ED586106

A Comprehensive Examination of Reading Heterogeneity in Students with High Functioning
Autism: Distinct Reading Profiles and their Relation to Autism Symptom Severity
Nancy S. McIntyrea, Emily J. Solaria, Ryan P. Grimma, Lindsay E. Lerroa,
Joseph E. Gonzalesb and Peter C. Mundya
a
School of Education, One Shields Avenue, University of California, Davis, 95616, USA
b
Department of Psychology, University of Massachusetts, Lowell, USA
Article Citation (Published April 2017):

McIntyre, N. S., Solari, E. J., Grimm, R. P., Lerro, L. E., Gonzales, J. E., & Mundy, P. C. (2017).
A comprehensive examination of reading heterogeneity in students with high functioning autism:
Distinct reading profiles and their relation to Autism Symptom Severity. Journal of Autism and
Developmental Disorders, 47(4), 1086-1101.
Research Funded by: NIMH 1RO1MH085904, IES R324A120168

Running Head: READING SUBGROUPS HFASD
Abstract
The goal of this study was to identify unique profiles of readers in a sample of 8-16-year olds
with higher functioning autism spectrum disorders (HFASD) and examine the profiles in relation
to ASD symptom severity. Eighty-one students were assessed utilizing a comprehensive reading
battery that included basic word reading, language, and comprehension. Using Latent Profile
Analysis, four empirically distinct profiles of readers emerged. Next, using the Autism
Diagnostic Observation Schedule, Second Edition (ADOS-2; Lord et al., 2012), analyses were
conducted to determine if significant differences existed between profiles as a result of ASD
symptomatology. Findings demonstrate the heterogeneous nature of reading profiles in students
with HFASD and significant differences between the reading profiles and ASD symptom
severity.
Keywords: Reading; Language; Reading Profiles; Higher Functioning Autism
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Current science emphasizes the need to not only distinguish groups of children affected
by autism spectrum disorders (ASD) from comparison children but also to investigate the nature
of heterogeneity in development among children affected by ASD (Georgiades et al., 2013;
Happe, Ronald & Plomin, 2006). The expectation and need to understand psychological
heterogeneity is especially true for older children because as cognitive, language, and emotional
processes develop and differentiate with age it is likely that there are greater degrees of freedom
for the expression of heterogeneity. There are many approaches to studying heterogeneity in
ASD including, for example, the study of differences in social engagement (Wing & Gould,
1979), differences in social attention (Rice, Moriuchi, Jones & Klin, 2012), differences in
executive function (Tager-Flusberg & Joseph, 2003; Geurts, Verte, Oosterlaan, Roeyers, &
Sergeant, 2004), sensory processing (Lane, Young, Baker, & Angley, 2010), and language
(Pickles, Anderson, & Lord, 2014; Rapin, Dunn, Allen, Stevens & Fein, 2009; Tager-Flusberg,
2006), as well as multidimensional approaches (Beglinger & Smith, 2001; Insel, 2014).
There are many reasons why understanding heterogeneity in ASD is of great interest.
One of these is that the identification of valid subgroups holds the promise of enabling a more
precise alignment of treatments and educational plans for affected individuals with ASD
(Beglinger & Smith, 2005; Miles et al. 2005). This is an especially important consideration for
school-aged children who begin to experience their kindergarten through 12th grade classrooms
as their primary venue for intervention. Currently we have very little information on the
heterogeneity of ASD that informs and advances contemporary educational practices for
elementary and secondary students with ASD (Dingfelder & Mandell, 2011; Kasari & Smith,
2013; Machalicek et al., 2008). This is particularly true for higher functioning children for
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whom very little evidence-based information is available to guide optimal education in inclusive
regular education classrooms (Machalicek et al., 2008). This is unfortunate for two reasons.
First, current epidemiological data not only indicate that 1 in 66 children in second grade
throughout the nation are affected by ASD, but 47% of these children have average to above
average intellectual ability and 25% have borderline IQ. Only 28% of these second grade
children are affected by intellectual disabilities (Christensen et al., 2016). Many school-aged
children with ASD function in a range of intelligence that allows them to receive their education
in regular education classrooms (de Bruin, Deppeler, Moore, & Diamond, 2013; Fleury et al.,
2014), which would suggest that these students should gain benefit from general education
instruction, with individualized special education supports.
Second, although children with higher functioning ASD (HFASD) are capable of
receiving their education in regular education classrooms, they are at risk for academic
difficulties. One specific difficulty that has been empirically demonstrated in the literature is in
reading; these difficulties share similarities to students identified as reading disabled. Multiple
studies report symptomatology similar to reading comprehension disability, or individuals who
are able to fluently decode words, yet have difficulties understanding the meaning of written text,
in 33 - 65% of the samples (Estes, Rivera, Bryan, Cali, & Dawson, 2011; Jones et al., 2009;
Nation, Clarke, Wright, & Williams, 2006; Norbury & Nation, 2011; Ricketts, Jones, Happé, &
Charman, 2013). Furthermore, poor reading abilities have been shown to be substantially
discrepant from IQ in many children, leading to the concern that many students are
underachieving (Jones et al., 2009). This provides evidence that current school-based reading
instruction does not sufficiently prevent negative reading comprehension outcomes for children
with HFASD. Less is known about the development of basic word recognition skills in students
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with HFASD. Some studies have suggested that word decoding or word reading is not a specific
deficit that is more prevalent in this population of students (e.g. Brown, Oram-Cardy, & Johnson,
2013), however, it has not been thoroughly examined with a comprehensive word recognition
skills battery in large samples.
With a deeper, evidence-based understanding of the nature and variability of reading
difficulties, or disturbances, in school-aged children with HFASD, beyond what is already
known about reading comprehension disability, and including the development of word
recognition, it may be possible to develop more targeted methods of instruction for this
population (Reutebuch, El Zein, Kim, Weinberg, & Vaughn, 2015). In this study, we extend the
current knowledge about the reading development and disability in students with HFASD in
three ways. First, we provide a deeper understanding of reading impairments in this sample,
beyond reading comprehension difficulties, with a close examination of basic reading
development. Second, we attempt to determine if meaningful subgroups or profiles of reading
strengths and weaknesses can be identified in a sample of students with HFASD. Third, we
investigate the relation between HFASD reading subgroups and ASD symptomatology.
Development of Reading: Subcomponent Skills and Profiles of ASD Struggling Readers
Reading for meaning develops over time and builds upon two brain regions already
present in infancy: the visual object recognition and oral language systems (Dehaene, 2009). By
the time children are 5 or 6 years old, key visual recognition processes are well developed but
still maximally plastic. Children’s vocabulary grows 10-20 words per day by the end of their
second year, and by the time they are 6 years old, most have expert knowledge of phonology,
basic grammar rules, and a vocabulary of several thousand words. In the phonological stage of
reading (Frith, 1985), children develop letter-sound correspondence requiring proficient letter
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recognition skills and phonological awareness, or the ability to discern individual speech sounds.
They learn to decode words, progressing from the simple to the complex. Morphemic awareness
develops as well, and children learn that prefixes, root words, and suffixes are associated with
pronunciation and meaning. In the orthographic stage (Frith, 1985), the lexical pathway used to
identify words by sight develops and progressively supplements the decoding/phonological
pathway. Oral language processing creates meaning from the words. These two processes may
develop relatively independently (Adlof, Catts, & Lee, 2010) and the relationship between these
factors and reading comprehension changes over time. Cain & Oakhill (2008) noted that for
younger children decoding is more important and the correlation between reading and listening
comprehension is low. By high school however, decoding differences are generally small and
the correlation between reading and listening comprehension is high. Therefore, they posited
that based on this model one should expect a person’s reading comprehension to develop to the
same level as their listening comprehension once word reading is fluent.
The Simple View of Reading describes successful reading comprehension as the result of
sufficient decoding and linguistic comprehension skills (Gough & Tunmer, 1986). These two
component skills are described as multiplicative in nature and therefore both sets of skills must
be operating sufficiently for successful reading comprehension. The Component Model of
Reading (Joshi & Aaron, 2000), based upon the Simple View, incorporated processing speed, as
measured by speed of letter naming, as a third predictor of reading comprehension. Prior studies
have used the Component Model to investigate how poor readers may fall into subgroups that
differ across the components of word decoding and linguistic comprehension (Aaron, 1997;
Catts, Hogan & Fey, 2003; Catts & Kamhi, 1999; Gough & Tunmer, 1986). At least three
subgroups of poor readers are predicted by this model: (a) poor readers with word recognition
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problems only (e.g. dyslexics), (b) poor readers with linguistic comprehension problems only
(e.g. poor comprehenders and/or hyperlexics), and (c) poor readers with difficulties in both
components [e.g. garden variety poor readers (Gough & Tunmer, 1986), mixed reading disabled
(Catts & Kamhi, 2005), or language-learning disabled (LLD; Berninger & May, 2011)].
Furthermore, Aaron, Joshi, Gooden, and Bentum (2008) demonstrated the utility of the
Component Model in identifying the facet(s) of reading that is(are) the source of a child’s
reading difficulty in order to better target intervention efforts.
A deeper examination of the two component skills, word recognition and linguistic
comprehension, reveals many essential sub skills. For example, poor readers who struggle with
accurate lower-level word recognition skills typically demonstrate deficits in phonological
processing, or the processing of speech sounds. There is empirical evidence that demonstrates a
correlational relation between facets of phonological processing and word recognition including:
phonological awareness (Bradley & Bryant. 1983; Goswami & Bryant, 1990; Share, 1995;
Swanson, Trainin, Necoechea, & Hammill, 2003; Wagner, Torgesen, & Rashotte, 1994),
phonological decoding (Rastle & Coltheart, 1998; Rey, Ziegler, & Jacobs, 2000; Swanson et al,
2003), and rapid automatized naming (Kirby, Parrila, & Pfeiffer, 2003; Manis, Doi, & Bhada,
2000; Swanson et al, 2003). Vocabulary development has also been linked with word
recognition skill (Biemiller, 2007; Biemiller & Boote, 2006; Chiappe, Chiappe & Gottardo,
2004; Nation, 2009; National Reading Panel, 2000; Ouellette & Beers, 2010; Perfetti, 2007).
Linguistic comprehension, or the oral language processing that creates meaning from
words, has a profound effect on the comprehension of written texts (e.g., Nation & Snowling,
2004; Roth, Speece, & Cooper, 2002). Empirical evidence suggests that higher-level linguistic
comprehension skills are underpinned by the depth and breadth of one’s vocabulary (Ouellette &
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Beers, 2010; Perfetti, 2007; Ricketts, Nation & Bishop, 2007; Roth, Speece & Cooper, 2002;
Senechal, Ouellette, & Rodney, 2006), syntax and grammar (Cain & Oakhill, 2006; Muter,
Hulme, Snowling, & Stevenson, 2004; Nation, Clarke, Marshall, & Durand, 2004), verbal
reasoning and integration of background knowledge during reading to generate inferences
(Hannon & Daneman, 2001; Long & Lea, 2005; McNamara, 2001), and narrative recall (Fuchs,
Fuchs, & Maxwell, 1988; Leslie & Caldwell, 2009). All of these facets of oral language support
the construction of a globally coherent situation model of a text; semantic, grammatical and
syntactic information provide the foundation of the text-based mental model, then continuous
connections between prior knowledge, inferences, and text ideas are made to create the situation
model required for proficient reading comprehension (Kintsch, 1988; Van Dijk & Kintsch,
1983).
Empirical evidence exists to demonstrate that both word recognition and linguistic
comprehension account for substantial unique variance in reading comprehension for children
with ASD, supporting the Simple View in this population (Jones et al., 2009; Lindgren, Folstein,
Tomblin, & Tager-Flusberg, 2009; Nation et al., 2006; Norbury & Nation, 2011; Ricketts et al.,
2013). Similar to the subtypes described by Catts et al. (2003) with a typically developing
reading sample, many samples with ASD have displayed profiles comparable to poor
comprehenders, or hyperlexics, who demonstrate adequate word decoding alongside poor
language and reading comprehension (e.g. Brown et al., 2013; Jones et al, 2009; Nation et al,
2006; Newman et al., 2007; Huemer & Mann, 2010; Wei, Christiano, Yu, Wagner & Spiker,
2015; Zuccarello et al., 2015).
Other researchers have reported evidence that subgroups of children with poor
comprehension have significant concomitant lower-level phonological, rapid naming, and/or
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word decoding deficits (Asberg & Sandberg, 2012; Nation et al., 2006; White et al., 2006).
White et al. (2006) found that, similar to those with typical development, phonological skills
were a strong predictor of word recognition and spelling in 8-12-year-olds with ASD. However,
Gabig (2010) found that while phonological awareness was delayed in development for 5-7-year
olds with ASD in their sample, it was not significantly related to word reading or decoding, but it
was significantly correlated with receptive vocabulary. Similarly, in several other studies, word
recognition skills have been shown to correlate with language abilities, reporting subgroups of
children with poor word recognition associated with poor oral language skills (e.g. Brown et al.,
2013; Jacobs & Richdale, 2013; Lindgren et al., 2009; Nation et al., 2006; Norbury & Nation,
2011; Ricketts et al., 2013). Three studies have reported that children with ASD who have age-
appropriate language skills scored significantly higher than those with language impairments on
standardized measures of reading comprehension, word recognition, and decoding (Lindgren et
al., 2009; Lucas & Norbury, 2014; Norbury & Nation, 2011). None of the studies reviewed
reported a subgroup of children displaying a dyslexic profile, or one in which impaired word
recognition is concomitant with proficient linguistic comprehension.
Several studies have placed emphasis on exploring higher-level linguistic comprehension
factors in more detail. For example, participants with ASD have been shown to have difficulty
integrating background knowledge and inferred knowledge explicitly with global text (Saldana
& Frith, 2007), using background knowledge to interpret and remember specific information or
resolve ambiguities in discourse (Wahlberg & Magliano, 2004), or responding to questions about
inferred emotions (Tirado & Saldana, 2016). Language impairment in adolescents with ASD
was associated with poorer performance on a passage-level inference measure (Norbury &
Nation, 2011), and in elementary school-aged children verbal ability was the strongest predictor
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of performance on inferential reading comprehension questions (Lucas & Norbury, 2015).
Norbury & Nation (2011) suggested that difficulties integrating information from different
sources for global coherence and inference generation might be highly dependent on variance in
the language skills of students with ASD.
Reading Comprehension and ASD Symptomatology
Reading for meaning is fundamental for accessing social, cultural, and political milieus
through written documents, and is a cognitively complex process. Current research suggests that
the risk for reading comprehension disability may be related to ASD symptomatology and be a
component of the social-communicative and cognitive phenotype of school-aged children with
