Language Intervention in Autism: The Implications of Neurobiological Research

Language Intervention in Autism: The Implications of Neurobiological Research

Anne Bramlett, MS, CCC/SLP

Becky Hary, MS, CCC/SLP and Calli Liamis OT attended training along with eight other therapists

At Speech & Occupational Therapy of North Texas, we encourage our therapists to acquire specialized training for the populations we serve.  We recently provided a fantastic opportunity for continuing education credits.  Many of our therapists attended this great webinar regarding the implications of neurobiological research on language intervention for children on the autism spectrum.  Diane Williams, PhD, CCC/SLP, the presenter, is an associate professor in the Department of Speech-Language Pathology at Duquesne University in Pittsburgh, PA.   Dr. Miller has participated in- and reviewed – research on the neurological basis of developmental disorders and how this research can shape how we help children.

All of the speech language pathologists in attendance agreed that the information reinforced what they experienced working with children on the spectrum.  Many commented that they used the recommended strategies on a consistent basis.   In the presentation there were two basic assumptions gleaned from research about ASD:

• Individuals with ASD learn and act differently because their brains function differently.
• Environmental input can influence learning but may not change the underlying basic neurological differences.

Those of us who work with children on the spectrum would probably concur that these children’s brains function differently.  According to Dr. Williams, research re-confirms what has been hypothesized for many years: Individuals with ASD have abnormal connectivity within brain regions, even at the neuronal level.  This impacts synchronicity of perceiving and reacting to information.  The more complex the information, whether it is sensory, motor, memory, language, or concept formation, the more an individual with autism will struggle.  The struggle is relative to the degree of severity of autism an individual experiences.   Or should we say the level of struggle determines the level of severity.

When considering environmental modifications, research suggests that modifications can help learning but may not change the basic neurological differences.  This is likely true in many situations.  However, some families have found that diet, and other forms of treatment seem to change the wiring for some individuals on the spectrum.    The most important thing to understand is that there are modifications and strategies that can lead to greater learning and social engagement for individuals with autism.

 Factors that Contribute to Language Difficulty for Children on the Spectrum:

Language learning requires coordination across a number of processing centers (sensory, motor, memory, etc…)  Since these children have difficulty with connectivity between neurological centers, we must integrate comprehension and production with social and contextual cues.  This means presenting new information in the right environment with the right materials – based on the unique needs of the child.  So for learning the concept of fruit, you could be playing in a kitchen with a specific toy fruit or real fruit, constantly using the name of the fruit as the child manipulates it or eats it.  You would also use the printed word and a photo or drawing, depending on the needs of the child.  So narrow concept, repetition of the word, and appropriate activity for the concept.

Language learning in typically developing infants occurs through a combination of computational, cognitive, and social skills.  By computational skills, research is referring to the ability to discriminate what isolated sounds go with a specific object or movement.  This, along with the cognitive and social challenges found in ASD can be associated again with poor neural connectivity – receiving and producing the correct understanding of/ or response to information.  To facilitate the best learning, it will be critical to focus the child with ASD’s attentional resources on the faces, voices, objects and motions most important for connecting a word or action with a specific object or activity.  It would be important to reduce the cognitive processing load when teaching new information by limiting the visual and auditory stimulation in the environment.  This does not mean to teach only in isolation, but to have environments available that are distraction free when introducing new information.  Very quickly learning needs to be generalized into real life situations so that the child is able to practice across settings and internalize that words and actions are attached to all appropriate environments.  This is another reason why parent training is such an important part of a treatment program.  Families need to feel confident in carrying out real life communication and learning in typical environments.  For families in Mckinney, speech therapy is available at our Stonebridge location, located within an ABA clinic.

In typical language learning, children develop concepts and prototypes, in part through paying attention to voices, observing actions, and experiencing what happens in given situations.   A very simplistic explanation:  They figure out what goes together or how things work through focusing their senses.   Again, we can see how this is compromised for children with autism due to weakness in neurological connectivity.   They have difficulty with focus in part because of limited skill in attending to faces and voices.  We have to make new or important information very salient so that children on the spectrum will develop these important concepts or prototypes.  A good example from the training was teaching the prototype of a cat.  We take for granted that once we see one cat and learn that label, we will know that a cat of a different color is still a cat.  This is not necessarily so for individuals with autism.  Temple Grandin shared the example of finally learning that cats and dogs where different by focusing in on the differences in their noses.  It was difficult to get the big picture.

I sometimes visualize a child with autism seeing a high interest picture in their mind, but not being able to “capture” the sounds of the associated word long enough to get the association into their working memory.  So they have some great pictures with no relevant language.  For families in Frisco, occupational Therapy is available at our Frisco clinic.

Recommendations for Therapy and Home activities

Teach Attending to Speech by:

• Reducing competing auditory information as much as possible so that the human voice can be the obvious point of attention
• Clearly pair language with what the words are in reference to

Making Connections

• Make sure the child is attending to or handling the named object
• Try to insure that the child is not focusing on just one aspect of the object ( in other words, decides that an orange means round because of the shape, so that they then think a ball is represented by the word “orange”)

Adapt Environmental Input

• Provide visual input since many children with autism have extreme difficulty with attaching meaning to spoken language. This is because verbal language is transient and may not allow enough processing time for the connection to make it to working memory.
• Simplify the environment so there is less information competing for cognitive attention.
• Reduce the amount of language so the child doesn’t have to separate it from the spoken language stream. Start out with “car” then “fast car”, and move towards “the car is going fast”.  Pair with visuals and activities, such as playing with a car.

More Evidence Based Practices

• Slow the rate of speech
• Use emphatic stress
• Use over-repetition of associations between spoken words and referents
• Focus on a small number of vocabulary words relevant to the child, first presented in a single context and then across several contexts

These are just my summary comments of this informative presentation.  Since I am also the mother of an adult with autism, I found the information really described my son’s cognitive and sensory functioning with great accuracy.

The research-based recommendations from the presentation were very encouraging since these are all strategies that we currently use in our clinics.  It is always good to get a refresher on neurological findings. More autism research is occurring now than ever before due to the increase  in ASD and the strong advocacy within the autism community.   Together we can improve the quality of life for our clients and family members on the spectrum.  If you would like to find out how we can help your child, please contact us at 972-424-0148.  We provide speech therapy at Frisco, McKinney, and Plano locations. We also provide occupational Therapy in Plano, Frisco, and McKinney.