-Language acquisition begins in correlation with cognitive skills such as joint attention (from lecture)
-"A variety of studies have shown that after children have begun progressing in the process of language acquisition, they learn new words best in joint attentional interactions, in which children and adults coordinate their attention to each other and an object of mutual interest (p. 33). "
-often take place during routine situations (bathing, feeding, diaper changing, book reading, car rides) that are recurrent activities in child's daily experience
-experimental study showed that mother who used their language to follow their child's attention (an object that was already the focus of the child's interest) had children with larger vocabulary than mothers who used language to direct child to something new p. 34-children with autism have difficulty engaging in joint attention, therefore language comes from "out of nowhere" p. 34
-This involves scaffolding, as discussed in Vygotsky's Social Pragmatic Theory, which helps infants who are just getting started to discern the mother's communicative intentions and so to enter into a state of joint attentional focus. This type of scaffolding, also known as maternal follow-in language, may not be necessary as the child grows older and becomes more skillful at determining communicative intentions in less child friendly linguistic interactions p. 35
-clear findings of the Carpenter, Nagell and Tomasello study, regarding the children's ability to engage in nonlinguistically mediated joint attention with adults at approx. 1 year of age is integrally related to their emerging linguistic skills, presents issues with all early language acquisition theories that do not support the social dimension of the process (all but the social pragmatic theory) since they don't answer the question regarding why language acquisition begins when it does, on the heels of the emergence of joint attentional skills (not a coincidence) p. 36
(behavioral characteristic of children with autism)
-31% in the range of intellectual disability (IQ ≤70 or an examiner's statement of intellectual disability)
-23% in the borderline range (IQ = 71-85)
-46% with IQ scores of >85 or an examiner's statement of average or above average intellectual ability (CDC, 2014)
-Children with autism & distinctive way of interacting with social environment
-Cognitive deficits, social interaction deficits, & correlation with deficits which include
1. Imitation, play, language, ToM, executive function etc.
-weaknesses (outweigh the strengths): abstract, cross-moal processing, complex tasks, organizing concrete information
-strengths: concrete, visual spatial, rote memory
(*Corbett, B. A., Constantine, L. J., Hendren, R., Rocke, D., & Ozonoff, S. (2009). Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder and typical development. Psychiatry research, 166(2), 210-222.)
1. Response inhibition:
-Inattention & impulsivity
a. Across visual & auditory modalities
2. Working memory -
-Spatial working memory
3. Flexibility/shifting -
-Ex. flexibly to shift between color naming, word reading & inhibition
4. Planning -
5. Fluency -
-Ability to fluently retrieve words beginning with same letter & ability to retrieve lexical items from designated categories, respectively
6. Vigilance - ability to maintain attention and alertness over prolonged periods of time
A. 1910, Eugen Bleuler coined term "autism,"
derived from Greek word autos, meaning self
B. Hans Asperger published first definition of Asperger's Syndrome in 1944. He challenged notion that all children with autism were cognitively disabled or schizophrenic. Identified pattern of behavior & abilities he termed "autistic psychopathy," (autism - self & psychopathy - personality), disorder of personality.
-Pattern included "a lack of empathy, little ability to form friendships, one-sided conversation, intense absorption in a special interest & clumsy movements"
Reported on "clever-sounding" language, invented words & children speaking like grown-ups, "little professors"
1st to report on odd non-verbal communication: eye-gaze, gestures, posture, voice quality, prosody & word choice
1st to report on lack of humor & pedantry
Reported on disturbed relations to people as well as objects
C. Leo Kanner, 1943
-outlined behaviour pattern, present from early childhood, which he named "early infantile autism''
-Reported on disturbed relations to people but not objects
-1st to describe language peculiarities (e.g., echolalia, pronoun reversal, difficulty generalizing word meanings & painstakingly specific answers)
-Reported on adherence to routines, good rote memory skills, limited repertoire of spontaneous activity, lack of social interest & engagement, perseverative behavior
-Argued "brilliant parents" yet "very few warm hearted fathers and mothers" produced "affect hungry children"
-Concluded "fundamental disorder in children's ability to relate themselves in ordinary way to people& situations from beginning of life"
D. Lori Wing, 1981
-first to use the term "Asperger's syndrome" in a paper she published in 1981
-Translated Hans Asperger's paper from German to English
-Relabeled "autistic psychopathy" with Asperger's name
-Key in determining autism as a mental disorder affecting people across "spectrum of intelligence"
-Argued that autism was a spectrum of disorders, on one end Kanner's cases and on the other Asperger's
-Described disorder as "lack of ability to understand and use the rules governing social behavior."
