The Scerts Model a framework for working with children with social communication disorders and delays- including autism spectrum disorder By Marla Bosch M.A.SLP © R-SLP Speech Language Pathologist August 2014 The SCERTS Model The SCERTS® Model Collaborators Barry Prizant, Ph.D. Amy Wetherby, Ph.D. Emily Rubin, MS http://www.commxroads.com/ Amy Laurent, Ed.M, OTR/L Objectives of presentation Review of the neurology of social disorders including ASD. To introduce the key elements of the SCERTS framework To show how the SCERTS framework links with ASD and social communication disorders. AND Hitting the ground running! Working together as a team to provide the Supports needed for our children to be socially and emotionally ready to learn. The SCERTS Model Scerts: Is a lens to support the assessment and programming framework for children with autism and/or developmental needs. Acknowledges that most learning during childhood takes place “…in the social context of daily activities and experiences” - therefore everyday, natural routines in the home and early childhood setting are used Acknowledges that caregivers and familiar adults play a critical part in supporting a child’s learning. The first step: Understanding social communication disorders and ASD Children with a diagnosis of ASD have delays or difficulties in: the development of communication the development of social relationships play and imagination Many young children with ASD under- or over-react to sensory information… why? . The role of the brain: Social motivation theory of Autism Children with disordered social language show physical neurological differences in the way they process social stimuli. When neurotypical infants look at peoples faces, regions in the limbic system “light up” with endorphins and intrinsically reward that child. MRI demonstrates that children with ASD process objects in the same way that their neurotypical peers process social stimuli. The Social Motivation Theory of Autism http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329932/ Social motivation models of ASD posit that early-onset impairments in social attention set in motion developmental processes that ultimately deprive the child of adequate social learning experiences and that the resulting imbalance in attending to social and non-social stimuli further disrupts social skill and social cognition development. When we are not biologically motivated to seek social relationships, our skills diminish due to lack of experience and practice. The neurology of social competence By 6 months of age, a child begins to follow gaze and can recognize when they have lost a caregiver’s attention. A neurotypical infant will show distress when a caregiver’s eyes shift away. The neurology of social competence By 10 months of age, a child begins to shift gaze from a caregiver to objects of reference to predict and anticipate the actions of others. The neurology of social competence By 12 months of age, a child will initiate shared attention on desired items or items that are of interest to the child. http://autismspeaks.player.abacast.com/asdvideogloss ary-0.1/player/autismspeaks (social interaction typical video) The neurology of social competence The social motivation theory… these capacities ensure that a neuro-typical child: is drawn toward social vs. non-social stimuli, derives pleasure from this engagement, notices attention shifts of others, initiates bids for engagement, actions, and objects of interest Practices ways of getting MORE social attention… they become skilled. Unique neurological differences in social communication development in ASD Children with Autism Spectrum Disorder (ASD) show limited neural sensitivity to social stimuli and tend not to look toward people’s faces. Children with these vulnerabilities tend not to look toward others or tend to look at the mouths of the speaker. Limited shared positive affect is an early indicator of these differences. Children at risk for ASD miss gaze shifts between people and objects. They have difficulty predicting actions and initiating bids for engagement. http://autismspeaks.player.abacast.com/asdvideoglossary0.1/player/autismspeaks (on website: social interaction #3 ASD and both for #6) (And repetitive behaviors and restricted interests #2) Unique neurological differences in social communication development in ASD Similarly, when neurotypical children hear speech sounds, these are processed as social or intentional stimuli, while children with vulnerabilities simply hear sounds, making the intentions of individual words more ambiguous. Individuals with social and emotional vulnerabilities may process social stimuli (e.g., faces, speech sounds) in regions of the brain typically reserved to process images and sounds that are non-biological. This makes predictions of actions, intentions, and emotions less efficient and more intellectual. Shape video: http://www.youtube.com/watch?v=n9TWwG4SFWQ Unique neurological differences lead to… Secondary challenges or what have previously been referred to as “Autistic Behaviors” arise as a result of a history of