Important Predictors of Language Development for a Young Child on the Autism Spectrum
Contributed by Kristie Brown Lofland, M.S., CCC-A
Like autism, there is a continuum or spectrum of approaches in teaching or enhancing communication in children on the autism spectrum. When trying to determine what approach works best for communication development, there are to date, no controlled research studies that compare one type of approach to another. At this point in time, we do not know what works “best.” We do have considerable research data suggesting that intensive ABA and Verbal Behavior Therapy can be quiet effective for many, but not all, young children on the spectrum. We also have increasingly hard evidence to suggest that some of the eclectic approaches can also be effective for some children. However, we know very little about the effectiveness of any of these interventions for older children on the autism spectrum. (Bopp, Smith, Mirenda, 2006).
There are a large number of different intervention models, including so called “name-brand” programs that have been developed to treat children with ASD (e.g., RDI, DIR, Verbal Behavior, etc.). When selecting an intervention model, the supportive research for the intervention is rarely considered when choosing an intervention practice. Likewise, when a research-based intervention is chosen, the intervention practice is not conducted with consistency or fidelity and therefore, the practices are modified significantly and thus, decreases the effectiveness.
The average number of individual treatments currently used by parents is seven. Interestingly, the treatment provider that is used most often is a Speech-Language Pathologist (SLP). (Bopp, Smith, Mirenda, 2006). Regardless of what “type” of intervention is selected for the child, the SLP is most likely on the team and has the unique opportunity to make a contribution to any treatment program.
What does the current research tell us about these interventions and how do families make an informed decision about what is right for their young child with autism? What skills should be targeted and why? Do we know what predicts language outcomes?
We know that social communication is a core feature of autism. We also know that young children with autism demonstrate delays in receptive and expressive language although the extent of the delay varies across individuals. There is a tendency for children on the autism spectrum to have better expressive language than receptive language skills on formal measures or by parent report, though the exact reason for this remains unknown and research in this area continues (Hurley et al, 2010). The diagnosis of autism is predictive of later receptive but not expressive language functioning (Thrum, Lord, Lee, & Newschaffer, 2007; Weismer, Lord, Esler, 2010). Knowing this information, it is necessary to examine the individual differences among young children with autism and look at how the differences affect development over time.
Individual differences of young children with autism that can be considered “predictors” of outcomes are cognitive ability, the age of the child at the start of intervention, and the severity of the autism. However, these differences tell us little about which skills to target in order to improve treatment efficacy (Bopp, Smith, Mirenda, 2006). Recent research indicates that there are treatable skills that will effect communication outcomes: object imitation (Ingersoll & Schreibman, 2006), motor imitation (Stone & Yoder, 2001), verbal imitation (Sallows & Graupner, 2005; Smith Zaidman-Zait, & Mirenda, 2005), joint attention (Charman et al., 2003) early gestures (Brady, Marquis, Fleming & McClean, 2004), early language and nonverbal skills (Szatmari, Bryson, Boyle, Streiner, & Duku, 2003), and synchronized behavior with caregivers (Siller & Sigman, 2002).
Longitudinal research in the predictors of communication development indicated that more joint attention and responsive parental involvement with children at ages 1-2 predicted the child’s grammatical development at age 2-7. In addition, increased responsiveness to joint attention and increased imitation at 20 months predicted increased levels of receptive but not expressive language at 42 months (Charman et al., 2003). Stronger motor imitation skills at age 2 predicted better expressive language outcomes at age 4, over and above the effects of their initial language levels (Stone & Yoder, 2001). Higher levels of synchronized and undemanding utterances from parents in preschool predicated significant gain in language and communication skills over 16 years (Siller & Sigman, 2002). More non-verbal communicative interactions observed at age 2 predicted language, communication, and social development at age 7 (Charman et al., 2005). Play development (functional and pretend) predicts receptive and expressive language in young children with autism (Pry Peterson, & Baghdadli, 2009; Weismer, Lord, Esler, 2010).
