A systematic review of pragmatic language interventions for children with autism spectrum disorder

Current practices of Portuguese speech-language pathologists with preschool-age children with pragmatic impairment: A cross-sectional survey

This study aims to investigate the practice patterns used by Portuguese speech-language pathologists (SLPs) with preschool-age children with pragmatic impairment and to identify the actual need(s) perceived by SLPs in this field. A total of 351 SLPs responded. The results reveal that 81.5 per cent of the respondents (n=286) reported working or had previously worked with preschool-age children with pragmatic impairment arising from autism spectrum disorder, developmental language disorder, or both. Considering the clinical practice, similarities and differences were found, many of which are due not to the inherent characteristics of each disorder but to the scarcity of research in clinical pragmatics. These results are also reflected in the needs perceived by SLPs and the degree of confidence with which they work with these children. Implications for clinical practice and directions for future research are discussed.

Friendship interventions for children with neurodevelopmental needs: A systematic review and meta-analysis

RATIONALE

Children with neurodevelopmental disorders such as attention-deficit hyperactivity disorder (ADHD), autism, developmental language disorder (DLD), intellectual disability (ID), and social (pragmatic) communication disorder (SPCD) experience difficulties with social functioning due to differences in their social, emotional and cognitive skills. Previous systematic reviews have focussed on specific aspects of social functioning rather than broader peer functioning and friendships.

OBJECTIVE

To systematically review and methodologically appraise the quality and effectiveness of existing intervention studies that measured friendship outcomes for children with ADHD, autism, DLD, ID, and SPCD.

METHOD

Following PRISMA guidelines, we searched five electronic databases: CINAHL, Embase, Eric, PsycINFO, and PubMed. Two independent researchers screened all abstracts and disagreements were discussed with a third researcher to reach consensus. The methodological quality of studies was assessed using the Cochrane Risk of Bias Tool for Randomised Trials.

RESULTS

Twelve studies involving 15 interventions were included. Studies included 683 children with a neurodevelopmental disorder and 190 typically-developing children and diagnosed with either autism or ADHD. Within-group meta-analysis showed that the pooled intervention effects for friendship across all interventions were small to moderate (z = 2.761, p = 0.006, g = 0.485). The pooled intervention effect between intervention and comparison groups was not significant (z = 1.206, p = 0.400, g = 0.215).

CONCLUSION

Findings provide evidence that some individual interventions are effective in improving social functioning and fostering more meaningful friendships between children with neurodevelopmental disorders and their peers. Effective interventions involved educators, targeted child characteristics known to moderate peer functioning, actively involved peers, and incorporated techniques to facilitate positive peer perceptions and strategies to support peers. Future research should evaluate the effectiveness of friendship interventions for children with DLD, ID and SPCD, more comprehensively assess peer functioning, include child self-report measures of friendship, and longitudinally evaluate downstream effects on friendship.

Endophenotyping social cognition in the broader autism phenotype

Relatives of individuals with autism spectrum disorder (ASD) may display milder social traits of the broader autism phenotype (BAP) providing potential endophenotypic markers of genetic risk for ASD. We performed a case-control comparison to quantify social cognition and pragmatic language difficulties in the BAP (n = 25 cases; n = 33 controls) using the Faux Pas test (FPT) and the Goldman-Eisler Cartoon task. Using deep phenotyping we then examined patterns of inheritance of social cognition in two large multiplex families and the spectrum of performance in 32 additional families (159 members; n = 51 ASD, n = 87 BAP, n = 21 unaffected). BAP individuals showed significantly poorer FPT performance and reduced verbal fluency with the absence of a compression effect in social discourse compared to controls. In multiplex families, we observed reduced FPT performance in 89% of autistic family members, 63% of BAP relatives and 50% of unaffected relatives. Across all affected families, there was a graded spectrum of difficulties, with ASD individuals showing the most severe FPT difficulties, followed by the BAP and unaffected relatives compared to community controls. We conclude that relatives of probands show an inherited pattern of graded difficulties in social cognition with atypical faux pas detection in social discourse providing a novel candidate endophenotype for ASD.

A systematic review of prevalence of pain in nursing home residents with dementia

BACKGROUND

The prevalence of dementia in nursing home (NH) residents is high, and pain is a troublesome symptom for them. Several studies since 2010 have focused on pain in NH residents with dementia, but there is a lack of systematic reviews on the prevalence of pain in NH residents with dementia.

AIM

To systematically review observational studies published from 2010 to 2023 on how pain is assessed and prevalence of pain found in NH residents with dementia.

METHODS

A systematic search was conducted in the MEDLINE, PubMed, PsycINFO, Embase, CINAHL, AgeLine, and Cochrane databases for studies published from January 2010 to August 2023. Studies were included if they were observational studies with a quantitative design where self-report, staff assessment, and/or chart review were used to define the prevalence of pain in samples or subsamples of NH residents with dementia.

RESULTS

Of 184 studies considered, 25 were included. The studies assessed pain as daily, present, clinically relevant, chronic, intermittent, persistent pain and/or if pain affected quality of life. The prevalence of pain was high in most studies of NH residents with dementia independent of whether pain was reported as presence of pain or clinically relevant pain, but the prevalence varied from 8.6% to 79.6%. This prevalence was quite stable across the NH stay, but higher towards the end of life (up to 80.4%). Study designs and methodologies differed considerably. About half relied on an observational assessment inventory.

CONCLUSION

The number of studies focusing on pain in NH residents with dementia was restricted and methodologies differed considerably. Relatively few studies used an observational assessment inventory. In view of the fact that residents with dementia may have difficulties communicating pain, clinicians should pay attention to pain in these residents, systematically and reliably uncover pain by use of observational inventories, and subsequently treat pain to secure high quality care.

Pragmatic language and associations with externalizing behaviors in autistic individuals and those who have lost the autism diagnosis

Background

Pragmatic language weaknesses, a core feature of autism spectrum disorder (ASD), are implicated in externalizing behavior disorders (Gremillion & Martel, 2014). Particularly in a clinical setting, these co-occurring externalizing disorders are very common in autism; rates of Attentional Deficit-Hyperactive Disorder (ADHD) and Oppositional Defiant Disorder (ODD) are as high as 83% (ADHD) and 73% (ODD; Joshi et al., 2010). It is possible that pragmatic language weaknesses impact the ability to effectively communicate one's needs, which may lead autistic children to utilize externalizing behaviors in order to achieve a desired outcome (Ketelaars et al., 2010; Rodas et al., 2017).

Methods

The aim of the current study is to investigate the relationship between pragmatic language, assessed via multiple modalities, and externalizing behaviors, assessed by parent interview, in youth with autistic (n=33) or neurotypical (NT; n=34) developmental histories, along with youth diagnosed with autism, who lost the diagnosis (LAD) by adolescence (n=31).

Results

The autism group had significantly more pragmatic language difficulties, and more externalizing behaviors and disorders; ADHD symptoms were particularly more prevalent, while LAD and NT groups did not differ. Challenges in pragmatic language abilities were associated with more externalizing symptoms when controlling for other facts that typically influence such symptoms, including nonverbal cognition, structural language, executive functioning, and autistic characteristics, but did not remain when age was included in the model.

Conclusions

We discuss the mechanisms underlying difficult-to-manage externalizing behaviors and implications for interventions and long-term outcomes for youth with and without a history of autism.

Children with autism spectrum disorder who demonstrate normal language scores use a bottom-up semantic processing strategy: Evidence from N400 recordings

INTRODUCTION

The N400 is an electrophysiological component that reflects lexical access and integration of words with mental representations.

METHODS

Thirty-five young children with a range of language capabilities (n = 21 neurotypical controls, 10 males, mean age = 6.3 ± 0.9 years; n = 14 children with autism, 12 males, mean age = 6.4 ± 1.1 years) completed an auditory semantic categorization paradigm to evoke the N400. Electroencephalograph (EEG) data were acquired with a 64-channel electrode cap as children listened via ear inserts to binaurally presented single syllable words and decided whether the words were congruent (in) or incongruent (out) with a pre-specified category. EEG data were filtered, epoched, and averaged referenced, and global field power (GFP) was computed. The amplitude of the N400 peak in the GFP was submitted to a multiple linear regression analysis.

