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

Autistic and non-autistic adults use discourse context to determine a speaker's intention to request

The current study focuses on how autistic adults utilize context to determine whether ambiguous utterances (e.g., "I'm thirsty") are intended as indirect requests or as literal comment/questions. Two questions are addressed: (1) How do autistic adults compare to neurotypical adults in using context to interpret an utterance's intention as either literal or a request? (2) What cognitive mechanisms correlate with indirect request interpretation, and are these different for participants in each group? Twenty-six autistic and 26 neurotypical college students participated, engaging in an online experiment where they read narratives that ended with utterances open to literal or request interpretations, based on context. After each narrative, participants selected the best paraphrase of the utterance from two options, literal versus request. Following this task, participants completed two mentalizing measures (a false belief and emotion-identification task) and several executive functioning tests. The best model for predicting paraphrase choice included scores on the emotion-identification task and context as main effects, along with the interaction between both. Participants with higher emotion-identification test scores were more likely to provide correct paraphrases. Models including group as a main effect and/or interaction were not better at fitting the data, nor were any models that included executive functioning measures as main effects or interactions. Emotion-identification test scores, but not autism diagnosis, predict how adults infer whether an utterance is a request. Findings suggest that autistic adults use context similarly to neurotypical adults when interpreting requests, and that similar processes underlie performance for each group.

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

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

Weighing the role of social cognition and executive functioning in pragmatics in the schizophrenia spectrum: A systematic review and meta-analysis

Pragmatic impairment is diffused in schizophrenia spectrum disorders, but the literature still debates its neurocognitive underpinnings. This systematic review and meta-analysis aimed to investigate the neurocognitive correlates of pragmatic disorders in schizophrenia and determine the weight of social cognition and executive functioning on such disorders. Of the 2,668 records retrieved from the literature, 16 papers were included in the systematic review, mostly focused on non-literal meanings and discourse production in schizophrenia. Ten studies were included in the meta-analysis: pragmatics was moderately associated with both social cognition and executive functions (especially inhibition), but the link with social cognition was stronger. The mediation analysis showed that social cognition mediated the relationship between executive functions and pragmatics. Based on this, we proposed a hierarchical neurocognitive model where pragmatics stems from social cognition, while executive functions are the fertile ground supporting the other two domains, and we discuss its theoretical and clinical implications.

Exploring Spanish writing abilities of children with developmental language disorder in expository texts

Introduction

Numerous studies have shown that children with developmental language disorder (DLD), in addition to oral language difficulties, exhibit impaired writing abilities. Their texts contain problems in grammar, organization, cohesion, and length of written output. However, most of these studies have been conducted with English speakers. English is characterized by complex phonological structure, opaque orthography, poor morphology and strict word order. The aim of this research is to observe the writing abilities of children with DLD in a language with simple phonological structure, transparent orthography, rich morphology and flexible word order like Spanish in the production of expository texts.

Methods

Twenty-six children with DLD (mean age in months = 128.85) and 26 age-and sex-matched typically developing (TD) children (mean age in months = 124.61) wrote an expository text about their favorite animal.

Results

In order to analyze how the two groups plan and encode written texts, we looked at word frequency and sentence structure, grammatical complexity and lexical density, and omissions and errors. Compared to the TD group, the children with DLD omitted more content words; made more errors with functional words, verb conjugation and inflectional morphemes, and made a large number of spelling errors. Moreover, they wrote fewer words, fewer sentences, and less structurally and lexically complex texts.

Discussion

These results show that children with DLD who speak a transparent orthography language such as Spanish also have difficulties in most language areas when producing written texts. Our findings should be considered when planning and designing interventions.

