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You Can Know Me Now If You Listen: Sensory, Motor, and Communication Issues in a Nonverbal Person With Autism


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This case report describes an intensive approach to treating autism and provides an intersection between a first-person narrative paired with intervention and outcomes. In-depth conversations between a person with autism and an occupational therapist provide insight into understanding differences and difficulties in sensory processing and regulation, praxis, and communication. Individuals with autism may be intellectually and emotionally intact but hampered by deficits that interfere with the ability to move the body efficiently. These sensorimotor deficits underlie the ability to communicate with others and to develop relationships. This article illustrates the benefits of an intensive therapeutic program designed to address sensory and motor differences underlying communication, as well as the vital role the occupational therapist plays in addressing these underlying differences to improve functional communication and social participation.
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The American Journal of Occupational Therapy 547
You Can Know Me Now If You Listen: Sensory, Motor,
and Communication Issues in a Nonverbal Person
With Autism
• autism
• communication
• effectiveness
• movement
• sensory processing
Rachel Freret Shoener, BSOT, OTR/L, is Supervisor
of Occupational Therapy at the TALK Institute and School,
395H Bishop Hollow Road, Newtown Square, PA 19073;
Moya Kinnealey, PhD, OTR/L, FAOTA, BCP, is
Department Chairperson and Professor, Occupational
Therapy, Temple University, Philadelphia.
Kristie P. Koenig, PhD, OTR/L, is Assistant Professor
in the Department of Occupational Therapy, New York
University Steinhardt, New York.
This case report describes an intensive approach to treating autism and provides an intersection between a first-
person narrative paired with intervention and outcomes. In-depth conversations between a person with autism
and an occupational therapist provide insight into understanding differences and difficulties in sensory process-
ing and regulation, praxis, and communication. Individuals with autism may be intellectually and emotionally
intact but hampered by deficits that interfere with the ability to move the body efficiently. These sensorimotor
deficits underlie the ability to communicate with others and to develop relationships. This article illustrates the
benefits of an intensive therapeutic program designed to address sensory and motor differences underlying
communication, as well as the vital role the occupational therapist plays in addressing these underlying differ-
ences to improve functional communication and social participation.
Shoener, R. F., Kinnealey, M., & Koenig, K. P. (2008). You can know me now if you listen: Sensory, motor, and communica-
tion issues in a nonverbal person with autism. American Journal of Occupational Therapy, 62, 547–553.
Rachel Freret Shoener, Moya Kinnealey, Kristie P. Koenig
What do we believe versus what do we know about people who do not speak and who
cannot tell us about themselves? (Donnellan & Leary, 1995, p. 97)
There is growing evidence to suggest that the high prevalence of mental retardation
reported in people with autism is not supported by empirical data and that mea-
sures of intelligence are inadequate to take into account “the interfering symptoms
of autism on the process of assessment” (Edelson, 2006, p. 74). Autism self-advocates
who have gained access to communication after being classified as mentally retarded
have articulated the power of misassumption. As Rubin stated, “I was sadly assumed
to be mentally retarded. No one made the distinction in real life if I was labeled
mentally retarded or was mentally retarded” (Rubin et al., 2001, p. 418).
When David, the key informant in this case report, gained access to commu-
nication at age 14, he vividly described the experience of living with a sensory regu-
latory disorder, dyspraxia, and having no means of communication despite his
intelligence. David is an 18-year-old student diagnosed with pervasive developmen-
tal disorder not otherwise specified, apraxia of speech (a neurological motor speech
disorder), and dyspraxia (a sensory-based movement disorder).
I began so angry typing and never had dreamed to be having dreams ever, then the typ-
ing here in OT freed my little voice to be heard and I could release anger finally, and
I could need no more to hold in all my thoughts because I can tell in real words finally
all I needed, and little by little through years of daily struggle of working the muscles
and trying to focus to stay still and really learning to feel my body move when I walk
or talk and control movements.
548 September/October 2008, Volume 62, Number 5
David attends a private school for students with language
disorders, autism spectrum disorders (ASD), and apraxia of
speech. The curriculum is characterized by an emphasis on
speech and language using the Association Method, intensive
speech therapy, intensive occupational therapy, and the rapid
prompting method (RPM; Mukhopadhyay, 2007). The asso-
ciation method is a multisensory, phonics-based curriculum
that systematically teaches children with language disorders
to speak, read, and write fluently (DuBard & Martin, 2000).
Speech therapy is provided intensively to develop precise
articulation, oral motor control, and verbal fluency.
Intervention is specifically designed to reduce or alleviate the
student’s difficulties in decoding, organizing, associating,
storing, and retrieving information pertinent to the produc-
tion of clear, articulate speech. Occupational therapy is pro-
vided using a sensory integration approach, a relationship-
based approach, and principles of motor learning and motor
control. Sensory integration focuses on somatosensory, pro-
prioceptive, and vestibular experiences to improve sensory
modulation and establish body scheme as a foundation for
praxis and motor planning. A relational approach is based on
respect for people and building a relationship on trust, which
leads to the student’s desire to be engaged in learning and
relationships (Greenspan & Wieder, 1998, 2005). RPM,
developed by Soma Mukhopadhyay, focuses on the initiation
of responses without physical support using tactile, visual,
verbal, and auditory stimuli (Mukhopadhyay, 2007). RPM
focuses the student’s attention on written alphabetic and
numeric symbols to provide a communication method for
people who are primarily nonverbal.
