J Autism Dev Disord (2012) 42:2761–2766 DOI 10.1007/s10803-012-1534-8
BRIEF REPORT
Brief Report: The Relationship Between Language Skills, Adaptive Behavior, and Emotional and Behavior Problems in Pre-schoolers with Autism Carlie J. Park • Gregory W. Yelland John R. Taffe • Kylie M. Gray
•
Published online: 24 April 2012 Ó Springer Science+Business Media, LLC 2012
Abstract This study investigated the relationship between structural language skills, and communication skills, adaptive behavior, and emotional and behavior problems in pre-school children with autism. Participants were aged 3–5 years with autism (n = 27), and two comparison groups of children with developmental delay without autism (n = 12) and typically developing children (n = 20). The participants were administered standardised tests of structural language skills, and parents completed the Vineland Adaptive Behavior Scales and the Developmental Behaviour Checklist. Results indicated that for children with autism, communication skills, and in particular receptive communication skills, were associated with social and daily living skills, and behavior problems. Receptive structural language skills were associated with expressive communication skills. There were no associations found between structural language skills and social or daily living skills, nor behavior problems. The results of this study suggest that communication skills are more closely linked to functional and behavioral outcomes in autism than structural language skills. Keywords Autism Language Adaptive behavior Behavior problems
C. J. Park G. W. Yelland J. R. Taffe K. M. Gray Centre for Developmental Psychiatry and Psychology, School of Psychology and Psychiatry, Monash University, Clayton, Australia K. M. Gray (&) Centre for Developmental Psychiatry and Psychology, ELMHS, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC 3168, Australia e-mail:
[email protected]
Introduction In addition to social impairments and restricted and repetitive behaviors, many children with autism also experience language deficits (Park et al. 2012), behavior problems (Baghdadli et al. 2003; Herring et al. 2006; Murphy et al. 2005) and difficulties with functioning independently in their environment (adaptive behaviour skills; Freeman et al. 1988; Venter et al. 1992). These difficulties are related, for example, to poor communication skills are associated with behavior problems (Carr and Durrand 1986; Matson and Tessa 2008). Behavior problems are thought to serve communicative functions such as avoiding undesirable activities, and gaining social attention, objects or activities. Such findings have proven clinically useful; it is now common practice to address behavior problems using functional communication training (Charlop-Christy et al. 2002; Reese et al. 2005). One question than has not been addressed is whether it is the understanding or the use of communication that is important for reducing behavioral problems (i.e. receptive or expressive communication). Other research has documented that structural language skills (the more formal aspects of language including vocabulary and grammar) are associated with adaptive behavior skills; communication, daily living and social skills (e.g. Liss et al. 2001; Stone et al. 1999; Szatmari et al. 2003). However, there are discrepancies in the findings of some of these studies possibly due to differences in methodology; for example the use of direct measures compared to parent report measures, the study of individuals at varying developmental levels and chronological ages, and the inclusion or not of children with autism and an intellectual disability. What remains unclear is exactly which adaptive behaviors are associated with structural
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(n = 12), and (c) were typically developing (n = 20). Diagnoses of DSM-IV Autistic Disorder were confirmed by a psychologist (KG) experienced in the assessment and diagnosis of children with autism on the basis of case file reviews. All of the participants with a diagnosis of autism met the cut off on the autism diagnostic observation schedule (ADOS) for autism or autism spectrum disorder. No participants from the group with developmental delay without autism or the group of typically developing children met the ADOS cut-off criteria. A cut-off score of 85 on the wechsler preschool and primary scale of intelligence (WPPSI-III) was used to differentiate the typically developing participants from the participants with developmental delay without autism.
language skills, and whether there are different patterns of association between these skills for children with autism compared to children with other developmental difficulties. The development of a clearer understanding of the relationship between structural language skills, behavior problems, and adaptive behavior is the first step towards designing targeted programs to improve these skills. The current study was designed to investigate the relationship between language skills, adaptive behavior, and behavior problems. Separate measures of receptive and expressive language and communication skills were included. Comparison groups of children with developmental delay without autism and typically developing children were included to investigate whether observed relationships were unique to autism, related to developmental delay, or common to all pre-school aged children. It was expected that better communication skills would be associated with lower levels of behavioral problems, and better structural language skills would be associated with higher levels of adaptive functioning.
