Speech Atypicalities & Expressive Prosody in Autism ......Motor speech disorders: negave...

1 School of Public Health and Health Sciences: Department of Communication Disorders School of Public Health and Health Sciences: Department of Communication Disorders

Mary V. Andrianopoulos, Ph.D. Department of Communication Disorders University of Massachusetts – Amherst

MA ACT Early Summit

October 12, 2017

Speech Atypicalities & Expressive Prosody in Autism:

Empirical Evidence, Theories & Early Identification

2 School of Public Health and Health Sciences: Department of Communication Disorders

Today’s Objectives

1.  Introduction to “Speech Atypicalities”, Motor Speech Impairment and Expressive Prosody;

2.  Empirical evidence regarding atypical Speech,

Prosody and Motor Speech in children with ASD; 3.  Past and current research at UMass Amherst

regarding the acoustic-perceptual, motoric and prosodic features of ASD;

Today’s Objectives 4.  Theoretical constructs that support the

underlying mechanisms regarding the Speech Atypicalities and Expressive Prosody in ASD;

5.  The Need for Early Identification and Early

Intervention of Atypical Speech and Motor Impairment in children with Neurodevelopmental Disabilities and ASD;

6.  Early Identification using the LAMS

•  Language-Neutral Assessment of Motor Speech (Velleman, Andrianopoulos, Rupela, 2013)

Hans Asperger (1906-1980)

Studied 4, then 34 individuals Ages 5- 35 years Primary Features:

•  “Communication - abnormal content” (tangential and verbose)

•  “Stereotypical speech” •  “Grammar acquired at later age”

•  “Lack of ability to understand and use the rules governing social behavior”

•  “Poor comprehension of jokes, other’s facial expression, non-verbal gestures”

•  “Become intensely interested in 1 or 2 subjects” •  “Report facts, good rote memory, but little grasp of

meaning”

Hans Asperger (1906-1980)

▪ Primary Features (continued) •  “Delayed walking” •  “Gestures are limited, or else large and clumsy” •  “Vocal intonation monotonous, droning, exaggerated” •  “Gross motor movements are clumsy and ill-coordinated”

•  “Posture and gait appear odd” •  “Most, or 90% of the 34 cases are poor at games involving motor skills”

Historical Background of Autism

1943 Kanner: (child psychiatrist - 1894-1981)

▪ Studied 11 children “who were similar to each other but whose pattern of difficulties were quite different from children diagnosed with other conditions”

▪ Gender: 8 boys; 3 girls ▪ Primary features www.fansshare.com

•  “Social withdrawal; Aloneness; Stereotypical behaviors” •  “Deafness” suspected in 2 (18%) •  “Several were somewhat clumsy in gait and gross motor performances”

▪ Kanner coined term “early infantile autism” ▪ “autism” taken from Greek word “autos” (self)

Review of the Literature

What Do We Know About Language, Speech, Motor Abilities, Prosody and ASD?

Communication Abilities and ASD

•  Difficulty with communication and social interaction is a hallmark feature of ASD (Center for Disease Control, 2014a)

•  Language abilities are one area that is very variable

across the spectrum: •  skills ranging from non-existent to rather

sophisticated; •  severity ranges from very impaired to above

average.

Communication Abilities and ASD

▪  Yet, some distinct features of ASD speech and language may be present across the entire spectrum: •  abnormal prosody; vocal / motoric differences •  structural language deficits •  problems with narrative coherence

(Boucher,2012;Eigsti,Bennetto,&Dadlani,2007;Kjelgaard&Tager-Flusberg,2001;McCabe,Hillier&Shapiro,2013;Nadig&Shaw,2012)

Language and ASD ▪ Most children with ASD begin to speak later than their TD peers, and develop language skills at a slower rate (Tager-Flusberg et al., 2005)

▪ Structurally simpler, less coherent narratives than typically developing peers (Diehl et al., 2006; McCabe et al., 2013)

▪ Children with HFA have a strong vocabulary, but have trouble using the words they know in social contexts, especially words relating to mental state (Tager-Flusberg et al., 2005)

