1
|
Moskowitz L, Will E, Black C, Roberts J. The Effect of Anxiety and Autism Symptom Severity on Restricted and Repetitive Behaviors Over Time in Children with Fragile X Syndrome. RESEARCH SQUARE 2023:rs.3.rs-3353765. [PMID: 37961141 PMCID: PMC10635355 DOI: 10.21203/rs.3.rs-3353765/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Restricted and repetitive behaviors (RRBs) are highly prevalent and reduce function in individuals with fragile X syndrome (FXS). As transdiagnostic features of intellectual disability, elevated rates of RRBs in FXS could represent various underlying known co-occurring conditions in FXS such as anxiety or autism spectrum disorder (ASD), yet this distinction has not been investigated. Further, delineating whether RRBs are more indicative of anxiety or ASD in FXS may clarify phenotypic profiles within FXS and improve differential assessment. Methods We longitudinally examined the potentially independent or multiplicative effect of ASD and anxiety symptom severity on RRBs in 60 children with FXS. Anxiety was measured using the Child Behavior Checklist (CBCL), ASD severity was measured using the Childhood Autism Rating Scale (CARS), and RRBs were measured using The Repetitive Behavior Scale - Revised (RBS-R). We estimated a series of moderated regression models with anxiety and ASD symptoms at the initial assessment (Time 1) as predictors of RRBs at the outcome assessment two years later (Time 2), along with an anxiety-by-ASD interaction term to determine the potential multiplicative effect of these co-occurring conditions on RRBs. Results Results identified a significant interaction between ASD and anxiety symptom severity at the initial assessment that predicted elevated sensory-motor RRBs two years later. Increased sensory-motor RRBs were predicted by elevated ASD symptoms only when anxiety symptom severity was low. Likewise, increased sensory-motor RRBs were predicted by elevated anxiety symptoms only when ASD symptom severity was low. Interestingly, this relationship was isolated to Sensory-Motor RRBs, with evidence that it could also apply to total RRBs. Conclusions Findings suggest that ASD and anxiety exert independent and differential effects on Sensory-Motor RRBs when at high severity levels and a multiplicative effect when at moderate levels.
Collapse
Affiliation(s)
| | | | - Conner Black
- NewYork-Presbyterian Weill Cornell Medical Center
| | | |
Collapse
|
2
|
MacFarlane H, Salem AC, Bedrick S, Dolata JK, Wiedrick J, Lawley GO, Finestack LH, Kover ST, Thurman AJ, Abbeduto L, Fombonne E. Consistency and reliability of automated language measures across expressive language samples in autism. Autism Res 2023; 16:802-816. [PMID: 36722653 PMCID: PMC10123085 DOI: 10.1002/aur.2897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/19/2023] [Indexed: 02/02/2023]
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with substantial clinical heterogeneity, especially in language and communication ability. There is a need for validated language outcome measures that show sensitivity to true change for this population. We used Natural Language Processing to analyze expressive language transcripts of 64 highly-verbal children and young adults (age: 6-23 years, mean 12.8 years; 78.1% male) with ASD to examine the validity across language sampling context and test-retest reliability of six previously validated Automated Language Measures (ALMs), including Mean Length of Utterance in Morphemes, Number of Distinct Word Roots, C-units per minute, unintelligible proportion, um rate, and repetition proportion. Three expressive language samples were collected at baseline and again 4 weeks later. These samples comprised interview tasks from the Autism Diagnostic Observation Schedule (ADOS-2) Modules 3 and 4, a conversation task, and a narration task. The influence of language sampling context on each ALM was estimated using either generalized linear mixed-effects models or generalized linear models, adjusted for age, sex, and IQ. The 4 weeks test-retest reliability was evaluated using Lin's Concordance Correlation Coefficient (CCC). The three different sampling contexts were associated with significantly (P < 0.001) different distributions for each ALM. With one exception (repetition proportion), ALMs also showed good test-retest reliability (median CCC: 0.73-0.88) when measured within the same context. Taken in conjunction with our previous work establishing their construct validity, this study demonstrates further critical psychometric properties of ALMs and their promising potential as language outcome measures for ASD research.
Collapse
Affiliation(s)
- Heather MacFarlane
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Alexandra C. Salem
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Steven Bedrick
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jill K. Dolata
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
- School of Communication Sciences and Disorders, Pacific University, Forest Grove, Oregon
| | - Jack Wiedrick
- Biostatistics & Design Program, Oregon Health & Science University, Portland, Oregon, USA
| | - Grace O. Lawley
- Computer Science and Electrical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Lizbeth H. Finestack
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sara T. Kover
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington, USA
| | - Angela John Thurman
- MIND Institute, University of California Davis Health, Sacramento, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, California, USA
| | - Leonard Abbeduto
- MIND Institute, University of California Davis Health, Sacramento, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, California, USA
| | - Eric Fombonne
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
3
|
Hoffmann A. Communication in fragile X syndrome: Patterns and implications for assessment and intervention. Front Psychol 2022; 13:929379. [PMID: 36619013 PMCID: PMC9817301 DOI: 10.3389/fpsyg.2022.929379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Fragile X syndrome (FXS) is the most common cause of inherited intellectual disability and is associated with a high rate of autism diagnosis. Language delays have been noted in the areas of overall communication and the specific areas of receptive, expressive, and pragmatic language, as well as in development of speech sounds and literacy. It has been widely noted that those individuals with a diagnosis of both FXS and autism tend to have more significant intellectual disability and language disorder. In this study, the research exploring the FXS language phenotype is presented, and the roles of cognition, autistic symptomatology, and gender are highlighted as possible. Implications for assessment and intervention approaches based on the strengths and weaknesses of the FXS language phenotype are provided.
