Kentucky Autism Training Center Newsletter Articles

The Picture Exchange Communication System (PECS)

By Julie Stewart, M.Ed.


The Picture Exchange Communication System (PECS) was created by Lori Frost and Andy Bondy in 1985 and is a unique alternative/augmentative communication intervention and is currently in its second edition.  PECS is divided into six distinct phases and starts by teaching an individual to exchange a picture of a desired item to a “communicative partner” to immediately receive access to the item.  When a child reaches mastery of Phase I, as designated by the PECS protocol, after teaching the child to understand the exchange, the child moves into Phase II.  Below are the descriptions provided on the PECS website for phase:


Phase II (Distance and Persistence):

Still using single pictures, students learn to generalize this new skill by using it in different places, with different people and across distances.  They are also taught to be more persistent communicators.

Phase III (Picture Discrimination):

Students learn to select form two or more pictures to ask for their favorite things.  These are places in a communication book—a ring binder with Velcro® strips where pictures are stored and easily removed for communication.

Phase IV (Sentence Structure):

Students learn to construct simple sentences on a detachable sentence strip using an “I want” picture followed by a picture of the item being requested.

Attributes and Language Expansion:

Students learn to expand their sentences by adding adjectives, verbs and prepositions.

Phase V (Answering Questions):

Students learn to use PECS to answer the question “What do you want?”

Phase VI (Commenting):

Now students are taught to comment in response to questions such as, “What do you see?”, “What do you hear?” and “What is it?”.  They learn to make up sentences starting with “I see”, “I feel”, “It is a”, etc.”


To successfully implement this evidence-based practice it is essential for individuals to attend an official training provided by the Pyramid Educational Consultants.  This training experience will help you discover the nuances that reading the manual simply cannot provide.  However, it is important to approach using PECS with a student with flexibility and an eagerness to troubleshoot.  Each student’s experience with PECS will be different and the pace of mastery for each phase will vary.  Be ready to plan ahead to be able to provide instruction and communicative opportunities across the entire schoolday and not during isolated events, such as lunch or snacktime.  For some students, PECS is just what they need to understand the power of communication and sometimes motivates them to begin using verbal language to communicate wants and needs.  BUT of course PECS is not an intervention that will produce results for all students and all options for teaching communication should be evaluated!!


Julie Stewart is a Field Training Coordinator for the KY Autism Training Center. She provides direct training and technical assistance to education staff, social and community personnel, counselors, job coaches and families.

KY Autism Training Center Winter 2013 Newsletter February 2013

Facing the Toilet Training Challenge

By Julie Stewart, M.Ed.


One of the greatest challenges families face is the dreaded toilet training process.  Here at the KATC, during almost any professional or family training we provide, we get questions about toilet training across ages and development levels.  It is the family’s decision on when and how to support a child’s involvement in learning the process of using the toilet, however some children may never demonstrate the interest or self-initiation that provides the signs to start “training” that their neurotypical peers may show.  There are some general helpful hints for supporting your child’s toilet training and then more intense program that has been determined to be effective.

Here are some general tips for supporting toilet training:

  • Only attempt toilet training when the child is wearing underwear
  • Begin training on a schedule, having the child go to the bathroom on set time interval (ex. every 30minutes) and stay for a set about of time
    Provide intense levels of liquids to increase the child’s opportunity to practice
  • Always verbalize “time for potty” or “go to bathroom” at the beginning of the intervals; pair with a sign if your child does not vocally communicate
  • Immediately when the child voids (urinates or defecates) in the toilet, provide them with behavior specific praise (“Great job going pee-pee”) and tangible/edible preferred item

IMPORTANT: If toileting is a difficult task to master for your child, the toy or edible given after voiding MUST NOT BE AVAILABLE at ANY OTHER TIME.  Controlling their access to this preferred item will increase it’s motivating potential and increase the likelihood that it will be a strong reinforcer for toileting.

