Autistic symptomatology and language ability in autism spectrum disorder and specific language impairment

Early trajectories and moderators of autistic language profiles: A longitudinal study in preschoolers

LAY ABSTRACT

Language development can greatly vary among autistic children. Children who struggle with language acquisition often face many challenges and experience lower quality of life. However, little is known about the early language trajectories of autistic preschoolers and their moderators. Autistic language can be stratified into three profiles. Language unimpaired experience little to no language difficulties; language impaired show significant difficulties in language; minimally verbal never develop functional language. In this study, we used a longitudinal sample of preschoolers with autism and with typical development (aged 1.5-5.7 years). We replicated the three language profiles through a data-driven approach. We also found that different factors modulated the language outcome within each group. For instance, non-verbal cognition at age 2.4 moderated the participants' attribution to each language profile. Moreover, early intervention moderated verbal outcome in the language impaired profile. In conclusion, we provided a detailed description of how autistic preschoolers acquire language, and what factors might influence their trajectories. Our findings could inspire more personalized intervention for early autistic language difficulties.

Theoretical-Methodological Foundations for the Global Integration Method (Método de Integração Global-MIG) in the Treatment of Autism Spectrum Disorder

Currently, there is no intervention model for autism spectrum disorder (ASD) that addresses all levels and factors of the International Classification of Functioning, Disability and Health (ICF, WHO). The most researched programs focus on naturalistic, developmental and behavioral approaches to socio-communication. Less attention has been paid to motor and environmental reactivity aspects (behavior/interest restriction and sensory reactivity). The evidence rationale for the Global Integration Method (MIG, "Método de Integração Global"), a model addressing sensorimotor reactivity in addition to socio-communication, is presented. MIG is an integrative, interdisciplinary, family-oriented intervention and naturalistic program that addresses all levels and moderating factors of ASD's impact. MIG's theoretical rationale is based on the predictive coding impairment and embodied cognition hypotheses. MIG incorporates both bottom-up (flexible therapeutic suit, social-motor synchronization) and top-down (schematic social information processing, narratives, imagery) strategies to promote the building and use of accurate, flexible and context-sensitive internal predictive models. MIG is based on the premises that predictive coding improves both socio-communication and environmental reactivity, and that the postural stabilization provided by the flexible therapeutic suit frees information processing resources for socio-cognitive learning. MIG builds on interdisciplinary, professionally and parentally mediated work based on behavioral principles of intensive training in a situated environment.

Atypical brain lateralization for speech processing at the sublexical level in autistic children revealed by fNIRS

Autistic children often exhibit atypical brain lateralization of language processing, but it is unclear what aspects of language contribute to this phenomenon. This study employed functional near-infrared spectroscopy to measure hemispheric lateralization by estimating hemodynamic responses associated with processing linguistic and non-linguistic auditory stimuli. The study involved a group of autistic children (N = 20, mean age = 5.8 years) and a comparison group of nonautistic peers (N = 20, mean age = 6.5 years). The children were presented with stimuli with systematically decreasing linguistic relevance: naturalistic native speech, meaningless native speech with scrambled word order, nonnative speech, and music. The results revealed that both groups showed left lateralization in the temporal lobe when listening to naturalistic native speech. However, the distinction emerged between autism and nonautistic in terms of processing the linguistic hierarchy. Specifically, the nonautistic comparison group demonstrated a systematic reduction in left lateralization as linguistic relevance decreased. In contrast, the autism group displayed no such pattern and showed no lateralization when listening to scrambled native speech accompanied by enhanced response in the right hemisphere. These results provide evidence of atypical neural specialization for spoken language in preschool- and school-age autistic children and shed new light on the underlying linguistic correlates contributing to such atypicality at the sublexical level.

Different hemispheric lateralization for periodicity and formant structure of vowels in the auditory cortex and its changes between childhood and adulthood

The spectral formant structure and periodicity pitch are the major features that determine the identity of vowels and the characteristics of the speaker. However, very little is known about how the processing of these features in the auditory cortex changes during development. To address this question, we independently manipulated the periodicity and formant structure of vowels while measuring auditory cortex responses using magnetoencephalography (MEG) in children aged 7-12 years and adults. We analyzed the sustained negative shift of source current associated with these vowel properties, which was present in the auditory cortex in both age groups despite differences in the transient components of the auditory response. In adults, the sustained activation associated with formant structure was lateralized to the left hemisphere early in the auditory processing stream requiring neither attention nor semantic mapping. This lateralization was not yet established in children, in whom the right hemisphere contribution to formant processing was strong and decreased during or after puberty. In contrast to the formant structure, periodicity was associated with a greater response in the right hemisphere in both children and adults. These findings suggest that left-lateralization for the automatic processing of vowel formant structure emerges relatively late in ontogenesis and pose a serious challenge to current theories of hemispheric specialization for speech processing.

Current practices of Portuguese speech-language pathologists with preschool-age children with pragmatic impairment: A cross-sectional survey

This study aims to investigate the practice patterns used by Portuguese speech-language pathologists (SLPs) with preschool-age children with pragmatic impairment and to identify the actual need(s) perceived by SLPs in this field. A total of 351 SLPs responded. The results reveal that 81.5 per cent of the respondents (n=286) reported working or had previously worked with preschool-age children with pragmatic impairment arising from autism spectrum disorder, developmental language disorder, or both. Considering the clinical practice, similarities and differences were found, many of which are due not to the inherent characteristics of each disorder but to the scarcity of research in clinical pragmatics. These results are also reflected in the needs perceived by SLPs and the degree of confidence with which they work with these children. Implications for clinical practice and directions for future research are discussed.

Morphosyntactic skills in Arabic-speaking children with autism spectrum disorder: Evidence from error patterns in the sentence repetition task

Background and aims

Although autism spectrum disorder (ASD) has not traditionally been associated with morphosyntactic impairments, some children with ASD manifest significant difficulties in this domain. Sentence Repetition (SRep) tasks are highly reliable tools for detecting morphosyntactic impairment in different languages and across various populations, including children with ASD. This study is among the first to evaluate morphosyntactic abilities of Palestinian-Arabic (PA) speaking children using a PA SRep task.

Methods

A total of 142 PA-speaking children, aged 5-11, participated in the study: 75 children with typical language development (TLD) and 67 children with ASD. The PA SRep task targeted morphosyntactic structures of varying complexity (simple subject-verb-object [SVO] sentences, biclausal sentences, wh-questions, relative clauses). Children's accuracy scores were assessed across these structures and error patterns encompassing morphosyntactic and pragmatic aspects were analyzed.

Results

Two subgroups of ASD emerged: 43% showed age-appropriate language skills (ASD  +  NL) pairing up with TLD peers, while 57% showed signs of morphosyntactic impairment (ASD  +  LI). Children in both groups exhibited a higher frequency of morphosyntactic errors than pragmatic ones. Children with ASD  +  LI showed difficulties with producing complex morphosyntactic structures, such as relative clauses and object wh-questions. Error analysis revealed that children in the ASD  +  LI group produced sentence fragments and simplified constructions when complex structures were targeted.

