00100	
00200	    OBJECTIVE MEASUREMENT OF NONSPEAKING  CHILDRENS' INTERACTIONS
00300	  	WITH A COMPUTER-CONTROLLED PROGRAM FOR THE
00400	          STIMULATION OF LANGUAGE DEVELOPMENT
00500	
00600	
00700	            KENNETH MARK COLBY
00800			  AND
00900		    HELENA C. KRAEMER
01000	
01100		One  difficulty  in  evaluating  treatment  improvements   in
01200	disorders  whose  defining  characteristics  are purely behavioral is
01300	that we lack objective measurements. An objective measurement is  one
01400	which is intersubjectively confirmable and impartially independent of
01500	individual opinions, intuitions, and judgemments. When humans try  to
01600	be  both   participants   in   and   observer-recorders   of,   their
01700	interactions,  objective  measurement becomes impossible.    But when
01800	one participant in an interaction is a machine such as a computer, an
01900	opportunity  arises for the machine itself to record observations and
02000	to collect data.  This capacity of a computer allows us to develop  a
02100	measurement  standard  ,  a basis of comparison in which interactions
02200	can be considered  similar  or  different  according  to  objectively
02300	defined measurement criteria.
02400		While  developing  a  computer-aided  treatment  method   for
02500	stimulating language behavior in nonspeaking autistic children (Colby
02600	and  Smith,1971,  Colby,1973),  we  became  interested  in  how   the
02700	interactions  between  these  children  and the machine differed from
02800	those of (1) normal children  and  (2)  other  types  of  nonspeaking
02900	children.    To  evaluate the treatment method we attempted to follow
03000	changes in interactions over time and to assess whether these changes
03100	could  be  considered as an improvement. If no changes occurred or if
03200	the changes were judged as retrogressive, then the  treatment  should
03300	be  discontinued.     We  chose  to define improvement as a change in
03400	interactions  towards  those  characteristic   of   normal   speaking
03500	children.
03600		The   treatment   involves   letting  a  child  play  with  a
03700	computer-controlled   audio-visual    device    consisting    of    a
03800	typewriter-like  keyboard and a television-like video display screen.
03900	When a child presses a key, a symbol,  letter,  word,  expression  or
04000	drawing  appears  on  the screen accompanied by a sound, mainly human
04100	voice sounds and some animal or machine sounds. The  overall  program
04200	is divided into "games" of varying complexity. A sitter who sits with
04300	the child changes the games in accordance with the child's  interests
04400	and  abilities.  The simplest game is Game #1 in which pressing a key
04500	produces that key's symbol on the video screen accompanied by a voice
04600	pronouncing  the  corresponding  letter or number. We shall limit our
04700	discussion of objective measurement to the data collected in this one
04800	game.
04900		To keep track of the child's interactions with the machine, a
05000	program  was  written  (by  Earl Sacerdoti, a graduate student in the
05100	Department of Computer Science, Stanford University)  which  recorded
05200	the  game  the child was playing, which key was pressed at what exact
05300	time and whether the sound for this key was  played  over  the  audio
05400	device.  The  computer-controlled  system  is designed so   that if a
05500	child presses a single key or several keys in bursts of less  than  a
05600	second's duration, the sound for the first pressing is played but the
05700	rest are not, in order to avoid confusing the child. As soon  as  the
05800	child  pauses  at the end of such a burst, a buffer is cleared of all
05900	the symbols accumulated during the burst, and when the  next  key  is
06000	pressed, its sound is played. Striking the keys at an extremely rapid
06100	rate indicates a child is ignoring the  sound  and  paying  attention
06200	only to his visual and/or tactile experience.
