A commentary on children's books about autism: What messages do they send about neurodiversity?

The past three decades have seen an exponential increase in the publication of children's books about autism. This increased availability of children's books is exciting because they have the power to promote understanding, acceptance, and appreciation of neurodiversity. However, growing concerns have been raised by both autistic and non-autistic people that some children's books about autism may work against neurodiversity, rather than promoting it. This Commentary discusses the strikingly different ways in which children's books about autism portray key concepts related to neurodiversity, including autistic differences, agency, abilities, and communication. We present concrete examples (including books by autistic authors); highlight the views of autistic and non-autistic parents of autistic children; and discuss how different books may leave readers with different impressions of autism and neurodiversity. Given the vastly different themes that emerge across different books, we conclude that it is important for educators, families, and other members of the autism community to make informed and individualized choices about what books they use for what purpose. We emphasize the need for systematic, high-quality research on children's books about autism, including content analyses and studies that determine what messages these books send to their intended audience: children. It is vital that autistic people continue to shape this conversation, contributing unique insights that inform research priorities and the methodological approaches used to investigate them.

Parent Certainty and Consistency When Completing Vocabulary Checklists in Young Autistic Children.

PURPOSE: Using a novel parent report measure, this study investigated whether asking parents to rate their certainty when reporting on child vocabulary skills provided additional insight into parent report and emerging language abilities in young autistic children. Specifically, we investigated whether parent certainty varied based on whether the child was reported to understand, understand and say, or neither understand nor say the word and whether standardized measures of expressive and receptive language abilities and/or autistic traits predicted parent certainty. Lastly, we investigated whether certainty was associated with inconsistency in parent report of child word knowledge. METHOD: Twenty-one parents and their autistic children ages 2-5 years participated. One parent per child completed the MacArthur-Bates Communicative Development Inventories (MCDI) Words and Gestures form and a custom vocabulary checklist including 24 object nouns from the MCDI. Within the custom form, parents indicated whether their child understood, understood and said, or neither understood nor said 24 target nouns and reported how certain they were about their responses using a 5-point scale. Expressive language, receptive language, and autistic traits were measured via direct assessment using standardized measures. RESULTS: Parent certainty varied widely and was higher for words the parents reported the children understood and said compared to that for words children either understood or neither understood nor said. Certainty ratings were higher when a child had higher standardized receptive and expressive language scores. Lastly, parent certainty was associated with reporting consistency, clarifying previous findings of inconsistencies in parent report of child vocabulary. CONCLUSION: Findings from this study indicate that measuring parent certainty provides critical information when assessing early vocabulary skills in autistic children. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23671497.

Visual perceptual salience and novel referent selection in children with and without autism spectrum disorder.

Background & Aims: Many young children with autism spectrum disorder (ASD) demonstrate striking delays in early vocabulary development. Experimental studies that teach the meanings of novel nonwords can determine the effects of linguistic and attentional factors. One factor that may affect novel referent selection in children with ASD is visual perceptual salience-how interesting (i.e., striking) stimuli are on the basis of their visual properties. The goal of the current study was to determine how the perceptual salience of objects affected novel referent selection in children with ASD and children who are typically developing (TD) of similar ages (mean age 3-4 years). Methods: Using a screen-based experimental paradigm, children were taught the names of four unfamiliar objects: two high-salience objects and two low-salience objects. Their comprehension of the novel words was assessed in low-difficulty and high-difficulty trials. Gaze location was determined from video by trained research assistants. Results: Contrary to initial predictions, findings indicated that high perceptual salience disrupted novel referent selection in the children with ASD but facilitated attention to the target object in age-matched TD peers. The children with ASD showed no significant evidence of successful novel referent selection in the high-difficulty trials. Exploratory reaction time analyses suggested that the children with autism showed "stickier" attention-had more difficulty disengaging (i.e., looking away)-from high-salience distracter images than low-salience distracter images, even though the two images were balanced in salience for any given test trial. Conclusions and Clinical Implications: These findings add to growing evidence that high perceptual salience has the potential to disrupt novel referent selection in children with ASD. These results underscore the complexity of novel referent selection and highlight the importance of taking the immediate testing context into account. In particular, it is important to acknowledge that screen-based assessments and screen-based learning activities used with children with ASD are not immune to the effects of lower level visual features, such as perceptual salience.