RESULTS

N400 amplitude was found to predict language scores only for the children with ASD who have language scores in the normal range (r2  = 0.72).

CONCLUSIONS

This finding that N400 amplitude only predicted language scores in children with ASD and normal language scores suggests that these children may rely more on basic semantic processing (as reflected by the N400) and less on anticipating and predicting upcoming words. This suggests preferential utilization of a bottom-up strategy to access higher order language.

The fuzzy boundaries of the social (pragmatic) communication disorder (SPCD): Why the picture is still so confusing?

Introduction

Since the introduction of Social (Pragmatic) Communication Disorder (SPCD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) in 2013, a debate has arisen in the scientific community about its usefulness in differential diagnosis for other clinical categories such as Autism Spectrum Disorder (ASD) and Specific Language Impairment (SLI). Indeed, SPCD criteria share a common deficit in communication and pragmatic skills with these diagnostic entities. Available assessment tools seem scarce and not sensitive enough to clarify diagnostic criteria and clinical boundaries. This study aims to review the existing literature on diagnostic screening for SPCD to highlight confounding variables in the domains examined, overlap with other diagnostic entities, and lack of specificity of available assessment tools in identifying the core deficits of the disorder.

Methods

The search strategy was defined by combining the following keywords: "social pragmatic communication disorder," "DSM-5," "differential diagnosis," and "child." The search was performed in three databases: Medline (PubMed), Scopus, and Web of Science. All studies published between 2013 and April 2023, written in English, and with a major focus on SPCD were included in the review.

Results

After the screening for the eligibility, 18 studies were included in the review. Most of these studies aimed to investigate the differential diagnosis between SPCD and other diagnostic categories (e.g., specific language impairment and autism spectrum disorder). Of these researches, only 6 were ad hoc experimental studies, while the others were based on previously collected databases.

Conclusions

SPCD seems to have its own peculiarities and characteristics, indicating its clinical relevance, as emphasized by the DSM-5. However, the lack of specific instruments and a number of confounding variables make it difficult to identify and differentiate SPCD from other diagnostic entities. Further research is needed to overcome the lack of specific clinical instruments and lack of empirical studies.

Structural and pragmatic language in young children with sex chromosome trisomy (XXX, XXY, XYY): Predictive value for neurobehavioral problems one year later

Objective: To investigate pragmatic language abilities in young children with an increased risk for adverse neurobehavioral and neurocognitive outcomes due to an extra X or Y chromosome (sex chromosome trisomy; SCT) and to investigate to what degree early structural and pragmatic language abilities are predictive of neurobehavioral problems one year later. Method: In total, 72 children with SCT and 71 controls aged 3-7 years were included. Language assessments included parent-reported pragmatic language skills and direct assessment of structural language abilities. Parent-reported behavioral outcomes were measured one year after the initial language assessment. Results: Children with SCT demonstrated weaker pragmatic language skills compared to controls. These differences were not driven by karyotype, time of diagnosis, or ascertainment bias and irrespective of the presence of structural language impairment. Odds of having pragmatic difficulties was 23 times higher in the SCT group, with 25% of the children not meeting age-expectations. In addition, language, in particular pragmatic language, was an important predictor for later affective, oppositional defiant, pervasive developmental, attention deficit, and social-emotional problems in young children with SCT. Conclusions: This study is one of the first studies that directly illustrates the relationship between language and behavioral outcomes in children with SCT. Our results stress the importance to closely monitor pragmatic language in addition to structural language in clinical care of children with SCT, as pragmatic language abilities could serve as an early marker for children at risk for developing behavioral problems.

Primary school children rate children with autism negatively on looks, speech and speech content

Adults and adolescents form negative first impressions of ASD adults and children. We examined the first impression ratings of primary school children (6-9 years) of their ASD peers. 146 school children rated either silent videos, speech or transcribe speech from 14 actors (7 ASD, 7 TD). The ASD actors were rated more negatively than the typically developing actors on all three stimulus types. Children with ASD are likely to be judged more negatively than their peers at the very start of their formal education. Contrary to previous research, for primary school children, the content of the speech was judged as negatively as the delivery of the speech.

The impact of subtle language and communication difficulties on the daily lives of autistic children without intellectual disability: Parent perspectives

BACKGROUND

Autistic children without intellectual disability will likely experience higher level language and communication difficulties. These may appear subtle, in that they are not immediately evident to those who do not know the child well and may not manifest in all environments. Because of this, the impact of such difficulties may be underestimated. This phenomenon has similarly attracted little research attention, meaning the extent to which subtle language and communication difficulties contribute to the needs of autistic individuals without intellectual disability may be underspecified in clinical services.

AIMS

To offer a detailed exploration of how relatively subtle language and communication difficulties impact on autistic children without intellectual disability and what strategies parents recognize can mediate those negative effects.

METHODS & PROCEDURES

Twelve parents of autistic children from the target group (aged 8-14 years, attending mainstream school) were interviewed about how subtle language and communication difficulties impact their autistic child. Rich accounts were derived then analysed using thematic analysis. Eight of the children discussed had previously been interviewed independently in a parallel study. Comparisons are discussed in this paper.

OUTCOMES & RESULTS

Parents reported heterogeneous but pervasive higher level language and communication difficulties which universally impacted key areas of the children's function: peer relationships, developing independence and performance in education. Communication difficulties were also universally associated with negative emotional responses, social withdrawal and/or negative self-perceptions. While parents identified a range of ad hoc strategies and naturally occurring opportunities that improved outcomes, there was little mention of the means to address primary language and communication difficulties. The current study showed a number of parallels with child accounts, demonstrating the benefits of collecting data from both sources in clinical and research investigations. However, parents were more concerned about longer term implications of language and communication difficulties and highlighted their impact on the child developing functional independence.

CONCLUSIONS & IMPLICATIONS

Subtle language and communication difficulties, typically identified in this higher ability autistic group, can impact significantly on key areas of childhood function. Support strategies seem to be parent generated and inconsistently applied across individuals, without the benefit of coherent specialist services. Dedicated provision and resources targeting areas of functional need may be beneficial to the group. In addition, the commonly reported association between subtle language and communication difficulties and emotional well-being indicates the need for greater exploration using empirical methods, and joined-up clinical working between speech and language therapy and mental health services.

WHAT THIS PAPER ADDS

What is already known on the subject There is now a wide understanding of how language and communication difficulties can impact the individual. However, where those difficulties are relatively subtle, for example, in children without intellectual disability and where difficulties are not immediately evident, less is known. Research has often speculated on how identified differences in higher level structural language and pragmatic difficulties might impact on the function of autistic children. However, to date dedicated exploration of this phenomenon is limited. The current author group explored first-hand accounts of children. Corroborative evidence from parents of the same children would add further weight to understanding this phenomenon. What this paper adds to the existing knowledge This study provides a detailed exploration of parents' perspective relating to the impact of language and communication difficulties on autistic children without intellectual disability. It provides corroborative detail that support child accounts of the same phenomenon, indicating the impact on peer relationships, school outcomes and emotional well-being. Parents also report functional concerns around the child's ability to develop independence and this paper demonstrates how parents and children might deviate in their accounts, with parents reporting increased concerns around the longer term implications of early language and communication difficulties. What are the potential or actual clinical implications of this work? Relatively subtle language and communication difficulties can have a significant impact on the lives of autistic children without intellectual disability. Greater service provision for this group is therefore indicated. Interventions could focus on areas of functional concern where language is implicated, for example, peer relationships, developing independence and school success. Additionally, the relationship between language and emotional well-being points to further integration between speech and language therapy and mental health services. Differences found between parental and child reports highlight the need to collect data from both parties during clinical investigations. Parental strategies may offer benefits for the wider population.

