Background and Aims Research shows that language abilities in autism are highly heterogeneous and that parents play a crucial role in children's development. However, the bidirectional relationships between parenting stress, parenting behaviours and children's language abilities in autism remain under-researched. Furthermore, fathers are often excluded from autism parenting research. This study therefore aimed (1) to compare mothers and fathers with respect to the levels of self-reported parenting stress and behaviours and (2) to examine associations between parenting stress, parenting behaviours and children's language abilities, as well as whether these associations differ between mothers and fathers. Methods This cross-sectional study included 92 autistic children aged 2–6 with their mothers and fathers. Parenting stress and parenting behaviours were measured with self-report questionnaires. Children's receptive and expressive language abilities were measured using a combination of standardised tests, which were chosen depending on the children's age, abilities and community language (i.e., Dutch or French). Wilcoxon signed-rank tests were used to compare mothers and fathers. Zero-order and partial Spearman correlations were adopted to examine associations among variables, and Fisher's r-to-z transformations compared the strength of associations between maternal and paternal correlations. Results Mothers reported higher scores on parenting stress and several positive parenting behaviours (i.e., positive parenting, supervision, rules, rewarding, stimulating the development and adapting the environment) than fathers. No significant differences were found in the amount of autonomy support, discipline and indulging. In mothers, multiple parenting behaviours (i.e., autonomy support, supervision, discipline and stimulating the development) were significantly correlated with children's language abilities, although these associations weakened when controlling for children's non-verbal cognitive abilities. In fathers, only supervision correlated significantly with children's language abilities. Mothers showed no significant associations between self-reported parenting stress and behaviours. In fathers, however, higher parenting stress was linked to lower positive parenting, rewarding and stimulating the development and to higher discipline and indulging. Paternal stress was also related to lower receptive language abilities, a pattern not observed in mothers. Conclusions More differences than similarities emerged in parenting experiences and practices between mothers and fathers. Mothers reported more parenting stress and positive parenting practices compared to fathers, whereas no differences were found for negative parenting practices. Gender differences also appeared in the associations between parenting stress, parenting behaviours and child's language abilities. More specifically, maternal parenting behaviours were more strongly related to children's language abilities than paternal parenting behaviours. Importantly, these associations weakened after controlling for children's cognition, suggesting a complex interplay between these variables to be further researched. Parenting stress was related to both parenting behaviours and children's language abilities only in fathers, and not in mothers. Implications These findings suggest the importance of including both mothers and fathers in autism parenting research and clinical practice. They encourage future longitudinal and intervention studies to further examine the interrelations between parenting stress, parenting behaviours and children's language development, while also considering the role of child characteristics that may influence these associations, in order to inform parent-mediated language interventions.
Background and Aims Although developmental language disorder (DLD) is a lifelong, neurodevelopmental condition, its presentation in adulthood has received scant research and clinical attention. Several longitudinal studies have demonstrated that poor language ability may be negatively associated with wider life factors in adulthood. Moreover, although a growing body of qualitative evidence illustrates the lived experience of adults with DLD, more quantitative research on this subject is needed, which may guide evidence-informed assessment and support practices for adults. In this short report, we aim to explore the presentation of DLD in adulthood. We share the demographic characteristics, language difficulties, and mental health profile of a sample of adults with DLD based on self-report data. Methods We collected data from 92 adult participants recruited via Engage with Developmental Language Disorder (E-DLD), an international database set up to facilitate DLD research. Participants completed a DLD screening questionnaire, a set of demographic questions, and measures of emotional health including anxiety, depression, and self-esteem. We used the resulting data to construct an overview of the characteristics and profiles of two subgroups in the database: (a) adults who self-reported a clinical diagnosis of DLD (n = 30); and (b) adults who scored highly on the screening questionnaire (“possible DLD,” n = 62) but who did not have a formal diagnosis. For some measures, we also include a comparative sample of typical adults with no confirmed or suspected DLD (n = 91). Results More women than men completed the survey, with the average age of the DLD participants being just under 37 years of age, whereas the controls were on average 43 years of age. About 70% of the DLD participants were UK residents, while 30% were from countries across the world. Participants with DLD tended to be lower earners than controls but were represented in all income bands. In total, 43% (39) were parents and 43% (39) were living with a partner. Word finding and expressive language were the most reported areas of language difficulty, and the clinically diagnosed sample reported significantly more pragmatic language challenges than the “possible DLD” group. Respondents across both DLD groups had higher levels of emotional challenges including anxiety, depression, alexithymia, and low self-efficacy compared to the comparison sample. Conclusions Adults with DLD are a diverse group, with potentially more women than men seeking diagnosis or recognition in adulthood. It is possible that the high rates of emotional difficulties may indicate notable levels of need in those with DLD in adulthood. Implications Our findings show that there are many adults with likely DLD without a formal diagnosis. As such, they are unlikely to qualify for support. We recommend that services providing for adults with DLD should make every effort to be accessible to those on lower incomes, given our income findings, and services could usefully collaborate with mental health services to understand the complexities of co-occurring needs. Speech and language services should also consider how to work alongside other advocates to increase recognition of DLD in adulthood, given the lifelong impact of DLD, whether diagnosed or not.