ASD; several studies have reported significant associations between individual differences in
reading development and diagnostic status, social functioning, or autistic symptom severity in
samples of school-aged children with ASD (Asberg, Kopp, Berg-Kelly, & Gillberg, 2010; Estes
et al., 2011; Jones et al., 2009; Norbury & Nation, 2011; Ricketts et al., 2013). Reading is a
written form of communication between the author and the reader, and as such, is likely to be
impacted by deficits in social communication abilities such as understanding an author’s
intentions or purpose for writing a text, which impedes learning from the text. Furthermore,
impairments in social communication skills may impact reading comprehension through
impeding the development of rich networks of semantic and episodic knowledge typically
developed through socially-mediated learning. Additionally, challenges in understanding social
norms may lead to difficulty developing skills that rely on social knowledge such as
understanding characters’ intentions, inference generation, and understanding of narrative
elements.
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The cognitive characteristics of many children with ASD include the tendency to focus
on details rather than global meaning (Booth & Happe, 2010), leading to particular problems
generating global coherence or processing at the gist level across a text (e.g., Pellicano, 2010),
which in turn leads to difficulty recalling, retelling, and comprehending stories (Diehl, Bennetto,
& Young, 2006; Williams, Goldstein, & Minshew, 2006). Furthermore, this local processing
bias, or weak central coherence (Happe & Frith, 2006), has been posited to lead to particular
difficulty integrating information both from the text and from background knowledge for
inference generation (Norbury & Nation, 2011) and global comprehension (Ricketts et al., 2013).
Another cognitive characteristic associated with ASD is the tendency to have restricted or fixated
interests, and this can limit exposure to situations where individuals learn about a wide variety of
topics and develop oral language skills across multiple contexts. This restricts vocabulary growth
except in fields of specific interests, and leads to more literal, less flexible understanding of
words and phrases. Combined, these difficulties constrain creation of a coherent mental model of
text that draws on a reader’s ability to combine text-based information with relevant background
knowledge to generate inferences about things not explicitly stated in the text (Kintsch, 1988;
McNamara, 2001). Overall, it may be that the severity of the social communication and ASD-
specific cognitive difficulties align with the severity of reading comprehension deficits for many
children affected by ASD.
In summary, there have been several attempts to unpack the relation between ASD
symptomatology, language, and reading performance. The existing empirical literature suggests
individuals with ASD have particular difficulties with reading comprehension and those
difficulties may be associated with both language and symptom severity of individuals with
ASD. The extant data also presents some evidence that similar profiles of struggling readers exist
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to those seen in typically developing populations, with perhaps the exception of a reading profile
that exhibits a dyslexic profile of poor word recognition alongside discrepantly proficient
linguistic comprehension. However, very few studies of reading in ASD have utilized reading
batteries that assess the Simple View of Reading and include the key sub skills supporting
linguistic comprehension and word recognition. Therefore, we still know very little about the
potential difficulties individuals with ASD have on tasks related to word recognition and how
these lower level reading variables interact with linguistic and reading comprehension.
Furthermore, measurement of reading ability varies depending on the assessments used (Cutting
& Scarborough, 2006), and different findings from previous studies could be the result of using
different reading measures. Therefore, use of multiple measures of each component of reading
would be beneficial.
Current Study
Previous research has started to investigate reading development in school-aged children
with ASD. To our knowledge, no studies have analyzed subgroups, or distinct profiles, of
school-aged readers with ASD using an extensive reading battery that includes the sub skills of
lower-level word recognition abilities, including phonological processing and processing speed
measures, and higher-level linguistic and reading comprehension skills. In the current study, a
comprehensive reading and language assessment battery was collected with school-aged children
with HFASD to answer the following research questions: (a) Do individuals with HFASD
exhibit distinct reading profiles? (b) How do distinct reading subgroup profiles relate to ASD
symptom severity? Based on previous literature, we hypothesize that HFASD readers are
heterogeneous in nature, with relative strengths and weaknesses, therefore distinct profiles will
emerge. We also hypothesize that similar to previous research, individuals with HFASD who
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demonstrate more severe reading discrepancies will also have more severe ASD
symptomatology.
Method
Participants
This research was conducted in compliance with the Institutional Review Board and
written parental consent and child assent was obtained prior to data collection. Participants were
81 (66 male) children, aged 8 to 16 years, who had a community diagnosis of ASD (see
descriptive statistics in Table 1). Enrolled subjects were recruited from the local community
through school districts, a university research subject tracking system, and word of mouth.
Individuals were included in the HFASD sample if they had a community diagnosis of ASD that
was confirmed by trained researchers using the Autism Diagnostic Observation Schedule,
Second Edition (ADOS-2; Lord et al., 2012), and if they had had a full-scale IQ (FIQ) estimate ≥
75 as measured on the Wechsler Abbreviated Scales of Intelligence-II (WASI-2, Wechsler,
2011). A total of 93 individuals with ASD were recruited for this study; they all met criteria for
ASD on the ADOS, but 12 individuals were ineligible for the study due to FIQ < 75.
Exclusionary criteria included an identified syndrome other than ASD or ADHD (e.g. Fragile X),
significant sensory or motor impairment (e.g. visual impairments), a neurological disorder (e.g.
epilepsy, cerebral palsy), psychotic symptoms (e.g. hallucinations or delusions), or any major
medical disorder that could be associated with extended absences from school. Twenty-eight
percent of the children with HFASD also met criteria for ADHD according to parent report of a
community diagnosis. Most of the children in this sample spent much, or all, of their school day
in a general education classroom setting: 65% were in general education 81-100% of the day,
12% were in general education 41-80% of the day, 10% were in general education 1-40% of the
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day, 10% were not in general education at all, and three percent did not report placement.
Eighty-four percent of the children attended public schools, and 91% had an IEP or 504 Plan.
Measures and Procedures
Data reported are from assessment sessions that were conducted by members of trained
research group in a university-based child assessment laboratory over two 2.5-hour sessions.
Diagnostic Measures and Sample Description. The ADOS-2 (Lord et al., 2012) is a
semi-structured diagnostic assessment shown to have strong predictive validity compared to best
estimate clinical diagnoses (Charman & Gotham, 2013). Scores were utilized to both confirm
ASD diagnosis and as a distal measure in the second research question. Modules 3 and 4 were
administered, providing scores for Social Affect (SA) and Restricted and Repetitive Behavior
(RRB). The Module 3 yielded a raw subscore for SA and for RRB that combined to create the
Total Score. Intraclass correlations for interrater reliability for Module 3 were reported as 0.92
for SA, 0.91 for RRB and 0.94 for overall total raw score. Intraclass correlations for interrater
reliability for Module 4 were reported to be 0.93 for Social Interaction, 0.84 for Communication,
0.92 for Communication + Social Interaction, and 0.82 for Stereotyped Behaviors and Restricted
Interests (Lord et al., 2012). Module 4 scores were converted via the modified Module 4
algorithm per Hus & Lord (2014).
IQ. The WASI-2 (Wechsler, 2011) provided an estimate of verbal and nonverbal
cognitive ability. Two verbal subtests, Vocabulary and Similarities, measured expressive
vocabulary and abstract semantic reasoning and formed the verbal composite (VIQ). Two
nonverbal subtests, Block Design and Matrix Reasoning, measured spatial perception, visual
abstract processing & problem solving with motor and non-motor involvement and formed the
performance composite (PIQ). Combined, the four subtests yielded an age-normed standard
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score measurement of full-scale IQ (FIQ). The Full-Scale IQ (FSIQ) index has established
internal consistency (0.96) and test-retest reliability for children ages 6-16, r = 0.94 (Wechsler,
2011). In this sample, internal consistency Cronbach’s alpha coefficients were .89 for
Vocabulary; .88 for Similarities; .87 for Block Design; and .92 for Matrix Reasoning.
Phonological processing and rapid automatized naming. The Elision and Nonword
Repetition (NWR) subtests were administered from the Comprehensive Test of Phonological
Processing, Second Version (CTOPP-2; Wagner, Torgesen & Rashotte, 1999) that yielded age-
normed scaled scores (M = 10, SD = 3) measuring phonological awareness (PA) and expressive
phonology/phonological memory respectively. The internal consistency Cronbach’s alpha
coefficient from our sample for Elision (alpha = .93) was consistent with publisher reported
alphas (alphas = .81–.91; Wagner, Torgesen, & Rashotte, 1999). The internal consistency
Cronbach’s alpha coefficient from our sample for NWR (alpha = .78) was consistent with
publisher reported alphas (alphas = .73–.80).The speed at which participants were able to
connect orthographic and phonological representations was measured using two rapid
automatized naming (RAN) tasks from the CTOPP-2; Rapid Letter Naming and Rapid Digit
Naming subtests yielded separate age-normed scaled scores (M = 10, SD = 3), and combined for
an age-normed RAN index score (M = 100, SD = 15). Alternate-form reliability coefficients
from our sample for Rapid Letter Naming (.89) and Rapid Digit Naming (.87) were consistent
with publisher reported alternate-form reliability coefficients (.70–.93).
Word Recognition. The Test of Word Reading Efficiency, Second Edition (TOWRE-2,
Torgesen, Wagner, & Rashotte, 2012) provided an age-normed standard score (M = 100, SD
=15) measuring accuracy and fluency of sight word recognition (Sight Word Efficiency: SWE)
and phonemic decoding (Phonemic Decoding Efficiency: PDE). Participants read as many real
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words (SWE) or decodable nonwords (PDE) as they were able to in 45 seconds per subtest.
Internal consistency Cronbach’s alpha coefficients from our sample for SWE (alpha = .97), and
PDE (alpha = .87) were generally consistent with publisher reported alphas for both subtests
(alphas > .90; Torgesen, Wagner, & Rashotte, 2012). Text-level reading accuracy was assessed
with age-normed scaled scores (M = 10, SD = 3) from the Gray Oral Reading Tests – Fifth
Edition (GORT-5; Wiederholt & Bryant, 2012). Publisher (Wiederholt & Bryant, 2012) reported
Cronbach’s alpha coefficients for GORT-5 Accuracy scores ranged between .85 and .94 in the
normative sample, and .93 in an ASD subgroup.
Linguistic Comprehension. The Recalling Sentences subtest from the Clinical
Evaluation of Language Fundamentals, Fourth Edition (CELF-4; Semel, Wiig, Secord, 2003)
provided an age-normed scaled score (M = 10, SD = 3) assessing sentence-level semantic and
syntactic expressive language skills. In order to accurately recall increasingly longer and more
complex sentences, one must strategically utilize language structure (e.g., syntax) and meaning.
Publisher (Semel, Wiig, & Secord, 2003) reported Cronbach’s alpha reliability coefficients
ranged from .86 - .93 in the normative sample and .97 in an ASD subsample. Expressive
vocabulary was measured with the Vocabulary subtest from the WASI-II (Wechsler, 2011),
which yielded an age-normed T-score (M = 50, SD =10). This subtest was designed to measure
verbal concept formation and semantic knowledge by asking the participant to orally define
words of increasing complexity. The Auditory Reasoning subtest of the Test of Auditory
Processing Skills, Third Edition (TAPS-3; Martin & Brownwell, 2005) provided an age-normed
scaled score (M = 10, SD = 3) assessing higher order linguistic processing related to listening
comprehension, understanding implied meanings and idioms, and to making inferences.
Participants are read short vignettes (approximately 2-3 sentences each) and asked to respond to
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one question for each vignette. In order for an answer to receive credit, a participant must either
make the correct inference, or correctly interpret an abstraction or idiom. Internal consistency
Cronbach’s alpha from our sample for Auditory Reasoning (alpha = .87) was generally
consistent with publisher reported alphas (alphas = .91-.96; Martin & Brownwell, 2005). The
Story Recall subtest of the Wide Range Assessment of Memory and Learning, Second Edition
(WRAML2, Sheslow & Adams, 2003) tapped the ability to listen to and utilize narrative
structure to organize and retell gist and verbatim details of two orally presented narratives and
yielded an age-normed scaled score (M = 10, SD = 3). Internal consistency Cronbach’s alpha
from our sample for Story Recall (alpha = .95) was generally consistent with publisher reported
alphas (alphas = .91-.92; Sheslow & Adams, 2003).
Reading Comprehension. The Gray Oral Reading Tests – Fifth Edition (GORT-5;
Wiederholt & Bryant, 2012) provided a standardized measurement of reading comprehension
that yielded age-normed scaled scores (M = 10, SD = 3). The individually administered test is
comprised of 16 progressively more difficult reading passages read aloud by the child, each
followed by 5 open-ended comprehension questions given orally by the tester with the passage
removed from view. Question types vary, from those asking for recall of details to those
requiring higher order processing such as synthesis of the main idea, understanding of causal
relations, or ability to make predictions. Publisher (Wiederholt & Bryant, 2012) reported
Cronbach’s alpha reliability coefficients for Comprehension scores range between .90 and .96 in
the normative sample, and .97 in an ASD subsample.
Analytic Strategy
Differentiated Profiles of Reading Skills. All analyses were conducted using Mplus
7.11 (Muthén & Muthén, 1998 - 2015). To answer the first research question, we began by
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iteratively fitting a series of unconditional latent profile analyses beginning with a one-profile
model and increasing the number of profiles by one with each subsequent run. The twelve
reading-related measures (i.e. RAN, NWR, Elision, PDE, SWE, GORT Accuracy, CELF
Recalling Sentences, Expressive Vocabulary, TAPS Auditory Reasoning, WRAML Story Recall,
and GORT Comprehension) were used as latent profile indicators. See Figure 1 for a conceptual
diagram of the full model. As the twelve indicators represented the four broader constructs,
including the indicators simultaneously allows profiles to reflect differences across the four
constructs concomitantly. This analysis also provides an empirical method of deriving reading
profiles as opposed to using relatively arbitrary cutoff scores. Finally, examining the results in
light of the twelve indicators (and, consequently, the four broader constructs) simultaneously
enabled us to identify the greatest discrepancies across constructs among the emergent profiles.
Multiple fit indices were used to compare the models as no single fit index has been
shown to perfectly identify the optimal model (Nylund, Asparouhov, & Muthén, 2007). First, we
utilized the Bayesian Information Criterion (BIC; Schwartz, 1978) and adjusted BIC (ABIC)
with lower values indicating a preferred model. Additionally, we used two likelihood ratio based
indices, the Lo-Mendell-Rubin (LMR) test and the bootstrapped likelihood ratio test (BLRT).
Both tests assess whether adding a profile significantly improves model fit such that a non-
significant p-value for a k-class model indicates the model with k - 1 classes is preferred. For
further information on these three fit indices, see Nylund et al. (2007). Finally, we employed two
information-heuristic indices, the Bayes Factor (BF) and correct model probability (cmP) that
