Learn to use non-verbal communication to jumpstart verbal communication.
This comprehensive, intervention-focused course discusses how children with autism develop speech and language and how best to initiate interventions for children who have limited functional communication. Presented from the perspective of a practicing SLP who is also a board certified behavior analyst, this course features effective interventions drawn from both fields with video examples of implementation included throughout the presentation.
Content presented will support the SLP in making critical intervention decisions, including whether intervention should focus on the development of vocal language or on an alternative method of communication, variables that must be considered to teach an alternative communication system (with focus on sign language), and how and when to transition a child from an alternative communication system to vocal communication. Offered for 0.9 ASHA CEUs – 9 contact hours.
Course Run Time: 9:00:00
The content of this online CE course does not focus exclusively on any specific proprietary product or service. Presenter financial and non-financial disclosures may be found by clicking on the Presenter & Disclosures tab.
Video PowerPoint presentation with author narration & downloadable handout.
Tamara S. Kasper, MS, CCC-SLP, BCBA, is a pediatric Speech-Language Pathologist who has treated children with challenging behavior since 1990, specializing in children with autism since 1995. Tamara's commitment to the children she serves led her to pursue treatment methods outside the field of Speech-Language Pathology. She has advanced training in Nancy Kaufman's strategies for apraxia of speech and partnered with Nancy to create The K&K Sign to Talk Materials. She has advanced training in Applied Behavior Analysis/Applied Verbal Behavior and under the mentorship of renowned Behavior Analyst Dr. Vincent Carbone and his protégé she became a Board Certified Behavior Analyst. Tamara is a frequently invited international lecturer, enthusiastically sharing intervention techniques that build functional verbal behavior, social communication skills and combine social skills training with physical training. She has lectured and treated individuals across the United States and Canada as well as in Ethiopia, Senegal, Greece, Germany, England, Ireland, and other countries. She is a past recipient of WISHA's Clinical Achievement Award. Tamara directs The Center for Autism Treatment near Milwaukee, Wisconsin.
Financial — Tamara Kasper is a presenter of online CEU courses sponsored by Northern Speech Services receives royalty payments.
Financial — Tamara Kasper is an author of treatment materials published by Northern Speech Services; receives royalty payments.
Financial — Tamara Kasper is Owner and Director of The Center for Autism Treatment; ownership interests.
Financial — Tamara Kasper is an author of treatment materials that are self-published; receives royalty payments.
Nonfinancial — Tamara Kasper is a student mentor with the University of Wisconsin-Milwaukee; receives no compensation.
This program is offered for 0.9 ASHA CEUs (Intermediate Level; Professional Area).
ASHA CEUs: NSS online courses are registered with ASHA and are offered for ASHA CEUs. The number of ASHA CEUs is noted above. Note that 0.1 ASHA CEU = 1 contact hour = equals 1 CEE.
ASHA CE Registry: During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.
ASHA CEUs: Attendees must meet at least one of the following conditions in order to be eligible to earn ASHA CEUs:
If an attendee is not an ASHA member or CCC holder but meets any of the above criteria, they may inform the ASHA CE Registry of their eligibility by visiting this site.
Licensing Boards: Most state licensing boards DO accept CEUs earned online (usually classified as home-study credits). Some state boards do, however, place a limit to the number of credits that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any credit limits related to home-study courses prior to registering for this course.
Additional accrediting agencies by which Northern Speech is an approved CE provider:
Course Completion Timeframe: You have unlimited time to complete this online course. You may log off and log on as you wish in order to complete all sections of this course.
Content Access: Access to course materials and content does not expire, even after completing the post test. You may continue to review course material by logging into your NSS account, clicking the My Online Courses tab, and then viewing your desired course.
Certificate of Completion: On successful completion of the post test (80%), a certificate will be immediately available for download and/or printing. This certificate will include your name, date of completion (based on Eastern Time Zone, USA/Canada), and number of contact hours (CEUs / CEEs). Please note that CEUs are awarded on the date of successful test completion, not the date of course enrollment. Please ensure that you successfully complete the post test prior to any licensure renewal dates.
