Motor Hand Movements in Prelinguistic Children with Autism Spectrum Disorders

Transcription

1 Motor Hand Movements in Prelinguistic Children with Autism Spectrum Disorders Barbara Braddock, PhD, CCC-SLP Saint Louis University Jena McDaniel, BSEd Vanderbilt University Jess Poyer and Jane Hilton, PhD, CCC-SLP University of Virginia American Speech-Language Hearing Association Annual Convention (November, 2010)

2 Course Preintentional and Intentional Communication Gesture Types Gesture Assessment Gesture Use in Atypical Development Motor Hand Use in Atypical Development Object Use in Atypical Development Research Phase I: Case Series Research Phase II: Gesture Data Tracker

3 Two Types of Infant Communication Preintentional Intentional

4 Preintentional Communication Communication of some learners may be entirely or predominantly nonsymbolic (Snell, 2002). A set of behaviors and/or communication forms and meanings unique for the child.

5 Intentional Communication Communication act is defined as a sequence of observable behaviors in that: 1) the sender performs an signal or form, 2) that is directed towards another individual, and 3) in a manner that appears to indicate some communication function. (Wetherby & Prizant, 1989)

6 Communication Intentionality Children learn intentionality through caregiver s interpretation of the child s behaviors. Gestures are one of the most consistent early indicators of intentionality.

7 JOINT ATTENTION Request information Comment BEHAVIOR REGULATION Request action Protest Request Object SOCIAL INTERACTION Unknown context Known context Taken from Crais et al., 2009

8 Protesting for behavior regulation 9-12 months (Crais et al., 2004)

9 Communicative Gesture Actions performed with the intent to communicate Typically involve the fingers, hands, and arms Can include facial features (lip smacking for eating) Full body motions (bouncing for horsie ) (Iverson & Thal, 1998)

10 Gesture Progression Research consistently documents a continuous development of communication, from early gestures progressing to first words. (Volterra, Caselli, Capirici, & Pizzuto, 2005)

11 Gesture Types DEICTIC GESTURE: Examples requesting, reaching, showing, giving and pointing Used to indicate or call attention to an object Can be used to single out a referent from other possible ones Communication function must be interpreted in relation to current context

12 Child reaches to request an object (Ritualized requests include reaching with open-close grasping, placing an adult s hand on an object, or pulling at an empty hand to obtain something; Bates et al., 1979; Crais et al., 2009; Capone & McGregor, 2004)

13 Movement of another s hand to request an object (Crais et al., 2009; Capone & McGregor, 2004)

14 Child shows an object (Showing, giving and pointing increase in occurrence at 11 months as reaching and other more primitive gestures decline; Blake & Dolgoy, 1993; Bates et al., 1979; Crais et al., 2009; Capone & McGregor, 2004)

15 Child gives an object (Crais et al., 2009; Capone & MacGregor, 2004)

16 Pointing to obtain an object for behavioral regulation Pointing to object/event for joint attention (Crais et al., 2009; Capone & McGregor, 2004)

17 About half of all deictic points between 8 and 11 months are accompanied by vocalizations (Carpenter et al., 1983)

18 Gesture Types CONVENTIONAL GESTURE: Comprehension and production is culturally-defined (example: waving bye-bye). Typically observed in young children s communications a few months after deictic gestures. Often tied to the context of familiar games and social routines. As language develops used in a wide range of different contexts.

19 For example, a young child may nod head yes, wave bye-bye and as gesture progresses use other conventional gestures, such as thumbs up or high five.

20 Gesture Types REPRESENTATIONAL GESTURE: Similar to conventional gestures (Example: waving arms to resemble bird in flight). Typically represent some aspect of a referent (such as size, shape, direction of movement). Must be produced empty-handed (without referent in hand).

21 Representational gestures appear in the first half of the second year of life (Representational gestures emerge around the 25-word milestone and have been also labeled as iconic, symbolic, emptyhanded, referential; Acredolo & Goodwyn, 1988, Capirici et al., 1996; Nicoladis, Mayberry, & Genesee, 1999).

22 Gesture Assessment Observation of gesture production Parental diaries Parental questionnaires Naturalistic observation Data trackers: quantify/classify gesture (may be used in combination with parental diaries, questionnaires, and naturalistic observation)

23 CDI (Fenson et al., 1994)

24

25 Naturalistic Observation Videotaping of parent-child interaction. Variations can be introduced. Communication temptation tasks and procedures Communication and Symbolic Behavior Scales (CSBS; Wetherby & Prizant, 1993).

