Showing papers in "Journal of Autism and Developmental Disorders in 1997"
TL;DR: It may be that measures of nonverbal social communication skills are especially important in the study of preschool intervention programs because these measures appear to tap into a cardinal component of the early social disturbance of autism.
Abstract: Highly structured, intensive early intervention may lead to significant developmental gains for many children with autism. However, a clear understanding of early intervention effects may currently be hampered by a lack of precision in outcome measurement. To improve the precision and sensitivity of outcome assessment it may be useful to integrate research on the nature of the social disturbance of autism with research on early intervention. In this regard, it may be that measures of nonverbal social communication skills are especially important in the study of preschool intervention programs. This is because these measures appear to tap into a cardinal component of the early social disturbance of autism, and because these measures have been directly related to neurological, cognitive, and affective processes that may play a role in autism. The research and theory that support the potential utility of these types of measures for early intervention research are reviewed. Examples are provided to illustrate how these types of measures may assist in addressing current issues and hypotheses about early intervention with autism including the “recovery hypothesis,” the “pivotal skill hypothesis,” and the relative effectiveness of discrete trial versus incidental learning approaches to early intervention. A cybernetic model of autism is also briefly described in an effort to better understand one potential component of early psychoeducational treatment effects with children with autism.
398 citations
TL;DR: The use of instructional strategies for children who may be characterized as visual learners are addressed and a description of how visually cued instruction can be applied in various contexts is described.
Abstract: Instructional considerations for children with autism who continue to struggle with current treatment models are discussed Specifically, the use of instructional strategies for children who may be characterized as visual learners are addressed The discussion begins with a review of research that illuminates the learning style differences associated with autism Next, the instructional strategies of both behavioral and incidental teaching methods are examined in light of the research Finally, using a case study as the backdrop, the discussion concludes with a description of how visually cued instruction can be applied in various contexts
375 citations
TL;DR: A single set of criteria, as operationalized by individually structured questions in the ADI/ADI-R, was effective in differentiating autism from mental handicap and language impairment in subjects with a range of chronological ages and developmental levels.
Abstract: Results from ROC curves of items from two scales, the Autism Diagnostic Interview (ADI) and Autism Diagnostic Interview-Revised (ADI-R), operationalizing DSM-IV criteria for autism are presented for 319 autistic and 113 other subjects from 8 international autism centers. Analyses indicate that multiple items were necessary to attain adequate sensitivity and specificity if samples with varying levels of language were considered separately. Although considering only current behavior was generally sufficient when a combination cutoff and additive model was employed, predictive power was highest when history was taken into account. A single set of criteria, as operationalized by individually structured questions in the ADI/ADI-R, was effective in differentiating autism from mental handicap and language impairment in subjects with a range of chronological ages and developmental levels.
371 citations
TL;DR: The forms, functions, and complexity of nonverbal communication used by very young children with autism were investigated and autistic children were less likely to point, show objects, or use eye gaze to communicate, but were more likely to directly manipulate the examiner's hand.
Abstract: The forms, functions, and complexity of nonverbal communication used by very young children with autism were investigated. Fourteen children with autism were matched to 14 children with developmental delays and/or language impairments on the basis of CA, MA, and expressive vocabulary. Subjects participated in a structured communication assessment consisting of 16 situations designed to elicit requesting or commenting behavior. Children with autism requested more often and commented less often than controls. Autistic children were less likely to point, show objects, or use eye gaze to communicate, but were more likely to directly manipulate the examiner's hand. The autistic group also used less complex combinations of behaviors to communicate. Implications for early identification and intervention are discussed.
321 citations
TL;DR: Evidence from clinical studies suggests that unusual sensory responses are present in a majority of autistic children, that they are manifested very early in development, and that they may be linked with other aspects of autistic behavior.
Abstract: Sensory-perceptual abnormalities in people with autism are discussed from two perspectives: published firsthand accounts and existing psychological research evidence. A range of abnormalities, including hyper- and hyposensitivity, sensory distortion and overload, and multichannel receptivity and processing difficulties, are described in firsthand accounts and frequently portrayed as central to the autistic experience. A number of dangers are inherent in uncritically accepting these accounts at face value and in any wider generalization to the autistic population as a whole. Evidence from clinical studies suggests that unusual sensory responses are present in a majority of autistic children, that they are manifested very early in development, and that they may be linked with other aspects of autistic behavior. In addition, experimental studies using a range of indices have found evidence of unusual responses to sensory stimuli in autistic subjects. However the clinical and experimental research to date suffers from serious methodological limitations and more systematic investigation is warranted. Key issues for future psychological research in the area are identified.
