Teaching the "Unteachable":

Giving Children with

severe Autism

a voice


Visual communication analysis:
Applying self determination theory to autism

Introduction

  • Currently there is no effective mainstream therapy for nonverbal children with autism
  • Widely used standard of care (ABA) relies   exclusively on contingent rewards. Negative outcomes as predicted by SDT often occur
  • Children taught with current widely used methods struggle with basic topics like  alphabet for years
  • Hypothesis: VCA combined with choice-giving software is an efficacious treatment for maladaptive behaviors and teaching communication to nonverbal autistic children

Method

  • 2 Studies      N1 = 5 participants, T1 = 30  session  (90,598 data points)
                               N2 = 10 participants, T2 = 100 sessions (651,006 data points)
  • First Dependent variable - letters correct per minute
  • Second Dependent variable - number of maladaptive behaviors per session
  • Repeated measures ANOVA with a correction used to test letters correct per minute
  • Paired sample t-test used to test changes in behavior
  • Combinatorial subgroup repeated measures ANOVA used to test robustness of  post hoc study

Results

Study 1


Letters correct per minute were tested with a repeated measures ANOVA with a Huyhn-Feldt correction. F(4.52, 18.09) = 3.948,  p = 0015

Participants A1 and C1 had a diagnosis of severe autism and intellectual disability. The three other participants did not have any diagnosis.

Maladaptive Behaviors

Participant

Baseline Behavior count

Final Behavior Count

Percent Decrease

A1 - autism

29.33

1.33

95.45%

B1

N/A

N/A

N/A

C1 - autism

12.66

0.66

94.74%

D1

N/A

N/A

N/A

E1

N/A

N/A

N/A

Qualitative Behavior Data

Participant

Baseline Behavior 

Number of Initial Therapists Assigned

A1 - autism

Biting, pulling hair, pinching, throwing, licking

2 + 2 parents

B1

N/A

1

C1 - autism

Hitting, pulling, hair, kicking, punching, spitting

2

D1

N/A

1

E1

N/A

1

  

Participant

Qualitative Behavior Change

A1 - autism

No longer confined to stroller. No headphones or chewy toy

B1

More confidence

C1 - autism

Sleeps in own bed, more verbal

D1

More confidence

E1

More confidence

Study 2


Letters correct per minute were tested with a repeated measures ANOVA with a Greenhouse-Geisser correction. F(2.14, 19.28) = 8.954,  p = 0004

​

Maladaptive Behaviors

Participant

Baseline Behavior count

Final Behavior Count

Percent Decrease

A2

7.67

0

100%

B2

7.33

0

100%

C2

18.67

2.00

89.3%

D2

28.57

2.00

93.0%

E2

4.67

2.00

57.1%

F2

3.33

1.00

70.0%

G2

46.33

1.00

97.8%

H2

17.67

1.67

90.6%

I2

4.00

2.33

41.7%

J2

11.67

0.33

97.1%

      

Statistics

Baseline Behavior count

Final Behavior Count

Percent Decrease

Mean

15.0

1.23

91.8%

Std. Deviation

13.65

0.89

0.20

There was a significant difference in the scores for baseline behaviors (M=15.0 , SD= 13.65) and the post treatment behaviors (M=1.23, SD=0.98 ); t(8) = , p = 4.1 E-7

Qualitative Behavior Data

Participant

Baseline Behavior 

Number of Iniital Therapists Assigned

A2

Pinching, pulling hair, grabbing, eloping, damage equipment

2

B2

Hitting, scratching

1

C2

Hitting, pulling hair, kicking, biting, pinching

2

D2

Hitting,  pinching, pulling hair, scratching, biting

2

E2

Pinching, pulling hair, spitting, scratching, biting

2

F2

Hitting, scratching, throwing, eloping, biting

3

G2

Hitting, pinching, kicking, pulling, biting

2

H2

Hitting, grabbing, pinching, pulling hair, throwing, kicking, slapping

2

I2

Hitting, scratching, pinching, biting, throwing, eloping, pulling hair

2

J2

Hitting, grabbing, pulling hair, biting, eloping, kicking

3

              

Participant

Qualitative Behavior Change

A2

Toilet trained

B2

More regular bowel movements, more emerging language

C2

Toilet trained, more verbal,  No more eating from baby bottle

D2

Toilet trained, more verbal

E2

Toilet trained, no chewy, no headphones, language emerging

F2

More verbal

G2

More verbal

H2

Toilet trained

I2

Toilet trained, language emerging

J2

Was able to go back to government school

Robustness Testing

To test the robustness of Study 2, a combinatorial subgroup repeated measures ANOVA was calculated.

 The table attached in the downloadable paper gives the p values for the F test for each subgroup.  It should be noted that using an alpha = 0.025 and a Greenhouse-Geisser correction, every ANOVA subgroup test was statistically significant.

Researchers hypothesized that with the use of Visual Communication Analysis participants would learn to type independently. As reported above, this hypothesis was supported by the data. In study 1, all five participants learned to type with an average of LCPM 7.52. In study 2, all 10 participants learned to type with an average LCPM of 21.74.


These numbers not only represent learning and accuracy, but also the participants’ success with novel tasks. As displayed in Tables 1 and 2 above, each participant engaged in new tasks and progressively more difficult tasks, during each session, while maintaining a reasonable LCPM. This data challenges traditional approaches to testing and teaching children with Autism. All 12 of the participants from both studies who were diagnosed with Autism Spectrum Disorder were also diagnosed with Intellectual Disability (the Diagnostic and Statistical Manual of Mental Disorders’ (DSM) new classification for Mental Retardation). These participants attended different schools, and were diagnosed by different professionals in different fields. However, with the use of VCA, with a maximum span of 100 sessions, all children showed a remarkable ability to learn and to succeed despite being presented with progressively more difficult and advanced tasks. Another 100 sessions with these children might show continued growth, and their ability to master various skills and information (e.g. fractions, human anatomy, geography, the use of contractions, etc.). This data is great news for parents, professionals and educators alike, as it can inform the child’s actual cognitive abilities, treatment plans and Individualized Education Plans (IEP), and most importantly, give each child a means to communicate through typing.

To read the full paper and the complete results, please download the full paper.

Download the full paper

This video was presented at the conference.

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