Current Issue

According to the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) of the American Psychiatric Association, the definition and diagnostic criteria for autism spectrum disorder (ASD) include deficits in social communication, and repetitive behaviors or interests. Due to defects in social communication, a critical criterion for ASD, it is difficult to have social interaction and conversation with others, and problems may occur in verbal and non-verbal communication for social interactions. These social communication problems are closely related to pragmatic language skills in terms of language use.

Pragmatic language skills refer to the ability to use the language appropriately in the context of social interaction or context (Bates, 1976). Since such skills are essential factors for children to build relationships with family, teachers, and peers (Russell, 2007), they are considered one of the key elements of social skills, in addition to school life and academic achievement. It is universally acknowledged that pragmatic language difficulties are prevalent among children with ASD, although they show atypicality in various characteristics and domains of communication depending on their cognitive level or language ability (Paul & Norbury, 2012). Especially, according to Song (2019), a group that requires particular attention in pragmatic language support is high functioning ASD (HF-ASD). A child with autism spectrum disorder who exhibits cognitive abilities in the low-average to above-average range is said to have high-functioning autism spectrum disorder (Sansosti et al., 2010). It is reported that children with HF-ASD have normal language development in general. They have less trouble understanding meaning and grammar but suffer from pragmatic language difficulties. Specifically, they demonstrate less intention to communicate, use inappropriate language in a given circumstance, or fail to take turns in conversation. They use straightforward expressions that can embarrass the opponent and ask questions constantly, attempting or maintaining the interaction. In addition, there is difficulty initiating, maintaining, switching, and ending a conversation due to a lack of communication skills (Mesibov & Schopler, 1992), and they show limited and repetitive interests, which is a common characteristic of children with ASD. Children with HF-ASD speak in a long-winded and repetitive manner, are unable to comprehend complex social interactions or understand others’ emotional states, and have difficulty listening. Due to these deficiencies in pragmatic language skills, it is difficult to engage with friends and adjust to school life (Adams & Stephenson, 2016).

As mentioned above, it is necessary to evaluate pragmatic language skills in order to detect and intervene at an early stage for children with HF-ASD. Tools to evaluate pragmatic language skills are divided into indirect evaluation, in the form of questionnaires or checklists filled out by parents and caregivers, and direct evaluation, which induces specific responses in children (Song et al., 2016). Because the examination of pragmatic language skills is context-and situation-dependent, it analyzes how to conduct communication or conversation skills in natural scenarios whenever possible. For this reason, it is not easy to elicit and evaluate the ability to respond flexibly and appropriately to situations that change over time through a structured formal assessment procedure (Adams, 2002). Furthermore, in a constrained evaluation setting, there is a restriction on adequately recognizing pragmatic deficits in natural situations by dealing with a small number of particular communication partners, such as the examiner or the primary caregiver (Bishop & Adams, 1989; Kim et al., 2018; Song et al., 2016). As a result, meta-pragmatic language evaluation has lately become a viable alternative to pragmatic skills assessment that can also represent situational or context-dependent pragmatic language characteristics and even offer implications for interventions (Kim et al., 2018).

Meta-pragmatic refers to the ability to recognize and explain the interaction rules of spoken language applied to a specific situation or context (Bernicot & Laval, 1996; Karmilof-Smith, 1986). In addition, meta-pragmatic is the ability to reflect the conventional rules of language use, a term that broadly includes the ability to reflect language depending on the context (Collins et al., 2014). According to Collins et al. (2014), the development of meta-pragmatic awareness in children with typical development begins from the age of 5 to 6, and meta-pragmatic ability begins to be fully displayed after the age of 7. In the lower grades of elementary school, meta-pragmatic skills are elaborated, and understanding of upper language skills such as indirect and idiomatic expressions develops as it becomes possible to grasp the speaker’s perception of intention (Bernicot et al., 2007).

