Supporting Diverse Learners with Autism Through a Culturally Responsive Visual Communication Intervention

Abstract

Rates of inclusion for children with disabilities continue to increase. Schools are also experiencing an increase in culturally and linguistically diverse students. As such, the diversity of children in classrooms across the country continues to dramatically shift and teachers are challenged to implement culturally responsive and relevant interventions. Social skills are a significant area of development for which children with disabilities frequently require intervention. Yet, important considerations regarding cultural awareness and relevancy should be made when implementing social skills interventions as research emphasizes the necessity of diverse representation in interventions. This column discusses the implementation and cultural considerations of a visual communication support used to increase social engagement among children during mealtimes.

Keywords

children disabilities diversity inclusion mealtimes

Classroom diversity within the United States has continued to expand as an increasing number of students with autism spectrum disorder (ASD) are educated in inclusive classrooms alongside their typical peers. Simultaneously, schools are experiencing an increase in culturally and linguistically diverse students (McFarland et al., 2017). This presents unique opportunities and challenges to educators in ensuring all students have access to appropriate and culturally relevant instruction and are meaningfully included. One particular challenge is implementing culturally responsive and relevant interventions.

Culturally responsive interventions are important because they help foster equity through inclusion and community membership. Furthermore, cultural awareness on the part of educators is critical because providing evidence-based services requires both professional expertise and the knowledge of family values and culture. Culturally responsive and relevant teaching highlights what unique students and families bring to learning and incorporates their perspectives and cultures. In using culturally responsive and relevant instruction, educators further students’ self-determination and cultural competence while understanding and supporting students’ communication styles (Gay, 2010).

Without considering culture in developing and implementing interventions, teachers risk alienating families and students by (a) mistaking unfamiliar cultural norms for inappropriate behavior, (b) selecting interventions and target skills that are not prioritized within a family, and (c) ultimately choosing interventions that are not sustainable due to low social validity and acceptability (Fong et al., 2016). By incorporating culturally responsive and relevant teaching practices into interventions, educators may increase students’ access to quality services (Fong et al., 2016) and increase the overall acceptability and fit of the intervention. Implementing culturally responsive and relevant interventions is of particular importance when supporting the social development of diverse students with ASD as social skills interventions are particularly susceptible to these risks. Without careful consideration of culturally responsive and relevant pedagogy, social skills instruction may inadvertently privilege the norms of one culture over another, or target behaviors that are not a priority to the student’s family.

Social Development and Autism

Instruction targeting social communication skills is critical as they play an important role in supporting meaningful and successful inclusion. Social communication skills enable children to access desired outcomes such as academic engagement and integration into the classroom’s social learning community. These skills also support positive behavioral outcomes, as students utilize these skills to navigate the classroom and create peer friendships thereby accessing community membership (Bauminger et al., 2010). Schwartz (2000) identifies, belonging as community membership, as a significant, poignant outcome of inclusion settings. Community membership remains important beyond school settings, with effective social engagement linked to higher quality of life in adulthood for individuals with ASD and other disabilities (Howlin et al., 2004).

Yet students with ASD often differ in their social development from their typically developing peers, leading to challenges in social awareness, social competence, peer interactions, and overall social communication (Locke et al., 2017). These social differences often result in students with ASD having fewer friends, experiencing higher rates of loneliness, and feeling less socially integrated into their classroom structure, leading students with ASD to be often situated outside existing social networks within classrooms (Locke et al., 2017). In other words, students with ASD often do not demonstrate belonging to a group of peers and/or teachers. Unfortunately, if not addressed, social difficulties are likely to continue throughout the school-age years and into adulthood, affecting their quality of life across the lifespan (Locke et al., 2017). As such, interventions that support the social communication skills of students with ASD are critical.

This column describes the development and cultural considerations of snack talk, a naturalistic visual communication support for school-age students with ASD designed to increase community membership through conversation engagement and social communication skill development at mealtimes such as breakfast, snack, lunch, or dinner. This intervention is suited for students with ASD throughout the school-age years who would benefit from additional support in social communication. Educators can use this intervention to support students with ASD in increasing the complexity of their social communication skills as well as increase their ability to use these skills independently. Particular attention in the following is given to procedures for adapting the intervention to meet the needs of students from culturally and linguistically diverse backgrounds as well as students with diverse communication needs.

