More and Less Social Comprehension

Study Overview
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Brief Summary
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The goal of this early Phase 1 clinical trial is to assess if the social content of a story impacts autistic children's listening comprehension of stories. The main questions this study aims to answer are: Does removing social content from a story improve listening comprehension in autistic children? Does listening comprehension of more social versus less social stories differentially predict performance on a standardized reading comprehension measure? Participants will listen to more social and less social stories while viewing accompanying pictures and answer comprehension questions about the stories and complete a standardized assessment of reading comprehension. In addition, participants complete measures of their nonverbal cognition, hearing status, autism severity, language abilities, and social communication abilities to help characterize individual differences in participants.

Detailed Description
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Listening comprehension is an important predictor of later reading comprehension, academic success, health, psychosocial, and vocational outcomes; yet roughly 65% of autistic school-age children have poor comprehension. Non-autistic comprehension of more social (e.g., narrative) texts is better than less social (e.g., expository texts) because non-autistic individuals can bootstrap their real-world social understanding to better understand the text. In contrast, autistic comprehension of less social texts has been shown in a small pilot study to be better than more social texts, which is likely due to their social communication impairments. The Construction-Integration Theory of Comprehension stipulates that a situation model (i.e., a mental representation) is constructed through interactions between child factors (i.e., individual differences in a child's abilities) and text factors (i.e., individual differences across texts). Both linguistic child factors (e.g., vocabulary and morphosyntax) and social child factors (e.g., social communication and theory of mind) predict reading comprehension in autistic children. However, these factors have not been examined for listening comprehension in autistic children and have only been examined for more social texts. Text factors (e.g., word concreteness and narrativity) impact comprehension in non-autistic individuals but have all but been ignored for autistic individuals. The goal of this study is to examine how social information in texts impacts listening comprehension of stories in 9- to 12-year-old autistic children. Further, how listening comprehension of more or less social stories predicts reading comprehension on a standardized reading comprehension measure will also be assessed. In addition, individual differences in cognition, language, and social communication will be evaluated to determine how individual differences across children impacts comprehension and may predict response to intervention in future studies. The primary hypothesis is that stories with less social content (i.e, less social texts) will improve comprehension in autistic children compared to stories with more social content (i.e., more social texts). The secondary hypothesis is that comprehension or more social stories will better predict reading comprehension performance because these measures tend to include stories with more social information. In addition, both child and text factors impact comprehension and that social and linguistic child and text factors differentially contribute, depending on the content of the text. That is, the linguistic factors will predict comprehension across text type whereas the social factors will specifically predict comprehension of more social texts. The proposed project lays the methodological and empirical groundwork for using a precision medicine approach to identify and manipulate child and text factors for novel, effective comprehension interventions for autistic individuals. After completing eligibility, participants will complete an experimental measure, the Socialness Story Task, that measures children's comprehension of more social and less social stories. Participants will also complete a standardized test of reading comprehension. In addition, participants will complete various experimental and standardized tests of nonverbal cognition, hearing status, autism severity, language, and social communication to assess individual differences. Participants complete all measures across two, 2.5 hour sessions.

Official Title
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More and Less Social Comprehension: Child and Text Factors for Autistic Children

Conditions
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Autism Spectrum Disorder

Intervention / Treatment
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* Behavioral: More Social Stories
* Behavioral: Less Social Stories


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Has a community or educational autism diagnosis (based on parent report); Is between the ages of 9;0 to 12;11 (years; months); Uses verbal phrase-level spoken language (based on parent report). Exclusion Criteria: Speaks more than one language (based on parent report); Has a known chromosomal abnormality (e.g., Fragile X syndrome, Down syndrome; based on parent report); Has an intellectual impairment or cognitive disability (IQ < 70; based on parent report); Has Cerebral palsy (based on parent report); Uncorrected visual impairments (based on parent report); Minimal spoken language or no phrase spoken language (based on parent report or clinical observation).

Ages Eligible for Study
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Minimum Age: 9 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Intervention Model: Single Group Assignment
Interventional Model Description: A within-subjects design is used where participants complete both treatments: listening to more social stories and less social stories.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: More and Less Social Comprehension<br>Participants listen to more social and less social comprehension stories and answer comprehension questions about the stories. | Behavioral: More Social Stories<br>* Children listen to four stories while looking at accompanying images that contain more social information (e.g., characters referencing, dialogue, mental and emotional state words, and narrativity) as measured by a text analysis.<br>Behavioral: Less Social Stories<br>* Children listen to four stories while looking at accompanying images that contain less social information (e.g., characters referencing, dialogue, mental and emotional state words, and narrativity) as measured by a text analysis.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percent of correct comprehension questions for more social stories at baseline | The Socialness Story Comprehension Task assesses listening comprehension of more and less social stories. Participants listen to stories while looking at picture scenes and then answer three open-ended comprehension questions about each story. The participant is presented with two practice stories first, and then eight main stories. One practice story and four of the main stories are more social. Comprehension questions are scored as correct or incorrect. Participant scores may range from 0% (0 comprehension questions correct) to 100% (all 12 comprehension question correct). Higher scores are indicative of better comprehension of more social stories. | Baseline | 
| Percent of correct comprehension questions for less social stories at baseline | The Socialness Story Comprehension Task assesses listening comprehension of more and less social stories. Participants listen to stories while looking at picture scenes and then answer three open-ended comprehension questions about each story. The participant is presented with two practice stories first, and then eight main stories. One practice story and four of the main stories are less social. Comprehension questions are scored as correct or incorrect. Participant scores may range from 0% (0 comprehension questions correct) to 100% (all 12 comprehension question correct). Higher scores are indicative of better comprehension of less social stories. | Baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Reading comprehension as measured by the Gray Oral Reading Test, Fifth Edition (GORT-5) at baseline | The Gray Oral Reading Test, Fifth Edition (GORT-5) is a standardized assessment that measures children's reading comprehension. The GORT-5 consists of up to16 stories that children read aloud and then answer comprehension questions about. Scaled scores for the comprehension score indicate very poor (scores between 1 to 3), poor (scores between 4 to 5), below average (scores between 6 to 7), average (scores between 8-12), above average (scores between 13 to 14), superior (scores between 15 to 16), and very superior (scores between 17 to 20) performance. Higher scores indicate better reading comprehension. | Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Autism, Social Communication, Listening Comprehension, Reading Comprehension, Language, Individual Differences