Professional Documents
Culture Documents
Karen D. Bopp
Pat Mirenda
Purpose: This exploratory study examined predictive relationships between 5 types of
Bruno D. Zumbo
behaviors and the trajectories of vocabulary and language development in young
The University of British Columbia,
children with autism over 2 years.
Vancouver, Canada
Method: Participants were 69 children with autism assessed using standardized
measures prior to the initiation of early intervention (T1) and 6 months (T2), 12 months
(T3), and 24 months (T4) later. Growth curve modeling examined the extent to which
behaviors at T1 and changes in behaviors between T1 and T2 predicted changes
in development from T1 to T4.
Results: Regardless of T1 nonverbal IQ and autism severity, high scores for inattentive
behaviors at T1 predicted lower rates of change in vocabulary production and language
comprehension over 2 years. High scores for social unresponsiveness at T1 predicted
lower rates of change in vocabulary comprehension and production and in language
comprehension over 2 years. Scores for insistence on sameness behaviors, repetitive
stereotypic motor behaviors, and acting-out behaviors at T1 did not predict the rate
of change of any child measure over 2 years beyond differences accounted for by
T1 autism severity and nonverbal IQ status.
Conclusions: The results are discussed with regard to their implications for early
intervention and understanding the complex factors that affect developmental outcomes.
KEY WORDS: autism, child development, problem behavior, predictors
R
esearch suggests that a number of variables are related to differ-
ences in the development of children with autism spectrum disorders
(ASD). For example, for children who receive early intervention, initial
IQ score (Gabriels, Hill, Pierce, & Rogers, 2001; Harris & Handleman, 2000;
Liss et al., 2001; Lovaas & Smith, 1998; Sallows & Graupner, 2005; T. Smith,
Eikeseth, Klevstrand, & Lovaas, 1997), chronological age at the onset of
intervention (Fenske, Zalenski, Krantz, & McClannahan, 1985; Harris &
Handleman, 2000; Lovaas, 1987), and autism severity score (DeMyer, 1973;
Eaves & Ho, 1996; Liss et al., 2001) have all been found to be related to
cognitive, language, and adaptive behavior outcomes over time. However,
even with early intervention, it is estimated that only approximately 15%
of individuals with autism are reasonably self-sufficient as adults and
another 15% to 20% function well with periodic support (Volkmar & Pauls,
2003). In addition, in a review of treatments for young children with ASD,
Schreibman (2000) noted a wide heterogeneity in the outcomes of inter-
vention and remarked that there is no “one size fits all” treatment for this
population. The lack of 100% effectiveness of early intervention leads one to
1106 Journal of Speech, Language, and Hearing Research • Vol. 52 • 1106–1120 • October 2009 • D American Speech-Language-Hearing Association
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conclude that there are other variables affecting outcomes at risk for isolation within or exclusion from typical home,
that have not yet been identified (Ingersoll, Schreibman, school, and community settings and thus may put him/
& Stahmer, 2001). Identifying these variables and un- her at risk for delayed or even disordered language devel-
derstanding the process of language development in opment. However, although these behaviors are often ob-
autism and the factors that influence differential out- served in clinical settings, almost no studies to date have
comes are critical for improving treatment efficiency. examined them as sources of variability in language
What are some of the factors that may influence dif- development. This study attempted to explore the rela-
ferential language outcomes in ASD? Performance-based tionship between these five behaviors and language
theory suggests that language disorders are secondary to development.
