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Accurate representation of autism spectrum disorder (ASD) in fragile X syndrome (FXS) is necessary for the field. We examined classifications of ASD using three approaches--Autism Diagnostic Observation Schedule (ADOS-2; Lord et al. 2012), Childhood Autism Rating Scale (CARS2-ST; Schopler et al. 2010), and Vineland Adaptive Behavior Scales (VABS-II; Sparrow et al. 2005)--in 45 adolescents with FXS. Maladaptive items from the VABS-II plus a maternal interview were matched with Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association 2013) criteria for ASD. Results indicated discrepant classifications. The ADOS-2 yielded the highest rate of comorbid autism (71%); CARS2-ST and VABS-II/DSM-5 yielded lower rates (38% and 42%, respectively). A singular measure of autism symptomology is insufficient to characterize autism in FXS.

The development of an expressive language score for people with autism based on the ADOS-2 was recently reported by Mazurek et al. (2019). The current study examined the construct validity of the ADOS-2 expressive language score (ELS) in a sample of adolescents with fragile X syndrome (n = 45, 10 girls), a neurodevelopmental disorder with high rates of autism symptomology. The ADOS-2 ELS showed strong convergent validity with multiple assessments of expressive language, receptive language, and nonverbal cognition. Divergent validity was demonstrated between the expressive language score and chronological age, symptoms of anxiety/depression, and rule-breaking behaviors. This expressive language score is a promising measure of expressive language ability that can be used in research when other language assessments are unavailable.

Purpose: The aim of this study was to investigate language growth in individuals with fragile X syndrome (FXS) from early childhood to adolescence and the influence of maternal responsivity on language growth. Method: We conducted a longitudinal analysis of language development in 55 youths (44 males, 11 females) with FXS. Data collection spanned the ages of 11-216 months. We measured expressive and receptive vocabulary with standardized tests. The number of different words and mean length of utterance were obtained from language sample analyses of mother-child interactions. We also measured maternal comments (responsivity indicator) produced during the language samples and child nonverbal IQ. Results: Growth models indicated that rates of number of different words and receptive vocabulary were related to maternal commenting. Mean length of utterance did not change significantly over time. Expressive vocabulary measured with a standardized test grew, but the growth was not related to maternal commenting. Nonverbal IQ was related to all language outcomes at age of 10 years and to changes over time in vocabulary. Visual analysis indicated that the highest scores on standardized tests were produced by girls; however, measures derived from language sample analyses appeared similar for boys and girls. Language models for boys only were similar to the total sample models with lower scores at age of 10 years for some outcomes. Conclusion: Results of persistent language impairments for most youths with FXS suggest the need for continued, focused interventions aimed at improved language productions in addition to a responsive environment.

Accurate representation of autism spectrum disorder (ASD) in fragile X syndrome (FXS) is necessary for the field. We examined classifications of ASD using three approaches-Autism Diagnostic Observation Schedule (ADOS-2; Lord et al. 2012 (See CR28)), Childhood Autism Rating Scale (CARS2-ST; Schopler et al. 2010 (See CR35)), and Vineland Adaptive Behavior Scales (VABS-II; Sparrow et al. 2005 (See CR36))-in 45 adolescents with FXS. Maladaptive items from the VABS-II plus a maternal interview were matched with Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association 2013 (See CR7)) criteria for ASD. Results indicated discrepant classifications. The ADOS-2 yielded the highest rate of comorbid autism (71%); CARS2-ST and VABS-II/DSM-5 yielded lower rates (38% and 42%, respectively). A singular measure of autism symptomology is insufficient to characterize autism in FXS., Author(s): Heather Fielding-Gebhardt [sup.1] [sup.2] , Shelley L. Bredin-Oja [sup.2] , Steven F. Warren [sup.2] [sup.3] , Nancy C. Brady [sup.2] [sup.3] Author Affiliations: (1) grid.266515.3, 0000 0001 2106 0692, [...]

