This research addresses the challenges of assessing receptive language abilities in minimally verbal children with autism spectrum disorder by comparing several adapted measurement tools: a standardized direct assessment of receptive vocabulary (i.e. Peabody Picture Vocabulary Test-4); caregiver report measures including scores on the Vineland-II Communication domain and a vocabulary questionnaire consisting of a list of words ranging from simple, developmentally early, to more advanced words expected to be understood by at least some older children and adolescents; an eye-tracking test of word comprehension, using a word-image pair matching paradigm similar to that often used in studies of infant language acquisition; and a computerized assessment using a touch screen for directly measuring word comprehension with the same stimuli used in the eye-tracking experiment. Results of this multiple-method approach revealed significant heterogeneity in receptive language abilities across participants and across assessment methods. Our findings underscore the need to find individualized approaches for capturing the potential for language comprehension of minimally verbal children with autism spectrum disorder who remain otherwise untestable, using several types of assessment that may include methods based on eye-tracking or touch-screen responding.

Attending preferentially to social information in the environment is important in developing socio-communicative skills and language. Research using eye tracking to explore how individuals with autism spectrum disorder deploy visual attention has increased exponentially in the past decade; however, studies have typically not included minimally verbal participants. In this study, we compared 37 minimally verbal children and adolescents with autism spectrum disorder with 34 age-matched verbally fluent individuals with autism spectrum disorder in how they viewed a brief video in which a young woman, surrounded by interesting objects, engages the viewer, and later reacts with expected or unexpected gaze-shifts toward the objects. While both groups spent comparable amounts of time looking at different parts of the scene and looked longer at the person than at the objects, the minimally verbal autism spectrum disorder group spent significantly less time looking at the person’s face during the episodes where gaze following—a precursor of joint attention—was critical for interpreting her behavior. Proportional looking-time toward key areas of interest in some episodes correlated with receptive language measures. These findings underscore the connections between social attention and the development of communicative abilities in autism spectrum disorder.

This paper describes the (Sin Exclusión) Transdisciplinary Autism Assessment and Resources ([S]TAAR) model and presents early metrics tracking efficiency and equity in access to high-quality comprehensive autism evaluations for young children. Retrospective chart reviews over one year (08/2018–08/2019) with n = 173 children were reviewed. Through care coordination with community providers, the model was developed to meet local needs by increasing throughput of children (< 4 years old) evaluated by a transdisciplinary team. Team-based processes included pre-visit triage, synchronous evaluation procedures, case conferencing, huddles, and care coordination. The model led to increased patient throughput, reductions in waitlist and time to diagnosis, and improved provider satisfaction. Improvements in access to care were equitable across patient race, ethnicity, language, and insurance type.

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Given existing barriers to a timely autism diagnosis, this study compares the efficiency and equity of diagnoses conducted in-person vs. telehealth in a developmental behavioral pediatrics setting. The transition to telehealth was prompted by the COVID-19 pandemic. Eleven months of clinic data in electronic medical records were retrospectively analyzed for children diagnosed with autism in-person (N = 71) vs. telehealth (N = 45). Time to autism diagnosis, patient demographics, and deferred diagnoses did not significantly differ across visit types. However, privately insured patients and families living farther from the clinic had a longer time to diagnosis via telehealth vs. in-person. Results of this exploratory study highlight the feasibility of telehealth evaluations for autism and which families may benefit from additional support to ensure a timely diagnosis.

Objective Children with a history of prematurity are at increased risk for neurodevelopmental disorders, including autism. This case series describes four patients with comparable prenatal and divergent neonatal histories who were referred for comprehensive autism evaluations between 21-36 months of age by a NICU follow-up program. Method Patients were born at approximately 25 weeks gestation (i.e. extremely premature) following otherwise uncomplicated pregnancies and weighed less than 1000 grams at birth (i.e. extremely low birth weight). Patients A and B experienced significant neonatal complications (e.g. hemorrhage, respiratory failure). Children were later evaluated for autism by an interprofessional team affiliated with a children’s hospital. Results Patient A had average intellectual, motor, and language abilities with mild symptoms of autism on a standardized rating scale. Patient B had impaired intellectual, motor, and language abilities with severe symptoms of autism on the same rating scale. Patient C had average intellectual abilities, borderline language and motor abilities, and did not display autism features. Patient D had borderline intellectual abilities, low average receptive and expressive language, and also did not display autism features. Conclusions All patients presented with developmental delays in at least one domain. Those who experienced complications in the NICU met DSM-5 criteria for Autism Spectrum Disorder. However, patients with similar prenatal histories who did not face additional complications in the NICU presented with comparatively intact social communication and behavior. This case series suggests the relative importance of peri- and neonatal factors in the etiology of autism in children with a history of extreme prematurity.