Tools For Identifying Children’s Risk for Autism Spectrum Disorder


The Autism Observation Scale for Infants, or AOSI, can help ascertain young children with tuberous sclerosis complex who are at higher risk for autism spectrum disorder, according to findings recently published in Pediatric Neurology.

According to researchers, tuberous sclerosis complex (TSC) occurs in one out of every 6,000 people.

“Currently, no single factor has been identified as a consistent predictor of [autism spectrum disorders (ASD)]; but single-gene disorders with a high prevalence of ASD, such as TSC, provide us with opportunities to investigate the underlying biology and identify potential treatments,” Jamie Capal, MD, of the division of neurology at the Cincinnati Children’s Hospital Medical Center, and colleagues wrote. “Evaluation of the AOSI as an objective assessment tool to identify early ASD-associated behaviors in infants with TSC has been shown in a small prospective longitudinal cohort of infants, but using the AOSI to predict later ASD risk in this population has not been previously reported.”

To see if AOSI could be used a prediction tool, researchers analyzed test results from 79 children between 0 to 36 months of age with TSC who were given the AOSI at 12 months. These participants were also given both the Autism Diagnostic Observation Schedule-2 (ADOS-2) and Autism Diagnostic Interview-Revised at 24 months. The children were categorized as ASD or non-ASD according based on the ADOS-2 results.

Capal and colleagues found that those with ASD had a mean AOSI total score at 12 months that was “significantly higher” than the non-ASD group (11.8 ± 7.4 vs. 6.3 ± 4.7).

Researchers also discovered that by utilizing an AOSI total score cut-off of 13, an “excellent specificity” was observed, but was but was significantly “less sensitive” for identifying children who would meet ASD classification at 24 months. Capal and colleagues also determined that a participant’s AOSI total score was helpful for establishing risk for ASD at 24 months as determined by the ADOS-2, and that the OR of the AOSI prognosticating ASD on the ADOS-2 at 24 months was 1.16 (95% CI, CI 1.06-1.27; < .001).

“Single-gene syndromes with a high prevalence of neurodevelopmental disorders such as TSC provide us with unique opportunities to investigate the underlying biology and identify potential treatments for ASD by providing highly enriched populations in which ASD symptoms can be identified and measured before the formal diagnosis of ASD is made,” Capal and colleagues wrote. “However, evaluation of existing tools such as the AOSI and continued development of new assessment approaches with improved sensitivity and specificity are essential for this progress to take place, not only for TSC but the broad spectrum of ASD causes, including idiopathic ASD.”

Citing the lack of evidence and the low quality of the evidence that is available, or that which conflicts or is of poor quality such as, the U.S. Preventive Services Task Force has previously stated that there is currently insufficient evidence to support universal autism spectrum disorder screening for children aged 18 to 30 months unless concerns are raised by parents or clinicians.

The debate over the use of available screening tests for autism has continued. Since the USPSTF recommendation, another study found that using the Attention Deficit Hyperactivity Disorder Rating Scale Fourth Edition is inaccurate, while another, different study found the Modified Checklist for Autism in Toddlers Follow-up Interview provided accurate and timely outcomes. – by Janel Miller

Disclosure: Capal reports no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures.


Toys and Communication


As technology progresses, electronic children’s toys have become extremely compacted sources of educational materials. Due to the eye-catching visuals and fun sounds, the electronic toys promote increased interactions from children compared to basic, ‘old-fashioned’ toys, right?

The American Speech-Language-Hearing Association (ASHA) recently published an article in the ASHA Leader discussing that very topic. An associate professor of communications science and disorders at Northern Arizona University, Anna V. Sosa, was the lead author of a study regarding the subject of verbal interactions between parents and their children when using various types of toys distinguished by whether they were electronic (e.g. talking farms, baby cellphones) or basic, non-electronic toys (e.g. blocks, books, puzzles). The study, published in JAMA Pediatrics, focused on the type of toy used for play and how parents interactions with their children changed depending on the toy type.

Previous studies have already identified that children’s language development is influenced by the amount and quality of language exposure they receive. The general effect tended to highlight greater vocabulary growth and use by children if their parents used more words, as well as encouraging statements when interacting with them.

The study completed by Sosa and her team found that parents utilized the greatest number of words per minute with their children when playing with books, followed by puzzles and blocks. The least amount of words per minute between parent and child were noted with interactions involving electronic toys. The electronic toy interactions also turned out to demonstrate limited use of content-specific words, the very words the toy was meant to elicit, as well as the fewest number of conversational turns, child vocalizations, and parental responses – all integral parts for a child’s development of speech, language, and social norms.

It is highly recommended that parents do their research when considering the types of toys and interactions to expose their children to, with an emphasis on limiting play with electronic toys and increasing parent-child interactions. We know funneling through research articles can be a daunting task though, so always feel free to ask your friendly neighborhood SLP about this topic and other recommendations to promote your child’s speech and language development.

