Pragmatic Language in Children and Adolescents With Autism Spectrum Disorder: Do Theory of Mind and Executive Functions Have a Mediating Role?

High neural noise in autism: A hypothesis currently at the nexus of explanatory power

Autism is a neurodevelopmental difference associated with specific autistic experiences and characteristics. Early models such as Weak Central Coherence and Enhanced Perceptual Functioning have tried to capture complex autistic behaviours in a single framework, however, these models lacked a neurobiological explanation. Conversely, current neurobiological theories of autism at the cellular and network levels suggest excitation/inhibition imbalances lead to high neural noise (or, a 'noisy brain') but lack a thorough explanation of how autistic behaviours occur. Critically, around 15 years ago, it was proposed that high neural noise in autism produced a stochastic resonance (SR) effect, a phenomenon where optimal amounts of noise improve signal quality. High neural noise can thus capture both the enhanced (through SR) and reduced performance observed in autistic individuals during certain tasks. Here, we provide a review and perspective that positions the "high neural noise" hypothesis in autism as best placed to provide research direction and impetus. Emphasis is placed on evidence for SR in autism, as this promising prediction has not yet been reviewed in the literature. Using this updated approach towards autism, we can explain a spectrum of autistic experiences all through a neurobiological lens. This approach can further aid in developing specific support or services for autism.

Browsing problematic social media use in autism spectrum disorder: The role of social anxiety

Accessing the Internet is one of the most frequent free-time activities among autistic and non-autistic adolescents. Autistic individuals may experience communicative benefits from using the Internet. However, they may also be at risk of developing Problematic Social Media Use (PSMU). To date, PSMU in autistic adolescents remains underinvestigated, and no research has analyzed the role of emotional correlates. The present study aims to investigate possible differences in terms of PSMU comparing autistic participants to their non-autistic peers, and examine the role of two dimensions of social anxiety (i.e., humiliation/refusal and performance anxiety) as reported by both children and parents in worsening the levels of PSMU. A total of 183 participants (76 on the autism spectrum), aged (8-17 years) participated in the study. Questionnaires on social media use and on social anxiety were administered. Moreover, parents of the participants were asked to complete a questionnaire related to their children's social anxiety. Results showed similar levels of PSMU across the two groups. However, a different pattern of relationships between PSMU and age, and the two dimensions of social anxiety was observed in autistic adolescents as compared to the non-autistic peers, revealing that individual characteristics and specific social anxiety beliefs might be relevant to understanding PSMU in autism. The clinical and preventive implications of these findings are discussed.

A Comprehensive Investigation of Social Anxiety and Social Evaluative Stress in Autistic Children and Adolescents and Specific Learning Disorders

The aim was to investigate trait social anxiety and social evaluative stress in autistic children and adolescents and Specific Learning Disorders (SLD). This was done by evaluating behavioral, subjective, and autonomic responses to the Trier Social Stress Test (TSST). Study 1 included 280 children and adolescents: 60 autistic without intellectual disability (ID), 70 SLD, and 150 non-diagnosed (ND) peers. Study 2 involved 55 participants: 15 autistic without ID, 15 SLD, and 20 ND. The sample was predominantly male. In Study 1, behavioral (quality of public speech) and subjective (valence, arousal, perceived competence, and worries) aspects of social stress were examined. Study 2 expands upon the first study, as physiological responses to social stress were also measured. Trait social anxiety was investigated using both parents' and children's reports in the two studies. Parents of autistic participants and with SLD reported higher trait social anxiety in their children than the parents of ND. No differences emerged from the participants' self-reports, though those autistic and with SLD were assigned lower scores in the public speech quality than ND. Autistic children and adolescents reported lower arousal and higher perceived competence than ND, while those with SLD reported a lower perception of competence. Autistic participants had a decreased cardiac reactivity across the TSST when compared to SLD and ND. Our findings show unique patterns of responses within each group, confirming that the combined investigation of trait anxiety and social stress responses could be a valuable insight in research and clinical practice.

