What Do ‘Social Communication' Abilities of Preschool Children with ASD Look Like? A Qualitative Case Study

Background:  Challenges in social communication are a hallmark feature in ASD; however, social communication descriptions vary throughout the literature and in clinical assessment tools. Currently, no literature provides descriptions of functioning (what a child with ASD can do), or the range of social communication abilities expected. The ICF defines ‘functioning’ as a person’s actions – beyond ‘impairments’, and including characteristics of the environment and person. Together these features describe how well a person is functioning in his community. Understanding the range of functional abilities of children with ASD is necessary to: (i) create a common language of abilities; (ii) examine groups of children with similar abilities; and (iii) describe the abilities of children with ASD over time.

Objectives:  Examine the phenomenon of everyday social communication in children aged 3-5 years with ASD from the perspectives of their parents and professionals.

Methods:  An exploratory qualitative case study design examined parents’ and professionals’ views of observable functional social communication abilities of preschool children with ASD. A purposeful sample of parents, educators and clinicians with diverse backgrounds and experience with children with ASD was selected from urban and suburban settings. During three rounds of focus groups, participants’ responses to open-ended questions were audio taped and transcribed verbatim. Qualitative content analysis was done iteratively and independently by two coders using NVivo9 software. Coding remained at surface meaning of the participant descriptions with similar codes grouped into constructs. Data analyses examined consistently reported codes within and between groups. Construct definitions, developed from these codes, were revised and ranked by participants.

Results: Participants (n=31) included 5 parents, 13 early childhood educators and 13 clinicians. All professionals worked directly with preschool children with ASD (3 professionals were also parents of adolescents with ASD). Parents had mainly male children (6/7) in the age range 5-8 years old, and two parents had two children with ASD. All parents actively participate in provincial or regional autism organizations. Of the 13 characteristics of social communication derived from the content analysis, the 3 key constructs highly reported by all groups (Round 1) and ranked as most important for observable social communication (Round 2) by participants were: communicative intent; communicative skills; and reciprocity in an interaction. In Round 3, these constructs were further refined by each group in Round 3, with descriptions of the range of abilities (lowest to highest level of ability). Participants emphasized the importance of knowing the nature of the environment, which importantly influences the child’s everyday social communication ability.  

Conclusions: This study identified foundational constructs of the functional picture of social communication abilities of pre-school children with ASD. This work is being used to inform descriptions of what preschool children with ASD can do and will support the development of a tool (the Autism Classification System of Functioning: Social Communication [ACSF:SC]) to describe and classify the functional social communication abilities more specifically and systematically.