Conclusions

The current study extends the cross-linguistic evidence of the heterogeneity of morphosyntactic profiles in children with ASD to Arabic-speaking children. Error analysis indicates that poor morphosyntax, rather than pragmatics, challenges children's performance on the SRep task.

Implications

Our results emphasize the importance of comprehensive language assessment in children with ASD and underscore the need for tailored intervention plans targeting impaired morphosyntactic structures in some children with ASD.

Oral language interventions can improve language outcomes in children with neurodevelopmental disorders: A systematic review and meta-analysis

Background

Young people who fail to develop language as expected face significant challenges in all aspects of life. Unfortunately, language disorders are common, either as a distinct condition (e.g., Developmental Language Disorder) or as a part of another neurodevelopmental condition (e.g., autism). Finding ways to attenuate language problems through intervention has the potential to yield great benefits not only for the individual but also for society as a whole.

Objectives

This meta-analytic review examined the effect of oral language interventions for children with neurodevelopmental disorders.

Search Methods

The last electronic search was conducted in April 2022.

Selection Criteria

Intervention studies had to target language skills for children from 2 to 18 years of age with Developmental Language Disorder, autism, intellectual disability, Down syndrome, Fragile X syndrome, and Williams syndrome in randomised controlled trials or quasi-experimental designs. Control groups had to include business-as-usual, waiting list, passive or active conditions. However, we excluded studies in which the active control group received a different type, delivery, or dosage of another language intervention. Eligible interventions implemented explicit and structured activities (i.e., explicit instruction of vocabulary, narrative structure or grammatical rules) and/or implicit and broad activities (i.e., shared book reading, general language stimulation). The intervention studies had to assess language skills in receptive and/or expressive modalities.

Data Collection and Analysis

The search provided 8195 records after deduplication. Records were screened by title and abstract, leading to full-text examinations of 448 records. We performed Correlated and Hierarchical Effects models and ran a retrospective power analysis via simulation. Publication bias was assessed via p-curve and precision-effect estimate.

Main Results

We examined 38 studies, with 46 group comparisons and 108 effects comparing pre-/post-tests and eight studies, with 12 group comparisons and 21 effects at follow-up. The results showed a mean effect size of d = 0.27 at the post-test and d = 0.18 at follow-up. However, there was evidence of publication bias and overestimation of the mean effects. Effects from the meta-analysis were significantly related to these elements: (1) receptive vocabulary and omnibus receptive measures showed smaller effect sizes relative to expressive vocabulary, grammar, expressive and receptive discourse, and omnibus expressive tests; and (2) the length of the intervention, where longer sessions conducted over a longer period of time were more beneficial than brief sessions and short-term interventions. Neither moderators concerning participants' characteristics (children's diagnosis, diagnostic status, age, sex, and non-verbal cognitive ability and severity of language impairment), nor those regarding of the treatment components and implementation of the language interventions (intervention content, setting, delivery agent, session structure of the intervention or total number of sessions) reached significance. The same occurred to indicators of study quality. The risk of bias assessment showed that reporting quality for the studies examined in the review was poor.

Authors’ Conclusions

In sum, the current evidence base is promising but inconclusive. Pre-registration and replication of more robust and adequately powered trials, which include a wider range of diagnostic conditions, together with more long-term follow-up comparisons, are needed to drive evidence-based practice and policy.

A Bayesian statistics tutorial for clinical research: Prior distributions and meaningful results for small clinical samples

OBJECTIVES

Bayesian statistics provides an effective, reliable approach for research with small clinical samples and yields clinically meaningful results that can bridge research and practice. This tutorial demonstrates how Bayesian statistics can be effectively and reliably implemented with a small, heterogeneous participant sample to promote reproducible and clinically relevant research.

METHODS/RESULTS

We tested example research questions pertaining to language and clinical features in autism spectrum disorder (ASD; n = 20), a condition characterized by significant heterogeneity. We provide step-by-step instructions and visualizations detailing how to (1) identify and develop prior distributions from the literature base, (2) evaluate model convergence and reliability, and (3) compare models with different prior distributions to select the best performing model. Moreover, in step three, we demonstrate how to determine whether a sample size is sufficient for reliably interpreting model results. We also provide instructions detailing how to examine results with varied bounds of clinical interest, such as the probability that an effect will reflect at least one standard deviation change in scores on a standardized assessment. This information facilitates generalization and application of Bayesian results to a variety of clinical research questions and settings.

CONCLUSION

The tutorial concludes with suggestions for future clinical research, ensuring the utility of our step-by-step instructions for a broad clinical audience.

Language Abilities are Associated with Both Verbal and Nonverbal Intelligence in Children on the Autism Spectrum

Intellectual abilities factor into levels of functioning used to characterize autism. Language difficulties are highly prevalent in autism and may impact performance on measures of intellectual abilities. As such, nonverbal tests are often prioritized in classifying intelligence in those with language difficulties and autism. However, the relationship between language abilities and intellectual performance is not well characterized, and the superiority of tests with nonverbal instructions is not well established. The current study evaluates verbal and nonverbal intellectual abilities in the context of language abilities in autism and the potential benefit of tests with nonverbal instructions. Participants were 55 children and adolescents on the autism spectrum who underwent a neuropsychological evaluation as part of a study examining language functioning in autism. Correlation analyses were performed to examine relations between expressive and receptive language abilities. Language abilities (CELF-4) were significantly correlated with all measures of both verbal (WISC-IV VCI) and nonverbal intelligence scores (WISC-IV PRI and Leiter-R). There were no significant differences between nonverbal intelligence measures with verbal or nonverbal instructions. We further discuss the role of assessment of language abilities in interpreting results of intelligence testing in populations with higher prevalence of language difficulties.

Language in autism: domains, profiles and co-occurring conditions

This article reviews the current knowledge state on pragmatic and structural language abilities in autism and their potential relation to extralinguistic abilities and autistic traits. The focus is on questions regarding autism language profiles with varying degrees of (selective) impairment and with respect to potential comorbidity of autism and language impairment: Is language impairment in autism the co-occurrence of two distinct conditions (comorbidity), a consequence of autism itself (no comorbidity), or one possible combination from a series of neurodevelopmental properties (dimensional approach)? As for language profiles in autism, three main groups are identified, namely, (i) verbal autistic individuals without structural language impairment, (ii) verbal autistic individuals with structural language impairment, and (iii) minimally verbal autistic individuals. However, this tripartite distinction hides enormous linguistic heterogeneity. Regarding the nature of language impairment in autism, there is currently no model of how language difficulties may interact with autism characteristics and with various extralinguistic cognitive abilities. Building such a model requires carefully designed explorations that address specific aspects of language and extralinguistic cognition. This should lead to a fundamental increase in our understanding of language impairment in autism, thereby paving the way for a substantial contribution to the question of how to best characterize neurodevelopmental disorders.

