I have covered so much material in the course of making this blog and we have discussed many aspects of communication in our discussions. It is a key factor for those with ASD and how they function.
4 Strategies I would focus on include:
1. Co-treating with SLPs and Educators/Families:
It is important to all use the same key words. You and the SLP can help others understand some commonality in the speech of those with ASD including:
-oral sensitivities
-motor impairments
-low tone
-prosody
-sound/syllable repetition
-word repetition
-word revisions
-slow articulation
-pause time
-misplaced stress in words
-monotonous tome
-loud high pitch
-nasality
-sing-song voice
Once the verbal expectations are known/understood by listeners, they may more more willing to interact with the child with ASD.
Motivation and interest and attention should be primary focuses of interactions. Co-treatment sessions such as making and using puppets seem to be one example that is good. We have also discussed using Sponge Bob to help teach idioms and expression sayings. Homographs also need to be taught.
The rationale for co-treating is that many things can be worked on at the same time in a naturalistic setting and motivation will be present. Also, it helps generalize skills if all team members are on the same page.
2. Context:
Consider auditory and visual distractions, social complexity, and of course motivation to communicate! Use high contrast and boundaries to establish work and play areas and help with expectations/predictions. Materials used should also be considered. We have discussed using their choices/interests such as Thomas and trampolines to expand communication skills as well as motor skills and social/play skills. Another example is using repetitive stories and songs and leaving out parts they need to fill in. Also you can leave a key piece of a task out so they have to ask for it.
The rationale for the use of context is to not overwhelm the child from the start but to motivate them to communicate. It will be a more efficient use of time and be more meaningful to the student.
3. Consider Interventions:
Remember feeding and speech use different muscles and that oral motor techniques may not necessarily lead to speech. Joint attention and imitation should be developed first. Consider random or blocked techniques (or a combination). Consider continuous or discrete interventions (or both). Find the best fit for the child. Random has better transfer and continuous allows you to use the natural environment and incidental teaching which I feel is important. Consider body awareness and postural cues and facial interpretation ability when planning communication, socialization and play. Know that the above techniques may vary depending on the skill desired. Social Stories are good for preparation for a multitude of experiences and flip videos are good visual feedback as only 2 examples. Remember sensory desires such as proprioception too.
My Rationale for using a variety of interventions is to focus on the individual and the skill being developed. Task analysis can help you decide what might be the best way to proceed. Don't forget reinforcement, interest and motivation. DTT may be better for difficult skills as there is immediate reinforcement but the long term goal is continuous random interactions in the natural environment so the child can generalize skills learned in many different settings and the interaction is the reinforcement.
4. Total Communication:
It is important to be aware of the numerous ways to facilitate communication especially for those who are nonverbal or show no intent. Many items below use the visual strengths of this population. Consider that communication involves a listener and a speaker.
-PECS
-Sign language
-augmentative devices
-PROMPT
-NSOMEs
-Integration Stimulation
-Verbal Behavior
-The Denver Mode
-building on echolalia
It is important to know various programs or strategies to empower those working with the child with ASD and enabling educated choices or alterations to best meet the child's needs.
My rationale for this is to reduce the frustration and increase the desire for the child to want to communicate. Many of the above also use the visual strengths of this population. They an be used together or variations such as photos or transitional objects can be used. Again, the best fit is important. I like to allow the child with ASD to have as many avenues and opportunities as possible to communicate.
Finally, I encourage you to combine communication, play and social skills. You can build communication and social skills (hidden curriculum) during physical tasks and basically during any intervention. Remember your speech as well and gear it toward your goals. Remember sensory needs and motivate the child. Enjoy yourself and teach other professionals and families how to engage the child for optimal communication.
Saturday, May 1, 2010
Saturday, April 24, 2010
Different Approaches to Facilitation of Speech/Communication
Different Approaches to Facilitation of Speech/Communication:
PROMPT
- the systematic manipulation of tactual-kinesthetic-proprioceptive input to oral-motor structures
-muscle movement simulation for speech sounds and timing
-planes of movement for co-articulation and how they coordinate to create speech
-speech, language and social goals considered
-Research continues with subjects with ASD
- physical-sensory aspects of motor performance, cognitive-linguistic and social-emotional aspects
NSOME
-any technique to influence speaking without requiring sound production
-warm-ups to increase blood flow for ease of muscle control, not needed prior to speaking
-influence tongue, lip and jaw resting postures, strength, tone, ROM, and muscle control
-oral motor exercises: sensory stimulation of lips, jaw, soft palate, larynx, and respiratory muscles
-blowing, tongue push-ups, pucker-smile, tongue wags, big smile, tongue-to-nose-to-chin, cheek puffing, blowing kisses, tongue curling
-benefits: tongue elevation, awareness of articulators, tongue and lip strength, lateral tongue movements, jaw stabilization, lip/tongue protrusion, drooling control, VP competence, sucking ability
-not strong research, claimed effectiveness in catalogs selling materials
-teaching the parts does not help the whole/ doesn’t assist in speech development, more effective to train the whole
-strength/force measurement not always objective although there are several objective measures
-may not strengthen articulator strength, to improve articulation stimulation must be done with pertinent actions, an end goal expectation and integration of abilities
-articulatory strength is very low compared to the oral motor strength for feeding, swallowing, sucking, breathing (same structures/different functions);breathing for speech is different than for any other activity as one example
-context is important for possible skill transference
-teaching isolated motions may not lead to speech according to evidence, speech is improved through practicing speaking in the context
-studies show motions activate different parts of the brain than speech movements
The Denver Model
-developmental
-intensive teaching, specific teaching approach
-develop social-communication skills
-skill building
-affective connection, relationship building, understanding emotional exchanges
-understanding communication
-inclusive setting in a group, used to be center based, recommended one-on-one for the ASD population
-start early to prevent confounding effects of ASD
-family based, families choose objectives
-individualized
-will consider using other techniques in addition such as ABA, PROMPT, imitation/symbolic play, pragmatics,
-teach peer play, imitation- nonverbal communication, receptive language/understanding, games, pretend play for social interaction
-use of puppets and dolls
-dialogs/play scripts so they know what to do when playing, ex. turn taking
-verbal
ABA/Verbal Behavior
-analyzing the function of the behavior: to get something or avoid something, behavior analysis-antecedent, behavior, consequence, function
-direct instruction, DTT, precision teaching, verbal behavior (uses student motivation to teach language skills, determine the function of language based upon the student’s use of words, signs, or pictures)
-teach basic communication and language skills
-immediate feedback
-positive reinforcement
-team based
-data collection
-Verbal Behavior can be used with sign, devices nonverbal and verbal communication
-requests, vocabulary and intraverbals are important
Augmentative and Assistive Technology
- high and low tech/aided and unaided (PECS, objects and voice output devices)
-consider developmental level, fine motor abilities
-objects, photographs or line drawings
-purpose or goals of communication
-to support communication, reduce frustration, encourage speech
-total communication- combing several modes of communication such as speech and sign language
PECS (Picture Exchange Communication System)
-modify communication demands making it effective
-exchange pictures for a desired item, answer/respond, comment
-to increase functional communication between a listener and a speaker
-may increase speech
Sign Language
-using gestures of hand signals to communicate
-need to consider the audience, many people may not understand
-family and educational professionals would also need to learn the same gestures, ASL or ESL that are used by the child
-can eliminate frustration
-paired with speech = Total Communication
-need finger isolation/fine motor ability
Facilitated Communication
-for non-speaking population that cannot use sign language or access devices
-a facilitator provides support to the arm, wrist or hand to support their ability to type, point, or use devices
-controversy- typed data may be facilitator driven
-support is faded back as pointing increases
-goal independent communication
-may have an extensive duration
Integral Stimulation Method
-to improve motor planning and processing as speech is acquired
-visual and auditory models
-visual attentions to instructor’s face (“listen to me, watch me, do what I do”)
-bottom up approach
-tactile, gestural and prosodic cueing which is constantly added or faded dependent on progress
-Dynamic Temporal and Tactile cueing (a variation)
Note: not all approaches have been covered.
ABA Forum (2010). Sally Rogers: Intensive Autism Treatment the Denver Way. http://www.abaforum.dk/artikler/2003/sally_rogers.php
Autism-Resources.com(2010)Severe Communication Impairment, Facilitated Communication, and Disclosures of Abuse. http://www.autism-resources.com/papers/severe_communications_impairment
Burkaba, C. (2010). What is Applied Verbal Behavior> http://www.christinaburkaba.com/AVB.htm
Lof, G. (2008). Evidence-Driven Speech Sound Intervention: Alternatives to Nonspeech Motor Exercises. 2008 ASHA Convention, p.1-9.
Miller-Kuhaneck, H. (2004). Autism: A comprehensive Occupational Therapy Approach. 2nd ed. Bethesda, MD: American Occupational Therapy Association, Inc.
Mirenda, P. (July 2003).Toward Functional Augmentative and Alternative Communication for Students With Autism: Manual Signs, Graphic Symbols, and Voice Output Communication Aids. Language, Speech, and hearing Services in Schools, V 34, p. 203–216.
