**2. Methods**

This chapter will describe two different studies and discuss their results.

#### **2.1. Study 1. Comparison of the** *Functional Communicative Profile and the Functional Communicative Profile-Revised* **of children and adolescents with autism spectrum disorders**

#### *2.1.1. Methods*

Participants were 50 children and adolescents with ages between 3 years 9 months and 14 years 8 months (average 7 years 11 months) of both genders with Autism Spectrum Disorders (ASD) attending a specialized Speech-Language Pathology (SLP) service for periods of six months to two years.

All participants were assessed according to the criteria of the *Functional Communicative Profile* (FCP) and of the *Functional Communication Profile – Revised* (FCP-R). The results were recorded, scored and classified.

Since the FCP-R is a tool with technical data, extensive and detailed; therefore it was applied by means of interviews with the speech-language therapist of each participant. All the SLPs have been assigned to each participant for at least six months prior to the interview. This time was considered enough to the therapists to have all the information demanded by the FCP-R. The analysis of the FCP considered the five minutes with more symmetric interaction of each sample.

#### *2.1.2. Data analysis*

Speech; Voice; Oral; Fluency and Non-Oral Communication. To this study the areas of Behavior; Attentiveness; Receptive Language; Expressive Language and Pragmatic/Social

The analysis of the functional communicative profile (FCP) adopts the criteria proposed by Fernandes (2004). It uses 15-minute filmed samples of patient-therapist interaction. In these situations the dyads play with toys regularly used in language-therapy sessions and that usually produced good communicative situations. Data are recorded, transcribed and

The analysis of the FCP uses the Pragmatic Recording Protocol [8]. This study used the data about the communicative functions. After the record of the data in the specific protocols the incidence of each communicative function expressed by the participant is determined as well as the proportion of the communicative space occupied, the number of communicative acts expressed per minute and the proportion of more interactive communicative acts expressed.

The occupation of the communicative space is determined by the ratio of communicative acts produced by the participant and by the therapist in each sample. The number of communica‐ tive acts expressed per minute was obtained by the ratio of communicative acts expressed and the size of the sample (in minutes). The proportion of interactive communicative acts is defined by the ratio of all communicative acts expressed by the participant and those that expressed

were selected.

**2. Methods**

*2.1.1. Methods*

two years.

recorded, scored and classified.

analyzed with a specific protocol.

140 Autism Spectrum Disorder - Recent Advances

one of the more interactive communicative functions.

This chapter will describe two different studies and discuss their results.

**2.1. Study 1. Comparison of the** *Functional Communicative Profile and the Functional Communicative Profile-Revised* **of children and adolescents with autism spectrum disorders**

Participants were 50 children and adolescents with ages between 3 years 9 months and 14 years 8 months (average 7 years 11 months) of both genders with Autism Spectrum Disorders (ASD) attending a specialized Speech-Language Pathology (SLP) service for periods of six months to

All participants were assessed according to the criteria of the *Functional Communicative Profile* (FCP) and of the *Functional Communication Profile – Revised* (FCP-R). The results were

Since the FCP-R is a tool with technical data, extensive and detailed; therefore it was applied by means of interviews with the speech-language therapist of each participant. All the SLPs have been assigned to each participant for at least six months prior to the interview. This time was considered enough to the therapists to have all the information demanded by the FCP-R. The data obtained by the FCP-R and FCP assessments were individually analyzed, identifying the global performance based on individual comparison.

This comparison used the following areas of the FCP-R:


Data obtained with the use of both tools were compared by the t-Student test and the adopted significance level was 0.05 (5%).

With the purpose of verifying if there were linear correlations between the analyzed areas of both tools the Correlation test was also used. The correlation test identifies the correlation coefficient, that can be positive or negative. In the first case, the positive correlation, the variables present a similar behavior, i.e., if one of them increases the other increases also, and vice-versa. In the negative correlation the variables present the opposite behavior, i.e., if one of them increases the other decreases, and vice-versa.

Data about communication interactivity, number of communicative acts expressed per minute (CAM) and the proportion of communicative space occupied (CSO) were analyzed by means of their averages.

#### *2.1.3. Results and comments*

The comparison between the FCP and the FCP-R used the proportion of communicative interaction (CI), the CAM and the CSO obtained by each participant's FCP. CI was obtained by the ratio of the more interpersonal communicative acts expressed and the total of commu‐ nicative acts expressed. It is considered a very significant data about the overall interactivity of the communication. CAM and CSO were obtained as described above.

The descriptive statistics is presented in the following tables.

The median of the results regarding CI was determined in order to classify the participants as more interactive or less interactive. The individual results presented large variation and the objective of this classification was to associate theses results with the selected areas of the FCP-R. The areas of *Behavior, Attentiveness, Receptive Language, Expressive Language* and *Social/ Pragmatic* of the FCP-R were considered the most relevant to this comparison. The median of CI in the FCP was 53.75. Therefore, individuals with interactivity above this level were e i

expressed and interactivity of

d the total of c f the communic

S

considered the more interactive group and those bellow this level were considered less interactive participants. T The descriptive e statistics is pr resented in the e following tabl les.

FCP-R used th P. CI was obtai e acts expresse nd CSO were o

he proportion o ined by the rat ed. It is consid obtained as des

of communicat tio of the more dered a very scribed above.

tive interaction e interpersonal significant dat

n (CI), the CAM communicativ ta about the o

M and ve acts overall

or less theses *nguage* e FCP p and

21.61

*P-R* is presented

d in Figure 1.

e FCP and the articipant's FCP communicative cation. CAM an

The association of values of CI obtained in the area of *Behavior of the FCP-R* is presented in Figure 1. Average Standard erro Median or 54.35 3.05 53.75

tion

the area of *Beha*

articipants.

*avior of the FCP*

tandard Devia

CI obtained in t


**Table 1.** Descriptive statistics – Communication Interactivity-FCP t those bellow th his level were c considered less s interactive pa

n of values of C

The association

T

F Figure 1. Proport tion of communi ication interactiv vity de interactivi ity in the area of **Figure 1.** Proportion of communication interactivity de interactivity in the area of *Behavior*

> **Severity Behavior(%)**

T i Table 2 shows interactivity of the compariso f communicatio on of the results on verified by t Normal s in the area of the FCP. f *Behavior in the e FCP-R* and its s correlation wi Table 2 shows the comparison of the results in the area of *Behavior in the FCP-R* and its correlation with the proportion of interactivity of communication verified by the FCP.

6

Mild 14

Modera 60

f *Behavior*

ate Sever

18

re Profou

2

und

ith the proport

tion of

arding served izes a


**Table 2.** Association between the area of *Behavior* in the FCP-R and the proportion of communicative interaction in the FCP.