Positive Predictive Values Associated With Adapting the Redmond Sentence Recall Measure Into a Kindergarten Screener for Developmental Language Disorder

PURPOSE

Researchers estimate the prevalence of developmental language disorder (DLD) in 5-year-olds to be between 7% and 12%. Current identification systems in public schools typically favor referral identification formats over targeted or universal screenings. Public schools face unique challenges when assessing the value of screening measures for DLD that include real-world considerations such as administration, time, and resource constraints. This study used the positive predictive value (PPV) of the Redmond Sentence Recall (RSR) to assess its fidelity when administered by special education paraprofessionals. Our obtained PPV was compared across three areas: (a) previous studies that have utilized the RSR, (b) rates extrapolated from the participating school district's preexisting referral system from a previous study, and (c) expectations based on DLD prevalence.

METHOD

Language screenings were conducted in two elementary schools using the RSR administered by school-based paraprofessionals trained on the screener protocol. One hundred sixty-four kindergarten students (age range: 5-6 years) were screened. Confirmatory testing was completed on all students who failed the screener.

RESULTS

Of the 164 students screened, 19 failed the RSR (11.5%), and 14 met criteria (8.5%) for DLD (PPV = .74). Our PPV was similar to previously published studies that utilized the RSR using research assistants and was higher than the PPV associated with teacher-based referrals from the participating school district.

CONCLUSION

The RSR represents a potentially useful screener for identifying children at risk for previously unidentified language disorders in public schools.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22044479.

Structural-visual approach for dental examination in children with autism spectrum disorder: A systematic review

INTRODUCTION

Conducting Dental examination in children with autism is challenging due to the limitation in cooperativeness that is caused by impairment of communication, social interaction, and sensory sensitivities.

AIMS

This study aims to provide evidence base for the structural-visual approach in reducing uncooperativeness behavior to dental care in children with autism spectrum disorder (ASD).

METHODS

Searches were conducted in the electronic databases PubMed, PsycINFO, and Cochrane from inception to October 2021 (CRD42022383409). Randomized controlled trials (RCTs), non-RCTs, and pre/post-test and qualitative studies that conducting visual pedagogy and visual learning methods were included. The quality of evidence was assessed with Cochrane Collaboration's Risk of Bias Tool for RCTs, Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) for non-RCTs, and Critical Appraisal Skill Program (CASP) for qualitative studies.

RESULTS

The initial search identified 270 studies, and 256 remained after removing duplicates. After screening titles and abstracts, 62 studies were remained for full-text assessed, and finally 13 eligible studies were selected for reviews. The studies analyzed various structural-visual interventions, participants, study design, countries, and outcomes.

CONCLUSION

The structural-visual approach could reduce uncooperative behavior in children with ASD. Future study should investigate the wide range of age and varied behavior approach as the evidence-based of the clinical management.

Behaviors related to autism spectrum disorder in children with developmental language disorder and children with 22q11.2 deletion syndrome

Background and Aim

Children with Developmental Language Disorder (DLD) are at an increased risk to develop behaviors associated with Autism Spectrum Disorder (ASD). The relationship between early language difficulties and the occurrence of ASD-related behaviors in DLD is poorly understood. One factor that may hinder progress in understanding this relationship is the etiological heterogeneity of DLD. We therefore study this relationship in an etiologically homogeneous group of children, who share phenotypic characteristics with children with DLD: children with the 22q11.2 Deletion Syndrome (22q11DS). We compare children with 22q11DS, to children with DLD and age-matched typically developing children (TD).

Method

44 children with 22q11DS, 65 children with DLD and 81 TD children, between 3.0-6.5 years old, participated in a longitudinal cohort study that included a baseline measure and a follow-up measure with a 1-year interval. A parental questionnaire (SRS-2) was used to measure the incidence of behaviors in two key behavioral domains associated with ASD: Social Communication and Interaction and Restricted Repetitive Behaviors and Interests. At baseline, we assessed children's expressive and receptive language abilities as well as their intellectual functioning with standardized tests. We compared the distribution of ASD-related behaviors between the three groups. We used regression analyses to investigate whether language abilities at baseline predict ASD-related behavior at follow-up, accounting for ASD-related behavior at baseline, demographic variables and intellectual functioning.

Results

Both the children with 22q11DS and the children with DLD displayed significantly more ASD-related behaviors than the TD children. Over 30% of children in both clinical groups had scores exceeding the subclinical threshold for ASD in both behavioral domains. Both in 22q11DS and DLD, baseline receptive language scores were negatively correlated with ASD-related behaviors 1 year later, when controlling for baseline SRS-scores. However, this association was statistically significant only in children with 22q11DS, even when controlled for IQ-scores, and it was significantly stronger as than in the TD group. The strength of the association did not differ significantly between 22q11DS and DLD.

Conclusion

Both children with 22q11DS and children with DLD present with elevated rates of ASD-related behaviors at a preschool-age. Only in children with 22q11DS we observed that weaker receptive language skills were related to increased behavioral problems in the domain of social communication and interaction one year later.

Implications

Our findings indicate that relations between early language impairment and other behavioral phenotypes may be more feasible to detect in a subgroup of children with a homogeneous etiology, than in a group of children with a heterogeneous etiology (such as children with DLD). Our results in 22q11DS reveal that receptive language is especially important in predicting the occurrence of ASD-related behaviors. Future research is needed to determine to what extent receptive language predicts the occurrence of ASD-related behaviors in children with DLD, especially among those children with DLD with the weakest receptive language. Clinically, screening for ASD-related behaviors in children with developmental language difficulties is recommended from a young age, especially among children with receptive language difficulties.

Structural and Pragmatic Language Impairments in Children Evaluated for Autism Spectrum Disorder (ASD)

Pragmatic language impairments are common in neurodevelopmental disorders, especially in autism spectrum disorder (ASD). The relationship between structural language skills and pragmatic competence in children with autistic symptoms, however, is largely unknown. We investigated this relationship based on the Children's Communication Checklist-2 and early language delay among children (N = 177, 19% females) clinically evaluated for ASD, differentiated into ASD (n = 148) and non-ASD (n = 29). Structural language deficits were common and associated with reduced pragmatic competence in both groups. Pragmatic language impairments were most profound in children with ASD. Early language delay and structural language deficits were less common in females. Our findings suggest that assessment of structural language skills should be included in the evaluation of children with suspected ASD.

Language Impairment in Autistic Adolescents and Young Adults

PURPOSE

Little is known about the specific nature of language abilities of autistic adolescents and young adults with language impairment (LI), limiting our knowledge of developmental trajectories and ability to develop efficacious speech/language supports. An important first step is establishing proof of concept of identification of LI in this population, with considerations for feasibility of assessment. This research note describes such a study in a sample of autistic adolescents and young adults with LI.

METHOD

Thirteen autistic adolescents and young adults completed an assessment protocol of age-referenced language and nonverbal cognitive assessments. Assessment took place once per year for 3 years; the first two assessments were conducted in person, and the final was conducted online due to the pandemic. All assessments included measures of overall language and morphosyntax; the third added measures of expressive and receptive vocabulary, verbal working memory, and nonverbal intelligence (NVIQ). Analysis included descriptives and comparison of individual performance with epidemiological criteria for LI.

