JoanneVolden,Ph.D.CIRCA,Oct.29,2015

Au#smSpectrumDisorders� Problemswithsocialcommunication� Repetitivebehaviour� Bothvaryacrosschildrenandwithinachildovertime.

� Prevalence:1in68(CentresforDiseaseControl,2014)

Whatis“socialcommunica#on”?� Andwhatispragmatics?

Bob’s“joke”

Example:Bob

� Positive:� Wordswereokay.�  Sentencestructurewasfine.� Wantedtoestablishsocialcontact.�  Jokesasameanstoestablishcontact.�  Triedtoadheretosocialconventions.

Bob’scommunica#on(cont.)� Whatwaswrong?

� Didn’tunderstandthejoke.�  Linkstotopic.�  Introductionoftopic.� Howtointerspersetopicintoflow.

Whatispragma#cs?�  Isitthesamethingassocialcommunication?

�  Atleastinpart,theanswerdependsuponone’sdefinitionofpragmatics.

Defini#ons�  Broad:Behaviorsthatencompasssocial,emotional,andcommunicativeaspectsofsocialinteraction(Adamsetal.,2005;Martin&MacDonald,2003).

� Narrow:Concernedwiththeappropriateuseoflanguageacrossavarietyofsocialcontexts(Berko-Gleason,2005).

Modelsofpragma#cs(Owens,1999)

SocialCommunica#oninASD� Socialcommunicationdeficitspersisteveninthehighestfunctioningandhighestachievinggroups(Tager-Flusberg,Paul&Lord,2005;Kelleyetal.,2006)

�  Kelleyetal.foundsemanticandpragmaticproblemsevenin“optimaloutcome”children.

�  Implication:Easytomissproblemsifyou’rerelyingonstandardizedtests.�  Subtleproblemsmaystillbepresentwhichwillmanifestselveswhenmoveintohighergradeswithmorecomplexdemands.

ImpactofCommunica#veImpairment� Needcompetencetofunctioninschoolandsociety(Bryant,2009).

� Thosewhoaremorecompetentarebetterliked(Brinton&Fujiki,1995;Bryant,2009).�  Implicationsforpsychologicalwell-being,andsubsequentacademicandworkskills(Rubin,Bukowski,&Parker,1998).

�  Adolescentsandadultsrelatetoeachotherthroughconversation,soifthesearelacking,youthwithASDareatadisadvantage.�  Alsocomplicatedbypossiblepoorunderstandingof“friendship”andwhatitinvolves(Turner,2008).

Impact(cont.)� Avoidanceofsocialsituations,generalizedanxiety,problemsmaintainingajobandestablishingfriends(Landa,2000;Howlin,2003).

� Overall,socialandcommunicativeaspectsmoredirectlyrelatedtoclinicaloutcomesthananyotheraspectofthedisorder(Venter,Lord&Schopler,1992;Howlin,2003).

Anecdotaldescriptors�  “peculiarandoutofplaceinordinaryconversation,irrelevant”(Kanner,1946)

�  “formal,demonstratingalackofeaseintheuseofwords”(Rutter,1965)

�  “stereotypic,inappropriate”(Bartak,Rutter&Cox,1975)�  “metaphorical”(Cantwell,Baker,&Rutter,1978;Kanner,1946).

Whattypesofproblems?TherehavebeenanumberofstudiesthathaveestablishedthatspecificpragmaticproblemsexistinASD.�  E.g.Initiatingconversation,introducingtopics,developingtopicsappropriately,switchingtopicsappropriately,interruptingconversations,introducingunusualtopics.

�  Inalmostanyareaofpragmaticsthatonecouldname,significantdifferencesfromthetypicalpopulationhavebeenfound.

But,thestoryisn’ten#relystraighQorward…� Neologismsandidiosyncraticlanguage(Volden&Lord,

1991)

�  4groups(MA:HFAmatchedtotypicaladults,autismplusintellectualdisabilitymatchedtopeerswithintellectualdisability,allmatchedonCA).

