Autism and developmental receptive language disorder--a comparative follow-up in early adult life. I: Cognitive and language outcomes

Homozygous microdeletion of exon 5 in ZNF277 in a girl with specific language impairment

Specific language impairment (SLI), an unexpected failure to develop appropriate language skills despite adequate non-verbal intelligence, is a heterogeneous multifactorial disorder with a complex genetic basis. We identified a homozygous microdeletion of 21,379 bp in the ZNF277 gene (NM_021994.2), encompassing exon 5, in an individual with severe receptive and expressive language impairment. The microdeletion was not found in the proband's affected sister or her brother who had mild language impairment. However, it was inherited from both parents, each of whom carries a heterozygous microdeletion and has a history of language problems. The microdeletion falls within the AUTS1 locus, a region linked to autistic spectrum disorders (ASDs). Moreover, ZNF277 is adjacent to the DOCK4 and IMMP2L genes, which have been implicated in ASD. We screened for the presence of ZNF277 microdeletions in cohorts of children with SLI or ASD and panels of control subjects. ZNF277 microdeletions were at an increased allelic frequency in SLI probands (1.1%) compared with both ASD family members (0.3%) and independent controls (0.4%). We performed quantitative RT-PCR analyses of the expression of IMMP2L, DOCK4 and ZNF277 in individuals carrying either an IMMP2L_DOCK4 microdeletion or a ZNF277 microdeletion. Although ZNF277 microdeletions reduce the expression of ZNF277, they do not alter the levels of DOCK4 or IMMP2L transcripts. Conversely, IMMP2L_DOCK4 microdeletions do not affect the expression levels of ZNF277. We postulate that ZNF277 microdeletions may contribute to the risk of language impairments in a manner that is independent of the autism risk loci previously described in this region.

Age 31 mental health outcomes of childhood language and speech disorders

OBJECTIVE

Language disorders are associated with emotional and behavioral problems in childhood and adolescence. Although clinical studies with small samples suggest that psychosocial difficulties continue into adulthood, adult mental health outcomes of childhood language disorders are not well known. The objective of this prospective longitudinal study is to determine whether the age 31 mental health outcomes of individuals who had childhood language disorders differ from the outcomes of typically developing controls.

METHOD

A 26-year cohort study followed up children with language or speech disorders from age 5 to age 31. The children were selected from a 1-in-3 random sample of 5-year-olds using a 3-stage screening and assessment process. A control group matched by sex, age, and classroom or school was also selected. Diagnoses were assigned with the Composite International Diagnostic Interview with the additional criterion that Global Assessment of Functioning scores indicated at least mild impairment. Dimensional psychosocial self-report measures were also administered.

RESULTS

Rates of diagnosis at age 31 years were equivalent between participants who had childhood language disorders and controls, with and without multiple imputation to estimate missing outcomes. Differences in rates of affective and substance use disorders could not be ruled out because of attrition in the cohort with language disorders, who were less likely to participate at age 31. Psychosocial scores for both cohorts were in the normal range. The cohort with language disorders had poorer self-rated physical health than controls.

CONCLUSION

Mild/moderate language disorders may not have significant long-term mental health consequences in early adulthood.

The development of the neural substrates of cognitive control in adolescents with autism spectrum disorders

BACKGROUND

Autism spectrum disorders (ASDs) involve impairments in cognitive control. In typical development (TYP), neural systems underlying cognitive control undergo substantial maturation during adolescence. Development is delayed in adolescents with ASD. Little is known about the neural substrates of this delay.

METHODS

We used event-related functional magnetic resonance imaging and a cognitive control task involving overcoming a prepotent response tendency to examine the development of cognitive control in young (ages 12-15; n = 13 with ASD and n = 13 with TYP) and older (ages 16-18; n = 14 with ASD and n = 14 with TYP) adolescents with whole-brain voxelwise univariate and task-related functional connectivity analyses.

RESULTS

Older ASD and TYP showed reduced activation in sensory and premotor areas relative to younger ones. The older ASD group showed reduced left parietal activation relative to TYP. Functional connectivity analyses showed a significant age by group interaction with the older ASD group exhibiting increased functional connectivity strength between the ventrolateral prefrontal cortex and the anterior cingulate cortex, bilaterally. This functional connectivity strength was related to task performance in ASD, whereas that between dorsolateral prefrontal cortex and parietal cortex (Brodmann areas 9 and 40) was related to task performance in TYP.

CONCLUSIONS

Adolescents with ASD rely more on reactive cognitive control, involving last-minute conflict detection and control implementation by the anterior cingulate cortex and ventrolateral prefrontal cortex, versus proactive cognitive control requiring processing by dorsolateral prefrontal cortex and parietal cortex. Findings await replication in larger longitudinal studies that examine their functional consequences and amenability to intervention.

Empirically derived model of social outcomes and predictors for adults with ASD

This study used data from the National Core Indicators (NCI) Survey to derive an empirically validated measurement model for social outcomes and associated constructs for both individuals with Autism Spectrum Disorder (ASD) and individuals with other disabilities. Items consistent with the survey structure of the NCI were selected as initial indicators of the latent constructs Social Relationships, Community Inclusion, and Opportunity for Choice in factor analyses. Results yielded a novel factor structure that is different from the original NCI survey structure. Three factors emerged as a result of these analyses: Personal Control, Social Determination, and Social Participation and Relationships. The factor structure of each of these constructs was consistent although not identical across individuals with ASD and individuals with developmental disabilities other than ASD.