RESULTS

All participants qualified for LI, with overall receptive and expressive language scores persistently in the LI range. Other outcomes were variable. Some participants had nonword repetition and vocabulary abilities within age expectations, and some consistently showed adultlike morphosyntactic performance. NVIQ was variable, with no consistent associations with language outcomes.

DISCUSSION

Our findings support the use of the current protocol, as implemented in person or online, to identify LI in autistic adolescents and young adults. This exploratory work is limited by a small sample and missing data. The findings contribute to our understanding of linguistic strengths and variability in the language skills of autistic young adults with LI.

Early Neuro-Psychomotor Therapy Intervention for Theory of Mind and Emotion Recognition in Neurodevelopmental Disorders: A Pilot Study

The aim of the present study is to explore the effect of early neuro-psychomotor therapy to improve theory of mind skills and emotion recognition in children with neurodevelopmental disorders. A pilot study was set up, consisting of in-group training activities based on the neuro-psychomotor approach. Children were evaluated using Neuropsychological Assessment for Child (Nepsy-II), Test of Emotion Comprehension (TEC), and Social Communication Questionnaire (SCQ). For data analysis, one-sample Wilcoxon signed rank test was used with a significance of p < 0.05. Two children with a developmental language disorder and four children with autism spectrum disorders participated in a 3-month training program. Our findings revealed significant improvement in emotion recognition, as measured with Nepsy-II (p = 0.04), while no statistical improvement was found for theory of mind. Despite the limited sample, early neuro-psychomotor therapy improves emotion recognition skills in children with neurodevelopmental disorders. However, considering the explorative nature of the study, findings should be interpreted with caution.

Evaluating Interactive Language for Children with Autism Spectrum Disorder (ASD) in Different Contexts

Autism spectrum disorder (ASD) is characterized by impairments in the use of appropriate interactive language (including structural language and pragmatic skills) in social contexts. However, the phenotype and causes of interactive language deficits in children with ASD, in different contexts, are still unclear. In this study, we examined the structural language and pragmatic skills of children with ASD in four contexts: playing, drawing, reading, and free talking. We found that while children with ASD did not exhibit deficits in structural language (e.g., vocabulary and utterance), they clearly exhibit deficits in pragmatic skills. We, also, found that contexts played a key role in the use of interactive language by children with ASD. For example, the reading context had a significant impact on the diversity of vocabulary, while the playing and drawing contexts made an important contribution to the formation of complex utterances. The free talking context, on the other hand, contributed to producing more turns. Furthermore, Spearman’s rank correlation analysis was used to examine the relationships between maternal input and children’s language output. We found that the correlations between structural language and maternal input in children with ASD were not as high as revealed in previous studies, while a, relatively, obvious relationship was found between pragmatic skills and maternal input. Specifically, the total number of turns (TNT) for a child with ASD is related to their mother’s TNT, as are the total number of words (TNW) and number of different words (NDW). These results suggest that (1) assessment of pragmatic skills should be included in the evaluation of children with suspected ASD (2) the influence of context on pragmatic skills needs to be taken into account, when assessing the pragmatic development of children with ASD; and (3) the impact of maternal language on children’s language use is of great importance, for children with ASD.

Structural language impairment in Autism Spectrum Disorder versus Loss of Autism Diagnosis: Behavioral and neural characteristics

This study probed for structural language impairment using behavioral and functional neuroimaging methods in individuals with Autism Spectrum Disorder (ASD) and those diagnosed with ASD in childhood who no longer meet criteria for ASD, referred to as Loss of Autism Diagnosis (LAD¹). Participants were drawn from Fein et al. (2013): ASD (n = 35), LAD (n = 31), and Neurotypical (NT; n = 34). Criteria for structural language impairment were: Scores ≤ 82 on Clinical Evaluation of Language Fundamentals-4 (CELF) Core Language, an omnibus measure of language; and scores ≤ 7 on CELF Recalling Sentences, a clinical marker of structural language impairment. Task-based fMRI examined lateralization of significantly activated language-related brain regions in groups with structural language impairment (LI²) versus normal-range language (LN³), collapsed across ASD, LAD¹, and NT status. Results showed no ASD versus LAD group differences in the proportion of participants with structural language impairment according to either metric (Recalling Sentences or Core Language). Functional MRI results indicated greater left hemisphere lateralization within significantly activated regions in the LI² group. Structural language abilities were not meaningfully associated with either social abilities or lifetime ADHD symptoms in LI² subgroups, further suggesting the presence of structural language impairment. Findings indicate the presence of persistent structural language difficulty even in the absence of ASD symptoms in some individuals within the LAD¹ group and unique patterns of language-related neural specialization for language function in LI² relative to LN³.

A longitudinal case study of six children with autism and specified language and non-verbal profiles

Language skills as well as general cognitive skills show a considerable variation in children with autism spectrum disorder (ASD). In previous studies, at least three profiles based on these skills have been suggested; autism with language and non-verbal cognitive skills within the average/normal range (ALN), autism with language disorder (ALD) without concurrent non-verbal cognitive disability, and autism with language disorder and cognitive disability, i.e. autism with a more general delay (AGD). The aim of the present longitudinal case study is to illustrate these three groups more thoroughly by presenting the developmental trajectories of children belonging to each profile. Six children were chosen based on their language and cognitive profiles from the first age 3-year assessment. They came from a larger group of children with ASD identified by autism screening at child health-care centres at age 2.5 years. These six children represent one boy and one girl from each of the three subgroups ALN, ALD and AGD, and were assessed a second time at age 5 and a third time at age 8 years, regarding expressive and receptive language skills, autistic severity and non-verbal cognitive skills. Although preliminary, our results indicate a rather stable developmental trajectory from age 3 to 8 years characterising children with autism based on language and non-verbal cognitive functioning. Thus, in order to help intervention planning and increase predictions of outcome, it seems important to specify both linguistic and cognitive level already at the first assessment in children with ASD.

Comparing Theory of Mind Development in Children with Autism Spectrum Disorder, Developmental Language Disorder, and Typical Development

BACKGROUND

Theory of mind (ToM) is the ability to recognize, comprehend, and consider oneself's and others' mental states and perspectives to predict and explain behaviors and motivations. It is widely accepted that children with autism spectrum disorder (ASD) experience difficulties with ToM. However, there are also findings suggesting that ToM abilities might also be compromised in children with Developmental Language Disorders (DLD).

PURPOSE

To assess ToM abilities in three groups of children: 1. ASD with no language difficulties; 2. DLD, known for their language disorder; and 3. TD with no language issues.

MATERIALS AND METHODS

A total of 41 preschool children aged 5-to-6 were examined and assigned to one of the three groups based on previous clinical reports and a standardized Hebrew language assessment tool. Nonverbal IQ was established with a standardized test to verify within average range placement (>75 IQ). ToM skills were examined with a Hebrew version of the ToM Task Battery and parent's questionnaire (ToMI).