limitations in individual child factors such as cognitive
processing (e.g., motivation, attention, memory, and re-
tention) and social–affective skills (e.g., imitation, joint
Inattentiveness
attention, reciprocity, etc.; Evans, 2001). According to a Inattentiveness refers to behaviors that indicate high
social–interactionist perspective, language is developed distractibility (e.g., difficulty staying focused on relevant
through a motivation to interact socially with others; so- people or activities) and/or decreased awareness of ob-
cial experiences, in turn, motivate the acquisition of many jects, activities, or the environment. There is no direct
dimensions of language (Abbeduto & Boudreau, 2004). In empirical evidence of a relationship between inatten-
fact, a number of specific social–affective behaviors have tiveness and language development in autism; however,
been found to predict language development in this popu- there is some indirect evidence. Recent research has found
lation. These behaviors include, for example, motor imita- that the inability to both initiate and respond to joint at-
tion skills (Sallows & Graupner, 2005; Stone & Yoder, tention is closely related to language difficulties in this
2001; Toth, Munson, Meltzoff, & Dawson, 2006), verbal population (e.g., Charman et al., 2003; Rollins & Snow,
imitation skills (Sallows & Graupner, 2005; V. Smith, 1998; Sigman & McGovern, 2005; V. Smith et al., 2007;
Mirenda, & Zaidman-Zait, 2007), the ability to initiate Travis et al., 2001). Three basic components—attention,
and /or respond to joint attention (e.g., Charman et al., shared affect, and shared intentions—constitute the ca-
2003; Rollins & Snow, 1998; Sigman & McGovern, 2005; pacity for joint attention (Yoder & McDuffie, 2006).
V. Smith et al., 2007; Travis, Sigman, & Ruskin, 2001), Hypothetically, children who lack the first component,
and pretend play skills (e.g., Sigman & McGovern, 2005; attention, may be less likely to engage in joint attention
V. Smith et al., 2007; Toth et al., 2006; Yoder, 2006). interactions and this, in turn, may result in delayed lan-
Social–affective behaviors may not be the only fac- guage development over time (Mundy & Markus, 1997).
tors that influence language development in children
with autism. One area that has received little attention
to date is child “problem” behaviors and their potential Socially Unresponsive Behavior
impact. Of course, the extent to which any given behavior Socially unresponsive behavior refers to a decreased
can be deemed problematic depends both on one’s per- capacity to either initiate or respond to social and /or
spective and on the context in which the behavior occurs. emotional exchanges by other people and is one of the
The National Research Council (2001) described the com- hallmarks of ASD. Such behaviors include a failure to
plexity of this issue as follows: smile in response to others, avoidance of eye contact, and
failure to respond to verbal or physical overtures (e.g.,
From a child’s perspective, problem behaviors in-
one’s name being called or pointing by others). In their
clude the inability to understand demands of a class-
early description of three subgroups of children with au-
room or a parent and to communicate his or her needs
tism, Wing and Gould (1979) noted that the children who
and wants, severe difficulty in initiating and main-
were most socially impaired (i.e., those in their “socially
taining social interactions and relationships, confu-
aloof ” group) were also the most language impaired, es-
sion about the effects and consequences of any of his
pecially with regard to comprehension. More recently,
or her behaviors, and engagement in restrictive and
Mundy and his colleagues proposed a “social orienting
repetitive behaviors and interests that may limit the
model” to explain the relationship between social and lan-
child’s ability to learn and to fit in with peers. From a
guage development in autism (Mundy & Markus, 1997;
teacher’s or parent’s perspective, problem behaviors
Mundy & Neal, 2001). They hypothesized that early im-
include lack of compliance with or disruption of class-
pairments in social attention deprive the child with
room routines, tantrums, destruction of property,
autism of social information input during infancy and
and aggression against self or others. ( pp. 115–116)
preschool development and that this deprivation dis-
Problem behaviors such as acting-out, repetitive ste- rupts normal brain and behavioral development. This
reotypic motor behaviors, insistence on sameness, social cycle then acts like a negative feedback loop, affecting
unresponsiveness, and inattentiveness may place a child subsequent socio-communicative development. Dawson
1108 Journal of Speech, Language, and Hearing Research • Vol. 52 • 1106–1120 • October 2009
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Acting-out behavior (maximum score = 19) 8.86 (1–18) 3.92 7.41 (0–17) 4.00
Repetitive sensory motor behavior (maximum score = 22) 10.25 (2–20) 3.68 9.07 (0–17) 3.83
Insistence on sameness behavior (maximum score = 6) 3.94 (1–6) 1.51 3.31 (0–6) 1.66
Socially unresponsive behavior (maximum score = 20) 5.78 (0–13) 2.96 4.04 (0–13) 3.15
Inattentiveness (maximum score = 10) 6.72 (3–10) 1.72 5.87 (1–9) 1.80
Note. T2 = Time 2.
