ASA's 37th National Conference on Autism Spectrum Disorders (July 13-15, 2006)

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Friday, July 14, 2006: 10:45 AM-12:00 PM
#2179- Using the Procedural Knowledge Profile © To Establish Communication Goals and Objectives
This program describes the background, rationale and application of the Procedural Knowledge Profile. The PKP is a new and unique way to analyze how effectively a student with ASD interacts within an environment and his knowledge of the function of objects contained within the environment. The PKP was applied to 25 students with ASD and the results of those Profiles along with related communication goals and strategies will be reviewed during the formal presentation.

Presenters:Howard Shane, Ph.D., Children's Hospital Boston, Professor at Harvard Medical School, Director of Communication Disorders at Boston Children’s Hospital, and Director of the Mona - Howard Shane is Associate Professor at Harvard Medical School, Director of Communication Disorders at Boston Children’s Hospital, and Director of the Monarch Children’s Hospital Collaborative Program. He is a Fellow of ASHA and received the Goldenson Award for Innovations in Technology from United Cerebral Palsy. He has authored numerous papers and chapters and produced numerous computer innovations related to autism and other developmental disabilities.

Sharon Weiss-Kapp, M.Ed., Degree, in, Speech, Pat, MGH Institute of Health Profession, Clinical Assistant Professor in the Language Laboratory in the Graduate Program in Communication Sciences and Disorders at MGH I - Ms. Weiss-Kapp received both her M.Ed. Degree in Speech Pathology & Audiology and B.S. Degree from Northeastern University. Ms. Weiss-Kapp is a speech-language pathologist with wide-ranging experience treating and evaluating spoken and written language disorders. She is a Clinical Assistant Professor in the Language Laboratory in the Graduate Program in Communication Sciences and Disorders at MGH Institute of Health Professions, and a founding faculty member of the Hanson Initiative for Language and Literacy. Ms. Weiss-Kapp is the President, CEO, and developer of the Wisnia Kapp Reading Program (WKRP).

Debra Mandell, OTR, MS, Bellefaire JCB, Director, Monarch School of Bellefaire JCB - Debra Mandell brings to her position as Director of Monarch School formal training in two important disciplines: occupational therapy (B.S.O.T.) and health administration (M.S.H.A.). Ms. Mandell honed her skills in management and supervision during her nine years as Program Director of the Child Development Center at Cooper Hospital University Medical Center. Her many years of experience working with special-needs populations have made her sensitive to the needs of Monarch School students, parents and staff.

Jeffery Richards, M.Ed., Bellefaire JCB, Instructional Media Specialist - Jeffery Richards,M.Ed.---Jeff graduated Magna Cum Laude from Georgia Southern University with a Bachelor of Science in Education and received his Masters Degree in 1984. He taught in the public schools, Cuyahoga Community College and Georgia Southern University. He has a certificate in Educational Media and holds teaching certificates in several states. He has experience in photography, video production, computer and Internet technology, as well as an extensive customer service background. Jeff has been working as the Instructional Media Specialist at Monarch School for Children with Autism at Bellefaire JCB in Shaker Heights, Ohio for the past 3 years.

Rebecca Fleisch Cordeiro, M.Ed., Children's Hospital Boston, Emerging Technologies Specialist in the Center for Communication Disorders at Children’s Hospital Boston - Rebecca Fleisch Cordeiro, M.Ed., is the Emerging Technologies Specialist in the Center for Communication Disorders at Children’s Hospital Boston. Rebecca earned a graduate degree in Instructional Design at the University of Massachusetts. Prior to her tenure at Children’s Hospital, she served as a software training consultant to industry and schools, designing customized courseware and implementing training. In her role at the CCD, she collaborates with clinicians, patients, families, and computer specialists to identify, design, and develop technologies that will facilitate clinical productivity, improve patient access, or provide alternatives for patient therapy.

Parents and teachers often report that even in the absence of spoken language, children with ASD demonstrate competence in procedural knowledge. Procedural knowledge is defined here as the ability to interact effectively within an environment and to demonstrate knowledge of the function of the objects contained within an environment. Importantly, there is no requirement for symbolic understanding in order to acquire procedural knowledge because the individual interacts with tangible objects within a natural context. These procedural skills are often learned with minimal or no spoken language assistance. They are often associated with routines or predictable interactions within a well known context. For example, acquiring knowledge of how to operate a faucet can occur during the routine of washing hands before eating, or after toileting. There is, in essence, a non-verbal relationship between the faucet and the person. This silent relationship has no necessity for linguistic interpretation. Similarly, the configuration of the open passageway of a door invites the individual to pass through it, without the need to label the interaction. The experience and interaction with the door itself, leads to a functional imprint, bypassing the need for linguistic mediation. The act of walking through a door does not require an internal or external monologue of labeling the door, or activation of specific functional information about “doors: e.g., “this is a passageway that I can use for moving myself from one room to another”. Use of the door requires no meta-cognitive or linguistic interaction. In other words, one doesn't have to consciously think about the function of a door in order to appropriately interact with it. Recognition of the door is gained through sense impressions such as form, size, color, texture etc., and knowledge of its function is gained through exposure and routine use of it. It might well be that the stronger the non-linguistic relationship between object and a person, the easier it will be to establish procedural knowledge.