RESULTS

Children with ASD had significantly lower ToM scores compared to the children with DLD, and TD. The ToM scores of the children with DLD were similar to the scores of the TD children. According to the parents' questionnaires, both the ASD children and the DLD children had less developed ToM skills compared to their TD peers.

CONCLUSION

The present findings suggest that children with ASD have a fundamental difficulty in ToM that is independent of their language abilities. Children with DLD show difficulties in everyday social interactions that involve ToM. It is possible that both ASD and language disorders influence ToM development, suggesting that different developmental routes affect the acquisition of ToM.

Brief Report: Emotional and Behavioral Problems Among Young Children with ASD: An Exploratory Study of ADOS E-Codes and Child Characteristics

Emotional and behavioral problems (EBPs), such as anxiety, overactivity, and aggression, can influence the diagnosis of autism spectrum disorder (ASD). The gold standard diagnostic tool for ASD, the Autism Diagnostic Observation Schedule-Second Edition, includes three items ("E-codes") for EBPs that are frequently associated with ASD. Few empirical investigations have explored the use of E-codes. This study examined the relationship between E-codes and child characteristics (e.g., cognitive abilities, ASD symptom severity) in a sample of young children with ASD (N = 233). Findings indicated that E-codes positively correlated with ASD symptom severity and negatively associated with IQ. Symptom severity also significantly accounted for the variance in EBPs. Implications for ASD assessment as well as future research are discussed.

Feasibility and Outcomes of the Early Start Denver Model Delivered within the Public Health System of the Friuli Venezia Giulia Italian Region

The Early Start Denver Model (ESDM) is an evidence-based early intervention model for young children with autism spectrum disorder (ASD). It is crucial to investigate the feasibility of the ESDM in community settings in contexts that are culturally different from American universities in which the model was originally developed. The aim was to further evaluate the effectiveness of the ESDM delivered within the Italian community setting at low intensity. We compared a group aged 19 to 43 months receiving the ESDM for 2 h per week over the course of 1 year with a concurrent, comparable, non-randomized control group receiving treatment as usual (TAU). Children were evaluated at baseline (T0) and after 6 months (T1) and 12 months (T2) of intervention. Feasibility was evaluated by parent and therapist questionnaires, retention rate, and therapist treatment fidelity. Both groups made similar gains in cognition and language abilities. The ESDM group made larger improvement in domains measured by the ESDM Curriculum Checklist, including communication, social skills, and maladaptive behaviors. Feasibility seemed well supported by retentions, therapists and parent satisfaction, and treatment fidelity. Our study further supports the feasibility of the ESDM implemented within the Italian public health system and suggests a better response in the ESDM-treated group than in the control group.

Comparing Early Pragmatics in Typically Developing Children and Children with Neurodevelopmental Disorders

This study examined the early pragmatic language skills in typically developing (TD) preschool-age children, children with language impairment (LI) and children with autism spectrum disorder (ASD). Two hundred and sixty-two TD children, 73 children with LI, and 16 children with ASD were compared on early pragmatics through direct assessment (DA). Post hoc analysis revealed that children in two clinical groups displayed significant pragmatic language deficits. Children in the ASD group who were older exhibited comparable degree of impairments as their LI peers, suggesting a relatively stagnant development of pragmatic language skills in children with ASD. Findings also supported the use of DA in identifying pragmatic language deficits, which have implications for the adoption of this assessment approach in clinical settings.

Deep Neural Network-based Handheld Diagnosis System for Autism Spectrum Disorder

Objective

The aim of the present work was to propose and implement deep neural network (DNN)-based handheld diagnosis system for more accurate diagnosis and severity assessment of individuals with autism spectrum disorder (ASD).

Methods

Initially, the learning of the proposed system for ASD diagnosis was performed by implementing DNN algorithms such as a convolutional neural network (CNN) and long short-term memory (LSTM), and multilayer perceptron (MLP) with DSM-V based acquired dataset. The performance of the DNN algorithms was analyzed based on parameters viz. accuracy, loss, mean squared error (MSE), precision, recall, and area under the curve (AUC) during the training and validation process. Later, the optimum DNN algorithm, among the tested algorithms, was implemented on handheld diagnosis system (HDS) and the performance of HDS was analyzed. The stability of proposed DNN-based HDS was validated with the dataset group of 20 ASD and 20 typically developed (TD) individuals.

Results

It was observed during comparative analysis that LSTM resulted better in ASD diagnosis as compared to other artificial intelligence (AI) algorithms such as CNN and MLP since LSTM showed stabilized results achieving maximum accuracy in less consumption of epochs with minimum MSE and loss. Further, the LSTM based proposed HDS for ASD achieved optimum results with 100% accuracy in reference to DSM-V, which was validated statistically using a group of ASD and TD individuals.

Conclusion

The use of advanced AI algorithms could play an important role in the diagnosis of ASD in today's era. Since the proposed LSTM based HDS for ASD and determination of its severity provided accurate results with maximum accuracy with reference to DSM-V criteria, the proposed HDS could be the best alternative to the manual diagnosis system for diagnosis of ASD.

Evaluating atypical language in autism using automated language measures

Measurement of language atypicalities in Autism Spectrum Disorder (ASD) is cumbersome and costly. Better language outcome measures are needed. Using language transcripts, we generated Automated Language Measures (ALMs) and tested their validity. 169 participants (96 ASD, 28 TD, 45 ADHD) ages 7 to 17 were evaluated with the Autism Diagnostic Observation Schedule. Transcripts of one task were analyzed to generate seven ALMs: mean length of utterance in morphemes, number of different word roots (NDWR), um proportion, content maze proportion, unintelligible proportion, c-units per minute, and repetition proportion. With the exception of repetition proportion (p [Formula: see text]), nonparametric ANOVAs showed significant group differences (p[Formula: see text]). The TD and ADHD groups did not differ from each other in post-hoc analyses. With the exception of NDWR, the ASD group showed significantly (p[Formula: see text]) lower scores than both comparison groups. The ALMs were correlated with standardized clinical and language evaluations of ASD. In age- and IQ-adjusted logistic regression analyses, four ALMs significantly predicted ASD status with satisfactory accuracy (67.9-75.5%). When ALMs were combined together, accuracy improved to 82.4%. These ALMs offer a promising approach for generating novel outcome measures.

Measuring the Emergence of Specific Abilities in Young Children with Autism Spectrum Disorders: The Example of Early Hyperlexic Traits

The presence of a restricted interest in written materials, including an early ability to name and recognize letters and numbers, is regularly reported in preschoolers with autism spectrum disorders (ASDs). There is, however, scarce information on this early ability akin to emerging hyperlexic traits in preschoolers with ASD younger than 3 years old. Here, we defined a measure of early naming and recognition of letters and numbers in 155 preschoolers with ASD using a sliding window approach combined with a 90th percentile threshold criterion, and subsequently compared the profiles of children with ASD with and without early hyperlexic traits. Using this measure, we found that 9% of children with ASD showed early hyperlexic traits. The early ability to name and recognize letters and numbers was associated with a higher level of restricted and repetitive behaviors yet more social-oriented behaviors at baseline and with better expressive and written communication at baseline and one year later. This study contributes to a better definition of the profile of children with ASD with an early ability in letters and numbers akin to emerging hyperlexic traits, a skill that is associated with promising social strengths and language abilities in this subgroup of children.