26 Gesture Use in Atypical Development Osterling & Dawson, 1994 Compared typically children with those later diagnosed with ASD Relative to TD children, children later diagnosed with ASD: Failed to orient to name more often Showed objects less often (DEICTIC GESTURE) Looked at the face of another less often Did not point (DEICTIC GESTURE) (Pointing deficits in ASD; See reviews by Charman, 1998; Goodhart & Baron-Cohen, 1993).

27 Motor Hand Use in Atypical Development Iverson & Wozniak, 2007 Examination of the vocalizations and rhythmic hand movements in younger infant of children with ASD. As a group, they demonstrated attenuated patterns of change in rhythmic arm activity around babble onset time. More likely to exhibit delayed onset of reduplicated babbling (and reductions in language development at 18 months).

28 Object Use in Atypical Development Ozonoff et al., month old infants (9 were subsequently diagnosed with ASD). Coded repetitive behaviors during play task (spinning, rotating, unusual visual exploration). Relative to two comparisons (children with typical development and general developmental delay), the ASD outcome group displayed significantly more atypical object exploration.

29 Object Use in Atypical Development Rogers et al., children (mean age 34 months) with Autism. Relative to two comparisons (children with typical development and general developmental disability), the children with autism were significantly more impaired in overall imitation abilities. Impaired motor imitation skills were strongly correlated with joint attention and ASD symptoms.

30 Literature Review Summary Intentional communication is first observed in children s production of gestures. Young children s gestures can be classified by type: Deictic, conventional, representational. Assessment of gesture may proceed using parent diaries, questionnaires, naturalistic observation, data trackers. Differences in rhythmic hand movement and object exploration may be related to ASD. Research suggests that early reductions in gesture use is characteristic of a later ASD diagnosis.

31 Research Phase I: Project Aim To determine how hand movement fits into the developmental picture given that motor hand acts relate to object exploration; and the gesture production is linked to language development.

32 Research Phase I: Questions 1. What types of hand movement characterize children with ASD when examined during social communication with another? 2. Does the proportional use of hand movement by category change between pre- and post-treatment measurements?

33 Research Phase I: Case Series Participants Five males with a medical diagnosis of ASD. Aged 2;5 3;7. English as the primary language. No known complicating factors (e.g., traumatic brain injury, or prior neurological disease or injury). Vision and hearing reported to be normal or near normal.

34 Research Phase I: Methods and Procedures All children with ASD completed pre- and posttreatment measurement. Pre- and post-treatment measurement consisted of a standardized language assessment (CSBS; Wetherby & Prizant, 1993). Following the CSBS pre-test, all children with ASD received DIR and ABA intervention 4x week over six weeks. After the completion of the intervention, the CSBS assessment was re-administered (post-test).

35 CSBS Motor hand acts and gestures produced in the CSBS Communication Temptations subtests were coded from videotape: 1. Wind-up toy 2. Balloon 3. Bubbles 4. Peek-a-boo 5. Walk Mouse, Creep Mouse 6. Blocks in a box 7. Jar 8. Toys in a bag

36 Coding 1) Motor hand acts were coded in 1 of 10 categories: Infantile rhythmic hand movement (IRM) Idiosyncratic hand movement (IDIO) Appropriate action on a object (AA) Inappropriate action on a object (IA) Rejecting protest motor hand act (REJ) Protection motor hand act (PRO) Reaction motor hand act (RE) Movement of another s body (MAB) Give motor act (GIV) Reach motor act (RCH)

37 Coding 2) Gestures were coded in 1 of 3 categories clearly directed towards the examiner. (DEICTIC, REPRESENTATIONAL, CONVENTIONAL) 3) Use of trained augmentative and alternative communication system was coded. (MANUAL SIGN or PECS)

38 Coding All vocalizations were coded: 1. With hand movement 2. Without hand movement

39 Research Phase I: Results What type of hand movement characterizes children with ASD when examined during social communication with another (given a standard communication temptation task and toy set)? Motor hand acts accounted for more than 85% of all hand movements. Few hand movements were coded as emptyhanded gestures (less than 15%).

40 Hand movements produced by children at relatively higher proportions at Time 1 by category Appropriate Action on object (AA) Infantile Rhythmic movements (IRM) Inappropriate Action on object (IA) Give (GVR) Idiosyncratic movements (IDIO) Rejection (REJ)

41 Proportional use of hand movements by category significantly changed between pre- and post-test measurements (each reaching statistical significance p<.008) Proportion Pre Post AA GVR IRM IA IDIO REJ

42 Research Phase I: Summary Why quantify and categorize motor hand movement from videotaped assessment? Offers diagnostic & prognostic value in both cognitive and language realms of development (i.e., motor imitation, play, gesture). Allows for a more sensitive measure of progress over intervention time. Provides clinician with more flexible, and individual assessment and treatment options.

