Autistic children at risk of being underestimated: school-based pilot study of a strength-informed assessment

Abstract

BackgroundAn important minority of school-aged autistic children, often characterized as ‘nonverbal’ or ‘minimally verbal,’ displays little or no spoken language. These children are at risk of being judged ‘low-functioning’ or ‘untestable’ via conventional cognitive testing practices. One neglected avenue for assessing autistic children so situated is to engage current knowledge of autistic cognitive strengths. Our aim was thus to pilot a strength-informed assessment of autistic children whose poor performance on conventional instruments suggests their cognitive potential is very limited.MethodsThirty autistic children (6 to 12 years) with little or no spoken language, attending specialized schools for autistic children with the highest levels of impairment, were assessed using Wechsler Intelligence Scale for Children (WISC-IV), Raven’s Colored Progressive Matrices board form (RCPM), Children’s Embedded Figures Test (CEFT), and a visual search task. An age-matched control group of 27 typical children was also assessed.ResultsNone of the autistic children could complete WISC-IV; only six completed any subtest. In contrast, 26 autistic children could complete RCPM, with 17 scoring between the 5th and 90th percentile. Twenty-seven autistic children completed the visual search task, while 26 completed CEFT, on which autistic children were faster than RCPM-matched typical children. Autistic performance on RCPM, CEFT, and visual search were correlated.ConclusionThese results indicate that ‘minimally verbal’ or ‘nonverbal’ school-aged autistic children may be at risk of being underestimated: they may be wrongly regarded as having little cognitive potential. Our findings support the usefulness of strength-informed approaches to autism and have important implications for the assessment and education of autistic children.

Why We Should Study the Broader Autism Phenotype in Typically Developing Populations

“…Less than 50% of people with an ASD have average or above-average intelligence, and at least 30% are considered to have an intellectual disability (Centers for Disease Control and Prevention, 2014;Elsabbagh et al, 2012; but see Courchesne, Meilleur, Poulin-Lord, Dawson, & Soulières, 2015). Many cognitive abilities are influenced by both chronological and mental age, yet most studies match the control group to the ASD group based on either mental or chronological age because of intrinsic difficulties in matching for both.…”

Understanding definitions of minimally verbal across instruments: evidence for subgroups within minimally verbal children and adolescents with autism spectrum disorder

“…Data from existing longitudinal studies suggest that 30%–40% of clinically ascertained children with ASD remain minimally verbal into adulthood (Howlin et al., ; Pickles, Anderson, & Lord, ). Studies of school‐aged children have begun to examine the utility of different instruments to estimate cognitive and language abilities (Brady, Anderson, Hahn, Obermeier, & Kapa, ; Courchesne, Meilleur, Poulin‐Lord, Dawson, & Soulières, ; Naigles & Chin, ; Plesa‐Skwerer, Jordan, Brukilacchio, & Tager‐Flusberg, ) and interventions to improve spontaneous communication (Kasari et al., ; Shire et al., ).…”

Adaptive trajectories and early risk factors in the autism spectrum: A 15‐year prospective study

“…Recent research shows that nonverbal IQ trajectories are highly variable and poorly predicted by behavioral phenotypic presentation [Visser et al, 2017]. Intelligence of minimally verbal individuals may be considerably underestimated [Courchesne, Meilleur, Poulin-Lord, Dawson, & Soulières, 2015].…”