Pitt Innovation Challenge 2020
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Thinking in Speech
Thinking in Speech
A cognitive therapy that helps children with autism independently cope with everyday events that cause stress, by developing their ability to use "inner speech" - the voice in our heads we use to think.
- Problem: Behavioral treatments for autism teach children specific scripted social responses rather than generalizable problem-solving skills.
- Solution: Thinking in Speech (TiS) is a cognitive therapy that teaches children with autism how to develop inner speech, the voice in our head we use when thinking, to cope with any challenging situations they may encounter.
- Novelty: Despite the increasing number of autism diagnoses, there is a clear need for professionals who work with children with autism to receive training in how to work with this population, and for children with autism to have access to treatment that focuses on developing problem solving skills for a variety of settings.
- Impact: According to one estimate “caring for Americans with autism… would rise to $461 billion by 2025 in the absence of more-effective interventions."
- How $100K moves this forward: This award funds a randomized-control trial to compare TiS with treatment-as usual, develops a standardized online training curriculum, and develops the wireframe (storyboard) for the cloud-based dissemination platform needed for nationwide adoption.
Autism is a neurocognitive developmental disorder, characterized by social and communication impairments, along with repetitive behaviors. According to the CDC in 2019, one in 54 children has autism.
Typical treatments are behavioral, such as Applied Behavior Analysis (ABA). Children are rewarded for memorizing scripts or exhibiting new behaviors, but not when nor how to adapt them to new situations. But real-life is unpredictable; if you can’t adapt, you don’t know what to do, and everything in life becomes stressful. This is what happens to autistic children and why they are prone to meltdowns. Moreover, recent research is challenging both the safety and effectiveness of ABA.
Surprisingly, professionals working with this population receive little training about autism. Typically in graduate training programs it is a brief section in a course on developmental disorders or diagnostic assessments. Those interested in autism are told, “you’ll learn what to do once you’re in the field.”
According to one estimate, “The cost of caring for Americans with autism had reached $268 billion in 2015 and would rise to $461 billion by 2025 in the absence of more-effective interventions and support across the life span.” Thinking in Speech can be this “more-effective intervention.”
Unlike behavioral therapies, TiS is a cognitive intervention that develops inner speech, the voice in our head we use when thinking, which is required for effective self-regulation. Prior research found that children with autism have diminished inner speech. By learning to develop inner speech, children can think through challenging situations that would otherwise cause emotional meltdowns. Autistic children also have underdeveloped interoception; they are unaware of visceral cues like tightening of the stomach, that alert and prepare us for stressful situations. As a result, these children are surprised when stressful situations happen; they panic and meltdown.
TiS is the only intervention that helps autistic children: 1) recognize the “feelings” needed to prepare for challenging situations in all areas of their lives; and (2) develop inner speech needed to independently cope with these same challenging situations. Our proof-of-concept study found that autistic children treated by TiS-trained graduate students were better at coping in stressful situations than children treated by experienced SLPs who did not use TiS.
Through remote training, we can deliver this safe and effective therapy to professionals across the country, reducing health care costs, and giving autistic children a better chance to grow up and lead productive lives.
The competitive landscape analysis below summarizes key features of this solution, and current competitors working to solve similar healthcare problems.
- Barbara L. Baumann, PhD, Faculty member in the Department of Psychiatry and national trainer and consultant for Alternatives for Families: a Cognitive Behavior Therapy, with expertise in global training and dissemination.
- Janice Nathan, MS, CCC-SLP, Founder of Nathan Speech Services, LLC., the developer of TiS, and a speech-language pathologist with over 20 years of experience working with children and adults with autism, and who grew up with a brother and mother with autism.
- Shaun M. Eack, PhD, The James and Noel Browne Professor of Social Work and Psychiatry and Co-Director of the Center for Excellence in Autism Research at the University of Pittsburgh with over 100 peer-review articles.
- Valire Carr Copeland, PhD, MPH, Professor and Associate Director of the Public Health Social Work Training Program, and a faculty affiliate in the UPMC Children’s Hospital Leadership Education in Neurodevelopmental and Related Disabilities and Autism Program.
- Barry R. Nathan, PhD, Research Director for Nathan Speech Services, LLC., co-author of the Thinking in Speech treatment guide, and co-PI with Dr. Carr Copeland on the TiS pilot study with African American families.
- Milestone 1: Develop standardized curriculum for teaching TiS intervention to SLPs, including video-recordings for training, protocols for trainees’ videotaped session requirements, and 1:1 feedback sessions; and adaptations needed for online learning platform (Key Team members: Baumann, J. Nathan, B. Nathan).
- Milestone 2: Design wireframe (storyboard) for dissemination platform and upload all training requirements for initial pilot testing (Key Team members: B. Nathan, Baumann).
- Milestone 3: Complete a randomized control trial of Thinking in Speech, comparing speech-language pathologists using TiS with speech-language pathologist using their usual treatment (Key Team members: Eack, Baumann, Carr Copeland, B. Nathan, J. Nathan).
Path to Impact Plan
Our dissemination/implementation roadmap focuses on three areas:
Training. Prior research showed that TiS can be successfully used by graduate students trained by Janice Nathan. With this award, we can standardize this training for use by other professionals. Once this training has been tested, we can begin the train-the-trainer program for adoption by university SLP graduate programs and TiS certification programs. Eventually, we will extend this training to special education programs.
Dissemination Platform. With this award we can design the wireframe (storyboard) of our dissemination platform for TiS trainers and users and develop a prototype website for uploading all training components for pilot testing with a select group of users. With additional funds (e.g., from SBIR/STTR; autism non-profits and other foundations, etc.) we will add additional resources (scheduling calendars, Communities of Practice interfaces, etc.), and begin beta testing. This will facilitate our long-term objectives for international adoption.
Research. With this grant we can conduct a RCT, positioning us for clinical trials funded by NIH and NSF, and led by Drs. Baumann and Eack. We also will expand our research on autism in Black families, led by School of Social Work professor, Dr. Carr Copeland.
Frequently Asked Questions
I need more detail about the online training program. What is it? What is the actual product, or is this a social program?
A standardized curriculum is needed to train professionals based on the TiS book. This will be uploaded onto the new dissemination platform, and include demonstration videos, quizzes, secure upload for recorded sessions for fidelity checks, etc. Long-term we will develop this into a train-the-trainer curriculum. This will become the salable product.
How is this different from Janice’s online “Improving Behavior and Social Skills” course offered through Summit Education?
That course is only a 6-hour workshop presentation for CEU credits. This will be a train-the-trainer curriculum with trained professionals providing the online training and leading the 1:1 feedback and consulting sessions. It will become a multi-course certification program, not just a single workshop.
Do you have a long-term expansion plan? Otherwise your online dissemination platform seems more like simply a learning platform.
The learning platform is the first phase. Ultimately, it becomes a full-service ecosystem, with interfaces for Communities of Practice (SLPs special education teachers, TiS trainers, etc.); new training courses, (TiS literacy development), a TiS research repository, and business systems (payment processing, trainer tracking system, trainee tracking system, etc.).
Why not use Applied Behavior Analysis (ABA)?
The only large-scale study of ABA was conducted for the Department of Defense. It found no evidence that ABA was effective for autism. In addition, there have been complaints by adults with autism who were subjected to ABA as children, and new research is documenting long-term trauma caused by ABA.