have only recently been applied to mixture modeling (Masyn, 2013). The BF provides pairwise
comparisons of adjacent models that provides a ratio of the probability of a model with k classes
being preferred compared to a model with k + 1 classes. Values between 1 - 3 are weak evidence
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for the k-class model, 3 - 10 are moderate evidence, and values greater than 10 indicate strong
evidence. The cmP provides a probability that each model is preferred compared to all of the
models under consideration. While not considered a fit index, we also examined entropy, which
provides a measure of the strength of classification, with values between .80 and 1.00 or greater
indicative of good classification (Ram & Grimm, 2009). While fit statistics aided us in
identifying a chosen model, we also considered the substantive interpretation of the latent
profiles in each model to ensure the chosen model was theoretically viable (Muthén, 2003).
Linking Reading Profiles to ASD Symptomatology. After choosing the preferred
unconditional model, we examined differences in ASD symptomatology based on latent profile
membership to answer the second research question. This was accomplished by estimating
profile-specific means. This process has been shown to result in a shift in the latent profiles,
thereby altering the substantive interpretation of them (Asparouhov & Muthén, 2014a; Nylund-
Gibson, Grimm, Quirk, & Furlong, 2014). Therefore, we implemented the BCH approach
(Asparouhov & Muthén, 2014b; Bakk, Tekle, & Vermunt, 2013; Bolck, Croon, & Hagenaars,
2004; Vermunt, 2010) in order to account for classification error and avoid profile shifts. This
method does so by applying weights to individuals based on posterior probabilities of profile
membership. Finally, the BCH approach estimated profile-specific means of ADOS and
conducted all pairwise comparisons. For technical details of the BCH approach, see Asparouhov
& Muthén (2014b), Bakk, Tekle, & Vermunt (2013), and Bolck, Croon, & Hagenaars (2004).
Results
This section is divided into three subsections reflecting the model building steps. First,
we provide descriptive statistics to compare the present sample to national norms. Next, we
describe the latent profile enumeration process and label and interpret the emergent profiles.
19
Finally, we present the results of the relation between the reading profiles and ASD
symptomatology severity.
Descriptive Statistics
Descriptive statistics, all reported as standard scores can be seen in Table 1. The
descriptive statistics demonstrate that the sample met criteria for ASD on the ADOS-2; measures
of IQ show normal range. A range of scores was seen on the reading related measures. On
average, the overall sample scored at least one standard deviation below the normed mean on all
reading measures. The one exception is the word decoding measure, PDE and SWE, where the
sample scored closer to the normed average of 100. In order to determine if the heterogeneity of
the samples reading abilities, next we conducted a series of latent profile analyses.
Identifying Differentiated Reading Profiles
Fit statistics of the six latent profile models can be seen in Table 2. Values in boldface
indicate the preferred model for a particular fit index. The BIC reached a minimum value at the
4-profile model. However, the only statistically significant LMR value occurred with the 2-
profile model. The BLRT never became non-significant and, thus, was non-informative in
choosing a preferred model. Both the BF and cmP supported the 4-profile model. The entropy
value for the 4-profile model was .90.
While statistical evidence was clear for the 4-profile model, we also examined the profile
plot to ensure theoretical viability. Though the analysis was conducted using age-normed
standardized scores, these were rescaled to z-scores for the profile plot to foster interpretability.
The four profiles were characterized by their performance on the reading and language measures.
The profile plot for the 4-profile model can be seen in Figure 2. The profile demarcated by a
dashed line with square markers was labeled Readers with Comprehension Disturbance and
20
accounted for approximately 20% of this sample. These students were characterized by average
rapid automatized naming, phonological awareness, word decoding and word recognition, text
reading accuracy, and expressive vocabulary, alongside low-average phonological memory,
sentence-level syntactic expressive language skills, and story recall. Concomitant deficits in
auditory reasoning/inference, and reading comprehension typified this profile. The profile
demarcated by a dotted line with triangle markers accounted for about one-third of the sample
and was distinguished by poor performance (approximately 1 SD below average) across all
language and reading variables, so we termed this profile Readers with Global Disturbance. The
profile at the bottom of the plot depicted by a solid line with diamond markers accounted for
about 14% of the sample and was marked by very poor performance on all language and reading
variables, this subgroup was called Readers with Severe Global Disturbance. In particular,
RAN, sentence-level syntactic expressive language skills, auditory reasoning/inference, narrative
retelling, and reading comprehension were very low with scores approximately 2 SD or more
below average. The final profile with a solid line with circular markers accounted for about 32%
of the sample and was delineated by scores in the average range on all language and reading
variables; this subgroup is called Average Readers.
We also examined potential differences in age and gender among the emergent profiles
using the three-step method (Asparouhov & Muthén, 2014a; Nylund-Gibson, Grimm, Quirk, &
Furlong, 2014). There were no effects of either age or gender. Readers of any age or either
gender were equally likely to be assigned to any of the latent profiles.
Relating Reading Profiles to ASD Symptomatology
The final step in this analysis was to relate ASD symptomatology (i.e. ADOS-2 total
score) to the heterogeneous reading profiles using the BCH approach. Results can be seen in
21
Figure 3. The Readers with Severe Global Disturbance (M = 14.38) had the highest level of ASD
symptomatology and this was significantly higher than both the Readers with Global
Disturbance (M = 10.15) and Average Readers (M = 9.98) profiles. Readers with
Comprehension Disturbance (M = 11.31) did not significantly differ from any of the other three
profiles and there were no other significant differences across profiles.
Discussion
There is converging evidence that many individuals with ASD demonstrate difficulties
with reading; the majority of previous studies have concentrated specifically on reading
comprehension disturbance (Estes et al., 2011; Jones et al., 2009; Nation, K., Clarke, P., Wright,
B., & Williams, C., 2006; Norbury & Nation, 2011; Ricketts, Jones, Happé, & Charman, 2013).
There is some evidence that beyond reading comprehension disturbance, there are different
profiles of readers in school-aged children with ASD (e.g., Brown et al., 2013; Jones et al, 2009;
Nation et al, 2006). In addition, research has delineated language subgroups in children and
adolescents with ASD (Rapin et al., 2009; Tager-Flusberg & Joseph, 2003), and language
impairments have been linked to reading difficulties in this population (Lindgren et al., 2009;
Lucas & Norbury, 2014; Norbury & Nation, 2011). However, the relation between these
language and reading subgroups was previously unexamined using comprehensive reading and
language batteries. In the present study, the first research question probed the heterogeneity of
reading and language performance for individuals with HFASD based upon a comprehensive
battery of assessments of phonological processing, word recognition, and linguistic and reading
comprehension measures. The inclusion of both lower-level reading sub skills that are related to
word recognition and variables related to higher-level linguistic comprehension allowed
22
simultaneous consideration of the relation between the two domains outlined by the Simple View
of Reading and their sub skills. Four distinct profiles emerged from the sample of students with
HFASD: Readers with Comprehension Disturbance, Readers with Global Disturbance, Readers
with Severe Global Disturbance and Average Readers. The second research question
investigated the relation between the subgroups of readers and ASD symptomatology in order to
further understand the relation between the social-communicative and cognitive phenotype of
ASD and reading related skills in sample of individuals diagnosed with HFASD.
HFASD Reading Subgroups
The Readers with Comprehension Disturbance typified the poor comprehender or
hyperlexic reading disability profile predicted by the Component Model of Reading. This
subgroup has been frequently reported in prior studies of reading with individuals with ASD
(e.g., Brown et al., 2013; Jones et al, 2009; Nation et al, 2006; Newman et al., 2007; Huemer &
Mann, 2010; Wei et al., 2015; Zuccarello et al., 2015) and shares characteristics with a language
subgroup reported by Rapin et al. (2009) whose members demonstrated adequate phonology and
vocabulary alongside linguistic comprehension deficits. Grigorenko, Klin, and Volkmar (2003)
noted disagreement in the literature as to whether hyperlexia is synonymous with a reading
comprehension disorder, or whether it is a unique condition characterized by an almost obsessive
interest in letters and words, precocious and unprompted emergence of word decoding, and an
extreme degree of discrepancy between word recognition and other cognitive skills that emerges
between 3 and 5 years of age (Healy, 1982). Individuals in this profile demonstrated strong
phonological awareness, decoding, and word reading skills; it is possible that some of the
children in this group may have been considered hyperlexic earlier in their development. We do
not have data depicting the sample’s early reading development prior to age 8, but even if some
23
of the children demonstrated a precocious and circumscribed interest in word reading and
decoding when very young, they are now functioning in the average range, similar to findings
reported by Newman et al. (2007).
Single word expressive vocabulary for children in the Readers with Comprehension
Disturbance profile was in the average range. However, the two measures reported to be
sensitive markers of language impairment, Nonword Repetition and Recalling Sentences
(Condouris, Meyer, & Tager-Flusberg, 2003; Norbury & Nation, 2011; Rapin, Dunn, Allen,
Stevens, & Fein, 2009), posed a challenge for many of these children. Therefore, in this
subgroup, word recognition abilities did not necessarily align with structural language abilities as
reported in prior studies of reading and language in ASD (Lindgren et al., 2009; Lucas &
Norbury, 2014; Norbury & Nation, 2011). Furthermore, children in this profile displayed higher-
level linguistic comprehension deficits ranging from approximately 1 to nearly 2 standard
deviations below average across the auditory reasoning/inference, story recall, and reading
comprehension measures. In summary, while children in this subgroup demonstrated adequate
word recognition skills and single word vocabulary and therefore may appear to be proficient
readers if other sub skills are not assessed, their moderate to profound structural language and
linguistic comprehension difficulties significantly impaired reading for meaning.
Readers with Global Disturbance corresponded with the garden variety poor reader
(Gough & Tunmer, 1986), or mixed reading disability subtype (Catts & Kamhi, 2005), and has
also been reported in prior studies of reading in ASD samples (Asberg & Sandberg, 2012;
Davidson & Weismer, 2014; Gabig, 2010; White et al., 2006; Nation et al., 2006). Children in
this subgroup shared characteristics with a language subgroup reported by Rapin et al. (2009)
who struggled with phonology, vocabulary, and linguistic comprehension. Similarly, Tager-
24
Flusberg and Joseph (2003) identified an impaired language subtype of children with ASD who
tended to have phonological processing deficits and scores 1-2 SD below the mean on most
language tests. Unlike Readers with Comprehension Disturbance, Readers with Global
Disturbance demonstrated overall low word reading and decoding abilities commensurate with
their poor language skills. Similar to children in the Readers with Global Disturbance, the
Readers with Severe Global Disturbance resembled Rapin et al. (2009) and Tager-Flusberg &
Joseph’s (2003) language impaired subtypes previously described, but with far more severe
impairment. The distinction between the two latter profiles may be thought of as categorically
distinct areas of a continuum, such as the difference between the terms “below average” and “far
below average” that are sometimes used in diagnostic measures. This is consistent with
longitudinal evidence from Pickles et al. (2014) that oral language impairments in ASD present
in parallel patterns of development and proficiency levels after the age of seven. Together these
two subtypes comprised about 47% of the sample.
The individuals in the Average Readers subgroup did not struggle with the reading or
language measures, and in fact exhibited intact reading skills overall. Their performance across
the language measures was similar to that of Rapin et al.’s (2009) subgroup that demonstrated
average or above performance on all language and cognitive measures. Similarly, this subgroup
shared many characteristics with Tager-Flusberg and Joseph’s (2003) description of a group of
children with ASD with normal linguistic abilities who have intact phonological skills, fluency,
syntax and morphology, expressive language, and average to large lexicons. They noted
however, that comprehension may still be impaired at the discourse level, as well as for more
open-ended questions such as “why, when, and how”. Therefore, more complex measures of
reading and linguistic comprehension that require increased demands on cognitive resources,
25
inferential thinking, and social knowledge might still pose a challenge for those in the Average
group.
Many of the children in all subgroups performed poorly on the auditory
reasoning/inference measure. This is consistent with Tager-Flusberg and Joseph’s (2003) finding
regarding difficulty with open-ended questions, as well as research indicating that children with
ASD often have difficulties integrating information from background knowledge with that from
the text for global coherence and inference generation (Norbury & Nation, 2011; Wahlberg &
Magliano, 2004). However, some studies have demonstrated that there are aspects of inferencing
which may be preserved in children with ASD such as automatic inference generation between
sentences in very short passages (Saldana & Frith, 2007) and inferring emotions of main
characters in short texts (Tirado & Saldana, 2016). However, Tirado and Saldana (2016) also
found that their participants had difficulty responding to questions about those inferred emotions.
It is possible that for individuals with ASD, there is particular difficulty with a deep
understanding of inferences in situations that are more abstract such as in the context of reading
unknown text, and that these difficulties may be exacerbated in longer texts. This is an important
area to target for explicit instruction.
This study found both similarities and differences compared to the subgroups of neuro-
typical readers reported by Catts et al. (2003). The most prominent difference was that no
dyslexic profile emerged in our study whereas this subgroup made up 35.5% of the poor readers
in their sample. This finding is consistent with previous studies of reading in samples with ASD
(Lindgren et al., 2009; Lucas & Norbury, 2014; Norbury & Nation, 2011). Similar to these prior
studies, poor word reading and decoding in our sample was generally associated with structural
26
language difficulties as well as language and reading comprehension impairments, not as a stand-
alone dyslexic profile.
However, both the Readers with Global Disturbance and the Readers with Severe Global
Disturbance profiles resembled the Catts et al. (2003) language-learning disabilities subgroup.
Combining our two Global Disturbance profiles would account for 47.3% of our sample
compared to 35.7% in the Catts et al. sample. Thus, while we identified a similar subgroup, the
prevalence rates differed between the two studies. The differences might be a result of the
younger age (i.e., second grade) used in the Catts et al. (2003) study. However, language delay
and impairment is common in children with ASD (Pickles et al., 2014) and it is probable that
children with ASD who struggle with reading are more typified by impairments in either
language comprehension alone or language comprehension coupled with word reading
difficulties. This could explain the lack of a dyslexic profile along with a greater prevalence of
children who resembled the language-learning disabilities subgroup in Catts et al. (2003).
Relation of Reading Profiles to ASD Symptom Severity

