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The criteria for early use of nonvocal communication systems with nonspeaking autistic children.

Criteria to differentiate nonspeaking subjects from speaking autistic preschool-age children were examined. The data on several developmental features previously recorded at 4 1/2 years of age were compared between 10 nonspeaking and 10 speaking children who were followed until late childhood. Total DQ, subscale DQs of intellectual, self-care, and motor ability, and several speech production features (variety of phone categories, distortion in vowels, and disappearance of babbling) were the most distinctive indices between the two groups. We believe that an early use of a nonvocal communication system by autistic children with these features results in more successful outcomes than before.

Autistic Disorder↗

Sign language and multisensory input training of children with communication and related developmental disorders.

This report deals with the preliminary findings of a research project on simultaneous communication and multisensory input in the treatment of six autistic and communication disordered children. The children, aged 5 to 12, were taught manually signed English and speech using a multisensory-intrusion approach. The hypothesis was that such a technique would serve to alleviate the children's difficulties in information processing, organization of experience, and affect. The dependent measures were behavioral ratings derived from both structured (teaching) and unstructured (free play) sessions. The results indicate that the children manifested a consistent acquisition of sign lanuage, which in some cases transferred into verbal communication skills. Moreover, statistical analyses of some of the observed socioaffective behaviors (i.e., nonsolitary play, interaction with peers and adults, exploration, and detachment) revealed tendencies supportive of the hypothesis. The variability of the data preclude any categorical statement in relation to the hypothesis. However, the preliminary results strongly support the continuation of the study.

Auditory Perception↗

The pre-linguistic autism diagnostic observation schedule.

The Pre-Linguistic Autism Diagnostic Observation Schedule (PL-ADOS) is a semistructured observation scale designed for use as a diagnostic tool for children less than 6 years old who are not yet using phrase speech and are suspected of having autism. The PL-ADOS takes approximately 30 minutes to administer and is appropriate for use with this population because of its emphasis on playful interactions and the use of toys designed for young children. Reliability studies indicated that both individual activity ratings and summary ratings could be reliably scored from videotaped assessments by naive raters. Additionally, PL-ADOS scores of nonverbal preschool-aged children referred for clinical diagnosis and classified on the basis of a diagnostic team's clinical judgment, clearly discriminated between autistic and nonautistic developmentally disabled children. The resulting diagnostic algorithm is theoretically linked to diagnostic constructs associated with ICD-10 and DSM-IV criteria for autism.

Autistic Disorder↗

The effects of self-instruction training on a deaf child's semantic and pragmatic production.

Effects of self-instruction training on the communication skills of a profoundly hearing-impaired child were studied. Self-instruction training included modeling a series of problem-solving steps in order to direct communication production. Communication production was operationalized as signed semantic and pragmatic functions. A multiple baseline was used to assess treatment and generalization (treatment variations of person and setting) effects. There was evidence to suggest that self-instruction was immediately effective on pragmatic behaviors but such behaviors were reduced when another person administered treatment. In contrast, self-instruction training had a gradual influence on semantic behaviors and those effects were maintained when treatment included a different person and setting. Implications of the clinical study were discussed.

Behavior Therapy↗

Teaching severely retarded persons to sign interactively through the use of a behavioral script.

The direct and generalized effects of a program for teaching severely mentally retarded individuals to sign interactively with one another in several social play situations was examined. As part of the teaching program, a behavioral script specifying the responses to be made was employed. The results indicated that participants showed an increase in their signing skills in a training play situation, generalized use of these skills in a second play situation, and maintained the trained skills over a two to four month period. Directions for future research are discussed.

Adolescent↗

Discordant mental and physical efforts in an autistic patient.

