As a primary one teacher in a unit for children with autistic spectrum disorders, I am going to evaluate the way in which the Social Use of Language Programme (SULP) (Rinaldi 1993, 1995) has been implemented within the unit. I am also going to consider how effective the programme has been in meeting the varying needs of the children within the unit.
The unit in which I work is located within a mainstream school and we currently have a role of 24 children aged five to ten. When we embarked on the Social Use Of Language Programme, the unit role was only 12, and this is the period that I am going to discuss in this assignment. Most of the children have been diagnosed with an autistic spectrum disorder. The majority are high functioning; and many are, in fact, diagnosed with Asperger syndrome. However, within the group of pupils there are a number of differing needs which I will go on to describe later.
It is now commonly accepted that the impairments in autistic disorders present with varying degrees, but are linked by some common features. Wing (1996) describes these features as the 'autism triad of impairments'. Autism is now distinguished by the co-occurrence of impairments in social interaction, social communication and social imagination, thus highlighting the social nature of the disorder. The most commonly used diagnostic tools (DSM 1V and ICD 10) are now based on the triad. These common features should ensure that interventions for all children on the autistic spectrum will be based on this triad of impairments, and cater towards the differing levels of these needs presenting in individual children.
As previously discussed, two common features of autistic spectrum disorders are impairments in social interaction and communication. Certain other conditions can also overlap with autism. One such condition is semantic/pragmatic disorder, a diagnosis of some children with complex language and communication difficulties. Characteristics of this disorder include delayed language development, receptive language difficulty, difficulty with comprehension, impaired conversational skills eg turn taking, difficulty with question forms and difficulty with the use of gestures.
Jordan (1999) argues that, given the breadth of the autistic spectrum today and as long as these difficulties go hand in hand with impaired understanding of the function of language, lack of social empathy and restricted imagination, then the criteria for autism are met. A study by Lister-Brooke and Bowler in 1992 concluded that semantic pragmatic disorder does not exist without the autistic spectrum. However, the list of criteria given above for semantic/pragmatic disorder defines exactly the areas of difficulty that are evident in almost all of the children in our unit and is useful for teasing out the areas of difficulty in which we, as a staff team, were interested in working on. We were especially concerned with the development of pragmatic awareness.
Typically developing children learn to use language to communicate wants and needs from an early age, and are pre-programmed to interact with others. Language is made up of the following areas, which are the basis of the linguistic rules, which a child must learn in order to communicate:
Semantics - this refers to content and meaning and understanding of language
Syntax - this refers to the form language takes, sequencing and grammatical structure
Pragmatics - this refers to the way language is used, social skills of communication,
Interpretation and inference.
The development of communication in young children also depends on the development of intent. Children with autistic spectrum disorders seem to lack the social pre-programming that allows them to communicate with others and develop functional communication at the same rate as their peers. Language development is often delayed or impaired as a result, being produced often as a result of copying, rather than developing through a social framework or being fuelled by meaningful interactions.
From birth, we behave as if the behaviour of other people towards us is intentional and purposeful - an attempt to let us share their ideas. We look for meaning in the acts of others and we try to help them find meaning in ours.
MacKay & Anderson (2000)
Many of the characteristic impairments in autism centre on the pragmatic component of communication. Several of the children in the unit have pragmatic difficulties. The area of pragmatics is concerned with functional language and intent.
Pragmatics refers to the use of language to express ones intentions and get things done in the world.
This can be broken down into four further areas:
- a: understanding meaning in conversation (eg inference, literal interpretation)
- b: interaction (eg initiation, facial expression)
- c: structural or linguistic rules (grammar, vocabulary and prosody)
- d: the wider influences upon our communications such as education, culture and background.
Children who have pragmatic difficulties can have impairments in some or all of these areas; therefore the term pragmatic difficulties is broad. For example, within the unit we have a wide range of difficulties that go from children who show little or no eye contact with minimal verbal communication to those who can sit and take turns in a group, maintaining a conversation appropriately.
