Use of a Novel Tele-Assessment Tool for the Identification of Autism in Preschool-Aged Children.

Natural language sampling (NLS) is a common methodology in research and clinical practice used to evaluate a child's spontaneous spoken language in a naturalistic context. Autism spectrum disorder (ASD) is a complex neurodevelopmental condition that results in heterogeneous language profiles. NLS has emerged as a useful method for better understanding language use and development in this population. Prior work has examined the effects that contexts (e.g., home, lab) and conversational partners (e.g., examiner, parent) have on childrens language production, but less is known about remote collection of interactions between parents and children with ASD at home. Increasing our understanding of in-home remote NLS with children with ASD will improve naturalistic approaches to language assessment in children with ASD. We analyzed natural language samples of 90 dyads of parents and four- to seven-year old children with ASD collected remotely in the home using items and activities from the family's own home. The 15-min parent-child interactions were transcribed and analyzed for the child's language level measured by the number of different words. We examined the range of activities and the relationship between activities and the child's language level. We found that in-home parent-child activities fell into 13 descriptive categories, but we found no significant difference in child's language level (measured by the mean number of different words) across activities. We found that dyads involving children with higher language levels engaged in significantly fewer different activities compared to children with lower language levels. We found no difference in the number of different words elicited in the five most frequent activities in our sample. These results support the feasibility of remote in-home language sampling. While the types of activities that parent-child dyads engaged in did not affect the richness of language elicited, the number of different activities was associated with the child's language level. Allowing parents to steer children with lower language levels toward more different activities may allow children with lower language to more fully demonstrate their spoken language abilities.

Disfluencies can be classified as stuttering-like disfluencies (SLDs) or typical disfluencies (TDs). Dividing TDs further, stalls (fillers and repetitions) are thought to be prospective, occurring due to planning glitches, and revisions (word and phrase revisions, word fragments) are thought to be retrospective, occurring when a speaker corrects language produced in error. In the first study assessing stalls, revisions, and SLDs in matched groups of children who stutter (CWS) and children who do not stutter (CWNS), we hypothesized that SLDs and stalls would increase with utterance length and grammaticality but not with a child's expressive language level. We expected revisions to be associated with a child having more advanced language but not with utterance length or grammaticality. We hypothesized that SLDs and stalls (thought to be planning-related) would tend to precede grammatical errors. We analyzed 15,782 utterances from 32 preschool-age CWS and 32 matched CWNS to assess these predictions. Stalls and revisions increased in ungrammatical and longer utterances and with the child's language level. SLDs increased in ungrammatical and longer utterances, but not with overall language level. SLDs and stalls tended to occur before grammatical errors. Results suggest that both stalls and revisions are more likely to occur in utterances that are harder to plan (those that are ungrammatical and/or longer) and that, as children's language develops, so do the skills they need to produce both stalls and revisions. We discuss clinical implications of the finding that ungrammatical utterances are more likely to be stuttered.

Previous research links resting frontal gamma power to key developmental outcomes in young neurotypical (NT) children and infants at risk for language impairment. However, it remains unclear whether gamma power is specifically associated with language or with more general cognitive abilities among young children diagnosedwith autism spectrum disorder (ASD). The current study evaluates differences in resting frontal gamma power between young autistic and NT children and tests whether gamma power is uniquely associated with individual differences in expressive language, receptive language and non-verbal cognitive abilities in autistic and NT children. Participants included 48 autistic children and 58 age- and sex-matched NT children (ages 22-60months). Baseline electroencephalography (EEG) recordings were acquired from each participant. Children also completed the Mullen Scales of Early Learning (MSEL). We found thatfrontal gamma power at rest did not differ between autistic and NT children. Among autistic children, reduced frontal gamma power was significantly associated with both higher expressive language skills and higher non-verbal cognitive skills, controlling for age and sex. The interaction between frontal gamma power and diagnostic status no longer explained unique variance in expressive language skills after controlling for variance associated with non-verbal cognitive skills across autistic and NT children. Together, these findings suggest that reduced gamma power is associated with both better expressive language and non-verbal cognitive skills among young autistic children. Moreover, associations between high frequency neural activity and cognition are not specific to verbal abilities but reflect neural mechanisms associated with general higher-order cognitive abilities in ASD.

