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This study examined the extent to which early intervention (EI) speech-language pathologists (SLPs) use and recommend language input strategies for caregivers of children with language delays and the child factors associated with these decisions. Participants included 213 SLPs who completed an online survey. Wilcoxon signed-rank tests, Friedman's analyses of variance, and Spearman correlations were used to determine the extent to which EI SLPs used and recommended language input, child factors that influenced recommendations and input, and relationships between SLPs' self-reported strategies and recommendations to caregivers. EI SLPs reported recommending expanding on child utterances more than other strategies. EI SLPs reported using grammatical input more than telegraphic input and recommended grammatical phrases as children made gains in spoken language. Language strategies used by SLPs inconsistently aligned with their recommendations to caregivers. Results underscore the importance of evaluating recommendations to caregivers in the context of EI.

Purpose: Using a novel parent report measure, this study investigated whether asking parents to rate their certainty when reporting on child vocabulary skills provided additional insight into parent report and emerging language abilities in young autistic children. Specifically, we investigated whether parent certainty varied based on whether the child was reported to understand, understand and say, or neither understand nor say the word and whether standardized measures of expressive and receptive language abilities and/or autistic traits predicted parent certainty. Lastly, we investigated whether certainty was associated with inconsistency in parent report of child word knowledge. Method: Twenty-one parents and their autistic children ages 2-5 years participated. One parent per child completed the MacArthur-Bates Communicative Development Inventories (MCDI) Words and Gestures form and a custom vocabulary checklist including 24 object nouns from the MCDI. Within the custom form, parents indicated whether their child understood, understood and said, or neither understood nor said 24 target nouns and reported how certain they were about their responses using a 5-point scale. Expressive language, receptive language, and autistic traits were measured via direct assessment using standardized measures. Results: Parent certainty varied widely and was higher for words the parents reported the children understood and said compared to that for words children either understood or neither understood nor said. Certainty ratings were higher when a child had higher standardized receptive and expressive language scores. Lastly, parent certainty was associated with reporting consistency, clarifying previous findings of inconsistencies in parent report of child vocabulary. Conclusion: Findings from this study indicate that measuring parent certainty provides critical information when assessing early vocabulary skills in autistic children.

Author(s): Brianna Piro-Gambetti [sup.1] [sup.2] [sup.4] , Jessica Greenlee [sup.1] [sup.3] , Emily J. Hickey [sup.1] , Jennifer M. Putney [sup.1] [sup.2] , Emily Lorang [sup.1] , Sigan L. Hartley [...], Autistic youth are at risk for internalizing mental health problems such as depression and anxiety. Similarly, parents of autistic youth report higher levels of depression than parents of typically developing children. The goal of this study was to examine bidirectional associations between parent depression symptoms and the internalizing problems of autistic youth in 188 families across four time points (T1-T4; spaced 12 months apart). A cross-lagged panel model revealed that mother (T1 and T2) and father (T1) depression symptoms positively predicted the youth's internalizing problems 12 months later. The youth's internalizing problems at T3 positively predicted maternal depression symptoms at T4. Future research should explore genetic and environmental pathways that link parent depression and internalizing problems in autistic youth.

This study examined differences in mother-child relationship quality and parent-rated child behavior problems based on child verbal status (i.e., minimally verbal versus verbal) in mothers and their adolescent and adult children with autism spectrum disorder (n = 219 dyads; child M[subscript age] = 25.38 years, SD = 10.22). Relationship quality was assessed via parent-reported maternal burden and mother-child closeness, and coded speech samples ascertaining maternal critical and positive remarks regarding the child. Groups did not differ in relationship quality. The verbal group was more likely to display disruptive and socially inappropriate behaviors, but otherwise the groups did not differ in behavior problems. Verbal status moderated the relationship between behavior problems and negative (maternal burden, critical remarks) but not positive (mother-child closeness, positive remarks) aspects of relationship quality.

