Rhea Paul

Sacred Heart University · College of Health Professions

Delayed or impaired language development is a common developmental concern, yet there is little agreement about the criteria used to identify and classify language impairments in children. Children's language difficulties are at the interface between education, medicine and the allied professions, who may all adopt different approaches to conceptua...

Purpose: The JSLHR Supplement on Implementation Science is aimed at providing discussion and examples of research in implementation science, the study of methods designed to promote the incorporation of research findings into clinical practice. Methods: Practitioners in the language science area were invited to submit articles that address their...

This study examined the acceptability of a mobile application, SpeechPrompts, designed to treat prosodic disorders in children with ASD and other communication impairments. Ten speech-language pathologists (SLPs) in public schools and 40 of their students, 5-19 years with prosody deficits participated. Students received treatment with the software...

Aggregate factors of performance on child outcome measures, family resources, and community support were predictive of longitudinal expressive language outcomes in children with Autism Spectrum Disorder.

Disorders of speech, language and social communication are common developmental disorders that greatly increase a child's risk for academic underachievement, social disadvantage and poorer employment prospects. In addition, children presenting for psychiatric evaluation are known to have high rates of previously unsuspected language and social comm...

In this study, we employed an eye-gaze paradigm to explore whether children (ages 8–12) and adolescents (ages 12–18) with autism spectrum disorders (ASDs) are able to use prosodic cues to determine the syntactic structure of an utterance. Persons with ASD were compared to typically developing (TD) peers matched on age, IQ, gender, and receptive lan...

Purpose: This study compared pragmatic language in youths (9-17 years) with autism spectrum disorder (ASD) and those with typical development (TD) on the Yale in vivo Pragmatic Protocol (YiPP), a semistructured, dynamic conversational assessment. Method: Participants (n = 118) were divided into groups based on age and diagnosis. Each completed t...

Background: Language deficits in ASD are both highly prevalent and have significant impact on adaptive functioning. For 80% of individuals with ASDs who acquire spoken language, deficits in prosody are among the most chronic impairments. Prosodic speech deficits impede social interaction and limit participation in daily activities. Despite the hand...

Communication deficits are a core symptom or ASD, and the assessment of individuals with these disorders requires both formal testing and careful observation of natural and seminatural communicative activities. For children in prelinguistic phases of communication, assessment is aimed at establishing the communicative basis for a formal language sy...

The present study aims to investigate the perception and production of several domains of prosodic performance in a cross-sectional sample of preadolescents and adolescents with and without high-functioning autism (HFA). To look at the role of language abilities on prosodic performance, the HFA groups were subdivided based on “high” and “low” langu...

Typically developing children start using words around age 1 and develop conversational ability by 18 to 24 months. In autism, these communicative behaviors are delayed and impaired to varying degrees. Affected areas of language development include articulation, word use, syntax and morphology, echolalia (repetition with similar intonation of words...

Core Communicative Deficits at the Prelinguistic Stage Intervention Methods: An Overview Prelinguistic Stage Core Communicative Deficits at the Early Language Stage Intervention Methods at the Early Language Stage Conclusion

Assessing Prelinguistic Communication Assessing Early Linguistic Communication Assessing Communication in Children with Advanced Language Conclusion

In this study we examined the social behaviors of 4- to 12-year-old children with autism spectrum disorders (ASD; N = 24) during three tradic interactions with an adult confederate and an interaction partner, where the interaction partner varied randomly among (1) another adult human, (2) a touchscreen computer game, and (3) a social dinosaur robot...

In this study we examined the social behaviors of 4-to 12-year-old children with autism spectrum disor-ders (ASD; N = 24) during three tradic interactions with an adult confederate and an interaction partner, where the interaction partner varied randomly among (1) another adult human, (2) a touchscreen computer game, and (3) a social dinosaur robot...

ABSTRACT We aimed to disentangle contributions of socio-pragmatic and structural language deficits to narrative competence by comparing the narratives of children with autism spectrum disorder (ASD; n=25), non-autistic children with language impairments (LI; n=23), and children with typical development (TD; n=27). Groups were matched for age (6½ to...

Prosody production atypicalities are a feature of autism spectrum disorders (ASDs), but behavioral measures of performance have failed to provide detail on the properties of these deficits. We used acoustic measures of prosody to compare children with ASDs to age-matched groups with learning disabilities and typically developing peers. Overall, the...