Children with specific language impairment and their contribution to the study of language development

Children with specific language impairment (SLI) are distinguishable from typically developing children primarily in the pace and course of their language development. For this reason, they are appropriate candidates for inclusion in any theory of language acquisition. In this paper, the areas of overlap between children with SLI and those developing in typical fashion are discussed, along with how the joint study of these two populations can enhance our understanding of the language development process. In particular, evidence from children with SLI can provide important information concerning the role of language typology in language development, the optimal ages for acquiring particular linguistic details, the robustness of the bilingual advantage for children, the role of input in children's acquisition of grammatical details, the unintended influence of processing demands during language assessment, the contributions of treatment designs to the study of typically developing children, and the study of individual differences in language development.

Engagement in vocational activities promotes behavioral development for adults with autism spectrum disorders

This study examined the bidirectional relations over time between behavioral functioning (autism symptoms, maladaptive behaviors, activities of daily living) and vocational/educational activities of adults with autism spectrum disorders (ASD). Participants were 153 adults with ASD (M age = 30.2 years) who were part of a larger longitudinal study. Data were collected at two time points separated by 5.5 years. Cross-lag models were used, which accounted for stability over time while testing both directions of cross-lagged effects. Results suggested that greater vocational independence and engagement was related to subsequent reductions in autism symptoms and maladaptive behaviors, and improvements in activities of daily living. Relations between earlier behavioral variables (symptoms, behaviors, and activities of daily living) and later vocational independence were not statistically significant.

Predicting young adult outcome among more and less cognitively able individuals with autism spectrum disorders

BACKGROUND

The range of outcomes for young adults with Autism Spectrum Disorders (ASD) and the early childhood factors associated with this diversity have implications for clinicians and scientists.

METHODS

This prospective study provided a unique opportunity to predict outcome 17 years later for a relatively large sample of children diagnosed with ASD at 2 years old. Diagnostic and psychometric instruments were administered between 2 and 19 with data from 2, 3, and 19 included in this study. Clinicians administered tests without knowledge of previous assessments whenever possible. Caregivers provided additional information through questionnaires.

RESULTS

Significant intellectual disabilities at 19 were predicted by age 2 about 85% of the time from VIQ and NVIQ scores together, though prediction of young adult outcome for youths with average or higher intelligence was more complex. By 19, 9% of participants had largely overcome core difficulties associated with ASD and no longer retained a diagnosis. These youths with Very Positive Outcomes were more likely to have participated in treatment and had a greater reduction in repetitive behaviors between age 2 and 3 compared to other Cognitively Able youths (VIQ ≥70) with ASD. Very Positive Outcome youths did not differ phenotypically from Cognitively Able ASD individuals at 2 but both groups differed from Cognitively Less Able individuals (VIQ <70).

CONCLUSION

Those most at risk for intellectual disabilities and ASD can be reliably identified at an early age to receive comprehensive treatment. Findings also suggest that some cognitively able children with ASD who participate in early intervention have very positive outcomes, although replication with randomized, larger samples is needed. In order to improve understanding of very positive outcomes in ASD, future research will need to identify how variations in child characteristics and environmental factors contribute to the nature and timing of growth across individuals and areas of development.

Brain-region-specific alterations of the trajectories of neuronal volume growth throughout the lifespan in autism

Several morphometric studies have revealed smaller than normal neurons in the neocortex of autistic subjects. To test the hypothesis that abnormal neuronal growth is a marker of an autism-associated global encephalopathy, neuronal volumes were estimated in 16 brain regions, including various subcortical structures, Ammon's horn, archicortex, cerebellum, and brainstem in 14 brains from individuals with autism 4 to 60 years of age and 14 age-matched control brains. This stereological study showed a significantly smaller volume of neuronal soma in 14 of 16 regions in the 4- to 8-year-old autistic brains than in the controls. Arbitrary classification revealed a very severe neuronal volume deficit in 14.3% of significantly altered structures, severe in 50%, moderate in 21.4%, and mild in 14.3% structures. This pattern suggests desynchronized neuronal growth in the interacting neuronal networks involved in the autistic phenotype. The comparative study of the autistic and control subject brains revealed that the number of structures with a significant volume deficit decreased from 14 in the 4- to 8-year-old autistic subjects to 4 in the 36- to 60-year-old. Neuronal volumes in 75% of the structures examined in the older adults with autism are comparable to neuronal volume in age-matched controls. This pattern suggests defects of neuronal growth in early childhood and delayed up-regulation of neuronal growth during adolescence and adulthood reducing neuron soma volume deficit in majority of examined regions. However, significant correction of neuron size but limited clinical improvements suggests that delayed correction does not restore functional deficits.

Cognitive and language skills in adults with autism: a 40-year follow-up

BACKGROUND

It is well established that very few individuals with autism spectrum disorders (ASD) and an IQ below 70 are able to live independently as adults. However, even amongst children with an IQ in the normal range, outcome is very variable. Childhood factors that predict later stability, improvement or decline in cognitive functioning remain uncertain and, in particular, very little is known about trajectories in later adulthood.

METHOD

Changes in cognitive and language ability from childhood to adulthood were assessed in 60 individuals with autism, all of whom had an IQ in the average range as children. Mean age in childhood = 6 years (range 2-13 years); mean age in adulthood = 44 years (range 29-64 years). Trajectories of change and factors related to current cognitive abilities were explored.

RESULTS

For the majority of participants (N = 45, 75%), who were testable both as children and adults, IQ remained very stable and language also improved over time. However, 15 individuals could not be assessed on standard tests as adults and their developmental level could be estimated only on the Vineland Adaptive Behavior Scales. Almost all these adults (apart from one who had suffered a major stroke) showed severe aggressive or self-injurious behaviours; none had ever developed language above a 3-year level, and seven had developed epilepsy.

CONCLUSIONS

For most individuals with autism who had an IQ in the average range (i.e. ≥ 70) as children, childhood IQ proved a reliable predictor of cognitive functioning well into mid- to- later adulthood. However, a significant minority was no longer testable on standard tests as adults. Their current very low levels of functional ability were generally associated with severe behavioural disturbance and persisting and severe language impairment; 50% of these individuals had also developed epilepsy, pointing to the role of organic brain dysfunction. Implications for early intervention are discussed.

