Abstract
Numerous studies have investigated the predictors of language in pre-verbal toddlers and verbally fluent children with autism spectrum disorder (ASD). The present study investigated the concurrent relations among expressive language and a set of empirically-selected social communication variables—joint attention, imitation, and play—in a unique sample of 37 minimally verbal (MV) children and adolescents with ASD. Results revealed that imitation and play were significantly correlated with expressive language, even when controlling for non-verbal IQ, but joint attention was not. Imitation was the only predictor variable to reach significance within the regression model. Findings demonstrate that predictors of expressive language vary for subpopulations of the autism spectrum, and have broader implications for intervention design for older, MV individuals with ASD.
Similar content being viewed by others
References
Anderson, D. K., Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A., et al. (2007). Patterns of growth in verbal abilities among children with autism spectrum disorder. Journal of Consulting and Clinical Psychology, 75(4), 594.
Bal, V. H., Katz, T., Bishop, S. L., & Krasileva, K. (2016). Understanding definitions of minimally verbal across instruments: Evidence for subgroups within minimally verbal children and adolescents with autism spectrum disorder. Journal of Child Psychology and Psychiatry, 57(12), 1424–1433.
Baldwin, D. A. (1995). Understanding the link between joint attention and language. In C. Moore, P. J. Dunham, & P. Dunham (Eds.), Joint attention: Its origins and role in development (pp. 131–158). New York: Psychological Press.
Barokova, M., & Tager-Flusberg, H. (2018). Commentary: Measuring language change through natural language samples. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-018-3628-4.
Bedford, R., Pickles, A., & Lord, C. (2016). Early gross motor skills predict the subsequent development of language in children with autism spectrum disorder. Autism Research, 9(9), 993–1001.
Bishara, A. J., & Hittner, J. B. (2012). Testing the significance of a correlation with nonnormal data: Comparison of Pearson, Spearman, transformation, and resampling approaches. Psychological Methods, 17(3), 399.
Bono, M. A., Daley, T., & Sigman, M. (2004). Relations among joint attention, amount of intervention and language gain in autism. Journal of Autism and Developmental Disorders, 34(5), 495–505.
Bottema-Beutel, K. (2016). Associations between joint attention and language in autism spectrum disorder and typical development: A systematic review and meta-regression analysis. Autism Research, 9(10), 1021–1035.
Brignell, A., Williams, K., Jachno, K., Prior, M., Reilly, S., & Morgan, A. T. (2018). Patterns and predictors of language development from 4 to 7 years in verbal children with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 48, 1–14.
Broce, I., Bernal, B., Altman, N., Tremblay, P., & Dick, A. S. (2015). Fiber tracking of the frontal aslant tract and subcomponents of the arcuate fasciculus in 5–8-year-olds: relation to speech and language function. Brain and Language, 149, 66–76.
Caselman, T. D., & Self, P. A. (2008). Assessment instruments for measuring young children’s social-emotional behavioral development. Children and Schools, 30(2), 103–115.
Chang, Y. C., Shih, W., Landa, R., Kaiser, A., & Kasari, C. (2018). Symbolic play in school-aged minimally verbal children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(5), 1436–1445.
Charman, T. (2003). Why is joint attention a pivotal skill in autism? Philosophical Transactions of the Royal Society of London B: Biological Sciences, 358(1430), 315–324.
Charman, T., Baron-Cohen, S., Swettenham, J., Baird, G., Cox, A., & Drew, A. (2000). Testing joint attention, imitation, and play as infancy precursors to language and theory of mind. Cognitive Development, 15(4), 481–498.
Chenausky, K., Kernbach, J., Norton, A., & Schlaug, G. (2017). White matter integrity and treatment-based change in speech performance in minimally verbal children with autism spectrum disorder. Frontiers in Human Neuroscience, 11, 175.
Chenausky, K. V., Norton, A., & Schlaug, G. (2016a). Effect of auditory-motor mapping training and speech repetition training on consonant and vowel accuracy in minimally verbal children with autism spectrum disorder. The Journal of the Acoustical Society of America, 139(4), 2046.
Chenausky, K., Norton, A., Tager-Flusberg, H., & Schlaug, G. (2016b). Auditory-motor mapping training: Comparing the effects of a novel speech treatment to a control treatment for minimally verbal children with autism. PLoS ONE, 11(11), e0164930.
Coxe, S., West, S. G., & Aiken, L. S. (2009). The analysis of count data: A gentle introduction to Poisson regression and its alternatives. Journal of Personality Assessment, 91(2), 121–136.
Dominick, K. C., Davis, N. O., Lainhart, J., Tager-Flusberg, H., & Folstein, S. (2007). Atypical behaviors in children with autism and children with a history of language impairment. Research in Developmental Disabilities, 28(2), 145–162.
