Exploring links between language and cognition in autism spectrum disorders: Complement sentences, false belief, and executive functioning

The link between the factuality of verb and the theory of mind ability of Mandarin-speaking children with high-functioning autism

BACKGROUND

Weak theory of mind (ToM) ability is a core deficit in children with autism. A growing body of work has found that there is a close relation between complement syntax and ToM in autistic children. However, researchers have not yet investigated whether other linguistic components may explain the difficulties in ToM reasoning in autistic children.

AIMS

To determine whether verb factuality (i.e., mental and action verbs) is related to ToM ability, as measured by a false belief understanding (FBU) task after controlling the effect of complement syntax for Mandarin-speaking autistic children.

METHODS & PROCEDURES

Participants were verbal autistic children, aged 4-7 years. Their IQ performance (verbal, performance and total IQ) and the comprehension of complement syntax were evaluated. A total of 38 children scoring over 9 points in complement syntax test and 90 points in the verbal IQ test were selected to complete verb factuality and FBU task. The χ2 tests and correlation analyses were carried out on two relations: (1) ToM ability and understanding of verb factuality; and (2) ToM ability and comprehension of complement syntax.

OUTCOMES & RESULTS

A total of 11 autistic children completed the action verb factuality task, while 14 completed the mental verb factuality task and 13 completed both tasks. Participants performed well on the verb factuality task, and their ToM performance appeared to be related to their linguistic ability, regardless of the type of verb (i.e., action or mental verb). However, complement syntax scores did not significantly predict the success of the FBU task for the autistic children.

CONCLUSIONS & IMPLICATIONS

The results of this study link weaker ToM ability with the understanding of verb factuality among autistic children aged 4-7 and provide new evidence for the view that the development of language facilitates improvement of ToM skills. The findings shed new light on how language affects or determines social interactions.

WHAT THIS PAPER ADDS

What is already known on the subject ToM ability is crucial for social interaction. It has been claimed that mental verb factuality (e.g., think, had thought) may play a role in the development of ToM reasoning in typically developing children, but whether there is a link between the mastery of verb factuality and ToM skills in autistic children is still unclear. What this study adds to existing knowledge Correlational analysis revealed links between verbal ToM measured by unexpected location task and factuality test of mental verbs as well as action verbs. More importantly, this study confirmed the extra role of verb factuality in explaining ToM ability after excluding the influence of the complement syntax. What are the potential or actual clinical implications of this work? This study suggests that the factuality of verbs could serve as a tool for autistic children to infer the mental states of others. Thus, training on this linguistic structure could be taken into consideration when improving the social skills of autistic children.

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.

Emotional descriptions increase accidental harm punishment and its cortico-limbic signatures during moral judgment in autism

Individuals with autism spectrum disorder (ASD) present difficulties in integrating mental state information in complex moral tasks. Yet, ASD research has not examined whether this process is influenced by emotions, let alone while capturing its neural bases. We investigated how language-induced emotions modulate intent-based moral judgment in ASD. In a fMRI task, 30 adults with ASD and 27 neurotypical controls read vignettes whose protagonists commit harm either accidentally or intentionally, and then decided how much punishment the protagonist deserved. Emotional content was manipulated across scenarios through the use of graphic language (designed to trigger arousing negative responses) vs. plain (just-the-facts, emotionless) language. Off-line functional connectivity correlates of task performance were also analyzed. In ASD, emotional (graphic) descriptions amplified punishment ratings of accidental harms, associated with increased activity in fronto-temporo-limbic, precentral, and postcentral/supramarginal regions (critical for emotional and empathic processes), and reduced connectivity among the orbitofrontal cortex and the angular gyrus (involved in mentalizing). Language manipulation did not influence intentional harm processing in ASD. In conclusion, in arousing and ambiguous social situations that lack intentionality clues (i.e. graphic accidental harm scenarios), individuals with ASD would misuse their emotional responses as the main source of information to guide their moral decisions. Conversely, in face of explicit harmful intentions, they would be able to compensate their socioemotional alterations and assign punishment through non-emotional pathways. Despite limitations, such as the small sample size and low ecological validity of the task, results of the present study proved reliable and have relevant theoretical and translational implications.