The relationship between parent report of adaptive behavior and direct assessment of reading ability in children with autism spectrum disorder

PURPOSE

This study was designed to shed light on the profile of reading ability in children with autism spectrum disorder (ASD). A key aim was to examine the relationship between parent report of adaptive behavior and direct assessment of reading ability in these children.

METHOD

The authors investigated children's reading ability using the Wide Range Achievement Test—Fourth Edition (Wilkinson & Robertson, 2006) and the Neale Analysis of Reading Ability—Third Edition (Neale, 2007). Parent report data was collected using the Vineland Adaptive Behavior Scales—Second Edition (Sparrow, Cicchetti, & Balla, 2005). Participants were 21 children with ASD (6-11 years) and their primary caregivers.

RESULTS

Direct assessment of children's reading ability showed that some children with ASD have difficulty learning to read and exhibit particular weaknesses in comprehension. The results revealed positive relationships between Vineland Adaptive Behavior Scales scores in the Adaptive Communication domain and direct assessment of children's reading ability across 3 measures of reading (word-level accuracy, passage-level accuracy, and passage-level comprehension).

CONCLUSIONS

Although literacy levels vary among children with ASD, some clearly struggle with reading. There is a significant relationship between parent self-report of adaptive behavior and direct assessment of children's reading ability.

Language and internalizing and externalizing behavioral adjustment: developmental pathways from childhood to adolescence

Two independent prospective longitudinal studies that cumulatively spanned the age interval from 4 years to 14 years used multiwave designs to investigate developmental associations between language and behavioral adjustment (internalizing and externalizing behavior problems). Altogether 224 children, their mothers, and teachers provided data. Series of nested path analysis models were used to determine the most parsimonious and plausible paths among the three constructs over and above stability in each across age and their covariation at each age. In both studies, children with poorer language skills in early childhood had more internalizing behavior problems in later childhood and in early adolescence. These developmental paths between language and behavioral adjustment held after taking into consideration children's nonverbal intellectual functioning, maternal verbal intelligence, education, parenting knowledge, and social desirability bias, as well as family socioeconomic status, and they applied equally to girls and boys.

Non-word repetition impairment in autism and specific language impairment: evidence for distinct underlying cognitive causes

Language-impaired individuals with autism perform poorly on tests such as non-word repetition that are sensitive clinical markers of specific language impairment (SLI). This has fuelled the theory that language impairment in autism represents a co-morbid SLI. However, the underlying cause of these deficits may be different in each disorder. In a novel task, we manipulated non-word stimuli in three ways known to influence the repetition accuracy of children with SLI. Participants with SLI were affected differently by these manipulations to children with autism. Children with autism performed similarly to language-matched typical children in terms of levels and patterns of performance, and types of error made, suggesting that the underlying cognitive cause of non-word repetition deficits is different in each disorder.

The Development of Adaptive Behavior in Toddlers and Preschoolers with Fragile X versus Autism

Although there is extensive research in the early detection of autism, no study has compared the adaptive behavior of young children with fragile X syndrome (FXS) and children with autism across ages. We investigated the cross-sectional development of adaptive behavior in children with FXS and children with autism between 18 and 83 months of age. Analyses revealed a significant relationship between age and adaptive behavior standard scores for children with FXS, with decreased performance across ages. Analyses also revealed that children with FXS had a relatively flat performance across domains while children with autism are typically more variable with lower scores in the communication domain relative to other domains. Delays in adaptive behavior were evident for children with FXS and children with autism at 24 months of age as reported in previous literature. Implications and future directions are discussed.

Predictors of phrase and fluent speech in children with autism and severe language delay

OBJECTIVE

To examine the prevalence and predictors of language attainment in children with autism spectrum disorder (ASD) and severe language delay. We hypothesized greater autism symptomatology and lower intelligence among children who do not attain phrase/fluent speech, with nonverbal intelligence and social engagement emerging as the strongest predictors of outcome.

METHODS

Data used for the current study were from 535 children with ASD who were at least 8 years of age (mean = 11.6 years, SD = 2.73 years) and who did not acquire phrase speech before age 4. Logistic and Cox proportionate hazards regression analyses examined predictors of phrase and fluent speech attainment and age at acquisition, respectively.

RESULTS

A total of 372 children (70%) attained phrase speech and 253 children (47%) attained fluent speech at or after age 4. No demographic or child psychiatric characteristics were associated with phrase speech attainment after age 4, whereas slightly older age and increased internalizing symptoms were associated with fluent speech. In the multivariate analyses, higher nonverbal IQ and less social impairment were both independently associated with the acquisition of phrase and fluent speech, as well as earlier age at acquisition. Stereotyped behavior/repetitive interests and sensory interests were not associated with delayed speech acquisition.

CONCLUSIONS

This study highlights that many severely language-delayed children in the present sample attained phrase or fluent speech at or after age 4 years. These data also implicate the importance of evaluating and considering nonverbal skills, both cognitive and social, when developing interventions and setting goals for language development.

Lexical composition in children with autism spectrum disorder (ASD)

For sixty-seven children with ASD (age 1;6 to 5;11), mean Total Vocabulary score on the Language Development Survey (LDS) was 65·3 words; twenty-two children had no reported words; and twenty-one children had 1-49 words. When matched for vocabulary size, children with ASD and children in the LDS normative sample did not differ in semantic category or word-class scores. Q correlations were large when percentage use scores for the ASD sample were compared with those for samples of typically developing children as well as children with vocabularies <50 words. The 57 words with the highest percentage use scores for the ASD children were primarily nouns, represented a variety of semantic categories, and overlapped substantially with the words having highest percentage use scores in samples of typically developing children as well as children with lexicons of <50 words. Results indicated that the children with ASD were acquiring essentially the same words as typically developing children, suggesting delayed but not deviant lexical composition.