Language development in children with autism is influenced by proximal (e.g., parent language input) and distal (e.g., socioeconomic status) environmental constructs. Studies have found that "rich and responsive" parent language input supports autistic children's language development, and recent work has reported positive associations between measures of socioeconomic status (SES) and child language skills. However, little is known about how these proximal and distal environmental constructs interact to shape language development in autism. In a sample of 74 autistic school-aged children, the present study investigated the associations among measures of SES, the quantity and quality of language produced by parents and children during home-based dyadic parent-child interactions, and children's expressive and receptive language skills. Results showed that annual household income was positively associated with parent number of total words (NTW), parent number of different words (NDW), and parent mean length of utterance (MLU), while neither parent education level nor annual household income were significantly associated with measures of child language skills. Parent MLU was positively associated with child MLU and child expressive language skills. Findings suggest that annual household income may influence both the quantity and quality of parent language input, and that parent MLU, a qualitative measure of parent language input, may play a particularly important role in shaping autistic children's expressive language development. Future research should study longitudinal associations among SES, parent language input, and child language skills, as identifying environmental predictors of language skills in autism may facilitate the creation of more effective interventions that support language development.

Background and AimsMinimally verbal (MV) autistic children constitute a considerable portion of the autism spectrum, representing approximately one-third of the autistic individuals. Despite the urgency of understanding this population, relatively few studies have focused specifically on the language abilities of MV autistic children. This study aims to examine the language abilities of Greek-speaking preschool-aged MV children with autism prior to intervention. Specifically, we sought to identify the children's strengths and weaknesses across various language systems (receptive, expressive, and organizational) and modalities (phonological, semantic, and morphosyntactic), and also assess the influence of nonverbal intelligence (performance intelligence quotient [PIQ]) and age on their language performance.MethodsTwenty-six MV autistic preschoolers (mean age = 5;3) from Greece participated in the study. They were assessed using Level I of the LaTo tool, a standardized battery for evaluating language in young Greek-speaking children. The tool comprises 10 subtests covering expressive, receptive, and organizational language within the phonological, semantic, and morphosyntactic modality. Standard scores were compared across language systems (receptive, expressive, and organizational) and modalities (phonological, semantic, and morphosyntactic). Linear regression models were also used to evaluate the influence of age and PIQ on the children's language performance.ResultsThe children showed widespread difficulties across language systems and modalities. Performance was particularly low in expressive language and phonological awareness tests; however, MV children showed relatively better performance in receptive and organizational language, especially in tests that utilized visual support cues. Notably, performance in organizational language tests significantly exceeded performance in both expressive and receptive language tests. Regression analyses indicated a significant negative association between age and language performance across most domains, suggesting an age-related decline in the children's language abilities. No significant relationship was found between PIQ and language outcomes, indicating that nonverbal intelligence did not predict linguistic performance.ConclusionsThe study confirms that MV autistic children experience substantial but non-uniform language difficulties. While expressive and phonological skills were severely compromised, receptive and organizational language skills showed relative strengths, particularly when tests incorporated nonlinguistic knowledge and visual scaffolding. The negative effect of age on language performance underscores the risk of language deterioration over time for the specific population, while the lack of correlation between language performance and PIQ suggests that linguistic ability in MV autistic children is not tightly linked to their general cognitive function. The findings also reinforce the notion that language development in MV children is a heterogeneous process influenced by task effects.ImplicationsThe findings have significant implications for the design of language assessment and intervention strategies for MV children. Interventions that draw on semantic scaffolding and incorporate visual aids—such as picture-based communication tools—seem to be a promising approach to implement language treatment programs for the specific population. Also, the variability across language domains emphasizes the need for personalized intervention plans grounded in detailed language profiling rather than broad cognitive assessments. Finally, the results highlight the urgency of early identification and targeted support, and call for the development of standardized criteria for MV classification to facilitate cross-study comparability and improved clinical practices.

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.

