Research Review Structural Language in Autistic Spectrum Disorder Characteristics and Causes

Journal of Child Psychology and Psychiatry 53:3 (2012), pp 219–233 doi:10.1111/j.1469-7610.2011.02508.
Research Review: Structural language in autistic

spectrum disorder – characteristics and causes
Jill Boucher
Autism Research Group, City University, London, UK
Background: Structural language anomalies or impairments in autistic spectrum disorder (ASD) are
theoretically and practically important, although underrecognised as such. This review aims to high-
light the ubiquitousness of structural language anomalies and impairments in ASD, and to stimulate
investigation of their immediate causes and implications for intervention. Method: Studies of struc-
tural language in ASD are reviewed (based on a search of the literature and selected as meeting defined
inclusion criteria), and explanatory hypotheses are discussed. Results: Some individuals with ASD
never acquire language. Amongst those who do, language abilities range from clinically normal (ALN) to
various degrees of impairment (ALI). Developmental trajectories and individual profiles are diverse, and
minority subgroups have been identified. Specifically: language is commonly but not always delayed
and delayed early language is always characterised by impaired comprehension and odd utterances,
and sometimes by deviant articulation and grammar. Nevertheless, by school age an ‘ASD-typical’
language profile emerges from group studies, with articulation and syntax least affected, and compre-
hension, semantics and certain facets of morphology most affected. Thus, even individuals with ALN
have poor comprehension relative to expressive language; also semantic-processing anomalies and
idiosyncratic word usage. It is argued that impaired socio-emotional-communicative relating, atypical
sensory-perceptual processing, and uneven memory/learning abilities may underlie shared language
anomalies across the spectrum; and that varying combinations of low nonverbal intelligence, semantic
memory impairment and comorbidities including specific language impairment (SLI), hearing
impairment, and certain medical syndromes underlie ALI and variation in individual profiles.
Conclusions: Structural language is universally affected in ASD, due to a complex of shared and
unshared causal factors. There is an urgent need for more research especially into the characteristics
and causes of clinically significant language impairments. Keywords: Autistic spectrum disorder,
language, social interaction, mindreading, sensory-perceptual abilities, specific language impairment,
intelligence, memory.
The immediate aims of this review article are to

Introduction
highlight the ubiquitousness of structural language
All individuals with autistic spectrum disorder
abnormalities in ASD and to promote discussion of
(ASD) have, by definition, significantly impaired
their immediate psychological1 causes. The longer-
communication (APA, 2000; WHO, 1992), and the
term aim is to stimulate investigation of clinically
socio-communicative, pragmatic and discourse
significant language impairments in ASD. Socio-
impairments in ASD have been extensively investi-
communicative and use of language impairments are
gated and discussed. A substantial subgroup of
not the focus of this article (but see Charman &
individuals with ASD has additional clinically sig-
Stone, 2007; Loukusa & Moilanen, 2009; McCann &
nificant structural language impairments (where
Peppé, 2003 for relevant reviews).2 Nor are the
‘clinically significant’ is defined as performance at
genetic causes and neurobiological correlates of
least 1.5 SD below the mean on standardised lan-
language in ASD a central focus, although alluded to
guage tests). A substantial subgroup has little or no
at various points (see Abrahams & Geschwind, 2008;
language. Moreover, as will become apparent in the
Groen, Zwiers, van der Gaag, & Buitelaar, 2008;
course of this article, in those individuals who score
Herbert & Kenet, 2007; Liu, Peterson, & Szatmari,
within the normal range on language tests by later
2008 for relevant reviews).
childhood, the course of structural language devel-
In the first main section of the review, behavioural
opment is frequently if not always atypical, with
studies of structural language in verbal individuals
subtle linguistic anomalies persisting even in the
most able. Despite the pervasiveness of these
1
impairments and anomalies in ASD, and their likely ‘Psychological’ is used here to refer to explanations at the level
theoretical and undoubted practical significance, of behaviour or mental processes, including emotional and
conative as well as intellectual processes. ‘Cognitive’ is used
structural language in ASD has been relatively little
according to its dictionary definition to refer only to intellectual
researched over recent decades.
functions such as thinking, knowing and reasoning.
2
Structural language and communication are, in reality,
indissolubly linked. An artificial divide is made here to sharpen
Conflict of interest statement: No conflicts declared. the focus of attention onto structural language in ASD.
2011 The Author. Journal of Child Psychology and Psychiatry 2011 Association for Child and Adolescent Mental Health.
Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main St, Malden, MA 02148, USA
220 Jill Boucher J Child Psychol Psychiatry 2012; 53(3): 219–33
with ASD are reviewed in two subsections covering, 2001). However, Shriberg, Paul, McSweeny, Klin,
respectively, studies of ‘language normal’ (ALN) par- and Cohen (2001) reported that a third of individuals
ticipants, and studies of ‘language impaired’ (ALI) have subphonemic articulatory distortions (e.g. an
participants or ‘unselected’ (mixed ability) groups. imperfect/r/sound, or slightly lisped/s/). Similarly,
The distinction between ‘ALN’ and ‘ALI’ is artificial in Cleland, Gibbon, Peppé, O’Hare, and Rutherford
that language abilities in ASD lie along a continuum, (2010) reported that 41% of individuals with ASD
but is made herein because explanations of higher and ostensibly normal language had at least some
and lower language abilities in ASD necessarily dif- articulatory errors, with 12% of the total group
fer. In the studies reviewed, mean language/verbal having clinically significant impairments.
abilities in ‘ALN’ groups were ‡85; and in ‘ALI’ groups Regarding semantics and grammar in ALN,
£75. These criteria do not preclude some overlap Asperger described language used by his patients as
amongst outliers. It is also accepted that standard superior in breadth of vocabulary and grammatical
scores are not strictly comparable across different correctness, although idiosyncratic and pedantic
language tests. However, use of these criteria for (Asperger, 1944/1991 translated in Frith, 1991).
inclusion in the review enables comparisons to be However, receptive and expressive vocabulary aver-
made between more and less linguistically able aged across groups with ALN has subsequently been
groups with ASD. found to be either average (Kjelgaard & Tager-Flus-
Studies reviewed satisfy the following methodo- berg, 2001) or in the low normal range (Howlin, 2003).
