Short Bits

Changes in Autism Severity

A MIND Institute study evaluated changes in symptom severity in early childhood and the potential factors associated with those changes. The researchers used the ADOS Calibrated Severity Score (CSS). They computed a severity change score for participants as the difference between their ADOS CSS scores at age 6 and at age 3. A change of 2 points or more was considered a significant change in symptom severity. The study classified participants based on their severity change score into a Decreased Severity Group, a Stable Severity Group, and an Increased Severity Group (16.8%). Nearly 30% of young children had less severe autism symptoms at age 6 than they did at age 3. In some cases, children lost their autism diagnoses entirely. But some children appeared to get worse. The researchers were not able to predict which children would do well and which children would develop more severe autism symptoms.

Optimal outcome is a standard achieved when someone previously diagnosed with autism spectrum disorder (ASD) no longer meets autism diagnostic criteria due to loss of autism symptoms. In this study, seven participants had an ADOS CSS below the ASD cutoff at age 6, potentially indicating optimal outcome. Children showing decreasing symptom severity had better adaptive skills in multiple domains compared with those in the stable or increased severity groups. Girls with autism decreased in severity more than boys and increased in severity less than boys during early childhood. It may be that girls seem to have decreased autism severity because they are able to camouflage or hide their symptoms in social situations. Children with higher IQs were more likely to show a reduction in ASD symptoms.

Waizbard-Bartov, E., Ferrer, E., Young, G. S., Heath, B., Rogers, S., Wu Nordahl, C. W., Solomon, M., & Amaral, D. G. (2020). Trajectories of autism symptom severity change during early childhood. Journal of Autism and Developmental Disorders, 44(3), 546–563. https://doi.org/10.1007/s10803-020-04526-z

Sesame Street Teaches Self-Regulation

Sesame Street’s Cookie Monster is known to have problems with self-regulation, particularly when it comes to cookies. A few years ago, Sesame did a series of 5-min segments in the style of a coming attractions trailers, showing footage of Cookie in various film parodies (e.g., Cookies of the Caribbean, The Hungry Games, Furry Potter and the Goblet of Cookies) where he uses executive functioning skills (such as patience, focusing, and memorization) to solve problems. Many of these are available on YouTube by searching for “Cookie’s Crumby Pictures.” In these segments, you see Cookie Monster’s attempt to master executive function skills such as self-control (try not to eat the cookie), delayed gratification (eat the cookie later), flexible thinking (think about something else so you don’t eat the cookie), working memory (remember a strategy that worked before to keep from eating the cookie), and task persistence (being motivated to try and wait to eat the cookie). Along with Cookie Monster, children can learn the behavioral strategies necessary to manage emotions, navigate friendships, cope with stressful situations, and improve executive function tasks, such as impulse control, working memory, focusing, and shifting attention. Children are not likely to recognize the movies being parodied, but adults will. The format encourages adults to watch the segments with children, and in so doing, they can provide children with support to use the skills being taught.

Children and Mild Traumatic Brain Injury

It has often been assumed that younger children recover better from traumatic brain injuries (TBIs) than older children, but that is not the case. The belief that young children have a better outcome from TBIs was based on the thought that a child’s brain was more tolerant to injury due to neuroplasticity. But research has shown that the immature brain is often more vulnerable to deficits and not necessarily more plastic. Children between the ages of birth and 4 years have the highest rate of emergency department visits for mild TBIs (mTBIs). mTBIs account for 75% to 85% of all TBIs. Young children who experience TBIs may demonstrate decreased play engagement, including gaze initiation and joint attention. Changes in cognition and language may be reported shortly after the injury, but further deficits are likely to emerge over time as the child is expected to acquire new skills. Children who sustain a TBI before entering school are at increased risk of experiencing later-developing deficits in new and emerging skills such as advanced language and reading. Children injured before age 7 have been found to perform more poorly on measures of intellectual function than children injured after age 7. In elementary school, these children perform worse on complex pragmatic and verbal recall. Furthermore, they are likely to show changes in behavioral regulation and increasing deficits in executive functioning. Because the deficits associated with mTBI are likely to become more obvious as the children grow older, they would benefit from sustained monitoring and comprehensive assessment when concerns arise.

