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J Autism Dev Disord (2009) 39:388–393

DOI 10.1007/s10803-008-0618-y


Brief Report: Pragmatic Language in Autism Spectrum Disorder:

Relationships to Measures of Ability and Disability
Joanne Volden Æ Jamesie Coolican Æ
Nancy Garon Æ Julie White Æ Susan Bryson

Published online: 15 July 2008

Ó Springer Science+Business Media, LLC 2008

Abstract Pragmatic language skill is regarded as an area everyday situations, to target adaptive skills in intervention
of universal deficit in Autism Spectrum Disorder (ASD), and to intervene in functional, community-based contexts.
but little is known about factors related to its development
and how it in turn might contribute to skills needed to Keywords Pragmatic language  Structural language 
function in everyday contexts or to the expression of ASD- Adaptive function  Severity of symptoms
related symptoms. This study investigated these relation-
ships in 37 high-functioning children with ASD. Multiple
regression analyses revealed that structural language skills While communicative dysfunction is one of the central
significantly predicted pragmatic language performance, characteristics of ASD, its profile of symptoms varies
but also that a significant portion of variance in pragmatic widely from person to person. At one extreme, there are
scores could not be accounted for by structural language or children with ASD whose structural (i.e., lexical and syn-
nonverbal cognition. Pragmatic language scores, in turn, tactic) language is within normal limits (Landa 2000),
accounted for significant variance in ADOS Communica- while at the other extreme, some children with autism
tion and Socialization performance, but did not uniquely remain essentially nonverbal (Bryson et al. 1988; Lord and
predict level of communicative or social adaptive func- Paul 1997). Even when structural language is apparently
tioning on the Vineland. These findings support the notion intact, difficulties with pragmatic language (i.e., the
of pragmatic language impairment as integral to ASD but appropriate social use of language) persist. Thus, prag-
also highlight the need to measure pragmatic skills in matics is consistently agreed upon as the domain that is
specifically and universally impaired in ASD (Landa 2000;
Tager-Flusberg et al. 2005; Young et al. 2005).
Pragmatic language impairment may be defined as a
J. Volden (&)  J. White
Speech Pathology and Audiology, mismatch between language and the situation in which it is
University of Alberta, Edmonton, Canada used, so that the language employed is in some way
e-mail: inappropriate to the situational demands (Volden and Lord
1991). Clinical reports describe language in speakers with
J. Volden
Autism Research Institute of Alberta, Edmonton, Canada autism as ‘‘peculiar and out of place in ordinary conver-
sation, irrelevant’’ (Kanner 1946, p. 243), ‘‘formal,
J. Coolican  N. Garon demonstrating a lack of ease in the use of words’’ (Rutter
Department of Psychology, Dalhousie University,
1965, p. 41), ‘‘stereotypic, inappropriate’’ (Bartak et al.
Halifax, NS, Canada
1975), and ‘‘metaphorical’’ (Cantwell et al. 1978, p. 357;
N. Garon  S. Bryson Kanner 1946). Focussed investigations, using either anal-
IWK Health Centre, Halifax, Canada ysis of conversational samples or structured experimental
tasks, have documented several specific pragmatic diffi-
S. Bryson
Departments of Pediatrics and Psychology, culties, including identifying the topic initiated by a
Dalhousie University, Halifax, Canada speaker and making a relevant comment (Adams 2002;

