Abstract
Data from children with ASD who are learning Indo-European languages indicate that (a) they vary hugely in their expressive language skills and (b) their pragmatic/socially-based language is more impaired than their structural language. We investigate whether similar patterns of language development exist for Mandarin-exposed children with ASD. Parent report data of the Putonghua Communicative Development Inventory—Toddler Form were collected from 160 17–83-month-old children with ASD. These children with ASD demonstrated similar levels of variability as Western children with ASD. In particular, they could be divided into three distinct subgroups (high verbal, middle verbal, low verbal), all of which manifested relative strengths in lexical and grammatical language compared to pragmatic usage of decontextualized language.
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Notes
In the present study, we consider the pragmatic skills of children with ASD to include both the narrow concept of pragmatics (i.e., is concerned with the linguistic aspect of language use, including the child’s discourse and narrative skills such as turn-taking, producing speech act, use of figurative and inferential language, etc.) and the broad concept of pragmatics (i.e., is concerned with the communicative and functional aspects of language use, such as the child’s early use of communicative gestures and joint attention). This is because we wish to focus on the natural language use of young children with ASD, which includes an integration of the linguistic, social and communicative aspects of early pragmatic development.
As with the MCDI, the section of ‘How Children Use Words’ in the PCDI also contains 5 items about the frequency of the child’s use of words for the past, future, absent object (production), absent object (comprehension) and absent owner. For the purpose of analyzing expressive language in children with ASD, we only report the results of the 4 production items in the present study.
We also compared results of the MV group to the Tardif et al. (2008) norms from TD boys at 22 months of age, even though their overall vocabulary trended higher (p = .06) than the MV group. We found no significant group differences on noun, t (73) = 1.24, p > .05, d = .28, word combination, χ2 = 2.62, p > .05, V = .19, and sentence complexity, t (73) = .19, p > .05, d = .04; however, the TD22 group had higher scores on the verb, pronoun, classifier, and question word lexical subcategories (ts > 2.23, ps < .05, ds > .51), and on the possessive and aspect marker grammatical items (chi-squares > 6.10, ps < .05, Vs > .29), as well as on 3 of the 4 decontextualized language items (chi-squares > 19.13, ps < .001, Vs > .51) except for ‘absent toys/animals’ which trended higher (χ2 = 3.54, p = .06, V = .22).
The results were similar if we omit 9 additional children aged between 5;0 and 5;6.
References
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Publishing.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.: American Psychiatric Publishing.
Baron-Cohen, S. (2000). Theory of mind and autism: A fifteen year review. In S. Baron-Cohen, H. Tager-Flusberg & D. J. Cohen (Eds.), Understanding other minds: Perspectives from developmental cognitive neuroscience (pp. 3–20). Oxford: Oxford University Press.
Baron-Cohen, S., Baldwin, D. A., & Crowson, M. (1997). Do children with autism use the speaker’s direction of gaze strategy to crack the code of language? Child Development, 68(1), 48–57.
Bauminger-Zviely, N., Golan-Itshaky, A., & Tubul-Lavy, G. (2017). Speech acts during friends’ and non-friends’ spontaneous conversations in preschool dyads with high-functioning autism spectrum disorder versus typical development. Journal of Autism and Developmental Disorders, 47(5), 1380–1390.
Bishop, D. V. M. (2003). The children’s communication checklist—2. London: Psychological Corporation.
Bruinsma, Y., Koegel, R. L., & Koegel, L. K. (2004). Joint attention and children with autism: A review of the literature. Mental Retardation and Developmental Disabilities Research Reviews, 10(3), 169–175.
Bryant, J. B. (2015). Pragmatic development. In E. Bavin & L. R. Naigles (Eds.), The Cambridge handbook of child language (2nd ed., pp. 438–457). Cambridge: Cambridge University Press.
Charman, T., Drew, A., Baird, C., & Baird, G. (2003). Measuring early language development in preschool children with autism spectrum disorder using the MacArthur Communicative Development Inventory (Infant Form). Journal of Child Language, 30(1), 213–236.
