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SOAS Working Papers in Linguistics Vol.

14 (2006): 3-13

Language impairments in autism: evidence against mind-blindness


Acha Belkadi
aichaaitouali@hotmail.com

Introduction
Autism is a developmental disorder which causes severe cognitive and social deficits1
and affects four in every ten thousands individuals2. A triad of impairments
impairments in social interaction, impairments in verbal and non verbal communication
and an inappropriately restrictive behaviour are found across the entire autistic
population and are critical for a diagnostic3. Characteristically, the severity of these
impairments varies from individuals to others and even, within the same individual4.
Because autism is marked by great variation, it is mostly referred to as the Autistic
Spectrum of Disorders (ASD)5. Although not universal in autism, deficits in language,
particularly delays in language acquisition, are the principal early manifestation of the
disorder 6. Again, the range of language abilities varies and goes from total muteness to
the use of an apparent grammatically complex language7. But it appears that over half of
the autistic population is affected by some sort of language impairments. In many cases,
these impairments involve all aspects of language pragmatic8, lexical9, syntactic10,
morphological11, phonological and phonetic12.
The heterogeneity of the autistic population does not make the task of finding a cause
for the spectrum of disorders easy13. But one theory, Mind-blindness, has been very
popular among psychologists working on ASD. The Mind-blindness hypothesis holds
that one unique deficit, in the cognitive function of mentalizing, causes the range of
deficits found in autism. Children with autism are prevented from a normal development
because they lack a Theory of Mind, which is the ability to recognize that one and others
have mental states, such as thoughts, wishes, intentions or beliefs and that these can be
different from selfs14. Language impairments found in autism come as consequences of
more general deficiencies in communication caused by this deficit in the Theory of
Mind15.
In this paper, we argue that recent research into language impairments in autism and
other developmental disorders invites us to re-evaluate this common consensus. Of

Tager-Flusberg, 2000a
Baron-Cohen et al., 1985
3
Frith, 2003; Tager-Flusberg, Ibid; Howlin, 2003
4
Hill & Frith, 2003
5
Happ, Ibid
6
Risi et al., Ibid
7
Aarons & Gittens, 1999
8
Aarons & Gittens, 1999; Young et al., 2005
9
Lord et al., Ibid
10
Tager-Flusberg, 2000b; Tager-Flusberg & Joseph, 2005
11
Tager-Flusberg, 2004
12
Baron-Cohen, 1995; Kjelgaard & Tager-Flusberg, 2001
13
Tager-Flusberg, 2004b
14
Baron-Cohen et al., 1985; Baron-Cohen, 1995; Gillot, Furniss & Walter, 2004
15
Frith & Happ, 1998; Frith, 1998
2

Acha Belkadi

Deficit in
Theory of
Mind

Impairments
in
Social Interaction

General
Impairments
in Communication

Restrictive
Behaviour

Language
Deficits
Figure 1. Mind-blindnesss account of impairments found in ASD

course, the aim of our re-evaluation is not to deny that a mentalizing deficit effectively
underlies the range of social and communicative disorders. But Mind-blindness does not
account for the whole picture of language deficits found in autism16. And in the context
of research findings in different fields (Linguistics, Genetics and Neurobiology)
concerning the possible modular nature of the mind, a specific language disorder should,
perhaps, be included into the set of cognitive deficits brought forward to explain the
Autistic Spectrum of Disorders.

1. Autism and Language-Specific Research


A range of language impairments are characteristic of verbal autistic children. One
category of impairments, Pragmatic Language Disorders (PLDs), affects all autistic
children (Young et al., 2005). Those Pragmatic Language Disorders are characterised by
deficits in comprehension, in particular (i) a low understanding of non-literal sequences
such as metaphors, jokes or irony; (ii) a poor command of indirect speech acts such as
questions (Aarons & Gittens, 1999) and (iii) difficulties with presuppositions and other
conversational conventions such as politeness, turn-taking or levels of formality
(Young et al., 2005). Linked to PLDs are further impairments in the production of
speech. Among those are (i) personal pronouns reversal for instance the use of I
instead of you and vice-versa , (ii) the misuse of such prepositions as in, on,
under, next to (), and (iii) the prevalence, in speech, of echolalia formal
repetition of others utterances (Fay, 1988; Aarons & Gittens, 1999).
16

