A Comprehensive List of Autism Therapies (Part Two of Three)

Orton – Gillingham Approach – uses “multi-sensory” methodology – “triple enforced” learning means that students may use visualizations/mental imagery, written, and spoken modalities – highly structured, systematic and hierarchical – has been around since the 1930s – primarily for dyslexia, though claims to help various language disorders, including autism – when used as intended, it is intensive and expensive – research generally positive, though some contradictory

Pivotal Response Training (PRT) – pivotal is another word for crucial, and includes general areas, such as motivation, social initiation, and understanding rather than specific behaviors – derived from ABA, but is more child initiated, play based, and does not focus on specific behaviors – part of Early Start Denver Model approach – research seems generally positive but limited

The PLAY Project – (Play and Language for Autistic Youngsters) – uses DIR/Floortime model – focus is on teaching parents to become interventionists using strategies of DIR/Floortime, such as following child’s lead – intensive and expensive, but perhaps a little less so than most other approaches – research limited, but generally positive

PECS (Picture Exchange Communication System) – approach most effective for establishing communication motivation and initiation – children are taught to use basic pictures to request objects and basic needs – the official approach, taught by the Pyramid Educational Consultants, is, wait for it…intensive and costly, although probably not as much as many other methods – research generally positive, though mainly for short term use and in single settings – difficult to implement, as at least early on requires multiple caregivers

Rapid Prompting Method (RPM) – the main provider of this is called HALO, which labels their method Soma-RPM, developed by a mother (named Soma) with an autistic son – uses stimuli such as rapid speech and paper tearing to supposedly match the preferred modality of the autistic individual – appears to at least sometimes use facilitated communication to “encourage” communication via pointing – has received media attention from PBS, HBO, and CBS – not backed by any good research, and the long debunked methods of facilitated communication have had multiple tragic results

Relationship Development Intervention (RDI) – developed by Dr, Steven Gutstein – intensive training program, primarily for in home use, intended to gradually strengthen social connections – has multiple catch phrases, such as dynamic intelligence, emotional referencing, flexible thinking, relational information processing, etc. – the RDIconnect company trains certified consultants, who then train parents their specific strategies – potentially expensive, and independent research almost nonexistent

Relational Frame Theory (RFT) – extremely confusing theory of language , using operant conditioning principles and loads of jargon – I haven’t heard of anybody actually using this to treat language disorders, but there is tons of information on the internet from its adherents as if RFT is the greatest thing since sliced bread, and that it can treat everything from stress to autism

Reciprocal Imitation Therapy (RIT) – Dr. Brooke Ingersoll – uses principles of ABA and pivotal response training to specifically address imitation and play abilities – involves parallel play and ties imitation into social reasons for imitating – starts by adult imitating, and providing opportunity for child then to imitate – spends more time selecting things with intrinsic interest than traditional ABA like therapy – seems possibly helpful for specific groups – research very limited at this point

TEACCH – Treatment and Education of Autistic and Communication related handicapped Children – school based program developed state-wide in North Carolina, and sometimes used elsewhere – prototype TEACCH model places several children in small self-contained classes, usually with one teacher and one aide – intended to provide autistic individual with structure and organization, with such things as physical boundaries, routines, visually based cues, etc. – sometimes used along with other strategies – some research suggests it may be beneficial, but as usual, almost all research has not been independently verified – also, research results seem to be largely dependent upon skills and experience of staff

Stem Cell Therapy – intended to address possible immunologic based inflammatory conditions that are thought to contribute to autism – treatments involve IV injections of a child’s own banked cord blood – research has yet to link autism and neuroinflammation, let alone demonstrate that this particular treatment works – this may show promise many years in the future, but at this stage it is extremely experimental

Son-Rise – similar to DIRFloortime and RDI in that parents become therapists and engage at child’s level of interest – opposes itself to behavioral therapies, such as ABA – attempts to build relationships between autistic child and caregivers – very time consuming (requires home volunteers or at least one stay at home parent) and very expensive – program may not always be implemented in the same way every time, which impedes research – reliable research very limited, but there seems to be some positive anecdotal evidence (although that can be said for just about all of these programs)

Visual Therapy – addresses areas of focus and concentration, among others – sometimes claimed to help general learning problems or other areas, such as ADHD – various approaches addressing visual deficits in autism go by monikers such as visual therapy, vision training, developmental optometry, and visual management training – these address eye tracking, aim, depth perception, visual perception – multiple groups have condemned behavioral vision therapy as scientifically unproven, including the American Academy of Pediatrics, and U.K. College of Optometrists

Sensory Integration Therapy – used to treat Sensory Processing Disorder, and often used in addressing sensory issues common in autism – these sensory issues include hypersensitivity, and sometimes hyposensitivity, to light, sound, and touch – Sensory Integration Therapy is usually done by occupational therapists, and includes activities such as deep pressure, bouncing, swinging, and systematic desensitization – very popular, with adherents espousing several studies that support it – unfortunately, there seem to be more studies showing mixed or no benefits

SCERTS – stands for Social Communication, Emotional Regulation, and Transactional Support – Practitioners following the SCERTS model use a combination of techniques and strategies, many borrowed from other interventions, in order to meet the specific needs of the individual child – more child directed than ABA approaches, and so implements aspects such as following child’s lead, manipulating the environment, and communication temptations – emphasizes social-pragmatic language therapy – parents and professionals are trained to implement strategies as a team approach – independent research and reviews are extremely rare

