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esearch suggests that a number of variables are related to differences 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 intervention 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
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Inattentiveness
Inattentiveness refers to behaviors that indicate high
distractibility (e.g., difficulty staying focused on relevant
people or activities) and/or decreased awareness of objects, activities, or the environment. There is no direct
empirical evidence of a relationship between inattentiveness and language development in autism; however,
there is some indirect evidence. Recent research has found
that the inability to both initiate and respond to joint attention is closely related to language difficulties in this
population (e.g., Charman et al., 2003; Rollins & Snow,
1998; Sigman & McGovern, 2005; V. Smith et al., 2007;
Travis et al., 2001). Three basic componentsattention,
shared affect, and shared intentionsconstitute the capacity for joint attention (Yoder & McDuffie, 2006).
Hypothetically, children who lack the first component,
attention, may be less likely to engage in joint attention
interactions and this, in turn, may result in delayed language development over time (Mundy & Markus, 1997).
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Acting-Out Behavior
Acting-out behaviors are those that cause harm or
damage to the child him/herself, to another person, and/or
to the environment (e.g., tantrums, aggressive behaviors,
and property destruction). They also include noncompliant
behaviors (i.e., refusing to follow directions, stubbornness) and other behaviors that indicate emotional dysregulation or distress (e.g., screaming, crying, whining).
Acting-out behaviors have often been linked to communication, cognitive, and social skills. This may be because
childrens inability to regulate their behavior during cognitively demanding tasks or situations places them at a
learning disadvantage over children who are able to do
so (Bronson, 2000). In addition, children with acting-out
behaviors may be rejected by their peers and, as a result,
may be deprived of opportunities to practice and develop
prosocial skills such as sharing and cooperating (Kaiser
& Rasminsky, 2003). Acting-out behaviors have also been
viewed as communicative, as they can function to enable
an individuals access to desired items, activities, or interactions (I want ____) or escape from undesired tasks or
interactions (I dont want ___; Bopp, Brown, & Mirenda,
2004). Despite these potential links, no research has examined the relationship between acting-out behavior and
language development over time in children with ASD.
Summary
The literature examining child problem behaviors
as predictors of language development in ASD is still in
its infancy. Very few investigations have examined the
relationships between these behaviors and development
in children with autism under the age of 6. Finally, with
some exceptions (e.g., Dissanayake, Sigman, & Kasari,
1996; Epstein et al., 1985), the majority of studies conducted in this area have been descriptive or have only
examined relationships at one point in time, providing a
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restricted view of the relationships between child problem behaviors and other developmental domains. Thus,
the purpose of this exploratory study was to examine the
extent to which problem behaviors predicted changes
in the developmental trajectories of vocabulary and language skills in young children with ASD over 2 years.
Specifically, we were interested in whether the presence
of problem behaviors prior to the onset of intervention
and /or changes in problem behavior during the first
6 months of intervention were related to changes in child
development over 2 years. Identifying these relationships is important for understanding the process of language development in ASD and the factors that influence
the differential outcomes reported in the literature. In the
end, such information may also help to improve treatment effectiveness by allowing therapists to set priorities
based on empirical information rather than on simple
heuristics. The specific questions addressed in this study
were:
1.
2.
Do scores in one or more types of child problem behavior at the onset of intervention predict changes
in the developmental trajectories of vocabulary and
language skills in young children with ASD over
2 years?
Do changes in scores related to one or more types of
child problem behavior over a 6-month period predict
changes in the developmental trajectories of vocabulary and language skills in young children with ASD
over 2 years?
Method
Participants
Data for this study were accessed from a database
established for a project examining early intervention
outcomes for 69 children with ASD and their parents in
British Columbia (BC), Canada. Prior to entry into the
study, 55 children were diagnosed with autism and 14
were diagnosed with pervasive developmental disorder,
not otherwise specified (PDD-NOS). All diagnoses were
made by experienced community-based clinicians who
were not involved in the study. Specifically, 28 children
(41%) received a diagnosis from an autism team that included, at a minimum, a psychologist or psychiatrist, a
pediatrician, and a speech-language pathologist; 22 (32%)
received a diagnosis from a pediatrician; 12 (17%) received a diagnosis from a psychiatrist; and 7 (10%) received a diagnosis from a registered psychologist or
another qualified professional. In addition, the Childhood Autism Rating Scale (CARS; Schopler, Reichler, &
Renner, 1988) was administered at the outset of the
study by psychologists who were naive to the original
diagnosis.
