Teaching Social Communication: Insights into Parent and Caregiver Training

Brooke Ingersoll and Anna Dvortcsak, co-authors of Project imPACT, discuss their comprehensive social skills training curriculum for families of young children with autism.

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Transcript

Johnandrew Slominski 0:00
Welcome back to the Autism Annex Podcast—I’m your host, Johnandrew Slominski.  

If you take a brief moment to survey your social interactions in the past week: work, family, friends, maybe a nosy neighbor—you’ll probably find a huge variety.  Some are pleasant, some planned…others…maybe not so much.  In any case, they all boil down, at their most basic level, to a couple of people—just trying to communicate their ideas and their needs with one another.

 STAR Autism Support has spent a few years thinking about social learning and emotional regulation,  and my guests today have been at the forefront of teaching and researching social communication for individuals with autism.  

 The value of teaching social communication, especially in home and community settings, can hardly be overstated. Today, we’ll  talk about project imPACT, my guests’ specialized curriculum, and the ways in which further education on social communication can empower parents and caregivers. 

My guests, Anna Dvortcsak and Brooke Ingersoll:

Anna Dvortcsak 1:22
Hi, I'm Anna Dvortcsak, a speech language pathologist, and co-developer of Project imPACT.  I provide direct services to children and families here in Portland, Oregon, and then I also train professionals internationally to work with families and parents and children to communicate their needs within their family and community settings.

Brooke Ingersoll 1:44
And I'm Brooke Ingersoll, and I'm the other co-developer of the Project imPACT curriculum.  I'm a clinical psychologist and I'm a professor in psychology at Michigan State University, where I direct the Michigan State Autism Research Lab.

Johnandrew 1:57
Welcome to both of you, and thank you so much for being here.  Let's go back to the beginning of Project imPACT, the coaching program you co-developed for parents and caregivers of children with autism and other developmental delays.  What were some of the challenges you found in your research that led to this program, or even, the gaps that you aimed to close with the curriculum?

Anna 2:28
Yeah, so one of the challenges when we came to Portland together and started developing Project imPACT, that we found for families, was access to services.  So, families had a real challenge being able to access services for their child and were often asked to wait six to eight months, which as a parent, when you know that there's something you want to do to help your child be able to communicate--waiting is not one of those areas.  So, how could we improve access to services?  And one way is thinking about how could we get the parent involvement.

Brooke 3:03
And one of the things we really noticed as missing in the community at the time was materials and strategies that could really support community providers to do parent training.  So parent training had a really strong evidence-base in the research, and parent involvement in services has been shown to be best practices, but on the ground in the community, we found very few providers who had the necessary skills to be able to do that.  So one of the things we were really looking to do with Project imPACT was to take what we knew about best practices, evidence-based practice both in the strategies we chose to work with the children but also the whole process around coaching parents and put it together in a way to help support community providers to be able to do these types of services.

Johnandrew 3:55
So, best practices do show that parental involvement is key.  And so I'm wondering: what are the benefits of early intervention, and when do you recommend that parents start?

Brooke 4:09
Well, I think, I mean, we know from the research and just personal experience that early intervention really sets the child and the family up for success.  So there's quite a bit of really important early social interaction that occurs that really lays that foundation for learning all sorts of additional skills.  And so, when you have a child that is missing some of those milestones, or slower to acquire those skills, that actually can set them up for a number of challenges down the road.  So, the earlier we can get in and really build those early social communication skills and get the child a foundation for how to communicate, how to engage, how to really control their environment in a meaningful way, the much better outcomes kids are going to have over time.

Anna 5:00
And likewise with their families.  I mean, it's really creating those learning opportunities, so unless families are in child development, we don't really understand what the child is doing to communicate really from even zero to three months old, and all of those aspects.  And so if a child is not yet initiating, responding, they might not have all those opportunities for learning earlier which will create greater gaps.  And that's why it's really important to build that in from the beginning.

Johnandrew 5:30
If you'll forgive the oversimplifying question here: what is it about explicitly learning social communication that's so important for children with ASD?

Anna 5:42
So that they can advocate for themselves.  So that they can communicate. So they can get in the very beginning, simplistic way, so they can ask for what they want, and tell, and communicate when they don't want things.  Because otherwise they're going through life, and I think of this as a parent with my children, you want your child to be able to communicate what they need, and what they don't need at the basic level, you know, and then as it progresses, to be able to engage in things that are motivating and exciting for them.  And then later, of course, in life, to build that independence too--to know how to navigate the world--again, to become independent.

