The rationale for computer-based treatment of language difficulties in nonspeaking autistic children

Some principles are described which underlie a computer-based treatment method for language difficulties in nonspeaking autistic children. These children are assumed to be dissymbolic with a primary difficulty in processing any type of symbols, language being the most important symbolic system used in human communication. The main treatment principle involved the encouragement of exploratory play with a keyboard-controlled audio-visual display on which symbols can be made to appear accompanied by human-voice and other sounds. Adult interference is minimized so a child can self-select and self-direct his own play. It is reported that, thus far, 13 out of 17 nonspeaking autistic children have shown linguistic improvement. The 4 cases of failure to improve were children who refused to play with the display device.This research is supported by Grant PHS MH 06645-12 from the National Institute of Mental Health and in part, by Research Scientist Award (No. 1-K05-K-14,333) from the National Institute of Mental Health. The author expresses his deep indebtedness to co-workers Horace Enea, David Smith, Malcolm Newey, and Maxine Colby, each of whom has put years of effort into this project.     

Factors impacting on the outcomes of Greek intervention programmes for children with autistic spectrum disorders

This study explored the best predictors of the progress of children with autistic spectrum disorders (ASD), on some developmental domains (autistic severity, language, communication and socialisation), which are related to the core features of ASD. Eighty-six children (2.5–14 years old) with ASD, from 10 schools in Greece, were included in the study, and their developmental progress was assessed over a period of 9 months. The data indicated that, apart from the factors related to the child (e.g., non-verbal IQ, language, adaptive behaviour, autistic severity, behavioural problems at baseline, as well as the age that the child started treatment), which were correlated to the child's developmental progress, there are also factors in the child's environment that influence his or her developmental progress; the most important being the levels of parental stress, and the parents’ abilities to discipline their child. These findings suggested that there are some factors (age that a child starts treatment, parental stress and parents’ abilities to discipline their child) that the intervention programmes, the teachers and the parents could take into account, in order to enhance the children's gains.     

Ontogeny of communicative functions in autism

Autistic children have been stereotyped as noncommunicative and noninteractive; however, this may be partly attributed to traditional research approaches that do not consider the intentions of the child or the context of the social interaction. This discussion reviews some recent investigations that have used a developmental pragmatics framework to study language and communicative behaviors associated with autism. A working model of the ontogeny of communicative functions in autistic children is proposed. The communicative profile associated with autism is explained by factors related to the child's language-learning environment, as well as factors inherent in the child. Clinical implications for the design of language intervention programs for autistic children are offered.The author would like to extend thanks to Drs. Adriana Schuler, Carol Prutting, Robert Koegel, Richard Flower, Susan Curtiss, and Martin Glasser for their contributions to this work. This paper contains material presented at the annual convention of the American Speech-Language Hearing Association, Cincinnati, Ohio, 1983.     

Surviving Black Holes and Finding the Third Dimension,with Alex

This article discusses challenges in the treatment of a child, Alex, who is 11?years old when he begins treatment with the author. By the end of Alex’s first year of treatment, his sessions have become so deadening that his therapist often struggles to stay awake. Some days, she remains alert, but finds herself unable to feel or think. During a particularly grueling stretch, the author encounters Francis Tustin’s The Protective Shell, Tustin’s account of her psychoanalytic work with autistic children. Tustin’s ideas, when used by this author, have a transformative effect on Alex’s treatment. The author comes to understand that Alex employs autistic defenses, or protections—i.e., he is partially encapsulated. Tustin’s formulations regarding the etiology of autistic protections facilitate new possibilities for understanding and metabolizing Alex’s communications. In addition, the author grasps the importance of becoming a bolder and more active therapeutic presence with Alex.     

