Autism Spectrum Disorder (ASD) contains a wide range of developmental disabilities that differ in severity and symptoms. ASD most commonly affects communication, language and social skills. These deficits are often seen early, allowing for a proactive diagnosis. In the psychology world, many studies have been conducted to further understand the implications of these specific deficits. Some questions often asked are, how will a child’s age of diagnoses affect their further development? Will their stunted language abilities ever catch up to those of their peers or will they continue to struggle with communication? What do these deficits mean for their sociability? A large contributing factor to the answer of these questions have to do with where exactly that specific child is on the spectrum and what exactly their symptoms are. Much research has been done though to help parents, doctors and other professionals better understand the implications of these general questions and concerns. The following paper will aim to answer these questions and better inform the public to the deficits on language, communication and social skills that come along with ASD.

A common question being asked is concerned with the outcome of children with ASD who have language delays and those without. Some psychologists believe that children with ASD that have language deficits actually have better outcomes. Their argument here is that the clear showing of that deficit allows for quicker and earlier diagnosis, meaning early intervention (Goodwin, Matthews & Smith, 2017). Other researchers argue though that children with ASD and no language delay have it no better. While they don’t suffer from that symptomology, the lack of it means a likely late diagnosis and intervention leaving them vulnerable to other symptoms (Goodwin et al. 2017). In a study done by Goodwin et al. (2017), they looked at ASD with and without language delays and the implications that has for further development but importantly adaptive functioning. The level of adaptive functioning helps measure the ability of one’s treatment, possibility of living on their own, quality of life and many others. Previous research has shown that adults with ASD who gained language function by age five had better adaptive functioning (Goodwin et al. 2017). By conducting a study looking at children and adolescents with and without language deficits and their age of diagnosis, Goodwin et al. (2017) aimed to better test that statement. Through patient interviews, parent interviews, and various assessments, they found no real significant difference. Both the language delayed and non-language delayed groups had impaired adaptive functioning by school (Goodwin et al. 2017).  Although those with the delay often find earlier intervention, it doesn’t necessarily mean that they have any more of a good outcome than those without it. Adaptive functioning seems to have less to do with language deficits, showing the same implications regardless of the age of true language onset (Goodwin et al. 2017).

Understanding where the language deficits arise from in people with ASD is important. Many studies have found an overarching issue to be with problems producing and processing prosody (Grossman, Bemis, Skwerer & Tager-Flusberg, 2010). Prosody is the melody or rhythm of speech which helps tell us exactly what a person means and their emotion behind their speech (Grossman et al. 2010). This is often what lends to the problem of individuals with ASD struggling with understanding sarcasm. The implication of issues with prosody is that it creates communication problems and a lack of social skills. Grossman et al. (2010) show two types of prosody, affective and grammatical; both of which those with ASD struggle with. Affective prosody is the changing of pitch to indicate emotional state while grammatical prosody tells the type of statement being used (Grossman et al. 2010). We’ve learned of these struggles through studies indicating that those with ASD find it hard to use prosody in matching emotions with emotional faces or social situations as well as struggling with lexical stress (Grossman et al. 2010). Combined, this issue impairs language development and understanding along with communication all together. The study done by Grossman et al. (2010) showed interesting results. In comparing normally developing individuals to those with high functioning autism, the deficit seemed to be in producing prosody correctly. Their prosodic production was significantly different than normally developing participants showing exaggerated pauses and labored, slow annunciations (Grossman et al. 2010). Both groups scored equally well in understanding affective prosody and perceiving emotions based off prosodic cues, as well as understanding lexical stress in determining the meaning in word pairs (Grossman et al. 2010).

As with many other characteristics of ASD, language delays and abilities are on a spectrum differing from person to person. There are variations in language improvement as well as development. A study conducted by Wodka, Mathy and Kalb (2013), looked at the predictive differences between severely language delayed individuals who gain phrase speech ability around 5-7 years of age, and ASD children who made larger language improvements to fluency by the same age. They hypothesized that children with worse cognitive and characteristic autism impairments were those who would remain nonverbal longer (Wodka et al. 2013). Through a variety of parent interviews, clinician observations, IQ assessments and behavioral checklists, they compared severely language impaired individuals with only word ability to those with phrase ability and then to those who were fluent speakers.  The results shed light onto the predictive elements that create the perfect storm for these deficits. There was a slope effect showing those with only word use as having the lowest verbal and nonverbal IQ, lowest social impairment and worse stereotyped behaviors (Wodka et al. 2013). These scores were followed by those with phrase speech and finally fluent speakers with the highest scores in IQ, sociability and behavior (Wodka et al. 2013). These results showed that individuals with ASD who have better nonverbal IQ scores and better sociability have a much earlier and better chance of attaining phrase speech and eventually fluent speech (Wodka et al. 2013). The good news is that although this study put the severely delayed individuals far behind their other delayed peers, they will make notable gains in speech improvement, just at a slower rate Wodka et al. 2013).

