Speech and Language
|Posted on October 10, 2017 at 7:20 PM|
My nonverbal child can sing but can't speak. Why is this?
Many parents have reported that their nonverbal child with autism can sing but will not speak. This was certainly the case with musical prodigy Logan Blade whose family describes him as nonverbal except when a microphone is put in his hand. He now has two records that he has released on iTunes. This is also the case with internet sensation "Isaac" whose rendition of Peabo Bryson and Regina Belle's A Whole New World in perfect pitch left many experts in speech and language baffled. A simple internet search of this question brings up parents describing instances of humming or singing in the absence of spoken words. But why is this?
Did you know that music and language are generally housed in two separate parts of the brain? This is not to say that there is no overlap. In general, in nonmusical neurotypicals (NTs) language use and interpretation is housed in the left hemisphere of the brain. This is why if we have a stroke in the left hemisphere of the brain we may be likely to receive a diagnosis of Aphasia (impaired language use or comprehension or both) while a stroke in the right hemisphere of the brain will usually not affect language. The interpretation of music and rhythm in NTs who are not musicians is generally housed in the right hemisphere of the brain (Ono et. al 2011). This information is based on knowledge obtained from imaging scans of the brain (e.g., MEG).
So, what does this have to do with nonverbal autism? A lot. Studies using imaging such as EEGs have found that individuals with autism have decreased brain activity in the left hemisphere of the brain but increased activity in the right hemisphere of the brain (Floris et. al 2015). You will remember that the left hemisphere "houses language" and the right hemisphere "houses music."
So, let's simplify this. If it is true that language is a left hemisphere task and music is a right hemisphere task and brain scans of children and adults with autism have shown greater activity in the right hemisphere of the brain as compared to the left hemisphere, would it make sense that a child with autism would be more likely to sing than to speak? Yes! This is perhaps why so many have been shown to have "absolute" pitch (see evidence section). This is also why M.B.C.T. uses musical strengths to help bring about verbal speech in nonverbal children with autism. This may also be why certain sounds and pitches are painful (More studies need to be done on this, but imagine if you heard incessant talking while you were trying to relax. The humming of the air-conditioning or other sounds NT's tune out may not be so easily ignored in those with autism.)
Yes, music has been known and shown to shape and change the brain! We share many more fascinating research studies at our conference on M.B.C.T. through www.ciaoseminars. Join us!
American Speech-Language-Hearing Association (www.asha.org/public/speech/disorders/Aphasia/ retrieved 10/11/15).
Logan Blade | Unspoken | CD Baby Music Store (store.cdbaby.com/cd/loganblade2 retrieved 10/11/15)
Oimet, T., Foster, N. E., Tryfon, A., & Hyde, K. L. (2012). Auditory- musical processing in autism spectrum disorders: A review of behavioral and brain imaging studies. Annals of the New York Academy of Sciences, 1252, 325–331.
Ono, K., Nakamura, A., Yoshiyama, K., Kinkori, T., Bundo, M., Kato, T., & Ito, K. (2011). The effect of musical experience on hemispheric lateralization in musical feature processing. Neuroscience Letters. [Epub ahead of print].
Floris, Barber, Nebel, & Mostofsky (2015). Atypical Rightward Cerebral Asymmetry in Male Adults with Autism Stratifies Individuals with and without Language Delay. Human Brain mapping 00:00-00.
Flagg, Cardy, Roberts, Roberts (2005). Language lateralization development in children with autism: Insights from the late field magnetoencephalogram. Neuroscience Letters, 386(2), 82-87.
Sandiford, G. S., Mainess, K., Daher, N. (2012). A pilot study on the efficacy of Melodic Based Communication therapy for eliciting speech in nonverbal children with autism. Journal of Autism and Developmental Disorders. Oct. 14 [Epub ahead of print].
Sandiford, G. S., Mainess, K., Daher, N. (2013). Improving pragmatics in nonverbal children with autism using melodic based communication therapy. Autism 3: 116. doi: 10.4172/2165-7890.1000116
|Posted on October 8, 2017 at 8:25 PM|
My child has autism and does not speak. What should I do?
