Prelinguistic communication complexity predicts expressive language in initial minimally verbal autistic children.

BACKGROUND: Prelinguistic communication complexity refers to the use of different communication forms such as eye gaze, gestures and vocalisations and the degree to which these forms are coordinated and how directed to a communication partner. To date, little is known about the relationship between prelinguistic communication complexity and expressive language in minimally verbal autistic children. AIMS: To test the hypothesis that prelinguistic communication complexity predicts expressive language 12 months later in autistic children and explore whether there are any differences in specific prelinguistic intentional communicative behaviours that are related to later expressive language levels. METHODS & PROCEDURES: This longitudinal study examined 37 minimally verbal autistic children (29-71 months old). The Communication Complexity Scale (CCS) was used to measure participants' prelinguistic communication behaviours, which were extracted from a semi-structured play interaction at Time 1. The Chinese Communicative Development Inventory (CCDI) was used to examine participants' expressive language at Time 1 and Time 2 (12 months later). According to Time 2 vocabulary size, participants were divided into two groups: Low CCDI, between 0 and 62 words, and High CCDI, more than 100 words. Linear regression was used to examine the relationship between early prelinguistic communication complexity and later expressive language. Binary logistic regression was used to determine which of the early communication behaviours were uniquely significantly related to later expressive language levels. OUTCOMES & RESULTS: There was a significant positive relationship between prelinguistic communication complexity and expressive language 12 months later, even after controlling for age and concurrent language. Findings revealed a group difference in the frequency of gesture and vocalisation combinations between the Low and High CCDI groups at Time 1. Gesture-vocalisation combinations also predicted better expressive language levels at Time 2. CONCLUSIONS & IMPLICATIONS: Our findings suggest that it may be beneficial to incorporate different complex communication behaviours into prelinguistic intervention targets for minimally verbal autistic children. The CCS hierarchies can be used as a reference for the intervention goals of minimally verbal autistic children. These findings highlight the importance of targeting gesture and vocalisation combinations when autistic children transition from single prelinguistic communication behaviours to multimodal behaviours. WHAT THIS PAPER ADDS: What is already known on this subject Children use eye gaze, gestures and vocalisations to communicate with others before they learn spoken language. There is strong evidence suggest that the frequency of prelinguistic communication predicts later linguistic achievements in autistic children. However, less is known about whether prelinguistic communication complexity also predicts later language and which specific behaviours are most predictive of language outcomes. What this study adds Minimally verbal autistic children who exhibit more complex prelinguistic communication behaviours have better expressive language 12 months later. Gestures combined with vocalisations predict better expressive language in minimally verbal autistic children. What are the clinical implications of this work? When identifying intervention targets for minimally verbal autistic children, the clinicians may reference the prelinguistic communication behaviours from the CCS. The gesture and vocalisation combinations are the key behaviours when targets transit from single form to two-form behaviours.

Linguistic, concept and symbolic composition in adults with minimal receptive vocabulary.

In this paper, we examine some basic linguistic abilities in a small sample of adults with minimal receptive vocabulary, whose receptive mental verbal age ranges from 1;2 to 3;10. In particular, we examine whether the participants in our study understand noun phrases consisting of a noun modified by an adjective. We use stimuli that they can recognise by name. Except for one participant, we find that, while all of them understand the noun and adjective in isolation, none seems to understand these noun phrases, which means that they seem to not do linguistic composition. In order to test whether the difficulty is linguistic or conceptual, we ran two other studies, one on concept composition, and the other on iconic symbolic composition (composition of pictograms). Results suggest that linguistic composition is particularly difficult in this population, and that vocabulary breadth may not predict compositional abilities.

The effect of responsiveness to speech-generating device input on spoken language in children with autism spectrum disorder who are minimally verbal†.

The use of speech-generating devices (SGD) in early interventions for children with autism spectrum disorder (ASD) can improve communication and spoken language outcomes. The purpose of this study was to describe children's responsiveness to SGD input modeled by a social partner during adult-child play interactions over a 24-week intervention trial and explore the effect of that responsiveness on spoken language growth. This secondary analysis consisted of 31 children with less than 20 functional words at study entry who received a blended behavioral intervention (JASPER + EMT) as part of a randomized controlled trial. Significant improvements were seen in rate of responsiveness to both adult SGD models and adult natural speech models; only rate of responsiveness to SGD models at entry was a significant predictor of frequency of commenting and was a more robust predictor of number of different words post-intervention. Lastly, at entry, children with more joint attention and language responded to SGD models at significantly higher rates. Attention and responsiveness to SGD output may be important mechanisms of language growth and children who have more joint attention skills may particularly benefit from use of an SGD.

