you're a professor at the university of pittsburgh correct and you've been there how long eight years eight years and so it seems like home now oh yeah it's it's burgas home now iowa well it hurted school well well known across the country yes and what department are you there kucha i'm in communication science and disorders as in what what is that what are they doing there are we training students that work with people with communication disorders so that's a variety of disorders from language disorders to oral motor speech disorders fluency voice my area of specialty is augmentative an alternative communications so people who cannot talk or whose natural speech is not functional to meet their daily needs and communication our department also works with swallowing disorders so you're training people students  on to become professionals yes speech language what ologists our department also trains individuals for in audiology so ideologists that again i have my focus on  people whose natural speech is not functional so i'm providing them with other means to be able to communicate and you you've done something probably the average professor hasn't and you started a nonprofit organization organization called would you tell us what that is the ac institute and yes i co founded that fifteen years ago actually would be celebrating and twenty sixteen our fifteenth anniversary and yeah so we need to celebrate we are a resource and advocacy group that works across the various stakeholders that are providing rehabilitation services for people with significant are severe communication disorders that need a what a wide range of interventions and then roughly five years or seven years ago  we added a clinic program so that we could i have a gold standard or a model for they are p and assessments for people that need a interventions and the term a speech generating devices so these are actually trying to vices that help people communicate that's correct so what were you located we're on ave near duquesne university and across from mercy hospital yeah right and right in the heart of education health care right i drive back and forth between the university of pittsburgh and my office at forbes tower and then clinic so what type of deficiencies do you deal with in particular well one of the most common communication disorders right now that we're seeing and in our clinic are children with autism one actually across the lifespan individuals with autism because autism isn't something you brought up that's correct so for the audience i would you please tell us what are autism is  autism is a general term for a group of complex disorders in brain development and it is characterized by difficulties  with social interaction verbal and nonverbal communication language skills behaviors and particularly repetitive behaviors or stereotypic behaviors  n and play is that from the time of birth and as a show itself later to have that diagnosis you generally generally need to be diagnosed before the age of three so although at birth child would appear typically developing by age of three these behaviors have started to manifest themselves and what is medical science attributed t that's really difficult to answer i think the jury is still out in that we have a lot of people speculating and we know that there's a lot of areas different areas of the brain that are affected by an individual that has autism  the prevalence is growing and i think that's why we see so many children with autism coming to our clinic whether or not it's a nation it's the environment it's so so there are a lot of theories but there's not really a true conclusion as to what causes autism so so there's a possibility could be lack of nutrition during development from  the mother could be viral right in i wouldn't want to try to say what is the specific cause i think what our bigger concern is right now is that we are seen the prevalence increasing so we rub ok she doesn't read more prevalent in males or females more prevalent in males but also in females if we look at the incidence right now it's one in sixty four bursts so when i was growing up i don't think i knew anybody that had autism and i certainly don't remember having the term even when years into my daughter so i don't remember hearing that word autism yes is it a new name for something that was just diagnosed and treated or has the prevalence increased so much in the last fifty years where we've had seen the dramatic increase has been since  two thousand and it's close to one hundred twenty percent increase so hundred twenty percent increase since the year two thousand yeah between two thousand and two thousand and ten is it because we're collecting more statistics and actually looking you know to identify new or have something happen that the rate of that change i believe there's a combination of both but there is something definitely happening because that's global i go to china to work  in a hospital in shanghai and rehabilitation programs in china and in china we're we're seeing the same type of incidence as the same type of increases be  right for male and female it's one in sixty eight so yet we know that if a male child born it's going to be less than one even more than one in sixty eight wow that's one in fifty that's scary that's absolutely scary well i agree that it's scary and so we want to identify these children as early as possible there is new research showing that earlier we can start working with infants and toddlers that might be showing some of the characteristics that are typical of children with autism the more likely we are to be able to improve their skills and even decrease what might be considered the characteristics of autism what are some of the signs that a parent would notice one when they see it presenting itself well early before  a child might be ready to speak would be poor i contact lack of social interaction you know even very young children before they're speaking and saying words kids with autism you don't see those things not to the same degree and then certainly by the time