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As we embark upon a new millennium, we can not help but wonder what lies ahead in our rapidly advancing technological future. What is the course that our profession will be taking? What will the speech therapy session of the future look like? Will our clients and students interface with a computer screen rather than a live person? Will we be replaced by a virtual reality speech-language pathologist? I doubt that a Virtual Therapist will ever take the place of a real live warm-bodied creative human being or that a computer program will be able to create the modifications in an individual's speech production all by itself. However, the fact is that presently computer therapy is available as a wonderful adjunct to the established mode of delivery.
I am a speech-language pathologist who has been practicing for the past twenty-two years. I am also the mother of an eight-year-old son with autism. During a visit to Disney World in 1994, I viewed an exhibit that demonstrated many computerized applications. It struck me that this technology offers the opportunity for our children with autism to have an optimistic view of an independent future. It was at that time that I began to include computerized-based learning in my son's program as well as in the programs of the other autistic children that I instruct.
The Miami Children's Hospital Dan Marino Center located in Weston, Florida is a facility dedicated to providing speech therapy as well as other therapeutic interventions for many children with autism and pervasive developmental delays. Presently, I have had the pleasure of assisting June Dickinson, the Director of Rehabilitative Services, in designing a specialized program specifically dedicated to the implementation of computer-based speech and language therapy. Roberto Tuchman, M.D., the Executive Medical Director of the center and a leading expert in the field of autism, is an advocate of computer-based learning for children with autism. He has coined the phrase, "Developmental Abilities Technology," when he refers to this mode of training. Dr. Tuchman feels that accessing the computer for language development therapy will help these individuals to reach their potential through the repetitive task design that this technology can provide.
I can honestly state that incorporating this technology into my practice has yielded very exciting and successful results for my clients as well as my own child. For the most part, children with autism take to the computer like a fish to water. When analyzing the reasons for this phenomenon, I chalk it up to several factors. First of all, the computer can be very predictable. As we all know, often autistic individuals do not transition well to new activities. Even with computer software, the program is usually not well received the first time the program is introduced. However, each subsequent time, the child remembers, perhaps, the animation, or the design of the program. The child feels comfortable with the repetition of the activity. It is during these times that this child will be receptive to the material that is being presented. It is then up to the ingenuity of the therapist to make slight modifications to the presentation so that the task does not become too robotic, especially with an autistic individual.
Another reason computer therapy is successful is often due to the engaging animation that is often included with these programs. We are always looking for appropriate and effective reinforcers when we are involved in a therapy situation. The software designers usually include stimulating characters when the child picks the correct answer. Instead of using food or bubbles, your behavioral shapers are built into the program. There are also programs that are voice-activated. In other words, the little characters are brought to life when the student vocalizes. I have restructured my other teaching metholodolgies based on the knowledge that I have gained from experience with computer-based learning. For instance, I find that most autistic individuals have an easier time visually focusing on material that is illustrated on a vertical plane. This is how computer information is displayed via the monitor. I feel that this presentation is conducive to learning.
As a software reviewer, I have had the opportunity to utilize many different programs with my clients and my son, Blake. From my experience, I have come to realize that the type of software that is used is critical to the success. Many of the software programs that are available in stores (called OTSS- off-the-shelf software) may not be effective for individuals with autism. These programs were not designed for these children and have inherent problems because of this fact. Though there may be some entertainment value, the educational advantage may be minimal. One of the companies that has designed software specifically for individuals with special needs is Laureate Learning Systems. They provide the most comprehensive line of specialized language software that I have seen. This company offers over 80 different programs for children and adults with special needs. Their programs cover the wide range of language needs from early vocabulary development to complex syntax training.
Initially, you may want to start with receptive language training. Laureate's Exploring Early Vocabulary Series is one of the early developing programs, which focuses on teaching vocabulary within different scenes utilizing a category format. I have used this series for several years with both my students and my son, Blake. This series, which includes Exploring First Words, Exploring First Words II, and Exploring First Verbs, is designed to expand the understanding of 50 vocabulary words per program. The 50 words are divided into 10 common categories, and each screen depicts 5 pictures within the category. For example, when Blake uses Exploring First Words, we may select to work on the category of animals. When chosen, the screen appears illustrating 5 farm animals. The program offers three different activities that can be accomplished. The first activity, which is called Explore Nouns requires that the he select any object he so desires. If Blake, for instance picks the cow, the computer will respond by saying, "This is a cow." The cow then "moos." In Exploring First Verbs, when an object is selected, the computer uses the verb in a sentence ("The boy is singing.") and then animates. The second activity, Explore Nouns and Descriptions follows the same procedure, though adds an additional sentence denoting a description of the object. ("This is a dog. Dogs bark.") Identify Nouns is the third activity offered. This time the computer will ask Blake to find one of the objects ("Find the cheese.") If selected correctly, a funny little animated character pops up for positive reinforcement. I find that having the animation as built-in reinforcement increases his ability to stay on-task during the course of the session. Blake really enjoys this program. He uses a touchscreen (a device that fits over the monitor which allows the individual to select an item by touching it on the screen), since he is unable to utilize a mouse or trackball.
