Autistic Preschool Research Articles

Automated segmentation of child-clinician speech in naturalistic clinical contexts.

Computational approaches hold significant promise for enhancing diagnosis and therapy in child and adolescent clinical practice. Clinical procedures heavily depend n vocal exchanges and interpersonal dynamics conveyed through speech. Research highlights the importance of investigating acoustic features and dyadic interactions during child development. However, observational methods are labor-intensive, time-consuming, and suffer from limited objectivity and quantification, hindering translation to everyday care. We propose a novel AI-based system for fully automatic acoustic segmentation of clinical sessions with autistic preschool children. We focused on naturalistic and unconstrained clinical contexts, which are characterized by background noise and data scarcity. Our approach addresses key challenges in the field while remaining non-invasive. We carefully evaluated model performance and flexibility in diverse, challenging conditions by means of domain alignment. Results demonstrated promising outcomes in voice activity detection and speaker diarization. Notably, minimal annotation efforts -just 30 seconds of target data- significantly improved model performance across all tested conditions. Our models exhibit satisfying predictive performance and flexibility for deployment in everyday settings. Automating data annotation in real-world clinical scenarios can enable the widespread exploitation of advanced computational methods for downstream modeling, fostering precision approaches that bridge research and clinical practice.

Effects of Difficulties in Executive Functions on Behavioral and Adaptive Problems in Italian Autistic Preschoolers.

To describe the relationship between executive functions (EF) and symptom's severity, behavioral problems, and adaptive functioning in autistic preschoolers. Seventy-six autistic preschoolers (age-range: 37-72 months; SD: 8.67 months) without intellectual disability were assessed. Executive functions were measured by both performance-based (Battery for Assessment of Executive Functions -BAFE-) and indirect measures (Behaviour Rating Inventory of Executive Function - Preschool Version -BRIEF-P); adaptive skills were assessed using the Vineland Adaptive Behavior Scales Second Edition (VABS-II); ASD severity was evaluated through the ADOS-2 and the SCQ; the Child Behavior Checklist (CBCL ½-5) questionnaire was used to describe the emotional/behavioral profile. A considerable rate of autistic preschoolers showed weaknesses in one or more measures of EF, in particular in inhibition and working memory at both performance-based and parent report measures. EF measures explained a significant proportion of variance in the emotional/behavioral profile, and in the adaptive skills, particularly in the socialization domain. Specifically, the most relevant EF predictors are Inhibition, Emotional Control and Cognitive Flexibility subscales of the BRIEF-P. Assessment of EF in autistic preschoolers may identify those children at higher risk for emotional/behavioral problems and adaptive difficulties. EF are a crucial target for early intervention in preschoolers with autism with the potential to improve child outcomes.

Dysregulation Profile in Preschoolers with Autism Spectrum Disorder: An Italian Multi-Center Perspective.

Background/Objectives: Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition characterized by social communication impairments and repetitive behaviors. Recent reports show that one in thirty-six 8-year-old children are autistic, signifying a considerable public health concern. According to previous studies, emotional dysregulation (ED) affects 50-60% of individuals with ASD and includes symptoms such as poor emotional control, heightened reactivity, and a low frustration tolerance. The main aims of the current study are to investigate the prevalence of ED among autistic preschoolers (below 6 years of age) and to assess the impacts of gender and intellectual disability on their emotional dysregulation profile. Methods: Data have been collected from three children's research hospitals in Italy (IRCCS Stella Maris Foundation, Stella Maris Mediterraneo Foundation, and IRCCS Bambino Gesù). Parents of 825 autistic pre-schooled children (mean age: 39.68 months, SD: 10.51 months) completed a general questionnaire and the Child Behaviour Checklist (CBCL), a reliable caregiver-reported assessment tool which provides a dysregulation profile. Results: A total of 30% of the children displayed a severe-to-moderate ED (emotional dysregulation) profile, with these children exhibiting significantly higher emotional-behavioral problems compared to those without ED. Males with ED exhibited greater emotional reactivity than females with ED. However, no significant relationships were found between ED and age, autism severity (ADOS-2), or intellectual disability. Conclusions: The results underline the importance of early, tailored interventions to face emotional challenges in young children with ASD, potentially improving long-term outcomes for this population.

