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Research and Publications

Grinker, R., Chambers, N., Njongwe, N., Lagman, A., Guthrie, W., Stronach, S., Richard, B., Kauchali, S., Killian, B., Chhagan, M., Yucel, F., Kudumu, M., Barker-Cummings, C., Grether, J., & Wetherby, A. (in press). “Communities” in community engagement: Lessons from autism research in South Africa and South Korea. Autism Research.
Abstract:  Little research has been conducted on behavioral characteristics of children with ASD from diverse cultures within the US or from countries outside of the US or Europe, with little reliable information yet reported from developing countries. We describe the process used to engage diverse communities in ASD research in two community-based research projects—an epidemiological investigation of 7-12 year olds in South Korea and the Early Autism Project, an ASD detection program for 18-36 month old Zulu-speaking children in South Africa. Despite the differences in wealth between these communities, ASD is under-diagnosed in both settings, generally not reported in clinical or educational records. Moreover, in both countries there is low availability of services. In both cases, local knowledge helped researchers to address both ethnographic as well as practical problems. Researchers identified the ways in which these communities generate and negotiate the cultural meanings of developmental disorders. Researchers incorporated that knowledge as they engaged communities in a research protocol, adapted and translated screening and diagnostic tools, and developed methods for screening, evaluating, and diagnosing children with ASD.


 

Barber, A., Wetherby, A., & Chambers, N. (in press). Brief report: Repetitive behaviors in young children with autism spectrum disorder and developmentally similar peers: A follow up to Watt et al. (2008). Journal of Autism and Developmental Disorders.
Abstract:  The present study extended the findings of Watt et al. (J Autism Dev Disord 38:1518-1533, 2008) by investigating repetitive and stereotyped behaviors (RSB) demonstrated by children (n = 50) and typical development (TD; n = 50) matched on developmental age, gender, and parents' education level. RSB were coded from videotaped Communication and Symbolic Behavior Scales Behavior Samples (Wetherby and Prizant 2002) using the Noldus Pro Observer© video software. Children with ASD demonstrated significantly higher frequencies of RSB with body objects excluding categories involving banging or tapping objects or surfaces. Behaviors demonstrated by both groups indicated overlapping RSB profiles at this age. These findings highlight the significance of RSB in the early identification and support the need for future research to further determine ASD-specific RSB.
Link to PubMed


 

Salisbury, C., Woods, J & Copeland, T. (in press). Provider perspectives on adopting and using family centered services in natural environments.  Topics in Early Childhood Special Education. 30(3), 132-147.
Abstract:  An exploratory case study was undertaken to investigate the perspectives and experiences of six early intervention providers as they adopted and implemented a collaborative consultation approach to home visiting in urban neighborhoods. Survey, semistructured interview, and focus group methods were used over a 2-year period to obtain data about provider perspectives about the home visiting approach and their experiences in implementing it with parents of infants and toddlers receiving Part C services. The intensity of provider concerns about the use of collaborative consultation and routines-based, family-centered home visiting practices improved at posttest. Providers attributed these changes in large part to the culture of the organization as a learning community and its ongoing administrative support for reflective practice and problem solving about implementation issues. Providers also identified specific factors, such as time and opportunity to practice and problem solving with feedback, as having an impact on their ability to move forward in adopting and using family-centered home visiting practices. Challenges were identified related to home visiting generally, and a consultative approach specifically, in complex urban family settings. Implications for research and practice are discussed.



Woods, J. & Brown, J. (2011).  Integrating family capacity-buidling and child outcomes to support social communication development in young children with autism spectrum disorders. Topics in Language Disorders, 31(3), 235-246.
Abstract:  The focus of this article is on the transactional relationship of research and practice for speech–language pathologists serving infants and toddlers with and at risk for autism spectrum disorder in Individuals with Disabilities Education Act supported early intervention. Specifically, information is provided on (a) the relationship between parent-implemented social communication interventions for young children with autism spectrum disorder and family-centered practice; (b) the importance of family-centered practice to capacity building with families within their natural environments; and (c) adult learning principles that build the family's capacity to meet their child's social communication needs. Examples from previous and current research, as well as implications for future research, are provided.



