Narrative Skill in Boys with Fragile X Syndrome with and without Autism Spectrum Disorder

How to Assess Oral Narrative Skills of Children and Adolescents with Intellectual Disabilities: A Systematic Review

Children and adolescents with intellectual disabilities (ID) often encounter difficulties with narrative skills. Yet, there is a lack of research focusing on how to assess these skills in this population. This study offers an overview of the tools used for assessing oral narrative skills in children and adolescents with ID, addressing key questions about common assessment tools, their characteristics, and reported evidence. A systematic review was conducted of the literature published between 2010 and 2023 in the PsycINFO, ERIC, Education, and Psychology databases. An initial 1176 studies were reviewed by abstract, of which 485 were read in full text, leading to the selection and analysis of 22 studies. Most of the identified tools involve analyzing language samples obtained using wordless picture story books. Three common tools are emphasized. Studies have primarily identified inter-rater reliability and test-criterion evidence for validity. The main tools and their characteristics are discussed in depth to aid readers in discerning suitable options for research or practical applications. The importance of reporting diverse sources of evidence for validity and reliability within this population is highlighted.

A longitudinal investigation of pragmatic language across contexts in autism and related neurodevelopmental conditions

Background

Pragmatic language, or the use of language in social contexts, is a critical skill in daily life, supporting social interactions and the development of meaningful social relationships. Pragmatic language is universally impacted in autism spectrum disorder (ASD) and pragmatic deficits are also common in other neurodevelopmental conditions, particularly those related to ASD, such as fragile X syndrome (FXS). This study used a multi-method, longitudinal approach to characterize potentially unique pragmatic profiles across different neurodevelopmental disabilities, and across contexts that varied in degree of social demand. The utility of computational linguistic analyses, as an efficient tool for capturing pragmatic abilities, was also explored.

Methods

Pragmatic skills of boys with idiopathic ASD (ASD-O, n = 43), FXS with and without ASD (FXS-ASD, n = 57; FXS-O, n = 14), Down syndrome (DS, n = 22), and typical development (TD, n = 24) were compared using variables obtained from a standardized measure, narrative, and semi-naturalistic conversation at up to three time points.

Results

Pragmatic language was most significantly impacted among males with ASD-O and FXS-ASD across all three contexts, with more difficulties in the least structured context (conversation), and also some differences based on FXS comorbidity. Patterns of group differences were more nuanced for boys with FXS-O and DS, with context having less of an impact. Clinical groups demonstrated minimal changes in pragmatic skills with age, with some exceptions. Computational language measurement tools showed some utility for measuring pragmatic skills, but were not as successful as traditional methods at capturing differences between clinical groups.

Conclusion

Overlap and differences between ASD and other forms of neurodevelopmental disability in general, and between idiopathic and syndromic ASD in particular, have important implications for developing precisely tailored assessment and intervention approaches, consistent with a personalized medicine approach to clinical study and care in ASD.

What Predicts Oral Narrative Competence Among African American Children? Exploring the Role of Linguistic and Cognitive Skills

PURPOSE

Oral narrative, or storytelling, skills may constitute a linguistic strength for African American children, with implications for academic and social well-being. Despite this possibility, few studies have examined individual differences in oral narrative skill among African American children. To address this gap in the literature, this study examined how children's linguistic and cognitive skills predicted their competence in structuring oral stories, both on average and for children with different levels of narrative skill.

METHOD

Fictional oral narratives were elicited from a sample of 144 typically developing African American children, aged 4-8 years, using a wordless picture book as the stimulus. The effects of children's vocabulary, complex syntax, and nonverbal cognitive skills on macrostructural performance were assessed using linear regression to test average effects and simultaneous quantile regression to test effects across different levels of narrative skill.

RESULTS

Children's competence in using complex syntax and nonverbal cognition, but not vocabulary, was predictive of narrative production, on average and as a function of narrative skill. Syntactic complexity appeared increasingly more relevant as children's narrative skill increased, whereas nonverbal cognition emerged as the most important for children at the lower to moderate ends of the narrative skill distribution.

CONCLUSIONS

Both linguistic and cognitive skills help explain individual differences in African American children's macrostructural competence. Promoting children's development of complex syntax and nonverbal reasoning may provide potential mechanisms for supporting oral narrative skill development.

