Making Intensive Voice Treatment (LSVT LOUD®) Accessible for a Child with Autism Spectrum Disorder (ASD) and Mixed Dysarthria Using a Novel, Pre-Treatment Protocol

Making Intensive Voice Treatment (LSVT LOUD®) Accessible for a Child with Autism Spectrum Disorder (ASD) and Mixed Dysarthria Using a Novel, Pre-Treatment Protocol

Jessica Galgano, PhD, CCC-SLP, Grace Tsang, MS, CCC-SLP, Lorraine Ramig, PhD, CCC-SLP

What is it about?

This case report is about the use of a new pre-treatment protocol, which prepared a child with ASD and mixed dysarthria for LSVT LOUD. Initially, the child was deemed unstimulable for the intensive LSVT LOUD program. During stimulability testing, he was unable to follow behavioral models and had decreased stamina for intensive, repetitive practice and intervention.

The team chose to implement an individualized, pre-treatment protocol consisting of low-dose treatment which gradually increased in intensity over the course of 18 months. Following this novel pre-treatment period, the child was able to participate in the LSVT LOUD gold standard protocol. Significant gains in loudness and functional communication were noted.

Why is it important?

Research shows repetitive treatment delivered at a high intensity and paired with targeted practice produces the greatest gains in motor learning tasks. Currently, those who are unable to follow behavioral models or commit to intensive treatment, either physically or behaviorally, are not considered candidates for LSVT LOUD or other intensive treatments. The promising result in this case opens the possibility for designing and implementing individualized, pre-treatment protocols to prepare and permit more children to benefit from intensive treatment. This type of approach provides more children with a chance to participate even if they are not judged to be candidates during initial stimulability testing.

Read the full study HERE.


Perspectives

For additional perspectives on this treatment study and line of treatment research, we asked lead researcher and author on this study Dr. Jessica Galgano, PhD, CCC-SLP a few questions. Her insights are provided below.

Why did you want to study LSVT LOUD in Autism?

Researchers estimate a significant portion of children with neurodevelopmental disorders, such as ASD, also have motor speech disorders. Though Speech-Language Pathologists are familiar with working with the cognitive communication challenges children with autism may face, there is much less research on treatments that address their motor speech difficulties.

What were the key take away points from this study?

One key takeaway is that pre-treatment protocols can be designed and implemented to give children who are otherwise deemed unable to participate in LSVT LOUD a chance to train and prepare for the gold-standard protocol which may open the door to functional communication and the chance to have some control of their speech. Given that this particular child made significant improvements despite initial testing showing lack of stimulability, there is a possibility more individuals could benefit from intensive programs given the application of individualized, pre-treatment protocols.

“This novel research documenting a preparatory protocol for children who might not be ready for intensive treatments, such as LSVT LOUD, is exciting. As Dr. Galgano states, the motor speech challenges many of these children face are often undertreated. Having clinical tools to improve voice and speech for these children can potentially unlock the door of verbal communication. We congratulate Dr. Galgano and her co-authors on this innovative case study and look forward to future research in this area.”

– Dr. Cynthia Fox, CEO and Co-Founder, LSVT Global, Inc.

How might this impact SLPs who are working with people with children with autism?

SLPs may now consider LSVT LOUD as a viable treatment option for children with autism and motor speech concerns. While research continues to support the efficacy of intensive treatment, some children are prevented from receiving it given cognitive, physical, or behavioral challenges. This case is a preliminary step in addressing ways clinicians can make LSVT LOUD accessible for a greater number of children.

Were there any surprises or key things you learned?

I was impressed with the commitment and motivation demonstrated by the participant and his family throughout the process. Despite not meeting initial requirements for LSVT LOUD candidacy, this child was able to make significant gains and fully participate in the program. Furthermore, he was able to maintain gains five-months post-treatment! Commitment, motivation and perseverance made a significant difference and played a part in the child’s ability to complete the intensive program.

What happens next in terms of your research on LSVT LOUD and autism?

Much further study is necessary regarding treatment of pediatric dysarthria, especially among the ASD population. This case report illustrates a need for researchers to study how clinicians can accommodate the comorbid conditions that this and other populations may face through use of a pre-treatment protocol which can allow more children to access the benefits of LSVT LOUD and other intensive interventions.

 Resources 

  1. View LSVT LOUD References HERE
  2. View this On Demand webinar to learn more about treating childhood populations with LSVT LOUD HERE
  3. Learn about our new LSVT LOUD for KIDS Training and Certification Course HERE
  4. Explore options for becoming LSVT LOUD certified HERE

About the Author

Jessica Galgano, PhD, CCC-SLP

Dr. Galgano received her Ph.D. from Columbia University in Biobehavioral Sciences. Prior to receiving her doctorate, she received a M.Phil. from Columbia University as well as M.A. and B.S. degrees from New York University (NYU). She holds a faculty instructor position at NYU Grossman School of Medicine and permanent NY licenses as an elementary teacher (Pre-K – 8th grade) and Teacher for the Speech and Hearing Handicapped. She is an adjunct instructor at New York University, Columbia University, Teachers College, NYU, and San Francisco State University on the topics of Adult Language disorders, Motor Speech Disorders in adults and children, and Voice Disorders in adults and children. She is also one of seven certified LSVT LOUD® faculty instructors worldwide and acts as one of LSVT Global’s clinical experts in LSVT LOUD. Dr. Galgano has published research on the neural underpinnings of speech and voice production using brain imaging techniques and has also examined the effectiveness of intensive voice treatment in adults and children with neurogenic speech disorders secondary to Cerebral Palsy and in children with Autism. She has numerous years of clinical experience as a Speech Language Pathologist treating individuals with neurogenic speech, language, and voice disorders in hospitals and schools around the country and is now the Founder and Executive Director of Open Lines Speech and Communication, a private practice based in NYC and Los Angeles.