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Definitions of Nonverbal and Minimally Verbal in Research for Autism: A Systematic Review of the Literature

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Abstract

This systematic review examined definitions of “nonverbal” or “minimally verbal” and assessment measures used to evaluate communication in intervention studies focusing on improving expressive verbal communication in children with autism spectrum disorder (ASD). We reviewed sample size, number of participants, participant age, and male/female representation. Our analysis yielded relatively few studies with non/minimally verbal children with ASD focusing on verbal expressive communication. Further, we found large inconsistencies in measures used, definitions of “nonverbal” and “minimally verbal”, and ages targeted. Guidelines are suggested to create a more uniform assessment protocol with systematic descriptions of early communication learners as a foundational step for understanding the heterogeneity in this group and replicating research findings for this subgroup of children with ASD.

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References

*Indicates that the studies were used in the systematic analysis

  • Anisfeld, M., Rosenberg, E. S., Hoberman, M. J., & Gasparini, D. (1998). Lexical acceleration coincides with the onset of combinatorial speech. First Language,18(53), 165–184.

    Google Scholar 

  • *Almirall, D., DiStefano, C., Chang, Y. C., Shire, S., Kaiser, A., Lu, X., et al. (2016). Longitudinal effects of adaptive interventions with a speech-generating device in minimally verbal children with ASD. Journal of Clinical Child & Adolescent Psychology,45(4), 442–456.

    Google Scholar 

  • Bal, V. H., Katz, T., Bishop, S. L., & Krasileva, K. (2016). Understanding definitions of minimally verbal across instruments: Evidence for subgroups within minimally verbal children and adolescents with autism spectrum disorder. Journal of Child Psychology and Psychiatry,57(12), 1424–1433.

    PubMed  Google Scholar 

  • Baxter, S., Enderby, P., Evans, P., & Judge, S. (2012). Interventions using high-technology communication devices: a state of the art review. Folia Phoniatrica et Logopaedica,64(3), 137–144.

    PubMed  Google Scholar 

  • Bopp, K. D., Mirenda, P., & Zumbo, B. D. (2009). Behavior predictors of language development over 2 years in children with autism spectrum disorders. Journal of Speech, Language, and Hearing Research. https://doi.org/10.1044/1092-4388(2009/07-0262).

    Article  PubMed  Google Scholar 

  • Bradshaw, J., Steiner, A. M., Gengoux, G., & Koegel, L. K. (2015). Feasibility and effectiveness of very early intervention for infants at-risk for autism spectrum disorder: A systematic review. Journal of Autism and Developmental Disorders,45(3), 778–794.

    PubMed  Google Scholar 

  • Brown, R. (1973). A first language: The early stages. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Camarata, S. (2014). Late talking children: A symptom or a stage?. Cambridge, MA: MIT Press.

    Google Scholar 

  • Camarata, S., & Nelson, K. E. (2002). Measurement and the diagnosis and treatment of language disorders in children. Peabody Journal of Education,77(2), 106–116.

    Google Scholar 

  • Camarata, S., & Swisher, L. (1990). A note on intelligence assessment within studies of specific language impairment. Journal of Speech, Language, and Hearing Research,33(1), 205–207.

    Google Scholar 

  • Camarata, S., Lancaster, H., & Kan, D. (2014). Assessment Tools: Evaluating our measurements. Assessing Listening and Spoken Language in Children with Hearing Loss, 19–42.

  • Campbell, T. F., Dollaghan, C. A., Rockette, H. E., Paradise, J. L., Feldman, H. M., Shriberg, L. D., et al. (2003). Risk factors for speech delay of unknown origin in 3-year-old children. Child Development,74(2), 346–357.

    PubMed  Google Scholar 

  • Chakrabarti, B. (2017). Commentary: Critical considerations for studying low‐functioning autism. Journal of Child Psychology and Psychiatry, 58(4), 436-438.

    PubMed  Google Scholar 

  • Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology,52(1), 685–716.

    PubMed  Google Scholar 

  • *Charlop-Christy, M., Carpenter, M., Le, L., LeBlanc, L., & Kellet, K. (2002). Using the picture exchange communication system (PECS) with children with autism: Assessment of PECS acquisition, speech, social-communicative behavior, and problem behavior. Journal of Applied Behavior Analysis,35, 213–231.