Social Stories Therapy – can refer to these generally, or Carol Gray’s extensive program with tons of books and materials for sale – social stories provide an individual with information about those situations that he may find difficult or confusing – various situations are described in detail with the goal of the stories to increase the individual’s understanding of, make him more comfortable in, and possibly suggest some appropriate responses for the situation in question. – while the term “Social Stories” is actually trademarked, and refers to a specific program, many of these created by professionals and caregivers are offered free or for lower cost on the Internet and within applications for technology devices – these all seem to be useful as a tool for specific behaviors that can be used in addition to other strategies for other skills and behaviors

Ziggurat Model – uses checklists filled out by team members to determine underlying deficits of child with autism – team members are supposed to work on needs as determined by levels, starting with sensory and biological needs, then reinforcement, then structure and visual supports, then task demands, then skills to teach – seems complicated and jargon laden, with many new acronyms to learn – no apparent independent research or reviews

One I forgot earlier:

Cognitive-Behavioral Therapy (CBT) – psychotherapy approach that addresses how people think and feel, trying to eliminated negative thoughts and feelings – used for various pyschological disorders, but research suggests CBT may be very effective, especially in helping treat specific behavioral aspects of high functioning autism

In summary; looking at the various autism therapies in this way can accomplish some things: one major similarity between all of these therapies becomes evident (besides their high cost). They all are intensive. In fact they often rely on this intensity, which tells us that intensity is crucial. Also, one can’t help but to feel that the time involved in relying on any one program, must preclude one from learning about what other programs have to offer. The evidence suggests that at this point no one approach is more effective than the others, and that the most effective intervention is likely one in which strategies and techniques overlap.

It is my conviction that any of these programs would be best utilized as adjunct or complementary therapies. Not only do these methods tend to take a lot of time at a lot of cost, they sometimes tend to essentially over-simplify more complex disorders. There is no short cut to simply treating the deficit. Ultimately, there is nothing better than having a comprehensive evaluation designed to identify deficits, and then working on the deficits themselves one by one. Various programs can be effective in supplementing this, but skepticism is warranted when someone advocates one method at the exclusion of all others, or the ignorance of treating complex sets of disorders.

One more part remains in this multi-part look at autism/language interventions: I will look at various specific techniques and strategies, many of which come from the specific autism programs that I’ve already looked at, and many of which don’t.

A Comprehensive List of Autism Therapies (Part One of Three)

I’ve been meaning to do this post for years.  A while back I started a list of short summaries of all the autism treatments I’ve heard of, which just kept growing as I kept hearing of more.  My purpose was, and is, to provide some listing for parents and professionals to get a general, but comprehensive, idea of what’s out there.  What started as a simple endeavor, however, has blossomed into a huge amount of information much too big for one sitting.  My more in-depth research for the following approaches honestly depressed me.  Most of us know that there are a lot of snake oil salesmen on the autism gravy train, but it is just extremely difficult parsing through the scads of information (including the piles of dubious and/or refuted claims) not just with these combined, but even with each individual approach.  To make this as comprehensive as possible, I’ve included any therapy, including those designed more for reading or language,  whose proponents claim the therapy to be beneficial for people with autism.

My first part of this three part post will alphabetically cover approximately half of the most commonly used autism treatment programs.  My second part will cover the second half, along with my general opinion on these approaches.  In part three, I intend to provide a comprehensive list of the specific language interventions, or techniques, found throughout these programs – as well as many additional ones not found in any them, despite their effectiveness with language intervention.  At that time I also intend to provide all parts combined in a handy PDF file, for convenient reference.  So, here goes…

Applied Behavior Analysis (ABA) – uses methods of behaviorism, such as classical conditioning, rewards and punishments – intensive – popularly used with autism, but is designed for any severe language disability – there are different ABA based interventions, such as Lovaas Method, and Early Start Denver Model – extensively researched, generally positive, but not conclusive, and seems more effective with certain subgroups – has reputations for both being successful and for creating “robotic,” emotionless children

Applied Verbal Behavior (AVB) – a form of ABA that uses principles of behaviorism focusing on teaching the child to realize that language can get him what he wants – uses terms directly from B.F. Skinner, such as mands and tacts

Animal Therapy – mainly includes dog therapy or horse therapy (so far) – It seems that dogs can be helpful in creating some motivation for socialization. However, the type of dog, the incredible cost for a trained dog, and the lack of research should all be considered. – Horse Therapy, AKA Equine Therapy, seems to be gaining in popularity especially in autism – appears to be beneficial, but, as with many of these therapies, should not ignore directly addressing specific communication disorders that involve disabled people communicating with other people

Auditory Integration Therapy (AIT) – popular ones are the Tomatis and Berard methods – aims to reduce hypersensitivities to sound through systematic desensitization process using music – the use of AIT to treat all sorts of cognitive ailments, from communication disorders to ADHD to preparation for childbirth has continued despite organizations such as the American Speech Language Pathology Association (ASHA) issuing position statements against it – may be mildly helpful, but these practitioners have a history of making huge claims that are unsupported

Biomedical Treatments – there are many of these, too many for me to adequately cover in a short synopsis – a good short review of the research can be found in this link – these include vitamins B6 and C, melatonin, amino acids, folic acids, antifungal agents, gastrointestinal medications, hyperbaric oxygen chambers, immune therapies, chelatin, and more – to this point, for these “alternative” therapies, the jury is way out on any of them that may consistently work for large groups of people with autism