Background & Aims Autistic children have difficulties establishing and maintaining eye contact. Previous interventions for eye gaze rely on human professionals, who may be too costly or even inaccessible to many families of autistic children. These challenges have led to the application of technology, such as social robots, the use of which in autism therapy is theory-driven. Thus, the present study examined whether robot-based intervention (RBI) and human-based intervention (HBI) improved autistic children's eye gaze. Methods In this randomized controlled trial study, 121 Chinese-speaking autistic children aged 4–9 years (34 females) participated and were randomly assigned to three conditions: RBI, HBI, and waitlist control. The robot/human experimenter narrated stories while detecting the eye gaze of the autistic children. They prompted the child if he/she lost eye contact with the robot/human continuously for more than 5 s. Children's eye gaze abilities were evaluated in both the experimental setting and parental report. Results Our experimental data showed that the children in the RBI had their eye gaze improved 1 month after the intervention. Their parents also perceived their autistic children to have better eye contact immediately and 1 month after intervention. Parents of the children in the HBI reported an improvement in eye gaze 1 month after intervention, which was not evident in the experimental setting. Children in the waitlist group did not show any improvement. Conclusion The present study showed that RBI could promote the eye gaze of autistic children under the conditions studied. Implication Our innovative design for RBI addresses clinicians’ concerns about the capacity to interact with autistic children in real time. Specific hands-on training workshops should be offered to enhance clinicians’ knowledge and skills in using robots in the clinical context. This randomized controlled trial was registered with the Chinese Clinical Trial Registry (no. ChiCTR2300073238).
Background and Aims Adaptive functioning is a strong predictor of long-term outcomes for autistic individuals, yet evidence regarding its association with ADOS-2 comparison scores, nonverbal IQ (NVIQ), and early language development remains inconsistent. Findings on the contributions of IQ and ADOS-2 comparison scores are mixed, and early linguistic abilities have received comparatively less attention. This study examined how receptive language delay, NVIQ, and ADOS-2 comparison scores relate to later adaptivity in nonverbal and minimally verbal autistic children. Methods Participants were 4- to 12-year-old autistic children ( N = 44) who completed ADOS-2 Module 1 at baseline, indicating limited expressive language but variability in age and developmental profiles. Baseline assessments included ADOS-2 comparison scores, NVIQ (Leiter-3), and receptive vocabulary (PPVT-III). Adaptive functioning was measured 2 to 3 years later using Vineland-3 subscales. To examine the contribution of each variable, we fitted multiple linear regression models with Vineland-3 scores as the dependent variable and standardized test scores as continuous predictors, while controlling for children's age (in months) and the testing interval between the ADOS-2 and the Vineland-3. We first fitted separate models for each predictor, followed by additive models including the three predictors. Additional models included interaction terms between NVIQ and ADOS-2 comparison scores, PPVT-III scores and ADOS-2 scores, NVIQ and PPVT-III scores, and their three-way interaction. Model comparisons were conducted to determine which model provided a better fit for the data. Results NVIQ emerged as the only significant predictor of adaptive functioning. Although ADOS-2 comparison scores and receptive vocabulary were significantly associated with adaptivity in the simpler models, these effects were no longer significant once NVIQ was included, suggesting that their predictive value was largely accounted for by NVIQ. Unlike earlier reports, higher NVIQ in this sample was not associated with greater adaptive difficulties, which suggests this relationship is not uniform across subgroups of autistic children. Interaction analyses did not reveal significant moderation effects, although some interactions involving NVIQ or receptive language delay and ADOS-2 approached conventional significance thresholds. These effects require confirmation in larger samples. Conclusions Adaptive functioning in autistic children with limited expressive language abilities is predicted more strongly by NVIQ than by ADOS-2 comparison scores, receptive language delay or the interaction of these three variables. Implications These findings indicate that early NVIQ remains a meaningful predictor of adaptive functioning in minimally verbal autistic children, underscoring the importance of including nonverbal cognitive assessments in early prognostic evaluations. The absence of meaningful associations with ADOS-2 comparison scores and receptive vocabulary delay when NVIQ was accounted for suggests that adaptive outcomes may depend less on trait profile or linguistic comprehension than may be assumed, and that autistic children may successfully compensate for early marked autistic traits and comprehension difficulties.
