Response to Music-Mediated Intervention in Autistic Children with Limited Spoken Language Ability.

PURPOSE: Autistic children with limited spoken language ability (LSLA) often do not respond to traditional interventions, reducing their social inclusion. It is essential to identify effective interventions, and sensitive measures to track their intervention response. METHODS: Using data from an RCT comparing music-mediated and play-based interventions, we investigated the impact of spoken language ability on outcomes, and measured response to intervention through natural language sample measures. RESULTS: Children with lower verbal IQ, relative to higher verbal IQ, made some greater gains over the course of music-mediated intervention. Natural language samples were helpful in characterizing communication and tracking change. CONCLUSION: Music-mediated interventions hold promise as effective interventions for autistic children with LSLA. Natural language samples are robust in characterizing this subgroup.

Implications of video chat use for young children's learning and social-emotional development: Learning words, taking turns, and fostering familial relationships.

Parents of young children use video chat differently than other screen media, paralleling expert recommendations (e.g., American Academy of Pediatrics Council on Communications and Media, 2016), which suggest that video chat, unlike other screen media, is acceptable for use by children under 18 months. Video chat is unique among screen media in that it permits contingent (time-sensitive and content-sensitive) social interactions. Contingent social interactions take place between a child and a partner (dyadic), with objects (triadic), and with multiple others (multi-party configurations), which critically underpin development in multiple domains. First, we review how contingent social interaction may underlie video chat's advantages in two domains: for learning (specifically learning new words) and for social-emotional development (specifically taking turns and fostering familial relationships). Second, we describe constraints on video chat use and how using chat with an active adult (co-viewing) may mitigate some of its limitations. Finally, we suggest future research directions that will clarify the potential advantages and impediments to the use of video chat by young children. This article is categorized under: Linguistics > Language Acquisition Psychology > Learning Cognitive Biology > Social Development.

Joint engagement and movement: Active ingredients of a music-based intervention with school-age children with autism.

BACKGROUND: The effectiveness of music-based interventions (MI) in autism has been attested for decades. Yet, there has been little empirical investigation of the active ingredients, or processes involved in music-based interventions that differentiate them from other approaches. OBJECTIVES: Here, we examined whether two processes, joint engagement and movement, which have previously been studied in isolation, contribute as important active ingredients for the efficacy of music-based interventions. METHODS: In two separate analyses, we investigated whether (1) joint engagement with the therapist, measured using a coding scheme verified for reliability, and (2) movement elicited by music-making, measured using a computer-vision technique for quantifying motion, may drive the benefits previously observed in response to MI (but not a controlled non-MI) in children with autism. RESULTS: Compared to a non-music control intervention, children and the therapist in MI spent more time in triadic engagement (between child, therapist, and activity) and produced greater movement, with amplitude of motion closely linked to the type of musical instrument. CONCLUSIONS: Taken together, these findings provide initial evidence of the active ingredients of music-based interventions in autism.

Towards greater transparency in neurodevelopmental disorders research: use of a proposed workflow and propensity scores to facilitate selection of matched groups.

BACKGROUND: Matching is one commonly utilized method in quasi-experimental designs involving individuals with neurodevelopmental disorders (NDD). This method ensures two or more groups (e.g., individuals with an NDD versus neurotypical individuals) are balanced on pre-existing covariates (e.g., IQ), enabling researchers to interpret performance on outcome measures as being attributed to group membership. While much attention has been paid to the statistical criteria of how to assess whether groups are well-matched, relatively little attention has been given to a crucial prior step: the selection of the individuals that are included in matched groups. The selection of individuals is often an undocumented process, which can invite unintentional, arbitrary, and biased decision-making. Limited documentation can result in findings that have limited reproducibility and replicability and thereby have poor potential for generalization to the broader population. Especially given the heterogeneity of individuals with NDDs, interpretation of research findings depends on minimizing bias at all stages of data collection and analysis. RESULTS: In the spirit of open science, this tutorial demonstrates how a workflow can be used to provide a transparent, reproducible, and replicable process to select individuals for matched groups. Our workflow includes the following key steps: Assess data, Select covariates, Conduct matching, and Diagnose matching. Our sample dataset is from children with autism spectrum disorder (ASD; n = 25) and typically developing children (n = 43) but can be adapted to comparisons of any two groups in quasi-experimental designs. We work through this method to conduct and document matching using propensity scores implemented with the R package MatchIt. Data and code are publicly available, and a template for this workflow is provided in the Additional file 1 as well as on a public repository. CONCLUSIONS: It is important to provide clear documentation regarding the selection process to establish matched groups. This documentation ensures better transparency in participant selection and data analysis in NDD research. We hope the adoption of such a workflow will ultimately advance our ability to replicate findings and help improve the lives of individuals with NDDs.