After several months of using these methods, David
learned to independently communicate through typing.
Through this newfound ability to communicate, David has
shared many insights, including his difficulties with body
movements, his sensory challenges, and his love of life by
having found a means of communicating with others.
Through these descriptions, occupational therapists can gain
insight into guiding effective interventions. Like people with
cerebral palsy, Parkinson’s disease, or stroke, those with
autism may be intellectually and emotionally intact, even
though their bodies do not reliably allow them to demon-
strate who they are and what they know. The importance of
occupational therapy cannot be overstated. In David’s words,
We want to be heard but it’s hard and in here being [in]
OT has helped me tell my story of [a] happy life that’s come
since being able to talk, but before that I had to be cautious
because I was so much overlooked to be ignorant and to be
able to share.
Occupational therapist: What was it like for you to finally
be able to communicate?
It was heaven.
Assessment Results
Occupational therapy is based on the principle that engage-
ment in occupation includes the subjective (emotional or
psychological) aspects of performance and the objective
(physically observable) aspects of performance (American
Occupational Therapy Association, 2002, 2003). David’s
goals, based on a thorough evaluation, were to address the
developmental parameters of sensory processing and modu-
lation, motor/praxis, emotional/relational, and communica-
tion/cognition. Table 1 displays initial evaluation results for
David as well as the current results of the Sensory Profile
(Dunn, 1999). Administration of standardized testing
revealed significant difficulties with balance, strength, gross
and fine motor skills, visual motor skills, and motor plan-
ning/praxis skills. Although David was unable to complete
these assessments in 2002, he was able to complete them in
2007 after intervention, and the results are summarized in
Table 2. Clinical observations provided further evidence of
both difficulties and progress in these areas, as described in
Table 1. Sensory Profile Test Scores for David
Difference Rating
2002 2007
Sensory Processing
Auditory processing Definite Definite
Visual processing Typical Typical
Vestibular processing Definite Definite
Touch processing Definite Typical
Multisensory processing Definite Probable
Oral sensory processing Definite Typical
Sensory processing: endurance/tone Definite Typical
Modulation: body position/movement Definite Probable
Modulation: movement/activity level Definite Probable
Modulation: sensory input/emotional Probable Typical
Modulation: visual input/emotional/activity Definite Typical
Behavior and Emotional Responses
Emotional/social responses Definite Probable
Behavioral outcomes of sensory processing Definite Probable
Thresholds for response Definite Definite
Sensory seeking Definite Typical
Emotionally reactive Definite Probable
Low endurance/tone Definite Typical
Oral sensory sensitivity Definite Probable
Inattention/distractibility Definite Definite
Poor registration Typical Typical
Sensory sensitivity Definite Definite
Sedentary Definite Definite
Fine motor/perceptual Definite Definite
Note. Typical = within 1 SD from the mean; probable = within 1–2 SD from
the mean; definite = 2 SD from the mean.
The American Journal of Occupational Therapy 549
Table 3. The primary therapist who obtained these clinical
observations is certified in the Sensory Integration and Praxis
Tests from the University of Southern California/Western
Psychological Service and has extensive experience providing
occupational therapy using a sensory integrative frame of
reference. David’s behaviors and skills were analyzed by
administering specific observations that include those origi-
nally defined by A. Jean Ayres as “clinical observations”
(Blanche, 2002). His present levels were documented in his
individualized education plan each year. Annually, David
participated in occupational therapy evaluations involving
standardized and nonstandardized assessments to document
changes over time. The evidence indicated sensory process-
ing difficulties involving modulation of his sensory system
and dyspraxia, a sensory-based movement disorder.
Goals and Plan for Intervention
Specific goals and interventions were designed according to
David’s needs for functional performance and engagement
in meaningful occupations at school and at home. David has
been an active participant in an intensive academic language
program and intensive intervention during speech and lan-
guage therapy (8 hr weekly) and occupational therapy (6 hr
weekly). Table 4 details David’s daily schedule at school,
including academic instruction and specific therapeutic
interventions. Occupational therapy intervention occurs at
the school in treatment rooms fully equipped with numerous
ceiling hooks for suspended equipment, therapy balls, mats,
fine motor activities, visual motor activities, and a variety of
gross motor equipment. Occupational therapy involves a
sensory integration approach using key constructs that dem-
onstrate fidelity to occupational therapy–sensory integration
intervention. These include ensuring physical safety, present-
ing sensory opportunities, maintaining appropriate level of
alertness, challenging his postural and bilateral motor con-
trol, collaborating in activity choice, and challenging his
praxis and organization of behavior (Parham et al., 2007).
Although David’s challenges can be recorded as severe and
his progression slow, he has demonstrated tremendous
improvement in his adaptive responses and functional prog-
ress in all areas over a 5-year period.
