Language Acquisition of Autisme

8/13/2019 Language Acquisition of Autisme

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Language acquisition in autism spectrum disorders:

A developmental review

Inge-Marie Eigsti a,*, Ashley B. de Marchena a, Jillian M. Schuh a, Elizabeth Kelley b

a Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, United Statesb Department of Psychology, Queens University, 351 Humphrey Hall, Kingston, ON K7L 3N6, Canada

Contents

1. Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 682

2. Language in ASD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 682

2.1. Discourse and pragmatic functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 683

2.2. Prosody . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 684

2.3. Syntax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 685

2.4. Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 686

2.5. Semantics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 686

2.6. Phonology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 687

3. General issues in language assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 687

3.1. Implications of findings for theories of language acquisition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 688

3.2. Between-domain interactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 688

3.3. Statistical learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 688

3.4. Non-verbal children with autism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 688

4. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 689

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 689

Research in Autism Spectrum Disorders 5 (2011) 681691

A R T I C L E I N F O

Article history:

Received 19 August 2010

Accepted 4 September 2010

Keywords:

Autism

Language acquisition

Development

Review

A B S T R A C T

This paper reviews the complex literature on language acquisition in the autism spectrum

disorders (ASD). Because of the high degree of interest in ASD in the past decade, the field

has been changing rapidly, with progress in bothbasicscience and applied clinical areas. In

addition, psycholinguistically-trained researchers have increasingly begun to test theories

of language acquisition in studies of ASD, because it is characterized by meaningful

differences in ability across a wide range of language, social, and cognitive domains. As

such, ASD has served as a natural laboratory in which to explore a variety of theories of

language acquisition. We provide an overview of the current state of knowledge of

language acquisition in autism spectrum disorders, also noting gaps in our current

knowledge. We also review implications of this work for theories of typical language

acquisition, and discuss some promising future directions. While the pragmatic deficits

that characterize autism spectrum disorders are widely acknowledged, both clinicians and

researchers should consider the phonological and morphosyntactic differences that likelyplay an important role in language comprehension and production for affected children.

2010 Elsevier Ltd. All rights reserved.

* Corresponding author. Tel.: +1 860 486 6021; fax: +1 860 486 2760.

E-mail address: [email protected](I.-M. Eigsti).

Contents lists available at ScienceDirect

Research in Autism Spectrum Disorders

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1750-9467/$ see front matter 2010 Elsevier Ltd. All rights reserved.doi:10.1016/j.rasd.2010.09.001
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1. Introduction

The onset of language skills is a special developmental milestone established by a highly uniform course across children,

despite quite striking differences in the structure of the language being learned, individual differences in intelligence or

sociability, parent factors, culture, and so on. However, not all individuals go on to develop functional language skills. The

presence of language delays or deficits is a clear signal of developmental impairments; importantly, the study of such

impairments can also help to elucidate the nature of the language acquisition process, by throwing into sharper relief the

developmental course of language acquisition (Cicchetti & Rogosch, 1996; Curtiss, Katz, & Tallal, 1992). Investigating theatypical course of language acquisition in children with autism spectrum disorders (ASD) is important for both practical and

theoretical reasons. Practically, gaining a better understanding of the course of language acquisition can lead to possible

language interventions or treatments for these children. From a more theoretical perspective, elucidating the atypical course

of language development in children with ASD can inform us about the necessary and sufficient conditions for language

development in children with typical development (TD). In studying childhood disorders, it is critical not to simply work

backwards from the adult model, and interpret findings from the endstate of development (Paterson, Brown, Gsodl, Johnson,

& Karmiloff-Smith, 1999), but rather to take a developmental approach and examine the course of the disorder over time.

Research in language development has often been a history of debate between the nativist and constructionist positions.

Impaired language learners are an important source of data about the constraints on language acquisition and the cognitive

domains that impact language acquisition. The nature of language impairments, their causes, and related strengths and

weaknesses in non-language domains, can address important questions of domain-specific predispositions for the language

learner and elucidate the domain-general mechanisms that may underlie language learning. Related mechanisms and

processes include social cognition, attentional and learning mechanisms, knowledge of causeeffect relationships, meta-representational abilities, and so on.

This paper has two primary goals: first, to review empirical evidence about language acquisition in autism spectrum

disorders within the domains of phonology, the lexicon, morphology and syntax, and pragmatics and discourse functions;

and second, to discuss the implications of these findings for language acquisition in typical development.

The autism spectrum comprises disorders characterized by impairments or delays in two interrelated domains: social

interactions, and language and communication. A third characteristic was the presence of restricted and highly repetitive

motor behaviors and unusual and perseverative psychological interests. It is likely that no singlecause for ASDexists, though

there appears to be a clear impact of genetic differences and a significant neurobiological component.