Developmental Language Disorder and Autism: Commonalities and Differences on Language

Language and communication deficits characterize both autism spectrum disorder and developmental language disorder, and the possibility of there being a common profile of these is a matter of tireless debate in the research community. This experimental study addresses the relation of these two developmental conditions in the critical topic of language. A total of 103 children (79 males, 24 females) participated in the present study. Specifically, the study’s sample consisted of 40 children with autism, 28 children with developmental language disorder, and 35 typically developing children between 6 and 12 years old. All children completed language and cognitive measures. The results showed that there is a subgroup inside the autism group of children who demonstrate language difficulties similar to children with developmental language disorder. Specifically, two different subgroups were derived from the autism group; those with language impairment and those without. Both autism and language-impaired groups scored lower than typically developing children on all language measures indicating a common pathology in language ability. The results of this study shed light on the relation between the two disorders, supporting the assumption of a subgroup with language impairment inside the autism spectrum disorder population. The common picture presented by the two developmental conditions highlights the need for further research in the field.

Postnatal AVP treatments prevent social deficit in adolescence of valproic acid-induced rat autism model

Studies have shown that arginine-vasopressin (AVP) is an important neuropeptide regulating social behaviors. The present work aimed to detect changes in the AVP numbers and level in a valproic acid (VPA)-induced rat model of autism and the underlying mechanism of its pathogenesis. Our results indicated that infants exposed to VPA showed obviously impaired communication and repetitive behaviors with reduced number of AVP-ir cells in paraventricular nucleus (PVN) and cerebrospinal fluid (CSF). The postnatal subcutaneous injection of AVP can alleviate social preference deficits and stereotyped behaviors, accompanied with the increase of the AVP concentrations in the CSF. We concluded that AVP system was involved in etiology of VPA-induced autism-like symptoms and postnatal AVP treatment rescued the behavioral deficits,which could be a promising treatment for autism.

What is the nature of peer interactions in children with language disorders? A qualitative study of parent and practitioner views

BACKGROUND AND AIMS

Children with Language Disorders (LDs) can exhibit increased levels of social withdrawal, aggression and problems managing social conflicts. The reasons underlying this pattern of social interaction profiles remain unclear. This qualitative study aimed to document the nature of social interactions between children with LDs and their peers, and to evaluate explanations for their social behaviour, as understood by parents and practitioners.

METHODS

This study focused on children with LDs who spend school hours with other children with LDs. Three parent focus groups (n = 8) and three practitioner focus groups (n = 10) were conducted with parents of children aged 4-12 attending specialist language schools and practitioners working at these schools. This was a mixed clinical sample. All children of participating parents had LD as their primary area of need, which was the reason they required specialist schooling. Focus groups were conducted across two specialist schools in the UK between March and June 2018.

RESULTS

An inductive reflective thematic analysis of the data identified three themes; social knowledge, coping strategies, and emotional competence. Parents and school staff reported that children with LDs experience difficulties managing peer interactions due to a combination of challenges including difficulties with understanding and regulating emotions, and difficulties understanding social situations. Some of the children with LDs were described as having developed strategies to cope with their challenges, for example imposing structure on their social interactions to manage uncertainty, which has implications for their social interactions with peers.

CONCLUSIONS

Children with LDs have difficulties understanding emotions, difficulties understanding their peer's intentions and difficulties resolving conflict situations independently according to their parents and practitioners working with these children. Participants proposed a novel explanation that social withdrawal may be used adaptively by children with LDs to process information. This study demonstrates the complexity of the relationship between Language Disorders and peer interaction profiles.Implications: Suggestions are offered regarding future research directions, such as investigating the specific contribution language skills make to children's emotion understanding, to better understand the reasons for peer interaction difficulties in children with Language Disorders.

Brief Report: Predicting Social Skills from Semantic, Syntactic, and Pragmatic Language Among Young Children with Autism Spectrum Disorder

The language and social skill deficits associated with autism spectrum disorder (ASD) warrant further study. Existing research has focused on the contributions of pragmatic language to social skills, with little attention to other aspects of language. We examined the associations across three language domains (semantics, syntax, and pragmatics) and their relations to parent- and teacher-rated social skills among children with ASD. When parent-reported language skills were considered simultaneously, only semantics significantly predicted children's social skills. For teacher-reported language skills, all three language domains predicted children's social skills, but none made unique contributions above and beyond one another. Further research should consider the impact of social context on language expectations and interventions targeting semantic language on children's development of social skills.

Social Communication and Structural Language of Girls With High-Functioning Autism Spectrum Disorder

Purpose The purpose of this study was to characterize social communication and structural language of school-age girls with high-functioning autism spectrum disorder (HF-ASD) compared to a matched group of girls who are typically developing (TD). Method Participants were 37 girls between 7;5 and 15;2 (years;months)-18 HF-ASD and 19 TD. Children completed the Test of Pragmatic Language-Second Edition (TOPL-2) and Clinical Evaluation of Language Fundamentals-Fifth Edition. Parents completed the Children's Communication Checklist-2 United States Edition (CCC-2) and Receptive and Expressive Communication subdomains of the Vineland Adaptive Behavior Scales-Second Edition. Results In the area of social communication, girls with HF-ASD earned significantly lower scores and were more often classified as having an impairment on the TOPL-2 and the CCC-2. However, 28% and 33% earned average scores on the TOPL-2 and the CCC-2, respectively. In the area of structural language, no significant differences were found between groups on Clinical Evaluation of Language Fundamentals-Fifth Edition indexes. In contrast, girls with HF-ASD earned significantly lower scores and were more often classified as having an impairment on the Vineland Adaptive Behavior Scales-Second Edition. Sixty-one percent and 83% scored below average on the Receptive and Expressive Communication subdomains, respectively. Conclusions It has been argued that girls with HF-ASD, when compared to boys with HF-ASD, may have advantages for social communication and structural language that mask their impairments. However, when compared to girls who are TD, girls with HF-ASD demonstrated impaired social communication and structural language. Clinicians should include and carefully examine multiple sources of information when assessing girls with HF-ASD.

