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See Dr. Diehl's presentation on reading comprehension in children with autism, Reading It and Meaning It. The presentation was made at the 18th Annual Autism Conference (October 2018), sponsored by the Kennedy Krieger Institute, Center for Autism and Related Disorders (CARD).

Transcript

Meet Sylvia Diehl, autism expert

My name is Sylvia Diehl. I worked for over 30 years at the University of South Florida teaching courses in autism and augmentative and alternative communication. And after I retired, I decided that I really wanted to focus on educating parents in evidence-based practices. And so I'm really focusing on teaching them what I taught my graduate students all those years. So that's my present passion at this moment. Part of that is reading, because we know that reading comprehension is an area of need for children with autism.

Executive functioning and reading comprehension

I'd first like to start off by talking about executive functioning. We know that executive functioning impacts children with autism in all kinds of ways, particularly in reading comprehension. We also know though it's not specific to children with autism, so children with ADHD struggle with executive functioning and children with traumatic brain injury suffer with delays in that area. When we talk about reading however, executive functioning really comes into mind, because what we know about good readers is — what do they do? They check themselves. They go, "Oh, did I understand that? 

That kind of repair and reflection is part of executive functioning and that's very difficult for them. Another part of executive functioning is flexibility. And so the ability of being able to attack something flexibly is very difficult. So somebody might be reading, and it may go off in a different way and it throws them something within a reading passage may remind them — may have "pounce" on it — and remind them of The Lion King. And so then they've gone to The Lion King and they have difficulty bringing themselves back. As you can see as I'm going through, executive functioning is a really broad term that encompasses a lot of things. In fact people call it the CEO of the brain. Other things it involves are the working memory. If I have to hold things in my memory — so for instance if I said, "say 'horse, chicken, dog,'" and then, "horse, chicken, dog." 

That's no problem. But then if I say, "Okay, say those three words in alphabetical order," I have to hold that in my memory and then be able to put "chicken, dog, horse," in the right order. So that ability to hold something in the short-term memory is sometimes difficult for children with autism, although if they've put it in their memory — their long-term memory is wonderful, and they are the proverbial elephant. They just never forget. Many times those kinds of things — being able to follow through on a project — which really involves, you know, homework, science projects, all of those kinds of things — in what order — how do I get started?  All of those things really involve executive functioning issues.

Theory of mind in children with autism

The next of the core characteristics that I'd like to address is theory of mind. Theory of mind is being able to take someone else's perspective. Do I think I know what you're thinking? You know, and then later on, do I think I know what you think about someone else? And when we talk about theory of mind we don't just talk about feelings.

We also talk about words like knowing and remembering and thinking, and understanding, "How do I think? What is my opinion?" as well as, "How do you think, and what is your opinion?" We have those two things on the cognitive level, and then on an affective level we have, how does someone feel when they fell down and skinned their knee? Or how do I feel? 

Many times when I'm with children and they'll have fallen down and they have a skinned knee and it's obvious they feel awful. And I'll say, "How do you feel?" And they'll say "Happy," because they want to give you the answer that they'd like and they're not as in touch with their feelings at that point. So we spend a great deal of time trying to get them to understand not only how they feel but how others feel, and get what they know and what other people would know.

When we think about it in terms of reading comprehension, the impact is just huge. If you have a narrative story, especially if they have multiple characters, well, why did Anne want to get to the top of the hill?  And why did Joe want to get to the top of the hill? Why did they have that argument? Did they feel proud of each other when they were done? All that kind of character perspective and their own background and what their motive is comes into it. And it's all pretend, so someone has to, "It's not real," which may be difficult for children with autism. The reader has to say, "Oh, this is a pretend story about Polly, but this is what Polly is thinking." A lot of times when we're dealing with theory of mind we have to really talk about the difference between someone speaking and someone thinking and what they might be thinking.

What might be their motive behind those things? And that's very difficult for children with autism.

I think in anything, especially when you're talking about people's emotions and how other people feel, that connection is so important. That's one of the reasons why it's very important that we use evidence-based strategies like activating schemas. You know, you have to start with a child with autism where they are, what their functional experience is. 

