Journal of Autism and Developmental Disorders

, Volume 49, Issue 4, pp 1366–1377 | Cite as

Parents’ Use of Internal State Language with Toddlers at High and Low Genetic Risk for Autism Spectrum Disorder

  • Susan B. CampbellEmail author
  • Amanda S. Mahoney
  • Celia A. Brownell
  • Elizabeth L. Moore
  • Amy B. Tavares
Original Paper


Parents of toddlers with an older sibling with autism spectrum disorder (ASD; high risk, HR) and parents of low risk (LR) toddlers with typically-developing older siblings read a wordless picture book to their child at 22 and 28 months. Parents’ and toddlers’ internal state language (ISL) was coded; parents reported on toddlers’ use of ISL. Diagnostic assessments conducted at 36 months identified three groups: ASD, HR-noASD, LR. Parents did not differ in overall ISL, but parents of toddlers with later ASD attempted to elicit ISL from their children less than parents of LR toddlers. Toddlers increased their use of ISL with age, but those with ASD had lower scores and less age-related improvement than children in the other two groups.


High risk siblings Parents’ internal state language Children’s state words Autism spectrum disorder 



This study was supported by the National Institute of Mental Health R01 MH091036 to Dr. Campbell. We thank Dr. Nancy Minshew, Dr. Mark Strauss, Dr. Carla Mazefsky, Dr. Holly Gastgeb, Ms. Stacey Becker, and the staff at Autism Center of Excellence, University of Pittsburgh for overseeing initial recruitment and assessment of participating families. The Autism Center of Excellence was supported by award number HD055748 (PI Minshew) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Recruitment was also facilitated by the Clinical and Translational Science Institute, supported by the National Institutes of Health through Grant Numbers UL1 RR024153 and UL1TR000005. Thanks are due to Taylor Day, Kristen Decker, Stephanie Fox, Phebe Lockyer, and Emily Schmidt for overseeing data collection, and to Rachel Fleming, Kendra Guinness, and Mariel McMarlin for assistance with data collection and coding. Special thanks go to the parents and children who participated in this study.

Author Contributions

SBC was responsible for the overall conduct of the study. SBC, ASM, and CAB prepared the manuscript. ASM oversaw the coding and management of the book reading data with the assistance of ABT. ELM oversaw the data analyses with the assistance of ASM. CAB developed the book reading task and coding system and contributed to the conceptualization of the study. All co-authors read, edited, and approved the manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest.

Ethical Approval

This study was approved by the University Internal Review Board. Informed consent was obtained from all parents who participated in this study at each visit.


