Language functioning in Autism Spectrum Disorder: A scoping review

Lima, Leilane Júlia Chaves de; Britto, Denise Brandão de Oliveira e; Nogueira, Gabriela Damaris Ribeiro; Lemos, Stela Maris Aguiar

doi:10.1590/1982-0216/20242626423

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REVIEW ARTICLES • Rev. CEFAC 26 (2) • 2024 • https://doi.org/10.1590/1982-0216/20242626423 copy

Language functioning in Autism Spectrum Disorder: A scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

to map and synthesize scientific evidence on language functioning in children and adolescents with autism spectrum disorder Autism Spectrum Disorder.

Methods:

this scoping review aimed at mapping and synthesizing scientific evidence on language functioning in children and adolescents with Autism Spectrum Disorder. A research question, article selection, and compilation of results were used as research strategies. The selection criteria were studies with samples of children and adolescents, addressing Autism Spectrum Disorder, speech-language-hearing therapy, communication, language, and functioning. After independent evaluators read the titles, keywords, abstracts, and full texts, they recorded the following data for the review: year of publication, type of study, country of origin, sample size, age of participants, instruments used, language subsystems assessed, and results.

Literature review:

the search found 1,056 articles, of which 536 were read in full, and 16 were included. There was great variability in assessment instruments and few studies involving adolescents. Individuals with Autism Spectrum Disorder had changes in language functioning related to pragmatics, morphosyntax, semantics, and phonology.

Conclusion:

the preliminary evidence map indicates that children and adolescents with ASD have a variety of language changes.

Keywords:
Child Language; Autism Spectrum Disorder; Speech, Language and Hearing Sciences; International Classification of Functioning, Disability and Health; Communication Barriers

Database	Strategy
VHL	(Child OR Niño OR Criança OR Crianças OR Adolescent OR Adolescente OR Adolescente OR Adolescentes OR Adolescência OR Jovem OR Jovens OR Juventude) AND ("Autistic Disorder" OR "Trastorno Autístico" OR "Transtorno Autístico" OR Autismo OR "Autismo Infantil" OR "Síndrome de Kanner" OR "Autism Spectrum Disorder" OR "Trastorno del Espectro Autista" OR "Transtorno do Espectro Autista" OR "Transtorno de Espectro Autista" OR "Transtorno do Espectro do Autismo") AND ("Language Development" OR "Desarrollo del Lenguaje" OR "Desenvolvimento da Linguagem" OR "Child Language" OR "Lenguaje Infantil" OR "Linguagem Infantil" OR "Linguagem da Criança" OR "Communication Barriers" OR "Barreras de Comunicación" OR "Barreiras de Comunicação" OR "Speech, Language and Hearing Sciences" OR Fonoaudiología OR Fonoaudiologia) AND ("International Classification of Functioning, Disability and Health" OR "Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud" OR "Classificação Internacional de Funcionalidade, Incapacidade e Saúde" OR "CIF" OR "Disability Evaluation" OR "Evaluación de la Discapacidad" OR "Avaliação da Deficiência" OR Funcionalidade OR Functionality)
MEDLINE via PubMed	(Child OR Adolescent) AND ("Autistic Disorder" OR "Autism Spectrum Disorder") AND ("Language Development" OR "Child Language" OR "Communication Barriers" OR "Speech, Language and Hearing Sciences") AND ("International Classification of Functioning, Disability and Health" OR "Disability Evaluation" OR Functionality)
COCHRANE	(Child OR Adolescent) AND ("Autistic Disorder" OR "Autism Spectrum Disorder") AND ("Language Development" OR "Child Language" OR "Communication Barriers" OR "Speech, Language and Hearing Sciences") AND ("International Classification of Functioning, Disability and Health" OR "Disability Evaluation" OR Functionality)
CINAHL	(Child OR Adolescent) AND ("Autistic Disorder" OR "Autism Spectrum Disorder") AND ("Language Development" OR "Child Language" OR "Communication Barriers" OR "Speech, Language and Hearing Sciences") AND ("International Classification of Functioning, Disability and Health" OR "Disability Evaluation" OR Functionality)
SCOPUS	(Child OR Adolescent) AND ("Autistic Disorder" OR "Autism Spectrum Disorder") AND ("Language Development" OR "Child Language" OR "Communication Barriers" OR "Speech, Language and Hearing Sciences") AND ("International Classification of Functioning, Disability and Health" OR "Disability Evaluation" OR Functionality)
Web of Science	(Child OR Adolescent) AND ("Autistic Disorder" OR "Autism Spectrum Disorder") AND ("Language Development" OR "Child Language" OR "Communication Barriers" OR "Speech, Language and Hearing Sciences") AND ("International Classification of Functioning, Disability and Health" OR "Disability Evaluation" OR Functionality)
EMBASE	(Child OR Adolescent) AND Autism AND ('Language Development' OR 'Communication Barrier') AND 'International Classification of Functioning, Disability and Health'