    PubMed  PubMed Central  Google Scholar 

  • Chenausky, B. (2017). Commentary: Critical considerations for studying low-functioning autism. Journal of Child Psychology and Psychiatry,58(4), 436–438.

    Google Scholar 

  • *Chenausky, K., Norton, A., Tager-Flusberg, H., & Schlaug, G. (2016). Auditory-motor mapping training: Comparing the effects of a novel speech treatment to a control treatment for minimally verbal children with autism. PLoS ONE,11(11), e0164930.

    PubMed  PubMed Central  Google Scholar 

  • *DiStefano, C., Shih, W., Kaiser, A., Landa, R., & Kasari, C. (2016). Communication growth in minimally verbal children with ASD: The importance of interaction. Autism Research,9(10), 1093–1102.

    PubMed  Google Scholar 

  • Drash, P. W., High, R. L., & Tudor, R. M. (1999). Using mand training to establish an echoic repertoire in young children with autism. The Analysis of Verbal Behavior,16(1), 29–44.

    PubMed  PubMed Central  Google Scholar 

  • *Esch, J. W., Esch, B. E., & Love, J. R. (2009). Increasing vocal variability in children with autism using a lag schedule of reinforcement. The Analysis of Verbal Behavior,25(1), 73–78.

    PubMed  PubMed Central  Google Scholar 

  • Fenson, L. (2007). MacArthur-Bates communicative development inventories. Baltimore, MD: Paul H. Brookes Publishing Company.

    Google Scholar 

  • Franchini, M., Duku, E., Armstrong, V., Brian, J., Bryson, S. E., Garon, N., et al. (2018). Variability in verbal andnonverbal communication in infants at risk for autism spectrum disorder: Predictors andoutcomes. Journal of Autism and Developmental Disorders,48(10), 3417–3431.

    PubMed  Google Scholar 

  • *Franco, J. H., Davis, B. L., & Davis, J. L. (2013). Increasing social interaction using prelinguistic milieu teaching with nonverbal school-age children with autism. American Journal of Speech-Language Pathology. https://doi.org/10.1044/1058-0360(2012/10-0103).

    Article  PubMed  Google Scholar 

  • *Green, J., Charman, T., McConachie, H., Aldred, C., Slonims, V., Howlin, P., et al. (2010). Parent-mediated communication-focused treatment in children with autism (PACT): A randomised controlled trial. The Lancet,375(9732), 2152–2160.

    Google Scholar 

  • *Gevarter, C., & Horan, K. (2018). A behavioral intervention package to increase vocalizations of individuals with autism during speech-generating device intervention. Journal of Behavioral Education,28, 1–27.

    Google Scholar 

  • *Gordon, K., Pasco, G., McElduff, F., Wade, A., Howlin, P., & Charman, T. (2011). A communication-based intervention for nonverbal children with autism: What changes? Who benefits? Journal of Consulting and Clinical Psychology,79(4), 447.

    PubMed  Google Scholar 

  • Gordon, B., & Stark, S. (2007). Procedural learning of a visual sequence in individuals with autism. Focus on Autism and Other Developmental Disabilities, 22(1), 14–22.

    Google Scholar 

  • *Harris, S. L., Wolchik, S. A., & Milch, R. E. (1983). Changing the speech of autistic children and their parents. Child & Family Behavior Therapy,4(2–3), 151–173.

    Google Scholar 

  • *Hingtgen, J. N., & Churchill, D. W. (1969). Identification of perceptual limitations in mute autistic children: Identification by the use of behavior modification. Archives of General Psychiatry,21(1), 68–71.

    PubMed  Google Scholar 

  • Hoff, E. (2013). Language development (5th ed.). Cengage Learning.

  • Holyfield, C., Drager, K. D., Kremkow, J. M., & Light, J. (2017). Systematic review of AAC intervention research for adolescents and adults with autism spectrum disorder. Augmentative and Alternative Communication,33(4), 201–212.

    PubMed  Google Scholar 

  • Interagency Autism Coordinating Committee (IACC). (2011). IACC Strategic plan for autism spectrum disorder research. https://iacc.hhs.giv/strategicplan/2011/index.shtml.

  • Interagency Autism Coordinating Committee (IACC). (2017). IACC strategic plan for autism spectrum disorder research: 2016-2017 update. US Department of Health and Human Services Interagency Autism Coordinating Committee. National Institutes of Health.

