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An Overview Of Katie Anawalt Certified Soma® Rapid Prompting Method Provider Speech-Language Pathologist Assistive Technology Specialist Los Angeles, CA NATIONAL TACA AUTISM CONFERENCE Costa Mesa, CA October 18, 2019 ▪ Acronym ▪ Created by Soma Mukhopadhyay ▪ Defined as “a teaching method that empowers the learner with the best possible means to express his/her learning, understanding, reasoning, and thoughts” (S. Mukhopadhyay, personal communication, July 26, 2011). ▪ An engaging academic method that leads toward communication. ▪ Distinct method ▪ Strategy that has been used to help teach people with autism and/or other disabilities ▪ Core Features of RPM ▪ Presumes competence ▪ Academic lesson planning and implementation ▪ The open learning channels (VATK) ▪ The 4 goals of an RPM session (CCTS) ▪ RPM involves no training. ▪ RPM is defined by its AAC materials. ▪ RPM Provider always holds the letter board. ▪ RPM Provider always provides the same fixed level of VATK prompts that are constant and repetitive. ▪ RPM never fades prompts. ▪ RPM does not aim for independence. ▪ RPM does not aim to fade the letterboard. ▪ RPM does not set baselines and goals. ▪ RPM precludes other methods and therapies. Multiple modes of communication are not encouraged. ▪ RPM is harmful. ▪ RPM is pseudoscience. ▪ “Independent communication is always preferable to assisted communication, as long as the independent skills allow the person to meet his or her communication and cognitive potential” (ASHA, 1994). ▪ In RPM, "prompt dependency is preferred to the alternative of allowing no response or no learning to occur" (HALO, n.d.). ▪ Reasoning ▪ Motivation ▪ Emotional Readiness ▪ Sensory Readiness ▪ Motor Readiness ▪ Self-regulation ▪ What Does Independence Mean to You? ▪ Self-esteem / Self-confidence ▪ Anxiety - anxiety is linked to reduced independence (Esbensen, Bishop, Seltzer, Greenberg, & Taylor, 2010) ▪ Fear of voice being taken away – wanting independence, but also wanting to maintain being heard. ▪ Parental/caregiver concerns about transition process ▪ Hyposensitivity (under-responsiveness) / hypersensitivity (over-responsiveness) ▪ Sensory avoidance / sensory seeking ▪ Enhanced sensory perception ▪ Difficulties with sensory integration ▪ Over-preoccupation with sensory aspects in environment (Grapnel, Cicchetti, & Volkmar, 2015) ▪ Some research provides evidence that autism is primarily a neuro-motor condition instead of a social or behavioral one (https://unitedforcommunicationchoice.org/research/). ▪ Dyspraxia = difficulty planning what to do and how to do it (e.g., think, plan, go, reflect on feedback) ▪ Impairments in motor movement are not limited to motor stereotypies (Lord et al., 1994; Loftin et al., 2008) ▪ Might see… ▪ early motor delays ▪ gait abnormalities (stiffer gait, trouble maintaining a straight line when walking) ▪ difficulties with gross and fine motor coordination ▪ postural control/stability challenges - SEATING ▪ imitation (resonating the actions of others with own motor planning) ▪ difficulty with body awareness ▪ hyperactivity & impulsivity ▪ Sensory-motor differences are likely to affect one’s actions (one’s readiness for learning and independence, level of attention, over and under stimulation). ▪ RPM carefully observes and pays attention to sensory-motor inputs that are important for targeting sensory-motor ability. Increasing motor demand and/or fading prompts Decreasing complexity of message ▪ According to Hume and Odom (2007), independent functioning can be defined as “on-task engagement in an activity in the absence of adult prompting” (p. 1166). ▪ Per Zimmer-Gembeck and Collins, independence is “enacting self-government, self-regulated behaviors that are based on one’s personal decisions” (as cited in Hume, Boyd, Hamm, & Kucharczyk, 2014, p. 103). ▪ “Independence generally refers to aspects of human functioning that involve being a physically and mentally separate individual” (Raeff, 2010, p. 31). ▪ Individual demonstrates the capacity to act on his or her own. ▪ Freedom of choice and social responsibility - Independence and interdependence are compatible and can coexist. ▪ Independence with choices vs. letterboard ▪ What is the socially dominant notion of independence in your culture? Does that dominant notion fit in with your personal view of independence? ▪ What does independence mean to you? To people in your family and community? ▪ What does it mean for someone who may always need a communication partner? ▪ There are multiple varieties of independence. ▪ Everyone’s situation is different. ▪ Independence is not a simple yes/no dichotomy. It is on a spectrum. ▪ Dynamic – varies across contexts & stages of development ▪ Cultural understandings of independence ▪ Define oneself separately and/or in relation to others ▪ Autonomy is independent decision making; acting on one’s own interests, preferences, and abilities (Wehmeyer, 2000) ▪ Functional Independence = ability to