ERIC ED607135: Task Engagement during Narrative Writing in School-Age Children with Autism Spectrum Disorder Compared to Peers with and without Attentional Difficulties

2020·0.53 MB·English

by  ERIC

Research in Autism Spectrum Disorders 76 (2020) 101590
ContentslistsavailableatScienceDirect
Research in Autism Spectrum Disorders
journal homepage: www.elsevier.com/locate/rasd
Task engagement during narrative writing in school-age children
T
with autism spectrum disorder compared to peers with and without
attentional difficulties
Matthew Carl Zajica,*, Emily Jane Solaria, Nancy Susan McIntyreb, Lindsay Lerroc,
Peter Clive Mundyd,e
aReadingandAcademicDevelopmentResearchGroup,CurrySchoolofEducationandHumanDevelopment,UniversityofVirginia,405EmmetSt.
South,Charlottesville,VA22904,UnitedStates
bFrankPorterGrahamChildDevelopmentInstitute,UniversityofNorthCarolinaatChapelHill,CB8180,ChapelHill,NC27599,UnitedStates
cTheSwainCenterforListening,CommunicationandLearning,795FarmersLn#23,SantaRosa,CA95405,UnitedStates
dSchoolofEducation,UniversityofCalifornia,Davis;OneShieldsAve,Davis,CA95616,UnitedStates
eMINDInstitute,UniversityofCalifornia,Davis,282550thSt.,Sacramento,CA95817,UnitedStates
ARTICLE INFO ABSTRACT
Keywords: Background: Childrenwithautismspectrumdisorder(ASD)demonstratehighlyvariablewriting
Attention-deficit/hyperactivitydisorder skills. Few studies have examined if engagement during writing assessments may differ for
Autismspectrumdisorder childrenwithASDandiftaskengagementisrelatedtotheirwritingassessmentperformance.
Education ThisstudyexaminednarrativewritingandbroadtaskengagementinchildrenwithASDcom-
School-age
pared to peers with attention-deficit/hyperactivity disorder (ADHD) and typically developing
Taskengagement
(TD)peers.
Writtenexpression
Method: SixtychildrenwithASD,32childrenwithADHD,and29TDchildrencompletedas-
sessmentsofcognitiveskills,symptomseverity,andspontaneousnarrativewriting.Timespent
engagedduringwritingwasassessedduringthespontaneousnarrativewritingtask.
Results: TheASDgroupperformedlowestontextorganizationandqualityscoresaswellasword
productionscoreswhilealsospendingtheleasttimeengagedwiththewritingtask.Timespent
engagedwasmoststronglyassociatedwithnarrativewritingscoresintheASDgroupandex-
plaineduniquevarianceintextorganizationandqualityscoresandwordproductionscoresafter
controllingforrelatedage,cognitiveskills,andsymptomseverityvariables.TheADHDgroup
showedsimilarassociationsbetweentimespentengagedandwordproductionscores,andtime
spentengagedexplaineduniquevarianceinwordproductionscores.
Conclusions: TimespentengagedcompletingthewritingtaskappearedlowestfortheASDgroup
andmaysuggestwritingtaskengagementtobeamoreprominentdifficultyareaforchildren
withASDcomparedtopeerswithADHDandTDpeers.Implicationsforbetterunderstandingand
supportingthewritingskillsofchildrenwithASDarediscussed.
⁎Correspondingauthor.
E-mailaddresses:[email protected](M.C.Zajic),[email protected](E.J.Solari),[email protected](N.S.McIntyre),
[email protected](L.Lerro),[email protected](P.C.Mundy).
https://doi.org/10.1016/j.rasd.2020.101590
Received6June2019;Receivedinrevisedform8May2020;Accepted24May2020
Available online 17 June 2020
1750-9467/ © 2020 Elsevier Ltd. All rights reserved.
