A Discrepancy in Comprehension and Production in Early Language Development in ASD: Is it Clinically Relevant?

The Comprehension of Grammatical Structures in a Pediatric Population with ASD and Epilepsy: A Comparative Study

Autism Spectrum Disorder (ASD) and epilepsy represent a comorbidity that negatively influences the proper development of linguistic competencies, particularly in receptive language, in the pediatric population. This group displays impairments in the auditory comprehension of both simple and complex grammatical structures, significantly limiting their performance in language-related activities, hampering their integration into social contexts, and affecting their quality of life. The main objective of this study was to assess auditory comprehension of grammatical structures in individuals with ASD and epilepsy and compare the results among the three groups. A non-experimental cross-sectional study was designed, including a total of 170 participants aged between 7 and 9 years, divided into three groups: a group with ASD, a group with epilepsy, and a comorbid group with both ASD and epilepsy (ASDEP). The comprehension of grammatical structures was assessed using the CEG and CELF-5 instruments. Statistical analyses included MANOVA and ANOVA to compare scores between groups to verify associations between study variables. The results indicate that the group with ASD and epilepsy performed worse compared to the ASD and epilepsy-only groups, respectively. Additionally, a significant and directly proportional association was observed among all variables within the measures of grammatical structure comprehension. The neurological damage caused by epilepsy in the pediatric population with ASD leads to difficulties in understanding oral language. This level of functioning significantly limits the linguistic performance of these children, negatively impacting their quality of life and the development of core language skills.

Receptive language and receptive-expressive discrepancy in minimally verbal autistic children and adolescents

Among the approximately one-third of autistic individuals who experience considerable challenges in acquiring spoken language and are minimally verbal (MV), relatively little is known about the range of their receptive language abilities. This study included 1579 MV autistic children and adolescents between 5 and 18 years of age drawn from the National Database for Autism Research and the SFARI Base data repository. MV autistic children and adolescents demonstrated significantly lower receptive language compared to the norms on standardized language assessment and parent report measures. Moreover, their receptive language gap widened with age. Overall, our sample demonstrated significantly better receptive than expressive language. However, at the individual level, only about 25% of MV autistic children and adolescents demonstrated significantly better receptive language relative to their minimal expressive levels. Social skills explained a significant proportion of the variance in parent-reported receptive language skills, while motor skills were the most significant predictor of greater receptive-expressive discrepancy. Findings from this study revealed the heterogeneous language profiles in MV autistic children and adolescents, underscoring the importance of individualizing interventions to match their different communication strengths and needs and integrating multiple interconnected areas to optimize their overall development of language comprehension, socialization, and general motor skills.

Assessing receptive verb knowledge in late talkers and autistic children: advances and cautionary tales

PURPOSE

Using eye-tracking, we assessed the receptive verb vocabularies of age-matched late talkers and typically developing children (experiment 1) and autistic preschoolers (experiment 2). We evaluated how many verbs participants knew and how quickly they processed the linguistic prompt. Our goal is to explore how these eye-gaze measures can be operationalized to capture verb knowledge in late talkers and autistic children.

METHOD

Participants previewed two dynamic scenes side-by-side (e.g., "stretching" and "clapping") and were then prompted to find the target verb's referent. Children's eye-gaze behaviors were operationalized using established approaches in the field with modifications in consideration for the type of stimuli (dynamic scenes versus static images) and the populations included. Accuracy was calculated as a proportion of time spent looking to the target, and linguistic processing was operationalized as latency of children's first look to the target.

RESULTS

In experiment 1, there were no group differences in the proportion of verbs known, but late talkers required longer to demonstrate their knowledge than typically developing children. Latency was predicted by age but not language abilities. In experiment 2, autistic children's accuracy and latency were both predicted by receptive language abilities.

