Santhanan Hewitt 2015 Evidence Based Assessment Asd

Evidence-Based Communication Assessment and Intervention, 2015
Vol. 9, No. 4, 140181, http://dx.doi.org/10.1080/17489539.2016.1153814

EBP Advancement Corner
Evidence-based assessment and autism spectrum

disorders: A scoping review
Siva priya Santhanam & Lynne E. Hewitt
Department of Communication Sciences and Disorders, Bowling Green State University, Bowling Green, OH,
USA
.................................................................................................................................................
Abstract
Assessment of language and communication in autism spectrum disorders (ASD) is a critical element in
developing appropriate and effective interventions and supports. While there is a large literature on diagno-
sis of autism, the information available to guide clinical practice for communication and language specifi-
cally is sparser. In this scoping review, we sought to identify research articles and critical reviews dealing
with communication assessment for individuals with autism. The first and second author each conducted an
independent search of relevant scholarly databases to identify articles published between 1995 and 2013.
Differences were resolved via discussion; 54 relevant articles were identified using the search terms:
autism + language + assessment; autism + speech + assessment; and autism + communication + assess-
ment. While guidelines for best practice are premature, especially given the diversity of developmental and
cognitive profiles in ASD, emerging consensus was seen in the following areas: (a) formal norm- and crite-
rion-referenced tests not designed specifically for ASD have been investigated and shown to be feasible and
interpretable in use with individuals with autism; (b) language sample analysis and/or structured observa-
tional elicitations of communication in naturalistic contexts are widely advocated as a means to ensure the
full profile of an individuals strengths and challenges; (c) caregiver report measures in several studies com-
pared favorably with formal tests, therefore many scholars support their use to supplement direct testing in
clinical environments, because they can serve as probes of naturally occurring communication behaviors.
Keywords: Evidence-based practice; Communication; Language; Assessment; Autism
Autism spectrum disorder (ASD) is a generated a sense of urgency to develop

neurodevelopmental disorder that persists appropriate and effective services for this
throughout the individuals life span. population. In discussing the need for
Individuals on the autism spectrum exhibit improved evidence, the conversation often
deficits in social interaction and in acquiring focuses on treatment, yet assessment is
and using language for communication, equally critical for optimal outcomes. Valid
and they demonstrate the presence of and informative assessments are fundamen-
restricted and repetitive behaviors (5th ed.; tal to the design of interventions, and
DSM-5, American Psychiatric Association, thus evidence-based practice (EBP) for
2013).The most recent Centers for Disease assessment is a critical element in improving
Control and Prevention (CDC) figures are outcomes. The American Speech-Language
that one in 68 children is diagnosed with an and Hearing Association (ASHA) defines
ASD (Center for Disease Control & Preven- evidence-based practice as an integration of
tion, 2012). The increased identification of current empirical evidence, clinical exper-
children and adults on the spectrum has tise, and client values (American Speech-
Language-Hearing Association, 2004).
Robey, Apel, Dollaghan, Ellmo, and Hall
For correspondence: Lynne E. Hewitt, Department of Communica-
tion Sciences and Disorders, Bowling Green State University,
(2004) indicate that EBP in the field
Bowling Green, OH, USA. E-mail: lhewitt@bgsu.edu of speech-language pathology must be
2016 Informa UK Limited, trading as Taylor & Francis Group

EBP ADVANCEMENT CORNER: EVIDENCE-BASED ASSESSMENT 141
followed at the levels of assessment, screen- restrict participation in play, at school, and
ing, diagnosis, intervention, and program in other social scenarios. During the first
planning. The purpose of the current scop- year of life, children with ASD exhibit a
ing review is to investigate what evidence restricted range of preverbal acts and com-
exists supporting clinical practice in speech- municative behaviors for social interaction,
language assessment for individuals with joint attention, and regulation (Mundy,
ASD. Scoping reviews synthesize a large vol- Sigman, & Kasari, 1990; Wetherby, Prizant,
ume of existing literature and determine the & Hutchinson, 1998); they demonstrate a
scope or extent to which a specific topic area delay in the development of pointing and
has been researched (Pham et al., 2014). other conventional gestures (Dawson et al.,
Researchers in the past have provided 2004) and lack the ability to imitate the
evidence-based guidelines for clinical actions and vocalizations of the adults in
practitioners to help them choose the their environment (Tager-Flusberg, Paul, &
appropriate intervention approaches target- Lord, 2005). As they move into the early
ing social skills (Charlop & Milstein, 1989; stages of verbal communication, a delay in
Burgess & Turkstra, 2006; Wang & Spillane, the acquisition of first words and a difficulty
2009), communication (Bondy & Frost, in transitioning to multiword speech are
1994; Sussman, 1999; Kasari, Freeman, & characteristic of children with ASD (Paul,
Paparella, 2006), and restricted and repeti- Chawarska, Klin, & Volkmar, 2007).
tive behaviors (Boyd, 2012). However, the Furthermore, children with ASD may per-
concept of EBP in the assessment process in sist at much older ages in exhibiting pat-
autism spectrum disorders has received less terns of development seen only in early
attention. Ozonoff, Goodlin-Jones, and language development among neurotypical
Solomon (2005) reviewed evidence-based children (e.g., pronoun reversals, Fay,
criteria for the selection of appropriate tools 1979; and echolalia, Tager-Flusberg et al.,
for assessment of individuals on the autism 2005). Preschool children with ASD
spectrum. They provided an empirically develop some functional use of language,
supported comprehensive assessment bat- but they frequently do not progress on a par
tery and set of strategies that aid in the diag- with their peers. The areas of language that
nosis of ASD. The review focused on may be affected include vocabulary, mor-
assessment for diagnosis, not for providing pho-syntax, and pragmatics (Kjelgaard &
practice guidelines for clinicians in specific Tager-Flusberg, 2001; Tager-Flusberg,
domains, such as social functioning, sensory 1995). Furthermore, problems with com-
disturbances, communication impairments, munication persist through adolescence and
etc. Thus a need exists for guidance for adulthood. Most adolescents and adults
practitioners in assessment in core domains with ASD experience significant deficits in
of autism impairment; of these, communi- the area of social communication or prag-
cation impairments are of most relevance matics. Inability to understand conversa-
for speech-language pathologists. tional rules such as taking turns, initiating,
Almost all individuals on the autism sustaining, and terminating a conversation
spectrum face significant difficulties with (Loukousa & Moilanen, 2009), an inability
communication. Communication deficits to apply conversational repairs and revi-
are among the earliest signs of ASD, being sions, and an inability to understand the
noted during the prelinguistic stage and mental state of others (Happe, 1993) are all
continuing through adulthood (Tager- common problems that adolescents and
Flusberg, 1996). Deficits in communication adults with ASD face on a daily basis. This
142 EBP ADVANCEMENT CORNER: EVIDENCE-BASED ASSESSMENT
scenario suggests that children and adults developmental perspective (Burack, Iarocci,
with ASD require an array of evidence- Bowler, & Mottron, 2002). Individuals on
based assessments in order to qualify for the autism spectrum present with different
treatment services that address different communication needs at different ages,
areas of language and communication. and individuals may have very different
Researchers in the last two decades have strengths and needs. A particular develop-
focused on developing empirically sup- mental challenge is posed by the lack of
ported diagnostic measures and treatment normative guidance for pragmatic and
programs that target communication for social communication development, both
individuals on the autism spectrum. Two key areas of concern in individuals on
valid measures that are considered the the spectrum. Guidelines have been devel-
gold standard for diagnosing ASD are the oped for social communication develop-
Autism Diagnostic Observation Schedule ment and assessment for toddlers and
(Lord, Rutter, DiLavore, & Risi, 1999) and preschoolers with ASD (Landa, 2005;
the Autism Diagnostic InterviewRevised Wetherby, Watt, Morgan, & Shumway,
(Lord, Rutter, & Le Couteur, 1994). With 2007). Less is known regarding ages and
respect to intervention, Volkmar, Reichow, stages of pragmatic development in the
and Doehring (2011) investigated treat- school-age years and beyond. Pragmatics
ment approaches targeting communication is, of course, a key feature of ASD, but all
and social interaction in autism, finding aspects of language need to be evaluated;
that although there are many evidence- thus guidance is needed across the age
based treatment approaches available for span and across the range of language
individuals with ASD, there is no single phenomena (phonology, semantics, mor-
best-suited approach that fits all individu- pho-syntax, and pragmatics).
als with ASD, and that there is a vast gap A particular problem for assessment in
between existing research evidence and this population is the fact that available
current clinical practice. Therefore, select- assessment measures are not specific to
ing a specific approach and planning the ASD. While most norming protocols use
intervention that matches the current full range sampling nowadays, the number
communication requirements of a client of individuals with autism included in
with ASD depends on the professionals norming populations is relatively small.
decision. This decision-making process is For example, the Peabody Picture Vocabu-
guided by a careful and comprehensive lary Test, 4th Edition, is considered a
assessment protocol. Given the important relatively well-constructed test with a
role that assessment of communication well-validated approach to sampling. The
abilities plays in determining appropriate manual states that the sampling plan
intervention, there is an urgent need for sought to closely match cases with the pro-
research to guide clinical practice in assess- portion in the U.S. population. For partici-
ment of communication in ASD. pants between the ages of 2 and 18, the
total number of individuals with autism
ISSUES IN ASSESSMENT OF COMMUNICATION
included in the norming sample was 4
IN ASD
(Dunn & Dunn, 2007, p. 44). Clearly an N
of 4 would not sample the range of pre-
Assessing language and communication in sentations of individuals diagnosed with
ASD faces a number of challenges. Assess- ASD. Information about the disability sta-
ment of communication should follow a tus of individuals above the age of 18 in
the norming population was not reported. nosis-blind approach may not be appropri-
These examples show that even a rigor- ate for ASD, however, given the diversity
ously developed formal test purporting to in profiles in autism and characteristics of
use full-range sampling may not have suf- the disorder not seen in other populations
ficiently sampled the population to ensure with language impairments. For example,
its appropriateness for a person on the children with ASD might present with dif-
autism spectrum. ferences in their sensory (Myles et al.,
A further issue affecting assessment in 2004) or attentional (Rao & Landa, 2013)
ASD is the range of ability levels seen in profiles; these children may present as dif-
individuals on the autism spectrum. Diverse ficult-to-test clients.
adaptive and cognitive profiles may impact Given the complex communication pro-
testing protocols (Joseph, Tager-Flusberg, & file and challenges involved in assessing
Lord, 2002). Individuals with autism may communication in individuals with autism,
demonstrate IQs (intelligence quotients) there is limited scientific guidance to
qualifying them as having an intellectual inform assessment practices. This scoping
disability (Matson & Shoemaker, 2009), review investigated the existing research
while others perform in the average range, on the assessment of communication and/
and others still at superior levels. For some, or language in individuals with ASD. The
a significant discrepancy may exist in their purpose was to synthesize the scope of
verbal and performance IQs (Dietz, what has been done in validating language
Swinkels, Buitelaar, van Daalen, & van and communication assessment protocols
Engeland, 2007; Matson & Shoemaker, for ASD, in order to determine what the
2009; Munson, et al., 2008). Some individ- current state of science is in this critical
uals with autism exhibit savant abilities in area and to determine whether it is possi-
mathematics, literacy, arts, visuospatial ble at this time to begin to develop best
tests, and rote memory but face difficulties practice clinical recommendations, or
with everyday adaptive functioning whether the literature to date is insuffi-
(Happe, 1999). cient to provide that guidance.
Autism spectrum disorders in current
consensus are not divisible into clear sub-
groups that can be differentially diagnosed METHODS
(5th ed.; DSM5, American Psychiatric
Literature search
Association, 2013). Children and adults on
the spectrum may demonstrate a wide A thorough and organized literature search
range of individual differences in adaptive was conducted by each author indepen-
functioning for communication. For exam- dently, using the databases EBSCO (Elton
ple, a child might have strengths in acqui- B. Stephens Co.) Academic Search com-
sition of vocabulary and syntax but plete, PsycINFO, Medline, CINAHL
demonstrate difficulties with social com- (Cumulative Index of Nursing and Allied
munication. Therefore, clinicians working Health Literatures), and ISI (Institute for
with an individual with ASD must use dis- Scientific Information) Web of Science.
cretion to assess communication in a man- These five databases were chosen in order
ner appropriate to the clients unique to cover the full range of publications
profile. Diagnosis-blind assessment has related to assessment of speech, language,
long been advocated by child language and communication in ASD. As a cross-
experts (see, e.g., Johnston, 2006). A diag- check of the appropriateness and compre-
hensiveness of the selected databases, a parameter was construed broadly, such

