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

虽然四分之一的自闭症儿童在五岁以后仍然很少说话，但我们并不知道所有的自闭症儿童都是如此。 限制这些语言能力极低的自闭症儿童的语言能力的因素。一个强大 贡献者可能是伴随的运动言语障碍，儿童言语失用症（CAS）。CAS 是计划和安排讲话顺序的能力受损，这使得讲话不一致 而且不精确但是，由于产生可理解的语言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， 在最低限度的语言自闭症儿童的可理解性，并制定干预措施， 应对CAS的策略（如果存在）。该项目提出了三项研究，以调查 自闭症和CAS的语言障碍儿童中CAS与言语的关系一是 将一组11名符合CAS标准的自闭症儿童与一组 11人不符合CAS标准。我们假设面部运动跟踪，一种非侵入性的 方法研究言语运动功能，将揭示+CAS组表现出较低的运动 一致性和精确度优于-CAS组。接下来，我们研究临床体征之间的关系 语音运动参数和可懂度。我们假设更严重的CAS 预测较低的运动一致性和精度，以及较低的可理解性，在另一组 22名患有自闭症+CAS的最低语言能力儿童。最后，我们通过前面的调查， 治疗一组20名患有自闭症+CAS的语言障碍儿童。首先，我们确定演讲 每个孩子的动作都是无序的，降低了可理解性。然后，我们创建一组 包括这些动作的单音节和双音节刺激， 在一系列的单一受试者实验中。治疗将涉及运动学习的原则（集中 和分布式实践）和动态提示，这已被证明是有效的治疗 CAS.感知（基于可理解性）和客观（基于运动）结果测量将 证明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生。 孩子这些发现将为自闭症儿童的最低语言水平的临床实践提供信息， 为这一受严重影响的人群制定新的干预措施。

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.