Narrative performance of optimal outcome children and adolescents with a history of an Autism Spectrum Disorder (ASD)

Spontaneous Generation of Unconventional Language and Its Link with Grammatical Performance in Chinese Adults With and Without ASD

This study investigated the generation of unconventional language in the spontaneous speech of Chinese adults with autism spectrum disorder (ASD), and how it was related to their grammatical performance, when compared to neurotypical (NT) controls. Twenty Cantonese-speaking adults with ASD and 20 NT controls completed three interview tasks in the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), and their spontaneous speech was recorded and transcribed. Utterances containing unconventional language (neologisms, idiosyncratic phrases, and pedantic language), morphosyntactic errors, mean length of utterance (MLU), and mazes were computed. The ASD group produced more neologisms, idiosyncratic phrases, and pedantic language than the NT group and their grammatical difficulties were shown in shorter MLU but not morphosyntactic errors. Mazes were more frequent in the ASD than the NT group. While the use of unconventional language increased with MLU in the NT group, it correlated positively with mazes in the ASD group. Generation of unconventional language, particularly pedantic language, in Cantonese-speaking NT adults is linked to more advanced grammar, while it appears to be a common speech characteristic among autistic speakers regardless of individual grammatical performance.

Language is a critical mediator of autistic experiences within the criminal justice system

Autism spectrum disorder is characterized by social communication challenges and restricted and repetitive behaviors and interests, but also by highly heterogeneous language skills. The recent International Society of Autism Research (INSAR) policy statement, Autism and the Criminal Justice System: Policy opportunities and challenges (INSAR, 2022), aims to prevent, reduce, and improve interactions between autistic individuals and the criminal justice system. This policy statement provides a foundation for considering how to include language in these important aims. In this commentary, we outline the centrality of language skills to these interactions and provide specific recommendations that can inform future research and provide guidance for autistic individuals, community partners, and individuals working within the criminal justice system. Considering language as a part of justice system policy for autistic individuals will result in greater equity and inclusion, particularly for autistic individuals with co-occurring language deficits and those who are linguistically diverse. Moreover, it will allow autistic individuals to combat other barriers to effectively navigating interactions with the criminal justice system, such as those related to the core features of autism. We advocate for a greater role for service providers who can assess challenges in language skills, and identify the specific accommodations each autistic individual will need to prevent, reduce, and improve interactions with the criminal justice system.

Pragmatic language and associations with externalizing behaviors in autistic individuals and those who have lost the autism diagnosis

Background

Pragmatic language weaknesses, a core feature of autism spectrum disorder (ASD), are implicated in externalizing behavior disorders (Gremillion & Martel, 2014). Particularly in a clinical setting, these co-occurring externalizing disorders are very common in autism; rates of Attentional Deficit-Hyperactive Disorder (ADHD) and Oppositional Defiant Disorder (ODD) are as high as 83% (ADHD) and 73% (ODD; Joshi et al., 2010). It is possible that pragmatic language weaknesses impact the ability to effectively communicate one's needs, which may lead autistic children to utilize externalizing behaviors in order to achieve a desired outcome (Ketelaars et al., 2010; Rodas et al., 2017).

Methods

The aim of the current study is to investigate the relationship between pragmatic language, assessed via multiple modalities, and externalizing behaviors, assessed by parent interview, in youth with autistic (n=33) or neurotypical (NT; n=34) developmental histories, along with youth diagnosed with autism, who lost the diagnosis (LAD) by adolescence (n=31).

Results

The autism group had significantly more pragmatic language difficulties, and more externalizing behaviors and disorders; ADHD symptoms were particularly more prevalent, while LAD and NT groups did not differ. Challenges in pragmatic language abilities were associated with more externalizing symptoms when controlling for other facts that typically influence such symptoms, including nonverbal cognition, structural language, executive functioning, and autistic characteristics, but did not remain when age was included in the model.

Conclusions

We discuss the mechanisms underlying difficult-to-manage externalizing behaviors and implications for interventions and long-term outcomes for youth with and without a history of autism.

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.

Analysis of Noun Phrase Ambiguity in Narratives Reveals Differences in Referential Establishment But Not Cohesion for Older Autistic Children

PURPOSE

Stories told by autistic narrators often contain relatively frequent use of ambiguous references. However, it remains unclear whether this ambiguity is driven by ambiguous character establishment (e.g., "Once upon a time, she/the girl…") and/or ambiguous cohesion (e.g., "Two girls lived in a castle. She/The girl…"). In this study, we directly compared rates of each type of ambiguity within and between narratives told by autistic and non-autistic children, to determine which type of ambiguity is relatively more common in narratives told by autistic children.

METHOD

Thirty-three 10- to 17-year-old autistic participants (n = 17) and non-autistic peers (n = 16), who were not statistically different in age, standardized language scores, and IQ scores (p > .8 for all), watched two short animated videos alone and then described the videos' events to two listeners who were openly unfamiliar with the videos. We transcribed video recordings of narratives and coded all referential noun phrases (NPs) as either clear or ambiguous. We further categorized ambiguous NPs as either ineffective introduction or ineffective cohesion.

RESULTS

Autistic children produced significantly higher rates of ambiguous establishment than non-autistic peers, whereas between-group comparisons' rates of ambiguous cohesion were not statistically significant.

CONCLUSIONS

Older children on the autism spectrum show differences in the way they introduce characters, selecting NP types that are only appropriate when their listener is already familiar with the referent. In contrast, once they have introduced characters, they show cohesive skills that are comparable to those of non-autistic peers. Findings support theories arguing that autistic children show differences in their application of social pragmatic principles (listener/context-specific pragmatic rules), whereas their use of linguistic pragmatics (context-independent rules) is similar to that of non-autistic peers.

Listener- Versus Speaker-Oriented Disfluencies in Autistic Adults: Insights From Wearable Eye-Tracking and Skin Conductance Within a Live Face-to-Face Paradigm

PURPOSE

Our study addresses three main questions: (a) Do autistics and neurotypicals produce different patterns of disfluencies, depending on the experimenter's direct versus averted gaze? (b) Are these patterns correlated to gender, skin conductance responses, fixations on the experimenter's face, alexithymia, or social anxiety scores? Lastly, (c) can eye-tracking and electrodermal activity data be used in distinguishing listener- versus speaker-oriented disfluencies?

METHOD

Within a live face-to-face paradigm combining a wearable eye-tracker with electrodermal activity sensors, 80 adults (40 autistics, 40 neurotypicals) defined words in front of an experimenter who was either staring at their eyes (direct gaze condition) or looking elsewhere (averted gaze condition).

RESULTS

Autistics produce less listener-oriented (uh, um) and more speaker-oriented (prolongations, breath) disfluencies than neurotypicals. In both groups, men produce less um than women. Both autistics' and neurotypicals' speech are influenced by whether their interlocutor systematically looks at them in the eyes or not, but their reactions go in opposite directions. Disfluencies seem to primarily be linguistic phenomena as experienced stress, social attention, alexithymia, and social anxiety scores do not influence any of the reported results. Finally, eye-tracking and electrodermal activity data suggest that laughter could be a listener-oriented disfluency.

CONCLUSIONS

This article studies disfluencies in a fine-grained way in autistic and neurotypical adults while controlling for social attention, experienced stress, and experimental condition (direct vs. averted gaze). It adds to current literature by (a) enlightening our knowledge of speech in autism, (b) opening new perspectives on disfluency patterns as important signals in social interaction, (c) addressing theoretical issues on the dichotomy between listener- and speaker-oriented disfluencies, and (d) considering understudied phenomena as potential disfluencies (e.g., laughter, breath).

