5369 Assessment of Repetitive Verbal and/or Vocal Behavior In Students with Autism [ASHA Session]

Thursday, July 7, 2011: 1:00 PM-2:15 PM
Miami 1 (Gaylord Palms Resort and Convention Center)
Recorded Presentation MP3 Handout

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The aim of this presentation is to describe a video-based experimental analysis of repetitive verbal and/or vocal behavior (echolalia) in a population of students with autism, and to present a framework for assessment of these behaviors through analysis of frequency, behavioral function and effectiveness of repetitive utterances in multiple communicative contexts. Communication difficulties and repetitive/stereotypic behaviors are two components within the triad of symptoms used in the diagnosis of children with autism (American Psychiatric Association, 2000). Repetitive verbal and/or vocal behaviors have been observed in the expressive (spoken) language of a large percentage of children with autism (Frith, 2008). Repetitive verbal and vocal behaviors (i.e., echolalia) are a barrier of context. It prevents a student’s communication partner from understanding the context, intent and meaning of their spoken utterances, and therefore influences the effectiveness of his or her communication. The presence of repetitive verbal and vocal behaviors may be highly work interfering and may limit a student’s ability to engage meaningfully in their environment(s) by preventing access to his or her social interactions, educational curriculum, the community and from effectively communicating basic wants and needs.

Repetitive verbal and vocal behaviors have been categorized under two broad terms, echolalia (delayed and immediate) and non-communicative vocalizations/verbalizations (NCVs). Both types of behavior have been defined, described and analyzed according to a variety of strategies which have included: observational scales (Pasco et al, 2008; Schuler, 2003; Ruble, 2001; Tarplee & Barrow, 1999), acoustic analysis (Bleszynski, 1998; Paccia & Curcio, 1982), interview/rater forms (Duker, 1999), environmental functional analysis (Ahearn, Clark, MacDonald, & Chung, 2007; Lerman et al., 2005; Dixon, Benedict, & Larson, 2001; Durand & Crimmins, 1987; Rehfeldt & Chambers, 2003; Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994), descriptive analysis (Mace & Lalli, 1991) and neuroimaging modalities (Cho, et al., 2009). Within these strategies, multiple variables have been used to describe the repetitive verbal and vocal behavior of students with autism including: behavioral motivation/function (Ahearn, Clark, MacDonald, & Chung, 2007; Benedict & Larson, 2001; Durand & Crimmins, 1987; Lerman, Parten, Addison, Vorndram, Volkert, & Kodak, 2005; Rehfeldt & Chambers, 2003; Taylor, Hoch, & Weissman, 2005), degree/level of communicative intent  (Schuler, 2003), type/frequency of pragmatic or communicative function (Rae & Dickerson, 2007; Ruble, 2001; Tarplee & Barrow, 1999; Prizant & Dunchan, 1987; Prizant, 1984), non-verbal communication (Tarplee & Barrow, 1999) and super-segmental devices (Dobbinson, Perkins & Boucher, 2003; Tarplee & Barrow, 1999; Bleszynski, 1998; Paccia & Curcio, 1982). Results gained from these methods of analysis have generally suggested the repetitive verbal and vocal behaviors may serve some level of communicative or interactive functions (Stribling, Rae & Dickerson, 2007; Schuler, 2003, Dobbinson, Perkins & Boucher, 2003; Bleszynski, 1998; Wetherby, 1986; Prizant & Rydell, 1984; Prizant & Duchan, 1981; Paccia & Curcio, 1982). However, proposed interventions for these behaviors continue to be variable and ill-defined in the literature, likely due to the inconsistency and controversy in assessment methods. Given the variability with which repetitive verbal and vocal behaviors have been studied, there is a need for a consistent and systematic approach to analysis in order to develop an effective roadmap for intervention.  The aim of this presentation is to describe a video/observation based experimental analysis of repetitive verbal and vocal behavior of a population of students with autism and to present a framework for assessment of these behaviors.

