Conventions for unconventional language: Revisiting a framework for spoken language features in autism.

Background and aims: Autism has long been characterized by a range of spoken language features, including, for instance: the tendency to repeat words and phrases, the use of invented words, and "pedantic" language. These observations have been the source of considerable disagreement in both the theoretical and applied realms. Despite persistent professional interest in these language features, there has been little consensus around terminology, definitions and developmental/clinical interpretation. Main contribution: This review paper updates and expands an existing framework for unconventional language in autism to include a broader range of non-generative (echolalia and self-repetition) and generative (idiosyncratic phrases, neologisms and pedantic language) features often observed in the language of individuals on the autism spectrum. For each aspect of the framework, we review the various definitions and measurement approaches, and we provide a summary of individual and contextual correlates. We also propose some transitional language features that may bridge non-generative and generative domains (e.g., mitigated echolalia and gestalt language). Conclusions: This updated framework offers a unified taxonomy and nomenclature that can facilitate further investigation and interpretation of unconventional language in autism. Implications: There are important implications of this work for our understanding of the complex interplay between autism and language development. Equally important are the clinical ramifications that will guide evidence-based practice in assessment and intervention for individuals on the autism spectrum.

Word imageability is associated with expressive vocabulary in children with autism spectrum disorder.

Background & aims: Throughout typical development, children prioritize different perceptual, social, and linguistic cues to learn words. The earliest acquired words are often those that are perceptually salient and highly imageable. Imageability, the ease in which a word evokes a mental image, is a strong predictor for word age of acquisition in typically developing (TD) children, independent of other lexicosemantic features such as word frequency. However, little is known about the effects of imageability in children with autism spectrum disorder (ASD), who tend to have differences in linguistic processing and delayed language acquisition compared to their TD peers. This study explores the extent to which imageability and word frequency are associated with early noun and verb acquisition in children with ASD. Methods: Secondary analyses were conducted on previously collected data of 156 children (78 TD, 78 ASD) matched on sex and parent-reported language level. Total expressive vocabulary, as measured by the MacArthur Bates Communicative Development Inventory (MB-CDI), included 123 words (78 nouns, 45 verbs) that overlapped with previously published imageability ratings and word input frequencies. A two-step hierarchical linear regression was used to examine the relationship between word input frequency, imageability, and total expressive vocabulary. An F-test was then used to assess the unique contribution of imageability on total expressive vocabulary when controlling for word input frequency. Results: In both the TD and ASD groups, imageability uniquely explained a portion of the variance in total expressive vocabulary size, independent of word input frequency. Notably, imageability was significantly associated with noun vocabulary and verb vocabulary size alone, with imageability explaining a greater portion of the variance in total nouns produced than in total verbs produced. Conclusions: Imageability was identified as a significant lexicosemantic feature for describing expressive vocabulary size in children with ASD. Consistent with literature on TD children, children with ASD who have small vocabularies primarily produce words that are highly imageable. Children who are more proficient word learners with larger vocabularies produce words that are less imageable, indicating a potential shift away from reliance on perceptual-based language processing. This was consistent across both noun and verb vocabularies. Implications: Our findings contribute to a growing body of literature describing early word learning in children with ASD and provide a basis for exploring the use of multisensory language learning strategies.

Parental tuning of language input to autistic and nonspectrum children.

Caregivers' language input supports children's language development, and it is often tuned to the child's current level of skill. Evidence suggests that parental input is tuned to accommodate children's expressive language levels, but accommodation to receptive language abilities is less understood. In particular, little is known about parental sensitivity to children's abilities to process language in real time. Compared to nonspectrum children, children on the spectrum are slower to process language. In this study, we ask: Do parents of autistic children and those of nonspectrum children tune their language input to accommodate children's different language processing abilities? Children with and without a diagnosis of autism (ages 2-6 years, N = 35) and their parents viewed a display of six images, one of which was the target. The parent labeled the target to direct the child's attention to it. We first examined children's language processing abilities by assessing their latencies to shift gaze to the labeled referent; from this, we found slower latencies in the autistic group than in the nonspectrum group, in line with previous findings. We then examined features of parents' language and found that parents in both groups produced similar language, suggesting that parents may not adjust their language input according to children's speed of language processing. This finding suggests that (1) capturing parental sensitivity to children's receptive language, and specifically language processing, may enrich our models of individual differences in language input, and (2) future work should investigate if supporting caregivers in tuning their language use according to children's language processing can improve children's language outcomes.

