The Relationship Between Joint Attention and Language in Children With Autism Spectrum Disorders

Reevaluación de la brecha del lenguaje receptivo-expresivo en individuos con síndrome de Down

Speech perception is often considered specific to the auditory modality, despite convincing evidence that speech processing is bimodal. The theoretical and clinical roles of lipreading for speech perception, however, have received little attention in speech-language pathology. The aims of this study were to investigate how lipreading ability can be assessed to facilitate clinical decision making in speech and language intervention, to determine how lipreading affects speech development in a hearing impaired cohort and to assess the interaction of lipreading skills with other factors thought to give rise to variation in communication skills in hearing impaired children. Five pieces of evidence that support lipreading as an integral part of speech processing are reviewed in Chapter 1. Definitions of hearing loss and lipreading are also presented. Ways of assessing lipreading ability are essential for both research and clinical practice and a review of lipreading tests in Chapter 1 highlights the inadequacy of assessment tools in this area. Factors often cited in the literature as affecting lipreading skills in a hearing and /or hearing impaired cohort are also examined. These include gender, age, socioeconomic status, intelligence, degree of hearing loss and aetiology of hearing loss. Chapter 2 details a longitudinal study by Dodd, McIntosh, and Woodhouse (1992) which described the communication development of children with hearing impairment and investigated the associations between communication skills and other linguistic and non¬linguistic factors. Lipreading skills were assessed using the Speechreading Assessment for Children with Hearing Impairment (SPACHI), a test developed for the study, and this data is also discussed. An association was found between lipreading skills and speech development. Those children with good lipreading skills had better speech skills as measured quantitatively through their phonemic repertoire. They had fewer phonemes missing and a higher percent of correct consonants. As a whole group, receptive and expressive language skills were below age appropriate scores. Chapter 3 reports new analysis of unused data from the longitudinal study which indicated associations between memory skills and other speech and language parameters. The results show that lipreading skills were highly correlated with some parameters of speech and language skills. Children who had better lipreading skills at an early age had better speech skills as measured qualitatively in their phonological repertoire. They also had more developmental error patterns. Poor lipreaders had significantly more phonemes missing from their phonemic repertoires and made significantly more nondevelopmental speech errors than the good lipreaders. Good lipreaders had better visual memory skills. The longitudinal study was limited by a number of factors, including low participant numbers and the lack of adherence to current best assessment practice in the assessments used. It also became evident that the SPACHI was inadequate and needed revision. It did not clearly delineate the level at which a child’s lipreading skills were plateauing (i.e., word, phrase, sentence or conversational speech) and there was no contingency for test familiarity, therefore making the test unreliable if used too frequently. In order to assess lipreading for research purposes, it may be necessary to test the skill in isolation, as well as multimodally. There was no ability to accurately assess both visual and auditory visual modalities using the SPACHI and there were insufficient test items per section to clearly determine competence at specific levels of ability. Finally, no hearing children were assessed for validity and reliability measurements using the test. Chapter 4 describes the development and content of the Lipreading Assessment of Children with Hearing Impairment (LACHI), a revised and enhanced version of the SPACHI. The LACHI provides an assessment of children’s lipreading skills across the word, phrase, sentence, question and conversational levels. There are three interchangeable test forms (the Farm, the Beach and the Park) and they can be used to test auditorily, visually (lipreading) or auditory-visually, without test familiarity being an issue. Chapter 5 provides an overview of the use of the LACHI on a cohort of hearing children and children with impaired hearing, evaluating LACHI performance in terms of gender, age and socioeconomic status. On average, girls performed significantly better than boys, and older children performed better than younger children, although some younger children had excellent lipreading skills. Socioeconomic grouping affected the hearing group only, with those from a higher socioeconomic group performing better. Data on the internal structure of the LACHI was evaluated and indicated that the interchangeable forms are not significantly different, with test section five being the most difficult for both the hearing and hearing impaired cohorts. The communication development of children with hearing impairment is examined in more depth in Chapter 6. No past research has provided such an overview of lipreading in relation to other communication skills. The cross-sectional study examined speech skills using free speech analysis and the Diagnostic Evaluation of Articulation and Phonology (DEAP). Receptive and expressive language skills were also investigated as was visual and auditory memory. Lipreading skills were assessed using the LACHI. Results confirmed the association between good lipreading and better speech skills by the type of error patterns (more developmental) and Percent Consonants Correct, Percent Vowels Correct and Percent Phonemes Correct (all higher). Visual memory was better than auditory memory. Expressive and receptive language scores were age appropriate. Chapter 7 looks at the interplay of lipreading skills and other factors including intelligence, gender, age, socioeconomic status and degree of hearing loss in the hearing impaired cohort. Categories of good and poor lipreaders were established. Comparisons of the two groups’ speech, language and memory skills revealed that good lipreading skills were associated with degree of hearing loss, age and gender, as well as better expressive language, speech and supra-segmental characteristics. In contrast, receptive language, auditory and visual memory, intelligence and socioeconomic grouping did not discriminate between the groups. Some of these findings were surprising and were further explored in terms of the interplay of the skills with each other. In Chapter 8, the results of the study are discussed. Associations between lipreading skills and speech skills in a hearing impaired cohort are considered, as well as the relationship between memory, language and lipreading. A discussion on the effectiveness and potential use of the LACHI as an important assessment tool in clinical intervention with hearing and other disordered populations is presented. The overwhelming evidence from the data collected in this thesis indicates there is an association between good lipreading skills and better expressive speech skills in a hearing impaired cohort, with memory skills implicated in lipreading ability. This adds evidence to the theoretical discussions on multimodal speech processing and accessing the phonological code. Finally, the LACHI was found to be an efficient and effective measurement of lipreading skills in hearing children and children with hearing impairment.