Relationship between different types of complement syntax and false belief in Mandarin-speaking children with autism spectrum disorder and typically developing children

Previous studies have shown that complement syntax is closely associated with false belief (FB) in children with autism spectrum disorder (ASD). However, the relationship between different types of complement syntax and FB remains unclear. This study examined the relationship between different types of complement syntax and FB in both ASD and typically developing (TD) children. Thirty Mandarin-speaking ASD and TD children, each matched for language ability, were included. Children completed different types of complement syntax tasks, verbal and nonverbal FB. For the ASD children, results demonstrated that sentential complement syntax independently predicted verbal and nonverbal FB, while phrasal complement syntax only predicted nonverbal FB. For the TD children group, sentential complement syntax only predicted verbal FB. This indicates that as the language demands of the FB task decrease, ASD children can use both types of complement syntax for its prediction. Moreover, the characteristics of ASD children differ from TD children in terms of the relationship between different types of complement syntax and FB. The results of this study support de Villiers’ point of view from the Mandarin perspective and provide evidence for the social-cognitive component of the theory of mind.

Second-Order False Beliefs and Linguistic Recursion in Autism Spectrum Disorder

This study investigates the role of recursive language and working memory (WM) in second-order false belief skills in Danish-speaking children with autism spectrum disorder (ASD; n = 62; 8 females) and typical development (n = 41; 15 females), ages 6-16. Second-order false belief skills correlated with receptive grammar, vocabulary, and age; sentential complement production predicted second-order false beliefs, controlling for age, receptive grammar and WM. Regressions showed that second-order false belief was associated with age across groups, but with sentential complements in the ASD group only. Second-order false belief skills improved in children who received training in either recursive phrases (d = 0.21) or WM (d = 0.74), compared to an active control group. Results suggest that false belief skills are entwined with both linguistic and executive functions.

Language level predicts perceptual categorization of complex reversible events in children

Language plays a well-documented role in perceptual object categorization, but little is known about its role in the categorization of complex events. We explored this here with a perspective from age or developmentally appropriate language capacities in neurotypical children between the ages of two and four years (N = 21), and from delayed language development in a clinical group of children (N = 20), whose verbal mental ages (VMA) often fell far below their chronological ages (CAs). All participants watched two demonstrations of a series of transitive events (e.g. tiger jumps over a girl). The toy agents were then moved out of sight, and participants had to act out the same event type, based on a different tiger and girl that were selected among two distractors. We aimed to determine how mastery of this task relates to CA in the neurotypical group, and whether task performance in the clinical group was predicted by VMA and a standardized measure of grammatical comprehension. Results from a series of logistic mixed-effect regression models showed that neurotypical children start to perform correctly on this task with a chance of around 50% during their third year of CA but reach ceiling performance only during their fourth. A similar pattern emerged for VMA in the clinical group, despite a wide range of CAs and diagnoses. In addition, grammatical comprehension predicted performance. These patterns suggest that language competence plays a role in the perceptual categorization and encoding of complex reversible events.

Training Syntax to Enhance Theory of Mind in Children with ASD

Preschool children with neurotypical development (ND) trained on sentential complements ("X thinks/says that") improve their Theory of Mind (ToM) performance. Can complementation training also enhance ToM in children with Autism Spectrum Disorder (ASD)? Thirty-three children with ASD (Mage = 8;11) and 20 younger ND peers (Mage = 4;3) were trained on sentential complements (4-6 weeks, 2-3 times per week, via the DIRE i-Pad App). Pre-training and post-training comparisons show that (1) training boosted both complementation and ToM performance across groups; (2) improvements remained 4-6 weeks after training ended; (3) participants with milder ASD symptoms made most gains. Training on sentential complements thus seems beneficial for addressing ToM difficulties in children with ASD, especially those with milder symptoms.

Are Executive Dysfunctions Relevant for the Autism-Specific Cognitive Profile?