Charman, T., Howlin, P., Berry, B., & Prince, E. (2004). Measuring developmental progress of children with autism spectrum disorder on school entry using parent report. Autism, 8(1), 89–100.
Charman, T., Swettenham, J., BaronCohen, S., Cox, A., Baird, G., & Drew, A. (1997). Infants with autism: An investigation of empathy, pretend play, joint attention, and imitation. Developmental Psychology, 33(5), 781–789.
Chiang, C.-H., Soong, W.-T., Lin, T.-L., & Rogers, S. J. (2008). Nonverbal communication skills in young children with autism. Journal of Autism and Developmental Disorders, 38(10), 1898–1906.
Dennis, M., Lazenby, A., & Lockyer, L. (2001). Inferential language in high-function children with autism. Journal of Autism and Developmental Disorders, 31, 47–54.
Durrleman-Tame, S., Burnel, M., & Reboul, A. (2017). Connections among complementation sentences, executive functioning, and theory of mind in autism. In L. R. Naigles (Ed.), Innovative investigations of language in autism spectrum disorder (pp. 163–182). Washington, DC: American Psychological Association.
Eigsti, I.-M., Bennetto, L., & Dadlani, M. B. (2007). Beyond pragmatics: Morphosyntactic development in autism. Journal of Autism and Developmental Disorders, 37(6), 1007–1023.
Eigsti, I.-M., de Marchena, A. B., Schuh, J. M., & Kelley, E. (2011). Language acquisition in autism spectrum disorders: A developmental review. Research in Autism Spectrum Disorders, 5(2), 681–691.
Fenson, L., Dale, P. S., Reznick, J. S., Thal, D., Bates, E., Hartung, J. P., et al. (1993). The MacArthur communicative development inventories: User’s guide and technical manual. San Diego: Singular Publishing Group.
Geurts, H. M. (2007). CCC-2-NL: Children’s communication checklist-2. Amsterdam: Harcourt Assessment B.V.
Geurts, H. M., & Embrechts, M. (2008). Language profiles in ASD, SLI, and ADHD. Journal of Autism and Developmental Disorders, 38(10), 1931–1943.
Happe, F. G. E. (1993). Communicative competence and theory of mind in autism. A test of relevance theory. Cognition, 48, 101–109.
Huang, A. X., Jia, M., & Wheeler, J. J. (2013). Children with autism in the People’s Republic of China: Diagnosis, legal issues, and educational services. Journal of Autism and Developmental Disorders, 43(9), 1991–2001.
Ingram, D. (1981). Procedures for the phonological analyses of children’s language. Baltimore, MD: University Park Press.
Jyotishi, M., Fein, D. A., & Naigles, L. R. (2017). “Didn’t I just say that?” Comparing parent report and spontaneous speech as indicators of grammatical development. Research in Developmental Disabilities, 61, 32–43.
Kjelgaard, M. M., & Tager-Flusberg, H. (2001). An investigation of language impairment in autism: Implications for genetic subgroups. Language & Cognitive Processes, 16(2–3), 287–308.
Krug, D. A., Arick, J., & Almond, P. (1980). Behavior checklist for identifying severely handicapped individuals with high levels of autistic behavior. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 21(3), 221–229.
Lam, K.-H., & Ho, C. S.-H. (2014). Pragmatic skills in Chinese dyslexic children: Evidence from a parental checklist. Asia Pacific Journal of Developmental Differences, 1, 4–19.
Lee, D., & Chen, G.-P. (1989). Ravens progressive matrices (CRT): Chinese version. Shanghai: East China Normal University.
Leech, K., Wei, R., Harring, J., & Rowe, M. (2017). Ready for kindergarten: A training program designed to encourage parent-child conversation during the preschool years. Paper presented at the 2017 Society for Research in Child Development Biennial Meeting, Austin, Texas, USA.
Liang, W., Hao, B., Wang, S., Jiang, Y., Yang, Y., Zhang, Z., et al. (2002). Vocabulary development of toddlers in urban Beijing. Chinese Journal of Pediatrics, 40(11), 650–653.
