Beyond the motor account of amyotrophic lateral sclerosis: Verbal humour and its relationship with the cognitive and pragmatic profile.

BACKGROUND: Amyotrophic Lateral Sclerosis (ALS) was traditionally described as a disease restricted to the motor system. However, recent findings suggested that it also affects cognition, especially executive functions, social cognition, language and pragmatics. A relevant issue in current research is thus the description of the cognitive phenotype of ALS and the identification of the most vulnerable aspects. AIMS: The focus was on a communicative phenomenon placed at the crossroads of pragmatic and other cognitive domains, namely humour, which till now has been poorly explored in ALS. The first aim was to investigate whether ALS is associated with impairments in understanding and appreciating jokes. The second aim was to explore the predictors of humour comprehension and appreciation in patients, to confirm the involvement of pragmatic skills and to explore the role of other cognitive and clinical aspects. METHODS & PROCEDURES: A total of 30 non-demented patients with ALS and 27 controls were assessed with a task of verbal humour comprehension and appreciation, including two types of jokes: phonological and mental. We also administered a battery of pragmatic and other language tasks, and cognitive and socio-cognitive tasks. Mixed-effects models were used to test differences in the humour task between the two groups. Multiple regressions determined the best predictors of humour comprehension and appreciation in patients. OUTCOMES & RESULTS: Patients obtained lower comprehension accuracy scores than controls in the humour task, independently of the type of joke. Conversely, patients and controls did not differ in joke appreciation and both rated mental jokes as funnier than the phonological ones. Patients' comprehension accuracy was predicted by pragmatic skills and ALS severity, whereas appreciation was predicted by several clinical variables and, to a smaller extent, by language skills. CONCLUSIONS & IMPLICATIONS: The findings suggest that humour is a very vulnerable aspect in ALS, and that impairment in humour comprehension might be part of the larger cognitive impairment, being linked to pragmatic impairment. Clinical variables were also important, especially in relation to humour appreciation. More generally, these data speak in favour of pragmatics as a relevant aspect to sketch the cognitive phenotype of ALS. On the practical level, these findings point to the need of supporting communication at large, not only motor-related aspects such as dysarthria but also social-pragmatic aspects such as understanding jokes, to increase well-being in ALS. What this paper adds What is already known on this subject The literature of the last decades has shown that ALS comes with impairment in several cognitive domains, affecting especially executive functions as well as language. There is also initial evidence that the pragmatics of communication and humour comprehension are impaired, although non-serious talk has been documented in conversational interaction among people with ALS. What this paper adds to existing knowledge This study offers compelling evidence of an impairment in the comprehension of jokes in ALS, whereas the appreciation of joke funniness seems to be spared. The study also highlights the interplay of cognitive factors (especially pragmatics) and clinical factors (related to disease severity) in predicting the patients' performance in the humour task. What are the potential or actual clinical implications of this work? The study's findings call for the need of increased awareness among scholars as well as practitioners and caregivers of the profile of humour comprehension and appreciation in ALS. On a practical level, we highlight the need of assessing humour comprehension and adapting the communicative style accordingly. Second, we recommend that intervention programmes targeting communication in ALS go beyond speech-related difficulties and include pragmatic aspects such as humour. Considering the important communicative and social function of humour, as well as its use as a coping strategy, humour interventions are key to improve the quality of life of individuals with ALS.

Assessing Pragmatic Skills Using Checklists with Children who are Deaf and Hard of Hearing: A Systematic Review.

This paper investigates the use of checklists to assess pragmatics in children and adolescents who are deaf and hard of hearing. A systematic literature review was undertaken to identify all of the published research articles between 1979 and 2018 on the topic of the assessment of pragmatics for this population of children and adolescents. The 67 papers identified in this review were analyzed and all papers that utilized a checklist to assess pragmatic skills were identified. Across the 18 different published papers on the use of pragmatic skills among children who are deaf and hard of hearing, nine checklists were identified. These nine checklists were then compared and contrasted on six key features including identification of a theoretical framework or model; the type of pragmatic skills measured; the age range of the child assessed; the information/outputs generated; the primary informant for the assessment; and reliability, validity, and normative data. The resulting analysis provides a comprehensive guide to aid clinicians, educators, and researchers in selecting an appropriate checklist to assess pragmatic skills for children and adolescents who are deaf and hard of hearing.

