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Collaboration Across Disciplines in Meeting the Needs of Students with Autism

At the McCarton School in New York City, students with autism are taught in an integrated model. Professionals in Applied Behavior Analysis (ABA), Occupational Therapy, and Speech and Language Pathology work together to develop goals, provide intervention, and evaluate progress. Such a collaborative/integrated model is unique. Often when such disciplines are providing services to students with autism, they do so in an independent manner. While the collaborative model requires more planning and cooperation, it also potentially enables better service coordination and may accelerate learner progress.

In an integrated model, clinicians from each discipline bring their unique expertise and perspectives to develop a comprehensive approach to effectively address each child’s challenges. Collaborative teaching is a complex paradigm which merges instruction with team-teaching. ABA teachers, speech-language pathologists (SLPs), and occupational therapists (OTs) work together to understand how each student is functioning and how to formulate and implement an appropriate and functional plan.

ABA as the Framework

Collaboration between all the disciplines makes for maximally effective programming. The unique contributions from ABA include the development of clearly defined goals, the delineation of precise instructional strategies, the collection of objective data, and the use of data to evaluate progress and to make decisions regarding alterations in instructional objectives or methods. ABA interventionists use scientifically validated methods, and value the incorporation of methods that have been demonstrated to have efficacy. Many ABA programs do not provide services in language and OT, because these disciplines have smaller bodies of research supporting their effectiveness with learners with autism. The McCarton School employs specialists from all of these disciplines, and uses the specificity, accountability, and responsiveness of ABA instruction in all of the student’s educational services and decisions.

Contributions of Speech and Language Programming

The contributions that ABA makes to speech and language programming include operationally defining targets within all areas of the curriculum and objectively evaluating learner progress. Teachers and speech pathologists work in collaboration, employing shaping principles and taking into account varying prompt levels, such as phonemic cues or visual supports. Acquisition criteria must be reasonable and possible; this ensures success. The formulation of measurable goals facilitates the collection of data, which are monitored on a consistent basis so that modifications (e.g. removal of mastered goals, introduction of prompts), can be made as necessary.

Speech-language pathologists provide the foundation skills for communication, which are the essential components for daily functioning across all domains. A considerable number of language goals are targeted via naturalistic teaching approaches (such as incidental teaching or natural environment training) which can target the generalization of skills learned within a more structured ABA format such as discrete trial instruction. For example, while ABA teachers may target sorting picture cards into groups of foods and furniture, SLPs may work on the same target but within more generalized contexts, such as a storybook or during snack. Additionally, SLPs may lend support to facilitating the development of basic requesting skills during manding sessions, as well as to extending the skill of manding into the natural environment.An understanding of pragmatic skills is vital when working in a classroom setting, as pragmatic language skills augment the degree to which a student can navigate the educational environment independently. SLPs explain, model, and train ABA teachers on the various components of pragmatics and how to incorporate these goals across the school day. These skills can include appropriately greeting peers during circle time, encouraging interactions among peers during social times such as snack, improving conversational skills while talking during morning meeting, and commenting on their environment during community walks.A significant part of the school day for young learners involves play, an area which may seem fun and effortless, but is actually complex and requires an extensive understanding of language development. SLPs work with ABA teachers to set up simple play sequences (e.g., for a garage – first get gas, next wash the car, and then go down the ramp). SLP’s and ABA teachers can work together to develop goals and programs in the area of imaginative play. Goals might include using narration while expanding a play schema (dressing up as doctors, using a variety of items to perform an examination, and using context-appropriate scripts). These are also areas in which ABA research and data collection methods can inform best practice teaching approaches, allowing for very fruitful collaboration.

Collaboration with Occupational Therapists

What occupational therapy brings to the collaboration is a perspective of human performance viewed from two different vantage points: a) sensory integration, sensory processing and regulation and b) motor learning / motor skill acquisition. Occupational therapists examine how a child receives information through different sensory systems, and how that information is processed and interpreted. Subsequently, the clinician examines how the child responds to the sensation. A sensory diet is put in place that helps the child to cope more efficiently with everyday life situations, overcome sensory sensitivities and help different systems receive process and respond to stimuli in an organized, regulated and appropriate way.