�  Examinedlanguagesamplesfrom2oftheitemsontheADOS(descriptionofaposter,socialconversation)

�  Foundveryfewtrueneologisms,andnosignificantgroupdifferencesonfrequency.

Wedidfind…� …thatmoreoftheparticipantsinthegroupswithASDusedneologismsandidiosyncraticlanguage…sotheywereinfrequentbutsalient.

� Thisnotion,thatarelativelysmallamountofatypicalbehaviorcanhavealargeimpactonlisteners,hasalsobeennotedbyBishop(1998),andrecentlybyPauletal.,(2009).

Variability� Symptomsvarywithinpersonovertimeandacrosscases.

� Nosingleareaofpragmaticsthatisalwaysimpaired.

� Evenwithinindividual,skillsnotgenerallyabsententirely,maybedemonstratedsporadically.

�  Ingroupstudies,ASDwillperformlesswellthanmatchedcontrolsonanyparticularaspectofpragmatics,butoftengreatvariabilitywithintheASDgroup

Elementsofpragma#cs� CommunicativeorSpeechActs� ConversationalManagement/DiscourseSkills

�  Turn-Taking�  Topicmanagement�  BreakdownandRepair�  Presupposition�  Style

Communica#on/SpeechActs�  Infree-playorunstructuredsituations,childrenwithASDdemonstratelessfrequentandlessvariedspeechactsthanlanguagematchedcontrols.� Moreinstrumentalspeechactsthansocialones

(Wetherby&Prutting,1984).�  Suggesteddifferentdevelopmentalorder;sequentialvs

simultaneous.

�  But,inolderchildren,highproportionofspeechactstogetattentionandtocomment(Stone&Caro-Martinez,1990).

Conversa#onalmanagement/Discourse� Difficultiesinmostareashavebeenreported,butnotallhavebeensystematicallystudied.

� Muchoftheearlyresearchweakenedby�  SmallsamplesthatvariedwidelyintermsofCAandMA

�  Failuretouseacontrolgroup.� Whencontrolswereincluded,sometimesmatchedonCA,sometimesonMA,rarelyonLA.

� Oftenfocussedonlyonverbal,andignorednonverbalaspectsofcommunication(e.g.gestures,bodylanguage).

Turn-taking� Childrenwithautism(averageCA=12;averageMA=9)lesslikelytorespondtoconversationalpartner’scomments,(Cappsetal.,1998).

� AdolescentswithASD(averageCA14.5)ratedasunresponsivetopartnercues,andwith“littlereciprocalexchange”(Paul,etal.,2009).

Repairs�  AdultswithASDwerelessflexibleintheirresponsestorequestsforclarification(Paul&Cohen,1984)

�  School-agedchildrenrespondedtostackedseriesofrequestsforclarification,andusedvarietyofstrategies,addingmoreinfoassequenceprogressed(Volden,2004).�  Evidenceinsupportofthenotionthattheyhadrepairstrategiesin

theirrepertoire,butdidn’tnecessarilyknowwhenorhowtousethem.Whengivenincreasinglydirectivepromptswereabletorepair.

�  Changeinstrategyalsoshowsabilitytorememberwhatdidn’twork,sosomedegreeofperspectivetaking.

Topic� Anecdotaldescriptionssuggestdifficultiesintopic

Irrelevant,peculiar,outofplace,metaphorical(Kanner,1946)Ambiguous,disorganized(Lovelandetal,1989)

Empiricalworkontopic�  Changetopicsmorefrequently(Curcio&Paccia,1987)�  Difficultyindistinguishing“new”from“old”information

(McCaleb&Prizant,1985)�  Useofcohesivedevices(Fineetal.,1994)�  Contingencyinpreschoolchildren(Tager-Flusberg&Anderson,

1991)�  ComparedchildrenwithautismtochildrenwithDS,in

conversationalplaysampleswithmothercollectedathome.�  BothASDandlanguage-matchedDSweremorecontingentthan

non-contingent�  ButchildrenwithASDwerelesscontingentthanchildrenwith

DownSyndrome,althoughclosertonormalpattern.�  UnlikebothtypicalsandDS,childrenwithASDdidn’tgetbetterat

buildingandmaintainingatopicastheirlanguagedevelopmentadvanced.