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23549550.

Filled Pauses Produced by Autistic Adults Differ in Prosodic Realisation, but not Rate or Lexical Type

We examined the use of filled pauses in conversations between homogeneous pairs of autistic and non-autistic adults. A corpus of semi-spontaneous speech was used to analyse the rate, lexical type (nasal "uhm" or non-nasal "uh"), and prosodic realisation (rising, level or falling) of filled pauses. We used Bayesian modelling for statistical analysis. We found an identical rate of filled pauses and an equivalent preference of "uhm" over "uh" across groups, but also a robust group-level difference regarding the intonational realisation of filled pauses: non-autistic controls produced a considerably higher proportion of filled pause tokens realised with the canonical level pitch contour than autistic speakers. Despite the fact that filled pauses are a frequent and impactful part of speech, previous work on their conversational use in autism spectrum disorder (ASD) is limited. Our account is the first to analyse the intonational realisation of filled pauses in ASD and the first to investigate conversations between autistic adults in this context. Our results on rate and lexical type can help to contextualise previous research, while the novel findings on intonational realisation set the stage for future investigations.

Consistency and reliability of automated language measures across expressive language samples in autism

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with substantial clinical heterogeneity, especially in language and communication ability. There is a need for validated language outcome measures that show sensitivity to true change for this population. We used Natural Language Processing to analyze expressive language transcripts of 64 highly-verbal children and young adults (age: 6-23 years, mean 12.8 years; 78.1% male) with ASD to examine the validity across language sampling context and test-retest reliability of six previously validated Automated Language Measures (ALMs), including Mean Length of Utterance in Morphemes, Number of Distinct Word Roots, C-units per minute, unintelligible proportion, um rate, and repetition proportion. Three expressive language samples were collected at baseline and again 4 weeks later. These samples comprised interview tasks from the Autism Diagnostic Observation Schedule (ADOS-2) Modules 3 and 4, a conversation task, and a narration task. The influence of language sampling context on each ALM was estimated using either generalized linear mixed-effects models or generalized linear models, adjusted for age, sex, and IQ. The 4 weeks test-retest reliability was evaluated using Lin's Concordance Correlation Coefficient (CCC). The three different sampling contexts were associated with significantly (P < 0.001) different distributions for each ALM. With one exception (repetition proportion), ALMs also showed good test-retest reliability (median CCC: 0.73-0.88) when measured within the same context. Taken in conjunction with our previous work establishing their construct validity, this study demonstrates further critical psychometric properties of ALMs and their promising potential as language outcome measures for ASD research.

A Comprehensive Analysis of Speech Disfluencies in Autistic Young Adults and Control Young Adults: Group Differences in Typical, Stuttering-Like, and Atypical Disfluencies

PURPOSE

The purpose of this study was to examine the nature of speech disfluencies in autistic young adults and controls by using a wide-range disfluency classification of typical disfluencies (TD; i.e., filled pauses, revisions, abandoned utterances, and multisyllable word and phrase repetitions), stuttering-like disfluencies (SLD; i.e., sound and syllable repetitions, monosyllable word repetitions, prolongations, blocks, and broken words), and atypical disfluencies (AD; i.e., word-final prolongations and repetitions and atypical insertions).

METHOD

Thirty-two autistic young adults and 35 controls completed a narrative telling task based on socially complex events. Frequencies of total disfluencies, TD, SLD, AD and stuttering severity were compared between groups.

RESULTS

The overall frequency of disfluencies was significantly higher in the autistic group and significant between-group differences were found for all disfluency categories. The autistic group produced significantly more revisions, filled pauses, and abandoned utterances, and each subtype of SLD and AD than the control group. In total, approximately every fourth autistic participants scored at least a very mild severity of stuttering, and every fifth produced more than three SLD per 100 syllables.

CONCLUSIONS

Disfluent speech can be challenging for effective communication. This study revealed that the speech of autistic young adults was highly more disfluent than that of the controls. The findings provide information on speech disfluency characteristics in autistic young adults and highlight the importance of evaluating speech disfluency with a wide-range disfluency classification in autistic persons in order to understand their role in overall communication. The results of this study offer tools for SLPs to evaluate and understand the nature of disfluencies in autistic persons.

Here's the Story: Narrative Ability and Executive Function in Autism Spectrum Disorder

Background

Difficulties with narrative have been reported in individuals diagnosed with autism spectrum disorder (ASD), but the role of executive function on narrative ability has not been examined in ASD. In this study, we aimed to (1) examine whether narrative abilities of ASD children differed from neurotypical (NT) children who did not differ in age, sex, and IQ; and (2) investigate relations between executive function and narrative ability in ASD children.

Method

Narratives were elicited from 64 ASD children and 26 NT children using a wordless picture book and coded to derive several aspects of narrative ability such as propositions, evaluative devices, and self-repairs. Executive functions (specifically, inhibition and working memory) were measured using both experimenter-administered assessment and parent-report measures.

Results

Compared to NT children, ASD children produced fewer propositions but did not differ in their use of evaluative devices and self-repairs during narrative production. Greater inhibitory challenges related to more self-repairs involving repetition of story elements, whereas working memory did not relate to any of the measures of narrative ability among ASD children.

Conclusions

This study revealed that narratives by verbally fluent ASD children were shorter and less complex than those by NT children but did not differ in the specific features of narratives. Furthermore, although ASD children did not make more self-repairs than NT children, difficulty with inhibition was related to more self-repairs, indicating more dysfluent narrative production in ASD children, which has implications for intervention.

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.

The impact of subtle language and communication difficulties on the daily lives of autistic children without intellectual disability: Parent perspectives

BACKGROUND

Autistic children without intellectual disability will likely experience higher level language and communication difficulties. These may appear subtle, in that they are not immediately evident to those who do not know the child well and may not manifest in all environments. Because of this, the impact of such difficulties may be underestimated. This phenomenon has similarly attracted little research attention, meaning the extent to which subtle language and communication difficulties contribute to the needs of autistic individuals without intellectual disability may be underspecified in clinical services.

AIMS

To offer a detailed exploration of how relatively subtle language and communication difficulties impact on autistic children without intellectual disability and what strategies parents recognize can mediate those negative effects.

METHODS & PROCEDURES

Twelve parents of autistic children from the target group (aged 8-14 years, attending mainstream school) were interviewed about how subtle language and communication difficulties impact their autistic child. Rich accounts were derived then analysed using thematic analysis. Eight of the children discussed had previously been interviewed independently in a parallel study. Comparisons are discussed in this paper.

OUTCOMES & RESULTS

Parents reported heterogeneous but pervasive higher level language and communication difficulties which universally impacted key areas of the children's function: peer relationships, developing independence and performance in education. Communication difficulties were also universally associated with negative emotional responses, social withdrawal and/or negative self-perceptions. While parents identified a range of ad hoc strategies and naturally occurring opportunities that improved outcomes, there was little mention of the means to address primary language and communication difficulties. The current study showed a number of parallels with child accounts, demonstrating the benefits of collecting data from both sources in clinical and research investigations. However, parents were more concerned about longer term implications of language and communication difficulties and highlighted their impact on the child developing functional independence.

