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Michigan State
University

 

 

 

This is to certify that the

thesis entitled
THE ABILITY OF AUTISTIC CHILDREN TO ORIENT THENSELVES

AND RESPOND TO FAMILIAR AND NOVEL AUDITORY STIMULI:

ENVIRONMENTAL, VOCAL, AND MUSICAL SOUNDS.
presented by

Dimitra Akogiounoglou

has been accepted towards fulfillment
of the requirements for

Master degree in Music

QM

Major professor

Date October 23, 1990

0-7 639 MS U is an Affirmative Action/Equal Opportunity Institution

 

 

 

PLACE iN RETURN BOX to remove this checkout from your record.
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MSU Is An Affirmative Action/Equal Opportunity Institution
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——u—- A.

 

THE ABILITY 0F AUTISTIC CHILDREN TO ORIENT THEMSELVES
AND RESPOND TO FAMILIAR AND NOVEL AUDITORY STIMULI:
ENVIRONMENTAL, VOCAL, AND MUSICAL SOUNDS.

By

Dimitra Akogiounoglou, RMT- BC

A THESIS

Submitted to
Michigan State University
in partial fullfillnent of the requirements
for the degree of

MASTER OF MUSIC, MUSIC THERAPY

Department of Music Therapy

1990

ABSTRACT

THE ABILITY OF AUTISTIC CHILDREN TO ORIENT THEMSELVES
AND RESPOND TO FAMILIAR AND NOVEL AUDITORY STIMULI:
ENVIRONMENTAL, VOCAL, AND MUSICAL SOUNDS.

BY

Dimitra Akogiounoglou

A frequent observation that educators, clinicians, and
researchers make about autistic children is their unusual
responsiveness to music and rhythm. The present study is designed to
explore the ability of school-age autistic children to respond
overtly to familiar and novel auditory stimuli: environmental, vocal,
and musical sounds.

A literature review is given on areas related to the experiment,
such as the diagnostic concepts and the possible causes of autism,
stimulus overselectivity, auditory perception and auditory evoked
responses of autistic children, as well as autism and music therapy.
A typical, detailed behavioral profile of an autistic child is
outlined.

Results of the study showed a strong preference of autistic
children to respond with movement. There was an indication of weak
preference toward musical excerpts rather than toward environmental
and vocal sounds. There was a significant difference between the
responses of younger and older autistic children, the younger showing
a greater number. No differences were found among male and female,

or higher- and lower-functioning children.

Copyright by
Dimitra Akogiounoglou
1990

Dedicated to the memory of my father,

George Akoyunoglou

ii

AKNOWLEDGMENTS

The author would like to express her gratitude and great
appreciation to Professor Roger Smeltekop for his guidance,
support, and expert advise during this research study.
Furthermore, the author wishes to thank the members of her
committee, Dr. A1 Leblanc and Dr. Charles Ruggiero, for their
individual contributions of expertise, their cooperation and
assistance throughout the study.

For their cooperation and participation in the study, the
author extends her gratitude to Jill Hempfling, Suzanne
Gainforth, and Tamara King, who willingly offered their valuable
time to help with the collection of data.

Special thanks are extended to the students and staff of the
Center for Autism, Flint, Michigan, for their cooperation and
participation.

With special recognition and in gratitude for their support
and encouragement throughout the completion of the study, the
author thanks her husband and her family.

Throughout her graduate work and during this research
project, the author was a recipient of a scholarship from the
Greek Section of Scholarships and Research of "ALEXANDER S.
ONASSIS" Public Benefit Foundation, from which help and

continuous support have made this study possible.

iii

TABLE OF CONTENTS

Page

LIST OF TABLES vi

LIST OF FIGURES vii
CHAPTER

1. An Experimental Study

Introduction . . . . . . . . . . . . . . . . . . 1

Purpose of the Study . . . . . . . . . . . . . 2

The Problem and Subproblems . . . . . . . . . . 2

Definitions . . . . . . . . . . . . . . . . . . 3

Limitations . . . . . . . . . . . . . . . . . . 4

Assumptions . . . . . . . . . . . . . . . . . . 6

Ethical Considerations . . . . . . . . . . . . . 7

2. A Review of Literature Related to Autism

Introduction . . . . . . . . . . . . . . . . . . 9

Diagnosis of Autism . . . . . . . . . . . . . 11

Causes of Autism . . . . . . . . . . . . . . . . 14

(a) Genetic Factors . . . . . . . . . . . . 16

(b) Neurochemical Studies . . . . . . . . . . 18

(c) Neurophysiological Studies . . . . . . . 21

(d) Neuropathological examinations . . . . . 25

Remarks . . . . . . . . . . . . . . . . . . 27

The Behavioral Profile of an Autistic Child . . 28

(a) Disorders of the Special Senses . . . . . 28

iv

(b) Disorders of Speech .

(c) Motor Behavior . . .

(d) Odd Behaviors, Including Resistance . .

to Change
(e) Abnormalities of Mood
(f) Other Agnosias . . .

(g) Uneven Development .

Overselectivity of Sensory Stimuli in Autism .

Auditory Perception . . . .

Auditory Evoked Responses of

Music Therapy and Autism . .
3. Methodology . . . . . . . . . .
4. Analysis of Data . . . . . . .
5. Discussion . . . . . . . . . .

APPENDICES

Appendix A. . . . . . . . . . . .
Appendix B. . . . . . . . . . . .
Appendix C. . . . . . . . . . . .

REFERENCES 0 O O O O O O O O O O O O

Autistic Children

29

30

31

32
32
33
34
39
45
51
S7
65

83

91
92
93
94

8.

LIST OF TABLES

Distribution of Response Types Elicited . . . . .
by each Sound Stimulus.

Distribution of Average per Trial Measurement . .
Scores of Subjects to each Auditory Stimulus.

Means of Measurement Scores of all Subjects . . .
to each Auditory Stimulus.

Distribution of Total Measurement Scores . . . .
of the Subjects in Each Behavioral Category.

Means for Total Measurement Scores per Subject. .
for all Three Trials in Each Behavioral Category.

Distribution of Total Measurement Scores . . . .
on Each Main Behavioral Grouping to Each of
the Main Auditory Stimulus Types.

Means for Total Measurement Scores for . . . . .
Behavioral Response Categories and for
Auditory Stimulus Types.

Average Scores - Work-up for the Mann-Whitney . .
"U" Test.

vi

Page

67

72

73

75

76

77

78

81

LIST OF FIGURES

Figure

1. Total Measurement Scores of Biochemical Responses
to Each of the 12 Stimuli in the actual order of

Presentation during Testing.

Total Measurement Scores of Motor Developement
Responses to Each of the 12 Stimuli in the actual

order of Presentation during Testing.

Total Measurement Scores of Speech Responses to .

Each of the 12 Stimuli in the actual order of

Presentation during Testing.
Total Measurement Scores of all Behavioral

Categories to Each of the 12 Stimuli in the
actual order of Presentation during Testing.

vii

page
70

70

71

71

CHAPTER I

AN EXPERIMENTAL STUDY

INTRODUCTION

 

Though autistic children seem to see and hear adequately,
their behavior often resembles that of children whose vision or
hearing is severely impaired. This has been a prominent
research problem that many investigators are trying to solve.
How much can they hear? Condon (1975) suggested that a delayed
echo of an auditory stimulus prevents the autistic child from
responding to auditory stimuli in normal synchrony. Tanguay and
Edwards (1982) suggested that brainstem transmission time is
longer in autistic children than in normals. No one answer has
yet been found.

Parental reports indicate that an absence of response to
sounds occurs in 70% of autistic children, and the occurrence
correlates strongly with disturbances of social relating
(Ornitz, Guthrie, & Farley, 1978). How could the relative lack of
responsiveness to speech and the often reported strong
responsiveness to music be reconciled with a general auditory
imperception? When presented with different auditory stimuli, to

which ones do autistic children attend, and which ones do they

ignore? This is the basic question asked in this study, and
since the capacity to orient to novel auditory information in
the environment is very critical to language and knowledge
acquisition, it appears to be a very important question to be
answered about autistic children. Evidence suggests that autism
cannot be regarded as being based on a multiple impairment, but
rather on a selective perceptual impairment, in which the
children do not respond to some sensory stimulus modalities
while preferring others (Schopler, 1965; Hermelin & O'Connor,

1971).

PURPOSE‘QEHTEEHSTEQX
The purpose of the present study is twofold:

(a) To explore the ability of autistic children to respond
overtly to novel auditory stimuli-environmenta1, vocal, and
musical sounds;

(b) To investigate whether there are differences in overt
behavioral responses of autistic children among each one of the
three categories of auditory stimuli: environmental,

vocal, and musical sounds.

THE PROBLEM AND SUBPROBLEMS
This study is based on a non-directional null hypothesis,
stating: There are no differences in the overt behavioral

responses of autistic children to environmental, vocal, and

musical auditory stimuli.

The main research question which is asked throughout this
study is: Does the autistic child respond overtly and within a
10 second latency period to environmental, vocal, and musical
auditory stimuli?

Several other questions are asked as well:
Does the autistic child emit a greater number of behaviorally
observed responses to musical than non-musical auditory stimuli?
Does the autistic child emit a greater number of responses on the
biochemical, motor deve10pment, or verbal aspects of his or her
behaviorally observed responses?

In this study the above questions were explored, possible

answers were offered, and further questions were generated.

DEFINITIONS

 

Auditory Perception: Auditory perception is the act of

 

recognizing sensation through the medium of the ear, retaining
the image and relating it to previous experiences. It does not
include auditory acuity, association with activity symbols, or
formation of concepts (Reagan, 1973).

Speech Perception: Speech perception refers to the act of
differentiating among speech sounds.

Musical Perception: Musical perception refers to the act

 

of differentiating among musical sounds.

Behavioral Observation Audiometry: Behavioral Observation

 

Audiometry or BOA is a testing method based on observations of
overt behavioral responses to controlled auditory signals
(stimuli). In other words, the examiner observes changes in
behavior (responses) which are time-locked to auditory signals
(Lloyd, 1975).

Latency Period: Latency period is the time lapse between

 

the end of acoustic stimulation and the moment at which a
behavioral response is emitted by the subject. Based on studies
(Engeland, 1984; Stevens 8 Gruzelier, 1984), the latency period
which will be used in this study has been defined as a 10 second
period of silence between auditory stimuli.

Familiar and Novel Auditory Stimuli: Familiar auditory

 

 

stimuli are the auditory stimuli that are familiar or known to
the subject, i.e. everyday sounds like a doorbell. Novel
auditory stimuli are the auditory stimuli that are new or
unfamiliar to the subject, i.e. unexpected or rare sounds such as

plates breaking.

LIMITATIONS

The testing took place in the Genessee Intermediate School

District, at the Center for Autism, in Flint, Michigan. The

researcher attempted to control for factors such as age, sex,
and IQ, yet various problems did arise.

Due to the limited population of autistic subjects,
difficulties were encountered in forming balanced samples. The
male:female ratio in the majority of studies (Gillberg, 1984)
has fallen between 1.4:1 and 3.4:1. Investigators like Wing
(1981) have observed that the male:female ratio increases with
IQ. There are significantly more autistic boys than girls with
an IQ greater than 50 compared to children with a lower IQ, but
even among children with IQs less than 50, the malezfemale ratio
fails to achieve unity. In the present study, the male:female
ratio was 1.7:1 (five boys and three girls) which falls within
the ranges in the majority of studies.

Since the testing took place at the Genesee Intermediate
School District, at the Center for Autism, in Flint, the best
room that was available for the testing was used. This room was-
the physical education therapist's office and had various
equipment stored on shelves. This presented a problem during the
testing since it was not possible to eliminate all of the
distracting material from the room, and some had to be covered
with pieces of cloth. The experiment was affected to some degree
by the visual distractions offered in the room for the subjects,
but the investigator eliminated most distractions by placing the

child on a chair facing a clear wall with the speakers on the

6

left and on the right in such a way to block most of the visual
distractions of the room.

This investigation involved the study of eight subjects.
Although this may be regarded as a limitation, consideration
must be given to the rarity of this syndrome. Many research
studies on various aspects of autism have used a small number of
subjects (Naramsihackari & Himwich, 1975; Wetherby & Prutting,
1984; Abrahamsen & Mitchell, 1990). Thus, for the present

experiment eight subjects can be considered an adequate number.

ASSUMPTIONS

 

Although most researchers investigating auditory
perception and discrimination of autistic people have been using
physiological measurements for collecting data, it seems very
appropriate for this study to use behavioral observation testing
with the autistic subjects. The overt behaviors of autistic
children when occuring in close proximity to a stimulus, are
considered as a direct reflection of their ability to orient
themselves and respond to familiar and novel auditory stimuli.
This method detects the presence of a response, and is
independent of the constancy of the response pattern or duration.
It has been largely used by audiologists, and although it has
not been used with autistic people, it suits best the purposes

of the present study.

