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

Speech and language patterns in autism: Towards natural language processing as a research and clinical tool

Speech and language differences have long been described as important characteristics of autism spectrum disorder (ASD). Linguistic abnormalities range from prosodic differences in pitch, intensity, and rate of speech, to language idiosyncrasies and difficulties with pragmatics and reciprocal conversation. Heterogeneity of findings and a reliance on qualitative, subjective ratings, however, limit a full understanding of linguistic phenotypes in autism. This review summarizes evidence of both speech and language differences in ASD. We also describe recent advances in linguistic research, aided by automated methods and software like natural language processing (NLP) and speech analytic software. Such approaches allow for objective, quantitative measurement of speech and language patterns that may be more tractable and unbiased. Future research integrating both speech and language features and capturing "natural language" samples may yield a more comprehensive understanding of language differences in autism, offering potential implications for diagnosis, intervention, and research.

Analysis of Autistic Adolescents' Essays Using Computer Techniques

PURPOSE

Challenges associated with narrative discourse remain consistently observable across the entire spectrum of autism. We analyzed written narratives by autistic and non-autistic adolescents and aimed to investigate narrative writing using quantitative computational methods.

METHODS

We employed Natural Language Processing techniques to compare 333 essays from students in the final eighth grade of primary school: 195 written by autistic and 138 by non-autistic participants.

RESULTS

Autistic students used words with a positive emotional polarity statistically less frequently (p < .001), and their stories were less abstract (p < .001) than those written by peers from the non-autistic group. However, autistic adolescents wrote more complex stories in terms of readability than participants from the non-autistic group (p < .001). The writing competencies assessed by teachers did not differ significantly between the two groups.

CONCLUSION

Findings suggest that written narratives by autistic individuals may exhibit characteristics similar to those detected by computational methods in spoken narratives. Collecting data from national exams and its potential usefulness in distinguishing autistic individuals could pave the way for future large-scale and cost-effective epidemiological studies on autism.

Sentence Production and Sentence Repetition in Autistic Adolescents and Young Adults: Linguistic Sensitivity to Finiteness Marking

PURPOSE

Despite the clinical utility of sentence production and sentence repetition to identify language impairment in autism, little is known about the extent to which these tasks are sensitive to potential language variation. One promising method is strategic scoring, which has good clinical utility for identifying language impairment in nonautistic school-age children across variants of English. This report applies strategic scoring to analyze sentence repetition and sentence production in autistic adolescents and adults.

METHOD

Thirty-one diverse autistic adolescents and adults with language impairment (ALI; n = 15) and without language impairment (ASD; n = 16) completed the Formulated Sentences and Recalling Sentences subtests of the Clinical Evaluation of Language Fundamentals-Fifth Edition. Descriptive analyses and regression evaluated effects of scoring condition, group, and scoring condition by group on outcomes, as well as group differences in finiteness marking across utterances and morphosyntactic structures.

RESULTS

Strategic and unmodified item-level scores were essentially constant on both subtests and significantly lower in the ALI than the ASD group. Only group predicted item-level scores. Group differences were limited to: percent grammatical utterances on Formulated Sentences and percent production of overt structures combined on Sentence Repetition (ALI < ASD).

DISCUSSION

Findings support the feasibility of strategic scoring for sentence production and sentence repetition to identify language impairment and indicate that potential language variation in finiteness marking did not confound outcomes in this sample. To better understand the clinical utility of strategic scoring, replication with a larger sample varying in age and comparisons with dialect-sensitive measures are needed.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25822336.

Phenotyping variability in early socio-communicative skills in young children with autism and its influence on later development

Children with autism spectrum disorder (ASD) often face challenges in early social communication skills, prompting the need for a detailed exploration of specific behaviors and their impact on cognitive and adaptive functioning. This study aims to address this gap by examining the developmental trajectories of early social communication skills in preschoolers with ASD aged 18-60 months, comparing them to age-matched typically developing (TD) children. Utilizing the early social communication scales (ESCS), the research employs a longitudinal design to capture changes over time. We apply a principal component analysis (PCA) to ESCS variables to identify underlying components, and cluster analysis to identify subgroups based on preverbal communication profiles. The results reveal consistent differences in early social communication skills between ASD and TD children, with ASD children exhibiting reduced skills. PCA identifies two components, distinguishing objects-directed behaviors and social interaction-directed behaviors. Cluster analysis identifies three subgroups of autistic children, each displaying specific communication profiles associated with distinct cognitive and adaptive functioning trajectories. In conclusion, this study provides a nuanced understanding of early social communication development in ASD, emphasizing the importance of low-level behaviors. The identification of subgroups and their unique trajectories contributes to a more comprehensive understanding of ASD heterogeneity. These findings underscore the significance of early diagnosis, focusing on specific behaviors predicting cognitive and adaptive functioning outcomes. The study encourages further research to explore the sequential development of these skills, offering valuable insights for interventions and support strategies.

