Quantifying repetitive speech in autism spectrum disorders and language impairment

Psychometric Properties of the Chinese Version of the Gilliam Autism Rating Scale-Third Edition (CV-GARS-3)

Gilliam Autism Rating Scale-Third Edition (GARS-3) serves as an effective screening tool for autism spectrum disorder (ASD) that is based on the latest and authoritative diagnostic criteria, however, there is a deficiency in adaptive research in China. We aimed to revise the Chinese version of GARS-3 (CV-GARS-3) and evaluate its psychometric characteristics, providing a theoretical basis for the improvement of ASD screening tools in China. This study developed CV-GARS-3 through translation and cultural adaptation of GARS-3. 362 ASD individuals, 126 typical development individuals, and 103 individuals with other disorders were recruited to analyze the psychometric characteristics of CV-GARS-3. The results showed that exploratory structural equation model demonstrated satisfactory goodness-of-fit. Within the non-verbal ASD samples, all items loaded on anticipated factors. Regarding verbal ASD samples, 3 items exhibited considerable cross-loadings and were categorized under unexpected factors. Meanwhile, acceptable criterion validity was reflected in the four subscales (r = 0.71) and the six subscales (r = 0.74). Satisfactory reliability was observed in the four subscales (Cronbach's α = 0.96, inter-rater consistency = 0.86, test-retest consistency = 0.87) and the six subscales (Cronbach's α = 0.94, inter-rater consistency = 0.81, test-retest consistency = 0.81). In addition, receiver operating characteristic analysis demonstrated that both the four subscales (sensitivity = 89%, specificity = 85%, accuracy = 88%) and the six subscales (sensitivity = 86%, specificity = 88%, accuracy = 86%) had outstanding screening effects. Therefore, the results suggested that the CV-GARS-3 is considered as a useful tool for the screening and auxiliary diagnosis of ASD. Notably, the expression of scale should be further improved to adapt the context of Chinese culture and achieve more precise diagnostic results.

Speech and language patterns in autism: Towards natural language processing as a research and clinical tool

Speech and language differences have long been described as important characteristics of autism spectrum disorder (ASD). Linguistic abnormalities range from prosodic differences in pitch, intensity, and rate of speech, to language idiosyncrasies and difficulties with pragmatics and reciprocal conversation. Heterogeneity of findings and a reliance on qualitative, subjective ratings, however, limit a full understanding of linguistic phenotypes in autism. This review summarizes evidence of both speech and language differences in ASD. We also describe recent advances in linguistic research, aided by automated methods and software like natural language processing (NLP) and speech analytic software. Such approaches allow for objective, quantitative measurement of speech and language patterns that may be more tractable and unbiased. Future research integrating both speech and language features and capturing "natural language" samples may yield a more comprehensive understanding of language differences in autism, offering potential implications for diagnosis, intervention, and research.

Frequency and characteristics of echoes and self-repetitions in minimally verbal and verbally fluent autistic individuals

Background and aims

Nongenerative speech is the rote repetition of words or phrases heard from others or oneself. The most common manifestations of nongenerative speech are immediate and delayed echolalia, which are a well-attested clinical feature and a salient aspect of atypical language use in autism. However, there are no current estimates of the frequency of nongenerative speech, and the individual characteristics associated with nongenerative speech use in individuals across the autistic spectrum are poorly understood. In this study, we aim to measure and characterize spontaneous and nongenerative speech use in minimally verbal and verbally fluent autistic children and adolescents.

Methods

Participants were 50 minimally verbal and 50 verbally fluent autistic individuals aged 6 to 21 years. Spontaneous and nongenerative speech samples were derived from SALT transcripts of ADOS-2 assessments. Participants' intelligible speech utterances were categorized as spontaneous or nongenerative. Spontaneous versus nongenerative utterances were compared between language subgroups on frequency of use and linguistic structure. Associations between nongenerative speech use and a series of individual characteristics (ADOS-2 subscale scores, nonverbal IQ, receptive vocabulary, and chronological age) were investigated over the whole sample and for each language subgroup independently.

Results

Almost all participants produced some nongenerative speech. Minimally verbal individuals produced significantly more nongenerative than spontaneous utterances, and more nongenerative utterances compared to verbally fluent individuals. Verbally fluent individuals produced limited rates of nongenerative utterances, in comparison to their much higher rates of spontaneous utterances. Across the sample, nongenerative utterance rates were associated with nonverbal IQ and receptive vocabulary, but not separately for the two language subgroups. In verbally fluent individuals, only age was significantly inversely associated with nongenerative speech use such that older individuals produced fewer nongenerative utterances. In minimally verbal individuals, there were no associations between any of the individual characteristics and nongenerative speech use. In terms of linguistic structure, the lexical diversity of nongenerative and spontaneous utterances of both language subgroups was comparable. Morphosyntactic complexity was higher for spontaneous compared to nongenerative utterances in verbally fluent individuals, while no differences emerged between the two utterance types in minimally verbal individuals.

Conclusions

Nongenerative speech presents differently in minimally verbal and verbally fluent autistic individuals. Although present in verbally fluent individuals, nongenerative speech appears to be a major feature of spoken language in minimally verbal children and adolescents.

Implications

Our results advocate for more research on the expressive language profiles of autistic children and adolescents who remain minimally verbal and for further investigations of nongenerative speech, which is usually excluded from language samples. Given its prevalence in the spoken language of minimally verbal individuals, nongenerative speech could be used as a way to engage in and maintain communication with this subgroup of autistic individuals.