Subjects were exposed to various auditory stimuli, where
an equal number of environmental and musical sounds were
presented, as well as two vocal/speech sounds. The sounds chosen
are considered to be representatives of all other sounds, and
examples of good sound quality were used. The environmental.
sounds included everyday sounds: doorbell, telephone ring,
plates breaking, and a baby crying. The musical sounds included
both vocal and instrumental excerpts and both classical and
American popular music. The vocal sounds -- spoken material --

included phrases spoken by both a male and a female voice.

ETHICAL CONSIDERATIONS:

 

A form of the proposal of this study was submitted for
approval to the Michigan State University Human Subject's
Committee. After approval was granted, the Center for Autism at
Flint was contacted. A copy of the proposal was given to the
principal of the school, Mrs. M. E. Hicks, and permission was
asked to obtain information from the files of children to
identify the ones that could fit in to the requirements of the
study. Consent forms were sent to parents, short letters
briefly stating the purpose of the study and asking for
permission (signed) for their child to participate in the
experiment (see Appendix A). If the child was verbal or high-

functioning, the child was asked as well. Children were known

to the experimenter by their first names only. No documented
connections were made between files, names, and faces. Children
were tested individually and no two children were in the testing
room at the same time. Parents had the right to withdraw from
the study whenever they so decided. Parents were assured that no
names would be used in the actual report of the study, since no
names were attached to the data.

The three judges were given no names but merely numbers.
All observations were treated as data and numbers and were not
connected to a child. Each child, when coming for a testing
session, was assigned a sequence number and the observation
sheets were coded with that same number. This assured both
anonymity and confidentiality of the test- results. All
videotapes were kept in the Michigan State University Music
Therapy Clinic under the responsibility of the experimenter and
all tapes were erased as soon as the study had taken its final
form and all data had been coded, counted and analyzed. No other
person viewed the videotapes apart from the experimenter, her

advisor, and the three observers.

CHAPTER II

A REVIEW OF LITERATURE RELATED TO AUTISM

INTRODUCTION

Numerous researchers have attempted to investigate specific
areas of basic perceptual abnormalities in autistic children.
Among the perceptual dysfunctions proposed as central to autism
are the following: a basic defect in sensorimotor integration
(Ornitz, 1983), an inability to relate present to past
experiences (Rimland, 1964), a pervasive language disorder
(Churchill, 1978), and an inability to interpret social and
emotional cues (Rutter, 1983). On the basis of clinical and
research observations, the most pronounced information
processing defects in early infantile autism appear to be with
auditory and verbal stimuli.

One of the characteristics frequently associated with autism
is an inconsistent response to sound. Several researchers have
proposed theories of auditory processing disorders. Evidence
from brainstem-evoked auditory responses has generally indicated
that brainstem transmission time is longer in autistic children
than in normals (Rosenblum et al., 1980; Tanguay & Edwards,

1982). Since detecting, paying attention to, and learning about

10

new and significant information is an essential requirement for
normal development, a defect in attentional orientation to new
and significant information could have devastating consequences.
Researchers consistently observe that people with autism do not
seem to pay attention to their environment in a normal fashion.
They sometimes seem oblivious to even novel, unexpected sounds
and may not give any overt indication that they were surprised
or curious about the source. Their attentional orientation to
the world clearly differs from normal, but at present there
exists no adequate framework for predicting their attentional
orientations (Courchesne, 1987). Although it is still not
possible to know how auditory functioning relates to various
perceptual deficits in autism, it has provided investigators a
fertile area for research.

In the following pages, a review of literature on autism
and auditory awareness will be given, to provide the reader with
the essential background knowledge needed to understand the basic

deficits and the nature of the disorder of autistic children.

DIAGNOSIS _o_r AUTI SM

Kanner (1943) was the first to name and describe the
syndrome of early infantile autism and to delineate the
behavioral abnormalities, which he considered to be of basic
importance in making a diagnosis. The points that Kanner listed
were:

1. A profound lack of affective contact with other people,
2. An anxiously obsessive desire for the preservation of

sameness,

3. A fascination for objects, which are handled with skill
in fine motor movements,

4. Mutism, or a kind of language that does not seem to be
intended to serve interpersonal communication,

5. Good cognitive potential.

Although Kanner considered that the above points summarized the
essential features of the condition, during the course of his
writings on the subject he described in great detail the full
range of behavior seen in autistic children (Kanner, 1973).
Since Kanner's original description of the diagnostic criteria,
many researchers have struggled to identify the criteria which

are necessary to make the diagnosis of early infantile autism.

ll

12

In 1964, Rimland listed six criteria which he considered

of importance when making the diagnosis of autism. These were:

1. Presence of the syndrome from early childhood,

2. Lack of physical responsiveness,

3. Preservation of sameness,

4. Autistic aloneness and isolation,

5. Unusual performance in memory, music, and mechanical
skills,

6. Good physical health and motor development.

Rutter and Schopler (1986) identified three clinical
features as essential for diagnosis of early infantile autism.
These are:

l. Deficits in the capacity to form relationships,
associated with a poor appreciation of socioemotional cues, a
lack of modulation of behavior according to social context, and
a weak integration of social, emotional, and communicative”
behaviors;

2. Deficits in the use of language for social communication,
associated with poor synchrony and reciprocity in conversational
interchange, impaired use of variations in cadence to reflect
communicative modulation, together with abnormalities of
language including stereotyped usages and delayed echolalia; and

3. Restricted, repetitive, and stereotyped patterns of

behavior, associated with abnormal preoccupations with parts of

13

objects or play materials, and distress over changes in small
details in the environment.

Although many researchers have proposed and argued as to
what the criteria for diagnosis of autism should be, the
American Psychiatric Association has offered a systematic
approach of explicit diagnostic criteria in the Diagnostic and
Statistical Manual of Mental Disorders - III, Revised. The
symptoms delineated in DSM-III,R are:

l. Onset of the disorder before 30 months of age,

2. Deviance in the development of social relationships and
pervasive lack of responsiveness to other people,

3. Gross deficits in language development. If speech is
present, peculiar speech patterns such as immediate and delayed
echolalia, metaphorical language, and pronoun reversal,

4. Restricted, repetitive, and stereotyped patterns of
behavior, and bizarre responses to various aspects of the
environment, e.g. resistance to change, peculiar interest in or
attachment to animate or inanimate objects.

It is clear from this account of the diagnostic criteria
that the definition of autism is based upon behavioral symptoms
in early childhood. The literature on autism is still expanding
to include more research on the domains of behavior that Kanner

first suggested as central to the syndrome.

CAUSES 9: AUTISM

The behaviors characterizing early infantile autism
strongly suggest that this disorder relates to some form of
neurological dysfunction. Current research is focused on two
aspects of this problem: first, the identification of the
neurological correlates of autism, and second, attempts at
identifying the cause of this handicapping condition. Mesibov
and Dawson (1986) note a few identified neurological correlates,
such as soft neurological signs (e.g. hypotonic or flaccid
muscle tone, poor coordination), seizure disorders, abnormal
electroencephalograms (EEGs), unusual sleep patterns, and
several conditions known to be related to brain damage. This
large number of neurological correlates has suggested an
underlying neurological dysfunction in the brain of the autistic
individual. However, this emphasis on a neurological explanation
is relatively recent.

Historically, particularly following Kanner's original
description, all research was focused on psychogenic factors
(i.e., not due to an organic illness but to unidentified
psychological causes) in order to understand this syndrome.
Attention to the parental role was initiated by Kanner's (1954)
description of the parental characteristics of his first 100

autistic children. Although he noted that there was very little

l4

15

mental illness in the families of the autistic children, the
parents were described as obsessive, unemotional, and cold.
Bettelheim (1967) took a more extreme position, arguing that
autism was the child's defense against the hostility of parents
who had emotionally rejected the child. After a long period of
assuming that parents had a strong role in causing their
children's autism, a number of studies showed evidence that the
parents of autistic children have problems no different than the
parents of children with other types of handicaps, such as
mental retardation, brain damage, and dysphasia (DeMyer, Alpern,
Barton, DeMyer, Churchill, Hingtgen, Bryson, Pointius, &
Rimberlin, 1972).

In general, the research investigating the psychogenic
hypothesis has failed to support it (Ornitz & Ritvo, 1976).
This led to the promotion of several neurological theories. In
1964, Rimland presented in his twin study the first
neurobiological explanation of autism. Since then, several
investigators have proposed neurological hypotheses on the causes
of this syndrome. Thus, most research is focused on four
distinct neurological and pathological areas: (a) genetic
factors, (b) neurochemical studies, (c) neurophysiological
studies, and (d) neuropathological examinations. A
representative number of studies from each of these four areas

of research will be reviewed in the following pages.

16

(a) Genetic Factors

 

Because of the rarity of the syndrome of early infantile
autism, genetic studies are quite scarce. However, there is
accumulating evidence which can suggest that genetic factors are
responsible for autism, a disorder of unknown etiology. The
evidence for a genetic contribution to the syndrome of autism
comes from two types of studies: twin studies and family
studies.

Folstein and Rutter (1977) studied 21 pairs of twins and
found that none of the 10 fraternal (dizygotic) pairs was
concordant for autism, but four pairs of the 11 identical
(monozygotic) pairs were concordant. Concordance was determined
through behavioral observation of the twins, and the degree of
concordance was estimated by examining whether autism, diagnosed
according to strict criteria, was present in both twins. This
monozygotic-dizygotic difference in concordance pointed to an
important genetic factor in the etiology of autism. In all, the
21 twin pairs gave rise to 25 autistic children. Thus, Folstein
and Rutter (1977) developed a hypothesis and proposed that the
co-twins (the twins who did not meet the criteria of the
autistic syndrome) might exhibit some cognitive impairment
without necessarily manifesting the full autistic syndrome. From

their further examination of the twins, they found that in

l7

addition to the four identical co-twins, five other identical
co—twins showed some cognitive impairment. Therefore, nine of
the 11 monozygotic twin pairs were concordant for a cognitive
deficit. August, Stewart, and Tsai (1981) attempted to test the

hypothesis proposed by Folstein and Rutter (1977) by looking at
the siblings of autistic children. The experimental group
consisted of the siblings of 41 autistic individuals, which
summed to the total of 71 siblings. The control group consisted
of 38 siblings of 15 Down's syndrome individuals. Their findings
suggested that some 15% of the siblings of autistic children,
compared with only 3% of the siblings of Down's syndrome
individuals, bad language disorders, learning disabilities, or
mental retardation. This showed the likely role of an inherited
predisposition to cognitive abnormalities.

Recently, 'the results of another twin study were reported
by Ritvo, Freeman, Mason-Brothers, Mo, and Ritvo (1985). Their
sample consisted of 40 twin pairs. The authors found a
concordance for autism of 95.7% in the identical twins (22 of
23) and 23.52 in the fraternal twins (four of 17). The authors
also studied the non-twin siblings of these 40 autistic subjects.
From their data, the authors yielded a 10.32 incidence of
possible cognitive processing pathology among all nonautistic
siblings (78 nonautistic siblings, of which eight were possibly

pathologic).

18

Unfortunately, the data do not allow a test of any specific
hypothesis. Pauls (1987) suggests that in order to adequately
test any genetic hypothesis, the phenotypes of the parents need
to be known. Thus, further research is required to support the

possibility of a genetic basis for autism.

(b) Neurochemical Studies

 

The normal development of the central nervous system (CNS)
involves chemical processes which are the tepic of various
studies of neuronal maturation. There are a number of chemical
compounds in the human brain which are called neurotransmitters.
Nerve cells communicate information received from the
environment to the brain through the chemical actions of
neurotransmitters at the synapses between the cells. A certain
group of neurotransmitters, called monoamines, consists of
dopamine, norepinephrine, and serotonin. Anatomical studies
indicate that monoamines are found in areas of the brain which
control emotions and behaviors. The behavioral, emotional, and
cognitive symptoms presented by autistic individuals strongly
suggest that CNS functioning is altered in autism. Neurochemical
studies of autistic individuals have been undertaken to examine
processes related to neural transmission in the central and

peripheral nervous system (Anderson & Hoshino, 1987). A rather

19

small, yet representative number of studies will be reviewed in
the following paragraphs on the neurobiochemical causes of
autism.

Serotonin is a monoamine neurotransmitter found in the areas
of the brain that control emotions and behaviors. Serotonin
travels around the human body through the peripheral bloodstream,
where it is carried in platelets. Yuwiler, Geller, and Ritvo
(1976) gathered data that suggest that some autistic children
have above-normal blood serotonin concentrations in their blood.
Takahashi, Kanai, and Miyamoto (1976) found that the autistic
group in their study had a mean platelet serotonin level
significantly higher than the mean of the normal group.