CogMed – commercial software specifically designed to treat working memory in ADHD and other cognitive deficits – 25 sessions cost approximately $2,000 – there seem to be some benefits, but more research needed – gains may be short term and not generalizable to deficits outside of working, or short term, memory

DAN! (Defeat Autism Now) – created by Autism Research Institute, which owns the http://www.autism.com domain, so often first place people happen upon for information – DAN! as a program label has been discontinued, but the ARI seems to still be promoting its foundations that autism as a biomedical disorder should be treated primarily as a combination of lowered immune response, external toxins from vaccines and other sources, and problems caused by certain foods – DAN! and ARI have been the subject of much controversy, but has been extremely influential for many years – advocates ABA, and Theory of Mind, but with no specific language therapy

DIR/ Floor Time – by Dr. Stanley Greenspan – DIR stands for Developmental, Individual-Difference, Relationship-Based – it includes following the child’s lead, and using things that already interest the child. It assumes six milestones of typical emotional and communicative development and attempts, through intensive play and interaction, to guide children through each of these stages – has some very good parts, but the program itself can be grueling and expensive

Elimination diets (casein/gluten free diets) – The current thinking is that there is at least some evidence showing that a casein-free diet, when combined with a gluten-free diet, can help improve the behavior of some children with autism. Although the casein-free diet combined with a gluten-free diet is popular, there is little evidence in the current scientific literature to support or refute this intervention. Scientists have concluded that there are currently not enough published studies to draw a meaningful conclusion. Strong caution should be taken when modifying diets of autistic children, who are often finicky eaters anyway, to ensure that they are getting adequate nutrition.

Fast ForWord – Educational software produced by the Scientific Learning Corporation, with emphasis on phonological awareness. Suggested to help auditory comprehension, memory, attention, and other cognitive skills, as well as reading. Expensive and time consuming. Has been extensively researched, with debatable (and often debated) results

Hanen Program – includes other regimented programs, such as “More Than Words,” and “It Takes Two to Talk” – designed for younger kids, and attempts to intensively involve parents – Speech-language pathologists attend workshops to learn to train parents to learn to become interventionists – expensive and intensive -includes strategies for modeling, expansion, extension, following child’s lead, etc.

Interactive Metronome – according to their site – used by SLPs (among many other groups) for TBI, autism, ADD, Sensory Integration Disorder (and many other etiologies) for things such as focus, coordination, tuning out distractions, and many more – research seems sketchy, and perhaps unethical

Jungle Memory – Dr. Tracy Alloway – computer software for working memory in older kids – progressively difficult games, similar to CogMed – again, research limited, but suggests that gains are short term and not as generalizable as adherents indicate

Language Experiences – also LEA, or learning experience approach – has been used for decades with various populations and disorders, such as hearing impaired, English language learners, reading disorders and poverty – attempts to use student’s own vocabulary, backgrounds, and specific language patterns to create reading texts specific to that child – as usual with these approaches, results seem generally positive, but mixed

Lindamood-Bell (LiPS (Lindamood Phonemic Sequencing)) – this company also has other programs, such as Seeing Stars and Visualizing and Verbalizing for Language Comprehension and Thinking – often is extremely expensive – has been popular since 1986, mainly for phonemic awareness, oral motor coordination, and overall multi-sensory, though it has branched out into comprehension, math, and more – though it has many advocates, it also seems to have very incomplete research – according to this article, of 31 studies that had been submitted by LMB to the What Works Clearinghouse (WWC) division of the U.S. Department of Education Institution of Education Sciences, only one was approved for review

Music Therapy – may be also known as neurological music therapy – some supportive research exists – seems great as an adjunct, but not to shift focus from treating specific language deficits (As an analogy: It can be imagined that research would suggest that “music therapy” could be effective in helping depression. It could cheer a client up after all. But it would obviously not be best practices for somebody to primarily use music therapy to treat depression rather than treating the more complex (and more difficult to treat) root psychological and life situations.)

Magnetic Resonance Therapy (MRT) – seems to use primarily Transcranial Magnetic Stimulation (TMS, of course), along with other forms of neuro-feedback – TMS is a cutting edge modality, which may offer some hope for treating depression, migraines, and some other brain based disorders (and it is very useful in areas such as the study of language and the brain) – research on its effectiveness with autism is extremely limited, and still in very early experimental stages – appears to be very expensive and with dubious effectiveness

Narrative Based Language Intervention (NBLI) – hybrid language intervention approach that combines naturalistic activities such as storytelling with skill-based activities to address language and communication goals – research seems positive, but mainly for older kids

Stuttering’s “Monster Study”

The twentieth century saw a slew of research studies that gained notoriety as much for the ethical boundaries they pushed as well as the psychological insights that were gained.  The attention garnered by these studies, which included the Stanford prison experiment, Stanley Milgram’s shock experiment, and John Watson’s “Little Albert,” helped highlight the need to create ethical standards and reviews in research.  The “Monster Study” was different, though.  It’s lessons went long swept under the rug.

