An observational study of parental language during play and mealtime in toddlers at variable likelihood for autism.

Parental language input influences child language outcomes but may vary based on certain characteristics. This research examined how parental language differs during two contexts for toddlers at varying likelihood of autism based on their developmental skills. Parental language (quantity, quality, and pragmatic functions) was analyzed during dyadic play and mealtime interactions as a secondary data analysis of observational data from a study of toddlers at elevated and lower likelihood of autism. Child developmental skills and sensory processing were also assessed. Parents used more words per minute, directives, and verbs during play and more adjectives, descriptions, and questions during mealtime. Parental language differed based on child fine motor skills, receptive language, and levels of sensory hyporesponsiveness but not autism likelihood. Overall, this study found that parental language varies based on context and child developmental skills. Future research examining parental language should include pragmatic functions and context across developmental trajectories.

Is traditional back translation enough? Comparison of translation methodology for an ASD screening tool.

Early identification of autism spectrum disorders (ASD) in non-English speaking children often relies on translation of English ASD screening measures. Most measures employ a forward-back translation approach, despite data suggesting that this method may result in poor psychometric properties. Some studies in non-ASD fields have suggested that a rigorous method of translation with cultural adaptation may yield better psychometric properties, but no studies in the ASD field have compared the two approaches directly. This investigation compares these two translation methodologies to determine if they produce psychometrically similar or dissimilar measures. Three hundred and eighty US-based Spanish-speaking caregivers of children 8-16 months old were randomly assigned to complete either a forward-back Spanish translation or a rigorous translation with cultural adaptation of a parent-report ASD screening tool. Measurement invariance analyses determined that the two translations were psychometrically dissimilar. Additional qualitative explanatory methods using cognitive interviews examined textual differences and participant preferences between non-invariant items. LAY SUMMARY: Autism screening questionnaires created in English need to be translated into other languages so non-English speaking parents can fill them out accurately. Traditionally, researchers have not considered cultural differences when they translate these questionnaires. When we compared a direct translation to a translation with cultural adaptations, the two questionnaires were statistically different. Parents interpreted and responded to the same questions differently, depending on which version they filled out.

Cultural Adaptations to Parent-Mediated Autism Spectrum Disorder Interventions for Latin American Families: A Scoping Review.

PURPOSE: This scoping review maps research in parent-mediated autism spectrum disorder interventions culturally adapted for Latin American populations, to provide an overview of the available evidence across perspectives and disciplines and to identify gaps in the research knowledge base. METHOD: A systematic search for relevant articles was conducted using six databases and archival and forward hand searches of articles that met inclusion criteria. Titles and abstracts were reviewed by three authors, followed by full-text reviews of remaining articles. Twenty-one articles met inclusion criteria and were retained for data extraction. The ecological validity framework was used to frame data analysis and results. RESULTS: In total, 19 studies described unique implementations of 16 different interventions, which spanned 21 articles, representing a range of study designs and implementing a variety of adaptations. Most adaptations consisted of surface-structure changes, spanning the dimensions of language, concepts, methods, context, and persons. Few articles were identified that described international studies or studies examining direct parent-mediated strategies with large sample sizes and strong methodological designs. CONCLUSIONS: Several intervention adaptations that have potential for clinical utility are presented. Clinicians working with Latin American families are encouraged to discuss potential adaptations openly with families before choosing and implementing specific strategies.

Psychometric Comparison of the English and Spanish Western-Hemisphere Versions of the Modified Checklist for Autism in Toddlers-Revised.

OBJECTIVES: Parent-report screening tools for autism spectrum disorder (ASD) are widely used to promote early identification of children with or at risk for ASD. Most screening tools have been developed in English in the United States or United Kingdom; thus, translated versions are needed for use with culturally and linguistically diverse populations. Traditional translation methods include a forward translation, back translation, and review. However, when used in new cultural and linguistic contexts, this "forward-back" approach may have limitations, including differing psychometric properties compared with original instruments. This study presents a psychometric analysis of the forward-back translation methodology of an ASD screening tool. METHODS: A retrospective chart review design was used to examine Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R; Robins et al.) records from 2974 toddlers. Data were compared between caregivers who completed the original English M-CHAT-R and caregivers who completed its forward-back "Spanish-Western Hemisphere" translation to compare select psychometric properties of the 2 instruments. RESULTS: Significant differences were observed between the 2 versions, including a higher overall risk score, higher initial screen-positive rate, and increased likelihood of leaving items blank among Spanish-speaking respondents. CONCLUSION: Traditional translation methods seemed to affect select psychometric properties between translations of the M-CHAT-R. A more rigorous cultural adaptation approach may be necessary to maintain equivalence with the original instrument. Until new rigorous translations are available, it is recommended that language-specific screening tools continue to be used, along with recommended follow-up interviews, to avoid exacerbating existing health disparities.

Rigorous Translation and Cultural Adaptation of an Autism Screening Tool: First Years Inventory as a Case Study.