search of a language-focused database, Lin- that assessments of social skills and social
guistics and Language Behavior Abstracts competencies were included, as these areas
(LLBA), was also conducted. This yielded are typically assessed by speech-language
many fewer hits (e.g., 38 as compared to pathologists. Use of the term autism may
322), and the hits overlapped with those have resulted in some misses where only
of the other databases searched at a rate of the term Asperger syndrome was used.
80%, with the discrepancies not fitting the However, most studies of Asperger syn-
criteria for inclusion in this review. This drome contain the word autism and thus
database was therefore excluded and the would be found with this strategy.
original list used.
The filters used during the search were
the all journals and year filters, along INCLUSION AND EXCLUSION CRITERIA
with English. The search criteria were
Inclusion criteria were that the language
set to all fields with the exception of ISI
of publication must be English, and the
Web of Science, as it does not have that
study must specifically address speech, lan-
option; for this search, the topic choice
guage, or social communication assessment
was selected for each of the search terms
for individuals with ASD as a primary
entered. The first search was limited to
research question. Studies recommending
peer-reviewed articles published between
ways to assess theory of mind and social
the years 1995 and 2011, so that autism
interactional skills were included in the
identified using DSM-IV and more recent
review. Experimental, qualitative, and pro-
criteria would be the focus, and so that
grammatic/descriptive reviews of assess-
editions of published assessments used in
ment of communication in ASD were
the studies would be reasonably current. A
included, and no age restrictions were
second search was conducted by each
placed on the search. Triangulation was
author with the same terms and databases
used, and descriptive, qualitative, and
but extending through June 2013, in order
experimental studies were included, yield-
to locate any additional resources pub-
ing useful information on the topic of
lished since the original searches.
interest.
The review excluded studies that focused
only on diagnosis or screening of ASD, and
SEARCH TERMS, FILTERS, AND STUDY SELECTION
those that did not investigate the assess-
CRITERIA
ment of communication directly. Studies
The terms used in the search were: that measured language and communica-
autism + language + assessment, tion as outcome variables or input variables
autism + speech + assessment, and were also excluded, unless the purpose of
autism + communication + assessment. The the study was to establish the validity of an
rationale for the selection of assessment assessment. Intervention and treatment
over diagnosis was to minimize the hits studies were excluded under this last crite-
relating specifically to the diagnosis of aut- rion, as language measures for treatment
ism itself. The goal of this review was to research are selected to measure outcome
locate articles pertaining to speech, lan- variables, but their quality and applicability
guage, and communication in already is not investigated specifically. One type of
diagnosed individuals. The communication study that posed difficulties relative to the
above criteria was those that used language different algorithms, and this may have
or communication measures to compare caused some undetermined change in hits.
groups; information from such studies Because there were numerous changes at
could be used to validate use of a particular that time, it is also possible that other
assessment protocol in ASD, but studies of search engines were affected as well.
this type were not always directly investi- Figure 1 is a flowchart showing the search
gating the assessments. Such studies were process.
included when they could be used to The systematic search of peer-reviewed
inform clinical protocols. For example, a articles that addressed speech, language,
study comparing subject pronoun use in and communication in individuals with
children with ASD and typical children was ASD resulted in a total 54 published
included, as it investigated the use of nar- between 1995 and 2013 articles meeting
rative assessment, and thus its results selection criteria. Each author conducted
might provide guidance for selecting appro- two independent searches, one in 2011
priate elicitation contexts sensitive to diffi- and the other in 2013. In May 2011, the
culties experienced in referencing by first author identified 57 articles for further
children with ASD. review. Out of these articles, 42 that
described speech, language, or communi-
cation assessment in ASD were located. In
STUDY SELECTION June 2011, the second author conducted a
search and identified 65 articles for further
Studies were selected following two levels
review. The follow-up review resulted in
of screening. As a primary step, both
43 articles in total. A percentage agree-
authors screened the titles and abstracts of
ment between both the authors on the
the articles from the electronic search. The
searches was found to be 97.6%. Follow-
reference lists of identified studies were
ing discussion to resolve disagreements, a
also screened for relevant articles. Both
final list of 36 total articles was selected for
authors then read the full texts of all the
the review from Search 1.
identified articles, applying the inclusion
Search 2 was conducted in January
criteria. The original searches were con-
2013 by the first author and in June 2013
ducted during 2011, the first in May 2011,
by the second author. The first author
and the second in June 2011. Using the
identified 10 articles and shortlisted 8 of
inclusion criteria, the two investigators
them for the review. The second author
independently evaluated each study that
identified 21 articles, and selected 18 arti-
resulted from the search, per the inclusion
cles for the review, 10 more than the first
and exclusion criteria listed above. The
author had found. The percentage agree-
percentage of agreement between the
ment for Search 2 between the two
searches was calculated and found to be
authors was 44.4% (8/18). Factors that
97.6%; differences were resolved via dis-
might explain the discrepancy include the
cussion. In order to bring the search up to
time difference (databases updated in Jan-
date, both authors conducted the search
uary) and, perhaps most significantly,
again in 2013, in January and June,
changes in the Ohiolink databases used by
respectively. It should be noted that in
our university, which were implemented
December 2012 our library changed the
in December 2012. Following discussion, a
search platform for PsycINFO from O-
total of 18 articles was added to the final
Search to EBSCO; these platforms have
list of articles, for a total of 54 articles
Figure 1. Flowchart showing search process employed for locating articles on the assessment of speech, language, and
communication in individuals with autism spectrum disorders.
included in the scoping review from different from those used to analyze data
Searches 1 and 2. from intervention research. For interven-
tion research, some consensus exists
Data analysis regarding factors influencing study qual-
ity (e.g., Wells & Littell, 2009). In the
Criteria to determine quality of studies absence of standards specific to research
of assessment methods are necessarily on assessment, we did not attempt to
analyze study quality per se, electing classified as mixed measures. The sixth
instead to use inclusive criteria in order category of articles was not experimental:
to identify as much as possible the type These were critical reviews of language
of research that has been completed. The and communication assessments for ASD
goal was to uncover what, if any, scien- to provide clinical guidelines. Articles that
tific consensus exists on assessing lan- did not fall within any of these categories
guage and communication in individuals were included in others. These broad
with ASD. This broad approach means categories captured the range of studies
that our results included studies and included; an attempt at conducting a more
reviews of quite different types, some fine-grained division of types of studies,
experimental, some qualitative, and some such as by linguistic sub-components (e.g.,
critical analyses and reviews expressing syntax, pragmatics, etc.) was determined
expert opinions. No one set of criteria to be challenged by a great degree of over-
for judging quality could be determined lap within studies. Therefore the above
for this disparate set of studies; instead, mutually exclusive broader categories were
results were organized by type. The used. However, we did enumerate and we
strength of the evidence for any particu- report below which were the most com-
lar assessment was indirectly assessed monly assessed aspects of language. We
based on numbers of studies reporting also report the range of ages of participants
positive results. We also report the in the studies.
authors interpretation of their main
findings in our summary table.
Our approach to data analysis was RESULTS
descriptive and enumerative. Studies were
Figure 2 shows the number of articles in
classified according to four categories:
each category of assessment addressed in
norm- and criterion-referenced formal
the articles. Table 1 provides a list of articles
tests, observational assessments, language
selected for the review listed in the
sample analyses, and parent report mea-
alphabetical order. For each article included
sures. Articles that used a combination of
in the table, participant characteristics,
one or more of these categories were
Figure 2. Number of articles identified in each category of assessment.

