It Takes a Community: How Environmental Systems Construct (In)Competence in Autistic Peer Interactions.

PURPOSE: This study aims to illustrate how environmental systems shape the peer interactions of an autistic student within the classroom. METHOD: Drawing on the bioecological model of human development, this situated discourse analysis used thematic coding and microanalysis to examine data from semistructured interviews and 10 sessions of direct classroom observations of a 9-year-old autistic student and his classroom communication partners. RESULTS: Convergent data across participants, time, and data sources revealed the following systemic influences on peer interaction: predominant medicalized view of autism (macrosystem), educational practices (exosystem), misaligned roles across adults and peers in the classroom (mesosystem), and multimodal opportunities for direct interaction that were supported by objects and physical contact and inhibited by rapid pacing (microsystem). CONCLUSIONS: Findings illustrate the environmental complexities associated with the development of peer interactions for autistic students. We offer explicit clinical implications for how environmental factors can be addressed in the school-based eligibility determination process and in the Individualized Education Program.

Children Born Prematurely May Demonstrate Catch-Up Growth in Pre-Adolescence.

Introduction Children born prematurely often score lower on standardized tests of language in early childhood. Less is known about longer term outcomes. This investigation considered language outcomes in pre-adolescent children born very preterm/very low birthweight, as assessed by both standardized test scores and language sample measures, and explored attention abilities as a possible moderating factor. Method The present investigation provided a longitudinal follow-up to Mahurin Smith et al. (2014) by examining the language outcomes of 84 children at the 11-year time point (39 with a history of prematurity and 45 born at full term) and a total of 82 at the 12-year time point (37 with a history of prematurity, 45 born at full term). Assessments included subtests of the Clinical Evaluation of Language Fundamentals- Fourth Edition, productive language measures taken from narrative tasks, and parent and examiner ratings of attention. Results Gestational age significantly predicted standardized language scores at age 11 years, but this effect was no longer statistically significant at age 12 years. When parent ratings of attention were considered as additional variables, gestational age was no longer a significant predictor. Gestational age did not serve as a significant predictor for the productive language measures at either time point. Discussion Results indicate that catch-up growth in language may take place in pre-adolescence for many children born prematurely. Clinical implications focus on the need to utilize multiple forms of language assessment and to directly consider the potential role of attention on standard test results.

Volume and Verve: Understanding Correction/Behavioral Warnings in Teacher-Child Classroom Interactions Involving an African American Kindergarten Student.

Purpose Using a framework of culturally and linguistically responsive classroom management, this study employed both quantitative and qualitative analyses of ethnographic data to illustrate patterns of corrections/behavioral warnings in teacher-child interactions for an African American child in the classroom. Method Three child participants and their teacher were recruited for the study: MJ, an African American kindergartner, the focal child, and two same-sex Filipino classmates who spoke a nonmainstream dialect of English, Ben and Leo, for frame of reference. None of the three boys were diagnosed with language-learning difficulties. Data analyses included (a) categorical analyses of observational field notes taken across a 7-week period of classroom observation and (b) situated discourse analysis taken from video-recorded small group literacy lessons also in the classroom. Results Two key findings emerged. First, MJ, the focal participant, received a relatively high frequency of correction/behavioral warnings, both relative to the other forms of teacher-initiated interaction and also relative to his two classmates. Second, the majority of MJ's corrections/behavioral warnings were directed toward his volume and verve-features that have been associated with the communication style of many African American students. Conclusions We need to include teachers and administrators in our discussions about the communication style of African American students and broaden these discussions to explicitly consider the influence of nonverbal features, such as volume and verve, on patterns of teacher-student communication interactions. In particular, such communication features may be contributing to high-stakes outcomes for African American children, such as referrals, diagnoses, educational placements, and disciplinary actions.

Communication Profile of a Minimally Verbal School-Age Autistic Child: A Case Study.