Consistency and inconsistency in caregiver reporting of vocabulary.

Vocabulary checklists completed by caregivers are a common way of measuring children's vocabulary knowledge. We provide evidence from checklist data from 31 children with and without autism spectrum disorder. When asked to report twice about whether or not their child produces a particular word, caregivers are largely consistent in their responses, but where they are inconsistent, these inconsistencies affect verbs more than nouns. This difference holds both for caregivers of children with autism spectrum disorder and caregivers of typically-developing children. We suggest that caregivers may be less sure of their child's knowledge about verbs than nouns. This data converges with prior evidence comparing language samples of words children produce in a recorded interaction with checklist data, and it has implications for how researchers use checklist data in cases where the reliability of estimates of verb knowledge is critical.

Identifying Childhood Expressive Language Features That Best Predict Adult Language and Communication Outcome in Individuals With Autism Spectrum Disorder.

Purpose Several studies have reported that "useful speech" at 5 years of age predicts outcomes in individuals with autism spectrum disorder (ASD), but this skill has been vaguely defined. This study investigates which specific aspects of expressive language in children with ASD best predict adult language and communication outcomes. Method Language samples from 29 children (ages 47-72 months) enrolled in a longitudinal project (e.g., Lord et al., 2006) were transcribed and coded for spoken language features. Hierarchical linear regression was used to compare the following childhood variables as predictors of adult language and communication outcomes: noun diversity, verb diversity, mean length of utterance, and proportion of utterances that were socially motivated. Results Childhood verb diversity was a value-added predictor of all four adult outcome measures (i.e., verbal IQ, Autism Diagnostic Observation Schedule Communication + Social Interaction Algorithm totals, Peabody Picture Vocabulary Test scores, and Vineland Adaptive Behavior Scales Communication Domain scores), while noun diversity and proportion of utterances that were socially motivated were not value-added predictors of any adult outcome measures. In a second set of regression analyses, mean length of utterance was substituted for verb diversity and was a value-added predictor of two out of four adult outcome measures (i.e., verbal IQ and Vineland Adaptive Behavior Scales Communication Domain scores). The pattern of findings for the other predictors remained the same as in the previous analyses. Conclusion These results have implications for our understanding of early language in ASD and for clinical decision making in early childhood.

Toddlers' word learning through overhearing: Others' attention matters.

In laboratory settings children are able to learn new words from overheard interactions, yet in naturalistic contexts this is often not the case. We investigated the degree to which joint attention within the overheard interaction facilitates overheard learning. In the study, 20 2-year-olds were tested on novel words they had been exposed to in two different overhearing contexts: one in which both interlocutors were attending to the interaction and one in which one interlocutor was not attending. Participants learned the new words only in the former condition, indicating that they did not learn when joint attention was absent. This finding demonstrates that not all overheard interactions are equally good for word learning; attentive interlocutors are crucial when learning words through overhearing.

The robustness of eye-mouth index as an eye-tracking metric of social attention in toddlers.

Eye-tracking research on social attention in infants and toddlers has included heterogeneous stimuli and analysis techniques. This allows measurement of looking to inner facial features under diverse conditions but restricts across-study comparisons. Eye-mouth index (EMI) is a measure of relative preference for looking to the eyes or mouth, independent of time spent attending to the face. The current study assessed whether EMI was more robust to differences in stimulus type than percent dwell time (PDT) toward the eyes, mouth, and face. Participants were typically developing toddlers aged 18 to 30 months (N = 58). Stimuli were dynamic videos with single and multiple actors. It was hypothesized that stimulus type would affect PDT to the face, eyes, and mouth, but not EMI. Generalized estimating equations demonstrated that all measures including EMI were influenced by stimulus type. Nevertheless, planned contrasts suggested that EMI was more robust than PDT when comparing heterogeneous stimuli. EMI may allow for a more robust comparison of social attention to inner facial features across eye-tracking studies.

Brief Report: Learning Language Through Overhearing in Children with ASD.

We explored whether children with autism spectrum disorder (ASD) learn new nouns from overheard speech. Thirteen children (4-5 years) with ASD participated in an Addressed condition, in which they were directly taught a novel label (e.g., toma) for one of three novel objects, and an Overheard condition, in which the objects and label were presented in a conversation between two adults. In both conditions, children were then asked to identify the labeled object (e.g., "find the toma"). Children selected the target novel object at rates above chance in the Addressed condition, and of critical importance, they also did so in the Overheard condition. This suggests that, like TD children, children with ASD may learn from language that is not directed to them.

