Pedantic speaking style differentiates Asperger syndrome from high-functioning autism

Interpretations of meaningful and ambiguous hand gestures in autistic and non-autistic adults: A norming study

Gestures are ubiquitous in human communication, and a growing but inconsistent body of research suggests that people with autism spectrum disorder (ASD) may process co-speech gestures differently from neurotypical individuals. To facilitate research on this topic, we created a database of 162 gesture videos that have been normed for comprehensibility by both autistic and non-autistic raters. These videos portray an actor performing silent gestures that range from highly meaningful (e.g., iconic gestures) to ambiguous or meaningless. Each video was rated for meaningfulness and given a one-word descriptor by 40 autistic and 40 non-autistic adults, and analyses were conducted to assess the level of within- and across-group agreement. Across gestures, the meaningfulness ratings provided by raters with and without ASD correlated at r > 0.90, indicating a very high level of agreement. Overall, autistic raters produced a more diverse set of verbal labels for each gesture than did non-autistic raters. However, measures of within-gesture semantic similarity among the responses provided by each group did not differ, suggesting that increased variability within the ASD group may have occurred at the lexical rather than semantic level. This study is the first to compare gesture naming between autistic and non-autistic individuals, and the resulting dataset is the first gesture stimulus set for which both groups were equally represented in the norming process. This database also has broad applicability to other areas of research related to gesture processing and comprehension. The video database and accompanying norming data are available on the Open Science Framework.

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.

Language and Speech Characteristics in Autism

The aim of this paper is to provide information regarding diversity in speech and language profiles of individuals with Autism Spectrum Disorders (ASD) and try to classify these profiles according to the combination of the communication difficulties. Research findings confirm the existence of heterogeneity of communication challenges in ASD across the lifespan. A lot of children with ASD experience communication challenges and strengths across all language sub-systems including pragmatics, grammar, semantics, syntax, phonology, and morphology in both oral and written language, while some children with autism demonstrate exceptional language abilities incl. linguistic creativity. Communication issues vary on a continuum of severity so that some children may be verbal, whereas others remain non-verbal or minimally-verbal. The diversity of profiles in speech and language development stem from either the presence of comorbid factors, as a core symptom of autistic behavior without comorbidity or both, with the development of complex clinical symptoms. Difficulties with the semantic aspect of language affect the individual's skills in abstract thinking, multiple meanings of words, concept categorization, and so on. Finally, the coexistence of ASD with other communication difficulties such as a Language Disorder, Apraxia of Speech, Speech Sound Disorders or/and other neurodevelopmental disorders raises the need for examining more carefully the emergence of new clinical profiles and clinical markers useful in performing differential diagnosis and different intervention.

Assessment of the Autism Spectrum Disorder Based on Machine Learning and Social Visual Attention: A Systematic Review

The assessment of autism spectrum disorder (ASD) is based on semi-structured procedures addressed to children and caregivers. Such methods rely on the evaluation of behavioural symptoms rather than on the objective evaluation of psychophysiological underpinnings. Advances in research provided evidence of modern procedures for the early assessment of ASD, involving both machine learning (ML) techniques and biomarkers, as eye movements (EM) towards social stimuli. This systematic review provides a comprehensive discussion of 11 papers regarding the early assessment of ASD based on ML techniques and children's social visual attention (SVA). Evidences suggest ML as a relevant technique for the early assessment of ASD, which might represent a valid biomarker-based procedure to objectively make diagnosis. Limitations and future directions are discussed.

Social Communication and Structural Language of Girls With High-Functioning Autism Spectrum Disorder

Purpose The purpose of this study was to characterize social communication and structural language of school-age girls with high-functioning autism spectrum disorder (HF-ASD) compared to a matched group of girls who are typically developing (TD). Method Participants were 37 girls between 7;5 and 15;2 (years;months)-18 HF-ASD and 19 TD. Children completed the Test of Pragmatic Language-Second Edition (TOPL-2) and Clinical Evaluation of Language Fundamentals-Fifth Edition. Parents completed the Children's Communication Checklist-2 United States Edition (CCC-2) and Receptive and Expressive Communication subdomains of the Vineland Adaptive Behavior Scales-Second Edition. Results In the area of social communication, girls with HF-ASD earned significantly lower scores and were more often classified as having an impairment on the TOPL-2 and the CCC-2. However, 28% and 33% earned average scores on the TOPL-2 and the CCC-2, respectively. In the area of structural language, no significant differences were found between groups on Clinical Evaluation of Language Fundamentals-Fifth Edition indexes. In contrast, girls with HF-ASD earned significantly lower scores and were more often classified as having an impairment on the Vineland Adaptive Behavior Scales-Second Edition. Sixty-one percent and 83% scored below average on the Receptive and Expressive Communication subdomains, respectively. Conclusions It has been argued that girls with HF-ASD, when compared to boys with HF-ASD, may have advantages for social communication and structural language that mask their impairments. However, when compared to girls who are TD, girls with HF-ASD demonstrated impaired social communication and structural language. Clinicians should include and carefully examine multiple sources of information when assessing girls with HF-ASD.

