Brief Communication
Comunicação Breve
CoDAS 2013;25(4):388-90
Cibelle Albuquerque de la Higuera Amato1
Thaís Helena Ferreira Santos1
Milene Rossi Pereira Barbosa1
Fernanda Dreux Miranda Fernandes1
Descritores
Linguagem Transtorno autístico Estudos de intervenção Criança Adolescente
Keywords
Language Autistic disorder Intervention studies Child Adolescent
Correspondence address:
Fernanda Dreux Miranda Fernandes R. Cipotânea, 51, Cidade Universitária, São Paulo (SP), Brazil, CEP: 05360-160. E-mail: fernandadreux@usp.br
Received: 07/31/2013
Accepted: 08/05/2013
Study carried out at the Research Laboratory in Speech-Language Pathology in Autism Spectrum Disorders, Department of Physical therapy, Speech-language pathology and audiology and Ocupational therapy, School of Medicine, Universidade de São Paulo – USP – Sao Paulo (SP), Brazil
(1) Department of Physical therapy, Speech-language pathology and audiology and Ocupational therapy, School of Medicine, Universidade de São Paulo – USP – Sao Paulo (SP), Brazil.
Financial support: Fapesp #2011/10193-5.
Conlict of interests: nothing to declare.
Longitudinal study of language therapy in 142 children
and adolescents with autism spectrum disorders
Estudo longitudinal da terapia de linguagem de 142 crianças
e adolescentes com distúrbios do espectro do autismo
ABSTRACT
The last 25 years produced important changes in the Speech Language intervention for children with Autism Spectrum Disorders in the whole world. They refer to diagnostic criteria, research methods and systematization of data about diagnostic and intervention processes. In this context, the irst results about the use of a recording system used on a specialized service highlights the importance of including information about each intervention process on reliable and accessible systems. This procedure allows the association among several types of data and studies with large populations, something that is not usual in the ield.
RESUMO
389 Language therapy in autism spectrum disorders
CoDAS 2013;25(4):388-90
Figure 1. Association between age at therapy onset and the number of indexes of progress in 2 years of speech-language therapy
18
16
14
12
10
8
6
4
2
0
age
progress
1 6 11 16 21 26 31 36 41 46 51 56 61 66 71 76 81 86 91 96 101 106 111 116 121 126 131 136 141
INTRODUCTION
The last 25 years produced important changes in speech language intervention with children with autism spectrum di-sorders (ASD) in the whole world. The irst Brazilian service of language therapy in childhood psychiatry is completing its 27th year and relects this evolution in the Brazilian reality.
The implications of diagnostic criteria supported mainly by clinical observation has been widely discussed, as the differential diagnosis within the autism spectrum. Most of the studies that describe these pictures point out to the need for multidiciplinary perspectives for the diagnosis(1). Methodological issues in these studies are frequently men-tioned(2). The need for systematizaton of data about diagnosis and intervention processes is mentioned in analyses about the World Report on Disabilities published by the World Health Organization in 2012(3,4).
In this context, this brief report presents the irst results of the use of a data recording system used on a specialized service.
METHODS
The ethical committee of the School of Medicine, Universidade de São Paulo authorized the use of the databases of the Research Laboratory on Speech-Language Therapy in ASD (LIF-DEA) of the School of Medicine, Universidade de São Paulo, Sao Paulo, Brazil (protocol #228/11).
As a preliminary study, we sought to identify the association between chronological age at treatment onset and the number of progress indexes observed in the last 24 months (i.e. the last four semestral assessments). Data refers to 142 participants
with ages ranging from 2 to 16 years about which there were complete sets of information. Progress indexes conside-red were: increase on the scores of each of the seven observed areas of the Social-Cognitive Performance, improvement in the number of communicative initiatives, larger proportion of use of the communicative space, improvement in communication’s interactivity, and increase in the proportion of use of vocal and verbal communication.
