And more...

Benítez-Barrera et al. found that when caregivers of young children with hearing loss used a remote microphone system (RMS) at home, their children were able to potentially access about 12% more child-directed speech (CDS). The RMS allowed children to access CDS that they’d otherwise miss because their caregivers were physically too far away. With an RMS running about $200 a unit, we thought it was worth bringing to your attention the potential benefit of parents using this technology in the home setting.

In a meta-analysis, Edmunds et al. found that how responsive parents of children with ASD were to their child’s communication was directly related to their child’s communication skills. They also looked at studies on responsiveness interventions, but found the evidence to be inconclusive. According to their analysis, more research is needed to conclude whether or not teaching parent responsiveness alone is enough to improve child outcomes—and if so, which ones. 

Hustad et al.  looked at development of speech intelligibility in children with cerebral palsy (CP), and the results can be used to guide decisions that we make in terms of timing of intervention. Specifically, the findings suggest that a child with CP is a good candidate for speech therapy if they do not:

  • demonstrate at least 25% intelligibility for single words by 29 months

  • demonstrate at least 50% intelligibility by 40 months

  • demonstrate at least 75% intelligibility by 58 months

And, by the age of 40 months, the authors suggest that therapy may also need to include some type of AAC system. The authors state, "Intelligibility focused therapy may still be beneficial, but as children enter a reduction in rate of growth after 5 years, progress may be slower with regard to change in speech." 

Justice et al.’s  study of language development in children from very low-income households, shows significantly lower receptive language skills in these children, much of which was found to be explained by dysregulated parent–child interactions, which is associated with parent distress.

Research gets us closer and closer to being able to really predict autism as early as possible. This study of 12-month-olds by Kadlaskar et al. found that those who end up with an autism diagnosis respond differently to caregiver touch—they’re more likely to a) not attend to the touch as a communicative act, and/or b) turn away from touch; also, their response predicts later autism severity.

We’ve discussed the topic of early regression in autism recently here, and Ozonoff and Iosif’s recent review of the research further confirms that language regression in the first year occurs for the majority of children with autism. Findings from their meta-analysis also suggest that standardized, normed checklists and questionnaires (like the Communication and Social Behavior Scales) completed by parents can be an effective way to identify lack of language development and loss of skills. 


Benítez-Barrera, C.R., Thompson, E.C., Angley, G.P., Woynaroski, T., & Tharpe, A.M. (2019). Remote microphone system use at home: Impact on child-directed speech. Journal of Speech, Language, and Hearing Research. doi: 10.1044/2019_JSLHR-H-18-0325

Edmunds, S.R., Kover, S.T., Stone, W. (2019). The relation between parent verbal responsiveness and child communication in young children with or at risk for autism spectrum disorder: A systematic review and meta‐analysis. Autism Research. doi: 10.1002/aur.2100

Hustad, K., Sakash, A., Natzke, P., Broman, A., & Rathouz, P. (2019). Longitudinal growth in single word intelligibility among children with cerebral palsy from 24 to 96 months of age: Predicting later outcomes from early speech production. Journal of Speech, Language, and Hearing Research. doi: 10.1044/2018_JSLHR-S-18-0319

Justice, L.M., Jiang, H., Purtell, K.M., Schmeer, K., Boone, K., Bates, R., Salsberry, P.J. (2019). Conditions of Poverty, Parent-Child Interactions, and Toddlers' Early Language Skills in Low- Income Families. Maternal and Child Health Journal. doi: 10.1007/s10995-018-02726-9.

Kadlaskar G., Seidl A., Tager-Flusberg H., Nelson C.A., Keehn B. (2019). Atypical Response to Caregiver Touch in Infants at High Risk for Autism Spectrum Disorder. Journal of Autism and Developmental Disorders. doi: 10.1007/s10803-019-04021-0 

Ozonoff, S. & Iosif, A. (2019). Changing conceptualization of regression: What prospective studies reveal about the onset of autism spectrum disorder. Neuroscience & Biobehavioral Reviews. doi: 10.1016/j.neubiorev.2019.03.012

And more...

