Research Article

Lexical Acquisition and Phonological Development

in Minimally Verbal Children With Autism
Spectrum Disorders
Maysoon F. Billera and Kayleigh A. Yeagera
a
Department of Communication Sciences and Disorders, University of Central Arkansas, Conway

ARTICLE INFO ABSTRACT

Article History: Purpose: This study examines two components of lexical acquisition and pho-
Received December 9, 2021 nological development that occur during the first 50-word stage of language
Revision received March 1, 2022 development in neurotypical (NT) children. One component is how children learn
Accepted May 10, 2022 words based on their existing speech sound inventories (i.e., in-phonology and
out-of-phonology word learning). The other component is the relationship
Editor-in-Chief: Holly L. Storkel between the children’s number of words and the number of phonemes in their
Editor: Toby Macrae speech sound inventories. The goal of this study is to determine if the same
two components occur in children with autism spectrum disorders (ASDs) who
https://doi.org/10.1044/2022_LSHSS-21-00184 are older than their NT peers but are in the same stage of lexical development.
Method: This study involved 20 minimally verbal children with ASDs, ages 28–
72 months, who produced five to 50 spoken words. The children’s spoken
words were obtained from the MacArthur–Bates Communicative Development
Inventories. The speech sound inventories were obtained from the utterances
produced during assessment/play sessions with the children. The children’s
spoken words from the Communicative Development Inventories (CDI) were cat-
egorized as either in-phonology or out-of-phonology based on whether the
words began with a phoneme in the child’s existing speech sound inventory.
Additionally, the children’s number of spoken words on the CDI was compared
to the number of phonemes in their speech sound inventories.
Results: The children in this study produced in-phonology words more often
than out-of-phonology words (z = −3.922; p < .001). Moreover, there was a mod-
erate positive correlation between the children’s number of spoken words and
the number of phonemes in their speech sound inventories (r = .534, p = .019).
Conclusions: The relationship between lexical acquisition and phonological
development appears to exist for the children in this study, who are in the first
50-word stage of development. Clinical implications for increasing the expres-
sive language of children with ASDs were discussed.

Children with autism spectrum disorders (ASDs)
vary greatly in their language abilities (Tager-Flusberg
et al., 2005). Along the continuum of spoken language,
there are children with ASDs who are fully verbal, mini-
mally verbal, and nonverbal. Children with autism who are
fully verbal have mastered various language skills in the
Correspondence to Maysoon F. Biller: mbiller@uca.edu. Disclosure:
The authors have declared that no competing financial or nonfinancial
interests existed at the time of publication.
areas of semantics, phonology, syntax, and morphology.
They have adequate verbal communication; however, they
still demonstrate deficits in pragmatic skills (Rapin &
Dunn, 1997). Minimally verbal children use some words,
but “significantly fewer than expected levels relative to
age” (Koegel et al., 2020, p. 2968). Koegel et al. viewed
“significantly fewer” to mean an expressive spoken vocabu-
lary below the 10th percentile for the child’s age. In this
study, that would equate to fewer than 50 words for a child
who is 30 months of age or older (Fenson et al., 2007;
Koegel et al., 2020). Approximately 25%–30% of children