logical criteria unless otherwise stated: (a) minimum Moreover, higher order language processing as as-
group sizes 10, (b) evidence that ASD participants sessed by the Clinical Evaluation of Language Fun-
satisfy current diagnostic criteria (noting that early damentals – Revised (CELF-R – Semel, Wiig, & Secord,
criteria were less rather than more inclusive), (c) few 1987) is more impaired than vocabulary (Kjelgaard &
or no cases of PDD-NOS included, and (d) compari- Tager-Flusberg, 2001), comprehension being partic-
son groups (identified in the text when included) ularly affected (Koning & Magill-Evans, 2001; Saa-
appropriately matched for age and ability (as iden- lasti et al., 2008; Seung, 2007). Consistent with the
tified in the text, ‘language-matched’ indicating broad picture that emerges from these findings, Min-
matched for vocabulary comprehension unless shew, Goldstein, and Siegel (1997) and Williams,
otherwise stated; ‘well-matched’ indicating matched Goldstein, and Minshew (2006) reported intact per-
on two or more relevant measures). No mention of formance on ‘simple’ tests such as a letter-cued word
comparison groups signals studies making compar- fluency task or the Vocabulary subtest from the
isons with standardised norms or normative data. Wechsler scales (Wechsler, 1997a,b) but impaired
‘See also’ before a reference signals a study of inter- performance on ‘complex’ tests such as reading com-
est, but not meeting the inclusion criteria. prehension or the detection of verbal absurdities.
In the second main section of the review, theories Group based findings do not, of course, entail that all
and evidence relating to the psychological causes of individuals with ALN have below average language
atypical language across the spectrum (excluding abilities on certain tests. However, they do show that
mutism) are presented and discussed. The review superior semantic and grammatical abilities in people
concludes with a brief overview in which implica- with ALN are less common than is often supposed.
tions for future research, including intervention The precise nature of the higher order language
studies, are indicated. processing difficulties in ALN is not clear. How-
ever, anomalous semantic processing is certainly
involved. Numerous clinicians and researchers have
Patterns of language abilities and impairments confirmed Asperger’s observation of idiosyncratic or
inappropriate utterances (e.g. Mayes & Calhoun,
Studies of language in groups with ALN
2001; Tantam, 1988; Volden & Lord, 1991). In their
Studies of ALN sometimes report findings on Asper- detailed study of natural language samples, Volden
ger syndrome (AS) groups (in whom language has and Lord noted in addition that real words were
been clinically normal from the start); sometimes on frequently used with incorrect meaning, for example
‘high-functioning autism language normal’ (HFA-LN) ‘waves’ for ‘leaves’. Other evidence of semantic
groups (in whom currently normal language was anomalies in ALN is more subtle. Dunn, Gomes, and
preceded by early delay or deviance); and sometimes Sebastian (1996) reported an excess of low frequency
on mixed AS + HFA-LN groups. Few differences responses in a category-cued word fluency test,
between language in AS as compared to HFA-LN relative to language-ability-matched groups with
have been reported, and studies of language in ‘ALN’ specific language impairment (SLI) or typical devel-
generally are considered first. Findings from studies opment (TD). Similarly, Walenski, Mostofsky, Gidley-
specifically comparing language in AS and HFA-LN Larson, and Ullman (2008) reported superior
groups are noted at the end of the section. naming speed for low frequency but not high
Productive phonology (‘articulation’) is normal in frequency stimuli compared to full scale IQ (FSIQ)-
individuals with ALN, in terms of group averages on matched controls (see also Toichi & Kamio, 2003). In
an articulation test (Kjelgaard & Tager-Flusberg, studies of verbal memory in able adults with ASD
doi:10.1111/j.1469-7610.2011.02508.x Structural language in ASD 221
compared to verbal IQ (VQ)-matched controls, Bow- correlating with mean length of utterance (MLU) and
ler, Matthews, and Gardiner (1997) showed impaired VQ. Eigsti and Bennetto (2009) reported reduced
use of semantic clustering; and Bowler, Gaigg, sensitivity to grammatical errors in children with
and Gardiner (2008) reported that whereas neuro- HFA-LN relative to well-matched controls. However,
typical participants developed similar sequences in reduced sensitivity occurred only when errors were
recall of words over repeated trials, idiosyncratic embedded in long sentences, suggesting that mem-
sequences were developed by participants with ASD. ory load may explain this finding. Negative evidence
Even children whose early diagnosis of PDD-NOS comes from a study by Diehl, Bennetto, Watson,
or other high-functioning ASD no longer applies Gunlogson, and McDonough (2008) showing unim-
showed immature lexical knowledge on a test of paired utilisation of syntax to disambiguate senten-
the understanding of verb-argument structures, tial meaning in an HFA-LN group, relative to controls
whilst performing normally on tests of single word matched for FSIQ- and CELF receptive language
comprehension and naming (Kelley, Paul, Fein, & scores. Similarly, Kelley et al.’s (2006) study of well
Naigles, 2006). recovered cases of PDD-NOS/ASD showed intact
Some have argued that intact use of category cues productive morphology and syntax, coexisting with
in single word recall tasks shows that semantic subtly impaired lexical-semantics.
knowledge is intact in ALN (Mottron, Morasse, & There is correspondingly little evidence of anoma-
Belleville, 2001; Whitehouse, Maybery, & Durkin, lous brain activity associated with grammatical pro-
2007). However, intact performance on some tests of cessing in ALN. However, Just, Cherkassky, Keller,
semantic knowledge does not prove that semantic and Minshew (2004) reported atypical brain activity
processing is entirely normal. Thus, Kelley et al. during a sentence comprehension task relative to
(2006), whose findings were cited above, noted that FSIQ-matched controls, which they ascribed to
vocabulary tests assess knowledge of the identifica- atypically reduced reliance on syntactic processing.
tion function of words, but do not probe conceptual
networks underlying word meanings. Consistent Language in AS compared to language in HFA-
with this observation, Minshew, Meyer, and Gold- LN. Four behavioural studies have compared
stein (2002) reported intact category identification mature language abilities in individuals with AS and
coexisting with impaired category formation. Simi- individuals with HFA-LN and found no significant
larly, Dunn and Bates (2005) reviewed the discrep- differences. Specifically: individuals with HFA-LN
ant evidence and concluded: ‘Although there is are reported to resemble individuals with AS in
significant evidence that individuals with autism having low normal levels of language (Howlin, 2003);
comprehend basic concepts and word meanings, a tendency to produce idiosyncratic or inappropriate
they do not appear to extract and apply commonal- utterances (Mayes & Calhoun, 2001); comprehen-
ities among category members’. sion more impaired than expression (Howlin, 2003;
Behavioural observations of anomalous semantic Seung, 2007); and articulatory distortions in a third
processing are supported by findings of anomalous of cases (Shriberg et al., 2001). Moreover, the studies
brain activity in individuals with ALN during by Mayes and Calhoun, Howlin, and Seung included
semantic processing tasks. For example, McCleery assessment of nonlinguistic ASD-related behav-
et al. (2010) showed abnormal brain activation in iours, and found no significant group differences in
response to picture-word pairs but not to picture- relationships between language and ASD-related
environmental sound pairs in young children in a behaviours. Consistent with these behavioural
predominantly HFA-LN group (3 of 14 participants observations, a small-group study comparing lan-
were diagnosed with PDD-NOS). Other studies guage-related brain activity in individuals with either
showing abnormal brain activity in ALN groups rel- HFA-LN (n=8) or AS (n=2) found no differences, the
ative to well-matched controls during semantic pro- same anomalous brain activity being observed in all
cessing tasks include those of adults by Braeutigan, participants relative to TD controls (Gaffrey et al.,
Swithenby, and Bailey (2008) and by Harris et al. 2007).
