Looking or talking: Visual attention and verbal engagement during shared book reading of preschool children on the autism spectrum

Abstract

Visual attention and active engagement during shared book reading are important for facilitating emergent literacy learning during the preschool years. Children on the autism spectrum often show difficulties in language and literacy development, yet research investigating potential indicators of shared book reading engagement, including visual attention and verbal engagement, for this group of preschoolers is currently limited. To better understand the relationship between children’s visual attention and verbal engagement during shared book reading, parent shared book reading behaviors, and children’s emergent literacy skills (e.g. receptive vocabulary and letter-name knowledge), we observed 40 preschoolers on the spectrum and their parents sharing an unfamiliar storybook. Videos of the shared book reading interactions were transcribed and coded for child and parent behaviors using observational coding schemes. Strong significant associations were found between children’s visual attention, verbal engagement, and parents’ use of questions and/or prompts during the shared book reading interaction. Contrary to expectations, children’s visual attention was not related to their emergent literacy skills. Overall, our findings emphasize the interplay between parent behaviors and how preschoolers on the spectrum engage in this important literacy-related context and provide directions for future research.

Lay abstract

Children who have an autism diagnosis often have trouble learning to talk and read. These difficulties become noticeable before children start school and may be linked to lower attention and engagement in literacy-related activities such as sharing storybooks with their parents. To date, few researchers have looked at possible ways to measure how children on the autism spectrum engage during shared storybook reading, for example, where children look or how much they talk, and how this may be related to their letter-name knowledge and their vocabulary knowledge. In this study, we analyzed videos of 40 preschoolers on the spectrum and their parents sharing an unfamiliar storybook. We wanted to see whether where children looked (i.e. toward the storybook, their parent, or elsewhere) and how much they talked were related to what their parents did (e.g. ask questions or provide prompts) and/or children’s letter-name knowledge and vocabulary. The videos were coded for different child and parent behaviors. We found that where children looked and how much they talked were strongly related to each other and what parents did during the shared book reading interaction, particularly asking questions and using prompts. In contrast to what we expected, where children looked was not related to children’s letter or vocabulary knowledge. Overall, results of the study draw attention to the connection between what parents do and what preschoolers on the spectrum do when sharing storybooks and provide directions for future research.

Keywords

autism spectrum disorder emergent literacy preschool children shared book reading

Between 30% and 50% of school-age children on the autism spectrum show significant challenges in becoming proficient readers (Arciuli et al., 2013; Nation et al., 2006; Ricketts, 2011). These challenges may present during the preschool years, also known as the emergent literacy stage of development. Emerging research demonstrates marked heterogeneity across emergent literacy skills among preschoolers on the spectrum, with relatively stronger print-related knowledge (e.g. alphabet knowledge) and weaker meaning-related skills (e.g. oral language, vocabulary; for a review, see Westerveld et al., 2016). During the preschool years, children are exposed to a variety of literacy-related activities, including shared book reading (SBR; Whitehurst & Lonigan, 1998). A rich home literacy environment, including SBR activities, has been shown to be important in typical development (i.e. children without autism), for facilitating the print-related emergent literacy skills needed for later word decoding (e.g. alphabet knowledge, early phonological awareness, and print concepts), as well as the oral language–related precursors to reading comprehension (i.e. vocabulary knowledge and story comprehension; Evans & Shaw, 2008; Sénéchal, 2006; Sénéchal & LeFevre, 2002). SBR is a literacy-related activity that parents regularly engage in with their young children (Sénéchal, 2006), including children on the spectrum (Westerveld & van Bysterveldt, 2017), in the family home. Early emergent literacy challenges in children on the spectrum may be associated with lower attention and engagement in activities shown to facilitate emergent literacy learning, such as SBR with parents (Sénéchal, 2006). Although links between emergent literacy, visual attention, and engagement during SBR have been shown for typically developing (TD) preschoolers (e.g. Han & Neuharth-Pritchett, 2015; Son & Tineo, 2016), whether this generalizes to children on the spectrum requires more in-depth investigation.

Child engagement and parent behaviors during SBR

Active child engagement and parent–child interactions during SBR are important for facilitating emergent literacy learning for TD preschool-age children (Reese et al., 2010; Sénéchal & LeFevre, 2002; Whitehurst et al., 1988). This is in line with social constructivist theories (Vygotsky, 1981) that emphasize the importance of parent–child interactions and adult scaffolding within learning tasks for promoting children’s learning during the preschool period. In support, behaviors used by parents during SBR activities have been shown to guide attention and enhance overall engagement during SBR and learning of emergent literacy skills for TD children and children with language disorder (Kang et al., 2009; Luo & Tamis-LeMonda, 2017; McGinty et al., 2012). Broadly, these parent behaviors can be categorized as meaning related or print related (Sénéchal & LeFevre, 2002) and can include labeling and describing pictures, pointing to text and pictures as they read, and asking closed- and open-ended questions about story content. Different associations have been found between parent use of these types of SBR behaviors and emergent literacy for TD children, whereby parent use of meaning-related SBR behaviors is related to children’s vocabulary performance (receptive and expressive), while print-related SBR behaviors are linked to children’s alphabet knowledge (Han & Neuharth-Pritchett, 2015; Hindman et al., 2008).

A pivotal skill for facilitating children’s engagement and subsequent learning during SBR is joint attention/engagement (Farrant & Zubrick, 2012), which refers to the triadic sharing of attention between a child, another person, and an object or event (Bakeman & Adamson, 1984). This sharing of attention, both visually and communicatively, can occur in both a coordinated (i.e. active attendance to both a shared object and the other person) and a supported (i.e. active attendance to the object without explicit acknowledgment of the partner) manner (Adamson & Chance, 1998). In the context of SBR, this dynamic process involves parents using strategies to support their child to actively coordinate and share their attention between the parent and a storybook, which forms an important interpersonal context for language and emergent literacy learning (Farrant, 2012). Asking questions related to story content and utterances that prompt attention have been shown to be important behaviors used by parents for facilitating joint attention and turn-taking behaviors and increasing verbal engagement and responsiveness during SBR for TD children (Ezell & Justice, 1998; Son & Tineo, 2016). Recent research indicates that parents of children on the spectrum also use a range of SBR behaviors, including questions and prompts, to facilitate joint interaction and enhance learning opportunities (Tipton et al., 2017). However, children on the spectrum may be less inclined to respond to these behaviors given characteristic social impairments, including impairments or the absence of joint attention observed in early childhood (Mundy et al., 1990). Consequently, children on the spectrum may be disadvantaged in SBR, with individual child characteristics potentially impeding upon their ability to jointly engage and reap full benefit. Consistent with this possibility, 3- to 5-year-old children on the spectrum have been shown to demonstrate limited engagement during SBR without instruction (e.g. Fleury & Schwartz, 2017).

To our knowledge, only one recent study has investigated the quality of engagement of preschoolers on the spectrum during SBR with parents (Fleury & Hugh, 2018). In their descriptive study, Fleury and Hugh compared the SBR practices and interactions of parents of 3- to 5-year-old children on the spectrum (n = 17) and TD children (n = 20) to identify factors related to child engagement. The proportion of child engagement (passive: looking at the book, with no interaction or parental prompts; active: looking to the parent and/or book while actively sharing attention verbally or nonverbally; or disruptive/unengaged: behavior that impedes attention/engagement or no attention to the parent or book) and parent reading quality were measured for nine books across three book types (familiar, nonfiction, and fiction). Lower levels of passive engagement and higher levels of disruptive/unengaged behaviors were observed for children on the spectrum compared to their TD peers; nonverbal IQ was positively associated with a higher proportion of time spent in passive engagement. Although parent reading quality (drawing attention to text, promoting interactive reading, and using literacy strategies) and book type (familiar fiction, unfamiliar fiction, and unfamiliar nonfiction) were found to predict active child engagement for all children, regardless of disability status, specific parent behaviors were not measured.

Measuring SBR engagement

There is a lack of consensus regarding the definition and measurement of engagement across learning tasks for children on the spectrum (Keen, 2009), with studies varying in their operationalization of this multidimensional construct (e.g. McWilliam & Bailey, 1992; Ruble & Robson, 2007). In the context of SBR, engagement comprises a number of discrete components of joint attention, including sustained visual attention to the storybook, coordinated attention to the parent, and verbal communication related to book content (Richter & Courage, 2017). Various studies have utilized visual attention (i.e. eye gaze; for a review, see Drysdale et al., 2018) and verbal participation (e.g. Fleury & Schwartz, 2017) as discrete measures of engagement across active tasks for children on the spectrum. To our knowledge, only two studies have investigated these different components of engagement concurrently during naturalistic SBR for TD children (e.g. Guo & Feng, 2013; Son & Tineo, 2016), while no studies have been conducted with children on the spectrum. Son and Tineo delineated visual and verbal components of engagement to investigate links with mothers’ attention talk during SBR and emergent literacy skills in TD children from low-income families (n = 51; mean age = 4.5 years; standard deviation (SD) = 3.6 years). They found a moderate association between children’s visual attention (looks to the storybook and parent combined) and verbal engagement (r = 0.39). Limited associations were found between children’s verbal engagement and emergent literacy skills (letter-word identification only; r = −0.32); no associations were found between children’s visual attention and any emergent literacy measure. Furthermore, Guo and Feng investigated the effects of an SBR intervention on increasing joint engagement in 37 4- to 5-year-old children and their parent/caregiver. Results showed a significant increase in coordinated eye gaze and verbal engagement across experimental conditions (p < 0.05); however, links to emergent literacy were not explored.