Collapse
Affiliation(s)
- Anne Hoffmann
- Department of Communication Disorders and Sciences, Rush University Medical Center, Chicago, IL, United States,Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States,*Correspondence: Anne Hoffmann,
| |
Collapse
|
4
|
Hoffmann A, Thurman AJ, Sterling A, Kover ST, Finestack L, Berry-Kravis E, Edgin JO, Drayton A, Fombonne E, Abbeduto L. Analysis of a Repetitive Language Coding System: Comparisons between Fragile X Syndrome, Autism, and Down Syndrome. Brain Sci 2022; 12:575. [PMID: 35624962 PMCID: PMC9139711 DOI: 10.3390/brainsci12050575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
Expressive language sampling (ELS) is a frequently used tool for language analysis, as it can be used across widely ranging cognitive and language abilities. ELS can also evaluate pragmatic language, including excessive self-repetition, which is challenging to assess with traditional standardized assessments. This study explored how a well-established ELS protocol can assess three types of linguistic self-repetition in three neurodevelopmental disabilities: fragile X syndrome (FXS), autism spectrum disorder (ASD), and Down syndrome (DS). We examined its ability to differentiate between these disorders, the relationships between repetitive language and other participant characteristics, and initial construct validity. We found that the groups with FXS and ASD differed significantly on each of the three repetitive language measure, and that the group with DS differed from either ASD or FXS on two. Cognitive ability was significantly related to phrase repetition in the group with ASD. When the groups were combined, there was evidence of convergent and divergent validity. This study extends previous research on ELS and supports its use as a means to characterize pragmatic language. It also provides information about the relationships between repetitive language and other phenotypic characteristics.
Collapse
Affiliation(s)
- Anne Hoffmann
- Departments of Communication Disorders and Sciences and Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| | - Angela John Thurman
- MIND Institute, School of Medicine, University of California Davis Health, Sacramento, CA 95817, USA; (A.J.T.); (A.D.); (L.A.)
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, CA 95817, USA
| | - Audra Sterling
- Waisman Center, Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI 53706, USA;
| | - Sara T. Kover
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA 98195, USA;
| | - Lizabeth Finestack
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Jamie O. Edgin
- Department of Psychology and Sonoran UCEDD, College of Science, The University of Arizona, Tucson, AZ 85721, USA;
| | - Andrea Drayton
- MIND Institute, School of Medicine, University of California Davis Health, Sacramento, CA 95817, USA; (A.J.T.); (A.D.); (L.A.)
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, CA 95817, USA
| | - Eric Fombonne
- Departments of Psychiatry and Pediatrics, School of Medicine, Oregon Health and Science University, Portland, OR 97239, USA;
| | - Leonard Abbeduto
- MIND Institute, School of Medicine, University of California Davis Health, Sacramento, CA 95817, USA; (A.J.T.); (A.D.); (L.A.)
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, CA 95817, USA
| |
Collapse
|
5
|
Diez-Itza E, Viejo A, Fernández-Urquiza M. Pragmatic Profiles of Adults with Fragile X Syndrome and Williams Syndrome. Brain Sci 2022; 12:brainsci12030385. [PMID: 35326341 PMCID: PMC8946534 DOI: 10.3390/brainsci12030385] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 02/01/2023] Open
Abstract
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.
Collapse
|
6
|
Shaffer R, Thurman AJ, Ronco L, Cadavid D, Raines S, Kim SH. Social communication in fragile X syndrome: pilot examination of the Brief Observation of Social Communication Change (BOSCC). J Neurodev Disord 2022; 14:4. [PMID: 35034602 PMCID: PMC8903546 DOI: 10.1186/s11689-021-09411-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 12/08/2021] [Indexed: 12/17/2022] Open
Abstract
Background Social communication is a key area of difficulty in fragile X syndrome (FXS) and there are not yet adequate outcome measurement tools. Appropriate outcome measures for FXS have been identified as a key area of research interest in order to evaluate future therapeutic trials. The Brief Observation of Social Communication Change-Minimally Verbal (BOSCC-MV), an outcome measure with strong psychometrics developed for autism spectrum disorder, has promise as an outcome measure to assess social communication change with FXS participants. Methods We examined the BOSCC-MV via central coders in this multi-site-trial to assess its appropriateness for FXS. Eighteen minimally verbal males ages 3–12 years were enrolled and assessed on two consecutive days and 7 participants completed a third visit 6 months later. We examined test-retest reliability, inter-rater reliability, and both convergent and divergent validity with standard clinical measures including the Autism Diagnostic and Observation Schedule-2, Vineland 3, Social Responsiveness Scale, and the Aberrant Behavior Checklist. Results The BOSCC-MV in FXS demonstrated strong inter-rater and test-retest reliability, comparable to previous trials in idiopathic ASD. Strong convergent validity was found with Autism Diagnostic Observation Schedule-2 and Vineland-3. Divergent validity was demonstrated between BOSCC-MV and unrelated measures. Conclusions The BOSCC-MV shows promise as a FXS social communication outcome measure, warranting further large-scale evaluation.
Collapse
Affiliation(s)
- Rebecca Shaffer
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, 3333 Burnet Avenue, MLC 4002, Cincinnati, OH, 45229, USA.
| | - Angela John Thurman
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health, MIND Institute, University of California Davis Health, Sacramento, CA, USA
| | - Lucienne Ronco
- Fulcrum Therapeutics, Cambridge, MA, USA.,Deep Genomics Therapeutics, Toronto, ON, Canada
| | - Diego Cadavid
- Fulcrum Therapeutics, Cambridge, MA, USA.,University of Massachusetts Medical School, Worcester, MA, USA
| | | | - So Hyun Kim
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
7
|
Luyster RJ, Zane E, Wisman Weil L. Conventions for unconventional language: Revisiting a framework for spoken language features in autism. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2022; 7:23969415221105472. [PMID: 36382068 PMCID: PMC9620674 DOI: 10.1177/23969415221105472] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
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.