J Autism Dev Disord (2009) 39:388–393 389

Paul and Cohen 1984; Tager-Flusberg and Anderson 1991), language measures have been developed. One such mea-
knowing how much information is relevant to include in an sure is the Test of Pragmatic Language (TOPL; Phelps-
utterance (Surian et al. 1996; Volden 2002), and main- Terasaki and Phelps-Gunn 1992). The TOPL samples a
taining the topic of conversation (Baltaxe 1977; Baltaxe range of typically developing pragmatic behaviours. Pic-
and D’Angiola 1992; Volden 2002). Nevertheless, there are tures depicting common social situations are shown to the
very few studies that have examined a broad spectrum of child, briefly described, and the child is asked to generate a
pragmatic language skills. response for one of the pictured characters.
In contrast to the universal nature of pragmatic com- The TOPL successfully distinguished ASD from typical
munication deficits in ASD, impairments in structural development in a recent study conducted by Young and her
language (i.e., phonology, vocabulary and syntax) are not colleagues (2005). Participants aged 6–14 with ASD, and
necessarily present. Although, early studies (Bartolucci with normal cognition and structural language were com-
et al. 1976, 1980; Boucher 1976, 1988; Tager-Flusberg pared to a group of typically developing matched controls.
1981, 1985; Tager-Flusberg et al. 1990) concluded that As expected, the participants with ASD performed signif-
there were no autism-specific deficits in phonology, syntax icantly worse than their typical counterparts, obtaining a
or lexical knowledge, more recent work (Kjelgaard and mean TOPL standard score of 78 compared to 97 for the
Tager-Flusberg 2001; Rapin and Dunn 2003; Eigsti et al. controls. Thus, even among high-functioning children and
2007) provides evidence of syntactic impairment, but none adolescents with ASD, pragmatic language skills, as mea-
have found it to be universal. Unfortunately, none of these sured by the TOPL, were a relative weakness.
studies included a comprehensive measure of pragmatic The current study extends the work of Young et al.
language skills. (2005) by examining factors that might influence, or be
Recently, Klin et al. (2007) have argued that because affected by, the acquisition of pragmatic skills. We asked
communicative and social adaptive skills are both central the following research questions: (1) Is pragmatic language
and defining features of ASD, a better understanding of the skill, as indexed by the TOPL, accounted for by nonverbal
individual factors (e.g., general intelligence, structural cognitive ability and structural language skill?; and (2)
language) that might influence acquisition of these pivotal What are the relative contributions of nonverbal cognition,
skills could be very important in planning more effective structural language and pragmatic language skill in pre-
intervention. Clark et al. (2002) took a step in this direction dicting (i) communicative and social adaptive skill in
by examining the contribution of executive function abil- everyday contexts, and (ii) severity of communicative and
ities to predictions of adaptive behaviour and social ASD symptoms. We expected that structural lan-
communication scores in children with ADHD or conduct guage would contribute significantly to variability in
disorder. They found that executive function skills con- pragmatic language skill. All three factors—nonverbal
tributed unique variance to the prediction of adaptive cognitive ability, structural language and pragmatics—
behaviour, communication, and socialization scores on the were each expected to predict communicative and social
Vineland Adaptive Behaviour Scale (VABS) in each adaptive behavior and severity of corresponding autistic
group. Pragmatic language skills may play a similar role, symptoms.
but very few studies have examined pragmatic profiles.
Recent work (Philofsky et al. 2007) used the Children’s
Communication Checklist—Version 2 (CCC-2; Bishop Methods
2003), a parent report checklist designed to evaluate
communicative competence, to compare detailed prag- Participants
matic profiles of children with ASD and children with
Williams’ Syndrome. They found that there were both Participants were 37 children, aged 6–13 years, who met
similarities and differences in pragmatic profile between criteria for autism/ASD based on the Autism Diagnostic
the groups, but they did not relate these findings to mea- Observation Schedule (ADOS; Lord et al. 1999), the
sured differences in other language domains, or to Autism Diagnostic Interview-Revised (Lord et al. 1994)
differences in adaptive functioning. and expert clinical opinion using DSM-IV criteria, recrui-
One reason for this gap in the literature is the difficulty ted from the Hospital for Sick Children (HSC) in Toronto,
in measuring pragmatic skill (Adams 2002; Bishop 1998; Ontario, Canada. Children were excluded from the study if
Bishop and Baird 2001). Because pragmatics refers to the they had cerebral palsy or another neuromotor disorder that
appropriate contextual use of language, it is difficult to would interfere with administration of assessment instru-
extrapolate from performance measured in a single stan- ments, a known genetic/chromosomal or neurological
dardized situation to a person’s overall pragmatic disorder, or if English was not the primary language spoken
competence. Nevertheless, some standardized pragmatic in the home.

