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THE SIGNIFICANCE of LANGUAGE REGRESSION in SUBTYPING WITHIN the AUTISM SPECTRUM DISORDERS by LAUREN ARLEESIA JONES (Under the Di

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THE SIGNIFICANCE of LANGUAGE REGRESSION in SUBTYPING WITHIN the AUTISM SPECTRUM DISORDERS by LAUREN ARLEESIA JONES (Under the Di THE SIGNIFICANCE OF LANGUAGE REGRESSION IN SUBTYPING WITHIN THE AUTISM SPECTRUM DISORDERS by LAUREN ARLEESIA JONES (Under the Direction of Jonathan M. Campbell) ABSTRACT Individuals diagnosed with autism spectrum disorders (ASD) present with a wide range of heterogeneity; subtype validation therefore represents a major emphasis within this line of research. The published literature is reviewed, including subtype theory, past and present areas of ASD subtype research, and comparison of individuals with ASD with and without a history of language regression. Review conclusions indicate that while no one subtype solution explains all of autism variability, ASD likely exists on a continuum of developmental level and symptom severity on which exist overlapping subgroups that differ on severity level. Additionally, the validity of regressive autism as a subtype of ASD has not yet been determined and warrants continued attention. The purpose of the current study was to investigate the validity of ASD subclassification based on history of language regression. Participants (N =183 children, 2-17 years of age, diagnosed with an ASD) were divided into 4 groups on the basis of language history (i.e., delayed with regression, delayed with plateau, delayed without regression or plateau, and typical early language). Variable domains included adaptive behavior, symptom severity, and social-emotional functioning, which were measured using archival clinical assessment data. Multivariate analysis of variance and descriptive discriminant analysis were used to identify possible latent constructs that best explain group differences. A general trend of lesser symptom severity/better symptom-related adaptive functioning was noted for the typical vs. the delay groups, and better symptom-related adaptive behavior functioning for the plateau vs. the regression group. Groups formed on the basis of early language history may therefore exist on a continuum of level of pathology and prognosis, with individuals with more typical early language functioning better than those with a history of plateau or delayed/deviant language development, and individuals with plateau better functioning than those with a history of regression. INDEX WORDS: Autism spectrum disorders, Children, Subtype theory, Language regression, Language plateau, Language delay THE SIGNIFICANCE OF LANGUAGE REGRESSION IN SUBTYPING WITHIN THE AUTISM SPECTRUM DISORDERS by LAUREN ARLEESIA JONES B.S., Furman University, 1999 M.Ed., The University of Georgia, 2001 A Dissertation Submitted to the Graduate Faculty of the University of Georgia in Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY ATHENS, GEORGIA 2007 THE SIGNIFICANCE OF LANGUAGE REGRESSION IN SUBTYPING WITHIN THE AUTISM SPECTRUM DISORDERS by LAUREN A. JONES Major Professor: Jonathan Campbell Committee: Yvette Getch Randy Kamphaus Roy Martin Electronic Version Approved: Maureen Grasso Dean of the Graduate School The University of Georgia May 2007 © 2007 Lauren A. Jones All Rights Reserved iv DEDICATION To my colleagues, friends and family; with notable appreciation to P., L. and V., who have always and lovingly supported me beyond expectation or measure. v ACKNOWLEDGEMENTS I would like to sincerely thank my academic advisor, Jonathan M. Campbell, for his mentorship, advice and detailed, conscientious guidance regarding my research and graduate career at the University of Georgia. I also gratefully acknowledge each member of my dissertation committee for their time and commitment regarding review and development of this manuscript and research, as well as my academic career, overall. Finally, I extend my appreciation and gratitude to the individuals involved in providing access to the clinical sample used in this study, making this investigation possible. vi TABLE OF CONTENTS Page ACKNOWLEDGEMENTS .............................................................................................................v LIST OF TABLES ....................................................................................................................... viii CHAPTER 1 Introduction and Literature Review ...............................................................................1 The Emphasis of Subtyping in Autism Spectrum Disorders Research .....................1 Language Development in Autism Spectrum Disorders ...........................................2 Manuscript Content ...................................................................................................3 References .................................................................................................................5 2 Autism Spectrum Disorders: Subtype Research and the Empirical Findings of Autism with and without a History of Language Regression ................................................8 Subtyping theories and empirical findings: Introduction ........................................10 Importance of Subtyping .........................................................................................12 Subtyping Methodology: Empirical vs. Conceptual Approaches ...........................13 Types of Subtyping Classification: Categorical vs. Dimensional ...........................15 Subtype Theory and Research: Autism Classification ............................................16 Subtype Theory and Research: Current Diagnostic Classifications ........................17 Subtype Theory and Research: Conceptual Approaches to Subtyping ...................27 Subtype Theory and Research: Empirical Approaches to Subtyping .....................33 Conclusions from PDD Subtyping Research ..........................................................48 vii Autism and Language Regression: A Summary of Research Findings ..................49 Conclusions .............................................................................................................74 References ...............................................................................................................82 3 The Validity of Autism Subtyping by History of Language Regression: A Comparison Study of Clinical Characteristics ........................................................90 Introduction .............................................................................................................92 Background Information: Language Regression and Plateau in Autism ................93 Current Investigation ...............................................................................................97 References .............................................................................................................138 4 Dissertation Conclusion .............................................................................................143 viii LIST OF TABLES Page Table 1: Changes in DSM and ICD Childhood Psychosis/PDD Classifications Across Time .....19 Table 2: Participant Characteristics Across the Total Sample .......................................................99 Table 3: Descriptions of Language Regression Categories Used for Data Entry Coding ...........102 Table 4: Scales Used to Derive BASC Composite Scales ...........................................................107 Table 5: Correlational Matrix for the MANOVA Dependent Variables ....................................110 Table 6: Participant Characteristics Across the Language Development History Groups ..........114 Table 7: Group Means and Standard Deviations for Symptom Severity Contrasts ....................116 Table 8: M ANOVA Pairwise Contrasts Across Symptom Severity Variables ..........................116 Table 9: Group Means and Standard Deviations for Adaptive Behavior Contrasts ....................118 Table 10: M ANOVA Pairwise Contrasts Across Adaptive Behavior Variables ........................118 Table 11: TL vs. DLR Contrast Dimensionality Statistics for Adaptive Behavior Variables .....119 Table 12: TL vs. DL Contrast Dimensionality Statistics from Analysis of Adaptive Behavior Variables .......................................................................................................................119 Table 13: DLR vs. DLP Contrast Dimensionality Statistics for Adaptive Behavior Variables ..120 Table 14: Group Means and Standard Deviations for Social-Emotional/Behavioral Contrasts ..121 Table 15: M ANOVA Pairwise Contrasts Across Social-Emotional/Behavior Variables ..........121 Table 16: TL vs. DLR Contrast Dimensionality Statistics for Social-Emotional/Behavioral Variables .......................................................................................................................122 ix Table 17: TL vs. DL Contrast Dimensionality Statistics for Social-Emotional/Behavioral Variables .......................................................................................................................123 Table 18: Group Means and Standard Deviations for All Variables Contrasts ...........................124 Table 19: M ANOVA Pairwise Contrasts Across All Dependent Indicator Variables ...............124 Table 20: TL vs. DLR Contrast Dimensionality Statistics All Dependent Variables .................125 1 Chapeter 1 INTRODUCTION AND LITERATURE REVIEW The Emphasis of Subtyping in Autism Spectrum Disorders Research The autism spectrum disorders (ASDs), or pervasive developmental disorders (PDDs), are a class of neurodevelopmental disorders of socialization, communication and behavior. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text
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