Collapse
Affiliation(s)
- Rhiannon J Luyster
- Rhiannon J Luyster, Communication Sciences
and Disorders, Emerson College, 120 Boylston St, Boston, MA 02216, USA.
| | - Emily Zane
- Communication Sciences and Disorders, James Madison
University, Harrisonburg, VA, USA
| | - Lisa Wisman Weil
- Communication Sciences and Disorders, Emerson College, Boston, MA, USA
| |
Collapse
|
8
|
Jiang A, Wang L, Lu JYD, Freeman A, Campbell C, Su P, Wong AHC, Liu F. Sex Differences in Dopamine Receptor Signaling in Fmr1 Knockout Mice: A Pilot Study. Brain Sci 2021; 11:brainsci11111398. [PMID: 34827397 PMCID: PMC8615700 DOI: 10.3390/brainsci11111398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 12/02/2022] Open
Abstract
Fragile X syndrome (FXS) is an X-chromosome-linked dominant genetic disorder that causes a variable degree of cognitive dysfunction and developmental disability. Current treatment is symptomatic and no existing medications target the specific cause of FXS. As with other X-linked disorders, FXS manifests differently in males and females, including abnormalities in the dopamine system that are also seen in Fmr1-knockout (KO) mice. We investigated sex differences in dopamine signaling in Fmr1-KO mice in response to L-stepholidine, a dopamine D1 receptor agonist and D2 receptor antagonist. We found significant sex differences in basal levels of phosphorylated protein kinase A (p-PKA) and glycogen synthase kinase (GSK)-3β in wild type mice that were absent in Fmr1-KO mice. In wild-type mice, L-stepholidine increased p-PKA in males but not female mice, decreased p-GSK-3 in female mice and increased p-GSK-3 in male mice. Conversely, in Fmr1-KO mice, L-stepholidine increased p-PKA and p-GSK-3β in females, and decreased p-PKA and p-GSK-3β in males.
Collapse
Affiliation(s)
- Anlong Jiang
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada; (A.J.); (L.W.); (J.Y.D.L.); (A.F.); (C.C.); (P.S.); (A.H.C.W.)
| | - Le Wang
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada; (A.J.); (L.W.); (J.Y.D.L.); (A.F.); (C.C.); (P.S.); (A.H.C.W.)
| | - Justin Y. D. Lu
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada; (A.J.); (L.W.); (J.Y.D.L.); (A.F.); (C.C.); (P.S.); (A.H.C.W.)
| | - Amy Freeman
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada; (A.J.); (L.W.); (J.Y.D.L.); (A.F.); (C.C.); (P.S.); (A.H.C.W.)
| | - Charlie Campbell
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada; (A.J.); (L.W.); (J.Y.D.L.); (A.F.); (C.C.); (P.S.); (A.H.C.W.)
| | - Ping Su
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada; (A.J.); (L.W.); (J.Y.D.L.); (A.F.); (C.C.); (P.S.); (A.H.C.W.)
| | - Albert H. C. Wong
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada; (A.J.); (L.W.); (J.Y.D.L.); (A.F.); (C.C.); (P.S.); (A.H.C.W.)
- Department of Pharmacology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Fang Liu
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada; (A.J.); (L.W.); (J.Y.D.L.); (A.F.); (C.C.); (P.S.); (A.H.C.W.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Department of Physiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Correspondence:
| |
Collapse
|
9
|
Bush L, Martin GE, Landau E, Losh M. A Longitudinal Study of Parent-Child Interactions and Language Outcomes in Fragile X Syndrome and Other Neurodevelopmental Disorders. Front Psychiatry 2021; 12:718572. [PMID: 34819882 PMCID: PMC8606641 DOI: 10.3389/fpsyt.2021.718572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022] Open
Abstract
Difficulties with pragmatic language (i.e., language in social contexts, such as conversational ability) are a noted characteristic of the language profiles of both fragile X syndrome (FXS) and autism spectrum disorder (ASD), conditions which show significant phenotypic overlap. Understanding the origins and developmental course of pragmatic language problems in FXS and other developmental conditions associated with language impairment is a critical step for the development of targeted interventions to promote communicative competence across the lifespan. This study examined pragmatic language in the context of parent-child interactions in school-age children with FXS (who did and did not meet ASD criteria on the ADOS; n = 85), idiopathic ASD (n = 32), Down syndrome (DS; n = 38), and typical development (TD; n = 39), and their parents. Parent-child communicative interactions were examined across multiple contexts, across groups, and in relationship to pragmatic language outcomes assessed 2 years later. Results showed both overlapping and divergent patterns across the FXS-ASD and idiopathic ASD child and parent groups, and also highlighted key differences in pragmatic profiles based on situational context, with more pragmatic language difficulties occurring for both ASD groups in less structured interactions. Differences in parental language styles during parent-child interactions were associated with child language outcomes, likely reflecting the complex interplay of discourse style inherent to a parent, with the inevitable influence of child characteristics on parent language as well. Together, findings help delineate the dynamic and multifactorial nature of impaired pragmatic skills among children with FXS and other neurodevelopmental disorders associated with language impairment, with potential implications for the development of targeted interventions for pragmatic communication skills.
Collapse
Affiliation(s)
- Lauren Bush
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States.,Department of Psychiatry and Behavioral Sciences, Autism Assessment, Research, Treatment, and Services Center, Rush University Medical Center, Chicago, IL, United States
| | - Gary E Martin
- Department of Communication Sciences and Disorders, St. John's University, Staten Island, NY, United States
| | - Emily Landau
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Molly Losh
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| |
Collapse
|
10
|
Friedman L, Lorang E, Hilvert E, Sterling A. "Are We Done Yet?" Question-Asking in Boys With Fragile X Syndrome and Idiopathic Autism Spectrum Disorder. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1822-1834. [PMID: 32421422 PMCID: PMC7839035 DOI: 10.1044/2020_jslhr-19-00139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 12/19/2019] [Accepted: 02/14/2020] [Indexed: 06/11/2023]
Abstract
Purpose Question-asking serves as a tool to learn new information and is important in both academic and social settings. Boys with idiopathic autism spectrum disorder (ASD) and boys with fragile X syndrome and comorbid ASD (FXS + ASD) have similar social communication deficits, which may have downstream effects on their question-asking ability. This study examined question-asking in school-age boys with idiopathic ASD and FXS + ASD, including the role of ASD severity, expressive grammatical complexity (measured by mean length of utterance [MLU]), and IQ. Method Twenty-five boys with FXS + ASD and 21 boys with idiopathic ASD (ages 9-16 years) were included in this study. Autism Diagnostic Observation Schedule assessments were transcribed and coded for the frequency, function, and appropriateness of spontaneous questions asked. We examined group differences in these aspects of question-asking and relationships between question-asking and ASD severity, MLU, and IQ within each group. Results Boys with FXS + ASD asked more questions than boys with idiopathic ASD, although boys with idiopathic ASD asked a higher proportion of appropriate questions. Boys with idiopathic ASD also asked the examiner more personal questions than the boys with FXS + ASD. ASD severity and MLU were related to the proportion of clarification questions in FXS + ASD, and ASD severity was also related to the proportion of personal questions in this group. For the boys with idiopathic ASD, ASD severity was related to the total number of questions asked. Conclusions Our findings highlight similarities and differences between boys with FXS + ASD and idiopathic ASD in their spontaneous question production and indicate that ASD severity and grammatical language are differentially important for question-asking. This study has implications for targeted treatment in question-asking skills for boys with FXS + ASD and ASD.
