Verbal Autistic Children Research Articles

Concurrent predictors of behavioral inflexibility in minimally verbal and verbal autistic children.

Behavioral inflexibility (BI) refers to the rigid and inflexible patterns of behaviors that are a core aspect of autism. Few studies have investigated BI in autism separately from other restricted and repetitive behaviors (RRBs). The present study used a relatively new measure, the behavioral inflexibility scale (BIS; Lecavalier, L., Bodfish, J., Harrop, C., Whitten, A., Jones, D., Pritchett, J., Faldowski, R., & Boyd, B. (2020). Autism Research, 13(3), 489-499), to examine the relationship of BI and variables that are both core symptoms in autism as well as symptoms associated with cooccurring mental health conditions, atypical sensory experiences, and adaptive functioning in a sample of 87 children with autism. Additionally, we aimed to understand how these relationships may be related to autistic individuals' verbal status: minimally verbal (MV) or verbal. Results revealed that anxiety, attention deficit/hyperactive, depressive, oppositional defiance problems, and sensory differences were all significantly correlated with BI in the MV group. In contrast, only anxiety, depressive, and oppositional defiance problems were significantly correlated with BI in the verbal group. Linear regression analyses showed that oppositional defiance problems and atypical sensory experiences explained a significant proportion of the variance of BI in the MV group, whereas only depressive problems were significant in the verbal group after accounting for other mental health conditions. Overall, our findings demonstrate that multiple aspects of psychopathology are significantly related to BI and can have broader implications for interventions and mental health care in autistic children.

The use of formal language as a strong sign of verbal autistic children in diglossic communities: The case of Arabic

AbstractThe current study aimed to investigate whether the use of formal language (Modern Standard Arabic [MSA]) by young children in diglossic Arab communities offers diagnostic insights, especially for verbal autistic children and to further explore this phenomenon. We used a cohort study design, with 4–6‐year‐old fluent first language Arabic‐speaking children attending Arabic Kindergartens in two representative Kuwait governates. Reported cases for MSA use were assessed via a computer‐based structured language test and corroborated cases were further assessed for exposure to sources of MSA, verbal IQ, temperamental characteristics, and autism spectrum disorder (ASD). Four children from the same class without developmental difficulties were selected for each MSA user as control group. The frequency of MSA use among verbal pre‐schoolers was 0.46%. Use of MSA did not correlate with parents' education, amount of exposure to MSA, verbal IQ, but with severity of ASD. Predicted probability of ASD in the presence of MSA was 0.86. Executive functions of ASD‐MSA users were similar to those of the control group and significantly higher than unselected autistic peers in the literature. The use of MSA has the potential to serve as a strong sign for the diagnosis of verbal autistic children, often missed or delayed in being diagnosed. We also discuss strategies via which language is acquired in ASD.

Does Gestural Communication Influence Later Spoken Language Ability in Minimally Verbal Autistic Children?

The current study examined the predictive role of gestures and gesture-speech combinations on later spoken language outcomes in minimally verbal (MV) autistic children enrolled in a blended naturalistic developmental/behavioral intervention (Joint Attention, Symbolic Play, Engagement, and Regulation [JASPER] + Enhanced Milieu Teaching [EMT]). Participants were 50 MV autistic children (40 boys), ages 54-105 months (M = 75.54, SD = 16.45). MV was defined as producing fewer than 20 spontaneous, unique, and socially communicative words. Autism symptom severity (Autism Diagnostic Observation Schedule-Second Edition) and nonverbal cognitive skills (Leiter-R Brief IQ) were assessed at entry. A natural language sample (NLS), a 20-min examiner-child interaction with specified toys, was collected at entry (Week 1) and exit (Week 18) from JASPER + EMT intervention. The NLS was coded for gestures (deictic, conventional, and representational) and gesture-speech combinations (reinforcing, disambiguating, supplementary, other) at entry and spoken language outcomes: speech quantity (rate of speech utterances) and speech quality (number of different words [NDW] and mean length of utterance in words [MLUw]) at exit using European Distributed Corpora Project Linguistic Annotator and Systematic Analysis of Language Transcripts. Controlling for nonverbal IQ and autism symptom severity at entry, rate of gesture-speech combinations (but not gestures alone) at entry was a significant predictor of rate of speech utterances and MLUw at exit. The rate of supplementary gesture-speech combinations, in particular, significantly predicted rate of speech utterances and NDW at exit. These findings highlight the critical importance of gestural communication, particularly gesture-speech (supplementary) combinations in supporting spoken language development in MV autistic children.