Lord, C., & Paul, R. (1997). Language and communication in autism. In D. J. Cohen & F. R. Volkmar (Eds.), Handbook of autism and pervasive developmental disorders (2nd ed., pp. 195–225). New York: Wiley.
Losh, M., & Capps, L. (2003). Narrative ability in high-functioning children with autism or Asperger’s syndrome. Journal of Autism and Developmental Disorders, 33(3), 239–251.
Loukusa, S., Leinonen, E., Jussila, K., Mattila, M.-L., Ryder, N., & al., H. E. e (2007). Answering contextually demanding questions: Pragmatic errors produced by children with Asperger syndrome or high-functioning autism. Journal of Communication Disorders, 40, 357–381.
Luyster, R., Kadlec, M. B., Carter, A., & Tager-Flusberg, H. (2008). Language assessment and development in toddlers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 38(8), 1426–1438.
Luyster, R., Lopez, K., & Lord, C. (2007a). Characterizing communicative development in children referred for Autism Spectrum Disorders using the MacArthur-Bates Communicative Development Inventory (CDI). Journal of Child Language, 34(3), 623–654.
Luyster, R., Qiu, S. P., Lopez, K., & Lord, C. (2007b). Predicting outcomes of children referred for autism using the MacArthur-Bates communicative development inventory. Journal of Speech Language and Hearing Research, 50(3), 667–681.
McCabe, H. (2013). Bamboo shoots after the rain: Development and challenges of autism intervention in China. Autism, 17(5), 510–526.
McCann, J., & Peppe, S. (2003). Prosody in autism spectrum disorders: A critical review. International Journal of Language & Communication Disorders, 38(4), 325–350.
McCleery, J. P., Tully, L., Slevc, L. R., & Schreibman, L. (2006). Consonant production patterns of young severely language-delayed children with autism. Journal of Communication Disorders, 39(3), 217–231.
Miniscalco, C., Franberg, J., Schachinger-Lorentzon, U., & Gillberg, C. (2012). Meaning what you say? Comprehension and word production skills in young children with autism. Research in Autism Spectrum Disorders, 6(1), 204–211.
Miniscalco, C., Rudling, M., Rastam, M., Gillberg, C., & Johnels, J. A. (2014). Imitation (rather than core language) predicts pragmatic development in young children with ASD: a preliminary longitudinal study using CDI parental reports. International Journal of Language & Communication Disorders, 49(3), 369–375.
Mitchell, S., Brian, J., Zwaigenbaum, L., Roberts, W., Szatmari, P., Smith, I., et al. (2006). Early language and communication development of infants later diagnosed with autism spectrum disorder. Journal of Developmental and Behavioral Pediatrics, 27(2), S69-S78.
Mullen, E. (1995). Mullen scales of early learning. Circle Pines, MN : American Guidance Service, Inc.
Mundy, P., Sigman, M., & Kasari, C. (1990). A longitudinal study of joint attention and language development in autistic children. Journal of Autism and Developmental Disorders, 20(1), 115–128.
Mundy, P., Sigman, M., & Kasari, C. (1994). Joint attention, developmental level, and symptom presentation in autism. Development and Psychopathology, 6, 389–401.
Mundy, P., Sigman, M., Ungerer, J., & Sherman, T. (1986). Defining the social deficits of autism: the contribution of non-verbal communication measures. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 27(5), 657–669.
Nadig, A., Lee, I., Singh, L., Bosshart, K., & Ozonoff, S. (2010). How does the topic of conversation affect verbal exchange and eye gaze? A comparison between typical development and high-functioning autism. Neuropsychologia, 48(9), 2730–2739.
Naigles, L. R., Cheng, M., Rattanasone, N. X., Tek, S., Khetrapal, N., Fein, D., et al. (2016). “You’re telling me!” The prevalence and predictors of pronoun reversals in children with autism spectrum disorders and typical development. Research in Autism Spectrum Disorders, 27, 11–20.
Naigles, L. R., & Chin, I. (2015). Language development in children with autism. In E. Bavin & L. R. Naigles (Eds.), Cambridge handbook of child language (2nd ed., pp. 637–658). Cambridge: Cambridge University Press.