43 Research Phase II: Gesture Data Tracker

44 Research Phase II: Questions Will speech-language clinicians and parents report similar patterns of children s motor hand movements? Will clinicians find the data tracker highly relevant to communication assessment, easy to use, and a potential guide for planning communication intervention?

45 Research Phase II: Methods Survey Respondents: parents (N=5) and speechlanguage clinicians (N=5). Child diagnoses included Autism Spectrum Disorder (ASD; N=2), Down Syndrome (DS; N=1) and Language Delay (LD; N=2). Expressive language level varied from vocalizations to multi-words. Each respondent observed child s interactions during play at an University Clinic, then completed the Gesture data tracker. Speech-language clinicians completed a survey regarding the use of the Gesture data tracker.

46 Research Phase II: Data Tracker The data tracker is made-up of 31 yes/no questions examining the presence or absence of motor hand movements in 5 areas: 1) sensorimotor hand movements (i.e., does the child repetitively bang an object against another surface?) 2) appropriate use of objects (i.e., does the child use an object in play for its intended use?) 3) communicative hand acts (i.e., does the child take another s hand as if to lead for communication?

47 Research Phase II: Data Tracker 4) adult-like gesture production (i.e., does the child point to an object to single it out to another person?) 5) idiosyncratic hand movements (i.e., does the child provide deep pressure with the hands to the face or body, as if to pinch or push?) (Additional items documented the frequency of selfinjurious, repetitive, and/sensory-driven hand movements; use of AAC system, and presence of vocalizations/verbalizations; motor notes, space for comments)

48 Research Phase 2: Agreement Results For questions in which both responded (N=120), interrater agreement between parents and clinicians for categorizing hand movements and gestures was moderately low. [# of agreements/# of agreements + # of disagreements] 89/ =.74 Agreement scores at.80 and above are considered acceptable.

49 Research Phase II: Clinician Survey How strongly do you agree or disagree with the following statements? Strongly agree Somewhat agree Neutral Somewhat disagree Disagree

50 1) I believe hand movement observations should be included in communication assessment for prelinguistic children. Strongly agree=4 Somewhat agree=1 Neutral Somewhat disagree Disagree

51 2) As I learn more about the value of children s hand movements, I would use the data tracker in my clinical practice with prelinguistic children. Strongly agree=4 Somewhat agree=1 Neutral Somewhat disagree Disagree

52 3) I found the listing of behaviors helpful in the observations of hand movements of prelinguistic children. Strongly agree=1 Somewhat agree=4 Neutral Somewhat disagree Disagree

53 4) I found the listing of vowels and consonants helpful in describing communication. Strongly agree=1 Somewhat agree=1 Neutral= 3 Somewhat disagree Disagree

54 6) This data tracker helps me visualize a developmental pattern in hand movements. Strongly agree=1 Somewhat agree=3 Neutral= 1 Somewhat disagree Disagree

55 5) It is easy to observe hand movements in real time. Strongly agree=1 Somewhat agree=2 Neutral Somewhat disagree=2 Disagree

56 7) This data tracker could assist in planning treatments that may engage children in hand movements plus vocalizations. Strongly agree=2 Somewhat agree=3 Neutral Somewhat disagree Disagree

57 8) This data tracker would be beneficial to document progress for treatment plans and IEPs of prelinguistic children. Strongly agree=2 Somewhat agree=3 Neutral Somewhat disagree Disagree

58 Research Phase II: Summary Why use a clinical data tracker in gesture measurement? More research is needed. Has potential to offer parents a reporting tool to quantify and categorize hand movements and gestures in their children. Has potential to offer speech-language clinicians an easy to use and accessible tool to examine children s complete communication profile.

59 Research Phase II: Summary Agreement between parents and clinicians was moderately low. Clinicians may not understand the value of reporting verbalization/vocalizations (and its link to motor hand and gesture co-productions). Clinicians do not endorse that hand movements are easy to observe in real time. Unclear if the data tracker assists clinicians in examining developmental pattern of motor hand acts and gesture.

60 Research Phase II: Implications Data tracker may not be as reliable in practice as counting frequency of behaviors from videotape. Clinicians generally do not have the time and resources to code hand movements and gestures from videotape. Combination of approaches may work best for busy clinicians. Improved tools for tracking and recording gestures in real time.

61 As we move to understand the complete communication profile in children with language delays and disorders, in this small sample, speech-language clinicians tend to agree that hand movements and gesture observations are valuable, and endorse their value in assessment and intervention.

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