Preliminary evidence supporting the clinical utility of an Analog Task of Prosocial Helping.

BACKGROUND: Prosocial helping is a fundamental communication behaviour that supports successful social relationships. This study investigated the clinical utility of the Analog Task of Prosocial Helping (AToP-H): a tool for assessing how helping is influenced by the communicative function it serves and the cues used to elicit helping in young children with and without a social communication disorder. AIMS: To present evidence of the AToP-H's reliability, validity and clinical utility. METHODS & PROCEDURES: The AToP-H examines three communicative functions expressed through helping-instrumental (request-based), informative (information-based) and empathic (emotion-based) helping-within a naturalistic context. Prosocial helping is elicited using semi-structured interactions in which increasingly explicit cues are provided to scaffold child responses. To gather reliability and validity evidence, the AToP-H was administered to 20 children with autism spectrum disorder (ASD) (49-79 months) and 20 with typical development (37-77 months). OUTCOMES & RESULTS: Procedural reliability and inter-observer agreement for the AToP-H were high. Item-level codes were consistent with overall task performance, showing strong internal consistency. Supporting construct validity, higher scores were observed in older children with ASD, consistent with an expectedly protracted developmental period for prosocial helping. Children with ASD required more cues to elicit helping overall and informative and empathic helping in particular. Furthermore, more children with ASD did not respond or required explicit cues to respond with informative and empathic helping. Supporting criterion-related validity, total helping cue scores were significantly correlated with measures of social cognition, social abilities and receptive language, but were only weakly correlated with general language. CONCLUSIONS & IMPLICATIONS: The AToP-H shows promise in measuring helping performance as an indicator of young children's social communication strengths and weaknesses as well as scaffolding cues to facilitate intervention planning. WHAT THIS PAPER ADDS: What is already known on the subject Prosocial helping is critical for successful relationships, which can be difficult for children with social communication disorders such as ASD. Two factors that influence helping are the communicative function of the helping behaviour and the cues used to elicit helping. Existing helping tasks have been developed for research purposes, focusing on internal validity with little attention to applying or generalizing results to clinical settings or groups. Thus, assessing factors that influence helping behaviours in naturalistic, ecologically valid contexts could provide clinicians with critical information to improve prosocial helping in children with social communication disorders. What this paper adds to existing knowledge This paper presents preliminary psychometric evidence for a naturalistic clinical task: the AToP-H, which assesses instrumental (request-based), informative (information-based) and empathic (emotion-based) helping elicited with increasingly explicit cues. What are the potential or actual clinical implications of this work? Evidence from samples of young children with and without ASD supports the reliability and validity of AToP-H scores. The AToP-H shows promise as a clinical tool to effectively assess and plan interventions targeting social communication, prosocial helping and associated interactions.

Cohesive Referencing Errors During Narrative Production as Clinical Evidence of Central Nervous System Abnormality in School-Aged Children With Fetal Alcohol Spectrum Disorders.

Purpose: Previous evidence suggests that cohesive referencing errors made during narratives may be a behavior that is revealing of underlying central nervous system abnormality in children with fetal alcohol spectrum disorders (FASD). The current research extends this evidence. Method: Retrospective analysis of narrative and clinical data from 152 children (ages 6 to 14), 72 of whom had confirmed FASD, was used. Narrative analysis was conducted blind to diagnostic status, age, or gender. Group performance was compared. The associations between measures of cohesive referencing and clinically gathered indices of the degree of central nervous system abnormality were examined. Results: Results show clear associations between elevated rates of cohesive referencing errors and central nervous system abnormality. Elevated error rates were more common in children with FASD than those without, and prevalence increased predictably across groups with more severe central nervous system abnormality. Risk is particularly elevated for those with microcephaly or a diagnosis of fetal alcohol syndrome. Conclusion: Cohesive referencing errors during narrative are a viable behavioral marker of the kinds of central nervous system abnormality associated with prenatal alcohol exposure, having significant potential to become a valuable diagnostic and research tool.

Brief Report: An Independent Replication and Extension of Psychometric Evidence Supporting the Theory of Mind Inventory.

