Measuring pragmatic language in speakers with autism spectrum disorders: Comparing the children's communication checklist--2 and the test of pragmatic language

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.

Social-Pragmatic Skills and Length of Bilingualism Predict Inhibitory Control in Children

PURPOSE

There is conflicting evidence regarding effects of bilingualism on inhibition, and the mechanisms that might underlie the effects remain unclear. A prominent account views additional demands on structural language use in bilinguals as being at the root of bilingual effects on inhibition. In this study, we tested the novel hypothesis that social-pragmatic skills (alone or together with structural language skills) are associated with inhibition in bilingual children.

METHOD

Parents of 114 typically developing 8- to 11-year-old Spanish-English bilingual children completed the Children's Communication Checklist-Second Edition to index social pragmatics and the Behavior Rating Inventory of Executive Function to index executive functioning skills. The Inhibit clinical scale score reflected children's inhibition. Children's language ability was indexed by the Clinical Evaluation of Language Fundamentals-Fourth Edition in English and Spanish. Length of bilingualism was operationalized continuously as the length of time children had been exposed to both languages in their lifetime. Moderation analyses tested the effects of structural language, social-pragmatic skills, and length of bilingual experience, and their interactions on inhibition.

RESULTS

While structural language skills were not associated with inhibition, they moderated the relation between social-pragmatic skills and inhibition, such that children with better social-pragmatic skills demonstrated better inhibition, and this effect was stronger for children with better structural language skills. Furthermore, longer length of bilingual experience was associated with better inhibition, and this effect was not moderated by any other predictor.

CONCLUSION

These results confirm a graded relationship between bilingualism and inhibition, and indicate that this association is not qualified by structural language or social-pragmatic skills.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21183916.

The clinical utility of the Children's Communication Checklist-2 in children with early childhood traumatic brain injury

ObjectivePediatric traumatic brain injury (TBI) is associated with long-term cognitive and behavioral deficits. Social communication impairments are common and impact functional outcomes, such as social engagement and academic performance. There are many barriers to identifying social communication deficits following TBI, including the absence of a standardized parent-reported communication measure for use in this population. The Children's Communication Checklist-Second Edition (CCC-2) has demonstrated utility in identifying communication deficits in diagnoses other than TBI. This study investigated the clinical utility of the CCC-2's social communication scales in children with TBI. Method: 203 children who sustained TBI or orthopedic injuries between the ages of 36 and 83 months were recruited as part of a larger, longitudinal study. We analyzed social communication subscale scores from the CCC-2 an average of 3.5 years postinjury. We used binary logistic regression analyses to examine the measure's accuracy in classifying children with and without social communication deficits on other measures of pragmatic language and social competence. Correlation analyses and linear mixed models were used to examine the construct validity of the CCC-2. Results: The CCC-2 was able to accurately classify those with and without pragmatic language impairments on the Comprehensive Assessment of Spoken Language 92% of the time (sensitivity = 55%) and 96% of the time on the Home and Community Social Behavior scale (sensitivity = 72%). The CCC-2 demonstrated strong correlations with and predictive validity for measures of social communication and competence. Conclusions: The findings offer support for the clinical utility of the CCC-2 in the pediatric TBI population.

Pragmatic Language Markers of Autism Diagnosis and Severity

Purpose

Assessment of pragmatic language difficulties is limited with conventional tests but can be performed with informant reports. We evaluated the performance of a parent-completed language scale in differentiating autism from typical development (TD) and another neurodevelopmental disorder. Specifically, we aimed to gauge the respective values of structural and pragmatic language scores for diagnostic discrimination and for predicting severity of social impairment in autistic children.

Method

174 children aged 7 to 17 (101 with autism, 45 with ADHD, 28 with TD) were evaluated with the ADOS-2 and an abbreviated version of the WISC. Parents completed the Children's Communication Checklist, 2nd Edition (CCC-2) and the Social Responsiveness Scale. CCC-2 mean differences across diagnostic groups were tested with analysis of variance and covariance. Multiple linear regression was used to compare the structural and pragmatic CCC-2 scores in predicting autism symptom severity.

Results

Both structural and pragmatic language scores discriminated between the three diagnostic groups, with stronger effects for the pragmatic scores. Pragmatic scores remained robust predictors of ADHD and ASD diagnoses even after accounting for cognitive and structural linguistic differences. Among autistic children, social impairment severity was associated with pragmatic, but not structural, language profiles.

Conclusions

In order to characterize pragmatic language, easy to administer parent questionnaires such as the CCC-2 may support clinicians who are considering an autism diagnosis and needing to evaluate and monitor social communication.

"Um" and "Uh" Usage Patterns in Children with Autism: Associations with Measures of Structural and Pragmatic Language Ability

Pragmatic language difficulties, including unusual filler usage, are common among children with Autism Spectrum Disorder (ASD). This study investigated "um" and "uh" usage in children with ASD and typically developing (TD) controls. We analyzed transcribed Autism Diagnostic Observation Schedule (ADOS) sessions for 182 children (117 ASD, 65 TD), aged 4 to 15. Although the groups did not differ in "uh" usage, the ASD group used fewer "ums" than the TD group. This held true after controlling for age, sex, and IQ. Within ASD, social affect and pragmatic language scores did not predict filler usage; however, structural language scores predicted "um" usage. Lower "um" rates among children with ASD may reflect problems with planning or production rather than pragmatic language.