Speech Differences and ASD §  Approximately 30% - 50% of children with ASD do not

develop functional communication or remain non-verbal or "minimally verbal" past the age of 5 years (Prizant, 1996; Gernsbacher, Sauer, Geye, Schweiger, Hill, Godsmith, 2008; Chenausky, Norton, Tager-Flusberg, & Schlaug, 2013; Tager-Flusberg and Kasari, 2013; Thurm, Manwaring, Swineford, & Farmer, 2014; Tager-Flusberg, 2014; Shire, Goods, Shih, Distefano, Kaiser, Wright, Mathy, Land, & Kasari, 2015; American Speech Language Hearing Association, 2015; Brignelli, Song, Zhu, Suo, & Lu, 2016)

§  Sound odd, awkward, or “bizarre” (Filipe et al., 2014; Grossman et al., 2013; Grossman & Tager-Flusberg, 2012; Nadig & Shaw, 2012)

▪  Differences in acoustic features (Filipe et al., 2014; Grossman et al., 2013; Nadig & Shaw, 2012)

▪  Differences in laryngeal quality (Sheinkopf et al., 2000)

Speech Differences and ASD ▪  Problems with motor imitation

(Peppe, S., McCann, J., & Gibbon, F., 2007)

▪  Groping & difficulty with non-speech oral motor movements (Adams, L., 1998)

▪  Increased repetitions & revisions; atypical patterns of fluency (Shriberg, L., Paul, R., Black, L., Santen, J., 2011; Turner, 1999)

▪  Some demonstrate difficulties oral motor skills. (Belmonte, M.K., Saxena-Chandhok, T., Cherian, R., Muneer, R., George L., Karanth, P., 2013)

Speech Differences and ASD

▪ Monotonous speech; atypical prosody (Nadig & Shaw, 2012; Nakai et al., 2013)

▪ Different stress patterns, high fundamental frequency, and other voice disorders such as poor volume control

(Tager-Flusberg et al., 2005; Shriberg et al., 2001)

General Motor Impairment and ASD

▪ Motor impairments and general motor deficits in individuals with ASD are a widely noted (i.e., hypotonia, motor apraxia, gross motor delays)

(Belmonte, Allen, Beckel-Mitchener, Boulanger, Carper & Webb, 2004; Diamond, 2000; Hardan, Kilpatrick, Keshavan, & Minshew, 2003; Muller, Kleinhans, Kemmotsu, Pierce, & Courchesne, 2003; Muller, Pierce, Ambrose, & Allen, 2004; Prizant, Wetherby, & Rubin, 2003; Ming, Brimacombe, & Wagner, 2007)

▪  Individuals with ASD are described as being “clumsy” and “uncoordinated”.

(Ghaziuddin, Butler, & Tsai, 1994; (Allen, Müller, & Courchesne, 2004; Ghaziuddin, Butler, Tsai & Ghaziuddin, 1994; Green, Baird, Barnett, Henderson, Huber & Henderson, 2002; Thede & Coolidge, 2007)

To support differences among children with ASD with respect to:

•  Linguistic Abilities •  General Motor •  Motor Speech / Articulation •  Vocal Differences •  Prosody (Receptive vs. Expressive)

Published Empirical findings are inconsistent…

Definitions Clinical Implications

What is a Motor Speech Impairment?

MSDs are disorders of speech resulting from: • “Neurologic” involvement

MSDs affect:

• Neuromuscular execution of speech (Dysarthria)

• Motor programming + planning (Apraxia) • Sensory innervation to speech mechanism

What is a Dysarthria? § Due to CNS and/or PNS involvement; § Dysarthria is categorized by:

§ associated clinical symptomatology of speech and; § location of breakdown within the CNS and/or PNS

§ Dysarthria affects Neuromuscular Execution, Control § changes in speed, strength, range, timing, coordination, accuracy

▪  In children, dysarthria is referred to as CD

19 School of Public Health and Health Sciences: Department of Communication Disorders http://www.nimd.go.jp/archives/english/tenji/a_corner/image/a03e.gif

Central and Peripheral Nervous Systems

19 http://what-when-how.com/neuroscience/the-cranial-nerves-organization-of-the-central-nervous-system-part-1/

Speech Characteristics of Childhood Dysarthria (CD)

§  Consistent distortions; §  Fast, slow or irregular speech rate; §  Incoordination of speech processes;

§ respiration, phonation, articulation, and nasal resonance;

§  Short bursts of speech; and §  Differences in pitch, volume/loudness, resonation, prosody,

§ and/or vocal quality (dysphonia)

What is Childhood Apraxia of Speech (CAS)?

