Imagine you want to apply to college or for your first job. You have a great academic record and stellar grades. At your interview, the interviewer asks you questions. You have the answers but when you speak, your voice is flat, you sound like a machine — a staccato tone, devoid of intonations or variance in pitch.
How successful do you think a person like that will be in getting into college or securing that job?
This is the challenge that a number of high functioning autistic teenagers face – they are extraordinarily intelligent but they are impeded in their attempts to lead an independent and fulfilling life. Their lack of effective communication skills inhibits their social integration and is a barrier to vocational acceptance.
“Prosody — rhythm, stress and intonation of speech — deficits have been observed in autistic kids for some time, and there have been no effective interventions developed by speech language pathologists or neuropsychologists,” says Dr. Michele Dunn, director of Montefiore Hospital’s Montefiore Autism Center, “It is time to think out of the box.”
With the help of former pro-football player Larry Harris, now a professional opera singer, Dr. Dunn, who practices at Montefiore Hospital in New York, is doing just that. The pair has collaborated on a novel project to help autistic young adults improve their speech prosody using opera singing techniques.
“You cannot take a one-size-fits-all approach, as every individual that is on the autism spectrum can present a different set of issues,” says Dr. Dunn. “If you can teach them a skill, they can learn it, provided they have a clear set of rules to follow.”
The incidence of autism has reached epidemic proportion. The Center for Disease Control estimates that 1 in 68 children suffer from autism and this population is aging fast. It is estimated that roughly 50,000 children diagnosed with an Autism Spectrum Disorder (ASD) turn 18 each year. According to the American Pediatric Association, more than 50 percent of youth with an ASD are not employed or do not participate in postsecondary-education.
“Autism spectrum disorder spans a lifetime. Over the next decade, approximately 500,000 adolescents with autism will transition into adulthood with minimal support systems in place. Not only do we need to think about housing supports for adults with autism, but we also need to work with large and small businesses to capitalize on the strengths of individuals with autism,” says Steffanie Marchese, senior director of international science and media at the non-profit, Autism Speaks, a leading autism science and advocacy organization.
Lawrence D. Shriberg, Ph.D., of the Waisman Center of Mental Retardation and Human Development, University of Wisconsin-Madison, conducted a study comparing a group of high functioning autistic male speakers with typical male speakers between 10 and 50 years of age that reveals the differences in their speech pattern.
That is precisely the approach that Dr. Dunn and Harris, an ex-NFL player for the Houston Oilers and a professional baritone who has performed a variety of roles from La Traviata to Aida in venues all over the world, take. Dunn and Harris believe that higher-functioning teens on the autism spectrum can and must acquire and understand voice skills in order to communicate.
“To move from say, point A to point B on the field, a professional football player has to follow rules. First they learn the sorts of motor skills needed and then they repeat the action to develop muscle memory and master the movement until it becomes organic,” he says. The same thing applies to autism, he explains.
Following a systematic approach Dunn and Harris’s clients are first taught the skills involved with producing a sound e.g. a less nasal timbre, then they work through words and small phrases to pre-formulated connected language, and finally to spontaneously generating sentences and paragraphs.
Dunn explains that different things that can go awry with speech among kids on the autism spectrum:
• they can have an unusual timber — they may sound too nasal or not be loud enough
• their sentences can have a strange melody
• they can be disfluent i.e. they may say “um” and “ah-ah” a lot
• they may repeat themselves over and over almost as if to get a running start on finishing their sentence.
Singers alter the sound they produce using their vocal cords, their mouth and tongue, lungs and diaphragm. The placement of the tongue, the shape of the mouth, the use of the chest cavity, the resonating of the nose cavity and other techniques result in creating different sounds. Singing also involves the breathing process. Air is inhaled and exhaled to push against the vocal cords and produce a certain sound.
Harris describes the hesitation technique he uses to help kids avoid repeating themselves or using words that have no meaning like ‘um, um, um’ that would be distracting to the listener, like this: “Say you want to pick up a table that is fixed to the ground. In order to engage all the muscles you need, all the vocal chords must also come together. You breathe in tightly, ‘huh,’ pause and then exhale as you lift the object.
At first kids are encouraged simply to make the sound in its raw form until they begin to understand that the sound cues them to understand they are about to pause. Once they get that, they are asked to engage the vocal cords without making any sound. That sensation and the pause gives these kids a second to hang onto to avoid repeats At the end of the line the patient learns how to respond spontaneously and respond normally in the real world,” Harris says.
Dunn met Harris at their church choir in Scarsdale and over the last six years—and something clicked. “I realized when I met Larry that in addition to his vast knowledge on how the human anatomy must function to create sound, Larry’s understanding of value of rule-based learning fit together with my own understanding of autistic kids,” she says.
The duo’s approach has stirred interest among others who deal with autism. “There has been a lot of intervention around the social and communication aspects of autism, using speech and language therapy, and even music therapy. But we have not been successful at remediating that residual monotone, flat prosody effect that still makes individuals at the high end of the autism spectrum sound different. I am excited about their new approach,” says Donna S. Murray, Ph.D., senior director, Autism Speaks, Autism Treatment Network.
Dr. Dunn and Harris are encouraged. Next up: a soon-to-be released manual on techniques to improve prosody among high-functioning autistic teenagers this year. They intend to use the proceeds from the sale of the manual and to raise money from grants to further their research and gather a larger body of objective data for scientific studies.