TeleRehabilitation of Social-Pragmatic Skills in Children with Autism Spectrum Disorder: A Principal Component Analysis

In many therapeutic settings, remote health services are becoming increasingly a viable strategy for behavior management interventions in children with autism spectrum disorder (ASD). However, there is a paucity of tools for recovering social-pragmatic skills. In this study, we sought to demonstrate the effectiveness of a new online behavioral training, comparing the performance of an ASD group carrying out an online treatment (n°8) with respect to a control group of demographically-/clinically matched ASD children (n°8) engaged in a traditional in-presence intervention (face-to-face). After a 4-month behavioral treatment, the pragmatic skills language (APL test) abilities detected in the experimental group were almost similar to the control group. However, principal component analysis (PCA) demonstrated that the overall improvement in socio-pragmatic skills was higher for ASD children who underwent in-presence training. In fact, dimensions defined by merging APL subscale scores are clearly separated in ASD children who underwent in-presence training with respect to those performing the online approach. Our findings support the effectiveness of remote healthcare systems in managing the social skills of children with ASD, but more approaches and resources are required to enhance remote services.

Non-pharmacological interventions for autistic children: An umbrella review

LAY ABSTRACT

What is already known about the topic?The delivery of evidence-based interventions is an important part of the clinical pathway for many autistic children and their families. However, parents, practitioners, and policymakers face challenges making evidence informed decisions, due to the wide variety of interventions available and the large, and often inconsistent, body of evidence regarding their effectiveness.What this paper adds?This is a comprehensive umbrella review, also known as a 'review of reviews', which examined the range of interventions available, the evidence for their effectiveness, and whether effects were influenced by factors relating to individual children (e.g. chronological age, core autism characteristics, and related skills) or the ways interventions were delivered (by whom and in what setting, format, mode, and amount). There was evidence for positive therapeutic effects for some, but not all, interventions. No single intervention had a positive effect for all child and family outcomes of interest. The influence of child and delivery characteristics on effects was unclear.Implications for practice, research, and policyThe findings provide parents, practitioners, and policymakers with a synthesis of the research evidence to inform decision-making and highlight the importance of individualised approaches in the absence of clear and consistent evidence. The findings also highlight the need to improve consistency and completeness in reporting of research studies, so that the same questions may be answered more comprehensively in the future.

Evaluating the Performance of Transformer-based Language Models for Neuroatypical Language

Difficulties with social aspects of language are among the hallmarks of autism spectrum disorder (ASD). These communication differences are thought to contribute to the challenges that adults with ASD experience when seeking employment, underscoring the need for interventions that focus on improving areas of weakness in pragmatic and social language. In this paper, we describe a transformer-based framework for identifying linguistic features associated with social aspects of communication using a corpus of conversations between adults with and without ASD and neurotypical conversational partners produced while engaging in collaborative tasks. While our framework yields strong accuracy overall, performance is significantly worse for the language of participants with ASD, suggesting that they use a more diverse set of strategies for some social linguistic functions. These results, while showing promise for the development of automated language analysis tools to support targeted language interventions for ASD, also reveal weaknesses in the ability of large contextualized language models to model neuroatypical language.

Detecting autism from picture book narratives using deep neural utterance embeddings

BACKGROUND

Deficits in the ability to use language in social contexts, including storytelling skills, are observed across the autism spectrum. Development in machine-learning approaches may contribute to clinical psychology and psychiatry, given its potential to support decisions concerning the diagnosis and treatment of psychiatric conditions and disorders.

AIMS

To evaluate the usefulness of deep neural networks for detecting autism spectrum disorder (ASD) from textual utterances, specifically from narrations produced by individuals with ASD.

METHODS & PROCEDURES

We examined two text encoders: Embeddings from Language Models (ELMo) and Universal Sentence Encoder (USE), and three classification algorithms: XGBoost, support vector machines, and dense neural network layer. We aimed to classify 25 participants with ASD and 25 participants with typical development (TD) based on their narrations produced during the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) picture book task. The results of computational approaches were compared with the results of standardized testing and classifications made by two psychiatrists (raters). The raters were asked to read utterances produced by a participant (without an examiner's statements and additional information) and assign a participant to one of the two groups: ASD or with typical development (TD).

OUTCOMES & RESULTS

The computer-based models had higher sensitivity, specificity, positive predictive values and negative predictive values than the raters, and lower than the two standardized instruments: ADOS-2 and Social Communication Questionnaire (SCQ).

CONCLUSIONS & IMPLICATIONS

Our findings lay the groundwork for future studies involving deep neural network-based text representation models as tools for augmenting the ASD diagnosis or screening. Both ELMo and USE text encoders provided promising specificities, sensitivities, positive predictive values and negative predictive values. Our results indicate the usefulness of page-level embeddings for utterance representation in ADOS-2 picture book task.

WHAT THIS PAPER ADDS

What is already known on this subject Deficits in the use of language in social contexts, and narrative ability in particular, are observed across the autism spectrum. Most research on narrative skills has applied hand-coding methods. Hitherto, machine-learning methods were used mostly for image recognition problems and data from screening questionnaires for ASD classification. Detection of mental and developmental disorders from textual input is an emerging field for machine and deep-learning methods. What this paper adds to existing knowledge This study explored the ability of several types of deep neural network-based text representation models to detect ASD. Both ELMo and USE provided the most promising values of specificity, sensitivity, positive predictive values and negative predictive values. What are the potential or actual clinical implications of this work? Competitive accuracy, repeatability, speed and ease of operation are all advantages of computerized methods. They allow for objective and quantitative assessment of narrative ability and complex language skills. Deep neural network-based text representation models could in the future support clinicians and augment the decision-making process related to ASD diagnosis, screening and intervention planning.

The experiences of speech-language therapists providing telerehabilitation services to children with autism spectrum disorder

Background

There has been an increased emergence of the use of telerehabilitation by speech-language therapists (SLTs) in South Africa since the COVID-19 pandemic in 2020.

Objectives

To explore the criteria that SLTs use when recommending telerehabilitation for children with autism spectrum disorder (ASD), the technical skills required, strategies used by SLTs, the restrictions encountered when conducting telerehabilitation and the views of SLTs on telerehabilitation in comparison to face-to-face therapy for children with ASD.

Method

A descriptive, phenomenological, qualitative study design was utilised. Purposive and snowball sampling techniques were employed. Six SLTs from the private sector, who had experience providing telerehabilitation to children with ASD, were recruited from three provinces in South Africa. Data were gathered via semistructured online interviews and analysed using thematic analysis.

Results

Two out of five themes that emerged from this study are presented in this paper, i.e. approaches to telerehabilitation and the benefits of telerehabilitation. Results revealed that telerehabilitation was used to provide assessment and therapy during the COVID-19 pandemic lockdowns as an alternative method of service delivery. Assessment and treatment strategies included synchronous and asynchronous methods, family collaboration, social stories, frequent breaks and interactive sessions. Telerehabilitation reduced the client’s and SLT’s travel costs and increased caregiver and clinician satisfaction. Client progress and increased awareness of SLT were viewed as further benefits.

Conclusion

Telerehabilitation was found to be beneficial to most children with ASD, and in most cases, the benefits far outweighed the challenges encountered. Clinical implications included the need for caregiver support in facilitating effective carryover, an increase in SLTs’ knowledge and the opportunity to provide services to a broader geographical range. Limitations of the study are included.

Effectiveness of interventions for children and adolescents with autism spectrum disorder in high-income vs. lower middle-income countries: An overview of systematic reviews and research papers from LMIC

Background

There is a multitude of systematic reviews of interventions for children and adolescents with autism spectrum disorder (ASD). However, most reviews seem to be based on research conducted in High-Income Countries (HIC). Thus, summary findings may not directly apply to Lower Middle-Income Countries (LMIC). Therefore, we conducted a Meta-Review analyzing systematic reviews on the effectiveness of interventions for target outcomes in children and adolescents with ASD to find out whether there are differences in effectiveness between HIC and LMIC and which interventions can be considered evidence-based in LMIC.

