Practice of Tasks To Promote Speech

Motor impairments of ASD individuals include gross motor patterns, proprioception, fine motor coordination, coordination, and initiation tasks. Mass et al. (2008) recognized the significance of neuroplasticity in the human brain and the impact that repeated behavioral intervention on ASD individuals could improve gross motor skills and also verbal motor skills. Motor learning needs to be more than an enhancement in performance- it needs to be an improved capability or skill that is retained over time (p. 278). This is called retention. When this improved behavior is retained and transferred to a new task, the process is called generalization. Motor movements and speech need to be generalized to better prepare individuals for social interactions. The authors identified two types of practice for generalization:

Random practice: different movements produced on successive trials, with unpredictable target
Blocked practice: practicing the same movement before advancing. Boundaries are identifiable beginning and end

Discrete-Trial Training (DTT) is systematic reinforcement pattern- providing multiple attempts to respond to a stimulus (Miller-Kuhaneck 2004). Using tasks analysis, behavioral skills are broken down and practiced in a predictable way. Reinforcement and prompting are more frequently offered than with random practice. While random skills do promote generalization, there is also a place for blocked trials. Blocked trials help ASD individuals enhance their performance in certain areas, however are not as successful at promoting generalization. More simply put, blocked trials will help a child learn a particular skill, but random practice will promote a learned behavior.

Surprisingly, ASD individuals are better able to generalize motor movements from random practice with continuous trials (Mass et al.) These individuals are better able to sequence their movements from retention using delayed feedback.
Two treatment activities to promote motor learning would be:
A child that is experiencing difficulty with bathroom ADL’s (brushing teeth, combing hair, washing hands). Using a behavioral approach, we would begin with pictures and categorization skills. Place two contrasting color mats on table (blue bathroom and yellow kitchen). Have child categorize pictures of 5 toothbrushes and 5 dinner plates into appropriate color mats. Blocked trials would be to place 5 toothbrush pictures onto the blue mat, then 5 dinner plate pictures onto the yellow mat. Progress to placing actual toothbrushes and plates on the mats in same sequence. Progress this to more randomized trials placing toothbrushes and plates onto the mats in no sequential order. Progress to having the child place the actual toothbrush in bathroom and plate on kitchen table. If the child is successfully able to perform this task then proceed to having try brushing his teeth (granted it is not a sensory issue). If the behavior is not learned, then try blocked trial of 5 toothbrushes in bathroom, 5 dinner plates on kitchen table. You may even have to place the color mats in designated areas.

Maas, E., Robin, D. A., Austermann Hula, S. N., Wulf, G., Ballard, K., Schmidt, R. Principles of Motor Learning in Treatment of Motor Speech Disorders. American Journal of Speech-Language Pathology. 2008. Vol. 17. 277-298