302 citations
TL;DR: Results indicated that parental perceptions of autistic children's behavior were more often linked to actual child and parental behaviors than in the comparison samples.
Abstract: This study examines the relation of parental perceptions and observed parent-child interactive behaviors. Samples observed included normally developing children, children with autism, and children with mental retardation who were equivalent on mental age. Parental perceptions of children's temperament and parental feelings of parenting stress were examined. Results indicated that parental perceptions of autistic children's behavior were more often linked to actual child and parental behaviors than in the comparison samples. Parents who reported their autistic children as more difficult in temperamental style had children who were less engaged during a social game with the parent and less responsive in interaction with an experimenter. Parents who reported greater stress had autistic children who were less responsive in social interactions with others.
292 citations
TL;DR: It is suggested that at least two components of inhibition are spared in individuals with autism, standing in contrast to flexibility and other executive deficits that have been found in previous studies.
Abstract: This study examined inhibitory function in nonretarded children with autism (n = 13) and normally developing controls (n = 13) matched on age and IQ. Tasks measuring motor and cognitive components of inhibition were administered to both groups. On the Stop-Signal paradigm, children with autism were able to inhibit motor responses to neutral and prepotent stimuli as well as control subjects. On the Negative Priming task, the groups were equally capable of inhibiting processing of irrelevant distractor stimuli in a visual display. Results suggest that at least two components of inhibition are spared in individuals with autism, standing in contrast to flexibility and other executive deficits that have been found in previous studies. These findings may help distinguish children with autism from those with other neurodevelopmental conditions that involve executive dysfunction.
263 citations
193 citations
TL;DR: Examination of whether teaching children with autism to pass tasks that assess mental state understanding had any positive effects on communication showed that no discernible improvement was seen on either measure of communication following mental state teaching.
Abstract: The present research examined whether teaching children with autism to pass tasks that assess mental state understanding had any positive effects on communication. Two aspects of communication previously shown to be deficient in children with autism were considered. These are conversational ability, in particular the ability to expand on conversation, and the use of mental state terms in speech. Results showed that no discernible improvement was seen on either measure of communication following mental state teaching. Discussion centers on real versus superficial changes in understanding mental states as a result of teaching.
171 citations
167 citations
TL;DR: Families experienced greater stress when the child showed more behavior problems overall, more externalizing and internalizing problems, and more problems on five of the nine narrow-band domains of Achenbach's Child Behavior Checklist.
Abstract: This study examined stress-support in 42 families of 3 to 18-year-old children with Prader-Willi syndrome. Parents were asked about themselves and their families, their child with Prader-Willi syndrome, family supports, and family stress. Compared to reported stress levels in families of children with mixed etiologies of retardation, parents of children with Prader-Willi syndrome showed higher levels of parent and family problems, and comparable levels of pessimism. Parents of children with Prader-Willi syndrome listed other family members and friends as their main supporters; often such supporters lived outside of the respondent's town or city. Although the child's age, IQ, and degree of obesity were not related to familial stress, families experienced greater stress when the child showed more behavior problems overall, more externalizing and internalizing problems, and more problems on five of the nine narrow-band domains of Achenbach's Child Behavior Checklist.
TL;DR: Ability to select through pointing out sexually relevant body parts or activities was not different by level of functioning, group, or gender, but there were differences in providing a sociosexual label, however, with better performance for those with developmental delay and for the higher functioning.
Abstract: Thirty-one individuals, 15 with autistic disorder and 16 with developmental delay, male and female, were asked to select from a series of drawings depicting sexually relevant activities and to define them. In addition they were asked to describe their sexual experiences, attitudes, and interests, using a semistructured interview format. Ability to select through pointing out sexually relevant body parts or activities was not different by level of functioning, group, or gender. There were differences in providing a sociosexual label, however, with better performance for those with developmental delay and for the higher functioning. No differences were evident for sexual experiences, likely because of the considerable variability across subjects and types of activity, with some individuals reporting very many and others very few. As to attitudes, individuals with autistic disorder endorsed more sexual activities than those with developmental delay. Higher knowledge of sexuality terms and activities was inversely related to their endorsement. Literalness and perseveration were evident in the responses of some, primarily those with autistic disorder. Results are discussed for their relevance to the reliability and validity of information on sexual awareness among the developmentally disabled. Suggestions for future research are offered.