This study aims to assess changes in the receptive and expressive language skills and to determine if the baseline characteristics such as communication, cognitive and motor skills, predict outcomes in preschool children with Autism Spectrum Disorder (ASD) following early intervention. We recruited 64 children participating in the Early Start Denver Model (ESDM) early intervention program at an Autism Specific Early Learning and Care Center (ASELCC) in Australia. Baseline characteristics across various developmental domains was measured using the Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behaviour Scales, 2nd Edition (VABS-II), and the ESDM Curriculum Checklist. Linear mixed-effects models were used to examine the effects of the intervention on outcomes. Fixed-effects such as time, groups (verbal and minimally verbal), and time-by-group interactions were assessed whilst adjusting for covariates. Further, multiple linear regression models were used to determine if the baseline characteristics were significant predictors of the outcomes following the early intervention. Among the 64 children who participated in this study, 38 children were verbal, whereas 26 were deemed to have minimal verbal skills. The mean age of the sample was 4.1 years with a significant male predilection (83%) and from a culturally and linguistically diverse (CALD) background (64%). Findings of the linear mixed effects model showed significant within and between group differences in the ESDM subscales, indicating higher magnitude of changes in the verbal group compared to the minimally verbal group. Finally, the multiple linear regression models suggested that baseline MSEL visual reception and expressive language scores were predictive of changes in the ESDM receptive and expressive communication scores. Understanding a child's baseline skill levels may provide valuable clues regarding what interventions would work best, or which interventions may be less suitable for individual preschool-aged children with ASD.