Tager-Flusberg, 2004; Williams et al., forthcoming

Language impairments in autism: evidence against mind-blindness

Because children with autism have severe impairments in communication and are often
reluctant to speak, especially around unknown people, a broad analysis of their verbal
skills remains challenging. As a consequence only a few studies have focused on nonpragmatic aspects of the autistic speech. (Tager-Flusberg, 2000a; Tager-Flusberg, 2004b)
But other levels of language are also affected. Thus, children with autism have been
found to have impaired phonological skills. For instance, their speech systematically
lacks intonation and can best be described as monotonous (Baron-Cohen, 1995). More
specific problems with the analysis of phonological representation of original phonetic
sequences have also been reported (Kjelgaard & Tager-Flusberg, 2001).
Most striking, are recent analysis associating grammatical deficits to the disorder.
Amongst others, are problems with morphological marking of finite verbs, such as the
omission of the past tense morpheme -ed or -s marking the third person of the singular
(Tager-Flusberg, 2004a). Other studies report problems with the parsing of subordinate
clauses that follow verbs of cognition, such as thing, know or guess and may also have
difficulties understanding complex wh-questions, such as (a), where the wh-phrase is
extracted from a lower syntactic position in the embedded clause. (Tager-Flusberg,
2000b: 20; Joseph & Tager-Flusberg, 2005).
a) When did the girl say that she broke the radio when

Another cognitive module, associated with the language faculty and responsible for
auditory processing, has been extensively investigated and found to be severely deficient
in a few cases of autism (Siegal & Blades, 2003). In one particular study (eponien et
al., 2003), 9 children with high-functioning autism17 were examined on their abilities to
discriminate various sequences of non-speech sounds, such as simple and complex tones,
and sequences of speech-sounds, such as vowels. Their brain responses to each type of
sounds were compared to those of 10 normal children without hearing impairments or
learning disabilities. During the examination, one standard and one deviant stimulus for
each class of sounds were conveyed to the children via two loud-speakers while they
were watching a soundless video on television. Although, children were told not to pay
attention to auditory stimuli projected by the speakers and to focus on the video instead,
their attention to particular type of sounds was actually observed. eponien et al. found
that children in the autistic group, like those in the control group, were unimpaired in
sensory sound processing. Both groups responded well to all types of stimuli and did not
display major problems in discriminating simple and complex non-speech sounds.
However, children with autism were found to have specific difficulties with the
discrimination of vowels. This display of an impaired attentional orientating for speech
sounds only, neither linked to a deficit in sensory processing or to the complexity of
sounds, led to the suggestion that the auditory processor dealing with the analysis of
speech sounds, such as vowels and maybe consonants, was not fully functional in autism.
Hence, it was concluded that individuals with autism were impaired in auditory
processing, but that this deficiency was entirely related to speech sounds. Impairments in
language found in autism, or at least those related to phonology, could possibly be
derived from such a deficient auditory processor.
17

Children with milder autistic symptoms and higher verbal and non verbal IQ.

Acha Belkadi

The research on auditory processing is still new and more advanced investigations on
this particular area are needed. Yet, primary results seem to be consistent with the
possibility of a damaged language faculty being at the origin of some language deficits
associated with autism. Also consistent with the proposal are recent findings from TagerFlusberg and Joseph (2003) of a neurocognitive phenotype for autism characterised by
language capacities. Looking at previous studies18 on language impairments in autism,
they found that the autistic population could be divided into two subgroups: one with
normal language skills and one with a severely impaired language. Those in the impaired
language subgroup had discrepancies at all levels of language, including complex syntax
and morphology. Furthermore, their profile was distinct from the profiles of other
subgroups, defined by other criteria, such as verbal and non-verbal IQ discrepancies.
Their classification of the autistic population highlights the fact that, unlike deficits in
social interaction, communication and general behaviour, language deficiency is not
universal in autism (Kjelgaard & Tager-Flusberg, 2001). It also puts the accent on the
fact that some children affected by the core symptoms of autism develop an otherwise
normal language. Therefore, in these cases, normal acquisition of language in autism is
possible despite severe deficits in Theory of Mind. For Tager-Flusberg and Joseph (Ibid),
language deficiency constitutes one of the various specific phenotypes of autism rather
than a mere general consequence of other phenotypes.
2. Autism and other Developmental Disorders
Similarities between the language deficits found in autism and those found in other
developmental disorders, such as Down syndrome and Specific Language Impairment
also support this hypothesis. Children diagnosed with Down syndrome, a genetic disorder
caused by an abnormal trisomy of chromosome 21, display some language impairments
similar to those found in ASD. The disorder, as autism, is commonly associated with
specific cognitive impairments. Attention span, auditory processing, short term memory
and symbolization are assessed as very poor. Furthermore, mental retardation seems to be
systematic within the population affected, with the majority of individuals not going
beyond a mental age of five years. Language acquisition is also delayed compared to
normally developing children but phonological, lexical and pragmatic skills are on
average acquired. In the case of morphosyntax, children with Down syndrome are
slightly deficient. As children with autism, they have difficulties with function words,
such as prepositions, auxiliaries and pronouns. They either do not employ them or use
them inappropriately. Besides, their misuses of pronouns often affect the cohesive logic
of their discourse. Furthermore, they tend to make mistakes with morphological tense
markers and assign verbs with the right inflection in only half of their utterances.
Children with Down syndrome also only rarely use morphemes denoting gender. Like
autistic children, who tend to use a very basic syntax (Tager-Flusberg, 2000a), children
with Down syndrome mostly produce telegraphic sentences. (Rondal, 1988:165-176;
Abbeduto & Murphy, 2004: 77-86). But, unlike children with autism, children with
18

