Descriptive statistics – Communication Interactivity-FCP
1. Introduction
The main purpose of this chapter is to discuss assessment tools that can be used with children and adolescents of the autism spectrum and verify their effectiveness. It will be based on two studies that present the application and comparison of 4 different diagnostic tools. These four instruments are not language-specific and therefore can be used with different groups of children that speak different languages. Certainly cultural variations must be considered but the possibility of using tools that are internationally recognized may contribute to the efforts in improving the amount of information about diagnosis and treatment as proposed by the World Health Organization (WHO) in the World Report on Disabilities (2012).
The first study associates two different methods for identifying the functional communicative profile of children with autism, specifically regarding the initiative and interactivity of communication of individuals with autism.
The FCP-R is a protocol designed to the individual communication assessment developed by Kleiman (1994). It provides a simple and organized evaluation procedure based on age and acquired and/or developmental deficits. It can be used in four different ways: based on an interview with the therapists or the parents; direct assessment of the child/adolescent of observation of filmed samples.
This tool assesses the individual communication abilities in the following areas: Sensory/Motor; Attentiveness; Behavior; Receptive Language; Expressive Language; Pragmatic/Social; Speech; Voice; Oral; Fluency and Non-Oral Communication. To this study the areas of Behavior; Attentiveness; Receptive Language; Expressive Language and Pragmatic/Social were selected.
The analysis of the functional communicative profile (FCP) adopts the criteria proposed by Fernandes (2004). It uses 15-minute filmed samples of patient-therapist interaction. In these situations the dyads play with toys regularly used in language-therapy sessions and that usually produced good communicative situations. Data are recorded, transcribed and analyzed with a specific protocol.
The analysis of the FCP uses the Pragmatic Recording Protocol [8]. This study used the data about the communicative functions. After the record of the data in the specific protocols the incidence of each communicative function expressed by the participant is determined as well as the proportion of the communicative space occupied, the number of communicative acts expressed per minute and the proportion of more interactive communicative acts expressed.
The occupation of the communicative space is determined by the ratio of communicative acts produced by the participant and by the therapist in each sample. The number of communicative acts expressed per minute was obtained by the ratio of communicative acts expressed and the size of the sample (in minutes). The proportion of interactive communicative acts is defined by the ratio of all communicative acts expressed by the participant and those that expressed one of the more interactive communicative functions.
2. Methods
This chapter will describe two different studies and discuss their results.
2.1. Study 1. Comparison of the Functional Communicative Profile and the Functional Communicative Profile-Revised of children and adolescents with autism spectrum disorders
2.1.1. Methods
Participants were 50 children and adolescents with ages between 3 years 9 months and 14 years 8 months (average 7 years 11 months) of both genders with Autism Spectrum Disorders (ASD) attending a specialized Speech-Language Pathology (SLP) service for periods of six months to two years.
All participants were assessed according to the criteria of the
Since the FCP-R is a tool with technical data, extensive and detailed; therefore it was applied by means of interviews with the speech-language therapist of each participant. All the SLPs have been assigned to each participant for at least six months prior to the interview. This time was considered enough to the therapists to have all the information demanded by the FCP-R.
The analysis of the FCP considered the five minutes with more symmetric interaction of each sample.
2.1.2. Data analysis
The data obtained by the FCP-R and FCP assessments were individually analyzed, identifying the global performance based on individual comparison.
This comparison used the following areas of the FCP-R:
Behavior;
Atention/Concentration;
Receptive Language;
Expressive Language;
Social/Pragmatic.
Data obtained with the use of both tools were compared by the t-Student test and the adopted significance level was 0.05 (5%).
With the purpose of verifying if there were linear correlations between the analyzed areas of both tools the Correlation test was also used. The correlation test identifies the correlation coefficient, that can be positive or negative. In the first case, the positive correlation, the variables present a similar behavior, i.e., if one of them increases the other increases also, and vice-versa. In the negative correlation the variables present the opposite behavior, i.e., if one of them increases the other decreases, and vice-versa.
Data about communication interactivity, number of communicative acts expressed per minute (CAM) and the proportion of communicative space occupied (CSO) were analyzed by means of their averages.
2.1.3. Results and comments
The comparison between the FCP and the FCP-R used the proportion of communicative interaction (CI), the CAM and the CSO obtained by each participant’s FCP. CI was obtained by the ratio of the more interpersonal communicative acts expressed and the total of communicative acts expressed. It is considered a very significant data about the overall interactivity of the communication. CAM and CSO were obtained as described above.
The descriptive statistics is presented in the following tables.
