Abstract
BackgroundAn important minority of school-aged autistic children, often characterized as ‘nonverbal’ or ‘minimally verbal,’ displays little or no spoken language. These children are at risk of being judged ‘low-functioning’ or ‘untestable’ via conventional cognitive testing practices. One neglected avenue for assessing autistic children so situated is to engage current knowledge of autistic cognitive strengths. Our aim was thus to pilot a strength-informed assessment of autistic children whose poor performance on conventional instruments suggests their cognitive potential is very limited.MethodsThirty autistic children (6 to 12 years) with little or no spoken language, attending specialized schools for autistic children with the highest levels of impairment, were assessed using Wechsler Intelligence Scale for Children (WISC-IV), Raven’s Colored Progressive Matrices board form (RCPM), Children’s Embedded Figures Test (CEFT), and a visual search task. An age-matched control group of 27 typical children was also assessed.ResultsNone of the autistic children could complete WISC-IV; only six completed any subtest. In contrast, 26 autistic children could complete RCPM, with 17 scoring between the 5th and 90th percentile. Twenty-seven autistic children completed the visual search task, while 26 completed CEFT, on which autistic children were faster than RCPM-matched typical children. Autistic performance on RCPM, CEFT, and visual search were correlated.ConclusionThese results indicate that ‘minimally verbal’ or ‘nonverbal’ school-aged autistic children may be at risk of being underestimated: they may be wrongly regarded as having little cognitive potential. Our findings support the usefulness of strength-informed approaches to autism and have important implications for the assessment and education of autistic children.
Highlights
An important minority of school-aged autistic children, often characterized as ‘nonverbal’ or ‘minimally verbal,’ displays little or no spoken language
Many minimally verbal autistic children are characterized by marked atypicality and existing findings suggest they may be disadvantaged by tests which require typicality, such as commonly used Wechsler-type intelligence tests and Vineland-type adaptive or developmental tests [6,7]
The WISC-IV subtest completed by the highest number of autistic children was matrix reasoning, Figure 1 Example of visual search test trial
Summary
An important minority of school-aged autistic children, often characterized as ‘nonverbal’ or ‘minimally verbal,’ displays little or no spoken language. Autistic childrena who reach school age with little or no spoken language, and acquire labels such as ‘nonverbal’ or ‘minimally verbal’, have recently attracted concern as a neglected subgroup in autism research [1] Many such children are judged ‘low-functioning’ or ‘untestable’ through conventional assessments of cognitive abilities, on which they may not achieve even a basal score. Current expert opinion recommendations for assessing minimally verbal school-aged autistic children emphasize ‘core domains’ (language, social behaviors, repetitive behaviors), typicality (in development and range of abilities), and comprehensiveness [5] This kind of assessment may not be practical due to limited resources, Courchesne et al Molecular Autism (2015) 6:12 and further, may not alleviate the risk of being underestimated faced by children whose developmental paths and range of abilities are highly atypical. Even tests considered ‘well-suited for use with minimally verbal children’ ([5]; Tables one to six), such as picture vocabulary tests, may require specific typical abilities, such as the ability to reliably point, which some or many nonspeaking autistic children may lack [8]
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