Brittany Barrios  

Dear Angie

A parent’s choice in the beginning of a child’s life is one of the most important aspects in a child’s development. It may be terrifying that parents could make the wrong decision. However, parent’s become more concerned when they find out that their child has autism. Some of the parent’s do not know what to do in this situation while others do.  When the parent’s go out looking for the help they need, parents get caught in an obstacle of finding the right doctor to help them. Every child is different, and  that is why it is so important that the doctor has gone through specific training to be able to help every autistic child that walks through the hospital door.  Every child is different and the severity of each child varies.

So when you are deciding which doctor to send, please make sure that they know how to approach the situation. Autism signs and symptoms vary from communication difficulties, repetitive behaviors, seizures, etc. For more information as to why it is so important that the caregivers working with an autistic child go through special training, here is a study and a paper on its importance,  “The Role of Training in Developing Services for Persons with Autism and Their Families” . It’s understandable that parents already have to learn to adapt. So why should the doctors and caregivers continue to give them a hard time? The fragile child should not be jumping from doctor to doctor either. Once that perfect doctor is found, they will grow more comfortable and learn to prosper from being autistic.

Thank you for your time.

Sincerely,

Brittany Barrios

A parent’s job and responsibility is to be able to care for and love their children. However, things may become complicated after learning that their child is diagnosed with autism. Parents fear the worst and see the negatives for their children. One of the signs of having an autistic child is the presence of a speech impediment. To help, therapy is one of the best decisions a parent could make. Therapy can be very beneficial, and throughout the years therapists have been conducting studies to determine what is the best technique to use during their sessions. To improve a child’s outcome, therapists have explored different environments, settings, the people who attend the sessions with them, and different materials to engage children. There are two specific techniques that therapist focus closely on, when they teach autistic children how to pronounce words, analog and naturalistic. Analog uses the stereotypical teaching, meaning that the child practices the word until they are correct and is reinforced with a treat. In naturalistic setting, the child learns outside the therapist’s office, the word that the child needs to learn will come out of interest. After conducting several studies, therapists should use the naturalistic technique as opposed to the analog technique.

Brief Explanation and Procedure of the Study\

A study was conducted by Robert L Koegel, Stephen Camarata, Lynn Kern Koegel, Ayala Ben-Tall, and Annette E. Smith. In this study they tested the two different techniques, naturalistic and analog, to see which method would be more beneficial to a child that is autistic and has a speech impediment. There were five children, four boys and one girl, and ranging from the ages. Each participant went through both techniques, either the naturalistic or analog first; no matter the order. Both sessions were conducted twice a week and lasted for forty-five minutes and a parent or guardian were also present.

Table I. Differences Between the Analog and the Naturalistic Condition

Analog                  Naturalistic

Stimulus items	Chosen by clinician Pictures/photographs containing target sounds	Chosen by child Objects and toys containing target sounds Selection of items of high interest to child
Steps	Begin with sounds in isolation; drill until mastered Sounds presented sequentially in words, phrases, and sentences; drill until mastered at each level	Begin with word production of item
Interaction	Clinician models sound production Direct feedback (e.g., motor placement cues)	Clinician models word following child attempts Clinician and child naturally (play) interact with stimulus items
Response-reinforce contingency	Child verbally reinforced for production of correct responses in a shaping paradigm, with successive approximations reinforced, and feedback provided for motor placement	A broad shaping contingency was employed so that both correct responses and verbal attempts were reinforced, and included a correct model of the target sound
Consequences	Social reinforces, desired objects, and edible reinforces	Social reinforces, and natural reinforces (e.g., opportunity to play with stimulus item)

Findings

To sum up the findings, the naturalistic had greater improvements where “all children showed high level of correct conversational use of the targeted sounds in the language samples when treatment was conducted using the naturalistic procedures” (Koegel, Camarata, etc). This shows that when the children were in the naturalistic setting, they were in control for the majority of the session. This is significant because they were able to choose where they wanted to be, and that would determine what words they would learn. For example, if a the session was being held outside and they found a bat, they would practice saying “bat”. The practice of the word came out more natural and it intrigued the child.

The purpose of the study was to teach children how to properly sound out the noises the letters make. In the naturalistic setting, the pronunciation came out naturally because they were in a place that was recognizable to them. For example the park, a classroom, their home or even a therapist office was used during the experiment. As a reward, the children were allowed to play with the stimuli. Naturalistic was the most successful, regardless of which technique was presented first, when the children were placed back in the naturalistic the data showed, “large gains, usually to near 100% correct conversational use of the target during the language samples occurred when treatment was conducted in the naturalistic setting,”(Koegel, Camarata, etc).