In addition to a heightened understanding of the neurobiology of ASD, language research has drawn on the concept of the

broader autism phenotype, which refers to the personality, language, social, or cognitive characteristics ofrelativesof an

affected individual. Generally, studies have found a sub-clinical but measurable similarity to the standard ASD presentation

in the domain of study. Data from studies of infant siblings of individuals affected by ASD have been particularly useful in

identifying early markers of autism and defining the broader autism phenotype. Studies of the broader autism phenotype forlanguage have indicated that the speech of first-degree relatives of individuals with ASD may be less grammatically and

pragmatically complex than the speech of first-degree relatives of individuals with other psychiatric disorders ( Landa,

Folstein, & Isaacs, 1991; Landa et al., 1992). A more recent study found that young siblings of children with ASD had a high

rate of language delay (Gamliel, Yirmiya, Jaffe, Manor, & Sigman, 2009). This is consistent with the central relevance of

language skills for the clinical presentation of ASD.

Language and communicative difficulties are of central importance in ASD. Many children with ASD are initially referred

for evaluation because of parents concerns about delayed language milestones ( Dahlgren & Gillberg, 1989; De Giacomo &

Fombonne, 1998). Furthermore, language milestones (especially, having language skills by age five years) are strongly

related to long-term prognosis (Lord & Paul, 1997; Rogers & DiLalla, 1990; Rutter, 1970; Stone & Yoder, 2001; Szatmari,

Bryson, Boyle, Streiner, & Duku, 2003). Given the importance of early language as a predictor of long-termoutcome,there is a

paucity of research examining the nature of communicative deficits and delays. For example, a research search-engine

(PubMed) search for references on autism (limited to birth to 18 years) yields 12,930 references, and a search for

language yields 16,110 references, but a conjoined search on those terms yields only 1210 references since 1966, excludingreviews and meta-analyses. In part, the lack of empirical attention reflects the fact that many researchers have attributed

language delays primarily to the lack of social interest or reciprocity. In addition, many early language studies were

conducted prior to the advent of rigorous, reliable diagnostic measures and may have not had purely autistic participants.

The current review, thus, can be quite comprehensive. We address high-level (i.e., suprasegmental) deficits in pragmatics

and discourse (conversational) functioning, to prosody, down through increasingly narrowly-scoped domains of

morphology and syntax, phonology, and phonetics. In general, we organize our review chronologically within domain,

though on occasion a different structure is more informative. We follow our review of research findings on language

development in ASD with a discussion of the implications for the study of typical language acquisition.

2. Language in ASD

Some have argued that language problems are due to social motivation deficits, and that basic language skills (such as

phonology and syntax) remain intact (Jordan, 1993) However, the research reviewed here overwhelmingly indicates a morefundamental deficit in language. The data suggest that language impairments are present across essentially all individuals

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with ASD (including deficits in pragmatics and discourse processes for individuals with Aspergers syndrome). In addition,

early studies indicated that some 50% of affected individuals never acquire functional speech ( Prizant, 1996; Rapin, 1991),

though more recent estimates find a smaller proportion of non-verbal individuals, typically around 25% (see Tager-Flusberg,

Paul, & Lord, 2005). Language acquisition in ASD is characterized by dramatic delays, with first words produced at age 38

months, on average, compared to 814 months in TD ( Howlin, 2003). Although some findings suggest that grammatical

development then proceeds in a typical fashion (Fein & Waterhouse, 1979; Howlin, 1984; Hoyson, Jamieson, & Strain, 1984;

Tager-Flusberg et al., 1990), more recent studies suggest that children with autismexhibit a greater degree of developmental

scatter that is, they produce grammatical structures that are less predicted based on previous productions (Eigsti, Bennetto,& Dadlani, 2007). Differences, of course, may reflect methodological factors (use of spontaneous versus structured tasks, for

example).

Language production in ASD is also characterized by some unusual features in addition to the domain-specific deficits

reviewed below. Many children with ASD engage in echolalia, the immediate or delayed imitation (echoing) of language

they have heard from conversational partners or from media such as cartoons or TV shows (Tager-Flusberg & Calkins, 1990).

These echoed utterances do not appear to move a childs syntactic skills into a more advanced range. In fact, the opposite

may be true; in a study of children with ASD, Down syndrome, and TD who were followed longitudinally, Tager-Flusberg and

Calkins (1990)found that spontaneous utterances were longer, and contained more advanced grammatical constructions

than imitated utterances, for the children with ASD. Although echolalia may not facilitate grammatical development, it

appears to have a partially communicative function. Prizant and Duchan (1981) found that over 33% of the echolalic

utterances produced by children in their sample had a turn-taking function, and 25% had a declarative function. In addition

to echolalia, individuals with ASD frequently invent novel words (neologisms), often with a specific idiosyncratic meaning

(Eigsti et al., 2007; Rumsey, Rapoport, & Sceery, 1985; Rutter, 1970; Tager-Flusberg & Calkins, 1990; Volden & Lord, 1991).Thus, individuals with ASD show linguistic forms (echolalia, neologisms) that are not seen in TD children, at least not with

such frequency or so late in acquisition.