Review of methods for conducting speech research with minimally verbal individuals with autism spectrum disorder.

The purpose of this paper was to review best-practice methods of collecting and analyzing speech production data from minimally verbal autistic speakers. Data on speech production data in minimally verbal individuals are valuable for a variety of purposes, including phenotyping, clinical assessment, and treatment monitoring. Both perceptual ("by ear") and acoustic analyses of speech can reveal subtle improvements as a result of therapy that may not be apparent when correct/incorrect judgments are used. Key considerations for collecting and analyzing speech production data from this population are reviewed. The definition of "minimally verbal" that is chosen will vary depending on the specific hypotheses investigated, as will the stimuli to be collected and the task(s) used to elicit them. Perceptual judgments are ecologically valid but subject to known sources of bias; therefore, training and reliability procedures for perceptual analyses are addressed, including guidelines on how to select vocalizations for inclusion or exclusion. Factors to consider when recording and acoustically analyzing speech are also briefly discussed. In summary, the tasks, stimuli, training methods, analysis type(s), and level of detail that yield the most reliable data to answer the question should be selected. It is possible to obtain rich high-quality data even from speakers with very little speech output. This information is useful not only for research but also for clinical decision-making and progress monitoring.

Attention to intentional versus incidental pointing gestures in young autistic children: An eye-tracking study.

Whereas a reduced tendency to follow pointing gestures is described as an early sign of autism, the literature on response to joint attention indicates that autistic children perform better when a point is added to other social cues such as eye gaze. The purpose of this study was to explore pointing processing in autism when it is the only available cue and to investigate whether autistic children discriminate intentional pointing gestures from incidental pointing gestures. Eye movements of 58 autistic children (48 male) and 61 typically developing children (36 male) aged 3-5 years were recorded as the children were watching videos of a person uttering a pseudoword and pointing intentionally with one hand and incidentally with the other hand. After 3 s, two different potential referents for the pseudoword gradually emerged in both pointed-at corners. In comparison with typically developing children, autistic children's fixations were significantly farther away from both pointed-at zones. Upon hearing a novel word, typically developing children shifted their visual attention toward the zone pointed intentionally. This trend did not emerge in the group of autistic children regardless of their level of vocabulary. Autistic children, independently of their level of language, pay little attention to pointing when no other social cues are available and fail to discriminate intentional pointing gestures from incidental ones. They seem to grasp neither the spatial nor the social value of pointing.

Professionals' views on how to conduct investigative interviews with adults with limited expressive language.

Adults with communication impairment are vulnerable to abuse and are over-represented as victims in the criminal justice system. Investigative interviewers rely largely on verbal accounts to establish whether a criminal offence occurred, and therefore the way these accounts are elicited is paramount. To date, little research has evaluated whether current interviewing protocols are appropriate for eliciting accurate and detailed information from adults with communication impairment. The present study explored this issue through qualitative interviews with professionals from various disciplines. Specifically, professionals (N = 22) who had extensive experience in interviewing, disability advocacy, and cognitive and communication impairment reflected on current recommended practice and how it could potentially improve. The results indicated widespread support for the current (open questioning) approach, although the professionals perceived that additional verbal and visual scaffolding could potentially enhance the amount of detail obtained without compromising accuracy. Suggestions for interview protocol modifications and future research are discussed.

Communication behaviours of children with cerebral palsy who are minimally verbal.

BACKGROUND: There is a lack of population-based studies exploring the communicative behaviours of minimally verbal children with cerebral palsy (CP), with factors associated with superior and poorer communication outcomes unknown. This study aimed to examine the communication behaviours of minimally verbal children with CP recruited from a representative community sample and to identify factors associated with communication outcomes. METHODS: Twenty minimally verbal children aged 5-6 years, recruited through the Victorian Cerebral Palsy Register, completed the Communication and Symbolic Behaviour Scales-Developmental Profile (CSBS-DP). Linear regressions examined child-related and environmental factors associated with communication outcomes. RESULTS: CSBS-DP total raw scores ranged from 0 to 113. Strengths were the use of conventional gestures and understanding of language. Challenges were noted in using sequential action schemes during play. Communication typically served to regulate the behaviour of others. All participants demonstrated reduced functional communication (Communication Function Classification System levels III-IV). In the multivariable regression model adjusted for cognition, poorer communication skills were associated with Manual Ability Classification System levels IV-V (P = 0.004). CONCLUSIONS: Although some children with CP who are minimally verbal use a variety of communication functions, significant functional limitations may be apparent. Severe upper limb impairment may provide an early indication of greater communication difficulties.