The median of the results regarding CI was determined in order to classify the participants as more interactive or less interactive. The individual results presented large variation and the objective of this classification was to associate theses results with the selected areas of the FCP-R. The areas of
The association of values of CI obtained in the area of
Average | 54.35 |
Standard error | 3.05 |
Median | 53.75 |
Standard Deviation | 21.61 |
Variance | 466 |
Table 2 shows the comparison of the results in the area of
|
||||||||||
|
6 | 14 | 60 | 18 | 2 | |||||
|
More | Less | More | Less | More | Less | More | Less | More | Less |
2 | 1 | 4 | 3 | 16 | 14 | 4 | 5 | 0 | 1 | |
|
0.5 | 0.39 | 0.16 | 0.37 | 0.72 | |||||
|
-0.33445 |
Data suggest that the group defined according to behavioral disorders do not present significant differences regarding the proportion of communication interactivity. However, when the linear correlation is considered it can be observed that as the severity increases in this domain the communication interactive proportion decreases. It characterizes a negative correlation, suggesting that participants with more sever behavioral disorders show less interactive communication.
Considering behavioral issues, [21] suggests that intervention focus on communication and interpersonal relationship tends to decrease the behavioral disorders of persons with ASD such as aggression and disruptive behaviors.
The values obtained to communication interaction in the FCP in the area of Attentiveness in the FCP-R are presented in Figure 2.
Table 3 shows the association of the results in the area of
|
||||||||||
|
16 | 38 | 36 | 8 | 2 | |||||
|
More | Less | More | Less | More | Less | More | Less | More | Less |
7 | 1 | 13 | 6 | 5 | 13 | 1 | 3 | 0 | 1 | |
|
0.0009* | 0.002* | 0.0008* | 0.18 | 0.72 | |||||
|
-0.44623 |
Observing the data we may conclude that the groups defined by deficits in
Figure 3 shows the values regarding the area of
Table 4 shows the association of the results in FCP-R’s area of
|
||||||||||
|
40 | 34 | 14 | 10 | 2 | |||||
|
More | Less | More | Less | More | Less | More | Less | More | Less |
15 | 5 | 9 | 8 | 2 | 5 | 0 | 5 | 0 | 1 | |
|
<0.001* | 0.34 | 0.07 | 0.03* | 0.72 | |||||
|
-0.74981 |
It is possible to consider that there is a negative correlation between the area of Receptive Language of the FCP-R and the communicative interaction of the FCP. As the severity of receptive language disorders increase, the communicative interaction decreases.
Figure 4 presents the results of the
Table 5 presents the association of the results in FCP-R’s area of
|
||||||||||
|
2 | 42 | 32 | 20 | 4 | |||||
|
More | Less | More | Less | More | Less | More | Less | More | Less |
1 | 0 | 16 | 5 | 7 | 9 | 2 | 8 | 0 | 2 | |
|
0.72 | <0.001* | 0.16 | <0.001* | 0.46 | |||||
|
-0.10007 |
These data suggest that there is a negative correlation between the area of Expressive Language of the FCP-R and the communicative interaction of the FCP. As the severity of the expressive language disorders increase, the communicative interaction decreases.
The negative correlations in both receptive and expressive language areas of the FCP-R indicate that IC decreases as the language disorders severity increases. A study conducted by [19], analyzing the functional aspects of the answers of children with severe Specific Language Impairment (SLI) observed that this children are less efficient than their peers of the same age. The authors suggest that this indicates that the formal aspects of language interfere directly in its functional efficiency.
Data about the association between communicative interaction as assessed by the FCP and the area of Social/Pragmatic of the FCP-R are displayed on Figure 5
Table 6 presents the association of the results in FCP-R’s area of
|
||||||||||
|
4 | 26 | 18 | 44 | 8 | |||||
|
More | Less | More | Less | More | Less | More | Less | More | Less |
2 | 0 | 11 | 2 | 7 | 2 | 4 | 18 | 2 | 2 | |
|
0.46 | <0.001* | 0.008* | <0.001* | 1 | |||||
|
0.683702 |
These results suggest that as the disorders in the social/pragmatic area increases, the communicative interaction decreases.However, there is no linear relation between these variables. The questions of the FCP-R regarding this area focus on some important social situations and pragmatic abilities but the answer takes into account just the occurrence of the situation, regardless of its frequency or of the consistency with which happens and not considering the focus of the subject’s intention.
These findings suggest that objective protocols to the characterization of the pragmatic abilities may not be sufficient to determine the functional communicative profile of a person with ASD. The specific functional assessment of communication seems to be necessary, with the FCP-R providing complementary but not exclusive information. Other studies also suggest the use of complementary assessment tools in order to characterize, identify and assess individuals with ASD due to the variability of the symptoms presented [2, 20].
Still considering the social/pragmatic area of the FCP-R it could be observed that the group with severe disorders has shown significant difference in the IC proportion. This result indicates that both protocols agree that individuals with low social/pragmatic abilities also have less communicative interaction.
These results also agree with several prior studies regarding this issue. [22] observed that children with ASD present less answers to interactive attempts by others and less spontaneous communication. [13] reported that children with ASD have great impairments in the functional use of communication. [1] observed that, even when interacting with a familiar interlocutor, children with ASD have great difficulties with the interactive use of communication. These authors point out that the FCP usually confirm these difficulties.
Data regarding the average of IC and the severity degree in the FCP-R show large deficits in IC as the severity increases. Figure 6 shows the association of the mean proportion of communicative interaction and the areas of the FCP-R that were considered in this study. It indicates that the overall severity of the FP-R is determinant to the proportion of IC.