Be sure to fade the use of reinforcement; some use sticker charts but be aware that stickers may not be very interesting and therefore not reinforcing for your child

For boys, putting cheerios or fruit loops in the bowl to make urinating a bit more interesting, creating a game
Putting food coloring in the toilet bowl that will interact with the yellowish urine, such as blue or red
Play card games on a lap-table or tray, read books, sing songs, etc. to extend the amount of time the child attempts

This is not an exhaustive list and should not be all the strategies you try, however hopefully it gives you an idea or two that you haven’t tried.  The most important step of all toilet training is to set your plan, stick with it for a period of time, and take on-going data to make a determination if it is working or not.  If your child starts to not have accidents but you haven’t taken data you may be responding to a placebo affect instead of factual information about how the training process is going.

For children who seemingly do not respond or who have not been successful when the more typical measures are taken in toilet training, there are other


Julie Stewart is a Field Training Coordinator for the KY Autism Training Center. She provides direct training and technical assistance to education staff, social and community personnel, counselors, job coaches and families.

KY Autism Training Center Winter 2013 Newsletter February 2013

Blake's Journey One Bite at a Time

By Jocelyn Warren, OTR/L


Feeding disorders are a common problem in children.  Review of studies has shown that between 46% and 89% of children with autism spectrum disorders have a feeding disorder.  Food selectivity or refusal, disruptive mealtime behaviors, and rigidity with mealtimes (only eat from certain bowl, have to sit in certain chair, etc) are among the commonly reported concerns.  The University of Louisville Autism Center at Kosair Charities provides feeding therapy to address these issues.

Blake’s Journey with feeding therapy began in 2011.  Initially he was seen at the Weisskopf Child Evaluation Center for an Interdisciplinary Team Feeding Evaluation.  His parents were concerned about Blake’s feeding as he had frequent spitting up and had an extremely limited diet.  His diet consisted of Lay’s original potato chips, licks of peanut butter, smoothies (mixture of his medications, baby food, and juice), and only a few varieties of Stage 2 baby foods.  Blake was also limited in his acceptance of drinks as he would only drink water, soy milk, and 7-Up.  During the evaluation, Blake was evaluated by a Dietician, Occupational Therapist, Psychologist, and a Speech Language Pathologist.  Blake had many issues with feeding that are commonly found in children diagnosed with an autism spectrum disorder including limited food variety and rigidity with feeding behaviors as he would only eat one brand of potato chips (what is it with those Lay’s potato chips???) and would only drink his smoothie from one particular cup.

Mom’s Story of Blake’s Journey


Speaking for myself, I can honestly say that Blake’s feeding issues have been more painful for me than Blake’s diagnosis of Autism and being nonverbal combined.  Not only was I dealing with the feelings of being a failure as a mother because of the guilt I was experiencing at what my child was eating, I was also criticized by family, friends, strangers and even the autism community.  In addition to his sensory issues and his rigidity, Blake would also vomit at the site or smell of food to get away from the table.  Blake’s behavior therapist once gave me the superhero name of “The Excrementorator,” and I have to agree that I had earned that title!  I feel certain that I had cleaned vomit up in every inch of my house and car, but also restaurants, Memaw’s house, department stores, etcetera.

When I sought Jocelyn Warren (Occupational therapist) for feeding therapy, I felt defeated and had up hope. The process of introducing food and having Blake interact with food seemed impossible.  I had tried feeding therapy once before, but it made things so much worse and his behavior was off of the charts.  I had never won a feeding battle with Blake, as it was one of the few things he had complete control over.
After a lot of vomiting and finally finding a positive reinforcer, Jocelyn started to have successful sessions with Blake.  Unlike therapy before, Jocelyn allowed me in the therapy room and she let me “take the spoon.” I was finally finding the confidence that I so desperately needed to be successful with implementing his therapy at home.

I started to realize after a short time working with Jocelyn I had enabled Blake’s avoidance of food by allowing him to escape when he would vomit. Not only did I enable his behavior, I feel certain that he was also picking up on may anxiety due to terrible past experiences with food.  Once I practiced allowing Blake to vomit while continuing on with the task at hand, he stopped vomiting to avoid the task.  I felt my anxiety decreasing and I feel certain that it did for Blake as well.  Blake does, however, continue to vomit due to sensory issues with new textures, but that was nothing compared to what it was like before.