Data suggest that the group defined according to behavioral disorders do not present signif‐ icant differences regarding the proportion of communication interactivity. However, when the linear correlation is considered it can be observed that as the severity increases in this domain the communication interactive proportion decreases. It characterizes a negative correlation, suggesting that participants with more sever behavioral disorders show less interactive communication. n c negative corre communication elation, sugge n. esting that pa articipants wit th more seve er behavioral disorders sho ow less inter

Considering behavioral issues, [21] suggests that intervention focus on communication and interpersonal relationship tends to decrease the behavioral disorders of persons with ASD such as aggression and disruptive behaviors. C r b Considering be relationship te behaviors. ehavioral issue ends to decrea es, Springhouse ase the behav e (2006) sugges vioral disorder sts that interve rs of persons ention focus on with ASD su n communicatio uch as aggress on and interper sion and disru

The values obtained to communication interaction in the FCP in the area of Attentiveness in the FCP-R are presented in Figure 2. T F The values obt Figure 2. tained to comm munication inte eraction in the FCP in the are ea of Attentiven ness in the FCP P-R are presen

F Figure 2. Proport tion of communi icative interactio on in the area of A Attentiveness. **Figure 2.** Proportion of communicative interaction in the area of Attentiveness.

**Severity** 

the normal and

e interaction. A

guage disorder

s the values re

T i Table 3 shows interaction of t the association the FCP. n of the results in the area of *A Attentiveness* of f the FCP-R and d the proportio on of communi Table 3 shows the association of the results in the area of *Attentiveness* of the FCP-R and the proportion of communicative interaction of the FCP.

l Mild

Modera

ate Sever

re Profou

und

ractive

rsonal uptive

nted in

icative

ificant d and ons of h low icative veness In this th the

ording

y: normal, mild high proportio

n of communi

*interaction* acco

vels of severity dividuals with

the proportion

*communicative i*

the first 3 lev sociated to ind

observed that

with ASD.

he FCP-R and *c*

interaction in results are ass

tion it can be

of individuals w

 *Language* of th

Normal


d differences reg moderate. In t garding the pr roportion of co \*Significant value in the t-Student test at 95%

communicative

functional lang

Figure 3 shows to the FCP.

m

c

f

F t

considered the more interactive group and those bellow this level were considered less

FCP-R used th P. CI was obtai e acts expresse nd CSO were o e following tabl

he proportion o ined by the rat ed. It is consid obtained as des

of communicat tio of the more dered a very scribed above.

assify the parti ective of this cl *entiveness, Recep* o this compari were considere

*P-R* is presented

54.35 3.05 53.75 21.61 466

tive interaction e interpersonal significant dat

n (CI), the CAM communicativ ta about the o

M and ve acts overall

or less theses *nguage* e FCP p and

re interactive o as to associate t *, Expressive Lan* ian of CI in the nteractive group

icipants as mor lassification wa *ptive Language,* ison. The medi d the more in

d in Figure 1.

les.

CP

in order to cla on and the obje f *Behavior, Atte* most relevant to ve this level w articipants.

*avior of the FCP*

More Interacti Less Interactiv

ity in the area of f *Behavior in the*

nd the proportio ioral disorders r, when the lin munication inte

Modera 60 ess More L 16 1 0.16 -0.33445

f *Behavior*

ive ve

*e FCP-R* and its

ate Sever

5on of communica

do not presen near correlation eractive propo

18 Less More L 14 4

s correlation wi

re Profou

Less More 5 0

ative interaction i nt significant d n is considered rtion decrease

2

und

Less 1

2in the FCP.

differences rega d it can be obs es. It character

ith the proport

tion of

arding served izes a

0.72

0.37

e FCP and the articipant's FCP communicative cation. CAM an resented in the

The association of values of CI obtained in the area of *Behavior of the FCP-R* is presented in

or

tion

Interactivity - FC as determined d large variatio R. The areas of nsidered the m teractivity abov s interactive pa the area of *Beha*

Average Standard erro Median tandard Devia Variance Communication egarding CI wa esults presented as of the FCP-R CP-R were con duals with int considered less CI obtained in t

Average 54.35 Standard error 3.05 Median 53.75 Standard Deviation 21.61 Variance 466

S

ptive statistics – C f the results re e individual re he selected area *gmatic* of the F erefore, individ his level were c n of values of C

interactive participants.

T t e i T

142 Autism Spectrum Disorder - Recent Advances

The compariso the CSO obtain expressed and interactivity of The descriptive

on between the ned by each pa d the total of c f the communic e statistics is pr

T T i r a w t T

Table 1. Descrip The median of interactive. Th results with th and *Social/Prag* was 53.75. The those bellow th The association

F T i

Figure 1. Proport Table 2 shows interactivity of

tion of communi the compariso f communicatio

**Figure 1.** Proportion of communication interactivity de interactivity in the area of *Behavior*

ication interactiv on of the results on verified by t

vity de interactivi s in the area of the FCP.

Mild 14 ss More Le 4 3 0.39

*r* in the FCP-R an ding to behavi vity. However main the comm

More Less More Less More Less More Less More Less 2 1 4 3 16 14 4 5 0 1


Normal 6 More Les 2 1 0.5

**Severity Normal Mild Moderate Severe Profound Behavior(%)** 6 14 60 18 2

Table 2 shows the comparison of the results in the area of *Behavior in the FCP-R* and its correlation with the proportion of interactivity of communication verified by the FCP.

> e area of *Behavio* defined accord cation interacti es in this dom

**p-value** 0.5 0.39 0.16 0.37 0.72

**Table 2.** Association between the area of *Behavior* in the FCP-R and the proportion of communicative interaction in the

Data suggest that the group defined according to behavioral disorders do not present signif‐ icant differences regarding the proportion of communication interactivity. However, when the

**Severity Behavior(%) Interactivity p-value Correlation coefficient** ation between th that the group n of communic verity increase

1900ral 1900ral 1900ral 1900ral 1900ral 1900ral

T D t t

**Interactivity**

**Correlation coefficient**

FCP.

Table 2. Associa Data suggest t the proportion that as the sev

**Table 1.** Descriptive statistics – Communication Interactivity-FCP

Figure 1.

c communicative e interaction whereas in t the moderate level they a re associated with the ind dividuals with **Table 3.** Association of the area *Attentiveness* of the FCP-R and the proportion of communicative interaction of the FCP.

ommunicative the significant

linear correlat

al impairment o

rea of *Receptive*

d mild levels t

Analyzing the

rs and the socia

egarding the ar

i i a interaction de interferes direc aspect, Lovela creases as the ctly in the IC s and and Landr e severity of t ince individua ry (1986) have the *Attentivene* als with better a e already state *ess* deficits in attentiveness r ed that an att creases. These results also hav ention deficit e data indicate ve higher prop may be respo e that attentiv ortions of IC. I onsible for bot Observing the data we may conclude that the groups defined by deficits in *attention/concen‐ tration* present significant differences regarding the proportion of communicative interaction

in the first 3 levels of severity: normal, mild and moderate. In the normal and mild levels the significant results are associated to individuals with high proportions of communicative interaction whereas in the moderate level they are associated with the individuals with low communicative interaction. Analyzing the linear correlation it can be observed that the proportion of communicative interaction decreases as the severity of the *Attentiveness* deficits increases. These data indicate that attentiveness interferes directly in the IC since individuals with better attentiveness results also have higher proportions of IC. In this aspect, [14] have already stated that an attention deficit may be responsible for both the functional language disorders and the social impairment of individuals with ASD.

Figure 3 shows the values regarding the area of *Receptive Language* of the FCP-R and *commu‐ nicative interaction* according to the FCP.

F Figure 3. Commu unicative interac ction and Recepti **Figure 3.** Communicative interaction and Receptive Language.