Social communication interventions benefit children with ASD in early childhood. However, the mechanisms behind such interventions have not been rigorously explored. This study examines the mechanism underlying a naturalistic developmental behavioral intervention, JASPER (Joint Attention, Symbolic Play, Engagement, and Regulation), delivered by educators in the community. Specifically, the analyses focus on the mediating effect of joint engagement on children's initiations of joint attention (IJA) skills and whether IJA postintervention are associated with later gains in children's receptive and expressive language. One hundred seventy-nine children, age 2-5years, were randomized to immediate JASPER treatment or waitlist (treatment as usual) control. Independent assessors blinded to time and treatment coded children's time jointly engaged and IJA during a 10-min teacher-child interaction at baseline, exit, and follow-up. Age-equivalent receptive and expressive language scores from the Mullen Scales of Early Learning were collected at baseline and follow-up. Mediation analyses with linear mixed models were used to explore the potential mediating effect of joint engagement on IJA. Joint engagement significantly mediated 69% of the intervention effect on young children's IJA and IJA predicted improvements in standardized language scores. Small but sustained changes in child-initiated joint engagement improved IJA, a core challenge in children with ASD, which in turn led to improvements in language.

Tuberculous meningitis (TBM) results in significant morbidity and mortality among children worldwide. Associated neurocognitive complications are common but not well characterized. The Mullen Scales of Early Learning (MSEL), a well-established measure for assessment of neurodevelopment, has not yet been adapted for use in India. This study's goal was to adapt the MSEL for local language and culture to assess neurocognition among children in India, and apply the adapted measure for assessment of children with TBM. Administration of MSEL domains was culturally adapted. Robust translation procedures for instructions took place for three local languages: Marathi, Hindi and Tamil. Multilingual staff compared instructions against the original version for accuracy. The MSEL stimuli and instructions were reviewed by psychologists and pediatricians in India to identify items concerning for cultural bias. MSEL stimuli unfamiliar to children in this setting were identified and modified within Visual Reception, Fine-Motor, Receptive Language and Expressive Language Scales. Item category was maintained for adaptations of items visually or linguistically different from those observed in daily life. Adjusted items were administered to six typically developing children to determine modification utility. Two children diagnosed with confirmed TBM (ages 11 and 29 months) were evaluated with the adapted MSEL before receiving study medications. Skills were below age-expectation across visual reception, fine motor and expressive language domains. This is the first study to assess children with TBM using the MSEL adapted for use in India. Future studies in larger groups of Indian children are warranted to validate the adapted measure.

هدفت الدراسة إلى الكشف عن فعالية التدريب على استراتيجيات التدخل المسبق للسلوك (ABI) في تنمية مهارات اللغة الاستقبالية والتعبيرية لدى الأطفال ذوي اضطراب طيف التوحد ، وتكونت عينة الدراسة الأساسية من (10) أطفال من ذوي اضطراب طيف التوحد ، وتم توزيعهن على مجموعتين، الأولى تجريبية، وعددها (6) أطفال، والثانية ضابطة، وعددها (4) أطفال، وتراوحت أعمارهم الزمنية ما بين (3.7 - 6) سنوات بمتوسط (4.4) سنوات وانحراف معياري(1.085)، وتراوحت نسب ذكائهم ما بين (70 - 77) بمتوسط (74.2) وانحراف معياري(2.529)، وتم تطبيق مقياس مهارات اللغة الاستقبالية والتعبيرية إعداد الباحثة - جلسات التدريب على استراتيجيات التدخل المسبق للسلوك (ABI) إعداد الباحثة، تم تدريب الأمهات على مدى (55) جلسة واستغرق تطبيق البرنامج فترة زمنية مدتها (14) أسبوعًا بمعدل (4) جلسات أسبوعيًا، وتوصلت نتائج الدراسة إلى وجود فروق ذات دلالة إحصائية بين متوسطي رتب درجات المجموعتين التجريبية والضابطة في مهارات اللغة الاستقبالية والتعبيرية في القياس البعدي لصالح المجموعة التجريبية، كما لا توجد فروق ذات دلالة إحصائية بين متوسطي رتب درجات المجموعة التجريبية في مهارات اللغة الاستقبالية والتعبيرية في القياسين البعدي والتتبعي.