1074 Language, Speech, and Hearing Services in Schools • Vol. 53 • 1074–1087 • October 2022 • Copyright © 2022 American Speech-Language-Hearing Association
with ASDs fail to develop spoken language beyond a mini-
mal level by the age of 5 years (Kasari et al., 2014). Nonver-
bal children over the age of 18 months do not demonstrate
any consistent spoken words (intelligible or word approxi-
mations) across all contexts and all speakers (Koegel et al.,
2020). They often communicate using unconventional and
conventional gestures.
As fully verbal children with autism have less con-
cerns with phonology, semantics, syntax, and morphology
and nonverbal children do not demonstrate enough speech
sound production or recognizable utterances to support
spoken language, this article primarily addresses the lan-
guage development of minimally verbal children with
autism. At some point in their language development,
many minimally verbal children with ASDs pass through
the single word or first 50-word stage of language devel-
opment. The research in neurotypical (NT) language
development highlights the interdependence between lexi-
cal acquisition and phonological development and their
direct influence on production variability within a child’s
spoken vocabulary (Ingram, 1989; Leonard et al., 1982;
Stoel-Gammon, 2011).
Lexical Acquisition and Phonological
Development in NT Children
Lexical Acquisition
During the first 50-word stage of development, com-
prehension of words develops earlier and more rapidly
than production, with comprehension being attained
5 months prior to production in classic studies of vocabu-
lary development (Bates et al., 1988; Benedict, 1979).
Children begin saying their first words at approximately
12 months of age, and from that point on, their vocabu-
lary begins to expand rapidly. Children have well over
200 spoken words by the age of 2 years and 1,000 words
by age 3 years (Nicolosi et al., 2006). Nevertheless, there
is variability in children’s word learning based on cross-
cultural and socioeconomic factors (Fenson et al., 1994;
Hart & Risley, 1975; Hoff, 2003; Rowe, 2012). Further-
more, variation in an individual child’s development could
reflect differences in the age the first word was spoken or
differences in the rate of vocabulary growth (Fenson
et al., 1994). During phonological development, children
by 24 months of age tend to attain more consonants in
the initial position than the final position of words (Bleile,
2004; Dyson, 1988; Stoel-Gammon, 1985). Stoel-Gammon
(1985) reports 11 word-initial consonants present in chil-
dren’s speech sound repertoires by the age of 24 months: /
b, t, d, k, g, m, n, f, s, h, and w/. Another model of
speech sound acquisition divides the 24 English conso-
nants into the Early, Middle, and Late 8 (Shriberg, 1993).
Biller & Yeager: Lexical and Phonological Development in ASDs
The Early 8 consonants are /m, n, j, b, w, d, p, and h/,
which emerge between the ages of 12–36 months and are
consistently produced by around 36 months. The Middle
8 consonants are /t, ŋ, k, g, f, v, tʃ, and dʒ/, which emerge
between the ages of 36–78 months and are consistently
produced around 66 months. Finally, the Late 8 conso-
nants are /ʃ, ʒ, l, r, s, z, θ, ð, and clusters/, which emerge
between the ages of 60–90 months and are consistently
produced around 90 months.
Phonological Development
The role that phonological development plays in the
acquisition of a child’s lexicon has been well documented
(Ingram, 1989; Schwartz & Leonard, 1982; Sosa & Stoel-
Gammon, 2006; Stoel-Gammon, 2011). The phonological
system appears to have a greater impact on lexical acquisi-
tion than lexical factors have on phonological development
(Stoel-Gammon, 2011). First, children more easily acquire
new words that begin with phonemes (e.g., vowels or con-
sonants) that are in their speech sound inventory (Brady
et al., 2015; Leonard et al., 1982; MacRoy-Higgins et al.,
2013; Schwartz & Leonard, 1982; Stoel-Gammon, 2011).
Some researchers focused solely on consonants (Leonard
et al., 1982; Schwartz & Leonard, 1982), whereas other
researchers considered vowels and consonants to be a part
of a child’s speech sound inventory (Brady et al., 2015;
MacRoy-Higgins et al., 2013; Stoel-Gammon, 2011). Sec-
ond, lexical acquisition and phonological development are
proportional and bidirectional. Children with larger lexi-
cons have a greater need for more developed phonological
skills. Conversely, children with smaller lexicons have less
developed phonological abilities (Stoel-Gammon 2011).
Lexical Acquisition and Phonological
Development
A pivotal study was performed on the influence of
phonological selection and avoidance during word learn-
ing (Schwartz & Leonard, 1982). When children learn new
words, they tend to imitate and spontaneously produce
words with certain phonological characteristics that they
can say (i.e., phonological selection). Conversely, children
avoid words with sounds that they find difficult to say (i.e.,
phonological avoidance). Based on this concept, Schwartz
and Leonard (1982) introduced the notion of in-phonology
and out-of-phonology word learning. In-phonology words
contained consonants that had been present in the child’s
spontaneous productions. Conversely, out-of-phonology
words contained consonants that had not been present in
the child’s spontaneous productions. In their study, 12 tod-
dlers were presented with 16 nonsense lexical concepts,
labeled eight nonsense words that were in-phonology and
eight nonsense words that were out-of-phonology for the
1075
child. The researchers found that the children produced in-
phonology nonsense words more often and earlier than
out-of-phonology nonsense words. They concluded that
children’s developing vocabularies are based on their speech
production abilities and preferences. These preferences can
be observed in the phonemes that constitute the words that
children produce (Schwartz & Leonard, 1982). Recognizing
the relationship between lexical acquisition and phonolo-
gical development in NT children will guide our research in
the same areas of development for children with ASDs.
Lexical and Phonological Development in
Children With ASDs
Lexical Development
Previous studies have examined lexical acquisition in
children with ASDs who range from being nonverbal to
fully verbal (Charman et al., 2003; Jimenez et al., 2021;
Luyster et al., 2007; Rescorla & Safyer, 2013; Tek et al.,
2008). For those children with ASDs who eventually
develop spoken language, the onset is often delayed: They
produce their first words at approximately 38 months of
age, compared to 8–14 months of age in NT children
(Howlin, 2003). Once children with ASDs expand their
spoken language, their lexical development has similarities
and differences to that of NT children. Children with ASDs
demonstrate a noun bias, learn words from various seman-
tic categories, and acquire verb meaning using syntactic
bootstrapping and sentence structure comparable to their
NT peers (Charman et al., 2003; Horvath et al., 2018;
Luyster et al., 2007; Rescorla & Safyer, 2013; Swensen
et al., 2007). However, there are differences in lexical devel-
opment between children with ASDs and their NT peers
such as fewer words in their lexicon and fewer social verbs
such as smile and share (Charman et al., 2003; Jimenez
et al., 2021; Tager-Flusberg et al., 2005). Another difference
between children with ASDs and NT children is their
understanding of the meaning of verbs that express some-
one’s mental state (i.e., theory of mind), such as remember,
think, and know (Kazak et al., 1997; Kelley et al., 2006).
Phonological Development
Phonological development in children with ASDs
appears to be one of the least affected domains in children
with ASDs in that these children usually follow a typical
developmental sequence in their speech sound acquisition
(cf. Eigsti et al., 2011). Whereas most individuals with ASDs
do not have specific impairments in articulation and phonol-
ogy, problems in these areas can be found in low-
functioning individuals with ASDs, and when children with
ASDs are in their early childhood years (Eigsti et al., 2011;
1076 Language, Speech, and Hearing Services in Schools • Vol. 53 • 1074–1087 • October 2022
Lord & Paul, 1997). Barring any other deficits that may
affect speech production, such as abnormalities of the oral
structures or childhood apraxia of speech, children with
autism follow a typical sequence in phonological develop-
ment (Rapin et al., 2009; Tager-Flusberg et al., 1997).
For the subset of children with ASDs who experience
phonological deficits, their differences are noticeable, start-
ing in infancy. Infants who were later diagnosed with ASDs
produced fewer speech-related vocalizations (Warlaumont
et al., 2014) and demonstrated delayed onset of canonical
babbling, as well as lower rates of canonical babbling com-
pared to their NT peers (Patten et al., 2014). Additionally,
they produced a significantly higher percentage of atypical
vocalizations such as squeals, growls, raspberries, car
sounds, and yelling than children with NT language devel-
opment (Plumb & Wetherby, 2013).
Older children with ASDs who are nonverbal or
minimally verbal may struggle with motor movement and
motor planning for speech production (Adams, 1998; Bhat
et al., 2011; De Giacomo et al., 2009; Gernsbacher et al.,
2008; Page & Boucher, 1998; Plumb & Wetherby, 2013;
Rogers et al., 2006; Stone & Yoder, 2001). Children with
ASDs were found to have poor oral motor and manual
motor abilities compared to NT children (Adams, 1998;
Gernsbacher et al., 2008) and poor production of complex
phonemes/syllables, indicative of severe motor planning
problems (Adams, 1998). Furthermore, there are researchers
who believe that there is a subgroup of children with autism
who has suspected childhood apraxia of speech (Chenausky
et al., 2019; Page & Boucher, 1998; Shriberg et al., 2011).
Lexical Acquisition and Phonological
Development
There is only one study to date that has examined
the relationship between lexical acquisition and phonolo-
gical development in a clinical population. Even though
the study focused on word learning in children with spe-
cific language impairment (Leonard et al., 1982) and not
on children with ASDs, it was important to review as
another example of in-phonology and out-of-phonology
word learning. The methodology in this study was similar
to the one used in the study of Schwartz and Leonard
(1982); however, the participants in the study of Leonard
et al. (1982) included children with specific language
impairment, as well as NT peers. Another prominent dif-
ference between the two studies was the position of the
consonant in the target words. Whereas Leonard et al.
(1982) used an existing consonant in the word-initial posi-
tion of their in-phonology target words, Schwartz and
Leonard used existing consonants in all word positions of
their in-phonology target words. Leonard et al. discovered
that NT children and children with SLI were more likely
to learn the novel words containing initial consonants in
the children’s existing inventory than words containing ini-
tial consonants outside of their inventories.
This Study
The notion that children acquire vocabulary based
on their speech sound inventories (i.e., sounds they are
currently producing) has been studied in NT children
(Schwartz & Leonard, 1982) and children with specific
language impairments (Leonard et al., 1982). There is a
paucity of studies that have applied this line of research to
children with ASDs. The lexical–phonological association
during the first 50-word stage of development, which
occurs between an NT child’s first and second birthdays,
has not been proven to exist in children with ASDs who
are older yet are still in the same developmental stage.
The aim of this study is to examine two components of the
lexical acquisition and phonological development in chil-
dren with ASDs to determine if they follow the same pat-
tern of development as their NT peers. First, we want to
determine if children with ASDs use more in-phonology
than out-of-phonology words. Second, we want to deter-
mine if the children’s spoken lexicon and speech sound
inventories are commensurate. Determining the relationship
between these two areas of development could guide treat-
ment goals for expanding spoken language in children with
ASDs. The research questions are as follows.
1. Do minimally verbal children with ASDs produce sig-
nificantly more in-phonology than out-of-phonology
words?
2. Are lexicon and phonological development commen-
surate in minimally verbal children with ASDs?
Our hypothesis for the first question is that mini-
mally verbal children with ASDs will produce more in-
phonology than out-of-phonology words, thus demonstrat-
ing phonological selection and avoidance. Our hypothesis
for the second question is that minimally verbal children
with ASDs will have a spoken vocabulary proportional to
their consonant inventory.
Method
Participants
The children were recruited from preschools and
schools in two regions of the Midwest. A flyer about the
study were sent to parents or caregivers via e-mail. If a
parent/caregiver indicated an interest in the study, an inter-
view was scheduled, and written consent to participate in
the study was obtained. The procedures for participant
Biller & Yeager: Lexical and Phonological Development in ASDs
recruitment and participant consent were approved by the
institutional review board at the University of Illinois at
Urbana–Champaign and the University of Central Arkansas.
Potential participants were excluded from the study if
they were reported by their parent/caregiver to have any
other any sensory impairments (e.g., hearing loss or
visual impairment) or if the children had too many or
too few spoken words, according to the inclusionary cri-
teria. The participants in the study included 20 children
with ASDs, consisting of 16 boys and four girls. They
ranged in age from 28 to 72 months, with a mean age
of 55 months. Regarding race, 18 children were reported to
be White, one child to be Black, and one child to be bira-
cial (White and Black). The children met the following
inclusionary criteria: (a) adequate hearing acuity or detec-
tion of sound; (b) a diagnosis of ASD by medical or educa-
tional personnel using a standardized measure for ASD
and meeting the criteria as determined by the Diagnostic
and Statistical Manual of Mental Disorders: Fifth Edition
(DSM-V; American Psychiatric Association, 2013); and (c)
a spontaneous spoken vocabulary of five to 50 words, as
measured by the MacArthur–Bates Communicative Devel-
opment Inventories (Fenson et al., 2007). The children in
this study would be considered minimally verbal as defined
by Koegel et al. (2020). Additionally, the Mullen Scales of
Early Learning (MSEL; Mullen, 1995) was given as a
descriptive measure of each child’s visual reception, fine
motor, receptive language, and expressive language skills.
The standardized tests for diagnosing the children with
ASDs were performed by medical professional or school
psychologists who were familiar with administering the
assessments. The parents completed the Communicative
Development Inventories (CDI) and the first author,
known as the examiner, administered the MSEL. (See
Table 1 for the children’s demographic information and
inclusionary data.)
All of the children passed either a formal audiologi-
cal pure-tone screening test or an informal sound detec-
tion task. The task consisted of three different noise-
makers (e.g., a piece of cellophane, a rattle, and a buzzer)
being placed out the child’s field of vision at a distance of
2 ft behind the right and the left ear. If the child turned
toward the sound, it confirmed his or her ability to
respond to acoustic stimuli at minimal to moderate levels.
All of the children met the DSM-V criteria for ASD:
Eleven were assessed using the Autism Diagnostic Obser-
vation Schedule–Second Edition (Lord et al., 2012), and
nine were assessed using the Childhood Autism Rating
Scale–Second Edition (Schopler et al., 2010). On the CDI,
the children produced five to 50 spoken words (M =
27.55, SD = 13.17). On the MSEL (Mullen, 1995), the
children’s scale scores were reported as development quo-
tients (DQs) instead of standard scores (Psychology
Research and Reference, 2022). The only exception was
1077
Table 1. Demographic information and descriptive measures for the participants.

