Association of Atypical Communication Characteristics with Psychiatric, Social, and Academic Functioning in Clinic-Referred Children with and without Autism Spectrum Disorder

Friday, May 13, 2016: 5:30 PM-7:00 PM
Hall A (Baltimore Convention Center)
E. Kang, M. D. Lerner and K. D. Gadow, Stony Brook University, Stony Brook, NY

Children with autism spectrum disorder (ASD) experience a variety of atypical communication characteristics (ACC), such as echolalia, odd pitch, and pragmatic difficulties, which play a significant role in life adjustment. Although it is well established that ACC are associated with emotional and behavioral problems in non-ASD clinic-referred youth (Baker & Cantwell, 1987), little is known about their relation in children with ASD, despite common psychiatric comorbidities in children with ASD (Gadow et al., 2005). Of equal or greater interest is the relation between ACC and psychiatric symptoms across ASD and non-ASD populations, and how most common ACC in ASD influence functional outcomes.      


This study explored the association of ACC with psychiatric symptoms in clinic-referred children with and without ASD, and of specific ACC with social and academic functioning in those with ASD. 


Clinic-referred children (6-18 years) with (N=283) and without (N=724) ASD were assessed with a well-validated parent-report questionnaire of psychiatric symptoms, ACC, and social (peer relations) and school functioning (i.e., special education, inclusion classroom). 


Rates of ACC are summarized in Table 1. Bonferroni-corrected chi-square tests revealed higher rates of specific types of ACC in ASD versus non-ASD groups (p<.001). When analyses were confined to the youth with ACC, those with ASD evidenced higher rates of nonverbal behavior, speech delay, repeating words, echolalia, odd tone of voice, and pragmatic difficulties (p ≤.005). ROC results revealed an AUC=0.69 (p<.001) for pragmatic difficulties, followed by speech delay, repeating words, echolalia, perseveration, and odd voice (all AUC≥.559, p≤.026).

Two-way ANOVAs revealed interactions between group (ASD, non-ASD) and global ACC (present, not present) in predicting ADHD (p≤.007) and ASD (p≤.019) symptoms, with increasing severity with higher ACC in the ASD group. Controlling for age, gender, and IQ yielded same pattern of results.

We conducted moderation analyses of specific ACC shown in our ROC analyses to distinguish ASD from non-ASD groups in predicting ADHD and ASD symptoms. There were significant (all p<.05) interactions between ASD status and repeating words in predicting ADHD inattention and all ASD symptom domains; perseverative speech in predicting ADHD hyperactive-impulsive and ASD repetitive symptoms; speech delay in predicting ASD communication; echolalia in predicting all ASD domains; and odd voice predicting ASD communication and repetitive behavior. Post-hoc analyses revealed such associations only in the ASD sample (all B≥1.21, p≤.03 vs. all p>.07 in non-ASD).

In the ASD sample, we examined associations of specific ACC with functional outcomes: speech delay with intellectual disability (r=.22, p=.001), being in inclusion classroom (r=.31, p<.001), dominating play (r=.28, p<.001), having a best friend (r=-.15, p=.019) and wanting friend (r=-14, p=.039). Repeating words was associated with inclusion classroom (r=.18, p=.006). Echolalia was associated with intellectual disability (r=.24, p<.001), being in inclusion classroom (r=.22, p=.001), having any friend (r=-.18, p=.009) and wanting friend (r=-14, p=.044). Odd voice was associated with difficulty relating to peers (r=.16, p=.02).


ACC are associated with more severe psychiatric symptoms and social and academic difficulties, and relations differ from non-ASD referrals. Results have implications for both clinical management and nosology.