Developmental and Functional Outcomes Amongst Culturally and Linguistically Diverse Autistic Children.

Children typically learn by attending to other people. Autism traits may impact access to social stimuli fundamental to early learning, increasing children's likelihood of a learning disability. Recent reports have highlighted that Autistic children from minority backgrounds have a higher likelihood of co-occurring intellectual disability. This study aimed to firstly confirm that early autism traits are concurrently and prospectively associated with lower developmental quotients, and secondly to examine the developmental and functional gains in Culturally and Linguistically Diverse (CALD) and non-CALD Autistic children following one year of Group-based Early Start Denver Model (G-ESDM). Secondary data on 114 non-CALD and 91 CALD Autistic preschoolers receiving the G-ESDM was utilised to address the study aims. Children were administered the Autism Diagnostic Observation Schedule (ADOS) at entry into the service. The Mullen Scales of Early Learning and the Vineland Adaptive Behaviour Scales-II were administered at both entry (Time 1) and 12 months later (Time 2). While no concurrent associations were found between autism traits and Developmental Quotient (DQ), significant associations were found prospectively with ADOS scores at Time 1 and DQ at Time 2, holding for both groups after controlling for DQ at Time 1. Autistic children made significant gains in cognition and functional behaviour following one year of early therapy, with no differences between the two groups. The results indicate that young Autistic children make significant gains in early development and add to the sparse research on the developmental and functional outcomes of Autistic children from CALD communities.

A Protocol for Basketball as Inclusive Sport to Boost Motor and Social Skills in Autistic Preschoolers

This paper presents the Early Basketball Protocol, a sports-based intervention designed to improve motor and socio-emotional skills in autistic preschoolers. Recognizing the paucity of sports protocols for younger autistic children, we developed this protocol using basketball rules to foster an inclusive setting where autistic preschoolers (n = 4) and their typically developing peers (n = 13) could engage in activities together. The protocol aims to simultaneously develop motor and socio-emotional skills through inclusive sports activities. Due to the COVID-19 pandemic, the effectiveness of the protocol was evaluated using parent-reported measures. A narrative approach synthesized the parental answers, and a pre–post-test analysis evaluated the preliminary application of the EB protocol based on parent-reported perceptions. Encouraging longitudinal results emerged, particularly in the improvement of socio-emotional skills for all participants. However, the early disruption of activities due to the pandemic may have contributed to the lack of improvement in gross motor skills. The paper discusses the practical implications of these findings and outlines future research directions, emphasizing the critical role of social inclusion.

Parent coaching to target language outcomes for Chinese-learning autistic preschoolers: A preliminary study

PurposeThe present study evaluates the preliminary effectiveness of a parent-implemented support program to enhance language outcomes in Chinese-learning preschoolers with a confirmed diagnosis or at elevated likelihood of autism, a lifelong neurodevelopmental condition. The program is delivered entirely online with the option of a group format. Because of cross-cultural differences in adult learning and parent-child interaction and because parent coaching programs for autism that are delivered online are only emerging, a specific study to evaluate the effectiveness of online support for Chinese families is warranted. MethodsA case control study with 22 families, 12 families in the Active support group and 10 in the Control group, was conducted. Families in the Active group attended 20 online lessons across 6 months in which they learned seven communication strategies to be implemented with their child at home. Extensive coaching and video feedback were provided. Before and after the online support, a 5 min parent-child interaction video collected at home via videoconferencing was used to code for mean length of utterances, type and token frequencies and percentage of pronoun production. ResultsAs revealed by the Wilcoxon Signed rank tests, the Active group showed significant support-related improvement on all language measures except for type token ratio, with effect sizes in at least the moderate range. The Control group did not show statistically reliable support-related changes. ConclusionsParent coaching delivered in an online mode and with the option of a group format is potentially effective in enhancing language outcomes for Chinese-learning autistic children. A larger-scale study based on these preliminary findings should be conducted.

Utilization of early therapeutic supports by autistic preschoolers in Australia: A cross-sectional study following implementation of the National Disability Insurance Scheme.

