Potential communicative acts in

Children with Autism Spectrum

Disorders

B A R B A R A B R A D D O C K , P H D , C O L L E E N P I C K E T T, B A , J A M I E
E Z Z E L G O T, B S , S H I VA N I S H E T H , B S ,
E M I LY K O R T E - S T R O F F, O T R , LY N N B O C K , M S

SSM CARDINAL GLENNON CHILDREN’S MEDICAL CENTER

D E PA R T M E N T O F P E D I AT R I C S
SAINT LOUIS UNIVERSITY

FILIP LONCKE, PHD

UNIVERSITY OF VIRGINIA

P R E S E N TAT I O N AT T H E A M E R I C A N S P E E C H - L A N G U A G E - H E A R I N G
A S S O C I AT I O N ( A S H A ) C O N V E N T I O N , N O V E M B E R 1 5 , 2 0 1 3
 Disclosure

 We have no relevant financial or nonfinancial

relationships to disclose.

 Project is partially funded by the John Allan Love

Charitable Foundation, and CVS Caremark
Community Grant.
 Presentation

 Define potential communicative acts (PCA)

 Describe the motor + language link

 Methods

 Results

 Clinical implications

 Future directions in the study of PCAs

 Sigafoos et al., 2002

 PCA is defined as any behavior produced by an

individual that may be interpreted by others as
communicative

 May include vocalization, body movement, face/eye

movement, breathing patterns, challenging
behaviors, and/or stereotypical movements

 Limited use of gestures, words, manual signs, and

AAC communication
 Potential communicative Acts (PCA)

 May or may not be directed towards another

 Terms avoids the issue whether a PCA represents

intentional communication

 Yet recognizes that parents or caregivers may attach

meaning to children’s idiosyncratic or informal behaviors

 How parents respond to PCA may be important to

children’s ongoing developmental progression
 Why Study PCA?

 From ecological systems perspective, language

development is influenced by the nature of the parent-
child dyad (Bronfenbrenner, 1979)

 Language develops in response to social relationships

and in coordination with developing motor skills around
objects in varied physical and social contexts (Piaget,
1969)

 Joint attention (Tomasello, 1986)

 Active learning (Vygotsky, 1978)

 Motor + Language Link

Coordination of motor and language learning in typical

developing children

 Giving, showing, and reaching about 8 months

 Distal point predicts onset of first words

 Distal point + vocalization associated with children’s

movement to 2-word utterances

 Distal pointing is a reliable predictor of first words and

vocabulary growth through 2 years
 Research Questions

 What is the role of potential communicative acts

when language is developing atypically in children
with ASD?

 How do patterns of potential communicative acts

vary in relation to specific profiles of language
comprehension, language expression, nonverbal
thinking, social/personal, and motor behaviors?
 Participants

 Mean age = 32.82 months (SD = 10.28; range 20 – 51

months)
 3 females, 14 males
 All met DSM-IV classification of Autism Spectrum
Disorders (N=17)
 No marked sensory impairment(s)
 English-speaking homes
 Diverse ethnic and socio-economic backgrounds (White,
n=10; African-American, n=6; Asian, n=1)
 20 or fewer intelligible words reported for functional
communication
 Methods

 Parents completed the Birth to Three Assessment and

Interventions System-Comprehensive Test of
Developmental Abilities, Second Edition (B-3 CTDA:
Ammer & Bangs, 2000)

 Five separate developmental age scores in months for

language comprehension, language expression,
nonverbal thinking, social/personal behaviors and motor
behaviors

 Percent development calculated by computing B-3

CTDA developmental age scores then dividing by each
participant’s age in months
 Mean percent development and standard deviation (SD)
based on child B-3 CTDA scores and child age in months

B-3 CTDA Variable Mean SD Range

_____________________________________________________________________
Language Comprehension .41 .27 .03- 0.98

Language Expression .44 .25 .18- 1.01

Nonverbal Thinking .76 .24 .35- 1.30

Social Personal Behaviors .70 .25 .21- 1.13

Motor Behaviors .82 .14 .51- 1.09

Note: Percent development was calculated by computing B-3 CTDA developmental age scores
per test manual instructions then dividing by each participant’s age in months.
 IPCA

 Parents or primary caregivers completed the Inventory of

Potential Communication Acts (IPCA; Sigafoos et al.,
2002, 2006)- 54 questions addressing ten major
communicative functions:
1) Social convention
2) Attention-to-self
3) Reject/protest
4) Requesting an object
5) Requesting an action
6) Requesting information
7) Comment
8) Choice making
9) Answer
10) Imitation
 IPCA

 Sigafoos J, Arthur-Kelly M, Butterfield N. Inventory of

potential communicative acts. Enhancing everyday
communications for children with disabilities. Baltimore
MD: Paul H. Brookes Publishing Co; 2006.