Children with autism spectrum disorder (ASD) show differences in their communication development when compared to children who are typically developing and other clinical populations. In addition, children with ASD show divergence and delays in their expressive language when compared to each other, and a reported 30% do not develop spoken language even with access to early intervention. In order to support children with ASD in their communication development, there is a critical need for (a) detailed accounts of the emergence of expressive language for children receiving early intervention, (b) investigation of factors that might explain differences in expressive language abilities, and (c) investigation of sensitive predictors of expressive language change for children receiving early intervention. Children with ASD are often recommended augmentative and alternative communication (AAC) as part of early intervention to augment existing communication abilities, thus providing a complementary communication system while supporting early language development. Augmentative and alternative communication can be introduced as a focused intervention to target communication specifically, or it can be introduced as part of a comprehensive intervention program targeting multiple domains of learning. When used as part of a comprehensive intervention program, AAC is believed to support communication development broadly, including children’s use of spoken language. Despite emerging evidence for its effectiveness as a focused intervention and potential to support spoken language development within the context of comprehensive interventions, little research exists examining the mechanisms underpinning outcomes of AAC interventions. The current project aimed to address this gap by investigating both the emergence of expressive language in children with ASD, and factors underpinning concurrent and longitudinal expressive language abilities for children receiving an AAC-infused comprehensive intervention program. This research was conducted as a series of three studies: Study 1 investigated the communication profiles of 246 children with ASD upon entry and exit to a comprehensive early intervention program; Study 2 investigated mechanisms underpinning concurrent expressive language abilities, and Study 3 investigated predictors of longitudinal expressive language abilities, in 48 children with ASD receiving an AAC-infused comprehensive intervention program. The findings from Study 1 documented that 58.7% of children who started early intervention as minimally verbal remained minimally verbal after approximately 12 months of intervention, while 41.3% went on to develop phrase speech (using two-word phrases), highlighting an as yet unmet clinical need, as well as research need to understand these differences. The findings from Study 2 challenged previously held beliefs regarding word learning abilities in children with ASD, and extended on previous research by investigating the relationship between symbolic word learning and expressive language level. By focusing on processes that might be relevant to children’s development within interventions incorporating AAC, the findings from Study 3 provided preliminary data on the characteristics of children who might experience the largest gains in spoken language within AAC-infused comprehensive interventions. This research demonstrated a novel approach to investigating variability in expressive language development in children with ASD. The findings from this research demonstrate potential to explain some of the variability through analysis of social-cognitive learning processes that might help predict change within intervention. Finally, the findings of this research have potential to inform how researchers and clinicians approach individual differences in all children who present with complex developmental profiles.

Prelinguistic communication complexity refers to the use of different communication forms such as eye gaze, gestures and vocalisations and the degree to which these forms are coordinated and how directed to a communication partner. To date, little is known about the relationship between prelinguistic communication complexity and expressive language in minimally verbal autistic children. To test the hypothesis that prelinguistic communication complexity predicts expressive language 12 months later in autistic children and explore whether there are any differences in specific prelinguistic intentional communicative behaviours that are related to later expressive language levels. This longitudinal study examined 37 minimally verbal autistic children (29-71 months old). The Communication Complexity Scale (CCS) was used to measure participants' prelinguistic communication behaviours, which were extracted from a semi-structured play interaction at Time 1. The Chinese Communicative Development Inventory (CCDI) was used to examine participants' expressive language at Time 1 and Time 2 (12 months later). According to Time 2 vocabulary size, participants were divided into two groups: Low CCDI, between 0 and 62 words, and High CCDI, more than 100 words. Linear regression was used to examine the relationship between early prelinguistic communication complexity and later expressive language. Binary logistic regression was used to determine which of the early communication behaviours were uniquely significantly related to later expressive language levels. There was a significant positive relationship between prelinguistic communication complexity and expressive language 12 months later, even after controlling for age and concurrent language. Findings revealed a group difference in the frequency of gesture and vocalisation combinations between the Low and High CCDI groups at Time 1. Gesture-vocalisation combinations also predicted better expressive language levels at Time 2. Our findings suggest that it may be beneficial to incorporate different complex communication behaviours into prelinguistic intervention targets for minimally verbal autistic children. The CCS hierarchies can be used as a reference for the intervention goals of minimally verbal autistic children. These findings highlight the importance of targeting gesture and vocalisation combinations when autistic children transition from single prelinguistic communication behaviours to multimodal behaviours. What is already known on this subject Children use eye gaze, gestures and vocalisations to communicate with others before they learn spoken language. There is strong evidence suggest that the frequency of prelinguistic communication predicts later linguistic achievements in autistic children. However, less is known about whether prelinguistic communication complexity also predicts later language and which specific behaviours are most predictive of language outcomes. What this study adds Minimally verbal autistic children who exhibit more complex prelinguistic communication behaviours have better expressive language 12 months later. Gestures combined with vocalisations predict better expressive language in minimally verbal autistic children. What are the clinical implications of this work? When identifying intervention targets for minimally verbal autistic children, the clinicians may reference the prelinguistic communication behaviours from the CCS. The gesture and vocalisation combinations are the key behaviours when targets transit from single form to two-form behaviours.