06300		To analyze data from several children  playing  Game  #1,  we
06400	examined  for  each  child  (1)  the  total  number  of  runs  (a run
06500	consisting of the same key being pressed),(2) the distribution of the
06600	lengths  of  runs,  (4)  the  number of gaps (blank spaces indicating
06700	non-listening to sound),and (5) the distribution of the length of the
06800	gaps.   From these observed values we computed statistics descriptive
06900	of the performance of the child and  relatively  independent  of  the
07000	length  of  the  game. These were (1) average run and gap length, (2)
07100	relative frequency distributions of runs and gaps, and (3) numbers of
07200	gaps  per  length  of  test.   Discarded  from  this  list were those
07300	measures which for normal children were insensitve to the age of  the
07400	child.  The  two  most  sensitive  measures  were  found  to  be: (1)
07500	proportion of runs of length 1 (%R1) and (2) relative number of  gaps
07600	(total  number of gaps divided by total length of runs). The data for
07700	these measures from normal and three types  of  nonspeaking  children
07800	(autistic,  aphasic, organic brain syndrome) appears in Tables 1. and
07900	2.
08000		From the normal children data we can construct  a  prediction
08100	line.  Normal  children  from  age  17  months  to 10 years appear to
08200	progress in the performance  characteristics  of  their  interactions
08300	along  this  line.    One can project the observed point describing a
08400	normal  child's  performance  onto  the  prediction  line,  and   the
08500	projection  points  with  but one exception, line up according to the
08600	age of the child. If  one  graphs  the  abscissa  of  the  projection
08700	against the age of the child, one can produce an age-prediction curve
08800	based on the performance characteristics. (See Fig. 1).
09000		Using curve fitting procedures on these data we found that
09100	the numerical  formula for prediction was:
09200		A(i) = 0.837 - 3.83 log (1 - % R1 + 0.809 TNG/TLR)
09300	For  each  normal  and  each  nonspeaking  child,  the  age-level  of
09400	performance was computed by this formula and appears in Tables 1  and
09500	2.   In  the  age  range  of  particular  interest  (1 -4 years), the
09600	age-level of the performance of normal children is closely comparable
09700	to   their   actual  chronological  age.   On  the  other  hand,  the
09800	performances of the nonspeaking children  are  comparable  to  normal
09900	children  less  than  4  years  of age.  Over time it can be assessed
10000	whether a  nonspeaking  child  is  progressing  towards  more  normal
10100	interactions (i.e.  achieving higher age-level performances), whether
10200	he has reached a plateau, or is retrogressing.
11700		We  have several cases of failure in which the final sessions
11800	of treatment show interactions indistinguishable from  those  of  the
11900	early sessions.   We must also be prepared for the possibilities that
12000	(1) a child's comprehension and speech improves as judged by clinical
12100	and  parental observation but his interactions do not change or (2) a
12200	child's interactions change towards the normal but he still does  not
12300	use  speech for social communication.    As yet, we have not observed
12400	either of these paradoxical outcomes.
12800		In  summary,  we  have  presented an objective measurement of
12900	children's  interactions  in  playing  with   a   computer-controlled
13000	audio-visual  device  programmed  to  stimulate language development.
13100	This measurement is useful in 3 ways: (1) it reveals  where  a  child
13200	stands  on  an  interaction  curve  relative to normal and other non-
13300	speaking children; thus treatment can be planned to suit the  child's
13400	position on an  age-equivalent curve, (2) changes in the interactions
13500	over time can be evaluated to see if a child is improving or not, and
13600	(3) if no change takes place or a child reaches a plateau and remains
13700	there for a long  time,  discontinuation  of  the  treatment  can  be
13800	justified.    Thus an objective measurement of interactions serves as
13900	a useful instrument in planning and terminating treatment of language
14000	deficiencies in nonspeaking children.
14100	
14200	                          References
14300	
14400	Colby, K. M. (1973). The rationale for computer-based treatment of
14500	     language difficulties in nonspeaking autistic children.
14600	     Journal of Autism and Childhood Schizophrenia, 3, 254-260.
14700	
14800	Colby, K. M. and Smith, D. C. (1971). Computers in the treatment
14900	     of nonspeaking autistic children.  In J. H. Masserman
15000	     (Ed.), Current Psychiatric Therapies, Grune  & Stratton,
15100	     N.Y.
15200	
15300	Rimland, B. (1971). The differentiation of childhood psychoses: an
15400	     analysis of checklists for 2,218 children.  Journal of
15500	     Autism and Childhood Schizophrenia, 1, 175-189.