Revisiting the simplification of adult language input in the context of naturalistic developmental behavioral interventions: A commentary.

Naturalistic developmental behavioral interventions (NDBI) are an evidence-based class of early interventions for improving language and social communication skills in autistic children. However, relatively little is known about how individual elements of NDBI support child development. This commentary focuses on one common element across NDBI models: the simplification of adult language input. Advances in developmental science focusing on the length and complexity of adult spoken utterances suggests that natural, grammatical utterances facilitate comprehension and expressive language development in autistic and nonautistic children. Yet, NDBI tend to recommend shorter and simpler adult utterances. We close by describing directions for future research which would inform recommendations around adult language input in NDBI to optimally support child language and communication development.

Electronic Toys Decrease the Quantity and Lexical Diversity of Spoken Language Produced by Children With Autism Spectrum Disorder and Age-Matched Children With Typical Development.

Many young children with autism spectrum disorder (ASD) have language delays. Play-based interactions present a rich, naturalistic context for supporting language and communication development, but electronic toys may compromise the quality of play interactions. This study examined how electronic toys impact the quantity and lexical diversity of spoken language produced by children with ASD and age-matched children with typical development (TD), compared to traditional toys without electronic features. Twenty-eight parent-child dyads (14 per group) played with both electronic and traditional toy sets in a counter-balanced order. We transcribed child speech during both play sessions and derived the number of utterances and number of different word (NDW) roots per minute that children produced. Children with ASD and children with TD talked significantly less and produced significantly fewer unique words during electronic toy play than traditional toy play. In this way, children appear to take a "backseat" to electronic toys, decreasing their communicative contributions to play-based social interactions with their parents. These findings highlight the importance of understanding how toy type can affect parent-child play interactions and the subsequent learning opportunities that may be created. Play-based interventions for children with ASD may be most effective when they incorporate traditional toys, rather than electronic toys.

Competing Perceptual Salience in a Visual Word Recognition Task Differentially Affects Children With and Without Autism Spectrum Disorder.

Differences in visual attention have long been recognized as a central characteristic of autism spectrum disorder (ASD). Regardless of social content, children with ASD show a strong preference for perceptual salience-how interesting (i.e., striking) certain stimuli are, based on their visual properties (e.g., color, geometric patterning). However, we do not know the extent to which attentional allocation preferences for perceptual salience persist when they compete with top-down, linguistic information. This study examined the impact of competing perceptual salience on visual word recognition in 17 children with ASD (mean age 31 months) and 17 children with typical development (mean age 20 months) matched on receptive language skills. A word recognition task presented two images on a screen, one of which was named (e.g., Find the bowl!). On Neutral trials, both images had high salience (i.e., were colorful and had geometric patterning). On Competing trials, the distracter image had high salience but the target image had low salience, creating competition between bottom-up (i.e., salience-driven) and top-down (i.e., language-driven) processes. Though both groups of children showed word recognition in an absolute sense, competing perceptual salience significantly decreased attention to the target only in the children with ASD. These findings indicate that perceptual properties of objects can disrupt attention to relevant information in children with ASD, which has implications for supporting their language development. Findings also demonstrate that perceptual salience affects attentional allocation preferences in children with ASD, even in the absence of social stimuli. LAY SUMMARY: This study found that visually striking objects distract young children with autism spectrum disorder (ASD) from looking at relevant (but less striking) objects named by an adult. Language-matched, younger children with typical development were not significantly affected by this visual distraction. Though visual distraction could have cascading negative effects on language development in children with ASD, learning opportunities that build on children's focus of attention are likely to support positive outcomes.

Psychophysiological and Eye-Tracking Markers of Speech and Language Processing in Neurodevelopmental Disorders: New Options for Difficult-to-Test Populations.

It can be challenging to accurately assess speech and language processing in preverbal or minimally verbal individuals with neurodevelopmental disabilities (NDD) using standardized behavioral tools. Event-related potential and eye tracking methods offer novel means to objectively document receptive language processing without requiring purposeful behavioral responses. Working around many of the cognitive, motor, or social difficulties in NDDs, these tools allow for minimally invasive, passive assessment of language processing and generate continuous scores that may have utility as biomarkers of individual differences and indicators of treatment effectiveness. Researchers should consider including physiological measures in assessment batteries to allow for more precise capture of language processing in individuals for whom it may not behaviorally apparent.

