Supporting AAC Users with Complex

Communication Needs and Behavioral

Challenges Across Settings

Lydia MacKay, M A , C C C -
SLP Sarah Aguilar, MS,
C C C -SLP
 Disclosure
Lydia MacKay has no relevant financial relationships to
disclose. She does have a relevant nonfinancial
relationship, as she is a L A M P Certified Professional
through the Center for A A C & A utism.

Sarah Aguilar has no relevant financial or

nonfinancial relationships to disclose.
 Learner Outcomes
O 3 functions or purposes of communication
beyond requesting objects

O 3 strategies for increasing communication skills

O 3 strategies for using communicative functions as

replacement behaviors for challenging or
interfering behaviors
Underlying beliefs:
No one is “too” anything to
communicate
O Not too “low”
O Not too “impaired”
O Not too
“functional” ???
O Not too “behavioral”
There are no prerequisites for AAC use..
O We don’t expect individuals to “prove” their ability to
use a particular system before moving on to
something more complex/robust
ASHA’s position regarding AAC and “Prerequisites”

“The currently accepted evidence in the literature suggests that no specific

skills are prerequisite for successful use of AAC in the broadest sense. AAC is
an intervention approach that can be the beginning of communication
development for an individual. A number of AAC options are available to
begin the intervention process.” (https://www.asha.org/njc/aac/). This has
been acknowledged in the AAC literature for over 20 years and aligns with
the Participation Model of AAC tool and strategy provision (Zangari, 2013).
There are no
prerequisites for
AAC use

https://www.youtube.com/watch?v
=OZ9_gxgEkMs&ab_channel=TheA

ACCoach

Modeling without expectation

Good communication skills are the only
foundation to ‘good behavior’
O (NB: the absence of challenging behavior is not
‘good’
behavior).
O All behavior is communication
O Better said… all behavior is communicative (it tells us
something)
O It’s our job to investigate
Communication is the exchange of information
Effective communication enables people to:
• express their thoughts, opinions and personality
• ask for and receive information
• build relationships
• make decisions
• express and meet their basic needs
• refuse or reject
• make requests and suggestions about services they receive
• take part in social activities
• be heard and understood
• participate in their community\
Every individual should have access to the
most robust/comprehensive
communication system they can access…
 We need more research!
O Gilroy, S.P., McCleery, J.P. & Leader, G. (2017). Systematic Review of Methods for Teaching
Social and Communicative Behavior with High-Tech Augmentative and Alternative
Communication M odalities. Review Journal of Autism & Developmental Disorders
https://doi.org/10.1007/s40489-017-0115-3

O Muharib, R. & Alzrayer, N.M. Rev J Autism Dev Disord (2017). The Use of High-Tech Speech-
Generating Devices as an Evidence-Based Practice for Children with Autism Spectrum
Disorders: A Meta-analysis Review Journal of Autism & Developmental Disorders
https://doi.org/10.1007/s40489-017-0122-4

O Esch, B. E., LaLonde, K. B., & Esch, J. W. (2010). Speech and language assessment: A verbal
behavior analysis. The Journal of Speech and Language Pathology – Applied Behavior
Analysis, 5(2), 166-191.
 Research on Aided Language
Senner, Jill E., & Baud, Mattthew R. (2017) The Use of an Eight-Step Instructional Model to Train School
Staff in Partner-Augmented Input. Communication Disorders Quarterly, Vol. 38 (2), 89-95.

An eight step model for training classroom teachers and staff resulted in increased modeling on
speech generating devices from pre- and post-test following one two hour
training and then live modeling to staff during self-contained classroom activities.

Thiemann-Bourque, K., Feldmiller, S., Hoffman, L., & Johner, S. (2018). Incorporating a
peer-mediated approach to speech-generating device intervention: Effects on communication of
Preschoolers With Autism Spectrum Disorder. Journal of Speech, Language, and Hearing
Research,
Vol. 61 • 2045–2061
 What are
Complex Communication Needs?

Let’s define and

discuss
 Who are you?
O Who is working with individuals
with CCN?

O How many of you would describe

yourself as comfortable with
AAC?