Subtyping the Autism Spectrum Disorder: Comparison of Children with High Functioning Autism and Asperger Syndrome

Since Hans Asperger's first description (Arch Psych Nervenkrankh 117:76-136, 1944), through Lorna Wing's translation and definition (Psychol Med 11:115-129, 1981), to its introduction in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM, 1994), Asperger Syndrome has always aroused huge interest and debate, until vanishing in the DSM fifth edition (2013). The debate regarded its diagnostic validity and its differentiation from high functioning autism (HFA). The present study aimed to examine whether AS differed from HFA in clinical profiles and to analyze the impact of DSM-5's innovation. Differences in cognitive, language, school functioning and comorbidities, were revealed when 80 AS and 70 HFA patients (3-18 years) were compared. Results suggested that an AS empirical distinction within autism spectrum disorder should be clinically useful.

Acoustic analysis of speech intonation pattern of individuals with Autism Spectrum Disorders

PURPOSE

This study aimed to analyze prosodic elements of speech segments of students with Autism Spectrum Disorders (ASD) and compare with the control group, using an acoustic analysis.

METHODS

Speech recordings were performed with a sample of individuals with ASD (n = 19) and with typical development (n = 19) of the male gender, age range: 8-33 years. The prosody questionnaire ALIB (Brazilian Linguistic Atlas) was used as script, which contains interrogative, affirmative and imperative sentences. Data were analyzed using the PRAAT software and forwarded to statistical analysis in order to verify possible significant differences between the two groups studied in each prosodic parameter evaluated (fundamental frequency, intensity and duration) and its respective variables.

RESULTS

There were significant differences for the variables tessitura, melodic amplitude of tonic vowel, melodic amplitude of pretonic vowel, maximum intensity, minimum intensity, tonic vowel duration, pretonic vowel duration and phrase duration.

CONCLUSION

Individuals with ASD present significant differences in prosody compared to those with typical development. It is noteworthy, however, the necessity of additional studies on the characterization of prosodic aspects of speech of individuals with ASD with a larger sample and a more restricted age group.

Behavioural and Emotional Disturbance in High-Functioning Autism and Asperger Syndrome

This study aimed to determine whether there were differences in behavioural and emotional disturbance (psychopathology) between children and adolescents with high-functioning autism and Asperger syndrome. Subjects consisted of 75 children and adolescents with high-functioning autism and 52 with Asperger's disorder (DSM-IV diagnoses). Psychopathology was measured using the Developmental Behaviour Checklist. Analysis of covariance (ANCOVA) controlling for the effects of age and cognitive level was used to determine whether the groups differed in their levels of psychopathology. It was found that children and adolescents with Asperger's disorder presented with higher levels of psychopathology than those with high-functioning autism, were more disruptive, antisocial and anxious, and had more problems with social relationships. The implications of these findings are discussed.

A comparative study of the spontaneous social interactions of children with high-functioning autism and children with Asperger's disorder

A comparative observational study was undertaken of the spontaneous social interactions of children with high-functioning autism and Asperger's disorder. The sample comprised 20 children with high-functioning autism, 19 children with Asperger's disorder and 17 typically developing children matched on chronological age and overall mental age. A one–zero time sampling technique was used in live coding of the children's spontaneous social and play behaviours in the schoolyard. Few differences were found between children with high-functioning autism and Asperger's disorder on the dimensions of social interaction investigated. In contrast, the social behaviour of both clinical samples often deviated markedly from that of the typically developing children. The findings confirmed that although children with high-functioning autism or Asperger's disorder are often socially isolated relative to their typically developing peers, they are capable of spontaneously engaging socially with other children. The results were supportive of the hypothesis that Asperger's disorder is on a continuum with autistic disorder.

Can the Children's Communication Checklist differentiate autism spectrum subtypes?

The study explored whether children with high functioning autism (HFA), Asperger syndrome (AS), and pervasive developmental disorder not otherwise specified (PDD-NOS) can be differentiated on the Children's Communication Checklist (CCC). The study also investigated whether empirically derived autistic subgroups can be identified with a cluster analytic method based on the Autism Diagnostic Interview–Revised. Fifty-seven children with HFA, 47 with AS, 31 with PDD-NOS, and a normal control group of 47 children between 6 and 13 years participated. Children with HFA,AS, and PDDNOS showed pragmatic communication deficits in comparison to the controls. Little difference was found between the three subtypes with respect to their CCC profile.A three-cluster solution explained the data best.The HFA cluster showed most autism characteristics, followed by the combined HFA + AS cluster, and then the PDD-NOS cluster. The findings support the autism spectrum concept based on severity of symptom impairment rather than distinct categories.