Pennsylvania Department of Education.(September 2005). An Introduction to Applied Behavior Analysis. Pennsylvania Depart of Education: bureau of Special Education: Pennsylvania Training and Technical Assistance Association. P. 1-6
The Prompt Institute (2010). History, Mission and Goals. https://promptinstitute.com/index.php?page=history-mission-goals
The PROMPT Institute. (2010). PROPMPT Research. https://promptinstitute.com/index.php?page=prompt-research
Strand, E. (2005). What is the Integral Stimulation Method? How is it used for treating apraxia speech in children? Apraxia-KIDS – A program of the childhood Apraxia of Speech Association (CASNA)
Wikipedia. (2010). Facilitated Communication. http://en.wikipedia.org/wiki/Facilitated_communication
Autism-Resources.com (2010).Severe Communication Impairment, Facilitated Communication, and Disclosures of Abuse. http://www.autism-resources.com/papers/severe_communications_impairment
PROMPT
- the systematic manipulation of tactual-kinesthetic-proprioceptive input to oral-motor structures
-muscle movement simulation for speech sounds and timing
-planes of movement for co-articulation and how they coordinate to create speech
-speech, language and social goals considered
-Research continues with subjects with ASD
- physical-sensory aspects of motor performance, cognitive-linguistic and social-emotional aspects
NSOME
-any technique to influence speaking without requiring sound production
-warm-ups to increase blood flow for ease of muscle control, not needed prior to speaking
-influence tongue, lip and jaw resting postures, strength, tone, ROM, and muscle control
-oral motor exercises: sensory stimulation of lips, jaw, soft palate, larynx, and respiratory muscles
-blowing, tongue push-ups, pucker-smile, tongue wags, big smile, tongue-to-nose-to-chin, cheek puffing, blowing kisses, tongue curling
-benefits: tongue elevation, awareness of articulators, tongue and lip strength, lateral tongue movements, jaw stabilization, lip/tongue protrusion, drooling control, VP competence, sucking ability
-not strong research, claimed effectiveness in catalogs selling materials
-teaching the parts does not help the whole/ doesn’t assist in speech development, more effective to train the whole
-strength/force measurement not always objective although there are several objective measures
-may not strengthen articulator strength, to improve articulation stimulation must be done with pertinent actions, an end goal expectation and integration of abilities
-articulatory strength is very low compared to the oral motor strength for feeding, swallowing, sucking, breathing (same structures/different functions);breathing for speech is different than for any other activity as one example
-context is important for possible skill transference
-teaching isolated motions may not lead to speech according to evidence, speech is improved through practicing speaking in the context
-studies show motions activate different parts of the brain than speech movements
The Denver Model
-developmental
-intensive teaching, specific teaching approach
-develop social-communication skills
-skill building
-affective connection, relationship building, understanding emotional exchanges
-understanding communication
-inclusive setting in a group, used to be center based, recommended one-on-one for the ASD population
-start early to prevent confounding effects of ASD
-family based, families choose objectives
-individualized
-will consider using other techniques in addition such as ABA, PROMPT, imitation/symbolic play, pragmatics,
-teach peer play, imitation- nonverbal communication, receptive language/understanding, games, pretend play for social interaction
-use of puppets and dolls
-dialogs/play scripts so they know what to do when playing, ex. turn taking
-verbal
ABA/Verbal Behavior
-analyzing the function of the behavior: to get something or avoid something, behavior analysis-antecedent, behavior, consequence, function
-direct instruction, DTT, precision teaching, verbal behavior (uses student motivation to teach language skills, determine the function of language based upon the student’s use of words, signs, or pictures)
-teach basic communication and language skills
-immediate feedback
-positive reinforcement
-team based
-data collection
-Verbal Behavior can be used with sign, devices nonverbal and verbal communication
-requests, vocabulary and intraverbals are important
Augmentative and Assistive Technology
- high and low tech/aided and unaided (PECS, objects and voice output devices)
-consider developmental level, fine motor abilities
-objects, photographs or line drawings
-purpose or goals of communication
-to support communication, reduce frustration, encourage speech
-total communication- combing several modes of communication such as speech and sign language
PECS (Picture Exchange Communication System)
-modify communication demands making it effective
-exchange pictures for a desired item, answer/respond, comment
-to increase functional communication between a listener and a speaker
-may increase speech
Sign Language
-using gestures of hand signals to communicate
-need to consider the audience, many people may not understand
-family and educational professionals would also need to learn the same gestures, ASL or ESL that are used by the child
-can eliminate frustration
-paired with speech = Total Communication
-need finger isolation/fine motor ability
Facilitated Communication
-for non-speaking population that cannot use sign language or access devices
-a facilitator provides support to the arm, wrist or hand to support their ability to type, point, or use devices
-controversy- typed data may be facilitator driven
-support is faded back as pointing increases
-goal independent communication
-may have an extensive duration
Integral Stimulation Method
-to improve motor planning and processing as speech is acquired
-visual and auditory models
-visual attentions to instructor’s face (“listen to me, watch me, do what I do”)
-bottom up approach
-tactile, gestural and prosodic cueing which is constantly added or faded dependent on progress
-Dynamic Temporal and Tactile cueing (a variation)
Note: not all approaches have been covered.
ABA Forum (2010). Sally Rogers: Intensive Autism Treatment the Denver Way. http://www.abaforum.dk/artikler/2003/sally_rogers.php
Autism-Resources.com(2010)Severe Communication Impairment, Facilitated Communication, and Disclosures of Abuse. http://www.autism-resources.com/papers/severe_communications_impairment
Burkaba, C. (2010). What is Applied Verbal Behavior> http://www.christinaburkaba.com/AVB.htm
Lof, G. (2008). Evidence-Driven Speech Sound Intervention: Alternatives to Nonspeech Motor Exercises. 2008 ASHA Convention, p.1-9.
Miller-Kuhaneck, H. (2004). Autism: A comprehensive Occupational Therapy Approach. 2nd ed. Bethesda, MD: American Occupational Therapy Association, Inc.
Mirenda, P. (July 2003).Toward Functional Augmentative and Alternative Communication for Students With Autism: Manual Signs, Graphic Symbols, and Voice Output Communication Aids. Language, Speech, and hearing Services in Schools, V 34, p. 203–216.
Pennsylvania Department of Education.(September 2005). An Introduction to Applied Behavior Analysis. Pennsylvania Depart of Education: bureau of Special Education: Pennsylvania Training and Technical Assistance Association. P. 1-6
The Prompt Institute (2010). History, Mission and Goals. https://promptinstitute.com/index.php?page=history-mission-goals
The PROMPT Institute. (2010). PROPMPT Research. https://promptinstitute.com/index.php?page=prompt-research
Strand, E. (2005). What is the Integral Stimulation Method? How is it used for treating apraxia speech in children? Apraxia-KIDS – A program of the childhood Apraxia of Speech Association (CASNA)
Wikipedia. (2010). Facilitated Communication. http://en.wikipedia.org/wiki/Facilitated_communication
Autism-Resources.com (2010).Severe Communication Impairment, Facilitated Communication, and Disclosures of Abuse. http://www.autism-resources.com/papers/severe_communications_impairment
Saturday, April 17, 2010
Motor Planning, Motor Control & Motor Learning
Consider the discussion on motor planning, motor control, and motor learning – describe:
1. The type of practice (i.e.: random or blocked) and the type of tasks (continuous or discrete) that may be used to promote verbal communication skills in children during social activity.
-Frietag et al (2008, p. 2) state that “It might be possible that difficulties in biological motion perception might underlie these impairments, imitation and joint attention skills, that are strongly linked to later social and language development.” As those with ASD have motor planning issues for gross or fine motor skills such as body language and speech, it is known they also have social impairments. These skills may be worked on together. The below task and practice types will be used in treatments below. Those with an asterisk are preferred or more beneficial to the student as per research.
-Type of Practice:
*Random -preferred -different target can be practiced intermixed, facilitates chunking, greater transfer and retention, skill gets stronger with an increase in practice, closer to daily life situations, enhances motor learning (Maas et al, 2008,p. 282 and 285), more complex speech taught before simpler will transfer to simpler speech skill development (Maas, 2008, p. 287) ex. Blends will lead to single sounds, speech may lead to non-speech development and movements for speech.
Blocked- different targets practiced in separate, successive blocks of the treatment phase, enhances performances during practice
-Type of Tasks:
*Continuous-natural environment, child led, play, incidental teaching, attention to multiple cues (Delprato, 2001, p. 316), leads to much higher speech intelligibility (study in Delprato, 2001, p. 322), normalized procedures are effective in teaching and language learning such as during free play (Delprato, 2001, p. 317).
Discrete- less effective (Delprato, 2001), maybe good initially?, highly structured, direct instruction with reinforcers, reinforcers may not be naturalistic. This may not apply to social verbal communication well.
2. Provide 2 treatment activities and how you would apply principles of task and practice to promote motor learning to help the child develop social skills with improved communicative understanding of others and expressed self-intent.
- Prepractice enables the individual with ASD to become accustomed to the methods of practice and feedback. (Maas, 2008, p. 292). This may actually be more discrete although random is preferred. It will prepare the child with ASD for motions, expectations, sensations, interactions, materials, etc. It may also help increase motivation as stress with be decreased. Rogers et al. (2003, p. 763) reports that imitation leads to early peer interaction. Also, being imitated can lead to “increased social initiative, orienting and engagement after adults imitated their actions with objects” (p. 765) however this aspect of play is less impaired than movements without objects. It seems a likely place to start and then expand to motor imitations since imitation of body and face lead to speech development (p. 765).
-My first treatment activity would be to use video clips to analyze play motions, social cues and speech/communication. Practice would be discrete and task would be a blend of blocked and continuous. This is because it is not in a natural environment but the skills can be monitored and discussed, analyzed and practiced/role-played together rather than repeatedly discussing one aspect (body awareness/space, physical task demands, environmental factors, sensory factors, body language, facial expressions, communication/speech, etc.). Brinton et al (2004, p. 285) note that a student who had this treatment “increased his awareness of social, emotional and contextual information needed to function appropriately in conversation.” I feel this is a good idea since it has feeds on some strengths of those with ASD such as visual input and memorization of lines. The clips will vary from in school free time, recess (sandbox, teeter-totter, swings, climbing equipment, etc.) and after school activities. This will assist the student in “anticipation, coordination and adaptation” (Schmitz, 2003, p. 17). This coincides also with Trecker and Miller-Kuhaneck (2004, p. 197-8) who mention that sensory input assists with body maps and imitation is a building block in play for new motor plans. They do suggest simple first then to more complex which is in contrast to other authors. I think it will be individualized to the particular student. Tanta (2004, p. 160) mentions using random practice and continuous tasks as teaching play scripts during incidental teaching moments is one good strategy. Others include context modification, peer mediation, predictable play routines, and child-directed strategies such as at recess. Maas (2008, p. 279 and 281)discusses the structure of practice of a schema or generalized motor program provides various types of information associated with each movement.” Like Tanta, Brinton et al, 2004, p. 286) mention playing a conversation game on preselected topics. Turn taking is developed. Practice is definitely blocked with discrete tasks and is highly structured. An example is “Make one comment on the topic, ask a question, and listen to the response.” The video clips of play sessions will be watched and analyzed and role-played in therapy. If needed, it could be reverted back to this more basic level of treatment. The same could be done with motor acts of the body or for speech depending on the student’s needs.
-The second treatment activity will definitely follow the random practice and continuous task route. The first treatment was more preparatory and this will be more naturalistic. It will occur during an indoor or outdoor recess. A peer or two may also have been prepared for the play and how to guide the child with ASD, what to expect and how to praise/respond to that particular individual. Tanta (2004, p. 163) discussed how to choose a peer or group for intervention: peer affect/high positive peer interactions, gender-often same sex is age appropriate and it may influence materials chosen to play with, developmental level- different chronological and developmental ages promote various types of play. I had a small group of a male child in regular education, a male self-contained student who was high on the spectrum and a female who is more involved who attends the ABA classroom. Although her speech and motor abilities were significantly more delayed. The three eventually became a very social and active/interactive group. Each contributed their own personal strengths to make it a cohesive and almost self-sufficient group for many goals/objectives. I think incidental teaching is really effective. I have done many sessions on the playground incorporating as many students as I could handle (especially if I had a specific activity planned/number of materials). When you bring novel materials to the playground, it increased typical peer interest as well. It benefits the child who receives Occupational therapy as they would have had experience with the materials in prior sessions. No matter what level of communication the student is at, I would defer questions and comments to the student. If the other students were all involved in a game or on equipment, I would encourage the student to go select whoever they wanted to play with. Student motivation, skill level/readiness, and sensory needs will all need to be taken into consideration. Hopefully, the first treatment will have be selected appropriately and they had the desire to practice and then to learn so they can function physically and socially in a natural setting.
Brinton et al. (July 2004). Description of a Program for Social Language Intervention: “If You Can Have a Conversation, You Can Have a Relationship.” Language, Speech and Hearing Services in Schools, v35, p. 283-290.