Fenson, L., Marchman, V. A., Thal, D. J., Dale, P. S., & Reznick, J. S. (2007). MacArthur-Bates communicative development inventories: User’s guide and technical manual. Baltimore: Brookes.
Fernell, E., Hedvall, Å., Norrelgen, F., Eriksson, M., Höglund-Carlsson, L., Barnevik-Olsson, M., et al. (2010). Developmental profiles in preschool children with autism spectrum disorders referred for intervention. Research in Developmental Disabilities, 31(3), 790–799.
Grondhuis, S. N., Lecavalier, L., Arnold, L. E., Handen, B. L., Scahill, L., McDougle, C. J., et al. (2018). Differences in verbal and nonverbal IQ test scores in children with autism spectrum disorder. Research in Autism Spectrum Disorders, 49, 47–55.
Hartley, S. L., Sikora, D. M., & McCoy, R. (2008). Prevalence and risk factors of maladaptive behaviour in young children with autistic disorder. Journal of Intellectual Disability Research, 52(10), 819–829.
Hilbe, J. M. (2011). Negative binomial regression. Cambridge: Cambridge University Press.
Hobson, J. A., Hobson, R. P., Malik, S., Bargiota, K., & Caló, S. (2013). The relation between social engagement and pretend play in autism. British Journal of Developmental Psychology, 31(1), 114–127.
Howlin, P., Savage, S., Moss, P., Tempier, A., & Rutter, M. (2014). Cognitive and language skills in adults with autism: A 40-year follow-up. Journal of Child Psychology and Psychiatry, 55(1), 49–58.
Hus, V., Maye, M., Harvey, L., Guthrie, W., Liang, J., & Lord, C. (2011). The adapted ADOS—Preliminary findings using a modified version of the ADOS for adults who are nonverbal or have limited language. San Diego: In Poster presented at the International Meeting for Autism Research.
Ingersoll, B., & Lalonde, K. (2010). The impact of object and gesture imitation training on language use in children with autism spectrum disorder. Journal of Speech, Language, and Hearing Research, 53(4), 1040–1051.
Ingersoll, B., & Meyer, K. (2011). Examination of correlates of different imitative functions in young children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(3), 1078–1085.
Ingersoll, B., & Schreibman, L. (2006). Teaching reciprocal imitation skills to young children with autism using a naturalistic behavioral approach: Effects on language, pretend play, and joint attention. Journal of Autism and Developmental Disorders, 36(4), 487.
Jahromi, L. B., Kasari, C. L., McCracken, J. T., Lee, L. S., Aman, M. G., McDougle, C. J., et al. (2009). Positive effects of methylphenidate on social communication and self-regulation in children with pervasive developmental disorders and hyperactivity. Journal of Autism and Developmental Disorders, 39(3), 395–404.
Kasari, C., Brady, N., Lord, C., & Tager-Flusberg, H. (2013). Assessing the minimally verbal school-aged child with autism spectrum disorder. Autism Research, 6(6), 479–493.
Kasari, C., Freeman, S., & Paparella, T. (2006). Joint attention and symbolic play in young children with autism: A randomized controlled intervention study. Journal of Child Psychology and Psychiatry, 47(6), 611–620.
Kasari, C., Gulsrud, A., Freeman, S., Paparella, T., & Hellemann, G. (2012). Longitudinal follow-up of children with autism receiving targeted interventions on joint attention and play. Journal of the American Academy of Child and Adolescent Psychiatry, 51(5), 487–495.
Kasari, C., Kaiser, A., Goods, K., Nietfeld, J., Mathy, P., Landa, R., et al. (2014). Communication interventions for minimally verbal children with autism: A sequential multiple assignment randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53(6), 635–646.
Kasari, C., Paparella, T., Freeman, S., & Jahromi, L. B. (2008). Language outcome in autism: Randomized comparison of joint attention and play interventions. Journal of Consulting and Clinical Psychology, 76(1), 125.
LeBarton, E. S., & Iverson, J. M. (2013). Fine motor skill predicts expressive language in infant siblings of children with autism. Developmental Science, 16(6), 815–827.
Leekam, S. R., Prior, M. R., & Uljarevic, M. (2011). Restricted and repetitive behaviors in autism spectrum disorders: A review of research in the last decade. Psychological Bulletin, 137(4), 562.
Leslie, A. M. (1987). Pretense and representation: The origins of theory of mind. Psychological Review, 94(4), 412.
Lewis, J. B., Lupton, L., & Watson, S. V. (2000). Relationships between symbolic play, functional play, verbal and non-verbal ability in young children. International Journal of Language and Communication Disorders, 35(1), 117–127.