What have they done, what do they know?  And bring those in, so they can organize their brain and say, "Oh, I understand. That's like when I did" — whatever. And that brings their learning in and organizes their learning so it makes sense.

Understanding multiple  perspectives in complex text

When we're talking about higher-level expectations in school, which in high school would be debate, compare and contrast, and those kind of higher-level arguments where you have to take multiple perspectives, that makes expository language much more difficult for children with autism.

In the beginning, expository language may be their strength because there's a paragraph about China — where China is, how many people are in China, what they like to eat, and all those facts very easy for them. Getting the big global part may not. Main topic may be difficult, so you could say, "Oh, what's the main topic?" 

And they might say, "Star Wars," because that's what they'd like to talk about. But as we go along, expositories get harder and harder and harder because we expect to know that this person thinks China is a player in the world's — in the world financial markets, and this person says "Absolutely not, we don't need China, we should pull up the United States a little bit more." same topic, but people — this person with this mind thinks this way, and this person with another mind thinks another way, is very difficult. They're trying to accept people that have two different minds in battling opinions, and that's sometimes very difficult for them.

Seeing the bigger picture

The last cognitive characteristic I'd like to talk about is central coherence. Central coherence is simply the ability to take clues that you find and form a higher meaning. So there's a trunk, there's some twigs, there's a branch, there's some leaves — "Oh, it must be a tree." 

Children with autism may look at that leaf and see every vein on that leaf much, much more in depth than we may ever see, but seeing where that leaf fits in the whole tree may be difficult for them. Now there is a little controversy about central coherence. Some people believe that children with autism have central coherence, but you have to tell them to use it.

For instance, if I gave you a worksheet with words that sound the same but mean differently according to context — if I say, "Okay, just fill in the right word in the sentence," they may not do as well than if I say, "I'd like to look — you to look at the sentences very carefully, and from what the sentence says pick out the right word that goes in that sentence."

So sometimes they have a lot of knowledge and a lot of abilities, but they aren't really sure when to use those knowledge and abilities. As it looks on the surface, without going deeper, children with autism have a terrible time with main topic, with summarization where you have to take out those important details, leave those unimportant details alone, all of those things that make you form a bigger whole. Because from their perspective they're usually only seeing those little parts of things rather than the big picture.

Adapting teaching strategies for students with ASD

One of the things I feel very strongly about is that as much as possible children with autism should be educated and have access to the general education curriculum. But because their learning style is sometimes not conducive to the learning style of the typical classroom, I find that if we can use the evidence-based practice that works with all the other children and just tweak it a little bit — so it works for children with autism, that makes that more possible and it makes the teacher be able to incorporate that child into the classroom.

Primarily we have a few things that are — literature that is specific to children with autism like anaphoric reference, some graphic organizer work, some grouping kinds of things and shared storybook reading — but for the most part what we do is take the evidence-based strategies that we know of and make them more visual to help the child with autism really understand the focus of the evidence-based strategy that we're working on, or to make the social communication part of the comprehension easier for that child to understand.

A lot of times I use thought bubbles for instance, so, "Here's Mr. Smith, he thinks that the penny has had its day and it should go away, right? And here's Mr. Robert, he thinks the penny is very, very important." I'm showing these two people who are kind of arguing with each other, and they both have a different thought bubble. Well then, I've made those two different perspectives visual for that child with autism, and they can understand the premise of what's being asked of them.

Adapting the summarizing strategy for students with ASD

The next strategy I'd really like to address is summarizing, because we know summarizing is kind of the gold star of knowing that you comprehended something. You took something you read and you put it in your own words. That means I have to choose what's important in that article. I have to choose what supports those arguments in that article and what really doesn't belong in that article.

When I'm first starting, I try to make the differences really very wide. I might take a short story and clip them — the sentences — and then put a few sentences of their narrowed and restricted interest such as Star Wars, Chewbacca, something like that in there. And I have three boxes. One says, "main, important facts of the story." One says, "supporting details."  And one says, "unimportant."  So I'm going to have them sort which ones of those stories are there. So they start to develop that pathway and that organization of their brain that as they're reading, "Oh no, I don't need that." 