Psychometrics of the Pragmatic Rating Scale for School-Age Children With a Range of Linguistic and Social Communication Skills

Purpose Social communication or pragmatic skills are continuously distributed in the general population. Impairment in these skills is associated with two clinical disorders, autism spectrum disorder (ASD) and social (pragmatic) communication disorder. Such impairment can impact a child's peer acceptance, school performance, and current and later mental health. Valid, reliable, examiner-rated observational measures of social communication from a semistructured language sample are needed to detect social communication impairment. We evaluated the psychometrics of an examiner-rated measure of social (pragmatic) communication, the Pragmatic Rating Scale-School Age (PRS-SA). Method The analytic sample consisted of 130 children, ages 7-12 years, from five mutually exclusive groups: ASD (n = 25), language concern (LC; n = 5), ASD + LC (n = 10), social communication impairment only (n = 22), and typically developing (TD; n = 68). All children received language and autism assessments. The PRS-SA was rated separately using video-recorded communication samples from the Autism Diagnostic Observation Schedule. Assessment data were employed to evaluate the psychometrics of the PRS-SA. Analysis of covariance models were used to assess whether the PRS-SA would detect differences in social communication functioning across the five groups. Results The PRS-SA demonstrated strong internal reliability, concurrent validity, and interrater reliability. PRS-SA scores were significantly higher in all groups compared to the TD group and differed significantly in most pairwise comparisons; the ASD + LC group had the highest (more atypical) scores. Conclusions The PRS-SA shows promise as a measure of social communication skills in school-age verbally fluent children with a range of social and language abilities. More research is needed with a larger sample, including a wider age range and geographical diversity, to replicate findings. Supplemental Material https://doi.org/10.23641/asha.15138240.

School-entry language skills as predictors of concurrent and future academic, social, and adaptive skills in kindergarteners with ASD

OBJECTIVE

This study compared language profiles of children with autism spectrum disorder (ASD) and typically developing (TD) children at kindergarten-entry and investigated whether kindergarten-entry language scores were predictive of concurrent and future academic achievement, peer interactions, and adaptive skills in children with ASD.

METHOD

Participants included 97 children (62 children with ASD; 35 TD children) assessed at kindergarten-entry and -exit. Language abilities were assessed using the Children's Communication Checklist-2 (CCC-2). Children with ASD and TD children's language scores were compared at baseline, and the ASD group was followed longitudinally. Regression analyses were performed to compare language scores between ASD and TD groups and to predict concurrent and future functional skills from kindergarten-entry language scores for children with ASD.

RESULTS

Children with ASD demonstrated significantly more impairments across all scales of the CCC-2 at kindergarten-entry compared to TD children. Within the ASD group, kindergarten-entry pragmatic language significantly predicted concurrent math and reading achievement. Both syntactic/semantic and pragmatic domains significantly predicted kindergarten-exit reading performance; pragmatics significantly predicted kindergarten-exit math performance. Pragmatics also predicted concurrent and kindergarten-exit peer play. Syntax/semantics significantly predicted concurrent adaptive communication skills, whereas pragmatics significantly predicted concurrent adaptive daily living and socialization skills, as well as kindergarten-exit socialization skills.

CONCLUSIONS

School-entry language abilities can serve as a valuable predictor of functional outcomes across the kindergarten year for cognitively-able children with ASD. Results highlight the need to target early language abilities to maximize academic, social, and adaptive skills.

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.

Pragmatic Language and Social Communication Tests for Students Aged 8–18 Years: A Review of Test Accuracy

Purpose

The accuracy of commercially available pragmatic language and social communication tests was reviewed.

Method

Online sources were searched to identify tests providing stand-alone pragmatic or social communication scores. Test manuals were examined to extract information about clinical and typically developing group comparisons, including sample size, inclusionary/exclusionary criteria, and mean group differences. Classification accuracy metrics, including sensitivity, specificity, optimal cut scores, and likelihood ratios, were reviewed.

Results

Six domain-specific pragmatic language and social communication tests and four omnibus language tests were identified. Test content varied and included video and audio recordings and question-and-answer formats to address hypothetical social vignettes, retell and comprehend narratives, interpret nonliteral language and multiple-meaning words, identify and display emotions, and infer another's perspective. Sample size and inclusionary/exclusionary criteria for comparisons of students with typical development (TD), developmental language disorder (DLD), autism spectrum disorder (ASD), and social (pragmatic) communication disorder (SPCD) varied widely. Mean group differences between TD and ASD or SPCD groups were generally larger (i.e., > 0.5 SD to > 2.0 SD s) than TD and DLD comparisons. Test authors interpreted these results as support for the accuracy of tests to identify deficits associated with ASD and SPCD and not DLD. Classification accuracy was reported for five domain-specific tests. Optimal cut scores ranged from 85 to 92, with adequate sensitivity and specificity (i.e., ≥ 80%); however, positive likelihood ratios and associated confidence intervals revealed limited confidence in reported levels.

Conclusions

Inadequate sample description for comparison and classification studies limit a clinician's ability to compare a student's profile with those in the samples. Although none of the tests meet all standards for test accuracy reviewed in this report, a checklist to guide test selection is provided to assist in identifying the best available test for a student's profile, if a test is needed.

Association between CCC-2 and Structural Language, Pragmatics, Social Cognition, and Executive Functions in Children with Developmental Language Disorder

(1) Background: Developmental Language Disorder (DLD) is diagnosed when the child experiences problems in language with no known underlying biomedical condition and the information required for its correct evaluation must be obtained from different contexts. The Children's Communication Checklist (CCC-2) covers aspects of a child's communication related to structural language and pragmatic skills, which are linked to social cognition or executive functions. The aim of this article is to examine parents' reports using the Spanish version of the CCC-2 questionnaire and its association with different formal assessments related to communication. (2) Methods: 30 children with DLD (3; 10-9 years old) and 39 age-matched (AM) children with typical development were assessed using formal measures of structural language, pragmatics, social cognition, and executive functions. Parents of children with DLD answered the Spanish version of the CCC-2. (3) Results: The performance of children with DLD was lower in all the formal assessments in comparison to AM children. The CCC-2 was significantly correlated with all the direct child assessments, although only formal measures of structural language predicted both the structural language and pragmatics scales of the CCC-2. (4) Conclusions: The CCC-2 answered by parents was consistent with formal assessments in children with DLD, and structural language seemed to be the best predictor of all the subscales.

