Communication interventions for minimally verbal children with autism: a sequential multiple assignment randomized trial. Early Language and Communication Development of Infants Later Diagnosed with Autism Spectrum Disorder Developmental Profiles of Infants and Toddlers with Autism Spectrum Disorders Identified Prospectively in a Community-Based Setting The Social Communication Intervention Project: a randomized controlled trial of the effectiveness of speech and language therapy for school-age children who have pragmatic and social communication problems with or without autism spectrum disorder. A Randomised Controlled Trial of an Information Communication Technology Delivered Intervention for Children with Autism Spectrum Disorder Living in Regional Australia Randomized comparative trial of a social cognitive skills group for children with autism spectrum disorder. Learning through interaction in children with autism: Preliminary data from asocial-communication-based intervention A communication-based intervention for nonverbal children with autism: what changes? Who benefits? Improvement in Social Competence Using a Randomized Trial of a Theatre Intervention for Children with Autism Spectrum Disorder Incorporating a Peer-Mediated Approach Into Speech-Generating Device Intervention: Effects on Communication of Preschoolers With Autism Spectrum Disorder. Early intervention in 208 Swedish preschoolers with autism spectrum disorder. A prospective naturalistic study. Enhancing interactions during daily routines: A randomized controlled trial of a web‐based tutorial for parents of young children with ASD A Parent-Mediated Intervention to Increase Responsive Parental Behaviors and Child Communication in Children with ASD: A Randomized Clinical Trial Short-term speech-language intervention for children with disorders of the autism spectrum. Outcome at 7 years of children diagnosed with autism at age 2: predictive validity of assessments conducted at 2 and 3 years of age and pattern of symptom change over time. Effectiveness of the parent-mediated intervention for children with autism spectrum disorder in south Asia in India and Pakistan (PASS): a randomised controlled trial. Social involvement of children with autism spectrum disorders in elementary school classrooms.
OBJECTIVE This study tested the effect of beginning treatment with a speech-generating device ( SGD ) in the context of a blended , adaptive treatment design for improving spontaneous , communicative utterances in school-aged , minimally verbal children with autism . METHOD A total of 61 minimally verbal children with autism , aged 5 to 8 years , were r and omized to a blended developmental/behavioral intervention ( JASP+EMT ) with or without the augmentation of a SGD for 6 months with a 3-month follow-up . The intervention consisted of 2 stages . In stage 1 , all children received 2 sessions per week for 3 months . Stage 2 intervention was adapted ( by increased sessions or adding the SGD ) based on the child 's early response . The primary outcome was the total number of spontaneous communicative utterances ; secondary measures were the total number of novel words and total comments from a natural language sample . RESULTS Primary aim results found improvements in spontaneous communicative utterances , novel words , and comments that all favored the blended behavioral intervention that began by including an SGD ( JASP+EMT+SGD ) as opposed to spoken words alone ( JASP+EMT ) . Secondary aim results suggest that the adaptive intervention beginning with JASP+EMT+SGD and intensifying JASP+EMT+SGD for children who were slow responders led to better posttreatment outcomes . CONCLUSION Minimally verbal school-aged children can make significant and rapid gains in spoken spontaneous language with a novel , blended intervention that focuses on joint engagement and play skills and incorporates an SGD . Future studies should further explore the tailoring design used in this study to better underst and children 's response to treatment . Clinical trial registration information-Developmental and Augmented Intervention for Facilitating Expressive Language ( CCNIA ) ; http:// clinical trials.gov/ ; NCT01013545 ABSTRACT . It is well recognized that delayed " first words " is among the most common presenting symptoms of autistic spectrum disorders ( ASD ) . However , data on earlier language and communication development in children with ASD are limited to retrospective reports from parents and from home videos . In this study , we prospect ively collected parent report data on early communication and language development in 97 infant siblings of children with ASD and 49 low-risk controls . Parents completed the  MacArthur Communicative Development Inventory-Infant Form  at 12 and 18 months . Analysis compared 3 groups defined on the basis of diagnostic assessment at 24 months : ( 1 ) siblings with ASD ( n = 15 ) , ( 2 ) siblings not meeting diagnostic criteria for ASD ( n = 82 ) , and ( 3 ) low-risk controls , none of whom had ASD ( n = 49 ) . Children with ASD showed delays in early language and communication compared with non-ASD siblings and controls . At 12 months , the ASD group was reported to underst and significantly fewer phrases and to produce fewer gestures . At 18 months , they showed delays in their underst and ing of phrases , comprehension and production of single words , and use of gestures . Siblings not diagnosed with ASD also used fewer play-related gestures at 18 months than low-risk controls , even when children with identified language delays were excluded . Overall , this prospect i ve study confirms that delays in communication and language development are apparent early in life in children with ASD , and emphasizes that developmental surveillance should include monitoring for delays in gesture , which may be among the earliest signs of ASD This prospect i ve , longitudinal , study charted the developmental profiles of young children with Autism Spectrum Disorders ( ASD ) identified through routine developmental surveillance . 