Speech-Language Pathologists' Ratings of Telegraphic Versus Grammatical Utterances: A Survey Study.

Purpose It is common for speech-language pathologists (SLPs) to simplify their utterances when talking to children with language delays, but there is disagreement about whether simplified utterances should be grammatical (e.g., Daddy is running, See the cookie?) or telegraphic (e.g., Daddy running, See cookie?). This study examined the extent to which SLPs reported grammatical versus telegraphic utterances to sound like something they would say and investigated whether results differed based on SLPs' perspectives about the usefulness of telegraphic input. Method Ninety-three practicing SLPs completed an online survey. SLPs rated the extent to which a list of telegraphic and grammatical utterances sounded like something they would say to a child with a language delay who is prelinguistic or at the one- or two-word stages of spoken language development. Results SLPs who did not view telegraphic input as useful or felt neutral about this issue rated grammatical utterances to sound significantly more like something they would say than telegraphic utterances. However, findings differed for SLPs who viewed telegraphic input as useful. There was no significant difference in the extent to which these SLPs reported grammatical versus telegraphic utterances to sound like something they would say. Conclusions As incorrect language models, telegraphic utterances are counterexamples to the grammatical structure of English that may make it more difficult for learners to detect regularities in the language input they hear. Unless empirical evidence emerges in support of telegraphic input, it may be beneficial to maximize grammatical input provided to children with language delays.

An investigation into maternal use of telegraphic input to children with Down syndrome.

Maternal input influences language development in children with Down syndrome (DS) and typical development (TD). Telegraphic input, or simplified input violating English grammatical rules, is controversial in speech-language pathology, yet no research to date has investigated whether mothers of children with DS use telegraphic input. This study investigated the quality of linguistic input to children with DS compared to age-matched children with TD, and the relationship between maternal input and child language abilities. Mothers of children with DS simplified their input in multiple ways, by using a lower lexical diversity, shorter utterances, and more telegraphic input compared to mothers of children with TD. Telegraphic input was not significantly correlated with other aspects of maternal input or child language abilities. Since children with DS demonstrate specific deficits in grammatical compared to lexical abilities, future work should investigate the long-term influence of maternal telegraphic input on language development in children with DS.

Comparing Automatic Eye Tracking and Manual Gaze Coding Methods in Young Children with Autism Spectrum Disorder.

Eye-gaze methods offer numerous advantages for studying cognitive processes in children with autism spectrum disorder (ASD), but data loss may threaten the validity and generalizability of results. Some eye-gaze systems may be more vulnerable to data loss than others, but to our knowledge, this issue has not been empirically investigated. In the current study, we asked whether automatic eye-tracking and manual gaze coding produce different rates of data loss or different results in a group of 51 toddlers with ASD. Data from both systems were gathered (from the same children) simultaneously, during the same experimental sessions. As predicted, manual gaze coding produced significantly less data loss than automatic eye tracking, as indicated by the number of usable trials and the proportion of looks to the images per trial. In addition, automatic eye-tracking and manual gaze coding produced different patterns of results, suggesting that the eye-gaze system used to address a particular research question could alter a study's findings and the scientific conclusions that follow. It is our hope that the information from this and future methodological studies will help researchers to select the eye-gaze measurement system that best fits their research questions and target population, as well as help consumers of autism research to interpret the findings from studies that utilize eye-gaze methods with children with ASD. Autism Res 2020, 13: 271-283. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The current study found that automatic eye-tracking and manual gaze coding produced different rates of data loss and different overall patterns of results in young children with ASD. These findings show that the choice of eye-gaze system may impact the findings of a study-important information for both researchers and consumers of autism research.

Using Telegraphic Input With Children With Language Delays: A Survey of Speech-Language Pathologists' Practices and Perspectives.

