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BEHIND THE TECHNOLOGY
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theoretical basis and design philosophy
We are speech-language pathologists and assistive technology specialists, who specialize in treating people on the autism spectrum. In order to address the complex communication needs of people on the autism spectrum, we have researched five areas related to language development: Neuro-Typical Development, Display of Affect, Joint Attention, Semiotics, and Spontaneous Speech.
neuro-typical
development
From a very young age, neurotypical children learn social, cognitive, and communicative abilities from their primary caregivers by listening to speech and looking at faces. Recognizing, interpreting, and mimicking their caregiver’s facial expressions allows infants to identify socially important people and understand others’ internal mental states (Baron-Cohen et al., 1994). In fact, when a mother establishes eye contact and communicates with her child, she helps to activate specific neurological structures in her baby’s brain, which allow her child to develop essential social, cognitive, and communication skills. When these components in the brain develop slowly or activate atypically, the global effects on a child can be profound — such as those seen in autism spectrum disorder.
display of affect
According to current research, children with ASD tend to display different neuro-anatomical characteristics such as slow-developing mirror neuron activity and hypostimulation of the fusiform gyrus (Kanvvisher et al., 1999; Pierce et al., 2001, 2004; Bolte et al., 2006). Mirror neurons play a role in learning, and the fusiform gyrus specifically functions to process human faces. Due to atypical functioning in these regions, children with ASD have deficits in processing facial expressions, recognizing familiar faces, and mimicking social-communicative behavior (Grelotti et al., 2002). These neuro-physiological challenges, along with other anatomical differences in the brain, create a cascade of problems for children with ASD — spanning from non-communicatively functional echolalic verbal responses to an impaired capacity to imagine the mental and emotional states of other people (theory of mind).
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Current research shows that people with ASD have, in fact, slow-developing mirror neuron activity — not a damaged system, which was the former view. Dr. Christian Keysers, a neuro science researcher, stated, “While most of us have their strongest mirror activity while they are young, autistic individuals seem to have a weak mirror system in their youth, but their mirror activity increases with age, is normal by about age 30, and unusually high thereafter.” Thus, increasing mirror neuron activity in people with autism may improve their ability to imitate social behavior (e.g., facial expressions) or mimic motor actions (e.g., speech production). Video self-modeling is one evidence-based treatment intervention that may stimulate mirror neuron activity in people with ASD. An important component of imitation, however, is attention: a person has to focus on social behavior in order to mimic it.
joint attention
First, joint attention occurs when two separate individuals share focus on an object, activity, or event — but it involves initiating and responding to bids to share attention. To initiate joint attention, people often point to something so that another person may see what they see. Joint attention is a pivotal skill, one which influences communication development and social interaction. Recent research shows that children with autism can be taught to expand their joint attention skills, but they have to learn some basic components, such as the ability to track where someone else is looking. The ability to monitor where someone is looking is part of what Baron-Cohen (1991) has called an Eye Direction Detector.
eye gaze
Baron-Cohen (1991) speculates that the innate ability to spontaneously reference an interesting object, event, or person in the world — using proto-declarative pointing (think of a one-year-old pointing at a plane) — allows young children to share the directed attention and interests of another individual: creating shared attention while, at the same time, stimulating theory of mind development. Theory of mind is a crucial social-cognitive ability that involves a number of skills such as understanding a person’s intentions, sharing attention, and tracking eye gaze. Baron-Cohen (1991) posits that theory of mind may be the underlying cognitive and motivational factor supporting the entirety of human communication.
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​Despite their difficulty sharing attention with another person, people with ASD can be highly motivated and focused to learn — given the right motivation. Mobile devices are objects which tend to be highly interesting and motivating to people with autism. Because of their inclination to attend to a device or computer, people with autism tend to respond well to interventions, games, or other activities that involve these devices. Additionally, these devices often use interfaces that incorporate pointing, so interacting with a child on the spectrum — while using an iPad — helps him point at interesting objects and share attention on the task
semiotics
Semiotics is the study of signs and symbols, including their use and meaning. Words, text, and sign language are all symbols that can carry meaning in languages. All languages are based on this principle: that words have meaning. Joint attention is a crucial factor in learning a symbol’s meaning, in that children must mutually attend to something — a smell, a sight, or a sound, for example — with their parents who then call the stimuli something: a rose (a smell), go (a visual event), or loud (a sound).
spontaneous speech
When working with people who have autism spectrum disorder, the trick is to find a motivating way to teach functional behaviors — such as learning to produce speech. Speech is a motoric activity and requires a lot of practice and imitation to master. Research shows that video self-modeling is an effective way to teach skills to people with autism — possibly because it stimulates mirror neuron activity in the brain. Mirror neurons are key to learning pretty much any motor activity — including speech development. When a person uses InnerVoice to learn to communicate, he/she is watching him/herself execute a target behavior — while being engaged. Equally important, engagement activates reward centers in the brain such as the dorsal striatum, which plays a crucial role in learning. InnerVoice seeks to stimulate mirror neuron and dorsal striatum activity: the combination of which encourages imitation and increases engagement.
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The most important aspect of InnerVoice, however, is the avatar-mediated communicative interaction that creates a multi-sensory semiotics event — simultaneously representing the associations shared among spoken, written, or gestured symbols with the meanings they represent.
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Currently, many apps or other programs focus on what children with ASD seem to need — from an adult’s perspective: sorting skills, sequencing, visual supports, vocabulary- and syntax-building systems. But these types of apps often are missing a key element — something that makes the app, or therapy approach, intrinsically engaging to a child with autism.