Brief report: Sentence comprehension strategies in children with autism and specific language disorders

Two groups of children with language disorders-one group with autism and one with relatively specific language impairment (LI)-and two groups of normal children matched to the disordered groups for mental and receptive language age were asked to act out a series of sentences. Half the experimental sentences were in active voice, and half were the same sentences given in passive voice. Within each set, events described in the sentences were probable, neutral, or improbable. Results revealed that the autistic group made little use of a semantically based probable event strategy for acting out sentences, but were likely to use a syntactically based word order strategy. The LI group was no more likely than the autistic group to use the semantic strategy, and was equally likely to use word order. Both groups resembled normals matched for receptive language age.We thank the teachers, parents, and students of the Foundation School in Orange, CT, and the Celantano School in New Haven for their cooperation in this study. We are especially appreciative of the help of Kathy Sinclair, Kathy Ayr, and Margaret Avalon. We also thank Warren Fay for his thoughtful comments during the revision process. This research was supported by grants from the NIMH Mental Health Clinical Research Center (grant #MH30929), The Children's Clinical Research Center (grant #RR00125), NICHD grant #HD-03008, the MacArthur Foundation, the Merck Foundation and Mr. Leonard Berger. Portions of this paper were presented at the Symposium for Research in Child Language Disorders, University of Wisconsin-Madison in June, 1985 and at the American Speech-Language and Hearing Association Convention, Washington, DC, in November 1985.     

Adults’ Versus Children’s Perceptions of a Child with Autism or Attention Deficit Hyperactivity Disorder

The present study examined public perceptions toward children with autism or with attention deficit hyperactivity disorder (ADHD). A convenience sample was used consisting of 30 children (7–12-year-olds) and 30 adults. Participants read a stereotyped scenario featuring either a child with autism, a child with ADHD, or a normal child. Child participants were significantly more likely than adults to (a) express dislike/avoidance toward a child described with either stereotypic autistic or ADHD behaviors, and (b) perceive the child with ADHD as unlike themselves. However, child participants and adults were equally likely to see the autistic child as unlike themselves. Reasons for the different perceptions of children and adults may include differences in perceived threat and in categorization.     

Cerebral asymmetry and the development of early infantile autism

Two experiments involving listening preferences of autistic and normal subjects were conducted to test the hypothesis that the right cerebral hemisphere is more active than the left hemisphere in autistic children. Results showed that when given a choice between verbal and musical material, the autistic children preferred music, while normal children showed no preference. Secondly, autistic children listened to both types of material predominantly with the left ear. Although normal subjects showed greater variation among themselves, they tended to listen to music more often with the left ear and to listen to verbal material more often with the right. These results support the notion that some autistic children are predominantly righthemisphere processors.This research was supported in part by a Minor Research Grant and a Summer Stipend from the Faculty of Arts, York University. Parts of this material have been presented at the 1977 meetings of the Society for Research in Child Development and the National Conference of the Canadian Society for Autistic Children. The author wishes to thank Patricia Crawford, Peter Morden, Susan B. Sussman, and Reva Tankle for their invaluable assistance on this project.     

Developmental effects in the cerebral lateralization of autistic,retarded, and normal children

This experiment was designed to determine whether increasing evidence of generalized developmental delay in early-onset psychosis was apparent at a cortical level in autistic children. Using magnitude of dominant ear advantage as an indicator of relative cerebral dominance, unwarned simple reaction time (RT) to monaural presentation of tones was investigated in matched groups of autistic, retarded, and normal children. Analysis of RTs and relative ear advantage as a function of group membership and chronological age indicated that the autistic children showed significant developmental delay in both RT and the establishment of cerebral dominance compared to the control groups. These results thus provide additional evidence of generalized maturational delay at a cortical level in early-onset psychosis, and suggest that the maturational delay of the autistic children is more extensive than the developmental deficits implied by their intellectual impairment.A preliminary version of this paper was presented at the 21st Annual Meeting of the Society for Psychophysiological Research, Washington, D.C., October, 1981. This report was prepared while the first author was a Visiting Research Fellow at Division TEACCH, Department of Psychiatry, University of North Carolina at Chapel Hill, and the second author was on sabbatical leave in the Department of Psychology, University of California at Los Angeles.     

Effects of age on communication skill levels and prevalence of maladaptive behaviors in autistic and mentally retarded children

This study investigated the effect of age on communication and maladaptive behavior in autistic and mentally retarded children. Forty-seven autistic and 128 mentally retarded children in a special school served as subjects. The cross-sectional method was used to compare junior and senior groups, and ratings on communication skills and maladaptive behaviors were obtained from teachers. We found that the skills of comprehension and conversation in autistic children improved significantly with age, and speech improved somewhat. In spite of this improvement in communication skills, maladaptive behaviors in the autistic children other than hyperactivity did not change significantly with age. Withdrawal improved significantly with age in the mentally retarded children but not in the autistic children.This study was supported in part by special grants from the Japanese Ministry of Health and Welfare for Research on Children with Abnormal Behaviors.     

