ASHA 2007 Transcript
 Visual Immersion Program (VIP): A Communication Program for Persons with Autism

Slide 1: Title Slide
(no audio)

Slide 2:

We want to thank you for coming to our session. My name is Howard Shane and I'm 
doing this program with Meghan O'Brien who is to my left and Dr. James Sorce who is 
sitting here as well.  Meghan and I will do most of the speaking but Jim made 
considerable contributions as did so many others. In your ASHA information sheet,  
when we first submitted this proposal last spring we were continuing to develop our 
proposal. At the time we refer to it as Say it with Pictures and has evolved into Visual 
Immersion Program or the VIP. And it's a program that is growing out the work we're 
doing in the Autism language program at Children's Hospital in Boston. 

Slide 3:

Part of our work is sponsored by the RERC on communication enhancement. That's the 
virtual RERC with a number of other centers and individuals in our field.  And we think 
there is a lot of really great work going on in the RERC and we certainly want to point 
out the sponsorship for this lecture.

Slide 4:

While the three of us have certainly contributed to this undertaking, there are a number of 
others who have made valuable contributions as well. Especially, the children and the 
parents who graciously bring their children to us and give us the opportunity to try and 
help them out. But, we learn so much from them. We have some outreach programs in 
the Boston schools called the Model Autism Program. There is also a program at the 
Monarch School in Cleveland, Ohio. And a number of individuals, including Marie 
Duggan, who happens to be here today as well who contributes so much to our center. 

Slide 5:

What we want to do today is overview the VIP, knowing the VIP is a comprehensive 
program that is intended to enhance language both as a expressive and receptive 
opportunity. We're convinced that the importance of comprehension is sometimes 
overlooked by programs intended to teach individuals on the Autism Spectrum. In other 
words, their focus is often on expression and we actually think it ought to be reversed.  
I'm going to review some of the key components of the VIP, and then we'll describe 
teaching concepts that we know are difficult for individuals with moderate to severe 
Autism to learn. And then we'll show you how we approach this using this approach. We 
will show you a number of clinical examples as well, where you will have an opportunity 
to see different children and adolescents reacting or responding to the principles that 
we'll be describing before we show you the actual videos. 

Slide 6:

The goal of the VIP is to use visual supports in everyday situations to teach 
communication not just in the therapy room, not just in the classroom, but in every 
situation. There some key ingredients I want to point out, that again keep in mind, it's 
important too see that it impacts both comprehension and expression. We see it as a 
closed language system, in that it has restrictive pragmatics, and we're going to target 
some basic communicative operations which I'll review. Both the instructor, who we 
sometimes refer to as 'mentor', and the learners exposed to our program will use the 
same visuals to communicate to one another. It is a combination Ðbut we're targeting 
comprehension. Also, we believe based on some survey work that we have reported on in 
the past and are continuing to explore. Something you may already know, that persons on 
the Autism spectrum have a strong attraction to electronic screen media. In our survey, 
for example, we found that video, DVD, computer screens were in some cases the most 
important form of entertainment. Sometimes more time was spent watching electronic 
media than all other forms of media combined. And we have been convinced for some 
time that if a person spends that much time looking at a computer screen or looking at a 
video Ð that there must be something inherent in that material that we want to take 
advantage ofÑand that we can then use to encourage that person not to just be 
entertained but also to learn. In other words, to improve those language concepts that 
eludes us so often by using electronic media. 

Slide 7:

So what is visual immersion? We're talking about an environment where it's a responsive 
environment that takes advantage of the visual supports we know are so useful. We didn't 
invent visual supports. People like youÑprofessionalsÑteachers, speech language 
pathologists have come to the realization that visual schedules, visuals for 
communication make a significant difference. But also the environment can be 
responsive so we want to establish and create an environment that enables the person to 
benefit from the visuals to improve their ability to understand what's going on around 
them. It needs to be done in the home, school, and in the community. We don't have all 
the answers. We're just getting better at trying to make it a universally applied 
instructional format. We want the person on the spectrum to have easy access not only to 
the electronic media but also to non electronic forms of expression, comprehension, and 
just understanding and helping with those transitions. 

