Enhancing the communication development of toddlers with autism spectrum disorders

In other research, the imitation skills of young children with autism have been related to later language outcomes. Stone and colleagues (Stone, Ousley & Littleford, 1997; Stone & Yoder, 2001) examined the imitation abilities of 2-year-olds who were diagnosed with autism, and then completed follow-up evaluations of the children’s language skills 1 to 2 years later. Toddler imitation skills, especially the ability to imitate body movements (as contrasted to actions on objects), were positively associated with later expressive language scores, after controlling for initial language levels.
The ability of toddlers with autism to initiate joint attention with adults has also been associated with later language outcomes. Charman et al., (2003) observed the extent to which 20-month-old children with ASD switched gaze between an adult and each of a series of mechanical toys that were selected for their potential to both attract attention and provoke feelings of uncertainty in the children. The toddlers with ASD who demonstrated relatively high levels of joint attention initiation at 20 months had higher expressive and receptive language scores at 42 months than those children who demonstrated relatively low levels of joint attention initiation. Other research indicates that early intentional communication for the purpose of requesting is also related to later language outcomes for children with ASDs (Sigman & Ruskin, 1999; McDuffie, 2004). This type of communication also generally involves coordination of attention between a desired object or action and a communicative partner, although with a different end goal than in joint attention initiation. McDuffie’s research indicated that early joint attention and requesting behaviors make unique contributions to predicting language outcomes for young children with autism.
The collective evidence from longitudinal investigations of young children with ASD, then, supports the idea that the nonverbal comprehension strategies suggested by Chapman (1978) are important not only for toddlers to solve the immediate challenge of determining what people mean by what they say, but also in enhancing language development across time. In addition, research suggests that the more a toddler with ASD expresses nonverbal communicative intents, both in requesting and in initiating joint attention, the better later language outcomes are likely to be. These findings are important complements to the limited intervention research on toddlers with ASD, in that they suggest imitation, object play, and initiating and responding to joint attention, and overall increases in intentional communicative acts should each be addressed in programs designed to improve the communication outcomes of toddlers with ASD.
Our intervention design can also benefit from examining the available evidence related to influences on communicative development that are more external to the child. The nature of caregiver-child interaction is an important consideration, but the impact of the quality of interaction on communication outcomes in this population has received limited attention to date. Two studies (Leekam, Hunnisett & Moore, 1998; Doussard-Roosevelt et al., 2003) have suggested that when caregivers use more perceptually salient cues (e.g., pointing and saying “Look” in conjunction with gazing at an object; being in physical proximity to the child; manipulating objects) to supplement their verbal initiations, young children with ASD are more likely to respond. Only one study to date has examined the impact of interaction strategies on language development in children with ASD across time. Siller and Sigman (2002) reported that the extent to which parents of preschoolers with autism talked about their child’s current focus of interest without directing the child’s behavior was positively associated with language outcomes 10 and 16 years later. Furthermore, the correlations between the early parent interaction strategies and later child language outcomes were quite high (.67 and .79 at 10- and 16-year follow-ups, respectively), suggesting the importance of further research in this area as well as the importance of addressing parent-child interactions as a component of early intervention for toddlers with ASD.