Opinion Conversations on the science of autism research.

Standard tests underestimate nonverbal children with autism

by  /  14 April 2015

R. Kremen Missed opportunities: Hanna Suzuki’s intellectual abilities were overlooked because of her verbal deficits.

Nonverbal doesn’t mean incapable. A pilot study of children with autism who have low or no verbal skills suggests that the right intelligence tests can reveal their hidden potential.

The findings, published 6 March in Molecular Autism, add to mounting evidence that standard intelligence tests underestimate the abilities of some children with autism. Alternative tests that tap their strengths, which may include pattern recognition and visual acuity, are likely to paint a more accurate picture of their cognitive abilities.

“This study shows even children with autism who we think appear as low-functioning might have intellectual potential that we are either not aware of, or underestimate,” says lead researcher Isabelle Soulières, assistant professor of psychology at the University of Quebec in Montreal.

Soulières and her team studied 30 children with autism who had little or no verbal ability. None of the children could complete the Wechsler Intelligence Scale for Children — a widely used intelligence test that relies heavily on verbal communication. But when the scientists used a picture-based test called the Raven’s Colored Progressive Matrices, 65 percent of the children scored in the normal range. Ten percent ranked in the 90th percentile.

In this test, participants complete a set of puzzle-like matrices by inserting the correct piece into the blank spot. No verbal instructions are given; the tester simply points to the blank space.

The researchers also administered the Children’s Embedded Figure Test, which involves finding hidden pictures, and visual search tests, in which the child locates a particular symbol amongst many similar symbols. Results for all three tests correlated. The consistency of these scores suggests that picture-based tests can reliably reveal intellectual ability in these children — one rooted in spatial rather than verbal skills.

“I think that developing alternative assessments for children with autism could uncover hidden potential and result in adaptations to how they are taught at school,” says Soulières.

I can easily believe that traditional tests underestimate some children with severe autism. One low-verbal girl I’ve met, 12-year-old Hanna Suzuki, was underestimated due to her limited verbal and motor skills. For years, teachers assumed that she had a significant intellectual delay. When she was 10, she was assigned first-grade math problems even though, it later surfaced, the math was far too easy for her. Using her body effectively and verbalizing the answers had been the obstacle.

Finally, last year Hanna tried a therapy called the Rapid Prompting Method. This approach, which teaches people to communicate by typing, often reveals that students have already taught themselves to read and spell. In a low-distraction environment, children gradually learn to focus, and to coordinate their bodies enough to point. They then learn to insert a stick through letters in a stencil and, sometimes, even to type.

Slowly and laboriously, Hanna can now peck out sentences on an iPad or keyboard. Though she struggles to hit the right keys and stay on task, her writing reflects thoughtful, age-appropriate language. When I asked about her past school experiences, she typed: “The work was not at my level,” referring to the lack of challenge. “I felt incapable.”

Hanna is now studying algebra and enjoys grade-level science lessons. She even interviews people in the community about their jobs, as a part of her therapy. “[My life] has changed tremendously,” she wrote. “I am so hopeful.”

Editor’s note: This article reflects the writer’s opinion. SFARI.org does not endorse the Rapid Prompting Method or any of the opinions described here.

TAGS:   autism, IQ, language, learning

42 responses to “Standard tests underestimate nonverbal children with autism”

  1. Ana says:

    Is there research on RPM? Because I could not find any reliable one.

  2. RPM lover says:

    You have to work with a child to believe it

  3. Dean says:

    “…with autism” sets off my PTSD symptoms. I am unfortunate enough to have grown up during the 1980s and be autistic. Some nights when the medication I need to maintain a regular sleep pattern (which has the fun side effect of making dreams more vivid) works too well, I dream of my male parent and his clones dancing around me, urinating in my mouth, and singing “lolly water”.

    This is the context in which I say “…with autism” causes my PTSD symptoms to leave me shaking and shivering during the rest of the day.

    Please stop using separationist language with us. It is insulting, demeaning, and contrary to the aims of the autism civil rights movement.

