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

Theory of mind deficits in non-fluent primary progressive aphasia

Theory of Mind (ToM) is a complex socio-cognitive subdomain that is under-researched in neurodegenerative disorders, particularly in persons with primary progressive aphasia. We studied 14 persons with non-fluent/agrammatic variant primary progressive aphasia (nfaPPA), and asked two questions: (1) whether persons with nfaPPA have intact or impaired ToM, with emphasis on their false belief attribution abilities, relative to healthy controls; and (2) whether false-belief attribution (a component of ToM) is associated with their syntactic and executive function (EF) abilities. False belief understanding was tested through nonverbal videos, with participants deciding whether the story ending was an appropriate end of each video scenario or not. Syntactic production abilities were measured through repetition of syntactically simple and complex sentences (comprising length-matched complement and adjunct sentences), and EF tasks, specifically, a digit-back and an attention-shifting task. Persons with nfaPPA were less accurate than controls in adapting their reasoning to the false beliefs of other agents in the nonverbal videos of the false belief attribution task. Their false belief attribution performance was significantly predicted primarily by their syntactic production, followed by their EF. The overall findings suggest that persons with nfaPPA may have impaired performances in ToM tasks, due to impairments in basic non-social cognitive functioning, such as syntactic and EF abilities.

Bilingualism Effects in Metaphor and Simile Comprehension and Production in Children With Autism Spectrum Disorder

Figurative language, including metaphors and similes, is a crucial component of communication; yet, it presents significant challenges for individuals with autism spectrum disorder (ASD). A critical gap in existing research is the impact of bilingualism on the ability of children with ASD to understand and produce non-literal speech. This study addresses this gap by examining the comprehension and production of metaphors and similes in monolingual and bilingual Greek-speaking children with high-functioning ASD. To the best of our knowledge, this is the first study to investigate these abilities in bilingual children with ASD. Thirty-three monolingual and 18 bilingual children participated in tasks designed to assess comprehension, production, and error patterns for metaphors and similes. The study has also investigated the roles of non-verbal intelligence, language skills (expressive vocabulary), and executive functions (working memory) in the children's performance in the metaphor and simile tasks. Results showed that the two groups did not differ in metaphor comprehension; however, bilingual autistic children with higher non-verbal intelligence appeared to have superior performance in metaphor comprehension compared to their bilingual peers with lower non-verbal intelligence. The bilingual autistic children outperformed their monolingual peers in metaphor production, likely due to their higher non-verbal intelligence ability, despite the fact that the bilingual group had lower expressive vocabulary scores than the monolingual children. Simile comprehension, on the other hand, favored monolingual children, while no significant group differences were observed in simile production. Regarding errors, both groups exhibited similar error patterns, with literal interpretations being the dominant error type across both groups, suggesting that pragmatic language difficulty is a hallmark feature in ASD. The findings challenge the misconception that bilingualism hinders language development in children with ASD and highlight its potential to provide benefits in the realm of non-literal language processing.

Different paths to multilingualism in Autism Spectrum Disorder (ASD): Naturalistic and non-interactive

This study is one of the few research efforts investigating unexpected non-interactive foreign language acquisition in children with Autism Spectrum Disorder (ASD). Participants included 46 English-Hebrew-speaking children (ages 4;10 to 12;0): 14 autistic children who acquired English via non-interactive input (ASD-NI); 12 autistic children (ASD-Nat), and 20 non-autistic children with typical language development (TLD-Nat) who acquired English and Hebrew naturalistically. Morpho-syntactic abilities were assessed using Sentence Repetition tasks in both languages. The results showed no group differences for morpho-syntax in English; in Hebrew, the ASD-NI group scored similarly to the ASD-Nat group but lower than the TLD-Nat group. Individual performance differences between Hebrew and English were observed across all groups. Additionally, correlations between exposure and SRep scores were found in both groups for Hebrew but not English. These findings highlight diverse paths to language acquisition in ASD, with children acquiring foreign languages via both naturalistic and non-interactive input.

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.

