AJ’s Journey: From Non-Verbal to Speech Production

I met AJ in April 2014, a mere 6 months ago. His story makes me realize why I do what I do, day in and day out. When I met AJ, he was 9 years old. He had a diagnosis of Autism. His family had relocated from India to Orange County a few months prior to our meeting. His mother later told me that they had made the move specifically because she wanted AJ to receive P.R.O.M.P.T therapy. His mother also revealed how AJ had been through no less than twelve speech therapists, several ABA therapists, and a few occupational therapists. They had also tried Neuro-Feedback therapy; several detox programs, and nutritional supplements, all in the hope that they would help with speech production. After all those setbacks and disappointments, it still amazes me that this family decided to move across the world to try another program. But I guess hope is a crazy thing.

During the initial evaluation, I realized that AJ was truly non-verbal. There were no vocalizations on demand. When asked to say “ah,” he would open his mouth, but there was no sound. He could imitate some lip movements with tactile prompts and cues, but again, without any vocalizations. He did spontaneously babble labial sounds like /baba/ and /mama/, but there was no intentional speech. I realized that at age 9, with little to no progress after years of speech therapy sessions, the odds were stacked against us. When I tried to explain this to his mother, she was quick to respond, “But it can’t hurt to try, right?” I knew then, I had to at least try. P.R.O.M.P.T therapy with tactile cues, in combination with Sara Johnson’s TalkTools® was definitely the way to go.

I saw AJ once a week for 45-minute sessions. His mother would sit through each session, carefully taking notes about the activities and target sounds and words. She would then practice all the activities each day during the week. This video is proof of AJ tremendous progress and his mother’s singular dedication. It was taken after merely 25 sessions of P.R.O.M.P.T. therapy. While there is clearly a long way to go, his incredible achievement so far, makes the future look bright and positive.

Social Thinking Conference in Long Beach, CA

Jan 28-30, 2015

As many of you know, I’ve been using Michelle Garcia Winner’s Social Thinking Curriculum for a while. I am so excited that I finally have the opportunity to attend a Social Thinking Conference. It promises to be three days packed with information about working with children and adults with social communication deficits! The courses for the conference include:

  • Informal, Dynamic Social Thinking Assessment and Core Treatment Strategies for Home and School. (Presented by Michelle Garcia Winner and Nancy Clements)
  • Implementing Social Thinking Concepts and Vocabulary into the School and Home Day. (Presented by Nancy Clements)
  • What’s Play Got to Do with Classroom Learning? Exploring Social Executive Functioning and Social Emotional Learning for 4-7 year olds. (Presented by Nancy Tarshis)

If you are able, I would highly recommend that you attend this conference. It happens about once or twice a year in the L.A. area. It isn’t meant solely for professionals like speech language pathologists and teachers, but also for parents and caregivers of children on the Autism Spectrum and children with social and communicative challenges. There is a special rate for non-professional attendees.

Conference Details

Long Beach Marriott
4700 Airport Plaza Drive
Long Beach, CA 90815

7:30 am- 8:30 am Sign In
8:30 am- 12:00 pm Conference
12:00 pm- 12:50 pm Lunch Provided
12:50 pm- 3:45 pm Conference

For registration and additional information, visit the Social Thinking website at http://www.socialthinking.com/conferences/workshops/long-beach-ca-jan-28-30

Thinkables & Unthinkables Double Deck

One of the new products in the Social Thinking Curriculum is the “Thinkable & Unthinkable Double Deck.” It is suitable for 3rd- 5th grade children with social communication/ social learning challenges. This is a set consists of two card decks:

The Unthinkables: This deck includes 14 sneaky Unthinkable characters. There are several cards for each character so it is convenient to use with groups. Each character’s name and power is included on the card.

The Thinkables: This deck includes 52 playing cards; 3 of each Thinkable , 9 Superflex cards, and 1 information card. Each character’s name and superpower is included on the card.