2.1. Discourse and pragmatic functions

The concept of pragmatics refers to the use of language as a tool for communication; specifically, how language is used

in the context of social interactions. Pragmatics comprises both linguistic functions, such as register (altering ones speech

depending upon whom one is speaking to), negotiation of turn-taking, and the choice of referential expressions (a versus

the), as well as non-linguistic functions, such as eye contact, body language and facial expressions. Discourse is a closely-

related concept, which refers to longer connected streams of speech. Pragmatics and discourse serve as the most socially

motivated domains of language, in that they require the speaker to be aware of and respond to the social status, knowledge,

interest, motivation, and other qualities of the listener; these skills exhibit a long trajectory of development in most children,

with an asymptote at approximately five years of age. In general, discourse and pragmatics are commonly acknowledged asthe most consistently-impaired domains in ASD, remaining impaired even in children with a history of ASD who no longer

meet the criteria for a diagnosis on the spectrum (Kelley, Paul, Fein, & Naigles, 2006).

Early research in this area suggested that individuals with autistic disorder were likely to use overly formal or precise

words, and generally odd phrasing, in talking to others (Rutter, Mawhood, & Howlin, 1992), something described in the

popular press as a Little Professor style of speech.Lord (1996)has suggested that pragmatic impairments may reflect, at

least in part, a lack of experience in peer interactions. If children have had little practice talking with children their own age,

preferring instead to interact with adults, they may end up using adult-like speech and may fail to learn age-typical

vocabulary items.

Discourse and pragmatics require an understanding of the structural form of language, but also how to use that structure

in the course of social interactions. A seminal paper by Tager-Flusberg and Anderson (1991) found that six children with ASD

were less conversationally responsive than their peers with Down syndrome; furthermore, there was no improvement in

this characteristic over thecourse of a year. Another study examined cohesive ties of reference,or those disparate elements

of an utterance that have the same referent; they can be pronominal ( he, it), demonstrative (that cat), and comparative (thefaster one). Children with ASD, compared with children with SLI and TD matched on mean length of utterance, made use of

those cohesive elements, but produced them less frequently (Baltaxe & DAngiola, 1996).

Participants in a conversational interaction will inevitably encounter a misunderstanding or unclear referent; to

recover, they will engage in conversational repair. The process of repair generally involves a request for clarification

from the listener; the original speaker must meet this request, drawing on linguistic skills (understanding the request

and its relationship to the original utterance, and generating a repaired utterance) and social skills (evaluating what

the listener must have missed, and filling that gap). This skill generally emerges by age 5 in TD, but continues to improve

through late childhood, with older children exhibiting a greater variety of repair strategies and generating more

information (Brinton, Fujiki, & Sonnenberg, 1988).Geller (1998)found a general failure to repair misunderstandings by

children with ASD. However,Volden (2004)assessed conversational repair events (engineered by the experimenter) in 9

children with ASD and 9 language-matched control children, and found that the ASD group was actually able to respond

to such failures of communication; they employed a variety of techniques to respond to the conversational failure, and

to add more information as the failure persisted. However, the ASD group also produced many more inappropriateresponses.

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Severalstudies have found thatindividuals with ASDare broadlyimpairedin their discourse abilities;specifically, they failto

respondadequately to questions andcomments (Capps, Kehres,& Sigman,1998), andthese conversationaldifficulties continue

into adulthood (Eales, 1993).Ghaziuddin and Gerstein (1996)examined spontaneous speech in 17 children (mean age of 16

years) with Aspergers (AS) and 13 children with high-functioning autism (HFA). Approximately 76% of the AS and 31% of the

HFA group had pedantic speech; these speech qualities were unrelated to age, circumscribed interests, or verbal IQ. More

generally,a study of pragmatic language skills in adults with ASDfoundimpairments in indirect requestcomprehensionand the

use of humor and inference, relative to controls matched on chronological age and IQ (Ozonoff & Miller, 1996).

Turning from discourse in interaction to extended discourse in the form of narrations, several studies suggestimpairments in this domain. Capps, Losh, and Thurber (2000)found that 13 children with ASD, and a developmentally

delayed control group, were less likely than TD controls (matched on language level) to identify the causes of characters

internal states during a story-telling task, although they were as likely to posit such internal states. Furthermore,

performance in the ASD group only was correlated with false belief task performance (thought to index theory of mind

skills). That is, theability to recognizethat other individuals have different mental representationsfrom ones own, and being

able to identify the motivations and causes of another persons emotional or mental state, was more tightly linked to

discourse skills in ASD, perhaps because they are both constrained by a similar limitation. Data from a more recent narration

study found that children with ASD were less able to construct a story that had clear, explicit links across story events, and

that story connectedness was not significantly related to recall of the storys gist (an association that was present in

controls,Diehl, Bennetto, & Young, 2006).Kelley et al. (2006)found that even very high functioning children with ASD had

difficulty communicating the causalstructure of a narrative, were less likely to discuss the goals of the characters in thestory,

and were more likely to misinterpret what was occurring in the story. Narrative ability is important for communication as

well as for the structuring of ones own thoughts; it is unclear what the implications of narrative difficulties might be forindividuals with ASD, though these abilities seem related to broader social-cognitive processing difficulties.