Sensory Processing
The prevalence of a sensory processing disorder in the gen-
eral population (5%–14%) is significantly less than in the
population with ASD (80%–90%; Ahn, Miller, Milberger,
& McIntosh, 2004; Huebner, 2001; O’Neill & Jones,
1997). Through his typing, David described his sensory
processing disorder:
Table 2. 2007 Test Scores for David
Sensory Integration and Praxis Tests
(Ayres, 2004) Subtests SD from the M
Postural praxis –3.00
Sequencing praxis –3.00
Oral praxis –3.00
Bilateral motor coordination –2.66
Praxis on verbal command –3.00
Bruininks–Oseretsky Test of Motor Proficiency,
2nd edition (Bruininks & Bruininks, 2005) Age equivalents
Fine motor precision <4.0
Fine motor integration <4.0
Manual dexterity <4.0
Upper-limb coordination 6.3–6.5
Bilateral coordination 4.6–4.7
Balance 4.10–4.11
Running speed and agility 5.0–5.1
Strength 4.10–4.11
Beery–Buktenica Developmental Test of Visual–
Motor Integration, 5th edition (Beery & Beery, 2004) Age equivalents
Visual perception 2.11
Motor coordination 3.3
Visual–motor integration 3.6
Table 3. Clinical Observations and Functional Skills
2002 2007
Significant difficulty motor planning
to imitate body positions
Able to imitate body positions with
close approximation
Significant difficulty motor planning
to gesture during conversations
Emerging use of gestures, such as
reaching out to touch a person’s
shoulder and pointing to indicate
desired objects during conversations
Required facilitation to manage and
don clothing; difficulty buttoning
Able to dress independently; able to
orient to the front of the shirt and
don independently; buttons shirt
Unable to perform smooth projected
action sequences; slow responses
Able to demonstrate smooth pro-
jected action sequences such as
catching a ball when thrown to the
side, away from midline
Often displayed rigid and jerky
movements; decreased balance and
slow responses
Smooth and fluid movements;
improved balance, for example can
stand and balance to tie his shoe
Difficulty with visual attention and
eye contact; significant difficulty
integrating vision with whole body
Attends visually with greater ease;
engages in eye contact easily for
several seconds at a time during
conversations; improved integration
of vision with whole body move-
ments, such as to walk on uneven
surfaces while looking at the visual
Initial typing began by pointing very
slowly to one letter at a time using
large movements from his shoulder
Types using small hand and finger
movements; learning to isolate
and individualize each finger with
increased speed and accuracy
550 September/October 2008, Volume 62, Number 5
Perceptions of senses: the senses all don’t work right and I
struggle to think, Really each time I use my body I can’t feel
my body; it feels stiff, I can’t move how I want; no muscles
work; they are really cement, The ears work but the sounds
are mixed up with all the sounds around the room, Sounds
are accosting me, I see but my body really can’t move in
response to each hard thing around me, Taste is ok, it’s
extreme; smell is all inside the room and that’s overwhelming
to my head and brain.
Intervention, Progress, and David’s
David is actively engaged in an individually designed sensory
diet (Frick & Hacker, 2001) four times daily with specific
sensory experiences to facilitate regulation and to increase
his body awareness. Intervention includes a “brushing and
buzzing program” (tactile input and deep vibration massage
to skin, muscles, and joints) and “heavy work” (involving
active proprioception, such as pulling and pushing with
added resistance). David also participates in therapeutic lis-
tening, a modified program specifically designed to desensi-
tize sound sensitivity and to improve auditory processing
(Frick & Hacker, 2001; Hall & Case-Smith, 2007). Because
his auditory system is highly sensitive, his program was scaled
back, slowly increasing listening time as he was able to accept
more auditory input.
The OT helps my body move better. OT much improved my
senses. They used to need more controlling me, but OT has
made my body calm, and now OT helps me use my body
how I want instead of it controlling.
In response to his sensory diet:
Touch is now heightened, From brushing, I’m now feeling
my body for how to each time move, and it feels good know-
ing where it is now instead of moving it to feel it, but now I
know I can move because it’s now usable. It’s getting easier
to move and think together.
David is able to discuss his “self-stimulative” behaviors,
which are common in people with autism. He indicates that
these “behaviors” serve a purpose beyond simply stimulation
of the body and can be better described as “self-regulatory.”
Although self-stimulative behaviors have been viewed as
atypical or disruptive, it is important to understand the
underlying reasons for these actions and fashion an appropri-
ate therapeutic intervention (Koenig, Stillman, & Kinnealey,
2006; Stillman, 2003). David’s self-regulatory actions fre-
quently involve vocalizations, moving around the room, and
Table 4. Example of David’s Schedule: Academic Areas and Therapeutic Interventions
Occupational Therapy: Individual therapy sessions focus on the developmental parameters of sensory
processing/modulation, motor/praxis, emotional/relational, and communication/cognition.
Example of a typical session:
Sensory diet/body wakeup: Sensory diet provided according to his individual needs and may include brushing and “buzzing,” body awareness activities provid-
ing proprioception and joint/skin compression with active muscle contraction such as wall push ups or prone wheelbarrow walks over peanut. Therapeutic
listening provided before therapy session.
Active sensorimotor activities: Activities such as prone in net swing, holding dowel horizontally and bilaterally, reaching in front or to side to knock down tar-
gets, walking down a balance beam while focusing visual attention across the room to read a sentence.
A primary focus of each activity is developing a trust relationship between the therapist and individual.
Each activity is adjusted and fine tuned to provide a “just-right challenge” in each of the five developmental parameters listed previously mentioned. Each
activity focuses on combining language and body action.