Brief Report: Vocabulary and Grammatical Skills of Bilingual Children with Autism Spectrum Disorders at School Age.

We examined the lexical and grammatical skills of monolingual and bilingual school-age children with autism spectrum disorders (ASD). Thirteen monolingual and thirteen bilingual children with ASD without intellectual disability, were compared on standardized measures of vocabulary and morphology. Findings revealed that bilingual children performed in the average monolingual range on a standardized receptive vocabulary test and slightly below the average range on a standardized morphological task in their dominant language. Prior work indicates that bilingual exposure is not detrimental for early language development in children with autism. The current findings suggest that at school age, bilinguals with ASD show similar language development patterns as those described in the literature on typically-developing bilinguals.

Can Bilingualism Mitigate Set-Shifting Difficulties in Children With Autism Spectrum Disorders?

This study investigated the effects of bilingualism on set-shifting and working memory in children with autism spectrum disorders (ASD). Bilinguals with ASD were predicted to display a specific bilingual advantage in set-shifting, but not working memory, relative to monolinguals with ASD. Forty 6- to 9-year-old children participated (20 ASD, 20 typically-developing). Set-shifting was measured using a computerized dimensional change card sort (DCCS) task, and by parent report of executive functioning in daily life. Results showed an advantage for bilingual relative to monolingual children with ASD on the DCCS task, but not for set-shifting in daily life. Working memory was similar for bilinguals and monolinguals with ASD. These findings suggest that bilingualism may mitigate some set-shifting difficulties in children with ASD.

Results of a RCT on a Transition Support Program for Adults with ASD: Effects on Self-Determination and Quality of Life.

Few evidence-based services exist for people with Autism Spectrum Disorder (ASD) as they transition into adulthood, particularly those that foster appreciation of one's own goals and strengths. We developed a transition service for adults with ASD (without Intellectual Disability), and conducted a randomized controlled trial (RCT) focusing on self-report of Quality of Life and Self-Determination outcomes. Thirty participants aged 18-29 were randomized to immediate or delayed intervention, with 26 participants analyzed after 4 were lost to follow-up. Curriculum was tailored to participants' self-expressed needs in three areas: social communication, self-determination, and working with others. Groups of four-to-six participants with ASD and two facilitators met weekly for 10 weeks. Positive intervention effects were observed on self-report of Quality of Life; the intervention group scored on average 2 points higher than the control group, 95% CI [-0.2, 3.9]. Positive effects were also observed on the Self Determination Scale (Interpersonal Cognitive Problem-Solving subdomain), where the intervention group scored 2 points higher than control group 95% CI [0.082, 3.4]. In addition, participants rated skills targeted by the curriculum 6 points higher after versus before intervention, 95% CI [3.7, 8.6]. This was echoed by a subset of parents rating their child's skills as seven points higher after versus before intervention, 95% CI [1, 14]. Autism Research 2018, 11: 1712-1728. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: These findings indicate that it is possible to increase Self-Determination and subjective Quality of Life in adults with ASD through a brief group-format service, and provide a model for doing so. Self-Determination abilities are linked to improved adult outcomes in individuals with other disabilities. These often overlooked factors should be incorporated in programming for adults with ASD as they transition to adulthood.

Bilingual children with autism spectrum disorders: The impact of amount of language exposure on vocabulary and morphological skills at school age.