Brown, J.A., & Woods, J.J. (2011). Performance feedback to support instruction with speech-language pathology students on a family-centered interview process. Infants and Young Children, 24(1), 42-55.
Abstract:  Gaining knowledge and skills in the practice of family-centered assessment procedures is an important component of the preservice education for early intervention providers. The purpose of this study was to examine the effectiveness of systematic instruction on speech-language pathology (SLP) practicum students' implementation of family-centered interview procedures guided by ethnographic principles. A single subject modified AB design with replication across participants was used to examine the effects of the instruction, including a didactic presentation, mock interviews, brief student reflection, and e-mailed graphic feedback with verbatim examples, on each student's use of ethnographic interview strategies. Results indicated a functional relationship between the instruction and the students' implementation of the interview process. The largest gains in exemplar strategy use were demonstrated following performance feedback e-mails consisting of graphs and verbatim examples. Social validity measures were rated highly from both the student participants and the parents who were interviewed. Systematic instruction in ethnographic principles can increase students' competency in conducting family-centered, culturally responsive interviews. Additionally, the use of graphic performance feedback with verbatim examples shows promise as a way of increasing strategy use.



Salisbury, C., Cambray-Engstrom, Elizabeth, & Woods, J (2010). Providers’ reported and actual use of coaching strategies in natural environments, Topics in Early Childhood Special Education.
Abstract:  This case study examined the agreement between reported and actual use of coaching strategies based on home visit data collected on a diverse sample of providers and families. Paired videotape and contact note data of and from providers during home visits were collected over a six month period and analyzed using structured protocols. Results of both descriptive and correlation analyses indicated providers used a range of coaching strategies, tended to underreport (under-represent) their efforts on contact notes, and demonstrated practices that were primarily collaborative and family-centered. Agreement between actual and reported use of coaching strategies was variable and did not support our anticipated finding. Implications for future research and practice are discussed.



Shumway, S. & Wetherby, A. (2009). Communicative acts of children with autism spectrum disorders in the second year of life. Journal of Speech, Language, Hearing Research, 52, 1139-1156.
Abstract:  PURPOSE: To examine the communicative profiles of children with autism spectrum disorders (ASD) in the second year of life. METHOD: Communicative acts were examined in 125 children 18 to 24 months of age: 50 later diagnosed with ASD; 25 with developmental delays (DD); and 50 with typical development (TD). Precise measures of rate, functions, and means of communication were obtained through systematic observation of videotaped behavior samples from the Communication and Symbolic Behavior Scales Developmental Profile (A. Wetherby & B. Prizant, 2002). RESULTS: Children with ASD communicated at a significantly lower rate than children with DD and TD. The ASD group used a significantly lower proportion of acts for joint attention and a significantly lower proportion of deictic gestures with a reliance on more primitive gestures compared with the DD and TD groups. Children with ASD who did communicate for joint attention were as likely as other children to coordinate vocalizations, eye gaze, and gestures. Rate of communicative acts and joint attention were the strongest predictors of verbal outcome at age 3. CONCLUSION: By 18 to 24 months of age, children later diagnosed with ASD showed a unique profile of communication, with core deficits in communication rate, joint attention, and communicative gestures.
Link to PubMed



Tager-Flusberg, H., Rogers, S., Cooper, J., Landa, R., Lord, C., Paul, R., Rice, M., Stoel-Gammon, C., Wetherby, A., & Yoder, P. (2009). Defining spoken language benchmarks and selecting measures of expressive language development for young children with autism spectrum disorders. Journal of Speech, Language, Hearing Research, 52, 643-652.
Abstract:  PURPOSE: The aims of this article are twofold: (a) to offer a set of recommended measures that can be used for evaluating the efficacy of interventions that target spoken language acquisition as part of treatment research studies or for use in applied settings and (b) to propose and define a common terminology for describing levels of spoken language ability in the expressive modality and to set benchmarks for determining a child's language level in order to establish a framework for comparing outcomes across intervention studies. METHOD: The National Institute on Deafness and Other Communication Disorders assembled a group of researchers with interests and experience in the study of language development and disorders in young children with autism spectrum disorders. The group worked for 18 months through a series of conference calls and correspondence, culminating in a meeting held in December 2007 to achieve consensus on these aims. RESULTS: The authors recommend moving away from using the term functional speech, replacing it with a developmental framework. Rather, they recommend multiple sources of information to define language phases, including natural language samples, parent report, and standardized measures. They also provide guidelines and objective criteria for defining children's spoken language expression in three major phases that correspond to developmental levels between 12 and 48 months of age.
Link to PubMed



Woods, J. &  Snyder, P. (2009). Interdisciplinary doctoral leadership training in early intervention: Research and practice in the 21st century.  Infants and Young Children. 22(1), 32-43.
Abstract:  This article examines issues associated with the preparation of doctoral-level personnel to assume interdisciplinary scholarship and leadership roles in early intervention (EI). Following a review of national reports focused on EI doctoral leadership training, the preparation of educational researchers, and interdisciplinary doctoral programs in rehabilitation sciences, we offer perspectives about interdisciplinary doctoral preparation in EI for the 21st century.