Association Method: The Association Method (DuBard & Martin, 2000) is a systematic, multisensory, phonics-based method used to develop fluency of reading,
writing, and oral language skills. Speech and language pathologists work in the classroom with the teachers to collaborate on his specific needs and learning pro-
cess. The occupational therapist provides ideas to adapt the classroom environment and materials based on his needs as well as to provide intervention for regula-
tion, sensory support, and writing or typing abilities.
Snack Time, Sensory Diet According to His Needs, and Motor Group: Motor planning activities are coupled with language. For example, jumping rope while
counting by 10 or basketball drills involving passing, dribbling, or shooting while naming capital cities in the United States (concepts from a history lesson).
Language Group Lesson: Language groups such as calendar or journal discussions are taught by teacher or speech and language pathologist. These language
groups are important for the motor memory and auditory memory practice of sequencing sounds into syllables, syllables into words, and words into sentences,
ultimately developing automaticity of speech and language.
Lunch Time
Recess: Group activities coordinated by occupational therapists and teachers, such as baseball, kickball, or gross motor activities on playground equipment.
Sensory Diet According to His Sensory Needs
Speech Therapy: Individual therapy sessions focus on articulation, proper rate of speech, breath support, volume, the development of auditory memory, and the
automatic recall of language.
Academics From Curriculum: Math, science, and history units are taught according to his academic level. Language components from the Association Method
are targeted and reinforced during this time to increase verbal communication, and Rapid Prompting (Mukhopadhyay, 2007) principles are used to enable him to
express his true level of comprehension of the subject matter through typing.
The American Journal of Occupational Therapy 551
stroking his face. These actions appear to be used for differ-
ent purposes at different times—sometimes to assist with
calming and decreasing anxiety, sometimes to block out
bombarding sensations, or sometimes to organize his
thoughts. Regardless of their importance, David is self-
conscious about these actions and would like to stop.
Really they help me to calm and be watchful really around
the room and feel better, We need them and can’t control
always like breathing.
Occupational therapist: Are there things someone could
do that might help you with these behaviors?
Yes to let me get really a lot of movement breaks before sitting
and concentrating for a long time.
Occupational therapist: How do you describe what it
looks like when you are attending to something?
Always aware, never secure.
Motor Skills, Praxis, and Movement
Praxis is defined as the ability to have an idea of what to do,
plan and sequence the action, and execute the action (Ayres,
1979; Miller, Anzalone, Lane, Cermak, & Osten, 2007).
The idea, plan, and ability to act are based on the sensori-
motor understanding of our bodies and what they can do.
When we give our bodies “commands,” they should respond
in the way we intended. The inability to do this is dyspraxia,
a sensory-based movement disorder in which people have
difficulty with volitional and controlled body movements
(Miller, Cermak, Lane, Anazalone, & Koomar, 2004; Miller
et al., 2007). Dyspraxia can also be found in the face and
mouth, which interferes with facial expressions and speech.
In spite of movement differences and dyspraxia, receptive
language and cognitive ability can be intact (Davis, 2001;
Donnellan & Leary, 1995; Leary & Hill, 1996.)
Donnellan and Leary (1995) described movement dif-
ferences in people with ASD, Parkinson’s disease, and cata-
tonia as an interference or shift in the efficient or effective
use of movement occurring when a person is starting, stop-
ping, executing, continuing, combining, or switching move-
ments. There is ongoing research on movement differences
and motor challenges for people with autism (Davis, 2001;
Donnellan & Leary, 1995; Greenspan & Wieder, 1998,
2005; Leary & Hill, 1996; Mostofsky et al., 2006;
Teitelbaum, Tietelbaum, Fryman, & Maurer, 2002). For
people like David, developing and executing a motor plan
efficiently is difficult and frustrating. He explained,
Moving my body is impaired and I can’t move and think at
the same time. My body feels like cement and moving takes
so much hard concentration.
Intervention, Progress, and David’s
David’s therapy program has been designed to incorporate
body awareness with motor planning and use of each of the
senses: to look, speak, hear, and move at the same time.
To type I move one hand, but to speak takes my mouth which
always never moves right, I have words I want to share all
the time. Teach me how...Really just moving is hard.
Occupational therapist: How is it different now than
before OT?
Absolutely much easier.
Communication and Behavior
In OT there’s happiness, in [this school] there’s happiness
because here I find my place . . . learning only lessons of hope
necessary like air for lungs and learning lessons of kindness to
myself, seeing me not as retarded, forgotten, less than human,
but as a smart mind trapped and slowly pushing through the
dismal body to show my brilliant mind.
From an educational background and knowledge of the
human body, the sensory systems, and psychosocial con-
cepts, the occupational therapist has the preparation to be
able to provide a safe place to voice emotions, difficulties,
and accomplishments. Occupational therapists must have a
primary focus on intervention that enables the individual to
develop volitional control of his or her body while presuming
intellectual competence. David is an example of a student
for whom a team of professionals was willing and able to
provide intensive intervention and support. His improved
motor abilities enabled him to communicate and participate
more fully in his daily life.
The enhancement of therapy when ongoing communica-
tion is incorporated can be multifaceted. As Rubin et al. (2001)
stated, “Our view is that competence should be presumed, with
the burden on the teachers and others around the person to
find ways of helping the person communicate” (p. 427).