The distribution of the average proportion of communicative interaction in this group of participants shows that there is an important decrease in interactivity associated to the increase in severity of the disorders in the areas of the CFP-R that were analyzed.
The following data refer to the association between other aspects of the FCP – communicative acts expressed per minute (CAM) and proportion of the communicatuve space occupied (CSO) and the same areas of the FCP-R.
|
|||||
|
|
|
|
|
|
|
11.3 | 7.4 | 7.9 | 8.1 | 15.4 |
|
38 | 42.6 | 44.1 | 39.7 | 39 |
The number of communicative acts expressed per minute was similar in the participants with mild to moderate behavior disorders; but it varied in those with
The association of behavior disorders identified by the FCP-R and the indicators of communicative intent (CAM and CSO) of the FCP has similar results for the various severity scores. It may suggest that the isolated communicative intent (no adequately addressed) doesn’t result in functional efficiency. This brings to attention the issue of the need to take the communicative context into consideration when analyzing pragmatic abilities of individuals with ASD [5, 12].
The averages of CAM and CSO associated to the Attentiveness area of the FCP-R are presented in Table 8.
|
|||||
|
|
|
|
|
|
|
8.3 | 9.1 | 7.2 | 9 | 7 |
|
41.4 | 45.7 | 40 | 39 | 52 |
Although the CAM average didn’t present a linear distribution, it has a slight decrease between the
The averages of CAM and CSO associated to the
|
|||||
|
|
|
|
|
|
|
8.5 | 8.2 | 8.7 | 6.2 | 7.8 |
|
43.7 | 40.9 | 45.1 | 40.4 | 42 |
CAM’s average shows a decrease tendency as the deficits in receptive language increases, although this is not a linear association. These data seem to suggest that language comprehension is closely associated to the performance regarding the initiative to communicate that is reflected in the number of communicative acts expressed per minute. The association of the severity of the deficits in receptive language and IC has shown that the difficulties in understanding the language expressed may be associated with the few IC. The same occurs with the expressive language: individuals with more impairments tend to show less CAM.
The averages of CAM and CSO associated to the
|
|||||
|
|
|
|
|
|
|
13 | 8.4 | 8.3 | 7.8 | 5.6 |
|
24 | 43.7 | 44.6 | 38.7 | 44.5 |
These data point out to the interdependency between the severity of the deficits in
A longitudinal study of the pragmatic abilities of children with SLI [3] indicated that the CAM is the clearer parameter of disorder for these children.
The association of the social/pragmatic area and CAM and CSO has shown that even small impairments in this area of the FCP-R have are related to proportional deficits in the FCP. These data confirm prior studies [6, 7] that assessed pragmatic therapeutic intervention processes in 6-month to 1-year periods and observed association of results regarding CAM, CSO and IC.
The averages of CAM and CSO associated to the
|
|||||
|
|
|
|
|
|
|
9.8 | 8.8 | 8.8 | 7.5 | 8.1 |
|
33.5 | 45.2 | 40.1 | 42.5 | 44.8 |
The CAM average for the
The analysis of the CAM and CSO averages regarding the selected areas of the FCP-R are presented in figures 7 and 8.
Several studies have been conducted regarding the development, adaptation and validation of diagnostic and severity scales for ASD in Brazil [15, 17]. There is still no single tool that can provide all the information regarding characterization and severity scores. Therefore the use of complementary protocols seems to be the better alternative for comprehensive and detailed diagnostic and description that will allow efficient planning of intervention procedures. It is true to other countries where other languages are used. Linguistic and cultural adaptations are at least as important as the translation from one language to the other when the use of a foreign assessment toll is proposed.
The second study aimed to identify useful tools to the assessment of the diagnostic hipothesis of ASD and their specific characteristics
2.2. Study 2. Comparing the results of DAADD and ABC of children included in Autism Spectrum Disorders
2.2.1. Methods
Participants were 45 individuals with ASD and their language therapists. All the individuals were assessed and received language therapy at the Speech-Language Research Laboratory in Autism Spectrum Disorders (LIF-DEA) of the School of Medicine – University of São Paulo (FMUSP), Brazil. They all had been diagnosed with ASD by neurologists and/or psychiatrists according to the DSM-IVtr (2002) or the IDC-10 (2003) criteria.
The
According to the DAADD guidelines the participants were divided groups according to their ages (2-to-4years; 4-to-6 years and 6-to-8 years) and age-specific protocols were used to the assessment. Each group comprised 15 participants. Familiar income and school level were not considered inclusion criteria. The DAADD uses technical data, is extensive and demands detailed information; therefore it was applied during an interview with the speech-language therapists of the 45 participants. All the therapists are speech-language pathologists and audiologists (fonoaudiólogas) and were working with the participants for at least 1 year [10].
Figure 9 shows the distribution of the participants according to their ages.