There is a lot of variation in the studies on language development and ASD. Some have shown that the issue is less in comprehension and more in expression of language, which would fall in line with the results found in the Grossman et al. (2010) paper. Others have found that the delays are being seen in both categories with problems in the number of words and phrases being understood, making it an expression problem (Weismer, Lord & Esler, 2010). Weismer et al. (2010) looked at the difference between those with language delays with ASD and those with non-autism delays to pinpoint the characteristic autism deficits. In looking at toddler aged children, aged 24-36 months, Weismer et al. (2010) used similar methods to previous studies that have been discussed. Clinicians were used to diagnose and their cognitive abilities were tested as well as their language abilities. The results again showed that while the developmentally delayed group without an autism diagnosis still struggled with language deficits, they were much less severe than the ASD group (Weismer et al. 2010). Further, the ASD individuals scored worse on their nonverbal cognitive abilities and had a more delayed developmental timeline. While language deficits can be seen in other language delayed disorders, the ASD individuals are showing a much larger and more prolonged deficit.

Longitudinal studies are a vital way to understand the developmental pattern and long-term implications of disorders such as ASD. As previously mentioned, often the language deficits in ASD will make great improvements just at a slower rate. Studies that look at the delay in toddlers and then follow up with those individuals in adolescence to see the effects of those delays are important. While we’ve seen that language abilities will get better, some studies have shown that there still are some language oddities in adolescence. Things such as verbal oddities, communication impairments and social withdrawal are all effects caused by developmental language delays in ASD (Michelotti, Charman, Slonims & Baird, 2002). The largest lasting effect caused by language problems seem not be verbal issues as much as social impairments. In a study by Michelotti et al. (2002), they used a longitudinal study to understand the strength of the correlations of severe language delays with the primary problem that is a lack of social skills seen as an autistic trait. By looking at children around the age of 4 and then again at the age of 8, they were able to see a strong correlation between the two. At the first time of research, at age 4, there were little typical “autistic traits” that his paper classifies as social problems. The parental concerns was with language delays and the implications of their child’s verbal and communication abilities (Michelotti et al. 2002). By the age of 8 when the researchers regrouped with the participants and their parents, the concern had changed to focus on the lack of social skills and heightened autistic traits including repetitive behaviors. Even the children who displayed language delays that had not yet had the ASD diagnosis by age 4, were found to be in a special school or some sort of special learning program and with an ASD diagnosis at age 8 (Michelotti et al. 2002. This shows that while their language abilities bettered, and the parents no longer had a large concern for it, the autistic traits continued to morph into a diagnosis and further social issues.

It is clear that language delays are a strong indicator for ASD. While many other developmental disorders affect language abilities, it seems none as heavily as ASD. Children with autism have worse language delays, nonverbal cognitive IQ and a larger social impairment. While they have a slower development, they do make strides in language abilities and many children get to the level of language fluency. Although those with ASD’s language skills improve, their social and communicative skills become impaired as a result, well into adolescence and adulthood.

References

Wodka, E.L., Mathy, P. & Kalb, L. (2013). Predictors of Phrase and Fluent Speech in Children with Autism

and Severe Language Delay. Pediatrics, 131(4).

Goodwin, A., Matthews, N.L. & Smitch, C.J. (2017). The Effects of Early Language on Age at Diagnosis

and Functioning at School Age in Children with Autism Spectrum Disorder. J Autism Dev Disord,

47, 2176-2188.

Michelotti, J., Charman, T., Slonims, V. & Baird, G. (2002). Follow-up of Children with Language Delay

and Features of Autism from Preschool Years to Middle Childhood. Developmental Medicine

and Child Neurology, 44, 812-819.

Weismer, S.E., Lord, C. & Esler, A. (2010). Early Language Patterns of Toddlers on the Autism Spectrum

Compared to Toddlers with Developmental Delay. J Autism Dev Disord, 10, 1259-1273.

Grossman, R.B., Bemis, R.H., Skwerer, D.P. & Tager-Flusberg, H. (2010). Lexical and Affective Prosody in

Children with High-Functioning Autism. Journal of Speech, Language and Hearing Research, 53,

                778-793.