An official website of the United States government
Background: "Frank autism," recognizable through the first minutes of an interaction, describes a behavioral presentation of a subset of autistic individuals that is closely tied to social communication challenges, and may be linked to so-called "prototypical autism." To date, there is no research on frank autism presentations of autistic adolescents and young adults, nor individuals diagnosed with autism spectrum disorder (ASD) in childhood who do not meet diagnostic criteria during or after adolescence (loss of autism diagnosis, LAD). In addition, there are currently no data on the factors that drive frank autism impressions in these adolescent groups. Methods: This study quantifies initial impressions of autistic characteristics in 24 autistic, 24 LAD and 26 neurotypical (NT) individuals ages 12 to 39 years. Graduate student and expert clinicians completed five-minute impressions, rated confidence in their own impressions, and scored the atypicality of behaviors associated with impressions; impressions were compared with current gold-standard diagnostic outcomes. Results: Overall, clinicians' impressions within the first five minutes generally matched current gold-standard diagnostic status (clinical best estimate), were highly correlated with ADOS-2 CSS, and were driven primarily by prosodic and facial cues. However, this brief observation did not detect autism in all cases. While clinicians noted some subclinical atypicalities in the LAD group, impressions of the LAD and NT groups were similar. Limitations: The brief observations in this study were conducted during clinical research, including some semi-structured assessments. While results suggest overall concordance between initial impressions and diagnoses following more thorough evaluation, findings may not generalize to less structured, informal contexts. In addition, our sample was demographically homogeneous and comprised only speaking autistic participants. They were also unmatched for sex, with more females in the non-autistic group. Future studies should recruit samples that are diverse in demographic variables and ability level to replicate these findings and explore their implications. Conclusions: Results provide insights into the behavioral characteristics that contribute to the diagnosis of adolescents and young adults and may help inform diagnostic decision making in the wake of an increase in the demand for autism evaluations later than childhood. They also substantiate claims of an absence of apparent autistic characteristics in individuals who have lost the diagnosis.
more »
« less
This content will become publicly available on August 1, 2026
Associations between pragmatic language and Theory of Mind in individuals with a history of autism and those who have lost the autism diagnosis
Although theory of mind (ToM) is seen as a primary contributor to pragmatic language use in autistic individuals, less work has considered the influence of structural language. This study examines grammaticality judgements, ToM (Reading the Eyes in the Mind, Social Attribution Test), and pragmatic language (a de novo measure based on Pragmatic Language Scales), and their associations, in three groups with heterogenous abilities: Current autism (n = 36); those with a history of autism spectrum disorder, who no longer display symptoms ( “loss of autism diagnosis”, LAD; n = 32), and non-autistic (n = 36) adolescents and adults with fluent verbal skills. Results showed pragmatic difficulties in autism, relative to both other groups, difficulties in affective ToM relative to both other groups, and difficulties in structural language relative to neurotypical controls; LAD individuals showed no impairments. While pairwise associations of structural language and matrix reasoning with pragmatic language were observed, ToM was the only unique predictor of pragmatic language when all measures were included in the models. Results suggest complex interactions among pragmatic and structural language, and ToM, and that pragmatic language improves meaningfully with broad changes in broad aspects of autism when individuals lose the autism diagnosis.