 Contact directly:
Professor Sigafoos
School of Educational Psychology and Pedagogy
jeff.sigafoos@vuw.ac.nz
 PCA Coding

 Potential communicative act were classified into one

of eight mutually exclusive categories by type:
1. Facial expression
2. Eye gaze
3. Vocalizations
4. Challenging behavior
5. Body movement
6. Stereotyped behavior
7. Imitation
8. Gesture
 Gesture Coding

 To be coded as a gesture, movements must relate to

one of five gesture categories (McNeill, 1992;
Nicoladis et al., 1999):

1. Deictic point
2. Deictic show-me gesture
3. Emblem gesture
4. Manual sign
5. Iconic gesture
 Inter-rater agreement

 Mean percent inter-rater agreement between the two

trained coders was high for classifying reported potential
communicative acts by category type:
100 % (n=4) for facial expression
90% (n=6) for eye gaze
90% (n=11) for vocalizations
95% (n=6) for challenging behavior
97% (n=36) body movement
100% (n=3) for stereotyped behavior
100 % (n=2) for imitation
100% (n=4) for gestures
 Mean proportions

100
90
80
70
60
50
40
30
20
10 Mean proportions of
0 different types of PCA
 Body Movement

 All parents reported that they inferred meaning through

child’s body movement (100%)

 Frequently reported informal motor behaviors included:

1. Child takes another’s hand or arm as if to lead, n=14
2. Child grabs or takes an object, n=14
3. Child moves towards a person, object, or activity, n=14
4. Child moves away from a person, object, or activity, n=13

Varied idiosyncratic motor behaviors, to name a few:

1. Child flips around, n=1
2. Child struggles to get free when held, n=1
3. Child opens mouth, n=1
 For a listing of reported Body Movements

 Braddock, B.A., Pickett, C, Ezzelgot, J., Sheth, S.,

Korte-Stroff, E., Loncke, F., & Bock, L. (2013).
Potential communicative acts in children with
Autism Spectrum Disorders. Developmental
Neurorehabilitation. Published on line ahead of
print
http://www.ncbi.nlm.nih.gov/pubmed/23869845
Relationship between PCA and B-3 CTDA scores

 Number of different types of PCA was related to B-3

CTDA language expression percent development
scores

 Pearson correlation (r= .49, p< .04)

 Children with least impaired expressive language

produced more varied PCA
Relationship between gesture and B-3 CTDA scores

 Significant and positive correlations were found between

number of gesture types and B-3 CTDA language
comprehension (r= .58, p <.01), language expression (r=
.65, p<.005), and nonverbal thinking (r= .48, p <.05)
percent development scores

 No significant correlations were found between number

of body movement types and B-3 CTDA percent
development scores

 Results show that number of body movement types was

not related to child ability, while number of gesture types
was related to receptive and expressive language
 B-3 CTDA Language expressive Subgroups

Number of Gesture types

4
3.56
3.5
3
2.5
2
Number of Gesture types
1.5 1.38

1
0.5
0
Most impaired Least impaired U= 5.5, p<.003
 Percent Use/Gesture Types

Emblem gesture type: Wave 9/17 = 53%

Emblem gesture type: Head shake no 8/17 = 47%

Deictic gesture type: Point 7/17 = 42%

Alternative and augmentative communication: Manual sign more 6/17 = 35%

Deictic gesture type: Show-me gesture 4/17 = 24%

Emblem gesture type: Clap 4/17 = 24%

Emblem gesture type: Head shake yes 3/17 = 18%

Emblem gesture type: Shoulder shrug 1/17 = 6%

Iconic gesture type: Pantomime 1/17 = 6%

 Results

 Consistent with the authors’ initial hypothesis,

number of gesture types was found to be significantly
related to child language ability

 Contrary to the authors’ initial hypothesis, number

of body movement types was not found to be related
to child language ability or child motor ability
 Ecological systems perspective

 Parents responsive to children’s potential

communicative acts as judged in the high rate of
written responses on the IPCA

 Parents were able to attach meaning to children’s

body movement, vocalization, and early gesture in
particular physical and social spaces
 Clinical Implications

 Parents require the support of highly trained interventionists

to scaffold more conventional forms of communication

 To achieve this balance, parents and children must be

supported at multiple levels, to include securing appropriate
medical, educational and therapeutic environments.

 Support at multiple levels must be in place as early as possible

because behavioral intervention has the potential to change
young children’s brain function for improved social
communication in ASD (Dawson et al., 2012)
 EI Intervention

 Early as possible

 Move children into symbolic forms of

communication, such as words, gestures, manual
signs

 Parent training and support

 Highly trained therapists and educators

 Clinical Implications

 Pay attention to potential communicative acts and

gesture
 Parent education and support
 Early developmental screening, and ASD- specific
screening
 Referral for ASD evaluation, hearing evaluation, EI
services
 EI policy and advocacy
 Limitations

 Small sample size

 Analyses were largely correlational

 Parent report data

 Measurement at one time point

 Future directions in the study of PCAs

(1) theoretical impact and further research,

(2) clinical implication - research,
(3) the need to move to big(ger) data.
 Theoretical impact and further research

 Non-linguistic communication as a facilitator or an

alternative
 New research questions
 About the distinction between non-linguistic and
linguistic communication
 Validity research
 Educational and clinical research
 Clinical implications - research,

 PCA concept strikes a balance between an

educational approach and a developmental approach
 Developmental approach: seeks to analyze the
mechanisms that drives a child toward discovering
and applying the communicative power of behaviors
 Educational approach: seeks to identify how the
caregiver can coach behaviors into communicative
acts
 The need to move to big(ger) data

 Existing initiatives (e.g., Communication Matrix)

hold the promise to transcend the limitations of
idiosyncrasy by inviting many contributors
(caregivers, clinician) to make their data valuable

 Online materials
http://www.communicationmatrix.org/
 References

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(Second edition). Austin, TX: Pro-Ed; 2000.
 Braddock, B.A., Pickett, C, Ezzelgot, J., Sheth, S., Korte-Stroff, E., Loncke, F., & Bock, L. (2013).
Potential communicative acts in children with Autism Spectrum Disorders. Developmental
Neurorehabilitation. Published on line http://www.ncbi.nlm.nih.gov/pubmed/23869845
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