Language growth in verbal autistic children from 5 to 11 years.

To examine predictors and growth in language for verbal autistic and non-autistic children with/without low language from 4 to 11 years. Receptive and expressive language trajectories were compared in a community sample of 1026 children at ages 5, 7, and 11 years, across four groups: two autistic groups; one with and one without low language; and two non-autistic groups; one with and one without low language. Groups were delineated on baseline assessment at 4 years. Non-autistic and autistic children with low language had lower mean expressive language scores than the non-autistic typical language group (22.26 and 38.53 units lower, respectively, p < 0.001), yet demonstrated faster language growth across 5 to 11 years (p < 0.001 and p = 0.002, respectively). Both groups without low language had similar mean expressive language scores (p = 0.864) and a comparable rate of growth (p = 0.645). Language at 4 years was the only consistent predictor of language at 11 years for autistic children. Results were similar for receptive language in all analyses except there was no significant difference in rate of progress (slope) for the autistic with low language group compared with the typical language group (p = 0.272). Findings suggest early language ability, rather than a diagnosis of autism, is key to determining language growth and outcomes at 11 years in verbal children. Furthermore, children with low language showed developmental acceleration compared with same age peers.

Profiles of minimally verbal autistic children: Illuminating the neglected end of the spectrum.

Heterogeneity among individuals on the autism spectrum is widely acknowledged as a barrier to develop effective interventions. Overcoming this challenge requires characterization of individual differences, especially for children that are minimally verbal and often excluded from research studies. Most studies that describe autistic subgroups identify a single minimally verbal verbal group based on a single identifying measure (e.g., ADOS module one or single item indicating absence of phrase speech). Determining personalized courses of intervention requires a more detailed understanding since a single intervention will not be effective for all who are minimally verbal. The present study identified comprehensive profiles of cognitive, language, and social communication skills within a large, diverse, group of minimally verbal children with autism. The analysis combined baseline data from two studies to yield a sample of 344 participants, who were 3 to 8 years old at the time of study onset, with 60% who identified as having a race/ethnicity other than White. Via latent profile analysis (LPA), a three-group model was identified as best fit to the data. Profile identification was dependent on a participant's combination of cognitive, expressive, and social communication characteristics, rather than a single domain. One group (n = 206) had global delays, while the other two groups (n = 95 and n = 43) had variable strengths in cognition and communication. Findings suggest that low-frequency/minimally verbal communicators with autism have heterogeneous characteristics that can be systematically organized.

Are minimally verbal autistic children's modality and form of communication associated with parent responsivity?

Prior work examined how minimally verbal (MV) children with autism used their gestural communication during social interactions. However, interactions are exchanges between social partners. Examining parent-child social interactions is critically important given the influence of parent responsivity on children's communicative development. Specifically, parent responses that are semantically contingent to the child's communication plays an important role in further shaping children's language learning. This study examines whether MV autistic children's (N = 47; 48-95 months; 10 females) modality and form of communication are associated with parent responsivity during an in-home parent-child interaction (PCI). The PCI was collected using natural language sampling methods and coded for child modality and form of communication and parent responses. Findings from Kruskal-Wallis H tests revealed that there was no significant difference in parent semantically contingent responses based on child communication modality (spoken language, gesture, gesture-speech combinations, and AAC) and form of communication (precise vs. imprecise). Findings highlight the importance of examining multiple modalities and forms of communication in MV children with autism to obtain a more comprehensive understanding of their communication abilities; and underscore the inclusion of interactionist models of communication to examine children's input on parent responses in further shaping language learning experiences.

Real-time coded measures in natural language samples capture change over time in minimally verbal autistic children.