CONCLUSIONS & IMPLICATIONS

Subtle language and communication difficulties, typically identified in this higher ability autistic group, can impact significantly on key areas of childhood function. Support strategies seem to be parent generated and inconsistently applied across individuals, without the benefit of coherent specialist services. Dedicated provision and resources targeting areas of functional need may be beneficial to the group. In addition, the commonly reported association between subtle language and communication difficulties and emotional well-being indicates the need for greater exploration using empirical methods, and joined-up clinical working between speech and language therapy and mental health services.

WHAT THIS PAPER ADDS

What is already known on the subject There is now a wide understanding of how language and communication difficulties can impact the individual. However, where those difficulties are relatively subtle, for example, in children without intellectual disability and where difficulties are not immediately evident, less is known. Research has often speculated on how identified differences in higher level structural language and pragmatic difficulties might impact on the function of autistic children. However, to date dedicated exploration of this phenomenon is limited. The current author group explored first-hand accounts of children. Corroborative evidence from parents of the same children would add further weight to understanding this phenomenon. What this paper adds to the existing knowledge This study provides a detailed exploration of parents' perspective relating to the impact of language and communication difficulties on autistic children without intellectual disability. It provides corroborative detail that support child accounts of the same phenomenon, indicating the impact on peer relationships, school outcomes and emotional well-being. Parents also report functional concerns around the child's ability to develop independence and this paper demonstrates how parents and children might deviate in their accounts, with parents reporting increased concerns around the longer term implications of early language and communication difficulties. What are the potential or actual clinical implications of this work? Relatively subtle language and communication difficulties can have a significant impact on the lives of autistic children without intellectual disability. Greater service provision for this group is therefore indicated. Interventions could focus on areas of functional concern where language is implicated, for example, peer relationships, developing independence and school success. Additionally, the relationship between language and emotional well-being points to further integration between speech and language therapy and mental health services. Differences found between parental and child reports highlight the need to collect data from both parties during clinical investigations. Parental strategies may offer benefits for the wider population.

Linguistic markers of autism spectrum conditions in narratives: A comprehensive analysis

Background & Aims: Narratives are regularly elicited as part of standardized assessments for autism spectrum conditions (ASC) such as the ADOS, but have rarely been utilized as linguistic data in their own right. We here aimed for a specific and comprehensive quantitative linguistic profile of such narratives across nominal, verbal, and clausal domains of grammatical organization, and error patterns. Methods: We manually transcribed and annotated narratives elicited from the ADOS from a sample of bilingual autistic Spanish-Catalan children (n = 18), matched with typically developing controls (n = 18) on vocabulary-based verbal IQ. Results: Results revealed fewer relative clauses and more frequent errors in referential specificity and non-relational content-word choice in ASC. Frequent error types are also discussed qualitatively. Conclusions & Implications: These findings, based on more finegrained linguistically defined variables, help to disentangle previous inconsistencies in the literature, and to better situate language changes in the spectrum of neurocognitive changes in this population.

Structural language impairment in Autism Spectrum Disorder versus Loss of Autism Diagnosis: Behavioral and neural characteristics

This study probed for structural language impairment using behavioral and functional neuroimaging methods in individuals with Autism Spectrum Disorder (ASD) and those diagnosed with ASD in childhood who no longer meet criteria for ASD, referred to as Loss of Autism Diagnosis (LAD¹). Participants were drawn from Fein et al. (2013): ASD (n = 35), LAD (n = 31), and Neurotypical (NT; n = 34). Criteria for structural language impairment were: Scores ≤ 82 on Clinical Evaluation of Language Fundamentals-4 (CELF) Core Language, an omnibus measure of language; and scores ≤ 7 on CELF Recalling Sentences, a clinical marker of structural language impairment. Task-based fMRI examined lateralization of significantly activated language-related brain regions in groups with structural language impairment (LI²) versus normal-range language (LN³), collapsed across ASD, LAD¹, and NT status. Results showed no ASD versus LAD group differences in the proportion of participants with structural language impairment according to either metric (Recalling Sentences or Core Language). Functional MRI results indicated greater left hemisphere lateralization within significantly activated regions in the LI² group. Structural language abilities were not meaningfully associated with either social abilities or lifetime ADHD symptoms in LI² subgroups, further suggesting the presence of structural language impairment. Findings indicate the presence of persistent structural language difficulty even in the absence of ASD symptoms in some individuals within the LAD¹ group and unique patterns of language-related neural specialization for language function in LI² relative to LN³.

Brief Report: Linguistic Mazes and Perseverations in School-Age Boys with Fragile X Syndrome and Autism Spectrum Disorder and Relationships with Maternal Maze Use

Autism spectrum disorder (ASD) and fragile X syndrome (FXS) are neurodevelopmental disorders with overlapping pragmatic language impairments. Prior work suggests pragmatic language differences may run in families. This study examined specific pragmatic difficulties (i.e., linguistic mazes and perseverations) in boys (9-18 years) with idiopathic ASD (n = 26) and FXS+ASD (n = 29), and relationships with maternal maze use. Language samples were obtained separately for boys and mothers. Nonparametric analyses suggested that boys largely did not differ in their rates of mazes, but that boys with FXS+ASD exhibited more perseverations. Mazes were correlated between fragile X dyads. Maternal mazes were correlated with child perseverations among idiopathic ASD dyads. These findings have implications for the etiological significance of ASD-related language phenotypes.

Trastorno Específico del Lenguaje y Trastorno del Espectro Autista: similitudes y diferencias en el discurso narrativo

La producción de narraciones es una habilidad compleja que implica habilidades lingüísticas, sociales y cognitivas. El objetivo de este trabajo es realizar un análisis comparativo de la narrativa en niños con Trastorno del Espectro Autista y Trastorno Específico de Lenguaje, pues suele verse comprometida. Veinte niños con Trastorno del Espectro Autista, veinte niños con Trastorno Específico de Lenguaje y un grupo de control de veinte niños con desarrollo típico participaron en esta investigación. Para el análisis narrativo, la tarea utilizada fue la historia Rana, ¿dónde estás? La producción de recursos cohesivos es menor en el grupo Trastorno del Espectro Autista. Por otro lado, los errores de omisión y las sustituciones gramaticales son más frecuentes en el grupo Trastorno Específico de Lenguaje. La intervención debe ser diferente para los dos grupos, con la prioridad de mejorar los recursos de coherencia global y cohesión en Trastorno del Espectro Autista y trabajar en errores gramaticales funcionales en Trastorno Específico de Lenguaje.

Like, it's important: The frequency and use of the discourse marker like in older autistic children

BACKGROUND & AIMS

Discourse markers, such as well or like, serve a variety of functions to support conversational reciprocity: filling pauses, aiding word-finding, and modulating turn-taking by holding the conversational floor. Previous research shows that autistic individuals use discourse markers less frequently than non-autistic (NonAu) peers; however, the discourse marker like has not been included in that research, despite its ubiquitous use by NonAu individuals, and despite the fact that like serves important pragmatic functions that are not encoded by any other discourse marker. Specifically, like signals to the listener that the content of upcoming speech is 1) Important/new; 2) Loose/approximate; 3) Reformulative; or 4) Quotative. The current study addresses this gap in the literature by comparing the frequency of discourse marker like use between older autistic and non-autistic children as well as exploring patterns of usage between the four like functions.

METHODS

Twenty-one 10-to-17-year-old children on the autism spectrum and 20 NonAu peers-statistically matched on age, sex, IQ and language scores-engaged in a semi-structured interview with a researcher. Uses of discourse-marker like were identified from written transcripts of interviews and each use was categorized into one of the four functions.

