Novel linguistic evaluation of prefrontal synthesis (LEPS) test measures prefrontal synthesis acquisition in neurotypical children and predicts high-functioning versus low-functioning class assignment in individuals with autism

Combinatorial Language parent-report Scores Differ Significantly Between Typically Developing Children and Those with Autism Spectrum Disorders

Prefrontal synthesis (PFS) is a component of constructive imagination. It is defined as the process of mentally juxtaposing objects into novel combinations. For example, to comprehend the instruction "put the cat under the dog and above the monkey," it is necessary to use PFS in order to correctly determine the spatial arrangement of the cat, dog, and monkey with relation to one another. The acquisition of PFS hinges on the use of combinatorial language during early childhood development. Accordingly, children with developmental delays exhibit a deficit in PFS, and frequent assessments are recommended for such individuals. In 2018, we developed the Mental Synthesis Evaluation Checklist (MSEC), a parent-reported evaluation designed to assess PFS and combinatorial language comprehension. In this manuscript we use MSEC to identify differences in combinatorial language acquisition between ASD (N = 29,138) and neurotypical (N = 111) children. Results emphasize the utility of the MSEC in distinguishing language deficits in ASD from typical development as early as 2 years of age (p < 0.0001).

Language evolution is not limited to speech acquisition: a large study of language development in children with language deficits highlights the importance of the voluntary imagination component of language

Did the boy bite the cat or was it the other way around? When processing a sentence with several objects, one has to establish ‘who did what to whom’. When a sentence cannot be interpreted by recalling an image from memory, we rely on the special type of voluntary constructive imagination called Prefrontal synthesis (PFS). PFS is defined as the ability to juxtapose mental visuospatial objects at will. We hypothesised that PFS has fundamental importance for language acquisition. To test this hypothesis, we designed a PFS-targeting intervention and administered it to 6,454 children with language deficiencies (age 2 to 12 years). The results from the three-year-long study demonstrated that children who engaged with the PFS intervention showed 2.2-fold improvement in combinatorial language comprehension compared to children with similar initial evaluations. These findings suggest that language can be improved by training the PFS and exposes the importance of the visuospatial component of language. This manuscript reflects on the experimental findings from the point of view of human language evolution. When used as a proxy for evolutionary language acquisition, the study results suggest a dichotomy of language evolution, with its speech component and its visuospatial component developing in parallel. The study highlights the radical idea that evolutionary acquisition of language was driven primarily by improvements of voluntary imagination rather than by improvements in the speech apparatus.

Parent-Reported Assessment Scores Reflect the ASD Severity Level in 2- to 7-Year-Old Children

We investigated the relationship between parent-reported assessments and autism spectrum disorder (ASD) severity level. Parents evaluated 9573 children with ASD on five subscales-combinatorial receptive language, expressive language, sociability, sensory awareness, and health-using the Autism Treatment Evaluation Checklist (ATEC) and Mental Synthesis Evaluation Checklist (MSEC). The scores in every subscale improved with age, and there were clear differences between the three diagnostic categories. The differences between mild and moderate ASD, and moderate and severe ASD reached statistical significance in each subscale and in every age group in children 3 years of age and older. These findings demonstrate a consistent relationship between children's diagnoses and their assessments and provide evidence in support of the reliability of parent-report evaluations for ASD. Additionally, this is the first investigation of the relationship between ASD severity level and the ATEC/MSEC scores for the age range from 2 to 7 years.

Watching Videos and Television Is Related to a Lower Development of Complex Language Comprehension in Young Children with Autism

The effect of passive video and television watching duration on 2- to 5-year-old children with autism was investigated in the largest and the longest observational study to date. Parents assessed the development of 3227 children quarterly for three years. Longer video and television watching were associated with better development of expressive language but significantly impeded development of complex language comprehension. On an annualized basis, low TV users (low quartile: 40 min or less of videos and television per day) improved their language comprehension 1.4 times faster than high TV users (high quartile: 2 h or more of videos and television per day). This difference was statistically significant. At the same time, high TV users improved their expressive language 1.3 times faster than low TV users. This difference was not statistically significant. No effect of video and television watching duration on sociability, cognition, or health was detected.

Imagination in Autism: A Chance to Improve Early Language Therapy

Children with autism often have difficulties in imaginative play, Theory of Mind, and playing out different scenarios in their minds. Research shows that the root of these problems may be the voluntary imagination network that involves the lateral prefrontal cortex and its long frontoposterior connections to the temporal-parietal-occipital area. Previously disconnected visuospatial issues (stimulus overselectivity and tunnel vision) and language issues (lack of comprehension of spatial prepositions and complex recursive sentences) may be explained by the same voluntary imagination deficit. This review highlights the new insights into the mechanism of voluntary imagination, its difference from involuntary imagination, and its unusually strong critical period. Clearer developmental terminology and a better understanding of voluntary imagination have the potential to facilitate communication between therapists and parents, and improve therapy outcomes in children.

Novel Prefrontal Synthesis Intervention Improves Language in Children with Autism

Prefrontal synthesis (PFS) is defined as the ability to juxtapose mental visuospatial objects at will. Paralysis of PFS may be responsible for the lack of comprehension of spatial prepositions, semantically-reversible sentences, and recursive sentences observed in 30 to 40% of individuals with autism spectrum disorder (ASD). In this report we present data from a three-year-long clinical trial of 6454 ASD children age 2 to 12 years, which were administered a PFS-targeting intervention. Tablet-based verbal and nonverbal exercises emphasizing mental-juxtaposition-of-objects were organized into an application called Mental Imagery Therapy for Autism (MITA). The test group included participants who completed more than one thousand exercises and made no more than one error per exercise. The control group was selected from the rest of participants by a matching procedure. Each test group participant was matched to the control group participant by age, gender, expressive language, receptive language, sociability, cognitive awareness, and health score at first evaluation using propensity score analysis. The test group showed a 2.2-fold improvement in receptive language score vs. control group (p < 0.0001) and a 1.4-fold improvement in expressive language (p = 0.0144). No statistically significant change was detected in other subscales not targeted by the exercises. These findings show that language acquisition improves after training PFS and that a further investigation of the PFS-targeting intervention in a randomized controlled study is warranted.