"Little Albert's" Monster

“Little Albert’s” Monster

In 1939, Wendell Johnson, who is now the namesake of the University of Iowa’s eminent Speech and Hearing Center, together with one of his graduate students, Mary Tudor, undertook an experiment to gain more information into the behavioral nature of stuttering. Specifically, Johnson sought to question the prevailing theory that stuttering’s cause was entirely genetic, and therefore, little could be done to therapeutically help stutterers.  While Johnson’s ultimate goal may have been noble, his methods and subsequent cover-up led to this one, out of all of the era’s questionable studies, as the one that was dubbed the “Monster Study.”

Tudor was sent to an orphan’s home to pick subjects to test Johnson’s view that stuttering develops when speakers are criticized for normal mistakes.  Johnson, himself a stutterer, ultimately developed the diagnosogenic theory of stuttering, despite later hiding the research used to support this view that the diagnosis causes the disease.  Out of 22 test subjects, half (five previously identified stutterers, and six identified as having normal speech) were given sessions every few weeks in which they were criticized harshly for every mistake, and during which Tudor tried to convince them that they were stutterers.  Tudor also instructed teachers to be critical of the speaking of this group of children.  The other half were generally complimented on their speech.  The experiment lasted for nearly five months.  While the exact effects were disputed, the fact that these kids were harmed is very clear.  Tudor attempted three follow-ups, and in later correspondence to Johnson she expressed remorse for not being able to reverse the study’s earlier “deleterious effects.”

httpclas.uiowa.educomsciabout

Johnson’s Namesake at the University of Iowa

And so for decades, few outside of the participants, and Johnson’s colleagues at Iowa, knew about the study.  Meanwhile, the department named after Johnson grew into one of the more prestigious institutions of Speech-Language Pathology in the world.  Then, a 2001 story in the San Jose Mercury News brought what had been local whispers of a “Monster Study” into the national limelight.  The story was re-published in newspapers across America, immediately igniting a firestorm of controversy.  It also spawned litigation, ultimately leading to nearly million dollar settlements for 3 still living subjects, and for the descendants of three others.

Unfortunately lost in the details was Johnson’s big question.  Can you create a stutterer?  The results of Tudor and Johnson were themselves mixed.  According to their own ratings of the previously non-stuttering children, two kids from the normal group developed more stuttering, but two didn’t, and two others were even marked as improved.  While its effects on stuttering were ambivalent, the experiment clearly did have other negative consequences for its participants.  There were admitted increases across multiple areas of behavior, such as increased shyness, tics, anxiety, inhibition, and self-esteem.

Most insidious, perhaps, was the results of Johnson’s own actions.  Not only did he fail to publish results which were, at the best, ambivalent toward his hypothesis, he continued promoting his view that caregivers are almost solely responsible for stuttering.  Directly due to the diagnosogenic theory, therapy was greatly reduced for decades of stutters.  In its place, therapists worked almost exclusively with parents.  While we still don’t know exactly what causes stuttering, the research has clearly indicated a strong genetic component which can be triggered or exacerbated by events in the environment.  And critically, direct therapy can, and often does, help.

This fantastic story in The New York Times has many more details.  This article describes some more recent developments.

Piaget’s Constructivism

As a pioneering psychologist in the merging studies of cognition and learning, Jean Piaget helped change the common assumption that as thinkers, children are merely less complex versions of adults.  His twentieth century work built upon the classical roots of Socrates, and more recent work of Lev Vygotsky, Jerome Bruner, and others who believed learning to be a process facilitated, rather than caused, by teachers.  At the forefront of constructivist assumptions are the notions that the most effective learning takes place when learners are active and motivated participants in the process.

Visual of assimilation - accommodation cabinet

Visual of assimilation – accommodation cabinet

While constructivism as a system has been criticized as being too subjective and difficult to manage, as with so many complex systems it has several components that stand out as applicable outside of the larger theory as a whole.  The notions of assimilation and accommodation are two of my favorites.  Assimilation occurs when a learner adds new information, basically layering it on top of the old.  Accommodation occurs when a learner must change previously learned information before placement of new information is possible.  Assimilation is like placing files in a file cabinet, while accommodation is like needing to add new folders, or rearrange existing ones.  Because of this, learning is said to get more difficult as we age, with the tendency of older people to get what has been deemed, “hardening of the categories.”

Piaget and the constructivists also coined all kinds of terms, such as schema and equilibrium, not to mention those associated with the famed stages of development, such as the sensorimotor, concrete operational, and preoperational stages.  Piaget’s ballyhooed notion of object permanence (the understanding that an object exists even when out of sight) has been extensively studied and debated.

As with seemingly all mind related theories, the popularity of constructivism has followed the pendulum of favorability.  There are many specific aspects of constructivism, though, that should stand the test of time.  Some additional good information can be found hereThis, also is kind of cool.

Study Asks “Why do SLPs Select Specific SLI Tests?”

lshss april 2013

A study of survey responses regarding Specific Language Impairment testing was discussed in the April (2013) Language, Speech, and Hearing Services in Schools.  The authors basically found out what tests SLPs were giving and compared those to test characteristics, such as validity, reliability, etc.  They generally found that characteristics such as the inclusion of multiple facets, and testing time seemed to be more important in test selection, than characteristics such as reliability, accuracy, and validity.  SLPs also like to give single word vocabulary tests.  The synopsis is at this link.

