Early predictors of communication development in young children with autism spectrum disorder: joint attention, imitation, and toy play

Changes in Developmental Trajectories of Preschool Children with Autism Spectrum Disorder during Parental Based Intensive Intervention

Background: Research highlights the positive effects of early intensive intervention with parent and school involvement for preschool children with Autism Spectrum Disorder (ASD) on general developmental outcomes and social skills in randomized controlled trials. However, given the inter-individual variability in the response to treatment, it is necessary to investigate intervention effects in terms of mediators and moderators in order to explain variability and to highlight mechanisms of change. Methods: 25 children in the experimental group were exposed to early intensive intervention and 14 children in the control group were subjected to “as usual” intervention. The initial assessment was obtained at the time of diagnosis (T1) and the follow-up assessment was conducted after 15 months of intervention (T2) in both groups. Results: Participants in the experimental group achieved more prominent gains in both cognitive and socio-interactive skills. The role of specific factors able to predict general quotient and language quotient after intervention were investigated, pointing out the contribution of personal–social and performance abilities. Conclusions: The findings support the importance of parental involvement in targeting ASD core symptoms. Further, results informed our understanding of early predictors in order to identify specific elements to be targeted in the individualized intervention design.

Imitation in Chinese Preschool Children: Influence of Prior Self-Experience and Pedagogical Cues on the Imitation of Novel Acts in a Non-Western Culture

Both prior experience and pedagogical cues modulate Western children’s imitation. However, these factors have not been systematically explored together within a single study. This paper explored how these factors individually and together influence imitation using 4-year-old children born and reared in mainland China (N = 210)—a country that contains almost one-fifth of the world’s population, and in which childhood imitation is under-studied using experimental methodology. The behavior of children in this culture is of special interest to theory because traditional East Asian culture places high value on conformity and fitting in with the group. Thus, high-fidelity imitation is emphasized in the local culture. This value, practice, or norm may be recognized by children at a young age and influence their imitative performance. In this study, we crossed prior self-experience and pedagogical cues, yielding four demonstration groups in addition to a control group. This design allowed us to investigate the degree to which Chinese preschoolers’ imitation was modulated by the two experimental factors. High-fidelity imitation was significantly modulated by prior self-experience but not by pedagogical cues, as measured by the number of novel acts imitated and also the serial order of these acts. This study (i) expands our understanding of factors that modulate imitation of novel behaviors in preschoolers and (ii) contributes to efforts to broaden research beyond Western societies to enrich our theories, particularly regarding social learning and imitation. Imitation is a key mechanism in the acquisition of culturally appropriate behaviors, mannerisms, and norms but who, what, and when children imitate is malleable. This study points to both cross-cultural invariants and variations to provide a fuller picture of the scope and functions of childhood imitation.

Learning of skilled movements via imitation in ASD

Autism spectrum disorder (ASD) consists of altered performance of a range of skills, including social/communicative and motor skills. It is unclear whether this altered performance results from atypical acquisition or learning of the skills or from atypical "online" performance of the skills. Atypicalities of skilled actions that require both motor and cognitive resources, such as abnormal gesturing, are highly prevalent in ASD and are easier to study in a laboratory context than are social/communicative skills. Imitation has long been known to be impaired in ASD; because learning via imitation is a prime method by which humans acquire skills, we tested the hypothesis that children with ASD show alterations in learning novel gestures via imitation. Eighteen participants with ASD and IQ > 80, ages 8-12.9 years, and 19 typically developing peers performed a task in which they watched a video of a model performing a novel, meaningless arm/hand gesture and copied the gesture. Each gesture video/copy sequence was repeated 4-6 times. Eight gestures were analyzed. Examination of learning trajectories revealed that while children with ASD made nearly as much progress in learning from repetition 1 to repetition 4, the shape of the learning curves differed. Causal modeling demonstrated the shape of the learning curve influenced both the performance of overlearned gestures and autism severity, suggesting that it is in the index of learning mechanisms relevant both to motor skills and to autism core features. Autism Res 2020, 13: 777-784.. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Imitation is a route by which humans learn a wide range of skills, naturally and in therapies. Imitation is known to be altered in autism spectrum disorder (ASD), but learning via imitation has not been rigorously examined. We found that the shape of the learning curve is altered in ASD, in a way that has a significant impact both on measures of autism severity and of other motor skills.

The Upside to Feeling Worse Than Average (WTA): A Conceptual Framework to Understand When, How, and for Whom WTA Beliefs Have Long-Term Benefits

Our thoughts, feelings, and behaviors are shaped in critical ways by our beliefs about how we compare to other people. Prior research has predominately focused on the consequences of believing oneself to be better than average (BTA). Research on the consequences of worse-than-average (WTA) beliefs has been far more limited, focusing mostly on the downsides of WTA beliefs. In this paper, we argue for the systematic investigation of the possible long-term benefits of WTA beliefs in domains including motivation, task performance, and subjective well-being. We develop a conceptual framework for examining these possible benefits, we explore the usefulness of this framework to generate novel insights in an important psychological domain (skill learning), and we conclude with broader recommendations for research in other domains such as friendship formation, moral, and political decision making.

