Chat with us, powered by LiveChat After watching My Experience With Autism, post your perspectives regarding this video. What did you learn about autism that you did not know before or that surprised you? What symptoms or difficulties experienced by autistic individuals stood out to you t | Coms Paper
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PART A After watching My Experience With Autism, post your perspectives regarding this video. What did you learn about autism that you did not know before or that surprised you? What symptoms or difficulties experienced by autistic individuals stood out to you the most?https://www.youtube.com/watch?v=nGrvsJuGmU0&feature=youtu.bePART B – 2 PDF doc- use only for part bDescribe some of the common characteristics and needs of students with communication disorders and autism spectrum disorders. Outline some instructional and environmental modifications, accommodations, and adjustments that could be implemented within a school to meet the needs of these students.please cite paper APA formatbs_bs_banner
Autism Spectrum Disorder, Language Disorder, and Social
(Pragmatic) Communication Disorder: Overlaps,
Distinguishing Features, and Clinical Implications
Lauren J. Taylor1 and Andrew J. O. Whitehouse2
1
School of Psychology, University of Western Australia, and 2Telethon Kids Institute, University of Western Australia
Background: The diagnostic boundaries between autism spectrum disorder (ASD) and specific language impairment (SLI) are not clear-cut.
Evidence of the lack of distinct boundaries between these disorders comes from research identifying a group of children who have pragmatic
language difficulties that can be distinguished from those in children with SLI and those with ASD. These findings have led to the inclusion of
a new diagnostic category, social (pragmatic) communication disorder (SPCD), in the Diagnostic and Statistical Manual of Mental Disorders5th Edition DSM-5. While this new diagnostic category appears to capture a subgroup of children who may not have been recognised in the
DSM-IV, SPCD has been criticised due to a lack of empirical evidence, showing that the disorder is distinct from ASD in terms of aetiology,
intervention, and prognosis.
Objective: The purpose of this paper was to summarise the literature that has investigated overlaps in the phenotypes of SLI, ASD, and
SPCD. A secondary objective was to present a framework for the assessment and diagnosis of these three conditions.
Method and Results: In this paper, we review the research that has examined overlaps in the aetiologies and phenotypes of ASD, SPCD,
and SLI. While the results highlighted overlaps in the language profiles and autistic symptomatology, these three conditions could also be distinguished based on the severity of the social communication deficits and the absence of rigid and repetitive behaviour in strictly defined
cases of SPCD and SLI.
Conclusions: Strictly defined cases of SPCD and SLI can be distinguished from ASD. However, there is a lack of assessment tools that can
reliably distinguish these three conditions. We consider the clinical implications of the findings and present a model of assessment and diagnosis for ASD, SLI, and SPCD.
Key words:
assessment; autism; diagnosis; social communication disorder; specific language impairment.
What is already known about this topic?
What this topic adds
1 The boundaries between autism spectrum disorder (ASD), specific language impairment (SLI), and social (pragmatic) communication disorder (SPCD) are not clear-cut.
2 While SPCD was included in the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5), it is unclear
whether this disorder is distinct from ASD.
3 Assessment and diagnosis of ASD, SLI, and SPCD is challenging
because there are no measures that can reliably distinguish
these three conditions.
1 In this article, we summarise the evidence regarding overlap
between ASD, SLI, and SPCD in terms of aetiology, language,
autistic symptomatology, and long-term outcomes.
2 Strictly defined cases of SPCD can be distinguished from ASD
based on the severity of social communication deficits.
3 We present a framework for the assessment and diagnosis of
ASD, SLI, and SPCD.
Correspondence: Lauren Taylor, School of Psychology, M304, University
of Western Australia, 35 Stirling Highway, Crawley, Western Australia
6009, Australia.
Email: lauren.taylor@uwa.edu.au
Accepted for publication 4 April 2016
doi:10.1111/ap.12222
Australian Psychologist 51 (2016) 287–295
© 2016 The Australian Psychological Society
The language phenotype of autism spectrum disorder (ASD) is
highly heterogeneous. While some individuals with ASD fail to
develop functional verbal communication, others have fluent
language skills, experiencing difficulties only with social communication. The pragmatic difficulties in ASD contrast with the
structural language impairments, that is, in phonology, morphology, and syntax, observed in individuals with specific
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Autism, SLI, and social communication disorder
language impairment (SLI). A substantial body of empirical literature has been dedicated to understanding the phenomenology of SLI. However, this label has not previously been
included in the diagnostic nomenclature (see Rapin, 1996 for a
practitioner review of developmental language disorders).