Many studies have demonstrated pragmatic deficits in autism. However, studies have found similar pragmatic

impairments in individuals without autism, but with intellectual deficits (mental retardation, or MR), indicating that

cognitive limitations may be as limiting as social delays for development in this language domain (Abbeduto & Hesketh,

1997; Hemphill, Picardi, & Tager-Flusberg, 1991).

What may be the source of these high-level pragmatic and discourse deficits in ASD? There are two primary proposals in

the literature. One influential view grows out of the Theory of Mind approach, which suggests that difficulties in

representing the contents of other peoples minds are central in our understanding of ASD, and may provide a critical

constraint on pragmatic language skills (see e.g., Baron-Cohen, 1988). There is another possible source of pragmatic and

discourse impairment. The executive functions (EF) theory is designed to explicate the core deficits in ASD. Briefly, the EF

theory suggests that ASD involves impairments in a set of cognitive processes associated primarily with the functional

circuitry of the frontal lobes of the brain. These processes include working memory, inhibition, set-shifting, goal-

maintenance, and cognitive control, and the EF theory proposes that deficits in these processes may account for thesymptoms in ASD, including social deficits, communication delays, and repetitive behaviors (Ozonoff et al., 2004;

Pennington & Ozonoff, 1996; Rogers & Bennetto, 2000). By this account, children with autism may fail at pragmatic and

discourse tasks because they are unable to simultaneously consider and respond to multiple sources of information (from

self and other, for example) or to inhibit inappropriate, potent, or salient responses. While this theory seems plausible, there

is little specific evidence to support a specific role of EF in pragmatic abilities (and some evidence against it; see below).

In general, pragmatic deficits are nearly universal in individuals with both high- and low-functioning ASD. To date,

however, neither the Theory of Mind nor the EF theory has been found to account for symptoms of ASD across each of the

three domains (social skills, communicative skills, and repetitive behaviors). The question thus remains, about whether

these theories provide an explanatory mechanism for ASD.

2.2. Prosody

Closely linked to pragmatic abilities is the production and comprehension of prosody, which involves the rhythm, stress,and intonation of speech. To our knowledge, prosodic impairments have been found in every study of children with ASD

conducted to date, although it should be noted that relatively few studies have been conducted in this area. As Rutter et al.

(1992)found, prosodic oddities were present in ASD, though also shown to be common in a matched group of children with

language disorders. Shriberg et al. (2001)examined prosody production by 30 children with HFA or AS (15 per group)

compared with 53 TD controls, ages 1049. Results suggested that the ASD group used less appropriate prosodic phrasing,

including misplaced lexical stress, slowed phrasing, and less appropriate resonance qualities. Interestingly, though the ASD

group had more utterances that were coded as loud, their pitch and loudness were found to be in the appropriate range.

Another structured assessment of prosody compared 31 children with high-functioning ASD and 72 TD controls, matched on

verbal mental age (McCann, Peppe, Gibbon, OHare, & Rutherford, 2007). Findings indicated that the ASD group performed

significantly worse than controls on 11 of the 12 prosody subtests administered. Finally, in the only assessment of prosodic

comprehension in ASD to date, 21adolescents with ASD were compared to 22TD controls matched on age, IQ, and PPVTscores

(Diehl, Bennetto, Watson, Gunlogson, & McDonough, 2008). The ASD group was significant less able to use prosody to resolve

syntactic ambiguities. Although all studies to date show that individuals with ASDhave difficulties with prosodic productionand comprehension, more research is needed to identify the source of these difficulties.



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2.3. Syntax

Syntax refers to the combination of words into phrases. As such, it may be considered the most complex of the core

linguistic domains. While a number of researchers in the 1980s and 1990s concluded that despite initial delays in

acquisition, syntax was relatively unimpaired in ASD, this conclusion has been revisited more recently, with a different

outcome.

Findings in the 1970s seemed to indicate specific deficits in children with ASD as they acquired syntax. A study of three

verbal children with autism, matched to children with MR and younger TD controls on mental age, found poorer productionof past-tense verb forms, which they interpreted as a more general deficit in deictic syntactic categories, or those forms

that allow the speaker to express the relationships among speaker, listener, object of actions, and when the action occurs

relative to the time of speaking (Bartolucci & Albers, 1974). Prior and Hall (1979) found that 13 children with ASD, ages 715,

had more difficulty than control groups with Down syndrome or TD in comprehending transitive verb phrases (in which the

verb requires a direct object; e.g., the dog chews the bone). The ASD group was also less likely to use word meaning to assist

in comprehension. One careful examination of spontaneous speech samples in verbal children with ASD, compared with MR

and TD controls matched on non-verbal IQ, found that the ASD group was less able to harness syntactic knowledge in their

speech (Pierce & Bartolucci, 1977). Specifically, they had lower overall scores on a syntactic complexity measure; they

produced fewer transformations, fewer generalized transformations, and had a higher mean error rate, than control groups.

