Purpose: The purpose of the study was to examine how the language and communication skills of children diagnosed with ASD differ from those of a typically developing triplet sibling who grew up in the same environment.
Methods: The participants of the study were 5-year-old (64 months old) triplets, two girls and one boy. The language, speech and communication skills of the participants were evaluated with Turkish Early Language Development Test (TEDIL), LITMUS Turkish Sentence Repetition Test (LITMUS-TR), Turkish NonWord Repetition Test (TAST) and Communication Matrix.
Results: The TEDIL score of the brother with TD was average, whereas the TEDIL score of one of the sisters with ASD was poor. The other sister with ASD could not be administered any of the tests because she could not co-operate. The TD brother had a LITMUS score of 16 and a TAST score of 2; the sibling with ASD had a LITMUS score of 3 and a TAST score of 2. According to the communication matrix data, the brother with TD is able to use his communication skills in a diverse and functional way. While using language for social purposes, ASD sibling with a poor TEDIL score prefers verbal expressions instead of gestures and facial expressions. The other ASD sibling uses social and informational communication inconsistently, indicating a low level of communicative engagement.
Conclusion and Recommendations: Despite having similar genetic and environmental conditions, triplets have different language, speech and communication skills. These differences are noteworthy in terms of demonstrating neurodiversity and reminding us that individual differences should be emphasised in ASD.
autism spectrum disorder, typical development, triplets, neurodiversity
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Aarnoudse-Moens, C. S. H., Weisglas-Kuperus, N., van Goudoever, J. B., & Oosterlaan, J. (2009). Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children. Pediatrics, 124(2), 717–728. https://doi.org/10.1542/peds.2008-2816
Büyüktaşkapu, S. (2012). Annelerin özyeterlik algıları ile 1-3 yaş arasındaki çocuklarının gelişimleri arasındaki ilişkinin incelenmesi. Amasya Üniversitesi Eğitim Fakültesi Dergisi, 1(1), 18–30.
Brunsdon, V. E., Happe, F., & Charman, T. (2015). Cognitive heterogeneity in autism: A systematic review and meta-analysis. Developmental Review, 36, 1–27. https://doi.org/10.1016/j.dr.2015.01.001
Brunsdon, V. E. A., Colvert, E., Ames, C., Garnett, T., Gillan, N., Hallett, V., … Happé, F. (2015). Exploring the cognitive features in children with autism spectrum disorder, their co-twins, and typically developing children within a population-based sample. Journal of Child Psychology and Psychiatry, 56(8), 893–902. https://doi.org/10.1111/jcpp.12362
Charman, T. (2003). Why is joint attention a pivotal skill in autism? Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences, 358(1430), 315–324. https://doi.org/10.1098/rstb.2002.1199
Colvert, E., Tick, B., McEwen, F., Stewart, C., Curran, S. R., Woodhouse, E., … Bolton, P. (2015). Heritability of autism spectrum disorder in a UK population-based twin sample. JAMA Psychiatry, 72(5), 415–423. https://doi.org/10.1001/jamapsychiatry.2014.3028
Diken, İ. H., Ardıç, A., Diken, Ö., & Gilliam, J. E. (2012). Exploring the validity and reliability of Turkish version of Gilliam Autism Rating Scale-2: Turkish standardization study. Eğitim ve Bilim, 37, 318–328.
Durrleman, S., & Delage, H. (2016). Autism spectrum disorder and specific language impairment: Overlaps in syntactic profiles. Language Acquisition, 23(4), 361–386. https://doi.org/10.1080/10489223.2016.1179741
Eigsti, I. M., Bennetto, L., & Dadlani, M. B. (2007). Beyond pragmatics: Morphosyntactic development in autism. Journal of Autism and Developmental Disorders, 37(6), 1007–1023. https://doi.org/10.1007/s10803-006-0239-2
Eigsti, I. M., de Marchena, A. B., Schuh, J. M., & Kelley, E. (2011). Language acquisition in autism spectrum disorders: A developmental review. Research in Autism Spectrum Disorders, 5(3), 681–691. https://doi.org/10.1016/j.rasd.2010.09.001
Félix, J., Santos, M. E., & Benitez-Burraco, A. (2024). Specific language impairment, autism spectrum disorders and social (pragmatic) communication disorders: Is there overlap in language deficits? Review Journal of Autism and Developmental Disorders, 11(1), 86–106. https://doi.org/10.1007/s40489-022-00327-5
Flyvbjerg, B. (2006). Five misunderstandings about case-study research. Qualitative Inquiry, 12(2), 219–245. https://doi.org/10.1177/1077800405284363
Folstein, S., & Rutter, M. (1977). Infantile autism: A genetic study of 21 twin pairs. Journal of Child Psychology and Psychiatry, 18(4), 297–321. https://doi.org/10.1111/j.1469-7610.1977.tb00443.x
Frazier, T. W., Thompson, L., Youngstrom, E. A., Law, P., Hardan, A. Y., Eng, C., & Morris, N. (2014). A twin study of heritable and shared environmental contributions to autism. Journal of Autism and Developmental Disorders, 44(8), 2013–2025. https://doi.org/10.1007/s10803-014-2081-2
Güven, S., & Topbaş, S. (2014). Adaptation of the Test of Early Language Development - Third Edition (TELD-3) into Turkish: Reliability and validity study. International Journal of Early Childhood Special Education, 6, 151–176.
