A Comparison of On-Task Behavior in Person-Directed VS. AAC-Directed Apraxia Therapy for Children with Autism Spectrum Disorder By: Jeanna Probst Eastern.

A Comparison of On-A Comparison of On-Task Behavior in Task Behavior in Person-Directed VS. Person-Directed VS. AAC-Directed Apraxia AAC-Directed Apraxia Therapy for Children Therapy for Children with Autism Spectrum with Autism Spectrum DisorderDisorder

By: Jeanna ProbstEastern Illinois [email protected]

Introduction:Introduction:Autism Spectrum Disorder Autism Spectrum Disorder (ASD)(ASD)Deficits in 3 areas:

◦Social Interaction◦Language & Communication◦Repetitive & Restricted Interests

(Routine)Sensory Processing DeficitsJoint Attention Deficits

Developmental Apraxia of Developmental Apraxia of Speech (DAS)Speech (DAS)Neurological disorderDifficulty sequencing movements needed

to produce a clear and precise sound or utterance (Darley, Aronson & Brown, 1975; Hall, Jordan, & Robin, 2007; Tombin, Morris & Spriestersbach, 2000)

“sensory integration dysfunction, which interferes with planning and executing an unfamiliar task” (Marshalla, 1994, 1995; Darley et al., 1975; Hall et al., 2007)

Often associated with ASD

Joint AttentionJoint AttentionSchertz & Odom, (2004) define joint

attention as, “coordinating attention to an event or object with another individual, sharing interest and social engagement, and showing an understanding that the partner is sharing the same focus”(p. 42).

Language delays in ASD mainly due to deficit in the area of Joint Attention

Augmentative and Augmentative and Alternative CommunicationAlternative Communication “Augmentative and alternative communication refers to

the field or area of clinical, educational, and research practice to improve, temporarily or permanently, the communication skills of individuals with little or no functional speech and/or writing” (American Speech-Language-Hearing Association, 2002).

Augmentative: augment existing speech abilities Alternative: providing a substitute for ineffective speech Facilitates natural speech

Consistent model Immediate reinforcement

AAC devices are often used with ASD & DAS Helps the AAC users acquire functional

communication and develop expressive language

ASD - DAS - AACASD - DAS - AACCommonalities in ASD & DAS:

◦Neurological Disorder◦Routine◦Sensory Processing Deficits◦Joint Attention Deficits◦AAC provides a consistent model and

routine◦Limited research that looks at joint

attention in a person-directed model versus an AAC-directed model

Purpose and Research Purpose and Research QuestionQuestionLimited research in area of AAC and

ASD with DASPurpose: compare on-task behavior

in person-directed apraxia therapy to AAC- directed apraxia therapy in individuals diagnosed with ASD who also have apraxia of speech.

Is there a difference in the length of on-task behavior when using a person-directed stimulus mode versus AAC-directed stimulus mode for individuals with co-morbid ADS and DAS?

SubjectsSubjects

Subject Gender Age Disorder AAC System

Participant 1

Female 6 ASD/DAS Dynavox V

Participant 2

Female 6 ASD/DAS Dynavox MT4

Participant 3

Male 8 ASD/DAS Dynavox V max

MethodologyMethodologyRapid alternating subject treatment

designRandomly presented with stimuli (IV:

AAC-directed & Person-directed)◦5 minutes over 22 sessions

AAC Device: Mercury II by Assistive Technology Inc., the Dyanvox IV, and the Dynavox V max

Clinician: CDS graduate student, who was blind to the dependent variables

Oral Motor Activities◦Blow, Kiss, Raspberry, Pat Mouth, Click

Tongue, /p/, /b/, /m/

Video ClipsVideo ClipsPerson-Directed

◦Shows apraxia at workAAC-Directed

◦Imitation of one of the oral motor behaviors

Dependent VariablesDependent VariablesDependent Variable Description

Leave Work Area The subject left the identified work area (where the clinician or AAC system was).

Disruptive Behavior The subject displayed behaviors that were physically or verbally disruptive and were used to block out the stimulus: closing eyes, screaming, attention focused on sensory items (e.g., string), physical disruptions (e.g., hugging).

No Eye Contact The subject was within the defined work area and interacting with the stimulus, but no sustained eye contact with the stimulus or clinician was present.

On-Task Behavior The subject was interacting with the stimuli or clinician within the work area.

