Teaching Children with Autism Conversational Speech Using a Cue Card/Written Script Program.

Abstract This study assessed the efficacy of a written script/cue card program to teach verbal, literate, children with autism conversational speech skills. Scripted conversations were created about abstract, age appropriate topics. Children's lines were printed on "cue cards". Three boys, ages 8,9, and 10, were taught to respond to a conversational question and then ask a contextually appropriate question. Initially, all three boys demonstrated low frequencies of conversational speech. Following intervention, all three quickly met the training criteria, and maintained correct responding without cue cards. Responding generalized to untrained topics, and across conversants and settings. ********** Severe language disturbances are a hallmark feature of autism (Charlop-Christy & LeBlanc, 1999; Charlop-Christy & Carpenter, 2000). Approximately 50% of children with autism are functionally mute (Rutter, 1978), while the remainder of the children who do speak display severe language deficits (e.g., Rimland, 1964; Wing, 1976). Speech is usually limited to simple responses to questions, or to brief expressions of a need or desire (e.g., "1 want cookie") (Schreibman, 1988). This differs dramatically from conversational speech, which requires the use of several complex language skills including initiation and expansion of a conversational topic, establishing an interactive "to and fro" pattern of a conversation, and finally, maintaining a verbal exchange. The failure of children with autism to develop conversational speech has additional drawbacks. It eliminates opportunities to have extended verbal interactions with others and to learn through social interaction. In turn, this exacerbates the severe social with drawal and aloofness associated with autism (Charlop-Christy & Kelso, in press). Research has been conducted with children with autism addressing specific aspects of conversational speech such as spontaneous speech, (Charlop, Schreibman, & Thibodeau, 1985; Charlop & Trasowech, 1991; Charlop & Walsh, 1986), verbal assertiveness (McGee, Krantz, & McClannahan, 1984), and verbal responsiveness (Loveland & Tunali, 1991; Secan, Egel, & Tilley, 1989). Although few studies have targeted conversational speech as a complete chain of behaviors, these studies were important in that they focused on teaching particular components of conversational speech (e.g., asking a question). One approach that has been successful in teaching aspects of conversational speech is the use of pre-determined scripts. Goldstein and Cisar (1992) taught preschool-age children with autism role-specific dialogue in sociodramatic play situations. A loosely structured social script was taught through modeling, prompting, and reinforcement procedures. The children first were given a description of their specific role within the play situation (e.g., carnival worker who sold hotdogs). Role-appropriate behavior and speech were prompted and modeled by the teacher. Following teaching sessions, role-appropriate speech and play in various theme-related play settings increased, and generalized to three other sociodramatic play situations. Although conversational speech per se was not targeted in this study, increasing reciprocal social interaction skills, an important aspect of conversational speech, was addressed. Recent research by Krantz and McClannahan (1993) has provided a promising procedure using written scripts to facilitate social initiations of children with autism. Written scripts consisting of 10 single-line social initiation statements (e.g., "John, did you like to swing outside today?") were given to four children with autism while working on art projects. The children were physically prompted to read each initiation, and to check off each statement after it had been said. The written script then was faded out, word by word, from end to beginning. All children increased initiations, and the initiations generalized across settings, teacher, activity, and time. …