Collapse
Affiliation(s)
- Laura Friedman
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Waisman Center, University of Wisconsin–Madison
| | - Emily Lorang
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Waisman Center, University of Wisconsin–Madison
| | | | - Audra Sterling
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Waisman Center, University of Wisconsin–Madison
| |
Collapse
|
11
|
Abbeduto L, Berry-Kravis E, Sterling A, Sherman S, Edgin JO, McDuffie A, Hoffmann A, Hamilton D, Nelson M, Aschkenasy J, Thurman AJ. Expressive language sampling as a source of outcome measures for treatment studies in fragile X syndrome: feasibility, practice effects, test-retest reliability, and construct validity. J Neurodev Disord 2020; 12:10. [PMID: 32204695 PMCID: PMC7092603 DOI: 10.1186/s11689-020-09313-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/06/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The evaluation of treatment efficacy for individuals with fragile X syndrome (FXS) or intellectual disability (ID) more generally has been hampered by the lack of adequate outcome measures. We evaluated expressive language sampling (ELS) as a procedure for generating outcome measures for treatment research in FXS. We addressed: (a) feasibility, (b) practice effects over two administrations, (c) test-retest reliability over the repeated administrations, and (d) construct validity. We addressed these issues for the full sample as well as for subgroups defined by age, IQ, and ASD status. METHODS Participants were 106 individuals with FXS between ages 6 and 23 years who had IQs within the range of intellectual disability (IQ < 70). ELS procedures for collecting samples in conversation and narration were followed and analyzed separately. Five measures were derived from transcripts segmented into C-units (i.e., an independent clause and its modifiers): number of C-units per minute (talkativeness), number of different word roots (vocabulary), C-unit length in morphemes (syntax), percentage of C-units containing dysfluency (utterance planning), and percentage of C-units that were fully or partly unintelligible (articulatory quality). ELS procedures were administered twice at 4-week intervals for each participant. Standardized tests and informant reports were administered and provided measures for evaluating construct validity of ELS measures. RESULTS We found low rates of noncompliance, suggesting the task can be completed meaningfully by most individuals with FXS, although noncompliance was higher for younger, lower IQ, and more autistic participants. Minimal practice effects and strong test-retest reliability over the 4-week interval were observed for the full sample and across the range of ages, IQs, and autism symptom severity. Evidence of convergent construct validity was observed for the measures of vocabulary, syntax, and unintelligibility for the full sample and across the range of IQ and autism symptom severity, but not for participants under age 12. Conversation and narration yielded largely similar results in all analyses. CONCLUSIONS The findings suggest that the ELS procedures are feasible and yield measures with adequate psychometric properties for a majority of 6 to 23 years with FXS who have ID. The procedures work equally well regardless of level of ID or degree of ASD severity. The procedures, however, are more challenging and have somewhat less adequate psychometric properties for individuals with FXS under age 12.
Collapse
Affiliation(s)
- Leonard Abbeduto
- UC Davis MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California, 2825 50th St. Davis, Sacramento, CA, 95817, USA.
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences and Biochemistry, Rush University Medical Center, Chicago, USA
| | - Audra Sterling
- Waisman Center and Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, USA
| | | | - Jamie O Edgin
- Department of Psychology, University of Arizona, Tucson, USA
| | - Andrea McDuffie
- UC Davis MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California, 2825 50th St. Davis, Sacramento, CA, 95817, USA
| | - Anne Hoffmann
- Departments of Pediatrics, Neurological Sciences and Biochemistry, Rush University Medical Center, Chicago, USA
| | - Debra Hamilton
- Department of Human Genetics, Emory University, Atlanta, USA
| | - Michael Nelson
- Departments of Pediatrics, Neurological Sciences and Biochemistry, Rush University Medical Center, Chicago, USA
| | - Jeannie Aschkenasy
- Departments of Pediatrics, Neurological Sciences and Biochemistry, Rush University Medical Center, Chicago, USA
| | - Angela John Thurman
- UC Davis MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California, 2825 50th St. Davis, Sacramento, CA, 95817, USA
| |
Collapse
|
12
|
Shaffer RC, Schmitt L, John Thurman A, Abbeduto L, Hong M, Pedapati E, Dominick K, Sweeney J, Erickson C. The Relationship between Expressive Language Sampling and Clinical Measures in Fragile X Syndrome and Typical Development. Brain Sci 2020; 10:E66. [PMID: 31991905 PMCID: PMC7071383 DOI: 10.3390/brainsci10020066] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 11/24/2022] Open
Abstract
Language impairment is a core difficulty in fragile X syndrome (FXS), and yet standardized measures lack the sensitivity to assess developmental changes in the nature of these impairments. Expressive Language Sampling Narrative (ELS-N) has emerged as a promising new measure with research demonstrating its usefulness in a wide range of ages in developmental disabilities and typical development. We examined ELS-N results in FXS and age-matched typically developing (TD) controls along with cognitive, adaptive, and clinical measures. We found the groups differed significantly on all ELS-N variables. Cognitive abilities were related to lexical diversity, syntactic complexity, and unintelligibility for the FXS group, but only verbal abilities were related to syntactic complexity in TD. Autism spectrum disorder (ASD) symptomatology was related to less intelligibility in speech. Measures of hyperactivity were related to increased talkativeness and unintelligibility. In addition, FXS males in comparison to FXS females were more impaired in cognitive ability, ASD symptoms, hyperactivity, and anxiety. This study extends the previous ELS research, supporting its use in FXS research as a measure to characterize language abilities. It also demonstrates the relationships between ELS-N variables and measures of cognitive, adaptive, ASD symptoms, and clinical symptoms.