Research studies have used a range of criteria to identify children with SLI, which is generally accepted to occur when children experience a clinically significant delay in language
development despite having adequate hearing, non-verbal
intelligence, and educational opportunities (Bishop, 2003c;
Stark & Tallal, 1981).1
While “textbook” cases of ASD and SLI can be readily distinguished, in clinical practice, the boundaries between these two
disorders are not clear-cut. Extensive evidence now indicates
that a subgroup of children with ASD has a language impairment that resembles SLI (Kjelgaard & Tager-Flusberg, 2001;
Lewis, Murdoch, & Woodyatt, 2007; Lloyd, Paintin, & Botting,
2006; Rapin & Dunn, 2003; Rapin, Dunn, Allen, Stevens, &
Fein, 2009). For example, in one important study, Kjelgaard
and Tager-Flusberg (2001) divided children with ASD into
“normal” (ALN; standard scores greater than 85), “borderline”
(standard scores between 70 and 84), and “impaired” (ALI;
standard scores less than 70) language groups based on their
scores on a series of standardised language assessments. The
ALI subgroup demonstrated poor performance on tests of phonological processing, vocabulary, and higher-order grammatical
and semantic skills, with deficits in these areas closely resembling the SLI phenotype. There is substantial empirical support
for these findings, with a language impairment specifier outlined in the most recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This specifier will
capture children who present with ASD and comorbid language impairment.
Further evidence for the lack of clear-cut boundaries
between ASD and SLI comes from studies that have identified
children with communication characteristics that are intermediate between “textbook” ASD and SLI. Substantial research
has provided an evidence base for a subgroup of children with
primary pragmatic language impairments (PLI) who can be distinguished from children with SLI and those with ASD
(Bishop & Norbury, 2002; Botting & Conti-Ramsden, 1999,
2003a, 2003b). The DSM-5 contains a new category of neurodevelopmental disorders, Social (pragmatic) communication
disorder (SPCD), which may capture children previously considered to have PLI.2 SPCD is identified when children demonstrate deficits in using verbal and non-verbal communication
for social purposes (American Psychiatric Association, 2013).
Key diagnostic features include difficulties using communication for social purposes, understanding verbal and non-verbal
conversational rules, and understanding social nuances. The
pragmatic difficulties that characterise SPCD are likely to
resemble the core communication deficits of ASD, which may
suggest that ASD and SPCD are variable manifestations of the
same disorder (Tanguay, 2011). The distinguishing feature,
though, is rigid, repetitive, and stereotyped behaviour and
restrictive interests (RRBIs), which must be absent in SPCD
diagnoses. While this new diagnostic category appears to capture a subgroup of children who may not have been recognised
in the DSM-IV, social communication disorder has been
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L.J. Taylor and A.J.O. Whitehouse
criticised due to a lack of empirical evidence showing that the
disorder is distinct from ASD (Ozonoff, 2012; Skuse, 2012; Tanguay, 2011).
ASD, SLI, and SPCD: Genes, Behaviour,
and Longitudinal Outcomes
While extensive evidence has investigated aetiological and
behavioural overlaps between ASD and SLI, relatively less
attention has focused on SPCD. In this section, we review the
research that has investigated overlaps between ASD, SLI, and
SPCD at the genetic and behavioural levels.
Genes and the Familial Aggregation of Structural
and Pragmatic Language Deficits
While numerous twin studies have shown that both ASD and
SLI are highly heritable (Bailey et al., 1995; Bishop, North, &
Donlan, 1995; Constantino & Todd, 2003; Folstein & Rutter,
1977a, 1977b), no published literature has examined the heritability of SPCD, likely reflecting the recent addition of this label
to the diagnostic nomenclature. Evidence does exist to suggest
that structural and pragmatic language impairments aggregate
within families (Bernier, Gerdts, Munson, Dawson, & Estes,
2012; Bolton et al., 1994; Gerdts, Bernier, Dawson, & Estes,
2013; Landa et al., 1992; Pickles, St Clair, & Conti-Ramsden,
2013; Piven et al., 1997; Taylor et al., 2015; Whitehouse,
Barry, & Bishop, 2007). In addition, the results of early twin
(Dworzynski et al., 2007, 2008) and family (Bailey, Palferman,
Heavey, & Le Couteur, 1998; Folstein et al., 1999; Ruser et al.,
2007; Tomblin, Hafeman, & O’Brien, 2003) studies have
revealed overlaps in the language characteristics among parents
and siblings of children with ASD and those with SLI. For
example, there is an elevated rate of language and literacy
impairments in parents and siblings of ASD probands, and
some of these family members also demonstrate poor performance on tests of non-word and sentence repetition, heritable
markers for SLI (Bailey et al., 1998; Folstein et al., 1999; Lindgren, Folstein, Tomblin, & Tager-Flusberg, 2009; Ruser et al.,
2007). Results of more recent studies indicate that the heritable
phenotypes of ASD and SLI breed true in these families (Bolton
et al., 1994; Folstein & Rosen-Sheidley, 2001; Landa et al.,
1992; Lindgren et al., 2009; Pickles et al., 2013; Whitehouse
et al., 2007; Whitehouse, Coon, Miller, Salisbury, & Bishop,
2010). The results of a prospective, longitudinal study of infant
siblings of children with ASD also indicate that at 36 months,
high-risk siblings had worse pragmatic language skills than
low-risk siblings, with 35% of the high-risk group identified as
having PLI, relative to only 10% of the low-risk group (Miller
et al., 2014). However, this study was limited due to the indirect measures of pragmatic language (Language Use Inventory;
O’Neill, 2009) and the sample bias that may result in inflated
rates of pragmatic impairments in the high-risk siblings, who
may be vulnerable to social communication deficits due to the
family history of ASD. Nevertheless, these findings indicate that
pragmatic language impairments are highly heritable in ASD
and may also highlight possible relationships between ASD and
SPCD among families.