Thinkable and Unthinkable Double Deck
This set is not meant to be used by it self. It is a supplement to the “Superflex Curriculum.” Once the students are familiar with the Superflex characters, these card decks are perfect to reinforce the concepts. The cards can be used to play games like “Go Fish!” “Memory,” “I Spy,” “Guess Who?” or simply use them with your student’s favorite game like you would any language or articulation picture card set. To add a little movement to the activity, I place Unthinkables cards face down on a Twister mat. We play Twister and the child opens a card he/she lands on and tells what Superflex strategy they would use to defeat the Unthinkable character.

I would recommend using this card deck if you work with children struggling with social communication challenges.. It’s however one tool for practicing the broader concepts introduced in the Superflex line of products: The Superflex Curriculum Book, related comic books, the Thinkables, Superflex’s five Power Pals, and the very cool Five-Step Power Plan. All of the above products including the Thinkable and Unthinkable Double Deck are available at www.socialthinking.com

Monster Expected and Monster Unexpected

This idea was inspired by the “Tattle Monster” by Giggles Galore . They had used a tissue box to create a monster to take care of all the tattles in the house. And while I think it is an adorable idea, I wondered if I could use it to teach, “expected” and “unexpected” behaviors.

So, Mister (or should I say Monster) Expected and Monster Unexpected were born. The initial goal was for the little ones to sort pictures of “expected” and “unexpected” behaviors and feed them to the appropriate monster. But I realized it would be fun for older children to have the monsters in their classrooms or homes and write down “expected” and “unexpected” behaviors during the day and feed them to the monster. What fun it would be to read them aloud at the end of each day!

I covered old tissue boxes with red paper for Monster Unexpected and green paper for Monster Expected. I also cut out the teeth with white foam and taped it to the inside of the box, glue on the eyes and the monsters are ready to go.

Monster Activity

Monster ActivityMonster Activity

I decorated my monster with stickers to make it fun and colorful. I also found pictures demonstrating “expected” and “unexpected” behaviors and glued them to Popsicle sticks. The students then took turns describing the behaviors and stating whether they were “expected” or “unexpected.” The Popsicle sticks were then “fed” to the appropriate monster.

You can download the images I used on the Popsicle sticks here.

A Voice for Amelie Part 4: Incorporating Speak for Yourself (SfY) into Activities and Routines

This blog is a continuation from Amelie’s previous blog that included parent/ caregiver training. In addition to addressing her parents’ questions and concerns, I thought it was important to include suggestions for activities other than requesting for food or toys. I put together an excel worksheet that included the name of the activity, buttons to be kept open on the home (1st) page of SfY, corresponding buttons to be kept open on the 2nd page, and examples of phrases or sentences that can be modeled. The goal here is to model language using age appropriate activities. We weren’t expecting Amelie to formulate sentences like “put on the eyes” right away when playing with Mr. Potato Head. But, the idea is that if a wide variety of vocabulary and language structures were modeled using SfY, it would stimulate receptive language as well as encourage Amelie to use her “talker” for more than just requesting desired objects. It’s really the same old tried and trusted “Modeling Language for Language Stimulation in Young Children” theory that have been used for generations of early intervention specialists and speech-language pathologists, but with a small twist. In addition to verbal language, we also modeled the language structures using “Speak for Yourself.”

I am attaching the excel sheet that includes the activities and toys. I tried to incorporate materials and toys that are present in most households or clinics, or are fairly inexpensive to purchase if needed.

The categories of activities include: 1) Toys/ games/ art, 2) Cooking, 3) Outside, 4) Books, 5) Songs/music, and 6) Everyday Routines. I wanted to include a wide array of activities to ensure that Amelie was using her talker as much as possible during the day.

Of course, an important point to remember is that this is simply a starting point. You can add, change, delete or modify the language and vocabulary in any of the activities based on your client or child. I simply wanted other families and therapists to look at toys and materials they have at home or in their clinics and realize that there are infinite possibilities for using a child’s AAC system to build language beyond requesting. In addition, I would like to note that even though I’ve used “Speak for Yourself” as the AAC system for Amelie, most, if not all of these activities could be used with any other AAC system such as Proloquo2Go or any Dynavox system.

