Associations between pragmatic language and Theory of Mind in individuals with a history of autism and those who have lost the autism diagnosis

Although Theory of Mind (ToM) is seen as a primary contributor to pragmatic language use in autistic individuals, less work has considered the influence of structural language. This study examines grammaticality judgements, ToM (Reading the Eyes in the Mind task, Social Attribution test) and pragmatic language (a <i>de novo</i> measure based on Pragmatic Language Scales)-and their associations-in three groups with heterogenous abilities: current autism (<i>n</i> = 36); those with a history of autism spectrum disorder, who no longer display symptoms ('loss of autism diagnosis', LAD; <i>n</i> = 32) and non-autistic (<i>n</i> = 36) adolescents and adults with fluent verbal skills. 'Results showed that autistic individuals experience pragmatic difficulties and difficulties in affective ToM relative to both other groups, and difficulties in structural language relative to neurotypical controls; LAD individuals showed no impairments. While pairwise associations of structural language and Matrix Reasoning with pragmatic language were observed, ToM was the only unique predictor of pragmatic language when all measures were included in the models. Results suggest complex interactions among pragmatic and structural language, and ToM, and that pragmatic language improves meaningfully with broad changes in broad aspects of autism when individuals lose the autism diagnosis.This article is part of the theme issue 'At the heart of human communication: new views on the complex relationship between pragmatics and Theory of Mind'.