  4. Michelle Dawson says:

    The Rapid Prompting Method has been widely marketed as effective without anything resembling a fair test of its benefits and harms to autistics. This is bad science and bad ethics.

    Now SFARI is wrongly using our study as an occasion to uncritically promote Rapid Prompting. This is unethical, to say the least. In my view, it’s egregious.

    • Tracie Lindblad says:

      I am also appalled at the lack of credible reporting on RPM and linking it to these results which were based on a well designed research study. There is no scientific study that upholds the claims made by RPM proponents.

    • rachelkremen says:

      Thank you for your comments.
      Hanna was not touched as she typed, as is sometimes the case with facilitated communication. She typed independently, albeit slowly.

      • Shanni says:

        My son, too learned to type on his own through RPM. While the science may not yet be available, the method takes into account the unique motor and sensory issues that otherwise prevent verbal communication.

  5. ASD Dad says:

    At the heart of this research is the concept of intelligence, unfortunately that has been distorted by the continuance of psychometric testing that has changed little in almost a century. Soulières research could be a tipping point for psychologists and psychiatrists to rexamine amd reinvigorate their work with children for the benefit of all.

    Each and every time we are faced with a child with ASD we must undertake a multidisciplined approach to their education, just as we should with their health and medical needs.

  6. Martyn Matthews says:

    Great peice of recearch in regard to using non-verbal measures of intelligence, but……RPM sounds suspiciously like facilitated communication, which has no evidence base whatsoever and has been thoroughly exposed as a fraud. In fact here is a journal article comparing the two

    Tostanoski, A., Lang, R., Raulston, T., Carnett, A., & Davis, T. (2013). Voices from the past: Comparing the rapid prompting method and facilitated communication. Developmental neurorehabilitation, 17(4), 219-223.

    • Melody Grewal says:

      The conclusion of the article you cite is this: “Clients, proponents, and practitioners of RPM should demand scientific validation of RPM in order to ensure the safety of people with disabilities that are involved with RPM.”

      I don’t think anybody disagrees with that conclusion, but lack of study to date does not lead to the conclusion that RPM is FC. No one is touched in RPM and the end goal is independent typing. As a parent who has thought many years on this method for my son and will finally try it this summer, I think the call by those in academia that RPM is immediately discredited because there are no scientific studies is wrong. I would love to see those studies too, but in the meantime, I’m not going to wait 15 years. Valuable time for my son will have been lost by then and it does not hurt to at least try, especially seeing all the wonderful independent typing that is being done by many RPMers around the world.

      • Shanni says:

        Yes, Melody. I agree. There is an attempt by behaviorists (especially Travers and Todd) to associate RPM with FC. They are completely different. My son used RPM to learn to type with no person touching him, nor touching his keyboard. Travers and Todd would have us believe that this is not possible because there are no scientific studies, yet, I see my son typing his thoughts to me….asking questions, making jokes, doing homework……

  7. Hope says:

    RPM is a method to teach academics, and it is different from FC.

  8. James Todd, PhD says:

    In FC, the facilitator moves the person. In Rapid Prompting, the facilitator moves the letter board. There are no methodologically sound studies showing either works as claimed.

    Here is a critique from the journal Evidence-Based Communication Assessment and Intervention:

    “The only study investigating the rapid prompting method has serious methodological flaws but data suggest the most likely outcome is prompt dependency” by Russell Lang, Amy Harbison Tostanoski, Jason Travers, and James Todd


    • Melody says:

      Do you have a link to where I could read the full article?

      As a parent, I find it amusing that time was taken to study a study, instead of studying the actual subject. Please know I’m not trying to be difficult. I am a thinking parent who is looking to honestly evaluate this method for my own son. I realize there is no academic research (save the Cornell study) about it, but the cacaphony of researchers telling me there is no research instead of actually doing some if frustrating to me. All I have to weigh against the many examples of RPMers typing independently is academians telling me there is no research. Well, I’d love to see some! Please don’t tell me there is no research and then not do anything about it.

