Introduction to Language Programs

Introduction to Language Programs

Before describing programs designed to teach language, we provide some brief comments about the language delays typically seen in individuals with developmental delays such as autism, the important role language plays in human development, and behaviourists' approaches to the task of remedying language delays, with examples of outcome data from early and intensive intervention and individual differences in rates of progress.

Language Delays in Individuals with Autism

When parents are asked what area their child needs the most help at developing, almost all parents specify language. Some parents report that their child never spoke; others describe that their child made progress in language somewhere up to 16 to 24 months of age, at which point the child stopped talking over a period of a few weeks. Almost all individuals with autism vocalize, but most of these individuals are mute in the sense that they do not express words. Those individuals who do express words most often echo them either immediately or with a delay, using these words with little or no meaning. In short, individuals with autism have little or no expressive language. When asked how much the individuals understand what is said to them, it soon becomes apparent that there is a considerable delay in receptive language as well? There are exceptions to this in that some individuals with autism have relatively well-developed language skills, both expressive and receptive. Such occurrences, however, are rare. It is best to be prepared for much work when helping a student with developmental delays acquire language.

When asked what they consider to be the second most important problem, most parents refer to their child's tantrums. Tantrums often start in the first year of life. By the age of 3 or 4, one may observe the first signs of self-injury, as in head banging, and aggression toward caretakers, such as biting and scratching. From what is written about tantrums in Chapters 5 and 6, it seems likely that the delay in language acquisition and the excessive amount of tantrums are interrelated in that the individual's tantrums are a form of nonverbal communication based on an inadequate mastery of language.

Parents and teachers who become familiar with research related to autism and mental retardation are likely to learn of opinions to the effect that language development is mediated by some innate neurological structure, that this structure is damaged in individuals with autism and other developmental delays, and that language cannot be taught but rather develops according to neurologically regulated maturational processes. In short, parents and teachers receive the impression that there is nothing much one can do to help individuals with developmental delays learn language.

The language programs in this teaching manual will help all students develop language. Some students will acquire language that appears indistinguishable from that of typical individuals. We call these students auditory learners. Others, labelled visual learners, will not progress as well with the language programs as they are now designed. We attempt to help these latter students communicate as well, by emphasizing visual forms of communication as in the Reading and Writing Program (Chapter 29) and the Picture Exchange Communication System Program (Chapter 30).

The information we provide concerning establishing and strengthening language behaviours illustrates that the same learning principles used in the first hours of treatment (see Chapter 9) can be employed as building blocks when teaching the student communicative language. An additional teaching process that is essential to teaching complex language, discrimination learning, is described in detail in Chapter 16

The Importance of Teaching Language

One may infer that a person who experiences severe delays in vocally or visually mediated language will be placed outside so many social influences that it will be difficult or impossible for that person to grow up and develop as a typical individual. How can a parent or teacher help an individual develop to his maximum potential if that individual cannot comprehend what is said to him or understand what he reads in books? How can a person develop emotionally when he is unable to describe his feelings to others or understand what others describe about their own emotions? How can a person develop relationships with peers if he cannot converse with them? If a person's 'public language' eventually becomes the building block for that person's own 'private language,' how can a person without language skills evaluate and plan actions on a day-to-day basis? When parents state that their first priority is to help develop their child's language, they are in full agreement with most professionals that the acquisition of language is a critical contributor to a person's development. It is in recognition of the importance of language that the majority of our programs help teach language.

Typical persons acquire language without anyone knowing exactly how this acquisition occurs. We do know, however, that typical individuals acquire language in part by interacting with others who speak, and that this acquisition occurs during most of the individual's waking hours, 7 days a week, year after year. We also know that the process is gradual and stepwise. If language is learned, then the learning process of even a typical individual must be described as slow. Using a typical individual as a model, one may infer that teaching language to an individual who is delayed in language development will be a piecemeal process and require a great deal of time even if the individual practices language most hours of the day, 7 days a week for many years.