While there is a rich history of studies involving robots and individuals with autism spectrum disorders (ASD), few of these studies have made substantial impact in the clinical research community. In this paper we first examine how differences in approach, study design, evaluation, and publication practices have hindered uptake of these research r...

Preschoolers with severe autism and minimal speech were assigned either a discrete trial or a naturalistic language treatment, and parents of all participants also received parent responsiveness training. After 12 weeks, both groups showed comparable improvement in number of spoken words produced, on average. Approximately half the children in each...

Background: Although individuals with high-functioning autism (HFA) often have average syntactic and lexical skills, deficits in pragmatic language are a hallmark of the disorder (Tager-Flusberg et al., 1990). Difficulties with pragmatic language, including reduced turn-taking, reduced range of speech acts, and inadequate management of turns and...

In research, it has been difficult to characterize the prosodic production differences that have been observed clinically in Autism Spectrum Disorders (ASD). Moreover, the nature of these differences has been particularly hard to identify. This study examined one possible contributor to these perceived differences: motor planning. We examined the a...

Lexical stress refers to the opposition of strong and weak syllables within polysyllabic words and is a core feature of the English prosodic system. There are probabilistic cues to lexical stress present in English orthography. For example, most disyllabic English words ending with the letters “-ure” have first-syllable stress (e.g., “pasture”, but...

This study examines the processing of prosodic cues to linguistic structure and to affect, drawing on fMRI and behavioral data from 16 high-functioning adolescents with autism spectrum disorders (ASD) and 11 typically developing controls. Stimuli were carefully matched on pitch, intensity, and duration, while varying systematically in conditions of...

This chapter considers treatments that aim to enhance the ability of children with autism spectrum disorders (ASD) to communicate and use language. Since disorders of communication constitute one of the core symptom areas in ASD and represent an aspect of function in which all children on this spectrum experience significant disability, virtually e...

This study evaluates the effectiveness of an intervention package including a discrete trial program (Rapid Motor Imitation Antecedent Training (Tsiouri and Greer, J Behav Educat 12:185-206, 2003) combined with parent education for eliciting first words in children with ASD who had little or no spoken language. Evaluation of the approach includes s...

The purpose of this study is to examine the phonological and other vocal productions of children, 18-36 months, with autism spectrum disorder (ASD) and to compare these productions to those of age-matched and language-matched controls. Speech samples were obtained from 30 toddlers with ASD, 11 age-matched toddlers and 23 language-matched toddlers d...

The Vineland Adaptive Behavior Scale was administered to 54 children diagnosed with autism spectrum disorder (ASD) before age 2, and a matching group of 18 toddlers with developmental delay (DD). The group with ASD was more impaired on all scales of the Vineland than DD peers. When 18 ASD/DD pairs very closely matched on age, verbal and nonverbal d...

Background: Abnormalities in language and communication are hallmarks of the Autism Spectrum Disorders (ASD). In addition to well-established weaknesses in language (e.g. early language delays, weaknesses in high-level discourse, and abnormalities in pragmatic abilities), deficits in syntactic ability (combining words into phrases and using morphem...

Background: The role played by genetic factors in the incidence of ASD has led to studies of infants siblings of children with ASD, in order to identify earliest-appearing symptoms of the disorders, with the aim of potential early identification. Observations of poor responsiveness to language in older children with ASD suggest the possibility th...

The objectives of this report are: (a) to trace the theoretical roots of the concept clinical significance that derives from Bayesian thinking, Marginal Utility/Diminishing Returns in Economics, and the "just noticeable difference", in Psychophysics. These concepts then translated into: Effect Size (ES), strength of agreement, clinical significance...

This article focuses on using currently available data to assist speech-language pathologists (SLPs) in making decisions regarding a child's eligibility and considerations for recommended "dosage" of early intervention (EI) services. Literature describing the characteristics of infants and toddlers who are likely recipients of EI services was revie...

In a sample of 46 children aged 4-7 years with Autism Spectrum Disorder (ASD) and intelligible speech, there was no statistical support for the hypothesis of concomitant Childhood Apraxia of Speech (CAS). Perceptual and acoustic measures of participants' speech, prosody, and voice were compared with data from 40 typically-developing children, 13 pr...