RESULTS

There were no significant differences in like frequencies between groups, nor were there differences in relative proportions of functions used by each group.

CONCLUSIONS

Research consistently indicates that autistic individuals use discourse markers significantly less often than their NonAu counterparts, but the findings from our study suggest that this pattern does not persist to all such markers. This group of older autistic children use like as often as their peers and use it to signify similar information about upcoming speech to their listener.

Conventions for unconventional language: Revisiting a framework for spoken language features in autism

BACKGROUND AND AIMS

Autism has long been characterized by a range of spoken language features, including, for instance: the tendency to repeat words and phrases, the use of invented words, and "pedantic" language. These observations have been the source of considerable disagreement in both the theoretical and applied realms. Despite persistent professional interest in these language features, there has been little consensus around terminology, definitions and developmental/clinical interpretation.

MAIN CONTRIBUTION

This review paper updates and expands an existing framework for unconventional language in autism to include a broader range of non-generative (echolalia and self-repetition) and generative (idiosyncratic phrases, neologisms and pedantic language) features often observed in the language of individuals on the autism spectrum. For each aspect of the framework, we review the various definitions and measurement approaches, and we provide a summary of individual and contextual correlates. We also propose some transitional language features that may bridge non-generative and generative domains (e.g., mitigated echolalia and gestalt language).

CONCLUSIONS

This updated framework offers a unified taxonomy and nomenclature that can facilitate further investigation and interpretation of unconventional language in autism.

IMPLICATIONS

There are important implications of this work for our understanding of the complex interplay between autism and language development. Equally important are the clinical ramifications that will guide evidence-based practice in assessment and intervention for individuals on the autism spectrum.

How do autistic adults use syntactic and prosodic cues to manage spoken discourse?

Discourse studies investigating differences in the socio-communicative profiles of autistic (ASD) and neurotypical (NT) individuals have mostly relied on orthographic transcriptions, without taking prosodic information into account. However, atypical prosody is ubiquitous in ASD and a more accurate representation of their discourse abilities should also include prosodic cues. This exploratory study addresses this gap by segmenting the spoken discourse of 12 ASD and NT adults using the framework of Basic Discourse Units (BDUs). BDUs result from the mapping of syntactic boundaries on prosodic units, which can coincide in different ways and are associated with different discourse strategies. We hypothesized that the discourse of ASD adults would display more atypical strategies than NT adults, reflecting a 'pedantic' style and more difficulties in managing ongoing discourse. While ASD adults did not produce more discourse units associated with didactic or pedantic strategies than NT adults, they did produce less units associated with strategies of interactional regulation. This study provides initial evidence that multidimensional linguistic units, such as BDUs can help differentiate speech delivery strategies of ASD adults from those of their NT peers, even based on simple prosodic cues like silent pauses.

The interaction of fine motor, gesture, and structural language skills: The case of autism spectrum disorder

Motor skill differences have been consistently reported in individuals with ASD. Associations between motor skill and social communication skills have been reported in both typical development (TD) and autism spectrum disorder (ASD). The current study extends these findings to characterize performance on a fine motor imitation task, probing skills as a predictor of social and communicative functioning, and co-speech gesture use. These research questions were addressed by a secondary analysis of data collected during a previous study characterizing a cohort of individuals who were diagnosed with ASD in early childhood but lost the autism diagnosis (LAD) by the time of adolescence. Fine motor imitation skills were compared between 14 individuals with LAD, 15 individuals with autism spectrum disorder (ASD), and 12 typically developing (TD) individuals. LAD and TD groups had more advanced fine motor imitation skills than the ASD group, and abilities were significantly associated with ASD symptoms and amount of gesture use (though there was a counterintuitive interaction between group and fine motor skill in the LAD and TD groups only, in which lower motor skills predicted more ASD symptoms; this relationship was of a small effect size and is likely driven by the compressed range of fine motor skills in these two groups). Findings suggest that fine motor skills normalize along with social communication skills and restricted and repetitive behaviors and interests in individuals who lose the ASD diagnosis, and that individuals with better fine motor abilities produce more co-speech gesture.

Conversation During a Virtual Reality Task Reveals New Structural Language Profiles of Children with ASD, ADHD, and Comorbid Symptoms of Both

Many studies have utilized standardized measures and storybook narratives to characterize language profiles of children with Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD). They report that structural language of these children is on par with mental-age-matched typically developing (TD) peers. Few studies have looked at structural language profiles in conversational contexts. This study examines conversational speech produced in a virtual reality (VR) paradigm to investigate the strengths and weaknesses of structural language abilities of these children. The VR paradigm introduced varying social and cognitive demands across phases. Our results indicate that children from these diagnostic groups produced less complex structural language than TD children. Moreover, language complexity decreased in all groups across phases, suggesting a cross-etiology sensitivity to conversational contexts.

Evaluating atypical language in autism using automated language measures

Measurement of language atypicalities in Autism Spectrum Disorder (ASD) is cumbersome and costly. Better language outcome measures are needed. Using language transcripts, we generated Automated Language Measures (ALMs) and tested their validity. 169 participants (96 ASD, 28 TD, 45 ADHD) ages 7 to 17 were evaluated with the Autism Diagnostic Observation Schedule. Transcripts of one task were analyzed to generate seven ALMs: mean length of utterance in morphemes, number of different word roots (NDWR), um proportion, content maze proportion, unintelligible proportion, c-units per minute, and repetition proportion. With the exception of repetition proportion (p [Formula: see text]), nonparametric ANOVAs showed significant group differences (p[Formula: see text]). The TD and ADHD groups did not differ from each other in post-hoc analyses. With the exception of NDWR, the ASD group showed significantly (p[Formula: see text]) lower scores than both comparison groups. The ALMs were correlated with standardized clinical and language evaluations of ASD. In age- and IQ-adjusted logistic regression analyses, four ALMs significantly predicted ASD status with satisfactory accuracy (67.9-75.5%). When ALMs were combined together, accuracy improved to 82.4%. These ALMs offer a promising approach for generating novel outcome measures.

Structural and Contextual Cues in Third-Person Pronoun Interpretation by Children with Autism Spectrum Disorder and Their Neurotypical Peers

This study investigates the use of structural and discourse contextual cues in the interpretation of third-person pronouns by children and adolescents with autism and their neurotypical peers. Results show that referent-biasing contextual information influences pronominal interpretation and modulates looking patterns in both groups compared to a context-neutral condition. These results go against the predictions of Weak Central Coherence and the notion that pragmatics in general is impaired in ASD, since the ASD group was able to use details in discourse context to influence the pronominal interpretation process. However, although discourse context influenced looking patterns in both groups, the groups nevertheless diverged in the nature of these patterns, suggesting that behavioral differences may emerge in more complicated discourse tasks.