The present study examined heterogeneity in gesture production and its semantic integration among autistic children. Although previous studies have examined gesture-speech combinations in autism, less is known about whether there are individual variations in how autistic children gestured in relation to speech. Cantonese-speaking autistic children (N = 97; 79 boys, 18 girls, M age = 5 years, 2 months) were invited to participate in a 15-min parent-child interaction task. Autism characteristics were measured using the ADOS-2 comparison score, intellectual ability was indexed by overall IQ, and receptive language ability was measured using age-equivalent scores from the Mullen Scales of Early Learning. Hierarchical cluster analyses were conducted separately for reinforcing gestures, disambiguating gestures, supplementary gestures, and gestures without speech, together with selected child-based variables. Distinct clusters were identified for each type of gesture. Specifically, profiles with higher disambiguating gesture production tended to include children with fewer autism characteristics and stronger receptive language ability. Profiles with higher supplementary gesture production tended to include children with fewer autism characteristics. Other types of gestures did not show consistent profile patterns with child-based variables. These findings highlight the heterogeneous nature of multimodal communication in autism. In particular, examining the individual variations in how gestures reinforce, clarify, or add semantic information to speech may document a more fine-grained gesture-speech profile among autistic children.
One of the most influential attempts to characterize and explain the perceptual atypicalities of autism, as well as their relationship to the linguistic and social features of the condition, is the "enhanced perceptual functioning" (EPF) model. This model proposes stronger performance, an increased role, and greater autonomy of perception relative to other cognitive functions, and explains early language delay in autism as a temporary reliance on non-linguistic, perceptual processing of language. This paper presents an updated and reconceptualized version of the EPF framework, informed by accumulated knowledge of early language development and perceptual trajectories in autistic toddlers over the past two decades. The language-perception chimera model proposes that, due to a loss of the bias that typically prioritizes social information, the parental voice loses its unique status in triggering first-language acquisition. Consequently, the innate human drive to recognize, acquire, and master language becomes redirected toward its structural, non-communicative components. The selection, search, inspection, and manipulation of structural redundancies-characteristic of repetitive autistic behaviours-may therefore arise from the extension, to non-linguistic domains, of a mechanism through which children identify the language they will acquire. Seven arguments, based on cross-sectional and longitudinal observations of the early manifestations of prototypical autism, support this model. (1) Bayonet-shaped language trajectory: prototypical autism is preceded by reduced social interest and increased attention to non-social material. A plateau without communicative language follows the absence or regression of the few oral words typically acquired by 18 months. Later, language recovery, often including syntax, is delayed but common. (2) During this plateau, early interest in letters and occasional unexpected bilingualism indicate a spontaneous yet diverted orientation toward language. (3) Contemporaneous complex perception-based signs are highly specific to prototypical autism and contribute significantly to diagnostic certainty. (4) Early perception-based behaviours focus strongly on structural patterns. (5) Non-social language entry and complex perceptual behaviours arise when typically developing children experience a lexical and syntactic surge. (6) Veridical mapping phenomena and neuroimaging findings reveal enhanced pattern-language relationships. (7) The perception-language chimera can also account for certain savant abilities. When combined with a reconceptualization of autism as an asymmetric developmental bifurcation, the language-perception chimera model is the first to explain the occurrence, nature, idiosyncrasies, combinations, and developmental trajectories of the majority of social, language, and repetitive features observed in prototypical autism. This framework also clarifies the extent to which the innate mechanisms underlying language detection and acquisition in typical development are truly language-specific, as opposed to domain-general cognitive processes that converge to support language acquisition.
Background Developmental Language Disorder (DLD) is one of the most common neurodevelopmental disorders, affecting an estimated two students in every class of 30. Due to the importance of language for learning, students with DLD are at heightened risk for difficulties in the classroom and require high quality teaching and support. Despite this need, there is a lack of systematic evidence for whole class interventions and strategies targeting this population. Further, teachers and other professionals frequently rely on internet searches to identify ways to support students with DLD in the classroom, yet the quality and evidence of these online sources remain unclear. Aims The aims of this study were to: (1) systematically review peer-reviewed research on the effectiveness of whole class oral language interventions and strategies to support students with DLD, and (2) compare this evidence with recommendations from nonpeer-reviewed online sources. Methods A systematic review was conducted involving comprehensive searches of eight databases for relevant peer-reviewed studies, followed by a narrative synthesis of findings. A parallel search of internet sources (via Google) was conducted to identify nonpeer-reviewed online sources. Identified strategies from internet sources were coded, categorized using content analysis and compared with the peer-reviewed evidence. Results Eleven peer-reviewed studies met criteria for inclusion and provided evidence of improvements in oral language, vocabulary, grammar, and idiom comprehension, with most interventions delivered at set intervals and across tiers of support. Internet sources ( n = 32) included strategies across seven key categories; however, many commonly recommended strategies have not been examined for their effectiveness in peer-reviewed research at the whole-class level or when embedded across the school day. Conclusions This review highlights evidence-based strategies to support students with DLD in whole-class settings. However, notable gaps remain between online recommendations and the peer-reviewed evidence base, particularly regarding the effectiveness of commonly recommended strategies when implemented by teachers across the school day. Addressing these gaps is critical to ensuring that classroom practices for students with DLD are supportive and evidence-informed.