Hallmayer, J., Cleveland, S., Torres, A., Phillips, J., Cohen, B., Torigoe, T., … Risch, N. (2011). Genetic heritability and shared environmental factors among twin pairs with autism. Archives of General Psychiatry, 68(11), 1095–1102. https://doi.org/10.1001/archgenpsychiatry.2011.76
Herbert, M. R., Ziegler, D. A., Deutsch, C. K., O’Brien, L. M., Lange, N., Bakardjiev, A., & Kennedy, D. N. (2002). Dissociations of cerebral cortex, subcortical and cerebral white matter volumes in autistic boys. Brain, 126(5), 1182–1192. https://doi.org/10.1093/brain/awg110
Jaarsma, P., & Welin, S. (2012). Autism as a natural human variation: Reflections on the claims of the neurodiversity movement. Health Care Analysis, 20(1), 20–30. https://doi.org/10.1007/s10728-011-0169-9
Just, M. A., Cherkassky, V. L., Keller, T. A., & Minshew, N. J. (2004). Cortical activation and synchronization during sentence comprehension in high-functioning autism: Evidence of underconnectivity. Brain, 127(8), 1811–1821. https://doi.org/10.1093/brain/awh199
Kaçar, D. (2011). Anlamsız sözcük tekrarı testi geliştirme çalışması: Özgül dil bozukluğu olan çocuklarla ön çalışma bulguları [Yüksek lisans tezi]. Anadolu Üniversitesi, Sağlık Bilimleri Enstitüsü, Eskişehir
Kaçar-Kütükçü, D., & Topbaş, S. (2024). LITMUS Turkish sentence repetition test: The best items, effect of scoring and diagnostic accuracy. Applied Neuropsychology: Child, 12(1), 1–14. https://doi.org/10.1080/21622965.2024.2400483
Kapp, S. K., Gillespie-Lynch, K., Sherman, L. E., & Hutman, T. (2013). Deficit, difference, or both? Autism and neurodiversity. Developmental Psychology, 49(1), 59–71. https://doi.org/10.1037/a0028353
Karasar, N. (2024). Bilimsel araştırma yöntemi: Kavramlar, ilkeler, teknikler (39. basım). Nobel Akademik Yayıncılık.
Kjelgaard, M. M., & Tager-Flusberg, H. (2001). An investigation of language impairment in autism: Implications for genetic subgroups. Language and Cognitive Processes, 16(2–3), 287–308. https://doi.org/10.1080/01690960042000058
Meir, N., & Novogrodsky, R. (2019). Syntactic abilities and verbal memory in monolingual and bilingual children with High Functioning Autism (HFA). First Language, 40(4), 341-366. https://doi.org/10.1177/0142723719849981 (Original work published 2020)
Modyanova, N., Perovic, A., & Wexler, K. (2017). Grammar is differentially impaired in subgroups of autism spectrum disorders: Evidence from an investigation of tense marking and morphosyntax. Frontiers in Psychology, 8, 320. https://doi.org/10.3389/fpsyg.2017.00320
Murdaugh, D. L., Maximo, J. O., Cordes, C. E., O’Kelley, S. E., & Kana, R. K. (2017). From word reading to multisentence comprehension: Improvements in brain activity in children with autism after reading intervention. NeuroImage: Clinical, 16, 303–312. https://doi.org/10.1016/j.nicl.2017.08.012
Nicolaidis, C., Raymaker, D., McDonald, K., Lund, E., Leotti, S., Kapp, S. K., … Zhen, K. Y. (2019). The AASPIRE practice-based guidelines for the inclusion of autistic adults in research as co-researchers and study participants. Autism, 23(8), 2007–2019. https://doi.org/10.1177/1362361319830523
Nissen, T., & Wynn, R. (2014). The clinical case report: A review of its merits and limitations. BMC Research Notes, 7, 264. https://doi.org/10.1186/1756-0500-7-264
Oliver, B. R., & Plomin, R. (2007). Twins’ Early Development Study (TEDS): A genetically sensitive investigation of cognitive and behavioral development from childhood to young adulthood. Twin Research and Human Genetics, 10(1), 96–105. https://doi.org/10.1375/twin.10.1.96
Pellicano, E., & den Houting, J. (2022). Annual research review: Shifting from ‘normal science’ to neurodiversity in autism science. Journal of Child Psychology and Psychiatry, 63(4), 397–417. https://doi.org/10.1111/jcpp.13534
Riches, N. G., Loucas, T., Baird, G., Charman, T., & Simonoff, E. (2010). Sentence repetition in adolescents with specific language impairments and autism: An investigation of complex syntax. International Journal of Language & Communication Disorders, 45(1), 47–60. https://doi.org/10.3109/13682820802647676
