Pragmatic Language Outcomes Following Social Communication Intervention for Children with High Functioning Autism Spectrum Disorder or Social Pragmatic Communication Disorder: Evaluation of a Novel Preference-Based Measure

Background: Children with High-Functioning Autism Spectrum Disorder (HFASD) have significant, heterogeneous pragmatic (social use of language) deficits and may have structural language impairments (Landa 2000, Volden et al 2009). Children with Social (Pragmatic) Communication Disorder (SPCD) have similar communication difficulties but do not meet diagnostic criteria for ASD (DSMV). Pragmatic/language deficits have long-term effects on employment success and mental health (Howlin et al 2004, Mayes & Calhoun 2011). Speech-language therapy (SLT) may prevent adverse consequences in both groups but there are few trials of pragmatics intervention (Gerber et al 2012). A manualized intervention, the Social Communication Intervention Programme (SCIP) (Adams & Gaile 2015) provides relevant content but estimates of changes in pragmatics are required for trial purposes. Given pragmatics heterogeneity at baseline, a way forward is to adopt an individualized approach to language/pragmatics therapy planning and a preference-based outcome measure.

Objectives: To study the variability of a modified goal–attainment scaling method (SCIP- GAS) as primary endpoint to SCIP intervention for children with HFASD or SPCD; to study the relationship between parent outcome commentaries and SCIP-GAS scores.

Methods: 15 UK SLTs identified twenty children with pragmatics/language needs. Inclusion: aged 6-11; social communication difficulties on pragmatics checklist (Adams et al 2012); normal range non-verbal IQ. Baseline: Children’s Communication Checklist-2 (CCC-2) (Bishop 2003); Social Language Development Test (SLDT) (Bowers et al 2017) (secondary outcome); Module 3 ADOS-2 (Lord et al 2012). A researcher independent of the intervention completed testing. SLTs received SCIP training and six hours of supervision from a Research SLT (RSLT). Children received 20 direct SCIP therapy sessions. Primary endpoint SCIP-GAS: At Time 1 (T1) parents provided three prioritized communication goals. Expected steps in each goal were defined by RSLT at T1. After intervention (T2) parents and SLTs (independently) rated each goal compared to T1 baseline ability on a scale of -1 (got worse) to + 5 (greatly exceeded). Parents provided a commentary on outcomes. Two RSLTs compared parent comments with SCIP-GAS scores to derive guidance about clinical significance for a future trial.

Results: All children met criteria for communication impairment on CCC-2; 11 met ADOS criteria for ASD; 9 were defined as SPCD. All children except one progressed on SCIP-GAS parent outcomes (mean 6.8, SD 3.1). All children progressed on practitioner SCIP-GAS ratings (mean 8.6, SD 2.2). Clinical significance was associated with SCIP-GAS scores of 6-9; high clinical significance with scores above 9. SLDT: Making Inferences scores were significantly higher at T2; there were no T1-T2 differences on Multiple Interpretations or Supporting Peers.

Conclusions: A preference-based pragmatics measure showed feasibility as an outcome following social communication intervention for children who have HFASD and SPCD. Estimates of sample size and clinical significance for a full trial have been made.

This abstract presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG- 1014-35011). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care