Sign language and motor functioning in students with autistic disorder

Communication Profile of a Minimally Verbal School-Age Autistic Child: A Case Study

Purpose The present clinical focus draws on an intrinsic case study to provide a thick description of the communication profile of John, a 9-year-old minimally verbal autistic student. Method Specifically, traditional behavioral assessments, classroom video observations, and semistructured interviews were used to gather information regarding John's communication profile and potential sensory-motor differences. Results Convergent evidence indicated that John's expressive profile was characterized by single words, emergent word combinations, some conventional gestures, and a low frequency of communicative initiations. Concomitant language comprehension challenges and poor intelligibility associated with motor speech impairment were also indicated. His sensory-motor profile was marked by fine motor impairment, relative strengths in gross motor abilities, and sensory differences across visual, hearing, and tactile modalities. Conclusion Direct implications for supporting minimally verbal autistic students like John include the need to (a) consider sensory-motor influences on social interaction and (b) support flexible use of multimodal communication resources, including augmentative and alternative communication. Supplemental Material https://doi.org/10.23641/asha.12202448.

Differences in praxis performance and receptive language during fingerspelling between deaf children with and without autism spectrum disorder

Children with autism spectrum disorder present with a variety of social communication deficits such as atypicalities in social gaze and verbal and non-verbal communication delays as well as perceptuo-motor deficits like motor incoordination and dyspraxia. In this study, we had the unique opportunity to study praxis performance in deaf children with and without autism spectrum disorder in a fingerspelling context using American Sign Language. A total of 11 deaf children with autism spectrum disorder and 11 typically developing deaf children aged between 5 and 14 years completed a fingerspelling task. Children were asked to fingerspell 15 different words shown on an iPad. We coded various praxis errors and fingerspelling time. The deaf children with autism spectrum disorder had greater errors in pace, sequence precision, accuracy, and body part use and also took longer to fingerspell each word. Additionally, the deaf children with autism spectrum disorder had poor receptive language skills and this strongly correlated with their praxis performance and autism severity. These findings extend the evidence for dyspraxia in hearing children with autism spectrum disorder to deaf children with autism spectrum disorder. Poor sign language production in children with autism spectrum disorder may contribute to their poor gestural learning/comprehension and vice versa. Our findings have therapeutic implications for children with autism spectrum disorder when teaching sign language.

Persistent Angiogenesis in the Autism Brain: An Immunocytochemical Study of Postmortem Cortex, Brainstem and Cerebellum

In the current work, we conducted an immunocytochemical search for markers of ongoing neurogenesis (e.g. nestin) in auditory cortex from postmortem sections of autism spectrum disorder (ASD) and age-matched control donors. We found nestin labeling in cells of the vascular system, indicating blood vessels plasticity. Evidence of angiogenesis was seen throughout superior temporal cortex (primary auditory cortex), fusiform cortex (face recognition center), pons/midbrain and cerebellum in postmortem brains from ASD patients but not control brains. We found significant increases in both nestin and CD34, which are markers of angiogenesis localized to pericyte cells and endothelial cells, respectively. This labeling profile is indicative of splitting (intussusceptive), rather than sprouting, angiogenesis indicating the blood vessels are in constant flux rather than continually expanding.

Motor development and motor resonance difficulties in autism: relevance to early intervention for language and communication skills

Research suggests that a sub-set of children with autism experience notable difficulties and delays in motor skills development, and that a large percentage of children with autism experience deficits in motor resonance. These motor-related deficiencies, which evidence suggests are present from a very early age, are likely to negatively affect social-communicative and language development in this population. Here, we review evidence for delayed, impaired, and atypical motor development in infants and children with autism. We then carefully review and examine the current language and communication-based intervention research that is relevant to motor and motor resonance (i.e., neural "mirroring" mechanisms activated when we observe the actions of others) deficits in children with autism. Finally, we describe research needs and future directions and developments for early interventions aimed at addressing the speech/language and social-communication development difficulties in autism from a motor-related perspective.

Palm reversal errors in native-signing children with autism

Children with autism spectrum disorder (ASD) who have native exposure to a sign language such as American Sign Language (ASL) have received almost no scientific attention. This paper reports the first studies on a sample of five native-signing children (four deaf children of deaf parents and one hearing child of deaf parents; ages 4;6 to 7;5) diagnosed with ASD. A domain-general deficit in the ability of children with ASD to replicate the gestures of others is hypothesized to be a source of palm orientation reversal errors in sign. In Study 1, naturalistic language samples were collected from three native-signing children with ASD and were analyzed for errors in handshape, location, movement and palm orientation. In Study 2, four native-signing children with ASD were compared to 12 typically developing deaf children (ages 3;7 to 6;9, all born to deaf parents) on a fingerspelling task. In both studies children with ASD showed a tendency to reverse palm orientation on signs specified for inward/outward orientation. Typically developing deaf children did not produce any such errors in palm orientation. We conclude that this kind of palm reversal has a perceptual rather than a motoric source, and is further evidence of a "self-other mapping" deficit in ASD.