This study examined societal attitudes and knowledge regarding autism within Israel's culturally and socioeconomically diverse population. A total of 2,377 respondents completed the Societal Attitudes Towards Autism (SATA) questionnaire, translated into Hebrew and Arabic. The survey examined the effect of socio-demographic variables, including gender, age, education, income, ethnicity, and familiarity with autism or knowledge about and attitudes towards autism. Overall, respondents demonstrated positive attitudes ( M = 69.5%) and relatively high levels of knowledge ( M = 64.6%) about autism. Most respondents reported positive (56%) or very positive (35%) attitudes towards autism, and 91% of the participants expressed openness and acceptance towards autistic individuals. A substantial proportion of the respondents reported a high (56%) or very high (24%) level of knowledge about autism, suggesting that 80% the Israeli public is relatively well-informed. Women, midlife (30s to 50s) adults, respondents with higher education and high income, and respondents who were acquainted with an autistic individual reported more positive attitudes and had significantly greater knowledge about autism. Levels of autism acceptance and knowledge varied across ethnic groups, with Jewish respondents reporting more positive attitudes and greater autism-related knowledge than Muslim, Druze, and Christian respondents. Hierarchical regression analyses revealed that the level of knowledge was the strongest and most consistent predictor of positive attitudes. The findings underscore the importance of educational, socioeconomic, and cultural influences on public perceptions of autism. Promoting autism acceptance in multicultural societies such as Israel requires knowledge-based and culturally responsive educational programs, alongside opportunities for meaningful social contact between autistic and non-autistic individuals.
Background and Aims:Autism spectrum disorder is an early-onset neurodevelopmental condition, characterized by wide heterogeneity, including in language skills. Existing morphosyntactic comprehension assessment tasks are inadequate for many autistic children, leading to low task completion rates. Challenges in the assessment of morphosyntactic comprehension in these children may result in under-informed clinical profiles and hamper in-depth exploration of language profiles in research. Our aim was to develop a passive task (requiring no overt behavior) to assess syntactic comprehension in young French-speaking autistic children. We present the creation of MOSYCAT, a linguistically meaningful intermodal preferential looking task with eye-tracking, and then focus on its feasibility, acceptability, and potential clinical relevance. Methods:MOSYCAT tests four structures of varying syntactic complexity, simple intransitive sentences, simple subject-verb-object sentences, composite past tense sentences, and sentences with direct object pronominal clitics. Children viewed two videos while they listened to a sentence that matched only one of the videos. Four eye-tracking parameters were measured during their exploration of the videos: Exploration proportion (the proportion of time spent exploring the matching video), exploration accuracy (the proportion of trials in which children explored significantly more of the matching video), orientation latency (the latency of the first saccade toward the matching video), and orientation accuracy (the accuracy of the first saccade). A first version was administered to 56 non-autistic children, and then a reduced version to 23 additional non-autistic children and 21 autistic children of varying clinical profiles. All children were aged 2;6 to 5;11, a period when syntactic performance skills typically mature, but when many autistic children are not (yet) producing sentences. Results:Feasibility and acceptability were high, including in the autistic group, and more than 85% of autistic children provided usable data. A principal component analysis on MOSYCAT parameters demonstrated that two dimensions, mainly related to accuracy (exploration proportion, exploration accuracy) and speed of response (orientation latency), captured 86% of performance variability in non-autistic children. These dimensions correlated with standardized receptive morphosyntactic measures. The eye-tracking parameters yielded normal distributions, suggesting that MOSYCAT can be used to assess morphosyntactic abilities in all children, demonstrating its clinical relevance. These parameters improved with age in the non-autistic children, suggesting that MOSYCAT is sensitive to the maturation of morphosyntactic comprehension skills. As expected, autistic children performed below the non-autistic children, yet nearly all completed the task, contrary to other tasks, suggesting that MOSYCAT can assess language comprehension in autistic children from across the autism spectrum. Conclusions and Implications:MOSYCAT, a linguistically informed tool designed to assess morphosyntactic comprehension in young autistic children using a passive, eye-tracking task, proved to be clinically relevant and feasible for young autistic children. As such, it has both clinical and research potential for use in the identification and exploration of language profiles in autism. It should be noted that the assessment was not entirely standardized. Variable lighting conditions and break durations, as well as post-hoc calibration correction, were applied. These methodological choices, some of which mirror those common in clinical practice, were made to allow for wide assessment of the autistic children, many of whom required considerable support. Although promising, MOSYCAT is not ready for direct clinical transfer at this time.
