Is language ability associated with behaviors of concern in autism? A systematic review

Abstract

This review systematically synthesized evidence on the association between structural language ability and behaviors of concern (BoC) in autism. Four databases were searched for studies that included >10 autistic participants, measures of structural language (content and/or form of language) and BoC, and an analysis of their association. BoCs included self‐injurious behavior (SIB), aggression, tantrums, and externalizing behavior. Methodological quality of studies were assessed using the Newcastle Ottawa Scale. Forty‐five publications (n = 11,961) were included. Forty studies were cross‐sectional and five were prospective cohort studies. Over 70% of the studies investigating expressive language and SIB (n = 10), aggression (n = 5), tantrums (n = 3), and externalizing behavior (n = 17) reported an inverse association, where lower expressive language ability was associated with increased BoC. Eleven out of sixteen studies of combined expressive and receptive language reported an inverse relationship with SIB or aggression. All outcomes were rated as moderate to very low certainty of evidence. This review highlights evidence showing an inverse association between expressive or combined language ability and SIB, and externalizing behavior in autism. However, further high‐quality studies that use standardized, consistent measures of language and behavior and investigate longitudinal associations are needed. Early detection and support for reduced structural language difficulties have substantial potential to assist in reducing BoC.

Early trajectories and moderators of autistic language phenotypes: a longitudinal study in preschoolers

“…Bloom eld posits that a speaker can modify another human being's behavior through language with a level of e ciency and subtlety that could not be achieved by other means of communication. In accordance with Bloom ied's claim, autistic individuals with lower language abilities lack a crucial communication tool, resulting in more frequent externalizing behaviors such as self-aggression (Chan et al 2023), decreased social functioning (Chow et al 2022;Miranda et al 2023), and increased rejection by peers (van der Wilt et al 2019). Although many types of early interventions can greatly improve verbal outcome in ASD (Brignell et al 2018; Fuller and Kaiser 2020; Sandbank et al 2020), most intervention guidelines remain one-size-ts-all (Fuentes et al 2021).…”