Differences in Spontaneous Interactions of Autistic Children in an Interaction With an Adult and Humanoid Robot

Robots are promising tools for promoting engagement of autistic children in interventions and thereby increasing the amount of learning opportunities. However, designing deliberate robot behavior aimed at engaging autistic children remains challenging. Our current understanding of what interactions with a robot, or facilitated by a robot, are particularly motivating to autistic children is limited to qualitative reports with small sample sizes. Translating insights from these reports to design is difficult due to the large individual differences among autistic children in their needs, interests, and abilities. To address these issues, we conducted a descriptive study and report on an analysis of how 31 autistic children spontaneously interacted with a humanoid robot and an adult within the context of a robot-assisted intervention, as well as which individual characteristics were associated with the observed interactions. For this analysis, we used video recordings of autistic children engaged in a robot-assisted intervention that were recorded as part of the DE-ENIGMA database. The results showed that the autistic children frequently engaged in exploratory and functional interactions with the robot spontaneously, as well as in interactions with the adult that were elicited by the robot. In particular, we observed autistic children frequently initiating interactions aimed at making the robot do a certain action. Autistic children with stronger language ability, social functioning, and fewer autism spectrum-related symptoms, initiated more functional interactions with the robot and more robot-elicited interactions with the adult. We conclude that the children's individual characteristics, in particular the child's language ability, can be indicative of which types of interaction they are more likely to find interesting. Taking these into account for the design of deliberate robot behavior, coupled with providing more autonomy over the robot's behavior to the autistic children, appears promising for promoting engagement and facilitating more learning opportunities.

Teaching Object Play to Young Children With Disabilities: A Systematic Review of Methods and Rigor

In this systematic review, we examined the rigor and outcomes across 27 object play intervention studies using single-case research methodology. We focused on studies including children age 5 years or younger and examined several descriptive characteristics including materials, instructional packages, and settings. We also analyzed the facilitation and measurement of generalized play and several methodological features including quality, rigor, and visual analysis procedures. Overall, the identified studies demonstrated positive outcomes, although quality and rigor limited interpretations of the outcomes. Previous reviews also have noted strong outcomes and weak to moderate quality for single-case studies. Our results should be interpreted with caution given previous reviews of play intervention studies identified strong outcomes and quality from group-design studies. Additional replications testing robust interventions using single-case research with strong methodological rigor are warranted.

A preliminary investigation of fixed and repetitive models during object imitation training

Empirically based guidelines for imitation training for children with Autism Spectrum Disorder (ASD) are limited and there is no existing evidence about what types of imitative models foster faster acquisition of imitation in children with ASD. We compared rates of acquisition for two different methods for presenting the imitative model (i.e., repetitive, fixed) in simple (Experiment 1) and conditional (Experiment 2) discrimination arrangements. The results suggest that some children with ASD may acquire imitation more rapidly when repetitive models, rather than fixed models are used to present the target skill. In Experiment 3, we investigated the features of object imitation models that might influence acquisition. The results of Experiment 3 suggest that the dynamic nature of repetitive models might be responsible for the differential acquisition we observed in the earlier two Experiments. Additionally, the presence of an outcome (e.g., stacked blocks) during training does not enhance acquisition.

Do minimally verbal and verbally fluent individuals with autism spectrum disorder differ in their viewing patterns of dynamic social scenes?

Attending preferentially to social information in the environment is important in developing socio-communicative skills and language. Research using eye tracking to explore how individuals with autism spectrum disorder deploy visual attention has increased exponentially in the past decade; however, studies have typically not included minimally verbal participants. In this study, we compared 37 minimally verbal children and adolescents with autism spectrum disorder with 34 age-matched verbally fluent individuals with autism spectrum disorder in how they viewed a brief video in which a young woman, surrounded by interesting objects, engages the viewer, and later reacts with expected or unexpected gaze-shifts toward the objects. While both groups spent comparable amounts of time looking at different parts of the scene and looked longer at the person than at the objects, the minimally verbal autism spectrum disorder group spent significantly less time looking at the person's face during the episodes where gaze following-a precursor of joint attention-was critical for interpreting her behavior. Proportional looking-time toward key areas of interest in some episodes correlated with receptive language measures. These findings underscore the connections between social attention and the development of communicative abilities in autism spectrum disorder.

Enhanced gaze-following behavior in Deaf infants of Deaf parents

Gaze following plays a role in parent-infant communication and is a key mechanism by which infants acquire information about the world from social input. Gaze following in Deaf infants has been understudied. Twelve Deaf infants of Deaf parents (DoD) who had native exposure to American Sign Language (ASL) were gender-matched and age-matched (±7 days) to 60 spoken-language hearing control infants. Results showed that the DoD infants had significantly higher gaze-following scores than the hearing infants. We hypothesize that in the absence of auditory input, and with support from ASL-fluent Deaf parents, infants become attuned to visual-communicative signals from other people, which engenders increased gaze following. These findings underscore the need to revise the 'deficit model' of deafness. Deaf infants immersed in natural sign language from birth are better at understanding the signals and identifying the referential meaning of adults' gaze behavior compared to hearing infants not exposed to sign language. Broader implications for theories of social-cognitive development are discussed. A video abstract of this article can be viewed at https://youtu.be/QXCDK_CUmAI.

