Gender Differences in Pragmatic Communication in School-Aged Children with Autism Spectrum Disorder (ASD)

  • Olivia ConlonEmail author
  • Joanne Volden
  • Isabel M. Smith
  • Eric Duku
  • Lonnie Zwaigenbaum
  • Charlotte Waddell
  • Peter Szatmari
  • Pat Mirenda
  • Tracy Vaillancourt
  • Teresa Bennett
  • Stelios Georgiades
  • Mayada Elsabbagh
  • Wendy. J. Ungar
  • The Pathways in ASD Study Team


Possible gender differences in manifestations of autism spectrum disorder (ASD) were examined using data on production of narratives. The Expression, Reception and Recall of Narrative Instrument (ERRNI; Bishop, Expression, Reception and Recall of Narrative Instrument, Harcourt assessment, London, 2004) was administered to a sample of matched 8-year-old intellectually able boys and girls with ASD (13M, 13F), who had been selected from a large, longitudinal study. In addition, transcripts of the narratives were analyzed in detail. Significant gender differences were found in narrative production. Girls included more salient story elements than boys. On detailed language analysis, girls were also shown to tell richer stories, including more descriptors of planning or intention. Overall, our findings suggest that subtle differences in social communication may exist between intellectually able boys and girls with ASD. If reliably identifiable in young children, such gender differences may contribute to differential diagnosis of ASD. In addition, such differences may pave the way for differential approaches to intervention when the target is effective communication in sophisticated discourse contexts.


Pragmatics Gender Narrative Communication 



We are grateful to the parents and children who participate in the Pathways in ASD study, and to the current and past members of the study team. We are also grateful to our funders, the Canadian Institutes for Health Research, Kids Brain Health, Autism Speaks, the Sinneave Family Foundation, Alberta Innovates Health Solutions, The Mayberry Family Foundation, and The Government of British Columbia.

Author Contributions

OC and JV conceived of the study and its design, collected the data, performed the statistical analysis, participated in the design and interpretation of the data, and drafted the manuscript; IM-S contributed to the design of the study, participated in the design and interpretation of the data, and drafted the manuscript; and ED, LZ, CW, PS, PM, TV, TB, SG, ME, and WU participated in interpretation of the data, and critically reviewed and revised the manuscript. All authors read and approved the final manuscript.

Supplementary material

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Supplementary material 1 (DOCX 100 KB)
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Supplementary material 3 (DOCX 129 KB)


