided, however, to illustrate the need for overlapping support from SLP and applied behavior analysis (ABA) professionals.

Children with ASD generally do not spontaneously acquire adaptive communication skills at the same rate or with the same range of expression as typically developing children. Most will learn a variety of means to express themselves when they are provided with support, but their primary communication modalities may vary. Some will learn to use speech and language as a primary means of communication. Others will learn to use augmentative and alternative communication (AAC) systems, such as manual sign language, the Picture Exchange Communication System (PECS; Frost & Bondy, 2002), or computer-assisted speech-generating devices (SGDs). Learning to use communication signals appropriately in social contexts is challenging for all, regardless of the modality; and learning to express a normal range of semantic content and use more advanced linguistic forms is challenging for most.

Like typically developing children, many children with ASD begin to communicate at a prelinguistic level, either through direct manipulation of their caregivers or by using nonlinguistic vocalizations that are interpreted by caregivers as communication signals. Children with ASD, however, present with deficits in the development of joint attention—that is, the ability to share attention to an object or other stimulus simultaneously with another person. Joint attention is a crucial context for language learning (e.g., Dominey & Dodane, 2004; Tomasello & Farrar, 1986). Some children may learn to use conventional signals in an atypical manner without strategic environmental support, as seen in the case of children who use echolalia. They may use idiosyncratic vocal or nonvocal signals that are difficult for others to interpret, or they may produce challenging behavior (e.g., hitting, pinching, kicking, eloping, screaming) to achieve their goals when other signals are unavailable or ineffective. For example, a child may learn to use hitting as a means for escaping a nonpreferred or difficult task. Challenging behavior may also occur if the skills required for the use of specific communication signals exceed a child’s performance repertoire or his or her motivation. For example, it may be easier for a child to kick or pinch than to say, “I need a break.” Support for the prevention/reduction of challenging behavior and for the use of adaptive functional communication skills requires expertise in two areas:

1.Systematic analysis of environmental variables (antecedents, consequences)

2.Selection of appropriate replacement behaviors (e.g., Carr & Durand, 1985; Keen, Siagfoos, & Woodyatt, 2001).

In ABA, antecedents are events that occur immediately before the target behavior, and consequences are events that immediately follow it. A replacement behavior is a socially appropriate behavior a child is taught to use instead of a challenging behavior (e.g., a child may learn to raise his or her hand to request a break instead of kicking or punching someone).

Instruction does not always progress smoothly when children receive support for communication development. For example, children may pay attention to irrelevant stimuli, or they may lack the motivation to perform a particular task. Thus, children may need to alter their behaviors (e.g., focusing on a task rather than irrelevant distractions, performing a task that is not intrinsically motivating to them) for communication instruction to be effective. Sundberg (2014) described 23 different barriers to learning that may be observed during language instruction. The identification and reduction of these barriers requires expertise in behavior analysis. Barriers to language learning may continue to develop and become increasingly more difficult to manage without this type of support.

Clearly, supporting the communication needs of children with ASD involves professionals with expertise in communication modalities (e.g., speech, language, AAC), communication processes, linguistic forms, developmental sequences, and the use of interventions to promote development. It also requires professionals who are skilled in the analysis of behavior and in the application of positive behavior support procedures for preventing and reducing the performance of maladaptive behavior used to communicate. As a whole, these needs involve the combine...