O Who feels nervous,

uncomfortable, scared about
AAC?
We know that behavior occurs for a
limited number of purposes
 We know that behavior occurs for a
limited number of purposes

O Escape
O Attention/connection
O Ac cess to tangibles
O Sensory/Automatic
 We know we can’t accomplish teaching
communication for a variety of purposes
only using specific nouns

juice

TV

goldfish
 PROTEST/REFUSAL REQUEST

Sample Sample Phrases

(Modeling)
Phrases
(Modeling Each of our students communicates for a color Color that.
) variety of purposes. Some students use do Do it.
bad That is bad.
finished I am
problem behaviors to communicate rather down Get down.
drink Drink, please.
finished. than words or phrases. Use this guide to help eat Eat more.
no No, not that.
not Not you.
you find the CORE WORDS to teach your feel Feel it.

stop Stop it. students. Each of these words c a n be found find Find it.
COMMENT/DESCRIBE on the 84 loc ation LAMP Words for Life finished I am finished.
get Get me.
Sample Board. Go there.
Phrases go
have Have it?
(Modeling
Function When it Communicative Function hear Hear it?
)
big It is big. in Get in.
of to Target
little He is little. make Make me.
Behavior Happens
fast That is fast. mine That is mine.
slow Go slow. When a task more Do it more.
good Good work. or activity is new New one.
PROTEST/REFUSAL
bad Not bad. Escape too easy, too off Get off.
new That is new. hard, too on Get on.
like I like it. scary, or non- out Get out.
ATTENTION
preferred play Want to play?
Sample put Put it on.
Phrases When a
ATTENTIO read Read to me.
(Modeling) Attention student
N HELP ride Ride fast.
look Look at me. desires social
COMMENT/DESCRIBE sit Sit down.
come Come here. interaction
sleep Go to sleep.
you I need you. Access to When a Have some?
REQUEST some
talk Talk to me. student wants Do not talk.
COMMENT/DESCRIB talk
sit Sit down. Tangible an item or Want that.
E that
watch Watch me! s activity there Put it there.
HELP turn Turn it up/down.

Sample Can happen up Get up.

Phrases anytime; no want Want some?

Sensory assistance or CONSULT WITH SPEECH/DBS Watch it.
(Modeling watch
or interaction TO DETERMINE Wear it.
) wear
help Help me. Automatic from others is APPROPRIATE TARGET what What is that?
Remember:
You need a robust vocabulary to be able to
communicate for a variety of purposes….
 Resources for assessment
O Functional Communication
P rofile
O Communication M atrix
O VB M APP
 Access Methods
O Direct selection (touching)
O Switch access/partner assisted
scanning
O Eye gaze
 Big mac (as means of access)
Why a big mac with a BUT mac to say “YES!
rotating That’s using a big the
list of words on it doesn’t one” does.
work 8:0 0 -
Good
morning
10:00 - My YES
turn
12:00 – I’m
hungry
1:00 - My
turn
3:0 0 - I’m
ready
to go home.
 Teaching
Switch access
document (teaching
access)
Other ways to give access to words that provide means to
communicate for a variety of purposes (alternative access)
AAC Stories:
Refusal to activate
switch manually

- Classroom goal: activate a

switch for cause/effect

- OT goal: extend hand/arm

independently to activate a
switch

- Communication goal: ??
Other ways to give access to words that provide means to
communicate for a variety of purposes (direct select)
Modeling
O Use all of the above to
model
throughout the day;

O Visual – graphic about how

typical /verbal
communicators get hours
of modeling; if an
individual has only 20-3 0
minutes of therapy /week
it would take 8 4 years to
get similar input
Modeling

Image Courtesy of Kate A hern’s website

teachinglearnerswithmultiplespecialneeds.blogspot.com
The 5 elements of
LAMP
AAC Stories

Let’s all be better observers to

help
empower better communicators
 AAC Stories: perseverate on topic
swimming

swimming swimming

swimming
swimming

swimming
AAC Stories: Stim/play on device
Ketchup mustard ketchup
salt salt salt pepper pepper
salt pepper salt pepper salt
pepper

salt pepper salt pepper salt p

AAC Stories: Stim/play on device
More

music
You!

