The impact of subtle language and communication difficulties on the daily lives of autistic children without intellectual disability: Parent perspectives.

BACKGROUND: Autistic children without intellectual disability will likely experience higher level language and communication difficulties. These may appear subtle, in that they are not immediately evident to those who do not know the child well and may not manifest in all environments. Because of this, the impact of such difficulties may be underestimated. This phenomenon has similarly attracted little research attention, meaning the extent to which subtle language and communication difficulties contribute to the needs of autistic individuals without intellectual disability may be underspecified in clinical services. AIMS: To offer a detailed exploration of how relatively subtle language and communication difficulties impact on autistic children without intellectual disability and what strategies parents recognize can mediate those negative effects. METHODS & PROCEDURES: Twelve parents of autistic children from the target group (aged 8-14 years, attending mainstream school) were interviewed about how subtle language and communication difficulties impact their autistic child. Rich accounts were derived then analysed using thematic analysis. Eight of the children discussed had previously been interviewed independently in a parallel study. Comparisons are discussed in this paper. OUTCOMES & RESULTS: Parents reported heterogeneous but pervasive higher level language and communication difficulties which universally impacted key areas of the children's function: peer relationships, developing independence and performance in education. Communication difficulties were also universally associated with negative emotional responses, social withdrawal and/or negative self-perceptions. While parents identified a range of ad hoc strategies and naturally occurring opportunities that improved outcomes, there was little mention of the means to address primary language and communication difficulties. The current study showed a number of parallels with child accounts, demonstrating the benefits of collecting data from both sources in clinical and research investigations. However, parents were more concerned about longer term implications of language and communication difficulties and highlighted their impact on the child developing functional independence. CONCLUSIONS & IMPLICATIONS: Subtle language and communication difficulties, typically identified in this higher ability autistic group, can impact significantly on key areas of childhood function. Support strategies seem to be parent generated and inconsistently applied across individuals, without the benefit of coherent specialist services. Dedicated provision and resources targeting areas of functional need may be beneficial to the group. In addition, the commonly reported association between subtle language and communication difficulties and emotional well-being indicates the need for greater exploration using empirical methods, and joined-up clinical working between speech and language therapy and mental health services. WHAT THIS PAPER ADDS: What is already known on the subject There is now a wide understanding of how language and communication difficulties can impact the individual. However, where those difficulties are relatively subtle, for example, in children without intellectual disability and where difficulties are not immediately evident, less is known. Research has often speculated on how identified differences in higher level structural language and pragmatic difficulties might impact on the function of autistic children. However, to date dedicated exploration of this phenomenon is limited. The current author group explored first-hand accounts of children. Corroborative evidence from parents of the same children would add further weight to understanding this phenomenon. What this paper adds to the existing knowledge This study provides a detailed exploration of parents' perspective relating to the impact of language and communication difficulties on autistic children without intellectual disability. It provides corroborative detail that support child accounts of the same phenomenon, indicating the impact on peer relationships, school outcomes and emotional well-being. Parents also report functional concerns around the child's ability to develop independence and this paper demonstrates how parents and children might deviate in their accounts, with parents reporting increased concerns around the longer term implications of early language and communication difficulties. What are the potential or actual clinical implications of this work? Relatively subtle language and communication difficulties can have a significant impact on the lives of autistic children without intellectual disability. Greater service provision for this group is therefore indicated. Interventions could focus on areas of functional concern where language is implicated, for example, peer relationships, developing independence and school success. Additionally, the relationship between language and emotional well-being points to further integration between speech and language therapy and mental health services. Differences found between parental and child reports highlight the need to collect data from both parties during clinical investigations. Parental strategies may offer benefits for the wider population.

Assessment of inference-making in children using comprehension questions and story retelling: Effect of text modality and a story presentation format.