Executive functions (EF) have been shown to be important for the understanding of Autism Spectrum Disorder (ASD), but dysfunctions of EF are not autism-specific. The specific role of EF in ASD, its relationship to core autism characteristics, such as mentalizing, needs to be explored. Medline- and PsychINFO databases were searched for studies published between 1990 and 2020 that included measures of EF in ASD and typically developing control persons (TD) in combination with either Theory of Mind (ToM) or Weak Central Coherence (WCC) tasks. A pre-registered meta-analysis and cross-study regression was performed including a total of 42 studies (ASD n = 1,546, TD n = 1,206). Results were reported according to PRISMA guidelines. In all cognitive domains, the ASD group showed significantly reduced performance. Importantly, EF subdomains and ToM were not significantly correlated. This finding rules out a significant association between EF subdomains and ToM and questions the relevance of EF dysfunctions for the autism-specific feature of reduced mentalizing.

Syntactic Strategy Training for Theory of Mind in Deaf Children

Children who are deaf or hard of hearing (DHH) show delays in Theory of Mind (ToM) development. Complement sentences such as "Eliane says that Santa Clause exists" influence ToM performance. Can a training program targeting sentential complements enhance ToM? Twenty-one French-speaking DHH children (Mage = 8 years 11 months) with delays in ToM and sentential complements completed a first series of tests (T0). Children were tested again to control for maturation effects (T1), after which they were included in a 6- to 8-week training program targeting complements with verbs of communication. Post-training tests (T2) assessed if the training yielded improvements on complements (direct effect) and ToM (transfer effect). While no gains were noted in the absence of training (at T1), results indicate post-training (T2) improvements in complements and ToM tasks, suggesting that the acquisition of sentential complements provides a tool to represent subjective truths and boosts ToM reasoning in DDH children.

Implicit and Explicit Memory in Youths with High-Functioning Autism Spectrum Disorder: A Case-Control Study

Individuals with autism spectrum disorder (ASD) usually manifest heterogeneous impairments in their higher cognitive functions, including their implicit memory (IM) and explicit memory (EM). However, the findings on IM and EM in youths with ASD remain debated. The aim of this study was to clarify such conflicting results by examining IM and EM using two comparable versions of the Serial Reaction Time Task (SRTT) in the same group of children and adolescents with ASD. Twenty-five youths with high-functioning ASD and 29 age-matched and IQ-matched typically developing youths undertook both tasks. The ability to implicitly learn the temporal sequence of events across the blocks in the SRTT was intact in the youths with ASD. When they were tested for EM, the participants with ASD did not experience a significant reduction in their reaction times during the blocks with the previously learned sequence, suggesting an impairment in EM. Moreover, the participants with ASD were less accurate and made more omissions than the controls in the EM task. The implications of these findings for the establishment of tailored educational programs for children with high-functioning ASD are discussed.

The relationship between autistic characteristics, social engagement and executive function in a typical sample

Purpose

This study aims to represent a first attempt to examine in a non-clinical population the interplay between social engagement, executive function (EF) and theory of mind (ToM) within a social motivation theory framework.

Design/methodology/approach

A total of 170 participants (135 female; mean age = 19.01 and standard deviation = 1.27) completed measures of ToM (Faux Pas task), autistic traits (Autism Spectrum Quotient), social engagement (reward dependence subscale of the Temperament and Character Inventory), sociability and EF (both subscales of the Adult Temperament Questionnaire).

Findings

Path analyses found that EF, sociability and social engagement were negatively associated with autistic traits both directly and indirectly. Results indicate that EF may impact sociability and social engagement and their interaction may relate to the degree of autistic traits shown in a typical sample. However, ToM (as measured by the Faux Pas test) was not related to any of the other variables.

Originality/value

Sociability, social engagement and effortful control deficits may be linked to higher levels of autistic traits. These factors appear to form a hierarchy of factors underpinning autism spectrum disorder, with EF contributing to all aspects, followed by sociability and social engagement at a higher level. Future research examining in clinical populations the utility of a more integrated model of social motivation that incorporates EF appears warranted.