1st Page2nd PagePhrases or Sentences
putputPut eyes on Mr. Potato Head.
buteyesPut ears on Mr. Potato Head.
giveMr. Potato Head
1st Page2nd PagePhrases or Sentences
II want red crayon. 
wantwantI want green crayon.
1st Page2nd PagePhrases or Sentences
giveblockBlock up.
upupBlock down.
1st Page2nd PagePhrases or Sentences
pleasehiHi grandma.
goodbyeBye Daddy.
1st Page2nd PagePhrases or Sentences
likesqueezeSqueeze red play dough.
(You can
change the verb to roll or press)
Squeeze pink play dough.
1st Page2nd PagePhrases or Sentences
ahorsePig jump.
pigHorse jump.
goatSheep walk.
1st Page2nd PagePhrases or Sentences
makefeedFeed the baby doll.
givebaby doll
1st Page2nd PagePhrases or Sentences
makemixMix strawberry.
eatstrawberryMix banana.
1st Page2nd PagePhrases or Sentences
makemixMix blueberries.
eatoatmealMix cinnamon.
1st Page2nd PagePhrases or Sentences
wantwantWant swing.
thenswingWant slide.
1st Page2nd PagePhrases or Sentences
putputPut on arms.
onPut on legs.
1st Page2nd PagePhrases or Sentences
II see bear.
lookseeI see bird.
abearI see dog.
1st Page2nd PagePhrases or Sentences
eatateAte apple.
appleAte pear.
pearAte strawberry.
1st Page2nd PagePhrases or Sentences
hearhearI hear lion.
azebraI hear flamingo.
boa constrictor
1st Page2nd PagePhrases or Sentences
readreadRead book.
bookRead Bear Snores On.
(book icons)
1st Page2nd PagePhrases or Sentences
ridewheel(Child chooses the item)
1st Page2nd PagePhrases or Sentences
waswas(Child  chooses the item)
1st Page2nd PagePhrases or Sentences
walkdanceDance to the music.
1st Page2nd PagePhrases or Sentences
wantwantWant blanket.
sleepblanketWant pacifier.
readread(Child  picks a
book to read)
open all books
1st Page2nd PagePhrases or Sentences
wantwantWant dress.
weardressWant socks
1st Page2nd PagePhrases or Sentences
makewashWash pants.
wearT-shirtWash socks.
pantsWash shorts.

*Disclaimer: I want to state that although I can take credit for most of the content on the spreadsheet above, I have to thank Amelie’s mother for making it pretty and fun to read by formatting it and adding the colors.

A Voice for Amelie Part 3: Questions and Concerns

Just as we started opening up Amelie’s vocabulary on Speak for Yourself, her parents requested a training session at home. They wanted to make sure they were doing everything they could at home to incorporate her communication system. (For all of you who are wondering; yes this family is truly that awesome!) It was a unique opportunity. Most speech therapists (myself included) define our success by our client’s progress. But sometimes (especially for AAC), success should be measured by a caregiver’s motivation and ability to incorporate the AAC system in all arenas of the child’s life.

The training was scheduled during Amelie’s naptime. Amelie’s parents and her nanny were present. I prepared for the training session by putting together questions and concerns. I listed them below hoping that they may be useful for other therapists and families.

