Early Predictors of Pragmatic Language Skills in School-Age Children with ASD

Background: Children with autism spectrum disorders (ASD) frequently display deficits in pragmatic language skills and social communication. These difficulties emerge when children try to engage in age-appropriate social relationships, often wanting to establish friendships, but lacking the skills to do so. As such, they report more loneliness than their neurotypical peers (Bauminger & Kasari, 2000). The difficulties they experience may be the result of underlying social communication deficits, and difficulties with the pragmatics of language. Even when children with ASD achieve optimal outcomes they continue to demonstrate pragmatic language difficulties and social awkwardness (Sutera et al., 2007). Researchers frequently conclude pragmatics skills are a component of language consistently impaired in individuals with autism (Kelley et. al, 2006). Research on early social communication skills that predict later pragmatic skills in children with ASD may inform the targets of early interventions.

Objectives: Objectives are to test if joint attention and symbolic play skills in children with ASD ages 3-4 are associated with higher conversation quality scores in children at ages 8-9.

Methods: Participants in this longitudinal study include 23 children with ASD seen at 3-4 years and later at 8-9 years. These children participated in a larger study and are included here since they were given Module 3 of the Autism Diagnostic Observation Schedule – Generic (ADOS) that involves several presses in which pragmatic language can be assessed. At age 3-4 children received a battery of evaluations to assess communicative interactions, play skills, receptive and expressive language, and cognitive development. Specifically, one of the tests included the Structured Play Assessment (SPA).  

At age 8-9 children were assessed on the ADOS, Module 3. Portions of the structured interview that did not call for materials were assessed to specifically analyze pragmatic language in conversations in unstructured contexts without visual cues.

Videos were analyzed using the Yale-Adaptation of the Pragmatic Rating Scale (Y-PRS). This scale is based on ADOS videotaped interviews and modified from the Pragmatic Rating Scale developed by Landa et al. (1992). The PRS identifies 30 pragmatic behaviors frequently reported to be adversely impacted in ASD. The scale is divided into 3 categories: (1) Pragmatic Behaviors, (2) Speech and Language Behaviors, and (3) Other Communicative Behaviors.

Results: Significant associations were found between symbolic play types and frequency on the Structured Play Assessment at age 3-4 and subsequent conversation quality scores and pragmatics ratings in conversation at ages 8-9. The associations between joint attention and pragmatic language scores were non-significant.

Conclusions: Symbolic play types represent flexibility in play skills. These skills early in development were associated with later conversational quality. Thus, the presence of flexibility in play may allow children to further develop their representational, and social conversational abilities through multiple interactions with adults and peers. The extent to which specific aspects of pragmatic language are influenced by earlier social communication skills should be further investigated.