Methods

Electronic databases (PsycINFO, PubMed, Cochrane database of systematic reviews) were searched for reviews on interventions for ASD in children and adolescents from January 2011 through December 2021, which included studies not coming from HIC. Systematic reviews with qualitative and quantitative syntheses of findings were included. Two investigators independently assessed studies against predetermined inclusion/exclusion criteria and extracted relevant data including quality and evidence assessments. Evidence for different types of interventions in HIC vs. LMIC was planned to be compared, but none of the reviews assessed potential differences. Therefore, a narrative review of the studies from LMIC was conducted including an assessment of quality and evidence.

Results

Thirty-five reviews fulfilled the inclusion criteria. Eleven considered findings from HIC and LMIC. Sixty-nine percent included studies with various research designs; 63% provided a qualitative synthesis of findings; 77% percent assessed the quality of studies; 43% systematically assessed the level of evidence across studies. No review compared evidence from HIC and LMIC. A review of the studies from LMIC found some promising results, but the evidence was not sufficient due to a small number of studies, sometimes poor quality, and small sample sizes.

Conclusion

Systematic reviews on interventions for children and adolescents with ASD did not look for potential differences in the effectiveness of interventions in HIC and LMIC. Overall, there is very little evidence from LMIC. None of the interventions can be considered evidence-based in LMIC. Hence, additional research and mutually agreed methodological standards are needed to provide a more secure basis for evidence-based treatments in LMIC trying to establish evidence-based practices.

Efficacy, model of delivery, intensity and targets of pragmatic interventions for children with developmental language disorder: A systematic review

BACKGROUND

It is widely acknowledged that children with developmental language disorder (DLD) predominantly have difficulties in the areas of grammar and vocabulary, with preserved pragmatic skills. Consequently, few studies focus on the pragmatic skills of children with DLD, and there is a distinct lack of studies examining the effectiveness of pragmatic interventions.

AIMS

To carry out a systematic review of the literature on pragmatic interventions for children with DLD.

METHODS & PROCEDURES

This systematic review was registered with PROSPERO (ID = CRD42017067239). A systematic search in seven databases yielded 1031 papers, of which 11 met our inclusion criteria. The included papers focused on interventions for children with DLD (mean = 3-18 years), enhancing oral language pragmatic skills, published between January 2006 and May 2020, and were based on a group-study design such as randomized control trial or pre-post-testing. Study participants were monolingual speakers. The quality of papers was appraised using the Cochrane Risk of bias tool for randomized controlled trials.

OUTCOMES & RESULTS

There was a high degree of variability between the included intervention studies, especially regarding intensity, intervention targets and outcomes. The evidence suggested that pragmatic intervention is feasible for all models of delivery (individual, small and large group) and that interventions for pragmatic language are mostly focused on encouragement of conversation and narrative skills observed through parent-child interaction or shared book-reading activities.

CONCLUSIONS & IMPLICATIONS

This study highlights the importance of promoting and explicitly teaching pragmatic skills to children with DLD in structured interventions. A narrative synthesis of the included studies revealed that in addition to direct intervention, indirect intervention can also contribute to improving oral pragmatic skills of children with DLD.

WHAT THIS PAPER ADDS

What is already known on the subject? An increasing number of studies have shown that difficulties in acquiring pragmatic language is not only present in children with autism. What this study adds to existing knowledge? Interventions for pragmatic language in children with DLD are mostly focused on encouragement of conversation and narrative skills, very often through parent-child interaction or shared book-reading activities. Interventions that target language pragmatic are feasible for all models of delivery (individual, small and large group). What are the potential or actual clinical implications of this work? The efficacy of the existing studies varies, and it is difficult to give recommendations regarding the intensity and duration of the specific intervention. In addition to offering pragmatic intervention directly from a specialist, pragmatic interventions can also be carried out indirectly if the intervention is under the continuous supervision of a specialist.

Psychometric Properties of Standardized Instruments that are Used to Measure Pragmatic Intervention Effects in Children with Developmental Language Disorder: A Systematic Review

This review aimed to analyze the psychometric properties of standardized instruments that are used to measure pragmatic intervention effects in children with developmental language disorder. Following PRISMA structure, a comprehensive literature research was conducted in five electronic indexing databases: Central, PubMed, Medline, Web of Science and Scopus. Six studies between 2005 and 2019 were included and seven standardized instruments have been analyzed. All instruments present some evidence of validity and reliability, but none reported responsiveness. The instruments reviewed were not used for their original purpose, which may explain the results. The small number of studies prevent drawing clear conclusions. Future studies should focus on appropriate, valid, reliable, and responsive measures. Research focusing on psychometric properties is crucial, mostly about responsiveness.

Neurobiological Highlights of Cognitive Impairment in Psychiatric Disorders

This review is focused on several psychiatric disorders in which cognitive impairment is a major component of the disease, influencing life quality. There are plenty of data proving that cognitive impairment accompanies and even underlies some psychiatric disorders. In addition, sources provide information on the biological background of cognitive problems associated with mental illness. This scientific review aims to summarize the current knowledge about neurobiological mechanisms of cognitive impairment in people with schizophrenia, depression, mild cognitive impairment and dementia (including Alzheimer's disease).The review provides data about the prevalence of cognitive impairment in people with mental illness and associated biological markers.

Friend matters: sex differences in social language during autism diagnostic interviews

BACKGROUND

Autistic individuals frequently experience social communication challenges. Girls are diagnosed with autism less often than boys even when their symptoms are equally severe, which may be due to insufficient understanding of the way autism manifests in girls. Differences in the behavioral presentation of autism, including how people talk about social topics, could contribute to these persistent problems with identification. Despite a growing body of research suggesting that autistic girls and boys present distinct symptom profiles in a variety of domains, including social attention, friendships, social motivation, and language, differences in the way that autistic boys and girls communicate verbally are not yet well understood. Closely analyzing boys' and girls' socially-focused language during semi-structured clinical assessments could shed light on potential sex differences in the behavioral presentation of autistic individuals that may prove useful for identifying and effectively supporting autistic girls. Here, we compare social word use in verbally fluent autistic girls and boys during the interview sections of the ADOS-2 Module 3 and measure associations with clinical phenotype.

METHODS

School-aged girls and boys with autism (N = 101, 25 females; aged 6-15) were matched on age, IQ, and parent/clinician ratings of autism symptom severity. Our primary analysis compared the number of social words produced by autistic boys and girls (normalized to account for differences in total word production). Social words are words that make reference to other people, including friends and family.

RESULTS

There was a significant main effect of sex on social word production, such that autistic girls used more social words than autistic boys. To identify the specific types of words driving this effect, additional subcategories of friend and family words were analyzed. There was a significant effect of sex on friend words, with girls using significantly more friend words than boys. However, there was no significant main effect of sex on family words, suggesting that sex differences in social word production may be driven by girls talking more about friends compared to boys, not family. To assess relationships between word use and clinical phenotype, we modeled ADOS-2 Social Affect (SA) scores as a function of social word production. In the overall sample, social word use correlated significantly with ADOS-2 SA scores, indicating that participants who used more social words were rated as less socially impaired by clinicians. However, when examined in each sex separately, this result only held for boys.

LIMITATIONS

This study cannot speak to the ways in which social word use may differ for younger children, adults, or individuals who are not verbally fluent; in addition, there were more autistic boys than girls in our sample, making it difficult to detect small effects.

CONCLUSIONS

Autistic girls used significantly more social words than boys during a diagnostic assessment-despite being matched on age, IQ, and both parent- and clinician-rated autism symptom severity. Sex differences in linguistic markers of social phenotype in autism are especially important in light of the late or missed diagnoses that disproportionately affect autistic girls. Specifically, heightened talk about social topics could complicate autism referral and diagnosis when non-clinician observers expect a male-typical pattern of reduced social focus, which autistic girls may not always exhibit.