Measurement
Data were collected at baseline (i.e., prior to the initiation of early intervention, T1) and 6, 12, and 24 months
later (T2T4). Data collection occurred in each childs
home or early intervention center and was administered
by an assessment team that included registered psychologists, certified speech-language pathologists, and trained
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Data Analysis
Following construction of the predictor variables,
individual growth curve modeling (IGCM) using SAS
Proc Mixed computer software was used to answer each
research question. Individual growth trajectories developed through latent trajectory analysis are a rich and
flexible alternative to traditional methods for analyzing
longitudinal data (e.g., regression). IGCM was used in
order to take advantage of the multiwave data that were
available for investigation. IGCM enables the examination
of change as a continuous process, such that the amount
of change between time periods for a given participant is
a result of that participants underlying growth trajectory (Francis, Fletcher, Stuebing, Davidson, & Thompson,
1991). In addition, IGCM includes path analysis and regression to explore relationships among changes in individual variables over time (Keith, 1993; Schumacker &
Lomax, 2004).
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1111
Unconditional Model
Before analyses were conducted to examine the predictors of change in child development, unconditional
models were examined to determine whether there was
significant variance in the initial value and slope for each
of the child measures over 2 years and to examine whether
the model was linear or quadratic. Table 4 presents these
findings and the Akaike Information Criterion (AIC), the
unconditional model goodness-of-fit statistic, for each measure. There is no statistical test available to assess the
differences in AIC between models; however, models
with lower AIC values are preferred and are considered
a better fit (Tabachnick & Fidell, 2007). Overall, the results indicated that the children changed significantly
over 2 years on all measures (i.e., the variance in the
rate of change over 2 years was significant). With regard to the shape of the growth curves, the linear effect
was significant and the quadratic was not, in all cases.
Results
Conditional Model
Total number
of items
Coefficient
alpha
Acting-out behavior
Repetitive sensory motor behavior
Insistence on sameness behavior
Socially unresponsive behavior
Inattentiveness
19
22
6
20
10
.84
.75
.62
.78
.56
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Table 2. Scores for Time 1 (T1) behavior variables used to predict changes in child development over 2 years.
Child behavior variable
T1 M (range)
T1 SD
T2 M (range)
T2 SD
8.86 (118)
10.25 (220)
3.94 (16)
5.78 (013)
6.72 (310)
3.92
3.68
1.51
2.96
1.72
7.41 (017)
9.07 (017)
3.31 (06)
4.04 (013)
5.87 (19)
4.00
3.83
1.66
3.15
1.80
Note. T2 = Time 2.
Table 3. Raw scores for measures of child development from Time 1 to Time 4.
Time 1
Child measure
PPVT
EOWPVT
PLS AC
PLS EC
CARS
Time 2
Time 3
Time 4
M (range)
SD
M (range)
SD
M (range)
SD
M (range)
SD
9.87 (085)
10.51 (065)
12.96 (348)
13.96 (447)
36.34 (2550.5)
17.68
14.79
9.15
7.36
5.72
20.94 (097)
19.07 (075)
19.62 (344)
18.01 (644)
35.54 (17.549)
23.50
18.05
11.05
8.38
6.75
27.87 (0108)
24.45 (086)
23.56 (548)
21.21 (548)
34.83 (1949.5)
26.74
22.48
12.78
9.90
7.19
38.19 (0125)
33.90 (096)
28.86 (848)
25.67 (748)
34.53 (16.550.5)
29.27
26.29
13.25
12.19
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.
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PPVT
EOWPVT
PLS AC
PLS EC
Intercept estimate
t -value
Slope estimate
t -value
Goodness of fit (AIC)
12.78
5.88***
1.11
11.59***
2149.8
12.35
6.54***
0.93
10.59***
1988.5
14.77
11.55***
0.63
13.12***
1782.5
14.77
15.39***
0.48
12.01***
1571.2
Discussion
This study provides an initial exploration of the interrelationships between five types of behaviors and vocabulary and language development over time. It is unique
in that individual growth curve modeling was used to explore the impact of problem behaviors at T1 and changes
in problem behaviors 6 months later on changes in vocabulary and language development over 2 years.
Results of the conditional analyses related to autism
severity and NVIQ generally confirmed past research
that has found a relationship between these two measures
themselves and between NVIQ and other developmental
PPVT
EOWPVT
PLS AC
PLS EC
T1 CARS alone
0.04
3.10*
1977.1
0.01
1.75
1769.5
0.02
3.77**
1557.8
Slope estimate
t -value
AIC
0.04
2.73*
2137.5
Slope estimate
t -value
AIC
T1 NVIQ alone
0.02
0.02
3.85**
3.38**
1820.4
1676.1
0.004
1.26
1501.1
0.009
3.57**
1295.6
0.004
0.45
0.003
0.87
1492.5
0.02
2.11*
0.007
2.45*
1289.4
Centered age as calculated by age minus mean age at T1 was used as the measure of time.