    • Shanni says:

      My son learned to type with no person touching his computer keyboard. In fact, he had many, many years of ABA, and had a behavior interventionist at his side while he was learning each skill. Gradually, as my son became increasingly independent, the interventionist faded prompts, moved away, helped generalized the skill. RPM is the same. You begin with prompting, and fade, fade, fade. It takes lots of work.

  9. Jason Travers says:

    I agree with Michelle Dawson and sympathize with her frustration. This blog effectively contaminates an apparently legitimate study with pseudoscience by injecting propaganda for RPM. My first impression was that the study included participants who used RPM (and perhaps FC), but that does not appear to the be the case. RPM has not been demonstrated to produce authentic communication. Dr. Todd is correct in that the primary difference between FC and RPM is that in FC the person is moved to type messages while RPM requires movement of a letter board to produce messages. There remains no reason to believe RPM is a credible method for supporting authentic communication of people with autism or other developmental disabilities.

    • Melody says:

      As an interested parent, I’m curious what you think about those who call themselves RPMers, but now type independently? Do you feel the things they typed independently would also be considered not credible?

  10. Rick says:

    RPM is not to be trusted. There is video evidence that shows Soma, the founder of RPM, and all others who use it, move the letter board. Pseudoscience does no good for Hanna or her parents.

    • Melody says:

      Please note Hanna types independently.

    • rachelkremen says:

      Just to be clear, Hanna did not use a letter board for our interview. She typed directly on to an iPad that was on its own case/stand. It was not held by anyone.

      • Melody says:

        Rachel, Thanks for the continued clarification. This thread is so important to me. I really want to, unemotionally and with great thought, evaluate this method for my son.

      • Jason Travers says:

        Just to be clear, you have used real science to prop up pseudoscience. If RPM were authentic, it would have revolutionized special education and speech-language pathology. The phenomenon defies everything we know about autism and other developmental disabilities. RPM is not new; its been around for decades. Why hasn’t this become widespread if it works, even if only “for some people” as proponents often argue? If RPM worked for 1 in 100 people with autism we still would have tens of thousands of people who could use the method successfully. Is it because the establishment is suppressing alternative methods? Are scientists conspiring against RPM? Is there too much money to be made by educators and speech pathologists?

        Not only are we without one good reason to believe RPM is genuine, but we also have competing, elegant, and verifiable refutations for the phenomenon (c.f., ideomotor effect). Lastly, Soma requires trainees to sign a form agreeing they will not participate in any research she has not approved. That’s a story worthy of investigation. Authentic phenomenon can (must!) be replicated by independent observers to be given any credence.

        Please abstain from advancing RPM and other nonsense by attaching it to the coattails of legitimate research.

        • Melody says:

          Sir, As a mother, I feel compelled to tell you you likely have tipped me over to a decision by your response. My son is full-time in a Floortime school, which does have scientific research and was started by people with PhDs, but is in no way generally accepted or practiced in special education schools. We know iPads loaded with communication apps help immensely. Why doesn’t every one who needs one have one? The point that a therapy not universally used is immediately ineffective does not make sense. In fact, if we agree that ABA is universally accepted, then why are waiting lists years long? Why don’t public schools everywhere offer it? In the area where I live the public system actually evaluates children after a couple years of ABA and deems some to continue and some not. They are saying ABA works for some and not others in a government funded, public system supervised by Pychologists and SLPs. You have not addressed my question about independent typing. If you cannot understand why some therapies work for some on the spectrum, but not others, you do not understand autism in any way helpful to someone who has it.

          • Chris Hamilton says:

            Melody, I don’t know whether RPM is nonsense or not. I have seen videos where RPM students appeared to be genuinely communicating, and I have seen videos where they appeared not to be genuinely communicating. I don’t assume that I can tell by looking.

            As a parent, I would not subject my kid to RPM without better research support because it seems (based on its similarities to FC) to carry a high risk not just of not working, but of turning my kid into a sock puppet. That outcome strikes me as far worse than my child not getting the purported benefits of higher-level education or a more sophisticated communication method.

