Natural language acquisition and gestalt language processing: A critical analysis of their application to autism and speech language therapy.

Background and Aim: Recently, there has been a lot of interest surrounding the term gestalt language processor (GLP) which is associated with Natural Language Acquisition (NLA): a protocol intended to support the language development of autistic people. In NLA, delayed echolalia is presumed raw source material that GLPs use to acquire language in a stage-like progression from delayed echolalia to spontaneous speech. The aim of this article is to evaluate NLA in light of relevant literatures to allow scrutiny of NLA claims. Main contributions: First, we review the notion of gestalt language and situate it in the broader literature on language styles to update understanding of its significance. We then review the links from gestalt language processing to autism and identify definitional and conceptual problems and clarify the construct 'episodic memory'. We discuss the 'raw material view of delayed echolalia' and identify theoretical and empirical shortcomings. Finally, we review Blanc's language stages and their accompanying assessment and language support recommendations and challenge their validity. Conclusions & Implications: The term 'gestalt language processor' is definitionally and conceptually troubled, the assertion that autistic people are GLPs is misleading and unhelpful, and evidence is lacking that GLP represents a legitimate clinical entity. The theoretical basis of NLA lacks empirical support. NLA stages are implausible and their accompanying assessment and support recommendations lack justification. We recommend the use of alternate, individualized, theoretically-sound, evidence-based, neurodiversity-affirming supports that are sensitive and responsive to the heterogeneity that defines autism.

Development of a Manualized Intervention to Support Episodic Memory in Autistic Children: Elaborative Reminiscing Is Key.

Episodic memory (EM) is memory for past personal experiences. EM and social development are inextricably linked, and both are impacted in autistic persons. Parents of autistic children can be taught to engage in a unique conversational style (i.e., elaborative reminiscing) to support a child's memory and social development. This article discusses the importance of EM in autism and describes a new manualized caregiver training to support EM in autistic children. An uncontrolled pre-post study design was employed to test proof of concept. Results affirmed the potential of this intervention for increasing caregivers' elaborateness and improving children's EM in a family-centered, naturalistic way. Results suggest that further treatment development and examination of effectiveness are needed. We argue that these kinds of intervention are important: not only is EM theoretically potent for social cognitive development, it is essential for a sense of self-determination, social connection, and psychological well-being.

A Review of the Nature and Development of Lying and Deception and Considerations for Teaching Prosocial Lying to Autistic Persons.

Compared with their neurotypical (NT) counterparts, persons with autism appear to be less inclined to tell lies and less skilled in delivering sophisticated forms of deception. At the same time, some forms of deception like white lies and prosocial lies are frequent in human interaction because they are important for social success. This article challenges the reader to evaluate the therapeutic potential for prosocial deception and teaching white-lie telling to autistic persons. The nature and development of antisocial and prosocial lying in NT development and autism are reviewed. Considerations for when to (and when not to) teach the skill of empathic lying are discussed and recommendations for how to teach the comprehension and production of prosocial lies are offered.

A Review of the Nature and Development of Humor Appreciation and Considerations for Teaching Humor to Autistic Persons.

The development of humor is complex and heterogeneous within and across neurotypical and neurodivergent groups. Some autistics develop differences (not deficits) in humor appreciation, whereas others report difficulties "getting the joke" and identify this as in need of support. This is important because humor appreciation and comprehension are linked to psychological well-being and social success. This article describes the therapeutic potential for teaching humor comprehension to autistic persons and the benefit of broader education efforts to forge an understanding of the value of "different senses of humor." The nature and development of humor comprehension in neurotypical development and autism are reviewed. Considerations for whether and how to teach humor comprehension are offered that maximize goodness-of-fit, prioritize autistic autonomy, and promote the sharing and appreciation of different kinds of "funny."

The Inventory of Physical Activity Barriers for Community-Dwelling Adults 50 Years of Age and Older: Development and Preliminary Validation.

