Assessing the speech and language of children with autism

Two studies this month address communication assessment of children with autism spectrum disorders (ASD). One study focuses on evidence-based speech assessment, and a second study provides support for examining language at the discourse level.

SPEECH: Broome et al. reviewed 21 studies on speech assessment for children with ASD. The authors initially identified 116 articles, but a large number of those studies referred too generally to the speech characteristics assessed (e.g. “vocalizations,” “verbalizations,” “babble”), and were therefore excluded. Then, the authors reviewed the participant-specific information in the remaining studies, and included only those in which they were confident about the children’s ASD diagnoses. The authors then grouped children from the remaining 21 studies into two groups: 1) prelinguistic communicators and 2) communicators using words in order to attempt to draw conclusions.

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The researchers found that, across the literature, teams used a wide variety of assessment tasks and reporting standards, with heterogeneous participants. Due to these dissimilarities, the authors were unable to identify trends, and propose going back to methods proven for “speech assessment of a more general pediatric population.” Thus, in order to do your best at implementing evidence-based speech assessment, you’ll have to apply those methods the best you can to children with ASD.

The authors propose a set of guidelines for speech assessment for children with ASD, summarized as a checklist (see article Table 4). This checklist condenses the core components of assessment so that you can quickly determine how to collect data (think oral motor assessment, connected speech sample, stimulability testing, etc.) and how to analyze that data (think phonetic repertoire, syllable shape analysis, stress pattern analysis, and more), specific to whether you’re assessing a prelinguistic child or a verbal child. This checklist could be very handy both when preparing to collect data, as well as when analyzing and reporting the data.

LANGUAGE: Volden et al. make the case for assessing language “beyond sentences”, using narratives, so that we can better evaluate high-level language skills that might be overlooked when we assess school-aged children with ASD at the word or sentence level.

Within a larger sample of children with ASD from a multisite longitudinal study, the researchers examined 74 eight- and nine-year-olds’ performance on the Expression, Reception, and Recall of Narrative Instrument (ERRNI) and the Clinical Evaluation of Language Fundamentals–4 (CELF). Using 1.5 standard deviations below the mean as a cutoff for identifying “clinical concern”, the researchers found that 58% of the sample would be identified using both the ERRNI and the CELF, as compared to 53% that would be identified using the ERRNI alone, or 20% of the sample that would be identified using the CELF alone (whoa!) A similar pattern was noted when using 2 standard deviations below the mean as a cutoff (e.g. 41% of the sample would be identified using both tests, whereas 36% would be identified using only the ERRNI, and 14% would be identified using only the CELF).

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A caveat: this study’s sample included “intellectually able eight- and nine-year-olds with ASD who have age-appropriate word- and sentence-level syntactic and semantic skills.” Thus, this is a restricted portion of the larger population of children with ASD. Nonetheless, the takeaway is powerful—that we should think about assessing more broadly than a sentence-level language assessment like the CELF, and look at the discourse level. The authors suggest that a narrative-based test, like the ERRNI, should be used in conjunction with pragmatic assessment and a language sample.

 

Broome, K., McCabe, P., Docking, K., & Doble, M. (2017). A systematic review of speech assessments for children with Autism Spectrum Disorder: Recommendations for best practice. American Journal of Speech-Language Pathology, 26, 1011–1029.

Volden, J., Dodd, E., Engel, K., Smith, I. M., Szatmari, P., Fombonne, E., … Duku, E. (2017). Beyond sentences: Using the Expression, Reception, and Recall of Narratives Instrument to assess communication in school-aged children with autism spectrum disorder. Journal of Speech, Language, and Hearing Research, 60, 2228–2240.