390 J Autism Dev Disord (2009) 39:388–393

Procedure Table 2 Predictive relationship of nonverbal cognition, receptive

and expressive structural language to pragmatic language
As part of a larger study, participants were given a battery of Pragmatic language (TOPL) b sr2 (unique r2 (total
language and cognitive measures, including the Clinical variance) variance)
Evaluation of Language Fundamentals—3rd Edition
Stanford-Binet Abstract/Visual SS .19 .00 .04
(CELF-3; Semel et al. 1995), the Test of Pragmatic Lan-
CELF-Expressive language SS .49** .09** .64**
guage (TOPL; Phelps-Terasaki and Phelps-Gunn 1992), and
CELF-Receptive language SS .41* .05* .59**
the Stanford Binet Intelligence Scale, 4th Edition (SB-IV;
Total R2 .70***
Thorndike et al. 1986). Also, data from the Vineland
Adaptive Behavior Scale (VABS; Sparrow et al. 1984) were * p \ .05, ** p \ .01, *** p \ .001
obtained for 33 of 37 participants. These tests were admin-
istered by trained examiners over two sessions, separated by variables. Table 2 shows that the overall model was highly
1–2 weeks, at the Autism Research Unit of HSC. significant (p \ .001), accounting for 70% of the variance in
pragmatic language. CELF-Expressive language (b = .49,
p \ .01) followed by CELF-Receptive language (b = .41,
Results p \ .01) had the largest b weights in predicting pragmatic
language. Non-verbal cognitive scores made no significant
Cognition and Language Abilities contribution to the prediction. Table 2 shows that CELF-
Expressive language SSs (9%) and CELF-Receptive lan-
As shown in Table 1, participant mean Full Scale and Verbal guage SSs (5%) uniquely accounted for a small portion of the
IQs and standard scores on the Abstract/Visual Reasoning overall variance. The remainder of the variance (56%) was
(Abs/Vis) subtest of the SB-IV, the CELF-3 and the VABS accounted for by the three variables in combination. Thus,
Communication subscale were all within normal limits, the two CELF variables were accounting for a large amount
while the mean TOPL score was low average, and VABS of overlapping variance in pragmatic language.
Socialization score was more than two standard deviations
below the mean. In addition, TOPL scores were, on average, Predicting Vineland Communication Scores
significantly lower than CELF-3 Total scores on a paired
sample t-test (mean difference = 9.5, t (36) = 4.56, Another regression analysis was run, with VABS Com-
p \ .001), confirming that social language is less well munication SSs as the dependent variable, and SSs on Abs/
developed than structural language in this population. Vis, CELF-Expressive and Receptive language and TOPL
as independent variables. As shown in Table 3, the overall
Data Analysis model was significant (p \ .01), accounting for 43% of the
variance in communication skills. Standardized beta
The data were analysed using a series of standard multiple weights were largest for CELF-Expressive language
regression analyses. For each regression, the overall R2 had to (b = .51, p \ .1), although none of the predictor variables
be significant in order to interpret the independent variables. accounted for significant unique variance in VABS Com-
Standard ‘‘b’’ was used as an index of the relative importance munication SSs. Rather, the variance in communication
of each independent variable. Alpha was set at .05. was accounted for by the combined effect (30%) of all
three language variables.
Variance in Pragmatic Language
Predicting Vineland Socialization Scores
A regression was run using TOPL standard scores (SSs) as
the dependent variable and SSs on Abs/Vis, CELF-Expres- An analogous regression analysis was run, with VABS
sive language and CELF-Receptive language as independent Socialization SSs as the dependent variable and SSs on