Studies of bilingual children with Autism Spectrum Disorders (ASD) have focused on early language development using parent report measures. However, the effect of bilingual exposure on more complex linguistic abilities is unknown. In the current study, we examined the impact of amount of language exposure on vocabulary and morphological skills in school-aged children with ASD who did not have intellectual disability. Forty-seven typically developing children and 30 children with ASD with varying exposure to French participated in the study. We investigated the impact of amount of language exposure, nonverbal IQ, age, and working memory on language abilities via regression analyses. Current amount of language exposure was the strongest predictor of both vocabulary skills (accounting for 62% of the variance) and morphological skills (accounting for 49% of the variance), for both typically-developing children and children with ASD. These findings highlight the central role amount of language exposure plays in vocabulary and morphological development for children with ASD, as it does for typically-developing children. In addition, they provide further evidence that, when provided with adequate language exposure, many children with ASD are capable of acquiring two languages. Autism Research 2018, 11: 1667-1678. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We studied typically developing children and children with ASD living in a bilingual society who had varying exposure to French (ranging from bilinguals to monolinguals). We investigated the impact of amount of language exposure, nonverbal IQ, age, and working memory on their vocabulary and morphological skills. Current amount of language exposure was the strongest predictor of language skills in both groups of children. Findings indicate that when provided with adequate language exposure, many children with ASD are capable of acquiring two languages.

Music improves social communication and auditory-motor connectivity in children with autism.

Music has been identified as a strength in people with Autism Spectrum Disorder; however, there is currently no neuroscientific evidence supporting its benefits. Given its universal appeal, intrinsic reward value and ability to modify brain and behaviour, music may be a potential therapeutic aid in autism. Here we evaluated the neurobehavioural outcomes of a music intervention, compared to a non-music control intervention, on social communication and brain connectivity in school-age children (ISRCTN26821793). Fifty-one children aged 6-12 years with autism were randomized to receive 8-12 weeks of music (n = 26) or non-music intervention (n = 25). The music intervention involved use of improvisational approaches through song and rhythm to target social communication. The non-music control was a structurally matched behavioural intervention implemented in a non-musical context. Groups were assessed before and after intervention on social communication and resting-state functional connectivity of fronto-temporal brain networks. Communication scores were higher in the music group post-intervention (difference score = 4.84, P = .01). Associated post-intervention resting-state brain functional connectivity was greater in music vs. non-music groups between auditory and subcortical regions (z = 3.94, P < .0001) and auditory and fronto-motor regions (z = 3.16, P < .0001). Post-intervention brain connectivity was lower between auditory and visual regions in the music compared to the non-music groups, known to be over-connected in autism (z = 4.01, P < .00001). Post-intervention brain connectivity in the music group was related to communication improvement (z = 3.57, P < .0001). This study provides the first evidence that 8-12 weeks of individual music intervention can indeed improve social communication and functional brain connectivity, lending support to further investigations of neurobiologically motivated models of music interventions in autism.

Reduced sensitivity to context in language comprehension: A characteristic of Autism Spectrum Disorders or of poor structural language ability?

We present two experiments examining the universality and uniqueness of reduced context sensitivity in language processing in Autism Spectrum Disorders (ASD), as proposed by the Weak Central Coherence account (Happé & Frith, 2006, Journal of Autism and Developmental Disorders, 36(1), 25). That is, do all children with ASD exhibit decreased context sensitivity, and is this characteristic specific to ASD versus other neurodevelopmental conditions? Experiment 1, conducted in English, was a comparison of children with ASD with normal language and their typically-developing peers on a picture selection task where interpretation of sentential context was required to identify homonyms. Contrary to the predictions of Weak Central Coherence, the ASD-normal language group exhibited no difficulty on this task. Experiment 2, conducted in German, compared children with ASD with variable language abilities, typically-developing children, and a second control group of children with Language Impairment (LI) on a sentence completion task where a context sentence had to be considered to produce the continuation of an ambiguous sentence fragment. Both ASD-variable language and LI groups exhibited reduced context sensitivity and did not differ from each other. Finally, to directly test which factors contribute to reduced context sensitivity, we conducted a regression analysis for each experiment, entering nonverbal IQ, structural language ability, and autism diagnosis as predictors. For both experiments structural language ability emerged as the only significant predictor. These convergent findings demonstrate that reduced sensitivity to context in language processing is linked to low structural language rather than ASD diagnosis.

Intact non-word repetition and similar error patterns in language-matched children with autism spectrum disorders: A pilot study.

