Susan Ellis Weismer

Background: Elevated or reduced responses to sensory stimuli, known as sensory features, are common in autistic individuals and often impact quality of life. Little is known about the neurobiological basis of sensory features in autistic children. However, the brainstem may offer critical insights as it has been associated with both basic sensory processing and core features of autism.Methods: Diffusion-weighted imaging (DWI) and parent-report of sensory features were acquired from 133 children (61 autistic children with and 72 non-autistic children, 6–11 years-old). Leveraging novel DWI processing techniques, we investigated the relationship between sensory features and white matter microstructure properties (free-water-elimination-corrected fractional anisotropy [FA] and mean diffusivity [MD]) in precisely delineated brainstem white matter tracts. Follow-up analyses assessed relationships between microstructure and sensory response patterns/modalities and analyzed whole brain white matter using voxel-based analysis.Results: Results revealed distinct relationships between brainstem microstructure and sensory features in autistic children compared to non-autistic children. In autistic children, more prominent sensory features were generally associated with lower MD. Further, in autistic children, sensory hyporesponsiveness and tactile responsivity were strongly associated with white matter microstructure in nearly all brainstem tracts. Follow-up voxel-based analyses confirmed that these relationships were more prominent in the brainstem/cerebellum, with additional sensory-brain findings in the autistic group in the white matter of the primary motor and somatosensory cortices, the occipital lobe, the inferior parietal lobe, and the thalamic projections.Limitations: All participants communicated via spoken language and acclimated to the sensory environment of an MRI session, which should be considered when assessing the generalizability of this work to the whole of the autism spectrum.Conclusions: These findings suggest unique brainstem white matter contributions to sensory features in autistic children compared to non-autistic children. The brainstem correlates of sensory features underscore the potential reflex-like nature of behavioral responses to sensory stimuli in autism and have implications for how we conceptualize and address sensory features in autistic populations.

Language delay is often one of the first concerns of parents of toddlers with autism spectrum disorder (ASD), and early language abilities predict broader outcomes for children on the autism spectrum. Yet, mechanisms underlying language deficits in autistic children remain underspecified. One prominent component of linguistic behavior is the use of predictions or expectations during learning and processing. Several researcher teams have posited prediction deficit accounts of ASD. The basic assumption of the prediction accounts is that information is processed by making predictions and testing violations against expectations (prediction errors). Flexible (neurotypical) brains attribute differential weights to prediction errors to determine when new learning is appropriate, while autistic individuals are thought to assign disproportionate weight to prediction errors. According to some views, these prediction deficits are hypothesized to lead to higher levels of perceived novelty, resulting in “hyperplasticity” of learning based on the most recent input. In this article, we adopt the perspective that it would be useful to investigate whether language deficits in children with ASD can be attributed to atypical domain-general prediction processes.

Purpose: This study examined working memory in children with developmental language disorder (DLD). The overarching goal of this work was to integrate three primary processing-based hypotheses of DLD, (a) limited verbal working memory, (b) slowed processing speed, and (c) inefficient inhibition of interference, by using the serial-order-in-a-box–complex span (SOB-CS) computational model as our theoretical framework. We also examined the role of domain in working memory performance by varying the domain of interference and recall (i.e., verbal vs. nonverbal) task demands. Method: Participants were 55 school-age children, 21 children with DLD and 34 age-matched typically developing (TD) peers (9–13 years old). Results: Findings indicated that verbal and nonverbal working memory performance was poorer in the DLD than TD group. There was a modest benefit of dispersing interference and recall task demands across domains relative to task demands being within one domain, yet verbal interference affected performance to a greater degree than nonverbal interference in the DLD group. Conclusions: Overall findings supported a role for each of the processing-based hypotheses of DLD, albeit an incomplete role. In contrast, the SOB-CS model accounted for interrelationships among these processing-based factors and provided an explanation across patterns of findings. Thus, the SOB-CS model represents a useful step forward in explaining processing in children with DLD. Supplemental Material: https://doi.org/10.23641/asha.19526179