Collapse
Affiliation(s)
- Rebecca C. Shaffer
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (L.S.); (E.P.); (K.D.); (C.E.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - Lauren Schmitt
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (L.S.); (E.P.); (K.D.); (C.E.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - Angela John Thurman
- MIND Institute, University of California Davis, Sacramento, CA 95817, USA; (A.J.T.); (L.A.)
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, CA 95817, USA
| | - Leonard Abbeduto
- MIND Institute, University of California Davis, Sacramento, CA 95817, USA; (A.J.T.); (L.A.)
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, CA 95817, USA
| | - Michael Hong
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - Ernest Pedapati
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (L.S.); (E.P.); (K.D.); (C.E.)
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - Kelli Dominick
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (L.S.); (E.P.); (K.D.); (C.E.)
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - John Sweeney
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - Craig Erickson
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (L.S.); (E.P.); (K.D.); (C.E.)
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| |
Collapse
|
13
|
Hilvert E. Expressive language abilities of boys with idiopathic autism spectrum disorder and boys with fragile X syndrome + autism spectrum disorder: Cross-context comparisons. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2020; 5:2396941520912118. [PMID: 36381548 PMCID: PMC9620452 DOI: 10.1177/2396941520912118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIMS Understanding the unique expressive language profiles of children with phenotypically similar, but distinct neurodevelopmental disorders, such as idiopathic autism spectrum disorder and fragile X syndrome with a co-diagnosis of autism spectrum disorder (fragile X syndrome + autism spectrum disorder), has both clinical and theoretical implications. However, comparative studies of these two clinical groups have been limited, and results have been inconsistent, partially as a result of different assessment methods being utilized. Thus, the current study compared the expressive language profiles of boys with idiopathic autism spectrum disorder and boys with fragile X syndrome + autism spectrum disorder and examined whether a similar linguistic profile emerged across different language sampling contexts: a semi-structured conversation and the Autism Diagnostic Observation Schedule. METHODS Eighteen boys with autism spectrum disorder (Mage = 13.25 years) and 19 boys with fragile X syndrome + autism spectrum disorder (Mage = 12.19 years), matched on autism spectrum disorder symptom severity and similar in terms of chronological age and mean length of utterance, participated in this study. Boys produced two language samples: one semi-structured conversation and one taken from the Autism Diagnostic Observation Schedule. Language samples were coded for talkativeness, lexical diversity, mean length of utterance, intelligibility, and repetitive or perseverative language. RESULTS Analyses revealed that boys with autism spectrum disorder produced language samples that were more lexically diverse and intelligible, and that included less topic perseveration compared to boys with fragile X syndrome + autism spectrum disorder. With regards to sampling context, boys in both groups were more talkative and produced longer and more intelligible utterances in their conversation sample compared to their Autism Diagnostic Observation Schedule sample. However, boys with autism spectrum disorder and fragile X syndrome + autism spectrum disorder used a higher proportion of topic perseveration during the conversation sample. CONCLUSIONS Overall, we found similarities as well as distinctions in the expressive language profiles of boys with fragile X syndrome + autism spectrum disorder and boys with idiopathic autism spectrum disorder. Moreover, the Autism Diagnostic Observation Schedule sample elicited a relatively different language profile than the conversation sample for boys in both groups. IMPLICATIONS These findings help to further elucidate the unique language phenotypes of boys with idiopathic autism spectrum disorder and boys with fragile X syndrome + autism spectrum disorder. Moreover, our findings indicate that multiple language samples may be needed to obtain a comprehensive account of a child's expressive language ability.
Collapse
Affiliation(s)
- Elizabeth Hilvert
- Elizabeth Hilvert, University of Wisconsin
Madison, 1500 Highland Ave, Madison, WI 53705, USA.
| |
Collapse
|
14
|
Kover ST, Abbeduto L. Syntactic Ability of Girls With Fragile X Syndrome: Phonological Memory and Discourse Demands on Complex Sentence Use. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 124:511-534. [PMID: 31756147 PMCID: PMC6876634 DOI: 10.1352/1944-7558-124.6.511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
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.
Collapse
Affiliation(s)
- Sara T Kover
- Sara T. Kover, University of Washington; and Leonard Abbeduto, University of California, Davis
| | - Leonard Abbeduto
- Sara T. Kover, University of Washington; and Leonard Abbeduto, University of California, Davis
| |
Collapse
|
15
|
Abbeduto L, Thurman AJ, McDuffie A, Klusek J, Feigles RT, Ted Brown W, Harvey DJ, Adayev T, LaFauci G, Dobkins C, Roberts JE. ASD Comorbidity in Fragile X Syndrome: Symptom Profile and Predictors of Symptom Severity in Adolescent and Young Adult Males. J Autism Dev Disord 2019; 49:960-977. [PMID: 30382442 DOI: 10.1007/s10803-018-3796-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Many males with FXS meet criteria for ASD. This study was designed to (1) describe ASD symptoms in adolescent and young adult males with FXS (n = 44) and (2) evaluate the contributions to ASD severity of cognitive, language, and psychiatric factors, as well as FMRP (the protein deficient in FXS). A few ASD symptoms on the ADOS-2 were universal in the sample. There was less impairment in restricted and repetitive behaviors (RRB) than in the social affective (SA) domain. The best predictor of overall ASD severity and SA severity was expressive syntactic ability. RRB severity was best predicted by the psychiatric factors. Implications for clinical practice and for understanding the ASD comorbidity in FXS are discussed.