A closer look at the Autism Behavior Checklist: Discriminant validity and factor structure

The psychometric properties of the Autism Behavior Checklist (ABC; Krug, Arick, & Almond, 1980a, 1980b), a 57-item screening checklist for autism was investigated. Professional Informants completed the ABC on 67 autistic and 56 mentally retarded and learning-disabled children. The autistic children were the total population of autistic children aged 6–15 in two circumscribed suburban and rural regions. Using the total score, the ABC accurately discriminated 91% of the children, with 87% of the autistic and 96% of the nonautistic group correctly classified. Moreover, the accuracy of classification was virtually identical when only the more heavily weighted checklist items were used. A 3-factor model accounted for 32% of the total variance in the checklist. Seventeen items loaded.4 or more on Factor 1, 12 items loaded on Factor 2, and 10 items loaded on Factor 3. The present results fail to provide empirical support for a single unidimensional scale for autism. Also, there is little support for subdividing the checklist into five subscales based on symptom areas.This research was supported by grant No. 6603-1202-42 from the National Health Research and Development Program of Health and Welfare Canada to the second author and a Social Sciences and Humanities Research Council of Canada Doctoral Fellowship to the first author. We thank all of the parents and children who have contributed to this research. We also thank Isabel Smith, Julia McInnes, Margaret MacKinnon Doncaster, Mary Clark-Touesnard, Leslie Donovan, and Penny Corkum for data collection.     

Sign language and autism

Research findings and issues in teaching sign language to nonspeaking autistic children are reviewed. Data on over 100 children indicate that nearly all autistic children learn receptive and expressive signs, and many learn to combine signs. These children also exhibit marked improvement in adaptive behaviors. Speech skills are acquired by fewer children and may be developed through simultaneous speech and sign training. Possible explanations for these results are given, together with suggestions for future research and data collection. Recommended innovations include exposure to fluent signers and training in discourse and code-switching. Different sign language teaching methods need to be investigated more fully, including emphasis on training sign language within the children's total environment and with greater staff and parental participation.     

Training a blind autistic child to communicate through signs

Nonverbal autistic children have been successfully trained to communicate by the simultaneous use of speech and sign language. The advantage of this approach versus speech-only techniques may lie in these children's relative preference for visual input such as manual signs. Although apparently inapplicable due to its reliance on visual cues, sign language, accompanied by speech, has been used to train deaf-blind children. In the present case signs were used successfully with a blind 10- year- old autistic girl. After 8 months of training she was able to acquire a functional sign vocabulary, relying primarily on the tactile-kinesthetic and the auditory modalities. This newly acquired skill had a beneficial impact on the child's general functioning. The relevance of simultaneous communication or signed English for the blind autistic child is discussed.This research was supported in part under National Health Research and Development project No. 606-1240-44 to Dr. M. M. Konstantareas. The authors would like to express their appreciation to Miss Krista Phillips for her dedicated work with B. K. and to Dr. Maureen Dennis for referring B. K. to us. Thanks are also due to B. K.'s parents for their enthusiasm in carrying out our suggestions in the home.     

Joint attention in preverbal children: Autism and developmental language disorder