Roberts, J. A., Rice, M. L., & Tager-Flusberg, H. (2004). Tense marking in children with autism. Applied Psycholinguistics, 25(3), 429–448. https://doi.org/10.1017/S0142716404001201
Ronald, A., & Hoekstra, R. A. (2011). Autism spectrum disorders and autistic traits: A decade of new twin studies. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 156(3), 255–274. https://doi.org/10.1002/ajmg.b.31159
Rosen, N. E., Lord, C., & Volkmar, F. R. (2021). The diagnosis of autism: From Kanner to DSM-III to DSM-5 and beyond. Journal of Autism and Developmental Disorders. Advance online publication. https://doi.org/10.1007/s10803-021-04904-1
Rowland, C., & Fried-Oken, M. (2010). Communication Matrix: A clinical and research assessment tool targeting children with severe communication disorders. Journal of Pediatric Rehabilitation Medicine, 3(4), 319–329. https://doi.org/10.3233/PRM-2010-0144
Savaş, M. (2023). The effect of otitis media with effusion on language and cognitive skills in school-age children. Experimed, 13(2), 156–162. https://doi.org/10.26650/experimed.1317269
Schaeffer, J., Abd El-Raziq, M., Castroviejo, E. et al. Language in autism: domains, profiles and co-occurring conditions. J Neural Transm 130, 433–457 (2023). https://doi.org/10.1007/s00702-023-02592-y
Sezgin, N. (2011). Ankara Gelişim Tarama Envanteri (AGTE) için iki farklı geçerlik çalışması: Ölçüte bağlı ve eşzamanlı ayırdedici geçerliği. Turkish Journal of Child and Adolescent Mental Health, 18(3), 185–196.
Sutcliffe, A. G., & Derom, C. (2006). Follow-up of twins: Health, behaviour, speech, language outcomes and implications for parents. Early Human Development, 82(6), 379–386. https://doi.org/10.1016/j.earlhumdev.2006.03.007
Şimşek, K. N. (2020). Otizm spektrum bozukluğuna sahip bireylerin iletişim becerilerinin İletişim Matrisi aracılığıyla incelenmesi [Yüksek lisans tezi]. İstanbul Medipol Üniversitesi, Sağlık Bilimleri Enstitüsü, İstanbul
Şimşek, K. N., Günhan Şenol, N. E., Birol, N. Y., & Yaşar Gündüz, E. (2024). Investigation of communicative behaviors and communication functions of Turkish individuals with autism spectrum disorder through Communication Matrix. International Journal of Developmental Disabilities, 1–16. https://doi.org/10.1080/20473869.2024.2331836
Taçalan, P. S., & Çıldır, B. (2022). Türk otizm spektrum bozukluğu olan çocukların dil gelişim özellikleri. In Ö. A. Şenkal (Ed.), Güncel odyoloji ve dil konuşma bozuklukları çalışmaları (Bölüm 8, ss. 69–78). Akademisyen Kitabevi.
Tager-Flusberg, H. (2016). Risk factors associated with language in autism spectrum disorder: Clues to underlying mechanisms. Journal of Speech, Language, and Hearing Research, 59(1), 143–154. https://doi.org/10.1044/2015_JSLHR-L-15-0146
Tick, B., Bolton, P., Happé, F., Rutter, M., & Rijsdijk, F. (2016). Heritability of autism spectrum disorders: A meta‐analysis of twin studies. Journal of Child Psychology and Psychiatry, 57(5), 585–595. https://doi.org/10.1111/jcpp.12499
Topbaş, S., Kaçar-Kütükçü, D., & Kopkallı Yavuz, H. (2014). Performance of children on the Turkish Nonword Repetition Test: Effect of word similarity, word length, and scoring. Clinical Linguistics & Phonetics, 28(7–8), 602–616. https://doi.org/10.3109/02699206.2014.886725
Westerveld, M. F., Trembath, D., Shellshear, L., & Paynter, J. (2016). A systematic review of the literature on emergent literacy skills of preschool children with autism spectrum disorder. The Journal of Special Education, 50(1), 37–48. https://doi.org/10.1177/0022466915613593
Wittke, K., Mastergeorge, A. M., Ozonoff, S., Rogers, S. J., & Naigles, L. R. (2017). Grammatical language impairment in autism spectrum disorder: Exploring language phenotypes beyond standardized testing. Frontiers in Psychology, 8, 532. https://doi.org/10.3389/fpsyg.2017.00532