Roberts, J., Rice, M., & Tager-Flusberg, H. (2000) Tense marking in children with autism; further
evidence for overlap between autism and SLI. Paper presented at the Symposium on Research in Child
Language Disorders, Madison, W1; Kjelgaard & Tager-Flusberg (2001); Herbert, M. (and 10 others)
Abnormal asymmetry in language association cortex in autism. Ann. Neurol. 52, (pp. 588-596)

Language impairments in autism: evidence against mind-blindness

Down syndrome have normal capacities in mind-reading and Theory of Mind (BaronCohen et al., 1985). Moreover, social interaction and both verbal and non-verbal
communication are not impaired. On the contrary, they are amongst the strongest
qualities of individuals with the disorder. (Laws & Bishop, 2004) Such facts, indeed,
support the claim that impairments in the non social aspects of the autistic language may
not result from deficits in the Theory of Mind and may not come as consequences of more
general problems in communication.
The idea that language impairments found in autism might be caused by a specific
deficit affecting the language faculty, finds additional support in the recently recognized
common linguistic characteristics shared by children with autism and children with SLI.
Specific language impairment is a disorder present in nearly 7% of children and which
prevents normal acquisition of language from taking place. It is not associated with any
other cognitive or social discrepancies and occurs in children whose intellectual skills
appear to be perfectly normal. Commonly, SLI is thought to be caused by a deficient
language module. The range of language impairments associated with SLI is varied (van
der Lely & Ullman, 2001), yet two types of deficits are considered to be at the heart of
the disorders phenotype. Thus, all children with SLI have difficulties with the processing
of phonological sequences and with the analysis of inflectional morphemes. Phonological
deficiencies, particularly in building phonological representations for acoustic signals, are
especially visible in tasks involving the repetition of nonsense words. In fact, these types
of exercises are very poorly executed by all children with SLI. Problems with inflectional
morphology, for their part, are demonstrated by a strong pattern of errors in the
grammatical marking of tense - past tense among others - and the assignment of third
person markers. (Tager-Flusberg, 2004a; van der Lely & Ullman, Ibid)
Tager-Flusberg & her colleagues investigated the connection of autism with SLI. In
particular, they looked at whether core impairments found in the language disorder were
also present in autism (Tager-Flusberg & Joseph, 2003). In a first study (Tager-Flusberg
& Kjelgaard, 2001), they analysed the performances of 89 autistic children, aged between
four and fourteen years old, on a battery of language tests normally used to diagnose SLI.
Special attention was paid to their results on the non-word repetition task, involving oral
reproductions of sequences of nonsense words. More than half of the population observed
did not show satisfying competence. Contrasting these poor performances in non-word
repetition with the high occurrence of direct and mitigated echolalia in autistic speech,
Tager-Flusberg and Kjelgaard concluded that children with autism did not have specific
problems of articulation. Although, autistic individuals did slightly better than children
with SLI, who are reported to all systematically fail non-word repetition tasks, overall
they were, like them, unable to analyse the phonetic characteristics of original sequences
in order to get their phonological representations. In a second study19 , 62 children from
the original 89 who had taken part in the first study were tested on their morphosyntactic
skills. The paradigms presented to the participants were particularly designed to (i) obtain
regular and irregular past tense forms for series of lexical verbs such as wash or fall and
(ii) bring out the morpheme for the third person singular in the present tense. Among the
62 children, 20 were classified as language-impaired. Overall, their performances in both
tasks were found to be inferior to those in the normal language group. Most of their
errors, like those noted in children with SLI, were to omit the past tense and third person
19

Roberts et al., 2000 reviewed in Tager-Flusberg & Joseph, 2003 and Tager-Flusberg, 2004

Acha Belkadi

morphemes in contexts when they were obligatorily required. Convinced by their


consistent findings on both studies, Tager-Flusberg and her peers proposed that the
language deficits found in a subtype of autism were caused by the same language
disorder affecting subjects with SLI.