Lord, C., & Pickles, A. (1996). Language level and nonverbal social-communicative behaviors in autistic and language-delayed children. Journal of the American Academy of Child and Adolescent Psychiatry, 35(11), 1542–1550.
Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule—Second edition (ADOS-2). Los Angeles: Western Psychological Services.
Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.
Luyster, R. J., 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.
McDuffie, A., Yoder, P., & Stone, W. (2005). Prelinguistic predictors of vocabulary in young children with autism spectrum disorders. Journal of Speech, Language, and Hearing Research, 48(5), 1080–1097.
Meltzoff, A. N., & Moore, M. K. (1977). Imitation of facial and manual gestures by human neonates. Science, 198(4312), 75–78.
Miller, J., & Chapman, R. (2008). Systematic analysis of language transcripts (SALT). Research version.
Mundy, P., Delgado, C., Block, J., Venezia, M., Hogan, A., & Seibert, J. (2003). Early social communication scales (ESCS). Coral Gables: University of Miami.
Mundy, P., & Jarrold, W. (2010). Infant joint attention, neural networks and social cognition. Neural Networks, 23(8–9), 985–997.
Mundy, P., Sigman, M., Ungerer, J., & Sherman, T. (1987). Nonverbal communication and play correlates of language development in autistic children. Journal of Autism and Developmental Disorders, 17(3), 349–364.
Munson, J., Dawson, G., Sterling, L., Beauchaine, T., Zhou, A., Koehler, E., et al. (2008). Evidence for latent classes of IQ in young children with autism spectrum disorder. American Journal on Mental Retardation, 113(6), 439–452.
Murray, D. S., Creaghead, N. A., Manning-Courtney, P., Shear, P. K., Bean, J., & Prendeville, J. A. (2008). The relationship between joint attention and language in children with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 23(1), 5–14.
Muthén, L.K., & Muthén, B.O. (1998–2017). Mplus user’s guide (8th ed.). Los Angeles: Muthén & Muthén
Norrelgen, F., Fernell, E., Eriksson, M., Hedvall, Å., Persson, C., Sjölin, M., et al. (2015). Children with autism spectrum disorders who do not develop phrase speech in the preschool years. Autism, 19(8), 934–943.
Pickard, K. E., & Ingersoll, B. R. (2015). Brief report: High and low level initiations of joint attention, and response to joint attention: Differential relationships with language and imitation. Journal of Autism and Developmental Disorders, 45(1), 262–268.
Pierucci, J. M., Barber, A. B., Gilpin, A. T., Crisler, M. E., & Klinger, L. G. (2015). Play assessments and developmental skills in young children with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 30(1), 35–43.
Plesa Skwerer, D., Jordan, S. E., Brukilacchio, B. H., & Tager-Flusberg, H. (2016). Comparing methods for assessing receptive language skills in minimally verbal children and adolescents with autism spectrum disorders. Autism, 20(5), 591–604.
Redcay, E., & Saxe, R. (2013). 13 Do you see what I see? The neural bases of joint attention. In J. Metcalfe & H. S. Terrace (Eds.), Agency and joint attention (p. 216). New York: Oxford University Press.
Rogers, S. J., Hepburn, S. L., Stackhouse, T., & Wehner, E. (2003). Imitation performance in toddlers with autism and those with other developmental disorders. Journal of Child Psychology and Psychiatry, 44(5), 763–781.
Rogers, S. J., & Pennington, B. F. (1991). A theoretical approach to the deficits in infantile autism. Development and Psychopathology, 3(2), 137–162.
Roid, G. H., & Koch, C. (2017). Leiter-3: Nonverbal cognitive and neuropsychological assessment. In R. S. McCallum (Ed.), Handbook of nonverbal assessment (2nd ed., pp. 127–150). Switzerland: Springer.
Roid, G. H., Miller, L. J., Pomplun, M., & Koch, C. (2013). Leiter international performance scale (Leiter-3). Los Angeles: Western Psychological Services.
Schietecatte, I., Roeyers, H., & Warreyn, P. (2012). Exploring the nature of joint attention impairments in young children with autism spectrum disorder: Associated social and cognitive skills. Journal of Autism and Developmental Disorders, 42(1), 1–12.
Shinn-Cunningham, B., Bressler, S., & Wang, L. (2016). How auditory scene understanding can fail in special populations. The Journal of the Acoustical Society of America, 140(4), 3209.
Sigman, M., & McGovern, C. W. (2005). Improvement in cognitive and language skills from preschool to adolescence in autism. Journal of Autism and Developmental Disorders, 35(1), 15–23.
Smith, V., Mirenda, P., & Zaidman-Zait, A. (2007). Predictors of expressive language growth in children with autism. Journal of Speech, Language, and Hearing Research, 50(1), 149–160.