This study presents an independent replication and extension of psychometric evidence supporting the Theory of Mind Inventory (ToMI). Parents of 20 children with ASD (4; 1-6; 7 years; months) and 20 with typical development (3; 1-6; 5), rated their child's theory of mind abilities in everyday situations. Other parent report and child behavioral assessments included the Social Responsiveness Scale-2, Vineland Adaptive Behavior Scales-2, Peabody Picture Vocabulary Test-4, and Clinical Evaluation of Language Fundamentals-Preschool, 2. Results revealed high internal consistency, expected developmental changes in children with typical development, expected group differences between children with and without ASD, and strong correlations with other measures of social and communication abilities. The ToMI demonstrates strong psychometrics, suggesting considerable utility in identifying theory of mind deficits in children with ASD.

Assessing young children's intention-reading in authentic communicative contexts: preliminary evidence and clinical utility.

BACKGROUND: Identifying what a communication partner is looking at (referential intention) and why (social intention) is essential to successful social communication, and may be challenging for children with social communication deficits. This study explores a clinical task that assesses these intention-reading abilities within an authentic context. AIMS: To gather evidence of the task's reliability and validity, and to discuss its clinical utility. METHODS & PROCEDURES: The intention-reading task was administered to twenty 4-7-year-olds with typical development (TD) and ten with autism spectrum disorder (ASD). Task items were embedded in an authentic activity, and they targeted the child's ability to identify the examiner's referential and social intentions, which were communicated through joint attention behaviours. Reliability and construct validity evidence were addressed using established psychometric methods. OUTCOMES & RESULTS: Reliability and validity evidence supported the use of task scores for identifying children whose intention-reading warranted concern. Evidence supported the reliability of task administration and coding, and item-level codes were highly consistent with overall task performance. Supporting task validity, group differences aligned with predictions, with children with ASD exhibiting poorer and more variable task scores than children with TD. Also, as predicted, task scores correlated significantly with verbal mental age and ratings of parental concerns regarding social communication abilities. CONCLUSIONS & IMPLICATIONS: The evidence provides preliminary support for the reliability and validity of the clinical task's scores in assessing young children's real-time intention-reading abilities, which are essential for successful interactions in school and beyond.

Magnetic resonance imaging outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders.

BACKGROUND: Magnetic resonance (MR) technology offers noninvasive methods for in vivo assessment of neuroabnormalities. METHODS: A comprehensive neuropsychological/psychiatric battery, coupled with MR imaging, (MRI), MR spectroscopy (MRS), and functional MRI (fMRI) assessments, were administered to children with fetal alcohol spectrum disorders (FASD) to determine if global and/or focal abnormalities could be identified, and distinguish diagnostic subclassifications across the spectrum. The 4 study groups included: (i) fetal alcohol syndrome (FAS)/partial FAS (PFAS); (ii) static encephalopathy/alcohol exposed (SE/AE); (iii) neurobehavioral disorder/alcohol exposed (ND/AE) as diagnosed with the FASD 4-Digit Code; and (iv) healthy peers with no prenatal alcohol exposure. Presented here are the MRI assessments that were used to compare the sizes of brain regions between the 4 groups. The neuropsychological/behavioral, MRS, and fMRI outcomes are reported separately. RESULTS: Progressing across the 4 study groups from Controls to ND/AE to SE/AE to FAS/PFAS, the mean absolute size of the total brain, frontal lobe, caudate, putamen, hippocampus, cerebellar vermis, and corpus callosum length decreased incrementally and significantly. The FAS/PFAS group (the only group with the 4-Digit FAS facial phenotype) had disproportionately smaller frontal lobes relative to all other groups. The FAS/PFAS and SE/AE groups [the 2 groups with the most severe central nervous system (CNS) dysfunction] had disproportionately smaller caudate regions relative to the ND/AE and Control groups. The prevalence of subjects in the FAS/PFAS, SE/AE, and ND/AE groups that had 1 or more brain regions, 2 or more SDs below the mean size observed in the Control group was 78, 58, and 43%, respectively. Significant correlations were observed between size of brain regions and level of prenatal alcohol exposure, magnitude of FAS facial phenotype, and level of CNS dysfunction. CONCLUSIONS: Magnetic resonance imaging provided further validation that ND/AE, SE/AE, and FAS/PFAS as defined by the FASD 4-Digit Code are 3 clinically distinct and increasingly more affected diagnostic subclassifications under the umbrella of FASD. Neurostructural abnormalities are present across the spectrum. MRI could importantly augment diagnosis of conditions under the umbrella of FASD, once population-based norms for structural development of the human brain are established.

Magnetic resonance spectroscopy outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders.