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Table 6. Results from final models showing effects of child behavior predictors on language
outcomes from Time 1 to Time 4. Models also included T1 NVIQ and CARS scores.
Value
PPVT
EOWPVT
PLS AC
PLS EC
0.11
1.84
0.07
2.68*
0.02
0.98
0.04
1.46
0.02
0.35
0.13
2.19*
0.06
2.21*
0.04
1.59
0.04
1.49
0.09
1.54
0.07
2.53*
0.03
2.10*
0.004
0.30
0.02
1.55
0.02
0.43
0.03
1.23
0.02
1.94
0.006
0.58
0.003
0.31
0.05
1.79
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Limitations
This study attempted to examine behavioral predictors of developmental trajectories in young children with
ASD over time and, as is often case with exploratory studies, it has several limitations. First, a relatively small
sample size (N = 69) was used. Although small sample
sizes are not uncommon in ASD research (e.g., Charman
et al., 2005; Sigman & McGovern, 2005; Siller & Sigman,
2002; Stone & Yoder, 2001; Szatmari, Bryson, Boyle,
Streiner, & Duku, 2003), follow-up studies are needed to
examine the predictive relationships found here in a larger
group of participants. Second, the timeline of 2 years for
this investigation was relatively short for a longitudinal
design. Follow-up at 5 years and beyond for this group of
children would be optimal, in order to ascertain the stability of the findings.
Third, the data were originally collected for a purpose other than that for which they were used in this investigation. This resulted in several limitations. First,
information was not available about the extent to which
each childs treatment specifically targeted the problem
behaviors examined in this study. Second, items included
within each child behavior variable were limited to only
those items available in the existing measures in the data
set. Thus, none of the predictor variables incorporated all
possible behavioral manifestations of the behavior constructs. For example, the IS variable contained only six
items and did not include behaviors such as circumscribed
interests, which have been found to be related to child
development in other studies (e.g., Bishop et al., 2006).
Third, all of the items used to construct the predictor
variables originated from parent-report measures, and
none of the behaviors were directly observed by an experienced professional. Finally, even though care was taken
in the construction of the predictor variables with regard to psychometric and content validity, none of the
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Future Directions
The results of this research provide a preliminary
understanding of some of the child problem behaviors
that may be related to language development in young
children with ASD. Identifying such predictive relationships may provide guidance for the development of treatments that result in optimal outcomes (Koegel et al.,
1992). For example, many intervention programs target early socio-communicative behaviors such as imitation (Ingersoll, Schreibman, & Quy, 2003; Schreibman &
Ingersoll, 2005), an approach supported by recent research demonstrating predictive relationships between
imitation skills and development in other areas (e.g.,
V. Smith et al., 2007; Toth et al., 2006). The results of
the present study suggest that children who are more attentive and socially responsive are likely to make greater
gains in vocabulary and/or language development. These
findings support the theory that children with autism
learn language much like typical children do, through forms
of joint social engagement (e.g., Abbeduto & Boudreau,
2004; Luyster et al., 2007). If future research supports
this finding, specific approaches aimed at improving attentiveness and socially responsive behavior would appear to be critical as key components of early treatment
packages. In addition, research is needed to examine the
extent to which the predictive relationships found in
this investigation are common across young children
with ASD who receive various types of early intervention. This will add to our current, limited understanding of the influence of problem behaviors on the widely
heterogeneous outcomes observed in young children
with ASD (Schreibman, 2000).
In conclusion, this exploratory investigation opens
the door to future examinations of predictive relationships between specific child behaviors and changes in
child vocabulary and language development over time,
using analytic techniques that take advantage of multiwave data. This type of research has potential for adding
substantially to our current understanding of these complex relationships and for assisting service providers,
families, and policy makers to make more informed decisions about how to maximize the effectiveness of their
early intervention efforts.
Acknowledgments
This research was completed by the first author in partial
fulfillment of the requirements for a doctoral degree at the
University of British Columbia. Portions of this research were
presented at the International Meeting for Autism Research
in Seattle, May 2007; the American Speech-Language-Hearing
Association conference in Chicago, November 2008; and on a
public webcast at http://breeze.setbc.org/p65709571/. We are
grateful to the children and families who participated in this
study and to the many evaluators who were involved in data
collection. Partial funding was provided by the Human Early
Learning Partnership, the BC Ministry for Children and Family
Development, and the National Alliance for Autism Research /
Autism Speaks postdoctoral fellowship program.
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