Practice parameter: screening and diagnosis of autism: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society.

Autism is a common disorder of childhood, affecting 1 in 500 children. Yet, it often remains unrecognized and undiagnosed until or after late preschool age because appropriate tools for routine developmental screening and screening specifically for autism have not been available. Early identification of children with autism and intensive, early intervention during the toddler and preschool years improves outcome for most young children with autism. This practice parameter reviews the available empirical evidence and gives specific recommendations for the identification of children with autism. This approach requires a dual process: 1) routine developmental surveillance and screening specifically for autism to be performed on all children to first identify those at risk for any type of atypical development, and to identify those specifically at risk for autism; and 2) to diagnose and evaluate autism, to differentiate autism from other developmental disorders.

The screening and diagnosis of autistic spectrum disorders.

The Child Neurology Society and American Academy of Neurology recently proposed to formulate Practice Parameters for the Diagnosis and Evaluation of Autism for their memberships. This endeavor was expanded to include representatives from nine professional organizations and four parent organizations, with liaisons from the National Institutes of Health. This document was written by this multidisciplinary Consensus Panel after systematic analysis of over 2,500 relevant scientific articles in the literature. The Panel concluded that appropriate diagnosis of autism requires a dual-level approach: (a) routine developmental surveillance, and (b) diagnosis and evaluation of autism. Specific detailed recommendations for each level have been established in this document, which are intended to improve the rate of early suspicion and diagnosis of, and therefore early intervention for, autism.

Understanding the continuum of discrete-trial traditional behavioral to social-pragmatic developmental approaches in communication enhancement for young children with autism/PDD.

Clinicians are faced with the challenge of making informed decisions amidst heated debates over the most effective treatment approaches for young children with autism. This article provides a more specific focus to this debate by considering the practice of enhancing spontaneous language and related social-communicative abilities of young children with autism/pervasive developmental disorder (PPD). First, a historical perspective of the evolution of different approaches for enhancing communication and related abilities is presented, followed by a description of characteristics of the approaches. The approaches are described along a continuum from massed discrete trial, traditional behavioral to social-pragmatic, developmental. The current state of knowledge regarding the effectiveness of early services for children with autism/PDD is examined and conclusions are presented with consideration of the need for more meaningful outcome measures than are currently used for the next generation of outcome research.

Brothers and sisters of young children with communication disorders.

Family-centered approaches have revolutionized the way that clinicians provide services to young children with communication disorders and their families. With greater recognition of the significant impact that siblings have on each other's development and the potential stress and role confusion that siblings may experience when there is childhood disability in the family, it becomes more critical that the needs of siblings are considered and addressed. In this article, a variety of issues are considered relative to siblings' experiences. First, the roles of siblings and their effects on each other's development is reviewed, followed by a historical perspective of the impact of childhood disability on brothers and sisters. Next, sibling roles relative to a brother or sister with a communication disability are considered. Finally, clinical implications are discussed, with specific reference to active inclusion of siblings in family-centered assessment and intervention efforts.

Communication disorders and emotional/behavioral disorders in children and adolescents.

Recent research in child psychiatry has demonstrated a high prevalence of speech, language, and communication disorders in children referred to psychiatric and mental health settings for emotional and behavioral problems. Conversely, children referred to speech and language clinics for communication disorders have been found to have a high rate of diagnosable psychiatric disorders. Most of the emerging knowledge regarding relationships between communication disorders and psychiatric disorders has been presented in the child psychiatric literature. Speech-language pathologists and audiologists also need to be familiar with this information; an understanding of the complex interrelationship between communication disorders and emotional and behavioral disorders is important for diagnosis, assessment, and treatment. The purpose of this article is to review recent research and discuss clinical implications for professionals in speech-language pathology and audiology working with children and adolescents who have, or who are at risk for, developing emotional and behavioral disorders. Issues to be addressed include differential diagnosis, prevention, intervention, and the role of speech-language pathologists serving these children and adolescents.

Encoding of new versus old information by autistic children.

Research and literature on communication problems of autistic individuals have identified specific pragmatic deficiencies. This preliminary study focused upon describing autistic children's verbal performance in regard to the pragmatic ability of encoding new versus old information. Four autistic children with MLUs of 1.96-2.82 were videotaped on two occasions in interactions with their teachers or speech-language pathologists. All of the subjects' referential utterances, including referential echolalic utterances, were categorized as the encoding of new or old information. Two prominent means that speakers used for encoding new versus old information were examined: the encoding of new information through single-word utterances (i.e., a lexicalization strategy) and the use of contrastive stress to highlight new information in multiword utterances. The results revealed that the 4 subjects did encode new information through lexicalization in single-word utterances and through contrastive stress in multiword utterances. However, the subjects encoded old information almost as frequently as they encoded new information. The encoding of a new action or state change was marked relatively infrequently by the subjects, and they consistently produced repetitions of previously encoded information when they failed to offer new information to their listeners. The results are discussed in reference to cognitive processing patterns of autistic individuals.

Analysis of functions of delayed echolalia in autistic children.

This study was a preliminary attempt to determine how autistic children used delayed echolalia in naturalistic interactions with familiar people. Fourteen functional categories of delayed echolalia were derived based on videotape analyses of linguistic, extralinguistic, and paralinguistic features. Individual differences in functional usage were apparent across the three subjects. Delayed echolalia was found to vary along the dimensions of interactiveness, comprehension of the utterance produced, and relevance to linguistic or situational context. The diversity of delayed echolalic behavior is discussed in reference to its conventionality, the presence or absence of communicative intent, and its status as symbolic communicative activity.

Language acquisition and communicative behavior in autism: toward an understanding of the "whole" of it.

Deviant language characteristics, deficits in social interaction, and ritualistic and compulsive behaviors are now considered to be among the definitive characteristics of the autistic syndrome. There have been few attempts to bring a sense of cohesion to the varied communicative symptomatology evident in autism, because much of the research literature has been product oriented rather than process oriented, and has focused on language structure rather than function. Therefore, behaviors such as immediate echolalia, delayed echolalia, and interactive rituals are often viewed as isolated, deviant phenomena, rather than as phenomena related to predominant cognitive processing modes and cognitive-linguistic development in autism. This discussion reviews symptomatology of autistic communication in reference to "gestalt" versus "analytic" modes of cognitive processing, language acquisition, and language use. Based on research on language behavior of normal and autistic children, specific issues are considered, including a reconsideration of echolalic behaviors, patterns of social interaction, and patterns of cognitive-linguistic development in autism.

The functions of immediate echolalia in autistic children.

This research was intended to discover how immediate echolalia functioned for autistic children in interactions with familial adults. For echolalic children were videotaped at school and at home, in both group and dyadic interactions in natural situations such as lunchtime, family activities, and play activities in school. After conducting a multilevel analysis (of over 1,000 utterances) of verbal and nonverbal factors, response latency, and intonation, it was discovered that immediate echolalia is far more than a meaningless behavior, as has been previously reported. Seven functional categories of echolalia were discovered and are discussed in reference to behavioral and linguistic features of each category. It is argue that researchers who propose intervention programs of ech-abatement may be overlooking the important communicative and cognitive functions echolalia may serve for the autistic child.