Clinical language assessments often influence the types of services that autistic children are eligible to receive. However, these assessments often take place outside of the child's natural language environment. In this study, we assess the potential of using naturalistic language processing technology, the Language ENvironment Analysis (LENA) system, in clinical research. Within a sample of caregivers and autistic toddlers aged 16-33 months (N = 100), the current study examined associations between all LENA-generated variables and two clinical assessments of language: the Vineland Adaptive Behavior Scales, Third Edition: Communication Domain and the MacArthur Bates Communicative Development Inventories: Vocabulary Checklist. We also evaluated LENA test-retest reliability in a subsample of participants (n = 81). Some LENA-generated variables-specifically, the Conversational Turn Count, Vocal Productivity, and Automated Vocalization Assessment-exhibited small-to-moderate significant positive correlations with clinical language assessment variables. Additionally, all LENA-generated variables demonstrated moderate-to-good test-retest reliability within a 2-week period. To our knowledge, this is the first study that examines the psychometric properties of all LENA-generated variables in a single large sample. Findings show promising evidence of LENA's utility as a source of naturalistic language data for research with autistic toddlers. Trial Registration: ClinicalTrials.gov identifier: NCT05114538 ("Improving the Part C Early Intervention Service Delivery System for Children with ASD").

Low responsiveness to sensory stimuli, particularly stimuli that are social in nature (i.e., social hyporesponsiveness), predicts expressive language in autistic children and in infant siblings of autistic children (Sibs-autism), who are at high likelihood for a future diagnosis of autism and developmental language disorder. However, our understanding of whether social hyporesponsiveness can be addressed via early intervention to improve expressive language outcomes of Sibs-autism is limited. This randomized controlled trial investigated whether Project ImPACT, a caregiver-implemented Naturalistic Developmental Behavioral Intervention (NDBI), has an indirect effect on expressive language outcomes by reducing social hyporesponsiveness. Sibs-autism were randomized into a Project ImPACT group (n = 23) for 12 weeks of intervention, or into a non-Project ImPACT control group (n = 23). Social hyporesponsiveness was measured immediately following intervention, and expressive language was measured three months after the end of intervention. Project ImPACT indirectly influenced distal expressive language outcomes through social hyporesponsiveness, but only for infants whose caregivers had high levels of education at study entry. Clinical implications of the results are discussed.

Younger siblings of autistic children are at a high likelihood (HL) of autism, language, and/or cognitive delays. Vocal complexity, a continuous measure of the developmental maturity of vocal communication, is facilitated by parent-child interaction and predicts language outcomes. This study examined whether parents' intervention fidelity to Project ImPACT, a 12-week, parent-mediated, naturalistic developmental behavioral intervention (NDBI), mediated the effect of Project ImPACT on parents' verbal responsiveness (post-intervention) and children's vocal complexity (3 months post-intervention). Participants were 54 12- to 24-month-old HL child-parent dyads who received 12 weeks of Project ImPACT (n = 28) or business-as-usual (n = 26) . Project ImPACT indirectly improved both parents' verbal responsiveness and children's vocal complexity by improving parents' use of the intervention techniques. The efficacy of Project ImPACT in supporting early social communication might be attributed to how Project ImPACT helps parents improve the quality and frequency of their use of the intervention strategies across children's everyday settings.

Click to increase image sizeClick to decrease image size DISCLOSURE STATEMENTNo potential conflict of interest was reported by the author(s).Additional informationFundingThe original review was funded by the European Union [Grant COST 106/14], and National Health and Medical Research Council fellowship [Centre of Research Excellence in Child Language 1023493].

This chapter details findings from a study on one teacher’s Missed Linguistic Opportunities (MLOs) to address figurative language with emergent bilingual learners in the social studies classroom. The study provides insights on teacher practice rooted in a Pedagogical Language Knowledge (PLK) framework that allows us to examine how the teacher (mis)managed the instruction of abstract concepts in his linguistically diverse fifth-grade classroom. A form-function analysis of two terms highlights alternative pedagogical pathways to elicit a deeper understanding of both content and language knowledge with learners. The findings endorse the development of a PLK-noticing apparatus that can bolster teacher PLK and the associated instructional moves to anchor student understandings of abstract concepts in the social studies classroom.

