Peers' Evaluation of Stories Told by Optimal Outcome Children with a History of Autism Spectrum Disorders

Background: A study is following children who have a history of autism spectrum disorder (ASD), but who no longer meet diagnostic criteria for such a disorder. These children 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 small subset of children, once diagnosed with ASDs, achieve "optimal outcomes" (OO; Sutera et al., 2007; Helt et al., 2008; Kelley, Naigles, & Fein, 2010); however, pragmatic language skills may continue to show subtle impairments.

Objectives: Narratives are a highly sensitive tool for examining language skills. In order to assess potentially very subtle variability in pragmatic language ability, we asked high school students to read transcriptions of the Tuesday story and to evaluate them qualitatively for "story goodness."

Methods: Forty-five participants with high-functioning autism (HFA; n=15), typical development (TD; n=15) or OO (n=15) completed the Tuesday story narration. Participants were matched on age (mean=12.8, range 9-15) and verbal IQ. Narratives were transcribed by coders naïve to diagnosis. Transcriptions were read by five adolescents (ages 15-17), naïve to diagnosis, who rated the narratives on a five-point scale (1= poor, 5= excellent) according to: overall quality of story, story flow, comprehension, sophistication of language, correct use of grammar, story imagery, energy level, engagement level of the story, clarity of story content, and presence of oddity in wordings and themes.

Results: ANOVA tested for group differences in peer story ratings. The OO and HFA groups' ratings were significantly lower than TD group for: overall narrative quality [M(SD)= 3.1 (0.5), 3.0 (0.5), and 3.5(0.5) for OO, HFA, and TD, respectively; p= .03]; story flow [2.9 (0.7), 2.7 (0.6), and 3.4 (0.4); p < .01]; and comprehension [3.1 (0.5), 3.1 (0.5), and 3.7 (0.4); p < .01]. The HFA group received significantly lower scores than both OO and TD groups for sophistication of language [3.4 (0.5), 3.0 (0.5), and 3.4 (0.3); p= .04]. The HFA group received significantly lower scores than the TD group on grammatical structure; the OO group did not differ from either group [3.1 (0.4), 2.9 (0.4), and 3.3 (0.3); p= .02]. There were no group differences in any other narrative characteristics.

Conclusions: Tuesday narrations were evaluated in a previous study (Suh et al., 2012, INS presentation) for subtle aspects of pragmatic language such as clarity of pronoun use; the OO and TD groups did not differ on these measures. In this analysis, however, the OO group's narrations were evaluated by peers as having lower overall quality, overall flow, and being harder to comprehend relative to TD counterparts. Further data are being collected from additional raters to insure the reliability of rating scales. Despite having language and social skills in the average range, pragmatic language skills in OO may retain subtle deficits that are perceptible to untrained, lay interlocutors. This is meaningful, as peer interpretation of communications is crucial for social inclusion. We discuss implications of why these aspects of pragmatic language are so resistant to improvement.