In closing, there was nothing easy about feeding therapy and there’s no way to candy coat vomit!  I cannot begin to tell you how wonderful it feels to make progress.  I hope others affected by these issues will hear me when I say, if MY son can do this, ANYBODY can do this and to never give up.  Once I came out and started discussing my son’s issues with others, I have found that so many people tend to hide these issues.  I completely understand and I hope that you will seek help for your children and let go of the guilt and shame.  There are a lot of us out here.

Therapists Story of Blake’s Journey


After Blake’s evaluation, his mother and father and I worked together to determine our main goals for Blake.  We decided that decreasing his vomiting and getting Blake to no longer relying on baby food for a large majority of his diet would be our first goals.  Several behavioral strategies have been utilized to help Blake meet these goals.  Positive reinforcement and sensory desensitization are the main techniques that have been used for Blake.  Initially our goal was to help Blake be more flexible so that he could accept food that was very similar to foods that he already ate but slightly different.  We focused on introducing new flavors of Lay’s potato chips (who knew that Lay’s has 20 flavors of just their regular potato chips?).  Blake was soon eating Lay’s Barbeque, Sour Cream and Onion, and Cheddar and Sour Cream flavored chips.  The importance of his progress was not that he can eat different flavors of chips (nutritionally this did not add anything to his diet) however Blake was becoming more flexible with his eating.  During this time we also worked on Blake being able to eat the chips not just from the original bag, but also on a plate and from a plastic bag as well as him being able to drink his smoothie from a regular cup.

We used positive reinforcement and sensory desensitization to achieve these goals.  Every time Blake took a bite of a newly flavored potato chip or a drink  from a regular cup he was rewarded (positively reinforced) with a favored food/drink (Lay’s  classic potato chip, drink of 7-Up) or a brief time playing with a preferred toy/activity (tickling, singing song, swinging on the therapy swing, looking at his favorite book).  As it became easier for him to take bites of the newly flavored chips, he had to take more bites to earn the reward until finally he no longer required rewards to eat these new foods.  Utilizing sensory desensitization was also used simultaneously with positive reinforcement.  Initially Blake would become upset when he saw me bring the newly flavored chips into the therapy room.  Our first goal was to touch the chip (pick up the chip and put in the garbage can), then we transitioned to touching the chip to his lips, then teeth, then tongue, then back molars, and finally taking a bite.  Depending on the child, this might take only one session to move through these steps or it can take several weeks.  Blake required several weeks to move through this process and there were frequent upsets, gagging, and vomiting (just a quick note about vomiting, in Blake’s case he was being followed by a Gastroenterologist so we knew that the vomiting was not related to a medical issue but was more behavioral so the vomiting was ignored.  It is only recommended to ignore vomiting if it is clear that there is no medical reason).  Blake’s family worked on these skills at home, so soon Blake was eating new flavors of chips in many different environments including home and school.

Our next goal was to get rid of the baby food.  We focused on adding applesauce, yogurt, mashed sweet potatoes, mashed potatoes and gravy, pureed fresh fruits, oatmeal, and other types of smooth textured foods.  We also wanted to add a vegetable/fruit juice (Capri Sun Super V, Fruitables, V8 Splash) to his diet.  We continued to use positive reinforcement and sensory desensitization techniques to increase his acceptance to these foods.  Blake was very sensitive to the smells of new foods as well as looking at new foods.  I learned this the hard way when I brought in a very small bowl (about 1 tablespoon) of refried beans into the therapy room.  Blake was busy playing on the therapy swing and immediately began to gag and throw up before he even saw the food item.  His mother and I decided that we would just put the new food on the table during the therapy session and Mom would put the food item on the kitchen counter at home for one week before he was asked to even touch the food.  It was a huge celebration when Blake came to therapy and his mother shared with me that she had donated boxes and boxes of baby food to a local charity as Blake was eating so much of the smooth textured foods that he no longer needed the baby food…and best of all he wanted the regular food.

Our current goal is to add more textured foods to Blake’s diet.  He is eating fork mashed fruits, fork mashed vegetables, fork mashed stews (he loves his Mom’s beef stew), cereal crumbs, bacon crumbs, mashed rice, mashed noodles, mashed hot dogs, and many other items that are of mashed or crumb textures.  Blake still continues to struggle with taking a bite of harder textured foods such as a piece of fruit, meat, or vegetable but his progress has been steady.  It was also a huge celebration when Blake was able to eat his first Christmas dinner (turkey, mashed potatoes and gravy, and sweet potatoes) with his family.