Collapse
Affiliation(s)
- Leonard Abbeduto
- University of California, Davis, USA. .,UC Davis MIND Institute, 2825 50th St, Sacramento, CA, 95817, USA.
| | | | | | | | | | - W Ted Brown
- New York State Institute for Basic Research in Developmental Disabilities, New York, USA
| | | | - Tatyana Adayev
- New York State Institute for Basic Research in Developmental Disabilities, New York, USA
| | - Giuseppe LaFauci
- New York State Institute for Basic Research in Developmental Disabilities, New York, USA
| | - Carl Dobkins
- New York State Institute for Basic Research in Developmental Disabilities, New York, USA
| | | |
Collapse
|
16
|
Martin GE, Bush L, Klusek J, Patel S, Losh M. A Multimethod Analysis of Pragmatic Skills in Children and Adolescents With Fragile X Syndrome, Autism Spectrum Disorder, and Down Syndrome. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:3023-3037. [PMID: 30418476 PMCID: PMC6440309 DOI: 10.1044/2018_jslhr-l-18-0008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/26/2018] [Accepted: 07/16/2018] [Indexed: 05/19/2023]
Abstract
PURPOSE Pragmatic language skills are often impaired above and beyond general language delays in individuals with neurodevelopmental disabilities. This study used a multimethod approach to language sample analysis to characterize syndrome- and sex-specific profiles across different neurodevelopmental disabilities and to examine the congruency of 2 analysis techniques. METHOD Pragmatic skills of young males and females with fragile X syndrome with autism spectrum disorder (FXS-ASD, n = 61) and without autism spectrum disorder (FXS-O, n = 40), Down syndrome (DS, n = 42), and typical development (TD, n = 37) and males with idiopathic autism spectrum disorder only (ASD-O, n = 29) were compared using variables obtained from a detailed hand-coding system contrasted with similar variables obtained automatically from the language analysis program Systematic Analysis of Language Transcripts (SALT). RESULTS Noncontingent language and perseveration were characteristic of the pragmatic profiles of boys and girls with FXS-ASD and boys with ASD-O. Boys with ASD-O also initiated turns less often and were more nonresponsive than other groups, and girls with FXS-ASD were more nonresponsive than their male counterparts. Hand-coding and SALT methods were largely convergent with some exceptions. CONCLUSION Results suggest both similarities and differences in the pragmatic profiles observed across different neurodevelopmental disabilities, including idiopathic and FXS-associated cases of ASD, as well as an important sex difference in FXS-ASD. These findings and congruency between the 2 language sample analysis techniques together have important implications for assessment and intervention efforts.
Collapse
Affiliation(s)
- Gary E. Martin
- Department of Communication Sciences and Disorders, St. John's University, Staten Island, NY
| | - Lauren Bush
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Jessica Klusek
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Shivani Patel
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Molly Losh
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| |
Collapse
|
17
|
|
18
|
Dahlhaus R. Of Men and Mice: Modeling the Fragile X Syndrome. Front Mol Neurosci 2018; 11:41. [PMID: 29599705 PMCID: PMC5862809 DOI: 10.3389/fnmol.2018.00041] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/31/2018] [Indexed: 12/26/2022] Open
Abstract
The Fragile X Syndrome (FXS) is one of the most common forms of inherited intellectual disability in all human societies. Caused by the transcriptional silencing of a single gene, the fragile x mental retardation gene FMR1, FXS is characterized by a variety of symptoms, which range from mental disabilities to autism and epilepsy. More than 20 years ago, a first animal model was described, the Fmr1 knock-out mouse. Several other models have been developed since then, including conditional knock-out mice, knock-out rats, a zebrafish and a drosophila model. Using these model systems, various targets for potential pharmaceutical treatments have been identified and many treatments have been shown to be efficient in preclinical studies. However, all attempts to turn these findings into a therapy for patients have failed thus far. In this review, I will discuss underlying difficulties and address potential alternatives for our future research.
Collapse
Affiliation(s)
- Regina Dahlhaus
- Institute for Biochemistry, Emil-Fischer Centre, University of Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
19
|
Channell MM, Loveall SJ, Conners FA, Harvey DJ, Abbeduto L. Narrative Language Sampling in Typical Development: Implications for Clinical Trials. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:123-135. [PMID: 29222570 PMCID: PMC6105083 DOI: 10.1044/2017_ajslp-17-0046] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/29/2017] [Accepted: 09/05/2017] [Indexed: 05/20/2023]
Abstract
PURPOSE This study examined cross-sectional age-related trajectories of expressive language variables (syntactic complexity, lexical diversity, unintelligibility, dysfluency, and talkativeness) derived from a narrative language sampling procedure. METHOD Narrative samples were analyzed from 103 typically developing individuals, ages 4-21 years. RESULTS Results showed that this procedure was effective for the entire age range, with participants producing an utterance on virtually every page of the wordless picture books used to prompt the narrative. Importantly, the cross-sectional trajectories for syntactic complexity and lexical diversity showed age-related increases through the age of 18 years, although measures of other dimensions of language showed different relationships with age. CONCLUSIONS These data inform developmental work and document the extent to which the narrative procedure can be used to characterize expressive language over a wide age range. This procedure has been proposed as an outcome measure for clinical trials and interventions involving individuals with intellectual and developmental disabilities. The present data document the developmental levels for which the procedure and metrics derived are appropriate.
Collapse
|
20
|
Martin GE, Barstein J, Hornickel J, Matherly S, Durante G, Losh M. Signaling of noncomprehension in communication breakdowns in fragile X syndrome, Down syndrome, and autism spectrum disorder. JOURNAL OF COMMUNICATION DISORDERS 2017; 65:22-34. [PMID: 28161297 PMCID: PMC5340195 DOI: 10.1016/j.jcomdis.2017.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 01/13/2017] [Accepted: 01/19/2017] [Indexed: 05/15/2023]
Abstract
UNLABELLED The ability to indicate a failure to understand a message is a critical pragmatic (social) language skill for managing communication breakdowns and supporting successful communicative exchanges. The current study examined the ability to signal noncomprehension across different types of confusing message conditions in children and adolescents with fragile X syndrome (FXS), Down syndrome (DS), autism spectrum disorder (ASD), and typical development (TD). Controlling for nonverbal mental age and receptive vocabulary skills, youth with comorbid FXS and ASD and those with DS were less likely than TD controls to signal noncomprehension of confusing messages. Youth with FXS without ASD and those with idiopathic ASD did not differ from controls. No sex differences were detected in any group. Findings contribute to current knowledge of pragmatic profiles in different forms of genetically-based neurodevelopmental disorders associated with intellectual disability, and the role of sex in the expression of such profiles. LEARNING OUTCOMES Upon completion of this article, readers will have learned about: (1) the social-communicative profiles of youth with FXS, DS, and ASD, (2) the importance of signaling noncomprehension in response to a confusing message, and (3) the similarities and differences in noncomprehension signaling in youth with FXS (with and without ASD), DS, idiopathic ASD, and TD.