More music
you
AAC Stories

Moral of the
stories Keep
Modeling!
Ensinar NÃO!!!
(Pequenos "nãos"; desmarcado
virar em BIG nãos, eventualmente
um desses nãos é eficaz)

Tech Talk 8
(Direct
Select)
 Teach HELP!
Look!
O And
LOOK!
O And COME HERE!
O And I NEED a More music
BRE AK! you more
O And NOT THAT!

help
 O Engajamento do Ensino é mais poderoso
do que o ensino da Conformidade.
Quando você força a
conformidade, você está
encerrando as oportunidades
de comunicação
http://www.sightwords.com/2015/03/literacy-learning-for-aac-users/

http://www.wrightslaw.com/blog/child-is-disrupting-my-class-what-can-i-do/

http://www.amazingkids.org/the-childrens-institute-blog/page/3/
 Communication > Compliance
Visual supports /= Communication or Communication
Supports
AAC Stories: Comprando a programação
Observar a
interação do
aluno com o
horário levou
a uma melhor
comunicação
n intervenção.
AAC Stories:
Allowed student to
pick the activity.
Student always
left one activity
for last: Recess.
Worked on short
visit to tree,
retrieve toy
animal, then
return.
AAC Stories: Not
that!
Not yet!

OK.
Five
Not
Yets...
The problem with pounding a square peg into a round
whole isn’t that the hammering is hard work, it’s that
you’re destroying the peg.
-Paul Collins (Not Even
Wrong)
Troubleshooting common concerns
O They don’t “get it”
O They’re just playing
O Saying the same word over and over and over and
over
O What would you do if this individual was a verbal
communicator?

O We have done a disservice by teaching that if you

ask for something you get it … again,
communication is not just requesting…
We can’t figure it all out all at once…
O But… what if every individual had a least one way
to:
O Make a request
O Refuse
O Comment
O Gain attention
 Exemplos de metas…
Com acesso ao AAC (por exemplo, placa principal, dispositivo AAC), o aluno se
comunicará por pelo menos 4 funções (por exemplo, solicitar ações, solicitar
assistência, protestar / recusar, comentar) em uma sessão de 20 a 30 minutos
em pelo menos 4 pontos de dados.

Com acesso ao AAC (por exemplo, placa principal, dispositivo AAC), o aluno se
comunicará para 4 funções além de solicitar objetos/ações (por exemplo,
protestar/recusar, comentar, chamar a atenção, solicitar assistência) em uma
sessão de 20 a 30 minutos em pelo menos 4 pontos de dados.

Com acesso ao AAC (por exemplo, placa principal, dispositivo AAC) e

fornecido com não mais do que um modelo de ensino, o aluno usará uma
única mensagem de palavra para protestar/recusar dentro de 10 segundos
após iniciar um comportamento desafiador / interferente para protestar (por
exemplo, gritar, bater, etc.) em pelo menos 80% das oportunidades em pelo
menos 4 pontos de dados.
 Resources available
http://bit.ly/ASHA1350
O Core boards, with functions
O Core boards with fewer words
O Like/Don’t Like
O Year of Core
Words O
Conversation Pages
O Eye gaze
O Phrases organized by function to place in
the environment (Gail Van Tatenhove)
O Large icons for the table top
O Poster
 Your best resources
O Your fellow speech-language pathologists
O Your other colleagues (shout out to all the OTs
and PTs who are A A C specialists)
O Parents, siblings, paraprofessionals
O The A A C users that you have access to…
Modeling
Language on
Smartboard
I love Name:
Special nouns (people, foods, places)

Recurrence/continue

Stop, end or reject

Comments/Social
actions: direct others

adapted from 2012 Speak for Yourself LLC , Building Language: Where Do I Start?
 I love hugs Name:
Special nouns (people, foods, places)

Recurrence/continue
Mom, dad, sibling
Love, Mom, names, pet names,
dad, come, More, (do more,
do it more , some character names/TV
more, get more,
more down, more
play, play more)

Stop, end or reject

Comments/Social
actions: direct others

Good, bad, yes, no, Get, get me, down, play, eat, Stop! No, no
like, (like it, like that) drink, fast, slow, up, on, off, like, no eat, no
want that, get that, get up! go, not you! Not
that!

adapted from 2012 Speak for Yourself LLC , Building Language: Where Do I Start?
 Tools for AAC
Trainings
• Start with the sheet, Building Language: Where Do I Start? (from Speak for Yourself).
Fill out the sheet with families and staff to see how the child is communicating, and
brainstorm
about what next steps/words could be modeled in a routine. You can also use it with
families and staff to track new words the child is using!
• How to Model: I use these anchor chart scripts(after the Building Language Sheet). These
can be a starting “Script” to begin teaching communication during school or home routines.
You can say the sample phrases, or use your own. this is not prescriptive! This is merely a
guide so you can think about how to model. If you use AAC, the individual will, too!
• I made these materials with Nuvoice Pass, Chat Editor and Powerpoint. Click the link to
download tools on a PC only (or M ac that can use Windows OS). You can also use the
snipping tool to snip, copy and paste using a low tech page or board if you use a Mac.
Download PRC software to practice and write materials with
symbols Download TouchChat software to edit and make
materials
AAC Anchor Chart Routine: Pretend play,
Materials: TouchChat
animals, dolls, action figures, or play structure
Let’s Model: (words): get, in , on, out, more, it,

Say: Point to:

Let’s make it eat.

