Abstract
Comprehensive interventions for children with autism spectrum disorder (ASD) often incorporate augmentative and alternative communication (AAC); however, variability in outcomes exists even among children who access similar intervention. This study investigated predictors of expressive language change for 48 children with ASD aged 31 to 67 months receiving AAC-infused intervention. The relationships between participants’ initial responses to AAC and expressive language change were examined. Commonly reported predictors (IQ, chronological age, ASD symptomatology) did not significantly predict expressive language change. AAC factors (visual attention, object play, word learning) entered at Step 2 of a hierarchical multiple regression, explained an additional 42% of the variance. The findings provide preliminary data on child characteristics associated with expressive language changes within AAC-infused comprehensive interventions.
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Notes
Note that age equivalent scores were selected a priori for use in analyses. For completeness, analyses were re-run using raw scores with no impact on interpretation of findings.
References
Allen, M., Hartley, C., & Cain, K. (2015). Do iPads promote symbolic understanding and word learning in children with autism? Frontiers in Psychology,6, 1–9. https://doi.org/10.3389/fpsyg.2015.00138.
Anderson, D. K., Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A.,… Pickles, A. (2007). Patterns of growth in verbal abilities among children with autism spectrum disorder. Journal of Consulting and Clinical Psychology, 75, 594–604. https://doi.org/10.1037/0022-006x.75.4.594.
Bal, V., Katz, T., Bishop, S., & Krasileva, K. (2016). Understanding definitions of minimally verbal across instruments: Evidence for subgroups within minimally verbal children and adolescents with autism spectrum disorder. Journal of Child Psychology and Psychiatry and Allied Disciplines,57, 1424–1433. https://doi.org/10.1111/jcpp.12609.
Becerra, T., Massolo, M., Yau, V., Owen-Smith, A., Lynch, F., Crawford, P.,… Croen, L. (2017). A survey of parents with children on the autism spectrum experience with services and treatments. The Permanente Journal, 21, 16–009. https://doi.org/10.7812/tpp/16-009.
Beukelman, D. R., & Mirenda, P. (2013). Augmentative and alternative communication: Supporting children and adults with complex communication needs (4th ed.). Baltimore, MD: Paul H. Brookes Publishing Co.
Bopp, K. D., Mirenda, P., & Zumbo, B. D. (2009). Behavior predictors of language development over 2 years in children with autism spectrum disorders. Journal of Speech, Language, and Hearing Research,52, 1106–1120. https://doi.org/10.1044/1092-4388(2009/07-0262).
Boyd, B., Hume, K., McBee, M., Alessandri, M., Gutierrez, A., Johnson, L.,… Odom, S. (2014). Comparative efficacy of LEAP, TEACCH and non-model-specific special education programs for preschoolers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44, 366–380. https://doi.org/10.1007/s10803-013-1877-9.
Brady, N. C., Thiemann-Bourque, K., Fleming, K., & Matthews, K. (2013). Predicting language outcomes for children learning augmentative and alternative communication: Child and environmental factors. Journal of Speech, Language, and Hearing Research,56, 1595–1612. https://doi.org/10.1044/1092-4388(2013/12-0102).
Brignell, A., Song, H., Zhu, J., Suo, C., Lu, D., & Morgan, A. (2016). Communication intervention for autism spectrum disorders in minimally verbal children (Protocol). Cochrane Database of Systematic Reviews,8, 1–7. https://doi.org/10.1002/14651858.CD012324.
Camarata, S. (2014). Early identification and early intervention in autism spectrum disorders: Accurate and effective? International Journal of Speech-Language Pathology,16, 1–10. https://doi.org/10.3109/17549507.2013.858773.
Drager, K. D. (2009). Aided modeling interventions for children with autism spectrum disorders who require AAC. SIG 12 Perspectives on Augmentative and Alternative Communication,18, 114–120. https://doi.org/10.1044/aac18.4.114.
Drager, K. D., Postal, V. J., Carrolus, L., Castellano, M., Gagliano, C., & Glynn, J. (2006). The effect of aided language modeling on symbol comprehension and production in 2 preschoolers with autism. American Journal of Speech-Language Pathology,15, 112–125. https://doi.org/10.1044/1058-0360(2006/012).
Eapen, V., Črnčec, R., & Walter, A. (2013). Clinical outcomes of an early intervention program for preschool children with autism spectrum disorder in a community group setting. BMC Pediatrics,13, 1–9. https://doi.org/10.1186/1471-2431-13-3.
Eapen, V., Črnčec, R., & Walter, A. (2016). There are gains, but can we tell for whom and why? Predictors of treatment response following group Early Start Denver Model intervention in preschool-aged children with autism spectrum disorder. Autism Open Access,6, 168. https://doi.org/10.4172/2165-7890.1000168.