Virtual Reality Support for Joint Attention Using the Floreo Joint Attention Module: Usability and Feasibility Pilot Study

BACKGROUND

Advances in virtual reality (VR) technology offer new opportunities to design supports for the core behaviors associated with autism spectrum disorder (ASD) that promote progress toward optimal outcomes. Floreo has developed a novel mobile VR platform that pairs a user receiving instruction on target skills with an adult monitor.

OBJECTIVE

The primary objective of this pilot study was to explore the feasibility of using Floreo's Joint Attention Module in school-aged children with autism in a special education setting. A secondary objective was to explore a novel joint attention measure designed for use with school-aged children and to observe whether there was a suggestion of change in joint attention skills from preintervention to postintervention.

METHODS

A total of 12 participants (age range: 9 to 16 years) received training with the Joint Attention Module for 14 sessions over 5 weeks.

RESULTS

No serious side effects were reported, and no participants dropped out of the study because of undesirable side effects. On the basis of monitor data, 95.4% (126/132) of the time participants tolerated the headset, 95.4% (126/132) of the time participants seemed to enjoy using Floreo's platform, and 95.5% (128/134) of the time the VR experience was reported as valuable. In addition, scoring of the joint attention measure suggested a positive change in participant skills related to the total number of interactions, use of eye contact, and initiation of interactions.

CONCLUSIONS

The study results suggest that Floreo's Joint Attention Module is safe and well tolerated by students with ASD, and preliminary data also suggest that its use is related to improvements in fundamental joint attention skills.

The mediating role of joint attention in the relationship between motor skills and receptive and expressive language in siblings at risk for autism spectrum disorder

Language problems are highly prevalent in younger siblings of children with autism spectrum disorder (HR-sibs), yet little is known about early predictors. There is growing evidence that motor and language development are linked and this connection might be mediated by joint attention. Developmental changes in motor abilities change how children interact with objects and people (e.g., by showing), which may influence language development. This association has however not yet been studied in HR-sibs. The interrelationship between motor, joint attention and language skills was explored in younger siblings of typically developing children (LR-sibs, N = 31) and HR-sibs (N = 32). In both groups, motor skills (composite of fine and gross motor skills) at 10 months influenced receptive and expressive language at 36 months directly and indirectly through joint attention at 14 months. Group status moderated this direct and indirect effect with mainly significant effects in HR-sibs. This indicates that lower motor skills can have cascading effects on joint attention and language in HR-sibs. Consequently, assessment of early motor skills in HR-sibs might hold promise for early identification of motor difficulties but can also be indicative of language difficulties later in life, especially when difficulties with joint attention are also present.

Concurrent Social Communication Predictors of Expressive Language in Minimally Verbal Children and Adolescents with Autism Spectrum Disorder

Numerous studies have investigated the predictors of language in pre-verbal toddlers and verbally fluent children with autism spectrum disorder (ASD). The present study investigated the concurrent relations among expressive language and a set of empirically-selected social communication variables-joint attention, imitation, and play-in a unique sample of 37 minimally verbal (MV) children and adolescents with ASD. Results revealed that imitation and play were significantly correlated with expressive language, even when controlling for non-verbal IQ, but joint attention was not. Imitation was the only predictor variable to reach significance within the regression model. Findings demonstrate that predictors of expressive language vary for subpopulations of the autism spectrum, and have broader implications for intervention design for older, MV individuals with ASD.

A Sibling-Mediated Intervention for Children with Autism Spectrum Disorder: Using the Natural Language Paradigm (NLP)

We taught three typically developing siblings to occasion speech by implementing the Natural Language Paradigm (NLP) with their brothers with autism spectrum disorder (ASD). A non-concurrent multiple baseline design across children with ASD and sibling dyads was used. Ancillary behaviors of happiness, play, and joint attention for the children with ASD were recorded. Generalization of speech for the children with ASD across setting and peers was also measured. During baseline, the children with ASD displayed few target speech behaviors and the siblings inconsistently occasioned speech from their brothers. After sibling training, however, they successfully delivered NLP, and in turn, for two of the brothers with ASD, speech reached criterion. Implications of this research suggest the inclusion of siblings in interventions.

Symbolic Play in School-Aged Minimally Verbal Children with Autism Spectrum Disorder

Few interventions exist for school-aged minimally verbal children with autism spectrum disorder (ASD). Even though play skills are associated with children's production of language, few studies have focused on play for minimally verbal children. Fifty-eight minimally verbal children with ASD received a naturalistic developmental behavioral intervention. Children were randomized to receive a speech generating device in the context of the intervention or not. Children in both conditions improved in play skills at exit. Children demonstrated an increase in play skills in proximal (sessions) and distal (during blind assessment) contexts. Minimally verbal children with ASD can improve their play skills within a targeted intervention. Increases in symbolic play were associated with increases in expressive language skills.

