Towards a convergent account of pragmatic language deficits in children with high-functioning autism: Depicting the phenotype using the Pragmatic Rating Scale

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Abstract

Despite its prominence, pragmatic characteristic associated with autism is under-explored and thus was not well defined. The present study attempted to depict a relatively comprehensive profile of language pragmatics in children with high-functioning autism (HFA) using the Pragmatic Rating Scale (PRS). Pragmatic behaviors of 26 HFA children were contrasted with those of their normal counterparts. As predicted, the group with autism demonstrated substantial pragmatic difficulty when compared to their normal counterparts matched stringently on both verbal and non-verbal intelligence. The findings were discussed with relevance to lacking a “theory of mind”, weak central coherence and executive dysfunction.

Highlights

► We depicted the profile of language pragmatics in children with high-functioning autism (HFA) using the Pragmatic Rating Scale (PRS). ► We found that children with autism demonstrated substantial pragmatic difficulty when compared to their normal counterparts matched on both verbal and non-verbal intelligence. ► The findings were discussed in relation to lacking a “theory of mind”, weak central coherence and executive dysfunction.

Introduction

Pragmatics of language is relatively under-explored and is far from a coherent field of study. Nevertheless, it is no less important than other language fundamentals because it decides how language is to be used.

Thompson (1997) suggested central facets of pragmatic competence that could distinguish it from other major areas of linguistic enquiry. First, pragmatic competence entails knowledge of how language is construed and its permissible range of use. Second, it calls for the knowledge of how we share the world with others. Last but not least, it requires picking up cues from the language and social behavior of others, and an understanding of the rules which govern behaviors in a social context. In other words, pragmatic competence allows an individual to speak intelligibly, behave appropriately, and to understand the perspective of others. The cognitive prerequisites of sophisticated pragmatic development in a child would therefore include: (a) accurate perception and understanding of speech; (b) production of intelligible speech; (c) appreciation of cultural norms and (d) inhibition of inappropriate speech or behavior.

Beside the cardinal features contributing to a diagnosis of autism, pragmatic deficit is another conspicuous feature of the condition. Pragmatic deviance in autism usually does not violate any rules of syntax, phonology, or semantics (Bartak et al., 1975, Beisler et al., 1987, Ramondo and Milech, 1984, Tager-Flusberg, 1981, Tager-Flusberg, 1989, Tager-Flusberg, 1991, Wetherby and Prutting, 1984). In fact, it may be the only parameter of language that is deficient with variable severity across the spectrum regardless of the functional level and age of the affected individuals (Young, Diehl, Morris, Hyman, & Bennetto, 2005). Thus, it is all the more important to have a detailed picture of this distinguishing linguistic characteristic of autism.

In this study, we attempted to depict a relatively comprehensive profile of language pragmatics in children with high-functioning autism using the Pragmatic Rating Scale (Landa et al., 1992). The findings would then be discussed in conjunction with the cognitive impairments pertaining to the disorder.

Pragmatics problems in autism include: preoccupation with restricted topics, incorporation of irrelevant details, abrupt changes of topic (Volden, Mulcahy, & Holdgrafer, 1997), not letting others take their turn (Loveland, Landry, Hughes, Hall, & McEvoy, 1988) and failure to clarify ambiguities (Mesibov, Adams, & Klinger, 1997).

Landa (2000) emphasized the importance of understanding the cognitive roots of pragmatics. The cognitive phenomenon most frequently investigated in association with language pragmatics in autism is the “theory of mind” deficit. A ‘theory of mind’ is the cognitive capacity necessary for understanding the mental states of another person (Baron-Cohen, Leslie, & Frith, 1985). Tager-Flusberg (2000) highlighted a close connection between the capacity to understand other minds and the social use of language. The tendency of individuals with autism to interpret speech literally implies that they do not understand the mind of the speaker (Sperber & Wilson, 1981).

On the other hand, executive functions such as planning, behavioral inhibition, and cognitive flexibility appear essential to pragmatic communication. Thus, it is possible that an executive dysfunction in autism, such as perseveration, could account for pragmatic oddities like repetitive speech and Topic preoccupation. However, the relationship between executive dysfunction and pragmatic deficits in autism has received little attention.

In relevant literature, only a few formal measures were developed to assess pragmatics. One of the reasons could be that the most accurate observation of pragmatic competence should be made during a social conversation in a quasi-experimental environment, but in reality such a set-up is rarely encountered. In addition, the operational definition of pragmatic communication used in previous studies was rather narrow pertaining to comprehension of jokes, inferences, and indirect requests (Ozonoff and Miller, 1996, Rumsey and Hanahan, 1990). Past measures were also opened to question in that they seemed to be heavily dependent on comprehension and cognitive flexibility.

In the present study, the Pragmatic Rating Scale1 (PRS) was employed to tap the language characteristics of children with high-functioning autism (HFA). It is one of the few measures that can be used in a semi-social setting (Landa et al., 1992). The PRS categorizes 19 pragmatic anomalies that can be observed during a relatively lengthy interaction. Each behavior is clearly defined to enable consistent ratings by examiners without formal training in speech pathology (see footnote 1). The internal consistency of the scale was high, yielding a Cronbach's alpha of .85. A factor analysis on the 19 items generated 3 factors, with eigenvalues of 5.75, 2.35 and 1.82, leading to a further division of 3 subscales: Disinhibited social communication, Awkward/Inadequate expression, and Odd verbal interaction. Two items did not load on any of these subscales were classified as Other items. Each of these subscales represents tapping a separate, but not independent, domain within the category of language pragmatics.

At this point, it is worth re-emphasizing the importance of matching verbal intelligence, as ensured in the current investigation, when addressing complex language ability. In addition, the age range of the sample was strictly contained from 8.78 to 15.17 years. The HFA group was expected to perform less well than the control group on all 3 subscales.

Section snippets

Participants

In the initial screening, 31 children with HFA were recruited from a special school and two Parent Resource Centers serving families with autistic children. Thirty-four normal children in the control group were volunteers recruited from different schools.

Children with HFA included in this study received their diagnoses of autism from either clinical psychologists in child assessment centers or pediatric psychiatrists. Caregivers of prospective participants were interviewed before the actual

Results

The PRS total score of the autism group was significantly higher (indicating more pragmatic anomalies) than that of their normal counterparts matched on verbal intelligence [t(50) = 14.94, p < .001]. Thus, children with autism exhibited more pragmatic abnormalities than controls (Table 2).

The autism group scored significantly higher than the normal control group on all items except for “Terse” [Z = −.936, p = .349] (Table 3).

Discussion

As predicted, the group with autism demonstrated substantial pragmatic difficulty when compared to their normal counterparts matched stringently on both verbal and non-verbal intelligence.

The significant differences between control and autism groups presented here could not be attributed to task flaws such as ceiling or floor effects, as both groups demonstrated a degree of pragmatic difficulty, varying in frequency and severity. Neither could these findings be due to a difference in language

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