IQ

Theory
Mind

of

Language

ASD

Low (under 70) to


high

Severely
impaired

From severely impaired to normal


acquisition

SLI

Normal

Normal

Severely impaired

Down
syndrome

Low

High

Impaired to normal acquisition

Figure 2. Overlap between ASD, SLI and Down syndrome: IQ discrepancies, Theory of
Mind, and language deficits

Research on the overlap between autism, Down syndrome and SLI is still new and
further analyses are needed before one brings out a definite conclusion (Tager-Flusberg,
2004). But the striking similarities between language impairments found in the three
disorders, despite very different intellectual and social capabilities (as illustrated in
Figure 2.1 below), here again, argue for the recognition of an additional cognitive deficit,
involving the language module, to account for the wide range of autistic disorders. Of
course, the fact that no consistent genotypic description for autism exists, adds to the
difficulty in finding the origin of language impairments. Some topical issues in genetics,
however, offer a motivating perspective.

3. Evidence from Genetic Studies


In recent years, research for the genetic origin of the cognitive and behavioural anomalies
found in autism has centred its attention on the area surrounding chromosome 7q (BaronCohen, 2004). In 2002, Alarcn et al. investigated the presence of a possible Quantitative
Trait Locus (QTLs), associated with the language phenotype of autism, on chromosome
7q. Because siblings of autistic individuals with language impairments have more
difficulties linked to language delayed acquisition of language, problems with spelling
and slightly poorer articulation skills than siblings of autistic subjects with normal
linguistic skills, it was hypothesised that such QTLs could underlie significant regions of
autism linkage. DNA samples were collected from members of 152 families from the
Autism Genetic Resource Exchange and compared to measurements of three features of

Language impairments in autism: evidence against mind-blindness

the ADI-R20: the age at production of first word, the age at production of first phrase and
restrictive behaviours. Alarcn and her colleagues discovered that the three features of
the ADI-R they had measured were consistently present amongst direct relatives of
children with autism. Although, the age at first phrase did not seem to be related to a QTL
on chromosome 7q, a strong connection between the age at production of first word and
the chromosomal region was established. Relegating the absence of a correlation between
chromosome 7q and first phrase onset to fallibilities in their methodological organisation
and finding support in previous studies which had found a Quantitative Trait Locus for
language on chromosome 7q 35-36, Alarcn et al. put forward two claims. First, a
specific Locus for language is indeed located in the region of chromosome 7q. Second,
anomalies in specific genes situated on this chromosome may be at the origin of language
disorders found within the Autistic Spectrum of Disorders.
In another study, OBrien et al. (2003) also analysed DNA samples, but this time from
children with SLI and their siblings. Like Alarcn and her peers, they found a vivid
correlation between the language phenotype of SLI and the region of chromosome 7q.
Particularly, they established that the locus was situated nearby FOXP2 on chromosome
7q31 and that language impairments in SLI could be due to a genetic vulnerability in that
region. Of course, categorical theories linking chromosome 7q with the language module
are still premature. But, these initial breakthroughs should not be ignored by theorists
looking for the cognitive causes of autism. And, as suggested by Frith (1998), we trust
that a model of research into the origin of autism should recognise not one, but several
distinct cognitive deficits. Such a model should integrate deficits in Theory of Mind,
Executive functions21 and Central Coherence22, as well as vulnerabilities of the language
faculty as underlying deficits causing the Autistic Spectrum of Disorders.

4. The neurological perspective


Autism is associated with severe anomalies in the configuration of the cerebral organ
(Hill & Frith, 2003). Such regions of the brain as the amygdala, the cerebellum and the
frontal cortex said to implicate the mentalising function have been proved by
neuroimaging and post-mortem analyses to function abnormally (Happ & Frith, 1996;
Baron-Cohen, 2004). So far, language deficits have not consistently been linked to any
specific brain abnormalities. Nevertheless, it is possible that another cerebral region,
critical for normal language growth, is damaged in autism. Herbert et al. (2002, reviewed
in Tager-Flusberg & Joseph, 2003) looked at whether the language impaired phenotype
of autism could be associated with specific irregular growth patterns of the brain. They
compared the brain structures of 16 male children with autism, who were part of a
language impaired subgroup, with the brain structures of 16 boys without any language
disorder or learning disabilities. In particular, they observed the size of the language area
20