Variability in Verbal and Nonverbal Communication in Infants at Risk for Autism Spectrum Disorder: Predictors and Outcomes

Early communication impairment is among the most-reported first concerns in parents of young children with autism spectrum disorder (ASD). Using a parent-report questionnaire, we derived trajectory groups for early language and gesture acquisition in siblings at high risk for ASD and in children at low risk, during their first 2 years of life. Developmental skills at 6 months were associated with trajectory group membership representing growth in receptive language and gestures. Behavioral symptoms also predicted gesture development. All communication measures were strongly related to clinical and developmental outcomes. Trajectory groups further indicated slowest language/gesture acquisition in infants with later ASD diagnoses, in particular when associated with language delay. Overall, our results confirm considerable variability in communication development in high-risk infants.

Similarities in Functional Play and Differences in Symbolic Play of Children With Autism Spectrum Disorder

Contradictory reports of play strengths and weaknesses for children with autism spectrum disorders (ASD) persist in the literature. We compared the play of 19 children with ASD to 19 typically developing (TD) children matched on language and cognitive skills. All children were verbal. Results revealed no differences in indiscriminate actions, functional play, and object interest. The children with ASD showed less symbolic play and a significantly fewer number of children met criteria for emerging or mastered symbolic play. A specific deficit was observed for "doll as agent" symbolic play. Outcomes suggest that compared to children without disabilities, children with ASD may have comparable functional play skills and struggle with the transition to some, but not all types of symbolic play.

The Developmental Sequence and Relations Between Gesture and Spoken Language in Toddlers With Autism Spectrum Disorder

In typical development, gestures precede and predict language development. This study examines the developmental sequence of expressive communication and relations between specific gestural and language milestones in toddlers with autism spectrum disorder (ASD), who demonstrate marked difficulty with gesture production and language. Communication skills across five stages (gestures, word approximations, first words, gesture-word combinations, and two-word combinations) were assessed monthly by blind raters for toddlers with ASD participating in an randomized control trial of parent-mediated treatment (N = 42, 12-30 months). Findings revealed that toddlers acquired skills following a reliable (vs. idiosyncratic) sequence and the majority of toddlers combined gestures with words before combining words in speech, but in contrast to the pattern observed in typical development, a significant subset acquired pointing after first words.

Effects of coaching on the fidelity of parent implementation of reciprocal imitation training

Imitation is an important early social communicative skill that is often impaired in young children with autism. Reciprocal imitation training is an easy-to-implement intervention that targets social imitation and can be taught to parents or other caregivers to implement at home and in the community. In this study, parents of children with autism were taught to implement reciprocal imitation training. The quality of parent fidelity of intervention implementation and rates of child spontaneous imitation were examined in three phases: baseline, post-didactic training, and after the introduction of 1:1 coaching. The results suggest that coaching improved parent fidelity with all parent participants, and this correlated to an increase in spontaneous imitation with some of the child participants.

Predictors and growth in receptive vocabulary from 4 to 8 years in children with and without autism spectrum disorder: A population-based study

Few studies have examined growth and predictors of receptive vocabulary in children with autism spectrum disorder. Here we aimed to compare receptive vocabulary from 4 to 8 years and identify predictors of receptive vocabulary, at 8 years, in children with and without autism spectrum disorder. Participants were drawn from a nationally representative population-based study with two cohorts recruited at birth (N = 4983) and kindergarten (N = 5107). Receptive vocabulary growth was compared for children with and without autism spectrum disorder at 4 (n = 188, n = 7136), 6 (n = 215, n = 7297) and 8 (n = 216, n = 7408) years. Predictors of receptive vocabulary were analysed. Estimated mean receptive vocabulary scores for children without autism spectrum disorder were 2.3 units higher than the autism spectrum disorder group across three time points. This difference was significant (p = 0.004; 95% confidence interval 0.769-3.927). Children with and without autism spectrum disorder progressed at a similar pace. There was no significant difference between the proportions of children with and without autism spectrum disorder who had stable, improving and declining trajectories. Age was the only significant predictor of greater receptive vocabulary growth in children with autism spectrum disorder. Baseline receptive language and nonverbal IQ were significant predictors of receptive vocabulary ability at 8 years. These findings inform prognostic advice given to families on language outcomes.

SMARTer Approach to Personalizing Intervention for Children With Autism Spectrum Disorder

PURPOSE

This review article introduces research methods for personalization of intervention. Our goals are to review evidence-based practices for improving social communication impairment in children with autism spectrum disorder generally and then how these practices can be systematized in ways that personalize intervention, especially for children who respond slowly to an initial evidence-based practice.

METHOD

The narrative reflects on the current status of modular and targeted interventions on social communication outcomes in the field of autism research. Questions are introduced regarding personalization of interventions that can be addressed through research methods. These research methods include adaptive treatment designs and the Sequential Multiple Assignment Randomized Trial. Examples of empirical studies using research designs are presented to answer questions of personalization.

CONCLUSION

Bridging the gap between research studies and clinical practice can be advanced by research that attempts to answer questions pertinent to the broad heterogeneity in children with autism spectrum disorder, their response to interventions, and the fact that a single intervention is not effective for all children.

PRESENTATION VIDEO

https://doi.org/10.23641/asha.7298021.

The Shape Bias in Children With Autism Spectrum Disorder: Potential Sources of Individual Differences

Purpose

Children with autism spectrum disorder (ASD) demonstrate many mechanisms of lexical acquisition that support language in typical development; however, 1 notable exception is the shape bias. The bases of these children's difficulties with the shape bias are not well understood, and the current study explored potential sources of individual differences from the perspectives of both attentional and conceptual accounts of the shape bias.