ASHA CE Registry Submission: During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.
Purchase Orders: Purchase orders are NOT accepted when registering for online courses. Payment must be made online in the form of a credit or debit card payment.
What is an Online Course? Our Online Courses consist of video, audio, and/or text content and are offered for ASHA CEUs. Unlike a webinar, which requires participants to be logged on and at a computer at specific times, our Online Courses are available to you at any time, from any device, via your NorthernSpeech.com online account. You may work at your own pace and start and stop your course as you wish. Your course will conclude with a short post test. On successful completion of the post test (>80%), a printable certificate of completion is presented to you.
Receiving CEUs: Northern Speech is an ASHA CE Provider and our online courses are registered with ASHA and offered for ASHA CEUs. Please note that successful completion of the online post test is required prior to the awarding of CEUs. Please contact your state licensing board for acceptance policies related to CEUs earned online.
Registering for an online course: You may browse all online courses by clicking the Continuing Education tab above, then Online Courses. Once you find a course, click Enroll Now, and you will be asked to either log into your existing Northern Speech account or create a new online account. Once you’ve entered your account information and provided your credit card payment, your course will be immediately available to you.
Accessing your purchased course or returning to a purchased course: You will be able to access your online course by logging into your Northern Speech account and then clicking the My Online Courses tab on your profile screen. Click the course you would like to start or to resume. From there, proceed through the course sections until you are ready to complete the post test. You do not have to complete your course all at once. You may log on and off as you wish.
Testing requirements: Each online course concludes with a post test consisting of multiple choice or true & false questions. Scores of 80% or greater are required for successful course completion and awarding of CEUs. You may revisit course materials and retest as needed to achieve a passing score.
Number of CEUs offered: We offer courses from 1 to 21 contact hours. Each course will note the number of CEUs offered. Please note that 0.1 CEU = 1 contact hour = 1 CEE.
State licensing boards and online CEUs: NSS is an ASHA CE Provider and most state licensing boards DO accept ASHA CEUs earned online (usually classified as home-study credits). Some boards do, however, place a limit to the number of CEUs that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any CEU limits related to home-study courses prior to enrolling in an online course.
Course formats: Our course formats include: text, audio, video, and PowerPoint with author narration. Each course will note the format on the course description page.
Course handouts: Most of our online courses provide a link to download the accompanying handout as a PDF file.
Group discounts: Groups of 3 or more are eligible for a 20% discount on each registration on most of our online courses. To receive this discount, registrations need to be processed together via the "Group Rates" tab on the Online Course of your choice.
Computer requirements: For our online courses to function best, we recommend that you update your computer to include the newest version of your Internet browser (Safari, Chrome, Firefox, Edge, Internet Explorer, etc.) and newest version of your computer's operating system. Also a high-speed Internet connection is recommended (cable or DSL). Speakers or headphones will be required for many of our courses as many contain audio components.
Course Cancellation Policy: A purchased online course can be exchanged, refunded, or transferred to another individual if contact is made with NSS (via phone or email) within 30 days of purchase and the course materials have not been viewed or downloaded.