The medical diagnosis of the participants was determined by psychiatrists or neurologists working in public and private services of the state of São Paulo (Brazil). And the distribution of the diagnosis was: 29 children with ASD; seven with PDD; five with PDD-NOS; two with AS; one with High Functioning Autism (HFA) and one with Atypical Autism.
Data regarding the Autism Behavior Checklist (ABC) were retrieved from the individuals protocols registered at the LIF-DEA of FMUSP where it is regularly used during the annual assessment process. The ABC (Krug, Arick & Almond, 1993) identifies the non-adaptative behaviors and indicates the probability of the diagnosis of autism. The questionnaire focus on 57 items of atypical behavior within 5 areas: language, sensorial, relational, use of body and object and social abilities. The scores are totaled by area and generate the final general score.
Figure 10 shows the distribution of the participants according to the results of the ABC.
2.2.2. Data analysis
Data obtained in the two assessments were analyzed for each subject and the global performance was based on the overall results. Data resulting from the ABC and the DAADD wee associated according to their categories, as shown in Table 12.
Data of both protocols were compared and the adopted significance level was 0.05 (5%). The significant areas were analyzed by the t-Student test and the Wilcoxon test was used to verify linear correlations between them.
|
|
Language | Language |
Relational | Pragmatic |
Sensorial | Sensorial |
Use of body and object | Motor |
Social abilities | Behavior |
2.2.3. Results
It was observed that 20% of the older children were considered “without risk for autism” by the ABC.
Table 13 presents the more frequent answers to the DAADD regarding the developmental disorders considered. It was verified that either in G2 and G3 the most frequent diagnosis was “autism”.
|
|
|
|
Autism | 4 |
Rett | 9 | |
Asperger | 2 | |
|
Autism | 13 |
Rett | 2 | |
|
Autism | 10 |
Asperger | 5 |
Comparing the DAADD and the ABC it can be noted that although there is no significant difference, there is a great occurrence of RS according to the DAADD. In G1 these children were rated as with high risk for autism, maybe due to the several motor disorders observed.
With the increasing age these proportion decreases and the high risk for autism is the most frequent score of the ABC in groups G2 and G3. In G3 the DAADD attributes the diagnosis of AS to 75% of the participants of G3.
The Wilcoxon test was applied in the comparison of the ABC and DAADD areas. They were compared within each age group in tables 14, 15 and 16.
The answers to the DAADD and to the ABC are similar in each area. These data indicates that with increasing age the diagnosis identified by the DAADD is closer to the medical diagnosis.
|
|
|
|
|
|
|
|
|
|
ABC LG | 15 | 28.39 | 20.41 | 6.45 | 80.65 | 9.68 | 25.81 | 41.94 | 0.003 |
DA LGG AUT | 15 | 48.44 | 13.21 | 33.33 | 80.00 | 40.00 | 46.67 | 53.33 | |
ABC LG | 15 | 28.39 | 20.41 | 6.45 | 80.65 | 9.68 | 25.81 | 41.94 | 0.003 |
DA LGG RETT | 15 | 54.44 | 11.73 | 41.67 | 83.33 | 41.67 | 50.00 | 58.33 | |
ABC LG | 15 | 28.39 | 20.41 | 6.45 | 80.65 | 9.68 | 25.81 | 41.94 | 0.012 |
DA LGG DN | 15 | 43.14 | 12.31 | 29.41 | 70.59 | 3.29 | 41.18 | 47.06 | |
ABC RE | 15 | 48.25 | 17.37 | 19.05 | 78.57 | 35.71 | 47.62 | 61.90 | 0.001 |
DA PRAG AUT | 15 | 74.67 | 11.60 | 60.00 | 100.00 | 66.67 | 73.33 | 80.00 | |
ABC RE | 15 | 48.25 | 17.37 | 19.05 | 78.57 | 35.71 | 47.62 | 61.90 | 0.001 |
DA PRAG RETT | 15 | 79.56 | 11.67 | 66.67 | 100.00 | 66.67 | 80.00 | 86.67 | |
ABC RE | 15 | 48.25 | 17.37 | 19.05 | 78.57 | 35.71 | 47.62 | 61.90 | 0.002 |
