Saturday, October 8, 2011

Study: Auditory-Motor Mapping Training

As I know all too well from personal experience, getting a non-verbal child with autism to talk can be a real challenge.  Sometimes traditional approaches such as speech therapy and ABA work and other times they don't.  There doesn't seem to be any rhyme or reason as to why a child with autism can't or won't talk or why these traditional approaches work or not.

So some of the time you have to try something strange or different in order to help a child learn to talk.  That is definitely the case in a recently published paper were researchers tested a method called "Auditory-Motor Mapping Training" and found that it did help non-verbal children with autism learn to talk.

If you look at what this group is doing, which is basically singing words and playing the drums, it sounds a bit outlandish.  But you can't argue with success.  And, if you take the time to think really think about it, it does make a certain type of sense.

As we have been teaching the twins to talk, first with sign language, then with PECs, and now with an AAC device, one thing that we have noticed is that they seem to need some extra stimulus in order to learn a word.  It is as if they need a physical gesture (sign, AAC) or some visual sign (PECs, AAC) in order for them internalize a word.  We have also seen them use hand gestures (i.e. signs) or pictures in order to help their recall of a word.

So I am not surprised at all that pairing words with some extra stimulus would be effective. Maybe part of the problem in autism is that the typical auditory/speech pathways in the brain aren't functioning and you have to take the back door approach to get the words into the brain.

The abstract of the paper is below and the full text of the paper is freely available here.

Auditory-motor mapping training as an intervention to facilitate speech output in non-verbal children

Although up to 25% of children with autism are non-verbal, there are very few interventions that can reliably produce significant improvements in speech output. Recently, a novel intervention called Auditory-Motor Mapping Training (AMMT) has been developed, which aims to promote speech production directly by training the association between sounds and articulatory actions using intonation and bimanual motor activities. AMMT capitalizes on the inherent musical strengths of children with autism, and offers activities that they intrinsically enjoy. It also engages and potentially stimulates a network of brain regions that may be dysfunctional in autism. Here, we report an initial efficacy study to provide 'proof of concept' for AMMT. Six non-verbal children with autism participated. Prior to treatment, the children had no intelligible words. They each received 40 individual sessions of AMMT 5 times per week, over an 8-week period. Probe assessments were conducted periodically during baseline, therapy, and follow-up sessions. After therapy, all children showed significant improvements in their ability to articulate words and phrases, with generalization to items that were not practiced during therapy sessions. Because these children had no or minimal vocal output prior to treatment, the acquisition of speech sounds and word approximations through AMMT represents a critical step in expressive language development in children with autism.


Wan CY, Bazen L, Baars R, Libenson A, Zipse L, Zuk J, Norton A, Schlaug G. Auditory-motor mapping training as an intervention to facilitate speech output in non-verbal children with autism: a proof of concept study. PLoS One. 2011;6(9):e25505. Epub 2011 Sep 29. PubMed PMID: 21980480.


  1. M.J.

    When my son was three years old, in 1996, the literature said 50% of autistic children would never talk, or would regress.

    Catherine Maurices ABA handbook contained a curriculum for teaching language.This week I have been trying to determine how and when it was devised, without understanding so far. Rest assured, it does exist. It goes from simple to more difficult, and has a checklist, and as each word is understood, you check it off, and move off to the next ones. This is the pattern I used to teach my son hundreds of non-noun words...words that can't be visualized.

    I used this word checklist, crossed off the ones he knew, and moved on to the ones he didn't. For each and every word, I had a pictorial representation, or we acted it out.

    "Look, Ben, I am "below" the table. Now, you -- "below". "Below". Ball below table. Oh, look, Ben, Molly below table".

    EVERY word was taught visually or kinesthetically. The auditory pathways DON"T lead to understanding in autism. Thus, my son could memorize and repeat songs, prayers, and conversations from t.v., ver batim, with the particular inflections and sounds of the speaker, and have no idea what was being said. Echolalia.

    ONLY when words were presented visually or kinesthetically did he understand.

    Being a parent, I hope you understand what I am saying. Science is fucked on this one. Excuse my french. So many of them haven't an effing clue of how our children see the world. They cannot put themselves in their minds and see the difficulty with which our children renew auditory pathways with visual/kinesthetic understanding. They rewire their own brains. They are God blessed miracles.