To efficiently learn new words, children use constraints such as mutual exclusivity (ME) to narrow the search for potential referents. The current study investigated the use of ME in toddlers with autism spectrum disorder (ASD) and neurotypical (NT) peers matched on nonverbal cognition. Thirty-two toddlers with ASD and 26 NT toddlers participated in a looking-while-listening task. Images of novel and familiar objects were presented along with a novel or familiar label. Overall, toddlers with ASD showed less efficient looking toward a novel referent when a novel label was presented compared to NT toddlers, controlling for age and familiar word knowledge. However, toddlers with ASD and higher language ability demonstrated more robust use of ME than those with lower language ability.

Background: There is extremely limited population‐based research on social (pragmatic) communication disorder (SCD). Population‐based samples have the potential to better characterize the SCD phenotype by mitigating confounds and biases that are typical of convenience and clinical samples.Aims: The aims of this preliminary epidemiologic study were to advance our understanding of the SCD phenotype relative to developmental language disorder (DLD), obtain an estimate of prevalence, identify risk factors and lay the groundwork for future population level research of SCD.Methods & Procedures: We analysed existing data from the EpiSLI Database to examine social communication skills in 393 8th grade (13–14 years) children with and without a history of DLD. The primary measure used to evaluate SCD was the Children's Communication Checklist (CCC‐2). Two case definitions of SCD reflecting DSM‐5 criteria were examined. Both definitions involved significant pragmatic impairment, employing a commonly adopted clinical cut‐point of 1.5 SD. In one case, pragmatic deficits could occur along with structural language deficits and, in the other case (established using principal component analysis), pragmatic and social skills were disproportionately lower than structural language abilities.Outcomes & Results: When using the first case definition, SCD was much more common in children with a history of DLD than without DLD and history of language disorder at kindergarten was a significant risk factor for SCD in adolescence. However, it is important to note that SCD could be found in children with no prior deficits in other aspects of language. When the second definition was employed, SCD was equally distributed across children with and without a history of DLD. Male sex was a significant risk factor using this case definition of SCD. The estimated prevalence of SCD ranged from 7% (SE = 1.5%) to 11% (SE = 1.7%), acknowledging that prevalence depends on the cut‐point selected to determine communication disorder.Conclusions & Implications: These findings contribute to our understanding of the association between SCD and DLD by recognizing varying profiles of pragmatic and social communication difficulties, which in turn may help refine our diagnostic categories. Preliminary prevalence estimates of SCD can serve as an initial guidepost for identification and planning for intervention services for this condition.What this paper adds: What is already known on this subject: There is considerable debate about the diagnostic category of SCD and its relation to other neurodevelopmental disorders. What this study adds to existing knowledge: Using data from a US‐based epidemiologic sample of DLD, this study offers new information about the association between SCD and DLD, provides preliminary estimates of SCD prevalence, and identifies risk factors for SCD. Clinical implications of this study: Improved understanding of possible profiles of pragmatic and social communication deficits will help to clarify diagnostic categories and preliminary prevalence estimates may assist with ensuring availability of adequate intervention services.

This study examined verbal mediation during planning in school-age children with autism spectrum disorder (ASD) relative to age- and nonverbal IQ- matched typically developing peers using a dual-task paradigm. Analyses showed no group differences in performance. However, in the condition intended to disrupt verbal mediation, language skills were associated with planning performance for the TD group, but not the ASD group. Upon examining ASD subgroups with versus without comorbid structural language impairment, children with ASD and normal language appeared to rely on verbal mediation to a greater degree than children with ASD and language impairment, but to a lesser degree than TD peers. Thus, the role of verbal mediation in planning for children with ASD differs depending on language status.

