Assessing

Language Skills
in Individuals
with Autism
Spectrum
Disorders
April 28, 2021
Patricia Ybarra, MS, CCC-SLP
Shannon Wang, MA, CCC-SLP
Nancy Castilleja, MA CCC-SLP

Copyright © 2021 NCS Pearson. All rights reserved.

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Autism Spectrum Disorder (IDEIA, 2004)

Autism is a developmental disability significantly affecting verbal

and nonverbal communication and social interaction, generally
evident before age three, that adversely affects a
child’s educational performance.

Other characteristics often associated with autism are engagement

in repetitive activities and stereotyped movements, resistance
to environmental change or change in daily routines, and
unusual responses to sensory experiences.

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Diagnosis and Criteria Changed in DSM-5

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Autism Spectrum Disorder (DSM-5, 2013)
A. Persistent deficits in social communication and social interaction
across multiple contexts, as manifested by the following, currently or
by history . . .
1. Deficits in social-emotional reciprocity . . .

2. Deficits in nonverbal communicative behaviors used for

social interaction . . .

3. Deficits in developing, maintaining, and understanding

relationships . . .

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 Autism Spectrum Disorder (DSM-5, 2013)

B. Restricted, repetitive patterns of behavior, interests, and activities,

as manifested by at least two of the following, currently or by history . . .
1. Stereotyped or repetitive motor movements, use of objects, or
speech . . .

2. Insistence on sameness, inflexible adherence to routines, or

ritualized patterns of verbal or nonverbal behavior . . .

3. Restricted, fixated interests that are abnormal in intensity or focus . . .

4. Hyper- or hyporeactivity to sensory input or unusual interest in
sensory aspects of the environment . . .
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Autism Spectrum Disorder (299.00 DSM-5,
2013)

C. Symptoms are present in the early developmental period (but

may not become fully manifest until social demands exceed
limited capacities or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in

social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual

disability (intellectual developmental disorder) or global developmental
delay.

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Autism Spectrum Disorder (DSM-5):
Severity Levels

Level 3: Severe deficits requiring very substantial support

Level 2: Marked deficits requiring substantial support
Level 1: Noticeable impairments requiring support

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Assessment needs at each severity level

Severe

Moderate

Mild

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Diagnosis Often Made Late

• Most children diagnosed after age 4, though autism can be

reliably diagnosed as early as age 2.
• Autism affects all ethnic and socioeconomic groups.
• Minority groups tend to be diagnosed later and less often.
Centers for Disease Control, 2014

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Early Warning Signs
• Poor eye contact
• Does not look when you point to an object
• Does not engage in pretend or imaginative play
• No response to name
• Does not use gestures to communicate
• Excessive lining up of toys or objects
• No smiling or social responsiveness
( Johnson & Myers, 2007; National Institute of Health, 2013)

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Skills gained through play
Play development is significantly related to cognitive, language, and
social development.
It is during play that children learn:
• Appropriate behavior and • Building relationships
language • Imitation
• Task completion • Flexibility
• Imagination • Tolerance
• Turn taking • Reciprocity

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Development of Play
• Sensory motor play

• Exploratory and manipulative play

• Physical play

• Social play

• Pretend pay

Children with Autism Spectrum Disorder often demonstrate

different play skills than peers with typical development. This
is especially true of social play and pretend play.

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Social participation in play
Children begin to play on their own.

Unoccupied behavior- watches anything of momentary interest

Solitary- pursues own play without reference to others

Over time, children start participating in play that involves other people.

Onlooker- watches other children but doesn't play along

Parallel- plays alongside other children

Associative- Starts to play with others with some cooperation

Cooperative- plays with shared aim of playing with others

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Social Interaction: Joint Attention
Joint attention is about two people thinking about the same thing as one another.

1. Look at a partner

2. Attend to that partner

3. Read partner's affective state

4. Share partner's affective state

5. Reciprocal interaction
No Joint Attention= difficulty with subtle communication cues like facial
expressions, the tone of a speaker's voice, body language, etc.

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 Theory of Mind

1st order: A thinks X

2nd order: A thinks B thinks X
3rd order: A knows THEY think X (involves knowing a group's perspective)

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Language and Narrative Skills
A typical developing child can understand and tell short stories
between 2-3 years of age.
Semantic memory- words, ideas, and concepts are remembered
Episodic memory- memory of experiences throughout time develops.
Children are able to perceive the present moment as both continuation
of the past and a precursor to the future.
Episodic memory enables predicting and inferencing skills.