Objective: This randomized, multisite, intent-to-treat study tested the effects of 2 levels of treatment intensity (number of hours) and 2 treatment styles on the progress of young children with autism spectrum disorder (ASD). We predicted that initial severity of developmental delay or autism symptoms would moderate the effects of intensity and style on progress in 4 domains: autism symptom severity, expressive communication, receptive language, and nonverbal ability. Method: A total of 87 children with ASD, mean age 23.4 months, were assigned to 1 of 2 intervention styles (naturalistic developmental/behavioral or discrete trial teaching), each delivered for either 15 or 25 hours per week of 1:1 intervention for 12 months by trained research staff. All caregivers received coaching twice monthly. Children were assessed at 4 timepoints. Examiners and coders were naive to treatment assignment. Results: Neither style nor intensity had main effects on the 4 outcome variables. In terms of moderating the effects of initial severity of developmental delay and of autism symptom severity, neither moderated the effects of treatment style on progress in any of the 4 domains. In terms of treatment intensity, initial severity moderated effect of treatment intensity on only 1 domain, namely, change in autism symptom severity; in a secondary analysis, this effect was found in only 1 site. Conclusion: Neither treatment style nor intensity had overall effects on child outcomes in the 4 domains examined. Initial severity did not predict better response to 1 intervention style than to another. We found very limited evidence that initial severity predicted better response to 25 vs 15 hours per week of intervention in the domains studied. Clinical trial registration information: Intervention Effects of Intensity and Delivery Style for Toddlers With Autism: https://clinicaltrials.gov/; NCT02272192

This study examined whether style or intensity of child-focused intervention had a secondary effect on parental sense of efficacy and whether these effects varied by baseline level of parent stress. We randomized 87 children with autism, age 13–30 months, into one of four conditions: 15 versus 25 intervention hours crossed with 12 months of Early Intensive Behavioral Intervention versus Early Start Denver Model. Baseline parent stress was the putative moderator. Parent sense of efficacy, collected at baseline and the end of treatment, was the dependent variable. Analyses used generalized linear mixed model with full information maximum likelihood estimation. We tested main effects and interactions involving time, treatment intensity and style, and baseline parent stress to test moderation effects. Changes in parent efficacy across 12 months were related to intervention intensity but not style; this effect was moderated by level of parent stress at baseline. Parents with higher stress at the beginning of a 1-year, home-based, comprehensive intervention program had a higher sense of parenting efficacy if their child received lower intensity intervention; parents with lower stress at baseline had a higher sense of efficacy if their child received higher intensity intervention. Lay abstract This is a study of the secondary effects of interventions for young children with autism on their parents. Specifically, we were interested in the impact on parent’s sense of efficacy, or how confident and competent a parent feels about themselves as a parent. We tested three ideas: (1) that the style of the intervention, whether it was more or less structured and whether the parent had a more or less formal role, would impact a parent’s sense of efficacy; (2) that the intensity of the intervention, how many hours per week the intervention was delivered, would impact parental efficacy; and (3) that the parent’s level of stress prior to intervention would impact how intensity and style effected efficacy. We randomly assigned 87 children with autism, age 13–30 months, into one of four conditions: 15 versus 25 intervention hours crossed with two different styles of intervention. We used statistical tests to examine these ideas. We found that parental efficacy was related to intervention intensity but not style. Parents with higher stress at the beginning of a 1-year, home-based, comprehensive intervention program had a higher sense of parenting efficacy if their child received lower intensity intervention; parents with lower stress at baseline had a higher sense of efficacy if their child received higher intensity intervention. If a parent can emerge from the process of diagnosis and early intervention with an increased sense that they can make a difference in their child’s life (i.e. increased sense of efficacy), it may set the stage for meeting the long-term demands of parenting a child with autism.

The Early Communication Indicator (ECI) was designed to measure expressive communication progress in young children. We evaluated using the 6-min ECI procedure for a new purpose-a sampling context for stable measures of vocal development of young children with autism spectrum disorder (ASD). We evaluated how many ECI sessions were required to adequately stabilize estimates of volubility, communicative use, and phonological complexity of vocalizations at two periods (average of 10 months apart). Participants included 83 young children with ASD (M age = 23.33 months). At study initiation, two phonological complexity variables required two sessions; other variables required three. At study endpoint, all variables required fewer sessions. Findings support the feasibility and stability of using the ECI for the new purpose.

