Executive and Nonverbal Contributions to Pragmatic Language in Autism Spectrum Disorder

Pragmatic language deficits are universal in individuals with autism spectrum disorders. Pragmatic language skills require the integration of multiple communicative and social skills, and as such represent an intersection of two of the three major domains of impairment in ASD: communication and social interaction. Data from typically developing (TD) populations also suggests that pragmatic language is supported by complex skills such as gesture and the executive functions. Here we investigate common ground, a pragmatic language skill in which speakers adjust the contents of their speech based on their listener’s perceived knowledge, in adolescents with ASD and TD. We designed an experimental narrative paradigm in which participants watched brief cartoons and then described the cartoons to a listener who sometimes shared knowledge about the cartoons and sometimes did not. While the TD sample reliably reduced the number of words in their narrations when the listener shared knowledge about the cartoons, consistent with the common ground literature, this common ground effect was not observed in the ASD sample. The tendency to show a common ground effect was not related to general skills such as IQ, receptive vocabulary, or executive function, in either group. The relationship between common ground and gesture use was difficult to interpret due to an order effect. In the ASD sample only, the common ground effect was positively correlated with age, such that participants 15 and over tended to show the effect while younger participants did not. These results suggest that the tendency to use common ground is relatively stable by adolescence in typical populations; however, it is still undergoing a period of development in adolescents with ASD, pointing to the importance of pragmatic language interventions at this sensitive age. Finally, we present data on gesture use in ASD, suggesting that teens with ASD may be more likely to use gestures when they fulfill a self-serving role rather than a communicative role. We discuss these results in the context of the broader literature on gesture and discourse skills in ASD

Mutual Exclusivity in Autism Spectrum Disorders: Testing the Pragmatic Hypothesis

While there is ample evidence that children treat words as mutually exclusive, the cognitive basis of this bias is widely debated. We focus on the distinction between pragmatic and lexical constraints accounts. High-functioning children with autism spectrum disorders (ASD) offer a unique perspective on this debate, as they acquire substantial vocabularies despite impoverished social-pragmatic skills. We tested children and adolescents with ASD in a paradigm examining mutual exclusivity for words and facts. Words were interpreted contrastively more often than facts. Word performance was associated with vocabulary size; fact performance was associated with social-communication skills. Thus mutual exclusivity does not appear to be driven by pragmatics, suggesting that it is either a lexical constraint or a reflection of domain-general learning processes

Accuracy of initial diagnostic impressions of autism in toddlers and behaviors that inform these impressions.

Clinicians form initial impressions about a childs diagnosis based on behavioral features, but research has not yet identified specific behaviors to guide initial diagnostic impressions. Participants were toddlers (N = 55, mean age 22.9 months) from a multi-site early detection study, referred for concern for ASD due to screening or parent/provider concern. Within 5 min of meeting a child, clinicians noted ASD or non-ASD impression, confidence in impression, and behaviors that informed their impression. These clinicians also determined final diagnoses for each child. When a childs final diagnosis was ASD (n = 35), senior clinicians formed an initial impression of ASD in 22 cases (63%) but missed 13 cases (37%). When final diagnosis was non-ASD (n = 20), senior clinicians made an initial impression of non-ASD in all cases (100%). Results were similar among junior clinicians. Senior and junior clinicians used the same behaviors to form accurate impressions of ASD and non-ASD: social reciprocity, nonverbal communication, and eye contact. Senior clinicians additionally used focus of attention when forming accurate impressions of ASD and non-ASD; junior clinicians used this behavior only when forming accurate non-ASD impressions. Clinicians initial impressions of ASD are very likely to be consistent with final diagnoses, but initial impressions of non-ASD need follow-up. Toddlers who show all four atypical behaviors (social reciprocity, nonverbal communication, eye contact, and focus of attention) might receive expedited ASD diagnoses. However, presence of apparently typical behaviors should not rule out ASD; for some children a longer evaluation is necessary to allow for more opportunities to observe subtle social behavior

The first five minutes: Initial impressions during autism spectrum disorder diagnostic evaluations in young children.

Diagnosticians report that autism spectrum disorder (ASD) is immediately apparent in some, but not all, children ultimately diagnosed. Clinicians' initial diagnostic impressions have implications for ASD early detection, yet the literature raises questions about their accuracy. This study explores diagnostic impressions of ASD specialists made within the first 5 minutes of meeting a young child and investigates factors associated with the match between initial impressions and final diagnoses. Participants were children (n = 294, aged 12-53 months) referred for an ASD evaluation as part of multi-site ASD screening studies. After 5 minutes observing each child, clinicians with expertise diagnosing ASD recorded if they thought the child would meet criteria for ASD following a complete evaluation, and recorded their confidence in this impression. Clinicians' initial impressions matched the final diagnosis in 81% of cases. Ninety-two percent of cases initially thought to have ASD met criteria following a full evaluation; however, 24% of cases initially thought not to have ASD also met criteria, suggesting a high miss rate. Clinicians were generally confident in their initial impressions, reporting highest confidence for children initially thought correctly not to have ASD. ASD behavioral presentation, but not demographic characteristics or developmental level, were associated with matching initial impression and final diagnosis, and confidence. Brief observations indicating ASD should trigger referral to intervention services, but are likely to under-detect positive cases and should not be used to rule out ASD, highlighting the need to incorporate information beyond initial clinical impression. LAY SUMMARY: When children come in for an autism evaluation, clinicians often form early impressions-before doing any formal testing-about whether the child has autism. We studied how often these early impressions match the final diagnosis, and found that clinicians could not easily rule out autism (many children who initially appeared not to have autism were ultimately diagnosed), but were generally accurate ruling in autism (when a child appeared to have autism within 5 minutes, they were almost always so diagnosed)