Brooke 6:22
And I think some of those skills for when children are developing typically many of these skills just sort of develop so kind of quickly and in such an integrated fashion it's kind of hard to even think about the idea that we would sit down and teach them explicitly.  But when a child has a delay or has difficulty acquiring some of those skills, they really do benefit from some more direct explicit instruction.  And what we mean by explicit instruction is not necessarily sitting them down and teaching them, but really building on those natural opportunities that arise when the child is interested in something, when the child needs something, giving them some additional specific pointers on how to communicate in a way that is likely to be understood by their partner, and get the response that they want.

Johnandrew 7:07
How does a parent or caregiver get started with Project imPACT, and what's that experience like?

Anna 7:15
Yeah.  Well, first when they contact a provider, there will be some sort of intake session to understand what the goals they have for their child, and then an explanation of the structure of the program. Meaning, what will be their involvement, what will be their roll, within therapy.  So, depending on if you're using the individual or group format, in the individual format, letting them know that they will come to the sessions, and the first couple sessions would really be spent developing goals for their child in the four areas that we target for social communication.  So we're really spending the first couple session developing the goals for the child. 

Brooke 7:55
And then, we kind of have this co-development process where we're really taking what the parents' goals are for their child, and so there's a really nice process that we go through where the parent from the very beginning is brought in as an expert on their own child.  So they're contributing their thoughts and their ideas about their child, and then they're getting some feedback from the coach about some of the things the coach understands about the child, and then they're really working together to kind of develop goals that are completely in alignment with what the parent's goals are for the child and what the child's current skills and needs are. 

Anna 8:29
And then they come to the coaching sessions, where we systematically teach strategies, one at a time, to help the parent work toward these goals.  And so the explaining, okay, you know, for example, today you're going to learn how to follow your child's lead so we can get the engagement and motivation.  And we let the parents know when we give out the strategy, we then give them a brief overview and then we'll show them how to use it, and the majority of the session we'll have them interacting with their child while we're providing feedback to them.  And then having them practice.  So we have practice plans that enable parents to practice these strategies at home and in their daily activities so they can report back to us what went well, or what might be challenging, so we can fine-tune the use of the strategy for their individual child and family.

Brooke 9:23
And then the strategies themselves that we teach I think, if you think about packaging them together, there's a term you might've heard before, called Naturalistic Developmental Behavioral Interventions or NDBIs.  This is a general class of intervention strategies.  It is a really lovely integration of developmental interventions, communication science, and naturalistic ABA principles.  So they learn a set of strategies that build on each other, starting with really helping build the child's social engagement.  The parent is taught how to sort of see the world through their child's eyes, follow into what their child is doing, join in their child's activity, and connect with them that way.  And then at the end they are taught how to put all of the strategies together during their daily routines and activities so it becomes really kind of integrated in their normal day-to-day interactions with their child.

Johnandrew 10:15
So, one aspect of Project imPACT is that it's a Naturalistic Developmental Behavioral Intervention, a mouthful, or NDBI for short.  Which means, in part, a focus on things that the child wants or is interested in.  Could you explain what that all means for teaching communication?

Anna 10:39
Yeah.  I mean, I think that's a great question.  So it is an NDBI, meaning that we are wanting to teach within the natural environment, attend to the child's current developmental skills, and then try to expand the complexity of the skills so that they're more easily understood by multiple communicative partners.  And I think you highlighted something really important: in NDBIs, the child initiates the teaching episode, so we're not going to teach the child an arbitrary skill.  Say you're holding a cracker--they have to show you that they want the cracker somehow: by looking at you, or reaching towards it, before you would try to teach them a more complex skills.

Johnandrew 11:21
As part of this progression towards more complex skills, you've outlined five pillars in the form of an acronym: F.A.C.T.S., for short.   Focus on your child, Adjust your Communication, Create opportunities, Teach new skills, and Shape the interaction.  This unfolds beautifully for readers of your book, and for listeners, could you unpack these facts a bit?

Anna 11:45
So we want to begin with focusing on the child.  And that really, as Brooke was indicating earlier, really focus on looking at what is the child interested in, and then how are they communicating on their own?  So I think one of the challenges is that as adults, we often look at communication and think it's verbal--and so if a child's not verbal, then, people think they're not communicating.  But there are so many different behaviors that children will use to communicate, whether it's body posture changes, slight changes in the facial expressions, a gesture, you know, so sound. So it's really helping the families' parents attend to what the child is doing, and some of those nonverbal signs that might be indicating that they are communicating something, so that we can start to build on getting that back and forth engagement and responding to those cues.  Without having them have to do something else.

