Expressive skills higher than receptive in autism

Have you ever had a student who scored higher on expressive language than receptive on a standardized test? If not yet, it’s something you’ll see sooner or later, and is more likely to happen in certain populations than others. Recall how Haebig & Sterling found this to be the case sometimes for autism, and also occasionally Fragile X? There are quite a few studies in the literature demonstrating this effect in children with autism, but expected proportions are all over the place. This month’s article importantly demonstrates that the receptive­–expressive discrepancy is age-dependent.
 
The data from this study is pooled from previous longitudinal studies. They examined Preschool Language Scale scores of children with autism, and found that the majority of children with autism had receptive language scores lower than expressive between ages two and three, but as they approached ages four and five, the discrepancy disappeared. Now, a few things to note:

  1. They didn’t examine children older than age 5 ½, so we don’t know if the discrepancy may reappear or not for some kids.
  2. This study included few toddlers with very-low language scores, and children with more severe language disorders may be less likely to show an expressive language advantage.
  3. When examining previous literature along with this, it appears that a clinician could expect to see approximately 1/3 to 1/2 of an early childhood caseload of children with autism to demonstrate an expressive language advantage. But—again—it depends entirely on exactly what ages you’re looking at, what language measures are used, the range of severity of children with autism you’re considering, and perhaps other factors as well.

 
In addition to examining the scores of children with autism, the authors also looked at scores of late talkers (who did not later receive an autism diagnosis) and found that the receptive scores of these children were all higher than expressive. This information can support clinicians in understanding the likely trajectory of early childhood students on their caseload.
 
The authors suggest, “…these results underscore the notion that best clinical practice is to consider both receptive and expressive language during assessment rather than just considering overall language level.” They also state, “…most treatments for ASD do not directly target comprehension, a point that has been previously criticized (Camarata, 2014),” and, “…parents and clinicians should concentrate on what toddlers with ASD understand as well as focusing on their language production.

Davidson, M.M., & Weismer, S.E. (2017). A discrepancy in comprehension and production in early language development in ASD? Is it clinically relevant? Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.3109/17549507.2013.858773.