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Engagement is — as mentioned earlier — a key part of learning, involving specific neurological structures. By incorporating avatars into an augmentative and assistive communication approach, the device’s screen can encourage people with ASD to attend to faces for social-communicative semiotic cues, thus stimulating (in theory) fusiform gyrus activity. Additionally, watching oneself perform motor speech movements can stimulate mirror neuron activity, which is key to imitation. Pairing dynamic media — such as a short video of people running — with spoken and written words helps establish a semiotic process, assigning meaning to a symbol (a word).
universal design
InnerVoice is designed to be accessed, understood and used to the greatest extent possible by all people regardless of their age or ability. InnerVoice uses the principles of Universal Design to meet the needs of all people who wish to use it. is a fundamental condition of good design. If technology is accessible, usable, convenient and a pleasure to use, everyone benefits. By considering the diverse needs and abilities of all throughout the entire design process, we can create products, that meet peoples’ needs. Simply put, universal design is good design.
references
American Speech-Language-Hearing Association. (2011). Applications (apps) for speech-language pathology practice.
​Baron-Cohen, Simon (1995). Mindblindness: An essay on autism and theory of mind. Cambridge, MA: The MIT Press.
​Bloom, L & Lahey, M. Language development and language disorders. New York, Wiley, 1978
​Bolte S, Hubl D, Feineis-Matthews S, Prvulovic D, Dierks T, Poustka F. Facial affect recognition training in autism: can we animate the fusiform gyrus? Behav Neurosci 2006; 120: 211–6.
​Bavelier, D., Green, C. S., & Dye, M. W. G. Children, wired: For better and for worse. Neuron, 67(5), 692-701.
​Bellini, S, & Akullian, J. (2007). A meta-analysis of video modeling and video self-modeling interventions. Exceptional Children, 73(3), 264-287.
​Buggey, Tom. Video Self-Modeling Applications with Students with Autism Spectrum Disorder in a Small Private School Setting Focus on Autism and Other Developmental Disabilities, Volume 20, Number 1, Spring 2005, 52-63
​Buggey, T. (1995). An examination of the effectiveness of videotaped selfmodeling in teaching specific linguistic structures to preschoolers. Topics in Early Childhood Special Education, 15, 434–458.
Buggey, T. (1996). Efficacy of videotaped self-modeling with preschoolers with language delay. Memphis, TN: The University
​Grelotti D, Gauthier I, Schultz RT. Social interest and the development of cortical face specialization: what autism teaches us about face processing. Dev Psychobiol 2002; 40: 213–25.
​Kanwisher N, McDermott J, Chun MM. The fusiform face area: a module in human extrastriate cortex specialized for face perception. J Neurosci 1997; 17: 4302–11.
​Kanwisher N, Stanley D, Harris A. The fusiform face area is selective for faces not animals. NeuroReport 1999; 10: 183–7.
​Kawashima R, Sugiura M, Kato T, Nakamura A, Hatano K, Ito K, et al. The human amygdala plays an important role in gaze monitoring. Brain 1999; 122: 779–83.
Lanter, Elizabeth & Watson, Linda. (2008). Promoting literacy in students with ASD: The basics for the SLP. Language, speech, and hearing services in schools. 39. 33-43. 10.10
LeBlanc, L.A, Coates, A.M, Daneshvar, S, & Carlop-Christy, M.H (2003). Using Video Modeling and Reinforcement to Teach Perspective Talking to Children with Autism. Journal of Applied Behavior Analysis, 36.2, 253-257.
​Maas, Edwin, et al., Principles of Motor Learning in Treatment of Motor Speech Disorders, American Journal of Speech-Language Pathology, Volume 17, 277-298, 2008.Merrill, A., & Risch, J. (2014). Implementation and Effectiveness of Using Video Self-Modeling with Students with ASD.The Reporter,19(6).
Mirenda, p. (2003). “He’s not really a reader…” Perspectives on supporting literacy development in individuals with autism. . Topics in Language Disorders, 23, 271-282.
​Pierce K, Muller RA, Ambrose J, Allen G, Courchesne E. Face processing occurs outside the fusiform ‘face area’ in autism: evidence from functional MRI. Brain 2001; 124: 2059–73.
​Pierce K, Haist F, Sedagat F, Courchesne E. The brain response to personally familiar faces in autism: findings of fusiform activity and beyond. Brain 2004; 127: 2703–16.
Remington A., Fairnie J. A sound advantage: increased auditory capacity in autism. Cognition. 2017;166:459–465. [PubMed]
Roy, Deb. The Birth of a Word | Video on TED.com.” TED: Ideas Worth Spreading, Mar. 2011, www.ted.com/talks/lang/eng/deb_roy_the_birth_of_a_word.html.
​Schumann CM, Amaral DG. Stereological analysis of amygdala neuron number in autism. J Neurosci 2006; 26: 7674–9.
​Schumann CM, Barnes CC, Lord C, Courchesne E. (2009) Amygdala enlargement in toddlers with autism related to severity of social and communication impairments. Biol Psychiatry. Nov 15; 66(10):942-9. Epub 2009 Sep 2.
​Schumann CM, Hamstra J, Goodlin-Jones BL, Lotspeich LJ, Kwon H, Buonocore MH, et al. The amygdala is enlarged in children but not adolescents with autism; the hippocampus is enlarged at all ages. J Neurosci 2004.
Sénéchal, M., LeFevre, J., Smith-Chant, B. L., & Colton, K. V. (2001). On refining theoretical models of emergent literacy: The role of empirical evidence. Journal of School Psychology, 39(5), 439–460. (PDF) Promoting literacy in students with ASD:….
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