Developed by Brad Hendershott and Traci Sevick Draft 1 5/3/14

Direct Interaction for Communication Assessments

“Reading a Book Together”

What structures the direct interaction?

Reading a book while the studenttalks about and responds to evaluator questions regarding characters and events, pressing for an understanding of non-verbal communication, emotions, intentions and so forth. The activity also provides an opportunity to informally assess other social communication and language skills.

Caution: Many individuals with high functioning ASD exhibit relative strength interacting one-on-one with adults. It is essential that the SLP include assessment of social competencies with peers in authentic, naturally occurring contexts.

Who is it recommended for?

Functional use of speech to meet daily needs / Age or approximate developmental level
No speech or single words and some phrases / Younger school-aged from 4 to 8 years (K-3)
Uses multi-word phrases, but is not verbally fluent / Older school-aged to adolescent from 8 to 12 (4-8)
Verbally fluent; uses complex sentences / Teen or young adult from 13 to 21 (9-12)

What is needed for this activity?

A developmentally appropriate book that is primarily picture-based with limited or no text. This is to ensure that the task presses upon the student’s ability to accurately determine the story, characters, emotions, and motivations based upon non-verbal communication cues and other visual information. A book that may be successfully used for this task is “The Last Laugh” by Aruego and Dewey.

The book should focus on a high-interest narrative and include images of characters that may be analyzed to determine the “main idea” or theme, facial expressions, state-of-mind, motivations, and intentions. The images should allow for inferring both obvious and subtle emotions and motivations, first and second order Theory of Mind (e.g., “Do you think the bird knows what the snake is thinking about?”). A quiet, distraction-free setting will be ideal for reviewing the book together.

What prompts are provided?

Explain, “I have a story to read. It uses mostly pictures. I want you to talk about what’s happening in the story.” This task should provide the student with opportunities to spontaneously describe what they see. The evaluator may ask a few initial, open-ended questions to elicit descriptions; “What’s happening here?”. Provide the opportunity for the child to talk about and interpret what they see. As needed, prompt with additional questions to probe social-cognitive capabilities; “How do you think they’re feeling?”, “What do you think they’ll do next?” and so forth.

Usea least-to-most prompting strategy, at first providing unsupported opportunities to complete tasks. Then provide gradually increased prompts as needed (hierarchy of prompts: independent/no prompts, verbal, gesturing, modeling, partial physical, full physical assistance). Be sure to note the frequency and type of prompts needed to ensure the target student could participate successfully.

What is the focus of observation?

This semi-structured activity is particularly suited to help the SLP to observe for the presence of social thinking capabilities such as reading facial expression to determine state-of-mind, understanding the thinking and perspective of others, predicting what someone is going to do by considering available information, and so forth.

IMPORTANT: Some children with high functioning ASD are able to competently discuss the thoughts and feelings of others but struggle to apply that knowledge in real-world situations with peers. If a student performs well on this task, it is essential to also assess their social competence in natural contexts with multiple peers. While it is informative to assess competence 1:1 with an adult, ultimately we are primarily concerned with functioning among peers in unstructured situations that tend to be much more socially demanding.

In reference to developmental expectations, also observe for typical versus atypical skills with regard to:

(1)Social-emotional reciprocity: initiating, responsiveness to initiation from others, back-and-forth conversation, novel comments or questions, social smile and affective responding, establishing social closeness using verbal and non-verbal means , spontaneous sharing or showing, enjoyment of social interaction

(2)Non-verbal communication for social interaction: eye contact and body orientation, using gestures/expressions/prosody to regulate to others, understanding non-verbal communication during an interaction, conveying a full range of emotions, using facial expression to convey emotion (warm and happy, annoyed, worried, using), coordinated use of verbal and non-verbal communication

(3)Relationship development and understanding: understands the perspective of others, adjusts behavior based upon how others respond, picks up on obvious and subtle social cues, expresses emotion appropriately, adheres to social expectations, cooperative and imaginative play, development of peer friendships, asks/talks about interests of others

Overall presentation of social functioning: most individuals with ASD present with one of the three following social profiles: (a)very cut off and aloof – unresponsive, “in their own world”, disinterested in others, little or no eye contact; (b) very passive – may accept social approaches with subtle signs of enjoyment, rarely or never spontaneously initiatesexcept to get needs met, can be led by others, may be able to copyactions;or (c) active but odd –makes active approaches toward others but are often perceived as “strange” or inappropriate, may be highly intelligent yet have poor perspective-taking skills, wants friendships but lacks the skills to make them.