I am able to type out all my thoughts and feelings about
autism and being a boy struggling and really enslaved by
it and then [this school] gave me the ability to type and be
heard after 14 years of no one hearing me or knowing that I
had any intelligence and now I’m working on speaking and
being confident with my voice and having friends. I only
secretly dream for independence and for love and to have
friends that see the real me and that want only to be nice
to each person in the world no matter how difficult or how
they struggle in life to be or what they look like in physical
appearance because it’s the heart that lives and love for the
inside is all each person really wants in life and it’s all I want
and it’s all autistic kids dream about.
552 September/October 2008, Volume 62, Number 5
Discussion: Shifting Our Thinking
Learning how to interact and respond to the world is often
extremely difficult, frightening, and intimidating for people
with autism. Personal narratives from people with ASD,
coupled with their responses to interventions, can give the
therapist insight into how significantly a person’s sensory
processing, motor challenges, and communication difficul-
ties impede independence. Occupational therapists can
play a key role in reducing the interference of ASD on
occupational performance. David’s narrative highlights the
following key principle: Always presume intellect and
believe in the potential for competence (Koenig et al.,
2006; Stillman, 2003).
It is important to demonstrate belief in the student’s intel-
ligence through daily interactions. Edelson (2006) highlighted
the inability to accurately empirically test the intelligence of
people with ASD and suggested that autism may be a perfor-
mance deficit rather than a cognitive deficit. David’s narrative,
in conjunction with previous intelligence testing that wrongly
placed him in the mentally retarded range, highlights the
danger of not presuming intelligence. The “least dangerous
assumption” suggests that when there is no absolute evidence,
it is essential to make the safest and most respectful assump-
tion that would be the least dangerous to the individual if
proven to be false (Rossetti & Tashie, 2002).
David continues to receive occupational therapy services
with the goal of greater self-regulation and freedom of move-
ment, with full participation in relevant occupations and
independence as primary goals. He often discusses his goals
for making friends, going to college, teaching about autism,
and living independently.
Occupational therapist: How do you see yourself?
A teenager who has a lot of struggles but determined to
David has dreams and goals for the future:
Here the dreams mean taking my hand to help me to walk
and talk and invite someone into my life and thoughts and
to know each other like life friends. Those are my dreams.
I dream for the world to be hearing my voice, to change
people’s ideas about some struggles of autism, and for hope to
be realized by others with autism.
Personal narratives provide insight into a process that
goes beyond what can be measured (Jones, Zahl, & Huws,
2001). What does it mean to listen to David’s voice? David’s
narrative contributes to a new understanding of what it means
to be a nonverbal individual with autism. It does not mean
that David speaks for everyone on the autism spectrum. By
their nature, single case reports inevitably raise questions of
whether conclusions can be generalized to a larger population.
Nevertheless, important elements from this study are sup-
ported from existing literature, including the motor and per-
formance difficulties that may be mistaken for a generalized
cognitive deficit (Davis, 2001; Donnellan & Leary, 1995;
Edelson, 2006; Greenspan & Wieder, 1998, 2005; Leary &
Hill, 1996; Mostofsky et al., 2006; Teitelbaum et al., 2002);
the frustration that may be observed and misinterpreted; and
the need for professionals to initially presume a higher intel-
ligence than is readily apparent in people with these disorders.
Rubin’s narrative highlights that full participation for people
with autism “includes having a stake and effect in redefining
the notion of ability and diagnostic classifications associated
with presumed ability or disability” (Rubin et al., 2001, p.
426). Professionals have an ethical obligation to seek methods
for communicating with people with ASD that will access
their intelligence and free their voices. s
We offer a special thank you to David for sharing his won-
derful insights with us. Thank you, Bill Stillman, Jeannetta
Burpee, and Melinda Kotler, for your amazing determina-
tion and sincere passion that inspires all who work along side
you. Thank you to our colleague, Monica Conte, for your
insight and skill in cotreating David. Thank you to the
Magnolia team, Jackie Brown, Jeremy Miller, Suzanne
Hartman, Michael Meehan, Antonelle Fragment, and Linda
Murray, for the opportunity to collaborate on a daily basis
and provide such a wonderful learning environment for
students and professionals alike. Thank you to the people
with ASD who are teaching us so much—most important,
how to listen to your voices.
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... If I say "nonverbal," we already have an opinion on ability to speak, but we also may quickly make assumptions regarding cognitive ability. I have used the term nonverbal in my past writings, and I have been wrong (Shoener et al., 2008). I no longer say "high" or "low functioning" but rather discuss functioning by considering how much support someone Figure 1. ...
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No one builds their lives on remediated weaknesses. No one. Who does a deficits-based approach benefit? Those we serve, or the professional community? Do our current models of practice support flourishing? Our professional biases make it hard for us to see not only how our practice may be getting it wrong today but is also perpetuating systems that prevent us from getting it right tomorrow. A paradigm shift to a strengths-based model that interrogates the educational, research, and practice systems we work in is proposed. It is a shift that we must see, speak, and act on. Our vulnerability and willingness to rethink is our strength, which will meet the changing needs of society. This lecture will draw on literature from positive psychology, disability justice, well-being, and research that centers the voice of self-advocates.
... In addition to a (verbal or nonverbal) IQ below 50, the Commission describes allowing the eligibility for meeting "profound autism" through a lack of short phrases or sentences in speech [1]. However, autistic individuals may have expressive language or other communication without speech, especially if they have sensory-motor impairments such as apraxia of speech [77,78] and severe dyspraxia of movement [107][108][109]. These render some autistic individuals unable to produce their own speech without affecting an understanding of language [78], but through accessing a communication system they may express their ideas. ...