Naigles, L. R., & Tek, S. (2017). ‘Form is easy, meaning is hard’ revisited: (Re) Characterizing the strengths and weaknesses of language in children with autism spectrum disorder. Wiley Interdisciplinary Reviews: Cognitive Science. https://doi.org/10.1002/wcs.1438.
Norbury, C. F., Gemmell, T., & Paul, R. (2014). Pragmatics abilities in narrative production: a cross-disorder comparison. Journal of Child Language, 41(3), 485–510.
Nordahl-Hansen, A., Kaale, A., & Ulvund, S. E. (2014). Language assessment in children with autism spectrum disorder: Concurrent validity between report-based assessments and direct tests. Research in Autism Spectrum Disorders, 8(9), 1100–1106.
Ozcaliskan, S., Adamson, L. B., & Dimitrova, N. (2016). Early deictic but not other gestures predict later vocabulary in both typical development and autism. Autism, 20(6), 754–763.
Park, C. J., Yelland, G. W., Taffe, J. R., & Gray, K. M. (2012). Morphological and syntactic skills in language samples of pre school aged children with autism: Atypical development? International Journal of Speech-Language Pathology, 14(2), 95–108.
Potrzeba, E. R., Fein, D., & Naigles, L. (2015). Investigating the shape bias in typically developing children and children with autism spectrum disorders. Frontiers in Psychology, 6, 446.
Reetzke, R., Zou, X. B., Sheng, L., & Katsos, N. (2015). Communicative development in bilingually exposed Chinese children with autism spectrum disorders. Journal of Speech Language and Hearing Research, 58(3), 813–825.
Rescorla, L., & Safyer, P. (2013). Lexical composition in children with autism spectrum disorder (ASD). Journal of Child Language, 40(1), 47–68.
Roberts, J. A., Rice, M. L., & Tager-Flusberg, H. (2004). Tense marking in children with autism. Applied Psycholinguistics, 25(3), 429–448.
Robins, D. L., Casagrande, K., Barton, M., Chen, C. M. A., Dumont-Mathieu, T., & Fein, D. (2014). Validation of the modified checklist for autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics, 133(1), 37–45.
Rowe, M. L. (2013). Decontextualized language input and preschoolers’ vocabulary development. Seminars in Speech and Language, 34(4), 260–266.
Rundblad, G., & Annaz, D. (2010). The atypical development of metaphor and metonymy comprehension in children with autism. Autism, 14(1), 29–46.
Sah, W. H., & Torng, P. C. (2015). Narrative coherence of Mandarin-speaking children with high-functioning autism spectrum disorder: An investigation into causal relations. First Language, 35, 189–212.
Sah, W. H., & Torng, P. C. (2017). Production of mental state terms in narratives of Mandarin-speaking children with autism spectrum disorder. Clinical Linguistics & Phonetics, 31, 174–191.
Schoen, E., Paul, R., & Chawarska, K. (2011). Phonology and vocal behavior in toddlers with autism spectrum disorders. Autism Research, 4(3), 177–188.
Sheinkopf, S. J., Mundy, P., Oller, D. K., & Steffens, M. (2000). Vocal atypicalities of preverbal autistic children. Journal of Autism and Developmental Disorders, 30(4), 345–354.
Shin, S. Y., Leech, K., & Rowe, M. L. (2017). Parent-child decontextualized conversations and preschooler’s theory of mind. Paper presented at the 2017 Society for Research in Child Development Biennial Meeting, Austin, Texas, USA.
Smith, V., Mirenda, P., & Zaidman-Zait, A. (2007). Predictors of expressive vocabulary growth in children with autism. Journal of Speech Language and Hearing Research, 50(1), 149–160.
Snow, C. E. (1983). Literacy and language: relationships during the preschool years. Harvard Educational Review, 53(2), 165–189.
Stone, W. L., Ousley, O. Y., Yoder, P. J., Hogan, K. L., & Hepburn, S. L. (1997). Nonverbal communication in two- and three-year-old children with autism. Journal of Autism and Developmental Disorders, 27(6), 677–696.
Su, L.-Y. (2014). Modern child psychiatry (in Chinese). Changsha: Hunan Technology Press.
