Do Children and Adolescents with ASDs Who Have Achieved An Optimal Outcome Continue to Exhibit Pragmatic Language Deficits?

Background: A study is currently following children and adolescents who have a history of autism spectrum disorder (ASD), but who no longer meet diagnostic criteria for such a disorder. These individuals have achieved social and language skills within the average range for their ages and receive little or no school support. Several recent studies suggest that this subset of individuals, once diagnosed with ASD, achieves an "optimal outcome" (OO); Sutera et al., 2007, Kelley et al., 2006, and Helt et al., 2008). These prior studies indicate that some residual language deficits, particularly in the domain of pragmatics, may be present in individuals who achieve OO (Kelley et al., 2006; Kelley, Naigles & Fein, 2010).

Objectives: This study examines pragmatic language in individuals with an OO, ages 8 to 21 years, compared to those with high-functioning autism (HFA) and typically developing (TD) peers.

Methods: Participants included individuals with OO (n = 25), HFA (n = 22), and TD (n = 21) with a mean age of 13 years. Groups were matched on age, gender, and non-verbal IQ.  Diagnoses were confirmed via the Autism Diagnostic Observation Schedule (ADOS), ADI-R, and expert clinical judgment. Grammatical knowledge was evaluated using the Clinical Evaluation of Language Fundamentals-4, Core Language score (CELF-4). Pragmatic language was evaluated from ADOS videos using the Pragmatics Profile (PP) of the CELF-4; raters were blind to diagnosis. The PP consists of 52 items in three subsections: Rituals and Conversational Skills (“Rituals”), Asking For, Giving, and Responding to Information (“Information”), and Nonverbal Communication Skills (“Nonverbal”).  Items are scored on a 1-4 Likert scale; higher scores indicate better pragmatic language.

Results: All groups differed significantly in grammatical language abilities, with TD > OO > HFA, all p’s < .01; M(SD) = 108 (16), 101 (14), 119 (7), p < .001, for OO, HFA, and TD groups, respectively. However, all groups were in the average or high average range in grammatical knowledge. A repeated-measures MANCOVA with CELF-4 score as a covariate indicated that the HFA group scored significantly lower than OO and TD groups in pragmatic language (PP) scores, F(2,63) = 16.15, p < .001.  Post-hoc analysis indicated that in each PP domain, TD and OO groups did not differ, all p’s > .44, and HFA scored lower than both TD and OO, all p’s < .001. Across PP domains, scores were significantly correlated with ADOS Social + Communication scores, all r’s > -.57, all p’s < .001, and with Vineland Social scores, all r’s > .35, p’s < .01. Only the Nonverbal subscale of the PP was correlated with CELF-4 Core Language, r =.23, p = .04.

Conclusions: Unlike prior studies of children with an OO, performed when participants were ages 5 – 8 years (Kelley et al., 2006) and 10 years (Kelley et al., 2010), an analysis of spontaneous pragmatic language skills found no difference between OO and TD groups, even holding constant grammatical language knowledge. In contrast, pragmatic language skills in HFA group were significantly lower than OO and TD groups.