BACKGROUND: Health care providers, including physical therapists, need to identify the reasons for insufficient physical activity (PA) to assist the 56% to 73% of community-dwelling adults 50 years of age and older who are not performing the recommended 150 minutes of moderate to vigorous PA. Currently, there is no feasible, multifactorial tool to assess PA barriers among this population. Without a tool, health care providers must either rely on self-generated questions or collate results from multiple assessments to identify PA barriers related to personal, social, and environmental factors, which can be time-consuming and incomplete. PURPOSE: To develop the Inventory of Physical Activity Barriers (IPAB), an assessment tool that examines personal, social, and environmental PA barriers. METHODS: We developed and psychometrically evaluated the IPAB using a 3-phase process. For phase 1, we used a deductive method to develop the initial scale. During phase 2, we refined the scale and explored its psychometric properties by collecting cross-sectional pilot data on community-dwelling adults 50 years of age and older. We used descriptive statistics, item-scale correlations, construct validity via Mann-Whitney U test, and internal consistency via Cronbach α to analyze the data from phase 2. After identifying the scale's potential for being valid and reliable, we implemented phase 3, a modified Delphi technique. RESULTS: Using item-scale correlations, descriptive statistics, and consensus among PA experts, we refined the initial scale from 172 items to 40 items. The 40-item IPAB demonstrated good construct validity (determined by the scale's ability to differentiate between individuals who did and did not meet 150 min/wk of moderate to vigorous PA; P = .01) and internal consistency (Cronbach α of 0.97). CONCLUSION: Our preliminary results suggest that the IPAB is valid and reliable. Using the IPAB, health care providers will be able to identify patients' PA barriers and thus develop individualized PA prescriptions, an evidence-based method of increasing PA.

The Development and Preliminary Psychometric Evaluation of the Theory of Mind Inventory: Self Report-Adult (ToMI:SR-Adult).

This study describes the development and psychometric evaluation of a new self-report measure of social cognition: the Theory of Mind Inventory:Self-report-Adult (ToMI:SR-Adult). Adults with autism (or a suspicion of autism; n = 111) and typically developing adults (n = 109) completed a demographic questionnaire and the ToMI:SR-Adult online. Both quantitative and qualitative self-reports of one's own theory of mind functioning were collected. The ToMI:SR-Adult performed well under all examinations of reliability and validity (internal consistency, accuracy of classification, contrasting-groups). The qualitative data confirmed impressions of validity and revealed that the adults in our sample had high levels of self-insight regarding their own theory of mind. The ToMI:SR-Adult is offered as a promising research and clinical tool for the assessment of social cognition in adults.

Autobiographical Memory in Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, Hearing Loss, and Childhood Trauma: Implications for Social Communication Intervention.

Purpose Speech-language pathologists (SLPs) work with a variety of populations at risk for poor autobiographical and episodic memory. The purpose of this tutorial is to describe autobiographical memory and how it is affected in children with autism spectrum disorder, attention-deficit/hyperactivity disorder, hearing loss, and childhood trauma, as well as provide clinicians with practical strategies for supporting autobiographical memory in each of these clinical populations. Method This tutorial reviews the literature on (a) autobiographical and episodic memory in typical development; (b) its relation to theory of mind, personal narrative skills, and executive functions; (c) elaborative reminiscing in typical development; (d) how autobiographical memory is impaired in children with autism spectrum disorder, attention-deficit/hyperactivity disorder, hearing loss, and childhood trauma; and (e) strategies for supporting autobiographical memory in each clinical population. Conclusions When adequately prepared, SLPs are uniquely situated to address autobiographical and episodic memory in their work with children, families, and related professionals. This is a long-overdue focus of such great clinical import that justifies its inclusion in the traditional training and preparation of SLPs. Adapting elaborative reminiscing strategies for use with various clinical populations is promising for facilitating healthy EM development and related cognitive functions.

Brief Report: Me, Reporting on Myself: Preliminary Evaluation of the Criterion-Related Validity of the Theory of Mind Inventory-2 when Completed by Autistic Young Adults.

There is a need for increased understanding of self-report measures for autistic individuals. In this preliminary study, we examine how a theory of mind self-report relates to other self-report measures for groups of autistic and neurotypical individuals, as well as eye tracking outcomes. Expected patterns of relatedness emerged between self-reports and the eye tracking findings, which lends validity to the theory of mind measure. Self-report measures are critical for autistic individuals to share their own experiences and this is the first step in establishing a theory of mind self-report tool.

Using Story-Based Interventions to Improve Episodic Memory in Autism Spectrum Disorder.

Episodic memory (EM) and scene construction are critical for organizing and understanding personally experienced events and for developing several aspects of social cognition including self-concept, identity, introspection, future thinking, counterfactual reasoning, theory of mind, self-regulation, flexible problem-solving, and socially adaptive behavior. This article challenges the reader to think differently about EM in children with autism spectrum disorder (ASD), as we expand our understanding of autobiographical memory that requires an ability to travel back in time and re-experience an event. The role of EM in cognitive and behavioral functioning for children with and without ASD is described. The value of story-based interventions such as Social Stories and Comic Strip Conversations for supporting EM is discussed with adaptations recommended to ensure a rich personal recall of an event. By focusing on EM and scene construction, there is potential for increasing the potency of story-based interventions for achieving maximum therapeutic impact.