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Conducting an evaluation

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Increasing Rate of Early Identification

• Conduct developmental surveillance at every well-child visit.

• Administer developmental screenings as a standard at the 9-, 18-,
and 30-month visits (or 24-month, if no 30-month visit is
anticipated).
• Recommend an additional screening prior to beginning preschool
or kindergarten, or at the 4-year well-child visit (Duby et al., 2006).

(Recommendations from American Academy of Pediatrics)

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 Infants and Toddlers

Birth ➢ Primary Intersubjectivity- Infants and caregivers sharing feelings and emotions
via expressions and gestures
➢ Affect Attunement- emotions are nonverbally communicated

~8 months ➢ Secondary Intersubjectivity- Determining your reaction's effects on others

~15 months ➢ Symbolic/Representational Skills

• Awareness of Self
• Pretend Play
• Language

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Communication & Language Assessments for
Infants and Toddlers
Test Age Description
PLS-5 Birth - 7:11 Developmental assessment of emerging
interpersonal communication skills, language
comprehension, and expressive language
Bayley-4 16 days - 42 months SLPs are qualified to administer the Bayley-4, which
addresses cognition, receptive and expressive language, fine
and gross motor skills, social-emotional, and adaptive
behavior skills
Vineland-3 Parent/Caregiver forms Communication (Receptive, Expressive, Written); Daily Living
Birth - 90+ Skills (Personal, Domestic, Numeric,* Community, School
Community*); Socialization (Interpersonal Relationships, Play
Teacher forms and Leisure, Coping Skills); Motor Skills (Gross Motor, Fine
3:0 - 21:11 Motor); Maladaptive Behavior (Internalizing, Externalizing,
Critical Items.)

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PLS-5 Profile

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Bayley-4 Scales

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Vineland Adaptive Behavior Scales
Conducted as a parent/caregiver or teacher interview

• Communication (Receptive, Expressive, Written)

• Daily Living Skills (Personal, Domestic, Numeric,* Community,

School Community*);

• Socialization (Interpersonal Relationships, Play and Leisure,

Coping Skills);

• Motor Skills (Gross Motor, Fine Motor);

• Maladaptive Behavior (Internalizing, Externalizing, Critical Items.)

• Items appropriate for infants and toddlers

Ind-depth presentation via live webinar scheduled for 4/30/21 and

available as a recording afterwards on pearsonassessments.com.

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Semantics
• May have difficulty understanding figurative language (e.g., It is raining cats and
dogs. She is under the weather.)

• May associate one meaning with a word; may have difficulty with words with
multiple meanings (e.g., The baseball player caught the fly.)

• May have limited vocabulary

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Assessments that Address Vocabulary
Test Age Description
Peabody Picture Vocabulary Test, 2:6 - 90+ Evaluates receptive
Fifth Edition (PPVT – 5) vocabulary without the need to read or
write
Expressive Vocabulary Test, Third 2:6 - 90+ Evaluates expressive vocabulary without
Edition (EVT – 3) the need to read or write

Bracken Basic Concept Scale, 3:0 - 6:11 Evaluates understanding of basic concepts
Third Edition: Receptive needed to be successful in
(BBCS - 3:R) formal education

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Assessments that Address Vocabulary
Test Age Description
Bracken Basic Concept 3:0 - 6:11 Evaluates labeling of basic
Scale: Expressive (BBCS:E) concepts needed to be successful in
formal education
Boehm Test of Basic Concepts, 3:0 - 5:11 Measures understanding of 26 basic
Third Edition Preschool (Boehm - 3 concepts relevant to preshool and early
Preschool) childhood curriculum. Each concept
is assessed twice to determine the child's
understanding across contexts

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Morphology
• Development of morphological forms is consistent with peers with typical language
development

• Morphological error patterns are similar to those of children with developmental

language disorder (e.g., 3rd person singular, regular past tense –ed, pronoun case)

• It may be difficult to assess children's morphological productions if they have

limited verbal skills (e.g., one- to two-word utterances, idiosyncratic phrases,
echolalia/"movie talk")

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Syntax
• Development of syntactic forms is consistent with peers with typical language
development

• Understanding of sentence structures with multiple meanings may be

difficult (e.g., The children ran into the room with balloons.)

