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Cited by 474Autism Spectrum Disorder ResearchLanguage Development and DisordersChild Nutrition and Feeding Issues

Exploring the borderlands of autistic disorder and specific language impairment: a study using standardised diagnostic instruments

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Bishop, Dorothy V.M., Norbury, Courtenay Frazier·2002·Journal of Child Psychology and Psychiatry
DOI 10.1111/1469-7610.00114
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Abstract

Background: Two studies were conducted to test claims that pragmatic language impairment (PLI – previously referred to as semantic‐pragmatic disorder) is simply another term for autistic disorder or pervasive developmental disorder not otherwise specified (PDDNOS). Method: In Study 1, 21 children aged from 6 to 9 years with language impairments were subdivided on the basis of the Children's Communication Checklist into 13 cases of pragmatic language impairment (PLI) and eight cases of typical specific language impairment (SLI‐T). Parents completed the Autism Diagnostic Interview – Revised (ADI‐R) and the Social Communication Questionnaire (SCQ), and the children were given the Autism Diagnostic Observation Schedule – Generic (ADOS‐G). In Study 2, a further 11 children with SLI‐T and 18 with PLI were assessed using the SCQ and ADOS‐G. In addition, six children diagnosed with high‐functioning autism and 18 normally developing children were assessed. Results: There was good agreement between ADI‐R and SCQ diagnoses, but poor agreement between diagnoses based on these parental report measures and those based on ADOS‐G. In many children, symptom profiles changed with age. Four PLI children from Study 1 and one from Study 2 met criteria for autistic disorder on both parental report (ADI‐R or SCQ) and ADOS‐G. Many of the others showed some autistic features, but there was a subset of children with pragmatic difficulties who were not diagnosed as having autism or PDDNOS by either instrument. These children tended to use stereotyped language with abnormal intonation/prosody, but they appeared sociable and communicative, had normal nonverbal communication, and showed few abnormalities outside the language/social communication domains. Conclusions: Presence of pragmatic difficulties in a child with communication problems should prompt the clinician to evaluate autistic symptomatology, but it is dangerous to assume that all children with pragmatic difficulties have autism or PDDNOS.

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  • The change to a two-domain model was driven by factor analytic findings supporting a single social-communication factor, the somewhat arbitrary nature of categorizing specific behaviors as social or communicative given significant overlap, and the lack of diagnostic specificity of structural language deficits in ASD.

    “This change was driven by (1) a number of factor analytic findings supporting a single social–communication factor (Gotham et al. 2007; Robertson et al. 1999); (2) the somewhat arbitrary nature of categorizing specific behaviors as social or communicative given the significant overlap (Gotham et al. 2007); and (3) the lack of diagnostic specificity of structural language deficits (i.e., in”

    From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Bishop and Norbury 2002

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  • There is low agreement between diagnoses based on anamnestic interviews (ADI-R) and those based on behavioral observations, particularly for older and atypical cases.

    “Additionally, there is some evidence that there is low agreement between diagnoses based on anamnestic interviews (ADI-R) and those based on behavioral observations, particularly for older and atypical cases, and for better performance of the behavioral observation ([22, 30, 34–40].”

    From Autism spectrum disorder in ICD-11—a critical reflection of its possible impact on clinical practice and research (2024) · cites this paper as [35]

    The ‘Relationship between ADI-R, ADOS and previous diagnoses’ section reports poor agreement between ADI-R and ADOS-G diagnoses. The ‘Clinical implications: Assessment’ section suggests that the unusual, diagnostically challenging sample may partly explain it, and ‘Clinical implications: Diagnostic issues’ discusses children whose presentation changed with age. The paper does not establish that agreement is particularly low in older or atypical cases relative to other cases. (LLM, conf=0.84)

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Research works printed but not linked: 2

  1. [16]16. Mawhood, L., Howlin, P., & Rutter, M. (2000). Autism and developmental receptive language disorder -a comparative follow-up in early adult life. II. Journal of Child Psychology and Psychiatry, 41, 561-578.
  2. [19]19. Rapin, I., & Allen, D. (1987). Developmental dysphasia and autism in pre-school children: Characteristics and subtypes. The first international symposium on specific speech and language disorders in children (pp. 20-35). London: AFASIC.

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Authors
Bishop, D. V. M., & Norbury, C. F.
Affiliations
University of Oxford (GB)
Corresponding author
Bishop, Dorothy V.M.
ORCID
Venue
Journal of Child Psychology and Psychiatry
Publisher
Wiley
Published
2002-09-18
Volume
43
Issue
7
Pages
917-929
ISSN
  • 0021-9630 (ISSN-L)
  • 1469-7610
DOI
10.1111/1469-7610.00114
OpenAlex
W2126527128
Cited by
474
References
22
Citations by year
2026: 7 · 2025: 5 · 2024: 10 · 2023: 13 · 2022: 18 · 2021: 21 · 2020: 13 · 2019: 12 · 2018: 14 · 2017: 15 · 2016: 27 · 2015: 25 · 2014: 39 · 2013: 26 · 2012: 32
FWCI
7.35
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of Child Psychology and Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Royal Holloway Digital Repository (Royal Holloway University of London) (submittedVersion)
Funders
Wellcome Trust
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Social Sciences › Psychology › Developmental and Educational Psychology › Language Development and Disorders
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Keywords
pragmatic language impairment, autistic disorder, pervasive developmental disorder not otherwise specified, specific language impairment, diagnostic agreement, Children's Communication Checklist, ADI-R, Social Communication Questionnaire, Autism Diagnostic Observation Schedule, high-functioning autism, prosody
MeSH terms
Autistic Disorder, Child, Child, Preschool, Diagnosis, Differential, Humans, Language Disorders, Psychological Tests, Cluster Analysis

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