Geometry and spatial skills are closely linked to mathematics, and preschool children’s interactions with math help develop these abilities. Early language development is crucial for all aspects of children’s growth. This study explores the relationship between language development and geometry and spatial skills in preschool children. Data from 120 preschool children were collected using the Turkish Early Language Development Test (TEDIL) and the Geometry and Spatial Perception Test (GSPT). The data were analyzed using normality tests, descriptive, and correlational analyses, with multiple linear regression to assess if language development predicts geometry and spatial skills. Results show significant positive relationships between children's receptive, expressive, and verbal language skills and their geometry and spatial skills. Regression analysis indicates that receptive and expressive language skills are key predictors of geometry and spatial abilities. These findings contribute to the literature, offering insights into the connections between language and spatial development in early childhood.

Pediatric single-sided deafness (SSD) can seriously affect development, causing impaired spatial hearing skills, speech-language delays, and academic underachievement. Early cochlear implantation likely improves hearing-related outcomes, but its association with language development remains unclear. To investigate whether early cochlear implantation is associated with language outcomes for children with prelingual SSD. The Cochlear Implant for Children and One Deaf Ear study was initiated in 2015 and recruited participants at 4 academic hospitals in Flanders, Belgium, through 2019. This cohort study included 3 groups of children aged 2 to 5 years: children with SSD and a cochlear implant, children with SSD without a cochlear implant, and a control group with normal hearing. Language and hearing skills were assessed 1 to 2 times per year until the age of 10 years. Study completion rates were high (82%). Data analysis was performed from October to December 2020. Unilateral cochlear implant. Longitudinal vocabulary, grammar, and receptive language scores. The implanted group was hypothesized to outperform the nonimplanted group on all language tests. During the recruitment period, 47 children with prelingual SSD without additional disabilities were identified at the participating hospitals. Fifteen of the 34 children with an intact auditory nerve received a cochlear implant (44%, convenience sample). Sixteen of the remaining children were enrolled in the SSD control group (50%). Data from 61 children (mean [SD] age at the time of enrollment, 2.08 [1.34] years; 26 girls [42%]) were included in the analysis: 15 children with SSD and a cochlear implant, 16 children with SSD without a cochlear implant, and 30 children with normal hearing. Children with SSD and a cochlear implant performed in line with their peers with normal hearing with regard to grammar. In contrast, children with SSD without a cochlear implant had worse grammar scores than the group with implants (-0.76; 95% CI, -0.31 to -1.21; P = .004) and the group with normal hearing (-0.53; 95% CI, -0.91 to -0.15; P = .02). The 3 groups had similar vocabulary and receptive language abilities. These findings suggest that early cochlear implantation is associated with normal grammar development in young children with prelingual SSD. Although further follow-up will reveal the long-term outcomes of the cochlear implant for other skills, the current results will help clinicians and policy makers identify the best treatment option for these children.

Parent-child interaction is a foundational component of language development. This study examined parent-child interaction in deaf and hard-of-hearing children 6 or 9 months after they received hearing aids or cochlear implants. Expressive, receptive, and overall language skill were probed 9 to 18 months later. Thirteen DHH children and their parents participated in a videorecorded, semi-structured play interaction. Items from an adapted version of the Joint Engagement Rating Inventory were used evaluate parent-child interactions (i.e., fluency and con-nectedness, shared routines and rituals, child joint engagement, and parental sensitivity). Language skills were assessed using the Preschool Language Scales-5th (Zimmerman et al., 2011). Results indicate statistically significant re-lationships between child-parent joint engagement and expressive (p = .004), receptive language (p = .043), and total language scores (p = .007). The shared routines and rituals item was significantly related to expressive language (p = .037) and approached statistical significance with total language (p = .076) but was not significantly related to receptive language. The fluency and connectedness item was significantly related expressive language (p = .008) and total language (p = .028) but did not reach statistical significance with receptive language (p = .077). A quantitative measure of parental language input (i.e., words per minute) was not significantly related to any language variables.

