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Non-word Repetition Impairment in Autism and Specific Language Impairment: Evidence for Distinct Underlying Cognitive Causes

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Abstract

Language-impaired individuals with autism perform poorly on tests such as non-word repetition that are sensitive clinical markers of specific language impairment (SLI). This has fuelled the theory that language impairment in autism represents a co-morbid SLI. However, the underlying cause of these deficits may be different in each disorder. In a novel task, we manipulated non-word stimuli in three ways known to influence the repetition accuracy of children with SLI. Participants with SLI were affected differently by these manipulations to children with autism. Children with autism performed similarly to language-matched typical children in terms of levels and patterns of performance, and types of error made, suggesting that the underlying cognitive cause of non-word repetition deficits is different in each disorder.

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Notes

  1. Three participants with ASD scored under the ASD cut-off of 15 on the SCQ, with scores of 12, 13, and 4, respectively. Two of these participants (who scored 12 and 13) were taking part in another of our studies and, as a result, had data from another measure of ASD severity; the Developmental, Dimensional and Diagnostic Interview (3di; Skuse et al. 2004), a more detailed parent interview schedule that is based on the Autism Diagnostic Interview (Le Couteur et al. 2003). Each of these participants scored well above the ASD cut-off on the 3di. The final participant (who scored 4 on the SCQ) did not have any other parent report data available. However, this participant had been diagnosed by a UK-leading clinician in London. This, combined with our clinical impression of the child, make us entirely confident of his diagnosis, regardless of his score on the SCQ.

  2. It may strike the reader as out of keeping with a diagnosis of specific language impairment that four participants in the SLI group had a NVIQ score outside of the normal range. However, a notable proportion of individuals who manifest SLI early in life (during the period in which most receive a diagnosis) show below average NVIQ later in life (e.g., Conti-Ramsden et al. 2001; Mawhood et al. 2000), with NVIQ dropping as much as 20 points across time (Botting 2005). Therefore, to obtain a representative sample of children who receive a diagnosis of SLI, we did not set as an inclusion criterion that NVIQ be in the normal range. We did, however, decide that in cases where NVIQ was below 80, non-verbal abilities must be substantially superior to verbal abilities, reflecting the fact that language problems are identified as the most clinically significant feature among all participants with SLI.

  3. In fact, it is important to note that ADOS-G and ADI-R appear to have a surprisingly low specificity, which raises questions about their suitability for use in research studies. In the largest study of its kind, Risi, Lord, Gotham, Corsello, Chrysler et al. (2006) found that, if used in isolation, the specificity of each measure was less than 50 %, with the identification of around 29 % of non-spectrum children as having autism. If used together, specificity is improved, but in over 15 % of cases the instruments disagree on spectrum vs. non-spectrum diagnoses. These measures (particularly the ADI) have come under recent scrutiny, with some offering what we view as persuasive arguments that measures such as the SCQ and 3di are preferable to ADOS and ADI for research purposes (Bishop 2011, May 30).

Abbreviations

ASD-LI:

Language-impaired individuals with autism spectrum disorder

VMA-TD:

Verbal mental age-matched typically developing individuals

CA-TD:

Chronological age-matched typically developing individuals

SLI:

Specific language impairment

CELF:

Clinical Evaluation of Language Fundamentals

CLS:

Core language score

CNTNAP2:

Contactin associated protein-like 2

ATP2C2:

ATPase, Ca++ transporting, type 2C, member 2

CMIP:

c-Maf inducing protein

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Acknowledgments

The third author was funded by a Leverhulme Early Career Fellowship (ECF/2008/0469). An oral presentation of the results of this paper was delivered by the first author at the biennial meeting of the Society for Research in Child Development, Montreal, Canada, April 2011. We would like to thank the children and schools who participated in this study.

Author information

Authors and Affiliations

  1. Department of Psychology, Durham University, Durham, DH1 3LE, UK

    David Williams

  2. Department of Language and Communication Science, City University, London, EC1V 0HB, UK

    Heather Payne

  3. Department of Psychology and Human Development, Institute of Education, University of London, 25 Woburn Square, London, WC1H 0AA, UK

    Chloë Marshall

Authors
  1. David Williams
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  2. Heather Payne
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  3. Chloë Marshall
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Corresponding authors

Correspondence to David Williams or Chloë Marshall.

Additional information

This study was conducted during a City University Research Fellowship awarded to the first author.

Appendix

Appendix

See Table 4.

Table 4 Non-word stimuli
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Williams, D., Payne, H. & Marshall, C. Non-word Repetition Impairment in Autism and Specific Language Impairment: Evidence for Distinct Underlying Cognitive Causes. J Autism Dev Disord 43, 404–417 (2013). https://doi.org/10.1007/s10803-012-1579-8

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