Language profiles of high-functioning children with autism and children with a history of autism: What factors contribute to an optimal outcome?

Disagreement exists in the literature as to the precise nature of the language difficulties which high-functioning children with autism spectrum disorders experience. Debate also continues as to whether a small subgroup of children with autism has reached an optimal outcome in which they become virtually indistinguishable from their peers. The current study was designed to elucidate these two issues. Fourteen children with a history of autism who no longer met criteria for an autism spectrum disorder (the optimal outcome group) were compared to two other groups on a number of measures: a typically developing group matched on age, sex, and nonverbal intelligence, and a group of high-functioning children with autism matched on the same variables. The children ranged in age from eight to fourteen. The groups were tested on general language, syntax, semantics, pragmatics, social cognition, memory for faces, verbal memory, executive functioning, autism symptoms, and adaptive and problem behaviors. Results suggested that the optimal outcome group have become indistinguishable from their typically developing peers on most of the measures tested, though slight residual deficits in pragmatics and social cognition were discovered in some of these children. The high-functioning children with autism were indistinguishable from the other two groups on tests of general language and syntax, but continued to experience difficulties with pragmatic language, social cognition, executive functioning, and adaptive and problem behaviors. Different patterns of correlations between the tests were found within the groups. The optimal outcome children displayed many correlations between the language tests, and correlations between the different measures of adaptive and problem behaviors. Conversely, the high-functioning autistic group demonstrated a pattern of correlations that suggested that much of their language functioning is dependent upon nonverbal intelligence. Moreover, Theory of Mind was correlated with many of the other linguistic tests, a pattern that was not seen in the optimal outcome group. Possible developmental explanations for the differences between the groups are explored, and directions for future research to explore the developmental course of these optimal outcome children are suggested.