Collapse
Affiliation(s)
- Gary E Martin
- Department of Communication Sciences and Disorders, St. John's University, Staten Island, NY, USA.
| | - Jamie Barstein
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | - Jane Hornickel
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | - Sara Matherly
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Genna Durante
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Molly Losh
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| |
Collapse
|
21
|
Stasolla F, Damiani R, Perilli V, Di Leone A, Albano V, Stella A, Damato C. Technological supports to promote choice opportunities by two children with fragile X syndrome and severe to profound developmental disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:2993-3000. [PMID: 25118066 DOI: 10.1016/j.ridd.2014.07.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/22/2014] [Indexed: 06/03/2023]
Abstract
This study was aimed at assessing whether technological supports (i.e. optic sensors such as photocells) were successful enabling two boys with fragile X syndrome and severe to profound developmental disabilities to perform occupation and choice opportunities. A second goal of the study was to reduce stereotyped behaviours (i.e. hand mouthing and eye poking) exhibited by the participants. Finally, the third purpose of the study was to verify the rehabilitative effects of the intervention program on the indices of happiness of the participants. The study has been conducted according to a non-concurrent multiple baseline design across participants followed by intervention and cross over phases, where the associations between behavioural responses and environmental consequences were systematically inverted. Moreover, a maintenance phase was assessed. The results demonstrated that the technology is useful to facilitate employment and opportunities of choice, showing a growth of the indices of happiness and a decrease of stereotyped behaviours, from both participants involved. Clinical, practical and psychological implications of the findings are discussed.
Collapse
Affiliation(s)
| | - Rita Damiani
- Department of Educational Sciences, Psychology, Communication, University of Bari, Italy
| | | | - Antonia Di Leone
- Department of Educational Sciences, Psychology, Communication, University of Bari, Italy
| | - Vincenza Albano
- Department of Educational Sciences, Psychology, Communication, University of Bari, Italy
| | - Anna Stella
- Department of Educational Sciences, Psychology, Communication, University of Bari, Italy
| | - Concetta Damato
- Department of Educational Sciences, Psychology, Communication, University of Bari, Italy
| |
Collapse
|
22
|
Oakes A, Kover ST, Abbeduto L. Language comprehension profiles of young adolescents with fragile X syndrome. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2013; 22:615-26. [PMID: 23813199 PMCID: PMC3950769 DOI: 10.1044/1058-0360(2013/12-0109)] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
PURPOSE In this study, the authors sought to characterize the language phenotype of fragile X syndrome (FXS), focusing on the extent of impairment in receptive syntax, within-syndrome variability in those impairments in relation to gender, and the syndrome specificity of those impairments. METHOD The Test for Reception of Grammar, Version 2 ( Bishop, 2003), was used to examine the overall receptive syntactic skills of adolescents with FXS ( n = 35; 30 males, 5 females), adolescents with Down syndrome (DS; n = 28; 18 males, 10 females), and younger typically developing (TD) children ( n = 23; 14 males, 9 females) matched on nonverbal cognition. Performance on specific grammatical constructions and error types was examined for a subset of matched participants. RESULTS Participants with FXS had overall receptive syntax scores that were lower than those of the TD participants but higher than those of the participants with DS; however, there was no difference in performance between the FXS and DS groups when females were excluded. Grammatical constructions that were especially difficult for participants with FXS and those with DS were identified, especially relative clause constructions and reversible constructions requiring attention to word order encoded by syntactic features. CONCLUSION The current findings have implications for understanding the nature of the language learning difficulties of individuals with FXS and for language interventions.
Collapse
|
23
|
van Santen JPH, Sproat RW, Hill AP. Quantifying repetitive speech in autism spectrum disorders and language impairment. Autism Res 2013; 6:372-83. [PMID: 23661504 DOI: 10.1002/aur.1301] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 04/12/2013] [Indexed: 11/06/2022]
Abstract
We report on an automatic technique for quantifying two types of repetitive speech: repetitions of what the child says him/herself (self-repeats) and of what is uttered by an interlocutor (echolalia). We apply this technique to a sample of 111 children between the ages of four and eight: 42 typically developing children (TD), 19 children with specific language impairment (SLI), 25 children with autism spectrum disorders (ASD) plus language impairment (ALI), and 25 children with ASD with normal, non-impaired language (ALN). The results indicate robust differences in echolalia between the TD and ASD groups as a whole (ALN + ALI), and between TD and ALN children. There were no significant differences between ALI and SLI children for echolalia or self-repetitions. The results confirm previous findings that children with ASD repeat the language of others more than other populations of children. On the other hand, self-repetition does not appear to be significantly more frequent in ASD, nor does it matter whether the child's echolalia occurred within one (immediate) or two turns (near-immediate) of the adult's original utterance. Furthermore, non-significant differences between ALN and SLI, between TD and SLI, and between ALI and TD are suggestive that echolalia may not be specific to ALN or to ASD in general. One important innovation of this work is an objective fully automatic technique for assessing the amount of repetition in a transcript of a child's utterances.
Collapse
Affiliation(s)
- Jan P H van Santen
- Center for Spoken Language Understanding, Oregon Health & Science University, Beaverton, Oregon
| | | | | |
Collapse
|
24
|
Sterling A, Abbeduto L. Language development in school-age girls with fragile X syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:974-83. [PMID: 22676254 PMCID: PMC3627376 DOI: 10.1111/j.1365-2788.2012.01578.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Girls with fragile X syndrome (FXS) have a wide range of cognitive and language abilities. The range of language outcomes experienced by girls with FXS, however, has been relatively unexplored. The purpose of this exploratory study was to examine receptive and expressive language, with a focus on vocabulary and syntax, in a group of school-age girls with FXS. METHOD Twenty-one girls with FXS aged 7-15 years participated in the study. The girls completed a receptive vocabulary test, non-verbal IQ test and an expressive language sample. RESULTS The mean IQ for this group of girls was at the cut-off for intellectual disability. Vocabulary was an area of strength relative to non-verbal cognition. Age and non-verbal IQ were significant predictors of vocabulary performance. CONCLUSIONS The data suggest that a substantial portion of the sample would qualify for speech and language services. This study highlights the need for continued research in the area of language and cognitive development in girls with the full mutation of fragile X.
