Pragmatic communication by boys with fragile X syndrome: How do symptoms of autism spectrum and atte


Effective communication forms an important part of a child’s daily life. For example, producing and understanding speech are criticalfor interacting with others. However, more nuanced aspects of communication, such as social communication, or pragmatics,are equally important. Pragmatics refers to an array of skills such as turn-taking during conversations as well as appropriate use and understanding of context, tone, and gestures. Problems with pragmatics can impact the quality of communication and relationships with family, peers, and teachers.

Pragmatic language difficulties characterize children with many neurodevelopmental conditions, including Autism Spectrum Disorder (ASD), Attention-Deficit Hyperactivity Disorder (ADHD), and Fragile X Syndrome (FXS). What’s more, boys with FXS often have high levels of ASD and / or ADHD symptoms, although not always, and crucially, in a way that differs from one boy with FXS to another. The variable occurrence of these symptoms raises an important question: could differing levels of ASD and ADHD symptoms contribute to pragmatic language development for boys with FXS?

To answer this question, we 1) characterized pragmatic language skills by boys with FXS, and 2) investigated whether early ASD and ADHD symptoms predicted later outcomes in pragmatic abilities over time. The parents of 24 boys with FXS aged 3 to 11 yearscompleted a series of questionnaires about pragmatic language and communication and the presence of ASD and ADHD symptoms at three time points,each a year apart.

Profile of pragmatic skills by boys with FXS

First, we wanted to compare the profile of pragmatic language skills by boys in our sample with those of typically developing children who were at the same developmental level. The average developmental level of the boys in our sample was age 5; this was calculated based on standardized tests of cognitive ability.The boys with FXS showed greater difficulties than expected, given their cognitive ability, across several different areas of pragmatics, including: speaking coherently,starting conversations appropriately, avoiding the use of stereotyped language or speech, using context appropriately during conversations, and using non-verbal communication effectively. In sum, pragmatic language is an area of difficulty for boys with FXS.

Do differing ASD and ADHD symptoms matter to pragmatic language development?

Then, we looked at how differences between boys with FXS in terms of co-occurring ASD and ADHD symptoms, and pragmatic language abilities three years later. We found that having more ASD symptoms early was associated with greater pragmatic difficulties three years later. This aligns with existing research, and supports the idea that there is a strong relationship between ASD symptoms and pragmatics for boys with FXS.

We also found that having more ADHD symptoms was associated with greater pragmatic difficulties three years later. While this is a new finding in FXS research, there is some evidence from children with ADHD without FXS to support this finding. For example, some of the signs used by clinicians to diagnose ADHD (such as talking excessively, difficulties waiting one’s turn in conversation, interrupting upon others) overlap quite a lot with pragmatic difficulties. In addition, these pragmatic difficulties could be related to difficulties in executive functions, a set of cognitive functions that help us to plan, focus our attention, and juggle multiple tasks effectively. All of these represent a challenge for some boys with FXS, and may therefore be reflected in their communication.

Key findings

  1. Pragmatic abilitiesby our group of boys with FXS were lower than what would be expected given theirdevelopmental level

  2. For individual boys with FXS, higher levels of ASD and ADHD symptomswere related to greater difficultiesin pragmatic communication three years later

Communicating in social situations can be challenging for boys with FXS, and these difficulties may continue to impact upon social interactions and learning across many domains. Our study adds to existing knowledge about pragmatic language development by boys with FXS, and it provides new insights about what how early differences between individual children with FXS might relate to later differences in pragmatic language.These findings lay the foundations for future research to support pragmatic language intervention for boys with FXS.

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