Repeat After Me? Both Children With and Without Autism Commonly Align Their Language With That of Their Caregivers

Linguistic repetitions in children are conceptualized as negative in children with autism - echolalia, without communicative purpose - and positive in typically developing (TD) children - linguistic alignment involved in shared engagement, common ground and language acquisition. To investigate this apparent contradiction we analyzed spontaneous speech in 67 parent-child dyads from a longitudinal corpus (30 minutes of play activities at 6 visits over 2 years). We included 32 children with autism and 35 linguistically matched TD children (mean age at recruitment 32.76 and 20.27 months). We found a small number of exact repetitions in both groups (roughly 1% of utterances across visits), which increased over time in children with autism and decreased in the TD group. Partial repetitions were much more frequent: children reused caregivers' words at high rates regardless of diagnostic group (24% of utterances at first visit), and this increased in frequency (but not level) over time, faster for TD children (at final visit: 33% for autism, 40% for TD). The same happened for partial repetition of syntax and semantic alignment. However, chance alignment (as measured by surrogate pairs) also increased and findings for developmental changes were reliable only for syntactic and semantic alignment. Children with richer linguistic abilities also displayed a higher tendency to partially re-use their caregivers' language (alignment rates and semantic alignment). This highlights that all children commonly re-used the words, syntax, and topics of their caregivers, albeit with some quantitative differences, and that most repetition was at least potentially productive, with repeated language being re-contextualized and integrated with non-repeated language. The salience of echolalia in ASD might be partially explained by slight differences in frequency, amplified by lower semantic alignment, persistence over time, and expectations of echolalia. More in-depth qualitative and quantitative analyses of how repetitions are used and received in context are needed.

A systematic review of interventions for echolalia in autistic children

INTRODUCTION

Echolalia, the repetition of others' speech, is a common observation in autistic people. Research has established that echolalia is functional and meaningful for many; however, some clinicians and researchers continue to characterise it as pathological and in need of reduction. The aim of this systematic review was to understand the range and impact of interventions for echolalia in autistic children.

METHOD

A systematic search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 15 studies met predetermined inclusion criteria. Screening, data extraction and quality rating using the Scientific Merit Rating Scale (SMRS) were performed in duplicate.

RESULTS

Ten interventions across 15 papers were found. Results indicated that interventions generally decreased levels of echolalia. However, there were considerable inconsistencies in the definitions and conceptualisations of echolalia, administration, generalisation techniques and the measures used. The quality of the studies was very low.

CONCLUSION

Interventions for echolalia vary widely in terms of administration and measurement. There is limited consensus on the definition of echolalia among the reviewed studies, and no evidence that echolalia is recognised as functional or meaningful to the autistic children. Further, the lack of methodological rigour makes it difficult to draw clinical conclusions about the interventions.

WHAT THIS PAPER ADDS

What is already known Echolalia is the immediate or delayed repetition of others' speech and is a common observation in autistic children and in some older autistic people. While research and practice has established that echolalia is a functional and meaningful form of communication, particularly for those first developing spoken communication, some clinicians and researchers continue to characterise it as problematic and suggest that echolalia should be reduced or eliminated. What this study adds We systematically searched the literature about echolalia interventions to try to find out about the types of interventions that aim to reduce or eliminate echolalia. We found 15 studies on this topic. The way they defined echolalia was varied, and there was a range of interventions researched. None of the research papers recognised echolalia as functional or meaningful and the quality of the research was very low. What are the potential or actual clinical implications of this work? Clinicians, families and researchers should think carefully and critically about suggesting any programs or supports that aim to reduce echolalia as no recommendations can be drawn from the research we studied. Echolalia should be considered functional, and efforts made to understand the meaning and purpose of echolalic speech.

Automatic speaker diarization for natural conversation analysis in autism clinical trials

Challenges in social communication is one of the core symptom domains in autism spectrum disorder (ASD). Novel therapies are under development to help individuals with these challenges, however the ability to show a benefit is dependent on a sensitive and reliable measure of treatment effect. Currently, measuring these deficits requires the use of time-consuming and subjective techniques. Objective measures extracted from natural conversations could be more ecologically relevant, and administered more frequently-perhaps giving them added sensitivity to change. While several studies have used automated analysis methods to study autistic speech, they require manual transcriptions. In order to bypass this time-consuming process, an automated speaker diarization algorithm must first be applied. In this paper, we are testing whether a speaker diarization algorithm can be applied to natural conversations between autistic individuals and their conversational partner in a natural setting at home over the course of a clinical trial. We calculated the average duration that a participant would speak for within their turn. We found a significant correlation between this feature and the Vineland Adaptive Behaviour Scales (VABS) expressive communication score (r = 0.51, p = 7 × 10-5). Our results show that natural conversations can be used to obtain measures of talkativeness, and that this measure can be derived automatically, thus showing the promise of objectively evaluating communication challenges in ASD.

