Verbal and Pragmatic Performance in Children with EARLY Symptoms of Autism

Background: Parents and professionals often wonder about language outcomes for young children with autism. At this time, however, there is no consensus on language outcomes for this population. It is still unknown what percentage of children with early symptoms of autism who are not using verbal language to communicate at age 3 (i.e., who are nonverbal) will continue to be nonverbal later in middle childhood and young adulthood. As little as 15 years ago, Bailey, Phillips and Rutter (1996) predicted 50% of children with autism do not acquire useful language, an estimation that is still cited by many researchers and professionals, yet lacks any supporting empirical evidence. Determining verbal outcomes for these children can be complicated because researchers characterize language outcomes in different ways, such as the ability to use useful language or the ability to talk.

Objectives:  The current research investigated language outcomes of children who presented with symptoms of autism in the first few years of life.

Methods: The study included 75 children (age range from 6-24 years) who presented with language delays and symptoms of autism between 2 and 3 years of age and who attended a communication program at a university clinic. Participants were recruited by telephone. Standardized and nonstandardized language measures were administered to a subgroup of participants upon follow-up.

Results:  Findings revealed that the majority (81%) of children who presented with severe language delays and symptoms of autism in the first few years of life use verbal language by the time they reach school age. Of the 75 children, 53 (71%) were eventually diagnosed with an autism spectrum disorder. Thirty children with an autism spectrum diagnosis and who were reported to be verbal communicators by their parents were selected for follow-up testing. Results revealed that 37.5% scored within the normal range on the CELF-4 standardized assessment of language and 62.5% scored below the normal range. At the same time, while all these children had a diagnosis on the autism spectrum, not all of them demonstrated pragmatic difficulties as measured on the CELF-4 pragmatics scale.

Conclusions:  The majority of the children were found to use verbal language as their primary mode of communication. Language measures demonstrated the variability that characterizes language performance for children on the autism spectrum. Some children scored within the normal range on the standardized measure and yet were not communicatively competent. At the same time, other children scored well below the normal range and yet were able to communicate. Case studies will be presented.