• Understanding of complex sentences may be limited (e.g., After driving Jordan to

school, his mother goes to work.)

• Understanding and production of any sentence types is limited

• It may be difficult to assess children's syntax if they have limited verbal skills

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Assessments that Address Comprehensive
Language
Test Age Description
Preschool Language Scales, Fifth Birth - 7:11 Assesses communication development,
Edition (PLS - 5) with items that range from pre-verbal,
interaction-based skills to emerging
language to early literacy
Clinical Evaluation of Language 3:0 - 6:11 • Ideal for children who communicate at
Fundamentals, Preschool, Third the sentence level and who
Edition (CELF Preschool - 3) are suspected of having specific skills
deficits rather than overall language
delays
• Assesses a
child's semantics, morphology,
syntax, pragmatics, and pre-literacy
skills

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PLS-5 Profile

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Assessments that Address Comprehensive
Language
Test Age Description
Clinical Evaluation 5:0 - 21:11 Assesses a student's semantics,
of Language Fundamentals, Fifth morphology, syntax, and pragmatic
Edition (CELF - 5) skills. Provides information about the
impact of oral language skills on written
language, using the Reading
Comprehension and Structured Writing
tests.
Clinical Evaluation 9:0 – 21:11 • Ideal for students with subtle language
of Language Fundamentals, Fifth disorders
Edition Metalinguistics • Evaluates higher level language skills
CELF - 5 Metalinguistics) for students who have difficulties in the
classroom, but do not qualify for
services on tests of basic language skills

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 Examples
Uses abstract words like kindness or paradigm

I was hoping to wash my car today. Guess I'll wash it tomorrow. I thought of
two reasons why he didn't wash his car today: it's raining or he doesn't have
time.
I heard some people talking but only heard a few words...I heard
the words Pam, late dinner. Look at the picture and tell me what the girl could
have said.
Here is a sentence that can mean more than one thing. Your glasses are dirty.
What two things can the sentence mean?
The girl said I have to change the tire, so would you give me a hand? What
does that mean? Now find the sentence that means almost the same
thing. (Correct answer: I sure wish you would pitch in.)

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Pragmatics

• Understanding the nuances of social language may be difficult (e.g., understanding

figurative language, jokes, facial expressions, body language)

• Taking the perspective of a communication partner may be difficult (e.g.,

understanding the relevance of communication topic, provides sufficient context)

• Engaging in social interactions with communication partners may be difficult

(e.g., understanding how to initiate and maintain conversation)

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Assessments that Address Pragmatics
Test Age Description
Children's Communication 4:0 - 16:11 • Evaluates a student's language abilities
Checklist - 2, U.S. Edition (CCC - 2) in the areas of speech, vocabulary,
sentence structure, and social
language.
• Provides profiles for students who may
have pragmatic impairment

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Children's Communication Checklist-2

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Assessments that Address Behaviors
Associated with ASD
Test Age Description
Sensory Profile 2 Birth - 14:11 • Evaluates a child's sensory processing
patterns in the context of home,
school, and community-based activities
Social Skill Improvement System 3:0 - 18:0 • Measures social skills: communication,
(SSIS) Rating Scales cooperation, assertion, responsibility,
empathy, engagement, and self-control
• Allows for a comprehensive picture of
a student's abilities across school,
home, and community settings with
teacher, parent, and student forms.

Vineland Adaptive Behavior Scales, Birth - 90 • Measures adaptive behavior of

Third Edition (Vineland - 3) individuals in 5
domains: Communication, Daily Living
Skills, Socialization, Motor Skills, and
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Characteristics of tweens and teens with
Autism

May have many of the characteristics of younger children with autism

• May be nonverbal or have excellent verbal skills with few grammatical
errors
Regardless of level of language ability most continue to learn how to
• Read nonverbal cues like tone of voice, gestures, and body language
• Understand what is required in social situations

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 Middle and High School Students and Adults
with Autism
• Young adults want to be as independent as possible.
Regardless of language level, they want to be like
their age-level peers.
• They demonstrate behaviors that show they want to
be more independent at home and participate in the
same school activities as age-level peers.
• Even when their communication skills are
limited. Improving their ability to
communicate enthusiasm, anger, need for help etc.
Is even more critical as they age for their own (and
others') health, well- being, and safety.