Mullen Scales of Early Learning

Test for Vis. Rec. Composite
Child Age (Mo.) Gender Race autism DQa FM DQ RL DQ EL DQ score

1 28 M White ADOS-2 75 79 36 36 59
2 45 M White CARS2 38 24 29 27 49
3 70 M White ADOS-2 66 60 24 21 49
4 48 M White ADOS-2 54 56 46 33 49
5 53 M White CARS2 51 45 32 34 49
6 71 M White CARS2 35 28 21 28 49
7 45 F White CARS2 64 53 60 44 50
8 67 M White CARS2 31 31 24 22 49
9 52 M White CARS2 40 38 29 29 49
10 68 F White CARS2 37 38 20 22 49
11 59 M White ADOS-2 41 46 39 44 49
12 43 M White ADOS-2 56 79 35 30 52
13 46 M White ADOS-2 59 57 37 39 49
14 40 M White ADOS-2 60 55 63 53 49
15 71 F Black CARS2 38 38 42 41 49
16 42 F White ADOS-2 64 55 38 43 50
17 69 M Mixed ADOS-2 65 83 39 38 59
18 72 M White CARS2 72 71 74 39 80
19 53 M White ADOS-2 49 42 45 38 49
20 62 M White ADOS-2 58 60 45 44 49

Note. The children are listed in order from top to bottom by increasing the number of spoken words. Mo. = month; Vis. Rec. = Visual
Reception; FM = Fine Motor; RL = Receptive Language; EL = Expressive Language; DQ = developmental quotient; M = male; ADOS-2 =
Autism Diagnostic Observation Scale–Second Edition; CARS2 = Childhood Autism Rating Scale–Second Edition; F = female.
a
DQ was obtained for each scale score by dividing the child’s developmental age by his or her chronological age.