Functional echolalia in autism speech: Verbal formulae and repeated prior utterances as communicative and cognitive strategies

Echolalia, the echoing of prior speech, is a typical characteristic of autism. Long considered meaningless repetition to be avoided, echolalia may in fact be used functionally in autism. This paper explores the functions of echolalia by children with autism. Based on two prior studies, we designed an elicitation task involving images of 12 professions (teacher) and 12 objects (birthday cake) commonly associated with given conventionalized expressions in Mandarin (e.g., "sheng ri kuai le!" 'Happy birthday!'). Eight Chinese children with autism (mean age: 55.50 ± 8.64) were asked to name and describe these images. All our participants produced a relatively high proportion of echolalia, mostly for naming, description, and topic development, a small percentage being used as conversation maintenance strategy or as cognitive strategy. This indicates that echolalia is often used communicatively in autism speech.

Echolalia as defined by parent communication partners

Backgrounds and aims

Echolalia, the repetition of previous speech, is highly prevalent in Autism. Research into echolalia has historically assumed a clinical standpoint, with two opposing paradigms, behaviourism and developmentalism, offering differing support and intervention programs. These paradigms offer a multitude of clinical operationalised definitions; despite attempts, there continue to be challenges regarding how echolalia is to be defined. Stepping out of the dichotomous clinically orientated literature, we examined how parents summarise and formalise their understanding of echolalia as a communication partner. The objectives of this study were three-fold: (1) to investigate how echolalia is described and defined by parents; (2) to examine if existing clinical definitions align with those of parents; and (3) to begin to consider the implications of such findings for a collaborative approach between clinical perspectives and the parent experience. We bring to the fore the voices of parents, who have historically remained absent from echolalia literature. That is to say, we step outside of the clinical realm and listen to parents: something which has been previously unconsidered but represents a new vital addition to the echolalia literature.

Methods

We employed a Grounded Theory approach to document the definitions of 133 parents.

Results

We found that parents reported a multiplicity of important elements that are key to their understanding of echolalia.

Conclusions and implications

Additionally, we found that clinical definitions do not resonate within the parent experience; parents experience echolalia in a different way to that of clinicians and parents can offer insight into our understanding of the phenomena. Our findings show that while some parents might align themselves with either a behavioural or developmental positionality, sometimes there is an overlap depending upon the context in which their child repeats and some parents advance interpretations that are not readily aligned with either of the traditional clinical schools of thought. We present implications for both clinicians and parents in ways that point towards a collaborative approach to support the person with echolalia.

Say that again: Quantifying patterns of production for children with autism using recurrence analysis

The current research study characterized syntactic productivity across a range of 5-year-old children with autism and explored the degree to which this productivity was associated with standardized measures of language and autism symptomatology. Natural language samples were transcribed from play-based interactions between a clinician and participants with an autism diagnosis. Speech samples were parsed for grammatical morphemes and were used to generate measures of MLU and total number of utterances. We applied categorical recurrence quantification analysis, a technique used to quantify patterns of repetition in behaviors, to the children's noun-related and verb-related speech. Recurrence metrics captured the degree to which children repeated specific lexical/grammatical units (i.e., recurrence rate) and the degree to which children repeated combinations of lexical/grammatical units (i.e., percent determinism). Findings indicated that beyond capturing patterns shown in traditional linguistic analysis, recurrence can reveal differences in the speech productions of children with autism spectrum disorder at the lexical and grammatical levels. We also found that the degree of repeating noun-related units and grammatical units was related to MLU and ADOS Severity Score, while the degree of repeating unit combinations (e.g., saying "the big fluffy dog" or the determiner-adjective-adjective-noun construction multiple times), in general, was only related to MLU.

Language impairments in children with developmental language disorder and children with high-functioning autism plus language impairment: Evidence from Chinese negative sentences

There is controversy as to whether children with developmental language disorder (DLD) and those with high-functioning autism plus language impairment (HFA-LI) share similar language profiles. This study investigated the similarities and differences in the production of Chinese negative sentences by children with DLD and children with HFA-LI to provide evidence relevant to this controversy. The results reflect a general resemblance between the two groups in their lower-than-TDA (typically developing age-matched) performance. Both groups encountered difficulties in using negative markers, which suggests that they might be impaired in feature agreement. Slight differences were detected between the two groups. Specifically, children with DLD experienced difficulties with the agreement on the feature [+telic] and that on the feature [+dynamic], while children with HFA-LI had difficulties with the agreement on the feature [+dynamic] and that on the feature [−dynamic]. This study supports the idea of a common symptomatology for the two disorders. More importantly, it suggests that these two disorders, DLD and HFA-LI, are not altogether the same in terms of language impairment. This paper concludes that general labels should not be simply attached to any children with language disorders. Instead, atypical language is very worthy of further analysis in the categorization of language disorders.

Auditory perceptual learning in autistic adults

The automatic retuning of phoneme categories to better adapt to the speech of a novel talker has been extensively documented across various (neurotypical) populations, including both adults and children. However, no studies have examined auditory perceptual learning effects in populations atypical in perceptual, social, and language processing for communication, such as populations with autism. Employing a classic lexically-guided perceptual learning paradigm, the present study investigated perceptual learning effects in Australian English autistic and non-autistic adults. The findings revealed that automatic attunement to existing phoneme categories was not activated in the autistic group in the same manner as for non-autistic control subjects. Specifically, autistic adults were able to both successfully discern lexical items and to categorize speech sounds; however, they did not show effects of perceptual retuning to talkers. These findings may have implications for the application of current sensory theories (e.g., Bayesian decision theory) to speech and language processing by autistic individuals. LAY SUMMARY: Lexically guided perceptual learning assists in the disambiguation of speech from a novel talker. The present study established that while Australian English autistic adult listeners were able to successfully discern lexical items and categorize speech sounds in their native language, perceptual flexibility in updating speaker-specific phonemic knowledge when exposed to a novel talker was not available. Implications for speech and language processing by autistic individuals as well as current sensory theories are discussed.