TL;DR: A wealth of studies have confirmed Kanner's (1943) view that children with autism have impoverished pretend play, but there is disagreement about the exact nature of the impairments, the conditions under which they are manifested, and the processes underlying them.
Abstract: A wealth of studies have confirmed Kanner's (1943) view that children with autism have impoverished pretend play (for reviews see Harris, 1993; Jarrold, Boucher, & Smith, 1993; Wulff, 1985). However, there is disagreement about the exact nature of the impairments, the conditions under which the impairments are manifested, and the processes underlying them (Harris, 1993; Jarrold et al., 1993; Leslie, 1987; Perner, 1993). One source of the controversy lies in the fact that the production of pretense in children with autism has been assessed under two general setting conditions: (a) unstructured, spontaneous conditions, and (b) structured, prompted, or elicited conditions. All studies show an impairment in the production of pretend play in children with autism (in comparison to mental-aged matched controls) in unstructured, spontaneous conditions (Baron-Cohen, 1987; Lewis & Boucher, 1988; Riguet, Taylor, Benaroya, & Klein, 1981; Sigman & Ungerer, 1984; Ungerer & Sigman, 1981). After general or specific prompts are given, children with autism tend to produce some pretend play, although in many studies the group differences remain (Riguet et al., 1981; Sigman & Ungerer, 1984). In two studies they disappeared: Children with autism were unimpaired in pretend play (object substitution) under prompted conditions (Jarrold, Boucher, & Smith, 1996; Lewis & Boucher, 1988). Jarrold et al. (1996) also investigated the ability of children with
TL;DR: It is suggested that improving motivation and attention in children with autism may considerably influence test performance and interpretation in relation to the difficulty in administering and interpreting changes in performance on standardized tests with this population.
Abstract: The purpose of this experiment was to assess whether manipulation of variables related to motivation and attention in children with autism would influence performance on standardized tests. Two different testing conditions were compared: One consisted of the usual standardized testing procedures; during the other, specific variables that were hypothesized to relate to each child's responsiveness to task stimuli were manipulated. Data were collected in the context of a repeated reversals experimental design with condition order varied within and across children. Six children participated in a total of 44 separate testing sessions, controlled for order of conditions, number of sessions, and type of test. Results showed consistent differences between the two conditions, suggesting that improving motivation and attention in children with autism may considerably influence test performance and interpretation. Findings are discussed in relation to the difficulty in administering and interpreting changes in performance on standardized tests with this population.
TL;DR: The effects of touch therapy on three problems commonly associated with autism including inattentiveness (off-task behavior), touch aversion, and withdrawal are investigated.
Abstract: Autism affects 2 to 5 of 10,000 children. Although once considered primarily psychiatric in nature, autism is now generally thought to be an organic defect in brain development. Characterized by a failure to develop language or other forms of social communication, symptoms of autism include (a) withdrawal from or failure to develop normal relationships with people; (b) abnormal responses to one or more types of sensory stimuli (usually sound); (c) atypical movement, including immobility and hyperkinesis; (d) limited attention span and excessive off-task behavior; and (e) touch aversion. A variety of therapies have been tried with autistic children including structured activities, behavior modification, sensorimotor, and sensory integrative approaches. Touch therapy may also be beneficial for autistic children. Previous studies, for example, have shown that touch therapy alleviated anxiety and decreased cortisol levels and depression in child psychiatric patients (Field et al., 1992). In another study, vagal activity increased during touch therapy (Field, 1990). Since increased vagal activity has been associated with increased attention span (Porges, 1991), touch therapy may reduce the off-task behavior noted in children with autism. This study investigated the effects of touch therapy on three problems commonly associated with autism including inattentiveness (off-task behavior), touch aversion, and withdrawal.
TL;DR: Division TEACCH has served over 100 persons with autism through its supported employment program, demonstrating the success of the program which is due in large part to the broad array of long-term support services that are provided.