Developmental trajectories of verbal and nonverbal skills in individuals with a history of specific language impairment: from childhood to adolescence

PURPOSE

To investigate the longitudinal trajectories of verbal and nonverbal skills in individuals with a history of specific language impairment (SLI) from childhood to adolescence. This study focuses on SLI only and investigates within-participant measures across abilities.

METHOD

Verbal and nonverbal skills were assessed in 242 children with a history of SLI at ages 7, 8, 11, 14, 16, and 17. Discrete factor growth modeling was used to examine developmental trajectories for the whole group and to identify subgroups on the basis of a novel, developmental, multidimensional approach.

RESULTS

When expressive language, receptive language, and nonverbal skills were scaled to a common metric, the group of individuals with a history of SLI as a whole had stable skills growth throughout the 10-year time frame. Seven language subgroups were identified, but these differed only in severity and did not display mutually distinctive patterns of growth development. In contrast, 6 nonverbal skills subgroups were identified, and their trajectories did differ significantly, with evidence of deceleration in around one third of the sample.

CONCLUSION

Individuals with a history of SLI show steady language growth from age 7. However, different patterns of growth of nonverbal skills are observed from childhood to adolescence.

Developmental Communication Impairments in Adults: Outcomes and Life Experiences of Adults and Their Parents

Purpose

This study identifies the outcomes and documents the longitudinal life experiences of adults who attended a specialist residential school for children with pervasive and complex developmental communication impairments.

Method

Semistructured interviews were carried out with 26 adult ex-pupils who had attended the school and the parents of 15 of the ex-pupils.

Results

Seven key themes were identified from the data, including (a) lack of appropriate support and the impact of this in early childhood, (b) advantages and disadvantages of specialist educational provision compared to mainstream and other provision, (c) changing impact of developmental communication impairments over time, (d) challenging transition away from specialist educational provision, (e) absence of appropriate support for adults with developmental communication impairments, (f) persisting impact of developmental communication impairments on social and emotional functioning in adult life, and (g) differences in perspective between the adult ex-pupils and their parents.

Conclusion

Across the adult ex-pupils and their parents, the perceived reported benefits of early intervention, parental support, specialist educational provision, and guidance at times of transitions should inform current service provision for this vulnerable group of individuals and their families.

Comparing the functional performance of children and youths with autism, developmental disabilities, and no disability using the revised pediatric evaluation of disability inventory item banks

OBJECTIVE. We compared the functional performance of children with autism spectrum disorders (ASD), intellectual and developmental disabilities (IDD), and without disabilities using the revised Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) Social/Cognitive, Daily Activities, and Responsibility domains. METHOD. A nationally representative sample of parents of children ages 0-21 without disabilities (n = 2,205), with ASD (n = 108), or with IDD (n = 150) completed an online survey. We obtained predicted PEDI-CAT scaled scores for three reference ages (5, 10, 15) from a modified analysis of covariance model and compared each group's scores using contrasts of the regression parameters. RESULTS. We found no significant differences between the ASD and IDD groups. The group with ASD demonstrated significantly lower performance than the group without disabilities across the three domains at ages 10 and 15. CONCLUSION. Scores on the PEDI-CAT differentiated the group with ASD from the group without disabilities. Children with ASD and IDD did not demonstrate different performance profiles.

Behavioral and physiological responses to child-directed speech of children with autism spectrum disorders or typical development

Young boys with autism were compared to typically developing boys on responses to nonsocial and child-directed speech (CDS) stimuli. Behavioral (looking) and physiological (heart rate and respiratory sinus arrhythmia) measures were collected. Boys with autism looked equally as much as chronological age-matched peers at nonsocial stimuli, but less at CDS stimuli. Boys with autism and language age-matched peers differed in patterns of looking at live versus videotaped CDS stimuli. Boys with autism demonstrated faster heart rates than chronological age-matched peers, but did not differ significantly on respiratory sinus arrhythmia. Reduced attention during CDS may restrict language-learning opportunities for children with autism. The heart rate findings suggest that young children with autism have a nonspecific elevated arousal level.

Social, emotional, and behavioral functioning of secondary school students with low academic and language performance: perspectives from students, teachers, and parents

PURPOSE

Adolescence is a time of transition when young people with language difficulties are at increased risk of experiencing social, emotional, and behavioral difficulties (SEBD). Most studies of social, emotional, and behavioral functioning (SEBF) in individuals with language difficulties focus on children with a clinical diagnosis of language impairment. This study explores SEBF in a nonclinical group of 12-year-old students with low educational and language performance from their own perspectives and those of their parents and teachers.

METHOD

The Strengths and Difficulties Questionnaire ( Goodman, 1997) was given to 352 mainstream secondary school students who were underperforming academically and had poor language performance. Two hundred and twenty-five of their parents and 230 of their teachers also completed the questionnaire.

RESULTS

Students with low educational attainment and poor language showed significantly greater SEBD than a normative sample as reported by themselves, their parents, and their teachers. Significant differences were found across informants, with students identifying more overall difficulties than parents or teachers.

CONCLUSION

Secondary school students with low academic and language performance are more vulnerable to experiencing SEBD compared to typically developing peers. The extent of their difficulties varied depending on the informant, emphasizing the importance of gaining views from multiple perspectives.

Postschool educational and employment experiences of young people with specific language impairment

PURPOSE

This study examined the postschool educational and employment experiences of young people with and without specific language impairment (SLI).

METHOD

Nineteen-year-olds with (n = 50) and without (n = 50) SLI were interviewed on their education and employment experiences since finishing compulsory secondary education.