**Receptive** 

nts the results

unicative interac

nts the associ

T Table 4 shows the association **Severity**  n of the results Normal in FCP-R's are Mild ea of *Receptive L* Moderat *Language* and F te Severe CP's communi e Profou Table 4 shows the association of the results in FCP-R's area of *Receptive Language* and FCP's communicative interaction.

ive Language.

*ve Language* are

und

Less 1

2on of the FCP.

of the FCP-R an the communi

nd the icative

vity of

ation interactiv

CP's communi

icative

icative interact

tion.

the communic

*nguage* and FC

R according to

*Expressive Lan*

ea of the FCP-R

Interactive nteractive

P-R's area of

More Less I

sive Language

results in FCP


> Figure 4 presen the FCP.

F t

F

Figure 4. Commu

1900ral 1900ral 1900ral 1900ral 1900ral 1900ral

Table 5 prese interaction.

T i

c i communicative interaction dec e interaction o creases. of the FCP. As s the severity of receptive la anguage disor rders increase, **Table 4.** Association of the Receptive language area of the FCP-R and the proportion of communicative interaction of the FCP.

of the *Expressiv*

ction and Express

iation of the r

area of the FCP-R

sive Language

s More Les 9 8 0.34

ive Language.

in FCP-R's are

Mild

ea of *Receptive L*

Interactive nteractive

ss More Le 2 5 0.07

R and the propor

Moderat

*Language* and F

te Severe

ess More L 0

10

CP's communi

e Profou

Less More 5 0

icative interactio

2

und

Less 1

2on of the FCP.

of the FCP-R an the communi

nd the icative

vity of

ation interactiv

CP's communi

icative

icative interact

tion.

0.72

0.03\*

14

More Less I

34

It is possible to consider that there is a negative correlation between the area of Receptive Language of the FCP-R and the communicative interaction of the FCP. As the severity of receptive language disorders increase, the communicative interaction decreases. \* I c \*Significant va It is possible to communicative lue in the t-Stu o consider that e interaction o udent test at 95% there is a nega of the FCP. As %ative correlation s the severity n between the of receptive la area of Recepti anguage disor ive Language o rders increase,

ptive language a

ction and Recepti

n of the results

Normal

40

More Less 15 5 <0.001\*

Figure 4 presents the results of the *Expressive Language* area of the FCP-R according to the communication interactivity of the FCP. i F interaction dec Figure 4 presen creases. nts the results of the *Expressiv ve Language* are ea of the FCP-R R according to the communic

F Figure 4. Commu unicative interac ction and Express **Figure 4.** Communicative interaction and Expressive Language

F

Figure 3. Commu

unicative interac

the association

**Severity Receptive Language (%) Interactivity p-value** 

ation of the Recep

1900ral 1900ral 1900ral 1900ral 1900ral 1900ral

Table 4 shows

T

T

Table 4. Associa

t

the FCP.

in the first 3 levels of severity: normal, mild and moderate. In the normal and mild levels the significant results are associated to individuals with high proportions of communicative interaction whereas in the moderate level they are associated with the individuals with low communicative interaction. Analyzing the linear correlation it can be observed that the proportion of communicative interaction decreases as the severity of the *Attentiveness* deficits increases. These data indicate that attentiveness interferes directly in the IC since individuals with better attentiveness results also have higher proportions of IC. In this aspect, [14] have already stated that an attention deficit may be responsible for both the functional language

Figure 3 shows the values regarding the area of *Receptive Language* of the FCP-R and *commu‐*

ction and Recepti

ive Language.

in FCP-R's are

Mild

ea of *Receptive L*

Interactive nteractive

ss More Le 2 5 0.07 -0.74981

R and the propor

n between the of receptive la

ea of the FCP-R

Interactive nteractive

P-R's area of

Moderat

*Language* and F

te Severe

ess More L 0

1tion of communi

area of Recepti anguage disor

R according to

*Expressive Lan*

10

CP's communi

e Profou

Less More 5 0

icative interactio

ive Language o rders increase,

the communic

*nguage* and FC

2

und

Less 1

2on of the FCP.

of the FCP-R an the communi

ation interactiv

vity of

CP's communi

icative

icative interact

0.72

0.03\*

14

More Less I

34

s More Les 9 8 0.34

40 34 14 10 2

More Less More Less More Less More Less More Less 15 5 9 8 2 5 0 5 0 1


area of the FCP-R

%ative correlation s the severity

*ve Language* are

More Less I

sive Language

results in FCP

n of the results

Table 4 shows the association of the results in FCP-R's area of *Receptive Language* and FCP's

Normal

40

**Severity Normal Mild Moderate Severe Profound**

More Less 15 5 <0.001\*

ptive language a

**p-value** <0.001\* 0.34 0.07 0.03\* 0.72

udent test at 95% there is a nega of the FCP. As

of the *Expressiv*

**Table 4.** Association of the Receptive language area of the FCP-R and the proportion of communicative interaction of

ction and Express

iation of the r

disorders and the social impairment of individuals with ASD.

*nicative interaction* according to the FCP.

144 Autism Spectrum Disorder - Recent Advances

F

Figure 3. Commu

**Figure 3.** Communicative interaction and Receptive Language.

unicative interac

the association

**Severity Receptive Language (%) Interactivity p-value correlation coefficient**  ation of the Recep

lue in the t-Stu o consider that e interaction o creases.

nts the results

unicative interac

nts the associ

1900ral 1900ral 1900ral 1900ral 1900ral 1900ral

Table 4 shows

T

communicative interaction.

**Receptive Language (%)**

**Interactivity**

**correlation coefficient**

the FCP.

T

Table 4. Associa

\*Significant va It is possible to communicative interaction dec

\*Significant value in the t-Student test at 95%

Figure 4 presen the FCP.

\* I c i

F t

F

Figure 4. Commu

1900ral 1900ral 1900ral 1900ral 1900ral 1900ral

Table 5 prese interaction.

T i

T i Table 5 prese interaction. nts the associ iation of the r results in FCP P-R's area of *Expressive Lan nguage* and FC Table 5 presents the association of the results in FCP-R's area of *Expressive Language* and FCP's communicative interaction.


\*Significant value in the t-Student test at 95%

**Table 5.** Association of the Receptive language area of the FCP-R and the proportion of communicative interaction of the FCP.

nd the icative These data suggest that there is a negative correlation between the area of Expressive Language of the FCP-R and the communicative interaction of the FCP. As the severity of the expressive language disorders increase, the communicative interaction decreases.