Normally we try to keep this section fairly brief for you all, but holy moly there was so much research this month!

  • Bradshaw, et al. examined differences in communication and play in groups of infants at high- and low-risk for ASD. High-risk 12-month-olds who were considered “prewalkers” (who didn’t stand or walk) showed significantly lower scores on the CSBS in terms of play skills, gesture use, word use, and behavior measures such as protesting. Even though both high-risk and low-risk groups had similar numbers of prewalkers, standers, and walkers, the authors suggest their results “confirm that the lower social communication scores observed in high-risk infant prewalkers are clinically significant and suggests that these infants may be at higher risk for social communication delays.” SLPs working in the PSP model could keep this information in mind while discussing intake and evaluation plans or while reviewing quarterly updates during teaming meetings. Note: the authors caution that the participants in their study were mostly white, highly educated families, and that results may not generalize to all populations.

  • In a study of over 1200 families in poor rural regions, Burchinal et al. confirmed the presence of a large gap in school readiness skills that emerges during the first five years of life. Specifically, children who experienced poverty before the age of two had more significant delays on their language, cognitive, social, and executive functioning. Self-regulation and executive functioning skills played an important role in school readiness at age five. Check out the original article for a more in-depth analysis of the relationship between poverty & school readiness.

  • If you’re an EI therapist, you’ve most likely evaluated a child who was born premature at one time or another, so you’re also most likely familiar with the idea of age correction. You may have corrected for age on one or more assessments, but you may have also wondered if that’s best practice. And, if it is, when should we stop correcting for age? Harel-Gardassi et al. used the Mullen Scales of Early Learning (MSEL) test to see how age correction impacted the scores of preterm infants at 1, 4, 8, 12, 18, 24, and 36 months of age. Not surprisingly, corrected age scores were found to be significantly higher than chronological scores at all ages, with factors such as gestational age and birth weight affecting the level of difference between the two scores. These findings also suggest that if you use the MSEL, you should be using age correction until the adjusted age of three, not the currently recommended age of two.

  • In terms of input, the large majority of what children, including infants, are exposed to on a day-to-day basis is connected speech, while isolated words are heard infrequently and inconsistently. So, do the single words that infants are exposed to have any kind of impact on their language development? This recent study by Keren-Portnoy et al. of 12-month-olds showed that isolated words, instead of words presented at the end of an utterance, were easier for the children to recognize and remember.

  • Lim and Charlop found that speaking a child’s heritage language during play-based intervention sessions seemed to help four bilingual children with ASD play in more functional and interactive ways. The experimenters followed scripts for giving play instructions, verbal praise, and making comments related to play in both English and each child’s heritage language (in this study, Korean or Spanish). None of the children played functionally or interactively before the intervention, but all of the children showed an increase in play during and after intervention sessions in both English and the heritage language, with more impressive gains seen in heritage language sessions. More research is needed, but SLPs should keep this in mind when working with bilingual children with ASD (note: study done on older children).

  • In a qualitative study by Núñez & Hughes, Latina mothers reported higher satisfaction with early intervention services when they had bilingual support through an interpreter or bilingual SLP, received clear explanations about services and paperwork, felt the SLP respected their wishes, and were provided with strategies to work on with their children outside of SLP sessions.

  • Rague et al. found that infants with Fragile X syndrome use fewer gestures than infants at both high and low risk for ASD. Children with Fragile X who used fewer gestures tended to have lower nonverbal abilities. A lack of early gesture use in infants with Fragile X may be an indicator of the child’s broad cognitive ability.  

  • Thrum et al. found that toddlers between 18 and 24 months with language delay had significantly more socioemotional and behavioral problems compared to toddlers without language delay. At 18 months, more than half of children with language delays had scores within the range of clinical concern! These results underscore the importance of early detection & treatment for children with language delays.

  • Torrisi et al. found that toddlers’ communication scores on the Ages and Stages Questionnaire (ASQCS) were not directly associated with mothers’ diagnoses of PTSD related interpersonal violence, but communication development was affected when mothers showed more controlling behavior and were less sensitive to their toddlers. Both of these qualities of maternal behavior were also correlated with severity of PTSD symptoms. This is important information to keep in mind when providing services to families at risk for experiencing or with a history of interpersonal violence.