Whilethese findings, along with thelandmarkbook documentinga variety of syntactic deficits in ASD(Hermelin & OConnor,

1970) consistently demonstrated that syntactic development in ASD was aberrant, conclusions must be tempered by the

dramatic differences in autism diagnosis in that era.

In contrast, several studies have concluded that syntax is not specifically impaired in ASD (on the basis ofperformance being at the level expected based on full-scale IQ or other domain-general mental age measure). Shulman

and Guberman (2007)found that children with ASD were able to draw on syntactic information in order to produce

novel verbs to the same degree as TD controls matched on core language scores. Tager-Flusberg et al. (1990)found that

the rate of growth in syntactic complexity for a sample of children with ASD followed longitudinally paralleled the

growth in a sample with Down syndrome; interestingly, the ASD group produced significantly fewer closed-class

(functor) words at several stages of utterance length. They were also found to have a more limited syntactic

repertoire, relative to their MLU (Scarborough, Rescorla, Tager-Flusberg, Fowler, & Sudhalter, 1991). Another careful

assessment of language skills in a sample of children with autism, schizophrenia, and other emotional disturbances

(e.g., depression) found few differences across a variety of story-telling, sentence repetition, and story-completion tasks.

Compared to mental-age-matched TD controls, all of the clinically-affected participants produced language that was

grammatically less complex, but few other differences were reported (Waterhouse & Fein, 1982). In an older study,

contrasting social and grammatical functions in language, participants with ASD produced language that was equally as

complex as chronological-age-matched dysphasic control subjects with a current language delay (possibly what wewould now characterize as SLI, Cantwell, Baker, & Rutter, 1978).

More recent studies have found syntactic delays in individuals with ASD using a variety of approaches. One study

compared high-functioning children with ASD to TD controls (matched on receptive vocabulary), as well as a group of low-

functioning children with ASD and younger TD controls (also matched on receptive vocabulary), and found that the mean

length of utterance (MLU; the average number of morphemes per utterance) for the younger TD participants was

significantly longer than the low-functioning children with ASD (Volden & Lord, 1991); the higher-functioning groups did

not differ. Examining performance on third-person and past-tense marking tasks, Roberts, Rice, and Tager-Flusberg (2004)

found that low-IQ (but not higher-IQ) participants with autism were as impaired as a higher-IQ sample with SLI, and that

performance was correlated with non-word repetition abilities. They took this findingto suggest that ASD maybe made up of

at least two subtypes, one that shares characteristics of SLI (in that grammatical skills are specifically impaired), and one

which does not.

A number of studies have shown that children with ASD produce language whose grammatical structure is more rigid,

that is, includes a reduced set of syntactic structures in comparison to a control group (Rapin & Allen, 1988; Shapiro, 1977;Shapiro & Kapit, 1978).Eigsti et al. (2007)found that a sample of children with autism produced syntactically less complex

spontaneous language relative to TD and developmentally delayed children. In a study of older children with autism and TD

controls (ages 916) matched on age, IQ, and receptive vocabulary (Eigsti & Bennetto, 2009), the autism group was

significantly impaired in their ability to judge the grammaticality of sentences (a task with very minimal response demands).

Performance was particularly impaired in third person singular and present progressive marking. Another finding, drawn

from the same sample of children, identified correlations between knowledge of a syntactic distinction (count-mass nouns)

and performance on assessments of executive function (Eigsti & Bennetto, submitted for publication), suggesting a potential

role for EF in the syntactic skills of children with ASD.

In summary, findings have been somewhat conflicting in addressing the relative delay or deficit in syntactic development

of children with ASD; however, the majority of studies have concluded that there is a clear delay in this domain of language.

As mightbe expected, social and cognitivefactors appear to contribute significantly to developmental progress; in one study,

mutual attention was found to account for approximately 89% of the variability in monthly syntactic complexity growth

rates (Rollins & Snow, 1998). In a longitudinal study of a very large sample ( n = 138) of children with low and highfunctioning ASD, cognitive ability at preschool period was found to account for the largest proportion of variability in



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language and social skills at the school-age period (Stevens et al., 2000); in contrast, abilities at school age were not strongly

predicted by preschool social abnormality or severity of autistic symptoms.

2.4. Morphology

Morphemes are the smallest meaningful units of language; morphological development refers to the development and

understanding of these units and how such units are combined into words. For example, jumper,jumped,jumps,jumpy, and

longjumpall use the morpheme jump in combination with -er,-ed, -s, -y, andlong-to add to or change the meaning. TDchildren have been found to be highly sensitive to many probabilistic as well as rule-based constraints on combining

morphemes into words including item frequency, phonological characteristics, and neighborhoods (e.g.,Marchman, 1997).