This study investigated the bidirectional effects of change in maladaptive behaviors among adolescents and adults with fragile X syndrome (FXS) and change in their intergenerational family relationships over a 7.5-year period. Indicators of the intergenerational family relationship between premutation carrier mothers and their adolescent or adult son/daughter with FXS included a measure of the quality of the relationship, as well as descriptions provided by mothers of their relationship with their son/daughter (positive remarks, critical remarks). Maladaptive behaviors decreased, maternal positive remarks increased, and maternal critical remarks and relationship quality remained stable over time. Bidirectional effects of change were observed in predicting maladaptive behaviors and maternal positive remarks, although maladaptive behaviors more strongly predicted positive remarks than the reciprocal association. This research suggests prioritizing maladaptive behaviors in the context of family interventions.

Autism spectrum disorder (ASD) and fragile X syndrome (FXS) are neurodevelopmental disorders with overlapping pragmatic language impairments. Prior work suggests pragmatic language differences may run in families. This study examined specific pragmatic difficulties (i.e., linguistic mazes and perseverations) in boys (9-18 years) with idiopathic ASD (n = 26) and FXS+ASD (n = 29), and relationships with maternal maze use. Language samples were obtained separately for boys and mothers. Nonparametric analyses suggested that boys largely did not differ in their rates of mazes, but that boys with FXS+ASD exhibited more perseverations. Mazes were correlated between fragile X dyads. Maternal mazes were correlated with child perseverations among idiopathic ASD dyads. These findings have implications for the etiological significance of ASD-related language phenotypes.

This survey study examined augmentative and alternative communication (AAC) practices reported by early intervention speech-language pathologists (SLPs) across the United States (N = 376). The study examined (a) types of AAC that SLPs reported using (i.e., sign language, photographs, pictures, symbols, talking switches, and iPad apps or dedicated speech-generating devices); (b) SLPs' perspectives on the influence of child spoken language ability on AAC recommendations; (c) factors that influenced AAC decision-making within early intervention; and (d) perceived barriers associated with AAC implementation. SLPs reported that they were significantly more likely to introduce all types of AAC to children without spoken language abilities compared to children in later stages of language development. On average, they were most likely to report using or recommending sign language and photographs, and least likely to report using or recommending talking switches or speech-generating devices. Of the options provided, child expressive and receptive language abilities were rated as the most important factors to consider when determining AAC use, followed by cognitive ability, diagnosis, and chronological age. SLPs identified caregiver buy-in and carryover across providers as the most significant barriers to AAC implementation. Recommendations for future research and current AAC practices within early intervention are discussed.

Purpose: Question-asking serves as a tool to learn new information and is important in both academic and social settings. Boys with idiopathic autism spectrum disorder (ASD) and boys with fragile X syndrome and comorbid ASD (FXS + ASD) have similar social communication deficits, which may have downstream effects on their question-asking ability. This study examined question-asking in school-age boys with idiopathic ASD and FXS + ASD, including the role of ASD severity, expressive grammatical complexity (measured by mean length of utterance [MLU]), and IQ. Method: Twenty-five boys with FXS + ASD and 21 boys with idiopathic ASD (ages 9-16 years) were included in this study. Autism Diagnostic Observation Schedule assessments were transcribed and coded for the frequency, function, and appropriateness of spontaneous questions asked. We examined group differences in these aspects of question-asking and relationships between question-asking and ASD severity, MLU, and IQ within each group. Results: Boys with FXS + ASD asked more questions than boys with idiopathic ASD, although boys with idiopathic ASD asked a higher proportion of appropriate questions. Boys with idiopathic ASD also asked the examiner more personal questions than the boys with FXS + ASD. ASD severity and MLU were related to the proportion of clarification questions in FXS + ASD, and ASD severity was also related to the proportion of personal questions in this group. For the boys with idiopathic ASD, ASD severity was related to the total number of questions asked. Conclusions: Our findings highlight similarities and differences between boys with FXS + ASD and idiopathic ASD in their spontaneous question production and indicate that ASD severity and grammatical language are differentially important for question-asking. This study has implications for targeted treatment in question-asking skills for boys with FXS + ASD and ASD.

Maternal input influences language development in children with Down syndrome (DS) and typical development (TD). Telegraphic input, or simplified input violating English grammatical rules, is controversial in speech-language pathology, yet no research to date has investigated whether mothers of children with DS use telegraphic input. This study investigated the quality of linguistic input to children with DS compared to age-matched children with TD, and the relationship between maternal input and child language abilities. Mothers of children with DS simplified their input in multiple ways, by using a lower lexical diversity, shorter utterances, and more telegraphic input compared to mothers of children with TD. Telegraphic input was not significantly correlated with other aspects of maternal input or child language abilities. Since children with DS demonstrate specific deficits in grammatical compared to lexical abilities, future work should investigate the long-term influence of maternal telegraphic input on language development in children with DS.