Visual attention during SBR

Children’s visual attention during SBR includes maintained eye gaze or sustained attention to a storybook (e.g. print and illustrations; Justice et al., 2005) and/or an adult reader (e.g. parent; Tomasello & Farrar, 1986), which forms the foundation for joint engagement in this context. Links have been shown between where children direct their gaze during SBR, particularly within the pages of a storybook, and their emergent literacy learning. For example, Evans and Saint-Aubin (2013) found a positive correlation between eye fixations on text and 4-year-old TD children’s alphabet knowledge, whereas receptive vocabulary performance was linked to fixations on illustrations. However, characteristics of autism may influence where preschoolers on the spectrum focus their visual attention in this social learning context and subsequent links to early learning. It is widely acknowledged that TD preschoolers infrequently look at the print during SBR (3%–7% of reading time) without direct prompting, preferring to look at the pictures (e.g. Evans & Saint-Aubin, 2005; Justice et al., 2005; Roy-Charland et al., 2007); however, time spent looking at print can be increased through targeted adult prompting (Justice et al., 2008). Available research indicates differences in the duration spent looking at pictures and print during e-book viewing between children on the spectrum who show minimal verbal communication and TD peers; minimally verbal children spent little time looking at either print or pictures while viewing e-books under different conditions (Thompson et al., 2018). However, whether this generalizes to verbal children on the spectrum during SBR with traditional storybooks, which is more dynamic and involves coordinated joint attention, and whether their focus of attention is associated with emergent literacy learning are largely unknown. Children on the spectrum often experience attentional difficulties (for a review, see Chita-Tegmark, 2016) and show atypical responsiveness to social cues that are linked to social communication difficulties (Vivanti et al., 2014), which may impede upon both their ability to focus attention toward the storybook and/or their parent and their learning in the SBR context compared to their TD peers. Alternately, an atypical detailed focus of attention common to autism (Happé & Frith, 2006), as well as high motivation for letters as reported by parents (Lanter et al., 2013), may draw attention to the storybook and potentially benefit preschoolers on the spectrum in learning print-related emergent literacy skills via SBR by drawing their visual focus to print stimuli.

This study

There is an assumption that children learn early literacy and language skills through social engagement and joint attention (Farrant, 2012). For children on the spectrum, these aspects may be displayed through looking behavior, verbal behavior, or both, but may not function in the same manner as their TD peers. As a group, children on the spectrum show a pattern of relative strengths and challenges across their emergent literacy skills and may be disadvantaged in SBR contexts due to challenges in attention and reciprocal social communication. Thus, an understanding of how discrete indicators of engagement during SBR (i.e. visual attention and verbal participation) are related, and potentially more important, for this population is valuable to support emergent literacy learning. Previous research largely demonstrates a narrow focus on the quantity of engagement (e.g. time) during SBR, predominantly in school and clinical contexts (Keen, 2009). Albeit useful for informing interventions, such a focus does not inform researchers or clinicians/educators of the qualitative aspects (e.g. reciprocity) of interactions during SBR that are crucial for facilitating learning in this context. To date, only one study has measured aspects of visual attention and verbal engagement in combination to investigate engagement during SBR for children on the spectrum (Fleury & Hugh, 2018); however, these discrete components of engagement may be linked to differing elements of children’s emergent literacy as found in TD children (e.g. Evans & Saint-Aubin, 2013; Kang et al., 2009; Son & Tineo, 2016). Thus, we separated out visual attention and verbal engagement in order to look more closely at what is happening in an SBR context more broadly for children on the spectrum, explore how parent and child factors are related to both, and potential links to emergent literacy. We utilized two distinct measures of engagement: (1) visual attention, defined as visual gaze directed toward the storybook, parent, or elsewhere while the parent reads and/or asks questions/prompts the child; and (2) verbal engagement, defined as verbal participation or involvement in learning activities (i.e. SBR) related to on-task behavior (Keen, 2009). Furthermore, we explored the nuances of how children on the spectrum engage during this reciprocal task (i.e. where they look and what they talk about) in a naturalistic setting. We focused on parent SBR behaviors shown to facilitate engagement during SBR in previous SBR intervention research (e.g. Fleury & Schwartz, 2017; Mucchetti, 2013; Tipton et al., 2017). Furthermore, receptive vocabulary and alphabet knowledge were chosen as measures of emergent literacy given that these are important predictors of later reading ability for TD children (National Early Literacy Panel (NELP), 2008) and children on the spectrum (Westerveld et al., 2018) and are linked to visual attention during SBR for TD children (e.g. Evans, Saint-Aubin, 2013). Alphabet knowledge includes skills such as letter-name and letter-sound knowledge that are highly correlated (r = 0.76; Westerveld et al., 2017) and are predictive of later reading ability in children on the spectrum (letter-sound knowledge; Westerveld et al., 2018) and TD children (letter-name knowledge; NELP, 2008).

Our research questions included the following:

What are the relationships between different aspects of visual attention and child verbal engagement during SBR for preschoolers on the spectrum?

Are different aspects of visual attention and verbal engagement during SBR associated with parent behaviors and/or individual child characteristics such as autism traits and nonverbal IQ?

Are different aspects of visual attention and overall verbal engagement during SBR associated with the emergent literacy skills of preschoolers on the spectrum?

Given the paucity of research in this area, we tentatively predicted weak to moderate associations between children’s visual attention to the storybook and/or parent and their overall verbal engagement based on previous research with TD preschoolers (Son & Tineo, 2016, although noting looks to book/parent were combined for visual attention). Furthermore, we predicted that children’s overall engagement (visual attention to the storybook/parent and verbal engagement) would be associated with parent use of SBR behaviors and children’s nonverbal IQ (Fleury & Hugh, 2018). Finally, we expected that children’s visual attention to the storybook would be associated with their letter-name knowledge (Lanter et al., 2013), while visual attention to the parent and overall verbal engagement would be associated with children’s receptive vocabulary (Hindman et al., 2008).

Method

Design and procedure

Data were extracted from two existing databases compiled as part of an evaluation of literacy profiles (Westerveld et al., 2017) and an SBR intervention study (Westerveld, O’Leary, & Paynter, 2019 (unpublished manuscript; see below for details), which received ethical clearance by the Griffith University ethics committee (AHS/13/14/HREC; AHS/34/15/HREC). Video footage of Time 1 SBR sessions, associated transcripts, and other data of interest for a subset of participants were extracted for analyses.

Emergent literacy skills of children with autism spectrum disorder

This project investigated the emergent literacy skills of preschools with autism spectrum disorder (ASD) and longitudinal preschool predictors of word reading ability in the first year of schooling (Westerveld et al., 2017). Participants included 57 preschool-aged children with autism and their parents.

SBR intervention for preschoolers with autism

This project included a pre-test–post-test randomized control group study investigating the efficacy of an intensive SBR intervention for preschoolers with ASD (Westerveld, O’Leary, & Paynter, 2019). Participants included 17 preschool-aged children with autism and their parents.

Participants

Participants were a subset of children on the spectrum and their parents who completed Time 1 videos for the initial studies (see Westerveld et al., 2017, and Westerveld, O’Leary, & Paynter, 2019, for further details). For both initial projects, participants were recruited through AEIOU early childhood services for children on the autism spectrum, private speech pathology clinics, Applied Behavior Analysis (ABA) clinics, a children’s hospital, and social media. To be included in the prior projects, children were required to have a formal autism diagnosis, be of preschool age and have not commenced formal schooling, possess the ability to speak in short sentences, and be able to participate in preschool-like activities. Confirmation of child eligibility was obtained via parent report and performance on the Vineland Adaptive Behavior Scales (VABS-II; Sparrow et al., 2005) communication domain. To verify autism diagnosis, written documentation such as letters from child psychologists and results regarding children’s performance on the Autism Diagnostic Observation Schedule (ADOS; Lord et al., 2012) were provided by parents. Where ADOS results were not available, parents completed the Social Communication Questionnaire—Lifetime form (SCQ; Rutter et al., 2003). A cut-off of 11 was used for the SCQ in line with Eaves et al.’s (2006) findings. Of the 58 children (literacy: n = 41; intervention: n = 17) across studies, 12 children (literacy cohort) were excluded due to missing Time 1 videos or obscured footage and 6 children (intervention cohort) were excluded due to missing videos and/or standardized measure scores. Thus, the current sample included 40 children (33 males; 7 females) aged between 39 and 70 months (mean = 56.68, SD = 6.19) and their parents who completed the Time 1 video for each study (literacy: n = 29; intervention: n = 11). All families resided in southeast Queensland, Australia (see Table 1 for parent demographics and home literacy information).

Table 1.

Parent demographic and home literacy information.

Demographic/home literacy environment	N	%
Age (n = 39), years
21–30	3	7.5
31–40	26	65.0
41–50	10	25.0
Primary language spoken (n = 40)
English	39	97.5
Arabic	1	2.5
Country of birth
Australia	32	80.0
New Zealand	1	2.5
United Kingdom	1	2.5
Papua New Guinea	1	2.5
Indonesia	1	2.5
Japan	1	2.5
Egypt	1	2.5
South Africa	1	2.5
Highest education level (n = 40)
Secondary school	13	32.5
Tertiary education	27	67.5
How often do you read to your child? (n = 39)
Seldom	2	5.0
Sometimes	10	25.0
Often	14	35.0
Very often	13	32.5
At what age did you start reading to your child? (n = 28)
Less than 12 months	21	52.5
1–2 years	4	10.0
2–3 years	3	7.5
How many books does your child own? (n = 25)
10 or more	16	17.5
50 or more	9	22.5
100 or more	8	20.0
200 or more	1	2.5
How many books do you own? (n = 28)
10 or more	4	10.0
50 or more	5	12.5
100 or more	16	40.0
400 or more	3	7.5

Measures

Autism characteristics

The SCQ (Rutter et al., 2003) was used to measure autism symptoms as in previous research (e.g. Paynter et al., 2013; Schwenck & Freitag, 2014). Research has shown the SCQ to have good psychometric properties, with high sensitivity and specificity (sensitivity = 0.88 and specificity = 0.72; Chandler et al., 2007), fair internal consistency (Snow & Lecavalier, 2008), and convergent validity (Eaves et al., 2006). A cut-off score of 11 or above was used as recommended in previous preschooler research (e.g. Eaves et al., 2006).

