Current Research in Pragmatic Language Use Among Deaf and Hard of Hearing Children.

In this article, we provide a narrative review of research literature on the development of pragmatic skills and the social uses of language in children and adolescents, with a focus on those who are deaf and hard of hearing (DHH). In the review, we consider how pragmatic skills may develop over time for DHH children and adolescents depending on age, language context, amplification devices, and languages and communication modalities. The implications of these findings for enhancing intervention programs for DHH children and adolescents and for considering ideal contexts for optimizing the pragmatic development of DHH children are considered.

Language disorders.

Developmental language disorders (DLD) are prevalent and persistent among school-age children but are often underrecognized. This chapter discusses the ways in which the various components of communication are impacted by these disorders and outlines the differences in expression seen in different languages. Research on biological and psychologic roots of the syndrome is also reviewed. As yet, no single definitive cause has been identified; the disorders are likely to result from a constellation of genetic, biological, and cognitive weaknesses that are influenced by environmental experiences. Basic methods of assessment and differential diagnosis are presented and the principles guiding the development of intervention programs are discussed.

A Case-Based, Brief, Intensive Interprofessional Education Experience for School Practitioners.

Professionals from healthcare and education frequently work together to serve clients in public schools. We devised an interprofessional activity including students in occupational therapy, physical therapy, speech-language pathology, social work, and education in which students designed an interprofessional intervention program for a school child with complex needs. Allied health students who expressed interest in pediatric practice were recruited to participate. Students filled out the Interdisciplinary Education Perception Scale (IEPS), a Likert-scale measure of perceptions about related disciplines, before and after the experience. Quantitative analysis of responses on the IEPS showed a significant improvement in interdisciplinary perceptions after the experience as evidenced by higher IEPS scores. Qualitative analysis using a narrative thematic description of reflections on the experience confirmed this finding. These findings suggest a brief, intensive preservice interprofessional experience can have a positive effect on students' interprofessional attitudes, and points toward aspects of these experiences, including student-led discussions and small group conversations, that students find especially appealing.

Brief Report: A Mobile Application to Treat Prosodic Deficits in Autism Spectrum Disorder and Other Communication Impairments: A Pilot Study.

This study examined the acceptability of a mobile application, SpeechPrompts, designed to treat prosodic disorders in children with ASD and other communication impairments. Ten speech-language pathologists (SLPs) in public schools and 40 of their students, 5-19 years with prosody deficits participated. Students received treatment with the software over eight weeks. Pre- and post-treatment speech samples and student engagement data were collected. Feedback on the utility of the software was also obtained. SLPs implemented the software with their students in an authentic education setting. Student engagement ratings indicated students' attention to the software was maintained during treatment. Although more testing is warranted, post-treatment prosody ratings suggest that SpeechPrompts has potential to be a useful tool in the treatment of prosodic disorders.

From the Editor: An Introduction to the JSLHR Supplement on Implementation Science.

PURPOSE: The JSLHR Supplement on Implementation Science is aimed at providing discussion and examples of research in implementation science, the study of methods designed to promote the incorporation of research findings into clinical practice. METHODS: Practitioners in the language science area were invited to submit articles that address their experience with various aspects of implementation science. RESULTS: Six articles from several research groups comprise this supplement. CONCLUSIONS: Implementation science is an aspect of intervention research that merits consideration by communication disorders scientists. More extensive practice of implementation science will improve uptake of evidence-based practice in the clinical community.

The use of prosody during syntactic processing in children and adolescents with autism spectrum disorders.

In this study, we employed an eye-gaze paradigm to explore whether children (ages 8-12) and adolescents (ages 12-18) with autism spectrum disorders (ASDs) are able to use prosodic cues to determine the syntactic structure of an utterance. Persons with ASD were compared to typically developing (TD) peers matched on age, IQ, gender, and receptive language abilities. The stimuli were syntactically ambiguous but had a prosodic break that indicated the appropriate interpretation (feel the frog … with the feather vs. feel … the frog with the feather). We found that all groups were equally sensitive to the initial prosodic cues that were presented. Children and teens with ASD used prosody to interpret the ambiguous phrase as rapidly and efficiently as their TD peers. However, when a different cue was presented in subsequent trials, the younger ASD group was more likely to respond in a manner consistent with the initial prosodic cue rather than the new one. Eye-tracking data indicated that both younger groups (ASD and TD) had trouble shifting their interpretation as the prosodic cue changed, but the younger TD group was able to overcome this interference and produce an action consistent with the prosodic cue.