(2006), and of school-age children by Dunn and By contrast, Howlin (2003) reported that language
Bates (2005; see also Knaus, Silver, Lindgren, Had- levels were slightly lower in HFA-LN than in AS
jikhani, & Tager-Flusberg, 2008). adults matched for nonverbal IQ (NVIQ), with dif-
Compared with the solid evidence of higher order ferences in single word naming approaching signifi-
anomalies of semantic processing in ALN, there is cance. Kamio and Toichi (2007) reported that
little positive evidence, and some negative evidence, individuals with HFA-LN were less sensitive to
of grammatical impairments, whether of syntax semantic similarity than AS participants matched
(defined herein as knowledge of the rules and for FSIQ. Ghaziuddin et al. (2000) reported that
conventions governing word order) or morphology. participants with HFA-LN produced shorter, less
Positive evidence includes Volden and Lord’s (1991) complex and less grammatically correct sentences
report that non-developmental grammatical errors, than an AS group when differences in FSIQ were
although rare, were significantly more common in partialled out. These findings suggest that delayed
school-age children with ALN than in controls, language in individuals with HFA-LN is associated
with subtle but persistent effects in at least some nouns, errors of verb tense marking, impaired use of
individuals. articles and conjunctions, and diminished use of
closed class words generally, especially in the early
stages of language acquisition (Bartolucci, Pierce, &
Studies of language in groups with ALI and in
Streiner, 1980; Howlin, 1984; see also Tager-Flus-
unselected (mixed ability) groups
berg et al., 1990; Waterhouse & Fein, 1982). These
Until the 1980s, diagnostic criteria for ‘early child- findings were variously interpreted as indicative of
hood autism’ included language impairment (Ritvo & deviant development, impaired deixis, or DD.
Freeman, 1977; Rutter, 1968). Studies of language Semantic development, by contrast, was consis-
prior to the mid- or late-1980s therefore focused tently recognised as deviant. Kanner (1946) noted
solely on individuals with ALI. These studies are the frequent use of stereotyped and idiosyncratic
important because changes in diagnostic criteria in language, including neologisms. Bartak, Rutter, and
the mid-1980s resulted in a switch of research Cox (1975) reported that an excess of stereotypic,
interest from individuals with ALI to language-nor- echolalic and bizarre language constituted the major
mal groups (as reviewed above), and studies of ALI difference between an ALI group and a NVIQ-mat-
are now relatively rare. However, because methods ched but slightly older SLI group. Other researchers
of early diagnosis had not been established, and commented on the persistence of echolalia in less
adults with ASD were undiagnosed, only school-age able individuals with ALI, noting the idiosyncratic
children were studied in this early period. Findings but functional usages of echoic utterances in con-
from these early studies of school-age children are texts resembling those in which they were originally
reviewed first, below. Improved early diagnosis heard (Fay & Schuler, 1980; Prizant & Duchan,
enabled later researchers to study language and its 1981). Fay and Schuler wrote:
precursors in younger unselected groups or groups
with ALI, and findings from these studies are con- If there is one pervasive theme in the study of the
sidered in a second subsection. Findings from a language of childhood autism it is the permanence of the
small number of relatively recent studies of school- initial learning situation. How can speech be brought
into line with adult models if the only associations are
age children with ALI, and from rare studies of adults
first associations that are tenaciously stored and recy-
with ALI, are considered in a third subsection.
cled as if they were cast in concrete? [Italics as in the
original].
Early studies: language in school-age children
with ALI. These studies appeared to show delayed Fay and Schuler went on to suggest that the pau-
and limited, rather than deviant, development of city and rigidity of the associations to words or
phonology and syntax. Thus, articulation was phrases learned by a child with autism entails that
reported to be superior to that of language-matched language for these individuals denotes but does not
children with developmental delay (DD; Boucher, connote – i.e. words and phrases are used like proper
1976) or – in a small-group study (group sizes 9 and names, having a single referent rather than a rich,
12) – broadly similar to that of nonverbal mental age generalisable network of associations and meaning.
(NVMA)-matched children with DD (Bartolucci, Anomalous processing of linguistic meaning was
Pierce, Streiner, & Eppel, 1976). Bartolucci et al. also indicated by studies showing impaired use of
also reported significant correlation between articu- lexical or sentential meaning to facilitate verbal
lation and syntax in ALI participants; and Pierce and recall. Thus Fyffe and Prior (1978), Hermelin and
Bartolucci (1977) reported that the grammatical O’Connor (1967), and others showed that children
system used by children with ALI was rule-governed with ALI differ from language-matched children with
and similar to that of NVMA-matched DD and TD DD in that recall of sentences or of semantically
groups, again suggestive of delayed syntactic devel- related words is not superior to recall of unrelated
opment. Similarly, Tager-Flusberg (1981) showed word lists. These findings led some researchers to
that children with ALI resembled well matched propose that children with autism have a funda-
young TD controls in preferring a word order strategy mental impairment in the acquisition of conceptual
to a ‘probable event’ strategy in sentence compre- knowledge (Fay & Schuler, 1980; Hermelin &
hension, suggestive of mental age (MA)-appropriate O’Connor, 1970; Menyuk, 1978). However, tests of
syntactic abilities. Prior and Hall (1979) reported knowledge of basic and superordinate categories
that children with autism had impaired compre- failed to confirm this hypothesis (Tager-Flusberg,
hension of transitive and intransitive phrases rela- 1985; Ungerer & Sigman, 1987). Moreover, Tager-
tive to language-matched DD and young TD Flusberg (1991) showed that children with ALI can
children. However, children with ALI resembled use semantic cues to aid verbal recall (see also Bou-
controls in their pattern of response, again suggest- cher & Warrington, 1976), even though they do not
ing delay rather than deviance. spontaneously use a clustering strategy when
Early findings on morphology in school-age chil- recalling semantically related word lists. These mixed
dren with ALI relative to established norms included findings prefigured similar observations in individu-
impaired comprehension and use of personal pro- als with ALN, as noted in the previous section.
