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Autism and SLI: diagnostic distinctions

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Autism and specific language impairment both involve problems with language and communcation, so how are they distinguished? This slide show accompanies a youtube video for the RALLI campaign.

Publicada em: Saúde e medicina
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Autism and SLI: diagnostic distinctions

  1. 1. Autism and specific languageimpairment: diagnostic distinctions Dorothy V. M. Bishop Dorothy V. M. Bishop Dorothy V. M. Bishop
  2. 2. The traditional view SpecificAutistic Languagedisorder Impairment
  3. 3. Textbook view of specific language impairment (SLI)• Selective problem with language development• Other aspects of development – self help skills, socialisation, nonverbal abilities, motor skills – all developing normally• Overall impression is that language is like that of a much younger child
  4. 4. Textbook view of autistic disorder• Difficulties are pervasive and affect three areas of development (the autism ‘triad’) • Communication • Social interaction • Behaviour/interests – repetitive and restricted• Qualitative differences from typical development
  5. 5. The autistic triad socialcommunication autistic disorder interests
  6. 6. However!Some children don’t fit neatly into these categories
  7. 7. Evidence for development of autistic features in some children with receptive language impairmentsBartak, L., Rutter, M., & Cox, A. (1975). A comparative study of infantileautism and specific developmental receptive language disorder: I. Thechildren. British Journal of Psychiatry, 126, 127-145.
  8. 8. Selection criteria: Bartak et al, 1975 • Impaired verbal comprehension • Boys, aged 5-10 years • Nonverbal IQ of 70+ • Normal hearing • No neurological disease 19 23 receptive 5 mixedautistic languagedisorder disorder
  9. 9. proportionVery similar language findings for autistic and language-impaired
  10. 10. Bartak et al: nonlanguage autistic receptive SLI lacks imaginative play attachment to odd objects resistance to change ritualistic activities quasi-obsessional activities difficult adaptation to new situations 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 proportionBut very different behaviour findings for autistic and language-impaired
  11. 11. Bartak et al: language use autistic receptive SLI never used gesture fails to respond to questions no spontaneous chat inappropriate remarks metaphorical language (ever) stereotyped utterances (ever) echolalia (ever) pronoun reversal (ever) 0 0.2 0.4 0.6 0.8 1 proportionAnd very different in language use for autistic and language-impaired
  12. 12. autistic-like behaviours seen in SLI at follow-up autistic receptive SLI rituals lacks imaginative play stereotyped mannerisms fails to show sympathy no group participation metaphorical language stereotyped utterances 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 proportionBut SLI start to show more autistic behaviours at follow-up in middle childhoodCantwell, D., et al. (1989). Infantile autism and developmental receptive dysphasia: acomparative follow-up into middle childhood. J Autism and Developmental Disorders, 19, 19-31.
  13. 13. Howlin et al, 2000 • Follow-up of original sample into adulthood • Some of the original language-impaired sample show more evidence of social and behavioural problems, similar to autismHowlin, P., Mawhood, L., & Rutter, M. (2000). Autism and developmental receptivelanguage disorder - a comparative follow-up in early adult life. II. Social, behavioural, andpsychiatric outcomes. Journal of Child Psychology and Psychiatry, 41, 561-578.
  14. 14. Example of man with receptive SLI diagnosis in childhood"In all aspects of self-care he was entirely independent andhe could use a telephone and manage his financeshimself. Most of his spare time was spent pursuing hispreoccupation with buses and his less intense interest inCB radio. He spent a lot of time hanging around busstations, going on bus journeys when he could afford it,and looking at bus magazines. His social overtures weresomewhat limited and he would speak if spoken to butwould not make the first move. There were two friendsthat he visited regularly; one shared his interest in buses,the other was interested in CB radio. These relationshipswere clearly selective, did involve some apparent pleasurein each others company, and some sharing ofconfidences, but there was still nonetheless a slightly oddquality to them because of their restricted range ofinterests. He did not appear to be lonely." (p. 384).
  15. 15. Autistic-like impairments in communication and socialinteraction in some cases of language impairment
  16. 16. Bishop & Norbury, 2002 • Study of children receiving special educational provision for language/communication disorders • Direct observation, language assessment and parental report • Significant numbers of children with autistic-like language features but who did not meet criteria for autism on ‘gold standard’ autism assessmentsBishop, D. V. M., & Norbury, C. F. (2002). Exploring the borderlands of autisticdisorder and specific language impairment: A study using standardised diagnosticinstruments. Journal of Child Psychology and Psychiatry, 43, 917-929.
  17. 17. Fractionating the autistic triadcommunication social autistic disorder Elements of the triad that form autistic disorder can be dissociated: many children with just one or two areas of difficulty interests
  18. 18. Diagnostic dilemmasq Diagnosis complicated by: q Changing clinical picture with age q Difficulties in evaluating autistic-like symptoms in children with receptive language problems
  19. 19. Diagnostic dilemmas, ctd.q Categorical diagnosis not well suited to capturing clinical variationq Textbook cases of SLI and autism are easy to recognise but many children less clearcutq No clear dividing line between SLI and autismq Current deliberations for revisions of DSM and ICD diagnostic classifications:  Considering removing requirement of third triad element (repetitive behaviour) for ASD diagnosis  Considering adding new category of ‘social communication impairment’ that would incorporate intermediate cases