Tryptophan, an essential aminoacid, is the dietary precursor
of serotonin and of the vitamin nicotin acid. Hoshino, Yamamoto,
Kaneko, Tachibana. Watanabe, Ono, & Kumashiro (1984) reported
that both plasma free tryptophan and blood serotonin levels were-
significantly higher in autistic subjects than in normal
controls. Thus, the well-established elevation of blood
serotonin seen in autistic individuals has prompted speculation
that central serotonin systems are dysfunctional in autism
(Anderson & Hoshino, 1987).

Dopamine, a monoamine neurotransmitter, appears to be
especially important in the control of motor function, in

cognition, and in regulating hormone release (Moore & Bloom,

20

1978). Lake, Ziegler, and Murphy (1977) found decreased
dopamine serum levels in 11 autistic children and their families.
Once dopamine is released from the neuron, it is enzymatically
degraded to homovalillic acid and dihydroxyphenylacetic acid (HVA
and DOPAC respectively) (Anderson & Hoshino, 1987). Martineau,
Garreau, Barthelemy, Callaway, and LeLord (1981) studied the
biochemical and electrophysiological effects of Vitamin B6 and
magnesium in 12 autistic children and 11 normal children. Before
treatment, the autistic children showed a higher level of
homovalillic acid (HVA), whereas after the treatment they
exhibited a decrease in urinary HVA. This possibility of
increased central dopamine function, which is supported by
pharmacological observations, deserves further careful study.

Norepinephrine is an important neurotransmitter in both the
central nervous system and in the peripheral sympathetic nervous
system. Lake, Ziegler, and Murphy (1977) found, along with
decreased dopamine-b-hydroxylase (the enzyme that helps produce
norepinephrine from dopamine), an elevated norepinephrine level
in 11 autistic children as compared to normals. In a preliminary
study of five autistic boys and nine normal boys, urine level of
norepinephrine was reported to be lower in the autistic subjects
(Young, Cohen, Brown, and Caparulo, 1978).

These areas of neurochemical research in autism appear to

hold special promise. As Anderson and Hoshino (1987) suggest,

21

additional studies will help reach a greater consensus as to
which aspects of neurochemical functioning are abnormal, and

which are normal, in autism.

(c) Neur0physiological Studies

 

The neurophysiological approach is another major area of
study on the causes of autism. In the last decade, there is a
strong suggestion of the possibility that numerous systems within
the brainstem do not function properly in early infantile autism.
Neurophysiologic studies of cortical and subcortical events have
focused on the autistic disturbances of language, communication,
sensory modulation, and motility. These investigations have
included electroencephalogram (EEG), radiologic, event-related-
potential, autonomic, brainstem auditory evoked response, and
vestibular studies.

EEG studies have suggested a deficiency in hemispheric
lateralization. Small (1975) showed that in autistic children,
their mean integrated EEG voltage over the left hemisphere did
not show the normal increment over the right hemisphere. In
addition, in the forementioned study the abnormal EEG findings
were significantly related to other indications of impaired CNS
functioning, such as lower intelligence, positive neurological

signs, and poorer follow-up status. Ornitz (1987), in a review

22

of literature on neurophysiologic studies, concluded that
although there is evidence from EEG studies for unfavorable
cerebral lateralization in autism, dichotic listening studies or
CT scan studies do not support that concept. A recent study by
Balottin, Bejor, Cecchini, Martelli, Palazzi, and Lanzi (1989)
tested the hypothesis that specific computerized tomography
brainscan (or CAT scan) findings are associated with infantile
autism, but their results did not show any significant
differences between the autistic and the normal groups. Thus,
the authors concluded that "autism is nonspecifically associated
with brain-scan abnormalities, and that other nonorganic and/or
organic factors should be taken into account" (p. 109).

Sleep studies have shown some differences between autistic
and normal children. Tanguay, Ornitz, Forsythe, and Ritvo (1976)
compared a group of autistic children (ages 36-62 months) to an
agedmatched group of normals and to a group of normal infants
(ages below 18 months). They found that the rapid eye-movement
(REM) activity of REM sleep in autistic children is reduced and
is similar to that found in normal infants. They suggested that
this indicates brain mechanism immaturity in the autistic
individuals.

Maturational deviation has also been reported in event-
related-potential studies in the awake autistic child. One early

study of evoked responses to flashes and clicks in waking

23

autistic children found that the visually evoked response (VER)
of the autistic children was more variable than the VER of the
normal children (Small, 1971). Yet, the evidence was
inconclusive, since no statistical analysis of the data was
presented. In 1978, Student and Sohmer found longer auditory
nerve transmission latency and longer brainstem transmission time
for the auditory evoked response (AER) in a group of 10 autistic
children compared to 12 normal children. Courchesne, Kilman,
Galambos, and Lincoln (1984) compared nonretarded autistic
adolescents with normal controls. They found that the late AERs
waves (wave P300) of the autistics were significantly smaller in
response to target stimuli requiring an active response and in
response to novel stimuli presented during the same testing
trials.

Autonomic response studies have focused on the regulation of
cardiovascular and respiratory responses. Disturbances in
autonomic function have been found in a number of children
diagnosed as autistic or psychotic. In a review of literature of
autonomic studies by Piggot (1979), the author cites a study by
Hutt, Forrest, and Richer (1975). As the reviewer states, "they
found significantly more arrhythmia in autistic children than in
normal children when they recorded their heart rates in
situations varying from an external stimulation to an adult

actively attempting to involve the child in a task" (p. 525).

24

Other reports of elevated peripheral blood flow (Cohen & Johnson,
1977) and heart rate (Kootz & Cohen, 1981) in autistic
individuals provide further evidence of abnormal autonomic
responsivity.

The brainstem auditory evoked responses (BAER) seem to be
the most direct measure of brainstem funtioning, yet results from
BAER studies on autistic children are not in agreement.
Rosenblum, Arick, Krug, Stubbs, Young, & Pelson (1980) reported
significantly prolonged Brainstem transmission time (BSTT) in
autistics, yet Gillberg, Rosenhall, & Johansson (1983) did not
find consistent group differences between autistics and controls.
However, they did identify a subgroup of the autistic individuals
with prolonged BSTT.

Vestibular reflexes also provide a measure of brainstem
function, and a number of vestibular studies in autistics have
been reported. Ornitz, Brown, Mason, and Putnam (1974) found
significantly decreased duration of nystagmus and total number of
nystagmic beats in the autistic as compared to normal children in
conditions in which the children had minimal light input and eye
fixation, and with light input and no eye fixation. Ornitz and
Ritvo (1976) suggested that since autistic children show
pronounced peculiarities of behavior (e.g. staring both at fixed
and spinning objects) this could reflect disturbances in visual-

vestibular interactions. Ornitz, Atwell, Kaplan, and Weatlake

25

(1985) found that the time constants of decay of the nystagmus
response were prolonged in autistic children compared to those of
age-matched normal children and a group of normal young infants.
The neurophysiologic studies reviewed in the previous
paragraphs provide some evidence for distortion at the cortical
and subcortical level of functioning of autistic children.
Future studies should further examine these hypotheses in order
to provide more conclusive evidence of the neurophysiologic

factors involved in the etiology of autism.

(d) Neuropathological Examinations

 

Disturbances in neurological functions are consistently
found in children with autism. Researchers have suggested
central nervous system dysfunction in infantile autism, yet
conflicting results have been produced from post-mortem
examinations and in vivo brain imaging studies.

Williams, Hauser, Purpura, DeLong, and Swisher (1980)
examined four autistic subjects who died at ages 4, 14, 27, and
33. Neuropathological examinations on brain weight and Golgi
Stains were normal. Ritvo, Freeman, Scheibel, and others (1986)
in an autopsy research report found abnormalities in the
cerebellum of four autistic subjects. In fact, they found lower

purkinje cell counts in the cerebella of the autistic subjects.

26

As Courchesne (1989) suggests, partial loss of certain cell types
of brain cells, called purkinje cells, can result in abnormal
neurophysiological activity. This was evidenced in his study
done with autistic subjects. Courchesne (1989) used magnetic
resonance imaging (MRI), a new modality of in vivo brain imaging,
to investigate the neocerebellar vermis (i.e. a narrow structure
in the midline of the left and right hemisphere) of the autistic
group. His findings showed anatomical abnormalities in the
neocerebellar vermis. Specifically, neocerebellar vermal lobules
VI and VII were significanlty diminished in size in the autistic
group, but the paleocerebellar vermal lobules I-V and VIII were
normal in size. The vermal lobules VI and VII have usually been
viewed as principally involved in motor control. Autistic
individuals, however, exhibit impaired social, communication, and
cognitive functioning, and show abnormalities in attention,
sensory modulation, serotonin and dopamine activity (as.
mentioned in previous paragraphs), memory, and complex motivated
behaviors. Because there is no significant deficit in motor
control, per se, there is a strong need for more research in
this area for uncovering the functional significance of vermal
lobules VI and VII, and their relationship to the specific

patterns of behaviors exhibited by autistics.

27
Remarks

Although there is a strong conviction that childhood autism
is a biologically based disorder, researchers have not been able
to find organic causes. The search for specific etiologies seems
to have made little progress in the past 40 years. Since
Kanner's original description of infantile autism, a variety of
neurological conditions have been defined, but not linked to the
various behavioral symptoms that these children exhibit. A few
reasons for this significant lack of knowledge may be:

(a) our limited knowledge of brain physiology and of
functional relationships between brain and behavior;

(b) the heterogeneity of autistic children who exhibit
behaviors in a wide range of frequency, intensity, and severity;

(c) the need to control a variety of factors (i.e. age, diet,
and other) in an already small group of children;

(d) the need to find autistic children who are high
functioning to allow for research to be free of the influence of
mental retardation; and

(e) the difficulty in connecting the various neurobiological
results from the various studies in all the different fields of

investigation.

THE BEHAVIORAL PROFILE quéfi AUTISTIC CHILD

 

 

Wing and Wing (1965) have offered a brief but systematic
description of the behavioral abnormalities of autistic children.-
These are classified and listed under various headings in order
to clarify the relationship between the basic disabilities and
the social difficulties to which they lead. The same headings
will be used in the following description of the behavioral
profile of an autistic child. Many observations that this author
made while working at a school for autistic children will be
added to the observations and remarks of Wing and Wing (1965).
One should always keep in mind that no child ever has all of

these disabilities at any age.

(a) Disorders gf_the Special Senses.

Vision: Autistic children have an inability to recognize
things seen. Their ability to separate figure from ground tends
to develop very slowly. For example, a child may not recognize
his/her own house from a distance. They use mostly peripheral
vision , which can be considered as their main characteristic.
Many times they look at people or objects as if they are
invisible, looking past them but through them. Various times

they cover their eyes with their hands in order to avoid

28

29

something visual, and they avoid direct eye-contact with other
people. Although they tend to ignore strong lights, they like to
look at shiny surfaces, certain colors, and the reflections of
light. There are other visual disorders that autistic children
might have, such as difficulty in seeing moving things (i.e.
airplanes).

Hearing: There is an apparent non-reaction to noise often
seen in autistic children. An autistic child may not react to a
loud noise behind him/her, but might be fascinated with whispers
in a room. They have special interest in certain sounds, and
music is particularly enjoyed. A usual reaction to sounds they
want to avoid is to cover their ears with their hands.

Other senses: Autistic children like to explore their
environment through touch, smell, and taste. They often prefer
soft objects, and they identify new objects in peculiar ways
(i.e., by licking). They are not sensitive to temperature
changes, so they often are indifferent to cold or hot objects,
and they don't seem to feel pain. They lack the ability to
localize a sensation. They like unusual tastes and smells, not

necessarily pleasant ones.

(b) Disorders of speech.
Communication through speech presents great difficulties for

autistic children. Speech may not develop at all, or may begin

30

and then be lost. If any speech develops at all, various
abnormal characteristics are present: echolalia, frequent
repetition of phrases, inability to answer questions due to
echolalia, mix-ups over words with two meanings, use of fragments
of speech to convey meanings, use of words that are not
understood by the child, incorrect word order, use of second or
third person when talking about self, no use of abstract or
subtle meanings, marked difficulty in understanding speech,
frequent use of a 'special voice' different from the normal
voice, and use of speech in an arrhythmic and monotone voice.

Autistic children are quite sensitive to the way people
address them. Oftentimes they avoid someone who is talking to
them in a loud manner, whereas other times they are able to
follow a low tone conversation, even when no one is talking to
them. Sometimes it is easier for them to follow a story or a
conversation that is recorded instead of live. Because they have
a strong interest in music and rhythm, they frequently pay close

attention to the words of songs.