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.

Discrepancy between WISC-III and WISC-IV Cognitive Profile in Autism Spectrum: What Does It Reveal about Autistic Cognition?

The cognitive profile and measured intellectual level vary according to assessment tools in children on the autism spectrum, much more so than in typically developing children. The recent inclusion of intellectual functioning in the diagnostic process for autism spectrum disorders leads to the crucial question on how to assess intelligence in autism, especially as some tests and subtests seem more sensitive to certain neurodevelopmental conditions. Our first aim was to examine the cognitive profile on the current version of the most widely used test, the Wechsler Intelligence Scales for Children (WISC-IV), for a homogenous subgroup of children on the autism spectrum, i.e. corresponding to DSM-IV diagnosis of “autism”. The second aim was to compare cognitive profiles obtained on the third edition versus 4^th edition of WISC, in order to verify whether the WISC-IV yields a more distinctive cognitive profile in autistic children. The third aim was to examine the impact of the WISC-IV on the cognitive profile of another subgroup, children with Asperger’s Syndrome. 51 autistic, 15 Asperger and 42 typically developing children completed the WISC-IV and were individually matched to children who completed the WISC-III. Divergent WISC-IV profiles were observed despite no significant intelligence quotient difference between groups. Autistic children scored significantly higher on the Perceptual Reasoning Index than on the Verbal Comprehension Index, a discrepancy that nearly tripled in comparison to WISC-III results. Asperger children scored higher on the VCI than on other indexes, with the lowest score found on the Processing Speed Index. WISC-IV cognitive profiles were consistent with, but more pronounced than WISC-III profiles. Cognitive profiles are a valuable diagnostic tool for differential diagnosis, keeping in mind that children on the autism spectrum might be more sensitive to the choice of subtests used to assess intelligence.

Narrative performance of optimal outcome children and adolescents with a history of an Autism Spectrum Disorder (ASD)

Autism Spectrum Disorders (ASDs) have traditionally been considered a lifelong condition; however, a subset of people makes such significant improvements that they no longer meet diagnostic criteria for an ASD. The current study examines whether these "optimal outcome" (OO) children and adolescents continue to have subtle pragmatic language deficits. The narratives of 15 OO individuals, 15 high-functioning individuals with an ASD (HFA), and 15 typically developing (TD) peers were evaluated. Despite average cognitive functioning, the ASD group produced narratives with fewer central "gist" descriptions, more ambiguous pronominal referents, idiosyncratic language, speech dysfluency (more repetitions and self-corrections), and were less likely to name story characters. The OO participants displayed only very subtle pragmatic and higher-level language deficits (idiosyncratic language and self-correction dysfluency).

Asperger's disorder will be back

This review focuses on identifying up-to-date number of publications that compared DSM-IV/ICD-10 Asperger's disorder (AspD) to Autistic Disorder/High-functioning Autism (AD/HFA). One hundred and twenty-eight publications were identified through an extensive search of major electronic databases and journals. Based on more than 90 clinical variables been investigated, 94 publications concluded that there were statistically significant or near significant level of quantitative and/or qualitative differences between AspD and AD/HFA groups; 4 publications found both similarities and differences between the two groups; 30 publications concluded with no differences between the two groups. Although DSM-5 ASD will eliminate Asperger's disorder. However, it is plausible to predict that the field of ASD would run full circle during the next decade or two and that AspD will be back in the next edition of DSM.

Atypical perception of affective prosody in Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is characterized by impairments in language and social–emotional cognition. Yet, findings of emotion recognition from affective prosody in individuals with ASD are inconsistent. This study investigated emotion recognition and neural processing of affective prosody in high-functioning adults with ASD relative to neurotypical (NT) adults. Individuals with ASD showed mostly typical brain activation of the fronto-temporal and subcortical brain regions in response to affective prosody. Yet, the ASD group showed a trend towards increased activation of the right caudate during processing of affective prosody and rated the emotional intensity lower than NT individuals. This is likely associated with increased attentional task demands in this group, which might contribute to social–emotional impairments.

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This study investigated processing of affective prosody in ASD

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Including 19 high-functioning adults with ASD and 20 neurotypical (NT) adults

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Using behavioral measures for emotion recognition and fMRI

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Individuals with ASD showed lower ratings of emotional intensity than NT

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A trend towards increased activation of caudate during affective prosody in ASD

A comparison of pragmatic language in boys with autism and fragile X syndrome

PURPOSE

Impaired pragmatic language (i.e., language use for social interaction) is a hallmark feature of both autism spectrum disorder (ASD) and fragile X syndrome (FXS), the most common known monogenic disorder associated with ASD. However, few cross-population comparisons of ASD and FXS have been conducted, and it is unclear whether pragmatic language profiles in these conditions overlap.