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"This Online Course by Tami Kasper is amazing!" – Nancy Kaufman, MA, CCC-SLP (Creator of the Kaufman K-SLP Treatment Materials)
“I really enjoyed the sections on manding for information and to peers and what the prerequisite skills look like for these. Also, manding using noun-verb combinations versus hand frames was really helpful to me. The video examples were very helpful.” – K.S. (Apr. 2020)
“I liked the videos of examples and going over therapy techniques.” – S.G. (Mar. 2020)
"I enjoyed going over what types of signs should not be used and why. I often taught very basic signs. This class has encouraged me to expand my ASL knowledge to provide more specific signs." – J.C. (Feb. 2020)
"I liked the use of peers. I really was impressed. I also enjoyed the behavioral approach. I was taught behavioral modification by Dr. Whaley years ago and am excited to see it improved and used in behavioral training again. The most beneficial discussion was the use of things the Autistic child enjoys as a positive reinforcement even though to use the activity or object he likes may be considered unusual." – E.C. (Jan. 2020)
"I thoroughly enjoyed so many of the topics that it is difficult to choose just one. I am very familiar with verbal behavior and ABA principles as I work in an ABA based program. I still learned a lot from these sections of the program. The one that will probably have the biggest impact in m own practice is the use of the Kaufman cards to shape syllables into words. I have the cards but realize that I can change many things about how I am using them to be more efficient and effective. I loved the inclusion of so many videos to demonstrate techniques. I am sure that I will revisit some of them in the future for the purpose of training staff with whom I work." – L.J. (Dec. 2019)
"The general over view of children with Autism. This course looked at more involved children as well as higher functioning children, which I found to be very helpful. The speaker lectured and then showed the skill in a video with real learners." – J.A. (Nov. 2019)
"Excellent videos and specific examples and outlines of her methods and procedures. I appreciated going over ways to increase initial communication in a young child with no language." – N.L. (Oct. 2019)
"I enjoyed the videos of the group interactions - especially how the group branched out to do the fitness sessions." – S.P. (Sept. 2019)
"All of it was beneficial! I began a new job in a school district, and the majority of my caseload is students ages 5-12 diagnosed with autism. I particularly enjoyed suggestions/strategies for teaching initial signs and requests as I am hoping to incorporate more sign language into my therapy this upcoming school year. Very engaging! I LOVED all the videos - especially the videos that showed the therapist working with the child." – R.C. (Aug. 2019)
"The lecturer was engaging and video examples were helpful. Going over teaching student how to ask conversational questions and strategies for involving typical peers in social skills intervention was most beneficial." – R.N. (July 2019)
"I found the fact that introducing general signs like more is not appropriate was very useful. I like that the course was very thorough with video example all along the way." – K.W. (June 2019)
"I liked the practical tools for application and videos to show them in action." – K.R. (May 2019)
"I appreciated the integrated use of ABA principles with speech-language therapy practices. I liked the videos that clearly demonstrated what the presenter was discussing." – R.M. (Apr. 2019)
"I LOVED this course! I really found the teaching recommendations for minimally verbal children with the steps clearly outlined to be very helpful. The videos were great too and really assisted in understanding the course material. I thought the content was great and that everything in it was super applicable and helpful." – K.W. (Apr. 2019)
"The entire webinar was excellent. My mind is spinning. I want to use all the strategies with my students." – M.W. (Mar. 2019)
"I really thought the practices for shaping behaviors by investigating and using the children's motivation/interest was important. I loved the videos of the difficult behaviors and lack of interest from kids and how to gear the sessions so the kids enjoyed the interactions. I thought it was an excellent course." – T.E. (Feb. 2019)
"Enjoyed the whole course - very useful immediately! Very well organized and at a good pace. Excellent course." – S.K. (Jan. 2019)
"The section on building motivators and selecting vocabulary was particularly beneficial for my daily practice. I really liked the numerous examples and video clips provided throughout the course. I thought this was an excellent course." – A.A. (Dec. 2018)
"I loved watching the videos of the social skills small group activities, especially the ones that involved friends and fitness. I love the way Tammy talked through the skills with the children, helped them problem solve, helped them discuss coping strategies, and helped them handle loss. The video examples were well done and made the course very interesting. This course held my attention the entire time. I thought the course was excellent." – C.W.C. (Nov. 2018)