Solitary symbolic play, object substitution and peer role play skills at age 3 predict different aspects of age 7 structural language abilities in a matched sample of autistic and non-autistic children

BACKGROUNDS AND AIMS

Early symbolic play abilities are closely related to long-term language development for both autistic and non-autistic children, but few studies have explored these relations for different dimensions of pretence and of language. The current study explores carer-reported measures of solitary symbolic play, object substitution and peer role play abilities at age 3, and their respective relations with parent-reported semantics, syntax and narrative abilities at age 7 for both autistic and non-autistic children.

METHODS

We conducted secondary data analyses exploring links between different aspects of pretence and of language on the Longitudinal Study of Australian Children population cohort. We identified 92 autistic children and used propensity score matching to match them with 92 non-autistic children based on demographic and developmental information such as non-verbal IQ and socioeconomic status. We explored concurrent and longitudinal relations using correlation and regression models. Results: Both correlational and hierarchical regression analyses confirmed the significant effects of age 3 symbolic play abilities in facilitating age 7 semantics, syntax and narrative abilities for autistic children. We found that object substitution held most prominent influence, followed by peer role play and solitary symbolic play. In contrast, for non-autistic children, none of the age 3 symbolic play abilities were significant predictors, whereas socioeconomic status at birth and age 3 language abilities held significant influences on their age 7 semantics, syntax and narrative abilities. Conclusion: We discuss the implications of our findings for play interventions targeting language outcomes.

A systematic review of self-report measures used in epidemiological studies to assess alcohol consumption among older adults

Background

There is a lack of standardization regarding how to assess and categorize alcohol intake in older adults. The aim of this study was to systematically review methods used in epidemiological studies to define drinking patterns and measure alcohol consumption among older adults.

Methods

A systematic search was conducted in the MEDLINE, PubMed, PsycINFO, EMBASE, and CINAHL databases for studies published from January 2009 to April 2021. Studies were included if they were observational studies with a quantitative design; the mean age of the participants was ≥ 65 years; questionnaires, screening tools, or diagnostic tools were used to define alcohol consumption; and alcohol consumption was self-reported.

Results

Of 492 studies considered, 105 were included. Among the 105 studies, we detected 19 different drinking patterns, and each drinking pattern had a wide range of definitions. The drinking patterns abstaining from alcohol, current drinking, and risk drinking had seven, 12 and 21 diverse definitions, respectively. The most used questionnaire and screening tools were the quantity-frequency questionnaire, with a recall period of 12 months, and the full and short versions of the Alcohol Use Disorders Identification Test, respectively.

Conclusion

No consensus was found regarding methods used to assess, define, and measure alcohol consumption in older adults. Identical assessments and definitions must be developed to make valid comparisons of alcohol consumption in older adults. We recommend that alcohol surveys for older adults define the following drinking patterns: lifetime abstainers, former drinkers, current drinkers, risk drinking, and heavy episodic drinking. Standardized and valid definitions of risk drinking, and heavy episodic drinking should be developed. The expanded quantity-frequency questionnaire including three questions focused on drinking frequency, drinking volume, and heavy episodic drinking, with a recall period of 12 months, could be used.

Effectivity of Play-Based Interventions in Children with Autism Spectrum Disorder and Their Parents: A Systematic Review

Evidence of the effectivity of play-based interventions in children with autism spectrum disorder (ASD) was evaluated by PRISMA-based literature study and a Risk of Bias (RoB) assessment. Many of the 32 eligible randomized controlled trials (RCT) reported improved social interaction, communication, daily functioning and play behaviour. They also reported decreased problem behaviour, better parental attunement and parent-child interaction. We assessed 25/32 of the RCTs with high RoB, mainly related to homogeneity of the study population, lack of power, and performance bias. We concluded with due care that the effectivity of play-based interventions differed across RCTs, most reported improvements are found in ASD symptoms, everyday functioning, and parental attunement. In future research, findings should be replicated, taking account of the RoB.

Assessment and Treatment of Prosody Behavior in Individuals with Level 1 Autism: A Review and Call for Research

Differences in prosody behavior between individuals with autism spectrum disorder (ASD) and their typically developing peers have been considered a central feature of ASD since the earliest clinical descriptions of the disorder (e.g., Kanner, 1943/1973). Prosody includes pitch and volume among other dimensions of vocal-verbal behavior that discriminate responses of the listener; thus, people with ASD whose prosody has confusing or off-putting effects may have fewer social opportunities at work, at school, or in the community. The purpose of this review is to examine the state of the literature intervening on prosody with individuals with ASD and to provide recommendations for researchers who are interested in contributing to the scientific understanding of prosody.

Recent Updates in Psychopharmacology for the Core and Associated Symptoms of Autism Spectrum Disorder

PURPOSE OF REVIEW

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by core deficits in social communication and restricted, repetitive patterns of behavior. This article aims to review the recent literature pertaining to psychopharmacology for the core and associated symptoms of ASD including social impairment, repetitive behaviors, irritability, and language impairment.

RECENT FINDINGS

Recent medication trials targeting social impairment in ASD have focused on neuropeptides (oxytocin and vasopressin) and memantine. None of these three medications has demonstrated consistent benefit for social impairment in ASD; however, additional studies are underway. Two double-blind, placebo-controlled studies on selective serotonin reuptake inhibitors (SSRIs) provide evidence against the use of SSRIs for repetitive behaviors in youth with ASD. Preliminary studies have investigated cannabidiol (CBD) for irritability in ASD but further studies are needed to demonstrate safety and efficacy. Finally, three double-blind, placebo-controlled studies provide preliminary evidence for folinic acid for the treatment of verbal language deficits in children with ASD. The identification of safe and effective pharmacological treatments to ameliorate the core and associated symptoms of ASD has proven difficult.

A randomised controlled feasibility trial of music-assisted language telehealth intervention for minimally verbal autistic children-the MAP study protocol

BACKGROUND

About 30% of children with autism spectrum disorder (ASD) do not develop functional speech and remain non-verbal or minimally verbal even after years of speech, language and educational interventions. A wide range of interventions have been developed for improving communication in ASD, but none have proved effective in eliciting functional language in ASD children. Research has found that people with ASD are more likely to have perfect pitch and prefer music to language. Further, it seems that language delay tends to co-occur with better musical skills. Brain imaging research has found that music alongside words increases the attention that people with ASD pay to spoken words.

METHODS

In this protocol, we describe our music-assisted programmes (MAP) that will use music to attract the attention of people with ASD to speech. MAP may open the brain pathways to language and therefore help improve communication skills for people with ASD more than standard communication protocols. In particular, we aim to develop and test whether individualised, easily used MAP would increase spoken language in 24-60-month-old, nonverbal or minimally verbal children with ASD. We will develop a structured training method, delivered through naturalistic, interactive activities (e.g. songs) to teach language to ASD children. We will test this by comparing two groups: one undertaking music-assisted programmes, and the other receiving speech and language therapy in the way that is recommended in NHS clinics. Participants will be allocated to groups randomly. The feasibility of MAP will be assessed through estimations of recruitment and retention rates, the sensitivity and reliability of the outcome measures, the intensity and frequency of the trial, the usability of the MAP app (beta version), and the burden of the assessments for the children and parents.

DISCUSSION

This feasibility randomised controlled trial will establish the acceptability and estimate the power of the MAP intervention to improve early word learning in children with ASD. In the longer term, this research will help us develop an app for parents or carers of children with ASD to design their own songs and implement their own individualised MAP.

TRIAL REGISTRATION

ISRCTN, ISRCTN12536062 . Registered on 26 June 2019.

Father-Child Interactions in Preschool Children with ASD: A Systematic Review

Studies on parental interaction in the context of ASD has mainly focused on mothers, even if fathers and their children seem to form close and supportive relationships that may have unique effects on child development. Given the impact of ASD symptoms on a child's ability to interact with significant others, recent findings strengthen the importance of including caregivers during treatment to guarantee a better adaptation to the child's impairments. Despite this, fathers are scarcely involved, and interventions seem to not be tailored to their interactive characteristics and needs. For this reason, a systematic review was conducted to investigate fathers and children with ASD behaviors during interaction. This review found 12 observational studies that identified social, cognitive, and affective interactive modalities in father-child dyads through three psychology-focused journal databases: PubMed, PsycINFO and Scopus. The significant variation in both sample size and in the measures used to assess dyadic outcomes limits the ability of this work to make robust recommendations for intervention. Despite this, the results revealed characteristic behaviors of this dyad that consequently allow specific targets to be worked on during intervention. In fact, from fathers' individual strengths and weaknesses, it is possible to implement interventions that are complementary with maternal characteristics from the perspective of personalized and optimized treatment.

