Speech sound error patterns may signal language disorder in Swedish preschool children with autism

BACKGROUND

Within cohorts of children with autism spectrum disorder (ASD) there is considerable variation in terms of language ability. In the past, it was believed that children with ASD either had delayed articulation and phonology skills or excelled in those areas compared to other language domains. Very little is known about speech sound ability in relation to language ability and non-verbal ability in Swedish preschool children with ASD.

AIM

The current study aimed to describe language variation in a group of 4-6-year-old children with ASD, focusing on in-depth analyses of speech sound error patterns with and without non-phonological language disorder and concomitant non-verbal delays.

METHOD & PROCEDURES

We examined and analysed the speech sound skills (including consonant inventory, percentage of correct consonants and speech sound error patterns) in relation to receptive language skills in a sample of preschool children who had screened positive for ASD in a population-based screening at 2.5 years of age. Seventy-three children diagnosed with ASD participated and were divided into subgroups based on their receptive language (i.e., non-phonological language) and non-verbal abilities.

OUTCOMES & RESULTS

The subgroup division revealed that 29 children (40%) had language delay/disorder without concurrent non-verbal general cognitive delay (ALD), 27 children (37%) had language delay/disorder with non-verbal general cognitive delay (AGD), and 17 children (23%) had language and non-verbal abilities within the normal range (ALN). Results revealed that children with ALD and children with AGD both had atypical speech sound error patterns significantly more often than the children with ALN.

CONCLUSIONS & IMPLICATIONS

This study showed that many children who had screened positive for ASD before age 3 years - with or without non-verbal general cognitive delays - had deficits in language as well as in speech sound ability. However, individual differences were considerable. Our results point to speech sound error patterns as a potential clinical marker for language problems (disorder/delay) in preschool children with ASD.

WHAT THIS PAPER ADDS

What is already known on the subject Children with autism spectrum disorder (ASD) have deficits in social communication, restricted interests and repetitive behaviour. They show very considerable variation in both receptive and expressive language abilities. Previously, articulation and phonology were viewed as either delayed in children with ASD or superior compared with other (non-phonological) language domains. What this paper adds to existing knowledge Children with ASD and language disorders also have problems with speech sound error patterns. What are the potential or actual clinical implications of this work? About 75% of children with ASD experience language delays/disorders, as well as speech sound problems, related to speech sound error patterns. Understanding/acknowledging these phonological patterns and their implications can help in the diagnosis and intervention of speech sound disorders in children with ASD. Direct intervention targeting phonology might lead to language gains, but more research is needed.

A Longitudinal Study of Joint Attention, Motor Imitation and Language Development in Young Children with Autism Spectrum Disorder in Taiwan

This longitudinal study examined early predictors of language development in 74 young children with Autism Spectrum Disorder (ASD) in Taiwan. Participants were assessed twice (initial age between 17 and 35 months) on responding to joint attention (RJA), initiating joint attention (IJA), motor imitation with objects (object imitation; OI) and without objects (manual imitation; MI), and receptive and expressive language. The two assessments were 18 months apart. Results showed that both RJA and MI concurrently and longitudinally predicted receptive and expressive language across the two assessments. These findings were not entirely consistent with the limited and mixed findings of Western longitudinal studies. However, they have implications for early interventions aiming to facilitate language development in children with ASD internationally.

Real-time coded measures in natural language samples capture change over time in minimally verbal autistic children

Prior research supports the use of natural language sampling (NLS) to assess the rate of speech utterances (URate) and the rate of conversational turns (CTRate) in minimally verbal (MV) autistic children. Bypassing time-consuming transcription, previous work demonstrated the ability to derive URate and CTRate using real-time coding methods and provided support for their strong psychometric properties. (1) Unexplored is how URate and CTRate using real-time coding methods capture change over time and (2) whether specific child factors predict changes in URate and CTRate in 50 MV autistic children (40 males; M = 75.54, SD = 16.45 (age in months)). A NLS was collected at Time 1 (T1) and Time 2 (T2) (4.5 months between T1 and T2) and coding was conducted in ELAN Linguistic Annotator software using a real-time coding approach to derive URate and CTRate. Findings from paired samples Wilcoxon tests revealed a significant increase in child URate (not examiner URate) and child and examiner CTRate from T1 to T2. Child chronological age, Mullen expressive language age equivalent scores, and URate and CTRate at T1 were predictive of URate and CTRate at T2. Findings support using NLS-derived real-time coded measures of URate and CTRate to efficiently capture change over time in MV autistic children. Identifying child factors that predict changes in URate and CTRate can help in the tailoring of goals to children's individual needs and strengths.