Assessing pragmatic language in autism spectrum disorder: the Yale in vivo Pragmatic Protocol.

PURPOSE: This study compared pragmatic language in youths (9-17 years) with autism spectrum disorder (ASD) and those with typical development (TD) on the Yale in vivo Pragmatic Protocol (YiPP), a semistructured, dynamic conversational assessment. METHOD: Participants (n = 118) were divided into groups based on age and diagnosis. Each completed the YiPP, which included 4 pragmatic domains (discourse management, communicative functions, conversational repair, presupposition). The participant's response to each probe was scored correct or incorrect; incorrect scores elicited cues from the examiner, and level of cue required for a correction was also scored. RESULTS: The YiPP showed high reliability and internal consistency, with moderate concurrent validity, sensitivity, and specificity. The group with ASD performed worse overall on YiPP probes compared to their TD counterparts on both error (d = 0.96) and cue (d = 0.91) scores. Item analyses revealed greater gaps between older students with ASD and their TD peers than between the 2 younger groups. CONCLUSIONS: These data suggest that a probe measure designed to assess pragmatic abilities in children with ASD within a conversational context has some validity for contributing to diagnostic classification and can identify specific areas of pragmatic vulnerabilities as part of a clinical assessment.

Prosodic development in middle childhood and adolescence in high-functioning autism.

The present study aims to investigate the perception and production of several domains of prosodic performance in a cross-sectional sample of preadolescents and adolescents with and without high-functioning autism (HFA). To look at the role of language abilities on prosodic performance, the HFA groups were subdivided based on "high" and "low" language performance on the Clinical Evaluation of Language Fundamentals-Fourth Edition (CELF-4) (Semel, Wiig, & Secord). Social and cognitive abilities were also examined to determine their relationship to prosodic performance. No significant differences were seen in prosody scores in the younger versus older subgroups in typically developing (TD) group with age-appropriate language. There was small but significant improvement in performance with age in the groups with HFA. Comparing performance at each age level across diagnostic groups showed that preteens with HFA and higher language levels perform similarly to their TD peers on all prosodic tasks, whereas those with lower language skills scored significantly worse than both their higher language and TD peers when looking at composite perception and production findings. Teens with HFA showed no deficits on perception tasks; however, those with low language levels had difficulty on several production tasks when compared to the TD group. Regression analyses suggested that, for the preteen group with HFA, language was the strongest predictor of prosodic perception, whereas nonverbal IQ was most highly predictive of prosodic production. For adolescents with HFA, social skills significantly contributed to the prediction of prosodic perception and, along with language abilities, predicted prosodic production. Implications of these findings will be discussed.

Pragmatics abilities in narrative production: a cross-disorder comparison.

We aimed to disentangle contributions of socio-pragmatic and structural language deficits to narrative competence by comparing the narratives of children with autism spectrum disorder (ASD; n = 25), non-autistic children with language impairments (LI; n = 23), and children with typical development (TD; n = 27). Groups were matched for age (6½ to 15 years; mean: 10;6) and non-verbal ability; ASD and TD groups were matched on standardized language scores. Despite distinct clinical presentation, children with ASD and LI produced similarly simple narratives that lacked semantic richness and omitted important story elements, when compared to TD peers. Pragmatic errors were common across groups. Within the LI group, pragmatic errors were negatively correlated with story macrostructure scores and with an index of semantic-pragmatic relevance. For the group with ASD, pragmatic errors consisted of comments that, though extraneous, did not detract from the gist of the narrative. These findings underline the importance of both language and socio-pragmatic skill for producing coherent, appropriate narratives.

Adaptive behavior in toddlers under two with autism spectrum disorders.

The Vineland Adaptive Behavior Scale was administered to 54 children diagnosed with autism spectrum disorder (ASD) before age 2, and a matching group of 18 toddlers with developmental delay (DD). The group with ASD was more impaired on all scales of the Vineland than DD peers. When 18 ASD/DD pairs very closely matched on age, verbal and nonverbal development were selected, differences were found only on Vineland Receptive Communication and Daily Living. Correlation analyses to explore connection of these areas of difference with cognition and autistic symptoms suggested that Vineland Daily Living scores were significantly correlated with nonverbal ability and with ADOS total algorithm scores. Vineland Receptive Communication scores correlated significantly only with ADOS total algorithms. The clinical implications of these findings are discussed.

Comparing spoken language treatments for minimally verbal preschoolers with autism spectrum disorders.

