Pragmatic Language Differences in Conversation Might Differentiate between Autism and Trauma-related Disorders

Abstract

Background: Clinicians are concerned about differential diagnosis of autism from Disinhibited Social Engagement Disorder (DSED), as DSED is associated with maltreatment and autism is not. Language and social communication difficulties are common in maltreated children, but DSED is rarely identified within the maltreatment literature. It is unknown if/how the language profiles of children with DSED differ from autistic children. Objectives: it was hypothesised that receptive and expressive language difficulties may present in DSED but pragmatic differences, associated with autism, may differentiate autism from DSED. METHODS: We conducted 2 studies: Study 1 compared the receptive vocabulary of 43 children with autism; 24 children with DSED and 37 typically developing (TD) children. Study 2, was an in-depth case series comparing the language profiles (receptive and expressive language and pragmatic language) of autistic children (n = 10) and children with DSED (n = 11), via standardised assessment, and Speech and Language Therapist (SLT) analysis of conversational speech. Results: Receptive vocabulary did not significantly differ between groups, but autistic children had greater difficulty when semantic reasoning was required. Children with DSED had greater expressive language difficulties than autistic children (standardised and conversational assessment). While difficulties in narrative discourse overlapped between autism and DSED, other pragmatic language differences differentiated autism from DSED, when SLTs analysed conversational speech. Caregiver report did not identify these differences. Conclusions: Maltreated children may present with DSED and are at higher risk of expressive and pragmatic language difficulties. However, observation of pragmatic language differences, associated with autism, may help differentiate autism from DSED.