"Um" and "Uh" Usage Patterns in Children with Autism: Associations with Measures of Structural and Pragmatic Language Ability

Pragmatic language difficulties, including unusual filler usage, are common among children with Autism Spectrum Disorder (ASD). This study investigated "um" and "uh" usage in children with ASD and typically developing (TD) controls. We analyzed transcribed Autism Diagnostic Observation Schedule (ADOS) sessions for 182 children (117 ASD, 65 TD), aged 4 to 15. Although the groups did not differ in "uh" usage, the ASD group used fewer "ums" than the TD group. This held true after controlling for age, sex, and IQ. Within ASD, social affect and pragmatic language scores did not predict filler usage; however, structural language scores predicted "um" usage. Lower "um" rates among children with ASD may reflect problems with planning or production rather than pragmatic language.

Combining voice and language features improves automated autism detection

Variability in expressive and receptive language, difficulty with pragmatic language, and prosodic difficulties are all features of autism spectrum disorder (ASD). Quantifying language and voice characteristics is an important step for measuring outcomes for autistic people, yet clinical measurement is cumbersome and costly. Using natural language processing (NLP) methods and a harmonic model of speech, we analyzed language transcripts and audio recordings to automatically classify individuals as ASD or non-ASD. One-hundred fifty-eight participants (88 ASD, 70 non-ASD) ages 7 to 17 were evaluated with the autism diagnostic observation schedule (ADOS-2), module 3. The ADOS-2 was transcribed following modified SALT guidelines. Seven automated language measures (ALMs) and 10 automated voice measures (AVMs) for each participant were generated from the transcripts and audio of one ADOS-2 task. The measures were analyzed using support vector machine (SVM; a binary classifier) and receiver operating characteristic (ROC). The AVM model resulted in an ROC area under the curve (AUC) of 0.7800, the ALM model an AUC of 0.8748, and the combined model a significantly improved AUC of 0.9205. The ALM model better detected ASD participants who were younger and had lower language skills and shorter activity time. ASD participants detected by the AVM model had better language profiles than those detected by the language model. In combination, automated measurement of language and voice characteristics successfully differentiated children with and without autism. This methodology could help design robust outcome measures for future research. LAY SUMMARY: People with autism often struggle with communication differences which traditional clinical measures and language tests cannot fully capture. Using language transcripts and audio recordings from 158 children ages 7 to 17, we showed that automated, objective language and voice measurements successfully predict the child's diagnosis. This methodology could help design improved outcome measures for research.

Echolalia from a transdiagnostic perspective

Background & aims

Echolalia, the repetition of one's or others' utterances, is a behavior present in typical development, autism spectrum disorder, aphasias, Tourette's, and other clinical groups. Despite the broad range of conditions in which echolalia can occur, it is considered primarily through a disorder-specific lens, which limits a full understanding of the behavior.

Method

Empirical and review papers on echolalia across disciplines and etiologies were considered for this narrative review. Literatures were condensed into three primary sections, including echolalia presentations, neural mechanisms, and treatment approaches.

Main contribution

Echolalia, commonly observed in autism and other developmental conditions, is assessed, observed, and treated in a siloed fashion, which reduces our collective knowledge of this communication difference. Echolalia should be considered as a developmental, transdiagnostic, and communicative phenomenon. Echolalia is commonly considered as a communicative behavior, but little is known about its neural etiologies or efficacious treatments.

Conclusions

This review is the first to synthesize echolalia from a transdiagnostic perspective, which allows for the direct comparisons across and within clinical groups to inform assessment, treatment, conceptualization, and research recommendations.

Implications

Considering echolalia transdiagnostically highlights the lack of consensus on operationalization and measurement across and within disorders. Clinical and research future directions need to prioritize consistent definitions of echolalia, which can be used to derive accurate prevalence estimates. Echolalia should be considered as a communication strategy, used similarly across developmental and clinical groups, with recommended strategies of shaping to increase its effectiveness.

Conventions for unconventional language: Revisiting a framework for spoken language features in autism

Background and aims

Autism has long been characterized by a range of spoken language features, including, for instance: the tendency to repeat words and phrases, the use of invented words, and "pedantic" language. These observations have been the source of considerable disagreement in both the theoretical and applied realms. Despite persistent professional interest in these language features, there has been little consensus around terminology, definitions and developmental/clinical interpretation.

Main contribution

This review paper updates and expands an existing framework for unconventional language in autism to include a broader range of non-generative (echolalia and self-repetition) and generative (idiosyncratic phrases, neologisms and pedantic language) features often observed in the language of individuals on the autism spectrum. For each aspect of the framework, we review the various definitions and measurement approaches, and we provide a summary of individual and contextual correlates. We also propose some transitional language features that may bridge non-generative and generative domains (e.g., mitigated echolalia and gestalt language).

Conclusions

This updated framework offers a unified taxonomy and nomenclature that can facilitate further investigation and interpretation of unconventional language in autism.

Implications

There are important implications of this work for our understanding of the complex interplay between autism and language development. Equally important are the clinical ramifications that will guide evidence-based practice in assessment and intervention for individuals on the autism spectrum.