Additional Pragmatic Skills: makingcomments relevant and to the topic or situation, shifting topic appropriately, asking questions or for help (not perseverative), providing enough information (not too much or too little), timing comments appropriately (not blurting or interrupting), disagreeing appropriately, respecting personal space, using polite forms (please, thank you, excuse me), greeting and leaving others, using names, use of interjections to convey emotion (e.g., “oh no…”, “Ah ha!”), (only certain skills are highlighted here; the use of a separate pragmatic skills checklist is recommended)

Receptive language: attentiveness, processing speed, following single and multi-step directions, understanding non-literal language (inferences, idioms, indirect requests),understanding basic concepts (time, space, quantity), answering “wh” questions, detecting teasing and sarcasm

Expressive language: level of linguistic development, narrative and sequencing skills, vocabulary (may appear advanced for age), use of echolalia or scripting (e.g., extensive rote recall of movie or character dialogue), prosody/rate/rhythm, fluency (non-stuttering or cluttering: whole word and phrase repetitions, revisions, interjections OR true stuttering: blocks, prolongations, part-word repetitions, articulation, voice (formally evaluate in any domain for suspected impairment)

Procedures: “Reading a Book Together”

Explain to the student that the two of you are going to read a book together. Ask an open-ended question to get started, “What’s happening in this picture?” Pause and allow opportunities for spontaneous description of the images along with the thoughts and feelings of the characters.

Start with simple, literal comprehension questions to check for a basic understanding; “What do you think is happening in this picture?”, “Who is this?”, “Where are they?”.

Then shift tohigher level inferential questions that probe social cognition, “What do you think the snake is thinking about?” “Why do you think that?”

Many students with high functioning ASD can answer questions about basic emotions and perspective. To probe deeper, ask “second order” Theory of Mind (ToM) questions, “Do you think the bird knows what the snake is thinking?”, “Do you think the snake knows that the bird can’t see him?” Such questions probe the student’s ability to think about the awareness others have of the thinking and perspectives of a third party.

Many individuals with ASD have some ToM and perspective-taking skills. However, their skills are less developed or sophisticated when compared to a typically developing peer.


The next level of questions probes evaluative comprehension, “Why do you think the author wrote this book?, “What is the author’s message?”, “What does the book say about bullying?” Probe mental state vocabulary (e.g., anxious, proud, confused, suspicious, unaware, embarrassed) and understanding of abstract concepts (e.g., loyalty, patriotism, bullying).

Analyze your notes against the behaviors and characteristics listed in the “focus of the observation” section. For further guidance, go through the “Core Social Communication and Associated Language Characteristics of ASD” noting relative strengths (i.e. skills within the normal range) and signs of atypical skill development. If skills were significant discrepant from typical development, attempt to describe the adverse educational and/or functional impact associated with the skill deficit.

Language for the Communication Assessment Report

“To further assess [name]’s social communication skills, a semi-structured activity was setup providing [name] with an opportunity to read and discuss children’s storybook. This activity provided the opportunity to elicit skills that are often impaired or absent among individuals with ASD including: reading non-verbal communication (facial expression, gestures), inferring and talking about emotional states (thinking about what others are thinking), predicting actions, and determining the “main idea” or context based upon multiple cues. This activity also provides an opportunity to informally assess comprehension skills. Many individuals with ASD perform better with literal comprehension tasks (e.g., “What is happening here?”, “Where is he?”, “What is that?”) while struggling with higher level inferential and evaluative comprehension questions (e.g., “Why did he…”, “How did they…”, “What was the author saying about…”) as well as questions related to abstract concepts.

Throughout the direct interaction, pragmatic skills were informally assessed such as the ability to maintain the topic, engage in a balanced conversation, asking questions to find out about others, making requests, and so forth. The following observations of [name] were recorded as a result of this peer-based play activity:”

Using bullet points summarize the student’s responses noting both skills that appeared relatively intact as well as those that were clearly atypical.Be sure to note any models or prompts needed to help the target student produce the skill. In addition, report observations with regard to other pragmatic skills,functional communication, and receptive and expressive language levels.