Increasing the Vocal Responding of Children with Autism and Related Disabilities Vincent J. Carbone, Ed.D., BCBA-D NYS Licensed Behavior Analyst Carbone Clinic New York – Boston – Dubai Association for Behavior Analysis-International Chicago, Illinois May 29,

A large number of children with autism fail to develop echoic responses (vocal imitation) to adult sounds and words (Esch, Carr & Michael, 2005).  Some reports estimate that approximately one-third to one- half of individuals with autism do not use speech functionally (National Research Council, 2001). For language delayed or impaired children, failure to emit even limited vocal responses may present serious implications for the later acquisition of vocal verbal behavior (Whitehurst, Smith, Fischel, Arnold, & Lonigan, 1991). 2

Typically developing children produce early speech sounds without explicit instruction or planned interventions. However, with many children with autism the direct or automatic reinforcement typically experienced during development may not be sufficient to produce frequent and varied sound production. This essential repertoire may therefore require precise teaching procedures involving planned direct reinforcement and the manipulations of variables that make sound production more likely (Tincani, Crozier, & Alazetta, 2006). 3

However, the more immediate and urgent need of non-vocal children with autism is the acquisition of an alternative form of communication since the speech production of many of these individuals is insufficient to control the behavior of a listener. As a result researchers have investigated the effects of teaching an alternative method of communication on the development of vocalizations in children with autism. (Anderson, 2001; Millar, Light & Schlosser, 2006; Schlosser & Wendt, 2008; Tincani, 2004; Tincani, Crozier & Alazetta, 2006) Most of the research in this area has investigated the benefits of speech generating devices (SGDs), manual sign language and PECS on the development of vocalizations. 4

In almost all of the studies the researchers taught mands with the alternative methods and measured the effects upon speech production. Overall, the results are mixed and no one method of alternative communication appears to be particularly stronger than another in supporting the development of vocal responding.. However, it appears that manual sign language may have some advantage over the other forms of alternative communication (Anderson, 2001; Curtis, 2012; Tincani, 2004). Additional researcher is needed to draw any definitive conclusions. 5

Consequently, investigators have attempted to produce vocalizations with alternative methods of communication by combining the effects of prompt delay and echoic prompting during mand opportunities. ( Carbone, Sweeney-Kerwin, Attanasio & Kasper, 2010; Gevarter, et al., 2016; Tincani, 2004; Tincani, et al., 2006). Within the study that I will describe today children with autism were taught manual sign language. 6

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Method Participants and Setting  Three participants were included in this study. All participants attended a private, publicly funded school serving mostly children with developmental disabilities. Participants were selected for inclusion in this study because none had demonstrated a consistent or functional vocal responding repertoire.  A pre-baseline sound inventory was recorded for two hours over several days to assess the frequency and variety of vocal productions. 8

Tony was a 4-year-old boy diagnosed with autism. He had acquired 15 manual sign mands but produced few vocalizations when manding. Ralph was a 4-year-old boy with Down syndrome. He had acquired 10 manual signs and he produced very few vocalizations while manding. Nick was a 6-year-old boy with autism. He had a weak mand repertoire with sign language and required partial physical prompts or full physical prompts to produce his manual sign mands. His sound production was very limited. 9

Dependent Variable  The dependent variable measured in the study was the occurrence of any vocal response, including a speech sound, word approximation, or adult word form, as recorded when the sound occurred simultaneously with the manual sign, after the emission of a sign during the 5-second time delay, or after a vocal prompt.  A trained observer recorded the sound productions by transcribing phonetically all sounds emitted during the session.  Inter-observer agreement was conducted for 30 percent of the sessions yielding a range of 96% - 100%. 10

Experimental Conditions In all of the experimental conditions the experimenter sat at a table in front of the participant with six items for which the child had manded for with a manual sign when the relevant MO was in effect and the item was present. The experimenter displayed each of the items individually indicating its availability. The items were randomly rotated through this process for 50 trials during each session in each condition. Two sessions were conducted each day. Baseline After the child declared motivation for the displayed item correct manual signs resulted in delivery of the item. Failure to respond in five seconds resulted in the experimenter prompting the manual sign mand. 11

SEE PROCEDURES NEXT SLIDE Prompt Delay and Vocal Prompt  After declaring motivation for the item displayed any manual sign that was accompanied by a vocalization resulted in reinforcement by delivery of the item. Failure to produce a vocalization with the sign resulted in a 5 sec. prompt delay. Any vocalization that occurred during this period resulted in reinforcement. If a vocalization did not occur during this period the experimenter presented a vocal prompt by saying the name of the reinforcer. The prompt was repeated three times if needed to evoke a vocal response. If no response occurs at this time the reinforcer was delivered. 12

