Mrs. Kavitha Navakulan

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Communication barriers: linguistic perspective of the challenges of autistic children lives in northern Sri Lanka

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Communication barriers: Linguistic perspective of the challenges of Autistic children live in northern Srilanka Mrs.Kavitha Navakulan Department of Linguistics. University of Jaffna. :

Communication barriers: Linguistic perspective of the challenges of Autistic children live in northern Srilanka Mrs.Kavitha Navakulan Department of Linguistics. University of Jaffna . Autism Spectrum disorder is a serious neuro developmental disorder that impairs a child’s ability to communicate and interact with others. It also includes restricted repetitive behaviors, interests and activities. As a result the children are affected by significant impairment in social occupational and other areas of functioning. The term Autism Spectrum disorder covers the wide range of disorders. According to the American Psychiatric Association’s diagnosis and Statistical Manual of Mental Disorders (DSM -5) ASD is now defined as a single disorder which includes Autism, Asperser’s syndrome, childhood disintegrative disorder and pervasive developmental disorder.   The wide range of symptoms and severity are referred by the term “spectrum” in Autism Spectrum disorder .

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According to Fombonne there has been a sharp increase in the prevalence of ASD. In the United States, 1 in 68 children are identified as having diagnosis of ASD. The report of the study (Perera et al, 2000) indicates that In Sri Lanka 1 in 93 children as being identified as having ASD. Approximately 38,000 Sri Lankans are suffering from ASD. But pediatricians point out that the number should be higher than this approximate value. As one of the very focusing disorder in the global context, coping mechanisms for ASD are urgently needed by the individuals.

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Autism risk genes and environmental factors may be the causes for Autism. The risk factors denote events before and during birth. They include early marital age, at the time of conception, maternal illness, and certain difficulties in the peri -natal stage such as oxygen deprivation. These factors alone do not cause autism. Rather they appear to increase risk, when they conjoin with genetic factors. Symptoms of ASD include both core symptoms and associated symptoms. Core symptoms include: Language and communication issues. Deficits in social interaction. Restricted and repetitive patterns of behaviors, interests or activities. Autism risk genes and environmental factors may be the causes for Autism. The risk factors denote events before and during birth. They include early marital age, at the time of conception, maternal illness, and certain difficulties in the peri-natal stage such as oxygen deprivation. These factors alone do not cause autism. Rather they appear to increase risk, when they conjoin with genetic factors.

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Language and communication issues are core symptoms of autism. Some people with higher functioning (“Level 1”) autism may face problems with using idioms and social conversation. On the other hand people with more severe challenges may face difficulty in producing a single word. At the same time people with moderately severe autism may express odd speech patterns and other language related problems. These language and communication issues not only affect the conversation skill but affect schooling, friendship and basic life skills also. Issues related to communication and social interactions are:

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Living in his/her own world. Do not show interest in making play mates. Fails to respond to others’ questions. Poor eye contact and lack of facial expression. Unable to speak or having speech delay or may lose previous speaking skill. Fail to initiate the conversation. Having abnormal rhythm and tone of speech. Inappropriate usage of words and phrases with repeating them often. (Echolalia). Do not understanding simple questions or commands. Do not showing emotions or feelings. Social interaction may be in the form of passive, disruptive or aggressive.  

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Avoiding others. Like to being alone. Inappropriate attachment to objects. Do not respond while called. Do not point any needed/ interested object. Difficulty in playing with peers. Inappropriate laughing. Do not understanding fear and dangers.

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Even though there are number of treatment methods, therapeutic techniques and approaches available to face the challenges related to communication. It is difficult to utilize all of them in northern part of Sri Lanka. The identified challenges related to compensate the communicational needs of both children and adults with ASD are :-   Availability of standardized screening tools and diagnostic tools are very limited. Parents want to travel to south to consult a child psychiatrist. Number of residential schools to admit Autistic children are very poor. Training for special educator is very limited. To enhance the lives of children /adults with ASD, there is a vast need for speech therapy, special education; occupational therapy and physical therapy. But accessibility of the experts in those fields is very poor in northern part of Sri Lanka.

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The number of SLPs / Speech therapists who can deal the communication difficulties is very poor. University training programs to solve the speech and language problems are not sufficient. Admitting the children in special education centers is limited by the age of children with of ASD. (Age limit for admission is 14). Social stigma is associated with the disorder. Due to that family members hesitate to take them to schools or special education centers. The application of different treatment methods and therapeutic techniques is associated with higher cost. Awareness on ASD among family members and teachers is very poor. It also worsens the prevailing situation.