repeated failure with social interactions & a limited repertoire of conventional strategies for coping with these challenges. As well, children with ASD also frequently present with developmental delays in speech and language and physical skills. Remember: all behavior serves a function. For example, self regulating behaviors such as head banging or spinning: child may be trying to achieve endorphins that they do not get from social engagement. Lining up buses on the carpet? The child may need to be soothed by visual rhythm. Temple Grandin Templin Grandin Video: http://www.youtube.com/watch?v=XcWx8UVhzpQ Essentially, three primary characteristics are recognized as defining autistic spectrum disorder (ASD): 1. deficits in social interaction 2. deficits in communication 3. restricted repertoire of interests and behaviors Developmental Dimensions Addressed in SCERTS 1. Social Communication (SC); two core challenges have been identified : a. Capacity for joint attention b. Capacity for symbol use 2. Emotional Regulation (ER) a. Self-regulation b. Mutual regulation 3. Transactional Support (TS) = The IPP for the educators and families a. Interpersonal support b. Educational and learning supports c. Family support SCERTS Core Values: 1. Development of spontaneous, functional communication abilities and emotional regulatory capacities 2. Principles and research on child development frame assessment and educational efforts. Goals and activities are developmentally appropriate and functional. 3. All domains of a child’s development (e.g., communicative, socio-emotional, cognitive, and motor) are viewed as interrelated and interdependent. Assessment and educational efforts must address these relationships. 4. All behavior is viewed as purposeful serving a variety of functions (e.g., communication, emotional regulation). For children who display unconventional or problem behaviors, there is an emphasis on developing a range of supports for emotional regulation. 5. A child’s unique learning profile of strengths and weaknesses determines appropriate accommodations for facilitating competence in the domains of social-communication and emotional regulation. 6. Natural routines across home, school, and community environments provide the contexts for learning and for developing positive relationships. Progress is measured in daily experiences and routines. SCERTS Model: The SCERTS curriculum guides the SCERTS Assessment Process (SAP) and is: designed to yield a developmental profile consistent with the child’s functioning in natural environments and involves direct observation of child in natural activities and settings. The primary domains of SCERTS address these priorities: SC - Social Communication; Supporting a student’s ability to communicate, comprehend, and collaborate with others. ER – Emotional Regulation; Supporting a student’s ability to cope, make transitions, and actively engage in the classroom TS – Transactional Support; learning accommodations and curriculum modifications embedded in the natural environment to foster SC and ER **We always keep in mind developmental progression and neurology when we create activities/programs and work towards outcomes** Reviewing the challenges of SC and ER for a child with a social disorder SC - Social Communication; students with ASD show limited initiations, difficulty with social forms of language, and limited understanding of social norms and perspectives, ER – Emotional Regulation; Difficulty predicting that others are a source of engagement or support leads to both underarousal and over-arousal; this, paired with limited ability to learn how to cope from others leads to unconventional coping strategies. TS – Transactional Support; the “invisible” nature of ASD makes it difficult for communicative partners to recognize the need to externalize one’s thoughts and create accommodations. SCERTS Social Communication • The goal for all children is to become competent and confident communicators so they can be part of social activities and learning • Children who communicate effectively have more opportunities for play and learning and are more able to enjoy social relationships SCERTS communication stages The Scerts program and assessment is based on the child's communication stage: Social Partner – the child may or may not communicate intentionally using gestures and vocalisations Language Partner – the child is communicating using words, gestures and/or symbols Conversational Partner – the child uses words, phrases and sentences. They are learning about conversations (SC) Social Communication Goals are targeted in Joint Attention The ability to share attention, emotion and intention with others Symbol Use The ability to understand and use objects, pictures, words or signs SCERTS: (ER) Emotional Regulation the ability to attend to, process and filter environmental and sensory information the ability to stay focused, engaged and being able to adapt to different situations When children are emotionally well regulated they are ready and ‘available’ for learning Frequently observed coping strategies or signs of