Determining Effective Communication Through Motoric Analysis in Nonverbal Children With Autism Voula Constantarakos, MHSc.,CCC-SLP Marla Rolleri, MS, CCC-SLP Megan Weisbrode, MS, OTR/L November 17, 2006 2006, Constantarakos, Rolleri, Weisbrode 1
School For Children 270 Industrial Way West Eatontown, NJ A nonprofit specialized school for children with multiple disabilities and autism 2006, Constantarakos, Rolleri, Weisbrode 2
Seminar Agenda Observations prior to study Literature review Current study Subjects Method Results Conclusion Discussion Questions 2006, Constantarakos, Rolleri, Weisbrode 3
Why? 2006, Constantarakos, Rolleri, Weisbrode 4
Observations: Sign Language Required frequent visual, verbal and/or physical prompting to acquire and use sign language. Decreased accuracy of sign production. Frequently confused signs while requesting. Limited number of spontaneous communicative interactions. 2006, Constantarakos, Rolleri, Weisbrode 5
Observations: Picture Exchange Communication System (PECS) Required less visual, verbal and/or physical prompting to acquire and use PECS. Increase in the amount and frequency of items requested. Increase in number of spontaneous communicative interactions. 2006, Constantarakos, Rolleri, Weisbrode 6
Observations: Motor Planning Required visual, verbal and/or physical prompting to perform age appropriate fine motor and motor imitation activities. Demonstrated intricate fine motor skills within the context of a preferred activity and/or a repetitive stereotyped movement, but were unable to perform these skills upon request. 2006, Constantarakos, Rolleri, Weisbrode 7
Hypothesis PECS is a more effective mode of functional communication for nonverbal children with autism who exhibit motor planning and fine motor deficits. 2006, Constantarakos, Rolleri, Weisbrode 8
Current Evidence: Sign Language Sign language acquisition varies with children who have autism: Some acquire a large number of signs and produce phrases/sentences (Seal & Bonvillian, 1997). Others make only minimal progress, acquiring only two or three signs (Seal & Bonvillian, 1997; Layton & Watson s study [as cited in Mirenda, 2003]). 2006, Constantarakos, Rolleri, Weisbrode 9
Current Evidence: PECS A positive correlation exists between the use of PECS and speech development for children with autism under the age of 5. Bondy & Frost s study (as cited in Frost & Bondy, 2002). When PECS is the primary mode of communication, a decrease in aggressive behaviors is noted (Frea, 2001). Despite weak motor imitation skills, PECS is able to be used effectively (Tincani, 2004). 2006, Constantarakos, Rolleri, Weisbrode 10
Current Evidence: Motor Planning Children with autism often present with motor planning difficulties: Motor functioning difficulties constitute a major problem for many children with autism. Damasio & Maurer s study (as cited in Seal and Bonvillian, 1997). Problems experienced by individuals with autism include delayed initiation of motor actions, problems stopping or changing movements, difficulty combining motor acts and general difficulty with the execution of movement (Yack, Sutton, & Acquilla, 1998). 2006, Constantarakos, Rolleri, Weisbrode 11
Objectives of Study Determine the most effective mode of communication, sign language or PECS, for nonverbal children with autism. Consider the child s fine motor coordination and motor planning abilities when determining the most effective mode of communication for nonverbal children with autism. 2006, Constantarakos, Rolleri, Weisbrode 12
Subjects Prior to the study, all subjects demonstrated difficulty effectively communicating using sign language. Six nonverbal children diagnosed with autism spectrum disorders (ASD). Ages range from 3 to 9 years. All enrolled in self-contained classrooms for children with ASD. 2006, Constantarakos, Rolleri, Weisbrode 13
Subjects Exposure to Modes of Communication Prior to the study the subjects received: Formal sign language training Less than one year (3 subjects) More than one year (3 subjects) Formal PECS training: No training (2 subjects) Less than one year (2 subjects) More than one year (2 subjects) 2006, Constantarakos, Rolleri, Weisbrode 14
Method Occupational Therapy assessments: Peabody Developmental Motor Scales (PDMS) (Folio & Fewell, 1983) administered in a non-standardized manner (i.e., tactile and visual models provided for all tasks) to determine approximate fine motor age equivalents*. Clinical observations were conducted throughout assessment (utilizing fine motor and motor imitation tasks), determining upper extremity motor planning abilities*. 2006, Constantarakos, Rolleri, Weisbrode 15
Method Continued Speech-Language Assessments: Stimulus Preference Assessment conducted. Verbal Motor Production Assessment for Children (VMPAC) (Hayden & Square, 1999) administered by Speech-Language Pathologists. All students completed Phase I of PECS before initiation of baseline data collection. Baseline data collected over a ten day period in a quiet one-to-one environment. Five days for each mode of communication. Children were presented with preferred items during each session. 2006, Constantarakos, Rolleri, Weisbrode 16
Data Collection Date: Therapist: Sign Language/PECS Student: Items Requested Verbal Prompt Visual Prompt Physical Prompt Spontaneous Requests Total Requests 2006, Constantarakos, Rolleri, Weisbrode 17