Magnetic resonance (MR) technology offers noninvasive methods for in vivo assessment of neuroabnormalities. A comprehensive neuropsychological/behavioral, MR imaging (MRI), MR spectroscopy (MRS) and functional MRI (fMRI) assessment was administered to children with fetal alcohol spectrum disorders (FASD) to determine whether global and/or focal abnormalities could be identified and to distinguish diagnostic subclassifications across the spectrum. The four study groups included (1) FAS/partial FAS; (2) static encephalopathy/alcohol exposed (SE/AE); (3) neurobehavioral disorder/alcohol exposed (ND/AE) as diagnosed with the FASD 4-Digit Code; and (4) healthy peers with no prenatal alcohol exposure. Results are presented in four separate reports: MRS (reported here) and neuropsychological/behavioral, MRI and fMRI outcomes (reported separately). MRS was used to compare neurometabolite concentrations [choline (Cho), n-acetyl-aspartate (NAA) and creatine (Cre)] in a white matter region and a hippocampal region between the four study groups. Choline concentration in the frontal/parietal white matter region, lateral to the midsection of the corpus callosum, was significantly lower in FAS/PFAS relative to all other study groups. Choline decreased significantly with decreasing frontal white matter volume and corpus callosum length. These outcomes suggest low choline concentrations may reflect white matter deficits among FAS/PFAS. Choline also decreased significantly with increasing severity of the 4-Digit FAS facial phenotype, increasing impairment in psychological performance and increasing alcohol exposure. NAA and Cre concentrations did not vary significantly. This study provides further evidence of the vulnerability of the cholinergic system in FASD.

Neuropyschological and behavioral outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders.

BACKGROUND: Clinical and research advancements in the field of fetal alcohol spectrum disorders (FASD) require accurate and valid identification of FASD clinical subgroups. OBJECTIVES: A comprehensive neuropsychological battery, coupled with magnetic resonance imaging, (MRI), MR spectroscopy (MRS), and functional MRI (fMRI) were administered to children with fetal alcohol spectrum disorders (FASD) to determine if global and/or focal abnormalities could be identified across the spectrum, and distinguish diagnostic subclassifications within the spectrum. The neuropsychological outcomes of the comprehensive neuroimaging study are presented here. METHODS: The study groups included: 1) FAS/Partial FAS; 2) Static Encephalopathy/Alcohol Exposed (SE/AE); 3) Neurobehavioral Disorder/Alcohol Exposed (ND/AE) as diagnosed by an interdisciplinary team using the FASD 4-Digit Code; and 4) healthy peers with no prenatal alcohol. A standardized neuropsychological battery was administered to each child and their primary caregiver by a psychologist. RESULTS: Use of the 4-Digit Code produced three clinically and statistically distinct FASD clinical subgroups. The three subgroups (ND/AE, SE/AE and FAS/PFAS) reflected a linear continuum of increasing neuropsychological impairment and physical abnormality, representing the full continuum of FASD. Behavioral and psychiatric disorders were comparably prevalent across the three FASD groups, and significantly more prevalent than among the Controls. All three FASD subgroups had comparably high levels of prenatal alcohol exposure. CONCLUSIONS: Although ND/AE, SE/AE, and FAS/PFAS are distinct FASD subgroups, these groups are not distinguishable solely by their neuropsychological profiles. While all children within a group shared the same magnitude of neuropsychological impairment, the patterns of impairment showed considerable individual variability. MRI, MRS and fMRI further distinguished these FASD subgroups.

Functional magnetic resonance imaging outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders.

A comprehensive neuropsychological/psychiatric, MR imaging, (MRI), MR spectroscopy (MRS), and functional MRI (fMRI) assessment was administered to children with fetal alcohol spectrum disorders (FASD) to determine if global and/or focal abnormalities could be identified, and distinguish diagnostic subclassifications across the spectrum. The four study groups included: 1. FAS/Partial FAS; 2. Static Encephalopathy/Alcohol Exposed (SE/AE); 3. Neurobehavioral Disorder/Alcohol Exposed (ND/AE); and 4. healthy peers with no prenatal alcohol exposure. fMRI outcomes are reported here. The neuropsychological/psychiatric, MRI, and MRS outcomes are reported separately. fMRI was used to assess activation in seven brain regions during performance of N-back working memory tasks. Children across the full spectrum of FASD exhibited significant working memory deficits and altered activation patterns in brain regions that are known to be involved in working memory. These results demonstrate the potential research and diagnostic value of this non-invasive MR tool in the field of FASD.