Pragmatic Profiles of Toddlers With Autism Spectrum Disorder at the Onset of Speech

Using speech to communicate pragmatic functions is challenging among individuals with Autism Spectrum Disorder (ASD). Given the role language plays in developing everyday skills, we traced the unique pragmatic profile of early words, seeking comparison to typically developing (TD) toddlers at similar lexical stages. Twenty-four mother-toddler dyads participated (9 ASD and 15 TD). Dyads were video recorded when toddlers reached a productive lexicon of 40–70 words. These recordings were captured three times during naturalistic interaction and at two consecutive visits with a 2-month interval. Seven thousand three hundred seventy-six productions were analyzed and classified into four communicative intentions (Declaratives, Requests, Objections, and Non-Communicative speech). ASD toddlers were delayed in the emergence of words compared to TD toddlers, with a greater within-group variability (median 28 months, IQR 24.5–35, median 17 months, IQR 17–18, respectively, p < 0.001). In both groups, the most common communicative intention was Declarative. However, the percentage of Declaratives was higher among TD toddlers across visits compared to ASD toddlers. In both groups, most productions were directed toward the communicative partner, but ASD toddlers used Non-Communicative speech more often than TD peers. Non-Communicative speech gradually decreased over time. We conclude that while TD toddlers begin to talk with an already-established knowledge of the main communicative functions of words, ASD toddlers seem to have only a partial understanding and gradually improve communicative use as they expand their lexicon. These findings bear theoretical and practical implications for early intervention in ASD. We suggest that communicative profiles are affected by individual characteristics and by the interaction style.

Perceptual inference is impaired in individuals with ASD and intact in individuals who have lost the autism diagnosis

Beyond the symptoms which characterize their diagnoses, individuals with autism spectrum disorder (ASD) show enhanced performance in simple perceptual discrimination tasks. Often attributed to superior sensory sensitivities, enhanced performance may also reflect a weaker bias towards previously perceived stimuli. This study probes perceptual inference in a group of individuals who have lost the autism diagnosis (LAD); that is, they were diagnosed with ASD in early childhood but have no current ASD symptoms. Groups of LAD, current ASD, and typically developing (TD) participants completed an auditory discrimination task. Individuals with TD showed a bias towards previously perceived stimuli-a perceptual process called "contraction bias"; that is, their representation of a given tone was contracted towards the preceding trial stimulus in a manner that is Bayesian optimal. Similarly, individuals in the LAD group showed a contraction bias. In contrast, individuals with current ASD showed a weaker contraction bias, suggesting reduced perceptual inferencing. These findings suggest that changes that characterize LAD extend beyond the social and communicative symptoms of ASD, impacting perceptual domains. Measuring perceptual processing earlier in development in ASD will tap the causality between changes in perceptual and symptomatological domains. Further, the characterization of perceptual inference could reveal meaningful individual differences in complex high-level behaviors.

Eliciting Language Samples for Analysis (ELSA): A New Protocol for Assessing Expressive Language and Communication in Autism

Expressive language and communication are among the key targets of interventions for individuals with autism spectrum disorder (ASD), and natural language samples provide an optimal approach for their assessment. Currently, there are no protocols for collecting such samples that cover a wide range of ages or language abilities, particularly for children/adolescents who have very limited spoken language. We introduce a new protocol for collecting language samples, eliciting language samples for analysis (ELSA), and a novel approach for deriving basic measures of verbal communicative competence from it that bypasses the need for time-consuming transcription. Study 1 presents ELSA-adolescents (ELSA-A), designed for minimally and low-verbal older children/adolescents with ASD. The protocol successfully engaged and elicited speech from 46 participants across a wide range of ages (6;6-19;7) with samples averaging 20-25 min. The collected samples were segmented into speaker utterances (examiner and participant) using real-time coding as one is listening to the audio recording and two measures were derived: frequency of utterances and conversational turns per minute. These measures were shown to be reliable and valid. For Study 2, ELSA was adapted for younger children (ELSA-Toddler [ELSA-T]) with samples averaging 29 min from 19 toddlers (2;8-4;10 years) with ASD. Again, measures of frequency of utterances and conversational turns derived from ELSA-T were shown to have strong psychometric properties. In Study 3, we found that ELSA-A and ELSA-T were equivalent in eliciting language from 17 children with ASD (ages: 4;0-6;8), demonstrating their suitability for deriving robust objective assessments of expressive language that could be used to track change in ability over time. We introduce a new protocol for collecting expressive language samples, ELSA, that can be used with a wide age range, from toddlers (ELSA-T) to older adolescents (ELSA-A) with ASD who have minimal or low-verbal abilities. The measures of language and communication derived from them, frequency of utterances, and conversational turns per minute, using real-time coding methods, can be used to characterize ability and chart change in intervention research. LAY SUMMARY: We introduce a new protocol for collecting expressive language samples, ELSA, that can be used with a wide age range, from toddlers (ELSA-T) to older adolescents (ELSA-A) with autism spectrum disorder who have minimal or low-verbal abilities. The measures of language and communication derived from them, frequency of utterances and conversational turns per minute, using real-time coding methods, can be used to characterize ability and chart change in intervention research.

Semantic-Pragmatic Impairment in the Narratives of Children With Autism Spectrum Disorders

Narrative impairments are common in autism spectrum disorders (ASDs). The Autism Diagnostic Observation Schedule (ADOS) battery includes a story-telling activity using a picture book called Tuesday. The current study aimed to identify differences between children with ASD and children with typical development (TD) on the production of Tuesday narratives, with a special focus on semantic-pragmatic aspects. Participants were 48 cognitively-able boys, in the age range of 4;10–7;0 years. Twenty-four participants were boys with ASD and 24 participants were TD boys. The semantic-pragmatic analysis included measures of: story details (characters setting, objects, and actions), central ideas, evaluative comments, and unrelated text. Results showed that the narratives produced by children with ASD included fewer central ideas, and fewer settings, characters, and actions, but not objects, as compared with the narratives produced by their TD peers. The number of evaluative comments and utterances that were unrelated to the story did not differ between the groups. A negative correlation was found between the autism severity level and the number of central ideas and number of characters mentioned in the narratives of the ASD participants. Taken together, as a group, these findings point to a semantic-pragmatic impairment in ASD. However, individual analysis revealed heterogeneity within the ASD group in this area. Some of the results may be explained by cognitive deficits in maintaining central coherence (the Weak Central Coherence account). This study has important clinical implications. Defining the specific differentiating measures can maximize the use of the ADOS story-telling activity by clinicians. The association found between the autism severity level and some of the semantic measures can be used in evaluating the severity of the ASD symptoms.

Gender Differences in Pragmatic Communication in School-Aged Children with Autism Spectrum Disorder (ASD)

Possible gender differences in manifestations of autism spectrum disorder (ASD) were examined using data on production of narratives. The Expression, Reception and Recall of Narrative Instrument (ERRNI; Bishop, Expression, Reception and Recall of Narrative Instrument, Harcourt assessment, London, 2004) was administered to a sample of matched 8-year-old intellectually able boys and girls with ASD (13M, 13F), who had been selected from a large, longitudinal study. In addition, transcripts of the narratives were analyzed in detail. Significant gender differences were found in narrative production. Girls included more salient story elements than boys. On detailed language analysis, girls were also shown to tell richer stories, including more descriptors of planning or intention. Overall, our findings suggest that subtle differences in social communication may exist between intellectually able boys and girls with ASD. If reliably identifiable in young children, such gender differences may contribute to differential diagnosis of ASD. In addition, such differences may pave the way for differential approaches to intervention when the target is effective communication in sophisticated discourse contexts.

Linguistic markers of autism in girls: evidence of a "blended phenotype" during storytelling

Background

Narrative abilities are linked to social impairment in autism spectrum disorder (ASD), such that reductions in words about cognitive processes (e.g., think, know) are thought to reflect underlying deficits in social cognition, including Theory of Mind. However, research suggests that typically developing (TD) boys and girls tell narratives in sex-specific ways, including differential reliance on cognitive process words. Given that most studies of narration in ASD have been conducted in predominantly male samples, it is possible that prior results showing reduced cognitive processing language in ASD may not generalize to autistic girls. To answer this question, we measured the relative frequency of two kinds of words in stories told by autistic girls and boys: nouns (words that indicate object-oriented storytelling) and cognitive process words (words like think and know that indicate mentalizing or attention to other peoples' internal states).