Later studies: language in preschool children with However, the discrepancy between comprehension
ALI and in unselected preschool groups through to and production was much smaller in the ASD group
early school-age. The view that language acquisi- than in a TD comparison group in both studies
tion is predominantly delayed rather than deviant (confirmed by Hudry et al., 2010), and Charman
in ALI remained dominant until the end of the et al. suggest that words and phrases may be used
last century (Lord & Paul, 1997). However, once by children with ASD without full meaning.
advances in early diagnosis made it possible to Taken together, these four studies of language in
include very young children in research studies, a preschool children with ASD show that up to the age
different picture emerged. Thus, Rapin and Dunn of approximately 6;0 years, most – but not all –
(2003) reported that 63% of children with ALI children with ASD have markedly delayed language
of preschool-age (up to c. 6;0 years), fall into the development that includes significant abnormalities
clinical category of ‘mixed receptive/expressive of phonology and grammar, contrary to findings from
language disorder’ that includes impaired phonology earlier studies of older children. To explain this dis-
and grammar (and which is the most common crepancy, Rapin and Dunn (2003) speculated that
form of SLI); whereas only 37% have impairments either the profile of language impairments changes
restricted to the higher order processing problems with age in children with ASD, or that children in
that relate most clearly to semantic meaning. How- groups previously studied had higher nonverbal
ever, preschool children with ALI invariably have intelligence than the children in their study. The
impaired language comprehension, never expressive latter explanation was disconfirmed by Eigsti et al.’s
language impairment alone; and in this they differ findings on a relatively able ASD group, whereas the
from groups with SLI. former explanation received support from a follow-
Rapin and Dunn’s observation of delayed and up study by Rapin, Dunn, Allen, Stevens, and Fein
deviant phonology in preschool children with ALI (2009). In this study, children with ALI who had been
was confirmed in case studies of four siblings by assessed as preschoolers were reassessed aged
Wolk and Giesen (2000); and the observation of between 7;0 and 9;0 years. On reassessment, 11% of
impaired grammar in preschool children with ASD the group had clinically normal language, and 73%
was confirmed by Eigsti, Bennetto, and Dadlani had intact articulation with mild or moderate
(2007). In the latter study, spontaneous language impairments of higher order semantic and syntactic
used by 16 preschool children with ASD and past or comprehension, conforming in general terms to the
present language impairment or delay was compared profile identified in early studies of school-age chil-
with that of age-, language- and NVIQ-matched dren. Of the remaining children assessed by Rapin
children with DD, and very young TD children. Three et al. (2009), the majority were globally impaired,
measures of structural language analysis were used: intellectually and linguistically. However, a small
the Inventory of Productive Syntax (IPSyn; Scarbor- subset had unimpaired comprehension but signifi-
ough, 1990); MLU as measured in morphemes; and cant articulatory impairments, a profile corre-
Number of Different Word Roots (NDWR) to assess sponding to that identified in the study of individuals
lexical-semantic knowledge. The children with ASD with ALN by Cleland et al. (2010).
were significantly impaired on the IPSyn; moreover, Rapin et al.’s (2009) longitudinal study does much
the pattern of their scores differed from that in con- to reconcile recent findings on preschool children with
trols, and was thus deviant rather than simply de- ASD with early findings on school-age children with
layed. Children with ASD also had shorter mean ALI. Moreover, these authors’ findings are consistent
MLU than the DD group, and somewhat shorter MLU with those from two other longitudinal studies. Geurts
than the TD group. By contrast, they produced a and Embrechts (2008) reported that at preschool-age
similar number of different word roots as the TD language profiles in a majority of children with ALI
group, and significantly more than the DD group, resemble those of SLI, including expressive phono-
although they also produced significantly more jar- logical and syntactic impairments; but by school-age
gon than controls. language profiles in the two conditions have diverged,
Two large-scale studies of unselected groups of with higher order processing and pragmatic impair-
preschool children with ASD reported delayed lan- ments now predominating in ALI. Similarly, a study by
guage onset and a slowed rate of development in Bennett et al. (2008) showed that structural language
most but not all children, according to parental impairments were more common in children with ASD
observations (Charman, Drew, Baird, & Baird, 2003; when assessed at preschool age than when assessed
Luyster, Lopez, & Lord, 2007). For example, in the at c. 7;0 years. Moreover, the persistence of structural
Charman et al. study a level of phrasal under- impairments at age 7;0 was a good predictor of a
standing that TD children have at approximately diagnosis of ALI in adolescence.
1 year 4 months was not achieved (as a group) until
age 4:0, and when NVMA equivalent was at least Later studies: language in school-age children and
3 years 6 months. In both studies the children with adults with ALI or in unselected school-age or
ASD understood more words and phrases than they adult groups. In the major study by Kjelgaard
spontaneously used, following the normal pattern. and Tager-Flusberg (2001) cited above (also reported
in Tager-Flusberg & Joseph, 2003), language was Shulman and Guberman (2007) reported intact use of
assessed in an unselected group of 89 children with syntax in a group of rising 6;0 year old children with
ASD aged between 4;0 and 14;0 years (mean ALI, relative to very young TD children; and superior
7.3 years, therefore predominantly of school-age). use of syntax relative to age- and language (CELF)-
Clinical tests of articulation, single word compre- matched) children with SLI. Two other studies have
hension, single word naming, nonword repetition shown that children with ALI perform better than age-
and higher order receptive and expressive language and NVIQ-matched children with SLI on, respectively,
using the CELF (Preschool or CELF-III versions) were tests of the comprehension of grammar (Botting &
administered to all children able to cooperate, and Conti-Ramsden, 2003) and the processing of syntac-
participant scores were compared with age appro- tic complexity (Riches, Loucas, Baird, Charman, and
priate norms. Unsurprisingly, in view of the wide Simonoff (2010).
range of age and ability represented, results across Morphology, on the other hand, is more likely to be
the whole group were heterogenous. However, when significantly impaired. Thus, detailed linguistic
divided into ALN, language-borderline and ALI sub- analysis of natural language samples in seven young
groups on the basis of vocabulary comprehension adults with ALI showed that morphological errors
scores, findings from this study were largely con- were common in all the participants, generally con-
sistent with the ‘classic’ profile of linguistic strengths sisting of truncations, omissions, or substitutions
and weaknesses that had emerged from the early especially of ‘closed class’ words such as conjunc-
studies of school-age children with ASD. Specifically: tions, articles, or pronouns (Dobbinson, 2000).