Snack Talk: A Social Communication Support

Snack talk (Gauvreau, 2019) is a visual support intervention used to promote and facilitate social communication among peers during the mealtime routine. Visual supports are identified as an evidence-based practice (Wong et al., 2015) as well as a naturalistic instructional approach (Division for Early Childhood of the Council for Exceptional Children [DEC], 2014). The visual support in this strategy includes a leading topic question and a variety of visuals representing different answers. Snack talk cards are created based on topical interests of targeted students. Interests are determined by teachers and classroom staff through partnership and conversations with students and families. Following identification of student preferences, these visual communication supports are created using simple internet searches for visuals that correspond with the topic question and possible answers.

This instructional strategy is implemented during mealtimes. One consistent routine commonly occurring in many educational, home, and community settings is mealtime, yet this time is often not utilized for meaningful and targeted instruction. Although differences are present, these settings often include different family members, peers, and/or teachers. Opportunities for social interactions during mealtimes are presented across these contexts, affirming the social significance of this routine. In addition, families of diverse cultures, socioeconomic status, and overall norms and beliefs identify mealtimes as a valued daily routine (Jarrett et al., 2016), emphasizing the potential of utilizing mealtimes as a context for implementation of culturally responsive and relevant intervention. Furthermore, in addition to providing numerous instances for embedded instruction, opportunities to incorporate each student’s family values, beliefs, and culture into intervention are also present. Mealtimes also provide a context where students sit in close proximity to each other, fostering engagement in social interactions and conversation (Snow & Beals, 2006). While proximity may facilitate conversation engagement for some students, for many students with ASD, additional supports are often needed to promote engagement in meaningful social interactions, highlighting the importance of this intervention as a whole.

This strategy provides supports for students with ASD to effectively engage in social conversations regardless of their modality of communication or the level of their communication complexity. For example, this intervention can be used to support students who are developing initial social communication skills such as gaining their peer’s attention for a conversation initiation as well as supporting the growth of students who are developing more nuanced social communication skills such as probing peers for additional information through questioning or changing the topic of conversation. These visual communication supports are easy to make and can be created at relatively no cost. Steps of implementation are simple, equipping educators with a sustainable approach to target social skills within a naturally occurring routine. Finally, because students of all social communication abilities can easily participate in this intervention, relationships are fostered among all members of the class. This intervention encourages an environment that supports community membership, cultivating a sense of belonging for students of all abilities to learn, play, and grow together.

The overall goals of implementation of snack talk supports are twofold for students with ASD. First, the intervention seeks to increase engagement in conversation with peers at meal tables. Second, these supports aim to increase complexity of communication and conversation skills.

Creating Snack Talk Cards

This intervention utilizes low-cost and low-tech visual communication supports easily designed and created with tools available in most classrooms. There are minimal steps to creating snack talk cards. First, teachers identify, or help students identify, highly preferred topics. This is done through direct observation of preferred topics, asking students what they enjoy and want to talk about, as well as reaching out to parents to identify interests. These topics might include broad interests such as favorite television shows, games, places to visit, or restaurants. Although these interests should be balanced and support students in expanding beyond preferred topics, it is important to utilize these specific interests when beginning the intervention. Furthermore, incorporating preferred topics at the beginning of intervention ensures students will be excited and motivated to communicate and engage with their peers.

Next, teachers collect pictures of these high-interest topics from fair use, royalty-free, or Creative Commons photos from internet sources such as Google Images, Boardmaker (Peake, 2003), and Clipart or printed resources such as magazines. Topics are then grouped into broader categories so that multiple students’ interests are represented on one card. For example, a favorite stuffed animal, a favorite board game, and a favorite toy might all be placed under the broader question of: “What do you like to play with?” By doing so, multiple students are motivated to engage with the same snack talk card and each other.

Once images have been grouped, they are pasted onto the same sheet of paper, either physically or electronically. Each sheet is labeled with a question about the topic of the visual communication support, such as “Where do you like to eat?” or “What activities do you do with your family?” The questions and pictures can be differentiated based on the communication strengths and needs of each student. For example, for students who are emerging readers, text can be included underneath the pictures. Once sheets are complete, laminating cards allow for easy clean up and long-term reuse.