Metaphor comprehension and production in verbally able children with Autism Spectrum Disorder

Research in the field of figurative language processing in Autism Spectrum Disorders (ASD) has demonstrated that autistic individuals experience systematic difficulties in the comprehension of different types of metaphors. However, there is scarce evidence regarding metaphor production skills in ASD. Importantly, the exact source of metaphor processing difficulties in ASD remains largely controversial. The debate has mainly focused on the mediating role of structural language skills (i.e., lexical knowledge) and cognitive abilities (i.e., Theory of Mind and executive functions) in ASD individuals' ability to comprehend and generate metaphors. The present study examines metaphor comprehension and production in 18 Greek-speaking verbally able children with ASD and 31 typically-developing (TD) controls. Participants completed two tasks, namely, a low-verbal multiple-choice sentence-picture matching task that tested their ability to comprehend conventional predicate metaphors, and a sentence continuation task that assessed their ability to generate metaphors. The study also included measures of fluid intelligence, expressive vocabulary, and working memory within the sample. The results show that the ASD group had significantly lower performance than the TD group in both metaphor comprehension and production. The findings also reveal that expressive vocabulary skills were a key factor in the metaphor comprehension and production performance of the children with ASD. Working memory capacity was also found to correlate significantly with metaphor comprehension performance in the ASD group. Conversely, no correlations were found in the TD group with neither of the above factors. Of note, children with ASD generated significantly more inappropriate responses and no-responses to the metaphor production task compared with the control group. The overall results reveal that children with ASD had difficulty with both comprehending and using metaphorical language. The findings also indicate that TD children may employ diverse cognitive strategies or rely on different underlying skills when processing metaphors compared with children with ASD.

Comprehension of Spatial Demonstratives in Mandarin-speaking Children on the Autism Spectrum: The Roles of Theory of Mind and Executive Function

The present study aimed to examine whether Mandarin-speaking children on the autism spectrum showed differences in comprehending spatial demonstratives ("this" and "that", and "here" and "there"), as compared to typically developing (TD) children. Another aim of this study was to investigate the roles of theory of mind (ToM) and executive functions (EF) in the comprehension of spatial demonstratives. Twenty-seven autistic children (mean age 6.86) and 27 receptive-vocabulary-matched TD children (mean age 5.82) were recruited. Demonstrative comprehension was assessed based on participants' ability to place objects in certain locations according to experimenters' instructions which involved these demonstratives in three different conditions (same-, opposite-, and spectator-perspective conditions). Four false-belief tasks were administered to measure ToM, and the word-span task and the dimensional change card sort task were used to measure two subcomponents of EF - working memory and mental flexibility - respectively. Children on the autism spectrum were found to score below TD children in the comprehension of spatial demonstratives. In addition, the results showed that ToM and working memory were conducive to the correct interpretation of spatial demonstratives. The two cognitive abilities mutually influenced their respective roles in spatial demonstrative comprehension in the three different conditions. The findings suggest that the comprehension of spatial demonstratives comprehension is an area of need in Mandarin-speaking children on the autism spectrum, and it might be linked to their differences in cognitive abilities.

Variability of theory of mind versus pragmatic ability in typical and atypical development

INTRODUCTION

Numerous studies have linked deficits in Theory of Mind (ToM) with language problems. We aimed to explore the similarities and differences between children's patterns of performance on a ToM task that requires minimal linguistic skill and a pragmatic inference task that relies on both ToM and language. We assessed variability in pragmatic inference skills and ToM across populations of children (8-14 years) displaying varying cognitive profiles. We further compared the sensitivity of ToM versus pragmatic ability to core language skills, memory and executive functioning (EF).

METHOD

ToM was tested using the Social Attribution Task (SAT-MC-II). Pragmatic ability was assessed in an implicature comprehension task. Receptive vocabulary, grammar comprehension, short-term and working memory (STM and WM) capacity and EF were measured using Hungarian adaptations of standard tasks and tests developed by the authors' lab. In addition to typically developing (TD) children (n = 33), we included children with neurodevelopmental disorders where ToM and/or language abilities are vulnerable: autism spectrum disorder (ASD, n = 26), attention deficit hyperactivity disorder (ADHD, n = 25) and developmental language disorder (DLD, n = 18).

