Enhancing Spontaneous Speech Production in a Previously Nonverbal Adult with Autism

Background: Individuals with autism who fail to develop speech normally rarely develop speech after age 5 (Pickett et al., 2009).  However, we have succeeded in training one individual to produce oral speech, starting at 14 years of age (O’Grady et al., IMFAR 2004, 2005).  AI (not his real initials) initially used individual consonants and vowels, with prompting, for communicative purposes.  At age 16, AI began using, with prompting, 1-3 word utterances with carrier phrases.  By age 21.1, although his speech capabilities had continued to improve, his intelligibility and initiation of communication were still limited.  All observed spontaneous utterances consisted of requests for reinforcing items.  Here we report on focused efforts to improve AI’s spontaneous initiation and fluency with oral speech, beginning at approximately age 21.3.

Objectives: To determine if it was possible, to (1) increase expressive mean length of utterance, (2) increase intelligibility of expressive verbal communication, and (3) increase spontaneous use of expressive verbal vocabulary, in a previously non-verbal, low-functioning individual with autism, by a concerted, concurrent use of several approaches. 

Methods: The speech and language curriculum was organized to teach expressive use and receptive knowledge of target words simultaneously.  Targets were systematically chosen with consideration given to motor ability, language development, and reinforcing value.  The five-step teaching procedure included (1) errorless exposure, (2) errorless prompting, (3) expansion of utterance to a two-word phrase, (4) use in novel context with delayed prompting, and (5) unprompted use in novel context.  These teaching procedures were based upon such principles as errorless learning, generalization (Carter & Hotchkis 2002), feedback (Maas et. al. 2008, Hula et. al. 2008), and effects of over learning (Rohrer & Taylor 2005).  Intelligibility was addressed via the PROMPT method (Chumpelik (Hayden) 1984; Hayden, 2006), addition of manual signs, and the Goldman Fristoe Test of Articulation–2 (Goldman & Fristoe, 2000).   Data collection relied upon review of audio- and video-taped sessions (the bulk of the data), results recorded in instructors’ contemporaneous notebooks, and family report.

Results: At age 21.3, 28 target words were introduced to AI’s curriculum.  Of these targets, 16 were believed to be novel or not previously programmed.  The remaining 12 were carried over from the previous speech curriculum.  By age 21.10, eleven words met criteria for improved usage:  AI demonstrated the ability to use these words to verbally and manually express targets in two-word phrases, in novel situations, without prompting. Of the 28 target words, 19 have been reported in spontaneous speech at least once. 

Conclusions: Often, functional communication targets are chosen without consideration of the student’s motor ability or current language ability.  In this case, the same words were targeted simultaneously for intelligibility, functional communication, and receptive language.  Generalization was programmed from the beginning, by words being taught in their naturally occurring environment and their use resulting in contextual reinforcement.  It is hypothesized that this coordinated effort allowed for the maximum exposure and practice required to acquire the spontaneous use of spoken communication.