Theory of Mind, Executive Functions, and Syntax in Bilingual Children with Autism Spectrum Disorder

Impairments in Theory of Mind (ToM) are a core feature of Autism Spectrum Disorder (ASD). ToM may be enhanced by various factors, including bilingualism, executive functions (EF), and complex syntax. This work investigates the language-cognition interface in ASD by exploring whether ToM can be enhanced by bilingualism, whether such ToM boosts would be due to EF or syntax, and whether routes to mentalizing would differ between bilinguals and monolinguals on the spectrum. Twenty-seven monolingual Greek-speaking and twenty-nine bilingual Albanian-Greek children with ASD were tested on ToM reasoning in verbal and low-verbal ToM tasks, an executive function 2-back task, and a sentence repetition task. Results revealed that bilingual children with ASD performed better than monolinguals with ASD in the low-verbal ToM and the 2-back tasks. In the sentence repetition task, bilinguals scored higher than monolinguals in complex sentences, and specifically in adverbials and relatives. Regarding the relations between ToM, EF, and sentence repetition, the monolingual group’s performance in the verbal ToM tasks was associated with complement syntax, whereas, for the bilingual children with ASD, performance in both verbal and low-verbal ToM tasks was associated with EF and adverbial clause repetition. The overall pattern of results suggests that mentalizing may follow distinct pathways across the two groups.

Validation of the Tunisian Social Situation Instrument in the General Pediatric Population

Background

In order to better understand the deployment of the theory of mind (ToM) in Tunisian neurotypical children, we have developed a new tool of assessment of the ToM called the “Tunisian Social Situations Instrument” (TSSI). We opted for the creation of this test in view of the intercultural differences in the development of social skills. Our purpose was to validate this tool in general pediatric population.

Methods

It was a cross-sectional evaluative study that aimed to validate the TSSI in the general pediatric population. We initially conducted a beta test and a pre-validation study before taking the initial version of the TSSI on 123 neurotypical children. Then, we followed the typical validation procedure: appearance validity, content validity, construct validity, and reliability study.

Results

Regarding the validity of appearance, the TSSI was comprehensible and adapted to the Tunisian pediatric population. About content validity, the exploratory factor analysis extracted 6 factors that explain 69.3% of the total variance. These factors were respectively social clumsiness types 1 and 2, intention attribution, emotional ToM, epistemic ToM, and simple comprehension questions. The subdomains of social clumsiness (types 1 and 2) and emotional ToM had a Cronbach alpha higher than 0.8. This factor structure as well as the significant inter-correlation between subdomains and the global score were in favor of a good construct validity. The internal consistency study showed good reliability of the final version of the TSSI (alpha of Cronbach at 0,809). Regarding the performance of children at the TSSI, we have noticed a significant association between the global score, age, and verbal intelligence.

Conclusion

This work offers valuable insights about ToM and provides clinicians with a reliable tool to assess social clumsiness and emotional ToM in typically developing children.

Cognitive and Affective Aspects of Theory of Mind in Greek-Speaking Children with Autism Spectrum Disorders

Substantial research indicates that individuals with Autism Spectrum Disorder (ASD) have difficulties with Theory of Mind (ToM) abilities, but rarely have studies used a comprehensive battery to measure both the cognitive and affective aspects of ToM. The present study tested this ability in 24 Greek-speaking children with ASD (ages 7-14), and their performance was compared to 24 age-, gender- and language-matched typically developing controls. Results showed that ASD children's performance was selectively impaired in both ToM aspects, supporting the distinction between ToM components. This is the first study of ToM abilities among Greek-speaking children with ASD, and the findings confirm that children with ASD are experiencing difficulties with socio-emotional understanding across languages and cultures.