Preschoolers with severe autism and minimal speech were assigned either a discrete trial or a naturalistic language treatment, and parents of all participants also received parent responsiveness training. After 12 weeks, both groups showed comparable improvement in number of spoken words produced, on average. Approximately half the children in each group achieved benchmarks for the first stage of functional spoken language development, as defined by Tager-Flusberg et al. (J Speech Lang Hear Res, 52: 643-652, 2009). Analyses of moderators of treatment suggest that joint attention moderates response to both treatments, and children with better receptive language pre-treatment do better with the naturalistic method, while those with lower receptive language show better response to the discrete trial treatment. The implications of these findings are discussed.

Social robots as embedded reinforcers of social behavior in children with autism.

In this study we examined the social behaviors of 4- to 12-year-old children with autism spectrum disorders (ASD; N = 24) during three tradic interactions with an adult confederate and an interaction partner, where the interaction partner varied randomly among (1) another adult human, (2) a touchscreen computer game, and (3) a social dinosaur robot. Children spoke more in general, and directed more speech to the adult confederate, when the interaction partner was a robot, as compared to a human or computer game interaction partner. Children spoke as much to the robot as to the adult interaction partner. This study provides the largest demonstration of social human-robot interaction in children with autism to date. Our findings suggest that social robots may be developed into useful tools for social skills and communication therapies, specifically by embedding social interaction into intrinsic reinforcers and motivators.

Sensitivity to probabilistic orthographic cues to lexical stress in adolescent speakers with autism spectrum disorder and typical peers.

Lexical stress refers to the opposition of strong and weak syllables within polysyllabic words and is a core feature of the English prosodic system. There are probabilistic cues to lexical stress present in English orthography. For example, most disyllabic English words ending with the letters "-ure" have first-syllable stress (e.g., "pasture", but note words such as "endure"), whereas most ending with "-ose" have second-syllable stress (e.g., "propose", but note examples such as "glucose"). Adult native speakers of English are sensitive to these probabilities during silent reading. During testing, they tend to assign first-syllable stress when reading a nonword such as "lenture" but second-syllable stress when reading "fostpose" (Arciuli & Cupples, 2006 ). Difficulties with prosody, including problems processing lexical stress, are a notable feature of autism spectrum disorder (ASD). The current study investigated the ability of adolescents with ASD (13-17 years of age) to show this sensitivity compared with a group of typically developing peers. Results indicated reduced sensitivity to probabilistic cues to lexical stress in the group with ASD. The implications of these findings are discussed.

Enhancing the application and evaluation of a discrete trial intervention package for eliciting first words in preverbal preschoolers with ASD.

This study evaluates the effectiveness of an intervention package including a discrete trial program (Rapid Motor Imitation Antecedent Training (Tsiouri and Greer, J Behav Educat 12:185-206, 2003) combined with parent education for eliciting first words in children with ASD who had little or no spoken language. Evaluation of the approach includes specific intervention targets and functional spoken language outcomes (Tager-Flusberg et al., J Speech Lang Hear Res 52:643-652, 2009). Results suggest that RMIA, with parent training, catalyzes development of verbal imitation and production for some children. Three of five participants acquired word production within the DTT framework and achieved milestones of early functional spoken language use (Tager-Flusberg et al., J Speech Lang Hear Res 52:643-652, 2009). The implications of these findings for understanding the role of discrete trial approaches to language intervention are discussed.

The neural underpinnings of prosody in autism.

This study examines the processing of prosodic cues to linguistic structure and to affect, drawing on fMRI and behavioral data from 16 high-functioning adolescents with autism spectrum disorders (ASD) and 11 typically developing controls. Stimuli were carefully matched on pitch, intensity, and duration, while varying systematically in conditions of affective prosody (angry versus neutral speech) and grammatical prosody (questions versus statement). To avoid conscious attention to prosody, which normalizes responses in young people with ASD, the implicit comprehension task directed attention to semantic aspects of the stimuli. Results showed that when perceiving prosodic cues, both affective and grammatical, activation of neural regions was more generalized in ASD than in typical development, and areas recruited reflect heightened reliance on cognitive control, reading of intentions, attentional management, and visualization. This broader recruitment of executive and "mind-reading" brain areas for a relative simple language-processing task may be interpreted to suggest that speakers with high-functioning autism (HFA) have developed less automaticity in language processing and may also suggest that "mind-reading" or theory of mind deficits are intricately bound up in language processing. Data provide support for both a right-lateralized as well as a bilateral model of prosodic processing in typical individuals, depending upon the function of the prosodic information.

