Pragmatic difficulties in children with autism associated with childhood epilepsy

Purpose: The intention of this study was to examine specific pragmatic functions in 35 children, aged 6–11 years, with a history of epilepsy (mean length of duration 6.5 years), who demonstrated autistic features, ASD or autistic regression. Method: The children's ability to recognize and convey communicative intentions, conversational engagement and paralinguistic features were investigated using the Pragmatics Profile of Everyday Communication Skills in Children using semi-structured key-worker interviews. The association between weak or abnormal prosody and epileptic focus was also examined. Results: Findings demonstrate a strong association between early onset epilepsy with autism or autistic regression and additional pragmatic impairment. A number of children exhibited weak or abnormal prosody in association with temporal lobe EEG abnormalities, particularly in the non-dominant hemisphere. Consideration is given to recent studies of the converse—the presence of a reducing prevalence of epilepsy in the autism population and acknowledgment of implications for learning within the autistic population.     

Clinical assessment of pragmatic language impairment: A generalisability study of older people with Alzheimer's disease

Background: The Profile of Pragmatic Impairment in Communication (PPIC) is a clinical rating scale designed for the assessment of multiple facets of pragmatic language impairment in neuropsychiatric disorders. The PPIC has its origin in Grice's analysis of implicature and the Gricean principle of co‐operation and conversational maxims. Aims: We sought to evaluate the psychometric properties of the PPIC and to generate a profile of pragmatic language impairment associated with Alzheimer's disease (AD). Methods & Procedures: Speech samples were solicited from patients with AD (n = 13) and age‐matched healthy volunteers (n = 13) using several structured/semi‐structured tasks. Three trained raters made blind ratings on the PPIC on two occasions. Other raters evaluated mental status, aphasia, and communicative effectiveness. A generalisability analysis was conducted. Outcomes & Results: Good to excellent generalisability coefficients (0.86–0.94) were observed on most PPIC scales. PPIC ratings were strongly related to mental status and communicative effectiveness but not associated with aphasia. Diagnosis of AD made no substantive contribution to the prediction of PPIC ratings independently of mental status impairment. Conclusions: Results demonstrate evidence of good to excellent reliability, convergent validity, and discriminant validity of most PPIC scales. The observed associations are consistent with the view that pragmatic language impairment in AD is primarily a function of cognitive decline.     

Autism,primary pragmatic difficulties,and specific language impairment: can we distinguish them using psycholinguistic markers?

Three groups of children with communication disorders were examined using a series of psycholinguistic markers to explore whether the tasks could identify children with impairments other than specific language impairment (SLI), and to examine whether the different groups within this clinical population could be distinguished reliably from one another. The groups comprised children with autistic spectrum disorders (ASD; n = 13, all males; mean age 10 years 10 months, range 10 years 2 months to 12 years 6 months); children with primary pragmatic language impairment (PLI) but who did not have definite ASD diagnoses (n = 25, 22 males, three females; mean age 11 years 3 months, range 10 years 2 months to 12 years 5 months); and children with specific language impairment (SLI) without marked pragmatic language difficulties (n = 29, 25 males, 4 females; mean age 10 years 10 months, range 10 years 2 months to 11 years 9 months). Clinical markers examined were: the Children's Non-Word Repetition (CNRep), the Past Tense Task (PTT), and the Clinical Evaluation of Language Fundamentals, Recalling Sentences. First, it was found that the a priori groupings were not sufficiently defined and that four groups were actually present. The PLI group was in fact two separate samples: those with PLI pure and those with some autistic-like behaviours (referred to here as PLI plus, following Bishop 1998). Second, group comparisons indicated that CNRep was significantly lower for children with SLI than all other groups (although this measure was not such a good discriminator using a specificity analysis). Third, the markers were able to discriminate between all types of communication impairment in normal control participants (n = 100; 51 females, 49 males; mean age 11 years, range 10 years 5 months to 11 years 6 months) with sensitivity levels of at least 75% and specificity of 80%. Recalling Sentences was the most efficient marker for all groups. Finally, analysis showed that children with PLI plus could be accurately distinguished from all others, scoring most favourably overall on communication markers and on performance IQ scores.     