Cross-lagged panel analysis was used to examine associations between two joint engagement variables; higher order supported joint engagement and higher order supported joint engagement that co-occurs with caregiver's follow-in talk (higher order supported joint engagement + follow-in), and expressive and receptive vocabulary in a group of young autistic children (n = 91) with language delay (mean chronological age = 39 months). Variables were measured twice, 8 months apart. Coefficients for cross-lagged variable pairs were derived from structural equation models. Early higher order supported joint engagement was significantly associated with later expressive and receptive vocabulary (bs = 0.18 and 0.26, respectively), and early higher order supported joint engagement + follow-in was significantly associated with later expressive and receptive vocabulary (bs = 0.14 and 0.15, respectively). Associations between early vocabulary and later joint engagement were not significant. Linear contrasts between cross-lagged associations did not show a significantly superior association for any early joint engagement variables and later vocabulary variables. However, our results suggest that higher order supported joint engagement and higher order supported joint engagement + follow-in may be useful initial intervention targets for developmental interventions aimed at promoting autistic children's language development who are initially language delayed. Lay abstract In this study, we used a cross-lagged panel analysis to examine correlations over time between two types of engagement between children and their parents and children's later expressive and receptive vocabularies. This kind of design can help researchers understand which early developmental achievements "drive" later developmental achievements. It is important for intervention researchers to know which developmental achievements happen first, so that they can set intervention goals appropriately. The two joint engagement variables we examined were (a) higher order supported joint engagement, which occurs when caregivers influence their child's play with toys and the child reciprocally responds to the caregiver, but does not manage the interaction by shifting gaze between the toys and the caregiver, and (b) higher order supported joint engagement that co-occurs with caregiver's follow-in talk (higher order supported joint engagement + follow-in). Follow-in talk occurs when the caregiver talks about objects and events that the child is focused on. Ninety-one autistic children (n = 91) with language delay (mean chronological age = 39 months) participated, along with their primary caregivers. Each of the four variables was measured twice, 8 months apart. Our statistical procedures showed that early higher order supported joint engagement and early higher order supported joint engagement + follow-in were significantly associated with later expressive and receptive vocabulary. In contrast, associations between early vocabulary variables and later joint engagement variables were not significant. Our results suggest that higher order supported joint engagement and higher order supported joint engagement + follow-in may be useful initial intervention targets, for developmental interventions aimed at promoting language development in autistic children who are initially language delayed.

In this second of two primary papers, we examined moderators of treatment effects for younger siblings of children with autism spectrum disorders whose parents were taught to use a parent-implemented intervention called "Improving Parents As Communication Teachers". Investigators randomized 97 high-risk siblings and their primary parent to either the Improving Parents As Communication Teachers or control group, used intent-to-treat analysis, and used assessors and coders who were blinded to group assignment. We hypothesized that a cumulative risk score (incorporating younger siblings' sex, multiplex status, and behavioral risk) would moderate the effect of Improving Parents As Communication Teachers on younger siblings' proximal skills related to their continuously measured communication challenges. Pre-intervention level of parents' depressive symptoms was the proposed moderator of Improving Parents As Communication Teachers on parenting-related stress and parenting efficacy. In high-risk siblings with no additional risk factors (i.e. girls with only one older sibling with autism spectrum disorder and who score at low risk on an autism spectrum disorder screen), parental receipt of Improving Parents As Communication Teachers training had indirect effects on children's expressive language ability or autism spectrum disorder diagnosis through earlier effects on high-risk siblings' intentional communication or expressive vocabulary. "Improving Parents As Communication Teachers" intervention did not show moderated or total effects on parenting-related stress or parenting efficacy. Lay Abstract In this second of two primary papers, we examined two pre-intervention characteristics that might describe for whom a parent-implemented intervention, "Improving Parents As Communication Teachers," worked. Investigators randomized 97 high-risk siblings and their primary parent to either the Improving Parents As Communication Teachers or control group, used intent-to-treat analysis, and used assessors and coders who were blinded to group assignment. We predicted that a combined risk score (incorporating young siblings' sex, multiplex status, and behavioral risk) would describe the subgroup for whom Improving Parents As Communication Teachers affected the targeted skills related to reducing communication challenges. We also predicted that pre-intervention level of parents' depressive symptoms would describe the parents whose parenting stress and effectiveness as parents would be improved by learning to use Improving Parents As Communication Teachers. In girls with only one older sibling with autism spectrum disorder and who scored at low risk on an autism spectrum disorder screen, parental receipt of Improving Parents As Communication Teachers training had an indirect effect on children's expressive language ability or autism spectrum disorder diagnosis through earlier effects on high-risk siblings' intentional communication or expressive vocabulary. We did not confirm our prediction regarding Improving Parents As Communication Teachers' effect on parenting-related stress or sense of parenting effectiveness.

