Does phonetic repertoire in minimally verbal autistic preschoolers predict the severity of later expressive language impairment?

Trajectories of expressive language development are highly heterogeneous in autism. Yoder et al. found that parental responsiveness, child response to joint attention, child communicative intent and consonant inventory were unique predictors of expressive language growth in minimally verbal preschoolers 16 months later ( n = 87). This study applied these predictors to an independent sample, over a 12-month period ( n = 27). A broader measure of phonetic repertoire, combining reported, elicited and observed speech sounds, was included to further understand the contribution of speech production skills. Expressive language growth was highly variable: 65% remained minimally verbal at mean age 5;2, while 7% gained over 340 words. Contrary to expectations, communicative intent, parent responsiveness and response to joint attention were not found to predict expressive language growth or outcome. In contrast, both consonant inventory and phonetic repertoire were significant predictors (adjusted R2 = 0.29 and 0.45). These results underscore the contribution of speech production abilities to expressive language development in this population, which may reflect an additional deficit rather than a consequence of core autism symptoms. Future work should include those with the most persistently limited expressive language, so that findings can be generalized and additional barriers to communication identified and addressed. Lay abstract What is already known about the topic? Language skills vary enormously in autism: while some autistic individuals can engage in sophisticated conversations, many remain minimally verbal, meaning they use few or no words regularly for communication. We do not know what causes this variation, but we do know that certain child and family characteristics can be measured when a child is young, and this information can improve our prediction of how expressive language might develop over time. What this article adds? We examined four characteristics, which have already been found to predict language development in young minimally verbal autistic children. We followed the expressive language progress of 27 minimally verbal children, aged three to five, for a year. One-third no longer met the minimally verbal criteria at the end of the study. In this sample, only one factor predicted language progress, which was the child’s initial speech skills (the number of different speech sounds that the child made during an interaction). This finding adds to the evidence that speech skills contribute to language development in autism. In some cases, persistent and severe expressive language difficulties may reflect an additional deficit in speech production, rather than a consequence of core autism features. Implications for practice, research or policy Our findings suggest that there are factors other than social skills that influence language development in autism. Careful assessment of speech production should be considered when language does not develop as expected. Future research should evaluate speech skills interventions for minimally verbal autistic individuals, as well as promoting the use of alternative communication systems.

Initiation and response of joint attention bids in autism spectrum disorder children depend on the visibility of the target

Background and aims Response to joint attention (RJA) and initiation of joint attention (IJA) are impaired in pre-schoolers with autism spectrum disorder (ASD). Children’s response to joint attention may depend on the presence of the target in the child's field of vision or on the type of deictic index (head and eye orientation, pointing and verbalisations) used by the adult to initiate joint attention. Methods This study deals with 50 ASD children aged from 2 years 8 months to 11 years 7 months, with a communicative level comparable to children under 31 months of age, according to the French version of the Early Social Communication Scales (ECSP, by its French acronym). We compared the aforementioned ASD children with 50 typically developing (TD) children, aged 9 to 30 months who had no communication disorders according to the ECSP. During the ECSP test, we analysed joint attention behaviours on three posters present or absent from the children's visual field. Results We did not observe any difference in the number of IJAs between groups, but ASD children were less responsive than TD children were. Our results showed a developmental progression in the responses of children with ASD if several deictic cues were used by an adult simultaneously (looking and pointing, or looking and verbalising to indicate a target), whether the referent was present or absent from the child’s visual field. In addition, we observed developmental progression when the referent was behind the child and the adult only used their gaze to refer to it. Conclusion Thus, we argue that the type of cues used affects ASD children’s response behaviours during joint attention towards a referent that may be present or absent from their visual field. Implications: Regarding the social and the sensory difficulties of children with ASD, many therapeutic approaches focus their intervention methods on non-verbal communication skills and joint attention. This fundamental research makes it possible to identify the most appropriate type of deictic index for children with ASD with developmental delay, depending on the presence or absence of the referent in the child's visual field.