Studies of morphological development in children with ASD are few in number but suggest that at least early-acquired

morphological rules are learned as efficiently in ASD as in controls ( Waterhouse & Fein, 1982).Cantwell et al. (1978)found

that 12 boys with ASD with a mean age of 9 were similar to dysphasic controls (likely fitting a SLI profile, in todays

terminology) in the use of nine morphemes in spontaneous speech (though they had more abnormal and echolalic speech).

In contrast to this null finding, Bartolucci, Pierce, and Streiner (1980) found that 10children withASD (with a mean age of 10)

were more likely to omit obligatory morphemes than TD and developmentally delayed control groups matched on mental

age, which they suggested may reflect a specific delay in morpheme production (rather than general language delay). These

conflicting results may highlight the relevance of control groups; when compared to a sample matched on overall mental

age, an ASD group may appear to have syntactic deficits, though these are not apparent when compared with a language-

impaired sample. Several authors have suggested that children with ASD have difficulty with functors such as prepositions,

conjunctions, and pronouns (Churchill, 1972; Ricks & Wing, 1975). Thus, the research investigating morphologicaldevelopment in children with ASD is mixed and would benefit from more research, particularly as all of these studies were

conducted prior to the advent of the current diagnostic system.

2.5. Semantics

While studies of syntax focus on a persons knowledge of how to use the structure of language, knowledge of the

meanings of words, and how these meanings map onto the real world, is also critical to language use. This is the study of

semantics. Studies of semantic processes in individuals with ASD have produced highly conflicting results.

Several studies have directly investigated the contribution of semantic factors to grammatical processing. One study

found that children with ASD were better at recalling semantically related items than unrelated ones, and were better at

recalling syntactically coherent sentences (rather than syntactically random groupings), though they benefited significantly

less from syntactic relatedness than the TD control group (Ramondo & Milech, 1984). Similarly, Paul, Fisher, and Cohen

(1988)found that children with ASD were able to use word order to act out passive and active sentences; they were lessinfluenced by the semantic probability of the occurrence of events in the real world (e.g., tigers are more likely to eat

antelopes than the converse) than were typically-developing children. Similarly,Tager-Flusberg (1981)found that children

with autism made use of syntactic information as they acted out spoken sentences, but were affected by semantics to a lesser

extent than controls. These findings agree with a study fromHermelin and OConnor (1967), which indicated that children

with ASDdiffered from a TD group in that they were no better at recallingactual sentences than simpleword lists, suggesting

that they did not incorporate semantic or linguistic structure into their on-line processing of speech. Thus, individuals with

autism may use semantic information to interpret syntactic structure in a different manner than typically developing

individuals; more research needs to be conducted to clarify this issue.

Recent studies have examined the contribution of other biases to word learning. In a longitudinal study of very young

children with ASD, mean age 33 months, and TD children matched on language at the initial visit, the ASD group was able to

map novel words onto novel objects as well as their peers (Tek, Jaffery, Fein, & Naigles, 2008). Interestingly, they were less

likely to use object shape (as opposed to object texture) to learn new words, a bias that was robust in TD group by age 24

months. Another study examined the role of linguistic biases in word-learning for older children and adolescents, showingthe typical use of the mutual exclusivity bias in both the ASD and TD groups ( de Marchena, Eigsti, Worek, Ono, & Snedeker,

submitted for publication). That is, children with ASD were able to efficiently map novel words onto novel-and-unnamed

objects, consistent with a bias that category labels apply to mutually exclusive sets of objects (and that each object has only

one category name). These biases (shape bias versus mutual exclusivity/novel name-novel object bias) may differ in the

degree to which they are domain-specific versus linguistic in nature; alternatively, ASD may be characterized by an

extremely delayed and extended developmental trajectory for acquisition, such that biases become operational far later in

ASD than in typical development. This would account for the absence of a shape bias at age 33months but the presence of the

mutual exclusivity bias in school-age children.

Several researchers have concluded that individuals with autism are generally unimpaired in the comprehension and

production of semantic information. One study asked children with ASD to sort pictures into piles on the basis of category

membership, and found similar performance across ASD, MR, and younger TD groups ( Tager-Flusberg, 1985). Another

sorting study found similar abilities in age-matched MR, TD, and ASDgroups (mean age of 6 years) in sorting items into form,

color and functional categories (Ungerer& Sigman, 1987).Eigsti et al. (2007)found that an ASD group produced a greatervariety of different words in spontaneous speech than an MR group matched on receptive vocabulary. Kjelgaard and Tager-



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Flusberg (2001) found that receptive vocabulary as measured by the Peabody Picture Vocabulary Test (PPVT) was a strength

relative to standardized syntactic measures in a large cohort of children with autism.

