Representational drawing ability is associated with the syntactic language comprehension phenotype in autistic individuals

The relationship between symbolic thinking and language abilities is a topic of intense debate. We have recently identified three distinct language comprehension phenotypes: command, modifier and syntactic (Vyshedskiy et al., 2024). Individuals in the command phenotype were limited to comprehension of simple commands, while those in the modifier phenotype showed additional comprehension of color, size, and number modifiers. Finally, individuals in the most-advanced syntactic phenotype added comprehension of spatial prepositions, verb tenses, flexible syntax, possessive pronouns, complex explanations, and fairytales. In this report we analyzed how these three language phenotypes differed in their symbolic thinking as evidenced by their drawing abilities. In a cohort of 39,654 autistic individuals 4- to 21-years-of-age, parents reported that ‘drawing, coloring and art’ was manifested by 36.0% of participants. Among these individuals, representational drawing was manifested by 54.1% of individuals with syntactic-phenotype, 27.7% of those with modifier-phenotype, and 10.1% of those with command-phenotype (all pairwise differences between the phenotypes were statistically significant, p  < 0.0001). The ability to draw a novel image per parent’s description (e.g. a three-headed horse) was reported by 34.6% of individuals with syntactic-phenotype, 7.9% of those with modifier- phenotype, and 1.9% of individuals with command-phenotype (all pairwise differences between the phenotypes were statistically significant, p  < 0.0001). These results demonstrate strong association between representational drawing ability and the syntactic-language-comprehension-phenotype, suggesting a potential benefit of drawing interventions in language therapy.