Table 5. Associa

**Severity Expressive Language (%**

**Interactivity**

**p-value Correlation Coefficient**  ation of the Recep

ggest that ther e interaction of

re displayed on

**Severity** 

suggest that

These data sug communicative

of the FCP-R ar

T

T c

o

The negative correlations in both receptive and expressive language areas of the FCP-R indicate that IC decreases as the language disorders severity increases. A study conducted by [19], analyzing the functional aspects of the answers of children with severe Specific Language Impairment (SLI) observed that this children are less efficient than their peers of the same age. The authors suggest that this indicates that the formal aspects of language interfere directly in its functional efficiency. i T l a e i interaction dec The negative c language disor aspects of the efficient than t interfere direct creases. correlations in b rders severity answers of chi their peers of tly in its functio both receptive increases. A s ildren with sev the same age. onal efficiency and expressiv study conduct vere Specific L The authors s . ve language are ted by Rocha a Language Impa suggest that th eas of the FCPand Befi-Lope airment (SLI) o his indicates th hat the formal

Normal

Mild 42

Modera


07

ess More L

R and the propor

etween the are the expressive

 7 \* 0.16

32

ate Sever

Less More L

tion of communi

ea of Expressiv language diso

9 2

20

Less

8 0 1\* 0.46

icative interactio

ve Language of orders increase,


P and the area

re Profou

Mor e

4

L

Less 2

6on of the FCP.

f the FCP-R an , the communi

nd the icative

as the ctional re less guage

gmatic

t IC decreases yzing the func this children ar aspects of lan

a of Social/Prag

und

<0.001

16 5 <0.001\*

ss More Le

area of the FCP-R

%e correlation be the severity of

**%)** <sup>2</sup>

**<sup>y</sup>**More Les 1 0 0.72

ptive language a

udent test at 95% re is a negative f the FCP. As t

Data about the association between communicative interaction as assessed by the FCP and the area of Social/Pragmatic of the FCP-R are displayed on Figure 5 D Data about the e association be etween commu unicative inter action as asses ssed by the FCP

n Figure 5

F Figure 5. Commu unicative interac ction and Social/P **Figure 5.** Communicative interaction and Social/Pragmatics

T Table 6 presen ts the associati on of the resul ts in FCP-R's a area of *Social/Pr ragmatics* and F FCP's commun Table 6 presents the association of the results in FCP-R's area of *Social/Pragmatics* and FCP's communicative interaction.

Normal

Pragmatics

Mild

Modera

ate Sever

area increase

Less

18 2 1\* 1

ative interaction

es, the commu s of the FCP-R

re Profou

Mor e

8

L

Less 2

of the FCP.

unicative inter R regarding thi

und

icative interact

tion.

action s area

cial/pragmatic

%ers in the soc


\* \*Significant va lue in the t-Stu \*Significant value in the t-Student test at 95%

These results

T

d decreases.How wever, there is no linear relat tion between th hese variables. . The questions **Table 6.** Association of the Social/pragmatics area of the FCP-R and the proportion of communicative interaction of the FCP.

udent test at 95% as the disord

These results suggest that as the disorders in the social/pragmatic area increases, the commu‐ nicative interaction decreases.However, there is no linear relation between these variables. The

yzing the func this children ar as the ctional re less questions of the FCP-R regarding this area focus on some important social situations and pragmatic abilities but the answer takes into account just the occurrence of the situation, regardless of its frequency or of the consistency with which happens and not considering the focus of the subject's intention. focus on some important social situations and pragmatic abilities but the answer takes into account just the occurrence of the situation, regardless of its frequency or of the consistency with which happens and not considering the focus of the

The negative correlations in both receptive and expressive language areas of the FCP-R indicate that IC decreases as the language disorders severity increases. A study conducted by [19], analyzing the functional aspects of the answers of children with severe Specific Language Impairment (SLI) observed that this children are less efficient than their peers of the same age. The authors suggest that this indicates that the formal aspects of language interfere directly in

both receptive increases. A s ildren with sev the same age. onal efficiency

ptive language a

udent test at 95% re is a negative f the FCP. As t

Normal

Mild 42

Modera


07

ess More L

R and the propor

etween the are the expressive

ve language are ted by Rocha a Language Impa suggest that th

action as asses

Interactive nteractive

5 7 \* 0.16

32

ate Sever

Less More L

tion of communi

ea of Expressiv language diso

eas of the FCPand Befi-Lope airment (SLI) o his indicates th

ssed by the FCP

*ragmatics* and F

ate Sever

Mor e

on of communica

area increase . The questions

44

L

Less

18 2 1\* 1

ative interaction

es, the commu s of the FCP-R

FCP's commun

re Profou

Mor e

8

L

Less 2

of the FCP.

unicative inter R regarding thi

und

9 2

20

Less

8 0 1\* 0.46

icative interactio

ve Language of orders increase,


P and the area

re Profou

Mor e

4

L

Less 2

6on of the FCP.

f the FCP-R an , the communi

nd the icative

t IC decreases

aspects of lan

und

<0.001

16 5 <0.001\*

ss More Le

area of the FCP-R

%e correlation be the severity of

and expressiv study conduct vere Specific L The authors s

unicative inter

**%)** <sup>2</sup>

**<sup>y</sup>**More Les 1 0 0.72

Data about the association between communicative interaction as assessed by the FCP and the

etween commu n Figure 5

.

ction and Social/P

on of the resul

Table 6 presents the association of the results in FCP-R's area of *Social/Pragmatics* and FCP's

**%)** <sup>4</sup>

**Social/ Pragmatic (%)** 4 26 18 44 8

**<sup>y</sup>**More Les 2 0 0.46

**Severity Normal Mild Moderate Severe Profound**

al/pragmatics are

**p-value** 0.46 <0.001\* 0.008\* <0.001\* 1

udent test at 95% as the disord no linear relat

**Table 6.** Association of the Social/pragmatics area of the FCP-R and the proportion of communicative interaction of the

These results suggest that as the disorders in the social/pragmatic area increases, the commu‐ nicative interaction decreases.However, there is no linear relation between these variables. The

Normal

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**Figure 5.** Communicative interaction and Social/Pragmatics

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146 Autism Spectrum Disorder - Recent Advances

T l a e i

a of Social/Prag guage gmatic These findings suggest that objective protocols to the characterization of the pragmatic abilities may not be sufficient to determine the functional communicative profile of a person with ASD. The specific functional assessment of communication seems to be necessary, with the FCP-R providing complementary but not exclusive information. Other studies also suggest the use of complementary assessment tools in order to characterize, identify and assess individuals with ASD due to the variability of the symptoms presented [2, 20]. subject's intention. These findings suggest that objective protocols to the characterization of the pragmatic abilities may not be sufficient to determine the functional communicative profile of a person with ASD. The specific functional assessment of communication seems to be necessary, with the FCP-R providing complementary but not exclusive information. Other studies also suggest the use of complementary assessment tools in order to characterize, identify and assess individuals

Still considering the social/pragmatic area of the FCP-R it could be observed that the group with severe disorders has shown significant difference in the IC proportion. This result indicates that both protocols agree that individuals with low social/pragmatic abilities also have less communicative interaction. with ASD due to the variability of the symptoms presented (Santos et al, 2012; Barbosa et al, 2011). Still considering the social/pragmatic area of the FCP-R it could be observed that the group with severe disorders has shown significant difference in the IC proportion. This result indicates that both protocols agree that individuals with

These results also agree with several prior studies regarding this issue. [22] observed that children with ASD present less answers to interactive attempts by others and less spontaneous communication. [13] reported that children with ASD have great impairments in the functional use of communication. [1] observed that, even when interacting with a familiar interlocutor, children with ASD have great difficulties with the interactive use of communication. These authors point out that the FCP usually confirm these difficulties. low social/pragmatic abilities also have less communicative interaction. These results also agree with several prior studies regarding this issue. Watson et al (2007) observed that children with ASD present less answers to interactive attempts by others and less spontaneous communication. Laugerson et al (2009) reported that children with ASD have great impairments in the functional use of communication. Amato and Fernandes (2010) observed that, even when interacting with a familiar interlocutor, children with ASD have great difficulties with

icative interact tion. Data regarding the average of IC and the severity degree in the FCP-R show large deficits in IC as the severity increases. Figure 6 shows the association of the mean proportion of com‐ municative interaction and the areas of the FCP-R that were considered in this study. It indicates that the overall severity of the FP-R is determinant to the proportion of IC. the interactive use of communication. These authors point out that the FCP usually confirm these difficulties. Data regarding the average of IC and the severity degree in the FCP-R show large deficits in IC as the severity increases. Figure 6 shows the association of the mean proportion of communicative interaction and the areas of the FCP-R that were considered in this study. It indicates that the overall severity of the FP-R is determinant to the proportion of IC.

