Many children with autism spectrum disorders are vocal, yet non-verbal. They may produce consonants, vowels and syllables, but do not use words to communicate. Though it is difficult to judge whether or not these children exhibit apraxia of speech, a specialized approach of shaping successive word approximations, combined with sign language, may help non-verbal children with autism to become verbal communicators.
There is a great deal of evidence to support that new behaviors can be established by breaking a task down into smaller units and shaping them toward the target behavior using reinforcement techniques (Skinner, l957). Utilizing these well-known techniques of Operant Conditioning, consonants and vowels can be shaped into best approximations of words to become functional vocabulary until the children are able to master the adult form of the words (Sweeney-Kerwin et al., 2005; Kasper & Goodwin, 2003; Kaufman, 1998, 2001). These techniques have been highly effective for children with apraxia of speech, as the task of verbal imitation is simplified into smaller units that can be more easily mastered and utilized immediately and functionally. For example, a child may not be able to say “apple” due to the difficulty of the final /l/, as well as the vowel /ae/, not to mention that it is a two syllable word. The child can be taught to say it as “ah-po” (using the phonological processes of vowel neutralization and vocalization (Khan, l985), thus simplifying the motor coordination of the word and making it easier to produce. Once the child can imitate the “word shell” for “apple”, he or she would be rewarded ideally by being given a piece of apple. As therapy continues, efforts would be made to assist the child to eventually be able to say “apple” accurately. The Kaufman Speech Praxis Treatment Approach follows the application of operant conditioning and is a systematic method of shaping word approximations toward target, functional vocabulary to be moved directly in expressive language. However, the Kaufman approach relies heavily upon verbal imitation, a skill that is usually lacking in non-verbal children with autism.
One solution to helping children with autism spectrum disorders to begin to verbally imitate is to first shape sign language to communicate. Often, children with autism have missed out on many opportunities to hear words during exciting and motivating situations. They have few experiences with attempting to produce words and receiving items. Sign language may be an excellent choice in these situations as the child can be physically assisted in moving his hands to make the sign. Every time the teacher or significant other helps the child produce the sign, the teacher says the word several times. Often, as the child has more experience using sign language to request specific needs and desires, which have always been paired with hearing the word, the sign itself might trigger the verbalization ”automatically” (Sundberg et al., 1986; Yoon and Bennet, 2000). The child would then be reinforced more quickly or in greater amounts when he or she produces the sign with verbalization. If the child never verbalizes anything close to how the word is produced, we would then work on achieving best word approximations through echoics (verbal imitation) of the highest level of consonant-vowel combinations toward the target word as can be obtained (Kasper & Kaufman, 2005). Signs would be chosen that represent the children’s most powerful motivators so that they will have the ability to eventually use verbal mands (requests) for their favorite foods, drinks, toys and activities.
Teaching manual signs has been found to benefit children with autism as they can be easily shaped with hand-over-hand prompting and fading (Sundberg & Partington, l998). Combining sign language with successive verbal approximations of words via the Kaufman techniques has been shown to be an effective method of helping children with autism become verbal communicators. Dr. Vincent Carbone, a Board Certified Behavior Analyst with over 25 years of experience designing learning environments for people with autism and developmental disabilities, conducted research with his colleagues comparing the use of the Kaufman approach of successive approximations to a second method of modeling whole words for imitation (Sweeney-Kerwin, et al., 2005). Dr. Carbone’s study demonstrated that providing successive approximations toward target words for two children with autism was more effective and efficient (fewer trials to criterion) in teaching production of the target words. In addition, use of the Kaufman “word shells” resulted in generalization of improved verbal imitation to untaught words. Ms. Tamara Kasper, M.S. CCC/SLP, BCBA, conducted a single subject design (Kasper and Godwin, 2003) showing the success of sign language to increase vocalizations and successive approximations using the Kaufman word shells to shape vocalizations. Their results demonstrated significant improvement in test scores and intelligibility as well as generalization of improved articulation to untaught words.