  • Iverson, J. M., Shic, F., Wall, C. A., Chawarska, K., Curtin, S., Estes, A., et al. (2019). Early motor abilities in infants at heightened versus low risk for ASD: A Baby Siblings Research Consortium (BSRC) study. Journal of Abnormal Psychology,128(1), 69.

    PubMed  PubMed Central  Google Scholar 

  • Jack, A., & Pelphrey, K. A. (2017). Annual Research Review: Understudied populations within the autism spectrum—current trends and future directions in neuroimaging research. Journal of Child Psychology and Psychiatry,58, 411–435.

    PubMed  Google Scholar 

  • *Jones, E. A. (2009). Establishing response and stimulus classes for initiating joint attention in children with autism. Research in Autism Spectrum Disorders,3(2), 375–389.

    Google Scholar 

  • *Kasari, C., Kaiser, A., Goods, K., Nietfeld, J., Mathy, P., Landa, R., et al. (2014). Communication interventions for minimally verbal children with autism: A sequential multiple assignment randomized trial. Journal of the American Academy of Child & Adolescent Psychiatry,53(6), 635–646.

    Google Scholar 

  • Kim, S. H., Bal, V. H., Benrey, N., Choi, Y. B., Guthrie, W., Colombi, C., et al. (2018). Variability in autism symptom trajectories using repeated observations from 14 to 36 months of age. Journal of the American Academy of Child & Adolescent Psychiatry,57(11), 837–848.

    Google Scholar 

  • Koegel, L. K. (2000). Interventions to facilitate communication in autism. Journal of Autism and Developmental Disorders,30(5), 383–391.

    PubMed  Google Scholar 

  • Koegel, L. K., Bryan, K. M., Su, P., Vaidya, M., & Camarata, S. (2019). Intervention for non-verbal and minimally-verbal individuals with autism: A systematic review. International Journal of Pediatric Research,5(2),

    Google Scholar 

  • Koegel, L. K., Koegel, R. L., & Smith, A. (1997). Variables related to differences in standardized test outcomes for children with autism. Journal of Autism and Developmental Disorders,27(3), 233–243.

    PubMed  Google Scholar 

  • *Koegel, R. L., O'Dell, M. C., & Koegel, L. K. (1987). A natural language teaching paradigm for nonverbal autistic children. Journal of Autism and Developmental Disorders,17(2), 187–200.

    PubMed  Google Scholar 

  • *Koegel, R. L., Shirotova, L., & Koegel, L. K. (2009a). Brief report: Using individualized orienting cues to facilitate first-word acquisition in non-responders with autism. Journal of Autism and Developmental Disorders,39(11), 1587–1592.

    PubMed  PubMed Central  Google Scholar 

  • *Koegel, R. L., Vernon, T. W., & Koegel, L. K. (2009b). Improving social initiations in young children with autism using reinforcers with embedded social interactions. Journal of Autism and Developmental Disorders,39(9), 1240–1251.

    PubMed  PubMed Central  Google Scholar 

  • Koegel, R. L., & Traphagen, J. (1982). Selection of initial words for speech training with nonverbal children. In R. L. Koegel, A. Rincover, & A. L. Egel (Eds.), Educating and understanding autistic children (pp. 65–87). San Diego: College-Hill Press.

    Google Scholar 

  • Lancaster, H. S., & Camarata, S. (2019). Reconceptualizing developmental language disorder as a spectrum disorder: Issues and evidence. International Journal of Language & Communication Disorders, 54(1), 79–94.

    Google Scholar 

  • *Laski, K. E., Charlop, M. H., & Schreibman, L. (1988). Training parents to use the natural language paradigm to increase their autistic children's speech. Journal of Applied Behavior Analysis,21(4), 391–400.

    PubMed  PubMed Central  Google Scholar 

  • Light, J., & Mcnaughton, D. (2015). Designing AAC research and intervention to improve outcomes for individuals with complex communication needs. Augmentative and Alternative Communication, 31, 85–96. https://doi.org/10.3109/07434618.2015.1036458.

    Article  PubMed  Google Scholar 

  • Lombardo, M. V., Lai, M. C., & Baron-Cohen, S. (2019). Big data approaches to decomposing heterogeneity across the autism spectrum. Molecular Psychiatry,24, 1435–1450.