articulation was unimpaired in the ALN and bor- Similarly, in the study by Condouris et al. (2003)
derline subgroups, but mildly impaired (and proba- cited above, mean MLU as measured by morphemes
bly MA-appropriate) in the ALI subgroup. Expressive was 2 SDs. below age-related norms, despite the fact
and receptive single word vocabulary were more that vocabulary comprehension was normal or bor-
impaired than articulation in all three subgroups, derline-normal in most participants. In another
but most significantly impaired in the ALI subgroup. study using a subset of Kjelgaard and Tager-Flus-
Similarly, scores on the CELF in 44 children who berg’s (2001) participants, 62 children divided as in
completed this test showed that higher order recep- the original study into ALN, borderline and ALI
tive and expressive language was more impaired subgroups, were tested for their production of verb
than single word vocabulary in all three subgroups, tense endings (Roberts, Rice, & Tager-Flusberg,
with the handful of children with ALI able to com- 2004). The ALI subgroup performed particularly
plete the CELF having the most marked difficulties. poorly. However, errors also occurred in the other
Notably, subtest scores on the CELF in all three two subgroups, use of irregular past tense forms
subgroups were below age-related norms, with such as ‘ran’, ‘spoke’ being particularly impaired.
receptive language significantly more impaired than Botting and Conti-Ramsden (2003) also reported
expressive language, and productive syntax least deviant verb tense marking in school-age children
affected. Finally, standard scores for children tested with ALI but did not note the kinds of errors made.
on the Preschool version of the CELF were lower than All the above evidence indicates that the acquisition
standard scores for children aged from 6:0 upwards and use of certain morphemes is impaired in ALI.
tested on CELF-III, consistent with findings from Evidence relating specifically to morphosyntax (the
Rapin et al.’s (2009) and other longitudinal studies. rules governing morpheme combinations) is sparse.
In addition to the above findings, one novel However, in their study of idiosyncratic language in
and challenging finding emerged from Kjelgaard and ALN and ALI subgroups, Volden and Lord (1991)
Tager-Flusberg’s study: namely that nonword repe- noted that the majority of neologisms used by both
tition was significantly impaired in the ALI subgroup groups resulted from combining morphemes in log-
(though not in the ALN or borderline subgroups). ical but incorrect ways (e.g. ‘redundiate’ to mean
Findings from other studies of school-age children ‘make redundant’), suggesting that morphosyntax is
or adults are also largely consistent with findings from relatively unimpaired.
the early studies, although there have been no recent Regarding lexical-semantics: in the study by
studies of articulation in groups with ALI. Regarding Condouris et al. (2003) mean scores on the NDWR
syntactic abilities: Condouris, Meyer, and Tager- were, like mean MLUs, 2 SDs below age-related
Flusberg (2003) used the IPSyn to analyse gram- norms. This finding differs from that reported by
matical structures occurring in the spontaneous Eigsti et al. (2007) in their study of preschool chil-
language of the 44 children able to complete the CELF dren, in which NDWR was unimpaired relative to
in Kjelgaard and Tager-Flusberg’s (2001) study. young TD children, and superior to that of children
Nonsignificant impairment relative to established with DD. It is also inconsistent with the relatively
norms was reported on combined subtest scores.3 good performance on vocabulary tests, as commonly
observed. However, Condouris et al.’s finding may be
3
Performance was significantly poor on the Question–Negation explained by the repetitious and formulaic nature of
subtest, probably for pragmatic and social reasons, as the spontaneous language in older individuals with ALI
authors point out. (Perkins, Dobbinson, Boucher, Bol, & Bloom, 2006).
Thus, Perkins et al. noted that linguistic analysis of is so markedly delayed in most – but not all – indi-
natural language samples from seven young adults viduals4, (b) why an ‘ASD-typical’ language profile
with ALI showed repeated use of preferred lexical emerges from group studies of older children and
items, phrases and also grammatical frames, limit- adults with ASD, (c) why language outcomes in
ing the range and variety of words and word forms ASD are so heterogeneous, in terms of both
used. individual profiles and the degree to which language
A literature search identifies no studies of the is impaired, and (d) why language in some preschool
brain correlates of language in ALI groups, specifi- children with delayed language is strikingly more
cally. This is no doubt partly because of ethical impaired and deviant than in most older children
and practical difficulties associated with brain and adults. Before discussing possible answers to
investigations with this group, especially in the these questions, it is important to note that causal
case of functional studies; but is nevertheless chains underlying atypical language development
regrettable. and outcomes in ASD are complex and interactive,
even when considering psychological causes only.
‘Single cause’ explanations rarely if ever apply; nor
Summary of empirical findings on structural
do ‘single effects’ of individual causal factors often
language at different ages and across the spectrum
occur, as will be evident from what follows.
Language is often but not always delayed in ASD.
Preschool children with delayed language – including
Explaining delayed language in some but not all
those classed as ‘HFA-LN’ by later childhood – have
individuals
significantly impaired comprehension and process-
ing of meaning, and approximately two-thirds of the Delayed language is most readily explained by the
group have additional, clinically significant impair- socio-emotional-communicative impairments that
ments of expressive phonology and grammar. Over are characteristic of very young children who will
subsequent years, the early occurring articulatory later be diagnosed with ASD. These impairments of
and syntactic impairments tend to resolve, stabilis- dyadic (one-to-one) relating include lack of empathy
ing at MA- appropriate levels in most individuals. (Charman et al., 1997; Sigman, Kasari, Kwon, &
Certain morphological errors and anomalies are Yirmiya, 1992); lack of preferential responsiveness to
more persistent; and comprehension, semantics, social stimuli such as faces and voices (Baranek,
and the processing of meaning generally are most 1999; Dawson, Meltzoff, Osterling, Rinaldi, &
reliably and severely affected in persistent cases of Brown, 1998; Dawson et al., 2004; Klin, 1991; Kuhl,
ALI. Coffey-Corina, Padden, & Dawson, 2005); lack of
When language is not delayed, or when early lan- spontaneous imitation of others’ actions (Carpenter,
guage delays and impairments have largely resolved Tomasello, & Striano, 2005; Charman et al., 1997);
by later childhood, an uneven language profile can and impairment of timing mechanisms subserving
nevertheless be detected. This shows the same pat- rhythmicity and synchronisation within infant-carer
tern of relative peaks and troughs as commonly oc- interactions (Gernsbacher, Sazuer, Geye, Schweig-
curs in persistent ALI, as summarised above. ert, & Goldsmith, 2008; Wimpory, Nicholas, & Nash,
Specifically: comprehension is more affected than 2002; see also Iverson & Wozniak, 2007).5 These
expression, although words and phrases may be early occurring socio-emotional impairments may be
used idiosyncratically. Articulation is normal in all exacerbated by abnormal speech perception (shown
but a small subgroup, although minor mispronun- behaviourally by Alcántara, Weisblatt, Moore, &
ciations are not uncommon. Syntax, and possibly Bolton, 2004; Lepistö et al., 2008, 2009; and neu-
also morphosyntax, is unimpaired. However, certain robiologically by Cardy, Flagg, Roberts, & Roberts,
morphemic anomalies persist; and despite normal 2008; Jansson-Verkasalo et al., 2003; and Redcay &
performance on vocabulary tests, semantic pro- Courchesne, 2008).
