Understanding the Speech Mechanism: Impact on teaching and program development.

I was co-treating with a speech therapist on Monday working with a child with autism that also appears to present with severe apraxia. While I'm not ready to debate the diagnosis or what it means, what is clear is that the child has a very difficult time articulating. Now as an ABA therapist, what does this mean to me, and how can I teach or shape his vocal behavior?

Many ABA therapists and programs do not feel that certain related services are necessary and that all behaviors can be addressed in an ABA program. While I agree that using good teaching and analyzing behavior and shaping behavior this is true, I as an ABA therapist simply do NOT have the knowledge base that a speech therapist has and I feel that this role is imperative on a team. That being said...

The two of us were targeting the "eh" sound found in many words, and the therapist was talking to me about "jaw grading". I didn't know what this was, nor had I ever tried to monitor it or shape it. Getting into a discussion about articulation, we discussed all the components within communication and cognitively, that a child must be able to plan (motor planning) or rather coordinate in order to speak and more importantly, to articulate so that he can be understood. Below I will highlight the areas as I understand them, as a behavior analyst, not as a speech therapist.

• Jaw grading - the child needs to open his jaw to an appropriate degree, and this requires planning. For example, a jaw almost completely closed (found in the 'eee" sound) or completely open (found in the 'ah' sound) are the easiest positions and easier to shape and teach. However, three positions in the middle (one of those producing the 'eh') are levels of jaw grading and requires skill to identify what level the jaw should be open to target a specific sound
• Lip closure - in addition to the above, lips need to be shaped in a certain way in order to produce target sounds, paired with appropriate jaw grading. Another area that a child must gauge level of lip closure, opening, forming, etc. that is needed in order to produce the target sound.
• Tongue placement - while all this is going on, the child needs to place his tongue in the correct position, which is also difficult to prompt. Therapists have become quite adept at prompting the lips and jaw, but the tongue presents quite a challenge, as evidenced in trying to teach a child with artic difficulties the "l" sound.
• Breath and volume - how loud the child says the target. With kids that are low-tone, this presents as a unique challenge.
• Tone - how appropriately is it said? This can be a problem for many children on the spectrum who sound robotic at times, or their voice fluctuation is off.
• Retrieval - Cognitively, in addition to all of the above, the child needs to retrieve the target label, request, word, etc. when needed. Often children will imitate beautifully when presented a model, but the word falls apart when they have to label it with no model, or are requesting spontaneously.

All of this, requires a lot of work for some of our kids. It is amazing they find the energy to talk at all, given how much is involved and how much cognitive energy must be expended in order to get the target out.

What does this mean for our programs?

- Collaboration with speech therapists is necessary, and how to prompt the appropriate Jaw grading, lip closure, etc. is imperative. While as ABA therapists we are not PROMPT trained, there are techniques that can be taught to us to help us obtain the target sounds.

- Practice. Repeated practice in isolation and distributed practice throughout the day (sound familiar?) However the targets need to be clear and identified upon in a team fashion with the speech therapist input regarding the skills mentioned above and what the child is capable of doing at this point.

- What is difficult? When functional words you want to target encompass skill levels that the child is having a difficult time with. This is where speech and ABA butt heads a little. The speech therapists want to hold off on the words and sounds the child can't say until they can do so with fluency, and the ABA therapists want to get this kid communicating one way or another. A compromise has to be reached here. Functional words need to be targeted, while these sounds may need to be prioritized as speech goals. For example "I jump on trampoline" may be impossible for a child to say, but it is his favorite activity, and asks for it a hundred times a day, the articulation needs to be shaped, even if it appears he isn't ready for it.

Co-treating with speech therapists is always incredibly informative, this time more than others, and I felt like I had a stronger understanding of "why" a child may not be able to get a word or sound out. This also shows how collaboration is necessary in addition to informative and helpful. Any comments are appreciated. I do have a lot more respect for how touch it is for some of our kids to get these words out and give them props for trying.