The Autism Society Event and Education Recordings Archive

Researchers estimate that up to one half of children with autism have difficulty acquiring speech, which results in their reliance on alternative forms of communication, such as the Picture Exchange Communication System. While learning such systems do not inhibit the development of speech, they conversely do not guarantee speech acquisition. For those children who remain nonverbal, a more intensive intervention program is required. A therapeutic program which adapts strategies used to treat childhood apraxia of speech will be presented. When the communication needs of a child with ASD are assessed, there are many areas that must be evaluated. The ability to understand language (comprehension), the ability to formulate thoughts into grammatical sentences (expressive language), and the ability to use communication in social contexts (pragmatics) are just some of the important areas. It has been well documented that children with autism spectrum disorders (ASD) can have difficulties in all of these. However, there is one other critical aspect of communication. This is the area of speech.

Human beings communicate in a variety of ways, including gestures, body language, printed words, etc. However, our primary means of communicating is through talking (speech). It is well documented that a significant number of children with autism are nonverbal. Some researchers have suggested that up to 50% of autistic children have major difficulty acquiring speech (Scott, Clark, and Brady, 2000). For those children who are nonverbal, the principle method of intervention historically has been to teach an alternative means, so that the child would at least have functional communication. Research to date has suggested that learning an alternative means of communication does not inhibit the development of speech (Wetherby and Prizant, 2000). Conversely, though, it does not guarantee the acquisition of speech. Perhaps the most commonly used alternative communication system with children with ASD is the Picture Exchange Communication System (PECS), developed by Frost and Bondy. They state in their 1994 training manual “…the longer term data with over 70 preschoolers who have used PECS for over one year indicates that more than 2/3rds of these children have developed independent speech.” However, in a 1995 article, Bondy and Frost reported on 66 young children with autism under the age of five who had no previous functional speech or exposure to augmentative communication systems. Over a 5 year period using PECS, 52% developed function speech and no longer needed AAC supports. An additional 21% did use some speech, but continued to require additional visual-graphic symbols or written words for functional communication. Again, this research indicates that not all nonverbal children with autism will automatically develop speech after functional alternative communication systems are put into place. Notably, Frost and Bondy make the following statements in their training manual: “It is important to understand that PECS is used because it provides a child with a rapidly acquired functional communication system. The development of speech is not the primary purpose of using PECS….the acquisition of speech can be viewed as a fortunate by-product of the approach and not its direct focus.”

Schwartz et al. (1998) evaluated the acquisition and use of PECS as a means of teaching functional communication skills to young nonverbal children with severe communication delays. After PECS training, the researchers looked at its effect on a number of dependent variables, one of them being acquisition of spontaneous speech. They reported that the children fell into two distinct groups: those who talked (44%) and those who did not (56%). They stated “The different speech patterns observed among the children were interesting…there were no systemic differences in the children's abilities prior to intervention, yet their outcomes fall into two distinct categories. These different outcomes suggest the need for further empirical study to determine whether it is possible to predict which children will use PECS as a bridge to speech and which children will continue to depend on PECS. Specifically, the child's ability to verbally imitate should be analyzed to determine whether this predicts which children will acquire speech more readily…”

Difficulty with imitation skills is called apraxia, and is defined as “A problem with the ability to plan movement (praxis). This is usually caused by some determined (acquired) or undetermined (developmental) problem in the cortex.” (Skinder-Meredith, and Stoeckel, 2004). The presence of developmental, or childhood, apraxia in children with ASD has been a topic of interest for many years. It has been suggested by other researchers that children with autism could have significant difficulties with motor imitation skills (Rogers and Pennington, 1991). However, whether childhood apraxia of speech (CAS) accounts for the lack of verbal skills in a subgroup of children with ASD is not known at this time. Wetherby and Prizant (2000) state “The difficulties children with autism have with learning to speak or using sign language may be compounded by apraxia, in addition to sociocommunicative and symbolic impairments… the role of apraxia in speech and language acquisition of children with ASD is frequently observed by clinicians and merits attention and consideration, but little research is available.” More research is needed to determine exactly how apraxia and autism are related. However, when strategies used to treat childhood apraxia of speech are integrated into a structured intensive program, nonverbal children with ASD can be taught to speak. Many parents, educators and therapists are unfamiliar with how to develop speech skills, focusing instead on augmentative systems in the hope that speech might follow. The above reports clearly indicate that often does not happen. Some pre-packaged programs are now being marketed to develop speech in children with CAS, but their use with children with ASD has not been well investigated. Additionally, pre-packaged programs can be costly, and may not meet the individual pattern of strengths and needs for children with ASD.

The purpose of this presentation is to share information with parents, educators and therapists on how to develop speech as a functional means of communication in nonverbal children with autism.

Objectives of Presentation Participants will learn: - The various parameters of verbal communication: speech, language and pragmatics - How neurotypical children acquire speech: the importance of imitation - Possible reasons why some children with ASD have difficulty acquiring verbal speech - Understanding similarities and differences between CAS and speech difficulties of children with ASD - How to develop a treatment framework for developing imitation skills: choosing what and how to teach - Developing gestural imitation, vocal imitation, and sound sequence imitation - Developing a “syllable grid” to track imitation skills - How to teach children with ASD to attach meaning to sound sequences - Establishing functional verbal speech skills in a variety of communication environments

Sources

Frost, Lori, and Bondy, Andrew (1994). The Picture Exchange Communication System Training Manual; Pyramid Educational Consultants, Inc.

Rogers, S.J., and Pennington, B.F. (1991). A theoretical approach to the deficits in infantile autism. Development and Psychopathology,3, 137-162.

Schwartz, Iline S., Garfinkle, Ann N., Topics in Early Childhood Special Education, 02711214, Fall, 1998, Vol. 18, Issue 3.

Scott, J., Clark, C., and Brady, M. (2000), Students with Autism: Characteristics and Instructional Programming for Special Educators, Singular Publishing Company.

Skinder-Merideth, Amy, and Stoeckel, Ruth; Childhood Apraxia of Speech: Assessment and Treatment, workshop presented by the Hendrix Foundation and the Childhood Apraxia of Speech Association of North America, October 8-9, 2004.

Wetherby, Amy, and Prizant, Barry (2000). Autism Spectrum Disorders: A Transactional Developmental Perspective; Paul H. Brookes Publishing Co.

Content Area: Communication