Speech ability may limit spoken language development in some minimally verbal autistic children. In this study, we aimed to determine whether an acoustic measure of speech production, vowel distinctiveness, is concurrently related to expressive language (EL) for autistic children. Syllables containing the vowels [i] and [a] were recorded remotely from 27 autistic children (4;1-7;11) with a range of spoken language abilities. Vowel distinctiveness was calculated using automatic formant tracking software. Robust hierarchical regressions were conducted with receptive language (RL) and vowel distinctiveness as predictors of EL. Hierarchical regressions were also conducted within a High EL and a Low EL subgroup. Vowel distinctiveness accounted for 29% of the variance in EL for the entire group, RL for 38%. For the Low EL group, only vowel distinctiveness was significant, accounting for 38% of variance in EL. Conversely, in the High EL group, only RL was significant and accounted for 26% of variance in EL. Replicating previous results, speech production and RL significantly predicted concurrent EL in autistic children, with speech production being the sole significant predictor for the Low EL group and RL the sole significant predictor for the High EL group. Further work is needed to determine whether vowel distinctiveness longitudinally, as well as concurrently, predicts EL. Findings have important implications for the early identification of language impairment and in developing language interventions for autistic children.

The beginning of the preschool period (4-5 years) is a time of active formation and improvement of the neuropsychological mechanisms of the main linguistic levels of spoken language (phonological, lexical-semantic and grammatical) in their two main aspects - receptive (perception and processing of verbal information ) and expressive (language encoding and generation of independent utterances). However, the existing diagnostic procedures, both in Bulgaria and worldwide, mainly focus on the state of children‘s expressive language skills. The processes related to the perception and processing of linguistic information often remain outside the attention of specialists. The probable reason for this fact is that in the development of children‘s language, perception and understanding precede expressive abilities. This unproven claim directs researchers‘ attention to the realization of children‘s language skills at the expense of the state of impressive language. It is known that there are variants in which children remember and use „ pattern expressions“ without a sufficient degree of understanding. Incomplete decoding of grammatical forms is most fully highlighted in the process of speech therapy diagnostics and has a high prognostic value regarding both the oral and written language of children. In the literacy period, similar type of deficits have a negative impact on reading skills related to decoding and understanding of written texts. The difficulties multiply as the volume and complexity of the learning texts increase during the different stages of schooling. The diagnostic tools available in our country for assessing early language development mainly focus on the state of children‘s expressive language ability (as in Diagnostics and prevention of language 3 – 4, D.P.E. 3 – 4, Stoyanova, Yosifova, Poppandova, Netsova, 2010; VERBA-2, Andonova 2022a, 2022b). This explains the need to develop and test a detailed diagnostic model for evaluating receptive language abilities at the main levels of the language system – lexical, morphological and syntactic. The material presents the conceptual framework of the first in our country hierarchically structured Model for the evaluation of receptive language in children with typical development at the age of 4 – 5 years. The purpose of the model is to derive age norms for decoding and understanding the Bulgarian language, which have a high prognostic value for the early diagnosis and prevention of children at risk of future learning difficulties.

Mean length of utterance (MLU) is a common measure of expressive language complexity in young children, including autistic children. However, means, by nature, obscure some information about spread and variability in data. Thus, we aimed to examine a new approach to characterizing linguistic complexity in autistic children by investigating the validity of two novel measures-range of length of utterance (RLU), standard deviation of length of utterance (SDLU)-alongside established measures: MLU and total utterances (TU). Participants were 40 autistic children (12 girls, 28 boys; Mage = 41.78 months). Children participated in 10-min, play-based language samples with their caregivers. Language samples were transcribed and measures (MLU, TU, SDLU, and RLU) were derived. To examine the criterion validity of these measures, we used regression analyses to examine how well each measure explained variance in children's expressive language, as measured by the Preschool Language Scales-Fifth Edition (PLS-5). All measures (MLU, SDLU, RLU, and TU) significantly predicted PLS expressive language (ps < .001). Effect size comparisons revealed that all four predictors had large effect sizes (R2 > .6). In absolute terms, MLU had the smallest effect size (R2 = .682), followed by TU (R2 = .72) and RLU (R2 = .781), and SDLU had the largest effect size (R2 = .822). Findings suggest that these novel measures (SDLU and RLU) explained significant variance in children's expressive language, as measured by the PLS-5, as did MLU and TU. SDLU had the largest explanatory power, in absolute terms, followed by RLU and TU. MLU had the smallest effect size, indicating that it had the lowest explanatory power for explaining variance in children's expressive language as compared to the other three measures. Thus, examining spread and variability in utterance length data might provide important, previously overlooked, information about the complexity of autistic children's spoken language. https://doi.org/10.23641/asha.30559880.