How Children with Autism Spectrum Disorder, Developmental Language Disorder, and Typical Language Learn to Produce Global and Local Semantic Features

A local processing bias, often considered a cognitive style unique to autism spectrum disorder (ASD), may influence the types of semantic features acquired by children with ASD and could contribute to weaknesses in word learning. Children with developmental language disorder (DLD) also struggle to learn semantic aspects of words, but this cognitive style has not been ascribed to children with DLD. The purpose of this study was to explore whether global–local processing differences influence the type of semantic features children with ASD, DLD, and their neurotypical peers learn to produce when learning new words. Novel word definitions produced by 36 school-aged children (12 with ASD, 12 with DLD, and 12 with typical language) who participated in an extended word-learning paradigm were used to extract newly learned semantic features. These semantic features were then coded for global and local attributes and analyzed to detect whether there were differences between groups. Results indicated that the children with ASD and DLD produced more global, rather than local, semantic features in their definitions than the children with typical language. An over-reliance on global, rather than local, features in children with ASD and DLD may reflect deficits in depth of word knowledge.

The role of linguistic and cognitive factors in emotion recognition difficulties in children with ASD, ADHD or DLD

BACKGROUND

Many children with neurodevelopmental disorders such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) or developmental language disorder (DLD) have difficulty recognizing and understanding emotions. However, the reasons for these difficulties are currently not well understood.

AIMS

To compare the emotion recognition skills of children with neurodevelopmental disorders as well as those children's skills with the skills of their typically developing (TD) age peers. Also, to identify the role of underlying factors in predicting emotion recognition skills.

METHODS & PROCEDURES

The 6-10-year-old children (n = 50) who participated in the study had either ASD, ADHD or DLD and difficulties recognizing emotions from face and/or in voice. TD age peers (n = 106) served as controls. Children's skills were tested using six forced-choice tasks with emotional nonsense words, meaningful emotional sentences, the FEFA 2 test, photographs, video clips and a task in which facial expressions and tones of voice had to be matched. Expressive vocabulary, rapid serial naming, auditory and visual working memory and Theory of Mind skills were explored as possible explanatory factors of the emotion recognition difficulties of the diagnosed children.

OUTCOMES & RESULTS

Children with ASD, ADHD or DLD did not significantly differ from each other in their linguistic or cognitive skills. Moreover, there were only minor differences between children with these diagnoses in recognizing facial expressions and emotional tone of voice and matching the two. The only significant difference was that children with ADHD recognized facial expressions in photographs better than children with DLD. The participants with diagnoses scored significantly lower than the controls in all but one emotion recognition tasks presented. According to the linear regression analysis, first-order Theory of Mind skills predicted the delay relative to typical development in the recognition of facial expressions in the FEFA 2 test, and expressive vocabulary and working memory skills together predicted the delay in the recognition of emotions in the matching task.

CONCLUSIONS & IMPLICATIONS

Children with ASD, ADHD or DLD showed very similar emotion recognition skills and were also found to be significantly delayed in their development of these skills. Some predictive factors related to linguistic and cognitive skills were found for these difficulties. Information about impaired emotion recognition and underlying linguistic and cognitive skills helps to select intervention procedures. Without this information, therapy might unnecessarily focus on only symptoms.

Identifying Language and Cognitive Profiles in Children With ASD via a Cluster Analysis Exploration: Implications for the New ICD-11

The new version of the International Classification of Diseases (ICD-11) mentions the existence of four different profiles in the verbal part of the Autism Spectrum Disorder (ASD), describing them as combinations of either spared or impaired functional language and intellectual abilities. The aim of the present study was to put ASD heterogeneity to the forefront by exploring whether clear profiles related to language and intellectual abilities emerge when investigation is extended to the entire spectrum, focusing on verbal children. Our study proposed a systematic investigation of both language (specifically, structural language abilities) and intellectual abilities (specifically, nonverbal cognitive abilities) in 51 6- to 12-year-old verbal children with ASD based on explicitly motivated measures. For structural language abilities, sentence repetition and nonword repetition tasks were selected; for nonverbal cognitive abilities, we chose Raven's Progressive Matrices, as well as Matrix Reasoning and Block Design from the Wechsler Scales. An integrative approach based on cluster analyses revealed five distinct profiles. Among these five profiles, all four logically possible combinations of structural language and nonverbal abilities mentioned in the ICD-11 were detected. Three profiles emerged among children with normal language abilities and two emerged among language-impaired children. Crucially, the existence of discrepant profiles of abilities suggests that children with ASD can display impaired language in presence of spared nonverbal intelligence or spared language in the presence of impaired nonverbal intelligence, reinforcing the hypothesis of the existence of a separate language module in the brain. Autism Res 2020, 13: 1155-1167. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The present work put Autism Spectrum Disorder heterogeneity to the forefront by exploring whether clear profiles related to language and cognitive abilities emerge when investigation is extended to the entire spectrum (focusing on verbal children). The use of explicitly motivated measures of both language and cognitive abilities and of an unsupervised machine learning approach, the cluster analysis, (a) confirmed the existence of all four logically possible profiles evoked in the new ICD-11, (b) evoked the existence of (at least) a fifth profile of language/cognitive abilities, and (c) reinforced the hypothesis of a language module in the brain.

Effects of Spatial Location of Auditory Tones on Pitch Discrimination

Pitch discrimination accuracy has been found to be affected by many factors, including handedness, musical training, interfering stimuli, and spatial location of the auditory stimulus. Separating the stimulus input location of interference tones from initial (reference) and final (comparison) tones leads to more accurate pitch discrimination, but the effects of spatial location relationships between the reference, interference, and comparison tones have not been fully explored. This study examined the impact of stimulus spatial location in 24 young, nonmusician females. Participants determined whether the pitch of reference and comparison tones were the same or different in 20 pitch discrimination conditions with varied interference, spatial relationships, and frequencies. Findings revealed that pitch discrimination accuracy was significantly better when (a) there was no interference, (b) the comparison tone was presented to the contralateral brain hemisphere from reference and interference tones, and (c) the comparison tone was presented to the left ear. We discussed the implications of these findings for therapy programs to strengthen pitch discrimination abilities.

Visual and verbal semantic productions in children with ASD, DLD, and typical language

PURPOSE

Associations between visual and verbal input allow children to form, augment, and refine their semantic representations within their mental lexicons. However, children with autism spectrum disorder (ASD) and with developmental language disorder (DLD; also known as specific language impairment) process visual and verbal information differently than their typically developing peers, which may impact how they incorporate visual and verbal features into their semantic representations. The purpose of this exploratory study was to investigate how children with ASD and DLD use visually and verbally presented input to produce semantic representations of newly learned words.

METHOD

Semantic features produced by 36 school-aged children (12 with ASD, 12 with DLD, and 12 with typical language development) were extracted from previously collected novel word definitions and coded based on their initial presentation modality (either visual, verbal, or both in combination) during an extended novel word learning paradigm. These features were then analyzed to explore group differences in the use of visual and verbal input.

RESULTS

The children with ASD and DLD produced significantly more visually-presented semantic features than their typical peers in their novel word definitions. There were no differences between groups in the proportion of semantic features presented verbally or via both modalities in combination. Also, the children increased their production of semantic features presented via both modalities combined across the sessions; this same increase in production was not observed for the semantic features taught in either the visual or verbal modality alone.