109 children with Autistic Disorder ( AD ) , ‘ broader ’ ASD , and developmental and /or language delays ( DD/LD ) were assessed using the Mullen Scales of Early Learning ( MSEL ) at 12-months ( n = 10 assessment s ) , 18-months ( n = 45 assessment s ) , and 24-months ( n = 99 assessment s ) . The children with AD performed most poorly , overall , than the ASD and DD/LD groups on the MSEL . Furthermore , the children with AD/ASD displayed an uneven cognitive profile , with poorer performance on verbal ( particularly receptive language ) relative to nonverbal skills . There was also evidence of developmental slowing in verbal skills from 18- to 24-months for children on the spectrum , especially those with AD . Given that the poor receptive , relative to expressive , language profile emerges very early in life for children with AD/ASD , this cognitive profile may serve as an additional red flag to social attention and communication deficits . Receptive language should therefore be stringently monitored in any developmental surveillance program for autism spectrum disorders in the second year of life BACKGROUND Children who show disproportionate difficulty with the pragmatic as compared with the structural aspects of language are described as having pragmatic language impairment ( PLI ) or social communication disorder ( SCD ) . Some children who have PLI also show mild social impairments associated with high-functioning autism or autism spectrum disorder ( ASD ) . There is little robust evidence of effectiveness of speech- language interventions which target the language , pragmatic or social communication needs of these children . AIMS To evaluate the effectiveness of an intensive manualized social communication intervention ( SCIP ) for children who have PLI with or without features of ASD . METHODS & PROCEDURES In a single-blind RCT design , 88 children with pragmatic and social communication needs aged 5;11 - 10;8 , recruited from UK speech and language therapy services , were r and omly assigned in a 2:1 ratio to SCIP or to treatment-as-usual . Children in the  SCIP  condition received up to 20 sessions of direct intervention from a specialist research speech and language therapist working with supervised assistants . All therapy content and methodology was derived from an intervention manual . A primary outcome measure of structural language and secondary outcome measures of narrative , parent-reported pragmatic functioning and social communication , blind-rated perceptions of conversational competence and teacher-reported ratings of classroom learning skills were taken pre-intervention , immediately post-intervention and at 6-month follow-up . Analysis was by intention to treat . OUTCOMES & RESULTS No significant treatment effect was found for the primary outcome measure of structural language ability or for a measure of narrative ability . Significant treatment effects were found for blind-rated perceptions of conversational competence , for parent-reported measures of pragmatic functioning and social communication , and for teacher-reported ratings of classroom learning skills . CONCLUSIONS & IMPLICATION S There is some evidence of an intervention effect on blind and parent/teacher-reported communication outcomes , but not st and ardized language assessment outcomes , for 6 - 11-year-old children who have pragmatic and social communication needs . These findings are discussed in the context of the increasingly central role of service user outcomes in providing evidence for an intervention . The substantial overlap between the presence of PLI and ASD ( 75 % ) across the whole cohort suggests that the intervention may also be applicable to some verbally able children with ASD who have pragmatic communication needs This exploratory r and omised controlled trial tested the effectiveness of a tablet-based information communication technology early intervention application to augment existing therapy with the aim of improving visual motor , imitation , language and social skills in young children with ASD who reside in regional areas . Fifty-nine participants were recruited and r and omised to either a therapy-as-usual group or intervention group . With the exception of the expressive language subscale on the Mullen Scales of Early Learning , no significant between-group differences were recorded for visual motor , imitation , receptive language and social skills of participants between baseline and post-intervention . When all participants were pooled and measured over time , improvements were shown in