Trajectory research in children with an autism diagnosis: A scoping review

LAY ABSTRACT

The types of outcomes studied in children on the autism spectrum include clinical characteristics, such as social functioning, communication, language, or autism symptoms. Research that measures these outcomes at multiple timepoints is useful to improve our understanding of what to expect as children develop. In trajectory studies, researchers assess outcomes at three or more timepoints. This method has advantages over two-timepoint studies because it allows researchers to describe changes in the speed of development, such as accelerations, plateaus, or slowdowns. We identified and reviewed 103 published trajectory studies in children (to age 18 years) with an autism diagnosis. Importantly, we did not include studies of treatments or their effects, nor did we summarize the results of studies. Instead, this review summarizes the characteristics of the available published research, including the methods used, the many different outcomes that have been studied over time and the ages over which they have been studied. This summary may be of interest to autistic people and caregivers (parents) who want to know about the existence of research that provides answers about what to expect during an autistic child's development. We have recommended that future trajectory research efforts try to make up for the lack of studies from low- and middle-income countries; that more attention is given to the following outcomes that are meaningful to caregivers and autistic people; and to try to fill in the age gaps where more outcome-specific data are needed.

Early development score as a prognostic factor in nonverbal/minimally verbal children with autism spectrum disorder: A matched case-control study in Cyprus

Background and Aims

Children with autism spectrum disorder (ASD) present with impairments in social interaction and stereotypic behaviors. About a third may exhibit delays in verbal expression beyond preschool age, potentially categorizing them as nonverbal/minimally verbal (NV/MV), a condition that can persist into adulthood and affect their quality of life. The risk and prognostic factors associated with this reduced verbal outcome remain uncertain. This study aims to identify such factors within children diagnosed with ASD in Cyprus.

Methods

In this case-control study, 56 children aged 3-12 years, with an ASD diagnosis, participated. Among them, cases were 22 children classified as ASD-NV/MV, and controls were 34 children classified as verbal (ASD-V), matched by age group and gender. Retrospective information on familial, perinatal, and developmental risk and prognostic factors were collected to calculate the familial risk score (FRS), perinatal risk score (PRS), and developmental risk score (DRS). Early development information was collected for the Early Development Score (EDS) and Early Gesture Score (EGS), to measure the children's skill level as toddlers across milestones. A low EDS and/or low EGS reflected general developmental delays and decreased frequency of early gestures and were considered in the DRS. A parent report questionnaire was utilized to determine the current overall linguistic level and status of participants, distinguishing cases from controls.

Results

Age group and gender-matched cases and controls were similar in socioeconomic status and demographic characteristics (p > .05). Among the various familial (e.g., sibling with ASD), perinatal (e.g., prematurity), and developmental (e.g., ASD regression) factors examined individually, as well as collectively as scores in a conditional logistic regression (CLR) model, only a high DRS (p = .03), due to low EDS (p = .04) was significantly associated with linguistic status. When considering all risk scores in a multivariate CLR model, children with a high DRS were more likely to belong to the cases than to the control group (p = .02). In a subsequent model with low EDS and low EGS, only the low EDS was significantly associated with the case group. Results showed that children with ASD and a low EDS, reflecting general delays in early development, were 4.5 times more likely to belong to the cases group than those with a high EDS (p = .02).

Conclusions

Early developmental delays in developmental milestones across various domains like gesture, motor, play, linguistic, cognition, and joint attention, in toddlerhood, were associated with later decreased verbal outcomes. Children in the sample with such early delays (low EDS), had a higher likelihood of persistent language delays (ASD-NV/MV) even at late school age. Future studies are needed to duplicate findings and explore possible contributing factors affecting linguistic outcome in ASD through prospective studies exploring within ASD differences.