CONCLUSION

Eye gaze can be used to assess receptive verb vocabulary in a variety of populations, but in operationalizing gaze behavior, we must account for between- and within-group differences. Bootstrapped cluster-permutation analysis is one way to create individualized measures of children's gaze behavior, but more research is warranted using an individual differences approach with this type of analysis.

Sex/Gender Differences in the Language Profiles of Italian Children with Autism Spectrum Disorder: A Retrospective Study

Sex/gender (S/G) differences in ASD language profiles have been poorly investigated. The present study aims to explore whether male (M) and female (F) children with ASD and with normal non-verbal cognitive abilities differ in their linguistic profiles. A sample of 76 Italian children with ASD (range: 4.9-8 years), including 50 Ms and 26 Fs, was retrospectively recruited. Language profiles were analyzed using standardized tests for the evaluation of receptive and expressive vocabulary as well as grammar. Grammatical comprehension was the most impaired domain compared to the other language measures in both M and F children. Comparing language profiles between S/G, Fs showed significantly better scores than Ms in grammatical production (p = 0.002), and Ms showed better active negative sentence comprehension (p = 0.035). Moreover, comparing the language profiles between Ms and Fs with a receptive disorder, Fs had significantly worse grammatical comprehension and better grammatical production than Ms. Even among children without a receptive disorder, Fs had significantly higher grammatical production scores. The S/G differences in language profile, particularly better expressive language in Fs than Ms, can partially contribute to the delayed ASD diagnosis or underdiagnosis of Fs without intellectual disability. Finally, the results document the importance of accurately investigating both expressive and receptive abilities in children with ASD.

Semantic and Syntactic Properties of Words and the Receptive-Expressive Gap in Autistic and Non-Autistic Children

PURPOSE

The goal of this work was to examine the semantic and syntactic properties of the vocabularies of autistic and non-autistic infants and toddlers to see if children in these two groups know different kinds of words. We focused on both receptive and expressive vocabularies. For expressive vocabulary, we looked only at the "active" lexicon: Of those words that are already in children's receptive vocabulary, we asked which ones they also produce.

METHOD

We used an existing data set of 346 parent report vocabulary checklists (MacArthur-Bates Communicative Development Inventory: Words and Gestures) from 41 autistic and 27 non-autistic children at multiple timepoints between the ages of 6 and 43 months. We coded the words on the checklists for various semantic and syntactic properties and evaluated which properties predicted whether children understood and produced those words.

RESULTS

Overall, we replicated a common finding that autistic children have smaller receptive vocabularies than non-autistic children, but we found that of the words they understand, autistic children produce a similar proportion of those words as non-autistic children. While we found that some syntactic properties are more or less likely to be represented in children's early vocabularies (e.g., nouns are more likely to be understood and produced than words that are not nouns), these patterns did not differ across autistic and non-autistic children.

CONCLUSIONS

The semantic and syntactic compositions of autistic and non-autistic children's vocabularies are similar. Thus, while receptive vocabularies are relatively smaller for autistic children, they do not appear to have specific difficulty with words that have particular syntactic or semantic properties, or with adding words to the expressive vocabulary that they already understand.

A Comparison of the Clinical Presentation of Preterm Birth and Autism Spectrum Disorder: Commonalities and Distinctions in Children Under 3

Premature infants and infants later diagnosed with autism spectrum disorder (ASD) share many commonalities in clinical presentations. However, prematurity and ASD also have differences in clinical presentation. These overlapping phenotypes can lead to misdiagnoses of ASD or missing a diagnosis of ASD in preterm infants. We document these commonalities and differences in various developmental domains with the hope of aiding in the accurate early detection of ASD and timely intervention implementation in children born premature. Given the degree of similarities in presentation, evidence-based interventions designed specifically for preterm toddlers or toddlers with ASD may ultimately aid both populations.