PURPOSE: We investigated whether enhanced auditory short-term memory may contribute to the learning of novel word forms in children with Autism Spectrum Disorder. We also evaluated whether delayed but qualitatively normal, versus atypical, cognitive processes underlie non-word repetition in this population via a detailed error analysis. METHOD: English-speaking children with Autism Spectrum Disorder (who had significant language delay) and typically-developing children matched pairwise on language ability were compared on the Syllable Repetition Task (Shriberg et al., 2009). RESULTS: All children exhibited better performance on stimuli of shorter vs. longer syllable length. In addition there was a significant interaction whereby children with Autism Spectrum Disorder performed better than typically-developing children at the longest syllable length. Repetition accuracy was significantly correlated with language level in both groups. In contrast, the relationship between Repetition accuracy and age was only marginally significant in the Autism Spectrum Disorder group and did not reach significance in the typically-developing group. This underscores the importance of language level to non-word repetition performance, and supports the practice of matching on language rather than age alone. An error analysis (Shriberg et al., 2012) showed many similarities between groups in terms of number of consonants deleted, encoding accuracy, and transcoding accuracy components of the task. However the Autism Spectrum Disorder group tended to display better auditory short-term memory with a medium effect size, though this did not reach significance given the small sample size. CONCLUSION: These findings extend evidence of delayed but qualitatively normal non-word repetition previously described in preadolescents with Autism Spectrum Disorder (Williams et al., 2013) to younger kindergarten-age children with Autism Spectrum Disorder and language delay, indicating that non-word repetition is not an area of specific difficulty for this population. With respect to enhanced auditory short-term memory, we found preliminary evidence of better memory for longer nonwords in children with Autism Spectrum Disorder compared to younger typically developing children who were matched on language.

Learning language in autism: maternal linguistic input contributes to later vocabulary.

It is well established that children with typical development (TYP) exposed to more maternal linguistic input develop larger vocabularies. We know relatively little about the linguistic environment available to children with autism spectrum disorders (ASD), and whether input contributes to their later vocabulary. Children with ASD or TYP and their mothers from English and French-speaking families engaged in a 10 min free-play interaction. To compare input, children were matched on language ability, sex, and maternal education (ASD n = 20, TYP n = 20). Input was transcribed, and the number of word tokens and types, lexical diversity (D), mean length of utterances (MLU), and number of utterances were calculated. We then examined the relationship between input and children's spoken vocabulary 6 months later in a larger sample (ASD: n = 19, 50-85 months; TYP: n = 44, 25-58 months). No significant group differences were found on the five input features. A hierarchical multiple regression model demonstrated input MLU significantly and positively contributed to spoken vocabulary 6 months later in both groups, over and above initial language levels. No significant difference was found between groups in the slope between input MLU and later vocabulary. Our findings reveal children with ASD and TYP of similar language levels are exposed to similar maternal linguistic environments regarding number of word tokens and types, D, MLU, and number of utterances. Importantly, linguistic input accounted for later vocabulary growth in children with ASD.

Global Similarities and Multifaceted Differences in the Production of Partner-Specific Referential Pacts by Adults with Autism Spectrum Disorders.

Over repeated reference conversational partners tend to converge on preferred terms or referential pacts. Autism spectrum disorders (ASD) are characterized by pragmatic difficulties that are best captured by less structured tasks. To this end we tested adults with ASD who did not have language or intellectual impairments, and neurotypical comparison participants in a referential communication task. Participants were directors, describing unlexicalized, complex novel stimuli over repeated rounds of interaction. Group comparisons with respect to referential efficiency showed that directors with ASD demonstrated typical lexical entrainment: they became faster over repeated rounds and used shortened referential forms. ASD and neurotypical groups did not differ with respect to the number of descriptors they provided or the number of exchanges needed for matchers to identify figures. Despite these similarities the ASD group was slightly slower overall. We examined partner-specific effects by manipulating the common ground shared with the matcher. As expected, neurotypical directors maintained referential precedents when speaking to the same matcher but not with a new matcher. Directors with ASD were qualitatively similar but displayed a less pronounced distinction between matchers. However, significant differences and different patterns of reference emerged over time; neurotypical directors incorporated the new matcher's contributions into descriptions, whereas directors with ASD were less likely to do so.

Children's referential understanding of novel words and parent labeling behaviors: similarities across children with and without autism spectrum disorders.

