Speech Emerges In Children On The Autism Spectrum With Severe Language Delay At Greater Rate Than Previously Thought

New findings published in Pediatrics (Epub ahead of print) by the Kennedy Krieger Institute’s Center for Autism and Related Disorders reveal that 70 percent of children with autism spectrum disorders (ASD) who have a history of severe language delay, achieved phrase or fluent speech by age eight. This suggests that more children presenting with ASD and severe language delay at age four can be expected to make notable language gains than was previously thought. Abnormalities in communication and language are a defining feature of ASD, yet prior research into the factors predicting the age and quality of speech attainment has been limited.

The study used the largest sample to date to examine the relationship between key deficits associated with ASD and attainment of phrase and/or fluent speech following a severe language delay, characterized by a child not putting words together into meaningful phrases by age four. As a common milestone of speech development, phrase speech is defined as using non-echoed three-word utterances that sometimes involve a verb and are spontaneous meaningful word combinations; whereas fluent speech is defined as the ability to use complex utterances to talk about topics outside of the immediate physical context.

“We found that nonverbal intelligence was the strongest predictor of phrase speech, while social interest and engagement were as robust, if not greater, when predicting the age that children attained phrase speech and fluent speech,” said Ericka L. Wodka, Ph.D., a neuropsychologist in Kennedy Krieger’s Center for Autism and Related Disorders and lead study author. “Children with typical nonverbal intelligence attained language almost six months ahead of those with scores below the average.”

These findings reinforce that core abilities, such as nonverbal intelligence and social engagement, have a greater influence on the development of communication than other behaviors associated with ASD, such as repetitive and abnormal sensory behaviors. “Our findings continue to support the importance of considering both nonverbal intellectual level and social communication in treatment planning, highlighting the differing impact of these factors as related to treatment goals,” said Dr. Wodka.

Data for this retrospective study were from the Simon Simplex Collection (SSC), a unique multi-site database project that gathers biological and phenotypic data on children with ASD aged four- to eighteen-years-old without a previous genetic history of ASD. The database establishes a permanent repository of genetic samples from 2,700 families, each of which has one child affected with an ASD and unaffected parents and siblings.

From the SSC, a total of 535 children, ages eight years or older, were studied. Using the Autism Diagnostic Interview-Revised (ADI-R), a standard parent-interview that distinguishes children with ASD from non-ASD populations, and the Autism Diagnosis Observation Schedule (ADOS), a clinician-administered observation that assesses social, communicative and stereotyped behaviors, researchers selected children because they either had no phrase speech at their time of enrollment in the SSC or their phrase speech onset occurred after age four. Based on ADI-R results and their language presentation, children in this study were administered one of four evaluation modules – no words or single words (Module 1), phrase speech (Module 2) or fluent speech (Module 3 or 4). Of the 535 participants in the study, 119 children mastered phrase speech and 253 children were speaking fluently by their eighth birthday, while 163 children never attained phrase or fluent speech

“We hope the results of this study empower parents of children with autism and severe language delays to know that, with the appropriate therapy, a child will likely make significant gains in this area over time; however, progress should be expected to be slower for those children with lower intellectual abilities,” said Dr. Wodka. “Additionally, we hope these findings provide clinicians with better defined therapeutic targets for their patients with autism.”

Future longitudinal studies, including both simplex and multiplex families, are required to fully capture the prevalence and predictors of language development in children with ASD. Additionally, further research into the impact of social cognition strategies (e.g., perspective taking) on the development of language, as well as the relationship among specific social deficits and fluent speech development, may hold important implications to the design of intervention.

Source: Kennedy Krieger Institute

Thanks to Sue Marinez for alerting me to this report.

Little evidence supports autism treatment options in adolescents

Jennifer Wetzel of Vanderbilt University reports on some findings by researchers there:

Vanderbilt University researchers studying interventions for adolescents and young adults with autism are reporting today that there is insufficient evidence to support findings, good or bad, for the therapies currently used.

Although the prevalence of autism is on the rise, much remains to be discovered when it comes to interventions for this population, the researchers concluded.

“Overall, there is very little evidence in all areas of care for adolescents and young adults with autism, and it is urgent that more rigorous studies be developed and conducted,” said Melissa McPheeters, Ph.D., M.P.H., director of Vanderbilt’s Evidence-Based Practice Center and senior author of the report, a systematic review of therapies published by the Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ).

In reaching their conclusions, the researchers screened more than 4,500 studies and reviewed 32 studies published over the last 31 years that evaluated therapeutic interventions for people with ASD aged 13-30.

