(also called "classic" autism) This is what most people think of when hearing the word "autism." People with autistic disorder usually have significant language delays, social and communication challenges, and unusual behaviors and interests. Many people with autistic disorder also have intellectual disability.

•  Knowledge of how to use language to achieve goals (e.g. appropriately using language to get a desired object, )

Prevalence and Prognosis:

The reported prevalence of language delay in children two to seven years of age ranges from 2.3 to 19 percent(15-19). Severe speech and language disorders in young children can negatively affect later educational achievement, even after intensive intervention (20). Several studies have shown that children with speech and language problems at two and a half to five years of age have increased difficulty reading in the elementary school years (21-23). Children in whom speech and language impairments persist past five and a half years of age have an increased incidence of attention and social difficulties (24). Children with specific speech and language impairments at seven and a half to 13 years of age have been shown to have impaired writing skills, with marked deficits in spelling and punctuation compared with children without speech and language impairments (25). The likelihood of persistent difficulties for young children with speech and language problems appears to be directly related to the range of language functions that are impaired, with the best prognosis for children who have a developmental speech delay (26).

Diagnosing this disorder:

Speech language pathologists diagnose this disorder.  When children exhibit language skills below what is expected for their age, developmental disorders are often suspected by the child’s parent, pediatrician or teacher. The child is then referred to the speech-language pathologist who will conduct a full diagnostic evaluation of the child’s receptive and expressive language skills, using standardized tests and informal measures. The speech-language pathologist will also evaluate other measures of communication to rule out other issues. The child’s vision and hearing must be screened prior to testing as well to achieve valid test results. Children exposed to multiple languages should be screened in all languages and tested in their primary language. This multilingual assessment framework is referred to as a “difference vs. disorder” approach.  Assessment data is obtained in all languages of exposure. Any noted errors or differences in communication skills are then analyzed and assigned to three main categories:  1- errors appropriate for the child’s age (developmental errors); 2- errors attributed to the interaction between the two languages spoken (cross-linguistic influence); and 3- atypical errors.

Receptive language disorder is diagnosed when an individual does not demonstrate the ability to comprehend age-appropropriate vocabulary, follow instructions or understand foundational communication skills such as turn-taking and perspective-taking during conversation. Careful diagnosis is important to distinguish receptive language disorder from other communication disorders and other diagnoses such as intellectual disability, autism and/or other physical and developmental problems which may first manifest as language problems.

Treatment:

Individuals benefit from a regular schedule of speech therapy with a speech-language pathologist. Parent and teacher involvement in the use of strategies learned in therapy provides maximum benefit.  Treatment for a receptive language disorder is tailored to each child’s needs (27-30).

 Materials and Method

 This study was a causal-comparative that including 30 children in ages 2 to 8 years old ( 15 girls and 15 boys) with ASD, who elected by random sampling. Tests used in this study was Childhood Autism Rating Scale (CARS) and Newsha test.

The diagnosis was made by a child psychiatrist based on DSM-IV-TR criteria and using Autism Diagnostic Interview-Revised (ADIR) and Autism Diagnostic Observation Schedule (ADOS). All children  were trained Rehabilitation Center. In this research, Autism Rating Scale, Childhood Autism Rating Scale was(CARS) used to assess the severity of symptoms in children. The CARS is a behavior rating scale that is utilized to assess symptoms of Autistic Disorder. In addition, it is able to differentiate children with Autistic Disorder from other developmental delays. It is conducted as an observation which can be completed during a testing session or in classrooms. However, some items can be answered from parent report or from reports of history. The CARS contains 15 items that are utilized to compare the behavior of the child being assessed to the behavior of typically developing children. The 15 items include: (1) relating to people, (2) imitation, (3) emotional response, (4) body use, (5) object use, (6) adaptation to change, (7) visual response, (8) listening response, (9) taste, smell, and touch response and use, (10) fear or nervousness, (11) verbal communication, (12) nonverbal communication, (13) activity level, (14) level and consistency of intellectual response, and (15) general impressions. Each item is rated on a Likert scale as follows: 1 (within normal limits for a child that age), 2 (mildly abnormal), 3 (moderately abnormal), and 4 (severely abnormal). Midpoints between these values can also be utilized (e.g., 2.5). A total score is computed from the sum of the 15 items. Those with a total score of 30 or above fall within the autistic range (yields an agreement rate of 87%). Psychometric studies on the CARS yield promising results with an internal consistency of α = .94, interrater reliability average of .71 (good agreement), and coefficient kappa of .64 for test retest reliability. In regards to validity, there was high criterion related validity, r = .84 ( Schopler et al., 1988). This scale (CARS) can be completed by a clinician or teacher or parent, based on subjective observations of the child's behavior. Each of the fifteen criteria listed above is rated with a 7-point score. Lower scores indicate less severity of Autism. Total CARS score indicates total score of severity about Autism Spectrum Disorders(ASD) (30-32).