the typical child is saying their first words these children are not and so what we don't want to happen is really if you're born with that issues neurologically happening like in the brain development that's always going to be something that you're going to be living with endings of ganglion something something like that and you can train other pathways well we know that the there's a lot of neural plasticity in the brain i think my bigger concern of what we are seeing is that the individual with the scope of practice to be evaluating these children regarding their communication skills their speech and their language development is a speech language pathologist so although parents  are concerned about the behaviors and trying to get some of the behaviors under control what you really want to be looking at is this is an issue where we want to be providing  interventions that are helping that child develop their language skills because by the time they're getting into school and school age we want them to have the language to learn and if you're entering school without language then that's automatically putting you back and just technology per se in many things that we're seeing happen in within the community of thinking of what's going to work it is not necessarily the same thing of providing a piece of technology as understanding where that child's strengths and weaknesses are and how to set up technology that's going to facilitate development and interactions with their with the world around them so unification as ever communication is everything but it's also language is everything so when you identify that a child has does sometimes get confused with a d d well yes because it is a spectrum disorder so and the population of children that i work with or even into adulthood across lifespan that have autism are the individuals that have limited use of verbal speech so it's symptoms that the parent is saying and then going to the professional and say not my child is look for you know i realize you see observe things on a daily basis but is there an age of the bit of the child the baby is it's developing and that one to three year period of time that  should pay more attention to even just as a preventative measure in observing your child well yeah we need parents interacting with anything any child and observing things  we do have a stronger evidence base now showing that the earlier the intervention the better outcomes can be established so but look at good parenting skills good parenting skills are that face to face interaction sharing the focus with your infant and your toddler as they're growing up in stimulating you're doing shared reading you're doing shared play you're not sitting them down in front of the television set to be your babysitter or providing a nine month old with an i pad and saying oh isn't that great that they're they know how to shuffle through the pages that is you know what are we doing there and the same is true with individuals recommending an i pad to be a solution to be building communication skills that's the that is the in the scope of practice for speech language pathologist and of speech language but solid just that has training and augmented as an alternative communication so when when you see a child is unable to talk or not and will communicate you first a check to make sure that you're properly right and that and then yelling in the right that's a medical problem that way right because that definitely affects why that's correct but we do have children with hearing impairments that also have autism so that a comprehensive and very thorough evaluation is important i know we have parents coming to our clinic from not only across the country but canada and worldwide to be evaluated and when they come here are intensive evaluation at its shortest is a series of three days and it's not just in the clinic we take these children to multiple environments so they they're using words or we're seeing how they're attempting to the parents in the lobby of the hotel for example you are going to take a short little break here in a minute and we'll continue this wonderful conversation about autism in return please stay tuned to healthy pets healthy owners will be back in a few seconds with as her specialty is autism and and speech and development for communication skills yes augmentative and alternative communication so in my area of expertise is per vibing technologies or other interventions to support the use of natural speech so when individuals natural speech is not functioning they can use voice output technology to do so so you can communicate you have devices and one of these devices call home speech generating devices and that's a classification of durable medical equipment so there's funding associated with those types of devices that are not associated with off the shelf devices and i've seen these devices way yes and they have pictures on them so that if someone is unable to communicate somebody with autism for example they can hit the different keys graphic symbols yes graphics some to say stored vocabulary and so yes it might be a picture of a bird says bird right or something eating same hungry yes correct and so that and that's had its simplest form ok but you can actually hit keys in succession and create census that's right and that that  is language programs that are set up and for children that are nonreaders we can use graphic symbols that have single meanings and there's other graphic symbols that have multiple meanings to them so that they have a richer and a more robust vocabulary in a limited amount of symbols and then you can use spelling based methods too so that's where someone that is really skilled with knowing how the language software works and then evaluating an individual with autism and understanding their cognitive linguistic skills can match the technology features to their strengths and then what they need to be able to show gains in improving their communication so so people that have been diagnosed with autism are they skilled according to  deficiencies