Delprato (2001). Comparisons of Discrete-Trials and Normalized Behavioral Language Intervention for Young children with Autism. Journal of Autism and Developmental Disorders, v31,n 13, p. 315-325.
Frietag et al (2008). Perception of biological Motion in Autistic Spectrum Disorders. Neuropsychological. p. 1-15.
Maas et al. (August 2008). Principles of Motor Learning in Treatment of Motor Speech Disorders. American Journal of Speech-Language Pathology, v17, p. 277-298.
Rogers et al (2003) Imitation Performance in Toddlers with Autism and Those with Other Developmental Disorders. Journal of Child Psychology, v 44, n5, p. 763-781
Schmidtz, C., Martineau, J., Barthelemy, C. and Assaiante, C. (May 2003). Motor control and children with autism: deficit of anticipatory function? Neuroscience Letters 348, p. 17-20.
Tanta, K. (in Miller-Kuhaneck 2004). Promoting Peer Interaction in Children With an Autism Spectrum Disorder. (chapter 7, p. 155-170), Autism a Comprehensive Occupational Therapy Approach 2nd edition. Bethesda, MD: The American Occupational Therapy Association, Inc.
Trecker, A. and Miller-Kuhaneck, H. (in Miller-Kuhaneck 2004). Play and Praxis in Children With an Autism Spectrum Disorder (chapter 9, p. 193-213), Autism a Comprehensive Occupational Therapy Approach 2nd edition. Bethesda, MD: The American Occupational Therapy Association, Inc.
1. The type of practice (i.e.: random or blocked) and the type of tasks (continuous or discrete) that may be used to promote verbal communication skills in children during social activity.
-Frietag et al (2008, p. 2) state that “It might be possible that difficulties in biological motion perception might underlie these impairments, imitation and joint attention skills, that are strongly linked to later social and language development.” As those with ASD have motor planning issues for gross or fine motor skills such as body language and speech, it is known they also have social impairments. These skills may be worked on together. The below task and practice types will be used in treatments below. Those with an asterisk are preferred or more beneficial to the student as per research.
-Type of Practice:
*Random -preferred -different target can be practiced intermixed, facilitates chunking, greater transfer and retention, skill gets stronger with an increase in practice, closer to daily life situations, enhances motor learning (Maas et al, 2008,p. 282 and 285), more complex speech taught before simpler will transfer to simpler speech skill development (Maas, 2008, p. 287) ex. Blends will lead to single sounds, speech may lead to non-speech development and movements for speech.
Blocked- different targets practiced in separate, successive blocks of the treatment phase, enhances performances during practice
-Type of Tasks:
*Continuous-natural environment, child led, play, incidental teaching, attention to multiple cues (Delprato, 2001, p. 316), leads to much higher speech intelligibility (study in Delprato, 2001, p. 322), normalized procedures are effective in teaching and language learning such as during free play (Delprato, 2001, p. 317).
Discrete- less effective (Delprato, 2001), maybe good initially?, highly structured, direct instruction with reinforcers, reinforcers may not be naturalistic. This may not apply to social verbal communication well.
2. Provide 2 treatment activities and how you would apply principles of task and practice to promote motor learning to help the child develop social skills with improved communicative understanding of others and expressed self-intent.
- Prepractice enables the individual with ASD to become accustomed to the methods of practice and feedback. (Maas, 2008, p. 292). This may actually be more discrete although random is preferred. It will prepare the child with ASD for motions, expectations, sensations, interactions, materials, etc. It may also help increase motivation as stress with be decreased. Rogers et al. (2003, p. 763) reports that imitation leads to early peer interaction. Also, being imitated can lead to “increased social initiative, orienting and engagement after adults imitated their actions with objects” (p. 765) however this aspect of play is less impaired than movements without objects. It seems a likely place to start and then expand to motor imitations since imitation of body and face lead to speech development (p. 765).
-My first treatment activity would be to use video clips to analyze play motions, social cues and speech/communication. Practice would be discrete and task would be a blend of blocked and continuous. This is because it is not in a natural environment but the skills can be monitored and discussed, analyzed and practiced/role-played together rather than repeatedly discussing one aspect (body awareness/space, physical task demands, environmental factors, sensory factors, body language, facial expressions, communication/speech, etc.). Brinton et al (2004, p. 285) note that a student who had this treatment “increased his awareness of social, emotional and contextual information needed to function appropriately in conversation.” I feel this is a good idea since it has feeds on some strengths of those with ASD such as visual input and memorization of lines. The clips will vary from in school free time, recess (sandbox, teeter-totter, swings, climbing equipment, etc.) and after school activities. This will assist the student in “anticipation, coordination and adaptation” (Schmitz, 2003, p. 17). This coincides also with Trecker and Miller-Kuhaneck (2004, p. 197-8) who mention that sensory input assists with body maps and imitation is a building block in play for new motor plans. They do suggest simple first then to more complex which is in contrast to other authors. I think it will be individualized to the particular student. Tanta (2004, p. 160) mentions using random practice and continuous tasks as teaching play scripts during incidental teaching moments is one good strategy. Others include context modification, peer mediation, predictable play routines, and child-directed strategies such as at recess. Maas (2008, p. 279 and 281)discusses the structure of practice of a schema or generalized motor program provides various types of information associated with each movement.” Like Tanta, Brinton et al, 2004, p. 286) mention playing a conversation game on preselected topics. Turn taking is developed. Practice is definitely blocked with discrete tasks and is highly structured. An example is “Make one comment on the topic, ask a question, and listen to the response.” The video clips of play sessions will be watched and analyzed and role-played in therapy. If needed, it could be reverted back to this more basic level of treatment. The same could be done with motor acts of the body or for speech depending on the student’s needs.
-The second treatment activity will definitely follow the random practice and continuous task route. The first treatment was more preparatory and this will be more naturalistic. It will occur during an indoor or outdoor recess. A peer or two may also have been prepared for the play and how to guide the child with ASD, what to expect and how to praise/respond to that particular individual. Tanta (2004, p. 163) discussed how to choose a peer or group for intervention: peer affect/high positive peer interactions, gender-often same sex is age appropriate and it may influence materials chosen to play with, developmental level- different chronological and developmental ages promote various types of play. I had a small group of a male child in regular education, a male self-contained student who was high on the spectrum and a female who is more involved who attends the ABA classroom. Although her speech and motor abilities were significantly more delayed. The three eventually became a very social and active/interactive group. Each contributed their own personal strengths to make it a cohesive and almost self-sufficient group for many goals/objectives. I think incidental teaching is really effective. I have done many sessions on the playground incorporating as many students as I could handle (especially if I had a specific activity planned/number of materials). When you bring novel materials to the playground, it increased typical peer interest as well. It benefits the child who receives Occupational therapy as they would have had experience with the materials in prior sessions. No matter what level of communication the student is at, I would defer questions and comments to the student. If the other students were all involved in a game or on equipment, I would encourage the student to go select whoever they wanted to play with. Student motivation, skill level/readiness, and sensory needs will all need to be taken into consideration. Hopefully, the first treatment will have be selected appropriately and they had the desire to practice and then to learn so they can function physically and socially in a natural setting.
Brinton et al. (July 2004). Description of a Program for Social Language Intervention: “If You Can Have a Conversation, You Can Have a Relationship.” Language, Speech and Hearing Services in Schools, v35, p. 283-290.
Delprato (2001). Comparisons of Discrete-Trials and Normalized Behavioral Language Intervention for Young children with Autism. Journal of Autism and Developmental Disorders, v31,n 13, p. 315-325.
Frietag et al (2008). Perception of biological Motion in Autistic Spectrum Disorders. Neuropsychological. p. 1-15.
Maas et al. (August 2008). Principles of Motor Learning in Treatment of Motor Speech Disorders. American Journal of Speech-Language Pathology, v17, p. 277-298.
Rogers et al (2003) Imitation Performance in Toddlers with Autism and Those with Other Developmental Disorders. Journal of Child Psychology, v 44, n5, p. 763-781
Schmidtz, C., Martineau, J., Barthelemy, C. and Assaiante, C. (May 2003). Motor control and children with autism: deficit of anticipatory function? Neuroscience Letters 348, p. 17-20.
Tanta, K. (in Miller-Kuhaneck 2004). Promoting Peer Interaction in Children With an Autism Spectrum Disorder. (chapter 7, p. 155-170), Autism a Comprehensive Occupational Therapy Approach 2nd edition. Bethesda, MD: The American Occupational Therapy Association, Inc.
Trecker, A. and Miller-Kuhaneck, H. (in Miller-Kuhaneck 2004). Play and Praxis in Children With an Autism Spectrum Disorder (chapter 9, p. 193-213), Autism a Comprehensive Occupational Therapy Approach 2nd edition. Bethesda, MD: The American Occupational Therapy Association, Inc.
Saturday, April 10, 2010
Motor Impairments & Aspects of Speech
What are the motor impairments of children which impact ability to execute the motor skill of voice onset, phonation, and articulation in autism? How do we know this? What is an application of this knowledge to a direct clinical example?
Here are some introductory terms explained by Gretz (2010. Glossary. CASANA online):
Articulation-Contact between two structures (such as the lips, jaw, tongue, velum)
of the oral cavity that shapes the vocal tract.
Voiced-Speech sounds produced using the vibrating vocal folds
Phonological Awareness -Understanding of the sound structure of language, including the recognition that words are composed of syllables and phonemes that can be changed and manipulated to create new words and meaning.
Phonology-The speech sound system of a language and the rules for combining them.
Phonation - process by which vocal folds produce certain sounds through quasi-periodic vibration (those who study laryngeal anatomy and physiology and speech production in general) Other phoneticians, though, call this process quasi-periodic vibration voicing and they use the term phonation to refer to any oscillatory state of any part of the larynx that modifies the airstream, of which voicing is just one example. Wikipedia (2010. online resource).
Motor skill deficits have focused on gross and fine motor occupations especially by occupational therapists. A speech therapist may consider the motor impairments of speech acts. Poor posture may affect correct patterns of speech breathing. The lack of attention to faces and in imitation skills can hinder development of motor skills needed for speech. Davis et al. (2008) cite means, motive and opportunity as three interconnected necessities for communication. A student with ASD will have listeners in family members, teachers, aides, and classmates. There is a wide array of means for communication available especially for nonverbal students. Once motivation is present the three-fold compilation to communicate is there. In younger children with ASD obtaining a desired item is often used to begin intervention. Treating the whole system is much more complex and would take a detailed assessment using interviews, observation and standardized assessments as per Froleck (2004). Individuals with ASD can have low tone, hypersensitivities of the mouth or motor planning/coordination issues that can impair speech production. “The core impairment in planning and/or programming spatiotemporal parameters of movement sequences results in errors in speech sound production and prosody.” (American Speech-Language-Hearing Association, 2007, p. 4).
Oral- motor control also contributes to speech production. The picky diet of an individual with ASD can impede this progression if certain foods are avoided. The same muscles used in speech production are enhanced by swallowing and sucking while sucking, swallowing and chewing are not foundations for speech. The sequence of oral-motor control will be listed below for your reference (adapted from American Speech-Language-Hearing Association, 2007, p. 8-9). Also, for your reference a language development chart from the Child Development Institute can be accessed via a link on the sidebar or it can be viewed on a separate page noted at the top of the blog.
