Neurobiology of Autism

Neurobiology of Autism (Dr. Martha Burns, PhD, CCC-SLP)

I had the opportunity to listen to a recorded presentation “Neurobiology of Autism: Interventions that Work by Dr. Martha Burns, PhD, CCC-SLP on current research in the field of neurobiology of Autism. The original presentation was delivered in November 2013. Dr. Burns is one of the leading researchers in this field. The purpose of the presentation was to summarize the new research in the area of neurobiology as it pertains to children on the Autism Spectrum. The reason I was intrigued was because it explained autism in a way that, for me, finally made sense. Not only did it explain (in theory at least) why children on the autism spectrum demonstrate the characteristics that they do, but also why almost every autistic child presents differently from the others. The purpose of this blog isn’t to recreate Dr. Burns’ presentation, but to quickly highlight the salient points for parents and other professionals. However, I highly recommend listening to the actual presentation since there were so many details embedded within it that are beyond the scope of this blog.

The presentation was broadly divided into three major sections:

  • Etiology of autism- In summary, Dr. Burns narrows the causes of autism to genetic mutations (age of parents, environmental factors causing mutations in the fetus) and neurotoxicology (certain antibodies in the mother may enter the amniotic fluid and these can cause autism). In essence, Dr. Burns refutes theories that suggest that diet and immunizations may be possible causes of autism.
  • Neurobiology of Autism- This portion of the presentation discussed the use of “Diffusion Tensor Imaging” (an imaging technique that is more sophisticated than MRI scans). Using this technology, researchers were able to map white matter fiber tracts. These fiber tracts develop in individuals from the 3rd trimester until about 30 years of age. These are long fibers tracts that run across multiple lobes of the brain. Some of these fiber tracts in the left hemisphere of the brain impact speech development and auditory processing. Because these fibers are long, they are particularly vulnerable. According to Wass (2011), autism is a disorder of long white matter fiber tract development. A study by Wolf, et. al. (2012) also surmised that there was aberrant development of white matter fiber tracts in children with autism spectrum disorder. They also found that the fiber tracts in infants up to about 6 months of age are similar in typical children and children on the autism spectrum. After 6 months of age, they noticed a blunted development in these longitudinal fiber tracts in children with autism. This explains why often parents report that their children appeared typically developing in infancy and the autism-like symptoms were not present until later. Researchers have also found that the development of these fiber tracts is different among children with autism. Hence we see a great diversity in skills, abilities and deficits in children on the autism spectrum. In addition, since the longitudinal (long) fiber tracts are insufficiently developed, the short tracts that are overused. This results in an increase in repetitive and stereotypical behaviors, so frequently seen in children on the autism spectrum. Just as the white matter fiber tracts in the left hemisphere of the brain impact speech and language development, fiber tracts in the right hemisphere impact social skills and pragmatics (Stanley & Adolph, 2013).
  • Interventions that may prove to be beneficial- So the most crucially, how do the above findings about the neurobiology of autism impact interventions? In a crux, according to Dr. Burns, therapies that drive longitudinal white matter tract development are beneficial. Because the theory of neuroplasticity is well documented, well-designed therapy programs based on neuroscience are effective. It now appears that the combination of computerized interventions such as Fast ForWord® and individualized clinical approaches hold the greatest promise. Dr. Burns also discussed the three levels of processing:
             High Level —- Complex Problem Solving
             Mid Level —- Grammar and Vocabulary
             Low Level —- Perceptual Skills
    Researchers believe that it is the low level processing (perceptual skills) that drives the white matter tracts. These perceptual skills can be impacted effectively through computerized programs such as Fast ForWord®. However, it important to note that perceptual skills should not be addressed in isolation. The most effective interventions should therefore include computerized approaches that drive neuroplasticity and behavior interventions for functional limitations.

While new research that explains Autism is enlightening, what is truly exciting for me, is the knowledge that we can now tailor interventions and treatment programs so that they are truly effective.

Treating Vowels: A Tactile Treatment Program (Part III)

The second part of Sam’s treatment for vowels was the speech production or articulation portion.  We began by targeting the round vowels such as /Ʊ/.  A lesson plan was created that included auditory bombardment, production of the sound in isolation with PROMPT and tactile cues, production of the sound in words using a functional or communication task, and production of the sound in a word using drills.

For the round vowels multiple tactile cues were provided to elicit the lip rounding.  The TalkTools Tactile Tubes were particularly helpful.  Since they come in different diameters, different tubes were used to elicit different sounds.  Initially the use of Renee R. Hill’s and Sara R. Johnson’s Ice Stick was also very helpful to elicit lip rounding.  The added thermal stimulation provided by the cold Ice Stick yielded some good results.  The Ice Stick placed horizontally was used to elicit lip retraction for vowels such as /i/.  In addition, two Bite Blocks placed between the molars simultaneously on both sides also assisted with stabilizing the jaw height while aiding lip retraction.

Following the principals of Hodson and Paden’s Cycle’s Approach, a vowel was targeted for a few weeks and then a new vowel was selected.  Once all the sounds were targeted, the same targets were then re-cycled.  The functional or communication tasks were the highlight of the session.  This portion is important since it gives us as therapists the opportunity to shape the sound in one phonetic context using multiple trials.  For example, when targeting the “ee” sound, I used the Honey Bee Tree game.  I worked on the words “tree” and “leaf” when Sam placed the leaves on the tree.  When he pulled the leaves out and the bees fell, I targeted the word “bee.”  I try to elicit the word at least 8-10 times per activity.  In a half hour session, I try to include at least 4-5 similar communication activities.  Apart from being able to target the same word through multiple repetitions, the communication task also gives the child an opportunity to use the sound in a meaningful way rather than simply naming pictures in a drill.