Prior research supports the use of natural language sampling (NLS) to assess the rate of speech utterances (URate) and the rate of conversational turns (CTRate) in minimally verbal (MV) autistic children. Bypassing time-consuming transcription, previous work demonstrated the ability to derive URate and CTRate using real-time coding methods and provided support for their strong psychometric properties. (1) Unexplored is how URate and CTRate using real-time coding methods capture change over time and (2) whether specific child factors predict changes in URate and CTRate in 50 MV autistic children (40 males; M = 75.54, SD = 16.45 (age in months)). A NLS was collected at Time 1 (T1) and Time 2 (T2) (4.5 months between T1 and T2) and coding was conducted in ELAN Linguistic Annotator software using a real-time coding approach to derive URate and CTRate. Findings from paired samples Wilcoxon tests revealed a significant increase in child URate (not examiner URate) and child and examiner CTRate from T1 to T2. Child chronological age, Mullen expressive language age equivalent scores, and URate and CTRate at T1 were predictive of URate and CTRate at T2. Findings support using NLS-derived real-time coded measures of URate and CTRate to efficiently capture change over time in MV autistic children. Identifying child factors that predict changes in URate and CTRate can help in the tailoring of goals to children's individual needs and strengths.

What do parents of nonverbal and minimally verbal autistic children think about genomic autism research?

In Summer 2021, a genomic study of autism, Spectrum 10 K, was paused due to backlash from the autistic and autism communities. This raised important questions about how these communities perceive genomic research. The Personal Experiences of Autism and Perceptions of DNA-based research study was established to address this issue among a range of sub-groups within these communities. Twenty parents of nonverbal or minimally verbal autistic children took part in the current study. Data were provided in diverse formats including online interviews, telephone interviews, and writing. This approach was co-produced with autistic experts by experience and involved a parent of a minimally verbal autistic child. Data were analysed using reflexive Thematic Analysis. We found that participants were supportive of autism research, including some genomic research, as long as it is designed to support autistic people and is ethical and transparent. However, while some believed that polygenic scores, genomic predictors of the statistical probability of being autistic, would be helpful, others argued that this would only be true in an ideal world and that the world is too far from ideal. Participants felt excluded from the autistic and autism communities and that the dominant voices in those communities do not represent them or their children. We concluded that genomic researchers need to work with the autistic and autism communities to design future work, and that it is important to ensure a representative range of voices are heard.

Vowel distinctiveness as a concurrent predictor of expressive language function in autistic children.

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.

Examining the Impact of Group-Based Social Skills Intervention in Autistic Children Aged Eight to 15 Years.

Introduction Autism spectrum disorder (ASD) is a neurological and developmental disorder, which poses challenges to social communication and behavior, particularly affecting social functioning. Individuals with ASD face significant social challenges, including difficulty understanding social cues and body language, limited ability to engage in reciprocal social interactions, and challenges with establishing empathy. A preference for routines and repetitive behaviors limits their ability to adapt to new or unexpected social situations. These problems tend to escalate during adolescence. These often cause distress to the individual as well as the caregivers. Group-based social skills interventions (GSSIs) are a widely used and effective modality for addressing core social impairments in children with autism. This study aims to assess the impact of GSSI on the broad age group of eight to 15 years, involving parents to enhance the transferability of children's social skills. Methods This was a single-arm interventional studywhere 30 verbal autistic children, aged eight to 15 years, withintelligence quotient (IQ) > 70 were enrolled after utilizing theBinet Kamat Test of Intelligence (BKT) to assess IQand the Indian Scale for Assessment of Autism (ISAA) tograde severity of autism. The children received GSSI frominterdisciplinary therapists for 12 sessions, on a weekly basis, lasting 90 minutes each for a period of three months. After each therapy session, parents received summaries of each session and were delegated reinforcing homework assignments to enable generalization and maintenance of the skills taught. Outcome measures were taken at three points in time by utilizing the Social Communication Questionnaire (SCQ) and the parent-rated Social Responsiveness Scale 2 (p-SRS-2):T1: pre-therapy at the time of enrolment; T2: immediately post-therapy at the end of three months of training; and T3: long-term follow-up, three months after the end of training. Results Mean SCQ scores were as follows: T1 = 21.87, T2 = 18.57, and T3 = 18.57 (p = 0.000). This progressive decline at T1, T2, and T3indicated a decreasing trend in the severity of difficulties in the social communication domain. Mean p-SRS-2 scores were as follows: T1 = 73.00, T2 = 64.57, and T3 =64.30 (p < 0.0001). This declining trend at T1, T2, and T3suggested a statistically significant decrease in the severity of difficulties faced in various social aspects tested by the p-SRS-2, i.e., social awareness, social cognition, social communication, and social motivation, along with a reduction in restricted interests and repetitive behaviors (RRBs). Very strong correlation coefficients were obtained for SCQ scores (T1-T2 = 0.921, T1-T3 = 0.921, and T2-T3 = 1.000), as well as for p-SRS-2 scores (T1-T2 = 0.743, T1-T3 = 0.746, and T2-T3 = 0.989), which reinforced the statistical significance of the data. Conclusion GSSI is an effective parent-assisted intervention foradolescents with ASD, with effects lasting up to three months post-intervention.