Nonverbal IQ

Two subscales of the Mullen Scales of Early Learning (MSEL; Mullen, 1995) were utilized: Visual Reception and Fine Motor. A Developmental Quotient (DQ) score was calculated (by averaging the child’s age equivalent across the two subscales, divided by the child’s chronological age in months, and multiplying by 100) as a measure of children’s nonverbal IQ as per previous research with young children on the spectrum (e.g. Davidson & Ellis Weismer, 2014; Yang et al., 2016). The MSEL is a widely used measure of child development used in previous autism research (e.g. Davidson & Ellis Weismer, 2014; Yang et al., 2016) that has demonstrated construct, convergent, and divergent validity with autism samples (Bishop et al., 2011; Swineford et al., 2015).

Receptive vocabulary

The Peabody Picture Vocabulary Test—Fourth Edition (PPVT-4; Dunn & Dunn, 2007) was used as a measure of children’s receptive vocabulary as per previous research examining language skills of children on the spectrum (e.g. Condouris et al., 2003; Westerveld et al., 2016). The PPVT-4 is a widely used measure with strong psychometric properties reported by the developers (split-half reliability and Cronbach’s alpha of 0.94 or higher for both forms; test–retest reliability r = 0.93) with evidenced utility as a proxy for verbal IQ in autism studies (Krasileva et al., 2017). Standard scores and age equivalent scores were calculated, with age equivalent scores used in main analyses as per previous research with children on the spectrum (e.g. Paynter & Peterson, 2010). This decision was made a priori to capture the range of individual differences as some children on the spectrum may score too low on raw scores to achieve meaningful standard scores.

Alphabet knowledge (letter name)

To date, no valid, norm-referenced tests for assessing emergent literacy skills in preschoolers on the spectrum are available. Thus, alphabet knowledge was assessed using a letter-name subtest from the Phonological Awareness Literacy Screening for Preschoolers (PALS-PreK; Invernizzi et al., 2004). The PALS-PreK is a developmentally appropriate measure of emergent literacy for 4-year-old children that shows acceptable reliability (internal consistency) and validity (criterion, predictive, and construct) for TD populations (Invernizzi et al., 2004). The letter-name knowledge task involved presenting children with all 26 letters of the alphabet in random order, printed upper case, on a sheet of white paper. One point was allocated for each letter named correctly (maximum score = 26).

Parent–child SBR video

Parents of both cohorts were requested to video record sharing Pip and Posy, the Big Balloon (Scheffler, 2012) with their child. The book is suitable for preschool-aged children with a clear narrative structure with simple text and illustrations. Parents of children from the literacy cohort were asked to share two books without controlling for book order. Of these, nine children were read the target book first; 20 were read this book second. Children from the intervention cohort (n = 11) were only read Pip and Posy, the Big Balloon. Videos were recorded either in the family home by parents or at the child’s early learning center (n = 1). Parents were requested “to read to their child as they normally would.” The decision was made a priori not to control for reading duration in analysis as controlling for book was deemed of greater importance and variability in reading duration was expected as per previous research (e.g. McGinty et al., 2012).

Transcription

All parent and child utterances produced during the video-recorded parent–child SBR sessions were transcribed verbatim and entered into SALT (Systematic Analysis of Language Transcripts; Miller et al., 2016) by trained research assistants. As per SALT conventions, an utterance was defined as a communication unit (Miller et al., 2016). Unintelligible words were transcribed as an X. Original SALT transcripts were further coded using systematic sequential observation as described below.

Child engagement

We delineated measures of children’s engagement during SBR into two constructs: sustained visual attention and verbal engagement.

Visual attention

Children’s visual attention during the SBR session was coded according to whether the child was directing their gaze toward the storybook, the parent, or elsewhere per parent (attention to storybook) and parent or child utterance (attention to parent or elsewhere). Children were deemed as attending if they held their gaze in the specified direction for at least 2 s. Total scores and the percentage of total reading duration time a child spent looking per component were calculated; total scores were used for the correlation analysis.

Verbal engagement

Children’s level of verbal engagement was measured using an adapted version of Son and Tineo’s (2016) coding scheme. The original scale consisted of four indicators scored on a three-point rating scale (1 = not engaged; 2 = somewhat engaged; 3 = fully engaged). To reduce potential subjectivity and error in coding, we utilized a modified dichotomous scale (1 = not engaged; 2 = fully engaged). The original four indicators were retained: (1) text reading, (2) story description, (3) story inference, and (4) responsivity (see Supplemental Appendix A for details and examples). We amended the responsivity indicator to reflect a measure of verbal engagement in response to parent questions and/or prompts. Individual videos were viewed in time sequence and codes simultaneously entered into pre-existing SALT transcripts. No limit was placed on the number of times the video could be viewed for coding purposes. Given that children on the spectrum demonstrate considerable variability in speech and language abilities (Kjelgaard & Tager-Flusberg, 2001), both partial (e.g. xxxx ba boon) and completely intelligible (e.g. oh oh no oh no up up) utterances were included in analyses as indicators of children’s verbal engagement. This decision was made to ensure that the engagement attempts (as observed in the video footage) of children with lower oral language abilities were included. Utterances that were completely unintelligible in which the child was not engaged with the parent and storybook reading were excluded (1.83% of overall utterances); there were no completely unintelligible utterances in which the child was observed to be engaged. The responsivity indicator was used as a measure of child responsiveness. This indicator was coded per child response (or nonresponse) to each parent question and/or prompt and was not mutually exclusive (e.g. child response also coded in line with content of utterance). All other indicators were coded per child utterance. Scores for each indicator were summed to obtain a total verbal engagement score.

Parent behaviors

Parent SBR behaviors were coded utilizing aspects of a clinical observation scale as per the initial studies (see Supplemental Appendix B for details). Four types of parent behaviors were coded in the original transcripts: (1) exposure to book vocabulary/language, (2) explicit teaching of print-related skills, (3) explicit teaching of story structure, and (4) use of questions. Individual videos were viewed in time sequence and codes simultaneously entered into pre-existing SALT transcripts by a trained research assistant. To extend upon previous work (Westerveld, Paynter, & Wicks, 2019; unpublished manuscript), parent verbal prompts were also coded to investigate how responsive children were to specific types of parent prompts/input. Scores for each parent behavior category were calculated using SALT and summed to obtain a total frequency. Questions and prompts were further summed to obtain a total composite score to investigate the overall responsiveness of children.

Reliability

Reliability of transcription was obtained in both initial studies. In each instance, videos were randomly selected (20% per study). Associated transcripts were first checked for accuracy by an independent researcher who noted any disagreements in utterances while viewing each video; there were 98 disagreements (1.6%) across all transcripts. Following this, transcripts were blind-coded for parent behaviors and intraclass reliability coefficients calculated to assess rater agreement. Inter-rater reliability in this study was established via blind-coding of eight randomly selected transcripts (20%) by an independent assessor (experienced in language sample analysis). Each video was viewed and the associated transcript was recoded for child verbal engagement and visual attention. A Krippendorff’s alpha coefficient (Krippendorff, 1980) was then calculated to quantify the level of agreement between raters as used in previous research (e.g. Westerveld et al., 2012). Krippendorff’s alpha using ordinal scaling was 0.93, which reflects an excellent agreement between the independent coders.

Results

Data screening and preliminary analysis

Missing value analysis of each variable showed <5% missing with analysis, suggesting that data were missing completely at random (MCAR), Little’s MCAR test: χ²(15) = 22.68, p = 0.091, ns. Thus, data were deleted listwise by analysis as per recommendations under these conditions (Tabachnick & Fidell, 2007). Violations of normality were observed across all child and parent SBR and emergent literacy variable distributions (Shapiro–Wilk statistic: p < 0.05), with a potential ceiling effect indicated for letter-name knowledge. Square root transformation showed no change in outcomes; thus, median scores were reported, and nonparametric analyses were conducted to answer the research questions posed. Outlying scores were identified across variable distributions (n = 6, Z > 3.29) and were excluded from further analyses using listwise deletion by analysis. No significant correlations were found between age in months and children’s SCQ, DQ, PPVT-4 (age equivalent), and letter-name knowledge scores (r = −0.13 to 0.15, all p > 0.05), as such age was not entered into analyses. Preliminary analyses (Mann–Whitney U tests) indicated a significant difference in reading duration between children with low nonverbal IQ (<70) and those who fell above the clinical cut-off (U = 108.00, Z = −2.32, p = 0.020). Further inspection showed no significant differences on any other variable; thus, data were analyzed at group level. No significant associations were found between reading duration (in seconds) and parent-reported frequency of SBR with their child (r_s = 0.12, p = 0.472) nor their child’s interest in books (r_s = 0.21, p = 0.272). An examination of the effect of reading duration on the other variables tested showed moderate to strong associations for visual attention to the book (r_s = 0.79, p < 0.001), total verbal engagement (r_s = 0.62, p < 0.001), parent use of book language (r_s = 0.62, p < 0.001), and number of questions and prompts (r_s = 0.77, p < 0.001). No significant associations were found between reading duration and child characteristics (SCQ: r_s = −0.30, p = 0.064; nonverbal IQ: r_s = 0.28, p = 0.077).