Collapse
Affiliation(s)
- A Sterling
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705-2280, USA.
| | | |
Collapse
|
25
|
Martin GE, Roberts JE, Helm-Estabrooks N, Sideris J, Vanderbilt J, Moskowitz L. Perseveration in the connected speech of boys with Fragile X syndrome with and without autism spectrum disorder. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2012; 117:384-99. [PMID: 22998486 PMCID: PMC3494464 DOI: 10.1352/1944-7558-117.5.384] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
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.
Collapse
|
26
|
Pierpont EI, Richmond EK, Abbeduto L, Kover ST, Brown WT. Contributions of phonological and verbal working memory to language development in adolescents with fragile X syndrome. J Neurodev Disord 2011; 3:335-47. [PMID: 21993552 PMCID: PMC3261261 DOI: 10.1007/s11689-011-9095-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 09/27/2011] [Indexed: 11/30/2022] Open
Abstract
Fragile X syndrome (FXS) is the most common inherited cause of intellectual disability. Although language delays are frequently observed in FXS, neither the longitudinal course of language development nor its cognitive predictors are well understood. The present study investigated whether phonological and working memory skills are predictive of growth in vocabulary and syntax in individuals with FXS during adolescence. Forty-four individuals with FXS (mean age = 12.61 years) completed assessments of phonological memory (nonword repetition and forward digit recall), verbal working memory (backward digit recall), vocabulary, syntax, and nonverbal cognition. Vocabulary and syntax skills were reassessed at a 2-year follow-up. In a series of analyses that controlled for nonverbal cognitive ability and severity of autism symptoms, the relative contributions of phonological and working memory to language change over time were investigated. These relationships were examined separately for boys and girls. In boys with FXS, phonological memory significantly predicted gains in vocabulary and syntax skills. Further, verbal working memory was uniquely associated with vocabulary gains among boys. In girls with FXS, phonological and working memory skills showed no relationship with language change across the 2-year time period. Our findings indicate that, for adolescent boys with FXS, acquisition of vocabulary and syntax may be constrained by the ability to maintain and manipulate phonological representations online. Implications for the identification and treatment of language disorders in this population are discussed. The present study is the first to identify specific cognitive mechanisms contributing to language growth over time in individuals with FXS.
Collapse
Affiliation(s)
- Elizabeth I Pierpont
- Department of Psychology, University of Wisconsin-Madison, 1202 W. Johnson Street, Madison, WI, 53706, USA,
| | | | | | | | | |
Collapse
|
27
|
McDuffie A, Abbeduto L, Lewis P, Kover S, Kim JS, Weber A, Brown WT. Autism spectrum disorder in children and adolescents with fragile X syndrome: within-syndrome differences and age-related changes. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2010; 115:307-26. [PMID: 20567604 PMCID: PMC2887668 DOI: 10.1352/1944-7558-115.4.307] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The Autism Diagnostic Interview-Revised (ADI-R) was used to examine diagnostic profiles and age-related changes in autism symptoms for a group of verbal children and adolescents who had fragile X syndrome, with and without autism. After controlling for nonverbal IQ, we found statistically significant between-group differences for lifetime and current autism symptoms for the Communication and Restricted Interests/Repetitive Behaviors domains, but not the Reciprocal Social Interaction domain. Effect sizes for differences in Reciprocal Social Interaction also were smaller than effect sizes for the other domains, with one exception. Overall, severity of autism symptoms improved with age for all participants, with the least improvement noted for Restricted Interests and Repetitive Behaviors. FMRP did not account for unique variance in autism symptoms over and above nonverbal IQ.
Collapse
Affiliation(s)
- Andrea McDuffie
- University of Wisconsin, Waisman Center, Madison, WI 53705, USA.
| | | | | | | | | | | | | |
Collapse
|
28
|
Stribling P, Rae J, Dickerson P. Using conversation analysis to explore the recurrence of a topic in the talk of a boy with an autism spectrum disorder. CLINICAL LINGUISTICS & PHONETICS 2009; 23:555-582. [PMID: 19669991 DOI: 10.1080/02699200802491165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Some higher functioning individuals with autism spectrum disorders (ASDs) are reported to produce perseverative talk, especially around 'special interests'. Topic perseveration is a form of pragmatic impairment captured in Prizant and Rydell's (1993) continuum of unconventional verbal behaviour in autism. Although widely reported, there is little systematic empirical research into this phenomenon. This paper considers the utility of Conversation Analysis in developing knowledge in this area, drawing upon data involving a boy with an ASD interacting with a researcher and a mobile robot platform. Although a frequency analysis of the boy's talk on a single topic may suggest that it is perseverative in nature, in a sequential analysis of both talk and non-spoken activities this study aims to show how these may be interactionally-embedded. It is suggested that, in considering the interactional salience of apparently perseverative talk, it can be useful to explore the participation framework in which the topic is revisited.
Collapse
Affiliation(s)
- Penny Stribling
- Centre for Research into Cognition, Emotion & Interaction, School of Human & Life Sciences, Roehampton University, Whitelands College, Holybourne Avenue, London SW154JD, UK.
| | | | | |
Collapse
|
29
|
Finestack LH, Richmond EK, Abbeduto L. Language Development in Individuals with Fragile X Syndrome. TOPICS IN LANGUAGE DISORDERS 2009; 29:133-148. [PMID: 20396595 PMCID: PMC2854517 DOI: 10.1097/tld.0b013e3181a72016] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Fragile X syndrome (FXS) is the leading inherited cause of intellectual disability. The syndrome is caused by a single gene mutation on the X chromosome. Although individual differences are large, most individuals with FXS display weaknesses across all language and literacy domains compared to peers of the same chronological age with typical cognitive and language development. Expressive, receptive, and pragmatic language abilities as well as literacy skills are similar to those of younger, typically developing peers at similar cognitive and language developmental levels, although there are areas in which impairments exceed developmental-level expectations. One area of special impairment is the higher occurrence of repetition in the language of individuals with FXS compared to developmentally matched peers. In this paper, we review the behavioral, language, and literacy characteristics of individuals with FXS and discuss potential clinical implications.
Collapse
|