The Use of Mobile Technology in the Treatment of Prosodic Deficits in Autism Spectrum Disorders

Background:  Language deficits in ASD are both highly prevalent and have significant impact on adaptive functioning.  For 80% of individuals with ASDs who acquire spoken language, deficits in prosody are among the most chronic impairments. Prosodic speech deficits impede social interaction and limit participation in daily activities. Despite the handicapping nature of prosodic disorders, there are few interventions to treat these deficits.

Objectives: The purpose of this study is to assess the feasibility and preliminary utility of an application, SpeechPrompts,for iOS devices in the treatment of prosodic disorders in school-age children with ASD.

Methods:  Students, 5-19 years of age with a diagnosis of ASD and prosody deficits, were enrolled in the study (N=40). These students were recruited from the caseloads of school-based speech-language pathologists (SLPs; N=10) in an educational setting. SLPs recorded speech samples for each student pre and post intervention. These samples were rated by an SLP unfamiliar with the students using a Likert scale for each of the following prosodic features: Rate, Rhythm, Intensity, Stress, Global Intonation.  SpeechPrompts is an iOS application whose main function is to provide a visual representation of the prosodic features of speech. The application provides both real-time feedback and opportunities for the student to match their speech to an adult or peer target. Each SLP received an iPad with the SpeechPrompts application. A brief tutorial was provided to each SLP and included instruction on the use of the main features of the application. The application was presented to the enrolled students as part of their speech and language services. The SLPs were instructed to use the application as them deemed fit using clinical judgment. Intervention duration was ten weeks. SLPs completed weekly engagement questionnaires for each of their students which rated the students’ and SLPs’ experiences with SpeechPrompts. SLPs also completed end-of-study surveys.

Results:  Usage data collected revealed SLPs accessed the application daily during the school week with a median frequency of 2.5 sessions per day. Post-treatment prosody ratings based on speech samples obtained at end of treatment indicated improvements in prosodic functioning with greatest improvements observed in vocal intensity and stress patterns. Engagement measures indicated that students enjoyed the sessions (88%), did not engage in disruptive behavior while using the application (88%) and looked forward to using the application again (96%). All SLPs enrolled in the study reported that they felt comfortable recommending SpeechPrompts to colleagues in end-of-study surveys.

Conclusions:  Results of this study suggest that SpeechPrompts has the potential to be a useful tool in the treatment of prosodic disorders as seen by improvement in prosodic functioning in this small group of students. Moreover, the application appears to maintain the student’s attention and engagement over the course of treatment. In conclusion, SpeechPrompts provides SLPs with an additional tool in their repertoire to address these difficult to treat set of speech difficulties commonly observed in children with ASDs.