Assessing Communication in Children with Autism Spectrum Disorder Who Are Minimally Verbal

Using Language Environment Analysis System (LENA) in Natural Settings to Characterize Outcomes of Pivotal Response Treatment

PURPOSE

Despite the importance of monitoring changes in expressive language in early intervention, existing approaches to language assessment are often costly, time-intensive, and capture limited variability in autistic children. The Language ENvironmental Analysis (LENA) system has thus received considerable attention as an automated approach that may hold promise for capturing fine-grained changes in language development in a more efficient and cost-effective manner. However, evaluations of the utility of the LENA system for tracking response to early intervention in unstructured contexts are currently limited.

METHODS

This study aimed to build on prior research through evaluating the use of LENA in the context of a well-defined clinical sample from a randomized controlled trial (RCT) of Pivotal Response Treatment (PRT) that demonstrated expressive language gains across standardized and manually-coded measures.

RESULTS

Exploration of automatically-derived LENA metrics (i.e., child vocalizations, conversational turns) revealed no significant association with standardized language assessments (i.e., Mullen expressive language subscale, MacArthur Bates Communicative Development Inventory, Vineland-II expressive language subscale). Furthermore, relative to the delayed treatment group, children participating in PRT did not show significantly greater improvement in the number of vocalizations or conversational turns during naturalistic, daylong LENA recordings collected in home settings from baseline to post-intervention.

CONCLUSION

Implications and future directions for natural language sampling and the measurement of expressive language in early intervention are discussed.

Evaluation of the effectiveness of a serious game titled "Kookism" on the receptive lexicon in 4-9-year-old autistic children

Background

Autistic children often face difficulties with semantic skills such as receptive lexicon. Games based on behavioral principles have been emphasized for treating autistic children. Serious Games are a new and effective way to alleviate deficits in autistic children.

Objectives

The present study aimed to design and investigate the efficiency of a Serious Game titled "Kookism" on the receptive lexicon of autistic children.

Methods

The empirical study with a pretest-posttest design, and a two-months follow-up, involved 30 children (aged 4-9) at Birjand and Zahedan, Iran. The participants were selected by convenience sampling and randomly divided into experimental and control groups (each 15 participants). The control group received the Applied Behavior Analysis (ABA), while the experimental group received a treatment consisting of the ABA plus the "Kookism" game. The 20-min sessions were held every other day for two months. Data were collected using MacArthur-Bates Communicative Development Inventories. After confirming the essential assumptions for the covariance analysis, ANCOVA was used to analyze the data.

Results

The findings showed a significant difference between the experimental and control groups in the increase in the participants' receptive lexicon after eliminating the effects of the covariate (p < 0.05). Two months later, there was no statistically significant difference. (P = 0.144, F = 0.077, p > 0.05).

Conclusions

The findings of this study indicate that Serious Games significantly improved the receptive lexicon of autistic children. This result remained for up to two months.

Response to Music-Mediated Intervention in Autistic Children with Limited Spoken Language Ability

PURPOSE

Autistic children with limited spoken language ability (LSLA) often do not respond to traditional interventions, reducing their social inclusion. It is essential to identify effective interventions, and sensitive measures to track their intervention response.

METHODS

Using data from an RCT comparing music-mediated and play-based interventions, we investigated the impact of spoken language ability on outcomes, and measured response to intervention through natural language sample measures.

RESULTS

Children with lower verbal IQ, relative to higher verbal IQ, made some greater gains over the course of music-mediated intervention. Natural language samples were helpful in characterizing communication and tracking change.

CONCLUSION

Music-mediated interventions hold promise as effective interventions for autistic children with LSLA. Natural language samples are robust in characterizing this subgroup.

Predicting Communication Skills Outcomes for Preschool Children with Autism Spectrum Disorder Following Early Intervention

Purpose

This study aims to assess changes in the receptive and expressive language skills and to determine if the baseline characteristics such as communication, cognitive and motor skills, predict outcomes in preschool children with Autism Spectrum Disorder (ASD) following early intervention.

Methods

We recruited 64 children participating in the Early Start Denver Model (ESDM) early intervention program at an Autism Specific Early Learning and Care Center (ASELCC) in Australia. Baseline characteristics across various developmental domains was measured using the Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behaviour Scales, 2nd Edition (VABS-II), and the ESDM Curriculum Checklist. Linear mixed-effects models were used to examine the effects of the intervention on outcomes. Fixed-effects such as time, groups (verbal and minimally verbal), and time-by-group interactions were assessed whilst adjusting for covariates. Further, multiple linear regression models were used to determine if the baseline characteristics were significant predictors of the outcomes following the early intervention.