Testing the effects of expression, intensity and age on emotional face processing in ASD.

Individuals with autism spectrum disorder (ASD) commonly show global deficits in the processing of facial emotion, including impairments in emotion recognition and slowed processing of emotional faces. Growing evidence has suggested that these challenges may increase with age, perhaps due to minimal improvement with age in individuals with ASD. In the present study, we explored the role of age, emotion type and emotion intensity in face processing for individuals with and without ASD. Twelve- and 18-22- year-old children with and without ASD participated. No significant diagnostic group differences were observed on behavioral measures of emotion processing for younger versus older individuals with and without ASD. However, there were significant group differences in neural responses to emotional faces. Relative to TD, at 12 years of age and during adulthood, individuals with ASD showed slower N170 to emotional faces. While the TD groups' P1 latency was significantly shorter in adults when compared to 12 year olds, there was no significant age-related difference in P1 latency among individuals with ASD. Findings point to potential differences in the maturation of cortical networks that support visual processing (whether of faces or stimuli more broadly), among individuals with and without ASD between late childhood and adulthood. Finally, associations between ERP amplitudes and behavioral responses on emotion processing tasks suggest possible neural markers for emotional and behavioral deficits among individuals with ASD.

Lexical Development in Young Children With Autism Spectrum Disorder (ASD): How ASD May Affect Intake From the Input.

Purpose: Most children with autism spectrum disorder (ASD) have below-age lexical knowledge and lexical representation. Our goal is to examine ways in which difficulties with social communication and language processing that are often associated with ASD may constrain these children's abilities to learn new words and to explore whether minimizing the social communication and processing demands of the learning situation can lead to successful learning. Method: In this narrative review of recent work on lexical development in ASD, we describe key findings on children's acquisition of nouns, pronouns, and verbs and outline our research program currently in progress aimed at further elucidating these issues. Conclusion: Our review of studies that examine lexical development in children with ASD suggests that innovative intervention approaches that take into account both the social communication and processing demands of the learning situation may be particularly beneficial. Presentation Video: https://doi.org/10.23641/asha.7324013.

Differential Attention to Faces in Infant Siblings of Children with Autism Spectrum Disorder and Associations with Later Social and Language Ability.

A growing body of literature has begun to explore social attention in infant siblings of children with autism spectrum disorder (ASD) with hopes of identifying early differences that are associated with later ASD or other aspects of development. The present study used eye-tracking to familiar (mother) and unfamiliar (stranger) faces in two groups of 6-month-old infants: infants with no family history of ASD (low-risk controls; LRC), and infants at high risk for ASD (HRA), by virtue of having an older sibling with ASD. HRA infants were further characterized based on autism classification at 24 months or older as HRA- (HRA without an ASD outcome) or HRA+ (HRA with an ASD outcome). For time scanning faces overall, HRA+ and LRC showed similar patterns of attention, and this was significantly greater than in HRA-. When examining duration of time spent on eyes and mouth, all infants spent more time on eyes than mouth, but HRA+ showed the greatest amount of time looking at these regions, followed by LRC, then HRA-. LRC showed a positive association between 6-month attention to eyes and 18-month social-communicative behavior, while HRA- showed a negative association between attention to eyes at 6 months and expressive language at 18 months (all correlations controlled for non-verbal IQ; HRA- correlations held with and without the inclusion of the small sample of HRA+). Differences found in face scanning at 6 months, as well as associations with social communication at 18 months, point to potential variation in the developmental significance of early social attention in children at low and high risk for ASD.

The effects of early institutionalization on emotional face processing: evidence for sparing via an experience-dependent mechanism.