Younger siblings of children with autism spectrum disorders (ASD) are at higher risk for acquiring these disorders than the general population. Language development is usually delayed in children with ASD. The present study examines the development of pre-speech vocal behavior in infants at risk for ASD due to the presence of an older sibling with...

Background: Prosodic deficits in individuals with autism spectrum disorders (ASD) have been consistently reported in the literature (Kanner, 1943; Paul, 1987; Shriberg et al., 2001). However, the majority of these studies report solely on prosodic production. Little information is known regarding the understanding of prosody in individuals with ASD...

Background: Prelinguistic vocal behavior is known to be related to speech development in typical children (Oller, 1999; McCune & Vihman, 2001) and has been shown to be atypical in preschoolers with ASD (Sheinkopf et al., 2000). Expressive language delay is a nearly universal feature of the development of children with ASD (Tager-Flusberg et al., 20...

Background: The role played by genetic factors in the incidence of ASD has led to studies of infants siblings of children with ASD. Observations of poor responsiveness to language in older children with ASD suggest the possibility that abnormal attention to language may be one root of the communication deficits in this population. Research in inf...

IntroductionLinguistic Characteristics of Children with DLDScreening and Assessment of Language in Children with DLDIntervention for Children with DLDConclusions References

Despite recent increases in the number of toddlers referred for a differential diagnosis of autism spectrum disorders (ASD), knowledge of short-term stability of the early diagnosis as well as cognitive outcomes in this cohort is still limited. Cognitive, social, and communication skills of 89 clinic-referred toddlers were assessed at the average a...

In this article, we comment on specific aspects of Peppé (Peppé, 2009). In particular, we address the assessment and treatment of prosody in clinical settings and discuss current theory on neurological models of prosody. We argue that in order for prosodic assessment instruments and treatment programs to be clinical effective, we need assessment in...

Several major transitions in language use take place during the first 5 years of life. Each transition allows the child to move to a higher level of complexity of expression and to accomplish communicative goals more flexibly and precisely than was done at the previous level. At least three of these transitions appear to be modulated to some degree...

Background: Therapists working with children with Autism Spectrum Disorders (ASD) frequently adjust the way they speak to what helps the individual child, often manipulating their vocal prosody and expressivity to better engage the child and help him focus as well as to process information better. Typically, therapists are unaware that they are doi...

Background: Prelinguistic vocal behavior is known to be related to speech development in typical children (Oller, 1999; McCune & Vihman, 2001). However, prelinguistic behavior has been shown to be atypical in preschoolers with ASD (Sheinkopf et al., 2000), and expressive language delay is a nearly universal feature of the development of children...

Background: Impairment in social interaction is a core symptom of autism spectrum disorders (ASD), and weak processing of nonverbal affective information is considered a critical skill impacting social reciprocity. Although there have been numerous studies testifying to weaknesses in facial affect recognition, both at behavioral and neurological le...

Background: Prosody, defined as changes in the pitch (fundamental frequency), intensity (amplitude), and duration of speech, is central to the deficits in social communication that characterize individuals with autism spectrum disorders (ASD). Despite its clinical significance, the comprehension of prosody has not been extensively investigated usin...

Background: Autism and related disabilities are severe disorders of development, disrupting social relationships, communication, play, adaptive skills, and academic skills. These disruptions often lead to life-long disability. The development of functional spoken language by the end of preschool is known to be related to improved outcomes in this...

The aims of this article are twofold: (a) to offer a set of recommended measures that can be used for evaluating the efficacy of interventions that target spoken language acquisition as part of treatment research studies or for use in applied settings and (b) to propose and define a common terminology for describing levels of spoken language abilit...

Children with autism benefit from intensive, early intervention that focuses on increasing the frequency, form, and function of communicative acts. Available evidence shows that highly structured behavioral methods have important positive consequences for these children, particularly in eliciting first words. However, the limitation of these method...

Until recently children with autism spectrum disorders (ASD) were rarely diagnosed before the age of 3 to 4 years. But a major thrust of current research has been to lower the age of identification, due in part to evidence supporting the effectiveness of early intervention. Late talkers -- toddlers who appear to be developing normally but do not be...

Twenty-nine youth with autism spectrum disorders and 26 with typical development between 12 and 18 years of age were engaged in structured interviews (ADOS). The interviews were videotaped and rated for atypical conversational behaviors by trained raters, using the Pragmatic Rating Scale (Landa et al. Psychol Med 22:245-254, 1992). The ASD group wa...