M.C.Zajic,etal. Research in Autism Spectrum Disorders 76 (2020) 101590
1. Introduction
Autism spectrum disorder (ASD) is a neurodevelopmental disorder wherein individuals demonstrate persistent difficulties in
social communication and social interaction across multiple contexts alongside the presence of restricted, repetitive patterns of
behaviors, interests, or activities (American Psychiatric Association, 2013). In recent years, researchers have expanded beyond
clinical understandings of ASD to consider how the social cognitive features of ASD may influence development across different
domains, such as academic skill development (Bauminger-Zviely, 2014). Children with ASD without a co-occurring intellectual
disabilityorothersevere communication difficultiesdemonstrateheterogenous academicskills(Ibrahim, 2020; Keen,Webster,&
Ridley,2016;Whitby&Mancil,2009).Yet,limitedresearchhassoughttounderstandthedifferentfactorsunderlyingthishetero-
geneity(e.g.,Corbett&Iqbal,2018).
Anemergingresearchareafallsonunderstandingthewrittenlanguageskillsofschool-agechildrenwithASD(e.g.,Finnegan&
Accardo,2018;Zajic&Asaro-Saddler,2019;Zajic&Wilson,2020).Overthelast20years,studieshavefoundthatchildrenwithASD
demonstrate heterogeneous writing skills (e.g., Brown, Johnson, Smyth, & Oram Cardy, 2014; Dockrell, Ricketts, Charman, &
Lindsay,2014;Grace,Enticott,Johnson,&Rinehart,2017;Griswold,Barnhill,Myles,Hagiwara,&Simpson,2002;Kushki,Chau,&
Anagnostou,2011;Mayes&Calhoun,2003a,2006a;Mylesetal.,2003;Zajicetal.,2018)withwritingdifficultiessuggestedtooccur
more frequently than reading or mathematics difficulties (Mayes & Calhoun, 2006a; Mayes, Waschbusch, Calhoun, & Mattison,
2019).WhilenotallchildrenwithASDstrugglewiththesamewritingdifficulties,empiricalstudiescomparingchildrenwithASDto
theirtypicallydeveloping(TD)peersandtotheirpeerswithotherdevelopmentaldisordershavesuggestedahigherprevalenceof
difficulties in handwriting and text organization and quality (Mayes & Calhoun, 2006a; Zajic & Wilson, 2020) with a lower pre-
valenceofdifficultiesinspelling,grammar,andpunctuation(Finnegan&Accardo,2018).Empiricalstudieshaveofferedtentative
explanationsforsomeofthesedifficulties,includingfactorsrelatedtocognition(i.e.,IQ;Mayes&Calhoun,2003b,2008),language
andsocial communication(Brownetal.,2014;Dockrelletal., 2014;Graceetal.,2017; Hilvert,Davidson,&Gámez,2020),and
attentionandexecutivefunctions(Dirlikovetal.,2017;Graceetal.,2017;Hilvert,Davidson,&Scott,2019;Zajicetal.,2018).
PartofthedifficultyofunderstandingthecomplexityofthewritingchallengesaffectingchildrenwithASDisthatwritingisa
complex,multifacetedsetofskills.Accordingtothesimpleviewandthenot-so-simpleviewofwriting,writingskillscanbebroadly
conceptualizedintotranscription(handwriting,keyboarding,andspelling)andtextgeneration(turningideasintowords,sentences,
andlargerdiscourseunits;Berninger&Amtmann,2003;Berninger&Winn,2006).Thesewritingskillsrelyonadditionalsocialand
cognitive processes to help navigate different writing scenarios, including executive functions and attention (Berninger & Winn,
2006)aswellasmotivation(Hayes&Berninger,2014).Thesesocialcognitiveprocessessupportself-regulationduringwritingby
managinghowwritersdevelopplans,gathercontenttowriteabout,organizeandconstructcontentappropriatetothewritingtask,
andregulatethoughtsandbehaviorstoremainengagedduringwritingtasks(Graham,2018;Hayes&Berninger,2014;Zimmerman
&Risemberg,1997).Theimportanceofself-regulationtowritinghasbeenwellsupportedbyunderlyingtheoriesofwrittenlanguage
developmentandhasresultedineffectiveinstructionalapproachesthathelpstrugglingwritersbecomemorestrategicintheirwriting
choices(seeBerninger&Winn,2006;Graham,2018;Harris&Graham,2016;Hayes&Berninger,2014;Zimmerman&Risemberg,
1997). Writers remain strategically engaged with the writing process through formulating intentions, planning, monitoring, and
reacting in order to gather, organize, write, and revise across most writing activities (see Graham, 2018). Children experiencing
difficulties with self-regulation and associated skills (e.g., control mechanisms; Graham, 2018) may have challenges with staying
engagedwiththeirwriting.