RESULTS

Results revealed a significant but only moderate positive correlation between pragmatic inference and ToM indicating that the two abilities are related but distinct. The ASD group showed impairments in both ToM and pragmatic inference ability but no significant deficit was observed in ADHD or DLD relative to TD children in either skill. However, while SAT-MC-II results were only affected by verbal WM and vocabulary measures, pragmatic performance was associated with STM, verbal WM, EF, grammatical skills and vocabulary.

CONCLUSION

Our findings indicate that disentangling the contributions of different cognitive skills to ToM tasks may help clarify the role of ToM in language skills and identify distinct patterns of ToM and pragmatic skills in developmental disorders.

Involvement of Executive Functions in Idiom Comprehension: A Life-Span Perspective

Objectives-Our aim is to investigate the executive functions involved in idiom comprehension. The understanding of idioms has largely been explored from a developmental perspective. However, little is known about the cognitive processes involved. Recent studies highlight the contributions of working memory and inhibitory control in idiom processing. We investigated executive functions' implication in idiom comprehension from a life-span perspective. Methods-The participants of this study were aged from 6 years to adulthood (n = 109 participants). An idiom comprehension task and executive tests were administered. Results and Conclusions-The results indicated that idiom comprehension improved across all the age groups tested. Moreover, the involvement of inhibition and cognitive flexibility processes was specific at different ages and particularly involved during adolescence.

Defining the Characteristics of Story Production of Autistic Children: A Multilevel Analysis

Several studies suggest that a valuable tool to examine linguistic skills in communication disorders is offered by procedures of narrative discourse assessment. Following this line of research, we present an exploratory study aimed to investigate storytelling abilities of autistic children to better define the characteristics of their story production. Participants included 41 autistic children and 41 children with typical development aged between 7.02 and 11.03 years matched on age, gender, level of formal education, intelligence quotient, working memory, attention skills, theory of mind, and phonological short-term memory. Narrative production was assessed by analysing the language samples obtained through the "Nest Story" description task. A multilevel analysis including micro- and macro-linguistic variables was adopted for narrative assessment. Group differences emerged on both micro- and macro-linguistic dimensions: autistic children produced narratives with more phonological errors and semantic paraphasias (microlinguistic variables) as well as more errors of global coherence and a fewer number of visible events and inferred events (macrolinguistic variables) than the control group.This study shows that even autistic children with adequate cognitive skills display several limitations in their narrative competence and that such weaknesses affect both micro- and macrolinguistic aspects of story production.

Uh and um in autism: The case of hesitation marker usage in Dutch-speaking autistic preschoolers

English-speaking autistic children use the hesitation marker um less often than non-autistic children but use uh at a similar rate. It is unclear why this is the case. We employed a sample of Dutch-speaking children from the Preschool Brain Imaging and Behavior Project to examine hesitation markers in autistic and non-autistic preschoolers with the aim to 1) make a crosslinguistic comparison of hesitation marker usage and 2) examine hypotheses regarding the underlying linguistic mechanisms of hesitation markers: the symptom hypothesis and the signal hypothesis. We found initial group differences in all hesitation markers but these results were rendered insignificant after controlling for age, sex and nonverbal cognition. We found significant correlations between hesitation marker usage and expressive and receptive language, but not autism traits. Lastly, we show interesting cross-linguistic differences in hesitation marker usage between Dutch-speaking participants and previously described English-speaking participants, such as a preference for um over uh.

Disfluencies as a Window into Pragmatic Skills in Russian-Hebrew Bilingual Autistic and Non-Autistic Children