We investigated whether there was mental effort in response to verbal commands in a 16-year old girl with autism, a high degree of non-compliance with commands and symptoms of autonomic dysfunction by monitoring the brainstem autonomic tone during an attempt to perform isometric exercise. An index of cardiac vagal tone (CVT), cardiac sensitivity to baroreflex (CSB), heart rate (HR) and mean arterial blood pressure (MAP) were measured simultaneously. Physical non-compliance with our commands meant there was no force applied by the patient during the attempted exercise, but CVT and CSB were both reduced and sustained at very low levels throughout the attempt, while MAP and HR were increased concurrently to higher levels in the same period. This vagal withdrawal to allow concurrent increases in HR and MAP is an arousal response appropriate for isometric exercise, which is a sign of a positive mental effort to comply with our commands. These results demonstrate discordant mental and physical efforts in our patient. In this particular case, the physical inabilities in some instances could have been mislabelled as mental non-compliance due to autism. It would be worthwhile to investigate the prevalence of discordant mental and physical efforts in autism.

Adolescent↗

Using case study methods to investigate the effects of interactive intervention for children with autism spectrum disorders.

PURPOSE: The purpose of this multiple case study was to describe outcomes for three parents and their children following participation in a social interactive model of language intervention. More specifically, this study sought to clarify if changes in children's participation, engagement, and initiation of social interaction could be observed following an 11-week intervention. METHOD: Three preschool children with autism spectrum disorders and their mothers participated in an 11-week intervention program. The intervention taught parents to follow the children's lead, promote children's participation in routines, and model language at the children's level. Outcome measures included estimates of parents' responsive language input, and measures of children's rate of communication, number of engagements in social interaction, and initiations. RESULTS: The results indicated that all three mothers increased their responsive comments during play interactions and were rated as being more responsive on a rating scale. All three children evidenced positive outcomes in vocabulary and the number of engagements in social interaction. In addition, improvement was observed in social initiation skills for all three children. CONCLUSIONS: Increases in mothers' responsiveness and children's engagement in social interactions are consistent with the theoretical mechanisms of the social interaction model of language intervention. The results suggest that further randomized control trials of this intervention approach are warranted.

Autistic Disorder↗

Easily overlooked language disabilities during childhood and adolescence. A cognitive-linguistic perspective.

The population of individuals with LLD make up a heterogeneous group. The identification of individuals with LLD may vary depending on the type(s) and adequacy of the tests used. Assessment protocols for evaluating the language functioning of older school-aged and adolescent individuals are few and far between. This state of affairs necessitates speech-language pathologists to begin to develop a variety of informal tools to assess the higher level (and perhaps more subtle) language abilities of these individuals. Because language functioning entails the convergence of a variety of cognitive and linguistic processes, these informal protocols must be informed by the developmental literature so as to take into account both language-specific (e.g., lexical knowledge, syntactic structure, semantic complexity) and general cognitive processes. Careful task and process analyses must be done to characterize the language performance of any individual.

Adolescent↗

Twin language or phonological disorder?

The acquisition of language in the preschool years by multiple-birth children is often reported to be atypical. Some researchers have claimed that they use 'twin language', i.e. an autonomous language specific to a multiple-birth set. This claim was investigated by describing and comparing the phonological characteristics of the speech of 19 sets of two- to four-year-old multiple-birth children, and by measuring multiple-birth children's understanding of their twins' or triplets' context-free speech. The results indicated that multiple-birth children are prone to phonological disorder and consequently their speech is often unintelligible. Siblings' phonologies evidenced some similarities, although they were not identical. Multiple-birth children were better able to understand their siblings' mispronunciations than were other children of the same age, although that understanding was dependent on how closely the error form resembled the adult form. While these three factors conspire to give the impression that 'twin language' is common, none of these findings provided support for the claim that multiple-birth children use an autonomous language.

Articulation Disorders↗

The role of parental input in the development of a morphological system.