BACKGROUND: Reading and listening comprehension are essential for accessing the school curriculum. Inference-making is integral to successful comprehension and involves integrating information between clauses (local coherence) and integrating information with background knowledge (global coherence). We require appropriate methods to assess comprehension and inference-making in order to identify areas of difficulty and provide appropriate support. AIMS: Typically developing children's ability to generate local and global coherence inferences was assessed. The effect of text modality (reading and listening comprehension) and presentation format (stories presented in segmented and whole story format) was explored using two comprehension measures (question answering and story retell). The main aims were to determine whether there were advantages for reading or listening comprehension and for segmented or whole text presentation. METHODS & PROCEDURES: Typically developing children in Year 3 (n = 33) and Year 5 (n = 40) either read or listened to short stories. Their ability to generate global and local coherence inferences was assessed in two ways: answers to inference-tapping questions and story retelling (scored for inclusion of necessary inferences). Stories were presented in either a whole format (all questions after the story) or a segmented format (questions asked at specific points during story presentation); the retelling was always after the complete story and questions had been presented. OUTCOMES & RESULTS: For both comprehension measures, there was developmental progression between age groups and a benefit for the reading modality. Scores were higher for global coherence than local coherence inferences, but the effect was significant only for the question-answering responses, not retells. For retells there was a benefit in presenting the text as a whole compared with the segmented format, but this effect was not present for the comprehension questions. There was a significant interaction between inference type and modality for both comprehension measures (question answering and story retell): for the local coherence inferences scores were significantly greater in the reading compared with the listening modality, but performance on the global coherence inferences did not differ significantly between modalities. CONCLUSIONS & IMPLICATIONS: Clinicians, teachers and other professionals should consider the modality and presentation format for comprehension tasks to utilize areas of strength and support areas of difficulty. Oral presentation may result in poorer comprehension relative to written presentation in general, and may particularly affect local integrative processing. These findings have important implications for the development of appropriate assessments as well as for supporting children with comprehension difficulties. What this paper adds What is already known on the subject Reading and listening comprehension are critical for accessing the school curriculum and educational success. Inference-making is integral to successful comprehension and involves integrating information between clauses (local coherence) as well as integrating information with background knowledge (global coherence). Children have an awareness of the need to generate coherence inferences, but not all children will generate sufficient coherence inferences for adequate comprehension during text presentation. Existing assessment tools measure comprehension by asking questions after story presentation. This provides an overall indication of comprehension or inference-making ability and can identify children with comprehension or language and communication difficulties. What this paper adds to existing knowledge The study compared coherence inference-making in two presentation conditions: whole format (all questions after the story) or segmented format (questions asked at specific points during story presentation). Children (aged 7-10 years) were assessed in the reading or listening modality. Two comprehension measures were used (inference-tapping questions and story retell). There was developmental progression and a benefit for the reading modality for both comprehension measures. Scores were higher for global coherence than local coherence inferences for the comprehension questions. There was a benefit in presenting the text as a whole compared with the segmented format for story retells. What are the potential or actual clinical implications of this work? The results are important for clinicians and other professionals assessing and supporting comprehension skills. The results suggest that the modality and presentation format of comprehension tasks should be considered to utilize areas of strength and support areas of difficulty. The optimum form of input and structure may depend on a child's individual profile and the skill being assessed or supported. Targeted questions may identify a child's potential to generate an inference. This may assist identification of children who may require more targeted or specialist intervention. The reading modality may provide a means of support for development of verbal comprehension.

Assessing school-aged children's inference-making: the effect of story test format in listening comprehension.

BACKGROUND: Comprehension is critical for classroom learning and educational success. Inferences are integral to good comprehension: successful comprehension requires the listener to generate local coherence inferences, which involve integrating information between clauses, and global coherence inferences, which involve integrating textual information with background knowledge to infer motivations, themes, etc. A central priority for the diagnosis of comprehension difficulties and our understanding of why these difficulties arise is the development of valid assessment instruments. AIMS: We explored typically developing children's ability to make local and global coherence inferences using a novel assessment of listening comprehension. The aims were to determine whether children were more likely to make the target inferences when these were asked during story presentation versus after presentation of the story, and whether there were any age differences between conditions. METHODS & PROCEDURES: Children in Years 3 (n = 29) and 5 (n = 31) listened to short stories presented either in a segmented format, in which questions to assess local and global coherence inferences were asked at specific points during story presentation, or in a whole format, when all the questions were asked after the story had been presented. OUTCOMES & RESULTS: There was developmental progression between age groups for both types of inference question. Children also scored higher on the global coherence inference questions than the local coherence inference questions. There was a benefit of the segmented format for younger children, particularly for the local inference questions. CONCLUSIONS & IMPLICATIONS: The results suggest that children are more likely to make target inferences if prompted during presentation of the story, and that this format is particularly facilitative for younger children and for local coherence inferences. This has implications for the design of comprehension assessments as well as for supporting children with comprehension difficulties in the classroom.