Implications

These findings emphasized the importance of monitoring early development closely for children at risk for ASD, pre-diagnosis, to provide additional early support for those more likely to be ASD-NV/MV. Parents and specialists like pediatricians, educators, speech-language pathologists, among others, can track the EDS score of children at risk for ASD and refer to the appropriate specialists for early stimulation, intervention, and parent consultation promptly.

Studies pertaining to language impairment in school-age autistic individuals underreport participant socio-demographics: A systematic review

LAY ABSTRACT

Although exclusion of racially and ethnically minoritized autistic individuals from research is a long-standing issue, we have yet to determine how exclusion impacts areas of autism research important for identifying language impairment. Diagnosis depends on the quality of the evidence (i.e. research) and is often the pathway to gaining access to services. As a first step, we examined how research studies related to language impairment in school-age autistic individuals report participant socio-demographics. We analyzed reports using age-referenced assessments in English (n = 60), which are commonly used by both practitioners and researchers to diagnose or identify language impairment. Findings showed only 28% of studies reported any information on race and ethnicity; in these studies, most (at least 77%) of the participants were white. In addition, only 56% of studies reported gender or sex and specified what they were reporting (gender, sex, or gender identity). Just 17% reported socio-economic status using multiple indicators. Altogether, findings indicate broad issues with underreporting and exclusion of racially and ethnically minoritized individuals, which might overlay with other aspects of identity including socio-economic status. It is impossible to determine the extent and precise nature of exclusion without intersectional reporting. To ensure that language in autism research is representative of the autistic population, future research must implement reporting guidelines and broaden inclusion of who participates in research studies.

Language acquisition can be truly atypical in autism: Beyond joint attention

Language profiles in autism are variable and atypical, with frequent speech onset delays, but also, in some cases, unusually steep growth of structural language skills. Joint attention is often seen as a major predictor of language in autism, even though low joint attention is a core characteristic of autism, independent of language levels. In this systematic review of 71 studies, we ask whether, in autism, joint attention predicts advanced or only early language skills, and whether it may be independent of language outcomes. We consider only conservative estimates, and flag studies that include heterogenous samples or no control for non-verbal cognition. Our review suggests that joint attention plays a pivotal role for the emergence of language, but is also consistent with the idea that some autistic children may acquire language independently of joint attention skills. We propose that language in autism should not necessarily be modelled as a quantitative or chronological deviation from typical language development, and outline directions to bring autistic individuals' atypicality within the focus of scientific inquiry.

Describing (pre)linguistic oral productions in 3- to 5-year-old autistic children: A cluster analysis

LAY ABSTRACT

For most autistic children, spoken language emergence and development happen after the age of 3. Once they start developing and using spoken language, some eventually manage to reach typical levels of language abilities, while others remain minimally speaking into adulthood. It is therefore difficult to consider young autistic preschoolers as a homogeneous group in terms of spoken language levels. In our study, we breakdown a representative and inclusive group of children on the spectrum aged from 3 to 5 into five subgroups that correspond to different linguistic profiles. To do so, we qualitatively described children's (pre)verbal productions elicited during interactions with a parent and with an experimenter. We then used a type of statistical analysis called cluster analysis to group together the children that had a similar expressive (pre)linguistic behavior. Using this analysis, we were able to delineate five linguistic profiles with qualitatively different patterns of vocal production. Two of these profiles are composed of speaking children; the three others are composed of non- or minimally speaking children. Our findings show that traditional binary division of speaking versus nonspeaking autistic children is not precise enough to describe the heterogeneity of early spoken language in young autistic children. They also support the use of qualitative descriptions of vocal productions and speech to accurately document children's level of language, which could, in turn, help design very finely tailored language intervention specific to each child.