Few studies haveofferedpreliminary insightsintothe roles ofthesecontrol mechanisms inchildrenwith ASD(Hilvert et al.,
2019; Zajic & Wilson, 2020). Recent observational and intervention studies have been split regarding the examination of skills
associatedwithattentionandself-regulation:observationalstudiesgenerally focusonattentional difficultiesthroughuse ofcom-
parisongroups(e.g.,Dirlikovetal.,2017;Graceetal.,2017;Zajicetal.,2018),whileinterventionstudiesprioritizestructuringthe
writingprocess via self-managementinterventions (Asaro-Saddler, 2016). The focus onattention acrossobservational studieshas
suggested that attentional difficulties may play a role in the writing difficulties experienced by some individuals with ASD in
handwriting(Dirlikovetal.,2017;Graceetal.,2017)aswellastextgeneration(Zajicetal.,2018).Followingthisfocusonexecutive
functionskills,Hilvertetal.(2019)reportedthatchildrenwithASDwithgreaterexecutivedysfunctionweremorelikelytoexhibit
idiosyncraticlanguageuse(i.e.,greaterfrequencyoflongwordsandrarewords).
Alimitationofthecurrentresearchliteratureisalackofexaminationintohowchildrenengagewiththewritingprocessduring
writingassessments.AwidearrayofpsychoeducationalassessmentshavebeendeemedappropriateforusewithchildrenwithASD
(Corbett&Iqbal,2018),andtherelativelysmallsetofstudiesthathaveexaminedthewrittenlanguageskillsofchildrenwithASD
haveusedaverywidearrayofdifferentassessments(seeZajic&Wilson,2020).Additionally,theseassessmentsoftenemphasize
scoringwrittenproductswithlessemphasisplacedonhowchildrencompletethetasks.
Children with ASD demonstrate highly variable engagement patterns in educational settings (Bryan & Gast, 2000; Sparapani,
Morgan,Reinhardt,Schatschneider,&Wetherby,2016;Wilkinson,2008),yetstudiesfocusedonengagementduringwritingtasks
remainlimited(e.g.,Hilvertetal.,2020).Typically,studiesrelyonwrittenproductmeasuresorexamineproductivitysolelyasword
production,resultinginfewavailable studiesthat provideinsightsinto howparticipantsengage duringtheassessment.Griswold
etal.(2002)commentedthatsomeoftheirchildrenwithASDrefusedtowritebutofferedlimitedinsightsintowhytheyrefusedor
howchildrenengagedduringtheassessment.Dockrelletal.(2014)comparedwritersandnonwriterswitheitherASDorspecific
languageimpairmenttofindthatnonwritersacrossgroupswereyoungeranddemonstratedhigherASDsymptomseverityscoresbut
werenodifferentfromwritersoncognitive,language,ortranscriptionskills.Inarecentstudy,Hilvertetal.(2020)reportedthat
school-agechildrenwithASDexperiencegreaterdifficulties gettingstartedandstaying ontaskduringpersonalnarrativewriting
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M.C.Zajic,etal. Research in Autism Spectrum Disorders 76 (2020) 101590
compared to their TD peers. Other studies have examined writing skills using designs that did not allow for examining writing
engagement.Forexample,Brownetal.(2014)askedparticipantstocompleteapersuasiveessayusinganunspecifiedamountoftime
(reportingthatallparticipantsfinishedwithin30minbutwithlimitedadditionaldetails).