-jaw control - 15 months
-upper and lower lips
-tongue development
-individual articulators (lips, different portions of the tongue)
Although speech and feeding may use the same muscles they actually have a negative correlation “ as feeding patterns involve tight linking of lips with jaw in a highly rhythmic stereotyped pattern. To produce a variety of syllables within varied prosodic patterns requires the child to overcome the interdependent inflexible patterns associated with sucking. “ (American Speech-Language-Hearing Association, 2007, p. 8). The tongue is used for sucking and swallowing and eventually moving food around in the mouth but is also used to produce certain syllables. Motor planning and coordinating the use of the lips, tongue, jaw and breath takes time and development. Individuals with ASD may not experience the practice stage of babbling seen in typical peers that helps form and refine speech sounds. This adjustment phase continue through age 5 and 6 for articulation and even in the middle school years and beyond speech can still be less consistent than adult speech. (American Speech Language-Hearing Association, 2007).
Prizant in Gretz (1996 in 2010, CASANA, www.apraxia-kids.org) concurs that oral motor skills “can be a significant factor inhibiting the development of speech in some children with autism. For instance:
* Some children demonstrate the classic symptoms of oral motor problems such as difficulty in coordinating movement of the articulators (lips, tongue, jaw, etc.), feeding difficulties, drooling past the age when most children are able to control saliva, and low facial muscle tone.
* Symptoms that are consistent with a diagnosis of developmental apraxia of speech. These symptoms may include: use of primarily vowel-like vocalizations and limited consonant repertoire (consonants require greater motor-planning ability); intelligibility which decreases with length of utterance (single word and single syllable production may be more clear than extended utterances or multisyllabic words); differences in automatic versus volitional speech (echolalia may be more clearly articulated compared to spontaneous speech attempts).”
Toth et al. (2006, in Frietag et al. 2008, p. 1481) states that “it might be possible that difficulties in biological motion perception might underlie these impairments imitation and joint attention skills, which are skills, that are strongly linked to later social and language development.” In the How Do We Know This? Section of this blog post, agreement is made by Dr. Michael Crary as nonspeech motor functions are the first area to look at. (1993 in 2010, CASANA, www.apraxia-kids.org).
Shriberg et al. (2001, Appendix, p. 1115) describe a prosody-voice profile of males with ASD. I filled it in with commonly found areas noted throughout the article. The following findings are from a study they did using males with High Functioning Autism (HFA), Asperger’s (AS) and typical peers: It involves exclusion codes where the individual will interrupt/overtalk others or may only use one word. Prosody-voice codes include phrasing issues of sound/syllable repetition, word repetition, one word revisions and repetition and revision. The rate had slow articulation and pause time. The stress displayed issues in multisyllabic words, reduced/equal stress such as monotonous speech and excessive/equal/misplaced stress. Voice is the final area of the profile and they have determined that those with ASD tend to be loud, use high pitch/falsetto, and have laryngeal features such as register breaks and diplophonia and exhibit nasal resonance features. The HFA group took longer to speak and used stress inappropriately which may affect a listener’s patience and following the conversation, question or response. Fay and Schuler (1980, in Shriberg, et. al., 2001, p. 1100) report that some members of the HFA group may use a “sing-song” voice. Listeners may also not interact with the individual with ASD due to nasality common in their voice (Shriberg, 2001, Appendix, p. 1115). The authors also note some articulation distortions (p. 1104). In my experience it does seem as they may have low tone of the jaw and mouth/cheek muscles or praxis issues at times. In summation of this article, “Speech that is too loud and/or high pitched can create an impression of overbearing for or insistence; speech that is too slow and/or nasal may create the impression that the speaker is condescending” (Shriberg, 2001, p. 1110). An individual with ASD may have issues with voice modulation due to listed prosody factors, mood, internal or external stress or attempted sensory habituation.
How do we know this?
In the same article by Gretz on speech production “Dr. Michael Crary outlines a number of areas for clinical observation and evaluation, including: nonspeech motor functions…speech motor functions…articulation and phonological performance…language performance…other: ability to sustain and shift attention, reaction to speech, distractibility.” This would be a good reference to review prior to considering the need for a speech evaluation (1993 in 2010, CASANA, www.apraxia-kids.org).
Powell (2010) discusses two ways to assess how we know why speech delays are evident. These include quantitative and qualitative methods. Quantitiative assessments use numbers or scores while “Qualitative approaches de-emphasize the use of numbers and attempt to describe the individual's language. Standardized tests (such as the Test of Language Development - Primary:3 [TOLD-P:3] or the Clinical Evaluation of Language Fundamentals - 3 [CELF-3]) are good examples of the quantitative approach to language measurement. Analysis of a spontaneous sample of language elicited under naturalistic conditions would be an example of a qualitative approach.” (Powell, 2010, CASANA, www.apraxia-kids.org). It is best to use both as mentioned by Froleck et al. (in Miller-Kuhaneck, et al., 2004). Qualitative information can be obtained through observation in a natural environment and documenting language production. Powell (2010) tends to use standardized assessments first to rule out certain types of problems and to help gear informal observations. On a standardized assessment, it is important to note that “A low score could be related to low language ability (it could also be related to other factors such as attending, hearing, vision, compliance, etc.)” (Powell, 2010, CASANA, www.apraxia-kids.org). A final thought is to remember that speech and language are two separate entities.
What is an application of this knowledge to a direct clinical example?
“Frequent practice of sounds and words helps to improve speech (Velleman, 2005) and reduce some of the pressures associated with expressive language.” (in Solomon, M. and Pereira, L. 2010). Repetitive books are suggested as one intervention. They are because of their “predictability, presence of carrier phrases, frequent practice of target sounds, familiar inflection, and an introduction to phonemic awareness.” (Solomon, M. and Pereira, L. 2010). Books may be especially good with those who have ASD due to having pictural accompaniments which may help predict what comes next as well as the rhyming. It lessens their cognitive demands and may increase willingness to communicate. Having a cozy comfortable reading environment may also be conducive. As you read the same story after the child is familiar with it, you can leave blanks for them to fill. This is also good with common songs while winging as another example. This promotes more active involvement in the occupation. This activity also lessens the response which may be easier at first to entice the child. Later, depending on the story expectations can be made for phrases or sentences. Some children’s book also can be purchased with puppets for when the story know and can say the majority of the story. You wouldn’t want to use all character puppets demanding a fine motor task along with the motor task at first. To increase motivation, the therapist may have a puppet of the main character. If the child is very resistant to this method they may want to read along with a cassette version of the story to prepare them. You always want the just right challenge to encourage self concept and decrease frustration. It also may help those with ASD produce inflection, stress and pauses or other prosody components at appropriate places as they will tend to memorizes the lines. It can also help with emotional expression depending on the story. Since those with ASD may already use a sing-song voice, this may be a good starting activity to be generalized as progress is made. See the List of Repetitive Books & Helpful Hints by Solomon and Pereira by clicking on the page at the top of the blog.
In Summary, motor impairments need to be considered when assessing the individual with ASD’s ability to use speech. There are some characteristics specific to the diagnosis that impact speech performance. This occupation must be distinguished from language and quantitative and qualitative measures together are most beneficial in assessment. There are numerous interventions. A basic one that may appeal to children with ASD has been provided. Please see further links related to this post added as pages to this blog.
References
Davis B, Velleman S .Semin Speech Lang. 2008 Nov; 29(4):312-9. (2008) Establishing a basic speech repertoire without using NSOME: means, motive, and opportunity.
American Speech-Language-Hearing Association. (2007). Childhood Apraxia of
Speech [Technical Report]. Available from www.asha.org/policy.
Frietag, C.M., Konrad, C., Haberlen, M., Kleser, C., von Gontard, A., Reith, W., Troje, Nl., Krick, C. (2008) Perception of biological motion in autism spectrum disorders. Nauropsycholgia, 46: 1480-1494.
Froleck, Clark, G., Miller-Kuhaneck, H. and Waitling, R. in Miller-Kuhaneck, et al (2004) Chapters 6: Evaluation of the Child With an Autism Spectrum Disorder. Bethesda, MD: the American Occupational Therapy Association, Inc.
Gretz, S. (2010. online resource).Glossary of Speech and Language Terms. The Childhood Apraxia of Speech Association of North America (CASANA). www.apraxia-kids.org http://bboard.misericordia.edu/webct/cobaltMainFrame.dowebct?appforward=/webct/startFrameSet.dowebct%3Fforward=manageCourse.dowebct%26lcid=463865245001
Gretz, S. (2010 online resource). Speech Production and Children with Autism. The Childhood Apraxia of Speech Association of North America (CASANA). www.apraxia-kids.org http://bboard.misericordia.edu/webct/cobaltMainFrame.dowebct?appforward=/webct/startFrameSet.dowebct%3Fforward=manageCourse.dowebct%26lcid=463865245001
Powell, T. (2010). A Brief Overview Of Language and Approaches To It's Assessment: One Professional's Perspective. The Childhood Apraxia of Speech Association of North America (CASANA). www.apraxia-kids.org http://bboard.misericordia.edu/webct/cobaltMainFrame.dowebct?appforward=/webct/startFrameSet.dowebct%3Fforward=manageCourse.dowebct%26lcid=463865245001
Shriberg, L. D., et. al. (2001) Speech and prosody characteristics of adolescents and adults with high-functioning autism and Asperger syndrome. Journal of Speech, Language, and Hearing Research, 44(5): 1097-1115.
Solomon, M. and Pereira, L. (2010). Repetitive Books: An Effective Therapeutic Strategy for Children Diagnosed with Apraxia of Speech. The Childhood Apraxia of Speech Association of North America (CASANA). www.apraxia-kids.org http://bboard.misericordia.edu/webct/cobaltMainFrame.dowebct?appforward=/webct/startFrameSet.dowebct%3Fforward=manageCourse.dowebct%26lcid=463865245001
Spitzer, S. in Miller-Kuhaneck, et al (2004) Chapters 5: Common an Uncommon Daily Activities in Individuals with Autism: Challenges and Opportunities for Supporting Occupation. Bethesda, MD: the American Occupational Therapy Association, Inc.
Wikepedia. (2010 online resource). Phonation. http://en.wikipedia.org/wiki/Phonation
Here are some introductory terms explained by Gretz (2010. Glossary. CASANA online):
Articulation-Contact between two structures (such as the lips, jaw, tongue, velum)
of the oral cavity that shapes the vocal tract.
Voiced-Speech sounds produced using the vibrating vocal folds
Phonological Awareness -Understanding of the sound structure of language, including the recognition that words are composed of syllables and phonemes that can be changed and manipulated to create new words and meaning.
Phonology-The speech sound system of a language and the rules for combining them.
Phonation - process by which vocal folds produce certain sounds through quasi-periodic vibration (those who study laryngeal anatomy and physiology and speech production in general) Other phoneticians, though, call this process quasi-periodic vibration voicing and they use the term phonation to refer to any oscillatory state of any part of the larynx that modifies the airstream, of which voicing is just one example. Wikipedia (2010. online resource).
