Research in Autism Spectrum Disorders 5 (2011) 681691

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Research in Autism Spectrum Disorders

Journal homepage: http://ees.elsevier.com/RASD/default.asp

Language acquisition in autism spectrum disorders: A developmental review

Inge-Marie Eigsti a,*, Ashley B. de Marchena a, Jillian M. Schuh a, Elizabeth Kelley b
a b

Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, United States Department of Psychology, Queens University, 351 Humphrey Hall, Kingston, ON K7L 3N6, Canada

A R T I C L E I N F O

A B S T R A C T

Article history: Received 19 August 2010 Accepted 4 September 2010 Keywords: Autism Language acquisition Development Review

This paper reviews the complex literature on language acquisition in the autism spectrum disorders (ASD). Because of the high degree of interest in ASD in the past decade, the eld has been changing rapidly, with progress in both basic science and applied clinical areas. In addition, psycholinguistically-trained researchers have increasingly begun to test theories of language acquisition in studies of ASD, because it is characterized by meaningful differences in ability across a wide range of language, social, and cognitive domains. As such, ASD has served as a natural laboratory in which to explore a variety of theories of language acquisition. We provide an overview of the current state of knowledge of language acquisition in autism spectrum disorders, also noting gaps in our current knowledge. We also review implications of this work for theories of typical language acquisition, and discuss some promising future directions. While the pragmatic decits that characterize autism spectrum disorders are widely acknowledged, both clinicians and researchers should consider the phonological and morphosyntactic differences that likely play an important role in language comprehension and production for affected children. 2010 Elsevier Ltd. All rights reserved.

Contents
1. 2. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . Language in ASD . . . . . . . . . . . . . . . . . . . . . 2.1. Discourse and pragmatic functions . 2.2. Prosody . . . . . . . . . . . . . . . . . . . . . . . 2.3. Syntax . . . . . . . . . . . . . . . . . . . . . . . . 2.4. Morphology . . . . . . . . . . . . . . . . . . . 2.5. Semantics . . . . . . . . . . . . . . . . . . . . . 2.6. Phonology . . . . . . . . . . . . . . . . . . . . . General issues in language assessment. . . . 3.1. Implications of ndings for theories 3.2. Between-domain interactions . . . . . 3.3. Statistical learning . . . . . . . . . . . . . . 3.4. Non-verbal children with autism . . Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . .......... .......... .......... .......... .......... .......... .......... .......... .......... of language .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... acquisition. .......... .......... .......... .......... .......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 682 682 683 684 685 686 686 687 687 688 688 688 688 689 689

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* Corresponding author. Tel.: +1 860 486 6021; fax: +1 860 486 2760. E-mail address: inge-marie.eigsti@uconn.edu (I.-M. Eigsti). 1750-9467/$ see front matter 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.rasd.2010.09.001