Selective impairments in components of affective prosody in neurologically impaired individuals.

The intent and feelings of the speaker are often conveyed less by what they say than by how they say it, in terms of the affective prosody - modulations in pitch, loudness, rate, and rhythm of the speech to convey emotion. Here we propose a cognitive architecture of the perceptual, cognitive, and motor processes underlying recognition and generation of affective prosody. We developed the architecture on the basis of the computational demands of the task, and obtained evidence for various components by identifying neurologically impaired patients with relatively specific deficits in one component. We report analysis of performance across tasks of recognizing and producing affective prosody by four patients (three with right hemisphere stroke and one with frontotemporal dementia). Their distinct patterns of performance across tasks and quality of their abnormal performance provides preliminary evidence that some of the components of the proposed architecture can be selectively impaired by focal brain damage.

Evaluating social (pragmatic) communication disorder.

BACKGROUND: Social (pragmatic) communication disorder (SPCD) is a new diagnosis introduced by DSM-5, characterised by problems with verbal and nonverbal social communication. It is currently unclear whether SPCD is a valid diagnostic category, because little is known about the characteristics of those who meet its criteria. We sought to identify and describe cases of SPCD, to contribute to debates about its validity. We investigated whether the symptoms of SPCD cluster together to form a coherent syndrome that is distinct from autism spectrum disorder (ASD) in terms of its core and associated features. METHODS: Participants were young people (N = 1,081, age range = 4-18 years) who had attended a specialist social communication disorders clinic for children with fluent language and normal-range intelligence. Standardised parent-report data were collected using the Developmental, Dimensional and Diagnostic Interview (3Di), Child Communication Checklist (CCC) and Strengths and Difficulties Questionnaire (SDQ). An algorithm was designed using 3Di and CCC items to implement DSM-5 SPCD criteria. RESULTS: Eighty-eight young people met our criteria for SPCD, with 801 meeting DSM-5 ASD criteria and the remaining 192 having neither SPCD nor ASD ('clinical comparison group'). The core symptoms of SPCD co-occurred to a moderate degree (average interitem correlation = .22). SPCD cases had autistic social difficulties that were intermediate between ASD and the clinical comparison group. SPCD was associated with high rates of nonautistic psychopathology, with 63.5% scoring in the abnormal range of the SDQ's Total Problems scale. CONCLUSIONS: We did not find evidence that SPCD is qualitatively distinct from ASD. Rather, it appears to lie on the borderlands of the autism spectrum, describing those with autistic traits that fall just below the threshold for an ASD diagnosis. SPCD may have clinical utility for identifying people with autistic traits that are insufficiently severe for ASD diagnosis, but who nevertheless require support.

Conversation breakdowns in the audiology clinic: the importance of mutual gaze.

BACKGROUND: Conversational breakdowns are a persistent concern for older adults with hearing impairment (HI). Previous studies in experimental settings have investigated potential causes of breakdowns in conversations with a person with HI, and effective strategies for repairing these breakdowns. However, little research has explored the causes of hearing-related communication breakdowns, and their repairs, in extended, naturally occurring conversations in a healthcare setting. AIMS: To analyse systematically instances of clients' initiations of repair within video-recorded initial audiology appointments, and to examine the interactional environment in which they occurred. METHODS & PROCEDURES: Participants included 26 audiologists and their older adult clients (aged 55+ years). Companions were present in 17 of the 63 appointments. Conversation analysis (CA) was used to examine the video-recorded audiology appointments with older adults with HI. The corpus was systematically analysed for all instances of 'other-initiated repair' by clients (initiation of repair targeting the prior speakers' turn). A collection of 51 instances of other-initiated repair were identified. These instances were analysed in detail for: (1) the interactional environment in which they occurred; (2) the strategy by which the client initiated repair; and (3) the strategies used by the audiologist to repair the communication breakdown. OUTCOMES & RESULTS: In 76% (n = 39) of the 51 cases of other-initiated repair from the client, there was a lack of mutual gaze between participants (i.e., either the audiologist or the client were looking away or facing in another direction during the prior turn). More specifically, many of these instances occurred when the audiologist was speaking to the client while multitasking. Audiologists used multiple-repair strategies in their responsive turn in an attempt to repair the communication breakdown efficiently. CONCLUSIONS & IMPLICATIONS: These findings, from extended, naturally occurring conversations with older adults with HI in clinic settings, highlight the importance of face-to-face communication even in quiet one-to-one settings. Clinicians should remain aware of their movements and gaze when speaking to clients during appointments. The findings also provide further support for the importance of communication programs in hearing rehabilitation.