Parameters	Population	Concept	Context
PCC strategy	WHO childhood (0 to 11 years, 11 months and 29 days) and adolescence (12 to 20 years)	Functioning	Scientific production worldwide
Inclusion criteria	Children and adolescents Both sexes ASD diagnosis	Functional aspects of language Assessment of communicative and linguistic aspects	Clinical context (clinical environments, offices, home assessment) National health systems School context
Exclusion criteria	Children with a suspected diagnosis or complaint	Addressing behavioral and motor aspects only Other speech and language changes not associated with ASD	Research with self-reported data (questionnaires) Survey

Article	Country	Design	Sample	Tests/protocols applied	Language subsystems	Functional aspects of the language
Arutiunian et al., 2022¹⁴14. Arutiunian V, Lopukhina A, Minnigulova A, Shlyakhova A, Davydova E, Pereverzeva D et al. Language abilities of Russian primary-school-aged children with Autism Spectrum Disorder: Evidence from comprehensive assessment. J Autism Dev Disord. 2022;52(2):584-99. https://doi.org/10.1007/s10803-021-04967-0 PMID: 33733294. https://doi.org/10.1007/s10803-021-04967...	Russia	Cross-sectional analytical	ASD: 82 children (17 girls) TD: 25 children (11 girls)	Russian Child Language Assessment Battery Phoneme detection test from the Russian Test of Phonological Processing Custom-made word repetition test	Pragmatic Morphosyntactic Semantic Phonological	Children with ASD had high variability in language skills (from normal to deficient). Children with ASD had more difficulty understanding speech and answering implicit questions. Children with ASD had lower sentence processing scores than TD children. They repeated short sentences and phrases with high-frequency words better than long sentences and sentences made up of low-frequency words. Children with ASD performed worse in object naming, action naming, noun comprehension, and verb comprehension than TD children. Children with ASD had more difficulty with pseudoword repetitions, phoneme detection, and phonological discrimination than TD children.
	Russia	Cross-sectional analytical	7 to 11 years		Pragmatic Morphosyntactic Semantic Phonological
Broome et al., 2021²⁸28. Broome K, McCabe P, Kimberley A, Doble M, Carrigg B. Speech abilities in a heterogeneous group of children with Autism. J Speech Lang Hear Res. 2021;64(12):4599-613. https://doi.org/10.1044/2021_JSLHR-20-00651 PMID: 34731586. https://doi.org/10.1044/2021_JSLHR-20-00...	Australia	Longitudinal descriptive	ASD: 23 children (2 girls)	Preschool Language Scale-Fourth Edition (PLS-4) Communication and Symbolic Behavior Scales (CSBS) Polysyllable Preschool Test (POP) First Words First Sentences Test (FWFST) Spontaneous speech samples	Pragmatic Semantic Phonological	Children with ASD had high variability in language skills. However, in general, there was a tendency towards greater receptive than expressive vocabulary and greater production of initial consonants in relation to the middle or final consonants. To better describe the children’s language characteristics, they were divided into three subgroups (A, B, and C) according to their functioning: A. Relatively high speech and language skills: children had high receptive and expressive vocabulary, high nonverbal communication, and high speech; they made few articulation errors. B. Greater receptive and nonverbal communication skills in relation to speech and expressive language: children had high receptive vocabulary, high nonverbal communication, low expressive vocabulary, and low speech; they used few words and had low phonemic precision. C. Low language and speech ability: children had low language, nonverbal communication, and speech levels; they used fewer than 10 recognizable words.