Motor skill deficits have focused on gross and fine motor occupations especially by occupational therapists. A speech therapist may consider the motor impairments of speech acts. Poor posture may affect correct patterns of speech breathing. The lack of attention to faces and in imitation skills can hinder development of motor skills needed for speech. Davis et al. (2008) cite means, motive and opportunity as three interconnected necessities for communication. A student with ASD will have listeners in family members, teachers, aides, and classmates. There is a wide array of means for communication available especially for nonverbal students. Once motivation is present the three-fold compilation to communicate is there. In younger children with ASD obtaining a desired item is often used to begin intervention. Treating the whole system is much more complex and would take a detailed assessment using interviews, observation and standardized assessments as per Froleck (2004). Individuals with ASD can have low tone, hypersensitivities of the mouth or motor planning/coordination issues that can impair speech production. “The core impairment in planning and/or programming spatiotemporal parameters of movement sequences results in errors in speech sound production and prosody.” (American Speech-Language-Hearing Association, 2007, p. 4).
Oral- motor control also contributes to speech production. The picky diet of an individual with ASD can impede this progression if certain foods are avoided. The same muscles used in speech production are enhanced by swallowing and sucking while sucking, swallowing and chewing are not foundations for speech. The sequence of oral-motor control will be listed below for your reference (adapted from American Speech-Language-Hearing Association, 2007, p. 8-9). Also, for your reference a language development chart from the Child Development Institute can be accessed via a link on the sidebar or it can be viewed on a separate page noted at the top of the blog.
-jaw control - 15 months
-upper and lower lips
-tongue development
-individual articulators (lips, different portions of the tongue)
Although speech and feeding may use the same muscles they actually have a negative correlation “ as feeding patterns involve tight linking of lips with jaw in a highly rhythmic stereotyped pattern. To produce a variety of syllables within varied prosodic patterns requires the child to overcome the interdependent inflexible patterns associated with sucking. “ (American Speech-Language-Hearing Association, 2007, p. 8). The tongue is used for sucking and swallowing and eventually moving food around in the mouth but is also used to produce certain syllables. Motor planning and coordinating the use of the lips, tongue, jaw and breath takes time and development. Individuals with ASD may not experience the practice stage of babbling seen in typical peers that helps form and refine speech sounds. This adjustment phase continue through age 5 and 6 for articulation and even in the middle school years and beyond speech can still be less consistent than adult speech. (American Speech Language-Hearing Association, 2007).
Prizant in Gretz (1996 in 2010, CASANA, www.apraxia-kids.org) concurs that oral motor skills “can be a significant factor inhibiting the development of speech in some children with autism. For instance:
* Some children demonstrate the classic symptoms of oral motor problems such as difficulty in coordinating movement of the articulators (lips, tongue, jaw, etc.), feeding difficulties, drooling past the age when most children are able to control saliva, and low facial muscle tone.
* Symptoms that are consistent with a diagnosis of developmental apraxia of speech. These symptoms may include: use of primarily vowel-like vocalizations and limited consonant repertoire (consonants require greater motor-planning ability); intelligibility which decreases with length of utterance (single word and single syllable production may be more clear than extended utterances or multisyllabic words); differences in automatic versus volitional speech (echolalia may be more clearly articulated compared to spontaneous speech attempts).”
Toth et al. (2006, in Frietag et al. 2008, p. 1481) states that “it might be possible that difficulties in biological motion perception might underlie these impairments imitation and joint attention skills, which are skills, that are strongly linked to later social and language development.” In the How Do We Know This? Section of this blog post, agreement is made by Dr. Michael Crary as nonspeech motor functions are the first area to look at. (1993 in 2010, CASANA, www.apraxia-kids.org).
Shriberg et al. (2001, Appendix, p. 1115) describe a prosody-voice profile of males with ASD. I filled it in with commonly found areas noted throughout the article. The following findings are from a study they did using males with High Functioning Autism (HFA), Asperger’s (AS) and typical peers: It involves exclusion codes where the individual will interrupt/overtalk others or may only use one word. Prosody-voice codes include phrasing issues of sound/syllable repetition, word repetition, one word revisions and repetition and revision. The rate had slow articulation and pause time. The stress displayed issues in multisyllabic words, reduced/equal stress such as monotonous speech and excessive/equal/misplaced stress. Voice is the final area of the profile and they have determined that those with ASD tend to be loud, use high pitch/falsetto, and have laryngeal features such as register breaks and diplophonia and exhibit nasal resonance features. The HFA group took longer to speak and used stress inappropriately which may affect a listener’s patience and following the conversation, question or response. Fay and Schuler (1980, in Shriberg, et. al., 2001, p. 1100) report that some members of the HFA group may use a “sing-song” voice. Listeners may also not interact with the individual with ASD due to nasality common in their voice (Shriberg, 2001, Appendix, p. 1115). The authors also note some articulation distortions (p. 1104). In my experience it does seem as they may have low tone of the jaw and mouth/cheek muscles or praxis issues at times. In summation of this article, “Speech that is too loud and/or high pitched can create an impression of overbearing for or insistence; speech that is too slow and/or nasal may create the impression that the speaker is condescending” (Shriberg, 2001, p. 1110). An individual with ASD may have issues with voice modulation due to listed prosody factors, mood, internal or external stress or attempted sensory habituation.
How do we know this?
In the same article by Gretz on speech production “Dr. Michael Crary outlines a number of areas for clinical observation and evaluation, including: nonspeech motor functions…speech motor functions…articulation and phonological performance…language performance…other: ability to sustain and shift attention, reaction to speech, distractibility.” This would be a good reference to review prior to considering the need for a speech evaluation (1993 in 2010, CASANA, www.apraxia-kids.org).
Powell (2010) discusses two ways to assess how we know why speech delays are evident. These include quantitative and qualitative methods. Quantitiative assessments use numbers or scores while “Qualitative approaches de-emphasize the use of numbers and attempt to describe the individual's language. Standardized tests (such as the Test of Language Development - Primary:3 [TOLD-P:3] or the Clinical Evaluation of Language Fundamentals - 3 [CELF-3]) are good examples of the quantitative approach to language measurement. Analysis of a spontaneous sample of language elicited under naturalistic conditions would be an example of a qualitative approach.” (Powell, 2010, CASANA, www.apraxia-kids.org). It is best to use both as mentioned by Froleck et al. (in Miller-Kuhaneck, et al., 2004). Qualitative information can be obtained through observation in a natural environment and documenting language production. Powell (2010) tends to use standardized assessments first to rule out certain types of problems and to help gear informal observations. On a standardized assessment, it is important to note that “A low score could be related to low language ability (it could also be related to other factors such as attending, hearing, vision, compliance, etc.)” (Powell, 2010, CASANA, www.apraxia-kids.org). A final thought is to remember that speech and language are two separate entities.
What is an application of this knowledge to a direct clinical example?
“Frequent practice of sounds and words helps to improve speech (Velleman, 2005) and reduce some of the pressures associated with expressive language.” (in Solomon, M. and Pereira, L. 2010). Repetitive books are suggested as one intervention. They are because of their “predictability, presence of carrier phrases, frequent practice of target sounds, familiar inflection, and an introduction to phonemic awareness.” (Solomon, M. and Pereira, L. 2010). Books may be especially good with those who have ASD due to having pictural accompaniments which may help predict what comes next as well as the rhyming. It lessens their cognitive demands and may increase willingness to communicate. Having a cozy comfortable reading environment may also be conducive. As you read the same story after the child is familiar with it, you can leave blanks for them to fill. This is also good with common songs while winging as another example. This promotes more active involvement in the occupation. This activity also lessens the response which may be easier at first to entice the child. Later, depending on the story expectations can be made for phrases or sentences. Some children’s book also can be purchased with puppets for when the story know and can say the majority of the story. You wouldn’t want to use all character puppets demanding a fine motor task along with the motor task at first. To increase motivation, the therapist may have a puppet of the main character. If the child is very resistant to this method they may want to read along with a cassette version of the story to prepare them. You always want the just right challenge to encourage self concept and decrease frustration. It also may help those with ASD produce inflection, stress and pauses or other prosody components at appropriate places as they will tend to memorizes the lines. It can also help with emotional expression depending on the story. Since those with ASD may already use a sing-song voice, this may be a good starting activity to be generalized as progress is made. See the List of Repetitive Books & Helpful Hints by Solomon and Pereira by clicking on the page at the top of the blog.
In Summary, motor impairments need to be considered when assessing the individual with ASD’s ability to use speech. There are some characteristics specific to the diagnosis that impact speech performance. This occupation must be distinguished from language and quantitative and qualitative measures together are most beneficial in assessment. There are numerous interventions. A basic one that may appeal to children with ASD has been provided. Please see further links related to this post added as pages to this blog.
References
Davis B, Velleman S .Semin Speech Lang. 2008 Nov; 29(4):312-9. (2008) Establishing a basic speech repertoire without using NSOME: means, motive, and opportunity.
American Speech-Language-Hearing Association. (2007). Childhood Apraxia of
Speech [Technical Report]. Available from www.asha.org/policy.
Frietag, C.M., Konrad, C., Haberlen, M., Kleser, C., von Gontard, A., Reith, W., Troje, Nl., Krick, C. (2008) Perception of biological motion in autism spectrum disorders. Nauropsycholgia, 46: 1480-1494.
Froleck, Clark, G., Miller-Kuhaneck, H. and Waitling, R. in Miller-Kuhaneck, et al (2004) Chapters 6: Evaluation of the Child With an Autism Spectrum Disorder. Bethesda, MD: the American Occupational Therapy Association, Inc.
Gretz, S. (2010. online resource).Glossary of Speech and Language Terms. The Childhood Apraxia of Speech Association of North America (CASANA). www.apraxia-kids.org http://bboard.misericordia.edu/webct/cobaltMainFrame.dowebct?appforward=/webct/startFrameSet.dowebct%3Fforward=manageCourse.dowebct%26lcid=463865245001
Gretz, S. (2010 online resource). Speech Production and Children with Autism. The Childhood Apraxia of Speech Association of North America (CASANA). www.apraxia-kids.org http://bboard.misericordia.edu/webct/cobaltMainFrame.dowebct?appforward=/webct/startFrameSet.dowebct%3Fforward=manageCourse.dowebct%26lcid=463865245001
Powell, T. (2010). A Brief Overview Of Language and Approaches To It's Assessment: One Professional's Perspective. The Childhood Apraxia of Speech Association of North America (CASANA). www.apraxia-kids.org http://bboard.misericordia.edu/webct/cobaltMainFrame.dowebct?appforward=/webct/startFrameSet.dowebct%3Fforward=manageCourse.dowebct%26lcid=463865245001
Shriberg, L. D., et. al. (2001) Speech and prosody characteristics of adolescents and adults with high-functioning autism and Asperger syndrome. Journal of Speech, Language, and Hearing Research, 44(5): 1097-1115.
