Language-Free Assessment Tool for Motor Speech Disorders in Difficult-to-Test Populations

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LANGUAGE-FREE ASSESSMENT TOOL FOR MOTOR SPEECH DISORDERS IN DIFFICULT-TO-TEST

POPULATIONS

Banumathy Nagamani Shelley Velleman

Mary Andrianopoulos Marcil Boucher

Liz Thayer Amy Kuck

University of Massachusetts - Amherst

2 Communication Disorders, UMass-Amherst

With much appreciation to:

  The parents and children who participated   Fulbright Scholar Program   U.S. Department of Education, Office of Special

Education Programs   Cure Autism Now   Other graduate students who contributed to the

research: Michele Boisvert, Michele Boucher, Joanne Kabaniuk


Children with ASD perform poorly on:  imitation tasks (Berkeley et al., 2001; Leary & Hill, 1996; Manjiviona & Prior, 1995;

Jones & Prior, 1985; Mostofsky, Dubey, Jerath, Jansiewicz, Goldberg, & Denckla, 2006)

 tasks on command, and actual tool use; revealing generalized praxis deficit. (Jones & Prior, 1985; Mostofsky, Dubey, Jerath, Jansiewicz, Goldberg, & Denckla, 2006)

MOTOR-SPEECH DISORDERS IN CHILDREN WITH AUTISM


MOTOR-SPEECH DISORDERS IN CHILDREN WITH AUTISM

• Possibility of a more basic problem in motor speech programming/planning and/or sensory-motor integration in children with ASD (Smith & Bryson, 1994; Prizant, 1996; Green, Shriberg & Campbell, 2002; Rogers, Hepburn, Stackhouse & Wehner, 2003; Velleman, Andrianopoulos, et al. 2009).


TESTING YOUNG CHILDREN WITH AUTISM

• Lack of expressive vocabulary •  Imitation deficits • Better responses to video models than to live models

(Nikopoulos, 2007)


NEED FOR THE STUDY

 It is vital to identify motor speech disorders (apraxia, dysarthria) in young children with ASD and other developmental disorders.

 facilitate early intervention for children in these difficult-to-test populations

 maximize oral communication

  Necessitates development of sensitive tools to identify / diagnose variant motor speech behaviors.


 Existing standardized measures cannot be used with very young, very delayed, or very uncooperative children.

 Not possible to use existing tools in contexts such as India, where several languages and dialects are in use.

Need for the study (Contd…)


Dysarthria:  muscle weakness/paralysis, atypical muscle tone or

muscle rigidity  reduced range of movement and precision of speech

articulators, incoordination of speech musculature  Alterations in pitch, loudness, vocal roughness,

speech intelligibility, and rate of speech (fast, slow, irregular)

Key Differential Motor-Speech Symptoms


Childhood apraxia of speech:  more difficulty in sequences than in single postures  vowel deviations  atypical prosody

Key Differential Motor-Speech Symptoms


AIMS OF THE STUDY   Develop a language-free assessment battery to identify

motor speech disorders, especially motor planning deficits, in very young children, especially those who are difficult to test due to autism and other developmental disorders.

  Evaluate the effectiveness of this tool for this purpose.

  Explore the presence of motor speech symptoms in these populations.


1. Does the language-free test serve as an effective tool for the differential diagnosis of motor speech disorders?

2. Do children with ASD exhibit motor speech deficits? If so, what is the nature of these deficits?

RESEARCH QUESTIONS


METHOD

Participants:

  Five (5) typically developing (TD) children

  Three to five years of age

  Four ethnic groups (Caucasian, African American, North Asian, & South Asian)


METHOD

Participants, cont:

Five (5) children each with   autism – diagnosed by neurologist or psychologist   language delays for other reasons (e.g., prematurity,

various syndromes)

  Three to five years of age


METHOD

Children with speech-language delays were included as controls for comprehension and expressive language deficits in children with autism spectrum disorders.