	Australia	Longitudinal descriptive	2 to 6 years		Pragmatic Semantic Phonological
Ferrara et al., 2020¹⁵15. Ferrara M, Camia M, Cecere V, Villata V, Vivenzio N, Scorza M et al. Language and pragmatics across neurodevelopmental disorders: An investigation using the Italian version of CCC-2. Journal Autism Dev Disord. 2020;50(4):1295-309. https://doi.org/10.1007/s10803-019-04358-6 PMID: 31901121. https://doi.org/10.1007/s10803-019-04358...	Italy	Cross-sectional analytical	ASD: 19 children TD: 70 children (34 girls)	Children’s Communication Checklist 2 (CCC-2)	Pragmatic	Children with ASD had a high level of stereotypical language and difficulty in initiating and using contexts.
	Italy	Cross-sectional analytical	8 to 10 years	Children’s Communication Checklist 2 (CCC-2)	Pragmatic
Mazzagio, Shield, 2020¹⁶16. Mazzaggio G, Shield A. The production of pronouns and verb inflections by Italian children with ASD: A new dataset in a null subject language. J Autism Dev Disord. 2020;50(4):1425-33. https://doi.org/10.1007/s10803-019-04349-7 PMID: 31894460. https://doi.org/10.1007/s10803-019-04349...	Italy	Cross-sectional analytical	ASD: 23 children (2 girls) TD: 35 children (18 girls)	Children’s Communication Checklist 2 (CCC-2)	Morphosyntactic Pragmatic	Children with ASD were less likely to produce pronouns in the context of picture identification but more likely to produce overt rather than null pronouns in association with verbs that are marked for first- and second-person subjects. Children with ASD have been able to acquire and use pronominal forms but struggle to understand when and where to use them conventionally, pointing to underlying challenges with pragmatics.
	Italy	Cross-sectional analytical	ASD: 3.7 to 10.3 years. TD: 4.8 to 6.4 years	Children’s Communication Checklist 2 (CCC-2)	Morphosyntactic Pragmatic
Baixauli-Fortea et al., 2019¹⁷17. Baixauli-Forteaa I, Casasb AM, Berenguer-Fornerb C, Colomer-Diagoc C, Roselló-Miranda B. Pragmatic competence of children with autism spectrum disorder. Impact of theory of mind, verbal working memory, ADHD symptoms, and structural language. Appl Neuropsychol Child. 2019;8(2):101-12. https://doi.org/10.1080/21622965.2017.1392861 PMID: 29161137. https://doi.org/10.1080/21622965.2017.13...	Spain	Cross-sectional analytical	ASD: 52 children TD: 37 children (18 girls)	Children’s Communication Checklist 2 (CCC-2)	Pragmatic	Children with ASD had stereotypical language, difficulty in initiation, use of context and nonverbal language, and included irrelevant details in the narrative.
	Spain	Cross-sectional analytical	7 to 11 years	Children’s Communication Checklist 2 (CCC-2)	Pragmatic
Friedman, Sterling, 2019³3. Silva EAM. Transtorno do Espectro Autista (TEA) e a linguagem: a importância de desenvolver a comunicação. Revista Psicologia & Saberes. 2020;9(18):174-88.	USA	Narrative literature review	74 studies	Not applicable	Pragmatic Morphosyntactic Semantic	Children with ASD had: - Difficulties with maintaining the topic, greetings and goodbyes, changing appropriate direction, and using conversation repair strategies. - Difficulties with sentence structuring, regular and irregular past tense, present tense, and regular third-person singular verbs. - Deficit in the production and understanding of personal pronouns, mental state terms, and prepositions.