Abstract: Division TEACCH has served over 100 persons with autism through its supported employment program. Three models of supported employment are utilized: individual placement model, dispersed enclave model, and mobile crew model. Within each of these models there is an emphasis on utilizing individual strengths and interests, identifying appropriate jobs, and providing extensive long-term support. A retention rate of 89% demonstrates the success of the program which is due in large part to the broad array of long-term support services that are provided.
TL;DR: Substantial clinical improvement was noted almost immediately in each patient, with aggression, self-injury, explosivity, and poor sleep hygiene most improved when administered risperidone in an open-label fashion.
Abstract: Many autistic patients with mental retardation have difficulties with explosivity and aggression. They often prove resistant to various pharmacotherapeutic interventions. In this study, 11 male outpatients (mean 18.3 years) were administered risperidone in an open-label fashion. The risperidone was started at 0.5 mg daily, and titrated upwards until maximum clinical benefit occurred. Serial clinical interviews were conducted, and Conners Parent-Teacher Questionnaires (short form) were completed by the caretakers. Substantial clinical improvement was noted almost immediately in each patient, with aggression, self-injury, explosivity, and poor sleep hygiene most improved. The modal dose for optimal response was 0.5 mg bid. Weight gain was a significant side effect (average velocity of 0.47 kg per week), while none of the patients experienced extrapyramidal side effects.
TL;DR: A survey of the sexual behavior of 89 adults with autism living in group homes in North Carolina found that the majority of individuals were engaging in some form of sexual behavior.
Abstract: A survey of the sexual behavior of 89 adults with autism living in group homes in North Carolina found that the majority of individuals were engaging in some form of sexual behavior. Masturbation was the most common sexual behavior. However, person-oriented sexual behaviors with obvious signs of arousal were also present in one third of the sample. The relationship between sexual behavior and demographic variables and other types of behaviors is explored. Information regarding group home sexuality policies and procedures are described.
TL;DR: Doubts are raised about the clinical effectiveness of HDPM in autistic disorder as assessed by the Children's Psychiatric Rating Scale (CPRS), the Clinical Global Impression Scale, and the NIMH Global Obsessive Compulsive Scale.
Abstract: Several reports have described salutary effects such as decreased physical aggression and improved social responsiveness being associated with the administration of high doses of pyridoxine and magnesium (HDPM) in open-labeled and controlled studies of patients with autism. Despite this fact, this intervention remains controversial. A 10-week double-blind, placebo-controlled trial was undertaken to examine both the efficacy and safety of HDPM in autism. Twelve patients were enrolled, and 10 patients (mean age 6 years 3 months) were able to complete the study. HDPM at an average dose of 638.9 mg of pyridoxine and 216.3 mg of magnesium oxide was ineffective in ameliorating autistic behaviors as assessed by the Children's Psychiatric Rating Scale (CPRS), the Clinical Global Impression Scale, and the NIMH Global Obsessive Compulsive Scale. Furthermore, no clinically significant side effects were noted during HDPM administration. A trend for a transient change on the CPRS was found that was possibly due to a placebo response. This study raises doubts about the clinical effectiveness of HDPM in autistic disorder.
TL;DR: Clinically, several characteristic behaviors have been informally observed in persons with Smith-Magenis syndrome, including moderate levels of mental retardation, speech delay hyperactivity, aggression, and significant sleep disturbances.
Abstract: Smith-Magenis syndrome is a recently identified syndrome mental retardation associated with interstitial chromosome deletions at 17pll.2 (Smith et al, 1986). Although the genetic and physical features of Smith-Magenis syndrome are becoming better characterized, distinctive cognitive or behavioral profiles have yet to be described. At present, Smith-Magenis syndrome is an underdiagnosed disorder, with only about 100 cases reported in the literature. Prevalence estimates suggest, however, that this disorder may be reasonably common, affecting approximately 1 in 25,000 births (Greenberg et al., 1991). More cases are likely to be identified in the months ahead due to increased awareness of the syndrome and to advances in molecular cytogenetic techniques. Physically, persons with Smith-Magenis syndrome often show a flat midface, brachycephaly (flat head shape), a broad nasal bridge, brachydactyly (short fingers), and short stature. More variable physical features include ocular pathology, prominent jaw, down-turned mouth, ear abnormalities, congenital heart defects, and scoliosis (e.g., Finucane, Jaeger, Kurtz, Weinstein, & Scott, 1993; Greenberg et al., 1991; Stratton et al., 1986). Clinically, several characteristic behaviors have been informally observed in persons with Smith-Magenis syndrome, including moderate levels of mental retardation, speech delay hyperactivity, aggression, and significant sleep disturbances. Many individuals with Smith-Magenis syndrome
TL;DR: Overall, results indicated that children with autism performed as well as both groups of comparison subjects on general attention questions and social perception questions relating to stories containing one cue, but performed more poorly than both comparison groups on social perception Questions relating to Stories containing multiple cues.