Accounts about language development, as written by developmental psychologists and linguists, have been largely descriptive and highly theoretical, allowing for no specific guidelines on how to teach language. Some 35 years ago, behavioural psychologists began to explore procedures for teaching language. The teaching procedures developed were based on sound scientific data and were described in sufficient detail so as to be replicable by others. Many of these procedures generated very advanced use and understanding of language. We have been able to take advantage of the discoveries of these investigators in presenting the language programs in this manual. The yield of behavioural psychology has developed knowledge in a gradual and incremental manner, and, although there is still much that needs to be discovered, the future looks brighter now for those individuals who need help in learning to talk.

Overview of the Language Programs

The language programs presented in this manual have been arranged in order of difficulty, with receptive language programs preceding expressive language programs. Examples of how to teach receptive language are presented in Chapters 15, 17, and 18. These chapters are followed by Chapter 22, which outlines procedures for teaching students to imitate the speech of other persons. Acquisition of verbal imitation is essential to mastering subsequent programs emphasizing expressive language, as in the labelling of objects and behaviours (Chapters 23 and 24, respectively). Expressive and receptive language programs go hand in hand and start with the identification and labelling of objects in the student's immediate environment. Programs that help the student describe the behaviours of others as well as her own behaviours are then introduced, followed by programs that teach the student to obtain what she desires. The language programs in this manual also include procedures for teaching abstract concepts such as colour, size, and shape (Chapter 25), and prepositions (Chapter 27). Procedures for teaching the beginnings of grammar are presented in Chapter 26.

More advanced language programs will be described in an upcoming volume, which includes procedures for teaching the student pronouns, cause-effect relationships, an understanding of time, how to converse with others, how to describe her own and other people's feelings, and how to describe events that have happened in the past as well as what may happen in the future. Other programs in the advanced volume help the student listen to stories told by others, tell her own stories, and use language to facilitate imagination. Emphasis is placed on the social and functional aspects of language. All language programs are generalized from the one-on-one teaching situation to family, peers in the community, and especially school environments.

Although there is no clear-cut division between early and advanced language, we decided to make the division after prepositions (which are in this volume) and prior to pronouns (which are in the upcoming volume). We placed the division at this point because most visual learners encounter significant problems acquiring personal pronouns and other advanced and abstract vocal language. Nevertheless, visual learners have made major progress when taught how to read and write (Chapter 29).

Note that in this manual, language programs are intermixed with programs that are intended to help the student obtain a necessary context for and better comprehension of language. For example, the Matching and Sorting Program (Chapter 12) helps the student identify (discriminate, attend to) objects in her environment, a skill critical to learning early receptive and expressive labels. The Nonverbal Imitation Program (Chapter 13) teaches the student to imitate the actions of other persons and is important for several reasons, one of them being that imitation can be used to prompt (i.e., model) the correct nonverbal response to verbal requests made by the teacher.

Every attempt has been made to intermix language and non-language programs in a way that should help accelerate the student's learning, although we do not claim to have the final answer on how to sequence these programs optimally. It is reasonable to plan the student's program schedule according to a developmental sequence for no reason other than that, in development, simple behaviours precede the more complex ones. However, a typical developmental sequence may not always be ideal. For example, although there appears to be general agreement in scientific literature that receptive language (understanding) precedes expressive usage of language, recent data suggest that the opposite may occur in many students with developmental delays; that is, some of the students learn expressive labels before they master receptive counterparts. To illustrate, we have observed that some students make no progress in learning receptive identification of objects even after 2 months of intensive training. When expressive labelling of objects is first introduced, however, some of these same students acquire this skill within a day. All of this underscores the necessity of being flexible, willing to explore alternatives, and, most important, adhering to scientific procedures whereby data from language programs are tested and reviewed. If one proceeds according to scientific paradigms, one will be in a position to continuously update and improve upon the treatment presently available.