Kim et al., 2018¹⁸18. Kim N, Choi U, Ha S, Lee SH, Song DH, Cheon K. Aberrant neural activation underlying idiom comprehension in Korean children with high functioning Autism Spectrum Disorder. Yonsei Med J. 2018;59(7):897-903. https://doi.org/10.3349/ymj.2018.59.7.897 PMID: 30091324. https://doi.org/10.3349/ymj.2018.59.7.89...	South Korea	Cross-sectional analytical	ASD: 15 children (1 girl) TD: 18 children (8 girls)	Korean Autism Social Language Task (KASLAT)	Pragmatic	Children with ASD had difficulties interpreting sentences according to the context, especially regarding idiomatic expressions.
	South Korea	Cross-sectional analytical	mean age ± SD ASD: 9.66 ± 2.19 TD: 10.47 ± 2.78	Korean Autism Social Language Task (KASLAT)	Pragmatic
Brynskov et al., 2017¹⁹19. Brynskov C, Eigsti I-M, Jørgensen M, Lemcke S, Bohn O-S, Krøjgaard P. Syntax and morphology in Danish-speaking children with Autism Spectrum Disorder. J Autism Dev Disord. 2017;47(2):373-83. https://doi.org/10.1007/s10803-016-2962-7 PMID: 27844246. https://doi.org/10.1007/s10803-016-2962-...	Denmark	Cross-sectional analytical	ASD: 21 children (5 girls) TD: 21 children (6 girls)	Clinical Evaluation of Language Fundamentals, Preschool, Second Edition (CELF Preschool - 2), Dansk Impressiv Morfologisk (DIM) test	Morphosyntactic	Children with ASD repeated sentences within the short-term memory period without fully understanding or knowing the grammar and had poor verbal inflection and use of pronouns. There was great variability in the results.
	Denmark	Cross-sectional analytical	ASD: 5 to 6 years TD: 4 to 6 years		Morphosyntactic
Lane et al., 2016²⁷27. Lane JD, Shepley S, Lieberman-Betz R. Promoting expressive language in young children with or at-risk for Autism Spectrum Disorder in a preschool classroom. J Autism Dev Disord. 2016;46(10):3216-31. https://doi.org/10.1007/s10803-016-2856-8 Erratum in: J Autism Dev Disord. 2017 Feb;47(2):523. PMID: 27422402. https://doi.org/10.1007/s10803-016-2856-...	USA	Cross-sectional descriptive	ASD: 4 children	Behavioral observation - free activity	Pragmatic	Children with ASD were less likely to use meaningful verbalizations to communicate desires and interests.
	USA	Cross-sectional descriptive	4 to 5 years	Behavioral observation - free activity	Pragmatic
Lee et al., 2015²⁰20. Lee SB, Song SH, Ham JH, Song DH, Cheon K. Idiom comprehension deficits in high-functioning Autism Spectrum Disorder using a Korean Autism Social Language Task. Yonsei Med J. 2015;56(6):1613-8. https://doi.org/10.3349/ymj.2015.56.6.1613 PMID: 26446644. https://doi.org/10.3349/ymj.2015.56.6.16...	South Korea	Cross-sectional analytical	ASD: 16 children (4 girls) TDAH: 16 children (2 girls) TD: 10 children	Korean Autism Social Language Task (KASLAT)	Pragmatic	Children with ASD faced greater difficulty than TD children in understanding idiomatic expressions. They failed to consider the social context and tended to interpret expressions literally.
	South Korea	Cross-sectional analytical	mean age ± SD ASD: 9.31 ± 1.70 ADHD: 8.00 ± 1.59	Korean Autism Social Language Task (KASLAT)	Pragmatic
Suh et al., 2014²¹21. Suh J, Eigsti I, Naigles L, Barton M, Kelley E, Fein D. Narrative performance of optimal outcome children and adolescents with a history of an Autism Spectrum Disorder (ASD). Journal Autism Dev Disord. 2014;44(7):1681-94. https://doi.org/10.1007/s10803-014-2042-9 PMID: 24500659. https://doi.org/10.1007/s10803-014-2042-...	USA	Cross-sectional analytical	ASD (previous treatment and no current symptoms): 15 children. High-functioning ASD: 15 children TD: 15 children	Language Data Exchange System (CHILDES)	Morphosyntactic Pragmatic	Children with ASD without apparent symptoms and high-functioning ASD had self-correction disfluency and idiosyncratic language. All three groups had well-developed morphological and syntactic language skills.