Examining time spent engaged during writing also may provide further exploration into the role of attentional skills during
writingforchildrenwithASDcomparedtopeerswithattentionaldifficulties.Attentionisadistinctcontrolmechanismthatsupports
broaderexecutivefunctionandself-regulationskillsbyhelpingtoregulatethebehaviorsusedduringawritingtask(seeBerninger&
Amtmann,2003; Graham,2018;Hayes&Berninger, 2014).Studiesfocused ontheattentionalskillsofchildrenwithASDduring
writing have usedboth measures of attentional difficulties as well as comparisongroups, commonly incorporating peers withat-
tention-deficit/hyperactivitydisorder(ADHD)toofferamultiplegroupperspective(e.g.,Graceetal.,2017;Mayes,Breaux,Calhoun,
&Frye,2019;Mayes&Calhoun,2006a;Zajicetal.,2018).IndividualswithADHDexhibitpatternsofinattentiveand/orhyperactive
behavior that can impact self-regulation and academic task management (American Psychiatric Association, 2013; DuPaul &
Langberg,2015).ChildrenwithADHDdemonstratesimilarwritingchallengestothosenotedinchildrenwithASD,withdifficulties
fallingacrosstextorganization,production,andconstruction(DeBonoetal.,2012;Mayes&Calhoun,2006b;Mayesetal.,2019a;
Molitor,Langberg,&Evans,2016).Yet,similartothefindingsofchildrenwithASD,thewritingskillsofchildrenwithADHDappear
to be heterogeneous (see Molitor et al., 2016) and have received limited sustained examination (see Graham, Fishman, Reid, &
Hebert,2016).PrevalenceestimatesofASDandADHDcomorbiditygreatlyrangeinschool-agechildren(16–44%)withchildren
demonstratinginternaldistractibilitywithhighASDsymptomseverityandhighexternaldistractibilitywithhighADHDsymptom
severity(seeDeprey&Ozonoff,2018).ADHDsymptomseveritymayplayaroleinthewrittenlanguagedifficultiesexperiencedby
childrenwithASD,asthelevelofADHDsymptomseverityobservedinchildrenwithASDhasbeenshowntobepredictiveofwriting
challengesthatarerelatedtobroadercognitiveandexecutivefunctiondifficulties(Dockrelletal.,2014;Hilvertetal.,2019;Zajic
etal.,2018).OngoingresearchisneededthatexamineschildrenwithASDtopeerswithADHDthatconsidersbothbetween-group
differencesinengagementaswellaswithin-grouprelationshipsbetweentaskengagementandwritingskills.
2. Currentstudy
ThisstudyexaminednarrativewritingandbroadtaskengagementinchildrenwithASDcomparedtochildrenwithADHDandTD
childrentoconsiderbetween-groupdifferencesinnarrativewritingandtimespentengagedandtoexplorewithin-grouprelationships
between narrative writing, time spent engaged, and related factors (i.e., age, cognitive abilities, and ASD and ADHD symptom
severity).ThisstudycontributestotheliteratureexploringwritingdevelopmentinchildrenwithASDandoffersnewinsightsrelative
totaskengagementduringwritingthatmayinformfutureassessmentandinstructionalresearch.Importantly,thestudyusedtheTest
of Written Language, 4th Edition (TOWL-4; Hammill & Larsen, 2009), a standardized, picture-based psychoeducational narrative
writingassessmentthatseparateswritingintodistincttaskstages(Scripting,Planning,andWriting).UsingtheTOWL-4allowedfor
examinationofbroadtaskengagementduringwritingwhereparticipantsreceivedavisualstimulustowriteabout(whichpotentially
allowedforlessambiguityaboutthetaskdemandscomparedtowhatmightbeexpectedwithmoreabstractornon-picture-based
writingtasks).ThecurrentstudyfocusedontaskengagementspecificallyduringtheWritingTaskStage,andapreviouspublication
examinedengagementduringthePlanningTaskStagewiththeincludedparticipants(seeZajic,Solari,McIntyre,Lerro,&Mundy,
2020).Threeresearchquestionsguidedthisstudy:
1) DochildrenwithASDdifferfrompeerswithADHDorTDpeersa)onnarrativewritingscoresandb)ontimespentengagedwitha
structured,picture-basednarrativewritingtask?
2) Dogroupsdifferintheira)relationshipsbetweennarrativewritingscoresandtimespentengaged,andb)relationshipsbetween
thesewritingtaskvariablesandage,cognitiveskills,andASDandADHDsymptomseverity?