Speech Impairments Explain Unique Variance in Adaptive Behavior Skills in Young People With Down Syndrome

Background Down syndrome (DS) is a disorder characterized by impairments in global cognitive abilities and adaptive function. In addition, individuals with DS demonstrate pronounced speech and language deficits. However, little is known about the linguistic correlates of impaired adaptive functioning in DS. Method Using the Adaptive Behavior Assessment System-Second Edition and the Children's Communication Checklist-Second Edition (CCC-2), this study investigated the unique variance in adaptive skills accounted for by speech and language impairments in individuals with DS (N = 29, M _age = 13.46). Results Pearson correlations revealed that a composite of CCC-2 structural language scales, but not pragmatic language scales, was significantly correlated with the Adaptive Behavior Assessment System-Second Edition Global Adaptive Composite, Conceptual, and Practical domains. Further investigation utilizing hierarchical regression analyses identified only the Speech scale on the CCC-2 as contributing unique variance to the prediction of adaptive behavior scores in the Global Adaptive Composite, Conceptual, and Practical domains. Conclusion Speech impairments may serve as flags to identify children with DS who are at risk for adaptive behavior deficits and reinforce the need for speech-language therapies that focus on speech for these individuals. Supplemental Material https://doi.org/10.23641/asha.13231985.

Social Skills Training in Autism Spectrum Disorder Across the Lifespan

Social skills training programs for individuals with autism spectrum disorder are effective in improving social competence, although effects are frequently not robust across all outcomes measured. When aggregating across the social skills training programs with the strongest evidence, common elements can be identified in both the treatment delivery method and the social skills content targeted. However, social skills training programs continue to remain limited in their generalizability and scope. Existing research has primarily tested programs designed for school-aged children with autism spectrum disorder, who have average or above average intellectual functioning.

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

Pragmatic language (PL) is defined as the ability to use language effectively in communicative exchanges. Previous findings showed that deficits in PL are a core characteristic of the communicative profile of individuals with autism spectrum disorder (ASD). While different lines of research have revealed a close link between PL and theory of mind (ToM), and between PL and executive functions (EFs), to our knowledge, few studies have explored the relationship between these three domains in children with ASD, and their results have been contradictory. The present study thus aimed to contribute to our understanding of PL in children with ASD and to analyze the underlying mediating role of ToM and EFs. PL is a complex and multifaceted construct. In the present study, we focused on two specific aspects, such as the comprehension of nonliteral language, and the ability to make inferences. After testing 143 participants (73 with ASD), our results confirmed that impairments in PL are a crucial feature of the ASD profile. Children with ASD were also more impaired than their typically developing peers in both ToM and EFs. When the mediating role of ToM and EFs on PL was considered, it emerged that only ToM contributed significantly to the relationship between group and PL. We discussed the potential importance of interventions not focused exclusively on PL, but also involving ToM. LAY SUMMARY: In everyday life, we use pragmatic language to interact successfully with others. Individuals with autism experience significant difficulty in pragmatic language, showing consequent impairments in communication. This study compared the comprehension of nonliteral language, and the ability to make inferences of children with autism and children with typical development, focusing on the role of social and cognitive abilities. Children with autism had difficulties in pragmatic language compared to children with typical development. In addition, the capacity to consider the perspective, intentions and beliefs of other people contributed significantly to the pragmatic language. Autism Res 2021, 14: 932-945. © 2020 International Society for Autism Research and Wiley Periodicals LLC.

Social Communication and Structural Language of Girls With High-Functioning Autism Spectrum Disorder

Purpose The purpose of this study was to characterize social communication and structural language of school-age girls with high-functioning autism spectrum disorder (HF-ASD) compared to a matched group of girls who are typically developing (TD). Method Participants were 37 girls between 7;5 and 15;2 (years;months)-18 HF-ASD and 19 TD. Children completed the Test of Pragmatic Language-Second Edition (TOPL-2) and Clinical Evaluation of Language Fundamentals-Fifth Edition. Parents completed the Children's Communication Checklist-2 United States Edition (CCC-2) and Receptive and Expressive Communication subdomains of the Vineland Adaptive Behavior Scales-Second Edition. Results In the area of social communication, girls with HF-ASD earned significantly lower scores and were more often classified as having an impairment on the TOPL-2 and the CCC-2. However, 28% and 33% earned average scores on the TOPL-2 and the CCC-2, respectively. In the area of structural language, no significant differences were found between groups on Clinical Evaluation of Language Fundamentals-Fifth Edition indexes. In contrast, girls with HF-ASD earned significantly lower scores and were more often classified as having an impairment on the Vineland Adaptive Behavior Scales-Second Edition. Sixty-one percent and 83% scored below average on the Receptive and Expressive Communication subdomains, respectively. Conclusions It has been argued that girls with HF-ASD, when compared to boys with HF-ASD, may have advantages for social communication and structural language that mask their impairments. However, when compared to girls who are TD, girls with HF-ASD demonstrated impaired social communication and structural language. Clinicians should include and carefully examine multiple sources of information when assessing girls with HF-ASD.