or reserve ranking well i went to college a ranking is it is a spectrum disorder which means that there are very degrees to the characteristics that are associated as difficulties with communicate and that's right ok so we tend in medicine to classify everything stage one cancer stage three cancer and i just want to know autism is works the same way it's been it's been right you know granting that would be the good word because you know i wouldn't want to do that because it would be unfair you don't want to set lower expectations for a child because they're not i would reacting to z environment and that's what we're finding when you really match your interventions in your treatment to the specifics of how that child's manifesting their their difficulties then it's amazing what some of the children already have up there in their head that they're able to express and and it's very hard work it's not a matter of just putting something down in front of a child like an i pad and assuming that they just know where vocabulary is and they know how to th n communicate using graphic symbols it's very intense work and work that we do well maybe i'm thinking of one of the children at school we have a contract and they work with the schools  hospitals not as much hospitals people come to our clinic but we do have children that come to our clinic after school we have a contract that we are providing the speech and language services to a partial hospitalization program here in pittsburgh called plea we we work closely with the team at plea for the children that whose school districts have  having them at plea because their school program has been ineffective in working with their religious order are there like camps that you go through for the children go to well we do offer a camp in pittsburgh in the summer it's always filled we don't necessarily have all children with autism at our campus every july we run it out of  crown plaza here in pittsburgh at pittsburgh cells so that we take advantage of going over to south hills village mall and there are many of the businesses at the mall that plan special communication activities just for our campers so they have been wonderful in setting up situations very daily common interactions with our campers students and their families some of our families say this is the most fun i've ever had bringing my child to shopping and then we go to another day to one of the museums we've worked this past year with the science center in the year before with the children's art museum and so this helps children with autism to start to integrate and see life in a different way than they may be being present and being stuck in a home yes and working on just behaviors and one of the most recent studies that has come out on autism is showing that repetition in a task is actually detrimental to it individual with we learned that rote learning we learned that's how we have are and so that kids with autism it's a problem it can be a problem because they can't generalize to use that skill in other contexts and so one of the things that we've always done it in our treatments at least in our clinic is to do multiple contexts which means what well we're providing exposure to a skill and to even a vocabulary world word in many ways that may occur in the environment so for example i'm working with a child right now on with a speech generating device and we were teaching the word turn because turn is a very common word that kids use all the time but it's used in many different contexts so when he was first accessing the key i was standing up and turning around in circles and then said oh i'm getting dizzy please tell me to stop he already knew how to hit stop and go so we had stop and i stopped but then i immediately went to the light and said we've got to turn it off and we'll be in the dark so getting them to say turn on and turn off because that's a different use of the turn the word turn and then we were playing with music and we were turning the music up and turning it down so that was using the word turn the same symbol the same location but in a variety of different contexts so that he's not stuck on he's only not and i think how it is not is that we have a lot of individuals that aren't necessarily trained and realize the distinction between how you work with a child with autism versus a better better intervention the younger the child is yes and you you will be able to be integrated into mainstream life even though you have this deficit i think we have to work hard to do that we i don't want to set lower expectations for a child until we've done intensive interventions with that child and that it's a matter of are you going getting the resources that are looking at your child as the unique human being that they are it's not an off the shelf issue it's not just getting a piece of technology in individualized for the situation program person and  there are many kids with autism that live a normal happy life that's right that's right how do people get a hold of  well we have websites for the ac institute w w w dot ac institute die hard and you'll have that up and i can talk clinic and you can look that up on the web too we have a variety of resources at the clinic website to download related to autism the parents have to go through physician's offices to get there i know we have parents that find us on the web or have heard about us locally and call us up and make an appointment and again we have parents from all over the country that come to pittsburgh to to have an evaluation preferable you know i think it's wonderful for the work you've been doing a known you for a number of years and and so please keep up the good work and you're doing a lot of good for a lot of people well i hope so at it's like my passion and i think just so that people can appreciate that it's not just an i pad it's everything that goes behind it and make sure you get that evaluation it's so important it makes a difference now thank you katia heal from a c social professor universe of pittsburgh we thank you for watching healthy