METHOD

The authors used seminaturalistic and standardized assessment methods to characterize pragmatic language abilities of 29 school-aged boys with idiopathic ASD, 38 with FXS and comorbid ASD, 16 with FXS without ASD, 20 with Down syndrome, and 20 with typical development.

RESULTS

Similar severity of pragmatic language deficits was observed in both of the groups with ASD (idiopathic and fragile X-associated). ASD comorbidity had a detrimental effect on the pragmatic language skills of the boys with FXS. Some different patterns emerged across the two pragmatic assessment tools, with more robust group differences observed in pragmatics assessed in a seminaturalistic conversational context.

CONCLUSION

These findings have implications for pragmatic language assessment and intervention, as well as for understanding the potential role of the fragile X gene, Fragile X Mental Retardation-1, in the pragmatic language phenotype of ASD.

The use of prosody during syntactic processing in children and adolescents with autism spectrum disorders

In this study, we employed an eye-gaze paradigm to explore whether children (ages 8–12) and adolescents (ages 12–18) with autism spectrum disorders (ASDs) are able to use prosodic cues to determine the syntactic structure of an utterance. Persons with ASD were compared to typically developing (TD) peers matched on age, IQ, gender, and receptive language abilities. The stimuli were syntactically ambiguous but had a prosodic break that indicated the appropriate interpretation (feel the frog … with the feathervs.feel … the frog with the feather). We found that all groups were equally sensitive to the initial prosodic cues that were presented. Children and teens with ASD used prosody to interpret the ambiguous phrase as rapidly and efficiently as their TD peers. However, when a different cue was presented in subsequent trials, the younger ASD group was more likely to respond in a manner consistent with the initial prosodic cue rather than the new one. Eye-tracking data indicated that both younger groups (ASD and TD) had trouble shifting their interpretation as the prosodic cue changed, but the younger TD group was able to overcome this interference and produce an action consistent with the prosodic cue.

Prosodic development in middle childhood and adolescence in high-functioning autism

The present study aims to investigate the perception and production of several domains of prosodic performance in a cross-sectional sample of preadolescents and adolescents with and without high-functioning autism (HFA). To look at the role of language abilities on prosodic performance, the HFA groups were subdivided based on "high" and "low" language performance on the Clinical Evaluation of Language Fundamentals-Fourth Edition (CELF-4) (Semel, Wiig, & Secord). Social and cognitive abilities were also examined to determine their relationship to prosodic performance. No significant differences were seen in prosody scores in the younger versus older subgroups in typically developing (TD) group with age-appropriate language. There was small but significant improvement in performance with age in the groups with HFA. Comparing performance at each age level across diagnostic groups showed that preteens with HFA and higher language levels perform similarly to their TD peers on all prosodic tasks, whereas those with lower language skills scored significantly worse than both their higher language and TD peers when looking at composite perception and production findings. Teens with HFA showed no deficits on perception tasks; however, those with low language levels had difficulty on several production tasks when compared to the TD group. Regression analyses suggested that, for the preteen group with HFA, language was the strongest predictor of prosodic perception, whereas nonverbal IQ was most highly predictive of prosodic production. For adolescents with HFA, social skills significantly contributed to the prediction of prosodic perception and, along with language abilities, predicted prosodic production. Implications of these findings will be discussed.

The michigan autism spectrum questionnaire: a rating scale for high-functioning autism spectrum disorders

Although the DSM-5 has recently created a single category of autism spectrum disorder (ASD), delineation of its putative subtypes remains clinically useful. For this process, screening instruments should ideally be brief, simple, and easily available. The aim of this study is to describe the validity of one such instrument. We administered the Michigan Autism Spectrum Questionnaire (MASQ), a 10-item questionnaire, to 42 patients with ASD (age range 6-13 years, mean 9.7 years, SD 2.5, one female) and 18 patients with other psychiatric disorders (age range 6-17 years, mean 11.7 years, SD 3.8, 6 females). Responses to each item were scored from 0 to 4 yielding a total score of 30. Patients with intellectual disability were excluded. As a group, patients with ASD scored higher than those with other psychiatric disorders (Chi-square test with 1 df = 16.019, P < 0.0001). Within the ASD group, a linear discriminant analysis found that the best cut-off points were 22 or above for Asperger syndrome, 14 to 21 for autism/PDDNOS, and less than 14 for those with other psychiatric disorders. We propose that the MASQ can be used as a brief measure to screen high-functioning ASD from other psychiatric disorders and to identify its possible subtypes.