"The information is very practical. It is in-depth and basic all at the same time. The way it is tied to A-B-C is very helpful." – C.P. (Oct. 2018)
"It was excellent! The discussions on building motivators and establishing vocabulary were especially beneficial. Tamara is an excellent speaker with very helpful information. I loved the many videos she showed as an example of the information she taught. Very thorough course!" – M.B. (Sept. 2018)
"I appreciated the discussion on incorporating movement and physical activity in my treatment sessions." – D.H. (Aug. 2018)
"I found the topic of pairing and motivation to be especially helpful when considering some of my more behavioral children on my caseload." – L.K. (July 2018)
"I enjoyed the hand cues demonstration video. I loved loved loved all the videos used as examples." – A.A. (June 2018)
"I loved how exercise was incorporated with speech therapy to promote interactions with peers. I liked how much I learned about the benefit of using competitive and cooperative games to help with conversational skills." – M.W. (May 2018)
"It was very functional and brought attention to things that are often overlooked." – E.J. (Apr. 2018)
"Very good course. I work with autistic children and although I am doing a lot of these strategies already, it is good to hear new strategies and activities." – C.S. (Mar. 2018)
"I thought the course was well executed. It really opened my eyes as to how prompt dependent children become when using only the targets 'more, want, etc.' I also appreciated the videos as I am a visual learner." – E.W. (Feb. 2018)
"The improvement of vocal quality and intelligibility of young children with Autism was excellent. I liked the videos and stories from the author's work." – C.C. (Jan. 2018)
"The accompanying videos were extremely helpful in understanding how to deliver the approaches. It was a great course and very informative!" – H.B. (Dec. 2017)
"The strategies that were shared for oral language and sign language will prove extremely useful for my daily practice. The steps to developing social language with peers were extremely interesting. I could relate this topic directly to the needs of my students. What I liked best about this Online Course was the way in which examples and video tapings were utilized. It definitely provided clear examples of the various strategies that were presented." – I.G. (Nov. 2017)
"Determining the initial vocabulary targets and social interactions with peers were the most helpful discussions. I liked the videos of kids engaging in therapy activities." – E.M.A. (Oct. 2017)
"I liked the social skills training and appreciated that practical and useful therapeutic intervention was presented with research to back it up. Comprehensive presentation!" – J.T. (Sept. 2017)
"The various techniques and strategies for facilitating language in children with ASD were beneficial... I see kids birth to 5 years old so many of these ideas will be very useful in writing up their IEPs. I like that the course was easy to navigate... loved the outlines, handout type slides and the gal presenting it made it easy to listen to... good videos too." – J.L. (Aug. 2017)
"Absolutely everything was beneficial!!!!! Loved the videos, handouts were excellent, forms will be so helpful!!!!" – L.W. (July 2017)
"I enjoyed the examples of using ABA to teach social skills. I liked the clarity of presentation. This course was great." – H.S. (June 2017)
"The overall explanation of blending ABA practices with speech pathology was excellent. The two disciplines work so amazingly together, and this was a wonderful explanation on how to blend them. It was also helpful that she covered the full progression. I am very knowledgeable in how to start therapy with kiddos like this, but progressing once the basics have been covered is harder. I loved the models the presenter provided, because it is much easier to carry over what I have learned into my practice when I've seen an example." – J.B. (May 2017)
"This course had specific examples of real life activities for social group activities and provided me with a great number of starting points for a variety in our group planning. I've been providing therapy using various techniques highlighted here, so some of it was reinforcing and reassuring me that I am heading in the right direction with my treatment. In addition, it gave me areas to improve on with my therapy and provided me with concrete examples of how I may work to elicit desired results." – M.Y. (Apr. 2017)
"The entire presentation was engaging and could be applied to my everyday work, however the topic I found to be the most beneficial was the srategies to improve social interaction and conversational skills. The topics and ideas I could apply to the students that I work with tomorrow and having the videos was extra helpful." – L.M. (Mar. 2017)
"The modules on teaching verbal with sign and shaping words were most beneficial. I liked that there were many examples of techniques." – E.H. (Feb. 2017)
"I liked the information on managing behaviors and getting autistic children to cooperate and want to interact with others." – S.S. (Feb. 2017)