Pragmatic Profiles of Adults with Fragile X Syndrome and Williams Syndrome

Linguistic phenotypes of individuals with Fragile X (FXS) and Williams (WS) syndromes exhibit various degrees of pragmatic impairment, involving difficulties in social communication and in adapting to conversational principles. The goal of the present study was to explore syndrome-specific pragmatic profiles of adults with FXS and WS based on the assessment of the observance of Gricean maxims of conversation. The participants were 12 Spanish-speaking adults (6 FXS/6 WS), without a diagnosis of ASD, whose extensive naturalistic conversations (71,859 words) were transcribed and coded with the CHILDES/TALKBANK tools and the PREP-CORP pragmatic protocol. Violations of the maxims of conversation were analyzed, and indexes of cooperation and conversational response were obtained. Both groups showed reduced verbal production and repetitive dysfluencies; prominent features in the FXS profile were higher proportion of non-contingent language, perseverations of topic and form, and impulsive conversational responses; in the WS profile, salient characteristics were higher proportion of tangential utterances, reformulations, and conversational responses reflecting overly literal interpretation. Pragmatic profiles of violation of conversational maxims reflect specific communication skills impaired in adults with FXS and WS and raise the need for assessment and intervention methods that specifically address their social communication abilities.

Narrative Analysis in Adolescents With Fragile X Syndrome

This study analyzed narratives of male and female adolescents with fragile X syndrome (FXS). The impact of structural language, cognition and autism symptomatology on narrative skills and the association between narratives and literacy were examined. Narratives from 32 adolescents with FXS (24 males, 8 females) were analyzed for macrostructure. Relationships between narrative macrostructure, language scores, cognitive scores, Childhood Autism Rating Scale-Second Edition scores and literacy skills were examined. Males produced more simplistic narratives, whereas the females' narratives were more complex. Language scores predicted narrative scores above and beyond nonverbal cognitive skills and autism symptomatology. Narrative scores correlated with literacy scores. Narrative skills in FXS are predicted by language skills and are correlated with literacy skills. Investigation into narrative interventions in FXS is needed.

The effects of incorporating extended conversations into video-based story retelling instruction on oral narrative skills in adolescents with intellectual disability in China

BACKGROUND/AIMS

Oral narrative language is a persistent area of language difficulty for individuals with intellectual disability (ID). This study aims to explore the effectiveness of a comprehensive intervention program that incorporates extended conversations into video-based story retelling instruction with a novel visual support strategy, Story Hand, to develop oral narrative skills in adolescents with ID in China.

METHODS

Using a single-case multiple-probe across participants design, the researchers examined whether the comprehensive intervention program could improve participants' oral narrative skills both microstructurally and macrostructurally.

RESULTS

All three participants demonstrated moderate to high treatment effects in the microstructural narrative outcomes (i.e., the mean length of utterance in morphemes [MLU-M] and the number of different words [NDW]) and one of the macrostructural narrative outcomes (i.e., the complexity of story grammar [SG-complexity]) in response to the comprehensive intervention program, and these acquired effects were maintained at a high level for up to one month. However, all three participants demonstrated limited treatment effects in one of the macrostructural narrative outcomes (i.e., cohesion) in response to the comprehensive intervention program.

CONCLUSIONS/IMPLICATIONS

The comprehensive intervention program that incorporates extended conversations into visually supported video-based story retelling instruction offers an option for teachers to develop oral narrative skills in adolescents with ID. However, the relative effectiveness of the different components of the intervention needs to be further explored.

Neuropsychological and ASD phenotypes in rare genetic syndromes: A critical review of the literature

OBJECTIVE

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by core deficits in social communication and restricted and repetitive behaviors and interests. Recent advances in clinical genetics have improved our understanding of genetic syndromes associated with ASD, which has helped clarify distinct etiologies of ASD and document syndrome-specific profiles of neurocognitive strengths and weaknesses. Pediatric neuropsychologists have the potential to be impactful members of the care team for children with genetic syndromes and their families.

METHOD

We provide a critical review of the current literature related to the neuropsychological profiles of children with four genetic syndromes associated with ASD, including Tuberous Sclerosis Complex (TSC), fragile X syndrome (FXS), 22q11.2 deletion syndrome, and Angelman syndrome. Recommendations for assessment, intervention, and future directions are provided.

