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30 November 2016 • EP MAGAZINE | eparent.com

BY MICHELLE BOUDREAU

•PHOTOS PROVIDED BY MICHELLE BOUDREAU

Autism spectrum disorder, according to the Mayo Clinic, “is aserious neurodevelopmental disorder that impairs a child'sability to communicate and interact

with others. It also includes restrictedrepetitive behaviors, interests, and activi-ties. These issues cause significant impair-ment in social, occupational and otherareas of functioning.” As many as 42% ofchildren with ASD are reported to haveimpairment in both verbal expression andcomprehension abilities.1 The Center forDisease Control records the rate of ASDdiagnosis to be one in 68, giving insight tothe vast number of students affected byASD and the associated language deficits.2

Not surprisingly, the language compre-hension deficits of students with ASDimpact the classroom environment. Theability to understand the English languageis foundational to success within the curriculum utilized in theUnited States’ educational system. As a result, students who strug-

gle with language comprehension often falter in their educationalperformance. They fall behind academically and frequently expe-

rience psychosocial problems, which inturn affect relationships with their peersand teachers. There is, however, a solutionto this challenge. Students with ASD canimprove their language comprehensionthrough a scientifically-based andresearch-validated program.

hiSToryLanguage comprehension is a complex

brain process. Multiple parts of the brainare involved and the connection betweenthem is fundamental to comprehension.The Dual Coding Theory of cognition,researched and developed by Allan Paivioof the University of Western Ontario, stip-ulates that both visual and verbal repre-

sentations of words, sentences, and paragraphs are necessary formemory and language comprehension. A person must be able toassociate images with words, and vice-versa, for effective cognitiveprocessing to take place. Connections between the imaginal areasof the brain and the verbal or language areas of the brain are thecritical, functional process for comprehension. Albert Einstein

Language comprehenSiondeficiTS for chiLdren wiTh

auTiSm SpecTrum diSorder (aSd)need noT neceSSariLy

Be permanenT

The Scienceof improved

LanguagecomprehenSionBrain connecTiviTy and auTiSm SpecTrum diSorder

WRITTEN ON BEHALF OF LINDAMOOD-BELL

1. “Verbal Expression and Comprehension Deficits in Young Children With Autism.” ResearchGate.Web. 19 Jan. 2016.

2. “Data & Statistics.” Centers for Disease Control and Prevention. Centers for Disease Control andPrevention, 12 Aug. 2015. Web. 19 Jan. 2016.

30 November 2016 • EP MAGAZINE | eparent.com

eparent.com | EP MAGAZINE • November 2016 31

attested to this fact saying, “If I can’t picture it, I can’t understandit.”

Only in recent years have language comprehension deficitsbegun to be identified as a specific type of learning disability.Previously, the symptoms of comprehension deficits wereacknowledged, such as poor recall or difficulty with expression,but the underlying problems were not. As a consequence, treat-ment was limited to “language only” strategies that attempted tomitigate and remediate the symptoms, instead of addressing thecause of the deficit.

While some children with ASD have a tremendousability for compartmentalized memory, theircapacity is typically limited to specific subjectdomains. For example, a child might have anuncanny ability to recall baseball statisticsbut struggles to retain information from asimple reading paragraph. Another childcould demonstrate the ability to decodewords at a level much higher than anticipat-ed, but cannot extract meaning from thematerial. This apparent disparity fosters amisconception of the true nature of the lan-guage comprehension deficit in studentswith ASD, when in reality, it is caused by aweakened connection between the imagerygenerating and language parts of the brain.

Key educaTionaL iSSueSThe US Education Model: Language is

the basis for teaching and learning in theUnited States. All learning requires a basicfoundation of language comprehension,regardless of the subject matter. Textbooksand oral instruction rely primarily on lan-guage to communicate the curriculum.Furthermore, the teaching process oftenrelies on delivering content through lan-guage-based repetition. The premise isthat if students exhibiting at-risk languagecomprehension skills are exposed to the material enough times,he or she will learn it.