DA PRAG AS | 15 | 75.83 | 9.99 | 62.50 | 93.75 | 68.75 | 75.00 | 81.25 | |
ABC RE | 15 | 48.25 | 17.37 | 19.05 | 78.57 | 35.71 | 47.62 | 61.90 | 0.002 |
DA PRAG DN | 15 | 75.42 | 10.15 | 62.50 | 93.75 | 68.75 | 75.00 | 81.25 | |
ABC BO | 15 | 62.67 | 15.76 | 36.00 | 84.00 | 48.00 | 68.00 | 76.00 | 0.017 |
DA BEH AS | 15 | 43.33 | 26.01 | 8.33 | 91.67 | 16.67 | 50.00 | 66.67 | |
ABC BO | 15 | 62.67 | 15.76 | 36.00 | 84.00 | 48.00 | 68.00 | 76.00 | 0.041 |
DA BEH DN | 15 | 43.03 | 29.05 | 0.00 | 90.91 | 18.18 | 54.55 | 72.73 |
|
|
|
|
|
|
|
|
|
|
ABC LG | 15 | 60.00 | 25.51 | 22.58 | 93.55 | 35.48 | 61.29 | 83.87 | 0.001 |
DA LGG AS | 15 | 25.56 | 19.02 | 8.33 | 75.00 | 8.33 | 25.00 | 33.33 | |
ABC LG | 15 | 60.00 | 25.51 | 22.58 | 93.55 | 35.48 | 61.29 | 83.87 | 0.001 |
DA LGG DN | 15 | 14.44 | 15.26 | 0.00 | 50.00 | 0.00 | 16.67 | 16.67 | |
ABC RE | 15 | 61.11 | 17.33 | 19.05 | 95.24 | 57.14 | 61.90 | 69.05 | 0.018 |
DA PRAG DN | 15 | 46.67 | 17.99 | 20.00 | 80.00 | 40.00 | 40.00 | 60.00 | |
ABC SE | 15 | 59.09 | 19.59 | 22.73 | 100.00 | 45.45 | 63.64 | 72.73 | 0.005 |
DA SE AUT | 15 | 34.81 | 20.52 | 11.11 | 88.89 | 22.22 | 33.33 | 44.44 | |
ABC SE | 15 | 59.09 | 19.59 | 22.73 | 100.00 | 45.45 | 63.64 | 72.73 | 0.005 |
DA SE RETT | 15 | 34.81 | 20.52 | 11.11 | 88.89 | 22.22 | 33.33 | 44.44 | |
ABC SE | 15 | 59.09 | 19.59 | 22.73 | 100.00 | 45.45 | 63.64 | 72.73 | 0.001 |
DA SE AS | 15 | 23.33 | 22.54 | 0.00 | 83.33 | 16.67 | 16.67 | 33.33 | |
ABC SE | 15 | 59.09 | 19.59 | 22.73 | 100.00 | 45.45 | 63.64 | 72.73 | 0.001 |
DA SE DN | 15 | 24.00 | 20.28 | 0.00 | 80.00 | 20.00 | 20.00 | 40.00 | |
ABC BEH | 15 | 49.12 | 23.91 | 13.16 | 81.58 | 26.32 | 52.63 | 73.68 | 0.008 |
DA MOT AUT | 15 | 28.00 | 23.66 | 0.00 | 70.00 | 10.00 | 20.00 | 50.00 | |
ABC BEH | 15 | 49.12 | 23.91 | 13.16 | 81.58 | 26.32 | 52.63 | 73.68 | 0.009 |
DA MOT RETT | 15 | 26.67 | 22.91 | 0.00 | 72.73 | 9.09 | 18.18 | 45.45 | |
ABC BEH | 15 | 49.12 | 23.91 | 13.16 | 81.58 | 26.32 | 52.63 | 73.68 | 0.016 |
DA MOT AS | 15 | 27.50 | 25.09 | 0.00 | 75.00 | 12.50 | 25.00 | 37.50 | |
ABC BEH | 15 | 49.12 | 23.91 | 13.16 | 81.58 | 26.32 | 52.63 | 73.68 | 0.001 |
DA MOT DN | 15 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | |
ABC BO | 15 | 64.00 | 17.63 | 32.00 | 88.00 | 52.00 | 68.00 | 80.00 | 0.005 |
DA BEH AUT | 15 | 30.91 | 26.35 | 0.00 | 90.91 | 9.09 | 27.27 | 36.36 | |
ABC BO | 15 | 64.00 | 17.63 | 32.00 | 88.00 | 52.00 | 68.00 | 80.00 | 0.009 |
DA BEH RETT | 15 | 36.19 | 27.46 | 0.00 | 85.71 | 14.29 | 42.86 | 57.14 | |
ABC BO | 15 | 64.00 | 17.63 | 32.00 | 88.00 | 52.00 | 68.00 | 80.00 | 0.003 |
DA BEH AS | 15 | 30.30 | 23.47 | 0.00 | 81.82 | 9.09 | 27.27 | 36.36 | |
ABC BO | 15 | 64.00 | 17.63 | 32.00 | 88.00 | 52.00 | 68.00 | 80.00 | 0.003 |
DA BEH DN | 15 | 32.12 | 25.22 | 0.00 | 81.82 | 9.09 | 27.27 | 45.45 |
|
|
|
|
|
|
|
|
|
|
ABC SE | 15 | 43.94% | 21.37% | 0.00% | 77.27% | 31.82% | 45.45% | 59.09% | 0.030 |
DA SE AS | 15 | 28.33% | 28.14% | 0.00% | 75.00% | 0.00% | 25.00% | 50.00% | |
ABC SE | 15 | 43.94% | 21.37% | 0.00% | 77.27% | 31.82% | 45.45% | 59.09% | 0.020 |
DA SE DN | 15 | 13.33% | 35.19% | 0.00% | 100.00% | 0.00% | 0.00% | 0.00% | |
ABC BEH | 15 | 40.00% | 24.33% | 0.00% | 73.68% | 13.16% | 47.37% | 57.89% | 0.001 |
DA MOT DN | 15 | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% |
3. Discussion
The results of the two protocols tend to be more similar with the increasing age. The DAADD has shown to be more sensible in the different age-groups, while the ABC seems to be more specific only in the older group. It must be noted that the ABC aims just to identify the risk for autism while the DAADD differentiates the children that already have the diagnosis within the autism spectrum.
