Parent-Child Interactions in School-Age Children with Autism Spectrum Disorder, Fragile X Syndrome, and Down Syndrome

Background: Difficulties in pragmatic language are a hallmark of autism spectrum disorder (ASD), and are also prominent in other neurodevelopmental disorders showing phenotypic and genetic overlap with ASD, such as fragile X syndrome (FXS) (e.g., Roberts et al., 2007). High rates of noncontingent and perseverative language have been reported in both idiopathic and syndromic ASD (FXS-ASD), though differences were observed as well (Martin et al., 2018). Understanding the impact of these difficulties across communicative contexts and conversational partners has important implications for illuminating potentially shared etiologic pathways and informing targeted interventions. This study examined pragmatic profiles of these groups during parent-child interactions to characterize both child and parent contributions to communication, including parental contingency and responsiveness, known to impact language outcomes (Haebig, McDuffie, Weismer, 2013; Siller & Sigman, 2008).

Objectives: Pragmatic skills including contingency, perseveration, initiations, and responsiveness were examined during parent-child interactions in school-aged children with ASD, FXS, Down syndrome (DS), and typical development (TD) and their parents.

Methods: Participants included boys with ASD (n=34), FXS-ASD (n=41), FXS-Only (FXS-O) (n=11), DS (n=22) and TD (n=22). Parent-child language samples from a five-minute dyadic free-play interaction were transcribed verbatim and analyzed using a detailed hand-coding system (Roberts et al., 2007). Language samples were examined for discrete pragmatic skills described above and parent strategies (e.g., use of scaffolds, praise, narration), which were considered in relation to parental features of the Broad Autism Phenotype (BAP). Nonverbal mental age, receptive and expressive vocabulary, and mean length of utterance were controlled in analyses.

Results: Boys with ASD and FXS-ASD were less contingent than all other groups (ps<.01). Boys with ASD were less responsive during conversation compared to all other groups, including FXS-ASD (ps<.02). Boys with FXS-ASD were more perseverative than all other groups (ps<.01). No significant differences emerged in initiations (ps>.11). Similarly, parents of children with ASD and FXS-ASD were less contingent compared to parents of children with DS (ps<.06) and TD (ps<.08), whereas only parents of children with FXS-ASD differed from the FXS-O parent group (p=.01). Parents of individuals with FXS-ASD were more perseverative than parents of children with DS and TD (ps<.02), though they did not differ significantly from the ASD or FXS-O groups (ps>.28). No significant differences in responsiveness or initiations emerged (ps>.12). Finally, parents of children with ASD used marginally fewer parent strategies (e.g., scaffolds, narration) compared to parents of children with DS (p=.05), which was related to BAP features in the ASD parent group (p<.05).

Conclusions: Consistent with prior literature examining discrete pragmatic skills during examiner-child interactions (Martin et al., 2018), results highlight both areas of overlap and divergence across idiopathic and syndromic ASD. Interestingly, similar profiles emerged in parents, which may highlight the ways in which parental language style can be bidirectionally influenced by child pragmatics, as well as BAP status, during dyadic interactions. Overall, results of this study have the potential to inform pragmatic language interventions that are aimed at improving dyadic contingency in school-age children with ASD.