Mothers' and Children's Story-Telling: A Study of Dyads with Typically Developing Children and Children with ASD.

The production of specific mental state terms types and functions by caregivers and their TD children and caregivers and their children with ASD were assessed in two contexts: a parent's story-telling task and a child's story-telling task. Caregivers of children with ASD produced less causal talk and proportionally less desire and cognitive talk than did caregivers of TD children. When focusing only on variation in our ASD sample, caregivers' and children's production of different mental state references varied with context and were predicted by different child characteristics (i.e., theory of mind, autism severity, language level). We conclude that caregivers are likely adjusting different aspects of mental state input depending on different aspects of child development although these adjustments may not always be optimal.

Using communication to reduce challenging behaviors in individuals with autism spectrum disorders and intellectual disability.

This article describes the relationship between expressive communication impairments and common challenging behaviors in individuals with Autism Spectrum Disorder and Intellectual Disability. The communication challenges of individuals with Autism Spectrum Disorder/Intellectual Disability are described and several evidence-based intervention strategies are proposed to support communication so as to decrease challenging behaviors. Recommendations for practice are offered.

The social validity of Social Stories™ for supporting the behavioural and communicative functioning of children with autism spectrum disorder.

This study examines the social validity of a family-centred collaborative approach to developing Social Stories™ to support the behavioural and communicative functioning of children with autism spectrum disorder (ASD). Twenty children with Pervasive Developmental Disorder (PDD)/Autism, PDD-Not Otherwise Specified, or Asperger's Disorder (aged 4-12 years) participated in a multiple baseline design across behaviours with a 6-week follow-up. The effects of behaviour stories (to reduce problem behaviours) and communication stories (to facilitate communication) as assessed by parental subjective perceptions of child functioning were evaluated and compared. Using daily parental ratings, behaviour stories were deemed effective for 11 of 17 stories (64.7%), whereas communication stories were deemed effective for 10 of 19 stories (52.6%), with great variability in effect size for both. Results also indicated variability in performance across specific story targets, although parents' perceived effects of Social Stories™ were not linked to any known child characteristics. This study argues that intervention using Social Stories™ to address behavioural and communicative functioning can yield socially valid outcomes across a range of child characteristics and intervention targets. Implications for clinical practice and how present methodological limitations can be addressed in future research are considered.

Psychometric evaluation of the Theory of Mind Inventory (ToMI): a study of typically developing children and children with autism spectrum disorder.

Two studies examined the psychometric properties of the Theory of Mind Inventory (ToMI). In Study One, 135 caregivers completed the ToMI for children (ages 3 through 17) with autism spectrum disorder (ASD). Findings revealed excellent test-retest reliability and internal consistency. Principle Components Analysis revealed three subscales related to the complexity of ToM understanding. In Study Two, data were collected for 124 typically developing children (2 through 12 years). Findings again revealed excellent test-retest and internal consistency. The ToMI distinguished groups by age (younger vs. older children) and developmental status (typically developing vs. ASD), and predicted child performance on a ToM task battery. Utility of the ToMI, study limitations and directions for future research are discussed.

Dysphagia management: a survey of school-based speech-language pathologists in Vermont.

PURPOSE: This study (a) gathered information about the kinds of dysphagia management services school-based speech-language pathologists (SLPs) provide, (b) examined the attitudes of SLPs related to dysphagia management, (c) compared the responses of SLPs on the basis of their experience working in a medical setting, and (d) investigated the relationship between SLPs' training and their confidence to provide dysphagia services. METHOD: Fifty-two school-based SLPs practicing in Vermont responded to a survey designed to gather information on the variables of interest. RESULTS: Respondents reported a low incidence of students requiring dysphagia services and SLPs providing a wide range of dysphagia services. Results indicated variability in attitudes related to dysphagia management, but trends were also evident. Chief among them were SLPs' low levels of confidence to provide dysphagia services and the need for additional training in dysphagia management. SLPs who had experience in a medical setting reported greater confidence to evaluate and treat students with dysphagia compared to those without experience in a medical setting. Relationships between a variety of previous training experiences and confidence to treat dysphagia were also revealed. CONCLUSION: This study expanded previous research in this area. Factors accounting for our results, limitations, directions for future research, and implications for practice are discussed.

Brief report: preliminary evaluation of the theory of mind inventory and its relationship to measures of social skills.