The Social Use of Language Programme was designed by Wendy Rinaldi and first published in 1993. It was initially developed for use with teenagers with moderate learning difficulties but later proved useful with other groups such as children on the autistic spectrum. As the author expanded her work, she became aware of the possibilities for development of the programme by using the pack with younger children. She then designed a pack with resources that were more suitable for use with younger children. The primary and pre-school teaching pack revolves around a set of monster characters, Moby and Friends. The characters appear in a set of stories, each of the stories focusing on a particular communication skill or topic of self/other awareness. The author claims the programme to 'have enormous benefit to this younger age group in order to enable the children to communicate with each other and to develop friendships'. (Rinaldi, W 1995)
Rinaldi's programme was devised to assist younger children with the development of pragmatic awareness and to introduce some concepts that are fundamental in any communicative situation. These concepts include eye contact, listening and turn taking. The author suggests that introducing these basic concepts in a way that is fun and interesting will help the children to become more aware of their own difficulties and strive to improve them.
The stories start with the basic skills listed above and then move onto more difficult concepts such as friendship skills. Ordering the sessions according to the teacher's manual is therefore very important as a means of building up basic skills. Children are assessed on communication skills and self/other awareness before embarking on the programme, and assessment is continuous throughout. Children are then usually grouped appropriately, with each group including two members of staff. This is essential for the modelling activities, which take place. An initial session sets up and gels the group. The sessions that follow begin with warm up activities such as 'who has the ted?' and then move on to raising awareness of skills such as good looking, through the various stories available eg the 'Looking Luke' story.
Next, the two adults present a model conversation between speaker (A) and listener (B), first with B being a poor communicator then with B being a good communicator. Children feed back on these modelled conversations, with staff asking prompting questions to focus observations. Key points from each of the activities can be reinforced with the posters and stickers of the various characters available in the pack. The children are then asked to join in a game that requires them to use the interaction skill being practised. The children then go on to have conversation practice in both the listener and speaker roles, with the other part usually being taken by an adult at first. Other children observe and give feedback, and the leader revises the learning points from the lesson.
Once the children have worked on all the basic interaction skills they go on to look at more abstract concepts through more complicated stories. Stories and concepts that may be covered in this part of the session are (for example) 'Bertie the rabbit who wanted to be best', which examines winning and losing. Other activities in this final part of the session may include matching games or find a partner games.
The programme requires each activity to be applied to all communication skills and each self/other awareness topic before moving on to the next. For example, good sitting is taught using all the interaction skills activities available before moving onto the next skill.
I am going to examine the extent to which the social and communication needs of the children within the unit have been met by the implementation of the Social Use of Language Programme. In order to evaluate this fully I must first consider the outcomes that we hoped to achieve through this implementation.
As part of a multi disciplinary team consisting of teachers, speech and language therapists, psychologists, parents and auxiliaries, we discussed the possible uses of SULP and the benefits for our particular children. We discussed individual children and their needs, with a view to possible groupings, and collaborated to create a practical strategy for the teaching of SULP within the unit. We also listed our desired outcomes, which were as follows:
- To increase pragmatic awareness eg facilitating understanding of conversational strategies
- To work also on the semantic area of language by teaching vocabulary and concepts in relation to themselves and each other
- To introduce basic skills such as good looking and listening consistently, using a unit-wide approach that would hopefully be transferred as children moved through the classes
- To differentiate in terms of ability by using initial observation and assessment sheets
- To introduce more abstract concepts and increase children's understanding of appropriate social behaviour
- To provide good models in each group
- To facilitate the development and maintenance of friendships
- To relate our activities to the talking and listening attainments of the 5-14 curriculum
- To apply a multi disciplinary approach at all times eg leaders being teacher one week and speech and language therapist the next, thus avoiding predictability and ensuring all staff know how SULP works.