Comparing Early Pragmatics in Typically Developing Children and Children with Neurodevelopmental Disorders

This study examined the early pragmatic language skills in typically developing (TD) preschool-age children, children with language impairment (LI) and children with autism spectrum disorder (ASD). Two hundred and sixty-two TD children, 73 children with LI, and 16 children with ASD were compared on early pragmatics through direct assessment (DA). Post hoc analysis revealed that children in two clinical groups displayed significant pragmatic language deficits. Children in the ASD group who were older exhibited comparable degree of impairments as their LI peers, suggesting a relatively stagnant development of pragmatic language skills in children with ASD. Findings also supported the use of DA in identifying pragmatic language deficits, which have implications for the adoption of this assessment approach in clinical settings.

School-entry language skills as predictors of concurrent and future academic, social, and adaptive skills in kindergarteners with ASD

OBJECTIVE

This study compared language profiles of children with autism spectrum disorder (ASD) and typically developing (TD) children at kindergarten-entry and investigated whether kindergarten-entry language scores were predictive of concurrent and future academic achievement, peer interactions, and adaptive skills in children with ASD.

METHOD

Participants included 97 children (62 children with ASD; 35 TD children) assessed at kindergarten-entry and -exit. Language abilities were assessed using the Children's Communication Checklist-2 (CCC-2). Children with ASD and TD children's language scores were compared at baseline, and the ASD group was followed longitudinally. Regression analyses were performed to compare language scores between ASD and TD groups and to predict concurrent and future functional skills from kindergarten-entry language scores for children with ASD.

RESULTS

Children with ASD demonstrated significantly more impairments across all scales of the CCC-2 at kindergarten-entry compared to TD children. Within the ASD group, kindergarten-entry pragmatic language significantly predicted concurrent math and reading achievement. Both syntactic/semantic and pragmatic domains significantly predicted kindergarten-exit reading performance; pragmatics significantly predicted kindergarten-exit math performance. Pragmatics also predicted concurrent and kindergarten-exit peer play. Syntax/semantics significantly predicted concurrent adaptive communication skills, whereas pragmatics significantly predicted concurrent adaptive daily living and socialization skills, as well as kindergarten-exit socialization skills.

CONCLUSIONS

School-entry language abilities can serve as a valuable predictor of functional outcomes across the kindergarten year for cognitively-able children with ASD. Results highlight the need to target early language abilities to maximize academic, social, and adaptive skills.

Effects of interventions for social anxiety and shyness in school-aged children: A systematic review and meta-analysis

In school, shyness is associated with psychosocial difficulties and has negative impacts on children's academic performance and wellbeing. Even though there are different strategies and interventions to help children deal with shyness, there is currently no comprehensive systematic review of available interventions. This systematic review and meta-analysis aim to identify interventions for shy children and to evaluate the effectiveness in reducing psychosocial difficulties and other impacts. The methodology and reporting were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and checklist. A total of 4,864 studies were identified and 25 of these met the inclusion criteria. These studies employed interventions that were directed at school-aged children between six and twelve years of age and described both pre- and post-intervention measurement in target populations of at least five children. Most studies included an intervention undertaken in a school setting. The meta-analysis revealed interventions showing a large effect in reducing negative consequences of shyness, which is consistent with extant literature regarding shyness in school, suggesting school-age as an ideal developmental stage to target shyness. None of the interventions were delivered in a classroom setting, limiting the ability to make comparisons between in-class interventions and those delivered outside the classroom, but highlighting the effectiveness of interventions outside the classroom. The interventions were often conducted in group sessions, based at the school, and involved activities such as play, modelling and reinforcement and clinical methods such as social skills training, psychoeducation, and exposure. Traditionally, such methods have been confined to a clinic setting. The results of the current study show that, when such methods are used in a school-based setting and involve peers, the results can be effective in reducing negative effects of shyness. This is consistent with recommendations that interventions be age-appropriate, consider social development and utilise wide, school-based programs that address all students.

Bilingualism in children with a dual diagnosis of Down syndrome and Autism Spectrum Disorder

Research shows that a substantial proportion of children with Down syndrome (DS) also meet the clinical criteria for Autism Spectrum Disorder (ASD). Children with this dual diagnosis display a linguistic profile that includes significant language delays and language impairments which often differ from the impairments observed in each developmental disability (DD) separately. Given the challenges observed with language acquisition for children with DS-ASD, concerns might be raised regarding the outcomes and suitability of a bilingual environment for children with this dual diagnosis specifically. The aim of this research was to explore the language profiles of four children with DS-ASD. A multiple case-study approach was employed. Four children with a confirmed DS-ASD diagnosis who had received exposure to two languages (English and Welsh) were assessed on a range of cognitive and linguistic measures. Performance was compared to three control groups; bilinguals with DS, English monolinguals with DS and mental age-matched typically developing bilinguals. Assessments comprised of expressive and receptive language, phonological awareness, working memory and non-verbal cognitive abilities. Considerable variability was found in the cognitive and linguistic profiles of the case-study participants. Children with DS-ASD displayed similar language profiles to that of the bilingual and monolingual children with DS in the areas tested, although performance was generally lower than that of the TD bilingual children. Although substantial variability was found, participants were developing bilingual abilities in a similar trajectory to children with DS in line with the degree of exposure to each language. This research highlights the need to assess bilingual children with complex dual diagnoses with an individualistic approach and carefully consider how to appropriately assess and treat bilingual children within speech and language therapy provisions.

Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review

Top-tier evidence on the safety/tolerability of 80 medications in children/adolescents with mental disorders has recently been reviewed in this jour-nal. To guide clinical practice, such data must be combined with evidence on efficacy and acceptability. Besides medications, psychosocial inter-ventions and brain stimulation techniques are treatment options for children/adolescents with mental disorders. For this umbrella review, we systematically searched network meta-analyses (NMAs) and meta-analyses (MAs) of randomized controlled trials (RCTs) evaluating 48 medications, 20 psychosocial interventions, and four brain stimulation techniques in children/adolescents with 52 different mental disorders or groups of mental disorders, reporting on 20 different efficacy/acceptability outcomes. Co-primary outcomes were disease-specific symptom reduction and all-cause discontinuation ("acceptability"). We included 14 NMAs and 90 MAs, reporting on 15 mental disorders or groups of mental disorders. Overall, 21 medications outperformed placebo regarding the co-primary outcomes, and three psychosocial interventions did so (while seven outperformed waiting list/no treatment). Based on the meta-analytic evidence, the most convincing efficacy profile emerged for amphetamines, methylphenidate and, to a smaller extent, behavioral therapy in attention-deficit/hyperactivity disorder; aripiprazole, risperidone and several psychosocial interventions in autism; risperidone and behavioral interventions in disruptive behavior disorders; several antipsychotics in schizophrenia spectrum disorders; fluoxetine, the combination of fluoxetine and cognitive behavioral therapy (CBT), and interpersonal therapy in depression; aripiprazole in mania; fluoxetine and group CBT in anxiety disorders; fluoxetine/selective serotonin reuptake inhibitors, CBT, and behavioral therapy with exposure and response prevention in obsessive-compulsive disorder; CBT in post-traumatic stress disorder; imipramine and alarm behavioral intervention in enuresis; behavioral therapy in encopresis; and family therapy in anorexia nervosa. Results from this umbrella review of interventions for mental disorders in children/adolescents provide evidence-based information for clinical decision making.