RESULTS

On average, young people with SLI were less successful than their peers without SLI, but they did attain some achievements. Young people with SLI obtained ∼2, mostly vocational qualifications in the first few years post school. Young people continuing in education at 19 years were most commonly in lower level educational placements than their typically developing (TD) peers. Performance IQ and language/literacy skills were the strongest predictors of educational experience level at this age. Young people with SLI truant less and report feeling more supported than TD peers. In terms of employment, similar proportions of young people with and without SLI had jobs. A larger proportion of young people with SLI, however, were not in education, employment, or training at 19 years of age.

CONCLUSION

In the immediate postschool years, young people with SLI fare less well in education and employment than their TD peers.

Early childhood predictors of the social competence of adults with autism

Longitudinal research into adult outcomes in autism remains limited. Unlike previous longitudinal examinations of adult outcome in autism, the twenty participants in this study were evaluated across multiple assessments between early childhood (M = 3.9 years) and adulthood (M = 26.6 years). In early childhood, responsiveness to joint attention (RJA), language, and intelligence were assessed. In adulthood, the parents of participants responded to interviews assessing the adaptive functioning, autistic symptomology and global functioning of their children. RJA and early childhood language predicted a composite measure of adult social functioning and independence. Early childhood language skills and intelligence predicted adult adaptive behaviors. RJA predicted adult non-verbal communication, social skills and symptoms. Adaptive behaviors changed with development, but symptoms of autism did not. Additional factors associated with adult outcomes are discussed.

Associations between syntax and the lexicon among children with or without ASD and language impairment

Five groups of children defined by presence or absence of syntactic deficits and autism spectrum disorders (ASD) took vocabulary tests and provided sentences, definitions, and word associations. Children with ASD who were free of syntactic deficits demonstrated age-appropriate word knowledge. Children with ASD plus concomitant syntactic language impairments (ASDLI) performed similarly to peers with specific language impairment (SLI) and both demonstrated sparse lexicons characterized by partial word knowledge and immature knowledge of word-to-word relationships. This behavioral overlap speaks to the robustness of the syntax-lexicon interface and points to a similarity in the ASDLI and SLI phenotypes.

A nationwide survey on quality of life and associated factors of adults with high-functioning autism spectrum disorders

The psychosocial outcomes of individuals with high-functioning autism spectrum disorder (HFASD) appear to be diverse and are often poor relative to their intellectual or language level. To identify predictive variables that are potentially ameliorable by therapeutic intervention, this study investigated self-reported psychosocial quality of life and associated factors for adults with HFASD. All participants (n = 154) had a diagnosis of autism spectrum disorder, were over 18 years of age, lived in the community, and had used one or more support services during the survey period. The results demonstrated that psychosocial quality of life was lower than that of the general Japanese adult population. Environmental factors, such as mother’s support and early diagnosis, were associated with better quality of life, and aggressive behaviors were associated with poorer quality of life, while expressive language level at preschool years, a conventional outcome predictor, did not predict quality of life. These results emphasize that quality of life measures should be included as outcome indicators in treating individuals with HFASD.

Research review: structural language in autistic spectrum disorder - characteristics and causes

BACKGROUND

Structural language anomalies or impairments in autistic spectrum disorder (ASD) are theoretically and practically important, although underrecognised as such. This review aims to highlight the ubiquitousness of structural language anomalies and impairments in ASD, and to stimulate investigation of their immediate causes and implications for intervention.

METHOD

Studies of structural language in ASD are reviewed (based on a search of the literature and selected as meeting defined inclusion criteria), and explanatory hypotheses are discussed.

RESULTS

Some individuals with ASD never acquire language. Amongst those who do, language abilities range from clinically normal (ALN) to various degrees of impairment (ALI). Developmental trajectories and individual profiles are diverse, and minority subgroups have been identified. Specifically: language is commonly but not always delayed and delayed early language is always characterised by impaired comprehension and odd utterances, and sometimes by deviant articulation and grammar. Nevertheless, by school age an 'ASD-typical' language profile emerges from group studies, with articulation and syntax least affected, and comprehension, semantics and certain facets of morphology most affected. Thus, even individuals with ALN have poor comprehension relative to expressive language; also semantic-processing anomalies and idiosyncratic word usage. It is argued that impaired socio-emotional-communicative relating, atypical sensory-perceptual processing, and uneven memory/learning abilities may underlie shared language anomalies across the spectrum; and that varying combinations of low nonverbal intelligence, semantic memory impairment and comorbidities including specific language impairment (SLI), hearing impairment, and certain medical syndromes underlie ALI and variation in individual profiles.

CONCLUSIONS

Structural language is universally affected in ASD, due to a complex of shared and unshared causal factors. There is an urgent need for more research especially into the characteristics and causes of clinically significant language impairments.

Transition from school to work for students with autism spectrum disorders: understanding the process and achieving better outcomes

Individuals and their parents frequently turn to pediatricians, adolescent medicine specialists, and psychologists to answer questions about the course and outcomes of their disorder. This article provides a description of the characteristics of autism spectrum disorders (ASD) in adolescence and early adulthood. It also describes essential elements of high school programs designed to increase positive outcomes for youth with ASD and provides detailed information about various employment support models. Finally, the implications of transition programming for medical specialists and psychologists are discussed.

Effectiveness of semantic therapy for word-finding difficulties in pupils with persistent language impairments: a randomized control trial

BACKGROUND

Word-finding difficulties (WFDs) in children have been hypothesized to be caused at least partly by poor semantic knowledge. Therefore, improving semantic knowledge should decrease word-finding errors. Previous studies of semantic therapy for WFDs are inconclusive.

AIMS

To investigate the effectiveness of semantic therapy for secondary school-aged pupils with WFDs using a randomized control trial with blind assessment.