"Lots of great strategies were introduced. I'm already trying to incorporate the single word approximations of familiar words into daily therapy. I liked the progression from single words to conversation." – K.R. (Jan. 2017)
"This eCourse was phenomenal! It went above and beyond my expectations. I intend to re-listen to sections because there was too much information to absorb in just one viewing. The sections on working with kids with limited interests or reinforcers, increasing compliance, increasing motivation to communicate will be extremely helpful. Additionally, the section about which words/signs to teach first, when to begin targeting word combination and the discussion of the importance of TTR vs. MLU was thought provoking and will be very useful to me. Most of the sections on social communication were interesting to me. However, I primarily work with lower functioning kids, so a lot of that info was less relevant to me, although there was plenty of grains of information that I will keep in mind while working with my students, both to avoid some of the pitfalls pointed out by the instructor and to prepare my students for the future when they are better able to engage in social communication." – K.G. (Jan. 2017)
"The methods to develop speech and social skills acquisition were most helpful, but I thought the course included all aspects that should be taught in a great clinic. I am a SLP and BCBA and found this to be so incredibly informative and well presented. It was amazing! We need more Tamara Kasper videos." – M.L. (Jan. 2017)
"This was one of the most helpful courses I have ever taken! It was great! The sections on manding for information and peer interaction were most beneficial, but I liked EVERYTHING!" – K.J. (Dec. 2016)
"All of it was excellent! My son has autism and most of my caseload at the clinic I work at have autism. It was a great course!" – A.L. (Dec. 2016)
"Much of this course will apply in the therapy I provide daily to preschoolers in the public schools. I liked the group class examples and game/teaching ideas to promote connections and interactions, since I run a social group with my students. I liked the video examples and the realistic approach with ideas that I can immediately apply in my therapy." – C.R. (Dec. 2016)
"I liked everything! This is an outstanding course with great strategies to implement in any setting. The videos were awesome and very helpful!" – A.G. (Dec. 2016)
"I really appreciated the instruction on teaching initial signs/requesting and shaping vocal responses. The presenter directly addressed many of the issues that I've run into working with children on the autism spectrum and provided evidence based ideas that I feel will help improve the efficacy of my services for these children." – L.J. (Dec. 2016)
"Learning how to elicit mands initially with non verbal children with ASD, but also progressing from mands to phrases, to conversational skills was very beneficial. Watching the videos helped demonstrate teaching new skills." – E.E. (Nov. 2016)
"I really felt that the set up of the topics were organized and very easy to implement due to the specific details and videos." – K.C. (Nov. 2016)
"I liked how she had videos that were related to what she just covered. She also gave good suggestions for vocabulary and good ideas for assessing motivators (which is difficult for some kiddos sometimes). I also liked how she implemented typical aged peers in the therapy for social skills. This is a great idea, one that would not be permitted at my location, but something that made me think." – S.G. (Oct. 2016)
"I love the social groups portion, especially the Friends & Fitness!!! The videos are priceless in demonstrating the application of techniques presented. I wish I had some constructive criticism, but I don't. Great presenter, great presentation!" – K.T. (Oct. 2016)
"Loved the discussion on signs not to teach initially and why! Loved the pieces on pairing reinforcers with other items and people to expand reinforcers. Have already started this discussion with my team." – L.M. (Sept. 2016)
"The portion on choosing a communication system for learners with extremely limited vocalizations was really helpful." – D.M. (Sept. 2016)
"The instruction on selection of initial vocabulary and in identifying strong motivators that will be conducive to learning was most beneficial. I liked the video samples to illustrate concepts and the sheer amount of EBP information provided." – T.F. (Aug. 2016)
"I liked that I have not seen this content presented/discussed anywhere else. It covered more than I expected!" – J.D. (Aug. 2016)
"I found many of the topics interesting; one was establishing a Functional Communication System using the Sign to Talk program would be useful for students to shape their speech intelligibility. Another topic of interest was the workings of the Social Skill groups and how they were facilitated to increase conversational skills. The video clips demonstrating Tammy Kasper's approaches with the ASD students were helpful reinforcement to maintain my attention to this lengthy training." – K.A. (Aug. 2016)
"I really liked all of it. The combination of ABA techniques and speech language pathology principles is something that I have been seeking. I feel it is essential to look at motivators, reinforcers and to collect pertinent data. The delivery of the course with evidence based information, current research, and relevant video clips was great!" – K.B. (Aug. 2016)