Purpose Speech-language pathologists (SLPs) often simplify their language input when talking to young children with language delays, but there is some controversy regarding whether simplified input should be telegraphic (e.g., Ball under, Doggie go, More toy) or grammatical (e.g., The ball went under; Go, Doggie! More toys). The purpose of this study was to evaluate SLPs' practices and perspectives on using telegraphic input when working with children with language delays at the prelinguistic, one-word, or two-word stages of spoken language development. Method Practicing SLPs were recruited from a university-sponsored professional development conference focused on current best practices in speech-language pathology. Respondents completed an online survey that included questions about their own practices, as well as their overall perspectives on the usefulness of simplifying language input in different ways. Results The vast majority of SLPs (82%) reported using telegraphic input. SLPs reported using telegraphic input more frequently when prompting for verbal imitations than when describing play or providing a directive/request. Surprisingly, only 30% of SLPs who reported using telegraphic input felt that it was useful. SLPs reported that receptive language is the most important child characteristic to consider when deciding what kind of language input to provide. Conclusions These findings suggest the need for more purposeful clinical decision making in the context of providing simplified language input. In addition, in-depth, qualitative studies are needed to characterize the complex interactions among beliefs, experiences, practices, and perspectives pertaining to simplified language input.

Cross-situational and ostensive word learning in children with and without autism spectrum disorder.

Numerous experimental studies have shown that infants and children can discover word meanings by using co-occurrences between labels and objects across individually ambiguous contexts-a phenomenon known as cross-situational learning. Like typically developing children, high-functioning school aged children with autism spectrum disorder (ASD) are capable of cross-situational learning. However, it is not yet clear whether cross-situational learning is similarly available to children with ASD who are younger and show a broader range of language and cognitive abilities. Using eye-tracking methodology, the current study provided the first evidence that preschool and early school-aged children with ASD can rely on cross-situational statistics to learn new words. In fact, children with ASD learned as well as typically developing children with similar vocabulary knowledge. In both groups, the children with the highest cross-situational learning accuracy were those who showed the best familiar word processing skills. Surprisingly, children in both groups learned words equally well in the cross-situational task and an ostensive word-learning task, which presented only a single label-object pairing at a time. In combination, these results point to similarities in the word learning abilities available to typically developing children and children with ASD.

Thinking Ahead: Incremental Language Processing is Associated with Receptive Language Abilities in Preschoolers with Autism Spectrum Disorder.

In typical development, listeners can use semantic content of verbs to facilitate incremental language processing-a skill that is associated with existing language skills. Studies of children with ASD have not identified an association between incremental language processing in semantically-constraining contexts and language skills, perhaps because participants were adolescents and/or children with strong language skills. This study examined incremental language processing and receptive language in young children with ASD with a range of language skills. Children showed a head start when presented with semantically-constraining verbs (e.g., Read the book) compared to neutral verbs (e.g., Find the book). Children with weaker receptive language showed a smaller head start than children with stronger receptive language skills, suggesting continuity between typical development and ASD.

Auditory-visual misalignment: A theoretical perspective on vocabulary delays in children with ASD.

In this commentary, we describe a novel theoretical perspective on vocabulary delays in children with autism spectrum disorder (ASD)-a perspective we refer to as auditory-visual misalignment. We synthesize empirical evidence that: (a) as a result of differences in both social and nonsocial visual attention, the auditory-visual statistics available to children with ASD for early word learning are misaligned; (b) this auditory-visual misalignment disrupts word learning and contributes to the vocabulary delays shown by children with ASD; and (c) adopting a perspective of auditory-visual misalignment has important theoretical and clinical implications for understanding and supporting vocabulary development in children with ASD. Theoretically, the auditory-visual misalignment perspective advances our understanding of how attentional differences impact vocabulary development in children with ASD in several ways. By adopting the point of view of the child, we provide a framework that brings together research on social and domain-general visual attention differences in children with ASD. In addition, the auditory-visual misalignment perspective moves current thinking beyond how misalignment disrupts vocabulary development in the moment, and considers the likely consequences of misalignment over developmental time. Finally, considering auditory-visual misalignment may assist in identifying active ingredients of existing language interventions or in developing new interventions that deliver high quality, aligned input. Future research is needed to determine how manipulating auditory-visual alignment changes word learning in ASD and whether the effects of auditory-visual misalignment are unique to ASD or shared with other neurodevelopmental disorders or sources of language impairment. Autism Research 2018, 11: 1621-1628. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This article describes a new way of thinking about vocabulary delays in children with autism spectrum disorder (ASD). We suggest that children with ASD may have difficulty learning words because their attention is not tuned in to what is most important for learning, creating a mismatch between what they see and what they hear. This perspective brings together research on different types of attentional differences in people with ASD. It may also help us to understand how language interventions work.