the composite score, which is only reported in standard
scores. A DQ is obtained by dividing the child’s develop-
mental age by his or her chronological age. Since most of
the children obtained the lowest possible T score of 49 on
all of the scales, developmental quotients allowed for vari-
ability in the children’s abilities to be revealed. On the
Visual Reception scale, the children’s quotients ranged
from 31 to 75 (M = 52.65, SD = 12.97). On the Fine
Motor scale, their quotients ranged from 24 to 83 (M =
51.90, SD = 16.64). On the Receptive Language scale, the
children’s quotients ranged from 21 to 74 (M = 38.90,
SD = 13.76). On the Expressive Language scale, their
quotients ranged from 21 to 53 (M = 35.25, SD = 8.46).
Overall, the children’s Early Learning composite standard
scores ranged from 49 to 80 (M = 51.80, SD = 7.31).
the session. During the children’s assessment/play sessions,
the examiner administered the MSEL. The eight communi-
cation temptation activities from the Communication and
Symbolic Behavior Scales (Wetherby et al., 2003) were per-
formed in an attempt to elicit spontaneous speech from the
children. These activities consisted of blowing bubbles,
blowing up a balloon and letting it go, using a wind-up
toy, reading a book, opening a small jar with food inside
it, playing with blocks, playing with a bag of toys that was
difficult to open, and playing a finger game. The same toys
and adult interaction style were used each session in an
attempt to make the content of the assessment/play sessions
uniform across participants.
Measures

Procedure Speech Sound Inventories

The data for the study were collected during the
parent/caregiver session and the two, 30-min assessment/
play sessions with the child. The children and their parents
were seen either at home or at the child’s preschool. The
parent/caregiver completed a social history and the CDI.
During the parent/caregiver session, the examiner was given
a copy of the medical report containing the child’s diagno-
sis of ASD. The assessment/play sessions were video-
recorded with an Apple iPad Pro and audio-recorded with
a Sony digital voice recorder, which ran the entire length of
The children’s speech sound inventories (e.g., all
vowels and consonants) were derived from the utterances
spoken by the children during the two 30-min assessment/
play sessions, which were video- and audio-recorded. Cap-
tured on the videos were the administration of the MSEL,
the communication temptation activities, all interactions
between the examiner and the child, and any other utter-
ances produced by the child. Every utterance produced
throughout the session was transcribed phonetically, which
included complete words, word approximations, syllables,
and phonemes (e.g., vowels and consonants). Additionally,

1078 Language, Speech, and Hearing Services in Schools • Vol. 53 • 1074–1087 • October 2022
utterances that were imitated, elicited, spontaneous, or
produced during vocal play were included in the transcrip-
tion in an effort to obtain a representative and thorough
sample since it was difficult to elicit language from chil-
dren with such limited verbal output (Broome et al., 2017;
Saul & Norbury, 2020). The examiner transcribed 15 out
of the 20 children’s assessment/play sessions and two grad-
uate students in communication sciences and disorders
transcribed the other five children’s sessions. The number
of utterances among the children varied greatly depending
upon their level of spoken language.
Lexicon
The children’s spoken vocabulary was derived from
the words reported by the parents on CDI that the chil-
dren “comprehended and said.” Upon completion of the
CDI, the examiner analyzed the results with three consid-
erations in mind. First, the child’s spontaneous production
of the word on the CDI had to meet a certain criterion to
be counted. An utterance was considered to be a word if
it contained at least 50% of the consonants from the target
word with at least one consonant and one vowel from the
original word and the consonants produced in the correct
order (Leonard et al., 1982). For example, the ba was
counted as an acceptable production of ball, but u was
not accounted as an acceptable production of you. Sec-
ond, misarticulation of the initial phoneme was consid-
ered. If a child misarticulated a phoneme during the
assessment/play session (e.g., t/k), it was noted on his or
her speech sound inventory form. Furthermore, the child
was not given credit for having that phoneme in his or her
speech sound inventory. When transcribing the session, if
the word-initial sound was misarticulated, the word was
included in the list of spoken vocabulary on the CDI.
However, the production was categorized as being out-of-
phonology because the child misarticulated the word-initial
phoneme. For instance, a child consistently substituted
t/k. If the child said tomb for comb, then the word comb
would appear on his total list of words, but it would count
as being out-of-phonology. Third, dialectical variation of
the initial phoneme was examined. Two of the children in
the study used an acceptable African American English
dialectal variation of d/θ and d/ð. Consequently, their
spoken words on the CDI using those variations were
counted as being in-phonology. For example, the chil-
dren said dat for that. They were given credit for having
that phoneme in their speech sound inventory and for it
being an in-phonology word.
In-Phonology and Out-of-Phonology Words
The examiner compared the words produced on
each child’s CDI to the list of phonemes that comprised
each child’s speech sound inventory, thereby creating two
lists of words that represented in-phonology and out-of-
Biller & Yeager: Lexical and Phonological Development in ASDs
phonology words. The first group contained the number
of words from the child’s CDI that began with word-
initial phonemes from the child’s existing consonant reper-
toire known as in-phonology words. The second group
contained the number of words that did not begin with
word-initial phonemes from the child’s existing phoneme
repertoire or were misarticulations of a phoneme and were
known as out-of-phonology words.
Reliability
The examiner scored all the children’s data for in-
phonology and out-of-phonology words. An undergradu-
ate student in communication sciences and disorders was
trained to code in-phonology and out-of-phonology words
based on the word-initial phonemes of the spoken words
on the CDI and the children’s speech sound inventories.
Prior to coding the data, the examiner and undergraduate
student agreed on the coding rules for the three consider-
ations listed in the Lexicon section. Training of the under-
graduate student continued until the student reached at
least 70% agreement with the examiner over three consec-
utive sessions. For computing reliability, the student’s
scoring decisions were compared to those of the examiner.
Reliability was calculated by dividing the total number of
agreements by the total number of agreements and dis-
agreements, and multiplying by 100, to arrive at the per-
centage of agreement. An acceptable level of agreement
was 80%. Reliability on agreement of in-phonology words
was 85% and that of out-of-phonology words was 100%.
Data Analysis
Due to the small sample size in this study (N = 20), a
normal distribution of scores could not be assumed. In this
case, nonparametric statistics were used because there is
not the assumption that data are drawn from a normal dis-
tribution. The nonparametric Wilcoxon signed-ranks test
was chosen to determine if there was a significant difference
between in-phonology and out-of-phonology words. The
Wilcoxon is more sensitive to a smaller sample size, and by
ranking the pairs of scores, it eliminates the effects of out-
liers. A Spearman rank-order correlation was performed to
determine the relationship between the total number of spo-
ken words and the number of phonemes in the children’s
speech sound inventory.
Results
In-Phonology and Out-of-Phonology Words
Statistical analysis revealed that the minimally ver-
bal children with ASDs in this study produced
1079
significantly more in-phonology than out-of-phonology
words (see Figure 1). The Wilcoxon signed-ranks test was
performed using IBM SPSS Statistics for Windows, Version
27, and revealed that the children produced significantly
more in-phonology words than out-of-phonology words
(z = −3.922, p = < .001) with a large effect size (r = −.62).
The children produced from four to 42 in-phonology words
(M = 24.30, SD = 12.14) and from zero to eight out-of-
phonology words (M = 3.20, SD = 2.57). Given the fact
that Leonard et al. (1982) used word-initial consonants
from the children’s existing consonant repertoires for their
target words, a Wilcoxon signed-ranks test was performed
on in-phonology words and out-of-phonology words con-
taining consonants only. The consonant-only analysis
revealed very similar results (z = −3.921, p < .001). The
children produced from two to 39 in-phonology words
(M = 21.75, SD = 11.15) and from zero to eight out-of-
phonology words (M = 2.90, SD = 2.40). In-phonology
and out-of-phonology word learning was evidenced by the
children with the fewest number of spoken words and the
children with the greatest number of words. In fact, the gap
between in-phonology and out-of-phonology words grew
wider as the children’s spoken vocabulary grew larger. As
the children’s total number of words increased, their in-
phonology words increased disproportionately to their
number of out-of-phonology words. For example, the chil-
dren with the fewest number of spoken words were Child 1
and Child 2. Child 1 had four in-phonology words and one
out-of-phonology word for a total of five words. Likewise,
Child 2 had eight in-phonology words and zero out-of-
phonology words for a total of eight words. The children
with the greatest number of words were Child 19 and 20.
Child 19 had 42 in-phonology words and six out-of-
phonology words for a total of 48 words. Child 20 had 42
in-phonology words and eight out-of-phonology words for
a total of 50 spoken words.
Lexical Size and Phonological Development
A Spearman’s rank-order correlation was performed
on the relationship between the total number of phonemes
(i.e., vowels and consonants) and the total number of
words produced by children in this study. As shown in
Figure 2, there was a moderate positive correlation
between phonemes and words (r = .534, p = .019), which
was significant at the .05 level. Of the 44 English pho-
nemes, the number of phonemes ranged from 21 to 40
(M = 28.45, SD = 5.25) and the total number of words
ranged from five to 50 (M = 27.60, SD = 13.09). When
examining Table 2, the relationship between the number
of words and the number of phonemes is more evident for
the children who had the least and the greatest number of
words (i.e., the children at the lowest and the highest end
of the table). For example, Child 2, who produced close
to the fewest number of words (eight words), had the few-
est number of phonemes (21 phonemes). Likewise, Child
19 and Child 20 who had the greatest number of words
(48 and 50, respectively) had close to the greatest number
of phonemes (35 and 36, respectively).
Speech Sound Inventories
After examining the association between lexical acquisi-
tion and phonological acquisition, it is worthwhile to examine