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1. Introduction The onset of language skills is a special developmental milestone established by a highly uniform course across children, despite quite striking differences in the structure of the language being learned, individual differences in intelligence or sociability, parent factors, culture, and so on. However, not all individuals go on to develop functional language skills. The presence of language delays or decits is a clear signal of developmental impairments; importantly, the study of such impairments can also help to elucidate the nature of the language acquisition process, by throwing into sharper relief the developmental course of language acquisition (Cicchetti & Rogosch, 1996; Curtiss, Katz, & Tallal, 1992). Investigating the atypical course of language acquisition in children with autism spectrum disorders (ASD) is important for both practical and theoretical reasons. Practically, gaining a better understanding of the course of language acquisition can lead to possible language interventions or treatments for these children. From a more theoretical perspective, elucidating the atypical course of language development in children with ASD can inform us about the necessary and sufcient conditions for language development in children with typical development (TD). In studying childhood disorders, it is critical not to simply work backwards from the adult model, and interpret ndings from the endstate of development (Paterson, Brown, Gsodl, Johnson, & Karmiloff-Smith, 1999), but rather to take a developmental approach and examine the course of the disorder over time. Research in language development has often been a history of debate between the nativist and constructionist positions. Impaired language learners are an important source of data about the constraints on language acquisition and the cognitive domains that impact language acquisition. The nature of language impairments, their causes, and related strengths and weaknesses in non-language domains, can address important questions of domain-specic predispositions for the language learner and elucidate the domain-general mechanisms that may underlie language learning. Related mechanisms and processes include social cognition, attentional and learning mechanisms, knowledge of causeeffect relationships, metarepresentational abilities, and so on. This paper has two primary goals: rst, to review empirical evidence about language acquisition in autism spectrum disorders within the domains of phonology, the lexicon, morphology and syntax, and pragmatics and discourse functions; and second, to discuss the implications of these ndings for language acquisition in typical development. The autism spectrum comprises disorders characterized by impairments or delays in two interrelated domains: social interactions, and language and communication. A third characteristic was the presence of restricted and highly repetitive motor behaviors and unusual and perseverative psychological interests. It is likely that no single cause for ASD exists, though there appears to be a clear impact of genetic differences and a signicant neurobiological component. In addition to a heightened understanding of the neurobiology of ASD, language research has drawn on the concept of the broader autism phenotype, which refers to the personality, language, social, or cognitive characteristics of relatives of an affected individual. Generally, studies have found a sub-clinical but measurable similarity to the standard ASD presentation in the domain of study. Data from studies of infant siblings of individuals affected by ASD have been particularly useful in identifying early markers of autism and dening the broader autism phenotype. Studies of the broader autism phenotype for language have indicated that the speech of rst-degree relatives of individuals with ASD may be less grammatically and pragmatically complex than the speech of rst-degree relatives of individuals with other psychiatric disorders (Landa, Folstein, & Isaacs, 1991; Landa et al., 1992). A more recent study found that young siblings of children with ASD had a high rate of language delay (Gamliel, Yirmiya, Jaffe, Manor, & Sigman, 2009). This is consistent with the central relevance of language skills for the clinical presentation of ASD. Language and communicative difculties are of central importance in ASD. Many children with ASD are initially referred for evaluation because of parents concerns about delayed language milestones (Dahlgren & Gillberg, 1989; De Giacomo & Fombonne, 1998). Furthermore, language milestones (especially, having language skills by age ve years) are strongly related to long-term prognosis (Lord & Paul, 1997; Rogers & DiLalla, 1990; Rutter, 1970; Stone & Yoder, 2001; Szatmari, Bryson, Boyle, Streiner, & Duku, 2003). Given the importance of early language as a predictor of long-term outcome, there is a paucity of research examining the nature of communicative decits and delays. For example, a research search-engine (PubMed) search for references on autism (limited to birth to 18 years) yields 12,930 references, and a search for language yields 16,110 references, but a conjoined search on those terms yields only 1210 references since 1966, excluding reviews and meta-analyses. In part, the lack of empirical attention reects the fact that many researchers have attributed language delays primarily to the lack of social interest or reciprocity. In addition, many early language studies were conducted prior to the advent of rigorous, reliable diagnostic measures and may have not had purely autistic participants. The current review, thus, can be quite comprehensive. We address high-level (i.e., suprasegmental) decits in pragmatics and discourse (conversational) functioning, to prosody, down through increasingly narrowly-scoped domains of morphology and syntax, phonology, and phonetics. In general, we organize our review chronologically within domain, though on occasion a different structure is more informative. We follow our review of research ndings on language development in ASD with a discussion of the implications for the study of typical language acquisition. 2. Language in ASD Some have argued that language problems are due to social motivation decits, and that basic language skills (such as phonology and syntax) remain intact (Jordan, 1993) However, the research reviewed here overwhelmingly indicates a more fundamental decit in language. The data suggest that language impairments are present across essentially all individuals