Salley, J., Crook, L., Ciccia, A., Haarbauer-Krupa, J., & Lundine, J. (2020). Traumatic brain injury in young children: A scoping review. Seminars in Speech and Language, 41(2), 125–142.

Emotional ABCs

Children with autism spectrum disorder, language impairment, hearing loss, and attention-deficit hyperactivity disorder all exhibit delays and difficulties in interpreting emotions. Emotional ABCs is an online program for children aged 4 to 11 years designed to teach emotional understanding. It consists of 20 units to instruct students in four major areas of social emotional learning: self-awareness, social awareness, self-management, and responsible decision making. All lessons include a warm-up, mini-lesson, activity, share-out, and a self-reflection, and each can be taught as a stand-alone lesson to target specific skills. The program begins with photos to match emotional expressions, then to match labels to expressions, and then to notice subtle differences in emotions (e.g., the difference between bored and sad or between angry and frustrated). Later lessons require that children identify emotions in situations, the reason for the emotions, and the possible strategies the character might use to regulate the emotion. If you are directly employed by a school, at this time, you can sign up for free access to the materials at: https://www.emotionalabcs.com

Children With Tourette Syndrome

Tourette syndrome (TS) is a neurodevelopmental disorder characterized by motor and vocal tics that occur for at least 1 year, affecting between 3 and 9 per 1,000 children. TS often co-occurs with other mental, emotional, or behavioral disorders, including attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), learning disorders (LD), and other behavioral problems, which may be more impairing than TS alone. In this study, children who had TS were more than 4 times as likely to have a co-occurring condition compared with children who never had TS. Of the children currently with TS, 80% had at least one co-occurring condition, compared with 18% of children who never had TS. ADHD and learning disability were the most common co-occurring conditions among children with TS. TS severity was associated with school measures; compared with children with mild TS, children with moderate or severe TS were significantly more likely to have an Individualized Educational Plan (IEP) and their parents were more likely to be contacted about school problems. A previous study among children with tic disorders also found that the severity of tics impacted academic problems.

Claussen, A., Bitsko, R., Holbrook, J. R., Bloomfield, J., & Giordano, K. (2018). Impact of Tourette syndrome on school measures in a nationally representative sample. Journal of Developmental & Behavioral Pediatrics, 39(4), 335–342. https://doi.org/10.1097/DBP.0000000000000550

Adolescent Communication Skills

Typically developing 10th grade students completed a questionnaire about the importance of 14 communication skills. Each statement was introduced with the leader phrase, “The ability of your friends to . . .,” for example, “The ability of your friends to listen to you without interrupting you at the wrong time”; “The ability of your friends to understand your point of view in a conversation and not just see things from their own perspective.” Skills were associated with empathy discourse management and figurative language. The five skills rated most important were associated with empathy (nonverbal comprehension, perspective-taking, tact, turn-taking, vocal tone comprehension). The four lowest ranked scores were a mix of figurative language and discourse management (eye contact, humor comprehension, slang use, narrative organization). Knowing what adolescents consider most important for communication can provide guidance for intervention objectives for adolescents with language learning impairment.

Reed, V., & Trumbo, S. (2020). The relative importance of selected communication skills for positive peer relations: American adolescents opinions. Communication Disorders Quarterly, 41(3), 135–150.