Speak for Yourself Categories

Categories for Speak for Yourself App

  1. How soon should we leave a word “open” on SfY?
    As I understand it, a child has to use a word consistently (about 3-4 times) for it to be considered a part of her vocabulary. It should then be left open as a part of her vocabulary. Think of it this way: when a child learns to say a word, she can access it anytime she wants. We don’t take it away and give it to her only when we want her to say it. I would look at teaching words in the SfY the same way. For Amelie we did deviate slightly for a session to work on discrimination as described in the blog “A Voice for Amelie Part 2: Ready to Choose.” As a therapist or parent, you know your client’s or child’s learning patterns and as such you are the best judge of how quickly you can open up words on the SfY. But the important thing to remember is to allow a child to access his/her vocabulary as soon as possible. Assuming that having multiple buttons open at once may overwhelm the child, is at best presumptuous and undermines a child’s true potential.
  2. What’s more important, errorless learning or using the device independently?
    My opinion is that independence is more important than always picking the right word correctly. So decreasing the amount of physical prompts as quickly as possible is recommended. Maybe model once or provide a physical prompt once and then step back to see what she can do. Self-corrections are a great way to learn. Think about how typical children learn language. They have errors in articulation and grammar too. If your child/ client has trouble self-correcting, or is looking at you for help, go ahead and model again. The point to remember is that using physical prompts excessively 1) assumes you know what the child wants and, 2) will reduce the opportunities for a child fix a communication breakdown by self correcting.
  3. How often and when should my child/ client have access to her communication system?
    Again, think about how often and when a typical child has access to her voice and her words. That’s right…all the time and everywhere. If “Speak for Yourself” is your child/ client’s voice and communication system, it should really be accessible as often as possible. Even if she doesn’t have the words open that seem appropriate for the situation, she should still have the iPad accessible. How great would it be if it were a natural response for her to reach for the iPad when she wants to comment on something, or ask for something? We can always open or program words for her when appropriate. But the goal for now is to hammer in the idea that this app is (at least for now) her voice and her communication system.
  4. Besides making requests, how can we incorporate SfY in our daily lives?
    Using the app to model language everyday is key. It will take some getting used-to. The primary mode of learning for any child is imitation. So the more you model using the app, the more she will use it. While it may be really overwhelming to imagine using the app for every conversation, maybe make a list of daily routines during which you can use SfY. For example:
    – Greetings (e.g., Hi Mommy, Bye Sonali)
    – Diaper changes (e.g., Change diaper)
    – Bath time (wash)
    – Getting dressed (Want dress)
    – Getting into the car (e.g., Go out, Go in car)
    – Going to the park (More swing)
    – Nap time (Wear pajamas)
    – Talk about something unexpected that may happen (e.g., go beach)
    – Use it with a friend, neighbor, or extended family (e.g., Hi, How are you?)
  5. Should my client/child have time to play and babble with SfY?
    Yes! As often and for as long as possible during the day.

Other important points to remember:
* If you don’t model using SfY for more than just making requests, she won’t know how to use it for more than just making requests.
** When modeling, think about your goals. If you are targeting 2-3 word utterances, that’s what you want to model.
*** When modeling, you are showing her how to talk using SfY. She isn’t necessarily expected to imitate right away. If she does, that’s great, but if she doesn’t, it doesn’t mean that she isn’t learning. When we model language to a young child, we don’t expect her to imitate the whole sentence right away. She may imitate just a key word, or not say anything at all. She’s still learning.

Fast ForWord: Does it Really Work?

Fast Forward Does It Work I have been exposed to the Fast ForWord® program for several years. I was introduced to the program during my Clinical Fellowship (first year of work after grad school). I worked at a private practice in Pasadena, CA. The owner of the private practice was a veteran in implementing the program and used it with a wide variety of students with disabilities ranging from mild auditory processing to severe autism. My first reaction on viewing the program was skepticism. How can any computer program take the place of a real, live clinician? How can sitting in front of a computer for an hour a day fix all the language and learning problems? Now, 12 years later, as an owner of a private practice and a Fast ForWord provider, my perspective hasn’t really changed. Fast ForWord cannot (and wasn’t designed to) take the place of a therapist, nor can it truly “fix” all language and learning challenges. So perhaps, it is more productive to look at what it was really meant to do, and then decide if it truly does work.

According to Dr. Martha Burns, language processing can be broadly divided into three hierarchical levels: Low Level (Perceptual Skills or Listening skills), Mid Level (Grammar and Vocabulary), and High Level (Complex Problem Solving). If the three levels are viewed as a pyramid, the Perceptual skills would form the base, Grammar and Vocabulary skills would form the middle portion, and Problem Solving skills would form the tip of the pyramid. As you can imagine a shaky foundation or base could potentially cause the entire pyramid to fall. Our ability to quickly perceive (listen to) sounds, tell if two sounds are same or different, put sounds together to form words, and also manipulate sounds to change words and their meanings is truly the foundation of language. Several conditions in young children can lead to impairments in these Low Level processing skills. Autism, ADD, ADHD, middle ear infections, and seizures are only a few conditions that lead to these impairments. The goal of the Fast ForWord programs, therefore, is not repair high-level problem solving skills, or even to teach grammar and vocabulary. The primary focus of Fast ForWord is to enable a child to perceive miniscule changes in speech sounds that occur at a rapid rate during spontaneous conversation or classroom lessons. Of course, this may result in changes in mid- and high-level processing, but these changes are a product of the progress seen in low-level processing. However, this does not eliminate the need for more traditional individual therapy to work on grammar, expanding vocabulary, and problem solving. In fact, Fast ForWord may make traditional behavioral approaches more effective and productive.