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with ASD (including decits in pragmatics and discourse processes for individuals with Aspergers syndrome). In addition, early studies indicated that some 50% of affected individuals never acquire functional speech (Prizant, 1996; Rapin, 1991), though more recent estimates nd a smaller proportion of non-verbal individuals, typically around 25% (see Tager-Flusberg, Paul, & Lord, 2005). Language acquisition in ASD is characterized by dramatic delays, with rst words produced at age 38 months, on average, compared to 814 months in TD (Howlin, 2003). Although some ndings suggest that grammatical development then proceeds in a typical fashion (Fein & Waterhouse, 1979; Howlin, 1984; Hoyson, Jamieson, & Strain, 1984; Tager-Flusberg et al., 1990), more recent studies suggest that children with autism exhibit a greater degree of developmental scatter that is, they produce grammatical structures that are less predicted based on previous productions (Eigsti, Bennetto, & Dadlani, 2007). Differences, of course, may reect methodological factors (use of spontaneous versus structured tasks, for example). Language production in ASD is also characterized by some unusual features in addition to the domain-specic decits reviewed below. Many children with ASD engage in echolalia, the immediate or delayed imitation (echoing) of language they have heard from conversational partners or from media such as cartoons or TV shows (Tager-Flusberg & Calkins, 1990). These echoed utterances do not appear to move a childs syntactic skills into a more advanced range. In fact, the opposite may be true; in a study of children with ASD, Down syndrome, and TD who were followed longitudinally, Tager-Flusberg and Calkins (1990) found that spontaneous utterances were longer, and contained more advanced grammatical constructions than imitated utterances, for the children with ASD. Although echolalia may not facilitate grammatical development, it appears to have a partially communicative function. Prizant and Duchan (1981) found that over 33% of the echolalic utterances produced by children in their sample had a turn-taking function, and 25% had a declarative function. In addition to echolalia, individuals with ASD frequently invent novel words (neologisms), often with a specic idiosyncratic meaning (Eigsti et al., 2007; Rumsey, Rapoport, & Sceery, 1985; Rutter, 1970; Tager-Flusberg & Calkins, 1990; Volden & Lord, 1991). Thus, individuals with ASD show linguistic forms (echolalia, neologisms) that are not seen in TD children, at least not with such frequency or so late in acquisition. 2.1. Discourse and pragmatic functions The concept of pragmatics refers to the use of language as a tool for communication; specically, how language is used in the context of social interactions. Pragmatics comprises both linguistic functions, such as register (altering ones speech depending upon whom one is speaking to), negotiation of turn-taking, and the choice of referential expressions (a versus the), as well as non-linguistic functions, such as eye contact, body language and facial expressions. Discourse is a closelyrelated concept, which refers to longer connected streams of speech. Pragmatics and discourse serve as the most socially motivated domains of language, in that they require the speaker to be aware of and respond to the social status, knowledge, interest, motivation, and other qualities of the listener; these skills exhibit a long trajectory of development in most children, with an asymptote at approximately ve years of age. In general, discourse and pragmatics are commonly acknowledged as the most consistently-impaired domains in ASD, remaining impaired even in children with a history of ASD who no longer meet the criteria for a diagnosis on the spectrum (Kelley, Paul, Fein, & Naigles, 2006). Early research in this area suggested that individuals with autistic disorder were likely to use overly formal or precise words, and generally odd phrasing, in talking to others (Rutter, Mawhood, & Howlin, 1992), something described in the popular press as a Little Professor style of speech. Lord (1996) has suggested that pragmatic impairments may reect, at least in part, a lack of experience in peer interactions. If children have had little practice talking with children their own age, preferring instead to interact with adults, they may end up using adult-like speech and may fail to learn age-typical vocabulary items. Discourse and pragmatics require an understanding of the structural form of language, but also how to use that structure in the course of social interactions. A seminal paper by Tager-Flusberg and Anderson (1991) found that six children with ASD were less conversationally responsive than their peers with Down syndrome; furthermore, there was no improvement in this characteristic over the course of a year. Another study examined cohesive ties of reference, or those disparate elements of an utterance that have the same referent; they can be pronominal (he, it), demonstrative (that cat), and comparative (the faster one). Children with ASD, compared with children with SLI and TD matched on mean length of utterance, made use of those cohesive elements, but produced them less frequently (Baltaxe & DAngiola, 1996). Participants in a conversational interaction will inevitably encounter a misunderstanding or unclear referent; to recover, they will engage in conversational repair. The process of repair generally involves a request for clarication from the listener; the original speaker must meet this request, drawing on linguistic skills (understanding the request and its relationship to the original utterance, and generating a repaired utterance) and social skills (evaluating what the listener must have missed, and lling that gap). This skill generally emerges by age 5 in TD, but continues to improve through late childhood, with older children exhibiting a greater variety of repair strategies and generating more information (Brinton, Fujiki, & Sonnenberg, 1988). Geller (1998) found a general failure to repair misunderstandings by children with ASD. However, Volden (2004) assessed conversational repair events (engineered by the experimenter) in 9 children with ASD and 9 language-matched control children, and found that the ASD group was actually able to respond to such failures of communication; they employed a variety of techniques to respond to the conversational failure, and to add more information as the failure persisted. However, the ASD group also produced many more inappropriate responses.