Previous research has provided evidence that reading comprehension is negatively
associated with ASD diagnosis and symptom severity (Asberg et al., 2010; Estes et al., 2011;
Jones et al., 2009; Norbury & Nation, 2011; Ricketts et al., 2013). Results of this study are
consistent with these previous findings: reading comprehension scores were highest when ASD
symptomatology as measured by the ADOS-2 was lowest. Readers with Severe Global
Disturbance, who demonstrated the poorest linguistic and reading comprehension abilities, had
significantly higher levels of ASD symptomatology than children in the Average Reader and
Global Disturbance subgroups. They also struggled the most with sight word recognition and
text reading accuracy, consistent with individuals referred to in the typically developing
27
literature as having a language-learning disability (LLD; Berninger & May, 2011). The current
study provides additional evidence that the social communicative and cognitive phenotype of
ASD impacts both linguistic and reading comprehension for many students with ASD throughout
the school-age years.
Potential Implications for Treatment of Reading Disturbance
The majority of students with HFASD are educated in general education classrooms.
Extant data suggests that these students are being underserved in these settings in the area of
reading development, with many of them scoring at least one grade level below their typically
developing peers on reading assessments. In this sample of higher-functioning children with
ASD, 65% of the students were in general education classes 81-100% of the day, and an
additional 12% were in these classes 41-80% of the day, yet almost 68% of the students
demonstrated various profiles of moderate to severe language and reading difficulties.
Furthermore, these profiles were related to the severity of social communication and cognitive
characteristics associated with ASD. This has important implications for educating students with
an ASD diagnosis, particularly in socially-mediated, language-based learning contexts. It is
difficult to expect general education teachers to know how to meet the reading instructional
needs of individuals with HFASD when very little is known about the development of the sub
skills necessary for successful comprehension in this population of students.
In order to address the unique instructional needs of students with ASD, and to be able to
develop the most effective reading intervention protocols, a more in-depth investigation into
reading profiles in this population was necessary. The results of this study demonstrate that
assessment and intervention methods must be tailored to meet the specific reading needs of
individual students, and the specific skill deficits depicted in these profiles can be addressed.
28
Thorough assessment of both word recognition and linguistic comprehension sub skills is
important; for example, average single word expressive vocabulary was higher for all subgroups
than was auditory reasoning ability and an overreliance on vocabulary skill level could lead to
overlooking a key domain for intervention. When planning intervention, students in the Readers
with Comprehension Disturbance subgroup, who demonstrate dissociation between word
recognition skills and comprehension, would benefit from explicit structural language
intervention and linguistic comprehension instruction. However, students in the Severe Global
and Global Disturbance subgroups would benefit from explicit phonological processing, word
recognition, and linguistic comprehension intervention. The Severe Global Disturbance
subgroup would likely benefit from a much more intense intervention in these areas and may
require additional behavioral scaffolding to sufficiently engage with the intervention. These
types of targeted interventions could be implemented through collaborations with various school
professionals including reading specialists, speech and language pathologists, and special
education or general education teachers.
Conclusions
The proportion of individuals with reading disturbance has been shown repeatedly to be
greater in samples of individuals with ASD than in the general population. The data in the
present study concurred with previous literature that a large percentage of individuals with ASD
demonstrate reading disturbance and that this disturbance is associated with language
impairments. Furthermore, this study provided additional evidence that phonological awareness
is associated with word decoding for school-aged children with ASD, as is seen in typically
developing samples, and word recognition deficits were concomitant with language deficits. It
has also been argued and shown empirically that there is a significant relation between the
29
social-communicative and cognitive phenotype of ASD and reading performance. The present
study demonstrates support for this finding in a much more specific way, by showing that ASD
symptom severity is related differentially to specific profiles of readers.
Limitations and Future Directions

