Recent research published in the renowned journal Pediatrics revealed that 70% of children diagnosed with autism spectrum disorders (ASD) who have a history of severe language delay can achieve fluent sentences or speech by the age of 8 years. These results suggest that 4-year-old children who have severe language delays can make notable language improvements. These results have important implications both at a therapeutic level and for future research on the topic.

The study

The research used the largest sample to date to examine the relationship between key deficits associated with ASD and the achievement of fluent speech or expression following severe language delay. As a common milestone in language development, a sentence is defined as the use of uncopied three-word expressions, which sometimes contain a verb and are spontaneous and meaningful; while fluent speech is characterized as the ability to use complex expressions to talk about topics that are outside the immediate physical context.

“We found that non-verbal intelligence was the most important predictor for constructing sentences, while social interest and engagement were just as relevant, or even more so, in predicting the age at which children reach sentences and develop fluent speech. language,” said Dr. Ericka L. Wodka , a neuropsychologist at Kennedy Krieger 's Center for Autism and Related Disorders and lead author of the study. “Children with average nonverbal intelligence achieved language almost six months earlier than those with below-average scores.”

These findings reinforce that basic skills, such as nonverbal intelligence and social engagement, have a greater influence on communication development than other behaviors associated with ASD, such as repetitions and abnormal sensory behaviors. “Our findings continue to support the importance of considering both nonverbal intelligence level and social communication when planning treatment, highlighting the different impacts of these factors in relation to treatment goals,” says Dr. Wodka.

The instruments

Data for this retrospective study were drawn from the Simon Simplex Collection (SSC), a unique multi-site database project, which collects biological and phenotypic data from children with ASD who are between four and eighteen years of age without previous genetic history of ASD. The database establishes a permanent repository of samples from 2,700 families, each of which has a child affected with ASD, and parents and siblings who have not been affected by the disorder.

From the SSC, a total of 535 children, aged eight and older, were chosen for the study. Using the Autism Diagnostic Interview-Revised (ADI-R), a standardized parent interview that distinguishes children with ASD from the population without these disorders, and the Austism Diagnosis Observation Schedule (ADOS, Observation Scale for the Diagnosis of Autism ), an observation administered by a therapist and that evaluates social, communicative and stereotypical behaviors, the researchers selected children who, or did not have developed the ability to construct sentences at the time they enrolled in the SSC , or the beginning of their development began after four years.

Based on the results on the ADI-R and their language presentation, children in this study were administered one of four assessment modules, namely: no words or single words (Module 1), sentences (Module 2) , or fluent speech (Modules 3 or 4). Of the 535 study participants, 119 were fluent in phrasing and 253 were fluent by age 8, while 163 never achieved fluent phrasing or language.

Implications on treatments and future research

“We hope that the results of this study will help parents of children with autism and severe language delays know that, with the right therapy, a child is likely to make significant progress in this area over time; however, expectations for progress should be lower for those children with lower intellectual abilities,” says Dr. Wodka. “Additionally, we hope that these findings will provide professionals with better and more defined therapeutic goals for their patients with autism.”

Future longitudinal studies, including both single and multiple families, are required to fully capture the prevalence and predictors of language development in children with ASD. In addition to this, future studies on the impact of social cognition strategies (e.g., perspective taking) on language development, as well as the relationship between specific social deficits and the development of fluent speech, may have implications important for the design of interventions.

Source: Kennedy Krieger Institute