Clinical application of speech intelligibility research: The River Street Autism Program at Coltsville.

Abstract

Introduction Children with autism spectrum disorders (ASD) have severe deficits in communication. Because of this problem, behavioral researchers have sought to develop procedures to improve speech production in children with autism (cf. Koegel & Koegel, 1995; Lovaas, 1977; Lovaas, 2003). These researchers have developed powerful and effective strategies for teaching children to produce initial sounds, words, sentences, and conversational speech. Thus, many children have benefited from these procedures with the development of functional vocal repertoires. While some of these children have adequate intelligibility, there is a portion of this population with compromised intelligibility, due to a limited consonant inventory and less complex syllabic structure (National Research Council, 2001). To address this issue, this article will first review the research in this area and then discuss a model of intervention for children with ASD based on these research findings. Guidelines will be provided on how to: 1) assess intelligibility problems; 2) use the normal developmental model when selecting appropriate targets; 3) sequence treatment objectives; 4) improve intelligibility problems using behavioral interventions; 5) program for generalization; and 6) evaluate program success and troubleshooting. Finally, outcome data for five children on the autism spectrum who have received treatment within the context of this model will be provided. Review of the Research Assessment For children with intelligibility problems, speech language pathologists (SLPs) customarily assess sounds in initial, medial and final positions using picture cues with standardized articulation assessments (Newman & Creaghead, 1989). While this is effective in providing information that will guide treatment for the majority of children with intelligibility issues, these tests pose certain problems for children on the autism spectrum. Specifically, these children do not respond well to traditional assessment tools due to their characteristic language delays, excesses in problem behavior, and depressed motivation. Koegel, Koegel and Smith (1997) reported that modifications to the testing situation to respond to these problems will result in significantly higher test scores. Based on the success of this research, Dyer, Fitzgerald, Harris, and Harris (2005) developed an assessment tool that was designed to respond to these problems by: 1) decreasing demands on expressive language production that are often intrinsic to standardized articulation assessment; 2) providing external motivation with stimulus variation and child preferred items; 3) providing behavioral support through individual behavioral support plans and 4) presenting items in a discrete trial format (cf. Koegel & Schreibman, 1982). In addition, the assessment was delivered by a teacher who had stimulus control in a familiar setting, rather than an SLP who had limited contact with the child. The results of the study showed that this assessment method was more effective in providing information on the child's articulation ability than traditional assessment in the context of reversal designs for four children. This suggests that evaluators take steps to address deficits in motivation and language comprehension in the assessment process in order to gain a more representative sample of children's speech production. Treatment Accumulating studies have documented behavioral intervention techniques in the treatment of articulation for children with autism. Using discrete trial techniques described by Koegel and Schreibman (1982), Dyer, Santarcangelo, and Luce (1987) provided articulation treatment to two adolescents with ASD who had persistent articulation errors. After intervention, the first child met criterion on correct production of three separate sounds in less than 200 trials. The second child met criterion on seven sounds in less than 100 trials. …