Su, Y., Jin, Y., Wan, G.-B., Zhang, J.-S., & Su, L.-Y. (2014). Interpretation of wh-words in Mandarin-speaking high-functioning children with autism spectrum disorders. Research in Autism Spectrum Disorders, 8(10), 1364–1372.
Su, Y., & Su, L.-Y. (2015). Interpretation of logical words in mandarin-speaking children with autism spectrum disorders: uncovering knowledge of semantics and pragmatics. Journal of Autism and Developmental Disorders, 45(7), 1938–1950.
Suh, J., Orinstein, A., Barton, M., Chen, C.-M., Eigsti, I.-M., Ramirez-Esparza, N., et al. (2016). Ratings of broader autism phenotype and personality traits in optimal outcomes from autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(11), 3505–3518.
Sullivan, M., Finelli, J., Marvin, A., Garrett-Mayer, E., Bauman, M., & Landa, R. (2007). Response to joint attention in toddlers at risk for autism spectrum disorder: A prospective study. Journal of Autism and Developmental Disorders, 37(1), 37–48.
Sun, X., Allison, C., Auyeung, B., Matthews, F. E., Baron-Cohen, S., & Brayne, C. (2013). What is available for case identification in autism research in mainland China? Research in Autism Spectrum Disorders, 7(5), 579–590.
Tager-Flusberg, H. (1993). What language reveals about the understanding of minds in children with autism. In S. Baron-Cohen, H. Tager-Flusberg & D. Cohen (Eds.), Understanding other minds: Perspectives from autism (pp. 138–157). New York: Oxford Publications.
Tager-Flusberg, H. (1994). Dissociations in form and function in the acquisition of language by autistic children. In H. Tager-Flusberg (Ed.), Constraints on language acquisition: Studies of atypical children (pp. 175–194). Hillsdale, NJ: Erlbaum.
Tager-Flusberg, H. (1997). Language and understanding minds: Connections in autism. In S. Baron-Cohen, H. Tager-Flusberg & D. J. Cohen (Eds.), Understanding other minds: Perspectives from autism and developmental cognitive neuroscience (2nd ed.). Oxford: Oxford University Press.
Tager-Flusberg, H. (2001). Understanding the language and communicative impairments in autism. International Review of Research in Mental Retardation, 23, 185–205.
Tager-Flusberg, H., & Anderson, M. (1991). The development of contingent discourse ability in autistic children. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 32(7), 1123–1134.
Tager-Flusberg, H., Calkins, S., Nolin, T., Baumberger, T., Anderson, M., & Chadwick-Dias, A. (1990). A longitudinal study of language acquisition in autistic and Down syndrome children. Journal of Autism and Developmental Disorders, 20, 1–21.
Tager-Flusberg, H., Paul, R., & Lord, C. (2005). Language and communication in autism. In F. Volkmar, R. Paul, A. Klin & D. J. Cohen (Eds.), Handbook of autism and pervasive developmental disorders, diagnosis, development, neurobiology, and behavior (pp. 335–364). Hoboken, NJ: Wiley.
Tager-Flusberg, H., Rogers, S., Cooper, J., Landa, R., Lord, C., & Paul, R. (2009). Defining spoken language benchmarks and selecting measures of expressive language development for young children with autism spectrum disorders. Journal of Speech, Language, and Hearing Research, 52, 643–652.
Tardif, T., Fletcher, P., Zhang, Z., & Liang, W. (2008). The Chinese communicative development inventory (Putonghua and Cantonese versions): Manual, forms, and norms. Beijing: Peking University Medical Press.
Taumoepeau, M., & Reese, E. (2013). Maternal reminiscing, elaborative talk, and children’s theory of mind: An intervention study. First Language, 33(4), 388–410.
Tek, S., Mesite, L., Fein, D., & Naigles, L. (2014). Longitudinal analyses of expressive language development reveal two distinct language profiles among young children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(1), 75–89.
Tomasello, M. (2015). The usage-based theory of language acquisition. In E. Bavin & L. R. Naigles (Eds.), The Cambridge handbook of child language (2nd ed., pp. 69–87). Cambridge: Cambridge University Press.