Methods

One hundred two verbally fluent school-aged children [girls with ASD (N = 21) and TD (N = 19), and boys with ASD (N = 41) and TD (N = 21)] were matched on age, IQ, and maternal education. Children told a story from a sequence of pictures, and word frequencies (nouns, cognitive process words) were compared.

Results

Autistic children of both sexes consistently produced a greater number of nouns than TD controls, indicating object-focused storytelling. There were no sex differences in cognitive process word use in the TD group, but autistic girls produced significantly more cognitive process words than autistic boys, despite comparable autism symptom severity. Thus, autistic girls showed a unique narrative profile that overlapped with autistic boys and typical girls/boys. Noun use correlated significantly with parent reports of social symptom severity in all groups, but cognitive process word use correlated with social ability in boys only.

Conclusion

This study extends prior research on autistic children's storytelling by measuring sex differences in the narratives of a relatively large, well-matched sample of children with and without ASD. Importantly, prior research showing that autistic children use fewer cognitive process words is true for boys only, while object-focused language is a sex-neutral linguistic marker of ASD. These findings suggest that sex-sensitive screening and diagnostic methods-preferably using objective metrics like natural language processing-may be helpful for identifying autistic girls, and could guide the development of future personalized treatment strategies.

When do Children with Autism Spectrum Disorder Take Common Ground into Account During Communication?

One feature of autism spectrum disorder (ASD) is a deficit in verbal reference production, that is, providing an appropriate amount of verbal information for the listener to refer to things, people, and events. However, very few studies have manipulated whether individuals with ASD can take a speaker's perspective to interpret verbal reference. A critical limitation of all interpretation studies is that comprehension of another's verbal reference required the participant to represent only the other's visual perspective. Yet, many everyday interpretations of verbal reference require knowledge of social perspective (i.e., a consideration of which experiences one has shared with which interlocutor). We investigated whether 22 5;0-7;11-year-old children with ASD and 22 well-matched typically developing (TD) children used social perspective to comprehend (Study 1) and produce (Study 2) verbal reference. Social perspective-taking was manipulated by having children collaboratively complete activities with one of two interlocutors such that for a given activity, one interlocutor was Knowledgeable and one was Naïve. Study 1 found no between-group differences for the interpretation of ambiguous references based on social perspective. In Study 2, when producing referring terms, the ASD group made modifications based on listener needs, but this effect was significantly stronger in the TD group. Overall, the findings suggest that high-functioning children with ASD know with which interlocutor they have previously shared a given experience and can take this information into account to steer verbal reference. Nonetheless, they show clear performance limitations in this regard relative to well-matched controls. Autism Res 2018, 11: 1366-1375. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: No one had studied if young children with autism spectrum disorder (ASD) could take into account previous collaboration with particular conversation partners to drive how well they communicate with others. In both their language understanding and spoken language, we found that five to 7-year-olds with ASD were able to consider what they had previously shared with the conversation partner. However, they were impaired when compared to typically developing children in the degree to which they tailored their spoken language for a specific listener.

Individual differences in the production of disfluency: A latent variable analysis of memory ability and verbal intelligence

Recent work has begun to focus on the role that individual differences in executive function and intelligence have on the production of fluent speech. However, isolating the underlying causes of different types of disfluency has been difficult given the speed and complexity of language production. In this study, we focused on the role of memory abilities and verbal intelligence, and we chose a task that relied heavily on memory for successful performance. Given the task demands, we hypothesised that a substantial proportion of disfluencies would be due to memory retrieval problems. We contrasted memory abilities with individual differences in verbal intelligence as previous work highlighted verbal intelligence as an important factor in disfluency production. A total of 78 participants memorised and repeated 40 syntactically complex sentences, which were recorded and coded for disfluencies. Model comparisons were carried out using hierarchical structural equation modelling. Results showed that repetitions were significantly related to verbal intelligence. Unfilled pauses and repairs, in contrast, were marginally ( p < .09) related to memory abilities. The relationship in all cases was negative. Conclusions explore the link between different types of disfluency and particular problems arising in the course of production, and how individual differences inform theoretical debates in language production.

Speaker-Versus Listener-Oriented Disfluency: A Re-examination of Arguments and Assumptions from Autism Spectrum Disorder

We re-evaluate conclusions about disfluency production in high-functioning forms of autism spectrum disorder (HFA). Previous studies examined individuals with HFA to address a theoretical question regarding speaker- and listener-oriented disfluencies. Individuals with HFA tend to be self-centric and have poor pragmatic language skills, and should be less likely to produce listener-oriented disfluency. However, previous studies did not account for individual differences variables that affect disfluency. We show that both matched and unmatched controls produce fewer repairs than individuals with HFA. For silent pauses, there was no difference between matched controls and HFA, but both groups produced more than unmatched controls. These results identify limitations in prior research and shed light on the relationship between autism spectrum disorders and disfluent speech.

Pragmatic competence of children with autism spectrum disorder. Impact of theory of mind, verbal working memory, ADHD symptoms, and structural language

The primary aim of this study is to increase the existing knowledge about the pragmatic skills of children with autism spectrum disorders (ASD). Specifically, the study has two objectives. The first is to provide a profile of characteristics based on The Children's Communication Checklist (CCC-2) pragmatics scales (inappropriate initiation, stereotyped language, use of context, nonverbal communication, and general pragmatics) and narrative task indicators. To this end, children with ASD will be compared to children with typical development (TD), controlling the effects of sex and structural language (speech, syntax, semantics, coherence). The second objective is to analyze whether theory of mind (ToM), verbal working memory, ADHD symptoms, and structural language can predict pragmatic competence in children with ASD without intellectual disability (ID). The results showed worse performance in the group with ASD on the majority of the pragmatic aspects evaluated. In addition, the application of ToM skills and structural language were significant predictors of the pragmatic skills of the children with ASD. These findings reinforce the importance of focusing intervention programs on mentalist abilities through experiences in real social scenarios, along with strengthening structural language components.

Syntactic and Story Structure Complexity in the Narratives of High- and Low-Language Ability Children with Autism Spectrum Disorder

Although language impairment is commonly associated with the autism spectrum disorder (ASD), the Diagnostic Statistical Manual no longer includes language impairment as a necessary component of an ASD diagnosis (American Psychiatric Association, 2013). However, children with ASD and no comorbid intellectual disability struggle with some aspects of language whose precise nature is still outstanding. Narratives have been extensively used as a tool to examine lexical and syntactic abilities, as well as pragmatic skills in children with ASD. This study contributes to this literature by investigating the narrative skills of 30 Greek-speaking children with ASD and normal non-verbal IQ, 16 with language skills in the upper end of the normal range (ASD-HL), and 14 in the lower end of the normal range (ASD-LL). The control group consisted of 15 age-matched typically-developing (TD) children. Narrative performance was measured in terms of both microstructural and macrostructural properties. Microstructural properties included lexical and syntactic measures of complexity such as subordinate vs. coordinate clauses and types of subordinate clauses. Macrostructure was measured in terms of the diversity in the use of internal state terms (ISTs) and story structure complexity, i.e., children's ability to produce important units of information that involve the setting, characters, events, and outcomes of the story, as well as the characters' thoughts and feelings. The findings demonstrate that high language ability and syntactic complexity pattern together in ASD children's narrative performance and that language ability compensates for autistic children's pragmatic deficit associated with the production of Theory of Mind-related ISTs. Nevertheless, both groups of children with ASD (high and low language ability) scored lower than the TD controls in the production of Theory of Mind-unrelated ISTs, modifier clauses and story structure complexity.