Receptive language and receptive-expressive discrepancy in minimally verbal autistic children and adolescents.

Among the approximately one-third of autistic individuals who experience considerable challenges in acquiring spoken language and are minimally verbal (MV), relatively little is known about the range of their receptive language abilities. This study included 1579 MV autistic children and adolescents between 5 and 18 years of age drawn from the National Database for Autism Research and the SFARI Base data repository. MV autistic children and adolescents demonstrated significantly lower receptive language compared to the norms on standardized language assessment and parent report measures. Moreover, their receptive language gap widened with age. Overall, our sample demonstrated significantly better receptive than expressive language. However, at the individual level, only about 25% of MV autistic children and adolescents demonstrated significantly better receptive language relative to their minimal expressive levels. Social skills explained a significant proportion of the variance in parent-reported receptive language skills, while motor skills were the most significant predictor of greater receptive-expressive discrepancy. Findings from this study revealed the heterogeneous language profiles in MV autistic children and adolescents, underscoring the importance of individualizing interventions to match their different communication strengths and needs and integrating multiple interconnected areas to optimize their overall development of language comprehension, socialization, and general motor skills.

Measurement invariance of Child Behavior Checklist internalizing and externalizing factors between non-speaking/partially verbal and speaking autistic children

BackgroundThe Child Behavior Checklist (CBCL) is commonly used to screen for emotional and behavioral concerns (EBC) in autistic children; however, few studies have tested the measurement invariance across language groups. MethodThe current study conducted a multi-group confirmatory factor analysis to examine the factorial invariance of the broadband internalizing and externalizing factor structure between 311 speaking and 1778 non-speaking/partially verbal (NSPV) autistic children using the Simons Simplex Collection (N = 2089), which represents a specific phenotypic presentation of autism. ResultsThe two-factor structure achieved configural and metric but not scalar invariance, suggesting that, while the CBCL appears useful as a measure of EBC in autistic youth within language groups in our sample, the Internalizing and Externalizing domain scores might not be comparable between language groups due to measurement bias. ConclusionsWhile EBC in autistic children can be measured using the CBCL, comparisons between NSPV and speaking children should be approached with caution. Measures that demonstrate invariance across language groups are a critical research priority in understanding how EBC manifest across ability levels, particularly in the development of appropriate mental health interventions. Considerations for practical implications of scalar non-invariance are discussed.

Prelinguistic communication complexity predicts expressive language in initial minimally verbal autistic children.

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.

Structure and acoustics of the speech of verbal autistic preschoolers.

In this study, we report an extensive investigation of the structural language and acoustical specificities of the spontaneous speech of ten three- to five-year-old verbal autistic children. The autistic children were compared to a group of ten typically developing children matched pairwise on chronological age, nonverbal IQ and socioeconomic status, and groupwise on verbal IQ and gender on various measures of structural language (phonetic inventory, lexical diversity and morpho-syntactic complexity) and a series of acoustical measures of speech (mean and range fundamental frequency, a formant dispersion index, syllable duration, jitter and shimmer). Results showed that, overall, the structure and acoustics of the verbal autistic children's speech were highly similar to those of the TD children. Few remaining atypicalities in the speech of autistic children lay in a restricted use of different vocabulary items, a somewhat diminished morpho-syntactic complexity, and a slightly exaggerated syllable duration.

The link between the factuality of verb and the theory of mind ability of Mandarin-speaking children with high-functioning autism.