  1. Adams, C. (2002). Practitioner review: The assessment of language pragmatics. Journal of Child Psychology and Psychiatry, 43(8), 973–987. Scholar
  2. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). American Psychiatric Association: Washington, DC.Google Scholar
  3. American Speech-Language-Hearing Association (2015). Language in brief. Retrieved from
  4. Andersson, G. W., Gillberg, C., & Miniscalco, C. (2013). Pre-school children with suspected autism spectrum disorders: Do girls and boys have the same profiles? Research in Developmental Disabilities: A Multidisciplinary Journal, 34(1), 413–422. Scholar
  5. Attwood, T., & Grandin, T. (2006). Asperger’s and girls. Arlington: Future Horizons, Inc.Google Scholar
  6. Baio, J., Wiggens, L., Christensen, D., Maenner, M., Daniels, J., Warren, Z., … Dowling, N. (2018). Prevalence of Autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 sites, United States, 2014. MMWR Surveillance Summaries, 67(No. SS-6), 1–23. Scholar
  7. Baird, G., & Norbury, C. F. (2016). Social (pragmatic) communication disorders and autism spectrum disorder. Archives of Disease in Childhood, 101(8), 745–751. Scholar
  8. Banney, R. M., Harper-Hill, K., & Arnott, W. L. (2015). The Autism Diagnostic Observation Schedule and narrative assessment: Evidence for specific narrative impairments in autism spectrum disorders. International Journal of Speech-Language Pathology, 17(2), 159–171. Scholar
  9. Bishop, D. V. (2004). Expression, reception and recall of narrative instrument. London: Harcourt assessment.Google Scholar
  10. Botting, N. (2002). Narrative as a tool for the assessment of linguistic and pragmatic impairments. Child Language Teaching & Therapy, 18(1), 1–21. Scholar
  11. Buckner, J. P., & Fivush, R. (1998). Gender and self in children’s autobiographical narratives. Applied Cognitive Psychology, 12(4), 407–429.Google Scholar
  12. Capps, L., Losh, M., & Thurber, C. (2000). ‘The frog ate the bug and made his mouth sad’: Narrative competence in children with autism. Journal of Abnormal Child Psychology, 28(2), 193. Scholar
  13. Carter, A. S., Black, D. O., Tewani, S., Connolly, C. E., Kadlec, M. B., & Tager-Flusberg, H. (2007). Sex differences in toddlers with autism spectrum disorders. Journal of Autism & Developmental Disorders, 37(1), 86–97. Scholar
  14. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Oxford: Routledge.Google Scholar
  15. Cowley, J., & Glasgow, C. (1994). The renfrew bus story (American Ed.). Centreville: The Centreville School.Google Scholar
  16. Dean, M., Kasari, C., Shih, W., Frankel, F., Whitney, R., Landa, R., Lord, C., … Harwood, R. (2014). The peer relationships of girls with ASD at school: Comparison to boys and girls with and without ASD. J Child Psychol Psychiatr, 55, 1218–1225. Scholar
  17. Diehl, J., Bennetto, L., & Young, E. (2006). Story recall and narrative coherence of high-functioning children with autism spectrum disorders. Journal of Abnormal Child Psychology, 34(1), 87–102. Scholar
  18. Ehlers, S., & Gillberg, C. (1993). The epidemiology of Asperger syndrome. A total population study. Journal of Child Psychology & Psychiatry & Allied Disciplines, 34(8), 1327–1350. Scholar
  19. Gillam, R. B., & Pearson, N. A. (2004). Test of narrative language. Austin: PRO-ED.Google Scholar
  20. Gillberg, C., & Steffenburg, S. (1987). Outcome and prognostic factors in infantile autism and similar conditions: A population-based study of 46 cases followed through puberty. Journal of Autism & Developmental Disorders, 17(2), 273–287. Scholar
  21. Harrop, C., Shire, S., Gulsrud, A., Chang, Y., Ishijima, E., Lawton, K., & Kasari, C. (2015). Does gender influence core deficits in ASD? an investigation into social-communication and play of girls and boys with ASD. Journal of Autism & Developmental Disorders, 45(3), 766–777. Scholar
  22. Hartley, S. L., & Sikora, D. M. (2009). Sex differences in autism spectrum disorder: An examination of developmental functioning, autistic symptoms, and coexisting behavior problems in toddlers. Journal of Autism & Developmental Disorders, 39(12), 1715–1722. Scholar