Studies assessing domains pertaining to structural language in autism vary in reporting practices and approaches to assessment: A systematic review

LAY ABSTRACT

Under the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), language impairment can co-occur with autism. It is not yet clear how research defines, reports, and characterizes structural language abilities of autistic individuals eligible for school-based special education services (aged 3-21 years) in the United States. In the United States, students typically must be formally diagnosed to be eligible for services and supports. However, the quality of diagnosis is only as good as the research evidence on which diagnosis depends. To evaluate evidence quality, we examined how studies of school-aged autistic individuals report assessments of language ability. This systematic review included 57 studies using English language age-referenced assessments used to measure structural language. Findings showed many differences across studies in how language abilities were measured and reported. Also, none of the studies fully reported the variables relevant to characterizing language impairment. Outcomes were similar across versions of the Diagnostic and Statistical Manual of Mental Disorders. Findings indicate that researchers and clinicians should pay attention to reporting diagnostic and grouping criteria. Carefully interpreting research evidence is critical for ensuring that diagnostic criteria and supports are representative of and accessible to autistic individuals and relevant parties.

Synchrony perception across senses: A systematic review of temporal binding window changes from infancy to adolescence in typical and atypical development

Sensory integration is increasingly acknowledged as being crucial for the development of cognitive and social abilities. However, its developmental trajectory is still little understood. This systematic review delves into the topic by investigating the literature about the developmental changes from infancy through adolescence of the Temporal Binding Window (TBW) - the epoch of time within which sensory inputs are perceived as simultaneous and therefore integrated. Following comprehensive searches across PubMed, Elsevier, and PsycInfo databases, only experimental, behavioral, English-language, peer-reviewed studies on multisensory temporal processing in 0-17-year-olds have been included. Non-behavioral, non-multisensory, and non-human studies have been excluded as those that did not directly focus on the TBW. The selection process was independently performed by two Authors. The 39 selected studies involved 2859 participants in total. Findings indicate a predisposition towards cross-modal asynchrony sensitivity and a composite, still unclear, developmental trajectory, with atypical development associated to increased asynchrony tolerance. These results highlight the need for consistent and thorough research into TBW development to inform potential interventions.

Social drivers of health in communicative outcomes of racially and ethnically minoritized autistic adolescents and adults

Despite their importance, little is known about how social drivers of health shape communicative outcomes in autism. Even less is known when considering the intersection of race and language impairment. An understanding of factors in communicative outcomes is key for characterizing developmental trajectories and informing supports. This cross-sectional observational study examined the role of social drivers of health in communicative outcomes of racially and ethnically minoritized autistic adolescents and adults. Participants ages 13 to 30 (N = 73) completed a behavioral assessment protocol, including language and nonverbal cognitive skills, as well as social drivers of health (sense of community, unmet services, barriers to services). Correlational analyses revealed associations between social drivers of health on social communication impairment and real-world communication. Generalized linear mixed-effects modeling revealed that language predicted real-world communication, but sense of community predicted social communication impairment. Findings point to the importance of assessing both individual differences and social drivers of health in outcomes in autism research. Future work should focus on social drivers of health in larger-scale analyses of outcomes in minoritized autistic individuals during the transition to adulthood, considering supports that align with service eligibility and person-centered outcomes.

Testing the Labeling Effect in Autistic Children

PURPOSE

Our objective was to test the labeling effect in autistic children. The effect has been robustly tested in typically developing (TD) individuals. TD children expect that any two objects that receive the same linguistic label will have similar properties, which suggests that they generate concepts based on acts of labeling. The labeling effect has not been tested on autistic children, who may not be equally attuned to the relevance of linguistic clues or may not generalize as swiftly as TD children.