Inclusionary criteria for ASD & delayed participants:

 Vocabularies of at least 10-50 oral words  Ability to imitate around 10 oral words

 No structural or craniofacial differences  No uncorrected auditory or visual deficits

 No recent history of injurious or destructive behavior

Informed consent was obtained from all parents/caregivers


Demographic information: Typically Developing Group


Demographic information: Autism Spectrum Disorders Group


Demographic information: Late Talkers Group


Test Stimuli The test stimuli were developed based on:  Measures used for assessing less severe children

(Verbal Motor Production Assessment for Children, Hayden & Square, 1999; Early Motor Control Scales, Hayden, Wetherby, Cleary & Prizant, in press)

 Differentially diagnostic features of CAS highlighted by research studies in the literature and by ASHA (2007a, b).

Items were specifically designed to meet the needs of younger children in the age range of 2 to 4 years


Assessment

Sequential Functions

Single Functions

Speech Tasks

Non Speech Tasks

Non Speech Tasks

Speech Tasks

Speech and Non-speech tasks comprise both observational and task based items.


Speech stimuli included observation and imitation of:

 Basic “universal” vowels, stops, continuants

 Syllables common to English, all Indian languages, and most other languages

 Single pitches and ranges of pitches.


Non Speech Stimuli assessed:

 Observation of functional use of oral structures for eating

 Range and accuracy of lip, tongue and jaw positions and movements in imitation


Use of Video

  Samples of the typically developing children performing the assessment tasks were digitally video recorded

  Edited video samples served as models for children with ASD and other young speech-language delayed children

 Video samples were played via computer during testing

Unique features of the assessment tool


“Language-free”

 Meaningful elicited speech not language-specific

  Example: To elicit [a], say “I’m tired” in child’s language, put head down on pillow, say “Ahhh”

  Sequences are elicited using “alien” creatures with CVCV names (e.g., [patu], [bomi],

[diba], [tuno]

  Thus, assessment can be administered in any language

Unique features of the assessment tool


SCORING AND ANALYSIS  Responses scored using rating scales to quantify subjective

perceptual attributes.

 Target features chosen for analysis included:

 Production of sounds, syllables, oral gestures, manual gestures, and pretend functions

 spontaneously vs. in imitation

 singly vs. in sequences

 Today, we focus on performance in imitation


RESULTS: TEST ADMINISTRATION

 Most children from all three groups were able to complete most of the items in the test although they were young and represented a range of ages and abilities.

 Many children needed neither the video nor the play routines (e.g., pillow for “Ahh!”). However, they were useful as back-up.

 The children especially liked the “aliens.”


RESULTS: TEST ADMINISTRATION

 Video was helpful in eliciting responses from children with ASD who had difficulty in imitating tasks when presented live.

 One child with ASD who had no imitation skills had difficulty with many tasks, even with video models.


RESULTS: MOTOR SPEECH  Non-speech  All three groups performed more poorly on sequencing tasks

than on single tasks, as expected; especially ASD  ASD group had more difficulty on all non-speech tasks

Non-speech

TD - % correct

LT - % correct

ASD - % correct

Single 96 88 81

Sequence 90 86 60


RESULTS: MOTOR SPEECH

  Speech  Again all three groups performed more poorly on sequencing

tasks than on single tasks, as expected  Again children with ASD had more difficulty on all tasks  However, LT group showed biggest discrepancy between singles

and sequences for speech

Speech TD - % correct

LT - % correct

ASD - % correct

Single 100 89 70

Sequence 96 77 67


Speech vs. Nonspeech  Groups differed with respect to whether they did better on

speech vs. non-speech single actions

Single Actions

TD - % correct

LT - % correct

ASD - % correct

Non-Speech

96 88 81

Speech 100 89 70


Speech vs. Nonspeech  Groups also differed, in a different way, with respect to

whether they did better on speech vs. non-speech sequences of actions

Action Seq.

TD - % correct

LT - % correct

ASD - % correct

Non-Speech

90 86 60

Speech 96 77 67


LIMITATIONS of the STUDY

 Small numbers of subjects per group

 Groups not well matched for age or sex


 Overall TD children performed best on all the test items followed by LTs and then ASDs, as expected.

 Cannot rule out motivation, imitation skills, comprehension as factors, especially since the LT’s were older as a group.