In order to isolate the properties of language whose development can withstand wide variations in learning conditions, we have observed children who have not had access to any conventional linguistic input but who have otherwise experienced normal social environments. The children we study are deaf with hearing losses so severe that they cannot naturally acquire spoken language, and whose hearing parents have chosen not to expose them to a sign language. In previous work, we demonstrated that, despite their lack of conventional linguistic input, the children developed spontaneous gesture systems which were structured at the level of the sentence, with regularities identifiable ACROSS gestures in a sentence, akin to syntactic structure. The present study was undertaken to determine whether one of these deaf children's gesture systems was structured at a second level, the level of the gesture-that is, were there regularities WITHIN a gesture, akin to morphologic structure? We have found that (1) the deaf child's gestures could be characterized by a paradigm of handshape and motion combinations which formed a matrix for virtually all of his spontaneous gestures, and (2) the deaf child's gesture system was considerably more complex than the model provided by his hearing mother. These data emphasize the child's contribution to structural regularity at the intra-word level, and suggest that such structure is a resilient property of language.

Child, Preschool↗

Predictors and correlates of adaptive functioning in children with developmental disorders.

Autism is a developmental disorder marked by impairments in socialization, communication, and perseverative behavior and is associated with cognitive impairment and deficits in adaptive functioning. Research has consistently demonstrated that children with autism have deficits in adaptive functioning more severe than their cognitive deficits. This study investigates the correlates and predictors of adaptive functioning as measured by the Vineland Adaptive Behavior Scales in high- and low-functioning children with autism and their age and nonverbal IQ matched controls. Thirty-five 9-year-old children with high-functioning autism (HAD) were compared with 31 age-matched children with developmental language disorder (DLD), and 40 9-year-old children with low-functioning autism (LAD) were compared with 17 age-matched children with low IQ on adaptive functioning, IQ, autistic symptomology, and tests of language and verbal memory. Results indicate that both groups with autism were significantly impaired compared to their matched controls on Socialization and Daily Living, but not Communication and that these impairments were more pronounced in the HAD group than in the LAD group. Adaptive behavior was strongly correlated with autistic symptomology only in the HAD group. Regression analyses indicated that IQ was strongly predictive of adaptive behavior in both low-functioning groups, but tests of language and verbal memory predicted adaptive behavior in the higher functioning groups. Results suggest that IQ may act as a limiting factor for lower functioning children but higher functioning children are impaired by specific deficits, including autistic symptomology and impaired language and verbal memory.

Adaptation, Psychological↗

Brain mapping of language and auditory perception in high-functioning autistic adults: a PET study.

We examined the brain organization for language and auditory functions in five high-functioning autistic and five normal adults, using [15O]-water positron emission tomography (PET). Cerebral blood flow was studied for rest, listening to tones, and listening to, repeating, and generating sentences. The autism group (compared to the control group) showed (a) reversed hemispheric dominance during verbal auditory stimulation; (b) a trend towards reduced activation of auditory cortex during acoustic stimulation; and (c) reduced cerebellar activation during nonverbal auditory perception and possibly expressive language. These results are compatible with findings of cerebellar anomalies and may suggest a tendency towards atypical dominance for language in autism.

Adolescent↗

Theoretical and practical considerations in the psychological and educational assessment of the student with intractable epilepsy: dynamic assessment as an adjunct to static assessment.

Assessing the student with intractable epilepsy requires skill not only in evaluating cognitive problems, but also detecting seizures and discovering how to adapt instruction to minimize their negative impact on learning. Ironically, assessment efforts are seen as compromised by the occurrence of seizures during testing, when determining how seizure events may interfere with learning and the instructional modifications that are necessary to cope with them, should be a key part of assessment. A dual approach to assessment is recommended that combines the identification of cognitive deficits with an evaluation of how recurring seizures may prevent the student from engaging in instruction. Without also evaluating the student's response to instruction, teaching to specific cognitive needs is limited by insufficient knowledge about how to keep the student involved in instruction when seizures occur. Static assessment evaluates cognitive functioning at the time of testing, without changing the way that the student learns and responds. By engaging the student in teaching/learning sessions, dynamic assessment explores how the student best learns despite cognitive deficits and the disruptive effect of seizures. This paper includes a description of the authors'experience in using dynamic assessment as an adjunct to static assessment in evaluating a student with intractable epilepsy.

Child↗

Autism and autism risk in siblings of children with specific language impairment.