Neurodevelopmental Trajectory During Infancy and Diagnosis of Autism Spectrum Disorder as an Outcome at 32 Months of Age.

Many children with autism spectrum disorder (ASD) have notable difficulties in motor, speech and language domains. The connection between motor skills (oral-motor, manual-motor) and speech and language deficits reported in other developmental disorders raises important questions about a potential relationship between motor skills and speech-language deficits in ASD. To this end, we examined data from children with ASD (n = 1781), 2-17years of age, enrolled in the Autism Speaks-Autism Treatment Network (AS-ATN) registry who completed a multidisciplinary evaluation that included diagnostic, physical, cognitive and behavioral assessments as part of a routine standard of care protocol. After adjusting for age, non-verbal IQ, Attention Deficit Hyperactivity Disorder (ADHD) medication use, and muscle tone, separate multiple linear regression analyses revealed significant positive associations of fine motor skills (FM) with both expressive language (EL) and receptive language (RL) skills in an impaired FM subgroup; in contrast, the impaired gross motor (GM) subgroup showed no association with EL but a significant negative association with RL. Similar analyses between motor skills and interpersonal relationships across the sample found both GM skills and FM skills to be associated with social interactions. These results suggest potential differences in the contributions of fine versus gross motor skills to autistic profiles and may provide another lens with which to view communication differences across the autism spectrum for use in treatment interventions.

This study was designed to produce a new parent-report measure, the Diagnostic Receptive Expressive Assessment of Mandarin-Infant Toddler Assessment of Communication and Language (DREAM-IT) in order to provide norms for the developmental skills of children aged 0-36 months in four areas: expressive language, receptive language, cognitive play and social skills. The scale was designed to be both broader and deeper than existing instruments that neglect one or more of these significant domains involved in early language. Items were chosen by a group of specialists with clinical experience working with the age group and with attention to the developmental literature. Caregivers were tested individually by a trained person who asked the questions and provided examples. In addition to an extensive health questionnaire, caregivers answered questions in Mandarin about their child's behaviour using a scale of 'not yet', 'sometimes' or 'always' or listing out words and/or sounds understood or said by the child. The 476 participating caregivers were recruited at maternal and child healthcare clinics centred in Chengdu, China, 191 of whom were tested a second time seven months later. The children were sampled in three-month age-bands from 0 to 36 months. The sample was balanced for child gender by age band, and parental education was balanced. Caregivers of 0-24-month-old children and caregivers of 12-36 months were each asked a different set of questions, to determine the appropriate age range and cutoff points for each question, requiring the sample size to be doubled for children aged 12-24 months. The results were subject to item-response theory analysis to remove outlying items, and the resulting internal reliability was high for each domain (average Cronbach's alpha=0.87). The final instrument (between 67 and 113 questions in total) was refined to include the least redundant questions that had the highest intercorrelations, with attention paid to coverage of all domains across the age range. Two scales were developed: one for children 0-18 months, the second for children aged 18-36 months. The longitudinal design permitted the creation of growth curves and norms for each domain for six-month intervals from 0 to 36 months. A small sample of 32 parents of children with Down syndrome aged 18-36 months provided validation that the scales are highly sensitive to developmental delay. The instrument shows considerable promise for detecting early communication problems in children in China. What is already known on the subject In China, efforts were made in recent years to develop language assessments for infants and toddlers, but limitations existed with the domains included and number of items included per age group. Many clinical practitioners also continued to rely on language subtests of general developmental scales, which were limited in depth and breadth of language skills tested and were never intended for diagnosis of language delay. What this paper adds to existing knowledge This paper discusses the development of a valid caregiver report instrument for early communication and language skills of infants and toddlers in mainland China. The Diagnostic Receptive Expressive Assessment of Mandarin-Infant Toddler (DREAM-IT) includes foundational domains necessary for language and communication development in young children (receptive language, expressive language, cognitive play and social communication domains). The results show strong internal reliability (Cronbach's alpha) for each domain on a sample of 716 children sampled in three-month age bands from 0 to 36 months. The external validity proved strong when tested on a group of 32 young children with Down syndrome. What are the potential or actual clinical implications of this work? Besides helping to inform the diagnosis of language delays in infants and toddlers in China, the caregiver report instrument has special features to support clinical practitioners in a field that is just emerging in China. The unique support features include the automatic generation of a profile of relative strengths and weaknesses of the child on the report and the recommendation of child-specific caregiver coaching videos on a companion app.