After reviewing the CARS scors, to collect samples of children's speech  and evaluation of them through Newsha test. The Newsha test that assess the development of language skills, motor and social skills of child at age thirteen measures from birth. This test is currently one of the valid scale for measuring growth in persian children and is a clear criteria for evaluating children's growth. By performing this test, we can judge  about various aspects of child ‘s growth.

 According to this subject  that  this test is a norm-reference test, by executing it on Persian Language children with developmental delay can be charted child's progress in his treatment program. In this study in order to use Newsha test, the three subtests: evaluation of expressive language, receptive language and cognitive in children with autism  is used. Each developmental skills in the age range 16 to 18 months (level 6); age range of  19 to 24 months (level 7); age range of 25 to 30 months (level 8); age range of 31 to 36 months (level 9); age range of 37 to 42 months (level 10); age range  of 43 to 48 months (level 11); age range of 49 to 60 months (level 12) and  age range of  61 months  and higher (level 13) examined. To better understand the problems of each of the subjects, first was conducted  (CARS) test, then the disorder in each of the language skills was detected with use subtests of expressive language, receptive language and cognitive’s Newsh.

Results:

To obtain the amount of impairment  the subjects in each group,   was performed to determine the mean, variance , standard deviation and  t-test. In this study, 15 girls and 15 boys participated. (Tables.1,2) shown the mean, standard deviation and other statistical calculations relating to the understanding and use of research subjects of receptive language skills and  expressive language in normal children and autistic children.

Table.1: Statistical calculations in autistic children

                             Table.2: Statistical calculations in normal children

 In (Figures.1,2,3)  shown differents  the standard scores of normal children and scores of autistic children. Figures showed scores of autistic children is lower than the normal children.

 Discusion:

Speech and language delay in children is associated with increased difficulty with reading, writing, attention, and socialization. Although physicians should be alert to parental concerns and to whether children are meeting expected developmental milestones, there currently is insufficient evidence to recommend for or against routine use of formal screening instruments in primary care to detect speech and language delay. In children not meeting the expected milestones for speech and language, a comprehensive developmental evaluation is essential, because atypical language development can be a secondary characteristic of other physical and developmental problems that may first manifest as language problems. Types of primary speech and language delay include developmental speech and language delay, expressive language disorder, and receptive language disorder. Secondary speech and language delays are attributable to another condition such as hearing loss, intellectual disability, autism spectrum disorder, physical speech problems, or selective mutism. When speech and language delay is suspected, the primary care physician should discuss this concern with the parents and recommend referral to a speech-language pathologist and an audiologist. There is good evidence that speech-language therapy is helpful, particularly for children with expressive language disorder.

 Conclusion:

Children with autism have significant disturbance in understanding and use of  receptive language and expressive language skills. The overall results of this study showed that  the inability of autistic children the use of language skills has a significant defect.

 Conflict of Interest

The authors declare that they have no competing interests.

 Acknowledgment
  The authors  would like to thank the  children, mothers and personels who help them, in this study.