This study presents updated information on a parent-report measure of Theory of Mind (ToM), formerly called the Perception of Children's Theory of Mind Measure (Hutchins et al., J Autism Dev Disord 38:143-155, 2008), renamed the Theory of Mind Inventory (ToMI), for use with parents of children with autism spectrum disorder (ASD). This study examines the responses of parents of adolescents with ASDs and explores the relationship of parental responses on the ToMI to measures of autistic symptoms and social skills. Descriptive statistics were compared to previous samples; correlations and regressions were conducted to examine the ToMI's criterion-related validity with social skills and ASD symptoms. Results support use of the ToMI with adolescent samples and its relationship to social impairments in ASDs.

Video-based coping skills to reduce health risk and improve psychological and physical well-being in Alzheimer's disease family caregivers.

OBJECTIVE: To determine whether video-based coping skills (VCS) training with telephone coaching reduces psychosocial and biological markers of distress in primary caregivers of a relative with Alzheimer's disease or related dementia (ADRD). METHODS: A controlled clinical trial was conducted with 116 ADRD caregivers who were assigned, alternately as they qualified for the study, to a Wait List control condition or the VCS training arm in which they viewed two modules/week of a version of the Williams LifeSkills Video adapted for ADRD family care contexts, did the exercises and homework for each module presented in an accompanying Workbook, and received one telephone coaching call per week for 5 weeks on each week's two modules. Questionnaire-assessed depressive symptoms, state and trait anger and anxiety, perceived stress, hostility, caregiver self-efficacy, salivary cortisol across the day and before and after a stress protocol, and blood pressure and heart rate during a stress protocol were assessed before VCS training, 7 weeks after training was completed, and at 3 months' and 6 months' follow-up. RESULTS: Compared with controls, participants who received VCS training plus telephone coaching showed significantly greater improvements in depressive symptoms, trait anxiety, perceived stress, and average systolic and diastolic blood pressures that were maintained over the 6-month follow-up period. CONCLUSIONS: VCS training augmented by telephone coaching reduced psychosocial and biological indicators of distress in ADRD caregivers. Future studies should determine the long-term benefits to mental and physical health from this intervention. TRIAL REGISTRATION: http://www.clinicaltrials.gov; #NCT00396825.

Maternal epistemological perspectives and variations in mental state talk.

PURPOSE: This study examined how complexity of maternal epistemological beliefs predicted mothers' and children's talk about the mind. METHOD: Twenty-eight mothers of 5- to 10-year-olds completed a measure of receptive vocabulary, and mothers and children participated in a storytelling task specifically designed to elicit talk about the mind. Their use of mental state terms to encode pragmatic functions and mothers' epistemologies were assessed and compared. RESULTS: Maternal mental state talk and amount of talk increased with epistemological complexity. With the number of utterances held constant, mothers with simple, dualistic perspectives of knowledge used mental states more often to direct interaction; mothers with more complex epistemologies used mental states more often to encourage child reflection. Mothers with the less complex perspective underperformed on the receptive vocabulary measure in comparison to others. Children's amount of talk and use of a variety of mental state terms also increased with maternal epistemological complexity. The amount of talk and mental state terms produced by mothers and children frequently persisted after the effects of maternal receptive vocabulary were removed. CONCLUSIONS: Maternal epistemologies predict several qualities of mothers' and children's mental state talk that may contribute to children's developing theory of mind.

Beyond false beliefs: the development and psychometric evaluation of the perceptions of children's theory of mind measure-experimental version (PCToMM-E).

The Perceptions of Children's Theory of Mind Measure (Experimental version; PCToMM-E) is an informant measure designed to tap children's theory of mind competence. Study one evaluated the measure when completed by primary caregivers of children with autism spectrum disorder. Scores demonstrated high test-retest reliability and correlated with verbal mental age and ToM task battery performance. No ceiling effects were observed. In addition, caregivers accurately predicted their children's ToM task battery performance. In study two the scores of primary caregivers of typically developing children demonstrated high test-retest reliability and distinguished children on the basis of age and developmental status. Ceiling effects were not evident until late childhood. The utility of the PCToMM-E and directions for future research are discussed.

Using social stories and comic strip conversations to promote socially valid outcomes for children with autism.

Very little is documented regarding the efficacy of social stories and comic strip conversations for promoting an understanding of social situations and the appropriate social behaviors of individuals with autism spectrum disorder (ASD). In addition, few studies on the efficacy of social stories have examined whether outcomes are socially valid. The purpose of this article is to respond to some of the gaps in the literature on the efficacy of a frequently used intervention for children with ASD and to describe a family-centered collaborative approach to developing social stories and comic strip conversations. The results of intervention employing an A-B design are reported for two case vignettes. Clinical implications, limitations of the available data, and potential factors contributing to outcome variability are discussed.