· Web view2020. 1. 24. · Abstract. We investigated the Early Sociocognitive Battery (ESB), a novel measure of preverbal social communication skills, in children with autism

Social communication, language and autism symptoms 1

Abstract

We investigated the Early Sociocognitive Battery (ESB), a novel measure of preverbal social

communication skills, in children with autism participating in the Paediatric Autism

Communication Trial-Generalised (PACT-G). The associations between ESB scores,

language and autism symptoms were assessed in 249 children aged 2-11 years. The results

show that ESB subscale scores (social responsiveness, joint attention and symbolic

comprehension) were significantly associated with concurrent autism symptoms and

receptive and expressive language levels. The pattern of association between the ESB

subscale scores differed between the ADOS-2 symptom domains and expressive and

receptive language. These findings indicate the potential utility of the ESB as a measure of

preverbal social communication in children with autism.

Key words: Autism; symptom severity; language; preverbal social communication


Brief Report: Associations between preverbal social communication skills, language and

symptom severity in children with autism: An investigation using the Early

Sociocognitive Battery

In typically developing children, language learning is a social process (e.g.

Tomasello, 2000). The early emergence of interpersonal skills, such as reacting to others’

emotional expressions, gaze following, responding to bids for joint attention, and

understanding the meaning of symbols (i.e., words, gestures, images that convey meaning),

play a key role in later communication development (Morales et al., 2000; Mundy, Sigman,

& Kasari, 1990; Tomasello, 1988) and underpins early word learning (Chiat, 2001; Chiat &

Roy, 2008). These pivotal skills are often impaired in young children with autism and

delayed development in this area is associated with poor language outcomes (e.g. Bottema-

Beutel, 2016; Dawson et al., 2004; Murray et al., 2008) and more severe social

communication difficulties in this population (e.g., Charman, 2003).

Extensive research has been dedicated to understanding early social communication

skills and their association with language acquisition in autism (e.g. Charman, 2003; Mundy

et al., 1990; Mundy, Sigman, & Kasari, 1994). These studies have often used experimental

paradigms to measure early social communication in infants and young children (Charman et

al., 1998; Sigman, Kasari, Kwon, & Yirmiya, 1992; Tomasello, Striano, & Rochat, 1999).

The experimental paradigms have been refined to create a range of standardised measures of

early social communication, such as the Communication and Symbolic Behaviour Scales

(CSBS; Wetherby & Prizant, 2002), the Early Social Communication Scales (ESCS; Seibert,

Hogan, & Mundy, 1982) and Short Play and Communication Evaluation (SPACE; Shire,

Shih, Chang, & Kasari, 2018). While these assessments measure the expression of nonverbal

social communication, i.e., observable behaviours that indicate social interaction, requesting,


joint attention (both initiation of and response to joint attention) and symbolic play skills, the

assessments do not measure social responsiveness or the child’s comprehension of symbols

such as gesture. These latter skills are particularly important in the context of assessing

children with autism, as delayed language development, at least in a sub-set of this

population, may represent a fundamental impairment in complex symbolic function (Ricks &

Wing, 1975; Wing & Wing, 1971).

Furthermore, currently available social communication scales have been developed

for infants and young children and are not standardised for older children with autism. While

early social communication skills have rarely been measured in minimally verbal school-aged

children with autism, there is an emerging body of research indicating that there may be a

different pattern of association between early communication skills and language

development in school-aged children with autism as compared to very young children (Bean

& Eigsti, 2012; Pecukonis, Plesa Skwerer, Eggleston, Meyer, & Tager-Flusberg, 2019). For

example, the results of two recent studies of response to joint attention indicate that this skill

was associated with receptive (Bean & Eigsti, 2012), but not expressive (Pecukonis et al.,

2019) language in school-aged children and adolescents with autism (aged 7-19 years). These

findings indicate that associations between preverbal social communication skills and

language may vary for subgroups of people with autism. Few studies have investigated early

social communication skills in older children with autism, yet this work is important to

understand possible barriers to language acquisition in these children.