            Just my two cents. In any case, it’s very unfortunate that the discussion of this genuinely interesting research paper has been derailed by the blog author’s shoehorning in an unrelated controversy. I hope to see more research along these lines. (And the blog author owes Michelle Dawson and her colleagues an apology. I will keep in mind that I shouldn’t assume that SFARI’s blog is held to the same rigorous standard as the research it funds.)

          • Melody says:

            Hi Chris, Thanks for your comments! It’s great to hear from other parents who has thought upon this. You’re right, I think the same thing too when I watch RPM videos. Sure, in the letterboard ones, the practitioner could be moving them. But the independent typing ones, with iPads propped up and the person doing it all on their own, those are the ones that interest me. And the individuals in the independent typing ones tell me that RPM helped them get there. I am willing to give it the years that they say took them to get to that independent typing point. If my son were to stay forever at the letterboard stage, I’m not sure how I’d feel, but right-now me thinks I probably wouldn’t let it continue. My son is currently full-time in a wonderful private Floortime school and he has access to Proloquo2Go on both his school and home iPad. We just started the Proloquo2Go about a year ago and already he has been able to communicate to us many things he could not say, but he independently typed into the keyboard function of Proloquo. Sometimes he’s typed things that he’s then brought the iPad to show to me. I wasn’t even in the same room nor had I any clue that he was thinking about those things; so no one can accuse me of suggesting those ideas to him. It has cut down on his upset behavior immensely; I guess from just being able to finally express what he means without having to verbalize it. To my knowledge (please correct me if I’m wrong), he has access to everything that could help him communicate, but RPM purports to give him a way to segway from academic learning to the sophisticated higher thinking skills that academics lead to. Proloquo has shown me my son cannot necessarily verbalize what he means, but he can type it. For this reason, I am willing to give it a shot now. It’s only 2 days to try with Elizabeth Vosseller. http://www.growingkidstherapy.com/ She was a skeptic herself before and has degrees from top-ranked schools. I’ve had series of therapies from awful therapists in my 12 years in autismland; so to me, the 2 days of intro RPM would at worst, be no worse, but at best, be a life changer. The academians against it have not convinced me with their arguments. The ones given show their bias toward presuming incompetence. Reminds me of therapist who told me my son did not mean this or that and did not believe him until he typed it into a Proloquo2Go app independently. Having met lovely children with cerebral palsy who could not communicate until given electronic help have convinced me ideomotor effect is one of those bad ideas in Psychology. The movements of those children did mean something before, but we didn’t have a way to understand them.

            I can see how someone might think the research paper and RPM are linked, but I didn’t actually. I saw it as an opinion piece, with the author stating some research and then showing how she felt that research might apply. It never crossed my mind that the original paper was about RPM. I think people are allowed to write opinion pieces as long as they make it clear. To me, this article is very clear what is and is not linked. The author cannot account for some who may read it differently, just like any other kind of writing. If we are not allowed to take others’ findings and state how we feel they might apply to situations we know, then wouldn’t that be a damper on writing in general. I don’t think an apology is owed, as this is an opinion piece that comments on research. The researchers can state that they don’t like it, but I don’t think the author needs to apologize for stating her opinion. If we wrote assuming that readers did not have critical, discerning reading skills, then not much interesting would get written in my opinion.

            You obviously love your kid and want the best for him/her. Hope all works out well for your family. Thanks again for the dialogue.

          • Chris Hamilton says:

            Best of luck to you and your child, Melody.

          • opinion says:

            Melody, is there anything specific that would dissuade you from trying RPM? You seem to keep moving the goalposts, which tells me your mind is already made up.

          • Melody says:

            Hi, Yes, absolutely. Someone proving to me that a child who now types independently (and explained to me that they got to that point through RPM) doesn’t. I’m not moving the goalposts. Actually the Cornell paper in support of RPM is not proof enough for me. I did put it in the yay column of my decision chart and I took the points from the other articles critiquing it and put that in the nay column; so those washed out. The tipping point for me right now is that I can see with my own eyes those children who type independently. I live the reality every day that my son can independently type into the Proloquo2Go screen to communicate with me; so I know he has some of those skills that come out through typing that he does not verbalize. The children who type independently told me that RPM helped them get there. Absolutely, I am open to dissuasion. My appointment isn’t for another 4 months. I can still cancel, but no one has given me any evidence against the children who type independently. They type without prompt, physical touch or assistance. They told me they learned how to do it by starting with RPM. All the evidence washes out, but that truth stands bright before my eyes. I’m not going to look away. I’m going to face it with courage and let my son try. Temple Grandin’s experience should teach all ASD parents that professionals do not always know the best way.

