The role of maternal input in the development of wh-question comprehension in autism and typical development.

Social deficits have been implicated in the language delays and deficits of children with autism (ASD); thus, the extent to which these children use language input in social contexts similarly to typically developing (TD) children is unknown. The current study investigated how caregiver input influenced the development of wh-question comprehension in TD children and language-matched preschoolers with ASD. Children were visited at four-month intervals over 1.5 years; mother-child play sessions at visits 1-2 were coded for maternal wh-question use. At visits 3-5 children watched videos in the Intermodal Preferential Looking paradigm, to assess their comprehension of subject and object wh-questions. Mothers' use of wh-questions with verbs and complex wh-questions positively predicted wh-question comprehension in the TD group; in contrast, mothers' use of wh-questions with 'be' as the main verb negatively predicted wh-question comprehension in the ASD group. Thus, TD children and children with ASD appear to use their linguistic input differently.

Parent-reported early symptoms of autism spectrum disorder in children without intellectual disability who were diagnosed at school age.

Despite efforts to detect autism spectrum disorder during toddlerhood, many children with autism spectrum disorder remain undiagnosed until school age. To identify characteristics of children whose autism spectrum disorder might not be diagnosed during toddlerhood, this study used archived Autism Diagnostic Interview-Revised records to examine the historical presentation of autism spectrum disorder symptoms in 48 school-age children with autism spectrum disorder. Children diagnosed after starting school (Late-Diagnosed; n = 24) were compared to age-matched children diagnosed before school age (Early-Diagnosed; n = 24). Symptom presentation was similar between groups, with the Late-Diagnosed group exhibiting only marginally fewer symptoms historically. The most commonly reported historical symptoms were negative symptoms, namely, deficits in social behaviors. Positive symptoms, such as unusual preoccupations, rituals, and mannerisms, were less commonly reported. These findings may aid earlier identification of autism spectrum disorder in children who would likely be diagnosed at school age.

Training: improving antenatal detection and outcomes of congenital heart disease.

OBJECTIVES: This study describes the design, delivery and efficacy of a regional fetal cardiac ultrasound training programme. This programme aimed to improve the antenatal detection of congenital heart disease (CHD) and its effect on fetal and postnatal outcomes. DESIGN SETTING AND PARTICIPANTS: This was a prospective study that compared antenatal CHD detection rates by professionals from 13 hospitals in Wales before and after engaging in our 'skills development programme'. Existing fetal cardiac practice and perinatal outcomes were continuously audited and progressive targets were set. The work was undertaken by the Welsh Fetal Cardiovascular Network, Antenatal Screening Wales (ASW), a superintendent sonographer and a fetal cardiologist. INTERVENTIONS: A core professional network was established, engaging all stakeholders (including patients, health boards, specialist commissioners, ASW, ultrasonographers, radiologists, obstetricians, midwives and paediatricians). A cardiac educational lead (midwife, superintendent sonographer, radiologist, obstetrician, or a fetal medicine specialist) was established in each hospital. A new cardiac anomaly screening protocol ('outflow tract view') was created and training on the new protocol was systematically delivered at each centre. Data were prospectively collected and outcomes were continuously audited: locally by the lead fetal cardiologist; regionally by the Congenital Anomaly Register and Information Service in Wales; and nationally by the National Institute for Cardiac Outcomes and Research (NICOR) in the UK. MAIN OUTCOME MEASURES: Patient satisfaction; improvements in individual sonographer skills, confidence and competency; true positive referral rate; local hospital detection rate; national detection rate of CHD; clinical outcomes of selected cardiac abnormalities; reduction of geographical health inequality; cost efficacy. RESULTS: High levels of patient satisfaction were demonstrated and the professional skill mix in each centre was improved. The confidence and competency of sonographers was enhanced. Each centre demonstrated a reduction in the false-positive referral rate and a significant increase in cardiac anomaly detection rate. According to the latest NICOR data, since implementing the new training programme Wales has sustained its status as UK lead for CHD detection. Health outcomes of children with CHD have improved, especially in cases of transposition of the great arteries (for which no perinatal mortality has been reported since 2008). Standardised care led to reduction of geographical health inequalities with substantial cost saving to the National Health Service due to reduced false-positive referral rates. Our successful model has been adopted by other fetal anomaly screening programmes in the UK. CONCLUSIONS: Antenatal cardiac ultrasound mass training programmes can be delivered effectively with minimal impact on finite healthcare resources. Sustainably high CHD detection rates can only be achieved by empowering the regional screening workforce through continuous investment in lifelong learning activities. These should be underpinned by high quality service standards, effective care pathways, and robust clinical governance and audit practices.

The Effects of Early Language on Age at Diagnosis and Functioning at School Age in Children with Autism Spectrum Disorder.

Research suggests that toddlers with no language delay (NLD) should have better outcomes than those with language delay (LD). However, the predictive utility of language milestones relative to co-varying factors such as age at diagnosis, IQ, and ASD symptomatology is unclear. This study compared school-aged children with ASD and NLD (n = 59) to a well-matched group with ASD and LD (n = 59). The LD group was diagnosed at younger ages and their historical ASD symptoms were more severe than the NLD group. The groups were similar in current ASD symptoms and adaptive functioning at school age. Language milestones were correlated with adaptive functioning, but IQ and social symptoms of ASD were stronger predictors of functioning at school age. Therefore, language milestones may not be the best indicators of prognosis for children who are diagnosed after toddlerhood.

Comprehension of wh-questions precedes their production in typical development and autism spectrum disorders.

Children with autism spectrum disorders (ASD) rarely produce wh-questions (e.g. "What hit the book?") in naturalistic speech. It is unclear if this is due to social-pragmatic difficulties, or if grammatical deficits are also involved. If grammar is impaired, production of wh-questions by rote memorization might precede comprehension of similar forms. In a longitudinal study, 15 children with ASD and 18 initially language-matched typically developing (TD) toddlers were visited in their homes at 4-month intervals across a 3-year period. The wh-question task was presented via intermodal preferential looking. Silent "hitting" events (e.g. an apple hitting a flower) were followed by test trials in which the apple and flower were juxtaposed on the screen. During test trials, subject-wh- and object-wh-question audios were sequentially presented (e.g. "What hit the flower?" or "What did the apple hit?"). Control audios were also presented (e.g. "Where's the apple/flower?"). Children's eye movements were coded off-line, frame by frame. To show reliable comprehension, children should look longer to the named item (i.e. apple or flower) during the "where" questions but less at the named item during the subject-wh and object-wh-questions. To compare comprehension to production, we coded 30-min spontaneous speech samples drawn from mother-child interactions at each visit. Results indicated that comprehension of subject- and object-wh-questions was delayed in children with ASD compared with age-matched TD children, but not when matched on overall language levels. Additionally, both groups comprehended wh-questions before producing similar forms, indicating that development occurred in a similar manner. This paper discusses the implications of our findings for language acquisition in ASD.