Physiological arousal in autism and fragile X syndrome: group comparisons and links with pragmatic language

This study tested the hypothesis that pragmatic (i.e., social) language impairment is linked to arousal dysregulation in autism spectrum disorder (ASD) and fragile X syndrome (FXS). Forty boys with ASD, 39 with FXS, and 27 with typical development (TD), aged 4-15 years, participated. Boys with FXS were hyperaroused compared to boys with TD but did not differ from boys with ASD. Dampened vagal tone predicted pragmatic impairment in ASD, and associations emerged between cardiac activity and receptive/expressive vocabulary across groups. Findings support autonomic dysfunction as a mechanism underlying pragmatic impairment in ASD and suggest that biophysiological profiles are shared in ASD and FXS, which has implications for understanding the role of fragile X mental retardation-1 (FMR1, the FXS gene) in the pathophysiology of ASD.

Predicting treatment success in social skills training for adolescents with autism spectrum disorders: The UCLA Program for the Education and Enrichment of Relational Skills

This study seeks to examine the predictors of positive social skills outcomes from the University of California, Los Angeles Program for the Education and Enrichment of Relational Skills, an evidence-based parent-assisted social skills program for high-functioning middle school and high school adolescents with autism spectrum disorders. The results revealed that adolescents with higher parent-reported baseline social skills and lower self-reported perceived social functioning demonstrated greater improvement in social skills following the intervention.

Treating clients with Asperger's syndrome and autism

Asperger's syndrome (AS) is a form of autism spectrum disorder (ASD) affecting many individuals today. Although neurobiological correlates for AS have been identified, like many ASDs, AS is not completely understood. AS as a distinct disorder is also not universally accepted and in the DSM-5 AS is not considered a separate nosological entity. In contrast to some other ASDs, individuals with AS are commonly characterized by having standard or higher than average intelligence, yet difficulties in social skills and communication can present challenges for these individuals in everyday functioning. Counseling a person with AS or autism presents a unique challenge for the mental health care provider. We have compiled this review consisting of some recent ideas regarding counseling the client with AS with the goal of providing some clinical insights and practical clues. Although the focus of the present paper is largely on AS, many of these strategies could also apply to individuals with high-functioning autism (HFA).

Language and communication in autism: an integrated view

Children with autism spectrum disorders can have varying degrees of difficulty acquiring spoken and written language, but symptoms of communication impairment associated with social impairment are uniformly present, distinguishing autism spectrum disorders from other neurodevelopmental disabilities. Early diagnosis and early intervention involving parents can improve prognosis. Red flags for social communication problems can be observed early. This article summarizes findings from the National Standards Project of the National Autism Center, which identified 11 types of treatment, 8 of which address communication. Both contemporary behavioral approaches and naturalistic developmental approaches are included in this set.

The neural underpinnings of prosody in autism

This study examines the processing of prosodic cues to linguistic structure and to affect, drawing on fMRI and behavioral data from 16 high-functioning adolescents with autism spectrum disorders (ASD) and 11 typically developing controls. Stimuli were carefully matched on pitch, intensity, and duration, while varying systematically in conditions of affective prosody (angry versus neutral speech) and grammatical prosody (questions versus statement). To avoid conscious attention to prosody, which normalizes responses in young people with ASD, the implicit comprehension task directed attention to semantic aspects of the stimuli. Results showed that when perceiving prosodic cues, both affective and grammatical, activation of neural regions was more generalized in ASD than in typical development, and areas recruited reflect heightened reliance on cognitive control, reading of intentions, attentional management, and visualization. This broader recruitment of executive and "mind-reading" brain areas for a relative simple language-processing task may be interpreted to suggest that speakers with high-functioning autism (HFA) have developed less automaticity in language processing and may also suggest that "mind-reading" or theory of mind deficits are intricately bound up in language processing. Data provide support for both a right-lateralized as well as a bilateral model of prosodic processing in typical individuals, depending upon the function of the prosodic information.

Autism, context/noncontext information processing, and atypical development

Autism has been attributed to a deficit in contextual information processing. Attempts to understand autism in terms of such a defect, however, do not include more recent computational work upon context. This work has identified that context information processing depends upon the extraction and use of the information hidden in higher-order (or indirect) associations. Higher-order associations underlie the cognition of context rather than that of situations. This paper starts by examining the differences between higher-order and first-order (or direct) associations. Higher-order associations link entities not directly (as with first-order ones) but indirectly through all the connections they have via other entities. Extracting this information requires the processing of past episodes as a totality. As a result, this extraction depends upon specialised extraction processes separate from cognition. This information is then consolidated. Due to this difference, the extraction/consolidation of higher-order information can be impaired whilst cognition remains intact. Although not directly impaired, cognition will be indirectly impaired by knock on effects such as cognition compensating for absent higher-order information with information extracted from first-order associations. This paper discusses the implications of this for the inflexible, literal/immediate, and inappropriate information processing of autistic individuals.