Pragmatic and Conversational Features of Arabic-Speaking Adolescents With Autism Spectrum Disorder: Examining Performance and Caregivers' Perceptions

Purpose This study investigates the features of pragmatic and conversational skills in the language of Arabic-speaking adolescents with autism spectrum disorder (ASD) by comparing them with typically developing (TD) Arabic-speaking adolescents in Saudi Arabia. It aims to identify the differences in the pragmatic skills of the two groups and the perception of those skills by caregivers, with respect to four main pragmatic areas: discourse management, communicative function, conversational repair, and presupposition abilities. Method Data for this study were collected from 15 Saudi adolescents with ASD and a control group of 15 TD adolescents, matched for gender and language abilities. All the participants were in the normal IQ range. The caregivers of the adolescents with ASD and TD adolescents also participated in this study. Data were collected on the adolescents' performances using the Yale in vivo Pragmatic Protocol. In addition, the Pragmatics Profile of Everyday Communication Skills (PPECS) was used to collect data on the caregivers' perceptions of the adolescents' abilities. The combination of tools in this study allows for a unique comparison between actual performance and caregivers' perceptions. Results As expected, both the adolescents' performances and the caregivers' perceptions reflected an overall deficit in the pragmatic and conversational skills of adolescents with ASD. However, we also identified an inconsistency between the caregivers' estimation of the participant's pragmatic abilities and the actual abilities demonstrated by the adolescents. In particular, TD adolescents performed significantly better than adolescents with ASD in the pragmatic areas of turn-taking, topic maintenance, and topic initiation, but the caregivers did not detect differences between the two groups in these discourse management abilities. Conclusions This study has important implications for both ASD interventions and assessment. It provides a comprehensive assessment approach for measuring pragmatic skills, including both direct (participants' performances) and indirect (caregivers' perceptions) measures. Future research may benefit from adopting the combined approach used in this study to explore pragmatics in ASD. Differences between caregivers' perceptions and the performances of individuals with ASD should be considered, as well as the influence of various factors on their communication.

A Distinction Between Linguistic and Social Pragmatics Helps the Precise Characterization of Pragmatic Challenges in Children With Autism Spectrum Disorders and Developmental Language Disorder

Purpose Children with autism spectrum disorders (ASDs) and children with developmental language disorder (DLD) face challenges with pragmatics, but the nature and sources of these difficulties are not fully understood yet. The purpose of this study was to compare the competence of children with ASD and children with DLD in two pragmatics tasks that place different demands on theory of mind (ToM) and structural language. Method Twenty Spanish-speaking children with ASD, 20 with DLD, and 40 age- and language-matched children with neurotypical development were assessed using two pragmatics tasks: a linguistic pragmatics task, which requires competence with structural language, and a social pragmatics task, which requires competence with ToM as well. Results For linguistic pragmatics, the ASD group performed similarly to the DLD and language-matched groups, and performance was predicted by structural language. For social pragmatics, the ASD group performed lower than the DLD and language-matched groups, and performance was predicted both by structural language and ToM. Conclusions Children with ASD and children with DLD face difficulties in linguistic pragmatics tasks, in keeping with their structural language. Children with ASD face exceptional difficulties with social pragmatics tasks, due to their difficulties with ToM. The distinction between linguistic and social pragmatic competences can inform assessment and intervention for pragmatic difficulties in different populations.

Social Skills Training in Autism Spectrum Disorder Across the Lifespan

Social skills training programs for individuals with autism spectrum disorder are effective in improving social competence, although effects are frequently not robust across all outcomes measured. When aggregating across the social skills training programs with the strongest evidence, common elements can be identified in both the treatment delivery method and the social skills content targeted. However, social skills training programs continue to remain limited in their generalizability and scope. Existing research has primarily tested programs designed for school-aged children with autism spectrum disorder, who have average or above average intellectual functioning.

Relations between Everyday Executive Functioning and Language in Youth with Down Syndrome and Youth with Autism Spectrum Disorder

Language and executive functioning are major impairments in many neurodevelopmental disorders, but little is known about the relations between these constructs, particularly using parent-report. Thus, the current research sought to examine relations between executive function and language in two groups - Down syndrome (DS; n=41; Mage = 11.2) and autism spectrum disorder (ASD; n=91; Mage = 7.7). Results were as follows: in DS, executive function predicted pragmatic, but not structural language after covarying for age, sex, and social functioning; in ASD, executive function predicted both. Findings highlight the interrelatedness of language and executive functioning and may have implications for intervention development.

Problem behavior in young children referred with language difficulties: Relations to language and intentional communication

BACKGROUND AND AIMS

This exploratory study aims to examine the relative contribution of language and intentional communication to internalizing and externalizing problem behavior.

METHODS

Twenty-nine Dutch-speaking children (age range 24-46 months) referred with language difficulties participated in this study. For the majority of children, these early language difficulties appeared to be part of a broader neurodevelopmental disorder, mainly autism spectrum disorder. Parent ratings on the Achenbach Child Behavior Checklist 1½-5 were predicted from children's language level and intentional communicative abilities, the latter being assessed by both parent report and direct observation. In all series of hierarchical regression analyses, chronological age and nonverbal mental age were included as covariates.

RESULTS

Parents commonly reported withdrawal, emotionally reactive behavior, attention problems, and aggressive behavior. Parent-rated intentional communication was the most important predictor of internalizing problem behavior and played an important role in the prediction of aggressive behavior as well. However, chronological age and/or nonverbal mental age also predicted parent-rated levels of externalizing problem behavior, especially attention problems.

CONCLUSIONS

The relation between language difficulties and problem behavior may be influenced by maturation and children's ability to communicate intentionally.Implications: Language proficiency should, therefore, be independently assessed from children's intentional communicative abilities which, in turn, may differ across contexts.

"If you catch my drift...": ability to infer implied meaning is distinct from vocabulary and grammar skills

Background: Some individuals with autism find it challenging to use and understand language in conversation, despite having good abilities in core aspects of language such as grammar and vocabulary. This suggests that pragmatic skills (such as understanding implied meanings in conversation) are separable from core language skills. However, it has been surprisingly difficult to demonstrate this dissociation in the general population. We propose that this may be because prior studies have used tasks in which different aspects of language are confounded.