This presentation will propose an assessment framework which details the collection and rating of student’s verbal and/or vocal behavior through the medium of video/observation based scales in five (5) contexts, with the aim of describing the communicative effectiveness and behavioral function of defined verbal and/or vocal behavior. Video/observation based scales were used as they have been reported in the literature as a successful method for analyzing the communication abilities and behavioral function of students with autism (Tager-Flusberg et al., 2009); As well they have reported sufficient levels of inter-rater reliability, validity and content (Pasco, Gordon, Howlin & Charman, 2008; Hwang & Hughes, 2000). The procedure/method is detailed as follows:

Students should be videotaped for 30 minute segments in five contexts including: Group Teaching (GT), Leisure-Based Language Sample Context with student’s speech/language pathologist (LS), Isolated Leisure (IL), Dyadic Leisure with Peer (DL) and One to One Teaching (OT) involving previously mastered verbal target(s) (defined as past targets where the student met criterion for the target at 80% or above over 2 consecutive sessions) and new target(s) (defined as current targets at an accuracy level of 40% or below).

Repetitive verbal and vocal behaviors present along a spectrum of effectiveness which can be described/quantified based on three factors including: frequency (see table 1), communicative effectiveness (see tables 2 and 3) and behavioral function (see table 5) of the verbal and/or vocal behavior. These three factors should be taken in the perspective of multiple communicative contexts (described above, i.e., GT, LS, IL, DL and OT). Within each context a student’s frequency and level of communicative effectiveness for repetitive verbal and/or vocal behavior should be rated on a scale from 1-6 (see tables 1-3). Behavioral function should be rated on a scale from 1-4 (see table 5).

 

 

Frequency of Repetitive Verbal and/or Vocal Behavior

 

1

Absolute

Repetitive verbal and/or vocal behavior is observed in all of the student’s expressive spoken language (96-100%)

2

Pervasive

Repetitive verbal and/or vocal behavior is observed more than three-quarters (76-95%) of the student’s expressive spoken language

3

Severe

Repetitive verbal and/or vocal behavior is observed in more than half (51-75%) of the student’s expressive spoken language

4

Moderate

Repetitive verbal and/or vocal behavior is observed in less than half (26-50%) of the student’s expressive spoken language

5

Mild

Repetitive verbal and/or vocal behavior is observed in less than a quarter (6-25%) of the student’s expressive spoken language

6

Absent

Repetitive verbal and/or vocal behavior is not observed in the student’s expressive spoken language (0-5%)

**Table 1

 

 

Communicative Effectiveness of Repetitive Verbal and/or Vocal Behavior

 

1

Non-communicative

Utterances Absent of A-D

2

Minimally Communicative

D Only

3

Mildly Communicative

D + 1 of A-C

4

Moderately Communicative

D + 2 of A-C

5

Adequately Communicative

D + 2 of A-C + effectiveness of message conveyed as evidenced by comprehension by student’s communication partner

6

Generative Language

Novel language produced through an analytic mode of processing

**Table 2

 

 

Characteristics of Repetitive Verbal and/or Vocal Behavior

Description

A

Non-verbal Behaviors

Eye Contact, Push Away, Reaching, Body Orientation, Waving, Nodding/Shaking Head, Pointing, Gesture

B

Mitigation

Change from model utterance/integration of novel language into preexisting language forms

C

Super Segmentals

Increased volume, Changes in prosody from model utterance

D

Semantic Contextuality

Utterances are associated with meaning related to items/activities/topics in student’s immediate environment

**Table 3

A proposed hypothesis for the study and presentation is that as a student’s effectiveness in communication increases, the frequency of instances of non-contextual repetitive verbal and/or vocal behavior will decrease. If frequency of repetitive verbal and vocal behavior is inversely proportional to a given student’s level of communicative effectiveness, then an overall rating describing a student’s spontaneous language competency could be assigned to each student based on this relationship (see table 4). 

 

Communicative Effectiveness of Students with Autism

 

Rating

Label

Range

Description

1

Profoundly Impaired

2

Range and frequency of pragmatic acts used is significantly reduced or restricted to unconventional means of communication. Message(s) are not effectively conveyed to communication partner(s). 

2

Severely Impaired

3-4

Range and frequency of pragmatics acts used is significantly reduced or restricted to unconventional means of communication.  Message(s) are almost never effectively conveyed to communication partner(s). 

3

Moderately Impaired

5-6

Range and frequency of pragmatics acts used is reduced. Presence of unconventional means of communication is still observed with moderate frequency. Message(s) are sometimes effectively conveyed to communication partner(s). 

4

Mildly Impaired

7-8

Range and frequency of pragmatics acts used is adequate or slightly reduced. Presence of unconventional means of communication is observed with mild/moderate frequency. Message(s) are often effectively conveyed to communication partner(s). 

5

Adequate

9-10

Range and frequency of pragmatics acts used is adequate. Presence of unconventional means of communication is observed with mild frequency or is absent. Message(s) are almost always effectively conveyed to communication partner(s). 