Studies that have integrated biological, psychosocial, and behavioral underpinnings to understand autism spectrum disorder (ASD) and family health implicate electrodermal activity (EDA) as a compelling area of investigation. EDA is [...], Introduction: Despite robust evidence in the broader family process literature for within-couple associations between romantic partners' physiological responding, this linkage has not been tested directly among parents raising a child with autism spectrum disorder (ASD). Explicit attention to these parents is warranted on the basis of the established family-wide challenges associated with the persistent emotional, functional, and behavior impairments typically observed in children with ASD (see Karst & Van Hecke, 2012). The first purpose of this study is to extend examination of within-couple associations between electrodermal activity (EDA) to mothers and fathers of children with ASD. The second purpose is to test 2 potential moderators of EDA synchrony reflecting heightened challenges among parents of children with ASD, namely parenting as an observed conflict topic and global parenting stress. Method: Both parents wore wrist sensors that captured continuous EDA during a recorded marital conflict interaction. Trained coders provided ratings of emotional intensity and conflict topics, including whether the topic of parenting was discussed. Parents reported their global level of parenting stress. Dyadic multilevel modeling was used to test our hypotheses and accounted for interaction factors (e.g., movement data, emotional intensity). Results: Findings identified significant positive associations between parents' EDA. One moderator result emerged; specifically, father EDA was a stronger predictor of mother EDA when parenting was discussed as a conflict topic. Conclusion: This study extends evidence of within-couple physiological linkage to parents raising a child with ASD and provides a foundation for future research examining the family-wide implications of this linkage. Public Significance Statement This study extended investigation of romantic partners' physiological connections to parents raising a child with autism spectrum disorder. The findings of this study suggest that an indicator of parents' physiological arousal (specifically, their electrodermal activity levels) was positively associated with their partner's, and that the connection within couples may be stronger during conflict discussions related to parenting. Keywords: autism spectrum disorders, dyadic interactions, families, parenting, physiological synchrony Supplemental materials: http://dx.doi.org/10.1037/fsh0000525.supp

The past three decades have seen an exponential increase in the publication of children's books about autism. This increased availability of children's books is exciting because they have the power to promote understanding, acceptance, and appreciation of neurodiversity. However, growing concerns have been raised by both autistic and non‐autistic people that some children's books about autism may work against neurodiversity, rather than promoting it. This Commentary discusses the strikingly different ways in which children's books about autism portray key concepts related to neurodiversity, including autistic differences, agency, abilities, and communication. We present concrete examples (including books by autistic authors); highlight the views of autistic and non‐autistic parents of autistic children; and discuss how different books may leave readers with different impressions of autism and neurodiversity. Given the vastly different themes that emerge across different books, we conclude that it is important for educators, families, and other members of the autism community to make informed and individualized choices about what books they use for what purpose. We emphasize the need for systematic, high‐quality research on children's books about autism, including content analyses and studies that determine what messages these books send to their intended audience: children. It is vital that autistic people continue to shape this conversation, contributing unique insights that inform research priorities and the methodological approaches used to investigate them. Lay Summary: Children's books about autism have the potential to promote neurodiversity, but they also have the potential to (unintentionally) work against it. It is important to make informed and individualized choices about what books we use for what purpose. The field needs more high‐quality, systematic research on children's books about autism—particularly studies that involve autistic perspectives. [ABSTRACT FROM AUTHOR]

