Children screening positive for language delay at 2.5 years: language disorder and developmental profiles

Purpose: To characterize language disorder and developmental profiles in children who screened positive for language delay but negative for autism at 2.5 years of age. Patients and methods: The first 100 children who screened positive for language delay – but negative for autism – in 2016 were assessed in detail by speech language pathologists. Parents completed a newly developed questionnaire covering eight domains – Motor, Executive functions, Perception, Memory, Language, Learning, Social skills and Child’s behaviour – with impairment scored for each domain. Results: ICD-10 language disorder diagnoses were made in 87/100 children (29 girls, 58 boys). Of 52 children with mixed receptive–expressive language disorder, 32% had problems in other developmental areas according to the “global rating” in the impairment questions of the questionnaire. Of the 35 with expressive language disorder, 21% had problems in other areas according to the impairment questions. Thirteen children had isolated language delay with no other diagnoses according to the speech and language pathologists’ assessment; however, 23% of them had problems according to the parental rating on the impairment questions. Conclusion: Most children screening positive for language delay but negative for autism at age 2.5 years were diagnosed with ICD-10 language disorder diagnoses. Parents in about one in four cases reported impairing problems within other developmental areas. Possible explanations for the findings are discussed

Assessing false-belief understanding in children with autism using a computer application: a pilot study

We have developed a False-Belief (FB) understanding task for use on a computer tablet, trying to assess FB understanding in a less social way. It is based on classical FB protocols, and additionally includes a manipulation of language in an attempt to explore the facilitating effect of linguistic support during FB processing. Specifically, the FB task was presented in three auditory conditions: narrative, silent, and interference. The task was assumed to shed new light on the FB difficulties often observed in Autism Spectrum Disorder (ASD). Sixty-eight children with ASD (M = 7.5 years) and an age matched comparison group with 98 typically developing (TD) children were assessed with the FB task. The children with ASD did not perform above chance level in any condition, and significant differences in success rates were found between the groups in two conditions (silent and narrative), with TD children performing better. We discuss implications, limitations, and further developments

Development problems were common five years after positive screening for language disorders and, or, autism at 2.5 years of age

Aim: This study identified whether children who had screened positive for either developmental language disorder (DLD) or autism spectrum disorder (ASD) at the age of 2.5 years had neurodevelopmental assessments five years later. Methods: Our study cohort were 288 children born from 1 July 2008 to 20 June 2009 who screened positive for DLD and, or, ASD at 2.5 years. Of these, 237 children were referred to, and assessed, at the Paediatric Speech and Language Pathology clinic (n = 176) or the Child Neuropsychiatry Clinic (n = 61) at the Queen Silvia Children's Hospital, Gothenburg, Sweden. Clinical registers covering all relevant outpatient clinics were reviewed five years later with regard to established diagnoses. Results: When the 237 were followed up five years later, 96 (40%) had established neurodevelopmental disorders or problems, often beyond DLD and ASD. Co‐existing problems were common in this cohort and multidisciplinary assessments were indicated. The other 60% did not appear in subsequent clinic records. It is likely that this 40% was a minimum rate and that more children will be referred for developmental problems later. Conclusion: Five years after they had been screened positive for DLD and, or autism at2.5 years, 40% of our cohort had remaining or other developmental problems

Children who screen positive for autism at 2.5 years and receive early intervention: a prospective naturalistic 2-year outcome study

BACKGROUND: Previous research has stressed the importance of early identification and intervention for children with autism spectrum disorders. METHODS: Children who had screened positive for autism at the age of 2.5 years in a general population screening and then received a diagnosis of autism spectrum disorder were enrolled in an intervention program provided by Swedish habilitation services. The following interventions were available: a comprehensive intervention based on Applied Behavior Analysis – Intensive Learning (IL) – in two settings, which included home- and preschool-based (IL Regular) and only home-based (IL Modified) and eclectic interventions. RESULTS: There was considerable variability in terms of outcome, but intervention group status was not associated with any of the chosen outcome variables. CONCLUSION: The main finding was that the type of intervention was not critical for outcome of adaptive or global functioning. The variability in outcome demonstrates the need for continuous assessments and evaluation of the child’s function and behavior throughout the intervention period

Autism in Toddlers: Can Observation in Preschool Yield the Same Information as Autism Assessment in a Specialised Clinic?

We wanted to know whether preschool observation of children suspected of suffering from autism can provide the same information about core autism symptoms as the Autism Diagnostic Observation Schedule (ADOS) performed in a clinic. Forty 2–4-year-old children (9 girls, 31 boys), referred for assessment of suspected autism spectrum disorder participated in the study. The symptom areas covered by the ADOS algorithm were scored by an education specialist after free-field observation of each child in the preschool without using the prescribed ADOS materials. The ADOS was then completed in a clinic setting by examiners blind to the preschool results. Excellent agreement across results obtained at the two different types/settings of observations was found. The only significant difference found was with regard to spontaneous initiation of joint attention. The present study does not address the issue of whether or not one of the methods used is superior to the other when it comes to determining the “true” level of “autism problems” in these children. However, it is of interest that free-field preschool observation of children with suspected autism using a structured checklist yields very similar information as that obtained at ADOS assessment performed in a clinic setting

Autism With and Without Regression : A Two-Year Prospective Longitudinal Study in Two Population-Derived Swedish Cohorts

Peer reviewedPublisher PD

Language problems at 2½ years of age and their relationship with school-age language impairment and neuropsychiatric disorders