This study examined an insufficiently studied predictor of functional language, social motivation, in a group of 87 young children with autism spectrum disorder. Participants (age 14–31 months at the start of the study) were assessed at four times over 24 months. We tested total and indirect associations between early social motivation and later expressive language to understand the behavioral mechanisms by which social motivation might affect functional language development. Results from this study show that early social motivation predicts functional language 2 years later in young children with autism spectrum disorder. In addition, this positive longitudinal association is serially mediated by intentional communication and then receptive language. These findings are consistent with the elicited bootstrapping hypothesis which proposes that children with relatively stronger social motivation produce more intentional communication. This, in turn, elicits others’ linguistic input which impels receptive language development. This process eventually results in relatively increased expressive language development. Lay abstract About one-third of children with autism spectrum disorder never develop the language that they need in different day-to-day situations. Identifying potential factors that can predict later language development is crucial to understanding why some children with autism spectrum disorder successfully develop language while others do not. This study sought to investigate one of the understudied predictors of language development, social motivation, and to test theories for why this association may occur. Testing the theories requires that we measure children’s ability to deliberately and directly communicate with others (i.e. intentional communication) and children’s language understanding between the measures of social motivation and later expressive language. We tested 87 children with autism spectrum disorder, aged 14–31 months, at four times over 24 months. We found that children with relatively stronger social motivation had relatively better language use 2 years later. This positive link was partly due to a child’s ability to produce intentional communication and to understand language. Although we did not measure parents’ talking to their children, a theory that inspired this study suggests that children who use frequent intentional communication probably motivate others to talk with them frequently, which facilitates children’s language understanding which leads to the development of expressive language. This theory, if confirmed to be true, can provide guidance for parents who want to help their children learn to talk. Parents could look for intentional communication from their children and respond by talking to their children. Effective intervention on both parent and child targets will likely enhance treatment efficacy. Future work is needed to test these ideas.

We examined the effectiveness of systematic prompting of peer-related behaviors delivered during small group academic instructional sessions with three dyads of preschool-aged children with deficits in social competence. One child was randomly assigned as the target child in each dyad. A multiple-probe single-case research design was utilized to examine the functional relation between a system-of-least prompts procedure and the frequency of unprompted peer-related social behaviors emitted by target children during small group instructional sessions. The results support a functional relation between systematic prompting and peer-related behaviors, and all three target children increased their use of peer-related behaviors. Furthermore, we examined the effect of intervention on the untrained peer play partner (i.e., observational learning). Two of the three peers increased their use of peer-related social behaviors; however, results were variable and did not support a functional relation. Our study extends the research in this area by examining the effectiveness of small group instruction on potentially context dependent, complex social behaviors (e.g., sharing materials, complimenting a friend, offering to help).

A pivotal response treatment package consisting of clinician-delivered and parent-implemented strategies was recently found to be effective in improving language and social communication deficits in children with autism spectrum disorder. Reciprocal vocal contingency, an automated measure of vocal reciprocity, may provide stronger and complementary evidence of the effects of the pivotal response treatment package. Reciprocal vocal contingency is derived through an automated process from daylong audio samples from the child’s natural environment. Therefore, reciprocal vocal contingency is at lower risk for detection bias than parent report and brief parent–child interaction measures. Although differences were non-significant at baseline and after 12 weeks of intervention for the 48 children with autism spectrum disorder who were randomly assigned to the pivotal response treatment package or a delayed treatment control group, the pivotal response treatment package group had higher ranked reciprocal vocal contingency scores than the control group after 24 weeks ( U = 125, p = .04). These findings are consistent with results from parent report and parent–child interaction measures obtained during the trial. The participants in the pivotal response treatment package exhibited greater vocal responsiveness to adult vocal responses to their vocalizations than the control group. Findings support the effectiveness of the pivotal response treatment package on vocal reciprocity of children with autism spectrum disorder, which may be a pivotal skill for language development. Lay abstract A recent randomized controlled trial found that children with autism spectrum disorder who received a pivotal response treatment package showed improved language and social communication skills following the intervention. The pivotal response treatment package includes clinician-delivered and parent-implemented strategies. Reciprocal vocal contingency is an automated measure of vocal reciprocity derived from daylong audio samples from the child’s natural environment. It may provide stronger and complementary evidence of the effects of the pivotal response treatment package because it is at lower risk for detection bias than parent report and brief parent–child interaction measures. The current study compared reciprocal vocal contingency for 24 children with autism spectrum disorder in the pivotal response treatment package group and 24 children with autism spectrum disorder in the control group. The pivotal response treatment package group received 24 weeks of the pivotal response treatment package intervention. The control group received their usual intervention services during that time. The groups did not differ in reciprocal vocal contingency when the intervention started or after 12 weeks of intervention. However, after 24 weeks the pivotal response treatment package group had higher ranked reciprocal vocal contingency scores than the control group. These findings are consistent with results from parent report and parent–child interaction measures obtained during the trial. The participants in the pivotal response treatment package exhibited greater vocal responsiveness to adult vocal responses to their vocalizations than the control group. Findings support the effectiveness of the pivotal response treatment package on vocal reciprocity of children with autism spectrum disorder, which may be a pivotal skill for language development.

