Autism + Teens
Marquette researchers from many disciplines focus on everything from social skills to aids for caregivers.
By Nicole Sweeney Etter
Once a week, a group of teens gathers in a conference room in Cramer Hall for some important life lessons: How do you strike up a conversation with someone new? How do you slip out of a socially awkward situation? How many times can you call a new acquaintance without it getting weird?
These might sound like social basics, but for teens with autism, the education can be life-transforming. Developed at the University of California, Los Angeles, the 14-week Program for the Enrichment and Education of Relational Skills teaches autistic teens how to make friends. Marquette is the only PEERS site in the Midwest and, with funding from the Autism Society of Southeast Wisconsin, is able to offer it to families free of charge. Families from as far away as Montana and Pennsylvania have asked to participate, and some drive for hours to attend the weekly sessions.
“Before I started doing this group, I didn’t have any friends and wasn’t involved with anybody or anything at my school. But now I have switched schools and have been talking to kids there and slowly building friendships,” says 15-year-old Nick Sansone of Highland, Ind., who is now active in his school’s book club, film society and theatre program, even landing a small role in a school production of It’s a Wonderful Life.
The innovative program is just one of the ways Marquette researchers are working to improve the lives of those with autism, from studying motor control deficits to exploring new techniques to enhance speech therapy to finding new tools that may ease the discomfort of hospital visits.
The focus on autism, a complex developmental disorder characterized by impaired social interaction and communication skills, has never been more important. “Autism rates are increasing at an exponential pace,” says Dr. Amy Van Hecke, an assistant professor of psychology and director of the Marquette Autism Clinic and Project, which offers PEERS. “We went from 1 in 10,000 (births) in the 1980s, and now we’re at 1 in 88. The rate of increase is alarming, and the autism research community is very focused on understanding why. However, it’s also crucial to help people with autism lead satisfying lives now.”
And so Van Hecke believes in focusing on what children with autism can do instead of what they can’t do — and that starts with strengthening relationship skills.
“Having at least one good relationship — it’s quality, not quantity — is protective,” she says. “And these kids who are isolated — if we don’t ameliorate that, they’re just continuing on a path of negative outcomes. The areas of the brain that respond to social stimulation may not develop appropriately, and once that cycle begins, there’s not a lot we can do.”
Elsewhere in Cramer Hall, a child moves a robotic handle to capture a cursor jumping around on a screen. It’s happening in the lab of Dr. Robert Scheidt, an associate professor of biomedical engineering who studies how the brain uses sensory information to guide movement. With doctoral student Nicole Salowitz, the lab is exploring what that means for children with autism.
“The track that she’s taking is really very novel,” Scheidt says of Salowitz. “It’s not a way that people have really looked at autism in the past.”
Children with autism struggle with coordination and sensory deficits and motor control issues. Their muscles are often very rigid and tense. But why? Like many aspects of autism, the cause is unknown.
“The question we’re exploring is whether motor coordination deficits in autism are related to sensory processing deficits,” Scheidt says. “We use the robots and functional brain imaging to look at how the brain combines sensory information from vision and from muscle sensors to learn new patterns of coordinated movement. The problem of transforming sensation into action is a challenge for any brain to perform. By characterizing this process in autistic children, we hope to better understand how their sensorimotor learning may differ from that of typically developing children.”
The lab tested autistic children ages 11–16 in two ways: Children were asked to imitate someone drawing a shape in the air and to trace a shape on paper while watching their hand in a mirror. Children with autism struggled with imitation. During mirror drawing, some performed better while others performed much worse than control children. The findings suggest differences in how children with autism use sensory information to guide movements, Salowitz says.
“Now we’ll use robots to really measure it and quantify it,” Salowitz says.
It’s possible, Scheidt says, that the cognitive, behavioral and motor control problems of autism are all related to a common deficit in the brain.
“No. 1 is figuring out what is autism. If we can figure out what parts of the brain might be impaired in relation to sensorimotor learning, that may provide insight about what’s going on in other aspects of autistic behavior,” Salowitz says. “This is just the beginning.”
Bob Marley’s song Get Up, Stand Up pumping through the integrated therapy room in Marquette’s Speech and Hearing Clinic signals it’s time for the 6-year-old child to start the next activity. The colorful space, with its giant bouncy ball, mats, swings and other equipment for “functional play,” was designed for children with autism spectrum disorders, Down syndrome and other health conditions. A pilot project has made speech therapy more fun by incorporating music — and early results show that music may be key to coaxing words out of an otherwise nonverbal child.
“Although music has long been a tool used in speech-language therapy with adults and children with various disorders, we are trying to determine if there is a significant increase in skills in children with autism spectrum disorders when music is a primary component of the therapy process,” explains Wendy Krueger, a clinical instructor of speech pathology and audiology.
Last spring, Scott Palahniuk, the primary clinician and now senior speech pathology major, communicated with his 6-year-old client by singing instead of speaking. Palahniuk was shocked when he brought his guitar to a session and the boy reached out to strum along. When the boy rolled on his belly on a giant ball as Palahniuk sang “roll, roll, roll the ball” to the tune of Row, Row, Row Your Boat, the boy chimed in with “la, la, la” and later ran to his augmentative communication device to type, “I’m excited!” The show of emotion and communication — and eventual increase in vocal output — were huge steps forward for a child who spent previous therapy sessions screaming, spitting and throwing fits.
“His mom was ecstatic,” Palahniuk says. “A couple of times, her jaw just dropped.”
This semester, the technique is being used with other clients, and music sessions are being alternated with non-music sessions to test their effectiveness.
Helping the entire family
Autistic kids who arrive at Children’s Hospital of Wisconsin for an appointment might be handed a “coping” kit that includes a book, communication cards, note pad, spinning toy, squishy ball, and other objects designed to soothe and distract.
Reducing autistic children’s challenging behaviors — such as hitting, screaming or fleeing — makes life easier for everyone, says Dr. Norah Johnson, an assistant professor of nursing who led the team that designed the coping kit.
“Large children with developmental disabilities can become quite scared,” Johnson says, “and hospitals can be loud, noisy and rushed.”
Johnson knows what families go through — her 16-year-old son has autism. And so she understands that reducing difficult behaviors can reduce Mom and Dad’s stress — which in turn can lead to a healthier family environment.
She also helps families cope by writing social scripts — booklets that prepare children for some medical procedures. Johnson and clinical instructor Jenn Drake were the first to publish research on the effectiveness of coping kits that include social scripts with autistic children.
“I wanted to show that these booklets could help children get through procedures faster, with fewer problems, and that it would save hospitals money in the long run, in addition to being more humane,” Johnson says.
Next she teamed up with Dr. Iqbal Ahamed, an associate professor of mathematics, statistics and computer science at Marquette, to create an iPad application for use by children with autism to study whether it reduces parental and child anxiety before hospital diagnostic imaging tests. The interactive, photo-rich application can be customized for a child undergoing nuclear medicine, a CT scan or an MRI or X-ray.
She is also collaborating with Dr. Abir Bekhet, an assistant professor of nursing who is studying how nurses can promote the health of caregivers of those with autism spectrum disorders.
“If you can do things to help the kids feel more comfortable,” Johnson says, “and then if you can help parents be positive and resilient, you can better support families for good outcomes.”
Read more about the Marquette Autism Project and PEERS.