RESULTS

There is vast heterogeneity in terms of the cognitive, language, and developmental abilities of these populations. The within- and across-syndrome variability characteristic of genetic syndromes should be carefully considered during clinical evaluations, including possible measurement limitations, presence of intellectual disability, and important qualitative differences in the ASD-phenotypes across groups.

CONCLUSIONS

Individuals with genetic disorders pose challenging diagnostic and assessment questions. Pediatric neuropsychologists with expertise in neurodevelopmental processes are well suited to address these questions and identify profiles of neurocognitive strengths and weaknesses, tailor individualized recommendations, and provide diagnostic clarification.

Evaluation of a Combined Explicit-Implicit Approach to Teach Grammatical Forms to Children With Grammatical Weaknesses

Purpose Many children with developmental disorders experience difficulty mastering grammatical forms, including children with developmental language disorder and a subset of children with autism spectrum disorder (ASD). One of the key language features in both of these populations is a weakness in the expressive use of grammatical forms. There is a paucity of studies that evaluate the effectiveness of interventions targeting grammatical forms for populations other than developmental language disorder. The current study evaluated a combined explicit-implicit intervention approach to teach grammatical forms to children with ASD symptomology. Method Researchers used a single-subject, nonconcurrent multiple baseline, A-B-C study design. Three children with characteristics of ASD (2 with formal diagnoses) between the ages of 5 and 9 years participated in treatment targeting a weak grammatical structure. After baseline, each participant completed a series of treatment sessions that comprised implicit instruction, followed by a series of treatment sessions that incorporated explicit instruction. Accuracy of use was assessed during each session across baseline, implicit-only, and explicit-implicit conditions as well as 1 week, 1 month, and 2 months posttreatment. Results All participants produced target forms with low accuracy across baseline and implicit-only treatment sessions. Within three explicit-implicit treatment sessions, all participants demonstrated a marked increase in level and upward trend in their production accuracy. Gains in accuracy were maintained 2 months posttreatment for 2 of the 3 participants. Conclusions The current study provides preliminary evidence to support the use of explicit approaches to teach grammatical forms to children with ASD symptomology and motivates further investigation in this area.

Syntactic Ability of Girls With Fragile X Syndrome: Phonological Memory and Discourse Demands on Complex Sentence Use

This study was designed to establish the extent of delay in complex sentence use by females with fragile X syndrome (FXS) and to identify sources of variability among individuals. Females with FXS (n = 16; 10;2-15;7) and younger typically developing girls (n = 17; 4;1-8;11) were group-wise matched on nonverbal cognition and receptive syntax. Language samples (conversation and narration) yielded syntactic complexity in terms of mean length of C-unit (MLCU) and Developmental Level sentence coding (DLevel; Rosenberg & Abbeduto, 1987 ). Complex syntax was not weaker than developmental expectations; however, MLCU was lower than expected for age. Phonological memory and verbal working memory correlated with measures of syntactic complexity in narration. Discourse demands may play an important role in the language produced by females with FXS.

Inferential language use by youth with Down syndrome during narration

We examined inferential language use by youth with Down syndrome (DS) in the context of narrative storytelling relative to younger typically developing (TD) children and same-aged peers with fragile X syndrome (FXS) matched on nonverbal cognitive ability level. Participants' narratives were coded for the use of different types of inferential language. Participants with DS used proportionately less inferential language overall relative to their counterparts with TD or FXS, although mean length of utterance accounted for group differences observed for the DS-TD group comparison only. Patterns of inferential language use varied across inferential subtypes and across participant groups, with mean length of utterance playing a significant role in group differences. These findings suggest potential syndrome specificity to the DS phenotype regarding impairments in inferential language use that can be partially explained by level of expressive syntactic ability and should be considered in future research. Clinical interventions within the DS population, therefore, should target to some extent the use of inferential language and complex sentence structure.

