Ellis Weismer Susan, Kover Sara T
Department of Communication Sciences & Disorders and Waisman Center, University of Wisconsin-Madison, Madison, WI, USA.
Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, USA.
J Child Psychol Psychiatry. 2015 Dec;56(12):1327-37. doi: 10.1111/jcpp.12406. Epub 2015 Mar 10.
There is wide variation in language abilities among young children with autism spectrum disorders (ASD), with some toddlers developing age-appropriate language while others remain minimally verbal after age 5. Conflicting findings exist regarding predictors of language outcomes in ASD and various methodological issues limit the conclusions that can be drawn about factors associated with positive language growth that could provide insights into more effective intervention approaches for increasing communication skills.
Language development was investigated in 129 children with ASD participating in four assessments from mean age 2½ years (Visit 1) through 5½ years (Visit 4). Language ability was measured by a clinician-administered test of comprehension and production. Hierarchical linear modeling was used to identify predictors of language ability. Stability of language status was examined in subgroups of Preverbal versus Verbal children identified at Visit 1. Discriminant function analysis was used to classify another subset of cases according to Low Language (minimally verbal) versus High Language outcome at Visit 4.
ASD severity was a significant predictor of growth in both language comprehension and production during the preschool period, while cognition predicted growth in production. For the highest and lowest language performers at Visit 4, cognition, maternal education, and response to joint attention correctly classified over 80% of total cases. The vast majority of children who were preverbal at 2½ years attained some level of verbal skills by 5½ years.
Findings indicate that it is possible, by 2½ years, to predict language growth for children with ASD across the preschool years and identify factors that discriminate between children who remain minimally verbal at 5½ years from those with high language proficiency. Results suggest that early intervention focused on reducing core ASD symptoms may also be important for facilitating language development in young children with ASD.
自闭症谱系障碍（ASD）幼儿的语言能力存在很大差异，一些幼儿语言发展与年龄相符，而另一些幼儿到5岁后仍几乎不会说话。关于ASD语言结果的预测因素存在相互矛盾的研究结果，各种方法学问题限制了我们对与积极语言发展相关因素的结论，而这些因素可能为提高沟通技能的更有效干预方法提供见解。
对129名ASD儿童进行了语言发展调查，这些儿童从平均年龄2.5岁（第1次访视）到5.5岁（第4次访视）参与了四项评估。语言能力通过临床医生实施的理解和表达测试进行测量。使用分层线性模型来确定语言能力的预测因素。在第1次访视时确定的非语言儿童与语言儿童亚组中检查语言状态的稳定性。使用判别函数分析根据第4次访视时的低语言（几乎不会说话）与高语言结果对另一组病例进行分类。
ASD严重程度是学龄前儿童语言理解和表达发展的重要预测因素，而认知能力预测表达能力的发展。对于第4次访视时语言表现最高和最低的儿童，认知能力、母亲教育程度和对共同注意的反应正确分类了超过80%的总病例。绝大多数在2.5岁时不会说话的儿童在5.5岁时达到了一定程度的语言技能。
研究结果表明，到2.5岁时，可以预测ASD儿童在整个学龄前阶段的语言发展，并确定能够区分5.5岁时仍几乎不会说话的儿童与语言能力高的儿童的因素。结果表明，专注于减少ASD核心症状的早期干预对于促进ASD幼儿的语言发展也可能很重要。
