00100	
00200	THE 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  difficult.     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		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  data  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	two children.
07900		To analyze data from several children  playing  Game  #1,  we
08000	examined  for  each  child  (1)  the  total  number  of  runs  (a run
08100	consisting of the same key being pressed),(2) the distribution of the
08200	lengths  of  runs,  (4)  the  number of gaps (blank spaces indicating
08300	non-listening to sound),and (5) the distribution of the length of the
08400	gaps.   From these observed values we computed statistics descriptive
08500	of the performance of the child and  relatively  independent  of  the
08600	length  of  the  game. These were (1) average run and gap length, (2)
08700	relative frequency distributions of runs and gaps, and (3) numbers of
08800	gaps  per  length  of  test.   Discarded  from  this  list were those
08900	measures which for normal children were insensitve to the age of  the
09000	child.  The  two  most  sensitive  measures  were  found  to  be: (1)
09100	proportion of runs of length 1 (%R1) and (2) relative number of  gaps
09200	(total  number of gaps divided by total length of runs). The data for
09300	these measures from normal and three types  of  nonspeaking  children
09400	(autistic,  aphasic, organic brain syndrome) appears in Tables 1. and
09500	2.
09600		From  the  normal children data we can construct a prediction
09700	line as shown in the graph of Fig. 4. Normal  children  from  age  17
09800	months   to   10   years   appear  to  progress  in  the  performance
09900	characteristics of their  interactions  along  this  line.   One  can
10000	project  the  observed  point describing a normal child's performance
10100	onto the prediction line, and, as can be seen, the projection  points
10200	with but one exception, line up according to the age of the child. If
10300	one graphs the abscissa of the projection  against  the  age  of  the
10400	child,   one  can  produce  an  age-prediction  curve  based  on  the
10500	performance characteristics. (See Fig. 5).
10600		Using curve fitting procedures on these data we found that
10700	the numerical  formula for prediction was:
10800		A(i) = 0.837 - 3.83 log (1 - % R1 + 0.809 TNG/TLR)
10900		For each normal and each nonspeaking child, the age-level  of
11000	performance  was computed by this formula and appears in Tables 1 and
11100	2.  In the age  range  of  particular  interest  (1  -4  years),  the
11200	age-level of the performance of normal children is closely comparable
11300	to  their  actual  chronological  age.  On  the   other   hand,   the
11400	performances  of  the  nonspeaking  children are comparable to normal
11500	children less than 4 years of age.  Over  time  it  can  be  assessed
11600	whether  a  nonspeaking  child  is  progressing  towards  more normal
11700	interactions (i.e.  achieving higher age-level performances), whether
11800	he has reached a plateau, or is retrogressing.
11900		As yet we do not have complete data from start to  finish  of
12000	treatment  on  an  improved  case  of  a  nonspeaking autistic child.
12100	However, Fig.  6 shows some current (Aug.l973) interactions of D.,  a
12200	nonspeaking  autistic  10  year old boy whom we treated for two years
12300	three years ago and whose language development gained markedly.   (We
12400	were  not  collecting  this  type  of data when he was in treatment.)
12500	Stretches of D's  interactions  are  quite  normal  looking  and  his
12600	location  on  the  age-equivalent  curve  of  Fig.  5 shows him to be
12700	performing slightly better than a normal three year old.  (It  should
12800	be  noted  that  between ages 3-4 a normal child achieves grammatical
12900	complexity roughly equivalent to adult  colloquial  language,  making
13000	occasional   mistakes.   Between  ages  4-5  language  becomes  fully
13100	established with all  adult  grammatical  forms,  deviating  only  in
13200	style).
13300		We  have several cases of failure in which the final sessions
13400	of treatment show interactions indistinguishable from  those  of  the
13500	early  sessions.  The  data  of  the child in Fig.2 over the past two
13600	years reveal periods of retrogression and no overall improvement.  We
13700	will  try  for  another  year  and  if  no  change  occurs,  we  will
13800	discontinue. We must also be prepared for the possibilities that  (1)
13900	a child's comprehension and speech improves as judged by clinical and
14000	parental observation but his interactions do  not  change  or  (2)  a
14100	child's  interactions change towards the normal but he still does not
14200	use speech for social communication.    As yet, we have not  observed
14300	either of these paradoxical outcomes.
14400		In  summary,  we  have  presented an objective measurement of
14500	children's  interactions  in  playing  with   a   computer-controlled
14600	audio-visual  device  programmed  to  stimulate language development.
14700	This measurement is useful in 3 ways: (1) it reveals  where  a  child
14800	stands  on  an  interaction  curve  relative to normal and other non-
14900	speaking children; thus treatment can be planned to suit the  child's
15000	position on an  age-equivalent curve, (2) changes in the interactions
15100	over time can be evaluated to see if a child is improving or not, and
15200	(3) if no change takes place or a child reaches a plateau and remains
15300	there for a long  time,  discontinuation  of  the  treatment  can  be
15400	justified.    Thus an objective measurement of interactions serves as
15500	a useful instrument in planning and terminating treatment of language
15600	deficiencies in nonspeaking children.
15700	
15800	                          References
15900	
16000	Colby, K. M. (1973). The rationale for computer-based treatment of
16100	     language difficulties in nonspeaking autistic children.
16200	     Journal of Autism and Childhood Schizophrenia, 3, 254-260.
16300	
16400	Colby, K. M. and Smith, D. C. (1971). Computers in the treatment
16500	     of nonspeaking autistic children.  In J. H. Masserman
16600	     (Ed.), Current Psychiatric Therapies, Grune  & Stratton,
16700	     N.Y.
16800	
16900	Rimland, B. (1971). The differentiation of childhood psychoses: an
17000	     analysis of checklists for 2,218 children.  Journal of
17100	     Autism and Childhood Schizophrenia, 1, 175-189.