Background: International research has shown that language delay (LD) is associated with social, cognitive, emotional and/or behavioural deficiencies, but there is still a need for extended knowledge about LD at early age and its relationship with long-term language impairment and neuropsychiatric disorders in Swedish children. Aims: To study (a) if children with a positive screening result or a negative screening result at 2½ years of age showed persistent or transient language difficulties at 6 years of age and, (b) whether or not children identified by language screening at 2½ years of age were diagnosed with language, neurodevelopmental and/or neuropsychiatric impairments at school age. Materials and methods: At the 2½-year screening 25 children with LD and 80 screening-negative children constituted the study population, i.e. in all 105 children (Study I). At the 6-year examination the follow-up group consisted of 99 children – 22 children from the LD group and 77 children from the screening-negative group (Study II). The 7-8-year-old follow-up (study III and IV) included 21 of the 22 children with LD who participated in study II. Screening results from nurses were re-classified blindly (study I) by the use of Reynell Developmental Language Scale. Study II included tests that examined both reception and production in different areas of speech and language as well as linguistic awareness. Study III and IV consisted of a multidisciplinary in-dept examination of language, intellectual functions and the presence of neuropsychiatric/neurodevelopmental disorders. Results: The sensitivity of the screening tool was 0.69, and the specificity was 0.93 (study I). The 6-year examination showed that there was still a highly persistent and significant difference between the children with and without LD on almost every variable tested (study II). In studies III-IV it was found that 62% of the LD children also had received a neuropsychiatric diagnosis at age 7-8 years: eight children were diagnosed with ADHD and five children with ASD. Half of the 21 children with LD had marked problems with performance on narrative tasks according to the Bus Story test and the NEPSY Narrative Memory Subtest independently of co-occurrence of neuropsychiatric disorder. The only difference between the children with LD pure and those who had LD+AD/HD or LD+ASD was on Freedom from Distractibility, where children with AD/HD and ASD scored low. In addition, children with ASD had a much lower overall cognitive level (FSIQ) and poorer results on tasks assessing Processing Speed. Conclusion: It is possible to identify children with LD at 2½ years of age. All children identified with LD at 2½ years of age also appeared to be at later risk of complex neurodevelopmental/ neuropsychiatric disorders. Remaining language problems at 6 years of age strongly predicted the presence of neuropsychiatric/ neurodevelopmental disorders at age 7-8 years. The observed difficulties, including narrative problems, in the LD children indicate that these children are at high risk of persistent language impairment and future problems concerning reading and writing. Clinical implications: Children identified with late developing language at 2½ years of age need to be followed carefully for several years. Follow-up should include neuropsychiatric as well as speech-language assessments, and the multidisciplinary team should be particularly prepared to diagnose ASD, AD/HD, and various kinds of learning disorders. Assessment of non-word repetition, semantic and narrative skills at the follow-up occasions may be a useful clinical tool for identifying children with more persistent subtle language problems who are at risk of academic failure

Pre-schoolchildren with autism spectrum disorders are rarely macrocephalic: a population study

Numerous clinical studies over the past decades have concluded that there is an association between autism spectrum disorders (ASD) and large head size. Lately, some studies have reported conflicting results. The present study was conducted with a view to assess the presence of macrocephaly in a community-representative group of pre-school children with ASD. The prevalence of ASD in this general population was 0.8%. Thirty-three children (5 girls, 28 boys) recruited after general population screening for ASD, and diagnosed with ASD (two-thirds not globally delayed) were assessed as regards growth parameters; height, weight, and head circumference (HC), at birth and at comprehensive medical-psychiatric diagnostic examinations at a mean age of 3 years. Macrocephaly in the present study was defined as HC above the 97th percentile, and ≥2 SD above recorded length/height. Only one of the 33 children (3%) had macrocephaly which is similar to the general population prevalence. Another 9% had a big but proportional head. None of the children were microcephalic. In this community-based study we found no evidence to support a strong link between a large head size and ASD. Conclusions must be guarded because of the relatively small number of ASD cases included

Autism in Preschoolers: Does Individual Clinician’s First Visit Diagnosis Agree with Final Comprehensive Diagnosis?

Comprehensive clinical diagnosis based on all available information is considered the “gold standard” in autism spectrum disorders (ASD). We examined agreement across independent assessments (clinical judgment) of 34 young children (age 24–46 months) with suspected ASD, assessed by a multidisciplinary team, and final comprehensive clinical diagnosis. Agreement across settings and between each clinician’s assessment and final diagnosis was moderate. The poorest fit was found at assessment in connection with psychological evaluation and the best with preschool observation and parent interview. Some individual clinicians had good and others had poor fit with final diagnosis. Disagreement across assessments was pronounced for girls. The findings suggest that multidisciplinary assessments remain important and that comprehensive clinical diagnosis should still be regarded as the gold standard in ASD

Preschoolers assessed for autism: parent and teacher experiences of the diagnostic process

Many parents of young children with autism spectrum disorder (ASD) have often been recommended to “wait and see” when they have first expressed concerns. This comparative, descriptive, partly longitudinal questionnaire study aimed to evaluate parent/preschool teacher experiences as regards time of first concern about the child and about the diagnostic process at a specialized Child Neuropsychiatry Clinic. Participants were parents and teachers of 34 preschool children with suspected ASD (26 boys, 8 girls, mean age 37 months) drawn from a general population cohort. Most of the parents, and the teachers, had their first concern about the child's development before the child's second birthday. Generally, they were satisfied with the diagnostic process and did not regret their participation in it