Exploring the Relationship Between Gesture and Language in ASD

In this paper, we will explore the relationship between gesture and language in autism spectrum disorders (ASD). Gesture and speech have been shown to share the same neural substrates, and it has been proposed that speech evolved over time from a gestural repertoire. Simultaneously, research in gesture and language has shown that gesture plays a critical role in language development, and a gestural disturbance may be a predictor of future language development. Individuals with autism often present with imitation deficits, developmental dyspraxia, and deficits in motor coordination. Taken together, these deficits pose challenges to the speech-language pathologist providing therapy to these clients. If gesture is indeed critical to language development, and individuals with ASD demonstrate gestural deficits, new therapies are needed to bridge this gap. We will describe an innovative battery of tasks assessing gesture and discuss future gestural intervention.

Motor coordination in autism spectrum disorders: a synthesis and meta-analysis

Are motor coordination deficits an underlying cardinal feature of Autism Spectrum Disorders (ASD)? Database searches identified 83 ASD studies focused on motor coordination, arm movements, gait, or postural stability deficits. Data extraction involved between-group comparisons for ASD and typically developing controls (N = 51). Rigorous meta-analysis techniques including random effects models, forest and funnel plots, I (2), publication bias, fail-safe analysis, and moderator variable analyses determined a significant standardized mean difference effect equal to 1.20 (SE = 0.144; p <0.0001; Z = 10.49). This large effect indicated substantial motor coordination deficits in the ASD groups across a wide range of behaviors. The current overall findings portray motor coordination deficits as pervasive across diagnoses, thus, a cardinal feature of ASD.

Sign communication in Cri du chat syndrome

This paper presents findings from a study on the use of sign supported Norwegian (SSN) in two individuals with Cri du chat syndrome (CCS). The study gives a first account of some selected aspects of production and intelligibility of SSN in CCS. Possible deviance in manual parameters, in particular inter- and/or intra-subject variation in the use of handshape is investigated. Second, the question is addressed to what extent the isolated signs and isolated speech are intelligible and to what extent the combination of signs and speech in SSN contributes to a better intelligibility compared to each part in isolation. Results showed inter-subject variation, as well as individual consistency of deviancy in phonetic handshape parameters. Both participants were slightly more intelligible in their sign articulation when signs and speech production were analyzed separately. Importantly, intelligibility was greatly increased when signs and speech were combined. This emphasizes the importance of SSN for facilitating communication in children with CCS.

LEARNING OUTCOMES

The reader will be able to identify Signed Supported Communication as an artificial communication form, which can be used as an aid for language development in different groups of children, including children suffering from Cri du chat syndrome. The paper shows the reader to recognize that although children with Cri du chat do not produce words or signs accurately, their intelligibility can improve when they use simultaneous combinations of words and signs.

Motor coordination in autism spectrum disorders: a synthesis and meta-analysis

Are motor coordination deficits an underlying cardinal feature of Autism Spectrum Disorders (ASD)? Database searches identified 83 ASD studies focused on motor coordination, arm movements, gait, or postural stability deficits. Data extraction involved between-group comparisons for ASD and typically developing controls (N = 51). Rigorous meta-analysis techniques including random effects models, forest and funnel plots, I (2), publication bias, fail-safe analysis, and moderator variable analyses determined a significant standardized mean difference effect equal to 1.20 (SE = 0.144; p <0.0001; Z = 10.49). This large effect indicated substantial motor coordination deficits in the ASD groups across a wide range of behaviors. The current overall findings portray motor coordination deficits as pervasive across diagnoses, thus, a cardinal feature of ASD.

Interventions to Improve Communication

Children with autism benefit from intensive, early intervention that focuses on increasing the frequency, form, and function of communicative acts. Available evidence shows that highly structured behavioral methods have important positive consequences for these children, particularly in eliciting first words. However, the limitation of these methods in maintenance and generalization of skills suggests that many children with autism will need to have these methods supplemented with less adult-directed activities to increase communicative initiation and carry over learned skills to new settings and communication partners. Providing opportunities for mediated peer interactions with trained peers in natural settings seems to be especially important in maximizing the effects of this intervention.