This information can inform the educational interventions and approaches used. Therapists and teachers can better identify the nature of particularly appealing / motivating reinforcers, including sensory reinforcers. Sensory breaks within the overall structure of a daily sensory diet may help with maintaining the child at a level of ‘optimal arousal’ (a state of productive alertness) where learning and skill development can be promoted without evoking behavioral or emotional overreactions. Examples of sensory breaks can be different types of ‘heavy work’ (jumping on trampolines, or hippity hop balls, carrying heavy objects around rooms, running on treadmills, resistance activities, movement / exercise protocols) or intense short bursts of sensory stimulation (rotary stimulation, localized proprioceptive input, use of hand manipulatives, or visual stimulation).

Occupational therapists focus on gross and fine motor coordination skills and utilize motor learning guidelines while working on skill development. Principles regarding guidance (physical, verbal, visual modeling), feedback and variability in practice are employed when presenting therapeutic activities across different areas of performance following a developmental progression. A variety of programs can be jointly carried out by ABA and OT staff members (gross motor imitation, fine motor imitation, ball playing, graphomotor tasks such as coloring, handwriting, cutting with scissors, ADL’s – personal hygiene). Often the occupational therapist will introduce the new skills and focus on developing the necessary movement patterns. At the same time, emphasis is placed on muscle strengthening and bilateral coordination. Interventions are intense, fast paced and provide multiple opportunities for consistent practice. ABA therapists collaborate with this process by providing intensive practice that tends to accelerate skill mastery.

The occupational therapists’ knowledge of kinesiology and human biomechanics can also be useful in recommending several types of adaptations in the children’s classroom environment that helps enhance their performance (slant boards, seating adjustments, foot rests and back supports, inflated cushions, pencil grips, adapted scissors, modified worksheets, weighted writing mediums and utensils etc.).

Consistency of Strategies Employed

Speech and occupational therapists use the techniques of their disciplines in conjunction with more behavioral educational strategies such as visual schedules, token economy systems, and the use of behavior intervention plans. The use of such strategies across all interventionists helps with maintaining instructional control where necessary and provides consistency in rules and expectations across staff members and instructional contexts within the school environment. Such consistency is critical to achieving maximal success within speech and OT sessions.

Speech and language therapists work with other members of the team to develop oral motor protocols that focus on desensitization and on the development of deep diaphragmatic breathing. The input from occupational therapists is helpful in this regard, as understanding how the sensory systems are responding to input assists SLPs in creating appropriate plans. Behaviors targeted might include engaging in inappropriate oral play or exhibiting feeding difficulties due to taste, texture, or temperature aversions. Oral-sensory-motor protocols are written collaboratively and carried out by all disciplines throughout the school day.

ABA therapists and occupational therapists are trained by SLPs to use different augmentative communication devices within the context of their therapy sessions and they use communicative strategies to elicit active, self-initiated and meaningful responses from the children. The implementation of the students’ various modes of communication, such as sign language, PECS, augmentative devices, and visual supports are trained and supported across all disciplines and all settings. Speech and language related goals can be targeted during movement activities especially during the use of suspended equipment which is highly motivating for the students. Speech and language therapists can themselves conduct parts of their sessions in a sensory-rich environment such as the gym.

Summary

A collaborative model enables learners to receive services that address all areas of deficit. The strength of each discipline can be maximized, while the consistency of approach ensures that the learner receives interventions that are individually tailored, maximally effective, and fully comprehensive. ABA provides the framework, with a focus on well-defined instructional strategies, data collection, data-based decision making, and consistent implementation across therapists and environments. Future directions include research aimed at applying ABA methods to the experimental analysis of the effectiveness of speech and OT protocols.

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