A combined linguistic and prosodic treatment approach for language-communication skills in children with autism spectrum disorders : a proof of concept study

Abstract

Background The complex nature of Autism Spectrum Disorders (ASD) and the challenges regarding effective treatment methods for this population gave incentive to this research. Despite deficits in auditory processing, listening skills, pragmatic skills and social interaction, children with ASD possess inherent strengths in terms of certain auditory processing abilities. These auditory processing abilities include superior pitch discrimination (Bonnel et al., 2010; Heaton, 2005, 2008; Mottron et al., 2000), the ability to discriminate stressed words better than unstressed words (Paul et al., 2005), and the ability to process information when absolute pitch values and timing of pitch direction changes are modified within a melody (Ouimet et al., 2012). These strengths may be utilized in language therapy. An integrated approach in which language therapy is combined with prosodically varied speech may enhance the effect of language treatment. Results from research regarding the neurological foundations of processing melodic and rhythmic stimuli suggest that specific elements of prosody, such as variations in intonation and stress, may stimulate areas of the brain often found to be atypical in individuals with ASD (Boddaert, 2004; Samson et al., 2006). Elements of prosody such as intonation and stress variation therefore warrant research into a different treatment approach to stimulate atypical, but more effective processing (Bertone et al., 2005; Gervais, 2004). This study aimed to determine whether the use of prosodically varied speech within a traditional language therapy framework had any effect on the listening skills, pragmatic skills, and social interaction behaviour of three children with ASD. Method A single participant multiple baseline design across participants was implemented. Three participants were selected for this research. The performance of the participants was compared before treatment, after a three week period of treatment, and after a two-week withdrawal period from treatment utilising prosodically varied speech within a traditional language therapy approach. The following aspects of behaviour (investigated by means of specific assessment scales) were analysed for each participant:  Listening skills (as determined by the BLM G-5 (2010) Listening Skills Observation Checklist)  Pragmatic skills (as determined by the Pragmatic Skills Checklist - Shipley & McAfee, 2009, form 8-7)  Stereotyped, social communication and social interaction behaviour (as determined by the Gilliam Autism Rating Scale, 2nd edition). The use of prosodic speech variation within a traditional language treatment framework is a recent intervention approach for children with ASD (Sandiford, Mainess, & Daher, 2013; Wan et al., 2011). This approach has not been tested extensively, and therefore a single-participant design was used to provide ‘‘proof of concept’’ of such an approach (Smith, Dawson, Guthrie, & Lord, 2007). Results The results were analysed quantitatively and qualitatively, and indicated positive behavioural changes in listening skills, pragmatic skills, and social interaction behaviour for all the participants. Change in behaviours was measured after using prosodically varied speech within a traditional language therapy framework. There was a high measure of agreement between the scores of the researcher and the external rater on the assessment scales used to measure behavioural change in the participants. Statistical significance was not calculated for each individual due to the limited data, but visual inspection indicated that all the participants showed positive behavioural changes in performance across all areas after three weeks of treatment, independent of their pre-treatment performance level. Conclusions The use of prosodically varied speech within a traditional language therapy framework appears to be a viable form of treatment for children with ASD. However, while general trends were observed, the findings should not be generalised to all individuals with ASD because of the heterogeneity of this population. The research was evaluated and implications for further research, as well as for clinical practice, were presented.