Figure 1. Number of in-phonology (In-phono) and out-of-phonology (Out-phono) words used by the participants. The children are listed in
order from left to right by increasing the number of spoken words. The children’s spoken words were obtained from the MacArthur–Bates
Communicative Development Inventories (Fenson et al., 2007). The speech sound inventories were obtained from the utterances produced
during assessment/play sessions with the children. The children’s spoken words from the Communicative Development Inventories (CDI)
were categorized as being either in-phonology or out-of-phonology based on whether the words began with a phoneme in the child’s exist-
ing speech sound inventory.

1080 Language, Speech, and Hearing Services in Schools • Vol. 53 • 1074–1087 • October 2022
Figure 2. A Spearman rank-order correlation was performed to determine the relationship between the number of spoken words and the
number of phonemes in the children’ speech sound inventory. The plot indicated a moderate positive correlation between the number of
words on the Communicative Development Inventories (CDI) and the number of phonemes produced by the children.

the children’s speech sound inventories, as displayed in
Table 2. Recall that the children ranged in age from 28 to
72 months with a mean age of 55 months. The children
produced seven to 20 out of the 20 vowels, which included
monothongs and diphthongs (M = 13.25, SD = 3.62) and
10–21 of the 24 consonants (M = 15.10, SD = 2.32). Many
of the children in this study (19 out of 20) produced seven
or eight of the Early 8 consonants (/m, n, j, b, w, d, p, and
h/), which are consistently produced by their NT peers at
36 months (Leonard et al., 1982). However, the children
were inconsistent in their production of the Middle 8 con-
sonants (/t, ŋ, k, g, f, v, tʃ, and dʒ/), which are consistently
produced by the age of 66 months. In fact, not one child
produced all of the Middle or Late 8 consonants. It is inter-
esting to note that approximately three quarters of the chil-
dren (15–17 children) produced /t, k, g, and ʃ/, but only
approximately half of the children (nine to 10 children)
produced /ŋ, f, and tʃ/ and less than a quarter of the chil-
dren (two to four children) produced /v and dʒ/. Of the
Late 8 consonants (/ʃ, ʒ, l, r, s, z, θ, ð, and clusters/), which
are consistently produced by the age of 90 months, almost
all the children (19 of the 20) produced /ʃ/, /s/, or /z/; half
of the children (10 of the 20) produced /l/ or /r/; and less
than a quarter of the children (two children) produced /ʒ/
or /θ and ð/. The children exhibited typical sound substitu-
tions such as p/f, d/ θ, d/ð, t/k, d/g, w/l, and w/r.
Discussion
In this study, we examined two components of lexi-
cal acquisition and phonological development in children
with ASDs who were in the first 50-word stage of lan-
guage development. The first component we investigated
was in-phonology and out-of-phonology word learning.
Our hypothesis regarding our first question was confirmed
in that the children with ASDs in this study overwhelmingly
produced spoken words that began with consonants from
their existing speech sound inventory. According to the the-
ory set forth by Schwartz and Leonard (1982), the children
selected and avoided words according to their individual
phonological preferences. The children were heavily influ-
enced by their existing speech sound inventories as opposed
to speech sounds, which they had yet to develop. Moreover,
this study appears to confirm the notion that the children
with ASDs have similar word learning styles as NT chil-
dren in the same stage of development. We posit that these
children were able to use their auditory–articulatory feed-
back loop, which is a foundational skill of speech produc-
tion, during in-phonology and out-of-phonology word
learning (Stoel-Gammon, 2011). The children may have
become aware of the tactile and kinesthetic sensations
related to speech production of their preferred phonemes,
and “heard the acoustic output creating an auditory articu-
latory feedback loop” (Stoel-Gammon, 2011, p. 9).
The second component we explored was a relation-
ship between the number of words and the number of
phonemes produced by the children in this study. Our
hypothesis for the second question was somewhat con-
firmed. The children’s lexical acquisition and phonological
development seemed to be proportional only among the
children who had the least and the greatest number of
words. The child in the study (Child 2), who produced
close to the fewest number of words, had the fewest num-
ber of phonemes, perhaps because the child’s limited con-
sonant inventory could not support an expanded reper-
toire (Stoel-Gammon, 2011). Conversely, the two children
who produced the most words (Child 19 and Child 20)
had close to the greatest number of phonemes, suggesting
that the demands of their more developed vocabulary

Biller & Yeager: Lexical and Phonological Development in ASDs 1081

Table 2. Number of words, number of consonants, and consonant inventories for the participants.