Descriptive statistics

Table 2 shows child performance on standardized measures of autism characteristics, nonverbal IQ, receptive vocabulary, and letter-name knowledge. Considerable heterogeneity was shown, with wide variability across children’s performance on all measures (see Table 1). Nonverbal IQ scores ranged from those indicating intellectual disability (<70; n = 16) to within age-expected ranges and over (>100; n = 8). Children’s receptive vocabulary as measured on the PPVT-4 ranged from significantly below to significantly above average.

Table 2.

Child performance on measures of autism characteristics, nonverbal IQ, receptive vocabulary, and letter-name knowledge (n = 40).

Variable	Mean	Median	SD	Range
SCQ	17.00	16.00	6.70	5–32
Nonverbal IQ (DQ)	76.56	79.28	22.37	41–119
PPVT-4 (SS)	86.55	83.00	17.11	54–127
PPVT-4 (AE)	46.50	42.00	14.14	25–81
LNK (RS)	15.75	22.50	10.59	0–26

SD: standard deviation; SCQ: Social Communication Questionnaire; DQ: Developmental Quotient; PPVT-4: Peabody Picture Vocabulary Test—Fourth Edition; SS: standard score; AE: age equivalent score; LNK: letter-name knowledge—upper case; RS: raw score (maximum = 26).

Descriptive analysis of child behaviors

Visual attention

Children’s visual attention was widely variable across each visual attention measure (see Table 3). Wilcoxon signed-rank test statistics were conducted to assess differences between visual attention measures in the percentage of reading time children spent looking. Comparisons between measures indicated that children spent a larger percentage of reading time looking toward the storybook (median = 21.75) compared to looking toward the parent (median = 0.35; Z = −5.51, p < 0.001) and looking elsewhere (median = 1.55; Z = −5.48, p < 0.001), with large effects. Observations obtained from viewing each video-recorded session footage revealed that all children mostly produced utterances while directing their gaze toward the book, despite their parent asking a question or prompting engagement. Further inspection showed that 18 children (45%) did not look toward their parent throughout the SBR session at any time.

Table 3.

Descriptive summary of child visual attention and verbal engagement during SBR.

Variable	N	Mean	Median	SD	Range
Visual attention (book)
Frequency	40	58.38	52.00	28.71	24–125
%Duration	40	21.08	21.75	6.39	10–32.28
Visual attention (parent)
Frequency	40	3.28	1.50	5.52	0–26
%Duration	40	1.45	0.35	6.39	0–11.35
Visual attention (elsewhere)
Frequency	40	7.30	5.00	9.23	0–43
%Duration	40	3.01	1.55	3.74	0–15.36
Total child utterances	40	36.68	28.50	26.14	0–97
Total verbal engagement	40	16.75	11.50	14.40	0–49
Spontaneous utterances	40	8.13	3.50	9.17	0–34
Utterances in response to parent	40	11.88	7.50	11.25	0–38
Text reading	39	3.20	0.00	15.71	0–14
Story description	39	12.95	8.00	16.56	0–31
Story inference	39	5.40	2.00	15.63	0–14

SBR: shared book reading; SD: standard deviation.

n values vary due to exclusion of outlier scores; see Supplemental Appendix A for a detailed description of visual attention and verbal engagement coding scheme.

Verbal engagement

Children produced an average (median score) of 28.50 utterances (range = 0–97) during the SBR session; one child produced no utterances and 10% of children produced eight utterances or less. An average (median score) of 11.50 utterances were produced across all three verbal engagement categories (text reading, story description, and story inference) either spontaneously or in response to parent questions/prompts; however, a wide range of scores were observed. The most frequent type of child utterance was related to story description, followed by utterances related to story inference; however, it was noted that 13 children (32.5%) scored zero instances of story inference. Limited text reading was observed (75% scoring zero). On average, 71% of children’s verbal engagement was in response to parent questions and prompts.

Descriptive analysis of parent behaviors

Table 4 shows a descriptive summary of parent behaviors observed. Parents varied widely in the length of time they spent sharing the book with their child (median = 232.00 s, range = 105–770 s), the total number of utterances they produced (median = 59.00, range = 27–146), and the SBR behaviors they utilized. One parent read the book verbatim to their child with no diversion from the printed text; all others utilized SBR behaviors in addition to reading the text at varying degrees of frequency. On average, in addition to reading the text, parents most frequently produced utterances that were questions or prompts (35% of total utterances), followed by utterances related to book language (20% of total utterances).

Table 4.

Descriptive summary of parent SBR behaviors.

Variable	N	Mean	Median	SD	Range
Total parent utterances	40	69.18	59.00	32.34	27–146
Use of book language	39	16.10	10.50	18.65	0–57
Questions/prompts	40	24.03	20.50	17.84	0–60

SBR: shared book reading; SD: standard deviation.

n values vary due to exclusion of outlier scores.

Correlations between child and parent measures

Our research questions centered on exploring the relationships between aspects of children’s visual attention and verbal engagement during SBR, parent SBR behaviors, individual child characteristics, and their emergent literacy performance (see Table 5 for bivariate Spearman’s correlations (rho)).

Table 5.

Spearman’s correlations between child visual attention and verbal engagement, parent behaviors, SCQ, nonverbal IQ, and emergent literacy measures.

	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15
1. VA book	–	0.06	0.001	0.76*	0.50*	0.82*	0.23	0.73*	0.51*	0.90*	0.84*	−0.27	0.22	0.15	0.12
2. VA parent		–	0.17	0.50*	0.49*	0.18	0.34*	0.39*	0.37*	0.14	0.05	0.18	0.12	−0.11	−0.15
3. VA elsewhere			–	0.16	0.06	0.09	−0.15	0.16	−0.03	0.21	0.24	0.12	−0.25	−0.50*	−0.25
4. VE total				–	0.85*	0.75*	0.32*	0.92*	0.66*	0.78*	0.67*	−0.20	0.25	0.08	−0.006
5. CU spontaneous					–	0.44*	0.24	0.70*	0.65*	0.45*	0.42*	−0.08	0.28	0.16	−0.08
6. CU response Q/P						–	0.38*	0.67*	0.56*	0.89*	0.69*	−0.22	0.33*	0.25	0.15
7. VE text reading							–	0.17	0.12	0.28	0.06	0.25	0.05	0.19	0.26
8. VE story description								–	0.56*	0.75*	0.66*	−0.30	0.13	−0.06	−0.06
9. VE story inference									–	0.44*	0.34*	−0.18	0.41*	0.32*	−0.14
10. Parent Q/P										–	0.87*	−0.27	0.17	0.08	0.18
11. Words											–	−0.19	0.07	−0.01	0.18
12. SCQ												–	−0.06	−0.06	0.21
13. DQ													–	0.71*	0.12
14. PPVT-4														–	0.14
15. LNK															–

SCQ: Social Communication Questionnaire; VA: visual attention; VE: verbal engagement; CU: child utterances; Q/P: questions and prompts; Words: parent use of book language; DQ: Developmental Quotient; PPVT-4: Peabody Picture Vocabulary Test—Fourth Edition; LNK: letter-name knowledge.

p < 0.05.

Visual attention and verbal engagement

Our first research question sought to explore the relationships between different aspects of children’s visual attention and verbal engagement during SBR. There were strong positive significant associations between children’s visual attention to the book and their overall verbal engagement with parents (r_s = 0.76, p < 0.001, $r_{s}^{2} = 0.58$ ), their spontaneous utterances (r_s = 0.50, p = 0.001, $r_{s}^{2} = 0.25$ ), utterances in response to parent questions/prompts (r_s = 0.82, p < 0.001, $r_{s}^{2} = 0.67$ ), utterances related to story description (r_s = 0.73, p < 0.001, $r_{s}^{2} = 0.53$ ), and utterances related to story inference (r_s = 0.51, p = 0.001, $r_{s}^{2} = 0.26$ ), during the SBR session. A high intercorrelation between children’s visual attention to the storybook and their utterances in response to parent questions/prompts was noted (r > 0.80). A strong positive significant association was found between children’s visual attention to the parent and their total verbal engagement (r_s = 0.50, p = 0.004, $r_{s}^{2} = 0.25$ ). Moderate positive significant associations were found between visual attention to the parent and the number of spontaneous child utterances produced (r_s = 0.49, p = 0.001, $r_{s}^{2} = 0.24$ ), utterances related to text reading (r_s = 0.34, p = 0.033, $r_{s}^{2} = 0.12$ ), story description (r_s = 0.39, p = 0.012, $r_{s}^{2} = 0.15$ ), and story inference (r_s = 0.37, p = 0.018, $r_{s}^{2} = 0.14$ ). All other correlations for visual attention to the storybook or parent were nonsignificant. No significant correlations were found between visual attention elsewhere and any other engagement measure.