Background and aims Autism research has traditionally been shaped by the idea that autistic people have “deficits” compared to neurotypical people. This approach often involves directly comparing the two groups, with the expectation that autistic people will perform worse. However, neurodiversity advocates argue that autism should be seen as a valid way of being, and should not be defined in contrast to norm-centred ideals. This review aimed to assess to what extent autism research in the field of language and communication is structured around such norm comparisons. Methods Following PRISMA protocols, a cross-sectional systematic review methodology was used to gather a sample of 249 relevant articles published in 2023. Articles were assessed as to whether they included a neurotypical comparison group and how the autistic group was expected to perform in contrast to neurotypicals. Additionally, we coded whether the study was an intervention, and whether non/minimally speaking (NMS) participants or those with intellectual disability (ID) were included, as we expected patterns to differ in these cases. Main contribution We found that almost half (49%) of the studies compared autistic and neurotypical participants, and this rose to 75% when interventions and studies involving ID or NMS participants were excluded. When predictions were made about which group would perform better, 60% of studies expected autistic people to do worse, while only 4% expected them to do better. Intervention studies were less likely to make direct comparisons, and studies involving ID or NMS participants also tended not to use neurotypical comparison groups. Conclusions Overall, our findings show that autism research is still largely built on comparisons with neurotypical norms, reflecting an assumption of deficit. Implications For research to align with the neurodiversity perspective, future studies will need to move away from these deficit-based traditions. Suggestions for alternative, less norm-based approaches are discussed.
Background and aims There are high levels of co-occurring mental health diagnoses reported for autistic adults, yet research into psychological interventions that support wellbeing is only just emerging. This mixed-methods systematic review characterized all available psychological interventions for autistic adults, the measures used to evaluate their effectiveness, the extent to which the interventions have been designed or adapted for autistic people, and the elements theorized to contribute to wellbeing. Methods A protocol was registered with PROSPERO (CRD42023385232) before commencement. The review used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A Patient and Public Involvement process sought input from an expert panel of autistic counselors who work with autistic people to develop the search strategy. All study designs were included in the review to meet the objective of summarizing the available evidence since 2012, the point at which National Institute for Health and Care Excellence introduced Clinical Guidelines for working with autistic adults in the United Kingdom. Screening was performed on 100% of the records by two independent reviewers. Risks of bias that can occur in autism research specifically were assessed. Quality appraisal was undertaken using the Quality Assessment Tool for Studies with Diverse Designs . Mixed-methods and qualitative syntheses were used to summarize the findings. Main contribution A total of 4,186 papers were identified from the literature search, resulting in 69 papers meeting the criteria for inclusion. The majority ( n = 42) were pilot or exploratory designs. Few studies identified how adaptations to existing therapeutic interventions affected wellbeing outcomes. Similarly, few studies described the theorized mechanisms of change in reported wellbeing or designed interventions specifically for autistic people. Conclusions There are few empirical studies of psychological interventions for autistic adults, and imprecise definitions of what wellbeing means for autistic people demonstrate conceptual and methodological ambiguity. Further discussion to agree community-based prioritization of the relevance of mental health outcomes is required. A minority of studies ( n = 29) used outcome measures designed for, or standardized with, autistic people. The most common therapeutic interventions were based on mindfulness or cognitive-behavioral therapies, suggesting limited choice of evidence-based psychological interventions for autistic people and practitioners. Implications Research into improving the wellbeing of autistic adults is still at an early stage of development, principally focused on assessing the feasibility of interventions. Current intervention studies are reliant on outcome measures with unknown suitability to evaluate meaningful change for autistic adults. This review provides an essential point of reference for clinical researchers and practising clinicians. A list of outcome measures that have been validated for use with autistic people is shared as a finding. The findings add to literature advocating for neurodiversity-affirmative clinical and research practices, which incorporate autistic phenomenology and recommend a critical approach towards psychological interventions.
