Prevalence and functional impact of social (pragmatic) communication disorders

Background:To evaluate the utility of the Children’s Communication Checklist-2 (CCC-2) for measuring inclusion and exclusion criteria of Social (Pragmatic) Communication Disorder (SPCD) and to ascertain prevalence rates and functional impact of SPCD in a community sample.Method:We used parent and teacher responses to the CCC-2 to approximate inclusion (poor social-pragmatic skills) and exclusion (poor structural language skills or autistic symptomatology) criteria for SPCD. We tested the prevalence of SPCD using these criteria in a population-based sample of children (n = 386) aged 5-6 years old. We also investigated the academic and behavioural profiles of children with more broadly-defined limitations in social-pragmatic competence.Results:Regardless of the diagnostic algorithm used, the resulting prevalence rates for SPCD indicated that very few children had isolated social communication difficulties (0-1.3%). However, a larger proportion of children (range: 6.1-10.5%) had social-pragmatic skills outside the expected range alongside structural language difficulties and/or autism spectrum symptoms, and this was associated with a range of adverse academic and behavioural outcomes. Conclusions:A considerable proportion of children in the early years of primary school have social-pragmatic deficits that interfere with social and scholastic activity, however these rarely occur in isolation. Exclusionary criteria articulated by DSM-5 may lead to under-identification of individuals with social-pragmatic deficits that may benefit from tailored support and intervention.

Pragmatic, linguistic and cognitive factors in young children's development of quantity, relevance and word learning inferences

To better understand the developmental trajectory of children's pragmatic development, studies that examine more than one type of implicature as well as associated linguistic and cognitive factors are required. We investigated three- to five-year-old English-speaking children's (N = 71) performance in ad hoc quantity, scalar quantity and relevance implicatures, as well as word learning by exclusion inferences, using a sentence-to-picture-matching story-based task. Children's pragmatic abilities improved with age, with word learning by exclusion acquired first, followed by relevance and ad hoc quantity implicatures, and finally scalar quantity implicatures. In an exploratory analysis (with a subset of the data N = 58), we found that structural language knowledge was a predictor of pragmatic performance (but no evidence for an association with socioeconomic status or Theory of Mind, controlling for structural language). We discuss reasons why this developmental pattern emerges with reference to linguistic and extra-linguistic properties of these inferences.

Association between CCC-2 and Structural Language, Pragmatics, Social Cognition, and Executive Functions in Children with Developmental Language Disorder

(1) Background: Developmental Language Disorder (DLD) is diagnosed when the child experiences problems in language with no known underlying biomedical condition and the information required for its correct evaluation must be obtained from different contexts. The Children’s Communication Checklist (CCC-2) covers aspects of a child’s communication related to structural language and pragmatic skills, which are linked to social cognition or executive functions. The aim of this article is to examine parents’ reports using the Spanish version of the CCC-2 questionnaire and its association with different formal assessments related to communication. (2) Methods: 30 children with DLD (3; 10–9 years old) and 39 age-matched (AM) children with typical development were assessed using formal measures of structural language, pragmatics, social cognition, and executive functions. Parents of children with DLD answered the Spanish version of the CCC-2. (3) Results: The performance of children with DLD was lower in all the formal assessments in comparison to AM children. The CCC-2 was significantly correlated with all the direct child assessments, although only formal measures of structural language predicted both the structural language and pragmatics scales of the CCC-2. (4) Conclusions: The CCC-2 answered by parents was consistent with formal assessments in children with DLD, and structural language seemed to be the best predictor of all the subscales.

Structural and Pragmatic Language Impairments in Children Evaluated for Autism Spectrum Disorder (ASD)

Pragmatic language impairments are common in neurodevelopmental disorders, especially in autism spectrum disorder (ASD). The relationship between structural language skills and pragmatic competence in children with autistic symptoms, however, is largely unknown. We investigated this relationship based on the Children’s Communication Checklist-2 and early language delay among children (N = 177, 19% females) clinically evaluated for ASD, differentiated into ASD (n = 148) and non-ASD (n = 29). Structural language deficits were common and associated with reduced pragmatic competence in both groups. Pragmatic language impairments were most profound in children with ASD. Early language delay and structural language deficits were less common in females. Our findings suggest that assessment of structural language skills should be included in the evaluation of children with suspected ASD.

