Increasing Communication Skills: A Case Study of a Man with Autism Spectrum Disorder and Vision Loss

Abstract

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, APA, 2000), autism is neurodevelopmental disorder that is characterized by impairments in social and communicative behaviors with great variations in ability, depending on developmental level, intelligence, and chronological age. Thus, autism is spectrum disorder that affects large number of children (1 in every 150) to various degrees (Centers for Disease Control and Prevention, 2007). Autism is further defined as qualitative impairments in social interaction, which include impairments in nonverbal and verbal behaviors ranging from the lack of spoken language with no attempt to use alternate modes to only mild delays in conversation (APA, 2000). Although the degree of communication problems varies, one common thread for all individuals who are diagnosed with autism is that if interventions are not designed to meet the individual's needs in socially significant manner, the individual has poor prognosis (Heward, 2009). Thus, it is important to consider the whole person when designing interventions by taking into account additional disabilities as well as individual strengths. Two of the more common tools for teaching communication skills to individuals with disabilities related to communication are the Picture Exchange Communication System (PECS; Bondy & Frost, 1994), which relies on the exchange of pictures representing desired object, place, or event, and mand training (Rosales & Rehfeldt, 2007; Skinner, 1957). Skinner (1957), behaviorist, coined the term mands, along with other verbal operants (tacts, intraverbals, and echoics), under the umbrella of verbal behavior that is based on the principles of applied behavior analysis. The term mand is defined as a verbal operant for which the form of the response is under the functional control of motivating operations and specific reinforcement (Cooper, Heron, & Heward, 2007, p. 30); that is, people request specific items or things only when they are motivated to do so. This motivation is often derived from state of deprivation. Both methods have endured much success. Sundberg and Partington (1998) provided basic recommendations for mand training: (1) establish that motivating factor or an establishing operation (such as state of deprivation) is in place prior to beginning the session; (2) consider those items that are motivating to the individual; (3) use only items to which the therapist can easily control access; (4) select only those items or activities that the person understands through some means of communication, such as imitation or pulling you; (5) use reinforcers that are easy to deliver; and (6) use reinforcers that can be delivered on multiple occasions (such as sip of juice instead of an entire cup). The study presented here used these recommendations. PURPOSE OF THE STUDY The primary goal of the study was to teach nonverbal man who was blind and was diagnosed with autism to use sign language to mand for two highly desirable items: food and drink. However, because of the severity of the autism and vision loss, the use of mands was selected over PECS, which relies heavily on the ability to see the item that is depicted. To begin the mand training, some preliminary work was required to get the participant to use correct American Sign Language (ASL). The correct use of ASL was required because of the individual's use of idiosyncratic signs that differed from ASL and were all similar to one another in form, which resulted in the caretakers' inability to discern what the individual was requesting. This lack of ability to discern the participant's wants and needs resulted in the desired item not being delivered and the man engaging in self-mutilation or other destructive behaviors until the desired object was provided. METHOD Participant and setting The participant in the study was nonverbal 28-year-old man who was blind because of rare retinal disease he contracted at age 12, and who had profound autism. …