For preverbal children, episodes of joint attention are contexts for communication with responsive adults. This study describes the joint attention of 3- to 5-year-old children, 15 with autistic disorder (AD) and 15 with developmental language disorder (DLD), during play sessions with unfamiliar adults. Adults used fewer conventional than literal bids for joint attention with AD children and vice versa with DLD children. Children with AD were less likely to engage in joint attention than children with DLD. In the allocation of attention, AD children monitored the channel of communication with the adult 37% less often than DLD children. We discuss how perturbations in reciprocal interactions permeate the sharing situation and the implications of this problem for the mastery of cultural conventions.The work reported here was supported by the National Institute of Neurologic Disorders and Stroke, U.S. Public Health Service (Program Project NS 20489, Isabelle Rapin, principal investigator) and by a grant from the Georgia State University Chancellor's Initiative Fund awarded to Lauren B. Adamson. The article is based in part on a master's thesis submitted to Georgia State University by the first author under the direction of Lauren Adamson. The authors acknowledge the contributions of committee members Roger Bakeman and Robin Morris and are grateful to Linda Eudy and Tricia Jones for their diligent coding of videotapes. An earlier version of this paper was presented as a poster at the Biennial Meeting of the Society for Research in Child Development, March 30–April 2, 1995, Indianapolis, Indiana.     

Effects of age on adaptive behavior levels and academic skill levels in autistic and mentally retarded children

This study investigated the effect of age on adaptive behavior and academic skill in autistic and mentally retarded children. Subjects were 47 autistic and 128 mentally retarded children from a special school. Cross-sectional comparisons were made between junior and senior groups using ratings obtained from teachers on adaptive behaviors and academic skills. We found that the levels of toilet training, eating skills, participation in group activities, and self-control in the autistic children improved significantly with age. The skills of number concepts in the autistic children also improved with age. However, these adaptive and academic levels were in general significantly lower than those of the mentally retarded children. The levels of initiative did not improve significantly in either the autistic or the mentally retarded children, and they were significantly lower in the autistic children. The implications of these findings in the context of our previous study on the changes of communication and maladaptive behaviors with age in the autistic children are discussed. This study was supported in part by Foundations' Fund for Research in Psychiatry Grant No. 71-500 to the principal author.     

Pragmatic impairments in adults with childhood diagnoses of autism or developmental receptive language disorder

Audiotaped conversational samples from adults diagnosed as having autistic disorders (n=15) or developmental receptive language disorders (n=17) in childhood were transcribed and analyzed using methods based on those of Bishop and Adams (1989). Subjects with autism showed substantially greater pragmatic impairment not explicable by generalized impairment of verbal skills. This was mainly due to autistic subjects' greater difficulty in forming context-relevant communicative intentions; in contrast, pragmatic impairments arising from failures in translating intentions into spoken utterances (i.e., impairments at the level of execution) did not distinguish between the groups. In both diagnostic groups, impairment in forming appropriate communicative intentions was closely related to more generalized impairment of reciprocal social behavior.The author was supported by the Bethlem Royal and Maudsley Hospital Research Fund. Lynn Mawhood very kindly provided all of the primary data and extracted the conversational samples from her recorded interviews. I also thank Dorothy Bishop, Mary Crowson, Helen Eales, and Professor Sir Michael Rutter for advice and help in various aspects of the study.     

Delay Versus Deviance in Autistic Social Behavior

The pattern of acquisition of social, communication, and daily living skills was examined for autistic children, compared to retarded and normal controls, by quantifying intradomain scatter on the Vineland Adaptive Behavior Scales. Autistic children were matched to normal children and mentally retarded children on Vineland raw scores; group differences in scatter were examined for each domain of adaptive behavior. Autistic children had significantly more scatter on Communication and Socialization than both control groups. Item analyses showed that the autistic children had particular weaknesses on items reflecting attention to and pragmatic use of language, as well as play and reciprocal social interaction; the autistic children had particular strengths on items reflecting written language and rote language skills, and rule-governed social behavior. The number of items showing consistent group differences, however, was small, suggesting that although autistic development appears sequentially deviant and not merely delayed, individual autistic children derive their scatter from different items, and are a developmentally heterogenous group.     