To begin to address this gap in the literature, we included the Early Sociocognitive

Battery (ESB; Roy & Chiat, 2019) as a baseline measure of preverbal communication skills

in the Paediatric Autism Communication Trial-Generalised (PACT-G; see Green et al., 2018;

Green et al., 2010 for details of the original trial). The ESB is a novel measure of the early

emerging skills of social responsiveness, joint attention and symbolic comprehension and


builds on experimental paradigms that have previously been used to measure early social

communication in children with autism (e.g., Sigman et al., 1992; Tomasello et al., 1999).

The ESB has advantages over other measures of early social communication skills, as it is

brief, can be administered nonverbally, requires no verbal response and includes subscales

that measure social responsiveness and symbolic comprehension. The predictive validity of

the ESB has been measured in a longitudinal study of children referred to clinical services for

early language difficulties, but not autism. In that study, ESB scores at age 2 ½-4 (T1) years

were used to predict language and social communication outcomes 18-months later (at age 4-

5) years and again at age 9-11 years (Chiat & Roy, 2008, 2013; Roy & Chiat, 2019). The

results indicated that ESB scores predicted language expression and comprehension

(Preschool Language Scales scores) and social communication skills (Peer-Prosocial and

Pragmatic composite scores from the Strengths and Difficulties Questionnaire and Children’s

Communication Checklist-2, respectively) at T2 (Chiat & Roy, 2008). ESB scores also

predicted longer-term social communication outcomes (Social Responsiveness Scale (SRS;

Constantino & Gruber, 2005) scores) and parent-reported ‘late’ autism diagnoses at T3 for

children with early language difficulties (Chiat & Roy, 2013; Roy & Chiat, 2019). In

community samples of typically developing children, ESB scores were positively correlated

with scores on the British Picture Vocabulary Scale-3rd Edition (r = .35-.41, p < .001) (BPVS-

3 Dunn, Dunn, & Styles, 2009), thus demonstrating concurrent validity. The measure has

good test-retest (ICC = .95) and interrater (ICC = .90-.95) reliability (Chiat & Roy, 2008;

Roy & Chiat, 2019). Sensitivity and specificity have also been established for outcomes

including contact with clinical services at T2 (sensitivity = .80, specificity = .86) and social

communication problems (SRS scores)/parent-reported autism diagnosis at T3 (sensitivity

= .89, specificity =.75) (Chiat & Roy, 2013; Roy & Chiat, 2019).


While Chiat and Roy (2008) have previously investigated ESB scores in a community

sample of typically developing 2-4-year-old children and a sample of children referred to

clinical services for language difficulties, the ESB has not been used either to examine

preverbal social communication in children with autism, or to explore these skills in middle

childhood. Therefore, in this study, we investigated the associations between ESB scores,

language, autism symptom severity and nonverbal ability in the PACT-G sample. Based on

previous research that showing that low levels of early social communication skills are

associated with later language and social communication outcomes (Chiat & Roy, 2013; Roy

& Chiat, 2019), we hypothesised that the ESB subscale scores for social responsiveness, joint

attention and symbolic comprehension would predict expressive and receptive language

levels and autism symptoms in our sample.

Method

Participants

Two hundred and forty nine (197 male, 52 female) children, aged between 2 and 11

years, were recruited to the Paediatric Autism Communication Trial-Generalised (see Green

et al., 2018; Green et al., 2010, for the PACT-G trial protocol and a full description of PACT

therapy, as described in our original study) between January 2017 and April 2018. PACT-G

is a multisite, randomised controlled trial of a social communication intervention for children

with autism, taking place in South London, Greater Manchester and the North-East of

England. At all sites, children who were younger than 5 years at baseline were recruited via

referral from local paediatric, mental health and speech and language therapy services, and

those who were 5 years or older either from special schools, or by referral from local clinical

services. Children included in the trial met the following criteria:

Confirmed diagnosis of autism, obtained from community-based clinical services;


Met the ‘Autism’ cut-off on the Autism Diagnostic Observation Schedule-2nd

Edition (ADOS-2; Lord et al., 2012) and scored ≥12 (children younger than 5

years) or ≥15 (children 5 years or older) on the Social Communication

Questionnaire (SCQ; Rutter, Bailey, & Lord, 2003);

Nonverbal age equivalent scores of more than 12 months, measured using the Fine

Motor and Visual Reception subscales of the Mullen Scales of Early Learning

(MSEL; Mullen, 1995), or the Special Nonverbal Composite Score on the British

Ability Scales-School Age (BAS; Elliott & Smith, 2011);

Children who were aged 5 years and older were between P3 and P8 on the English

curriculum1;

The child’s nursery, school or education provider agreed to take part in the study.

