Early Predictors of Communication Development in Young Children with Autism Spectrum Disorder: Joint Attention, Imitation, and Toy Play

This study investigated the unique contributions of joint attention, imitation, and toy play to language ability and rate of development of communication skills in young children with autism spectrum disorder (ASD). Sixty preschool-aged children with ASD were assessed using measures of joint attention, imitation, toy play, language, and communication ability. Two skills, initiating protodeclarative joint attention and immediate imitation, were most strongly associated with language ability at age 3-4 years, whereas toy play and deferred imitation were the best predictors of rate of communication development from age 4 to 6.5 years. The implications of these results for understanding the nature and course of language development in autism and for the development of targeted early interventions are discussed.     

Symbolic Play in School-Aged Minimally Verbal Children with Autism Spectrum Disorder

Few interventions exist for school-aged minimally verbal children with autism spectrum disorder (ASD). Even though play skills are associated with children’s production of language, few studies have focused on play for minimally verbal children. Fifty-eight minimally verbal children with ASD received a naturalistic developmental behavioral intervention. Children were randomized to receive a speech generating device in the context of the intervention or not. Children in both conditions improved in play skills at exit. Children demonstrated an increase in play skills in proximal (sessions) and distal (during blind assessment) contexts. Minimally verbal children with ASD can improve their play skills within a targeted intervention. Increases in symbolic play were associated with increases in expressive language skills.     

The effect of context on imitation skills in children with autism

Children with autism exhibit deficits in imitation skills. Previous authors have suggested that they may have particular difficulty imitating in natural social interactions, but properly controlled experiments investigating this possibility have not been conducted. To investigate this possibility, children with autism and typically developing children were compared on a series of imitation tasks presented either in a structured-elicited or naturalistic-spontaneous condition. Modeled actions were counterbalanced across conditions. Results suggest children with autism imitated less than typically developing children overall; however, this difference was mainly evident when the imitation task was presented in a spontaneous context. In addition, they exhibited less coordinated joint attention during imitation than the typically developing children. These findings support the hypothesis that children with autism are particularly impaired in their ability to imitate spontaneously.     

Brief Report: An Exploratory Study of Lexical Skills in Bilingual Children with Autism Spectrum Disorder

Studying lexical diversity in bilingual children with autism spectrum disorders (ASD) can contribute important information to our understanding of language development in this diverse population. In this exploratory study, lexical comprehension and production and overall language skills were investigated in 14 English-Chinese bilingual and 14 English monolingual preschool-age children with ASD. Results indicated that both groups had equivalent scores on all but one measure of language and vocabulary, including English production vocabulary, conceptual production vocabulary, and vocabulary comprehension. When comparing the two languages of bilingual participants, there were no significant differences in production vocabulary size or vocabulary comprehension scores. The results provide evidence that bilingual English-Chinese preschool-age children with ASD have the capacity to function successfully as bilinguals.     

Exploring individual trajectories of social communicative development in toddlers at risk for autism spectrum disorders

Whilst impairments in joint attention, imitation, and pretend play are well documented in children with autism spectrum disorder (ASD), the developmental trajectories of these symptoms remain unknown. The main objective was to explore these trajectories in a sample of children at risk for ASD between the ages of 2 and 4 years. After screening positive for ASD, 17 children were prospectively followed with 6-monthly assessments of social communicative skills and general development. During this study, 9 children were diagnosed with ASD. Results showed that there was growth in imitation skills and in pretend play ability. Also, a slightly increased amount of initiation of joint attention was noted. However, the quality of joint attention behaviours did not significantly improve and growth rates did not significantly differ between children with ASD and non-ASD cases. There was a great intra-individual variability, especially in the performances on the imitation tasks. Also interindividual variability was apparent: some children with ASD showed a delayed development of imitation or pretend play, whereas others had a more clearly deviant developmental profile. The importance of looking at individual trajectories and variability in the study of social communicative development in children with ASD is discussed.     