Autism Detection in Children: Integrating Machine Learning and Natural Language Processing in Narrative Analysis

Despite the consensus that early identification leads to better outcomes for individuals with autism spectrum disorder (ASD), recent research reveals that the average age of diagnosis in the Greek population is approximately six years. However, this age of diagnosis is delayed by an additional two years for families from lower-income or minority backgrounds. These disparities result in adverse impacts on intervention outcomes, which are further burdened by the often time-consuming and labor-intensive language assessments for children with ASD. There is a crucial need for tools that increase access to early assessment and diagnosis that will be rigorous and objective. The current study leverages the capabilities of artificial intelligence to develop a reliable and practical model for distinguishing children with ASD from typically-developing peers based on their narrative and vocabulary skills. We applied natural language processing-based extraction techniques to automatically acquire language features (narrative and vocabulary skills) from storytelling in 68 children with ASD and 52 typically-developing children, and then trained machine learning models on the children's combined narrative and expressive vocabulary data to generate behavioral targets that effectively differentiate ASD from typically-developing children. According to the findings, the model could distinguish ASD from typically-developing children, achieving an accuracy of 96%. Specifically, out of the models used, hist gradient boosting and XGBoost showed slightly superior performance compared to the decision trees and gradient boosting models, particularly regarding accuracy and F1 score. These results bode well for the deployment of machine learning technology for children with ASD, especially those with limited access to early identification services.

Assessing the Impact of Bilingualism on the Linguistic Skills of Children with Autism Spectrum Disorder (ASD) in Greece: A Scoping Review

(1) Background and Objectives: This review aims to identify the latest literature on the possible effect of bilingualism on the linguistic skills of children with autism spectrum disorder (ASD) residing in Greece. (2) Materials and Methods: The literature was searched in the databases of Scopus and PubMed by selecting articles and by reviewing four studies published in peer-reviewed journals. This Scoping Review is based on the standards of PRISMA recommendations for scoping reviews, while the PCC framework was used as a guide to construct clear and meaningful objectives and eligibility criteria. (3) Results: The publications included in the review addressed a variety of language-related skills, including morphology, the syntax-pragmatics interface, narrative ability, as well as both receptive and expressive language skills. (4) Conclusions: Three out of four studies provide evidence that bilingual ASD children are not disadvantaged compared to monolingual peers but rather enjoy some benefits, to a certain extent, due to bilingualism. However, the number of the reviewed studies as well as the limitations of the studies themselves render this conclusion tentative. Additionally, the findings set guidelines that speech therapists, educators, psychologists, and doctors in the Greek context need to follow when treating or educating bilingual children with ASD.

Reading comprehension differences between children with Autism Spectrum Disorder and low cognitive abilities and children with Autism Spectrum Disorder and intact cognitive skills: the roles of decoding, fluency and morphosyntax

Introduction

Reading comprehension is one of the most important skills learned in school and it has an important contribution to the academic success of children with Autism Spectrum Disorder (ASD). Though previous studies have investigated reading comprehension difficulties in ASD and highlighted factors that contribute to these difficulties, this evidence has mainly stemmed from children with ASD and intact cognitive skills. Also, much emphasis has been placed on the relation between reading comprehension and word recognition skills, while the role of other skills, including fluency and morphosyntax, remains underexplored. This study addresses these gaps by investigating reading comprehension in two groups of school-aged children with ASD, one with intact and one with low cognitive abilities, also exploring the roles of word decoding, fluency and morphosyntax in each group's reading comprehension performance.

Methods

The study recruited 16 children with ASD and low cognitive abilities, and 22 age-matched children with ASD and intact cognitive skills. The children were assessed on four reading subdomains, namely, decoding, fluency, morphosyntax, and reading comprehension.

Results

The children with ASD and low cognitive abilities scored significantly lower than their peers with intact cognitive abilities in all reading subdomains, except for decoding, verb production and compound word formation. Regression analyses showed that reading comprehension in the group with ASD and intact cognitive abilities was independently driven by their decoding and fluency skills, and to a lesser extent, by morphosyntax. On the other hand, the children with ASD and low cognitive abilities mainly drew on their decoding, and to a lesser extent, their morphosyntactic skills to perform in reading comprehension.

