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00100 THE RATIONALE FOR COMPUTER-BASED TREATMENT OF
00200 LANGUAGE DIFFICULTIES IN NONSPEAKING AUTISTIC
00300 CHILDREN
00400
00500 KENNETH MARK COLBY
00600
00700 No one person could conceive, implement and utilize the
00800 treatment method I shall discuss shortly. Hence let me express at the
00900 start my deep indebtedness to my co-workers at Stanford University-
01000 Horace Enea, David Smith, Malcolm Newey and Maxine Colby, each of
01100 whom has put years of effort into this project.
01200
01300 We began about seven years ago with a notion and two facts.
01400 The notion was that a nonspeaking autistic child's primary difficulty
01500 lay in an inability to process symbols (dissymbolia),language being
01600 of course the most important symbolic system used in human
01700 communication. The first fact, oft repeated in the literature,
01800 indicated that prognosis was highly correlated with speech, the
01900 outlook for nonspeakers being poor. The second fact was the common
02000 clinical observation that these children played for hours with
02100 machines while remaining indifferent to interactions with people.
02200
02300 There is now increasing evidence in the research literature
02400 supporting this notion of a primary difficulty in symbol
02500 processing.[Churchill,1972; Frith,1972; Hermelin and O'Connor,1970;
02600 Rutter, Bartak, and Newman,1971]. A dysphasic or aphasic child also
02700 has difficulty with language but he can acquire other symbolic
02800 systems such a gesturing and drawing. He may even learn to read. But
02900 the nonspeaking autisitc child has great difficulty with all symbolic
03000 processes, not just language, and hence can be called "dissymbolic".
03100
03200 The cause of this difficulty remains unknown. Nowadays few
03300 experts in the field defend a psychogenic etiology since the
03400 supporting evidence is weak and the disconfirming evidence is gaining
03500 in strength [Rutter,et al,1971]. Regardless of the original cause, if
03600 we understand the crux of the child's difficulty, we could try to
03700 devise a remedial treatment which takes advantage of the fact that
03800 the child is fascinated by machines. Our beginning working idea was
03900 to create a machine a nonspeaking child could play with in which the
04000 play process involves the child's use of language skills.
04100
04200 The system we developed consists of a television-like screen
04300 and a typewriter-like keyboard. Pressing the keys on the keyboard
04400 causes symbols to appear on the screen accompanied by sounds of human
04500 voices and other noises common in a child's life. It is much like
04600 having your own Sesame Street to play with. But rather than being a
04700 passive recipient of what the television show provides, a child in
04800 our situation is an active initiating agent controlling the machine.
04900 Instead of having things done to him, things are done by him. The
05000 merits of the machine are that it is untiring, predictable, always
05100 saying the same thing the same way, never angry, never bored and
05200 controllable- properties which are notoriously lacking in humans.
05300 This audio-visual- tactile experience is provided by a computer
05400 program running on a PDP-6/10 time-sheared computer in the Stanford
05500 Artificial Intelligence Project. The program is divided into games
05600 intended to give the child various types of opportunities at playing
05700 with and interacting with symbols. For example, in one game, when a
05800 child presses the key showing the letter H, an H appears on the
05900 screen and a voice says "H". In another game pressing the key
06000 labelled "H" produces a running horse on the screen accompanied by
06100 the sound of horse's hoofs. There exist over 1000 such experiences
06200 on the system. The games are organized at various levels of
06300 complexity and are designed to show a child how English is put
06400 together from sounds and letters into words and expressions. I shall
06500 not go into the details of the games here. They are throughly
06600 described in the literature.[Colby and Smith,1971]. Instead I shall
06700 try to sketch the rationale or major principles underlying this
06800 approach.
06900
07000 First, consider how normal children acquire language. They
07100 are not taught formally as are adults learning a second language.
07200 Children are simply exposed to members of a linguistic community and
07300 given an opportunity to explore language usage in everyday
07400 communication between themselves and other humans who encourage and
07500 correct. From this exposure, exploration and corrective feedback
07600 they come to associate the sounds and meanings of words. They come to
07700 sense that certain sounds, human voice sounds, are not just sounds in
07800 themselves like the wind in the trees, but that they are about
07900 something else, that is, they are symbolic. Between the ages of
08000 roughly 2 months and 4 years normal children spend thousands of hours
08100 listening, practicing and playing with language. Mastery of a
08200 language, that is getting most of it right, does not come until far
08300 into adolescence, if ever. A normal child can make an interpretation
08400 of expressions he has never heard before. A nonspeaking autistic
08500 child, being dissymbolic, does not show this course of development.