Teaching caregivers to implement video modeling imitation training via iPad for their children with autism

Children with autism fail to imitate from an early age and this lack of imitation is a salient diagnostic marker for the disorder. For children with Autism Spectrum Disorder (ASD), increased imitation skills appear to be related to increased skill development in a variety of areas. Video modeling was recently validated as a technique to support imitation acquisition in young children with autism. The purpose of this research was to determine if there is a functional relation between caregiver implemented Video Modeling Imitation Training (VMIT) via iPad and increased imitation skills in young children with autism. In addition, a secondary analysis of language development after exposure to VMIT was also conducted. A multiple baseline design across four caregivers and their children with autism was implemented. Results indicated that all four caregivers were able to successfully create video models on an iPad when provided with minimal training and implement VMIT with fidelity for their children. All four children made substantial gains in their imitation skills during caregiver implemented treatment. Imitation skills maintained post treatment and, to varying degrees, generalized to imitation of live models. Expressive language skills increased to varying degrees for all participants.     

Imitation and language abilities in adolescents with Autism Spectrum Disorder without language delay

Introduction Difficulties imitating gestures have been found in several studies in children and adolescents with Autism Spectrum Disorders (ASD). It has been hypothesized that imitation abilities might be precursors of language abilities in young children with autism. No study on imitation and language abilities in adolescents with ASD has been performed to date. Methods Fifteen male adolescents with ASD, 16 male and 13 female controls were compared regarding imitation abilities of upper and lower facial movements, and language skills as assessed by the pragmatic rating scale and the Aachen Aphasia test (AAT). Results Autism Spectrum Disorder subjects showed reduced imitation abilities of facial movements and non-meaningful combined hand-and-finger gestures. Regarding language, ASD subjects showed difficulties in AAT spontaneous speech measures and reduced pragmatic language abilities. Correlations of imitation and language measures differed between ASD, male and female controls. Conclusion The weak and differential correlations of imitation and language measures in the three comparison groups might imply a differential organization of language and imitation networks in the three comparison groups. Pragmatic abilities, which are a central feature in ASD, were not related to imitation abilities. Therefore, imitation and language abilities in ASD might not be as closely correlated as previously expected. An erratum to this article is available at .     

Autism severity and motor abilities correlates of imitation situations in children with autism spectrum disorders

Impaired performance in a range of imitation tasks has been described in children with autism spectrum disorders (ASD) and several underlying mechanism have been suggested. This study examined whether imitation abilities are related to autism severity and to motor skills. Furthermore, the performance of children with ASD in four imitation situations (body movements and ‘action on objects’, using meaningful and non-meaningful tasks) was compared. Twenty-five children aged 32–51 months diagnosed with autism (23) and ASD (2) were evaluated for autism severity using the Autism Diagnosis Observation Schedule and for gross and fine motor skills using the Peabody Developmental Motor Scales. Controlling for cognitive level, imitation abilities in all four situations correlated significantly only with autism severity measures and mostly with socio-communication deficits. Motor abilities were below average and did not correlate with imitation abilities nor with autism severity. Comparison of the four imitation situations revealed that performances of meaningful actions were better than non-meaningful actions and imitation of ‘action on objects’ was better than imitation of body movements. The current research supports the fact that socio-communication deficits and not motor abilities are linked to imitation abilities in young children with autism.     

Teaching Reciprocal Imitation Skills to Young Children with Autism Using a Naturalistic Behavioral Approach: Effects on Language, Pretend Play, and Joint Attention

Children with autism exhibit significant deficits in imitation skills which impede the acquisition of more complex behaviors and socialization, and are thus an important focus of early intervention programs for children with autism. This study used a multiple-baseline design across five young children with autism to assess the benefit of a naturalistic behavioral technique for teaching object imitation. Participants increased their imitation skills and generalized these skills to novel environments. In addition, participants exhibited increases in other social-communicative behaviors, including language, pretend play, and joint attention. These results provide support for the effectiveness of a naturalistic behavioral intervention for teaching imitation and offer a new and potentially important treatment option for young children who exhibit deficits in social-communicative behaviors.     