Slide 8:

I mentioned earlier that we have isolated seven communicative operations. Protesting and 
refusal-- we don't need to teach many children how to protest. We do want to teach them  
to use more symbolic means of doing that. And requestingÑwe'll certainly see some 
demonstration examples of that. That's certainly and important part of the PECS program 
which everybody knows about. You're going to see us using the TLC. The TLC within 
the VIP is to give directive and also to be able to comment. As we move along we have 
strategies for questions, social conventions, and also for transitions. One of our focuses 
will be on the comments and also the directives. 

Slide 9:

What the VIP is not. It is not meant to teach abstract concepts, with liberty and justice for 
all for example. Or the passive voice, complex syntactic structures, figurative language, 
or humor.  However, we feel that being able to better understand spoken language or 
language that is being transmitted, visually or spoken, sets the stage or creates a way of 
being able to learn and essentially launch the ability to benefit from these more complex 
functions.

Slide 10:

We all know this. I know my mom used to say don't comment on the obvious. I might 
have spent my whole life doing that. But, as practicing speech and language pathologists 
we learned what we do needs to be generalized to the natural environmentÑin helping 
with daily routines, operational knowledge. It's amazing sometimes how well individuals 
on the spectrum understand what happening around them, what's happening in their 
environment. They know how to operate their VCR, know how to make lunch, they know 
how everything in the house operates. And they've learned all of this through 
observation. And it's a visual opportunity. But, when we begin to impose language on 
them-- that's when they sometimes breakdown and that's why their operational 
understanding is considerable. We also want to be able to use our information in a 
preferred play routine. As a practicing speech language pathologist we also do many 
things on the tabletop and you'll see some of the instruction on the tabletop. But also 
there's the virtual settingÑusing the electronic media to help them understand. So again, 
it's not just entertainment it's more edu-tainment. Using something that attracts them for 
reasons we don't always understand. It is a tremendous magnet. It pulls them in. So of 
course we're saying what can we do to make this an opportunity to learn or to improve 
the opportunity? This is what I mean: we all do work in the natural environment; we all 
do work on the tabletop and now maybe the addition is to the virtual setting. Some 
children do better when they are exposed to things on a tabletop some do better when it's 
presented to them in a virtual way. So when you personalize itÑit has to depend on the 
individual.

Slide 11:

Here's an example of a natural school setting. There's Mike with his teacher. And they're 
using something we call a Mobile Language Display or MLD. (Which is basically Velcro 
adherence for activities in the classroom.) Mike is being given instruction. Some people 
refer to it as aided language or augmented input. And we're giving him information to be 
able to improve is ability to understand that particular routine. 


Slide 12:

You're going to meet the ALP familyÑthat's capital A, capital L, capital P. These are 
materials we've been creating that gives us the ability to demonstrate to families that 
come to see us at Children's Hospital ways of teaching some of these language concepts 
and also giving them  so they have some materials that they can take away. We'll get to 
those in a moment. There's a family and there's some other objects that are readily 
available and that are used in doing some of these tabletop activities.

Slide 13:
Here's an example of a virtual setting. Some examples here from something called The  
Great Action Adventure. You're probably, or many of you are, already aware of this but 
here we're demonstrating the concept of climbing.

Slide 14:
Some of you know the Mayer-Johnson symbols, again to demonstrate climbing. Again 
the action there's something interesting about it but it also captures the essence of what 
we're trying to communicate.

 
Slide 15:

Here we have a homemade video and here's Kara doing some climbing. She's also going 
to be a great actress. 


Slide 16:

Here we have an example of an extremely popular character, and as we all know video is 
important. If we can just capture those concepts which are so elusive by being able to get 
to video content then we can also demonstrate the concept of climbing. So if we take 
advantage of that opportunity to teach children that represents the concept we think this is 
an important way to get this idea across. That's what we're going to demonstrate in the 
TLC. How can that type of dynamic scene do something that is so interesting and then 
apply it to more generic language?

Slide 17:

Just quickly, communication should be easy. What do I mean? I mean that if we want to 
make the distinction between just making a communicative statement where a child says 
something, asks something, and we accept it and move on. We want to be able to do that 
in an easy way. We want to separate that from language arts where we are focused on 
teaching specific language concepts. Every communicative situation, every time a child 
communicates it shouldn't be necessarily an opportunity to expand their language, to 
make it more than what it was intended to be. Not that I'm suggesting that we don't want 
to do that, but let's at least understand that we want to draw that distinction. Make 
communication easy. And at times it certainly makes sense to be able to introduce a 
teaching opportunity.
  
