Predictors of Phrase and Fluent Speech in Children With Autism and Severe Language Delay

I chose to read this article because it reviewed a large number of children with Autism and PDD-NOS  who had significant language delays. The study examined what predictors educators could look for and expect when working with children with ASD and/or PDD-NOS. The study found that by age 9, 24% of children with Autism obtain fluent speech and 30% are termed nonverbal. Whereas 59% of children with pervasive developmental disorder not otherwise specified (PDD-NOS) obtain fluent speech and 4% are termed nonverbal by age 9.

I found these results to be very interesting, as they clearly show that obtaining verbal language is much more difficult for children with an Autism diagnosis. The researchers noticed the same trend and posed the questions, "why [are there] a large number of children with ASD [that] do not develop meaningful language during their preschool years?" One of the theories that the researchers had was that repetitive behaviors may have an adverse effect on language development. I think that this theory is relevant because if a child's behaviors are appropriate and manageable, then they are in a positive learning state to learn verbal language. 

This article gave me great insight into what I need to focus on when doing my research study. I will need to focus first on the participants behaviors that may be impeding his/her learning, then move onto the language acquisition training. 

 

Reference:

Wodka, E. L., Mathy, P., & Kalb, L. (2013). Predictors of phrase and fluent speech in children with 

       autism and severe language delay. Pediatrics - Official Journal of the American Academy of 

       Pediatrics, 131(4), e1128-e1134. doi:10.1542/peds.2012-2221

Picture Exchange Communication System (PECS) or Sign Language: An Evidence-Based Decision-Making Example

I chose this article because it uses a 7-step decision-making process with three hypothetical students in order to determine whether each student should use PECS or Sign Language as a communication intervention. The decision-making process outlined for the three hypothetical students with ASD is evidence-based. 

Here are the 7-steps in the decision-making process: 

1.) Develop the Parameters to Guide the Search for Evidence: 
- This step is used to answer a specific question or solve a problem. A child's characteristics, intervention or practice and the outcome you want through intervention to occur should all be listed under this step. 

2.) Search for Evidence: 
- This step is used to search for evidenced-based research that covers the intervention you are thinking of using. Ultimately, you want to find research studies that involve students that are similar to the one that you are determining the intervention for and covers the desired outcome that you are wanting. 

3.) Evaluate Each Study for Quality and Summarize Findings: 
- Teachers must determine whether the research studies they find are "high-quality" based on similar standards that we are currently using for our own research studies. However, this process needs to be short and simple for teachers as they do not have extensive time for this step. Spencer, Peterson, and Gillam (2008) give three questions for teachers to follow in order to determine if the research study is "high-quality". 
     1.) How strong is the relationship between the intervention or practice and the outcome? 
     2.) Is the effect replicated across multiple individuals? 
     3.) Can alternative explanations for the outcome be ruled out? 

4.) Consider Student and Family Factors: 

- Teachers need to consider several factors with the child in order to help guide them to which intervention would be more effective. Some factors include, the child's fine motor abilities, independent vocalizations, and matching and discriminating between graphics, symbols, and pictures. Teachers also need to consider a few family factors such as willingness to utilize the chosen intervention as well as how involved they are in the decision making process for their child's education and interventions. 

5.) Consider Teacher and School Factors: 

- Teachers need to determine how likely they are to utilize the chosen intervention, school policy with communication interventions, and can all members of the child's team support and utilize the communication intervention. 

6.) Integrate the Evidence: 

- Based on the research evidence and the child's ability levels, teachers can then determine which communication intervention is the best "fit" for the child. 

7.) Monitor the Outcomes: 

- Teachers need to maintain an accurate data log of the child's progress throughout the intervention cycle in order to determine if the chosen intervention is working for the child. 

I found this article to be extremely helpful for my own decision-making process with students that I work with. Although I will be using a randomized selection process for my research participants, I will utilize these methods for students that I work with in the future. 

References:

Spencer, T. D., Peterson, D. B., & Gillam, S. L. (2008). Picture exchange communication 
        system (PECS) or sign language: an evidence-based decision-making example. 
       Teaching Exceptional Children, 41(2), 40-47. Retrieved from 
        http://search.proquest.com/docview/201172195?accountid=166077

Link Link to the Article: 

           Unfortunately I cannot provide a link to this particular article as I got it from the BACB database through my supervisors login and it does not allow me to Permalink the article. If anyone is interested in reading this article let me know and I can send you the PDF format. 

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Language Outcomes in Toddlers with ASD

I chose to read this research article because I was curious about language deficits in one and two year old children with autism. Researchers took 37 children with autism, ages 15-25 months, and followed them for a two-year period. They focused on three main language area deficits, which are: expressive language, joint attention, and responsiveness to speech. It is no surprise that the researchers found that there was a higher rate of vocabulary growth in the children that had more verbal imitation skills, joint attention, and words at baseline. They also found that the best predictors of verbal acquisition at 3 years of age happens at 18-24 months, which were requesting, receptive language, and number of consonants the child can sound out. After the 2-year follow-up visit, the researchers found that 54% of the participants were considered to have "good" language.

After reading this article, I learned that I may see more language acquisition growth in some of the participants that may have more of the verbal language communication skills described in this study (e.g. joint attention, requesting, etc.).

Here's the link to the article:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2946084/

Reference: 

Paul, R., Chawarska, K., Cicchetti, D., & Volkmar, F. (2008). Language outcomes of toddlers 
       with autism spectrum disorder: a two-year follow up. National Institute of Health 
       Manuscript, 1(2), 97-107. doi:10.1002/aur.12.