    PubMed  PubMed Central  Google Scholar 

  • Lorah, E. R., Parnell, A., Whitby, P. S., & Hantula, D. (2015). A systematic review of tablet computers and portable media players as speech generating devices for individuals with autism spectrum disorder. Journal of Autism and Developmental Disorders,45(12), 3792–3804.

    PubMed  Google Scholar 

  • Lovaas, O. I., Koegel, R., Simmons, J. Q., & Long, J. S. (1973). Some generalization and follow-up measures on autistic children in behavior therapy. Journal of Applied Behavior Analysis,6(1), 131–165.

    PubMed  PubMed Central  Google Scholar 

  • Marchman, V. A. (2006). MacArthur-Bates Communicative Development Inventories: user's guide and technical manual. Baltimore: Brookes Publishing.

    Google Scholar 

  • *Miller, A., & Miller, E. E. (1973). Cognitive-developmental training with elevated boards and sign language. Journal of Autism and Childhood Schizophrenia,3(1), 65–85.

    PubMed  Google Scholar 

  • McEvoy, R. E., Loveland, K. A., & Landry, S. H. (1988). The functions of immediate echolalia in autistic children: A developmental perspective. Journal of Autism and Developmental Disorders,18(4), 657–668.

    PubMed  Google Scholar 

  • Moorcroft, A., Scarinci, N., & Meyer, C. (2019). A systematic review of the barriers and facilitators to the provision and use of low-tech and unaided AAC systems for people with complex communication needs and their families. Disability and Rehabilitation: Assistive Technology, 14(7), 710–731.

    PubMed  Google Scholar 

  • Mundy, P., & Newell, L. (2007). Attention, joint attention, and social cognition. Current Directions in Psychological Science,16(5), 269–274.

    PubMed  PubMed Central  Google Scholar 

  • National Research Council, Committee on Educational Interventions for Children with Autism. (2001). Educating Children with Autism. National Academics Press; https://www.nap.edu/catalog/10017.html.

  • *Oxman, J., Konstantareas, M. M., & Liebovitz-Bojm, S. F. (1979). Simultaneous communication training and vocal responding in nonverbal autistic and autistic-like children. International Journal of Rehabilitation Research,2(3), 394–395.

    Google Scholar 

  • *Ozonoff, S., & Cathcart, K. (1998). Effectiveness of a home program intervention for young children with autism. Journal of Autism and Developmental Disorders,28(1), 25–32.

    PubMed  Google Scholar 

  • Pavelko, S. L., Owens, R. E., Jr., Ireland, M., & Hahs-Vaughn, D. L. (2016). Use of language sample analysis by school-based SLPs: Results of a nationwide survey. Language, Speech, and Hearing Services in Schools,47(3), 246–258.

    PubMed  Google Scholar 

  • Pickett, E., & Gordon, B. (2009). Speech acquisition in older nonverbal individuals with autism: A review of features, methods, and prognosis. Cognitive and Behavioral Neurology,22(1), 1–21.

    PubMed  Google Scholar 

  • *Rogers, S. J., Hayden, D., Hepburn, S., Charlifue-Smith, R., Hall, T., & Hayes, A. (2006). Teaching young nonverbal children with autism useful speech: A pilot study of the Denver model and PROMPT interventions. Journal of Autism and Developmental Disorders,36(8), 1007–1024.

    PubMed  Google Scholar 

  • Rose, V., Trembath, D., Keen, D., & Paynter, J. (2016). The proportion of minimally verbal children with autism spectrum disorder in a community-based early intervention programme. Journal of Intellectual Disability Research,60(5), 464–477.

    PubMed  Google Scholar 

  • Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism diagnostic interview-revised (p. 30). Los Angeles: Western Psychological Services.

    Google Scholar 

  • *Sandiford, G. A., Mainess, K. J., & Daher, N. S. (2013). A pilot study on the efficacy of melodic based communication therapy for eliciting speech in nonverbal children with autism. Journal of Autism and Developmental Disorders,43(6), 1298–1307.

    PubMed  Google Scholar 

  • *Scanlan, J. B., Leberfeld, D., & Freibrun, R. (1963). Language training in the treatment of the autistic child functioning on a retarded level. Mental Retardation,1(5), 305.