The proportion of minimally verbal children with autism spectrum disorder in a community-based early intervention programme.

BACKGROUND: Estimates of the proportion of children with autism spectrum disorder (ASD) who are minimally verbal vary from 25%to 35%. However, there is a lack of consensus in defining minimally verbal and few detailed reports of communication outcomes for these children following intervention. The aim of this study was to explore how minimally verbal children have been defined and to document the proportion of minimally verbal children in a group of children with ASD receiving a community based early intervention programme. METHOD: A longitudinal cohort design was used to examine the proportion of children who met criteria for minimally verbal in 246 children with ASD when they entered and exited an early intervention programme. RESULTS: Overall, 26.3% of the children in this study exited the programme using 'fewer than five spontaneous and functional words' and 36.4% exited not using 'two word phrases' as indicated by direct assessment. However, our findings were mixed depending on measures and definitions used, with parent report indicating that as many as 29.4% of children were not 'naming at least three objects' consistently, and 43.3% not using 'phrases with a noun and verb' consistently at exit. More than half of the children who entered the programme with minimal speech exited the programme with a similar language profile. A small percentage of children (1.2%-4.7%) regressed in their language level over time. CONCLUSIONS: Despite advances in early intervention, and access to services at a younger age, around a quarter of individuals with ASD in this study exited early intervention with significant communication needs. Our findings are considered in relation to the literature and clinical implications, and future research directions are discussed.

Longitudinal study of symptom severity and language in minimally verbal children with autism.

BACKGROUND: A significant minority of children with autism spectrum disorder (ASD) are considered 'minimally verbal' due to language development stagnating at a few words. Recent developments allow for the severity of ASD symptoms to be examined using Autism Diagnostic Observation Schedule (ADOS) Social Affect (SA) and Restricted and Repetitive Behaviors (RRB) domain severity scores. The aim of the current study was to explore language outcomes in a cohort of minimally verbal children with autism evaluated through the preschool years and determine if and how ASD symptom severity in core domains predicts the development of spoken language by age 5. METHODS: The sample consisted of 70 children with autism aged 1-5 years at the first evaluation who were examined at least 1 year later, during their fifth year of age. The ADOS overall level of language item was used to categorize children as minimally verbal or having phrase speech, and the Mullen Scales of Early Learning was used as a continuous measure of expressive language. RESULTS: At Time 1, 65% (n = 47) of children in the sample were minimally verbal and by Time 2, 36% (n = 17 of 47) of them had developed phrase speech. While the Time 1 ADOS calibrated severity scores did not predict whether or not a child remained minimally verbal at Time 2, change in the SA calibrated severity score (but not RRB) was predictive of the continuous measure of expressive language. However, change in SA severity no longer predicted continuous expressive language when nonverbal cognitive ability was added to the model. CONCLUSIONS: Findings indicate that the severity of SA symptoms has some relationship with continuous language outcome, but not categorical. However, the omnipresent influence of nonverbal cognitive ability was confirmed in the current study, as the addition of it to the model rendered null the predictive utility of SA severity.

Preschool language variation, growth, and predictors in children on the autism spectrum.

BACKGROUND: There is wide variation in language abilities among young children with autism spectrum disorders (ASD), with some toddlers developing age-appropriate language while others remain minimally verbal after age 5. Conflicting findings exist regarding predictors of language outcomes in ASD and various methodological issues limit the conclusions that can be drawn about factors associated with positive language growth that could provide insights into more effective intervention approaches for increasing communication skills. METHODS: Language development was investigated in 129 children with ASD participating in four assessments from mean age 2½ years (Visit 1) through 5½ years (Visit 4). Language ability was measured by a clinician-administered test of comprehension and production. Hierarchical linear modeling was used to identify predictors of language ability. Stability of language status was examined in subgroups of Preverbal versus Verbal children identified at Visit 1. Discriminant function analysis was used to classify another subset of cases according to Low Language (minimally verbal) versus High Language outcome at Visit 4. RESULTS: ASD severity was a significant predictor of growth in both language comprehension and production during the preschool period, while cognition predicted growth in production. For the highest and lowest language performers at Visit 4, cognition, maternal education, and response to joint attention correctly classified over 80% of total cases. The vast majority of children who were preverbal at 2½ years attained some level of verbal skills by 5½ years. CONCLUSIONS: Findings indicate that it is possible, by 2½ years, to predict language growth for children with ASD across the preschool years and identify factors that discriminate between children who remain minimally verbal at 5½ years from those with high language proficiency. Results suggest that early intervention focused on reducing core ASD symptoms may also be important for facilitating language development in young children with ASD.