Parent behaviors and individual child characteristics

The second research question asked whether different aspects of children’s visual attention (i.e. looks to the storybook, parent, and elsewhere) and their verbal engagement during SBR were associated with parent behaviors and/or individual child characteristics such as autism traits and nonverbal IQ. Strong positive significant associations were found between children’s visual attention to the storybook and parent use of book language (r_s = 0.84, p < 0.001, $r_{s}^{2} = 0.71$ ) and use of questions/prompts (r_s = 0.90, p < 0.001, $r_{s}^{2} = 0.81$ ). There were no significant associations between visual attention to the parent or elsewhere and either parent behavior measure. Strong positive to moderate significant associations were found between both parent behaviors measured and children’s total verbal engagement (Q/P: r_s = 0.78, p < 0.001, $r_{s}^{2} = 0.61$ ; book language: r_s = 0.67, p < 0.001, $r_{s}^{2} = 0.45$ ), spontaneous utterances (Q/P: r_s = 0.45, p = 0.004, $r_{s}^{2} = 0.20$ ; book language: r_s = 0.42, p = 0.008, $r_{s}^{2} = 0.18$ ), utterances related to story description (Q/P: r_s = 0.75, p < 0.001, $r_{s}^{2} = 0.56$ ; book language: r_s = 0.66, p < 0.001, $r_{s}^{2} = 0.44$ ), and utterance related to story inference (Q/P: r_s = 0.44, p = 0.005, $r_{s}^{2} = 0.19$ ; book language: r_s = 0.34, p = 0.035, $r_{s}^{2} = 0.12$ ). Children’s utterances in response to parent questions/prompts were strongly positively significantly associated with both parent questions/prompts (r_s = 0.89, p < 0.001, $r_{s}^{2} = 0.79$ ) and use of book language (r_s = 0.69, p < 0.001, $r_{s}^{2} = 0.48$ ). A moderate positive significant association was found between children’s nonverbal IQ and their responses to parent questions/prompts (r_s = 0.33, p = 0.035, $r_{s}^{2} = 0.11$ ). No significant correlations were found between children’s SCQ sores and any measure.

Emergent literacy skills

Our final research question asked whether visual attention and verbal engagement during SBR were associated with the emergent literacy skills of preschoolers on the spectrum. There was a strong negative significant association found between children’s looks away from either the storybook or parent (i.e. visual attention elsewhere) and their receptive vocabulary (r_s = −0.50, p = 0.001, $r_{s}^{2} = - 0.25$ ), while a strong positive significant association was found between children’s receptive vocabulary and their nonverbal IQ (r_s = 0.71, p < 0.001, $r_{s}^{2} = 0.50$ ). All other associations for receptive vocabulary were nonsignificant. No significant associations were found between children’s letter-name knowledge and any visual attention or verbal engagement measure.

Discussion

This study focused on exploring different aspects of visual attention and verbal engagement during SBR for preschoolers on the spectrum and the SBR behaviors of their parents. A secondary aim was to explore the links between these variables and concurrent child emergent literacy skills. Our findings expand upon previous work (e.g. Fleury & Hugh, 2018; Tipton et al., 2017) by providing insight into what engagement during SBR looks like more broadly for preschoolers on the spectrum and elucidating important relationships between differential aspects of children’s visual attention and verbal engagement and parent behaviors. Significant relationships found between the length of time spent reading and various child and parent behaviors were expected; longer reading duration naturally affords children greater opportunities to visually attend and verbally engage and parents to utilize SBR behaviors in attempts to engage their child. Findings show that parents of preschoolers on the spectrum were able to facilitate their child’s attention and engagement using common SBR strategies, regardless of their child’s individual characteristics. Considering that children on the spectrum are at increased risk of persistent language and literacy difficulties, a better understanding of the interplay between parent SBR behaviors, overall engagement and the nuances of children’s engagement with parents during SBR provides insight into how these children may in future reap full benefit from this important early learning context that can inform interventions aimed at improving long-term reading outcomes.

Child visual attention and verbal engagement

This study built on previous work (Fleury & Hugh, 2018) by differentiating visual attention and verbal engagement as separate constructs and further delineating children’s focus of attention between the storybook, their parent, and elsewhere. Children displayed limited instances of coordinated joint attention; most children rarely looked toward the parent either while they or the parent spoke throughout the SBR session, with 45% scoring zero. In contrast, children demonstrated an overall tendency to look toward the storybook when they made utterances either spontaneously or in response to parent questions/prompts and when their parent spoke, indicating comparatively higher levels of supported joint attention across the group consistent with previous research (Adamson et al., 2009). Given evidence suggesting that children on the spectrum show less interest in SBR compared to their TD peers and their peers with Down syndrome (e.g. Dynia et al., 2014; Westerveld & van Bysterveldt, 2017) and higher levels of passive engagement (i.e. onlooking behavior with no verbal interaction) to TD peers, the high degree of sustained visual attention to the storybook and thus supported joint engagement observed overall in our study is a novel finding that warrants further investigation.

A wide variability was also found across verbal engagement indicators, which was expected given the heterogeneity in autism and based on previous SBR studies for children on the spectrum (Fleury et al., 2014; Fleury & Schwartz, 2017) and language disorder (McGinty et al., 2012). However, the heterogeneity observed suggests that interpretation/generalization of findings from group to individual level should be made with caution and future research that investigates subtypes is needed to inform individualized interventions of discrete strengths/needs in order to inform practice. Children’s verbal engagement was largely centered on labeling and describing aspects of the story and book content, with limited text reading, which is in line with that expected for their age (Saracho & Spodeck, 2010). Furthermore, children made few utterances related to story inference despite parent facilitation, with a large number scoring zero for this indicator. This finding is novel and may provide insight into what aspects of SBR engagement to target in interventions to support children’s story comprehension. As predicted, children produced the most utterances in response to parent questions/prompts (71% of total verbal engagement). Questions and prompts during SBR are a known turn-taking tool used by parents to elicit and increase child participation and responsiveness for both children with language disorder (McGinty et al., 2012) and children on the spectrum (Fleury & Schwartz, 2017; Tipton et al., 2017). As such, this result was somewhat expected, but the high correlation found may indicate that children on the spectrum rely more on this behavior by their parent than other children to maintain attention and facilitate active participation.

Relationship between visual attention and verbal engagement

Our first research question centered on exploring the relationships between different aspects of visual attention and verbal engagement of preschoolers on the spectrum during SBR. SBR is a social learning context that requires children to share their attention between the storybook and their parent while engaging verbally. Overall, results suggested that if children attended to either the storybook or parent, these were related to the amount of verbal engagement more broadly. Strong correlations were found between children’s visual attention to both the storybook and parent and their overall verbal engagement; however, the effect for attention to the storybook was noticeably greater. This result contrasts with Son and Tineo’s (2016) finding in TD children from low-income families; however, this may be due to differences in measurement given that they combined looks to both the storybook and parent in their visual attention measure. Impairments in joint attention and restricted interests are diagnostic features of autism (American Psychiatric Association (APA), 2013) that may influence what children focus on during social learning contexts such as SBR. Hence, the high correlation between visual attention to the storybook and overall verbal engagement may reflect a narrow focus on the storybook while verbally engaging, rather than looking toward the parent, as was observed in the data. Furthermore, the strong correlation found between visual attention to the parent and overall verbal engagement suggests that if children looked toward their parent it was a good indicator of their verbal engagement; however, this behavior was rare within the sample. Furthermore, the high degree of overlap between visual attention to the storybook and verbal engagement compared to attention to the parent found may suggest that these components of supported joint engagement may be more contingent upon each other during SBR for preschoolers on the spectrum compared to their TD peers. However, replication and further investigation are required to confirm this interpretation.

Factors related to children’s visual attention and verbal engagement

Our remaining research questions asked whether visual attention and verbal engagement during SBR were associated with parent behaviors, individual child characteristics, and children’s emergent literacy skills. Both child visual attention to the storybook and overall verbal engagement were strongly related to parents’ use of SBR behaviors. This is consistent with Fleury and Hugh (2018) who found significant associations between the quality of parents’ reading during SBR and the amount of time children on the spectrum spent actively engaged. SBR intervention research has consistently demonstrated the efficacy of parent-mediated techniques for increasing active participation during SBR for young children who are TD (Justice & Ezell, 2000), as well as those on the spectrum who show limited verbal engagement during SBR without adult facilitation (Fleury & Schwartz, 2017; Golloher, 2017; Mucchetti, 2013). Thus, the results support and extend upon previous research by providing insight into how specific parent behaviors (e.g. asking questions and using prompts related to book content) and different aspects of attention/engagement are potentially linked for children on the spectrum in this learning context. Furthermore, findings suggested that children’s utterances related to story description and story inference were moderate to strongly related to parent SBR behavior, which may reflect reciprocity between parent–child dyads related to storybook discussion. Promisingly, this may further indicate that parents of children on the spectrum are potentially adept at prompting and maintaining their child’s attention. As such, these parents may have adapted to their child’s social communication and attentional challenges by actively prompting and maintaining interaction in ways that are tailored to their child’s needs as shown in previous research (Tipton et al., 2017; Watson, 1998). Moreover, due to known attentional differences (Chita-Tegmark, 2016), children on the spectrum may rely more on their parents to facilitate and maintain interaction during SBR than other children; however, causal assumptions cannot be made due to the cross-sectional design of this study.