A Few Facts About…Second Language Acquisition

There are many different terms and abbreviations used in discussing the topic of second language acquisition.   Just some of these include second language learning, L2 acquisition, ELL (English language learners), and ESL (English as a Second Language).  ESL and ELL are sometimes used interchangeably, and sometimes argued to be completely different things.  ESL seems to be an older term that, depending upon the source, is either being phased out, or is continuing to be used to distinguish a specific pull-out program, as opposed to somebody in the general education environment who happens to not speak English.  Some claim that ELL is more politically and technically correct, since English could be a third or fourth language.  In all my years I’ve never experienced any language issues with a student learning English as a third or fourth language, but I suppose it is technically possible.  Also, use of these terms seems to be different in different places.  There is a good little description of ESL and ELL issues in this link.

One of the preeminent researchers in second language acquisition is Stephen Krashen.  According to Krashen, learning is less important than acquisition.  His theory includes five main hypotheses, which he’s labeled the Acquisition-Learning hypothesis, the Monitor hypothesis, the Natural Order hypothesis, the Input hypothesis, and the Affective Filter hypothesis.  His Affective Filter hypothesis embodies one of his main views that  a number of affective variables play a facilitative, but non- causal, role in second language acquisition.  These variables include: motivation, self – confidence, and anxiety.  You can find a lot of his stuff at his site.

Sphere Flags Clip Art

Second language acquisition presents some interesting challenges for those who teach language.  In school settings, speech-language pathologists are supposed to only work with students with disabilities.  For students whose primary language then is something other than English, this means that a language disability should exist in that student’s first language in order to qualify for services.  Theoretically and legally, the disability should have nothing to do with the fact that the student has learned another language prior to English.  In the real world, it gets complicated.  Some kids do all right with their first language in preschool, and then face problems as parents may attempt to use more English at home.  Maybe one parent speaks more English.  Aunts, uncles, grandparents, friends, etc. all bring their own language preferences and abilities to the mix.  Then there are things like code-switching, the switching between languages in a conversation or with different conversation partners.  Commonly, these kids also display a silent period, in which they are so focused on comprehension that they don’t speak much.  Also, there can be language loss of the first language if it is not continuously reinforced.  There have been controversies over the extent to which academics should be taught in one language over the other, as well as the extent to which English must be learned, and who is responsible.  I think most experts agree that bilingualism is an awesome attribute.  More info can be had here.

As an interesting aside, this recent study suggested that second language learners may have an advantage in learning to read compared to native language speakers.  The study’s authors suggested that this may be due to an increased awareness in language overall – metalinguistic awareness.

Study Questions Ritalin’s Impact on Academics

This large, long study found that children had worse academic outcomes after being treated with Ritalin, a common medication used in the treatment of ADHD.  A 1997 policy reform in Quebec expanded coverage and use of Ritalin, providing ideal conditions to study its use relative to the rest of Canada.  Generally, there were little overall improvements in short term outcomes, and worsened long term outcomes, highlighted by increased incidents of repeating grades, lower standardized math scores, and more school dropouts.

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One especially interesting consequence of increased ritalin use was a large reported increase in unhappiness, especially among girls.  The study authors hypothesized that increased Ritalin use, while decreasing adverse behaviors, also decreased attention these students received from teachers.  They surmised that use of these medications may be a substitute for more beneficial learning interventions.

A study summary from The Atlantic can be found here:  http://www.theatlantic.com/health/archive/2013/06/study-ritalin-doesnt-help-academics/276894/

A link to the full study can be found here:  http://www.nber.org/papers/w19105.pdf

SLP in Kenya Finding New Meaning in Work

This story from Advance is really cool.  Christopher Merkley, a Speech-Language Pathologist,  became known as the  only “speaking specialist” in a large area of Africa.  People would come from far and wide to see him, and because of widespread cultural feelings, such that disabled people are possessed by evil spirits, he had to get permission from village elders for therapy.  He gives other details, including descriptions of a lack of electricity in their clinic, very few supplies, and a local thirst for knowledge that can help those of us in far different settings to give our vocation some much needed perspective.  Here’s the link:  http://speech-language-pathology-audiology.advanceweb.com/Features/Articles/Speaking-Specialist.aspx

The DSM-V is Out! So What?

On May 17th, the American Psychiatric Association announced the release of the fifth edition of the Diagnostic and Statistical Manual, the first major revision in almost 20 years to this, the “bible” of modern psychiatry.

Some of the changes:  Initial diagnoses of what was Asperger’s Syndrome will now be made under the larger umbrella of Autism Spectrum Disorder.  Note that this will only apply to people being evaluated for the first time.  Also, it does not mean that Asperger’s as a descriptor will necessarily go away; it will only be eliminated as a DSM-V diagnostic category.

There will be a new diagnostic category, called Social Communication Disorder.  Dr. Amy Weatherby is the first speech-language pathologist to serve on the DSM-5 board and helped to craft the language of this newly defined category. It highlights those with social communication/social pragmatic challenges who do not exhibit the more “restricted, repetitive patterns of behavior, interests, or activities” which has been one of the diagnostic hallmarks of ASD.  Here’s the official criteria:

A. Social Communication Disorder (SCD) is an impairment of pragmatics and is diagnosed based on difficulty in the social uses of verbal and nonverbal communication in naturalistic contexts, which affects the development of social relationships and discourse comprehension and cannot be explained by low abilities in the domains of word structure and grammar or general cognitive ability.

B. The low social communication abilities result in functional limitations in effective communication, social participation, academic achievement, or occupational performance, alone or in any combination.