Discussion

The results suggest that reading comprehension was more strongly affected in the children with ASD and low cognitive abilities as compared to those with intact cognitive skills. About half of the children with ASD and intact cognitive skills also exhibited mild-to-moderate reading comprehension difficulties, further implying that ASD may influence reading comprehension regardless of cognitive functioning. Finally, strengths in decoding seemed to predominantly drive cognitively-impaired children's reading performance, while the group with ASD and intact cognitive skills mainly recruited fluency and metalinguistic lexical skills to cope with reading comprehension demands, further suggesting that metalinguistic awareness may be a viable way to enhance reading comprehension in ASD.

Figurative language processing in autism spectrum disorders: A review

Impairments in the broader domain of pragmatics are considered to be a defining feature of Autism Spectrum Disorders (ASD). A challenging aspect of pragmatic competence is the ability to process nonliteral language. Interestingly, previous studies in figurative language comprehension in ASD have demonstrated conflicting results regarding participants' performance. The main scientific debate focuses on the underlying skills which facilitate processing of nonliteral speech in ASD. Namely, Theory of Mind (ToM), language abilities and Executive functions (EFs) are regarded as factors affecting autistic individuals' performance. This review addresses figurative language comprehension in ASD in light of the above three interpretive accounts. We reviewed data from recent studies in this field concluding that autistic children indeed encounter systematic difficulties in the processing of non-literal language. Moreover, only ToM and verbal skills were found to correlate the most with figurative language comprehension in ASD. Notably, we found that differences related to research methodology and tasks' properties may have led to discrepancies between studies' results. Finally, we argue that future studies should encompass in their experimental design figurative comprehension tasks with minimal linguistic demands and also measures of ToM, verbal ability and EFs in order to shed more light in the independent contribution of those skills to the processing of nonliteral language in ASD.

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

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

Bilingualism effects on cognition in autistic children are not all-or-nothing: The role of socioeconomic status in intellectual skills in bilingual autistic children

LAY ABSTRACT

Previous research has suggested that bilingualism may improve cognition in children with autism, and that this boost may stem from improvement in executive functions. The Wechsler Intelligence Scales for Children are considered to be reliable and valid measures of intelligence when administered to autistic children. These measures have so far revealed unusual psychometric properties in monolingual autistic children, notably distinctive patterns of strengths and weaknesses and low inter-correlation among verbal and nonverbal IQ subtests. The way bilingualism affects the intellectual functioning of autistic children has not been explored yet. Nor has there been a satisfactory factor structure that explains monolingual and bilingual autistic children's IQ performance in terms of individual factors, such as age and socioeconomic status. The current study examined the intelligence profiles of 316 bilingual and age- and gender-matched monolingual children with autism using the Wechsler Intelligence Scales for Children-Third Edition. The study applied clustering models to extract intelligence subtypes of autism, and mediation analyses to examine potential mediation effects of age and socioeconomic status on the children's verbal and nonverbal IQ performance. The results support the mediational role of the children's socioeconomic status in the association between bilingualism and intelligence. Low-socioeconomic status bilingual autistic children outperformed their monolingual peers on both verbal and nonverbal subtests, while the differences faded in medium-socioeconomic status and high-socioeconomic status children. The findings emphasize the positive effects of bilingualism on low-socioeconomic status autistic children's intelligence and also highlight high-socioeconomic status as a factor that may mitigate discrepant patterns of strengths and weaknesses in monolingual children's IQ performance.