13 Prompt Delay and Echoic Prompting Procedures BASELINE MO Sign Response Reinforce TREATMENT MO Sign Response ---(5 sec Delay)--- Vocalization---Reinforce OR MO Sign Response ---(5 Sec Delay)---NR--(Up to 3 Echoic Prompt)--- Vocalization--Reinforce OR MO--Sign Response ---(5 Sec Delay)--- NR-- (Up to 3 Echoic Prompts)---NR-----Small Reinforcer

Modified Phonetic Transcription Transcribe Example Vowels: ekey ehred ipie Teach as oh-ih ihpin abait Teach as a-ih ahhad ookay Teach as oh-uu ohcod oomoon uuwood uhbud Vowel Diphthongs: owhow, about Teach as ah-oo awlaw Teach as oh-oo oyboy Teach as o-e Vowels Influenced by R: erbutter, bird orfor, oar arcar, large eartear Teach as ih-uh airfair Teach as a-uh Transcribe Example Consonants: ppork bbug tto ddog kking ggo mmad nname vvote ngring ffor th-thing th+them ssay zzoo shship zhbeige hhen chchew jjoin wwin Teach as oo-ihn yyet Teach as e-eht rrow llet 14

15 Prompt Delay and Echoic Prompting to Improve Vocal Production NICK Reinforcer Nick, Mattie & PeterNick, Mattie & Peter 1. Ball ______NR  Prompt Delay  ih 2. Puzzle ______NR  Prompt Delay  e 3. Puzzle Yuu 4. Ball _____NR  Prompt delay  ___NR  Echoic Prompt  uh MATTIE 5. Marble mmm  Prompt Delay  arpwuh PETER 6. Cracker ___NR  Prompt Delay  guh  PROMPT  guhkuh

16 Time Delay, Echoic Prompting and Differential Reinforcement of Vocalizations Bobby and Christy REINFORCER 1. Music mooihk 2. Key ke 3. Ball buh  TIME DELAY  buu  PROMPT  baw 4. Ball bo  TIME DELAY  NR  PROMPT  bo  PROMPT  baw 5. Potty che  TIME DELAY  pohdeh 6. Cereal shoh  TIME DELAY  NR  PROMPT  shoh  PROMPT  shoh  PROMPT  shoh 7. Key che  TIME DELAY  ke 8. Jump bohguhmp  TIME DELAY  NR  PROMPT  duhmp  PROMPT  duhmp  PROMPT  juhm 9. Jump juhmp 10. Cereal che  TIME DELAY  kyuu  TIME DELAY  ke  PROMPT  shoh  PROMPT  shieyoh Bobby w/ Christy Bobby & Brian Case Study Data

Experimental Design:  A multiple baseline across participants was used to verify the effectiveness of the independent variables (Baer, Wolf, & Risely, 1968). Results All three participants showed an increase in vocal production Graphs are on next slide. 17

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19 EFFECTS OF TIME DELAY AND ECHOIC Treatment Procedure

20 VARIETY OF WORD APPROXIMATIONS

21 Tony Word Approximations “wahwah” for water, “buu” for book, “reahl” and “eahl” for cereal, “ve” and “oove” for movie, “puh” & “buhbul” for puzzle, “cahn” & “ahnd” for candy

Conclusions  Time Delay and echoic prompting can increase vocalizations of children with autism when combined with manual sign language.  The portability, ease of acquisition for some children, speed of the response and possibility of development of a full linguistic system suggests that manual sign may be a superior method of alternative communicate to combine with prompt delay and echoic prompting. 22

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References Anderson, A. E. (2002). Augmentative communication and autism: A comparison of sign language and the picture exchange commuication system. Dissertation Abstracts International, 62 (09), 4269B. Esch, B.E., Carr, J.E., & Michael, J. (2005) Evaluationg stimulus-stimulus pairing direct reinforcement in the establishment of an echoic repertoire of children diagnosed with autism. The Analysis of Verbal Behavior, 21, Gervater, C., O’Reilly, M.F., Kuhn, M., Mills, K., Ferguson, R., Watkins, L., Sigafoos, J., Lang, R., Rojeski, L., Lancioni, G. (201). Increasing the vocalizations of children with autism during intervention with a speech generating device. Journal of Applied Behavior Analysis, 49, Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research, 49,

National Research Council. (2001). Educating children with autism. Washington, DC: National Academy Press. Schlosser, R. W., & Wendt, O. (2008b). Effects of augmentative and alternative communication intervention on speech production in children with autism: A systematic review. American Journal of Speech-Language Pathology, 17, 212–230. Tincani, M. (2004). Comparing the picture exchange communication system and sign language training for children with autism. Focus on Autism and Other Developmental Disablities, 19,

Tincani, M., Crozier, S., & Alazetta, L. (2006). The Picture Exchange Communication System: Effects on manding and speech development for school-aged children with autism. Education and Training in Developmental Disabilities, 41, Whitehurst, G. J., Smith, M., Fischel, J. E., Arnold, D. S., & Lonigan, C. J. (1991). The continuity of babble and speech in children with specific expressive language delay. Journal of Speech and Hearing Research, 34,