There is little research on the production of speech disfluencies such as silent pauses, repetitions, self-corrections, and filled pauses (e.g., eh, em) in monolingual autistic children, and there is no data on this crucial part of speech production in bilingual autistic children. This study aims to address this gap by examining disfluency production in bilingual autistic and non-autistic children across two linguistically distinct languages, HL-Russian (the home language) and SL-Hebrew (the societal language). Fifty-one bilingual Russian-Hebrew-speaking autistic and non-autistic children aged 5-9 (autistic: n = 21; non-autistic: n = 30), matched for age and non-verbal intelligence, participated in picture-based story-generation tasks (LITMUS MAIN, Gagarina et al., ZAS Papers in Linguistics, 63:1-36, 2019). Audio recordings of narrative samples were transcribed, coded, and scored for eleven disfluency types using CLAN tools. The non-autistic group produced higher overall disfluency rate than the autistic group. The autistic group exhibited fewer filled and silent pauses than the non-autistic group in HL-Russian. Furthermore, non-autistic children manifested varied distribution of disfluency types across languages, while autistic children displayed more consistent patterns across languages. In summary, we replicated findings from previous research on monolinguals only partly, as no between-group difference in filled pauses was found in SL-Hebrew. Additionally, bilingual autistic children exhibited language-universal patterns of disfluency production, whereas their non-autistic peers displayed language-specific patterns.

How language affects social cognition and emotional competence in typical and atypical development: A systematic review

BACKGROUND

The ability to understand the mental state of others (social cognition), as well as language, is crucial for children to have good social adaptation. Social cognition (SC) has been shown to be a hierarchical model of three factors (Cognitive, intermediate and affective SC) interrelated with linguistic processes. Children on the autism spectrum and children with developmental language disorder (DLD) or social communication disorder (SCD) manifest language and SC difficulties, albeit in different ways.

AIMS

This systematic review aims to find how language and SC interact with each other and identify linguistic and socio-affective profiles in the target population.

METHODS

About 1593 articles were systematically reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide in November 2022, obtaining, through inclusion/exclusion criteria, a total of 38 articles for qualitative assessment. The majority of them were on autism (26) or DLD (14) and to a lesser extent SCD (3).

MAIN CONTRIBUTION

Although SC is related to all components of language, SC is strongly related to narrative and morphosyntax and partially related to lexicon. Pragmatics shows a complex relation with SC due to greater sensitivity to other factors such as age or task, and prosody appears to be more related to emotional processes. Besides, autistic, SCD and DLD children showed differences in their language and socio-affective performance. Mainstream DLD children have lower performance in general language, where autistic and SCD children have more linguistic variation and are lower in pragmatic and SC tasks, SCD children being more associated with language production difficulties and autistic children with both receptive and productive language.

CONCLUSION

Each language component has a different interaction with SC. Likewise, different linguistic profiles are partially found for each disorder. These results are important for future lines of research focusing on specific components of interaction and socio-emotional processes, as well as for clinical and educational treatment.

WHAT THIS PAPER ADDS

What is already known on the subject The hierarchical model of Schurz et al. (2021), divide social cognition into three brain constructs: cognitive social cognition (CSC), affective social cognition (ASC) and intermediate social cognition (ISC). They observe a large relationship between language and ISC, a fact that has been corroborated with some other studies. Studies have also found lower linguistic and socio-affective abilities in children with autism and language and communication disorders compared with children with neurotypical development, and large behavioural and neurocognitive overlaps between these disorders (Durrleman et al., 2019; Löytömäki et al., 2019). What this paper adds to existing knowledge This is the first review that relates all linguistic components (narrative, lexicon, morphosyntax, pragmatic and prosody) with the three constructs of social cognition (Cognitive, intermediate and affective). Moreover, it is the first review that studies the socio-linguistic factors comparing autism, developmental language disorder and social communication disorder with each other and with neurotypical development in children aged from 4 to 9 years. What are the potential or actual clinical implications of this work? Understanding how language and social cognition interact with each other in autism spectrum disorder, developmental language disorder and social communication disorder allows us to trace socio-linguistic profiles for each of the studied disorders, understand better children with these difficulties, and, with this, find specific potential intervention points to improve and prevent these difficulties.

Social Functioning in Children and Adolescents with ADHD and Autism Spectrum Disorder: A Cross-Disorder Comparison

OBJECTIVE

Social functioning can be defined according to three main components: social perception, social performance, and social knowledge. Although they are important in daily life relationships and in children's adaptation, these components have never been tested together in children and adolescents with Attention Deficit/Hyperactivity Disorder (ADHD) or with Autism Spectrum Disorder (ASD) using lab-based tasks. The present study used a cross-disorder approach to compare the performance of children with ADHD and ASD and non-diagnosed (ND) peers utilizing a task that involves these three fundamental social functioning components.