Ratings of Broader Autism Phenotype and Personality Traits in Optimal Outcomes from Autism Spectrum Disorder

The study examines whether "optimal outcome" (OO) children, despite no longer meeting diagnostic criteria for Autism Spectrum Disorder (ASD), exhibit personality traits often found in those with ASD. Nine zero acquaintance raters evaluated Broader Autism Phenotype (BAP) and Big Five personality traits of 22 OO individuals, 27 high functioning individuals with ASD (HFA), and 23 typically developing (TD) peers. HFA children displayed higher ratings than their peers on all BAP traits. OO were indistinguishable from TD, with the exception of greater extraversion (e.g., increased talkativeness), a potential tendency to be less emotionally stable, and pragmatic language deficits such as getting sidetracked in conversation. Overall, OO individuals are not showing BAP characteristics, but may be subject to other mild ADHD-like characteristics.

Linguistic camouflage in girls with autism spectrum disorder

Background

Autism spectrum disorder (ASD) is diagnosed more frequently in boys than girls, even when girls are equally symptomatic. Cutting-edge behavioral imaging has detected “camouflaging” in girls with ASD, wherein social behaviors appear superficially typical, complicating diagnosis. The present study explores a new kind of camouflage based on language differences. Pauses during conversation can be filled with words like UM or UH, but research suggests that these two words are pragmatically distinct (e.g., UM is used to signal longer pauses, and may correlate with greater social communicative sophistication than UH). Large-scale research suggests that women and younger people produce higher rates of UM during conversational pauses than do men and older people, who produce relatively more UH. Although it has been argued that children and adolescents with ASD use UM less often than typical peers, prior research has not included sufficient numbers of girls to examine whether sex explains this effect. Here, we explore UM vs. UH in school-aged boys and girls with ASD, and ask whether filled pauses relate to dimensional measures of autism symptom severity.

Methods

Sixty-five verbal school-aged participants with ASD (49 boys, 16 girls, IQ estimates in the average range) participated, along with a small comparison group of typically developing children (8 boys, 9 girls). Speech samples from the Autism Diagnostic Observation Schedule were orthographically transcribed and time-aligned, with filled pauses marked. Parents completed the Social Communication Questionnaire and the Vineland Adaptive Behavior Scales.

Results

Girls used UH less often than boys across both diagnostic groups. UH suppression resulted in higher UM ratios for girls than boys, and overall filled pause rates were higher for typical children than for children with ASD. Higher UM ratios correlated with better socialization in boys with ASD, but this effect was driven by increased use of UH by boys with greater symptoms.

Conclusions

Pragmatic language markers distinguish girls and boys with ASD, mirroring sex differences in the general population. One implication of this finding is that typical-sounding disfluency patterns (i.e., reduced relative UH production leading to higher UM ratios) may normalize the way girls with ASD sound relative to other children, serving as “linguistic camouflage” for a naïve listener and distinguishing them from boys with ASD. This first-of-its-kind study highlights the importance of continued commitment to understanding how sex and gender change the way that ASD manifests, and illustrates the potential of natural language to contribute to objective “behavioral imaging” diagnostics for ASD.

Beyond Sentences: Using the Expression, Reception, and Recall of Narratives Instrument to Assess Communication in School-Aged Children With Autism Spectrum Disorder

PURPOSE

Impairments in the social use of language are universal in autism spectrum disorder (ASD), but few standardized measures evaluate communication skills above the level of individual words or sentences. This study evaluated the Expression, Reception, and Recall of Narrative Instrument (ERRNI; Bishop, 2004) to determine its contribution to assessing language and communicative impairment beyond the sentence level in children with ASD.

METHOD

A battery of assessments, including measures of cognition, language, pragmatics, severity of autism symptoms, and adaptive functioning, was administered to 74 8- to 9-year-old intellectually able children with ASD.

RESULTS

Average performance on the ERRNI was significantly poorer than on the Clinical Evaluation of Language Fundamentals-Fourth Edition (CELF-4). In addition, ERRNI scores reflecting the number and quality of relevant story components included in the participants' narratives were significantly positively related to scores on measures of nonverbal cognitive skill, language, and everyday adaptive communication, and significantly negatively correlated with the severity of affective autism symptoms.

CONCLUSION

Results suggest that the ERRNI reveals discourse impairments that may not be identified by measures that focus on individual words and sentences. Overall, the ERRNI provides a useful measure of communicative skill beyond the sentence level in school-aged children with ASD.

Rates of autism and potential risk factors in children with congenital heart defects

OBJECTIVE

Atypical development, behavioral difficulties, and academic underachievement are common morbidities in children with a history of congenital heart defects and impact quality of life. Language and social-cognitive deficits have been described, which are associated with autism spectrum disorders. The current study aimed to assess the rates of autism spectrum disorders in a large sample of children with a history of congenital heart defects and to assess medical, behavioral, and individual factors that may be associated with the risk of autism spectrum disorders.

DESIGN

Participants included 195 children with a history of congenital heart defects, who are followed in a large-scale longitudinal study. Measures included behavioral data from 4-year-old neurodevelopmental evaluations and parent-report data from a later annual follow-up.

RESULTS

Using established cutoffs on an autism spectrum disorder screener, children with congenital heart defects showed higher rates of "possible" autism spectrum disorders than national rates, (Chi-square Test of Equal Proportions), all Ps < .05. A stepwise variable selection method was used to create a "best prediction model" and multivariable logistic regression was used to identify variables predicting diagnostic status. Factors associated with diagnostic risk included medical (delayed sternal closure, prematurity, positive genetic findings), behavioral (cognitive, language, attention issues), and individual (socioeconomic, cultural/racial) variables. ROC analyses identified a cutoff of 7 to maximize sensitivity/specificity based on parent-reported diagnosis.

CONCLUSIONS

Risk of autism spectrum disorder screening status in children with congenital heart defects was higher than expected from population rates. Findings highlight the need for referral to a specialist to assess the presence and severity of social-communication issues and congenital heart defects population-specific screening thresholds for children with concern for autism spectrum disorders.

Quantitative analysis of disfluency in children with autism spectrum disorder or language impairment

Deficits in social communication, particularly pragmatic language, are characteristic of individuals with autism spectrum disorder (ASD). Speech disfluencies may serve pragmatic functions such as cueing speaking problems. Previous studies have found that speakers with ASD differ from typically developing (TD) speakers in the types and patterns of disfluencies they produce, but fail to provide sufficiently detailed characterizations of the methods used to categorize and quantify disfluency, making cross-study comparison difficult. In this study we propose a simple schema for classifying major disfluency types, and use this schema in an exploratory analysis of differences in disfluency rates and patterns among children with ASD compared to TD and language impaired (SLI) groups. 115 children ages 4–8 participated in the study (ASD = 51; SLI = 20; TD = 44), completing a battery of experimental tasks and assessments. Measures of morphological and syntactic complexity, as well as word and disfluency counts, were derived from transcripts of the Autism Diagnostic Observation Schedule (ADOS). High inter-annotator agreement was obtained with the use of the proposed schema. Analyses showed ASD children produced a higher ratio of content to filler disfluencies than TD children. Relative frequencies of repetitions, revisions, and false starts did not differ significantly between groups. TD children also produced more cued disfluencies than ASD children.