Topicmanagementinschoolaged�  Samefindingwithschool-ageparticipants(Cappsetal.,1998).ParticipantswithASDwerewillingtoengageandsustaindialoguewithexaminer,butdidn’textendthetopicwithnewinformation.Reliedondevelopmentallyprimitivewaysofsustainingconversation,e.g.repetition,orroutinized,oddscripts,�  E.gE:Doyoulikecrackerjacks?(3sec.pause)Ilikecrackerjacks.

�  C:Ilikecrackerjacks,doyoulikecrackerjacks?What’syourname?�  E:Cindy�  C:Ilikecrackerjacks.What’syourname?

�  Similarpatternrecentlyfoundinnarratives–ASDtellingsofnarrativesseemedmorelikeliststhanstories.Indicativeofsuperficialunderstanding(Diehl,etal.,2006)

Irrelevant/Inappropriate�  Frequentirrelevant/inappropriateremarks(Loveland&

Tunali,1991,Volden,Holdgrafer&Mulcahy,1993;Cappsetal.,1998).

�  Inataskwhereparticipantswereaskedtodescribeageometricshapetoalistener:� Didyouknowthatazebraissomethinglikeahorse?�  It’sdottedorhorsespotted.�  Theoneofthelefthasdots,theoneontherighthasbeencut.

�  Inthemidstofaconversationaboutafter-schoolactivities,�  Sabre-toothtigerscan’tfly.

Examples�  Inataskwhereparticipantswereaskedtodescribeageometricshapetoalistener:� Didyouknowthatazebraissomethinglikeahorse?�  It’sdottedorhorsespotted.�  Theoneofthelefthasdots,theoneontherighthasbeencut.

�  Inthemidstofaconversationaboutafter-schoolactivities,�  Sabre-toothtigerscan’tfly.

InappropriateUYerances� Toinvestigatedirectly,lookedforutterancesjudgedtobeinappropriate,classifiedastofeaturesledtojudgmentsofinappropriacy(Bishop&Adams,1989)

� MeanproportionofinappropriateutterancesinASD(.19)significantlydifferentfrommeanproportionincontrols(.02);t(16)=2.8,p<.02

Specificsub-types� Toolittleinformation

�  A:Wheredoyougettheskytrain?�  C:Attheend.�  A:Attheend?�  C:Attheendofthetrack.

� Toomuchinformation�  Listing10-15specificitemsinanarrativedescriptionof“whattodowhenyougotoagrocerystore”

Unusual/sociallyinappropriatecontentorstyle� A:Yougettotheendoftheskytrainandthenwhat?� C:Well,seabusisthewaytogettoskytrain.� OR� A:So,youwatchthemovie.Thenwhat?� C:Acabbagekeepsrollingupinmyhead.

Topicinadolescenceandadults�  “GoodnessofFit”:Detailedconversationalanalysisanalyzedthe“goodnessoffit”betweenadjacentutterancesinconversationbyseeinghowwellthey“meshed”.ParticipantswithAsperger’ssyndromemuchlesswell-meshedthancontrols(Adamsetal.,2002).

� Pauletal.,(2009),alsofoundthatitemsaboutprovidingirrelevantdetail,inappropriatetopicshifts,andtopicpre-occupationorperseverationdifferentiatedASDfromtypical.

Howwouldyoudescribethis?

T’sdescrip#on

�  “Iwoulddescribeitasaunilateraltrianglewithablackdotrunningstraightalongthepoint,fromtheapextothecentreofthebase,linedwithverticalstripes.”

Conversa#onalStyle?�  Significantproportionofthe“inappropriateutterances”wereinstancesofdifficultywithconversationalstyle.Notfrequent,butsalient.

