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From interactive computer programs to group sing-alongs, Children's Hospital Boston's Communication Disorders Center is finding new and exciting ways to help children with communication difficulties learn and interact.

by Anna Gonski

Eight-year-old Brian Lundy sits engrossed in the images and sounds on his computer. He giggles and smiles, swaying to the music and repeating each word after it's spoken by the animated character on the screen. Brian's mother, Ann, sits a few feet behind him in awe. "Brian has zero attention span," she says, making the zero sign with her hand. "None whatsoever."

What's captivating her son is Puddingstone Place, a new virtual environment developed by Howard Shane, PhD, director of the Communication Disorders Center (CDC) at Children's Hospital Boston. The software is aimed at helping children like Brian, who have communication disorders, improve their language and communication skills.

Children with a variety of developmental disorders—from autism spectrum disorders to Fragile-X syndrome (a genetic condition causing delays in speech, language and motor skills development)—have difficulty mastering language and communication concepts. Brian, for example, has a Landau-Kleffner syndrome variant, a rare epileptic disorder characterized by loss of language, and autistic and obsessive/compulsive behaviors, including an extreme lack of focus and some auditory challenges.

"At first, Brian didn't have any spoken language at all; he only communicated through sign language," says Ann. "But he's made tremendous progress in the past few years, moving to a combination of pictures and sign, then voice and sign and now he mostly uses voice."

Brian attends a regular elementary school where he takes part in an aggressive speech and language program, working with therapists during seven separate daily sessions that concentrate on various communication skills. But he still has difficulty with certain aspects of language, like word retrieval. "He'll often describe the action an object makes, rather than its actual name," says Ann. "For example, he might refer to a shovel as a 'digger.' And other times, he won't be able to come up with any word at all."

That's why an interactive software program like Puddingstone Place could really benefit Brian. An engaging animated character named "Champ" guides children through a virtual house comprised of photo-realistic scenes of various rooms, all of which contain common household objects. When a child clicks on something, its name pops up on screen and is spoken aloud by the computer. And some items, like the toaster in the kitchen and the hammer in the garage, can be double-clicked to initiate the action and sounds the object makes.

The proof is in the pudding
Through clinical observation and parent interviews, Shane and his team found that children with developmental disorders are particularly engaged by visuals in the form of electronic screen media—TV, video, computers and video games. His research also revealed that they respond best to animated onscreen characters.

"We've long known that children with developmental disorders respond best when things are presented visually," says Janice Ware, PhD, associate director of Children's Developmental Medicine Center. "With computers so accessible to children today, a highly sophisticated computer program like Puddingstone Place could definitely be used to supplement speech/language and behavioral programs."

The software is designed to be used with a parent, teacher or clinician, since many children who have trouble with language also have a hard time with social communication. "Adults who are working with the children can capitalize on their attention and interest and begin to work with them on language and communication skills," says Shane.

To address Brian's word retrieval difficulty, Shane sets the program to give partial auditory cues for each word, allowing Brian to come up with the full word on his own. In the kitchen Brian is given the cue "re" after which he immediately says, "refrigerator." Interestingly, when Brian returns to the kitchen later, he says "refrigerator" without the auditory cue.

"The idea is that the child will learn the name of an object and then the visual connection to what it is and what it does," says Shane. "Our hope is that, ultimately, he can transfer these skills to the real world."

Brian also has a problem recognizing and interpreting the sounds around him, which makes it tough for him to follow directions. "When directions are spoken to Brian in simple terms, he's generally able to understand them," explains Ann. "But as they get more complex, it gets really challenging for him."

So Shane guides him to the playroom for the "Dress Up Champ" game, which asks Brian to make choices about what Champ will wear—a baseball uniform, a firefighter suit, a cowboy outfit or some combination of the three. He first selects the firefighter suit, and when he mistakenly tries to place the pants where the shirt belongs, Champ tells him that his pants don't go there. Brian giggles and places them in the right spot.

"The Dress Up Champ game helps kids with a lot of different skills," says Shane. "For example, it's asking Brian to follow directions in a sequence, which he sometimes has trouble with, using visual cues—one of his strengths and verbal cues that hopefully he can learn to connect with the visuals." Brian likes the game so much that he plays it all the way through four times, excitedly repeating each item of clothing and dressing up Champ.

