The Relation Between Pragmatic Language Impairment and Bully Victimization in Children with ASD

Background: The CDC has declared “bullying among youth to be a significant public health problem.” According to a recent national longitudinal study, 24.5% of children are victims of bullying during elementary school; prevalence rates increase to 34.1% during middle school. Children with ASD experience rates of bully victimization 16 times that of typically developing children. While there is a general consensus that communication problems are related to peer relational difficulties, to date, little is known about what aspects of communication are related to heightened vulnerability to bully victimization in children with ASD.

Objectives: The purpose of the present study was to investigate the relation between pragmatic language impairment and bully victimization. Pragmatic language impairment involves a mismatch between communication behavior and social context.  We hypothesized that pragmatic language impairment would be associated with bully victimization, above and beyond verbal IQ and general communication abilities, because, unlike these aspects of functioning, pragmatics is impaired in all individuals with ASD, regardless of verbal or nonverbal cognitive functioning.

Methods: 44 children (ages 9 - 13 years) participating in a longitudinal study of development in children at high and low risk for ASD.  Children were classified as: ASD (n = 21) and Non-ASD (n = 23); mean age = 10.00; SD = 1.13.  Bully Victimization was measured with the Victimization T-score from the Reynolds Bullying Victimization Scales for Schools (RBVSS). Pragmatic Language Impairment and General Communication were assessed with the Social Interaction Deviance Index (SIDI) and the General Communication Composite (GCC) score of the Children’s Communication Checklist-2 (CCC-2). Verbal IQ was measured using the VIQ standard score of the Stanford-Binet Intelligence Scales, Fifth edition (SB-5).

Results: Chi-Square analyses revealed that a significantly higher percentage of children with ASD scored in the clinically significant range on the Victimization subscale of the RBVSS than children without ASD  (42.9% versus 0%, respectively; X² = 12.39, Fisher’s = .0001).  Mann-Whitney nonparametric tests revealed that children with ASD scored significantly lower in verbal IQ (Z = -4.16, p = .0001), and significantly more impaired in pragmatic language (Z = -2.75, p = .006) and general communication (Z = -3.69, p= .0001) than children without ASD.  

To test our hypothesis that pragmatic language impairment would be associated with bully victimization, above and beyond verbal IQ and general communication, we conducted a linear multiple regression analysis with standard scores from the VIQ, GCC and SIDI as independent variables, and the Victimization T-score from the RBVSS as the criterion variable.  As hypothesized, the SIDI pragmatic language impairment score significantly predicted Bully Victimization (F = 5.00; p = .03), explaining14% of the variance (R = .36).   The other IVs were excluded from the model in the linear regression.

Conclusions: The results of this study supported our hypothesis.  Pragmatic language impairment, over and above lower verbal IQ and general communication, is significantly related to bully victimization in children with ASD.  The impact of early and ongoing pragmatic language intervention on bully victimization of children with ASD should be examined.