There are many types of support for young autistic children and their families, but service use in this population is not well understood. In this study, primary caregivers of autistic preschoolers were surveyed (n = 95) and a selection were then interviewed (n = 19) to understand how early, therapeutic supports were accessed by families in Australia following the establishment of a National Disability Insurance Scheme (NDIS). This article presents the quantitative data from surveys and interviews. Families usually accessed at least two types of support. The most accessed supports were occupational therapy, speech pathology and psychology, with 43% of the sample accessing some other form of support. Multiple linear regression indicated that children's higher level of support need, living in less remote or less socio-economically disadvantaged areas, and high household income were associated with higher numbers of supports accessed. Services tended to follow an individual, clinic-based model and little use of alternative service delivery was reported. The findings indicate that Australian families are accessing a wider range of support types than before the NDIS and children with more substantial autism-related support needs are likely to access a greater number of types of supports. Socio-economic inequities continue to exist and should be addressed.

Emotion dysregulation in autism: Severity and correlates in early childhood.

Emotion dysregulation (ED) is common and severe in older autistic youth, but is rarely the focus of early autism screening or intervention. Moreover, research characterizing ED in the preschool years (when autism is typically diagnosed) is limited. This study aimed to characterize ED in autistic children by examining (1) prevalence and severity of ED as compared to children without an autism diagnosis; and (2) correlates of ED in autistic children. A sample of 1864 parents (Mean child age = 4.21 years, SD = 1.16 years; 37% female) of 2-5 year-old children with (1) autism; (2) developmental concerns, but no autism; and (3) no developmental concerns or autism completed measures via an online questionnaire. ED was measured using the Emotion Dysregulation Inventory-Young Child, a parent report measure characterizing ED across two dimensions: Reactivity (fast, intense emotional reactions) and dysphoria (low positive affect, sadness, unease). Autistic preschoolers, compared to peers without developmental concerns, had more severe ED (+1.12 SD for reactivity; +0.60 SD for dysphoria) and were nearly four and three times more likely to have clinically significant reactivity and dysphoria, respectively. Autistic traits, sleep problems, speaking ability, and parent depression were the strongest correlates of ED in the autism sample. While more work is needed to establish the prevalence, severity, and correlates of ED in young autistic children, this study represents an important first step. Results highlight a critical need for more high-quality research in this area as well as the potential value of screening and intervention for ED in young autistic children.

Socio-Communicative Behaviors Involving Minimally Speaking Autistic Preschoolers and Their Typically Developing Peers: Effects of an Augmentative and Alternative Communication Intervention Package.

The purpose of this study was to examine the effectiveness of an augmentative and alternative communication (AAC) intervention package consisting of systematic instruction and aided AAC modeling with speech-output technology on the acquisition, maintenance, and generalization of socio-communicative behaviors in four minimally speaking, preschool-aged, autistic children. A multiple-probe design across behaviors (i.e., initiating a request for a turn, answering questions, and commenting) replicated across participants was implemented to evaluate the effects of the intervention package on socio-communicative behaviors. Furthermore, a pretreatment and posttreatment multiple-generalization-probe design was used to assess generalization across typically developing peers who were not a part of the intervention. Maintenance data were collected 3 weeks post intervention. Visual analysis, corroborated by nonoverlapping of all pairs statistics, established a strong functional relationship between the AAC intervention package and all targeted socio-communicative outcomes for two participants. For the other two participants, inconsistent intervention effects were observed. In terms of generalization from interacting with the researcher to typically developing peers, a functional relationship between the intervention and generalization outcomes for all targeted behaviors was established for only one participant (i.e., Aiden). The outcomes of this study suggest that aided AAC modeling and systematic instruction using a speech-output technology may lead to gains in socio-communicative behaviors in some minimally speaking, preschool-aged, autistic children. https://doi.org/10.23641/asha.27091879.

Sociodemographic and Clinical Profile of 915 Autistic Preschoolers Engaged in Intensive Early Intervention in Australia.