There is mounting evidence that sign language promotes verbal skills (speech) in children with autism, (Barrera, et al, 1980, Barrera & Sulzer-Azaroff, 1983, Carr and Dores, 1981; Layton, 1988; McIlvlane et al., 1984; Yoder and Layton, 1988) and provides an opportunity to then shape consonants and vowels to form functional words through echoics (verbal imitation). In order to provide stimulus items that would motivate children to learn, the K & K Sign and Say (Kasper & Kaufman, 2005) program was produced. Its purpose is to provide photographs of foods, drinks, toys and activities that many children, especially those on the spectrum of autism or who exhibit other developmental challenges, would be highly motivated to request. On the back of each photograph is a picture of the manual sign, a description of how the sign is produced, as well as a series of word approximations to help shape the child’s vocalizations. A complete manual is also provided as to the specific use of the K&K Sign and Say methods.
In our opinion, shaping the behavior of “speaking” can be accomplished for many children with autism and apraxia of speech, especially through initially shaping signs or sign approximations as the initial avenue toward verbal imitation. In our clinical practices, using successive approximations, cueing, fading and the effective use of reinforcement is proving to be a highly successful method to help children who otherwise have been vocal, yet non-verbal, to become functional verbal communicators.
Research on shaping new behaviors through operant conditioning has been cited in the literature since l957. The Kaufman techniques follow this behavioral shaping method with the end goal of verbal communication. These techniques have been utilized with systematic methodology since 1989. Unpublished data, pre and post videotapes as well as anecdotal successful outcome feedback from around the world provide some evidence in support of this approach. However, as with all treatment methods for childhood apraxia of speech, more scientific evidence regarding treatment efficacy is needed. In particular, we hope to see and participate in treatment research studies on this methodology with well defined subject inclusion criterion for this dually diagnosed population of children with autism spectrum disorders and possible apraxia of speech. Peer reviewed, published treatment data are greatly needed on this, as well as other, speech treatment methods for CAS and autism spectrum disorders.
Kaufman Children’s Center for Speech, Language, Sensory-Motor, and Social Connections, Inc. http://www.kidspeech.com
Tamara Kasper, MS/CCC-SLP, BCABA: http://www.kasperautism.com
Dr. Vincent Carbone http://www.drcarbone.net
Northern Speech Services http://www.nss-nrs.com
Barrera, R. & Sulzer-Azaroff, B. (1983). An alternating treatment comparison of oral and total communicationtraining program with echolalic autistic children. Journal of Applied Behavior Analysis, 4, 379-394.
Brady, D. O., & Smouse, A. (1992) A simultaneous comparison of three methods for Language training with anautistic child: An experimental case analysis. Journal of Autism and Childhood Schizophrenia, 8, 271-279.
Carbone, V. J. (2004). 2004 Tutorial: Clinical applications of verbal behavior research with children with autism. Proceedings of the 30th Annual International Convention Association for Behavior Analysis. Boston, Massachusetts.
Carbone, V. J. (2002) Teaching verbal behavior to children with autism and related disabilities. Unpublished Workshop Manual.
Carr, E. & Dores, P. (1981) Speech vs. sign comprehension in autistic children; analysis and
prediction. Journal of Experimental Child Psychology, 37, 587-597.
Casey, L. O. (1978) Development of communicative behavior in autistic children: A parent program using manual signs. Journal of Autism and Childhood Schizophrenia, 8, 45-59.
Fulwiler, R. & Fouts, R. (1976) Acquisition of American Sign Language by a non-communicating autistic child, Journal of Autism and Childhood Schizophrenia, 6, 43-50.
Kasper, T., & Godwin, J. (2004). Teaching verbal behavior: Hands on training for tutors and therapists. Unpublished Workshop Manual.
Kasper, T., & Godwin, J. (2003). Improving vocal verbal behavior via tutor-modeled successive approximations. Proceedings of the 29th Annual International Convention Association for Behavior Analysis. San Francisco, California.