Diverse Representations

As an intervention, numerous opportunities are presented to embed culturally responsive and relevant practices within the classroom to support their culturally and linguistically diverse students. These supports allow teachers multiple opportunities to incorporate family ideals, cultures, and beliefs, promoting inclusion of each student’s individuality and identity within the classroom. This can be done by creating snack talk cards with each student in mind. Specifically, some ways to incorporate cultures include creating these visual communication supports with various foods and drinks commonly eaten at home for each student, incorporating cultural rituals and activities in cards that identify preferred events, as well as including specific holidays that each student may celebrate.

Educators identify difficulties discussing racial differences and racial inequities (Pollock, 2009), emphasizing the need for increased attention to these variables within this intervention. These identified challenges may be attributed to beliefs that children are too young to identify and engage in conversation regarding race, or that educators worry that having these conversations may be perceived by others as racist (Copenhaver-Johnson, 2006). In contrast, early childhood literature indicates that children as young as 3 years are aware of racial differences (Jordan & Hernandez-Reif, 2009). Without meaningful, explicit instruction targeting race in classrooms, students may begin to develop inaccurate racial messages. One approach to begin teaching race is through the use of picture books. Utilizing picture books can facilitate conversations regarding differences and it prevents students from forming inaccurate racial bias often present due to the absence of targeted instruction around this critical topic.

Although this intervention does not include picture books, this research can be utilized to inform the creation and development of these visual communication supports. Furthermore, instruction targeting race can also be provided through careful attention to developing visual communication supports that include equitable representation of individuals with different skin tones, gender, and disability status. For students who are learning English, bilingual cards can be made, promoting access to inclusion and community membership for these students.

The foundation of incorporating family ideals, cultures, and beliefs is building a strong partnership with families. To foster this on-going partnership, a meaningful relationship must be established through continuous rapport building. During this relationship building process, teachers seek to understand each family’s culture and norms, as well as their hopes, dreams, and goals for their child. This collaborative relationship serves as the building block to developing effective, sustainable interventions. Through strong partnerships, the individuality of each student and their beliefs, norms, and family ideals are honored. Ultimately teaching students from a young age the value and strength in diversity.

This practice aligns with research identifying positive relationships with racial differences that students as young as 3 years old may identify in their peer circles (Jordan & Hernandez-Reif, 2009) and encourages feelings of pride and acceptance of aspects of identity in all students. Positive conversations regarding identifying racial differences are promoted through incorporation of representation of all racial differences, ensuring that these meaningful conversations occur in a safe, supportive environment.

Adapting Snack Talk to Support Students With Diverse Communication Skills

Snack Talk cards can be easily adapted to support and include students of all abilities in various stages of language and social communication skill development. By using these supports, teachers are able to facilitate a naturalistic environment for intervention through social conversations. For students who are nonverbal, minimally verbal, or who use augmentative and alternative communication (AAC) systems such as the Picture Exchange Communication System (PECS; Bondy & Frost, 1994), these cards can be used as a visual communication support that facilitates conversation engagement with their peers. These students can use their AAC systems, eye gaze, and gestural prompting to ask and answer questions even when their communication needs differ from their classmates. These cards also provide a support for their peers to include these students within their social networks and within the classroom community while developing and strengthening meaningful bonds. Although this intervention has similar qualities to PECS (Bondy & Frost, 1994), the ultimate goals of these instructional strategies differ as PECS focuses on teaching foundational communication skills and snack talk focuses on developing and supporting reciprocal communication skills needed for sustained engagement in social conversations.

Similarly, snack talk cards serve as a visual communication support for students who experience discrepancies between their expressive and receptive language abilities. Because these visual communication supports can be used by students with verbal and/or nonverbal language, students can ask and answer questions in a manner that is aligned with their support needs. For example, a student may ask a peer a question using a nonverbal gestural prompt such as showing their peers the card, but answer another student’s question verbally. For students who are reading, these cards can include text that prompts sentence expansion when asking and answering questions. By using these visual communication supports, teachers are able to simultaneously engage and include students with varying levels of language and communicative supports needs in meaningful conversations about shared interests.