cessing is anomalous, possibly in association with Anomalous one-to-one socio-emotional-communi-
an impoverished conceptual or lexical meaning base. cative behaviours create what might be termed
It is important to point out, finally, that the above ‘self-originating social deprivation’. Specifically: the
‘ASD-typical’ language profile, whether at a high level
of overall function as in individuals with ALN or at 4
In an important subgroup, language development is normal
lower levels of overall function as in persistent ALI, initially but then regresses or plateaus, either temporally or
emerges from group studies and masks considerable permanently (Rapin, 2006; see also Mawhood, Howlin, &
heterogeneity amongst individual profiles. Rutter, 2000 for an account of language regression in later
childhood). The causes of regression at various life stages in
ASD are not well understood, and although of undoubted
importance are not considered herein.
Explaining atypical language development in 5
It is not established that all these abnormalities occur in-
ASD: Theories and evidence
nately in all infants with incipient ASD. However, as argued by
Theories of atypical language development in ASD Leekam (2005) any one such impairment would tend to lead to
must explain at least the following: (a) why language the others.
infant does not attend to or respond to people, and aspects of the ASD-typical structural language pro-
this distorts carers’ interactions with the child, file, as argued by Bloom (2000), Frith and Happé
including the amount and kind of language that is (1994), Hobson (1993), Tager-Flusberg (2000), and
used (Warren et al., 2010). Impoverished and atypi- others. For example, joint attention impairments are
cal social interactions thus prevail from very early associated with language delay and predict later
childhood when the foundations of communicative language competence generally (e.g. Ruble et al.,
interchange and language are normally established. 2008; Siller & Sigman, 2008). More particularly,
As pointed out by Kuhl (2004), social deprivation, early word learning is normally based in part on the
however caused, has devastating effects on language apprehension of social cues such as the speaker’s
acquisition. In the case of ASD, diminished and direction of gaze. Young children with ASD are less
anomalous child-carer/carer-child interactions have likely than other children to utilise such cues (Bar-
been shown to be associated with poor language on-Cohen, Baldwin, & Crowson, 1997; Parish-Mor-
outcomes in both the short term (Bopp, Mirenda, & ris, Hennon, Hirsch-Pasek, Golinkoff, & Tager-
Zumbo, 2009; Ruble, McDuffie, & King, 2008; Siller Flusberg, 2007; but see Luyster & Lord, 2009),
& Sigman, 2008) and in the longer term (Siller & biasing towards the acquisition of unshared – i.e.
Sigman, 2002). Moreover, if, as argued originally by idiosyncratic – word meanings. Impaired mindread-
Hobson (1993) and now widely agreed (Boucher, in ing can also explain the problems that younger or
press), early occurring impairments of dyadic inter- less able individuals have in understanding and
action underlie later-manifesting ‘mindreading’ using person-centred (deictic) terms, such as ‘you’/
impairments in ASD, the indirect effects of very early ‘me’, ‘here’/‘there’, ‘now’/‘then’ (Hobson, Garcı́a-
interaction impairments on structural language Pérez, & Lee, 2010). Diminished use of mental state
acquisition are considerable (see below). words such as ‘think’ or ‘know’ (Tager-Flusberg,
Why, then, do not all toddlers with ASD have 2000), and impaired comprehension of words refer-
delayed language, although all are, by definition, ring to emotions (Hobson & Lee, 1989), may also be
socially, emotionally and communicatively impaired? explained in this way.
Nonverbal intelligence (NVIQ) is associated with Sensory-perceptual anomalies are probably uni-
language outcomes in ASD (Stevens et al., 2000; versal in ASD (Mottron & Burack, 2006), and would
Thurm, Lord, Li-Ching Lee, & Newschaffer, 2007) have certain predictable effects on structural lan-
and high NVIQ may enable some individuals to guage acquisition and processing across the spec-
acquire language via an atypical route. Suggested trum. Anomalous speech perception has already
compensatory routes include utilisation of superior been mentioned as a likely contributory cause of
rote learning and associative ability (Bloom, 2000); language delay, and may also underlie the abnor-
precocious reading ability, or extended use of intact malities of pre-speech vocalisation detected in most
computational modules subserving the acquisition children with ASD (Oller et al., 2010). Abnormal
of phonology and syntax (Frith & Happé, 1994). speech perception might plausibly also underlie
Normal NVIQ does not, however, guarantee protec- the articulatory impairments that persist in some
tion from clinically significant language impairment, individuals, although this has not been shown
as is evident from studies of high-functioning indi- empirically, and other explanations (e.g. motor inco-
viduals with ALI (e.g. Bennett et al., 2008; Eigsti ordination) are possible.
et al., 2007; Stevens et al., 2000). Abnormalities of sensory-perceptual processing
variously conceptualised in terms of weak central
coherence (Happé & Frith, 2006), enhanced percep-
Explaining the ASD-typical language profile that
tual processing (Mottron, Dawson, Soulières, Hubert,
emerges from group studies
& Burack, 2006), or enhanced discriminability in
All individuals with full forms of ASD share certain association with reduced generalisation (Plaisted,
psychological characteristics with potential effects 2001) may have other effects on language acquisition
on language development, and these charcteristics in ASD. In particular, weak central coherence/
probably underlie the ASD-typical language profile enhanced perceptual processing would predispose
that emerges from group studies, as argued next. towards encoding the acoustic characteristics of
Impaired mindreading in its numerous manifesta- heard speech in place of meaning, as demonstrated
tions is widely recognised as implicated in the com- in ALN groups (e.g. Järvinen-Pasley, Wallace, Ramus,
municative impairments diagnostic of ASD (Sperber Happé, & Heaton, 2008; Kamio, Robins, Kelley,
& Wilson, 2002). Impaired mindreading can also Swainson, & Fein, 2007; Toichi & Kamio, 2002) as
help to explain why language comprehension has well as in groups with ALI (e.g. Hermelin & O’Connor,
consistently been shown to be more affected than 1970). This, combined with good immediate memory
expression, in that individuals with ASD fail to take and rote learning (see below), may help to explain
account of other people’s knowledge, thoughts echolalia, and also the formulaicity so heavily relied
and feelings in interpreting speech (Surian, Baron- on in expressive language (Perkins et al., 2006).