Methods: The present study used novel language tasks and factor analysis to test whether pragmatic understanding of implied meaning, as part of a broader domain involving social understanding, is separable from core language skills. 120 adult participants were recruited online to complete a 7-task battery, including a test assessing comprehension of conversational implicature.

Results: In confirmatory analysis of a preregistered model, we compared whether the data showed better fit to a two-factor structure (including a “social understanding” and “core language” factor) or a simpler one-factor structure (comprising a general factor). The two-factor model showed significantly better fit.

Conclusions: This study supports the view that interpreting context-dependent conversational meaning is partially distinct from core language skills. This has implications for understanding the pragmatic language impairments reported in autism.

Gaze and Motor Traces of Language Processing: Evidence from Autism Spectrum Disorders in Comparison to Typical Controls

We investigated what strategies underlie figurative language processing in two groups of participants distinguished by the presence of a developmental deficit, highly-verbal participants with autism, and control participants without autism in two age ranges each. Individuals with autism spectrum disorder are characterised by impaired social interaction and communication. Even at the high end of the spectrum, where structural language is adequate, difficulties in comprehending non-literal aspects of language are widely attested. The exact causes of these problems are, however, still open to debate. In an interactive sentence-picture matching task participants selected the most suitable image representation of a non-literal figurative expression that matched the target meaning, while their eye-movements and hand movements were being tracked. Our results suggest that individuals with ASD have different processing patterns than typically developing peers when interpreting figurative language, even when they provide the correct answers. Both children with and without autism, and participants with autism display greater uncertainty and competition between alternatives when providing the answer, often reflected in also considering the literal interpretation of the expression against its target figurative meaning. We provide evidence that expression transparency and decomposability play a central role in figurative language processing across all groups.

"If you catch my drift...": ability to infer implied meaning is distinct from vocabulary and grammar skills

Background: Some individuals with autism find it challenging to use and understand language in conversation, despite having good abilities in core aspects of language such as grammar and vocabulary. This suggests that pragmatic skills (such as understanding implied meanings in conversation) are separable from core language skills. However, it has been surprisingly difficult to demonstrate this dissociation in the general population. We propose that this may be because prior studies have used tasks in which different aspects of language are confounded. Methods: The present study used novel language tasks and factor analysis to test whether pragmatic understanding of implied meaning, as part of a broader domain involving social understanding, is separable from core language skills. 120 adult participants were recruited online to complete a 7-task battery, including a test assessing comprehension of conversational implicature. Results: In confirmatory analysis of a preregistered model, we compared whether the data showed better fit to a two-factor structure (including a "social understanding" and "core language" factor) or a simpler one-factor structure (comprising a general factor). The two-factor model showed significantly better fit. Conclusions: This study supports the view that interpreting context-dependent conversational meaning is partially distinct from core language skills. This has implications for understanding the pragmatic language impairments reported in autism.

"If you catch my drift...": ability to infer implied meaning is distinct from vocabulary and grammar skills

Background: Some individuals with autism find it challenging to use and understand language in conversation, despite having good abilities in core aspects of language such as grammar and vocabulary. This suggests that pragmatic skills (such as understanding implied meanings in conversation) are separable from core language skills. However, it has been surprisingly difficult to demonstrate this dissociation in the general population. We propose that this may be because prior studies have used tasks in which different aspects of language are confounded. Methods: The present study used novel language tasks and factor analysis to test whether pragmatic language skills are separable from core language skills. 120 adult participants were recruited online to complete a 7-task battery, including a test assessing comprehension of conversational implicature. Results: In confirmatory analysis of a preregistered model, we compared whether the data showed better fit to a two-factor structure (including a pragmatic conversation comprehension and core language factor) or a simpler one-factor structure (comprising a general language factor). The two-factor model showed significantly better fit. Conclusions: This study supports the view that interpreting context-dependent conversational meaning is partially distinct from core language skill. This has implications for understanding the pragmatic language impairments reported in autism.

Contribution of Theory of Mind, Executive Functioning, and Pragmatics to Socialization Behaviors of Children with High-Functioning Autism

Social difficulties are a key aspect of autism, but the intervening factors are still poorly understood. This study had two objectives: to compare the profile of ToM skills, executive functioning (EF), and pragmatic competence (PC) of children with high-functioning autism (HFA) and children with typical development (TD), and analyze their mediator role in social functioning. The participants were 52 children with HFA and 37 children with TD matched on age, intelligence quotient, and expressive vocabulary. Significant differences were found on measures of ToM, both explicit and applied, EF, and PC between children with HFA and TD. Multiple mediation analysis revealed that applied ToM skills and PC mediated the relations between autism symptoms and social functioning. Implications for social cognitive interventions to address these findings are discussed.

Autism, spectrum or clusters? An EEG coherence study

BACKGROUND

Autism prevalence continues to grow, yet a universally agreed upon etiology is lacking despite manifold evidence of abnormalities especially in terms of genetics and epigenetics. The authors postulate that the broad definition of an omnibus 'spectrum disorder' may inhibit delineation of meaningful clinical correlations. This paper presents evidence that an objectively defined, EEG based brain measure may be helpful in illuminating the autism spectrum versus subgroups (clusters) question.

METHODS

Forty objectively defined EEG coherence factors created in prior studies demonstrated reliable separation of neuro-typical controls from subjects with autism, and reliable separation of subjects with Asperger's syndrome from all other subjects within the autism spectrum and from neurotypical controls. In the current study, these forty previously defined EEG coherence factors were used prospectively within a large (N = 430) population of subjects with autism in order to determine quantitatively the potential existence of separate clusters within this population.