"For me, the most useful portion was about establishing reinforcers and examining qualities of preferred items to expand the child's preferred items. I liked the very detailed step-by-step information. The video examples were helpful." – S.P. (Aug. 2016)
"The presenter was extremely knowledgeable and easy to follow. She gave specific directions and provided clear examples. Fantastic CEU!!" – C.F. (Aug. 2016)
"I learned about the importance of teaching patients to ask WH questions and how this greatly influences their conversational skills." – A.C. (Aug. 2016)
"All topics were great, but the one I found most beneficial to me was the topic on first words / combining words. I enjoyed the videos. They were great examples on how to apply the different strategies." – E.G. (Aug. 2016)
"I found the discussion about social groups beneficial. I have many students with autism who have good verbal skills but poor social skills that would benefit from social groups." – K.W. (Aug. 2016)
"Since I am new to working with children with autism, I felt the whole thing was important for me to see from teaching children how to speak up through social communication skills. I loved all of the video samples. In addition, the presenter appeared to love working with these children. I admired her ideas and ownership of errors that helped make her better at her job!" – S.P. (Aug. 2016)
"I appreciated the variety in examples of complexity of levels of speech of children with autism accompanied with videos." – E.H. (July 2016)
"The information on how to establish initial mands was quite beneficial to me. This was a very thorough and interesting presentation." – T.B. (July 2016)
"The discussions on building motivators and selecting vocabulary were most helpful. The presenter was engaging and offered fresh ideas to use with autistic students based on research. I liked the use of video examples to enhance learning." – L.E. (July 2016)
"There was so much included in this training that picking just one topic is challenging. I loved all of it. The first thing I plan to incorporate is the physical activity and partner work in my social skills groups. The videos were extremely helpful." – C.A. (July 2016)
"I loved how she spoke about all of the different assessment tools that she used with her clients. I was glad to review them and see which one(s) will work best with the students on my caseload." – J.S. (July 2016)
"I took this e-course with a specific student in mind that I wanted to use the Sign to Talk program with. I found many other topics applicable to other students that I work, such as peer interaction, use of pivot phrases, and selecting initial vocabulary." – K.W. (June 2016)
"I appreciated how the speaker showed the progression of her clients improved communication skills and socially appropriate behavior over time. She demonstrated many methods and activities that can be used even in the public school setting. I enjoyed this course and thought it was presented very well." – P.G. (June 2016)
"This whole course was absolutely amazing. I have taken numerous courses on AAC and this just showed me a different way to teach communication to kids with ASD and they do have a chance of becoming verbal." – K.K. (May 2016)
"I enjoyeded all topics, but really enjoyed choosing first words and moving beyond single words and basic requesting. It provided a lot of ideas to use in my daily sessions." – J.D. (Apr. 2016)
"My favorite discussions were on reinforcer assessment, determining words for initial vocabulary, use of Kaufman noun/verb cards, and training asking of "WH" questions. I like that all of the information and strategies presented are things I can immediately put into practice with my current clients. The strategies were well organized and presented, easy to follow." – J.L. (Mar. 2016)
"The successive shaping of words was the most useful topic. I liked the video examples." – J.H. (Feb. 2016)
"I liked the practical applicability to my daily practice. I really appreciated the material on finding motivating reinforcers and giving reinforcer more quickly for more accurate verbalizations." – K.S. (Feb. 2016)
"Very thorough. Married ABA with strategies used for speech/language therapy (communication development)." – S.S. (Feb. 2016)
"This course is good. I especially liked the discussion re: behaviours and communication." – K.G. (Feb. 2016)
"I found all of the information relevant. Everything from shaping verbal behavior to the social skills training! I liked the video models and examples. It helped me identify with the material and relate it to other learners and situations that I've encountered and helped me to pre-visualize what I might do in similar situations." – V.D.A. (Feb. 2016)
"The discussion on what to include for initial vocabulary was really beneficial." – K.O. (Jan. 2016)
"I liked the use of videos and examples. The additional classes offered for social interaction (fitness, etc.) were very helpful." – J.S. (Jan. 2016)
"The info on initiating communication/speech with children on the spectrum was most beneficial. The course was very functional and useful immediately." – J.H. (Jan. 2016)