Purpose: The purpose of this narrative review was to examine the evidence for imitation training for targeting grammar in children with developmental language disorder. Method: Studies investigating imitation training were compiled from two databases--PsycINFO and Linguistics and Language Behavior Abstracts--as well as from reference lists of several books and articles reviewing language therapy. Results: Twenty-one studies were reviewed. We summarized the demographic and methodological characteristics of the included studies. We identified substantial differences in the implementation of imitation training across the studies and noted a lack of studies considering how those differences might affect therapy outcome. Studies showed a rapid increase in the production of grammatical targets during imitation training activities, higher performance relative to a control group that did not receive any therapy, and generalization to untrained exemplars. However, the studies did not unequivocally link the increased performance to the imitation training therapy. Studies also showed limited generalization to conversational speech. Conversationally based therapy resulted in faster or higher usage in conversational speech, while imitation training resulted in faster immediate gains in usage during therapy trials. Conclusion: We believe that imitation training can continue to be a useful tool in a speech-language pathologist's toolbox, but with suggested modifications. Specifically, we suggest use of imitation training as a means for rapidly achieving production of previously absent grammatical targets. However, we do not recommend sole or long-term use of imitation training for working on grammar. Further research is needed to refine our use of the procedure.

Purpose: The aim of this study was to investigate language growth in individuals with fragile X syndrome (FXS) from early childhood to adolescence and the influence of maternal responsivity on language growth. Method: We conducted a longitudinal analysis of language development in 55 youths (44 males, 11 females) with FXS. Data collection spanned the ages of 11-216 months. We measured expressive and receptive vocabulary with standardized tests. The number of different words and mean length of utterance were obtained from language sample analyses of mother-child interactions. We also measured maternal comments (responsivity indicator) produced during the language samples and child nonverbal IQ. Results: Growth models indicated that rates of number of different words and receptive vocabulary were related to maternal commenting. Mean length of utterance did not change significantly over time. Expressive vocabulary measured with a standardized test grew, but the growth was not related to maternal commenting. Nonverbal IQ was related to all language outcomes at age of 10 years and to changes over time in vocabulary. Visual analysis indicated that the highest scores on standardized tests were produced by girls; however, measures derived from language sample analyses appeared similar for boys and girls. Language models for boys only were similar to the total sample models with lower scores at age of 10 years for some outcomes. Conclusion: Results of persistent language impairments for most youths with FXS suggest the need for continued, focused interventions aimed at improved language productions in addition to a responsive environment. Supplemental Material: https://doi.org/10.23641/asha. 13022825, Fragile X syndrome (FXS) is an X-linked disorder associated with delays in cognitive and language development, particularly in males. This inherited disorder affects approximately 1.4 per 10,000 males and 0.9 [...]

Purpose: Our purpose was to test the competing sources of input (CSI) hypothesis by evaluating an intervention based on its principles. This hypothesis proposes that children's use of main verbs without tense is the result of their treating certain sentence types in the input (e.g., "Was 'she laughing'?") as models for declaratives (e.g., "She laughing"). Method: Twenty preschoolers with specific language impairment were randomly assigned to receive either a CSI-based intervention or a more traditional intervention that lacked the novel CSI features. The auxiliary "is" and the third-person singular suffix -"s" were directly treated over a 16-week period. Past tense -"ed" was monitored as a control. Results: The CSI-based group exhibited greater improvements in use of "is" than did the traditional group (d = 1.31), providing strong support for the CSI hypothesis. There were no significant between-groups differences in the production of the third-person singular suffix -"s" or the control (-"ed"), however. Conclusions: The group differences in the effects on the 2 treated morphemes may be due to differences in their distribution in interrogatives and declaratives (e.g., "'Is' he hiding/He 'is' hiding" vs. "'Does' he hide/He hide's'"). Refinements in the intervention could address this issue and lead to more general effects across morphemes.