In contrast to Fleury and Hugh’s (2018) study, our findings suggested that where children directed their visual attention (i.e. toward the storybook, parent, or elsewhere) was not significantly associated with their nonverbal IQ. However, as we measured aspects of visual attention and verbal engagement separately, direct comparisons cannot be made, as Fleury and Hugh combined elements into broad engagement measures. Furthermore, it may be that nonverbal IQ is linked to oral language ability rather than attention in this study given the strong effect indicated between children’s nonverbal IQ and PPVT-4 scores (r = 0.70, p < 0.001). Interestingly, children’s vocabulary knowledge was negatively related to instances of looking elsewhere during the SBR session, which may suggest that those children with lower language ability were more likely to divert their attention away (i.e. disengage) from the joint activity. Consistent with previous findings (Fleury & Hugh, 2018), how much children responded to parent questions/prompts was positively related to their nonverbal IQ, while children’s engagement related to story inference was related to both nonverbal ability and vocabulary knowledge (higher PPVT-4 score; Westerveld et al., 2017). Together, these findings may reflect both the strong link between nonverbal IQ and oral language ability shown and assist in understanding the role nonverbal IQ plays in the meaning-related emergent literacy of children on the spectrum. Results may also suggest that children with a lower nonverbal IQ and language ability, who were found to produce fewer words, may require a higher degree of targeted adult scaffolding more broadly and adapted response formats (e.g. pointing, use of props, and simplified questioning) to facilitate attention and active participation, vocabulary learning, and meaning-related emergent literacy skills (e.g. Mucchetti, 2013); however, further investigation is required to confirm this supposition.

The lack of associations found between children’s letter-name knowledge and any other child or parent variable was unexpected given previous research indicating that children on the spectrum demonstrate a high motivation for letters as reported by parents (Lanter et al., 2013) and the positive relationship shown between visual attention to text during SBR and 4-year-old TD children’s alphabet knowledge (Evans & Saint-Aubin, 2013). However, these nonsignificant associations may be more reflective of the measurements utilized (e.g. observational coding) or suggest that children learn these skills in other contexts, such as early intervention programs or through interaction with other aspects of their environments (i.e. environmental print). Furthermore, letter-name knowledge is a constrained skill, due to the finite number of elements to be learned, that correlates with literacy measures only when children are in the process of learning the alphabet (Paris, 2005). Many of the children in this sample had mastered this constrained skill, as shown by the ceiling effect for letter-name knowledge whereby the majority of children scored in the upper range restricting variance, which may have decreased the association between letter-name knowledge and children’s visual attention and verbal engagement and parent SBR behaviors.

Limitations and future directions

Results of the study should be interpreted in line with several limitations. First, information pertaining to the type and amount of early intervention children had received was not collected in either initial study and our sample primarily included parents who reported reading to their child at a young age and were more likely to value reading/literacy. Thus, caution is required in generalizing results to the broader autism population. Furthermore, we assessed a small number of concurrent emergent literacy skills, using a cross-sectional design. Emergent literacy learning involves a number of interrelated processes that may influence different aspects of reading development at different points in time (National Institute of Child Health and Human Development (NICHD), 2005). Thus, while few links were found with concurrent emergent literacy skills, it may be that visual attention and verbal engagement during SBR predict future skills acquisition rather than those measured concurrently. In addition, our broad observational measures of visual attention may have been inadequate in identifying links to children’s concurrent receptive vocabulary and letter-name knowledge. Given that children in this study predominantly focused their attention toward the storybook while they verbally engaged, investigations that delve into exactly what children are looking at using more fine-grained measurement (e.g. eye tracking) are required to tease out the relationships between these factors both concurrently and across time. Moreover, future research that extends upon current longitudinal work (e.g. Westerveld et al., 2018) is suggested to investigate the potential developmental links between different aspects of children’s visual attention and verbal engagement and their precursor literacy skills in this literacy learning context. Second, consistent with previous research (e.g. Hindman et al., 2008, 2014; Rees et al., 2017; Son & Tineo, 2016), we did not control for differences in reading duration time. In contrast, other studies (e.g. Blake et al., 2006; Fleury & Hugh, 2018; Luo & Tamis-LeMonda, 2017) did so by calculating proportional frequencies. The benefits of using proportions would be standardizing the potential confound and allowing for comparisons across participants. However, given that the children were read two books in the initial studies, we argue that controlling for the book that was read was of greater importance by minimizing practice effects. Moreover, we believe that the method used is more ecologically valid, as parents were instructed to read the book to their child “as they normally would” and variability in reading time was expected as per previous research (e.g. McGinty et al., 2012). Hence, by retaining a raw duration score, we feel that we were able to capture a more accurate representation of SBR behaviors between parents of children on the autism spectrum and their preschool-aged child. Third, we did not correct for the heightened risk of Type 1 error consequential of multiple analyses. However, minimizing Type 2 error to ensure thorough exploration was deemed of greater importance and application of Bonferroni correction may inhibit a detailed analysis of diverse communities (Moran, 2003). The strong effects found indicated fair stability of the results and identify areas for future research that could both confirm and extend upon the current findings. Finally, as a comparison group was not included, we cannot determine whether the behavior of children included in this study differs from that of their peers. Given previous research suggesting that children on the spectrum show less interest in SBR compared to their peers who are TD or who have Down syndrome (e.g. Dynia et al., 2014; Westerveld & van Bysterveldt, 2017), further investigations that include comparison to TD and/or children with intellectual disability in visual/verbal attention between groups would be of interest to inform future intervention research.

Implications

This research extends upon current knowledge by highlighting the strong links between aspects of visual attention and verbal engagement in children on the spectrum during SBR, as well as unique parent and child factors linked to each. Findings also provide valuable insight into the nuances of children’s attention and engagement in this shared learning context. These novel and important findings may be used to inform future intervention research aimed at improving long-term literacy outcomes for this group of children who are at high risk for persistent language and literacy difficulties. For example, given the strong relationships found between child and parent behaviors, it is important to understand the specific nature of the parent questions and/or prompts utilized, and the types of conversations they elicit, to guide the development of targeted intervention strategies for this group of children. Furthermore, our study indicates that more research is needed to better understand why preschoolers on the spectrum often struggle with their emergent literacy learning. We recommend future research investigate the underlying learning processes, such as the focus of visual attention during SBR and whether this is linked to emergent literacy learning similar to TD children, to better understand how to best support the emergent literacy learning of children on the spectrum in this context. Moreover, future investigations could consider utilizing more in-depth emergent literacy skill measurement (e.g. print concepts, story comprehension, phonological awareness) to gain a more global understanding of overall literacy learning for this group of children.

Conclusion

Visual attention and verbal interaction during SBR are components of joint attention known to facilitate emergent literacy learning for TD preschool-age children. Results from our study suggest that aspects of visual attention, particularly to a storybook, and the amount that preschoolers on the spectrum verbally engage during SBR are strongly related to the behaviors used by their parent. Our findings provide valuable insight into the interplay between different aspects of visual attention and verbal engagement during SBR for preschoolers on the spectrum and the facilitative behaviors executed by their parents; however, these did not link to children’s emergent literacy. This highlights the need to explore other factors (e.g. cognitive processing style and discrete focus of attention) or include longitudinal measures of emergent literacy that may explain the early literacy learning of this group of children. We recommend that future research could investigate the visual preferences preschoolers on the spectrum show during SBR activities and whether these preferences can be changed through the use of targeted prompting to enhance learning of particular emergent literacy skills similar to their TD peers. Such research would allow for greater understanding of the underlying learning mechanisms involved, which can help inform and support early intervention for facilitating long-term reading success. Our study promisingly shows that parents of children on the spectrum can engage their child during SBR and this is related to children paying attention to the storybook and what they talk about. Considering that SBR is an important context for intervention for this group of children, who often struggle with their emergent literacy learning, continued efforts are needed that extend our knowledge to understand how these children can reap full benefit from SBR with parents in the family home and achieve long-term reading success.

Supplemental Material

AUT900594_Supplemental_material_Appendix_A – Supplemental material for Looking or talking: Visual attention and verbal engagement during shared book reading of preschool children on the autism spectrum

Supplemental material, AUT900594_Supplemental_material_Appendix_A for Looking or talking: Visual attention and verbal engagement during shared book reading of preschool children on the autism spectrum by Rachelle Wicks, Jessica Paynter and Marleen F Westerveld in Autism

Supplemental Material

AUT900594_Supplemental_material_Appendix_B – Supplemental material for Looking or talking: Visual attention and verbal engagement during shared book reading of preschool children on the autism spectrum

Supplemental material, AUT900594_Supplemental_material_Appendix_B for Looking or talking: Visual attention and verbal engagement during shared book reading of preschool children on the autism spectrum by Rachelle Wicks, Jessica Paynter and Marleen F Westerveld in Autism

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors acknowledge the financial support of the Cooperative Research Centre for Living with Autism (Autism CRC), established and supported under the Australian Government’s Cooperative Research Centres Program.

ORCID iDs

Rachelle Wicks

Jessica Paynter

Marleen F Westerveld

Supplemental material

Supplemental material for this article is available online.

References

Adamson

L. B.

Bakeman

Deckner

D. F.

Romski

(2009). Joint engagement and the emergence of language in children with autism and Down syndrome. Journal of Autism and Developmental Disorders, 39, 84–96. https://doi.org/10.1007/s10803-008-0601-7

Adamson

L. B.

Chance

(1998). Coordinating attention to people, objects, and symbols. In Wetherby

A. M.

Warren

S. F.

Reichle

(Eds.), Transitions in prelinguistic communication: Preintentional to intentional and presymbolic to symbolic (pp. 15–37). Brookes.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

Arciuli

Stevens

Trembath

Simpson

I. C.

(2013). The relationship between parent report of adaptive behavior and direct assessment of reading ability in children with autism spectrum disorder. Journal of Speech, Language, and Hearing Research, 56, 1837–1844. https://doi.org/10.1044/1092-4388(2013/12-0034)

Bakeman

Adamson

L. B.

(1984). Coordinating attention to people and objects in mother-infant and peer-infant interaction. Child Development, 55, 1278–1289. https://doi.org/10.2307/1129997

Bishop

S. L.

Guthrie

Coffing

Lord

(2011). Convergent validity of the Mullen Scales of Early Learning and the differential ability scales in children with autism spectrum disorders. American Journal on Intellectual and Developmental Disabilities, 116, 331–343. https://doi.org/10.1352/1944-7558-116.5.331

Blake

Macdonald

Bayrami

Agosta

Milian

(2006). Book reading styles in dual-parent and single-mother families. British Journal of Educational Psychology, 76, 501–515. https://doi.org/10.1348/000709905X49719

Chandler

Charman

Baird

Simonoff

Loucas

Meldrum

Scott

Pickles

(2007). Validation of the Social Communication Questionnaire in a population cohort if children with autism spectrum disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1324–1332. https://doi.org/10.1097/chi.0b013e31812f7d8d

Chita-Tegmark

(2016). Attention allocation in ASD: A review and meta-analysis of eye-tracking studies. Review Journal of Autism and Developmental Disorders, 3, 209–223. https://doi.org/10.1007/s40489-016-0077-x

10.