dysregulation in children with ASD Mouthing or chewing on objects or fingers Holding or hording familiar and comforting objects Toe walking and rocking/ Hand flapping Humming or sub-vocalizing Avoiding eye contact Turning away, bolting, or removing oneself from a distressful situation Use of scripted language, delayed echolalia & repetitive questions (e.g., “what’s next,” don’t touch me”). Emotions expressed through echolalia, as opposed to emotional words. Preoccupation with specific topics or areas of interest Adherence to sameness, rigidity in following “rules, inflexibility Emotional Regulation Mutual regulation – the child’s ability to seek support from others to help them regulate Self regulation – strategies used by the child to self regulate Emotional Regulation 1. Helping your child regulate emotions video. http://www.autismspot.com/videos/Understanding-Feelings-and-HowRegulate-Emotions 2. Occupational Therapists are excellent resources to help us understand emotional and sensory regulation. 3. CARC: Zones of Regulation in November 2014! In a nut shell: To ensure a child's active engagement, there is a strong emphasis on preventing problem behaviors that interfere with learning and the development of relationships. Families and educational teams learn about essential interpersonal modifications, environmental arrangement, and visual supports and how they can be embedded in natural, functional, and meaningful contexts. SCERTS Transactional Supports are: • the planned supports and strategies that are used to help the child participate and learn • the supports and strategies used when working on the child’s goals in Social Communication and Emotional Regulation • support to families and to the team Transactional supports are often referred to as the “adult” goals T ransactional S upport Transactional Support: the planned supports and strategies that we use to help the child participate in social interactions and everyday activities AND the planned supports that we put in place to help us support each other Interpersonal support Support to families How the communication partners (adults and peers) adjust their language, interaction styles and how they provide models of play and behaviour The SCERTS framework recognizes that the needs and priorities of caregivers and change over time as they learn more about ASD and how they can support their child. Interpersonal support goals A family support plan includes: work across all the child’s goals in social communication (SC) and emotional regulation (ER) Educational/learning supports such as provision of information and resources. Coaching/modeling of strategies to facilitate the child’s development include the partner responding to the child’s signals, encouraging interaction with peers and setting the stage for engagement Emotional support such as facilitating partnerships with other services as needed and helping the parent learn skills to cope with the challenges Learning support Support among professionals The environment, routines and activities are structured to encourage social communication and emotional regulation Children with ASD are challenging at times to work with and professionals also need to be supported through professional development and learning, as well as being available to support each other emotionally. Learning support goals A professional support plan includes: work across all the child’s goals in SC and ER include visual supports and adaptation of activities to meet the child’s Educational support such as team meetings, attendance at workshops/seminars Handout 1.4 Professionals need to be flexible, responsive to changes, and respect decisions made by the family Emotional support such as informal discussion, supervision and mentoring arrangements 1 Transactional Support includes Interpersonal Support - the strategies used by adults when interacting with the child e.g., using gesture. Learning Support – the environment, routines and activities are structured to encourage social communication and emotional regulation, e.g. modifying an activity to ensure success for the child Examples of Interpersonal support (The “Hanen” strategies of your program!) An adult partner needs to be responsive - notice and respond to child’s attempts to communicate foster initiation - offer choices at the right level set the stage for engagement - be at the child’s level (nose to nose) adjust the amount of language used - use simple sentences model appropriate behaviour Repeat repeat repeat Examples of: Learning supports Structured activities e.g. clear beginning and end to the activity Visual supports - to organise the day Sensory Supports Using motivating toys and activities Adjustments to activities so that the child has success Start small! Look at how far you have already come! There are lots of great Supports in place! By identifying the gaps and breakdowns in a child’s SC and ER during our daily routines… we have a place to start. Trying to “throw in “ visuals or to panic and re-work entire routines is not the answer. We start with ONE routine or SKILL or OBJECTIVE at a time, look closely