Table 1. Studies addressing assessment of speech, language, and communication in ASD, 19952013. 148
Studies Participant characteristics Investigators

included in Procedure & Type of interpretation of
No. review Sample Size Age range Purpose of study Results assessment used findings
1 Alt and N = 36: 18 with 5 to 13 years To determine The Receptive One- Norm-referenced Using computer-
Moreno ASD; 18 typically whether there is Word test administration of
(2012) developing alternate-forms Picture Vocabulary tests can be reliable.
children reliability in paper- Test and the It is an additional
and computer- Expressive One- tool available for
administered Word testing and for
standardized Picture Vocabulary storing responses,
vocabulary tests. To Test (ROWPVT-4) and its use can
determine whether were administered to expand to
behavior ratings all children. Test telepractice.
would improve in scores and behavior Professionals must
children with ASD ratings were consider individual
during computerized compared across differences in
test administration both administration children before
formats. Behavior deciding which
ratings were format can be used
obtained from a 1- for assessment
min videotaped
sample of test
administration.
Standard scores and
behavioral ratings
EBP ADVANCEMENT CORNER: EVIDENCE-BASED ASSESSMENT
did not differ by

format of test
administration
2 Barbaro and 109 children with Children were To investigate the Mullen Scale of Early Norm-referenced Professionals must
Dissanayake Autistic Disorder referred at developmental Learning was test monitor receptive
(2012) (AD), ASD, and 12 months profiles of children administered to all language carefully
DD. with ASD from 12 to children at 12, 18, during the second
24 months and 24 months. year of life in
Gross motor, visual children with autism
reception, fine
motor, receptive and
expressive language
skills were assessed.
Children with AD
demonstrated poorer
performance than
children with ASD
and DD on cognitive
and receptive
language tasks
3 Barnes and 28 neurotypicals; Mean age To analyze the story In a previous study, Narrative language Narratives
Baron-Cohen 28 individuals 30 years elements of participants watched sample analysis assessment appears
(2012) with high- narratives of 4 short clips of a sensitive to features
functioning autism individuals with high- television show and of ASD;
or Asperger functioning autism or retold the story in macrostructure
syndrome Asperger syndrome writing. The structure elements should be
of the narrative was evaluated
analyzed and coded
for the presence of
story elements:
setting, character,
conflict, and
resolution.
Participants with
high-functioning
autism or Asperger
syndrome provided
local details of story
elements rather than
global details
4 Bishop and Parents and Range = 5 to To determine Checklists were Norm-referenced Provides a simple
Baird (2001) teachers of 151 17 years whether the completed by test and cost-effective
children Childrens parents and a method for
Communication professional who obtaining systematic
Checklist (CCC) knew the child well. information about
provided valid and Referrals included 5- pragmatic difficulties
(Continued)
149
Table 1. (Continued) 150

reliable information to 17-year-olds with from parents and

when completed by autism, Asperger professionals.
parents, and to syndrome, or specific Parents can be a
consider its learning disability. valid source of
usefulness in a Based on parent and information about
clinical context professional ratings, the childs pragmatic
the pragmatic profile. This type of
composite of the assessment allows
CCC was lowest for one to quantify
the group with severity of
autism and highest impairment in
for those with aspects of
specific learning communication that
disability. Internal are not easy to
consistency was assess using
relatively good for conventional tests
parent and teacher
ratings, but interrater
reliability was not
high
5 Bruckner 272 typically Typically To evaluate whether Logistic regression Norm-referenced Deletion of these
et al. (2007) developing developing the validity of the was used to identify test items from the test
infants; 209 infants younger Receptive biased items. Items should increase the
toddlers with ASD than 18 months Vocabulary scale of are considered extent to which the
of age and the MacArthur biased if authors are
toddlers with Communicative characteristics other measuring the size
ASD older than Development than those being of the respondents
18 months Inventory for Infants, measured by the mental lexicon with
a parent report instrument change the total score from
measure of early the probability that a the MCDI-I
vocabulary, could be person will get an
improved for item correct. 25
children with ASD by items were identified
removing items that as showing large
are biased bias
6 Chan, 46 Chinese- 5 and 6 years To investigate Children were Norm-referenced Test of expressive
Cheung, speaking children of age language subdivided into high- test language is more
Leung, impairment in and low-functioning sensitive than the
Cheung, and children with autism based on their comprehensive
Cheung nonverbal IQ. The language test in
(2005) Expressive language discriminating
scale of the Chinese children with autism
version of the RDLS from typically
(Reynell developing peers
Developmental
Language Scale) was
used to test
language
production, and the
Token Test was used
to examine verbal
comprehension
7 Charman, 134 preschool Range = 1;6 to To compare norms The pattern of Norm-referenced Parent report of very
Drew, Baird, children with ASD 7;2 years on the MacArthur- development of test early language
and Baird Bates CDI with other understanding of competence using
(2003) atypical norms. To phrases, word the CDI Infant and
examine patterns of comprehension and Toddlers forms, to
associations expression, and substitute for or in
production of addition to direct
gestures in children language
with ASD was assessments where
compared with the these are possible,
typical pattern will be useful in both
clinical and research
work with children
with ASD
(Continued)
151