Tuller, L., Ferre, S., Prevost, P., Barthez, M.-A., Malvy, J., & Bonnet-Brihault, F. (2017). The effect of computational complexity on the acquisition of French by children with ASD. In L. R. Naigles (Ed.), Innovative investigations of language in autism spectrum disorder (pp. 115–140). Washington, DC: American Psychological Association.
Volkmar, F. R., Cicchetti, D. V., Dykens, E., Sparrow, S. S., Leckman, J. F., & Cohen, D. J. (1988). An evaluation of the autism behavior checklist. Journal of Autism and Developmental Disorders, 18(1), 81–97.
Weismer, S. E., Gernsbacher, M. A., Stronach, S., Karasinski, C., Eernisse, E. R., Venker, C. E., et al. (2011). Lexical and grammatical skills in toddlers on the autism spectrum compared to late talking toddlers. Journal of Autism and Developmental Disorders, 41(8), 1065–1075.
Weismer, S. E., Lord, C., & Esler, A. (2010). Early language patterns of toddlers on the autism spectrum compared to toddlers with developmental delay. Journal of Autism and Developmental Disorders, 40(10), 1259–1273.
Wittke, K., Mastergeorge, A. M., Ozonoff, S., Rogers, S. J., & Naigles, L. R. (2017). Grammatical language impairment in autism spectrum disorder: Exploring language phenotypes beyond standardized testing. Frontiers in Psychology, 8, 532.
Xu, J., Zhang, H., Guo, Z., & Liu, Q. (2014). A comparative study of the Snijders-Oomen Non-verbal Intelligence Test among those with special needs and normal persons. Chinese Journal of Special Education, 170(8), 55–59.
Yang, X., Huang, Y., Jia, M., & Chen, S. (1993). Clinical application of autism behavior checklist. Chinese Mental Health Journal, 7(6), 279–280.
Yi, L., Fan, Y. B., Zhao, J., Huang, D., Li, Y. Y., & Zou, X. B. (2013). Atypical understanding of mental terms in Chinese-speaking children with autism spectrum disorder. Research in Autism Spectrum Disorders, 7(11), 1411–1417.
Zheng, Q., Jia, Z. H., & Liang, D. D. (2015). Metaphor and metonymy comprehension in Chinese-speaking children with high-functioning autism. Research in Autism Spectrum Disorders, 10, 51–58.
Zhou, P., Crain, S., Gao, L., & Jia, M. (2017). The use of linguistic cues in sentence comprehension by Mandarin-speaking children with high-functioning autism. Journal of Autism and Developmental Disorders, 47(1), 17–32.
Zhou, P., Crain, S., Gao, L., Tang, Y., & Jia, M. (2015). The Use of Grammatical morphemes by Mandarin-speaking children with high functioning autism. Journal of Autism and Developmental Disorders, 45(5), 1428–1436.
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This work was supported by the National Natural Science Foundation of China (31500889), Innovation-Driven Project of Central South University (2016CXS025), the Philosophy and Social Science Fund Project of Hunan Province (17YBA424), and Hunan Provincial Natural Science Foundation of China (2018JJ2494) to the first author. Part of the work has been presented at the International Meeting for Autism Research (2014–2016). We gratefully acknowledge our invaluable undergraduate research assistants in data collection, as well as the children and families who participated in the study. We are grateful to the support from the teachers in the autism training centers who assisted in the execution of this project.
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YS and LN designed the original data collection, performed the analysis and drafted the manuscript. LYS participated in the design and coordination of the study and performed the clinical measurement. All authors approved the final manuscript.
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Su, Y.(., Naigles, L.R. & Su, LY. Uneven Expressive Language Development in Mandarin-Exposed Preschool Children with ASD: Comparing Vocabulary, Grammar, and the Decontextualized Use of Language via the PCDI-Toddler Form. J Autism Dev Disord 48, 3432–3448 (2018). https://doi.org/10.1007/s10803-018-3614-x
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DOI: https://doi.org/10.1007/s10803-018-3614-x