CONCLUSION

Children with ASD and DLD benefit from visually presented semantic information, either in isolation or combined with verbal input, during tasks of word learning. Also, the reinforcement of combined visual-verbal input appears to enhance semantic learning over time.

Specificity of Phonological Representations for Children with Autism Spectrum Disorder

This study investigated whether children with autism spectrum disorder (ASD) are sensitive to mispronunciations of familiar words and compared their sensitivity to children with typical-development. Sixty-four toddlers with ASD and 31 younger, typical controls participated in a looking-while-listening task that measured their accuracy in fixating the correct object when it was labelled with a correct pronunciation versus mispronunciation. A cognitive style that prioritizes processing local, rather than global features, as claimed by the weak central coherence theory, predicts that children with ASD should be more sensitive to mispronunciations than typical controls. The results, however, reveal no differences in the effect of mispronunciations on lexical processing between groups, even when matched for receptive language or non-verbal cognitive skills.

The mediating role of joint attention in the relationship between motor skills and receptive and expressive language in siblings at risk for autism spectrum disorder

Language problems are highly prevalent in younger siblings of children with autism spectrum disorder (HR-sibs), yet little is known about early predictors. There is growing evidence that motor and language development are linked and this connection might be mediated by joint attention. Developmental changes in motor abilities change how children interact with objects and people (e.g., by showing), which may influence language development. This association has however not yet been studied in HR-sibs. The interrelationship between motor, joint attention and language skills was explored in younger siblings of typically developing children (LR-sibs, N = 31) and HR-sibs (N = 32). In both groups, motor skills (composite of fine and gross motor skills) at 10 months influenced receptive and expressive language at 36 months directly and indirectly through joint attention at 14 months. Group status moderated this direct and indirect effect with mainly significant effects in HR-sibs. This indicates that lower motor skills can have cascading effects on joint attention and language in HR-sibs. Consequently, assessment of early motor skills in HR-sibs might hold promise for early identification of motor difficulties but can also be indicative of language difficulties later in life, especially when difficulties with joint attention are also present.

Telehealth and autism: Are telehealth language assessments reliable and feasible for children with autism?

BACKGROUND

Access to timely and appropriate speech-language pathology (SLP) services is a significant challenge for many families. Telehealth has been used successfully to treat a range of communication disorders in children and adults. Research examining the use of telehealth for children with autism has focused largely on diagnosis, parent-implemented interventions, and behavioural interventions involving interactions between clinicians and parents. There is, however, very limited research into the use of telehealth directly to assess or intervene with children with autism. This paper reports the outcomes of a study of telehealth language assessments with primary school-aged children with autism.

AIMS

To evaluate the reliability and feasibility of telehealth language assessments for school-aged children with autism.

METHODS & PROCEDURES

The language skills of 13 children with autism aged 9-12 who attended mainstream schools or support classes were assessed using the Clinical Evaluation of Language Fundamentals-4th Edition. An SLP delivered and scored four subtests of the assessment via telehealth from a remote location. A second SLP at the same location as the child co-scored the online subtests to provide a measure of reliability and delivered the remaining subtests. The local SLP completed checklists in both conditions to provide observations regarding behaviour. Parent feedback was elicited via survey.

OUTCOMES & RESULTS

There was strong interrater reliability between the telehealth and face-to-face conditions (correlation coefficients ranged from r = 0.919 to 0.990 across the subtests and Core Language Score) and good agreement between clinicians on all measures. Analysis using the Wilcoxon Signed Rank test indicated no significant differences in children's behaviour between the telehealth and face-to-face conditions, although variation between individuals was observed. Parents provided generally positive feedback about the use of telehealth for the assessments.

CONCLUSIONS & IMPLICATIONS

The findings of this study provide preliminary support the use of telehealth assessments of school-aged children with autism. Comparison of telehealth and face-to-face assessment scores showed high agreement and correlation, and while the children showed individual differences in their behaviour during the telehealth sessions, there was no clear difference between the conditions at the group level. The findings suggest that telehealth may present a reliable and feasible approach to the assessment of language for children with autism in some circumstances as a primary or adjunct service model, while acknowledging that individual differences among these children may be important to consider when planning both assessment and intervention via telehealth.

Contemporary Trainee Knowledge of Autism: How Prepared Are Our Future Providers?

Background: Over the last several decades, the prevalence of Autism Spectrum Disorder (ASD) has continued to increase, creating a unique challenge for general physicians who are likely to encounter these patients in their practice. The primary aim of this cross-sectional study design was to identify potential knowledge gaps that were present among medical students and pediatric trainees (interns, residents, and fellows) particularly during the management of a sick child with ASD. Methods: A 23-question online survey was developed and distributed to medical students and pediatric trainees at a tertiary children's hospital affiliated with a medical school. Results: Medical students and pediatric trainees reported a low general knowledge of ASD and were unfamiliar with sensory issues that are often present in these children. Increased discomfort and insufficient didactic and clinical training for providing care to children with ASD during an acute illness were also identified. Both medical students and trainees reported the need for increased education and training, preferentially via patient interaction and small group-based learning. We found that as education/training levels increased, participants perceived increased comfort, and knowledge in managing an ill child with ASD. Conclusions: A perceived knowledge gap and discomfort is present amongst medical students and pediatric trainees on the management of children with ASD. Across all education levels, awareness for sensory dysregulation in ASD children is low. Education programs using direct patient interaction and small group learning were the preferred training modalities to learn how to provide optimal care for children with ASD.

Parental care-seeking pathway and challenges for autistic spectrum disorders children: A mixed method study from Bhubaneswar, Odisha

BACKGROUND

Autism spectrum disorder (ASD) is globally a major cause of childhood disability. It is estimated that in India approximately 1.7-2 million children are affected with this disorder. Early diagnosis is an important criterion to start early interventions for ASD treatment. However, for every childhood problem that receives a medical diagnosis, there is a period between a parents' first recognition of unusual symptoms and the eventual diagnosis. Several factors influence this initial symptoms recognition and final diagnosis.

AIMS

The present study attempts to decipher parents' perception regarding ASD and to understand the early signs of ASD recognition among parents, treatment-seeking pathways adopted their experiences and challenges in the overall process.

SETTING AND DESIGN

A facility-based cross-sectional study was undertaken at Bhubaneswar, Odisha.

METHODOLOGY

Parents of children with ASD were recruited for this study. Seventy-six interviews were conducted, and the data were analyzed.

RESULTS

The major symptom identified by the majority of the parents was social difficulty among their children. Maximum parents had not heard about ASD before their child was diagnosed with the disorder. Parents consulted multiple professionals or traveled long distances to confirm the diagnosis. Child psychiatrists often confirmed the diagnosis and referred patients to rehabilitation centers.

CONCLUSION

Lack of awareness, unavailability of services, and stress contributed to the delay in ASD diagnosis. There is a need for designing proper awareness and genuine center for the treatment. Similarly, referral and counter-referral mechanism is also required to be established to save delay in diagnosis and initiate prompt treatment in the field of ASD.