00100	THE OBJECTIVE MEASUREMENT OF AUTISTIC CHILDRENS' INTERACTION
00200	   PATTERNS WITH A COMPUTER-CONTROLLED PROGRAM FOR
00300	   THE STIMULATION OF LANGUAGE DEVELOPMENT
00400	
00500	
00600	            KENNETH MARK COLBY
00700			  AND
00800		    HELENA C. KRAEMER
00900	
01000		One  difficulty  in  evaluating  treatment  improvements   in
01100	disorders  whose  defining  characteristics  are purely behavioral is
01200	that we lack objective measurements. An objective measurement is  one
01300	which is intersubjectively confirmable and impartially independent of
01400	individual opinions, intuitions, and judgemments. When humans try  to
01500	be   both   participants   in   and   observer-recorders   of,  their
01600	interactions, objective measurement becomes  impossible.    But  when
01700	one participant in an interaction is a machine such as a computer, an
01800	opportunity arises for the machine itself to record observations  and
01900	to  collect data.  This capacity of a computer allows us to develop a
02000	measurement standard , a basis of  comparison  in  which  interaction
02100	patterns  can  be  considered  similar  or  different  according   to
02200	objectively defined measurement criteria.
02300		While  developing  a  computer-aided  treatment  method   for
02400	stimulating language behavior in nonspeaking autistic children (Colby
02500	and Smith,1971,Colby,1973), we became interested in the  patterns  of
02600	interaction  between  these  children  and  the machine and how these
02700	patterns differed from those of (1) normal  children  and  (2)  other
02800	types  of  nonspeaking  children. To evaluate the treatment method we
02900	attempted to follow changes in interaction patterns over time and  to
03000	assess  whether  these changes could be considered as an improvement.
03100	If no changes occurred or if the changes were judged as  "worsening",
03200	then  the  treatment  should  be  discontinued.  We  chose  to define
03300	improvement as a  change  in  the  interaction  pattern  towards  the
03400	pattern  characteristic of normal speaking children in particular age
03500	groups.
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		In  Fig.  1 the first column on the left indicates the number
06400	of the game, the second column indicates the key  struck,  the  third
06500	column  shows  the time of striking in hours-minutes-seconds, and the
06600	fourth  shows whether the sound for that key was played ("played") or
06700	not (blank space). The data of Fig. 1 illustrates the interaction  of
06800	a  normal  speaking 17 month old boy. Fig.2 shows the interactions of
06900	an eight year old nonspeaking boy clinically  diagnosed  as  autistic
07000	and  with  a  score of +26 on Rimland's E2 scale.    (A score greater
07100	than +20 is considered by Rimland to indicate a true  case  of  early
07200	infantile  autism  (Rimland,1971).    It is noteworthy how, on simple
07300	visual inspection, the pattern of  the  8  year  old  autistic  child
07400	resembles  that  of  a  17  month  old  normal child.  In this way an
07500	objective measurement allows us  to  establish  equivalences  between
07600	different  children.  Fig.3 demonstrates the interactions of a normal
07700	speaking 4 year old boy which are strikingly different from the other
07800	children.
07900		To  analyze  data  from  several children playing Game #1, we
08000	examined 6 numerical scores for each child: (1) the total  number  of
08100	runs  (a run consisting of the same key being pressed),(2) the length
08200	of the run, (3) the average length of a run, (4) the number  of  gaps
08300	(blank  spaces  indicating  non-listening to sound),(5) the length of
08400	the gap, and (6) the average length of a  gap.  The  data  for  these
08500	measures from normal and autistic children appear in Tables 1 and 2.
08600		From the normal children data we can  construct  a  curve  as
08700	shown  in  the graph of Fig. 4. Normal children from age 17 months to
08800	10 years progress in their interaction patterns along this curve. The
08900	interaction  patterns  of  a  nonspeaking  autistic  child locate him
09000	somewhere on this curve. Over time it can be estimated whether he  is
09100	progressing  towards  a more normal pattern, whether he has reached a
09200	plateau or whether he is retrogressing.   We have  not  yet  observed
09300	the  latter  case.  Since  the  data of the curve is longitudinal, it
09400	would  be  ideal  if  we  could  show  the  progress  in  normal  and
09500	nonspeaking  autistic groups of children over 10 year periods.  Since
09600	we have only cross-sectional data thus far, this is what we  used  to
09700	construct the curve.
09800		As yet we do not have complete data from start to  finish  of
09900	treatment  on  an  improved  case  of  a  nonspeaking autistic dhild.
10000	However, Fig.  5 shows the current (Aug.l973) interaction pattern  of
10100	J.,  a  10  year  old  boy  whom  we  treated for two years and whose
10200	language development gained markedly.   (We were not collecting  this
10300	type  of data when he was in treatment.) Stretches of J's interaction
10400	patterns  are  quite  normal  looking  and  his   location   on   the
10500	interaction-pattern  curve can be seen in the graph of Fig.4.      We
10600	have several  cases  of  failure  in  which  the  final  sessions  of
10700	treatment  show  interaction patterns indistinguishable from those of
10800	the early sessions.  The data of the child in Fig.2 reveal no  change
10900	over  the  past  two  years.  We  will try for another year and if no
11000	change occurs, we will discontinue. We must also be prepared for  the
11100	possibilities that (1) a child's comprehension and speech improves as
11200	judged by clinical  and  parental  observation  but  his  interaction
11300	patterns  do  not change or (2) a child's interaction patterns change
11400	towards the normal but he  still  does  not  use  speech  for  social
11500	communication.   As  yet,  we  have  not  observed  either  of  these
11600	paradoxical outcomes.
11700		In summary, we have presented  an  objective  measurement  of
11800	children's interaction patterns in playing with a computer-controlled
11900	audio-visual device programmed  to  stimulate  language  development.
12000	This  measurement  is  useful in 3 ways: (1) it reveals where a child
12100	stands on an interaction curve relative  to  normal  and  other  non-
12200	speaking autistic children; thus treatment can be planned to suit the
12300	child's position on the curve (2) changes in the interaction  pattern
12400	over time can be evaluated to see if a child is improving or not, and
12500	(3) if no change takes place or a child reaches a plateau and remains
12600	there  for  a  long  time,  discontinuation  of  the treatment can be
12700	justified.   Thus an objective measurement  of  interaction  patterns
12800	serves  as  a useful instrument in planning and terminating treatment
12900	of language deficiencies in nonspeaking autistic children.
13000	                          References
13100	
13200	Colby, K. M. (1973). The rationale for computer-based treatment of
13300	     language difficulties in nonspeaking autistic children.
13400	     Journal of Autism and Childhood Schizophrenia, 3, 254-260.
13500	
13600	Colby, K. M. and Smith, D. C. (1971). Computers in the treatment
13700	     of nonspeaking autistic children.  In J. H. Masserman
13800	     (Ed.), Current Psychiatric Therapies, Grune  & Stratton,
13900	     N.Y.
14000	
14100	Rimland, B. (1971). The differentiation of childhood psychoses: an
14200	     analysis of checklists for 2,218 children.  Journal of
14300	     Autism and Childhood Schizophrenia, 1, 175-189.