The need for diagnostic protocols that consider the association of communication and behavior disorders of children with ASD is clear. These protocols must provide means for the careful observation and record of communicative behaviors [16, 18].
The comparison of the different areas of the DAADD and the ABC has shown that the DAADD is more efficient to the identification of language disorders. It must be considered, however, that this is not the purpose of the ABC. The use of both protocols may be complementary, applied as needed along the diagnosis process. In several countries and in different regions of many countries providing services of medical diagnosis for children with ASD takes precious time. The time spent waiting for the conclusion of the diagnostic process would be extremely important to the child’s development. The sooner the child receives appropriate therapy and education, the better the prognosis (Volkmar, Chawarska & Klin, 2005) Therefore, the use of screening tools that helps to identify children at risk for ASD or with some probability of receiving this diagnosis may represent the better use of resources that are frequently limited.
The comparison of different protocols, especially considering the needs of non-English-speaking groups, allow a more comprehensive perspective about tools that can be used in the assessment process of children with developmental disorders.
4. Conclusions
During the last decades important changes have taken place regarding the concept and prevalence of ASD. This resulted in a greater need for screening tools that can be used in public health programs designed to provide services to an increasing number of children as soon as possible in their development.
The diagnosis of ASD often produces, besides the emotional stress in the affected families, large social and emotional impact. It implies in the urgent need for efficient models of screening and diagnosis that can support intervention plans that are individually planned and implemented. Early diagnosis and intervention are essential to the better prognosis; therefore clinicians and researchers have been dedicated to the development of efficient strategies to the identification of disorders and intervening factors.
Several diagnostic and assessment tools have been proposed, aiming the early identification of ASD. However, the efforts to improve the early identification of children with ASD will only be effective if the diagnosed children have access to appropriate intervention services. Considering that the assessment process may be long and expensive and that the diagnosis frequently depends on clinical impressions, the use of specific and sensitive tools is essential.
In this context an important aspect to be considered in the use of specific tools to the assessment and diagnosis of children with ASD is that it should be possible to use them despite the diversity of symptoms that are characteristic of these children. Besides, these tools should also be able to identify the central features of ASD. Cultural aspects and the possibility of use in different contexts should also be considered.
Finally, although there are several tools for the screening, assessment, diagnosis and follow-up of children with ASD, there is not just one protocol that can be universally used. In the clinical practice the assessment, diagnosis and follow-up of intervention processes still depends on the clinician’s abilities that chooses specific and complementary tools.
References
- 1.
. 2010. Interactive use of communication by verbal and non-verbal autistic children. Pro Fono Rev Atual Cien, . &Amato ,C.A.H Fernandes ,F.D.M 22 7 (December2010 ),373 378 ,0104-5687 Amato, C.A.H. & Fernandes, F.D.M. 2010. Interactive use of communication by verbal and non-verbal autistic children. Pro Fono Rev Atual Cien, vol. 22, No 7, (December 2010), pp.373-378, ISSN 0104-5687 - 2.
. 2011. Pervasive developmental disorders screening test- II: viabilidade de aplicação em indivíduos do espectro autístico. Rev Soc Bras Fonoaudiol, .,Barbosa ,M.R.P .,Pimentel ,A.G.L .,Amato ,C.A.H .,Fernandes ,F.D.M .,Balestro ,J.I . &Santos ,T.H.F Valino ,V.C 16 supl2011 ,668 2179-0841 Barbosa, M.R.P., Pimentel, A.G.L., Amato, C.A.H., Fernandes, F.D.M., Balestro, J.I., Santos, T.H.F. & Valino, V.C. 2011. Pervasive developmental disorders screening test – II: viabilidade de aplicação em indivíduos do espectro autístico. Rev Soc Bras Fonoaudiol, vol 16, supl 2011, pp.668, ISSN 2179-0841 - 3.
Befi-lopes D. M Puglisi M. L Rodrigues A Giusti E Gândara J. P Araújo K 2007 Communicative profile of children with language impairment: longitudinal characterization of pragmatic abilities. Rev SocBefi-Lopes, D.M., Puglisi, M.L., Rodrigues, A., Giusti, E., Gândara, J.P. & Araújo, K. 2007. Communicative profile of children with language impairment: longitudinal characterization of pragmatic abilities. Rev Soc - 4.
Bras Fonoaudiol ,12 4 October-December2007 ),265 276 ,1982-0232 Bras Fonoaudiol, vol. 12, No 4 (October-December 2007), pp. 265-76, ISSN 1982-0232 - 5.