This study examined two facets of the use of social cues for early word learning in parent-child dyads, where children had an Autism Spectrum Disorder (ASD) or were typically developing. In Experiment 1, we investigated word learning and generalization by children with ASD (age range: 3;01-6;02) and typically developing children (age range: 1;02-4;09) who were matched on language ability. In Experiment 2, we examined verbal and non-verbal parental labeling behaviors. First, we found that both groups were similarly able to learn a novel label using social cues alone, and to generalize this label to other representations of the object. Children who utilized social cues for word learning had higher language levels. Second, we found that parental cues used to introduce object labels were strikingly similar across groups. Moreover, parents in both groups adapted labeling behavior to their child's language level, though this surfaced in different ways across groups.

Brief report: Conveying subjective experience in conversation: production of mental state terms and personal narratives in individuals with high functioning autism.

Mental state terms and personal narratives are conversational devices used to communicate subjective experience in conversation. Pre-adolescents with high-functioning autism (HFA, n = 20) were compared with language-matched typically-developing peers (TYP, n = 17) on production of mental state terms (i.e., perception, physiology, desire, emotion, cognition) and personal narratives (sequenced retelling of life events) during short conversations. HFA and TYP participants did not differ in global use of mental state terms, nor did they exhibit reduced production of cognitive terms in particular. Participants with HFA produced significantly fewer personal narratives. They also produced a smaller proportion of their mental state terms during personal narratives. These findings underscore the importance of assessing and developing qualitative aspects of conversation in highly verbal individuals with autism.

Acoustic and perceptual measurement of expressive prosody in high-functioning autism: increased pitch range and what it means to listeners.

Are there consistent markers of atypical prosody in speakers with high functioning autism (HFA) compared to typically-developing speakers? We examined: (1) acoustic measurements of pitch range, mean pitch and speech rate in conversation, (2) perceptual ratings of conversation for these features and overall prosody, and (3) acoustic measurements of speech from a structured task. Increased pitch range was found in speakers with HFA during both conversation and structured communication. In global ratings listeners rated speakers with HFA as having atypical prosody. Although the HFA group demonstrated increased acoustic pitch range, listeners did not rate speakers with HFA as having increased pitch variation. We suggest that the quality of pitch variation used by speakers with HFA was non-conventional and thus not registered as such by listeners.

Intact and impaired mechanisms of action understanding in autism.

Typically developing children understand and predict others' behavior by extracting and processing relevant information such as the logic of their actions within the situational constraints and the intentions conveyed by their gaze direction and emotional expressions. Children with autism have difficulties understanding and predicting others' actions. With the use of eye tracking and behavioral measures, we investigated action understanding mechanisms used by 18 children with autism and a well-matched group of 18 typically developing children. Results showed that children with autism (a) consider situational constraints in order to understand the logic of an agent's action and (b) show typical usage of the agent's emotional expressions to infer his or her intentions. We found (c) subtle atypicalities in the way children with autism respond to an agent's direct gaze and (d) marked impairments in their ability to attend to and interpret referential cues such as a head turn for understanding an agent's intentions.

How does the topic of conversation affect verbal exchange and eye gaze? A comparison between typical development and high-functioning autism.

Conversation is a primary area of difficulty for individuals with high-functioning autism (HFA) although they have unimpaired formal language abilities. This likely stems from the unstructured nature of face-to-face conversation as well as the need to coordinate other modes of communication (e.g. eye gaze) with speech. We conducted a quantitative analysis of both verbal exchange and gaze data obtained from conversations between children with HFA and an adult, compared with those of typically developing children matched on language level. We examined a new question: how does speaking about a topic of interest affect reciprocity of verbal exchange and eye gaze? Conversations on generic topics were compared with those on individuals' circumscribed interests, particularly intense interests characteristic of HFA. Two opposing hypotheses were evaluated. Speaking about a topic of interest may improve reciprocity in conversation by increasing participants' motivation and engagement. Alternatively, it could engender more one-sided interaction, given the engrossing nature of circumscribed interests. In their verbal exchanges HFA participants demonstrated decreased reciprocity during the interest topic, evidenced by fewer contingent utterances and more monologue-style speech. Moreover, a measure of stereotyped behaviour and restricted interest symptoms was inversely related to reciprocal verbal exchange. However, both the HFA and comparison groups looked significantly more to their partner's face during the interest than generic topic. Our interpretation of results across modalities is that circumscribed interests led HFA participants to be less adaptive to their partner verbally, but speaking about a highly practiced topic allowed for increased gaze to the partner. The function of this increased gaze to partner may differ for the HFA and comparison groups.