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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.
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This content will become publicly available on November 1, 2025
Investigating frank autism: clinician initial impressions and autism characteristics
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.
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- Award ID(s):
- 2152202
- PAR ID:
- 10613721
- Publisher / Repository:
- NSF Public Access Repository
- Date Published:
- Journal Name:
- Molecular autism
- ISSN:
- 2040-2392
- Subject(s) / Keyword(s):
- Autism diagnosis Autism in adulthood Five-minute impressions Loss of autism diagnosis Optimal outcomes Prototypical autism
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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