Should Echolalia Be Considered a Phonic Stereotypy? A Narrative Review

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) defines echolalia as a pathological, parrotlike, and apparently senseless repetition (echoing) of a word or phrase just uttered by another person and classifies this condition among the “restrictive and repetitive behaviours” of Autism Spectrum Disorder (ASD). The authors reviewed the existing literature on echolalia and its role in the development of children with ASD. Current conceptualizations include echolalia among repetitive behaviors and stereotypies and thus interpret this symptom as lacking any communicative significance, with negative effects on learning and sensory processing. Echoic behaviors, however, have been described in neurotypical infants and children as having a substantial effect on the consequent development of language and communication. Relevant research has documented a functional role of echolalia in ASD children as well since it facilitates the acquisition of verbal competencies and affords a higher degree of semantic generalization. This developmental function could be restricted to specific contexts. Considering echolalia as stereotypy and treating it as a disturbing symptom could impair the development of ASD-specific learning and communication processes. In light of this evidence, the authors propose a different conceptualization of echolalia and suggest that this symptom be considered among atypical communication patterns in children with ASD, with implications for treatment and prognosis.

Evaluating atypical language in autism using automated language measures

Measurement of language atypicalities in Autism Spectrum Disorder (ASD) is cumbersome and costly. Better language outcome measures are needed. Using language transcripts, we generated Automated Language Measures (ALMs) and tested their validity. 169 participants (96 ASD, 28 TD, 45 ADHD) ages 7 to 17 were evaluated with the Autism Diagnostic Observation Schedule. Transcripts of one task were analyzed to generate seven ALMs: mean length of utterance in morphemes, number of different word roots (NDWR), um proportion, content maze proportion, unintelligible proportion, c-units per minute, and repetition proportion. With the exception of repetition proportion (p [Formula: see text]), nonparametric ANOVAs showed significant group differences (p[Formula: see text]). The TD and ADHD groups did not differ from each other in post-hoc analyses. With the exception of NDWR, the ASD group showed significantly (p[Formula: see text]) lower scores than both comparison groups. The ALMs were correlated with standardized clinical and language evaluations of ASD. In age- and IQ-adjusted logistic regression analyses, four ALMs significantly predicted ASD status with satisfactory accuracy (67.9-75.5%). When ALMs were combined together, accuracy improved to 82.4%. These ALMs offer a promising approach for generating novel outcome measures.

Phonic and Motor Stereotypies in Autism Spectrum Disorder: Video Analysis and Neurological Characterization

Stereotypies are among the core symptoms of Autism spectrum disorder (ASD) and can cause significant clinical impairment. At present, phonic stereotypies in ASD have been scarcely explored. This study investigates the frequency, variability, and typologies of phonic and motor stereotypies in children with ASD and their association with clinical neurological variables. We examined 35 patients by recording standardized video sessions and administering the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2). Phonic stereotypies were present in 83.0% of the patients. The most prevalent subtypes were noncommunicative vocalizations (60.0%), single syllables (37.1%), and echolalic stereotypies (22.9%). Noncommunicative vocalizations were more frequent in nonverbal patients (OR = 4.629, p = 0.008), while echolalic stereotypies were more represented in verbal patients (OR = 0.279, p = 0.028). Patients with intellectual disability (ID) showed a higher number (F(1,26) = 9.406, p = 0.005) and variability (F(1,25) = 7.174, p = 0.013) of motor stereotypies, with a higher number (F(1,26) = 13.268, p = 0.005) and variability (F(1,26) = 9.490, p = 0.005) of stereotypies involving the head/trunk/shoulders category. Patients with guttural stereotypies showed a higher variability of total motor stereotypies (OR = 1.487, p = 0.032) and self-directed motor stereotypies (OR = 4.389, p = 0.042). These results, combined with a standardized video-analysis, document the frequency and variability of phonic stereotypies among children with ASD. Correlations between specific phonic stereotypies and verbal abilities should be investigated further.

Perceptual category learning in autism spectrum disorder: Truth and consequences

The ability to categorize is fundamental to cognitive development. Some categories emerge effortlessly and rapidly while others can take years of experience to acquire. Children with autism spectrum disorder (ASD) are often able to name and sort objects, suggesting that their categorization abilities are largely intact. However, recent experimental work shows that the categories formed by individuals with ASD may diverge substantially from those that most people learn. This review considers how atypical perceptual category learning can affect cognitive development in children with ASD and how atypical categorization may contribute to many of the socially problematic symptoms associated with this disorder. Theoretical approaches to understanding perceptual processing and category learning at both the behavioral and neural levels are assessed in relation to known alterations in perceptual category learning associated with ASD. Mismatches between the ways in which children learn to organize perceived events relative to their peers and adults can accumulate over time, leading to difficulties in communication, social interactions, academic performance, and behavioral flexibility.

Comparing the Pragmatic Speech Profiles of Minimally Verbal and Verbally Fluent Individuals with Autism Spectrum Disorder

Although pragmatic speech impairments have been found across the autism spectrum, how these manifest in minimally verbal (MV) individuals with autism spectrum disorder (ASD) has not been studied. We compared the pragmatic speech profiles of MV (n = 50) and verbally fluent (VF) individuals with ASD (n = 50; 6-21 years-old) based on natural language sampling during the Autism Diagnostic Observation Schedule-2. MV individuals with ASD primarily used their speech to agree/acknowledge/disagree, respond to a question, and request. In contrast, the primary pragmatic function used by VF individuals was commenting. Out of the total non-echolalic speech, groups did not differ proportionally in labeling and response to questions. Findings highlight the importance of investigating multiple aspects of pragmatic communication across different conversational partners and contexts.

