Communication Growth in Minimally Verbal Children with Autism

Background: Approximately 30% of children with autism spectrum disorders (ASD) are minimally verbal past age 5.  School-aged minimally verbal children with ASD are often excluded from research so information on their communication development is limited.  Interventions for this population focus on discrete speech skills, often requesting in response to prompts, with limited attention to how children engage in reciprocal communication and how they initiate communication. This study examines how minimally verbal children with ASD initiate communication interchanges (CI) over the course of six-month intervention, and what communicative functions those CI serve. CI are rounds of talk between partners serving a single communicative function (Ninio et al., 1994).  The developmental course of CI has been documented in typically developing children and children with language impairment (Ninio et al., 1994, Snow et al, 1996).

 

Objectives: This study seeks to investigate child initiations of CI over time, as well as document communicative functions observed.  

Methods: Participants included 53 minimally verbal children with ASD from an intervention study, using a blend of two existing interventions - Joint Attention, Symbolic Play, Engagement and Regulation (JASPER) (Kasari et al, 2006) and Enhanced Milieu Teaching (EMT) (Kaiser, 1993).  Participants were randomized to Speech (spoken language only) or AAC (spoken language plus augmentative/alternative communication device) versions of the intervention. Forty-eight sessions occurred, twice per week (one hour each) over the six months.

Intervention sessions were videotaped and participant communication was transcribed at entry and monthly over the course of intervention (seven time points).  These transcripts were coded for CI and analyzed for proportion of child initiations per session and communicative functions.

Results: Children in both treatment groups showed significant growth in the proportion of child initiated CI over the course of intervention (f=13.81, p=.0002).  Average proportion of child initiation CI at entry was 53% (SD = 25%) which increased to 71% (SD = 14%) by the end of intervention.  There was no effect of treatment group (f=.27, p=.60) or site (f=2.19, p=.11) on the growth trajectory.  CI served a variety of communicative functions, and these proportions did not change significantly over the course of intervention.  CI for the function of negotiating (possession of objects or activities) was the largest proportion, averaging 48% over time.  Discuss functions (joint attention, fantasy play, thoughts) accounted for an average of 31% of CI.  Establishing mutual attention was used rarely, accounting for an average of 5% of CI and the remaining CI had an unknown or ambiguous function (16%). 

 

Conclusions: This study highlights the ability of children with ASD who are minimally verbal to initiate communicative interactions serving a variety of functions when provided the opportunity to do so. Beyond requesting, children participated in communication for the purpose of discussing and sharing attention. In addition, the findings demonstrate growth in children’s frequency of initiations through brief targeted intervention.