Investigating Pragmatic Communication Abilities in Minimally Verbal Children and Adolescents with Autism Spectrum Disorder

Background: Individuals with ASD demonstrate difficulties with pragmatic communication or an incongruence between situational demands and the communication employed (Tager-Flusberg et al., 2005; Volden et al., 2009). The pragmatic communication abilities of minimally verbal (MV) individuals with ASD and how these abilities change with age, has not been studied in-depth, although these individuals comprise 30% of the ASD population (Tager-Flusberg & Kasari, 2013). This research is relevant for assisting in the design of developmentally appropriate interventions to improve social communication in MV individuals with ASD.

Objectives: To compare the pragmatic communication abilities of MV children and adolescents with ASD.

Methods: Thirteen MV children with ASD (MV-C; 10 males; age range:6-11 years) and 13 MV adolescents with ASD (MV-A; 12 males; age range:12-18 years) were administered the ADOS (n=24 Module 1; n=2 Module 2). Transcripts of the ADOS sessions were coded for pragmatic functions building on a coding scheme developed by Tager-Flusberg & Anderson, 1991. Intelligible utterances were coded for contingency and function and adjusted for session length. Contingency was assessed in terms of adjacency (follows or doesn’t follow prior adult utterance) and topic relevancy (contextually appropriate or inappropriate) and the utterances were coded for function. Function was assessed in terms of requests, agreement, disagreement, “yes” and “no” responses, scripted recitation (e.g., repeating fragments from various media) and perseverative speech (repetition of a word/phrase when inappropriate). Structural language was assessed in terms of rate/minute of intelligible utterances, different words used, and mean length of utterance in words (MLUw).

Results: MV-C had a lower rate of adjacent (t(24)=2.537, p <.05) and contingent utterances (t(24)=2.669, p <.05) compared to MV-A, but the groups didn’t differ in nonadjacent utterances (p >.05), indicating that MV-A are responding in a more “topically related” way that builds upon the previous utterance elicited by the adult, compared to MV-C. When assessing function, MV-C had fewer requests (t(24)=2.677, p <.05), responses indicating agreement (t(24)=2.649, p <.05), disagreement (t(24)=2.633, p <.05), and “yes” and “no” responses (t(24)=3.066, p <.05) compared to MV-A, but they did not differ in scripted recitation or perseverative speech (ps >.05), suggesting that MV-A are utilizing a wider range of responses to maintain engagement with the examiner compared to MV-C. When assessing structural language, MV-C had fewer intelligible utterances (t(24)=2.876, p <.05) compared to MV-A; however the groups didn’t differ in their rate/minute of different words used or MLUw (ps >.05; see Figure 1). Although, the groups didn’t differ in the use of structural language, significant differences emerged when evaluating pragmatic communication.

Conclusions: Findings highlight developmental differences between MV-C and MV-A in their ability to engage in social exchanges, including conversations, as suggested by increasing contingency and a wider range of pragmatic functions demonstrated during the interactive ADOS sessions. Findings underscore the potential for improvement in pragmatic communication even among MV individuals with ASD, which should be a primary focus of language intervention. Clinical implications of the study findings suggest the utilization of speech and language therapy to support communicative development.