Meeting the communication needs of students on the autism spectrum in Australian classrooms: Adjustments reported by educators and specialists

PURPOSE

The purpose of this study was to examine educators' and specialists' provision of communication adjustments for students on the autism spectrum in mainstream and supported education settings.

METHOD

Secondary analysis of data collected from educators and specialists in the Australian Autism Educational Needs Analysis was undertaken. Thematic analysis of adjustment descriptions identified 11 categories. The use of the 11 specific adjustment categories with reference to (a) participant group (educator versus specialists), and (b) setting (mainstream versus supported) were described and associations investigated using Chi-square analyses.

RESULT

Only 32% of the 381 educators and specialists reported using adjustments. Of the adjustments reported, those categorised as "Multimodal Communication", "Structured Teaching", and "Assistive Technology" were frequently included by both groups. Significant associations were apparent between groups and the use of specific adjustments including naturalistic communication strategies. Significant differences were evident in the proportion of specific adjustments used by participants in supported as opposed to mainstream settings.

CONCLUSION

Possible reasons for the differences in the adjustments reported by educators and specialists and the role that setting may play in these are discussed. These include resourcing, the choice of adjustment being driven by school setting rather than student need, and possible differences between professionals in describing the adjustments made.

The Value of Non-Referential Gestures: A Systematic Review of Their Cognitive and Linguistic Effects in Children's Language Development

Speakers produce both referential gestures, which depict properties of a referent, and non-referential gestures, which lack semantic content. While a large number of studies have demonstrated the cognitive and linguistic benefits of referential gestures as well as their precursor and predictive role in both typically developing (TD) and non-TD children, less is known about non-referential gestures in cognitive and complex linguistic domains, such as narrative development. This paper is a systematic review and narrative synthesis of the research concerned with assessing the effects of non-referential gestures in such domains. A search of the literature turned up 11 studies, collectively involving 898 2- to 8-year-old TD children. Although they yielded contradictory evidence, pointing to the need for further investigations, the results of the six studies-in which experimental tasks and materials were pragmatically based-revealed that non-referential gestures not only enhance information recall and narrative comprehension but also act as predictors and causal mechanisms for narrative performance. This suggests that their bootstrapping role in language development is due to the fact that they have important discourse-pragmatic functions that help frame discourse. These findings should be of particular interest to teachers and future studies could extend their impact to non-TD children.

Evaluating 'Enhancing Pragmatic Language skills for Young children with Social communication impairments' (E-PLAYS): a feasibility cluster-randomised controlled trial

Background

This article reports the results from a feasibility study of an intervention (‘E-PLAYS’) aimed at supporting children who experience difficulties with social communication. E-PLAYS is based around a dyadic computer game, which aims to develop collaborative and communication skills. A pilot study found that when E-PLAYS was delivered by researchers, improvements on communication test scores and on collaborative behaviours were observed. The aim of this study was to ascertain the feasibility of running a full-scale trial to test the effectiveness of E-PLAYS in a National Health Service (NHS) setting with delivery by speech and language therapists and teaching assistants.

Methods

The study was a two-arm feasibility cluster-randomised controlled trial of the E-PLAYS intervention with a treatment as usual control arm. Data relating to recruitment and retention, treatment fidelity, acceptability to participants, suitability of outcomes and feasibility of collecting health economic measures and of determining cost-effectiveness were collected.

Speech and language therapists selected suitable children (ages 4–7 years old) from their caseload. E-PLAYS intervention (experimental group) was then delivered by teaching assistants overseen by speech and language therapists. The control group received usual care. Assessments included blinded language measures and observations, non-blinded teacher-reported measures of peer relations and classroom behaviour and non-blinded parent-reported use of health and education resources and quality of life.

Results

Planned recruitment was for 70 children, in the event, 50 children were recruited which was sufficient for feasibility purposes. E-PLAYS was very highly rated by children, teaching assistants and speech and language therapists and treatment fidelity did not pose any issues. We were able to collect health economic data which suggests that E-PLAYS would be a low-cost intervention.

Conclusion

Based on recruitment, retention and adherence rates and our outcome measures, a full-scale randomised controlled trial estimated appears feasible and warranted to assess the effectiveness of E-PLAYS for use by the NHS and schools.

Trial registration

ISRCTN 14818949 (retrospectively registered).

A Longitudinal Study of Parent-Child Interactions and Language Outcomes in Fragile X Syndrome and Other Neurodevelopmental Disorders

Difficulties with pragmatic language (i.e., language in social contexts, such as conversational ability) are a noted characteristic of the language profiles of both fragile X syndrome (FXS) and autism spectrum disorder (ASD), conditions which show significant phenotypic overlap. Understanding the origins and developmental course of pragmatic language problems in FXS and other developmental conditions associated with language impairment is a critical step for the development of targeted interventions to promote communicative competence across the lifespan. This study examined pragmatic language in the context of parent-child interactions in school-age children with FXS (who did and did not meet ASD criteria on the ADOS; n = 85), idiopathic ASD (n = 32), Down syndrome (DS; n = 38), and typical development (TD; n = 39), and their parents. Parent-child communicative interactions were examined across multiple contexts, across groups, and in relationship to pragmatic language outcomes assessed 2 years later. Results showed both overlapping and divergent patterns across the FXS-ASD and idiopathic ASD child and parent groups, and also highlighted key differences in pragmatic profiles based on situational context, with more pragmatic language difficulties occurring for both ASD groups in less structured interactions. Differences in parental language styles during parent-child interactions were associated with child language outcomes, likely reflecting the complex interplay of discourse style inherent to a parent, with the inevitable influence of child characteristics on parent language as well. Together, findings help delineate the dynamic and multifactorial nature of impaired pragmatic skills among children with FXS and other neurodevelopmental disorders associated with language impairment, with potential implications for the development of targeted interventions for pragmatic communication skills.

Emotional Availability and Play in Mother-Child Dyads with ASD: Changes during a Parental Based Intervention

(1) Background: Parental involvement during intervention with children with Autism Spectrum Disorder (ASD) has been demonstrated to be fundamental for children’s developmental outcomes. However, most research focused on child gains especially considering cognitive functioning and symptoms severity, whereas parental and dyadic changes during intervention need further investigation. (2) Methods: 29 mothers in interaction with their preschool children with ASD were analyzed through two standardized behavioral and observational measures to evaluate the dyadic Emotional Availability (EA) and play skills before (T1) and after (T2) a parental-based intervention. (3) Results: Results revealed mothers increased affective quality and major awareness in understanding the signals produced by the child, that in turn was more responsive, involving also using more complex play strategies. Interestingly, the role of specific factors able to predict parental characteristics was investigated, pointing out the important contribution of mothers’ perceptions of having a difficult child and child language communicative abilities. (4) Conclusions: the study enhances knowledge about child and caregiver variables that impact on dyadic outcomes, identifying important target areas to be addressed during intervention. Further, our results suggest that a parental-based intervention supports and facilitates improvements in both children’s and caregivers’ affective quality and cognitive abilities.

Early Brain Injury and Adaptive Functioning in Middle Childhood: The Mediating Role of Pragmatic Language

OBJECTIVE

Traumatic brain injuries (TBIs) often adversely affect adaptive functioning (AF). However, the cognitive mechanisms by which AF is disrupted are not well understood in young children who sustain TBI. This study examined pragmatic language (PL) and executive functioning (EF) as potential mechanisms for AF disruption in children with early, predominantly mild-complicated, TBI.

METHOD

The sample consisted of 76 children between the ages of 6 and 10 years old who sustained a TBI (n = 36) or orthopedic injury (OI; n = 40) before 6 years of age and at least 1 year prior to testing (M = 4.86 years, SD = 1.59). Children's performance on a PL and an expressive vocabulary task (which served as a control task), and parent report of child's EF and AF were examined at two time points 1 year apart (i.e., at age 8 and at age 9 years).

RESULTS

Injury type (TBI vs. OI) significantly predicted child's social and conceptual, but not practical, AF. Results indicated that PL, and not expressive vocabulary or EF at time 1, mediated the relationship between injury type and both social and conceptual AF at time 2.

