Minimally Verbal School-Aged Children with Autism Spectrum Disorder: The Neglected End of the Spectrum: Minimally verbal children with ASD

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Abstract

It is currently estimated that about 30% of children with autism spectrum disorder remain minimally verbal, even after receiving years of interventions and a range of educational opportunities. Very little is known about the individuals at this end of the autism spectrum, in part because this is a highly variable population with no single set of defining characteristics or patterns of skills or deficits, and in part because it is extremely challenging to provide reliable or valid assessments of their developmental functioning. In this paper, we summarize current knowledge based on research including minimally verbal children. We review promising new novel methods for assessing the verbal and nonverbal abilities of minimally verbal school-aged children, including eye-tracking and brain-imaging methods that do not require overt responses. We then review what is known about interventions that may be effective in improving language and communication skills, including discussion of both nonaugmentative and augmentative methods. In the final section of the paper, we discuss the gaps in the literature and needs for future research.

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Thirty years and counting: finding meaning in the N400 component of the event-related brain potential (ERP).

Marta Kutas, Kara Federmeier (2011)

We review the discovery, characterization, and evolving use of the N400, an event-related brain potential response linked to meaning processing. We describe the elicitation of N400s by an impressive range of stimulus types--including written, spoken, and signed words or pseudowords; drawings, photos, and videos of faces, objects, and actions; sounds; and mathematical symbols--and outline the sensitivity of N400 amplitude (as its latency is remarkably constant) to linguistic and nonlinguistic manipulations. We emphasize the effectiveness of the N400 as a dependent variable for examining almost every aspect of language processing and highlight its expanding use to probe semantic memory and to determine how the neurocognitive system dynamically and flexibly uses bottom-up and top-down information to make sense of the world. We conclude with different theories of the N400's functional significance and offer an N400-inspired reconceptualization of how meaning processing might unfold.

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Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model.

Geraldine Dawson, Sally Rogers, Jeffrey Munson … (2010)

To conduct a randomized, controlled trial to evaluate the efficacy of the Early Start Denver Model (ESDM), a comprehensive developmental behavioral intervention, for improving outcomes of toddlers diagnosed with autism spectrum disorder (ASD). Forty-eight children diagnosed with ASD between 18 and 30 months of age were randomly assigned to 1 of 2 groups: (1) ESDM intervention, which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years; or (2) referral to community providers for intervention commonly available in the community. Compared with children who received community-intervention, children who received ESDM showed significant improvements in IQ, adaptive behavior, and autism diagnosis. Two years after entering intervention, the ESDM group on average improved 17.6 standard score points (1 SD: 15 points) compared with 7.0 points in the comparison group relative to baseline scores. The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children. In contrast, over the 2-year span, the comparison group showed greater delays in adaptive behavior. Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder, not otherwise specified, than the comparison group. This is the first randomized, controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis. Results of this study underscore the importance of early detection of and intervention in autism.

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The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): new methods for more potent eHealth interventions.

Kathleen L. Collins, Victor Strecher, Debra Murphy (2007)

In this article two new methods for building and evaluating eHealth interventions are described. The first is the Multiphase Optimization Strategy (MOST). It consists of a screening phase, in which intervention components are efficiently identified for inclusion in an intervention or for rejection, based on their performance; a refining phase, in which the selected components are fine tuned and issues such as optimal levels of each component are investigated; and a confirming phase, in which the optimized intervention, consisting of the selected components delivered at optimal levels, is evaluated in a standard randomized controlled trial. The second is the Sequential Multiple Assignment Randomized Trial (SMART), which is an innovative research design especially suited for building time-varying adaptive interventions. A SMART trial can be used to identify the best tailoring variables and decision rules for an adaptive intervention empirically. Both the MOST and SMART approaches use randomized experimentation to enable valid inferences. When properly implemented, these approaches will lead to the development of more potent eHealth interventions.