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.

Examining Treatment Outcomes Across Contexts: How Do Child Baseline Characteristics Impact Measurement of Treatment Response?

The evaluation of the overlap between the ADOS BOSCC and Standard BOSCC as well as the exploration of child characteristics that may predict change are important steps in consolidating data-driven definitions of "improvement". Participants were seen between 2 and 5 times with Standard BOSCC and ADOS BOSCC observations over the course of early intervention trials (Grzadzinski et al. in J Autism Dev Disord 46:2464, 2016; Kim et al. in Autism 23:5, 2019). Results showed consistency between the Standard BOSCC and ADOS BOSCC, highlighting the utility of both as metrics of change and treatment outcome across contexts. Baseline characteristics may play a role in the tailoring of early intervention to maximize treatment outcome and may offer guidance when determining which outcome measures to use.

Using the Clinical Global Impression scale to assess social communication change in minimally verbal children with autism spectrum disorder.

Assessing improvements in social communication behaviors in minimally verbal children with autism spectrum disorder (ASD) is often challenging. The Clinical Global Impression Scale (CGI) is a 7-point scale that has been adapted so that clinicians can easily and quickly rate social communication behaviors. The current study evaluated the CGI-Improvement (CGI-I) subscale as a measure of social communication change in minimally verbal children with ASD. The sample included 54 minimally verbal school-age children with ASD enrolled in a social communication intervention trial. CGIs were rated by interventionists and the study coordinator at baseline and at Week 6 of intervention, and were compared to scores on the Communication Complexity Scale (CCS). Results indicated that CGI ratings corresponded with CCS scores at baseline and Week 6. Children who were rated as more severe on social communication at baseline demonstrated lower complexity of communication compared to those who were rated as less severe. Those who demonstrated fast response to intervention at Week 6 showed greater improvement in their joint attention than those who were slower responders. These results provide support for the utility and validity of the CGI-I as a measure of social communication change in minimally verbal children. This study tested the CGI, a clinician rating scale, with a group of children with ASD with limited language who received intervention to improve social interactions and communication. Children's CGI ratings were comparable to other assessments in measuring social communication. The CGI may be a useful tool for those interested in quickly and easily tracking changes in children's social communication over the course of treatment. LAY SUMMARY: This study tested the Clinical Global Impression (CGI), a clinician rating scale, with a group of children with ASD with limited language who received intervention to improve social interactions and communication. Children's CGI ratings were comparable to other assessments in measuring social communication. The CGI may be a useful tool for those interested in quickly and easily tracking changes in children's social communication over the course of treatment.

Extending the Usefulness of the Brief Observation of Social Communication Change (BOSCC): Validating the Phrase Speech and Young Fluent Version.

The current study investigated the utility of the Brief Observation of Social Communication Change-Phrase Speech Young Fluent (BOSCC-PSYF) as an outcome measure of treatment response by analyzing the measure's psychometric properties and initial validity. The BOSCC coding scheme was applied to 345 administrations from 160 participants diagnosed with autism. Participants included individuals of any age with phrase speech, or individuals under the age of 8 years with complex sentences. All were receiving behavioral intervention throughout the study. Test-retest and inter-rater reliability were good for the Early Communication and Social Reciprocity/Language domains, and fair for the Restricted and Repetitive Behavior domain. Significant changes occurred over time in the Early Communication and Social Reciprocity/Language domains, and Core Total scores. The BOSCC-PSYF may provide a low-cost, flexible, and user-friendly outcome measure that reliably measures changes in broad social communicative behaviors in a short period of time.

The Brief Observation of Symptoms of Autism (BOSA): Development of a New Adapted Assessment Measure for Remote Telehealth Administration Through COVID-19 and Beyond.

Interest in telehealth assessment for autism has increased due to COVID-19 and subsequent expansion of remote psychological services, though options that are easy for clinicians to adopt and available through the lifespan are limited. The Brief Observation of Symptoms of Autism (BOSA) provides a social context with standardized materials and activities that can be coded by clinicians trained in the Autism Diagnostic Observation Schedule. The current project examined psychometric properties to determine optimal use for each BOSA version. Three hundred and seven participants with 453 BOSAs were included to determine best performing items for algorithms, validity, sensitivity, specificity, recommended cut-offs, and proposed ranges of concern. While preliminary, the BOSA provides a promising new option for telehealth-administered assessment for autism.

Measuring Change in the Communication Skills of Children With Austim Spectrum Disorder Using the Communication Complexity Scale.

Changes in minimal verbal communication by children with autism spectrum disorder (ASD) were measured with the Communication Complexity Scale (CCS) and other communication assessments. The CCS measures complexity of preverbal and beginning verbal communication used to communicate behavior regulation and joint attention. The purpose was to investigate if the CCS was responsive to changes associated with a behavioral intervention aimed at improving communication skills. Changes were detected with CCS scores, rates of initiating joint attention, and the Mullen Scales of Early Learning (MSEL) Expressive Language subscale. Significant changes in CCS scores were also detected for a subgroup of participants who did not show significant changes on the MSEL Expressive Language subscale, demonstrating that CCS scores are sensitive to changes associated with a behavioral intervention.

Concurrent Validity and Reliability for the Communication Complexity Scale.

Purpose: The Communication Complexity Scale (CCS; Brady et al., 2012) was created to fill a void in measures of expressive communication skills in individuals who communicate primarily with presymbolic or early symbolic means. CCS scores reflect expressive communication observed during interactive communication contexts. Method: Two studies were completed to examine the reliability and validity of the revised CCS scores. Participants in both studies had minimal verbal skills (i.e., produced less than 20 functional words). Study 1 examined interobserver agreement, test-retest reliability, and concurrent validity for 239 participants with intellectual disabilities between the ages of 3-66 years, assessed with the protocol developed at the University of Kansas (KU CCS). CCS scores were compared with scores from the Vineland Adaptive Behavior Scales-Second Edition (Sparrow, Cicchetti, & Balla, 2005) and the Communication Matrix (Rowland & Fried-Oken, 2010). Study 2 examined the reliability and concurrent validity for CCS scores derived from 110 children (chronological age = 3-9) with autism from diverse backgrounds. These children were assessed with the Early Social Communication Scale (Mundy et al., 2003). CCS scores were compared with rates of communication derived from the Early Social Communication Scale. Results: CCS scores were moderately correlated with scores from existing measures of early communication. In addition, CCS scores from different raters were reliable, and test-retest scores were highly similar. Conclusions: These findings support the validity and reliability of the CCS when used with individuals across a wide range of ages and with various types of disabilities. The CCS can be used in research and clinical practice to describe extant communication levels in individuals with minimal verbal skills.