Apraxia Awareness Day 2016!

May 14th is Apraxia Awareness Day!

Childhood Apraxia of Speech (CAS) is a neurological speech disorder that can significantly decrease a child’s intelligibility. Although the causes of CAS are not fully understood, it is believed there is a deficit regarding formulating, relaying, and/or storing motor plans for speech movements. Despite the unknowns regarding CAS, there are resources for more information, such as the Childhood Apraxia of Speech Association of North America (CASANA). Please visit their website for additional information and resources such as brochures and handouts to promote awareness of CAS.

Also, enjoy this quick read from a mother of a child with CAS about meeting Ronda Rousey, the former UFC Women’s Bantamweight Champion. Ronda Rousey openly discussed that she had a speech impediment as a child, but did not previously use a specific label to refer to the disorder — until this mother shared some information with her. The story is both educational and inspirational.

Stuttering and Public Speaking

This week is National Stuttering Awareness Week [May 9th – 15th]. The Stuttering Foundation recently sent out their Summer 2016 Newsletter and an interesting article about John Moore caught our attention.

Who is John Moore? He is a corporate marketing executive and has worked with companies such as Starbucks and Whole Foods. Another label Mr. Moore identifies with, according to the article, is stutterer. As a person who stutters, Mr. Moore manages his stuttering by using learned tools to minimize disfluencies and decrease avoidance behaviors. He even calls himself ‘The Stuttering Presenter’ and self-discloses to his audiences when making speeches.

Mr. Moore also shares some advice, included in the article, regarding public speaking. He discusses the importance of being in control and remembering that the audience wants you, as a speaker, to succeed. He also mentions other important pieces of advice. To read in further detail, please refer to the Summer 2016 Newsletter on The Stuttering Foundation website.

BHSM Coloring Contest

CTSPS invites you to participate in our annual coloring contest for Better Hearing and Speech Month! ‪#‎bhsm‬ ‪#‎slp‬ ‪#‎atx‬

Gift certificates to Barnes and Noble will be awarded to our winners.

Winners will be chosen at the end of May and will have their artwork posted at each of our offices (with parental permission). Coloring pages can be picked up at the front desk of either office location or here: BHSM-Coloring-Page. Entrants should make the front office aware of the name and age associated with submitted coloring pages. One entry per person please. Entries will be judged according to age, 7 and under and 8+. The contest is open to current patients and siblings only. Colored pages may be submitted in-person, via picture to our office email:, or posted to our FB page.

Good Luck!


Take a look at the winning artwork from 2015: Better Hearing and Speech Month Contest Winner Announced!

Central Texas Speech Pathology and Texas Neuro Rehab Co-Sponsor Austin Dysphagia Forum 2016

Once again, Central Texas Speech and Texas Neuro are co-sponsoring this wonderful event.  Each session is free and is worth 2.0 CE hours.  The schedule follows:


February 25, 2016 (2.0 CE hours)

Topic: Personal Medical Rehab Stories, from diagnosis to functional life.
Speaker: Panel of Speakers with history of TBI, CVA, Dysphagia


March 24, 2016 (2.0 CE hours)

Topic: Laryngectomee: treatment, Communication, Outcomes, Technology
: Panel of Laryngectomee Speakers moderated by Frank Brick,

New Voices Club of Austin


April 28, 2016 (2.0 Ethics CE hours)

Topic: Trauma and the Ethics of Trauma Informed Care.

Speaker: Cynthia Penwell, LCSW. (Works with with children/adolescents/adults)


May 26, 2016 (2.0 CE hours)

Topic: HPV and Laryngeal Papilloma, Throat Cancer
: Dr. Chad Whited. (Otolaryngologist, Head and Neck Surgeon with specialization in voice, swallowing and airway disorders. The only fellowship trained Otolaryngologist in Austin).


June 23, 2016 (2.0 CE hours)

Topic: Improving Life Satisfaction by Building Executive Functioning Skills
: Kelly Ramsey, Executive Director with Rehab Without Walls


Place: Texas Neuro Rehab Center, 1106 W. Dittmar Road, Austin, TX 78745. (Travel main road into campus thru low water crossing, then follow curve of road to left. Park in parking lot in front of Lone Star Therapy building. Free parking! Walk up walkway between Administration and Lone Star. Enter Lone Star building on left. Look for signs for Austin Dysphagia Forum. We meet in Room 639 Wrangler Conference Room.

Time: 6.30 – 8.30 pm

Cost: FREE !! Sponsored by Texas Neuro Rehab Center and Central Texas Speech Pathology Services.

CEU: TSHA approved. Accepted for: Texas SLP License & meets ASHA CE requirement.

Questions? Contact Christina Portell at (512) 709-9631 (Cell),

Join austindysphagiaforum yahoo group at for updates.