While families spoke a range of additional languages, they were required to have enough

English to potentially participate in the intervention, and speak English to their child, at least

some of the time. Children with epilepsy were included if this was controlled by medication.

Children and/or parents with significant hearing or visual impairments were excluded as were

parents with severe learning disability or psychiatric disorder. Child characteristics are

presented in Table 1. All parents provided informed, written consent before taking part in

PACT-G.

[Insert Table 1 about here]

Procedure and Measures

The data were collected at baseline, prior to randomisation and the delivery of any

trial intervention. Assessments were administered over three or four sessions conducted at

home, school and clinic or research lab. Child assessments (ADOS-2, MSEL, BAS, One

Word Picture Vocabulary Tests (Martin & Brownell, 2011a, 2011b), ESB), were usually

1 In England, the P scales supplement the national curriculum by describing targets for children aged 5-16 years with special educational needs. Children at P3 are beginning to communicate with intent and P8 represents a language age equivalent of approximately 4 years in a typically developing child.


administered in the clinic or research laboratory but could also be administered at home or

school. Parent interviews (Vineland Adaptive Behavior Scales-2nd Edition; Sparrow,

Cicchetti, & Balla, 2005) were administered either at the home or research laboratory; parent

questionnaires were usually completed between visits.

Autism Symptomatology. The Autism Diagnostic Observation Schedule-2nd Edition

(ADOS-2; Lord et al., 2012) is a semi-structured assessment of the social communication

symptoms and restricted, repetitive and stereotyped behaviours that characterise autism.

Subscale total scores for Social Affect (SA) and Restricted and Repetitive Behaviour (RRB)

can be used to calculate calibrated domain scores, which are standardised according to the

child’s age and verbal ability (Hus, Gotham, & Lord, 2014) .

Nonverbal Ability. The visual reception and fine motor subscales from the MSEL, and the

nonverbal composite score from the BAS were used as measures of nonverbal ability. As our

sample included children older than 5 years, who were thus outside the age range to derive

standard scores, we used the age equivalent scores from the MSEL to create a nonverbal

developmental quotient (NVDQ; nonverbal mental age equivalent/chronological age * 100).

Language Skills. Language was assessed using a range of parent-report and researcher-

administered assessments. The Expressive and Receptive One Word Vocabulary Tests

(Martin & Brownell, 2011a, 2011b) provided a direct measure of the child’s vocabulary.

Parent-reported receptive and expressive vocabulary scores were obtained from the Words

and Gestures and Words and Sentences forms from the MacArthur-Bates Communicative

Development Inventories (MCDI; Fenson et al., 1994). We also used the Receptive and

Expressive Communication subdomain scores from the Vineland Adaptive Behavior Scales-

2nd Edition-Survey Interview Form (VABS-II; Sparrow et al., 2005) to measure the child’s

adaptive communication skills.


Early Sociocognitive Battery (ESB; Roy & Chiat, 2019). The ESB measures three sets of

socio-cognitive skills:

1. Social Responsiveness: The researcher demonstrates a series of scenarios, e.g.,

banging her finger with a hammer, during which she expresses facial expressions that

represent six different emotions (hurt, surprise, frustration/anger, fear, distraction,

achievement). The child’s response to the emotional expression is measured by the

duration of looks to the face, either fleeting (1 point), or for at least two seconds (2

points), (maximum total score 12).

2. Joint attention: The researcher has six plastic eggs, which she opens, one at a time, to

show the child a small object. Larger versions of these objects are placed behind and

around the child and the researcher directs the child’s attention to these objects using

either eye gaze or pointing paired with the verbal cue, “I brought my [object] today.”

The child’s responses are scored based on whether they alternate gaze between the

small object and the researcher’s face (1 point), and whether they follow the

researcher’s direction of gaze (2 points) or point (1 point) to the larger object

(maximum total score 18).

3. Symbolic Comprehension: This task comprises three symbolic conditions that

measure the child’s understanding of gesture, miniature objects and substitute objects.