Blake has made so much progress as his family is able to follow through with these techniques in the home environment and do so at every meal and snack.  It is so important for families and therapists to work closely so that the techniques used in the clinics can be used in the home environment.  Blake continues to attend feeding therapy one time a week.  With his hard work and his family’s effort, we expect Blake’s journey to continue to move forward at a steady pace.


If you are interested in learning more about understanding the common issues of feeding problems for children with ASD, strategies/techniques to utilize at home to expand food variety and when to seek professional help watch the Techniques to Expand Food Variety for Children with ASD webinar by Jocelyn Warren.


Jocelyn Warren, OTR/L is a Senior Occupational Therapist at the University of Louisville Weisskopf Center for the Evaluation (WCEC). She graduated from The Ohio State University in 1989 and received a Masters in Special Education from the University of Louisville in 2011.  She has been a Senior Occupational Therapist at the Weisskopf Child Evaluation Center (WCEC) for the past 12 years.  Jocelyn initiated the development of the Feeding Disorders Clinic at WCEC in 2003. At WCEC she serves as a team member on interdisciplinary team diagnostic evaluations, completes individual occupational therapy evaluations, participates in feeding disorder outreach programs, and provides intervention services.  She has presented at state and national conferences.

KY Autism Training Center Winter 2013 Newsletter February 2013

Sleep Problems in Children with Autism

By P. Gail Williams, M.D.


Prevalence: Sleep problems are very common in children with autism. Studies indicate that 50 to 80% of children with autism experience sleep difficulties at some time.  This is much higher than the 9 to 50% rate of sleep problems for typically developing children.

Neurobiology: The increased prevalence of sleep disorders among children with ASD is likely due to neurobiologic alterations in the sleep-wake cycle.  Neurotransmitters which have been implicated in ASD sleep problems include Gamma-aminobutyric acid (GABA), serotonin and melatonin.

Impact: Disordered sleep is frequently associated with behavior problems and inattention in typically developing and developmentally disabled children.  Sleep problems in ASD are correlated with increased maternal stress and parental sleep disruption.  Repetitive behaviors and insistence on sameness may also be increased with poor sleep patterns.

Types of sleep disorders: Insomnia is the most commonly reported sleep problem in children with ASD.  Problems falling asleep, increased wakenings, and decreased efficiency of sleep have been reported by parents in numerous studies.  In addition to the neurobiologic  alterations mentioned earlier, children with ASD may have medical conditions such as epilepsy and reflux which interrupt sleep.  Certain medications may predispose to insomnia. Conditions that can be associated with ASD, such as ADHD, anxiety, and depression may also contribute to sleep problems.  Core behavioral concerns such as limited communication and self regulation and strong preoccupations  can lead to difficulty in setting effective bedtime routines.

Other sleep disorders seen with some frequency in autism include sleep disordered breathing, most commonly obstructive sleep apnea (OSA), which may require tonsillectomy and adenoidectomy or other medical treatment.  Children with ASD may also have more parasomnias, including night terrors, sleep walking and confusional arousals.  Children with autism sometimes have rhythmical movements of the head, trunks, or limbs, especially during the transition from wakefulness to sleep.  Restless legs syndrome may also occur. Sleep diaries and sleep questionnaires such as the Children’s Sleep Habits Questionnaire are often useful additions to a complete sleep history.  Specific assessment using actigraphy (wrist device to measure activity levels) or polysomnography (overnight sleep study measuring brain wave activity, heart rate, oxygenation, movement, etc.) may be necessary for diagnosis in some cases but these strategies are often not well tolerated by children with autism.




Medical treatment of sleep disrupting conditions: It is critical that underlying medical conditions that interfere with sleep be addressed with appropriate medical management.  These may include gastroesophageal reflux disease, eczema, constipation, seizures, reactive airway disease and dental problems. In addition, restless legs syndrome and periodic limb movement disorder can be associated with iron deficiency which often responds to iron supplements.  Conditions such as anxiety, depression and ADHD may need to be treated with medication in order to assure appropriate sleep patterns.