La comprensión de las meteduras de pata en escolares con autismo. Su relación con variables cognitivas y de teoría de la mente

El presente estudio tiene una doble finalidad. La primera es analizar dos de las variables implicadas en la comprensión de las meteduras de pata (MP) en el autismo (Cociente Intelectual; CI, y la Falsa Creencia; FC). La segunda, examinar en detalle las dificultades encontradas en la tarea de MP, dividida la población con autismo en dos grupos según su CI (Grupo 1= rango CI 100-120, Grupo 2 = rango CI 70-85). De dicha tarea de MP, se adaptaron cuatro historias (viñetas y narración) de Baron-Cohen, O’Riordan, Stone, Jones y Plaisted (1999), y se administraron a los dos grupos de niños y pre-adolescente con autismo (N = 34) de entre 7 y 12 años (M = 9.6, DE = 1.55), que las resolvieron a partir de respuestas de elección dicotómica y de explicación verbal. Los resultados demuestran la capacidad predictiva del CI total (r = 0.53; p < 0.001; R2 = 0.28) y de la FC (r = 0.51; p < 0.001; R2 = 0.26). El 40 % de la variabilidad de la tarea de MP se vio explicada por las variables predictores FC y Vocabulario. Además, se encontraron diferencias significativas entre grupos (el Grupo 1 respondió mejor que el Grupo 2) tanto en respuestas de elección forzada personaje (ii) e ignorancia (vii) y la suma total como en su explicación verbal. Estos resultados se discuten más detalladamente debido a su posible repercusión en la vida diaria de las personas con autismo.

The Impact of Grammar on Mentalizing: A Training Study Including Children With Autism Spectrum Disorder and Developmental Language Disorder

Training on complements in English, German, and Mandarin has been reported to trigger improvements on both complements and Theory of Mind (ToM), with typically developing (TD) pre-schoolers on the verge of developing these skills (Hale and Tager-Flusberg, 2003; Lohmann and Tomasello, 2003; Shuliang et al., 2014). In the current study, we build on the idea that increasing mastery of complementation holds the promise of enhancing ToM, and seek (i) to replicate the positive effects observed in previous work for this effect in French-speaking TD children, and (ii) to pilot extending this to clinical children, more specifically those with Autism Spectrum Disorder (ASD) and Developmental Language Disorder (DLD), through exploring whether improvement in the latter, clinical groups follows that of the TD group. Sixty children with ToM difficulties, 16 with ASD (aged 5;6–11;8), 20 with DLD (aged 4;8–9;0) and 24 typically developing children aged (2;9–5;3 years), participated in a 4-week training program. Half received training targeting sentential complements and half received a control training targeting lexical skills. Complementation training, but not lexical training, led to a significant direct increase in complements, and also had the indirect effect of significantly boosting belief reasoning. TD and clinical groups followed the same patterns of performance. These results confirm previous findings in other languages for TD, and further suggest promising new directions for therapeutic programs addressing ToM delays in populations of different aetiologies, namely the incorporation of a motivating training on complementation.

A Review of Language, Executive Function, and Intervention in Autism Spectrum Disorder

Difficulties with both executive functions and language skills are common but variable in autism spectrum disorder (ASD). Executive functions and language skills are related to one another, such that vocabulary, syntax, and pragmatics are related to domains of working memory, shifting, and inhibition in ASD, although the directionality of these relationships remains unclear. Moreover, interventions that target pragmatic ability have been found to improve executive function skills, and conversely, executive function interventions are linked with improvements in social skills in children with ASD. We review the literature on executive functions, language skills, and their relationship in ASD; discuss factors that may be driving inconsistent findings; and explore clinical applications from the research thus far.

Comprehension of Embedded Clauses in Schizophrenia With and Without Formal Thought Disorder

Formal thought disorder (FTD) in schizophrenia (SZ) is clinically manifested primarily through language production, where linguistic studies have reported numerous anomalies including lesser use of embedded clauses. Here, we explored whether problems of language may extend to comprehension and clause embedding in particular. A sentence-picture matching task was designed with two conditions in which embedded clauses were presupposed as either true (factive) or not. Performance across these two conditions was compared in people with SZ and moderate-to-severe FTD (SZ + FTD), SZ with minimal FTD (SZ-FTD), first-degree relatives of people with SZ, and neurotypical controls. The SZ + FTD group performed significantly worse than all others in both conditions, and worse in the nonfactive than in the factive one. These results demonstrate language dysfunction in comprehension specific to FTD is a critical aspect of grammatical complexity and its associated meaning, which has been independently known to be cognitively significant as well.