Social Communication Competence and Functional Adaptation in a General Population of Children: Preliminary Evidence for Sex-by-Verbal IQ Differential Risk

ObjectiveThe proportion of schoolchildren with mild social communicative deficits far exceeds the number diagnosed with an autistic spectrum disorder (ASD). We aimed to ascertain both the population distribution of such deficits and their association with functional adaptation and cognitive ability in middle childhood.MethodThe parent-report Social and Communication Disorders Checklist was administered to participants (n = 8,094) in the Avon Longitudinal Study of Parents and Children. We correlated impairment severity with independent clinical diagnoses of ASD, cognitive abilities, and teacher-rated maladaptive behavior.ResultsSocial and Communication Disorders Checklist scores were continuously distributed in the general population; boys had mean scores 30% higher than girls. Social communicative deficits were associated with functional impairment at school, especially in domains of hyperactivity and conduct disorders. A sex-by-verbal IQ interaction effect occurred: verbal IQ was protective against social communication impairments across the range of abilities in female subjects only. In male subjects, this protective effect did not exist for those with above-average verbal IQ.ConclusionsSocial communicative deficits are of prognostic significance, in terms of behavioral adjustment at school, for boys and girls. Their high general population prevalence emphasizes the importance of measuring such traits among clinically referred children who do not meet diagnostic ASD criteria. Above-average verbal IQ seems to confer protection against social communication impairments in female subjects but not in male subjects.     

Autistic social impairment in the siblings of children with pervasive developmental disorders

OBJECTIVE: Sibling recurrence risk in autism has been estimated to be approximately 10%. This study investigated subsyndromal autistic impairments among siblings of probands with pervasive developmental disorders. METHOD: The authors used the Social Responsiveness Scale to obtain quantitative assessments of autistic social impairment in three groups of proband-sibling pairs: 1) autistic children from multiple-incidence families and their closest in age nonautistic brothers (N=49 pairs); 2) children with any pervasive developmental disorder, including autism, and their closest-in-age brothers (N=100 pairs), and 3) children with psychopathology unrelated to autism and their closest-in-age brothers (N=45 pairs). RESULTS: Sibling Social Responsiveness Scale scores were continuously distributed and substantially elevated for both the autistic and pervasive developmental disorder groups. Highest scores (i.e., greatest impairment) were seen among siblings of autistic probands from multiple-incidence families, followed by siblings of probands with any pervasive developmental disorder, then siblings of probands with psychopathology unrelated to autism. CONCLUSIONS: Taken together with previous findings, these results support the notion that genetic susceptibility factors responsible for common, subsyndromal social impairments may be related to the causes of categorically defined pervasive developmental disorders.     

The management of conversational topic by a ten year old child with pragmatic difficulties

A case study is presented of a 10-year-old child described as having 'pragmatic difficulties', for the initiation and management of conversational topic. Video-recorded naturally-occurring conversations between the child and his peers at school are subjected to a detailed sequential analysis, drawing on some of the insights gained into the collaborative management of topic by researchers working in the tradition of conversation analysis (Button and Casey 1984, 1985). We find that our subject uses some helpful devices to generate and manage conversational topics but has difficulty collaborating with his conversational partners. We consider some of the different ways in which social-cognitive abilities are implicated in alternative courses of action available for the initiation and management of topic, and find that our subject's behaviours support the suggestion of Bishop (1997) that a difficulty in the development of social cognition underlies the interactional problems experienced by children with pragmatic language impairment. Consideration is given to ways in which the child's conversational behaviours are subject to influence from the styles of talk he is exposed to in interactions with adults in the language unit setting in which he spends much of his time.     

Cognitive functioning in severe psychiatric disorders: a general population study

In clinical samples, patients with severe psychiatric disorders are found to have cognitive impairments. Less is known whether this applies to samples derived from the general population. We aimed to study cognitive functioning in a population-based sample comprising individuals with schizophrenia, other non-affective psychoses, bipolar disorders, major depressive disorder, and controls derived from the same population. The current analysis was based on 148 persons with severe mental disorders and 66 control subjects, derived from the Psychoses in Finland study. All subjects were interviewed with SCID, and a neuropsychological test battery was administered. Subjects with schizophrenia had a generalized cognitive impairment (d = 0.43–1.07), while those with other non-affective psychoses were impaired in verbal memory and processing speed (d = 0.43–0.59). Subjects with bipolar disorders were not impaired. Unipolar major depressive disorder associated with slowed processing speed (d = 0.64). Our findings on cognitive impairments in subjects with schizophrenia and other non-affective psychoses derived from the general population support previous findings of a generalized cognitive dysfunction in these subjects. However, our results suggest that subjects with bipolar disorders from non-clinical populations may not have significant cognitive impairments. Our results emphasize the importance of using control samples derived from the same population and studied similarly as those with disorders in evaluating cognitive functioning of subjects with severe mental disorders.     