more »
« less
- Award ID(s):
- 2152202
- PAR ID:
- 10613623
- Publisher / Repository:
- NSF Public Access Repository
- Date Published:
- Journal Name:
- Philosophical transactions Royal Society Biological sciences
- ISSN:
- 1471-2970
- Subject(s) / Keyword(s):
- Autism spectrum disorder Theory of Mind Loss of autism diagnosis (LAD) optimal outcomes
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
More Like this
-
-
Language in autism is heterogeneous, with a significant proportion of individuals having structural language difficulties and inclusion of language impairment as a specifier under Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria for autism. This systematic review asked: What are the reporting patterns of variables pertaining to structural language in autism prior to and after publication of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.)? What norm-referenced assessments does research use to characterize the language abilities of autistic individuals with respect to language impairment? This preregistered review (PROSPERO: CRD42021260394) followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches took place in September 2022 and included Linguistics and Language Behavior Abstracts, PsycINFO, PubMed, and the Directory of Open Access Journals. Search terms included three essential concepts: autism, language, and age. Two coders independently screened and evaluated articles. Searches yielded 57 qualifying studies, with mostly consistent reporting practices prior to and after the Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Studies varied in how they defined language groups and in what norm-referenced measures they used. Interpreting research on structural language in autism requires attention to diagnostic and grouping criteria. Although inconsistency in reporting in original studies limited this review, better understanding the available information on structural language in autistic individuals aged 3–21 years may support identification of language needs. Lay abstractUnder the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), language impairment can co-occur with autism. It is not yet clear how research defines, reports, and characterizes structural language abilities of autistic individuals eligible for school-based special education services (aged 3–21 years) in the United States. In the United States, students typically must be formally diagnosed to be eligible for services and supports. However, the quality of diagnosis is only as good as the research evidence on which diagnosis depends. To evaluate evidence quality, we examined how studies of school-aged autistic individuals report assessments of language ability. This systematic review included 57 studies using English language age-referenced assessments used to measure structural language. Findings showed many differences across studies in how language abilities were measured and reported. Also, none of the studies fully reported the variables relevant to characterizing language impairment. Outcomes were similar across versions of the Diagnostic and Statistical Manual of Mental Disorders. Findings indicate that researchers and clinicians should pay attention to reporting diagnostic and grouping criteria. Carefully interpreting research evidence is critical for ensuring that diagnostic criteria and supports are representative of and accessible to autistic individuals and relevant parties.more » « less
-
Abstract This study explores the intersection of Theory of Mind (ToM) abilities and driving performance among novice drivers, with a focus on autistic individuals. The purpose is to investigate how ToM deficits may impact driving behaviors and decision-making, ultimately informing the development of tailored interventions and training programs for autistic drivers. We conducted a series of driving simulations using a custom-built driving simulator, capturing multimodal data including driving performance metrics, attention allocation, and physiological responses. Participants were categorized based on NEPSY scores, which assess ToM abilities, and self-reported autism spectrum disorder (ASD) diagnosis. Driving tasks were designed to simulate real-world scenarios, particularly focusing on intersections and merging, where ToM skills are crucial for safe navigation. Our analysis revealed differences in driving behaviors among participants with varying ToM abilities as determined through the NEPSY. Participants with lower NEPSY scores exhibited less smooth driving behaviors, increased risk-taking tendencies, and differences in attention allocation compared to those with higher scores. Alternatively, individuals with ASD displayed comparable driving patterns overall. ToM abilities influence driving behaviors and decision-making, particularly in complex social driving scenarios. Tailored interventions addressing ToM deficits and stress management could improve driving safety and accessibility for autistic individuals. This study underscores the importance of considering social cognitive factors in driving education and licensure pathways, aiming for greater inclusivity and accessibility in transportation systems.more » « less
-
null (Ed.)Abstract Beyond the symptoms which characterize their diagnoses, individuals with autism spectrum disorder (ASD) show enhanced performance in simple perceptual discrimination tasks. Often attributed to superior sensory sensitivities, enhanced performance may also reflect a weaker bias towards previously perceived stimuli. This study probes perceptual inference in a group of individuals who have lost the autism diagnosis (LAD); that is, they were diagnosed with ASD in early childhood but have no current ASD symptoms. Groups of LAD, current ASD, and typically developing (TD) participants completed an auditory discrimination task. Individuals with TD showed a bias towards previously perceived stimuli—a perceptual process called “contraction bias”; that is, their representation of a given tone was contracted towards the preceding trial stimulus in a manner that is Bayesian optimal. Similarly, individuals in the LAD group showed a contraction bias. In contrast, individuals with current ASD showed a weaker contraction bias, suggesting reduced perceptual inferencing. These findings suggest that changes that characterize LAD extend beyond the social and communicative symptoms of ASD, impacting perceptual domains. Measuring perceptual processing earlier in development in ASD will tap the causality between changes in perceptual and symptomatological domains. Further, the characterization of perceptual inference could reveal meaningful individual differences in complex high-level behaviors.more » « less
-
Schaeffer, J; Novogrodsky, R; Perovic, A; Prévost, P; Tuller, L (Ed.)Alongside the behavioral features of autism, this neurodevelopmental disorder is characterized by important differences in the neural circuitry underlying language processing. Regarding brain structure, most neurotypical individuals have larger left-hemisphere volumes of brain regions that are important for language, compared to the same regions in the right hemisphere (the right half of the brain). This asymmetry is due to neural specialization of left hemisphere regions for the purpose of language functions. In contrast, the brains of autistic individuals seem to be more symmetrical, suggesting that language difficulties are associated with reduced left hemisphere specialization for language in the brain. The activity of brain regions involved in language also differs in autism. Examining brain activity reveals nuanced and important differences in the processes underlying language production and comprehension in neurotypical and autistic individuals, even when their language behavior appears similar.more » « less
