Understanding the nature of language and communication disorders in High-Functioning Autism Spectrum Disorder (HFASD) populations may provide insight into why females are more likely than males to go undiagnosed. Language and communication skills were compared between 13 females and 13 males (aged 8.11-11.06) with HFASD. Gender-normative data was also ascertained from 26 typically developing children (TD) matched for age and gender. All children had typical range PIQ, slight variation here was controlled for in analysis. Results show females outperforming males in pragmatic and semantic tasks and in certain language-of-emotion tasks. TDs outperformed HFASDs in above-sentence level tasks, but not in basic vocabulary or sentence level tasks. This study highlights specific strengths/weaknesses in language and communication for female HFASD, which could aid more accurate identification of the female autistic phenotype. It indicates the need for larger follow up studies in this area.

Female children with autism spectrum disorder (FwASD) and performance intelligence quotient (PIQ) over 70 were compared with male children with ASD (MwASD) and typically developing (TD) controls (age 8-11 years) using a range of language and pragmatic measures. Functional ability was assessed using clinical observations and parent, teacher and self-reports. Results were compared between measures, and with direct assessments of language and pragmatics, in order to identify potential biases. This study found that FwASD performed better than MwASD but worse than TD controls on clinical observations of pragmatic ability. FwASD also performed worst overall on a parental measure of emotions. Additionally, there were patterns of differences between clinician, parent, teacher and self-reports and direct assessments, which indicate the need for assessment data to be collected from multiple informants. Findings also have implications for the accurate identification of ASD in females and appropriate provision of support.

Subtle language and communication difficulties are persistent and pervasive for autistic individuals without intellectual disability. They are thought to impact negatively on functionality, social interrelations and emotional well-being, although this relationship is under-explored in the literature. The personal accounts of autistic children could add valuable insight into how they experience subtle language and communication difficulties and what impact this has on their daily lives. In this study, 12 autistic children (9–14 years), without intellectual disability, were interviewed on this topic, using specially developed methods/materials to facilitate rich self-reporting. Results showed the children could provide detailed insight into their difficulties and the impact of these on key aspects of functionality (education and daily living) and social interrelations (including friendship building). They also demonstrated a potentially bi-directional relationship between subtle language and communication difficulties and negative emotions; with negative emotions limiting communicative competence and subtle linguistic difficulties leading to negative emotional responses. This study indicates the need for further investigation into the subtle difficulties experienced by autistic children without intellectual disability and its likely impact. Implications for clinical practice include the need for better identification of subtle language and communication difficulties and provision of appropriate therapeutic services which may help to ameliorate negative functional, social and emotional sequelae. Lay abstract Subtle language and communication difficulties are experienced by many autistic individuals even when they do not have additional learning disabilities. These difficulties may affect a person’s day-to-day living, social relationships and emotional well-being. However, currently, there is not much research into this topic. To date, no one has asked autistic children about their own language and communication difficulties or how they feel it affects them. Asking the children could provide valuable new insights. In this study, 12 autistic children (9–14 years), without learning disability, were interviewed on this topic. We developed interview questions, resources and interview procedures with the support of the autistic community. We also worked with an autistic researcher to analyse our results. We aimed to get the most genuine report of the autistic child’s experiences. Our results showed that the children could give detailed insight into their language and communication difficulties if they were given the right support. They told us about how subtle language and communication difficulties affected their ability to learn, take part in certain activities and seek help. They talked about how subtle difficulties affect their ability to talk to new people, talk in groups and ultimately make friends. They also told us about the emotional upset that these subtle difficulties could have. They suggest that communication breakdown leads to negative feelings, but also that negative feelings can lead to more difficulties explaining themselves. The results of this study suggest that we should do more research on the effects of subtle language and communication difficulties. There are also implications for clinical practice. We should identify subtle language and communication difficulties through thorough assessment because these are often missed. We should also develop therapy and strategies that are aimed at individuals with subtle language and communication difficulties because this could help prevent additional difficulties with learning, help-seeking, friendship-making and emotional well-being.