Developmental Correlates of Different Types of Motor Imitation in Young Children with Autism Spectrum Disorders

This study used a concurrent correlational design to examine associations between three types of motor imitation with objects and three proposed correlates in 32 two- and three-year-old children diagnosed with ASD. Attention-following and fine motor ability were significant, unique correlates of imitation in an observational learning context. Attention-following was a significant correlate of imitation in a direct elicitation context. Social reciprocity was a significant correlate of imitation in an interactive play context. These associations were observed after controlling for general developmental level. Results support previous findings that motor imitation may not reflect a unitary construct for children with ASD and that different skills may underlie the performance of different types of motor imitation. Implications for interventions targeting motor imitation are discussed. This research was supported by NICHD Grant R21 HD42437 to Dr Wendy Stone.     

Meta-analysis of receptive and expressive language skills in autism spectrum disorder

Clinical anecdotes suggest that children with autism spectrum disorder (ASD) often show an atypical language profile in which expressive language exceeds receptive language competency. However, the few studies to directly explore this language profile have yielded inconsistent findings. This meta-analysis examined 74 studies that reported the receptive and expressive language performances of children and youth with ASD. Four potential predictors (age, language domain, source of language data, method of ASD diagnosis) were separately analyzed for their contribution to the relative receptive and expressive language impairment in ASD. Contrary to popular belief, the current meta-analyses found no evidence that an expressive advantage is common in ASD. Overall, children and youth with ASD showed equally impaired receptive and expressive language skills, both falling roughly 1.5 SD below peers with typical development. No discrepancies were found in receptive and expressive language across developmental stages, cognitive abilities, vocabulary, global language skills, caregiver report measures, clinician-administered measures, mixed method measures, or method of ASD diagnosis. Although some individual children with ASD may have an expressive-better-than-receptive language profile, this profile is not common enough to be a useful marker of ASD.     

Brief Report: Effect of a Focused Imitation Intervention on Social Functioning in Children with Autism

Imitation is an early skill thought to play a role in social development, leading some to suggest that teaching imitation to children with autism should lead to improvements in social functioning. This study used a randomized controlled trial to evaluate the effect of a focused imitation intervention on initiation of joint attention and social-emotional functioning in 27 young children with autism. Results indicated the treatment group made significantly more gains in joint attention initiations at post-treatment and follow-up and social-emotional functioning at follow-up than the control group. Although gains in social functioning were associated with treatment, a mediation analysis did not support imitation as the mechanism of action. These findings suggest the intervention improves social functioning in children with ASD.     

Promoting Imitation in Young Children with Autism: A Comparison of Reciprocal Imitation Training and Video Modeling

The inability to imitate is a salient diagnostic marker for autism. It has been suggested that for children with autism, imitation may be a prerequisite skill that can assist in the development of various skills. Using a multiple baseline design across subjects, the purpose of this research was to determine if two interventions, reciprocal imitation training and video modeling were effective in promoting imitation acquisition in young children with autism. Six boys were matched across various features (i.e., age, language, autism severity) and randomly placed in a treatment condition. Results indicated that all six participants increased their imitation skills to varying degrees in both conditions, and imitation maintained and generalized at higher than baseline levels post treatment.     

Early Social,Imitation, Play,and Language Abilities of Young Non-Autistic Siblings of Children with Autism

Studies are needed to better understand the broad autism phenotype in young siblings of children with autism. Cognitive, adaptive, social, imitation, play, and language abilities were examined in 42 non-autistic siblings and 20 toddlers with no family history of autism, ages 18–27 months. Siblings, as a group, were below average in expressive language and composite IQ, had lower mean receptive language, adaptive behavior, and social communication skills, and used fewer words, distal gestures, and responsive social smiles than comparison children. Additionally, parents reported social impairments in siblings by 13 months of age. These results suggest that the development of young non-autistic siblings is affected at an early age and, thus, should be closely monitored, with appropriate interventions implemented as needed.     