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 Age-appropriate assessment tools and procedures
Obtain assessment data using
• Language sampling
• Dynamic assessment
• Parent and teacher questionnaires or interviews
• Observations
➢ At home with different family members
➢ At school with teachers and classmates
➢ At work (if applicable) with coworkers and supervisors
• Review portfolios of classroom work
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 Age-appropriate norm-referenced assessments that
address vocabulary (middle/high school and adults)

Test Age Description

Peabody Picture Vocabulary Test, 2:6 - 90+ Evaluates receptive

Fifth Edition (PPVT – 5) vocabulary without the need to read or
write

Expressive Vocabulary Test, Third 2:6 - 90+ Evaluates expressive vocabulary without
Edition (EVT – 3) the need to read or write

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 Age-appropriate, norm-referenced tests for general
language skills for older students and adults
TITLE AGE FORMAT SCORES
Vineland Adaptive Birth-90 Interview with Measures adaptive
parents/caregivers and Behavior of individuals in 5 domains:
Behavior Scales-3 teachers Communication,
(Vineland-3) Daily, Living Skills, Socialization, Mot
or Skills, and Maladaptive Behavior

Children's 4-16 Caregiver report: ratings Domain scaled scores

based on frequency General Communication
Communication Checklist observed Composite (GCC)
(CCC-2) Social Interaction Difference Index
CELF-5 5-21 Tasks: Structured, semi- Core Language, Receptive
structured, observational, Language, Expressive Language,
and interactive Language Content and Structure,
Pragmatics, Reading, Writing
CELF-5 Metalinguistics 9-21 Interview, structured tasks Metalinguistics index, Meta-Semantic
and Meta-Pragmatic Index
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 Age appropriate, norm-referenced assessments that
address pragmatics/social communication (older students/adults)
Test Age Description
Children's Communication 4:0 - 16:11; • Evaluates a student's language abilities in the areas
Checklist - 2, U.S. of speech, vocabulary, sentence structure, and
Edition (CCC - 2) social language.
• Provides profiles for students who may
have pragmatic impairment for Initiation, Scripted
Language, Context, Nonverbal Communication,
Social Relations, and Interests

CELF-5 Pragmatics Profile 5:0-21:11 • 50 item test examining presence of appropriate

pragmatic language behaviors in the areas of
• Rituals and conversation
• Asking for, giving, responding to information
• Nonverbal communication

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CELF-5

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 A quick look at each

Skill tested Examples

Rituals and Conversational Skills Greets others; uses strategies to get attention
Asks for , Gives, Responds to Asks for help; recognizes other's feelings from
Information nonverbal cues
Nonverbal Communication Uses body language/gestures; adjusts distance to
another person according to the situation

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45
1. Select three activities to do before or after
testing or as a "break" between subtests.
2. Note atypical behaviors
3. Mark each behavior observed after the
examinee leaves the session (not during
the interaction).

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CELF-5

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 Types of Behaviors Observed Example
Nonverbal: Gaze, Gesture, Expression, Did not coordinate gaze with speaker's gaze and
Body Language ongoing talk
Verbal: Manner of Communication Used too much nonspecific language to enable
understanding of what he/she was trying to
communicate
Verbal: Relevance of Communication Said things not relevant to current situation,
topic, event, or participants
Verbal: Quality and Quantity of Provided too much information; provided
Communication redundant information
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 Examples
Uses abstract words like kindness or paradigm

I was hoping to wash my car today. Guess I'll wash it tomorrow. I thought of
two reasons why he didn't wash his car today: it's raining or he doesn't have
time.
I heard some people talking but only heard a few words...I heard
the words Pam, late dinner. Look at the picture and tell me what the girl could
have said.
Here is a sentence that can mean more than one thing. Your glasses are dirty.
What two things can the sentence mean?
The girl said I have to change the tire, so would you give me a hand? What
does that mean? Now find the sentence that means almost the same
thing. (Correct answer: I sure wish you would pitch in.)