Table 7. Average of CAM and CSO associated to the *Behavior* area of the FCP-R

The distribution of the average proportion of communicative interaction in this group of participants shows that there is an important decrease in interactivity associated to the increase in severity of the disorders in the areas of the CFP-R that

The following data refer to the association between other aspects of the FCP – communicative acts expressed per minute

**Behavior**

**CAM** 11.3 7.4 7.9 8.1 15.4 **CSO(%)** 38 42.6 44.1 39.7 39

The number of communicative acts expressed per minute was similar in the participants with mild to moderate behavior disorders; but it varied in those with *normal* behavior and even more to the ones with profound behavior disorders. However, considering the proportion of the communicative space that was occupied by the participants, all groups had

**Normal Mild Moderate Severe Profound** 

(CAM) and proportion of the communicatuve space occupied (CSO) and the same areas of the FCP-R.

Figure 6. Mean proportion of communicative interaction associated with the FCP-R **Figure 6.** Mean proportion of communicative interaction associated with the FCP-R

were analyzed.

The distribution of the average proportion of communicative interaction in this group of participants shows that there is an important decrease in interactivity associated to the increase in severity of the disorders in the areas of the CFP-R that were analyzed.

The following data refer to the association between other aspects of the FCP – communicative acts expressed per minute (CAM) and proportion of the communicatuve space occupied (CSO) and the same areas of the FCP-R.


**Table 7.** Average of CAM and CSO associated to the *Behavior* area of the FCP-R

The number of communicative acts expressed per minute was similar in the participants with mild to moderate behavior disorders; but it varied in those with *normal* behavior and even more to the ones with profound behavior disorders. However, considering the proportion of the communicative space that was occupied by the participants, all groups had an average bellow 50% (that would indicate an even distribution of CEO among the dyad). It suggests that the large number of communicative acts expressed per minute doesn't leads to commu‐ nicative efficiency.

The association of behavior disorders identified by the FCP-R and the indicators of commu‐ nicative intent (CAM and CSO) of the FCP has similar results for the various severity scores. It may suggest that the isolated communicative intent (no adequately addressed) doesn't result in functional efficiency. This brings to attention the issue of the need to take the communicative context into consideration when analyzing pragmatic abilities of individuals with ASD [5, 12].

in Table 8.

The averages of CAM and CSO associated to the Attentiveness area of the FCP-R are presented


**Table 8.** Average of CAM and CSO associated to *Attentiveness*

Although the CAM average didn't present a linear distribution, it has a slight decrease between the *severe* and *profound* groups. It suggests that the participants with large attention deficits may even occupy the communicative space symmetrically but their communicative intent is reduced. Children with severe attention deficits may show more difficulties to start commu‐ nication when compared to children with mild no none attention deficits.

The averages of CAM and CSO associated to the *Receptive Language* area of the FCP-R are presented in Table 9.


**Table 9.** Average of CAM and CSO associated to *Receptive Language*

The distribution of the average proportion of communicative interaction in this group of participants shows that there is an important decrease in interactivity associated to the increase

The following data refer to the association between other aspects of the FCP – communicative acts expressed per minute (CAM) and proportion of the communicatuve space occupied (CSO)

**Behavior**

**CAM** 11.3 7.4 7.9 8.1 15.4 **CSO(%)** 38 42.6 44.1 39.7 39

The number of communicative acts expressed per minute was similar in the participants with mild to moderate behavior disorders; but it varied in those with *normal* behavior and even more to the ones with profound behavior disorders. However, considering the proportion of the communicative space that was occupied by the participants, all groups had an average bellow 50% (that would indicate an even distribution of CEO among the dyad). It suggests that the large number of communicative acts expressed per minute doesn't leads to commu‐

The association of behavior disorders identified by the FCP-R and the indicators of commu‐ nicative intent (CAM and CSO) of the FCP has similar results for the various severity scores. It may suggest that the isolated communicative intent (no adequately addressed) doesn't result in functional efficiency. This brings to attention the issue of the need to take the communicative context into consideration when analyzing pragmatic abilities of individuals with ASD [5, 12].

The averages of CAM and CSO associated to the Attentiveness area of the FCP-R are presented

**Attentiveness**

**CAM** 8.3 9.1 7.2 9 7 **CSO(%)** 41.4 45.7 40 39 52

Although the CAM average didn't present a linear distribution, it has a slight decrease between the *severe* and *profound* groups. It suggests that the participants with large attention deficits may even occupy the communicative space symmetrically but their communicative intent is

**Normal Mild Moderate Severe Profound**

**Normal Mild Moderate Severe Profound**

in severity of the disorders in the areas of the CFP-R that were analyzed.

**Table 7.** Average of CAM and CSO associated to the *Behavior* area of the FCP-R

**Table 8.** Average of CAM and CSO associated to *Attentiveness*

and the same areas of the FCP-R.

148 Autism Spectrum Disorder - Recent Advances

nicative efficiency.

in Table 8.

CAM's average shows a decrease tendency as the deficits in receptive language increases, although this is not a linear association. These data seem to suggest that language compre‐ hension is closely associated to the performance regarding the initiative to communicate that is reflected in the number of communicative acts expressed per minute. The association of the severity of the deficits in receptive language and IC has shown that the difficulties in under‐ standing the language expressed may be associated with the few IC. The same occurs with the expressive language: individuals with more impairments tend to show less CAM.

The averages of CAM and CSO associated to the *Expressive Language* area of the FCP-R are presented in Table 10.


**Table 10.** Average of CAM and CSO associated to *Expressive Language*

These data point out to the interdependency between the severity of the deficits in *expressive language* and the CAM. There is a clear decrease in the number of communicative acts expressed per minute as the severity of the deficits increases. Therefore, it seems clear that the expressive language abilities are directly associated to the CAM in the FCP.

A longitudinal study of the pragmatic abilities of children with SLI [3] indicated that the CAM is the clearer parameter of disorder for these children.

The association of the social/pragmatic area and CAM and CSO has shown that even small impairments in this area of the FCP-R have are related to proportional deficits in the FCP. These data confirm prior studies [6, 7] that assessed pragmatic therapeutic intervention processes in 6-month to 1-year periods and observed association of results regarding CAM, CSO and IC.

The averages of CAM and CSO associated to the *Social/ Pragmatic* area of the FCP-R are presented in Table 11.