receptive and pragmatic language and social skills ; these gains were maintained , thus suggesting skill acquisition OBJECTIVE This study evaluated the efficacy of a targeted social skills training group in school-aged children with autism spectrum disorder ( ASD ) . The intervention , Seaver-NETT ( Nonverbal communication , Emotion recognition , and Theory of mind Training ) , is a 12-session cognitive-behavioral intervention ( CBI ) for verbal , school-aged children targeting ASD-specific social behavioral impairments . METHOD Sixty-nine children with ASD , 8 to 11 years of age , with verbal IQs greater than 70 , participated in a r and omized comparative trial to examine the efficacy of NETT relative to a facilitated play group . Treatment outcomes included caregiver reports of social behavior and neuropsychological assessment s of social cognition conducted by blinded raters . Outcomes were collected at baseline , endpoint , and 3 months posttreatment . RESULTS Significant improvements were found on social behavior outcomes such as nonverbal communication , empathic responding , and social relations in the NETT condition relative to the active control at endpoint . Verbal IQ moderated the interaction effect on social behavior , with higher verbal IQ associated with improvements in the CBI condition . No significant improvements were found on social cognitive outcomes . No significant group differences were found at 3-month follow-up conducted with approximately half the sample ( n = 34 ) . CONCLUSION These data indicate that targeted CBI social skills groups such as NETT improve social communication deficits in verbal , school-aged children with ASD . The moderating effects of high verbal IQ suggest a need to consider participant and treatment characteristics associated with outcomes in future studies . Clinical trial registration information-Neural and Behavioral Outcomes of Social Skills Groups in Children With Autism Spectrum Disorder ; https:// clinical trials.gov ; NCT01190917 The study evaluates a social-communication-based approach to autism intervention aim ed at improving the social interaction skills of children with autism spectrum disorder . We report preliminary results from an ongoing r and omized controlled trial of 51 children aged 2 years 0 months to 4 years 11 months . Participants were assigned to either a target treatment or community treatment group . Families in the target treatment group were given 2 hours of therapy and coaching each week in an intervention emphasizing social-interaction and the parent-child relationship . Children in the community treatment group received a variety of services averaging 3.9 hours per week . After 12 months , outcomes were measured to determine changes in the groups in social interaction and communication . In addition , a regression analysis was conducted to determine whether changes in social interaction skills were associated with language development . Results suggest that children in the treatment group made significantly greater gains in social interaction skills in comparison to the community treatment group , but no between-group differences were found for st and ard language assessment s. Initiation of joint attention , involvement , and severity of language delay were found to be significantly associated with improvement of language skills in children with autism . Finally caregiver skills targeted by the intervention were found to be significantly associated with changes in children ’s interaction skills OBJECTIVE This article examines the form and function of spontaneous communication and outcome predictors in nonverbal children with autism following classroom-based intervention ( Picture Exchange Communication System [ PECS ] training ) . METHOD 84 children from 15 schools participated in a r and omized controlled trial ( RCT ) of PECS ( P. Howlin , R. K. Gordon , G. Pasco , A. Wade , & T. Charman , 2007 ) . They were aged 4 - 10 years ( 73 boys ) . Primary outcome measure was naturalistic observation of communication in the classroom . Multilevel Poisson regression was used to test for intervention effects and outcome predictors . RESULTS Spontaneous communication using picture cards , speech , or both increased significantly following training ( rate ratio [ RR ] = 1.90 , 95 % CI [ 1.46 , 2.48 ] , p < .001 ; RR = 1.77 , 95 % CI [ 1.35 , 2.32 ] , p < .001 ; RR = 3.74 , 95 % CI [ 2.19 , 6.37 ] , p < .001 , respectively ) . Spontaneous communication to request objects significantly increased ( RR = 2.17 , 95 % CI [ 1.75 , 2.68 ] , p < .001 ) , but spontaneous requesting for social purpose s did not ( RR = 1.34 , 95 % CI [ 0.83 , 2.18 ] , p = .237 ) . Only the effect on spontaneous speech persisted by follow-up ( 9 months later ) . Less severe baseline autism symptomatology ( lower Autism Diagnosis Observation Schedule [ ADOS ] score ; C. Lord et al. , 2000 ) was associated with greater increase in spontaneous speech ( RR = 0.90 , 95 % CI [ 0.83 , 0.98 ] , p = .011 ) and less severe baseline expressive language impairment ( lower ADOS item A1 score ) , with larger increases in spontaneous use of speech and pictures together ( RR = 0.62 , 95 % CI [ 0.44 , 0.88 ] , p = .008 ) . CONCLUSION Overall , PECS appeared to enhance children 's spontaneous communication for instrumental