Table 1 Mean standard scores, (SD), and [Range] on assessment measures

CA Stanford-Binet (n = 37) CELF-3 (n = 37) TOPL Vineland (n = 33)
(years;months) (n = 37)
Full Verbal Abs/Vis Total Rec Exp Comm Social

8;6 (1;9) 97.8 92.3 103.1 90.3 94.3 87.9 80.1 91.0 65.8
(18.4) (21.9) (18.8) (22.8) (23.9) (22.4) (19.9) (17.4) (12.1)
[45–140] [55–158] [60–160] [50–142] [50–150] [50–131] [57–125] [58–129] [48–93]

J Autism Dev Disord (2009) 39:388–393 391

Table 3 Predictive relationship of nonverbal cognition, structural Table 4 Predictive relationship of nonverbal cognition, structural
language and pragmatic language to adaptive behaviour scores language and pragmatic language to symptom severity
b sr2 (unique r2 (total b sr2 (unique r2 (total
variance) variance) variance) variance)

Vineland Communication ADOS Communication

Stanford-Binet Abstract/Visual SS -.05 .00 .02 Abstract/Visual SS -.14 .02 .04
CELF-Expressive language SS .52 .12 .42** CELF-Exp SS .31 .03 .08
CELF-Receptive language SS .15 .01 .35** CELF-Rec SS -.01 .00 .11*
Pragmatic language (TOPL) SS .02 .00 .30** TOPL -.69* .14* .22**
Total R2 .43** Total R2 .26*
Vineland Socialization ADOS Social
Stanford-Binet Abstract/Visual SS .28 .05 .04 Abstract/Visual SS -.04 .00 .02
CELF-Expressive language SS .16 .00 .00 CELF-Exp SS .64* .11* .02
CELF-Receptive language SS -.32 .02 .00 CELF-Rec SS -.29 .02 .10*
Pragmatic language (TOPL) SS .07 .00 .00 TOPL -.67* .14* .15**
Total R2 .07 Total R2 .27*
p \ .1, * p \ .05, ** p \ .01 p \ .1, * p \ .05, ** p \ .01

Abs/Vis, CELF-Expressive and Receptive language and Discussion

TOPL as independent variables. This overall model failed
to reach significance (see Table 3). Pragmatic language should logically be an important factor
in considering a person’s long-term ability to function
Predicting ADOS Communicative Impairment effectively in his or her community because it stands at the
intersection of language and social skills, impairments
A regression analysis was conducted using ADOS Com- central to defining features of ASD. This paper examines
munication algorithm scores as the dependent variable and the contributions of nonverbal cognitive and structural
SSs on Abs/Vis, CELF-Expressive and Receptive lan- language skills to the prediction of pragmatic language
guage, and TOPL as independent variables (see Table 4). scores, as well as the extent to which each of the three
The overall model was significant (p \ .05), accounting for predicted everyday functional skills and severity of ASD
26% of the variance in communicative impairment. Stan- symptoms in a sample of relatively high-functioning
dardized beta weights were largest for pragmatic language youngsters with ASD.
(b = -.69, p \ .05) with better TOPL scores being asso- Structural language abilities, as measured by the CELF-
ciated with less severe communicative impairment. The 3, accounted for a large portion of the variance in prag-
remaining variables made no significant unique contribu- matic language as indexed by the TOPL. Because the
tion to the prediction of ASD symptoms as measured by the expression of pragmatic competence often requires verbal
ADOS. skill, this close relationship is not surprising. It is however,
noteworthy that 30% of the variance associated with TOPL
Predicting ADOS Social Impairment scores is not accounted for by nonverbal cognitive ability
or by structural language skill. Thus, pragmatic language
A similar regression was run, with ADOS Social algorithm scores measure additional language/communication skills
scores as the dependent variable and SSs on Abs/Vis, that are not captured by standard measures of structural
CELF-Expressive and Receptive language, and TOPL as language competence. This finding highlights the impor-
independent variables (see Table 4). The overall model tance of examining pragmatic language skill in addition to
was significant (p \ .05), accounting for 27% of the vari- traditional assessments of syntax, semantics, and vocabu-
ance in social impairment. Standardized beta weights were lary when evaluating communicative dysfunction in ASD.
largest for expressive language (b = .64, p \ .05) and In terms of adaptive behaviour, the combined structural
pragmatic language (b = -.67, p \ .05) but the relation- and pragmatic communication measures accounted for
ships of each to social impairment are in the opposite 30% of the variance in Vineland Communication scores.
direction. Better TOPL scores are associated with less Contrary to expectations, pragmatic language did not
severe social impairment, while better expressive language contribute significant unique variance. Also contrary to
is actually associated with more social impairment. expectations, Vineland Socialization scores were not