Sleep practices: Once medical and psychiatric conditions have been adequately treated, healthy sleep practices should be implemented.  These practices should include getting adequate exercise during the day, limiting naps and caffeine and getting adequate exposure to light. In the evening, stimulation should be decreased with an established bedtime routine and minimal exposure to technology.  The sleep environment should be cool, dark and quiet, although a background noise machine may be helpful for some children.

Behavioral treatment: Visual schedules for bedtime routines can be very helpful for children with ASD. For children who fall asleep very late, gradually moving the bedtime to an earlier time may be helpful. Helping the child learn to fall asleep on their own is very important.  This may involve the parent sitting next to the bed but not engaging in eye contact or physical touch and then moving further away from the child’s bed on successive nights until the parent is no longer in the room.  The Bedtime Pass can be helpful for nighttime wakenings.  The child gets one curtain call but then has to turn in the pass; if the pass is not used, it can be turned in the next morning and a reward given.

Melatonin/pharmacology: Several research studies have indicated that melatonin may be helpful in addressing poor sleep onset in children with autism. Melatonin is usually given 30 minutes before bedtime, generally in a dose range of 1 to 6 mg.  Melatonin seems safe and effective in the short term; long term studies are not currently available.  An extended release form of melatonin may be helpful to sustain sleep. In some instances, other medications for sleep may be required.

Helpful resources: Strategies to Improve Sleep in Children with Autism Spectrum Disorders (Autism Treatment Network toolkit available for free download at Autism Speaks website)

Sleep and Autism: Helping Your Child (available at autism.org.uk)


Gail Williams, M.D. is an Associate Professor for the University of Louisville Department of Pediatrics and Clinical Co-Director of the University of Louisville Autism Center.  She is a board certified developmental/behavioral pediatrician and works in a multidisciplinary setting seeing children of all ages with such concerns as autism, learning disabilities, attention deficit hyperactivity disorder, Tourette syndrome, and mental retardation.  Dr. Williams is also the director of the STAR (Systematic Treatment of Autism and Related Disorders) biomedical clinic.  While her primary responsibilities are clinical, she also engages in clinical research and has authored several articles on autism and other developmental topics.

Teach Social Skills in School Using Lunch Bunch


by Julie Stewart, M.Ed.

Individuals with autism spectrum disorders are impacted by a qualitative impairment in social interaction.  Although this area of challenge will impact individuals across the lifespan, it is an area that does not receive as much intervention attention as other areas.  To embed intervention across the day teachers must be creative and systematically plan for teaching social skills.  Finding times during the day to work on social skills is difficult with all of the demands for academic production and using times of the day that are naturally social, such as lunch, help teachers to begin to target social goals/objectives.  One particular way for teachers to facilitate social skills training is to create opportunities through a structured “Lunch Bunch”.

When setting up a Lunch Bunch program at your school, make sure to recognize the importance of the following steps and components:

  1. Select target peers to participate
  2. Select skills to target for the student with ASD participating
  3. Select location (separate table in the lunchroom, classroom, library, etc.)
  4. Facilitate instruction on the targeted goals through purposeful inclusion of student(s) with ASD in conversation during lunchtime
  5. Make sure to take data and provide reinforcement for target behaviors
  6. If time permits include facilitation of a game with students
  7. Students return to their respective classes at the conclusion of lunch

Systematically targeting social skills across the day is essential, however social groupings such as Lunch Bunch help students with ASD and their typically developing peers to get to know one another better, both positively impacted.  Lunch Bunch should be offered at least a few times a week and should continue across the school year with a variety of peer partners. Good luck teaching essential social skills that will impact the lives of your students now and in their futures!

You can learn more about how to set up a Lunch Bunch program at your school by watching the the webinar "Targeting Social Skills Across the School Day:  Lunch Bunch and Beyond".

Julie Stewart is a Field Training Coordinator for the KY Autism Training Center. She provides direct training and technical assistance to education staff, social and community personnel, counselors, job coaches and families.

KY Autism Training Center Summer 2012 Newsletter August 2012

Three Benefits of Online Social Networks for ASD Support Groups

By Diandre Glover Thomas


Parents of children with autism are often isolated from their peers while managing issues with their children that range from coping with a diagnosis to transitioning into adulthood.  Although support groups provide parents with a network of individuals who are understanding of issues related to autism finding time to talk with parents outside of those meetings may be a challenge.  Online communities and social networks can provide parents with a way to reach out to other parents at a time that is convenient for them.  There are three primary benefits of starting or joining an existing online community or social network.