Profiles and correlates of language and social communication differences among young autistic children

Delays in early language development are characteristic of young autistic children, and one of the most recognizable first concerns that motivate parents to seek a diagnostic evaluation for their child. Although early language abilities are one of the strongest predictors of long-term outcomes, there is still much to be understood about the role of language impairment in the heterogeneous phenotypic presentation of autism. Using a person-centered, Latent Profile Analysis, we first aimed to identify distinct patterns of language and social communication ability in a clinic-based sample of 498 autistic children, ranging in age from 18 to 60 months (M = 33 mo, SD = 12 mo). Next, a multinomial logistic regression analysis was implemented to examine sociodemographic and child-based developmental differences among the identified language and social communication profiles. Three clinically meaningful profiles were identified from parent-rated and clinician-administered measures: Profile 1 (48% of the sample) “Relatively Low Language and Social Communication Abilities,” Profile 2 (34% of the sample) “Relatively Elevated Language and Social Communication Abilities,” and Profile 3 (18% of the sample) “Informant Discrepant Language and Relatively Elevated Social Communication Abilities.” Overall, young autistic children from the lowest-resource households exhibited the lowest language and social communication abilities, and the lowest non-verbal problem-solving and fine-motor skills, along with more features of attention-deficit/hyperactivity disorder and atypical auditory processing. These findings highlight the need for effective community-based implementation strategies for young autistic children from low-resource households and underrepresented communities to improve access to individualized quality care.

Influence of Family Sports Games on the Development of Early Communication Skills in Autistic Children

With the development of society, the number of autistic children in China is increasing, which not only makes the family's happiness very low, but also seriously affects the development of teenagers and society. Among the symptoms of autistic children, early childhood communication skills have received extensive attention. In traditional rehabilitation training, with a lack of parents' participation, most of the training cannot arouse the interest of autistic children, so the treatment effect is not obvious. Based on this, this paper proposes the application of family sports games to improve the early communication ability of autistic children. This article aims to investigate the role of family sports games in promoting the development of early communication skills in autistic children. This paper uses the fuzzy comprehensive evaluation method to score the comprehensive ability of family sports games. The experimental results of this paper show that before the experiment, the comprehensive scores of children's communication ability in the control group and the experimental group were 18.92 and 18, respectively, which were generally low, and there was no significant difference. This shows that the communication skills of the two groups of children before the experiment are relatively poor. After the test, the children's comprehensive score of communication ability in the experimental group increased by 35.8 points, and the difference was significant, indicating that family sports games have a great impact on the development of children's communication ability.

Lexical Acquisition and Phonological Development in Minimally Verbal Children With Autism Spectrum Disorders

PURPOSE

This study examines two components of lexical acquisition and phonological development that occur during the first 50-word stage of language development in neurotypical (NT) children. One component is how children learn words based on their existing speech sound inventories (i.e., in-phonology and out-of-phonology word learning). The other component is the relationship between the children's number of words and the number of phonemes in their speech sound inventories. The goal of this study is to determine if the same two components occur in children with autism spectrum disorders (ASDs) who are older than their NT peers but are in the same stage of lexical development.

METHOD

This study involved 20 minimally verbal children with ASDs, ages 28-72 months, who produced five to 50 spoken words. The children's spoken words were obtained from the MacArthur-Bates Communicative Development Inventories. The speech sound inventories were obtained from the utterances produced during assessment/play sessions with the children. The children's spoken words from the Communicative Development Inventories (CDI) were categorized as either in-phonology or out-of-phonology based on whether the words began with a phoneme in the child's existing speech sound inventory. Additionally, the children's number of spoken words on the CDI was compared to the number of phonemes in their speech sound inventories.

RESULTS

The children in this study produced in-phonology words more often than out-of-phonology words (z = -3.922; p < .001). Moreover, there was a moderate positive correlation between the children's number of spoken words and the number of phonemes in their speech sound inventories (r = .534, p = .019).

CONCLUSIONS

The relationship between lexical acquisition and phonological development appears to exist for the children in this study, who are in the first 50-word stage of development. Clinical implications for increasing the expressive language of children with ASDs were discussed.