8 Charman 26 children with Initial To examine the 26 children Standardized Standard measures
et al.(2005) ASD assessment at predictive validity of diagnosed with observational, of language and
2 years, symptom severity, autism at age 2 standardized parent cognitive ability
followed by cognitive and were re-assessed at interview, and when measured at
assessment at language measures ages 3 and 7 years. norm-referenced age 3 are better
3 years and taken at ages 2 and At each age test predictors of
7 years 3 years to outcome symptom severity language outcomes
at age 7 and cognitive and at age 7. However,
language at age 2, informal
assessments were assessment of early
completed. emerging nonverbal
Structured adult social
child interactions communication is a
were used to elicit more reliable
verbal and measure than testing
nonverbal formal language
communication. 2
standard
assessments (ADOS
& ADI-R) and one
parent report
(MacArthur-Bates-
CDI) for nonverbal
communicative acts
9 Clifford, 41 children with Range = 48 to To determine Children were filmed Observational COSMIC has the
Hudry, ASD 73 months reliability and validity in a school setting potential to describe
Brown, of COSMIC during a 5-min and evaluate
Pasco, and teacher-directed spontaneous social
Charman activity and 10-min communication skills
(2010) free play. Videotapes in young children
were coded for with ASD in
social classroom setting
communication on
various categories:
initiation of
vocalization/single
word, gesture, eye
contact, follows
gaze/point,
show/give, initiation
joint attention,
request object/action
comparing with
ADOS-G
10 Condouris 44 children with Range = 4 to To investigate The PPVT-III, EVT, Norm-referenced Both standardized
et al. (2003) autism 14 years whether standardized and CELF were tests and language measures and
tests and measures conducted, and sample analysis language samples
derived from natural natural language are useful in
language samples samples were identifying language
provide comparative collected from impairments in
assessments of interaction with children with autism
language skills parents. IPSYN and
number of different
words were used to
assess the language
samples. Children
were impaired in
both measures of
assessment
11 Cunningham To discuss variables The Vineland Review Specific guidelines
(2012) important for Adaptive Behavior for assessment of
assessment Scales (VABS), the social interaction
measures that Autism Diagnostic skills have been
measure change in Observation provided: (1)
social interaction in Schedule (ADOS; consensus on best
children with autism using the newly practice assessment
developed autism protocol, (2) existing
severity rating measures should be
system), the Social improved, and (3)
Responsiveness multimethod
Scale (SRS), and the approach for
Early Social assessment must be
Communication practiced
Scales (ESCS) were
reviewed
(Continued)
153

12 Dennis, High-functioning Mean age To explore whether Noninferential (oral Observational Inferential language
Lazenby, and autism (n = 8); 9.9 years for the level of difficulty vocabulary task) and tasks can be used to
Lockyer matched controls both groups in inferential inferential assess pragmatic
(2001) (n = 24) language tasks is (presupposition and language inferencing
related to the implication, script in children with high-
inferential demands inferencing, functioning autism
in the task metaphor language,
and speech acts)
tasks were
performed by all
participants.
Children with high-
functioning autism
performed better on
noninferential than
on inferential tasks
13 Drew, Baird, Sample 1: 8 boys Reassessed at To describe the Overall frequency of Norm-referenced SCATA might prove
Taylor, Milne, and 1 girl; 42 months; SCATA, to examine nonverbal test (SCATA); useful to measure
and Sample 2: 24 reassessed at which early communicative acts Screening checklist change in early
Charman boys and 5 girls 37 months nonverbal did not change (MCHAT) communicative
(2007) communicative acts between the two ability in young
are associated with assessments, the samples of children
later language Modified Checklist with ASD
outcomes for Autism in

Toddlers (MCHAT)
and the Social
Communication
Assessment of
Toddlers with Autism
(SCATA)
14 Eigsti, 48 children, 16 in Range = 3 to To examine Investigation of Language sample MLU, IPSyn can be
Bennetto, each group 6 years grammatical abilities syntactic and higher analysis used to assess
and Dadlani in children with level discourse grammar. Type
(2007) autism and compare abilities using token ratio,
it with children with transcription of grammatical errors,
developmental speech during free and developmental
disabilities and play sessions for 30 scatter of
typical development min grammatical
structures were
assessed
15 Goldberg 37 children Range = 18 to To understand Parents were given Standardized parent Parent reports are
et al. (2003) 21 months regression of skills in the regression interview useful sources of
autism supplement form information to
along with the ADI- measure regression
R. They were asked in skills, including
to document language
regressions in
language and other
skills
16 Halle and 1 child with ASD 3-year-old To describe a Used a 3-step Observational The assessment
Meadan structured protocol assessment protocol protocol:
(2007) for assessing tailored to measure interviewing parents
request, reject, and request, reject, and and teachers and
repair behavior of repair behaviors. observing the child
young children with Recorded behaviors in a natural context,
autism and obtained interaction with the
percentage of each. child during daily
Case study routines, and
presented creating
opportunities for
communication are
useful in assessing
request, rejection,
and repair behavior
17 Hudry et al. 152 children with Range = 24 to To examine the Four different Standardized As the receptive
(2010) autism 59 months relative delay in measures were observational language
receptive and administered. On all (ADOS), interview impairment may be
expressive language measures, receptive (ADI-R), norm- masked by the
in children with language was more referenced (MSEL), expressive language,
autism impaired than and parent report parents and
expressive language (MCDI) professionals must
modify and simplify
the way in which
they interact with
children with ASD
(Continued)
155

18 Hutchins, Study 1: 135 Study 1: To determine the Summary of two Parent report The ToMI is a quick
Prelock, and caregivers; Study Caregivers of psychometric studies that and easy measure to
Bonazinga 1: 124 caregivers 3- to 17-year- properties of the examined the use of administer while
(2012) olds with ASD; Theory of Mind the ToMI for children controlling for
Study 2: Inventory (ToMI) revealed excellent factors related to the
Caregivers of testretest reliability childs motivation,
typically and internal cognition, language,
developing 2- consistency for the and situation
to 12-year-olds measure
19 Kenworthy 76 children with Mean age = To determine the Onset of first word Standardized parent Early language
et al. (2012) autism 9;1 relationship between and first phrase were interview (ADI-R) milestones will be
early language obtained and norm- useful in identifying
milestones and later retrospectively from referenced test language
structural language, the ADI-R reports. (VABS) impairments in later
adaptive functioning Sentence repetition ages
and autism task and Vineland
symptoms Adaptive Behavior
Scale were
administered to all
children. Early
language was
predictive of later
structural language
and adaptive
communication, but
not predictive of
autism symptoms or
adaptive skills
20 Kjelgaard 89 children with Range = 4 to To re-examine the A series of Norm-referenced Children with autism
and Tager- autism 14 years language profiles of standardized tests to tests may have language
Flusberg a large and well- assess phonology, commensurate with
(2001) defined group of lexical, and higher IQ or may
children with autism language abilities demonstrate
was used. The tests language
included the impairment; formal
Goldman Firstoe tests can reveal
Test of Articulation, these individual
the Peabody differences, but use
Picture Vocabulary of language samples
Test-III, the recommended to
Expressive complement test use
Vocabulary Test, the
Clinical Evaluation
of Language
Fundamentals, and
the repetition of
nonsense words.
Childrens
performance on the
different language
measures rendered
different subgroups
21 Kjellmer et al. 94 children Range = 4 to To assess language Reynell Norm-referenced Assessment of
(2012) 6;8 years comprehension in Developmental test language
preschoolers with Language ScalesIII comprehension
ASD, to assess used to assess should be a critical
differences between language part of all language
ASD subgroups, and comprehension assessment in
to determine the longitudinally over children with ASD
relationship between 2 years. Children
language with autism revealed
comprehension, delay in language
performance, and comprehension and
verbal IQ large differences in
language profiles
within the group
22 Landa (2005) To provide a review Detailed review of Review A parent report in
of different tests social combination with an
used to assess social communication observational tool is
communication in assessment necessary to gain a
preschoolers and measures has been more complete
toddlers with ASD provided; the Ages picture of the childs
(Continued)
157

