Autism, AAC, and Motor Learning (G. Meier, CSHA 2014)

transcript

Autism, AAC and Motor Learning

Gwendolyn Meier, SLP, MTVilla Esperanza Services

gmeier@villaesperanzaservices.org

Thursday, April 3, 14

Disclaimer

• The speaker has no financial or non-financial interests in the information or products in this presentation

The Speech & Language Center

Today’s screen shots can be found in the full presentation - link on the CSHA 2014 tab at

scaacn.blogspot.com/p/csha-2014.html

AgendaMaximizing Motor Skills in:

• Autism

• AAC Assessment

• Teaching

• Prompting

• Communication displays - high & low tech

• Core vocabulary learning & use

Slideshow

Terminology

• Symbol = Icon

• Comprehension = Recognition

• Device = Any visually-based AAC system

• Student = Learner of any age

Moving to Budapest!

AAC AssessmentThe snapshot

• Test of icon recognition (e.g., TASP)

• Present a few systems

• Final recommendation

The full assessment

• Initial impression

• System trial/teaching period

• Final recommendation

Teaching Hungarian

• HOW are we teaching this new language?

Hungarian:

• More likely to learn in meaningful chunks at first

• Before segmentation occurs

Is there someone here who speaks English?Beszél itt valaki angolul? (BE-seyl it VÅ-lå-ki ÅN-go-loul)

Where is the toilet? Hol van a mosdó? (hol vån å MOSH-doa?)

Teaching AAC• HOW are we teaching this new language?

In AAC:

• More likely to learn sequences made meaningful by the reaction they elicit

Teaching Hungarian• HOW are we teaching this new language?

Hungarian:

• Flashcards?

• Scripted interaction?

• Conversation?

How are we teaching this new language?

In AAC:

• Labeling?

• Requesting?

• Answering questions?

• Conversation?

• Icon recognition?

• Verbal cues?

• Motor patterns?

• Gesture cues?

• Visual cues?

Teaching Language in Autism

• Use strengths to shore up weaknesses

In autism:

(-) Auditory weakness

(-) Symbolic weakness

(+) Visual strength

(?) Motor skills

Teaching AAC Language• Modeling and Augmented input highlight the

auditory boundaries between words

‣ Human speech alone does not

Teaching AAC Language• Neurons that fire together, wire together

(Hebb’s rule)

In AAC:

• Seeing language

• Hearing language

• Add motor pattern

= Multi-sensory stimulation

In infancy...• With the motor pattern for speaking

words comes increased ability to perceive that word in spoken language*

* Halloran & Halloran, 2006. Language Acquisition Through Motor Planning. Center for AAC and Autism.

In AAC infancy...?

• With the motor pattern for navigating to words comes increased ability to perceive that word in spoken language (?)

Multi-Sensory LanguageModeling & Augmented Input

• See the visual, See the movement, Hear the auditory feedback, Experience the natural consequence

Modeling for Milo

Language Acquisition......requires organization and interpretation of the world through a system of symbols and referents.

catball

AAC Language Acquisition......requires organization and interpretation of the world through a system of symbols and referents.

• AAC visuals (objects, photos, icon, text) add an element of “referent” to spoken words that have no physical referent

outsidegowant

The key to making the iconic or arbitrary symbol-to-referent

connection may be in the comprehension skill that the

learner brings to the task.

Namy, L., Campbell, A. & Tomasello, M. (2004). The changing role of iconicity in non-verbal symbol learning. Journal of Cognition & Development, 5, 37-57.

Symbol Comprehension

Symbol Comprehension• Without understanding of the

referent, the iconicity of the visual symbol may not affect his learning of its meaning

✴ The iconic symbol may appear just as meaningless as the arbitrary symbol until it is given meaning through its use

Barton, A., Sevik, R. & Romski, M.. (2006). Exploring Visual-Graphic Symbol Acquisition by Preschool Age Children with Developmental and Language Delays. Augmentative and Alternative Communication, Vol 22(1), 10-20.

PECS & Symbol Comprehension

• PECS Phase 3: Discrimination Training

- Aims to teach icon discrimination skills given a limited field of choices

Picture Communication BooksRely on icon association/

understanding

A Dual Role for Symbols

• Visual-graphic AAC icons themselves play a role in their acquisition

• The message to represent an idea

• The medium to achieve communication

Sevcik, R. A., Romski, M. A., & Wilkinson, K. (1991). Roles of graphic symbols in the language acquisition process for persons with severe cognitive disabilities. Augmentative and Alternative Communication, 7, 161–170.

• Gissette’s icon Recognition?

• How is she going to learn to use “Put” + “on” to request?

Teaching AAC• HOW are we teaching this new language?

In AAC:

• Icon recognition?

• Verbal cues?

• Motor patterns?

• Gesture cues?

• Visual cues?

• Labeling?

• Requesting?