  23. Hebert-Myers, H., Guttentag, C. L., Swank, P. R., Smith, K. E., & Landry, S. H. (2006). The importance of language, social, and behavioral skills across early and later childhood as predictors of social competence with peers. Applied Developmental Science, 10(4), 174–187. Scholar
  24. Hiller, R. M., Young, R. L., & Weber, N. (2014). Sex differences in autism spectrum disorder based on DSM-5 criteria: Evidence from clinician and teacher reporting. Journal of Abnormal Child Psychology, 42(8), 1381–1393. Scholar
  25. Kauschke, C., van der Beek, B., & Kamp-Becker, I. (2016). Narratives of girls and boys with autism spectrum disorders: Gender differences in narrative competence and internal state language. Journal of Autism and Developmental Disorders, 46, 840–852. Scholar
  26. Kelley, E., Naigles, L., & Fein, D. (2010). An in-depth examination of optimal outcome children with a history of autism spectrum disorders. Research in Autism Spectrum Disorders, 4(3), 526–538. Scholar
  27. Kim, S. H., Paul, R., Tager-Flusber, H., & Lord, C. (2014). Language and communication in autism. In F. Volkmar, S. Roger, R. Paul & K. A. Pelphry (Eds.), Handbook of autism and pervasive developmental disorders, volume I: Diagnosis, development and brain mechanisms (pp. 230–262). Hoboken: Wiley.Google Scholar
  28. King, D., Dockrell, J., & Stuart, M. (2014). Constructing fictional stories: A study of story narratives by children with autistic spectrum disorder. Research in Developmental Disabilities, 35(10), 2438–2449. Scholar
  29. King, D., Dockrell, J. E., & Stuart, M. (2013). Event narratives in 11–14 year olds with autistic spectrum disorder. International Journal of Language & Communication Disorders, 48(5), 522–533. Scholar
  30. Kopp, S., & Gillberg, C. (2011). The autism spectrum screening questionnaire (ASSQ)-revised extended version (ASSQ-REV): An instrument for better capturing the autism phenotype in girls? A preliminary study involving 191 clinical cases and community controls. Research in Developmental Disabilities, 32, 2875–2888. Scholar
  31. Kreiser, N., & White, S. (2014). ASD in females: Are we overstating the gender difference in diagnosis? Clinical Child & Family Psychology Review, 17(1), 67–84. Scholar
  32. Kuo, M. H., Orsmond, G. I., Cohn, E. S., & Coster, W. J. (2013). Friendship characteristics and activity patterns of adolescents with an autism spectrum disorder. Autism: The International Journal of Research & Practice, 17(4), 481–500. Scholar
  33. Lai, M., Lombardo, M. V., & Baron-Cohen, S. (2014). Autism. Lancet, 383(9920), 896–910. Scholar
  34. Lai, M., Lombardo, M. V., Pasco, G., Ruigrok, A. N. V., Wheelwright, S. J., Sadek, S. A., … Baron-Cohen, S. (2011). A behavioral comparison of male and female adults with high functioning autism spectrum conditions. PLoS ONE, 6(6), 1–10. Scholar
  35. Landa, R., & Goldberg, M. (2005). Language, social and executive functions in high functioning autism: A continuum of performance. Journal of Autism and developmental Disorders, 35(5), 557–573. Scholar
  36. Lawson, L., Joshi, R., Varbaro, J., & Dissanayake, C. (2018). Gender differences during toddlerhood in autism spectrum disorder: A prospective community-based longitudinal follow-up study. Journal of Autism and Developmental Disorders. Scholar
  37. Lord, C., Risi, S., Lambrecht, L., Cook, E. H. Jr., Leventhal, B. L., DiLavore, P. C., Pickles, A., & Rutter, M. (2000). The Autism Diagnostic Observation Schedule Generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism & Developmental Disorders, 30(3), 205–223. Scholar
  38. Losh, M., & Capps, L. (2003). Narrative ability in high-functioning children with autism or Asperger’s syndrome. Journal of Autism & Developmental Disorders, 33(3), 239–251. Scholar
  39. Losh, M., & Capps, L. (2006). Understanding of emotional experience in autism: Insights from the personal accounts of high-functioning children with autism. Developmental Psychology, 42(5), 809–818. Scholar