Ellis Weismer, S., & Kover, S. T. (2015). Preschool language variation, growth and predictors in children on the autism spectrum. Journal of Child Psychology and Psychiatry,56, 1327–1337. https://doi.org/10.1111/jcpp.12406.
Flippin, M., Reszka, S., & Watson, L. (2010). Effectiveness of the picture exchange communication system (PECS) on communication and speech for children with autism spectrum disorders: A meta-analysis. American Journal Of Speech-Language Pathology,19, 178–195. https://doi.org/10.1044/1058-0360(2010/09-0022).
Frost, L. A., & Bondy, A. S. (2002). The picture exchange communication system training manual (2nd ed.). Newark, DE: Pyramid Educational Products Inc.
Ganea, P. A., Preissler, M. A., Butler, L., Carey, S., & DeLoache, J. S. (2009). Toddlers’ referential understanding of pictures. Journal of Experimental Child Psychology,104, 283–295. https://doi.org/10.1016/j.jecp.2009.05.008.
Ganz, J. B. (2015). AAC interventions for individuals with autism spectrum disorders: State of the science and future research directions. Augmentative and Alternative Communication,31, 1–12. https://doi.org/10.3109/07434618.2015.1047532.
Ganz, J. B., Earles-Vollrath, T., Heath, A., Parker, R., Rispoli, M., & Duran, J. (2012). A meta-analysis of single case research studies on aided augmentative and alternative communication systems with individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders,42, 60–74. https://doi.org/10.1007/s10803-011-1212-2.
Ganz, J. B., Earles-Vollrath, T., Mason, R., Rispoli, M., Heath, A., & Parker, R. (2011). An aggregate study of single-case research involving aided AAC: Participant characteristics of individuals with autism spectrum disorders. Research in Autism Spectrum Disorders,5, 1500–1509. https://doi.org/10.1016/j.rasd.2011.02.011.
Ganz, J. B., Mason, R. A., Goodwyn, F. D., Boles, M. B., Heath, A. K., & Davis, J. L. (2014). Interaction of participant characteristics and type of AAC with individuals with ASD: A meta-analysis. American Journal on Intellectual and Developmental Disabilities,119, 516–535. https://doi.org/10.1352/1944-7558-119.6.516.
Gulsrud, A. C., Hellemann, G., Shire, S., & Kasari, C. (2015). Isolating active ingredients in a parent-mediated social communication intervention for toddlers with autism spectrum disorder. Journal of Child Psychology and Psychiatry,57, 606–613. https://doi.org/10.1111/jcpp.12481.
Iacono, T., Trembath, D., & Erickson, S. (2016). The role of augmentative and alternative communication for children with autism: Current status and future trends. Neuropsychiatric Disease and Treatment,12, 2349–2361. https://doi.org/10.2147/ndt.s95967.
Kasari, C., Freeman, S., & Paparella, T. (2000). Early intervention in autism: Joint attention and symbolic play. International Review of Research in Mental Retardation,23, 207–237. https://doi.org/10.1016/S0074-7750(00)80012-9.
Lee, L. C., David, A. B., Rusyniak, J., Landa, R., & Newschaffer, C. J. (2007). Performance of the Social Communication Questionnaire in children receiving preschool special education services. Research in Autism Spectrum Disorders,1, 126–138. https://doi.org/10.1016/j.rasd.2006.08.004.
Leyfer, O., Tager-Flusberg, H., Dowd, M., Tomblin, J., & Folstein, S. (2008). Overlap between autism and specific language impairment: Comparison of Autism Diagnostic Interview and Autism Diagnostic Observation Schedule scores. Autism Research,1, 284–296. https://doi.org/10.1002/aur.43.
Light, J., & McNaughton, D. (2014). Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication? Augmentative and Alternative Communication,30, 1–18. https://doi.org/10.3109/07434618.2014.885080.
Lord, C., Rutter, M., DiLavore, P., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule (2nd ed.). Torrance, CA: Western Psychological Services.
Maloney, E. S., & Larrivee, L. S. (2007). Limitations of age-equivalent scores in reporting the results of norm-referenced tests. Contemporary Issues in Communication Science & Disorders,34, 86–93.
McDuffie, A., Lieberman, R. G., & Yoder, P. (2012). Object interest in autism spectrum disorder: A treatment comparison. Autism: The International Journal of Research and Practice,16(4), 398–405. https://doi.org/10.1177/1362361309360983.
Millar, D. C. (2009). Effect of AAC on the natural speech development of individuals with autism spectrum disorders. In P. Mirenda & T. Iacono (Eds.), Autism spectrum disorders and AAC (pp. 171–192). Baltimore, MD: Paul H. Brookes Publishing Co.
