A case study of the development of language and communicative skills for six children with autism

Autism is a pervasive developmental disorder in which individuals are impaired in their social interactions, ability to imagine, and ability to communicate. Although a disturbance in communication has long been a defining feature of autism, we know relatively little about how pragmatic skills develop in these children because of the paucity of longitudinal research. If children with autism have extraordinary difficulties with the pragmatic component of language, social interactionist theories of language acquisition would suggest that these children would have problems with other subsystems of language as well. This study was an exploratory longitudinal investigation of the language and communication skills of six children with autism studied previously by Helen Tager-Flusberg. Each child with autism was matched on age and MLU at the beginning of the study to a child with Down syndrome, and studied for a period of 4-24 months. A parallel case study design was employed. Videotaped spontaneous, unstructured parent-child interactions were previously, transcribed, and coded for lexical and syntactic diversity by Tager-Flusberg and her colleagues. For this study, transcripts were further coded for communicative repertoire and conversational move using the Inventory of Communicative Acts--Abridged. I adopted a growth modeling perspective to represent each child's change over time in the syntactic, lexical, and pragmatic domains. In general, children with autism had slower growth in grammar, faster growth in lexicon, and negative growth in pragmatics, as compared to their Down syndrome controls. I also used qualitative analyses to compare the repertoire and proportions of communicative intents used by each child with autism to those of typically developing children. The communicative repertoires of the children with autism were qualitatively different. When examined within a developmental framework of theory of mind, it was evident that the pragmatic deficits corresponded to disordered development of a theory of mind. Furthermore, three children with autism had not reached the earliest level of theory of mind and exhibited difficulties establishing a joint focus. These children also made no practical gains in syntactic acquisition, suggesting a relationship between pragmatics and syntax. Implication for methods, theory and clinical interventions are discussed.