Wetherby, A., Brosnan-Maddox, S., Peace, V., & Newton, L. (2008). Validation of the Infant-Toddler Checklist as a broadband screener for autism spectrum disorders from 9 to 24 months of age. Autism, 12 (5), 455-479.
Abstract:  The purpose of this study was to examine the validity of the Infant-Toddler Checklist (ITC) as a broadband screener to detect infants and toddlers with communication delays including ASD from a general population sample. The ITC was used to screen 5,385 children from 6–24 months of age. Three surveillance methods were used to detect children with possible ASD and diagnosis was confirmed at a mean age of 3 years. Positive and negative predictive values support the validity of the ITC for children 9–24 months of age but not 6–8 months. Of 60 children diagnosed with ASD, 56 had a positive screen on the ITC; parent concern increased with child age from less than half reporting concern from 6–15 months and nearly three-fourths at 21–24 months. Implications for improving early detection of ASD are discussed.
Link to PubMed



Morgan, L., Wetherby, A., & Barber, A. (2008). Repetitive and stereotyped movements in children with autism spectrum disorders late in the second year of life. Journal of Childhood Psychology and Psychiatry, 49, 826-837.
Abstract:  OBJECTIVES: The purpose of this study was to examine group differences and relationships with later developmental level and autism symptoms using a new clinical tool developed to measure repetitive and stereotyped movements (RSM) in young children. METHOD: Videotaped behavior samples using the Communication and Symbolic Behavior Scales Developmental Profile (CSBS; Wetherby & Prizant, 2002) were coded for children with autism spectrum disorders (ASD; n = 50), developmental delays without ASD (DD; n = 25), and typical development (TD; n = 50) between 18 and 24 months of age. RESULTS: Children with ASD demonstrated significantly higher rate and larger inventory of RSM with objects and body during a systematic behavior sample than both the DD and TD groups. Measures of RSM were related to concurrent measures of social communication and predicted developmental outcomes and autism symptoms in the fourth year for the ASD group. None of the correlations between RSM and autism symptoms remained significant when controlling for CSBS Symbolic level. RSM with objects predicted unique variance in the severity of autism symptoms in the fourth year beyond that predicted by social communication measures alone. CONCLUSIONS: This study provides support for the diagnostic significance of RSM in children under 24 months of age and documents the utility of this RSM measurement tool as a companion to the CSBS.
Link to PubMed



Watt, N., Wetherby, A., Barber, A., & Morgan, L. (2008) Repetitive and stereotyped behaviors in children with autism spectrum disorders in the second year of life. Journal of Autism and Developmental Disorders, 38, 1518-1533.
Abstract:  This study examined repetitive and stereotyped behaviors (RSB) in children with autism spectrum disorders (ASD, n = 50), developmental delays without ASD (DD; n = 25) and typical development (TD, n = 50) between 18 and 24 months of age. Children with ASD demonstrated significantly higher frequency and longer duration of RSB with objects, body, and sensory behaviors during a systematic behavior sample than both the DD and TD groups. RSB with objects were related to concurrent measures of symbolic capacity and social competence in the second year and predicted developmental outcomes as well as severity of autism symptoms at 3 years in children with communication delays. RSB in the second year appear to be important for early identification and prediction of developmental outcomes.
Link to PubMed



Wetherby, A., Watt, N., Morgan, L., & Shumway, S. (2007). Social communication profiles of children with autism spectrum disorders in the second year of life. Journal of Autism and Developmental Disorders, 37, 960-975.
Abstract:  This study examined social communication profiles from behavior samples videotaped between 18 and 24 months of age in three groups of children: 50 with autism spectrum disorders (ASD), 23 with developmental delays (DD), and 50 with typical development (TD). The ASD group scored significantly lower than the DD group on 5 social communication measures and the TD group on all 14 measures, indicating distinct profiles late in the second year. Understanding was the strongest predictor of developmental level and behavior regulation and inventory of gestures were the strongest predictors of autism symptoms at 3 years of age. The predictive relations suggest five pivotal skills late in the second year that have a cascading effect on outcomes of children with ASD.
Link to PubMed
 