The communicative function of question production in autistic children

Six children diagnosed as autistic and who also were reported to be using questions inappropriately in their conversations with adults were each placed in a conversational context in which the adult responses to their questions were systematically varied. The dependent variable was the occurrence and amount of appropriate conversational continuation associated with each type of adult response. Differential listener response did affect the occurrence of conversational continuation and to a lesser degree the amount of continuation. These data were interpreted to support the hypothesis that repetitive questioning in this population serves the communicative function of conversation initiation. Furthermore, it appears that the autistic conversants lack the conversational management skills to maintain the conversation following the listener's answer to the question.Portions of this paper were presented at the University of Wisconsin-Madison Symposium on Research in Child Language Disorders, June 1980.     

Pragmatic Inferences in High-Functioning Adults with Autism and Asperger Syndrome

Although people with autism spectrum disorders (ASD) often have severe problems with pragmatic aspects of language, little is known about their pragmatic reasoning. We carried out a behavioral study on high-functioning adults with autistic disorder (n = 11) and Asperger syndrome (n = 17) and matched controls (n = 28) to investigate whether they are capable of deriving scalar implicatures, which are generally considered to be pragmatic inferences. Participants were presented with underinformative sentences like “Some sparrows are birds”. This sentence is logically true, but pragmatically inappropriate if the scalar implicature “Not all sparrows are birds” is derived. The present findings indicate that the combined ASD group was just as likely as controls to derive scalar implicatures, yet there was a difference between participants with autistic disorder and Asperger syndrome, suggesting a potential differentiation between these disorders in pragmatic reasoning. Moreover, our results suggest that verbal intelligence is a constraint for task performance in autistic disorder but not in Asperger syndrome.

Communicative behavior of adults with an autistic four-year-old boy and his nonhandicapped twin brother

Sixteen female preschool teachers were videotaped playing in dyads with a nonverbal, socially unresponsive autistic 4-year-old boy and his nonhandicapped fraternal twin brother. Eight adults were informed that the autistic child had a language disability and did not talk or understand much language; eight adults were not informed about any differences between the children. Language to the autistic child was simpler, more concrete, and more often accompanied by gestures than language to his brother for both groups of subjects. Informed teachers made greater speech modifications to the autistic child and were more successful at keeping him on-task than uninformed adults. The theoretical and practical implications of communicative adjustments to children with language and social impairments are discussed.A portion of this paper was submitted as a master's colloquim paper to the University of Minnesota by the second author and presented at the annual meeting of the American Educational Research Association, Los Angeles, April 1981. The research was supported by a Graduate Research Grant to the first author and by the Center for Research in Human Learning.     

Childhood and current autistic features in adolescents with schizotypal personality disorder

The diagnostic boundaries between autistic- and schizophrenia-spectrum disorders have varied over the years, and some overlap in diagnostic criteria persists. The present study examined childhood and current signs of autistic disorder (AD) in adolescents with schizotypal personality disorder (SPD) or other personality disorders, as well as healthy controls. A structured interview was administered to rate participants' current symptoms. Participants' guardians were interviewed with the Autism Diagnostic Inventory-Revised (ADI-R), a clinical assessment of childhood and current autistic signs. Compared to both the other personality-disordered and healthy groups, adolescents with SPD were rated as having significantly more impairment on childhood and current social functioning, and having more unusual interests and behaviors. For the entire sample, impaired childhood social functioning and unusual interests and behaviors were associated with higher negative symptom scores. Current impairments in social functioning, unusual interests and behaviors, and communication were also linked with greater negative symptoms. However, neither childhood nor current autistic features significantly predicted later conversion to an Axis I psychotic disorder over the course of three years of follow-up. The findings indicate that past and current autistic signs are more common in adolescents with SPD, but neither current nor childhood autistic features are linked with conversion to psychosis.     