PPVT or EOWPVT. In the final analysis, the inclusion such as those available in other statistical packages (e.g.,
of T1 NVIQ in the models for PPVT and EOWPVT and SPSS). However, the statistical effects can be illustrated
the inclusion of both T1 NVIQ and T1 CARS in the model by examining the average rate of change in language
for PLS EC resulted in models that were a better fit, as or vocabulary growth for a prototypical child with mean
reflected in the lower AIC values in Table 5 compared inattentiveness and/or social unresponsiveness scores at
to those in Table 4. Thus, both T1 CARS and T1 NVIQ T1 and with scores ±1 standard deviation above and be-
scores were included in all subsequent models for PLS low the mean (Brooks & Meltzoff, 2008; Singer & Willet,
EC, and T1 NVIQ scores alone were included in all sub- 2003). Figures 1–3 display these results.
sequent models for PPVT and EOWPVT. Figure 1 displays the results for the EOWPVT, sug-
T1 scores for child behavior as predictors of vocabu- gesting that a child with fewer inattentive and socially
lary and language development. Table 6 presents the unresponsive behaviors at T1 (–1 SD) would have a rap-
results of the child behaviors as predictors of vocabu- idly accelerating growth curve, whereas a child with more
lary and language development from T1 to T4 (i.e., over inattentive and socially unresponsive behaviors at T1
2 years). The results revealed that two of the five be- (+1 SD) would have a much slower acceleration in growth
havior variables measured at T1 predicted significant of vocabulary production over 2 years. In Figure 2 (PLS
changes in vocabulary or language development mea- AC), a child with fewer inattentive and socially unrespon-
sures. First, a high score on inattentive behavior at T1 sive behaviors at T1 (–1 SD) would have greater rate of
was predictive of less of an increase in the rate of change acceleration over the first 12-month period only, com-
for EOWPVT and PLS AC over 2 years, regardless of T1 pared to a child with more inattentive and socially un-
NVIQ. Second, a high score on social unresponsiveness responsive behaviors at T1 (+1 SD). Finally, in Figure 3
at T1 was predictive of less of an increase in the rate of (PPVT), a child with fewer socially unresponsive behav-
change for EOWPVT, PPVT, and PLS AC over 2 years, iors at T1 (–1 SD) would have a slightly more rapid growth
regardless of T1 NVIQ. Scores for IS behaviors, RSMBs, acceleration over the first 12 months only, compared to
and acting-out behaviors at T1 did not predict the rate of a child with more socially unresponsive behaviors at
change of any child measure over 2 years beyond differ- T1 (+1 SD).
ences accounted for by T1 CARS and NVIQ status. Difference scores for problem behavior from T1 to T 2
The IGCM software used in this analysis (SAS Proc as predictors of vocabulary and language development.
Mixed) does not yield conventional effect size estimates The results indicated that changes in any of the problem
Table 3. Raw scores for measures of child development from Time 1 to Time 4.
PPVT 9.87 (0–85) 17.68 20.94 (0–97) 23.50 27.87 (0–108) 26.74 38.19 (0–125) 29.27
EOWPVT 10.51 (0–65) 14.79 19.07 (0–75) 18.05 24.45 (0–86) 22.48 33.90 (0–96) 26.29
PLS AC 12.96 (3–48) 9.15 19.62 (3–44) 11.05 23.56 (5–48) 12.78 28.86 (8–48) 13.25
PLS EC 13.96 (4–47) 7.36 18.01 (6–44) 8.38 21.21 (5–48) 9.90 25.67 (7–48) 12.19
CARS 36.34 (25–50.5) 5.72 35.54 (17.5–49) 6.75 34.83 (19–49.5) 7.19 34.53 (16.5–50.5) 7.83
Note. PPVT = Peabody Picture Vocabulary Test; EOWPVT = Expressive One Word Picture Vocabulary Test; PLS = Preschool Language Scale;
AC = Auditory Comprehension; EC = Expressive Communication; CARS = Childhood Autism Rating Scale.