Slide 18:

Now as for visual supports. Most language instruction programs working with people on 
the Autism spectrum do use visual supports. We recognize that. We honor that.

Slide 19:

Why are visuals needed? Because of comprehension or auditory processing problems that 
people with severe or moderate to severe Autism experience and we have data to support 
that. They respond favorably to visual supports. Now you know, you can't always 
separate comprehension from auditory processing. Use of the visual is an alternative 
modality. And again you're taking advantage of their relative strength. We like to use the 
term sustained presence. There's something about having the visual continue to appear 
that gives the person, let's say the person with an auditory processing impairment, the 
ability to then process or to understand what is being presented because of the sustained 
presence. Maybe that's one reason why visuals are so importantÑit is that sustained 
presence. Several surveys have demonstrated or shown that an estimated 50% of people 
on the Autism Spectrum are non-speaking. We as the profession, as professionals, have 
made augmentative communication as important as it is. So the work we're doing with 
persons with Autism is really the work of the individual working in AAC. 

Slide 20:

Symbol representations.

Slide 21:
 
Here we're going to talk about level of representation. 

Slide 22:

We know about these kinds of materials. We call these 3D photos. And we find that for 
some individuals we have to capture the level at which they're understanding these 
materials. And what we may not have used before are these 3D photos. What we do is we 
cut out the photo and cut out the background. Then we mount it on foam board or 
cardboard to give it a more three dimensional look. Quite often it makes the difference in 
some individuals being able to understand what the material is really trying to represent. 
We know photographs sometimes work. Sometimes line drawings work and sometimes 
color photo works. But, for some individuals 3D photo makes a significant difference.

Slide 23:

Types of representations.

Slide 24:

We use what we call scene cues, element cues, and manual signs and gestures. We're 
going to focus on scene and element cues in this discussion today. 

Slide 25:

A scene cue is a perceptual representation and it's a symbol which illustrates and entire 
event. It captures the essence of what you what the individuals to do. Just hold that 
thought and we'll show you some examples. It captures the essence of what is expected. 
And there are two types of scene cues. They can be dynamic or they can be static. 

Slide 26:

This is an example of a dynamic scene cue. And this is using some materials that come 
from our ALP family. This is Mr. ALP's car. 

Slide 27:

 Video: "The car pushes the block."

Shane 28:
In the video 'the car pushes the block.' We also try to have the materials act in ways they 
normally wouldn't act. So you give a child a car and a little figurine the child is going to 
put the figurine in the car. But we want to expand on that. So it's really not based on 
routine and expectation. It's based on the actual language of what is being shown. So in 
this case you heard it but you also saw it. 


Slide 29:

Now here's an example of a static scene cue. So in the ALP program you can use these 
dynamic scenes but you can also use static scenes where there are quite a few graphics, 
which are printable. You can switch between the dynamic and static as well. 

Slide 30:

And then there are elements. Those of you familiar with the Folk's sentence builder, an 
old language teaching program, which is kind of based on semantic relations. We'll see 
the relationship between those programs and what we're trying to do here. We've 
borrowed heavily from that idea. But the idea is that agents, actions, and objects are 
taught. This is the hard stuffÑthe spatial representations, attributes, and action verbs. 
Persons on the spectrum tend to do very well with nounsÑit's when you get to the more 
relational or connectors of language that's when we start to see breakdown. 

Slide 31:

Here are some examples of element cues-- agents, actions, and objects. These are all 
included in your handout. 

 
Slide 32:

If we're doing elements, but this time representing them with text. Obviously, you would 
use whole words and that's what you see here.

Slide 33:

Symbolate is an interesting concept. Symbolate is the concept of stringing concepts 
together through a series of isolated symbols.  Many of you in your role of speech 
language pathologists don't always know what this says. But, we believe that it doesn't 
actually improve comprehension just because you string symbols together and throw 
visuals at somebody. They need to have some prior knowledge of language elements and 
semantic relations in order to benefit even if you are going to use them as complex a 
sentence as what you see here. We believe, paradoxically, while you're trying to improve 
comprehension the introduction of this kind of string of symbols could in fact impair 
comprehension or get in the way of comprehension. 

Slide 34:

 Types of displays.