If your child has autism and does not speak, you should consult with a speech-language pathologist regarding his/her treatment plan. You may find a speech-language pathologist through ASHA ProFind or reach out to your local school district in writing regarding your concerns.
If you wish to screen your child's speech/language development, you may wish to try our quick screening app for preschoolers, the ITSELF: P. You may also choose to save or send the results to share with your local speech-language pathologist.
If you wish to try M.B.C.T. with your child, view our parent resources or click on the Find an M.B.C.T. Provider Near you link! You may consider our Level 1 M.B.C.T. app while using this approach or record your own standardized melodies.
Becoming a part of your child's unique world is important. For example, if your child likes bubbles, blow and pop bubbles while adding language to the activity. Presuming competence is an imporant concept for parents with a child with autism to embrace as well. This simply means assuming your child has the ability and the desire to learn new things even when he/she is not able to say so.
|Posted on October 8, 2017 at 5:15 PM|
What are research based melodies?
The term research based melodies as it is used in M.B.C.T. refers specifically to the melodies tested in the original randomized controlled trial on M.B.C.T.
These melodies are available in our Level 1, Level 2, and First Signs apps as well as in the M.B.C.T. Therapy Kit. The melodies follow the general rule of one note per syllable and a different melody for each word. Our supplemental apps meant for children who are verbal do not necessarily follow this rule.
View our products page for more information.
|Posted on October 8, 2017 at 5:00 PM|
Can I give the ITSELF: P screener without parent input?
The ITSELF: P is our quick communication screener app meant to allow parents, teachers, clinicians, pediatricians, etc. to quickly screen all areas of communication in preschool children based on current published normative data.
This app may be given by or with input from someone who knows the child well, such as a parent, teacher or family member.
You may also choose to engage the child in conversation and observe him or her in play. You will want to set up communication temptations (e.g., an interesting toy visible, but out of reach, a favorite food kept in tightly closed clear container, or a fun musical toy that you turn on then off - waiting for the child’s response).
The app works best when the informer knows the child well.
View our products page to purchase this app.
|Posted on October 5, 2017 at 12:10 AM|
Do you offer training classes in M.B.C.T.? When/where is the next course? Are they offered for continuing educational units? Can parents attend?
A full-day intensive course in M.B.C.T. is offered through Ciao Seminars. The first half of the course explores the literature and evidence behind M.B.C.T. We specifically explore the evidence to support the use of M.B.C.T. for the nonverbal population with autism. The second half of the course gives attendees the opportunity to practice the 10 steps with a peer partner. The courses are offered for 6.5 CEUs currently. For more information on our next training course please visit www.ciaoseminars.com. Parents are welcome to attend our courses or to view the parent training video available under parent resources.
|Posted on October 2, 2017 at 6:40 AM|
Is Melodic Based Communication Therapy Evidence Based Practice?
The most common definitions of Evidence-Based Practice (EBP) involve “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research” (Sackett et. al. 1996).
The American Psychological Association (APA) defines EBP as "the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences."
The American Speech-Language-Hearing Association (ASHA) uses the following definition of EBP: "the integration of research evidence with practitioner expertise and client preferences and values into the process of making clinical decisions. Note that although this is referred to as "evidence-based" practice, the roles of clinician expertise and client preferences and values are equally important. The notion that external research evidence somehow "trumps" all other considerations is one of the big myths surrounding EBP."
The American Medical Association defines evidence as "a provisional departure point in the consideration of whether or not a particular course of action is to be taken in any clinical context" (Virtual Mentor. January 2013, Volume 15, Number 1: 86-89).
What does this mean?
The goal of EBP is to combine clinical expertise/expert opinion, external scientific evidence, client/patient/caregiver perspectives to provide high quality services that reflect the specific needs, interests, and values of the population served.
M.B.C.T. was developed by a speech-language pathologist after years of working with nonverbal children with autism in the field. The approach is meant to combine clinical expertise/expert opinion, external scientific evidence from multiple fields of study, and the needs and interests of the child to facilitate verbal speech.
M.B.C.T. pulls scientific evidence from a variety of fields including speech-language pathology, neurology, behavioural science, music, and occupational therapy to address the multifaceted needs of the nonverbal child with autism. See our blog on evidence to read more on this.