Use of Mutual Exclusivity and its Relationship to Language Ability in Toddlers with Autism Spectrum Disorder

To efficiently learn new words, children use constraints such as mutual exclusivity (ME) to narrow the search for potential referents. The current study investigated the use of ME in toddlers with autism spectrum disorder (ASD) and neurotypical (NT) peers matched on nonverbal cognition. Thirty-two toddlers with ASD and 26 NT toddlers participated in a looking-while-listening task. Images of novel and familiar objects were presented along with a novel or familiar label. Overall, toddlers with ASD showed less efficient looking toward a novel referent when a novel label was presented compared to NT toddlers, controlling for age and familiar word knowledge. However, toddlers with ASD and higher language ability demonstrated more robust use of ME than those with lower language ability.

Overall prognosis of preschool autism spectrum disorder diagnoses

BACKGROUND

Autism spectrum disorder is a neurodevelopmental disorder characterised by social communication difficulties, restricted interests and repetitive behaviours. The clinical pathway for children with a diagnosis of autism spectrum disorder is varied, and current research suggests some children may not continue to meet diagnostic criteria over time.

OBJECTIVES

The primary objective of this review was to synthesise the available evidence on the proportion of preschool children who have a diagnosis of autism spectrum disorder at baseline (diagnosed before six years of age) who continue to meet diagnostic criteria at follow-up one or more years later (up to 19 years of age).

SEARCH METHODS

We searched MEDLINE, Embase, PsycINFO, and eight other databases in October 2017 and ran top-up searches up to July 2021. We also searched reference lists of relevant systematic reviews.

SELECTION CRITERIA

Two review authors independently assessed prospective and retrospective follow-up studies that used the same measure and process within studies to diagnose autism spectrum disorder at baseline and follow-up. Studies were required to have at least one year of follow-up and contain at least 10 participants. Participants were all aged less than six years at baseline assessment and followed up before 19 years of age.

DATA COLLECTION AND ANALYSIS

We extracted data on study characteristics and the proportion of children diagnosed with autism spectrum disorder at baseline and follow-up. We also collected information on change in scores on measures that assess the dimensions of autism spectrum disorder (i.e. social communication and restricted interests and repetitive behaviours). Two review authors independently extracted data on study characteristics and assessed risk of bias using a modified quality in prognosis studies (QUIPS) tool. We conducted a random-effects meta-analysis or narrative synthesis, depending on the type of data available. We also conducted prognostic factor analyses to explore factors that may predict diagnostic outcome.

MAIN RESULTS

In total, 49 studies met our inclusion criteria and 42 of these (11,740 participants) had data that could be extracted. Of the 42 studies, 25 (60%) were conducted in North America, 13 (31%) were conducted in Europe and the UK, and four (10%) in Asia. Most (52%) studies were published before 2014. The mean age of the participants was 3.19 years (range 1.13 to 5.0 years) at baseline and 6.12 years (range 3.0 to 12.14 years) at follow-up. The mean length of follow-up was 2.86 years (range 1.0 to 12.41 years). The majority of the children were boys (81%), and just over half (60%) of the studies primarily included participants with intellectual disability (intelligence quotient < 70). The mean sample size was 272 (range 10 to 8564). Sixty-nine per cent of studies used one diagnostic assessment tool, 24% used two tools and 7% used three or more tools. Diagnosis was decided by a multidisciplinary team in 41% of studies. No data were available for the outcomes of social communication and restricted and repetitive behaviours and interests. Of the 42 studies with available data, we were able to synthesise data from 34 studies (69% of all included studies; n = 11,129) in a meta-analysis. In summary, 92% (95% confidence interval 89% to 95%) of participants continued to meet diagnostic criteria for autism spectrum disorder from baseline to follow-up one or more years later; however, the quality of the evidence was judged as low due to study limitations and inconsistency. The majority of the included studies (95%) were rated at high risk of bias. We were unable to explore the outcomes of change in social communication and restricted and repetitive behaviour and interests between baseline and follow-up as none of the included studies provided separate domain scores at baseline and follow-up. Details on conflict of interest were reported in 24 studies. Funding support was reported by 30 studies, 12 studies omitted details on funding sources and two studies reported no funding support. Declared funding sources were categorised as government, university or non-government organisation or charity groups. We considered it unlikely funding sources would have significantly influenced the outcomes, given the nature of prognosis studies.