Inferential narrative comprehension ability of young school-age children on the autism spectrum

Background and aims The purpose of the current exploratory study was to describe the inferential narrative comprehension skills of young school-age children on the autism spectrum who, as a group, are at high risk of significant and persistent reading comprehension difficulties. Our aim was to investigate whether the anticipated difficulties in inferential narrative comprehension in the group of children with autism could be explained by the children’s structural language ability as measured using a broad-spectrum standardized language test. Methods The participants were 35 children with a diagnosis of autism spectrum disorder (ASD), aged between 5;7 and 6;11, who attended their first year of formal schooling, and 32 typically developing (TD) children, matched to the ASD group for age and year of schooling. Children on the autism spectrum were divided into below normal limits (ASD_BNL, standard score ≤80; n = 21) or within normal limits (ASD_WNL, standard score >80; n = 14) on a standardized language test. All children participated in a narrative comprehension task, which involved listening to a novel story, while looking at pictures, and answering eight comprehension questions immediately afterwards. Comprehension questions were categorized into factual and inferential questions, with further categorization of the inferential questions into those tapping into the story characters’ internal responses (mental states) or not. Children’s responses were scored on a quality continuum (from 0: inadequate/off topic to 3: expected/correct). Results Our results showed significantly lower scores across factual and inferential narrative comprehension in the ASD_BNL group, compared to the ASD_WNL and TD groups, supporting the importance of structural language skills for narrative comprehension. Furthermore, the TD group significantly outperformed the children in the ASD_WNL group on inferential comprehension. Finally, the children in the ASD_WNL group showed specific difficulties in answering the internal response inferential questions compared to their TD peers. Conclusions Results from this exploratory study highlight the difficulties children on the autism spectrum may have in inferential narrative comprehension skills, regardless of sufficient structural language skills at word and sentence level. These findings support the importance of routinely assessing these narrative comprehension skills in children on the spectrum, who as a group are at high risk of persistent reading comprehension difficulties. Implications In this study, we demonstrate how narrative comprehension can be assessed in young school-age children on the autism spectrum. The scoring system used to categorize children’s responses may further assist in understanding children’s performance, across a quality continuum, which can guide detailed goal setting and assist in early targeted intervention planning.

Exploring the Neural Structures Underlying the Procedural Memory Network as Predictors of Language Ability in Children and Adolescents With Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder

Introduction: There is significant overlap in the type of structural language impairments exhibited by children with autism spectrum disorder (ASD) and children with attention deficit hyperactivity disorder (ADHD). This similarity suggests that the cognitive impairment(s) contributing to the structural language deficits in ASD and ADHD may be shared. Previous studies have speculated that procedural memory deficits may be the shared cognitive impairment. The procedural deficit hypothesis (PDH) argues that language deficits can be explained by differences in the neural structures underlying the procedural memory network. This hypothesis is based on the premise that the neural structures comprising the procedural network support language learning. In this study, we aimed to test the PDH in children with ASD, ADHD, and typical development (TD).Methods: One hundred and sixty-three participants (ages 10–21): 91 with ASD, 26 with ADHD, and 46 with TD, completed standardized measures of cognitive and language ability as well as structural magnetic resonance imaging. We compared the structural language abilities, the neural structures underlying the procedural memory network, and the relationship between structural language and neural structure across diagnostic groups.Results: Our analyses revealed that while the structural language abilities differed across ASD, ADHD, and TD groups, the thickness, area, and volume of the structures supporting the procedural memory network were not significantly different between diagnostic groups. Also, several neural structures were associated with structural language abilities across diagnostic groups. Only two of these structures, the inferior frontal gyrus, and the left superior parietal gyrus, are known to be linked to the procedural memory network.Conclusions: The inferior frontal gyrus and the left superior parietal gyrus, have well-established roles in language learning independent of their role as part of the procedural memory system. Other structures such as the caudate and cerebellum, with critical roles in the procedural memory network, were not associated with structural language abilities across diagnostic groups. It is unclear whether the procedural memory network plays a fundamental role in language learning in ASD, ADHD, and TD.