Watt, N., Wetherby, A., & Shumway, S. (2006). Prelinguistic predictors of language outcome at three years of age.  Journal of Speech, Language, & Hearing Research, 49, 1224-1237.
Abstract:  Purpose: The purpose of this study was to examine the predictive validity of a collection of prelinguistic skills measured longitudinally in the second year of life to language outcome in the third year in children with typical language development. Method: A collection of prelinguistic skills was assessed in 160 children early (M=14.31months; SD=1.36) and late (M=19.76 months; SD=1.16) in the second year using the Communication and Symbolic Behavior Scales Developmental Profile Behavior Sample (CSBS DP, Wetherby & Prizant, 2002). The relationship between the prelinguistic skills and receptive and expressive language near the third birthday was examined. Results: Significant correlations were observed between many prelinguistic skills and language outcome. Regression analyses indicated that comprehension both early and late contributed unique variance to receptive and expressive language outcome. In addition, early in the second year inventory of conventional gestures contributed uniquely to receptive language outcome, and acts for joint attention contributed uniquely to expressive outcome. Late in the second year, inventory of consonants contributed uniquely to expressive outcome. Conclusions: The findings demonstrate continuity between prelinguistic and linguistic skills and how individual differences in a number of prelinguistic skills contribute collectively and uniquely to language outcome in typically developing children.
Link to PubMed



Wetherby, A. & Woods, J. (2006) Early social interaction project for children with autism spectrum disorders beginning in the second year of life: A preliminary study. Topics in Early Childhood Special Education, 26(2), 67-82.
Abstract:  The Early Social Interaction (ESI) Project (Woods & Wetherby, 2003) was designed to apply the recommendations of the National Research Council (2001) to toddlers with autism spectrum disorders (ASD) by using a parent-implemented intervention that (a) embeds naturalistic teaching strategies in everyday routines and (b) is compatible with the mandate of the Individuals with Disabilities Education Improvement Act (IDEIA) of 2004, Part C. This quasi-experimental study is a preliminary effort by the authors to evaluate the effects of ESI on the social communication outcomes for a group of 17 children with ASD who entered ESI at age 2 years. The results indicated significant improvement on 11 of 13 social communication measures. The researchers compared the ESI group with a contrast group of 18 children with ASD who entered early intervention at age 3 years. The contrast group's results were comparable to those of the ESI postintervention group on communicative means and play, but the contrast group as a whole demonstrated significantly poorer performance on all other social communication measures. These findings offer promise for the use of parent-implemented interventions in promoting social communication for toddlers with ASD.



Kashinath, S., Woods, J., & Goldstein, H. (2006).  Enhancing generalized teaching strategy use in daily routines by parents of children with autism. Journal of Speech, Language, Hearing Research, 49, 466-485.
Abstract:  PURPOSE: The purpose of this study was to examine the effects of facilitating generalized use of teaching strategies by parents of children with autism within daily routines. METHOD: Five preschool children with autism participated in intervention with a parent within daily routines in the family's home. Parents learned to include 2 teaching strategies in target routines to address their child's communication objectives. Parent-child interactions in routines were videotaped for data coding and analysis. Proactive programming of generalization occurred by systematic selection of intervention routines and by embedding intervention in multiple routines. Generalization data were collected by measuring strategy use in untrained routines. A multiple baseline design across teaching strategies was used to assess experimental effects. RESULTS:
All parents demonstrated proficient use of teaching strategies and generalized their use across routines. The intervention had positive effects on child communication outcomes. All parents perceived the intervention to be beneficial. CONCLUSION: Results from this study add to the limited body of evidence supporting parent-implemented interventions in natural environments with young children with autism spectrum disorder. Additional research that replicates this approach with children of varying ages and disabilities and families with diverse characteristics is needed to support the generality of these findings.
Link to Pub Med