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Several studies have found that individuals with ASD are broadly impaired in their discourse abilities; specically, they fail to respond adequately to questions and comments (Capps, Kehres, & Sigman, 1998), and these conversational difculties continue into adulthood (Eales, 1993). Ghaziuddin and Gerstein (1996) examined spontaneous speech in 17 children (mean age of 16 years) with Aspergers (AS) and 13 children with high-functioning autism (HFA). Approximately 76% of the AS and 31% of the HFA group had pedantic speech; these speech qualities were unrelated to age, circumscribed interests, or verbal IQ. More generally, a study of pragmatic language skills in adults with ASD found impairments in indirect request comprehension and the use of humor and inference, relative to controls matched on chronological age and IQ (Ozonoff & Miller, 1996). Turning from discourse in interaction to extended discourse in the form of narrations, several studies suggest impairments in this domain. Capps, Losh, and Thurber (2000) found that 13 children with ASD, and a developmentally delayed control group, were less likely than TD controls (matched on language level) to identify the causes of characters internal states during a story-telling task, although they were as likely to posit such internal states. Furthermore, performance in the ASD group only was correlated with false belief task performance (thought to index theory of mind skills). That is, the ability to recognize that other individuals have different mental representations from ones own, and being able to identify the motivations and causes of another persons emotional or mental state, was more tightly linked to discourse skills in ASD, perhaps because they are both constrained by a similar limitation. Data from a more recent narration study found that children with ASD were less able to construct a story that had clear, explicit links across story events, and that story connectedness was not signicantly related to recall of the storys gist (an association that was present in controls, Diehl, Bennetto, & Young, 2006). Kelley et al. (2006) found that even very high functioning children with ASD had difculty communicating the causal structure of a narrative, were less likely to discuss the goals of the characters in the story, and were more likely to misinterpret what was occurring in the story. Narrative ability is important for communication as well as for the structuring of ones own thoughts; it is unclear what the implications of narrative difculties might be for individuals with ASD, though these abilities seem related to broader social-cognitive processing difculties. Many studies have demonstrated pragmatic decits in autism. However, studies have found similar pragmatic impairments in individuals without autism, but with intellectual decits (mental retardation, or MR), indicating that cognitive limitations may be as limiting as social delays for development in this language domain (Abbeduto & Hesketh, 1997; Hemphill, Picardi, & Tager-Flusberg, 1991). What may be the source of these high-level pragmatic and discourse decits in ASD? There are two primary proposals in the literature. One inuential view grows out of the Theory of Mind approach, which suggests that difculties in representing the contents of other peoples minds are central in our understanding of ASD, and may provide a critical constraint on pragmatic language skills (see e.g., Baron-Cohen, 1988). There is another possible source of pragmatic and discourse impairment. The executive functions (EF) theory is designed to explicate the core decits in ASD. Briey, the EF theory suggests that ASD involves impairments in a set of cognitive processes associated primarily with the functional circuitry of the frontal lobes of the brain. These processes include working memory, inhibition, set-shifting, goalmaintenance, and cognitive control, and the EF theory proposes that decits in these processes may account for the symptoms in ASD, including social decits, communication delays, and repetitive behaviors (Ozonoff et al., 2004; Pennington & Ozonoff, 1996; Rogers & Bennetto, 2000). By this account, children with autism may fail at pragmatic and discourse tasks because they are unable to simultaneously consider and respond to multiple sources of information (from self and other, for example) or to inhibit inappropriate, potent, or salient responses. While this theory seems plausible, there is little specic evidence to support a specic role of EF in pragmatic abilities (and some evidence against it; see below). In general, pragmatic decits are nearly universal in individuals with both high- and low-functioning ASD. To date, however, neither the Theory of Mind nor the EF theory has been found to account for symptoms of ASD across each of the three domains (social skills, communicative skills, and repetitive behaviors). The question thus remains, about whether these theories provide an explanatory mechanism for ASD. 2.2. Prosody Closely linked to pragmatic abilities is the production and comprehension of prosody, which involves the rhythm, stress, and intonation of speech. To our knowledge, prosodic impairments have been found in every study of children with ASD conducted to date, although it should be noted that relatively few studies have been conducted in this area. As Rutter et al. (1992) found, prosodic oddities were present in ASD, though also shown to be common in a matched group of children with language disorders. Shriberg et al. (2001) examined prosody production by 30 children with HFA or AS (15 per group) compared with 53 TD controls, ages 1049. Results suggested that the ASD group used less appropriate prosodic phrasing, including misplaced lexical stress, slowed phrasing, and less appropriate resonance qualities. Interestingly, though the ASD group had more utterances that were coded as loud, their pitch and loudness were found to be in the appropriate range. Another structured assessment of prosody compared 31 children with high-functioning ASD and 72 TD controls, matched on verbal mental age (McCann, Peppe, Gibbon, OHare, & Rutherford, 2007). Findings indicated that the ASD group performed signicantly worse than controls on 11 of the 12 prosody subtests administered. Finally, in the only assessment of prosodic comprehension in ASD to date, 21 adolescents with ASD were compared to 22 TD controls matched on age, IQ, and PPVT scores (Diehl, Bennetto, Watson, Gunlogson, & McDonough, 2008). The ASD group was signicant less able to use prosody to resolve syntactic ambiguities. Although all studies to date show that individuals with ASD have difculties with prosodic production and comprehension, more research is needed to identify the source of these difculties.