Different Tales: The Role of Gender in the Oral Narrative-Reading Link Among African American Children

Evidence suggests that oral narrative skills are a linguistic strength for African American children, yet few studies have examined how these skills are associated with reading for African American boys and girls. The current study uses longitudinal data of a sample of 72 African American 4-year-olds to examine how preschool oral narrative skills predict reading from first through sixth grades and explores differences by gender. Findings indicate that although girls demonstrated stronger narrative skills, their narrative skills did not moderate change in reading. For boys, narrative skills moderated change in reading over time such that as preschool narrative skills increased, their reading scores showed greater change over time. Educational implications and directions for future research are discussed.

A Retrospective Video Analysis of Canonical Babbling and Volubility in Infants with Fragile X Syndrome at 9-12 Months of Age

An infant's vocal capacity develops significantly during the first year of life. Research suggests early measures of pre-speech development, such as canonical babbling and volubility, can differentiate typical versus disordered development. This study offers a new contribution by comparing early vocal development in 10 infants with Fragile X syndrome and 14 with typical development. Results suggest infants with Fragile X syndrome produce fewer syllables and have significantly lower canonical babbling ratios compared to infants who are typically developing. Furthermore, the particular measures of babbling were strong predictors of group membership, adding evidence regarding the possible utility of these markers in early identification.

Evaluation of language and communication skills in adult key word signing users with intellectual disability: advantages of a narrative task

The evaluation of language and communication skills in adults who use augmentative and alternative communication (AAC) in general and key word signing (KWS) in particular, can be an elaborate task. Besides being time-consuming and not very similar to natural communication, standard language tests often do not take AAC or KWS into account. Therefore, we developed a narrative task specifically for adults with intellectual disability (ID) who use KWS. The task was evaluated in a group of 40 adult KWS users. Outcome measures on the narrative task correlated significantly with measures of standard language and communication tests for verbal language, but not for use of manual signs. All narrative measures, for both verbal language and manual signing, correlated highly with similar measures from a conversation sample. The developed narrative task proved useful and valid to evaluate the language and communication skills of adults with ID taking into account both their verbal language and manual sign use.

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.

Outcome measures for clinical trials in fragile X syndrome

OBJECTIVE

Progress in basic neuroscience has led to identification of molecular targets for treatment in fragile X syndrome (FXS) and other neurodevelopmental disorders; however, there is a gap in translation to targeted therapies in humans. One major obstacle to the demonstration of efficacy in human trials has been the lack of generally accepted endpoints to assess improvement in function in individuals with FXS. To address this problem, the National Institutes of Health convened a meeting of leading scientists and clinicians with the goal of identifying and standardizing outcome measures for use as potential endpoints in clinical trials in FXS.

METHODS

Participants in the meeting included FXS experts, experts in the design and implementation of clinical trials and measure development, and representatives from advocacy groups, industry, and federal agencies.

RESULTS

The group generated recommendations for optimal outcome measures in cognitive, behavioral, and biomarker/medical domains, including additional testing and validation of existing measures and development of new measures in areas of need. Although no one endpoint or set of endpoints could be identified that met all criteria as an optimal measure, recommendations are presented in this report.

CONCLUSION

The report is expected to guide the selection of measures in clinical trials and lead to the use of a more consistent battery of measures across trials. Furthermore, this will help to direct research toward gaps in the development of validated FXS-specific outcome measures and to assist with interpretation of clinical trial data by creating templates for measurement of treatment efficacy.

Longitudinal profiles of expressive vocabulary, syntax and pragmatic language in boys with fragile X syndrome or Down syndrome

BACKGROUND

Fragile X syndrome (FXS) and Down syndrome (DS) are the two leading genetic causes of intellectual disability, and FXS is the most common known genetic condition associated with autism. Both FXS and DS are associated with significant language impairment, but little is known about expressive language across domains over time or the role of autism in language development in FXS.

AIMS

To compare three domains of language production (vocabulary, syntax, pragmatics) over time within and across groups of boys with FXS with and without autism spectrum disorder (FXS-ASD, FXS-O), boys with DS, and typically developing (TD) boys.

METHODS & PROCEDURES

Twenty-nine boys with FXS-O, 40 boys with FXS-ASD, 34 boys with DS, and 48 younger TD boys of similar non-verbal mental age living in the United States participated in the study. The Antonyms, Syntax Construction and Pragmatic Judgment subtests of the Comprehensive Assessment of Spoken Language were administered annually over 3 years.