RESULTS

By use of a recently published software package, NbClust, the current investigation determined that the 40 EEG coherence factors reliably identified two distinct clusters within the larger population of subjects with autism. These two clusters demonstrated highly significant differences. Of interest, many more subjects with Asperger's syndrome fell into one rather than the other cluster.

CONCLUSIONS

EEG coherence factors provide evidence of two highly significant separate clusters within the subject population with autism. The establishment of a unitary "Autism Spectrum Disorder" does a disservice to patients and clinicians, hinders much needed scientific exploration, and likely leads to less than optimal educational and/or interventional efforts.

Parent-Reported Communication Abilities of Children with Sotos Syndrome: Evidence from the Children's Communication Checklist-2

Sotos syndrome is a congenital overgrowth syndrome associated with intellectual disability. This study investigated communicative abilities of children with Sotos syndrome (n = 31), using the Children’s Communication Checklist, second edition. A cross-syndrome approach was used to establish the specificity of these abilities. Children with Williams syndrome (n = 34) were used as a comparison group. In both groups, the majority of participants had communicative impairment. Children with Sotos syndrome had an uneven pragmatic language profile and greater impairment with social relations, compared with restricted interests. Overall, children with Sotos syndrome had difficulties with both language structure and pragmatic language and a specific profile of relative difficulty with using nonverbal communication, using context-appropriate language and understanding peer relationships.

Dissociations in the neural substrates of language and social functioning in autism spectrum disorder

Impairments in social communication (coupled with intact nonsocial language skills) are common in autism spectrum disorder (ASD). However, the neural correlates of these social communication deficits in adolescents and young adults with ASD are not fully understood. The communication checklist self-report (CC-SR) was administered to adolescents and young adults with ASD (n = 52) and typically developing (TD) controls (n = 64) to assess structural-language, pragmatic-language, and social-engagement. One high-resolution T1-weighted structural image was obtained from each participant. FreeSurfer was used to quantify cortical thickness. A main effect of diagnosis, with the ASD group performing worse than the TD group on all three CC-SR scales, and a diagnosis by scale interaction, driven by low social-engagement self-ratings in the ASD group, were found. There were also group differences in the relationship between scores on two of the three CC-SR scales and cortical thickness in multiple regions (pragmatic-language: left rostral frontal; social-engagement: left medial prefrontal). These interactions were driven by poorer self-ratings of language/social skills associated with decreased cortical thickness in the ASD group, while in the TD group worse self-ratings were associated with thicker cortex. Self-ratings of language/social-communication were lower in the ASD than the TD group. Moreover, language/social-communication self-ratings showed a different relationship with cortical thickness for the ASD and TD groups in the left inferior frontal region for pragmatic language ratings and the left medial prefrontal cortex for social engagement ratings. These findings suggest thinner cortex is associated with more impaired pragmatic language and social communication abilities in ASD. Autism Res 2018, 11: 1175-1186. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The present study examines the associations between brain structure and language/social communication ability in adolescents and young adults with autism spectrum disorder (ASD) as compared to neurotypical adolescents and young adults. We utilized thickness of the cerebral cortex as a measure of brain structure, and we found different correlations between language or social communication ability and cortical thickness in distinct regions for the ASD and TD groups. These findings suggest that for regions implicated in language/social communication ability, decreased cortical thickness is associated with more impaired pragmatic language and social communication abilities in ASD.

Maternal Interactive Behaviours in Parenting Children with Williams Syndrome and Autism Spectrum Disorder: Relations with Emotional/Behavioural Problems

This study compared maternal responsiveness to children with two neurodevelopmental disorders sharing different but, in some cases, overlapping social phenotypes-Williams syndrome (WS) and autism spectrum disorder (ASD)-and explored the relations between maternal responsiveness and child emotional/behavioural problems (EBP). The sample included 16 pre-schoolers with WS and 43 with ASD, and their mothers. Responsiveness was assessed during a mother-child interaction task. Mothers completed the CBCL 1½-5, providing a measure of EBP. No significant differences emerged between groups, and most dyads were characterized by less responsive behaviours. Maternal responsiveness proved related to child developmental age, but not with EBP. These results provide further insight into the rearing environment of children with neurodevelopmental disorders, highlighting the need for early relationship-based interventions.

Speech Rate Entrainment in Children and Adults With and Without Autism Spectrum Disorder

PURPOSE

Conversational entrainment, a phenomenon whereby people modify their behaviors to match their communication partner, has been evidenced as critical to successful conversation. It is plausible that deficits in entrainment contribute to the conversational breakdowns and social difficulties exhibited by people with autism spectrum disorder (ASD). This study examined speech rate entrainment in children and adult populations with and without ASD.

METHOD

Sixty participants including typically developing children, children with ASD, typically developed adults, and adults with ASD participated in a quasi-conversational paradigm with a pseudoconfederate. The confederate's speech rate was digitally manipulated to create slow and fast speech rate conditions.

RESULTS

Typically developed adults entrained their speech rate in the quasi-conversational paradigm, using a faster rate during the fast speech rate conditions and a slower rate during the slow speech rate conditions. This entrainment pattern was not evident in adults with ASD or in children populations.

CONCLUSION

Findings suggest that speech rate entrainment is a developmentally acquired skill and offers preliminary evidence of speech rate entrainment deficits in adults with ASD. Impairments in this area may contribute to the conversational breakdowns and social difficulties experienced by this population. Future work is needed to advance this area of inquiry.

Social skills in children with RASopathies: a comparison of Noonan syndrome and neurofibromatosis type 1

Background

Gene mutations within the RAS-MAPK signaling cascade result in Noonan syndrome (NS), neurofibromatosis type 1 (NF1), and related disorders. Recent research has documented an increased risk for social difficulties and features of autism spectrum disorder (ASD) among children with these conditions. Despite this emerging evidence, the neuropsychological characteristics associated with social skills deficits are not well understood, particularly for children with NS.