Short-term and working memory skills in primary school-aged children with specific language impairment and children with pragmatic language impairment: phonological, linguistic and visuo-spatial aspects.

BACKGROUND: Children with specific language impairment (CwSLI) are consistently reported to have short-term memory (STM) and working memory (WM) difficulties. AIM: To compare STM and WM abilities in CwSLI with children with pragmatic language impairment (CwPLI). METHODS & PROCEDURES: Primary school-aged CwSLI (n= 12) and CwPLI (n= 23) were assessed on measures of STM and WM. OUTCOMES & RESULTS: CwPLI had significantly higher scores than CwSLI on STM tasks, and this difference could not be accounted for by differences in receptive language ability. There were no between-group differences for WM tasks. The majority of CwSLI and a significant proportion of CwPLI scored in the impaired range on each of the memory measures. In contrast, some CwPLI scored within the normal range. CONCLUSIONS & IMPLICATIONS: CwPLI present with a different profile of STM but not WM ability to CwSLI. Clinical implications are discussed.

Implementation of a manualized communication intervention for school-aged children with pragmatic and social communication needs in a randomized controlled trial: the Social Communication Intervention Project.

BACKGROUND: Speech-language interventions are often complex in nature, involving multiple observations, variable outcomes and individualization in treatment delivery. The accepted procedure associated with randomized controlled trials (RCT) of such complex interventions is to develop and implement a manual of intervention in order that reliable treatment delivery can be achieved. AIMS: To present the rationale, structure and content of an intensive manualized intervention as implemented within an RCT for children with complex pragmatic and social communication needs; to investigate factors associated with implementation in a mainstream school environment; and to determine treatment fidelity. METHODS & PROCEDURES: The manualized SCIP intervention, including procedures for developing individualized treatment plans, was developed and then implemented within an RCT with 57 school-aged children with complex pragmatic communication needs (CwPLI). The paper describes the delivery protocol, staffing requirements, and content and structure of the intervention. A mapping procedure for individualization of intervention and the implemented components of intervention are presented. The findings from a school-therapy alliance checklist for recording factors affecting implementation in a school context are also reported. Treatment fidelity was carried out using measures of delivered versus planned treatment content and quality of therapy. OUTCOMES & RESULTS: The manual was effective at detailing intervention procedures and allowing for development of individualized treatment plans whilst maintaining satisfactory treatment fidelity. Treatment planning and delivery required continuous specialist speech and language therapist input with assistants needing substantive training and supervision. Key components of intervention for CwPLI were therapies aimed at improving conversation skills, narrative construction, comprehension monitoring, understanding of social cues and metapragmatic awareness. The school-therapy alliance checklist indicated high rates of therapist-education staff and therapist-parent liaison. Parents were nearly always involved in treatment planning though only half-attended therapy sessions. Learning support provision in schools for participating children was highly variable. CONCLUSIONS & IMPLICATIONS: Predetermining theoretical background, structure, and content in a treatment manual contributed towards the quality and reliability of intervention within the context of an RCT. The implementation of SCIP intervention in a broader clinical context is discussed with reference to staff expertise, the therapeutic process and the essential ingredients of social communication intervention.

The Social Communication Intervention Project: a randomized controlled trial of the effectiveness of speech and language therapy for school-age children who have pragmatic and social communication problems with or without autism spectrum disorder.

BACKGROUND: Children who show disproportionate difficulty with the pragmatic as compared with the structural aspects of language are described as having pragmatic language impairment (PLI) or social communication disorder (SCD). Some children who have PLI also show mild social impairments associated with high-functioning autism or autism spectrum disorder (ASD). There is little robust evidence of effectiveness of speech-language interventions which target the language, pragmatic or social communication needs of these children. AIMS: To evaluate the effectiveness of an intensive manualized social communication intervention (SCIP) for children who have PLI with or without features of ASD. METHODS & PROCEDURES: In a single-blind RCT design, 88 children with pragmatic and social communication needs aged 5;11-10;8, recruited from UK speech and language therapy services, were randomly assigned in a 2:1 ratio to SCIP or to treatment-as-usual. Children in the SCIP condition received up to 20 sessions of direct intervention from a specialist research speech and language therapist working with supervised assistants. All therapy content and methodology was derived from an intervention manual. A primary outcome measure of structural language and secondary outcome measures of narrative, parent-reported pragmatic functioning and social communication, blind-rated perceptions of conversational competence and teacher-reported ratings of classroom learning skills were taken pre-intervention, immediately post-intervention and at 6-month follow-up. Analysis was by intention to treat. OUTCOMES & RESULTS: No significant treatment effect was found for the primary outcome measure of structural language ability or for a measure of narrative ability. Significant treatment effects were found for blind-rated perceptions of conversational competence, for parent-reported measures of pragmatic functioning and social communication, and for teacher-reported ratings of classroom learning skills. CONCLUSIONS & IMPLICATIONS: There is some evidence of an intervention effect on blind and parent/teacher-reported communication outcomes, but not standardized language assessment outcomes, for 6-11-year-old children who have pragmatic and social communication needs. These findings are discussed in the context of the increasingly central role of service user outcomes in providing evidence for an intervention. The substantial overlap between the presence of PLI and ASD (75%) across the whole cohort suggests that the intervention may also be applicable to some verbally able children with ASD who have pragmatic communication needs.