METHODS

We reproduced Graham et al.,'s (Frontiers in Psychology 10.3389/fpsyg.2012.00586, 2013) design on 30 autistic children of different ages. Participants were divided into two groups depending on whether objects presented to them were named alike or differently (Same or Distinct Label between-individuals condition). The dependent variable was the number of target actions the child performed on an object, depending on whether that object made the same sound as a previously shown test object.

RESULTS

We did not reproduce results similar to those reported in Graham et al., (Frontiers in Psychology 10.3389/fpsyg.2012.00586, 2013). Children in the Same Label group did not perform significantly more actions than children in the Distinct Label group when the objects that were handed to the children did not make the same sound as the test object.

CONCLUSIONS

Autistic children do not seem to be sensitive to the labeling effect to the same extent as TD children. If these results are confirmed, intervention programs for autistic children should consider trainings on this way of generating concepts shared by their linguistic community.

Early trajectories and moderators of autistic language profiles: A longitudinal study in preschoolers

LAY ABSTRACT

Language development can greatly vary among autistic children. Children who struggle with language acquisition often face many challenges and experience lower quality of life. However, little is known about the early language trajectories of autistic preschoolers and their moderators. Autistic language can be stratified into three profiles. Language unimpaired experience little to no language difficulties; language impaired show significant difficulties in language; minimally verbal never develop functional language. In this study, we used a longitudinal sample of preschoolers with autism and with typical development (aged 1.5-5.7 years). We replicated the three language profiles through a data-driven approach. We also found that different factors modulated the language outcome within each group. For instance, non-verbal cognition at age 2.4 moderated the participants' attribution to each language profile. Moreover, early intervention moderated verbal outcome in the language impaired profile. In conclusion, we provided a detailed description of how autistic preschoolers acquire language, and what factors might influence their trajectories. Our findings could inspire more personalized intervention for early autistic language difficulties.

Sentence production and sentence repetition in autistic adolescents and young adults: Linguistic sensitivity to finiteness-marking

Purpose

Despite the clinical utility of sentence production and sentence repetition to identify language impairment in autism, little is known about the extent to which these tasks are sensitive to potential dialectal variation. One promising method is strategic scoring (Oetting et al., 2016), which has good clinical utility for identifying language impairment in nonautistic school-age children across dialects of English. This report applies strategic scoring to analyze sentence repetition and sentence production in autistic adolescents and adults.

Method

Thirty-one diverse autistic adolescents and adults with language impairment (ALI; n=15) and without language impairment (ASD; n=16) completed the Formulated Sentences and Recalling Sentences subtests of the Clinical Evaluation of Language Fundamentals-5th Ed (Wiig et al., 2013). Descriptive analyses and regression evaluated effects of scoring condition, group, and scoring condition by group on outcomes, as well as group differences in finiteness-marking across utterances and morphosyntactic structures.

Results

Strategic and unmodified item-level scores were essentially constant on both subtests and significantly lower in the ALI than the ASD group. Only group predicted item-level scores. Group differences were limited to: percent grammatical utterances on Formulated Sentences and percent production of overt structures combined on Sentence Repetition (ALI < ASD).

Discussion

Findings support the feasibility of strategic scoring for sentence production and sentence repetition to identify language impairment and indicate that potential dialectal variation in finiteness-marking did not confound outcomes in this sample. To better understand the clinical utility of strategic scoring, replication with a larger sample varying in age and comparisons with dialect-sensitive measures are needed.

Intellectual development in young children with autism spectrum disorders: A longitudinal study

Intelligence profiles in autism have been characterized by great variability. The questions of how autistic children's intelligence changes over time, and what factors influence these changes deserve study as part of efforts to document child autism profiles, but also because the relationship between intellectual functioning and children's background characteristics is poorly understood, particularly in a longitudinal context. A total of 39 autistic children and 39 age-matched neurotypical children (5-9 years old) completed two IQ assessments at preschool age and up to 4 years later. Repeated-measures analyses assessed longitudinal changes in the children's verbal (VIQ), performance (PIQ), and full-scale IQ (FSIQ) at group level. We further sought to identify clusters with distinct profiles in each group by adopting an unsupervised K-means clustering approach, and detect possible between-subgroup differences in terms of children's socioeconomic status and autism severity. The largest cluster in the autistic group was composed of children whose PIQ significantly dropped at follow-up, while the second largest cluster improved in all quotients; the smallest cluster, wherein children had more highly educated mothers than the rest of the clusters, was characterized by large improvement in VIQ. For the neurotypical children, there was a two-cluster division; the majority of them improved in the three quotients, while very few dropped in PIQ at follow-up. The relation between socioeconomic status and IQ changes was significant for both groups. The findings demonstrate both the complexity of intelligence changes in autism and the need to view this complexity through the lens of the children's socioeconomic diversity.

