Six-Months Clinical Outcomes Following Treatment As Usual (TAU) for Autism: Focus On Language and Communication

Background:  

Language and communication impairments in children with autism spectrum disorders (ASD) are increasingly recognized. In 2011 Kjellmer showed that for children with ASD, receptive and expressive language is mainly related to cognitive level, whereas non-verbal communication skills seem to be also related to severity of autism symptoms and adaptive functioning.

Objectives:  

To describe language and communication outcomes for ASD toddlers after six-months of treatment as usual.

Methods:  

70 partecipants (57 males and 13 females; mean age = 35,2 months) with a DSM-IV-TR diagnosis for Autism or PDDNOS, confirmed by ADOS-G, were recruited. Language and communication outcomes were studied using the following measures: ADOS-Communication; Griffiths-Language; Vineland-II scales (VABS); and MacArthur Communication Development Inventories (MCDI). Language/Communication measures were subdivided by cognitive level, measured using Griffiths Developmental Quotient (gr.1 IQ>70; gr.2 IQ 55-69; gr.3 IQ<55), and diagnostic group (Autism vs PDD-NOS) according to DSM-IV-TR. This study was funded by Italian Ministry of Health.

Results:  

At baseline and at endpoint, cognitive level was related to the mean score such that gr.1 (IQ>70) showed the highest mean scores, the gr.2 (IQ 55-69) showed lower mean scores, and the gr.3 (IQ<55) showed the lowest. For the ADOS scores the trend was opposed. At six-months follow-up, in gr.1, improvements from T0 to T1 were found in: VABS Composite score (p< .005). In gr.2, improvements were found in: MCDI-Comphrension (p< .005); MCDI-Production (p< .005); MCDI-Gestures (p< .005); VABS-Communication (p< .005); VABS-Daily Living skills (p< .005). In gr. 3 improvements were found in: MCDI-Comphrension (p< .005); MCDI-Production (p< .005); MCDI-Gestures (p< .005); and ADOS-Communication (p< .005). Also, diagnoses were related to the mean score such that PDDNOS group showed the highest mean scores, and the Autism group showed the lowest. In Autism improvements from T0 to T1 were found in MCDI-Comphrension (p< .001); MCDI-Production (p< .005); MCDI-Gestures (p< .001); and ADOS-Communication (p< .005); VABS-Communication (p< .005); VABS-Daily Living skills (p< .005); and VABS-Composite (p<.005). In PDD-NOS improvements from T0 to T1 were found in: MCDI-Gestures (p< .005) and ADOS-Communication (p< .005).

Conclusions:  

Our study showed two opposed findings. On the one hand, both at baseline than at endpoint, higher language and communication skills are mainly related to higher cognitive level and to lower severity of autism spectrum disorder; on the other side, at six-months follow-up, children with (a) severe/moderate developmental delay than normal cognitive level; and with (b) less severe autism (PDDNOS than Autism) showed higher statistical and clinical outcomes. In conclusion, these findings highlighted the importance of considering these aspects when managing the early intervention and showed that treatment as usual seem to have played a role in having improved the Language/Communication skills especially in children with autism and moderate/severe development delay.