Condouris

Meyer

Tager-Flusburg

(2003). The relationship between standardized measures of language and measures of spontaneous speech in children with autism. American Journal of Speech-Language Pathology, 12, 349–358. https://doi.org/10.1177/1362361305051395

11.

Davidson

M. M.

Ellis Weismer

(2014). Characterization and prediction of early reading abilities in children on the autism spectrum. Journal of Autism and Developmental Disorders, 24, 828–845. https://doi.org/10.1007/s10803-013-1936-2

12.

Drysdale

B. M.

Moore

D. W.

Furlonger

B. E.

Anderson

(2018). Gaze patterns of individuals with ASD during active task engagement: A systematic literature review. Review Journal of Autism and Developmental Disorders, 5, 1–14. https://doi.org/10.1007/s40489-017-0119-z

13.

Dunn

L. M.

Dunn

L. M.

(2007). Peabody Picture Vocabulary Test-4. American Guidance Service.

14.

Dynia

J. M.

Lawton

Logan

J. A. R.

Justice

L. M.

(2014). Comparing emergent-literacy skills and home-literacy environments of children with autism and their peers. Topics in Early Childhood Special Education, 34, 142–153. https://doi.org/10.1177/0271121414536784

15.

Eaves

L. C.

Wingert

H. D.

H. H.

Mickelson

E. C. R.

(2006). Screening for autism spectrum disorders with the Social Communication Questionnaire. Developmental and Behavioral Pediatrics, 27, 95–103. https://doi.org/10.1097/00004703-200604002-00007

16.

Evans

M. A.

Saint-Aubin

(2005). What children are looking at during shared storybook reading: Evidence from eye movement monitoring. Psychological Science, 16, 913–920. https://doi.org/10.1111/j.1467-9280.2005.01636.x

17.

Evans

M. A.

Saint-Aubin

(2013). Vocabulary acquisition without adult explanations in repeated shared book reading: An eye movement study. Journal of Educational Psychology, 105, 596–608. https://doi.org/10.1037/a0032465

18.

Evans

M. A.

Shaw

(2008). Home grown for reading: Parental contributions to young children’s emergent literacy and word recognition. Canadian Psychology/Psychologie Canadienne, 49, 89–95. https://doi.org/10.1037/0708-5591.49.2.89

19.

Ezell

H. K.

Justice

L. M.

(1998). A pilot investigation of parents’ questions about print and pictures to preschoolers with language delay. Child Language Teaching and Therapy, 14, 273–278. https://doi.org/10.1191/026565998674997648

20.

Farrant

B. M.

(2012). Joint attention and parent-child book reading: Keys to help close gaps in early language development, school readiness and academic achievement. Family Matters, 91, 38–46. https://aifs.gov.au/sites/default/files/fm91d.pdf

21.

Farrant

B. M.

Zubrick

S. R.

(2012). Early vocabulary development: The importance of joint attention and parent-child book reading. First Language, 32, 343–364. https://doi.org/10.1177/0142723711422626

22.

Fleury

V. P.

Hugh

M. L.

(2018). Exploring engagement in shared reading activities between children with autism spectrum disorder and their caregivers. Journal of Autism and Developmental Disorders, 48, 3596–3607. https://doi.org/10.1007/s10803-018-3632-8

23.

Fleury

V. P.

Miramontez

S. H.

Hudson

R. F.

Schwartz

I. S.

(2014). Promoting active participation in book reading for preschoolers with autism spectrum disorder: A preliminary study. Child Language Teaching and Therapy, 30, 273–288. https://doi.org/10.1177/0265659013514069

24.

Fleury

V. P.

Schwartz

I. S.

(2017). A modified dialogic reading intervention for preschool children with autism spectrum disorder. Topics in Early Childhood Special Education, 37, 16–28. https://doi.org/10.1177/0271121416637597

25.

Golloher

A. N.

(2017). Adapted shared storybook reading: A study of its application for children with autism spectrum disorders in home settings. Focus on Autism and Other Developmental Disabilities, 33, 35–46. https://doi.org/10.1177/1088357616681281

26.

Guo

Feng

(2013). How eye gaze feedback changes parent-child joint attention in shared storybook reading? In Nakano

Y. I.

Conati

Bader

(Eds.), Eye gaze in intelligent user interfaces (pp. 9–21). Springer.

27.

Han

Neuharth-Pritchett

(2015). Meaning-related and print-related interactions between preschoolers and parents during shared book reading and their associations with emergent literacy skills. Journal of Research in Childhood Education, 29, 528–550. https://doi.org/10.1080/02568543.2015.1073819

28.

Happé

Frith

(2006). The weak coherence account: Detail-focused cognitive style in autism spectrum disorders. Journal of Autism and Developmental Disorders, 36, 5–25. https://doi.org/10.1007/s10803-005-0039-0

29.

Hindman

A. H.

Connor

C. M.

Jewkes

A. M.

Morrison

F. J.

(2008). Untangling the effects of shared book reading: Multiple factors and their associations with preschool literacy outcomes. Early Childhood Research Quarterly, 23, 330–350. https://doi.org/10.1016/j.ecresq.2008.01.005

30.

Hindman

A. H.

Skibbe

L. E.

Foster

T. D.

(2014). Exploring the variety of parental talk during shared book reading and its contributions to preschool language and literacy: Evidence from the Early Childhood Longitudinal Study-Birth Cohort. Reading and Writing, 27, 287–313. https://doi.org/10.1007/s11145-013-9445-4

31.

Invernizzi

Sullivan

Meier

J. D.

Swank

(2004). Phonological Awareness Literacy Screening for Preschoolers. Teacher’s manual. University of Virginia.

32.

Justice

L. M.

Ezell

H. K.

(2000). Enhancing children’s print and word awareness through home-based parent intervention. American Journal of Speech-Language Pathology, 9, 257–269. https://doi.org/10.1044/1058-0360.0903.257

33.

Justice

L. M.

Pullen

P. C.

Pence

(2008). Influence of verbal and nonverbal references to print on preschoolers’ visual attention to print during storybook reading. Developmental Psychology, 44, 855–866. https://doi.org/10.1037/0012-1649.44.3.855

34.

Justice

L. M.

Skibbe

Canning

Lankford

(2005). Pre-schoolers, print and storybooks: An observational study using eye movement analysis. Journal of Research in Reading, 28, 229–243. https://doi.org/10.1111/j.1467-9817.2005.00267.x

35.

Kang

J. Y.

Kim

Y. S.

Pan

B. A.

(2009). Five-year-olds’ book talk and story retelling: Contributions of mother-child joint bookreading. First Language, 29, 243–265. https://doi.org/10.1177/0142723708101680

36.

Keen

(2009). Engagement of children with autism in learning. Australasian Journal of Special Education, 33, 130–140. https://doi.org/10.1375/ajse.33.2.130

37.

Kjelgaard

M. M.

Tager-Flusberg

(2001). An investigation of language impairment in autism: Implications for genetic subgroups. Language and Cognitive Processes, 16, 287–308. https://doi.org/10.1080/01690960042000058

38.

Krasileva

K. E.

Sanders

S. J.

Bal

V. H.

(2017). Peabody Picture Vocabulary Test: Proxy for verbal IQ in genetic studies of autism spectrum disorder. Journal of Autism and Developmental Disorders, 47, 1073–1085. https://doi.org/10.1007/s10803-017-3030-7

39.

Krippendorff

(1980). Content analysis: An introduction to its methodology. SAGE.

40.

Lanter

Freeman

Dove

(2013). Procedural and conceptual print-related achievements in young children with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 28, 14–25. https://doi.org/10.1177/1088357612459270

41.

Lord

Rutter

DiLavore

P. C.

Risi

Gotham

Bishop

(2012). Autism Diagnostic Observation Schedule - second edition (ADOS-2) (2nd ed.). Western Psychological Services.

42.

Luo

Tamis-LeMonda

C. S.

(2017). Reciprocity between maternal questions and child contributions during book-sharing. Early Childhood Research Quarterly, 38, 71–83. https://doi.org/10.1016/j.ecresq.2016.08.003

43.

McGinty

A. S.

Justice

L. M.

Zucker

T. A.

Gosse

Skibbe

L. E.

(2012). Shared-reading dynamics: mothers’ question use and the verbal participation of children with specific language impairment. Journal of Speech, Language, and Hearing Research, 55, 1039–1052. https://doi.org/10.1044/1092-4388(2011/10-0298)

44.

McWilliam

R. A.

Bailey

D. B.

(1992). Promoting engagement and mastery. In Bailey

D. B.

Wolery

(Eds.), Teaching infants and preschoolers with disabilities (pp. 230–255). Macmillan.

45.