This approach, however, ignores the underlying processes andthe necessary connectivity between the imagery and verbal cen-ters in the brain. When these centers do not adequately communi-cate, due to a weak or underdeveloped connection, no amount ofrepetition of content-based instruction will remedy language com-prehension deficits. Consequently, many students fall further andfurther behind academically because they do not understand whatis being presented in the classroom.

Students navigate a continual cycle of instruction where com-prehension is tested (not taught), resulting in reward or penalty,depending on the test results. When a student is not capable oflearning due to language comprehension deficits, the results canbe devastating academically, socially, and emotionally. This isespecially true for students on the autism spectrum.Social and Psychological Impacts: Not only are students with

language comprehension deficits prone to academic struggles,

they also face related social and emotional challenges. They arelikely to ask questions repeatedly, attempting to grasp informationthey do not retain or understand. Similarly, students with ASD failto connect to the larger picture of the classroom objectives and arelikely to make unrelated comments. Teachers may mistake thesebehaviors as intentionally disruptive and take disciplinary steps.Peers often find the behaviors off-putting and distance themselvessocially, resulting in alienation of the student with ASD. Timing: The prevailing educational model requires students to

demonstrate failure to access the curriculum prior to mak-ing interventions and accommodations via special

education plans. Brain plasticity—the brain’s abil-ity to modify its structure—is at its highest

capacity in childhood. This indicates thenecessity of intervening as soon as languagecomprehension deficits are identified.Language comprehension is fundamental toall learning—inside the classroom andout—thus warranting the swiftest and mostrobust intervention available.

reSearch-vaLidaTed SoLuTionSThe need to engage in more effective

ways to address language comprehensiondeficits is essential given the rise in ASDdiagnoses and the associated comprehen-sion problems. As such, the educational

system in the United States must begin toadopt a more effective means of bothidentifying those deficits and remediatingthe underlying brain process, not merelytreating the symptoms. Current research isopening the doors to scientifically-basedand scientifically-validated interventions.Functional Activation: The neural con-

nections in a brain with autism are poorlysynchronized. This makes complex tasks,such as spatial reasoning and languagecomprehension, more difficult for persons

with ASD due to the inadequate communication between the brainregions that govern them.

Remediating this deficiency requires functional activation: cog-nitive exercises that electrochemically stimulate the brain’s abilityto send messages to and from the areas required to code theincoming language into mental representations (imagery) and thenverbally. This enhances the structural integrity of the brain. Bystrengthening the dendrites and axons—the conduit mechanismsof the brain—information is more readily transferred between therequired regions of the brain, allowing images to be associatedwith words and vice-versa. Visualizing and Verbalizing program: Dual Coding Theory

(DCT) emphasizes the need for both the mental representationaland the verbal cortical areas to be stimulated for optimal languagecomprehension. Paivio’s theory has been accepted for more thanfour decades but has more recently been examined through thelens of neurology to observe functional brain connectivity. NanciBell’s Visualizing and Verbalizing program develops what she calls

deficiTS in LanguagecomprehenSion can Be

improved Through STimuLaTingand STrengThening The

connecTion BeTweenThe verBaL and imaginaL

cenTerS of The Brain

32 November 2016 • EP MAGAZINE | eparent.com

concept imagery—the ability to create animagined or imaged gestalt from lan-guage—as a basis for comprehension andhigher order thinking. The development ofconcept imagery improves reading and lis-tening comprehension, memory, oralvocabulary, critical thinking, and writing.

The University of Alabama atBirmingham chose the Visualizing andVerbalizing program to conduct a study toassess the legitimacy of DCT and neurolog-ical validity of its premises as applied toASD students. In summary, the resultsproved promising for bolstering the brain’sability to comprehend language. Here is arecap of the research project:• Participants and controls. Forty-five

children participated in the study: 19typically-developing students and 26students who had been diagnosedwith ASD by a licensed clinical psy-chologist. The 26 subjects with ASDwere randomly assigned to twogroups. Thirteen of the 26 ASD stu-dents received the instruction. Thesecond group consisted of the other13 who did not receive the instruction.The typically-developing students alsodid not receive the instruction. Thethree groups provided a point of com-parison between typically-developingstudents, those with ASD, as well as ac o m p a r i s o nbetween theASD studentswho receivedthe instructionand those whodid not.