at what transactional supports we can provide… and then jump in! This is not an overwhelming process… but more a LENS to look at ways we adjust and support a child based on their social and emotional needs. We accommodate. They learn! A Review of Transactional Supports used in classroom settings for SC and ER. Universal Transactional Supports: Songs: Most children do great with songs allowing us to use them in a variety of ways. We can use songs to help them transition from one activity to the next such as a “Clean Up Song”, “A Sit Down Song”, “A Line Up Song” and more. We can use songs to help us learn about Pre-Literacy and Early Math Skills such as: “ABC Song”, “All The Letter’s Make a Sound Song”, “The Numbers Rumba”, “Five Monkeys Jumping on the Bed” and more. Phrases: Using the same phrases each time you do something specific is a wonderful Transactional Support. “Give me 5!”; or “Eyes on me” Routines: All children learn by using routines. We use routines throughout our whole day. Sticking with the same routine and using the same phrases will help your child not only understand but also communicate. Visuals: daily schedules, Help Boxes… etc etc etc… Visuals are amazing tools for every child. Classroom Based Transactional Supports to help with emotional regulation: With the use of various transactional supports and a progression of teaching for both understanding and expressing of emotions. 1. Describe your child’s emotions at specific times (“mad……Bobby is mad!”) 2. Teach your child methods for expressing this emotion in a functional manner and/or coping with this emotion (“mad…….take a break” or “happy….sad I’m happy!”) 3. Describe your child’s emotions during a day (“..Bobby feels sleepy”) 4. Describing others’ emotions (“Daddy is happy!”) 5. Teaching your child that his/her actions affect your emotions (“Bobby jump on sofa…. Mommy sad”) Some Fun Transactional Supports: 1. Emotion word picture symbols 2. Coping strategies picture symbols 3. Songs such as the “Feelings Song” 4. Feelings charts Sensory Supports We all needs ways to help integrate our sensory systems and to help our neurological systems take in the environment around us. Sensory integration is very important for children with autism in order to help them be at their optimal emotional arousal level for learning and engaging socially. A great way to help your child with their sensory needs is to engage in sensory times throughout your day. Your OT will be an excellent resource for helping to determine the sensory needs of a specific child. Often a child’s needs will change based on many factors including: familiarity of routine, the activity itself, partners, mood, time of day, etc. Sensory Activity/Requesting Pages: These pages can help our children request the type of sensory input they want and where. This gives the child awareness and ownership towards their sensory needs. This will help them use their language to ask for a sensory break in replacement of sensory-seeking behaviors. You can place pages like this in plastic sleeves and in your sensory folder or binder. Point to the pictures as you talk and engage in sensory activities with your child. Help your child call your name, request more and request the specific body part. a. “Tickles”: can be used with a massager toy or without b. “Scratches”: we all love a good back scratch! c. “Brushes”: can be used with a sensory brush d. “Squeezes”: for deep pressure can applied by your hands Sensory Time Schedule Pictures and Labels: create your own “Sensory Time” symbols with Boardmaker. You can create your own, laminate them and then use them to add to your child’s visual schedule, to label an area in your house and/or to label bins of sensory objects and toys. Also work on your child using the language and requesting the language. Classroom idea: a new way to look at the rice table! Sensory Boxes: Using sensory boxes throughout your day is also a great way to help your child emotional regulate. Using a plastic container and then fill it up with: water, sand, dry rice, popcorn kernels, dry beans, etc. You can then add in scoops, shovels, animals, funnels and more. Playing with a sensory box two to three times a day is a great way to help bring your child’s emotional arousal level down. Play Doh: Playing with Play-Doh is another way to help regulate your child’s great emotions. Using Visuals We as adults all rely on visual helpers every day. We use calendars, day timers, street signs, grocery lists, maps, and so on. Using visual cues in our environment allows us to plan, organize, and most of all be independent. Visuals are equally important to children because they are just beginning to learn how things work in the world. Why do visual supports make it easier for children to understand and communicate? • • • • • Words “disappear” right after we say them, visuals hold time and space. Visuals direct attention to themselves and hold attention. Visuals allow more time to process the information. Visuals assist in remembering. Using the same words every time a visual is shown, teaches your child those words. Anything we see