Autism Diagnostic Interview revised


Like impairments in language and Theory of Mind, deficiencies in Executive Functions also constitute a
subpart of the autistic phenotype. Problems with mental operations such as planning , working memory,
mental flexibility and prepotent inhibition are said to cause ASD repetitive behaviours. (cf. Hill (2004) and
Joseph et al. (2005) for a review of Executive Dysfunctions in autism)
22
This universal part of information processing is also deficient in autism. (cf. Frith & Happ (1994) for a
brief overview of Weak Central Coherence in autism)
21

10

Acha Belkadi

Genetic
Anomaly

Deficit
In the Theory
of Mind

Deficit in
Executive
Functions

Impairments
Restrictive
In Social
Behaviour
Interaction and
Communication

Deficit
In Central
Coherence

Language
Deficit

IQ
Language
Discrepancies
Impairments

Figure 3. The range of impairments found in ASD: a modular model

situated in the left and right hemispheres of the cortex. They found that the lateral frontal
language cortex in the right hemisphere was significantly larger in autistic children with
language impairments than in normal children. Besides, important language regions in the
left hemisphere perisylvian area, planum temporale and Heschels gyrus of children
with autism were found to be smaller than those of the children in the control group. They
concluded that these cerebral asymmetries, also found in children with SLI and other
language disorder, could be directly linked to the language impairments found in this
subgroup of autistic children.
Other deficits found in autism have not yet been linked to enlargement of specific parts
of the brain. It is therefore hard to draw a conclusion on the correlation between irregular
size of specific brain regions and particular cognitive deficits. Yet, Herberts findings
suggest that irregularities in specific areas of the brain could be responsible for the
malfunction of cognitive modules located in those regions (Tager-Flusberg & Joseph,
Ibid). And the idea of autism being caused by a language deficit, amongst other cognitive
discrepancies, is not inconsistent with the anatomy of the autistic brain. Significant
anomalies are, indeed, prominent across the entire cerebral configuration, including
around the regions involved in language production and comprehension. The reasons for
the defect of some cerebral regions are not categorically established. Yet, because of the
plasticity of the brain, a neuronal dysfunction preventing the necessary connection
between different cerebral sections seems more likely (Happ & Frith, 1996).
Williams et al. (forthcoming), in particular, suggest that a group of neurons located in
the frontal cortex - the mirror neurons (MNs) - are defective in autism and cause the
spectrum of disorders. The primary function of MNs is to link the information processed
by a higher-level visual module to the motor cortex. Other type of processed information,
such as recognition of facial expressions (linked to Theory of Mind) or vocal utterances

Language impairments in autism: evidence against mind-blindness

11

may also run in direction of the motor cortex through these particular neurons. According
to their proposal, a breakdown in the structure of mirror neurons, which causes poor
modulation in the brain and malfunctioning of critical cognitive functions, underlies the
range of deficits found in autism, including those linked to language.
From a neurobiological perspective, it seems possible that language impairments
found in autism are caused by an underlying language disorder. The classification of the
autistic population into subgroups according to their phenotypes (Tager-Flusberg and her
group, 2002; 2003) demonstrates a correlation between language impairments and
vulnerabilities in the language regions of the autistic brain - particularly, brain size
discrepancies. Williams and his colleagues (Ibid), who provide a plausible explanation
onto the ontogenetic cause of autism, even integrate a fault in the language faculty into
their model. But most striking, are the consistent findings of vulnerabilities in the frontal
lobes area of the brain across the autistic population (Happ & Frith, 1996; TagerFlusberg & Joseph, Ibid; Baron-Cohen, 2004; Williams et al., Ibid). Indeed, individuals
with damage to the frontal lobes, caused by various developmental disorders or head
injuries, display some of the same impairments as those commonly found in autism (Hill,
2004). Given those facts, future studies into the cause of language impairments in autism,
investigating this particular area of the brain, may bring important breakthroughs.
(Joseph et al. 2005).

Conclusion
The nature of linguistic impairments found in autism and recent breakthroughs in Genetics
powerfully suggest that the language module of individuals with autism is deficient. Given
the anatomy of the autistic brain and its scattered cerebral vulnerabilities, a model
recognising a deficit of the language faculty, together with deficits in the Theory of Mind,
as underlying sources of the Autistic Spectrum of Disorders seems coherent. Future studies
looking at specific neuronal breakdowns and at the correlation between frontal lobes
damage and specific language deficits in autism may bring crucial findings and, perhaps,
shed light into the origins of this terrible disorder.

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