(c) Motor Behavior.

 

One main feature that characterizes autistic behavior is
rocking behavior. Sitting or standing, they like to move their
body rhythmically either left to right, or back to front. Some

autistic children are characterized by clumsiness, while others

31

are very graceful. They often exhibit special movements, such as
finger flicking, or hand flapping. In some, their walking manner
presents a peculiar appearance. Some walk on their toes, others
walk with no synchrony, and some walk with a slight bend forward.
They are often characterized by hyperactivity, and they often
exhibit secondary self—stimulatory behaviors, such as head
banging and rocking. Usually they lean on a surface and hit
their head repeatedly, which frequently results in some injury,
yet the autistic child does not seem to be in pain. They find
great pleasure in certain movements, such as swinging and
spinning. Although some of their movements are stereotypical and
done in a repetitive manner, they are not the same for all

autistic children, and they change as the child grows older.

(d) Odd Behaviors, Including Resistance to Change.

 

 

Objects seem to be of great importance for autistic
children, as they like collections of specific objects, and they
are in great distress if an object is lost or misplaced. They
usually have one particular object that they hold and carry, and
if someone tries to take it away, they react with great
resistance. They make lines and patterns with all sorts of
objects, regardless of their proper use. The autistic child does
not play as normal children do, but exhibits odd routines of

behavior instead of play, and does not seem particularly

32

interested in joining in games with other children. Once a
routine is established, the autistic child has great difficulty
in changing and following an altered routine. He/she also

resists learning new things and establishing new routines.

(e) Abnormalities 2£_Mood.

 

The autistic child acts in a remote, aloof, and distant
manner. He/she looks cold and moodless when others show their
love, may lack outward signs of warmth, and might not be
'cuddly'. Often outbursts of rage and anger are present due to
frustration or even for no apparent reason. When frustrated, the
autistic child bursts into tears, stamping, kicking, and
yelling. Occasionally, he/she may start laughing for no apparent
reason. The autistic child can not share the feelings of other
people. When presented with real danger, the child might not
show fear at all, but might exhibit fear for harmless things,

e.g., taking a bath.

(f) Other Agnosias.
The autistic child often has difficulty in achieving or

reflecting knowledge in the following areas:
1. Failure to distinguish left from right
2. Difficulty in wrapping objects in paper
3. Little use of gesturing

4. Writing letters in reverse

33

5. Delayed and inefficient drawing

6. Peculiarities in dress habits, e.g. putting clothes on back
to front, reacting with anxiety if part of their clothing, such
as a button, is missing, or reacting to a new piece of clothing

7. Peculiarities in eating habits, e.g., either eating extremely
fast or having great difficulties in eating, wanting only creamy
foods.

8. Watching oneself with great curiosity in a mirror, or in
contrast, showing discomfort or avoidance with one's own

reflection.

(g) Uneven Development.

 

Some of the above listed disabilities occur in every
autistic child, but each has a particular pattern of abnormal
development and his/her own set of handicaps. Autistic children
present peculiarities in their development. They do not follow.
the slow and steady developmental process of the retarded child.
Sometimes they make leaps in their development, and other times
they take steps backwards. One must not forget that each child
is an individual and might exhibit all or just some of the above

characteristics, in varying degrees of severity.

OVERSELECTIVITY 92 SENSORY STIMULI‘1§_AUTISM

 

 

Experimenters and theorists working from a variety of
frameworks have considered the role of attentional disturbances
in the lack of responsivity to environmental stimuli of autistic
children. An even more common manifestation of these
disturbances in autistic children involves a lack of consistency
with which the children respond to a majority of stimuli. In
particular, a growing body of research has delineated a learning
characteristic known as stimulus overselectivity or overselective
responding in autistic children. Stimulus overselectivity refers
to a tendency of autistic children to respond to extremely
restricted portions of complex stimuli (Dunlap, Koegel, & Burke,
1981). The research on overselective responding is distinguished
from other similar work in that it has attempted to explicitly
and empirically define the observable nature of the phenomenon.

Lovaas, Schreibman, Koegel, and Rehm (1971) speculated that
the primary cognitive deficit in autism might be stimulus
overselectivity, a tendency of autistic children to selectively
respond to only one component of a complex cue. To validate
their hypothesis, Lovaas and his colleagues conducted a series of

six experiments to observe and delineate the exact nature of this

34

35

deficit. They found that the autistics responded primarily to
only one of the cues of a complex stimulus, involving
simultaneous presentation of auditory, visual, and tactile cues.
The control group (normal children) responded uniformly to all
three cues while the other control group (retarded children)
functioned at a level in between these two extremes. Based on
these results, Lovaas and Schreibman (1971) decided to
investigate the same problem using only two stimuli, auditory and
visual. They used two groups of children, autistic and normal,
who were rewarded for responding to a complex stimulus: the
simultaneous presentation of a 150W red floodlight and white
noise. Their findings included: (a) the autistic children showed
stimulus overselectivity as demonstrated by their differential
response to one of the two stimulus components, whereas the
normal children responded equally to both cues; (b) there was no
evidence that any one sense modality is impaired or preferred in
autistic children. In 1973, Koegel and Wilhelm reported that of
the 15 autistic children they studied, 12 were overselective,
while three of the 15 normal children showed similar
overselectivity.

The first study to seriously question Lovaas's original
hypothesis was by Kovattana and Kraemer (1974). They described a

study of visual discrimination learning that compared 20 autistic

36

children with 20 Down's syndrome and 20 normal controls. The
subjects were all boys. Their findings showed that the two
verbal autistic children performed as well as the normal
children. Kovattana and Kraemer (1974) questioned whether
overselective attention may be due to a language deficit, rather
than to the syndrome of autism. Wilhelm and Lovaas (1976)
provided further evidence on the matter. They compared samples
of moderately retarded, severely retarded, and normal children on
a visual overselectivity task. They found that both retarded
samples demonstrated significantly more overselectivity than did
the normal control sample, thus demonstrating that stimulus
overselectivity is not limited to autism.

Schover and Newsom (1976) questioned whether overselectivity
is just one of many developmental lags autistic children display,
rather than a unique feature of early childhood autism. They
matched a group of autistic children with a group of normal
children by mental age, and they gave both samples a visual
overselectivity task. They found no significant differences
between autistic and mental-age—matched normal children on the
overselective-attention task. Thus, they concluded that
overselectivity is probably one deve10pmental delay among many,
and in no way central to understanding autism. Further
experimentation attempted to clarify the nature of

overselectivity in autistic children. In 1977, Koegel and

37

Schreibman suggested that autistic children experience
extraordinary difficulty when responding to multiple-cue inputs.
These authors first trained the children to respond to individual
component cues. In the next phase they altered the contigency so
that responses to individual presentations were no longer
reinforced, but responses to both cues presented simultaneously
were reinforced. The results suggested that possibly autistic
children's attentional deficiencies might create problems in
distinguishing the complex stimulus from its components.

Bickel, Stella, and Etzel (1984) examined stimulus
overselectivity in preschool autistic children. After training
27 subjects to respond to only two-component auditory stimuli,
the investigators tested the subjects to determine which stimulus
elements of the complexes (i.e., multi-component auditory
stimuli) exerted control; in other words, which stimulus
controlled their responding. Their analysis of the results
indicated that overselective responding may be described as the
ordering of stimulus elements in a stimulus control hierarchy
rather than limited stimulus control.

Burke and Cerniglia (1990), in an attempt to extend the
previous studies, conducted a study to address questions such as:
(a) Would autistic children's correct responses to stimuli
decrease as the number of stimulus components is increased from

one to four?

38

(b) Would teaching autistic children to respond to single-
component stimuli influence their responses to multicomponent
stimuli?

Findings of this study showed that as the number of stimuli
increased from one to four, the children exhibited difficulties
in responding. In summary, data collected in the above study
suggest that autistic children's lack of responsivity may occur
in part as a result of a problem in responding to complex
multicomponent stimuli. Burke and Cerniglia (1990), at the end
of their study, suggest that "...Instead of assuming that
autistic children's limitations in responding to environmental
stimuli is a generalized characteristic, it may prove more
beneficial to determine under what circumstances their
limitations are more pronounced and how these limitations can be
remediated" (p.250). This should be the direction of future

research on stimulus overselectivity of autistic children.

AUDITORY PERCEPTION

 

The term auditory perception refers to the process of
receiving sound and interpreting the signal by relating it to
previously stored experiences (Reagan, 1973). The sound is
received by the auditory system, and it is interpreted in the
brain. The auditory system consists of the outer ear, the middle
ear, and the inner ear. In simple terms, the auditory system
works as follows: The outer ear, which is the visible portion of
the ear, serves as the path entrance for aerial waves. Beyond
the eardrum is the middle ear cavity, an irregularly shaped,
air-filled space in the temporal bone. The function of the
middle ear is the efficient transmission of sound energy. The
inner ear can be described as a bony labyrinth which consists of
three divisions: (a) the vestibule, (b) the semicircular canals,
and (c) the cochlea. The first two divisions are concerned with
bodily equilibrium, and the cochlea serves for hearing (Warren,
1982). As the aerial waves are converted into mechanical
vibrations in the middle ear and brought inward to the inner ear,
distortion of the auditory receptor cells evoke neural impulses.
These hair cells are located on a membrane within the cochlea.

The function of the hair cells is to convert the physical

39

40

stimulus of the aerial waves to electrochemical changes in the
neurons comprising the membrane. These electrochemical signals
are sent to multi-layered areas of the brain in the central
nervous system (Campbell, 1983). In other words, sound first
travels as aerial waves, then as mechanical vibrations, through
the ear to the receptor cells where it is translated into
patterns of nerve impulses, which are sent to the brain centers
and finally give rise to auditory perception.

Auditory perception is viewed as a primary factor in speech
perception, language and cognitive development, and emotional
growth of a child. There are many children that, due to an
auditory perceptual dysfunction, are found to perform below the
normal expectancy level in various areas (Reagan, 1973). All
aspects of auditory perception, particularly discrimination and
sequencing abilities, are fundamental to speech, reading, and the.
development of language. Consequently, impairment in auditory
perceptual functioning constitutes in the young child a learning
problem that could take the form of a learning disorder.
Pediatric audiology has developed a number of tools to test the
hearing sensitivity of young children (Cans & Flexer, 1983). The
first step in an assessment procedure is often the initial
identification of a problem through a screening test. The most

common screening instrument is the sweep test, which uses a

41

portable audiometer to present tones at about 20 to 25 dB
(Kneedler, 1984). The next step in evaluating more accurately
the extent and nature of the hearing loss can follow one of two
general directions: pure-tone audiometry and speech audiometry.
Pure-tone audiometry attempts to determine at what precise levels
of frequency and loudness an individual can detect sound. Pure-
tone testing is done with tones of various intensities (loudness)
and frequencies (pitch). Speech audiometry, in contrast to pure-
tone testing, measures the lowest levels of decibels at which a
person can detect speech and the level at which he or she can
understand speech (Kneedler, 1984). Some tests which are
described by Reagen (1973) used in assessing auditory perceptual
abilities are: a Screening Deep Test of Articulation,
particularly useful in testing children of Kindergarten age; the
Wepman Auditory Discrimination Test, designed to measure a
child's ability to discriminate among phonemic differences; the
Goldman-Fristoe-Woodcock Tests of Auditory Discrimination,
purported to assess speech sound discriminatory ability in daily
living; the Peabody Picture Vocabulary Test, which measures the
vocabulary gained through listening; the Assessment of Children's
language Comprehension, which examines the ability to understand
language and does not require verbalization; and the Northwestern
Syntax Screening Test, that measures a child's general use of

grammar. All these tests are being used extensively by

42

audiologists. However, they are of limited use when one tests
infants or mentally or physically handicapped children whose
young age or handicaps interfere with the assessment of their
hearing? The responses of infants and many handicapped children_
are too limited for the usual requirement in the testing of
hearing, that of speaking or signaling in some way when they hear
a sound. When testing these children, audiologists look for a
number of orienting responses or reflexive behaviors when a sound
occurs as an indication that the child is hearing. In such cases
the audiologist may get some index of sensitivity by using sound

field behavior observation audiometry. As Fulton and Lloyd (1975)

explain,

"...Behavior observation audiometry (BOA) refers to
the audiologist's attempt to elicit observable
responses to sound. The responses may be
respondents (or reflexive) and/or operants (or
'voluntary'), but they must be temporally and
reliably related to the auditory stimulus. The

auditory stimulus in BOA is usually speech or complex

sounds produced by noisemakers." (p. 12)

One problem that arises when using any of the orienting
responses as measures is that the child will not continue the
behaviors indefinitely. One way of increasing the number of

responses is to use visual reinforcements. Some tests developed

43

by audiologists based on this principle are: Puppet in Window
Illuminated, Visual Reinforcement Audiometry, and Peep Show (Cans
& Flexer, 1983).