Purpose The present clinical focus draws on an intrinsic case study to provide a thick description of the communication profile of John, a 9-year-old minimally verbal autistic student. Method Specifically, traditional behavioral assessments, classroom video observations, and semistructured interviews were used to gather information regarding John's communication profile and potential sensory-motor differences. Results Convergent evidence indicated that John's expressive profile was characterized by single words, emergent word combinations, some conventional gestures, and a low frequency of communicative initiations. Concomitant language comprehension challenges and poor intelligibility associated with motor speech impairment were also indicated. His sensory-motor profile was marked by fine motor impairment, relative strengths in gross motor abilities, and sensory differences across visual, hearing, and tactile modalities. Conclusion Direct implications for supporting minimally verbal autistic students like John include the need to (a) consider sensory-motor influences on social interaction and (b) support flexible use of multimodal communication resources, including augmentative and alternative communication. Supplemental Material https://doi.org/10.23641/asha.12202448.

Narratives About Autism: An Analysis of YouTube Videos by Individuals Who Self-Identify as Autistic.

Purpose The goal of this study was to expand the field's understanding of autism through the analysis of 1st-person perspectives from autistic video webloggers (vloggers). Method This study analyzed the representation of autism in 39 YouTube videos authored by self-identified autistic individuals and published between 2007 and 2015. Consistent with the cross-disciplinary tradition of narrative inquiry, thematic analyses of the video transcripts were conducted. Findings Vloggers were predominantly, but not exclusively, White male adults who spoke mainstream American English and self-identified as experiencing Asperger's syndrome. Key findings included (a) the predominance of a narrative about autism that incorporated features of both the medical model of disability and the neurodiversity paradigm to varying degrees, (b) a trend toward more medical model features across most content areas, and (c) a relatively high prevalence of neurodiversity paradigm features related specifically to language use and the description of autistic traits. Conclusions Implications include the need for clinicians to (a) familiarize themselves with the varying views of autism held within the autistic community, (b) reflect on the language used to talk about autism and listen to how clients and/or their caregivers talk about it, and (c) consider the exploration of potential positive dimensions of autistic traits.

Life Is a Stage: Autistic Perspectives on Neurotypicality.

Background: Professional interventions for autistic people often encourage the development of neurotypical behavior. However, the pressure to appear or behave neurotypically has been associated with negative mental health outcomes. Consequently, autistic perspectives on the concept of neurotypicality are a critical area for empirical research. As a follow-up to a prior study on perceptions of autism, the present study examined the concept of neurotypicality as represented in 39 online video logs authored by YouTubers who self-identified as autistic. The study aimed to understand autistic perspectives on neurotypicality to guide professional service provision toward practices that support overall well-being. Methods: Consistent with procedures frequently implemented within narrative inquiry, we identified three exemplary videos that presented salient and consistent narratives about neurotypicality. We submitted transcripts of these three videos to inductive thematic analysis to establish their distinctive features and hence the features of the narratives they embodied. Afterward, we used the distinctive features of the exemplary videos to deductively analyze the remaining 36 videos in the data set. Findings: The three exemplary videos presented features that related to three divergent narratives about neurotypicality that were supported by the data set as a whole: neurotypicality as (1) an achievement; (2) a masquerade; and (3) a curse. These three narratives differed sharply in regard to the desirability and feasibility of neurotypical conduct. Across all narratives, neurotypical behavior was associated with significant effort. Conclusions: Implications for professionals serving the autism community include the need to be prepared to offer clients different narratives about neurotypical behavior, as presented in writings and media authored by autistic individuals. A second implication concerns the need to align intervention and educational goals with a client's views and values. Finally, independent of the goals established between professionals and clients, the former must monitor the stress and effort associated with the enactment of neurotypicality and make changes accordingly. Lay summary: Why was this study done?: Professionals often want to help autistic clients to behave like people who are not autistic (often called neurotypicals). However, we do not know much about how people on the autism spectrum feel about the idea of neurotypicality. In this study, we analyzed 39 videos from YouTubers who identified as autistic to learn more about what they think of neurotypicality.What was the purpose of this study?: Our goal was to learn directly from autistic individuals and to help professionals (e.g., psychologists and speech-language therapists) to provide better services to the autistic community.What did the researchers do?: We chose three of the videos that were good examples of different ways of thinking about neurotypicality. We analyzed the three videos to identify their unique features. Then we identified examples of those features in the other 36 videos in our data set.What were the results of the study?: We identified three ways of thinking about neurotypicality: neurotypicality as (1) an achievement; (2) a masquerade or theatrical performance; and (3) a curse. These ways of thinking about neurotypicality differed mostly in regard to the extent to which neurotypicality was desired and considered possible. A shared characteristic was that neurotypical behavior required a lot of effort from autistic individuals.What do these findings add to what was already known?: The findings of our study highlight the effort associated with neurotypical behavior and the connection between neurotypical behavior and mental health. The study can help professionals to better understand what behaving neurotypically feels like for autistic individuals. It also has the potential to increase discussions about neurotypicality by amplifying the autistic voices that are still underrepresented in scientific studies.What are potential weaknesses in the study?: The ways of thinking about neurotypicality that we identified in our data may not be representative of all the autistic community because most of the vloggers in our data were white males who identified with Asperger's syndrome. Also, our study included only videos recorded in English and uploaded to YouTubeTM between 2005 and 2015. Future studies should include individuals from all areas of the autism spectrum and more recent data presented in more varied formats and languages.How will these findings help autistic adults now or in the future?: The findings of our study suggest that professionals who serve the autistic community should be able to share with others different views of neurotypicality, help clients work toward goals that are important to them, and monitor signs of stress caused by the effort to behave neurotypically. This should in turn positively impact the quality of services provided to the autistic community and with it the overall well-being of people on the autism spectrum.

