Relations Between Basic Indices of Attention to Social Events and Language in Children with Autism Spectrum Disorders and Typically Developing Children

Background:  Basic attention and intersensory processing skills are foundations for typical social-communicative development (Bahrick & Lickliter, 2012) and children with autism spectrum disorders (ASD) show impairments in these skills (Bebko etal., 2006; Bahrick & Todd, 2012). The Multisensory Attention Assessment Protocol (MAAP; Bahrick etal., 2011) assesses four basic indices of attention (disengagement, orienting, maintenance, intersensory processing) to audiovisual events.  It distinguishes between typically developing (TD) children and children with ASD in attention maintenance and disengagement to look to social events and can identify a subgroup of ASDs (ASD-FTD; those who fail to disengage from a competing central stimulus) who show enhanced attention deficits and symptom severity (Bahrick etal., 2012).

Objectives:  We investigated relations between basic attention indices (MAAP) and language functioning (Mullen Scales of Early Learning, 1995) in ASD and TD children. Given that intersensory processing and attention to faces are critical for learning language (Bahrick & Lickliter, 2012; Bahrick & Todd, 2012) we expected that indices of attention to social events would predict concurrent language functioning in TD and ASD children. Further, we predicted that ASD-FTD children would show more impaired language functioning than ASDs and TDs who show no failures to disengage.

Methods:  Children with ASD (N=21; M=4.23 years, SD=.86), who passed ADOS cutoffs, and TD children (N=21; M=2.47, SD=.50), matched on Mullen nonverbal adjusted age (ASD: M=2.61, SD=1.29; TD: M=2.98, SD=.85) participated. In the MAAP, trials of a 3s central visual event were immediately followed by two side-by-side peripheral events (10s), one moving in synchrony with its natural soundtrack.  Peripheral events were either social (two women speaking) or nonsocial (two objects striking a surface). Disengagement (latency to shift to peripheral event with the competing central event on), orienting (latency to shift to peripheral event with the central event off), intersensory processing (proportion of looking to sound-synchronous event), and attention maintenance (proportion of trial looking to peripheral events) were calculated. 

Results:  For the entire sample together (N=42), for social (but not nonsocial) events, faster latencies to disengage and orient, and higher intersensory processing and attention maintenance were associated with better Mullen Receptive and Expressive Language raw scores (r’s >.30, p’s<.05).  For TDs, attention maintenance and intersensory processing of social events predicted Expressive Language. For ASDs, attention maintenance and latency to disengage for social events predicted Expressive Language.  Further, the ASD-FTD subgroup showed lower Receptive and Expressive Language than ASDs and TDs who showed no failures to disengage (p’s<.004).

Conclusions:  Basic attention and intersensory processing of social, but not nonsocial, events assessed by the MAAP predicted concurrent Receptive and Expressive language for TD and ASD children. Further, a subgroup of children with ASD who failed to disengage to peripheral events and showed the greatest attention and intersensory processing impairments, showed more severe language impairments compared to TD and other ASD children. Findings demonstrate performance on the MAAP is predictive of social-communicative functioning, highlighting links between social attention and language.  Further, this simple method can identify a subgroup of individuals with ASD who are most in need of intervention.