Snack talk cards also may be used to facilitate language development for children. As children develop language to match their communication desires, children typically move from engaging in nonverbal gestural pointing to single word utterances and then more complex sentence development. Language development can be supported through educators prompting for additional language. For example, while a student may begin answering questions using gestures such as pointing, teachers can model and prompt students to move from gestures, to initial phoneme sounds, and eventually whole word utterances. Similarly, when children are in initial stages of language development, their first language partners are adults. As children become more adept at using conversational language with adults, teachers may begin prompting conversation between children and shift the reciprocal conversant role to other children.

Educators may also use this strategy to support various social communication instructional goals for students with ASD as they progress in their development of social communication skills toward independent use. As students with ASD typically develop social communication skills at different rates than their neurotypical peers, educators can use this intervention with students at different age groups by adapting the topics of the cards. For example, younger children may discuss favorite recess activities, while older students may discuss favorite videogames, music, sports teams, or family activities. Educators can then use a developmentally appropriate topic of conversation on snack talk cards to target the development of increasingly complex social communication skills and independence. Pertinent instructional goals for this instructional strategy could include (a) supporting a student in making initial bids for conversation with peers through saying a peer’s name, (b) responding to a question from a peer with an on-topic answer, (c) engaging in turn-taking within conversation, (d) using longer and more complex utterances by adding detail, (e) managing topic changes appropriately, and (f) asking open-ended and detail-probing wh- questions to extend conversation length. As students master more basic skills, educators can use this intervention to simultaneously bolster students’ independence with these skills before focusing on more complex skills.

Implementation Procedures of Snack Talk

Step 1: Introduce Cards to Children in the Classroom

To begin implementation, a variety of snack talk cards are placed on the table during mealtimes. Being mindful of the number of students sitting at the table, these cards are provided for pairs of students. By providing a table of students with a handful of cards, students are set up to engage with each other to access visual communication supports, minimizing the opportunity for students to engage independently with the card, but without their peers. Engagement is fostered, as students sitting at the table are close to each other in proximity and must engage with each other to look and participate in this intervention.

Step 2: Model Snack Talk Supports During Mealtimes

After the introduction of visual communication supports, teachers verbally model how to use these visuals to ensure that everyone at the table can participate. To model use, teachers use the visual support to first identify their own interests and preferred items, pointing and discussing a visual on the card. Following the initial model, teachers wait 5–10 s to see whether a student will naturally respond and engage with supports. In the event that a student does not respond independently, the teacher shows the card to a student at the table, asking the student the topic question of the card at hand. The teacher continues this model by going around the table and engaging with each student, ensuring each student has the opportunity to engage with the visual communication support with the teacher as it is simultaneously being modeled. As each student identifies a visual on the card, the teacher reinforces engagement, by narrating what student choices were. Once students have become comfortable engaging in this intervention with teachers as conversation partners, teachers may begin prompting and reinforcing reciprocal conversation bids between students.

Step 3: Use Least-to-Most Prompting

Least-to-most prompting (Cooper et al., 2014) aids in facilitation of these supports during mealtimes. Teachers start at the beginning of the prompting hierarchy, using the least amount of prompting necessary for children to engage with visual communication supports. In the event that a prompt does not successfully elicit use of the these supports, teachers may provide an additional prompt, moving up in the prompting hierarchy until the student engages with the card. As students with ASD become more independent and proficient with more fundamental social communication skills such as garnering peers attention for conversation initiation, educators may begin prompting more complex social communication skills such as turn-taking by using a level of least-to-most prompting appropriate to the needs of the student.