On the other hand, a number of findings are suggestive of semantic impairments. Several studies have shown that

children with ASD have difficulty understanding the meanings of verbs that indicate someones internal mental state (know,

think, remember, etc., Kazak, Collis, & Lewis, 1997; Kelley et al., 2006; Ziatas, Durkin, & Pratt, 1998). A study of children ages

49 found less prototypical word choices in the ASD group; that is, the children with ASD were more likely to say unusual

animals like aardvark in a word fluency task (Dunn, Gomes, & Sebastian, 1996). Studies have also found that individuals

with ASD are less primed by semantically-related words, though their priming by pictures is intact (Kamio, Robins, Kelley,Swainson, & Fein, 2007; Kamio & Toichi, 2000). Thus, while children with ASD may perform according to their mental age on

standardized tests of vocabulary and be able to perform basic categorization tasks, and appear age-typical in the size of

lexicon, their understanding of mental state verbs and semantic organization is clearly different than their typically

developing peers.

2.6. Phonology

Phonology refers to the way in which a speaker organizes the sounds of a language to encode meaning and overlaps with

phonetics, which refers to the physical production and articulation of speech. Phonology has been found in a variety of

clinical studies to be sensitive to neurological problems (Culbertson & Tanner, 2001) and thus provides an excellent targetfor

research in ASD.

A variety of studies have found essentially intact phonology in individuals with ASD across a wide age range. An early

study examining 47 boys with autism and severe language difficulties, ages 410, compared with 23 dysphasic NVIQ-matched controls, found that the ASD group had few articulatory problems in both a structured (Reynell Developmental

Language Scales) and spontaneous speech setting (Bartak, Rutter, & Cox, 1975). Similar data emerged in a very large sample

of 89 children with high-functioning ASD, compared to controls with SLI ( Kjelgaard & Tager-Flusberg, 2001). Both groups

scored within the normal range on the Goldman-Fristoe Test of Articulation (GFTA). However, when dividing the ASD group

into impaired versus non-impaired groups on the basis of PPVT scores, the children with the lowest scores performed

significantly worse on the GFTA (though their scores were within the average range and elevated in comparison to their

scores on other tests). The authors concluded that phonology is the most sparedaspect of language in children with ASD.

Some studies, however, have found significant phonological deficits in ASD. A small group of 9 autistic children (mean age

12) had delays on the Edinburgh Articulatory Scale compared to controls with MR (Bartolucci, Pierce, Streiner, & Tolkin-

Eppel, 1976). More recently, 80 children with ASD ages 910 were compared to 59 controls on the Nonword Memory Test

and a read-aloud task and were found to be more impaired in phonology ( Bishop et al., 2004). Similarly, a study of 30

individuals with HFA/Aspergers, compared to 53 age-matched controls (ages 1049 years) examined speech qualities from a

structured conversational interaction and found a high prevalence of articulatory and speech problems for the ASD group(Shriberg et al., 2001).Rapin, Dunn, Allen, Stevens, and Fein (2009)found that approximately 23% of their relatively large

sample of school-aged children with autism had severe expressive phonology deficits.

In general, studies seem to suggest that while most individuals with ASD do not have specific impairments, phonological

and articulatory problems can be found in low-functioning individuals with autism, and early in childhood (Lord & Paul,

1997). Alternatively, phonological deficits may be specific to particular subgroups within the autism spectrum with the rest

following a typical trajectory in phonological development (Rapin et al., 2009; Tager-Flusberg, Lord, & Paul, 1997).

3. General issues in language assessment

There are a number of factors that can make it difficult to generalize across research studies examining language and

communicative skills in autism. Children with ASD in particular may struggle with motivational and attention difficulties

that impact their responses to testing (Koegel, Koegel, & Smith, 1997; Tager-Flusberg, 2000). In addition, they are more likely

to perseverate and focus on irrelevant (from the experimenters perspective) aspects of the testing situation (Waterhouse &Fein, 1982). Some studies have found that children on the autism spectrum may respond better in computer-administered

testing situations (Tager-Flusberg, 2000). Complicating the clinical application of findings, spontaneous speech samples and

standardized assessments may yield dramatically different findings (Lord & Paul, 1997); but, if children are unresponsive to

the experimenter, they may not provide an accurate window into childrens underlying abilities ( Howlin, 1984; Tager-

Flusberg, 2000).

A final complication for research in this field is the choice of matching variables and control groups. In the past, it has too

often been the case that a highly heterogeneous ASD group is compared with a more homogenous control group (matched,

typically, on mean IQ). If non-verbal IQis a strength in ASD, and if groups are matched on VIQ, then the ASD group may

contain children who are not delayed on NVIQ; this could obscure language deficits relative to other domains. In general,

researchers have been moving away from a simplistic assumption that groups are well-matched if group differences do not

reach thep< .05 criterion (Mervis & Klein-Tasman, 2004), and instead, advocate a higher threshold, of group differences no

greater thanp < .20 and with similar ranges of ability. A second useful (albeit cumbersome) strategy is to select multiple

control groups (for example, one control group matched on verbal IQ and age, and then a second group matched on non-verbal IQ).