A Learning Model of Language Acquisition

It may be helpful to illustrate how language, when divided into expressive and receptive components, can fit into the learning model that forms the basis of our treatment programs. Consider that in receptive language, introduced in Chapter 15, the student receives the adult's message. The stimulus is verbal and the response is nonverbal; the teacher speaks to the student and the student behaves in accordance with the adult's request. For example, the adult may ask the student to stand up (a verbal stimulus). When the student does as requested (the student stands up, a nonverbal behaviour), one may infer that the student has acquired part of the meaning of the words stand and up.

We illustrate expressive language, introduced in Chapters 23 and 24, as the flip side of receptive language by considering the stimulus to be nonverbal and the student's response to be verbal. For example, the adult may hold up a glass of milk (a nonverbal stimulus) and teach the student to say, 'Milk' (a verbal response). Receptive and expressive language components may, at a later stage in teaching, become related by intermixing them. For example, the student may be asked to sit and, while seated, then be taught to label the behaviour by saying, 'I am sitting.' Mastery of such relationships gives further evidence that the student's language is acquiring meaning. In everyday terms, the student is beginning to know what he and others are talking about. Another relationship occurs when both the stimulus and the response are mostly verbal. For example, the adult may ask, 'What is your name?' and teach the student to answer, 'John.' Verbal interactions are often considered to be the basis of conversational speech.

The language relationships just described are summarized in Table 14.1 as three basic discriminations. In Discrimination 1, the student must learn to discriminate (attend to) an adult's speech in order to master receptive language. The student may not comprehend what is said to him in the beginning of treatment, behaving as if he cannot hear. By selective use of reinforcement (as presented in Chapter 16), one can teach the student to attend to (discriminate) what other people say. The adult knows that the student comprehends what is said to him when the student behaves in accordance with the adult's requests. Discrimination 1 may be simple, such as when the student learns to point to a doll (a nonverbal response) when the teacher requests, 'Point to doll' (a verbal stimulus). Or, the discrimination may involve a complex stimulus, such as 'Place the milk in the refrigerator after you have filled your glass.' If the student behaves correctly in response to this request, he understands a complex sentence involving a preposition (in), pronouns (you and your), and a temporal arrangement (after).

TABLE 14.1 Three Basic Discriminations in Language Training

Discrimination Stimulus Response Language Type

In Discrimination 2, the student must learn to at' tend to a particular object or nonverbal event and then signal to the adult that he is attending to that event by describing it correctly. As with Discrimination 1, Discrimination 2 may consist of a simple discrimination, such as responding with 'Apple' when shown an apple. The discrimination may also be complex; for example, the student may describe his morning activities by saying, 'I got up and brushed my teeth, then I had breakfast and went to school.'

Both the input and the response are verbal in Discrimination 3 (e.g., conversational speech such as 'What is your name?' 'My name is Lisa,' and 'Where do you live?' 'I live in Washington'). Like the other two discriminations, the stimuli in Discrimination 3 may be simple or complex. Complex stimuli may consist of the student saying, 'I want to play with Power Rangers,' and another individual responding, 'You don't have Red Ranger.'

All three discriminations contain mixtures of both verbal and nonverbal stimuli. For example, an adult may ask the student, 'What is your name?' To answer that question correctly, the student must discriminate (attend to) both verbal and nonverbal stimuli (the question and himself as a person). A more comprehensive definition of these discriminations would note that the presence of vocal versus non-vocal stimuli is a matter of degree (e.g., in Discrimination 1, the stimulus is largely auditory but may contain visual components).

It is essential that the teacher become familiar with discrimination learning procedures (see Chapter 16). If the teacher does not learn to apply such procedures, the student cannot be taught to overcome his language delays. This manual provides many concrete illustrations of discrimination learning. It is our experience that once the adult begins to practice the programs contained in this manual, technical terms such as discrimination learning will be readily understood and used in a constructive and creative manner. This is true not only for language, but also for most of the behaviours the student must learn in order to overcome his behavioural delays.