For each activity, the researcher uses a form of symbolic representation to indicate

which one of six objects the child should find. The child then selects the

corresponding object, scoring one point for each correct object selected (total score

18).

The ESB was administered and scored live by postdoctoral research associates and research

assistants who had been trained in the measure by the test developers. Training consisted of a

one-day workshop after which, research staff were expected to video-record one


administration of the ESB and return the tape to the trainers, for feedback on the fidelity of

administration and reliability of coding.

Statistical Analysis

Data were prepared and analysed using Stata 15 (StataCorp, 2017). Since many of the

children were either at basal on the expressive and receptive language measures, or outside

the normative age range of the measure (e.g., the MCDI), raw scores were used for all

analyses2. There were strong correlations between scores on the receptive (.65 < rs < .69, p

< .01) and expressive (.82 < rs < .87, p < .001) language measures, so we created receptive

and expressive language composite scores from the Vineland, MCDI and OWPVT prior to

any analysis. These composites were created by first transforming the raw scores for each

measure into z-scores to ensure that they were measured on a comparable scale, then taking

the mean of the standardised scores to derive the composites.

Several of the variables did not follow a normal distribution (see Supplementary

Figures F1-F3 for distributions of the ESB subscale scores), so we used nonparametric tests

(Spearman’s rank correlations) to examine the associations between age, nonverbal ability,

language and ADOS-2 SA and RRB domain scores. We calculated the ADOS-2 calibrated

domain scores based on Hus et al. (2014) and examined the SA and RRB subscales separately

as previous studies have shown differential associations between joint attention and empathic

responding and the social and repetitive behaviour domains of autism (e.g. Charman, 2003;

Mundy et al., 1994). We subsequently ran a series of multiple linear regression analyses to

investigate whether ESB subscale scores predicted concurrent receptive and expressive

language levels and autism symptom severity. Due to the strong positive associations

between nonverbal ability and ESB subscale scores (see Supplementary Table S1 for full

correlation matrix), NVDQ was entered as a predictor into the regression analyses. In

checking that the data met the assumptions for linear regression, we found that chronological 2 The raw scores provide an indication of language level, rather than language ability relative to chronological age.


age and nonverbal ability did not meet the assumption of linearity (i.e. the relationship

between these variables and the outcome variables was not linear). Thus, these two variables

were log transformed and the resulting variables entered into each of the regression models.

ESB subscale total scores for social responsiveness, joint attention and symbolic

comprehension were entered as predictor variables along with the transformed variables for

age and NVDQ. Outcome variables were ADOS-2 SA and RRB calibrated domain scores and

the receptive and expressive language composite scores. All ESB subscales were completed

for 231 children and these data were included in the regression analysis.

Results

Descriptive statistics for all measures are presented in Table 2.

[Insert Table 2 about here]

The results of the regression analyses showed that, while the models for both autism SA,

(F(5, 225) = 6.09, p <.001, R2 = .119) and RRB (F (2, 225) = 3.79, p = .0026, R2 = .078)

scores were significant, the pattern of association between the variables differed across

symptom domains (See Table 4). While joint attention was significantly associated with

concurrent ADOS SA scores, only symbolic comprehension showed an association with

ADOS RRB scores (Table 3). Lower ESB subscale scores were associated with higher

ADOS-2 scores (i.e., more symptoms), for both SA and RRB domains. The regression

models for receptive, (F(2, 225) = 73.97, p < .001, R2 = .62), and expressive, (F(2, 225) =

64.94, p < .001, R2 = .59), language were also significant (See Table 4). Chronological age,

nonverbal ability and social responsiveness showed significant associations with both

receptive and expressive language. While ESB joint attention was significantly associated

with receptive, but not expressive language, symbolic comprehension showed the opposite

pattern, showing a significant association with expressive, but not receptive language. Higher


ESB subscale scores were associated with higher language levels for both receptive and

expressive language.

[Insert Tables 3 and 4 about here]

Discussion

We investigated autism symptom severity and language in relation to preverbal social

communication skills in children with autism participating in the PACT-G study. Consistent

with our hypothesis, ESB subscale scores were associated with current language levels and

autism symptoms. However, the pattern of associations between each of the ESB subscales

and the outcome variables differed. Overall, the findings converge with a large body of

previous research showing that preverbal social communication skills are related to autism

symptom severity and delayed receptive and expressive language development in young and

minimally verbal school-age children with autism (e.g. Baron-Cohen, Baldwin, & Crowson,

1997; Bigham & Bourchier-Sutton, 2007; Charman, 2003; Dawson et al., 2004; Murray et al.,

2008; Pecukonis et al., 2019; Sigman et al., 1992; Thurm, Lord, Lee, & Newschaffer, 2007;

Ungerer & Sigman, 1981).