Acoustic Differences In The Imitation Of Prosodic Patterns In Children With Autism Spectrum Disorders.

In research, it has been difficult to characterize the prosodic production differences that have been observed clinically in Autism Spectrum Disorders (ASD). Moreover, the nature of these differences has been particularly hard to identify. This study examined one possible contributor to these perceived differences: motor planning. We examined the ability of children and adolescents with ASD to imitate prosodic patterns in comparison to a group with learning disabilities (LD) and a typically-developing (TD) comparison group. Overall, we found that both the ASD and LD groups were significantly worse at perceiving and imitating prosodic patterns than the TD comparison group. Similar to previous studies using non-imitative speech, participants with ASD showed a significantly longer duration of utterances than the two comparison groups when attempting to imitate an intonation pattern. The implications of differences in duration of utterances are discussed. This study also highlights the importance of using clinical comparison groups in studies of language performance in individuals with ASD.

Phonology and vocal behavior in toddlers with autism spectrum disorders.

The purpose of this study is to examine the phonological and other vocal productions of children, 18-36 months, with autism spectrum disorder (ASD) and to compare these productions to those of age-matched and language-matched controls. Speech samples were obtained from 30 toddlers with ASD, 11 age-matched toddlers and 23 language-matched toddlers during either parent-child or clinician-child play sessions. Samples were coded for a variety of speech-like and nonspeech vocalization productions. Toddlers with ASD produced speech-like vocalizations similar to those of language-matched peers, but produced significantly more atypical nonspeech vocalizations when compared to both control groups. Toddlers with ASD show speech-like sound production that is linked to their language level, in a manner similar to that seen in typical development. The main area of difference in vocal development in this population is in the production of atypical vocalizations. Findings suggest that toddlers with ASDs do not tune into the language model of their environment. Failure to attend to the ambient language environment negatively impacts the ability to acquire spoken language.

The hypothesis of apraxia of speech in children with autism spectrum disorder.

In a sample of 46 children aged 4-7 years with Autism Spectrum Disorder (ASD) and intelligible speech, there was no statistical support for the hypothesis of concomitant Childhood Apraxia of Speech (CAS). Perceptual and acoustic measures of participants' speech, prosody, and voice were compared with data from 40 typically-developing children, 13 preschool children with Speech Delay, and 15 participants aged 5-49 years with CAS in neurogenetic disorders. Speech Delay and Speech Errors, respectively, were modestly and substantially more prevalent in participants with ASD than reported population estimates. Double dissociations in speech, prosody, and voice impairments in ASD were interpreted as consistent with a speech attunement framework, rather than with the motor speech impairments that define CAS.

From Bayes through marginal utility to effect sizes: a guide to understanding the clinical and statistical significance of the results of autism research findings.

The objectives of this report are: (a) to trace the theoretical roots of the concept clinical significance that derives from Bayesian thinking, Marginal Utility/Diminishing Returns in Economics, and the "just noticeable difference", in Psychophysics. These concepts then translated into: Effect Size (ES), strength of agreement, clinical significance, and related concepts, and made possible the development of Power Analysis; (b) to differentiate clinical significance from statistical significance; and (c) to demonstrate the utility of measures of ES and related concepts for enhancing the meaning of Autism research findings. These objectives are accomplished by applying criteria for estimating clinical significance, and related concepts, to a number of areas of autism research.

Out of the mouths of babes: vocal production in infant siblings of children with ASD.

BACKGROUND: Younger siblings of children with autism spectrum disorders (ASD) are at higher risk for acquiring these disorders than the general population. Language development is usually delayed in children with ASD. The present study examines the development of pre-speech vocal behavior in infants at risk for ASD due to the presence of an older sibling with the disorder. METHODS: Infants at high risk (HR) for ASD and those at low risk, without a diagnosed sibling (LR), were seen at 6, 9, and 12 months as part of a larger prospective study of risk for ASD in infant siblings. Standard clinical assessments were administered, and vocalization samples were collected during play with mother and a standard set of toys. Infant vocal behavior was recorded and analyzed for consonant inventory, presence of canonical syllables, and of non-speech vocalizations, in a cross-sectional design. Children were seen again at 24 months for provisional diagnosis. RESULTS: Differences were seen between risk groups for certain vocal behaviors. Differences in vocal production in the first year of life were associated with outcomes in terms of autistic symptomotology in the second year. CONCLUSIONS: Early vocal behavior is a sensitive indicator of heightened risk for autistic symptoms in infants with a family history of ASD.