Autism and SLI: diagnostic distinctions
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The document discusses the diagnostic distinctions between Autism Spectrum Disorder (ASD) and Specific Language Impairment (SLI), suggesting that some children with language impairments exhibit autistic features without meeting the full criteria for autism. It highlights the overlap in language use and autistic-like behaviors in children with SLI, and emphasizes the challenges in diagnosis due to the evolving clinical presentations as children grow. The document also touches on potential revisions to diagnostic classifications considering the complexities of these disorders.
Autism and SLI: diagnostic distinctions
- 1. Autism and specific language impairment: diagnostic distinctions Dorothy V. M. Bishop Dorothy V. M. Bishop Dorothy V. M. Bishop
- 2. The traditional view Specific Autistic Language disorder Impairment
- 3. Textbook view of specific language impairment (SLI) • Selective problem with language development • Other aspects of development – self help skills, socialisation, nonverbal abilities, motor skills – all developing normally • Overall impression is that language is like that of a much younger child
- 4. Textbook view of autistic disorder • Difficulties are pervasive and affect three areas of development (the autism ‘triad’) • Communication • Social interaction • Behaviour/interests – repetitive and restricted • Qualitative differences from typical development
- 5. The autistic triad social communication autistic disorder interests
- 6. However! Some children don’t fit neatly into these categories
- 7. Evidence for development of autistic features in some children with receptive language impairments Bartak, L., Rutter, M., & Cox, A. (1975). A comparative study of infantile autism and specific developmental receptive language disorder: I. The children. British Journal of Psychiatry, 126, 127-145.
- 8. Selection criteria: Bartak et al, 1975 • Impaired verbal comprehension • Boys, aged 5-10 years • Nonverbal IQ of 70+ • Normal hearing • No neurological disease 19 23 receptive 5 mixed autistic language disorder disorder
- 9. proportion Very similar language findings for autistic and language-impaired
- 10. Bartak et al: nonlanguage autistic receptive SLI lacks imaginative play attachment to odd objects resistance to change ritualistic activities quasi-obsessional activities difficult adaptation to new situations 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 proportion But very different behaviour findings for autistic and language-impaired
- 11. Bartak et al: language use autistic receptive SLI never used gesture fails to respond to questions no spontaneous chat inappropriate remarks metaphorical language (ever) stereotyped utterances (ever) echolalia (ever) pronoun reversal (ever) 0 0.2 0.4 0.6 0.8 1 proportion And very different in language use for autistic and language-impaired
- 12. autistic-like behaviours seen in SLI at follow-up autistic receptive SLI rituals lacks imaginative play stereotyped mannerisms fails to show sympathy no group participation metaphorical language stereotyped utterances 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 proportion But SLI start to show more autistic behaviours at follow-up in middle childhood Cantwell, D., et al. (1989). Infantile autism and developmental receptive dysphasia: a comparative follow-up into middle childhood. J Autism and Developmental Disorders, 19, 19-31.
- 13. Howlin et al, 2000 • Follow-up of original sample into adulthood • Some of the original language-impaired sample show more evidence of social and behavioural problems, similar to autism Howlin, P., Mawhood, L., & Rutter, M. (2000). Autism and developmental receptive language disorder - a comparative follow-up in early adult life. II. Social, behavioural, and psychiatric outcomes. Journal of Child Psychology and Psychiatry, 41, 561-578.
- 14. Example of man with receptive SLI diagnosis in childhood "In all aspects of self-care he was entirely independent and he could use a telephone and manage his finances himself. Most of his spare time was spent pursuing his preoccupation with buses and his less intense interest in CB radio. He spent a lot of time hanging around bus stations, going on bus journeys when he could afford it, and looking at bus magazines. His social overtures were somewhat limited and he would speak if spoken to but would not make the first move. There were two friends that he visited regularly; one shared his interest in buses, the other was interested in CB radio. These relationships were clearly selective, did involve some apparent pleasure in each other's company, and some sharing of confidences, but there was still nonetheless a slightly odd quality to them because of their restricted range of interests. He did not appear to be lonely." (p. 384).
- 15. Autistic-like impairments in communication and social interaction in some cases of language impairment
- 16. Bishop & Norbury, 2002 • Study of children receiving special educational provision for language/communication disorders • Direct observation, language assessment and parental report • Significant numbers of children with autistic-like language features but who did not meet criteria for autism on ‘gold standard’ autism assessments Bishop, D. V. M., & Norbury, C. F. (2002). Exploring the borderlands of autistic disorder and specific language impairment: A study using standardised diagnostic instruments. Journal of Child Psychology and Psychiatry, 43, 917-929.
- 17. Fractionating the autistic triad communication social autistic disorder Elements of the triad that form autistic disorder can be dissociated: many children with just one or two areas of difficulty interests
- 18. Diagnostic dilemmas q Diagnosis complicated by: q Changing clinical picture with age q Difficulties in evaluating autistic-like symptoms in children with receptive language problems
- 19. Diagnostic dilemmas, ctd. q Categorical diagnosis not well suited to capturing clinical variation q Textbook cases of SLI and autism are easy to recognise but many children less clearcut q No clear dividing line between SLI and autism q Current deliberations for revisions of DSM and ICD diagnostic classifications: Considering removing requirement of third triad element (repetitive behaviour) for ASD diagnosis Considering adding new category of ‘social communication impairment’ that would incorporate intermediate cases