Language Development in Sex Chromosome Trisomies: Developmental Profiles at 2 and 4 Years of Age, and Predictive Measures

PURPOSE

Describing language development in children with sex chromosome trisomies (SCT) and testing the predictive value of early language measures on later outcomes.

METHOD

Thirteen children with SCT were followed longitudinally. Their developmental profile was assessed, with particular attention to language, at 2 and 4 years. The predictive value of direct (spontaneous speech analysis) and indirect (communicative development inventory) language measures at 2 on performances at 4 was tested.

RESULTS

Language performances at both ages were lower than non-verbal development. At 2, more than 50% of the group produced less than 50 words. At 4, impaired performances were observed in speech sound development and expressive morpho-syntax. Direct measures of Pre-syntactic development predicted later global language outcomes and Sentence Repetition. The number of consonants used at 2 was significantly related to Nonword Repetition at 4.

CONCLUSIONS

The study highlights the importance of early detection and careful follow-up for children with SCT.

Increased Intra-Subject Variability of Neural Activity During Speech Production in People with Autism Spectrum Disorder

Background

Communication difficulties are a core deficit in many people with autism spectrum disorder (ASD). The current study evaluated neural activation in participants with ASD and neurotypical (NT) controls during a speech production task.

Methods

Neural activities of participants with ASD (N = 15, M = 16.7 years, language abilities ranged from low verbal abilities to verbally fluent) and NT controls (N = 12, M = 17.1 years) was examined using functional magnetic resonance imaging with a sparse-sampling paradigm.

Results

There were no differences between the ASD and NT groups in average speech activation or inter-subject run-to-run variability in speech activation. Intra-subject run-to-run neural variability was greater in the ASD group and was positively correlated with autism severity in cortical areas associated with speech.

Conclusions

These findings highlight the importance of understanding intra-subject neural variability in participants with ASD.

Diagnosis and Treatment of Childhood Apraxia of Speech Among Children With Autism: Narrative Review and Clinical Recommendations

PURPOSE

Treatment for children with autism spectrum disorder (ASD) and low verbal ability is a largely neglected area of study. Existing research focuses on language abilities; however, a subset of children with ASD also has speech sound disorders (SSDs). The purpose of this tutorial is to provide clinicians with evidence-based recommendations to guide speech assessment and treatment among children with ASD, low verbal ability, and suspected childhood apraxia of speech (CAS).

METHOD

Multifaceted search procedures were used to identify studies that have assessed or treated speech sound production among children with ASD. A narrative review and synthesis of the literature is followed by practical clinical recommendations based on best available evidence.

CONCLUSIONS

It is critically important to consider all possible hindrances to the development of functional communication ability for children with ASD. Speech sound production has been identified as a key predictor of expressive language outcomes, yet there are very few studies that address assessment and treatment of SSDs among children with ASD. Less is known about the presentation of CAS among children with ASD and low verbal ability. More research is needed to determine whether existing speech assessment and treatment methods are appropriate for children with ASD, if modifications are needed, or if new methods should be designed.

Objective measurement of vocalizations in the assessment of autism spectrum disorder symptoms in preschool age children

Assessment of autism spectrum disorder (ASD) relies on expert clinician observation and judgment, but objective measurement tools have the potential to provide additional information on ASD symptom severity. Diagnostic evaluations for ASD typically include the autism diagnostic observation schedule (ADOS-2), a semi-structured assessment composed of a series of social presses. The current study examined associations between concurrent objective features of child vocalizations during the ADOS-2 and examiner-rated autism symptom severity. The sample included 66 children (49 male; M = 40 months, SD = 10.58) evaluated in a university-based clinic, 61 of whom received an ASD diagnosis. Research reliable administration of the ADOS-2 provided social affect (SA) and restricted and repetitive behavior (RRB) calibrated severity scores (CSS). Audio was recorded from examiner-worn eyeglasses during the ADOS-2 and child and adult speech were differentiated with LENA SP Hub. PRAAT was used to ascertain acoustic features of the audio signal, specifically the mean fundamental vocal frequency (F0) of LENA-identified child speech-like vocalizations (those with phonemic content), child cry vocalizations, and adult speech. Sphinx-4 was employed to estimate child and adult phonological features indexed by the average consonant and vowel count per vocalization. More than a quarter of the variance in ADOS-2 RRB CSS was predicted by the combination of child phoneme count per vocalization and child vocalization F0. Findings indicate that both acoustic and phonological features of child vocalizations are associated with expert clinician ratings of autism symptom severity. LAY SUMMARY: Determination of the severity of autism spectrum disorder is based in part on expert (but subjective) clinician observations during the ADOS-2. Two characteristics of child vocalizations-a smaller number of speech-like sounds per vocalization and higher pitched vocalizations (including cries)-were associated with greater autism symptom severity. The results suggest that objectively ascertained characteristics of children's vocalizations capture variance in children's restricted and repetitive behaviors that are reflected in clinician severity indices.