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Recently the Lancet published a Commission on the future of care and clinical research of autism, which included a side panel arguing for the adoption of “profound autism”, a term in- tended to describe autistic people who require constant supervision or care, thought to usually have significant intellectual disability, limited or no language, and an inability to advocate for themselves. This state-of-the-art review deconstructs problems with autism sublabels such as “profound autism” and low- and high-functioning labels. It then examines the communicative and cognitive capacities of minimally speaking autistic people, finding that such individuals can communicate (especially with responsive partners) and need nonverbal testing that allows them to demonstrate their potential strengths. It concludes with the ability of minimally speaking autistic people to self-advocate, and the influences of other people to both support and frustrate their communication.
... Epistemological violence is evident when researchers insist that facilitator influence is the only way to account for FC/ RPM users who failed message passing tasks under strict experimental conditions. This interpretation of data, we would argue, presupposes that autistic individuals with CCN lack the ability to communicate (rather than the ability to speak), although as we have noted, communicative performance is inevitably impacted by autistic challenges like anxiety, hypersensitivities, motoric differences, and being confronted with an unfamiliar environment and novel task requirements (e.g., Shoener et al., 2008). ...
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Debate surrounding the validity of the method of supported typing known as facilitated communication (FC) has been continuous since its inception in the 1990s. Views are polarized on whether FC can be considered an authenticated method for use by people with complex communication needs (CCN) or significant challenges in speech, language, and communication. This perspective article presents an analysis of the research arguing for—and against—the use of FC, combined with the lived experience knowledge of autistic adults who utilize FC, to rehabilitate its current standing as discredited and unevidenced. By considering extant qualitative and quantitative studies, as well as personal accounts of the use of this particular Augmentative and Alternative Communication (AAC) method, the authors argue that the current dismissal of FC is rooted in ableist and outdated approaches. FC research should be reconsidered and reconducted using current best practice autism research approaches, including coproduction and a presumption of autistic communication competence, to assess its validity as a potential AAC method for autistic individuals.
... Los terapeutas ocupacionales recomiendan intervenciones de estimulación somatosensorial para mitigar la disfunción sensorial y mejorar la capacidad funcional 7 . Es importante entender las diferencias y las dificultades que presenta en el procesamiento sensorial, la comunicación y la participación social 8 . En adolescentes con un autismo caracterizado por el "alto funcionamiento" (HFA), el terapeuta ocupacional les ayuda a identificar las actividades en las que desean participar y las barreras que dificultan su participación. ...
... In addition, many may display repetitive behaviors such as flapping or rocking, which are hypothesized by some (Shoener, et al. 2008) to be responses to the need for increased or decreased sensory input. Children with an ASD may also have motor difficulties and delays (Baranek, (2002). ...
Purpose. The prevalence of Autism Spectrum Disorder has dramatically increased over the past decades. People with Autism Disorder have weakness in maintaining the balance and disturbance of the posture due to developmental deficits in the nervous system and inferiority. Functional balance is all the balance skills a person needs to live independently.The purpose of the study is toinvestigatethe Neuromuscular training program on improve the functional balance for children with Autism Spectrum Disorder Methods. (7) Childs with Autism between the ages of 7 and 10 years were included in this study They were divided into one experimental, Berger Balance Test Scale (BBTS) was used to assess posture control consists of 14 items balance-related skills, with a maximum score of 56. The skill items include sitting to standing, standing to sitting, transfers, standing unsupported, sitting unsupported, standing with eyes closed, standing with feet together, standing with one foot in front, standing on one foot, turning 360 degrees, turning to look behind, retrieving object from floor, placing alternative foot on stool, and reaching forward with outstretched arm. PBS was scored after completion of the static and dynamic balance tests in pre- between and post-assessments. Results. ANCOVA test was used to analyses the data via SPSS software at the significant level of P < 0.05 shows that differences between the post-between and post measurement for experimental group in favor of the post measure in the functional balance test for post assessment for experimental group of the children with Autism Spectrum Disorder) Conclusions. Neuromuscular training program has a positive effect on the functional balance of children with neurodevelopmental disorders in the experimental group so, these training can be prescribed as an effective program for the rehabilitation of children with autism spectrum. Key words: Neurodevelopmental Disorders. Autism. Functional balance Neuromuscular training program
... The emphasis these youths have placed on controlling their bodies suggests that movement control and mind-body connection may be a helpful avenue for intervention. Perhaps this link holds a portion of explanatory power for the benefits seen in some studies exploring yoga [49] rhythm [50], sensorimotor [51], and music and movement [52] based interventions for people with autism. ...
