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

BACKGROUND: An 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. METHODS: Thirty 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. RESULTS: None 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. CONCLUSION: These 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.

Increased topographical variability of task-related activation in perceptive and motor associative regions in adult autistics.

BACKGROUND: An enhanced plasticity is suspected to play a role in various microstructural alterations, as well as in regional cortical reallocations observed in autism. Combined with multiple indications of enhanced perceptual functioning in autism, and indications of atypical motor functioning, enhanced plasticity predicts a superior variability in functional cortical allocation, predominant in perceptual and motor regions. METHOD: To test this prediction, we scanned 23 autistics and 22 typical participants matched on age, FSIQ, Raven percentile scores and handedness during a visuo-motor imitation task. For each participant, the coordinates of the strongest task-related activation peak were extracted in the primary (Brodmann area 4) and supplementary (BA 6) motor cortex, the visuomotor superior parietal cortex (BA 7), and the primary (BA 17) and associative (BAs 18 + 19) visual areas. Mean signal changes for each ROI in both hemispheres, and the number of voxels composing the strongest activation cluster were individually extracted to compare intensity and size of the signal between groups. For each ROI, in each hemisphere, and for every participant, the distance from their respective group average was used as a variable of interest to determine group differences in localization variability using repeated measures ANOVAs. Between-group comparison of whole-brain activation was also performed. RESULTS: Both groups displayed a higher mean variability in the localization of activations in the associative areas compared to the primary visual or motor areas. However, despite this shared increased variability in associative cortices, a direct between-group comparison of the individual variability in localization of the activation revealed a significantly greater variability in the autistic group than in the typical group in the left visuo-motor superior parietal cortex (BA 7) and in the left associative visual areas (BAs 18 + 19). CONCLUSION: Different and possibly unique strategies are used by each autistic individual. That enhanced variability in localization of activations in the autistic group is found in regions typically more variable in non-autistics raises the possibility that autism involves an enhancement and/or an alteration of typical plasticity mechanisms. The current study also highlights the necessity to verify, in fMRI studies involving autistic people, that hypoactivation at the group level does not result from each individual successfully completing a task using a unique brain allocation, even by comparison to his own group.