Younger siblings of children with autism spectrum disorders (HR-Sibs) are at elevated risk for social communication deficits and language delays. One way to mitigate this risk early, before these deficits and delays become clear or impairing, may be to equip parents to use the strategies taught through theImprovingParentsasCommunicationTeachers (ImPACT) intervention. In this randomized control trial, 97 HR-Sibs (mean age 14 months) and their primary caregiver were randomized to either ImPACT or a business-as-usual control group. Oura priori, preregistered hypothesis was that parents' participation in ImPACT training would indirectly attenuate younger siblings' social communication challenges 9 months later by sequentially increasing parents' use of ImPACT strategies immediately after the intervention phase and by improving children's midpoint proximal skills (e.g. motor imitation or intentional communication). Results supported this prediction. Lay abstract Later born siblings of children with autism spectrum disorders (ASD) are at elevated risk for language delay or ASD. One way to manage this risk may be for parents to use techniques taught inImprovingParentsasCommunicationTeachers (ImPACT) with the younger siblings during the period in which language delay and ASD may be too subtle to be diagnosed. ImPACT targets children's play, imitation, and communication skills. Improvement in these skills may reduce the severity of language delays and social communication deficits associated with ASD. In this study, 97 younger siblings of children with ASD and their primary parents were randomly assigned to ImPACT or a control group. We measured whether parents used ImPACT teaching strategies and whether children used the skills that ImPACT targets. We also measured children's later language ability and social communication skills. The results confirmed our predictions that parents' use of ImPACT strategies improves language ability by improving children's motor imitation and communication skills. Use of ImPACT also had a positive effect on children's language delay and ASD symptoms, supporting the clinical value of the findings. The study's methodological strengths make this one of the most rigorous tests of ImPACT and supports one way to manage the risk of language delay and ASD in younger siblings of children with ASD.

Multisensory processes include the capacity to combine information from the different senses, often improving stimulus representations and behavior. The extent to which multisensory processes are an innate capacity or instead require experience with environmental stimuli remains debated. We addressed this knowledge gap by studying multisensory processes in prematurely born and full-term infants. We recorded 128-channel event-related potentials (ERPs) from a cohort of 55 full-term and 61 preterm neonates (at an equivalent gestational age) in response to auditory, somatosensory, and combined auditory-somatosensory multisensory stimuli. Data were analyzed within an electrical neuroimaging framework, involving unsupervised topographic clustering of the ERP data. Multisensory processing in full-term infants was characterized by a simple linear summation of responses to auditory and somatosensory stimuli alone, which furthermore shared common ERP topographic features. We refer to the ERP topography observed in full-term infants as "typical infantile processing" (TIP). In stark contrast, preterm infants exhibited non-linear responses and topographies less-often characterized by TIP; there were distinct patterns of ERP topographies to multisensory and summed unisensory conditions. We further observed that the better TIP characterized an infant's ERPs, independently of prematurity, the more typical was the score on theInfant/Toddler Sensory Profile(ITSP) at 12 months of age and the less likely was the child to the show internalizing tendencies at 24 months of age. Collectively, these results highlight striking differences in the brain's responses to multisensory stimuli in children born prematurely; differences that relate to later sensory and internalizing functions.

This study tested whether the effect of treatment intensity or treatment style on children's frequency and maturity of spontaneous communication varied by initial severity of disability. Eighty‐seven toddlers with autism spectrum disorders were randomly assigned to either (a) 15 hrs per week of discrete trial teaching (DTT), (b) 25 hrs per week of DTT, (c) 15 hrs per week of a naturalistic developmental behavioral intervention (NDBI), or (d) 25 hrs per week of NDBI. Trained research staff implemented the 1:1 treatments in homes or educational centers over 12 months. We quantified the frequency and maturity of spontaneous communication during monthly 6‐min communication samples. We quantified disability severity at Time 1 using the developmental quotient from the Mullen Scales of Early Learning and the total calibrated severity score from the Autism Diagnostic Observation Schedule‐second edition. Higher levels of treatment intensity (i.e., more hours per week) benefited frequency and maturity of spontaneous communication growth rate only in children with relatively mild autism symptoms. Other results were nonsignificant. Autism Res 2020, 13: 1902‐1912. © 2020 International Society for Autism Research and Wiley Periodicals LLC

Q (1) What is the most effective cognitive, developmental, or behavioral intervention approach for preschoolers with autism spectrum disorder (ASD)?(2) What factors impact the effectiveness of inte...