This study investigated receptive and expressive language outcomes in children with autism spectrum disorder (ASD) with and without a history of language/communication regression, employing three progressively less stringent definitions of regression. Data were derived from a large, longitudinal sample of children with ASD in which regression was assessed at approximately 30 months. Results indicated poorer receptive language and larger discrepancies between receptive and expressive language in the regression group than the group without regression at 44 months but not 66 months. Number of words used before loss predicted receptive language at 44 months. Overall, results suggest that a regression profile in ASD is associated with modest and transient impacts on language outcomes that are no longer discernable at school entry.

The goal of this preliminary investigation was to compare demographic and clinical characteristics in a sample of children with likely Social (Pragmatic) Communication Disorder (SCD) (N = 117) to those in children with possible (N = 118) and some (N = 126) SCD traits, other developmental delay (DD) (N = 91) and autism spectrum disorder (ASD) (N = 642). We used data from the Study to Explore Early Development (SEED), a multi-site case–control study. Items reflecting SCD DSM-5 criteria were selected from an autism diagnostic measure, with SCD categories identified by creating quartiles. Our results suggest that SCD may fall along a continuum involving elevated deficits (in comparison to DD with no SCD) in social communication and restricted and repetitive behavior that do not reach the clinical threshold for ASD.

Background This study examined predictive relationships between two indices of language—receptive vocabulary and morphological comprehension—and inhibition in children with specific language impairment (SLI) and typically developing (TD) children. Methods Participants included 30 children with SLI and 41 TD age-matched peers (8–12 years). At two time points separated by 1 year, we assessed receptive vocabulary and morphological comprehension via standardized language measures and inhibition via a Flanker task. We used Bayesian model averaging and Bayesian regression analytical techniques. Results Findings indicated predictive relationships between language indices and inhibition reaction time (RT), but not between language indices and inhibition accuracy. For the SLI group, Year 1 inhibition RT predicted Year 2 morphological comprehension. For the TD group, Year 1 morphological comprehension predicted Year 2 inhibition RT. Conclusions This study provides preliminary evidence of a predictive relationship between language and inhibition, but this relationship differed between children with SLI and those with typical development. Findings suggest that inhibition RT played a larger predictive role in later morphological comprehension in children with SLI relative to the other relationships examined. Targeting inhibition skills as a part of language intervention may improve subsequent morphological comprehension. Supplemental Material https://doi.org/10.23641/asha.12014823

Purpose: This article reviews research on executive function (EF) skills in children with autism spectrum disorder (ASD) and the relation between EF and language abilities. The current study assessed EF using nonverbal tasks of inhibition, shifting, and updating of working memory (WM) in school-age children with ASD. It also evaluated the association between children's receptive and expressive language abilities and EF performance.Method: In this study, we sought to address variables that have contributed to inconsistencies in this area of research—including task issues, group comparisons, and participant heterogeneity. EF abilities in children with ASD (n= 48) were compared to typically developing controls (n= 71) matched on age, as well as when statistically controlling for group differences in nonverbal cognition, socioeconomic status, and social communication abilities. Six nonverbal EF tasks were administered—2 each to evaluate inhibition, shifting, and WM. Language abilities were assessed via a standardized language measure. Language–EF associations were examined for the ASD group as a whole and subdivided by language status.Results: Children with ASD exhibited significant deficits in all components of EF compared to age-mates and showed particular difficulty with shifting after accounting for group differences in nonverbal cognition. Controlling for social communication—a core deficit in ASD—eliminated group differences in EF performance. A modest association was observed between language (especially comprehension) and EF skills, with some evidence of different patterns between children on the autism spectrum with and without language impairment.Conclusions: There is a need for future research to examine the direction of influence between EF and language. It would be beneficial for EF interventions with children with ASD to consider language outcomes and, conversely, to examine whether specific language training facilitates aspects of executive control in children on the autism spectrum.Presentation Video: https://doi.org/10.23641/asha.7298144