Autism Diagnostic Interview—Revised

Leiter International Performance Scale–Revised

OBJECTIVES: To compare the effects of two 9-month parent-implemented interventions within the Early Social Interaction (ESI) Project. Both individual-ESI, offered 2 or 3 times per week at home or in the community, and group-ESI, offered once per week in a clinic, taught parents how to embed strategies to support social communication throughout everyday activities. METHODS: Participants in the randomized controlled trial included 82 children diagnosed with autism spectrum disorder at 16 to 20 months. Children were matched on pretreatment nonverbal developmental level and pairs were randomly assigned to treatment condition. Child outcomes included measures of social communication, autism symptoms, adaptive behavior, and developmental level. Child outcomes are reported from baseline to the end of the 9-month interventions. RESULTS: Children in individual-ESI showed differential change on a standardized examiner-administered observational measure of social communication, as they improved at a faster rate than children in group-ESI. Individual-ESI also showed differential efficacy on a parent report measure of communication, daily living, and social skills, as they showed improvement or stability, whereas group-ESI led to worsening or no significant change on these skills. Finally, individual-ESI showed differential change on examiner-administered measures of receptive language skills, as children in individual-ESI improved significantly, whereas group-ESI showed no change. CONCLUSIONS: These findings support the efficacy of individual-ESI compared with group-ESI on child outcomes, suggesting the importance of individualized parent coaching in natural environments. The efficacy of a parent-implemented intervention using little professional time has potential for community viability, which is particularly important in light of the lack of main effects on child outcomes of most other parent-implemented interventions.

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Parent-Implemented Social Intervention for Toddlers With Autism: An RCT

This evidence base update examines the level of empirical support for interventions for children with autism spectrum disorder (ASD) younger than 5 years old. It focuses on research published since a previous review in this journal (Rogers & Vismara, 2008). We identified psychological or behavioral interventions that had been manualized and evaluated in either (a) experimental or quasi-experimental group studies or (b) systematic reviews of single-subject studies. We extracted data from all studies that met these criteria and were published after the previous review. Interventions were categorized across two dimensions. First, primary theoretical principles included applied behavior analysis (ABA), developmental social-pragmatic (DSP), or both. Second, practice elements included scope (comprehensive or focused), modality (individual intervention with the child, parent training, or classrooms), and intervention targets (e.g., spoken language or alternative and augmentative communication). We classified two...

Evidence Base Update for Autism Spectrum Disorder

Standardized calibrated severity scores (CSS) have been created for Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) Modules 1–4 as a metric of the relative severity of autism-specific behaviors. Total and domain CSS were created for the Toddler Module to facilitate comparison to other modules. Analyses included 388 children with ASD age 12–30 months and were replicated on 435 repeated assessments from 127 children with ASD. Compared to raw scores, associations between total and domain CSS and participant characteristics were reduced in the original sample. Verbal IQ effects on Social Affect-CSS were not reduced in the replication sample. Toddler Module CSS increases comparability of ADOS-2 scores across modules and allows studies of symptom trajectories to extend to earlier ages.

The Autism Diagnostic Observation Schedule, Toddler Module: Standardized Severity Scores

Correlational studies have revealed a positive relationship between parent verbal responsiveness and language outcomes in children with autism. We investigated whether parents of young children on the autism spectrum could learn and implement the specific categories of verbal responsiveness that have been suggested to facilitate language development. Parents were taught to increase their verbal responsiveness in the context of a short-term language intervention that included group parent education sessions, as well as individual and small-group coaching sessions of parent-child play interactions. Parents in the treatment group increased their use of comments that: described their child's focus of attention; interpreted or expanded child communication acts; and prompted child communication. Preliminary treatment effects were also noted in children's prompted and spontaneous communication. These results support the use of parent-mediated interventions targeting verbal responsiveness to facilitate language development and communication in young children with autism.