08600
08700 The problem is not simply the development of language skills
08800 but also the acquisition of concepts necessary for a comprehensive
08900 enough model of how the world works, especially the human world. The
09000 conceptual or cognitive deficits shown by nonspeaking autistic
09100 children involve those concepts which are normally acquired through
09200 language or other symbolizations. Take the abstract concept of
09300 `danger'. To prevent a child from becoming hurt, a parent must
09400 identify certain concrete objects and situations as dangerous until
09500 the child grasps the abstract concept of danger. All this is done
09600 linguistically and through pointing. By way of language , objects and
09700 situations can be referred to and warned about even when they are not
09800 present, and referred to without pointing when they are present. An
09900 important socializing function of language is to mark off for a child
10000 what to pay attention to and what is to be done and not done. Many of
10100 the characteristics of autistic children, for example, the lack of
10200 empathy, can be viewed as a consequence of an inability to form
10300 regular conceptual patterns about the world because the necessary
10400 concepts acquired through language are missing. As one perceptive
10500 mother said about her autistic child,` a screw is not loose , a screw
10600 is missing'.
10700
10800 A poorly developed ability to process symbols has further
10900 consequences besides conceptual deficits. Without language a human
11000 has no awareness of being aware. He lacks the ability to self-monitor
11100 and to self-control by talking to himself. He cannot use symbols
11200 reflexively, that is, to to give himself orders and to comment on
11300 himself to himself. Having language, a normal child comes to realize
11400 the self is really two which can talk to one another. Finally, to
11500 become a person one must be recognized as a person by other people
11600 who treat you as if you had self-awareness and self-control. This
11700 recognition is virtually impossible for a child without language
11800 skills and probably represents the greatest tragedy in his life.
11900
12000 Thus far I have spoken of autistic children as if the
12100 nosological label stood for a single homogeneous group. Thirty years
12200 ago it seemed that might be the case. Now it appears as if there
12300 exist several autistic syndromes, none of which should be confused
12400 with childhood schizophrenia since they differ in onset, course,
12500 symptoms, family history and prognosis. There are speaking and
12600 nonspeaking autistic children. Among the nonspeaking group there are
12700 those whose linguistic development is normal until sometime in the
12800 second year when they lose their language abilities. The other major
12900 group are those children who, from the start, have trouble with
13000 language, understanding little and saying even less, perhaps one
13100 `mama' or `no' a year. In our experience the most difficult problem
13200 for differential diagnosis lies in deciding whether a nonspeaking
13300 child suffers from dysphasia (developmental aphasia), autism or
13400 perhaps both. Over time the correct diagnosis can be made when it
13500 becomes clear that the dysphasic child can mimic, draw pictures and
13600 signify greetings or farewells while the autistic child cannot.
13700
13800 Taking a cue from the normal child who treats language as a toy, our
13900 first principle was that the treatment should provide an opportunity
14000 for exploratory play. The treatment situation is not one of forced
14100 drill, instruction or training but one of play with the keyboard and
14200 video display. Operant conditioning methods reward the child with
14300 candy or food for his actions. We do not, believing that food
14400 rewards inhibit exploratory curiosity, as has been shown in animals
14500 both by Harlow and by Nissen. From our own experience and that of
14600 workers in computer-aided instruction, food rewards have been found
14700 to be distracting and disrupting. Exploratory learning requires a
14800 situation which invites exploration, time, security and minimal
14900 interference by adults.
15000
15100 In each of the sessions the child has a `sitter', an adult whose main
15200 task is to sit and not interfere. The sitter's task is difficult,
15300 especially if he has been trained to DO things. We want to give the
15400 child an opportunity to freely self-select those symbols which
15500 interest him, rather than to have an adult instruct him or quiz him
15600 about those symbols which he `should' learn. The sitter's behavior
15700 is crucial to this treatment method if the spirit of play rather than
15800 drill is to be provided. Of course the sitter offers social approval
15900 and encouragement when it is fitting.
16000
16100 An ideal treatment session results when the child is in a good mood,
16200 is interested in working the keyboard display, enjoys imitating the
16300 sounds and is successful in getting the machine to do what he wants.