Measures Wherever possible, participants’ cognitive skills were measured using the WPPSI-III. For children who were unable to complete the WPPSI-III, the cognitive scale of the Bayley Scales of Infant and Toddler Development was administered. The Caregiver Rating Scale of the Vineland Adaptive Behavior Scales (Vineland-II) was used to provide a measure of participant’s adaptive behavior skills including receptive and expressive communication skills, socialization and daily living skills. The ADOS (Gotham et al. 2008; Gotham et al. 2007; Lord and Spence 2006) was used to assist in selecting children with autism for the study. The revised autism algorithms were used to provide
Method Participants This study included children aged between 3 years, 6 months and 5 years, 11 months who (a) had autism (n = 27), (b) had developmental delay without autism
Table 1 Sample size, mean, standard deviation and range for gender, age and scores on the WPPSI-III, ADOS, TACL-III, SPELT-P2, VinelandII, and DBC-P for the groups with autism, developmental delay without autism and typically developing children Autism (n = 27)
Developmental delay (n = 10)
Typically developing (n = 20)
M
M
M
Age (months)
55.63
Gender (% males)
81 %
SD 7.00
55.30
SD 5.46
80 %
51.20
SD 7.32
45 %
WPPSI-III full scale IQ
76.08
17.11
71.70
11.40
112.0
8.4
WPPSI-III performance IQ
83.30
18.47
74.70
11.53
108.1
10.7
ADOS severity score
6.74
1.56
2.00
1.33
1.25
TACL-III total score
80.11
16.32
78.20
14.17
116.6
11.0
SPELT-P2 total score
72.35
20.00
68.67
22.83
115.8
11.1
Vineland-II adaptive behavior composite Communication skills
.64
78.44
13.58
84.00
17.70
109.9
10.8
79.52
15.10
81.20
19.98
109.6
11.8
Daily living skills
81.74
19.43
86.90
17.73
109.5
10.4
Social skills
78.15
13.42
90.00
18.08
107.5
11.4
65.78 19.04
23.50 10.25
48.30 19.00
31.64 11.19
18.9 9.1
1.4 6.3
DBC-P total behavior problem score Disruptive Self-absorbed
21.52
9.29
14.90
11.78
3.8
3.9
Communication disturbance
11.04
3.92
6.20
3.82
1.8
1.7
Anxiety
7.56
3.30
5.50
4.84
3.1
3.2
Social relating
5.67
2.84
2.00
2.36
.7
1.0
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clinical cut-offs for autism and autism spectrum disorder. The Developmental Behaviour Checklist (DBC-P; Dekker et al. 2002; Einfeld and Tonge 1995; Einfeld and Tonge 2002) was used as a measure of emotional and behavior problems. The participant’s receptive structural language abilities were measured using the total score of the Test for Auditory Comprehension of Language (TACL-III; CarrowWoolfolk 1999), which measures understanding of vocabulary, morphology, and syntax. The participants’ expressive structural language abilities were measured using the Structured Photographic Expressive Language Test, Preschool Version (SPELT-P2; Dawson et al. 2005).
services to children with developmental delay within the southern or eastern metropolitan regions of Melbourne, Australia. Participants and their caregiver(s) attended between one and three assessment sessions depending on the needs and time availability of families. The children were individually administered a series of standardised tests that assessed their cognitive and language skills, and their behavior. During this time, caregivers completed the two parent-report questionnaires; the Vineland-II and DBC-P.