The Influence of Language Context on Repetitive Speech Use in Children With Autism Spectrum Disorder

Purpose Although repetitive speech is a hallmark characteristic of autism spectrum disorder (ASD), the contributing factors that influence repetitive speech use remain unknown. The purpose of this exploratory study was to determine if the language context impacts the amount and type of repetitive speech produced by children with ASD. Method As part of a broader word-learning study, 11 school-age children with ASD participated in two different language contexts: storytelling and play. Previously collected language samples were transcribed and coded for four types of repetitive speech: immediate echolalia, delayed echolalia, verbal stereotypy, and vocal stereotypy. The rates and proportions of repetitive speech were compared across the two language contexts using Wilcoxon signed-ranks tests. Individual characteristics were further explored using Spearman correlations. Results The children produced lower rates of repetitive speech during the storytelling context than the play-based context. Only immediate echolalia differed between the two contexts based on rate and approached significance based on proportion, with more immediate echolalia produced in the play-based context than in the storytelling context. There were no significant correlations between repetitive speech and measures of social responsiveness, expressive or receptive vocabulary, or nonverbal intelligence. Conclusions The children with ASD produced less immediate echolalia in the storytelling context than in the play-based context. Immediate echolalia use was not related to social skills, vocabulary, or nonverbal IQ scores. These findings offer valuable insights into better understanding repetitive speech use in children with ASD.

NS-Pten adult knockout mice display both quantitative and qualitative changes in urine-induced ultrasonic vocalizations

The NS-Pten knockout (KO) mouse exhibits hyperactivity of the mammalian target of rapamycin (mTOR) and is a model of autism spectrum disorder (ASD). ASD presents with marked deficits in communication which can be elucidated by investigating their counterpart in mice, ultrasonic vocalizations (USVs). While USVs have been found to be altered in NS-Pten KO pups, no study has assessed whether this communication deficit persists into adulthood. In the present study, we investigate female urine-induced USVs, scent marking behavior, and open field activity in NS-Pten KO and wildtype (WT) adult male mice. Results showed that there was no difference in the quantity of vocalizations produced between groups, however, there were extensive alterations in the spectral properties of USVs. KO mice emitted vocalizations of a lower peak frequency, shorter duration, and higher peak amplitude compared to WT mice. KO animals also emitted a significantly different distribution of call-types relative to controls, displaying increased complex and short calls, but fewer upward, chevron, frequency steps, and composite calls. No significant differences between groups were observed for scent marking behavior and there was no difference between groups in the amount of time spent near the female urine. Overall, this study demonstrated that mTOR hyperactivity contributes to communication deficits in adult mice.

Association of genes with phenotype in autism spectrum disorder

Autism spectrum disorder (ASD) is a genetic heterogeneous neurodevelopmental disorder that is characterized by impairments in social interaction and speech development and is accompanied by stereotypical behaviors such as body rocking, hand flapping, spinning objects, sniffing and restricted behaviors. The considerable significance of the genetics associated with autism has led to the identification of many risk genes for ASD used for the probing of ASD specificity and shared cognitive features over the past few decades. Identification of ASD risk genes helps to unravel various genetic variants and signaling pathways which are involved in ASD. This review highlights the role of ASD risk genes in gene transcription and translation regulation processes, as well as neuronal activity modulation, synaptic plasticity, disrupted key biological signaling pathways, and the novel candidate genes that play a significant role in the pathophysiology of ASD. The current emphasis on autism spectrum disorders has generated new opportunities in the field of neuroscience, and further advancements in the identification of different biomarkers, risk genes, and genetic pathways can help in the early diagnosis and development of new clinical and pharmacological treatments for ASD.

The spectrum of involuntary vocalizations in humans: A video atlas

In clinical practice, involuntary vocalizing behaviors are typically associated with Tourette syndrome and other tic disorders. However, they may also be encountered throughout the entire tenor of neuropsychiatry, movement disorders, and neurodevelopmental syndromes. Importantly, involuntary vocalizing behaviors may often constitute a predominant clinical sign, and, therefore, their early recognition and appropriate classification are necessary to guide diagnosis and treatment. Clinical literature and video-documented cases on the topic are surprisingly scarce. Here, we pooled data from 5 expert centers of movement disorders, with instructive video material to cover the entire range of involuntary vocalizations in humans. Medical literature was also reviewed to document the range of possible etiologies associated with the different types of vocalizing behaviors and to explore treatment options. We propose a phenomenological classification of involuntary vocalizations within different categorical domains, including (1) tics and tic-like vocalizations, (2) vocalizations as part of stereotypies, (3) vocalizations as part of dystonia or chorea, (4) continuous vocalizing behaviors such as groaning or grunting, (5) pathological laughter and crying, (6) vocalizations resembling physiological reflexes, and (7) other vocalizations, for example, those associated with exaggerated startle responses, as part of epilepsy and sleep-related phenomena. We provide comprehensive lists of their associated etiologies, including neurodevelopmental, neurodegenerative, neuroimmunological, and structural causes and clinical clues. We then expand on the pathophysiology of the different vocalizing behaviors and comment on available treatment options. Finally, we present an algorithmic approach that covers the wide range of involuntary vocalizations in humans, with the ultimate goal of improving diagnostic accuracy and guiding appropriate treatment. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