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2.3. Syntax Syntax refers to the combination of words into phrases. As such, it may be considered the most complex of the core linguistic domains. While a number of researchers in the 1980s and 1990s concluded that despite initial delays in acquisition, syntax was relatively unimpaired in ASD, this conclusion has been revisited more recently, with a different outcome. Findings in the 1970s seemed to indicate specic decits in children with ASD as they acquired syntax. A study of three verbal children with autism, matched to children with MR and younger TD controls on mental age, found poorer production of past-tense verb forms, which they interpreted as a more general decit in deictic syntactic categories, or those forms that allow the speaker to express the relationships among speaker, listener, object of actions, and when the action occurs relative to the time of speaking (Bartolucci & Albers, 1974). Prior and Hall (1979) found that 13 children with ASD, ages 715, had more difculty than control groups with Down syndrome or TD in comprehending transitive verb phrases (in which the verb requires a direct object; e.g., the dog chews the bone). The ASD group was also less likely to use word meaning to assist in comprehension. One careful examination of spontaneous speech samples in verbal children with ASD, compared with MR and TD controls matched on non-verbal IQ, found that the ASD group was less able to harness syntactic knowledge in their speech (Pierce & Bartolucci, 1977). Specically, they had lower overall scores on a syntactic complexity measure; they produced fewer transformations, fewer generalized transformations, and had a higher mean error rate, than control groups. While these ndings, along with the landmark book documenting a variety of syntactic decits in ASD (Hermelin & OConnor, 1970) consistently demonstrated that syntactic development in ASD was aberrant, conclusions must be tempered by the dramatic differences in autism diagnosis in that era. In contrast, several studies have concluded that syntax is not specically impaired in ASD (on the basis of performance being at the level expected based on full-scale IQ or other domain-general mental age measure). Shulman and Guberman (2007) found that children with ASD were able to draw on syntactic information in order to produce novel verbs to the same degree as TD controls matched on core language scores. Tager-Flusberg et al. (1990) found that the rate of growth in syntactic complexity for a sample of children with ASD followed longitudinally paralleled the growth in a sample with Down syndrome; interestingly, the ASD group produced signicantly fewer closed-class (functor) words at several stages of utterance length. They were also found to have a more limited syntactic repertoire, relative to their MLU (Scarborough, Rescorla, Tager-Flusberg, Fowler, & Sudhalter, 1991). Another careful assessment of language skills in a sample of children with autism, schizophrenia, and other emotional disturbances (e.g., depression) found few differences across a variety of story-telling, sentence repetition, and story-completion tasks. Compared to mental-age-matched TD controls, all of the clinically-affected participants produced language that was grammatically less complex, but few other differences were reported (Waterhouse & Fein, 1982). In an older study, contrasting social and grammatical functions in language, participants with ASD produced language that was equally as complex as chronological-age-matched dysphasic control subjects with a current language delay (possibly what we would now characterize as SLI, Cantwell, Baker, & Rutter, 1978). More recent studies have found syntactic delays in individuals with ASD using a variety of approaches. One study compared high-functioning children with ASD to TD controls (matched on receptive vocabulary), as well as a group of lowfunctioning children with ASD and younger TD controls (also matched on receptive vocabulary), and found that the mean length of utterance (MLU; the average number of morphemes per utterance) for the younger TD participants was signicantly longer than the low-functioning children with ASD (Volden & Lord, 1991); the higher-functioning groups did not differ. Examining performance on third-person and past-tense marking tasks, Roberts, Rice, and Tager-Flusberg (2004) found that low-IQ (but not higher-IQ) participants with autism were as impaired as a higher-IQ sample with SLI, and that performance was correlated with non-word repetition abilities. They took this nding to suggest that ASD may be made up of at least two subtypes, one that shares characteristics of SLI (in that grammatical skills are specically impaired), and one which does not. A number of studies have shown that children with ASD produce language whose grammatical structure is more rigid, that is, includes a reduced set of syntactic structures in comparison to a control group (Rapin & Allen, 1988; Shapiro, 1977; Shapiro & Kapit, 1978). Eigsti et al. (2007) found that a sample of children with autism produced syntactically less complex spontaneous language relative to TD and developmentally delayed children. In a study of older children with autism and TD controls (ages 916) matched on age, IQ, and receptive vocabulary (Eigsti & Bennetto, 2009), the autism group was signicantly impaired in their ability to judge the grammaticality of sentences (a task with very minimal response demands). Performance was particularly impaired in third person singular and present progressive marking. Another nding, drawn from the same sample of children, identied correlations between knowledge of a syntactic distinction (count-mass nouns) and performance on assessments of executive function (Eigsti & Bennetto, submitted for publication), suggesting a potential role for EF in the syntactic skills of children with ASD. In summary, ndings have been somewhat conicting in addressing the relative delay or decit in syntactic development of children with ASD; however, the majority of studies have concluded that there is a clear delay in this domain of language. As might be expected, social and cognitive factors appear to contribute signicantly to developmental progress; in one study, mutual attention was found to account for approximately 89% of the variability in monthly syntactic complexity growth rates (Rollins & Snow, 1998). In a longitudinal study of a very large sample (n = 138) of children with low and high functioning ASD, cognitive ability at preschool period was found to account for the largest proportion of variability in