(Tiegerman-Farber pg. 323) Play is important to the development of adaptability, learning, cognition, & social behavior. The function of play is to exercise & develop manipulative & interactional strategies that kids will later integrate into more sophisticated task-oriented sequences. General theory suggests that kids learn to affect & control activities they are unable to execute or dominate in other contexts. In play, they learn to develop control over animate & inanimate objects & contexts. Influences the physical the physical & interactional behavior of all kids in the experience.
Play has social, cognitive, & integrative functions in early development.
Children with autism are limited in their social interaction with the environment, and because of their restricted experiences, they share many behavioral/learning problems with other children (Cerebral Palsy, brain damage, or mental retardation). They withdraw from interactional experiences & learn to manipulate by means of temper tantrums & disruptive behaviors.
Play is a natural means of teaching children with autism social interactional skills. Child-directed, rather than teacher-directed, activity. Play facilitates kid's choices of materials, activities, & peer partners. Learns specific behaviors that lead to responses from peers. Functional & symbolic play are associated with language abilities. Specific nonverbal skills, such as gestures, are also correlated with language acquisition.
-newborn infants engage in behaviors that rivet the adult's attention and elicit social interaction
-Echoing is typical in at very early stages of communication
-Stages by Stark:
1. 0-2 months-Reflexive cries & vegetative sounds
2. 2-5 months-Cooing and Laughing
3. 4-8 months-Vocal play and beginning babbling
4. 6-9 months-Reduplicated babbling
5. 9-18 months-Jargon babbling
a. Children at risk for autism
-Adults have trouble distinguishing the meaning of the cries(Ricks & Wing)
-Atypical vowelization- growling and tongue clicking(Wetherby, Yonclas, & Bryan)
-similar rate of production of a typical sounds at 15 months (Sheinkopf, Mundy, Oller, and Steffens)
-Atypical intonation in prelinguistic vocalizations (wetherby)
-less likely than peers to matched for mental age to imitate adult vocal production (Heilmann, Ullstadius, Dahlgren, and Gillberg)
-overall impaired imitation abilities (Rogers, Hepburn, Stackhouse, andWehner)
-Less likely to copy the speech that is heard
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative paly or in making friends; to absence of interest in peers.
Specify current severity:
Severity is based on social communication impairments and restricted repetitive patterns of behavior (see Table 2).
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
-demonstrated atypical eye contact, passivity, decreased activity level, and delayed language by 12 months of age (Zwaigenbaum et al., 2005);
-subtle differences in sensory-motor and social behavior (Baranek, 1999) as well as differences in the use of communicative gestures (Watson et al., 2013) by 9 to 12 months of age;
-a decline (from normative levels) in eye fixation from 2 to 6 months of age not observed in infants who did not develop autism (Jones & Klin, 2013).
(Rhea Paul & Robert Ownes)
Perceptual Capacity of infants with ASD
• Difference in quality of orienting to auditory & visual stimuli from TD
• Difficulty in discriminating consonants, not vowels as per a case study of child who later was diagnosed with autism
• Parents report poor response to name or voices, corroborated by some studies
• Reduced preference to child-directed speech
• Reduced preference for social stimuli
Preverbal Production in Infants with ASD
• Smaller inventory of well-formed syllables
• Atypical vocalization (tongue clicking)
• Atypical intonation
• Decreased imitation of adult vocal production
Prelinguistic Communication in Infants with ASD
• Lower rate of communicative expression
• Less likely to initiate commutative acts
• Fail to follow or use gaze to establish joint attention
• Fail to respond or use communicative gestures, especially pointing
• Fail to pair gaze & gesture for communicative purposes
• Communicative function express mainly wants & needs
• Communicative acts mainly protoimperative
• Much less frequent protodeclerative
Screening for autism calls for 2 different levels of investigation, each answering a different question.