Modeling early cortical serotonergic deficits in autism

Autism is a developmental brain disorder characterized by deficits in social interaction, language and behavior. Brain imaging studies demonstrate increased cerebral cortical volumes and micro- and macro-scopic neuroanatomic changes in children with this disorder. Alterations in forebrain serotonergic function may underlie the neuroanatomic and behavioral features of autism. Serotonin is involved in neuronal growth and plasticity and these actions are likely mediated via serotonergic and glutamatergic receptors. Few animal models of autism have been described that replicate both etiology and pathophysiology. We report here on a selective serotonin (5-HT) depletion model of this disorder in neonatal mice that mimics neurochemical and structural changes in cortex and, in addition, displays a behavioral phenotype consistent with autism. Newborn male and female mice were depleted of forebrain 5-HT with injections of the serotonergic neurotoxin, 5,7-dihydroxytryptamine (5,7-DHT), into the bilateral medial forebrain bundle (mfb). Behavioral testing of these animals as adults revealed alterations in social, sensory and stereotypic behaviors. Lesioned mice showed significantly increased cortical width. Serotonin immunocytochemistry showed a dramatic long-lasting depletion of 5-HT containing fibers in cerebral cortex until postnatal day (PND) 60. Autoradiographic binding to high affinity 5-HT transporters was significantly but transiently reduced in cerebral cortex of 5,7-DHT-depleted mice. AMPA glutamate receptor binding was decreased at PND 15. We hypothesize that increased cerebral cortical volume and sensorimotor, cognitive and social deficits observed in both 5-HT-depleted animals and in individuals with autism, may be the result of deficiencies in timely axonal pruning to key cerebral cortical areas.

Teaching Young Nonverbal Children with Autism Useful Speech: A Pilot Study of the Denver Model and PROMPT Interventions

This single subject design study examined two models of intervention: Denver Model (which merges behavioral, developmental, and relationship-oriented intervention), and PROMPT (a neuro-developmental approach for speech production disorders). Ten young, nonverbal children with autism were matched in pairs and randomized to treatment. They received 12 1-h weekly sessions of therapy and daily 1-h home intervention delivered by parents. Fidelity criteria were maintained throughout. Eight of the ten children used five or more novel, functional words spontaneously and spoke multiple times per hour by the conclusion of treatment. There were no differences in acquired language skills by intervention group. Initial characteristics of the best responders were mild to moderate symptoms of autism, better motor imitation skills, and emerging joint attention skills.

Effects on communicative requesting and speech development of the Picture Exchange Communication System in children with characteristics of autism

Few studies on augmentative and alternative communication (AAC) systems have addressed the potential for such systems to impact word utterances in children with autism spectrum disorders (ASD). The Picture Exchange Communication System (PECS) is an AAC system designed specifically to minimize difficulties with communication skills experienced by individuals with ASD. The current study examined the role of PECS in improving the number of words spoken, increasing the complexity and length of phrases, and decreasing the non-word vocalizations of three young children with ASD and developmental delays (DD) with related characteristics. Participants were taught Phases 1-4 of PECS (i.e., picture exchange, increased distance, picture discrimination, and sentence construction). The results indicated that PECS was mastered rapidly by the participants and word utterances increased in number of words and complexity of grammar.

Language development in autism

In this short review article, a summary of the behavioural impairments most commonly associated with the spectrum of autism-related disorders is presented, with a slightly amplified account of the defining communication impairment. The patterns of language ability and disability which typically occur in some forms of autism are then outlined, followed by a short section on possible cognitive, or psychological, explanations of these patterns. In particular, the hypothesis that defective socio-affective and socio-cognitive ('theory of mind') causes language impairments, and the hypothesis that temporal processing deficits cause these impairments, are outlined and briefly discussed. An extensive list of references is included, to support and amplify the summary data included in the review.

Toward Functional Augmentative and Alternative Communication for Students With Autism

Many individuals with autism are candidates for augmentative and alternative communication (AAC) systems, either to supplement (i.e., augment) their existing speech or to act as their primary (i.e., alternative) method of expressive communication. The purpose of this article is to summarize research and directions for future research with regard to two questions related to the delivery of AAC supports to these individuals: (a) What AAC modality is preferable to use? and (b) What do we know about the use of voice output communication aids with people with autism?

Hand preferences in sign-learning students with autistic disorder

The purpose of the study was fourfold: (a) to document the hand preferences of nonspeaking individuals with autism as they produced signs and nonsign actions; (b) to find out if sign-language proficiency in such individuals is associated with directionality or consistency of signing hand preference; (c) to explore the link between hand preference for signing and standardised measures of cognitive and motor development; (d) to compare the hand preferences (sign and nonsign actions) of such individuals to sign-learning children with normal cognitive functioning. In this study, the hand preferences of 14 nonspeaking students with autistic disorder were determined from videotape records of their sign production and nonsign actions. In their sign production, four students strongly favoured their right hands, four had a distinct left-hand preference, and six did not significantly favour either hand. There was little evidence linking sign-language proficiency, cognitive maturity, or motor development to strongly lateralised signing or handedness in general in these students. Compared with the hand preferences of the children in the two comparison groups, the autistic students were markedly less lateralised with respect to signing, but not nonsign actions.

Interventions to facilitate communication in autism

The purpose of this article is to discuss research opportunities arising from the current literature in the area of communication. Six general themes are discussed, including (a) increasing spontaneity, initiations, and the variety of functions of language verbal and nonverbal children with autism exhibit; (b) assessing and teaching precursors relating to positive outcome; (c) the importance of family involvement in intervention programs; (d) best practices for implementation of communicative interventions; (e) the interrelationship between language and other behavioral symptoms of autism; and (f) the social and pragmatic use of language. These areas are discussed in terms of improving assessment and intervention practices to produce greater long-term communicative outcomes for individuals with autism.