Method

Shape bias performance from the dataset of Potrzeba, Fein, and Naigles (2015) was analyzed, including 33 children with typical development (M = 20 months; SD = 1.6), 15 children with ASD with high verbal abilities (M = 33 months; SD = 4.6), and 14 children with ASD with low verbal abilities (M = 33 months; SD = 6.6). Lexical predictors (shape-side noun percentage from the MacArthur-Bates Communicative Development Inventory; Fenson et al., 2007) and social-pragmatic predictors (joint attention duration during play sessions) were considered as predictors of subsequent shape bias performance.

Results

For children in the low verbal ASD group, initiation of joint attention (positively) and passive attention (negatively) predicted subsequent shape bias performance, controlling for initial language and developmental level. Proportion of child's known nouns with shape-defined properties correlated negatively with shape bias performance in the high verbal ASD group but did not reach significance in regression models.

Conclusions

These findings suggest that no single account sufficiently explains the observed individual differences in shape bias performance in children with ASD. Nonetheless, these findings break new ground in highlighting the role of social communicative interactions as integral to understanding specific language outcomes (i.e., the shape bias) in children with ASD, especially those with low verbal abilities, and point to new hypotheses concerning the linguistic content of these interactions.

Presentation Video

https://doi.org/10.23641/asha.7299581.

[Autism spectrum disorders, a pilot parent-child unit]

Today, it is possible to work on the developmental trajectory of autism spectrum disorders. Due to brain plasticity, the earlier the treatment, the greater the benefits. A pilot unit has been created in a day hospital, offering a quick and intensive approach, between 18 and 36 months, focused on parental skills.

Support for Employees with ASD in the Workplace Using a Bluetooth Skin Resistance Sensor⁻A Preliminary Study

The application of a Bluetooth skin resistance sensor in assisting people with Autism Spectrum Disorders (ASD), in their day-to-day work, is presented in this paper. The design and construction of the device are discussed. The authors have considered the best placement of the sensor, on the body, to gain the most accurate readings of user stress levels, under various conditions. Trial tests were performed on a group of sixteen people to verify the correct functioning of the device. Resistance levels were compared to those from the reference system. The placement of the sensor has also been determined, based on wearer convenience. With the Bluetooth Low Energy block, users can be notified immediately about their abnormal stress levels via a smartphone application. This can help people with ASD, and those who work with them, to facilitate stress control and make necessary adjustments to their work environment.

Coordination is key: Joint attention and vocalisation in infant siblings of children with Autism Spectrum Disorder

BACKGROUND

Research indicates that social communicative behaviours develop atypically during the second year in Autism Spectrum Disorder (ASD). This study evaluated whether these behaviours also differed in the extent to which they were coordinated across modalities.

AIMS

To measure joint attention behaviours (e.g., gaze shifts, gestures), vocalisations and their coordination among a cohort of infants with an older sibling with ASD (heightened risk-HR).

METHODS & PROCEDURES

This prospective longitudinal study examined 50 HR infants at 14, 18 and 24 months. The Early Social Communication Scales (ESCS)-a structured toy-play task that assesses infant joint attention behaviour-was administered to infants at each age point in the home. Infants' joint attention behaviours, vocalisations and instances where they overlapped were coded from videos. At 36 months, nine infants received an ASD diagnosis (HR-ASD), 15 had a significant language delay (HR-LD) and 26 were classified no diagnosis (HR-ND).

OUTCOMES & RESULTS

Findings revealed that HR-ASD infants produced fewer advanced joint attention behaviours, and their vocalisations were less frequent and less advanced than HR-LD and HR-ND infants. Notably, HR-ASD infants also coordinated these behaviours together less frequently than their HR peers.

CONCLUSIONS & IMPLICATIONS

Differences in the coordination of early communicative behaviours may have negative cascading effects on social and language development for infants who develop ASD. Current intervention practices may be complemented by efforts to increase the coordinated quality of communicative behaviours.

Effects of Interventions That Include Aided Augmentative and Alternative Communication Input on the Communication of Individuals With Complex Communication Needs: A Meta-Analysis

PURPOSE

The purpose of this meta-analysis was to investigate the effects of augmentative and alternative communication (AAC) interventions that included aided AAC input (e.g., aided AAC modeling, aided language modeling, aided language stimulation, augmented input) on communicative outcomes (both comprehension and expression) for individuals with developmental disabilities who use AAC.

METHOD

A systematic search resulted in the identification of 26 single-case experimental designs (88 participants) and 2 group experimental designs (103 participants). Studies were coded in terms of participants, intervention characteristics, dependent variables, outcomes, and quality of evidence.

RESULTS

AAC interventions that included aided AAC input in isolation, or as part of a multicomponent intervention, were found to be highly effective across participants of various ages, disabilities, and language skills. The interventions typically included aided AAC input in conjunction with expectant delay, direct prompting (e.g., spoken, gestural), contingent responding, and open-ended questions. The interventions were found to be highly effective in supporting both comprehension and expression across the domains of pragmatics, semantics, and morphosyntax. Outcomes related to expression were reported more often than outcomes related to comprehension.