One of the criticisms of Fast ForWord has been that a clinician can target the areas addressed by Fast ForWord. Traditional auditory processing therapy focuses on skills such as following directions, phonological awareness, and auditory recall. While Fast ForWord targets the same areas, traditional approaches are merely asking the child to do things that are already challenging for him without making any modifications to the stimulus. Clinicians attempt to change the stimulus by saying it slower, or louder, or by using headphones to eliminate noise. While these are beneficial to some extent, they do not take into account the core deficit that many students face in terms of auditory processing: the speed with which sounds change within words. It is impossible for humans to stretch the speech sounds to reduce the rate. At present, the only software that can achieve this is Fast ForWord. Thus the traditional approaches provide compensatory strategies without really addressing the core area of deficit.

In my experience, it is rare to find sudden dramatic changes that encompass all language areas after a few weeks, or even a few months of Fast ForWord. It appears that although Fast ForWord drives neurological changes in the white matter tracts of the brain, these changes are not evident in a vacuum. They must be supported by behavioral intervention that targets higher-level language processing. In a crux, it just seems like Fast ForWord works best when it is done in conjunction with language therapy that targets mid- and high-level skills.

Superflex Superdecks: Product Review

Superflex SuperdecksAre you having trouble squeezing in time to develop novel therapy materials for your social thinking groups? You’re not alone. With a crazy schedule of both private and public school speech therapists, this new pack of cards is an incredible time-saver.

The Superflex Superdecks are card decks to help your students practice and promote the skills they learned in the Superflex Curriculum. It is important to note that the card decks do not replace the curriculum, but in fact supplement it. I used them after my students were at least familiar with the Unthinkables and the Superflex strategies. So if you’re looking at this set, consider purchasing the Superflex Curriculum and comic books first. The card decks are meant for kids between ages 8-11 years.

The game includes:

  • Unthinkable Card deck which includes 14 Unthinkables (2 each), 6 Superflex Cards, 18 Brain Sensory Cards.
  • Situation Card deck which includes 5 Power Pat cards, 47 situation cards.
  • Strategy Card deck which includes 52 Strategy cards.
  • Thinkables Card deck which includes 14 Thinkables (2 each), 6 Superflex cards, 18 Brain Sensory cards.
  • 5 Step Power Plan Cards (4 copies)
  • Thinkables/ Unthinkables Reference Card (4 copies)
  • An Informational and General Instruction booklet.

Even though I’ve been using the Superflex curriculum for a while now, it was really helpful to look through the Informational and General Instruction booklet. There was a lot of useful information about what’s included and general instructions about using the game.

The reference cards are an excellent visual to review all the Unthinkable and Thinkable characters. I spent a lot of time with these cards before using the card games. A good understanding of these characters is crucial to this program.

The 5 Step Power Plan includes the 5 Power Pals who will help the students review the steps to take in a socially tricky situation. I like the clean visual. I made several copies of this card and will sometimes have the students write or draw what the 5 Power Pals would do in each situation.

The Thinkable cards can be used as a game such as “Put ‘em to Rest.” The object of the game is to identify which Unthinkable is put to rest by the Thinkable. (The answers are on the back of the instruction card). You can build on this by asking your student to come up with a “Thinkable” moment and describe the Thinkable’s superpower.

The Unthinkable cards are used to play the “On the Scene!” game. The object of this game is to describe a time and situation when the Unthinkable character may make an appearance.

The Situation card deck contains various social situations where the Unthinkables appear. The object of the game is to identify which Unthinkable may be at work in that situation. (It might be useful to keep the reference cards for the characters handy for this game.) The situations are realistic and easy to relate to for most school-age students. You can also go on the Social Thinking website (www.socialthinking.com) for a blank template to make up more social situations.