Donepezil effects on language in children with Down syndrome: results of the first 22-week pilot clinical trial.

The aims of this article are twofold: (a) to offer a set of recommended measures that can be used for evaluating the efficacy of interventions that target spoken language acquisition as part of treatment research studies or for use in applied settings and (b) to propose and define a common terminology for describing levels of spoken language ability in the expressive modality and to set benchmarks for determining a child's language level in order to establish a framework for comparing outcomes across intervention studies. The National Institute on Deafness and Other Communication Disorders assembled a group of researchers with interests and experience in the study of language development and disorders in young children with autism spectrum disorders. The group worked for 18 months through a series of conference calls and correspondence, culminating in a meeting held in December 2007 to achieve consensus on these aims. The authors recommend moving away from using the term functional speech, replacing it with a developmental framework. Rather, they recommend multiple sources of information to define language phases, including natural language samples, parent report, and standardized measures. They also provide guidelines and objective criteria for defining children's spoken language expression in three major phases that correspond to developmental levels between 12 and 48 months of age.

Background Clinicians are concerned about differential diagnosis of autism from Disinhibited Social Engagement Disorder (DSED), as DSED is associated with maltreatment and autism is not. Language and social communication difficulties are common in maltreated children, but DSED is rarely identified within the maltreatment literature. It is unknown if/how the language profiles of children with DSED differ from autistic children. Objectives it was hypothesised that receptive and expressive language difficulties may present in DSED but pragmatic differences, associated with autism, may differentiate autism from DSED. METHODS: We conducted 2 studies: Study 1 compared the receptive vocabulary of 43 children with autism; 24 children with DSED and 37 typically developing (TD) children. Study 2, was an in-depth case series comparing the language profiles (receptive and expressive language and pragmatic language) of autistic children (n = 10) and children with DSED (n = 11), via standardised assessment, and Speech and Language Therapist (SLT) analysis of conversational speech. Results Receptive vocabulary did not significantly differ between groups, but autistic children had greater difficulty when semantic reasoning was required. Children with DSED had greater expressive language difficulties than autistic children (standardised and conversational assessment). While difficulties in narrative discourse overlapped between autism and DSED, other pragmatic language differences differentiated autism from DSED, when SLTs analysed conversational speech. Caregiver report did not identify these differences. Conclusions Maltreated children may present with DSED and are at higher risk of expressive and pragmatic language difficulties. However, observation of pragmatic language differences, associated with autism, may help differentiate autism from DSED.

We examined the associations of breastfeeding initiation and duration with language and motor skill development in a nationally representative sample of US children aged 10 to 71 months. Using cross-sectional data on 22399 children from the 2003 National Survey of Children's Health, we examined relationships between breastfeeding practices and children's language and motor skills development. Outcomes were based on each mother's response to questions regarding her level of concern (a lot, a little, not at all) about her child's development of expressive language, receptive language, fine motor skills, and gross motor skills. Breastfeeding data were based on mothers' recall. Methods of variance estimation were applied and multivariate polynomial regression modeling was done to estimate the effects of breastfeeding initiation and duration on children's development after adjustment for confounders. Mean age of the sample was 2.79 years; 67% were non-Hispanic white, 16% were Hispanic, and 9% were non-Hispanic black. Approximately 17% of mothers reported concerns about their child's expressive language development; approximately 10% had receptive language concerns; approximately 6% had concerns about fine motor skills; and 5% reported general motor skills concerns. Multivariate analysis revealed that mothers who initiated breastfeeding were less likely than mothers of never-breastfed children to be concerned a lot about their child's expressive and receptive language development and fine and general motor skills. Mothers of children breastfed 3 to 5.9 months were less likely than mothers of never-breastfed children to be concerned a lot about their child's expressive and receptive language and fine and general motor skills. As with all cross-sectional data, results should be interpreted with caution. Our findings suggest breastfeeding may protect against delays in young children's language and motor skill development. Fewer concerns about language and motor skill development were evident for children breastfed >or=3 months, and concerns generally decreased as breastfeeding continued >or=9 months.