Number Number of
Child Age (mo.) of words phonemes Speech sound inventory (vowels and consonants)

1 28 5 26 10 V /I, i, æ, u, ɔ, ɑ, ə, ʌ, aʊ, eɪ/

16 C /p, b, t, d, k, g, m, n, s, ʃ, ʒ, tʃ, w, j, h/a
2 45 8 21 11 V /i, ɛ, æ, u, ʊ, ɔ, ɑ, ə, ʌ, eɪ, oʊ/
10 C /b, d, g, m, n, f, v, w, j, h/a
3 70 17 28 11 V /I, i, ɛ, æ, u, ɔ, ɑ, ʌ, aɪ, eɪ, oʊ /
17 C /b, t, d, k, m, n, ŋ, f, s, z, ʃ, tʃ, dʒ, w, j, r, h/a
4 48 18 28 12 V /I, i, ɛ, æ, u, ʊ, ɔ, ɑ, ʌ, aɪ, eɪ, oʊ/
14 C /p, b, t, d, k, m, n, f, s, tʃ, dʒ, w, j, h/a
5 53 19 22 7V /i, ʊ, ɑ, ə, ʌ, aɪ, oʊ/
15 C /p, b, t, d, k, g, m, n, f, s, ʃ, tʃ, w, j, h/a
6 71 19 31 16 V /I, i, ɛ, æ, u, ʊ, ɔ, ɑ, ə, ʌ, aʊ, aɪ, eɪ, oʊ, ɛr, ar/
15 C /b, t, d, k, g, m, n, s, z, tʃ, dʒ, w, j, l, h/a
7 45 19 27 11 V /I, i, ɛ, æ, u, ɑ, ə, ʌ, aɪ, eɪ, oʊ/
16 C /p, b, t, d, k, g, m, n, f, s, z, ʃ, w, j, r, h/a
8 67 22 25 11 V /I, i, u, ɔ, ɑ, ə, ʌ, aʊ, aɪ, eɪ, oʊ/
14 C /p, b, t, d, k, g, m, n, ŋ, s, tʃ, w, j, h/a
9 52 23 24 12 V /I, i, æ, u, ʊ, ɔ, ɑ, ə, ʌ, aɪ, eɪ, oʊ/
12 C /p, b, t, d, k, m, n, s, ʃ, w, j, h/a
10 68 24 31 16 V /I, i, ɛ, æ, u, ʊ, ɑ, ə, ʌ, ɚ, ɝ, aɪ, eɪ, oʊ, ɛr, ar/
15 C /p, b, t, d, k, g, m, ŋ, s, z, ʃ, w, j, r, h/a
11 59 25 24 11 V /i, ɛ, æ, u, ɔ, ɑ, ʌ, aɪ, ɔɪ, eɪ, oʊ/
13 C /p, b, t, d, k, g, m, n, s, z, ʃ, l, h/
12 43 26 21 8V /i, æ, ɑ, ʌ, aʊ, aɪ, eɪ, oʊ/
13 C /b, t, d, g, m, n, f, s, z, w, j, l, h/a
13 46 30 22 10 V /I, i, æ, u, ʊ, ɑ, ʌ, aʊ, aɪ, eɪ/
13 C /p, b, t, d, k, g, m, n, ŋ, s, ʃ, w, h/a
14 40 30 28 13 V /I, i, ɛ, æ, u, ɔ, ɑ, ʌ, aʊ, aɪ, eɪ, oʊ, ɪr/
15 C /p, b, t, d, k, g, m, n, ŋ, s, ʃ, tʃ, w, j, h/a
15 71 35 40 19 V /I, i, ɛ, æ, u, ʊ, ɔ, ɑ, ə, ʌ, ɚ, ɝ, aʊ, aɪ, eɪ, oʊ, ɪr, ɛr, ɔr/
21 C /p, b, t, d, k, g, m, n, ŋ, f, v, θ, ð, s, z, ʃ, w, j, l, r, h/a
16 42 44 33 16 V /I, i, ɛ, æ, u, ʊ, ɑ, ə, ʌ, ɚ, ɝ, aʊ, aɪ, eɪ, oʊ, ɛr/
17 C /p, b, t, d, k, g, m, n, ŋ, s, z, ʃ, tʃ, w, j, l, h/a
17 69 44 35 17 V /I, i, ɛ, æ, u, ʊ, ɔ, ɑ, ə, ʌ, ɚ, ɝ, aʊ, aɪ, eɪ, oʊ, ɛr/
18 C /p, b, t, d, k, g, m, n, ŋ, θ, ð, s, z, ʃ, tʃ, w, j, h/a
18 72 46 31 16 V /I, i, ɛ, æ, u, ʊ, ɔ, ɑ, ə, ʌ, ɝ, aʊ, aɪ, ɔɪ, eɪ, oʊ/
15 C /p, b, t, d, m, n, s, z, ʃ, ʒ, tʃ, w, j, r, h/a
19 53 48 35 18 V /I, i, ɛ, æ, u, ʊ, ɔ, ɑ, ə, ʌ, ɚ, aɪ, ɔɪ, eɪ, oʊ, ɪr, ɛr, ɔr/
17 C /p, b, t, d, k, m, n, ŋ, f, s, ʃ, tʃ, dʒ, w, j, r, h/a
20 62 50 36 20 V /I, i, ɛ, æ, u, ʊ, ɔ, ɑ, ə, ʌ, ɚ, ɝ, aʊ, aɪ, ɔɪ, eɪ, oʊ, ɪr, ɛr, ɔr/
16 C /p, b, t, d, k, g, m, n, ŋ, f, s, z, ʃ, w, j, h/a