  40. Loveland, K., & Tunali, B. (1993). Narrative language in autism and the theory of mind hypothesis: A wider perspective. In S. Baron-Cohen, H. Tager-Flusberg & D. J. Cohen (Eds.), Understanding other minds: Perspectives from autism (pp. 247–266). Oxford: Oxford University Press.Google Scholar
  41. Loveland, K. A., McEvoy, R. E., Tunali, B., & Kelley, M. L. (1990). Narrative story telling in autism and Down’s syndrome. British Journal of Developmental Psychology, 8(1), 9–23. Scholar
  42. Maccoby, E. E. (2002). Gender and group process: A developmental perspective. Current Directions in Psychological Science, 11(2), 54–58. Scholar
  43. Makinen, L., Loukusa, S., Leinonen, E., Moilanen, I., Ebeling, H., & Kunnari, S. (2014). Characteristics of narrative language in autism spectrum disorder: Evidence from the Finnish. Research in Autism Spectrum Disorders, 8(8), 987–996. Scholar
  44. May, T., Cornish, K., & Rinehart, N. (2014). Does gender matter? A one year follow-up of autistic, attention and anxiety symptoms in high-functioning children with autism spectrum disorder. Journal of Autism & Developmental Disorders, 44(5), 1077–1086. Scholar
  45. McLennan, J. D., Lord, C., & Schopler, E. (1993). Sex differences in higher functioning people with autism. Journal of Autism and Developmental Disorders, 23(2), 217–227. Scholar
  46. Meier, C. R., DiPerna, J. C., & Oster, M. M. (2006). Importance of social skills in the elementary grades. ‎Morgantown: West Virginia University Press.Google Scholar
  47. Norbury, C. (2005). The relationship between theory of mind and metaphor: Evidence from children with language impairment and autistic spectrum disorder. British Journal of Developmental Psychology, 23(3), 383–399. Scholar
  48. Norbury, C. F., & Bishop, D. V. M. (2003). Narrative skills of children with communication impairments. International Journal of Language & Communication Disorders, 38(3), 287–313. Scholar
  49. Norbury, C. F., Gemmell, T., & Paul, R. (2014). Pragmatics abilities in narrative production: A cross-disorder comparison. Journal of Child Language, 41(3), 485–510. Scholar
  50. Novogrodsky, R. (2013). Subject pronoun use by children with autism spectrum disorders (ASD). Clinical Linguistics & Phonetics, 27(2), 85–93. Scholar
  51. Parish-Morris, J., Liberman, M., Cieri, C., Herrington, J., Yerys, B., Bateman, L., … Schultz, R. (2017). Linguistic camouflage in girls with autism spectrum disorder. Molecular Autism, 8, 48. Scholar
  52. Roux, A., Shattuck, P., Cooper, B., Anderson, K., Wagner, M., & Narendorf, S. (2013). Postsecondary employment experiences among young adults with an autism spectrum disorder. Journal of the American Academy of Child and Adolescent psychiatry, 52(9), 931–939. Scholar
  53. Rumpf, A., Kamp-Becker, I., Becker, K., & Kauschke, C. (2012). Narrative competence and internal state language of children with Asperger syndrome and ADHD. Research in Developmental Disabilities, 33, 1395–1407. Scholar
  54. Rutter, M., LeCouteur, A., & Lord, C. (2003). ADI-R: The Autism Diagnostic Interview-Revised. Los Angeles: Western Psychological Services.Google Scholar
  55. Semel, E., Wiig, E., & Secord, W. (2003). Clinical evaluation of language fundamentals (4th ed.). San Antonio: Pearson.Google Scholar
  56. Siller, M., Swanson, M. R., Serlin, G., & George, A. (2014). Internal state language in the storybook narratives of children with and without autism spectrum disorder: Investigating relations to theory of mind abilities. Research in Autism Spectrum Disorders, 8(5), 589–596. Scholar
  57. Solomon, M., Miller, M., Taylor, S., Hinshaw, S., & Carter, C. (2012). Autism symptoms and internalizing psychopathology in girls and boys with autism spectrum disorders. Journal of Autism & Developmental Disorders, 42(1), 48–59. Scholar