Online social networks:

  1. Give parents of children with autism an opportunity to meet and connect with other parents and communicate with them twenty four hours a day instead of waiting until the next support group meeting.  Through sharing pictures, videos and stories about their families’ highs and lows support group members are able to get to know each other better and form a deeper connection with one another.
  2. Help support groups organize meetings, activities and events.  The online community can help keep everyone informed on the support group’s activities and which may increase participation.  Support groups can post information about social activities and fundraisers such as awareness walks, bake sales, pot luck dinners and monthly meeting updates.
  3. Provide an excellent opportunity for parents to share information about helpful resources and/or provide supportive words of encouragement for online community members.  Parents can share if they had a tough day with their child or if their child did something they were really proud of.  Resources such as free training events, summer camp information or even recommending a doctor or barber for a child can be shared among parents in online communities.


If you would like to learn more about using social networks to help enhance your support groups communication and participation sign up to attend the FREE webinar  Social Media and Online Communities for Family Support Groups
that will air on Wednesday November 21, 2012 at 12:00 noon (EST).

Diandre Glover Thomas is the Program Coordinator for the KY Autism Training Center and manages the web content, newsletter, marketing and many of the social media and web based training activities for the center.


Kentucky Autism Training Center Fall 2012 Newsletter (November 2012)

Using Video Modeling to Enhance the Learning Process

by Laura Ferguson, M.Ed., BCBA


Modeling is an important part of the learning process. Modeling allows individuals to see what is expected of them and then practice the behavior. Individuals who are visual learners may acquire new skills more rapidly when the desired behaviors are demonstrated for them.  With so many different types of technology resources out there, modeling has become an even more accessible way to demonstrate targeted skills. One type of modeling that has been effective is video modeling.




What is video modeling?

Video modeling is a type of teaching that involves video recording a behavior that then provides a visual model of that targeted skill. This practice has been used to teach skills such as; play skills, functional skills, and social initiation. It has been used in instances to decrease disruptive behaviors and aid in transitions. 
Let’s look at the most popular form of video modeling and how it can be used to aid in successful transitions from preferred to non-preferred activities. The most popular form of video modeling is other-as-model. This involves recording a peer that has the same attributes or someone that the individual demonstrates interest in, appropriately engaging in the targeted skill.





Let’s look step by step how we would record a successful transition:

1. First select the target individual
2. Explain what behavior you would like them to engage in
3. Record the behavior in the most natural setting (how it would look when the   individual would engage in the behavior). Since the target behavior is transitioning, record the individual being given a warning of how much longer they have with the preferred item. Then have the adult place the demand to transition. Record the individual walking from the reinforcer to the non-preferred.
4. Once the individual has engaged in the behavior, record them contacting a reinforce, such as praise or a preferred item/activity
5. Now that the recording is complete, allow the target individual to watch the recording, and then practice the skill.






Video modeling is a great way to teach new skills. Hopefully you will find it useful in your home or classroom.


Laura Ferguson is a certified behavior analyst and a Field Training Coordinator for the KY Autism Training Center. She provides direct training and technical assistance to education staff, social and community personnel, counselors, job coaches and families.


KY Autism Training Center Fall 2012 Newsletter November 2012

Exploring Augmentative and Alternative Communication

by Dr. Karen Coulter

What is Augmentative and Alternative Communication (AAC)?  Simply put, it is a tool.  According to the Oxford online dictionary, a tool is ‘device or implement used to carry out a particular function.’  As a tool, the purpose or function of AAC is to augment a message or provide an alternative means for communicating when natural speech is not a functional option.  If a child or adult is unable to communicate using natural speech alone some form of AAC should be provided to support the most effective, interactive communication possible.   With this said, there are several of guidelines to bear in mind:

  • AAC is a process not a product
  • Everyone communicates and has a right to do so

In the process of sorting through the AAC toolbox you will need the help of a craftsman to pick the best tool and to learn how to use it.  That craftsman is a Speech Language Pathologist (SLP) with knowledge of AAC.