that helps us with communication by giving us information with our eyes is a visual support. The type of visual that works best with each individual child depends on what is meaningful to the child. The most widely recommended visuals are those that are used to provide children with information. **Visuals increase independence! We are Independence Facilitators! Visuals can be presented in several formats, depending on your child’s level of understanding. Ranging from most concrete to most abstract, possible visuals are: Objects – this would be considered the first level of visual representations and would include the actual objects (e.g., for some children, seeing a sandwich in their parent’s/teacher’s hand tells them “it’s time for lunch.”) Colour photographs – this would consist of coloured photographs of the concrete objects (e.g., for some children being shown a photograph of a bus means “we’re going to daycare” OR “we’re going home”) Black and white photographs – this level would consist of the same photographs but in black and white Colour line drawings – these are picture symbols that are often used with children who are able to understand at this level of abstraction Black and white line drawings – these are also picture symbols and serve the same purpose as coloured lined drawings Miniature objects – these are smaller versions of the objects Schedules help alleviate your child’s anxiety and improve your child’s understanding and cooperation Schedules provide your child with information about: • what regular activities are happening that day • what is the sequence of events to come • what new activities will occur • what is not happening • when it is time to stop one activity and start another Which Visuals to Use • use a maximum of six or seven visuals in the sequence • identify times of the day which are noticeably different from each other (e.g., when location changes or when activities change) • choose symbols that are general enough that they cover the range of possibilities for the activity (e.g., “lunch time” rather than a specific food) • label pictures with the exact words that you and others will use to refer to the activity Where to Put a Schedule • mount in a visible place where the schedule can be referred to easily (e.g., at their classroom desk, in your child’s bedroom) keep it accessible for your child to refer to on his own How to Use a Schedule choose a specific time(s) of the day where you can go over the pictures on the schedule with your child and name the pictures in order remove each picture once the activity is completed (e.g., snack time is finished) show the picture of the upcoming activity especially if your child does not wish to change activities (e.g., tidy up, then go outside) show changes in the regular routine by changing the pictures and describing the change (e.g., no daycare, today stay home) Choice Boards provide information about what options are available may be used to broaden your child’s play interests prompt your child to make a request or choice clarify spoken language How to Use Activity Choice Boards: • if using the choice board to expand your child’s play interests place some pictures of activities that he does not usually choose • if you are trying to encourage your child to make a choice independently, place pictures of activities or toys that he already likes and a picture of a non-preferred activity — • to ensure that he is making a choice start by placing 2 pictures of possible activities your child may choose from on a board and gradually add more pictures your child may indicate his choice by vocalizing, verbalizing, or gesturing give your child the indicated choice (e.g., activity, object, food) immediately to reinforce having made a choice Visual Picture Schedule- a process: So at the beginning, you may have a morning schedule with a new picture for each activity “boots off”, “lunch kit out” coat on hanger”. Once your child understands this routine and uses the language, then it is time to make a change. You can use a “morning time” picture (representing the entire routine) instead. Once the child understands and uses even more language, you may move to a schedule where the pictures are smaller but the words are bigger to increase preliteracy development. The next step would be to move this schedule into a small binder like a “Day Planner”. The following step would be to move it to a written schedule with small pictures next to the words. You could even have your child write/trace the words each morning. The main goal would be moving them to a day planner. We all use day planners and most schools start using them in first or second grade so you are preparing them for a life of organization. A beginner schedule with more detailed steps -Moving from actual photos to picture symbols. Visuals for Turn Taking! Visuals for sharing Visuals for getting through the tough stuff: FIRST/THEN Task Scripts can be used to further support an activity after a transition By breaking the task into visual steps Visual Activity Boards If you use visual activity boards at home, you also want them to