RESULTS
The results presented in Figure 1 show a general inversely proportional relation between both sets of information. It means that children who started language therapy in the earlier ages presented more indexes of progress than older children and adolescents. However, it is evident that this is not an absolute tendency; it is possible to observe that there are adolescents with up to the maximum possible indexes and children that started therapy processes at 4 years but didn’t present progress according to the proposed criteria.
Table 1 presents data about the result of the t-Student test applied to the averages of progress indexes observed in the different ages. It is clear that the only signiicant difference involves children at 4–5 years and 6–7 years.
DISCUSSION
390 Amato CALH, Santos THF, Barbosa MRP, Fernandes FDM
CoDAS 2013;25(4):388-90
Table 1. Student’s t-test to the progress indexes on the different
age groups
Age group
(years) 4–5 years 6–7 years 8–9 years
10 years and above
2–3 0.8011 0.1211 0.7960 0.2348
4–5 – 0.0272 0.6058 0.1181
6–7 – – 0.2680 0.8659
8–9 – – – 0.3374
the assessment of progress of individuals with different ages or different symptoms, that are not comprised in the adopted criteria. This way, the simple and objective use of other data from the system may allow the quicker identiication of answers (or their absence), as was done in a previous study(5).
The results in Table 1 are similar to those observed in a recent study(6), that identiied a general tendency of children presenting better responses to therapeutic intervention.
CONCLUSION
The changes that happened along time have inluenced on the organization of services that provide services to ASD children. One of the most important of them is the notion of autism spectrum. During the 1980s, the diagnosis of childhood autism was attributed only to a group of children with extremely severe disorders that often presented very little response to intervention. It was made clear by the large changes observed since criteria like the ones of the DSM-III started to be used and by the repercussions of the translation of the work by Hans Arperger, from German to English, in 1989 that allowed a new perspective to the assessment of these individuals. Therefore, during these three decades the diagnostic criteria evolved to a broader and more comprehensive perspective that considers the different degrees of severity, aiming to identify the common traits among these individuals and not just their description. It led to the use of the concept of autism spectrum that, in turn, modiied the epidemiological features regarding these disorders. In the 1980s it was considered that childhood autism
involved one child among 10 000 (or even 50 000). Nowadays it is considered that one child out of every 100 (or 70 when just boys are considered) is included in the autism spectrum. This difference in the diagnostic criteria certainly will demand speciic attention to individuals who received the diagnosis in the last decades of the last century or the beginning of the present one. These considerations will be easier once all the information about each intervention process is registered in reliable and accessible systems, allowing the association of information according to the information that is relevant for each analysis.
The irst trials conducted with data recorded on a speciic system reveal the possibility of studies with large populations, something that is not usual in this ield.
*CAHA, THFS and MRPB were responsible for collecting data and helping design the software. FDMF organized the project and coordinated the research.
REFERENCES
1. Laugeson EA, Frankel F, Mogil C, Dillon AR. Parent-assisted social skills training to improve friendships in teens with autism spectrum disorders. J Autism Dev Disord. 2009;39(4):596-606.
2. Kleeck AV, Schwarz AL, Fey M, Kaiser A, Miller J, Weitzman E. Should we use telegraphic or grammatical input in the early stages of language development with children who have language impairments? A meta-analysis of the research and expert opinion. Am J Speech Lang Pathol. 2010;19(1): 3-21.
3. McAllister L, Wylie K, Davidson B, Marshall J. The World Report on Disability: an impetus to reconceptualize services for people with communication disability. Int J Speech Lang Pathol. 2013;15(1):118-26. 4. Fernandes FD, Behlau M. Implications of the World Report on Disability for responding to communication disorders in Brazil. Int J Speech Lang Pathol. 2013;15(1):113-7.
5. Bedford R, Elsabbagh M, Gliga T, Pickles A, Senju A, Charman T, et al. Precursors to social and communication difficulties in Infants at-risk for autism: gaze following and attentional engagement. J Autism Dev Disord. 2012;42(10):2208-18.