392 J Autism Dev Disord (2009) 39:388–393

significantly predicted by our set of predictor variables. normal limits on most measures, but were quite heteroge-
One possible explanation is the well-documented finding neous. The relationships found here may differ in more
that children with ASD often do better in structured test homogeneous groups. Additional limitations include using
situations than they do spontaneously in unstructured a single pragmatic composite score as it is unlikely to reveal
everyday life (Klin et al. 2007; Young et al. 2005). Perhaps specific aspects of pragmatic language that may relate more
the structure of the test situation and its requirement for an directly to either ASD symptoms or to adaptive outcomes.
isolated response presents fewer processing demands than Similarly, our study is limited by using a global measure of
the myriad of competing stimuli that demand attention in nonverbal cognition which may not be sensitive enough to
real social contexts, leading to an over-estimate of prag- reveal significant relationships between particular nonver-
matic skills on standardized tests (Williams et al. 2006). bal abilities and pragmatic language skill. These detailed
In addition, the TOPL measures only the pragmatic relationships will need to be clarified in future research.
skills that emerge in the course of typical development. It Overall, pragmatic language as measured by the TOPL is
does not assess the qualitative abnormalities that are fre- strongly related to, but not dictated by, structural language.
quently reported as characteristic of the conversational Along with structural language, pragmatics contributes to
language in speakers with ASD (Bishop 1998; Bishop and everyday communicative functioning, but did not predict
Adams 1989). The CCC-2 (Bishop 2003) includes these how well the speaker would function socially. This may be
skills but was unavailable at the time our data were col- at least partially explained by the difficulties in attempting
lected. In addition, the development of observational to measure a contextually dependent skill in a standardized
protocols that could document and quantify pragmatic formal test. This study suggests the importance of devel-
language behaviours in everyday life, thus serving both to oping comprehensive assessments of pragmatic language to
corroborate parent reports and to enrich our understanding help document a person’s level of disability, and of
of the pragmatic challenges of individuals with ASD, emphasizing intervention in functional, community based
remains a pressing issue for future research. Finally, contexts as the foundation for skill development across
pragmatic language skill was the only factor from our set of domains.
predictors that contributed unique variance to predicting
the ADOS Communication scores. As expected, better Acknowledgments These data were collected as part of a larger
study, funded by NIH Grant # HD-01-110, held by Susan Bryson. The
pragmatic skills were associated with fewer ASD-linked authors thank NIH for their generous support. The first author also
communicative symptoms. This finding underscores how especially thanks Susan Bryson for generously sharing her data. Por-
central the connection is between social communication tions of the data were presented at the International Meeting for Autism
and ASD-linked communicative symptoms. Research 2007, Seattle, Washington, and at the Society for Research in
Child Language Development 2007, Madison, Wisconsin. As always,
Both pragmatic and expressive structural language con- the authors wish to acknowledge the generous contribution of time and
tributed significant unique variance to the prediction of energy from the participants and their families.
ASD-linked social behaviour. Better pragmatic skills were
also linked to fewer symptoms in the social domain, but
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