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

Abstract

Future studies of MV children must carefully consider the methods used to identify their sample, acknowledging that definitions including children with 'some words' may yield larger samples with a wider range of language and cognitive abilities. Broadly defined MV samples may be particularly important to delineate factors interfering with language development in the subgroup of children whose expressive impairments are considerably below their estimated nonverbal cognitive abilities.

Differences in profiles of emotional behavioral problems across instruments in verbal versus minimally verbal children with autism spectrum disorder

“…The Simons Simplex Collection is not a representative sample and may underrepresent MV children [Bal et al, ]; however, as the goal of this study was to compare instrument performance, rather than estimate prevalence of co‐occurring EBP, ascertainment bias seems unlikely to account for results. It is possible that the different time frames that the CBCL and ABC ask parents to report on their child's behavior (i.e., previous 6 months and 4 weeks, respectively) could have influenced results.…”

“…Autism spectrum disorder (ASD) is widely acknowledged as a heterogeneous syndrome, which manifests in different ways depending on the individual's age, language, and cognitive abilities. Recent studies suggest that approximately 30% of children with ASD remain minimally verbal [MV; Howlin, Savage, Moss, Tempier, & Rutter, ; Pickles, Anderson, & Lord, ], though precise estimates may vary by how MV is defined [Bal, Katz, Bishop, & Krasileva, ]. It is widely acknowledged that consideration of language level is essential in the assessment of children with ASD.…”

Describing Function in ASD: Using the DSM-5 and Other Methods to Improve Precision

“…The level of impairment used to denote “low” or “high” function is often obscured by the casual use of the terms to describe the average or modal presentation of a sample, failing to acknowledge the broad range of abilities actually encompassed by the study participants. Additionally, to categorize an individual as “low-functioning” may obscure strengths (e.g., average cognitive function in minimally verbal individuals; Bal, Katz, Bishop, & Krasileva, 2016), whereas classifying someone as “high-functioning” may underestimate impairments in areas such as daily living skills and supportive needs (e.g., Kenworthy, Case, Harms, Martin, & Wallace, 2010). Inconsistent and poorly defined subgroups make it impossible to carefully compare across studies of so-called “low-” or “high-functioning” individuals.…”

“…We recommend the use of broad but operationalized terms like few-to-no words, some single words, phrase speech, and fluent speech, consistent with the approach used in assessments like the ADOS-2 (Lord et al, 2012) and recommended as benchmarks for spoken language in ASD (Tager-Flusberg et al, 2009). Importantly, we are not advocating for a particular measure; rather, we propose that researchers should clearly operationalize the terminology they use to describe their sample, as well as the method implemented to derive that definition, as different approaches may result in different subgroups (Bal et al, 2016). …”

Fostering Communication in Elementary School Children on the Autism Spectrum Who Are Minimally Verbal

“…4 There have been a variety of terms used to describe this group of children or parts of this group of children (e.g., minimally verbal, nonverbal, complex communication challenges), and the descriptions of this population have varied widely between studies and publications. [4][5][6] For example, on the Autism Diagnostic Observation Schedule (ADOS-2), a child who meets module 1 criteria, which is defined as only using single words or rote phrases, is often considered minimally verbal. Other studies have used items from common measures such as the Vineland Adaptive Behavior Scales (e.g., names three objects, uses noun-verb combinations) or the Mullen Scales of Early Learning (e.g., number of words, phrase speech) to determine if a child is minimally verbal.…”