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Increasing Verbal Responsiveness in Parents of Children With Autism: a Pilot Study

This study compared language development in 30-month-old toddlers on the autism spectrum and 25- month-old late talking toddlers without autism. Groups were matched on overall productive vocabulary (and non- verbal cognition was controlled) in order to compare lan- guage acquisition patterns related to vocabulary composition and early lexical-grammatical relationships. Findings revealed that semantic categories of words— including psychological state terms—used by toddlers on the autism spectrum were very similar to those of late talkers. Both groups were equivalent with respect to grammatical complexity and proportion of toddlers com- bining words, though late talkers displayed a relatively stronger association between lexical-grammatical abilities. These tentative findings are consistent with a dimensional account of early, core linguistic abilities across different populations of children with language delay.

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Lexical and Grammatical Skills in Toddlers on the Autism Spectrum Compared to Late Talking Toddlers

Relatively little is known about trajectories of autism severity using calibrated severity scores (CSS) from the Autism Diagnostic Observation Schedule, but characterizing these trajectories has important theoretical and clinical implications. This study examined CSS trajectories during early childhood. Participants were 129 children with autism spectrum disorder evaluated annually from ages 2½ to 5½. The four severity trajectory classes that emerged—Persistent High (n = 47), Persistent Moderate (n = 54), Worsening (n = 10), and Improving (n = 18)—were strikingly similar to those identified by Gotham et al. (Pediatrics 130(5):e1278–e1284, 2012). Children in the Persistent High trajectory class had the most severe functional skill deficits in baseline nonverbal cognition and daily living skills and in receptive and expressive language growth.

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Trajectories of Autism Severity in Early Childhood

Many children with autism spectrum disorders (ASD) demonstrate deficits in language comprehension, but little is known about how they process spoken language as it unfolds. Real-time lexical comprehension is associated with language and cognition in children without ASD, suggesting that this may also be the case for children with ASD. This study adopted an individual differences approach to characterizing real-time comprehension of familiar words in a group of 34 three- to six-year-olds with ASD. The looking-while-listening paradigm was employed; it measures online accuracy and latency through language-mediated eye movements and has limited task demands. On average, children demonstrated comprehension of the familiar words, but considerable variability emerged. Children with better accuracy were faster to process the familiar words. In combination, processing speed and comprehension on a standardized language assessment explained 63% of the variance in online accuracy. Online accuracy was not correlated with autism severity or maternal education, and nonverbal cognition did not explain unique variance. Notably, online accuracy at age 5½ was related to vocabulary comprehension 3 years earlier. The words typically learned earliest in life were processed most quickly. Consistent with a dimensional view of language abilities, these findings point to similarities in patterns of language acquisition in typically developing children and those with ASD. Overall, our results emphasize the value of examining individual differences in real-time language comprehension in this population. We propose that the looking-while-listening paradigm is a sensitive and valuable methodological tool that can be applied across many areas of autism research.

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Individual Differences in the Real-Time Comprehension of Children with ASD

Purpose Eye-gaze methods have the potential to advance the study of neurodevelopmental disorders. Despite their increasing use, challenges arise in using these methods with individuals with neurodevelopmental disorders and in reporting sufficient methodological detail such that the resulting research is replicable and interpretable. Method This tutorial presents key considerations involved in designing and conducting eye-gaze studies for individuals with neurodevelopmental disorders and proposes conventions for reporting the results of such studies. Results Methodological decisions (e.g., whether to use automated eye tracking or manual coding, implementing strategies to scaffold children's performance, defining valid trials) have cascading effects on the conclusions drawn from eye-gaze data. Research reports that include specific information about procedures, missing data, and selection of participants will facilitate interpretation and replication. Conclusions Eye-gaze methods provide exciting opportunit...

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Courtney E. Venker

Papers

Increasing Verbal Responsiveness in Parents of Children With Autism: a Pilot Study

Lexical and Grammatical Skills in Toddlers on the Autism Spectrum Compared to Late Talking Toddlers

Trajectories of Autism Severity in Early Childhood

Individual Differences in the Real-Time Comprehension of Children with ASD

An Open Conversation on Using Eye-Gaze Methods in Studies of Neurodevelopmental Disorders