requesting using pictures , speech , or a combination of both . Some effects of training were moderated by baseline factors . For example , PECS appears to have increased spontaneous speech in children who could talk a little at baseline The efficacy of a peer-mediated , theatre-based intervention on social competence  in participants with autism spectrum disorder ( ASD ) was tested . Thirty 8-to-14 year-olds with ASD were r and omly assigned to the treatment ( n = 17 ) or a wait-list control ( n = 13 ) group . Immediately after treatment , group effects were seen on social ability , ( d = .77 ) , communication symptoms ( d = −.86 ) , group play with toys in the company of peers ( d = .77 ) , immediate memory of faces as measured by neuropsychological ( d = .75 ) and ERP methods ( d = .93 ) , delayed memory for faces ( d = .98 ) , and theory of mind ( d = .99 ) . At the 2 month follow-up period , group effects were detected on communication symptoms ( d = .82 ) . The results of this pilot clinical trial provide initial support for the efficacy of the theatre-based intervention Purpose This study examined the effects of incorporating a peer-mediated approach into a speech-generating device ( SGD ) intervention on communication of 45 nonverbal and minimally verbal preschoolers with autism spectrum disorder ( ASD ) and 95 peers without disabilities . The SGD was an iPad 2 ( Apple ) with voice output app . Method Effects were evaluated using a multivariate r and omized control trial design with repeated measures for 4 cohorts across baseline , intervention , generalization , and maintenance phases . Children were r and omly assigned to an experimental treatment that trained peers on use of the SGD or a business-as-usual comparison condition with untrained peers .  Communication outcomes were measured for both children with ASD and peers . Results Children receiving the treatment demonstrated significant increases in rates of communication and more balanced responses and initiations ( a measure of reciprocity ) than children in the comparison group . They were able to generalize improvements and maintain communication gains . Treatment fidelity was high for school staff and peer implementation . Conclusions Results support positive effects on communication of teaching young children with ASD and peers without disabilities to use the same SGD system in typical preschool activities . SGD interventions that utilize peer-mediated approaches may improve core deficits in communication and reciprocity and allow for greater classroom social participation and interactions with peers Early intervention has been reported to improve outcome in children with autism spectrum disorders ( ASDs ) . Several studies in the field have been r and omized controlled trials ( RCTs ) . The aim of this study was to assess ASD outcome in a large naturalistic study . Two hundred and eight children , aged 20 - 54 months , with a clinical diagnosis of ASD were given intervention and monitored prospect ively in a naturalistic fashion over a period of 2 years . The toddlers were considered representative of all but the most severely multiple disabled preschool children with ASD in Stockholm county . They fell into three cognitive subgroups : one with learning disability , one with developmental delay , and one with normal intellectual functioning . Data on intervention type and intensity were gathered prospect ively in a systematic fashion . Intervention was classified into intensive applied behaviour analysis ( ABA ) and non-intensive , targeted interventions , also based on ABA principles . Children were comprehensively assessed by a research team before the onset of intervention , and then , again , 2 years later . Change in Vinel and adaptive behaviour scales composite scores from intake ( T1 ) to leaving the study ( T2 ) was set as the primary outcome variable . The research team remained blind to the type and intensity of interventions provided . One hundred and ninety-eight ( 95 % ) of the original sample s stayed in the study throughout the whole 2-year period and 192 children had a complete Vinel and composite score results both at T1 and T2 . Vinel and composite scores increased over the 2-year period . This increase was accounted for by the subgroup with normal cognitive functioning . There was no significant difference between the intensive and non-intensive groups . Individual variation was considerable , but no child in the study was " problem-free " at follow-up . Our data do not support that children with ASD generally benefit more from the most intensive ABA intervention programs than from less intensive interventions or targeted interventions based on ABA Children with Autism Spectrum Disorder ( ASD ) often experience difficulty participating in everyday home routines , such as bed time or bath time . This r and omized controlled trial examined the efficacy of an interactive , web‐based parenting tutorial for improving children 's engagement in daily routines ( i.e. , proximal outcomes ) as well improving children 's social communication and parenting efficacy and stress ( i.e. , broad outcomes ) . Parents of children with ASD between 18 and 60 months were r and omly assigned to the  Tutorial  group ( n = 52 ) or the  Control group ( n = 52 ) . All parents completed question