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DOI 10.1007/s10803-008-0618-y
BRIEF REPORT
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: joanne.volden@ualberta.ca 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;
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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.
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390 J Autism Dev Disord (2009) 39:388–393
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]
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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)
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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
expressive structural language was related to greater social References
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