    PubMed  Google Scholar 

  • Schlosser, R. W., & Wendt, O. (2008). Effects of augmentative and alternative communication intervention on speech production in children with autism: A systematic review. American Journal of Speech-Language Pathology,17(3), 212–230. https://doi.org/10.1044/1058-0360(2008/021).

    Article  PubMed  Google Scholar 

  • *Schreibman, L., & Stahmer, A. C. (2014). A randomized trial comparison of the effects of verbal and pictorial naturalistic communication strategies on spoken language for young children with autism. Journal of Autism and Developmental Disorders,44(5), 1244–1251.

    PubMed  PubMed Central  Google Scholar 

  • Sherer, M. R., & Schreibman, L. (2005). Individual behavioral profiles and predictors of treatment effectiveness for children with autism. Journal of Consulting and Clinical Psychology,73(3), 525.

    PubMed  Google Scholar 

  • *Shire, S. Y., Shih, W., & Kasari, C. (2018). Brief report: Caregiver strategy implementation—Advancing spoken communication in children who are minimally verbal. Journal of Autism and Developmental Disorders,48(4), 1228–1234.

    PubMed  Google Scholar 

  • Speidel, G. E., & Nelson, K. E. (1989). A fresh look at imitation in language learning. In The many faces of imitation in language learning (pp. 1–21). New York: Springer.

  • *Strasberger, S. K., & Ferreri, S. J. (2014). The effects of peer assisted communication application training on the communicative and social behaviors of children with autism. Journal of Developmental and Physical Disabilities,26(5), 513–526.

    Google Scholar 

  • Tager-Flusberg, H. (2018). Early predictors of language development in autism spectrum disorder. Sources of Variation in First Language Acquisition: Languages, Contexts, and Learners, 391–408.

  • Tager-Flusberg, H., & Kasari, C. (2013). Minimally verbal school-aged children with autism spectrum disorder: The neglected end of the spectrum. Autism Research,6(6), 468–478.

    PubMed  Google Scholar 

  • Tager-Flusberg, H., Plesa Skwerer, D., Joseph, R. M., Brukilacchio, B., Decker, J., Eggleston, B., et al. (2017). Conducting research with minimally verbal participants with autism spectrum disorder. Autism, 21(7), 852–861.

    PubMed  Google Scholar 

  • Tager-Flusberg, H., Rogers, S., Cooper, J., Landa, R., Lord, C., Paul, R., et al. (2009). Defining spoken language benchmarks and selecting measures of expressive language development for young children with autism spectrum disorders. Journal of Speech, Language, and Hearing Research,52(3), 643–652.

    PubMed  PubMed Central  Google Scholar 

  • *Tardif, C., Latzko, L., Arciszewski, T., & Gepner, B. (2017). Reducing information’s speed improves verbal cognition and behavior in autism: A 2-cases report. Pediatrics,139(6), e20154207.

    PubMed  Google Scholar 

  • *Wan, C. Y., Bazen, L., Baars, R., Libenson, A., Zipse, L., Zuk, J., et al. (2011). Auditory-motor mapping training as an intervention to facilitate speech output in non-verbal children with autism: A proof of concept study. PLoS ONE,6(9), e25505

    PubMed  PubMed Central  Google Scholar 

  • *Wetherby, A. M., Guthrie, W., Woods, J., Schatschneider, C., Holland, R. D., Morgan, L., et al. (2014). Parent-implemented social intervention for toddlers with autism: An RCT. Pediatrics,134(6), 1084–1093.

    PubMed  PubMed Central  Google Scholar 

  • *Yoder, P. J., & Layton, T. L. (1988). Speech following sign language training in autistic children with minimal verbal language. Journal of Autism and Developmental Disorders,18(2), 217–229.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, CA, 94305, USA

    Lynn Kern Koegel

  2. Department of Hearing and Speech Sciences, Vanderbilt School of Medicine, Nashville, TN, 37205, USA

    Katherine M. Bryan, Pumpki L. Su & Stephen Camarata

  3. Koegel Autism Center, University of California, Santa Barbara, Santa Barbara, CA, 93106, USA

    Mohini Vaidya

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  1. Lynn Kern Koegel
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Koegel, L.K., Bryan, K.M., Su, P.L. et al. Definitions of Nonverbal and Minimally Verbal in Research for Autism: A Systematic Review of the Literature. J Autism Dev Disord 50, 2957–2972 (2020). https://doi.org/10.1007/s10803-020-04402-w

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