Tool selection by your SLP is one part matching needs and one part clinical skill.  When matching a tool within the diverse ASD population, each individual’s strengths and weaknesses must be taken into account.  Matching a tool to an individual takes clinical knowledge of how each strength and weakness lines up with any particular instrument.  The instrument isn’t as important as the individual’s needs.

Tool selection is a process not a product.  Within the selection process careful consideration must be given to what tools did or did not work before a final choice is made.  Perseverance can be as important to success as identifying barriers to AAC use. While this optimal system is being developed, an individual should never be without some a means of communication.  When an appropriate AAC system match is found for an individual, it will still need adjustments. Multimodal AAC systems are dynamic and must change as the needs of the individual change.

Other clinical skills a SLP provides include how to improve or shape an individual’s current communication into a more functional form.  Remember, learning to use AAC is learning how to use a new tool.  Changing the dynamic of communication expectations between individuals is the hardest step. In this process of change we are not only changing the AAC user’s behavior, we are changing our own.  Speech therapy offers accountability and coaching for this process.

Everyone communicates.  Everyone has a right to communicate.  These rights are summarized from the Communication Bill of Rightsput forth in 1992 by the National Joint Committee for the Communication Needs of Persons with Severe Disabilities. It states, ‘All people with a disability of any extent or severity have a basic right to affect, through communication, the conditions of their existence.’ How we communicate is the only difference.  Understanding how an individual with ASD currently communicates and identifying communication potential is part of the SLP’s clinical skill set.

Even though communication is a right for everyone, many times we turn on the mute button or take away a voice without knowing it.  For an individual with an AAC system self-expression can be obstructed or even stopped by a lack of access to appropriate vocabulary.  This issue can be addressed in part by the use of core and fringe vocabularies.  The AAC institute and Gail VanTatenhove elaborate on this topic.

AAC is an important to many individuals with an ASD diagnosis.  From 30 - 50% of these individuals are nonverbal and will remain so throughout their lifetime. Due to this need, the University of Louisville’s Autism Center will be continuing to provide further information about AAC in the upcoming months.  We have a previous webinar by Dr. Coulter, AAC 101 already available.  Future webinars will include the following titles: AAC Options –Different Technology Levels, AAC – the APPle of My iDevice and AAC Application – Developing Opportunities. She will also be hosting video podcasts covering the use of various AAC devices/ strategies.

Looking Further:

This list is not exhaustive and inclusion does not imply endorsement of the organization or the context of the Web site by Dr. Coulter.

Karen Coulter, Ph.D., C.C.C./S.L.P., A.T.P. is a Speech Language Pathologist and Assistive Technology Professional in the Department of Pediatrics at the University of Louisville’s Weisskopf Child Evaluation Center.  Dr. Coulter’s web site.


5 Things To Do Before You Choose an AAC App: Take A GULP. Zangari, C. January 11, 2012.  PrAACtical Thinking. March 12, 2012

Augmentative and Alternative Communication.1997. American Speech-Language-Hearing Association. October 17, 2012 Augmentative and Alternative Communication Decisions Adapted from a paper by Katya Hill, M.A., CCC-SLP, Assistant Professor, Speech-Language Pathology, Edinboro University of


AAC Institute. October 17, 2012 .

Baxter, S, Enderby, P, Judge, S,  & Evans, P. (2012). Barriers and facilitators to use of high technology augmentative and alternative communication devices: a systematic review and qualitative synthesis International Journal of Language Communication Disorders.  47(2), 115-129.

Guidelines for meeting the communication needs of persons with severe disabilities. (1992). ASHA, 34(Suppl. 7), 2–3.

Multimodal communication.  YAACK. 1999. October 17, 2012 .

Oxford Online Dictionary.  2012. October 17, 2012 .

KY Autism Training Center Fall 2012 Newsletter November 2012

Self Advocacy and College Students with ASD

by Diandre Glover Thomas


Student smiling with book

Students with disabilities are expected to advocate for themselves in college

     Students with autism have parents, teachers, counselors and other administrators who advocate for them during the high school years. However, when these students graduate from high school and attend college they are expected to advocate for themselves. Because of this shift in the expectation of a student with autism to become a self-advocate, it is essential for them to learn about their disability and most importantly be capable of communicating their needs to college disability resource centers when planning accommodations.