16400 The principle of success is important here because, in our view, many
16500 nonspeakers have given up on language. They have failed over and
16600 over and hence withdraw from trying. We do not let them fail. As
16700 one normal child said about the experience "it`s fun, you can't
16800 lose". There are students of autism who consider nonspeaking autistic
16900 children to be innately withdrawn from people and hence not acquiring
17000 language. We feel it is the other way around; they have so much
17100 difficulty with language they withdraw from people who unwittingly
17200 flood and overwhelm them with meaningless noises. No wonder they do
17300 not call, address, ask or answer questions of these giants who
17400 immediately spout gibberish. Autistic children are not aloof and
17500 indifferent to all people -- only to those who talk. I have often
17600 wondered if is not eye-to-eye contact they avoid but eye-to-a-mouth
17700 which , as far as the child is concerned, simply jabbers. If you say
17800 little or nothing to a nonspeaking child on first meeting him, our
17900 experience has been that you will more than likely find him in your
18000 lap, as affectionate as any other child.
18100
18200 There exists another myth in the literature which I would like to
18300 dispel. Autistic children are said to show pronominal reversal, using
18400 the second person singular pronoun "you" for the first person
18500 singular pronoun "I", and "I" for "you". This is not so. It is the
18600 normal child who reverses or converts personal pronouns. The
18700 autistic child LACKS the rule for correct pronoun assignments and
18800 simply echoes what he has heard. Pronouns are examples of deixis in
18900 which the denotation of the words shift depending on the speech
19000 situation in contrast to, for example, proper names whose denotations
19100 remain constant. The assignment rule for the variables "I" and "you"
19200 is that the speaker calls himself "I" and calls the listener "you".
19300 Young autistic children are ignorant of this rule, which is not
19400 actively taught by adults, but is somehow grasped by the normal child
19500 from the data of human dialogues. The autistic or dissymbolic child,
19600 unable to process language, echoes back, in an untransformed and
19700 uninterpreted way, what is said to him. If you say to him "Do you
19800 want your jacket" he will echo it, failing to transform the pronouns.
19900 Everybody calls him "you" so he believes "you" must be one of his
20000 names. Due to the limitations of short-term memory, an autistic
20100 child may echo only the terminal fragment of a long expression. In
20200 English "I" regularly appears at the beginning of an expression as
20300 the subject. If you place the pronoun "I" at the end of an
20400 expression, an autistic child can echo it as easily as "you". Some
20500 people believe that the pronoun "I" is an index of self-identity and
20600 that autistic children lack a sense of self. From our experience I
20700 would say that autistic children make a very clear distinction
20800 between self and non-self. They are in fact hyperautonomous, as
20900 anyone will find out when he tries to get the child to do something
21000 he does not want to do. Autistic children do not use "I" and "you"
21100 correctly because they are incognizant of a symbolic transformation
21200 rule necessary for the correct assignment and conversion of input
21300 pronouns. It is worth noting that even in normal children , "I" is
21400 never triggered by "you" but only by "me". [Fay,1969].
21500
21600 Returning from this digression on deixis, let me say something about
21700 our successes and our failures, especially the latter. Every
21800 treatment method reports its dramatic successes with one or two
21900 cases. What we need are long case series before we can compare
22000 methods and decide which is more effective relative to the effort
22100 required. Thus far our series of nonspeaking autistic children
22200 numbers 17 with 13 of the children improved. By improvement we mean
22300 only that the child begins voluntarily to use speech for social
22400 communication. We do not claim the method results in normal language
22500 ability with full comprehension, and correct pronunciation, syntax
22600 and grammar. Our aim is to rekindle the child's interest in
22700 attempting speech, to get him to try again, to get him off the
22800 ground, to stimulate or catalyze a damaged or slow-developing natural
22900 process of language acquisition.
23000 We have tried the method with other types of nonspeaking
23100 children. We failed with two schizophrenic children. One brain
23200 damaged child improved and one did not. We failed completely with 3
23300 children suffering from expressive aphasia. By failure we mean a
23400 child leaves us as he came, perhaps with some language understanding
23500 but producing no useful speech.
23600
23700 In studying our failures among the autistic group, we have tried to
23800 find some common denominator. We have found only two in our case
23900 series of 17 nonspeaking dissymbolic children. First, all these
24000 failure cases are children who showed no interest in playing with the
24100 machine. Regardless of our coaxing and persuading they would have
24200 nothing to do with it. Finally, becoming desperate, we would be
24300 forced to violate one of our basic principles of allowing free play.