Acquisition of Mandarin long passives by children with developmental language disorder

This study investigated the comprehension and production of long passives (i.e. bei-constructions with an overt agent) in Mandarin-speaking children with developmental language disorder (DLD). Seventeen preschool children with DLD (1 female; mean age: 61 months old) and 23 typically developing (TD) children (6 females; mean age: 62 months old) participated in a sentence-picture matching task (for comprehension) and an elicited production task. Their nonverbal working memory (NVWM) was measured with the fourth edition of the Wechsler Preschool and Primary Scale of Intelligence. Results showed that children with DLD were less accurate and more likely to choose the picture with reversed thematic roles than their TD peers on passives in the sentence-picture matching task; in the elicited production task, they produced fewer target responses than TD children in passives. For NVWM, although that of the DLD group was lower than that of TD children, most children in the DLD group were within the average range. Furthermore, their performance on passives in the comprehension and production tasks was significantly correlated with their NVWM, which adds to the body of work suggesting links between complex syntax and working memory. However, the fact that NVWM could be preserved in the face of difficulties with passives suggests that this link may be due to NVWM enhancing performance during tasks with a high visual component, while it may not be underlyingly responsible for syntactic impairments in children with DLD.

Current practices of Portuguese speech-language pathologists with preschool-age children with pragmatic impairment: A cross-sectional survey

This study aims to investigate the practice patterns used by Portuguese speech-language pathologists (SLPs) with preschool-age children with pragmatic impairment and to identify the actual need(s) perceived by SLPs in this field. A total of 351 SLPs responded. The results reveal that 81.5 per cent of the respondents (n=286) reported working or had previously worked with preschool-age children with pragmatic impairment arising from autism spectrum disorder, developmental language disorder, or both. Considering the clinical practice, similarities and differences were found, many of which are due not to the inherent characteristics of each disorder but to the scarcity of research in clinical pragmatics. These results are also reflected in the needs perceived by SLPs and the degree of confidence with which they work with these children. Implications for clinical practice and directions for future research are discussed.

Perspective-taking in deriving implicatures: The listener's perspective is important too

Theories of meaning propose that listeners understand a speaker's implicit meaning thanks to mutually assumed norms of conversation that take into account what the speaker has said, as well as contextual factors, including what the speaker knows. Emerging psycholinguistic research shows that listeners derive a particular kind of implicit meaning, quantity implicatures, when their speaker is knowledgeable about the situation but tend to not derive it otherwise. In this article we focus on if and how listeners use the knowledge that is available only to themselves, i.e., the listener's perspective, while deriving implicatures. To do so, we explore the derivation of ad hoc quantity implicature in situations where the speaker does or does not have full knowledge, while, in the latter case, the listener has two types of privileged knowledge. Two versions of a study with neurotypical English-speaking adults show that listeners are influenced by their own perspective while deriving implicatures, depending on the type of knowledge available to them. We discuss the implications of these findings for models of pragmatic interpretative strategies.

Comprehensive Assessments of Theory of Mind Abilities for School-Age Children: A Systematic Review

PURPOSE

Theory of mind involves perceiving both the thoughts and emotions of others. Theory of mind skills continue to develop in school-age individuals. For children at risk for social communication difficulties, evaluating theory of mind is warranted to determine whether theory of mind should be a target of intervention. There are hundreds of tasks designed to evaluate theory of mind, but many evaluate a single facet of the construct and have uneven psychometric properties. Comprehensive assessments evaluate both cognitive and affective aspects of theory of mind. The purpose of this systematic review was to identify comprehensive theory of mind assessments for school-age individuals and to critically appraise their measurement properties.

METHOD

Four databases were searched to identify 27 included records describing the measurement properties of comprehensive theory of mind assessments for 5- to 21-year-olds. Assessments appearing in at least three records were included. The methodological quality of the studies and the sufficiency of assessments' measurement properties were evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN).

RESULTS

Nine assessments were evaluated, and four met COSMIN standards for sufficient content validity and internal consistency to be recommended for clinical use.

CONCLUSIONS

Comprehensive assessments enable examiners to develop a profile of children's theory of mind strengths and needs. Strengths of the identified assessments include sufficient convergent validity and internal consistency. Further research is required to develop higher quality evidence for the content validity, structural validity, and reliability of the included assessments.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23817495.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Code-Switching During Narratives by Bilingual Children With and Without Developmental Language Disorder

PURPOSE

This study examined the frequency, direction, and structural characteristics of code-switching (CS) during narratives by Spanish-English bilingual children with and without developmental language disorder (DLD) to determine whether children with DLD exhibit unique features in their CS that may inform clinical decision-making.

