Language outcomes of toddlers with autism spectrum disorders: a two year follow‐up

Abstract

Thirty-seven children 15-25 months of age received clinical diagnoses of autism spectrum disorder (ASD) and were reevaluated two years later. All subjects were judged to have retained a diagnosis of ASD at the follow-up evaluation. Communication scores for the group as a whole during the first visit were significantly lower than nonverbal IQ. However, by the second visit, verbal and nonverbal scores were no longer significantly different. The group was divided into two subgroups, based on expressive language (EL) outcome at the second visit. The two groups were similar in the second year of life in terms of expressive communication skills and autistic symptoms, except for a trend toward more stereotypic and repetitive behavior in the worse outcome group. By the second visit, however, the groups differed significantly on all standard measures of expression and reception, as well as on autistic symptomotology and nonverbal IQ. When assessed during their second year, children who ended up in the better outcome group showed higher average nonverbal cognitive level, receptive language (RL) scores, number of sounds and words produced, use of symbolic play schemes, and response to joint attention bids. Regression analysis revealed that the variables for which significant differences between the two outcome groups in their second year of life were found provided significant prediction of EL outcome at age four. Stepwise regression identified RL and presence of stereotypic and repetitive at the first visit as significantly associated with EL outcome. Implications of these findings for early identification and intervention are discussed.

Using Spoken Language Benchmarks to Characterize the Expressive Language Skills of Young Children With Autism Spectrum Disorders

“…This hypothesis is supported by findings indicating that higher RRBs are associated with poorer language outcomes (Dominick, Davis, Lainhart, Tager-Flusberg, & Folstein, 2007;Paul et al, 2008;Ray-Subramanian & Ellis Weismer, 2012). For example, repetitive behaviors in toddlers with ASD between 15 and 25 months of age predicted expressive language scores between 3 and 5 years of age (Paul et al, 2008). Additional evidence includes the finding that increases in receptive and expressive language abilities from age 2 to 3 years significantly predicted decreases in RRBs even after controlling for gains in nonverbal cognition (Ray-Subramanian & Ellis Weismer, 2012).…”

“…Researchers propose that RRBs interfere with communication development by decreasing children's availability for learning and interacting with their environment (Richler, Bishop, Kleinke, & Lord, 2007;Richler, Huerta, Bishop, & Lord, 2010). This hypothesis is supported by findings indicating that higher RRBs are associated with poorer language outcomes (Dominick, Davis, Lainhart, Tager-Flusberg, & Folstein, 2007;Paul et al, 2008;Ray-Subramanian & Ellis Weismer, 2012). For example, repetitive behaviors in toddlers with ASD between 15 and 25 months of age predicted expressive language scores between 3 and 5 years of age (Paul et al, 2008).…”

“…It differentiates toddlers with "good" language outcomes (within two standard deviations of the mean on the Vineland Adaptive Behavior Scales-Second Edition, Survey Interview Form; Sparrow, Cicchetti, & Balla, 2005) from those with "poor" language outcomes (Paul et al, 2008) and accounts for a large proportion of variance in receptive and expressive language skills (Kjellmer, Hedvall, Fernell, Gillberg, & Norrelgen, 2012). However, the exact relationship between cognition and language outcomes remains unclear.…”

“…RJA and IJA have both been reported to predict language acquisition. Toddlers with ASD who achieved "good" language outcomes (an age-equivalent [AE] score above 30 months on the Vineland Adaptive Behavior Expressive Communication Scale) had better RJA skills than those with "poor" outcomes (Paul et al, 2008). Preschoolers with ASD with better RJA skills demonstrated faster language acquisition than those who were initially less responsive (Siller & Sigman, 2008).…”

“…Numerous research studies report significant impairments in both receptive and expressive language abilities (Ellis Weismer, Lord, & Esler, 2010;Paul, Chawarska, Cicchetti, & Volkmar, 2008) although structural language impairments (i.e., phonology, grammar, vocabulary) are not universal (Kjelgaard & Tager-Flusberg, 2001). It has been established since the 1980s that preschool and school-age children with ASD have uneven profiles across language domains (e.g., Wetherby & Prutting, 1984).…”