Tech Tuesday/Summer Study Series: Narrative and Autism Spectrum Disorder

Welcome to our last entry in this year’s “Summer Study Series!” Here in Massachusetts we still have a little summer left, though I know some of you have already headed back to school.

If you are here on the MindWing Blog, you probably have clearly seen the issues related to narrative language that our students with Autism Spectrum Disorder exhibit, and are aware of the connections between narrative and situational awareness, perspective-taking, and conversational skills, among other areas of social cognition, language processing, and executive functioning.

I am frequently asked to conduct evaluations encompassing social cognition and pragmatic language and always find it extremely valuable to include a detailed assessment of narrative language. However, in doing so, and having reviewed previous assessments of these students, I often find that I am like a newcomer to a desert landmark, standing there saying “Hey, look at this…?” Why haven’t the examiners before me documented and then suggested interventions around these inevitably present narrative language issues?

Given that narrative is an under-identified and under-supported area, but also to support our own assessments and interventions, I’d like to spread the word about Lynne Hewitt’s Narrative as a Critical Context for Advanced Language Development in Autism Spectrum Disorder (2019) as a helpful tutorial. I’ve seen Dr. Hewitt speak on the overlaps between speech-language pathology and cognitive behavioral therapy (CBT), so was very excited to see that she has written about this topic! Some of the major points of the tutorial are as follows:

• As a tutorial-style article, the piece is meant to contextualize previous research in the light of assessing and treating individuals with ASD. The article has a focus on adolescents and transition issues, but the information provided can be generalized to work with younger populations.
• “Sophisticated, challenging interventions” for adolescents are framed as important, with narrative as a potential focus, given these clients’ frequently exhibited struggles in transition, postsecondary education and in the work and social worlds, including the presentation of later psycho-social difficulties.
• Hewitt outlines the importance of narrative as it relates to nationally and locally adopted curriculum and standards: ”Interventions centered around narratives are important for helping the student understand and generate narrative language as an end in itself.” This principle is linked to both academic and social functions of narrative language.
• I particularly agreed with Dr. Hewitt’s angle that we should shoot higher in language intervention, and employ context. Specifically, intervening in narrative contexts allows us to work on point of view/perspective, inference, structuring language both “locally” within a sentence and globally as a coherent story a reader or listener would be able to understand.
• Also illuminated within the article are the cognitive processes involved in understanding narrative, such as represented thought, or the ability to interpret statements made by a character and recognize unreliable elements of a narrative.
• Specifically related to ASD, the author reviews research points about characteristics of narrative produced by those with this diagnosis, focusing on quantity (which tends to be OK) vs quality, which tends to be characterized by challenges in overall structure and referencing of cognitive/mental states of others. Also emphasized is the importance of personal experience narratives, which are key to social interaction in terms of “forming social bonds and blending in to social groups” within the expectations of the “hidden curriculum.”
• Hewitt offers a number of resources in assessment (both standardized and more qualitative) and intervention of narrative. I am looking forward to doing some further reading on the referenced protocol by McCabe and Bliss (2003) including narrative assessment tasks such as “losing a pet, having something stolen, being in an accident, or getting hurt.” Hewitt’s description of narrative intervention techniques does focus on teaching story elements; she acknowledges limited research on adolescent intervention while citing studies related to younger populations. I’d add to her review this helpful study by Westby and Noel which did focus on teaching narrative elements to adolescents and adults.
• Hewitt concludes with a case study (hypothetical) including objectives and strategies. She posits that a student’s/client’s area of interest, for example, Star Trek, can open motivational and contextual doors in developing narrative skills.

I’ve often found that last point to be very true and relevant, and leads me to a quick (and not new) tech tip. YouTube, again, is an extremely helpful resource for setting the context for any kind of narrative work. You don’t need to know your way around the Federation to find a Star Trek clip from any of the multitude of TV shows and movies that have been released at this point. Dropping into the middle of a story will provide clients with the opportunity to illuminate the larger narrative for you and work on some of the objectives described in this article. As an SGM^®/Thememaker^® user, you will certainly find the tutorial reinforcing of the techniques you are currently applying!

I hope you all have had, and will continue to have a great summer! Live Long and Prosper!

Hewitt, L. E. (2019). Narrative as a critical context for advanced language development in autism spectrum disorder. Perspectives of the ASHA Special Interest Groups, 4(3), 430-437. doi:10.1044/2019_pers-sig1-2018-0021Noel, K. K., & Westby, C. (2014). Applying theory of mind concepts when designing interventions targeting social cognition among youth offenders. Topics in Language Disorders, 34(4), 344-361. doi:10.1097/tld.0000000000000036