Speech Development Across Subgroups of Autistic Children: A Longitudinal Study

Subgroups of children with different speech profiles have been described however, little is known about the trajectories of speech development or stability of subgroups over time. This longitudinal study described both speech trajectories and subgroup stability of 22 autistic children, aged 2;0-6;11 years, over 12 months. Independent and relational speech analyses, vocabulary size and nonverbal communication were used in clustering. Results suggest varied speech trajectories, particularly for children with 'low language and low speech' at Time 1. Receptive vocabulary and consonant inventory at Time 1 may predict speech outcomes after 12 months. A small subgroup of children (n = 3) present with low expressive vocabulary and speech but higher receptive vocabulary and use of gestures. This unique profile remained stable.

Spoken Language Change in Children on the Autism Spectrum Receiving Community-Based Interventions

We assessed the spoken language of 73 preschool aged children on the autism spectrum receiving community-based early intervention at two time points, approximately 7 months apart. Using the Spoken Language Benchmarks, there was a small non-significant change in the proportion of children transitioning from below, to at or above, Phase 3 (word combinations). Using binomial regression, a model comprising seven of nine clinician-proposed child-related predictors explained 64% of the variance. None of the predictors were individually significant, although a large effect size (OR = 16.71) was observed for children's baseline rate of communicative acts. The findings point to substantial unmet clinical need in children with minimal verbal language, but also the relevance of clinician-proposed predictors of their spoken language outcomes.

Mechanisms by which Early Eye Gaze to the Mouth During Multisensory Speech Influences Expressive Communication Development in Infant Siblings of Children with and without Autism

Looking to the mouth of a talker early in life predicts expressive communication. We hypothesized that looking at a talker's mouth may signal that infants are ready for increased supported joint engagement and that it subsequently facilitates prelinguistic vocal development and translates to broader gains in expressive communication. We tested this hypothesis in 50 infants aged 6-18 months with heightened and general population-level likelihood of autism diagnosis (Sibs-autism and Sibs-NA; respectively). We measured infants' gaze to a speaker's face using an eye tracking task, supported joint engagement during parent-child free play sessions, vocal complexity during a communication sample, and broader expressive communication. Looking at the mouth was indirectly associated with expressive communication via increased higher-order supported joint engagement and vocal complexity. This indirect effect did not vary according to sibling status. This study provides preliminary insights into the mechanisms by which looking at the mouth may influence expressive communication development.

Speech Abilities in a Heterogeneous Group of Children With Autism

PURPOSE

This study aimed to provide detailed descriptive information about the speech of a heterogeneous cohort of children with autism spectrum disorder (ASD) and to explore whether subgroups exist based on this detailed speech data. High rates of delayed and disordered speech in both low-verbal and high-functioning children with ASD have been reported. There is limited information regarding the speech abilities of young children across a range of functional levels.

METHOD

Participants were 23 children aged 2;0-6;11 (years;months) with a diagnosis of ASD. Comprehensive speech and language assessments were administered. Independent and relational speech analyses were conducted from single-word naming tasks and spontaneous speech samples. Hierarchical clustering based on language, nonverbal communication, and spontaneous speech descriptive data was completed.