Mullen, E. (1995). Mullen scales of early learning. Circle Pines, MN: American Guidance Service Inc.
National Autism Center. (2015). Findings and conclusions: National standards project, Phase 2. Randolph, MA: Author.
Norrelgen, F., Fernell, E., Eriksson, M., Hedvall, Å., Persson, C., Sjölin, M.,… Kjellmer, L. (2014). Children with autism spectrum disorders who do not develop phrase speech in the preschool years. Autism, 19, 934–943. https://doi.org/10.1177/1362361314556782.
Odom, S. L., Boyd, B. A., Hall, L. J., & Hume, K. (2010). Evaluation of comprehensive treatment models for individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders,40, 425–436. https://doi.org/10.1007/s10803-009-0825-1.
Paul, R. (2007). Communication and its development in autism spectrum disorders. In F. Volkmar (Ed.), Autism and pervasive developmental disorders (2nd ed., pp. 129–155). Cambridge: Cambridge University Press. https://doi.org/10.1017/cbo9780511544446.005.
Paynter, J., Riley, E. P., Beamish, W., Scott, J. G., & Heussler, H. S. (2015). Brief report: An evaluation of an Australian autism-specific, early intervention programme. International Journal of Special Education,30, 13–19.
Pellecchia, M., Connell, J., Beidas, R., Xie, M., Marcus, S., & Mandell, D. (2015). Dismantling the active ingredients of an intervention for children with autism. Journal of Autism and Developmental Disorders,45, 2917–2927. https://doi.org/10.1007/s10803-015-2455-0.
Perry, A., Cummings, A., Geier, J. D., Freeman, N. L., Hughes, S., Managhan, T.,… Williams, J. (2011). Predictors of outcome for children receiving intensive behavioral intervention in a large community-based program. Research in Autism Spectrum Disorders, 5, 592–603. https://doi.org/10.1016/j.rasd.20https://doi.org/10.07.003.
Preissler, M. (2008). Associative learning of pictures and words by low-functioning children with autism. Autism,12, 231–248. https://doi.org/10.1177/1362361307088753.
Reichle, J., Ganz, J. B., Drager, K., & Parker-McGowan, Q. (2016). Augmentative and alternative communication applications for persons with ASD and complex communication needs. In D. Keen, H. Meadan, N. Brady, & J. Halle (Eds.), Prelinguistic and minimally verbal communicators on the autism spectrum (pp. 179–213). Singapore: Springer.
Roberts, J., Williams, K., Smith, K., & Campbell, L. (2016). Autism spectrum disorder: Evidence-based/evidence-informed good practice for supports provided to preschool children, their families and carers. Canberra, ACT: National Disability Insurance Agency (NDIA).
Rogers, S. J., & Dawson, G. (2010). Early Start Denver Model for young children with autism: Promoting language, learning, and engagement. New York: The Guildford Press.
Romski, M. A., Sevcik, R. A., Barton-Hulsey, A., & Whitmore, A. S. (2015). Early intervention and AAC: What a difference 30 years makes. Augmentative and Alternative Communication,31, 181–202. https://doi.org/10.3109/07434618.2015.1064163.
Rose, V., Trembath, D., Keen, D., & Paynter, J. (2016). The proportion of minimally verbal children with autism spectrum disorder in a community-based early intervention programme. Journal of Intellectual Disability Research,60, 464–477. https://doi.org/10.1111/jir.12284.
Rutter, M., Bailey, A., & Lord, C. (2003). The Social Communication Questionnaire. Los Angeles: Western Psychological Services.
Ryan, S., Shepherd, T., Renzoni, A., Anderson, C., Barber, M., Kingsnorth, S., et al. (2015). Towards advancing knowledge translation of AAC outcomes research for children and youth with complex communication needs. Augmentative and Alternative Communication,31, 148–158. https://doi.org/10.3109/07434618.2015.1030038.
Schreibman, L., Stahmer, A., Barlett, V., & Dufek, S. (2009). Brief report: Toward refinement of a predictive behavioral profile for treatment outcome in children with autism. Research in Autism Spectrum Disorders,3, 163–172. https://doi.org/10.1016/j.rasd.2008.04.008.
Shriberg, L. D., Paul, R., Black, L. M., & van Santen, J. P. (2011). The hypothesis of apraxia of speech in children with autism spectrum disorder. Journal of Autism and Developmental Disorders,41, 406–426. https://doi.org/10.1007/s10803-010-1117-5.
Smith, V., Mirenda, P., & Zaidman-Zait, A. (2007). Predictors of expressive vocabulary growth in children with autism. Journal of Speech, Language, and Hearing Research,50, 149–160. https://doi.org/10.1044/1092-4388(2007/013).