Hearing assessment of infants and those unable to make
voluntary responses can also be done by using physiological
measures that detect changes in skin resistance and brain wave
activity. Impedance audiometry (Robertson, Peterson, & Lamb,
1968) and auditory brainstem response audiometry (Hecox &
Galambos, 1974) have proven to be important in the hearing
evaluation of young children. The field of evoked response
audiometry is rapidly expanding and a variety of detection
techniques are being developed (Reneau & Hnatiow, 1975).
Although these methods are more difficult to administer and
interpret, they can be very helpful in determining hearing
disabilities in some cases.

Because autistic children frequently do not show response to
sound in the usual manner, hearing impairment can be overlooked
on the belief that this lack of response is part of their autism.
An often used initial assessment procedure is the traditional
office evaluation of the spoken voice. This requires close
observation for response to a variety of sounds in the room or
outside the building and it gives the examiner a rough estimation
of hearing (Lacamera & Lacamera, 1987). More specific

audiological testing may be required for accurate determination

44

of hearing capabilities, and it may need to be repeated a number
of times. If results still are uncertain, physiological testing
can be attempted, such as testing for brainstem-evoked response

or auditory-evoked potential.

AUDITORY EVOKED RESPONSES 2£_AUTISTIC CHILDREN

 

 

The word "autism" emphasizes the severely withdrawn,
detached behavior that autistic children exhibit. Their
unresponsiveness to. external stimulation is one of the main
characteristic features of autistic children. In many cases,
this unresponsiveness is so severe that the child is suspected by
his parents of being blind or deaf. As Rimland (1964) described,
the suspicion of deafness is very often the earliest
interpretation placed on the inaccessibility of the autistic
child by his parents. Therefore, systematic measurements and
neurophysiologic studies have attempted to investigate the nature
of their auditory selectivity, and to assess the consistency of
the autistic child's responding to auditory stimulation.

Koegel and Schreibman (1976) conducted an experiment on a
child who was at various times reported to be deaf, hard of
hearing, or functionally deaf, and at other times was reported to
have normal hearing. In this experiment, Koegel and Schreibman
(1976) measured his responses to systematically presented
auditory stimuli in order to determine if there was any pattern
in his responding. The auditory stimuli used were (a) white

noise, consisting of most of the frequencies within the human

45

46

range of hearing, and (b) the sound of a candy machine delivering
candy. The results of this experiment showed the following:

(a) he had a definite pattern in his responding to auditory
stimuli,

(b) his threshold for responding was consistent within any
given session, yet his threshold varied from session to session,
and,

(c) his' threshold to the sound of the candy feeder was

considerably lower than his threshold for the white noise.
The authors of this study, while discussing their results,
suggested that the lack of speech development of autistic
children might be a function of a problem in responding to
auditory stimuli. They proposed that autistic children should be
given thorough audiological examinations.

In 1981, Nober and Simmons conducted a study to investigate
the possibility that autistic adolescents may avoid speech
communication with the world around them by perceptually
suppressing auditory speech stimuli. The auditory stimulus used
was the subjects' own speech under three conditions: (a) with
speech in a delayed auditory feedback mode, (b) with a white
noise masking speech mode, and (c) with speech in a normal, quiet
listening mode. The speaking responses of five autistic

adolescents were compared with six normal controls on speech time

47

duration and sound level. Results showed that delayed auditory
feedback increased the speech sound pressure level (loudness) and
increased speech time duration for both groups.

Gans and Flexer (1983) reported their attempt to define
auditory response behavior in 31 severely and profoundly multiply
handicapped children. They used behavioral observation
audiometry, where five types of auditory stimuli were presented
and one observer, seated in front of the child, scored response
behaviors. They found that out of 9 possible response types,
searching, quieting, and localization were the most predominant
responses for all five stimuli. Additionally, the authors found
that the higher-functioning children responded much differently
to the sounds than did the lower-functioning children.

Apart from observational studies on the auditory responses
of autistic children, neurophysiologic research has suggested.
that major abnormalities in their psychophysiological functioning
result in their auditory attentional deficits.

In 1968, Ornitz, Ritvo, Panman, Lee, Carr, and Walter
reported that autistic children below the age of five years did
not show a decrease of auditory evoked responses (AER) during REM
sleep as did a comparably age-matched group of normal children.
Tanguay (1976) found significantly larger auditory evoked
responses over the right hemisphere as compared to the left

hemisphere in normal children but no consistent hemispheric

48

differences for AER in autistic children. He suggested that this
finding might indicate a definite disturbance in the development
of functional lateralization in the autistic child. Student and
Sohmer (1978) compared a group of 10 autistic children with 12
normal children. They found that the experimental group showed
longer auditory nerve transmission latency and longer brainstem
transmission time in their auditory evoked responses. In 1984,
Stevens and Gruzelier compared the electrodermal activity
elicited by auditory stimuli of 20 autistic subjects to their
matched retarded and normal controls. Their results showed that
the autistic group was virtually undifferentiated in isolated
features of electrodermal activity from the other control groups.
The only feature that reliably distinguished autistic children
from the controls were longer response latencies and longer
response rise times of their right compared to their left hand to
the 70 dB tones presented.

Van Engeland (1984) studied the spontaneous electrodermal
activity and the electrodermal orienting responses to auditory
stimuli of moderate intensity in a group of 35 autistic children
and in three control groups. He found that autistic children
were significantly more often nonresponsive to the first trial
and that when they responded, they showed electrodermal orienting
responses characterized by large amplitudes and fast recovery.

Van Engeland reached a hypothesis that "... when highly

49

physiological aroused, autistic children are abnormally open to
environmental stimuli and exposed to a stressing condition of
information overload" (p.276). He concluded that
nonresponsiveness of the autistic child can be explained as a.
defensive strategy to minimize the overload stress.

A different study by Courchesne, Lincoln, Kilman, and
Galambos (1985) explored the possibility of a modality difference
in information processing in ten nonretarded autistic
adolescents. They compared visual and auditory event-related
brain potentials (ERPs) to stimuli requiring simple
classification decisions and to unexpected, novel information.
Their results showed that the autistic group did not differ
significantly from the control group in their accuracy in
classifying targets. The authors discussed the possibility that
although visual ERP differences do not seem to reflect
maturational delay, the auditory ones may.

Martineau, Garreay, Roux, and LeLord (1987) recorded the
auditory evoked responses (AERs) of 16 autistic children, ages 2
- 10 years, and age-matched normal and retarded controls.
Several differences between the groups were found concerning the
frequency and the amplitudes of present AERs. The authors

suggest that the weak response amplitudes observed in autistic

children can be related to abnormalities in selective attention .

and responsiveness.

50

In 1989, Courchesne, Lincoln, Yeung-Courchesne, Elmasian,
and Grillon recorded two neurophysiological components of the
event-related brain potential, Nc and P3b, in auditory and visual
target detection tasks in groups of (a) nonretarded autistic,
(b) receptive developmental language disordered, and (c) normal
subjects. The nonretarded autistic subjects in this study
performed the auditory target detection tasks as accurately and
rapidly as normals. However, they had abnormally small auditory
P3b responses, which is characteristic of autistic children.
Since small auditory P3b responses are typically associated with
poorer or slower task performance, the authors suggested that the
autistic children may be using some unusual or alternate
physiological processes in order to perform to auditory tasks as
well as the normal subjects.

This possibility, as well as that of limited attentional
resources, constitutes the topic of current event-related brain

potential research in autism.

MUSIC THERAPY AND AUTISM

 

One of the most frequent observations that educators,
clinicians, and researchers make about autistic children is that
these children are unusually responsive to music. An increasing
body of evidence is available on attempts to investigate the
special interest and/or ability of autistic children in relation
to music. Even though many of the reports are in the anecdotal
form of case studies, the description of isolated examples of
autistic children with musical abilities can assist in
comprehending the relation between autism and music, as well as
understanding this disorder.

In 1952, Mahler attempted to analyze the meaning of music to
autistic children in terms of their psychological processes. He
believed that the autistic child can break through the ego
boundaries and reach out of his or her world with the help of the
music. A year later, Sherwin (1953) reported a study of the
musical responses of three autistic children. The common
characteristics of these children were their profound interest in
singing and listening to various selections of music, their
selectivity and preference for familiar and rhythmic pieces, and

their ability to remember and identify known melodies. Sherwin

51

52

offers three possible explanations for the reasons behind this
intriguing behavior: (a) the child is drawn by sound and
vibrations instinctively, (b) the child's preference for objects
rather than people favors his/her preoccupation with music, and
(c) the child may use music as a more appealing way of
communication because it is less specific than speech.

Various authors have observed that autistic children
frequently show strong positive responses to particular types of
musical stimuli. Pronovost (1961) reported a two-year study of
12 autistic children. During his observations, he found that all
autistic children but one showed a greater interest toward
musical sounds than environmental sounds. In 1964, Rimland
stated that musical abilities and/or interests are almost
universal in autistic children. Euper (1968) referred to this
interest or ability in music as an outstanding characteristic and
suggested the need for further research. Cain (1969) reported
that severely psychotic children respond positively to music, it
being one of their special isolated abilities. Viscott (1970)
reported a case study of an autistic child with musical
abilities, and referred to the child as a "musical idiot savant".
In a follow-up study of 11 autistic children, Kanner (1971)
mentioned great musical abilities noted in six of them. In 1972,
Frith reported an experiment on color and tone sequence

production in autistic children, and observed that they produced

53

far better tone sequences than color sequences. In 1974,
O'Connel described his study of an eight-year—old autistic boy
with exceptional musical ability and absolute pitch.

In view of the apparent relation between autism and music,
many authors have attempted to establish effective treatment
methods using music as their primary therapeutic tool and have
reported positive results in the autistic condition of the
subjects.

In 1964, Goldstein reported a treatment plan for an autistic
girl based on singing, dancing, and painting. The author
concluded that after a six-month period, noticeable progress was
made in motor skills, communication abilities, and social
awareness. Stevens and Clark (1969) conducted a study that
supported the use of music as an effective treatment for
autistic children. They suggested that music can be beneficial
in enhancing creativity, initiative, and social behavior skills.
Another study on the implementation of a music therapy treatment
program was done by Mahlberg (1973). A seven-year-old autistic
boy was provided with a treatment program designed to increase
attention span and enhance communication skills. Mahlberg
concluded that observable progress was made on all goals. A
similar study, by Saperston (1973) reported noticeable progress
in communication skills of an eight-year-old profoundly retarded

boy exhibiting autistic features, after attending a music therapy

54

program. In 1974, Hollander and Juhrs developed a treatment
method for autistic children based on the Orff-Schulwerk. The
main focus of the Orff treatment program, as described by the
authors, was language development. Schmidt, Franklin, and
Edwards (1976) studied the use of music in a teaching program of
three autistic children on individual and social behavior skills.
Alvin (1978) suggested that in the early stages of therapy, music
therapy treatment programs should be accepting and in a free
form, since music is usually appreciated by autistic children at
a concrete level. In 1984, Thaut developed a general music
therapy treatment model for autistic children, directed to four
prospective treatment areas: development of language,
socioemotional, cognitive, and perceptual motor skills. The
author attempted to tie aspects of the diagnostic characteristics
of the autistic children to appropriate music therapy techniques.
in a systematic fashion.

Various researchers have been trying to find the relation
between autism and music, and many experiments have been
conducted in order to begin to comprehend the nature of this
relationship. In 1978, Blackstock conducted two experiments
investigating listening preferences of autistic and normal
children, when given a choice between verbal and musical stimuli.
Results showed that autistic children preferred musical stimuli,

whereas normal children did not establish a preference. It was

55

also noted that autistic children attended to both stimuli
predominantly through the left ear, whereas normal children used
the left ear to listen to music and the right ear to attend to
spoken material. Another experimental study, done by Applebaum,
Egel, Koegel, and Imhoff (1979) tested autistic children and
normal children in their abilities to imitate individual tones
and series of tones. The results showed that autistic children
overall performed as well as or better than the age-matched
controls.

Campbell (1980) suggested that autistic children attend to
an auditory stimulus more often than a visual stimulus,
particularly when the auditory stimulus is musical. Thaut (1980)
found that in tone sequence production, autistic children scored
significantly better than the mentally retarded control group in
the areas of rhythm, originality, and total performance. In
1982, Soraci, Deckner, McDaniel, and Blanton found that when
music of medium range rhythm was played, the self-stimulatory
behaviors of autistic children were increased, rather than during
slow- or fast-rhythm music. Frith and Snowling (1983) observed
that hyperlexic autistic children perform well in phonetically
accurate word decoding, as in reading for sound instead of
meaning. Nelson, Anderson, and Gonzales (1984) suggested ways to
synthesize music activities in accordance with the

characteristics of children with pervasive developmental

56

disorders. Thaut (1987), in a study similar to Campbell's (1980)
found that autistic children attended longer to the musical
rather than the visual stimulus. Stamatis (1987) suggested that
music should be used in enhancing speech reality orientation and'
behavior management. Frith and Baron-Cohen (1987) refer to the
musical skill of autistic children as an "islet of ability", and
they state that this skill and especially their ability to
imitate tone sequences and sounds might form the basis for their
ability to very precisely initiate parts of speech (echolalia).

