Semantic and Syntactic Language Skills In Individuals with Optimal Outcomes

Background:  A study is currently following children who have a history of autism spectrum disorder (ASD), but who no longer meet diagnostic criteria for such a disorder. These children have achieved social and language skills within the average range for their ages and receive little or no school support. Several recent studies suggest that this small subset of children, once diagnosed with ASDs, achieve "optimal outcomes" (Sutera et al., 2007; Helt et al., 2008; Kelley, Naigles, & Fein, 2010). Kelley, Naigles, & Fein (2010) reported small differences in language scores in OO compared to typically developing adolescents.

Objectives:  The current study examines semantic and syntactic language skills as measured on the Comprehensive Evaluation of Language Fundamentals (CELF-IV) in a small cohort of individuals once diagnosed with an ASD who have since lost their diagnosis, known as the “optimal outcome” (OO) group. The study compares performance in the OO group to performance of a group of individuals with high-functioning autism (HFA) and a group of typically developing (TD) individuals.

Methods:  Participants included 28 OO individuals, 30 HFA individuals, and 24 TD individuals. Participants were matched on sex (85% males), age (M (OO) = 12.98, SD = 3.46; M (HFA) = 13.26, SD = 2.23; M (TD) = 14.30, SD = 3.00), and PIQ (M (OO) = 113.43, SD = 14.37; M (HFA) = 112.47, SD = 14.59; (M (TD) = 115.29, SD = 12.24). VIQ scores, although within the average range, differed significantly across the groups (M (OO) = 113.57, SD = 13.28; M (HFA) = 104.63, SD = 14.22; M (TD) = 112.75, SD = 12.69, p < .05).  We compared the three groups’ performance on the CELF-IV core language subtests (Formulated Sentences, Recalling Sentences, and Word Classes), as well as the Composite Score, using ANCOVA, with VIQ as a covariate.

Results:  The OO group’s performance was significantly poorer than TD on Recalling Sentences (p < .05), but not on the other subtests or the composite. The OO group scored higher than the HFA group on Word Classes (p < .01), and the TD group scored higher than the HFA group on Formulated Sentences, Word Classes, and the composite score (p < .01 for all three). However, all group means were well within the normal range; furthermore, all OO participants scored within the normal range on Word Classes and Formulated Sentences, with two participants scoring below average (SS<7) on Recalling Sentences.

Conclusions:  These results suggest that OO individuals are performing similarly to their TD peers on the core language skills measured by the CELF. Although most of the OO group is still well within normal range on verbal recall, the groups' performance was lower than would be consistent with their VIQ, suggesting a subtle residual deficit in immediately recalling and reproducing orally presented sentences.