Why Analog is not as Powerful as Naturalistic

Children that are so young have a more difficult time paying attention to almost anything, and that is why analog is not as effect. When the children are learning something new for the first time they need to be intrigued. The analog condition did offer rewards for every word that was pronounced correctly, but that doesn’t mean that the child was completely focused on learning, but more interested in the reward. The method that is being described in the table above makes it seem that the information is being drilled into the heads of the children. Therapist and child practice and practice until the word was properly pronounced. Hence, when the researchers tested to see if they remembered anything the outcome was lower than the naturalistic. Therefore when it came to the naturalistic condition, the children were able to pick their stimuli and showed more interest. Take to consideration when a child was in the analog condition and began acting out by, “refusing to enter the room or sit in the chair, verbally expressing “No Cards”. (Koegel, Camarata, etc). Not only was it difficult for the child to pay attention in an analog setting, but they child also began misbehaving and slows down the learning process.

When the study was finished they compared the two studies and found that, “data indicated low levels or no correct conversational use of the targeted speech sounds during…the analog condition” (Koegel, Camarata, etc). The analog condition is helpful but only in the slightest way, meaning that therapist should continue using the naturalistic condition.

Why People Question the Naturalistic Condition

Have you ever stop and considered the downside of children having some say in how and what word they want to learn? In the naturalistic condition the child is able to pick the word, and while they are learning the word, they are allowed to play with the object. Also recall that in the naturalistic condition the child and therapist are not in an ideal room, but could be outside, inside a classroom or at home. All of these locations have multiple items that could be distracting, as well as the child picking the word, as the word itself could disrupt the learning environment. Since the sessions are only 45 minutes long, that is not enough time, especially if a child’s attention span is very short. With all the possible distractions what can be so that they are limited, and how can the naturalistic condition be the best?

In the analog condition there are not many distractions that take place. They are in a room where there is complete focus and are there to learn. In these sessions the child continues to practice until the word is mastered before they can continue, and are motivated by the reinforces that they receive by the therapist.  However, the same techniques are used in the naturalistic condition, and that is why it is the best technique. The naturalistic condition keeps the child entertained and also motivates them. As long as the therapist continues to show motivation throughout the session, “learning is greater and disruptive behaviors occur at lower levels when naturalistic procedures focusing on motivation are incorporated”, (Koegel, Camarata, etc).

No matter what happens in the analog condition, children tend to perform better in the naturalistic condition.

Call to Action

Now that it is understood why the naturalistic condition is better for the child, regardless of their age or how advanced they are. Each child that participated in the experiment had a different scenario, either there were really behind in their mental age or they were only a couple months off, they all showed great improvement in the naturalistic condition. That is why  parents need to make sure that they know what kind of sessions they are placing their child in if they want to see improvement. Therapist also need to research how well the naturalistic technique in their session would be the most beneficial for their patient.

Parents only want to do the best for their child, especially if they are autistic and are struggling with their speech. What all parents need to do is to make sure that there voice is being heard by all the speech therapist. Even if the therapist may have their own techniques and ways that they teach, it is only fair that they listen to what the parents are asking of them. The parents are only looking out for the well being of the child. Autism is not easy to care for and something that should be not taken lightly. As for the therapist, listen to the parent and put yourself in the parents shoes, and help the parent as much as you can.

The only call to action that parents really need to do is make sure that they are heard. Gather all autism parents and voice your concern and something will change.

Conclusion

To conclude, the best technique that a therapist can use in their speech impediment sessions is the naturalistic condition. In this condition the child is being intrigued with learning as well as entertained. Great outcome come from these sessions, even though the environment may change the child is still able to focus as long as they are motivated. The changing environment benefits the child because they learn to use the word they learned in different context, furthering their knowledge. Analog does not compete with the naturalistic condition and that is why therapist will continue to use naturalistic condition in their sessions. That is why parents will and will continue to place their child in the naturalistic condition if they want to see their child improve no matter how behind they are or how old. Improvement will continue to prosper.

Works Cited

Koegel, Robert, Stephen Camarata, Lynn Kern Koegel, Ayala Ben-Tall, and Annette Smith. “Increasing Speech Intelligibility in Children with Autism.” Journal of Autism and Developmental Disorders, 28.3 (1999): 241-251.

For my primary research I conducted an interview with my best friend’s mother, Angie Lopez, as well as my best friend, Christian Lopez, since they both have first hand experience with an autistic child. The child is Christian’s brother and Angie’s son. I have had the pleasure of meeting and being part of his life for the past four years.  In the interview I asked questions that surrounded Aaron’s well being, how has he changed from child to preteen, how difficult it has been for the family, his behavior  and what resources were available to the family.

Aaron as a young child: How did he behave when he was a first born and what stood out?