C. Rule out Autism Spectrum Disorder (ASD). Autism Spectrum Disorder by definition encompasses pragmatic communication problems, but also includes restricted, repetitive patterns of behavior, interests or activities as part of the autism spectrum. Therefore, ASD needs to be ruled out for SCD to be diagnosed.

D. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities).

My initial reaction is that the criteria seems extremely subjective.  I can see many, many children who are socially awkward, or have behavior issues being diagnosed with this.  If a diagnostician can’t go into the home for a meaningful period of time (and they can’t), how does one effectively differentiate between social language issues which are the result of some interpersonal family issues, and an actual disorder?  How does one effectively determine that social issues are the result of what a child can’t do, versus what a child doesn’t want to do?  And even if a child isn’t able to effectively use social language, is it always because of a disorder, or is there an environmental component as well?

Practical ASL Cell Phone Closer to Reality

Engineers at the University of Washington are nearing completion of cell phone software that can work effectively without hogging as much bandwidth as typical video-conferencing.  This story from ScienceDaily reports that a field trial is nearing completion, with generally positive results.  The new software specifically optimizes video quality around the face and hands, which makes use of sign language on cell phones more practical for potentially, more people.

Recently in the News…

language news picture

Study Probes Connection Between Texting and Language ImpairmentThis study, from these people, at the University of Manchester, finds that teens with language impairment (or SLI, to be specific), don’t use texting technology as much as their typically developing peers.  The study authors surmised that this relative lack of texting is caused more by societal factors, such as shyness, and lack of friendship networks, rather than lack of ability.

Doctors and Sreenings – Good; Doctors and Referrals – Not so Good – A report spearheaded by John Hopkins Children’s Center shows that while pediatricians may be doing a good job of screening kids, referrals for further assessment often go unheeded.  The study recommended that instead of placing referrals in the hands of parents, these referrals should be directly placed to specialists.  My information comes from this this link from Science Daily.

Study Challenges Current Thinking on Language Evolution – Again from Science Daily:  According to a statistical analysis of more than 2,000 of the world’s languages, they may evolve more like biological organisms, and less from more random forces, as previously thought.  The bullet synopsis is that the more people speak a language, the simpler the language becomes.  The researchers called this the “Linguistic Niche Hypothesis.”  One possible explanation for this is that simplicity holds an evolutionary advantage over complexity, particularly when children learn languages.  It should be noted that simpler languages are not necessarily inferior languages.  They just do not have aspects which aren’t as necessary, such as elaborate gender marking, for example.  Pschologists from the Universities of Pennsylvania and Memphis conducted this analysis.  More info can be found at this Penn site.

Children Make up Their Own Rules To Help Them Learn Language – This study used computer analysis to theorize that early language development follows formulas that children generate on their own, rather than specific rules governing such things as nouns and verbs, as linguists have traditionally thought.  Or as I’ve simply put it, in language development, Form Follows Function.  Leading this work was Colin Bannard, at the University of Texas, and Elena Lieven and Michael Tomasello, two colleagues working at the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany.  The more in-depth article can be found at the University of Texas site.

Cognitive Referencing

Cognitive referencing is the practice of using IQ scores to establish eligibility for special education services, specifically in areas of language and learning disabilities.  It’s often called by it’s gentler label, the “discrepancy model.”   Many others disapprovingly call it the “wait to fail” model.  Cognitive referencing has been denounced by groups such as the American Speech-Language-Hearing Association (link), the President’s Commission on Excellence in Special Education, 2002, and very explicitly, by the U.S. Department of Education (link, pg. 31).  It has been eliminated in many states, but persists in many others.  Even those who don’t come right out and denounce this practice (as they should), state that it should be only one component of a larger process used to determine eligibility  (e.g. this CEC link).  The problem is that wherever it is used, the IQ-Academic discrepancy becomes the sole method of determining eligibility in nearly all cases.  In my state of Missouri, our state law very specifically mandates this discrepancy, unless a school district is willing to go through much expense and work to use other methods, such as RTI.  My guess is that 99% of kids tested for LD and Language Impairment in our state use only IQ comparison to determine eligibility.

Despite its prevalence, cognitive referencing is wrong on many levels.

  • It uses a single IQ score, ignoring standard deviation.  A kid that scores 80, may actually have a “true” IQ of something like 85 or 90, but could have performed poorly on that one day, for various reasons.  Tough luck for that kid.  An IQ score of 80 usually means that your academic or language scores have to be 58 or lower, an extremely difficult thing to do.
  • By even using IQ at all, the assumption is that this is as good as a kid can get.  That was the initial rational for the discrepancy model way back before we knew better.  Now we know that IQ can go up (or down) in relationship to environmental factors.  (When IQ scores of large groups of children are studied, IQ scores do tend to remain stable, especially in older children.  However, this skews the fact that a smaller percentage of children do show substantial IQ fluctuations over time.  For more on this interesting topic, see Sigelman and Rider, 2008.)
  • IQ and language are correlated.  Vocabulary and IQ especially correlate well.  This means that children with low language scores tend to have comparably low IQ scores.  It is virtually impossible to obtain a low IQ score and say that language difficulties didn’t have something to do with that score.
  • Kids with certain scores are especially difficult to qualify for special education under this model.  Whenever a child scores in the 70s you can just about rest assured that the kid will not qualify, and you will be testing that kid again, perversely hoping that the academic and/or language scores have fallen enough to qualify the next time.  In effect a child is punished for having an IQ score that just happens to be in that one certain range.
  • IQ scores can set artificially low levels of expectation for kids, teachers, and parents.  IQs describe obstacles, not limits.  It may be harder for someone with a lower IQ to learn, but it is never impossible.  Only comatose or dead people can’t learn, and IQ scores too often allow somebody to say, “Well he’s achieving close to his level.”  IQs can provide a stimulus to somebody with a high IQ who is not motivated to learn, and can provide a bit of insight into why a particular student may be having trouble learning, but to withhold helping a child because of a lower then average IQ is at the least dishonest, and borders on unethical.

