Let's Talk: Review of Conversation Intervention Approaches for School-Aged Children and Adolescents with Autism Spectrum Disorder.

Conversation skills are an important intervention focus for verbally fluent school-aged children and adolescents with autism spectrum disorder (ASD). Three sets of approaches for supporting conversation skills are reviewed. Pragmatic language approaches focus on teaching the verbal and nonverbal skills needed to initiate and maintain conversations including strategies for recognizing and repairing communication breakdowns. Social skill approaches focus on similar conversation behaviors, but these behaviors are usually taught for use within specific social tasks such as entering peer groups, maintaining interactions, and resolving conflicts. Peer-focused approaches enlist the support of peers through direct teaching of strategies to engage and maintain conversations with students with ASD (i.e., peer-mediated interventions) or through environmental arrangement strategies to promote interactions between students with and without ASD (i.e., peer networks). Conversation interventions that incorporate strategies from all three sets of approaches are most likely to promote optimal outcomes. These outcomes include opportunities for students with ASD to develop and refine conversation skills with classmates who are more open to interactions with peers of differing abilities.

The influence of scale structure and sex on parental reports of children's social (pragmatic) communication symptoms.

The addition of social (pragmatic) communication disorder [S(P)CD] to the DSM-5 taxonomy has left clinicians and researchers searching for appropriate diagnostic measures. Factor analysis procedures examined the extent to which S(P)CD symptoms presented within the Children's Communication Checklist-Second Edition (CCC-2) represented a unique construct and whether these factors were influenced by children's sex. Parents of 208 children (males = 125 and females = 83) from a community-based sample completed the CCC-2. Two pragmatic scores from the CCC-2 were analysed as follows: the social interaction difference index (SIDI) and a pragmatic composite from the original CCC (PC-5). Factor analysis failed to find a unique factor structure for either pragmatic composite. Analyses uncovered different factor structures for the CCC-2 SIDI and PC-5 composites and for boys and girls. S(P)CD represents a complex combination of symptoms that are poorly differentiated from other language and socioemotional behavioural difficulties.

Syntactic Complexity Across Language Sampling Contexts in School-Age Children, Ages 8-11 Years.

PURPOSE: Syntax has been called the structural foundation of language, as its development allows for more efficient and effective communication. Complex syntax production is known to lag in children and adolescents with language impairment. Conversation, narrative, and expository language sampling contexts are recommended tools for the comprehensive assessment of school-age children, including syntactic abilities. Despite these recommendations, few studies have examined syntactic differences obtained from these three sampling contexts in a within group sample of school-age children, (i.e., ages 8-11 years). Information about similarities and differences in syntactic measures obtained from these three sampling contexts is needed to identify the optimal sampling context(s) for eliciting complex syntax. METHOD: Conversational, narrative, and expository language samples were elicited from 85 children with typically developing language ages 8;0-11;11 (years;months). Samples were transcribed and analyzed for the mean length of utterance in words and clausal density, or the number of clauses per communication unit as measured by the subordination index. RESULTS: Syntactic measures differed significantly across the three sampling contexts. Namely, narrative and expository language samples elicited longer utterances and more syntactically complex language than conversation samples. Age-related differences in the syntactic measures were not detected. CONCLUSIONS: Differences in syntactic measures between conversation and narrative samples and conversation and expository samples within children ages 8-11 years support use of narrative and expository contexts as the most appropriate language sampling contexts for elicitation of complex syntax in school-age children ages 8-11 years. Conversation sampling is unlikely to elicit children's capacities for complex sentence production.

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.

"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.

Evidence of contingency awareness in people with profound multiple impairments: response duration versus response rate indicators.

Evidence of contingency awareness in people with profound multiple impairments is often elusive due to numerous variables that impede learning and contribute to performance variability. Recent research has shown that measuring duration of responding rather than rate has promise for more accurate inferences. Duration measures of adaptive-switch use were obtained with 50 participants during empirical tests for contingency awareness. Nearly 80% had test performance patterns indicative of cause-and-effect learning or contingency awareness. Rate data were obtained concurrent with duration measures for 33/50 participants. Although statistical analysis indicated an interaction of test condition and rate of responding, the performance pattern indicative of contingency awareness was observed in only about 50% of the sets of rate data. Further, rate-based indications of contingency awareness were not consistently confirmed by the duration data. The results strongly support inclusion of response duration measures in evaluation of adaptive-switch use and contingency awareness.

