Speaking the same language? Comparing the profile of language and discourse skills in school-aged autistic females and males with typical-range, intellectual functioning

Abstract

Females who meet criteria for autism spectrum disorder (ASD) are at greater risk than males of being undiagnosed (Dworzynski et al, 2012), or being diagnosed with other conditions (Giarelli et al, 2010). Currently, females represent only a quarter of the total diagnosed population (Loomes et al, 2017) and are particularly under-represented in higher IQ groups (≥70: Nicholas et al, 2008). A contributing factor in this discrepancy is the poorly understood presentation of surface behaviours associated with a female phenotype of ASD (Kreiser & White, 2014). Research suggests a more subtle presentation for autistic females in terms of play (Knickmeyer et al, 2008) and social behaviours (Head et al, 2014; Park et al, 2012), when compared with autistic males. Prior to this publication, there has been no dedicated analysis of language and communication profiles in higher ability autistic females compared to autistic males. Neither have there been comparisons of these measures with gender-matched typically developing (TD) controls. Preliminary research indicates the likelihood of gender differences in this area (Conlon et al, 2019; Kauschke et al, 2016). Exploring this profile has important implications for the ASD diagnostic domain of social communication, and accurate assessment of autistic females with higher cognitive ability. This thesis draws together research from three studies to present a comprehensive analysis of the language and communication profiles of autistic females (PIQ≥70). In so doing, it also provides further insight into the assessment of language in autistic children (of both genders) with higher cognitive ability. It investigates whether there are group and gender differences in structural or pragmatic language according to direct assessment (Study one) and functional reported measures (Study two). It also explores how autistic girls and boys with higher cognitive ability experience communication breakdown, and what impact this has on their wellbeing and relationship building (Study three). Methodological design compared 13 autistic females (performance IQ≥70) with matched autistic male and TD controls (8y11m-11y6m). In Study one, direct assessments were used to identify structural and pragmatic language profiles. In Study two, functional communication was assessed by clinician/researcher observations and self, parent and teacher reports. In Study three, qualitative accounts of the impact of communication breakdown (on well-being and relationship building) were reported by a subset (n=12) of autistic females and males, and analysed using an Interpretative Phenomenological Approach. Results from Study one showed differing language and communication profiles for autistic females compared to autistic males (PIQ≥70) and TD controls, using a range of direct assessments. TDs performed better than ASD children on above sentence level tasks. Group and gender differences were demonstrated on measures of semantic category generation, pragmatic inference and language of emotion, with TD females performing best, autistic males worst, and autistic females somewhere in between (generally alongside TD males). Observable pragmatic skills, as identified by the clinician/researcher, showed a similar pattern in Study two. There were clear biases in how respondents rated the functional communication difficulties of the different groups of children. Parents typically rated autistic females with more difficulties than would be anticipated from either clinician or teacher reports. However, parents and teachers both identified most emotional difficulties in the autistic female group. Self-report measures and qualitative interviews demonstrated the validity of including autistic children with higher cognitive ability in assessment processes. In Study three the autistic females proved particularly capable of providing rich descriptive data when given appropriate support. Qualitative analysis found that, despite their relatively subtle profile of language and communication impairment, autistic females and males consistently reported concerns around functionality, describing a direct impact on emotional well-being and relationship building. In conclusion, this research demonstrates the negative impact of relatively subtle communication difficulties experienced by autistic children (IQ≥70). It shows a different profile of language and communication skills for autistic females compared to autistic males and TD peers, reflecting research in the wider domain (Head et al, 2014; Knickmeyer et al, 2008; Park et al, 2012). The subtle presentation of language and pragmatic difficulties demonstrated in autistic females (when compared to autistic males) may in part explain poorer diagnostic rates for this group. However, findings representing their relative disadvantage when compared to TD females will likely impact on functional communication in gender-matched social groups. In interviews autistic children described the negative impact of communication breakdown on well-being, as well as relationship building with TD peers. Our results have implications for clinical practice and future research in the fields of gender differences and language and communication profiles for autistic children (IQ≥70).

Date of Award	31 Dec 2020
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Catherine Adams (Supervisor) & Jenny Freed (Supervisor)