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The number of infants diagnosed with Autism Spectrum Disorder (ASD) has grown dramatically, putting a significant demand for effective intervention methods, especially techniques targeting children with difficulties in non-verbal communicative behaviour. Its prevalence has progressively increased over time, there has been an increase in occurrence in the USA from 6.7% to 14.7% per 1000 children between the years 2000 and 2010.  (Baio, 2012). This essay will critically evaluate two methods of intervention; (1) parent-mediated communication-focused treatment (Schertz, & Odom, 2007); (2) Picture Exchange Communication System (Bondy & Frost, 1994). ASD is a lifelong developmental disability affecting social communication. The core symptomology of ASD reported in the DSM-V include deficits in social interaction and communication (APA, 2013). Many children with ASD experience deficits in verbal and non-verbal ability. Minimally verbal children find it difficult to use meaningful language, those with non-verbal communication difficulties find problems in understanding social signals (e.g., facial expressions, gestures, eye contact) (Kasari et al., 2013; Lord et al., 2000). There is no cure for Autism; however, this essay will discover whether the two mentioned intervention techniques are effective at promoting nonverbal communication in children with ASD. Typically developed 12-month-old infants usually show mastery in communicating non-verbally, using eye contact, gestures and facial expressions (Centelles et al., 2013). Such behaviours play a crucial role in a child’s language comprehension and production (Tomasello & Farrar, 1986; Rollins, 2003). ASD disrupts the normal functioning of nonverbal interaction and so, autistic children are left with a limited range of non-verbal communicative behaviours, which is thought to disrupt language development in later life (Mundy, Sigman, & Kasari, 1990).  Mundy, Sigman and Kasari (1994) suggest that children with autism display a disturbance in joint-attention. This is an important non-verbal communicative characteristic that allows children to coordinate their own eye-contact with others, to display attention and learning. Typically developing children show an aptitude for joint-attention between the ages of 9 and 18 months, signifying the early emergence of non-verbal communication skills (Bakeman, & Adamson,1984). It is argued that deficits in joint-attention in children with autism reflect disturbances in early developmental processes responsible for language acquisition, explaining the apparent language impairment many children with autism display (Murray et al., 2008).  Baldwin (1995) posits that without the ability to engage and appreciate non-verbal communication, then a child cannot recognise when communication is happening, thus, negatively affecting vocabulary development.  Murray et al. (2008) found children with autism who suffer language impairment also show significant deficits in pointing, inability to follow head turns and eye gazes; hence, we see that the development of non-verbal communicative strategies is crucial for the development of language. Therefore, the portrayal of deficits in gestural behaviours should provide an appropriate early indicator for autism. The screening of children for autism should take place between the ages of 9 and 18 months (as non-verbal ability appears early in age) allowing for early identification so that appropriate intervention efforts are undertaken.  Interventions have been designed to promote non-verbal communication, for instance, Schertz and Odom (2007) used a parent-mediated therapy style focusing on four phases- fixation on faces, turn taking, responding to, and initiating joint-attention. Infants (aged 24, 22 and 33 months respectively) and their parents were involved. The sessions were conducted in a familiar environment for daily one hour periods for 5 weeks. To promote interaction, parents played face to face games aiming to increase the child’s leniency for looking at faces (12-month-olds without autism have a greater tolerance to faces, Osterling & Dawson, 1994).  The turn-taking activities aimed to encourage reciprocity between child and parent as autistic children are commonly known to carry out isolated repetitive play (Honey et al., 2007). Responding to joint-attention strategies targeted shared joint-attention, for example, parents would establish eye contact and then introduce a toy and use excitement to encourage the child to look at parents face and toy. Finally, initiating joint-attention strategies encourages the child to engage the parent’s attention with regards to an object. Before intervention, infants showed varying levels of face focusing and turn-taking and none exhibited evidence of joint-attention. It was found that during the implementation of this therapy, each child progressed at different times, for example, Child A’s greatest area of improvement was face focusing with little progress in turn-taking and the joint-attention measures. Child B showed steady improvement in all phases of the intervention and Child C progressed rapidly on all but one phase. A post-intervention maintenance measure revealed higher performance across all phases compared to baseline performance, reflecting an advancement in non-verbal communication evidencing the effectiveness of the intervention.  However, the fact that improvement occurred at differing rates raises the question whether individual differences had been considered in the design. One could argue that personality will affect how a child responds to this intervention, for example, a study found that personality effects neural reactions to emotional facial expressions: Canli et al. (2002) discovered a correlation between extroversion and amygdala response to happy faces. They argue that amygdala response to happy faces was specific to extroverted persons. This reflects individual differences in the trait of extraversion as no other personality trait correlated significantly with neural activations in response to a specific emotion. Such findings do provide a plausible explanation for the variation in progression across children- it could be that children notice faces at different times due to personality effects, for example, autistic children are more introverted and so find it difficult to engage in joint-attention as noticing an expressive face requires a degree of extroversion (Schriber, Robins, Solomon & King, 2014). The point to make is that this therapy is useful, as illustrated by the overall improvement across the phases, however, the intervention can be improved by integrating personality effects into the design.  