• Study durationand intensity.Participants inthe experimen-tal study under-went 10 weeksof intensivei n s t r u c t i o nusing NanciB e l l ’ sVisualizing andVerbalizing pro-gram, a curriculum designed to stimu-late the conceptual imagery associat-ed with written or spoken language.The material stimulates all facets oflanguage comprehension: reading andlistening comprehension, memory,oral vocabulary, critical thinking, and

writing. Students received four hoursof instruction from Lindamood-Bellstaff, five days a week, for 10 weeks.

• Neurological observations andresults. All 45 study participants weresubject to two functional MRI (fMRI)scans to document their brain func-tion(s), at the beginning of the 10-weeks, and again at the end. The initialscans of typically-developing studentsshowed strong connectivity between

the imaginal andverbal corticalcenters whereasthose of the ASDstudents revealedonly loose con-nectivity betweenthe centers. At theconclusion of thestudy, when allstudents were re-scanned, theimaginal-verbalc o n n e c t i o nshowed markedimprovement inthose who hadreceived theVisualizing and

Verbalizing program. Those studentswho did not receive the instructionshowed no substantive change in theconnection between cortical centers(whether ASD or typically developing).

• Behavioral observations and results.Reading comprehension assessments

were also administered to all threegroups of participants at the beginningand end of the study. Typically-devel-oping students performed better thanboth ASD groups at both testing times.After 10 weeks, the 13 ASD studentswho received the intensive instructionshowed significant improvement(16.4%) on the comprehension test.Those ASD students who did notreceived no instruction had littlechange (2.6%) and continued to havelower scores than those of the typical-ly-developing students.

The 10-week study demonstrated thenecessity of a strong connection betweenthe imaginal and verbal cortical centers ofthe brain for language comprehension.Allan Paivio’s Dual Coding Theory was neu-rologically observable through fMRI scansof students receiving intensive instructionusing a high-imagery/verbalization instruc-tional process. Students with ASD, whostruggle to comprehend language, can havea strengthened connection between thebrain regions necessary for improvementsin memory and language comprehension.Objectives and benefits of intervention:

The primary goal of both parents and edu-cators of children with ASD is to providethem with the best means to live a fulfillinglife with meaningful relationships and theincreased ability to grasp what’s happeningin the world around them. The currentmethods for remediating language compre-hension deficits (and the associated behav-ioral/psychosocial problems) may not nec-

aS STudenTS maKe gainS inLanguage comprehenSion, TheyBecome BeTTer aBLe To manage

Their own Learning. The goaL iSTo have a LaSTing effecT on noTjuST The academic BuT aLSo The

pSychoSociaL Learning.

eparent.com | EP MAGAZINE • November 2016 33

essarily address the underlying impaired neurologicalprocess.

When students fall behind their peers academicallyand socially by a year or more, rigorous and intenseinterventions geared toward the brain’s required learn-ing mechanisms will prove necessary to close the gap.Weekly appointments for 20-60 minutes simply won’tbe sufficient. The University of Alabama at Birminghamstudy recorded notable improvements with a sensory-cognitive brain-based intervention for four hours perday, five days a week, for 10 weeks. Adopting the mind-set that intense and lengthy intervention is necessary ispivotal to success.

As students make gains in language comprehension,they become better able to manage their own learning.Self-regulation in learning is foundational to successfullearning throughout formal education and life outsidethe classroom. Students can begin to visualize whatthey learn—utilizing both the imaginal and verbal corti-cal centers—and apply it to all subjects. When the neu-rological pathways of the brain have been strengthenedto support the learning process, they naturally reinforcethemselves over the course of all other learning—con-tinuously stimulating the imagery-language connec-tion. The goal, of course, is to have a lasting effect onnot just the academic but also the psychosocial learn-ing.