2006; Fernandes et al, 2008) that assessed pragmatic therapeutic intervention processes in 6-month to 1-year periods and

**CSO(%)** 33.5 45.2 40.1 42.5 44.8


**Table 11.** Average of CAM and CSO associated to *Social/ Pragmatic* **CAM** 9.8 8.8 8.8 7.5 8.1

The CAM average for the *normal* group is higher than all the other groups. It may suggest that any social/pragmatic deficit interferes with the communicative initiative of individuals with ASD. Table 11. Average of CAM and CSO associated to *Social/ Pragmatic* The CAM average for the *normal* group is higher than all the other groups. It may suggest that any social/pragmatic

The analysis of the CAM and CSO averages regarding the selected areas of the FCP-R are presented in figures 7 and 8. deficit interferes with the communicative initiative of individuals with ASD. The analysis of the CAM and CSO averages regarding the selected areas of the FCP-R are presented in figures 7 and 8.

Figure 7. Average of CAM and the selected areas of the FCP-R. **Figure 7.** Average of CAM and the selected areas of the FCP-R.

assessment toll is proposed.

characteristics

Several studies have been conducted regarding the development, adaptation and validation of diagnostic and severity scales for ASD in Brazil [15, 17]. There is still no single tool that can provide all the information regarding characterization and severity scores. Therefore the use of complementary protocols seems to be the better alternative for comprehensive and detailed diagnostic and description that will allow efficient planning of intervention procedures. It is true to other countries where other languages are used. Linguistic and cultural adaptations are at least as important as the translation from one language to the other when the use of a foreign assessment toll is proposed.

The second study aimed to identify useful tools to the assessment of the diagnostic hipothesis of ASD and their specific characteristics

Several studies have been conducted regarding the development, adaptation and validation of diagnostic and severity scales for ASD in Brazil (Marteleto & Pedromonico, 2005; Pereira, Wagner & Riesgo, 2007). There is still no single tool that can provide all the information regarding characterization and severity scores. Therefore the use of complementary protocols seems to be the better alternative for comprehensive and detailed diagnostic and description that will allow efficient planning of intervention procedures. It is true to other countries where other languages are used. Linguistic and cultural adaptations are at least as important as the translation from one language to the other when the use of a foreign

The second study aimed to identify useful tools to the assessment of the diagnostic hipothesis of ASD and their specific

Figure 8. Average of CSO and the selected areas of the FCP-R.

2006; Fernandes et al, 2008) that assessed pragmatic therapeutic intervention processes in 6-month to 1-year periods and

**Social/Pragmatic** 

**CAM** 9.8 8.8 8.8 7.5 8.1 **CSO(%)** 33.5 45.2 40.1 42.5 44.8

The CAM average for the *normal* group is higher than all the other groups. It may suggest that any social/pragmatic

The analysis of the CAM and CSO averages regarding the selected areas of the FCP-R are presented in figures 7 and 8.

**Normal Mild Moderate Severe Profound** 

The averages of CAM and CSO associated to the *Social/ Pragmatic* area of the FCP-R are presented in Table 11.

observed association of results regarding CAM, CSO and IC.

Table 11. Average of CAM and CSO associated to *Social/ Pragmatic*

Figure 7. Average of CAM and the selected areas of the FCP-R.

deficit interferes with the communicative initiative of individuals with ASD.

Figure 8. Average of CSO and the selected areas of the FCP-R. **Figure 8.** Average of CSO and the selected areas of the FCP-R.

#### The CAM average for the *normal* group is higher than all the other groups. It may suggest that any social/pragmatic **2.2. Study 2. Comparing the results of DAADD and ABC of children included in Autism Spectrum Disorders** Several studies have been conducted regarding the development, adaptation and validation of diagnostic and severity scales for ASD in Brazil (Marteleto & Pedromonico, 2005; Pereira, Wagner & Riesgo, 2007). There is still no single tool

#### The analysis of the CAM and CSO averages regarding the selected areas of the FCP-R are presented in figures 7 and 8. *2.2.1. Methods* that can provide all the information regarding characterization and severity scores. Therefore the use of complementary protocols seems to be the better alternative for comprehensive and detailed diagnostic and description that will allow

The averages of CAM and CSO associated to the *Social/ Pragmatic* area of the FCP-R are

**Social/Pragmatic**

observed association of results regarding CAM, CSO and IC.

Table 11. Average of CAM and CSO associated to *Social/ Pragmatic*

Figure 7. Average of CAM and the selected areas of the FCP-R.

**Figure 7.** Average of CAM and the selected areas of the FCP-R.

Figure 8. Average of CSO and the selected areas of the FCP-R.

assessment toll is proposed.

foreign assessment toll is proposed.

of ASD and their specific characteristics

characteristics

**CAM** 9.8 8.8 8.8 7.5 8.1 **CSO(%)** 33.5 45.2 40.1 42.5 44.8

The CAM average for the *normal* group is higher than all the other groups. It may suggest that any social/pragmatic deficit interferes with the communicative initiative of individuals with

The analysis of the CAM and CSO averages regarding the selected areas of the FCP-R are

Several studies have been conducted regarding the development, adaptation and validation of diagnostic and severity scales for ASD in Brazil [15, 17]. There is still no single tool that can provide all the information regarding characterization and severity scores. Therefore the use of complementary protocols seems to be the better alternative for comprehensive and detailed diagnostic and description that will allow efficient planning of intervention procedures. It is true to other countries where other languages are used. Linguistic and cultural adaptations are at least as important as the translation from one language to the other when the use of a

The second study aimed to identify useful tools to the assessment of the diagnostic hipothesis

deficit interferes with the communicative initiative of individuals with ASD.

**Normal Mild Moderate Severe Profound**

The averages of CAM and CSO associated to the *Social/ Pragmatic* area of the FCP-R are presented in Table 11.

2006; Fernandes et al, 2008) that assessed pragmatic therapeutic intervention processes in 6-month to 1-year periods and

**Social/Pragmatic** 

**CAM** 9.8 8.8 8.8 7.5 8.1 **CSO(%)** 33.5 45.2 40.1 42.5 44.8

Several studies have been conducted regarding the development, adaptation and validation of diagnostic and severity scales for ASD in Brazil (Marteleto & Pedromonico, 2005; Pereira, Wagner & Riesgo, 2007). There is still no single tool that can provide all the information regarding characterization and severity scores. Therefore the use of complementary protocols seems to be the better alternative for comprehensive and detailed diagnostic and description that will allow efficient planning of intervention procedures. It is true to other countries where other languages are used. Linguistic and cultural adaptations are at least as important as the translation from one language to the other when the use of a foreign

The second study aimed to identify useful tools to the assessment of the diagnostic hipothesis of ASD and their specific

**Normal Mild Moderate Severe Profound** 

presented in Table 11.

150 Autism Spectrum Disorder - Recent Advances

presented in figures 7 and 8.

ASD.

**Table 11.** Average of CAM and CSO associated to *Social/ Pragmatic*

Participants were 45 individuals with ASD and their language therapists. All the individuals were assessed and received language therapy at the Speech-Language Research Laboratory in Autism Spectrum Disorders (LIF-DEA) of the School of Medicine – University of São Paulo (FMUSP), Brazil. They all had been diagnosed with ASD by neurologists and/or psychiatrists according to the DSM-IVtr (2002) or the IDC-10 (2003) criteria. efficient planning of intervention procedures. It is true to other countries where other languages are used. Linguistic and cultural adaptations are at least as important as the translation from one language to the other when the use of a foreign assessment toll is proposed. The second study aimed to identify useful tools to the assessment of the diagnostic hipothesis of ASD and their specific characteristics

The *Differential Assessment of Autism and Other Developmental Disorders* (DAADD) [10] was proposed to differentiate, by means of the identification of the child's behavior, specific developmental disorders such as autism, Rett syndrome (RS), Asperger syndrome (AS), pervasive developmental disorders not otherwise specified (PDD-NOS), apraxia, mental deficits (MD) and other syndromes (OS). These three last categories were not focused in this study because they are not included in the ASD according to the DSM-tr or the IDC-10.

