Identifying and Treating Childhood Apraxia of Speech in Minimally Verbal Children with Autism

尽管每四个自闭症儿童中就有一个在五岁以后仍然保持着最低限度的语言能力，但我们并不知道所有的情况 在这些自闭症儿童中，限制言语能力的因素。一个强大的 贡献者可能是伴随的运动性言语障碍，儿童言语失用(CAS)。中国科学院 是语言计划和顺序能力的障碍，这会使语言不一致 而且不精确。而是因为产生可理解的语音是获得口语的先决条件 语言，迫切需要了解CAS如何影响言语运动和 旨在提高自闭症儿童的语言清晰度，并制定综合干预措施 应对CAS的战略，如果存在的话。该项目提出了三项研究，以调查 自闭症儿童及CAS患者言语障碍与CAS的关系首先，我们 将符合CAS标准的11名患有自闭症的少言寡语儿童与一组 11不符合中科院标准的。我们假设面部运动跟踪是一种非侵入性的 方法通过对语音运动功能的研究，发现CAS组的运动强度较低 一致性和精确度均优于-CAS组。接下来，我们研究临床体征与 CAS对语音运动参数和可理解性的影响。我们假设更严重的CAS 预测在另外一组中，动作的一致性和精确度较低，可理解性较低 22例孤独症儿童的最低语言能力。最后，我们利用之前的调查来告知 治疗20例孤独症少言少语儿童的疗效。首先，我们确定演讲内容 每个孩子的动作都是混乱的，而且降低了可理解性。然后，我们创建一个集合 包括这些动作的单音节和双音节刺激，并训练参与者其中的子集 在一系列单一受试者的实验中。治疗将涉及运动学习的原则(集中 和分布式练习)和动态提示，已被证明对治疗有效 中国科学院。感性的(基于可理解性的)和客观的(基于运动的)结果衡量都将 展示这种有针对性的治疗在多大程度上改善了这些患者的言语产出 孩子们。这一发现将为自闭症儿童言语最少的临床实践提供指导，并导致 为这一严重受影响的人群开发新的干预措施。

Although one in four children with autism remain minimally verbal past age five, we do not know all the factors that limit spoken language in these minimally verbal children with autism. One powerful contributor may be a concomitant motor speech disorder, Childhood Apraxia of Speech (CAS). CAS is an impairment in the ability to plan and sequence for speech, which renders speech inconsistent and imprecise. But because producing intelligible speech is a prerequisite to acquiring spoken language, there is an urgent need to understand how CAS may affect speech movements and intelligibility in minimally verbal children with autism, and to develop interventions that incorporate strategies to address CAS, when present. This project proposes three studies to investigate the relationship between CAS and speech in minimally verbal children with autism and CAS. First, we compare a group of 11 minimally verbal children with autism who meet criteria for CAS to a group of 11 who do not meet criteria for CAS. We hypothesize that facial movement tracking, a non-invasive method to investigate speech motor function, will reveal that the +CAS group show lower movement consistency and precision than the –CAS group. Next, we investigate the relationship of clinical signs of CAS to speech movement parameters and to intelligibility. We hypothesize that more severe CAS predicts lower movement consistency and precision, and lower intelligibility, in an additional group of 22 minimally verbal children with autism+CAS. Finally, we use the previous investigations to inform treatment for a group of 20 minimally verbal children with autism+CAS. First we identify the speech movements for each child that are both disordered and degrade intelligibility,. Then, we create a set of mono- and bisyllabic stimuli involving these movements and train participants on a subset of them in a series of single-subject experiments. Treatment will involve principles of motor learning (massed and distributed practice) and dynamic cueing, which have been shown to be effective for treating CAS. Both perceptual (intelligibility-based) and objective (movement-based) outcome measures will demonstrate the extent to which this targeted treatment improves speech production in these children. The findings will inform clinical practice for minimally verbal children with autism and lead to the development of novel interventions for this severely affected population.