A variety of therapeutic methods have been used in treating
autistic children. One common feature though, is their
responsiveness to music. The causes are still unknown for this
intriguing relationship between autism and music, yet one cannot
overlook the power of music. Music is an experience that can
affect a person's mind, body, and emotions. It may bring change
in the behavior of the listener or the performer. Music can be
enjoyed at a concrete level without an understanding of abstract
processes. Music can simply be a pleasant or an unpleasant
sensation. The inclination of the autistic child to become
enamored of rhythm, order, and repetition, seems to indicate some

likely directions for treatment with the use of music.

CHAPTER III

METHODOLOGY

 

A group of eight school-age autistic children were
tested for their ability to respond overtly to various auditory

stimuli: environmental, vocal, and musical sounds.

SUBJECTS: This study consisted of eight school-age autistic
children. All of the subjects were enrolled in the Center for
Autism in Flint, Michigan. The group consisted of five boys and
three girls, ranging in age from 7 to 14 years, with a mean age
of 11 years. All children were diagnosed as autistic by agencies
not associated with the experiment, and for the purpose of
inclusion in this study, satisfied the diagnostic criteria
established in DSM—III-R (American Psychiatric Association, 1987
rev.). They all exhibited autistic behaviors, such as a lack of
responsiveness to other people, gross impairment in communication
skills, and bizarre responses to various aspects of the
environment. The speech development of all but one had been
delayed. At the time of testing, five were still nonverbal,
making occasional noises, but with no communicative language.
There were two who had minimal speech in the form of words, and
only one of the younger boys had acquired fairly good speech.

The IQ scores of this group ranged from 19 to 89 on the Leiter

57

58

International Performance Scale. An estimate of their
developmental age was given by their individual teachers. Their
D.A. ranged from 1 to 5 years, with a mean developmental age of

2.8 years.

Information about their hearing abilities was collected from
the children's files from previous auditory screening tests, and

none of the children were hearing impaired.

PILOT TESTING: The procedures were pilot tested first with

 

three subjects who did not take part in the actual experiment.
One subject was an autistic child, selected from the clients seen
at the Music Therapy Clinic of the Music Therapy Department at
Michigan State University. The other two subjects were severely
mentally retarded children selected from the students at the
Center for Autism in Flint, Michigan. All test trials were
videotaped. These tapes were used for the training of the three
observers who viewed and scored the tapes of the actual
experiment. The three observers viewed and scored the test trial
tapes a number of times until they reached a 952 agreement level
as evaluated by Kendall's Coefficient of Concordance. The
actual results of their last trial scores were W - .9574 and
W corrected for ties - .9681. As soon as this agreement level
was reached, the observers were judged as sufficiently reliable

to proceed with the scoring of the experimental tapes.

59

PROCEDURE: The subjects were tested individually. They were
tested in a room which was located on the first floor of the
Center for Autism in Flint, mostly used as a store room for
physical education equipment. This room was chosen because it
was a room whith which the children were not familiar and yet
was located on their school grounds.

Each child was assigned a number (from 1 to 8) and all
records and observation forms had that number as the
identification of each child. Only the principal of the school
knew which number corresponded to each child, so that the
primary investigator was not able to match records with names
or faces.

Each child was seated in a chair in the middle of the
room, with the experimenter seated in another chair across from
and facing the child. Due to anticipated behavioral difficulties
of three children, their teachers accompanied them and sat across
from them during the experiment.

The stimuli were presented through a stereo system (the
receiver was a KENWOOD KR 4070, and the tape deck was a SANKYO
SKD 1000) with two speakers (ADVENT 3) placed on top of two
tables, one on the right and one on the left side of the place
where the subject was seated. The speakers were placed at
approximately three feet above the floor, about the height of

the ears of the child. A Sony CCD-V3 videocamera was stationed at

60

an angle to be capturing all behavioral responses of the
subject, facing the child from about five feet high. The stereo
system was set up well in advance and was activated by the
experimenter prior to sitting in the chair.

The test consisted of 12 different auditory stimuli, each
one falling under one of the three larger categories of
environmental, vocal, and musical sounds. All stimuli were
presented on a monophonic basis, in a randomized alternating
order, half appearing from the right speaker of the stereo
system, and the other half appearing from the left speaker. The
environmental sounds that were presented were: a doorbell,
telephone ring, baby crying, and plates falling down. The
musical sounds were short excerpts from the "Carnival of the
Animals" by Saint-Saens, "Chim chim cheree" from Mary Poppins,
"I will wait for you" by Vikki Carr, and "Sunfin' USA" by the
Beach Boys. These excerpts cover a wide range of music styles,
tempi, rhythms, and media performed. In addition to the above
auditory stimuli, four vocal/speech excerpts were included,
with a male and a female voice speaking various phrases (see
Appendix C). All auditory stimuli ranged between 65 to 75
decibels on the A weighting scale. The experimenter used a
portable REALISTIC decibel meter and before each testing
reconfirmed that the intensity of the auditory stimuli ranged

from 65 to 75 dBA.

61

It was considered important early in the test to show the
subjects all the different stimulus conditions which were
presented. As a result, the experimenter intentionally chose not
to randomize the sounds presented, but to form a pseudorandom
scale where all stimuli were presented in a prearranged
formation (see Appendix C). However, the auditory stimuli did
appear in a random order from either the left or the right
speaker, having previously been determined by a flip of a coin.
There was a brief training procedure in which the child was told
explicitly what was expected of him/her during the actual
testing. Once the testing had begun the child was given minimal
additional verbal instruction.

All trials were videotaped in the order that the testing
occurred. The children came in a different order for each
testing session to help assure that any bias from the observers
might be minimized. Each child was tested three times on an
individual basis. Due to unforeseen illnesses and absences of
the children from the school, two subjects were tested only twice
while the other six participated in all three trials. The
testing lasted about 8 minutes from the time the child entered
the room until he/she left the room after the testing was over.
The actual response time which was recorded was about 6.5
minutes, during which all auditory stimuli were presented.

Verbal instructions were kept to a minimum.

62

RECORDING: A behavioral observation test was used to gather
data. The data collected was all evoked responses to the
auditory stimuli presented during the testing sessions. The
observation scale which was used was constructed by Buehler and
Richmond (1963) and was revised by the experimenter in order to
suit the needs of this study as best as possible.

Nine possible behavioral responses were listed on the
rating sheet in order to delimit the large array of possible
behaviors to record and thereby reduce the anxiety of and
increase the efficiency of the scorers (see Appendix B). The
behavioral observation scoring sheet consisted of three main
categories: biochemical responses, motor development responses,
and speech. Each one had several subcategories. The biochemical
responses referred to responses of affect (i.e. giggling,
laughing) and body contact responses (i.e. extending arm to
touch experimenter). The motor development responses referred to
responses such as changes in posture (i.e., postural shifts
within the limitations of the chair), movement (i.e. any limb
movement within the limitations of the chair), eye-movement (i.e.
any eye contact with the sources of the auditory stimuli),
gesture (i.e. any gesture made in reaction to the stimulus
presented), and locomotion (i.e. any movement away from the
chair). The third category of behavioral observations was the

speech responses, which included any sound responses (i.e.

63

vocalizations with no meaning), and verbal responses (i.e. any
utterances or words with meaning) (see Appendix B).

The observers selected a response category when they
believed that the child had emitted a behavioral change elicited
by the sound. Each observation was locked in time units, each
being 10 seconds long and with 3 time units for each auditory
stimulus presented. Each stimulus was 20 seconds long and was
followed by 10 seconds of silence that accounted for any
latency period reactions in part of the child. Each behavioral
change was checked on the rating sheet within the 10 second
period during which it occurred, and within the particular
auditory stimulus presented. The same three observers recorded
responses on all three trials of the eight children. For each
behavioral response, a check mark was given on the observation
sheet. Each response was counted as 1, and no response as 0.
When the data of the three observers were added, the responses
that were marked by all three of them received a measurement
score of 3, which suggested a strong behavioral response. The
responses marked by two of the observers totalled 2, and were
regarded as moderate behavioral responses. The reponses marked
by only one of them received a 1, which suggested a weak
behavioral response. Then, the data were added for all three
trials for each of the eight autistic children. For example, if

all three judges observed a specific behavior (e.g, eye-movement)

64

during the first 10 seconds of a particular auditory stimulus in
all three trials, the measurement score of the child in the eye-
movsnent behavioral category for that particular stimulus would
be 9.

Since two of the autistic children were tested only twice,
the investigator calculated the average measurement per trial by
dividing by two, whereas the total data collected from the

testing of the other six subjects were divided by three.

CHAPTER IV
ANALYSIS OF DATA
BASIS FOR THE STATISTICAL ANALYSIS:

Various reasons justify for use of nonparametric
statistical tests for the analysis of the data. One main reason
was the small sample of autistic children that participated in
the experiment. Another important reason was that the data
gathered was of ordinal measurement level. The measurement scale
used in each of the three trials was 0 - 3 points, depending on
the degree of responsiveness of the subject for each auditory

stimulus presented. Each subject collected:

0 points for no observed behavioral response
1 point for a weak behavioral response
2 points for a moderate behavioral response

3 points for a strong behavioral response.

The degrees of responsiveness of the subjects was
categorized as weak, moderate, or strong, depending on how overt
or obvious was the behavioral response to each of the three
judges. The validity of this measurement scale is justified by
the high level of agreement (95 Z) of the three judges, reached

during the pre-testing trials.

65

66

Once the three trials were added together, the measurement
scores became larger, yet the scale remained the same: the larger
the score, the stronger the response, the lower the score, the
weaker the response.

A third reason that nonparametric statistical tests were
used for the analysis of the data was that the subjects of this
group could not be assumed to represent a normal population

distribution.

RESULTS

General:
Table 1 lists the total number of responses of all subjects
in each of the nine behavioral categories during all trials for

each of the 12 auditory stimuli.

67
Table 1.

Distribution of Response Types Elicited by Each Sound Stimulus

 

 

 

 

Behavioral Responses

 

Stimulus l 2 3 4 5 6 7 8 9 Total
A(m) 6 9 7 138 161 2 26 15 3 367

B(e) 10 16 12 138 148 4 30 40 14 412

C(s) 5 8 8 149 148 4 29 49 17 417
D(m) 8 l3 9 139 137 7 32 29 5 379
B(e) 2 12 14 110 130 1 50 30 8 357

F(s) 6 2 15 132 135 3 44 45 16 398
G(e) 4 9 12 107 105 5 85 30 6 363
B(m) 10 0 10 103 104 13 72 27 7 346
1(8) 4 9 19 102 91 7 86 34 4 356
J(m) 12 0 7 106 98 9 84 22 3 341
K(e) 13 12 9 94 95 1 63 40 0 327

L(s) 11 6 17 91 92 8 75 30 0 330

 

 

‘Ngtg. Response definition: 1-affect, 2-body contact, 3-posture,
4-movement, 5-eye movement, 6-gesture, 7-locomotion, 8-vocal,
9-verbal. Stimulus definition: A-Saint-Saens, B-Doorbell, c-Male
voice, D-Chim-chim-cheree, E-Baby crying, F-Female voice,
G=Plates falling, H-Vikki Carr, I-Male voice, J-Beach Boys,
K-Telephone, LeFemale voice. Stimulus types: (m)-music,

(e)-environment, (s)-speech.

 

68

Movement, eye movement, locomotion, and vocal were the most
predominant responses for all 12 auditory stimuli. Overall,
there were slightly fewer responses towards the end of the
testing, with the lowest total number of responses during the
telephone ringing stimulus. Interestingly, the telephone ringing
stimulus received the highest measurement score in the affect
category and among the highest scores in the body-contact
behavioral category. The stimulus with the highest total
measurement score was the first spoken material stimulus by the
male voice (see Appendix C).

Another interesting observation is the decreasing
measurement scores in the movement and eye-movement categories
and the increasing measurement scores in the locomotion category
as the testing progressed. This observation can be easily seen
in the second graph (figure 2). One can speculate that the
decreasing behaviors of movement and eye-movement might imply the
fatigue of the autistic subjects toward the last part of the
testing session, and the increasing behaviors of locomotion might
be a manifestation of their short attention span. Another
observation one can make is that the total measurement scores
decreased toward the last part of the testing, and the stimuli
that appeared toward the end received the lowest scores of

behavioral responses (see figure 4).