	USA	Cross-sectional analytical	9 to 15 years	Language Data Exchange System (CHILDES)	Morphosyntactic Pragmatic
Paul et al., 2010²²22. Paul R, Orlovski SM, Marcinko HC, Volkmar F. Conversational behaviors in youth with high-functioning ASD and Asperger syndrome. Journal Autism Dev Disord. 2009;39(1):115-25. https://doi.org/10.1007/s10803-008-0607-1 PMID: 18607708. https://doi.org/10.1007/s10803-008-0607-...	USA	Cross-sectional analytical	ASD: 9 children Asperger: 15 children Pervasive developmental disorder-not otherwise specified: 5 children TD: 26 children.	Pragmatic Rating Scale (PRS) Coding	Pragmatic	Children with ASD had difficulties in managing topics and information related to difficulties in presuppositional skills and obtaining reciprocity related to attention and sensitivity to the partner's verbal and nonverbal cues. Difficulties in both verbal and nonverbal skills to maintain a balanced conversational exchange.
	USA	Cross-sectional analytical	2 to 18 years	Pragmatic Rating Scale (PRS) Coding	Pragmatic
Amato, Fernandes, 2010²³23. Amato CAH, Fernandes FDM. O uso interativo da comunicação em crianças autistas verbais e não verbais. Pró-Fono R. Atual. Cient. 2010;22(4):373-8. https://doi.org/10.1590/S0104-56872010000400002 https://doi.org/10.1590/S0104-5687201000...	Brazil	Cross-sectional analytical	ASD: 20 children (3 girls)	Pragmatic test - ABFW	Pragmatic	Children with ASD had difficulty interacting with others. Both nonverbal and verbal children with ASD made great use of gestures to communicate. The group of verbal children with ASD use more the verbal environment and less the vocal environment than nonverbal children with ASD, as observed in TD children.
	Brazil	Cross-sectional analytical	2 to 10 years	Pragmatic test - ABFW	Pragmatic
Saad, Godfield, 2009²⁶26. Lewis FM, Murdoch BE, Woodyatt GC. Communicative competence and metalinguistic ability: Performance by children and adults with Autism Spectrum Disorder. J Autism Dev Disord. 2007;37(8):1525-38. https://doi.org/10.1007/s10803-006-0265-0 PMID: 17665298. https://doi.org/10.1007/s10803-006-0265-...	Brazil	Narrative literature review	27 studies	Not applicable	Pragmatic Semantic	Children with ASD had greater difficulties in understanding idiomatic expressions than TD children and those with ADHD. Also, children with ASD tended not to consider the social context and interpret expressions literally.
Suh et al., 2014²¹21. Suh J, Eigsti I, Naigles L, Barton M, Kelley E, Fein D. Narrative performance of optimal outcome children and adolescents with a history of an Autism Spectrum Disorder (ASD). Journal Autism Dev Disord. 2014;44(7):1681-94. https://doi.org/10.1007/s10803-014-2042-9 PMID: 24500659. https://doi.org/10.1007/s10803-014-2042-...	USA	Cross-sectional analytical	ASD (previous treatment and non-apparent current symptoms): 15 children. High-functioning ASD: 15 children TD: 15 children	Language Data Exchange System (CHILDES)	Morphosyntactic Pragmatic	Children with ASD without apparent symptoms and high-functioning ASD had self-correction disfluency and idiosyncratic language. All three groups had well-developed morphological and syntactic language skills.
	USA	Cross-sectional analytical	9 to 15 years	Language Data Exchange System (CHILDES)	Morphosyntactic Pragmatic
Paul et al., 2010²²22. Paul R, Orlovski SM, Marcinko HC, Volkmar F. Conversational behaviors in youth with high-functioning ASD and Asperger syndrome. Journal Autism Dev Disord. 2009;39(1):115-25. https://doi.org/10.1007/s10803-008-0607-1 PMID: 18607708. https://doi.org/10.1007/s10803-008-0607-...	USA	Cross-sectional analytical	ASD: 9 children Asperger: 15 children Pervasive developmental disorder-not otherwise specified: 5 children TD: 26 children	Pragmatic Rating Scale (PRS) Coding	Pragmatic	Children with ASD had difficulties in managing topics and information, related to difficulties in presuppositional skills, and obtaining reciprocity, related to attention and sensitivity to the partner's verbal and nonverbal cues. Difficulties in both verbal and nonverbal skills to maintain a balanced conversational exchange.