Prior to beginning the SULP programme within the unit it was essential that we discussed, as a multi disciplinary team, the possible groupings of children based on factors such as pragmatic awareness, attention levels and behaviour, combined with the use of the SULP assessment profile. Class teachers and the speech and language therapist discussed all of these, and came up with three groups in which each child had a similar level of functioning as his/her group peers.
The first group consisted of two children who were still developing spoken language, had fairly short attention spans and little pragmatic awareness. It was decided that they could cope with one ten-minute session per week, broken down into appropriate steps suited to their needs. Our second group consisted of five primary one children who all had spoken language, but were still in the early stages of development in terms of attention and social skills. With this group we felt that basic skills and simple interactions were the most important areas on which we needed to concentrate. The third group consisted of our two primary four children and the remaining three primary ones. These children had the ability to sit fairly well in a group and maintain attention for longer periods of time. Some of the children in the group had developed well in terms of attention and had acquired some appropriate social skills such as eye contact and turn taking, so the main developmental objectives with this group were conversation skills and awareness of others.
Each group was given one session per week during which they completed activities from the SULP pack in sequence, but suited to their levels. The teacher or the speech and language therapist led the groups in turn and led the children through the activities described previously. The children were all introduced to the main characters around which SULP centres (Moby the monster and his various friends eg Looking Luke). Then, through the stories provided, they were introduced to some of the basic concepts and skills which SULP teaches - good sitting and good looking being the first two. The groups then moved through the basic skills and concepts at their own pace. Group one, for example, needed further work on good sitting and we continued with this for some time. A useful strategy with this group was to prompt the children with the picture of Moby the monster doing good sitting along with an adult model. We eventually found that the children were able to transfer this to the classroom. I feel that without the visual prompt and the character the children would have found it less easy to retain this concept.
Group two moved on through the pack at a quicker pace and were able to move on to interaction skills such as turn taking. One story which proved very useful was 'Timmy and Tommy take turns', which detailed a situation where two of the monsters were not taking turns nicely, and then resolved the problem. The children enjoyed the story and were able to discuss it with the adults in the group. This type of more complex scenario was harder for the children to relate to, and because it did not involve a specific action that they had to carry out; it was more difficult for them to apply this skill.
Group three revised the basic concepts and moved on to more complex stories and concepts. One story that was used very successfully with this group was 'Betty butting in', which dealt with interrupting. Again, the children enjoyed the story and were able to discuss it, eventually becoming able to respond to an adult prompt not to butt in and this became known as 'doing a Betty', a phrase which the children enjoyed using and could relate to.
With all three groups the basic concepts were continually revised. The children using the Moby and Looking Luke characters picked good sitting and good looking up well. One of the other basic concepts, good listening, was, however, much harder to teach, especially with the lower functioning children. In class this concept had to be supplemented with extra materials and activities and seemed too abstract a concept, with too many component parts to teach as a skill in itself.
With children on the autistic spectrum it is important not just to teach missing social skills, especially the more complex ones, by rote or for the sake of it. It is sometimes the case that this type of strategy can cause problems in later life by making people on the spectrum appear odd in social situations. I believe that we need to be conscious of our reasons for teaching these skills. It is important to make sure that we teach and look at different situations and reasons for using the strategies taught. SULP covers this well because all the skills are contextualised within the stories. However, it is essential to point out and discuss uses of the skills and strategies taught in other situations in order to help the children to transfer skills from situation to situation. Some of the children began to be able to transfer the basic skills quite quickly, but the more complex skills took longer and even then children normally had to be prompted by an adult in order to use a strategy taught.
A feature of SULP, which was useful in terms of the children's autism, was its ability to make the thoughts and feelings of the characters specific, thus increasing the childrens awareness of others. This is essential in order to address the inherent difficulties, which these children have with the concept of other people having thoughts and feelings.
It is not just that children with autism do not understand what others are thinking and feeling but that they do not understand that they are thinking and feeling.