Stone, W. L., Ousley, O. Y., & Littleford, C. D. (1997). Motor imitation in young children with autism: What’s the object? Journal of Abnormal Child Psychology, 25(6), 475–485.
Strid, K., Heimann, M., & Tjus, T. (2013). Pretend play, deferred imitation and parent-child interaction in speaking and non-speaking children with autism. Scandinavian Journal of Psychology, 54(1), 26–32.
Tager-Flusberg, H., & Kasari, C. (2013). Minimally verbal school-aged children with autism spectrum disorder: the neglected end of the spectrum. Autism Research, 6(6), 468–478.
Tager-Flusberg, H., Plesa Skwerer, D., Joseph, R. M., Brukilacchio, B., Decker, J., Eggleston, B., et al. (2017). Conducting research with minimally verbal participants with autism spectrum disorder. Autism, 21(7), 852–861.
Tager-Flusberg, H., Rogers, S., Cooper, J., Landa, R., Lord, C., Paul, R., et al. (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(3), 643–652.
Thiemann-Bourque, K. S., Brady, N. C., & Fleming, K. K. (2012). Symbolic play of preschoolers with severe communication impairments with autism and other developmental delays: More similarities than differences. Journal of Autism and Developmental Disorders, 42(5), 863–873.
Thurm, A., Lord, C., Lee, L. C., & Newschaffer, C. (2007). Predictors of language acquisition in preschool children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37(9), 1721–1734.
Thurm, A., Manwaring, S. S., Swineford, L., & Farmer, C. (2015). Longitudinal study of symptom severity and language in minimally verbal children with autism. Journal of Child Psychology and Psychiatry, 56(1), 97–104.
Toth, K., Munson, J., Meltzoff, A. N., & Dawson, G. (2006). Early predictors of communication development in young children with autism spectrum disorder: Joint attention, imitation, and toy play. Journal of Autism and Developmental Disorders, 36(8), 993–1005.
Van der Paelt, S., Warreyn, P., & Roeyers, H. (2014). Social-communicative abilities and language in preschoolers with autism spectrum disorders: Associations differ depending on language age. Research in Autism Spectrum Disorders, 8(5), 518–528.
Wan, C. Y., Bazen, L., Baars, R., Libenson, A., Zipse, L., Zuk, J., et al. (2011). Auditory-motor mapping training as an intervention to facilitate speech output in non-verbal children with autism: A proof of concept study. PLoS ONE, 6(9), e25505.
Whalen, C., Schreibman, L., & Ingersoll, B. (2006). The collateral effects of joint attention training on social initiations, positive affect, imitation, and spontaneous speech for young children with autism. Journal of Autism and Developmental Disorders, 36(5), 655–664.
Whyte, J., & Owens, A. (1989). Language and symbolic play: Some findings from a study of autistic children. The Irish Journal of Psychology, 10(2), 317–332.
Williams, J. H., Whiten, A., & Singh, T. (2004). A systematic review of action imitation in autistic spectrum disorder. Journal of Autism and Developmental Disorders, 34(3), 285–299.
Wodka, E. L., Mathy, P., & Kalb, L. (2013). Predictors of phrase and fluent speech in children with autism and severe language delay. Pediatrics, 131, e1128.
Yoder, P., Watson, L. R., & Lambert, W. (2015). Value-added predictors of expressive and receptive language growth in initially nonverbal preschoolers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 45(5), 1254–1270.
Acknowledgments
The authors would like to thank all of the participants and their families, as well as colleagues, staff, and students at the Center for Autism Research Excellence who assisted with recruitment and data collection, especially Robert Joseph, Karen Chenausky, Briana Brukilacchio, Anne Yoder, and Tim Brown, who provided advice on the statistical methods. MP participated in study design, performed statistical analyses and interpretation of data, assisted with video coding, and drafted the manuscript. DPS participated in study design and coordination, and revised the manuscript critically for intellectual content. SM assisted with data acquisition and video coding. BE assisted with data acquisition and video coding. HTF conceived of the study, participated in its design and interpretation of data, and revised the manuscript critically for intellectual content. All authors read and approved the final manuscript.
Funding
This study was funded by the National Institute on Deafness and Other Communication Disorders (P50DC013027).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed involving human participants in this study were in accordance with the ethical standards of the institutional research board at Boston University and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Pecukonis, M., Plesa Skwerer, D., Eggleston, B. et al. Concurrent Social Communication Predictors of Expressive Language in Minimally Verbal Children and Adolescents with Autism Spectrum Disorder. J Autism Dev Disord 49, 3767–3785 (2019). https://doi.org/10.1007/s10803-019-04089-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10803-019-04089-8