49
CELF-5 Metalinguistics

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CELF-5 Metalinguistics

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CELF-5 Metalinguistics

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CELF-5 Metalinguistics

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CELF-5 Metalinguistics

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Age- appropriate, norm referenced
assessments that address literacy (older students/adults)
Test Age Description
CELF-5 Reading 8:0 through 21:0 • Evaluates a student's language abilities
Comprehension and Written in the areas of speech, vocabulary,
Language sentence structure, and social
language.
• Provides profiles for students who may
have pragmatic impairment
Woodcock Reading Mastery 4:6 to 79:11, Grades 1-12 • Individually-administered
Tests-3 (WRMT-3) comprehensive assessment of reading
skills

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CELF-5 reading and writing tests

The student reads three stories (appropriate to age level), then answers
questions in these categories:
▪ Main idea
▪ Details
▪ Sequence of events
▪ Inference
▪ Prediction

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CELF-5 Reading and Writing Tests

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CELF-5 Reading and Writing tests

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Woodcock Reading Mastery Tests-3
• Listening Comprehension
• Readiness
✓ Letter Identification
✓ Phonological Awareness
✓ Rapid Automatic Naming
• Basic Skills
✓ Word Identification
✓ Word Attack
• Reading Comprehension
✓ Word Comprehension
✓ Passage Comprehension
• Oral Reading Fluency
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Older Students/Young Adults
with Autism
Phyllis R. Scott
Poor outcome data for students with
• mild to moderate
language impairments
• emotion regulation problems
• social communication disorders

Scott, P.R. (2021). Preparing High Schoolers with

Communication Disorders for the
Workplace. ASHA Leader, Vol. 26 (3), 28-29. 60
 National Autism Indicator Report (2017)
Developmental Disability Services and Outcomes in Adulthood (2017)
• About half a million youth on the autism spectrum will age into
adulthood over the next decade
• The majority of a typical life occurs in adulthood
• Only 1% of all autism research funding supports investigation of
topics related to adulthood and aging, according to a 2017 report
from the Interagency Autism Coordinating Committee
• Adulthood is the stage of life we know least about with respect to
autism research, policy and practice.

https://familyvoicesofca.org/wp-content/uploads/2017/06/Natl-Autism-Indicators-Report-2017_Final.pdf
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 Norm referenced assessment of adults who are
nonverbal or have emerging language skills
Assessment Age Type of measure
CELF-5 Pragmatics Profile 5-21 Rating scale to examine rituals & conversation,
asking/giving/responding to information, and
nonverbal communication
CELF-5 Pragmatics Activities 5-21 Checklist of atypical nonverbal communication
Checklist and relevance/manner/quality/quantity of
communication
Vineland Adaptive Behavior Birth to 90
Profile
Sensory Profile for 11+ Examine sensory processing patterns as an
Adolescents and Adults interview with client and/or caregiver
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 Areas Tested Examples
Communication Responds to questions; follows directions; asks questions;
comments about situations and emotions; reads and writes
simple sentences
Daily living skills Bathes and dresses self; uses kitchen utensils, careful with
sharp objects, looks both ways when crossing streets
Socialization Recognizes other's emotions; shows concern for others; has
friends; plays with others; requests help
Motor (optional) Walks up stairs; catches a ball; cuts with scissors; draws
recognizable form
Maladaptive Behavior Repetitive movements and speech; fixated interests; 63
Sensory Profile
• Norm-referenced questionnaire (infant, toddler, child, and
adolescent and adult editions)
• Determine how sensory processing may be contributing to or
interfering with a child's participation at home, school, and
community
• Provides information about sensory strengths and challenges
• Use the information to help you help the student or adult remain
calm and focused on activities, supporting behaviors that improve
participation and avoid scenarios that trigger behavioral
responses that can interfere with participation in home and
school activities.

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 Suggestions for successful collaboration with
stakeholders
1. Explain test results to teachers and family in a way that makes it clear what
the individual can do and what he/she has difficulty doing in the classroom
and at home.
2. Identify the pain points—what does each stakeholder consider a pressing
need at home and in the classroom?
3. Prioritize top needs—and keep the initial plan simple.
4. Make the goals/objectives functional for everyday use—not an additional
task.
5. Provide ideas/suggestions for daily practice within activities the student
does at home and at school already
6. Keep the communication lines open. Discuss what went well and what is
not working or is too difficult to implement as planned. Adjust strategies as
needed
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Autism assessments and other resources
​Resource ​Publisher
Social Thinking (Michelle Garcia SocialThinking.com​
Winner)​
Ages and Stages​, CSBS BrookesPublishing.com​
ADOS-2, CARS-2​ WPSPublish.com​
GARS-3​, GADS ProEdInc.com​
Plural Publishing (Autism/Social PluralPublishing.com​
Communication titles)
Social Skills Improvement Rating Pearson.com
Scales (SSIS)