Bilingualism Effects on the Cognitive Flexibility of Autistic Children: Evidence From Verbal Dual-Task Paradigms

The deficit in cognitive flexibility (i.e., the ability to adapt cognitive behavior to changing contexts) is one of the most prominent characteristics of autistic individuals. Inflexibility may manifest in restricted interests and increased susceptibility to the effects of misinformation either through inefficient inhibition of non-target information or deficient recall of correct information. Bilingualism has been shown to enhance executive functions in both typically developing children and autistic children; yet, the effect of bilingualism on cognitive flexibility in autism remains underexplored. In this study, we used verbal dual-tasks to compare cognitive flexibility across 50 monolingual autistic and 50 bilingual autistic children, and 50 monolingual and 50 bilingual typically developing children. The children were also administered language ability tests and a nonverbal global-local cognitive flexibility task, in order to investigate whether performance in the dual-tasks would be modulated by the children's language and executive function skills. The bilingual autistic children outperformed their monolingual autistic peers in the dual-tasks. The strength of the bilingualism effect, however, was modulated by the type of language processing that interfered with the target information in each dual-task, which suggests that the bilingual autistic children calibrated their processing resources and efficiently adapted them to the changing demands of the dual-task only to the extent that the task did not exceed their language abilities. Bilingual autistic children relied on their executive functions rather than on their language abilities while performing in the dual-tasks. The overall results show that bilingualism compensates for the reduced cognitive flexibility in autism.

Bilingualism effects in pronoun comprehension: Evidence from children with autism

The prevalence of autism worldwide has risen steadily in the last two decades, while bilingualism is also becoming increasingly prevalent in today's rapidly globalizing world. The current study aimed to investigate bilingualism effects in the pronoun resolution skills of children with autism in comparison to age-matched monolingual children with autism, as well as monolingual and bilingual children of typical development (Ν = 20 participants per group). Results showed that autistic children had general difficulty anchoring ambiguous pronouns to entities that were linguistically expressed in discourse, yet, the bilingual children with autism were more sensitive to the topicality of the entities in syntactic subject position and more prone to identify them as suitable referents of ambiguous null pronouns as compared to their monolingual peers. The findings suggest that bilingualism is not detrimental to autistic children's pronoun resolution skills. The current study aimed at determining how bilingualism influences ambiguous pronoun comprehension in children with autism as compared to bilingual and monolingual children of typical development. The findings show that bilingualism was not detrimental to the autistic children's pronoun resolution skills, further suggesting that having acquired more than one language does not exacerbate autistic children's deficits in the comprehension of pronouns.

Deconstructing the Native Speaker: Further Evidence From Heritage Speakers for Why This Horse Should Be Dead!

The category “native speaker” is flawed because it fails to consider the diversity between the speaker groups falling under its scope, as highlighted in previous literature. This paper provides further evidence by focusing on the similarities and differences between heritage speakers (HSs) and monolingually-raised speakers (MSs) of their heritage and majority languages. HSs are bilinguals who acquire a family (heritage) language and a societal (majority) language in early childhood. Naturalistic exposure from early childhood qualifies them as native speakers of their heritage language. Some HSs are simultaneous bilinguals, which makes them native speakers of their majority language as well. Others are early second language acquirers who may be indistinguishable from simultaneous bilinguals. Previous research shows that the heritage language productions of German HSs in the United States do not completely overlap with those of German MSs, who are, by default, native speakers. In overall clause type selection (independent main, coordinate main, and subordinate), the HSs differ from German MSs in German but are similar to English MSs in English. The present study examines the distribution of finite subordinate clauses and their types (relative, complement, and adverbial) across registers in 27 adolescent HSs of German in the United States, compared to 32 adolescent MSs of German and 32 MSs of English. All participants described a short video in two settings (formal/informal) and two modes (spoken/written). Results demonstrate that, even with respect to a specific phenomenon (subordinate clauses), HSs show similarities and differences to MSs of both languages. Concerning the distribution of subordinate clause types, HSs behave similarly to both English and German MSs. Concerning subordinate clauses in general, HSs use them less frequently than MSs in German. In English, the difference is more nuanced: HSs differentiate between settings in both modes, while MSs do so only in the written mode. This indicates that the category “native speaker” is not a meaningful descriptor since it covers speakers with varying production patterns. We propose that studies including native speakers should assure transparency and replicability of research by specifying and taking into account speaker characteristics such as bilingualism, proficiency, exposure and dominance.