naires at baseline ( T1 ) , 1 month after T1 ( T2 ; post‐tutorial completion ) , and 2 months after T1 ( T3 ) . Relative to the Control group , parents in the Tutorial group reported significantly higher use of evidence ‐based instructional strategies and higher levels of child engagement during routines at T2 and T3 . In addition , parents in the Tutorial group reported significantly lower parenting stress and higher parenting efficacy at T3 , as well as higher ratings of child social communication at T2 and T3 , compared to the Control group . Parents reported being highly satisfied with both the clinical content and technical aspects of the tutorial . These improvements in both proximal and broad parent‐child outcomes suggest that this tutorial may be a promising and accessible way for empowering some parents and improving parent‐child interactions . Autism Res 2018 , 11 : 667–678 . © 2018 International Society for Autism Research , Wiley Periodicals , Longitudinal research has demonstrated that responsive parental behaviors reliably predict subsequent language gains in children with autism spectrum disorder . To investigate the underlying causal mechanisms , we conducted a r and omized clinical trial of an experimental intervention ( Focused Playtime Intervention , FPI ) that aims to enhance responsive parental communication ( N = 70 ) . Results showed a significant treatment effect of FPI on responsive parental behaviors . Findings also revealed a conditional effect of FPI on children ’s expressive language outcomes at 12-month follow up , suggesting that children with baseline language skills below 12 months ( n = 24 ) are most likely to benefit from FPI .  Parents of children with more advanced language skills may require intervention strategies that go beyond FPI ’s focus on responsive communication PURPOSE To assess any changes in the Functional Communicative Profile ( FCP ) and in the Social Cognitive Performance ( SCP ) of children with Autism Spectrum Disorders , based on two short periods of intervention . METHODS The study was conducted with 21 children with Autism Spectrum Disorder diagnoses , r and omly allocated into two groups  , who received the same short-term intervention types ( 6 weeks with the mother and 6 weeks with the support of an educational software program ) . The intervention process was conducted by speech- language pathologists who were part of a graduate program in this area . RESULTS Sample s of 15-minute interaction sessions between the child and speech- language pathologist were used to assess the changes in the FCP and the SCP . The statistic analysis pointed out differences only in Group 1 for the variables " percentage of communicative space used " and " use of the mediating object " . CONCLUSION With the intervention sessions structured over 12 weeks , it was possible to observe a few changes in the children 's FCP and in the SCP . Therefore , we point out the need for new research studies of longer duration OBJECTIVE To examine the predictive validity of symptom severity , cognitive and language measures  taken at ages 2 and 3 years to outcome at age 7 in a sample of children diagnosed with autism at age 2 . METHOD Twenty-six children diagnosed with autism at age 2 were re-assessed at ages 3 and 7 years . At each age  symptom severity , cognitive and language assessment s  were completed . RESULTS The pattern of autistic symptom severity varied over time by domain . Across time , children moved across diagnostic boundaries both in terms of clinical diagnosis and in terms of instrument diagnosis on the Autism Diagnostic Interview-Revised ( ADI-R ) . On all measures group variability in scores increased with age . Although non-verbal IQ ( NVIQ ) for the group as a whole was stable across the 3 assessment s , this masked considerable individual instability . St and ard assessment s at age 2 did not predict outcome at age 7 even within the same domain of functioning . In contrast , st and ard assessment s at age 3 did predict outcome . However , a measure of rate of non-verbal communicative acts taken from an interactive play-based assessment at age 2 was significantly associated with language , communication and social outcomes at age 7 . CONCLUSIONS The trajectory of autism symptoms over time differed in different domains , suggesting that they may be , at least in part , separable . Variability in language , NVIQ and symptom severity increased over time . Caution is required when interpreting the findings from assessment s of children with autism at age 2 years . At this age measures of rate of non-verbal communication might be more informative than scores on st and ard psychometric tests . Predictive validity of assessment s at age 3 years was greater BACKGROUND Autism spectrum disorder affects more than 5 million children in south Asia . Although early interventions have been used for the treatment of children in high-income countries , no substantive trials have been done of the interventions adapted for use in low-income and middle-income countries ( LMICs ) . We therefore assessed the feasibility and acceptability of the parent-mediated intervention for autism spectrum disorder in south Asia ( PASS ) in India and Pakistan . METHODS A single-blind r and omised trial of the comparison of 12 sessions of