There is a paucity of information on the sociodemographic and clinical characteristics of autistic children with high support needs. This study aims to address this gap by profiling a cohort of 915 children enrolled in full-time early intervention for autism spectrum disorder (ASD) in Australia between 2012 and 2024. Intake questionnaires assessed the sociodemographic characteristics of families entering the service. Clinical measures included the Autism Diagnostic Observation Schedule (2nd ed.), Mullen Scales of Early Learning, and Vineland Adaptive Behaviour Scale (2nd and 3rd eds.). Family measures included the Parenting Stress Index (4th ed., Short Form) and Autism Family Experience Questionnaire. Results indicated a male to female ratio of 3.8:1, clear delays from the age of first concern to diagnosis and intervention, and notable proportions of culturally diverse families. While clinical data indicated cognitive and adaptive deficits beyond findings in other ASD studies, measures of stress and family experiences were comparable to other autism literature. By reporting these findings, this study aims to facilitate a more informed, tailored and nuanced approach to addressing the unique challenges faced by autistic children with high support needs. The scope and limitations of this cohort are discussed.

Prevention and Reduction of Anxiety in Autistic Preschoolers Through an Autism-Specific Parent-Mediated Intervention: A Pilot Randomised Controlled Trial Evaluating Short and Longer Term Outcomes.

Anxiety is a common co-occurring condition for autistic preschoolers. Whilst there has been extensive research evaluating anxiety prevention/reduction interventions for neurotypical preschoolers, such research is limited for autistic children. Fifty-seven parents of autistic 4-5-year olds, with varying levels of anxiety, participated in a randomised controlled trial of an autism-specific, parent-mediated intervention (CLK-CUES) to prevent or reduce anxiety in autistic preschoolers. Baseline, short-term (post-intervention) and longer term (12 months follow-up) assessments included child anxiety (ASC-ASD-P and PAS-R), intolerance of uncertainty, and parent well-being. (Trial registration ACTRN12620001322921). There were no reports of harmful effects of the intervention or trial. Linear mixed models show a significant group x time interaction for ASC-ASD-P Total score and the Uncertainty subscale with medium and large effect sizes. Post-hoc analyses show a significant decline for only the intervention group in anxiety (specifically, anxiety around uncertainty) from pre-post intervention, maintained at one year follow-up. There was no change on the PAS-R or other ASC-ASD-P subscales. CLK-CUES shows promise as a way to prevent and reduce anxiety in young autistic children, specifically anxiety related to uncertainty. Trials with larger samples are warranted. Findings also highlight the importance of using measures designed for autistic children.

Uh and um in autism: The case of hesitation marker usage in Dutch-speaking autistic preschoolers.

English-speaking autistic children use the hesitation marker um less often than non-autistic children but use uh at a similar rate. It is unclear why this is the case. We employed a sample of Dutch-speaking children from the Preschool Brain Imaging and Behavior Project to examine hesitation markers in autistic and non-autistic preschoolers with the aim to 1) make a crosslinguistic comparison of hesitation marker usage and 2) examine hypotheses regarding the underlying linguistic mechanisms of hesitation markers: the symptom hypothesis and the signal hypothesis. We found initial group differences in all hesitation markers but these results were rendered insignificant after controlling for age, sex and nonverbal cognition. We found significant correlations between hesitation marker usage and expressive and receptive language, but not autism traits. Lastly, we show interesting cross-linguistic differences in hesitation marker usage between Dutch-speaking participants and previously described English-speaking participants, such as a preference for um over uh.

Predictors of Change in Wellbeing and Mental Health of Parents of Autistic Pre-Schoolers.

Parenting is a rewarding experience but is not without its challenges. Parents of Autistic children face additional challenges, and as a result can experience lower levels of wellbeing and more mental health problems (i.e., depression, anxiety, stress). Previous studies have identified concurrent correlates of wellbeing and mental health. However, few have investigated predictors of subsequent wellbeing and mental health, or of change over time, among parents of pre-school aged autistic children. We examined child-, parent-, and family/sociodemographic factors associated with change in parents' mental health and wellbeing across three timepoints (spanning approximately one year) among 53 parents of Autistic pre-schoolers (M = 35.48, SD = 6.36months. At each timepoint, parents reported lower wellbeing and greater mental health difficulties compared to normative data. There was no significant group-level change over time in parent outcomes. However, individual variability in short-term (~ 5months) wellbeing and mental health change was predicted by a combination of child- and parent-related factors, while variability in medium-term (~ 10months) change was predicted by parent factors alone. Parents' description of their child and their relationship predicted change in both wellbeing and mental health. Furthermore, participating in a parent-mediated intervention (available to a subgroup) was a significant predictor of change in wellbeing. Our findings highlight potentially modifiable factors (e.g., learning healthier coping strategies) that may positively impact both short- and medium-term change in parental outcomes.

