Interventions for the Verbal Individual Behaviorally oriented speech

• • Interventions for the Verbal Individual Behaviorally oriented speech and language programs for children that have communicative speech typically target four major aspects of speech-language development. First, intervention often aims at increasing vocalizations and establishing imitative speech. Second, a general objective is to enlarge the learner’s vocabulary by (a) establishing new words and phrases, (b) enhancing the complexity of grammatical structures, and (c) developing the learner’s conversational skills. Third, intervention typically targets using the newly acquired speech forms in more functional and spontaneous ways; related content goals may include (a) establishing the spontaneous and generalized abilities to mand tact, (b) transforming echolalic utterances into more meaningful functional speech, and (c) sustaining verbal behavior in general. Fourth, intervention aims to facilitate the various pragmatic aspects of verbal behavior, such as developing better articulation, expanding length of utterance, and fine-tuning prosody. It is critical to note that these four general intervention objectives are not mutually exclusive, and they are also not bound to any particular instructional sequence. Examples for evidence-based communication intervention programs that are firmly grounded in behavioral principles include the following examples.

• • • Interventions for the Minimally Verbal Individual: Augmentative and Alternative Communication Individuals with ASD who do not develop sufficient natural speech or writing to meet their daily communication needs are candidates for intervention in the area of augmentative and alternative communication (AAC). Such individuals may show only pre-intentional communication, such as reaching for a desired item, or communication may show intent through behaviors such as pointing. When speech does develop, it is often limited to unusual or echolalic verbalizations. AAC is defined as the supplementation or replacement of natural speech and/or writing using aided and/or unaided strategies. Blissymbols, pictographs, Sigsymbols, tangible symbols, and electronically produced speech are examples of aided AAC. Manual signs, gestures, and body language are examples of unaided AAC. The use of aided symbols requires a transmission device, whereas the use of unaided symbols requires only the body. Major types of AAC intervention for individuals on the autism spectrum include the following approaches.

• • Restricted, Repetitive Behaviors and Interests The final core symptom of ASD is restricted or repetitive behaviors, interests, or activities (American Psychiatric Association, 2013). To meet the DSM-V diagnostic criteria for ASD, an individual must present with or have a history of at least two categories of restricted, repetitive behaviors and interests (RRBI). RRBI categories include (a) stereotyped or repetitive motor movements, use of objects, or vocalizations (e. g. , hand flapping, body rocking, lining up objects, echolalia or repetitive speech); (b) insistence on sameness, strict adherence to routines, or ritualistic verbal or nonverbal behavior (e. g. , major distress related to changes in routines, transitions); (c) highly circumscribed or perseverative interests (e. g. , intense focus or attachment to unusual objects, topics, or interests); or (d) hyper- or hyposensitivity to sensory input (e. g. , indifference to pain, excessive sniffing of objects, licking objects, covering ears) (American Psychiatric Association, 2013). RRBI in individuals with ASD is heterogeneous and can take the form of a variety of motor, vocal, and ritualistic behaviors, which vary greatly in terms of form, frequency, and intensity. To assist in examining the etiology, trajectory, and treatment of RRBI, researchers have factored RRBI into two subgroups: lower-order and higher-order RRBI.

• • Environmental Enrichment (EE) EE is similar to NCR in that access to stimulation is provided irrespective of the individual’s engagement in RRBI. EE involves increasing the quantity or quality of reinforces within a setting. EE is effective at reducing RRBI when the reinforcing properties of the environment successfully compete with and become more valued than the automatic reinforcement obtained through RRBI. For example, a teacher could conduct a preference assessment to identify a child’s preferred toys and activities. He or she could then identify times during the day when the child is likely to engage in lower-order RRBI and present the preferred toys and activities to the child during those times. Vollmer et al. (1994) found that when children with ASD were given access to their preferred items, lower-order RRBI decreased. However, for some individuals, EE may actually lead to an increase in vocal stereotypy. Van Camp et al. (2000) observed rates of hand flapping in a young boy and found that hand flapping was higher in the presence of preferred toys than when the child was alone without environmental stimulation. Given this variability in outcomes, it is important to evaluate the effects of environmental enrichment on RRBI for the individual prior to adopting the intervention whole scale.