METHODS & PROCEDURES

Fifteen participants with language impairments and WFDs (aged 9;11-15;11) were randomly assigned to a therapy versus waiting control group. In Phase 1 the therapy group received two 15-min semantic therapy sessions per week for 8 weeks with their usual speech and language therapist. Therapy for each participant targeted words from one of three semantic categories (animals, food, clothes). All participants were tested pre- and post-phase 1 therapy on the brief version of the Test of Adolescent Word Finding (TAWF), semantic fluency and the Test of Word Finding in Discourse (TWFD). In Phase 2 the waiting control group received the same therapy as the original therapy group, which received therapy targeted at other language areas. Testing after Phase 2 aimed to establish whether the waiting control group made similar progress to the original therapy group and whether the original therapy group maintained any gains.

OUTCOMES & RESULTS

The original therapy group made significant progress in standard scores on the TAWF (d= 0.94), which was maintained 5 months later. However, they made no progress on the semantic fluency or discourse tests. Participants in the waiting control group did not make significant progress on the TAWF in Phase 1 when they received no word-finding therapy. However, after Phase 2, when they received the therapy, they also made significant progress (d= 0.81). The combined effect of therapy over the two groups was d= 1.2. The mean standard scores on the TAWF were 67 pre-therapy and 77 post-therapy.

CONCLUSIONS & IMPLICATIONS

Four hours of semantic therapy on discrete semantic categories led to significant gains on a general standardized test of word finding, enabling the participants to begin to close the gap between their performance and that of their typically developing peers. These gains were maintained after 5 months. A small amount of therapy can lead to significant gains even with secondary aged pupils with severe language difficulties. However, further studies are needed to find ways of improving word-finding abilities in discourse.

Intentional communication in nonverbal and verbal low-functioning children with autism

In this study we characterized profiles of communicative functions and forms of children with autism and intellectual disability (n=26), as compared to typically developing children (n=26) with a comparable nonverbal mental age (2-5 years). Videotapes of the Communication and Symbolic Behavior Scales - Developmental Profile were analyzed using a standardized observation scheme in which three main functions were distinguished: behavior regulation, social interaction, and joint attention. Different forms of communication were also investigated: gestures, vocalizations/verbalizations, and eye gaze. Results indicated that in typically developing children the proportion of communication for the purpose of joint attention was much higher than for behavior regulation, whereas in children with autism the opposite pattern was seen. Low-functioning nonverbal children with autism mainly communicated for behavior regulation and not or only rarely for declarative purposes. Generally, this subgroup used the least complex forms to communicate. Low-functioning verbal children with autism differed from typically developing children only in the rate, not in the proportion of communication for specific functions. Combinations of three different communicative forms were used by verbal children with autism less frequently than by typically developing children.

LEARNING OUTCOMES

After reading this paper, readers should be able to: (1) describe early development of communicative functions, (2) explain differences in communication profiles with respect to form and function between verbal and nonverbal low-functioning children with autism and typically developing children matched on nonverbal mental age and (3) discuss clinical implications of the findings for communication interventions in verbal and nonverbal low-functioning children with autism.

Acquisition of Turkish grammatical morphology by children with developmental disorders

BACKGROUND

Many children with specific language impairment, Down syndrome or autism spectrum disorder have difficulty learning grammatical morphology, especially forms associated with the verb phrase. However, except for Hebrew, the evidence thus far has come from Indo-European languages.

AIMS

This study investigates the acquisition of grammatical morphology by Turkish-speaking children with developmental disorders. Syntactic, perceptual and usage features of this non-Indo-European language were predicted to lead to patterns of atypical learning that would challenge and broaden current views.

METHODS & PROCEDURES

Language samples were collected from 30 preschoolers learning Turkish: ten with developmental disorders, ten matched by age and ten by length of utterance. T-SALT then generated mean length of utterance, the total number of noun errors, the total number of verb errors and the per cent use in obligatory contexts for noun suffixes. Analyses also looked at the potential effects of input frequency on order of acquisition.

OUTCOMES & RESULTS

Turkish children in the MLU-W control group, aged 3;4, used noun and verb suffixes with virtually no errors. Children in the group with atypical language showed more, and more persistent, morphological errors than either age or language peers, especially on noun suffixes. Children in the ALD and MLU-W groups were acquiring noun case suffixes in an order that is strongly related to input frequencies.

CONCLUSIONS & IMPLICATIONS

These findings seem to reflect the influence of salience, regularity and frequency on language learning. Typical child-adult discourse patterns as well as the canonical SOV Turkish word order make verb suffixes perceptually salient, available in working memory and frequently repeated. The findings support the view that the language patterns seen in children with atypical development will differ from one language type to the next. They also suggest that regardless of language or syntactic class, children will have greater difficulty with those features of grammar that have higher cognitive processing costs.

Social participation in a nationally representative sample of older youth and young adults with autism

OBJECTIVE

To describe social participation and identify factors that affect it in a nationally representative sample of adolescents and young adults with autism.

METHODS

Longitudinal cohort study using data from the National Longitudinal Transition Study-2. The World Health Organization International Classification of Functioning, Disability, and Health model was used with participation as the dependent category.

RESULTS

A nationally representative sample of 725 youth with autism representing a weighted sample of 21,010 individuals was followed up for 4 years. The mean age at first interview was 15.4 years and 19.2 years at follow-up. More than half the youth at follow-up had not gotten together with friends in the previous year and 64% had not talked on the phone with a friend. Being employed or in secondary education was associated with the following factors (odds ratios): problems conversing (0.67), being teased (0.17), mental retardation (0.06), being above the poverty level (4.17), not using prescription medicine (4.11), general health status (2.30), and parental involvement with school (1.69) (all p < .001).

CONCLUSIONS

Many adolescents and young adults with autism become increasingly isolated. Although each aspect of social participation had its own distinct pattern of factors related to it, the ability to communicate effectively, less severe autism, coming from an environment that was not impoverished and having parents who advocated were associated with more positive outcomes. These data provide insights into the factors that affect the participation of youth with autism during their transition years and should ultimately lead to interventions that could improve those transitions.