Cohen, & Van der Lely, 1996). Certain facets of Plaisted’s (2001) enhanced discriminability hypoth-
impaired mindreading also help to explain some esis, on the other hand, is argued to be associated
with reduced categorisation ability, thereby contrib- The group of nonrandomly co-occuring conditions
uting (in combination with various other factors) to with effects on language probably includes SLI, and
the narrowed meaning that substantive terms may the relationship between SLI and ALI warrants more
have for people with ASD. extended discussion. Comorbid SLI was originally
Repetitive tendencies diagnostic of ASD most argued to be the main constituent of language
obviously affect the content of language used by impairment in ASD (Churchill, 1972; Rutter, Bartak,
people with ASD, whether at the level of echolalia & Newman, 1971). This hypothesis was rigorously
and formulaicity, or at the level of preferred topics tested in longitudinal studies reported by Bartak
and resistance to topic change. However, a longitu- et al. (1975, 1977), Cantwell, Baker, and Rutter
dinal study by Paul, Chawarska, Cicchetti, Volkmar, (1978), and Mawhood et al. (2000), but was not
and Rice (2008) identified repetitive behaviours in supported. Interestingly, however, at the outset of
toddlers (most of whom had PDD-NOS) as a signifi- these studies approximately 15% of potential par-
cant predictor of poor structural language at follow- ticipants were excluded on grounds of having ‘mixed
up, for reasons that are not clear. autism and SLI’.
Uneven memory and learning abilities are also Recent behavioural, neurobiological and genetic
universal across the spectrum (Boucher & Mayes, evidence has revived interest in links between SLI
2011). Mental age appropriate or superior immediate and ALI (see Williams, Botting, & Boucher, 2008 for
memory and rote learning ability have already been a review of the evidence). At the behavioural level,
mentioned as predisposing towards echoic and for- Kjelgaard and Tager-Flusberg’s (2001) report of im-
mulaic expression. Implicit learning of various paired nonword repetition, and Roberts et al.’s
kinds, including sequence learning and rule extrac- (2004) confirmation of errors in verb tense marking
tion, is also probably MA-appropriate, consistent demonstrated that certain ‘marker behaviours’
with relatively intact phonology and syntax within associated with SLI are also present in individuals
the ASD-typical language profile (Frith & Happé, with ALI. In addition, it is striking that a small sub-
1994). By contrast, explicit memory for unique group of older individuals with ALI continue to
events – ‘episodic memory’ – is impaired across the manifest marked phonological impairments in the
spectrum (Ben Shalom, 2003; Boucher & Mayes, absence of intellectual disability or comprehension
2011; Bowler, Gaigg, & Lind, 2011). Non-autistic impairment (Cleland et al., 2010; Rapin et al., 2009),
individuals with episodic memory impairment have resembling a subgroup of individuals with SLI.
diminished ability to acquire novel word definitions Moreover, a small subgroup of children with SLI
(Holdstock, Mayes, Isaac, Gong, & Roberts, 2002). have pragmatic impairments similar to those uni-
Impaired memory for unique events in ASD may versal in ASD, sometimes but not always accompa-
therefore – in combination with impaired mindread- nied by semantic impairments, but with intact
ing and enhanced discriminability – contribute to a phonology and grammar (Bishop & Norbury, 2002;
narrowed and idiosyncratic semantic meaning base. Botting & Conti-Ramsden, 1999; Rapin & Allen,
1983). Thus, a minority of cases of SLI resemble
prototypical forms of ALI, and a minority of cases of
Explaining heterogeneity
ALI resemble prototypical forms of SLI. This partial
Heterogeneity amongst individual profiles can be overlap in language profiles seems unlikely to have
explained by the many unshared factors that may occurred by chance, and suggests some degree of
contribute to linguistic anomalies and impairments overlap in the genetic factors contributing to each
in ASD. Some such factors occur more frequently condition (Bishop, 2010). On the other hand, the
than by chance, including comorbid sensory canonical language profile in ALI clearly differs from
impairments, epilepsy, Down syndrome, Fragile-X that in SLI, in which expression is more affected than
syndrome, Williams syndrome and tuberose sclero- comprehension, and grammatical and sometimes
sis (Kielinen, Rantala, Timonen, Linna, & Moilanen, phonological impairments are prominent (Leonard,
2004). Typical language profiles in these conditions 2000; Loucas et al., 2008). Indeed, the relative rarity
differ from each other and from the ‘ASD-typical’ of phonological and syntactic impairments in older
profile identified in this article, although some individuals with ALI, and the superiority of syntactic
descriptive overlaps occur (of theoretical interest, processing in ALI compared with SLI as shown in
but beyond the scope of this review to discuss). some studies, argue strongly against comorbid SLI
Other comorbidities occur by chance. For example, as a major contributor to persistent ALI.
children with ASD are as vulnerable as other chil- These arguments do not, however, preclude
dren to environmental deprivation, or to diseases or comorbid SLI as a contributory cause in a minority of
physical traumas that may affect language out- cases – perhaps between 10% and 20% on available
comes, such as cleft palate or head injury. Finally, evidence (Bartak et al., 1975; Cleland et al., 2010;
some children with ASD benefit from early diagnosis Rapin et al., 2009). On the assumption that this
and appropriate intervention but others do not, also percentage is stable across the spectrum, the effects
affecting language outcomes (Woods & Wetherby, of comorbid SLI should be most apparent in high-
2003). functioning individuals with relatively ‘pure’ ASD, as
in the studies by Cleland et al. and by Rapin et al. In Minshew, & Goldstein, 1996). Moreover, Ullman
lower functioning groups, the effects of comorbid SLI (2001) has argued that declarative memory (com-
would be largely masked by factors associated with prising episodic and semantic memory together) is
learning disabilities (as considered below), although necessary for the acquisition of lexical items
contributing to heterogeneity amongst individual including open class words such as nouns, adjec-
profiles. tives and verb stems, but also closed class words
If, as argued herein, comorbid SLI is probably with grammatical functions, such as articles, prep-
present in a minority of individuals with ALI, then ositions and conjunctions; also irregular grammati-
whatever processing anomalies underlie SLI may cal forms such as irregular past tense forms or
also contribute to language impairments in any plurals. If Ullman’s theory is correct, then Boucher
mixed ASD-SLI subgroup. It is beyond the scope of and colleagues’ hypothesis could explain the
this review article to discuss theories of the causes of morphemic impairments in ALI, as well as helping
SLI, but a critical review can be found in Leonard to explain the semantic impairments. There is some
and Deevy (2006). evidence of semantic memory impairment in
Heterogeneity in the sense of differences in the lower ability individuals with ASD (Boucher & Ma-
degree to which language is impaired may sometimes yes, 2011). In addition, impairments in semantic
be explained by additional factors such as those memory and word meaning were correlated in indi-
mentioned above. For example, an individual with viduals with ALI in a study by Boucher, Bigham,
ASD and hearing impairment or Down syndrome will Mayes, and Muskett (2008b). However, further
have a more severe structural language impairment investigation is needed to confirm or disconfirm this
than someone with ASD alone. hypothesis.