Oral-Motor and Lexical Diversity During Naturalistic Conversations in Adults with Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by impaired social communication and the presence of restricted, repetitive patterns of behaviors and interests. Prior research suggests that restricted patterns of behavior in ASD may be cross-domain phenomena that are evident in a variety of modalities. Computational studies of language in ASD provide support for the existence of an underlying dimension of restriction that emerges during a conversation. Similar evidence exists for restricted patterns of facial movement. Using tools from computational linguistics, computer vision, and information theory, this study tests whether cognitive-motor restriction can be detected across multiple behavioral domains in adults with ASD during a naturalistic conversation. Our methods identify restricted behavioral patterns, as measured by entropy in word use and mouth movement. Results suggest that adults with ASD produce significantly less diverse mouth movements and words than neurotypical adults, with an increased reliance on repeated patterns in both domains. The diversity values of the two domains are not significantly correlated, suggesting that they provide complementary information.

SYMPTOM PRESENTATIONS AND CLASSIFICATION OF AUTISM SPECTRUM DISORDER IN EARLY CHILDHOOD: APPLICATION TO THE DIAGNOSTIC CLASSIFICATION OF MENTAL HEALTH AND DEVELOPMENTAL DISORDERS OF INFANCY AND EARLY CHILDHOOD (DC:0-5)

Over the past 5 years, a great deal of information about the early course of autism spectrum disorder (ASD) has emerged from longitudinal prospective studies of infants at high risk for developing ASD based on a previously diagnosed older sibling. The current article describes early ASD symptom presentations and outlines the rationale for defining a new disorder, Early Atypical Autism Spectrum Disorder (EA-ASD) to accompany ASD in the new revision of the ZERO TO THREE Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5) (in press) alternative diagnostic classification manual. EA-ASD is designed to identify children who are 9 to 36 months of age presenting with a minimum of (a) two social-communication symptoms and (b) one repetitive and restricted behavior symptom as well as (c) evidence of impairment, with the intention of providing these children with appropriately tailored services and improving the likelihood of optimizing their development.

Teaching Social Communication Skills Through Human-Agent Interaction

There are a large number of computer-based systems that aim to train and improve social skills. However, most of these do not resemble the training regimens used by human instructors. In this article, we propose a computer-based training system that follows the procedure of social skills training (SST), a well-established method to decrease human anxiety and discomfort in social interaction, and acquire social skills. We attempt to automate the process of SST by developing a dialogue system named the automated social skills trainer , which teaches social communication skills through human-agent interaction. The system includes a virtual avatar that recognizes user speech and language information and gives feedback to users. Its design is based on conventional SST performed by human participants, including defining target skills, modeling, role-play, feedback, reinforcement, and homework. We performed a series of three experiments investigating (1) the advantages of using computer-based training systems compared to human-human interaction (HHI) by subjectively evaluating nervousness, ease of talking, and ability to talk well; (2) the relationship between speech language features and human social skills; and (3) the effect of computer-based training using our proposed system. Results of our first experiment show that interaction with an avatar decreases nervousness and increases the user's subjective impression of his or her ability to talk well compared to interaction with an unfamiliar person. The experimental evaluation measuring the relationship between social skill and speech and language features shows that these features have a relationship with social skills. Finally, experiments measuring the effect of performing SST with the proposed application show that participants significantly improve their skill, as assessed by separate evaluators, by using the system for 50 minutes. A user survey also shows that the users thought our system is useful and easy to use, and that interaction with the avatar felt similar to HHI.

Language and Speech in Autism

Autism is a developmental disability characterized by atypical social interaction, interests or body movements, and communication. Our review examines the empirical status of three communication phenomena believed to be unique to autism: pronoun reversal (using the pronoun you when the pronoun I is intended, and vice versa), echolalia (repeating what someone has said), and a reduced or even reversed production-comprehension lag (a reduction or reversal of the well-established finding that speakers produce less sophisticated language than they can comprehend). Each of these three phenomena has been claimed to be unique to autism; therefore, each has been proposed to be diagnostic of autism, and each has been interpreted in autism-centric ways (psychoanalytic interpretations of pronoun reversal, behaviorist interpretations of echolalia, and clinical lore about the production-comprehension lag). However, as our review demonstrates, none of these three phenomena is in fact unique to autism; none can or should serve as diagnostic of autism, and all call into question unwarranted assumptions about autistic persons and their language development and use.

Exploring Autism Spectrum Disorders Using HLT

The phenotypic complexity of Autism Spectrum Disorder motivates the application of modern computational methods to large collections of observational data, both for improved clinical diagnosis and for better scientific understanding. We have begun to create a corpus of annotated language samples relevant to this research, and we plan to join with other researchers in pooling and publishing such resources on a large scale. The goal of this paper is to present some initial explorations to illustrate the opportunities that such datasets will afford.

Language and Speech in Autism

Autism is a developmental disability characterized by atypical social interaction, interests or body movements, and communication. Our review examines the empirical status of three communication phenomena believed to be unique to autism: pronoun reversal (using the pronoun you when the pronoun I is intended, and vice versa), echolalia (repeating what someone has said), and a reduced or even reversed production-comprehension lag (a reduction or reversal of the well-established finding that speakers produce less sophisticated language than they can comprehend). Each of these three phenomena has been claimed to be unique to autism; therefore, each has been proposed to be diagnostic of autism, and each has been interpreted in autism-centric ways (psychoanalytic interpretations of pronoun reversal, behaviorist interpretations of echolalia, and clinical lore about the production-comprehension lag). However, as our review demonstrates, none of these three phenomena is in fact unique to autism; none can or should serve as diagnostic of autism, and all call into question unwarranted assumptions about autistic persons and their language development and use.