Changes in the autism behavioral phenotype during the transition to adulthood

We examined whether exiting high school was associated with alterations in rates of change in autism symptoms and maladaptive behaviors. Participants were 242 youth with ASD who had recently exited the school system and were part of our larger longitudinal study; data were collected at five time points over nearly 10 years. Results indicated overall improvement of autism symptoms and internalized behaviors over the study period, but slowing rates of improvement after exit. Youth who did not have an intellectual disability evidenced the greatest slowing in improvement. Lower family income was associated with less improvement. Our findings suggest that adult day activities may not be as intellectually stimulating as educational activities in school, reflected by less phenotypic improvement after exit.

Social competence intervention for youth with Asperger Syndrome and high-functioning autism: an initial investigation

Individuals with high functioning autism (HFA) or Asperger Syndrome (AS) exhibit difficulties in the knowledge or correct performance of social skills. This subgroup's social difficulties appear to be associated with deficits in three social cognition processes: theory of mind, emotion recognition and executive functioning. The current study outlines the development and initial administration of the group-based Social Competence Intervention (SCI), which targeted these deficits using cognitive behavioral principles. Across 27 students age 11-14 with a HFA/AS diagnosis, results indicated significant improvement on parent reports of social skills and executive functioning. Participants evidenced significant growth on direct assessments measuring facial expression recognition, theory of mind and problem solving. SCI appears promising, however, larger samples and application in naturalistic settings are warranted.

Developmental language impairment through the lens of the ICF: an integrated account of children's functioning

The conceptual framework of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) has the potential to advance understanding of developmental language impairment (LI) and enhance clinical practice. The framework provides a systematic way of unifying numerous lines of research, which have linked a wide array of factors to the functioning of children with LI. The result is an integrated account of LI where children's functioning emerges from the complex interaction of core linguistic processes, the ability to use them in social interactions, and a variety of environmental and personal factors. This account is well-suited to the clinical context because it focuses clinical attention on how such factors may be interacting to maintain a child's functional limitations, and on how they might work together to facilitate optimal everyday functioning, the ultimate goal of intervention. In this paper, the ICF's conceptual framework is described, and the nature of the relationships among its components explained. We explore how the integrated view of LI inspired by this conceptual framework differs from the prevailing impairment-driven account, provide examples from the literature that are consistent with the former view, and discuss its implications for clinical decision-making.

LEARNING OUTCOMES

As a result of this activity, the reader will be able to: (1) describe the nature of the relationships that exist among components of the ICF; (2) describe how interactions among components may shape the functioning of children with LI; (3) identify ways in which the integrated account of LI engendered by the ICF may improve clinical service.

Behavioral and physiological responses to child-directed speech as predictors of communication outcomes in children with autism spectrum disorders

PURPOSE

To determine the extent to which behavioral and physiological responses during child-directed speech (CDS) correlate concurrently and predictively with communication skills in young children with autism spectrum disorders (ASD).

METHOD

Twenty-two boys with ASD (initial mean age: 35 months) participated in a longitudinal study. At entry, behavioral (i.e., percentage looking) and physiological (i.e., vagal activity) measures were collected during the presentation of CDS stimuli. A battery of standardized communication measures was administered at entry and readministered 12 months later.

RESULTS

Percentage looking during CDS was strongly correlated with all entry and follow-up communication scores; vagal activity during CDS was moderately to strongly correlated with entry receptive language, follow-up expressive language, and social-communicative adaptive skills. After controlling for entry communication skills, vagal activity during CDS accounted for significant variance in follow-up communication skills, but percentage looking during CDS did not.

CONCLUSIONS

Behavioral and physiological responses to CDS are significantly related to concurrent and later communication skills of children with ASD. Furthermore, higher vagal activity during CDS predicts better communication outcomes 12 months later, after initial communication skills are accounted for. Further research is needed to better understand the physiological mechanisms underlying variable responses to CDS among children with ASD.

Social stress in young people with specific language impairment

Social interactions can be a source of social stress for adolescents. Little is known about how adolescents with developmental difficulties, such as specific language impairment (SLI), feel when interacting socially. Participants included 28 adolescents with SLI and 28 adolescents with typical language abilities (TL). Self-report measures of social stress, social skills and social acceptance were obtained. Participants with SLI reported experiencing significantly more social stress than did participants with TL. Both groups judged themselves as having adequate social skills and positive social acceptance. Expressive language ability was negatively associated with social stress, but did not predict social stress when social factors were included in the regression model. Perceived social skills and social acceptance scores predicted social stress, in that poorer scores predicted more social stress. Despite perceiving themselves as having adequate social skills and as being socially accepted, social interactions are nonetheless a source of stress for adolescents with SLI.

Asperger's syndrome and high-functioning autism: language, motor and cognitive profiles

The objective of this study is to compare the cognitive profile, the motor and language functioning and the psychosocial adaptation of children with Asperger syndrome (AS) and with high-functioning autism (HFA). Subjects were recruited through the department Autism and Developmental Disorders of the Heckscher-Klinikum. To be included in the study, the full-scale-IQ had to be at least 80. Subjects with AS had to have a normal early language development and subjects with HFA a clear delay in language development, as reported by their parents. The sample consisted of 57 children with Asperger syndrome and 55 children with high-functioning autism. The mean age of the children was 10 years. All subjects were examined with a standardised test battery. Children with AS had a higher full-scale-IQ than children with HFA. This was due to a higher verbal-IQ. There were no significant differences in the performance-IQ. At a mean age of 10 years, subjects with AS had better language skills than subjects with HFA, but at least 30% showed clear receptive language problems. Motor problems were present in about 50% of the children with AS and HFA. The level of psychosocial adaptation was clearly reduced, but was comparable for the two groups. The differences in verbal-IQ and language skills between the two groups could be explained through the definition of the syndromes. The presence of language problems in the subjects with AS at age 10, the comparable degree of motor impairment and level of psychosocial adaptation question the validity of the distinction between AS and HFA within the category of pervasive developmental disorders.