Procedures
Results
The study was approved by the Monash University Human Research Ethics Committee and the Victorian Department of Education and Early Childhood Development. Typically developing children were recruited from preschool centres and childcare centres located within the southern metropolitan region of Melbourne, Australia. Children with developmental delay were recruited from schools, early childhood services, and private practitioners providing
The demographic characteristics of participants are presented in Table 1. One participant completed a sufficient number of non-verbal items on the WPPSI-III to calculate a performance IQ, but completed an insufficient number of verbal items to calculate either a verbal or full scale IQ. Ten participants with autism and one with developmental delay without autism were unable to complete the SPELT-P2.
Table 2 Results of multiple regression analyses (regression coefficients) of the relationship between daily living skills, social skills, selfabsorbed problems and social relating problems, and communication skills for the three groups
Daily living skills
Receptive communication skills (Vineland-II)
Expressive communication skills (Vineland-II)
Autism (n = 27)
Autism (n = 27)
.58**
Dev delay (n = 10)
Typical develop (n = 20)
Dev delay (n = 10)
Typical develop (n = 20)
.49
.32
.24
.48
.30
Age
-.00
-.09
-.52
.21
-.26
-.27
PIQ
-.06
.13
-.11
.13
.11
-.25
Gender (female)
-9.56
Constant
46.99*
Social skills
.68**
5.18
-.52
2.08
-5.85
-1.32
44.83
111.30*
43.86*
53.45
117.32**
.41
.17
Age
-.36
.05
-.59
.04
.43**
PIQ
.16
.21
-.11
.22*
.31
.26
-.16
-.28
.23
-.23
Gender (female)
-9.75
4.69
-.73
-.22
-6.25
-1.73
Constant
42.02
37.34
132.82*
32.11
53.00
120.70**
-.78*
-.76
-.36
-.36
-.50
.45 -.47
Self-absorbed behavior Age
-.33
.05
-.65
.07
-.18
PIQ
.05
.25
-.10
.17
.28
-.36
1.81
-5.83
-.25
6.85
-13.14
-1.34
153.89**
Gender (female) Constant
117.56**
84.81*
-1.98*
-2.73
Age
-.39
PIQ
.19
Social relating problems
Gender (female) Constant
-2.22 104.30**
74.56**
87.16
171.15**
.60
-.72
-1.38
.68
-.42
-.67
.05
-.44
-.41
.34
-.18
.24
.36
.44 160.26**
5.21 66.55**
-3.11 97.56
-10.09 90.88
-.32 -.25 163.86**
* p \ .01, ** p \ .001
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Initial correlational analysis was used to identify potential significant relationships amongst variables. Multiple regression was then used to investigate the initial associations found between communication skills, and daily living skills, social skills, self-absorbed behaviors and social relating problems (see Table 2), and between structural language skills, and communication, social and daily living skills (see Table 3). The demographic variables age, non-verbal cognitive functioning (Performance IQ), and gender were entered into the multiple regression analyses as covariates to control for their impact on communication and language skills and to address the imperfect matching of non-verbal cognitive functioning between groups. A conservative p value (.01) was used in all analyses to adjust for the large number of analyses conducted. As can be seen in Table 2, for the group with autism, receptive communication skills were significantly positively associated with daily living and social skills, and significantly negatively associated with self-absorbed behaviors, and social relating problems. Receptive communication skills were not associated with disruptive
behavior, communication disturbance or anxiety for the group with autism. Expressive communication skills were significantly positively associated with social skills for the group with autism. There were no significant associations between expressive communication skills and daily living skills, nor any emotional and behavior problems for the group with autism. For the groups with developmental delay without autism and typically developing children, there were no significant associations between receptive and expressive communication skills, and daily living and social skills, nor with any emotional and behavior problems. As can be observed in Table 3, the positive relationship between receptive structural language skills and expressive communication skills was significant for the groups with autism, and developmental delay without autism, but not for the typically developing children. The positive relationship between receptive communication and structural language skills was also significant for the group with developmental delay without autism but not for the group with autism or for the typically developing children. The positive associations between receptive structural language