Tipo de ecolalia em crianças com Transtorno do Espectro Autista

RESUMO: O Transtorno do Espectro Autista (TEA) é uma síndrome caracterizada por prejuízos persistentes na comunicação social recíproca, com interação social restrita e padrões repetitivos de comportamentos, interesses e atividades. Os comportamentos repetitivos na linguagem podem manifestar-se pelo aparecimento da ecolalia, fenômeno persistente caracterizado como um distúrbio de linguagem, com repetição da fala do outro, dividida em imediata ou tardia. Teve como objetivo a verificação do tipo de ecolalia e das habilidades comunicativas em sete meninos com TEA, com idades entre quatro e sete anos, que fazem uso da comunicação oral. Foram realizadas duas atividades distintas: avaliação das crianças em uma sessão de atendimento fonoaudiológico em situação lúdica, analisada pelo Protocolo de Observação Comportamental e aplicação de um questionário com os pais e profissionais para verificar suas opiniões quanto ao uso, tipo e frequência de ecolalia. Das sete crianças do estudo, seis apresentaram ecolalia imediata e uma tardia; a criança que utilizou ecolalia tardia apresentou menor pontuação no protocolo de observação comportamental, porém para os demais sujeitos não houve relação direta entre o tipo e número de ecolalia com a pontuação. O questionário aplicado com pais e profissionais mostrou concordância quanto à presença da ecolalia. As crianças com TEA deste estudo apresentaram habilidades comunicativas e aspectos do desenvolvimento cognitivo comprometidos e maior número de ecolalias imediatas. Estudos com o tema ecolalia ainda são escassos na literatura nacional. Este relato de casos clínicos pode contribuir para futuras pesquisas sobre a caracterização da linguagem em crianças com TEA e conduta terapêutica dos fonoaudiólogos.

Measuring idiosyncratic interests in children with autism

A defining symptom of autism spectrum disorder (ASD) is the presence of restricted and repetitive activities and interests, which can surface in language as a perseverative focus on idiosyncratic topics. In this paper, we use semantic similarity measures to identify such idiosyncratic topics in narratives produced by children with and without ASD. We find that neurotypical children tend to use the same words and semantic concepts when retelling the same narrative, while children with ASD, even when producing accurate retellings, use different words and concepts relative not only to neurotypical children but also to other children with ASD. Our results indicate that children with ASD not only stray from the target topic but do so in idiosyncratic ways according to their own restricted interests.

Automated morphological analysis of clinical language samples

Quantitative analysis of clinical language samples is a powerful tool for assessing and screening developmental language impairments, but requires extensive manual transcription, annotation, and calculation, resulting in error-prone results and clinical underutilization. We describe a system that performs automated morphological analysis needed to calculate statistics such as the mean length of utterance in morphemes (MLUM), so that these statistics can be computed directly from orthographic transcripts. Estimates of MLUM computed by this system are closely comparable to those produced by manual annotation. Our system can be used in conjunction with other automated annotation techniques, such as maze detection. This work represents an important first step towards increased automation of language sample analysis, and towards attendant benefits of automation, including clinical greater utilization and reduced variability in care delivery.

Similarity Measures for Quantifying Restrictive and Repetitive Behavior in Conversations of Autistic Children

Restrictive and repetitive behavior (RRB) is a core symptom of autism spectrum disorder (ASD) and are manifest in language. Based on this, we expect children with autism to talk about fewer topics, and more repeatedly, during their conversations. We thus hypothesize a higher semantic overlap ratio between dialogue turns in children with ASD compared to those with typical development (TD). Participants of this study include children ages 4-8, 44 with TD and 25 with ASD without language impairment. We apply several semantic similarity metrics to the children's dialogue turns in semi-structured conversations with examiners. We find that children with ASD have significantly more semantically overlapping turns than children with TD, across different turn intervals. These results support our hypothesis, and could provide a convenient and robust ASD-specific behavioral marker.

Absence of substantial copy number differences in a pair of monozygotic twins discordant for features of autism spectrum disorder

Autism spectrum disorder (ASD) is a highly heritable disease (~0.9) with a complex genetic etiology. It is initially characterized by altered cognitive ability which commonly includes impaired language and communication skills as well as fundamental deficits in social interaction. Despite the large amount of studies described so far, the high clinical diversity affecting the autism phenotype remains poorly explained. Recent studies suggest that rare genomic variations, in particular copy number variation (CNV), may account for a significant proportion of the genetic basis of ASD. The use of disease-discordant monozygotic twins represents a powerful strategy to identify de novo and inherited CNV in the disorder. Here we present the results of a comparative genome hybridization (CGH) analysis with a pair of monozygotic twins affected of ASD with significant differences in their clinical manifestations that specially affect speech language impairment and communication skills. Array CGH was performed in three different tissues: blood, saliva, and hair follicle, in an attempt to identify germinal and somatic CNV regions that may explain these differences. Our results argue against a role of large CNV rearrangements as a molecular etiology of the observed differences. This forwards future research to explore de novo point mutation and epigenomic alterations as potential explanations of the observed clinical differences.