Measuring Social-Communication Difficulties in School-age Siblings of Children with ASD: Standardized versus Naturalistic Assessment

• In Event: Socio-cognitive abilities in children with Autism Spectrum Disorder

Abstract

Background: Younger siblings of children with autism spectrum disorder (ASD; high-risk siblings) who do not develop ASD themselves are at elevated risk for developing the broader autism phenotype (BAP), which consists of subclinical features of ASD, compared to siblings with no family history of ASD (low-risk siblings). The BAP has been linked to difficulties in social relationships and poor mental health outcomes in adulthood. Prospective studies of high-risk siblings provide an opportunity to characterize aspects of the BAP in childhood.

Objectives: To investigate school-age pragmatic communication skills in high- and low-risk children with BAP and ASD outcomes, as well as a comparison group, using two assessment methods (naturalistic task and standardized assessments).

Methods: Participants were assessed at school-age (M age=11.32 years, SD=2.53) and classified into one of three outcome groups: ASD (n=18; met DSM-5 criteria), BAP (n=23; based on clinical best estimate), or Comparison group (n=134; did not meet ASD or BAP criteria). During study visits, examiners engaged in conversation with participants for 7-10 minutes, beginning with an open-ended question (i.e., “What do you like to do for fun?”) and responding naturally to the participant. Participants were then rated using the Conversational Skills Rating Scale (CSRS; Spitzberg, 1995), which contains 25 behaviors rated from 1 (inadequate) to 5 (excellent), then summed to create a total score. Participants were also administered the Pragmatic Language (PL) and Nonliteral Language (NL) subtests of the Comprehensive Assessment of Spoken Language (CASL-2; Carrow-Woolfolk, 2017), and parents completed the Children’s Communication Checklist-2 (CCC-2; Bishop, 2006).

Results: Analysis of variance showed a significant effect of outcome group on CASL PL, F(2, 169)=48.27, p<.001, CASL NL, F(2, 163)=46.98, p<.001, and CCC-2 General Communication Composite (GCC), F(2, 160)=23.29, p<.001 (see Figure 1). Post hoc analyses for all subtests indicated that the ASD group scored significantly lower than BAP and Comparison groups, while BAP and Comparison groups did not differ. There was a significant effect of outcome group on CSRS Total Score, F(2, 172)=80.73, p<.001 (see Figure 1). Post hoc analyses indicated that the ASD group scored significantly lower than BAP and Comparison groups. The BAP group scored significantly lower than the Comparison group. Stepwise multinomial logistic regression analysis showed that in predicting BAP group membership over the Comparison group, the CSRS was the only significant predictor (see Table 1 for model information). ROC analysis determined that on the CSRS, a threshold of 89.5 was the optimal cutoff score for discriminating the BAP from Comparison group.

Conclusion: School-age children with BAP outcomes exhibited lower conversational skills with an examiner than comparison children, but standardized assessments of pragmatic communication skills did not differentiate the BAP group from the comparison group. This suggests that naturalistic conversation—and measures incorporating subtle verbal and nonverbal aspects of communication—may be more sensitive than standardized language assessments in identifying social-communication difficulties in children with BAP characteristics. Despite scoring in the average range on pragmatic tests, children with the BAP struggle implementing such skills moment-to-moment during interaction, making naturalistic tasks crucial when assessing social-communication difficulties.

Authors

• Devon Nicole Gangi, University of California - Davis
  Presenting Author

• Monique Moore Hill, UC Davis MIND Institute
  Non-Presenting Author

• Shyeena Maqbool, UC Davis MIND Institute
  Non-Presenting Author

• Gregory Young, University of California, Davis
  Non-Presenting Author

• Sally Ozonoff, University of California - Davis
  Non-Presenting Author