Teaching Children With ASD To Use Language For Reasoning and Problem-Solving

The ability to “think in speech” is critical for developing flexible thinking, and is the foundation for effective self-regulation. Children with ASD have difficulty with planning and reflecting on potential solutions to problems when faced with novel situations that are deemed stressful. In particular, generalization of these skills outside a therapy setting is known to be especially challenging for therapists, educators and families. Participants will learn practical strategies for teaching and generalization of these skills with children with ASD. Developing Language and Inner Speech to Establish Independent Problem-solving in Children with Autism Spectrum Disorder

The ability to “think in speech” is critical for flexible behavior and cognition, and is the foundation for effective self-regulation. (Vygotsky, 1987).  Parents use interpersonal dialogues to regulate the child’s behavior. Over time, the child internalizes these dialogues, and over time, the child is able to regulate his or her own behavior by engaging in dialogue with self, in the absence of others. Interpersonal dialogue becomes intrapersonal dialogue.  As noted by Williams, Bowler, and Jarrold (2012), behavioral and neuropsychological studies provide convincing evidence that several aspects of executive control depend to some extent on this form of linguistic thinking (e.g., Baldo et al., 2005; Gruber & Goschke, 2004). Initially, this self-talk is overt (out loud) and is almost universal among neurotypical, i.e., typically developing children (Winsler, de Leon, Wallace, Carlton, & Willson-Quayle, 2003). Later, during middle childhood, self-talk becomes internalized to form “inner speech.”

Evidence is emerging that individuals with autism spectrum disorders (ASD), a disorder of social communication, have diminished or underdeveloped inner speech. (Williams, et al., 2012).  ASD is diagnosed on the basis of a set of core impairments in communication, social engagement, and behavioral flexibility (American Psychiatric Association, 2000). Individuals with ASD engage in relatively little of the early communicative exchanges that are considered critical for the formation of verbal thinking. From a Vygotskian perspective, then, individuals with ASD would be expected to show a diminished tendency to employ inner speech as a primary means of thinking (Fernyhough, 1996, 2008).  

Along with social and communication difficulties, children with ASD also show a range of problems with executive functioning (O’Hearn, Asato, Ordaz, & Luna, 2008). These executive functions include planning, cognitive flexibility, response inhibition and working memory (Pennington & Ozonoff, 1996).  A relative lack of inner speech use by individuals with ASD would explain deficits in executive functioning that are frequently observed among people with ASD (Hill, 2004).

As a speech-language therapist who works primarily with children with ASD, the importance of developing inner speech for independent problem-solving is typically foremost in my clinical practice.  I have found that by developing the child’s independent problem-solving through the development of inner speech, a wide range of dysfunctional behaviors can be mitigated, including reduced emotional dysregulation, improved social interactions, and better academic problem solving.

The presentation will describe:

• Pre-cursor strategies to help the child’s readiness for inner speech problem-solving
• The research-based problem-solving framework used to help children with ASD develop inner speech for problem-solving, and
• Applications of inner speech for developing emotional control

I. Precursor Therapy Strategies to Help Develop Readiness for Inner Speech

 Children with Executive Dysfunction have difficulty with (Bialystok, et al. (2003):

•  Disengaging attention from an object or thought
•  Shifting attention and planning
•  Choosing between a set of equivalent alternatives
•  Interpreting rules given verbally
•  Following arbitrary or unstructured procedures

These children become easily and quickly overwhelmed when we are asking their brains to do that which is most difficult, i.e., using language for reasoning and problem solving.  As a result, they have difficulty self-regulating, i.e., staying calm and organized (coping skills).  Research indicates that language is a key factor for emotional development (Wagner et. al., 2005).

As a first step in therapy, I have found it helpful to “teach” the child to separate themselves from their brain.  For any other organ in the body we do this automatically: if I break my arm, I don’t say, “I’m broke”; if I have a stomach-ache, I localize the ache to my stomach.  By separating the child’s persona from his or her dysfunctional brain, the child develops an improved sense of self (“it’s not me, it’s my brain.”) and an increased sense of self-efficacy (“I need to help my brain to not do that.”), both of which are additional examples of helping them develop inner speech. The child learns to become “the boss of their brain.”

 Examples of explicit verbal interactions I have with each child to develop their inner speech strategies include:

• “I am smart.”
• “I need help.”
• “This is what hard feels like.” “This is what learning feels like.”
• “Please, say it again.”
• “Give me choices.”

For the child to become the “boss of my brain,” it is the child’s responsibility to show the adult that he/she can do this without adult intervention, a.k.a. empowering the child! Inner Speech empoweringphrases used in therapy include:

•  Listening EYES and ears.
•  No bad guesses.
•  Uh, oh! Your brain’s stuck!
•  Don’t let your brain tell you what to do!
•  Slow your brain down.
•  Is your brain trying to go to sleep on you?
•  You are too smart to let your brain be the boss!
•  Everyone has to [fill in the blank]. [“name(s)”] has to fill in the blank. It’s not a choice.
•  Nobody’s perfect. Name(s) isn’t perfect.  You don’t have to know everything, but you do have to show TRYING.

 II.  Cognitive Framework for Inner Speech Problem-solving

Williams et al. (2012) note that (1) “there is some (arguably justified) skepticism that efforts to train dialogic forms of inner speech have any meaningful long-term benefits for cognition among typically developing children (see Diaz & Berk, 1995)”, and (2) “no such training efforts have been targeted at children with ASD and we believe that there may be some value to conducting studies to explore this issue further.”  Dialogic refers to the form of verbal thinking that involves analyses of distinct perspectives of reality Fernyhough (2008).  This would include: compare and contrast, or accommodating multiple, alternative perspectives to a common topic of thought. (This is in contrast to “monologic” forms of inner speech in which the person describes one particular state of affairs.)