METHODS

Two hundred and twenty-five Italian children (86% boys) aged between 8 and 16 (66 with a clinical diagnosis of ADHD; 51 with a clinical diagnosis of ASD, level 1; 108 ND children) were enrolled. The three groups were matched for age, gender, and IQ. Social functioning was assessed using a lab-based task, including videos of problematic interactions among peers, created ad hoc for the study, and a semi-structured interview based on the Social Information Processing model.

RESULTS

Data were analyzed using one-way ANOVAs and multinomial mixed effects models. Our findings suggested that both groups with ADHD and ASD presented social functioning difficulties in comparison to ND children. However, a different pattern of performance emerged. Children with ADHD showed higher difficulties in social performance than those with ASD, whereas autistic children revealed more difficulties in social perception and in some aspects of social knowledge.

CONCLUSIONS

Our findings have important clinical implications for assessment, intervention, and differential diagnosis, and should encourage clinicians to investigate different aspects of social functioning and identify specific strengths and weaknesses in each social profile.

Figurative language processing in autism spectrum disorders: A review

Impairments in the broader domain of pragmatics are considered to be a defining feature of Autism Spectrum Disorders (ASD). A challenging aspect of pragmatic competence is the ability to process nonliteral language. Interestingly, previous studies in figurative language comprehension in ASD have demonstrated conflicting results regarding participants' performance. The main scientific debate focuses on the underlying skills which facilitate processing of nonliteral speech in ASD. Namely, Theory of Mind (ToM), language abilities and Executive functions (EFs) are regarded as factors affecting autistic individuals' performance. This review addresses figurative language comprehension in ASD in light of the above three interpretive accounts. We reviewed data from recent studies in this field concluding that autistic children indeed encounter systematic difficulties in the processing of non-literal language. Moreover, only ToM and verbal skills were found to correlate the most with figurative language comprehension in ASD. Notably, we found that differences related to research methodology and tasks' properties may have led to discrepancies between studies' results. Finally, we argue that future studies should encompass in their experimental design figurative comprehension tasks with minimal linguistic demands and also measures of ToM, verbal ability and EFs in order to shed more light in the independent contribution of those skills to the processing of nonliteral language in ASD.

Let's face it! The role of social anxiety and executive functions in recognizing others' emotions from faces: Evidence from autism and specific learning disorders

Youth with different developmental disorders might experience challenges when dealing with facial emotion recognition (FER). By comparing FER and related emotional and cognitive factors across developmental disorders, researchers can gain a better understanding of challenges and strengths associated with each condition. The aim of the present study was to investigate how social anxiety and executive functioning might underlie FER in youth with and without autism spectrum disorders (ASD) and specific learning disorders (SLD). The study involved 263 children and adolescents between 8 and 16 years old divided into three groups matched for age, sex, and IQ: 60 (52 M) with ASD without intellectual disability, 63 (44 M) with SLD, and 140 (105 M) non-diagnosed. Participants completed an FER test, three executive functions' tasks (inhibition, updating, and set-shifting), and parents filled in a questionnaire reporting their children's social anxiety. Our results suggest that better FER was consistent with higher social anxiety and better updating skills in ASD, while with lower social anxiety in SLD. Clinical practice should focus on coping strategies in autistic youth who could feel anxiety when facing social cues, and on self-efficacy and social worries in SLD. Executive functioning should also be addressed to support social learning in autism.