and Stages social

questionnaire, the communicative
ADI-R, the Ghuman ability
Folstein Screen for
Social Interaction,
the ADOS, the
Social
Responsiveness
Scale, the CSBS
Developmental
Profile, and the
Sequenced Inventory
of Communication
Development
23 Lewis, 20 children Age range for To determine The Test of Norm-referenced A comprehensive
Murdoch, 17 adults with children = 9;4 whether performance Language test language
and ASD to 15;1 years; on complex higher Competence (TLC) assessment on
Woodyatt age range for order language tasks was administered to individuals with ASD
(2007) adults = 18 to differed between children and adults will render
67 years individuals with ASD with ASD. No information on the
and the control differences were heterogeneity of
group, and if found for either language skills
individuals with ASD children or adults on within the group
differed as a group the TLC measures

based on their
developmental
language profile
24 Lloyd and 37 children Range = 5;10 To determine use of 3 groups of children Norm-referenced Support the use of
Paintin to 10;7 years CELF for language with communication test more detailed
(2006) skills in 3 groups of disorders were linguistic
children assessed using the assessments such as
CELF. The results the CELF with
were used to children who have
compare the ASD as well as
language skills of children with SLI
children with specific
language
impairment (SLI),
autistic spectrum
disorder (ASD), and
a middle group who
shared some
characteristics of
both SLI and ASD
(Shared group)
25 Lord et al. Children with Children were To examine Toddler ADI-R, Standardized Parent reports and
(2004) possible autism referred at regression and word Prelinguistic ADOS, interview (ADI-R); history of assessment
(n = 110); DD 2 years or loss in children with Mullen Scale of Early standardized using standardized
(n = 21); children before autism (longitudinal Learning, and observational measures are useful
with loss of skills study) Differential Ability (ADOS); Norm- in obtaining
(n = 19); and less Scale (DAS) referenced test information about
specific loss of administered to all (MSEL); IQ test loss of skills in
imitation (n = 12) children at ages 3, (DAS) children with autism
4, and 5. Acquisition
of a small number of
words following loss
was associated with
children diagnosed
with ASD at 5 years
of age. Loss of less
specific skill was
associated with
cognitive delays with
or without autism.
Little difference
between children
with autism with and
without word loss
26 Luiselli et al. To identify the Assessment Summary/Review Standardized
(2001) various instruments instruments used by assessment
used in assessment multiple disciplines instruments on
of ASD. across different various domains
national service (adaptive behavior,
(Continued)
159

centers were family assessment,

collected through a etc.) provide
survey objective information
11 assessment that can be used for
domains were diagnostic screening,
identified from the service planning,
instrument and evaluation of
assessment survey. education and
Percentage of use of treatment outcome
different assessment
tests/tools used
under each domain
was summarized
27 Luyster, Qiu, 81 children Enrollment at 2 To investigate 62 children referred Norm-referenced The CDI yielded
Lopez, and or 3 years whether scores on for possible autism test scores that were
Lord (2007) the MacArthur-Bates at age 2 years, and predictive of
Communicative 19 children with DD, outcome, suggesting
Development were followed to age that this parent
Inventory (CDI) at 9 years. Vocabulary, report measure may
ages 2 and 3 years prespeech, and be a quick and
predict outcome at gestures scores on informative
age 9 years in CDIs administered at assessment of early
children with ASD ages 2 and 3 years verbal and
and developmental were used to predict nonverbal skills in

delay (DD) follow-up IQ, children with ASD
language, adaptive
skills, and scores on
diagnostic measures
28 Luyster et al. 164 children with Range = 18 to To systematically Several cognitive, Standardized Parent report and
(2008) autism 33 months investigate language language, and observational direct standardized
in toddlers with ASD behavioral measures (ADOS-G); assessments of early
and to identify early were administered, interview (ADI-R); language in toddlers
correlates of with good structured with ASD can be
receptive and agreement among observational used
expressive language interview (ESCS); interchangeably
different measures norm-referenced particularly for
and parent reports (VABS); parent expressive language
report (MCDI)
29 Magiati, 22 children with 5;5 years at the To determine Parents completed Parent report Parent reports can
Moss, Yates, ASD and their time of internal consistency initial ATEC when be used to measure
Charman, parents enrollment; of the ATEC (Autism children were treatment progress
and Howlin followed up Treatment Evaluation 5;5 years old, and
(2011) after 56 years Checklist) and to then followed it up
determine whether it with another one
is concurrent with after 56 years.
other standardized ATEC has a high
measures that assess internal consistency,
progress after subscales are
therapy reliable and
consistent over time;
scores correlate with
standardized
measures of
language, cognition,
adaptive behavior
skills, and autism
severity
30 Manolitsi and 26 children with Range = 4;2 To determine use of Compared 26 Norm-referenced Narrative is a good
Botting ASD and SLI to 13 years narrative tools Greek children with tests and narrative tool for language
(2011) either ASD or SLI on language sample assessment
standardized analysis
measures of
structural and
pragmatic language
(CELF, TOPL) and a
structured narrative
task
31 McCool and 30 children Range = 11 to To investigate The Childrens Norm-referenced The CCC-2 has the
Stevens 17 years whether elevated Communication test potential to be used
(2011) levels of Checklist2 was as a screening tool
communication used to evaluate for identifying
impairment exist in these children; 19 speech, language,
(Continued)
161

individuals in out of 30 children and communication

residential care demonstrated deficits individuals in
features of ASD and residential care
others had difficulties
in speech, language,
and communication
32 Meadan 2 children with 2;8 and To examine the Used scripted Observational Speech-language
et al. (2006) ASD 3;3 years, repair strategies of 2 protocol with pathologists can
respectively young children with opportunities for arrange
ASD from an requests and repair. environmental or
environmental rather Environmental contextual factors to
than a variables examine their effects
developmental investigated were on communication
perspective activity type and repair. By
breakdown type. manipulating the
Videotapes were environment, repair
coded for childs behaviors change
behavior
33 Meadan 3 children with Two 3-year-old To examine Videoclips from Observational Differences in
et al. (2012) ASD children;one 5- judgments made by structured interpretation of
year-old different listeners of assessment of 3 communicative
communicative children with autism intents can impact
intents used by were used to code the implementation
young children with communicative of intervention.

autism intents. 24 adult Conversational
raters divided into 4 partners should
subgroups (familiar agree on what child
expert, familiar intends to
nonexpert, communicate; need
unfamiliar expert, for caregiver
and unfamiliar involvement in
nonexpert) rated the designing
videoclips. Familiar communication
expert adults are goals
more confident in
making the
judgments than
raters in the other 3
subgroups
34 Miniscalo, 31 Range = 1 to To identify whether The MacArthur Parent report, Parents of children
Franberg, 3 parents of children Communicative Norm-referenced with autism are
Schachinger- with ASD identify the Developmental test (CDI) capable of providing
Lorentzon, same language Inventory (parent Standardized test valid and trustworthy
and Gillberg problems as SLPs report) and Reynell (Reynell information
(2012) did. To describe Developmental Developmental regarding their
typical language Language Scale III Language Scale III) childrens language
profile of toddlers by SLPs were development
with ASD administered, and
scores were
compared
35 Murdock, 16 children with Range = 6 To measure social Classroom Observational Differences in verbal
Cost, and ASD to10 years communication observations with initiations, verbal
Tieso (2007) using the S-CAT SCAT assessments; responses, joint
(Social content validity and attention could be
Communication interrater reliability measured using the
Assessment Tool) investigated to SCAT
determine extent to
which SCAT
categorically
discriminated
between children
with and without
ASD and those
without ASD
36 Muskett et al. Analysis of one Exact age not To provide a Conversational Conversational Conversational
(2012) childs specified. 4 detailed description analyses of the analyses analyses can be a
conversational children were of the childs picture-naming useful clinical tool to
sample from between 8 and interaction during a subtest of the examine an
Schopler et al. 12 years dynamic assessment Assessment of individuals learning
(1988)s data-set procedure, and to Comprehension and in this case,
(4 children) examine whether Expression (ACE-N) picture-naming
these findings can of 1 child with ability
be clinically autism. Complex
applicable interactional
(Continued)
163

