Abstract
Inferential narrative comprehension is essential for social interaction and reading comprehension (Cain et al., 2001; Kendeou et al., 2008; McIntyre et al., 2020; van Kleeck, 2008). Research indicates that autistic children exhibit inferential comprehension difficulties compared to their typically developing (TD) peers (Norbury & Bishop, 2002; Nuske & Bavin, 2011; Young et al., 2005). In a study by Norbury and Bishop (2002), 6- to 10-year-old autistic children, children with developmental language disorder (DLD), children with pragmatic language impairment (PLI), and typically developing (TD) children responded to six questions (two factual and four inferential). The autistic children performed more poorly on the inferential questions than all other groups. Analysis showed that 70% of the children in the autism group demonstrated poor inferencing skills, compared to 25% in the DLD group. Although inferencing difficulties were observed across clinical groups, an autism diagnosis places children at additional risk. Nuske and Bavin (2011) matched children with autism spectrum disorder (ASD; ages 4;6 to 7;11) with TD children (ages 4;2 to 5;4). The children listened to six very short stories (5–7 sentences each), then answered literal and inferential questions. The autistic children showed specific difficulties answering questions that required script inferencing (requiring the ability to incorporate background script knowledge), as opposed to factual questions or propositional inferencing questions (i.e., based on logical relations).
In this study, the researchers sought to further describe the inferential narrative comprehension skills of autistic children in their first year of schooling compared to TD peers matched for age and year of schooling. They investigated the impact of structural language ability (i.e., spoken language skills at word and sentence levels as measured on a standardized language test) on the inferential comprehension skills of two subgroups of autistic children and compared to TD children matched for age and year of schooling. The researchers used an ecologically validated task containing a problem-oriented story that is reflective of the school curriculum as opposed to short scripts that had been used in other studies. In addition, they not only considered the children’s performance on factual versus inferential comprehension questions but also specifically looked at causal inference type questions linked to the story characters’ internal response, adopting a fine-grained coding system for analyzing the children’s responses.
Researchers asked two questions in this study:
Compared to their TD peers, do children on the autism spectrum show difficulties in inferential comprehension regardless of their structural language ability?
Do children on the autism spectrum show specific significant difficulties in answering inferential questions related to the story characters’ internal response regardless of their structural language ability?
Method
Participants were 35 children with a diagnosis of ASD, between 5;7 and 6;11 years and 32 TD children, matched to the ASD group for age and year of schooling. Children with ASD were divided into below normal limits (ASD_BNL, standard score ≤80; n = 21) or within normal limits (ASD_WNL, standard score >80; n = 14) on a standardized language test. The structural language skills of the autistic children were assessed using the core language subtests from the Clinical Evaluation of Language Fundamentals–Preschool (CELF-P2; Semel et al., 2006). The researchers used a cutoff of SS80 to divide the children in the autism group into the WNL and BNL groups.
All children participated in a narrative comprehension task, which involved listening to a recording of the story “Ana Gets Lost” while looking at pictures, and answering eight comprehension questions immediately afterwards. The story was about a girl who gets lost in the city while looking for her mom and dad. Following the exposure to the story, children were asked eight comprehension questions, without access to the pictures. Three of the questions were factual or literal and five of them were inferential; three of the inferential questions required reference to an internal state of a character (inferential mental) and two did not (inferential other).
Who is the story about? (factual/literal)
Why did Ana have to stay at home? (inferential other)
Why did Ana get bored? (inferential, internal state)
Where did Ana go to find her parents? (inferential other)
Why did Ana get scared? (inferential, internal state)
Who found Ana? (factual/literal)
What did the policeman do? (factual/literal)
Why were Ana’s parents happy to see her? (inferential, internal state)
Scoring of the children’s answers used a system developed by Blank and colleagues (1978a, 1978b). Children’s responses to the questions were categorized into four levels. Below are definitions of the four levels with examples in response to the inferential internal state question, “Why were Ana’s parents happy to see her?”
Expected/correct (3 points): The answer fully addresses the question (e.g., “Because they thought they had lost her.”)
Incomplete (2 points): The answer provides a potential justification, but the answer may be imprecise, poorly formulated, incomplete (e.g., “Because she was back.”)
Low contingency (1 point): The answer contains information that is not relevant to the question (“Because they love her.”)
Inadequate or off topic (0 Points): The answer is unrelated to the question or no response (e.g., “Because they were happy.”).
As a way to avoid the influence of expressive language difficulties for the autistic children, scoring of the answers did not take into account phonological processes, syntax/grammar difficulties, or length of answers/sentences.
Results (in relation to study questions)
There were no significant differences in mean rank scores between the TD group and the ASD_WNL group for factual comprehension.
Both the TD group and the ASD_WNL groups outperformed the ASD_BNL group with large effect sizes.
The mean rank score of the TD group on all the inferential questions was significantly higher than the mean rank score of the ASD_WNL group (large effect size).
The ASD_WNL group significantly outperformed the ASD_BNL group, with a large effect size.
There were no group differences between the ASD_WNL and TD groups for the inferential other questions but significant group differences on the internal state inferential comprehension questions (with a large effect size).
On the inferential (other) questions, three children in the ASD_BNL group (14.2%) and 10 children in the ASD_WNL group (71.4%) performed within or above the interquartile range (IQR) of the TD group versus 21 of the TD children (81.2%). In contrast, none of the children in the ASD-BNL group and only six children in the ASD_WNL group (43%) performed within or above (one child) the IQR of the TD group versus 27 TD children (84%).
Discussion
The ASD_BNL group had significantly lower scores across factual and inferential narrative comprehension compared to the ASD_WNL and TD groups. This finding supports the importance of structural language proficiency measured at the word and sentence levels for narrative comprehension. Children with autism, however, showed greater difficulties in inferential comprehension than their peers without autism, regardless of their structural language ability. Children in the ASD_WNL group showed significant difficulties in answering the internal state inferential questions, compared to their TD peers. Specific difficulties with this type of inferential comprehension task could not be explained by structural language impairment as these children all performed within expected ranges. Furthermore, nonverbal IQ does not explain these difficulties because the ASD_WNL group exhibited performance within the expected range. Recognizing internal states of characters is associated with theory of mind (ToM) skills. ToM deficits represent a primary difficulty in perhaps the majority of persons with autism (Baron-Cohen, 2000). ToM skills are critical for narrative comprehension because better ToM skills enable children to represent and monitor story characters’ internal states (e.g., thoughts and emotions) and make inferences about character emotions and behaviors. Dore et al. (2018) argue that if their framework is correct, links between ToM and inferential comprehension would be stronger for mental state inferences, but not factual, which is consistent with the results of this study if an autism diagnosis is viewed as a proxy for ToM impairments.
Narrative comprehension is essential for classroom participation and reading comprehension (Kendeou et al., 2008; Paris & Paris, 2007). Consequently, the findings of this study highlight the importance of routinely assessing children’s language skills beyond the word and sentence levels, as all children in the ASD_WNL group showed age-appropriate performance on the core language subtests of the CELF-P2.