Use of a Newly Developed Japanese Version of the Test of Pragmatic Language to Identify Children with Autism Spectrum Disorder from a Different Angle Than the Children’s Communication Checklist-2

Background: Pragmatic impairment is a core characteristic of autism spectrum disorder (ASD). However, except for the Children’s Communication Checklist-2 (CCC-2), few tests have been developed to evaluate pragmatic disability. As the CCC-2 is a parent report instrument, it cannot obtain data on language performance directly from children. To compensate for this limitation of the CCC-2, the Test of Pragmatic Language (TOPL) is administered to children. However, unfortunately, the TOPL cannot identify pragmatic language impairment better than the CCC-2. Therefore, in the present study, we developed a Japanese version of the TOPL (JTOPL) by devising 20 items regarding the comprehension of metaphors, irony, indirect requests, and control of politeness with another seven items regarding the status of the listener and selection of addressing form, among others.

Objectives: The purpose of the present study was to investigate whether the JTOPL reflects development when administered to elementary school children and discriminates between children with and without pragmatic impairment.

Methods: The JTOPL was administered to 102 typically developing (TD) elementary school children (48 boys, 54 girls; mean age: 117.58 months; standard deviation [SD]: 21.18). None showed Social Communication Questionnaire (SCQ) score over the cutoff point of 15. The mean number of correct responses to 27 items on the JTOPL was calculated for each of the six grades. The JTOPL was also administered to 11 elementary school children with ASD (10 boys, 1 girl; mean age: 116.45 months; SD: 19.74). The children with ASD were then compared with 54 randomly chosen TD children (48 boys, 6 girls; one per grade in terms of number of correct responses on the JTOPL). In addition, the correlation between the number of correct responses on the JTOPL and the general communicative competence (GCC) component of the CCC-2 was examined for TD children and children with ASD.

Results: The mean number of correct responses for each grade ranged from 21.6 to 24.8. These values did not differ in any pair of subsequent grades. The mean number of correct responses of the younger half of TD children was significantly lower than that of the older half (p<.001). The 11 children with ASD had significantly fewer correct responses than the 54 TD children (p<.01). No significant correlation was found between the number of correct responses on the JTOPL and the GCC component for TD children or children with ASD.

Conclusions: The results indicate that the JTOPL reflects development through elementary school age; however, a ceiling effect was seen in terms of the numbers of correct responses. To confirm the validity and reliability of the JTOPL, data from preschool children are needed. The JTOPL could discriminate between children with ASD and TD children while providing a different point of view from that of the CCC-2. While the CCC-2 focuses on inappropriate initiation, stereotyped language, use of context, and nonverbal communication, the JTOPL focuses mainly on figurative language comprehension reaching politeness control and the like. This difference might have led to the lack of correlation between the two instruments.