.1989. Pragmatic analysis of communicative behavior of autistic child. J Speech Hear Disord.Bernard-Optiz ,V.V 47 February1982 ),107 121 .1944-7515 Bernard-Optiz, V.V.1989. Pragmatic analysis of communicative behavior of autistic child. J Speech Hear Disord. Vol. 47 (February 1982), pp. 107-121. ISSN 1944-7515 - 6.
. 2006. Relation between social cognitive aspects and the functional communicative profile in a group of adolescents of the autistic spectrum. Pro Fono Rev Atual Cien, . &Cardoso ,C Fernandes F.D.M 18 1 (March,2006 ),89 98 ,0104-5687 Cardoso, C. & Fernandes F.D.M. 2006. Relation between social cognitive aspects and the functional communicative profile in a group of adolescents of the autistic spectrum. Pro Fono Rev Atual Cien, vol. 18, No. 1, (March, 2006), pp.89-98, ISSN 0104-5687 - 7.
. 2008. Language therapy and autism: results of three different models. Pro Fono Rev Atual Cien, .,Fernandes F.D.M .,Cardoso ,C .,Sassi ,F.C .,Amato ,C.A.H Sousa-Morato ,P.F 20 4 December,2008 ),267 272 ,0104-5687 Fernandes F.D.M., Cardoso, C., Sassi, F.C., Amato, C.A.H., Sousa-Morato, P.F. 2008. Language therapy and autism: results of three different models. Pro Fono Rev Atual Cien, vol. 20, No. 4 (December, 2008), pp. 267 – 72, ISSN 0104-5687 - 8.
. 2000. Aspectos funcionais da comunicação de crianças autistas. T Desenvolv,Fernandes ,F.D.M 9 51 (April,2000 ),25 35 ,0103-7749 Fernandes, F.D.M. 2000. Aspectos funcionais da comunicação de crianças autistas. T Desenvolv, vol. 9, No 51, (April, 2000), pp.25-35, ISSN 0103-7749 - 9.
. Pragmática. In: ABFW: teste de linguagem infantil nas áreas de fonologia, vocabulário, fluência e pragmática, Andrade, C.R.F., Befi-Lopes, D.M., Fernandes, F.D.M. & Wertzner, H.F.,Fernandes ,F.D.M 2000 2000 89 97 , Pró Fono,8-58549-145-0 BrazilFernandes, F.D.M. Pragmática. In: ABFW: teste de linguagem infantil nas áreas de fonologia, vocabulário, fluência e pragmática, Andrade, C.R.F., Befi-Lopes, D.M., Fernandes, F.D.M. & Wertzner, H.F., 2000, 89-97, Pró Fono, ISBN 8585491.45-0, Barueri, Brazil - 10.
. 2003. Differential Assessment of Autism and Other Developmental Disorders (DAADD). Linguisystems. . &Gail ,J.R Lynn ,K.C 15599948512003 Illinois.Gail, J.R. & Lynn, K.C. 2003. Differential Assessment of Autism and Other Developmental Disorders (DAADD). Linguisystems. ISBN 1-55999-485-1, 2003, Illinois. - 11.
.Kleiman ,L.I 2003 . Functional Communication Profile-Revised. LinguiSystems,15599948512003 Austin, Texas.Kleiman, L.I. 2003. Functional Communication Profile-Revised. LinguiSystems, ISBN 1-55999-485-1. 2003, Austin, Texas. - 12.
. 2000. Interventions to facilitate communication in autism. J Autism Dev Disord,Koegel ,L.K 30 5 (August,2000 ),383 391 ,0162-3257 Koegel, L.K. 2000. Interventions to facilitate communication in autism. J Autism Dev Disord, Vol. 30, No. 5, (August, 2000), pp. 383-391, ISSN 0162-3257 - 13.
. 2009. Parent-Assisted Social Skills Training to Improve Friendships in Teens with Autism Spectrum Disorders. J Autism Dev Disord, .,Laugeson ,E.A .,Frankel ,F . &Mogil ,C Dillon ,A.R 39 3 August,2009 ),596 606 ,0162-3257 Laugeson, E.A., Frankel, F., Mogil, C. & Dillon, A.R. 2009. Parent-Assisted Social Skills Training to Improve Friendships in Teens with Autism Spectrum Disorders. J Autism Dev Disord, vol. 39, No. 3 (August, 2009), pp. 596-606, ISSN 0162-3257 - 14.
. Joint attention and language in autism and developmental language delay. J Autism Dev Disord. . &Loveland ,K Landry ,S 16 3 335 349 ,0162-3257 Loveland, K. & Landry, S. Joint attention and language in autism and developmental language delay. J Autism Dev Disord. Vol.16, No. 3, pp. 335-349, ISSN 0162-3257 - 15.
. 2005. Validity of Autism Behavior Checklist (ABC): preliminary study. Rev Bras Psiquiatr. . &Marteleto ,M.R Pedromônico ,M.R 27 4 (December,2008 ),295 301 ,1516-4446 Marteleto, M.R. & Pedromônico, M.R. 2005. Validity of Autism Behavior Checklist (ABC): preliminary study. Rev Bras Psiquiatr. Vol. 27, No. 4, (December, 2008), pp. 295-301, ISSN 1516-4446 - 16.