  2. My eldest had a speech delay not autistic speech delay, to go with his NLD so the Hannen program worked well for us. He also had the funkiest echolalia I have ever heard of... he actually did his mid-sentence and then finished the sentence. But the echoing didn't start until age 4 - lasted about a year - and he started talking at 3.

    The youngest is on the severe end. We finally did the "Helen Keller water" moment... the only good thing about ABA and solely since they had him pissed at the time. They had a book he wanted to look through and signed "all done" and said "do this"... now, they had been told for 3yrs we'd done signs, pecs and words and they didn't care. They had a program and tough sh....t. He looked at her, said "NO!!!", slapped "all done" with is hands and took the book back. For the next while they taught him words, signs and pecs for objects. Then we got rid of them and by 5, I and his SrK teacher were teaching him to read. His reading is amazing at 10.

    Mine can tell you what he wants - sometimes using code words like "blow" for candles on a cake - but cannot express thoughts easily nor reply easily. We do have joint attention. I taught this but taking every echoed thought and using them as a "talk" moment. Took years. We have started with a flipbook of about 300 words - let's not discuss the head slam I had with the SLP wrt to the ACS and the Teacher will have same Tues - and we'll see if having the words at his fingers, allows him to tell us more.

    Some children never do small talk or chatter. But as long as they have the choice... that's what's important. YET, even the ACS didn't want to take my eldest b/c he was "autistic". Took me 2hrs to talk them into it.

    Why is autistic communication not the most important thing taught?? Why is behavioural training at the top of the list??

  3. >>>Why is autistic communication not the most important thing taught?? Why is behavioural training at the top of the list??

    EXACTLY! Although I used the ABA book, I ONLY used the curriculum, not that psycho-babble bullsh@t.

  4. How in the hell did Simon Baron-Cohen get 4 year old autistic kids to understand Anne put the marble "in" the basket, let alone to determine whether they attributed some dumbass theory of mind, to Sally's brain, eh?

    Our kids are "evil". That SOB is going DOWN...Do you know what I'm talking about, MJ or Farmwife??

  5. Even so called "normal" children can learn language more easily if words are sung, or if stuff rhymes.

    My daughter used to help children under her care transition by singing the instruction rather than speaking it. "Time for snack" if sung seems to be easier for children to hear.

    So why did it take so long to notice this? Teachers in nursery schools have been using rhyme and song for 50 or 60 years!

  6. Minority they contribute it to "echolalia". Many people - as Susan Senator mentioned in a blog post a little while back - call it "silly speak" (long ago I calle it stupid speak b/c I couldn't see the point in it and it frustrated me so much) and that is the attitude of most therapists/parents. We aren't told any different, and in the beginning we don't know.

    Now I know better... and it takes a LONG time to get Joint attention.

    So, R would say something from the tv and I'd say "Was Elmo singing songs today on Sesame Street" or something... I still remember about a year or so ago he walked up to me and said something - it's documented, I just don't remember what at the moment - and I missed it. He stared right at me and I went "that's nice R"... He wandered off and I went... DUH!!! to myself.

    A conversation a few days ago after he was playing on the computer "Dec second" before I would have said "that's your birthday" but now we're pushing WH answers so I said "what's on that day?" "Birthday" "What do you want for your birthday?" "Cake" "Anything else?" "Blow" (complete with mime) "OK, candles.... anything else, maybe wrapped in paper"... He thinks about it... "Pres...." "PRESENTS" (big grin)

    That's how you teach them to talk.

    UTBGGY - my NLD son has Theory of Mind. Ironically, my youngest - the severe one - does not have TOM issues. There's a huge difference btwn knowing what emotions are, how to handle your own, and understanding how your actions impact others. Then there's reading other people's emotions etc. S. B-C doesn't do a very good job explaining the difference and people don't understand what he means most of the time since the theories appear to overlap or are the same. This is poor research, poor writing, poor explaining on his part. I have tried to read some of his materials, due to my "poor" list above, I have no interest in continuing to do so.

  7. So, when school Autism training is made available, it makes it much easier for teachers and classroom staff to find the right course of action for the individual student. Unfortunately, there is no established cure or single treatment that is known to work with any specific Autism symptom, so the school Autism training is usually going to have to be somewhat broad and expansive.