At ABC Center Singapore, we have helped many children with autism to learn to talk. In this newsletter, we celebrate how Madhu*, a 5 year old boy who has been with ABC Center for the past eight months, has been learning. Previously, he mostly echoed words and sounds. Now, he is speaking and beginning to form sentences. We interview Ms. Jiwon Kang, M.A., BCBA, a Senior Behavior Analyst at ABC Center Singapore on this experience.
Ms. Jiwon Kang is a US-trained, Board Certified Behavior Analyst(BCBA) who has worked in this field for over a decade. Her clinical research has been presented at the Association for Behavior Analysis International (ABAI) and the European Association for Behavior Analysis, and published in the Asia Pacific Journal of Inclusive Education and the Journal of Special Education.When Madhu joined ABC Center Singapore, what was his skill level in speaking?
JK: When Madhu joined ABC Center, his speaker skills were significantly lower than his age. He was already 4 years old, but from a clinical standpoint, his speaker skills were emerging at level 1 — equivalent to age range of less than 2 years old.
He communicated his needs mostly by grabbing items with his hands. He could echo some sounds and words, and say the names of 6 different items such as food items, but he would not use this to communicate. If you asked him, ‘What do you want?’, he could not consistently answer this vocally.
If Madhu’s speech ability was low, how was he communicating?
JK: He mostly communicated his needs by grabbing or walking over to the item. Because he could not fully tell us what he wanted, sometimes Madhu would get frustrated, sometimes whining or lying on the floor when he could not find the items he wanted or when he needed help.
Can you describe the program you created in order to help Madhu?
JK: At ABC Center, the Individualized Learning program I created for him focused a lot on speaker lessons. We prioritized the words for him to learn, and systematically worked through these. We provided him with a lot of opportunities to successfully communicate. We also made sure that his reward for saying the words correctly was very strong so that he was motivated.
At ABC Center, our staff are well-trained in speaker lessons. We make sure that all proper protocol are followed. For instance, during the lessons, we make sure prompts are given only when necessary in order to make the child more independent.
What were the first words you taught him?
JK: Grapes, Rice, Beans were the first few words we taught him. He loved these, particularly, his grapes for snack.How do you motivate a child to speak? For Madhu specifically, what motivated him?
JK: We have a very clear method for teaching children to learn to speak. One of our techniques is to ensure that the child is properly motivated, by using reinforcers (or rewards) that the child really likes. For Madhu, he liked food, as well as different types of toys, including musical and tactile toys.
At ABC Center, our staff are aware that children could lose interest in certain rewards quickly. So, we have a process to take note of this, and to adjust quickly to the child. Madhu, for instance, would play with various types of toys and not all were equally rewarding for him. Therefore, a variety of reinforcers were prepared prior to conducting his lessons.
How did you progress from these first lessons on individual words – to eventually speaking more completely?
JK: That is another part of the Individualized Learning Program that I created for him. Being able to plan the sequence of lessons properly is important, so that the child learns quickly. We started with teaching him to say the name of the item he most wants, like ‘grape’. Then, we have to properly plan when to introduce the next words, while retaining knowledge of the first ones he has learned. There is a proper sequence to do this, including when and how to review previously learned words.
Eventually, we encourage him to put it into sentences, like ‘I want grape’. Similarly, this has to be properly planned so that he retains knowledge of previous words, while learning this sentence structure.
We also progressed his rewards. From using food and toys as rewards for a job well done, we have progressed to other rewards, for instance, giving him a well-deserved rest or play time.
At ABC, our Board Certified Behavior Analysts use their expertise to properly progress the lessons to make it optimum for the child.
How did you ensure your staff were teaching Madhu’s lessons well?
JK: At ABC Center, all our staff, and all our children’s lessons are supervised all the time. In fact, we have dual-level supervision – with Lead Technicians supervising our staff, and the BCBA’s (Board Certified Behavior Analyst) supervising and analyzing the child’s progress and continually adapting his program. This is part of our strict quality control and this has allowed us to give the best results we can for the children.
How quickly did Madhu progress? Did he meet or exceed your expectations?
JK: Indeed, Madhu has progressed quickly. He joined ABC Center Singapore in June 2016, and just like all children, we created a one-year lesson plan for him. But he progressed much faster, and we added four new lessons on top of his original plan by October 2016, and then we added a fifth new lesson in November 2016.
Why do you think Madhu’s program worked? What did ABC Center do to enable it?
JK: This is really a combination of multiple factors. First, it is the individualized lessons that a Board Certified Behavior Analyst creates for him. This is the strong foundation that is the basis of success. Then, at ABC Center, we have very strict supervision and training of all our staff in line with our USA standards. This makes sure that each lesson is done as accurately as possible. Then, most importantly, there is the important role of Madhu’s parents. They were very motivated to help Madhu.Center Singapore. From a child that used to just echo words and say only 6 words, he is now able to request for 50 different items, and some of these items using full sentences. The good thing is that Madhu is also able to generalize his skills across different items, and different people by saying “I want __(the item he wants)” even though he is not directly taught using the specific item. This is a great skill that Madhu has learned.
What are you working on as his next goals in communication?
JK: Our next goal for him is to continue with speaking in more sentences. We also want him to begin more intraverbal skills (being able to do more question and answer responses), as this is important for conversations. For instance, he is now learning how to complete various different fill-in-the-blank phrases (e.g. “You sit on a ___,” & “Happy birthday to ___”) or answering a few different simple questions such as his name and age.
We are really excited by Madhu’s progress. From a child who used to just echo sounds, he is now able to express what is on his mind, speak in a few (simple) sentences, and is beginning to engage in simple question -and-answer conversations. We look forward to seeing him progress even more and more.
Coming up in our next Newsletter (Mar / Apr 2017): A Child with Autism Learns to Speak (Part 2): Parent’s Perspective
*All children and parents’ names and photos are changed for confidentiality purposes.