Predictors of individual differences in minimally verbal peer communication exchanges following peer-oriented social intervention

School-age children on the autism spectrum who are minimally verbal (MVAS) use a limited repertoire of spontaneous communicative spoken words and reveal large heterogeneity in cognitive functioning. Despite the challenges to form peer social engagement posed by their unique social-communicative profile, few interventions have targeted peer interactions in the MVAS population. This study explored predictors of individual differences in treatment response among 54 school-age minimally verbal autistic children (8-16 years) following an RCT "school-based peer social intervention" (S-PSI) that compared two peer-oriented intervention modalities (conversation versus collaboration) versus a waitlisted control group. We examined autistic-symptom severity, age, verbal and nonverbal IQ, executive functions, and sensory-processing profile for their contribution to children's ability to form relevant spontaneous communication exchanges with a peer partner. Main findings revealed that larger deficits in sensory-processing (sensory-avoidance and sensory low-registration) and in executive functions contributed to greater growth in "relevant" (i.e., adequately attuned, participatory, reciprocal) communication following both interventions, but not for the waitlisted controls. Additionally, older participants with lower verbal and nonverbal IQ improved communication's relevancy more after the conversation intervention, whereas the collaboration intervention was more beneficial for younger participants. Lower autistic-symptom severity contributed to larger growth in relevancy for all groups. By identifying individual-level predictors of spontaneous, attuned, participatory, and reciprocal (i.e., "relevant") communication exchanges with peers, we optimized S-PSI personalization for this uniquely nonverbal, heterogeneous MVAS population. These new channels for tailoring peer interventions to better meet individuals' needs may result in reduced social isolation and loneliness and enhanced well-being.

Sequence Learning in Minimally Verbal Children With ASD and the Beneficial Effect of Vestibular Stimulation

People with autism spectrum disorder (ASD) and especially the minimally verbal, often fail to learn basic perceptual and motor skills. This deficit has been demonstrated in several studies, but the findings could have been due to the nonoptimal adaptation of the paradigms. In the current study, we sought to characterize the skill learning deficit in young minimally verbal children with ASD and explore ways for improvement. For this purpose, we used vestibular stimulation (VS) whose beneficial effects have been demonstrated in the typical population, but the data regarding ASD are limited. We trained 36 children ages 6-13 years, ASD (N = 18, 15 of them minimally verbal) and typical development (TD, N = 18), on a touch version of the visual-motor Serial-Reaction-Time sequence-learning task, in 10 short (few minutes) weekly practice sessions. A subgroup of children received VS prior to each training block. All the participants but two ASD children showed gradual median reaction time improvement with significant speed gains across the training period. The ASD children were overall slower (by ~250 msec). Importantly, those who received VS (n = 10) showed speed gains comparable to TD, which were larger (by ~100%) than the ASD controls, and partially sequence-specific. VS had no effect on the TD group. These results suggest that VS has a positive effect on learning in minimally verbal ASD children, which may have important therapeutic implications. Furthermore, contrary to some previous findings, minimally verbal children with ASD can acquire, in optimal conditions, procedural skills with few short training sessions, spread over weeks, and with a similar time course as non-ASD controls. Autism Res 2020, 13: 320-337. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Minimally verbal children with ASD who received specially adjusted learning conditions showed significant learning of a visual-motor sequence across 10 practice days. This learning was considerably improved with vestibular stimulation before each short learning session. This may have important practical implications in the education and treatment of ASD children.

Minimally verbal school-aged children with autism spectrum disorder: the neglected end of the spectrum

It is currently estimated that about 30% of children with autism spectrum disorder remain minimally verbal, even after receiving years of interventions and a range of educational opportunities. Very little is known about the individuals at this end of the autism spectrum, in part because this is a highly variable population with no single set of defining characteristics or patterns of skills or deficits, and in part because it is extremely challenging to provide reliable or valid assessments of their developmental functioning. In this paper, we summarize current knowledge based on research including minimally verbal children. We review promising new novel methods for assessing the verbal and nonverbal abilities of minimally verbal school-aged children, including eye-tracking and brain-imaging methods that do not require overt responses. We then review what is known about interventions that may be effective in improving language and communication skills, including discussion of both nonaugmentative and augmentative methods. In the final section of the paper, we discuss the gaps in the literature and needs for future research.