Identifying Pragmatic Language Skills Difficulties in School-Aged Boys with Autism Spectrum Disorder (ASD)

Background:  

For children with ASD who have structural language skills within normal limits, pragmatic communication difficulties remain a persistent and pervasive impairment (Landa, 2000; Tager-Flusberg, 2004). Few studies have examined pragmatic language ability by considering both parent perspectives and behavioural observation within a relatively homogenous group of children with ASD. Volden and Phillips (2010) compared two standardized pragmatic assessments:  the Children’s Communication Checklist-2 (CCC-2; Bishop, 2003, 2006), a parent-report instrument, and the Test of Pragmatic Language (TOPL; Phelps-Terasaki & Phelps-Gunn, 1992), a child observation measure, on their ability to identify pragmatic communication impairment in high-functioning children and youth with ASD.  They found that the CCC-2 identified pragmatic impairment in more children than the TOPL.  Since then, the Test of Pragmatic Language-Version 2 (TOPL-2; Phelps-Terasaki & Phelps-Gunn, 2007) has become available.  The present study compared the CCC-2 and the revised TOPL-2 on their ability to identify pragmatic impairment in a cognitively and linguistically able group.

Objectives:  

To compare the CCC-2 with the TOPL-2 on the ability to identify pragmatic language difficulties in children with ASD whose cognitive and receptive language skills are in the average range.

Methods:  

Fifteen boys aged 10-12, diagnosed with ASD based on ADOS results and DSM-IV criteria, met inclusion criteria of cognitive and receptive language ability in the average range. Parents completed the CCC-2; participants were administered the Clinical Evaluation of Language Fundamentals-4 (CELF-4), and the TOPL-2.

Results:  

As expected, despite receptive language skills in the average range on the CELF-4, participants demonstrated difficulties in pragmatic skills on both the CCC-2 and the TOPL-2.  Similar to the results reported in Volden and Phillips (2010), the parent-report CCC-2identifiedmore participants(13/15) as having pragmatic impairment whereas the TOPL-2 identified pragmatic deficits in only 8/15 participants. In addition, a bivariate linear regression analysis indicated that CELF-4CoreLanguage standard score significantly predicted the TOPL-2 standard score (Beta = .726, F(1,13)=14.452, p=.002) accounting for 53% of the variance.  A bivariate linear regression with CELF-4 Core Language standard score as the independent variable and CCC-2 General Communication Composite standard score as the dependent variable was not significant (Beta=.268, F(1,13)=1.006, p=.334, n.s.)

Conclusions:  

This comparison of the CCC-2 and the TOPL-2 supports previous findings suggesting that the CCC-2 is a more sensitive instrument for identifying pragmatic language impairment in children with ASD whose structural language skills and IQ were in the average range. In addition, these results suggest that the TOPL-2 is more reliant on structural language competence than the CCC-2.