Abstract: Research suggests that the attentional deficits found in children with autism may be related to impairments in social functioning (e.g., Courchesne et al., 1994a, 1994b; Lewy & Dawson, 1992; Schreibman & Lovaas, 1973). In the present investigation, 14 children with autism, 14 mentally handicapped, and 14 typically functioning children participated in a study designed to investigate the effects of number of social cues on the ability to interpret social situations. Participants were shown videotaped vignettes of child-child interactions in which the number of cues leading to the correct interpretation of the story varied from one to four (i.e., tone, content, nonverbal, or nonverbal with object). Subjects were then asked a series of questions which varied in degree of complexity. Overall, results indicated that children with autism performed as well as both groups of comparison subjects on general attention questions (i.e., identification of number and gender of interactants) and social perception questions relating to stories containing one cue. However, children with autism performed more poorly than both comparison groups on social perception questions relating to stories containing multiple cues. Results are discussed in terms of an attentional dysfunction hypothesis of autism.
TL;DR: Girls with fraX had significantly more autistic behaviors than controls; anxiety and posterior cerebellar area measures had distinct associations with subsets of autistic behaviors; these associations may have important implications for understanding the neurobiology of autism.
Abstract: Reports of autistic behaviors were examined for 30 school-age girls with fragile X (fraX) and 31 age- and IQ-matched controls through a structured interview administered to each girl's parent(s) IQ scores were obtained for each participant; anxiety, neuroanatomical, and molecular-genetic data were derived for girls with fraX Girls with fraX had significantly more autistic behaviors than controls These behaviors were qualitatively similar to those reported for boys with fraX, but were not correlated with IQ Anxiety in girls with fraX was positively correlated with abnormal social and communication behaviors; posterior cerebellar vermis area was negatively correlated with measures of communication and stereotypic/restricted behaviors Severity of stereotypic/restricted behaviors was negatively correlated with the prevalence of active non-fraX chromosomes Thus anxiety and posterior cerebellar area measures had distinct associations with subsets of autistic behaviors; these associations may have important implications for understanding the neurobiology of autism
TL;DR: It is suggested that autistic children's known deficits in attention and affective responsiveness to others persist even in structured interactions with a familiar partner in the home.
Abstract: Longitudinal videotape recordings of six young children with autism and six age- and language-matched children with Down syndrome in structured play with their mothers at home were coded for the focus of the child's visual attention for four bimonthly visits and for facial affect for two of the four visits. The main finding was that the children with autism showed reduced expression of positive affect in a familiar social context. The autistic group attended to the mother's face and the researchers only about half as much as the Down syndrome group, but these differences did not reach statistical significance. Compared to the Down syndrome group, the autistic group displayed a smaller proportion of their total positive affect toward the mother's face and toward the researcher, but only the latter group difference reached statistical significance. Although limited by the small sample size, these findings suggest that autistic children's known deficits in attention and affective responsiveness to others persist even in structured interactions with a familiar partner in the home.
TL;DR: Predictable population differences were found for key social behaviors of proximity to children, social bids from children, and focus of engagement on children, as well as for behavioral context variables of verbalizations, adult focus, and atypical behaviors.
Abstract: Data on the social behavior of typical children may inform practitioners and researchers regarding the appropriate goals of intervention for children with autism. This study assessed the ongoing levels of naturally occurring social behavior in 64 preschool-aged children. A 2 × 2 factorial design was used to analyze population (children with autism and typical children) and age (3 years 3 months vs. 4 years 4 months) differences at the time of preschool entry. Predictable population differences were found for key social behaviors of proximity to children, social bids from children, and focus of engagement on children, as well as for behavioral context variables of verbalizations, adult focus, and atypical behaviors. No differences were found in the amount of time spent focused on toys or objects. There were also no differences in the presenting behaviors of younger and older children with autism. Results are discussed in terms of implications for establishing early social intervention goals.