  • Yu, et al measured 9-month-old typically-developing infants’ attention to objects and joint attention with their parents, to tease out what exactly contributes to vocabulary growth in the first year of life. They found that sustained attention with and without joint attention predicted vocabulary size at 12 and 15 months, but joint attention alone did not predict vocabulary growth. We need more research to figure out exactly how to use this information clinically, but in the meantime, we can always continue to help caregivers make the best use of their children’s interest and attention during play to support vocabulary growth.

 

Bradshaw, J., Klaiman, C., Gillespie, S., Brane, N., Lewis, M., & Saulnier, C. (2018). Walking ability is associated with social communication skills in infants at high risk for autism spectrum disorder. Infancy. Advance online publication. doi: 10.1111/infa.12242.

Burchinal, M., Carr, R.C., Vernon-Feagans, L.V., Blair, C., Cox, M. (2018). Depth, persistence, and timing of poverty and the development of school readiness skills in rural low-income regions: Results from the family life project. Early Childhood Research Quarterly, 45, 115–130.

Harel-Gadassi, A., Friedlander, E., Yaari, M., Bar-Oz, B., Eventov-Friedman, S., Mankuta, D., & Yirmiya, N. (2018). Development assessment of preterm infants: Chronological or corrected age? Research in Developmental Disabilities, 80, 35–43.

Keren-Portnoy, T., Vihman, M., & Lindop Fisher R. (2018). Do infants learn from isolated words? An ecological study. Language Learning and Development. Advance online publication. doi: 10.1080/15475441.2018.1503542.

Lim, N. & Charlop, M. H. (2018). Effects of English versus heritage language on play in bilingually exposed children with autism spectrum disorder. Behavioral Interventions. Advance online publication. doi: 10.1002/bin.1644.

Núñez, G., & Hughes, M. T. (2018). Latina mothers’ perceptions and experiences of home-based speech and language therapy. Perspectives of the ASHA Special Interest Groups, 14(3), 40–56.

Rague, L., Caravella, K., Tonnsen, B., Klusek, J., & Roberts, J. (2018). Early gesture use in fragile X syndrome. Journal of Intellectual Disability Research, 62(7), 625–636.

Thurm, A., Manwaring, S.S., Jimenez, C.C., Swineford, L., Farmer, C., Gallo, R., Maeda, M. (2018). Socioemotional and behavioral problems in toddlers with language delay. Infant Mental Health Journal, 38(5), 569–580. 

Torrisi, R., Arnautovic, E., Pointet Perizzolo, V. C., Vital, M., Manini, A., Suardi, F., …, & Schechter, D. S. (2018). Developmental delay in communication among toddlers and its relationship to caregiving behavior among violence-exposed, posttraumatically stressed mothers. Research in Developmental Disabilities. Advance online publication. doi: 10.1016/j.ridd.2018.04.008.

Yu, C., Suanda, S. H., & Smith, L. B. (2018). Infant sustained attention but not joint attention to objects at 9 months predicts vocabulary at 12 and 15 months. Developmental Science. Advance online publication. doi: 10.1111/desc.12735.

We can’t catch ‘em all; or can we?

Have you ever worked with one of those “quirky” children and thought, “I wonder how he’ll do later?” I mean, sometimes a quirk is just that, but how do we know when a quirk is something more? And why does it matter? Well, we know that early identification (for purposes of securing early intervention) is important for children with autism. But the false-negative rate from screening might be as high as 60% in some cases. That means that some children with autism are not being caught before school age, either because their symptoms aren’t that bad, or the skills they do have are compensating for the deficits. Without a crystal ball, what can we do for those kids who would otherwise fall through the cracks? The authors of this study looked to compare results of the Autism Diagnostic Interview-Revised (ADI-R) in two groups of children with ASD: early diagnosed (before age 5), and late diagnosed (after age 5).