A limitation of the current study is that while the sample size was relatively large, the
developmental span across elementary and secondary school years was extensive. Future studies
would benefit from even larger samples at each age and grade level to more fully understand
reading profiles in students with ASD. Future studies would also benefit from data collection
with students with a broader range of ASD severity, as this study only included individuals with
HFASD. We would also suggest that text reading fluency be collected as a part of future reading
batteries as it is possible that while this sample showed relative strength on word reading, it may
not translate to fluent reading of connected text. In addition to text reading, we also note
limitations related to the language measures used in this study. In the future, we would suggest
collecting more robust measures of language development in order to gain a better understanding
of the role language plays in reading comprehension. Another limitation of this study is that the
standardized measures used may not have been robust enough to adequately capture the extent of
higher-level linguistic and reading comprehension challenges. A future study would benefit
from the inclusion of additional reading and language comprehension measures that are more
complex and would demand more cognitive resources, inferential thinking, narrative retelling,
and social knowledge. Longer texts, both fiction and nonfiction, that are similar to those used in
classrooms, as well as other genres such as persuasive essays or satire might also uncover
additional targets for intervention even for those in the Average Reader group. Longitudinal
studies would also contribute further to our understanding of patterns of subgroup membership
30
and how they may change with intervention and maturation. Finally, future investigations are
needed to further probe the specific aspects of ASD symptomatology that are associated with
reading and language-based learning in structured, multifaceted social contexts such as
classrooms in order to develop effective interventions for school-aged children with ASD.
Compliance with Ethical Standards
This study was funded by NIMH 1RO1MH085904, IES R324A110174, and the UC Davis
Department of Psychiatry, Lisa Capps Endowment for Research on Neurodevelopmental
Disorders (P. Mundy, PI).
Ethical approval: All procedures performed in studies involving human participants were in
accordance with the ethical standards of the institutional and/or national research committee and
with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent: Informed consent was obtained from all individual participants included in
the study.
31
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Tables & Figures
Table 1
Descriptive Statistics for the Full Sample
Measure M SD Range
PP and RAN
RANc 85.68 21.92 1-145
NWRa 7.50 2.15 1-13
Elisiona 9.94 3.08 1-15
Word Recognition
PDEc 94.89 14.81 58-127
SWEc 93.29 14.75 57-136
GORTAcca 8.03 2.69 2-16
Linguistic Comprehension
CELFrsa 7.36 3.15
Evocabb 46.96 9.89 24-69
AudReasa 6.04 2.77 1-11
StryReca 7.94 3.31 1-15
Reading Comprehension
GORTCompa 7.37 2.61 1-13
ASD Symptomatology
ADOS-2 Total 10.94 3.65 7-24
IQ
FIQc 100.00 14.00 76-132
VIQc 96.00 15.00 60-136
PIQc 105.00 16.00 71-150
Age 11.24 2.19 8-16
Note. PP = Phonological Processing; RAN = Rapid Automatized
Naming; NWR = Nonword Repetition; PDE = Phonemic Decoding
Efficiency; SWE = Sight Word Efficiency; GORTAcc = GORT text
accuracy; CELFrs = CELF Recalling Sentences; EVocab =
Expressive Vocabulary; AudReas = Auditory Reasoning; StryRec =
Story Recall; GORTComp = GORT reading comprehension.
a
Scaled score, M=10, SD = 3. bT-score, M = 50, SD = 10.
c
Standard score, M = 100, SD = 15.
42
Table 2
Fit Statistics of the Six LPA Models
LMR BLRT
Profile LL BIC ABIC p-value p-value BF cmP Min n
1 -2687.81 5472.31 5402.93 - - <.001 <.001 -
2 -2580.87 5311.15 5203.92 0.006 <.001 1.56 0.17 34
3 -2554.94 5312.03 5166.96 0.683 <.001 0.16 0.11 13
4 -2526.75 5308.38 5125.46 0.181 <.001 34.81 0.69 11
5 -2503.93 5315.48 5094.72 0.37 <.001 - 0.02 10
6 Did not converge
Note. LL = Log-likelihood; BIC = Bayesian Information Criterion; ABIC = Adjusted BIC; LMR = Lo-
Mendell-Rubin Likelihood Ratio Test; BLRT = Bootstrapped Likelihood Ratio Test; BF = Bayes Factor;
cmP = Correct Model Probability.
43
Table 3
Profile-specific Means (Standard Errors) of All Indicator Variables
Severe Global Comprehension Global