Characterizing social communication changes in amyotrophic lateral sclerosis.

BACKGROUND: Speech and language impairments are well-established in individuals with amyotrophic lateral sclerosis (ALS). However, knowledge about particular aspects of social communication and everyday conversational abilities is limited. AIMS: To investigate self- and informant-report ratings of social communicative abilities in ALS participants and matched healthy controls. METHODS & PROCEDURES: Thirty-two participants with ALS and 24 controls completed the La Trobe Communication Questionnaire (LCQ). Participants nominated a close other to provide an informant report on the LCQ. Demographic and clinical information was also collected. OUTCOMES & RESULTS: Informant ratings indicated greater difficulties in conversational initiation, effectiveness and partner sensitivity for ALS participants compared with controls. ALS participants did not rate their social communicative abilities as poorer than controls and self-reports only differed from informant ratings in the control group. LCQ scores were not significantly correlated with clinical/functional variables. CONCLUSIONS & IMPLICATIONS: Social communication can be reduced in ALS and individuals may lack insight into these difficulties. In order to understand and provide targeted interventions for such difficulties, clinical speech and language assessment should incorporate social communication assessment, including both a self- and informant-report format.

Differentiating Autism from Typical Development: Preliminary Findings of Greek Versions of a Pragmatic Language and Social Communication Questionnaire.

OBJECTIVE: A social pragmatic communication disorder is one of the primary characteristics of children with autism. Although several measures of pragmatics and social communication exist, many are not comprehensive, do not examine the quality of interactions across contexts and interlocutors, and cannot be easily administered and interpreted. The aim of this article is to report on preliminary data collected using the Greek version of comprehensive social communication and pragmatic language questionnaires completed by parents and teachers interacting with young children in different contexts. METHODS: A Greek translation of the social communication and pragmatic language questionnaires was administered to parents and teachers of 31 children diagnosed with autism and of 51 typically developing children aged 3.0-6.0 years. Analysis and Results: The performance on the Greek versions of the social communication and pragmatic language questionnaires of typically developing children was compared with the performance of the children with autism using a series of independent t tests. Descriptive statistics were used to summarize participant characteristics and performances on the measure. Preliminary results showed that significant differences with moderate effect sizes were found between groups on 63% of the 30 test items. CONCLUSIONS: The performance of children on questionnaires may lead to the development of easily administered and interpretable assessments for differentiating children with pragmatics and social communication impairments, such as children with autism, from typically developing children.

Inborn error metabolic screening in individuals with nonsyndromic autism spectrum disorders.

AIM: To perform metabolic testing on 406 patients (age range 3-22y [mean 6.71, SD 4.15], 343 males and 63 females) with nonsyndromic autism spectrum disorders (ASD) to assess the diagnostic yield. In addition, we reviewed our hospital's clinical database of 8500 patients who had undergone metabolic testing to be identified for inborn errors of metabolism (IEM), and described the characteristics of those with IEM and nonsyndromic ASD. METHOD: Neuropsychological evaluation included the Social Communication Questionnaire and Child Behavior Checklist. For metabolic testing/screening, urine samples were analyzed for the diagnosis of cerebral creatine deficiency syndromes, purine and pyrimidine disorders, amino acid metabolism defects, mucopolysaccharidoses, and organic acidurias. RESULTS: The 406 recruited participants fulfilled the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria of ASD. No biochemical evidence of a metabolic disorder was detected in any of the 406 patients studied. Concerning the retrospective evaluation from the 8500 who had metabolic testing, 464 individuals had a diagnosis of an IEM (394 without the diagnosis of ASD and 70 with ASD diagnosis). Only one individual with IEM had a diagnosis of nonsyndromic ASD at the time of the metabolic study; the metabolic testing had revealed diagnosis of urea-cycle disorder. INTERPRETATION: Metabolic testing should be considered in the work-up of individuals with syndromic ASD, but metabolic testing is not cost-effective for individuals with nonsyndromic ASD.

Sex-Based Differences in Perceived Pragmatic Communication Ability of Adults With Traumatic Brain Injury.