Background: To date, research exploring experiences and perspectives of people who have severe autism and are minimally verbal, has been sparse. Objectives: To build new understanding based on insider perspectives of people who have severe autism and are minimally verbal. We took interest in how these perspectives support, challenge, or augment current depictions of autism in academic literature. Method: Adopting a descriptive qualitative approach, three memoirs written by youths who have severe autism and are minimally verbal were examined using inductive thematic analysis. Analytic methods followed a recursive process of coding, collating, mapping, reviewing, creating clear themes, and then reporting using compelling extracts. Results: Analysis generated an over-arching theme regarding the youths’ concern that the way they are perceived from the outside does not match the people they are on the inside. In explaining this mismatch, the youths identify differences in the way their brains work, as well as difficulty controlling their bodies. Conclusions: These youths emphasize concepts of embodiment and physical control as central to their experiences of autism. Findings highlight the need for research exploring insider perspective and the development of innovative methods to gain insight into the understanding and interests of people who are minimally verbal. • Implications for rehabilitation • The development of a communication system (hi-tech or low tech) should be a top priority for intervention when serving clients who have severe autism and are minimally verbal. • When working with clients who have severe autism and are minimally verbal, clinicians should be cautious in applying and interpreting assessments of intelligence and understanding, since difficulties with verbal output and movement control can obscure results. • To improve information gathering and therapeutic outcomes, clinicians and educators should use varied assessment and intervention techniques, administered across multiple sessions, and environments. Consideration should be given to difficulties with movement initiation and movement inhibition when guiding and interpreting behaviors.
... The sweet worts produced from different time/temperature combinations and added or not of exogenous proteolytic extracts, were submitted to the following analyzes: °Plato by refratometric measure; extract (% m/m of dissolved solids); total nitrogen content by Kjeldahl method [18,19]; FAN-free amino nitrogen content-by ninhydrin method [20,21]. In addition, the nitrogen content lost by coagulation during boiling was determined by the difference between the total nitrogen contents before and after this stage. ...
... Reduction of this self regulatory behavior may be indicative of a better ability to process sensory stimulus without need of regulatory strategies. 18 These strategies allowed the child to plan his movements during exercise and direct his attention towards toys during therapy sessions. Optimal tracking towards sound helped him to learn to anticipate posture and movement to much extent in these 5 years apart from sensory improvement. ...
... With specific reference to sensory processing in autism, the studies reported hyper and hypo sensitivity in all modalities where children were reported to encounter sensory difficulties to 80% in terms of under-responsiveness/seeking of sensations and visual and auditory sensitivity ( Baker, Lane, Angley, & Young, 2008); the prevalence of sensory deficit from 80 to 90% ( Shoener, Kinnealey, & Koenig, 2008); and the evidence of increased and decreased sensory thresholds ( Joosten & Bundy, 2010). Baker, Lane, Angley, & Young (2008 investigated the impact of sensory processing on behavioral responsiveness in autism. ...
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Sensory perceptual experiences are now directly associated with the diagnosis of Autism Spectrum Disorder (ASD). Given that autism is a heterogenous disorder, literature abounds in evidences that report varied sensory perceptual issues affecting daily lives of individuals with autism. One question that motivated the current study is “Why do they report to have varied sensory profiles?” The answer lies in the way their bodies interact with the world around them—theory of embodiment in cognitive linguistics. Thirteen children with autism were observed through SPCR (Sensory Profile Checklist Revised (Bogdashina, 2003)) against 20 categories, which Bogdashina (2003) refers to as their bodily resources. Out of seven modalities, only three—vision, hearing and proprioception—were studied for current study. The findings were consistent with the embodiment thesis offered by cognitive linguistics—human beings are embodied beings.
In their recent article in Frontiers in Psychology, “Presuming autistic communication competence and reframing facilitated communication,” Melanie Heyworth, Tim Chan, and Wenn Lawson argue for a positive reappraisal of facilitated communication (FC). The authors base their argument on several dozen problematic claims. Some of these claims rely on inaccurate assumptions about augmentative and alternative communication (AAC), Applied Behavior Analysis (ABA), conversational pragmatics, message passing tests, cognitive testing, cueing, recent discoveries about autism, and/or the empirical research on FC. Other claims involve circular reasoning or are not supported by the studies cited as support. Still others involve biased characterizations of FC critics or biased takes on key concepts pertaining to FC and the rights of people with disabilities. This article will examine each of these claims, explaining what is wrong with its underlying assumptions, its underlying reasoning, or its characterization of FC critics and of disability rights. As we will see, there are no grounds for a positive reappraisal of FC.
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This article presents a non-speaking person's perspectives on independence and the implications of newfound communication abilities for her participation in the world and upon the meaning of intellectual ability. The person with the communication disability also has autism and, early in her life, was classified by school officials as 'severely retarded'. The narrative focuses especially on the concepts of independence, participation, and intellectual competence or intellectual performance, and their relationship to the concepts of democracy, freedom, and identity, all from a non-essentialist perspective. In addition, the article addresses practical questions about how, from her perspective, the non-speaking person developed the ability to communicate without physical support.
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This study is the first to systematically examine estimated rates of sensory processing disorders using survey data. Parents of incoming kindergartners from one suburban U.S. public school district were surveyed using the Short Sensory Profile, a parent-report screening tool that evaluates parents' perceptions of functional correlates of sensory processing disorders (McIntosh, Miller, Shyu, & Dunn, 1999a). A total of 703 completed surveys were returned, which represents 39% of the kindergarten enrollment (n = 1,796) in the district for the 1999-2000 school year. Of the 703 children represented by the surveys, 96 children (13.7% of 703) met criteria for sensory processing disorders based upon parental perceptions. A more conservative prevalence estimate of children having sensory processing disorders based on parental perceptions was calculated by assuming that all non-respondents failed to meet screening criteria. This cautious estimate suggests that based on parents' perceptions, 5.3% (96 of 1796) of the kindergarten enrollment met screening criteria for sensory processing disorders. These percentages are consistent with hypothesized estimates published in the literature. Findings suggest a need for rigorous epidemiological studies of sensory processing disorders.