processes were
identified. Naturally
occurring variations
in conversations can
provide relevant
information for
understanding the
examinees learning
potential
37 Nigam To provide Summary of different Review Use of dynamic
(2001) intervention strategies provided assessment while
strategies that are evaluating the use of
useful during AAC in children with
dynamic assessment autism is
recommended
38 Novogrodsky 23 children with Age range for To assess third- Children in both Narrative language Story-telling can be
(2013) ASD; 17 TD ASD children = person pronoun use groups participated sample analysis used to assess
children 6 to 14 years; in narratives in a story-telling and morpho-syntactic
age range for story-retelling task. abilities in children
TD children = No difference in with autism
5 to 15 years performance
between the two
groups of children
on the story-retell
task, but children
with ASD indicated
poorer performance
on use of third-
person pronouns
than peers on the
story-telling task
39 Park, Yelland, 17 children with Range = 3 to To examine whether Language samples Language sample Language
Taffe, and ASD;7 DD 6 years children with ASD were collected analysis assessment tools that
Gray (2012) children;19 TD have difficulties with during ADOS. The provide high
children morphological and IPSYN and Browns developmental
syntactic skills, and grammatical scores will fail to
to determine whether morphemes were capture uneven
they use rote used to assess developmental
learning to childrens patterns. Use of
compensate for their morphological and comprehensive
morphological and syntactical skills. language
syntactic deficits Results indicated that assessment tools that
children with autism provide information
have unevenly on level of
developed skills in functioning of
these areas grammatical
structures is
recommended
40 Pasco et al. 91 children with Range = 3;11 To determine the Participants were Observational Use of observational
(2008) ASD to 10;2 years reliability and validity videoed during measure of
of COSMIC everyday snack, free intentional
play, and teaching communication in
natural settings is a
valuable tool for
research and clinical
practice
41 Prelock et al. To describe an The steps in the VT- Review The role of family
(2003) interdisciplinary RAP for the involvement in the
model, the Vermont assessment of assessment of
Rural Autism Project children with ASD children with ASD
(VT-RAP) that includes families emphasized
as active participants
and collaborators in
the process have
been described
42 Reichow 35 children Range = 3 to To investigate the In a Developmental Norm-referenced CASL is a good
et al. (2008) 15 years concurrent validity of Disabilities clinic, tests measure for
subsets on the CASL evaluation of family adaptive use of
by comparing them and developmental language by children
with the assessment history, with ASD
of communication psychological
and social skills on testing, language
the Vineland test (CASL), and
(Continued)
165

Adaptive Behavior adaptive behavior

Scale (VABS) were
completed.
Pragmatic judgment
and inferences CASL
subtests significantly
correlated with the
communication and
social domains of
the VABS
43 Rubin and To evaluate social A description of the Review Curriculum-based
Laurent communicative SCERTS (Social assessment can be
(2004) competence in Communication used to assess social
adolescents with Emotional communicative
Asperger syndrome Regulation and competence
and high-functioning Transactional
autism Support) provided
with a curriculum-
based assessment
that elaborates the
developmental
objectives for the
child and his/her
communication
partners
44 Russell and To select tests that Questions, Critical review Research emphasis
Grizzle measure pragmatic checklists, and tests on developing an
(2008) language that assess PLCs evidence base for
competencies (PLC) were identified PLC assessments
to be used for The reliability and
assessment and validity of 24 PLC
research measures were
assessed
45 Schneider 10 children Range = 6 to To determine The Bilingual Norm-referenced A modified BAT can
and Hopp 21 years whether transcranial Aphasia Test (BAT) test be used to measure
(2011) direct stimulation was used to test
facilitates language subject-verb-object syntax in children
acquisition in sentences. Children with autism
children with autism were taught syntax,
and the test was
administered before
and after the
transcranial direct
stimulation
procedure. There
was syntax
acquisition following
the procedure
46 Syriopoulou- To present a method The observer, the Review Systematic
Delli (2011) of systematic techniques used, observation can
observation and and the diagnostic better guide
propose additional tools used in assessment to
techniques to assess assessment have understand the
and diagnose been described childs behavior and
children with PDD needs
47 Tager- To offer a set of A group of Review They recommend
Flusberg recommended researchers with multiple sources of
et al. (2009) measures that can interest and information to define
be used for experience in the language phases,
evaluating the study of language including natural
efficacy of development and language samples,
interventions that disorders in young parent report, and
target spoken children with ASD standardized
language acquisition worked for measures
as part of treatment 18 months through
research studies or a series of
for use in applied conference calls and
settings correspondence,
culminating in a
meeting held in
December 2007 to
achieve consensus
on the aims
(Continued)
167

48 Volden and 16 children with 9-year-olds To compare the 16 rigorously Norm-referenced CCC2 identified
Phillips ASD Childrens diagnosed children test pragmatic language
(2010) Communication with ASD were impairment better
Checklist2 (CCC matched to 16 than the TOPL.
2), a parent report typically developing Clinically, this can
instrument, with the children on age, be useful in
Test of Pragmatic nonverbal IQ, and documenting the
Language (TOPL) structural language presence of
skill. Both groups language
were given the dysfunction when
TOPL, and their traditional
parents completed standardized
the CCC2 language
assessments would
not reveal
communication
deficits
49 Volden et al. 294 children with Range = 2 to To determine the The PLS-4 and Norm-referenced PLS-4 can be used
(2011) autism 4;11 years suitability of the Vineland-II were test to determine early
Preschool Language administered semantic and
Scale-4 for 4 months after syntactic skills in
preschool-aged diagnosis. Parent preschool children
children with ASD reports were with ASD
completed during
initial diagnostic
assessment or
mailed before
assessment
50 Watson, Autism (n = 43); Recruited at 2 To compare gesture Videotapes of infants Observational Video observations
Crais, D (n = 30); D 7 years use in infants with at 9 12 and 15 can be used
Baranek, (n = 36) autism and infants 18 months, retrospectively to
Dykstra, and with DDs and TD retrospectively assess infants use of
Wilson infants assessed. A gestures. Video
(2013) significant difference observations also
between infants with caution the clinician
autism and other to pay attention to
infants in the use of the frequency of
joint attention and gesture usage in
behavior regulation infants with autism
gestures indicative of
pivotal social
communication
impairments
51 Weismer ASD (n = 257); Range = 2 to To characterize the The Vineland Norm-referenced There is consistency
et al. (2010) DD (n = 69) 3 years early language Adaptive Behavior tests among all 3
abilities of toddlers Scales-II, the measures used.
with ASD using Sequenced Inventory Therefore, SLPs and
multiple measures of of Communication psychologists can
language Development, and use these measures
assessment and the Mullen Scales of to evaluate
compare it with Early Learning were language
language administered. Scores development in
performance in from each of these children with ASD
developmentally language measures
delayed children were correlated
52 Williams 78 evaluations of Range = To identify the Review showed that Review Parent interview,
et al. (2009) 29 young children 12 months to practices in similar rates of ASD direct observation,
5 years assessment used by were found across standardized ASD
3 settings: public all sites. But measure,
schools, DD community standardized
eligibility evaluators did not cognitive measure,
determination follow best-practice standardized
centers, and guidelines, nor use adaptive measure,
hospital-based early valid instruments. more than one
childhood programs They did not session, observation
evaluate language in in more than 1
the native language, setting
nor address the Bilingual testing for
impact of native ASD: use of measure
language in in native language,
assessments. Some professional using
best-practice language used by
guidelines for ASD parents to the child
(Continued)
169