CONCLUSION

Aided AAC input may reduce input-output asymmetry and enhance expression and comprehension for individuals who use AAC; the evidence suggests that partners should utilize this strategy. Future research is needed to investigate the effects of AAC input (aided and unaided) on long-term language development for individuals who require AAC.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.6394364.

Sequential Associations Between Caregiver Talk and Child Play in Autism Spectrum Disorder and Typical Development

This study examined sequential associations between child play and caregiver talk in 98 caregiver-child dyads (Mmental age  = 14 months). Fifty dyads included a child with autism spectrum disorder (ASD). Analyses revealed sequential associations between child play and caregiver follow-in (FI) utterances (utterances related to the child's attentional focus) were stronger in the ASD as compared to the typically developing (TD) group. FI utterances were more likely to elicit functional play than caregiver-focused utterances, and more so in the ASD group. Across groups, FI directives were more likely to elicit functional play than FI comments. These findings have important implications for research involving caregiver-child play as an early intervention context for children with ASD.

No evidence of atypical attentional disengagement in autism: A study across the spectrum

The ability to disengage attention and reengage elsewhere has been proposed as a fundamental deficit in the autism spectrum, potentially disrupting development of higher cognitive domains. Eye-movements were recorded while 16 autism spectrum children of mixed ability, and 18 typically developing age-matched controls, completed the Gap–Overlap paradigm. A significant difference in latency to fixate target was found between Gap and Overlap conditions. A significant interaction with group was due to autism spectrum participants’ shorter latencies to fixate target in the Gap condition, but similar group responses in the Overlap condition. Considerable within-group variability emerged. We predicted that attentional disengaging would be related to specific features of the phenotype; however, there was no evidence of an association with receptive language, non-verbal IQ, sensory behaviors, or autistic severity in autism spectrum or typically developing groups. In conclusion, while atypical visual attention mechanisms may be a feature of autism spectrum, this is not explained by impaired visual disengaging but is more likely due to increased susceptibility of visual fixation offset cueing. Despite best efforts, nine additional autism spectrum children could not complete testing, and data from a further six were unusable; more work is needed to develop research methods that enable individuals across the spectrum to participate.

Object-directed imitation in autism spectrum disorder is differentially influenced by motoric task complexity, but not social contextual cues

We examined the role of social motivation and motor execution factors in object-directed imitation difficulties in autism spectrum disorder. A series of to-be-imitated actions was presented to 35 children with autism spectrum disorder and 20 typically developing children on an Apple^® iPad^® by a socially responsive or aloof model, under conditions of low and high motor demand. There were no differences in imitation performance (i.e. the number of actions reproduced within a fixed sequence), for either group, in response to a model who acted socially responsive or aloof. Children with autism spectrum disorder imitated the high motor demand task more poorly than the low motor demand task, while imitation performance for typically developing children was equivalent across the low and high motor demand conditions. Furthermore, imitative performance in the autism spectrum disorder group was unrelated to social reciprocity, though positively associated with fine motor coordination. These results suggest that difficulties in object-directed imitation in autism spectrum disorder are the result of motor execution difficulties, not reduced social motivation.

Decreased reward value of biological motion among individuals with autistic traits

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The Social Motivation Theory of ASD links social impairments to reduced value of social stimuli.

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We evaluated the reward value of human motion among people with a range of AQ scores.

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Subjects value human motion more than robotic or control motion, but this preference diminishes with higher AQ scores.

The Social Motivation Theory posits that a reduced sensitivity to the value of social stimuli, specifically faces, can account for social impairments in Autism Spectrum Disorders (ASD). Research has demonstrated that typically developing (TD) individuals preferentially orient towards another type of salient social stimulus, namely biological motion. Individuals with ASD, however, do not show this preference. While the reward value of faces to both TD and ASD individuals has been well-established, the extent to which individuals from these populations also find human motion to be rewarding remains poorly understood. The present study investigated the value assigned to biological motion by TD participants in an effort task, and further examined whether these values differed among individuals with more autistic traits. The results suggest that TD participants value natural human motion more than rigid, machine-like motion or non-human control motion, but this preference is attenuated among individuals reporting more autistic traits. This study provides the first evidence to suggest that individuals with more autistic traits find a broader conceptualisation of social stimuli less rewarding compared to individuals with fewer autistic traits. By quantifying the social reward value of human motion, the present findings contribute an important piece to our understanding of social motivation in individuals with and without social impairments.

Auditory attention in autism spectrum disorder: An exploration of volumetric magnetic resonance imaging findings

Studies have shown that individuals with autism spectrum disorder (ASD) tend to perform significantly below typically developing individuals on standardized measures of attention, even when controlling for IQ. The current study sought to examine within ASD whether anatomical correlates of attention performance differed between those with average to above-average IQ (AIQ group) and those with low-average to borderline ability (LIQ group) as well as in comparison to typically developing controls (TDC). Using automated volumetric analyses, we examined regional volume of classic attention areas including the superior frontal gyrus, anterior cingulate cortex, and precuneus in ASD AIQ (n = 38) and LIQ (n = 18) individuals along with 30 TDC. Auditory attention performance was assessed using subtests of the Test of Memory and Learning (TOMAL) compared among the groups and then correlated with regional brain volumes. Analyses revealed group differences in attention. The three groups did not differ significantly on any auditory attention-related brain volumes; however, trends toward significant size-attention function interactions were observed. Negative correlations were found between the volume of the precuneus and auditory attention performance for the AIQ ASD group, indicating larger volume related to poorer performance. Implications for general attention functioning and dysfunctional neural connectivity in ASD are discussed.