"Can I Play Too?" A Qualitative Study of Outdoor Play and Participation Among Autistic Preschoolers.

Outdoor play in homes, schools, and communities provides children with unique opportunities to explore their worlds, develop fundamental life skills, and experience belonging. However, few studies have explored outdoor free play among autistic preschoolers in natural settings from a neurodivergent-informed perspective. To explore the play preferences, opportunities, and challenges in outdoor play for autistic preschoolers. In this qualitative study, the authors used a multimethod approach to data collection using visual, verbal, and projective techniques and thematic analysis to identify and describe outdoor play occupation as expressed by autistic preschoolers. Home, community, and preschool environments in a city in Ireland. Seven autistic children and their parents, from seven diverse preschool settings in Ireland. Two overarching themes were identified: (1) outdoor play preferences and meaning and (2) the physical and social environments of outdoor play. The findings suggest that autistic preschoolers demonstrate distinctive play styles and preferences when playing freely outdoors, with physical and social barriers to outdoor play existing in community and educational contexts. The findings suggest that autistic preschoolers' outdoor play styles and preferences require support from adult advocates. Although the importance of relationships and social play cannot be overlooked, infrastructural accommodations for parents and schools are required if we are to create supportive and inclusive outdoor play environments and opportunities for freedom of expression for autistic children. Plain-Language Summary: This study explored the distinctive outdoor play preferences, opportunities, and challenges for autistic preschoolers. The findings show that autistic preschoolers face physical and social barriers to outdoor play and that they need parents, schools, and communities to create supportive and inclusive play environments and opportunities for freedom of expression.

Enhancing language development in autistic preschoolers through corrective interventions

Enhancing language development in autistic preschoolers through corrective interventions

Early trajectories and moderators of autistic language profiles: A longitudinal study in preschoolers.

Language development can greatly vary among autistic children. Children who struggle with language acquisition often face many challenges and experience lower quality of life. However, little is known about the early language trajectories of autistic preschoolers and their moderators. Autistic language can be stratified into three profiles. Language unimpaired experience little to no language difficulties; language impaired show significant difficulties in language; minimally verbal never develop functional language. In this study, we used a longitudinal sample of preschoolers with autism and with typical development (aged 1.5-5.7 years). We replicated the three language profiles through a data-driven approach. We also found that different factors modulated the language outcome within each group. For instance, non-verbal cognition at age 2.4 moderated the participants' attribution to each language profile. Moreover, early intervention moderated verbal outcome in the language impaired profile. In conclusion, we provided a detailed description of how autistic preschoolers acquire language, and what factors might influence their trajectories. Our findings could inspire more personalized intervention for early autistic language difficulties.

Autistic preschoolers display reduced attention orientation for competition but intact facilitation from a parallel competitor: Eye-tracking and behavioral data.

Recent research suggests that we might have underestimated the social motivation of autistic individuals. Autistic children might be engaged in a social situation, even if they seem not to be attending to people in a typical way. Our study investigated how young autistic children behave in a "parallel" situation, which we call "parallel competition," where people participate in friendly contests side-by-side but without direct interaction. First, we used eye-tracking technology to observe how much autistic children pay attention to two video scenarios: one depicting parallel competition, and the other where individuals play directly with each other. The results showed that autistic children looked less toward the parallel competition video than their typically developing peers. However, when autistic children took part in parallel competitions themselves, playing physical and cognitive games against a teacher, their performance improved relative to playing individually just as much as their typically developing peers. This suggests that even though autistic children pay attention to social events differently, they can still benefit from the presence of others. These findings suggest complementing traditional cooperative activities by incorporating parallel activities into educational programs for young autistic children. By doing so, we can create more inclusive learning environments for these children.

