Receptive language and receptive-expressive discrepancy in minimally verbal autistic children and adolescents

Among the approximately one-third of autistic individuals who experience considerable challenges in acquiring spoken language and are minimally verbal (MV), relatively little is known about the range of their receptive language abilities. This study included 1579 MV autistic children and adolescents between 5 and 18 years of age drawn from the National Database for Autism Research and the SFARI Base data repository. MV autistic children and adolescents demonstrated significantly lower receptive language compared to the norms on standardized language assessment and parent report measures. Moreover, their receptive language gap widened with age. Overall, our sample demonstrated significantly better receptive than expressive language. However, at the individual level, only about 25% of MV autistic children and adolescents demonstrated significantly better receptive language relative to their minimal expressive levels. Social skills explained a significant proportion of the variance in parent-reported receptive language skills, while motor skills were the most significant predictor of greater receptive-expressive discrepancy. Findings from this study revealed the heterogeneous language profiles in MV autistic children and adolescents, underscoring the importance of individualizing interventions to match their different communication strengths and needs and integrating multiple interconnected areas to optimize their overall development of language comprehension, socialization, and general motor skills. For the approximately one-third of autistic individuals who do not develop spoken language beyond a few words or phrases, little is known about how much they might understand spoken language. Our study found that minimally verbal autistic children and adolescents had much lower language comprehension compared to their non-autistic peers, and this gap widened as they got older. However, about a quarter of minimally verbal autistic children and adolescents understood significantly more language than they could produce. Those with better social skills had higher levels of understanding of spoken language, and those with better motor skills showed greater relative strength in understanding spoken language than producing it.