behaviors from T1 to T2 did not predict changes in any outcomes. More specifically, the results revealed that
of the vocabulary or language outcome measures over autism severity scores prior to the onset of intervention
2 years. were predictive of only one communicative measure over
time: language production. CARS scores at T1 when com-
bined in the model with T1 NVIQ did not predict dif-
Discussion ferential outcomes over 2 years in either vocabulary or
language comprehension skills. Autism severity scores
This study provides an initial exploration of the in- have often been linked to developmental outcomes for
terrelationships between five types of behaviors and vo- children with ASD (DeMyer, 1973; Eaves & Ho, 1996;
cabulary and language development over time. It is unique Liss et al., 2001); however, the results of this study sug-
in that individual growth curve modeling was used to ex- gest that they may have little bearing on children’s rate
plore the impact of problem behaviors at T1 and changes of development on a broad range of language skills. On
in problem behaviors 6 months later on changes in vo- the other hand, NVIQ prior to the onset of intervention
cabulary and language development over 2 years. was found to predict changes related to receptive and
Results of the conditional analyses related to autism expressive vocabulary development and expressive lan-
severity and NVIQ generally confirmed past research guage development over time. These results echo the find-
that has found a relationship between these two measures ings of previous research (Gabriels et al., 2001; Harris
themselves and between NVIQ and other developmental & Handleman, 2000; Liss et al., 2001; Lovaas & Smith,
T1 CARS alone
Slope estimate –0.04 –0.04 –0.01 –0.02
t -value –2.73* –3.10* –1.75 –3.77**
AIC 2137.5 1977.1 1769.5 1557.8
T1 NVIQ alone
Slope estimate 0.02 0.02 0.004 0.009
t -value 3.85** 3.38** 1.26 3.57**
AIC 1820.4 1676.1 1501.1 1295.6
T1 CARS plus T1 NVIQ
T1 CARS slope estimate –0.016 –0.03 –0.004 –0.02
t-value –0.88 –1.82 –0.45 –2.11*
T1 NVIQ slope estimate 0.02 0.015 0.003 0.007
t-value 3.09* 2.36* 0.87 2.45*
AIC 1815.5 1672.1 1492.5 1289.4
a
Centered age as calculated by age minus mean age at T1 was used as the measure of time.
*p < .05. **p < .001.
1114 Journal of Speech, Language, and Hearing Research • Vol. 52 • 1106–1120 • October 2009
1998; Sallows & Graupner, 2005; T. Smith et al., 1997), change and that poor attending skills negatively impact
although they reveal little about specific child charac- children’s ability to learn from the environment (Edelson,
teristics that may affect differential outcomes. Schubert, & Edelson, 1998). The results also lend support
Five problem behaviors were examined as potential the common practice of providing focused instruction on
predictors of language development in children with au- attending skills early in the treatment process (e.g.,
tism. The results indicate a relationship between inat- Lovaas, 2003).
tentive behaviors and language development over time. The number of socially unresponsive behaviors at
Inattentive behaviors in this study included, for exam- T1 also predicted children’s vocabulary or language de-
ple, not paying attention to sights and sounds in the velopment over 2 years. Socially unresponsive behaviors
environment; being distracted by noise; not listening to in this investigation included, for example, rarely smil-
instructions or a story; and looking away from tasks to ing, not looking at faces, actively avoiding eye contact,
notice other actions in the room. The results suggest that and failing to respond to one’s own name. The results sug-
children with more inattentive behaviors at T1 made sig- gest that children with more socially unresponsive be-
nificantly less progress in expressive vocabulary and lan- havior at T1 made significantly less progress over 2 years
guage comprehension development over 2 years. Thus, in both vocabulary comprehension and production and
prior to the start of treatment, it appeared that inatten- in language comprehension. Although social deficits are
tiveness hindered language development. These results central to the diagnosis of autism, researchers have only
support the suggestion that inattention is a correlate of recently started to examine how these deficits impact
Figure 1. Average growth curve of Expressive One Word Picture Figure 2. Average growth curve of Preschool Language Scale Auditory
Vocabulary Test (EOWPVT) scores over 2 years for a prototypical Comprehension (PLS AC) scores over 2 years for a prototypical child
child with T1 inattentive (IA) and social unresponsiveness (SU) scores with T1 inattentive and social unresponsiveness scores that were at the
that were at the mean and ±1 standard deviation above and below mean and ±1 standard deviation above and below the mean.
the mean.
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