Regarding the associations between ESB subscale scores and autism symptoms, we

found that only joint attention was related to the ADOS-2 SA domain, and only symbolic

comprehension to ADOS-2 RRB domain scores. There is longstanding evidence indicating

that joint attention is associated with the social communication symptoms, but not the

repetitive behaviours characteristic of autism (e.g. Charman, 2003; Delinicolas & Young,

2007; Mundy et al., 1994). This suggests that the core difficulties with joint attention drive

some of the social communication symptoms of autism. Our findings also indicate that poor

symbolic comprehension could contribute to the repetitive and stereotyped behaviours

observed in autism. These behaviours have consistently been linked to difficulties with

symbolic skills (e.g. Watt, Wetherby, Barber, & Morgan, 2008), suggesting that, rather than


demonstrating pretence, children with poor symbolic comprehension tend to use objects in a

repetitive or stereotyped way. Overall, the differential pattern of association between ESB

subscale scores and social and repetitive symptoms of autism may suggest that distinct

mechanisms underlie the social communication and repetitive behaviour domains and that

these two symptom domains follow different developmental trajectories (e.g. Charman,

2003).

Our results indicate that the preverbal social communication skills of social

responsiveness, joint attention and symbolic comprehension are differentially associated with

receptive and expressive language in children with autism. For example, scores on the social

responsiveness scale were associated with both receptive and expressive language levels.

While this finding is consistent with several previous studies, it has been suggested that social

responsiveness is indirectly associated with language via its association with joint attention

(e.g. Dawson et al., 2004). We did not test this hypothesis, but we did find that response to

joint attention was significantly associated with receptive, but not expressive language. It is

well established that response to joint attention is a necessary precursor to receptive language,

as children need to understand others’ intentions and use the direction of a speaker’s gaze to

correctly map novel words onto novel objects (Baron-Cohen et al., 1997; Tomasello, 2000).

Children with autism have been shown to use alternative, less effective strategies to learn

new words (Baron-Cohen et al., 1997), so it is unsurprising that, in our sample, those with

low scores on the ESB joint attention subscale also had low receptive language. This finding

is also consistent with recent cross-sectional results reported by Pecukonis et al. (2019), who

found that joint attention was not significantly associated with concurrent expressive

language in a sample of minimally verbal children and adolescents (aged 5-19 years) with

autism. However, Pecukonis et al. (2019) did not examine the associations between joint

attention and receptive language and we are unable to establish whether our finding of joint


attention as a significant predictor of receptive language levels is consistent with this recent

work. Interestingly, there was evidence of poor symbolic comprehension in our sample,

which converges with several early studies that showed poor understanding of gesture in

children with autism. This difficulty appears to be particularly pronounced in those with no

speech (e.g. Bartak, Rutter, & Cox, 1975; Wing & Wing, 1971). In our sample, symbolic

comprehension predicted expressive language, suggesting that this may be a core deficit

associated with delayed language development, at least in a subset of children with autism

(Ricks & Wing, 1975). Overall, our findings highlight the multi-faceted nature of language

development in autism, where a range of social communication and developmental factors

may interact to contribute to language delays in this population.

Our results suggest that there is at least a subgroup of children with autism who have

difficulties with preverbal social communication skills in middle childhood. One explanation

for this finding is that these difficulties are driven by low nonverbal ability or global

developmental delays. The results of previous studies of joint attention in children aged less

than four years, show differential patterns of joint attention difficulties based on

developmental level and IQ. For example, Mundy et al. (1994) showed that while children

with autism and a developmental age of less than 20 months had difficulties using eye

contact, following eye gaze and pointing, these difficulties were not present in children with

autism who had a developmental age beyond 20 months. In contrast, the results of recent

studies that have investigated associations between cognitive ability and joint attention in

minimally-verbal school aged children with autism have been mixed, with some findings

showing no associations (Bean & Eigsti, 2012) and others indicating that joint attention is

related to verbal- and nonverbal ability (Johnson Harrison, Lu, McLean, & Sheinkopf, 2016).