Confusion and inconsistency in diagnosis of Asperger syndrome: a review of studies from 1981 to 2010

This paper presents a review of past and current research on the diagnosis of Asperger syndrome (AS) in children. It is suggested that the widely used criteria for diagnosing AS in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV are insufficient and invalid for a reliable diagnosis of AS. In addition, when these diagnostic criteria are applied, there is the potential bias of receiving a diagnosis towards the high-functioning end of the autism spectrum. Through a critical review of 69 research studies carried out between 1981 and 2010, this paper shows that six possible criteria for diagnosing AS (specifically, the age at which signs and symptoms related to autism become apparent, language and social communication abilities, intellectual abilities, motor or movement skills, repetitive patterns of behaviour and the nature of social interaction) overlap with the criteria for diagnosing autism. However, there is a possibility that some finer differences exist in the nature of social interaction, motor skills and speech patterns between groups with a diagnosis of AS and autism. These findings are proposed to be of relevance for designing intervention studies aimed at the treatment of specific symptoms in people with an autism spectrum disorder.

Psychiatric disorders in individuals with high-functioning autism and Asperger's disorder: similarities and differences

OBJECTIVES

To investigate and compare the rate and type of psychiatric co-morbidity in individuals with diagnosis of high functioning autism (HFA) and Asperger's disorder (AS).

METHODS

This study includes 30 children and adolescents with diagnosis of HFA and 30 with diagnosis of AS. Diagnoses of HFA and AS were made using strict DSM-IV criteria. Psychiatric co-morbidity was assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL-T).

RESULTS

The rate of comorbid psychiatric disorders was very high in both groups (93.3% in HFA and 100% in AS). The most common disorder in both groups was attention deficit hyperactivity disorder. There was no statistically significant difference between groups in the rate of associated psychiatric disorders, except for major depressive disorder (P = 0.029) and ADHD-combined type (P = 0.030). The AS group displayed greater comorbidity with depressive disorders and ADHD-CT.

CONCLUSION

From a clinical perspective, it could be concluded that both disorders involve a high risk for developing psychiatric disorders, with AS patients at greater risk for depression. From a nosological perspective, the substantial similarities in terms of psychiatric comorbidity may support the idea that both disorders are on the same spectrum and differs in some aspects.

Cortical gyrification in autistic and Asperger disorders: a preliminary magnetic resonance imaging study

The validity of Asperger disorder as a distinct syndrome from autism is unclear partly because of the paucity of differentiating neurobiological evidence. Frontal lobe cortical folding between these disorders was compared using the gyrification index. Twenty-three boys underwent structural magnetic resonance imaging: 6 with high-functioning autism, 9 with Asperger disorder, and 8 controls. Using the first coronal slice anterior to the corpus callosum, total and outer cortical contours were traced to calculate the gyrification index. This index was also calculated for superior and inferior regions to examine dorsolateral prefrontal and orbitofrontal cortices, respectively. Analysis of variance revealed differences in the left inferior gyrification index, which was higher in the autism group compared with Asperger and control groups. There were no differences in age, intelligence quotient, and brain volume. These preliminary findings suggest that cortical folding may be abnormally high in the frontal lobe in autism but not Asperger disorder, suggesting distinct frontal lobe neuropathology.

Should the DSM V drop Asperger syndrome?

The DSM IV defines Asperger syndrome (AS) as a pervasive developmental (autistic spectrum) disorder characterized by social deficits and rigid focused interests in the absence of language impairment and cognitive delay. Since its inclusion in the DSM-IV, there has been a dramatic increase in its recognition both in children and adults. However, because studies have generally failed to demonstrate a clear distinction between AS and autism, some researchers have called for its elimination from the forthcoming DSM V. This report argues for a modification of its diagnostic criteria and its continued retention in the diagnostic manual.

Speech-feature discrimination in children with Asperger syndrome as determined with the multi-feature mismatch negativity paradigm

OBJECTIVE

Asperger syndrome, belonging to the autistic spectrum of disorders, involves deficits in social interaction and prosodic use of language but normal development of formal language abilities. Auditory processing involves both hyper- and hypoactive reactivity to acoustic changes.

METHODS

Responses composed of mismatch negativity (MMN) and obligatory components were recorded for five types of deviations in syllables (vowel, vowel duration, consonant, syllable frequency, syllable intensity) with the multi-feature paradigm from 8-12-year old children with Asperger syndrome.

