There is no vowel at the end of D O G: Considerations for teaching speech production.

Abstract

Introduction Deficits in speech and language development are one of the main features of autism (APA, 2004; Tager-Flusberg, Paul, & Lord, 2005). It has been estimated that 20 to 30 % of individuals with autism may not develop functional speech (Tager-Flusberg, Paul, & Lord, 2005). On the other hand, the development of speech and language is associated with better long term outcomes for individuals on the autism spectrum (Venter, Lord, & Schopler, 1992, Szmatari et al., 2003). Although numerous approaches are currently being used to help children with autism speech and communication skills , many lack empirical evidence to support their efficacy. Structured behavioral teaching programs based on learning theory, however, have a strong evidence base and are widely used with much success (Goldstein, 2002). Several behavioral teaching strategies have been used to target speech and language. One such strategy is known as discrete trial instruction (DTI). In this highly structured, adult-directed approach, the therapist creates short learning opportunities (trials), often in a massed trial sequence (Lovaas, 2002). Each trial consists of an antecedent (a question or command), a target behavior (the learning goal), and a consequence (performance feedback). The antecedent may be accompanied by a prompt which is gradually faded. Typically, the DTI curriculum begins by targeting basic learning skills (e.g., joint attention, gross motor imitation, following single -step directions) which can then be used as the basis for targeting more complex skills (e.g., vocal imitation, speech production, requesting, labeling, etc.). For each learning goal, mastery is based on a performance criterion established in advance by the therapist. A second set of behavioral approaches appear more natural and represent a hybrid of child-initiated and adult-directed strategies (Fey, 1986). Examples include natural learning paradigm (NLP) and incidental teaching (IT) (Koegel, Koegel, & Carter, 1999). The NLP protocol is designed to increase motivation by varying tasks, to increase responding by providing direct reinforcement, and to enhance generalization by providing loose structure and multiple exemplars (Lasky, Charlop, & Schreibman, 1988). The IT protocol is designed to increase the frequency of initiation by creating communicative temptations (e.g., providing a desired toy within sight but out of reach), waiting for a child to initiate communication, and then expanding his or her communicative attempts (e.g., Hart & Risley, 1968). For example, a therapist can place a cookie within sight but out of reach of a child who likes cookies. If the child signals his intent by pointing to the cookie and looking at the therapist, the therapist uses this initiation as a natural opportunity for language expansion (e.g., You want cookie? Say cookie). NLP and IT both rely more on environmental arrangement, modeling, and shaping than on direct instruction or physical prompting (Rogers, et al., 2006). However, both approaches have been demonstrated to be effective for teaching communication skills to children with autism (Goldstein, 2002; Koegel, 2000). Given that 20 to 30 % of children with autism do not develop functional speech, despite intensive intervention, there is a continued need to evaluate interventions in relation to the unique profiles of individual learners. In other words, when it comes to the selection of intervention strategies, one size does not fit all. Interventions must be fine tuned and matched to each learner's repertoire of abilities and limitations. For example, a child who does not spontaneously produce sounds and who demonstrates no imitation skills may require a more adult-directed program (e.g., DTI) to establish an initial vocal repertoire. However, a child who already has a vocal repertoire and who demonstrates spontaneous observational learning is far more likely to benefit from the use of more natural teaching procedures such as NLP or IT. …