Read the following scenario and then address the assignment prompts that follow.
Sam: From Gestures to Symbols
Sam is a 16-year-old young man with ASD and significant cognitive delays. As part of professional development training for his educational team, a speech-language pathology consultant followed him for 12 months. Sam now attends a public-school special day class that offers frequent instruction in varied settings to foster independence in the community.
History: Birth and Development
Sam was born six weeks premature following his mother’s hospitalization for pre-term labor. His birth history was significant for low birth weight (2 lbs., 10 oz.), respiratory distress, intraventricular hemorrhage, and a neonatal hospital stay of six weeks. He began receiving intervention services at 12 months of age to address speech, language, social-emotional, and cognitive delays. To date, evaluations yield developmental age equivalents up to the 24-month level. Since birth, Sam’s history is unremarkable for significant medical concerns and he is in good health. He has passed hearing screenings and wears corrective glasses.
Communication Profile at Baseline
At 14 years, 8 months of age, Sam spontaneously shared his intentions through nonverbal means, which included facial expressions (e.g., looking toward staff to request a snack), physical gestures (e.g., pulling his teacher’s hands to his head to request a head massage), and more conventional gestures (e.g., pointing to request and a head shake to reject). He also used unconventional nonverbal signals that included biting his hand to share positive and negative emotions and pinching to protest. Sam occasionally used a few verbal word approximations (e.g., “no,” “yes,” “more,” and” balloon”), the sign for “help,” and picture symbols on a voice output device. However, he typically used these symbols passively; most often in response to a direct verbal prompt from his social partner (e.g., “Do you want more?”).
At baseline, the SAP was administered to gather information about functional abilities in daily activities through observation and a comprehensive caregiver questionnaire. Given his baseline presentation, the SAP placed him at the Social Partner Stage, a stage that is relevant for individuals using pre-symbolic communication. With this profile, functional educational goals based upon parent priorities and evidence-based supports were determined.
The SAP was derived from longitudinal descriptive group research. It enables providers to select educational objectives that are predictive of gains in language acquisition and social adaptive functioning (Prizant et al., 2005). Sam’s educational team selected objectives shown to predict an individual’s symbolic growth, such as increasing his rate of spontaneous communication and his range of communicative functions. The team worked to move him beyond requesting objects to requesting specific people and actions. The SAP also facilitated the selection of evidence-based supports such as AAC when developing educational accommodations to address these objectives.
Sam’s individualized education program objectives shifted from those for passive responses (e.g., responding to questions such as “Where did you go?”) to initiating communication using AAC (e.g., requesting help or other actions, expressing emotions, and making choices of coping strategies). Throughout the day, Sam accessed an emotion necklace of laminated cards. On the front of each card was a graphic symbol representing an emotional state (e.g., happy, angry, and sad). On the back were symbols representing words Sam could use to request actions from others (e.g., “high five” for happy). This support fostered symbolic requests for communicative functions that Sam already exhibited spontaneously using nonverbal means at baseline (e.g., expressing emotion by biting his hand and looking toward staff).
During language art centers, Sam engaged in activities designed to elicit more sophisticated requests for preferred actions. Rather than identifying pictures, he could choose a preferred sensory activity, such as a head massage, a back rub, or tickling. Color-coded symbols paired with sentence templates allowed Sam to create his own sentences for functions already exhibited spontaneously using nonverbal means at baseline (e.g., requesting comfort by pulling his teacher’s hands toward his head).
Sam’s first quarterly review occurred around his 15th birthday. Observations and videos revealed a higher rate of spontaneous bids for communication and the emergence of symbols to express emotion (e.g., “happy” and “mad”), request coping strategies (e.g., “head squeezes” and “high fives”), and form simple sentence structures (e.g., “Jim squeeze head” and “Karen rub back”). By six months post-intervention, Sam began to take turns, requesting interaction using subject + verb sentences and then responding to interaction. His teacher might request that “Sam rub back” and Sam would oblige. At 12 months post-intervention, Sam continues to expand his symbolic language skills and recently began to generalize his sentences to include names of his peers.
By Emily Rubin,
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