Can Computer-Assisted Training of Prerequisite Motor Skills Help Enable Communication in People with Autism?

Background: Our and others' research indicates that in fully a third of people with autism who lack communicative speech, the communication deficit may actually be a deficit in motor skills necessary to move the mouth and the vocal tract. These individuals have difficulties in fine, gross and especially oral motor skills, and a disparity between impaired expressive language and relatively intact receptive language. Within this motor-impaired subgroup specifically, training in visuomotor skills prerequisite to effective communication may provide a 'back door' to developing social communication, via a route other than speech.

Objectives:  Given the labour-intensive nature of communication therapy in general, we therefore are interested in testing a computer-assisted, caregiver-mediated training programme for motor communicative skills, and contrasting learning effects between a motor-impaired autistic subgroup defined by impaired fine and especially oral motor skills and disparity between impaired expressive and more intact receptive language.

Methods:  Point OutWords (http://www.AutismCollaborative.org/PointOutWords/), free, tablet-based software designed and tested in collaboration with autistic clients and their communication therapists in India and England, and deployed worldwide, exploits the autistic fascination with parts and details to motivate attention to learning manual motor and oral motor skills essential for communication. Autistic clients practise pointing and dragging objects, then pointing at sequences of letters on a keyboard, and if and when able, speaking the syllables represented by these letters. Users and their parents or guardians can opt into network-based collection of data on motor interactions with Point OutWords, from which are derived several internal measures of baseline and change in visuomotor targeting error, touch force, and any anticipatory movements of the device by the caregiver. These measures of motor skills development internal to the software are complemented by external, standardised tests of motor and communicative development administered to children (Mullen Scales of Early Learning: Fine Motor, Receptive Language, Expressive Language) and parents (Movement Assessment Battery for Children (MABC-2) Checklist), Social Responsiveness Scale (SRS-2), Parenting Stress Index (PSI-4), Vineland Adaptive Behavior Scales II); these are analysed by a 2x2 (motor-impaired or motor-intact subgroup, Point OutWords treatment or iPad exposure control condition) repeated-measures analysis of variance, and also by Bayes factors as data are accumulated.

Results:  Pilot results indicate an increase in pointing and dragging accuracy in all internal measures p < 0.05). Current results show no significant effect of treatment or of subgroup; Bayes factors indicate neither conclusive evidence for or against any effects. Data acquisition continues, and updated results will be presented.

Conclusions:  Caregiver-mediated, computer-assisted therapies targeting prerequisite motor skills – and the Point OutWords therapy in particular – may or may not be an effective complement to traditional therapies that more directly address autistic social communicative deficits. Further exploration is warranted and is being implemented. Point OutWords is at least a useful demonstrator of the potential for a task-sharing approach to autism therapy that involves caregivers and avoids the need for additional clinical staff time.