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They found no statistically significant difference between groups in Autism Diagnostic Observation Schedule (ADOS) scores or ADI-R scores, although the early diagnosed group had marginally worse communication scores and more often flagged on items such as “used another’s body to communicate”, repetitive use of objects/parts of objects, and pronominal reversal (when children use "he", "she", "you", or their own name instead of “I” or “me”). The later diagnosed group had fewer symptoms and better communication, but again these differences were marginal.

The authors also found some trends between groups in terms of demographics. Children who were Hispanic, of racial minority, had an additional diagnosis such as ADHD, and/or had higher verbal and full-scale IQs were significantly more likely to be diagnosed later.

Now, if you forget the rest of this review, remember this part: in comparing individual items from the ADI-R, there were five symptoms that ALL of the later-diagnosed children displayed. “Deficits in:

  • reciprocal conversation
  • offering to share
  • imaginative play with peers
  • social verbalization/chatting and
  • showing/directing attention.”

What is interesting about these symptoms is that they were all negative. In other words, kids diagnosed later seemed to “not do” stuff they should have, rather than do extra stuff that would raise a concern (like flapping or showing repetitive interests). The authors suggest that “attention to deficits in these behaviors may facilitate earlier identification of ASD without other obvious impairments.” Completing or referring for a more formal assessment when you notice a child has these symptoms could make a difference in outcomes for these children.

*Note: some skills, like being able to have a back-and-forth conversation, aren’t a major concern if toddlers haven’t quite mastered them, but if a child is still demonstrating these deficits by preschool, make that referral!

Goodwin, A., Matthews, N. L., & Smith, C. J. (2018). Parent-reported early symptoms of autism spectrum disorder in children without intellectual disability who were diagnosed at school age. Autism. Advance online publication. doi: 10.1177/1362361318777243

Screening for ASD? There’s an app for that!

Screening for autism in early intervention. From 16–30 months, we have the M-CHAT-R. What do you use beyond 30 months? The SRS-2 is an option now, but there is not a lot of research on how well it works yet. The SCQ starts at 4 years. And all of those are completed through parent report.

What if we had a screener that combined parent report with objective measurement, that could be administered on a parent’s smart phone? Enter Cognoa!

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This two-part screener, intended for ages 18–72 months, is contained in a mobile app. Parents answer 15 questions (similar to the M-CHAT-R or SCQ), and then are prompted to record 1- to 2-minute videos of their children in everyday interactions. The questionnaire is scored immediately, and the videos are reviewed by experienced clinicians for a rating score. All of those scores go into algorithms (yay technology) to determine level of risk. Results are then sent to the family, physician, EI team, etc. Kanne, et al. evaluated Cognoa against other screening measures like the M-CHAT-R, SCQ, SRS, and CBCL and found it to be comparatively sensitive and more specific than those screenings. In other words, Cognoa correctly flagged for ASD evaluation as well as the screenings we already use, and it had fewer false positive screenings. Not bad! Unfortunately, there is a downside. Currently, Cognoa is only really available for parents whose employers buy access to the screenings as a health incentive to their employees. In the meantime, we might have to stick with the measures we already know, but keep your eyes and ears peeled in case this app picks up steam!

 

Kanne, S. M., Carpenter, L. A., & Warren. Z. (2018). Screening in toddlers and preschoolers at risk for autism spectrum disorder: Evaluating a novel mobile-health screening tool. Autism Research. Advance online publication. doi: 10.1002/aur.1959

 

Hey, wait! This isn’t the only article on autism screening tools found this month! Janvier et al. found that a simple picture-based developmental checklist could successfully differentiate children with and without ASD among low-income, minority families. This screening tool, The Developmental Check In, may be a useful way to screen for autism among underserved children, particularly when parents are not native English speakers.

 

Janvier, Y.M., Coffield, C.N., Harris, J.F., Mandell, D.S., & Cidav, Z. (2018). The Developmental Check-In: Development and initial testing of an autism screening tool targeting young children from underserved communities. Autism. Advance online publication: doi: 10.1177/1362361318770430

Parents' role in the identification of early signs of autism

There have been many advances in the early identification of autism in recent years, but did you know that the average age of diagnosis is still around 4 years old???!!!. I’m sure you’re thinking the same thing that I am—We need to do better than that!