Genetic testing and autism: Tutorial for communication sciences and disorders.

This tutorial provides professionals in communication sciences and disorders with an overview of the molecular basis and parental perceptions of genetic testing as associated with autism. The introduction notes the prominence of genetic testing within present-day medical practices and highlights related limitations and concerns through the lens of disability critique. The body of the tutorial provides an overview of four different forms of genetic variation, highlighting the potential associations with autism and available genetic testing. In sum, most autism cases cannot be associated directly with specified forms of genetic variation but are attributed instead to multiple genetic and environmental influences working in concert. Finally, the discussion focuses on parental perceptions of the genetic testing associated with autism, both the potential benefits and harms, and emphasizes the need to integrate first-person perspectives from autistic individuals.

Clinical Implications for Working With Nonmainstream Dialect Speakers: A Focus on Two Filipino Kindergartners.

Purpose: The purpose of this clinical focus piece is to increase familiarity with Philippine English (PE) and highlight clinical implications for working with nonmainstream dialect speakers. Method: The clinical focus draws on descriptive case study data from 2 Filipino kindergarten boys who live in the United States. Multiple ethnographic data sources were subjected to contrastive analyses regarding nonmainstream features in the children's speech that might be consistent with PE. Results: The 2 boys demonstrated grammatical and phonological features consistent with their home dialect, PE, and individualized variation relative to one another. We utilize these findings to illustrate 2 key implications for providing culturally competent clinical services when working with nonmainstream dialect speakers: (a) validate and support all Mainstream American English Learners in the classroom and (b) recognize that variance within a dialect is not always indicative of disorder. Explicit recommendations for clinical practice are provided. Conclusion: Understanding and validating the diversity of nonmainstream dialect speakers within the U.S. schools are critical to providing culturally competent speech-language services.

Illustrating a Supports-Based Approach Toward Friendship With Autistic Students.

Purpose: The present clinical focus article describes and illustrates 3 key elements of a supports-based approach to enhancing friendship with autistic students. Method: In comparison to the predominant skills-based approach, we highlight 3 key elements of a supports-based approach to social interaction for autistic children and youth. We then offer descriptive details of the activity-based music program as an illustrative example of a program that integrated all 3 elements of a supports-based approach. Specifically, we designed an activity-based music program to enhance social interaction among a 7-year-old autistic student and 4 of his nonautistic peers. Results: We focused on 3 key elements of a supports-based approach for enhancing peer interaction: (a) focusing on participation in a shared activity, (b) encouraging flexible use of multiple communicative resources, and (c) supporting egalitarian interaction. Conclusion: A supports-based approach presents a theoretically distinct and viable alternative to a skills-based approach in the design of social supports for autistic students and their peers.

