E ARLYCOMMUNICATION DEVELOPMENT AND INTERVENTION FORCHILDREN WITH AUTISMRebecca Landa 1,2 * 1 Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland 2 Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, Maryland Autism is a neurodevelopmental disorder defined by impair- ments in social and communi cation developme nt, accompanie d by stereotyped patterns of behavi or and intere st. The focus of this paper is on the early development of communication in autism, and early intervention for impairments in communication associated with this disorder. An overview of components of communication is provided. Communic ation characte ristics that are diagnostic of autism are sum- marized, with consideration of the overlap between social and com- munica tion impairment, particula rly for childre n with autism func- tioning at the prelinguistic level. Early communication development and predictors of communication functioning in aut ism are exam- ined, based on a review of prospective and retrospective studies. The focus of the discussion then turns to intervention. Consideration is given to the rationale for beginning intervention as early in lif e as possible for childr en with autism. Implicat ions of motor, imitation , and play deficits for communication-based intervention are exam- ined. Finally, issues related to the design and delivery of intervention for young children with autism are presented, along with a review of the major early intervention approaches for autism. ' 2007 Wiley-Liss, Inc. MRDD Research Reviews 2007;13:16 –25. Key Words: autism; communication; early development; early intervention A utism is a neu ro dev elopment al dis or der def ine d by imp airme nt s in soc ial and communication dev elo p- ment, accompanied by stereotyped patterns of behaviorand interest. Along with pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger syndrome, au- tism is categorize d as a perv asiv e dev elo pme nta l dis ord erwithin the DSM-IV [American Psychiatric Association (APA), 1994]. In clinical practice, the term autism spectrum disorder(ASD) is oft en use d to col lec tiv ely ref er to aut ism, PDD- NOS, and Asperger syndrome. In this paper, the term autism will be used, since much of the research is based on children who met criteria for autism. When the term ASD is used, it inc lus iv ely ref ers to aut ism and PDD-NOS. Asperger syn- drome is not discussed within this review. DEFINITION OF COMMUNICATION The focus of this paper is on the early development ofcommuni cation in autism and early interve ntion for impai r- ment s in communic ation assoc iated with this disor der. Com- munication is a broad concept, encompassing linguistic, para- linguistic, and pragmatic aspects of functioning. The linguistic domain incl udes phon ologi cal, morph ologi cal, synt actic, and semantic rule systems. Phonol ogic al rules estab lish ho w speec h soun ds (pho - nemes) ar e combined to form wor ds and how a par ticular speech sound is to be pronounced given the context of the speech sounds before and afte r it . Morph ol ogical rules involve signaling grammatical information at the word level, as when words are inflected with past tense markers such as ‘‘-e d’ ’. Syn tax is a rule system that guide s ho w words are combi ned int o sequences and hierarchica l structures of phr ases and sentences. The semantic sys tem in vo lves the ment al ‘ ‘dic tion ary’’ of wo rds and thei r meanings, how to combine words to form meaningful relationships such as pos- session (‘‘my shoe’’), abstract language processing (including literal and nonliteral meaning), and formation of a gist from a text or discourse. Paral inguist ic communicat ion inclu des pro xemics (e.g., use of space in communication as in distance between speakerand listener), facial expression (e.g., rolling the eyes to indi- cate that a comment was intended as sarcasm, or smiling as criti cism is given to con ve y tenderness and sincerity so tha t the listener knows that the comment was made out of con- cern rather than merely to criticize), intonation (e.g., using a rising intonational contour at the end of a declarative syntac- tic construction to signal that it is to be interpreted as a ques- tio n rather than as an ass ert ion), and gesture. Pragmatic s invo lv es disc our se management (e.g ., topic ini tiat ion and mainten ance), commu nicativ e intent ions (variety expressed and understood, as well as variety of forms used to communi- cate intentions), and presupposition (making judgments about the type and style of information presentation depending on cha rac terist ics of the context, ranging fro m list ener -spe cifi c characteristics to setting ). Grant sponsor: National Institute of Mental Health; Grant numbe rs: MH59630, 154MH066417. *Corres ponde nce to: Rebecca Landa , 3901 Green spring Avenue, Baltimo re, MD 21211. E-mail : landa@kenn edykrieger.org Received 29 November 2006; Accepted 11 December 2006 Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/mrdd.20134 MENTAL RETAR DATI ON AND DEVEL OPME NTAL DISABILIT IES RESEARCH REVIEWS 13: 16–25 (2007) ' 2007 Wiley-Liss, Inc.
