Socioeconomic Status and Quantity of Shared Book Reading, But Not Screen Time, are Positively Associated With Language Skills in a Nationally Representative Sample of Autistic Children

Studies have shown that both distal and proximal environmental factors influence language development in neurotypical children. More specifically, higher socioeconomic status (SES) and more frequent shared book reading have been linked to higher language skills in neurotypical children, while higher screen time has been linked to lower language skills. However, little research has focused on understanding how the environment shapes language development in autistic children, who often experience challenges using and/or understanding spoken language. The present study used data from the 2018-2022 United States National Survey of Children's Health to investigate the associations between SES, quantity of shared book reading and screen time experienced at home, and expressive and receptive language skills in a nationally representative sample of two to five year old autistic children. Structural equation modeling revealed that autistic children from higher SES households, and who experienced shared book reading more frequently at home, had higher expressive and receptive language skills. Shared book reading also mediated the association between SES and children's language skills. Contrary to what has been found in previous studies of neurotypical children, screen time was not associated with autistic children's expressive or receptive language skills. In all, findings suggest that distal (SES) and proximal (shared book reading) environmental factors play an important role in autistic children's language development. Findings have important implications for clinical practice, as interventions that promote frequent shared book reading may support autistic children's language development.