SummaryLanguage comprehension deficits for children with

autism spectrum disorder (ASD) need not necessarily bepermanent. Deficits in language comprehension can beimproved through stimulating and strengthening theconnection between the verbal and imaginal centers ofthe brain. As predicted by the Dual Coding Theory, theVisualizing and Verbalizing program develops conceptimagery—the ability to create an imaged gestalt, orwhole, from language. This approach recognizes thebrain process that underlies language comprehensionand remediates impairment with a scientifically-vali-dated intervention. Language comprehension is foun-dational to learning—both social and academic—in theeducational environment. With a better understandingof subject matter and social relationships, students arepoised for greater success in all areas of life.•

ABOUT THE AUTHOR:

Lindamood-Bell believes that all children and adults can learn to

their potential. For nearly 30 years, their research-validated instruc-

tion has consistently changed the lives of individuals with learning

challenges such as dyslexia, ADHD, and autism. In addition to

their nearly 100 Learning Centers and Seasonal Learning Clinics

nationally and internationally, their efforts include research collab-

orations with MIT, UAB, and previously with Wake Forest, and

Georgetown University. Lindamood-Bell has been recognized by

the U.S. Department of Education, Time, US News and World

Report, Neuron, NeuroImage, CNN, and PBS. Lindamood-Bell and

all of their Learning Centers are accredited by AdvancED. Visit lin-

damoodbell.com to learn more.

reSourceSIdentifying brain-processing issues is imperative to remediating lan-

guage comprehension deficits. While the current educational model

doesn’t often distinguish between the symptoms and the causes as it

relates to methods of support, both parents and educators are wise to

assess the root of the problem. To evaluate whether a child has impaired

concept imagery, consider the following indicators, taken from Nanci

Bell’s book, Visualizing and Verbalizing (used with permission):

1.Difficulty with critical, logical, abstract thinking and prob-

lem solving. Individuals appear unable to draw conclusions or

make inferences due to lacking a connection to the larger picture.

2.Difficulty with written language comprehension. Individuals

struggle to comprehend the main ideas from text though decoding

skills are adequate. Students may test poorly except when merely

factual data is being challenged.

3.Difficulty with oral language comprehension. Individuals may

show disinterest in orally-presented material or an ability to attend

to oral presentations. These individuals may be labeled as inatten-

tive listeners.

4.Difficulty following directions. Individuals grow easily confused

by directions involving more than one or two steps. They seem

unable to retain the instructions.

5.Difficulty in expressing language orally. Individuals may

recount stories out of sequence or articulate unimportant details.

Their language seems scattered or disconnected.

6.Difficulty expressing language in writing. Individuals’ writing

doesn’t reflect sequential thoughts leading to a coherent point.

They may have difficulty understanding the purpose of a question,

rendering a clear answer impossible.

7. Difficulty grasping humor. literal interpretation of language

precludes understanding of language-based humor, though physi-

cal humor does not. Individuals may laugh at inappropriate times.

8.Difficulty interpreting social situations. Individuals fail to grasp

the non-verbal communication, leaving them with only isolated

parts of information to guide behavior, resulting in inappropriate

social expression.

9.Difficulty with cause and effect. Whether in social or academic

situations, individuals who process only parts of information being

communicated, not the whole, cannot grasp how the part relates

to the whole. Verbal discussion of a problem may prove ineffective.

10. Difficulty with attention and focus. Individuals may not be

able to sustain focus or attention in learning or even in social situa-

tions.

11. Difficulty responding to a communicating world. Individuals

appear to find language a confusing puzzle or altogether meaning-

less and consequently opt to withdraw themselves and may end up

isolated socially.

12. Difficulty with mental mapping. Individuals may find following

a map difficult and get lost easily.

While none of these symptoms alone indicates weak conceptual

imagery as an underlying cause of language comprehension deficits,

they do raise the flag of concern. If multiple factors are present, they

give reason for further investigation or referral to a professional for eval-

uation.