Vers une clinique d’un enfant autiste en classe de maternelle

In nursery schools, teachers are sometimes confronted with children presenting a large range of behavioural incongruities. Isolation, agitation, emotional discharges are not only the manifestations of some developmental differences; they are also a way to show the child’s singularity. These manifestations do not have a communicational value, so teachers are often destabilized. Either they will assimilate these symptoms to mental retardation and wait for the maturational process to go on, or they will send the child to a developmental specialist who will diagnose autism. Kanner defines autism by three key-symptoms: extreme isolation, language disorders, an urgent need for the environment not to change and stereotypical movements. Despite the variability encountered in different cases, these three signs are recognized as the basis of autism. Nowadays, research on autism is an open field and several hypotheses regarding the origins of autism have been made. Autism is now defined as a behavioural syndrome resulting from interconnected factors, of which some may be of genetic origin. The authors present the case of a child who seemed to be autistic and use a clinical observation to enlighten questions raised by autism. This article illustrates the evolution of an autistic child, Alain, who needed special efforts and an emotional investment from the teacher. The teacher had to adapt his teaching method to the child’s needs. Forgetting models and approaches, Alain’s teacher managed to teach him things that seemed impossible to teach at the beginning. She established a plan and got deeper in the relationship. Regarding Alain’s case, it seems fundamental to consider autistic children as unique persons. Despite the key symptoms that we can find in many cases, these children are all different. Being more involved helped Alain to begin to see that he was a child, just a simple child, who could live among the others and not on the fringes. Autism has been the subject of several debates about the best approach and the best single theory to understand it: but that is ideology. Autism is too complex to be reduced to one and only one approach. A unique approach will not allow us to understand the mystery of autism.     

Parent and teacher agreement in the assessment of pervasive developmental disorders

Although it is well known that informants often disagree about the degree of psychopathology in children, this issue has not been systematically evaluated in children with autism. The objective of this paper is to estimate the extent of agreement between parents and teachers on the assessment of autistic symptoms and adaptive behavior skills. We assessed 83 children, 4–6 years of age, with a diagnosis of pervasive developmental disorder (PDD), using the Autism Behavior Checklist (ABC) and the Vineland Adaptive Behavior Scales (VABS). Parents and teachers rated each child on each measure. While there was good agreement between informants on the VABS, teachers tended to rate the PDD children higher that parents. In contrast, there was virtually no agreement on the ABC. High levels of stress experienced by parents appeared to be associated with parents reporting more autistic behaviors and less adaptive skills than teachers. As with other child psychiatric disorders, caution must be exercised in combining information from several informants.This grant was supported by awards from the Ontario Mental Health Foundation, the Vellum foundation, and Health and Welfare Canada. The authors express their gratitude to the families and clinicians who participated in the project.     

Autistic children exposed to simultaneous communication training: A follow-up

Fourteen originally mute, low-functioning autistic children, exposed to intensive simultaneous communication training, were followed up 1 to 4 years later. Psychometric testing, communication assessment, and teacher and parent interviews were employed. Results showed that at least half of the children who had become verbal by program termination remained verbal at follow-up. Higher-functioning and verbal children performed overall better than their lower-functioning and mute peers. Children exposed longer to the intensive program and those exposed to good schooling after termination fared better at follow-up, as did those whose parents were more involved in their training. Yet teachers and parents employed mainly speech rather than signs to communicate with these children, despite the children's difficulty with speech. Compared to the verbal children, who recalled signs and words equally well, the mute children recalled signs better than words. The findings are discussed for their relevance to choice of communication training with different subgroups of autistic children.This research was supported in part under National Health and Development project No. 606-1240-44. The author expresses her appreciation to Mrs. Ariane Blackman for her contribution to the research. Appreciation is also expressed to Dr. Joel Oxman for his input and to Miss Soula Homatidis for the data analyses.     

The effect of social context on the functional communication skills of autistic children

This study investigated autistic children's use of attention-directing gestures and language in three different interactive situations which varied in social context factors. These behaviors were videotaped and compared in autistic children (n=15), children with developmental language delay (n=14), matched on mental age and mean length of utterance (MLU), and MLU-matched young normal children (n=13). Results supported the hypothesis that autistic children's attention-directing behavior would differ most from that of the other groups in spontaneous interactions. However, contrary to expectation, the autistic children did not produce more attention-directing behavior when a high degree of adult direction was provided. Overall, the autistic group used attention-directing behaviors less frequently than the other groups, and in the autistic group these behavors varied less across social context factors. Results are interpreted in terms of their implications for language intervention programs with autistic children.This work was supported in part by National Institutes of Health grant NS18448. The authors thank Robin McEvoy, Michelle Kelley, Belgin Tunali, and Dennis Brunt for their help in coding and data analysis.