Oral Sensory-Motor Therapy as a Portal to Interaction in Autism
by Theresha A. Szypulski, M. A., CCC-SLP
Families of children with Autism Spectrum Disorders (ASD) list communication impairment as one of their greatest concerns. Speech production is a complex issue, involving respiration, phonation, articulation, resonation and prosady. All are impacted by sensory-motor dysfunction and dyspraxia. Oral sensory-motor attractions and aversions impact feeding, oral hygiene, and speech, often promoting socially unacceptable oral behaviors such as mouthing and biting. Everyone turns to the speech-language pathologist to "do something"...about everything.
Therapists working with non-verbal children often set speech and language goals far beyond the child’s developmental readiness, overlooking three areas of vital importance: sociocommunicative deﬁciencies, motor dysfunction and sensory deﬁcits.
- Sociocommunicative Deficiencies - Many children with ASD are stuck below a twelve month level in sociocommunicative skills. Their therapists mistakenly bypass the critical need for engagement, affect exchange and reciprocal interactions. Working on rote speech and language productions prematurely yields meaningless vocalizations and scripted phrases without pragmatic usefulness. The child may label collections of words or recite phrases, but is unable to interact purposefully.
- Motor Dysfunction - Praxis, or the ability to plan, execute and sequence unfamiliar purposeful movements is essential to talking. Many children with delays show varying degrees of difﬁculty with motor planning and sequencing, and are often labeled dyspraxic. Motor dysfunction in praxis and imitation in children with ASD impairs their ability to coordinate sequential movement for social affective, reciprocal exchange. Movement is the messenger of emotion and is foundational to expression of internal states and environmental responsiveness.
- Sensory Deficits - Early sensory motor experiences are essential to oral motor planning and coordination of the reﬁned movements required to create the subtle, quick, light contacts that comprise human speech. Children with ASD experience difﬁculty in engagement and social interaction because of poor regulation of arousal, attention, affect and action. To be effective, a therapist should analyze the oral sensory seeking/avoiding behaviors of the child and select tools and techniques to modulate the sensory experiences and subsequent movements. Where there is sensation, there is movement; where there is movement, there is sensation.
How does the Interactive Oral Sensory-Motor Approach Work?
I designed Interactive Oral Sensory-Motor (IOSM) techniques to address motor speech problems while simultaneously developing interaction and affect exchange between the face, eyes and mouth. Therapy focuses on this area, the "window of communication," where 90% of social interactive behaviors (facial expression, eye gaze, vocal and postural gestures) are exchanged.
The intimacy of face-to-face engagement inherent to oral sensory-motor techniques serves as a portal for developing affective interaction and engagement using the speech structures. If the client experiences the sensory modulation techniques in the oral area as pleasurable, willingness to interact increases. The key to success is that the therapist maintains control of the sensory stimulus. The child must engage with the therapist to obtain the desired sensory input. This creates the portal for development of interaction. Attaching emotion and intent to oral-vocal-facial behaviors permits these behaviors to become established for communicative purposes by selective reinforcement and conditioning.
Anna, a non-verbal 17 year-old with cognitive abilities at a 16 month level, unexpectedly and intermittently screams and grunts, while maintaining a clenched jaw. An oral sensory analysis revealed that she sought pressure throughout her temporo-mandibular and cricoarytenoid (speech) joints. She used screaming, grunting and clenching to provide for her sensory needs of pressure. Through the use of IOSM techniques, she learned to produce vocalizations at a socially acceptable pitch and loudness level, self-modulate from "too loud" or "too hard" cues, use acceptable voice and intonation levels.
To use the IOSM approach:
- First determine the client’s oral sensory seeking/avoiding behavioral profile.
- Next, assess oral motor capacities and tolerances.
- Then, provide the oral sensory input the client is seeking by guiding the stimulation within the comfortable tolerances of the client, while keeping input pleasurable.
- Engage the client in the "window" of communication by regulating the desirable sensory input, while enticing, but not commanding attention.
- Use the "teachable moment" to shape communicative behaviors, ranging from eye gaze to vocal productions to words and phrases.
- Mediate and shape undesirable, socially inappropriate behaviors, with this sensory approach, and replace with more acceptable behaviors.
The IOSM approach may not be the "magic bullet" that many hope for with pre- and non-verbal children. However, it certainly is one more weapon in the arsenal to combat one of the primary deficits in autism spectrum disorders.[Initially published in New Developments: Volume 9, Number 1 - Fall, 2003]