          • opinion says:

            Your child already types independently, you’ve said. Why not work on building on that skill (communication that is definitely independent) rather than taking this kind of risk?

            How could a person possibly prove, especially to someone who continues to change the criteria for credibility, that independent typing is not independent? You’re asking for the impossible as the one thing that would change your mind. That doesn’t sound like being open to dissuasion to me.

          • Melody says:

            Beause I don’t know how to build on it and no professionals in my area that I’ve asked seems to either. Everything my son types, he figured out how to do on his own in Proloquo.

            It’s not very risky to travel somewhere and see what someone who is both an MA and an SLP might be able to teach us for a couple days. If I don’t like it or find it creepy or suspicious in any way, I can leave at any time.

            How am I changing the criteria for credibility?

            I’m curious to know if you’re actually in agreement that some RPMers do type independently.

          • Anne says:

            I would love for you to read this blog Melody if you want to know about RPM. I will help you by sharing this post as a starting point: http://emmashopebook.com/2013/11/25/returning-home-2/

      • Seth Bittker says:

        Hi Rachel,
        With respect to your decision to include some information on the therapy Hanna was receiving in your article, you might have phrased it differently. An alternative: “Hanna tried a therapy that we shall not mention the name of or describe the nature of because there have not been any trials in the medical literature that establish the efficacy of said therapy. She currently appears to type independently in sentences and she even appears to express her own thoughts via such typing but this has not been tested under research conditions and we cannot be certain that the therapy was fundamental to her developing these abilities. She also appears to assert via typed statements that the therapy helped her but it should be noted that this is a subjective assessment and based on good research technique we should discount her views, since as she is the subject of the therapy this may have influenced her objectivity.”
        On second thought… I like your version better. To be clear I support your decision to include some information on the therapy being used by Hanna in your article. There is too much group think and self-censorship in discussions of autism and autism research. Information is good. People should make their own assessments based on the available data. If anything, you should be congratulated for writing an article in which so many wish to comment.

  11. Michelle says:

    Actually, standardized tests underestimate ALL kids who have learning disabilities, attention challenges, hyperfocus on their own interests and a lack of concern for low-interest topics, etc.

  12. Anon says:

    The academic “science” community is losing it. Between this type of post on pseudo-science “RPM” by a highly respected science agency (SFAR), and the nonsense modern-day Facilitated Communication on the iPad that Autism Speaks promotes, the academic community is not only embarrassing itself to its clinical community but is also doing damage to individuals with autism and their families around the world. Stop it – it is unethical.

  13. Connie says:

    My non verbal 9 year old appears very intelligent. I would love for her to be able to communicate with me. Even if to help with her fraustration. She can write her own name and it better on her I pad than I would have thought possible. She watches films she chose herself listens to music and nursery rymes and I recently caught her typing a well known children’s TV programme in to my I phone. She spelled it slightly wrong but it shows that inside her own word she is able to type if she wants to see a program on my phone she wants to see.

  14. Liz says:

    My now 6 year old was first tested by the school system when he had just turned 3. The test depended upon verbal skills. My husband and I both noted that his estimated IQ was based on nothing, since he was (and is) nonverbal. He shows his intelligence by navigating his ipad, observing and copying others and working until he figures out how to do something. It’s good to hear of nonverbal tests that might more accurately assess my son’s abilities.

  15. Shanni says:

    My son’s experience is similar To Hannah’s. Within 8 months of starting the Rapid Prompting Method, he learned to type independently on a keyboard or ipad. He’s now working on educational material that is appropriate for his age, rather than the work that was many years below.

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