Slide 35:

A visual scene display here with the concept of hot spots. There's been a lot of work in 
the RERC. In a paper that came out in Augmentative Communication News, Sarah 
Blackstone's newsletter, which was the result of a lot of thinking. We all know about grid 
displays. When I say grids I mean the traditional communication display. The grid where 
you put symbols within targets. The visual scene is a growing phenomenon, if you will, 
within our profession. We're using whole scenes as a way of communicating or 
describing information where there are hot spots. And so you touch something, within a 
scene something happens. 

Slide 36:

Here's an example of a program where developed in the mid-90's called Companion. The 
idea here is that there's this village and I have hot spots. I click on the house and it takes 
me to another representation and when I click on bed it takes me to the bedroom. I can 
navigate down. There's some work done by Janice Light that this kind of representation 
may be more meaningful to individuals than decontextualizing information that's 
presented in a grid. It's something to think aboutÑespecially for younger children, and 
that's what Janice Light's research has demonstrated. It seems to be more intuitive and 
more understandable. 

Slide 37: 
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Slide 38:
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Slide 39:

Here's another way to create a visual scene. Rather than take a photograph of a box of 
macaroni and putting it into a target area. Take a picture like this of an entire pantry and 
you have the important food items already made for you. 

Slide 40:

Here's a typical example of grids.

Slide 41:

These are grids arranged by category. They are obviously about food.

Slide 42:

Here's a conversational grid display with subjects, and verbs, and so forth. We're going 
to see more of that later. 

Slide 43:

Here's an example of a Mobile Language Display. Here's Mike working with his teacher. 
And I'm going to set this up. So he's going to say what he wants to do and he's going to 
go to a ring toss activity where he has to put a particular color ring into a particular bin so 
there's a number on it. And if you watch Mike who's doing very well with language 
comprehension, when he has these visual supports, you'll see him continuously referring 
back to the visual because it's giving him the information he needs to keep going. Craig, 
his teacher, is using a mobile language display to get him oriented and keep him focused 
on the task. So, that we're successful when we're having this interaction. 

Slide 44:
 Video ÐMike
Craig: What's first?
Mike: (unintelligible)
Craig: Are you ready?
Mike: Ready.
Craig: Let's go.
Craig: Mike, look at box 3. Mike, throw red in box 3. 




Slide 45:

Our teaching language concepts program is essentially a visual instruction system used 
for teaching language concepts which are particularly challenging for people with 
moderate to severe Autism including verbs, prepositions and attributes. It is a confined 
visual language which simply means that it is limited to the essential vocabulary and 
syntax needed to support everyday functional communication exchanges. Most typically 
instruction is going to begin in the virtual environment, using engaging video 
observational learning materials. And then instruction progresses to the tabletop 
environment, using manipulative materials, and finally extends to the natural 
environment. Hopefully, ultimately resulting in functional communication at home, the 
school, and community. 

Slide 46:

In our teaching language concepts program the learner is going to progress through all or 
some of the three phases of visual language instruction. Begining with the most concrete 
and ending with the most abstract representations. Depending on the learner's needs and 
abilities instruction can begin at any of these levels. We typically begin at the dynamic 
scene cue level, these are full-motion video clips of action scenes. Then we progress to 
static scene cues, which are photographs that capture a prototypical moment in the action 
scene. Finally we would end with language element cues, which are graphic icons 
representing each of the individual parts of speech like subject, object, verb, preposition, 
adjective, etc. In our program we are using a unique integration of video based 
observational learning with scene and element cues to promote language comprehension 
and expression.

Slide 47:

I'm going to show you some different examples of these dynamic scene cues and remind 
you of what they are. This is an example of a dynamic scene cue representing the 
concept, climb. You'll see Kermit climbing the ladder in a video.

 
Slide 48:
 Video: Climb. Kermit climbs ladder. Climb

Slide 49:
 
A lot of the individuals we're working with have spent some time working with this 
dynamic scene foundation. We present them with the identical materials on the tabletop, 
and they would be presented with the video clip, and would be required to reenact what 
they see happening on the screen. 

Slide 50:

Then we're going to progress to the static scene cue, which again are these photographs 
representing the prototypical moment in an action scene. So this photograph represents 
Kermit climbs the ladder and the learner would be expected to report the meaning in the 
photograph.

