Context Matters: Assessing Sex and Diagnostic Differences in Autistic Children’s Language Across Tasks With Differing Levels of Structure

Abstract Purpose Examine how task structure and participant sex influence social-word production in verbally fluent autistic and non-autistic youth during two ADOS‑2 Module 3 tasks (Picture Description and Telling a Story From a Book). Methods One hundred eleven verbally fluent autistic and non-autistic youth (ages 6–15) completed ADOS‑2 Module 3. Groups were matched on age and IQ. Transcripts of Picture Description and Telling a Story From a Book were processed with LIWC‑22 to quantify social words. Generalized linear models predicted social word production in each task using age, IQ, sex, and diagnostic group as predictors, including sex-by-diagnosis interactions. Associations between social-word use in each task and ADOS‑2 Social Affect scores were examined within the autistic group. Results In the Picture Description task, there was a significant interactive effect of sex and diagnosis. This was driven by non-autistic girls using more social words than any other subgroup. Autistic girls and boys did not differ. In the Telling a Story From a Book task, there were no significant effects of sex or diagnosis. Within the autistic group, participants who used fewer social words during Picture Description task were rated as having greater social difficulties by expert clinicians. Conclusion Task structure impacts detection of diagnostic and sex-related differences in social language: less structured contexts reveal diagnostic group differences, while structured narrative elicitation attenuates them. Social word production in unstructured settings relates to clinician-rated social difficulties, particularly for autistic girls, highlighting the importance of task selection when assessing pragmatic language.