EMERGE: Early Markers of Expressive and Receptive (language) Growth in Ethnically diverse autistic toddlers

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PROJECT ABSTRACT The majority of 18-24-month-old autistic children have no words, demonstrating significant delays in their language development, a leading source of concern that often brings them to the attention of physicians or other professionals in community settings91,92. About half of these children continue to show significant language delay, speaking no words at 30-33 months2 and exhibiting delays in language greater than expected for their nonverbal cognitive age2. The period of development between 18-30 months is critical for language learning, coinciding with the period of time parents note differences in their children’s development93. We do not understand why some children begin to use words and others do not but speaking early (before 36 months) has long-lasting and cascading effects on development94,95. This may be especially true for low income, racially and ethnically diverse children who are diagnosed later, and when diagnosed, often have lower cognitive/intellectual abilities8. Starting out with such disadvantage can limit opportunities for children, tracking them into specialized and segregated settings that result in poorer outcomes overall. Understanding why language outcomes diverge over this critical language learning window, especially for economically disadvantaged children and/or those from historically marginalized groups, is essential to optimize the targets and timing of early, effective interventions. Therefore, a major gap in our knowledge concerns the measures and timing of when we can predict spoken language outcomes of young children with autism, especially in historically marginalized and minoritized populations. To explore the vast heterogeneity in language outcomes, it will be necessary to deeply phenotype children using a range of concurrent neural and behavioral markers of spoken language and examine how these changes progress over time. This study will be the first to collect simultaneous social communication, language, sensory, motor development, and neural activity (via remote EEG) measures in the homes of families who have typically not been engaged in research studies, which we will do at three distinct times over the 18-30-month window of development. Participants include 132 18-month-old toddlers with autism who screen as having no words at study start. Our outcome will be the total number of novel words on a language sample. This study has the potential to dramatically improve our understanding of language growth among developmentally delayed, historically underrepresented, autistic toddlers. It also addresses a high priority need of the Interagency Autism Coordinating Council and NIH, which includes a focus on minimally verbal, intellectually disabled children and community samples of historically marginalized and minoritized populations.