According to the DAADD guidelines the participants were divided groups according to their ages (2-to-4years; 4-to-6 years and 6-to-8 years) and age-specific protocols were used to the assessment. Each group comprised 15 participants. Familiar income and school level were not considered inclusion criteria. The DAADD uses technical data, is extensive and demands detailed information; therefore it was applied during an interview with the speech-language therapists of the 45 participants. All the therapists are speech-language pathologists and audiologists (fonoaudiólogas) and were working with the participants for at least 1 year [10].

Figure 9 shows the distribution of the participants according to their ages.

The medical diagnosis of the participants was determined by psychiatrists or neurologists working in public and private services of the state of São Paulo (Brazil). And the distribution of the diagnosis was: 29 children with ASD; seven with PDD; five with PDD-NOS; two with AS; one with High Functioning Autism (HFA) and one with Atypical Autism.

Figure 9 shows

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F Figure 9. Age of the participants. **Figure 9.** Age of the participants.

Data regarding the Autism Behavior Checklist (ABC) were retrieved from the individuals protocols registered at the LIF-DEA of FMUSP where it is regularly used during the annual assessment process. The ABC (Krug, Arick & Almond, 1993) identifies the non-adaptative behaviors and indicates the probability of the diagnosis of autism. The questionnaire focus on 57 items of atypical behavior within 5 areas: language, sensorial, relational, use of body and object and social abilities. The scores are totaled by area and generate the final general score. T s P D D f a The medical di services of the PDD; five with Data regarding DEA of FMUS 1993) identifies focus on 57 ite abilities. The sc iagnosis of the state of São P h PDD-NOS; tw g the Autism B SP where it is s the non-adap ems of atypical cores are totale . participants w Paulo (Brazil). A wo with AS; on ehavior Check regularly used ptative behavio l behavior with ed by area and was determined And the distrib ne with High Fu klist (ABC) wer d during the a ors and indicate hin 5 areas: lan generate the fi d by psychiatri bution of the d unctioning Aut re retrieved fro annual assessm es the probabil nguage, sensor inal general sco sts or neurolog diagnosis was: tism (HFA) and m the individu ment process. T lity of the diag rial, relational, ore. gists working in 29 children wi d one with Aty uals protocols r The ABC (Krug gnosis of autism use of body a

Figure 10 shows the distribution of the participants according to the results of the ABC. F Figure 10 show ws the distribut tion of the part ticipants accord ding to the resu ults of the ABC

**analysis Figure 10.** Autism probability according to the *Autism Behavior Checklist*.

m probability acc

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> object es

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Data of both protocols were compared and the adopted significance level was 0.05 (5%). The significant areas were analyzed by the t-Student test and the Wilcoxon test was used to verify linear correlations between them.


he LIF-**Table 12.** ABC and DAADD areas

#### mond, nnaire *2.2.3. Results*

Data regarding the Autism Behavior Checklist (ABC) were retrieved from the individuals protocols registered at the LIF-DEA of FMUSP where it is regularly used during the annual assessment process. The ABC (Krug, Arick & Almond, 1993) identifies the non-adaptative behaviors and indicates the probability of the diagnosis of autism. The questionnaire focus on 57 items of atypical behavior within 5 areas: language, sensorial, relational, use of body and object and social abilities. The scores are totaled by area and generate the final general

. participants w

4y11m 5‐5y1

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Data obtained in the two assessments were analyzed for each subject and the global perform‐ ance was based on the overall results. Data resulting from the ABC and the DAADD wee

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sed to m, Rett NOS), study

4-to-6 pants. ensive ists of d were

03) was propos such as autism ecified (PDD-N ocused in this

s (2-to-4years; ised 15 partici cal data, is exte nguage therap udiólogas) and

n public and p ith ASD; seven ypical Autism.

registered at th g, Arick & Alm m. The question and object and

viduals were as Disorders (LIF d with ASD by

ail & Lynn, 200 ental disorders otherwise sp es were not fo

ng to their ages h group compr D uses technic h the speech-lan logists (fonoau

gists working in 29 children wi d one with Aty

uals protocols r The ABC (Krug gnosis of autism use of body a

s. All the indiv ism Spectrum D een diagnosed

(DAADD) (Ga ific developme disorders not e last categorie e IDC-10.

roups accordin sessment. Each ia. The DAADD interview with sts and audiol

sts or neurolog diagnosis was: tism (HFA) and

m the individu ment process. T lity of the diag rial, relational,

ults of the ABC

C.

ria.

guage therapist oratory in Auti They all had b -10 (2003) crite

*ental Disorders* behavior, speci evelopmental S). These three e DSM-tr or the

ere divided gr used to the ass nclusion criteri ied during an i age pathologis ynn, 2003).

ing to their age

es.

d by psychiatri bution of the d unctioning Aut

7 ‐ 8 years

re retrieved fro annual assessm es the probabil nguage, sensor inal general sco

ding to the resu

and their lang Research Labo MUSP), Brazil. T 002) or the IDC-

*Other Developme* n of the child's b ), pervasive de syndromes (OS ccording to the

participants we rotocols were u t considered in ore it was appli speech-langua year (Gail & Ly

cipants accordi

was determined And the distrib ne with High Fu

1m 6‐6y11m

klist (ABC) wer d during the a ors and indicate hin 5 areas: lan generate the fi

ticipants accord

uals with ASD ech-Language São Paulo (FM e DSM-IVtr (20

*f Autism and O* e identification yndrome (AS) D) and other s d in the ASD ac

guidelines the p age-specific pr level were not mation; therefo therapists are ts for at least 1 y

on of the partic

ere 45 individu apy at the Spee University of S ccording to the

*l Assessment of* by means of the S), Asperger sy al deficits (MD re not included

the DAADD g -8 years) and a me and school detailed inform pants. All the the participant

s the distributio

the participants.

3‐3y11m 4‐4

iagnosis of the state of São P h PDD-NOS; tw

g the Autism B SP where it is s the non-adap ems of atypical cores are totale

ws the distribut

**2.2.1. Metho**

**ods**

Participants w language thera of Medicine – psychiatrists ac

The *Differentia* differentiate, b syndrome (RS apraxia, menta because they a

According to t years and 6-to Familiar incom and demands the 45 particip working with t

Figure 9 shows

152 Autism Spectrum Disorder - Recent Advances

**2**

P l o p

T d s a b

A y F a t w

F

F

**Figure 9.** Age of the participants.

Figure 9. Age of

1900ral 1900ral 1900ral

The medical di services of the PDD; five with

Data regarding DEA of FMUS 1993) identifies focus on 57 ite abilities. The sc

Figure 10 show

T s P

D D

f a

F

F

Figure 10. Autism

2 ‐ 4

m probability acc

years 4 ‐ 6 y

in the two as . Data resulting

**Autism B**

associated according to their categories, as shown in Table 12.