We also found that nonverbal ability was significantly associated with all the ESB subscale

scores, thus our results are consistent with these latter findings and suggest that low preverbal


social communication skills in the PACT-G sample may reflect global developmental delays.

Nevertheless, measuring preverbal social communication skills in these children may provide

insight into the persistent nature of language impairments in older children with autism.

The results of our study could reflect limitations of the ESB as a measure of preverbal

skills in children with autism. The ESB has not previously been validated for typically

developing children who are older than four, or for children with autism, thus we are unable

to compare the scores for our sample to any published norms. The measure was developed for

young children, and, while a good proportion of our sample was developmentally at the age

for which the assessment has been developed and normed, it is possible that the materials

were not interesting or engaging for our older children. In addition, some of the children in

our sample were quite active and had limited attention, which at times interfered with the

administration of the assessment. Thus, low scores on the ESB could reflect difficulties with

the children’s attention and engagement, rather than low preverbal social communication

skills. Furthermore, evidence from previous studies indicates that the social context can

influence social responsiveness and joint attention in children with autism (Dawson &

Adams, 1984; Dawson & Galpert, 1990; Lewy & Dawson, 1992). Hence the ESB may have

failed to capture the early social communicative behaviours of some PACT-G children in the

assessment context even though these skills may have been present in naturalistic social

interactions.

This study is the first to investigate preverbal social communication in children with

autism using the ESB and the findings provide insight into the potential utility of the measure

for understanding early social communication problems in children with autism. The ESB

offers advantages over other measures of early social communication skills, such as the

CSBS (Wetherby & Prizant, 2002), and the ESCS (Mundy et al., 2003) as it is a brief, largely

nonverbal assessment, requiring minimal verbal comprehension and no verbal response. The


ESB also covers a wider age range than these other measures, which have been developed

and standardised for use in typically developing infants up to the age of 30-months. Thus,

they may produce ceiling effects in preschool-aged children with autism who have language

skills above the 30-month level. In addition, while these measures include tasks that assess

elicited or spontaneous symbolic play acts, they do not include tasks that assess the child’s

understanding of symbols such as gesture. Impaired symbolic skills are considered to be a

core area of difficulty in autism that makes an important contribution to language acquisition

or impairment in this population (Ricks & Wing, 1975). Thus, further investigation of

symbolic comprehension, using measures such as the ESB, may enhance our understanding

of expressive language development in children with autism.

In sum, our findings suggest that preverbal social communication skills may be

important intervention targets in children with autism through to middle childhood. And,

while we do not yet know whether the ESB is sensitive to change in preverbal social

communication skills over time, it is possible that, in the future, this assessment could be

used to detect changes in early emerging skills that are not typically captured in direct

assessments of language. Future intervention studies could include the ESB as an outcome

measure to examine whether this assessment is both sensitive to change and a predictor of

differential response to therapies that aim to improve preverbal social communication and

expressive language in children with autism.


Ethical approval

All procedures performed in this study involving human participants were in accordance with

the ethical standards of the North West – Greater Manchester Central Research Ethics

Committee (REF: 15/NW/0912) and the study complies with the 1964 Helsinki declaration

and its later amendments or comparable ethical standards.


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Table 1. Demographic characteristics of PACT-G sample (N = 249)

N (%) Mea

n

SD Min Max

Age (Years; Months) 5; 9 1; 5 2; 9 10; 11

Ethnicity

White-British 136 (55)

White non-British 13 (5)

Mixed/Multiple ethnic backgroundsa 23 (9)

Asian/Asian-British 31 (12)

Black/African/Caribbean/Black British 40 (16)

Other ethnic groupb 6 (2)

Parent Marital Status

Single 40 (16)

Married/Cohabiting 190 (76)

Separated/Divorced 18 (7)

Parent Education

At least one parent with post-16 education 105 (42)

Family Size

Number of Children 2.04 .89 1 6

Number of Adults 2.0 .86 1 7

Socioeconomic Status† 35 (14%)

NVDQc 249 (100%) 48.53 18.68 12.52 111.98

ADOS-2 CSS 7.39 1.26 6 10

VABS-II Receptive Language (Years; Months) 1; 6 0; 10 0; 0 7; 6

VABS-II Expressive Language (Years; Months) 1; 6 0; 11 0; 2 5; 10

Note: a. Includes mixed white and black Caribbean, white and black African, white and Asian, and any other

mixed backgrounds. b. Includes Arab. c. NVDQ was based on Mullen scores for n = 247 and the BAS for n = 2.