OBJECTIVE: To identify sex-based differences in self-reported and close other-reported perceptions of communication behaviors in adults with traumatic brain injury (TBI). DESIGN: Between-groups comparison of questionnaire data from men and women with TBI and their close others. SETTING: University academic department. PARTICIPANTS: Adults with medically documented TBI (n=160) and adults without TBI (n=81; control group) (N=241). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: La Trobe Communication Questionnaire, a standardized measure of communication problems in everyday life. RESULTS: Participants with TBI endorsed more communication problems than controls (P<.001). There were no significant differences in self-ratings (P=.20) or in the ratings of close others (P=.09) in communication behaviors of men with TBI compared with women with TBI. There was no difference between the self-ratings of women with TBI and their close others (P=.59). However, men with TBI significantly underreported communication problems compared with reports of close others (P<.001). CONCLUSIONS: Women with TBI might be more accurate than men with TBI in recognizing their own pragmatic communication problems.

Joint attention interventions for children with autism spectrum disorder: a systematic review and meta-analysis.

BACKGROUND: A core social-communication deficit in children with autism spectrum disorder (ASD) is limited joint attention behaviours-important in the diagnosis of ASD and shown to be a powerful predictor of later language ability. Various interventions have been used to train joint attention skills in children with ASD. However, it is unclear which participant, intervention and interventionist factors yield more positive results. AIMS: The purpose of this systematic review and meta-analysis was to provide a quantitative assessment of the effectiveness of joint attention interventions aimed at improving joint attention abilities in children with ASD. METHODS & PROCEDURES: The researchers searched six databases for studies meeting the inclusion criteria at two levels: title/abstract and full-text stages. Two independent coders completed data extraction using a coding manual and form developed specifically for this research study. Meta-analysis procedures were used to determine the overall effects of several comparisons including treatment type, treatment administrator, intervention characteristics and follow-up. MAIN CONTRIBUTION: Fifteen randomized experimental studies met inclusion criteria. All comparisons resulted in statistically significant effects, though overlapping confidence intervals suggest that none of the comparisons were statistically different from each other. Specifically, treatment administrator, dosage and design (control or comparison, etc.) characteristics of the studies do not appear to produce significantly different effects. CONCLUSIONS & IMPLICATIONS: The results of this meta-analysis provide strong support for explicit joint attention interventions for young children with ASD; however, it remains unclear which children with ASD respond to which type of intervention.

Narrative competence in children with pragmatic language impairment: a longitudinal study.

BACKGROUND: Children with pragmatic language impairment (PLI) show impairments in the use of language in social contexts. Although the issue has been gaining attention in recent literature, not much is known about the developmental trajectories of children who experience pragmatic language problems. Since narrative competence is an important predictor of both academic and social success, evaluating narrative competence in children with PLI is deemed important. AIMS: To examine the development of narrative competence of children with PLI compared with typically developing (TD) children using a prognostic longitudinal design. METHODS & PROCEDURES: Using the Dutch adaptation of the Renfrew Bus Story Test, narrative competence was assessed at ages 5-7 for a group of 84 children with PLI and a group of 81 TD children. Groups were compared on measures of narrative productivity, organization of story content and cohesion. OUTCOMES & RESULTS: Results showed an increase in narrative competence for both groups across most time points. The PLI group obtained lower scores on measures of narrative productivity and story content organization compared with their TD peers at all time points, but did not show more problems related to narrative cohesion. Most problems in the domain of narrative productivity and story content organization were shown to be independent of lower non-verbal intelligence. The developmental trajectory for the PLI group was largely similar to that of their TD peers, and showed a persistent developmental delay of approximately one year. Furthermore, qualitative differences were visible in the proportion of irrelevant T-units, which was consistently higher in the PLI group. The different narrative measures were found to be relatively stable over time. CONCLUSIONS & IMPLICATIONS: The results of this study suggest that narrative difficulties of children identified as pragmatically impaired persist at least until middle childhood. The persistence of the measured developmental delay, combined with the finding of qualitative differences, support the view of PLI as a deficit, which is consistent with the addition of social communication disorder (SCD) to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

School readiness of children with language impairment: predicting literacy skills from pre-literacy and social-behavioural dimensions.