Kasper, T. & Kaufman, N. (2005). K&K Sign & Say: Shaping Verbal Language for Individuals with Autism an d Other Developmental Challenge. Gaylord, MI: Northern Speech Services, Inc.
Kaufman, N. (1995). Kaufman speech praxis test for children. Detroit: Wayne State University Press.
Kaufman, N. (1998). Kaufman speech praxis treatment kit for children. Gaylord, MI: Northern Speech Services.
Kaufman, N. (2001). Kaufman speech praxis treatment kit for children-2. Gaylord, MI: Northern Speech Services.
Kaufman, N. (2005). Kaufman speech praxis workout book for children. Gaylord, MI:Northern Speech Services.
Layton, T. (1988) Language Training with autistic children using four different modes of presentation. Journal of Communication Disorders, 21, 333-350.
Layton, T. & Watson l. (1995) Enhancing communication in non-verbal children with autism. In K. A. Quill (Ed) Teaching Children with autism: Strategies to enhance communication and socialization. (pp 73-101) New York: Delmar Publishers.
Miguel, C.F, Carr, J. E. & Michael, J. (2002). The effects of a stimulus-stimulus pairing procedure on the vocal behavior of children diagnosed with autism. The Analysis of Verbal Behavior, 18, 3-13.
Palmer, D.C. (1996). Achieving parity: The role of automatic reinforcement. Journal of the Experimental Analysis of Verbal Behavior, 65, 289-290.
Schaeffer, B., Kollinzas, G., Musil, A., & McDowell, P. (1978). Spontaneous verbal language for autistic children through signed speech. Sign Language Studies, 21, 317-352.
Skinner, B. F. (1957). Verbal Behavior. Englewood Cliffs, NY: Prentice Hall.
Sundberg, M.L., Michael, J., Partington, J. W., & Sundberg, G.A. (1996). The role of automatic reinforcement in early language acquisition. The Analysis of Verbal Behavior, 13, 21-27.
Sundberg, M.L., & Partington, J.W. (1998). Teaching language to children with autism or other developmental disabilities. Pleasant Hill, CA: Behavior Analysts, Inc.
Sweeney-Kerwin, E., Zecchin-Tirri, G., Carbone, V.J.; Janeckey, M.; Murrary, D. & McCarthy, K. (2005). Improving the Speech Production of Children with Autism. Proceedings of the 31st Annual International Convention Association for Behavior Analysis. Atlanta, Georgia.
Yoder, P. & Layton, T. (1989) Speech following sign language training in autistic children with minimal verbal language. Journal of Autism and Developmental Disorders, 18,217-229.
Yoon, S.Y., & Bennett, G. M. (2000). Effects of a stimulus-stimulus pairing procedure on conditioning vocal sounds as reinforcers. The Analysis of Verbal Behavior, 17, 75-88.
[Nancy R. Kaufman, M.A., CCC/SLP is the director of the Kaufman Children’s Center for Speech, Language, Sensory-Motor and Social Connections, Inc. She has specialized in the area of Apraxia of Speech in Children since l979. An experienced clinician, diagnostician, author, presenter and clinical service award winner, Nancy presents The Kaufman Speech Praxis Treatment Approach nationally and internationally. Nancy works with children, professionals and families daily, providing video consultations as well.
Tamara S. Kasper, MS/CCC-SLP, BCBA, has practiced as a pediatric speech/language pathologist with emphasis on treatment of children with challenging behaviors for over 16 years. She has specialized in treatment of children within the autism spectrum for the last 10 years. In her pursuit of effective treatment methods, she became a Board Certified Behavior Analyst under the mentorship of Dr. Vincent Carbone. She has advanced training in application of Skinner’s analysis of verbal behavior, Greenspan’s DIR approach, and Kaufman’s strategies for apraxia of speech. She is co-author of the K&K Sign and Say kit. Currently, Ms. Kasper provides consulting services, training, and workshops to treatment teams who serve children with autism in the United States, Canada, and Europe.]