Step 4: Fade Prompting and Shaping Conversation Topics

Independent engagement with snack talk cards with peers during mealtimes is the ultimate goal of this intervention. However, implementation of this intervention begins with teacher-/adult-mediated intervention. It is critical to foster the transfer of conversation partners from teachers and/or adults, peers, or other students in the classroom. For many young children with ASD, engagement with teachers and/or adults commonly occurs at higher rates than that of children during the beginning phases of interventions. Adult engagement is attributed to consistent, immediate reinforcement that is commonly provided by the teacher/adult population because of the reliable responses they provide to children. In contrast, children may not be as reliable in responding to social communication from their peers, commonly attributed to other competing stimuli in the classroom. In other words, classrooms are busy settings, full of distractions that often inhibit students from consistently responding to their peers. This transfer of communication partners is critical to address through effective prompt fading and shifting of reinforcement during implementation of this intervention, ensuring intervention is supporting social skills among students in their naturalistic environment.

After the introduction and modeling of snack talk cards, teachers decrease their participation in student conversations by minimizing prompting and reinforcing communication initiation and responses between students. As students begin to engage independently with these cards, teachers begin to decrease prompting. This step is critical as it ensures students do not become prompt dependent or rely too heavily on the mediation of others to use these supports. Least-to-most prompting is beneficial in mitigating prompt dependency because the hierarchy ensures higher level prompts are only implemented when they are warranted. Teachers begin prompt fading by ensuring that as students begin to engage with the visual communication supports, they are aware of not only the level of prompting they are providing, but the necessity of that level of prompting. Furthermore, as students become more independent, teachers begin to provide less prompting, consistently focusing on the transfer of skills from prompted to independent engagement as well as the introduction of new, more complex, target social communication skills. Consequently, as increased independent engagement occurs, engagement in this intervention shifts from teacher-mediated intervention to peer-mediated intervention. The prompting role of teachers is gradually faded out, and conversation among children is fostered as teachers step back during implementation of intervention.

As students learn how to use these supports and engage consistently with teachers and peers about their preferred interest, teachers begin to shape intervention engagement and expand the student’s repertoire of topics. Repertoire expansion is done by encouraging students to engage using different snack talk cards in addition to cards that incorporate their preferred interests. In the event that talking about a preferred interest becomes reinforcing to students, teachers can use this conversation engagement as reinforcement for engaging in communication and engagement specifically around a neutral topic. Neutral topics are topics that include items or activities that are in a student’s language repertoire, but do not include their individualized, preferred interests. Incorporating new topics is important and teaches students that when engaging in communication with others, it is important to also talk about other valued topics of communication partners. Ultimately, strong reciprocal conversational social skills are promoted and opportunities for children to practice the social nuances of conversing are created.

Step 5: Reinforcement

As with any new skill or behavior, reinforcement plays a vital role in supporting and maintaining correct use and implementation. Teachers reinforce all students engaging in this intervention using verbal and nonverbal praise, as well as other established reinforcers and reinforcement contingencies (e.g., sticker charts, token boards). Teachers reinforce all students and peers at the mealtime table for responding and engaging with this support, and for initiating conversation. By providing immediate reinforcement following engagement with these visual communication supports, teachers promote future engagement in target behaviors.

Conclusion

The implications of increasing social engagement are tremendous, as successful demonstration of this skill set opens doors to a variety of other important, meaningful outcomes for students diagnosed with ASD. These outcomes play a large role in quality of life for all, emphasizing the need for effective intervention to foster and promote sustainable engagement in these important skills. Providing meaningful instruction that is culturally relevant and aligned with each student’s family culture is important, affecting a student’s life meaningfully across the lifespan. This practice assists in preventing students from developing inaccurate racial messages by ensuring representation of racial differences are present and discussed at an early age as well as proving inclusive representation of culturally and linguistically diverse students.

In addition to promoting positive conversations regarding race, this instructional strategy also provides supports for students to effectively engage in social conversations regardless of their modality of communication. These supports are easy to make and can be created at relatively low cost. Steps of implementation are simple, equipping teachers with a sustainable approach to target the development of increasingly complex social communication skills within a naturally occurring routine and provides a shared language for all educators involved in implementation in inclusive settings. Finally, because students of all abilities can easily participate in this intervention, relationships are fostered among all members of the class. This intervention encourages a culturally responsive and relevant environment that supports community membership, cultivating a sense of belonging for students to learn, play, and grow together.

Footnotes

Acknowledgements

The authors would like to thank the Supporting Transformative Autism Research (STAR) Initiative at the University of Virginia for supporting activities related to this work.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Katherine J. Bateman

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