69

Another observation one can make by looking at Table 1, is
that in the sixth behavioral response type, gestures of
explicitly pointing toward the speakers, the largest number of
responses fell under the musical auditory stimuli. The music
stimulus that received the most responses was the song "Chim-
chim—cheree", the only "children's" song on the tape.

The following graphs represent the total measurement scores
of all subjects in the three main behavioral categories: figure 1
outlines the total measurement scores of the two biochemical
behavioral categories, figure 2 outlines the total measurement
scores in the five motor development categories, and figure 3 the
measurement scores in the speech behavioral categories. Figure 4
respesents the total measurement scores in all nine behavioral
categories of all subjects.

In addition, further observations can be made from Table 2,
which lists the average per trial of the total number of
responses of each subject to each one of the 12 auditory stimuli.
Table 3 lists the means of the measurement scores of all subjects

to each of the 12 auditory stimuli.

70
28-

15%

10‘

; ,AQo

- Affect + Body-contaét

 

 

Figure 1, Total Measurement Scores of Biochemical Responses to

Each of the 12 Stimuli in the actual order of Presentation during

testing.

 

D Hovenent + Eye-meant 0 hcmtion A Posture X Gesture

M 2. Total Measurement Scores of Motor Development Responses

to Each of the 12 Stimuli in the actual order of Presentation

during testing.

71

 

 

 

D Uocal + Verbal

Figure 3. Total Measurement Scores of Speech Responses to Each of
the 12 Stimuli in the actual order of Presentation during

testing.

 

 

 

D Total Scores

Figure 4, Total Measurement Scores of all Behavioral Responses to
Each of the 12 Stimuli in the actual order of Presentation during

testing.

72
Table 2.

Distribution g£_Average per Trial Measurement Scores gf Subjects~

 

£2_Each Auditory Stimulus.

 

 

 

 

 

Subjects
* *

Stimulus 1 2 3 4 5 6 7 8 Total
Music

A 18.3 15 18 14.3 18.3 17 17 15.5 133.4

D 16 18.3 16.3 12.3 18.3 17 20.5 22.5 141.2

H 14.3 17.3 20 14 14 17 16.5 12 125.1

J 18 18.6 18.3 14 10.6 11 13 12.5 116
Environ.

B 19 18.3 20.6 10.6 19 18 21 21.5 148

E 15 19 18 12.6 17.6 14 21 16 133.2

C 16.3 17.6 18.6 11.3 18 18 15 15 129.8

K 15.3 19 16.3 14.6 11.6 19 18.5 14 128.3
Speech

C 21 20 21.3 14 14.3 19.6 20.5 24 154.7

F 17.3 20.3 19 13.6 17.3 19 16 22.5 145

I 14.3 17.6 17.3 15.3 11 19.6 21.5 9 125.6

L 18.6 19.3 16.6 10.6 10.6 23.5 15.5 13 127.7

 

 

Note. Stimulus definition: A-Saint-Saens, B-Chimrchim-cheree,
C-Vikki Carr, D-Beach Boys, E-Doorbell, F-Baby crying, G-Plates
falling, H-Telephone, I‘Male voice, J-Female voice, K-Male voice,

*
LnFemale voice. Subjects tested only twice.

Table 3.

Means 2: Measurement Scores 2E

 

Stimulus.

73

all Subjects £2_Each Auditory

 

 

 

Saint-Saens
Chim-chim-cheree
Vikki Carr

Beach Boys
Doorbell

Baby Crying
Plates Breaking
Telephone Rings
lst Male Voice
lst Female Voice
2nd Male Voice

2nd Female Voice

 

y; gg. MIN MAX
16.7 1.6 14.3 18.3
17.6 3.0 12.3 22.5
15.6 2.5 12.0 20.0
14.5 3.3 10.6 18.6
18.5 3.4 10.6 21.5
16.6 2.8 12.6 21.0
16.2 2.4 11.3 18.6
16.0 2.7 11.6 19.0
19.3 3.5 14.0 24.0
18.1 2.7 13.6 22.5
15.7 4.2 9.0 21.5
16.0 4.5 10.6 23.5

 

Note: MIN - Minimum measurement scores among all subjects.

MAX - Maximum measurement scores among all subjects.

74

From Table 2 one can make various observations. The .four
stimuli with the higher number of responses of all eight subjects
added were: the first male voice, the doorbell, the first female
voice, and the song "Chim-chim-cheree" (in numerical order). The
stimulus with the least number of responses was the song by the

Beach Boys, "Surfin' USA". Additionally, Table 3 shows that the

auditory stimulus with the largest deviation from the mean was
the second occurrence of the female voice, which also was the
last stimulus presented during the testing. The excerpt from the
'Carnival of the animals' by Saint-Saens obtained scores that
deviated the least from the mean. This was the first stimulus
presented. The auditory stimulus with the highest mean score was
the first occurrence of the male voice, and the stimulus with the
lowest mean score was the excerpt from 'Surfin' USA' by the Beach
Boys. An interesting observation is that the mean scores with
the least variation were the ones pertaining to the environmental
sounds. All maximum scores fell within two standard deviations
above the mean. The minimum scores deviated more below the mean
and some exceeded two standard deviations below the mean. The
doorbell, the plates breaking, and the musical excerpt by Saint-
Saens were the stimuli with minimum scores below two standard
deviations from the mean. The following table, no. 4, lists the
total number of responses in each behavioral category of each
subject individually, and table 5 lists the means of the

responses of the subjects in each behavioral category.

75

Table 4.

Distribution 2f_Total Measurement Scores 2f the Subjects i2 Each

 

 

 

Behavioral Category.

 

 

 

 

Subjects
* *
Responses 1 2 3 4 5 6 7 8 Total
Affect 17 10 17 9 13 l 24 0 91
Body-cont. 25 2 0 0 33 O 33 3 96
Posture 12 4 18 1 20 67 5 12 139
Movement 99 156 246 292 128 219 147 104 1409

Eyedmovt. 104 160 224 171 199 262 184 140 1444
Gesture 3 6 35 0 O 11 1 8 64

Locomotion 229 175 39 0 144 0 8 81 676

 

Vocal 115 144 5 0 10 37 33 47 391
Verbal 5 0 77 0 0 1 O O 83
*

Subjects tested only twice.

From table 4, one can easily see that the major number of
responses fell under the movement and eye-movement behavioral
categories. Even though most responses that occurred were
movement or eye-movement reactions to the stimuli presented, each
child had his/her unique ways of responding. Some did respond
vocally, whereas others did not. Some showed affect changes

during some stimuli, whereas others did not.

Table 5.

 

 

 

 

 

 

Means for Total Measurement Scores per Subject for all Three
321312“12_Each Behavioral Category.

5 552 MIN MAX
Affect 11.37 8.19 0 24
Body Contact 12.00 15.42 0 33
Posture 17.37 21.14 1 67
Movement 173.90 70.50 99 292
Eye-movement 180.50 49.10 104 262
Gesture 8.00 11.61 0 35
Locomotion 84.50 88.50 0 229
Vocal 48.90 53.00 0 144
Verbal 10.38 26.98 0 77

 

Note: MIN - Minimum

measurement scores among all subjects.

MAX - Maximum measurement scores among all subjects.

 

From table 5 one can make other observations as well. The

behavioral category 'gesture' had the lowest mean and the 'eye-

movement' had the highest.

This could be expected

autistic child often has difficulties in being direct,

since the

and the

'gesture' category referred to the specific gestures made by the

child toward the speakers, either by pointing or going to the

speakers in close relation to the sound stimulus presented at

77

that time. The scores that deviated the most from the mean were
in the 'locomotion' category. This seems rather natural since
within a group of autistic children variation in movement
activity and attentive behavior is expected. Some children

prefer to sit still in their chairs, whereas others do not. The

individual characteristics along with the severity of the
autistic behaviors of each autistic child, could be the reasons
why some children responded more overtly than others, some were
more vocal than others, and some were more active than others.
Table 6 shows the total number of responses of all subjects
in each of the main three behavioral categories during each of

the three main auditory stimulus types.

Table 6.

Distribution g£_Total Measurement Scores 23 Each Main Behavioral

 

Grouping £2_Each 2f the Main Auditory Stimulus Types.

 

Behavioral Categories

 

 

Stimulus Biochemical Motor-development Speech Total
Musical 58 1262 111 1431
Environmental 78 1218 168 1464

Spoken material 51 1252 195 1498

_¥

 

78

A rather interesting observation one can make by looking at
Table 6 is threefold: (a) the highest total measurement score in
the biochemical behavioral category was received during the
environmental auditory stimuli, (b) the highest total measurement
score in the motor development behavioral category was received
during the musical auditory stimuli, and (c) the highest total
measurement score in the speech behavioral category was received
during the spoken auditory stimuli. In addition, the highest
total measurement score of behavioral responses was received
during the spoken auditory stimuli.

The last table, Table 7, lists the means of the total number
of behavioral responses and the total number of scores in all

auditory stimuli of all eight autistic children.

Table 7.

Means ‘gf Total Measurement Scores for Behavioral Response

 

Categories and for Auditgry Stimulus Types.

 

N M so MIN MAX

 

Behavioral Responses 9 488 568 64 1444

Auditory Stimuli 12 366.08 30.06 327 417

 

79

Overall, the subjects responded more frequently by either moving
their body or turning their head or eyes toward the speakers,
than by any other type of behavioral response. As shown in Table
6, the largest number of responses fell under the motor
development category for all three sound stimulus types. Since
the mean score of all auditory stimuli was M_= 366.08 with a
standard deviation §2’8 30.06, one can see that the stimulus with
the highest number of responses (first occurrence of the male
voice - 417, Table 1) fell beyond one standard deviation from the
mean. On the other hand, the telephone rings received the lowest
number of responses and fell below one standard deviation from
the mean. So, all scores ranged within two standard deviations
from the mean at both ends. In addition, the total number of
behavioral responses in the nine behavioral categories ranged
within one standard deviation below the mean to two standard
deviations above the mean, with the 'eye-movement' category being
farthest from the mean. An interesting observation that one can
make from Table 6 is the difference in responses in the speech
category. During the environmental sounds and the spoken
material, more vocal and verbal responses occurred, while during
the musical stimuli fewer vocal and/or verbal responses were
emitted by the subjects. One can speculate that this could be
because the autistic child tended to listen to the musical

stimuli more attentively than to the other two auditory stimuli.

80

Statistical analysis was applied to the scores of all
subjects. The investigator selected the .10 level of
significance as the criterion for this study. For comparison
reasons several groupings and pairings were made. First, the
group was divided into two subgroups based on the age of the
autistic children. The younger group (YS) consisted of four
children, ages 7 to 10 years old, and the older subgroup (OS)
consisted of four children, ages 11 to 14 years old. A Mann-
Whitney "U" statistic was calculated between the two groups for
the total mean score on the combined three factors: music,
environmental, and spoken stimuli. With regards to the overall
frequency of responsivity to the three auditory stimuli, the
differences between the groups were significant at the .10 level
( U - 2, n - 4, p - 0.057). These results show that the two
subgroups of children responded differently to the stimuli
presented during the testings. To explain, the younger-aged
group tended to respond more overtly to the auditory stimuli than
the older-aged group. Thus, the differences seen in the
performance of the groups can be attributed to the differences in
their ages. The nonparametric Spearman Correlation Coefficient
was used to correlate subjects' age with their fluency in making
responses. The rho corrected for ties was -.518, and even though .

it did not obtain significance at the .10 level (p - .524), it

81

Table 8.

Average Scores :_Workeup for the Mann-Whitney "U" Test.

 

 

ID AGE GENDER IQ Average Score
1 9 M 20 203

2 10 M 19 219

3 9 M 89 220.3

4 14 M 32 157.6

5 12 M 20 182.3

6 7 F 39 201.5

7 13 F 40 217.5

8 14 F 23 197.5

 

Note: M- Male, F- Female.

was rather close. These results showed that as age went up, the
number of responses emitted by subjects went down.

The autistic group was also divided into two subgroups by
their functioning level. The teachers of the children rated them
as higher- or lower-functioning based on their everyday living
skills, social skills, and communicative skills. One of the
subgroups consisted of four lower-functioning autistic children
(LF), and the other consisted of four higher-functioning autistic
children (HF). The Mann-Whitney "U" test was computed, but no

significant differences were found in the overall average number

82

of behaviors emitted by the high- and the low- functioning
autistic groups. Also, no significant difference was found in
the average number of behaviors emitted by each group in the
three auditory stimulus categories of music, environment, and
spoken material ( U - 7, U - 6, and U I 5, respectively). The
Spearman correlation coefficient was also used to compare
subjects' IQ score with their number of responses. The obtained
correlation was low, and not significantly different from O. The
functioning level of an autistic child does not seem to play a
primary role in the overall performance during the testing. Any
differences that were observed might be due to other factors and
not primarily to the subjects' functioning level.