Background and Aims Children with developmental language disorder (DLD) have difficulty learning new words, but we know little about whether and to what extent their word-learning ability improves over time. Our primary goal was to compare the rate of development of word learning abilities, specifically the encoding of new lexical-semantic information, in children with DLD and their age-mates with typical language development (TLD). Secondary goals were to examine variation in outcomes according to the aspect of word knowledge under consideration, the word-learning context, and the cognitive abilities of the learners. Methods Children with DLD (n= 38) and TLD (n = 45) participated in two experiments each year from Grades 1 to 4. In each, they were taught a new set of 12 novel words and their referents. The experiments involved a cross-situational word learning context (Study 1) and ostensive naming and mutual exclusivity contexts (Study 2). Post-training probes measured knowledge of the phonological form of the word and the link between the word and its referent. In Year 1, we measured various aspects of cognition. Linear mixed models with fixed effects for diagnostic group, year, and context yielded main outcomes. Results Children with DLD were less able than peers with TLD to learn form- and link information in all three contexts and in all four years, but their relative rate of growth across the years was similar. Neither form- nor link-learning was consistently harder than the other for the DLD group; however, the size of the TLD-DLD performance gap was especially large for form learning in the ostensive naming (most direct) training context. The lower cognitive abilities of children with DLD, especially phonological short-term memory and receptive vocabulary knowledge, accounted for variance in form and link learning. With cognitive scores in the statistical models, the TLD-DLD gap in link learning was no longer significant. Conclusions As a group, primary school children with DLD present with weaknesses in word learning abilities but age-appropriate rates of improvement in those abilities over time. The problem reflects their lower verbal cognition. The extent of the problem varies with the context in which the word is learned and the aspect of word knowledge that is measured as an outcome. Implications The implication for scientists is that a diversity of contexts and outcome measures must be included in future research. The implication for clinicians is two-fold. First, brief opportunities to learn word forms in ostensive naming contexts may be leveraged for dynamic assessments, as it is this learning goal and this learning context that most effectively distinguished DLD from TLD. Second, when treating a child with DLD, the common practice of direct teaching is unlikely to be effective unless active engagement, sufficiently high dosage, optimally sized target sets, and rich vocabulary instruction are included.
Background & Aims:Early intervention efforts can be transformative for young children with autism, and parent involvement is an increasingly common component of many contemporary treatment models linked to enhanced long-term social communication and developmental outcomes. However, Spanish-speaking families face language barriers that limit opportunities to be trained in these strategies, directly contributing to disparities in their children's developmental outcomes. This study aims to address this barrier by exploring the feasibility, acceptability, and preliminary efficacy of a Spanish-translated and adapted pivotal response treatment (PRT) early intervention model. Methods:Using a multiple baseline across participant experimental design, the primary objective of this investigation was to evaluate the impact of ongoing participation in a Spanish PRT workshop on parent fidelity (mastery) of treatment implementation and child verbal responses using behavioral coding and parent-report measures. The study included three children with autism aged 18-60 months and their caregiver(s). Parents completed questionnaires, four PRT instructional lessons, and six in-person coaching sessions. Parent-child interaction videos were recorded at intake and after each in-person session to monitor participant process. Results:All participants met fidelity of implementation criteria (>80%) for the PRT strategies, demonstrating the ability to successfully implement the core intervention components. Parents also reported improvements in their self-perceived (a) comprehension of the PRT principles and (b) confidence in applying them effectively. Lastly, children demonstrated improvements in the frequency of their verbal responses. Conclusions & Implications:These results suggest that the Spanish adaptation of PRT can effectively teach parents to understand and implement basic PRT components and facilitate language development in their autistic children.
Purpose: This study explored the morphosyntactic characteristics of Hebrew-speaking children with autism spectrum disorder (ASD) and developmental language disorder (DLD) as well as the associations between morphosyntactic skills and phonological memory. Methods: Eighty Hebrew-speaking preschool children aged 5-to-6 years were assessed. All participants had nonverbal intelligence within average range IQ > 85. Language abilities were assessed using the Hebrew Goralnik test, which evaluates naming, articulation, comprehension, sentence imitation, expressive language, and storytelling skills. Morphosyntactic skills were assessed using the Katzenberger Hebrew Language Assessment test (KHLA). This test assessed the following language skills: (a) inflecting verbs for the past and future tense; (b) using the same verb in two verb-derivation patterns; (c) inflecting plural forms with changing stems and/or irregular suffixes; (d) deriving singular forms from nouns with irregular plural suffixes; (e) inflecting the plural adjectives of irregular inflected nouns; and (f) deriving consequential adjectives from a verb. In addition, phonological memory for nonsense words and syllables was assessed using the Shatil test. Results: Typically developing (TD) children achieved the highest KHLA and Shatil scores. One-way ANCOVAs controlling for nonverbal intelligence revealed significant group differences. Pairwise comparisons demonstrated that TD outperformed ASD-Language- normal (ASD-LN), ASD-Language-Impaired (ASD-LI), and DLD on the KHLA and phonological memory tasks. Associations were found between KHLA and Shatil scores in ASD-LI and DLD, suggesting that morphosyntactic skills are linked to phonological memory in these groups. Hierarchical regression analysis across all groups (n = 80) revealed that phonological memory contributes an additional 11% to the variance of morphosyntactic skills (KHLA) beyond the effects of language abilities. Conclusion: These results highlight differences in morphosyntactic skills among subgroups of children with TD, ASD-LN, ASD-LI, and DLD that are associated with difficulties in phonological memory, especially in children with ASD-LI and DLD.