So what are the implications of the longitudinal research? It appears that treatments focused on imitation (verbal and non-verbal), joint attention, gesture use, pointing, requesting behaviors, rate of communication, play skills and parent-child responsivity, and the use of undemanding utterances, or comments, may improve the outcomes of children with autism over time. What about other child characteristics that predict development in young children with autism such as acting-out behaviors, eating behaviors, stereotypic behaviors, social unresponsiveness, and inattentiveness? What does research say about these characteristics and their influence on communication development?
In a study conducted by Bopp in 2006, children who had more problems with acting-out behaviors made more progress in expressive vocabulary, expressive language, and social skills. Could it be that some, if not most, acting out behaviors are an indication of underlying communicative and social skills, rather than simply being behaviors that can interfere with development?
In the same study, children whose eating behavior improved over the first six months of intervention made more progress on social skills. The interpretation was that eating difficulties were primarily stereotypic behaviors related to eating. Therefore, children with more stereotypic behaviors made less progress with social skills. Children whose stereotypic behavior decreased made more progress with overall cognitive development and made more progress on expressive language and daily living skills. Past research has demonstrated that interventions that focused on pre-linguistic socio-communicative skills promoted social and language development over time. However, these interventions had little effect on changes in stereotypic behaviors. Stereotypic behaviors compete against the acquisition of language and social skills.
Children with more involved issues with inattentive behavior made less progress on receptive and expressive vocabulary, expressive language, social skills, and daily living. Children whose inattentive behavior decreased over the first year of intervention made more progress on expressive vocabulary over two years.
How does this research impact what intervention we should choose? Let’s go back to our list. It appears that treatments focused on improving:
• Imitation (verbal/non-verbal)
• Joint attention
• Gesture use
• Declarative pointing
• Requesting behavior
• Rate of communication
• Play skills
• Parent-child responsivity and the use of undemanding utterances
AND decreasing …
• Stereotypic behaviors
• Inattentive behaviors
AND understanding the meaning behind acting out behaviors may improve the outcomes and communication of young children with autism over time.
Bopp, K.D. (2006). Behaviour predictors of child development and parenting stress trajectories of children with autism (Doctoral dissertation. University of British Columbia, 2006). Dissertation Abstracts International, in press.
Bopp, K.D., Brown, K.E., & Mirenda, P. (2004). Speech-language pathologists’ role in the delivery of positive behavior support of individuals with developmental disabilities. American Journal of Speech-Language Pathology, 13, 5-19.
Brady, N.C., Marquis, J., Fleming, K., & McLean, L. (2004). Prelinguistic predictors of language grouth in children with developmental disabilities. Journal of Speech, Language, and Hearing Research, 47, 663-677.
Charman, T., Baron-Cohen, S., Swettenham, J., Baird, G., Drew, A. & Cox, A. (2003). Predicting language outcome in infants with autism and pervasive developmental disorder. International Journal of Language and communication Disorders, 38, 265-285.
Charman, T. & Swettenham, J. (2001). Repetitive behaviors and social-communicative impairments in autism: Implications for developmental theory and diagnosis. In J.A. Burack, T. Charman, N. Yirmiya, & P.R. Zelazo (Eds.), The development of autism: Perspectives from theory and research. Mahwah, New Jersey. Lawerence Eribaum Associates.
Chareman, t., Taylore, E., Cockerill, H., Brown, J. & Baird, G. (2005). Outcome at 7 years of children diagnosed with autism at age 2: Predictive validity of assessment conducted` at 2 and 3 years of age and pattern of symptom change over time. (2006). Journal of Child Psychology and Psychiatry, 46. 500-512
Thurm, A., Lord, C., Lee, L., Newschaffer,C. (2007). Predictors of language acquisition in preschool children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 37. 1721-1734.
Weismer, S. E., Lord, C. , Esler, A. (2010). Early language patterns of toddlers on the autism spectrum compared to toddlers with developmental delay. Journal of Autism and Developmental Disorders, 40, 1259-1273.