Researchers are increasingly utilizing physiological data like electrodermal activity (EDA) to understand how stress "gets under the skin." Results of EDA studies in autistic children are mixed, with some suggesting autistic hyperarousal, others finding hypoarousal, and yet others detecting no difference compared to non‐autistics. Some of this variability likely stems from the different techniques used to assess EDA. Therefore, the purpose of this study is to investigate and compare commonly used metrics of EDA (frequency of peaks, average amplitude of peaks, and standard deviation of skin conductance level) using two data processing programs (NeuroKit2 and Ledalab) and their link to observed child behavior. EDA data were collected using Empatica E4 wristbands from 60 autistic children and adolescents (5–18 years old) during a 7‐min play interaction with their primary caregiver. The play interaction was coded for a range of child behaviors including mood, social responsiveness, dysregulation, and cooperation. Results indicate a strong correlation between NeuroKit2 and Ledalab and a weak correlation between metrics within each program. Furthermore, the frequency of peaks was associated with more positive child social behaviors, and the magnitude of peaks was associated with less adaptive child behaviors. Recommendations for replication and the need for generalizability of this research are given. [ABSTRACT FROM AUTHOR]

Young children with Down syndrome (DS) have language delays beginning early in life. Book reading with parents provides a context for capitalizing on language learning opportunities. This study evaluated the quantity and quality of language input among mothers and fathers of young children with DS during book reading interactions and investigated associations with child language. Findings revealed that mothers were more talkative and used more descriptive language, whereas fathers spent more time reading the book text. Moreover, maternal and paternal input were correlated with different measures of child language, suggesting that mothers and fathers may use divergent approaches to support language development. [ABSTRACT FROM AUTHOR]

Although gestalt language development incorporates some neurodiversity-affirmative strategies (e.g. embracing echolalia), it is also associated with numerous ideas, assertions, and clinical strategies that lack theoretical and empirical support. For this reason, we believe it is premature to embrace gestalt language development as a neurodiversity-affirmative practice. Given the potential for miscommunication, we must strive for clarity and precision in our terminology (e.g. making a clear distinction between delayed echolalia and the broader set of ideas that comprise gestalt language development). The field of autism will benefit from in-depth discussions about the relationship between neurodiversity-affirmative practices and evidence-based practices.It was recently suggested that a set of ideas known as gestalt language development be embraced as a neurodiversity-affirmative practice. Neurodiversity refers to the idea that people interact with the world in many different ways and that there is not a single right way to do so. Some aspects of gestalt language development, such as embracing autistic communication, are consistent with neurodiversity. However, gestalt language development is also associated with numerous ideas, assertions, and clinical strategies that lack theoretical and empirical support. For this reason, we believe it is premature to embrace gestalt language development as a neurodiversity-affirmative practice. We propose that it is important to make sure we use language that differentiates between delayed echolalia and the broader set of ideas that comprise gestalt language development. We also suggest that it is important to discuss the relationship between neurodiversity-affirmative practices and practices supported by research evidence. [ABSTRACT FROM AUTHOR]

Demonstratives (e.g. here, that, these) and personal pronouns are early developing components of language, which are often impaired in young children with autism spectrum disorder (ASD). Additionally, demonstrative and personal pronoun use are linked to joint attention and language ability early in life for individuals with ASD. Fragile X syndrome (FXS) is a genetic disorder with a significant amount of overlap in its behavioural phenotype with ASD. The present study examined demonstrative and personal pronoun production during a conversation sample in adolescent boys with ASD and adolescent boys with FXS with a co-diagnosis of ASD (FXS+ASD). Findings indicated that grammatical complexity was related to both qualitative and quantitative aspects of demonstrative and personal pronoun production in boys with ASD, while grammatical complexity was related to the total number of demonstratives and personal pronouns produced in the boys with FXS+ASD. ASD severity was not related to demonstrative or personal pronoun production in ASD, although it was negatively correlated with the total number of personal pronouns produced by the boys with FXS. Additionally, groups did not differ significantly in production of personal pronouns, but they did differ significantly in multiple aspects of demonstrative use. Findings suggest that these groups produce similar rates of personal pronouns in the school-age years, while production of demonstratives differentiates these groups. This study contributes to the knowledge of the language phenotypes of idiopathic ASD and FXS+ASD, and provides implications for intervention targets for school-age children with these disorders. [ABSTRACT FROM AUTHOR]