METHOD

Spanish-English bilingual children, aged 4;0-6;11 (years;months), with DLD (n = 33) and with typical language development (TLD; n = 33) participated in narrative retell and story generation tasks in Spanish and English. Instances of CS were classified as between utterance or within utterance; within-utterance CS was coded for type of grammatical structure. Children completed the morphosyntax subtests of the Bilingual English-Spanish Assessment to assist in identifying DLD and to index Spanish and English morphosyntactic proficiency.

RESULTS

In analyses examining the contributions of both DLD status and Spanish and English proficiency, the only significant effect of DLD was on the tendency to engage in between-utterance CS; children with DLD were more likely than TLD peers to produce whole utterances in English during the Spanish narrative task. Within-utterance CS was related to lower morphosyntax scores in the target language, but there was no effect of DLD. Both groups exhibited noun insertions as the most frequent type of within-utterance CS. However, children with DLD tended to exhibit more determiner and verb insertions than TLD peers and increased use of "congruent lexicalization," that is, CS utterances that integrate content and function words from both languages.

CONCLUSIONS

These findings reinforce that use of CS, particularly within-utterance CS, is a typical bilingual behavior even during narrative samples collected in a single-language context. However, language difficulties associated with DLD may emerge in how children code-switch, including use of between-utterance CS and unique patterns during within-utterance CS. Therefore, analyzing CS patterns may contribute to a more complete profile of children's dual-language skills during assessment.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23479574.

The Effects of the Pragmatic Intervention Programme in Children with Autism Spectrum Disorder and Developmental Language Disorder

PURPOSE

Children with Autism Spectrum Disorder (ASD) and Developmental Language Disorder (DLD) frequently face pragmatic impairments which may result in learning, socialization, and mental health difficulties, therefore early intervention is crucial. In Portugal, the Pragmatic Intervention Programme (PICP) has been recently developed and validated, but its effects are unknown. This study aims to determine the effects of the PICP on preschool-age children with ASD or DLD with pragmatic impairments.

METHODS

A non-randomized controlled trial has been conducted. The children (n = 20) were assigned to the intervention (n = 11) or the control group (waiting list) (n = 9). Each child attended 24 PICP-based intervention sessions provided by a Speech and Language Therapist in kindergarten. The primary outcome measure was a Goal Attainment Scale (GAS) rated by parents and kindergarten teachers. Secondary outcomes include parent/teacher-reported communication skills (Escala de Avaliação de Competências Comunicativas) and an assessment of the child's general language ability (Teste de Linguagem-Avaliação da Linguagem Pré-Escolar).

RESULTS

GAS results show that all the children in the intervention group made progress. Statistically significant differences between pre- and post-intervention assessments were found for all secondary outcomes.

CONCLUSIONS

The main findings suggest that the PICP improves language in preschool-age children with ASD and DLD with pragmatic difficulties. Further research is needed to analyse the effects of the PICP for each neurodevelopmental disorder individually. These results are crucial and will contribute to future research and evidence-based practice.

Developmental Language Disorder (DLD) and Autism Spectrum Disorder (ASD): similarities in pragmatic language abilities. A systematic review

Objective

Pragmatics can be defined as the appropriate use of language in social interactions. Children with Autism Spectrum Disorder (ASD) and children with Developmental Language Disorder (DLD) exhibit difficulties in pragmatic language (PL), but the nature and sources of these difficulties have not been fully investigated yet. The purpose of this paper is to critically review empirical literature on the PL of children with ASD as compared to that of children with DLD.

Materials and methods

Thirteen studies that met established inclusion criteria were identified and reviewed.

Results

Children with ASD and children with DLD demonstrated several similarities in PL. However, a lot of differences were observed and mainly children with ASD faced more profound difficulties than children with DLD, while PL may be a distinct marker between the two groups.