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Applied Behavior Analysis (ABA) Applied Behavior Analysis was developed based on the Behavior theory. Pioneers who worked in this theory are Pavlov, Thorndike, Watson and Skinner. Baer, Wolf and Risely (1968) define ABA as “the process of applying some tentative principles of behavior to the improvement of specific behaviors and simultaneously evaluating whether or not any changes noted are indeed attributed to the process of application”. Behavior analysis is a scientifically validated approach to understanding behavior and how it is affected by the environment. Since the early 1960s, ABA has been used by many therapies to teach communication , social, play, self care work and community living skills to reduce the behavioral problems of autistic people. ABA methods contain the following three steps: An antecedent, which is a verbal or physical stimulus; A resulting behavior, which is the subject’s response or lack of response to the antecedent; A consequence, which based on the behavior, can include positive reinforcement of the desired behavior. Important principle and techniques associated with ABA methods include the following:

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Verbal Behavior Therapy   Verbal Behavior therapy is used to teach communication/verbal skills. Verbal Behavior therapy motivates children with ASD to learn language by connecting words with their purposes. Beyond using words as mere labels the students learn how to express language to make request and communicate ideas. This intervention focuses on understanding the usage of words. Verbal Behavior therapy focuses on four types of words. They are:   Mand : A request such as “milk” to ask for milk Tact : A comment used to share an experience or draw attention such as “car”                        to point out a car Intra-verbal : A word used to respond on answer a question Echoic : A repeated or echoed, word used to make the child to imitate the words

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Errorless learning is focused in this therapy. Immediate and frequent prompts are provided by the therapist to improve children’s communication. These prompts become less intrusive as quickly as possible, until the student no longer needs prompting. Verbal therapy is formed to encourage a child to learn language by improving a correlation between a word and its value. Families are encouraged to use VB principles ij the day to day life in order to strengthen the opening mechanisms of children with ASD.  

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Pivotal Response Training (PRT) Pivotal Response Training was developed by Dr.Robert C.Koegel, Dr.Lynn Kernkoegel and Dr.Laura at the University of California. Earlier it was called as the Natural Language Paradigm (NLP), which has been in development since 1970s. Goals of PRT are : development of communication, language and positive behaviors and relief from disruptive self-stimulatory behaviors. The PRT therapist targets “pivotal” areas of a child’s development. These include initiation of social interaction self management, response to multiple cues and motivation. Questions or instruction is given to the child to motivate to respond.

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Floor time Floor time is a specific therapeutic technique based on the Developmental Individual Difference relationship Model (DIR), developed in the 1980s by Dr.Stanley Greenspan. Floor time is a play based interactive intervention approach that emphasis individual differences, child –centered interests and affective interactions between a child and a caregiver. The main goals of floor time method are: encouraging attention and intimacy, two – way communication, encouraging the expression and use of feelings and ideas and logical thought and there are five steps in the floor time process : (1) Observation (2) Approach – open circles of communication (3) Follow the child’s lead (4) Extend and expand play (5) Child closes the circle of communication

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Picture Exchange Communication System (PECS) The Picture Exchange Communication System is an augmentative communication program designed for individuals with ASD and other disabilities who lack expressive language (Fuost & Bondy, 1994). In this system children are trained to exchange a picture for a desired item. PECS can be used at home, in the class room or in a variety of other settings. Children are helped to build vocabulary and to articulate desires, observations or feeling by using pictures. The program progresses in the following steps:

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Phase I : Performed the basis exchange with a wide range of pictures.   Phase II : Persists in getting an adult’s or peer’s attention and in moving across      increasing distances.   Phase III : Discriminates between a numbers of pictures in an array. Phase IV : Forms sentences using pictures. Phase V : Answers questions using pictures. Phase VI : Expands on previously mastered interactions.

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Augmentative and Alternative Communication (AAC) Augmentative and Alternative Communication (AAC) refers to a variety of interventions that are used to compensate for expressive communication deficits. This communication system consists of two main components: Communication devices and symbol system. Communication books, speech devices, computer manual sign, abstract symbol system, Picsyms, Sig symbols and board marker are used to fulfill the communicational needs instead of using expressive communication.

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other intervention methods or therapeutic techniques include: Speech Language therapy PROMPT therapy Auditory Integration Training TEACCH (Treatment and Education of Autistic and related communication handicapped children). Learning Experiences: An Alternative program for Preschoolers and Parents (LEAP) Fast for Word. Facilitated Communication (FC) VAN DIJK CURRICULAR Approach

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Joint Action Routines (JARs) Power Cards Conclusion Even though there are number of treatment methods, therapeutic techniques and approaches available to face the challenges related to communication. It is difficult to utilize all of them in northern part of Sri Lanka.

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THANK YOU

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