Early psychosocial deprivation has profound adverse effects on children's brain and behavioural development, including abnormalities in physical growth, intellectual function, social cognition, and emotional development. Nevertheless, the domain of emotional face processing has appeared in previous research to be relatively spared; here, we test for possible sleeper effects emerging in early adolescence. This study employed event-related potentials (ERPs) to examine the neural correlates of facial emotion processing in 12-year-old children who took part in a randomized controlled trial of foster care as an intervention for early institutionalization. Results revealed no significant group differences in two face and emotion-sensitive ERP components (P1 and N170), nor any association with age at placement or per cent of lifetime spent in an institution. These results converged with previous evidence from this population supporting relative sparing of facial emotion processing. We hypothesize that this sparing is due to an experience-dependent mechanism in which the amount of exposure to faces and facial expressions of emotion children received was sufficient to meet the low threshold required for cortical specialization of structures critical to emotion processing. Statement of contribution What is already known on this subject? Early psychosocial deprivation leads to profoundly detrimental effects on children's brain and behavioural development. With respect to children's emotional face processing abilities, few adverse effects of institutionalized rearing have previously been reported. Recent studies suggest that 'sleeper effects' may emerge many years later, especially in the domain of face processing. What does this study add? Examining a cumulative 12 years of data, we found only minimal group differences and no evidence of a sleeper effect in this particular domain. These findings identify emotional face processing as a unique ability in which relative sparing can be found. We propose an experience-dependent mechanism in which the amount of social interaction children received met the low threshold required for cortical specialization.

Greater Pupil Size in Response to Emotional Faces as an Early Marker of Social-Communicative Difficulties in Infants at High Risk for Autism.

When scanning faces, individuals with autism spectrum disorder (ASD) have shown reduced visual attention (e.g., less time on eyes) and atypical autonomic responses (e.g., heightened arousal). To understand how these differences might explain sub-clinical variability in social functioning, 9-month-olds, with or without a family history of ASD, viewed emotionally-expressive faces, and gaze and pupil diameter (a measure of autonomic activation) were recorded using eye-tracking. Infants at high-risk for ASD with no subsequent clinical diagnosis (HRA-) and low-risk controls (LRC) showed similar face scanning and attention to eyes and mouth. Attention was overall greater to eyes than mouth, but this varied as a function of the emotion presented. HRA- showed significantly larger pupil size than LRC. Correlations between scanning at 9 months, pupil size at 9 months, and 18-month social-communicative behavior, revealed positive associations between pupil size and attention to both face and eyes at 9 months in LRC, and a negative association between 9-month pupil size and 18-month social-communicative behavior in HRA-. The present findings point to heightened autonomic arousal in HRA-. Further, with greater arousal relating to worse social-communicative functioning at 18 months, this work points to a mechanism by which unaffected siblings might develop atypical social behavior.

The integrity of lexical acquisition mechanisms in autism spectrum disorders: A research review.

Research on autism spectrum disorders (ASD) has rapidly expanded in recent years, yielding important developments in both theory and practice. While we have gained important insights into how children with ASD differ from typically developing (TD) children in terms of phenotypic features, less has been learned about if and how development in ASD differs from typical development in terms of underlying mechanisms of change. This article aims to provide a review of processes subserving lexical development in ASD, with the goal of identifying contributing factors to the heterogeneity of language outcomes in ASD. The focus is on available evidence of the integrity or disruption of these mechanisms in ASD, as well as their significance for vocabulary development; topics include early speech perception and preference, speech segmentation, word learning, and category formation. Significant gaps in the literature are identified and future directions are suggested. Autism Res 2016, 9: 810-828. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.

Neural measures of social attention across the first years of life: characterizing typical development and markers of autism risk.

Few studies employing event-related potentials (ERPs) to examine infant perception/cognition have systematically characterized age-related changes over the first few years of life. Establishing a 'normative' template of development is important in its own right, and doing so may also better highlight points of divergence for high-risk populations of infants, such as those at elevated genetic risk for autism spectrum disorder (ASD). The present investigation explores the developmental progression of the P1, N290, P400 and Nc components for a large sample of young children between 6 and 36 months of age, addressing age-related changes in amplitude, sensitivity to familiar and unfamiliar stimuli and hemispheric lateralization. Two samples of infants are included: those at low- and high-risk for ASD. The four components of interest show differential patterns of change over time and hemispheric lateralization; however, infants at low- and high-risk for ASD do not show significant differences in patterns of neural response to faces. These results will provide a useful point of reference for future developmental cognitive neuroscience research targeting both typical development and vulnerable populations.

The role of early visual attention in social development.

