Social Deficits in Children With Autism Spectrum Disorder or Specific Language Impairment

Participants

A total of 57 Finish children took part in this study. Eighteen of these children had SLI (aged 5;0–7;7 years), 14 had ASD (aged 5;1–9;0), and 25 had TD (aged 4;11–8;8). To participate in this study, children with SLI had to show a discrepancy between verbal and nonverbal abilities in the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-R or WPPSI-III) or in Wechsler Intelligence Scale for Children–Third Edition (WISC-III). In addition, they had to show significant weaknesses in language tests conducted by a speech and language therapist. Although all children had language impairments, they were able to speak understandably using sentences. The children with ASD were diagnosed by experienced child psychiatrists or child neurologists using International Classification of Diseases–10 (ICD-10) criteria based on the Autism Diagnostic Interview–Revised (ADI-R; Rutter, Le Couteur, & Lord, 2003) and the Autism Diagnostic Observation Schedule (ADOS). The children had to show abnormalities (a) in reciprocal social interactions, (b) in patterns of communication, and (c) occurrence of a restricted, stereotyped, repetitive repertoire of interests and activities. The children’s IQs were within the normal range. TD in the TD children was verified by a parent-reported developmental history questionnaire. To get some information about their current language abilities, all children were investigated by the Test of Word Finding, Second Edition (TWF-2; German, 2000) and the Grammatical Closure subtest of the Illinois Test of Psycholinguistic Abilities (ITPA; Kirk, McCarthy, & Kirk, 1968). Both the Grammatical Closure subtest of ITPA and TWF-2 are used by speech and language therapists in the clinical assessment of the language abilities of Finnish children.

The children’s social perception abilities were investigated using subtests of the Social Perception domain of NEPSY-II (Korkman, Kirk, & Kemp, 2008). It is commonly used by Finnish psychologists in clinical settings when making conclusions about children’s neuropsychological skills such as social perception. The Social Perception domain includes two subtests: (a) Affect Recognition and (b) ToM, which is divided into two parts: Verbal tasks and Contextual tasks. The subtest of Affect Recognition examines the ability to match basic emotions (happy, sad, angry, afraid, and disgusted) and neutral expressions in photographs of children’s faces. Children aged 5 years and older start with items where three photographs are shown, and the task is to select two faces with the same feeling. These items are followed by tasks where the child is asked to select one of four faces from the bottom of the page that have the same feeling as the face at the top of the page. After that, they are shown four photographs, and the task is again to select two faces with the same feeling. Finally, children aged 7 years and over continue to tasks where they are shown a photograph for 5 s, after which they are immediately asked to point out two photographs out of six with the same emotion as the face in the photograph previously shown to them. In this subtest, all answers are given by pointing, so the children do not need to give verbal answers.

The ToM subtest measures understanding of mental functions and other people’s perspectives. In Verbal tasks, the questions are based on verbal scenarios with (six items) or without (11 items) pictorial support. They measure understanding of beliefs, intentions, others’ thoughts, ideas, and comprehension of figurative language. There are also two items where the child’s verbal and gestural imitation abilities are measured because imitation abilities are thought to be a background factor for the ToM. The child is asked to answer questions verbally, with the exception of an imitation question where the child is asked to imitate gestures or words which belong to the rhyme. In all of the items, the child can answer very briefly; a word is often sufficient for a correct answer, and in two of the questions, it is also possible to answer by pointing.

The Contextual tasks of the ToM subtest measure the child’s ability to relate emotion to the social context. In these items, the child is shown drawings with children in social contexts. In each drawing, there is a target girl whose face is not shown. The child is asked to select one of four photographs of the same girl’s face with different emotions that has the same emotion as the girl in the drawing. Thus, the child needs to infer the girl’s emotion on the basis of the social context, not her face. The child can answer by pointing at photographs, and verbal answers are thus not required.

