| Excerpt
taken from pages 1 - 5 of Improving Speech
and Eating Skills in Children with Autism
Spectrum Disorders - An Oral Motor Program
for Home and School
Introduction
Suzie, age 5, has a diagnosis of autism
spectrum disorder. She has a limited diet,
preferring crunchy foods, such as pretzels,
that are quick and easy to chew. Suzie
rejects slimy foods, such as canned peaches,
meats, foods with lumps, and most fruits
and vegetables. She is a very messy eater
and often stuffs her mouth with food.
Her parents dread brushing her teeth because
of the way she fights them. She sometimes
gags when they approach with her toothbrush.
Suzie spontaneously produces some single
words and phrases but does not consistently
imitate words and phrases after her parents
and teachers. She produces a limited variety
of speech sounds. Suzie will continue
to have difficulty imitating words and
phrases, expanding the variety of speech
sounds, accepting new foods, and tolerating
tactile input from others until this aversion
to tactile input is addressed through
oral-motor treatment.
Evaluation
of oral-motor skills has often been overlooked
in treatment programs for children with
autism spectrum disorders (ASD), partly
due to a general lack of considering the
development of the whole child. Thus,
programs have often encouraged verbal
imitation without focusing on the child's
ability to process the sensory information
and then produce the components of movements
needed to produce a sound or a syllable.
In the case of Suzie, this child is hypersensitive
to tactile input inside the mouth. Suzie
does not want to move the tongue vertically
to the top of the mouth to produce a /d/
or an /n/ sound because it does not feel
good to make contact with the palate or
roof of the mouth. In fact, as we saw
in the vignette, she may even gag when
her tongue makes contact there. Oral-motor
development is part of normal development
and must be considered when looking at
the child and her treatment program. They
are the components that form the foundation
of the sensory motor pat-terns that are
practiced during the development of the
simple as well as complex skills used
while eating and speaking. Children with
ASD, to varying degrees, are unable to
register and modulate sensory information
in one or more of the sensory systems
(Ayers, 1979; Henry & Myles, 2007;
Yack, Aquilla, & Sutton, 2002). This
interferes with the ability to initiate
movements, to plan movements, to sequence
movements, and to develop a feedback system.
All of these inhibit the development of
oral-motor skills, in turn affecting eating,
speech production, and communication.
Brief
Overview of Sensory Processing and Oral-Motor
Skills
Ayers, in her book Sensory Integration
and the Child (1979), documents the
symptoms of poor sensory processing that
can affect oral-motor development in children
with ASD. The number of sensory systems
that are not registering and modulating
information affects the level of severity
of the child's dysfunction. For example,
the child who is able to process information
through her proprioceptive, tactile, and
visual systems but not through the auditory
system will present a different level
of functioning from the child who is not
processing information well from any of
these systems.
The
first child would have a sense of where
his body is in space, accept being approached
by others, and possibly gain information
by reading. But he would be unable to
follow verbal directions, need frequent
repetition of verbal language, and possibly
be using scripted language to communicate.
The second child would easily become overstimulated
by information, causing him to over-react
or under-react and become defensive. This
child would present with a more severe
level of dysfunction, given his oral-motor,
eating, and speech production.
Children
with Differing Needs
Ayers (1979) cites three areas where children
with autism have poor sensory processing
- registering sensory information, modulating
sensory input, and initiating movement.
Each area is briefly described in the
following.
Registering
Sensory Information
Thomas, 7 years old, was attending to
a siren from a fire engine in the distance
and not to his teacher leading a lesson.
A hand on his shoulder from his teacher
assistant and the use of a microphone
by the teacher to amplify her voice brought
his attention back to the lesson.
Children
with ASD often do not pay attention to
information that is important, such as
speech sounds. For example, instead of
attending to speech, the child may attend
to a background noise, such as the humming
of a fan, not noticed by others around
her. According to Ayers (1979), in such
cases, the part of the brain that "decides"
which information to attend to and what
to do about that information is not "registering
well." Emily, a 5-year-old girl with
a diagnosis of ASD, had difficulty registering
touch sensations. She never felt drool
on her chin or food on her face. Emily
also stuffed food in her mouth with no
awareness that her mouth was already full.
Emily's mother wondered why she had to
constantly tell her daughter to wipe her
face or take small bites and swallow.
This
is commonly seen in children with ASD,
but in varying degrees. In-deed, the ability
to take in and respond to information
is inconsistent with-in and across individuals.
Motivation, strong sensations, and firm
input are needed in order for these children
to respond optimally to sensory input.
Modulating
Sensory Input
Terry, an 8-year-old boy with a diagnosis
of ASD, had difficulty modulating touch
input. He could not tolerate the way his
clothes felt against his skin. He spent
a lot of his time pulling and tugging
at his clothes. He frequently stood up
and pulled his pants up at the waist.
Instead of filtering out this touch sensation,
all he could think about was how his clothes
felt at that moment. This made it difficult
to attend to another child trying to talk
with him or to his teacher during a lesson
(Yack et al., 2002).
The
brains of many children with ASD are unable
to control sensory input, causing them
to receive too much input or not enough.
In other words, the child is unable to
balance the sensory input (Henry &
Myles, 2007). In the first situation,
the child is bombarded by input from one
or more sensory systems. In the second,
the child is not getting enough stimulation
and, therefore, may crave input from one
or more sensory systems.
Another
example involving the tactile system (touch)
is the child who needs strong, firm touch
in order to register input but then quickly
becomes overloaded and reacts defensively.
This child is unable to regulate and integrate
this input into his body awareness and
make sense of the input once it is registered.
This can result in oral-motor planning
problems. An example is the child who
has difficulty moving her mouth when requested
to do so. She cannot stick out her tongue
when asked or when given a visual model.
However, the child can be seen to stick
out her tongue while automatically licking
a lollipop. It is difficult to plan movements
when you do not have a good sense of your
body. Further, when the child cannot organize
and plan simple movements, he has trouble
developing more complex behaviors such
as speech production. In brief, the ability
to plan movements depends, in part, on
the accuracy of the child's touch system.
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