6

Proficient

11-12

Range and frequency of pragmatics acts used is proficient. Presence of unconventional means of communication is not observed. Message(s) are effectively conveyed to communication partner(s). 

**Table 4

Assessment of frequency and level of communicative effectiveness relative to behavioral function is also important to consider (see table 5). Hypotheses of this study and presentation relative to behavioral function include: a) Utterances whose primary motivation is self-stimulation will tend to have a non-communicative function and b) Greater than half of verbal utterances made by students in the study will be motivated by positive reinforcement (i.e., tangible or attention seeking functions). Functional Assessment conditions as described by Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994) should be used to assess verbal and/or vocal behavior. 

 

 

Functions of Behavior

 

Sensory Stimulation and Pain Relief

Behavior used to gain auditory, visual, olfactory, gustatory, kinesthetic, or proprioceptive sensory stimulations.

Attention Seeking

Behavior used to gain the social attention of an adult (teacher, parent, aide, family member) or social attention of a peer.

Escape/Avoidance

Behavior used to escape from a demanding or boring task, a setting, activity or event, attention from a peer or adult, social interaction with others or internal stimulation that is painful or discomforting.

Access (To material, activity or food)

Behavior used to gain an object, activity or event.

**Table 5

Additionally the following factors are critical to achieve a comprehensive analysis of these behaviors in students with autism: parent/caregiver interview to gain additional information regarding the context of students’ verbal/vocal behavior and standardized speech/language assessment. 

The procedure detailed above will serve to cross-classify frequency, effectiveness of communication and behavioral function of students’ verbal and/or vocal behavior. Assessment of frequency and communicative effectiveness of verbal and/or vocal behavior will allow for quantification of a student’s overall functional communicative effectiveness. This rating, taken in the context of behavioral analysis, will allow a student’s educational team to design an individualized plan for intervention aimed at both reducing repetitive verbal and/or vocal behavior and increasing/expanding spontaneous functional communication. This method of quantifying a student’s verbal and/or vocal behavior and overall communicative effectiveness will allow for continued assessment of a student’s progress in increasing communication and reducing repetitive verbal/vocal behaviors over time.

To our knowledge, this is the first proposed methodology which will assess and quantify repetitive verbal and/or vocal behavior by behavioral function, frequency and communicative effectiveness. The framework presented will allow for reduplication of methods and will take steps towards systematizing analysis of repetitive verbal and vocal behaviors in students with autism. The procedure described will further serve to drive a more efficient and individualized intervention model aimed at both reducing repetitive verbal/vocal behaviors in students with autism and increasing/expanding functional/spontaneous communication in this population.

**A full reference list will be available for the presentation. The full reference list exceeded the limits of the required word count.  

Presenters:

Schea N. Fissel, M.A., CCC-SLP
Speech-Language Pathologist
Kaiser Permanente
Schea N. Fissel M.A., CCC-SLP is an outpatient SLP for Kaiser Permanente, with specialized experience working with individuals with autism since 2008. Fissel is a doctoral student at Kent State University, focusing her research in the areas of autism and AAC. She’s presented locally and nationally on autism and echolalia.

Rebecca Embacher, M.Ed., BCBA
Research Project Manager
Cleveland Clinic Center for Autism
Rebecca Embacher, M.Ed., BCBA, is the research project manager at the Cleveland Clinic Center for Autism. She has worked with individuals with autism for over 10 years. Embacher is a graduate of John Carroll University and Cleveland State University.

Aletta Sinoff, Ph.D, CCC-SLP, BCBA-D
Director
The Cleveland Clinic Center for Autism, The Lerner School
Aletta Sinoff, Ph.D., CCC-SLP, BCBA-D, is the Director of the Cleveland Clinic Center for Autism (CCCA). From its inception 10 years ago, she has been an integral part of CCCA, serving as Assistant Director to the Early Childhood Program, prior to taking her current position as Director in December 2009.

Heather Sydorwicz, M.S., CCC-SLP, BCBA
Coordinator of Speech/Language Services
Cleveland Clinic Center for Autism
Heather Sydorwicz, M.S., CCC-SLP, BCBA, is the Coordinator of Speech/Language Services at the Cleveland Clinic Center for Autism. She has been working with individuals with autism and practicing as a Speech/Language Pathologist for 8 years in a variety of settings. Sydorwicz is a graduate of the University of New Hampshire.