Weak theory of mind (ToM) ability is a core deficit in children with autism. A growing body of work has found that there is a close relation between complement syntax and ToM in autistic children. However, researchers have not yet investigated whether other linguistic components may explain the difficulties in ToM reasoning in autistic children. To determine whether verb factuality (i.e., mental and action verbs) is related to ToM ability, as measured by a false belief understanding (FBU) task after controlling the effect of complement syntax for Mandarin-speaking autistic children. Participants were verbal autistic children, aged 4-7 years. Their IQ performance (verbal, performance and total IQ) and the comprehension of complement syntax were evaluated. A total of 38 children scoring over 9 points in complement syntax test and 90 points in the verbal IQ test were selected to complete verb factuality and FBU task. The χ2 tests and correlation analyses were carried out on two relations: (1) ToM ability and understanding of verb factuality; and (2) ToM ability and comprehension of complement syntax. A total of 11 autistic children completed the action verb factuality task, while 14 completed the mental verb factuality task and 13 completed both tasks. Participants performed well on the verb factuality task, and their ToM performance appeared to be related to their linguistic ability, regardless of the type of verb (i.e., action or mental verb). However, complement syntax scores did not significantly predict the success of the FBU task for the autistic children. The results of this study link weaker ToM ability with the understanding of verb factuality among autistic children aged 4-7 and provide new evidence for the view that the development of language facilitates improvement of ToM skills. The findings shed new light on how language affects or determines social interactions. What is already known on the subject ToM ability is crucial for social interaction. It has been claimed that mental verb factuality (e.g., think, had thought) may play a role in the development of ToM reasoning in typically developing children, but whether there is a link between the mastery of verb factuality and ToM skills in autistic children is still unclear. What this study adds to existing knowledge Correlational analysis revealed links between verbal ToM measured by unexpected location task and factuality test of mental verbs as well as action verbs. More importantly, this study confirmed the extra role of verb factuality in explaining ToM ability after excluding the influence of the complement syntax. What are the potential or actual clinical implications of this work? This study suggests that the factuality of verbs could serve as a tool for autistic children to infer the mental states of others. Thus, training on this linguistic structure could be taken into consideration when improving the social skills of autistic children.

Teaching Multi-step Requesting and Social Communication to Five Autistic Children Using Speech-Generating Devices and Systematic Instruction

ObjectivesWe evaluated a systematic instructional package for teaching a four-step SGD-based requesting and social communication sequence. Of interest was whether intervention would lead to accurate performance of the sequence, as well as generalization, maintenance, and discriminated/functional use.MethodsFive minimally verbal autistic children received systematic instruction to complete a four-step sequence on an iPad®-based SGD. The sequence involved (a) saying hello, (b) making a general request, (c) making a specific request, and (d) thanking the listener. The effects of instruction, which consisted of practice sessions, time delay, prompting, and reinforcement, were evaluated in a multiple-baseline across participants design.ResultsAll five participants reached 100% correct performance during intervention. This high level of correct responding generalized to a novel interventionist and was maintained at follow-up. Discriminated/functional use of the communication icons was evident.ConclusionsThe systematic instructional package was effective in teaching a four-step SGD-based requesting and social communication sequence to five minimally verbal autistic children.

Fine motor skill and expressive language in minimally verbal and verbal school-aged autistic children.

Fine motor skill is associated with expressive language outcomes in infants who have an autistic sibling and in young autistic children. Fewer studies have focused on school-aged children even though around 80% have motor impairments and 30% remain minimally verbal (MV) into their school years. Moreover, expressive language is not a unitary construct, but it is made up of components such as speech production, structural language, and social-pragmatic language use. We used natural language sampling to investigate the relationship between fine motor and speech intelligibility, mean length of utterance and conversational turns in MV and verbal autistic children between the ages of 4 and 7 while controlling for age and adaptive behavior. Fine motor skill predicted speech production, measured by percent intelligible utterances. Fine motor skill and adaptive behavior predicted structural language, measured by mean length of utterance in morphemes. Adaptive behavior, but not fine motor skill, predicted social-pragmatic language use measured by number of conversational turns. Simple linear regressions by group corrected for multiple comparisons showed that fine motor skill predicted intelligibility for MV but not verbal children. Fine motor skill and adaptive behavior predicted mean length of utterance for both MV and verbal children. These findings suggest that future studies should explore whether MV children may benefit from interventions targeting fine motor along with speech and language into their school years.