Screening tools for autism spectrum disorders serve a vital role in early identification of all children who may need evaluation and support. Recent studies suggest that traditional methods used in this field to translate such tools may be insufficient for maintaining linguistic, construct, or technical equivalence, resulting in screening tools that do not meet high psychometric standards in the new population. This study implemented a rigorous translation and cultural adaptation process by translating the First Years Inventory v3.1 (Baranek et al. First year inventory (FYI) 3.1. University of North Carolina at Chapel Hill Chapel Hill, NC, 2003) for a US-based Spanish-speaking population. A description of this process is provided with results from data collected during each phase. The unique challenges that were identified and addressed are detailed for future translation teams.

Cascading effects of attention disengagement and sensory seeking on social symptoms in a community sample of infants at-risk for a future diagnosis of autism spectrum disorder.

Recent work suggests sensory seeking predicts later social symptomatology through reduced social orienting in infants who are at high-risk for autism spectrum disorder (ASD) based on their status as younger siblings of children diagnosed with ASD. We drew on extant longitudinal data from a community sample of at-risk infants who were identified at 12 months using the First Year Inventory, and followed to 3-5 years. We replicate findings of Damiano et al. (in this issue) that a) high-risk infants who go on to be diagnosed with ASD show heightened sensory seeking in the second year of life relative to those who do not receive a diagnosis, and b) increased sensory seeking indirectly relates to later social symptomatology via reduced social orienting. We extend previous findings to show that sensory seeking has more clinical utility later in the second year of life (20-24 months) than earlier (13-15 months). Further, this study suggests that diminished attention disengagement at 12-15 months may precede and predict increased sensory seeking at 20-24 months. Findings add support for the notion that sensory features produce cascading effects on social development in infants at risk for ASD, and suggest that reduced attention disengagement early in life may set off this cascade.

In Search of Culturally Appropriate Autism Interventions: Perspectives of Latino Caregivers.

Most evidence-based autism spectrum disorder (ASD) interventions are tested with primarily White, mid-upper class, English-speaking populations, despite the increase in Latino children with ASD in early intervention programs throughout the United States. Unfortunately, interventions that are incongruent with a target population's culture may be relatively ineffective. This mixed-methods study explored how culturally appropriate, feasible, and acceptable Latino caregivers perceived intervention models, strategies, and targets. Survey data were compared for 28 Latino and 27 non-Latino White parents of young children with ASD. Further, 20 Latino caregivers participated in focus groups to describe their challenges, perspectives and preferences for intervention strategies and models, and unmet needs from providers. These findings underscore the need for culturally modified interventions for Latino children and families.

Unilateral forced nostril breathing and aphasia--exploring unilateral forced nostril breathing as an adjunct to aphasia treatment: a case series.

BACKGROUND AND PURPOSE: Unilateral forced nostril breathing (UFNB), a yogic pranayama technique, improves verbal and spatial cognition in healthy adults. The use of UFNB as an adjunct in aphasia recovery has not been explored. The current study investigated the use and potential benefit of combining UFNB with conventional speech-language therapy. METHODS: A multiple baseline single-subject AB design was conducted across three participants with stroke and aphasia. All participants practiced 40 minutes of UFNB daily at home, after instruction, and received conventional aphasia therapy. Speech and language skills were assessed before and after intervention, with individualized assessments throughout the period. Assessments included the Western Aphasia Battery-R (WAB-R) and the Communication Abilities of Daily Living-2 (CADL-2), as well as the Apraxia Battery for Adults if a diagnosis of apraxia was present. The Color Trails Test was performed and language samples collected for Correct Information Unit (CIU) and word productivity analyses. RESULTS: For the pre- and postassessments, visual inspection revealed an increase in CADL-2 scores for participants A2 and A3. In addition, A1 and A3 had a slight trend of increasing WAB-R aphasia quotients. Some change was observed for total number of CIUs and word productivity in two of the three participants. Attention did not markedly improve from baseline to treatment phase. CONCLUSION: This study suggests that UFNB combined with speech-language therapy may benefit overall language production and functional communication. Further investigation on use of UFNB treatment alongside traditional speech-language therapy is warranted.

Identifying behavioral measures of stress in individuals with aphasia.

PURPOSE: To develop valid indicators of stress in individuals with aphasia (IWA) by examining the relationship between certain language variables (error frequency [EF] and word productivity [WP]) and cortisol reactivity. METHOD: Fourteen IWA and 10 controls participated in a speaking task. Salivary cortisol was collected pre- and posttask. WP and EF were calculated from the language sample elicited during the speaking task. RESULTS: As expected, IWA had less WP and a higher EF than did control participants, and these effects were related to aphasia severity. Cortisol reactivity of IWA was moderately associated with WP, such that those with higher WP showed greater cortisol reactivity. The control group did not demonstrate this relation. Neither group demonstrated a relation between salivary cortisol reactivity and EF. CONCLUSION: WP in individuals with aphasia holds potential as a behavioral index of stress in this population.