Level 1: screening should be performed on all children & involves identifying children at risk for any type of atypical development
Routine Developmental Surveillance & Screening Specifically for Autism:
255 of kids in any practice demonstrate developmental issues at some point. Therefore developmental screening must become an absolutely essential routine for each and every well-child visit throughout infancy, toddler, & preschool years, & even beyond school age if concerns are raised. The additional use of Specific Developmental Probes increase the sensitivity & specificity of the screening process for autism.
Fewer than 30% of primary care providers conduct standardized screening tests
The AAP stresses the importance of developmental "surveillance" at every well--child visit; a flexible, continuous process that is broader than screening & includes eliciting & valuing parental concerns, specific probing regarding age-appropriate skills in each developmental domain, and skilled observations.
Parents usually are correct in their concerns about their child's development.
formal audiologic evaluation
-Specific Screening for Autism:
Level 2 : involves a more in-depth investigation of children already identified to be at risk for a developmental disorder, differentiates autism from other kinds of developmental difficulties, & includes evaluations by autism specialists aimed at determining the best means of intervention based on the child's profile of strengths and weaknesses
Diagnosis and Evaluation of Autism:
Once a child screens positive, he should then be referred for appropriate assessment by an experienced clinician, with expertise in the diagnosis of developmental disorders.
Level 2: should only be performed by professionals with specific expertise in the evaluation and treatment of autism.
-Interdisciplinary collaboration and consultation: psychologists, neurologists, SLP, audiologist, pediatrician, OT, physical therapist, & special educators.
Speech-language-communication evaluation should be performed on all children who fail language developmental screening procedures, by an SLP with training and expertise in evaluating kids with autism.
-direct standardized instruments
-procedures focusing on social-pragmatic abilities
Results from the SLP assessment should always be interpreted relative to a child's cognitive, motor, and socioemotional abilities.
What tools/measures are utilized and on what should such instruments focus?
-Gilliam Autism rating Scale (GARS)
-The Parent Interview for Autism (IPA)
-The Pervasive Developmental Disorders Screening Test-stage 2 (PDDST)
-Autism Diagnostic Interview-Revised (ADI-R)
-Direct Structured Observation Instruments:
-Screening Tool for Autism in Two-Year-Olds (STAT)
-The Childhood Autism Rating Scale (CARS)
-Autism Diagnostic Observation Schedule-Generic (ADOS-G)
-Diagnostic evaluations not specific to autism:
-degree of LI
-presence of nonspecific behavioral disorders (overactivity, aggression, anxiety, depressions
-Expanded medical and neurological evaluation:
-acquired brain injury
-difficulties common in autism: prenatal history, developmental history:milestones, regression, seizures, ADD, self-injury, depression or mania, or encephalopathic events.
- Family history & extended family history: mental retardation, fragile-X syndrome, tuberous sclerosis complex
-affective or anxiety disorders
-The focus should be on: longitudinal measurements of head circumference, unusual features (facial, limb, stature, etc.), gate, tone, reflexes, cranial nerves, and mental status including verbal and nonverbal language and play
-Cognitive Evaluation: by a psychologist or developmental pediatrician
-assessment of family, strengths, talents, stressors, and adaptation, as well as resources and supports
-psychological instruments should be appropriate for the mental and chronological age
-Measure of Adaptive Functioning:
-by the psychologist
-recommended instruments: Vineland Adaptive Behavior Scales and the Scales of Independent Behavior-Revised (SIB-R)
-Screening and full evaluation for sensorimotor skills (OT):
-assessment of gross and fine motor skills
-sensory processing abilities
-unusual or stereotyped mannerisms
and the impact of these components on the person's life
-Occupational Therapy (OT) Evaluation:
-if experiencing disruptions in functional skills or occupational performance in the areas of: leisure, or play; self-maintenance through activities of daily living, productive school and work tasks
-evaluate in different environments through activity analysis, the contributions of performance component abilities (sensory processing, fine motor skills, social skills) in goal-directed everydy routines
-Neurpsychological, behavioral, and academic assessment, as well as a cognitive assessment:
-social skills and relationships
-motivation and reinforcement
-Assessment of family functioning:
-parents level of understanding of the child's condition & offer appropriate counseling and education
-the need for available resources and social services and other supports
-Assessment of family resources, by social workers, psychologists
-Level 2 Laboratory Evaluation
-genetic testing, specifically DNA analysis for fragile X and high resolution chromosome studies
-Indications for a prolonged sleep-deprived EEG with adequate sampling of slow wave sleep: seizure, history of regressions
-neuroimaging for the presence of neurological features not explained by the diagnosis of autism (NOTE: no role in the diagnostic evaluation of autism at the present time-Functional imaging modalities (fMRI, SPECT, and PET) are used for research only
-Reevaluation at least 1 year within the initial diagnosis and continued monitoring
The differentiation of autism from other developmental disorders is accomplished during Level 2. Using the data collected from the various evaluations, professionals must also determine the possible existence of comorbid disorders. The differential diagnosis of autism includes consideration of mental retardation not associated with autism, specific developmental disorders (e.g., of language), and other psychiatric conditions (Volkmar et al., in press).