  58. Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland Adaptive Behavior Scales: Second Edition (Vineland II). Survey Interview Form/Caregiver Rating Form: Pearson Assessments.Google Scholar
  59. St Clair, M., Pickles, A., Durkin, K., & Conti - Ramsden, G. (2010). A longitudinal study of behavioral, emotional and social difficulties in individuals with a history of specific language impairment (SLI). Journal of Communication Disorders, 44(2), 186–199. Scholar
  60. Suh, J., Eigsti, I., Naigles, L., Barton, M., Kelley, E., & Fein, D. (2014). Narrative performance of optimal outcome children and adolescents with a history of an autism spectrum disorder (ASD). Journal of Autism & Developmental Disorders, 44(7), 1681–1694. Scholar
  61. Szatmari, P., Georgiades, S., Duku, E., Bennett, T., Bryson, S., Fombonne, E., … The Pathways in ASD Study Team. (2015). Developmental trajectories of symptom severity and adaptive functioning in an inception cohort of preschool children with autism spectrum disorder. JAMA Psychiatry. Scholar
  62. Tager-Flusberg, H. (1995). ‘Once upon a ribbit’: Stories narrated by autistic children. British Journal of Developmental Psychology, 13(1), 45–59. Scholar
  63. Tager-Flusberg, H., & Sullivan, K. (1994). Predicting and explaining behavior: A comparison of autistic, mentally retarded and normal children. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 35(6), 1059–1075. Scholar
  64. Tager-Flusberg, H., & Sullivan, K. (1995). Attributing mental states to story characters: A comparison of narratives produced by autistic and mentally retarded individuals. Applied Psycholinguistics, 16(3), 241–256. Scholar
  65. Taylor, J., Henninger, N., & Mailick, M. (2015). Longitudinal patterns of employment and postsecondary education for adults with autism and average-range IQ. Autism, 19(7), 785–793. Scholar
  66. Tillmann, J., Ashwood, K., Absoud, M., Bolte, S., Bonnet-Brilhault, F., Buitelaar, J., … Charman, T. (2018). Evaluating sex and age differences in ADI-R and ADOS scores in a large European multi-site sample of individuals with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48, 2490–2505. Scholar
  67. Volden, J., Dodd, E., Engel, K., Smith, I. M., Szatmari, P., Fombonne, E., … The Pathways in ASD Study Team. (2017). Beyond sentences: Using the Expression, Reception, and Recall of Narratives Instrument to assess communication in school-aged children with autism spectrum disorder. Journal of Speech, Language & Hearing Research. 60(8), 2228–2240. Scholar
  68. Wechsler, D. (2003). Wechsler Intelligence Scale for Children (4th edn.). Toronto: Pearson Education.Google Scholar
  69. Wijngaarden-Cremers, P., van Eeten, E., Groen, W. B., Van Deurzen, P. A., Oosterling, I. J., & Van der Gaag, R. J. (2014). Gender and age differences in the core triad of impairments in autism spectrum disorders: A systematic review and meta-analysis. Journal of Autism and Developmental Disorders, 44(3), 627–635. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Olivia Conlon
    • 1
    • 11
    Email author
  • Joanne Volden
    • 1
  • Isabel M. Smith
    • 2
  • Eric Duku
    • 3
  • Lonnie Zwaigenbaum
    • 1
  • Charlotte Waddell
    • 4
  • Peter Szatmari
    • 5
  • Pat Mirenda
    • 6
  • Tracy Vaillancourt
    • 7
  • Teresa Bennett
    • 3
  • Stelios Georgiades
    • 3
  • Mayada Elsabbagh
    • 8
  • Wendy. J. Ungar
    • 9
    • 10
  • The Pathways in ASD Study Team
  1. 1.University of AlbertaEdmontonCanada
  2. 2.Dalhousie University/IWK Health CentreHalifaxCanada
  3. 3.McMaster UniversityHamiltonCanada
  4. 4.Simon Fraser UniversityBurnabyCanada
  5. 5.Centre for Addiction and Mental HealthUniversity of TorontoTorontoCanada
  6. 6.University of British ColumbiaVancouverCanada
  7. 7.University of OttawaOttawaCanada
  8. 8.McGill University/Montreal Children’s HospitalMontrealCanada
  9. 9.Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoCanada
  10. 10.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  11. 11.University of AlbertaEdmontonCanada

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