So how can this horrible practice persist?  For starters, no states have been forced to abandon cognitive referencing.  It is almost amazing that so many have, considering the financial implications of having to provide more help to kids.  That nobody has come up with anything better seems to be the main excuse given for continuing the discrepancy model.  I don’t really understand why this practice hasn’t been challenged in court.  Perhaps someday, somebody such as these special ed lawyers with a great web site, will.

That cognitive referencing can continue to exist is a symptom of a larger problem in our society.  We attempt to find labels and categories to justify providing (a good thing) or withholding (not so good) help to kids that could really benefit from extra help.  In my opinion the most ethical method of providing special education services would be to establish a bare minimum of expected competence in various areas, and at least offer to help any child achieve the next step toward reaching that bare minimum.  If this were to happen those of us in special education might then be able to spend more effort looking for ways to help, and less time looking for excuses not to.

Language Podcasts

Here are some recent podcasts related to language and learning that I’ve found interesting:

American RadioWorks , by the American Public Media, has many great podcast documentaries.  Among those related to languageamerican public media pic and learning are:

  • Financing the Real World – “American RadioWorks goes to Holy Family Cristo Rey, a school that makes preparation for the work-world part of the curriculum.”
  • Education and Motivation – “American RadioWorks Executive Editor Stephen Smith talks with education reporter Emily Hanford on President Obama’s recent address to the country’s students.”
  • Put to the Test – “No Child Left Behind has had a dramatic effect on American schools. Producers spent two years in one high school documenting how high-stakes testing has reshaped teaching and learning.”
  • Rewiring the Brain; Early Deprivation and Child Development – “After the fall of communism in Romania, the world was shocked to discover a vast system of orphanages where unwanted children languished in cribs with little attention from caregivers. Sixteen years later… scientists are measuring how children recover from early neglect and discovering what early damage might be irreversible.”

psych files pic

The Psych Files podcasts – Michael Britt has done an inspiring with these terrific podcasts.  Among those related to language/learning are:

  • Episode 90: The Learning Styles Myth: An Interview with Daniel Willingham – “Guess what? There’s no such thing as learning style (the theory that each of us has a preferred way to learn new ideas. There are many supposed kinds of learning styles, such as a visual learning style, an auditory style, kinesthetic, etc.). Don’t believe it? Neither did I at first. I was sure for a long time that I personally had a visual learning style. Now I’m not so sure anymore. Listen to this interview with professor and author Daniel Willingham as he and I discuss the topic of learning styles.”
  • Episode 53: Mindful Learning, NCLB, and the True Foundations of Success – “Tired of rote memorization? Tired of NCLB? Try mindful learning. In this episode I explore psychologist Ellen Langer’s concept of mindful learning. What does it mean to teach and learn in a mindful way?”
  • Episode 29: Extrinsic vs. Intrinsic vs. the Motivation To Learn – “You’ve probably heard about the battle between intrinsic and intrinsic motivation. Well, here’s a new and powerful way to motivate students: the Motivation to Learn.”

Also try:

whole child picThe ASCD’s Whole Child Podcasts are topical, monthly, and archived on their site.  Some interesting past topics include:  Understanding the Education Stimulus Package, Meeting the Needs of English Language Learners,and Beyond the Test Bubble:  Accountability, Expectations, and Planning.

learning matters pic

UNC Charlotte’s Center for Teaching and Learning has some great podcasts under the title:  Teaching and Learning Matters.  Topics include: Creating Interesting Assignments, What is Cooperative Learning, and Respecting Diverse Talents and Ways of Learning.

Individual versus Group Testing

  • Testing takes too much time.
  • There is too much pressure to teach to the test.
  • Tests measure limited aspects of a student.
  • Ignores standard error of measurement.
  • Increases anxiety and stress

I don’t think I even have to write an introductory sentence for this post – if I did, it would be something like, “The way group testing is done now creates a lot of problems.”  It’s become almost cliche to say that No Child Left Behind’s emphasis on testing has created a lot of headaches and hassles.  The testing emphasis and the accompanying problems have been shared by other countries.  Research has been mounting in support of the overwhelming mountain of testimonies from educators, and even the general media at large has joined the bandwagon.  (For example:  CBS news story; Boston Globe article; UK Daily Telegraph study story)   Everyone agrees that accountability is a good thing, and there’s only one way to measure how our children are learning.  Well, actually, there’s something wrong with that last part… There is another way.  Individual testing.

I’ll go ahead and get my bias out of the way, because I am a diagnostician.  I test students for speech and language competency in order to decide special education eligibility, and to help provide planning for appropriate speech and language therapy.  I work with a team of other diagnosticians serving 13 school districts.  Most students that we test receive IQ and educational testing, and probably two-thirds get speech and language testing.  I am not exaggerating when I say that when we finish testing a child parents, teachers, and the students themselves know the tested child like never before.  We can tell exactly what’s wrong, and exactly how to fix it.  Individual testing trumps group testing in so many ways.  Individual testing specifically…

  • takes less time with greater accuracy.
  • is impossible to teach to the test.
  • We can measure any educationally relevant aspect of the student that we want.
  • frustrated test takertakes special circumstances into account.
  • has less anxiety.