The Strategy card deck contains possible Social Thinking strategies to use when the Unthinkables usually make their appearance. The object of the game is for the student to identify, which Unthinkable can be defeated by the strategy on the card. Since our focus is almost always on thinking of strategies when a situation is presented, I think it is really useful to work in reverse sometimes. It helps solidify the concept.

*Even though you can play the card games by themselves, some of my students prefer to use them with their favorite game (just like you would any flashcard set).

Overall: The Superflex Superdecks is a fun, engaging and motivating game to review and practice the Superflex Curriculum. I love the idea of creating your own Unthinkable characters and situations using the templates on the website. Even though the instructions for the card sets are provided, it is easy to create your own games to make it more exciting for your students. On days when the kids seem particularly lethargic and slow, we used the Unthinkables card set to play treasure hunt. I hide the character cards and the students take turns to find them. They then describe what the Unthinkables do in a social situation and come up with a strategy to cope with them. Really, the possibilities are endless! I definitely think this game is an excellent buy for around $40. You can purchase your set here.

Disclaimer: This item was provided to complete this review. No other forms of compensation were provided. The thoughts and opinions expressed in the review are the author’s.

A Voice for Amelie Part 2: Ready to Choose

Amelie began using Speak for Yourself (SfY) independently as long as a single button was open on the screen. She was using it consistently for about two weeks in the therapy room, at home and at school. Despite the enormous success, we knew it was too early to pat ourselves on the back. Having just one button open on the screen while she uses it to make requests wasn’t functional. It was critical that we started opening up the buttons that were familiar so she could discriminate and choose the one she wanted. So during one of her sessions, I tried opening up two buttons (banana and peach). She was familiar with both words. However, the only snack we had was a banana. We didn’t have a peach. We started the session by displaying her snack (banana), and then placing her iPad (now referred to as her “talker”) in front of her. By now, she knew the drill. Like a pro, she hit “eat” which lead her to the secondary page. Now, instead of just one option, there were two. The couple of times she hit “banana” there were no problems. But, when she hit “peach” and I said “Oh, sorry, we don’t have peach today,” there was a meltdown. If she could talk, I know she would be saying, “But I hit the button! What more do you want?!!” After a few episodes, I found myself thinking, “Gosh I wish there was an easier way to do this.” It made me think of an old PECS® training I had attended many years ago. They work on discrimination by pairing a highly desired object with something the child did not care about.

So for the next session, I asked mom to send a food item that Amelie doesn’t like (pickles) along with her favorite snack. So this session I displayed the two snacks and placed her talker in front of her. Once again, hitting “eat” was easy. Again, two options were open on the secondary page: a desired item (banana) and a non-preferred item (pickles). This time, when Amelie hit “pickles” and was presented with pickles, we didn’t have a meltdown. She looked confused. She even tried putting it in her mouth. She spat it out after a few seconds and instead of crying, she reached for her talker again. While this may not seem like a huge deal, to her nanny and I who waited for her outburst with our breaths held, it was an enormous achievement. For the next few trials, every time she hit “pickles,” she shook her head as if to say “no, no, that’s not it,” and then went ahead and hit “banana” instead. Suddenly it seemed that she realized that different buttons meant different words. She understood that because I gave her the pickle when she asked for it. Having her press a button and then say “Oh, I don’t have that,” was too much to process through her frustration. Now that she understands the concept of different buttons for different words, we are seeing a dramatic decrease in tantrums and meltdowns. I can now say, “I’m sorry, there’s no more banana. Would you like grapes instead?” There are no more tantrums. She reaches for her talker and tries again.

Hindsight is always 20/20. I think I should have worked on discrimination earlier than I did. I don’t think Amelie needed the two weeks I gave her to familiarize herself to her talker. Instead of closing all the buttons except the one she was requesting may not have been necessary. In the long run, I don’t think that two weeks is a lot of time lost, but I know that in the future I will push a little harder and move a little faster. While there is the occasional drama when she hits the wrong button sometimes (truthfully, it wouldn’t be Amelie without the drama), the big picture is that she has almost a dozen words on her talker that she can use to make a choice.

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.