NVDQ Nonverbal Developmental Quotient; ADOS CSS Autism Diagnostic Observation Schedule-2nd Edition

Calibrated Severity Score; VABS-II Vineland Adaptive Behavior Scales, Second Edition. † Dichotomised as at

least one parent in professional or administrative occupations (NS-SEC classes 1-3) versus all others.


Table 2. Number of participants (total N = 249), mean, SD, minimum and maximum raw scores for the Early Socio-cognitive Battery, ADOS-2 SA and RRB calibrated domain scores and language measures.

N Mean SD Min Max

Early Socio-cognitive Battery Subscale Total Scores

Social Responsiveness 241 2.69 3.34 0 12

Joint Attention 240 6.22 5.27 0 18

Symbolic Comprehension 232 4.62 4.68 0 18

ADOS-2 Social Affect Calibrated Domain Score

Module 1 (Few/no words) 110 7.29 1.43 4 10

Module 1 (Some words) 77 7.54 1.47 4 10

Module 2 (Phrase speech) 62 7.77 1.48 4 10

ADOS Restricted and Repetitive Behaviour Calibrated Domain Score

Module 1 (Few/no words) 110 7.69 1.22 5 10

Module 1 (Some words) 77 7.30 1.43 1 10

Module 2 (Phrase speech) 62 7.45 1.49 1 10

Language Measures (Raw Total Scores)

VABS-II Receptive Communication 249 17.24 7.28 1 36

VABS-II Expressive Communication 249 31.63 20.06 2 90

MCDI Receptive Vocabulary 239 207.25 132.05 0 396

MCDI Expressive Vocabulary 239 146.33 142.73 0 396

Receptive OWPVT 248 17.98 21.86 0 80

Expressive OWPVT 244 15.58 19.58 0 85

ADOS-2 Autism Diagnostic Observation Schedule-2nd Edition; SA Social Affect; RRB Rigid, Repetitive and Stereotyped Behaviour; VABS-II Vineland Adaptive Behaviour Scale-2nd Edition; MCDI MacArthur Bates Communicative Development Inventory; OWPVT One Word Picture Vocabulary Test.


Table 3. Regression models for NVDQ, chronological age and ESB subscale raw total scores as predictors of ADOS-2 SA and RRB calibrated domain scores

ADOS SA ADOS RRBB SE B t p ß B SE B t p ß

NVDQ -.321 .405 -.79 .429 -.089 .240 .369 .65 .516 .075Chronological Age -.583 .418 -1.39 .165 -.135 .540 .381 1.42 .157 .141ESB Social Responsiveness

-.019 .031 -.62 .538 -.045 .024 .028 .84 .404 .062

ESB Joint Attention -.070 .022 -3.16 .002 -.253 -.037 .020 -1.84 .067 -.151ESB Symbolic Comprehension

-.006 .027 -.23 .820 -.020 -.060 .025 -2.40 .017 -.217

Note: For the SA and RRB subscales of the ADOS-2, lower scores indicate fewer of the social communication difficulties and repetitive behaviours that characterise autism.


Table 4. Regression models for NVDQ, chronological age and ESB subscale raw total scores as predictors of receptive and expressive language composite scores

Receptive Language Expressive Language B SE B t p ß B SE B t p ß

NVDQ 1.62 .16 10.32 <.001 .76 1.62 .18 9.07 <.001 .70Chronological Age 1.27 .16 7.82 <.001 .50 1.25 .18 6.80 <.001 .45ESB Social Responsiveness

.03 .012 2.73 .007 .13 .03 .01 2.72 .007 .13

ESB Joint Attention .20 .009 2.22 .028 .12 .01 .010 1.20 .231 .07ESB Symbolic Comprehension

.013 .01 1.20 .23 .07 .03 .01 2.50 .013 .15

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