Additionally, individual testing …

  • specifically measures progress (or lack of) in very specific areas.

That’s the only bullet there, but its important enough to merit its own list.  Put another way, this means that when we are able to test kids this way, we can determine exactly what a student knows, and what a student should know, but doesn’t.  We can also tell what’s developmentally appropriate for each student to learn next.

So why don’t we just test each kid individually then?  Well, it would require a lot of change – change sparked and implemented by bureaucrats in an educational system who would only do so in response to mandates from politicians in a government who would only mandate in response to political pressure which would require much greater media attention.  As the ongoing attempt to overhaul health care has demonstrated, real change in our country is often extremely difficult.  Especially systematic change.  And even when the need for change is obvious.

Language News

Here’s some recent language learning news that I’ve found interesting:  language news picture

Talking helps language development more than reading alone – Although the conclusion of this UCLA study seems almost blatantly obvious, there is a significant implication, which is that the importance of talking to children has been obscured by the recent emphasis on reading with children.  The study found that back-and-forth conversation was strongly associated with future improvements in the child’s language score.  Conversely, adult monologueing, such as monologic reading, was more weakly associated with language development.  TV viewing had no effect on language development, positive or negative.  The study’s lead author, Dr. Frederick J. Zimmerman noted, “What’s new here is the finding that the effect of adult-child conversations was roughly six times as potent at fostering good language development as adult speech input alone.”

Inattentive behaviors in young children with autism predict lower later language development – The authors of this study, from the University of British Columbia, looked at autism from a different perspective than most previous research.  Rather than focusing on social and linguistic aspects of autism, the authors looked at five types of inappropriate behaviors and how these behaviors predicted later language development.  The study looked at some behaviors that parents and teachers frequently focus on, such as acting out, resistance to change, and socially unresponsive behavior, but the one that best predicted later language difficulties was inattentiveness.   This is strikingly significant for autism intervention.  Why is inattentiveness such a large problem?  Creating a desire to change is critical with these children.  Often, current intervention practices target making autistic children communicate (such as in ABA therapy), instead of trying to convince these kids to want to communicate.

Gene found to be associated with language, speech, and reading disorders – The gene in question is found on Chromosome 6.  The significance is that variability in the gene was associated with both language and reading disorders, but not other disorders, such as autism or hearing impairment.  Mabel Rice, from the University of Kansas, Shelley Smith, from the University of Nebraska, and Javier Gayán of Neocodex, Seville, Spain led a team of researchers that is part of a 20 year research program that is being funded by the National Institute on Deafness and Other Communication Disorders, one of the National Institutes of Health.

Achievement Based Teaching

Although the title of this post sure looks like a set up for some boring educational acronym, it really describes making learning fun.  More significantly, it describes using fun to teach.  The purpose of the bureaucratic looking title is to please the administrative types that sometimes try to understand why it is often in the best interest of our students to use teaching methods that are actually fun.  I could have called it “Goal Directed Teaching,” or “Learning for a Reason,” or “Why’s Before Whats,” but these other possibilities simply don’t seem to fit as well. 

Achievement oriented instruction is when a teacher provides a goal that requires the student to use a targeted skill to accomplish something.  This is not quite functional teaching, and its almost the opposite of drill.  The goal itself provides the motivation, and for this reason the choice of the goal is critical.  It is perhaps as or more important than any teaching method that may be used.  And this is how achievement oriented instruction most differs from traditional teaching. 

Here are some examples that may best serve to illustrate my overall point:

Target

Traditional Teaching

Achievement Based Teaching

simple addition

teacher instruction/ text book/ worksheets

using jelly beans, pennies, etc. and asking motivating questions, such as “Would you like two more, or six all together?”, etc.

labeling prepositions

discussing prepositions/ worksheets

asking preposition laden questions while playing hide and seek, hidden pictures, Simon Says, etc.

parts of speech

sentence diagrams/ teacher instruction/ worksheets

Mad Lib style activities, separate students into different parts of speech teams and score points when correctly identifying parts of speech, etc.

typing

drill

internet typing games, practice typing labels, letters, etc.

As you can see, the achievement based teaching column contains more possibilities, and an “etc.”  The only limit to one can go in the final column is the teacher’s imagination.  The more creative and varied the activities, the more salient is the learning.  This should not in any way disparage traditional teaching, however.  Another way to put it is that traditional teaching relies on expectations.  In achievement based teaching the learning is elicited.  The student constructs his own expectations, and uses specific targets to achieve these expectations.  Expectations and elicitations are both critical when teaching.

So when an administrator comes in and sees you playing a game with your kids, if you did this kind of teaching, you could say:  “You caught me on my ABT day.  Some days I do drill, some days I do direct instruction, some days worksheets, and about half of the days I do activities specifically designed to elicit my students’ target skills.  It just so happens that fun motivates.”

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Speech-Language Therapy, Technology, and Humor

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The Edgy Side of Speech Pathology; sharp, profane, but never dull

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In Spontaneous Speech

teaching children to communicate clearly and efficiently

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