�  Languageregister:� Differentlanguageregistersreflectwhospeakerisaddressing,wherehe/sheis,whatthesocialeventis,whattopicsareappropriateandthesocialrelationshipsbetweenthespeakers(Ervin-Tripp,1978)

Registerstudy(Volden,etal.,2007)� Askedparticipantstoexplain“howtogotoarestaurant”toaseriesoflistenersrepresentingdifferentlevelsoflanguagecompetence(adultexaminer,peer,baby,foreignlanguagespeaker).

� Then,administeredpromptstoseewhetherexplanationscouldbeimprovedandtodeterminepossiblesourcesofanticipateddifficultyinspontaneousadjustment.

Results�  SpeakerswithASDdiddemonstratesomesensitivitytoneedsofless

competentlistenersbysimplifyingscriptnarrative(feweracts,fewerutterances).Arguesforsomedegreeofperspective-takingskill.

�  Theywere,however,lessadeptinthatadjustmentthanappropriatelymatchedcontrols(fewerprototypicalacts,usingsignificantlymoreutterancesthanothergroups).

�  Whenprompted,performanceimproved,suggestingthatskillsmaybepresentbutnotspontaneouslyemployed,orthatskillsadditionaltoperspectivetakingareneededforsuccessfulpragmaticperformance.

�  Possibledeficitsinexecutivefunctioning,orthatASDisadisorderof

complexinformationprocessing(Minshew&Goldstein,1998)�  Clinically,skillscansometimesbeelicitedbydrawingattentionto

relevantcognitivestrategiesthatalreadyexistintheirrepertoireratherthanteachingadditionalskills.

Adults(Mitchell,2015)�  20adultswithASDmatchedto20typicalonCA,NVMA,andeducationallevel.

� Completedbatteryofformaltestsplusanalysisoflanguagesample.

�  Formaltestofpragmaticskills(CASL)showedgroupwithASDsignificantlybelowcontrols,butmeanstillwithinnormallimits.

� CommunicationChecklist–Adults(CC-A;Whitehouse&

Bishop,2009)informantmeasure,identifiedproblems.� Also,CASLscoressignificantlybelowCELFCoreLang.

Examples-LanguageSample�  Irrelevant:(Inreponseto“What’syourworkexperience?”).IworkedattheMayfairGolfandCountryClub.Inthelockerroom.Lockerroomattendantwasmyposition.Ishinedshoesforaliving.Anditwasprettygood.ThethingabouttheMayfairisthattheyhavereallyreallygoodfood.

�  Unannouncedtopicshift:(inresponseto“Whatisyourgreateststrength?”).Mysinging,Ithinkdefinitely.Myteacherwasecstaticaboutmyskill.IalreadyhadrawtalentandthankstoherIrefinedit.AndsomeofmyfavouritemusicisPinkFloyd.I’masuckerforclassicrock.

Wouldeveryoneagree?� Mitchelldidfollow-upstudywheresheevaluatedlistenerreactionstoaudio-tapedsamples.

�  59graduatestudentsratedthe“quality”oflanguagesamples.Participantswereblindtodiagnosisandsamplesrandomized.

�  “Quality”definedas(1)amountofinformationcommunicated(2)howeasyitwastounderstandthespeaker(3)howeasyitseemedfortheintervieweetoparticipateinthesituation/interaction.

Averagera#ngsofqualitybylisteners

Also,aaereachsample…�  Listenersaskedtorate,ona7pointscale,whataspectsofcommunicationinfluencedtheirratingsofquality.

� Results:Eachdomain’saverageinfluence(vocabandsyntax,fluencyandprosody,pragmatics)wassignificantlydifferentbetweengroups,aswaseachoftheasteriskedindividualaspectsonthefollowinggraphs.

Results

Finally…�  Listenersaskedtodecidewhetherornottheywouldofferasecondinterviewtotheperson,iftheywereanemployer.�  30%oftheHFAgroupvs75%ofthecontrolswouldbeofferedasecondintervieworajob.(Fisher’sexactprobability<.005)