TL;DR: Three groups of children: autistic, Down syndrome, and normally developing were studied for their capacity to imitate single pretend acts and a series of pretend acts that formed scripts.
Abstract: Although there has recently been considerable research interest in the difficulties that children with autism have engaging in pretend play, little attention has been paid to the ability of these children to imitate pretend play acts. Furthermore, suggestions that children with Down syndrome have relatively advanced abilities in pretend play have not been accompanied by an examination of their capacity to imitate pretend play. Three groups of children: autistic, Down syndrome, and normally developing were studied for their capacity to imitate single pretend acts and a series of pretend acts that formed scripts. While the children with autism were surprisingly better than the other two groups on the single-scheme task, they demonstrated specific difficulties on the multischeme task. Results are discussed in relation to current theories of autism and the notion of imitation.
TL;DR: It is implied that children with autism did show a tendency towards an analytic level of processing, though the groups differed on measures of counting speeds, the number or children showing patterns of global or analytic processing did not differ significantly across the groups.
Abstract: We examined the claim that children with autism have a "weak drive for central coherence" which biases them towards processing information at an analytic rather than global level. This was done by investigating whether children with autism would rapidly and automatically enumerate a number of dots presented in a canonical form, or count each dot individually to obtain the total. The time taken to count stimuli was compared across three participant groups: children with autism, children with moderate learning difficulties, and normally developing children. There were 22 children in each group, and individuals were matched across groups on the basis of verbal mental age. Results implied that children with autism did show a tendency towards an analytic level of processing. However, though the groups differed on measures of counting speeds, the number or children showing patterns of global or analytic processing did not differ significantly across the groups. Whether these results implicate a weak drive for central coherence in autism, which is both specific to, and pervasive in the disorder, is discussed.
TL;DR: A revised version of this scale, the Revised Behavior Summarized Evaluation Scale (BSE-R) completed the 20-item BSE scale with the most relevant items extracted from a similar evaluation carried out with very young children, and 9 items were added to the original scale concerning nonverbal communication, emotional, and perception areas.
Abstract: The Behavioral Summarized Evaluation scale (BSE), previously published and validated, was developed for the evaluation of the autistic behavior in developmentally disordered children. A revised version of this scale, the Revised Behavior Summarized Evaluation Scale (BSE-R) completed the 20-item BSE scale with the most relevant items extracted from a similar evaluation carried out with very young children. Thus 9 items were added to the original scale concerning nonverbal communication, emotional, and perception areas. This paper reports the reliability and validity studies of this new scale. In addition to confirming the previously published findings concerning the first version of the BSE, new items were extracted from the BSE-R content validity study. They involve fundamental functions such as intention and imitation which open new perspectives for a physiopathological approach to developmental disorders. The BSE-R is a useful tool for progressive recording of the evolution of patients both treated over long periods and included in short-term controlled therapeutic studies.
TL;DR: A framework for thinking about autism and principles of evaluation are reviewed and components of appropriate early intervention programs are described and guidelines for evaluating alternative treatments are provided.
Abstract: It is now well recognized that early diagnosis and intervention improves the prognosis for children with autism. It is crucial that professionals be aware and sensitive to the needs of autistic persons and their families. We must never lose sight of the long-term goal of treatment and must not become so infatuated with any one treatment that we fail to provide the education parents need. It is incumbent upon us, as professionals, to educate parents and help them evaluate the myriad of information with which they are bombarded. In this article a framework for thinking about autism and principles of evaluation are reviewed. Components of appropriate early intervention programs are then described and guidelines for evaluating alternative treatments are provided.
TL;DR: Sign language production of low-functioning students diagnosed with autistic disorder was examined and students' sign vocabulary size and accuracy of sign formation were highly correlated with their performance on two measures of apraxia and with their fine motor age scores.
Abstract: Sign language production of 14 low-functioning students diagnosed with autistic disorder was examined. Videotapes of the students signing with their teachers were analyzed for frequency and accuracy of sign location, handshape, and movement production. The location aspect of signs was produced more accurately by the subjects than either the handshape or movement aspects. Wide individual differences were evident among the students in the number of signs they produced, accuracy of sign formation, and performance on measures of motor functioning. Students' sign vocabulary size and accuracy of sign formation were highly correlated with their performance on two measures of apraxia and with their fine motor age scores.