Conclusion

The differences observed in the language profiles of ASD and DLD show that even if there is an overlap in some domains, the PL abilities of children of both clinical populations are likely to be controlled by different mechanisms and therefore these differences in PL may be considered as a distinguishable feature between the two populations.

Language impairments in children with developmental language disorder and children with high-functioning autism plus language impairment: Evidence from Chinese negative sentences

There is controversy as to whether children with developmental language disorder (DLD) and those with high-functioning autism plus language impairment (HFA-LI) share similar language profiles. This study investigated the similarities and differences in the production of Chinese negative sentences by children with DLD and children with HFA-LI to provide evidence relevant to this controversy. The results reflect a general resemblance between the two groups in their lower-than-TDA (typically developing age-matched) performance. Both groups encountered difficulties in using negative markers, which suggests that they might be impaired in feature agreement. Slight differences were detected between the two groups. Specifically, children with DLD experienced difficulties with the agreement on the feature [+telic] and that on the feature [+dynamic], while children with HFA-LI had difficulties with the agreement on the feature [+dynamic] and that on the feature [−dynamic]. This study supports the idea of a common symptomatology for the two disorders. More importantly, it suggests that these two disorders, DLD and HFA-LI, are not altogether the same in terms of language impairment. This paper concludes that general labels should not be simply attached to any children with language disorders. Instead, atypical language is very worthy of further analysis in the categorization of language disorders.

Comparing Early Pragmatics in Typically Developing Children and Children with Neurodevelopmental Disorders

This study examined the early pragmatic language skills in typically developing (TD) preschool-age children, children with language impairment (LI) and children with autism spectrum disorder (ASD). Two hundred and sixty-two TD children, 73 children with LI, and 16 children with ASD were compared on early pragmatics through direct assessment (DA). Post hoc analysis revealed that children in two clinical groups displayed significant pragmatic language deficits. Children in the ASD group who were older exhibited comparable degree of impairments as their LI peers, suggesting a relatively stagnant development of pragmatic language skills in children with ASD. Findings also supported the use of DA in identifying pragmatic language deficits, which have implications for the adoption of this assessment approach in clinical settings.

Reliability, validity and developmental sensitivity of the Language Use Inventory (LUI) in the Chinese context

BACKGROUND

Pragmatics has generally been defined as the ability to use language in social situations, it is commonly regarded as the third major component of language ability. To date, there is no tool for assessing early pragmatic development of Chinese-speaking children.

AIMS

To describe the translation of the Language Use Inventory (LUI) from English to Mandarin Chinese and to report findings on the Chinese version's reliability, validity and developmental sensitivity.

METHODS & PROCEDURES

The original English version of the LUI was translated into Mandarin Chinese. Parents of 177 typically developing (TD) toddlers and preschool children completed the inventory to examine its internal reliability and construct validity and how scores differed across ages and sexes. A total of 31 parents out of the 177 completed the LUI-Mandarin, again within 4 weeks, to assess test-retest reliability. To examine discriminative validity, 43 parents of age- and sex-matched TD children and children with autism spectrum disorder (ASD) recruited from Nanjing Brain Hospital affiliated with Nanjing Medical University completed the LUI-Mandarin.

OUTCOMES & RESULTS

Cronbach's alpha values for the LUI-Mandarin's three parts and for 11 of 12 LUI-Mandarin subscales were 0.707-0.992, with most values in the 0.825-0.992 range. Test-retest reliability ranged from 0.66 to 0.95, indicating good to excellent reliability. Factor analysis of the LUI-Mandarin revealed two different factors, and the total variance explained was 74.38%. The LUI-Mandarin total scores and subscale scores increased with age for both boys and girls, providing evidence of the inventory's developmental sensitivity. Girls, however, had higher total scores than boys at earlier ages (18-23 months). The results of the discriminant validity study revealed that performance was significantly lower in the ASD group than in the TD group with respect to LUI total scores and subscale scores (except for subscale A).

CONCLUSIONS & IMPLICATIONS

The LUI-Mandarin is the first and only questionnaire available in China that evaluates the pragmatic language skills of children aged between 18 and 47 months. The results of the study show that the LUI-Mandarin is a valid and reliable tool for Chinese toddlers and preschool children.