Measure Disturbance Disturbance Disturbance Average Readers
PP and RAN
RANc 71.70 (8.12) 96.79 (4.39) 80.24 (4.50) 90.31 (4.51)
NWRa 6.25 (0.54) 7.60 (0.50) 7.22 (0.44) 8.27 (0.45)
Elisiona 7.58 (1.24) 11.93 (0.78) 8.34 (0.79) 11.35 (0.38)
Word Recognition
PDEc 86.20 (4.64) 105.81 (3.99) 82.33 (3.32) 104.89 (2.09)
SWEc 76.70 (3.37) 101.22 (3.95) 86.64 (2.98) 102.66 (2.60)
GORTAcca 5.61 (0.70) 8.56 (0.66) 6.63 (0.30) 10.26 (0.58)
Linguistic
Comprehension
CELFrsa 2.67 (0.75) 7.18 (0.53) 6.74 (0.54) 10.28 (0.41)
EVocabb 35.36 (2.56) 47.22 (2.48) 42.94 (1.39) 55.74 (1.53)
AudReasa 2.75 (0.53) 4.66 (0.97) 6.71 (0.67) 7.67 (0.47)
StryReca 3.78 (0.76) 7.40 (1.05) 8.00 (0.63) 9.86 (0.58)
Reading
Comprehension
GORTCompa 3.50 (0.45) 5.85 (0.64) 7.42 (0.26) 10.00 (0.40)
Note. PP = Phonological Processing; RAN = Rapid Automatized Naming; NWR = Nonword Repetition; PDE = Phonemic Decoding
Efficiency; SWE = Sight Word Efficiency; GORTAcc = GORT text accuracy; CELFrs = CELF Recalling Sentences; EVocab =
Expressive Vocabulary; AudReas = Auditory Reasoning; StryRec = Story Recall; GORTComp = GORT reading comprehension.
a
Scaled score, M=10, SD = 3. bT-score, M = 50, SD = 10. cStandard score, M = 100, SD = 15.
44
PP and RAN Word/Text Linguistic Reading

