By: Elizabeth Zeppernick, M.Ed., BCBA, LBA

When compared to their neurotypical peers, individuals with Autism Spectrum Disorder (ASD) are more likely to have difficulty in maintaining conversations.  Researchers are motivated to discover and, in turn, clinicians are motivated to implement effective interventions and training procedures for building conversational skills.   

Past research has demonstrated that script training can effectively target this skill deficit (Wong et al., 2015).  Script training is the creation of and instruction in a predictable and appropriate string of sentences and phrases to facilitate a dialogue.  Scripts can be read, memorized or modeled by a support staff and then repeated by the individual in order to facilitate communication.  The scripts are meant to be relevant and functional for the individual.  Examples include training of appropriate responses and questions when meeting someone new, when ordering at a restaurant or when engaging in play when a peer holds an enticing toy.  Script training can be used during vocational training with an adult who must respond when a customer approaches them asking for help. 

Ideally, this type of support can be discrete so a support staff standing next to the individual is rarely socially acceptable or ideal!  Script training should also be flexible as it can be difficult, if not impossible to control what the responses of the other speaker.  For instance, if you teach an individual to say, “How are you?” and their companion answers, “I’m terrible,” then the follow up response is different than if they had answered, “I’m great.”

To study an intervention that could be both discrete and flexible, researchers Canestaro et al. (2021) evaluated the use of an Apple Watch® to deliver text-message prompting.  Working with three children aged 5-10 with ASD, they studied the effect of this intervention to increase both conversational initiations and responses. 

The three participants were chosen because they demonstrated difficulty in initiating and maintaining conversations with peers.  All participants had passed a reading pre-assessment to ensure they had the minimal skills required to read words and phrases that would be used during the intervention.  

Researchers recruited peers of typical development to serve as the participants' partners in conversation.  Initial baseline data was taken, which means the researchers measured the participants conversational skill level prior to training in order to later determine the effectiveness of the intervention.   

During training, the scripts or responses were texted to the Apple Watch® from a contact that was saved as SAY THIS.  The sender was out of sight and relied on livestream video to hear and see the conversation in real time.  When collecting data, initiations and responses were counted if they were both contextually appropriate and made when the participant was oriented to face the conversation partner.  

The initial stage of training consisted of video modeling and prompting the participants to open and read a text message when the vibration signaled that a message was received. Training from the researchers was done in a least-to-most prompting hierarchy which means the minimum amount of support is given in order for the individual to perform independently.  The hierarchy was as follows with as few steps being taken as necessary to ensure the success or accuracy of the participant: 

1. Verbal prompt, “Open the text message.”

2. Verbal prompt plus a gestural prompt which included pointing toward the watch. 

3. Physical guidance to open the text message. 

Once eight consecutive text messages were independently opened and read, the participant transitioned to training with a novel adult and after that stage, their peer served as their partner in conversation.  

Two of the three participants demonstrated increases in their initiations and responses.  The third participant demonstrated challenging behaviors in relation to wearing the watch but once the watch was removed, his initiations and responses increased. 

Results of this study aligned with a previous study by Lopez and Wiskow (2019) which also demonstrated that text messages received via a watch can be an effective means of prompting children with ASD.  The discrete, minimally intrusive intervention is socially acceptable and allows for a degree of flexibility that encourages initiations and responses in real-time so that they align with the natural and spontaneous responses of a peer.  

Sources: 

Canestaro, V. M., Akers, J. S., & O’Guinn, N. (2021). Promoting reciprocal conversations in children with autism using text-message prompting. Behavioral Interventions, 1-11. https://doi.org/10.1002/bin.1822

Lopez, A. R., & Wiskow, K. M. (2019). Teaching children with autism to initiate social interactions using textual prompts delivered via apple watches®. Behavior Analysis in Practice, 13, 641-647. https://doi.org/10.1007/s40617-019-00385-y

Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fetting, A., Kucharczyk, S., Brock, M. E., Plavnick, J. B., Fleury, V. P., & Schultz, T. R. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45(7), 1951-1966. https://doi.org/10.1007/s10803-014-2351-z

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