Quantifying communicative feedback in racially and ethnically diverse autistic adolescents who are minimally verbal or have language impairment - Language in autism is heterogeneous. Thirty percent of autistic individuals use significantly fewer spoken words than expected levels relative to age (i.e., are minimally verbal [MV-ASD]) past age 5, and more than 50% have significant challenges with structural language, or language impairment (ALI). Language skills in autism predict outcomes in adolescence and early adulthood. During this age, MV-ASD and ALI lose access to services and enter new environments where other people may not know how to communicate with them. Improving outcomes requires accurate assessment and responsive supports. Yet, we fail to measure language and communication in diverse adolescent ALI and MV-ASD. Emerging evidence using natural language sampling shows significant linguistic variability in MV-ASD and ALI, but these findings are based on primarily white (and therefore non-representative) samples. Currently, the prevalence of autism and likelihood of being MV-ASD are higher in racially and ethnically minoritized children than white children. Existing assessments often treat language use as decontextualized versus arising from dynamic interactions, and communication probes are designed to differentiate autistic from nonautistic youth. We do not have tools for examining heterogeneity in language and communication in context, which is vital for developing an ecologically valid understanding of the experiences of diverse MV-ASD and ALI to support the transition to adulthood. We urgently need to look to communicative feedback, or the implicit and explicit signals of communicative success or failure. Communicative feedback is understudied yet key for language acquisition and use. This participatory proposal will develop and use probes to measure communicative feedback in MV-ASD or ALI and caregivers. Our main hypothesis is that caregiver feedback will predict the proportion of communication success. We will use proven practices for inclusion: 1) a web-based RAND/UCLA modified Delphi study; 2) participatory approach; and 3) remote assessment. We will recruit 24 panelists with personal and professional expertise, 70 diverse MV-ASD and ALI ages 13 to 21 (35/group), and 70 caregivers. We hypothesize: 1) when presented with 50 items on potential probe stimuli, administration, feedback, and coding in two rounds, 24 diverse multi- stakeholder experts will reach stability on appropriateness; 2) probe completion rates will non-significantly differ from attrition up to the point of probes, and interrater reliability and satisfaction will non-significantly differ from acceptable; and 3) explanatory factors (use of personal interests and caregiver feedback) will predict communicative success; probe time may mediate these effects. This proposal responds to NOT-DC-23-009 and NIH and NIDCD priorities of promoting health equity through representative inclusion in research. This project will produce a new measure for assessing communication in diverse MV-ASD and ALI. Findings will support an R01 proposal on language and communication of diverse MV-ASD and ALI in the transition to adulthood and future translational study to build a gold-standard measure to assess communication.