That also follows over in math kinds of word problems — where people may put excessive sentences in a word problem, and even though Bobby has 17 cents I don't need that Bobby has 17 cents in that word problem.

These kinds of reading comprehension issues not only impact their reading scores but also impact their math scores, because typically children with autism do very well on the computation end of things — but the minute the language starts coming in it's a problem, because you have to use those little words, all together, you know, things that are not visually seen.

The power of semantic mapping

I'd really love to talk about semantic mapping which is one of my very favorite interventions. One, it really activates someone's schema. So we have the topic in the middle, so say the topic in the middle is China. Then as children add things, you know, "It's in Asia, it has many people," things like that, we add circles.

And it shows how various things are connected to each other very visually. And then if a child with autism comes off with, "But Chewbacca has big furry hair and he's six foot three," it's a way I can put the circle not connected to the China discussion, and show them that that topic is not appropriate at this time.

And it also helps them when they're organizing their writing. So I take it and I put the circle over here where it's not connected, and let them know that even though this is China talking time, at the end may — perhaps we could have two minutes of talking about Chewbacca.

Inference strategies for students with autism

Inference is something that is throughout every story that we read. Even through expository stories we have to make these jumps, and because it's not a direct kind of language, you know autism is a disorder of functional connectivity. So if I was to look at your brain, your whole brain would be lit up because your visual cortex would be reading the words — your language centers would be taking care of all that, and then any kinds of memories that that story brings up in you is also really lit. So you're on fire when you're reading. However, for children with autism you see a more direct kind of thing.

You see a lot of activity in that visual cortex and maybe a little bit in the language centers but much less in the environmental, kind of situational things that show those connections. So when it comes to inference we're not talking about very literal, very straightforward language. We're talking about getting information from a story and making predictions, or making assumptions on what we've read — but it's not directly there, you know. It's not, "William has a red sweater," it's like, "William looked outside and the skies were gray. He had a baseball game. I wonder what he's going to do."  And you have to infer that that's rainy.

One of the things we do intervention-wise, because children can infer when things are presented verbally and have a much more difficult time when things are presented auditorily — we start, separate from the story, where they are.  

Perhaps we have a baby with shampoo in their hair and they're crying and that kind of stuff. And we look, "What do we know, from just looking at the picture?" "Oh, the baby is crying, the baby has soap on its hair." And then, "What do we know from our head? What do we know just from our head, not what we saw in the picture?" 

"Oh, soap can sometimes get in your eyes, and soap can make you cry because it stings." And so, "Then what's our inference?" "The baby may be crying because the soap is stinging their eyes."  You give them an idea to do that on just a visual basis with a picture, and then you pull it to your text comprehension — so they can do that same order in what they're reading and see they can take part, which is similar to a question where part comes from the story and part comes from their head. They can take those and put them together and make an inference.

What do you already know?

It's very difficult for children sometimes to recognize their own knowledge. It may be specific to a person, it may be specific to an environment, it may be specific even to a story. So I always tell students, you know, you're not done unless everything you're doing is applied across materials, people, and settings.

When we're doing these kinds of things it activates what they already know, and that's important, and we need to cement that with them. "Oh look what you already know! This is already in your head. Here's my thought bubble. It's not so full." You know, "Look, you know much more about fish than I do." So they get that kind of theory of mind that goes back and forth.

Understanding character perspective

Another area of particular difficulty is character perspective. When we're understanding character perspective we have to be able to say, "Here's this pretend character Polly, and she's been raised by her grandmother, and she knows a lot about sewing and she knows a lot about playing with dolls, and here's this other character Dick who, you know, knows a lot about playing soccer." There's not much in between there.