Purpose: Joint attention predicts later language in Down syndrome (DS) and autism. The co-occurrence of autism in children with DS is 6%-19%, which is higher than in the general population. However, little is known about how co-occurring autism in DS impacts the development of joint attention. This study compared mother-child and father-child interactions in families of children with DS. Our purpose was to investigate differences in caregiver joint-attention bids and whether caregiver and child joint attention were associated with autistic traits and receptive language in children with DS., Method: Fifteen children with DS ( M age = 39.67 months) and their biological caregivers participated in the current study. We collected mother-child and father-child interactions in participant's homes. Using Wilcoxon signed-ranks tests, we examined if there were differences in mothers' and fathers' joint attention bids and if children responded differently to their bids. We used Spearman correlations to examine the associations between child autistic traits, receptive language, and caregiver and child joint attention., Results: We found that mothers initiated more joint-attention bids than fathers but did not find differences in child responsiveness or initiations based on communication partner. Mothers used more bids when children had more autistic traits. Child autistic traits were negatively correlated with child responsiveness to father joint-attention bids. Children with more autistic traits produced fewer joint-attention bids with both caregivers., Conclusions: Findings suggest mothers and fathers may use differing approaches to support their child's language development. Regardless of communication partner, children with more autistic traits engaged in fewer instances of joint attention.

The past three decades have seen an exponential increase in the publication of children's books about autism. This increased availability of children's books is exciting because they have the power to promote understanding, acceptance, and appreciation of neurodiversity. However, growing concerns have been raised by both autistic and non-autistic people that some children's books about autism may work against neurodiversity, rather than promoting it. This Commentary discusses the strikingly different ways in which children's books about autism portray key concepts related to neurodiversity, including autistic differences, agency, abilities, and communication. We present concrete examples (including books by autistic authors); highlight the views of autistic and non-autistic parents of autistic children; and discuss how different books may leave readers with different impressions of autism and neurodiversity. Given the vastly different themes that emerge across different books, we conclude that it is important for educators, families, and other members of the autism community to make informed and individualized choices about what books they use for what purpose. We emphasize the need for systematic, high-quality research on children's books about autism, including content analyses and studies that determine what messages these books send to their intended audience: children. It is vital that autistic people continue to shape this conversation, contributing unique insights that inform research priorities and the methodological approaches used to investigate them., (© 2023 The Authors. Autism Research published by International Society for Autism Research and Wiley Periodicals LLC.)

Background & Aims: This study compared gesture rate and purpose in participants with Down syndrome (DS) and fragile X syndrome (FXS), and the impact of autism spectrum disorder (ASD) symptoms on each syndrome., Methods: Twenty individuals with fragile X syndrome and 20 individuals with Down syndrome between nine and 22 years of age participated in this study. We coded gesture rate and purpose from an autism spectrum disorder evaluation, the Autism Diagnostic Observation Schedule - Second Edition., Results: We did not find between-group differences (Down syndrome compared to fragile X syndrome) in gesture rate or purpose. Notably, as autism spectrum disorder symptoms increased, the group with Down syndrome produced a lower rate of gestures, but used gestures for the same purpose. Gesture rate did not change based on autism spectrum disorder symptoms in the participants with fragile X syndrome, but as autism spectrum disorder symptoms increased, the participants with fragile X syndrome produced a larger proportion of gestures to regulate behavior and a smaller proportion for joint attention/social interaction., Conclusions: Overall, the amount or purpose of gestures did not differentiate individuals with Down syndrome and fragile X syndrome. However, the presence of autism spectrum disorder symptoms had a significant and unique impact on these genetic disorders. In individuals with Down syndrome, the presence of more autism spectrum disorder symptoms resulted in a reduction in the rate of gesturing, but did not change the purpose. However, in fragile X syndrome, the rate of gestures remained the same, but the purpose of those gestures changed based on autism spectrum disorder symptoms., Implications: Autism spectrum disorder symptoms differentially impact gestures in Down syndrome and fragile X syndrome. Individuals with Down syndrome and more autism spectrum disorder symptoms are using gestures less frequently. Therefore, clinicians may need to consider children with Down syndrome demonstrating symptoms of autism spectrum disorder as distinctly different from children with Down syndrome and few to no symptoms of autism spectrum disorder when implementing interventions or therapy techniques. Severity of autism spectrum disorder symptoms in fragile X syndrome affects qualitative gesture use and motivation to communicate through social gestures, which may be an appropriate goal to target in children with fragile X syndrome and heightened autism spectrum disorder symptoms., Competing Interests: Declaration of Interest: The Authors declare that there is no conflict of interest.