Impaired communication ability in SOX11 syndrome

BACKGROUND

Speech and language skills are important for social interaction and learning. This study characterised the communication abilities of verbal individuals with SOX11 syndrome using a standardised parent/carer questionnaire, the Children's Communication Checklist (CCC-2).

METHOD

Thirteen parent/carers of verbal individuals (aged 5-19 years) diagnosed with SOX11 syndrome completed the CCC-2. In order to contextualise findings, responses were compared to norms and to data from Noonan syndrome, a relatively well-known genetic diagnosis associated with communication impairment.

RESULTS

For all individuals, the CCC-2 composite score indicated significant communication difficulties. Language structure (speech, syntax, semantics and coherence), pragmatic language (inappropriate initiation, stereotyped language use of context and non-verbal communication) and autistic features (social relations and interests) scores were lower than typically developing norms. Subscale comparisons revealed relative difference in use of context compared to other pragmatic domains (stereotyped language and inappropriate initiation). Individual scores showed substantial variation, particularly in regard to language structure profile. Differences were more pronounced than for Noonan syndrome, specifically in domains of speech, syntax, non-verbal communication and social relations.

CONCLUSIONS

SOX11 syndrome is associated with communication impairment. It is important to assess communication abilities as part of the management of individuals with SOX11 syndrome and understand individual strengths and difficulties in order to provide targeted support.

White matter development and language abilities during infancy in autism spectrum disorder

White matter (WM) fiber tract differences are present in autism spectrum disorder (ASD) and could be important markers of behavior. One of the earliest phenotypic differences in ASD are language atypicalities. Although language has been linked to WM in typical development, no work has evaluated this association in early ASD. Participants came from the Infant Brain Imaging Study and included 321 infant siblings of children with ASD at high likelihood (HL) for developing ASD; 70 HL infants were later diagnosed with ASD (HL-ASD), and 251 HL infants were not diagnosed with ASD (HL-Neg). A control sample of 140 low likelihood infants not diagnosed with ASD (LL-Neg) were also included. Infants contributed expressive language, receptive language, and diffusion tensor imaging data at 6-, 12-, and 24 months. Mixed effects regression models were conducted to evaluate associations between WM and language trajectories. Trajectories of microstructural changes in the right arcuate fasciculus were associated with expressive language development. HL-ASD infants demonstrated a different developmental pattern compared to the HL-Neg and LL-Neg groups, wherein the HL-ASD group exhibited a positive association between WM fractional anisotropy and language whereas HL-Neg and LL-Neg groups showed weak or no association. No other fiber tracts demonstrated significant associations with language. In conclusion, results indicated arcuate fasciculus WM is linked to language in early toddlerhood for autistic toddlers, with the strongest associations emerging around 24 months. To our knowledge, this is the first study to evaluate associations between language and WM development during the pre-symptomatic period in ASD.

Theoretical-Methodological Foundations for the Global Integration Method (Método de Integração Global-MIG) in the Treatment of Autism Spectrum Disorder

Currently, there is no intervention model for autism spectrum disorder (ASD) that addresses all levels and factors of the International Classification of Functioning, Disability and Health (ICF, WHO). The most researched programs focus on naturalistic, developmental and behavioral approaches to socio-communication. Less attention has been paid to motor and environmental reactivity aspects (behavior/interest restriction and sensory reactivity). The evidence rationale for the Global Integration Method (MIG, "Método de Integração Global"), a model addressing sensorimotor reactivity in addition to socio-communication, is presented. MIG is an integrative, interdisciplinary, family-oriented intervention and naturalistic program that addresses all levels and moderating factors of ASD's impact. MIG's theoretical rationale is based on the predictive coding impairment and embodied cognition hypotheses. MIG incorporates both bottom-up (flexible therapeutic suit, social-motor synchronization) and top-down (schematic social information processing, narratives, imagery) strategies to promote the building and use of accurate, flexible and context-sensitive internal predictive models. MIG is based on the premises that predictive coding improves both socio-communication and environmental reactivity, and that the postural stabilization provided by the flexible therapeutic suit frees information processing resources for socio-cognitive learning. MIG builds on interdisciplinary, professionally and parentally mediated work based on behavioral principles of intensive training in a situated environment.