•  CAS is motor planning – programming problem that affects:

§ Voluntary use of speech for communication purposes

• CAS is characterized by difficulties with:

§ Sequencing articulatory movements; phonemes, and syllables; § Trial and error groping behaviours; and § Unusual and inconsistent substitution error patterns for both consonants and vowels (Rvachew, Hodge, & Ohberg, 2005; ASHA, 2007)

http://bb-healthguide.blogspot.com/2015/07/5-good-food-for-brain-development-of.html

CAS Localization •  The exact location of

breakdown of CAS is indeterminate;

•  Research supports a breakdown the cortical networks in the language dominant hemisphere;

•  CAS is typically congenital •  Speech never develops

appropriately, but due to a programming/planning problem.

Why is Early Identification of a MSD important?

Motorspeechdisorders:§ nega1veconsequencesforliteracy,educa1onalachievement,rela1onshipsandemployment(Lewisetal.,2004;Carriggetal.,2016)

§ occurwithorwithoutdiagnosedneurodevelopmentalcondi1ons(ASD,Downsyndrome,Williamssyndrome,7q11.23duplica1onsyndrome…)

§ notcompletelypredictablebasedonotherdiagnoses.

Prosodic Features of Speech

Pitch Stress

Loudness Tempo

Pauses

What is Prosody?

Prosody refers to aspects of speech that convey meaning •  What is said (lexical content) •  How it’s said (prosody)

Prosodic Development: Perception

•  ERP data indicate that ”…aspects of the human voice & prosody are processed early in life

(Grossman et al., 2010)

▪  “Studies show that newborns (2 days old) can

discriminate between different prosodies and speech sounds shortly after birth”(Perani et al., 2011)

▪ Head-turn listening procedures & sucking habituation studies show that infants prefer speech that is similar to the phrasing patterns in native language (Speer and Ito, 2009)

Prosodic Development: Perception

▪ “R Hemisphere plays a predominant role in processing emotional prosody”

(Wildgruber et al., 2002; as cited in Grossman et al., 2010)

▪ “An adult-like left hemispheric specialization for segmental information and an adult-like right hemispheric preference for suprasegmental information has been demonstrated in 4-y-old children using NIRS

(Wartenberger et al., 2007; as cited in Perani, 2011)

Prosodic Development: Production

• Lack of consistent evidence regarding developmental milestones of expressive prosody;

•  “Unclear how early infants’ vocalizations are influenced by the adult prosodic system” (DePaolis et al., 2008)

§  Most studies suggest that as the infant nears the end of the second year of life, the prosody of vocal productions become increasingly adult-like, coinciding with the increase in word production (Vihman, Macken, Millar, Simmons, & Millar, 1985; cited in Depaolis et al., 2008).

UnderlyingMechanismsofAtypicalSpeechandProsody

Differences reported among children with ASD, but what are the underlying mechanisms?

§  Linguistic Abilities and Development §  Receptive vs. Expressive Prosody Abilities §  Motor Speech / Articulation §  Vocal Differences §  Other Mechanisms or a combination there of:

Published Empirical findings are inconsistent…

Research at UMass Amherst

UMass-Amherst Research ▪  In a series of studies, our research teams have investigated the presence and type of motor, acoustic-perceptual and prosodic differences and/or impairments in children with ASD compared to TD and other cohorts

▪ Our research supports that children with ASD do exhibit underlying motoric, phonatory (voice-related) and prosodic differences that affect speech. We have identified the tasks the tease out the most salient and confirmatory signs and symptoms of Motor Speech Impairment.

UMass Amherst Atypical Speech & Prosody Studies

1.   What features distinguish the speech of individuals with ASD compared to typically developing peers?

2.   What underlying mechanisms and

processes contribute to these speech atypicalities observed children with ASD?