SUMMARY & DISCUSSION


 Children with ASD exhibit symptoms consistent with motor speech impairments, especially on speech and non-speech sequencing tasks.

 Also notable that children with ASD required higher numbers of trials for almost all test items than LTs. Requiring more trials to learn a motor task is considered a symptom of CAS.



 Overall, the test was able to differentiate the groups for the presence of motor speech symptoms.



IMPLICATIONS

 Video modeling may be an effective tool for assessing children with ASD

 It is imperative that we assess and treat the motor speech skills of children with ASD


FUTURE DIRECTIONS

 Increase numbers of subjects

 Improve subject matching

 Expand study to include children with Down syndrome, who are reported to demonstrate symptoms of both apraxia and dysarthria (with further thanks to the Fulbright Scholar Program!)

 Validate scoring to determine which items have most efficacy

 Revise test.


  American Speech-Language-Hearing Association. (2007a). Childhood Apraxia of Speech [Position Statement]. Available from www.asha.org/policy.

  American Speech-Language-Hearing Association. (2007b). Childhood Apraxia of Speech [Technical Report]. Available from www.asha.org/policy.

•  Berkeley, S.L., Zittel, L. L., Pitney, L.V. & Nichols, S.E. (2001). Locomotor and object control skills of children diagnosed with autism. Adapted Physical Activity Quarterly, 18, 405-416.

  Hayden, D. & Square, P. (1999). Verbal Motor Production Assessment for Children. The Psychological Corporation.

REFERENCES


REFERENCES CONTINUED   Hayden, D.A., Wetherby, A.M., Cleary, J.E. & Prizant, B.M.

(in press). Early Motor Control Scales. Brookes Publishing. •  Jones, V. & Prior, M. (1985). Motor imitation abilities and

neurological signs in autistic children. Journal of Autism and Developmental Disorders, 15(1), 37-46.

•  Leary, M.R. & Hill, D.A. (1996). Moving on: Autism and movement disturbance. Mental Retardation, 34(1), 39-53.

•  Manjiviona, J. & Prior, M. (1995). Comparison of Asperger syndrome and high-functioning autistic children on a test of motor impairment. Journal of Autism and Developmental Disorders, 25(1), 23-29.


REFERENCES CONTINUED •  Mostofsky, S.H., Dubey, P., Jerath, V.K., Jansiewicz, E. M.,

Goldberg, M.C. & Denckla, M.B. (2006). Developmental dyspraxia is not limited to imitation in children with autism spectrum disorders. Journal of the International Neuropsychological Society, 12, 314-326.

•  Nikopoulos, C. K. (2007). Use of video modeling to increase generalization of social play by children with autism. Journal of Speech-Language Pathology and Applied Behavior Analysis, 2(2), 195-212.

  Prizant, B.M. (1996). Brief report: Communication, language, social, and emotional development. Journal of Autism & Developmental Disorders, 26(2), 173-178.


REFERENCES CONTINUED   Rogers, S.J., Hepburn, S.L., Stackhouse, T. & Wehner, E.

(2003). Imitation performance in toddlers with autism and those with other developmental disorders. Journal of Child Psychology and Psychiatry, 44(5), 763-781.

  Shriberg, L. D., Green, J. R., Campbell, T. F., McSweeny, J. L., & Scheer, A. R. (2003). A diagnostic marker for childhood apraxia of speech: The coefficient of variation ratio. Clinical Linguistics and Phonetics, 17(7), 575-595.

•  Smith, I.M. & Bryson, S.E. (1994). Imitation and action in autism: A critical review. Psychological Bulletin, 116(2), 259-273.


REFERENCES CONTINUED •  Velleman, S. L., Andrianopoulos, M. V., Boucher, M. J.,

Perkins, J., Averback, K. E., Currier, A., et al. (2009, November). Motor speech disorders in children with autism. In R. Paul & P. Flipsen (Eds.), Speech sound disorders in children: In honor of Lawrence D. Shriberg (pp. 141-180). San Diego: Plural.

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Language-Free Assessment Tool for Motor Speech Disorders in Difficult-to-Test Populations

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