change as your child makes progress. A great example would be a Play-Doh® activity board (one of our favs). Your first board may have your color choices and a few actions like “open, roll, cut”. Then once your child is understanding and using these requesting words, you may want to add some prepositions such as “in, out”. With activity boards, it is limitless. You can add words to work on higher requesting skills like, “Mommy I want more purple Play-Doh® please” or words focusing on commenting such as, “like, cool, don’t like, favorite, wow”. Again there are endless possibilities depending on your goals for your child. Couple examples of Play-Doh® activity boards: Making choices: Within art you can work on making choices about what art to do and then making choices for items within your art project. Such as “finger paints or water paints” or “green or red.” Show your child the picture of finger paints and water paints and say “finger paints or water paints” if they don’t make a choice then take their finger and point to one and say it. Then play it. You can do the same with colors choices. Remember if you don’t have a picture for it then you can use the actual objects. Time based schedules A schedule with multiple school events with increased text size and decreased picture size Visuals can even be used for Play plans! Song choices! Subject + verb + noun Visuals: Visuals used to target vocabulary growth, sentence structure, and to increase expressive language- requesting and commenting. A written Schedule Universal Supports: All behavior serves a function: at the heart of SCERTS Q: How did your thinking about autism change in the course of the developing the SCERTS Model? Old: focusing on each child's stereotypical or repetitive patterns of behavior and considering these behaviors to be central to their disability. We neglected the function that they served for the child, simply discarding them as "autistic behaviors." NEW: I now see many of these behaviors as an artifact of each child's drive to cope with predicting the actions of other people, social expectations in less predictable environments, and making transitions. NEW: Many children with autism are coping with a heightened degree of stress and have developed repetitive, soothing behaviors as coping behaviors. Old: I used to ignore or discourage these behaviors New: I have learned to understand their function, change my behavior in an effort to prevent these behaviors, and model replacement strategies that may be more socially appropriate and more effective. A review: Developmental Dimensions Addressed in SCERTS 1. Social Communication (SC); 1. What level is my child communicating? (Social Partner Stage/ Language Partner Stage/ Conversational Partner) a. Capacity for joint attention b. Capacity for symbol use 2. Emotional Regulation (ER) a. Self-regulation b. Mutual regulation 3. Transactional Support (TS) = The IPP for the educators and families a. Interpersonal support b. Educational and learning supports c. Family support t d i The team can use SCERTS to: • assess the child’s strengths and needs in the areas of social compentcy and emotional regulation. • set goals for the child in social communication and emotional regulation for home and the early childhood setting • plan activities that are meaningful and purposeful, at home and at the early childhood setting • provide a balance of free play and structured activities. • identify the transaction support the communication partner will use (the adult goals) • monitor a child’s progress • ensure that we share successes and challenges and support each other • Allow the child’s behaviour teach you what is working and what isn’t. • **The Full Scerts Program is recommended, as is a 1-3 day training. • www.scerts.com This powerpoint as well as the following SCERTS assessment and planning sheets will be available through CARC website. 1. What is my child’s developmental stage? (handout) 2. Set our objectives for this child- in areas of Social Communication AND Emotional Regulation (handout on Frequently used Objectives and Supports). 3. How will we accommodate these objectives? What will our transactional supports look like? (Handout: Practice Principles for Success) (Handout: Educational Planning Grid) 4 Also posted: emotional key ring; several visual activity boards, and a first- then visual. My email: email@example.com “When you change you way you look at things, the things you look at change.” Wayne Dyer When children engage in more challenging behaviors, I have learned to move beyond the simplistic response of ignoring these undesirable behaviors to a more humbling process of recognizing that the antecedents may lie in my behavior, a variable that can easily be changed. For example, had I provided a clear and predictable end point, motivating and meaningful materials, and visual and organizational supports, the child may not have engaged in that challenging behavior. I also have learned that these moments of challenging behaviors present clear teachable opportunities for us to model emotional expression and appropriate coping strategies.