Purpose: Our purpose was to test the competing sources of input (CSI) hypothesis by evaluating an intervention based on its principles. This hypothesis proposes that children's use of main verbs without tense is the result of their treating certain sentence types in the input (e.g., Was she laughing?) as models for declaratives (e.g., She laughing). Method: Twenty preschoolers with specific language impairment were randomly assigned to receive either a CSI-based intervention or a more traditional intervention that lacked the novel CSI features. The auxiliary is and the third-person singular suffix -s were directly treated over a 16-week period. Past tense -ed was monitored as a control. Results: The CSI-based group exhibited greater improvements in use of is than did the traditional group (d = 1.31), providing strong support for the CSI hypothesis. There were no significant between-groups differences in the production of the third-person singular suffix -s or the control (-ed), however. Conclusions: The group differences in the effects on the 2 treated morphemes may be due to differences in their distribution in interrogatives and declaratives (e.g., Is he hiding/He is hiding vs. Does he hide/He hides). Refinements in the intervention could address this issue and lead to more general effects across morphemes., Children with specific language impairment (SLI) typically have a core of mild to severe deficits that affect their performance across linguistic components, including phonology, semantics, and pragmatics. Across languages, however, [...]

Purpose: This study examined sentence comprehension in children with specific language impairment (SLI) in a manner designed to separate the contribution of cognitive capacity from the effects of syntactic structure. Method: Nineteen children with SLI, 19 typically developing children matched for age (TD-A), and 19 younger typically developing children (TD-Y) matched according to sentence comprehension test scores responded to sentence comprehension items that varied in either length or their demands on cognitive capacity, based on the nature of the foils competing with the target picture. Results: The TD-A children were accurate across all item types. The SLI and TD-Y groups were less accurate than the TD-A group on items with greater length and, especially, on items with the greatest demands on cognitive capacity. The types of errors were consistent with failure to retain details of the sentence apart from syntactic structure. Conclusions: The difficulty in the more demanding conditions seemed attributable to interference. Specifically, the children with SLI and the TD-Y children appeared to have difficulty retaining details of the target sentence when the information reflected in the foils closely resembled the information in the target sentence. (Contains 4 tables and 2 figures.)

Purpose: The authors sought to determine whether a program of 5 weekly doses of milieu communication teaching (MCT) would yield improvements in children's communication and word use compared with a once-weekly delivery of the same treatment. Method: Sixty-four children with intellectual and communication delay were randomly assigned to receive 60-min sessions of MCT either 1 time or 5 times per week over a 9-month treatment. Growth curves were fit to data collected at 5 points before, during, and after the MCT was delivered. Results: With groups collapsed, significant growth across the experimental period was observed on all measures, but this was not associated unconditionally with treatment intensity. Children who played with 9 or more objects during a standard play assessment, an empirically identified cut-point,benefited more from the high- than from the low-intensity treatment on lexical measures (Hedges's "g" range = 0.49 to 0.65). Conclusions: More MCT is not always better for all children. Clinicians can expect that increasing the frequency of MCT sessions will yield moderate enhancement of outcomes if the child has high interest in objects. (Contains 3 tables and 2 figures.)

Purpose: The authors sought to determine whether a program of 5 weekly doses of milieu communication teaching (MCT) would yield improvements in children's communication and word use compared with a once-weekly delivery of the same treatment. Method: Sixty-four children with intellectual and communication delay were randomly assigned to receive 60-min sessions of MCT either 1 time or 5 times per week over a 9-month treatment. Growth curves were fit to data collected at 5 points before, during, and after the MCT was delivered. Results: With groups collapsed, significant growth across the experimental period was observed on all measures, but this was not associated unconditionally with treatment intensity. Children who played with 9 or more objects during a standard play assessment, an empirically identified cut-point, benefited more from the high- than from the low-intensity treatment on lexical measures (Hedges's g range = .49 to .65). Conclusions: More MCT is not always better for all children. Clinicians can expect that increasing the frequency of MCT sessions will yield moderate enhancement of outcomes if the child has high interest in objects. Key Words: children, communication, developmental disorders, early intervention, efficacy, intervention, language disorders, When speech-language pathologists (SLPs) intervene with young children who are significantly delayed in acquisition and use of first words, they must determine whether their early focus on intentional child communication [...]