The task of evaluating these meta-pragmatic abilities consists of identifying pragmatic rules, judging the appropriateness of behaviors, and correcting and recommending inappropriate expressions (Collins et al., 2014). The meta-pragmatic ability of participants was assessed in this study using the Korean Meta-Pragmatic Language Assessment for Children (KOPLAC, Kim et al., 2018), which was established by reflecting these types of tasks. The Korean Meta-Pragmatic Language Assessment for Children (KOPLAC) is composed of subdomains such as communication regulations, discourse and story information inferences, and metalinguistic awareness. Communication regulations assess whether the speaker understands the rules that govern the content of communication in relation to the conversational partner or situation. According to previous research, this was also referred to as register variation. Register variation refers to the flexible use of one’s language forms to suit the context of the situation. These include using polite language, speaking considering the age of the conversation partner, choosing vocabulary appropriate for the conversation partner, topic, and situation, and using age-appropriate language in peer relationships (Paul, 2007). Discourse and story information inferences examine factual information, inferences with text connections and missing information, problem solving and missing information recognition based on given audiovisual storytelling. The ability to infer information through stories begins to appear around the age of 3~4, and indirect meaning inference from conversations and stories becomes possible between the ages of 4~6 (Bernicot et al., 2007). Metalinguistic awareness measures the ability to understand the concealed meaning intended by the speaker in a conversational scenario through indirect expression, reference ability to discover or explain the target suggested in the context, and irony and analogy recognition.

As discussed above, children with HF-ASD have difficulties interacting with family, peers, and teachers due to defects in pragmatic language, therefore, it is necessary to identify the pragmatic language characteristics of these children and implement effective intervention. As a result, this study attempts to compare the pragmatic language characteristics of children with HF-ASD to those of typically developing children in terms of communication regulations, discourse and story information inferences, and metalinguistic awareness.

Here are the research questions for this study:

1. Is there a significant difference in pragmatic language ability between children with high-functioning autism spectrum disorder (HF-ASD) and children with typical development?

2. Do children with high-functioning autism spectrum disorder (HF-ASD) and typically developing children show different pragmatic language abilities depending on preschool and school age?

This study evaluated the pragmatic language ability of children aged 4 to 10 years using KOPLAC, and investigated the differences between the characteristics of the pragmatic language of children with HF-ASD and typically developing children. The results are shown in Table 3.

Typically developing children’s average KOPLAC total score was 69.07 (SD=17.51), showing a significant difference compared to the average of 34.57 (SD=19.47) for HF-ASD (F=21.19, p<.001). In all subdomains, the average of the HF-ASD group was lower than those of typically developing children, and children with HF-ASD showed significantly lower results in all subdomains except for irony and analogy. In terms of communication regulations according to the conversation partners, typically developing children averaged 57.18 (SD=21.19), a significant difference from the HF-ASD average of 34.20 (SD=27.59) (F=4.693, p<.05), and typically developing children’s discourse and story information inferences averaged 80.30 (SD=11.22), which was significantly higher than the HF-ASD average of 50.93 (SD=30.30) (F=8.449, p<.01). The average difference between typically developing children and those with HF-ASD was more than 30 points, with statistically significant differences in communication regulations related to context (F=56.962, p<.001), metalinguistic awareness: indirect expressions (F=51.991, p<.001), and metalinguistic awareness: references (F=25.424, p<.001). The average scores for metalinguistic awareness: irony and metaphor in a typically developing group were 53.36 (SD=46.82), while the HF-ASD group averaged 35.58 (SD=40.46). Although there was a difference in average values, it was not statistically significant (F=.077, p>.05).

Figure 1. 
Results of KOPLAC

Note. KOPLAC=Korean Pragmatic Language Assessment for Children; TD=typically developing; ASD=autistic spectrum disorders.