Note. The children are listed in order from top to bottom by increasing the number of spoken words. Listed are the consonants produced
correctly. V = vowels; C = consonants.
a
At least seven out of the Early 8 consonants are present (Shriberg, 1993).

created a demand for a larger and more complex phonolo-
gical system. This notion is in keeping with the bidirec-
tional relationship between phonological skills and lexical
development (Stoel-Gammon, 2011).
Besides looking at the relationships between phonol-
ogical development and lexical acquisition, the children’s
individual consonants should be examined for a trajectory
of development. The children followed a typical sequence
by producing the age-appropriate Early 8 phonemes.
However, they were inconsistent in production of the Mid-
dle and Late 8 phonemes. Their production of phonemes
tended to coincide with their number of words and not
with their chronological age. Interestingly, the children
seemed to either prefer certain phonemes or found them
easier to produce (/t, k, g, and ʃ/). Conversely, they also
seemed to avoid certain sound or found them harder to
produce (/ŋ, f, v, tʃ, and dʒ/). Their selection and avoidance
of these sounds were mirrored in their in-phonology and
out-of-phonology words. Perhaps a study with a larger
number of participants could determine the sequence of
phoneme development of children with autism as compared
to their NT peers. Additionally, there needs to be studies
that examine the individual phonological characteristics of
minimally verbal children with ASDs (Leonard et al., 1982;
Saul & Norbury, 2020 Yoder et al., 2015). Whereas this
study contains a description of the children’s number of
vowels and consonants and the children’s consonant pro-
duction in relation to the Early, Middle, and Late 8 classifi-
cation system, there was no statistical analysis of the chil-
dren’s phonological characteristics.