A Path Model of Expressive Vocabulary Skills in Initially Preverbal Preschool Children with Autism Spectrum Disorder

We examined direct and indirect paths involving receptive vocabulary and diversity of key consonants used in communication (DKCC) to improve understanding of why previously identified value-added predictors are associated with later expressive vocabulary for initially preverbal children with autism spectrum disorder (ASD; n = 87). Intentional communication, DKCC, and parent linguistic responses accounted for unique variance in later expressive vocabulary when controlling for mid-point receptive vocabulary, but responding to joint attention did not. We did not confirm any indirect paths through mid-point receptive vocabulary. DKCC mediated the association between intentional communication and expressive vocabulary. Further research is needed to replicate the findings, test potentially causal relations, and provide a specific sequence of intervention targets for preverbal children with ASD.

An Expanded View of Joint Attention: Skill, Engagement, and Language in Typical Development and Autism

This study provides an expanded view of joint attention and its relation to expressive language development. A total of 144 toddlers (40 typically developing, 58 with autism spectrum disorder [ASD], 46 with developmental delay [DD]) participated at 24 and 31 months. Toddlers who screened positive for ASD risk, especially those subsequently diagnosed with ASD, had poorer joint attention skills, joint engagement during parent-toddler interaction, and expressive language. Findings highlight the dynamic relation between joint attention and language development. In the ASD and DD groups, joint engagement predicted later expressive vocabulary, significantly more than predictions based on joint attention skills. Joint engagement was most severely impacted when toddlers did not talk initially and improved markedly if they subsequently began to speak.

Facilitating Autism Research

Early autism research focused on behavior and cognition. In recent decades, the pace of research has accelerated, and advances in imaging and genetics have allowed the accumulation of biological data. Nevertheless, a coherent picture of the syndrome at either phenotypic or biological level has not emerged. We see two fundamental obstacles to progress in basic understanding of autism. First, the two defining features (impairment in social interactions and communication, and restricted, repetitive behaviors and interests) are historically seen as integrally related. Others hold that these two major traits are fractionable and must be studied independently, casting doubt on autism as a coherent syndrome. Second, despite much recent research on brain structure and function, environmental factors, and genetics/genomics, findings on the biological level have not generally aligned well with those on the phenotypic level. In the first two sections, we explore these challenges, and in the third section, we review approaches that may facilitate progress, such as (1) including in studies all individuals defined by social impairment without regard to repetitive behaviors, (2) forming narrowly defined subtypes by thorough characterization on specific features, both diagnostic and non-diagnostic, (3) focusing on characteristics that may be relatively robust to environmental influence, (4) studying children as early as possible, minimizing environmental influence, and including longitudinal course as an important part of the phenotype, (5) subtyping by environmental risk factors, (6) distinguishing between what participants can do and what they typically do, and (7) aggregating large data sets across sites. (JINS, 2017, 23, 903-915).

Infants Born Preterm Demonstrate Impaired Exploration of Their Bodies and Surfaces Throughout the First 2 Years of Life

BACKGROUND

Non-object-oriented exploratory behaviors infants perform with their bodies and surfaces have been proposed to be key precursors of infants' object exploration, early learning, and future cognitive development. Little is known about the developmental trajectories of these behaviors, especially for infants born preterm.

OBJECTIVE

The purpose of the study was to longitudinally compare non-object-oriented exploratory behaviors performed by full-term and preterm infants.

DESIGN

The study followed 24 full-term and 30 preterm infants (6 with significant brain injury) performing non-object-oriented exploratory behaviors in prone, supine, and sitting from birth through 24 months.

METHODS

Infants were observed without objects or direct social interaction for 3 minutes in prone and supine (0 through 9 months) and in sitting (3 through 24 months). Behavioral coding produced data that were analyzed using hierarchical linear modeling. Developmental trajectories of behaviors were compared among full-term infants, preterm infants without significant brain injury, and preterm infants with significant brain injury.

RESULTS

Compared to full-term peers, preterm infants showed poorer postural control (less head lifting in prone), midline behavior (holding the head in midline, holding both hands in midline), hand-to-mouth and visual-motor behaviors against gravity, and more asymmetrical one-handed fisting. Preterm infants performed fewer bouts of non-object-oriented exploratory behaviors, and their behaviors were less variable with fewer combinations.

LIMITATIONS

There was a limited sample of infants born preterm with significant brain injury.

CONCLUSIONS

Non-object-oriented exploratory behaviors are important for early perceptual-motor development. Key differences were noted in these behaviors for infants born preterm. These differences may lead to impaired reaching, object exploration, and cognition. Early intervention programs should utilize assessments and interventions that target these very early non-object-oriented exploratory behaviors.