WHAT THIS PAPER ADDS

What is already known on this subject The LUI is a parent-report questionnaire that can provide comprehensive information about very young children's communicative competence. It is widely used both for assessment and to guide intervention. Additionally, it has been translated into French, Italian, Polish, Arabic, Portuguese and Norwegian and it shows good reliability and validity. What this paper adds to existing knowledge In the present study we describe the translation of the LUI from English to Mandarin Chinese and report findings on the Chinese version's reliability, validity and developmental sensitivity. What are the potential or actual clinical implications of this work? The LUI-Mandarin is the first and only questionnaire available in China that can evaluate pragmatic language skills of children aged between 18 and 47 months. The results show that the LUI-Mandarin is a valid and reliable tool for use with Chinese toddlers and preschool children.

Language Control and Code-Switching in Bilingual Children With Developmental Language Disorder

PURPOSE

The current study examined language control and code-switching in bilingual children with developmental language disorder (DLD) compared to bilingual peers with typical language development (TLD). In addition, proficiency in each language and cognitive control skills were examined as predictors of children's tendency to engage in cross-speaker and intrasentential code-switching.

METHOD

The participants were 62 Spanish/English bilingual children, ages 4;0-6;11 (years;months), including 15 children with DLD and 47 children with TLD. In a scripted confederate dialogue task to measure language control, children took turns describing picture scenes with video partners who were monolingual speakers of English or Spanish. The Dimensional Change Card Sort indexed cognitive control, the Bilingual English Spanish Assessment assisted in identifying DLD, and parent ratings from the Inventory to Assess Language Knowledge indexed proficiency in Spanish and English.

RESULTS

Children with DLD were more likely to engage in cross-speaker code-switching from Spanish to English (i.e., responding in English when addressed in Spanish) than children with TLD, even when controlling for proficiency in each language. Intrasentential code-switching (i.e., integrating both languages within an utterance) did not differ between groups. Cognitive control was more associated with cross-speaker than with intrasentential code-switching.

CONCLUSIONS

These findings highlight the need to consider cross-speaker and intrasentential code-switching separately when seeking distinguishing features of code-switching in bilingual children with DLD. The use of increased cross-speaker code-switching by children with DLD especially with Spanish speakers highlights the need for increased support of home language use.

Factors influencing resilience of parents with children with neurodevelopmental disorders: The role of structural language, social cognition, and social support

BACKGROUND

Resilience allows a more positive coping and improves parents' wellbeing when they face a difficult situation like having a child with a neurodevelopmental disorder (NDD). We aim to analyze the development of resilience in parents of children with different NDD (ASD, DLD and ADHD) with different levels of structural language and social cognition, as well as the social support available for their families, and compare it to children with typical development (TD).

METHOD

We analyzed the level of resilience of 156 parents, 73 with children with TD and 73 with three different NDD, taking into account variables such as age, structural language (receptive grammar) and social cognition (emotional understanding) of the children, and also the type of social support available to them.

RESULTS

Children with DLD and ASD showed lower receptive grammar and emotional comprehension skills, although only parents of children with ASD obtained better resilience scores. Moreover, age of children and formal support variables predicted the resilience of the parents according to the type of NDD.

DISCUSSION

The severity of social cognition and structural language difficulties of children with NDD and the fact of having support from professionals and family associations have a significant influence on the development of parental resilience.

Social Communication and pragmatic skills of children with Autism Spectrum Disorder and Developmental Language Disorder

PURPOSE

to assess the pragmatic and social communicative abilities of children with Typical Language Development (TLD), Autism Spectrum disorder (ASD) and Developmental Language Disorder (DLD).

METHODS

Participants were 40 parents and 29 teachers of 40 children ages between 3 and 6 years. Ten children had DLD, ten had ASD and 20 had typical development. All participants answered to the questionnaire of the "Assessment of Pragmatic Language and Social Communication - APLSC - parent and professional reports - beta research version. Data were submitted to statistical analysis.