Preliminary data on the development of emotion vocabulary in typically developing children (5-13 years) using an experimental psycholinguistic measure.

Introduction: Vocabulary of emotion is integral to emotional development and emotional intelligence is associated with improved mental health outcomes. Many language disordered groups experience emotional difficulties; Developmental Language Disorders, Attention Deficit Hyperactivity Disorder and autism. However, (as in the case of autism) research tends to focus on assessing recognition of emotional states, rather than exploring labeling skills. Where labeling is assessed, measures have focused on early-acquired vocabulary (happy, sad, angry) or self/parent reporting. To date, no objective assessment has been made of vocabulary of emotion across childhood. Methods: This study uses an experimental psycholinguistic measure, The Emotion Vocabulary: Expressive and Receptive ability measure (EVER) which includes two tasks (receptive vocabulary and word generation/expressive vocabulary). This measure has capacity to demonstrate vocabulary growth across age groups. 171 participants (5.0-13.11 years) completed The EVER Measure, alongside two closely matched standardized measures of basic language: BPVS (receptive vocabulary task) and CELF (word-association task). Assessments were completed online and en vivo (COVID testing restrictions dependent). Results: As predicted, children's accuracy increased on both receptive and expressive emotion vocabulary tasks, in line with age at time of testing. EVER scores were significantly predicted by age and correlated with matched basic language scores. Secondary analysis provided preliminary findings on age of acquisition for specific emotion vocabulary items. Discussion: The findings consequently demonstrate proof of concept for the use of The EVER Measure in assessing emotional vocabulary across childhood. This study provides important preliminary data on generating and recognizing emotion labels across typical child development. Critically, it extends current knowledge on emotion vocabulary acquisition into middle childhood, where linguistic ability is relatively mature. As such, findings have implications for research with potential clinical application in the assessment of older children, with either language or emotional differences or both. Findings demonstrate the need for a standardized tool, and its potential application in research and clinical practice is explored. A large-scale study offering proof of concept and reliability of The EVER Measure is indicated.

In their own words: The impact of subtle language and communication difficulties as described by autistic girls and boys without intellectual disability.

LAY ABSTRACT: Subtle language and communication difficulties are experienced by many autistic individuals even when they do not have additional learning disabilities. These difficulties may affect a person's day-to-day living, social relationships and emotional well-being. However, currently, there is not much research into this topic. To date, no one has asked autistic children about their own language and communication difficulties or how they feel it affects them. Asking the children could provide valuable new insights. In this study, 12 autistic children (9-14 years), without learning disability, were interviewed on this topic. We developed interview questions, resources and interview procedures with the support of the autistic community. We also worked with an autistic researcher to analyse our results. We aimed to get the most genuine report of the autistic child's experiences. Our results showed that the children could give detailed insight into their language and communication difficulties if they were given the right support. They told us about how subtle language and communication difficulties affected their ability to learn, take part in certain activities and seek help. They talked about how subtle difficulties affect their ability to talk to new people, talk in groups and ultimately make friends. They also told us about the emotional upset that these subtle difficulties could have. They suggest that communication breakdown leads to negative feelings, but also that negative feelings can lead to more difficulties explaining themselves. The results of this study suggest that we should do more research on the effects of subtle language and communication difficulties. There are also implications for clinical practice. We should identify subtle language and communication difficulties through thorough assessment because these are often missed. We should also develop therapy and strategies that are aimed at individuals with subtle language and communication difficulties because this could help prevent additional difficulties with learning, help-seeking, friendship-making and emotional well-being.