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language and social skills at the school-age period (Stevens et al., 2000); in contrast, abilities at school age were not strongly predicted by preschool social abnormality or severity of autistic symptoms. 2.4. Morphology Morphemes are the smallest meaningful units of language; morphological development refers to the development and understanding of these units and how such units are combined into words. For example, jumper, jumped, jumps, jumpy, and longjump all use the morpheme jump in combination with -er, -ed, -s, -y, and long- to add to or change the meaning. TD children have been found to be highly sensitive to many probabilistic as well as rule-based constraints on combining morphemes into words including item frequency, phonological characteristics, and neighborhoods (e.g., Marchman, 1997). Studies of morphological development in children with ASD are few in number but suggest that at least early-acquired morphological rules are learned as efciently in ASD as in controls (Waterhouse & Fein, 1982). Cantwell et al. (1978) found that 12 boys with ASD with a mean age of 9 were similar to dysphasic controls (likely tting a SLI prole, in todays terminology) in the use of nine morphemes in spontaneous speech (though they had more abnormal and echolalic speech). In contrast to this null nding, Bartolucci, Pierce, and Streiner (1980) found that 10 children with ASD (with a mean age of 10) were more likely to omit obligatory morphemes than TD and developmentally delayed control groups matched on mental age, which they suggested may reect a specic delay in morpheme production (rather than general language delay). These conicting results may highlight the relevance of control groups; when compared to a sample matched on overall mental age, an ASD group may appear to have syntactic decits, though these are not apparent when compared with a languageimpaired sample. Several authors have suggested that children with ASD have difculty with functors such as prepositions, conjunctions, and pronouns (Churchill, 1972; Ricks & Wing, 1975). Thus, the research investigating morphological development in children with ASD is mixed and would benet from more research, particularly as all of these studies were conducted prior to the advent of the current diagnostic system. 2.5. Semantics While studies of syntax focus on a persons knowledge of how to use the structure of language, knowledge of the meanings of words, and how these meanings map onto the real world, is also critical to language use. This is the study of semantics. Studies of semantic processes in individuals with ASD have produced highly conicting results. Several studies have directly investigated the contribution of semantic factors to grammatical processing. One study found that children with ASD were better at recalling semantically related items than unrelated ones, and were better at recalling syntactically coherent sentences (rather than syntactically random groupings), though they beneted signicantly less from syntactic relatedness than the TD control group (Ramondo & Milech, 1984). Similarly, Paul, Fisher, and Cohen (1988) found that children with ASD were able to use word order to act out passive and active sentences; they were less inuenced by the semantic probability of the occurrence of events in the real world (e.g., tigers are more likely to eat antelopes than the converse) than were typically-developing children. Similarly, Tager-Flusberg (1981) found that children with autism made use of syntactic information as they acted out spoken sentences, but were affected by semantics to a lesser extent than controls. These ndings agree with a study from Hermelin and OConnor (1967), which indicated that children with ASD differed from a TD group in that they were no better at recalling actual sentences than simple word lists, suggesting that they did not incorporate semantic or linguistic structure into their on-line processing of speech. Thus, individuals with autism may use semantic information to interpret syntactic structure in a different manner than typically developing individuals; more research needs to be conducted to clarify this issue. Recent studies have examined the contribution of other biases to word learning. In a longitudinal study of very young children with ASD, mean age 33 months, and TD children matched on language at the initial visit, the ASD group was able to map novel words onto novel objects as well as their peers (Tek, Jaffery, Fein, & Naigles, 2008). Interestingly, they were less likely to use object shape (as opposed to object texture) to learn new words, a bias that was robust in TD group by age 24 months. Another study examined the role of linguistic biases in word-learning for older children and adolescents, showing the typical use of the mutual exclusivity bias in both the ASD and TD groups (de Marchena, Eigsti, Worek, Ono, & Snedeker, submitted for publication). That is, children with ASD were able to efciently map novel words onto novel-and-unnamed objects, consistent with a bias that category labels apply to mutually exclusive sets of objects (and that each object has only one category name). These biases (shape bias versus mutual exclusivity/novel name-novel object bias) may differ in the degree to which they are domain-specic versus linguistic in nature; alternatively, ASD may be characterized by an extremely delayed and extended developmental trajectory for acquisition, such that biases become operational far later in ASD than in typical development. This would account for the absence of a shape bias at age 33 months but the presence of the mutual exclusivity bias in school-age children. Several researchers have concluded that individuals with autism are generally unimpaired in the comprehension and production of semantic information. One study asked children with ASD to sort pictures into piles on the basis of category membership, and found similar performance across ASD, MR, and younger TD groups (Tager-Flusberg, 1985). Another sorting study found similar abilities in age-matched MR, TD, and ASD groups (mean age of 6 years) in sorting items into form, color and functional categories (Ungerer & Sigman, 1987). Eigsti et al. (2007) found that an ASD group produced a greater variety of different words in spontaneous speech than an MR group matched on receptive vocabulary. Kjelgaard and Tager-