Solomon, M. and Pereira, L. (2010). Repetitive Books: An Effective Therapeutic Strategy for Children Diagnosed with Apraxia of Speech. The Childhood Apraxia of Speech Association of North America (CASANA). www.apraxia-kids.org http://bboard.misericordia.edu/webct/cobaltMainFrame.dowebct?appforward=/webct/startFrameSet.dowebct%3Fforward=manageCourse.dowebct%26lcid=463865245001
Spitzer, S. in Miller-Kuhaneck, et al (2004) Chapters 5: Common an Uncommon Daily Activities in Individuals with Autism: Challenges and Opportunities for Supporting Occupation. Bethesda, MD: the American Occupational Therapy Association, Inc.
Wikepedia. (2010 online resource). Phonation. http://en.wikipedia.org/wiki/Phonation
Sunday, April 4, 2010
Mismatch Negativity and article compare/contrast
Wikepedia (see link on the side) explains what Mismatch Negativity (MMN)is. MMN is basically a deviant sound played within a series of similar sounds. The article I chose did not have a good definition or I didn't relate it properly. I apologize. They cite that "MMN is thought to reflect an automatic neuronal response to a change in auditory input." (Dunn, Gomes, Gravel, 2008, p. 53). It has also been described as the "separation between the waveforms in response to the standard and deviant tones" (p. 57) on an event related potential (ERP). I personally liked viewing the data in a graph then comparing responses in milliseconds. The majority of research has been done with adults with ASD and is typically recorded while the individual is engaged by another activity such as watching a video. (Dunn et al., 2008). This study found that MMN in children was not as large as in adults. They also mention that they need to be able to focus their attention on different sounds. As we focused on attention this week, we can begin to make connections. A younger child may only be able to focus on one thing and block others out. That could be a possibility for the studies' results. The authors state that MMN is not related to language (p. 61) however that may be only from this study. They cite "impaired discriminative ability or abnormal automatic processing of infrequent changes in auditory information" as potential reasons for the lack of or little change in response. (Dunn et al., 2008, p. 61). I believe that children with ASD lack the ability to isolate sounds and that they either over respond behaviorally or tune all sounds out. "Normally if important auditory information is present in the environment but outside a child's current attentional spotlight, automatic auditory processing allows the child to register that information and rapidly shift attention if need be." (Dunn et al., 2008, p. 68). The younger child may only be able too focus attention on one thing at a time or need controlled attention (Lynch, 2009). They also may be unable to automatically switch their focus as an older individual who has had intervention or more time for development can. Younger children with ASD need to develop this ability for safety, communication, socialization and cognition (Dunn et al., 2008, p. 68).
Wikepedia mentions MMN in visual terms as well as auditory.
I'd also like to compare and contrast the findings of my articles. I had used them independently to gather information and had not noted any similarities or differences. In Dunn et al. (1980) the children had activation of different brain regions than the typical group. When given an auditory stimulus, they had a "large negativity over the frontal central areas. The children with autism evidence a bilateral negativity, which was larger laterally." (Dunn et al., 2008, p. 54) rather than bilaterally in the supratemporal plane of the auditory cortex (Alho, 1995; Scherg, Vajsar & Picton, 1989, in Dunn et al., 2008, p. 53). They exhibited a smaller variance than the typical group. Boddaert et al (2004) sis their measurements at rest and through passive listening. They used PET scans rather than MMN. They found similar but not exactly the same areas of the brain to be engaged while listening. "We found significant activation of the auditory cortex in the bilateral superior temporal gyrus (Brodmann's area 22 in both groups while subjects were listening to speech-like stimuli" and that "the control children activated the superior temporal cortex billaterally with left based asymmetry." (Boddart et al, 2004, p. 2119). "The left dominance was not observed in the autistic group. In addition, austistic children had additional significant activation outside the auditory cortex: the left temporal pole (Brodmann's area 38), the bilateral cingulum (Brodmann's area 38), the bilateral posterior parietal (Brodmann's area 19), the cerebellar hemispheres, and the brainstem." (p. 2119). Boddart et al.(2004) did link the location activation ( or non activation of speech areas) to meaningful speech where Dunn et al. (2008) did not. In Boddart et al. (2004), they found that this decreased activation could lead to word processing issues. In Bigler et all. (2007), they focus on the superior temporal gyrus (STG) since it is involved in auditory processing and language more so than the others. They look at the "relationship between head size, total brain volume, regional brain volume and neurophsyical function of the region" (p. 219). The authors also reviewed " IQ, language and total and regional brain volumes" as well as dimensional variable, language and IQ" and " neurobiological heterogeneity." (p. 220). Bigler at al. (2007) also used a standard assessment tool(Clinical Evaluation of Language Fundamentals- Third Edition or CELF-3) where the other two had not.
The second study by Boddaert et al., (2004) also used children as subjects. Both studies found less activation in the speech centers than typical children. Both studies had some differences found between adults and children. The third article I used, Bigler et al. (2007)while it also used children focused more on language. I has used it mainly for that intent as well. I did not find many similarities between the three studies excpet for the focus on autism.
Wikepedia mentions MMN in visual terms as well as auditory.
I'd also like to compare and contrast the findings of my articles. I had used them independently to gather information and had not noted any similarities or differences. In Dunn et al. (1980) the children had activation of different brain regions than the typical group. When given an auditory stimulus, they had a "large negativity over the frontal central areas. The children with autism evidence a bilateral negativity, which was larger laterally." (Dunn et al., 2008, p. 54) rather than bilaterally in the supratemporal plane of the auditory cortex (Alho, 1995; Scherg, Vajsar & Picton, 1989, in Dunn et al., 2008, p. 53). They exhibited a smaller variance than the typical group. Boddaert et al (2004) sis their measurements at rest and through passive listening. They used PET scans rather than MMN. They found similar but not exactly the same areas of the brain to be engaged while listening. "We found significant activation of the auditory cortex in the bilateral superior temporal gyrus (Brodmann's area 22 in both groups while subjects were listening to speech-like stimuli" and that "the control children activated the superior temporal cortex billaterally with left based asymmetry." (Boddart et al, 2004, p. 2119). "The left dominance was not observed in the autistic group. In addition, austistic children had additional significant activation outside the auditory cortex: the left temporal pole (Brodmann's area 38), the bilateral cingulum (Brodmann's area 38), the bilateral posterior parietal (Brodmann's area 19), the cerebellar hemispheres, and the brainstem." (p. 2119). Boddart et al.(2004) did link the location activation ( or non activation of speech areas) to meaningful speech where Dunn et al. (2008) did not. In Boddart et al. (2004), they found that this decreased activation could lead to word processing issues. In Bigler et all. (2007), they focus on the superior temporal gyrus (STG) since it is involved in auditory processing and language more so than the others. They look at the "relationship between head size, total brain volume, regional brain volume and neurophsyical function of the region" (p. 219). The authors also reviewed " IQ, language and total and regional brain volumes" as well as dimensional variable, language and IQ" and " neurobiological heterogeneity." (p. 220). Bigler at al. (2007) also used a standard assessment tool(Clinical Evaluation of Language Fundamentals- Third Edition or CELF-3) where the other two had not.
The second study by Boddaert et al., (2004) also used children as subjects. Both studies found less activation in the speech centers than typical children. Both studies had some differences found between adults and children. The third article I used, Bigler et al. (2007)while it also used children focused more on language. I has used it mainly for that intent as well. I did not find many similarities between the three studies excpet for the focus on autism.
Saturday, April 3, 2010
Word Finding
Describe word finding skills of children with autism. Describe the methods & findings of a research article on auditory processing. How will this impact ability to initiate a social exchange during a play based activity? What is 1 treatment strategy given the findings.
Children with ASD have a difficult time recognizing words. They see parts rather than wholes. This affects comprehension. An individual with ASD has difficulty maintaining attention. Weak Central Coherence (Pellicano et al. 2006, p. 78) also mention “poor performance by those with autism when integration of information in context is required.” Frith and Snowling (1993 in Lopez and Leekham, 2003) had an experiment that used homographs. The children with ASD understood a sentence better if the homograph was at the end of the sentence as it didn’t interfere with the sentence’s meaning. Lynch (2009) mentions how attention can be impacted in those with ASD. This in turn affects memory and hence the ability to retrieve a word upon demand. In simpler terms, their word finding abilities can be poor or inaccurate. Benson, Seaton and Johnson, (1997 in Sharma et al., 2009, p. 706) reported that teacher and parents describe school-age children as” children who are distracted by background sounds, do not follow multiple instructions, take longer to comprehend simple auditory directions, occasionally misconstrue what is being said, or appear to have “selective” hearing.” This sounds like they are discussing children with ASD, correct?
Sharma, Purdy, and Kelly (2009) researched how or if auditory processing, language and reading disorders were interconnected. They did not focus on children with ASD. It was interesting to note, however, that “at least 43% had another family member- such as a parent, sibling, or first cousin – who had a diagnosis of Asperger’s Syndrome, autism, APD, attention-deficit/hyperactivity disorder – attention deficit disorder, or reading/learning disorder.” (p. 708). It would be nice to have the number isolated although we are learning that attention plays a part in processing in those with ASD.
Sharma, Purdy and Kelly have defined the three conditions which they will investigate if they are related:
-Auditory Processing Disorder (APD): “ problems in one or more of the following auditory behaviors: sound localization and lateralization, auditory discrimination, auditory pattern recognition, temporal aspects of audition, and auditory performance decrements with competing acoustic signals and degraded acoustic signals.” (American Speech-Language-hearing Association Task Force on Central Auditory Processing Consensus Development, 1996 in Sharma, Purdy and Kelly, 2009, p. 707).
-Language Impairment (LI): “significantly poor language (receptive or expressive) when intelligence and hearing sensitivity are within normal limits, and there are no other physical or emotional difficulties” (Bishop, 1992 in Sharma, Purdy and Kelly, 2009, p. 707)
-Reading Disorder (RD): “Problems with written language in the presence of average nonverbal intelligence and having received adequate instruction to acquire written and spoken language” (McArthur and Bishop, 2001 in Sharma, Purdy and Kelly, 2009, p. 707).
Sixty-eight school age (7-12) children took part in the study where 65% were boys and 35% were girls (p. 708). The procedure involved an extensive list of assessments. The authors have a Table of the diagnostic tests on page 709 of the article. Almost one half of the study population had difficulty in all three areas. This study found significant correlations also to auditory memory and attention (p.716). Upon further discussion, it is also suggested that “If there is an underlying ability that links auditory processing, reading and language, another possible candidate is perceptual learning. (Moore, Amitay, and Hawkey, 2003 in Sharma, Purdy and Kelly, 2009, p. 716). This, however, this has not been explored in conjunction with ASD, LI and RD.
See Venn diagram with study results.