Angie’s third son, Aaron, was born June 13, 2003. According to Angie, “ As Aaron grew up, he could be seen as any ‘regular’ child. He wasn’t any different than any other kid.” This followed my prediction that autistic children do not show symptoms automatically. However, some autistic children do begin to do little actions like focusing on one specific item foreshadowing the future. As the child gets older that is when parents begin to question their child behavior. In the years to come Angie had her last child, Jakob, on August 4, 2004. This is when she started to question Aaron’s development, “As Aaron and his younger brother began to age, I noticed a difference in their speech. Jakob was able to speak more coherently while Aaron still had difficulties conveying a message with his words. Although we still understood him, he wasn’t as clear as his younger brother. And this raised questions.” Speech is one of the major components when it comes to diagnosing autism because it is one of the prominent signs. When it comes to children with autism’s their communication skills begin to trouble, having a conversation with others might be too difficult and do not know how to properly use the vocab they know. Aaron was clearly showing the early signs of an autistic child.

How did it affect the family to have an autistic child?

“Throughout Aaron’s life, he has been treated like every other child. The only true difference that we have to account for is his inability to adapt to rapid changes in his routine life. For example, if he was told he would have or do something at a certain time and it did not pan out in that specific order he would panic or have a tantrum.” Every child with autism behaves differently, and his was Aaron’s. It is important for the parents to be patient and understanding. Angie in these situations would have to, ”show him extra patience and understanding in order to calm him down or make him understand that things change.” Aaron is nowhere near seen as burden. His disorder was just something that the entire family would have to get used to it. In all honesty, I sometimes forget that he is, he is treated like any other thirteen year old. He is really an outstanding and unique child.

What resources were available and what helped Aaron?

In the articles I have read, parents usually have trouble finding a doctor that could help their autistic child. In the Lopez’s case finding a therapist was slightly difficult. Since the Lopez family had help from the military due to the parents military health benefits. They were able to find a doctor to help Aaron. Angie stated that “The military gave us the opportunity to give Aaron the necessary resources to help his motor and speech skills. However, without the military, the task of finding a doctor for Aaron would be nearly impossible.” The military was a great source that they were lucky to have. Not every family is as fortunate to obtain a reliable doctor or group of doctors to aid their child. Families have to travel from doctor to doctor. And some doctors are not as qualified or experience as others. The Lopez’s doctor was, “ extremely kind, patient, and imaginative when it came to Aaron. Every doctor we had, whether it was a speech therapist or aid for school, would never let him feel different and would encourage him to break his shell of discomfort with being social. The lessening of his antisocial aspects allowed him to better assimilate in his peer groups at school.” With the support of the doctor and therapist it helped Aaron grow and be comfortable with his own skin and ignore the disorder all together.  Without any of these resources around to help Aaron I don’t think he would be the same. All the moments and times that I was able to be around I have seen him socialize with his friends. It may have taken him a while for him to get comfortable around me, but I am always being reassured that he is. Continue reading “Primary Research”

Who are the people who help autistic children?

Many people care for autistic children: their parents, doctors, caregivers, teachers, therapists, etc. They are the people who have the power when it comes to autism, not money or big corporations. They are the ones who determine what kind of medication they should be taking, how their therapy sessions run, and how it alters their lives.

Who has the ultimate power?

Ultimately, the parents are the ones with the power. Parents are the ones who get to choose who helps their children. Although, when parents chose who helps their children, they take into consideration how well trained the professionals are in their fields. Who trains the professionals, and what is proper training? The journal, “The Role of Training in Developing Services for Persons with Autism and Their Families”, by Theo Peeters, discusses the importance of proper training. That is why parents are looking for professionals who are, “trained in autism before they assume responsibility for their children, instead of having to cope by trial and error for years”, (Peeters, Theo). Training is just as important as money and power. Autism caregivers are so powerful because parents will pick them and stay with them for years to come.

When it comes to training a therapist, doctor, caregiver, etc, they need to remember that autism is not just another disorder.Children cannot be placed into any ordinary therapy session when they are, “it causes them intolerable levels of confusion and pain”, (Peeters, Theo). Therapist need to realize not every child with autism is the same, because others have more dire needs. Some children have extreme shyness or have tendencies to cause harm to themselves. Every case is special which is why if one wants to help another who is in this situation, they themselves, need someone who is special in the same way. Imagination is a key factor when it comes to training.

How much can the government really do?

Another reason why parents and their caregivers are more important is because government can only go so far. The government does not know every single case and how special every case is.  How are they the ones to decide who they fund? As the government continues their involvement, “decisions makers fail to understand, parents and professionals risk having to “carry on” without the necessary information and training”, (Peeters, Theo). All the parents must gather and spread the word around so that proper funds will be dispersed.

Conclusion

When it comes to realizing who has the power, money does not equal power in all situations. Parents must consider who is helping their children, and make sure that they have the proper training and experience to work with their child. Autism is a special disorder and every child that has it, is a unique individual. Parents in this situation are the ones who hold the ultimate power because they have the power of choice.

Works Cited

Peeters, Theo. “The Role of Training in Developing Services for Persons with Autism and Their Families.” International Journal of Mental Health, vol. 29, no. 2, 2000, pp. 44–59. http://www.jstor.org/stable/41344938.

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