Language and Social Communication in Children with ASD: Longitudinal Impact on Anxiety and Externalizing Behaviors

Background:  Anxiety disorders are prevalent in about 40% of youth with an Autism Spectrum Disorder (ASD) (Jennett et al., 2013). It is still unclear whether or not anxiety functions in the same manner in children with ASD and those who are typically developing (TD). Children with ASD also present with higher levels of externalizing behaviors when compared to their TD peers (Kanne & Mazurek, 2011). Research has demonstrated that anxious children with ASD who present with co-occurring externalizing behaviors, are at greater risk for heightened anxiety symptomotology as well as to have an attenuated response to treatment (Stoch et al., 2012).

The influence of language abilities on the development of anxiety disorders has been understudied in children with ASD. In typically developing children, communication difficulties such as a stuttering, have been associated with higher levels of anxiety symptoms (Beitchman et al., 2001). However, in children with ASD, anxiety is actually more prevalent in those who are higher functioning and more verbal (Davis et al., 2011). Research findings examining the relationship between language and externalizing behavior problems in children with ASD have been mixed (Sipes et al., 2011; Matson et al., 2009). It is likely that different language domains are driving the differential findings among the research base. Thus, it is essential to determine the impact of specific language domains on anxiety and disruptive externalizing behaviors in order to help clarify conflicting findings in the literature.

Objectives: The primary aim of this study was to examine effects of language production and social communication on anxiety and co-occurring externalizing behaviors in young children with ASD. We examined the following research questions: 1a) To what extent does language production relate to child anxiety in young children with ASD over time? 1b) To what extent does social communication relate to child anxiety in young children with ASD over time? 2a) To what extent does language production relate to child externalizing behaviors in young children with ASD over time? 2b) To what extent does social communication relate to child externalizing behaviors in young children with ASD over time?

Methods: Participants were 126 children with ASD, ages 4 to 7 years and their mothers, who were recruited for a larger study examining the transition to early schooling for children with ASD and their families. Children were included in this study if their Full Scale IQ was above 70 (mean= 93.6, SD= 12.8), and English was their primary spoken language. Utilizing structural equation modeling we examined relationships among language production, social communication, anxiety symptoms, and externalizing behaviors.

Results : Social communication, but not language production, was inversely related to child anxiety (ß= -.64, p<.05) and co-occurring externalizing behaviors (ß= -.62, p<.05).

Conclusions: These findings suggest that children with ASD may be at heightened risk for anxiety and externalizing disorders due to their social communication deficits rather than to their language production deficits at large.