A psychological approach to understanding the social and language impairments in autism

This paper surveys current research on the social and communicative impairments in autism. In diagnostic schemes, the criteria for identifying autism in these domains include overlapping features. One approach to interpreting this overlap is to consider that social and communicative impairments reflect the same underlying cognitive deficit, referred to as the 'theory of mind' hypothesis of autism. On this view autism involves primary difficulties in identifying mental states in other people, and in interpreting behavior and action in relation to a person's mental state. Studies on the relationship between social behavior, communicative functioning, and theory of mind in children with autism are reviewed, emphasizing the connections between these areas of impairment that are central to the definition of the autistic syndrome.     

Collaborative competence in dialogue: Pragmatic language impairment as a window onto the psychopathology of autism

BackgroundPragmatic language, including conversational ability, can be difficult for people with autism. Difficulties with dialogue may reflect impairment in interpersonal engagement more than general language ability.MethodWe investigated conversational abilities among children and adolescents with and without autism (n = 18 per group) matched for language proficiency and productivity. Videotaped conversations from the Autism Diagnostic Observational Schedule (ADOS, Lord, Rutter, DiLavore, & Risi, 2001) were rated according to the Collaborative Competence in Dialogue (CCD) scale featuring six verbal and non-verbal ‘cues’ that conversational partners use to sustain dialogue.ResultsParticipants with autism produced significantly fewer ‘typical’ communicative cues and more cues rated as intermittent or rote/stereotyped, even when non-verbal items (gaze) were removed from consideration. Within the autism group, competence in dialogue was not correlated with ‘general’ language ability, but was correlated with a measure of pragmatic ability.ConclusionsDifficulties with collaboration in dialogue may mirror the intermittent or incomplete interpersonal engagement of children with autism.ImplicationsAssessment of language ability in autism should include observation in unstructured social settings.     

Brief Report: Relative Effectiveness of Different Home-based Behavioral Approaches to Early Teaching Intervention

The effectiveness of home-based early behavioral interventions for children (2:6–4:0 years old) with autistic spectrum disorders was studied over 9–10 months. Measures of autistic severity, intellectual, educational, and adaptive behavioral functioning were taken. There was no evidence of recovery from autism. High-intensity behavioral approaches (mean 30 h/week) produced greater gains than low-intensity programs (mean 12 h/week). Lovaas- and complete application of behavior analysis to schools approach-type interventions produced largest gains [similar to gains produced by longer-term clinic-based applied behavior analysis (ABA) programs]. Within the high-intensity groups, increased temporal input on the program was not associated with increased gains in the children. The results from clinic-based ABA trials were partially replicated on a home-based sample, using children with greater autistic and intellectual impairments.     

Relationship Between Symptom Domains in Autism Spectrum Disorders: A Population Based Twin Study

Factor structure and relationship between core features of autism (social impairments, communication difficulties, and restricted, repetitive behaviours or interests (RRBIs)) were explored in 189 children from the Twins Early Development Study, diagnosed with autistic spectrum disorders (ASDs) using the Development and Wellbeing Assessment (DAWBA; Goodman et al. in J Child Psychol Psyc 41:645–655, 2000). A bottom-up approach (analysis 1) used principal component factor analysis of DAWBA items indicating five factors, the first three mapping on the triad. In analysis 2, applying top-down DSM-IV criteria, correlations between domains were modest, strongest between social and communication difficulties. Cross-twin cross-trait correlations suggested small shared genetic effects between RRBIs and other symptoms. These findings from a clinical sample of twins indicate a fractionation of social/communicative and RRBI symptoms in ASD.     

Diagnostic Differentiation of Autism Spectrum Disorders and Pragmatic Language Impairment

The present study examined diagnostic differentiation between school-aged children with autism spectrum disorders (ASD) and children with pragmatic language impairment (PLI). Standardized diagnostic instruments were used to investigate the relationship between severity of ‘autism triad’ impairments and group membership. The Autism Diagnostic Observation Schedule was administered to 19 children with PLI and 22 children with ASD. Parents completed the Social Communication Questionnaire. There was a significant difference between diagnostic groups in the level of the severity of behaviors represented by the Communication and Reciprocal Social Interaction sub-domains on both diagnostic measures. Currently displayed Repetitive and Restricted Behaviors and Interests were not found to be useful for differentiating between groups. The similarities found between groups have important implications for intervention.     

