Application of the Communication Complexity Scale in Peer and Adult Assessment Contexts for Preschoolers With Autism Spectrum Disorders

A Comparison of Maternal and Clinician Perception of Communication in Autistic Toddlers

PURPOSE

Parent instruction in communication facilitation strategies for autistic toddlers relies on assumptions that parents interpret child behaviors in alignment with clinician definitions of communication. The purpose of this study was to identify features of child behaviors that are predictive of alignment in identification of child communication between clinical researchers and mothers of young autistic children.

METHOD

Participants were 33 mothers and their autistic children between 18 and 48 months of age. Mothers' and clinical researchers' perceptions of child communication were assessed using a procedure in which mothers and clinical researchers each independently identified child communication in the same ten 1-min video clips of each mother's child. Endorsed communicative acts were coded for the presence of conventional forms (e.g., vocalization) and potentially communicative forms (e.g., body movement). Multilevel binomial regressions, fit with Bayesian inference, were conducted to predict classification of maternal endorsements of child communication based on the presence of conventional and potentially communicative forms as either an aligned act (i.e., act endorsed by mother and clinical researcher as communicative) or a unique maternal endorsement (i.e., act endorsed by mother but not clinical researcher).

RESULTS

The presence of vocalization, verbalization, and gesture each significantly predicted increased likelihood of alignment; the presence of eye contact did not. Although repetitive and sensory behaviors significantly increased the likelihood of unique maternal endorsement, affect shifts and body movements each significantly reduced the likelihood of unique maternal endorsement, and hand activity was not significantly predictive of unique maternal endorsement.

CONCLUSIONS

Misalignment in mothers' and clinical researchers' identification of communication may be in part due to mothers' endorsement of behavioral forms that are not traditionally classified as part of a child's communication repertoire. Findings emphasize the need to work toward designing communication interventions that consider the ways in which clinicians and parents of autistic children each bring their own interpretive frameworks to the early intervention experience.

Changes in the early communicative behaviors of young children with significant cognitive and motor developmental delays in a two-year span

INTRODUCTION

This study examines longitudinal changes in communicative behavior of young children with significant cognitive and motor developmental delays (SDD) and determines their individual communicative trajectories. A second focus of this study is the relation of changes in communicative behavior with motor skills.

METHODS

Data consists of codes resulting from a self-developed coding scheme used on observations of 23 children in three different settings and responses on a questionnaire. First, group trends were determined to find out whether communication-related variables tend to significantly change over the course of two years. Furthermore, these findings were contrasted with the individual trajectories of the children. Next, the association of initial communicative skills and (the acquisition of) specific motor skills with the change in their communicative functioning was studied. Wilcoxon Signed Ranks and correlational analyses were used to answer the research questions.

RESULTS

Out of sixteen different variables related to communicative behavior, ten changed significantly over the course of two years. Children with more focus on prompt on the first datapoint showed a significantly larger increase of signs of functionality. Still, all children showed highly individual trajectories. Children with better motor skills on the first datapoint showed a significantly larger increase in communication rate.

CONCLUSIONS

Results show that if a myriad of detailed variables are taken into account children with significant cognitive and motor developmental disabilities do change regarding their communicative functioning, but that they tend to all show unique developmental trajectories. Children with stronger skills in some aspects of communication and motor functioning, can be considered advantaged regarding their communicative development.

Using the Clinical Global Impression scale to assess social communication change in minimally verbal children with autism spectrum disorder

Assessing improvements in social communication behaviors in minimally verbal children with autism spectrum disorder (ASD) is often challenging. The Clinical Global Impression Scale (CGI) is a 7-point scale that has been adapted so that clinicians can easily and quickly rate social communication behaviors. The current study evaluated the CGI-Improvement (CGI-I) subscale as a measure of social communication change in minimally verbal children with ASD. The sample included 54 minimally verbal school-age children with ASD enrolled in a social communication intervention trial. CGIs were rated by interventionists and the study coordinator at baseline and at Week 6 of intervention, and were compared to scores on the Communication Complexity Scale (CCS). Results indicated that CGI ratings corresponded with CCS scores at baseline and Week 6. Children who were rated as more severe on social communication at baseline demonstrated lower complexity of communication compared to those who were rated as less severe. Those who demonstrated fast response to intervention at Week 6 showed greater improvement in their joint attention than those who were slower responders. These results provide support for the utility and validity of the CGI-I as a measure of social communication change in minimally verbal children. This study tested the CGI, a clinician rating scale, with a group of children with ASD with limited language who received intervention to improve social interactions and communication. Children's CGI ratings were comparable to other assessments in measuring social communication. The CGI may be a useful tool for those interested in quickly and easily tracking changes in children's social communication over the course of treatment. LAY SUMMARY: This study tested the Clinical Global Impression (CGI), a clinician rating scale, with a group of children with ASD with limited language who received intervention to improve social interactions and communication. Children's CGI ratings were comparable to other assessments in measuring social communication. The CGI may be a useful tool for those interested in quickly and easily tracking changes in children's social communication over the course of treatment.

Measuring Change in the Communication Skills of Children With Austim Spectrum Disorder Using the Communication Complexity Scale

Changes in minimal verbal communication by children with autism spectrum disorder (ASD) were measured with the Communication Complexity Scale (CCS) and other communication assessments. The CCS measures complexity of preverbal and beginning verbal communication used to communicate behavior regulation and joint attention. The purpose was to investigate if the CCS was responsive to changes associated with a behavioral intervention aimed at improving communication skills. Changes were detected with CCS scores, rates of initiating joint attention, and the Mullen Scales of Early Learning (MSEL) Expressive Language subscale. Significant changes in CCS scores were also detected for a subgroup of participants who did not show significant changes on the MSEL Expressive Language subscale, demonstrating that CCS scores are sensitive to changes associated with a behavioral intervention.

Preverbal Communication Complexity in Infants

The development of prelinguistic communication in typically developing infants is marked by changes in complexity as well as frequency, yet most measures focus on frequency. In the current study we used the Communication Complexity Scale (CCS) to measure prelinguistic complexity of typically developing infants in a cross-sectional sample of 6-, 8-, 10- and 12-month-olds (N = 204) during semi-structured play interaction. For each toy/interactive episode, infants' highest level of communication complexity (ranging from 0 for no response to 12 for multi-word verbalization), for both joint attention (i.e., social) and behavior regulation (e.g., requesting) functions, was scored. In addition, the same interaction was coded for frequency of all prelinguistic communication acts. Results of multivariate models indicated age-related differences in prelinguistic complexity. Measures of prelinguistic complexity and frequency evidenced moderate to strong correlations, with age-related differences by function (joint attention and behavior regulation). Significant associations with parent-report communication questionnaires were observed for both complexity and frequency measures. Results indicate that evaluating complexity of infant preverbal communication skill with the CCS is a valuable approach that can meaningfully index developmental differences in prelinguistic and early linguistic communication.