Anderson: Excitement and Joy
History
Birth and Development
Anderson was a full-term baby delivered with no complications. Anderson's mother reported that as a baby and toddler, he was healthy and his motor development was within normal limits for the major milestones of sitting, standing, and walking. At age 3 he was described as low tone with awkward motor skills and inconsistent imitation skills. His communication development was delayed; he began using vocalizations at 3 months of age but had developed no words by 3 years.
Communication Profile at Baseline
Anderson communicated through nonverbal means and used communication solely for behavioral regulation. He communicated requests primarily by reaching for the communication partner's hand and placing it on the desired object. When cued, he used an approximation of the "more" sign when grabbing the hand along with a verbal production of /m/.
He knew about 10 approximate signs when asked to label, but these were not used in a communicative fashion. Protests were demonstrated most often through pushing hands. Anderson played functionally with toys when seated and used eye gaze appropriately during cause-and-effect play, but otherwise eye gaze was absent. He often appeared to be non-engaged and responded inconsistently to his name.
Assessment
The Communication Symbolic and Behavior Scales Developmental Profile (CSBS DP; Wetherby & Prizant, 1993) was used to determine communicative competence. This norm-referenced instrument for children 6–24 months old is characterized by outstanding psychometric data (i.e., sensitivity=89.4%–94.4%; specificity=89.4%). Although Anderson was 36 months old, this tool was chosen because it provides salient information about social communication development for children from 6 months to 6 years old.
Intervention
Anderson's team and family members developed communication goals that included spontaneously using a consistent communication system for a variety of communicative functions and initiating and responding to bids for joint attention. Research suggests that joint attention is essential to the development of social, cognitive, and verbal abilities (Mundy & Neal, 2001).
Because Anderson could not meet his needs through verbal communication, AAC was considered. He had been taught some signs but did not use them communicatively. More importantly, his motor imitation skills were so poor that it was difficult to differentiate his signs. His communication partners would need to learn not only standard signs, but Anderson's idiosyncratic signs. Therefore, the Picture Exchange Communication System (PECS; Bondy & Frost, 1994) was chosen to provide him with a consistent communication system. Additionally, a visual schedule was used at home and school to aid in transitions and to increase his symbolization.
Incidental teaching methods including choices and incomplete activities were embedded in home and preschool routines. In addition, a variety of joint activity routines (e.g., singing and moving to "Ring Around the Rosie" or "Row Your Boat" while holding hands) that were socially pleasing to Anderson were identified. These were infused throughout his day in various settings and with various people. Picture representations of these play routines also were represented in his PECS book.
Research
Several evidence-based strategies were chosen to support intervention, including PECS (Carr & Felce, 2007; Ganz & Simpson, 2004; Temple, 2007), visual supports (Bryan & Gast 2000; Krantz, MacDuff, & McClannahan, 1993), and incidental teaching (Cowan & Allen, 2007; Miranda-Linne & Melin, 1992).
Outcomes
By the end of the year, a video taken at preschool showed that Anderson was spontaneously using PECS for requests and protests. He was using speech along with his PECS requests in the "I want" format. He also used speech alone for one-word requests and for automatic routines such as counting or "ready, set, go." He shared excitement and joy in several joint activity routines with various people and referred to their facial expressions for approval and reassurance.
Sylvia Diehl, PhD, CCC-SLP, is an assistant professor in the Communication Sciences and Disorders Department of the University of South Florida, where she teaches courses in augmentative and alternative communication, language disorders, autism, and developmental disabilities.