The participating children were divided into preschool and school-age groups, and the pragmatic language characteristics of the typically developing group and the HF-ASD group were examined. The results are shown in Table 4, and as a result of verifying significance, no interaction effect was identified in the total score (F=.011, p>.05). Therefore, the pragmatic language ability of both groups increased when they reached school-age compared to preschool age. The results are shown to be the same in communication regulations according to conversation partners (F=.049, p>.05), metalinguistic awareness: indirect expressions (F=.002, p>.05), and metalinguistics: references (F=3.324, p>.05). Metalinguistic awareness: irony and metaphors was not tested on preschool-age children since earlier research has indicated that irony and metaphors emerge in earnest beyond the school age.

Figure 2. 
Interaction effects of group by age

However, the interaction effect was significant in communication regulations based on situational context (F=7.936, p<.01). In the case of children with HF-ASD, the school-age group average was lower than the preschool age group average, whereas typically developing children flshowed higher scores in the school-age group than the pre-school age group. Also, in both groups, the average of the school-age group was greater than the average of the preschool age group, and the average difference in the HF-ASD group was significantly larger than the average difference in the typically developing children group (F=5.331, p<.05).

This study examined how the pragmatic language characteristics of children with HF-ASD differ from those of typically developing children aged 4 to 10 years. The results of the study showed that the total pragmatic language score of children with HF-ASD was significantly lower than that of typically developing children. With the exception of irony and metaphor, children with HF-ASD showed significantly lower performance in subdomains than typically developing children. In addition, the participants were divided into preschool and school-age groups and the pragmatic language characteristics of the typically developing group and the HF-ASD group were examined. As a result, there was no interaction effect in the overall score of pragmatic language, communication regulations according to conversation partners, and metalinguistic awareness: indirect expression and metalinguistics: references. Interaction effects, on the other hand, were found to be substantial in communication regulations, discourse and discourse and story information inferences according to the situational context.

The total pragmatic language score of children with HF-ASD was significantly lower than that of typically developing children. This is consistent with the results of previous studies showing that children with HF-ASD showed lower performance than typically developing children in pragmatic skills such as topic maintenance and switching, speech correction, premise and reference ability, intention and function of communication, and information reasoning (Klin & Volkmar, 2000; Norbury et al., 2004; Simmons et al., 2014). The following is a discussion of the outcomes for each sub-area.

First, the ability to coordinate communication according to the conversation partners was significantly lower in children with HF-ASD than in typically developing children. This is consistent with studies showing that children with HF-ASD experience difficulty adequately expressing coordination according to their partners in conversational situations (Volden & Sorenson, 2009; Volden et al., 2007).

Second, children with HF-ASD had significantly lower scores in the capacity to coordinate communication based on situational context than typically developing children. Furthermore, because of their weak central cohesion, children with HF-ASD process information by focusing on a tiny section of the picture, making it difficult for them to understand the overall picture or scenario (Happé et al., 2001).

Third, children with HF-ASD had significantly lower scores in discourse and story information inferences than typically developing children. As previously stated, children with HF-ASD may have difficulty understanding and inferring the entire story due to their weak central cohesiveness (Beaumont & Newcombe, 2006; Norbury et al., 2014).

Fourth, metalinguistic awareness: indirect expressions also showed significantly lower performance in children with HF-ASD than typically developing children. This is due to the tendency to interpret the expressed words literally rather than through context, as well as the difficulty in interpreting the speaker’s intention (Happé, 1993; Happé et al., 2001; Norbury & Bishop, 2002).

Fifth, children with HF-ASD were found to have significantly low metalinguistic awareness: references. This is due to referential communication deficits that children with HF-ASD display by failing to recognize the interests of their conversation partners and responding and sharing information in accordance with their interests (Resches & Pérez Pereira, 2007; Sidera et al., 2016).

Finally, children with HF-ASD performed lower than typically developing children in metalinguistic awareness: irony and metaphor, but there was no statistically significant difference. This is inconsistent with the prior research findings which demonstrated that children with HF-ASD comprehend settings literally and have more difficulty understanding idiomatic expressions or metaphors than typically developing children (Caillies & Le Sourn-Bissaoui, 2008; Lee et al., 2014). These findings suggest that irony and metaphor comprehension reflect the sophistication and complexity of meta-pragmatic language perception, and that it should be taken into account that even typically developing children begin to develop in earnest at school age and continue until the age of 17.