It is this this dialogic form of inner speech that I have been working on with my children with ASD.  Below are the cognitive components of problem solving that I work on explicitly with both my children with ASD, as well as with their parents. 

Choice-making: A critical component of problem-solving is the ability to hold on to two or more pieces of information, while at the same time comparing and contrasting one's choices BEFORE making a final decision. 

Developing world knowledge: World knowledge is developed by personal experiences and watching/listening to others. In addition to choice-making, a child needs to activate world knowledge (i.e., every experience one has encountered), and compare and contrast the choice that was made with his/her life experiences, in order to decide on a logical response to the current situation or problem.  

In-depth Vocabulary Knowledge: Typical children learn, store and use novel vocabulary after one or two exposures to the word.  This is known as "fast mapping."  After the initial exposure, typical children gain a more in-depth understanding of vocabulary during their daily experiences.  For example, the word "close," as in, "My neighbor lives close by," will have different meanings to different children depending on their world knowledge.  Children that live in rural areas will have a different understanding of the concept of a "close neighbor" versus children growing up in New York City.

Pausing and Reflecting: Making complex decisions requires the ability to pause and think about our choices in relation to our world knowledge and current situation.  Responding with no pausing or repeating the last thing one has heard are examples of a limited ability to stop and think about novel information.

Asking for Help: The ability to understand what a problem "feels" like (e.g., a sensation of tightening in the stomach), and recognizing that when there is a problem that is unable to be independently resolved means that assistance is required is a very abstract concept that requires all of the above-listed components.

Mental State Vocabulary (learning the "shades of gray" in between the black and white): Verbs such as "think, know, believe" are considered mental state verbs as they describe thoughts and not actions.  In order to increase self-regulation or what are known as "coping skills," one has to understand that the category "mad" has many different degrees , e.g., annoyed, frustrated or enraged.  Each emotions word will have a different type of response, depending on the degree.

It is this ability to hold in mind and move flexibly between different perspectives on a situation that arguably facilitates efficient problem solving in situations where one might otherwise become, as referred to by Fernyhough (2008), “stuck in set.”

 III. Inner Speech for Emotional Development

Self-regulation is key for emotional development.  To cope in stressful situations requires applying many of the cognitive skills described previously, and in particular to avoid becoming “stuck in set.”  Developing labels is an important strategy to help the child understand their emotions.  From the perspective of dialogic inner speech, this would include learning alternative labels for similar emotions: e.g., uneasy versus content; confident versus arrogant; restrained versus chatty. 

Very often children with ASD experience the world in extremes, “All is well with the universe” versus “it's the end of the world”.   Children with ASD have not typically developed inner speech needed for nuanced reactions.

Verbal labeling can be especially important for associating the proper strategy to physiological reactions to a situation.  For example, a severe tightening in the stomach when trying to solve a math problems means, asking for help, rather than throwing a math book across the room and yelling, “I’m never going to do math again!”  The “excited” feeling I feel at my birthday party (higher heart rate) is different than the same physiological reaction I have when faced with a history test. 

Numerical labeling can also be useful.  Children with ASD when shown a scale from 1-10, will respond the same (“10”) to both, “How mad were you when your brother took your toy?” and “How mad were you when you had to wait for mom to give you a spoon for your cereal?”  When everything is a 10, you respond the same to anything that causes a tightening in your stomach.  By learning inner speech strategies, children with ASD learn to differentiate their experiences and better cope with stressful situations. 

As part of this presentation, I will give examples of how I apply these strategies and techniques in my clinical practice, and describe their impact on social skills, academic skills and everyday living skills, as I've seen them develop over time with my clients, as well as reactions of parents and teachers.

References

Alderson-Day, B. (2011). Verbal Problem-Solving in Autism Spectrum Disorders: A Problem of Plan Construction? Autism Research 4, 401–411.

Baldo, J. V., Dronkers, N. F., Wilkinse at al. (2005). Is problem solving dependent on language? Brain and Language, 92,240–250.

Bialystk, et al. (2003). Cogntivei complexity and attetional conrol in the bilingual mind. Child Development 70, 636-644.

Diaz, R. M., & Berk, L. E. (1995). A Vygotskian critique of self-instructional training. Development and Psychopathology, 7,369–392.

Fernyhough, C. (1996). The dialogic mind: A dialogic approach to the higher mental functions. New Ideas in Psychology, 14,47–62.

Fernyhough, C. (2008). Getting Vygotskian about theory of mind: Mediation, dialogue, and the development of social understanding. Developmental Review, 28, 225–262.

Gruber, O., & Goschke, T. (2004). Executive control emerging from dynamic interactions between brain systems mediating language, working memory and attentional processes. Acta Psychologica, 115,105–121.

Hill, E. L. (2004). Evaluating the theory of executive dysfunction in autism. Developmental Review, 24, 189–233.

O’Hearn, K., Asato, M., Ordaz, S., & Luna, B. (2008). Neurodevelopment and executive function in autism. Developmental Psychopathology, 20,1103–1132.

Pennington, B.F., & Ozonoff, S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry, 37, 51–87.

Vygotsky, L. S. (1987). Thinking and speech. The collected works of Lev Vygotsky (Vol. 1). New York: Plenum Press. (Original work published 1934)

Wagner et. al. (2005). The Children and Youth We Serve: A National Picture of the Characteristics of Students With Emotional Disturbances Receiving Special Education. Journal of  Emotional and Behavioral Disorders,13,79-96.

Williams,  et al., (2012). Inner speech is used to mediate short-term memory, but not planning, among intellectually high-functioning adults with autism spectrum disorder. Development and Psychopathology, 24, 225–239.