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: APA. (text revision).Google Scholar
  2. Brown, B. B., Morris, G., Nida, R. E., & Baker-Ward, L. (2012). Making experience personal: Internal states language in memory narratives of children with and without Asperger’s disorder. Journal of Autism and Developmental Disorders, 42, 441–446.CrossRefGoogle Scholar
  3. Brownell, C. A., Ramani, G. B., & Zerwas, S. (2006). Becoming a social partner with peers: Cooperation and social understanding in one- and two-year-olds. Child Development, 77, 803–821.Google Scholar
  4. Brownell, C. A., Svetlova, M., Anderson, A., Nichols, S. R., & Drummond, J. (2013). Socialization of early prosocial behavior: Parents’ talk about emotions is associated with helping and sharing in toddlers. Infancy, 18, 91–119.CrossRefGoogle Scholar
  5. Campbell, S. B., Mahoney, A. S., Northrup, J., Moore, E. L., Leezenbaum, N. B., & Brownell, C. A. (2018). Developmental changes in pretend play from 22- to 34-months in younger siblings of children with autism spectrum disorder. Journal of Abnormal Child Psychology, 46, 639–654.CrossRefGoogle Scholar
  6. Campbell, S. B., Moore, E. L., Northrup, J., & Brownell, C. A. (2017). Developmental changes in empathic concern and self-understanding in toddlers at genetic risk for autism spectrum disorder. Journal of Autism and Developmental Disorders, 47, 2690–2702.CrossRefGoogle Scholar
  7. Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., et al. (2010). Randomized controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125, e17–e23.CrossRefGoogle Scholar
  8. Dunn, J., Bretherton, I., & Munn, P. (1987). Conversations about feeling states between mothers and their young children. Developmental Psychology, 23, 132–139.CrossRefGoogle Scholar
  9. Dunn, J., Brown, J., & Beardsall, L. (1991). Family talk about feeling states and children’s later understanding of others’ emotions. Developmental Psychology, 27, 448–455.CrossRefGoogle Scholar
  10. Frith, U., Happé, F., & Siddon, F. (1994). Autism and theory of mind in everyday life. Social Development, 3, 108–124.CrossRefGoogle Scholar
  11. Garner, P. W., Jones, D. C., Gaddy, G., & Rennie, K. M. (1997). Low-income mother’s conversations about emotions and their children’s emotional competence. Social Development, 8, 37–52.CrossRefGoogle Scholar
  12. Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 39, 693–705.CrossRefGoogle Scholar
  13. Grazzani, I., Ornaghi, V., Agliati, A., & Brazzeli, E. (2016). How to foster toddlers’ mental state talk, emotion understanding, and prosocial behavior: A conversation-based intervention at nursery school. Infancy, 21, 199–227.CrossRefGoogle Scholar
  14. Hollingshead, A. A. (1975). Four-factor index of social status. Unpublished manuscript. New Haven: Yale University.Google Scholar
  15. Hughes, C., & Leekam, S. (2004). What are the links between theory of mind and social relations? Review, reflections, and new directions for studies of typical and atypical development. Social Development, 13, 590–619.CrossRefGoogle Scholar
  16. Hutchins, T. L., Brannick, M., Bryant, J. B., & Sillimman, E. R. (2005). Methods for controlling amount of talk: Difficulties, considerations, and recommendations. First Language, 25, 347–363.CrossRefGoogle Scholar
  17. Hutchins, T. L., Deraway, C., Prelock, P., & O’Neill, A. (2017). Mothers’ and children’s story-telling: A study of dyads with typically developing children and children with ASD. Journal of Autism and Developmental Disorders, 47, 1288–1304.CrossRefGoogle Scholar
  18. Iverson, J. M., Northrup, J. B., Leezenbaum, N. B., Parlade, M. V., Koterba, E. A., & West, K. L. (2018). Early gesture and vocabulary development in infant siblings of children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48, 55–71.CrossRefGoogle Scholar
  19. Lord, C., Risi, S., Lambrecht, L., Cook, E., Leventhal, B., DiLavore, P., et al. (2000). Autism diagnostic observation schedule-generic: A standard measure of social and communicative deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223.CrossRefGoogle Scholar
  20. Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism Diagnostic Interview-Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659–695.CrossRefGoogle Scholar
  21. Mullen, E. (1995). The Mullen Scales of Early Learning. Circle Pines: American Guidance Service.Google Scholar
  22. Ornaghi, V., Brazzelli, E., Grazzani, I., Agliati, A., & Lucarelli, M. (2017). Does training toddlers in emotion knowledge lead to changes in their prosocial and aggressive behavior? Early Education and Development, 28, 396–414.CrossRefGoogle Scholar
  23. Ornaghi, V., Brockmeier, J., & Grazzani Gavizzi, I. (2011). The role of language games in children’s understanding of mental states: A training study. Journal of Cognition and Development, 12, 239–259.CrossRefGoogle Scholar
  24. Ozonoff, S., Young, G. S., Carter, A., Messinger, D., Yirmiya, N., et al. (2011). Recurrence risk for autism spectrum disorders: A baby siblings research consortium study. Pediatrics, 128, e488–e495.Google Scholar
  25. Rogers, S. J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A., Guo, M., & Dawson, G. (2012). Effects of a brief Early Denver Start Model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 1052–1065.CrossRefGoogle Scholar
  26. Ruffman, T., Slade, L., & Crowe, E. (2002). The relation between children’s and mothers’ mental state language and theory-of-mind understanding. Child Development, 73, 743–751.CrossRefGoogle Scholar
  27. Ruffman, T., Slade, L., Devitt, K., & Crowe, E. (2006). What mothers say and what they do: The relation between parenting, theory of mind, language, and conflict/cooperation. British Journal of Developmental Psychology, 24, 105–124.CrossRefGoogle Scholar
  28. Rutter, M., Bailey, A., & Lord, C. (2003). Social Communication Questionnaire. Los Angeles: Western Psychological Services.Google Scholar
  29. Siller, M., Swanson, M. R., Serlin, G., & Teachworth, A. G. (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, 589–596.CrossRefGoogle Scholar
  30. Slaughter, V., Peterson, C. C., & Mackintosh, E. (2006). Mind what mother says: Narrative input and theory of mind in typical children and those on the autism spectrum. Child Development, 78, 839–858.CrossRefGoogle Scholar
  31. Symons, D. K., Fossum, K. M., & Collins, T. B. K. (2006). A longitudinal study of belief and desire state discourse during mother-child play and later false belief understanding. Social Development, 15, 676–691.CrossRefGoogle Scholar
  32. Szatmari, P., Chawarska, K., Dawson, G., Georgiades, S., Landa, R., et al. (2016). Prospective longitudinal studies of infant siblings of children with autism: Lessons learned and future directions. Journal of the American Academy of Child and Adolescent Psychiatry, 55, 179–187.CrossRefGoogle Scholar
  33. Taumoepeau, M., & Ruffman, T. (2006). Mother and infant talk about mental states relates to desire language and emotion understanding. Child Development, 77, 465–481.CrossRefGoogle Scholar
  34. Vivanti, G., Dissanayake, C., & the Victorian ASELCC Team (2016). Outcome for children receiving Early Start Denver Model before and after 48 months. Journal of Autism and Developmental Disorders, 46, 2441–2449.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Susan B. Campbell
    • 1
    Email author
  • Amanda S. Mahoney
    • 1
  • Celia A. Brownell
    • 1
  • Elizabeth L. Moore
    • 1
  • Amy B. Tavares
    • 1
  1. 1.Department of PsychologyUniversity of PittsburghPittsburghUSA

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