A Discrepancy in Comprehension and Production in Early Language Development in ASD: Is it Clinically Relevant?

The comparison sample included 32 children with ASD and 32 late talkers, and the ASD children in that sample were higher functioning than other children with ASD in the larger sample, so the results may not apply to children with more severe language deficits. The late talker group included 41% who were already catching up by 30 months, so it was not a sample of persistent late talkers. The late talkers and children with ASD were assessed with different versions of the same language test, PLS-3 and PLS-4, which may affect score comparison. The groups were not perfectly matched on expressive language, and the ASD group had lower nonverbal cognition, so statistical adjustment was required. The study used a convenience and clinical sample from families willing to continue in a long study, not an epidemiological sample, so it may not represent all children with ASD. Parents reported that 67% of children with ASD received intensive autism treatment, and speech-language therapy rates changed over time, so the role of treatment in language change cannot be separated. The diagnostic accuracy estimate came from the matched comparison of 32 children with ASD and 32 late talkers, and the reported odds ratio confidence interval was 27.14 to 11057.69. The study used DSM-IV-TR criteria rather than DSM-5 criteria.

The authors declared no conflicts of interest. The supplied text does not report a funding source.

Do not conclude that a comprehension-production gap can diagnose autism or rule it out. The diagnostic numbers came from the 32-child ASD and 32-child late talker comparison that excluded some severe language deficits, and the gap was much less common by 66 months in the broader ASD sample.