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Language and Communication Intervention for Children with Autism
Approaches for Teaching Early Multisymbol Combinations
The matrix strategy has been successfully used as one of the intervention procedures to teach generalized word combining skills to children with mental retardation and other developmental disabilities. Trained semantic relations using a matrix strategy include action-object (e.g., Striefiel, Wetherby, & Karlan, 1976, 1978; Karlan, Brenn-White, Lentz, Hodur, Egger, & Frankoff, 1982; Romski & Ruder, 1984), object-location or preposition-object (e.g., Bunce, Ruder, & Ruder, 1985; Ezell & Goldstein, 1989; Light, Watson, & Remington, 1990), and descriptor-object (e.g., Remington, Watson, & Light, 1990). Although attempts have been made to teach word combining skills to children with little or no functional speech using a matrix strategy with unaided systems such as Signed English (Karlan et al., 1982), speech + sign (Romski & Ruder, 1984), and manual signs (Light ct al., 1990; Remington et al., 1990), more research is needed to develop strategies for incorporating matrix training strategies into language interventions in naturalistic contexts (Goldstein, 1993). An example of a 4 x 4 matrix with action-object combinations is shown in Figure 1. A row represents an action and a column represents an object. Each cell of the matrix represents a unique action-object combination with the possibility of 16 action-object combinations. A clinician trains a subset of symbol combinations, and once the child has learned the subset the training starts on the next subset. The stepwise progression in the matrix provides the discriminative stimuli, and the child's response to the items of the matrix that are not in training subsets determines the generalization.
The matrix strategy is clearly an effective way of teaching manual sign (Light et al., 1990; Remington et al., 1990) and graphic symbol combinations (Nigam, 1999) to children with disabilities, but there is insufficient empirical evidence to support the efficacy of the matrix strategy for teaching children with autism. To date, only Nigam (1999) has demonstrated the efficacy of matrix instruction with children with autism, and his small sample (n = 2) prevents the generalization of findings. Further systematic replication studies are needed to determine the effectiveness of the matrix strategy to teach word, manual signs, and graphic symbol combinations to children with autism. Because each child possesses different strengths and weaknesses, the case study method and single-participant design would be suitable approaches to strengthen the existing knowledge base regarding the use of the matrix strategy.
Milieu Language Teaching Strategies
Milieu language teaching has been effective in teaching children with language disorders who do not speak frequently and who are learning early vocabulary and early semantic relations (Kaiser, Yoder, & Keetz, 1992). Early semantic relationships taught using specific milieu teaching approaches include agent-action, action-object, modifier-noun, and agent-action-object (Cavallaro & Bambara, 1982; Charlop, Schreibman, & Thibodeau, 1985; Hart & Risely, 1974; Warren & Gazdag, 1990; Warren et al., 1994). Specific training techniques such as incidental teaching, time delay and the mand-model procedure have been integrated into systematic approaches for early communication intervention. Strategies investigated have included the following:
Incidental Teaching. Incidental teaching has strong empirical support to validate its effectiveness in developing generalized communication skills in children with autism (McGee, Daly, Izeman, Mann, & Risley, 1991; McGee, Krantz, Manson, & McClannahan, 1983; McGee, Krantz, & McClannahan, 1999). Incidental teaching and the mand-model procedure are similar except that incidental teaching is child initiated, whereas the mand-model procedure is adult initiated through open-ended questions (e.g., "What is this?") or mands (e.g., "Tell me what do you want?"). The incidental-teaching strategy uses the naturally arising interactions between an adult and a child (e.g., play activity), and the adult systematically provides language instruction to develop communication skills (Hart & Risley, 1975). The child controls the incidence or activity in which language teaching occurs. A single, incidental-teaching episode with a child using graphic symbols might work like this:
(Context: During snack time, a child points to the symbol for "juice." The goal is to teach the graphic symbol combination with an action [verb] and object [noun].)
Child: Gains attention of an adult by vocalization and
points to the symbol for "juice."
Mand-Model.The mand-model strategy is a variation of incidental teaching in which teaching interactions are adult or clinician controlled rather than child initiated. The adult chooses a time to approach the child and request verbal behavior by using mands (a non-yes/no question) and if the child's response is incomplete or incorrect, provides a model (imitative prompts). A typical episode using the mand-model procedure with a child using graphic symbols might work like this:
(Context: Child is washing face after a snack activity. The goal is to teach the graphic symbol combination with an action [verb] and object [noun].)
Adult: "What are you doing?" (an open-ended question
that requires more than a "yes" or "no" answer).
The adult will wait for another opportunity to use the procedure if the child does not respond to the model. After an open-ended question, mand, and model, an expectant pause of 3 to 4 seconds is provided.
Reflection Exercise #8
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