A written communication strategy for a speaker with aphasia and apraxia of speech: Treatment outcomes and social validity

Background: Self-generated cueing strategies have been shown to facilitate communication in persons with speech and language impairments, and multiple benefits may be associated with targeting conversational competence. Aims: The purpose of this study was to train an individual (LG) with longstanding aphasia and apraxia of speech to substitute a self-initiated written word for protracted articulatory struggle, in three conversational settings. Methods & Procedures: A multiple-baseline design across three different settings was utilised, providing an opportunity for strategy practice with both familiar and unfamiliar conversational partners. Topics were constructed to be relevant and meaningful to LG. Several subject-evaluated psychosocial measures, including locus of control, were employed, and social validity ratings were solicited from unfamiliar raters. Outcomes & Results: LG adopted and successfully used the strategy across all settings, with both familiar and unfamiliar partners, at performance levels well above baseline. The number of abandoned conversational targets decreased considerably with strategy use, and social validation ratings indicated beneficial effects pertaining to communicative efficiency and comprehensibility in shorter, but not longer, conversational segments extracted from treatment videotapes. Conclusions: The training protocol was successful in improving LG's facility with targeted compensatory strategy use across designated conversational contexts. However, the clinical significance and social value of LG's strategy use in these settings may be mitigated by the accompanying communicative variables affecting the conversational exchange as a whole. Future efforts could focus on examining what variables in the longer treatment segments appeared to counter the positive effects of LG's strategy use as perceived in the shorter conversational samples. On a more positive note, changes in LG's locus of control scores from extreme internal to more moderate could reflect a greater degree of willingness on her part to allow others to participate in her recovery process, or perhaps herald a more realistic attitude towards the extent of her loss.     

Non-expert clinicians' detection of autistic traits among attenders of a youth mental health service

Aims: The aims of this study were to determine the point prevalence of autism spectrum disorders and to estimate the prevalence of autistic traits in a youth mental health service. Methods: Following three educational sessions on autism spectrum disorders, treating clinicians were interviewed to determine whether the clients on their caseloads had (i) a confirmed prior diagnosis of autism spectrum disorder; (ii) were felt to exhibit autistic traits; or (iii) were not felt to exhibit autistic traits. Results: Information on autism spectrum disorder status was obtained for 476 patients. Of the included patients, 3.4% (n = 16) had a confirmed diagnosis of autism spectrum disorder and 7.8% (n = 37) were reported by treating clinicians to exhibit autistic traits. Conclusions: The rate of autism spectrum disorder was higher in this population than that in community samples with twice as many again being identified as having autistic traits by their treating clinicians. This has implications for correct diagnosis and appropriate management in these settings.     

Social (pragmatic) communication disorder: a research review of this new DSM-5 diagnostic category

Social (pragmatic) communication disorder (SCD) is a new diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). The purpose of this review is to describe and synthesize the relevant literature from language and autism spectrum disorder (ASD) research relating to pragmatic language impairment and other previously used terms that relate to SCD. The long-standing debate regarding how social communication/pragmatic impairments overlap and/or differ from language impairments, ASD, and other neurodevelopmental disorders is examined. The possible impact of the addition of SCD diagnostic category and directions for future research are also discussed.     

Ontogeny of communicative functions in autism

Autistic children have been stereotyped as noncommunicative and noninteractive; however, this may be partly attributed to traditional research approaches that do not consider the intentions of the child or the context of the social interaction. This discussion reviews some recent investigations that have used a developmental pragmatics framework to study language and communicative behaviors associated with autism. A working model of the ontogeny of communicative functions in autistic children is proposed. The communicative profile associated with autism is explained by factors related to the child's language-learning environment, as well as factors inherent in the child. Clinical implications for the design of language intervention programs for autistic children are offered.The author would like to extend thanks to Drs. Adriana Schuler, Carol Prutting, Robert Koegel, Richard Flower, Susan Curtiss, and Martin Glasser for their contributions to this work. This paper contains material presented at the annual convention of the American Speech-Language Hearing Association, Cincinnati, Ohio, 1983.