BACKGROUND: School readiness generally captures the notion that children do best when they arrive at formal schooling with a certain threshold of skill that will help them thrive in the classroom's academic and social milieu. AIMS: To examine the dimensionality of the construct of school readiness among children with language impairment (LI), as well as the extent to which these dimensions relate to children's end-of-kindergarten literacy skills. METHODS & PROCEDURES: Participants were 136 preschool-aged children with LI. Children were assessed on measures of pre-literacy, social, and behavioural skills in preschool and reading and spelling in kindergarten. OUTCOMES & RESULTS: Confirmatory factor analyses indicated that school readiness for this sample of children with LI is best characterized as two dimensions: pre-literacy and socio-emotional. Of the two dimensions, pre-literacy readiness was predictive of children's future performance in reading and spelling. CONCLUSIONS & IMPLICATIONS: The results further our theoretical understanding of the dimensions of school readiness, as well as our knowledge of how these skills are related among children with LI. Identifying domain-specific readiness skills that are predictive of kindergarten success can help to identify means of early assessment and targets for speech-language intervention.

Performance of South African children on the Communication and Symbolic Behavior Scales-Developmental Profile (CSBS DP).

BACKGROUND: Substantial development in social communication skills occurs in the first two years of life. Growth should be evident in sharing emotion and eye gaze; rate of communication, communicating for a variety of functions; using gestures, sounds and words; understanding language, and using functional and pretend actions with objects in play. A delay in these early social communication skills may be the first sign of a developmental delay in young children in nearly all categories of disabilities-including specific language impairment, autism spectrum disorder, HIV/AIDS, lack of environmental stimulation or institutionalization, and global developmental delays-and early detection of these delays is critical for enrolment in appropriate early intervention services. AIMS: No standardized tests of early social communication skills exist for very young children in South Africa (SA). An existing evaluation tool that has the potential to be culturally fair for children from cultural backgrounds different to the standardization group is the Communication and Symbolic Behaviour Scales-Developmental Profile (CSBS DP). This study aimed to document the performance of a group of English-speaking SA children ranging in age from 12 to 24 months on the CSBS DP and to compare this performance with the original standardization sample. METHODS & PROCEDURES: Sixty-seven English-speaking SA children from a range of cultural and linguistic backgrounds were assessed on the CSBS DP Behaviour Sample. Group scores were compared with the original standardization sample using inferential statistics. OUTCOMES & RESULTS: The results provide preliminary support for the suitability and validity of the face-to-face Behaviour Sample as a measure of early social communication skills in this sample of English-speaking SA children from a range of cultural groups between 12 and 24 months of age. CONCLUSIONS & IMPLICATIONS: While further research in the SA population is needed, these findings are a first step towards validating a culturally appropriate measure for early detection of social communication delays in a sample of SA toddlers.

Early pragmatic language difficulties in siblings of children with autism: implications for DSM-5 social communication disorder?

BACKGROUND: We evaluated early pragmatic language skills in preschool-age siblings of children with autism spectrum disorder (ASD), and examined correspondence between pragmatic language impairments and general language difficulties, autism symptomatology, and clinical outcomes. METHODS: Participants were younger siblings of children with ASD (high-risk, n = 188) or typical development (low-risk, n = 119) who were part of a prospective study of infants at risk for ASD; siblings without ASD outcomes were included in analyses. Pragmatic language skills were measured via the Language Use Inventory (LUI). RESULTS: At 36 months, the high-risk group had significantly lower parent-rated pragmatic language scores than the low-risk group. When defining pragmatic language impairment (PLI) as scores below the 10(th) percentile on the LUI, 35% of the high-risk group was identified with PLI versus 10% of the low-risk group. Children with PLI had higher rates of general language impairment (16%), defined as scores below the 10(th) percentile on the Receptive or Expressive Language subscales of the Mullen Scales of Early Learning, relative to those without PLI (3%), but most did not evidence general language impairments. Children with PLI had significantly higher ADOS scores than those without PLI and had higher rates of clinician-rated atypical clinical best estimate outcomes (49%) relative to those without PLI (15%). CONCLUSIONS: Pragmatic language problems are present in some siblings of children with ASD as early as 36 months of age. As the new DSM-5 diagnosis of Social (Pragmatic) Communication Disorder (SCD) is thought to occur more frequently in family members of individuals with ASD, it is possible that some of these siblings will meet criteria for SCD as they get older. Close monitoring of early pragmatic language development in young children at familial risk for ASD is warranted.