OUTCOMES & RESULTS

TD boys scored higher than all other groups on all three subtests; boys with FXS-O and FXS-ASD scored higher than boys with DS in Syntax Construction; and boys with FXS-O scored higher than boys with FXS-ASD in Pragmatic Judgment. Within-group patterns varied between groups. Overall, the TD group showed significantly more change over time than all other groups.

CONCLUSIONS & IMPLICATIONS

Findings suggest that expressive language skills and growth across various domains are more impaired in boys with FXS and DS than would be expected based on non-verbal mental age, that for boys with DS syntax is more impaired than would be expected based on intellectual disability, and that autism status affects pragmatic language in boys with FXS. Findings suggest that language production across domains should be addressed during assessment and intervention for boys with FXS and boys with DS, with differing group profiles also suggesting potentially different areas of focus.

An investigation of narrative ability in boys with autism and fragile X syndrome

Whereas pragmatic language difficulties are characteristic of both autism and Fragile X syndrome, it is unclear whether such deficits are qualitatively similar or whether certain skills are differentially affected. This study compared narrative competence in boys with autism, Fragile X syndrome, Down syndrome, and typical development. Results revealed that an interaction between diagnosis and nonverbal mental age predicted narrative microstructure (e.g., complex syntax) but not macrostructure (e.g., thematic maintenance). Correlations with FMR1-related variation were investigated in children with Fragile X syndrome. While CGG repeat length was associated with many language characteristics, nonverbal IQ appeared to mediate these relationships. These findings are an important step toward understanding narrative abilities in boys with and without the FMR1 mutation.

Five Principles to Consider When Providing Narrative Language Intervention to Children and Adolescents With Developmental Disabilities

For many verbally expressive children and adolescents with developmental disabilities, it is important for speech-language pathologists to target narrative language skills in intervention. Although relatively little empirical evidence exists examining the narrative language profiles of children and adolescents with developmental disabilities, even less evidence exists evaluating narrative interventions for this population. Despite these limitations, drawing from research primarily involving adolescents with Down syndrome (DS), the author highlights five research-supported principles for clinicians to consider when designing and implementing narrative-focused interventions for individuals with developmental disabilities.

Perseveration in the connected speech of boys with Fragile X syndrome with and without autism spectrum disorder

Verbal perseveration is a frequently reported language characteristic of males with Fragile X syndrome and may be a defining feature or hallmark of the syndrome. We compared the verbal perseveration of boys with Fragile X syndrome with (n  =  29) and without (n  =  30) autism spectrum disorder, boys with Down syndrome (n  =  27), and typically developing boys (n  =  25) at similar nonverbal mental ages. During a social interaction, boys with both Fragile X syndrome and autism spectrum disorder produced significantly more topic perseveration than all other groups. In social interaction as compared to narration, boys with Fragile X syndrome (regardless of autism status) produced significantly more topic perseveration. These findings suggest that autism status, as well as language sampling context, affect perseveration in boys with Fragile X syndrome.

Social communication and theory of mind in boys with autism and fragile x syndrome

Impairments in the social use of language, or pragmatics, constitute a core characteristic of autism. Problems with pragmatic language have also been documented in fragile X syndrome (FXS), a monogenic condition that is the most common known genetic cause of autism. Evidence suggests that social cognitive ability, or theory of mind, may also be impaired in both conditions, and in autism, may importantly relate to pragmatic language ability. Given the substantial overlap observed in autism and FXS, this study aimed to better define those social-communicative phenotypes that overlap in these two conditions by comparing pragmatic language ability and theory of mind in children with idiopathic autism and children with FXS, with and without autism, as well as children with Down syndrome and typically developing controls. We further examined correlations between these cognitive-behavioral phenotypes and molecular genetic variation related to the Fragile X Mental Retardation-1 gene (FMR1) in the FXS group. Results indicated that children with idiopathic autism and those with FXS and autism performed comparably on direct-assessment measures of pragmatic language and theory of mind, whereas those with FXS only did not differ from controls. Theory of mind was related to pragmatic language ability in all groups. Pragmatic language and theory of mind also correlated with genetic variation at the FMR1 locus (Cytosine-Guanine-Guanine repeats and percent methylation). These results point toward substantial overlap in the social and language phenotypes in autism and FXS and suggest a molecular genetic basis to these phenotypic profiles.