RESULTS

Independent and relational speech analyses are reported. These variables are used in the cluster analyses, which identified three distinct subgroups: (a) children with high language and high speech ability (n = 10), (b) children with low expressive language and low speech ability but higher receptive language and use of gestures (n = 3), and (c) children with low language and low speech development (n = 10).

CONCLUSIONS

This is the first study to provide detailed descriptive speech data of a heterogeneous cohort of children with ASD and use this information to statistically explore potential subgroups. Clustering suggests a small number of children present with low levels of speech and expressive language in the presence of better receptive language and gestures. This communication profile warrants further exploration. Replicating these findings with a larger cohort of children is needed. Supplemental Material https://doi.org/10.23641/asha.16906978.

Predicting progress in word learning for children with autism and minimal verbal skills

Background

Approximately 30% of children diagnosed with autism remain minimally verbal past age 5. Interventions are often effective in increasing spoken communication for some of these children. Clinical and research decisions would be facilitated by identifying early indicators of progress in interventions. The purpose of this study was to investigate the relationship between speech sound measures obtained from the early phases of treatment and later treatment outcomes in children with autism and minimal verbal skills.

Methods

Twenty-three children (18 boys) between 5 and 9 years of age participated. We compared scores reflecting the phonemic features of word attempts produced during probes, and the number of correct words after 4 weeks of intervention to later word learning outcomes.

Results

Correlational and hierarchical regression analyses showed that both predictors were positively correlated with outcomes, but the phonemic scores were more strongly related than number of correct words.

Conclusion

We conclude that phonemic scoring may be a useful measure to determine proximal gains in a spoken word learning intervention. Proximal measures are particularly helpful when trying to decide if the current course of intervention should be maintained or altered.

Trial registration

https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=2&cx=-jg9qo3.

Autism-Centered Therapy for Childhood Apraxia of Speech (ACT4CAS): A Single-Case Experimental Design Study

Purpose A subset of children with autism spectrum disorder (ASD) has speech sound disorders, including childhood apraxia of speech (CAS). To date, virtually all speech treatment studies consider ASD an exclusionary criterion, resulting in little scientific evidence for treatment of CAS for children who also have ASD. This study proposes and tests a novel approach, Autism-Centered Therapy for Childhood Apraxia of Speech (ACT4CAS), as a theoretically and clinically informed speech treatment option for this population. Method Using a multiple-baseline design within and across participants, three children with co-occurring ASD and CAS received 11-18 treatment sessions. Treatment targets were individually designed and matched with untreated control words. Probes were administered at the start of each session to assess speech production accuracy perceptually. Changes in production accuracy were examined through visual inspection and quantified with effect sizes. Results Findings were mixed, with one child showing significant gains for half of the treated targets at follow-up and two children showing no clear improvement. Conclusions Preliminary evidence suggests potentially positive treatment effects for ACT4CAS when implemented as intended, although treatment intensity and disorder severity likely influence treatment outcome. Replication and comparison of ACT4CAS to other speech treatments is needed. Supplemental Material https://doi.org/10.23641/asha.14110445.

Identifying Childhood Expressive Language Features That Best Predict Adult Language and Communication Outcome in Individuals With Autism Spectrum Disorder

Purpose Several studies have reported that "useful speech" at 5 years of age predicts outcomes in individuals with autism spectrum disorder (ASD), but this skill has been vaguely defined. This study investigates which specific aspects of expressive language in children with ASD best predict adult language and communication outcomes. Method Language samples from 29 children (ages 47-72 months) enrolled in a longitudinal project (e.g., Lord et al., 2006) were transcribed and coded for spoken language features. Hierarchical linear regression was used to compare the following childhood variables as predictors of adult language and communication outcomes: noun diversity, verb diversity, mean length of utterance, and proportion of utterances that were socially motivated. Results Childhood verb diversity was a value-added predictor of all four adult outcome measures (i.e., verbal IQ, Autism Diagnostic Observation Schedule Communication + Social Interaction Algorithm totals, Peabody Picture Vocabulary Test scores, and Vineland Adaptive Behavior Scales Communication Domain scores), while noun diversity and proportion of utterances that were socially motivated were not value-added predictors of any adult outcome measures. In a second set of regression analyses, mean length of utterance was substituted for verb diversity and was a value-added predictor of two out of four adult outcome measures (i.e., verbal IQ and Vineland Adaptive Behavior Scales Communication Domain scores). The pattern of findings for the other predictors remained the same as in the previous analyses. Conclusion These results have implications for our understanding of early language in ASD and for clinical decision making in early childhood.