BACKGROUND: Several studies have shown that family members of children with autism have elevated rates of spoken and written speech and language problems. AIMS: This study asked whether there was also a greater rate of siblings with autism among probands with specific language impairment. METHODS & PROCEDURES: The probands in this study were 158 children with specific language impairment and 132 children with normal language status. These probands had 522 siblings who were examined for risk of autism using the Autism Behavior Checklist. Siblings found to be at risk were then examined using the Autism Diagnostic Interview--Revised and the Autism Diagnostic Observation Schedule-G. OUTCOMES & RESULTS: A concentration of siblings with risk for a diagnosis of autism was found in association with probands who had poor spoken language skills. Four siblings of the 522 (0.8%) met the diagnostic standards for autism. All the probands of these siblings had spoken language scores below -1 SD and three had diagnoses of spoken language impairment. CONCLUSIONS: These data provide additional support for a familial association between autism and spoken language impairment.

Autistic Disorder↗

Infantile autism reviewed: a decade of research.

Progress in the study of infantile autism over the past 10 years was reviewed in terms of classification and diagnosis, relation to other disorders, demographics, parental characteristics, genetics, intelligence, language, perceptual processes, behavioral characteristics, neurobiological, biochemical and pharmacological aspects, behavioral/educational treatment methodologies, prognosis, and theoretical considerations. This decade's research led to the now generally accepted position that infantile autism is a type of developmental disorder accompanied by severe and, to a large extent, permanent intellectual/behavioral deficits. However, its relationship to other forms of developmental disorders and to mental retardation remains to be delineated. Perceptual/cognitive/language defects appear central to the autistic syndrome, but the specific underlying mechanisms are unknown. Most studies indicate that autistic children have more signs of brain dysfunction than do normal children and about the same number as mentally retarded children. The overwhelming evidence suggests that te treatment of choice for maximal benefit to autistic children is a systematic, intrusive behavioral/educational approach. Yet, in spite of significant gains in almost all children treated, the typical prognostic picture is poor in terms of achieving self-supportive adulthood. The parents of autistic children have been found to be essentially similar to parents of children with organic brain disorders, and manifest no psychopathology which conceivably could induce the disorder. The vast majority of theoretical articles appearing in the 1970s proposed some from of neurobiological defect as the causative factor in autism. One of the major goals for future research is to undertake more extensive comparative studies on nonautistic brain dysfunctional children and autistic children that could yield cleared differential behavioral profiles and testable neurobiological hypotheses.

Autistic Disorder↗

Elective mutism: an analysis of 100 cases.

OBJECTIVE: An extended series of 100 children with elective mutism (EM) was clinically analyzed. METHOD: The total sample included two subgroups of clinically referred children at different locations and a subgroup of nonreferred children with EM. The study was based on comprehensive item sheets and, in the nonreferred sample only, the Child Behavior Checklist. RESULTS: EM is a rare disorder in the referred child psychiatric samples. It typically starts at preschool age, is more common in girls, and is seen in all social strata. A background of migration and early developmental risk factors is also quite common. Premorbid speech and language disorders play a role in one third of the clientele, and three quarters of children with EM had behavioral abnormalities during infancy and preschool age. School and unfamiliar people create the social context in which children with EM most frequently do not speak. Shyness and internalizing behavior problems are the most common personality features in EM, and comorbid diagnoses are quite frequent. CONCLUSION: This large series of affected children has identified the most typical features of EM and thereby extends the limited knowledge of this rare disorder of childhood.

Adolescent↗

Understanding childhood language disorders.

Developmental language disorders exist in 5% to 10% of preschoolers and have strong genetic implications. There are several variants of dysphasia: mixed receptive/expressive, expressive, or higher order language processing. Preschool children with pervasive developmental disorders are dysphasic as well as autistic. Some undergo a language and behavioral regression, most often as toddlers. The role of subclinical epilepsy in this regression is unknown because it is often ignored. Most dysphasic children speak by schoolage but are at substantial risk for reading/academic difficulty. Powerful new techniques to image the brain during language have no place in the routine workshop of children with dysphasia with or without autism.

Autistic Disorder↗