Literacy skills in primary school-aged children with pragmatic language impairment: a comparison with children with specific language impairment.

BACKGROUND: Children with pragmatic language impairment (CwPLI) are characterized by difficulties with the interpersonal use of language in social contexts and they possess a range of language difficulties that affect their educational attainment. Since literacy skills are central to this attainment, one way of identifying appropriate support needs for CwPLI would be to profile their reading and writing skills as a group. AIMS: To investigate the word reading, non-word reading, reading comprehension, and written expression skills of CwPLI and a comparison group of children with specific language impairment (CwSLI). CwSLI were recruited in order to examine any overlaps in literacy impairments for the two groups. METHODS & PROCEDURES: Primary school-aged CwPLI (n= 59) and CwSLI (n= 12) were recruited from speech and language therapists. Children completed standardized assessments of literacy skills. The level of impairment for each component literacy skill was examined for CwPLI and CwSLI. OUTCOMES & RESULTS: For the CwPLI, group mean scores on each of the literacy skills were at the lower end of the normal range compared with population norms. The range of individual scores was large, with some children scoring near floor level and others scoring up to 2 SDs (standard deviations) above the mean, illustrating the heterogeneity of literacy skills within the group. For the CwSLI, group mean scores on each of the literacy skills were between 1 SD and 2 SDs below the population mean. CwSLI were significantly more impaired on all of the literacy measures compared with CwPLI. This difference remained even when receptive language ability and non-verbal intelligence were controlled for. CONCLUSIONS & IMPLICATIONS: The results demonstrate that there is a high level of literacy impairment within CwPLI and CwSLI, providing evidence that individualized literacy skill intervention is important for the long-term academic outcome of these children.

A Subtle Profile With a Significant Impact: Language and Communication Difficulties for Autistic Females Without Intellectual Disability.

The presentation of autism in females is poorly understood, which is thought to contribute to missed or later- age diagnosis, especially for those without intellectual disability. Dedicated research into social and behavioral differences has indicated a specific female phenotype of autism. However, less has been done to explore language and communication profiles, despite known sex/gender differences in typically developing populations. This article provides a synthesis of recent work from this small but emerging field. It focuses on a series of four preliminary and explorative studies conducted by the authors and embeds this within the wider literature. Findings suggest a specific profile of language and communication strengths and weaknesses for autistic females without intellectual disability (compared to autistic males and typically developing females). Furthermore, despite the relatively subtle presentation of difficulties (compared to autistic males), the impact on functionality, social inter-relations and emotional well-being, appears to be equitable and significant. The discussion highlights the need for further empirical research and proposes areas for investigation. Implications for clinical practice include the need for better recognition, testing and provision of interventions dedicated to the language and communication difficulties for autistic females. This has relevance for diagnostic, mental health and speech and language therapy services.

Observational and Reported Measures of Language and Pragmatics in Young People with Autism: A Comparison of Respondent Data and Gender Profiles.

Female children with autism spectrum disorder (FwASD) and performance intelligence quotient (PIQ) over 70 were compared with male children with ASD (MwASD) and typically developing (TD) controls (age 8-11 years) using a range of language and pragmatic measures. Functional ability was assessed using clinical observations and parent, teacher and self-reports. Results were compared between measures, and with direct assessments of language and pragmatics, in order to identify potential biases. This study found that FwASD performed better than MwASD but worse than TD controls on clinical observations of pragmatic ability. FwASD also performed worst overall on a parental measure of emotions. Additionally, there were patterns of differences between clinician, parent, teacher and self- reports and direct assessments, which indicate the need for assessment data to be collected from multiple informants. Findings also have implications for the accurate identification of ASD in females and appropriate provision of support.

Speaking the Same Language? A Preliminary Investigation, Comparing the Language and Communication Skills of Females and Males with High-Functioning Autism.

Understanding the nature of language and communication disorders in High-Functioning Autism Spectrum Disorder (HFASD) populations may provide insight into why females are more likely than males to go undiagnosed. Language and communication skills were compared between 13 females and 13 males (aged 8.11-11.06) with HFASD. Gender-normative data was also ascertained from 26 typically developing children (TD) matched for age and gender. All children had typical range PIQ, slight variation here was controlled for in analysis. Results show females outperforming males in pragmatic and semantic tasks and in certain language-of-emotion tasks. TDs outperformed HFASDs in above-sentence level tasks, but not in basic vocabulary or sentence level tasks. This study highlights specific strengths/weaknesses in language and communication for female HFASD, which could aid more accurate identification of the female autistic phenotype. It indicates the need for larger follow up studies in this area.