Stahmer, A. C., & Ingersoll, B. (2004). Inclusive programming for toddlers with autism spectrum disorders: Outcomes from the children’s toddler school. Journal of Positive Behavior Interventions,6, 67–82. https://doi.org/10.1177/10983007040060020201.
Stahmer, A. C., Schreibman, L., & Cunningham, A. B. (2011). Toward a technology of treatment individualization for young children with autism spectrum disorders. Brain Research,1380, 229–239. https://doi.org/10.1016/j.brainres.2010.09.043.
Sullivan, J. R., Winter, S. M., Sass, D. A., & Svenkerud, N. (2014). Assessing growth in young children: A comparison of raw, age-equivalent, and standard scores using the Peabody Picture Vocabulary Test. Journal of Research in Childhood Education,28, 277–291. https://doi.org/10.1080/02568543.2014.883453.
Tager-Flusberg, H., & Kasari, C. (2013). Minimally verbal school-aged children with autism spectrum disorder: The neglected end of the spectrum. Autism Research,6, 468–478. https://doi.org/10.1002/aur.1329.
Tager-Flusberg, H., Rogers, S. J., Cooper, J., Landa, R., Lord, C., Paul, R.,… Yoder, P. (2009). Defining spoken language benchmarks and selecting measures of expressive language development for young children with autism spectrums disorders. Journal of Speech, Language, and Hearing Research, 52, 643–652. https://doi.org/10.1044/1092-4388(2009/08-0136.
Trembath, D., & Vivanti, G. (2014). Problematic but predictive: Individual differences in children with autism spectrum disorders. International Journal of Speech-Language Pathology,16, 57–60. https://doi.org/10.3109/17549507.2013.859300.
Trembath, D., Vivanti, G., Iacono, T., & Dissanayake, C. (2015). Accurate or assumed: Visual learning in children with ASD. Journal of Autism and Developmental Disorders,45, 3276–3287. https://doi.org/10.1007/s10803-015-2488-4.
Vivanti, G., & Dissanayake, C. (2016). Outcome for children receiving the early start denver model before and after 48 months. Journal of Autism and Developmental Disorders,46, 2441–2449. https://doi.org/10.1007/s10803-016-2777-6.
Vivanti, G., Dissanayake, C., Zierhut, C., & Rogers, S. J. (2013). Brief report: Predictors of outcomes in the Early Start Denver Model delivered in a group setting. Journal of Autism and Developmental Disorders,43, 1717–1724. https://doi.org/10.1007/s10803-012-1705-7.
Vivanti, G., Kasari, C., Green, J., Mandell, D., Maye, M., & Hudry, K. (2017). Implementing and evaluating early intervention for children with autism: Where are the gaps and what should we do? Autism Research. https://doi.org/10.1002/aur.1900.
Woynaroski, T., Watson, L., Gardner, E., Newsom, C., Keceli-Kaysili, B., & Yoder, P. (2016). Early predictors of growth in diversity of key consonants used in communication in initially preverbal children with autism spectrum disorder. Journal of Autism and Developmental Disorders,46, 1013–1024. https://doi.org/10.1007/s10803-015-2647-7.
Yoder, P., & Compton, D. (2004). Identifying predictors of treatment response. Mental Retardation and Developmental Disabilities Research Reviews,10, 162–168. https://doi.org/10.1002/mrdd.20013.
Yoder, P., & Stone, W. L. (2006). A randomized comparison of the effect of two prelinguistic communication interventions on the acquisition of spoken communication in preschoolers with ASD. Journal of Speech, Language, and Hearing Research,49, 698–711. https://doi.org/10.1044/1092-4388(2006/051).
Yoder, P., Watson, L. R., & Lambert, W. (2015). Value-added predictors of expressive and receptive language growth in initially nonverbal preschoolers with autism spectrum disorders. Journal of Autism and Developmental Disorders,45, 1254–1270. https://doi.org/10.1007/s10803-014-2286-4.
Acknowledgments
We warmly thank the children, parents and caregivers, and staff whose participation in this study made this research possible. In addition, our thanks go to Rhylee Sulek and Stephanie Sievers for their assistance with reliability coding. This study was conducted as part of Dr Rose’ Doctoral studies.
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VR, DT, DK and JP designed the study. VR completed data collection, preliminary analysis, and drafted the first manuscript. All authors contributed to subsequent drafts. Credibility checking of statistics was completed by JP. All authors read and approved the final manuscript.
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Rose, V., Paynter, J., Vivanti, G. et al. Predictors of Expressive Language Change for Children with Autism Spectrum Disorder Receiving AAC-Infused Comprehensive Intervention. J Autism Dev Disord 50, 278–291 (2020). https://doi.org/10.1007/s10803-019-04251-2
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DOI: https://doi.org/10.1007/s10803-019-04251-2