However, significant structural language impair-
ment frequently occurs in individuals with ASD but
Explaining why language is more pervasively
none of the kinds of additional problems outlined
impaired and deviant in preschool children than at
above. Moreover, an ‘ASD-typical’ language profile
later ages
emerges across group studies of the least affected to
the most affected school-age children and adults It is tempting to explain the widespread language
with ASD, with mainly quantitative differences in the impairments in preschool children with ASD simply
degree to which any facet of language is affected. as the consequences of language delay. Delayed
This should not occur if ALI results solely from onset will, of course, contribute, if only because a
comorbidities each of which is associated with a child who says their first words at age 3;0 may well
qualitatively different language profile. Instead, the have immature language at age 4;0. Eigsti and Ben-
emergence of a typical language profile across the netto (2009) went further, speculating that deviant
spectrum suggests that some other causal factor(s) development might result from the fact that for the
that are continuously distributed as opposed to child with markedly delayed language onset, the
present or not present, are the most common cau- process of language acquisition might resemble
se(s) of differences in the degree to which language is effortful second language learning. This suggestion
affected. assumes a critical period for language acquisition
It might be the case, for example, that one or more (Johnson & Newport, 1989), and is potentially inter-
of the shared psychological characteristics underly- esting. However, it is untested. It is also inconsistent
ing the typical profile occur in mild to severe forms with the fact that correct pronunciation is rarely
across the spectrum. Alternatively, or in addition, it achieved by second language learners, whereas
might be the case that – at least in lower functioning articulation is a relative strength in most individuals
individuals with ALI – generalised learning disabili- with ALI from school-age onwards. Moreover, this
ties contribute to the lower scores on language tests. hypothesis cannot explain differences in language
In particular, low nonverbal (‘fluid’) intelligence is profiles within preschool groups with ALI.
clearly associated with generalised learning disabil- An alternative suggestion is that a proportion of
ities, including delayed and limited language in ASD preschool children with ALI have comorbid but
(Stevens et al., 2000). transient SLI. SLI-like language impairments are
Another possibility, recently proposed by Boucher, common amongst ‘late talkers’ who are otherwise
Mayes, and Bigham (2008a) is that individuals with typically developing (Bishop & Edmundson, 1987). If,
ALI have more pervasive declarative memory as is suggested above, persistent SLI contributes to
impairments than individuals with ALN. Specifically, language impairments in a subset of school-age
it is hypothesised that individuals with ALI com- children and adults with ALI, and assuming that
monly have semantic memory impairment additional transient and persistent forms of SLI are genetically
to the episodic memory impairment that occurs related, then transient SLI-like impairments would
across the spectrum. Impaired semantic memory be expected to occur in some late talking preschool
could explain why verbal (‘crystallized’) intelligence children with ASD. This explanation is attractive in
is lower than nonverbal intelligence in most that it can explain why some but not all preschool
individuals with ALI (Lord & Paul, 1997; Siegel, children with ALI have phonological and grammatical
impairments. It also fits nicely with findings reported well established blocks to language acquisition,
by Bennett et al. (2008), Geurts and Embrechts would also be welcome. Although the foremost aim of
(2008), and Rapin and Dunn (2003), cited earlier. therapy must be communication by whatever
means, language is, for humans, the preeminent
means, and individuals with ALI deserve evidence-
Conclusion based remedial language interventions.
In this review, current knowledge concerning struc-
tural language abilities across the spectrum has
been summarised, and the complexity of explana- Acknowledgements
tions of the data has been indicated, with the aim of This article was commissioned as a Research Review
stimulating further research. The lack of recent article for the journal, for which the author has received
research into ALI is striking and regrettable, given a nominal honorarium. The author has declared that
the need for greater understanding to inform effec- she has no competing or potential conflicts of interest to
disclose in relation to this work. The author is grateful
tive intervention. Studies of the characteristics and
to Sophie Anns for her helpful comments on an earlier
immediate causes of language impairments in ALI –
draft of this article; and to two anonymous Reviewers
not least in adults – are urgently needed. With a few for their constructive comments and suggestions.
honourable exceptions, longitudinal studies of lan-
guage across the spectrum are also strikingly lack-
ing, and longitudinal studies of unselected groups Correspondence to
from infancy through to adulthood are also badly Jill Boucher, Autism Research Group, Department of
needed. Trials of interventions designed to capitalise Psychology, City University, Northampton Square,
on known islets of ability, as well as to counteract London EC1V 0HB UK; Email: jill.boucher.1@city.ac.uk
Key points
• Structural language impairments were originally a diagnostic criterion for ASD, widely considered to reflect
DD rather than deviance.
• Recently it has become clear that: (a) language in preschool children with ASD is frequently deviant as well as
delayed; (b) by school age, an ASD-typical language profile emerges characterised by deviant semantics and
morphology with relatively intact articulation and syntax; and (c) nevertheless, considerable heterogeneity
occurs across individual profiles and in the degree to which language is affected.
• The immediate causes of language anomalies and impairments in ASD are only partially understood, and are
certain to be complex.
• Research into the characteristics and causes of ALI is urgently needed to inform evidence-based interventions.
Bartak, L., Rutter, M., & Cox, A. (1977). Comparative study

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functioning autism: Controversy on episodic memory in Published online: 21 December 2011

Research Review Structural Language in Autistic Spectrum Disorder Characteristics and Causes

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Journal of Child Psychology and Psychiatry 53:3 (2012), pp 219–233 doi:10.1111/j.1469-7610.2011.02508.

Research Review: Structural language in autistic

The immediate aims of this review article are to

Bartak, L., Rutter, M., & Cox, A. (1977). Comparative study

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