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Flusberg (2001) found that receptive vocabulary as measured by the Peabody Picture Vocabulary Test (PPVT) was a strength relative to standardized syntactic measures in a large cohort of children with autism. On the other hand, a number of ndings are suggestive of semantic impairments. Several studies have shown that children with ASD have difculty understanding the meanings of verbs that indicate someones internal mental state (know, think, remember, etc., Kazak, Collis, & Lewis, 1997; Kelley et al., 2006; Ziatas, Durkin, & Pratt, 1998). A study of children ages 49 found less prototypical word choices in the ASD group; that is, the children with ASD were more likely to say unusual animals like aardvark in a word uency task (Dunn, Gomes, & Sebastian, 1996). Studies have also found that individuals with ASD are less primed by semantically-related words, though their priming by pictures is intact (Kamio, Robins, Kelley, Swainson, & Fein, 2007; Kamio & Toichi, 2000). Thus, while children with ASD may perform according to their mental age on standardized tests of vocabulary and be able to perform basic categorization tasks, and appear age-typical in the size of lexicon, their understanding of mental state verbs and semantic organization is clearly different than their typically developing peers. 2.6. Phonology Phonology refers to the way in which a speaker organizes the sounds of a language to encode meaning and overlaps with phonetics, which refers to the physical production and articulation of speech. Phonology has been found in a variety of clinical studies to be sensitive to neurological problems (Culbertson & Tanner, 2001) and thus provides an excellent target for research in ASD. A variety of studies have found essentially intact phonology in individuals with ASD across a wide age range. An early study examining 47 boys with autism and severe language difculties, ages 410, compared with 23 dysphasic NVIQmatched controls, found that the ASD group had few articulatory problems in both a structured (Reynell Developmental Language Scales) and spontaneous speech setting (Bartak, Rutter, & Cox, 1975). Similar data emerged in a very large sample of 89 children with high-functioning ASD, compared to controls with SLI (Kjelgaard & Tager-Flusberg, 2001). Both groups scored within the normal range on the Goldman-Fristoe Test of Articulation (GFTA). However, when dividing the ASD group into impaired versus non-impaired groups on the basis of PPVT scores, the children with the lowest scores performed signicantly worse on the GFTA (though their scores were within the average range and elevated in comparison to their scores on other tests). The authors concluded that phonology is the most spared aspect of language in children with ASD. Some studies, however, have found signicant phonological decits in ASD. A small group of 9 autistic children (mean age 12) had delays on the Edinburgh Articulatory Scale compared to controls with MR (Bartolucci, Pierce, Streiner, & TolkinEppel, 1976). More recently, 80 children with ASD ages 910 were compared to 59 controls on the Nonword Memory Test and a read-aloud task and were found to be more impaired in phonology (Bishop et al., 2004). Similarly, a study of 30 individuals with HFA/Aspergers, compared to 53 age-matched controls (ages 1049 years) examined speech qualities from a structured conversational interaction and found a high prevalence of articulatory and speech problems for the ASD group (Shriberg et al., 2001). Rapin, Dunn, Allen, Stevens, and Fein (2009) found that approximately 23% of their relatively large sample of school-aged children with autism had severe expressive phonology decits. In general, studies seem to suggest that while most individuals with ASD do not have specic impairments, phonological and articulatory problems can be found in low-functioning individuals with autism, and early in childhood (Lord & Paul, 1997). Alternatively, phonological decits may be specic to particular subgroups within the autism spectrum with the rest following a typical trajectory in phonological development (Rapin et al., 2009; Tager-Flusberg, Lord, & Paul, 1997). 3. General issues in language assessment There are a number of factors that can make it difcult to generalize across research studies examining language and communicative skills in autism. Children with ASD in particular may struggle with motivational and attention difculties that impact their responses to testing (Koegel, Koegel, & Smith, 1997; Tager-Flusberg, 2000). In addition, they are more likely to perseverate and focus on irrelevant (from the experimenters perspective) aspects of the testing situation (Waterhouse & Fein, 1982). Some studies have found that children on the autism spectrum may respond better in computer-administered testing situations (Tager-Flusberg, 2000). Complicating the clinical application of ndings, spontaneous speech samples and standardized assessments may yield dramatically different ndings (Lord & Paul, 1997); but, if children are unresponsive to the experimenter, they may not provide an accurate window into childrens underlying abilities (Howlin, 1984; TagerFlusberg, 2000). A nal complication for research in this eld is the choice of matching variables and control groups. In the past, it has too often been the case that a highly heterogeneous ASD group is compared with a more homogenous control group (matched, typically, on mean IQ). If non-verbal IQ is a strength in ASD, and if groups are matched on VIQ, then the ASD group may contain children who are not delayed on NVIQ; this could obscure language decits relative to other domains. In general, researchers have been moving away from a simplistic assumption that groups are well-matched if group differences do not reach the p < .05 criterion (Mervis & Klein-Tasman, 2004), and instead, advocate a higher threshold, of group differences no greater than p < .20 and with similar ranges of ability. A second useful (albeit cumbersome) strategy is to select multiple control groups (for example, one control group matched on verbal IQ and age, and then a second group matched on nonverbal IQ).