Results

Among the 64 children who participated in this study, 38 children were verbal, whereas 26 were deemed to have minimal verbal skills. The mean age of the sample was 4.1 years with a significant male predilection (83%) and from a culturally and linguistically diverse (CALD) background (64%). Findings of the linear mixed effects model showed significant within and between group differences in the ESDM subscales, indicating higher magnitude of changes in the verbal group compared to the minimally verbal group. Finally, the multiple linear regression models suggested that baseline MSEL visual reception and expressive language scores were predictive of changes in the ESDM receptive and expressive communication scores.

Conclusion

Understanding a child's baseline skill levels may provide valuable clues regarding what interventions would work best, or which interventions may be less suitable for individual preschool-aged children with ASD.

The Utility of Natural Language Samples for Assessing Communication and Language in Infants Referred with Early Signs of Autism

Natural Language Sampling (NLS) offers clear potential for communication and language assessment, where other data might be difficult to interpret. We leveraged existing primary data for 18-month-olds showing early signs of autism, to examine the reliability and concurrent construct validity of NLS-derived measures coded from video-of child language, parent linguistic input, and dyadic balance of communicative interaction-against standardised assessment scores. Using Systematic Analysis of Language Transcripts (SALT) software and coding conventions, masked coders achieved good-to-excellent inter-rater agreement across all measures. Associations across concurrent measures of analogous constructs suggested strong validity of NLS applied to 6-min video clips. NLS offers benefits of feasibility and adaptability for validly quantifying emerging skills, and potential for standardisation for clinical use and rigorous research design.

Lexical and Morphosyntactic Profiles of Autistic Youth With Minimal or Low Spoken Language Skills

PURPOSE

Autistic youth who are minimally or low verbal are underrepresented in research leaving little to no evidence base for supporting them and their families. To date, few studies have examined the types of words and word combinations these individuals use. The purpose of this study was to take a strengths-based approach to outline descriptive profiles of autistic youth who use few words and elucidate the lexical and morphosyntactic features of their spoken language.

METHOD

We analyzed language samples from 49 autistic youth ages 6-21 years who used fewer than 200 words. Systematic Analysis of Language Transcripts was used to investigate the relationship between number of different words (NDW) and proportion of nouns and verbs (vs. other word classes), mean length of utterance in morphemes (MLUm), and the frequency of early developing morphosyntactic structures. We used linear regression to quantify the relationship between NDW and lexical and morphosyntactic features.

RESULTS

Proportion of nouns and verbs produced did not increase significantly in those with higher NDW. Conversely, MLUm and the frequency of early developing morphosyntactic structures increased significantly in those with higher NDW.

CONCLUSIONS

Youth with higher NDW did not produce more nouns and verbs, suggesting lexical profiles that are not aligned with spoken vocabulary level. Youth with higher NDW had higher MLUm and more early morphosyntactic forms, suggesting that morphosyntactic profiles align with spoken vocabulary level. We discuss the implications for improving clinical services related to spoken language.

The utility of LENA as an indicator of developmental outcomes for young children with autism

BACKGROUND

There is growing understanding of the potential benefits of a multi-method approach to accurately capture language skills of children on the autism spectrum. Tools such as Language ENvironment Analysis (LENA) provide an efficient means of capturing and analysing early child vocalizations (CVs) and the language learning environment. While developed to capture whole-day recordings of child language in naturalistic settings, there is potential utility in capturing, but little knowledge about, primary LENA metrics-including CVs and conversational turns (CTs)-and novel metrics, such as vocalization ratios (VRs), sampled in clinical practice settings where children are often seen. Moreover, recent research indicates that the novel VR may offer a broad indicator of children's developmental level, beyond just their language abilities, a hypothesis yet to be investigated in a large sample of children for whom the LENA was designed (i.e., pre-schoolers).

AIMS

To explore the extent to which primary and novel LENA metrics collected during brief one-to-one clinical interaction was a useful indicator of developmental outcomes for children on the autism spectrum.

METHODS & PROCEDURES

Participants were recruited as part of an on-going research programme evaluating early intervention outcomes (n = 99; age 14-47 months). Language samples were collected at intake (T1) using the wearable LENA Digital Language Processors during a one-to-one, play-based assessment with a clinician. Direct (Mullen Scales of Early Learning-MSEL) and parent-report (Vineland Adaptive Behavior Scales-VABS) measures of verbal and non-verbal skills were also collected at intake (T1) and again at exit (T2), approximately 12 months later.

OUTCOMES & RESULTS

Few correlations were observed between child measures and CVs, a primary LENA metric. The novel VR metric was associated with concurrent direct assessment (MSEL) (and to a lesser extent parent report; VABS) measures of verbal and non-verbal skills, with moderate positive correlations found between VRs and all directly assessed subscale scores. However, VRs did not uniquely contribute to the prediction of child outcomes when baseline skills were also considered.