Introduction:Co-occurring conditions like sleep disturbances are prevalent in autism spectrum disorder (ASD) and have been linked to greater variability in clinical presentation, including social communication and behavioral challenges. This study examined the relationship between sleep disturbances and ASD characteristics in school-aged children. Method:In this descriptive, observational study, 24 children with ASD (ages 6-12) wore actigraphy monitors for up to seven nights to provide objective data on sleep onset latency, total nighttime sleep, and nighttime awakenings. Parents completed sleep diaries and the Autism Spectrum Rating Scale to assess impairments in social and communication, behaviors associated with ASD, and self-regulation. Results:Of the 24 participants, 23 wore actigraphy monitors. Twenty-two children experienced at least one sleep disturbance, and of these, 21 had usable actigraphy data, with an average of 6.43 nights analyzed. A greater number of sleep disturbances was associated with increased parent-reported social-communication difficulties but lower parent-reported behavioral dysregulation scores. Conclusions:Findings suggest that sleep disturbances may differentially influence the expression of ASD characteristics across social-communication and behavior. Considering sleep patterns in ASD research and clinical care may enhance understanding of variability in ASD and support the development of targeted interventions.
Background and aims:Children of Deaf adults (codas) acquire both a spoken language and a signed language from birth, making them bimodal bilinguals. While the language development of typically developing codas has been well studied, little is known about bimodal bilingual development in children with autism spectrum disorder (ASD). Methods:This study presents the first longitudinal case study of expressive spoken and signed language in an autistic bimodal bilingual child, spanning ten years of development. The participant, a hearing child with Deaf parents, was exposed to both English and American Sign Language (ASL) from birth. Expressive language samples were analyzed at ages 4;11, 6;6, 9;11, and 14;11 for syntactic complexity, lexical diversity, modality use, and echolalia. Results:Results revealed a significant expressive language delay in both modalities, with no consistent advantage of one modality over the other. Despite lifelong exposure to ASL, the child exhibited similarly limited language development in both English and ASL, challenging assumptions that signed language may be inherently more accessible for autistic individuals. Although there were global delays in expressive language in both modalities, there was evidence of pragmatic strengths and sensitivity to the linguistic preferences of his conversation partners. Unique features of bimodal bilingualism in autism, including code-blending, whispering, and cross-modal echolalia, are described. Conclusions:These findings highlight the need for further research into the developmental trajectories and communicative strategies of autistic bimodal bilingual children.
Minimally-verbal autism is well described in hearing populations, but little is known about minimally-signing autism in deaf children with early, full access to sign. This case series presents seven deaf autistic children born to Deaf parents and exposed to American Sign Language (ASL) from birth who nonetheless remain minimally expressive signers. Participants were drawn from a nationwide cohort of 23 native-ASL deaf children with autism. Four children completed the Autism Diagnostic Observation Schedule-2 (ADOS-2); all caregivers completed the Social Communication Questionnaire (SCQ). Selected children also received the Test of Nonverbal Intelligence-4 (TONI-4) and the ASL Receptive Skills Test (ASL RST). Six of seven children scored above the SCQ cutoff, and all four ADOS-2 cases met diagnostic criteria. Across cases, hallmark autistic features were evident, including limited reciprocal interaction, reduced joint attention, and restricted/repetitive behaviors. Expressive signing ranged from absent to small repertoires of echolalic or idiosyncratic signs, rarely coordinated with gaze or affect; symbolic play was similarly constrained. Two children completed standardized testing: one showed average nonverbal cognition but ASL comprehension <3 years; the other showed below-average nonverbal cognition and minimal ASL comprehension. These findings demonstrate that minimally expressive autism occurs in Deaf children with full access to a natural signed language, ruling out language deprivation or auditory processing as necessary explanations. Instead, domain-general constraints (limited generativity, social-pragmatic integration, and sensorimotor planning) likely contribute across modalities. Documenting minimally signing autism underscores the need for modality-sensitive diagnostic tools, neurodiversity-affirming supports, and longitudinal research to better understand and serve this underserved group.