Slide 51:

Finally, we progress to the element cues which represent the different components within 
the sentenceÑKermit climbs ladder. Again we're focusing here on this concept of climb 
which is challenging for some persons with Autism. 

Slide 52:

Now I think it's most appropriate to show you how we implement the materials with our 
learners using video examples. I'll begin with dynamic scene cues. This is Ryan- he is 
nine years ten months old and he has Autism. In terms of his language comprehension he 
is primarily following routine based directions and responding to context rather than 
spoken language.  Expressively he is using speech primarily for requesting and he 
frequently exhibits scripted language. In this video you'll see him presented with 
complex multi-element sentences and he won't execute the directives. Then he's 
presented with a dynamic scene cue and you'll notice he reacts to the scene and 
immediately reenacts the scene that he's observing. He does have some obsessive 
compulsive behaviors so he matches the little objects exactly to what he is seeing in the 
video. This is Ryan. 

Slide 53: 
Video Ryan
Howard: Ryan, I want you to have Kermit push the girl in the wheelchair.
Ryan: Push girl.
Howard: Have Kermit push the girl in the wheelchair. Ryan, Ryan, look.

*video: Kermit pushes girl in wheelchair. Push. Kermit pushes girl in wheelchair. Push. 
Push. Kermit pushes girl in wheelchair. Push. Push. Kermit pushes girl in wheelchair. 
Push.

Howard: Ryan, have the girl push the dog in the wheelchair. Ryan, have the girl push the 
dog in the wheelchair. Ryan, look.

Video: Push. Girl pushes dog in wheelchair. Push. Push. Girl pushes dog in wheelchair. 
Push.



Slide 54:

I now want to show you an example of someone who is using static scene cuesÑonce 
again those photographs representing a concrete concept. This is Avery, he is ten years 
nine months old. In terms of his language comprehension he follows contextual single 
step routine based commands. He is communicating about ten spoken word 
approximations. He's been introduced to the Picture Exchange Communication System 
for requesting. In this video you'll see him presented with static scene based cues and 
he'll recreate each. You'll notice that a lot of the cues he's presented with represent an 
action so he's inferring the movement from the photograph. In one of the examples he 
actually goes to seek out information from the visual scene. So the spoken directive is 
presented and he looks to find where the visual information is to support his 
comprehension of the spoken directive.

Slide 55:

Video: Avery

Howard: Have Kermit push the fire truck. Here. Have Kermit push the fire truck. Yeah 
there you go.
Howard: Can you put the bed on top of the bowl? Can you put the bed on top of the 
bowl? Put the bed on the bowl. Avery, good, put the bed on the bowl. Can you put the 
bed in the bowl? Can you put the bed in the bowl. Put bed in the bowl. There you go. Can 
you put the dog on the bowl? OnÑcheating. Put the dog on the bowl. Put the dog on the 
bowl. 

Slide 56:

We typically spend quite a bit of time with learners or the dynamic or the static level. 

Next I wanted to show you how we would transition between dynamic, which is the most 
concrete representation of the event, to the static level, which is that photographic 
representation. So this is Emaan who is five years ten months old and she is able to 
imitate dynamic scene cuesÑshe's great at that. So we're working on getting her to 
understand how to infer meaning from static scene cues. How you infer pushÑwhen the 
object is actually pushing and not just leaning as it appears in the photograph. In this clip 
you'll see her using a static scene cue successfully, then she'll be presented with another 
static scene cue and won't quite understand the concept. So, we go back to the dynamic 
to support her understanding of the task, and then we model the association between the 
visuals to get her to understand that the static is a representation of the dynamic.

Slide 57: 

Video: Emaan

Meghan: Can you make the boy stand on the ball? Kicking the ball. Make the boy stand 
on the ball. Good job! 
Emaan: A ball! He's standing on the ball!
Meghan: You ready? You ready? Can you put the man behind the cup?
Emaan: A cup!
Meghan: You want a cup? Can you put the man behind the cup? Put him in the cup. Put 
him behind the cup. On the cup. Let me show you. Let's see where is he? Here he is. The 
man is behind the cup. Good girl!


Slide 58:

So immediately she understands the dynamic scene cue and then we model the 
association between the static and the dynamic. Unfortunately that wasn't captured in that 
video clip.