The original study on M.B.C.T. was designed as a randomized controlled trial (RCT), which is generally considered to be "the design least susceptible to bias." Blocking was necessary prior to randomization to ensure both groups had an equal amount of 5, 6, and 7 year olds.
The original interdisciplinary research team, formed at Loma Linda University, consisted of speech-language pathologists, Dr. Karen Mainess and Dr. Givona Sandiford, pediatric neurologist, Dr. Sarah Roddy, neuroscientist Dr. Ernie Schwab, psychologist, Dr. Taryn Hudson, and statisticians, Dr. Noha Daher and Dr. Grenith Zimmerman. Speech-language pathology graduate students at Loma Linda University acted as clinicians and were given two full days of training in the approach. The results were first published in the Journal of Autism and Developmental Disorders under the editorship of Dr. Rhea Paul.
Though steps were standardized for the purposes of the research study, those trained in M.B.C.T. for clinical purposes are encouraged to make modifications based on their own clinical expertise and observations of the needs of the child.
Research on M.B.C.T. is ongoing. We have included several references on the evidence behind M.B.C.T. in this blog, however for more on this topic you may wish to attend one of our continuing education seminars at www.ciaoseminars.com.
Sources: Click on links in blog post to be directed to sources.
|Posted on October 1, 2017 at 8:35 PM|
|Posted on October 1, 2017 at 7:35 PM|
Who is Melodic Based Communication Therapy used for?
Melodic Based Communication Therapy (M.B.C.T.) was developed for children with autism who speak less than 10 words and have no functional speech. The original study included children ages 5:0-7:11, however many providers have reported success with children ages 2:0 and up. Another study set to begin in the summer of 2018 will include children ages 2:0-10:11.
The greatest predictors of success were found to be strengths in receptive language and attempts to imitate. Together these two factors accounted for 75% of the variability in number of correct words in the original study group. Age was not found to be a predictor of success with the approach, meaning all age groups in the original study made similar progress. See the blog post on evidence to learn more.
Though developed for nonverbal children with autism, some providers have reported some success with children who have symptoms of Childhood Apraxia of Speech (CAS). CAS is a motor speech disorder where children have trouble planning, coordinating, producing and sequencing sounds for speech. It can co-occur with autism, Down syndrome, or other developmental delays. More research is needed on the use of M.B.C.T. for this and other populations.
|Posted on October 1, 2017 at 6:55 PM|
May I make changes or combine M.B.C.T. with another approach?
While M.B.C.T. includes 10 standardized steps that represent the 10 standardized steps used in the initial study, modifications within the clinical setting are recommended based on the needs of the child and the observations of the therapist or parent. We discuss some potential modifications at the full-day course. Some modifications that have been used by our providers are as follows:
1. slowing down the song
2. removing consonants and singing the vowels only to simplify the word
3. using visual cues (e.g., pointing to the clinician's mouth)
4. decreasing, increasing, changing, or removing the use of preferred rewards based on the child's attention
5. using the songs in a functional task (e.g., singing banana when a banana is about to be eaten)
6. adding jumping or other movements other than clapping if the child does not tolerate hand over hand clapping
7. working in a group setting
Join us at our full-day course www.ciaoseminars.com for more information!
|Posted on October 1, 2017 at 6:50 PM|
What is Melodic Based Communication Therapy?
Melodic Based Communication Therapy (M.B.C.T.) is an evidence based intervention designed by a speech-language pathologist to help caregivers and therapists assist nonverbal and low verbal children (less than 10 words) with autism learn to speak. Also known as M.B.C.T., the approach is designed to make use of the musical strengths of the child with autism in order to increase verbal output.
M.B.C.T. differs from other music therapies in that it uses a standard melody for each target word. Standardization of the melody is made possible by use of a pre-recorded melody. Each melody is specific to its target word and differs significantly from the other melodies. Melodies for Level 1 and 2 of the approach follow the rule of one note per syllable. Caregivers and therapists may also record their own melodies following this rule. The approach also makes use of motor imitation and successive approximation of vocalizations to shape the target word.
M.B.C.T. is not meant to be used in isolation. It is meant to be used as part of a standard care approach for the nonverbal child with autism.