Early communication development and intervention for children with autism

Autism is a neurodevelopmental disorder defined by impairments in social and communication development, accompanied by stereotyped patterns of behavior and interest. The focus of this paper is on the early development of communication in autism, and early intervention for impairments in communication associated with this disorder. An overview of components of communication is provided. Communication characteristics that are diagnostic of autism are summarized, with consideration of the overlap between social and communication impairment, particularly for children with autism functioning at the prelinguistic level. Early communication development and predictors of communication functioning in autism are examined, based on a review of prospective and retrospective studies. The focus of the discussion then turns to intervention. Consideration is given to the rationale for beginning intervention as early in life as possible for children with autism. Implications of motor, imitation, and play deficits for communication-based intervention are examined. Finally, issues related to the design and delivery of intervention for young children with autism are presented, along with a review of the major early intervention approaches for autism.     

Parent voices: difficulty in accessing behavioral intervention for autism; working toward solutions

The history of autism treatment has been dominated by a series of failed treatments, passing fads, and misinformed theories of etiology. With the advances in teaching methods derived from the science of Applied Behavior Analysis however, significant remediation of the disorder is now possible. Yet at present parents or caregivers still face serious challenges in identifying scientifically‐validated treatment models, and in securing competent and well‐trained therapists. Four parents report on these challenges, on the steps they have taken to mitigate these difficulties in their own families, and on the long‐term solutions they are attempting to implement in the wider community. Copyright © 2001 John Wiley & Sons, Ltd.     

Pretend play: an application of an intervention program in autism

Methodologically and theoretically based on metarrepresentational deficit hypothesis, we design an intervention to teach the mental state of pretense to an autistic boy. The production and comprehension of symbolic play by means of the use of two specific strategies founded on pictorial analogy of the mental representation and process, was the focus of the learning. The efficiency and efectiveness of the program is reflected in the results that indicated the subject's competence to generate and comprehend the pretense as well as to generalize the acquired knowledge into other areas of mentalistic functioning. We discuss the possibility to develop a metarrepresentational knowledge based on the internalizing of the strategies of conceptual support.     

Differential rates of skill acquisition and outcomes of early intensive behavioral intervention for autism

Intensive behavioral intervention for very young children with autism has received increased attention in recent years. Researchers have documented unprecedented success in educating some young children with autism, although not every child makes dramatic developmental gains. It might be useful to identify early in treatment those children who will benefit most from the current methodology and who might require slight variations in instructional format or curricular focus. The present study suggests that initial learning rates are moderately correlated with treatment outcomes after two years. Among 20 children receiving early, intensive behavioral intervention, initial acquisition of skills was correlated with later learning rates, severity of autism symptomatology and adaptive behavior profiles two years into treatment. Implications are discussed, especially in light of the universal need for intensive intervention in this population. Copyright © 1999 John Wiley & Sons, Ltd.     

Prediction of treatment outcomes and longitudinal analysis in children with autism undergoing intensive behavioral intervention

Outcome prediction is an important component of treatment planning and prognosis. However, reliable predictors of intensive behavioral intervention (IBI) have not been clearly established. IBI is an evidence-based approach to the systematic teaching of academic, social, verbal, and daily living skills to individuals with autism spectrum disorder. Incorporating longitudinal analysis to IBI outcome studies may help to identify outcome predictors of clinical value. Twenty-four children with autism underwent on average two years of IBI and completed language, daily living skills, cognitive, and motor assessments (Early Learning Accomplishment Profile and the Learning Accomplishment Profile-Diagnostic, 3rd edition) every six months. We used multilevel analysis to identify potential longitudinal predictors including gender, age, intervention intensity, intervention duration, total intervention time, and pre-intervention functioning. Results indicated that total intervention time, pre-intervention functioning, and age caused the greatest increase in goodness-of-fit of the longitudinal multilevel models. Longitudinal analysis is a promising analytical strategy to identify reliable predictors of the clinical outcome of IBI.     

A social competence intervention for young children with high functioning autism and Asperger syndrome: a pilot study

The key features of Asperger Syndrome (AS) and high functioning autism (HFA) include marked and sustained impairment in social interactions. A multi-session, small group program was developed to increase social perception based on the assumption perceptual or interpretive problems underlying these social difficulties. Additionally, the group format espoused a play therapy orientation and the use of sociodramatic play was the primary therapeutic modality used. Qualitative analyses of the data resulted in an explanation of the key changes in social interactions that took place through the course of the intervention. Although each participant's experience in this group was unique, all children in this program demonstrated improvements in their social interactions, as they experienced development both emotionally and behaviorally. Findings suggest that, despite their rigid interests and behavior patterns, the social limitations of these children improved when provided with the necessary environmental resources.     