Using developmental regression to reorganize the clinical importance of autistic atypicalities

Early regression (ER) is often reported in autistic children with a prototypical phenotype and has been proposed as a possible pathognomonic sign present in most autistic children. Despite the uncertainties attached to its definition and report, using ER to anchor the autism phenotype could help identify the signs that best contribute to an autism diagnosis. We extracted retrospective data from 1547 autistic children between the ages of 6 and 18 years from the Simons Simplex collection. Logistic regression identified the atypicalities associated with a history of ER. Stepwise variable selection using logistic regression analysis followed by a bootstrap procedure of 1000 iterations identified the cluster of atypicalities best associated with ER. Linear and logistic regressions measured the association between combinations of atypicalities within the identified cluster and adaptative behaviors, diagnostic areas of severity, and other categories. Seven atypicalities significantly increased the likelihood of having experienced ER (OR = 1.73–2.13). Four (“hand leading—ever”, “pronominal reversal—ever”, “never shakes head at age 4–5” and “stereotypic use of objects or interest in parts of objects—ever”), when grouped together, best characterized the phenotype of verbal autistic children with ER. This clustering of signs was associated with certain persistent language difficulties, higher summary scores on a diagnostic scale for autism, and greater odds of receiving an “autistic disorder” diagnosis instead of another pervasive developmental disorder (PDD) diagnosis. These results raise questions about using language as a clinical specifier, defining cross-sectional signs independent of their relationship with an early developmental trajectory, and relying on polythetic criteria or equivalent weighted autistic atypicalities.

Exploring communicative competence in autistic children who are minimally verbal: The Low Verbal Investigatory Survey for Autism (LVIS).

Approximately one in three autistic children is unable to communicate with language; this state is often described as minimally verbal. Despite the tremendous clinical implications, we cannot predict whether a minimally verbal child is simply delayed (but will eventually develop spoken language) or will continue to struggle with verbal language, and might therefore benefit from learning an alternative form of communication. This is important for clinicians to know, to be able to choose the most helpful interventions, such as alternative forms of communication. In addition, the field lacks a standard definition of "minimally verbal." Even when we do agree on what the term means (e.g. fewer than 20 words), describing a child based on their lack of words does not tell us whether that child is communicating in other ways or how they are using those 20 words. To address these concerns, we developed the Low Verbal Investigatory Survey (LVIS), a one-page parent-report measure designed to help us characterize how minimally verbal autistic children are communicating. Parents of 147 children (aged 1-8 years) completed the LVIS. Here, we ask (1) whether the survey measures what it was designed to measure, that is, communicative ability in children without much spoken language, and (2) how the LVIS relates to cognitive and language ability, and symptoms of autism. Results suggest that this survey, which takes only 5 min to complete, is a good estimate of the child's communication skills. Furthermore, LVIS survey scores are correlated with other measures of language and cognitive abilities as well as autism symptomatology. The LVIS has the potential to save time and money in both clinical and research efforts to assess communication skills in minimally verbal autistic children.

Predictors of individual differences in minimally verbal peer communication exchanges following peer-oriented social intervention.

School-age children on the autism spectrum who are minimally verbal (MVAS) use a limited repertoire of spontaneous communicative spoken words and reveal large heterogeneity in cognitive functioning. Despite the challenges to form peer social engagement posed by their unique social-communicative profile, few interventions have targeted peer interactions in the MVAS population. This study explored predictors of individual differences in treatment response among 54 school-age minimally verbal autistic children (8-16 years) following an RCT "school-based peer social intervention" (S-PSI) that compared two peer-oriented intervention modalities (conversation versus collaboration) versus a waitlisted control group. We examined autistic-symptom severity, age, verbal and nonverbal IQ, executive functions, and sensory-processing profile for their contribution to children's ability to form relevant spontaneous communication exchanges with a peer partner. Main findings revealed that larger deficits in sensory-processing (sensory-avoidance and sensory low-registration) and in executive functions contributed to greater growth in "relevant" (i.e., adequately attuned, participatory, reciprocal) communication following both interventions, but not for the waitlisted controls. Additionally, older participants with lower verbal and nonverbal IQ improved communication's relevancy more after the conversation intervention, whereas the collaboration intervention was more beneficial for younger participants. Lower autistic-symptom severity contributed to larger growth in relevancy for all groups. By identifying individual-level predictors of spontaneous, attuned, participatory, and reciprocal (i.e., "relevant") communication exchanges with peers, we optimized S-PSI personalization for this uniquely nonverbal, heterogeneous MVAS population. These new channels for tailoring peer interventions to better meet individuals' needs may result in reduced social isolation and loneliness and enhanced well-being.