Australian Psychologist 51 (2016) 287–295
© 2016 The Australian Psychological Society
L.J. Taylor and A.J.O. Whitehouse
The results of several studies have also revealed overlaps in
genes that may confer susceptibility to ASD, SLI, and social
communication deficits. A specific gene located on 7q35, Contactin Associated Protein-Like 2 (CNTNAP2), has attracted particular interest as polymorphisms in this region have been
identified in multiple-incidence ASD families (Alarcón et al.,
2008; Arking et al., 2008; Bakkaloglu et al., 2008). Vernes
et al. (2008) also found significant associations between polymorphisms on CNTNAP2 and impaired non-word repetition, a
heritable marker for SLI. Recent evidence also indicates that
there may be associations between common genetic variants
related to ASD and semantic-pragmatic skills (St Pourcain
et al., 2013; Steer, Golding, & Bolton, 2010). These findings
indicate that there may be shared genetic influences on ASD
and social communication skills.
Autism, SLI, and social communication disorder
this task. In contrast, the SLI, PLI Pure, and ASD groups were
all impaired on the past tense-marking and sentence repetition
tasks and could not be distinguished on either of these measures. The PLI Plus group had significantly higher scores than
the SLI, PLI Pure, and ASD groups on the tense-marking task
and the SLI and PLI Pure groups on the sentence repetition
task. Sensitivity and specificity analysis revealed that the sentence repetition task was the most accurate marker, distinguishing all but the PLI Plus group from typically developing
peers. Therefore, while psycholinguistic markers can accurately
distinguish children with communication disorders from their
typically developing peers, these markers alone cannot reliably
discriminate ASD from SLI or from PLI.
ASD Symptomatology
Psycholinguistic Markers of SLI
Putative behavioural markers for SLI include impaired nonword repetition, poor oromotor skills (Barry, Yasin, & Bishop,
2007), and deficits in the acquisition and use of tense-marking
morphemes (Rice & Wexler, 1996; Tager-Flusberg & Joseph,
2003). Considerable research in this area has focused on nonword repetition tasks, which are purported to test phonological
short-term memory. In this task, children hear nonsense words
of increasing length and complexity and repeat them verbatim.
Extensive evidence indicates that children with SLI demonstrate poor performance on non-word repetition tasks, thought
to index phonological short-term memory, a core cognitive deficit in this population (Gathercole & Baddeley, 1990). Extensive
evidence indicates that a subgroup of children with ASD who
have comorbid language impairments demonstrate non-word
repetition performance that resembles children with SLI
(Kjelgaard & Tager-Flusberg, 2001; Lindgren et al., 2009; Loucas et al., 2010; Riches, Loucas, Baird, Charman, & Simonoff,
2011; Tager-Flusberg, 1996, 2006; Whitehouse, Barry, &
Bishop, 2008), highlighting overlaps in the language phenotypes of these two groups. However, the groups can be distinguished based on the error patterns as children with SLI make
more errors than children with ASD on long (four-syllable) relative to short (two-syllable) non-words (Riches et al., 2011;
Whitehouse et al., 2008). These findings indicate that the cognitive origin of the non-word repetition deficits may differ
between the two conditions.
Findings regarding children with PLI have been less conclusive. Botting and Conti-Ramsden (2003a, 2003b) explored
whether performance on non-word repetition, sentence repetition, and past tense-marking tasks could be used to distinguish
ASD, PLI, and SLI. While the scores for the ASD and SLI groups
were uniform, scores for the PLI group were highly variable.