Memory for actions in autism spectrum disorder

This study explored how memory for actions in children with autism spectrum disorder (ASD) and typically developing children might benefit from self-performance and experimenter demonstration, and whether these groups possess metamemory knowledge of their performance levels in this task. Children with autism were less accurate on the action memory task when they carried out each action themselves during encoding, or when no actions were implemented during this phase, but this difference was abolished when the experimenter demonstrated each action during encoding. Despite clear difficulties in the self-performed condition relative to typical children, the group with ASD also showed a beneficial effect of performing the actions themselves during instruction. Finally, children with autism were as accurate as typical children in judging the accuracy of their own memory performance, indicating an absence of metamemory difficulties for this task.     

Outcome measures for clinical drug trials in autism

This paper identifies instruments and measures that may be appropriate for randomized clinical trials in participants with autism spectrum disorders (ASDs). The Clinical Global Impressions scale was recommended for all randomized clinical trials. At this point, however, there is no "perfect" choice of outcome measure for core features of autism, although we will discuss five measures of potential utility. Several communication instruments are recommended, based in part on suitability across the age range. In trials where the intention is to alter core features of ASDs, adaptive behavior scales are also worthy of consideration. Several "behavior complexes" common to ASDs are identified, and instruments are recommended for assessment of these. Given the prevalence of cognitive impairment in ASDs, it is important to assess any cognitive effects, although cognitive data from ASD randomized clinical trials, thus far, are minimal. Guidance from trials in related pharmacologic areas and behavioral pharmacology may be helpful. We recommend routine elicitation of side effects, height and weight, vital signs, and (in the case of antipsychotics) extrapyramidal side-effects assessment. It is often appropriate to include laboratory tests and assessments for continence and sleep pattern.     

Evidence for syntactic alignment in children with autism

We report an experiment that examined whether children with Autistic Spectrum Disorder (ASD) spontaneously converge, or align, syntactic structure with a conversational partner. Children with ASD were more likely to produce a passive structure to describe a picture after hearing their interlocutor use a passive structure to describe an unrelated picture when playing a card game. Furthermore, they converged syntactic structure with their interlocutor to the same extent as did both chronological and verbal age-matched controls. These results suggest that the linguistic impairment that is characteristic of children with ASD, and in particular their difficulty with interactive language usage, cannot be explained in terms of a general deficit in linguistic imitation.     

Understanding indirect requests for information in high-functioning autism

Cognitive Processing - Few works have addressed the processing of indirect requests in High-Functioning Autism (HFA), and results are conflicting. Some studies report HFA individuals’...     

The search for autism disease genes

Autism is a heritable disorder characterized by phenotypic and genetic complexity. This review begins by surveying current linkage, gene association, and cytogenetic studies performed with the goal of identifying autism disease susceptibility variants. Though numerous linkages and associations have been identified, they tend to diminish upon closer examination or attempted replication. The review therefore explores challenges to current methodologies presented by the complexities of autism that might underlie some of the current difficulties, and finishes by describing emerging phenotypic, statistical, and molecular investigational approaches that offer hope of overcoming those challenges.     

Educational advocacy for children with autism

There exists a great divide between parents' demands for intensive behavioral interventions for their children with autism and the public education system's reluctance to support early intensive behavioral intervention programs. More and more, professionals with expertise in applied behavior analysis are being asked to advocate for effective, early behavioral intervention for autism in education litigation brought about by frustrated parents. The progress made in recent years in the behavioral treatment of children with autism and the schools' lack of adherence to the requirements of IDEA have made it possible for educational policy change through effective advocacy by behavioral interventionists. This paper discusses preparing for educational advocacy on behalf of young children with autism. We explore the personal and emotional reasons why parents choose to engage in the financially risky endeavor of educational litigation. We then outline an approach to developing expert testimony based upon evaluation of the target child and his/her educational history. Issues related to assessment, training, and ethical practice are addressed. Copyright © 2002 John Wiley & Sons, Ltd.     