Children with HF-ASD show greater achievement when they reach school age, just as typically developing children do, with the exception of communication regulations that vary depending on the situational context. Although the degree of accomplishment varies by subdomain, children with HF-ASD demonstrated greater achievement in pragmatic language skills. According to Moody (2014)’s pragmatic language intervention study, it is necessary to explicitly support the rules of language use, and in order to do so, the cognitive ability that enables such rule learning is required. In other words, intervention is possible for children with HF-ASD because there is no difference in cognitive ability from that of typically developing children, despite significant differences in pragmatic language. According to the findings of this study, performance in communication regulations and metalinguistic awareness (indirect expressions and references) depending on the conversational partners grew with reaching school age compared to preschool age, and this aspect did not differ from typically developing children. These accomplishments suggest that developmental and educational effects can be anticipated in children with HF-ASD whose cognitive capacities are within the normal range.

On the other hand, in discourse and story information inferences, both groups’ performance improved as they approached school age, although the range of improvement was substantially greater than that of typically developing children. According to Bernicot et al. (2007), the ability to infer information from stories begins to appear around the age of 3~4, and indirect meaning inferences from conversations and stories become possible between the ages of 4~6. Furthermore, while the ability to employ discourse markers diversifies by the age of 7, reference expressions emerge concurrently, and clear reference expressions in basic situations demonstrate adult-level abilities at about the age of 6 (Davies et al., 2015). Despite having average cognitive ability, children with HF-ASD, who are deficient in information inference and indirect semantics, do not process information based on social cognition as much as their peers do before entering school. However, when children reach school age, their ability to understand emotions and make causal inferences improves considerably; a significant intervention effect can be expected in this area.

Besides discourse and story information inferences, another area where the interaction effect between preschool and school-age shows is communication regulations based on situational context. According to Song et al. (2017), typically developing children showed less than 50% accuracy in the first half of school age, started to show more than 50% accuracy only when they reached school age, and reached less than 80% accuracy even at the age of 9. Situational context includes both language and non-linguistic components to actualize the speaker’s purpose and corresponding expressions in public and private contexts. While aspects other than language are incorporated, communication regulation is a challenging process even for typically developing children, and it is a particularly difficult task for children with HF-ASD who have social awareness deficiencies. Song and Kim (2018) conducted a social communication intervention for school-aged children with HF-ASD, and the mediation effect on context coordination was not identified after examining progress before and after the intervention using KOPLAC. According to the findings of this study, the average social communication of children with HF-ASD at school age was lower than at preschool age. It can be stated that the characteristics of children with HF-ASD who exhibit core deficits in social communication are reflected in these results, emphasizing the importance of appropriate intervention based on the situational context.

The understanding of idioms such as irony and metaphor is one aspect of the elaboration and complexity of metaphorical cognition, which begins to develop in earnest at school age and continues until the age of 17 (Spector, 1996). For this reason, ironies and metaphors for KOPLAC were conducted only for school-age children. There was no significant difference between peers in group comparison results, but previous studies also showed that they fail to consider social context and tend to interpret expressions literally, because autistic children find it hard to make contextual inferences in everyday speech (Dennis et al., 2001). Literal interpretation has been found to be a factor that makes understanding idioms difficult (Kerbel & Grunwell, 1998). However, considering the number of participants (21 school-age typically developing children and 13 children with HF-ASD), this remains a limitation of the study.

A follow-up study would need to increase the number of participants, specifically by dividing the school age into sub-age groups and recruiting enough participants for each group to examine how pragmatic language development continues after school age and differs from that of typically developing children. Also, it is necessary to determine the difference between the results of metapragmatic language by using alternative methods of pragmatic language evaluation rather than only a comparative study with clinical groups demonstrating pragmatic language difficulties.