Table 3 Results of multiple regression analyses (regression coefficients) of the relationship between adaptive behaviors (as measured by the Vineland-II) and structural language skills for each group
Receptive communication skills
Receptive structural language skills (TACL-III)
Expressive structural language skills (SPELT-P2)
Autism (n = 27)
Autism (n = 20)
Dev delay (n = 10)
Typical develop (n = 20)
Dev delay (n = 9)
.29
.74*
.68
-.46
Age
.18
.77
.39
-.89*
.31
.18
PIQ
.39
.64*
.03
.69
.83
-.30
Gender (female) Constant Expressive communication skills
.14 12.14 1.45**
1.12
Typical develop (n = 20) .29
15.95
5.32
.08
-3.74
10.36
-84.28*
17.51
104.48
-118.62
101.92
.82*
.82
1.56
2.15
.67
Age
-.04
1.27
.28
-.47
1.82
.27
PIQ
.10
.34
.17
.38
-.28
-.14
Gender (female)
6.04
-8.21
28.93
11.05
-49.55
-95.22
-8.20
-71.05
-210.18
38.07
.58
.32
-.02
.06
.62
.04
Age
.03
.53
-.09
-.63
-.07
-.00
PIQ
.41
.76
-.08
.63
.91
-.33
Constant Social skills
Gender (female) Constant Daily living skills
-8.62
28.56*
-8.21
15.04
5.11
-.21
-4.95
10.18
.35
-39.85
128.64
48.83
-54.67
142.41 .55
.17
.39
.26
-.37
.70
Age
.18
.71
.06
-.96
.26
.27
PIQ
.37
.57
-.04
.58
-.26
-2.74 25.46
19.12 -41.00
4.95 86.33
2.80 -54.42
10.01 63.71
Gender (female) Constant * p \ .01, ** p \ .001
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.79* 5.95 88.95
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skills, and social and daily living skills were not significant for any of the three groups. The relationships between expressive structural language skills, and communication, social and daily living skills, and emotional and behavior problems were not significant for any of the three groups.
Acknowledgments The authors would like to thank Deborah Sweeney, Helen Jeges, and Caroline Keating for their contribution to recruitment and assessment. They would also like to extend their gratitude to the children and their families who donated their time to participate in the study.
Discussion
References
The relationship between language and communication skills, adaptive behaviors, and emotional and behavioral problems was investigated in a sample of 57 pre-school aged children with autism, developmental delay without autism, and typically developing children. The study found that for children with autism, receptive communication skills were associated with adaptive behavior (daily living and social skills), and particular types of behavior problems (self-absorbed behavior and social relating). On the other hand, expressive communications skills were only associated with social skills and receptive structural language skills for children with autism. Aside from the latter association, structural language skills were not associated with emotional and behavior problems or adaptive behavior. The majority of these associations were unique to the group with autism. This study was potentially limited by small sample sizes particularly in the group with developmental delay without autism and due to the number of analyses conducted. Despite these limitations and the choice of a conservative alpha value, this study detected several significant differences. The results warrant replication using larger samples. This study expands on a discussion by Paul (2005) of the importance of functional communication skills in autism, by identifying that communication skills, and in particular receptive communication skills, appear to play more of a role in determining behavioral and functional outcomes for pre-school aged children with autism than structural language skills. A clinical implication of these findings is that interventions targeting structural language skills for children with autism would not necessarily be expected to result in secondary improvements in adaptive behavior and behavior problems. On the other hand, interventions targeting communication skills may lead to improvements in daily living and social skills, and a reduction in behavior problems relating to social interactions for children with autism. It would be interesting for future research to investigate whether functional communication skills continue to play more of a role in determining behavioral and functional outcomes than structural language skills for individuals with autism during different life-stages. This study has highlighted the need for separate assessments and intervention for communication and language skills, and for these skills to be investigated separately in research.
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