Abstract
Although language impairment is commonly associated with the autism spectrum disorder (ASD), the Diagnostic Statistical Manual no longer includes language impairment as a necessary component of an ASD diagnosis (American Psychiatric Association, 2013). However, children with ASD and no comorbid intellectual disability struggle with some aspects of language whose precise nature is still outstanding. Narratives have been extensively used as a tool to examine lexical and syntactic abilities, as well as pragmatic skills in children with ASD. This study contributes to this literature by investigating the narrative skills of 30 Greek-speaking children with ASD and normal non-verbal IQ, 16 with language skills in the upper end of the normal range (ASD-HL), and 14 in the lower end of the normal range (ASD-LL). The control group consisted of 15 age-matched typically-developing (TD) children. Narrative performance was measured in terms of both microstructural and macrostructural properties. Microstructural properties included lexical and syntactic measures of complexity such as subordinate vs. coordinate clauses and types of subordinate clauses. Macrostructure was measured in terms of the diversity in the use of internal state terms (ISTs) and story structure complexity, i.e., children's ability to produce important units of information that involve the setting, characters, events, and outcomes of the story, as well as the characters' thoughts and feelings. The findings demonstrate that high language ability and syntactic complexity pattern together in ASD children's narrative performance and that language ability compensates for autistic children's pragmatic deficit associated with the production of Theory of Mind-related ISTs. Nevertheless, both groups of children with ASD (high and low language ability) scored lower than the TD controls in the production of Theory of Mind-unrelated ISTs, modifier clauses and story structure complexity.
Highlights
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has de-emphasized language ability in the diagnosis of Autism Spectrum Disorders (ASD) by removing the criteria of “age-of-onset” and “no history of language delay” for Asperger’s syndrome, language impairment is commonly associated with ASD
To explore the question whether the narrative output of the children differed from the original story on microstructure and macrostructure, we undertook a series of qualitative comparisons targeting the specific narrative properties; to this end, and for each dependent variable, we used proportions by dividing each child’s raw scores by the total number of verb clauses
Higher language skills enhance the syntactic complexity of narration in autism as evinced by ASD-HL children’s higher use of coordinate, as well as oti-(that)/pu-(that-factive) complement clauses, relative to their ASD-LL peers
Summary
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has de-emphasized language ability in the diagnosis of Autism Spectrum Disorders (ASD) by removing the criteria of “age-of-onset” and “no history of language delay” for Asperger’s syndrome, language impairment is commonly associated with ASD. Receptive language is usually lower than expressive language in highly-verbal children with ASD (e.g., Hudry et al, 2010), though it is sometimes anecdotally reported that some school-aged children demonstrate relatively good receptive skills, despite their low expressive skills (Kasari et al, 2013) Within this framework, a distinction is often made between children with ASD who have age-appropriate language skills and those who have a language impairment similar to that found in children with Specific Language Impairment (SLI), but whose vocabulary levels and non-verbal cognition are intact (e.g., Rapin and Dunn, 2003; Tager-Flusberg and Joseph, 2003; Tager-Flusberg, 2006). Tek et al.’s (2014) longitudinal study revealed similar language growth patterns of children with ASD and good language skills with their typically-developing (TD) age-matched peers in a variety of language measures, including grammatical morphemes, vocabulary and sentence complexity, in contrast to an age-matched group with ASD and low verbal skills that exhibited developmental delays across the same language areas
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