Language Comprehension Predicts Later Cognitive Ability and Symptom Severity in Toddlers with ASD McGarry, E., Fiorello, K., Heldenberg, S., Reifler, A., Klaiman, C., Saulnier, C., & Lewis, M.. Marcus Autism Center, Children s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, 30329.
Background Language ability is often considered an important correlate to other areas of social and cognitive development in children with autism (Luyster, Kadlec, Carter & Tager-Flusberg, 2008). Studies have demonstrated that early nonverbal cognitive ability is predictive of receptive and expressive language skills (Luyster et al., 2008). Other studies have reported that early expressive language skills are a predictor of future cognitive ability (Mayo, Chlebowski, Fein, & Eigsti, 2012).
Luyster, Kadlec, Carter & Tager-Flusberg, 2008 Investigated early correlates of language abilities in 164 toddlers with ASD between the ages of 18 and 33 months Non-verbal cognitive ability was measured by the Mullen Visual Reception raw score, while Receptive and Expressive Language were measured by Mullen, Vineland, and MCDI subscales. Suggested agreement among different measures of early language (parent report and direct assessment) Non-verbal cognitive ability significantly predicted receptive and expressive language
Mayo, Chlebowski, Fein, & Eigsti, 2012 Examined the relationship between age of language acquisition and later functioning in 119 children with ASD Age of first words was defined as the age when a child first consistently produced single words other than mama or dada Cognitive development measured by the Mullen, and adaptive functioning was measured by the Vineland Producing first words by 24 months of age was a strong predictor of later cognitive ability and adaptive skills
Objectives Previous research supports a relationship between language skills and cognitive ability, and suggests that early expressive language is a predictor of later cognitive ability. This study investigates early language comprehension in toddlers with ASD to determine if receptive language skills can serve as a predictor of later cognitive ability and autism symptom severity.
Methods Participants included a clinically-referred sample of 24 toddlers with diagnoses of Autism Spectrum Disorder [83% Male (n=20), 17% Female (n=4)] All participants received gold-standard comprehensive assessments for a research reliable diagnosis. The Communication Symbolic Behavior Scales (CSBS), the Mullen Scales of Early Learning, and the Autism Diagnostic Observation Schedule (ADOS) were administered at two time points [Time 1 Mean Age= 22.79, (SD= 4.12), Time 2 Mean Age= 38.10 (SD=2.18)].
Methods Language comprehension was measured using the Understanding subscale of the CSBS. Cognitive ability was measured using a ratio Nonverbal IQ Score (NVIQ) calculated from the Mullen Fine Motor and Visual Reception subscales.
Communication and Symbolic Behavior Scales Amy Wetherby, Barry Prizant, 2002 Assessment tool used for evaluating communication in toddlers ages 12 months to 24 months Effective way to assess early prelinguistic behaviors, and to examine social vulnerabilities as well Only a portion of a global developmental assessment Autism Diagnostic Observation Schedule- Module 1 (ADOS-Mod.1: Lord et al., 2000) Mullen Scales of Early Learning
CSBS In Action 18 Months 15 Months
Mullen Scales of Early Learning Eileen M. Mullen, 1995 Assessment tool used to evaluate early cognitive and motor development across five domains in children birth to five years of age. Expressive and Receptive Language, Gross and Fine Motor, and Visual Reception Nonverbal IQ: Fine Motor e.g. pincer grasps, turning pages of a book, putting pennies in a slot, stringing beads, cutting/folding paper. Visual Reception e.g. tracking objects, looking under a cloth for a hidden item, sorting, matching, memory tasks.
Mullen In Action 17 Months
ADOS Module 1 Catherine Lord, Michael Rutter, et al., 2000 Play based assessment used to examine behaviors related to autism spectrum disorders through the observation of communication, social interaction, and play skills. Specifically, Module 1 is designed for children who are pre-verbal/only using single words.
ADOS Module 1 In Action 24 Months
Results: Receptive Language and Nonverbal IQ Time 1 CSBS Understanding Standard Scores were positively correlated with Time 2 Nonverbal IQ (r= 0.691, p<.001). Linear regression analysis revealed that Time 1 CSBS Understanding Standard Scores significantly predicted Time 2 Nonverbal IQ's, b=6.643 t(24)=4.378, p<.001. Additionally, Time 1 Understanding Standard Scores explained a significant proportion of variance in Time 2 Nonverbal IQs, R 2 =0.477, F(1,21)=19.171, p<.001.
140 Time 1 Language Comprehension and Time 2 Nonverbal IQ 120 T2 Mullen Nonverbal IQ 100 80 60 40 20 0 0 2 4 6 8 10 12 T1 CSBS Understanding Standard Score
Results: Receptive Language and Autism Symptom Severity Time 1 CSBS Understanding Scores were negatively correlated with Time 2 ADOS Module 1 Total Scores (r= -0.611, p<.05). Linear regression analysis revealed that Time 1 CSBS Understanding Scores significantly predicted Time 2 ADOS Module 1 Total Scores, b=-1.404, t(24)=-3.535, p<.05. Additionally, Time 1 CSBS Understanding Scores explained a significant proportion of variance in Time 2 ADOS Module 1 Total Scores, R 2 =0.373, F(1,21)=12.498, p<.05.
30 Time 1 Language Comprehension and Time 2 Autism Symptom Severity Time 2 Ados Module 1 Total Score 25 20 15 10 5 0 0 2 4 6 8 10 12 Time 1 CSBS Understanding Standard Score
Conclusions The results of this study suggest that early receptive language skills in two-year-olds with ASD are associated with both nonverbal cognition and autism sympomatology by age 3. These findings suggest that enhancing language comprehension could not only impact conceptual development, but also reduce severity of autism symptomatology. These results thus highlight the importance of speech and language therapy, as targeting receptive language early on may promote the development of important conceptual and social skills.
Clinical Implications Future studies should include larger samples and follow up with participants at a later age, to determine if early comprehension can be predictive of social ability as participants reach school age In addition, therapists should emphasize working with children in the home in addition to intervention in a clinical setting, as there are many natural learning opportunities available for parents to enhance language comprehension.
Sources Mayo, J., Chlebowski, C., Fein, D. A., & Eigsti, I. (2013). Age of first words predicts cognitive ability and adaptive skills in children with ASD. Journal Of Autism And Developmental Disorders, 43(2), 253-264. doi:10.1007/s10803-012-1558-0 Luyster, R., Kadlec, M., Carter, A., & Tager-Flusberg, H. (2008). Language Assessment and Development in Toddlers with Autism Spectrum Disorders. Journal of Autism Developmental Disorders, 38, 1426-1438. doi:10.1007/s10803-007-0510-1
Funding Sources and Acknowledgements Current or past NIH, R01 #MH83727 Simons Foundation, SF #94924 Acknowledgements All of the children & families who participated in research studies at the Marcus Autism Center as well as Emory University Marcus.org/research The presenting and listed authors have no financial relationships to disclose.