As a part of the generalization portion of the lesson, I would have Sam’s parent lead one of the activities in the clinic (so Sam can produce the target word with a person other than me) and I also provided the parents with a copy of the drill pictures to practice at home.

Treating Vowels: A Tactile Treatment Program (Part II)

When Sam began therapy he had difficulty tolerating any sensory input in or near is mouth. Bringing a toothette close to his mouth would lead to an involuntary tongue protrusion to resist any stimulation. Placing a bite block between his molars would lead to gag reflex. My first goal therefore was to decrease his tactile defensiveness, while building his proprioceptive awareness (knowing where his lips, tongue and jaw are in space) of his oral structures. The first step of course, was to build his trust and comfort level with me and the tools I would use. We named the toothette with the vibrator “Mr. Tickles.” Mr. Tickles would always start the session. Sam could tell Mr. Tickles where he wanted to be tickled. We would usually start with the palm of his hand or his arm and gradually work our way to his mouth. Within a few sessions, Sam could tolerate several minutes of stimulation with a toothette without any negative reactions.

vibrator-tootethOnce Sam’s tactile defensiveness was significantly reduced, my next goal was to stabilize his jaw and increase jaw grading (i.e. opening and closing of his mouth to various jaw heights without jaw sliding or jerking). Since Sam tended to “fix” his jaw at jaw height 1 (closed mouth position) during speech, my objective was to move him gradually through Sara R. Johnson’s Bite Block hierarchy. Unless Sam was able to lower his jaw to jaw height 3 or 4, production of vowels such as /Ɔ/ would be challenging. We started with Bite Block #2 and within several weeks were able to move to Bite Block #6, which requires considerable jaw opening. Sam can now hold a lower jaw position without sliding. As a part of a comprehensive oral motor or oral placement program, we also worked on lip rounding, lip seal and tongue retraction. Sara R. Johnson’s Horn and Straw Hierarchy’s were employed for this purpose. In addition, a tongue depressor with added “weights” (pennies taped to both ends) were used to build lip strength and lip closure.

Treating Vowels: A Tactile Treatment Program (Part I)

Sam came in with a diagnosis of Autism Spectrum Disorder and Apraxia of Speech. During the initial intake over the phone, his mother informed me that her main concern for Sam’s speech was his vowel production. And sure enough, all of Sam’s vowels were substituted by a neutral /Ʌ/. There was no discrimination even for round vowels like /Ʊ/ or /Ɔ/. On further observation, it was evident that Sam had oral motor deficits. There was limited if any jaw grading. He tended keep his jaw height at 1 for all his words. His lips did not appear to dissociate from his jaw with no rounding or retraction. Similarly, tongue and jaw dissociation was also limited. Basically, he used his jaw to elevate his tongue. For vowels, the tongue stayed at the floor of his mouth with little to no tongue elevation. Sam had difficulty imitating non-speech oral postures such as a lip pucker, smile, a wide open mouth, even with visual cues like a mirror. It was clear that using purely auditory and visual models to increase his vowel repertoire was a path to frustration and limited success. I therefore planned a unique treatment program that used a two pronged approach:

  • Building sensory awareness, increasing strength, coordination, grading and dissociation skills,
  • Using tactile approaches (P.R.O.M.P.T, TalkTools Therapy Tactile Tools for Apraxia of Speech and TalkTools Ice Stick) to build speech production for vowels.





Kimochi’s and Children with Social-Communication Disorders

kimochis-curriculum After 11 years in the field, I finally came across a curriculum that made teaching emotions a fun and positive learning experience. I was fortunate enough to be able to attend a presentation by Diann Grimm, M.A., CCC-SLP, Ed. S. on the Kimochi Curriculum. Kimochis in Japanese mean feelings. The program incorporates Kimochi characters with a pocket to place their Kimochis (emotions). Each Kimochi is a soft pillow with the feelings printed on one side and the corresponding facial expression on the other side. Using the Kimochis in conjunction with the feelings lessons as a part of the curriculum allows the children to learn to identify and express their emotions in a safe and focused manner. It fosters Social-Emotional Learning (SEL) which is a critical adjunct to the Social Thinking ® curriculum proposed by Michelle Garcia Winner. The adorable toys and the fun and child-friendly curriculum is a great way to support positive behavior, self awareness, social awareness, self management, relationship skills and decision making. It appears that some of the early research using this curriculum has shown positive results for children with Social-Emotional Learning difficulties (e.g. children on the Autism Spectrum). In addition, this curriculum has also been used for typical children in general education classrooms. I am so pleased and excited to offer the Kimochi Curriculum as a part of the Social Thinking groups. I think it will be an important piece to the puzzle that addresses the “Feelings-Communication-Behavior link” that Diann Grimm talks about.

Hello world!

I am so excited to finally launch my website. I want to officially thank everyone who helped make my vision a reality. I thought I’d write this blog to share ideas and techniques with parents and other speech language therapists. Thank you for reading and I can’t wait to hear your comments.