Slide 59:

Next is Neal who is five years eight months old and you'll first see him using scene cues 
to follow directions like you've seen in previous clips. Then he'll be presented with an 
array of scene cues and an action will be performed at the tabletop. He'll be required to 
match the scene cue to the action he sees being performed. 

Slide 60: 

Video: Neal

Howard: Can you have Woody push the car? You do it. Woody. You do it. Good boy! 
Okay now Neal. Neal. Here we go. Here's Woody, and there's Gumby, and there's 
Batman. Now tell me, Neal tell me. Neal, look it. Who's pushing? Tell me. Tell me. 
Good boy. That's right. That's Batman pushing the car. Okay Neal, look it. Neal look. 
Neal. Tell me. Tell me. Who's pushing the car? Good boy. Woody's pushing the car. 
Okay one more. One more. Push. Who's doing the pushing? Who's doing it now? Neal, 
who's pushing the car? Give me the picture. That's right Gumby's pushing the car. 

Howard: Tell me something, Neal. You do it mommy. Look Neal, this is Batman. You do 
it mommy have him climb. Neal, which one. Which one. Neal look it. Who's climbing? 
Who's climbing? Show me. Who's climbing. That's right batman is climbing. That's 
right. Neal, can you tell me? Which one? Which one? Look at mommy? Who's climbing? 
Show me. Who's climbing? That's right Batman is climbing. Good boy! Now Neal can 
you tell me which one. Which one? Which one? Look at mommy. Look it Neal. Who's 
climbing? That's right Woody. Woody's whatÑtell me the sentence. Woody. Yeah 
climbing. Alright. Do you want to take a break? Let's take a break.

Slide 61:

Next, is a clip of Courtney who is communicating primarily using single word utterances. 
So this element cues task is presented to promote the ability to communicate lengthier 
utterances and using more various parts of speech to describe. He's presented with an 
element cues task for comprehension and now is required to describe an action using 
these element cues. 

Slide 62:

Video: Courtney

Howard: What's this? Gumby. In the what? Which picture. In the what? Put it right here. 
Tell me the whole thing. Tell me. That's correct. Now. What about now. Tell me now. 
Fix the sentence. Gumby. Put it over here. Now tell me the sentence. That's right. 
Gumby's in the bed. That's great. Now, tell me something now. You know what this 
says. Push. Now watch. Ready, watch. What's happening there? How do we move the 
sentence? Put it right here. Gumby what. Gumby what. Gumby push. Which one. Put it 
over there. Tell me the whole sentence now. That's right. Nice job. Now tell me. Move it. 
Where does it belong? That's right. Nice job! Ready? Tell me what's going on here? Go 
ahead. Yea, mmhmm. Alright, you've got batman and you have ladder, what else? 
What's he doing? He's climbing. Look over here. Which one's climbing? Now tell me 
the whole sentence. Tell me. That's right. Smile on his faceÑyou know he's got it 
figured out. Now tell me here. Fix it. That's right now tell me the whole sentence.  Yea, 
that's right. What about now? What's going on here? His name is Woody. That's right. 
That's right. Now we can be generativeÑusing the whole scenes they're not generative. 
But now we can. What's going on here. Push that's right. Tell me the whole sentence. 
Woody, yea. Use your pictures. Say it with pictures. Push. Which one is it? Put it where it 
belongs. Put it where it belongs. There that's it. Tell me the sentenceÑtell me what's 
going on. Yea that's right. Woody is pushing the truck. What's going on here? What 
about batman? That's right batman's pushing the car. Look here. Tell me. What do we 
got? Batman. That's right block. Batman is on the block. Okay. 

Slide 63:

Next, we have Peter who is presented with a very similar task. He's been successful with 
the same task as Courtney which you saw in the previous clip using the picture based 
element cues.  Peter is currently working towards using the text based element cues to 
describe as you'll see in the clip.

Slide 64:

Video: Peter
Howard: Ready, what's happening? Okay tell me with the words. Go ahead tell me what 
you were starting to do. Put it up here. Woody, yeah yeah right. So tell me. Woody. 
That's good, that's really very good. Hey, what's going on here? Tell me. Put them all 
back. Now tell me. Gumby, yea. Very good, thank you so much. Okay very good. 