Predictors of reading comprehension ability in primary school-aged children who have pragmatic language impairment.

PURPOSE: Children who have pragmatic language impairment (CwPLI) have difficulties with the use of language in social contexts and show impairments in above-sentence level language tasks. Previous studies have found that typically developing children's reading comprehension (RC) is predicted by reading accuracy and spoken sentence level comprehension (SLC). This study explores the predictive ability of these factors and above-sentence level comprehension (ASLC) on RC skills in a group of CwPLI. METHOD: Sixty nine primary school-aged CwPLI completed a measure of RC along with measures of reading accuracy, spoken SLC and both visual (pictorially presented) and spoken ASLC tasks. RESULTS: Regression analyses showed that reading accuracy was the strongest predictor of RC. Visual ASLC did not explain unique variance in RC on top of spoken SLC. In contrast, a measure of spoken ASLC explained unique variance in RC, independent from that explained by spoken SLC. A regression model with nonverbal intelligence, reading accuracy, spoken SLC and spoken ASLC as predictors explained 74.2% of the variance in RC. CONCLUSIONS: Findings suggest that spoken ASLC may measure additional factors that are important for RC success in CwPLI and should be included in routine assessments for language and literacy learning in this group.

Integrating Language, Pragmatics, and Social Intervention in a Single-Subject Case Study of a Child With a Developmental Social Communication Disorder.

PURPOSE: This clinical focus article presents an illustration of a complex communication intervention, the Social Communication Intervention Programme (SCIP), as delivered to a child who has a social communication disorder (SCD). The SCIP intervention combined language processing and pragmatic and social understanding therapies in a program of individualized therapy activities and in close liaison with families. METHOD: The study used an enhanced AB single-subject design in which an 8-year-old child with an SCD participated in 20 therapy sessions with a specialist speech-language pathologist. A procedure of matching assessment findings to intervention choices was followed to construct an individualized treatment program. Examples of intervention content and the embedded structure of SCIP are illustrated. Observational and formal measurements of receptive and expressive language, conversation, and parent-teacher ratings of social communication were completed before therapy, after therapy, and at a 6-month follow-up session. RESULTS: Outcomes revealed change in total and receptive language scores but not in expressive language. Conversation showed marked improvement in responsiveness, appreciation of listener knowledge, turn taking, and adaptation of discourse style. Teacher-reported outcomes included improved classroom behavior and enhanced literacy skills. Parent-reported outcomes included improved verbal interactions with family members and personal narratives. CONCLUSIONS: This clinical focus article demonstrates the complexity of needs in a child with an SCD and how these can be addressed in individualized intervention. Findings are discussed in relation to the essential nature of language support including pragmatic therapy for children with SCDs. Discussion of the role of formal and functional outcome measurement as well as the proximity of chosen outcomes to the intervention is included.

Performance of children with social communication disorder on the Happé Strange Stories: Physical and mental state responses and relationship to language ability.

UNLABELLED: This study investigated whether a modified scoring method was useful for examining the ability of children with social communication disorder (CwSCD) to understand non-literal language and use mental state responses on the Happé Strange Stories (HSS) task. CwSCD and a control group of children with typical language development (CwTLD) completed 10 of the original HSS. CwSCD scored significantly lower on the HSS task than did CwTLD and were much less likely to produce mental state responses. There was a high level of inter-rater reliability (Weighted Kappa=0.907) across data from both groups. HSS performance and language ability correlated significantly for CwSCD. A regression model with age, nonverbal intelligence, receptive and expressive language as predictors explained 55.2% of the variance in HSS ability for CwSCD. The results suggest that the HSS have potential to be used as a clinical assessment to investigate high-level language and ability to infer intent in CwSCD. LEARNING OUTCOMES: Readers will be able to describe a modified scoring method for the Happé Strange Stories task. Readers will be able to identify areas of impairment for children with social communication disorder. Readers will identify how these areas of impairment have an effect on ability to understand non-literal language and produce mental state responses on the Happé Strange Stories task.