Narrative abilities are linked to social impairment in autism spectrum disorder (ASD), such that reductions in words about cognitive processes (e.g., think, know) are thought to reflect underlying deficits in social cognition, including Theory of Mind. However, research suggests that typically developing (TD) boys and girls tell narratives in sex-specific ways, including differential reliance on cognitive process words. Given that most studies of narration in ASD have been conducted in predominantly male samples, it is possible that prior results showing reduced cognitive processing language in ASD may not generalize to autistic girls. To answer this question, we measured the relative frequency of two kinds of words in stories told by autistic girls and boys: nouns (words that indicate object-oriented storytelling) and cognitive process words (words like think and know that indicate mentalizing or attention to other peoples’ internal states). One hundred two verbally fluent school-aged children [girls with ASD (N = 21) and TD (N = 19), and boys with ASD (N = 41) and TD (N = 21)] were matched on age, IQ, and maternal education. Children told a story from a sequence of pictures, and word frequencies (nouns, cognitive process words) were compared. Autistic children of both sexes consistently produced a greater number of nouns than TD controls, indicating object-focused storytelling. There were no sex differences in cognitive process word use in the TD group, but autistic girls produced significantly more cognitive process words than autistic boys, despite comparable autism symptom severity. Thus, autistic girls showed a unique narrative profile that overlapped with autistic boys and typical girls/boys. Noun use correlated significantly with parent reports of social symptom severity in all groups, but cognitive process word use correlated with social ability in boys only. This study extends prior research on autistic children’s storytelling by measuring sex differences in the narratives of a relatively large, well-matched sample of children with and without ASD. Importantly, prior research showing that autistic children use fewer cognitive process words is true for boys only, while object-focused language is a sex-neutral linguistic marker of ASD. These findings suggest that sex-sensitive screening and diagnostic methods—preferably using objective metrics like natural language processing—may be helpful for identifying autistic girls, and could guide the development of future personalized treatment strategies.

中文翻译：

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女孩自闭症的语言标记：讲故事过程中“混合表型”的证据

叙事能力与自闭症谱系障碍（ASD）的社交障碍有关，因此有关认知过程（例如思考、知道）的词语减少被认为反映了社会认知（包括心智理论）的潜在缺陷。然而，研究表明，典型发育中（TD）的男孩和女孩会以特定性别的方式讲述故事，包括对认知过程词汇的不同依赖。鉴于大多数关于自闭症谱系障碍叙事的研究都是在以男性为主的样本中进行的，因此先前显示自闭症谱系障碍中认知处理语言减少的结果可能无法推广到自闭症女孩。为了回答这个问题，我们测量了自闭症女孩和男孩讲述的故事中两种单词的相对频率：名词（表示面向对象讲故事的单词）和认知过程单词（例如“思考”和“知道”等表示心智化或关注的单词）。其他民族的内部状态）。12 名语言流利的学龄儿童 [患有 ASD (N = 21) 和 TD (N = 19) 的女孩，以及患有 ASD (N = 41) 和 TD (N = 21) 的男孩] 在年龄、智商、和母亲教育。孩子们根据一系列图片讲述一个故事，并比较词频（名词、认知过程词）。自闭症儿童（男女）始终比 TD 对照儿童产生更多的名词，这表明他们以对象为中心讲故事。TD 组中认知过程词汇的使用没有性别差异，但自闭症女孩比自闭症男孩产生的认知过程词汇明显更多，尽管自闭症症状的严重程度相当。因此，自闭症女孩表现出独特的叙事特征，与自闭症男孩和典型的女孩/男孩重叠。在所有群体中，名词的使用与父母对社会症状严重程度的报告显着相关，但认知过程中的词语使用仅与男孩的社交能力相关。这项研究通过测量相对较大且匹配的自闭症儿童和非自闭症儿童样本的叙述中的性别差异，扩展了先前对自闭症儿童讲故事的研究。重要的是，先前的研究表明，自闭症儿童使用较少的认知过程词汇仅适用于男孩，而以对象为中心的语言是自闭症谱系障碍的性别中立语言标记。这些发现表明，对性别敏感的筛查和诊断方法（最好使用自然语言处理等客观指标）可能有助于识别自闭症女孩，并可以指导未来个性化治疗策略的制定。