Get in! Let’s get on!

Get out!

Let’s get some more

AAC Anchor Chart Routine: Materials:

Let’s Model (words) :

Let’s make it eat.

Get in the water! Get on that rock.

Get out! Get up!

Let’s get some more.

AAC Anchor Chart Routine: Motor play
Materials: TouchChat
blanket, tunnel, fort, ball bin, wagon ride toy,
Let’s Model: (words): go, get, in, it, out, do, again

Say: Point to:

Let’s make it go.

Get in! / Get on!

Let’s get out!

Let’s do it again / do some more!

AAC Anchor Chart Routine: Materials:

Let’s Model (words) :

Let’s turn it / Make it Go!

It stopped.

Slow, slow……..fast!

You like that! Oh, look!

AAC Anchor Chart Routine: Play
Materials: TouchChat
sit n spin, spinning tops, you can also twirl the child
Let’s Model: (words): turn, it, stop, slow, fast, like, look!

Say: Point to:

Let’s turn it/ Let’s make it go

It stopped

Slow, slow……...FAST!

you like that! oh look!

AAC Anchor Chart Routine: Materials:

Let’s Model (words :

 Thank you
O Credit- John Halloran/PR C
O Gail Van
Tatenhove O
PrA A C tically AAC O
Project C ore
O Speak for Yourself
O All of the students/clients that were patient in our
floundering to getting to a better place of being able to
offer better access to communication.
O Last but not least THANK YOU for your attention and for
joining us today!
Questions?

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 References
O L A M P Approach Research
O Neno, C., Ellawadi, A., Cargill, L., Lyle, S. & David, A. (2016). Vocabulary Development
in School-Age Augmentative and Alternative Communication (AAC) Users. Poster
presented at the American Speech-Language Hearing Association Annual
Conference, Philadelphia, PA.
O Summary: Researchers collaborated to design and study the effects of a fully
immersive Language Acquisition through Motor Planning (LAMP)-based classroom.
Eight participants were in kindergarten and first grade and spent two hours in a
classroom co- taught by three speech-language pathologists and a special educator.
The classroom focused on instruction of a set of core vocabulary words instructed
across a variety of sensory and scientific/discovery activities. The immersive portion
of this classroom took place in large-scale language around a SMARTBoard
projecting the Words for Life language program that an adult would model the
sequences of the vocabulary being used by the teacher.
O The findings of this study indicated an upward trend in total use and duration of use
of the devices, total number of words used and the frequency of different words
used. The most significant data trend (compared to control classrooms) is that the
greatest language use was shown after the program had ended indicating that this
8-week intensive program "set the stage" for further language growth.
Research & Summaries Courtesy of the Center for A A C & Autism
 References
Zangari, C. (2013) 3 Responses to Programs that Make Kids “Prove Worthiness” Prior to
Providing Access to AAC. Retrieved from
http://praacticalaac.org/praactical/3-responses-to-programs-that-make-kids-prove-
worthiness-prior-to-providing-access-to-aac/.

Research & Summaries Courtesy of the Center for A A C &

Autism
 References, cont.
O L A M P & Language Learning
O Bedwani, M., Bruck, S, Costly, D. (2015). “Augmentative and Alternative Communication for
Children with Autism Spectrum Disorder: An Evidence-Based Evaluation of the Language
Acquisition through Motor Planning Programme. Cogent Education. 2(1).
O Summary: Eight participants received intervention with the L A M P approach and SGD for five
weeks.
All of the children had received previous intervention prior to the study, (up to 9 years) yet only 25% of
them were able to comment at the baseline assessment. At post-program assessment, all subjects
showed significant vocabulary increase, all were requesting using a symbolic means of
communication (on the device or using spoken language) and 100% of the children were
developing social communication through commenting. Other social communication
improvements were also observed in gaining attention (75%), expressing feelings (75%) and
greetings (87%). All of the children were independently communicating and were not restricted to
vocabulary that had been taught to them. Although not the focus of the study, 75% of the
children were observed to be using phrases on their device by week 5 of implementation and two
of the children in the study were observed at the week 9–10 post-program assessment to be
using words with multiple meanings in the right context.
O There were a range of other outcomes that parents, teachers and speech pathologists observed
and reported including an increase in joint attention, interest, motivation and engagement with
others, an overall increase in willingness to communicate and an overall increase in play and
social communication. For some of the children, this was the first time they were able to
communicate and participate in social situations. Behavior was also reported to have improved
with a corresponding decrease in frustration as a result of improved expressive communication.