CONCLUSIONS

A TBI during early childhood appears to subtly, but uniquely, disrupt complex language skills (i.e., PL), which in turn may disrupt subsequent social and conceptual AF in middle childhood. Additional longitudinal research that examines different aspects of PL and adaptive outcomes into adolescence is warranted.

Comparing the Pragmatic Speech Profiles of Minimally Verbal and Verbally Fluent Individuals with Autism Spectrum Disorder

Although pragmatic speech impairments have been found across the autism spectrum, how these manifest in minimally verbal (MV) individuals with autism spectrum disorder (ASD) has not been studied. We compared the pragmatic speech profiles of MV (n = 50) and verbally fluent (VF) individuals with ASD (n = 50; 6-21 years-old) based on natural language sampling during the Autism Diagnostic Observation Schedule-2. MV individuals with ASD primarily used their speech to agree/acknowledge/disagree, respond to a question, and request. In contrast, the primary pragmatic function used by VF individuals was commenting. Out of the total non-echolalic speech, groups did not differ proportionally in labeling and response to questions. Findings highlight the importance of investigating multiple aspects of pragmatic communication across different conversational partners and contexts.

Evidence-based support for autistic people across the lifespan: maximising potential, minimising barriers, and optimising the person-environment fit

Autism is both a medical condition that gives rise to disability and an example of human variation that is characterised by neurological and cognitive differences. The goal of evidence-based intervention and support is to alleviate distress, improve adaptation, and promote wellbeing. Support should be collaborative, with autistic individuals, families, and service providers taking a shared decision-making approach to maximise the individual's potential, minimise barriers, and optimise the person-environment fit. Comprehensive, naturalistic early intervention with active caregiver involvement can facilitate early social communication, adaptive functioning, and cognitive development; targeted intervention can help to enhance social skills and aspects of cognition. Augmentative and alternative communication interventions show preliminary evidence of benefit in minimising communication barriers. Co-occurring health issues, such as epilepsy and other neurodevelopmental disorders, sleep problems, and mental health challenges, should be treated in a timely fashion. The creation of autism-friendly contexts is best achieved by supporting families, reducing stigma, enhancing peer understanding, promoting inclusion in education, the community, and at work, and through advocacy.

A Play-Based, Peer-Mediated Pragmatic Language Intervention for School-Aged Children on the Autism Spectrum: Predicting Who Benefits Most

This study explored characteristics of children with autism with large intervention effects following a peer-mediated pragmatic language intervention, to devise algorithms for predicting children most likely to benefit. Children attended a 10-week intervention with a typically-developing peer. Data from a pilot study and RCT formed the dataset for this study. The POM-2 measured intervention outcomes. Children completed the EVT-2, TACL-4, and Social Emotional Evaluation at baseline, and parents completed the CCC-2 and CCBRS. High CCC-2 Use of Context and CCBRS Separation Anxiety scores and comparatively lower EVT-2, CCC-2 Nonverbal Communication and Cohesion scores predicted children with large intervention effects. Results can be used by clinicians to predict which children within their clinics might benefit most from participating in this intervention.

Assessing Social Communication and Collaboration in Autism Spectrum Disorder Using Intelligent Collaborative Virtual Environments

Existing literature regarding social communication outcomes of interventions in autism spectrum disorder (ASD) depends upon human raters, with limited generalizability to real world settings. Technological innovation, particularly virtual reality (VR) and collaborative virtual environments (CVE), could offer a replicable, low cost measurement platform when endowed with intelligent agent technology and peer-based interactions. We developed and piloted a novel collaborative virtual environment and intelligent agent (CRETA) for the assessment of social communication and collaboration within system and peer interactions. The system classified user statements with moderate to high accuracies. We found moderate to high agreement in displayed communication and collaboration skills between human-human and human-agent interactions. CRETA offers a promising avenue for future development of autonomous measurement systems for ASD research.

A Randomized Controlled Trial of a Play-Based, Peer-Mediated Pragmatic Language Intervention for Children With Autism

PURPOSE

This randomized controlled trial evaluated the effectiveness of a play-based pragmatic language intervention for children with autism.

METHODS

A sample of 71 children with autism were randomized to an intervention-first group (n = 28 analyzed) or waitlist-first (n = 34 analyzed) group. Children attended 10, weekly clinic play-sessions with a typically developing peer, and parents mediated practice components at home. The Pragmatics Observational Measure (POM-2) and the Social Emotional Evaluation (SEE) evaluated pragmatics before, after and 3-months following the intervention.

RESULTS

POM-2 gains were greatest for intervention-first participants (p = 0.031, d = 0.57). Treatment effects were maintained at 3-month follow-up (p < 0.001-0.05, d = 0.49-0.64). POM-2 scores were not significantly different in the clinic and home settings at follow-up.

CONCLUSION

Findings support the combination of play, peer-mediation, video-feedback and parent training to enhance pragmatic language in children with autism.

The feasibility and appropriateness of a peer-to-peer, play-based intervention for improving pragmatic language in children with autism spectrum disorder

Purpose: This study trialled a play-based, peer-to-peer intervention with children with autism spectrum disorder (ASD) to identify suitable instruments for measuring changes in pragmatic language following the intervention, and evaluate preliminary effectiveness. It also aimed to investigate the appropriateness of the intervention for participants. Method: Ten children with ASD, their typically developing peers, and parents participated. The Pragmatics Observational Measure (POM), Social Emotional Evaluation (SEE) and Profiling Elements of Prosody in Speech Communication (PEPS-C) measured the participant's social communication skills before, after, and 2-months following the intervention. Parent interviews were conducted two months after the intervention and responses were analysed using a thematic approach. Result: Children demonstrated gains in pragmatic language on the POM (χ²(3) = 11.160, p = 0.011) and related higher-level language on the SEE (χ²(2) = 6.686, p = 0.035). The PEPS-C did not produce any significant results. Parent interview responses indicated the intervention was appropriate for the children and families involved. Conclusion: The intervention warrants further investigation of effectiveness with a more robust research design. Consideration should be given to using observational measures of pragmatic language away from the clinic environment to evaluate generalisation, and future development of the intervention might consider variations in playmates and group size.

Evaluating 'enhancing pragmatic language skills for young children with social communication impairments' (E-PLAYS): protocol for a feasibility randomised controlled trial study

Background

A number of children experience difficulties with social communication and this has long-term deleterious effects on their mental health, social development and education. The proposal presented in this article describes a feasibility study for a trial to test an intervention (‘E-PLAYS’) aimed at supporting children with social communication impairments. E-PLAYS harnesses technology in the form of a novel computer game in order to develop collaborative and communication skills. Preliminary studies by the authors show that when E-PLAYS was administered by the research team, children with social communication impairments showed improvements on communication test scores and on observed collaborative behaviours. The study described here is a pragmatic trial to test the application of E-PLAYS delivered by NHS speech and language therapists together with schools.

Methods

This protocol outlines a two-arm feasibility cluster-randomised controlled trial of the E-PLAYS intervention with treatment as usual control arm, with randomisation at the level of the speech and language therapist. The aim of this study is to ascertain whether it will be feasible to progress to running a full-scale definitive trial to test the effectiveness of E-PLAYS in an NHS setting. Data relating to recruitment and retention, the appropriateness of outcomes and the acceptability of E-PLAYS to participants will be collected.

Speech and language therapists will select suitable children (ages 4–7 years old) from their caseloads and deliver either the E-PLAYS intervention (experimental group) or treatment as usual (control group). Assessments will include blinded language measures and observations, non-blinded teacher-reported measures of peer relations and classroom behaviour and parent-reported use of resources and quality of life. There will also be a qualitative process evaluation.

Discussion

The findings of this study will inform the decision as to whether to progress to a full-scale definitive randomised controlled trial to test the effectiveness of E-PLAYS when delivered by speech and language therapists and teaching assistants within schools. The use of technology in game form is a novel approach in an area where there are currently few available interventions.

Trial registration

ISRCTN 14818949 (retrospectively registered).