The Relations Among Language, Behavior, and Social Skills in Children with High Functioning ASD: Exploration to Inform Pivotal Interventions

Background: Research indicates that the development of communication, particularly expressive and receptive language skills, has the potential to improve outcomes for children with ASD (Hudry, et al., 2010; Ventner, Lord, & Schopler, 1992). Research substantiates that difficulty with language skills is related to behavioral and social skills problems. However, it is less clear how specific language constructs (i.e. expressive and receptive) are interrelated with behavioral performance areas, particularly for children with high functioning autism (HFA). Specific knowledge about the relations among language skills and behavior could lead to strategic interventions that have the potential to improve outcomes across domains for children with HFA.

Objectives: The purpose of this exploratory study was to examine the relations among functional receptive and expressive language ability, externalizing and internalizing behaviors, and functional social skills among children with HFA.

Specific hypotheses were: (1) functional expressive and receptive language would be negatively associated with externalizing and internalizing behaviors and (2) functional expressive and receptive language would be positively associated with functional social skills.

Methods: The sample included 1,182 children enrolled in the Autism Treatment Network (ATN) registry.  The ATN includes 17 centers focusing on best practices and standards of care for children with ASD.  Participants were between the ages of 2-17, had a diagnosis of ASD confirmed by DSM-IV-TR criteria and Autism Diagnostic Observation Schedule (ADOS), and obtained a Full Scale IQ score above 75 on standardized measures. Subscales of The Vineland Adaptive Behavior Scales – 2^nd Edition were utilized as measures of functional receptive and expressive language and social skills.  The Child Behavior Checklist was used as a measure of internalizing and externalizing behavior. A path analysis modeling procedure was utilized to examine the interrelationships among constructs using an a priori empirically- and theoretically-derived model.

Results: As predicted results from the path analysis model indicated that functional receptive language was negatively associated with both externalizing behavior (b = -.30) and internalizing behavior (b = -.16).  In contrast, functional expressive language was positively associated with externalizing behavior (b = .15), and not significantly associated with internalizing symptoms.  With regard to social skills, both functional receptive and expressive language ability were positively associated (b =.26 and b = .39 respectively) with social abilities.

Conclusions: Overall, the results suggest that language abilities are associated with functioning across both social and behavioral domains among children with HFA.  Results from our path model suggest that functional receptive language may prove to be a promising area for developing targeted language-based interventions, given its strong relationships with both behavior and social skills.  It is possible that interventions targeting this area may provide secondary benefits for both behavior and social interaction among children with HFA.  Future research using longitudinal designs and standardized language measures is needed to fully investigate these issues.

We acknowledge the members of the ATN for use of the data and the families who participated in the Registry. The ATN is funded by Autism Speaks and a cooperative agreement (UA3 MC 11054) from HRSA to the Massachusetts General Hospital.