Sleep problems in children with autism spectrum disorder and attention-deficit/hyperactivity disorder: A comparative study and effects on communication skills

Sleep disturbances are highly prevalent among children with neurodevelopmental disorders, like Autism Spectrum Disorder (ASD) and Attention-Deficit/Hiperactivity Disorder (ADHD). The first objective of this study is to examine the differences in sleep problems between a group of children with ASD without intellectual disabilities, a group with ADHD and a typically developing (TD) group. A second objective is aimed at analyzing the effects of sleep problems and symptom severity on their communication skills. Participants were 122 children between 7 and 12 years old distributed in three groups: 32 TD children, 47 children with ASD and 43 children with ADHD, matched on age and intelligence. Parents completed different questionnaires that measured sleep disturbances and communication skills. Findings show significant differences between the clinical groups and the TD group in most types of sleep disorders. Moreover, the group with ADHD showed significantly more sleep breathing disorders and hyperhidrosis in comparison with ASD and TD, as well as more total sleep problems. In contrast to ASD, the predictive power of sleep problems on communication difficulties was greater in the group with ADHD. The results of the mediation analysis indicate that in both groups, sleep problems partially mediate the relationship between symptoms and communication. This investigation highlights the need of considering sleep disorders when assessing communication skills in ASD and ADHD, given its indirect influence in this domain. Understanding the sleep dysfunctions of both conditions and their repercussions is crucial to develop adjusted interventions.

Can Enactment and Motor Imagery Improve Working Memory for Instructions in Children with Autism Spectrum Disorder and Children with Intellectual Disability?

This study explored the impacts of enactment and motor imagery on working memory for instructions in children with autism spectrum disorder (ASD), children with intellectual disability (ID) and typically developing (TD) children. The participants were asked to hear (hearing condition), imagine enacting (motor imagery condition) and actually enact (enactment condition) instruction sequences and then recall them orally. Compared with the hearing condition, all groups performed better in the enactment condition, with the greatest advantage exhibited by the TD group; however, only the TD children performed better in the motor imagery condition. In summary, enactment has a weaker facilitating effect on ASD children and ID children than on TD children, and motor imagery is ineffective in the former two groups.

The fuzzy boundaries of the social (pragmatic) communication disorder (SPCD): Why the picture is still so confusing?

Introduction

Since the introduction of Social (Pragmatic) Communication Disorder (SPCD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) in 2013, a debate has arisen in the scientific community about its usefulness in differential diagnosis for other clinical categories such as Autism Spectrum Disorder (ASD) and Specific Language Impairment (SLI). Indeed, SPCD criteria share a common deficit in communication and pragmatic skills with these diagnostic entities. Available assessment tools seem scarce and not sensitive enough to clarify diagnostic criteria and clinical boundaries. This study aims to review the existing literature on diagnostic screening for SPCD to highlight confounding variables in the domains examined, overlap with other diagnostic entities, and lack of specificity of available assessment tools in identifying the core deficits of the disorder.

Methods

The search strategy was defined by combining the following keywords: "social pragmatic communication disorder," "DSM-5," "differential diagnosis," and "child." The search was performed in three databases: Medline (PubMed), Scopus, and Web of Science. All studies published between 2013 and April 2023, written in English, and with a major focus on SPCD were included in the review.

Results

After the screening for the eligibility, 18 studies were included in the review. Most of these studies aimed to investigate the differential diagnosis between SPCD and other diagnostic categories (e.g., specific language impairment and autism spectrum disorder). Of these researches, only 6 were ad hoc experimental studies, while the others were based on previously collected databases.

Conclusions

SPCD seems to have its own peculiarities and characteristics, indicating its clinical relevance, as emphasized by the DSM-5. However, the lack of specific instruments and a number of confounding variables make it difficult to identify and differentiate SPCD from other diagnostic entities. Further research is needed to overcome the lack of specific clinical instruments and lack of empirical studies.

Non-literal language processing is jointly supported by the language and theory of mind networks: Evidence from a novel meta-analytic fMRI approach