This will impact the child’s ability to initiate a social exchange in a play based activity by interrupting the process of functional communication. Green (2004, p. 177) cites that children with ASD have:
-inability to predict what someone will do next
-difficulty explaining one’s behavior
-not comprehending how others see their behavior
- issues with emotions
-inability to interpret social cues, facial expressions and body language
- limited use of social cues, facial expression and body language
-not knowing what information the peer may already possess
-issues with perceiving another child’s interests
-focusing on one thing and excluding others
-inability to appropriately use turn-taking in communication
-lack of comprehension concerning pretend play
-poor eye contact
This is quite a list of things that could impede a social interaction during play. Even a higher functioning child, will have aspects of this. Not to mention, the child will have to battle with the environment, external and internal stimuli and possibly the inability to self-regulate in order to attend to playing with a peer and communicating socially and functionally.
Bellis and Anzalone (2008) cite that a multidisciplinary team is essential for those with a central auditory processing disorder. This is also true for those with ASD in order to promote optimal functioning. Any intervention should first allow the student to experience success. Approaches should include both top-down and bottom up (p. 145). Environmental modifications play a large role. As discussed in Module 3 (Lynch and Van Zelst, 2010), the environment can either be complex or structured for intervention. To enhance information gained from auditory input, interventions can include architectural changes for acoustics, assistive technology, noise reduction, special seating so the child can also see the speaker. Other environmental interventions could include checking comprehension often, hands- on activities, repeating, using visual aids to compliment learning, rephrasing is less complex mannerisms, having directions in writing for the student, pre-teaching, and providing a note taker if necessary. (p. 145). Preparing the peer for the interaction is suggested as OT services are not only direct. The play environment should be structured with a limited amount of toys and visual boundaries that help guide the play interaction with minimal distractions. (Green, 2004). A social story or “social autopsy” (Green, 2004, p. 180) prior may help the child with ASD learn expectations of interaction with a peer and how to play with specific toys. Turn taking, understanding body language and facial expression and other communication issues should be taught.
With a team approach, it will be optimal if the team functions in the appropriate way. Even using the same key terminology with an individual with ASD can make a difference; especially if discrete trials and manding have been used. With key supports, it is possible for those with ASD to function in appropriate ways and to interact with others.
Bellis, T. and Analone, A. (Fall 2008). Intervention approaches for Individuals with (Central) Auditory Processing Disorder. Contemporary Issues in communication Science and Disorders, 35, p. 143-153.
Green, S. (2004) in Miller-Kuhaneck. Autism: A Comprehensive Occupational Therapy Approach. Second edition. Chapter 8: Social skills Intervention for Children with an Autism Spectrum disorder. Bethesda, MD: American Occupational therapy Association, Inc.
Lynch, A. (Spring, 2009). Attention and Performance in Autism. Misericordia University. PDF.
Lynch, A. and Van Zelst, A. (Spring 2010). Autism and Pervasive Developmental Delay. Misericordia University. Course notes and discussion.
Pellicano, Mayberry, Durkin, and Maley (2006). Multiple cognitive capabilities/deficits in children with an autism spectrum disorder: “Weak” central coherence and its relationship to theory of mind and executive control. Development and Psychopathy, 18, p. 77-98.
Sharma, M., Purdy, S., and Kelly, A. (June 2009). Comorbidity of Auditory Processing, Language, and Reading Disorders. Journal of Speech, Language, and Hearing Research, 52, 706-722.
Children with ASD have a difficult time recognizing words. They see parts rather than wholes. This affects comprehension. An individual with ASD has difficulty maintaining attention. Weak Central Coherence (Pellicano et al. 2006, p. 78) also mention “poor performance by those with autism when integration of information in context is required.” Frith and Snowling (1993 in Lopez and Leekham, 2003) had an experiment that used homographs. The children with ASD understood a sentence better if the homograph was at the end of the sentence as it didn’t interfere with the sentence’s meaning. Lynch (2009) mentions how attention can be impacted in those with ASD. This in turn affects memory and hence the ability to retrieve a word upon demand. In simpler terms, their word finding abilities can be poor or inaccurate. Benson, Seaton and Johnson, (1997 in Sharma et al., 2009, p. 706) reported that teacher and parents describe school-age children as” children who are distracted by background sounds, do not follow multiple instructions, take longer to comprehend simple auditory directions, occasionally misconstrue what is being said, or appear to have “selective” hearing.” This sounds like they are discussing children with ASD, correct?
Sharma, Purdy, and Kelly (2009) researched how or if auditory processing, language and reading disorders were interconnected. They did not focus on children with ASD. It was interesting to note, however, that “at least 43% had another family member- such as a parent, sibling, or first cousin – who had a diagnosis of Asperger’s Syndrome, autism, APD, attention-deficit/hyperactivity disorder – attention deficit disorder, or reading/learning disorder.” (p. 708). It would be nice to have the number isolated although we are learning that attention plays a part in processing in those with ASD.
Sharma, Purdy and Kelly have defined the three conditions which they will investigate if they are related:
-Auditory Processing Disorder (APD): “ problems in one or more of the following auditory behaviors: sound localization and lateralization, auditory discrimination, auditory pattern recognition, temporal aspects of audition, and auditory performance decrements with competing acoustic signals and degraded acoustic signals.” (American Speech-Language-hearing Association Task Force on Central Auditory Processing Consensus Development, 1996 in Sharma, Purdy and Kelly, 2009, p. 707).
-Language Impairment (LI): “significantly poor language (receptive or expressive) when intelligence and hearing sensitivity are within normal limits, and there are no other physical or emotional difficulties” (Bishop, 1992 in Sharma, Purdy and Kelly, 2009, p. 707)
-Reading Disorder (RD): “Problems with written language in the presence of average nonverbal intelligence and having received adequate instruction to acquire written and spoken language” (McArthur and Bishop, 2001 in Sharma, Purdy and Kelly, 2009, p. 707).
Sixty-eight school age (7-12) children took part in the study where 65% were boys and 35% were girls (p. 708). The procedure involved an extensive list of assessments. The authors have a Table of the diagnostic tests on page 709 of the article. Almost one half of the study population had difficulty in all three areas. This study found significant correlations also to auditory memory and attention (p.716). Upon further discussion, it is also suggested that “If there is an underlying ability that links auditory processing, reading and language, another possible candidate is perceptual learning. (Moore, Amitay, and Hawkey, 2003 in Sharma, Purdy and Kelly, 2009, p. 716). This, however, this has not been explored in conjunction with ASD, LI and RD.
See Venn diagram with study results.
This will impact the child’s ability to initiate a social exchange in a play based activity by interrupting the process of functional communication. Green (2004, p. 177) cites that children with ASD have:
-inability to predict what someone will do next
-difficulty explaining one’s behavior
-not comprehending how others see their behavior
- issues with emotions
-inability to interpret social cues, facial expressions and body language
- limited use of social cues, facial expression and body language
-not knowing what information the peer may already possess
-issues with perceiving another child’s interests
-focusing on one thing and excluding others
-inability to appropriately use turn-taking in communication
-lack of comprehension concerning pretend play
-poor eye contact
This is quite a list of things that could impede a social interaction during play. Even a higher functioning child, will have aspects of this. Not to mention, the child will have to battle with the environment, external and internal stimuli and possibly the inability to self-regulate in order to attend to playing with a peer and communicating socially and functionally.
Bellis and Anzalone (2008) cite that a multidisciplinary team is essential for those with a central auditory processing disorder. This is also true for those with ASD in order to promote optimal functioning. Any intervention should first allow the student to experience success. Approaches should include both top-down and bottom up (p. 145). Environmental modifications play a large role. As discussed in Module 3 (Lynch and Van Zelst, 2010), the environment can either be complex or structured for intervention. To enhance information gained from auditory input, interventions can include architectural changes for acoustics, assistive technology, noise reduction, special seating so the child can also see the speaker. Other environmental interventions could include checking comprehension often, hands- on activities, repeating, using visual aids to compliment learning, rephrasing is less complex mannerisms, having directions in writing for the student, pre-teaching, and providing a note taker if necessary. (p. 145). Preparing the peer for the interaction is suggested as OT services are not only direct. The play environment should be structured with a limited amount of toys and visual boundaries that help guide the play interaction with minimal distractions. (Green, 2004). A social story or “social autopsy” (Green, 2004, p. 180) prior may help the child with ASD learn expectations of interaction with a peer and how to play with specific toys. Turn taking, understanding body language and facial expression and other communication issues should be taught.
With a team approach, it will be optimal if the team functions in the appropriate way. Even using the same key terminology with an individual with ASD can make a difference; especially if discrete trials and manding have been used. With key supports, it is possible for those with ASD to function in appropriate ways and to interact with others.
Bellis, T. and Analone, A. (Fall 2008). Intervention approaches for Individuals with (Central) Auditory Processing Disorder. Contemporary Issues in communication Science and Disorders, 35, p. 143-153.
Green, S. (2004) in Miller-Kuhaneck. Autism: A Comprehensive Occupational Therapy Approach. Second edition. Chapter 8: Social skills Intervention for Children with an Autism Spectrum disorder. Bethesda, MD: American Occupational therapy Association, Inc.
Lynch, A. (Spring, 2009). Attention and Performance in Autism. Misericordia University. PDF.
Lynch, A. and Van Zelst, A. (Spring 2010). Autism and Pervasive Developmental Delay. Misericordia University. Course notes and discussion.
Pellicano, Mayberry, Durkin, and Maley (2006). Multiple cognitive capabilities/deficits in children with an autism spectrum disorder: “Weak” central coherence and its relationship to theory of mind and executive control. Development and Psychopathy, 18, p. 77-98.
Sharma, M., Purdy, S., and Kelly, A. (June 2009). Comorbidity of Auditory Processing, Language, and Reading Disorders. Journal of Speech, Language, and Hearing Research, 52, 706-722.
Saturday, March 27, 2010
Auditory Processing
Auditory Processing
Students with ASD commonly have auditory processing differences than others. Those that I see in either a school or early intervention setting can’t isolate one auditory input within a field of others. They also react more adversely to typical auditory noises such as people talking. In the younger children, it seems they cannot get used to a sound. A preschool student covers his ears in the OT room a month after we had a fire drill while in that setting. In the middle school, it seems that the older students have learned to block all stimuli out. Not all of the students I see exhibit self stimulatory behaviors, however, many do. They may do these to focus their attention to that in avoidance of other stimuli or some will do it to create stimuli.
From reading several articles overall, it seems that there are neurological differences in children with ASD from their typical peers. The true is also found with adults. A report by Boddaert, N., Chabane, N., Belin, P. et al. (2004) also indicates that there are differences in areas of activation between children and adults with autism from PET scans. They performed a study with 10 boys and girl ages 4 to 10 years who have a diagnosis of autism. The PET scans were done during induced sleep with inactive listening to speech-like sounds. The typical auditory areas of the brain are less activated while other areas of the brain are. In typical children, the area includes the superior temporal cortex bilaterally mainly the left side and this is not activated in children with ASD (p. 2119). In children with ASD areas outside the auditory cortex were used. These included” the left temporal pole, the bilateral cingulum, the bilateral posterior parietal and the cerebral hemispheres, and the brainstem” (p. 2119). Several of these compose Brodmann’s area. The study also found that “in autistic children the abnormal right frontotemporal activation” (p. 2119) was not observed as it was in adults with ASD when compared to a similar study with adults. The authors also discuss that their abnormal cortical “auditory processing…can be involved in inadequate behavioral responses to sounds and in language impairments characteristic of autism” (p. 2117). They also indicate, however, that those with ASD can be misdiagnosed a deaf.