Use of the Children's Communication Checklist-2 for classification of language impairment risk in young school-age children with attention-deficit/hyperactivity disorder.

PURPOSE: Children with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk for language impairment (LI). This study examined the feasibility of using the Children's Communication Checklist-2 (CCC-2; Bishop, 2006) to classify risk for LI in young children, ages 5-8 years, with ADHD. METHOD: Parents of 32 children with ADHD and 12 typically developing peers completed the CCC-2. The Clinical Evaluation of Language Fundamentals, Fourth Edition (Semel, Wiig, & Secord, 2003) and the Test of Narrative Language (Gillam & Pearson, 2004) were administered to diagnose LI. Language samples were collected to examine clinical markers of LI. RESULTS: CCC-2 General Communication Composite scores ≤ 85 correctly classified 10 participants with ADHD diagnosed with LI as defined by composite scores ≤ 85 on the Clinical Evaluation of Language Fundamentals, Fourth Edition, or on the Test of Narrative Language. Five of these participants demonstrated 1 or more clinical markers of LI in language samples. Three additional participants, who received a General Communication Composite score ≤ 85 yet scored above 85 on the language tests, demonstrated CCC-2 profiles suggestive of pragmatic impairment. Sensitivity and specificity rates were 100% and 85.29%, respectively. CCC-2 scores and most measures were significantly correlated. CONCLUSION: The results support the feasibility of using the CCC-2 as a screener to identify children with ADHD who are at elevated risk for LI and need referral for comprehensive assessment.

Social knowledge in children with language impairments: examination of strategies, predicted consequences, and goals in peer conflict situations.

This study investigated social knowledge in school-age children, aged 8-12 years, with and without language impairment (LI and TD groups). A hypothetical peer conflict task was administered to examine the relationship among prosocial responses and parent/teacher ratings of children's social behaviours. Stimuli included 12 hypothetical peer conflict vignettes presented in an open-ended and forced choice condition. The LI group generated (open-ended) and selected (forced choice) fewer prosocial strategies. When asked to predict a friend's reaction to a selected conflict resolution strategy, the LI group predicted fewer positive consequences; however, the proportion of prosocial strategies followed by prediction of a positive peer consequence was similar across groups. Both groups identified more self-interest than relationship goals as the rationale for selected strategies. In the LI group, teacher ratings of children's social skills and problems in peer provocation situations were associated with selection of prosocial strategies. Implications for clinical service providers are discussed.

Narrative organization skills in children with attention deficit hyperactivity disorder and language impairment: application of the causal network model.

Studies suggest that the oral narratives of children with attention deficit hyperactivity disorder (ADHD) are less organized than those of typically developing peers. Many studies, however, do not account for children's language abilities. Because language impairment (LI) is a frequent comorbid condition in children with ADHD, this exploratory study investigated language abilities and narrative organization skills in children with and without ADHD. Narratives were elicited using the picture-sequence task and the single-picture task from the Test of Narrative Language (Gillam & Pearson, 2004). The causal network model (Trabasso, Van den Broek, & Suh, 1989) was applied to analyse the narratives. Specifically, narratives were examined to identify complete and incomplete superordinate and subordinate Goal-Attempt-Outcome (GAO) units. The results revealed no differences among the groups in the picture-sequence task. Children with ADHD+LI produced significantly fewer complete superordinate GAO units than typical children in the single-picture task. Theoretical and clinical implications are discussed.

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.

Reading emotion cues: social communication difficulties in pediatric populations.

Speech-language pathologists frequently address social communication difficulties in children with diverse linguistic profiles. Of consequence to effective management of social communication skills is that some children with language disorders may also have difficulty understanding emotional cues. The ability to recognize and comprehend the emotional meaning of messages is accomplished through integration of linguistic cues (e.g., what the speaker says), nonlinguistic cues (e.g., the speaker's facial expressions), and situational cues (e.g., predicting how the speaker is likely to feel about the particular topic). This article explores children's comprehension of emotion as expressed through facial expressions and situational cues. First, development of emotion comprehension in children with normal development is summarized. This is followed by a brief review of studies investigating emotion comprehension in clinical populations. Suggestions for assessment and intervention of children's emotion comprehension skills are presented.