Informativeness of the spoken narratives of younger and older adolescents with specific language impairment and their counterparts with normal language.

A large body of literature describing the narrative skills of young children with and without language impairments exists. However, there has been only limited study of the informativeness of narratives of adolescents with normally developing language (NL) and those of adolescents with specific language impairment (SLI), even though narratives play an important role in adolescents' complex social and academic lives and there is emerging evidence that narrative abilities in young children portend their later language proficiency. This study examined the informativeness of oral narratives produced by four groups of adolescents: younger adolescents with NL (mean age = 13years:2 months), older adolescents with NL (15:10), younger adolescents with SLI (13:2) and older adolescents with SLI (15:9). The results indicated that the narratives produced by the SLI adolescents consisted of fewer informative and more irrelevant/inaccurate responses than the narratives of their peers with NL. The SLI adolescents also tended to give more vague responses in their narratives than their NL counterparts, as well tending not to provide any responses to the pictures representing the story. Taken together, these results painted a picture of SLI adolescents producing less satisfying, complete, and cohesive narratives, findings consistent with those of the research on children with SLI. Language status more than age appeared to be the factor that affected the likelihood of the adolescents providing or not providing informative responses. These results suggested that the performance of adolescents with SLI may not catch up to the level of performance of their NL counterparts during adolescence.

A state of double jeopardy: impact of prenatal alcohol exposure and adverse environments on the social communicative abilities of school-age children with fetal alcohol spectrum disorder.

PURPOSE: This article is a retrospective examination of environmental risk, language performance, and narrative discourse data from a clinical database of school-age children with fetal alcohol spectrum disorder (FASD). METHOD: A case-defined diagnostic approach for measuring and reporting the full spectrum of disabilities in children with prenatal alcohol exposure is presented. Demographic, environmental, language, and social communication (as reflected by narrative discourse) data are reported for a large cohort of children with FASD between the ages of 6;0 (years;months) and 12;0. RESULTS: Children with FASD are a heterogeneous group with varying levels of compromise. The data demonstrate a substantial comorbidity between the effects of prenatal alcohol exposure and adverse caregiving environments. The data further reveal that school-age children with FASD often exhibit clinically meaningful deficits in language and social communication. CLINICAL IMPLICATION: Children with FASD may be particularly vulnerable to language and social communication deficits as a result of prenatal alcohol exposure and atypical or adverse social interactive experiences. Comprehensive assessment is recommended. Dynamic and functional assessment paradigms may document the language and social communicative deficits in children with FASD and other clinical populations with complex neurodevelopmental profiles.

Exploring the utility of narrative analysis in diagnostic decision making: picture-bound reference, elaboration, and fetal alcohol spectrum disorders.

PURPOSE: To evaluate classification accuracy and clinical feasibility of a narrative analysis tool for identifying children with a fetal alcohol spectrum disorder (FASD). METHOD: Picture-elicited narratives generated by 16 age-matched pairs of school-aged children (FASD vs. typical development [TD]) were coded for semantic elaboration and reference strategy by judges who were unaware of age, gender, and group membership of the participants. Receiver operating characteristic (ROC) curves were used to examine the classification accuracy of the resulting set of narrative measures for making 2 classifications: (a) for the 16 children diagnosed with FASD, low performance (n = 7) versus average performance (n = 9) on a standardized expressive language task and (b) FASD (n = 16) versus TD (n = 16). RESULTS: Combining the rates of semantic elaboration and pragmatically inappropriate reference perfectly matched a classification based on performance on the standardized language task. More importantly, the rate of ambiguous nominal reference was highly accurate in classifying children with an FASD regardless of their performance on the standardized language task (area under the ROC curve = .863, confidence interval = .736-.991). CONCLUSION: Results support further study of the diagnostic utility of narrative analysis using discourse level measures of elaboration and children's strategic use of reference.

Reliability issues and solutions for coding social communication performance in classroom settings.