Research & Summaries Courtesy of the Center for A A C & Autism

 References, cont.
O L A M P & Language L earning
O Pulliam, M. H. (2010). “The initial and renewed impact of an A A C device,
using the L A M P approach, on an individual with autism spectrum
disorder.” Master’s thesis. Arkansas State University, Jonesboro,
Arkansas.
O http://gradworks.umi.com/14/83/1483250.html
O Summary: Case study of a child who used the L A M P approach, then an
alternate approach, and the L A M P approach again several years later.
Vocabulary increase was only noted during the periods where the L A M P
approach was implemented. The same study was published recently in a
peer- reviewed journal but they focused on the A A C device rather than
the approach.
O Neeley, R., Pulliam, M. H., Catt, M., McDaniel, D.M. (2015). “The Impact of
Interrupted Use of a Speech Generating Device on the Communication
Acts of a Child with Autism Spectrum Disorder: A Case Study.”
Education. 9:371- 379.
Research & Summaries Courtesy of the Center for A A C &
Autism
 References, cont.
O L A M P & Language Learning
O Potts, M. and Satterfield, B. (2013). “Studies in A A C and Autism: The Impact of L A M P
as a Therapy Intervention.” Prentke Romich. Web. 2 Jan. 2015.
O http://www.gatfl.gatech.edu/tflwiki/images/4/43/LAMP_Rsch_Article.pdf
O Summary: The seven children in this study, who ranged from age three to age
seven, had a diagnosis of autism or pervasive developmental disorder-not otherwise
specified (PDD-NOS) and complex communication needs (CCN). All seven were
diagnosed with expressive-receptive language disorder. Four presented with
severe/profound apraxia. Two were found to have dysarthria of speech. Each
obtained a speech generating device (SGD) and received L A M P therapeutic
intervention. Each child demonstrated communication progress. Language samples
from six participants revealed gains as measured by mean length of utterance
(MLU) within the first year. Other progress was noted in areas such as enhanced
receptive vocabulary, spontaneous use of language, natural vocalization, and in the
reduction of difficult behaviors and increase in shared attention.
O Findings Were Presented: Satterfield, B. & Halloran, J., (2013, June). Research
Insights into L A M P (Language Acquisition through Motor Planning. Institute
Designed for Educating All Students (IDEAS) Conference. (St. Simon’s Island, GA.
June, 2013).
Research & Summaries Courtesy of the Center for A A C &
Autism
 References, cont.
O Motor Learning and Speech Generating Devices
O Dukhovny, E. Effect of Size-Centered vs. Location-Centered Grid Design on Aided A A C Productions. Poster
session presented at American Speech and Hearing Association Conference; 2015 Nov 12-14; Denver CO.
O Summary: Learning of aided A A C displays frequently begins with several large icons, with icon size decreasing as
more vocabulary is introduced (“size-centered design”). Another approach introduces small icons from the start,
with icon location maintained as new vocabulary is introduced (“location-centered design”). This on- going study
compares the effectiveness of these display designs with neurotypical adults. More subjects are needed but
location-centered design is trending toward significance for accuracy and speed of access. Findings support using
Vocabulary Builder in a complex communication system over providing limited vocabulary in an orientation that
will change as language develops.
O Dukhovny, E. and Gahl. S. (2014). “Manual motor-plan similarity affects lexical recall on a speech-generating device:
implications for A A C users.” Journal of Communication Disorders, 48, 52-60.
O Summary: Neurotypical adults were more successful with recall of motor patterns to access words on SGD when
the motor patterns for those words were dissimilar indicating that motor patterns play a role in access speed and
recall. “This study provides initial support for the use of motor sequences in SGD-based language production.... If
supported with further research findings, evidence of SGD-based motor plans for production will have significant
practical clinical implications. Prior research in A A C design has focused primarily on facilitating visual search of the
SGD interface by comparing the effectiveness of visual properties of the symbols on the grid, such as iconicity and
use of color cues (Thistle & Wilkinson, 2009). Developing motor plan automaticity is a complementary and, in later
stages of device use, possibly more efficient, approach to reducing the cognitive load of production (Grabowski,
2010). If SGD-based production quickly becomes automatic, as the current study suggests, one implication is that,
with continued SGD use, location of symbols on a grid becomes more relevant to fluent SGD production than the
internal visual characteristics of the symbols. Therefore, in planning SGD design and intervention, location of
symbols on the A A C device, and the resulting motor plans for accessing symbols, must be taken into account
along with visual considerations.”

