Minimally Verbal School-Aged Children with Autism Spectrum Disorder: The Neglected End of the Spectrum
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. Autism Res 2013, ●●: ●●-●●. © 2013 International Society for Autism Research, Wiley Periodicals, Inc.
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ABSTRACT: Autism (ASD) is vastly heterogeneous, particularly in early language development. While ASD language trajectories in the first years of life are highly unstable, by early childhood these trajectories stabilize and are predictive of longer-term outcome. Early neural substrates that predict/precede such outcomes are largely unknown, but could have considerable translational and clinical impact. Pre-diagnosis fMRI response to speech in ASD toddlers with relatively good language outcome was highly similar to non-ASD comparison groups and robustly recruited language-sensitive superior temporal cortices. In contrast, language-sensitive superior temporal cortices were hypoactive in ASD toddlers with poor language outcome. Brain-behavioral relationships were atypically reversed in ASD, and a multimodal combination of pre-diagnostic clinical behavioral measures and speech-related fMRI response showed the most promise as an ASD prognosis classifier. Thus, before ASD diagnoses and outcome become clinically clear, distinct functional neuroimaging phenotypes are already present that can shed insight on an ASD toddler's later outcome. VIDEO ABSTRACT. Copyright © 2015 Elsevier Inc. All rights reserved.Neuron 04/2015; DOI:10.1016/j.neuron.2015.03.023 · 15.98 Impact Factor
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ABSTRACT: Given the explosion in published behavioral interventions over the past several years, this review highlights the latest trends over the past year (2014) for children with complex learning and developmental needs. There were virtually no rigorous intervention studies published on developmental disorders in which the cause of the disorder is well known. Nearly all studies focus on autism spectrum disorder. Trends over the past year emphasize modular interventions with design improvements including comparisons of two active treatments and larger and more diverse samples. Far more community-implemented treatments on understudied populations were conducted, including minimally verbal children, girls, very young infants, and low-resourced families. Finally, new pilot data on prevention and neural mechanisms were published. An uptick in the number of rigorous tests of different interventions conducted in real-world settings with outcomes focused on core deficits bodes well for wide dissemination and implementation by nonspecialists in the community. Pilot and uncontrolled data on prevention and mechanism await further rigorous testing before conclusions can be drawn.Current Opinion in Neurology 02/2015; DOI:10.1097/WCO.0000000000000185 · 5.73 Impact Factor
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ABSTRACT: The heterogeneity in clinical presentation and outcome in neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD) autism spectrum disorder (ASD) necessitates the identification and validation of biomarkers that can guide diagnosis, predict developmental outcomes, and monitor treatment response. Electrophysiology holds both practical and theoretical advantages as a clinical biomarker in neurodevelopmental disorders, and considerable effort has been invested in the search for electroencephalography (EEG) biomarkers in ADHD and ASD. Here, we discuss the major themes in the evaluation of biomarkers and then review studies that have applied EEG to better inform diagnosis, focusing on the controversy surrounding the theta:beta ratio in ADHD; prediction of risk, highlighting recent studies of infants at high risk for ASD; and treatment monitoring, presenting new efforts in the redefinition of outcome measures in clinical trials of ASD treatment. We conclude that insights gained from EEG studies will contribute significantly to a more mechanistic understanding of these disorders and to the development of biomarkers that can assist with diagnosis, prognosis, and intervention. There is a need, however, to utilize approaches that accommodate, rather than ignore, diagnostic heterogeneity and individual differences.Current Opinion in Neurology 02/2015; 28(2). DOI:10.1097/WCO.0000000000000181 · 5.73 Impact Factor