Brooke 12:42
And I would say those strategies really fall very clearly into the more developmental camp--so these are strategies that have come out of the developmental science literature, communication science literature, and so they really lay what we consider to be the foundation groundwork, really, of building that social engagement and interaction where the child is then able to kind of learn to be able to take the next step, which is really trying to build initiations.  So that is the next set of strategies we teach, which are called Create Opportunities.  And those are ways of setting up the environment in natural ways to help encourage the child to be able to indicate that they want something.  And the child may do that verbally, but then they also do that non-verbally.  And so the way I like to think about that is we really set the groundwork by getting the child engaged, but now we're going to maybe kind of adjust their environment a little bit so that they are able to have more opportunities to practice initiating in any way--whether that be verbal or non-verbal.

And then the next set of strategies, which we call Teach New Skills, are based naturalistic ABA strategies, so it's basically using prompting or cuing and rewards or reinforcement to really help guild the child to use this slightly more complex skill than what they're using on their own.  So for example, if the child is playing a tickle game with the parent, and is having a great time and laughing and smiling, then the parent might create an opportunity by just pausing the tickles.  And then if the child indicates if they're enjoying it by maybe looking at the parent, then you might teach new skills by having the parent model a gesture or a word for the child to be able to use to indicate that they want more tickles.  And so it's really gently shaping using prompts and rewards to help the child use a skill that they're probably not able to use completely on their own.  And then over time, we teach the parent how to fade those prompts so that the child is communicating or engaging or playing in a more complex way.

Johnandrew 14:44
So, if I'm playing the home game, so far we’ve got Focus, Adjust, Create, and Teach…am I tracking the facts here?

Brooke 14:55
Just the last strategy is really what we call Shape the Interaction, where we're really helping the parent balance all of these strategies together and adapt them in the moment for what the child's doing.  So if the child's really excited about something, we might have the parent what we say move up the pyramid and start using more of that prompting and rewards.  If the child is sort of disengaged or having a bad day, we'll really move back down and really follow the child's lead to get them engaged again.  So it's really helping them to really apply how you can adjust the interactions slightly throughout the day.

Anna 15:29
Depending on what is the child's motivation, what's their mood, and what activity are you engaging in, and also I always say parents should attend to their own mood.  I mean, I'm thinking, how much time do I have to follow through, or some of those aspects as well, if they're thinking of how they're going to move up and down the pyramid. 

Johnandrew 15:49
You know, one of the strategies for parents that you cover in your book, that I found really interesting and surprising, and I think maybe people may not think of intuitively, is imitation.  Brooke Ingersoll, I know you've done some extensive work in this area; how does imitation work as a parent and caregiver strategy?

Brooke  16:12
I actually really love all the strategies that are in Project imPACT, and I think they each play an important roll, but I do think imitation is one of those really powerful strategies that parents can use early on to connect with their child. It's not a way that...I mean, parents do imitate their children naturally, particularly infants.  You have a newborn, you probably find yourself imitating some of your baby's facial expressions.  But as kids get a little bit older, they're really oftentimes expected to imitate others, and they don't have as much experience with being directly imitated--everything that they do, say move.  And so, I think it can be something that's very eye-catching for all of a sudden the parent to stop trying to get the child to do what the parent wants, and does exactly what the child does.  And I find that sometimes for a parent who's going through the program, that might be the first time the child stops and looks them.  And that can be a pretty powerful tool.  So I think it's one of those things that, it underpins a lot of building that space, and then as Anna said, once a child recognizes that somebody's paying attention to them, they get more opportunities to try out something new, and then they'll pay attention to someone else, and maybe they'll try out what they're doing.  And so it really does build that back and forth, sort of social communication exchange.

Anna 17:29
And letting the child lead.  It's a great way to let them lead if they also see that imitation of them and going back and forth.

Johnandrew 17:40
You’ve been very intentional, emphasizing the importance of child-led teaching when possible.  The portion of your book on receptive language, though, changes focus somewhat toward adult-led activities.  Could you talk a bit about that?