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Related to this matching question is a concern about differences within the autism spectrum. An ASD group is likely to include individuals with pervasive developmental disorder/not otherwise specied (PDD), with high- or low-functioning autistic disorder, or with Aspergers (and thus, no early language delay). It can be a strength to include participants across this spectrum, yet researchers must give attention to clearly characterizing their samples. First and foremost, we must commit to giving full diagnostic information about the ASD group. When attempting to explore the interactions of IQ, language, and social impairments, we may aim for a more homogenous sample. For example, several recent studies have attempted to empirically distinguish between individuals with ASD who demonstrate clear language difculties and those who do not (Lindgren, Folstein, Tomblin, & Tager-Flusberg, 2009; Loveas et al., 2010). Alternatively, it can be valuable to consider the generalizability of a nding across the whole spectrum, and any differences could be useful in understanding the etiology or phenotype associated with specic autism-related disorders. This individual differences approach takes the perspective that including a very wide range of abilities for a given skill provides us with the opportunity to investigate the precursors, predictors, and correlates of that skill. 3.1. Implications of ndings for theories of language acquisition While early studies of language in ASD (from the 1940s to the 1970s) implicated impairments across many language domains, subsequent research focused on decits specic to the suprasegmental domains of discourse and pragmatic functions. Currently, research is once again identifying decits within every domain of language. Identifying patterns of strength and weakness across language domains can serve to illuminate the inuence of associated social and cognitive processes, which also show a pattern of varying strength and weakness in ASD. 3.2. Between-domain interactions The presence of often dramatic variability across and between social, cognitive, and language domains in ASD presents researchers with the opportunity to examine relationships. This is more challenging in studies of typical development because there is generally a much smaller range of individual differences, and abilities tend to hang together such that a strength in one domain (e.g., cognition) or sub-domain (e.g., morphology) will be observed across all other domains or subdomains. The challenging converse to this apparent decoupling of language, social, and cognitive skills in ASD, is that these processes surely transact. That is, one process likely inuences development in another process, which then reinforces or promotes development in the rst process. Thus, for example, cognitive level likely inuences initial language input, in the sense that a higher-functioning child may have more attentional capacity to perceive language input; this in turn would reinforce cognitive capacities (such as development of working memory) as language skill increases. In another example, verbal abilities may promote the development of theory of mind capacity (e.g., de Villiers, 2000). Theory of mind skills likely support more effective social interactions, which in turn would promote improvements in language skills. Because of the coupling of these processes, disentangling their unique contributions will provide a signicant challenge. These issues will require careful teasing apart of individual capacities (working memory, attention, inhibition, theory of mind, low-level perceptual capabilities) into their most fundamental (and operationalizable) components, and also requires sufciently large sample sizes to be able to determine the variance contributed by multiple factors. This process, in addition, calls for powerful analytic techniques that are able to examine development over time (such as growth curve analysis). 3.3. Statistical learning There is currently a great deal of interest in the role that statistical regularities in language might play in language acquisition. Currently, we know little about specic differences that children with autism may exhibit in their use of statistical properties as they learn language. One study of adults with autism indicated signicant impairments in an implicit learning task (Mostofsky, Goldberg, Landa, & Denckla, 2000), however, a functional neuroimaging study of adolescents found no differences in implicit learning (Barnes et al., 2008). The interactions among language skills, implicit learning, and perception of linguistic regularities may provide an interesting arena in which to examine the contributions of such a learning system to language acquisition. This is work we are currently pursuing in our laboratory. 3.4. Non-verbal children with autism Previous estimates suggested that approximately 50% of individuals with an autism diagnosis will fail to develop any functional verbal language skills (Bryson, Clark, & Smith, 1988). Recently, however, because of earlier diagnosis and early intervention, it is likely that an increasing proportion of children will go on to develop verbal skills, though no current estimates are available (Koegel, 2000; Prizant, 1983). This population of children, who are able to develop language only with intensive early therapy, holds out the prospect of greatly improving our understanding of the possible barriers to acquisition. This can be done in the course of intervention studies, in which specic skills are deliberately taught, carefully tracking what other skills might also improve as a result. More generally, intervention studies open up the possibility of assessing the

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impact of growth within a specic (potentially non-linguistic) domain, such as executive functioning, on subsequent language development. Some preliminary work in this area has been quite promising (Fisher & Happe, 2005). 4. Conclusions In conclusion, research on the autism spectrum is one of the most rapidly-changing and exciting elds in psychology, with progress in both basic science and applied clinical areas. Researchers in language acquisition have recently turned to ASD, because studies of this and related disorders offer the possibility of examining meaningful differences in ability across a wide range of language, social, and cognitive domains. As such, it has served as a sort of natural laboratory in which to explore a variety of theories of language acquisition. At the same time, it is tempting to overlook a number of the subtleties in performance and ability that are part and parcel of working with a developmental disorder, which does not always arrive as neatly packaged as we might assume. This manuscript has provided an overview of the current state of knowledge of language acquisition in autism spectrum disorders, and has reviewed some implications for typical development, and some promising future directions. References
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