Going beyond the literal meaning of language is key to communicative success. However, the mechanisms that support non-literal inferences remain debated. Using a novel meta-analytic approach, we evaluate the contribution of linguistic, social-cognitive, and executive mechanisms to non-literal interpretation. We identified 74 fMRI experiments (n = 1,430 participants) from 2001 to 2021 that contrasted non-literal language comprehension with a literal control condition, spanning ten phenomena (e.g., metaphor, irony, indirect speech). Applying the activation likelihood estimation approach to the 825 activation peaks yielded six left-lateralized clusters. We then evaluated the locations of both the individual-study peaks and the clusters against probabilistic functional atlases (cf. anatomical locations, as is typically done) for three candidate brain networks-the language-selective network (Fedorenko, Behr, & Kanwisher, 2011), which supports language processing, the Theory of Mind (ToM) network (Saxe & Kanwisher, 2003), which supports social inferences, and the domain-general Multiple-Demand (MD) network (Duncan, 2010), which supports executive control. These atlases were created by overlaying individual activation maps of participants who performed robust and extensively validated 'localizer' tasks that selectively target each network in question (n = 806 for language; n = 198 for ToM; n = 691 for MD). We found that both the individual-study peaks and the ALE clusters fell primarily within the language network and the ToM network. These results suggest that non-literal processing is supported by both i) mechanisms that process literal linguistic meaning, and ii) mechanisms that support general social inference. They thus undermine a strong divide between literal and non-literal aspects of language and challenge the claim that non-literal processing requires additional executive resources.

Social perception in children and adolescents with ADHD: The role of higher-order cognitive skills

Despite children with ADHD frequently experiencing difficulties in social perception, the mechanisms underlying this impairment have been poorly explored. In this study, we examined social perception in children with ADHD, comparing them with typically-developing (TD) children on semi-naturalistic tasks, and considering the effect of nonverbal signal recognition. Our aim was to ascertain whether the two groups' social perception related to different types of stimulus (video, audio or combined/multimodal). The role of three higher-order cognitive skills (theory of mind, attention and pragmatic language) was also investigated. Thirty-six children with ADHD, and 36 TD controls were tested. Social perception was significantly associated with participants' ability to recognize nonverbal signals, and with the stimulus presentation modality. Children with ADHD only performed less well than TD children with combined stimuli. As concerns the higher-order cognitive skills, theory of mind had a significant role in both groups, but only with the video and combined stimuli, while attention explained most of the variance in social perception for all types of stimulus. Better pragmatic language skills were only associated with a better social perception in TD children, whatever the type of stimulus presented. Semi-naturalistic tasks should be included when assessing social perception in ADHD, and both theory of mind and attention should be the object of efforts to enhance social perception in the ADHD population.

Language in autism: domains, profiles and co-occurring conditions

This article reviews the current knowledge state on pragmatic and structural language abilities in autism and their potential relation to extralinguistic abilities and autistic traits. The focus is on questions regarding autism language profiles with varying degrees of (selective) impairment and with respect to potential comorbidity of autism and language impairment: Is language impairment in autism the co-occurrence of two distinct conditions (comorbidity), a consequence of autism itself (no comorbidity), or one possible combination from a series of neurodevelopmental properties (dimensional approach)? As for language profiles in autism, three main groups are identified, namely, (i) verbal autistic individuals without structural language impairment, (ii) verbal autistic individuals with structural language impairment, and (iii) minimally verbal autistic individuals. However, this tripartite distinction hides enormous linguistic heterogeneity. Regarding the nature of language impairment in autism, there is currently no model of how language difficulties may interact with autism characteristics and with various extralinguistic cognitive abilities. Building such a model requires carefully designed explorations that address specific aspects of language and extralinguistic cognition. This should lead to a fundamental increase in our understanding of language impairment in autism, thereby paving the way for a substantial contribution to the question of how to best characterize neurodevelopmental disorders.

Differences in pragmatic communication skills of adults with intellectual disabilities and dual diagnoses

INTRODUCTION

Pragmatics includes a set of skills related to language structure and meaning that allow the speaker to use the language appropriately and in accordance with different communication situations. The aim of this research was to determine the differences in pragmatic communication skills of adults with intellectual disabilities, dual diagnoses, and typical development, and to determine the effects of gender, age, the level of intellectual functioning and speech comprehension on their achievements on two assessment instruments.

METHODS

The sample included 180 adults (60 typically developing participants, 60 with intellectual disabilities, and 60 participants with dual diagnoses). We used two instruments to assess pragmatic communication skills - Communication Checklist - Adult, CC-A, and the Assessment Battery for Communication, ABaCo. In order to test the differences between the three groups of participants, we used canonical discriminant analysis.