PURPOSE: To explore the utility of time-interval analysis for documenting the reliability of coding social communication performance of children in classroom settings. Of particular interest was finding a method for determining whether independent observers could reliably judge both occurrence and duration of ongoing behavioral dimensions for describing social communication performance. METHOD: Four coders participated in this study. They observed and independently coded 6 social communication behavioral dimensions using handheld computers. The dimensions were mutually exclusive and accounted for all verbal and nonverbal productions during a specified time frame. The technology allowed for coding frequency and duration for each entered code. Data were collected from 20 different 2-min video segments of children in kindergarten through 3rd-grade classrooms. Data were analyzed for interobserver and intraobserver agreements using time-interval sorting and Cohen's kappa. Further, interval size and total observation length were manipulated to determine their influence on reliability. RESULTS: The data revealed interval sorting and kappa to be a suitable method for examining reliability of occurrence and duration of ongoing social communication behavioral dimensions. Nearly all comparisons yielded medium to large kappa values; interval size and length of observation minimally affected results. Implications The analysis procedure described in this research solves a challenge in reliability: comparing coding by independent observers of both occurrence and duration of behaviors. Results indicate the utility of a new coding taxonomy and technology for application in online observations of social communication in a classroom setting.

Social communication interventions for preschoolers: targeting peer interactions during peer group entry and cooperative play.

Some preschoolers with language impairment approach and manage peer interactions less effectively than typically developing peers. This article discusses assessment and intervention strategies for targeting preschoolers' social communication skills during peer entry and cooperative play situations. Essential features of effective interventions include identification of appropriate social communication targets, addressing and facilitating children's use of these targets during small group sessions with peers, and supporting generalization of newly acquired social communication behaviors to children's peer interactions within the classroom setting.

"Do I know what I need to do?" A social communication intervention for children with complex clinical profiles.

PURPOSE: Speech-language pathologists frequently address social communication difficulties in children with diverse clinical profiles. The purpose of this study was to investigate the feasibility of a social communication intervention for a school-age child with a complex cognitive and behavioral profile secondary to diagnosis of a fetal alcohol spectrum disorder. METHOD: A case study is presented to describe the implementation of the intervention targeting mental state verb production and social cognitive skills. The intervention included group role play of social scripts and a checklist to elicit the participant's statements about others' perspectives and strategies for completing the social script. Treatment data monitored the participant's responses to the checklist questions. Probe sessions, consisting of theory of mind false belief tasks, were used to examine mental state verb use. RESULTS: Treatment data demonstrated that the participant stated more strategies in response to checklist questions. The participant did not produce any mental state verbs during baseline probes, but did produce mental state verbs during the treatment phase. CLINICAL IMPLICATIONS: The results support use of this intervention to change children's linguistic and social cognitive skills. Suggestions for extending this intervention to include a generalization plan targeting classroom social communication interactions are provided.

Facilitating written work using computer word processing and word prediction.

OBJECTIVE: The purpose of this study was to investigate whether occupational therapy intervention that focused on teaching children to use word processing, either alone or with word prediction, was effective in improving the written communication skills of children with learning disabilities and handwriting problems. METHOD: A single-subject alternating treatments design was replicated across three children in grades 4 and 5. During the baseline phase the children wrote stories by hand; during the intervention phase, the children wrote stories, alternating among handwriting, word processing, and word processing with word prediction. Dependent variables focused on percentages of legible words, percentages of correctly spelled words, total amount written, and rate of writing. Data were analyzed by visual inspection. RESULTS: Results were variable. Two children had clear improvements in legibility when using either word processing alone or with word prediction. These same children demonstrated clear improvements in spelling when using word prediction. Though rate of writing was best for two children when using handwriting, relative to total amount produced, one method was not clearly preferable to another. CONCLUSION: Occupational therapy intervention involving word processing with word prediction improves the legibility and spelling of written assignments completed by some children with learning disabilities and handwriting difficulties. It is important to evaluate each child individually and provide training and ongoing support for technology use.

The Influence of Language/Cognitive Profile on Discourse Intervention Outcome.

Children with communication needs are often allocated intervention services as a result of the relationship between their cognitive ability and language performance. Children with higher cognitive skills relative to language skills are considered promising candidates for language services. In contrast, children who are delayed in both cognitive and language abilities are considered poor candidates for intervention and are often excluded from services, or given a lower priority for services. This study examines the effects of intervention on one aspect of pragmatic development (discourse skills) following intervention for two groups of young children with delayed language development: one group with measured cognitive performance above language performance, and the other group with similar delays in both language and cognitive performance. Repeated measures analyses of variance indicated significant differences between groups for two of 15 measures derived from language samples. Both favored the children with equivalent delays in language and cognition. These findings do not support the notion that children with equivalent delays in cognition and language development are poor candidates for language intervention. Service delivery and policy implications are discussed.