Abstract
ABSTRACTObjective:To review clinical and neurobiological features of minimally verbal children with autism spectrum disorder.Data source:We carried out a narrative review using the PubMed database. We considered the following search terms combined through the Boolean operator “AND”: “autism spectrum disorder”; “minimally verbal.”Data synthesis:To date, there is no shared definition of minimally verbal children with autism spectrum disorder. The heterogeneity in intellectual functioning and in linguistic abilities among these individuals suggests there is no single mechanism underlying their difficulties in learning to speak. However, the reasons why these children do not speak and the biological markers that can identify them are still unknown. Language impairment in these children can lead to several unfavorable consequences, including behavior problems (such as self-aggression, hetero-aggression, and property destruction), poorer daily living and social skills. Psychiatric comorbidities (including attention deficit/hyperactivity disorder, specific phobias, and compulsions) consist in a serious problem related to the lack of verbal language in individuals with autism spectrum disorder. Although in the literature there are very few evidence-based results, several findings suggest that an alternative and augmentative communication intervention, creating an extra-verbal communication channel, may be effective in these individuals.Conclusions:The exact definition, clinical characteristics, associated disorders, etiology, and treatment of minimally verbal subjects with autism spectrum disorder must still be further studied and understood.
Highlights
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),[1] the criteria for autism spectrum disorder (ASD) diagnosis include the presence of persisting deficits of social communication and social interaction in different contexts as well as patterns of restricted and repetitive behaviors, interests or activities
It is worth mentioning that the problem of communication in individuals with ASD is not limited to verbal language, and involves other areas of communication including mimicry and gestures
It is worth highlighting that the study methodology of a narrative review is more indicated than a systematic review in cases when the aim is to provide a broad perspective on a subject.[49]
Summary
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),[1] the criteria for autism spectrum disorder (ASD) diagnosis include the presence of persisting deficits of social communication and social interaction in different contexts as well as patterns of restricted and repetitive behaviors, interests or activities. About 25–30% of ASD children do not develop any functional verbal language or stay minimally verbal (MV).[3,4,5] That is, from an epidemiological point of view, in the general population the number of nonverbal or MV ASD children is not negligible at all. In the United States of America, ASD prevalence at the age of 8 years, according to DSM-5 criteria,[1] is 18.5 per 1,000 children, that is, 1 child out of 54 has an ASD.[6] it could be assumed that, at least in the USA, at the age of 8 years, about 5 out of 1,000 children (i.e., 1 out of 200) have an ASD and, at the same time, are nonverbal or MV. There is no exact and broad definition of MV in the field of ASD yet; in this review, the “MV” abbreviation will be used to refer to ASD children with completely absent speech
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