assessment and
native language
assessment have
been used by a
small percentage of
the evaluators
53 Worth and 1 child 11 years To assess the The ACE Norm-referenced A battery of
Reynolds linguistic deficits of a (Assessment of test and assessments, both
(2008) school-aged boy Comprehension and observational formal and informal,
with AS Expression), is a contributes to a
formal assessment thorough
tool. A subtest of the understanding of an
ACE, using color individual examinee
cards, semantic
links, and looking
and thinking tasks,
was used. The
childs social
understanding and
interpretation were
observed during the
assessment, and
information on his
functional language
skills was obtained
from his teacher.
The range of
assessments followed
in the study
contributed to a
better understanding
of the boys learning
and social deficits,
along with weakness
in functional
language skills
54 Young et al. Autism (n = 17); Range = 6 to To determine The Test of TOPL; norm- The TOPL is effective
(2005) matched controls 14 years whether the TOPL Pragmatic Language referenced SNAP: in assessing
(n = 17) and the SNAP would (TOPL) resulted in criterion-referenced pragmatic language
differentiate poorer scores in deficits in children
pragmatic language children with autism with autism when
disorders in children than in their compared with the
with autism and their matched controls. SNAP
matched controls However, the Strong
Narrative Assessment
Procedure (SNAP)
revealed similar
profiles for children
with autism and their
matched controls on
syntax, cohesion,
episode completion,
and story grammar
171
purpose of study, types of language assess- Preschool Language Scale (1 study) (Vol-
ments used, methods, procedures and den, et al., 2011)
results, and authors report of primary find- Test of Language Competence (1 study)
ings relative to assessment guidelines or (Lewis, Murdoch, & Woodyatt, 2007)
implications have been provided. Nonword repetition (1 studyusing
norms from literature, not a published
test) (Kjelgaard & Tager-Flusberg, 2001)
Formal testing Sequenced Inventory of Communica-
The following tests of language and com- tion Development (1 study; criterion-
munication found at least some support in referenced) (Landa, 2005)
the studies evaluated in this review: Receptive and Expressive One-Word
Vocabulary tests (1 study) (Alt &
Mullen Scales of Early Learning (3 Moreno, 2012)
studies) (Barbaro & Dissanayake,
2012; Lord, Shulman, & DiLavore, One testthe Social Communication
2004; Weismer, Lord, & Esler, 2010) Assessment for Toddlers with Autismwas
Clinical Evaluation of Language Funda- formulated specifically for ASD; one
mentals (3 studies) (Condouris, Meyer, studys findings were interpreted by the
& Tager-Flusberg, 2003; Lloyd & Paintin, authors as supporting its use for measuring
2006; Manolitsi & Botting, 2011) change over time (Drew, Baird, Taylor,
Peabody Picture Vocabulary Test (2 Milne, & Charman, 2007).
studies) (Condouris, Meyer, & Tager-
Flusberg, 2003; Kjelgaard & Tager-
Parent report instruments
Flusberg, 2001)
Expressive Vocabulary Test (2 studies) Another way to obtain normative data
(Condouris, Meyer, & Tager-Flusberg, without administering a formal test to the
2003; Kjelgaard & Tager-Flusberg, 2001) child on the spectrum is to employ stan-
Reynell Developmental Language dardized norm-referenced parent report
Scales-2 - English version (2 studies); measures. This review found several studies
Chinese version (1 study) (Kjellmer, investigating caregiver report-based assess-
Hedvall, Hold, Fernell, Gillberg, & ments. Evidence favoring use of the
Norrelgen, 2012; Miniscalo, Franberg, MacArthurBates Communication Devel-
Schachinger-Lorentzon, & Gillberg, opment Inventory (MB-CDI) was reported
2012) by six different studies, with a variety of foci
Test of Pragmatic Language (3 studies (Bruckner, Yoder, Stone, & Saylor, 2007;
2 positiveManolitsi & Botting, 2011; Charman, Drew, Baird, & Baird, 2003;
Young, Diehl, Morris, Hyman, & Ben- Hudry, et al., 2010; Luyster, Qiu, Lopez, &
netto, 2005, 1 negative, Volden & Phil- Lord, 2007; Luyster, Kadlec, Carter, &
lips, 2010) Tager-Flusberg, 2008; Miniscalo, Franberg,
Comprehensive Assessment of Spoken Schachinger-Lorentzon, & Gillberg, 2012).
Language (1 study) (Reichow, Salamack, All report results that the authors consider
Paul, Volkmar, & Klin, 2008) as speaking for its reliability and validity,
Bilingual Aphasia Test (1 study, adapted and therefore they recommend its use,
for use with low-verbal children) (Sch- either in conjunction with or instead of for-
neider & Hopp, 2011) mal tests of early language development.
Parent-report-based assessments for young measures, and both argue that useful, valid
children were supported by more than one data can be obtained from parent report.
study, including both the MB-CDI as well Thus overall the scoping review revealed
as information gleaned from the communi- that parent-report-based measures, across a
cation items on the Autism Diagnostic wide range of ages and communicative
Interview-Revised (Lord, Rutter, & Le Cou- domains, are in use, and studies of their
teur, 1994), which had 5 studies reporting utility for assessment of language and com-
positive findings (Charman, et al., 2005; munication in ASD have been positive.
Hudry, et al., 2010; Kenworthy, et al.,
2012; Landa, 2005; Luyster, Kadlec, Carter, Observational approaches
& Tager-Flusberg, 2008). The Vineland
Ten studies investigated using observa-
Adaptive Behavior Scales-II (VABS)
tional assessments, incorporating scripted
(Sparrow, Cicchetti, & Balla, 2005) is a
elicitation protocols, and all reported that
caregiver-report-based instrument that cov-
they found results supporting use of their
ers more domains than just language; many
protocols to measure language and com-
studies in this review used communication
munication in autism. Examples of abilities
and social subscales as benchmarks to vali-
measured included inferencing (Dennis,
date other assessments (e.g., Kenworthy
Lazenby, & Lockyer, 2001), social commu-
et al., 2012; Reichow, 2008). By implica-
nication skills in the classroom and home
tion, this suggests that it may have utility in
environments (Clifford, Hudry, Brown,
evaluating language and communication
Pasco, & Charman, 2010), communicative
functioning in autism, but no study had this
intents (Meadan, Halle, & Kelly, 2012),
as its primary goal in using the VABS-II.
and gestures (Watson, Crais, Baranek,
(We note that Pickles, Anderson, & Lord,
Dykstra, & Wilson, 2013).
2014; investigated language development
Several researchers advocated for com-
longitudinally using the communication
bining standardized with observational,
scores from the VABS-II, using a similar
structured elicitation approaches (Charman
rationale.) Another caregiver-report-based
et al., 2005; Lord et al., 2004; Luyster,
instrument, the Childrens Communication
Kadlec, Carter, & Tager-Flusberg, 2008).
Checklist, was investigated in multiple stud-
Some investigators argue that use of infor-
ies; each presented results that it (and its
mal protocols to supplement formal testing
more recent version, the CCC-2) is a reli-
is particularly important, because of the sig-
able and valid assessment for pragmatics, as
nificant differences in cognitive and sensory
well as screening for communication defi-
processing known to exist in ASD (e.g.,
cits more generally (Bishop & Baird, 2001;
Charman et al., 2005; Luyster et al., 2008).
McCool & Stevens, 2011; Volden & Phillips,
Halle and Meadan (2007), for example,
2010). This instrument extends through
express the view that a primary advantage
school age. Two other criterion-referenced
of structured elicitation is that it increases
parent-report-based instruments were
the chances of observing a behavior while
found in this search, one for theory of mind
maintaining a naturalistic context.
(Hutchins, Prelock, & Bonazinga, 2012) and
one for more general language and commu-
Language sample analysis
nication (Autism Treatment Evaluation
Checklist) (Magiati, Moss, Yates, Charman, Language sample analysis, either of natural
& Howlin, 2011). Both of these also report or naturalistically elicited language, was
that their results are in favor of the investigated in six of the studies included
in this scoping review. Two of these inves- assessments were not being conducted in
tigated narrative assessments, and the the home language. Cunningham (2012)
authors of both of these suggest that this is and Landa (2005) discuss social communi-
a sensitive measure of higher order lan- cation assessment best practices, with a
guage that should be a standard in any broad agreement with the findings of the
assessment protocol for individuals capable present scoping review, that multiple types
of producing narratives. A third study used of assessment are needed to obtain a
narrative to elicit morphosyntactic data comprehensive picture of social ability.
(Novogrodsky, 2013); the authors advocate Tager-Flusberg et al. (2009) developed a
for narrative elicitation as a valid and reli- preferred protocol for assessing interven-
able way to garner sufficient data to ana- tion outcomes, and they too recommend
lyze expressive morphosyntax. Three use of multiple measures, including obser-
studies used language sample data to score vations, formal tests, and parent reports.
the Index of Productive Syntax (Con-
douris, Meyer, & Tager-Flusberg, 2003; Domains assessed
Eigsti, Bennetto, & Dadlani, 2007; Park,
Yelland, Taffe, & Gray, 2012); two exam- Our review located only one article (Kjel-
ined mean length of utterance in mor- gaard & Tager-Flusberg, 2001) that
phemes, and one Browns 14 morphemes included phonological/articulatory assess-
(Eigsti, Bennetto, & Dadlani, 2007; Park, ment specifically for ASD. All other lan-
Yelland, Taffe, & Gray, 2012). All of these guage domains were widely represented,
report that these measures could be although few studies investigated seman-
applied reliably to measurement of mor- tics/vocabulary in isolation from other ele-
phosyntactic ability in the individuals stud- ments. Many studies used assessments that
ied. One study (Muskett, Body, & Perkins, crossed multiple language domains, includ-
2012) used conversational data to investi- ing vocabulary, employing battery tests
gate pragmatic abilities, also incorporating such as the Reynell, the CELF and the
a dynamic assessment protocol. CASL, or parent reports such as the VABS-
II and the CCC-2. For studies that focused
on one area, the most frequent was prag-
Reviews matics and social abilities (17 studies), fol-
Ten of the studies identified in the present lowed by morphosyntax (4).
report were classified as reviews, with a
range of purposes and methods. Reviews Age of study participants
looked at areas such as dynamic assess- The age ranges covered in the literature
ment for AAC (Nigam, 2001), curriculum- surveyed were from infant to adult. There
based assessment (Rubin & Laurent, 2004), were 10 that included infants and toddlers,
best practices for working with families 8 that included preschoolers, 28 that
(Prelock, Beatson, Bitner, Broder, & included elementary-age children, and 12
Ducker, 2003), and whether community that included middle- to high-school-age
practitioners are consistent in their assess- children. Only two studies included adults.
ment protocols (Williams, Atkins, & Soles,
2009). Williams et al. found that best-prac-
Other findings
tice guidelines for language assessments
were not being followed, particularly in Two studies found that formal measures
the case of dual language learners, where showed receptive language relatively more
impaired than expressive (e.g., Barbaro & ing that procedures designed for the gen-
Dissanayake, 2012; Hudry et al., 2010). eral population have the potential to be
One study (Alt & Moreno, 2012) investi- applied successfully to people with autism.
gated whether computer presentation The likelihood of all published formal tests
would produce reliable and valid results being independently validated for ASD is
comparable to those obtained by tradi- not high. The literature provides some
tional formats. They found no difference in modest support for the cautious assertion
performance based on format of the test. that individuals on the spectrum may be
successfully assessed with tests normed on
the general population.
That pragmatics and social communica-
DISCUSSION
tion were the domains most frequently
Despite the overall lack of a clear set of best investigated independently of other areas
practice guidelines, the present review did of language is not surprisingthese are
uncover information in the literature perti- core domains for ASD, and they are not
nent to developing appropriate assessment easy to assess. Formal testing of pragmatics
protocols. First, formal testing for language faces challenges owing to the difficulty of
abilities in ASD is, by and large, supported devising sufficiently rich contexts that are
in the literature, in that such testing has nonetheless standardized. Volden and
been shown to be at least feasible. For the Phillips (2010) found that the Test of Prag-
majority of studies using formal testing, matic Language was not as sensitive in
results showed that they were successfully identifying pragmatic language impairment
administered and produced interpretable as the Childrens Communication Check-
results. In addition, a few specific formal list-2. One way of dealing with the chal-
tests and language sampling procedures lenge of creating appropriate assessments
have been repeatedly investigated and of pragmatics is to use caregiver report
found positive results regarding their instruments. Several studies advocated an
appropriateness and utility in assessing this observational/language sampling approach
population. Even though full-range sam- to the assessment of pragmatics (e.g., Mea-
pling (McFadden, 1996) falls short of pro- dan, Halle, Watkins, & Chadsey, 2006 and
viding truly autism-specific norms, many 2012; Muskett, Body, & Perkins, 2012;
commercially available formal tests not Pasco, Gordon, Howlin, & Charman,
designed for those on the spectrum have 2008). Clinicians can benefit from using
been investigated experimentally and thus the approaches available in the literature
may be said to have some evidence of (e.g., the COSMIC observational tool,
validity for ASD (e.g., Bruckner, Yoder, Pasco et al., 2008), to avoid creating ad
Stone, & Saylor, 2007; Charman et al., hoc protocols with limited replicability.
2005; Condouris et al., 2003; Reichow, Russell and Grizzle (2008), in their critical
Salamack, Paul, Volkmar, & Klin, 2008; review, emphasized the need for an
Volden et al., 2011). In addition, six studies improved evidence base for the assessment
included in this scoping review found dif- of pragmatic language abilities in ASD.
ferences between children with ASD and The underrepresentation of adults in the
controls on the formal measures used. studies located during this review is unfor-
That 15 formal tests of widely varying tunate. Persistent deficits in functioning
design and purposes have some evidence throughout the lifespan (see, e.g., Shattuck
of validity for ASD is encouraging, indicat- et al., 2012) mean that adults continue to
need appropriate support. Interventions inventory the many dimensions of lan-