College Students With Histories of Developmental Language Disorder

Young adults with developmental language disorder (DLD) who were dismissed from services may conclude that their linguistic skills no longer lag behind their peers. According to a national study, 52.4% of students with accommodations in high school considered themselves to no longer have a disability when they entered college. Hence, many adults who would benefit from accommodations in college may not be aware of their linguistic disadvantage. In this study, cognitive profiles of 352 college students (50 with a history of DLD) were evaluated on a number of measures of reading, spoken language, and nonverbal cognition. Adults with DLD demonstrated deficits primarily associated with phonological-based skills—poor verbal working memory, nonword repetition, rapid automatic naming, and reduced reading fluency. The study indicated that these adults with DLD did not struggle with reading comprehension in general, but did demonstrate comprehension difficulties under timed conditions. The authors suggest that college students with DLD display distinct skill profiles that may warrant that these students receive accommodations. At the college levels, students with DLD will need to self-advocate, but the authors acknowledge that it can be difficult for these individuals to get the documentation necessary to access accommodations.

Del Tufo, S. N., & Earle, F. S. (2020). Skill profiles of college students with a history of developmental language disorder and developmental dyslexia. Journal of Learning Disabilities, 53(3), 228–240.

Barriers/Facilitators to Friendship for Children With Autism

Ten parents of children with autism spectrum disorder (ASD) were interviewed to assess their perceptions and attitudes about the barriers to friendship development for their children with autism. The children were all higher functioning with verbally fluent speech and without significant intellectual impairment. They all attended inclusive classrooms. Five primary themes arose from these interviews:

Parents expressed concerns regarding the difficulties their children experienced in making and sustaining friendships. Several parents reported that other children actively avoided their child and that their children had difficulty following the social rules in games. Parents reported that the topic of their child’s friendships was an emotional one for them because they recognized that their child did not have friends.

Daughrity, B. (2019). Parent perceptions of barriers friendship development for children with autism spectrum disorders. Communication Disorders Quarterly, 40(3), 142–151.

Stimuli and Narrative Production

Children between the ages of 3 and 5 years completed two narrative retells. One of these retells was in response to a 3-min animated video presented on a computer; the other retell was in response to static pictures presented in a book format. Children’s stories were then transcribed and coded for linguistic and narrative elements. Children produced significantly longer stories, greater syntactic complexity and lexical variety, and more action verbs when retelling an animated story compared with a book. The children’s mean scores on each of the story grammar (macrostructure) subcomponents were higher for narratives produced in response to the video compared with the book. Furthermore, examiners provided significantly fewer prompts when eliciting the retell with animation. Speech–language therapists should consider the impact of multimedia features within narrative prompts on children’s performance during an assessment.

Diehm, E. A., Wood, C., Puhlman, J., & Callendar, M. (2020). Young children’s narrative retell in response to static and animated stories. International Journal of Language and Communication Disorders, 55(3), 359–372.

Dosage for Motor Speech Therapy

Children (ages 43–47 months) with speech sound disorders with motor speech involvement (SSD-MSI) participated in a study to investigate optimal treatment dose frequency. Participants received 45 min of motor speech therapy intervention sessions either once per week (lower dose frequency) or twice per week (higher dose frequency) for a 10-week period. Treatment-related change was assessed at body structures, functions, and activity participation level as per the World Health Organization’s International Classification of Functioning framework: Children and Youth Version (ICF-CY) framework. These measures are related to articulation, functional communication, and speech intelligibility. Overall, the intervention approach in conjunction with home practice led to significant positive changes for all measures in children with SSD-MSI. No statistical differences between high- and low-dose-frequency groups were observed for any of the variables. This suggests limited benefits of 10 additional sessions per block. Thus, it is recommended that caregivers, speech–language therapists, and policy-makers perform a cost–benefit analysis before determining the dose frequency, when considering additional sessions per block.

Namasivayam, A. K., Pukonen, M., Goshulak, D., Granata, F., Le, F. J., Kroll, R., & van Lieshout, P. (2019). Investigating intervention dose frequency for children with speech sound disorders and motor speech involvement. Journal of International Language and Communication Disorders, 54(4), 673–686.

Websites for Information on Speech Sound Disorders