Atypical brain lateralization for speech processing at the sublexical level in autistic children revealed by fNIRS

Autistic children often exhibit atypical brain lateralization of language processing, but it is unclear what aspects of language contribute to this phenomenon. This study employed functional near-infrared spectroscopy to measure hemispheric lateralization by estimating hemodynamic responses associated with processing linguistic and non-linguistic auditory stimuli. The study involved a group of autistic children (N = 20, mean age = 5.8 years) and a comparison group of nonautistic peers (N = 20, mean age = 6.5 years). The children were presented with stimuli with systematically decreasing linguistic relevance: naturalistic native speech, meaningless native speech with scrambled word order, nonnative speech, and music. The results revealed that both groups showed left lateralization in the temporal lobe when listening to naturalistic native speech. However, the distinction emerged between autism and nonautistic in terms of processing the linguistic hierarchy. Specifically, the nonautistic comparison group demonstrated a systematic reduction in left lateralization as linguistic relevance decreased. In contrast, the autism group displayed no such pattern and showed no lateralization when listening to scrambled native speech accompanied by enhanced response in the right hemisphere. These results provide evidence of atypical neural specialization for spoken language in preschool- and school-age autistic children and shed new light on the underlying linguistic correlates contributing to such atypicality at the sublexical level.

Morphosyntactic skills in Arabic-speaking children with autism spectrum disorder: Evidence from error patterns in the sentence repetition task

Background and aims

Although autism spectrum disorder (ASD) has not traditionally been associated with morphosyntactic impairments, some children with ASD manifest significant difficulties in this domain. Sentence Repetition (SRep) tasks are highly reliable tools for detecting morphosyntactic impairment in different languages and across various populations, including children with ASD. This study is among the first to evaluate morphosyntactic abilities of Palestinian-Arabic (PA) speaking children using a PA SRep task.

Methods

A total of 142 PA-speaking children, aged 5-11, participated in the study: 75 children with typical language development (TLD) and 67 children with ASD. The PA SRep task targeted morphosyntactic structures of varying complexity (simple subject-verb-object [SVO] sentences, biclausal sentences, wh-questions, relative clauses). Children's accuracy scores were assessed across these structures and error patterns encompassing morphosyntactic and pragmatic aspects were analyzed.

Results

Two subgroups of ASD emerged: 43% showed age-appropriate language skills (ASD  +  NL) pairing up with TLD peers, while 57% showed signs of morphosyntactic impairment (ASD  +  LI). Children in both groups exhibited a higher frequency of morphosyntactic errors than pragmatic ones. Children with ASD  +  LI showed difficulties with producing complex morphosyntactic structures, such as relative clauses and object wh-questions. Error analysis revealed that children in the ASD  +  LI group produced sentence fragments and simplified constructions when complex structures were targeted.

Conclusions

The current study extends the cross-linguistic evidence of the heterogeneity of morphosyntactic profiles in children with ASD to Arabic-speaking children. Error analysis indicates that poor morphosyntax, rather than pragmatics, challenges children's performance on the SRep task.

Implications

Our results emphasize the importance of comprehensive language assessment in children with ASD and underscore the need for tailored intervention plans targeting impaired morphosyntactic structures in some children with ASD.

fNIRS Studies of Individuals with Speech and Language Impairment Underreport Sociodemographics: A Systematic Review

Functional near-infrared spectroscopy (fNIRS) is a promising tool for scientific discovery and clinical application. However, its utility depends upon replicable reporting. We evaluate reporting of sociodemographics in fNIRS studies of speech and language impairment and asked the following: (1) Do refereed fNIRS publications report participant sociodemographics? (2) For what reasons are participants excluded from analysis? This systematic review was preregistered with PROSPERO (CRD42022342959) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Searches in August 2022 included the terms: (a) fNIRS or functional near-infrared spectroscopy or NIRS or near-infrared spectroscopy, (b) speech or language, and (c) disorder or impairment or delay. Searches yielded 38 qualifying studies from 1997 to present. Eight studies (5%) reported at least partial information on race or ethnicity. Few studies reported SES (26%) or language background (47%). Most studies reported geographic location (100%) and gender/sex (89%). Underreporting of sociodemographics in fNIRS studies of speech and language impairment hinders the generalizability of findings. Replicable reporting is imperative for advancing the utility of fNIRS.