Spoken word recognition in children with autism spectrum disorder: The role of visual disengagement.

Deficits in visual disengagement are one of the earliest emerging differences in infants who are later diagnosed with autism spectrum disorder. Although researchers have speculated that deficits in visual disengagement could have negative effects on the development of children with autism spectrum disorder, we do not know which skills are disrupted or how this disruption takes place. As a first step in understanding this issue, this study investigated the relationship between visual disengagement and a critical skill in early language development: spoken word recognition. Participants were 18 children with autism spectrum disorder (aged 4-7 years). Consistent with our predictions, children with poorer visual disengagement were slower and less accurate to process familiar words; disengagement explained over half of the variance in spoken word recognition. Visual disengagement remained uniquely associated with spoken word recognition after accounting for children's vocabulary size and age. These findings align with a recently proposed developmental model in which poor visual disengagement decreases the speed and accuracy of real-time spoken word recognition in children with autism spectrum disorder-which, in turn, may negatively affect their language development.

Lexical Processing in Toddlers with ASD: Does Weak Central Coherence Play a Role?

This study investigated whether vocabulary delays in toddlers with autism spectrum disorders (ASD) can be explained by a cognitive style that prioritizes processing of detailed, local features of input over global contextual integration-as claimed by the weak central coherence (WCC) theory. Thirty toddlers with ASD and 30 younger, cognition-matched typical controls participated in a looking-while-listening task that assessed whether perceptual or semantic similarities among named images disrupted word recognition relative to a neutral condition. Overlap of perceptual features invited local processing whereas semantic overlap invited global processing. With the possible exception of a subset of toddlers who had very low vocabulary skills, these results provide no evidence that WCC is characteristic of lexical processing in toddlers with ASD.

Brief Report: Early Lexical Comprehension in Young Children with ASD: Comparing Eye-Gaze Methodology and Parent Report.

Lexical comprehension is commonly measured by parent report, but it may be difficult for parents of children with ASD to accurately judge their child's comprehension. We compared parent report to an eye-gaze measure of lexical comprehension in which participants observed pairs of images on a screen, along with accompanying speech that named one of the two images. Twenty-two toddlers with ASD participated. Trials were included if the target word was reported as unknown. Children spent significantly more time looking at the target after it was named than before (d = 0.66). These results provide evidence that eye-gaze measures can reveal emerging lexical knowledge in young children with ASD that may otherwise be overlooked.

Brief Report: Fast Mapping Predicts Differences in Concurrent and Later Language Abilities Among Children with ASD.

This study investigated whether the ability to learn word-object associations following minimal exposure (i.e., fast mapping) was associated with concurrent and later language abilities in children with ASD. Children who were poor learners at age 3½ had significantly lower receptive language abilities than children who successfully learned the new words, both concurrently (n = 59) and 2 years later (n = 53), lending ecological validity to experimental fast-mapping tasks. Fast mapping comprehension at age 3½ was associated with better language outcomes regardless of whether children had produced the new words. These findings highlight the importance of investigating processes of language learning in children with ASD. Understanding these processes will enable the development of maximally effective strategies for supporting word learning.

An Open Conversation on Using Eye-Gaze Methods in Studies of Neurodevelopmental Disorders.

PURPOSE: Eye-gaze methods have the potential to advance the study of neurodevelopmental disorders. Despite their increasing use, challenges arise in using these methods with individuals with neurodevelopmental disorders and in reporting sufficient methodological detail such that the resulting research is replicable and interpretable. METHOD: This tutorial presents key considerations involved in designing and conducting eye-gaze studies for individuals with neurodevelopmental disorders and proposes conventions for reporting the results of such studies. RESULTS: Methodological decisions (e.g., whether to use automated eye tracking or manual coding, implementing strategies to scaffold children's performance, defining valid trials) have cascading effects on the conclusions drawn from eye-gaze data. Research reports that include specific information about procedures, missing data, and selection of participants will facilitate interpretation and replication. CONCLUSIONS: Eye-gaze methods provide exciting opportunities for studying neurodevelopmental disorders. Open discussion of the issues presented in this tutorial will improve the pace of productivity and the impact of advances in research on neurodevelopmental disorders.