This article presents a study concerned with the influence of a sensory integrative program on the behaviour of autistic children. This study was small, dealing only with four institutionalized children from a behaviour therapy milieu, ranging in age from 11 years to 18 years. Each child received sensory integrative input three times a week for approximately 45 minutes duration. This study measures the effect of this input on the child's a) ability to integrate and organize sensory input and to respond with an adaptive motor response, b) maladaptive behaviours and attention span. Using a modification of Ayres' sensorimotor clinical observation tests to assess and reassess the four children, it was found after a four month treatment period that these children did display increased sensory integration and more adaptive behavioural (particularly social) skills.
The purpose of this study was to examine the construct validity of the praxis tests of the Sensory Integration and Praxis Tests (SIPT) and to determine whether the practic component of sensory integration-based developmental dyspraxia is a unitary or a multidimensional disorder. Developmental dyspraxia is an impaired ability to plan and execute skilled or nonhabitual motor tasks; however, its underlying cause, or even whether praxis is a unitary or multidimensional function, is not yet clarified. In this study, the Rasch model of measurement (Linacre, 1989; Wright & Masters, 1982; Wright & Stone, 1979) was used to explore the underlying construct of developmental dyspraxia. The Rasch model was chosen because its use enabled us to (a) confirm goodness-of-fit of individual items within SIPT praxis tests and (b) examine the hierarchical structure of item difficulties. The data included the raw scores of the SIPT praxis tests of 210 subjects from Canada and the United States. The results of the Rasch analyses revealed that each of these five SIPT praxis tests measures a single, unidimensional construct. When the items from the five tests were combined to create a single 117-item test, the items continued to define a single practic function. This indicates that a unitary practic component underlies both bilateral integration and sequencing deficits and somatodyspraxia. Finally, examination of the hierarchy of item difficulties resulted in recommendations for the development of a single screening test for developmental dyspraxia. The implications of these results for clinical practice and future research are discussed.
There are frequent claims in the literature that a majority of children with autism are mentally retarded (MR). The present study examined the evidence used as the basis for these claims, reviewing 215 articles published between 1937 and 2003. Results indicated 74% of the claims came from nonempirical sources, 53% of which never traced back to empirical data. Most empirical evidence for the claims was published 25 to 45 years ago and was often obtained utilizing developmental or adaptive scales rather than measures of intelligence. Furthermore, significantly higher prevalence rates of MR were reported when these measures were used. Overall, the findings indicate that more empirical evidence is needed before conclusions can be made about the percentages of children with autism who are mentally retarded.
Discusses the effects that parental attitude and practice may have on the special needs child's development. The Adlerian concept of organ inferiority and its effect on personality development as the foundation on which parents can build a strong childrearing philosophy are discussed. The use of encouragement and logical consequences sets the tone for training the special needs child to successfully cope with life tasks. It is contended that parents need to be aware of the child's inner environment, the family atmosphere, and the child's place in the family constellation. It is suggested that setting small tasks to be accomplished over a long period of time will assure a greater probability for success and will encourage parents to move forward in helping prepare their child for life. (4 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Internet-based first-hand accounts of five people who describe themselves as 'high functioning autistic' were analysed using a thematic analytic approach. Four central themes were identified. These were a sense of alienation, a sense of frustration, depression as a central emotion, and a pervasive sense of fear or apprehension. The findings not only imply that emotional issues are important and relevant to people with autism, but there is an implication that the predominant experienced emotions are unpleasant ones. This is in contrast to much of the literature on autism that points to the absence or lack of emotion compared to non-autistic controls. Issues of generalisability to a wider population of people with autism are discussed.
Sensory-perceptual abnormalities in people with autism are discussed from two perspectives: published firsthand accounts and existing psychological research evidence. A range of abnormalities, including hyper- and hyposensitivity, sensory distortion and overload, and multichannel receptivity and processing difficulties, are described in firsthand accounts and frequently portrayed as central to the autistic experience. A number of dangers are inherent in uncritically accepting these accounts at face value and in any wider generalization to the autistic population as a whole. Evidence from clinical studies suggests that unusual sensory responses are present in a majority of autistic children, that they are manifested very early in development, and that they may be linked with other aspects of autistic behavior. In addition, experimental studies using a range of indices have found evidence of unusual responses to sensory stimuli in autistic subjects. However the clinical and experimental research to date suffers from serious methodological limitations and more systematic investigation is warranted. Key issues for future psychological research in the area are identified.
Based on the educational team recommendations, occupational therapists and occupational therapy assistants working in educationally related settings provide services to students who are eligible for Section 504 or special education under IDEA and need occupational therapy to benefit from their education program. It is the occupational therapist's responsibility to develop an intervention plan based on the student's needs and the therapist's professional knowledge base. The occupational therapist chooses and applies any frame of reference within the domain and process of occupational therapy. Regardless of the frame of reference utilized, the desired outcome of occupational therapy services is always engagement in occupations that allows participation in a student's daily life. When students demonstrate deficits in sensory integration that contribute to a significant and documented discrepancy in their skills within their educational program, the use of a sensory integrative approach may be one frame of reference for, intervention chosen by the occupational therapist.