Slide 65:

The next thing we're going to discuss is how to get an individual from the scene cue level 
to the element cue level. Just like Emaan's clip transitioning from the dynamic to the 
static what we do is present the most abstract type of representation which would be the 
element cues and fade back to the static cues as needed.  Regan is eighteen years old, and 
is responding to routine based familiar directions, he communicates using speech, and 
frequently exhibits echolalia. He communicates a lot physically using gestures to indicate 
requests. So this is an example, Regan's been working with the static scene cue level for 
several weeks and we're just beginning to present him with element cues.

Slide 66:

 Video: Regan

Meghan: Okay Regan, can you put the man behind the cup?
Regan: The man.
Meghan: Yup, the man behind the cup.
Regan:  The man in the cup.
Meghan: Yup. We're going to do behind. So, the man behind the cup. The man behind 
the cup. Like this. Perfect.
Regan: Perfect
Meghan: Yup. Behind the cup.
Regan: In the cup. Behind cup. 
Meghan: Put the ball in bag. Ball. In. Bag.
Regan: Ball in bag. 
Meghan: Yup, perfect. Good job. Can you put the girl on the block?
Regan: In the block.
Meghan: Girl on the block.
Regan: On the block.
Meghan: That's right you put the ball on the block. I want you to put the girl on the 
block.
Regan: On. On block.
Meghan: Yea, you put the girl next to the block. I want you to put her on. Like this, 
Regan. Girl on the block. We'll do the kiss next. Put the girl on the block. First do this. 
Good. Girl's on the block. Yea. 
Regan: Block. On the block.
Meghan: That's right. We're going to do on again. But, this time we're going to put boy 
on the ball. Boy on  ball.
Regan: Boy. Boy. Boy on the ball.
Meghan: Very good, just like that. The boy's on the ball. Good Regan. Boy on the ball 
okay. Can you make. Can you put the man on the ball?
Regan: The man on the ball.
Meghan: Yeah, can you put the man on the block?
Regan: On the block. On the block.
Meghan: Very good. Now put the woman on the block.
Regan: Woman. Block. Woman block. Woman on. 


Slide 67:

We're finding it's challenging to transition from the scene cues to the element cues so 
currently what we're doing is introducing something called a mixed display where we 
have the static scene cue paired with the element cues to really point out the associations 
between the two types of visuals.

Slide 68:

Progressing from the dynamic scene cues to the static scene cues tends to be relatively 
easy in terms of our observations to date. The transition from static scene cues to element 
cues is relatively challenging. But we would hope that the payoff is worth it because we 
want to build the foundation for generative language. And our ultimate goal is for 
learners to combine these language element cues with their knowledge of semantic 
relations for generating novel sentences for requesting, directing, commenting, and 
asking questions across a variety of settingsÑat home, at school, and in the community. 

Slide 69:

This is an example of how we would combine those language elements in a 
conversational display in a more naturalistic manner.  Conversational displays are also 
known as a topic displays, which is a communicational grid display arranged by agent, 
action, and object. It can be either electronic or non electronic. Typically a lot of our 
conversational displays that we're using consist of removable symbols with accumulator 
window. So the learner can observe how the elements combine to generate full sentences. 
When we're using conversational displays we're using a lot of modeling of the 
utterances. We're using two way interactions to promote back and forth communication 
between the learner and mentor. We're using these displays during highly motivating 
activities with the child or adult we're working with who might be motivated to 
communicate during playground, bubbles, swimming, etc. Instruction may begin with a 
series of object elements Ð so preferred objects that the learner is requesting, and we 
would gradually add action elements and agent elements as the learner is successful. 
Finally, we would add adjectives, prepositions, and comments. 

Slide 70:

This is an example of a conversational display for a bubbles activity. Agents are on the 
left, we have actions here, attributes, prepositions, and then comments at the end. And 
our accumulator window is at the top. 

Slide 71:

This is an example of using a conversational display. This is Charlie; he is three years 
nine months old. When this clip was taken he was speaking primarily to request and he 
had been introduced to a Picture Exchange Communication system for requesting. This 
clip demonstrates how we can use visuals to get these kids directing and commenting and 
communicating for more pragmatic purposes. 