Overall Outcome of Language Programs

As mentioned earlier in this manual, there are significant differences among individuals within the same diagnostic category. We have found it helpful to classify students with developmental delays as being either visual or auditory learners. Auditory learners perform well on both auditory and visual tasks, and they are the ones who progress the furthest in the language programs as they are currently constructed. Perhaps the earliest sign that the student is an auditory learner is the student's relatively rapid rate of acquisition of verbal imitation (Chapter 22) and expressive language (Chapter 23). About 45% of a sample of students with autism acquired vocal language skills comparable to those of typical persons (McEachin, Smith, & Lovaas, 1993).

Visual learners vary considerably in their mastery of vocal language. Most visual learners make some progress in vocal language but have difficulty expressing them clearly. The expressive language of visual learners often appears stilted and is sometimes difficult to understand. Although many of these students can learn to express basic needs, some fail to master even the simplest vocal language skills. To help such students, we developed the Reading and Writing Program (Lovaas, Koegel, Simmons, & Long, 1973). The 1960s saw the inception of this program when we taught sight reading to echolalia children. This effort paralleled the endeavours of Hewitt (1964) and Sidman (1971). We hoped that, by learning to read, the children would acquire knowledge about the world through newspapers and books. No such development took place; the children did not attach meaning to what they read. They were individuals without experience, much like infants. It was as if the world had passed them by. This point is emphasized because we find it necessary to place the Reading and Writing Program in the context of the other programs in this and similar teaching manuals that help students attach meaning to the words they encounter. The meaning of a word, phrase, or sentence is provided by the stimulus context, and that context cues a response. This is consistent with the information provided in Table 14.1. Without a broad context or range of meaning, the student is likely to use a newly acquired printed word (or some other symbol, such as a picture) to facilitate only the simplest form of meaningful communication.

In our studies, we had the advantage of working inductively without significant reliance on widely available theory, which almost always emphasized irreversible pathology. The value of inductive empirical work is the objectiveness of such work; the data accumulated from inductive research closely guides the investigation. Through our studies we observed that students who failed to master vocal language still performed well in programs involving visual stimuli, such as Matching and Sorting and Nonverbal Imitation (Chapters 12 and 13, respectively). We therefore found it appropriate to use the distinction between visual and auditory learners to replace the grouping that some have referred to as low functioning versus high functioning. At this time, the failure to adequately teach visual learners can most profitably be attributed to our failure as teachers to develop more effective programs.

A distinction is also made among people in the typical population with respect to individual differences in preferences in modes of presentation. Some persons acquire and retain educational material more readily by visual rather than auditory modes of presentation; others prefer to learn by hearing rather than seeing educational material. Such observations help erase the idea of a qualitative difference existing between individuals with and without developmental delays, prompting us once more to look at the average environment for guidance in constructing educational environments for the non-typical person. Future research may well identify interactions among visual and auditory language programs which, in turn, will facilitate the acquisition of vocal language for visual learners.

Early on in our work with students with developmental delays, we hoped that the acquisition of language would result in major personality reorganization; we hoped that language would function as a pivotal behaviour. For example, we anticipated that, once language was mastered, the students we worked with would come out of their 'autistic shells' and start to behave more like typical individuals. We found this not to be the case. In technical terms, there appeared to be little or no evidence of response generalization (e.g., the acquisition of prepositions did not result in the mastery of pronouns). This was a bitter disappointment because we counted heavily on the role of language as facilitating a major leap forward. We found it discouraging that the students possessed little native knowledge, and that each student was instead a tabula rasa onto which experience had yet to be written. Despite these disappointments, we did find that the students' newly acquired language skills facilitated interactions with parents and peers, leading to less frustration on all sides. These language skills also helped the students learn more independently from their everyday environments and not only from explicitly designed teaching programs. In short, it was easier to teach the students the many cognitive, social, emotional, and self-help skills that were necessary for development once progress had been made in their understanding and use of language.

There is great efficiency in the learning processes introduced in this manual. We recognize that parents and other adults who work with students with developmental delays need to learn a great deal about teaching and be prepared for much hard work. In the future, there will be many more teachers and other professionals who will be knowledgeable in the effective teaching of students with developmental delays, lessening the burden on parents. We apologize for the 20- to 30-year delay in the application of effective treatment by the professional community.