Childhood language skills and adult literacy: a 29-year follow-up study

OBJECTIVE

Our aim was to assess the longitudinal trajectory of childhood receptive language skills and early influences on the course of language development.

METHODS

Drawing on data collected for a nationally representative British birth cohort, the 1970 British Cohort Study, we examined the relationship between directly assessed early receptive language ability, family background, housing conditions, early literacy environment, and adult literacy skills. A sample of 11349 cohort members who completed the English Picture Vocabulary Test at 5 years of age were studied again at 34 years of age, when they completed a direct assessment of their basic literacy skills. We contrasted experiences of individuals with language problems at age 5 against the experiences of those with normal language skills at that age, assessing the role of socioeconomic family background and early literacy environment in influencing the longitudinal course of developmental language problems. Statistical comparisons of rates with chi(2) tests at P values of .001, .01, and .05 were made, as well as multivariate logistic regressions.

RESULTS

Cohort members with receptive language problems at age 5 had a relatively disadvantaged home life in childhood, both in terms of socioeconomic resources and the education level of their parents, but also regarding their exposure to a stimulating early literacy environment. Although there is significant risk for poor adult literacy among children with early language problems, the majority of these children develop competent functional literacy levels by the age of 34. Factors that reduce the risk for persistent language problems include the child being born into a working family, parental education beyond minimum school-leaving age, advantageous housing conditions, and preschool attendance.

CONCLUSION

Effective literacy-promoting interventions provided by pediatric primary care providers should target both children and parents.

Twenty-year follow-up of children with and without speech-language impairments: family, educational, occupational, and quality of life outcomes

PURPOSE

Parents, professionals, and policy makers need information on the long-term prognosis for children with communication disorders. Our primary purpose in this report was to help fill this gap by profiling the family, educational, occupational, and quality of life outcomes of young adults at 25 years of age (N = 244) from the Ottawa Language Study, a 20-year, prospective, longitudinal study of a community sample of individuals with (n = 112) and without (n = 132) a history of early speech and/or language impairments. A secondary purpose of this report was to use data from earlier phases of the study to predict important, real-life outcomes at age 25.

METHOD

Participants were initially identified at age 5 and subsequently followed at 12, 19, and 25 years of age. Direct assessments were conducted at all 4 time periods in multiple domains (demographic, communicative, cognitive, academic, behavioral, and psychosocial).

RESULTS

At age 25, young adults with a history of language impairments showed poorer outcomes in multiple objective domains (communication, cognitive/academic, educational attainment, and occupational status) than their peers without early communication impairments and those with early speech-only impairments. However, those with language impairments did not differ in subjective perceptions of their quality of life from those in the other 2 groups. Objective outcomes at age 25 were predicted differentially by various combinations of multiple, interrelated risk factors, including poor language and reading skills, low family socioeconomic status, low performance IQ, and child behavior problems. Subjective well-being, however, was primarily associated with strong social networks of family, friends, and others.

CONCLUSION

This information on the natural history of communication disorders may be useful in answering parents' questions, anticipating challenges that children with language disorders might encounter, and planning services to address those issues.

Neurodevelopmental disorders: cluster 2 of the proposed meta-structure for DSM-V and ICD-11

BACKGROUND

DSM-IV and ICD-10 are atheoretical and largely descriptive. Although this achieves good reliability, the validity of diagnoses can be increased by an understanding of risk factors and other clinical features. In an effort to group mental disorders on this basis, five clusters have been proposed. We now consider the second cluster, namely neurodevelopmental disorders.

METHOD

We reviewed the literature in relation to 11 validating criteria proposed by a DSM-V Task Force Study Group.

RESULTS

This cluster reflects disorders of neurodevelopment rather than a 'childhood' disorders cluster. It comprises disorders subcategorized in DSM-IV and ICD-10 as Mental Retardation; Learning, Motor, and Communication Disorders; and Pervasive Developmental Disorders. Although these disorders seem to be heterogeneous, they share similarities on some risk and clinical factors. There is evidence of a neurodevelopmental genetic phenotype, the disorders have an early emerging and continuing course, and all have salient cognitive symptoms. Within-cluster co-morbidity also supports grouping these disorders together. Other childhood disorders currently listed in DSM-IV share similarities with the Externalizing and Emotional clusters. These include Conduct Disorder, Attention Deficit Hyperactivity Disorder and Separation Anxiety Disorder. The Tic, Eating/Feeding and Elimination disorders, and Selective Mutisms were allocated to the 'Not Yet Assigned' group.

CONCLUSION

Neurodevelopmental disorders meet some of the salient criteria proposed by the American Psychiatric Association (APA) to suggest a classification cluster.

Grammaticality judgments in autism: deviance or delay

Language in autism has been the subject of intense interest, because communication deficits are central to the disorder, and because autism serves as an arena for testing theories of language acquisition. High-functioning older children with autism are often considered to have intact grammatical abilities, despite pragmatic impairments. Given the heterogeneity in language skills at younger ages, this assumption merits further investigation. Participants with autism (n=21, aged nine to seventeen years), matched on chronological age, receptive vocabulary and IQ, to 22 typically developing individuals, completed a grammaticality judgment task. Participants with autism were significantly less sensitive than controls, specifically for third person singular and present progressive marking. Performance interacted with sentence length, with lower sensitivity to errors occurring at the end of the longest stimulus sentences. Performance sensitivity was associated with onset of single word and phrase speech, and with severity of autistic symptomatology. Implications of findings are discussed.