Faces convey important information about the social environment, and even very young infants are preferentially attentive to face-like over non-face stimuli. Eye-tracking studies have allowed researchers to examine which features of faces infants find most salient across development, and the present study examined scanning of familiar (i.e., mother) and unfamiliar (i.e., stranger) static faces at 6-, 9-, and 12-months-of-age. Infants showed a preference for scanning their mother's face as compared to a stranger's face, and displayed increased attention to the eye region as compared to the mouth region. Infants also showed patterns of decreased attention to eyes and increased attention to mouths between 6 and 12 months. Associations between visual attention at 6, 9, and 12 months and the Communication and Symbolic Behavior Scales DP (CSBS-DP) at 18 months were also examined, and a significant positive relation between attention to eyes at 6 months and the social subscale of the CSBS-DP at 18 months was found. This effect was driven by infants' attention to their mother's eyes. No relations between face scanning in 9- and 12-month-olds and social outcome at 18 months were found. The potential for using individual differences in early infant face processing to predict later social outcome is discussed.

The Modified Checklist for Autism in Toddlers in extremely low gestational age newborns: individual items associated with motor, cognitive, vision and hearing limitations.

The Modified Checklist for Autism in Toddlers (M-CHAT) has yielded elevated rates of screening failure for children born preterm or with low birthweight. We extended these findings with a detailed examination of M-CHAT items in a large sample of children born at extremely low gestational age. The sample was grouped according to children's current limitations and degree of impairment. The aim was to better understand how disabilities might influence M-CHAT scores. Fourteen participating institutions of the Extremely Low Gestational Age Newborns (ELGAN) Study prospectively collected information about 1086 infants who were born before the 28th week of gestation and had an assessment at age 24-months. The 24-month visit included a neurological assessment, the Bayley Scales of Infant Development, Second edition (BSID-II), M-CHAT and a medical history form. Outcome measures included the distribution of failed M-CHAT items among groups classified according to cerebral palsy diagnosis, gross motor function, BSID-II scores and vision or hearing impairments. M-CHAT items were failed more frequently by children with concurrently identified impairments (motor, cognitive, vision and hearing). In addition, the frequency of item failure increased with the severity of impairment. The failed M-CHAT items were often, but not consistently, related to children's specific impairments. Importantly, four of the six M-CHAT 'critical items' were commonly affected by presence and severity of concurrent impairments. The strong association between impaired sensory or motor function and M-CHAT results among extremely low gestational age children suggests that such impairments might give rise to false positive M-CHAT screening.

Neural correlates of familiar and unfamiliar face processing in infants at risk for autism spectrum disorders.

Examining the neural correlates associated with processing social stimuli offers a viable option to the challenge of studying early social processing in infants at risk for autism spectrum disorders (ASDs). The present investigation included 32 12-month olds at high risk for ASD and 24 low-risk control infants, defined on the basis of family history. Infants were presented with familiar and unfamiliar faces, and three components of interest were explored for amplitude and latency differences. The anticipated developmental effects of emerging hemispheric asymmetry for face-sensitive components (the N290 and P400) were observed, as were familiarity effects for a component related to attention (the Nc). Although there were no striking group differences in the neural response to faces, there was some evidence for a developmental lag in an attentional component for the high-risk group. The infant ASD endophenotype, though elusive, may be better defined through expanding the age of study and addressing change over time in response to varied stimuli.

Identifying early-risk markers and developmental trajectories for language impairment in neurodevelopmental disorders.

The effective identification of neurodevelopmental disorders is essential for early diagnosis and provision of intervention services. For many of these conditions, one of the primary domains of abnormality is language development. This review addresses what is known about the earliest indicators of language impairment across a range of neurodevelopmental disorders; consideration is given to both behavioral and neural markers, as well as patterns of change over time. A summary of the current state of the field, including challenges in research, is presented. The earliest features of the language phenotype in Down syndrome, Williams syndrome, Fragile X, specific language impairment (SLI), and autism spectrum disorder (ASD) are described, along with recent findings in the early neural markers of language impairment in SLI and ASD.

Language assessment and development in toddlers with autism spectrum disorders.

One of the primary diagnostic criteria for the diagnosis of autism spectrum disorders (ASD) is the presence of a language delay or impairment. Children with ASD are now being identified at significantly younger ages, and prior research has consistently found that early language skills in this population are heterogeneous and an important predictor for later outcome. The goal of this study was to systematically investigate language in toddlers with ASD and to identify early correlates of receptive and expressive language in this population. The study included 164 toddlers with ASD between the ages of 18 and 33 months who were evaluated on several cognitive, language and behavioral measures. Results suggested good agreement among different measures of early language, including direct assessment and parent report measures. Significant concurrent predictors of receptive language included gestures, non-verbal cognitive ability and response to joint attention. For expressive language, the most significant predictors were non-verbal cognitive ability, gestures and imitation. These findings have important implications for intervention programs targeting this population.