. 2007. A review of methodological issues in the differential diagnosis of autism spectrum disorders in children. Res Autism Spectr Disord, .,Matson ,J.L . &Nebel-Schwalm ,M Matson ,M.L 1 (2007 ),38 54 ,1750-9467 Matson, J.L., Nebel-Schwalm, M. & Matson, M.L. 2007. A review of methodological issues in the differential diagnosis of autism spectrum disorders in children. Res Autism Spectr Disord, Vol. 1, (2007), pp. 38-54, ISSN 1750-9467 - 17.
. .,Pereira ,A.M . &Wagner ,M.B Riesgo ,R.S 2008 . Autismo Infantil: Tradução e validação da CARS (Childhood Autism Rating Scale) para uso no Brasil. J. Pediatr,84 6 487 494 ,0021-7557 Pereira, A.M., Wagner, M.B. & Riesgo, R.S. 2008. Autismo Infantil: Tradução e validação da CARS (Childhood Autism Rating Scale) para uso no Brasil. J. Pediatr, Vol. 84, No. 6, pp. 487-494, ISSN 0021-7557 - 18.
. .,Posserud ,M .,Lundervold ,A.J . &Lie ,S.A Gillberg ,C 2010 . The prevalence of autism spectrum disorders: Impact of diagnostic instrument and non-response bias. Soc Psychiatr Epidemiol,45 (2010),319 327 0933-7954 Posserud, M., Lundervold, A.J., Lie, S.A. & Gillberg, C. 2010. The prevalence of autism spectrum disorders: Impact of diagnostic instrument and non-response bias. Soc Psychiatr Epidemiol, Vol. 45, (2010), pp. 319-327 ISSN 0933-7954 - 19.
Rocha , LC; Befi-Lopes, DM. Analyses of answers presented by children with and without specific language impairment. Pro Fono Rev Atual Cien, Vol. 18, No. 3, pp. 229-238, ISSN 0104-5687Rocha, LC; Befi-Lopes, DM. Analyses of answers presented by children with and without specific language impairment. Pro Fono Rev Atual Cien, Vol. 18, No. 3, pp. 229-238, ISSN 0104-5687 - 20.
. 2012. Comparing the use of the Childhood Autism Rating Scale and the Autism Behavior Checklist protocols to identify and characterize autistic individuals. J Soc Bras Fonoaudiol. .,Santos ,T.H.F .,Barbosa ,M.R. P .,Pimentel ,A.G.L .,Lacerda ,C.A .,Balestro ,J.I Amato ,C.A.H 24 1 December,2012 ),104 106 ,2179-6491 Santos, T.H.F., Barbosa, M.R. P., Pimentel, A.G.L., Lacerda, C.A., Balestro, J.I., Amato, C.A.H. 2012. Comparing the use of the Childhood Autism Rating Scale and the Autism Behavior Checklist protocols to identify and characterize autistic individuals. J Soc Bras Fonoaudiol. Vol. 24, No. 1 (December, 2012), pp. 104-6, ISSN 2179-6491 - 21.
Springhouse . Enfermagem psiquiátrica- Incrivelmente fácil.2006 . 1ª Ed., Guanabara-Koogan,978-8-52770-429-8 Rio de Janeiro, Brazil.Springhouse. Enfermagem psiquiátrica – Incrivelmente fácil. 2006. 1ª Ed., Guanabara-Koogan, ISBN 9788527704298, Rio de Janeiro, Brazil. - 22.
. 2007. The First Year Inventory: Retrospective Parent Responses to a Questionnaire Designed to Identify One-Year-Olds at Risk for Autism. J Autism Dev Disord. .,Watson ,L.R .,Baranek ,G.T .,Crais ,E.R .,Reznik ,J.S . &Dykstra ,J Perryman ,T 37 1 January,2007 ),49 61 ,0162-3257 Watson, L.R., Baranek, G.T., Crais, E.R., Reznik, J.S., Dykstra, J. & Perryman, T. 2007. The First Year Inventory: Retrospective Parent Responses to a Questionnaire Designed to Identify One-Year-Olds at Risk for Autism. J Autism Dev Disord. Vol. 37, No. 1 (January, 2007), pp. 49–61, ISSN 0162-3257 - 23.
World Health Organization World Report: Disabilities Geneva (CH): World Health Organization,2011 World Health Organization World Report: Disabilities. Geneva (CH): World Health Organization, 2011. - 24.
Volkmar, Fred; Chawarska, Kasia and Klin Autim in Infancy and Early Childhood. Annu. Rev. Psychol.2005 56:315–36 doi: 10.1146/annurev.psych.56.091103.070159. pp:315-572Volkmar, Fred; Chawarska, Kasia and Klin, Ami. Autim in Infancy and Early Childhood. Annu. Rev. Psychol. 2005. 56:315–36 doi: 10.1146/annurev.psych.56.091103.070159. pp:315-572