AUTHORS' CONCLUSIONS

Overall, we found that nine out of 10 children who were diagnosed with autism spectrum disorder before six years of age continued to meet diagnostic criteria for autism spectrum disorder a year or more later, however the evidence was uncertain. Confidence in the evidence was rated low using GRADE, due to heterogeneity and risk of bias, and there were few studies that included children diagnosed using a current classification system, such as the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the eleventh revision of the International Classification of Diseases (ICD-11). Future studies that are well-designed, prospective and specifically assess prognosis of autism spectrum disorder diagnoses are needed. These studies should also include contemporary diagnostic assessment methods across a broad range of participants and investigate a range of relevant prognostic factors.

Specific Language Impairment, Autism Spectrum Disorders and Social (Pragmatic) Communication Disorders: Is There Overlap in Language Deficits? A Review

Analysing language characteristics and understanding their dynamics is the key for a successful intervention by speech and language therapists (SLT). Thus, this review aims to investigate a possible overlap in language development shared by autism spectrum disorders (ASD), specific language impairment (SLI) and social (pragmatic) communication disorder (SPCD). The sources of this work were the PubMed, PsycInfo and SciELO databases, as well as the Scientific Open Access Repositories of Portugal. The final selection included 18 studies, focused on several linguistic areas. Results suggest that when individuals are matched according to some language or cognitive skills, they will also show similar characteristics in other language domains. Future work should be done based on spontaneous speech.

Graph Ricci curvatures reveal atypical functional connectivity in autism spectrum disorder

While standard graph-theoretic measures have been widely used to characterize atypical resting-state functional connectivity in autism spectrum disorder (ASD), geometry-inspired network measures have not been applied. In this study, we apply Forman–Ricci and Ollivier–Ricci curvatures to compare networks of ASD and typically developing individuals (N = 1112) from the Autism Brain Imaging Data Exchange I (ABIDE-I) dataset. We find brain-wide and region-specific ASD-related differences for both Forman–Ricci and Ollivier–Ricci curvatures, with region-specific differences concentrated in Default Mode, Somatomotor and Ventral Attention networks for Forman–Ricci curvature. We use meta-analysis decoding to demonstrate that brain regions with curvature differences are associated to those cognitive domains known to be impaired in ASD. Further, we show that brain regions with curvature differences overlap with those brain regions whose non-invasive stimulation improves ASD-related symptoms. These results suggest the utility of graph Ricci curvatures in characterizing atypical connectivity of clinically relevant regions in ASD and other neurodevelopmental disorders.

Naturalistic parent-child reading frequency and language development in toddlers with and without autism

BACKGROUND AND AIMS

The efficacy of parent-child reading for supporting language development has been well-established in the neurotypical (NT) literature. For children with autism spectrum disorder, (ASD) who may be at risk for delays in language development, prior research has shown promise for shared book-reading interventions. Yet there has been limited research on naturalistic parent-child reading with autistic children to date. The present study aimed to fill this missing link in the current literature.

METHODS

Fifty-seven autistic toddlers participated at two developmental time points: Time 1 (Mage = 30.4 months) and Time 2 (Mage = 43.8 months). An NT control group (N = 31) was matched on age to a subset of the ASD group (N = 33). We assessed group differences in parent-child reading frequency between age-matched NT and autistic groups. Using a one-year follow-up design, we evaluated the relationship between parent-child reading and autistic children's language development.