Marili, Andrianopoulos, Velleman, 2005

ASD, N=40 Age: 2;0-22

Acoustic High pitch Breathy, rough, Strained Monotone, Flat Prosody Speech Poor Speech Intelligibility Distorted consonants Omission of phonemes Poor -Increase complexity Motor Speech Non-verbal Struggle AMRs / Sequencing issues Neuromuscular Brisk reflexes Clumsiness Muscular Weakness Drooling, Eating issues

Perkins, , Andrianopoulos, Velleman, 2006

!CAS vs. TD, N=16

Age: 5-8;11 Acoustic Lower pitch vowel [i]. Motor Speech Decrease rate Increase duration phrases sentences Variable and/or inconsistent performance phrase sentence repetitions. Decreased MPT Slow rate AMRs SMR !

Boucher, Andrianopoulos, Velleman, 2007

ASD vs. CAS vs. TD; N=30

Age: 4-6;11 Acoustic Higher formant values, vowel [i] Decreased pitch vowel [i]. Motor Speech Decreased maximum phonation time Slower rate of speech uniform lengthening across phrases, pause length and vowel length Difficulty in producing 2 or more repetitions of syllables in AMR & SMR tasks. Variable and/or inconsistent performance across tasks.

Pecora, Andrianopoulos, Velleman, 2007

ASD vs. TD; N=10

Age: 4-9;11 Acoustic Pitch variation “monopitch” “monoloudness” Motor Speech Shorter MPT Longer duration, longer pauses Counting 1-10 Longer durations slower rate singing the “Happy Birthday” Variable and/or inconsistent performance across tasks.

Falcon, Andrianopoulos,

Velleman, 2011 ASD vs. TD; N=15 Age: 5;11-11;3 Acoustic Significantly greater variability of pitch children with ASD during both [a] and [i] Greater variability during spontaneous speech, narrative Motor Speech Respiratory vigilance Generally lower MPT of the fricative [f], prolongations, !

Boucher, Andrianopoulos, Velleman, 2013

!ASD vs. CAS vs. TD, N=30

Age: 8;4-12;7 Acoustic Lower formant values. Lower pitch values Mildly deviant voice, mild roughness and strain Inconsistent nasality Prosody Atypical production of prosody Motor Speech Significantly decreased MPT Slower rate of speech, increased utterance, pause, and vowel durations. Reduced number of syllable repetitions in AMR and SMR Variable and/or inconsistent.

Andrianopoulos, M.V., Velleman, S.L. Keator, L, Starr, M., Ryan, T., Lewandowski, A. (2015)

UMass Amherst Expressive Prosody Investigation

Expressive Prosodic Profile N=8 ASD Age 4 -10 yrs

Perceptual Acoustic PEPS-C (Peppe et al, 2011)

high pitch high F0 impaired contrastive stress

extended utterance duration

high max F impaired expressive affect

wide intensity range

decreased MPT poor imitation of complex tone and pitch

“odd/awkward”

Mary V. Andrianopoulos, Ph.D. Carlene McGuigan, MS candidate

Rachel Warshaw, B.A. University of Massachusetts – Amherst, MA

Elena Zaretsky, Ph.D.

Clark University – Worcester, MA

Perceptual Characteristics of Spontaneous Speech in High Functioning Autism:

Are We Discriminating Listeners?

Research Questions

1.  Are there distinct speech and language differences as perceived by human listeners that distinguish children with autism as sounding “different” compared to their age- and gender-matched neurotypically developing (TD) peers?

2.  Do experienced and non-experienced judges rate the narratives of children with ASD differently than they rate the narratives of TD peers?

Phase I: Participant Demographics - Narrative Study

Phase I: Baseline Group Means (S.D.)

Methodology: Human Listeners

Two (2) cohorts of 20 SLP and 20 non-SLP full-time graduate students were recruited across the university campus to participate as “listeners”. ▪ Human Judges (Listeners): N=40

• Group 1: n= 20 SLP Masters Graduate Students • Group 2: n=20 Non-SLP Graduate Students

▪ Participant orientation: • To apply a set of criteria to judge the perceptual and linguistic characteristics of the narratives

Methodology: Assessment Instrument

▪ Perceptual Rating Instrument Created: 13 Variables • 7 Linguistic

1) story sequencing; 2) topic organization 3) story details; 4) pronominal references; 5) causal language; 6) use of elaborations; 7) ToM language

• 6 Speech/Acoustic variables 1) articulation; 2) fluency; 3) intonation; 4) rate; 5) pitch; 6) loudness)