RESULTS

The assessment tool was useful in identifying the difference in performance of children with different social communicative profiles.

CONCLUSION

Children with ASD presented social and pragmatic impairments that were more significant than those presented by children with DLD. However, both children with ASD and with DLD presented more social pragmatic difficulties than children with TLD.

Understanding indirect requests for information in high-functioning autism

Few works have addressed the processing of indirect requests in High-Functioning Autism (HFA), and results are conflicting. Some studies report HFA individuals’ difficulties in indirect requests comprehension; others suggest that it might be preserved in HFA. Furthermore, the role of Theory of Mind in understanding indirect requests is an open issue. The goal of this work is twofold: first, assessing whether comprehension of indirect requests for information is preserved in HFA; second, exploring whether mind-reading skills predict this ability. We tested a group of (n = 14; 9–12 years) HFA children and two groups of younger (n = 19; 5–6 years) and older (n = 28; 9–12 years) typically developing (TD) children in a semi-structured task involving direct, indirect and highly indirect requests for information. Results suggested that HFA can understand indirect and highly indirect requests, as well as TD children. Yet, while Theory of Mind skills seem to enhance older TD children understanding, this is not the case for HFA children. Therefore, interestingly, they could rely on different interpretative strategies.

Developmental Language Disorder and Autism: Commonalities and Differences on Language

Language and communication deficits characterize both autism spectrum disorder and developmental language disorder, and the possibility of there being a common profile of these is a matter of tireless debate in the research community. This experimental study addresses the relation of these two developmental conditions in the critical topic of language. Α total of 103 children (79 males, 24 females) participated in the present study. Specifically, the study's sample consisted of 40 children with autism, 28 children with developmental language disorder, and 35 typically developing children between 6 and 12 years old. All children completed language and cognitive measures. The results showed that there is a subgroup inside the autism group of children who demonstrate language difficulties similar to children with developmental language disorder. Specifically, two different subgroups were derived from the autism group; those with language impairment and those without. Both autism and language-impaired groups scored lower than typically developing children on all language measures indicating a common pathology in language ability. The results of this study shed light on the relation between the two disorders, supporting the assumption of a subgroup with language impairment inside the autism spectrum disorder population. The common picture presented by the two developmental conditions highlights the need for further research in the field.

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.

Challenges Surrounding the Diagnosis of Autism in Children

This comprehensive thematic review aims to highlight and familiarize readers with the challenges and pitfalls encountered in differential diagnosis of autism spectrum disorders (ASD) in children to facilitate the process of accurate identification by stakeholders. Accordingly, articles that best answer our questions and highlight our concerns were chosen from well-established publishers with prime peer reviewed journals. Included are studies showing alternate views of the issues so as to point readers to other possibilities. ASD, a complex dynamic biological-neurodevelopmental disorder, is underscored by its heterogeneous symptomology, severity, and phenotypes - all characterized by social communication deficits and presence of restricted interests and repetitive behaviours (RRBs), the core symptoms in ASD. Language and intellectual capacities do not form ASD core symptoms although vary considerably. Accurate identification is challenging as ASD is often enmeshed with other neurodevelopmental disorders, and medical comorbidities, a situation now recognized as the rule rather than the exception in child psychiatry and developmental medicine. ASD is a disorder with varying performance and severity of symptoms over time, including unexpected loss of early skills, and lost diagnosis in some children following treatment. The review reiterates the urgency in accurate diagnosis in face of the rapid rise in ASD prevalence globally, and risk-increase in delayed or denied treatment with undesirable life-long consequences for most of the affected children. In addition, a call for change is advised to circumvent the ethical dilemma posed by the present "deficit model" in ASD diagnosis. Here, ASD prevalence is presented first, followed by emphasis on importance of accurate early diagnosis, and challenges in its accomplishment due to flaws in diagnostic instruments and other contributing factors. Next follow the required criteria for accurate identification, and its difficulties attributed to comorbid conditions, gender differences, and socio-economic and cultural influences. The conclusion includes future directions and a take away message.