'Form is easy, meaning is hard' revisited: (re) characterizing the strengths and weaknesses of language in children with autism spectrum disorder

Children with autism spectrum disorder (ASD) demonstrate impairments in social interaction and communication, and in repetitive/stereotypical behaviors. The degree to which children with ASD also manifest impairments in structural language-such as lexicon and grammar-is currently quite controversial. We reframe this controversy in terms of Naigles' (Naigles, Cognition 2002, 86: 157-199) 'form is easy, meaning is hard' thesis, and propose that the social difficulties of children with ASD will lead the meaning-related components of their language to be relatively more impaired than the form-related components. Our review of the extant literature supports this proposal, with studies (1) reporting that children with ASD demonstrate significant challenges in the areas of pragmatics and lexical/semantic organization and (2) highlighting their good performance on grammatical assessments ranging from wh-questions to reflexive pronouns. Studies on children with ASD who might have a co-morbid grammatical impairment are discussed in light of the absence of relevant lexical-semantic data from the same children. Most importantly, we present direct comparisons of assessments of lexical/semantic organization and grammatical knowledge from the same children from our laboratory, all of which find more children at a given age demonstrating grammatical knowledge than semantic organization. We conclude with a call for additional research in which in-depth grammatical knowledge and detailed semantic organization are assessed in the same children. WIREs Cogn Sci 2017, 8:e1438. doi: 10.1002/wcs.1438 This article is categorized under: Linguistics > Language Acquisition Linguistics > Language in Mind and Brain Neuroscience > Development.

Attention and written expression in school-age, high-functioning children with autism spectrum disorders

High-functioning children with autism spectrum disorders often find writing challenging. These writing difficulties may be specific to autism spectrum disorder or to a more general clinical effect of attention disturbance, as these children are often comorbid for attention-deficit/hyperactivity disorder (ADHD) symptomatology (and children with attention-deficit/hyperactivity disorder often also find writing challenging). To examine this issue, this study investigated the role of attention disturbance on writing in 155 school-age children across four diagnostic groups: high-functioning autism spectrum disorder (HFASD) with lower ADHD symptoms (HFASD-L), HFASD with higher ADHD symptoms (HFASD-H), ADHD symptoms but no autism spectrum disorder symptoms, and typical development. Both HFASD subgroups and the ADHD group displayed lower word production writing scores than the typical development group, but the clinical groups did not differ. The HFASD-H and ADHD groups had significantly lower theme development and text organization writing scores than the typical development group, but the HFASD-L and typical development groups were not significantly different. The findings support prior research reporting writing problems in children with autism spectrum disorder but also suggest that children with HFASD-H may be at greater risk for writing difficulties than children with HFASD-L. Better understanding the role of attention in writing development could advance methods for assessment and intervention for children with high-functioning autism spectrum disorder at risk for writing difficulties.

Narratives of children with high-functioning autism spectrum disorder: A meta-analysis

BACKGROUND

The aim of this meta-analysis was to analyze the narrative performance of children and adolescents with high-functioning Autism Spectrum Disorders (ASD) in terms of microstructure, macrostructure and internal state language.

METHOD

A systematic literature search yielded 24 studies that met the predetermined inclusion criteria. Effect sizes for each study were calculated for eight variables and analyzed using a random effects model. Intellectual ability, age and type of narrative were considered as potential moderators.

RESULTS

Results revealed that the children with ASD performed significantly worse than their peers on all the variables considered.

CONCLUSIONS

Findings are discussed taking into account the main explanatory psychological autism theories. Implications for intervention and orientations for future research are suggested.

Uh, Um, and Autism: Filler Disfluencies as Pragmatic Markers in Adolescents with Optimal Outcomes from Autism Spectrum Disorder

Filler disfluencies--uh and um--are thought to serve distinct discourse functions. We examined fillers in spontaneous speech by youth with autism spectrum disorder (ASD), who struggle with pragmatic language, and by youth with ASD who have achieved an 'optimal outcome' (OO), as well as in peers with typical development (TD). While uh rates did not differ, participants with ASD produced um less frequently than OO or TD groups. Um rate was associated with autism symptom severity, but not executive function or language abilities, suggesting that um serves a pragmatic, listener-oriented function. Moreover, in contrast to minimal production in ASD, the typical OO um production substantiates the normalization of subtle social communication in this population.

Uh and um in children with autism spectrum disorders or language impairment

Atypical pragmatic language is often present in individuals with autism spectrum disorders (ASD), along with delays or deficits in structural language. This study investigated the use of the "fillers" uh and um by children ages 4-8 during the autism diagnostic observation schedule. Fillers reflect speakers' difficulties with planning and delivering speech, but they also serve communicative purposes, such as negotiating control of the floor or conveying uncertainty. We hypothesized that children with ASD would use different patterns of fillers compared to peers with typical development or with specific language impairment (SLI), reflecting differences in social ability and communicative intent. Regression analyses revealed that children in the ASD group were much less likely to use um than children in the other two groups. Filler use is an easy-to-quantify feature of behavior that, in concert with other observations, may help to distinguish ASD from SLI. Autism Res 2016, 9: 854-865. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Story Goodness in Adolescents With Autism Spectrum Disorder (ASD) and in Optimal Outcomes From ASD

PURPOSE

This study examined narrative quality of adolescents with autism spectrum disorder (ASD) using a well-studied "story goodness" coding system.

METHOD

Narrative samples were analyzed for distinct aspects of story goodness and rated by naïve readers on dimensions of story goodness, accuracy, cohesiveness, and oddness. Adolescents with high-functioning ASD were compared with adolescents with typical development (TD; n = 15 per group). A second study compared narratives from adolescents across three groups: ASD, TD, and youths with "optimal outcomes," who were diagnosed with ASD early in development but no longer meet criteria for ASD and have typical behavioral functioning.

RESULTS

In both studies, the ASD group's narratives had lower composite quality scores compared with peers with typical development. In Study 2, narratives from the optimal outcomes group were intermediate in scores and did not differ significantly from those of either other group. However, naïve raters were able to detect qualitative narrative differences across groups.

CONCLUSIONS

Findings indicate that pragmatic deficits in ASD are salient and could have clinical relevance. Furthermore, results indicate subtle differences in pragmatic language skills for individuals with optimal outcomes despite otherwise typical language skills in other domains. These results highlight the need for clinical interventions tailored to the specific deficits of these populations.

Psychiatric Symptoms in Youth with a History of Autism and Optimal Outcome

Since autism spectrum disorder (ASD) is often comorbid with psychiatric disorders, children who no longer meet criteria for ASD (optimal outcome; OO) may still be at risk for psychiatric disorders. A parent interview for DSM-IV psychiatric disorders (K-SADS-PL) for 33 OO, 42 high-functioning autism (HFA) and 34 typically developing (TD) youth, ages 8-21, showed that OO and HFA groups had elevated current ADHD and specific phobias, with tics in HFA. In the past, the HFA group also had elevated depression and ODD, and the OO group had tics. The HFA group also showed subthreshold symptoms of specific and social phobias, and generalized anxiety. Psychopathology in the OO group abated over time as did their autism, and decreased more than in HFA.