Longitudinal Associations Across Prematurity, Attention, and Language in School-Age Children.

Purpose: This research note explores the potential role of attention in mediating previously reported associations between language outcomes and prematurity. Method: As a follow-up investigation to Mahurin Smith, DeThorne, Logan, Channell, and Petrill (2014), we employed multilevel modeling to analyze longitudinal data on language and attention collected when children were, on average, ages of 7, 8, and 10 years. The sample of 114 children taken from the Western Reserve Reading and Math Project was selected to oversample children with a history of prematurity while also controlling for differences in confounding influences such as age, gender, parental education, and race. Results: As predicted, attention differentially predicted language outcomes based on form of measurement. Specifically, parent and examiner ratings of attention were significantly associated with standardized test performance at all 3 time points (R2 = 15.2%-20%). Associations between attention and language sample measures were less consistent across home visits and tended to be smaller in effect size. Conclusion: Attention abilities are associated with children's language performance even in the absence of an attention-deficit/hyperactivity disorder diagnosis. Clinical implications, particularly as related to assessment, are discussed.

Longitudinal Effects on Early Adolescent Language: A Twin Study.

Purpose: We evaluated genetic and environmental contributions to individual differences in language skills during early adolescence, measured by both language sampling and standardized tests, and examined the extent to which these genetic and environmental effects are stable across time. Method: We used structural equation modeling on latent factors to estimate additive genetic, shared environmental, and nonshared environmental effects on variance in standardized language skills (i.e., Formal Language) and productive language-sample measures (i.e., Productive Language) in a sample of 527 twins across 3 time points (mean ages 10-12 years). Results: Individual differences in the Formal Language factor were influenced primarily by genetic factors at each age, whereas individual differences in the Productive Language factor were primarily due to nonshared environmental influences. For the Formal Language factor, the stability of genetic effects was high across all 3 time points. For the Productive Language factor, nonshared environmental effects showed low but statistically significant stability across adjacent time points. Conclusions: The etiology of language outcomes may differ substantially depending on assessment context. In addition, the potential mechanisms for nonshared environmental influences on language development warrant further investigation.

Causal effects on child language development: A review of studies in communication sciences and disorders.

UNLABELLED: We reviewed recent studies published across key journals within the field of communication sciences and disorders (CSD) to survey what causal influences on child language development were being considered. Specifically, we reviewed a total of 2921 abstracts published within the following journals between 2003 and 2013: Language, Speech, and Hearing Services in Schools (LSHSS); American Journal of Speech-Language Pathology (AJSLP); Journal of Speech, Language, and Hearing Research (JSLHR); Journal of Communication Disorders (JCD); and the International Journal of Language and Communication Disorders (IJLCD). Of the 346 eligible articles that addressed causal factors on child language development across the five journals, 11% were categorized as Genetic (37/346), 83% (287/346) were categorized as Environmental, and 6% (22/346) were categorized as Mixed. The bulk of studies addressing environmental influences focused on therapist intervention (154/296=52%), family/caregiver linguistic input (65/296=22%), or family/caregiver qualities (39/296=13%). A more in-depth review of all eligible studies published in 2013 (n=34) revealed that family/caregiver qualities served as the most commonly controlled environmental factor (e.g., SES) and only 3 studies explicitly noted the possibility of gene-environment interplay. This review highlighted the need to expand the research base for the field of CSD to include a broader range of environmental influences on child language development (e.g., diet, toxin exposure, stress) and to consider more directly the complex and dynamic interplay between genetic and environmental effects. LEARNING OUTCOMES: Readers will be able to highlight causal factors on child language development that have been studied over the past decade in CSD and recognize additional influences worthy of consideration. In addition, readers will become familiar with basic tenets of developmental systems theory, including the complex interplay between genetic and environmental factors that shapes child development.

From aardvark to ziggurat: A new tool for assessing children's use of rare vocabulary.