- mental retardation, specific developmental disorders, schizophrenia, selective mutism, stereotyped movement disorders, dementia, OCD, schizoid personality disorder, avoidant personality disorder.
Variety of strategies should be used: direct assessment, naturalistic observation, and interviewing significant others, including parents and educators, who can be invaluable sources of information. They can potentially provide qualitatively different information about a child's speech, language, and communicative abilities that may ultimately be integrated to develop a profile for differential diagnosis and intervention planning. Observations should include a child's interactions with a variety of persons including family members and peers, as well as professionals, because variability in communicative functioning across persons and settings is to be expected. Specific domains should be addressed in a comprehensive assessment for both preverbal and verbal individuals, taking into account their age, cognitive level, and socioemotional abilities
(Wetherby & Prizant pg.95)
As of 2000 there was no empirical data on possible relationships among imitation, joint attention, emotion sharing, and ToM. Without such data, clinical evidence and developmental theories must serve to suggest how an imitation/praxis deficit very early in life could disrupt socio-communicative development.
-The 1st and more obvious potential impact involves: the ability to speak. So we would target imitation? different theories
Because we hypothesize that one reason for the lack of speech development in some children with Autism is an underlying oral-motor dyspraxia
-The concept of verbal apraxia brought into the Denver MOdel treatment approach for young children with autism led to adding imitation training and other standard oral-motor therapy approaches aimed at treating oral dyspraxia. The addition of imitation training increased the success at developing speech as a primary communication system in previously nonverbal young children with autism.
Stern's (1985) Model, sharing emotions during the 3-6 month-old period is the main vehicle for interpersonal development. Assuming physical emotion postures and expressions actually induces an emotional experience and emotion sharing. iI has been suggested that infant's imitation of emotional expressions creates internal affective state that matches the partner's, giving the infant an internal sense of matching between self and others-the experience of emotional mirroring. This through imitation the infant is experiencing the synchrony between self and other's internal and external states.
Limitation of this model is that many children with autism do develop joint attention behaviors, speech, and some level of sharing experiences and affect; they are not devoid of social knowledge, interest, and reciprocal social relations
( Tiegerman-Farber pg. 323). Echolalia has been defined as the meaningless repetition of someone else's words. It has been described traditionally as a transition period between muteness and evidence of linguistic knowledge, but research on children's progress through the various learning stages is limited.
Echolalia has been described as a transitional phase of development that signals movement from:
1. echolalia without communicative intent
2. echolalia with the intent but limited linguistic competence
3. echolalia with intent and linguistic ability
It is important to understand how the child functions within the communicative context-specifically, how the child with autism uses whatever behavior he has developed for the purpose of communication.
Prizant & Wetherby (1987)- Children with ASD may not use conventional forms, such as pointing or showing, but they may use idiosyncratic behaviors, such as echolalia and self-stimulation, to signal various communicative functions. The meaning of the child's interaction can be determined only by analyzing his/her behavior within a social context.
Prizant & Rydell (1984) investigated functions of delayed echolalia (old forms applied to new situations) in kids with autism. Children repeat utterances long after they originally hear them.Immediate and delayed echolalia can best be described as a continuum of behaviors in regard to exactness of repetition, degree of comprehension, and underlying communicative intent. The use of echolalia as a form of communication i an unusual strategy for typically developing kids, but serves an important function in kids with autism. the fact that the child with autism can use these old forms in new contexts indicates that on some associative level, he establishes a relationship between a linguistic form (as rigid as it is) and an event. The production of a delayed echolaliac response indicates that the child perceived a relationship between a verbal utterance and a context. This leads to an increase in the child's linguistic abilities, where they can substitute, delete, or conjoin elements in the echoed response (delayed mitigated echolalia).