Girls' childhood trajectories of disruptive behavior predict adjustment problems in early adolescence.

BACKGROUND: It is widely recognized that early onset of disruptive behavior is linked to a variety of detrimental outcomes in males, later in life. In contrast, little is known about the association between girls' childhood trajectories of disruptive behavior and adjustment problems in early adolescence. METHODS: This study used nine waves of data from the ongoing Pittsburgh Girls Study. A semiparametric group-based model was used to identify trajectories of disruptive behavior in 1,513 girls from age 6 to 12 years. Adjustment problems were characterized by depression, self-harm, Post Traumatic Stress Disorder (PTSD), substance use, interpersonal aggression, sexual behavior, affiliation with delinquent peers, and academic achievement at ages 13 and 14. RESULTS: Three trajectories of childhood disruptive behavior were identified: low, medium, and high. Girls in the high group were at increased risk for depression, self-harm, PTSD, illegal substance use, interpersonal aggression, early and risky sexual behavior, and lower academic achievement. The likelihood of multiple adjustment problems increased with trajectories reflecting higher levels of disruptive behavior. CONCLUSION: Girls following the high childhood trajectory of disruptive behavior require early intervention programs to prevent multiple, adverse outcomes in adolescence and further escalation in adulthood.

Measuring pragmatic skills: early detection of infants at risk for communication problems.

BACKGROUND: For the early detection of children who are at risk of communication problems, we need appropriate assessment instruments. Two Dutch-language standardised screening instruments are available: the Dutch version of the Non Speech Test (NNST) and the Dutch version of the MacArthur Communicative Development Inventories (N-CDIs). These instruments gauge the precursors of language development, early vocabulary and early morphosyntactic skills. However, they do not adequately assess pragmatic skills. AIMS: To develop a norm-referenced instrument to examine the pragmatic skills of Dutch-speaking infants that is translatable into other languages. METHODS & PROCEDURES: The instrument 'Lists for the Evaluation of Pragmatic Skills in Infants' is based on 'The Pragmatics Profile of Everyday Communication Skills in Children' Dewart and Summers (1995). We translated the instrument into Dutch and transformed the structured interview format into a parent questionnaire. The parent questionnaire-Evaluatie van Pragmatische Vaardigheden (EPV)-was created following extensive research on item selection, norm table development, and reliability and validity studies. The EPV1 is applicable to children 6-15 months old; EPV2 is applicable to children 16-30 months old. OUTCOMES & RESULTS: We developed norm tables for the number of pragmatic skills achieved by the child and also for how and to what extent the skills are exhibited. For the norming study of EPV1 and EPV2 we included 390 and 534 infants respectively. The reliability scores are high for both lists. Concept validity and criterion validity studies demonstrate adequate results for the overall lists, the subscale components and specific items. CONCLUSIONS & IMPLICATIONS: The parent questionnaire is a valuable tool that specifically targets pragmatic skills in infants. The instrument can detect communication delays in infants. It is translatable into other languages and avoids having the infant examined directly by a stranger.

Assessing early communication skills at 12 months: a retrospective study of Autism Spectrum Disorder.

BACKGROUND: Early identification of Autism Spectrum Disorder (ASD) is currently limited by the absence of reliable biological markers for the disorder, as well as the reliability of screening and assessment tools for children aged between 6 and 18 months. Ongoing research has demonstrated the importance of early social communication skills in differentiating children later diagnosed with ASD from their typically developing (TD) peers, but researchers have not yet investigated whether these differences can be detected using community-ascertained systematic observation data as early as 12 months. AIMS: To investigate whether differences in early social communication skills can be detected at 12 months of age, comparing children later diagnosed with ASD, and TD peers; and to determine whether differences remain when groupings are based on age of subsequent ASD diagnosis. METHODS & PROCEDURES: From a prospective community-ascertained sample, we collected data on children in early life, then conducted retrospective analyses for those children who were later diagnosed with ASD by the age of 7 years, compared with matched TD peers. We analysed standardized observational data of early communication skills, collected using the Communication and Symbolic Behavior Scales-Developmental Profile (CSBS-DP) Behavior Sample, when participants were 12 months of age. OUTCOMES & RESULTS: Children in the ASD group exhibited significantly lower social communication skills than the TD group, including on the Total score and Social and Symbolic Composite scores of the CSBS-DP Behavior Sample. Differences on the Total score and Social Composite were also detected for both early and late ASD diagnosis groups when compared with the TD group. CONCLUSIONS & IMPLICATIONS: These findings give further support for the importance of social communication in assessing children at risk of ASD as early as 12 months of age. Future research could evaluate the sensitivity and specificity of direct observation of these early communication skills as diagnostic indicators for ASD at 12 months, and investigate whether it is possible to distinguish between ASD and other high-risk groups (e.g. developmental delay) at this age.