After children have developed the comprehension of an individual word vocabulary, they must master the skills necessary to understand sentences. Because autistic individuals often have difficulty in the areas of processing, grasping word order can often be a problem area. Programs like Laureate's Simple Sentence Structure, help to develop the understanding of sentences consisting of a Subject-Verb-Object structure. An example of this type of sentence would be: The boy (subject) is pushing (verb) the wagon (object). The program works by illustrating two contrasting pictures on the screen. The computer then asks the child to choose the correct picture. For instance, the screen may depict a girl riding a bike in one picture and a boy riding a bike in the other. The computer will then instruct the child to select the one that shows that the boy is riding the bike. Ifthe child identifies the correct picture, then we know that he understands the use of the subject (the boy) portion of this sentence. Another type of task, which targets verb usage, can be illustrated with this example: One picture shows a boy pushing a wagon and the other, a boy pulling a wagon. The child is then asked to select the picture which demonstrates, "The boy is pushing the wagon." If correctly identified, we then know that the child comprehends the verb (pushing) portion of the sentence. A similar activity uses contrasting objects. Finally, the Reversible Subject/Objects activity asks the child to discriminate between sentences such as "The cat is chasing the dog," and "The dog is chasing the cat." I also like to try to obtain a verbal response when I utilize this program. I may hold my hand over the mouse until the child verbalizes the sentence correctly in addition to selecting the correct picture. This is an example of the manner in which the speech-language pathologist can modify the original task. When you need to teach syntax, a program called Micro-LADS, which stands for Microcomputer Language Assessment Development System, trains 46 fundamental grammatical structures within seven separate programs called modules. At the beginning of each lesson, the individual is introduced to the target structure. Next, the student is asked to identify the picture that best represents the structure from an option of three items. An animated character reinforces the learner upon correct selection. I also like to try to obtain a verbal response when I utilize this program.
In addition to the receptive language software, I use programs that are designed to stimulate expressive language and pragmatic skills. Voice-activated software such as TalkTime With Tucker are very popular in my office. There are 5 different activities that are designed to elicit verbal responses from the child. It's helpful when working with an autistic child to utilize a starter phrase as a cue to promote language. TalkTime provides the opportunity to use these prompts. For instance, when we were recently teaching Zachary, a four-year-old with autism, to use the pronouns "you" and "me" appropriately, we accessed his favorite activity called "On Stage." In this scene, different animals instruct Zachary to ask them to perform tricks. For instance, if he wants the giraffe to dance, he must say, "Can you dance for me?" If he wants the tiger to sing, he must ask, "Can you sing for me?" It is with this type of repetition that the correct language will be developed. Later on, we may ask Zachary to apply his pragmatic ability to a live situation, such as asking his mom to bring him some juice ("Can you bring me some juice?").
It is my opinion both as a speech-language pathologist and as a parent of a child with autism that the implementation of computer learning in our children's' lives is an extremely effective method for teaching language and academic skills as well as for developing the abilities needed to live in this computer-oriented society. Exposing these individuals to the capabilities of computer-based instruction utilizing these specialized software programs has indeed enhanced my son's life as well as the many thousands of others that have had the privilege of using them. As Stacey Hoaglund, Zachary's mother, has stated, "Zach is very motivated to learn when he uses the computer. It keeps him focused on the activity. I feel that computer programming has played a very important role in developing Zach's language abilities."
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Valerie Herskowitz, M.A. CCC-SLP is a speech-language pathologist who has treated children and adults with developmental disabilities for the past 22 years. She is also the mother of Blake, an eight-year-old boy with autism. She has been in private practice since 1981.
Ms. Herskowitz is also a speech and language computer software consultant and is available to answer any questions that you may have regarding these programs or any other speech, language, or communication matter as it relates to autism.
You can reach her at: Dimensions: Speech, Language, and Learning Services 481 E. Mount Vernon Drive Plantation, Florida 33325 1-800-99SPEECH (997-7332) www.dimensionsspeech.com
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