CONCLUSIONS & IMPLICATIONS

The novel VR may provide an insight into autistic children's overall development in addition to their language ability, suggesting that even when collected in a short recording format, LENA might be a useful component of a multi-method assessment approach.

WHAT THIS PAPER ADDS

What is already known on the subject To accurately capture language skills of children on the autism spectrum, multi-method approaches, including natural language sampling, are recommended. Tools such as LENA provide an efficient means of capturing and analysing naturalistic child language and the language learning environment. What this paper adds to existing knowledge This study demonstrates the potential benefits, and limitations, of using LENA to augment assessment of young children on the autism spectrum. Specifically, LENA provides a complementary, and low burden, method for capturing child language samples. What are the potential or actual clinical implications of this work? Novel metrics, such as the VR, collected during brief clinical interactions might be a useful component of a multi-method assessment approach for children on the autism spectrum.

Clinician Proposed Predictors of Spoken Language Outcomes for Minimally Verbal Children with Autism Spectrum Disorder

Our aim was to explore insights from clinical practice that may inform efforts to understand and account for factors that predict spoken language outcomes for children with Autism Spectrum Disorder who use minimal verbal language. We used a qualitative design involving three focus groups with 14 speech pathologists to explore their views and experiences. Using the Framework Method of analysis, we identified 9 themes accounting for 183 different participant references to potential factors. Participants highlighted the relevance of clusters of fine-grained social, communication, and learning behaviours, including novel insights into prelinguistic vocal behaviours. The participants suggested the potential value of dynamic assessment in predicting spoken language outcomes. The findings can inform efforts to developing clinically relevant methods for predicting children's communication outcomes.

Emergent Literacy Assessment in Children With Autism Spectrum Disorder Who Have Limited Verbal Communication Skills: A Tutorial

Purpose Children with autism spectrum disorder (ASD) are at increased risk of experiencing difficulties with the development of literacy, including the emergent literacy skills recognized to underpin conventional literacy success. Comprehensive assessment is essential. Characteristics of ASD can make assessment challenging, and this can be compounded when children are unable to demonstrate their skills using spoken language. The purpose of this clinical tutorial is to outline the process of emergent literacy assessment for children with ASD who have limited verbal communication skills. A case example of a 5-year-old boy is presented. Method Pertinent literature is reviewed around the literacy profiles of children with ASD, the subgroup of children with ASD who have limited verbal communication skills, key components of emergent literacy, and previous research examining the emergent literacy abilities of children with ASD. The case report is described in depth and emphasizes the key factors to consider when designing an assessment battery and protocol. Results The case example information is interpreted, and its application is discussed. Key outcomes are highlighted including a greater understanding of the child's literacy strengths and needs and the implications for individualized instruction. Conclusion The clinical tutorial highlights the need for a comprehensive, well-planned assessment approach that involves all members of the educational team, and that is considerate to the needs of the individual child and responsive to their communication needs.

Multi-component communication intervention for children with autism: A randomized controlled trial

The objective of this study is to evaluate the effectiveness of a multi-component communication intervention on social communication for young children with autism. As many as half of children with autism are not yet talking by age 3, and up to a third of children with autism will remain minimally verbal past age 5. Spoken language outcomes are greatest when parents and clinicians are delivering language interventions to children with autism as compared to parents or clinicians alone. This study incorporates caregiver training, Discrete Trial Teaching, and JASP + EMT + SGD. A total of 68 children between ages 3 and 5 with autism, and their caregivers, participated in this study. Children were randomly assigned to the treatment or control group. Children in the treatment group received 36 sessions of the multi-component intervention in the clinic and at home. Children in both groups received a speech-generating device and the caregivers received an individualized training on how to program the speech-generating device. All participants were evaluated prior to intervention, immediately following intervention, and 4 months following intervention. Children in the intervention group demonstrated significantly greater joint attention than those in the control group immediately following intervention. Children in the intervention group, additionally, demonstrated greater social communication with their caregivers 4 months following intervention. This brief, multi-component intervention may be effective for improving social communication in young children with autism who are at risk for remaining minimally verbal. Future research is needed to understand for whom and under what conditions this intervention is most effective.

Lay abstract

This study reports the results of a randomized trial for preverbal preschoolers with autism that demonstrates the effects of multiple intervention strategies including caregiver training. About 50% of children with autism are not talking by age 3 and up to 30% of children with autism will remain minimally verbal past age 5. Interventions delivered by clinicians and caregivers have the greatest effects on spoken language and may reduce the rate of those who remain minimally verbal. Sixty-eight children ages 3–5 with autism and their caregivers participated in this randomized trial comparing the communication intervention to a comparison group. A brief, multi-component, communication intervention (including a speech-generating device) for children with autism that addresses core deficits may be effective in improving joint attention skills immediately following intervention and social communication skills 4 months following intervention. Future research is needed to understand for whom and under what conditions this intervention is most effective.