Parents reported the emergence of verbal language at the end of the intervention. This was most noticed in the children who began to fully engage in joint-attention, adding weight to the posit that interventions targeting non-verbal communicative behaviours are effective at promoting later language acquisition in autistic children. This intervention has shown that joint-attention appears to provide a foundation from which language ability can develop. This is extremely important as ASD is often characterised by severe language impairments, therefore, this intervention is effective because it has determined an early precursor for autism (joint-attention disability) and demonstrated that language impairment can be alleviated early on in life, increasing quality of life for the child (Kjelgaard & TagerFlusberg, 2001). Additionally, parents noted that aggression level subsided by the end, suggesting that children’s frustration levels (due to struggling to convey needs) had lessened with parent-mediated intervention, further demonstrating the effectiveness of this intervention (Singh et al., 2006). Another communication intervention promoting non-verbal communication is the Picture Exchange Communication System (PECS). PECS is based on the premise that children who cannot verbally communicate, are taught to communicate non-verbally using pictures (Bondy, & Frost, 1994). Children trade a picture of the desired item for the real item. This sets the foundation for basic communication where requests and thoughts can be conveyed non-verbally. For example, if the child submits a picture with a toy truck, they will receive the toy truck.  PECS is argued to be effective because 2D picture symbols resembling their referents is easier for children to engage with compared to sign language for many reasons: (1) they are easily understood by both children and the lay individual, therefore, easily applied at home by parents (Mirenda & Erickson, 2000); (2) some individuals with ASD suffer motor problems making it a challenge to learn manual signs (Hughes, 1996); (3) children with autism have difficulty in imitation making learning and using manual signs through imitation a difficult process (Carr, Pridal & Dores, 1981; Dawson & Adams, 1984). Therefore, picture-based communication systems more accessible and understood, they do not require comprehensive training for child and implementer, demonstrating PECS an effective tool to be used by parents and does not need to be professionally administered. A case study by Bondy and Frost (1994) of a 36-month-old male with ASD demonstrated that PECS had the power to elicit functional non-verbal communication and to also produce speech (speech was a secondary outcome). This child displayed no evidence of non-verbal communicative intent. The child was taught single pictures and their corresponding rewards and quickly learnt that requesting lead to receiving. In consecutive weeks, more than one photo-card is presented, forcing selectivity between two pictures. By the end, the non-verbal child began to successfully communicate their desires and thoughts in a non-verbal manner. The child’s picture repertoire grew to encompass 100 photo-cards including verbs, nouns and adjectives. After the continuous use of PECS for around a year, speech had developed fully showcasing how developing non-verbal communication skills (e.g., gestural exchange, requesting desired items, selectivity between items) is fundamental to speech. Pictures serve as an effective non-verbal communication procedure ultimately leading to language development (Ganz & Simpson, 2004). Such results illustrate the profound efficacy of non-verbal communicative procedures in encouraging the process of verbal communication in non-verbal children. A longitudinal study of 85 children with ASD taught to communicate with PECS supports the above (Bondy, & Frost, 1994). All children had no functional speech and all varied on cognitive level- some were cognitively lucid and others were not. Findings reveal that the longer PECS is used the more likely the children will begin communicating nonverbally and then make a switch from non-verbal to verbal communication. For example, speech became the sole form of communication for the 39/66 children who used PECS for more than one year, 25/ 85 children who have been using PECS for a month used a combination of speech and pictures, while 41/85 solely used speech. This highlights the speed at which children with ASD being to grasp functional non-verbal and verbal communication skills, suggesting this intervention is highly effective. However, PECS does not work for every child, there were 85 children in total and only some benefit. This may be due to cognitive ability, as it was mentioned that some were more cognitively able than others. Nonetheless, many children have developed the ability to communicate non-verbally (e.g., the process of exchange and request), so this intervention programme is successful as it makes children functional communicators leading to developments of speech repertoire. Unfortunately, the PECS system does not allow social communication with others at any given time, therefore quite limiting. It is also unrealistic because whenever a child wants to communicate they must always carry all pictures to be able to convey spontaneous ideas and desires. Furthermore, pictures can be lost or damaged which can make communication frustrating and possibly make a child think it is easier to not communicate at all. Therefore, PECS does not allow for independence in social communication. Additionally, is it possible to represent everything through pictures? e.g., how can a picture convey jealousy? The point to stress is that communication is still limited. Another limitation to PECS is that communication is led by an adult rather than by the child, teaching children that communication should always be led by the other person. Therefore, communication will lack spontaneity on the child’s part (Tincani, 2004; Adámková, 2008). Overall, both interventions (parent-mediated and PECS) have shown to be effective when accounting for non-verbal communication in children with ASD. It is clear to see that both methods lead to positive outcomes, parent-mediated intervention proved effective- showing that eye contact and joint-attention are possible to instil in children who have past the baseline age for natural development of non-verbal communication. PECS also proved effective demonstrating that operant conditioning is an effective tool in teaching intentional gestures, exchange and request in those without previous non-verbal ability. There were downfalls to parent-mediated intervention method, individual differences between children were not considered, potentially accounting for the varying rates at which children displayed non-verbal communication. In terms of PECS, it is reductionist, it is difficult to apply PECS in all social settings.  Nevertheless, the non-verbal ability was encouraged and adopted by all children exposed to the interventions, suggesting the interventions were designed well

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