ASSESSING SPEECH, LANGUAGE AND COMMUNICATION IN AUTISM SPECTRUM DISORDERS

Question 1

Atypical Development associated with risk for ASD

Answer 1

Attention to people
-Social smiling
-Sharing of affect
-Joint attention

Diagnosis hard to make, but typically between 2 and 4

Question 2

Communication impairments

Answer 2

-Limited responsiveness to speech
-Delayed development of language
-Use of other’s body as a tool

Baron-Cohen (1996):
-Protodeclarative pointing
-Gaze monitoring
-Pretend play

Question 3

Frequency of Communication

Answer 3

-Children with ASD initiate less intentional communication acts at 12 months and 24 months
-Some measures (CSBS, ESCS, PCA) compute the # of bids per unit of time
-New methods with automated recordings and analysis of child vocalizations cannot record intentionality

Question 4

Functions of Communication

Answer 4

-Typically developing children use protoimperatives (acts intended to regulate other person’s action) and protodeclarative (act intended to create social interaction/joint attention) by 19 months.
-Children with ASD have a limited number of communicative functions:
-Regulatory function [requests and protests]
-Limited communication for commenting, social interaction or establishing joint attention (Mundy and Stella, 2000)

Question 5

Means of Communication

Answer 5

-Typically, children develop gaze, babbling and conventional gestures from 6-10 months (Dawnson, 98)
-Children with ASD show lower rate of babbling, often atypical preverbal vocalization (Eposito, 2013) and non-conventional means such as pulling someone’s hand.

Question 6

Responsiveness to Communication

Answer 6

-Typically, by 12 months, children respond to their names and have a receptive vocabulary of about 40 words (Chapman, 2000)
-Most children w/ASD have reduced responsiveness to their names (parents often suspect deafness)

Question 7

Spoken Language

Answer 7

-When children with ASD acquire spoken language, most do between 2 and 6 (Paul 1984; Tager-Flusberg, 2005)
-Over 70% of children with severe ASD acquire at least phrase speech by 8 years old (Wodka, 2013)
-Receptive skills tend to lag behind expressive skills, but are harder to assess (Dodd, 2014)
-Wide variety, including normal/precocious language development except for pragmaitc skills (Tager-Flusberg, 2005)

Question 8

Obtaining a Communication Profile

Answer 8

-Collecting spontaneous language sample during play, book-reading, routine or interaction
-Sometimes need ellicitation procedure:
-Tempting a child to get a toy/action/food
-Engaging in social or play routine and interrupting it
-Pretending to misunderstand, not to hear, to make a mistake
-Doing something unexpected

Question 9

Assessing Language Forms and Meanings (1)
1 2 3

Answer 9

1-Responsiveness. Decreased understanding of conversational responsibility
-Analysis: Proportion of child’s response (verbal or gesture) to adult utterances
2-Echolalia. Immediate, delayed or scripts
-Analysis: proportion of echoed to spontaneous utterances
3-Use of pronouns. Often confusion of “you” and “me”
-Proportion of inappropriate pronouns in a sample

Question 10

Assessing Language Forms and Meanings (2)
4 5

Answer 10

4-Vocabulary and syntax
-Sometimes unusual words (idiosyncracies). -Measured by token-type ratio
-Synthax often relative strength. Measure by MLU
Use SALT for vocab and synthax, for children 3 to 13
5-Standardized instruments

Question 11

Assessing Pragmatics in Spoken Language (1)
1 2

Answer 11

1-Communicative function
-Observation, checklist, structured play
-Directing others, self-directing, reporting on past and ongoing events, predicting, reasoning, empathizing, imagining, negotiating

2-Conversation management
-Observation
-Initiating, maintaining topics, ending, speaking turns, switching topics when cued, reducing perseveration, transition phrases

Question 12

Assessing Pragmatics in Spoken Language (2)
3 4 5

Answer 12

3-Flexible use of language form according to context
-Observation
-Polite forms, language and speaking tone depending on age and social status, context/situation/partner-specific vocabulary

4-Presupposition about knowledge of conversation partner
-Observation

6-Conversation manner: succint, fluid, tangential, sparse, disorganized, repetitive
-Semi-structured interactions to ellicit specific behaviors
-Ask to pretend to be mom.dad with doll, ask clarification, giving choice and handing wrong object, ask to describe a sequence and note changes

Question 13

Establishing Eligibility for Speech-Language Services (1)

Answer 13

-Normal IQ (70-80 or above)
-Advanced vocabulary and sentence structure
-Poor pragmatic and social interaction skills, with difficulty increasing with age
-Typical assessment material not adequate to capture problem
-Need specific language tests and naturalistic assessment

Question 14

Establishing Eligibility for Speech-Language Services (2)

Answer 14

–Test of Pragmatic Language (TOPL-2; 2007)
-Six core components of pragmatic language
–Comprehensive Assessment of Spoken Language (CASL-2; 2017)
-Contrasts pragmatic judgment and supra- linguistic forms with lexical and syntactic skills
–Children’s Communication Checklist-2 (CCC-2; 2006)
-Highlights discrepancy between syntactic and pragmatic skills

Question 15

Assessing Pragmatics and Prosody

Answer 15

-Impaired theory of mind, difficulty drawinf appropriate conclusions to other’s thoughts and feelings
-Feeling /expressing empathy, expressing and understanding others’ emotion
-Obsessive interests
-Hard to negotiate entry in peer activity
-Prosodic difficulties often misinterpreted by others
-Assessment in informal conversation and speech sample

Question 16

Assessing Conversational and Narrative Skills

Answer 16

-Easier with trusted and predictible adults than with peers
-Conversational interactions and checklists
-Assess ability to produce and/or interpret narratives

Question 17

AAC Assessment Considerations

Answer 17

-A significant number of people witth ASD will remain non-or minimally-verbal.
-Can be used for many communicative functions, depending on functioning level
-Need to take into account communicative frequency, functions, means and responsiveness
-Need to take into account cognitive/linguistic functioning and language capabilitites: preintentional? Presymbolic? -Preliterate? Literate stage?
-Once the child has an AAC, take into account that needs might change

Question 18

Assessment Tools for Non-Verbal Children with ASD

Answer 18

-Checklists, interviews
-Normed-reference tools not always appropriate, better to use criterion-referenced tools
-Some specific tools for non-verbal children with ASD:
1-Augmentative communication 2-Assessment Profile. 3-11. Skills related to unaided systems
Matching Assistive Technology and Child, comprehensive, includes family and most appropriate technology
…

Question 19

Planning and Monitoring Communication Intervention

Answer 19

1-Establish goals collaboratively with family and school
2-Then, in order to plan intervention, use dynamic assessment to determin which factors, modifications, support, prompts, cues, scaffolds support positive changes in communication
3-Monitor, consistently with child, family and school