Comparing PECS vs Signs

I chose to read this particular article because it reflects the research study that I will be doing in the Spring. The study focused on comparing sign language and the Picture Exchange Communication System (PECS) effectiveness of children with autism acquiring verbal manding, or requesting, behavior. Researchers took two school-aged children with autism (one boy and one girl) and used an alternating treatment design with two phases (baseline and "best-treatment").

The procedure involved assessing the two participants for preferred items, imitation skills, and baseline in verbal language ability. Next, each participant was trained in Sign Language and PECS alternating for 15 sessions then switched to the other treatment for the next 10 sessions and finally used the "best treatment" design for 5 sessions.

The results of the study were very interesting and differed for both participants. Participant A (Carl) responded better to Sign Language, increasing verbal mands by 38%. Participant B (Jennifer) responded better to PECS, increasing verbal mands by 95%. The parents were interviewed at the conclusion of the study and stated that they thought their children's communication skills improved, however they did not like the alternate treatment design of the intervention.

I gained a few ideas by reading this study. First off, my initial idea of not implementing an alternative treatment design was a good choice as this study stated, it would have been more effective to only teach one method. Secondly, I learned that I need to do an interest inventory of the 5 words that I will teach my participants in order to ensure they are motivated (e.g. for "ball" find out if there is a particular ball that each participant enjoys. Overall, I really enjoyed reading this study and found it very helpful for my personal research purposes.

Permalink:

https://ezproxy.western.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=14239117&site=eds-live

References: 

Tincani, M. (2004). Comparing the picture exchange communication system and sign 
       language training for children with autism. Focus on Autism and Other Developmental 
       Disabilities, 19(3), 152-163.

What Do the Data Say?

Article Title: Picture Exchange Communication System (PECS): What Do the Data Say? 

This research article discussed the authors findings when they reviewed 34 articles that contained data and protocols of PECS. The researchers found that since PECS was created in 1994, the number of research articles published per year has increased greatly. 

Most of the articles studied whether or not PECS would aid in increasing functional communication and language acquisition. 26 out of 34 articles focused on children with PDD-NOS and ASD (around 386 between all of the articles). 

A few common themes amongst the articles were that the requesting methods taught through PECS were more effective than other language acquisition intervention methods. The treatment integrity of the studies varied based on individual characteristics of participants, trainers preparedness, supervision techniques, intervention fidelity, and the schedule of visits. The integrity and fidelity in which PECS is implemented has a direct effect on the results of functional communication and/or language acquisition. Another important factor that was reported across studies was that PECS provides nonverbal children and adults a way to functionally communicate with others regardless of whether they speak English or not.  

References

Sulzer-Azaroff, B., Hoffman, A. O., Horton, C. B., Bondy, A., & Frost, L. (2009).

        The picture exchange communication system (PECS): What do the data  

        say? Focus on Autism and Other Developmental Disabilities, 24(2), 89-

        103. doi:10.1177//1088357609332743

Here is the Permalink to the article: 

https://drive.google.com/file/d/0B6w69hl53K9HelJwZTBRa2hUdGs/edit?usp=sharing

Picture Exchange Communication System (PECS) versus Responsive Education and Prelinguistic Milieu Teaching (RPMT)

Article Title: A Randomized Comparison of the Effect of Two Prelinguistic Communication Interventions on the Acquisition of Spoken Communication in Preschoolers with ASD

This article was about an experimental study of the effectiveness of two communication interventions, Picture Exchange Communication System (PECS) and Responsive Education and Prelinguistic Milieu Teaching (RPMT) using a group of preschoolers with autism spectrum disorders (ASD). For those readers out there that are unfamiliar with these two communication interventions, let me take a moment to explain them. 

The Picture Exchange Communication System, or PECS, is a method that involves teaching an individual to make requests for items through the use of pictures. For example, if a boy wants to play with a ball, he would give a picture of a ball to his play partner (e.g. teacher, parent, sibling, peers, etc.). There is a full PECS training that involves five "phases" of formal training and is typically done with a partner when teaching the child to use it. 

The Responsive Education and Prelinguistic Milieu Teaching, or RPMT, is a method that focuses on two components: parent education (Responsive Education) and children (Prelinguistic Milieu Teaching). Parents receive one-on-one education and training about how to incorporate the intervention at home through play-based therapy. The children's piece involves the therapist to follow the child's lead through using "teachable moments" during play to focus on gestural, vocal and nonvocal methods of communicating their wants and needs appropriately. 

I was interested in this particular article a) because I am interested which method is more effective and b) because I had never heard of the RPMT method. The study was conducted over the course of 6 months and included three 20-minute intervention sessions per week that took place at the university clinic. Parents also received 15 hours of educational training in both methods in order to increase wrap around intervention. A computer program was used in order to randomize which child received which intervention (19 - PECS and 17 - RPMT). 

The results of the study were fascinating! Researchers found that PECS aided in high object examination using a variety of words that were not imitated by children. However, RPMT helped children that had lower object examination gain more words. After the 6 month research intervention was complete, the study found that PECS aided in acquiring verbal communication faster than RMPT. 

References

Yoder, P., & Stone, W. L. (2006). A randomized comparison of the effect of two prelinguistic 
      communication interventions on the acquisition of spoken communication in 
      preschoolers with ASD. Journal Of Speech, Language & Hearing Research, 49(4), 698-
      711. doi:10.1044/1092-4388(2006/051)


Here is the Permalink to the article: 

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