Both of their approaches to this problem are very different. One of the things I do, again, is to use thought bubbles to show the difference between what someone is thinking and what someone isn't thinking. For instance, if you play 20 Questions with a child with autism, typically if they have a bag of things and they're supposed to give you hints, you'll say, "Is it yellow?" And they'll go, "Yes!  It's a comb." Right? It's very difficult for them to keep a secret where your mind knows it doesn't know it and my mind does. So we spend a lot of time in those areas so they can understand just the pure fact that your mind might know something that my mind doesn't.

Family storybooks

What I start really early on is to make storybooks about their family. This is the Dickinsons' TV book, so-and-so likes — this is their favorite TV, Dick likes — this is their favorite TV, Daniel Tiger is this person's favorite TV — and then we do colors of people's shirts and different kinds of categories.

And then when things come up we might say, "You know, Mom's birthday is coming up and she really wants a blouse. What color do you think the blouse could be?" And I'll hand them mother's book, and he can go through and go, "Oh, her favorite color is blue. I think we should buy her a blue blouse." You know, that kind of application starts getting theory of mind directly into their lives.

Teaching comprehension and social communication together

When we're teaching reading, because there's such little time to talk about social communication as well as some of the comprehension issues and they dovetail together so well, it's a perfect time to teach social communication along with teaching reading comprehension.

I try to choose texts that highlight those things that may be difficult for the child at that particular time and then — also add times for them to make predictions,  time for them to make inferences, time for them to look at anaphoric reference, which is those nonspecific rules that sometimes they have difficulty with.

For instance, I had a young man who was just learning how to lie, and most children with autism don't lie very well. And so whereas we've been lying since we were two or three and by the time we're in adolescence we're pretty good at it, they're just kind of starting out.

This young man was using a scale that was addressing his own behavior, and being able to tell the teacher when he really just needed a break before he had a big blowup. So the scale was from one to five, and so four would be, you know, "I'm a little shaky," and five would be, "Leave me alone, I just need to calm down."  Well, at first he was really excited about it, it was working really well.

As he learned to start lying he realized that if he said a four or a five, he could get out of work. And so we were kind of excited, because that meant — if you're lying, that means I can fool your mind into thinking of something else. So that's growth, that's wonderful growth. However, his teachers were not so fond.

So I chose a parable, The Boy Who Cried Wolf, to show the effects of lying. And he learned how to kind of predict what was going to happen, but at the same time learned some social rules about the fact that if you lie all time people aren't going to help you.

I try and choose those kinds of texts that will allow me to create many kinds of directions to hit both social communication goals and reading comprehension goals.

Teaching anaphoric reference improves comprehension

One of my other strategies, and one that is certainly literature-based — O'Connor and Klein did a wonderful study in 2004 that showed that if you support anaphoric reference, children have better reading comprehension. Well, what is anaphoric reference?  It is simply referring to something in a non-specific way.

"William had a red shirt, he really loved it," so William's responding — is the referent for "he." And many times our children, because these are not definite specified words, don't get the idea that "he" refers back to "William." For that reason their reading comprehension might be great at a two-sentence level, but if you go through in longer and longer things, they can't keep creating that memory because they're not following through who exactly is "he" over here, who exactly is "they" over there, what's this, what's that, what's anything.

Those kinds of non-specific words are very difficult. One thing that O'Connor and Klein did was as you were reading, they would take a little laminated index card and write three words and say, "Okay well, here's 'he,' who is 'he' in this story?" and have them circle all along so they're keeping that continuum.

Another thing that I do that I really like is to use tape that goes on the book — invisible tape that goes on the book, but doesn't hurt the book. And I can use it color-coded so the "he's" are all blue and the "she's" are all pink and the objects are all green, so they can see how it goes throughout, and entertain the fact that this is an integrated story rather than sentence by sentence by sentence.

And truthfully, in research terms that's one of the most powerful studies that we have — that we know that teaching anaphoric reference will increase children's reading comprehension.

Shared read-alouds for students with autism

Another thing that I think is really important in the literature right now is shared read-alouds. It's always been shown that shared reading aloud is fabulous for children when they're learning how to read, and recent studies have shown it also is fabulous for children with autism.