RESULTS

Cross-group comparisons revealed that parents of age-matched NT children reported significantly more frequent weekly parent-child reading than parents of autistic toddlers. After a one-year follow-up with the autistic group, within-group analyses revealed that greater frequency of parent-child reading (controlling for maternal education, books in the home, and autism symptom severity) was associated with larger growth in autistic toddlers' receptive and expressive language skills.

CONCLUSIONS AND IMPLICATIONS

These findings have important clinical implications as they emphasize the potential of parent-child reading for supporting autistic children's language development. Findings demonstrate that frequency of parent-child reading is associated with language development over one year. Findings also demonstrate that parents of autistic children engage in less frequent parent-child reading than parents of age-matched NT peers, suggesting these parents may face more barriers to implementing parent-child reading than parents of NT children.

Children with ASD and Communication Regression: Examining Pre-Loss Skills and Later Language Outcomes Through the Preschool Years

This study investigated receptive and expressive language outcomes in children with autism spectrum disorder (ASD) with and without a history of language/communication regression, employing three progressively less stringent definitions of regression. Data were derived from a large, longitudinal sample of children with ASD in which regression was assessed at approximately 30 months. Results indicated poorer receptive language and larger discrepancies between receptive and expressive language in the regression group than the group without regression at 44 months but not 66 months. Number of words used before loss predicted receptive language at 44 months. Overall, results suggest that a regression profile in ASD is associated with modest and transient impacts on language outcomes that are no longer discernable at school entry.

Brain mRNA Expression Associated with Cortical Volume Alterations in Autism Spectrum Disorder

Numerous studies report abnormal cerebral cortex volume (CCV) in autism spectrum disorder (ASD); however, genes related to CCV abnormalities in ASD remain largely unknown. Here, we identify genes associated with CCV alterations in ASD by performing spatial correlations between the gene expression of 6 donated brains and neuroimaging data from 1,404 ASD patients and 1,499 controls. Based on spatial correlations between gene expression and CCV differences from two independent meta-analyses and between gene expression and individual CCV distributions of 404 patients and 496 controls, we identify 417 genes associated with both CCV differences and individual CCV distributions. These genes are enriched for genetic association signals and genes downregulated in the ASD post-mortem brain. The expression patterns of these genes are correlated with brain activation patterns of language-related neural processes frequently impaired in ASD. These findings highlight a model whereby genetic risk impacts gene expression (downregulated), which leads to CCV alterations in ASD.

Dysfunctions in Infants' Statistical Learning are Related to Parental Autistic Traits

Statistical learning refers to the ability to extract the statistical relations embedded in a sequence, and it plays a crucial role in the development of communicative and social skills that are impacted in the Autism Spectrum Disorder (ASD). Here, we investigated the relationship between infants’ SL ability and autistic traits in their parents. Using a visual habituation task, we tested infant offspring of adults (non-diagnosed) who show high (HAT infants) versus low (LAT infants) autistic traits. Results demonstrated that LAT infants learned the statistical structure embedded in a visual sequence, while HAT infants failed. Moreover, infants’ SL ability was related to autistic traits in their parents, further suggesting that early dysfunctions in SL might contribute to variabilities in ASD symptoms.

Grammatical Comprehension in Italian Children with Autism Spectrum Disorder

Language deficits represent one of the most relevant factors that determine the clinical phenotype of children with autism spectrum disorder (ASD). The main aim of the research was to study the grammatical comprehension of children with ASD. A sample of 70 well-diagnosed children (60 boys and 10 girls; aged 4.9–8 years) were prospectively recruited. The results showed that language comprehension is the most impaired language domain in ASD. These findings have important clinical implications, since the persistence of grammatical receptive deficits may have a negative impact on social, adaptive and learning achievements. As for the grammatical profiles, persistent difficulties were found during the school-age years in morphological and syntactic decoding in children with relatively preserved cognitive and expressive language skills. These data and the lack of a statistically significant correlation between the severity of ASD symptoms and language skills are in line with the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) perspective that considers the socio-communication disorder as a nuclear feature of ASD and the language disorder as a specifier of the diagnosis and not as a secondary symptom anymore. The presence of receptive difficulties in school-age ASD children with relatively preserved non-verbal cognitive abilities provides important hints to establish rehabilitative treatments.