Purpose: This study examined sentence comprehension in children with specific language impairment (SLI) in a manner designed to separate the contribution of cognitive capacity from the effects of syntactic structure. Method: Nineteen children with SLI, 19 typically developing children matched for age (TD-A), and 19 younger typically developing children (TD-Y) matched according to sentence comprehension test scores responded to sentence comprehension items that varied in either length or their demands on cognitive capacity, based on the nature of the foils competing with the target picture. Results: The TD-A children were accurate across all item types. The SLI and TD-Y groups were less accurate than the TD-A group on items with greater length and, especially, on items with the greatest demands on cognitive capacity. The types of errors were consistent with failure to retain details of the sentence apart from syntactic structure. Conclusions: The difficulty in the more demanding conditions seemed attributable to interference. Specifically, the children with SLI and the TD-Y children appeared to have difficulty retaining details of the target sentence when the information reflected in the foils closely resembled the information in the target sentence. Key Words: specific language impairment, syntax, memory, cognition, language disorders, Deficits in sentence comprehension have been well documented in children with specific language impairment (SLI). Studies have shown that even children described as having an expressive language disorder perform below [...]

Purpose: To evaluate the longitudinal effects of a 6-month course of responsivity education (RE)/prelinguistic milieu teaching (PMT) for young children with developmental delay. Method: Fifty-one children, age 24-33 months, with [...]

Purpose: To evaluate the efficacy of a 6-month course of responsivity education/ prelinguistic milieu teaching (RE/PMT) for children with developmental delay and RE/ PMT's effects on parenting stress in a randomized clinical trial. Method: Fifty-one children, age 24-33 months, with no more than 10 expressive words or signs, were randomly assigned to treatment/no-treatment groups. Thirteen children in each group had a diagnosis of Down syndrome. Results: In 1 of 2 multivariate comparisons, the RE/PMT group exhibited superior gains in communication compared with the no-treatment group. The treatment effect for overall use of intentional communication acts in the child-examiner context was significant (d= .68, 95% confidence interval = 0.12-1.24). There were no effects on child outcomes due to presence or absence of Down syndrome. RE/PMT led to modest increases in receding of child acts by parents of children who did not have Down syndrome. There were no effects on parenting stress associated with the intervention or the presence or absence of Down syndrome. Conclusions: RE/PMT may be applied clinically with the expectation of medium-size effects on the child's rate of intentional communication acts after 6 months of intervention. The approach warrants further investigation with modifications, such as delivery at higher intensity levels. KEY WORDS: early intervention, language intervention, early communication, milieu teaching, developmental delay, Prelinguistic milieu teaching (PMT) is an intervention for children with language delays who have a very limited or nonexistent lexical inventory and may be having significant difficulties in their production [...]

We tested four predictions based on the assumption that optional infinitives can be attributed to properties of the input whereby children inappropriately extract non-finite subject–verb sequences (e.g. the girl run) from larger input utterances (e.g. Does the girl run? Let's watch the girl run). Thirty children with specific language impairment (SLI) and thirty typically developing children heard novel and familiar verbs that appeared exclusively either in utterances containing non-finite subject–verb sequences or in simple sentences with the verb inflected for third person singular -s. Subsequent testing showed strong input effects, especially for the SLI group. The results provide support for input-based factors as significant contributors not only to the optional infinitive period in typical development, but also to the especially protracted optional infinitive period seen in SLI. [ABSTRACT FROM PUBLISHER]