Anna 17:59
Well good question.  We do try to keep it child-led so we're building the understanding of the directions.  So say for example the child wants to go outside, we can give the direction, you can go outside, but you need to get your shoes first.  But following directions can be challenging for children--sometimes all children don't follow them not because they don't understand but because they don't want to.  And unfortunately there are some things, like perhaps going to the dentist, or the doctor, or taking a bath, or brushing your teeth, that we might have to engage in.  And so with those following directions, we're trying to set up ways that yes, it's adult-led because the child needs to complete something really for their health or wellbeing, but they don't yet realize that and so the parent needs some strategies to be able to help the child follow through.  And so we do that by giving the parents cues to help the child follow through, and then the child has some sort of reward for it--if it's not self-motivating.

Brooke 19:05
All people have to do some things that are not what they want to do, and that's when those other things come into play.

Anna 19:14
And that can happen as you get older.  Thinking about older children cleaning up their room.  Well, why, if nobody is going to come in it.  Some of those aspects, so building in some of those tasks that I think we all have that we don't necessarily want to do, but until they have their later 20s or 30s and have the executive function skills to understand sort of why, then we're helped with those strategies.

Brooke 19:44
I will say that the one thing, although that aspect might be a little less child-directed because sometimes, as I said, sometimes there's things kids aren't choosing to do on their own, putting away their toys, it's time to get ready for bed.  I can tell you my children don't like to do that.  But we really do try to teach those direction follows within meaningful routines.  We don't try to target following directions for the sake of following directions.  It's really following directions within the context of activities of daily living. 

Anna 20:18
And I always tell parents even if we're not 100% sure of a child's comprehension level, I always like to assume some sort of understanding.  So I explain why.  Like, I know you don't want to pick up your toys, we need to clean up your toys so I don't trip over them.  Giving them, starting to build that understanding so it doesn't seem as arbitrary in giving them reasoning, I think it can expand language too.

Johnandrew 20:46
Going back now through more than ten years of Project imPACT, what are some of your most fulfilling moments?  Anna Dvortcsak, let's begin with you.

Anna 20:59
I mean, I can think of so many, and I was going to say that one of the most rewarding things is you are helping.  It's like, so many of the kids that you work with, it's this excitement as you are showing up to interact with them, and then seeing them be able to ask for things when they want them, or say when they don't want something, and then see them be successful in school.  Working with siblings is also wonderful, and so I think of this one time I had a brother come in, and then for the first time his brother with ASD said his name.  And it brought tears of joy because he's learning how to have this interaction.  So I think seeing those connections and the joy between the family and the child as they're able to interact and communicate is awesome.  And that's why I love--in addition to all the trainings--always working with families and children myself.  Because that's the real joy in helping them be able to communicate.

Johnandrew 21:59
Brooke Ingersoll: same question as I asked Anna.  What has been most fulfilling as you've seen students and families thrive in Project imPACT?

Brooke 22:08
So I don't do as much direct work with families myself.  Much of what I'm doing now tends to be more on the research end of things.  But one of the things that I think is really interesting is some of the work we've been doing recently has involved qualitative interviews with families who've gone through the program.  So, interviewing them about their experience with the program.  What did they notice?  And one of the things that has been an incredibly important theme that we've seen parents saying again and again is a theme around, "my child wants to be with me."  It really is about this moment where the parent is feeling connected to their child in a way that they have not felt before.  And I think of that as not only so important in the moment, but how important that is for setting up the entire trajectory of their relationship over time.  So, I see that when I think about why are we doing this, we're doing this to build that really important relationship from the very beginning.  So that not only is the child developing, but the child and the parent and the child and the siblings are really developing a connected relationship that's going to serve them throughout their life.

Johnandrew  23:20
Hi Podcast Listeners.  Johnandrew Slominski here.  You've been listening to my conversation with Brooke Ingersoll and Anna Dvortcsak, co-authors of the social communication curriculum Project imPACT.  Thank you both so much for your insights today.  If listeners would like to know more about Project imPACT, how can they find you?

Anna 23:43
On our website, which is project-impact.org.  

Brooke 23:49
www.project-impact.org.  Don't forget the dash.

Johnandrew 23:54
Punctation is important!  Thank you both. The Autism Annex Podcast was developed by STAR Autism Support.  As always, I'm your host and producer, Johnandrew Slominski.  Special thanks to my guests for sharing their curriculum with us today, and to you, for listening to this podcast episode.

To learn more about Project imPACT, visit project-impact.org.  The curriculum is also available at starautismsupport.com.  

Countless schools across North America are starting back in the next month.  We wish you all a wonderful new school year ahead.  Until next time, my friends, take good care of yourself, and one another.