Recognition Comprehension Comprehension
Reading
Profiles ADOS
Figure 1. Conceptual diagram of heterogeneous reading profiles and relation to ASD symptomatology.
45
0.5
-0.5
-1
-1.5
-2
-2.5
-3
c
E
cc
ab
R
rs
N
on
as
p
Re
m
PD
SW
W
LF
RA
Re
A
oc
isi
Co
ry
N
RT
EV
CE
El
ud
St
RT
O
A
G
O
G
Severe Global Disturbance (14.1%) Comprehension Disturbance (20.6%)
Global Disturbance (33.2%) Average Readers (32.1%)
Figure 2. Profile plot based on reading measures. PP = Phonological Processing; RAN = Rapid Automatized Naming; NWR = Nonword Repetition; PDE =
Phonemic Decoding Efficiency; SWE = Sight Word Efficiency; GORTAcc = GORT text accuracy; CELFrs = CELF Recalling Sentences; EVocab = Expressive
Vocabulary; AudReas = Auditory Reasoning; StryRec = Story Recall; GORTComp = GORT reading comprehension.
46
*
16
*
14
12 14.38
(5.54)
10
ADOS Mean
11.31
8 (2.99)
10.15 9.98
6 (3.32) (2.69)
0
Severe Global Comprehension Global Disturbance Average Readers
Disturbance Disturbance
Reading Profile
Figure 3. Means (standard deviations) of ADOS-2 scores by reading profile. An asterisk indicates significantly different (p < .05)
ADOS-2 means between a given pair of reading profiles.
47