RESULTS

Children with Asperger syndrome had larger MMNs for intensity and smaller MMNs for frequency changes than typically developing children, whereas no MMN group differences were found for the other deviant stimuli. Furthermore, children with Asperger syndrome performed more poorly than controls in Comprehension of Instructions subtest of a language test battery.

CONCLUSIONS

Cortical speech-sound discrimination is aberrant in children with Asperger syndrome. This is evident both as hypersensitive and depressed neural reactions to speech-sound changes, and is associated with features (frequency, intensity) which are relevant for prosodic processing.

SIGNIFICANCE

The multi-feature MMN paradigm, which includes variation and thereby resembles natural speech hearing circumstances, suggests abnormal pattern of speech discrimination in Asperger syndrome, including both hypo- and hypersensitive responses for speech features.

Reference production in young speakers with and without autism: effects of discourse status and processing constraints

We examine the referential choices (pronouns/zeros vs. names/descriptions) made during a narrative by high-functioning children and adolescents with autism and a well-matched typically developing control group. The process of choosing appropriate referring expressions has been proposed to depend on two areas of cognitive functioning: (a) judging the attention and knowledge of one's interlocutor, and (b) the use of memory and attention mechanisms to represent the discourse situation. We predicted possible group differences, since autism is often associated with deficits in (a) mentalizing and (b) memory and attention, as well as a more general tendency to have difficulty with the pragmatic aspects of language use. Results revealed that some of the participants with autism were significantly less likely to produce pronouns or zeros in some discourse contexts. However, the difference was only one of degree. Overall, all participants in our analysis exhibited fine-grained sensitivity to the discourse context. Furthermore, referential choices for all participants were modulated by factors related to the cognitive effort of language production.

Confusion Between Depression and Autism in a High Functioning Child

Autism is a diagnosis characterized by social and communication impairments. Onset of autism occurs before the age of 3. However, there can be delays in identification, diagnosis, and treatment. A number of symptoms of autism overlap with other childhood mental health disorders, often accounting for a delay in correct diagnosis. The following case highlights how a high-functioning female child with autism was misdiagnosed as having depression at a relatively late age. Clinicians with high-functioning child clients, who appear to have a flat affect and social isolation, are advised to be aware of the possibility of autism in such presentations. Issues around differentiating the diagnosis between depression and autism in children will be discussed, along with assessment and treatment of this particular case.

Bossy and nice requests: varying language register in speakers with autism spectrum disorder (ASD)

The ability to vary language style or register is important for successfully navigating social situations. For example, we speak differently to our boss than we do to our children. This project examined whether high-functioning speakers with ASD were able to vary the language used for requests along continua of "politeness/bossiness", whether any such adjustments were similar to those made by appropriately matched controls, and whether speakers with ASD were able to accurately interpret politeness/bossiness registers. High-functioning children and adolescents (aged 6-16) with ASD were compared to matched typically developing children and adolescents on ability to (1) produce both "nice" and "bossy" requests to puppet listeners and, (2) to judge which of two requests was more polite. Contrary to expectations, participants with ASD were as adept as controls in both producing and judging polite and bossy requests. These results suggest that, at least for high-functioning children and adolescents with ASD, some skill at adjusting language register exists in their repertoire. Future research should examine whether this skill is also present in younger children and in unstructured interactions. If these results hold, clinicians may be able to focus their intervention on teaching strategies for successful use of behaviours that already exist rather than training the responses themselves.

LEARNING OUTCOMES

The reader will become familiar with the functional importance of varying language registers or style according to situational demands. In addition, teaching a strategy for how to determine when a particular language behaviour should be used may sometimes be more effective than training the specific language response.

Fonoaudiologia e autismo: resultado de três diferentes modelos de terapia de linguagem

TEMA: as dificuldades de comunicação e linguagem são elementos essenciais dos distúrbios do espectro autista, fazendo parte da tríade de sintomas utilizada para o diagnóstico. OBJETIVO: verificar a existência de diferenças observáveis a partir das características do perfil funcional da comunicação e do desempenho sócio-cognitivo de crianças e adolescentes do espectro autístico, atendidos em três diferentes situações terapêuticas, tanto no que diz respeito a um período experimental pré-determinado de intervenção, quanto na manutenção dos resultados obtidos após um igual período de tempo de atendimento fonoaudiológico regular. MÉTODO: os sujeitos foram crianças e adolescentes com diagnósticos psiquiátricos incluídos no espectro autístico em início de processos de terapia fonoaudiológica. Os participantes foram divididos em três grupos de acordo com o desenho terapêutico oferecido por um período de seis meses. RESULTADOS: não indicaram diferenças estatisticamente significativas, embora observáveis. O grupo com mais indicadores de progresso durante o período específico de intervenção diferenciada, foi o grupo A, em que os sujeitos eram atendidos em duplas. O resultado não previsto foi que não só em nenhum dos grupos foi observada diminuição dos índices obtidos, após um período de seis meses, como em algumas situações o número de sujeitos com progresso aumentou após esse período. CONCLUSÃO: os resultados do presente estudo reiteram a adequação de procedimentos de determinação do perfil individual de habilidades e inabilidades de cada sujeito como fundamentação para definições a respeito do modelo de intervenção adotado.