Procedural understanding ranges from the rudimentary, e.g., opening a door or turning on a light, to sophisticated sequences such as navigating with a computer mouse, or working the remote for the VCR or DVD player. These behaviors are often the result of observational learning, the type of learning that occurs through passively observing another person. There is no motivating factor other than learning the skill, and there is no primary or secondary reinforcement for performing the skill.

Procedural knowledge can also be taught through explicit, structured instruction, as in the case of learning to ride a bicycle or leaning to tie shoes. Explicit, structured instruction requires an instructor to provide a task, map these components to a hierarchical sequence of learning, and then integrate each skill within the sequence until the task is fully reconstructed. In order to learn how to tie shoes for example, the learner needs to have the steps in the sequence broken down into its constituent parts. S/he must also be provided with repeated opportunities to practice each step in isolation, and be given multiple opportunities to practice integrating the steps until the complete sequence of tying the laces is mastered.

Trial and error behavior occurs when the learner has a desired outcome in mind, and engages in goal directed exploratory attempts to reach this goal, such as repeated attempts at pushing buttons on the remote control in order to make it turn “on” or “off”.

Procedural knowledge is not always acquired in the same manner. Some skills lend themselves more to being learned through observation, such as turning on a light. Other skills, e.g., pushing the correct button to turn on a VCR, may be learned through trial and error. More complicated routines, such as tying a shoe, may be learned through explicit instruction.

Description of Procedural Knowledge Profile (PKP) Tool

The PKP is a retrospective assessment, based on behaviors that the informants have witnessed. It evaluates several categories of functional concept knowledge including nouns, action verbs, and prepositions. It is an assessment tool that uses routines as a method of identifying an individual's understanding of the function of items within his/her environment. The PKP is typically used with students who have little or no spoken language. Four environments, kitchen, bathroom, bedroom and classroom, are used as the natural context for identifying routines and predictable sequences of behavior that lead to acquisition of procedural knowledge. For example, within the kitchen environment there are defined routines for washing hands, drinking, eating, and simple food preparation. Each one of these routines identifies the specific interactions with items or objects within the routine. When documenting the routine of washing hands before dinner, information is collected on how well the child can implement the steps in the routine, and how able he is to activate the faucet, use soap, turn off the faucet and dry his hands on a towel. In addition to identifying procedural understanding, associated language terms are identified that can be mapped to these interactions. Nouns, action verbs, and prepositions that specifically relate to the routines are catalogued within a checklist. Information regarding executive understanding is gleaned by determining at what level of independence the child identifies, executes, and maintains routines. This information serves as the baseline for establishing which routines and concepts are within the child's repertoire and are ready to have visual or spoken language mapped to them, and which routines and concepts need to be taught. It is extremely important to note here that attempting to map a symbol, whether it is visual, gestural, or spoken, to a concept that does not have an experiential basis attached to it, is inviting specific and rigid associations that preclude generalization of a concept. In other words, if a child is not able to demonstrate the concept of “turn” under a variety of different interactions in a meaningful environment, teaching the term in isolation will undoubtedly result in the child's inflexible association of the term to the specific task to which it is taught.

Application of Information Derived from the Procedural Knowledge Profile

Information derived from the PKP can be used as the basis for language intervention for students presenting with little or no understanding of symbol systems. Meaningful application of symbol systems such as spoken language, sign language, and visual systems require the individual to appreciate that the symbol represents something, and his need to use the symbol with the intention to communicate. The most effective use of symbols is as a type of “abbreviation” that activates prior knowledge about an object or experience. The more enriched the prior knowledge, the more opportunity for meta-linguistic, flexible use of symbols.

Teaching the use of symbols through routines gives the learner an excellent opportunity to acquire experience based or schematic associations. Multiple, experience-based associations are the enriched fields of the language system, because they afford the most flexible representations of an idea, concept or experience. Mapping symbols to this foundation provides the greatest opportunity for the development of an effective and meaningful communication system.

Teachers, parents, therapists and staff serve as respondents and work cooperatively to complete the observational inventory. The inventory is retrospective and based on the respondents' familiarity with the student's procedural skills. The respondents indicate the child's ability to effectively engage in a routine by checking off or circling designated steps within the routine sequence. They similarly indicate the items that specify the procedural elements and competencies the child demonstrates during the execution of these routines.

A complete PKP was administered to 25 children who attend the Monarch School for Children with Autism in Shaker Heights, Ohio. The protocols were completed cooperatively by each student's teacher, speech pathologist and parents. The children ranged in age from 5 to 22 and all have a diagnosis of autism spectrum disorders. The analysis of each student's PKP revealed the extent of each student's procedural knowledge within real world environments. These results also set the stage for the creation of communication goals that map symbols (spoken or visual) onto established patterns and routines. The final presentation will provide complete detail on the following: • Profile for each student • Overview of procedural knowledge across all students • Language and communication goals and objectives based on procedural knowledge findings

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