Self-Regulation and Academic Learning in Preschoolers with Autism Spectrum Disorder: Links to School Engagement and Levels of Autism Characteristics.

Children with autism spectrum disorder often demonstrate self-regulation challenges and academic difficulties. Although self-regulation has been well documented as an important factor for academic achievement in neurotypical children, little is known about how it is related to academic learning in autistic children, especially during preschool, a critical developmental period for both emergent academic skills and self-regulatory abilities. It is also unclear whether school engagement or autism characteristics influence the relation between self-regulation and academic learning in autistic children during preschool. Thirty-two autistic preschoolers participated in this study. Direct measures and parent reports were used to measure three dimensions of self-regulation, including executive function, effortful control, and emotion regulation. Classroom-based data from multiple academic programs were used to reflect their average rates of achieving new literacy and mathematics learning goals. Teachers reported the participants' levels of school engagement, and their autism characteristics were measured directly. Emotion regulation was significantly linked to the rate of meeting literacy learning goals in autistic preschoolers, whereas multiple executive function skills, including inhibitory and attentional control and working memory, were associated with their mathematics learning rate. Emotion regulation demonstrated a stronger association with literacy learning when autistic children were more engaged in classroom activities. Levels of autism characteristics did not mediate or moderate the association between self-regulation and academic learning. Future interventions and teaching should consider fostering self-regulation and facilitating school engagement for autistic preschoolers besides targeting their learning performance on specific academic content to promote their current and future academic success.

An Evaluation of Child and Parent Outcomes Following Community-Based Early Intervention with Randomised Parent-Mediated Intervention for Autistic Pre-Schoolers

BackgroundAs autistic children are being diagnosed at a younger age, the need to identify appropriate early supports has increased. Therapist-delivered and parent-mediated autism intervention may benefit children and parents.ObjectiveThis pilot study examined developmental outcomes for autistic pre-schoolers and mental health and wellbeing outcomes for their parents (n = 53) following a 10-month intervention period.MethodsAll families were accessing therapist-delivered interventions—the Early Start Denver Model (ESDM) or usual community services—and some families also received additional parent-coaching ESDM (P-ESDM). Families were assessed at 3 timepoints.ResultsOverall children made significant gains in cognitive skills and adaptive behaviour, with no differences between groups. Parents overall reported increased parenting stress over time. P-ESDM conferred no added benefit for child outcomes, and similarly, no clear benefit for parent outcomes.ConclusionsOur findings suggest that children receiving early intervention make developmental gains, regardless of type of intervention, and challenges assumptions that, as an adjunct to other intervention programs, P-ESDM improves child or parent outcomes. Further research is needed to explore the effects of parent-mediated programs.

Feasible Peer-Mediated Intervention for Autistic Children Using Minimal Speech: A Qualitative Intervention Development Process.

Qualitative engagement with stakeholders in the development of interventions can provide insight into strategies to maximize feasibility in real-life settings. We engaged stakeholders (autistic adults, early childhood educators, early childhood sector leaders and policy influencers, parents of autistic children, and speech-language pathologists) to inform the development of an educator-led peer-mediated intervention (PMI) for autistic preschoolers who use minimal speech that is feasible to implement in inclusive early childhood education and care (ECEC) settings. A qualitative iterative intervention design process was utilized. Stakeholders (N = 15) attended an online workshop and completed a document review exploring the acceptability and feasibility of the proposed embedded PMI. A two-step analysis procedure using the Theoretical Domains Framework and template analysis was conducted to identify the barriers, enablers, and supports to the implementation of embedded PMI in early childhood settings. While embedded PMI was unanimously acceptable to stakeholders, several participants expressed concerns regarding feasibility. Barriers to the successful integration and implementation of PMI in inclusive preschool contexts included access to skills, knowledge, and resources. Participants identified strategies to overcome modifiable barriers and to enhance the existing enablers. These strategies are reflected in the following themes: build on the familiar, build capacity in augmentative and alternative communication, adopt a whole center approach, adapt to meet the needs of the ECEC setting, and engage in proactive implementation. To address barriers to the implementation of embedded PMI, action is needed at various levels: macro (national/policy), meso (organization/setting), and micro (individual). https://doi.org/10.23641/asha.25155770.