Some of their key findings:

• Some evidence revealed that treatments could improve social skills and educational outcomes such as vocabulary or reading, but the studies were generally small and had limited follow-up.
• Limited evidence supports the use of medical interventions in adolescents and young adults with autism. The most consistent findings were identified for the effects of antipsychotic medications on reducing problem behaviors that tend to occur with autism, such as irritability and aggression. Harms associated with medications included sedation and weight gain.
• Only five articles tested vocational interventions, all of which suggested that certain vocational interventions may be effective for certain individuals, but each study had significant flaws that limited the researchers’ confidence in their conclusions. The researchers’ findings on vocational interventions will be featured in the Aug. 27 issue of Pediatrics.

Read Wetzel’s full article on Vanderbilt University.

Most Children with ASD Diagnosed After Age 5, Use Multiple Services and Medications

Fewer than one out of five school-aged children with special health care needs were diagnosed with autism spectrum disorder (ASD) by age 2, according to new data from an NIMH-funded study. These diagnoses were made by a variety of health care providers, and most children in the study used multiple health care services (such as speech or language therapy) and multiple medications.

Background

Identifying ASD at an early age allows children to start treatment sooner, which can improve their later development and learning, and may also reduce a child’s need for specialized services or treatments later in life.

To determine the experiences of school-aged children with special health care needs, Lisa Colpe, Ph.D., M.P.H., and Bev Pringle, Ph.D., of the NIMH Division of Services and Intervention Research, collaborated with colleagues who conducted more than 4,000 telephone interviews with parents or guardians of a child between the ages of 6-17 who had a confirmed diagnosis of ASD, intellectual disability, and/or developmental delay.

These survey interviews were a part of the Pathways to Diagnosis and Services Study, sponsored by NIMH using funds available from the American Recovery and Reinvestment Act of 2009 (Recovery Act). Additional collaborators on this project include the National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC) and the Maternal and Child Health Bureau at the Health Resources and Services Administration (HRSA).

Results of the Study

Key findings include:

• The median age when school aged children with special health care needs and ASD were first identified as having ASD was 5 years.
• Those identified as having ASD at younger than 5 years were diagnosed most often by generalists (such as pediatricians, family physicians, and nurse practitioners) and psychologists. Those identified later than 5 years were diagnosed primarily by psychologists and psychiatrists.
• Nine out of ten school-aged children with special health care needs and ASD used at least one health care service, such as behavioral intervention or modification services, sensory integration therapy, cognitive based therapy, occupational therapy, physical therapy, social skills training, or speech or language therapy.
  • Social skills training and speech or language therapy were the most commonly used service, each used by almost 60 percent, or three out of five, of these children.
• More than half of school-aged children with special health care needs and ASD used at least one psychotropic medication. “Psychotropic medication” refers to any medication used to treat a mental disorder.
  • Almost 33 percent of these children used stimulant medications
  • 25 percent used anti-anxiety or mood-stabilizing medications
  • 20 percent used antidepressants.

Further findings are available in the NCHS Data Brief and Frequently Asked Questions.

Significance

The new data detail the experiences of young children with ASD, describing when they are first identified as having ASD, who is making those identifications, and the services and medications the children use to meet their developmental needs.

What’s Next

NIMH encourages researchers to access and analyze the new dataset to produce more studies on the early life experiences and the diagnostic, service, and treatment issues relevant to children with ASD and special health care needs. The Pathways to Diagnosis and Services Study dataset can be accessed at http://www.cdc.gov/nchs/slaits/spds.htm.

Reference

Pringle BA, Colpe LJ, Blumberg SJ, Avila RM, Kogan MD. Diagnostic History and Treatment of School-Aged Children with Autism Spectrum Disorder and Special Health Care Needs. NCHS data brief, no 97. Hyattsville, MD: National Center for Health Statistics. 2012.

Source: NIMH

Seminar: Moving On: Preparing Students with Autism, Asperger’s and Learning Differences for College

If you are the parent of a high school student, you’ll want to know about this event sponsored by The Yale Child Study Center:

Moving On: Preparing Students with Autism, Asperger’s and Learning Differences for College

This full day seminar is designed to assist college-bound students on the autism spectrum (and their parents) cope with expectations and pressures, and understand their domestic and academic responsibilities. Topics include identifying the right program/institution, social and communication supports, and managing anxiety, among others.

Sunday, April 22, 2012, 10:00 a.m. – 4:00 p.m.
Yale University, School of Medicine
333 Cedar Street, New Haven, CT
Harkness Auditorium

You can download the workshop agenda here and find more information on the workshop here.

On the functional anatomy of the urge-for-action

Some premonitory urges are experienced as an urge to action.  Such urges have been described in a number of clinical conditions including Tourette syndrome and Obsessive-Compulsive Disorder (OCD).  An interesting article in the September 2011 issue of Cognitive Neuroscience looks at their functional underpinnings.  Here’s the abstract:

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