Background: Language form in high-functioning children with autism spectrum disorders (ASD) has been held to be a relative strength (Tager-Flusberg, 1995). Some recent studies suggest there may a subset of speakers with ASD who show specific grammatical deficits (Tager-Flusberg & Joseph, 2003), or more generalized weaknesses in grammatical function...

Background: Professionals are known to use enhanced prosody in working with children with autism spectrum disorders (ASD). However, no scientific evidence exists that enhanced prosody facilitates engagement, comprehension, or retention of information in ASD. Objectives: The purpose of the study was to measure the effects of prosodic style on narra...

Background: Autism spectrum disorders (ASD) are often associated with impaired expressive prosody. Existing methods for evaluating prosodic performance rely on time-consuming, subjective human judgments rather than automated methods. Objectives: The purpose of the study was to establish the validity of our automated digital measures of prosody by c...

Background: Since the first identification of the autistic syndrome, prosody has been reported to be impaired in individuals who speak (Kanner, 1943). Research has begun to identify profiles of deficits in this population across domains of prosodic function (Paul et al., 2005; Pepp et al, 2007). These studies have relied on perceptual judgments. Ob...

Background: Our preliminary work (Klin et al., 2007) demonstrated that persistent unusual and intense interests are common among children with autism spectrum disorders (ASD), yet limited empirical data exists on how these special interests develop. Objectives: To collect data and characterize the behaviors associated with special interests in ch...

Background: Deficits in prosody have been considered an identifying characteristic of ASD since Kanner (1943). Prosodic abilities have been shown to be related to attributions of social competence (Paul et al., 2005) and to success in vocational placements (Shriberg and Widder, 1990). Prosody has been found to remain impaired in speakers with ASD,...

The purpose of this study was to investigate the concurrent validity of subtests on the Comprehensive Assessment of Spoken Language (CASL) by comparing them with the assessment of communication and social skills on the Vineland Adaptive Behavior Scales (Vineland). The participants were 35 children and adolescents with higher functioning autism spec...

Thirty-seven children 15-25 months of age received clinical diagnoses of autism spectrum disorder (ASD) and were re-evaluated two years later. All subjects were judged to have retained a diagnosis of ASD at the follow-up evaluation. Communication scores for the group as a whole during the first visit were significantly lower than nonverbal IQ. Howe...

This paper reports a study of the ability to reproduce stress in a nonsense syllable imitation task by adolescent speakers with autism spectrum disorders (ASD), as compared to typically developing (TD) age-mates. Results are reported for both raters’ judgments of the subjects’ stress production, as well as acoustic measures of pitch range and durat...

This study tests the hypothesis that toddlers with autism spectrum disorders (ASD) will show differences from contrast groups in preferences for attending to speech. This study examined auditory preferences in toddlers with ASD and matched groups of (a) typical age-mates, (b) age-mates with nonautistic developmental disabilities, and (c) younger ch...

Introduction Communication deficits are one of the core symptoms of autism spectrum disorders (ASDs). People with ASD can be slow to begin talking, or may not learn to talk at all; others may learn to produce words and sentences but have difficulty using them effectively to accomplish social interactive goals. In this chapter we will discuss the co...

Increasing numbers of young children referred for a differential diagnosis of autism spectrum disorders (ASD) necessitates better understanding of the early syndrome expression and the utility of the existing state-of-the art diagnostic methods in this population. Out of 31 infants under the age of 2 years referred for a differential diagnosis, 19...

Symptoms of Autism Spectrum Disorders (ASD) begin to manifest during the first 2 years; there is limited evidence regarding type and timing of symptom onset. We examined factors related to parental age of recognition (AOR) of early abnormalities and the association between AOR and diagnosis and levels of functioning at 2 and 4 years in 75 toddlers...

Shriberg et al. [Shriberg, L. et al. (2001). Journal of Speech, Language and Hearing Research, 44, 1097-1115] described prosody-voice features of 30 high functioning speakers with autistic spectrum disorder (ASD) compared to age-matched control speakers. The present study reports additional information on the speakers with ASD, including associatio...

Speakers with autism spectrum disorders (ASD) show difficulties in suprasegmental aspects of speech production, or prosody, those aspects of speech that accompany words and sentences and create what is commonly called "tone of voice." However, little is known about the perception of prosody, or about the specific aspects of prosodic production that...