King’s Research Portal DOI: 10.1007/s10803-020-04364-z Document Version Peer reviewed version Link to publication record in King's Research Portal Citation for published version (APA): Taylor, L. J., Charman, T., Howlin, P. A., Slonims, V., Green, J., The PACT-G Consortium, & Emsley, R. A. (2020). Brief Report: Associations between preverbal social communication skills, language and symptom severity in children with autism: An investigation using the Early Sociocognitive Battery. Journal of Autism and Developmental Disorders, 50(4), 1434-1442. https://doi.org/10.1007/s10803-020-04364-z Citing this paper Please note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. 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Download date: 30. Sep. 2021 RUNNING HEAD: Social communication, language and autism symptoms Brief Report: Associations between preverbal social communication skills, language and symptom severity in children with autism: An investigation using the Early Sociocognitive Battery Lauren J. Taylor1, Tony Charman1,2, Patricia Howlin1, Vicky Slonims3, Jonathan Green4,5 & The PACT-G Consortium* 1. Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK 2. South London and Maudsley NHS Foundation Trust, London, UK 3. Guy’s & St. Thomas’ NHS Foundation Trust (Evelina Children’s Hospital), Newcomen Centre at St. Thomas’, London, UK 4. Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK 5. Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK * Listed in Acknowledgements ** Corresponding author: Lauren Taylor Department of Psychology, Henry Wellcome Building Institute of Psychiatry, Psychology and Neuroscience King’s College London 16 De Crespigny Park London SE5 8AF E: [email protected] P: +44 (0)20 7848 0405 Disclosure of Conflicts of Interest The Paediatric Autism Communication Trial-Generalised (PACT-G) is funded by the National Institute of Health Research (NIHR) and Medical Research Council [Efficacy and Mechanism Evaluation Programme (13/119/18)]. The authors declare that they have no conflict of interest. Social communication, language and autism symptoms 2 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 Social communication, language and autism symptoms 3 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, Social communication, language and autism symptoms 4 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 Social communication, language and autism symptoms 5 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, N = 181) years were used to predict language and social communication outcomes 18-months later (at age 4-5, N = 163) years and again at age 9-11 years (N = 108) (Chiat & Roy, 2008, 2013; Roy & Chiat, 2019). The results indicated that ESB scores predicted language expression