Speaking Your Mind: Language and Narrative in Young Children's Theory of Mind Development

Research consistently finds that language and theory of mind are interrelated. The content and qualities of language that specifically predict theory of mind remain under investigation and the question of why language might impact theory of mind development is open. In this chapter we analyze and highlight current findings and theory addressing theory of mind and language. The principal focus is upon typically developing children between ages 2 and 5, a period characterized by extensive development in language and social understanding. We propose that the study of young children's narrative development can inform how and why language and theory of mind are connected. False belief understanding and narrative comprehension share many similarities and this association provides a promising avenue for future work.

Executive Function Skills in School-Age Children With Autism Spectrum Disorder: Association With Language Abilities

PURPOSE

This article reviews research on executive function (EF) skills in children with autism spectrum disorder (ASD) and the relation between EF and language abilities. The current study assessed EF using nonverbal tasks of inhibition, shifting, and updating of working memory (WM) in school-age children with ASD. It also evaluated the association between children's receptive and expressive language abilities and EF performance.

METHOD

In this study, we sought to address variables that have contributed to inconsistencies in this area of research-including task issues, group comparisons, and participant heterogeneity. EF abilities in children with ASD (n = 48) were compared to typically developing controls (n = 71) matched on age, as well as when statistically controlling for group differences in nonverbal cognition, socioeconomic status, and social communication abilities. Six nonverbal EF tasks were administered-2 each to evaluate inhibition, shifting, and WM. Language abilities were assessed via a standardized language measure. Language-EF associations were examined for the ASD group as a whole and subdivided by language status.

RESULTS

Children with ASD exhibited significant deficits in all components of EF compared to age-mates and showed particular difficulty with shifting after accounting for group differences in nonverbal cognition. Controlling for social communication-a core deficit in ASD-eliminated group differences in EF performance. A modest association was observed between language (especially comprehension) and EF skills, with some evidence of different patterns between children on the autism spectrum with and without language impairment.

CONCLUSIONS

There is a need for future research to examine the direction of influence between EF and language. It would be beneficial for EF interventions with children with ASD to consider language outcomes and, conversely, to examine whether specific language training facilitates aspects of executive control in children on the autism spectrum.

PRESENTATION VIDEO

https://doi.org/10.23641/asha.7298144.

False belief and relative clauses in Autism Spectrum Disorders

Previous studies have suggested sentential complementation is the crucial ingredient of language that relates to false-belief (FB) reasoning, while the role of relative clauses (RCs) is less clear. Nevertheless, under the hypothesis that clausal embedding has a meta-representational effect, arguably implied in FB, one expects a link between FB and not only complementation but also relativization. Seventeen children with ASD (6 to 16 years, mean age 9;2) were assessed for RCs and FB. Comprehension of RCs significantly predicted FB performance, while none of the controlled factors played a predictive role (comprehension of simple sentences, vocabulary, morpho-syntax and working memory). Findings suggest that clausal embedding, common to both sentential complements and RCs, serves as a bootstrap for FB reasoning.

Assessing social-pragmatic inferencing skills in children with autism spectrum disorder

By utilizing the Pragma test this study investigated how sixteen five- to ten-year-old children with autism spectrum disorder (ASD) and sixteen typically developing (TD) children comprehended contextually challenging scenarios demanding 1) contextual inference with theory of mind (ToM), 2) contextual inference without ToM, 3) relevant use of language, 4) recognition of feelings, and 5) understanding false beliefs. The study also compared children's ability to explain their own correct answers. In addition, this study evaluated the sensitivity of three different methods for discriminating the children with ASD from the TD children: 1) the Pragma test, 2) the Social Interaction Deviance Composite (SIDC) of Children's Communication Checklist-2 (CCC-2), and 3) the Theory of Mind subtest of the Developmental Neuropsychological Assessment, Second edition (NEPSY-II). The results showed that children with ASD differed from TD children in questions demanding context utilization. However, the demand of mind-reading in utterance interpretation increased the difference between groups. Compared to TD children, children with ASD had more difficulties in explaining how they had used context to arrive at the correct answer. The discrimination power for detecting children with ASD from TD children was excellent in the Pragma test, good in the SIDC CCC-2 and fair in the Theory of Mind subtest of NEPSY-II. This study showed that by using contextually sensitive materials, such as the Pragma test, it is possible to detect the social-pragmatic inferencing difficulties of high-functioning children with ASD in structured test situations and not only in real-life situations or by using parental reports.