"Brian always responds very well to computers," says Ann. "This is definitely something I can see us using to reinforce the language and communication work he's doing in school and to help build his vocabulary. It's also a fun and highly motivating activity for him that holds his attention to the point where he doesn't realize it's educational."

Shane hopes to make Puddingstone Place commercially available in the coming year. Meanwhile, the CDC team is always brainstorming new and different ways to help children communicate. "Our hope is that by observing trends and patterns, we'll be able to develop new and more effective technologies for children with all communication disorders."

The sound of learning
Dorry Brown sits in front of a group of attentive 4- and 5-year-olds with various communication disorders. She holds up a picture of Champ with strips of Velcro strategically placed all over his body, and leads the children in the "Sticky Bubblegum Song." The song prompts the children, one by one, to indicate where they'd like to place the bubble gum on Champ. On his nose? His belly?

It's a fun, silly game that the kids enjoy immensely—but there's more at play here than a simple sing-along. As coordinator of Children's Group Language Therapy Program in the CDC, Brown uses this and other songs to encourage language and social communication skills in children with developmental disorders. "We know that music can support social and cognitive growth in children," says Brown, "particularly those with developmental differences, who often have trouble interacting and learning in typical educational environments."

Music has certainly helped 7-year-old Eric Dalton, who has Fragile X syndrome.

"When Eric was little, he only communicated in simple, single words and never sang or combined them," says his mother, Clare. "He basically had no expressive language."

Clare's pediatrician referred Eric to the CDC, where he was first introduced to Brown. "Eric was in this phase where he would repeat an action over and over when he was nervous or uncomfortable," says Clare. "At that time, it was opening and closing doors. So when we met Dorry, sure enough, he started opening and closing the door to her office."

What happened next would forever remain with Clare, and help her through a lot of difficult times with her son. "Dorry knelt down beside Eric and asked if she could have a turn opening and closing the door when he was finished," she recalls. "The look on his face was pure shock���he'd always been told to stop these types of behaviors. I could see that Dorry really connected with him, and I began to cry." After a few more bouts of opening and closing the door, Eric gave Brown a turn, and the two have maintained a close connection ever since.

Singing is participating
Eric has participated in all three language therapy groups that Brown facilitates. The groups meet twice a week, consist of five children each and are arranged by age (2- and 3-year-olds, 3- and 4-year-olds, and 4- and 5-year-olds). Each child is assigned a Speech Pathology graduate student who works with him one-on-one and during group activities. Brown oversees all interactions and also leads "circle time," when the group comes together to sing.

"That's when Dorry really works her magic," says Ware. "Her music captures and maintains the children's attention and provides built-in opportunities for repetition that are so critical to reinforcing language and communication learning."

The Sticky Bubblegum Song is a perfect example. It incorporates the names and locations of body parts, repeating them during every verse of the song. And that's not all. Through the years, Brown's musical repertoire has expanded to include visual supports, like the cut-out of Champ. "Music by itself captures and maintains children's attention," says Brown. "But when the lyrics are paired with actions and pictures, it encourages their participation."

Brown makes cassette tapes of all her songs for parents to use with their children outside of her group. "Dorry's tapes have made such a difference in our lives," says Clare. "We'd get in the car after therapy and sing all the way home, when we set the table or brushed our teeth we'd sing���it was a whole new way for me to connect with Eric."

Brown's approach to music has grown so popular through her classes and by word of mouth that she is now working to bring it to the general public through "Learning Together with Music," a CD that encompasses all of her tricks of the trade.

The CD is targeted at educators, parents and clinicians. It explores how to incorporate music into a child's life, identifies and explains the learning goals of each song and includes video clips from one of Brown's circle times. It also includes printable graphics and two interactive software games, which were developed from circle time songs. Champ appears in the Sticky Bubblegum game on both the Puddingstone Place and Learning Together with Music CDs.

"Dorry's program presents language therapy in such a joyful way—no words can describe it," says Clare. "It really opened my eyes to a whole new level of understanding with Eric. Dorry was the first person to show that my son's condition was okay—I didn't have to fix him or try to bring him up to my level."

To support the Communication Disorders Center, contact Brandt Henderson in the Children's Hospital Trust at (617) 355-5342 or

is published by Children's Hospital Boston.©2005
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