Evidence for reduced domain-specificity in auditory processing in autism

Neurological and behavioral findings indicate that atypical auditory processing characterizes autism. The present study tested the hypothesis that auditory processing is less domain-specific in autism than in typical development. Participants with autism and controls completed a pitch sequence discrimination task in which same/different judgments of music and/or speech stimulus pairs were made. A signal detection analysis showed no difference in pitch sensitivity across conditions in the autism group, while controls exhibited significantly poorer performance in conditions incorporating speech. The results are largely consistent with perceptual theories of autism, which propose that a processing bias towards featural/low-level information characterizes the disorder, as well as supporting the notion that such individuals exhibit selective attention to a limited number of simultaneously presented cues.     

Enhanced discrimination in autism

Children with autism are superior to typically developing children at visual search tasks (O'Riordan, Plaisted, Driver, & Baron-Cohen, in press; Plaisted, O'Riordan, & Baron-Cohen, l998b). This study investigates the reasons for this phenomenon. The performance of children with autism and of typically developing children was compared on a series of visual search tasks to investigate two related problems. The first issue was whether the critical determinant of search rate in children is the discriminability of the display items, as it is in normal adults. The second question investigated was whether the superior performance of individuals with autism on visual search tasks is due to an enhanced ability to discriminate between display items. The results demonstrated that discriminability is the rate-determining factor for children with and without autism, replicating earlier findings with normal adults, and that children with autism have an enhanced ability to discriminate between display items. Thus, it seems that an enhanced ability to discriminate between display items underlies superior visual search in autism.     

Perceptual similarity in autism

People with autism have consistently been found to outperform controls on visuo-spatial tasks such as block design, embedded figures, and visual search tasks. Plaisted, O'Riordan, and others (Bonnel et al., 2003; O'Riordan & Plaisted, 2001; O'Riordan, Plaisted, Driver, & Baron-Cohen, 2001; Plaisted, O'Riordan, & Baron-Cohen, 1998a, 1998b) have suggested that these findings might be explained in terms of reduced perceptual similarity in autism, and that reduced perceptual similarity could also account for the difficulties that people with autism have in making generalizations to novel situations. In this study, high-functioning adults with autism and ability-matched controls performed a low-level categorization task designed to examine perceptual similarity. Results were analysed using standard statistical techniques and modelled using a quantitative model of categorization. This analysis revealed that participants with autism required reliably longer to learn the category structure than did the control group but, contrary to the predictions of the reduced perceptual similarity hypothesis, no evidence was found of more accurate performance by the participants with autism during the generalization stage. Our results suggest that when all participants are attending to the same attributes of an object in the visual domain, people with autism will not display signs of enhanced perceptual similarity.     

Communicative abilities in autism: evidence for attentional deficits

Although there are many theories about autism, something all of them agree upon is that autistics are impaired in the ability to communicate. The explanation is either their incapacity to attribute mental states to others or the interference of irrelevant stimuli with the access and processing of the communication (low). Our study on mute autistic children aims to investigate their communicative ability in order to bring some new evidence on the debate. We used an experimental technique that allows autistic children to access and process the communicative acts in a familiar context for as long as needed. The experimental results show that our sample of autistic children performs as well as the control group of normal children in dealing with directs, indirects, ironies, deceits, and recoveries of failure. Independent of their respective difficulty, the felicitous outcome of any of these acts requires the capacity to attribute an adequate communicative intention to the actor. Moreover, our results show that, contrary to the established findings in the literature, autistics' performance in the standard false belief task, a task that requires one to understand the mental states of other people, is equivalent to the performance of normal subjects. We argue that an attentional deficit affects the communicative performance of autistics in experiments where classic methodologies are used; with the proper methodology, we can access the unexplored world where mute autistic children also communicate. As far as we know, this is the first systematic experiment on pragmatic abilities in mute autistic children. Indeed, our work shows that tests and methodologies which help to focus on the communicative task improve the autistics' performance with respect to those used in the literature. We conclude that the autistic communicative deficit is at the performance level and that it has an attentional nature.     

A modified Aitken Pivotal Condensation Method for partial regression and multiple correlation

In this modification of the Aitken Pivotal Condensation Method for obtaining partial regression weights and multiple correlation coefficients, the unit matrices used by Aitken are eliminated, with a resultant decrease in the computational work. Through a simplified arrangement of successive matrices, each one is reduced by the same simple rule. Other modifications also contribute to ease of computation and facilitate checking.