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.

Conceptualising compensation in neurodevelopmental disorders: Reflections from autism spectrum disorder

Within research into neurodevelopmental disorders, little is known about the mechanisms underpinning changes in symptom severity across development. When the behavioural presentation of a condition improves/symptoms lessen, this may be because core underlying atypicalities in cognition/neural function have ameliorated. An alternative possibility is 'compensation'; that the behavioural presentation appears improved, despite persisting deficits at cognitive and/or neurobiological levels. There is, however, currently no agreed technical definition of compensation or its behavioural, cognitive and neural characteristics. Furthermore, its workings in neurodevelopmental disorders have not been studied directly. Here, we review current evidence for compensation in neurodevelopmental disorders, using Autism Spectrum Disorder as an example, in order to move towards a better conceptualisation of the construct. We propose a transdiagnostic framework, where compensation represents the processes responsible for an observed mismatch between behaviour and underlying cognition in a neurodevelopmental disorder, at any point in development. Further, we explore potential cognitive and neural mechanisms driving compensation and discuss the broader relevance of the concept within research and clinical settings.

Language and False-Belief Task Performance in Children With Autism Spectrum Disorder

PURPOSE

Language is related to false-belief (FB) understanding in both typically developing children and children with autism spectrum disorder (ASD). The current study examined the role of complementation and general language in FB understanding. Of interest was whether language plays similar or different roles in the groups' FB performance.

METHOD

Participants were 16 typically developing children (mean age = 5.0 years; mental age = 6.7) and 18 with ASD (mean age = 7.3 years; mental age = 8.3). Children were administered FB and language tasks (say- and think-complements), receptive and expressive vocabulary tests, and relative clauses.

RESULTS

When mental age and receptive and expressive vocabulary were used as separate covariates, the typical control group outperformed the children with ASD in FB task performance. Chi-square analyses indicated that passing both complementation tasks was linked to the FB understanding of children with ASD. Children with ASD who passed FB tasks all passed say- and think-complement tasks. However, some children in the control group were able to pass the FB tasks, even if they failed the say- and think-complement tasks.

CONCLUSION

The results indicate that children with ASD relied more on complement understanding to pass FB than typically developing children. Results are discussed regarding the developmental pathways for FB understanding.

Can delusions be understood linguistically?

Delusions are widely believed to reflect disturbed cognitive function, but the nature of this remains elusive. The "un-Cartesian" cognitive-linguistic hypothesis maintains (a) that there is no thought separate from language, that is, there is no distinct mental space removed from language where "thinking" takes place; and (b) that a somewhat broadened concept of grammar is responsible for bestowing meaning on propositions, and this among other things gives them their quality of being true or false. It is argued that a loss of propositional meaning explains why delusions are false, impossible and sometimes fantastic. A closely related abnormality, failure of linguistic embedding, can additionally account for why delusions are held with fixed conviction and are not adequately justified by the patient. The un-Cartesian linguistic approach to delusions has points of contact with Frith's theory that inability to form meta-representations underlies a range of schizophrenic symptoms. It may also be relevant to the nature of the "second factor" in monothematic delusions in neurological disease. Finally, it can inform the current debate about whether or not delusions really are beliefs.

Theory of Mind in Children With Specific Language Impairment: A Systematic Review and Meta-Analysis

The relation between language and theory of mind (ToM) has been debated for more than two decades. In a similar vein, ToM has been examined in children with specific language impairment (SLI), albeit with inconsistent results. This meta-analysis of 17 studies with 745 children between the ages of 4 and 12 found that children with SLI had substantially lower ToM performance compared to age-matched typically developing children (d = .98). This effect size was not moderated by age and gender. By revealing that children with SLI have ToM impairments, this finding emphasizes the need for further investigation into the developmental interface between language and ToM as well as the extended consequences of atypical language development.