Background and Aims:Previous research has suggested that a word association task called the Kent-Rosanoff task, which measures syntagmatic and paradigmatic associations, can help detect language disorder (LD) in children. We aimed to investigate the performance pattern between the results of the Kent-Rosanoff word association task and other language measures in two groups of children with autism: (1) children with autism and language disorder (ALD) and (2) children with autism and average language ability (ALN). Methods:Forty-six children aged 6 to 9 years (9 girls, 37 boys) with autism participated in a comprehensive language assessment that focused on receptive vocabulary, receptive grammar and sentence repetition, and nonverbal cognitive ability. The children with autism were divided into two subgroups, namely ALD and ALN, based on language ability while the groups did not differ in nonverbal cognitive ability. The 50-item Kent-Rosanoff list was used to elicit word associations. The children's responses were categorized into four different categories: phonological, syntagmatic, paradigmatic, and other/no response. Results:Our results did not reveal any differences between children with ALN and ALD on the Kent-Rosanoff word association task. The most frequent category coded for both groups was paradigmatic responses. Conclusions:Children with ALD did not differ in their semantic associations when compared with the ALN group; thus, sources of diversity in language profiles in preschoolers with autism should perhaps be sought elsewhere or by using alternative measures. Implications:Our results show that the Kent-Rosanoff word association task did not distinguish between ALN and ALD. Future studies should continue exploring sensitive assessment formats of semantic depth in young children with or without LD and autism.
This article presents the historical roots of the dimensional perspective on autism, the epistemological and clinical critics of its assumptions and effects, and offers an alternative to it. Autism is increasingly being described as the “extreme far end” of a spectrum of traits distributed continuously and heterogeneously throughout the general population, and various comorbid neurodevelopmental conditions. This dimensional perspective, initially a response to the excesses of nominalism in the DSM, creates its own heuristic and clinical dead ends. In contrast with this dimensional paradigm, clinical experts recognize and diagnose prototypical autism based on the high similarity of specific clinical signs that are present during the preschool period. We propose viewing autism as a universal and evolutionarily stable, quasi-categorical possibility of human development, offering a prototypical presentation within a certain age range. We argue that prototypical autism needs to be further clinically described and scientifically investigated before anticipating the inclusion of nonprototypical presentations in an informative “autism spectrum.” To achieve this, instruments based on qualitatively defined signs, with weighted diagnostic value, and universally associated with clinical certainty, must be developed. In the meantime, we recommend that all clinicians suspend the use of DSM-5 clinical specifiers to focus on clinical certainty and the application of differential diagnoses, rather than on the diagnostic thresholds of DSM-5 and of standardized instruments.
Background & Aims:Mental state verbs (MSVs) describe people's internal states and processes. Reports on the use of MSVs in school-age children with autism spectrum disorder (ASD) are contradictory, and little is known about the developmental trajectories of these verbs in this population during early childhood. In contrast, among young, typically developing (TD) children, research has shown that the use of desire, perception, and physiological verbs precedes the use of cognitive and emotion verbs. This study aimed to describe the development of MSV use among autistic children as compared to TD children and investigate the variables that influence this development. Methods:A total of 118 children participated in the study (59 autistic and 59 TD children), aged 3-10 years. Parents of all children completed an MSV questionnaire indicating whether their child produced the MSVs included in it. Additionally, two variables influencing MSV use were examined: sentence repetition for estimating syntax and measures of theory of mind (TOM) ability, which included three tasks: diverse desires and first- and second-order false belief. Results:According to the parental questionnaire, cognitive and emotion verbs have a more protracted developmental trajectory in both autistic and TD children than other MSV categories (desire, perception, and physiological verbs), and they are more challenging for autistic children than for TD children. Cognitive and emotion verbs are also less common in preschoolers' speech than in that of school-aged children. In addition, language abilities, TOM, and group (autistic vs. TD) explained the variance in the development of cognitive and emotion verb use beyond age. Conclusions and Implications:These findings demonstrate the development of MSVs from all five semantic categories from the age of three years to the age of ten in autistic children. In addition, our results indicate a specific linguistic difference between autistic and TD children in the development of cognitive and emotion verbs, as was found in the MSV parental questionnaire. The study also highlights the role of syntax, TOM, and autism in relation to the development of these verbs, supporting the notion of complex developmental conditions associated with MSV development and, thus, the need to evaluate them in autistic children.