Research & Summaries Courtesy of the Center for A A C & Autism

 References- LAMP Components
O Readiness to Learn
O Ashburner, J., Ziviani, J., & Rodger, S. (2008). Sensory processing and classroom emotional,
behavioral, and educational outcomes in children with autism spectrum disorder. American Journal
of Occupational Therapy, 62(5), 564-573.
O Ayres, A. Jean (1983). Sensory Integration and the Child. Los Angeles: Western Psychological
Services
Csíkszentmihályi, Mihály (1998). Finding Flow: The Psychology of Engagement with Everyday Life.
New York: Basic Books.
O Ayres, J., Mailloux, Z., and Wendler, C. (1987). “Developmental dyspraxia: is it a unitary function?”
Occupational Therapy Journal of Research, 7, 93 -110 .
O Dunn W. (1997). Implementing neuroscience principles to support habilitation and recovery.
In: Christiansen C, Baum C, eds., Occupational Therapy: Enabling Function and Well-Being.
2nd ed. Thorofare, NJ: SL A CK Incorporated, 186-232.
O Kranowitz, Carol Stock and Miller, Lucy Jane, The Out-of-Sync Child: Recognizing and Coping
With Sensory Processing Disorder, Revised Edition. Skylight Press. 2 0 0 5
O Lupien, SJ, Maheu F, Tu M, Fiocco A, Schramek TE (2007). "The effects of stress and stress
hormones on human cognition: Implications for the field of brain and cognition". Brain and
Cognition 65: 209– 237
O Tomcheck, Scott D. and Dunn, Winnie. (2007). “Sensory Processing in Children with and
Without Autism: A Comparative Study Using the Short Sensory Profile.” American Journal of
Occupational Therapy, 61, 190-200.
 References- LAMP Components
O Joint Engagement
O Adamson, Lauren B., Bakeman, Roger and Deckner, Deborah F., (2004). “The development of symbol-infused joint
engagement.” Child Development. 75: 1171-118 7.
O Adamson, Lauren B.; Bakeman, Roger; Deckner, Deborah F.; and Romski, MaryAnn. (2009). “Joint Engagement and
the Emergence of Language in Children with Autism and Down Syndrome.” Journal of Autism and Developmental
Disorder. 39(1): 84-96.
O Bakeman R., Adamson L. B. (1984). “Coordinating attention to people and objects in motor-infant and peer-infant
interaction.” Child Development. 55: 1278-1289 .
O Harris S., Kasari C, Sigman MD. (1996). “Joint attention and language gains in children with Down Syndrome.”
American
Journal on Mental Retardation. 100:608-619.
O Kasari, Connie; Freeman, Stephanny; Paparella, Tanya. (2005). “Joint attention and symbolic play in young children
with autism: a randomized controlled intervention study.” Journal of Child Psychology and Psychiatry. 47: 611-620.
O Kasari, Connie; Paparella, Tanya; Freeman, Stephanny; Jahromi, Laudan B. (2008). “Language outcome in autism:
Randomized comparison of joint attention and play interventions.” Journal of Consulting and Clinical Psychology.
76: 125-137.
O Lewy, Arthur L. and Dawson, Geraldine. (1992). “Social stimulation and joint attention in young autistic children.”
Journal
of Abnormal Child P sychology. 20 (6): 5 5 5 -567.
O Moore, Chris; Dunham, Philip J. and Dunham, Phil. (1995). “Joint Attention Across Contexts in Normal and
Autistic Children.” In Sigman, Marian and Kassari, Connie eds. Joint Attention: It’s Origins and Role in
Development. London: Psychology Press.
O Siller, Michael and Sigman, Marian. “The Behaviors of Parents of Children with Autism Predict the
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