This study examined the relative contributions of parental reports of child-related and parent-related stress to their estimates of expressive and receptive language skills on the Minnesota Child Development Inventory in 152 children referred to a communicative disorders clinic. Correlational analysis showed moderately high agreement between parental estimates and objective measures of expressive and receptive language ability. Multiple-regression analyses revealed that independent measures of language acquisition accounted for the greatest amount of variance in parental estimates of expressive and receptive language skills. Stressful child behavior accounted for a small but statistically significant proportion of the variance in estimates of expressive and receptive language skills. Parental stress, in contrast, did not contribute significantly to language estimates. These findings suggest that parents are able to formulate estimates of language development which are relatively independent of personal or child-related stressors.

Penelitian ini bertujuan untuk melakukan kajian empiris guna mengetahui perbedaan keefektifan antara metode pembelajaran read aloud berbasis media gambar seri dengan metode lain yang biasanya digunakan oleh guru untuk meningkatkan kemampuan berbahasa reseptif pada anak usia dini. Jenis penelitian ini menggunakan rancangan eksperimen nonequivalent control group dengan pendekatan kuantitatif. Variabel dalam penelitian ini terdiri dari satu variabel bebas dan dua variabel tak bebas. Variabel bebas dalam penelitian ini adalah metode pembelajaran read aloud dengan media cerita gambar seri (X), sedangkan variabel tak bebas dalam penelitian adalah kemampuan bahasa ekspresif (Y1) dan kemampuan berbahasa ekspresif (Y2). Hasil penelitian menunjukkan bahwa (1) Metode pembelajaran read aloud dengan media cerita gambar seri lebih efektif dibandingkan metode pembelajaran yang biasa digunakan oleh guru untuk meningkatkan kemampuan berbahasa reseptif pada anak usia dini, secara statistik nilai Fhitung =5.766 dengan tingkat signifikan p = 0.022 lebih kecil dari 5%; (2) Metode pembelajaran read aloud dengan media cerita gambar seri lebih efektif dibandingkan metode pembelajaran yang biasa digunakan oleh guru untuk meningkatkan kemampuan berbahasa ekspresif pada anak usia dini, secara statistik nilai Fhitung = 1.028 tingkat signifikan p = 0.012 lebih kecil dari 5%. Pada hasil studi ini dapat memberikan wawasan serta inovasi baru dalam keefektifan pemeblajaran metode read aloud pada kegiatan bercerita gambar seri bermanfaat untuk mengembangkan kemampuan berbahasa reseptif dan ekspresif anak

External hydrocephalus in an infant is a condition in which the rate of growth of head circumference exceeds the expectations of the Nellhouse curve together with increased size of the subarachnoid spaces. Developmental milestones of 20 infants (aged 0-16 months) with external hydrocephalus were studied by the Mullen Scales of Early Learning. The areas of development that were studied were visual reception, fine motor, expressive language, receptive language, and total Mullen score. There were no significant differences between the study group and the general population in all 5 scores. The only prominent feature of our external hydrocephalus patients was hypotonia (transient in 9 [45%] and persistent in 2 [10%]). Although the term external hydrocephalus describes a roentgenographic presentation, the term benign enlargement of subarachnoid space is preferred in infants similar to our group by better describing the benign nature of the phenomenon in appropriately selected infants.