complete an activity or task (which may or may not be one’s interest/preference) without prompting from others. ▪ Can be independent, but not autonomous ▪ Can be autonomous, but not independent ▪ “The development of independence/behavioral autonomy can be challenging for ALL adolescents as high school students struggle to understand and respond to expectations of caregivers, multiple school staff, and peers, while also beginning to assert their own ideas and decisions” (Harter, 1999, as cited in Hume pg. 104) ▪ Add in the multi-dimensional challenges of individuals with disabilities who use RPM to learn and to communicate. ▪ Prompt dependency ▪ Poor generalization of skills ▪ Degree of impulse control ▪ Sensory processing differences ▪ Difficulties with organization and sequencing due to executive functioning difficulties ▪ Challenges with initiation & remaining engaged with materials ▪ Poor self-regulation (Hume, Boyd, Hamm, & Kucharcyk, 2014) ▪ Encoding challenges - Difficulty shifting thoughts or actions according to changes in environment & relating new stimuli to past experiences ▪ Interfering behaviors ▪ Communication partner’s perspective, level of understanding & training, listening skills and feedback. ▪ Presumes competence - RPM provides increased expectations and opportunities for independent actions ▪ Present age-level material when evident ▪ Communication – have a back-and-forth about process ▪ RPM can set the stage for individuals with disabilities to engage in choice-making and exploration, and allow them to exert control. ▪ RPM introduces new skills gradually - learn to fail and take risks in a supportive environment ▪ Positive and encouraging feedback – validate any attempt ▪ EBP embedded in RPM that support independent functioning. ▪ Communication Partner Training ▪ Environmental modifications ▪ Natural praise to promote independence and reduce prompts ▪ Modeling ▪ Communication to determine underlying purpose of an interfering behavior ▪ Prompt fading via graduated guidance and time delay ▪ Social narratives that engage the mind ▪ Task analysis – break a skill into smaller steps (handwriting) ▪ Sensory Supports catered to open learning channels ▪RPM helps organize the individual’s system via VATK prompts so he/she can express his/her thought in some fashion and build from there. ▪Never stagnant ▪Look at best environment – seating ▪Announce or Keep it on the Down Low ▪Establish rapport before working on Independence ▪ Trained ▪ Observant ▪ Listener ▪ Provides Feedback ▪ Working on independence minimizes the perception and/or potential for influence and minimizes the reliance on a particular support person and maximizes communication opportunities (Ashby, 2015, p. 1476) ▪Independence is complex. ▪It takes time and varies based on the individual. ▪RPM recognizes and is adaptable to the complexities of achieving independent communication. Ashby, C., Eunyoung, J., & Woodfield, C. L., Vroman, K., & Orsati, F. (2015). Wishing it go alone: The complicated interplay of independence, interdependence, and agency. Disability and Society, 30(10), 1474-1489. doi:10.1080/09687599.2015.1108901 Esbensen, A., Bishop, S., Seltzer, M., Greenberg, J., & Taylor, J. (2010). Comparisons between individuals with autism spectrum disorders and individuals with down syndrome in adulthood. American Journal of Intellectual and Developmental Disabilities, 115, 277–290. doi:10.1352/1944-7558-115.4.277 Grapel, J. N., Cicchetti, D. V., & Volkmar, F. R. (2015). Sensory features as diagnostic criteria for autism: Sensory features in autism. Yale Journal of Biology and Medicine, 88, 69-71. Hume, K., & Odom, S. (2007). Effects of an individual work system on the independent functioning of students with autism. Journal of Autism and Developmental Disorders, 37(6), 1166-1180. doi:10.1007/s10803-006- 0260-5 Hume, K., Boyd, B. A., Hamm, J. V., & Kucharczyk, S. (2014). Supporting independence in adolescents on the autism spectrum. Remedial and Special Education, 35(2), 102- 113. https://doi.org/10.1177/0741932513514617 Loftin, R. L., Odom, S. L., and Lantz, J. F. (2008). Social interaction and repetitive motor behaviors. J. Autism Dev. Disord., 38, 1124–1135. Lord, C., and Jones, R. M. (2012). Annual research review: re-thinking the classification of autism spectrum disorders. J. Child Psychol. Psychiatry, 53, 490–509. McCleery, J. P., Elliott, N. A., Sampanis, D. S., & Stefanidou, C. A. (2013). Motor development and motor resonance difficulties in autism: Relevance to early intervention for language and communication skills. Frontiers in Integrative Neuroscience,7(30), 1-20. doi: 10.3389/fnint.2013.00030 Raeff, C. (2010). Independence and interdependence in children’s developmental experiences. Child Development Perspectives, 4(1). 31-36. Torres, E. B., & Donnellan, A. M. (2015). Editorial research topic: Autism: the movement perspective. Frontiers in Integrative Neuroscience. doi: 10.3389/fnint.2015.00012 .
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