And recent studies have shown that it's fabulous for even older children. However, sustained silent reading — where they're just reading by themselves doesn't help. So it needs to be guided discussion that really talks to them about what's going on in it and being able to have discussions and writing down what's going on. And I think that is so rich and helpful.

It also is a perfect time to start getting them to talk with other children about what they've read and discuss what their opinion is according to others.

I love that time because it's so supporting and they learn the text so well that they're able to start forming opinions. It's one of my favorites.

The benefits of family shared read-alouds

I love shared read-alouds, because it's such a perfect thing for children and parents and such a special time and a great time to, you know, kind of take it all down just a little bit before they go to bed, and I think that's a wonderful sharing time. Teaching them how to support making predictions to teaching them how to support really listening to the words and looking at the pictures and making sense of a story by asking good questions.

A lot of times, we parent how we were parented. Some help with what kinds of questions make your child think, or not too many questions — if you ask a question every single minute or five or six questions a page, that child's going to forget what the story is about, right?  So those kinds of things make that time so much richer for the parent and for the child and really helps them.

In fact they even did a study that combines attention with the shared storybook reading with their parents aloud. And because children don't always pick out what's the most important — children with autism don't — they looked at whether if they read the story that was going to be read the next day, whether there was more attention than if they read a different story than was going to be read the next day.

And they found if they read the story that was going to be read the next day it primed that children's mind to know what to pay attention to, and they focused on it and they were able to answer questions and really be part of the classroom discussion. So I think that's wonderful and a way that parents can really help.

The strengths of students with autism

When we look at what do children with autism bring to the table? Well one, they love visuals. So the fact that they love visuals make it such fertile ground for us to teach them to read. So immediately I start to make symbols make sense to them by using either real objects — miniature objects — or line drawings or real photographs, so they start seeing that symbolization. And then that makes them excited because those are visual and that's exciting to them.

Many children — but not all — learn to decode quite early. I've had children who were three years old and could read The New York Times, and people go, "Oh my goodness!" Now, did she understand what she read? Oh, no. But she had this innate phonological sense, that she could read all of those words.

People used to say, "Oh, they have autism so that doesn't mean anything, that they can call words." Of course it does!  We spend a huge amount of time using something that's not innate, which is learning how to read, and teaching children phonics and how to read. With many children with autism we don't have to do that.

So we have extra time to spend on those semantic connections that we want to make and really make the social communication part of that. Their memory for facts is absolutely wonderful.

Using their narrowed and restricted interests to help them explore their strengths and expand it — for instance, I had a child that wanted to be a pilot. It was perfect!  You can find math in pilots, you can find geography in pilots, I can find biographies in pilots, it was wonderful. So we just expanded their narrowed or restricted interest in that.

They bring such fertile ground to want to read and such interests to want to read that it just makes you have so much fun when you're working with reading comprehension.

High expectations and positive feedback

For years we've known that if we expect a lot of children, that they do what we'd like. You know, if we tell them they're a failure then they act like a failure. If we tell them, "We expect great things," that we think they are so smart, they're going to do wonderful things, they will do well.

We haven't really considered what that's like for children with disabilities, and some recent studies have come out where it's so important that the child with autism feels like they are able, that they are empowered, that they have the power over their own mind, say to even change from being mad to being calm.

You know, many children with autism don't even think they have that power. They're waiting for someone else to calm them down, instead of internally being able to calm them down.

So as teachers — and parents — I think it's vital that we instill that in children with autism, that we think they can achieve, that we're proud of them and their achievements. So I always tell parents and teachers alike that you never say anything in front of a child with autism unless it's positive.

Now, you can describe what happened very easily. I can take a teacher and say, you know, "Johnny and I worked together very hard on reading this story today, and it was difficult for Johnny to realize what the pronouns were, but you know, before we were done, he did it." Then I just told the teacher what we did and made that connection, but I did it in a positive way.

And I think as teachers we all need to focus — and as parents — on talking about our children in positive ways. That doesn't mean you give them a reward for every single one, it means you recognize what you really enjoy about that child — and there is no child that you can't find things to enjoy in.