Use

s

nd DAADD area protocols were he t-Student tes

d that 20% of th

ents the more f ither in G2 and

**Age Group**

**ps** 

**G1** 

**G2** 

**G3** 

pmental disorde e DAADD and RS according t otor disorders o

**analysis**

**Figure 10.** Autism probability according to the *Autism Behavior Checklist*.

**2.2.2. Data a**

Data obtained overall results. Table 12.

**2**

D o T

*2.2.2. Data analysis*

T D a

Table 12. ABC an Data of both p analyzed by th

**2.2.3. Result**

**ts**

It was observed

Table 13 prese verified that ei

**2**

I

T v

T C o t

Table 13. Develo Comparing the occurrence of R the several mo

social It was observed that 20% of the older children were considered "without risk for autism" by the ABC.

Table 13 presents the more frequent answers to the DAADD regarding the developmental disorders considered. It was verified that either in G2 and G3 the most frequent diagnosis was "autism".


**Table 13.** Developmental disorders according to the DAADD in all age groups

Comparing the DAADD and the ABC it can be noted that although there is no significant difference, there is a great occurrence of RS according to the DAADD. In G1 these children were rated as with high risk for autism, maybe due to the several motor disorders observed.

With the increasing age these proportion decreases and the high risk for autism is the most frequent score of the ABC in groups G2 and G3. In G3 the DAADD attributes the diagnosis of AS to 75% of the participants of G3.

The Wilcoxon test was applied in the comparison of the ABC and DAADD areas. They were compared within each age group in tables 14, 15 and 16.

The answers to the DAADD and to the ABC are similar in each area. These data indicates that with increasing age the diagnosis identified by the DAADD is closer to the medical diagnosis.


Legend:ABC=Autism Behavior Checklist; LG=language, DA=Differential Assessment of Autism and Other Develop‐ mental Disorders, LGG=language, AUT=autism, RETT=Rett Syndrome, DN=pervasive developmental disorder not oth‐ erwise specified, RE=relating, PRAG=pragmatics, AS=Asperger Syndrome, BEH=behavior, BO=body-object use.

**Table 14.** Comparison of the different areas of the DAADD and the ABC to G1


Legend:ABC=Autism Behavior Checklist; LG=language, DA=Differential Assessment of Autism and Other Develop‐ mental Disorders, LGG=language, AUT=autism, RETT=Rett Syndrome, DN=pervasive developmental disorder not oth‐ erwise specified, RE=relating, PRAG=pragmatics, AS=Asperger Syndrome, BEH=behavior, BO=body-object use, SE=sensory, MOT=motor

**Table 15.** Comparison of the different areas of the DAADD and the ABC to G2.

With the increasing age these proportion decreases and the high risk for autism is the most frequent score of the ABC in groups G2 and G3. In G3 the DAADD attributes the diagnosis of

The Wilcoxon test was applied in the comparison of the ABC and DAADD areas. They were

The answers to the DAADD and to the ABC are similar in each area. These data indicates that with increasing age the diagnosis identified by the DAADD is closer to the medical diagnosis.

> **Maximum (%)**

**Percentile 25 (%)**

**Percentile 50 (Median) (%)** **Percentile**

**75 (%) p-value**

0.003

0.003

0.012

0.001

0.001

0.002

0.002

0.017

0.041

**Minimun (%)**

ABC LG 15 28.39 20.41 6.45 80.65 9.68 25.81 41.94

DA LGG AUT 15 48.44 13.21 33.33 80.00 40.00 46.67 53.33 ABC LG 15 28.39 20.41 6.45 80.65 9.68 25.81 41.94

DA LGG RETT 15 54.44 11.73 41.67 83.33 41.67 50.00 58.33 ABC LG 15 28.39 20.41 6.45 80.65 9.68 25.81 41.94

DA LGG DN 15 43.14 12.31 29.41 70.59 3.29 41.18 47.06 ABC RE 15 48.25 17.37 19.05 78.57 35.71 47.62 61.90

DA PRAG AUT 15 74.67 11.60 60.00 100.00 66.67 73.33 80.00 ABC RE 15 48.25 17.37 19.05 78.57 35.71 47.62 61.90

DA PRAG RETT 15 79.56 11.67 66.67 100.00 66.67 80.00 86.67 ABC RE 15 48.25 17.37 19.05 78.57 35.71 47.62 61.90

DA PRAG AS 15 75.83 9.99 62.50 93.75 68.75 75.00 81.25 ABC RE 15 48.25 17.37 19.05 78.57 35.71 47.62 61.90

DA PRAG DN 15 75.42 10.15 62.50 93.75 68.75 75.00 81.25 ABC BO 15 62.67 15.76 36.00 84.00 48.00 68.00 76.00

DA BEH AS 15 43.33 26.01 8.33 91.67 16.67 50.00 66.67 ABC BO 15 62.67 15.76 36.00 84.00 48.00 68.00 76.00

DA BEH DN 15 43.03 29.05 0.00 90.91 18.18 54.55 72.73

**Table 14.** Comparison of the different areas of the DAADD and the ABC to G1

Legend:ABC=Autism Behavior Checklist; LG=language, DA=Differential Assessment of Autism and Other Develop‐ mental Disorders, LGG=language, AUT=autism, RETT=Rett Syndrome, DN=pervasive developmental disorder not oth‐ erwise specified, RE=relating, PRAG=pragmatics, AS=Asperger Syndrome, BEH=behavior, BO=body-object use.

AS to 75% of the participants of G3.

154 Autism Spectrum Disorder - Recent Advances

**Variables n Means (%)**

compared within each age group in tables 14, 15 and 16.

**Standart deviation (%)**


Legend: ABC=Autism Behavior Checklist, DA=Differential Assessment of Autism and Other Developmental Disor‐ ders, DN=pervasive developmental disorder not otherwise specified, AS=Asperger Syndrome, BEH=behavior, BO=body-object use, SE=sensory, MOT=motor

**Table 16.** Comparison of the different areas of the DAADD and the ABC to G3.

### **3. Discussion**

The results of the two protocols tend to be more similar with the increasing age. The DAADD has shown to be more sensible in the different age-groups, while the ABC seems to be more specific only in the older group. It must be noted that the ABC aims just to identify the risk for autism while the DAADD differentiates the children that already have the diagnosis within the autism spectrum.

The need for diagnostic protocols that consider the association of communication and behavior disorders of children with ASD is clear. These protocols must provide means for the careful observation and record of communicative behaviors [16, 18].

The comparison of the different areas of the DAADD and the ABC has shown that the DAADD is more efficient to the identification of language disorders. It must be considered, however, that this is not the purpose of the ABC. The use of both protocols may be complementary, applied as needed along the diagnosis process. In several countries and in different regions of many countries providing services of medical diagnosis for children with ASD takes precious time. The time spent waiting for the conclusion of the diagnostic process would be extremely important to the child's development. The sooner the child receives appropriate therapy and education, the better the prognosis (Volkmar, Chawarska & Klin, 2005) Therefore, the use of screening tools that helps to identify children at risk for ASD or with some probability of receiving this diagnosis may represent the better use of resources that are frequently limited. The comparison of different protocols, especially considering the needs of non-Englishspeaking groups, allow a more comprehensive perspective about tools that can be used in the assessment process of children with developmental disorders.