Joint attention and oromotor abilities in young children with and without autism spectrum disorder

PURPOSE

This study examined the relationship between joint attention ability and oromotor imitation skill in three groups of young children with and without Autism Spectrum Disorder using both nonverbal oral and verbal motor imitation tasks. Research questions addressed a) differences among joint attention and oromotor imitation abilities; b) the relationship between independently measured joint attention and oromotor imitation, both nonverbal oral and verbal motor; c) the relationships between joint attention and verbal motor imitation during interpersonal interaction; and d) the relationship between the sensory input demands (auditory, visual, and tactile) and oromotor imitation, both nonverbal oral and verbal motor.

METHOD

A descriptive, nonexperimental design was used to compare joint attention and oromotor skills of 10 preschool-aged children with ASD, with those of two control groups: 6 typically developing children (TD), and 6 children with suspected Childhood Apraxia of Speech (sCAS) or apraxic-like symptoms. All children had at least a 3.0 mean length utterance.

RESULTS

Children with ASD had poorer joint attention skills overall than children with sCAS or typically developing children. Typically developing children demonstrated higher verbal motor imitation skills overall compared to children with sCAS. Correlational analyses revealed that nonverbal oral imitation and verbal motor imitation were positively related to joint attention abilities only in the children with ASD. Strong positive relationships between joint attention in a naturalistic context (e.g., shared story experience) and oromotor imitation skills, both nonverbal oral and verbal motor, were found only for children with ASD. These data suggest there is a strong positive relationship between joint attention skills and the ability to sequence nonverbal oral and verbal motor movements in children with ASD. The combined sensory input approach involving auditory, visual, and tactile modalities contributed to significantly higher nonverbal oral and verbal motor imitation performance for all groups of children.

CONCLUSIONS

Verbal children with ASD in this study had difficulties with both the social and cognitive demands of oromotor imitation within a natural environment that demanded cross-modal processing of incoming stimuli within an interpersonal interaction. Further, joint attention and oral praxis may serve as components of an important coupling mechanism in the development of spoken communication and later developing socialcognitive skills.

Increasing Functional Leisure Engagement for Children With Autism Using Backward Chaining

Research with individuals with disabilities has demonstrated the utility of intervention approaches to address toy play, also referred to as functional leisure engagement (FLE). Examples include prompting FLE, blocking stereotypy, and differentially reinforcing appropriate FLE with social or automatic (i.e., access to stereotypy) reinforcers. Backward chaining has yet to be evaluated, but may be useful for establishing more complex FLE. The current study employed a treatment package consisting of these components with three school-aged children with autism in a therapeutic classroom. Effects were evaluated during pretest and posttest sessions, which consisted of free access to toys in a novel setting. The percentage of session with FLE was evaluated using a multiple probe design across participants. Results showed all participants demonstrated an increase in FLE and two participants showed decreased stereotypy. Feasibility for classroom implementation is discussed.

Controlling attention to gaze and arrows in attention deficit hyperactivity disorder

The aim of this research was to assess implicit processing of social and non-social distracting cues in children with ADHD. Young people with ADHD and matched controls were asked to classify target words (LEFT/RIGHT) which were accompanied by a distracter eye-gaze or arrow. Typically developing participants showed evidence of interference effects from both eye-gaze and arrow distracters. In contrast, the ADHD group showed evidence of interference effects from arrow but failed to show interference from eye-gaze. This absence of interference effects from eye-gaze observed in the participants with ADHD may reflect an attentional impairment in attending to socially relevant information.

GOLIAH (Gaming Open Library for Intervention in Autism at Home): a 6-month single blind matched controlled exploratory study

BACKGROUND

To meet the required hours of intensive intervention for treating children with autism spectrum disorder (ASD), we developed an automated serious gaming platform (11 games) to deliver intervention at home (GOLIAH) by mapping the imitation and joint attention (JA) subset of age-adapted stimuli from the Early Start Denver Model (ESDM) intervention. Here, we report the results of a 6-month matched controlled exploratory study.

METHODS

From two specialized clinics, we included 14 children (age range 5-8 years) with ASD and 10 controls matched for gender, age, sites, and treatment as usual (TAU). Participants from the experimental group received in addition to TAU four 30-min sessions with GOLIAH per week at home and one at hospital for 6 months. Statistics were performed using Linear Mixed Models.

RESULTS

Children and parents participated in 40% of the planned sessions. They were able to use the 11 games, and participants trained with GOLIAH improved time to perform the task in most JA games and imitation scores in most imitation games. GOLIAH intervention did not affect Parental Stress Index scores. At end-point, we found in both groups a significant improvement for Autism Diagnostic Observation Schedule scores, Vineland socialization score, Parental Stress Index total score, and Child Behavior Checklist internalizing, externalizing and total problems. However, we found no significant change for by time × group interaction.

CONCLUSIONS

Despite the lack of superiority of TAU + GOLIAH versus TAU, the results are interesting both in terms of changes by using the gaming platform and lack of parental stress increase. A large randomized controlled trial with younger participants (who are the core target of ESDM model) is now discussed. This should be facilitated by computing GOLIAH for a web platform. Trial registration Clinicaltrials.gov NCT02560415.