A Bioecological framework to evaluate communicative participation outcomes for preschoolers receiving speech-language therapy interventions in Ontario, Canada.

BACKGROUND: The Preschool Speech and Language Program (PSLP) in Ontario, Canada, is a publically funded intervention service for children from birth to 5 years with communication disorders. It has begun a population-level programme evaluation of children's communicative participation outcomes following therapy. Data are currently being collected for all children who access this service--over 50,000 children each year. AIMS: To understand and evaluate how therapeutic interventions in speech-language therapy impact the everyday lives of children and families by applying a theoretical framework. MAIN CONTRIBUTION: This discussion paper critically examines how the Bioecological Model of Development can be applied to the study of communicative participation outcomes following speech and language therapy. This model will be used in future analyses of communicative participation outcomes data in Ontario's PSLP. The strengths and challenges of this approach are reviewed.

Treatment intensity and childhood apraxia of speech.

BACKGROUND: Intensive treatment has been repeatedly recommended for the treatment of speech deficits in childhood apraxia of speech (CAS). However, differences in treatment outcomes as a function of treatment intensity have not been systematically studied in this population. AIM: To investigate the effects of treatment intensity on outcome measures related to articulation, functional communication and speech intelligibility for children with CAS undergoing individual motor speech intervention. METHODS & PROCEDURES: A total of 37 children (32-54 months of age) with CAS received 1×/week (lower intensity) or 2×/week (higher intensity) individual motor speech treatment for 10 weeks. Assessments were carried out before and after a 10-week treatment block to study the effects of variations in treatment intensity on the outcome measures. OUTCOMES & RESULTS: The results indicated that only higher intensity treatment (2×/week) led to significantly better outcomes for articulation and functional communication compared with 1×/week (lower intensity) intervention. Further, neither lower nor higher intensity treatment yielded a significant change for speech intelligibility at the word or sentence level. In general, effect sizes for the higher intensity treatment groups were larger for most variables compared with the lower intensity treatment group. CONCLUSIONS & IMPLICATIONS: Overall, the results of the current study may allow for modification of service delivery and facilitate the development of an evidence-based care pathway for children with CAS.

Explaining pragmatic performance in traumatic brain injury: a process perspective on communicative errors.

BACKGROUND: The purpose of this study is to investigate the pragmatic abilities of individuals with traumatic brain injury (TBI). Several studies in the literature have previously reported communicative deficits in individuals with TBI, however such research has focused principally on communicative deficits in general, without providing an analysis of the errors committed in understanding and expressing communicative acts. Within the theoretical framework of Cognitive Pragmatics theory and Cooperative principle we focused on intermediate communicative errors that occur in both the comprehension and the production of various pragmatic phenomena, expressed through both linguistic and extralinguistic communicative modalities. AIMS: To investigate the pragmatic abilities of individuals with TBI. METHODS & PROCEDURES: A group of 30 individuals with TBI and a matched control group took part in the experiment. They were presented with a series of videotaped vignettes depicting everyday communicative exchanges, and were tested on the comprehension and production of various kinds of communicative acts (standard communicative act, deceit and irony). The participants' answers were evaluated as correct or incorrect. Incorrect answers were then further evaluated with regard to the presence of different intermediate errors. OUTCOMES & RESULTS: Individuals with TBI performed worse than control participants on all the tasks investigated when considering correct versus incorrect answers. Furthermore, a series of logistic regression analyses showed that group membership (TBI versus controls) significantly predicted the occurrence of intermediate errors. This result holds in both the comprehension and production tasks, and in both linguistic and extralinguistic modalities. CONCLUSIONS & IMPLICATIONS: Participants with TBI tend to have difficulty in managing different types of communicative acts, and they make more intermediate errors than the control participants. Intermediate errors concern the comprehension and production of the expression act, the comprehension of the actors' meaning, as well as the respect of the Cooperative principle.