Methods

Parents of children with NS (n = 39), NF1 (n = 39), and unaffected siblings (n = 32) between the ages of 8 and 16 years were administered well-validated caregiver questionnaires assessing their child’s social skills, language abilities, attention-deficit hyperactivity disorder (ADHD) symptoms and anxiety.

Results

With respect to overall social skills, average ratings of children in both clinical groups were similar, and indicated weaker social skills compared to unaffected siblings. Although ratings of social skills were outside of normal limits for more than four in ten children within the clinical groups, most of the deficits were mild/moderate. Fifteen percent of the children with NS and 5% of the children with NF1 were rated as having severe social skills impairment (< − 2SD). Independent of diagnosis, having fewer ADHD symptoms or better social-pragmatic language skills was predictive of stronger social skills.

Conclusions

Amidst efforts to support social skill development among children and adolescents with RASopathies, neuropsychological correlates such as social language competence, attention, and behavioral self-regulation could be important targets of intervention.

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.

Can you tell it by the prime? A study of metaphorical priming in high-functioning autism in comparison with matched controls

BACKGROUND

Problems with pragmatic aspects of language are well attested in individuals on the autism spectrum. It remains unclear, however, whether figurative language skills improve with language status and whether problems in figurative language are no longer present in highly verbal individuals with autism.

AIMS

To investigate whether highly verbal individuals with autism perform similarly as age-, intelligence- and verbal comprehension-matched controls on the processing of one of the most common types of figurative language, metaphors. The goal was to establish whether the participants with autism are primed similarly to controls by figurative expressions (metaphors) presented in different conditions.

METHODS & PROCEDURES

The experiment was designed as a cross-modal lexical-decision task where metaphors served as primes for target words related to their figurative or literal meaning.

OUTCOMES & RESULTS

Our findings show that both ASD and control participants made very few errors in the experimental task. However, the participants with ASD presented with problems in performance on the task, reflected in significantly slower reaction times compared with the typically developing peer groups. The similar response speed observed between the younger typical control children and the adult ASD participants suggests that the mechanisms underlying metaphor processing (e.g., selection of metaphorical versus literal interpretation) are still developing in high-functioning autism, very much like in typical children.

CONCLUSIONS & IMPLICATIONS

These results may suggest that metaphor processing requires more than adequate language competences. The findings are also suggestive of a delay in developing sensitivity to figurative language, rather than sheer inability. This suggests that a timely training programme can be implemented to improve figurative language abilities in 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.

Assessing pragmatic communication in children with Down syndrome

PURPOSE

Successful communication depends on language content, language form, and language use (pragmatics). Children with Down syndrome (DS) experience communication difficulties, however little is known about their pragmatic profile, particularly during early school years. The purpose of the present study was to explore the nature of pragmatic communication in children with DS.

METHOD

Twenty-nine six-year-old children with DS were assessed, in the areas of 1) initiation, 2) scripted language, 3) understanding context and 4) nonverbal communication, as reported by children's parents via the Children's Communication Checklist-2 (Bishop, 2003). Additionally, the relationships between pragmatics and measures of vocabulary, nonverbal mental ability and social functioning were explored.

RESULTS

Children with DS were impaired relative to norms from typically developing children in all areas of pragmatics. A profile of relative strengths and weaknesses was found in the children with DS; the area of nonverbal communication was significantly stronger, while the area of understanding context was significantly poorer, relative to the other areas of pragmatics assessed in these children. Relationships between areas of pragmatics and other linguistic areas, as well as aspects of vocabulary and social functioning were observed.

CONCLUSIONS

By the age of six children with DS experience significantly impaired pragmatic communication, with a clear profile of relative strengths and weaknesses. The study highlights the need to teach children with DS pragmatic skills as a component of communication, alongside language content and form.

Language Ability Predicts Cortical Structure and Covariance in Boys with Autism Spectrum Disorder

There is significant clinical heterogeneity in language and communication abilities of individuals with Autism Spectrum Disorders (ASD). However, no consistent pathology regarding the relationship of these abilities to brain structure has emerged. Recent developments in anatomical correlation-based approaches to map structural covariance networks (SCNs), combined with detailed behavioral characterization, offer an alternative for studying these relationships. In this study, such an approach was used to study the integrity of SCNs of cortical thickness and surface area associated with language and communication, in 46 high-functioning, school-age children with ASD compared with 50 matched, typically developing controls (all males) with IQ > 75. Findings showed that there was alteration of cortical structure and disruption of fronto-temporal cortical covariance in ASD compared with controls. Furthermore, in an analysis of a subset of ASD participants, alterations in both cortical structure and covariance were modulated by structural language ability of the participants, but not communicative function. These findings indicate that structural language abilities are related to altered fronto-temporal cortical covariance in ASD, much more than symptom severity or cognitive ability. They also support the importance of better characterizing ASD samples while studying brain structure and for better understanding individual differences in language and communication abilities in ASD.

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.

Can You Play with Fire and Not Hurt Yourself? A Comparative Study in Figurative Language Comprehension between Individuals with and without Autism Spectrum Disorder

Individuals with High functioning autism (HFA) are distinguished by relative preservation of linguistic and cognitive skills. However, problems with pragmatic language skills have been consistently reported across the autistic spectrum, even when structural language is intact. Our main goal was to investigate how highly verbal individuals with autism process figurative language and whether manipulation of the stimuli presentation modality had an impact on the processing. We were interested in the extent to which visual context, e.g., an image corresponding either to the literal meaning or the figurative meaning of the expression may facilitate responses to such expressions. Participants with HFA and their typically developing peers (matched on intelligence and language level) completed a cross-modal sentence-picture matching task for figurative expressions and their target figurative meaning represented in images. We expected that the individuals with autism would have difficulties in appreciating the non-literal nature of idioms and metaphors, despite intact structural language skills. Analyses of accuracy and reaction times showed clearly that the participants with autism performed at a lower level than their typically developing peers. Moreover, the modality in which the stimuli were presented was an important variable in task performance for the more transparent expressions. The individuals with autism displayed higher error rates and greater reaction latencies in the auditory modality compared to the visual stimulus presentation modality, implying more difficulty. Performance differed depending on type of expression. Participants had more difficulty understanding the culturally-based expressions, but not expressions grounded in human experience (biological idioms). This research highlights the importance of stimulus presentation modality and that this can lead to differences in figurative language comprehension between typically and atypically developing individuals. The current study also contributes to current debates on the role of structural language in figurative language comprehension in autism.