Therefore, the author divided this group into two subgroups:
“PLI pure,” that is, children with pragmatic impairments only,
and “PLI plus,” those with pragmatic impairments as well as
restricted social behaviour and/or interests. This division
resulted in significant differences across the four groups. While
the SLI groups could be distinguished from the ASD, PLI Pure,
and PLI Plus groups based on poor non-word repetition performance, the latter three groups could not be differentiated on
Australian Psychologist 51 (2016) 287–295
© 2016 The Australian Psychological Society
Investigations of ASD symptomatology in children with PLI
and those with SLI provide further insight into overlaps in the
behavioural presentations of these conditions. Leyfer, TagerFlusberg, Dowd, Tomblin, and Folstein (2008) reported that
41% of a group of children with SLI met diagnostic thresholds
for ASD in social and communication domains on “gold standard” measures of ASD in addition to showing a structural language deficit. Botting and Conti-Ramsden (1999) reported
similar results for a sample of children with PLI, the finding
that 40% of a sample of children identified as having primary
pragmatic language difficulties was considered to have difficulties in communication, reciprocal social interaction, and RRBI,
that is, the “triad” of autistic impairments.
Two studies have used standardised diagnostic measures of
ASD to determine whether PLI can be distinguished from ASD
and from SLI. Bishop and Norbury (2002) divided children
with communication difficulties into PLI (n = 13) and SLI
(n = 8) subgroups based on their scores on the Children’s Communication Checklist (CCC; Bishop, 1998). These authors then
investigated whether the SLI and PLI groups could be better
characterised as ASD. Bishop and Norbury (2002) found that
eight children (six PLI and two SLI) met diagnostic thresholds
for ASD on the Autism Diagnostic Interview-Revised (ADI-R;
Le Couter, Rutter, & Lord, 2003). While 10 of these children
(eight PLI and two SLI) also scored above the cut-off for PDDNOS on the Autism Diagnostic Observation Schedule-G
(ADOS-G; Lord, Rutter, DiLavore, & Risi, 1999), there was
poor agreement between the ADOS-G and ADI-R scores, with
only four children (all from the PLI group) meeting diagnostic
thresholds for PDD-NOS on both of these measures. Reisinger,
Cornish, and Fombonne (2011) reported similar findings.
While all of the children in the ASD group (n = 22) met
ADOS-G criteria for ASD, only seven of the 19 PLI participants
(36.8%) scored above this cut-off. Identical results were
reported for the Social Communication Questionnaire (SCQ;
Rutter, Bailey, & Lord, 2003), a parent-report measure of the
social and communication characteristics of ASD. The ASD
group also had significantly higher Communication and Reciprocal Social Interaction scores on the ADOS-G, indicating more
severe symptoms than the PLI group. These findings indicate
that while a small proportion of children with PLI meet
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Autism, SLI, and social communication disorder
diagnostic thresholds for ASD, there is a group of children with
core deficits in pragmatic language distinct from ASD.
The results of a comprehensive investigation of the behavioural and linguistic profiles of children with ASD, children
with SLI, and those with PLI revealed clear distinctions
between these three groups (Gibson, Adams, Lockton, &
Green, 2013). Gibson et al. (2013) recruited children with clinical diagnoses of PLI (n = 22), ASD (n = 21), and SLI (n = 19)
from specialist mental health services, speech and language
therapists, and specialist education providers in England and
Scotland. Inclusion in these groups was confirmed by scores on
the ADOS-G, SCQ, Children’s Communication Checklist-2
(CCC-2; Bishop, 2003a), and Test for Reception of Grammar-2
(TROG-2; Bishop, 2003b). The three groups were compared on
measures of social interaction, RRBI, and language ability, and
odds ratios from a multinomial logistic regression were used to
determine the relative importance of each measure in differentiating ASD, PLI, and SLI. The PLI group could be distinguished
from the SLI group based on more atypical social interactions
and better expressive language skills. These two groups could
not be distinguished in terms of repetitive behaviour. However,
repetitive behaviour, impaired social interaction, and high
expressive language scores were significantly associated with
ASD but not with PLI. These results suggest that there is a
graded pattern of social difficulties, with the SLI group demonstrating the least impairment in this area, followed by the PLI
and then the ASD groups. The findings also indicate that under
rigorous conditions, PLI can be distinguished from ASD based
on the severity of social interaction impairments and repetitive
behaviour in the latter group.
While ASD is distinguished diagnostically from SPCD based
on the absence of rigid and repetitive behaviour in this latter
group, few previous studies have established whether social
communication impairments occur without rigid and repetitive behaviours. In an investigation of the convergence of
DSM-5 criteria for ASD with DSM-IV diagnoses of pervasive
developmental disorders (PDDs), Huerta, Bishop, Duncan,
Hus, and Lord (2014) found that only 1.5% of a sample of
4,453 children with PDD and non-PDD diagnoses met social
communication criteria for ASD without displaying rigid and
repetitive beh…
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