SULP allows the group leader to make the feelings of the characters involved explicit, through modelling and discussion. This was something, which was very positive for the children, although feelings involved in different situations needed to be continually discussed anyway. SULP made this easier because the children had picture prompts and specific scenarios to discuss, and could relate back to these at relevant points during the school day. For example, a situation occurred in the playground where one of the children was hitting others. We established that this child enjoyed the reaction of the other child in response to the hitting, and we found the story 'Bert the bully' to be a useful talking point, which allowed the child to see that it made other children sad when they were hit. He also became more aware of the reasons behind the reaction of adults to this behaviour and was able to be slightly more empathetic towards other children upon discussion of the events. We used the story a lot with this child and it did prove effective.
Generally SULP did improve elements of the children's pragmatic awareness, especially the basic interaction skills such as looking and sitting. We continually discussed the reasons why we sit nicely in a group and look at someone who is talking to us, which was important, as a weekly group was not enough to ensure that the children picked up on this. Most of the children were more able to look at someone who was talking (although none were forced because this may lead to distress and sensory overload).
I still believe that, especially with the lower functioning children, these skills do not yet come naturally, and that they have been taught by rote. The children are responding to an adult prompt, which may not necessarily transfer itself to a situation where there are no prompts. This is why it is important to reinforce the skills taught in SULP in every possible situation, with the hope that one day this will transfer itself naturally. This, however, does depend on the individual and their needs. Some of the children may always need the prompt and are still looking for an adult prompt or picture to tell them what to do. It could be argued that this is one of the dangers of using such a programme. It acts as a crutch and when it is taken away the person falls at the first hurdle. With our younger children this is not as important, but I feel that it would be something to look out for in the later stages.
Another point, which I feel is relevant to mention in passing, is the use of monster characters throughout the programme. One of the inherent difficulties in autism is an impairment of social imagination and flexibility of thought. This has two consequences, firstly the difficulty that we have already discussed in trying to make sense of other people's thoughts and feelings. Secondly, there is a difficulty with imaginative play and imaginative situations. Surely it is much harder for the autistic child to relate to a series of monsters? I feel it has been a difficulty for most of the children but especially again the children with more severe difficulties. A strategy, which I used in my own classroom, was a series of storyboards with moveable photographs of the children for acting out and replaying different scenarios. This worked very well and was a useful supplement to the SULP pack. I feel that for children with autism it would be really useful to do the stories using the relevant children's names and photographs.
In conclusion, did the SULP pack help us to achieve our aims, which were set out at the beginning of the programme? Our main aim was to increase the children's pragmatic awareness and to a certain extent, with supporting strategies and materials, this has been achieved. Many of the children in the unit are now more able to turn take during conversation (mainly when reminded). For example, I previously mentioned the example of 'Betty butting in'. Many of the basic skills required during any interaction have been taught but these still require adult prompting in most cases. Many of the children respond appropriately when prompted with good sitting or good looking, and this is a big step forward for them. The character prompts have helped with this.
We were successful in our initial grouping of the children because we found that these worked well and the groups gelled, which made the sessions easier and therefore facilitated interaction within the groups. The multi disciplinary team approach, which is so important in autism, worked really well because we all had different knowledge and experience to bring to the group. This worked well in terms of knowing what support the children would require alongside SULP. The pack was not enough by itself, and we had to use supplementary materials such as circle time and storyboards, and revise the skills in many different contexts. However, we found that the SULP pack was a really good resource. The children picked up on the basic skills, which were being taught, and some of them were able to move onto more complex self/other awareness topics as the year progressed.
Although I have mentioned the difficulty with using monsters instead of real people, we still found that the children enjoyed the stories. Most of the children were able to discuss the stories within their group and the way in which Wendy Rinaldi has been careful to contextualise each story was useful, because the stories could all be linked in to each other and the children had other relevant stories to refer to. Another successful feature is the way in which the thoughts and feelings of the characters within the stories (and in the follow up role plays) are made so clear. The children were left in no doubt about how the story characters were feeling. Having said that, it is still true that this may not be transferred to real life situation, but I hope that the SULP pack has gone some way to helping the children to begin to do this.
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Written by Maggie Macaskill
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