• Answering questions?

• Conversation?

So, how do we teach new movement patterns?

Model + Consequence $$$ What’s the pay off $$$$

Visual Cues?

Physical Support for the Correct Movement Pattern

PROMPT TM

Practice! Practice! Practice!

DailyOver time

With supportWith meaningful consequences

Motor Skills in ASD• Various altered motor behaviors in autism:

• Slower repetitive hand movements

• Slower and less accurate manual dexterity

• Reduced ability for rapidly alternating movements (diadochokinesis)

Staples & Reid. (2010). Fundamental movement skills and autism spectrum disorders. Journal of Autism and Developmental Disorders, Vol 40(2), pp. 209-217.

Motor Skills in ASD1. Implicit motor learning processes are

relatively intact in autism

* Gowen, E. & Hamilton, A. (2013). Motor Abilities in Autism: A Review Using a Computational Context. Journal of Autism and Developmental Disorders, Vol 43(2), pp 323-344.

2. Reaction times improve to the level of NT subjects given repetition

• Serial reaction time task (SRT)

* Gowen, E. & Hamilton, A. (2013). Motor Abilities in Autism: A Review Using a Computational Context. Journal of Autism and Developmental Disorders, Vol 43(2), pp 323-344.

Serial Reaction Time Task

Imagine...PECS Phase 1

• Learning the “give”

• Efficiency comes with practice

2. Reaction times improve to the level of NT subjects given repetition

• Serial reaction time task (SRT)

3. Proprioceptive input may be more reliable than visual input when learning new motor patterns

Gowen, E. & Hamilton, A. (2013). Motor Abilities in Autism: A Review Using a Computational Context. Journal of Autism and Developmental Disorders, Vol 43(2), pp 323-344.

Proprioceptive support

• Use motor learning strength to teach the motor pattern

• Paired with a motivating consequence

• Then reduce the level of visual prompt

Milo - Learning “turn”

Sensory & Movement Differences

• Starting

• Stopping

• Continuing

• Combining and switching

• Thought

• Memory

• Emotion

• Speech

Stopping, / Switching

Take from the Right

Motor Plan VS. Icon Comprehension

• Consistent placement of icons and meaningful use of them in communication may be more important than iconicity of the picture

• Learners don't need to be able to recognize/"point to"/"give" an icon that is named before they can use that icon to get something done in the world

Motor Plan VS. Icon Comprehension

• Consistent placement of icons and meaningful use of them in communication may be more important than iconicity of the picture

• Learners don't need to be able to recognize/"point to"/"give" an icon that is named before they can use that icon to get something done in the world

Why the fuss about Motor Learning?

EVERY learned physical activity depends on motor learning

• Walking, driving, climbing/descending stairs, eating, dressing, typing, reading, Smartphone or computer access

Automatic Motor Patterns

When motor patterns change...

Automatic

Volitional

Imagine...

When Motor Patterns Change

• It brings our awareness to our movements

• Requires re-learning

• Ideation - Plan - Execution - Feedback

✴ Not conducive to communicating!

Speaking

• Automatic motor patterns for words and phrases are established as meaning is attached (in infancy)

• We don’t think about how to physically speak

• Focus on: the words to use, how it will be interpreted, our listener’s background...etc.

AAC Automaticity is aided when:

1. Consistent motor patterns to access vocabulary we need

2. There is a unique pattern to reach your word, regardless of the activity

3. Reliable, motivating consequences for use of symbols

Halloran & Halloran, 2006. Language Acquisition Through Motor Planning. Center for AAC and Autism.

Consistent motor patterns are extremely important when...

• When using multiple pages of vocabulary

• Visual tracking and scanning are not efficient

• When icon recognition is weak

• Teaching the use of core vocabulary and use of more abstract vocab/symbols

• A visual search is meaningless

When Motor Patterns Change

• By shifting locations of pictures:

• Awareness moves from the message to the execution

• We are actually testing

• Visual scanning skills

• Icon association/understanding

• Adding cognitive load

✴ Not conducive to communicating!

We can take advantage of motor learning when:

• Patterns build upon themselves as language grow

• Plan the end at the beginning

•Preserve relative location

Between activity-based pages...preserve locationClassroom Snack

Consistent Placement - Pic Card Shadows

Another benefit...

Today Tomorrow

Campus Job - “Here is your schedule”

As language system grows...preserve location

Motor patterns don’t change

NEW! in 2013

When we use motor learning to our advantage...

• Our lower-functioning students can generate multi-word phrases...

...across multiple pages

...using core vocabulary

...for greater communicative competence!

Thank you!Email: gmeier@villaesperanzaservices.org

Blog: www.scaacn.blogspot.com

Facebook: facebook.com/socalaac.scaacn

Twitter: @scaacn

Autism, AAC, and Motor Learning (G. Meier, CSHA 2014)

Education