     After a student with a disability enrolls in college it is the student’s responsibility to self identify as having a disability. The first step in this process is to contact the college's disability resource center.  Every college has their own application process; however, in general the student is asked to submit written documentation of their disability and meet with the disability service coordinator to assess the student's individual needs and arrange accommodations. Accommodations help college students with autism overcome obstacles that may create barriers that could prevent them from accessing the same educational opportunities as their peers. The prospective college student with autism needs to learn how to explain the need for accommodations to prevent specific barriers. For example, if a student needs extended time to take tests or a distraction free environment they need to be able to explain why they need those accommodations.

     Although, the high school Individualized Education Plan (I.E.P.) cannot be used to document a disability in college. It can be helpful for a student to become familiar with interventions that were used in high school to be able to explain the need for similar accommodations in college. High school students can learn about their disability from dialogue with teachers and parents. In addition, students can learn self advocacy skills through participating in IEP team meetings to discuss the student’s post-secondary goals. Learning to become a self advocate is an important skill for all students transitioning into adulthood; however, it is an essential skill needed to contribute to the overall success of college students with autism.

     To learn more about accommodations in college view the archived webinar presentation Accessing Disability Services at Public Postsecondary Institutions in Kentucky. Also, download a copy of the Kentucky Public College Disability Resource Center database and College and Autism brochure. In addition, more information about supporting college students with autism can be found on the KY Autism Training Center web site.


Diandre Glover Thomas is the Program Coordinator Senior for the KY Autism Training Center.

Starting a Social Skills Group for Individuals on the Autism Spectrum

by Laura Ferguson, M.Ed., BCBA


Individuals on the autism spectrum often find it difficult to form social relationships. Friendships that often form early in life for other individuals do not occur for individuals with autism. Parents, teachers and other professionals need to explicitly teach skills that are critical for social development.

Social development skills can be effectively taught through participation in social skills groups. These groups pair individuals on the autism spectrum with peers. Lesson plans and activities are set up to focus on specific skills that individuals need to acquire in order to form and maintain social relationships.

Let’s take a look at how social skills groups can be developed.  The first steps when attempting to start a social skills group are:

  1. Identify and assess areas of need for all participants. Decide what are the main areas of need and the outcome goals for each participant.
  2. Select appropriate intervention strategies. For example, if you choose video modeling for teaching initiation make sure the intervention is understood by all individuals facilitating the group.


Needs Assessment

A profile may be a good tool to use to get information from parents and professionals when identifying and assessing needs.  The Autism Social Skills Profile developed by Scott Bellini (2006) is a great tool used to provide a comprehensive measure of the social functioning for students with ASD.

When selecting the appropriate intervention strategy you need to make sure to:

Examine various curriculum
Make sure that you have a consistent plan, curriculum, and teaching procedure. When all participants and teachers involved understand prompt and fading procedures, precision teaching, and outcome goal the skill taught is more likely to generalize to the natural environment.

Consider the age and grade level of the participants of those involved.
Make sure the activities and lesson plans are appropriate for their age group. Appropriate age group activities will lead to more generalization of skills taught at group.

Make sure all activities and lessons have goals for social language development.

When looking at group dynamics make sure you are pairing individuals based upon needs. This way all participants benefit from the social skills group.


A sample lesson plan for social skills groups should include:

  • The layout and goal of that lesson
  • How to introduce the new skill. This should include prompt and fading procedures
  • Include ways to practice the new skill. This should include role- play
  • The skill should then be generalized through a game or activity
  • Lots of positive reinforcement
  • Some way to monitor progress for each participant involved.


Social skills are critical for individuals on the autism spectrum. This will be critical for employment and participating daily with peers. It is imperative that we teach these skills at a young age and continue to work on them throughout their life.  To learn more about how to start a social skills group view the webinar "Starting an Effective Social Skills Group".

Laura Ferguson is a certified behavior analyst and a Field Training Coordinator for the KY Autism Training Center. She provides direct training and technical assistance to education staff, social and community personnel, counselors, job coaches and families.

KY Autism Training Center Summer 2012 Newsletter August 2012