1. Speak Up! Increasing Vocal Volumes in Children with Autism
Sorah Stein, MA, BCBA, CSE
Indiana University South Bend
And
Partnership for Behavior Change
Sherry Forzley
Partnership for Behavior Change
Introduction
Results
Deficits in communication are one of the primary symptoms of autism. This might include, for example, weak or absent vocal communication, weak or absent verbal behavior, or idiosyncratic use of language. One idiosyncrasy observed that led to the present study is vocal volumes that are too loud or too quiet, impairing communication in social and academic settings, and less likely serve the function of accessing needs & wants.
The goal of the current study was to shape vocal volumes of three children with autism to appropriate conversational levels, across all verbal operants, in the clinic and home settings, while incorporating access to naturally occurring reinforcers.
Overall, data show slow and inconsistent mastery of vocal volume targets. Since January 2014, Child 3 mastered three targets, Child 2 mastered one target, and Child 1 remained on target one. Child 3 demonstrated fewer errors in reading aloud when he has not missed more than 2 therapy sessions, but his reading aloud levels did not generalize. Child 2 showed some consistent results when he started Methylphenidate Jan 30th; his data became sporadic around the time he experienced dietary changes and had Naltrexone added to his regimen. Child 1 remained consistently below target ranges with a few exceptions, however, his volumes slowly increased.
Method
Subjects
We identified three children diagnosed with Autism Spectrum Disorder with fundamental mand, tact, and intraverbal repertoires (Skinner, 1957) whose volume was either too loud or too quiet for functional, social interactions. Child 1 consistently vocalized below 70dB; Child 2 vocalized between 45dB and 85dB; Child 3 vocalized using appropriate volumes, however, he read, and at times, spoke at volumes outside the target range, therefore we included him in the intervention.
Baseline
To establish the target volume, we conducted probes with multiple center staff speaking in conversational tones, 2-feet away from the phone/app. Thus, we established the target as 70-90dB within the center and two of the children’s homes.
Child 2 demonstrated volumes within range on two of four targets. However, having worked with him intermittently over the past 18 months, it became evident he did not always speak in volumes within the target range. Therefore, he remained in the intervention. Child 1’s baseline data ranged from 48dB to 82dB with only 3 out of 20 data points within target range. Child 3’s baseline data ranged from 82dB to 95dB with 5 of 20 data points above the target range. His reading aloud program yielded similar results. We included him in the study to improve his reading aloud skills.
Intervention
This intervention is based on research on shaping vocal approximations with differential reinforcement (DRA) of improving responses (Newman et al., 2009) and putting all other responses on extinction. “Children mastered vocal skills more rapidly when they learned through shaping” (Newman et al., 2009). We adapted this intervention to focus on collecting measurement of volumes while incorporating the verbal operants and differential reinforcement to shape the vocal volume.
Behavior Measurement
Volumes were measured using a volume meter app for smartphones, Decibel10th (Skypaw, 2014). We used a piece of yarn cut to 24” to ensure correct distance between the microphone and the subject’s mouth. The child was prompted to emit a sound while the therapist captured the volume measurement. Data were measured as vocal volume in decibels.
Discussion
Anecdotally, caregivers and therapists reported an increase in vocal volumes, including singing, responding, manding, and vocal perseverations, with all three subjects. Additional opportunities for data collection, including more trials and spontaneous measurement, along with encouraging caregivers to only reinforce audible vocalizations will be our focus moving forward.
Interobserver agreement: Interobserver agreement (IOA) was collected on 45% of all sessions at 100%. Screen shots of each measurement were taken at the time of measurement and stored by date for IOA.
Weaknesses: Due to transitions in data entry, we missed a few opportunities to advance to new targets with one subject, however post “mastery” data showed inconsistencies. Also, confounding variables such as medication changes, alternative treatment,s and caregivers reinforcing low volumes unintentionally may have affected progress.
Skypaw, (2014). Decibel10th (3.8.2) [Mobile application software.] Retrieved from
Cipani, E., & Schock, K.M., (2011). Functional Behavior Assessment, Diagnosis, and Treatment, (2nd edition). New York: Springer.
Newman, B., Reinecke, D. and Ramos, M. (2009). Is a Reasonable Attempt Reasonable? Shaping versus Reinforcing Verbal Attempts of Preschoolers with Autism. Analysis of Verbal Behavior 25,