Thinking Ahead: Incremental Language Processing is Associated with Receptive Language Abilities in Preschoolers with Autism Spectrum Disorder

In typical development, listeners can use semantic content of verbs to facilitate incremental language processing-a skill that is associated with existing language skills. Studies of children with ASD have not identified an association between incremental language processing in semantically-constraining contexts and language skills, perhaps because participants were adolescents and/or children with strong language skills. This study examined incremental language processing and receptive language in young children with ASD with a range of language skills. Children showed a head start when presented with semantically-constraining verbs (e.g., Read the book) compared to neutral verbs (e.g., Find the book). Children with weaker receptive language showed a smaller head start than children with stronger receptive language skills, suggesting continuity between typical development and ASD.

Predicting Receptive-Expressive Vocabulary Discrepancies in Preschool Children With Autism Spectrum Disorder

PURPOSE

Correlates of receptive-expressive vocabulary size discrepancies may provide insights into why language development in children with autism spectrum disorder (ASD) deviates from typical language development and ultimately improve intervention outcomes.

METHOD

We indexed receptive-expressive vocabulary size discrepancies of 65 initially preverbal children with ASD (20-48 months) to a comparison sample from the MacArthur-Bates Communicative Development Inventories Wordbank (Frank, Braginsky, Yurovsky, & Marchman, 2017) to quantify typicality. We then tested whether attention toward a speaker and oral motor performance predict typicality of the discrepancy 8 months later.

RESULTS

Attention toward a speaker correlated positively with receptive-expressive vocabulary size discrepancy typicality. Imitative and nonimitative oral motor performance were not significant predictors of vocabulary size discrepancy typicality. Secondary analyses indicated that midpoint receptive vocabulary size mediated the association between initial attention toward a speaker and end point receptive-expressive vocabulary size discrepancy typicality.

CONCLUSIONS

Findings support the hypothesis that variation in attention toward a speaker might partially explain receptive-expressive vocabulary size discrepancy magnitude in children with ASD. Results are consistent with an input-processing deficit explanation of language impairment in this clinical population. Future studies should test whether attention toward a speaker is malleable and causally related to receptive-expressive discrepancies in children with ASD.

Subcortical Brain and Behavior Phenotypes Differentiate Infants With Autism Versus Language Delay

BACKGROUND

Younger siblings of children with autism spectrum disorder (ASD) are themselves at increased risk for ASD and other developmental concerns. It is unclear if infants who display developmental concerns, but are unaffected by ASD, share similar or dissimilar behavioral and brain phenotypes to infants with ASD. Most individuals with ASD exhibit heterogeneous difficulties with language, and their receptive-expressive language profiles are often atypical. Yet, little is known about the neurobiology that contributes to these language difficulties.

METHODS

In this study, we used behavioral assessments and structural magnetic resonance imaging to investigate early brain structures and associations with later language skills. High-risk infants who were later diagnosed with ASD (n = 86) were compared with high-risk infants who showed signs of early language delay (n = 41) as well as with high- and low-risk infants who did not have ASD or language delay (n = 255 and 143, respectively).

RESULTS

Results indicated that diminished language skills were evident at 12 months in infants with ASD and infants with early language delay. At 24 months of age, only the infants with ASD displayed atypical receptive-expressive language profiles. Associations between 12-month subcortical volumes and 24-month language skills were moderated by group status, indicating disordinal brain-behavior associations among infants with ASD and infants with language delay.

CONCLUSIONS

These results suggest that there are different brain mechanisms influencing language development in infants with ASD and infants with language delay, and that the two groups likely experience unique sets of genetic and environmental risk factors.