Language in autism: domains, profiles and co-occurring conditions.

This article reviews the current knowledge state on pragmatic and structural language abilities in autism and their potential relation to extralinguistic abilities and autistic traits. The focus is on questions regarding autism language profiles with varying degrees of (selective) impairment and with respect to potential comorbidity of autism and language impairment: Is language impairment in autism the co-occurrence of two distinct conditions (comorbidity), a consequence of autism itself (no comorbidity), or one possible combination from a series of neurodevelopmental properties (dimensional approach)? As for language profiles in autism, three main groups are identified, namely, (i) verbal autistic individuals without structural language impairment, (ii) verbal autistic individuals with structural language impairment, and (iii) minimally verbal autistic individuals. However, this tripartite distinction hides enormous linguistic heterogeneity. Regarding the nature of language impairment in autism, there is currently no model of how language difficulties may interact with autism characteristics and with various extralinguistic cognitive abilities. Building such a model requires carefully designed explorations that address specific aspects of language and extralinguistic cognition. This should lead to a fundamental increase in our understanding of language impairment in autism, thereby paving the way for a substantial contribution to the question of how to best characterize neurodevelopmental disorders.

Identifying Language and Cognitive Profiles in Children With ASD via a Cluster Analysis Exploration: Implications for the New ICD-11.

The new version of the International Classification of Diseases (ICD-11) mentions the existence of four different profiles in the verbal part of the Autism Spectrum Disorder (ASD), describing them as combinations of either spared or impaired functional language and intellectual abilities. The aim of the present study was to put ASD heterogeneity to the forefront by exploring whether clear profiles related to language and intellectual abilities emerge when investigation is extended to the entire spectrum, focusing on verbal children. Our study proposed a systematic investigation of both language (specifically, structural language abilities) and intellectual abilities (specifically, nonverbal cognitive abilities) in 51 6- to 12-year-old verbal children with ASD based on explicitly motivated measures. For structural language abilities, sentence repetition and nonword repetition tasks were selected; for nonverbal cognitive abilities, we chose Raven's Progressive Matrices, as well as Matrix Reasoning and Block Design from the Wechsler Scales. An integrative approach based on cluster analyses revealed five distinct profiles. Among these five profiles, all four logically possible combinations of structural language and nonverbal abilities mentioned in the ICD-11 were detected. Three profiles emerged among children with normal language abilities and two emerged among language-impaired children. Crucially, the existence of discrepant profiles of abilities suggests that children with ASD can display impaired language in presence of spared nonverbal intelligence or spared language in the presence of impaired nonverbal intelligence, reinforcing the hypothesis of the existence of a separate language module in the brain. Autism Res 2020, 13: 1155-1167. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The present work put Autism Spectrum Disorder heterogeneity to the forefront by exploring whether clear profiles related to language and cognitive abilities emerge when investigation is extended to the entire spectrum (focusing on verbal children). The use of explicitly motivated measures of both language and cognitive abilities and of an unsupervised machine learning approach, the cluster analysis, (a) confirmed the existence of all four logically possible profiles evoked in the new ICD-11, (b) evoked the existence of (at least) a fifth profile of language/cognitive abilities, and (c) reinforced the hypothesis of a language module in the brain.

Identifying language impairment in bilingual children in France and in Germany.

BACKGROUND: The detection of specific language impairment (SLI) in children growing up bilingually presents particular challenges for clinicians. Non-word repetition (NWR) and sentence repetition (SR) tasks have proven to be the most accurate diagnostic tools for monolingual populations, raising the question of the extent of their usefulness in different bilingual populations. AIMS: To determine the diagnostic accuracy of NWR and SR tasks that incorporate phonological/syntactic complexity as discussed in recent linguistic theory. The tasks were developed as part of the Language Impairment Testing in Multilingual Settings (LITMUS) toolkit, in two different national settings, France and Germany, and investigated children with three different home languages: Arabic, Portuguese and Turkish. METHODS & PROCEDURES: NWR and SR tasks developed in parallel were administered to 151 bilingual children, aged 5;6-8;11, in France and in Germany, to 64 children in speech-language therapy (SLT) and to 87 children not in SLT, whose first language (L1) was Arabic, Portuguese or Turkish. Children were also administered standardized language tests in each of their languages to determine likely clinical status (typical development (TD) or SLI), and parents responded to a questionnaire including questions about early and current language use (bilingualism factors) and early language development (risk factors for SLI). Monolingual controls included 47 TD children and 29 children with SLI. Results were subjected to inter-group comparisons, to diagnostic accuracy calculation, and to correlation and multiple regression analyses. OUTCOMES & RESULTS: In accordance with previous studies, NWR and SR identified SLI in the monolingual children, yielding good to excellent diagnostic accuracy. Diagnostic accuracy in bilingual children was fair to good, generally distinguishing children likely to have SLI from children likely to have TD. Accuracy was necessarily linked to the determination of clinical status, which was based on standardized assessment in each of the child's languages. Positive early development, a composite risk factor for SLI, and not variables related to language exposure and use, generally emerged as the strongest predictor of performance on the two tasks, constituting additional, independent support for the efficacy of NWR and SR in identifying impairment in bilingual children. CONCLUSIONS & IMPLICATIONS: NWR and SR tasks informed by linguistic theory are appropriate for use as part of the diagnostic process for identifying language impairment in bilingual children for whom the language of assessment is different from the home language, in diverse sociolinguistic contexts.