Autonomic Arousal to Direct Gaze Correlates with Social Impairments Among Children with ASD

The present study investigated whether autonomic arousal to direct gaze is related to social impairments among children with autism spectrum disorder (ASD). Arousal was measured through skin conductance responses (SCR) while the participants (15 children with ASD and 16 control children) viewed a live face of another person. Impairments in social skills was assessed with the Developmental, Dimensional and Diagnostic Interview. The level of arousal enhancement to direct gaze in comparison to arousal to faces with averted gaze or closed eyes was positively associated with impairments in social skills (use of language and other social communication skills and use of gesture and non-verbal play) among children with ASD. There was no similar association among children without ASD. The role of arousal-related factors in influencing eye contact behaviour in ASD is discussed.     

Symbolic Play of Preschoolers with Severe Communication Impairments with Autism and Other Developmental Delays: More Similarities than Differences

Children with autism are often described as having deficient play skills, particularly symbolic play. We compared the play of 35 children with autism to 38 children with other developmental delays. All children were preschool-age and produced less than 20 different words. Results indicated no significant differences across the two groups in their play. Children with autism engaged in more conventional play, that is, putting objects together according to how the toys were constructed (e.g., pieces in a puzzle, lid on a teapot). Results also indicated high correlations between play, language, and cognitive measures. Findings indicate that play relates to language and cognitive levels yet may not discriminate children with autism and children with other developmental delays early in their development.     

A brief report: Quantifying and correlating social behaviors in children with autism spectrum disorders

The current study investigated social behaviors, including initiating joint attention (IJA), responding to joint attention (RJA), social orienting, and imitation in 14 children with an autism spectrum disorder (ASD) compared to 12 typically developing children (TD). Results indicated that IJA and RJA were positively correlated with social orienting in both groups, replicating previous results with greater precision through the use of eye-tracking technology. Additionally, results supported the novel hypothesis that social orienting and imitation would be positively correlated in the ASD group, but not in the TD group. Joint attention and imitation were not significantly correlated in either group. Through the use of objective and automated eye gaze measurement more precise information is provided concerning the relation among commonly impaired social behaviors in children with ASD.     

Early language milestones predict later language,but not autism symptoms in higher functioning children with autism spectrum disorders

Language ability is a known predictor of outcome in children with autism but plays a more controversial role for higher functioning children with autism spectrum disorders (ASD). We studied the relationship between early language milestones and later structural language, adaptive functioning and autism symptoms in a sample of 76 children (mean age = 9.1 years) with an ASD, using two different language milestones: first phrase by 24 or 36 months. After controlling for age and nonverbal abilities, retrospectively reported early language milestones were predictive of later structural language abilities, measured by a sentence repetition task, and adaptive communication skills, but not autism symptoms or adaptive social skills. Acquisition of phrase speech by 24 months was sensitive to language and communication impairments in our ASD group, the majority (84%) of which had already acquired phrase speech by 36 months of age. Early available and easily collectable milestone data may be a useful marker of later language performance even in higher functioning, verbal children on the autism spectrum. When a detailed assessment of language is not possible, data on early milestones may be useful for identifying children at-risk in clinical settings and for language phenotyping in the laboratory.     

Nonverbal communication and play correlates of language development in autistic children

The aim of this study was to determine the social and cognitive correlates of language acquisition in autistic children. Functional and symbolic play skills were shown to be associated with language abilities in a sample of young autistic children (mean CA 54.5 months), thereby replicating previous findings. Certain types of nonverbal communication skills were also shown to be significant correlates of language development in this group of autistic children. These involved the ability to use gestures to coordinate visual attention between social partners with respect to objects or events. The play and nonverbal communication variables were not significantly correlated, suggesting that these variables reflect independent psychological factors associated with language development in young autistic children.