The influence of scale structure and sex on parental reports of children's social (pragmatic) communication symptoms

The addition of social (pragmatic) communication disorder [S(P)CD] to the DSM-5 taxonomy has left clinicians and researchers searching for appropriate diagnostic measures. Factor analysis procedures examined the extent to which S(P)CD symptoms presented within the Children's Communication Checklist-Second Edition (CCC-2) represented a unique construct and whether these factors were influenced by children's sex. Parents of 208 children (males = 125 and females = 83) from a community-based sample completed the CCC-2. Two pragmatic scores from the CCC-2 were analysed as follows: the social interaction difference index (SIDI) and a pragmatic composite from the original CCC (PC-5). Factor analysis failed to find a unique factor structure for either pragmatic composite. Analyses uncovered different factor structures for the CCC-2 SIDI and PC-5 composites and for boys and girls. S(P)CD represents a complex combination of symptoms that are poorly differentiated from other language and socioemotional behavioural difficulties.

Characteristics of communication among Japanese children with autism spectrum disorder: A cluster analysis using the Children's Communication Checklist-2

Some overlap has been suggested among the subtypes of autism spectrum disorder (ASD) in children. The Japanese version of the Children's Communication Checklist-2 (CCC-2) is a useful measure for identifying profiles in relation to communication impairments in children with ASD. The aim of this study was to investigate whether the CCC-2 could identify subtypes in relation to communication impairments in Japanese children with ASD. The study participants were 113 children with ASD but without intellectual disabilities aged 3-12 years. Parents were given the Japanese version of the CCC-2 and asked to rate their children, who were then classified into two groups based on statistical analysis. Significant differences were found between clusters in mean CCC-2 subscales. These results suggest that one subtype was associated with low language competence and strong characteristics of autism, while the other was associated with relatively high language competence and milder characteristics of autism.

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.

Pragmatic language impairment in children with Noonan syndrome

Noonan syndrome (NS) is a disorder causing symptoms like short stature, characteristic facial features, congenital heart disease, possible mental retardation, and pragmatic difficulties. This study describes the pragmatic skills in NS and discusses the linguistic profile of 17 informants aged 6-15 years, by comparing the participants' scores on the Children's Communication Checklist, 2nd edition (CCC-2) (Bishop, 2011), with a group of typically developing children of matching age and gender. Language impairments were common in the NS group. The results show that children and adolescents with NS do not have one coherent pragmatic profile. However, 76.5% of the participants displayed communication impairments, and pragmatic skills were significantly lower than in the control group.

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.

Psychometric equivalence of the Brazilian version of the Test of Pragmatic Language 2 – TOPL-2

INTRODUCTION

Considering the relevance of the investigation about the pragmatic function for language disorders diagnosis, as well as the relevance of validity evidence for test interpretation, this paper aimed to explore the psychometric equivalence between the American and Brazilian versions of the Test of Pragmatic Language, Second Edition (TOPL-2).

METHODS

A total of 81 students from the third to seventh year from public elementary schools of São Paulo (63% girls; average age=9.42 years, SD=0.93) with no complaints or indicators of low school performance were selected. Students answered the verbal application of the TOPL-2 Brazilian-Portuguese version. Some of the psychometric inquiries reported in the original version of the test were reproduced focusing on the analyses of difficulty, internal consistency, discrimination, and differential item functioning.

RESULTS

Most of the items (86%) presented similar difficulties to the American version. The internal consistency index had acceptable values (0.70). Few items (26%) showed adequate discrimination, but 49% were close to the desirable cutoffs. Eight items showed differential functioning; of which, five were favorable to boys.

CONCLUSION

Despite sample limitations related to size and variability, almost half of the items showed psychometric equivalence to the American version.

Communicative Development in Bilingually Exposed Chinese Children With Autism Spectrum Disorders

PURPOSE

We examined the association of bilingual exposure with structural and pragmatic language development in Chinese children with autism spectrum disorders (ASDs).

METHOD

The parents of 54 children with ASD exposed to 1 (n = 31) or 2 (n = 23) Chinese languages completed (a) a questionnaire to evaluate their child's competence in structural language and pragmatic ability in their dominant language (Children's Communication Checklist-Second Edition; Bishop, 2006), and (b) a questionnaire to assess their child's social functioning (Social Responsiveness Scale; Constantino & Gruber, 2005; Wang, Lee, Chen, & Hsu, 2012). In addition, parents completed thorough interviews regarding the linguistic environment of their children (Language Environment Interview; Hambly & Fombonne, 2011).

RESULTS

Multivariate analyses of variance revealed that bilingually exposed children with ASD did not demonstrate significantly different performance on any standard measure relative to their monolingual peers.

CONCLUSIONS

The findings suggest that bilingual language exposure is not associated with additional challenges for the development of the dominant language in children with ASD. The lack of negative associations in our sample is not likely to be due to the comparatively early diagnosis and/or intervention that are available in other countries. We discuss implications for decisions regarding the linguistic environment of children with ASD.