Results: Main Effect Diagnosis (ASD vs. TD) Statistically significant between group differences were found for four out of thirteen variables ▪ Variable 1 Sequencing (p=0.008) ▪ Variable 8 Articulation (p=0.001) ▪ Variable 9 Fluency (p=.005) ▪ Variable 12 Rate (p=0.016)

Nonsignificant differences were found for §  Variable 2 Topic organization (p=0.073) §  Variable 11 Pitch (p=0.058) (For all 6 variables, HFA had lower mean + greater variability)

AtypicalSpeechandAbnormalProsodyTheories

Speech attunement framework: (pragmatic deficits) lack of ability to ‘tune in’ to speech environment and ‘tune up’ speech behaviors.

(Diehl & Paul, 2013; Diehl & Paul, 2012; Shriberg et al., 2011; Schoen, Paul, & Chawarski, 2011*; Lyons, Simmons, & Paul, 2014*)

Motor deficits: distorted timing of connected speech, problems of motor imitation, speech-motor control.

(Diehl & Paul, 2012; Peppe et al., 2007; Shriberg et al., 2001;

Paul & Binachi, 2008*; Grossman et al., 2013*; Hubbard & Trauner, 2006*)

AtypicalSpeechandAbnormalProsodyTheories

Deficit in mechanisms that control pitch: auditory processing, phonological representation, motor functioning.

(Bonneh et al., 2010; Diehl & Paul, 2013)

Social reciprocal interaction impairment (Yasushi, 2014*; consistent with Paul et al., 2005*)

SystematicReview:Abnormal Prosody Theories

Poor language ability, atypical/delayed trajectory for prosodic development, prosody skills may lag in maturity, difficulty interpreting suprasegmental speech features.

(Peppe et al., 2011; Bonneh et al., 2010; Diehl et al., 2009; Shriberg et al., 2001; Diehl & Paul, 2013; Sharda et al., 2010*; Peppe & McCann, 2007*; DePape, 2012*; Nadig & Shaw 2012b*; van Santen et al., 2010*; Peppe et al., 2006*)

SystematicReview:Abnormal Prosody Theories

Nature of task: Performance may vary based on structure of task, number of training items/similar trials, language of directions, motivation.

(Diehl & Paul, 2013; Peppe et al., 2007; Sharda et al., 2010*; Peppe & McCann, 2007*; DePape, 2012*; Nadig & Shaw 2012b*; van Santen et al., 2010*; Peppe et al., 2006*)

Language-neutral Assessment of Motor Speech

(LAMS)

Shelley L. Velleman, Ph.D. Mary V. Andrianopoulos, Ph.D.

Vani Rupela, Ph.D.

The LAMS: Why a new test?

§ Thenature,consistency,anddevelopmentalprogressionofspeechatypicali1esisunclear,needtovalidatechildhoodmotorandprosodicsymptoms;

§ Appropriateinterven1onsdifferbySpeechSoundDisorders,MSDandASDprofiles;

§ Earlyspeechprofilescanpredictoutcomes(i.e.,ASDseverity;Plumb&Wetherby,2013;Schoenetal.,2011)

§ Muchmoreresearchneeded–butneedvalid,reliable,test,forEarlyIden1fica1on,thatislanguageneutralandnotacheck-offlist!

Results: Perceptual Observations, Output Function

Prosody ▪  “rigid”, “robotic, “patterned” ▪  “rote” ▪  “locked into prosodic patterns” ▪  cannot demonstrate contrastive stress ▪  “cannot manipulate prosody to express emotions”

Results: Perceptual Observations: Output Form

Meaningless tone patterns: ▪  unable to replicate complex intonation patterns ▪  “flat” tone Pitch: ▪  cannot replicate varying pitch Silence: ▪  atypical, prolonged silences Duration: ▪  longer duration

Disclosure Statements

▪ Mary Andrianopoulos has no financial relationships to disclose; however, she and her colleagues have benefited financially from funding awarded by the following agencies: ▪  U.S. DOE Office of Special Education Programs

• H325K054199 (2005-2009) • H325D080042 (2008-2012) • H325K090328 (2009-2013) • H325K120327 (2013-2018)

▪  Cure Autism Now (CAN, 2005-2007)

▪  Organization for Autism Research (OAR, 2010-2012)

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