When it comes to early identification of autism, previous research has shown that one way we can make sure we’re getting all of the information needed to make a well-informed decisions is by including more than one person’s input in the process. And, if we’re talking about the birth to 3 population and we’re talking about autism, we naturally think of including the parent, right? Many of the well-known, most frequently-used screening tools for identifying early signs of autism and communication delays are designed to be completed by the parent, or at least include a parent questionnaire component (think: M-CHAT and CSBS DP).

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But, exactly how should we be using parent input? Should we be putting more or less weight on our clinical observations? When we’re talking about children under two, how accurately is a parent able to identify the early signs of ASD compared to an experienced clinician? If you’ve wondered these same kinds of things, I have some good news for you: the results from this study help to clarify the role that parents play in the early identification of autism. 

This study included 188 siblings of children with ASD and their primary caregivers. Parents completed the Autism Parent Screen for Infants [APSI], and SLPs completed the corresponding Autism Observation Scale for Infants [AOSI] when the children were 12 months, and then again at 18 months. Parent response to the 19 items included in both the APSI and the AOSI (e.g., vocalizing back and forth, showing interest and pleasure, imitating, eye contact) were compared to the clinicians’ responses. And, the results were not only interesting, but also extremely informative: parents identified more behaviors on the APSI that differentiated children diagnosed with ASD from typically-developing children compared to clinicians’ identification of behaviors on the AOSI.

So, based on this information, when it comes to early identification of autism, we really should be viewing parents as a first line of defense. The setting as well as the context of our assessments limit our ability to get all of the information. We need to rely on parents to help us fill in the gaps, adding specificity and depth to our understanding of the developing communication skills of children under 18 months of age. Now more than ever, we need to see parents as our allies, and as key contributors to the assessment process.

Sacrey, et al., (2018). Parent and clinician agreement regarding early behavioral signs in 12- and 18-month-old infants at-risk of Autism Spectrum Disorder. Autism Research, 11(3), 539–547.

Throwback Pub (2008): Early gestures to predict vocabulary

Note: This study was part of a larger longitudinal study, information available here.

Wouldn’t it be fantastic if we could screen infants at 8 months and predict later development? This study looked at gesture and object use at 8 months, then followed up at ages 1;0 and 2;0 to determine whether later vocabulary can be predicted by early gesture and object use. The authors mailed out questionnaire packages to 1,477 families when their children were ages 0;8, 1;0, and 2;0. The Macarthur-Bates Communicative Development Inventories (CDI) were included in the packet, the CDI Words and Gestures (CDI:W&G) was completed for the first two data collections, and the CDI Words and Sentences (CDI:W&S) was completed at the 2-year mark.

In addition to measuring gestures to predict vocabulary use, the authors also examined the effects of SES and gender on vocabulary. Here’s what they found:

  • Gestures at 0;8 didn’t predict vocabulary (at 2;0) all that well. But gestures at 1;0 year did. Also, gestures predicted 2;0 vocabulary comprehension better than production.
  • Girls produced more words than boys at 1;0 and 2;0, but there were no differences between boys and girls in comprehension
  • Children in the two higher SES groups (there were 5 groups total) reportedly understood fewer words than the children in the lower SES groups. And children in the second lowest SES group were reported to produce more words than children in the higher SES groups

Remember that these fun facts were all based on the CDI, which relies on parent report. So how can we use this information? The authors suggest that parent estimation of their children’s skills may differ by SES; that is, families in lower SES backgrounds may overestimate their children’s abilities, or families from higher SES backgrounds may underestimate their children’s knowledge. This is something to keep in mind when many of our assessments in EI are based, in some capacity, on parent report.

 

Bavin, E. L., Prior, M., Reilly, S., Bretherton, L., Williams, J., Eadie, P., ... & Ukoumunne, O. C. (2008). The early language in Victoria study: Predicting vocabulary at age one and two years from gesture and object use. Journal of Child Language35(3), 687-701.