Wetherby, A., Woods, J., Allen, L., Cleary, J., Dickinson, H., & Lord, C. (2004).  Early indicators of autism spectrum disorders in the second year of life.  Journal of Autism and Developmental Disorders, 34, 473-493.
Abstract:  Three groups of 18 children were selected for this study, one group with autism spectrum disorders (ASD), one group with developmental delay in which ASD was ruled out (DD), and one group with typical development (TD), from a pool of 3,026 children who were screened with the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP, Wetherby & Prizant, 2002) Infant-Toddler Checklist under 24 months of age.  The CSBS DP Behavior Sample was videotaped on selected children as a second-level evaluation during the second year of life.  The Infant-Toddler Checklist had a sensitivity and specificity of 88.9% for this sample of children.  Significant group differences were found on the Infant-Toddler Checklist and the Behavior Sample, however, these differences did not distinguish children with ASD and DD with high accuracy.  The videotapes of the Behavior Sample were reanalyzed to identify red flags of ASD.  Nine red flags differentiated children in the ASD group from both the DD and TD groups and four red flags differentiated children in the ASD Group from the TD group but not the DD group. These 13 red flags were found to discriminate the three groups with a correct classification rate of 94.4%.
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Woods, J., Kashinath, S. & Goldstein, H. (2004), Effects of embedding caregiver implemented teaching strategies in daily routines on children’s communication outcomes. Journal of Early Intervention, 26, 175-193.
Abstract:  Effects of instructing caregivers to implement teaching strategies within daily routines were investigated using a multiple baseline design across caregiver strategies and participants. Four toddlers with developmental delays participated in intervention conducted by their primary caregiver within the family's preferred play routines. To assess generalization, caregiver teaching strategy use was observed during other caregiving and outdoor play routines. Caregiver strategy use increased subsequent to instruction within indoor play routines. Generalization to other routines, however, was limited in three of the four dyads. All four children demonstrated gains in communication objectives and test scores across multiple developmental domains improved. This study demonstrates the viability of teaching caregivers to embed effective teaching strategies within daily routines to improve the communication skills of toddlers.



Wetherby, A., Goldstein, H., Cleary, J., Allen, L., & Kublin, K. (2003).  Early identification of children with communication delays:  Concurrent and Predictive Validity of the CSBS Developmental Profile.  Infants and Young Children, 16, 161-174.
Abstract:  Communication disorders in infants and toddlers are significantly under-identified, prohibiting early intervention for many children and families who might benefit from services.  Researchers have sought to identify earlier and more accurate predictors of later language development.  This article describes the FIRST WORDS Project evaluation model for identifying children less than 24 months of age who are at risk for communication disorders using the CSBS Developmental Profile (CSBS DP, Wetherby & Prizant, 1998; 2002).  Children were first screened with a brief parent-report checklist distributed by healthcare and childcare providers and other community agencies serving families of young children.  Children were followed up with a more in-depth parent report tool and face-to-face evaluation.  This paper presents the results of two studies.  The first study examined the concurrent validity of the CSBS DP based on screening and evaluation with the CSBS DP for 232 children between 12 and 24 months of age.   The second study examined the predictive validity of the CSBS DP based on follow-up testing of receptive and expressive language for 246 children at 2 years of age and 108 children at 3 years of age.  These findings support the use of prelinguistic predictors and the important role of the family in screening and evaluation to improve early identification.



Wetherby, A., Allen, L., Cleary, J., Kublin, K., & Goldstein, H. (2002).  Validity and reliability of the Communication and Symbolic Behavior Scales Developmental Profile with very young children.  Journal of Speech, Language, & Hearing Research, 45, 1202-1219.
Abstract:  Three studies were conducted to evaluate the validity and reliability of the three measures of the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP)— 1) a one-page parent-report Checklist; 2) a four-page follow-up Caregiver Questionnaire (CQ); and 3) a Behavior Sample (BS), which is a face-to-face evaluation of the child.  Participants for these studies were drawn from a pool of 603 children for the Checklist and CQ (ages 6-24 months) and 364 children for the BS (ages 12-24 months).  Study 1 examined the concurrent relationship of standard scores for the Checklist, CQ, and BS.  Large correlations were found between the Checklist and CQ and moderate to large correlations were found between each of the parent report tools and the BS.  Study 2 examined test-retest stability by comparing the raw and standard scores over a 4-month retest interval.  The results indicated significantly greater retest raw scores but no significant differences between standard scores from test to retest for the Checklist, CQ and BS, providing evidence that the three measures detect growth over short periods but produce relatively stable rankings of children.  Study 3 examined the concurrent and predictive relationship of the three CSBS DP measures and children’s outcomes on standardized tests of receptive and expressive language at two years of age.  Moderate to large correlations were found between all of the CSBS DP measures and language outcomes at two.  Multiple regression analyses indicated that the three composites were a significant predictor of receptive and expressive language outcomes.  The findings from these three studies support the use of the CSBS DP as a screening and evaluation tool for identifying children with developmental delays at 12 to 24 months of age.
Link to PubMed