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A Comprehensive Examination of Reading Heterogeneity in Students with High Functioning

Nancy S. McIntyrea, Emily J. Solaria, Ryan P. Grimma, Lindsay E. Lerroa,

Joseph E. Gonzalesb and Peter C. Mundya

Article Citation (Published April 2017):

Research Funded by: NIMH 1RO1MH085904, IES R324A120168

conducted to determine if significant differences existed between profiles as a result of ASD

symptomatology. Findings demonstrate the heterogeneous nature of reading profiles in students

Keywords: Reading; Language; Reading Profiles; Higher Functioning Autism

of heterogeneity in development among children affected by ASD (Georgiades et al., 2013;

instruction, with individualized special education supports.

studies report symptomatology similar to reading comprehension disability, or individuals who

skills battery in large samples.

With a deeper, evidence-based understanding of the nature and variability of reading

difficulties, or disturbances, in school-aged children with HFASD, beyond what is already

beyond reading comprehension difficulties, with a close examination of basic reading

development. Second, we attempt to determine if meaningful subgroups or profiles of reading

Development of Reading: Subcomponent Skills and Profiles of ASD Struggling Readers

identify words by sight develops and progressively supplements the decoding/phonological

same level as their listening comprehension once word reading is fluent.

be operating sufficiently for successful reading comprehension. The Component Model of

reading difficulty in order to better target intervention efforts.

accurate lower-level word recognition skills typically demonstrate deficits in phonological

reasoning and integration of background knowledge during reading to generate inferences

comprehenders, or hyperlexics, who demonstrate adequate word decoding alongside poor

2015; Zuccarello et al., 2015).

comprehension have significant concomitant lower-level phonological, rapid naming, and/or

standardized measures of reading comprehension, word recognition, and decoding (Lindgren et

recognition is concomitant with proficient linguistic comprehension.

Several studies have placed emphasis on exploring higher-level linguistic comprehension

of performance on inferential reading comprehension questions (Lucas & Norbury, 2015).

the language skills of students with ASD.

Reading Comprehension and ASD Symptomatology

component of the social-communicative and cognitive phenotype of school-aged children with

impacted by deficits in social communication abilities such as understanding an author’s

impairments in social communication skills may impact reading comprehension through

developed through socially-mediated learning. Additionally, challenges in understanding social

understanding characters’ intentions, inference generation, and understanding of narrative

children affected by ASD.

Previous research has started to investigate reading development in school-aged children

75 as measured on the Wechsler Abbreviated Scales of Intelligence-II (WASI-2, Wechsler,

Measures and Procedures

algorithm per Hus & Lord (2014).

phonology/phonological memory respectively. The internal consistency Cronbach’s alpha

an age-normed RAN index score (M = 100, SD = 15). Alternate-form reliability coefficients

with publisher reported alternate-form reliability coefficients (.70–.93).

normative sample, and .93 in an ASD subgroup.

Linguistic Comprehension. The Recalling Sentences subtest from the Clinical

provided an age-normed scaled score (M = 10, SD = 3) assessing sentence-level semantic and

comprehension, understanding implied meanings and idioms, and to making inferences.

alphas (alphas = .91-.92; Sheslow & Adams, 2003).

Wiederholt & Bryant, 2012) provided a standardized measurement of reading comprehension

the normative sample, and .97 in an ASD subsample.

Linking Reading Profiles to ASD Symptomatology. After choosing the preferred

unconditional model, we examined differences in ASD symptomatology based on latent profile

method does so by applying weights to individuals based on posterior probabilities of profile

Identifying Differentiated Reading Profiles

value for the 4-profile model was .90.

reading accuracy, and expressive vocabulary, alongside low-average phonological memory,

RAN, sentence-level syntactic expressive language skills, auditory reasoning/inference, narrative

variables; this subgroup is called Average Readers.