A Randomized Case Series Approach to Testing Efficacy of Interventions for Minimally Verbal Autistic Children

BACKGROUND

Randomized Controlled Trials (RCTs) are the gold standard for assessing whether an intervention is effective; however, they require large sample sizes in order to detect small effects. For rare or complex populations, we advocate a case series approach as a more realistic and useful first step for intervention evaluation. We consider the importance of randomization to such designs, and advocate for the use of Randomization Tests and Between Case Effect Sizes to provide a robust and statistically powerful evaluation of outcomes. In this tutorial, we describe the method, procedures, and analysis code necessary to conduct robust single case series, using an empirical example with minimally verbal autistic children.

METHOD

We applied a pre-registered (https://osf.io/9gvbs) randomized baseline design with between-case effect size to a case series (n = 19), to test the efficacy of a novel, parent-mediated, app-based speech production intervention (BabbleBooster) for minimally verbal autistic children. Parent-rated probe scores were used to densely sample performance accuracy over time.

RESULTS

Parents were able to reliably code their children's speech productions using BabbleBooster. A non-significant Randomization Test and small Between-Case Effect Size (d = 0.267), suggested there was no evidence that BabbleBooster improved speech production in minimally verbal autistic children, relative to baseline scores, during this brief period of intervention.

CONCLUSION

The current analyses exemplify a more robust approach to examining treatment effects in rare or complex populations, where RCT may be difficult or premature to implement. To facilitate adoption of this method by researchers and practitioners, we provide analysis code that can be adapted using open source R packages. Future studies could use this case series design to evaluate interventions aiming to improve speech and language outcomes for minimally verbal autistic children, and other heterogeneous and hard to reach populations.

Feasibility of an app-based parent-mediated speech production intervention for minimally verbal autistic children: development and pilot testing of a new intervention

BACKGROUND

Training speech production skills may be a valid intervention target for minimally verbal autistic children. Intervention studies have explored various approaches albeit on a small scale and with limited experimental control or power. We therefore designed a novel app-based parent-mediated intervention based on insights from the video modelling and cued articulation literature and tested its acceptability and usage.

METHODS

Consultation with the autism community refined the initial design and culminated in a pilot trial (n = 19) lasting 16 weeks. Participants were randomly allocated an intervention duration in an AB phase design and undertook weekly probes during baseline and intervention via the app. We evaluated the acceptability of the intervention via feedback questionnaires and examined the usability variables such as adherence to the testing and intervention schedule, time spent on the app and trials completed during the intervention phase.

RESULTS

High acceptability scores indicated that families liked the overall goals and features of the app. Ten participants engaged meaningfully with the app, completing 82% of the test trials and uploading data in 61% of intervention weeks; however, of these, only three met the targeted 12.5 min of intervention per week.

CONCLUSION

We discuss the possible reasons for variability in usage data and how barriers to participation could be surmounted in the future development of this intervention.

Brief Report: Socioeconomic Factors Associated with Minimally Verbal Status in Individuals with ASD

About 30% of adults with autism are minimally verbal. Past research suggested that after age five, few gain verbal fluency, but studies have rarely investigated whether family environmental factors contribute to the acquisition of verbal fluency. The present study utilized data from the Autism Diagnostic Interview-Revised to compare changes in verbal fluency for 404 individuals with autism from childhood to adolescence and adulthood. Socioeconomic factors were examined across fluency groups (i.e., those who did/did not achieve verbal fluency). Findings indicated that fully 60% of those who were minimally verbal in early childhood acquired verbal fluency in adolescence and adulthood. Parent socioeconomic status differed across fluency groups, suggesting the importance of environmental factors for individual development.