Another 2 studies by Dunn, Gomes, and Gravel (2008) indicates that children with autism can either be hyper or hyposensitive to sound as discussed by other authors (p. 52). This study aimed to study event related potentials (ERPs) and mismatch negativity (MMN) in automatic and attentional processing during unpredictable changes in auditory input. The automatic processing mentioned is attentional in nature and can process typical auditory stimuli. “MMN has been elicited from adults by changes in a variety of acoutistic features, such as intensity, frequency, duration, and perceived location, and by changes in auditory patterns “(Naatanen, 1992; Naatanen, Jacobsen and Winkler, 2005, and Picton et al., 2000 in Dunn et al., 2008 p. 53). The authors also cite studies where latency is longer in children with ASD than in adults with ASD in regards to MMN. (p. 54). Other studies were discussed. The first study measures MMN in 68 children half who were diagnosed with ASD. They were matched by age, non-verbal IQ, and handedness. An oddball paradigm was used. In the second study the method was the same however, it was done for both ignore and attend situations. All children underwent a battery of standardized assessments in order to match samples. The procedure, an oddball paradigm, used a deviant stimulus randomly in a series of normal tones. In study one results were comparable to previous literatures noting that the “MMN was the largest in the frontal-central region and very small at the sides of the head and inverted in polarity at the mastoids for typically developing children “(Dunn et al., 2008, p. 58). “In the children with autism, there was a small difference between the standard and deviant waveforms in the fronto-central region that continued across the sides of the head and did not invert polarity at the mastoids” (Dunn et al., 2008, p. 58). The results were further analyzed and it was discovered the amplitude of MMN may increase with age. (p. 60). Abnormal automatic auditory processing may occur in those with ASD. The authors pursued study two in order to investigate the findings and that those with ASD had smaller MMNs than typical peers. A study by Gommes et al. (2000) was discussed. It found that “attention enhanced the amplitude of the MMN” (in Dunn et al, 2008). Study two used 20 children; half with ASD who were screened the same as in Study One. Results “ did not differ on the Pattern Analysis, memory for Digits or Memory for objects subtests of the Stanford-Binet” ( Dunn et al., 2008, p. 62). The study revealed no significant differences in reaction time or accuracy between the two groups. These two studies had similarities and contrasts with previously published studies. Receptive language and age did not influence the results. Auditory discrimination requires attention for unpredictable changes where it does not for those without ASD. “Data indicating that children with autism demonstrate significantly attenuated or absent MMN until the age of 9 is of significant interest, as typically developing children demonstrate this automatic component in response to simple tone contrast by the age of 4” (Kurtzberg et al., 1995; Shafer, Morr, Kreuzer and Kurtzberg, 2000 in Dunn et al., 2008, p. 68). This indicates that more effort is required in auditory processing while younger and that it requires attention/doesn’t occur automatically long past the change in typical peers. This may be why my clinical observations of my student’s behavioral reactions or stimming behaviors seem to occur more often with younger students. I still question changes in adolescence as well but did not find studies on that specific age group. The authors so mention that auditory processing requiring or stealing attention may lead to memorization of independent facts separate from the whole or linking concepts together, organizational issues, as well as socialization, education and language complexities.
There is one final article I wanted to include in this posting. Bigler, Mortensen, Neeley et al. relate the superior temporal gyrus to auditory processing, language and also social cognition. The authors do conduct a study of the role of the STG in psychometric IQ and language function. The results will not be discussed in detail within this blog. It is worth investigating. It does not go into auditory processing but is important to note the differences in language and socialization in children with ASD.
In light of the above research findings, there are numerous treatment strategies that could assist students with ASD who exhibit auditory processing difficulties. Since they cannot sustain attention and also demonstrate socialization issues, I think that preparing them in advance for situations with a pictorial routine, PECS systems for transitions, a daily schedule and social stories may be as critical as sensory and coping strategies. There are various programs that target auditory processing such as FastForward or therapeutic Listening however research I have reviewed so far does not include those with ASD and also does not strongly indicate the results were from the program itself.
Bigler, E., Mortensen, S., and Neeley et al., 2007). Superior Temporal Gyrus, Language Function, and Autism. Developmental Neurology, 3 (2), p. 217-238.
Boddaert, N., Chabane, N., Belin, P. et al. (November 2005). Perception of complex Sounds in Autism: Abnormal Auditory Cortical Processing in Children. American Journal of Psychiatry, 161: 1, p. 2117-2120.
Dunn, M., Gomes, H., and Gravel, J. (2008). Mismatch Negativity in Children with Autism and Typical Development. Journal of Autism and Developmental Disorders, 38: p.52-71.
Students with ASD commonly have auditory processing differences than others. Those that I see in either a school or early intervention setting can’t isolate one auditory input within a field of others. They also react more adversely to typical auditory noises such as people talking. In the younger children, it seems they cannot get used to a sound. A preschool student covers his ears in the OT room a month after we had a fire drill while in that setting. In the middle school, it seems that the older students have learned to block all stimuli out. Not all of the students I see exhibit self stimulatory behaviors, however, many do. They may do these to focus their attention to that in avoidance of other stimuli or some will do it to create stimuli.
From reading several articles overall, it seems that there are neurological differences in children with ASD from their typical peers. The true is also found with adults. A report by Boddaert, N., Chabane, N., Belin, P. et al. (2004) also indicates that there are differences in areas of activation between children and adults with autism from PET scans. They performed a study with 10 boys and girl ages 4 to 10 years who have a diagnosis of autism. The PET scans were done during induced sleep with inactive listening to speech-like sounds. The typical auditory areas of the brain are less activated while other areas of the brain are. In typical children, the area includes the superior temporal cortex bilaterally mainly the left side and this is not activated in children with ASD (p. 2119). In children with ASD areas outside the auditory cortex were used. These included” the left temporal pole, the bilateral cingulum, the bilateral posterior parietal and the cerebral hemispheres, and the brainstem” (p. 2119). Several of these compose Brodmann’s area. The study also found that “in autistic children the abnormal right frontotemporal activation” (p. 2119) was not observed as it was in adults with ASD when compared to a similar study with adults. The authors also discuss that their abnormal cortical “auditory processing…can be involved in inadequate behavioral responses to sounds and in language impairments characteristic of autism” (p. 2117). They also indicate, however, that those with ASD can be misdiagnosed a deaf.
Another 2 studies by Dunn, Gomes, and Gravel (2008) indicates that children with autism can either be hyper or hyposensitive to sound as discussed by other authors (p. 52). This study aimed to study event related potentials (ERPs) and mismatch negativity (MMN) in automatic and attentional processing during unpredictable changes in auditory input. The automatic processing mentioned is attentional in nature and can process typical auditory stimuli. “MMN has been elicited from adults by changes in a variety of acoutistic features, such as intensity, frequency, duration, and perceived location, and by changes in auditory patterns “(Naatanen, 1992; Naatanen, Jacobsen and Winkler, 2005, and Picton et al., 2000 in Dunn et al., 2008 p. 53). The authors also cite studies where latency is longer in children with ASD than in adults with ASD in regards to MMN. (p. 54). Other studies were discussed. The first study measures MMN in 68 children half who were diagnosed with ASD. They were matched by age, non-verbal IQ, and handedness. An oddball paradigm was used. In the second study the method was the same however, it was done for both ignore and attend situations. All children underwent a battery of standardized assessments in order to match samples. The procedure, an oddball paradigm, used a deviant stimulus randomly in a series of normal tones. In study one results were comparable to previous literatures noting that the “MMN was the largest in the frontal-central region and very small at the sides of the head and inverted in polarity at the mastoids for typically developing children “(Dunn et al., 2008, p. 58). “In the children with autism, there was a small difference between the standard and deviant waveforms in the fronto-central region that continued across the sides of the head and did not invert polarity at the mastoids” (Dunn et al., 2008, p. 58). The results were further analyzed and it was discovered the amplitude of MMN may increase with age. (p. 60). Abnormal automatic auditory processing may occur in those with ASD. The authors pursued study two in order to investigate the findings and that those with ASD had smaller MMNs than typical peers. A study by Gommes et al. (2000) was discussed. It found that “attention enhanced the amplitude of the MMN” (in Dunn et al, 2008). Study two used 20 children; half with ASD who were screened the same as in Study One. Results “ did not differ on the Pattern Analysis, memory for Digits or Memory for objects subtests of the Stanford-Binet” ( Dunn et al., 2008, p. 62). The study revealed no significant differences in reaction time or accuracy between the two groups. These two studies had similarities and contrasts with previously published studies. Receptive language and age did not influence the results. Auditory discrimination requires attention for unpredictable changes where it does not for those without ASD. “Data indicating that children with autism demonstrate significantly attenuated or absent MMN until the age of 9 is of significant interest, as typically developing children demonstrate this automatic component in response to simple tone contrast by the age of 4” (Kurtzberg et al., 1995; Shafer, Morr, Kreuzer and Kurtzberg, 2000 in Dunn et al., 2008, p. 68). This indicates that more effort is required in auditory processing while younger and that it requires attention/doesn’t occur automatically long past the change in typical peers. This may be why my clinical observations of my student’s behavioral reactions or stimming behaviors seem to occur more often with younger students. I still question changes in adolescence as well but did not find studies on that specific age group. The authors so mention that auditory processing requiring or stealing attention may lead to memorization of independent facts separate from the whole or linking concepts together, organizational issues, as well as socialization, education and language complexities.
There is one final article I wanted to include in this posting. Bigler, Mortensen, Neeley et al. relate the superior temporal gyrus to auditory processing, language and also social cognition. The authors do conduct a study of the role of the STG in psychometric IQ and language function. The results will not be discussed in detail within this blog. It is worth investigating. It does not go into auditory processing but is important to note the differences in language and socialization in children with ASD.
In light of the above research findings, there are numerous treatment strategies that could assist students with ASD who exhibit auditory processing difficulties. Since they cannot sustain attention and also demonstrate socialization issues, I think that preparing them in advance for situations with a pictorial routine, PECS systems for transitions, a daily schedule and social stories may be as critical as sensory and coping strategies. There are various programs that target auditory processing such as FastForward or therapeutic Listening however research I have reviewed so far does not include those with ASD and also does not strongly indicate the results were from the program itself.
Bigler, E., Mortensen, S., and Neeley et al., 2007). Superior Temporal Gyrus, Language Function, and Autism. Developmental Neurology, 3 (2), p. 217-238.
Boddaert, N., Chabane, N., Belin, P. et al. (November 2005). Perception of complex Sounds in Autism: Abnormal Auditory Cortical Processing in Children. American Journal of Psychiatry, 161: 1, p. 2117-2120.
Dunn, M., Gomes, H., and Gravel, J. (2008). Mismatch Negativity in Children with Autism and Typical Development. Journal of Autism and Developmental Disorders, 38: p.52-71.
Subscribe to:
Posts (Atom)