This study introduces a resource for examining children's use of low-frequency vocabulary and describes preliminary evidence of its validity. Using a corpus of >1400 transcripts from school-aged children, we derived a concordance of all words spoken by the children and generated a list of 2079 uncommon words we have called WERVE, the Wordlist for Expressive Rare Vocabulary Evaluation. Preliminary validity evidence for WERVE was examined through correlation analyses with WERVE results and other common language measures in a test sample of 112 children age 7 and 8 years. In addition, we replicated the correlation analyses using a sample of 38 eight-year-old children. WERVE results correlated strongly with established language sample measures and to a lesser but frequently significant degree with standardized test results. Results also showed developmental change from age 7 to age 8. Correlations ranged from medium to large. These results suggest that WERVE may be a useful tool for language sample researchers to explore.

Visualizing Syllables: Real-Time Computerized Feedback Within a Speech-Language Intervention.

Computerized technologies now offer unprecedented opportunities to provide real-time visual feedback to facilitate children's speech-language development. We employed a mixed-method design to examine the effectiveness of two speech-language interventions aimed at facilitating children's multisyllabic productions: one incorporated a novel computerized feedback system, VocSyl, while the other used a traditional noncomputerized pacing board. Eighteen children with a variety of diagnoses, all of whom were at the single word stage of development, enrolled in either one of the two explicit speech-language interventions (VocSyl or Pacing Board) or an active control group. Convergent findings between and within groups supported the effectiveness of the VocSyl condition. For the children with a clinical diagnosis of autism in particular, visual inspection of individual data on treatment versus control targets indicated positive treatment effects for both of the two children enrolled in the VocSyl condition and one of the two children enrolled in the Pacing Board condition. Although the study does not permit definitive conclusions about the effectiveness of any particular treatment tool or strategy in isolation, it offers preliminary support for the integration of real-time computerized feedback within speech-language intervention.

Impact of prematurity on language skills at school age.

PURPOSE: The existing literature on language outcomes in children born prematurely focuses almost exclusively on standardized test scores rather than discourse-level abilities. The authors of this study looked longitudinally at school-age language outcomes and potential moderating variables for a group of twins born prematurely versus a control group of twins born at full term, analyzing both standardized test results and language sample data from the population-based Western Reserve Reading Project (WRRP; Petrill, Deater-Deckard, Thompson, DeThorne, & Schatschneider, 2006). METHOD: Fifty-seven children born prematurely, at ≤32 weeks or <1,500 g, were compared with 57 children born at full term and were matched for age, gender, race, and parental education. Data included discourse-level language samples and standardized test results, collected at average ages 7, 8, and 10 years. The language samples were analyzed to yield a number of semantic and syntactic measures that were consolidated via factor analysis. RESULTS: Regression models showed significant differences between the 2 groups for standardized test results, although the mean score for both groups fell in the normal range. For the discourse-level language measures, however, differences never reached statistical significance. Parental education was significantly associated with improved standardized test scores. CONCLUSIONS: These findings suggest that in the absence of frank neurological impairment, sophisticated semantic and syntactic skills may be relatively intact in the discourse-level language of children born prematurely. Implications for assessment, particularly the potential role of attention and executive function in standardized testing tasks, are reviewed.

Severe speech sound disorders: an integrated multimodal intervention.

PURPOSE: This study introduces an integrated multimodal intervention (IMI) and examines its effectiveness for the treatment of persistent and severe speech sound disorders (SSD) in young children. The IMI is an activity-based intervention that focuses simultaneously on increasing the quantity of a child's meaningful productions of target words and providing supports to shape the quality of natural speech productions of target sounds by systematically incorporating the full range of each child's communicative repertoire, including augmentative and alternative communication (AAC) systems and natural speech and language. METHOD: A multiple-probe single-subject research design was used to assess the effectiveness of the IMI for 3 boys (ages 4 to 8) with moderate to severe SSD, all of whom used speech-generating AAC. RESULTS: All 3 participants demonstrated an increase in the amount of speech they produced (i.e., quantity) and an increase in the production accuracy of their target speech sounds (i.e., quality). CONCLUSION: This study demonstrated that simultaneously targeting natural speech and AAC speech using an integrated multimodal approach was effective in producing positive changes in both communication and speech production goals. These findings strongly suggest that integrating multimodal speech-generating AAC with traditional speech intervention was effective at supporting natural speech production for these children.