24400 We would spend weeks and months holding the child at the keyboard,
24500 pushing the keys for him, trying to overcome his resistance and
24600 negativism. But to no avail. Somehow we must be more ingenious in
24700 capturing these children's interest. We have thought of ways to do
24800 this and are currently trying to implement them.
24900
25000 Second, in cases where the child shows normal linguistic development
25100 until 16 or 22 months and then suddenly stops talking, we have failed
25200 absolutely. This history is suggestive of course of some type of
25300 cerebral insult such as a virus infection or auto-immune reaction,
25400 but these hypotheses remain unconfirmed.
25500
25600 Based on our experience we believe there is something powerful but
25700 not well-understood about the method. As I described it, he
25800 treatment is a complex variable, a shotgun prescription, the active
25900 ingredients of which are unclear. We need other workers in the field
26000 to adopt the method, improve it and hopefully help us find stronger
26100 catalysts for language acquisition.
26200
26300 Why haven't other workers tried this zero-risk and potentially
26400 promising method? Aside from the inertia which all new methods must
26500 face, there are three reasons. One is that everyone has his own
26600 preferred method which he believes in and may wish to improve. A
26700 second reason involves people's beliefs and misconceptions about
26800 computers. I have come across people with the following fantasy about
26900 our situation -- that we have a small, cowering, bewildered child
27000 sitting in front of a towering bank of flashing lights {the New
27100 Yorker-cartoon concept of a computer} while cold scientists in white
27200 coats observe him thru one-way mirrors. They say "the child is
27300 already too interested in machines, he needs relations with people --
27400 you are making him into even more of a robot". I hope from my brief
27500 description you can see this fantasy is not the case. It may sound
27600 paradoxical, but some nonspeaking children can become more human,
27700 i.e. become language users, by way of a machine which talks and which
27800 they find more acceptable on their own terms than they do talking
27900 humans.
28000
28100 A more realistic objection to computers is their cost. Few people in
28200 the world have access to million-dollar computers for this sort of
28300 work. But a large computer is not necessary to carry out this
28400 method. Mini-computers costing only a few thousand dollars are
28500 adequate. It may be that we do not need a computer at all if someone
28600 found a way to rapidly random-accessg both sounds and pictures. We
28700 are investigating this possibility. Once we can get the misconceived
28800 Satanic image of the computer out of the picture , I hope others will
28900 join us in discovering more about this technique for treating
29000 nonspeaking dissymbolic children.
29100
29200 REFERENCES
29300
29400
29500 [1] Churchill,D.W.,1972. The relation of infantile autism and early
29600 childhood schizophrenia to developmental language disorders
29700 of childhood. Journal of Autism and Childhood Schizophrenia,
29800 2,182-197.
29900 [2] Colby, K.M. and Smith, D.C., 1971. Computers in the treatment of
30000 nonspeaking autistic children. In Current Psychiatric Therapies,
30100 Masserman, J.H.(Ed.), Grune and Stratton, New York.
30200 [3] Fay, W.H., 1969. On normal and autistic pronouns. Journal of Speech
30300 and Hearing,36,242-249.
30400
30500
30600 [4] Frith, U., 1972. Cognitive mechanisms in autism: experiments with
30700 color and tone sequence production. Journal of Autism and
30800 Childhood Schizophrenia, 2, 160-173.
30900 [5] Harlow, H.(1953). Motivation as a factor in the acquisition of
31000 new responses. Current theory and research in motivation.
31100 University of Nebraska Press.
31200 [6] Hermelin, B. and O'Connor, N., 1970. Psychological Experiments
31300 With Autistic Children, Pergamon Press, London.
31400 [7] Nissen,H.W. (1954). The nature of the drive as innate determinant
31500 of behavior organization. Nebraska Symposium On
31600 Motivation,9,308.
31700 [8] Rutter, M., Bartak, L. and Newman, S., 1971. Autism- a central
31800 disorder of cognition and language? In Infantile Autism,
31900 Rutter, M.(Ed.), Churchill Livingstone, London.
32000
32100
32200
32300 ACKNOWLEDGEMENTS
32400
32500
32600 This research is supported by Grant PHS MH 06645-12 from the National
32700 Institute of Mental Health and by (in part) Reaearch Scientist Award
32800 (No. 1-K05-K-14,333) from the National Institute of Mental Health.