RESULTS

Discriminant analysis revealed two significant canonical functions. Function one (speech comprehension and the level of intellectual disability, social engagement, and paralinguistic scale) differentiates between typically developing participants and participants with dual diagnoses the most. The second canonical function (language structure, linguistic scale, paralinguistic scale, extralinguistic scale, and context scale) differentiates between participants with intellectual disabilities and participants with dual diagnoses the most. According to the results, age did not affect pragmatic achievements.

DISCUSSION

Pragmatic skills are very complex, and different instruments measure different dimensions of these abilities. The results of this research lead to the conclusion that we can differentiate between the pragmatic abilities of typically developing people, people with intellectual disabilities, and those with dual diagnoses with the help of the ABaCo battery and the CC-A questionnaire.

The Processes Underlying Positive Illusory Bias in ADHD: The Role of Executive Functions and Pragmatic Language Skills

OBJECTIVE

Children with ADHD often show a positive illusory bias (PIB), reporting an extremely positive idea of their own competence, despite their difficulties. The mechanisms underlying this phenomenon are still poorly understood. In the present study, we examined social PIB and investigated the role of executive functions (EFs) and pragmatic language (PL).

METHOD

Forty-one children with ADHD and 42 typically-developing children matched on age, IQ, and receptive language were administered measures of social competence, EFs and PL. The parents were also asked to estimate their child's social competence.

RESULTS

There was evidence of social difficulties and PIB in children with ADHD. Only PL, not EFs, seemed to mediate the association between ADHD and PIB.

CONCLUSION

Our findings suggest that PL abilities should be considered in efforts to improve self-perception in children with ADHD.

Do comorbid symptoms discriminate between autism spectrum disorder, ADHD and nonverbal learning disability?

Characterizing the functioning of individuals with neurodevelopmental disorders is crucial to their diagnosis. Research has found that children with different neurodevelopmental disorders, including autism spectrum disorders (ASD), attention deficit and hyperactivity disorder (ADHD), and nonverbal learning disability (NLD), may have comorbid symptoms of anxiety and depression, and problems with pragmatic language. The main aim of the present study was to identify any differences in the above-mentioned comorbid symptoms associated with these clinical profiles. A second aim was to establish how well signs of pragmatic language difficulties could discriminate between the three clinical profiles, in terms of their diagnostic power. For this purpose, 107 participants from 8 to 16 years old with a diagnosis of ASD, ADHD or NLD were compared with a group of typically-developing children. Self-reports on symptoms of anxiety and depression, and parents' reports on social and communication problems were analyzed. Our findings confirmed that symptoms of anxiety and depression, and problems with pragmatic language are associated with different neurodevelopmental disorders, but not in the same way. In terms of diagnostic power, we found that pragmatic language difficulties clearly discriminated children with ASD, ADHD or NLD from typically-developing children. Importantly, pragmatic language difficulties also discriminated adequately between ASD and NLD. Our findings are discussed in terms of the value of considering comorbid symptoms to obtain a more accurate diagnosis of neurodevelopmental disorders.

Children with hearing impairment and early cochlear implant: A pragmatic assessment

Extensive research has demonstrated the benefits of cochlear implants (CI) in contributing to improve the linguistic skills of children with hearing impairment; however, few studies have focused on the development of pragmatic ability and its relationship with age of implantation. Pragmatics is the ability to use language in different contexts and its development has crucial implications, e.g., social inclusion and professional attainments. In this study, we conducted a comprehensive assessment of pragmatic ability using the Language Pragmatic Abilities (APL Medea), a battery composed by five different tasks: Comprehension of Metaphors, Implicit meaning, Comics, Situations and Colors Game (a perspective taking task). Eighteen children with early CI, belonging to 3 different age groups (6; 11-7; 11, 8; 0-8; 11 and 9; 0-9; 11 years-old), and twenty-four children with typical development (Control Group) participated to the study. We also investigated how the precocity of CI, i.e., age of first implantation, may affect the pragmatic development. Globally, children with CI obtained lower scores in the APL Medea battery than typically hearing children. However, focusing on the Medea tasks separately, children with CIs differed from their hearing peers only in Comics and Colors Game tasks. Finally, age of implantation was a moderate but significant predictor of pragmatic performance.