Miller

J. F.

Andriacchi

Nockerts

Westerveld

Gillon

(2016). Assessing language production using SALT Software. A clinician’s guide to language sample analysis. New Zealand–Australia version (2nd ed.). SALT Software.

46.

Moran

M. D.

(2003). Arguments for rejecting the sequential Bonferroni in ecological studies. Oikos, 100, 403–405. https://doi.org/10.1034/j.1600-0706.2003.12010.x

47.

Mucchetti

C. A.

(2013). Adapted shared reading at school for minimally verbal students with autism. Autism International Journal of Research and Practice, 17, 358–372. https://doi.org/10.1177/1362361312470495

48.

Mullen

E. M.

(1995). Mullen Scales of Early Learning. American Guidance Service.

49.

Mundy

Sigman

Kasari

(1990). A longitudinal study of joint attention and language development in autistic children. Journal of Autism and Developmental Disorders, 20, 115–128. https://doi.org/10.1007/bf02206861

50.

Nation

Clarke

Wright

Williams

(2006). Patterns of reading ability in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 36, 911–919. https://doi.org/10.1007/s10803-006-0130-1

51.

National Early Literacy Panel. (2008). Developing early literacy: Report of the National Early Literacy Panel.

52.

National Institute of Child Health and Human Development. (2005). Pathways to reading: The role of oral language in the transition to reading. Developmental Psychology, 41, 428–442. https://doi.org/10.1037/0012-1649.41.2.428

53.

Paris

S. G.

(2005). Reinterpreting the development of reading skills. Reading Research Quarterly, 40, 184–202. https://doi.org/10.1598/RRQ.40.2.3

54.

Paynter

Peterson

(2010). Language and ToM development in autism versus Asperger syndrome: Contrasting influences of syntactic versus lexical/semantic maturity. Research in Autism Spectrum Disorders, 4, 377–385. https://doi.org/10.1016/j.rasd.2009.10.005

55.

Paynter

Riley

Beamish

Davies

Milford

(2013). The double ABCX model of family adaptation in families of a child with an autism spectrum disorder attending an Australian early intervention service. Research in Autism Spectrum Disorders, 7, 1183–1195. https://doi.org/10.1016/j.rasd.2013.07.006

56.

Rees

Nadig

Rvachew

(2017). Story-related discourse by parent–child dyads: A comparison of typically developing children and children with language impairments. International Journal of Child-Computer Interaction, 12, 16–23. https://doi.org/10.1016/j.ijcci.2017.01.001

57.

Reese

Sparks

Leyva

(2010). A review of parent interventions for preschool children’s language and emergent literacy. Journal of Early Childhood Literacy, 10, 97–117. https://doi.org/10.1177/1468798409356987

58.

Richter

Courage

M. L.

(2017). Comparing electronic and paper storybooks for preschoolers: Attention, engagement, and recall. Journal of Applied Developmental Psychology, 48, 92–102. https://doi.org/10.1016/j.appdev.2017.01.002

59.

Ricketts

(2011). Research review: Reading comprehension in developmental disorders of language and communication. Journal of Child Psychology and Psychiatry, 52, 1111–1123. https://doi.org/10.1111/j.1469-7610.2011.02438.x

60.

Roy-Charland

Saint-Aubin

Evans

(2007). Eye movements in shared book reading with children from kindergarten to Grade 4. Reading and Writing, 20, 909–931. https://doi.org/10.1007/s11145-007-9059-9

61.

Ruble

L. A.

Robson

D. M.

(2007). Individual and environmental determinants of engagement in autism. Journal of Autism and Developmental Disorders, 37, 1457–1468. https://doi.org/10.1007/s10803-006-0222-y

62.

Rutter

Bailey

Lord

(2003). SCQ: The Social Communication Questionnaire. Western Psychological Services.

63.

Saracho

O. N.

Spodek

(2010). Parents and children engaging in storybook reading. Early Childhood Development and Care, 180, 1379–1389. https://doi.org/10.1080/03004430903135605

64.

Scheffler

(2012). Pip and posy: The big balloon. Nosy Crow.

65.

Schwenck

Freitag

C. M.

(2014). Differentiation between attention-deficit/hyperactivity disorder and autism spectrum disorder by the Social Communication Questionnaire. ADHD Attention Deficit and Hyperactivity Disorders, 6, 221–229. https://doi.org/10.1007/s12402-014-0147-9

66.

Sénéchal

(2006). Testing the home literacy model: Parent involvement in kindergarten is differentially related to grade 4 reading comprehension, fluency, spelling, and reading for pleasure. Scientific Studies of Reading, 10, 59–87. https://doi.org/10.1207/s1532799xssr1001_4

67.

Sénéchal

LeFevre

J. A.

(2002). Parental involvement in the development of children’s reading skill: A five-year longitudinal study. Child Development, 73, 445–460. https://doi.org/10.1111/1467-8624.00417

68.

Snow

A. V.

Lecavalier

(2008). Sensitivity and specificity of the Modified Checklist for Autism in toddlers and the Social Communication Questionnaire in pre-schoolers suspected of having pervasive developmental disorders. Autism, 12, 627–644. https://doi.org/10.1177/1362361308097116

69.

Son

S. H. C.

Tineo

M. F.

(2016). Mothers’ attention-getting utterances during shared book reading: Links to low-income preschoolers’ verbal engagement, visual attention, and early literacy. Infant and Child Development, 25, 259–282. https://doi.org/10.1002/icd.1932

70.

Sparrow

S. S.

Cicchetti

D. V.

Balla

D. A.

(2005). Vineland Adaptive Behavior Scales (Vineland II): Survey interview form/caregiver rating form. Pearson Assessments.

71.

Swineford

L. B.

Guthrie

Thurm

(2015). Convergent and divergent validity of the Mullen Scales of Early Learning in young children with and without autism spectrum disorder. Psychological Assessment, 27, 1364–1378. https://doi.org/10.1037/pas0000116

72.

Tabachnick

B. G.

Fidell

L. S.

(2007). Using multivariate statistics (5th ed.). Pearson.

73.

Thompson

J. L.

Plavnick

J. B.

Skibbe

L. E.

(2018). Eye-tracking analysis of attention to an electronic storybook for minimally verbal children with autism spectrum disorder. The Journal of Special Education, 53, 41–50. https://doi.org/10.1177/0022466918796504

74.

Tipton

L. A.

Blacher

J. B.

Eisenhower

A. S.

(2017). Young children with ASD: Parent strategies for interaction during adapted book reading activity. Remedial and Special Education, 38, 171–180. https://doi.org/10.1177/0741932516677831

75.

Tomasello

Farrar

(1986). Joint attention and early language. Child Development, 57, 1454–1463. https://doi.org/10.1111/j.1467-8624.1986.tb00470.x

76.

Vivanti

Trembath

Dissanayake

(2014). Atypical monitoring and responsiveness to goal-directed gaze in autism spectrum disorder. Experimental Brain Research, 232, 695–701. https://doi.org/10.1007/s00221-013-3777-9

77.

Vygotsky

L. S.

(1981). The instrumental method in psychology. In: Wertsch

J. V.

(Ed.), The concept of activity in soviet psychology (pp. 134–143). M.E. Sharpe.

78.

Watson

L. R.

(1998). Following the child’s lead: Mothers’ interactions with children with autism. Journal of Autism and Developmental Disorders, 28, 51–59. https://doi.org/10.1023/a:1026063003289

79.

Westerveld

M. F.

Gillon

G. T.

Boyd

(2012). Evaluating the clinical utility of the profile of oral narrative ability for 4-year-old children. International Journal of Speech-Language Pathology, 14, 130–140. https://doi.org/10.3109/17549507.2011.632025

80.

Westerveld

M. F.

O’Leary

Paynter

(2019). Shared book reading intervention for preschoolers with ASD: A randomized control study. Unpublished manuscript.

81.

Westerveld

M. F.

Paynter

O’Leary

Trembath

(2018). Preschool predictors of reading ability in the first year of schooling in children with ASD. Autism Research, 11, 1332–1344. https://doi.org/10.1002/aur.1999

82.

Westerveld

M. F.

Paynter

Trembath

Webster

Hodge

Roberts

(2017). The emergent literacy skills of preschool children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47, 424–438. https://doi.org/10.1007/s10803-016-2964-5

83.

Westerveld

M. F.

Paynter

Wicks

(2019). Shared book reading behaviors of parents and their verbal preschoolers on the autism spectrum. Manuscript under review.

84.

Westerveld

M. F.

Trembath

Shellshear

Paynter

(2016). A systematic review of the literature on emergent literacy skills of preschool children with autism spectrum disorder. The Journal of Special Education, 50(1), 37–48. https://doi.org/10.1177/0022466915613593

85.

Westerveld

M. F.

van Bysterveldt

A. K.

(2017). The home literacy environment of preschool-age children with autism or down syndrome. Folia Phoniatrica Etlogopaedica, 69, 43–53. https://doi.org/10.1159/000475840

86.

Whitehurst

G. J.

Falco

F. L.

Lonigan

C. J.

Fischel

J. E.

DeBaryshe

B. D.

Valdez-Menchaca

M. C.

Caulfield

(1988). Accelerating language development through picture book reading. Developmental Psychology, 24, 552–559. https://doi.org/10.1037/0012-1649.24.4.552

87.

Whitehurst

G. J.

Lonigan

C. J.

(1998). Child development and emergent literacy. Child Development, 69, 848–872. https://doi.org/10.1111/j.1467-8624.1998.00848.x

88.

Yang

Paynter

Gilmore

(2016). Vineland Adaptive Behavior Scales: II profile of young children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46, 64–73. https://doi.org/10.1007/s10803-015-2543-1

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