One of the most interesting findings of the Prizant and Rydell (1984) study was that some of the noninteractive echolaliac utterances-those produced without communicative intent by the child-did serve meaningful purposes. Although some of the utterances served no specific functions, others served cognitive and/or conversational or turn-taking functions
psychological model, Bettelheim
-autism is the child's reaction to the mother's attitudes
-child with autism fears maternal destruction and rejects his/her mother
-child retreats within self, reality becomes fearful resulting in inactivity
1.Cognitive, Wetherby & Gaines
-cognitive abilities exceed linguistic abilities
-relationship between cognition and language is dynamic
-cognitive development may be necessary for intentional communication
-"cognitive development may not be sufficient for more advanced language development
1. autism as a PDD, Loveland, Landry, Hughes, Hall, and McEvoy
-severe deficits in language, cognition, and social development
-Language is severely delayed and described as disordered
-verbal language when developed is rigid, ritualistic, and stereotypical (verbal routines)
-presented a different pattern of use of gesture and language
Bryson et al. (2007)
-Lack of behaviors marker for ASD at 6-months, however, different risk markers than ones looked at in the study may reveal different findings
-Range in severity in symptoms, even in infancy
-Core symptoms -joint attention, repetitive behaviors, & language delays appear at 12-months & increase in severity over time
1. IQ drops from average to significantly below for some
-Secondary symptoms - irritability, sensory responsivity, poor gross motor development presents & in some cases appear before social problems
1. Autism disrupts not only social development, but multiple aspects of development
Six months -
-Sustained eye-contact & social smiles
-Atypicality in delayed motor development (reaching, grasping, holding transferring object, sitting)
-Unusual visual interest
Twelve months -
-Declined in social interest & engagement
-Unusual visual fixation
-Stereotypic body movement
-Poor language development
-Some show unusual response to sensory stimuli
Eighteen months +
-ASD present with continuous but increased symptoms from 12-18 months
-Social impairment & further social deterioration
-Increased symptoms in areas such as repetitive behavior, lack of language, poor nonverbal communication development, atypical play
-Infants who developed social impairment & nonsocial symptoms between 6-12 months were symptomatic of ASD at 24 months
-Some infants with seemingly normal social relatedness at 12 months, were diagnosed with autism at 24-36 months
1. Slow course of development
2. Intensifying symptoms
3. No pattern of loss of language
It's important for the SLP to also understand Level 2 evaluation in cognition, adaptive functioning, and sensorimotor an OT because the diagnostic process and therapy involves a collaborative effort.
Specific information that would be added to the child's developmental profile with evaluations in these areas:
-Cognition: looking at strengths and weaknesses of the child as well as the family members. Find out the comprehension of the child as well as the parents understanding of the disorder. Find out the kind of support and resources available to the child and family and the available support from the family for the child
-Adaptive Functioning: gain info about on their level of sensorimotor skills, sensory motor skills, and
-Sensorimotor: what their physical abilities are; repetitive/stereotyped of mannerisms, hyper/hypo active or sensory issues.
-Occupational Therapy: info about their level of fine and gross motor skills, how they function in different environments
For the SLP, they diagnose speech and language problems, they don't diagnose autism. but, all this information obtained from other professionals is important in the final diagnosis and when coming up with a treatment plan. Also, it's important for an SLP to understand the child's strengths and limitations when working on speech and langauge. A child must have a certain cognitive ability in order to understand the task the SLP is asking of them. This information also will help the SLP understand the family dynamic and amount of support the parents/family is willing or able to provide at home as well. Physical abilities and level of fine and gross motor skills are important for the SLP to know when determining play activities or other activities that involve the use of motor skills, as well as whether the child is verbal or nonverbal. Also, as far as sensorimotor skills, SLP's need to know if the child is overly sensitive to lights or sound so they can make accommodations during therapy.
2nd EditionDavid G Myers
13th EditionLori Watson, Patrick J. Hurley
3rd EditionDavid G Myers
Arlene Lacombe, Kathryn Dumper, Rose Spielman, William Jenkins