enter Dept name in Title Master
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
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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
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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
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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).
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TESTING YOUNG CHILDREN WITH AUTISM
• Lack of expressive vocabulary • Imitation deficits • Better responses to video models than to live models
(Nikopoulos, 2007)
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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.
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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…)
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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
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Childhood apraxia of speech: more difficulty in sequences than in single postures vowel deviations atypical prosody
Key Differential Motor-Speech Symptoms
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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.
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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
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METHOD
Participants:
Five (5) typically developing (TD) children
Three to five years of age
Four ethnic groups (Caucasian, African American, North Asian, & South Asian)
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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
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METHOD
Children with speech-language delays were included as controls for comprehension and expressive language deficits in children with autism spectrum disorders.
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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
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Demographic information: Typically Developing Group
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Demographic information: Autism Spectrum Disorders Group
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Demographic information: Late Talkers Group
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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
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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.
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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.
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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
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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
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“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
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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
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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.”
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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.
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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
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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
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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
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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
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LIMITATIONS of the STUDY
Small numbers of subjects per group
Groups not well matched for age or sex
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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
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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.
SUMMARY & DISCUSSION
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Overall, the test was able to differentiate the groups for the presence of motor speech symptoms.
SUMMARY & DISCUSSION
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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
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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.
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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
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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.
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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.
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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.
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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.