Autism Research - 2013 - Tager Flusberg - Minimally Verbal School Aged Children With Autism Spectrum Disorder The
Autism Research - 2013 - Tager Flusberg - Minimally Verbal School Aged Children With Autism Spectrum Disorder The
Autism Research - 2013 - Tager Flusberg - Minimally Verbal School Aged Children With Autism Spectrum Disorder The
It is currently estimated that about 30% of children with autism spectrum disorder remain minimally verbal, even after
receiving years of interventions and a range of educational opportunities. Very little is known about the individuals at
this end of the autism spectrum, in part because this is a highly variable population with no single set of defining
characteristics or patterns of skills or deficits, and in part because it is extremely challenging to provide reliable or valid
assessments of their developmental functioning. In this paper, we summarize current knowledge based on research
including minimally verbal children. We review promising new novel methods for assessing the verbal and nonverbal
abilities of minimally verbal school-aged children, including eye-tracking and brain-imaging methods that do not require
overt responses. We then review what is known about interventions that may be effective in improving language and
communication skills, including discussion of both nonaugmentative and augmentative methods. In the final section of
the paper, we discuss the gaps in the literature and needs for future research. Autism Res 2013, 6: 468–478. © 2013
International Society for Autism Research, Wiley Periodicals, Inc.
Keywords: behavioral intervention < intervention; early intervention < intervention; school age < pediatrics; spoken language;
minimally verbal ASD; alternative and augmentative communication; eye-tracking
Research in the field of autism spectrum disorder (ASD) cognitive skills? (c) Which interventions may be effective
has flourished over the past two decades. However, the in improving their language and communicative skills?
vast majority of studies have focused on either young
toddlers and preschoolers or older higher functioning,
verbal children primarily because they are easier to evalu- Minimally Verbal Children with ASD
ate using standard assessment tools, and they are more
compliant during behavioral or neuroimaging experi- It is not known how many children with ASD remain
mental investigations. Recently, the Interagency Autism with little expressive spoken language abilities by the
Coordinating Committee (IACC) highlighted the dearth time they reach school age. Older statistics suggest that
of knowledge about nonverbal children with ASD (IACC over half of all children with autism failed to acquire
2011 Strategic Plan: http://iacc.hhs.gov/strategic-plan/ spoken language [National Research Council, 2001];
2011/index.shtml). As awareness about this issue grew in however, more recent studies suggest that this figure is
recent years, Autism Speaks held a series of meetings in now lower, at around 30%, in part because of the broad-
2009 on “Characterizing cognition in nonverbal indi- ening of diagnostic criteria, in part because more verbal
viduals with autism,” and the National Institutes of children are now identified as having autism and in part
Health (NIH) convened a workshop that was held in April because of earlier diagnoses as well as greater access to
2010 to identify what is currently known, what are the more effective early interventions that significantly
gaps in our knowledge and what are the research oppor- improve spoken language and communication skills in
tunities that could address these gaps. In this paper, younger preschoolers with ASD, thus potentially prevent-
which grew out of the NIH workshop, we summarize ing them from remaining nonverbal at later ages
current research on minimally verbal school-aged chil- [Tager-Flusberg, Paul, & Lord, 2005].
dren with ASD, focusing on three main questions: (a) We do not understand why, despite access to interven-
Who are these children? (b) What novel technologies tions, some children fail to make progress in acquiring
could be used to assess their receptive language and other language, but what is clear is that this group of children
From the Department of Psychology and Department of Anatomy and Neurobiology, Boston University, Boston, Massachusetts (H.T.-F.); Graduate School
of Education, University of California, Los Angeles, California (C.K.)
Received September 3, 2012; accepted for publication August 7, 2013
Address for correspondence and reprints: Helen Tager-Flusberg, Department of Psychology, Boston University, 64 Cummington Street, Boston, MA
02215, USA. E-mail: [email protected]
Support for preparation of this paper was provided by grants from the National Institutes of Health (NIH) (NIDCD RO1 DC 10290-S1; P50 DC 13027)
and Autism Speaks (#2468) to HTF and NIH (NIMH R01 MH084864), Autism Speaks Hi Risk/Hi Impact (#5666) and HRSA (UA3MC11055) to C.K.
Published online 7 October 2013 in Wiley Online Library (wileyonlinelibrary.com)
DOI: 10.1002/aur.1329
© 2013 International Society for Autism Research, Wiley Periodicals, Inc.