Slide 72: 

Video: Charlie

Meghan: Charlie. This is Charlie. Do you want to pop or do you want to blow?
Charlie: Blow.
Meghan: Blow. I want to blowÉ
Charlie: Bubbles
Meghan: Bubbles! Okay! Blow bubbles. Whoa that was a big one! Okay it's my turn. It's 
Meghan's turn. Meghan's turn. Meghan. Meghan. Blow. Big. Bubbles. Let's read it 
together. Meghan blow big bubbles. Okay get ready, are you going to pop it? Whoa was 
that a big bubble? Do you want another one? Another one. Whoa! Whose turn is it now? 
Bubbles. More bubbles. Is it Charlie's turn or Meghan's turn? Meghan's turn. Is Meghan 
going to pop or blow?
Charlie: Blow
Meghan: Blow 
Meghan: Little or big.
Charlie: Big
Meghan: Meghan blow big bubbles. Here they come. Whoa they popped in your face. 
Okay Charlie I'm going to let you move the pictures now. You tell me what you want to 
do. Okay can you sit up? Okay. Whose turn? Show me. Bubbles, move it up here. Good 
job, bubbles. Do you want to blow or pop? 
Charlie: Pop.
Meghan: You want to pop. I want to pop the bubbles. That's right. Where's your popping 
finger? Where's that finger? There it is. Pop those bubbles Charlie. Pop them. They're 
everywhere. You're popping them! Good job. Hey Charlie watch this one. Let's make the 
bubbles go up. Bubbles up in the air. Go up! 
Charlie: Up
Meghan: Up! Are you ready? 1, 2É up! Bubbles. Wow!


Slide 73:

So that's an example of modeling expansion and enhancing the linguistic complexity of a 
child's message. 

Slide 74:

Now I'd like to go back to the challenge I was speaking about earlierÑtransitioning from 
static to element cues. We're finding that not only are individuals with Autism Spectrum 
Disorder experiencing difficulty reading these cues but also typically developing children 
who aren't yet literate are experiencing difficulty. So in this video clip you'll see a 
typically developing five year old who is not yet reading, and she's having difficulty 
understanding, should I read the symbols from right to left or left to right, and a lot of the 
individuals we're working with are having difficulty inferring the meaning of the action 
element and the prepositional element that's at the center of these phrases. 

Slide 75: 

Video: Skylar

Meghan: You do it. Do this. Put together the sentence--The cow pushes the ball. Nice. 
Good working. Alright I'm going to take this back and we're going to do one more like 
this. I'm going to give you. Do this. Good for you. Very good! Do you want a break?

Slide 76:

As Meghan indicated the moving from the scene to the element cue is very challenging 
and if it was easy we would have done it long ago because we had these preposition 
representations and action representations from Mayer Johnson and other symbol sets for 
some time. We're trying to understand a way of making that happen and how to do it 
better. We're looking at typical three, four, and five year old children to help us explore 
that question. And we're doing it with language. If I say to a typical five year old with 
language, have the ladder push the ball, they're going to get it. But if I try to introduce it 
just using visuals. Placing things as Anna was doing in the video it becomes more 
difficult. It begins to help us understand the difficult that individuals on the spectrum who 
also have difficulty with the language have. In light of that, so we're using what we call 
buildable displays, we're also looking at the use of typically developing children as 
models. We don't believe that the symbols that do exist to represent prepositions and 
adjectives are quite right so we are trying to develop better ways of creating elements. 
The prepositions and the action in order to give us a better ability for the child to 
understand that relationship between this isolated symbol and how it's related to the 
beginning of the sentence and the end of the sentence. It's difficult. We're going to 
continue to do thatÑtrying with typical children and also in our therapy situations. 
Trying to have a clinical model at our center so we can better understand how to solve 
this very challenging problem. We think it's the holy grail in terms of teaching language 
concepts. If it was easy it would have been done long ago.  So we think we have a 
beginning. We have a scope and sequence that seems to make some sense and we're 
going to be taking our research to explore and report on it so we can tell you about it.  
And of course we're trying to get generative language with our PECS program which is 
very effective for very early communication but it isn't enough. It sort of puts a ceiling 
on how far you can go. And a speech language pathologist certainly needs to understand 
that PECS is a good beginning but we need to go way beyond that and not just creating 
static, robotic, the same kind of sentence for wanting everything. We really want to teach 
a generative language and we really believe that that is a direction that we as a profession 
need to take. 

Slide 77:

Thank you slide

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