Using Auditory-Motor Mapping Training to Facilitate Speech Output in Nonverbal Children with Autism: An Intervention and Imaging Study

Language deficits represent the core diagnostic features of Autism Spectrum Disorders (ASD). In some cases, language deficits are observed after an apparently normal onset, while in others, language abilities never develop at all (Tager-Flusberg, 2003). Up to 25% of individuals with ASD lack the ability to communicate with others using speech sounds. Despite their verbal communication deficits, children with ASD often display enhanced music and auditory-perception abilities (Bonnel et al., 2003; Heaton, 2003). In addition, they enjoy auditory-motor activities such as making music, through singing or playing an instrument (Trevarthen et al., 1996). Such positive responses to music suggest that an intonation- or singing-based intervention may have significant therapeutic potential. Dr. Schlaug’s laboratory has successfully used an intervention known as Melodic Intonation Therapy (MIT) to facilitate speech output in stroke patients with Broca’s aphasia, who initially struggled to speak. Recently, they have also developed a similar therapy that is adapted for children with ASD. At the time of this study, there were no established techniques that reliably improve speech in nonverbal children with ASD (Francis, 2005). Two published case studies (Miller & Toca, 1979; Hoelzley, 1993) as well as Dr. Schlaug’s preliminary data from a number of nonverbal children with ASD have shown that an intonation-based technique has great potential. This research examined the potential utility of a novel intervention termed auditory-motor mapping training (AMMT), in assisting nonverbal children with ASD to develop speech. This intervention has significant therapeutic potential for at least three reasons. First, it capitalizes on the inherent musical strengths of children with ASD, and offers activities that they intrinsically enjoy. Second, it engages and potentially modifies a network of brain regions that may be dysfunctional in ASD (Lahav et al., 2007; Wan, Demaine, Zipse et al., 2010; Wan & Schlaug, 2010). Finally, AMMT is an adaptation of MIT that has been successful in facilitating speech output in stroke patients who previously struggled to speak. In addition, secondary to determining the efficacy of AMMT as an intervention for nonverbal children with ASD, the investigators also hoped to examine whether the severe language deficits in these nonverbal children were due to abnormalities in certain language pathways of the brain. They used structural brain imaging techniques such as diffusion tensor imaging to answer this question.