can only be optimally designed if valid and guage and communication, the majority of
reliable assessments are available. Studies experts included in this review advocate
of appropriate assessment protocols for for a multipronged strategy. A well-
communication and language in adults rounded protocol would incorporate lan-
with ASD are sorely needed. guage sample analysis of naturalistically
The presence in two studies of a finding collected data, coupled with a structured
of a receptive-expressive gap favoring observation designed to elicit any unob-
expressive language has important implica- served, rarer abilities. If it is important to
tions for intervention and environmental establish need for services or to compare
supports. A child who does not understand with a peer group, these informal measures
at the same level that he or she speaks is, would need to be coupled with a formal
because of not comprehending the lan- test and/or a norm-referenced caregiver
guage being spoken, at risk for being seen report instrument. The latter has a signifi-
as noncompliant. Such findings, should cant literature reporting positive findings to
they be extended and validated in further support it and offers an alternative when
work, indicate that consideration of a com- more complex assessments cannot be com-
prehensive approach to assessment, one pleted. Caregiver report measures are avail-
that considers both receptive and expres- able across the age range for children,
sive competencies, may be needed to providing a probe of real-world language
ensure children exhibiting these patterns use that may be otherwise unavailable, and
receive appropriate services. they offer normative comparisons when
Alternative stimulus presentation offers those are needed to obtain services or to
an intriguing new avenue that may be document progress. Clearly much remains
beneficial to children and adults on the to be done in establishing reliable and valid
spectrum. As technology evolves and protocols for language and communication
tablet-based test presentation becomes assessment in ASD across the age span and
more widely available, studies investigating across the ability continuum. Yet it is
potential advantages of such technological encouraging that the literature identified in
alternatives are needed. In addition to con- this scoping review provides at least some
venience, tablets offer the potential to empirical support for many common prac-
engage the attention of children being tices, and an emerging consensus on what
tested and potentially decrease variability those practices should be.
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Evidence-Based Communication Assessment and Intervention, 2015

Vol. 9, No. 4, 140181, http://dx.doi.org/10.1080/17489539.2016.1153814

Evidence-based assessment and autism spectrum

Keywords: Evidence-based practice; Communication; Language; Assessment; Autism

Autism spectrum disorder (ASD) is a generated a sense of urgency to develop

2016 Informa UK Limited, trading as Taylor & Francis Group

hensiveness of the selected databases, a parameter was construed broadly, such

Figure 2. Number of articles identified in each category of assessment.

Studies Participant characteristics Investigators

did not differ by

Studies Participant characteristics Investigators

reliable information to 17-year-olds with from parents and

Studies Participant characteristics Investigators

Studies Participant characteristics Investigators

outcomes for Autism in

children with ASD

Studies Participant characteristics Investigators

Studies Participant characteristics Investigators

and Stages social

differed as a group the TLC measures

Studies Participant characteristics Investigators

centers were family assessment,

and developmental were used to predict nonverbal skills in

Studies Participant characteristics Investigators

individuals in out of 30 children and communication

young children with communicative of intervention.

Studies Participant characteristics Investigators

Studies Participant characteristics Investigators

Adaptive Behavior adaptive behavior

Studies Participant characteristics Investigators

Studies Participant characteristics Investigators

need appropriate support. Interventions inventory the many dimensions of lan-

opmental Disabilities, 22, 389398. doi:10.1016/ trum Disorders, 6, 204211. doi:10.1016/

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