Fine-motor and Apraxia Severity Rating Subjects Chronological Age (months) Fine-Motor Age Equivalent (months)* Limb Apraxia Severity* (mild to severe) Oral-Motor Apraxia Severity (mild to profound) S1 39 17 Severe Profound S2 40 22 Severe Profound S3 42 20 Severe Profound S4 49 21 Severe Profound S5 87 27 Severe Severe S6 105 42 Moderate Severe 2006, Constantarakos, Rolleri, Weisbrode 18
100 90 Oral-Motor Apraxia Scale Age 3 Hayden & Square, 1999 80 70 60 50 40 30 20 Mean 5 th Percentile Subject 3 10 0 2006, Constantarakos, Rolleri, Weisbrode 19
100 90 Oral-Motor Apraxia Scale Age 7-12 Hayden & Square, 1999 80 70 60 50 40 30 20 Mean 5 th Percentile Subject 6 10 0 2006, Constantarakos, Rolleri, Weisbrode 20
Raw data Sign Language vs. PECS 2500 2000 C o u n t 1500 1000 500 0 Verbal prompt Visual prompt Physical prompt Spontaneous requests Total Requests Sign Language PECS 2006, Constantarakos, Rolleri, Weisbrode 21
Results: Sign Language vs. PECS Raw data indicates: Subjects required more visual, verbal and physical prompts to use sign language when requesting preferred items. More spontaneous requests were noted when using PECS. Subjects made more total requests using sign language. 2006, Constantarakos, Rolleri, Weisbrode 22
Data Analysis of Spontaneous Requests Sign Language vs. PECS 800 Spontaneous requests (out of 1000 total requests) 600 400 200 0 Sign Language PECS 2006, Constantarakos, Rolleri, Weisbrode 23
Data Analysis using Box-Whisker Plots Amount of spontaneous requests, for PECS and sign language, were normalized out of 1000 for all subjects. The limited variance between subjects, within each mode of communication, demonstrates the conclusiveness of the results. The difference between data groupings indicates subjects produced significantly more spontaneous requests when PECS is the primary mode of communication. 2006, Constantarakos, Rolleri, Weisbrode 24
Conclusion Nonverbal children with autism who exhibit significant delays in fine motor coordination and moderate to profound motor planning deficits require frequent visual, verbal and physical prompts to produce sign language. This results in limited spontaneous requests. Therefore, these students benefit from PECS as a means to spontaneously generate functional communication. 2006, Constantarakos, Rolleri, Weisbrode 25
Discussion Approximately 50% of children diagnosed with autism will remain functionally nonverbal in adulthood. Peeters & Gillberg s study (as cited in Tincani, 2004). This statistic emphasizes the importance of establishing an effective mode of communication for nonverbal children with autism. Assessment of fine motor coordination and motor planning abilities are recommended when determining the most effective mode of communication for nonverbal children with autism. Assessment tool modifications and clinical observations are important components in the assessment process. 2006, Constantarakos, Rolleri, Weisbrode 26
Future Research Future research should include a more detailed description of subjects with autism (i.e., fine motor coordination, level of oral-motor and limb apraxia). It is imperative future research focus on the development of a comprehensive assessment tool that will assist in determining the most effective means of communication for nonverbal children with autism. 2006, Constantarakos, Rolleri, Weisbrode 27
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References Folio, M. & Fewell, R. (1983). Peabody developmental motor scales and activity cards. Austin, TX: PRO-ED. Inc. Frea, W.D., Arnold, C.L. & Vittimberga, G.L. (2001). A demonstration of the effects of augmentative communication on the extreme aggressive behavior of a child with autism within a integrated preschool setting. Journal of Positive Behavior Interventions, 3 (4), 194-198. Frost, L. & Bondy, A. (2002). The Picture Exchange Communication System (2nd ed.). PECS outcome transitioning to other modalities (pp. 301-308). Newark, DE: Pyramid Educational Products, Inc. Hayden, D. & Square. P. (1999). Verbal motor production assessment for children. : The Psychological Corporation. Mirenda, P. (July 2003). Clinical forum. Toward functional augmentative and alternative communication for students with autism: manual signs, graphic symbols, and voice output communication aids. Language, Speech, and Hearing Services in Schools, 34, 203-216. Mirenda, P. & Erickson, K.A. (2000). Augmentative Communication and Literacy. In A.M. Wetherby & B.M. Prizant (Eds.), Autism Spectrum Disorders: Vol.9. A transactional developmental perspective (pp. 333-367). Baltimore, MD: Paul H. Broones Publishing Co., Inc. Schuler, A.L. & Baldwin, M. (1981). Nonspeech communication and childhood autism. Language Speech Hearing Services in Schools, 12 (October), 246-257. Seal, S.C. & Bonvillian, J.D. (1997). Sign language and motor functioning in students with autistic disorder. Journal of Autism and Developmental Disorders, 27 (4), 437-466. 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. Yack, E., Sutton, S. & Aquilla, P. (1998). Building bridges through sensory integration. Willowdale, ON: Print 3, Syd and Ellen Lerer. 2006, Constantarakos, Rolleri, Weisbrode 29
Contact Information vconstantarakos@holmdelschools.org mrolleri@edcollabinc.org mweisbrode@edcollabinc.org 2006, Constantarakos, Rolleri, Weisbrode 30
Special Thanks To: Anestis Karasaridis, PhD For all of the technical support! 2006, Constantarakos, Rolleri, Weisbrode 31