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Related to this matching question is a concern about differences within the autism spectrum. An ASD group is likely to

include individuals with pervasive developmental disorder/not otherwise specified (PDD), with high- or low-functioning

autistic disorder, or with Aspergers (and thus, no early language delay). It can be a strength to include participants across

this spectrum, yet researchers must give attention to clearly characterizing their samples. First and foremost, we must

commit to giving full diagnostic information about the ASD group. When attempting to explore the interactions of IQ,

language, and social impairments, we may aim for a more homogenous sample. For example, several recent studies have

attempted to empirically distinguish between individuals with ASD who demonstrate clear language difficulties and those

who do not (Lindgren, Folstein, Tomblin, & Tager-Flusberg, 2009; Loveas et al., 2010). Alternatively, it can be valuable toconsider the generalizability of a finding across the whole spectrum, and any differences could be useful in understanding

the etiology or phenotype associated with specific autism-related disorders. This individual differences approach takes the

perspective that including a very wide range of abilities for a given skill provides us with the opportunity to investigate the

precursors, predictors, and correlates of that skill.

3.1. Implications of findings for theories of language acquisition

While early studies of language in ASD (from the 1940s to the 1970s) implicated impairments across many language

domains, subsequent research focused on deficits specific to the suprasegmental domains of discourse and pragmatic

functions. Currently, research is once again identifying deficits within every domain of language. Identifying patterns of

strength and weakness across language domains can serve to illuminate the influence of associated social and cognitive

processes, which also show a pattern of varying strength and weakness in ASD.

3.2. Between-domain interactions

The presence of often dramatic variability across and between social, cognitive, and language domains in ASD presents

researchers with the opportunity to examine relationships. This is more challenging in studies of typical development

because there is generally a much smaller range of individual differences, and abilities tend to hang together such that a

strength in one domain (e.g., cognition) or sub-domain (e.g., morphology) will be observed across all other domains or sub-

domains.

The challenging converse to this apparent decoupling of language, social, and cognitive skills in ASD, is that these

processes surely transact. That is, one process likely influences development in another process, which then reinforces or

promotes development in the first process. Thus, for example, cognitive level likely influences initial language input, in the

sense that a higher-functioning child may have more attentional capacity to perceive language input; this in turn would

reinforce cognitive capacities (such as development of working memory) as language skill increases. In another example,

verbal abilities may promote the development of theory of mind capacity (e.g., de Villiers, 2000). Theory of mind skills likelysupport more effective social interactions, which in turn would promote improvements in language skills. Because of the

coupling of these processes, disentangling their unique contributions will provide a significant challenge.

These issues willrequire careful teasing apart of individual capacities (working memory, attention, inhibition, theory of

mind, low-level perceptual capabilities) into their most fundamental (and operationalizable) components, and also

requires sufficiently large sample sizes to be ableto determine the variancecontributedby multiple factors.This process,in

addition, calls for powerful analytic techniques that are able to examine development over time (such as growth curve

analysis).

3.3. Statistical learning

There is currently a great deal of interest in the role that statistical regularities in language might play in language

acquisition. Currently, we know little about specific differences that children with autism may exhibit in their use of

statistical properties as they learn language.One study of adults with autismindicated significant impairments in an implicitlearning task (Mostofsky, Goldberg, Landa, & Denckla, 2000), however, a functional neuroimaging study of adolescents found

no differences in implicit learning (Barnes et al., 2008). The interactions among language skills, implicit learning, and

perception of linguistic regularities may provide an interesting arena in which to examine the contributions of such a

learning system to language acquisition. This is work we are currently pursuing in our laboratory.

3.4. Non-verbal children with autism

Previous estimates suggested that approximately 50% of individuals with an autism diagnosis will fail to develop any

functional verbal language skills (Bryson, Clark, & Smith, 1988). Recently, however, because of earlier diagnosis and early

intervention, it is likely that an increasing proportion of children will go on to develop verbal skills, though no current

estimates are available (Koegel, 2000; Prizant, 1983). This population of children, who are able to develop language only with

intensive early therapy, holds outthe prospect of greatly improving ourunderstanding of the possible barriers to acquisition.

This can be done in the course of intervention studies, in which specific skills are deliberately taught, carefully tracking whatother skills might also improve as a result. More generally, intervention studies open up the possibility of assessing the



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impact of growth within a specific (potentially non-linguistic) domain, such as executive functioning, on subsequent

language development. Some preliminary work in this area has been quite promising (Fisher & Happe, 2005).

4. Conclusions

In conclusion, research on the autismspectrumis one of themost rapidly-changing and exciting fields in psychology, with

progress in both basic science and applied clinical areas. Researchers in language acquisition have recently turned to ASD,

because studies of this and related disorders offer the possibility of examining meaningful differences in ability across a widerange of language, social, and cognitive domains. As such, it has served as a sort of natural laboratory in which to explore a

variety of theories of language acquisition. At the same time, it is tempting to overlook a number of the subtleties in

performance and ability that are part and parcel of working with a developmental disorder, which does not always arrive as

neatly packaged as we might assume. This manuscript has provided an overview of the current state of knowledge of

language acquisition in autism spectrum disorders, and has reviewed some implications for typical development, and some

promising future directions.

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Language Acquisition of Autisme

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