Pragmatics performance, the relation to symptom severity, and early clinical predictors of pragmatics in 5~6-year-old children with autism spectrum disorder

Background Pragmatic language refers to the use of spoken language to effectively convey messages across diverse social communication contexts. However, minimal longitudinal research has focused on defining early predictors of pragmatic development in children with autism spectrum disorder (ASD). Methods In the current study, 71 ASD and 38 age- and gender- matched 24- to 30-month-old typically developing (TD) children were enrolled. Social-communication, language, and parent-child interaction measures were collected for the ASD group at baseline. Three years later, all subjects were assessed for pragmatic ability via the Chinese version of Language Use Inventory (LUI-Mandarin). First, the differences of pragmatic performance between the ASD group and the TD group at follow-up were analyzed. Second, pragmatic performance was correlated with autism symptomatology at follow-up, as well as the structural language difficulties and joint engagement (JE) levels at baseline for the ASD group. Furthermore, diverse multiple regression algorithms were performed to explore the effect of the early potential predictors of pragmatic development for the ASD group. Results First, our results revealed that performance was significantly lower in the ASD group than in the TD group with respect to LUI-Mandarin Total scores and subscale scores ( t = -3.358 ~ -6.870, p <  0.05). Second, correlation analysis showed that more severe symptoms of ASD at follow-up were associated with lower LUI-Mandarin Total scores ( r = -0.489 ~ -0.853, p  < 0.05), and better language performance of Gesell ( r  = 0.555, p  < 0.05). In addition, increased proportions of supported JE(SJE) state ( r  = 0.591, p  < 0.05) were associated with higher LUI-Mandarin Total scores, while increased proportions of unengaged (UE) state were associated with lower LUI-Mandarin Total scores ( r = -0.295, p  < 0.05) for the ASD group. Third, diverse multiple regression algorithms consistently indicated that the proportions of SJE during parent-child interactions was a significant contributor to pragmatic development for the ASD group in the prediction models. Conclusion In summary, our findings suggest that pragmatic language difficulties are present in children with ASD as early as preschool age. Additionally, given the close correlation between the LUI-Mandarin and symptom severity on ADOS/ADI-R, the LUI-Mandarin might be a good way to triage children who need to wait a long time for a more extensive evaluation. Furthermore, more time occupied in SJE could be an important predictor for better pragmatic language outcomes for children with ASD.