1082 Language, Speech, and Hearing Services in Schools • Vol. 53 • 1074–1087 • October 2022
 Overall, the children in this study had small lexicons
for their chronological age. The average age of the children
was 55 months, and yet the average number of words they
produced was 28. The small lexicon could have been due
to lack of practice. They may not have been speaking long
enough to use a variety of phonemes and syllable shapes
and mastering a variety of articulatory movements to pro-
duce an assortment of words. However, we did not gather
information about each child’s date of onset of spoken lan-
guage; hence, we cannot determine how long each child in
the study had been talking and practicing spoken language.
Another possibility for such small lexicons is that
the children were lacking the predictive factors that con-
tribute to expansion of expressive language (Yoder et al.,
2015). Two of these factors have been the child’s phonetic
repertoire and consonant inventory (Chenausky et al.,
2018; Saul & Norbury, 2020; Wetherby et al., 2007;
Yoder et al., 2015). A phonetic repertoire has been
defined as the number of consonants imitated correctly on
an experimental task (Chenausky et al., 2018) and has
been shown to be a predictor of expressive vocabulary
growth in children with ASDs (Chenausky et al., 2018;
Smith et al., 2007; Thurm et al., 2007). A consonant
inventory has been described as a set of consonants pro-
duced spontaneously by participants. Wetherby et al.
(2007) found a substantial correlation between the inven-
tory of consonants on the Communication and Symbolic
Behavior Scales Developmental Profile Infant–Toddler
Checklist (Wetherby & Prizant, 2002) and the inventory
of words produced by children with ASDs and children
with developmental delays. Additionally, they found that
the best predictors of verbal skills at age 3 years were acts
for behavior regulation and inventory of consonants.
In a study by Yoder et al. (2015), extensive model-
ing was used to determine four value-added predictors of
expressive language growth for preschoolers with ASDs.
Value-added predictors are determined by considering the
previous correlation between predictors used during the
modeling process. The four predictive factors were inten-
tional communication, consonant inventory, responding to
joint attention, and parent/caregiver linguistic responses.
A more recent study has investigated phonetic repertoire
and consonant inventory in children with ASDs (Saul &
Norbury, 2020). Twenty-seven preschool children with
ASDs were seen by the researchers in their homes every
4 months over a 12-month period. The researchers found
that both the phonetic repertoire and consonant inventory
were significant in predicting the children’s number of spo-
ken words for the vocabulary measures completed at every
4-month interval. Saul and Norbury (2020) confirmed the
importance of consonant production to the development of
spoken language in children with ASDs.
We concur with Yoder et al. that there needs to be
further research in consonant inventory growth in children
Biller & Yeager: Lexical and Phonological Development in ASDs
with ASDs (Yoder et al., 2015). The children in our study
demonstrated the Early 8 phonemes, which are consis-
tently produced at approximately 36 months. However,
beyond that measure, it is difficult to ascertain if they
have developed a large enough phonetic inventories to
support lexical growth. Besides phonetic inventory, the
remaining three predictive factors are in question. With-
out testing for the other three factors, we do not know
if or how they contributed to the success or failure of
the children in this study to expand their spoken lan-
guage. Although not a predictive model for spoken lan-
guage, Brady et al. (2021) suggests using an altogether
different form of measuring children’s progress in speech
production—a phonemic scoring method. This method
measures the production of every consonant and every
vowel in a target consonant–vowel–consonant word. Con-
sonants are measured on three features, which are place,
manner, and voicing. Vowels are measured on four fea-
tures, which are tongue height, advancement, rounding and
tenseness. This scoring system is sensitive to production
gains by showing improvement in production of phonemes
and syllables before gains are seen at the word level.
Clinical Implications
Knowing that children with ASDs produce new spo-
ken words based on phonological selection can have an
enormous impact on their treatment programs. The
lexical–phonological association for a child can be deter-
mined using results from a CDI and the child’s consonant
inventory. Since word comprehension precedes production
by at least 5 months (Benedict, 1979), the words that chil-
dren understand on the CDI can be used as a list of
potential target words to be trained in therapy. A clinician
could select words from the list that begin with the pho-
nemes from the child’s speech sound inventory. Other fac-
tors for word selection such as semantic class, syllable
shape, and the child’s own preferred items would be con-
sidered as well. This method of selecting target words to
expand a child’s spoken vocabulary can be enhance the
use of augmentative alternative communication. One
example would be using a speech-generating application,
installed on a tablet computer (Apple iPad, Microsoft Sur-
face Pro, Samsung Galaxy Tab, etc.), and programming a
set of words that match the criteria for target words
described in this study. All the words on the tablet screen
could be “masked” (or hidden) except for the target words
meeting the lexical–phonological criteria, and only those
words would be trained. Since the words begin with con-
sonants children are already producing, they would have a
better chance of imitating the words while using the
speech-generating device. As the children learn one set of
words, more words that meet the lexical–phonological cri-
teria could be unmasked, slowly expanding their target
1083
words and growing their vocabulary/lexicon with their
phonological skills.
The lexical–phonological association has been consid-
ered in very few treatment studies. A clinical case study
reported by Biller and Johnson (in press) used a combined
intervention program, incorporating both communication
and speech production strategies with a minimally verbal
child with ASDs. The study examined the spoken produc-
tion of preselected words by the participant, using a com-
bined intervention approach, consisting of three communi-
cation strategies and three speech production strategies dur-
ing structured play. The target words were chosen based on
the in-phonology and out-of-phonology word learning pre-
sented in this study. The results indicated that the child
demonstrated improved spontaneous and imitative produc-
tion of the target words during the treatment and main-
tained production of the target words 1 month after the
treatment ended. Additionally, the participant demon-
strated spontaneous production of seven out of the eight
target words on the posttreatment MacArthur–Bates CDI.
One treatment study reported that consonant inven-
tories were considered when selecting target words for
intervention (Brady et al., 2015). A study by Brady et al.
(2015) used a multimodal approach (e.g., the use of speech
and a speech generating device during intervention) to
teach preselected spoken vocabulary to minimally verbal
children with ASDs, based on a child’s initial speech
sound repertoire, phonotactic probability, and neighbor-
hood density. Phonotactic probability refers to the fre-
quency of occurrence of sound combinations in the lan-
guage, which can have either a high or a low probability
of occurrence. Neighborhood density refers to a cluster of
words that sound similar, differing by only one sound sub-
stitution, addition, or deletion (e.g., cat, cad, cap, and
cab). The researchers chose high-probability and high-
density target words that were easier for the children to
produce. Results of Brady et al.’s study indicated that
their intervention package promoted improved spoken
words for some minimally verbal children with ASDs.
Furthermore, the authors reported that the children more
easily acquired new words that incorporated consonants
from their existing consonant repertoire.
A second clinical implication from this study per-
tains to the children’s individual phonetic inventories.
Whereas many of the children in this study produced most
of the Early 8 consonants and some of the Middle 8 con-
sonants, there were some idiosyncrasies among the chil-
dren’s consonant inventories, such as the absence of /f/.
After conducting a probe, it would be beneficial to teach
each child the age-appropriate consonants missing from
their inventory. By teaching the missing consonants (and
vowels), it would give the child an expanded phonological
base with which to increase lexical acquisition. Teaching
the age-appropriate phonemes could be accomplished with
1084 Language, Speech, and Hearing Services in Schools • Vol. 53 • 1074–1087 • October 2022
small doses of discrete trial training (DTT) using traditional
articulation therapy involving auditory, visual, and tactile
cues. For example, treatment sessions could include a speech
practice time in which the child receives focused trials of the
target words similar to “shaping procedures characteristic of
the DTT approach, which allows the child to produce at
first relatively gross approximations of target words that are
gradually required to move closer to adult forms” (Tsiouri
et al., 2012, p. 1290). In communication intervention studies
using DTT, children have been taught receptive and expres-
sive language skills, joint attention, symbolic play, verbal
and motor imitation, production of individual sounds, sin-
gle words, or phrases, (Biller & Johnson, 2022; Goldstein,
2002; Kaiser et al., 2017, Kaiser et al., 2006; Paul et al.,
2013; Prizant et al., 2000; Tsiouri et al., 2012).
Limitations and Future Research
A primary limitation of this study was the small sam-
ple size, which was partially due to the inclusionary criteria.
There were several children with autism whose families were
willing to participate in the study; however, the children
were either nonverbal or had a spoken vocabulary over 50
words. Since the study focused on the first 50-word stage of
language development, we strictly adhered to that criterion.
Even though there was strong evidence that the children in
this study used in-phonology and out-of-phonology word
learning, a larger number of participants could give a
clearer understanding of the relationship between number of
words produced by the child and the number of phonemes
present in a child’s speech sound inventories.
A second consideration was the method used to
gather the children’s speech sound inventories. Unlike the
methodology used by Leonard et al. (1982), this study
analyzed imitative, elicited, and spontaneous productions
in all positions of words to acquire the children’s conso-
nant inventories. Combining the child’s productions dur-
ing the assessment sessions allowed for a broader range of
phonemes to be counted that may not have been heard if
the child was required to perform an imitative task. To
make the speaking situations as uniform across the partici-
pants as possible, the participants were recorded during
the administration of the MSEL while carrying out the
communication temptation activities from the CSBS.
However, those speaking situations are not as uniform as
using a list of preselected targets used in the study of
Schwartz and Leonard. Additionally, the children’s pro-
ductions could have been divided by position in the word
(e.g., initial, medial, or final position) to yield a more
refined analysis. A future study might compare the use of
more uniform stimuli to elicit speech sound production and
the use of spontaneous language samples to determine the
best sampling method for obtaining consonant inventories
from children with ASDs. Brady et al. (2015) used another
type of sampling method that provided an even more
extensive inventory of the children’s speech sounds—a Lan-
guage Environmental Analysis (LENA) device. It is a small
recorder often worn in a vest that records continuous ver-
bal productions of the children.
It would be noteworthy to conduct a treatment
study with children with ASDs that compares use of in-
phonology and out-of-phonology words as target stimuli.
One would predict that the in-phonology words would be
learned at a faster rate than the out-of-phonology words.
In conclusion, there appears to be mounting evi-
dence that phonological skills have an impact on expres-
sive language growth of children with ASDs (Chenausky
et al., 2018; Saul & Norbury, 2020; Yoder et al., 2015).
Children with autism who have a limited spoken vocabu-
lary should be given the same opportunity to improve
their speech sound production as other clinical popula-
tions. Leonard et al. (1982) suggested that target words in
treatment programs should adapt to the child’s phonolo-
gical characteristics because it is an effective method of
expanding of a child’s scant lexicon. They made this state-
ment about phonological characteristics and children with
specific language impairment; however, could it hold true
for children with autism as well.
Data Availability Statement
The data sets generated during and/or analyzed dur-
ing this study are available from the corresponding
author. They are stored on the campus of the University
of Central Arkansas and are available upon reasonable
request. The data sets contain analyses of language sam-
ples and speech sound inventories of minimally verbal
children with autism, ages 2;11–6;0 (years;months).
Acknowledgments
This work was supported by a University Research
Grant from the University of Central Arkansas (Grant
348R09 awarded to Maysoon F. Biller). The authors would
like to thank the many families and children who partici-
pated in this study, one spoken word at a time. They would
also like to thank the agencies in their region who promoted
the study and aided them in securing participants.
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