Data Recording SheetData Recording Sheet

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30Leaves Work Area

Disruptive Behavior

No Eye Contact

On-Task Behavior

Date:________ Time:_______ Participant:_______________

_______% Accuracy

Results: OverallResults: OverallMultivariate Analysis of Variance

(MANOVA)Overall significant difference,

F(4,57)=5.8; p=.001◦Higher occurrence of Disruptive

Behavior and No Eye Contact in Condition 1 (Person-Directed) than Condition 2 (AAC-Directed)

◦Disruptive Behavior (p=.034)◦No Eye Contact (p=.001)

Results: OverallResults: OverallCondition

On-Task Leave Work Area

No Eye Contact

Disruptive Behavior

1-Person-DirectedMean

.92 .03 .32* .42*

Standard Deviation

.12 .08 .18 .22

Number of Data Points Collected

30 30 30 30

2-AAC-DirectedMean

.98 .03 .17* .28*

Standard Deviation

.05 .07 .15 .27

Number of Data Points Collected

32 32 32 32

*significant difference

Results: On-Task BehaviorResults: On-Task Behavior

Overall On-Task:•Person-Directed: 92.4%

•AAC-Directed: 97.6%Both IV: 95%

•AAC significantly higher than Person-Directed (p=.001)

Person-Directed 97.7%, AAC-Directed 96%

Person-Directed 84%, AAC-Directed 97%Person-Directed 94.9%, AAC-Directed 98.9%

Results: No Eye ContactResults: No Eye Contact

No Eye Contact:Person-Directed: 33.9%AAC-Directed: 19%Overall: 26%P=.001

Person-Directed 38.6%, AAC-Directed 10%

Person-Directed 37.8%, AAC-Directed 11.5%

Person-Directed 27.7%, AAC-Directed 33.5%

Results: Disruptive Results: Disruptive BehaviorBehavior

Disruptive Behavior:Person-Directed: 41.5%AAC-Directed: 27%Overall: 34%P=.034

Person-Directed 44.8%, AAC-Directed 41%

Person-Directed 38.9%, AAC-Directed 11%

Person-Directed 41%, AAC-Directed 28.9%

Results: Leave Work AreaResults: Leave Work Area

Leave Work Area:Person-Directed: 3.4%AAC-Directed: 3.7%Overall: 3.6%

Person-Directed 3%, AAC-Directed 9.5%

Person-Directed 2.7%, AAC-Directed 1.5% Person-Directed 4.1%, AAC-Directed 0%

DiscussionDiscussionVariables to account for results

◦ASD is an individual disorder◦AAC was more routine orientation;

PD involved more variability Disruptive behaviors

◦Clear focus with AAC◦PD provided a richer multimodality

learning experience compared to the AAC device with flat 2-dimensional picture and auditory feedback

DiscussionDiscussionStrengths

Routine Design Limited time frame Focused/Controlled sensory input

Limitations Small subject size Technology Difficulties

DiscussionDiscussion Future Research

◦ Broader Sample (different severity levels of ASD and DAS) Lower and higher emerging level of AAC users

◦ Evaluate emerging imitation in Person-Directed vs. AAC-Directed conditions

◦ Evaluate if either of these conditions help develop joint attention

◦ Use of a video model instead of a static picture on the AAC device

◦ Replication to determine generalization of the present study

ReferencesReferencesAmerican Speech-Language-Hearing Association (2002). Augmentative and

Alternative Communication: Knowledge and Skills for Service Delivery. [Knowledge and Skills].

Available from http://www.asha.org/policy

Darley, F. L., Aronson, A. E., Brown, J. R. (1975). Motor Speech Disorders. W. B.

Saunders Company.

Hall, P. K., Jordan, L. S., & Robin, D. A. (2007). Developmental Apraxia of Speech:

Theory and Clinical Practice (2nd ed.). PRO-ED Inc.

Marshalla, P. (1994). The non-verbal apraxic child: speech-language techniques.

1-19.

Marshalla, P. (1995). Developmental apraxia of speech: facilitating vocal and

verbal expression. Speech Dynamics Incorporated, 1-25.

Schertz, H. H. & Odom, S. L. (2004). Joint attention and early intervention

with autism: a conceptual framework and promising approaches. Journal of

Early  Intervention, 21, 1, 42-54.

Tombin, J. B., Morris, H., & Spriestersbach, D.C. (2000). Diagnosis in Speech-

Language Pathology (2nd ed.). Singular Publishing Group, Inc.

ANY QUESTIONS?ANY QUESTIONS?