PASS ( plus treatment as usual ) with treatment as usual alone delivered by non-specialist health workers was done at two centres in Goa , India , and Rawalpindi , Pakistan . Children aged 2 - 9 years with autism spectrum disorder were r and omly assigned ( 1:1 ) by use of probabilistic minimisation , controlling for treatment centre ( Goa or Rawalpindi ) , age ( < 6 years or ≥6 years ) , and functional impairment ( Vinel and Adaptive Behaviour Scale Composite score < 65 or ≥65 ) . The primary outcome was quality of parent-child interaction on the Dyadic Communication Measure for Autism at 8 months . Analysis was by intention to treat . The study is registered with IS RCT N , number IS RCT N79675498 . FINDINGS From Jan 1 to July 30 , 2013 , 65 children were r and omly allocated , 32 to the PASS group ( 15 in Goa and 17 in Rawalpindi ) and 33 to the treatment-as-usual group ( 15 in Goa and 18 in Rawalpindi ) . 26 ( 81 % ) of 32 participants completed the intervention . After adjustment for minimisation factors and baseline outcome , the primary outcome showed a treatment effect in favour of PASS in parental synchrony ( adjusted mean difference 0·25 [ 95 % CI 0·14 to 0·36 ] ; effect size 1·61 [ 95 % CI 0·90 to 2·32 ] ) and initiation of communication by the child with the parent ( 0·15 [ 0·04 to 0·26 ] ; effect size 0·99 [ 0·29 to 1·68 ] ) , but time in mutual shared attention was reduced ( -0·16 [ -0·26 to -0·05 ] ; effect size -0·70 [ -1·16 to -0·23 ] ) . INTERPRETATION Our results show the feasibility of adapting and task-shifting an intervention used in a high-income context to LMICs . The findings also replicate the positive primary outcome treatment effects of a parent-mediated communication-focused intervention in the original UK Preschool Autism Communication Trial , with one negative effect not reported previously . FUNDING Autism Speaks , USA BACKGROUND Children with autism spectrum disorders ( ASD ) are increasingly included in general education classrooms in an effort to improve their social involvement . METHODS Seventy-nine children with ASD and 79 r and omly selected , gender-matched peers ( 88.6 % male ) in 75 early ( K-1 ) , middle ( 2nd-3rd ) , and late ( 4th-5th ) elementary classrooms across 30 schools completed social network surveys  examining each child 's reciprocal friendships , peer rejection , acceptance , and social involvement . RESULTS Across grade levels , peers less frequently reciprocated friendships with children with ASD than students in the matched sample . While children with ASD were not more likely to be rejected by peers , they were less accepted and had fewer reciprocal friendships than matched peers at each grade level . Although 48.1 % of children with ASD were involved in the social networks of their classrooms , children with ASD were more likely to be isolated or peripheral to social relationships within the classroom across all grade levels , and this difference is even more dramatic in later elementary grade s. CONCLUSIONS In inclusive classrooms , children with ASD are only involved in peers ' social relationships about half of the time , and appear to be even less connected with increasing grade level . Promoting children with ASD 's skills in popular activities to share with peers in early childhood may be a key preventive intervention to protect social relationships in late elementary school grade
There was no evidence that AAC improved frequency of speech , verbal expressive vocabulary or children 's social communication or pragmatic language immediately postintervention .
Overall , neither of the interventions ( PECS or FPI ) result ed in maintained improvements in spoken or non-verbal communication in most children .
AUTHORS ' CONCLUSIONS There is limited evidence that verbally based and ACC interventions improve spoken and non-verbal communication in minimally verbal children with ASD .
In the study that used an AAC intervention , there were significant gains in frequency of PECS use and verbal and non-verbal initiations , but not in expressive vocabulary or social communication immediately postintervention .
In the study that investigated a verbally based intervention , there were no significant gains in expressive language postintervention , but children with lower expressive language at the beginning of the study improved more than those with better expressive language at baseline .
Neither study investigated adverse events , other communication skills , quality of life or behavioural outcomes .
BACKGROUND Autism spectrum disorder ( ASD ) has an estimated prevalence of around 1.7 % of the population .
People with ASD often also have language difficulties , and about 25 % to 30 % of children with ASD either fail to develop functional language or are minimally verbal .
The ability to communicate effectively is an essential life skill , and difficulties with communication can have a range of adverse outcomes , including poorer academic achievement , behavioural difficulties and reduced quality of life .
Historically , most studies have investigated communication interventions for ASD in verbal children .
We can not assume the same interventions will work for minimally verbal children with ASD .
OBJECTIVES To assess the effects of communication interventions  for ASD in minimally verbal children .