	USA	Cross-sectional analytical	2 to 18 years	Pragmatic Rating Scale (PRS) Coding	Pragmatic
Amato, Fernandes, 2010²³23. Amato CAH, Fernandes FDM. O uso interativo da comunicação em crianças autistas verbais e não verbais. Pró-Fono R. Atual. Cient. 2010;22(4):373-8. https://doi.org/10.1590/S0104-56872010000400002 https://doi.org/10.1590/S0104-5687201000...	Brazil	Cross-sectional analytical	ASD: 20 children (3 girls)	Pragmatic test - ABFW	Pragmatic	Children with ASD had difficulty interacting with others. Both nonverbal and verbal children with ASD made great use of gestures to communicate. The group of verbal children with ASD used more the verbal environment and less the vocal environment than nonverbal children with ASD, as observed in TD children.
	Brazil	Cross-sectional analytical	2 to 10 years	Pragmatic test - ABFW	Pragmatic
Saad, Godfield, 2009²⁶26. Lewis FM, Murdoch BE, Woodyatt GC. Communicative competence and metalinguistic ability: Performance by children and adults with Autism Spectrum Disorder. J Autism Dev Disord. 2007;37(8):1525-38. https://doi.org/10.1007/s10803-006-0265-0 PMID: 17665298. https://doi.org/10.1007/s10803-006-0265-...	Brazil	Narrative literature review	27 studies	Not applicable	Pragmatic Semantic	Children with ASD had greater difficulties in understanding idiomatic expressions than TD children and those with ADHD. Also, children with ASD tended not to consider the social context and interpret expressions literally.
Lewis et al., 2007²⁴24. Saad AGF, Goldfeld M. A ecolalia no desenvolvimento da linguagem de pessoas autistas: uma revisão bibliográfica. Pró-Fono R. Atual. Cient. 2009;21(3):255-60. https://doi.org/10.1590/S0104-56872009000300013 https://doi.org/10.1590/S0104-5687200900...	Australia	Cross-sectional analytical	ASD: 20 children (4 girls) TD: 28 children	Test of Language Competence-Expanded Edition (TLC-E) The Test of Nonverbal Intelligence-Second Edition (TONI-2)	Pragmatic	Children with ASD were less skilled at resolving ambiguity, understanding inferential language, and using linguistic flexibility to produce speech within a communicative situation.
	Australia	Cross-sectional analytical	ASD: 9 to 17 years		Pragmatic
Stone et al., 1997²⁵25. Stone WL, Ousley OY, Yoder PJ, Hogan KL, Hepburn SL. Nonverbal communication in two- and three-year-old children with Autism. J Autism Dev Disord. 1997;27(6):677-96. https://doi.org/10.1023/a:1025854816091 PMID: 9455728. https://doi.org/10.1023/a:1025854816091...	USA	Cross-sectional analytical	ASD: 14 children Language delay: 14 children	Prelinguistic Communication Assessment (PCA)	Pragmatic	Children with ASD were more likely to request objects or actions and less likely to direct the examiner's attention to an object or activity of interest (i.e., comment). They also demonstrated a lower rate and proportionally fewer gestures associated with commenting (i.e., pointing and showing objects), a lower rate, and proportionally fewer acts involving staring. They performed direct manipulation of the examiner's hand, mainly to request.

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[1] Corresponding author: Denise Brandão de Oliveira e Britto, Avenida Professor Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 - Belo Horizonte, MG, Brazil. E-mail: denise.bob@gmail.com