The last grouping was done on the basis of gender, and so
one group consisted of five autistic boys and the other of three
autistic girls. The Mann-Whitney "U" was computed, but the
results did not show a significant difference in the average
number of behaviors emitted by the male and female autistic
children. Also, no significant differences were found in the
average number of behaviors emitted by the subjects of each group
in the three auditory stimulus categories, music, environment,
and spoken material ( U- 7, U - 4, U - 5, respectively). Thus,
any differences that were observed in the performance of the
male and female autistic children during the testing, might not

be attributed to their gender, but to other factors as well.

CHAPTER 5

DISCUSSION

Various researchers have investigated and established with
their studies that autistic children show a strong interest in
music and rhythm (Sherwin, 1953; Pronovost, 1961; Cain, 1969;
Viscott, 1970; Kanner, 1971; Thaut, 1987). The initial purpose
of this study was to explore the ability of school-age
autistic children to respond overtly to familiar and novel
auditory stimuli: musical, environmental, and spoken material.
One main finding of this study was that autistic children favored
the motor development responses. Thus, they responded to the
sounds more overtly by the use of their body. They moved their
heads, turned their bodies, or just shifted their eyes toward the
speakers. Sometimes, they even left their chairs to move toward
the speakers. The vocal and verbal responses were significantly
more prevalent when the autistic child was young (ages 7 to 10),
whereas the older children tended to respond verbally less often.
The lower functioning children tended to touch the experimenter
more frequently during the testing, but that behavior was not so
frequent in the higher functioning group. No differences were
seen between the responses of female and male autistic children.

Gender does not seem to play a big role in the behavioral

83

84

responses of autistic children to auditory stimuli. As seen from
the statistical analysis of the data, significant differences
were found only between the two age groups, older (ll-14 years
old) and younger (7 - 10 years old) autistic children. During
the testing, the older children seemed more hesitant to react
overtly, left their chairs fewer times to move toward a speaker,
and tended to be quiet rather than verbal. On the other hand,
the younger children moved more freely around the room, vocalized
more often, touched the experimenter more frequently, and were
more overt in their behavioral expressions in response to the
auditory stimuli. A reason for these differences might be that
older children have learned to be more attentive and to have more
of a "classroom" attitude, whereas younger children are still in
the process of learning to attend and focus on one task. Another
reason might be that the nature of younger children in general is
to be more overt and outgoing, and older children to be more in
control of their behaviors.

From the three categories of auditory stimuli presented
during the testing, no one category seemed to be favored. The
greatest number of responses were exhibited in the first
occurrence of the male voice, the doorbell ring, the first female
voice, and the song "Chim-chim-cheree" from the movie Mary
Poppins. The auditory stimulus that received the least number of

responses was the telephone ringing, which apparently did not

85

interest the autistic subjects as much as the other stimuli
presented. Differences in behavioral responses were seen during
the testing, such as moving the feet or tapping their knees
during the musical examples. The difference between the
behavioral reactions of the autistic children to the music as
compared to environmental or verbal sounds can be seen in the
scores received in the 'gesture' category, in which music
received a total of 31, environmental sounds received a total of
11, and spoken material received a total of 22. These results
coincide with the belief that autistic children show a strong
interest in music and rhythm.

In the original design of this study, the investigator also
wanted to see if autistic children favor the left or the right
ear when attending to auditory stimuli. The stimuli presented
during the testing were monophonic, and were presented either
from the right or from the left speaker. Due to unanticipated
difficulties, mainly during the rating of the videotaped testing
sessions, data for this research question was not gathered. The
experimenter had not foreseen the difficulty for the observers to
observe behavioral responses within 10-second locked time-units,
and at the same time observe whether the child was attending to
the stimuli from the right or the left ear. A suggestion for
future research on the issue would be to incorporate it in the

observation sheet, so it would be easier for the observers to

86

mark the responses. The videotaping equipment presented an
additional difficulty. The stand on which the videocamera was
set was about five feet high, and the lens was not a wide-angle
lens. As a result, in the videotapes that the observers saw, the
speakers were barely within the frame, and it was difficult to
get a fuller view of the room. Thus, it is suggested for further
research to use a videotaping procedure that will allow for a
view of the whole room.

However, the investigator made a notable observation. One
of the subjects, a 10-year-old, high-functioning, autistic boy
insisted on moving his chair next to the right speaker, from the
very outset of the testing. As soon as he heard the first
stimulus, which appeared from the right speaker, he would stand
up and move his chair next to the right speaker. During the
stimuli that were presented through the left speaker, this boy
turned his head or pointed to the speaker and asked the
experimenter to tell him where the stimulus was coming from. He
never moved to the left speaker, or acknowledged that some
stimuli did appear through the left speaker. Nevertheless,
during the stimuli that appeared through the right speaker, he
leaned his body as close to the speaker as he could and placed
his ear on the speaker, showing great interest and pleasure.
This observation contradicts Blackstock's (1978) finding that

autistic children attend to auditory stimuli mainly with their

87

left ear, yet one can not reach a conclusion by the responses of
only one autistic child. This issue requires further
investigation in order to understand the tendency of autistic
children to hear in a unilateral manner.

Overall, all autistic children who participated in this
study were able to attend during the experiment without
assistance and seemed to enjoy themselves. However, during the
study several unforeseen problems were encountered, uncontrolled
factors that might have affected the results. As mentioned
earlier in the study, the room that was used for the testing was
the physical education office and store room. Therefore, various
instruments and equipment, which the investigator was not able to
remove, were placed in this room during the testing. This
presented a problem, since it provided additional distraction
for the children. At the same time, this room was located close
to the gymnasium, and as it was not sound proof, various
extraneous sounds were able to penetrate and possibly affect the
performance of the autistic subjects. Several other uncotrolled
for factors, which were beyond the power of the investigator to
control, were: the schedule of children's classes which sometimes
conflicted with the testing, absences of children due to
illnesses, late replies of parents to the request of the

investigator for their child to participate in the experiment,

88

and intervention by teachers and insistance on being present
during the testing when they felt that the child might present
behavioral problems.

The initial purpose of this study was to explore the ability
of school-age autistic children to orient themselves and respond
overtly to auditory stimuli: musical, environmental, and spoken
material. Although the analysis did not show a significant
difference in the total number of responses of the autistic
children to the musical, environmental, and spoken material, the
investigator made the various observations that were presented in
the previous pages. These were felt to have supported the
evidence of an interest by autistic children in music. Studies
mentioned in previous chapters have found that autistic children
exhibit a great interest in music and rhythm. However, most of
these studies had focused on the actual interest and not the
reasons for this peculiarity of autistic children. This study
attempted to investigate whether this interest was a generalized
auditory perceptual characteristic of autistic children or an
exclusive interest in music. The results, however, were not
conclusive enough to make any speculations with confidence.

If this study is replicated, several of the uncontrolled
factors should be taken into consideration and controlled, and
additionally, a larger number of subjects would make the study

more valid. An additional category to the behavioral responses

89

in the observation form that could prove beneficial, is the
quieting response to auditory stimuli. During various testings,
some of the autistic children did respond to auditory stimuli by
quieting and becoming more attentive, but when the data was
collected, this quieting response was not accounted for in the
observation form that was used in the study. Thus, the
investigator believes that in future research, the addition of a
quieting behavioral category could be very beneficial. Another
idea for future research would be to use longer auditory stimuli
'for each of the three auditory categories, in order to see during
which stimuli the autistic child would remain attentive for a
longer period of time. The observation form to be used for such
an investigation would have to be different from the one used in
the present study. Other possibilities that merit further
consideration for future research are: the length of auditory
stimuli presented, the length of the latency period following
each stimulus, the order of stimuli appearances, and the number
of repeated testings.. Through changes in these areas, factors
such as attention span, interest level, and level of expectation
may be better controlled for.

Prior to the study, the investigator had various questions
in mind, some of which still remain unanswered. Many more
questions were raised during and even after the completion of the

experiment. The unusual sensitivity and attention of autistic

90

children toward music is an intriguing behavior that has captured
the attention of many researchers (Cain, 1969; Hoolander & Juhrs,
1974; Thaut, 1987). Further investigation and experimentation is
required in order to begin to understand the origins of this
behavior and its importance to the syndrome of autism. This
might eventually lead us a step closer to the inner life of the

autistic child.

APPENDIX

APPENDIX A
PARENTAL CONSENT FORM
Dear Parent,

I am writing to ask your permission for your child to participate
in my Auditory Awareness Testing Project. This is a research study
within my thesis work for the Master's degree in Music Therapy. The
study is supervised by R. Smeltekop, Chairperson of the Music Therapy
Department at Michigan State University.

The objective of my study is to see how autistic children respond
to various familiar and novel auditory stimuli and whether they
respond more overtly to any of the three categories: environmental,
vocal, and musical sounds. To accomplish this your child will be asked
to participate in three individual sessions, each one a week apart,
where the child will be asked to listen to 12 taped sounds. The
sessions will be videotaped and will be viewed by three observers for
purposes of data collection only.

This study has already been explained to the principal of your
child's school and to his/her classroom teacher, and it has been
approved by both. Your support would be most helpful for a deeper
understanding of music in Special Education and Therapy.

Therefore, I would be very thankful if you would also approve,
and indicate this by signing and returning the consent form below to
your school.

Yours Sincerely,

Dimitra Akogiounoglou, RMT-BC
Graduate student in Music Therapy

Roger Smeltekop, RMT-BC
Chairperson, Dept. of Music Therapy

 

AUDITORY AWARENESS TESTING PROJECT CONSENT FORM

 

 

I have read the explanation above and hereby give my consent for my
child to participate in your study. I understand that my child is free
to withdraw from the study at any time. I understand that my child
will remain anonymous and that his/her responses will remain
confidential. I understand that the videotapes will be viewed only for
purposes of data collection and that all will be erased at the end of
the study. Within these restrictions, I understand that when the study
is completed, the summary of the final results of it will be made
available to me upon my written request to the school.

Signed
Date
Child's name
Teacher's name

 

91

ID

APPENDIX B

 

Observer

 

AFFECT

BODY
CONTACT

 

POSTURE

MOVEMENT

EYE-
MOVEMENT

GESTURE

LOCOMOTION

 

VOCAL

VERBAL

 

 

DATE

Testing Trial

 

 

OBSERVATION FORM FOR BEHAVIORAL RESPONSES
'9§_AUTISTIC CHILDREN IQ_AUDITORY STIMULI

#1
_2_g

 

30

 

10

 

#2
39

 

30

 

10

 

#3
g

 

30

 

 

10

 

#4
_2_9

 

30

 

10

 

#5
33

 

30

 

10

 

#6
20

 

AFFECT

BODY
CONTACT

 

 

POSTURE

MOVEMENT

EYE-
MOVEMENT

GESTURE

LOCOMOTION

VOCAL

VERBAL

 

AFFECT

BODY
CONTACT

 

POSTURE

MOVEMENT

EYE-
MOVEMENT

GESTURE

LOCOMOTION

 

VOCAL

VERBAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AFFECT

BODY
CONTACT

 

POSTURE

MOVEMENT

EYE-
MOVEMENT

GESTURE

LOCOMOTION

 

VOCAL

VERBAL

 

 

STIMULUS

#1
#2
#3

#4
#5
#6

#7
#8
#9

#10
#11

#12

APPENDIX C

AUDITORY STIMULI LISTED IN THE ORDER OF PRESENTATION

Excerpt from "Carnival of the Animals" by Saint-Saens
Doorbell Rings

Male voice: "Hi, there! I'm really glad you're here.

How are you today? I hape everything is going well with
you. Thank you for participating and taking the time to
listen to my tape. I really hope you enjoy yourself."

Excerpt from "Chim-chim-cheree" from Mary Poppins
Baby crying

Female voice: "Did you have a fun day at school today?
My day has been very nice. I came over to the school
from Lansing early this morning. The weather outside
is so warm. So much sunshine!"

Plates falling and breaking
Excerpt from "I will wait for you" by Vikki Carr

Male voice: "Have you made plans for the summer? What
will you do? I enjoy swimming a lot and I like sitting
on the beach. Do you enjoy sitting in the sun? I also
enjoy going on picnics and being out in the woods."

Excerpt from "Surfin' USA" by the Beach Boys

Telephone ringing

Female voice: "I appreciate the time that you have given
to help me with my project. I would like to thank you
once again for participating, and I hope you have a nice

day. I'm glad I got the opportunity to meet you. It's
been really great!"

93

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