Results

Discussion

In this study, children with ASD had difficulty with Affect Recognition, but the children with SLI did not. The authors conclude that this supports the view that difficulties in emotion recognition from faces are associated with ASD (Kuusikko et al., 2009). The authors note that some studies such as those by Ford and Milosky (2003) or Spackman, Fujiki, and Brinton (2006) found that children with SLI had difficulties with emotion recognition. Their studies, however, required that the children make inferences about emotions, rather than simply recognize them. In this study, there were no such inference demands, which may have made the task easier for children with SLI, especially if they have inference difficulties.

In the NEPSY-II ToM subtest, both SLI and ASD groups differed from TD children but not from each other. Thus, this study is in line with earlier studies which have recognized that ToM difficulties belong to the ASD group (Baron-Cohen, 2000), and there is also an increasing number of studies suggesting that children with SLI also have difficulties with ToM (Taylor, Maybery, & Whitehouse, 2012). In the NEPSY-II, the ToM subtest consists of verbal tasks and nonverbal contextual tasks. Both the SLI and ASD groups differed from the TD children in verbal tasks but not the contextual tasks. The performance in verbal tasks was quite similar in ASD and SLI. On the more complex verbal Tom tasks, children need to make inferences to connect, verbal, visual, and world knowledge. The authors suggest that the performance of SLI children may have been weakened by the inference load.

The authors had expected that children with ASD would show weakness on the ToM contextual tasks of the NEPSY-II. They had not anticipated that there would not be a significant difference between the groups. They caution, however, that they do not claim on the basis of these results that children with ASD have no difficulty in inferring feelings or mental states based on visual or physical social context. In the contextual tasks, the children with ASD who managed to relate an emotion to the drawings that showed the person in the social context performed below the norm and significantly less well than children with SLI in the Affect Recognition subtest. One reason for this might be that in the contextual tasks of the ToM subtest, there is no need to separate or interpret such subtle feelings as in the Affect Recognition subtest, because differences between feelings in faces are clearer and the main point is the understanding of feelings caused by the situations of drawings. The contextual tasks of the ToM subtest measure the child’s ability to infer the other child’s emotions on the basis of the drawings of easy social contexts, which are not as multidimensional as many social contexts in real-life situations. The authors note that it is almost impossible to measure reliably children’s nonverbal social contextual inferring abilities in clinical settings using picture-based tasks, because structured test situations are not as complicated as real-life situations. Recognizing this is critical. The majority of assessments that are available to measure social, pragmatic language skills use relatively simplistic stimuli. It is not unusual for children with ASD, particularly those who are high functioning, to be able to pass these standardized tests.

The authors expected that compared with children with SLI, problems in social perception might be more separate from linguistic abilities in children with ASD (Colle, Baron-Cohen, & Hill, 2007), whereas in children with SLI, language difficulties could be at least partly associated with difficulties in social perception (Miller, 2006). The authors’ SLI data showed that the performance in the ToM verbal tasks was connected with the Grammatical Closure subtest of ITPA and TWF-2 measuring word-finding abilities. The subtest of Affect Recognition was not associated with language tests in children with SLI, which was to be expected because the Affect Recognition subtest does not require as much verbal reasoning and language use as verbal tasks of the ToM subtest.

In children with ASD, the correlation between TWF-2 and ToM verbal subtest almost achieved significance, but other connections were not found, which may suggest that social perception in children with ASD may be rather independent from language. On the basis of this study, it is not possible to explain the relationship between language and social perception. This study is unable to resolve whether the association between verbal ToM and grammatical closure subtest and TWF-2 was due to the association between language abilities and verbal ToM or whether the connection was simply due to the verbal or inference demands of the verbal ToM tasks.

The authors conclude that some kind of difficulty in social perception or social cognition can be seen in children with SLI by 5 to 7 years of age, and they advise that this should be taken into account in clinical practice. They report that Conti-Ramsden and Botting (2004) observed that 11-year-old children with SLI showed a withdrawn social style, and as many as one in three children had been victimized or bullied. In their study, poor pragmatic language skills, measured by the Children’s Communication Checklist and expressive language skills, were associated with social difficulties, whereas overall linguistic skills, gender, or nonverbal IQ were not.