Conversational behaviors in youth with high-functioning ASD and Asperger syndrome

Twenty-nine youth with autism spectrum disorders and 26 with typical development between 12 and 18 years of age were engaged in structured interviews (ADOS). The interviews were videotaped and rated for atypical conversational behaviors by trained raters, using the Pragmatic Rating Scale (Landa et al. Psychol Med 22:245-254, 1992). The ASD group was divided into AS and HFA/PDD-NOS subgroups. Significant differences were found among groups on approximately one-third of the PRS items. These items involved primarily the management of topics and information, reciprocity, intonation, and gaze management. The only differences to reach significance between the AS and HFA/PDD-NOS group were a greater tendency for overly formal speech on the part of the AS group, and more difficulty with gaze management on the part of the group with HFA/PDD-NOS. The implications of these findings for understanding and treating conversational deficits in ASD are discussed.

Examining the validity of autism spectrum disorder subtypes

The classification of autism spectrum disorders (ASDs) is a topic of debate among clinicians and researchers with many questioning the validity of the distinction among subtypes. This manuscript examines the validity of three ASD subtypes (Autism, Asperger's, and PDDNOS) by reviewing 22 studies published between 1994 and 2006. We reviewed studies that examined differences between the subtypes in terms of clinical and demographic characteristics, neuropsychological profiles, comorbidity, and prognosis. Results largely did not support differences between autism and Asperger's disorder based on current diagnostic criteria. Overall, the most salient group differences were noted when samples were categorized on IQ. Drawing definitive conclusions is difficult due to the inconsistent application of diagnostic criteria and circularity in methods.

Brief report: a scale for rating conversational impairment in autism spectrum disorder

There are few well-standardized measures of conversational breakdown in Autism Spectrum Disorders (ASD). The study's objective was to develop a scale for measuring pragmatic impairments in conversations of individuals with ASD. We analyzed 46 semi-structured conversations of children and adolescents with high-functioning ASD using a functional linguistic paradigm. Five constructs were developed that assessed difficulties related to the pragmatics of conversation: atypical intonation; semantic drift; terseness; pedantic speech; perseveration. The scale shows good inter-rater reliability and variation in the scales is not simply a reflection of IQ or language competence. This tool represents a way of characterizing language use in ASD and is an initial step towards developing a tool to evaluate change in degree of social impairments in conversation.

Language disorders: autism and other pervasive developmental disorders

This article summarizes current knowledge about language and communication impairments in children who have autism spectrum disorders. It reviews the language profiles that may be observed during the toddler and preschool years and in school-aged children and discusses receptive and expressive language skills that may be quite variable across the spectrum and the universal impairments in pragmatic aspects of language that are among the defining characteristics of the disorder. It concludes with clinical recommendations for pediatric screening of autism spectrum disorders and for continued monitoring of language difficulties in older children for whom interventions may be critical for enhancing effective communication in everyday life.

Defining the behavioral phenotype of Asperger syndrome

Asperger syndrome (AS) is characterized by social deficits and restricted interests in the absence of mental retardation and language delay. However, it is unclear to what extent the social deficits of AS differ from those of traditional autism. To address this issue, 58 subjects with AS were compared with 39 subjects with autism. Social deficits were classified according to Wing and Gould's method. Forty-six (79%) subjects with AS were rated as active but odd, while 32 (82%) with autism were described as aloof and passive, while a few subjects showed mixed features. Thus, despite the overlap between AS and autism, subjects with AS showed a distinct pattern of social impairment. Implications of these findings are discussed.

Narrative discourse in adults with high-functioning autism or Asperger syndrome

We report a study comparing the narrative abilities of 12 adults with high-functioning autism (HFA) or Asperger Syndrome (AS) versus 12 matched controls. The study focuses on the use of referential expressions (temporal expressions and anaphoric pronouns) during a story-telling task. The aim was to assess pragmatics skills in people with HFA/AS in whom linguistic impairments are more subtle than in classic autism. We predicted no significant differences in general narrative abilities between the two groups, but specific pragmatic deficits in people with AS. We predicted they use fewer personal pronouns, temporal expressions and referential expressions, which require theory of mind abilities. Results confirmed both predictions. These findings provide initial evidence of how social impairments can produce mild linguistic impairments.