3) Within groups, does time spent engaged explain additional variance in narrative writing scores after controlling for related
variables(i.e.,age,cognitiveskills,andASDandADHDsymptomseverity)?
3. Methods
All data were collected from children participating in a longitudinal study on academic, cognitive, and social development.
Familieswererecruitedthroughauniversity-affiliatedcenter’ssubjecttrackingsystem,byfliersthroughlocalschooldistricts,andby
wordofmouth.ThisresearchwasconductedincompliancewiththeInstitutionalReviewBoardattheUniversityofCalifornia,Davis.
In order to control for conditions that might significantly impact participants’ performance, exclusionary criteria included an
identifiedsyndromeotherthanASDorADHD,significantsensoryormotorimpairment,aneurologicaldisorder,psychoticsymptoms,
or any major medical disorder that could be associated with extended absences from school. This study included 121 children
between9–17yearsold,whichincluded60childrenwithASD(50male),32childrenwithADHD(25male),and29TDchildren(18
male). Children with ASD and ADHD came into the study with community diagnosesthat were confirmed via trained researcher
assessmentandparentreport.
3.1. Diagnosticandsymptomseveritymeasures
The Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2; Lord et al., 2012) confirmed diagnosis (ASD group) and
assessed ASD symptom severity (ASD and ADHD groups). The ADOS-2 is a semi-structured, standardized assessment of
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M.C.Zajic,etal. Research in Autism Spectrum Disorders 76 (2020) 101590
communication, social interaction, play, and restricted and repetitive behaviors. A research-reliable team member administered
either Module 3 (Child/Adolescent) or Module 4 (Adolescent/Adult) to calculate algorithm-adjusted Total Scores. Modules de-
monstratestronginterraterreliabilityviapublisher-reportedintraclasscorrelationcoefficients(αs=0.82−0.94;Lordetal.,2012).
TheSocialResponsivenessScale(SRS;Constantino&Gruber,2005)providedanadditionalassessmentofASDsymptomseverityfor
allgroups.Parents/guardianscompletedthe65-itemratingscalethatmeasuresASDsymptomseverityandgeneralsocialrespon-
siveness in naturally occurring contexts. The SRS provides a Total Score as a composite of five subscales (Awareness, Cognition,
Communication,Motivation,andMannerisms)andhasdemonstratedstronginternalconsistency(αs=0.93−0.97;Constantino&
Gruber,2005).
TheConners3(Conners,2008)confirmedADHDdiagnosis(ADHDgroup)andassessedADHDsymptomseverityacrossgroups.
TheConners3isacomprehensiveassessmentforidentifyingthepresenceofADHDsymptomatology,andparents/guardianscom-
pleted the DSM-IV Inattentive Scale and DSM-IV Hyperactive/Impulsive subscales. Both parent-report forms have strong demon-
stratedinternalconsistency(αs>0.90;Conners,2008).
3.2. Cognitivemeasures
TheWechslerAbbreviatedScaleofIntelligence,2ndEdition(WASI-II;Wechsler,2011)assessedcognitiveabilities.Twoverbal
(VocabularyandSimilarities)andtwononverbal(BlockDesignandMatrixReasoning)subtestswereadministeredtocomputeverbal
reasoning(VerbalComprehensionIndex[VCI]),nonverbalreasoning(PerceptualReasoningIndex[PRI]),andFull-ScaleIQ(FIQ)
estimates(Ms=100,SDs=15).InternalconsistencyCronbach’salphacoefficientsforthesampledemonstratedgreat-to-excellent
subtestreliabilities(αs=0.87−0.93)andwereconsistentwithpublisher-reportedalphas(α=0.96;Wechsler,2011).Allpartici-
pantshadanestimatedFIQofatleast73.
3.3. Writingmeasures
TheTOWL-4assessednarrativewritingviatheSpontaneousWritingsubtestwhereparticipantsproducedahandwritten,fictional
narrativeaboutaprovidedpicture.Duringtheassessment,participantslistentoasamplestoryaboutanexamplepicture(Scripting),
plan their own story about a new picture (Planning), and draft their story (Writing). Written responses are evaluated based on
ContextualConventions(21items;spelling,morphological,andgrammaticwritingconventions)andStoryComposition(11items;
textorganizationandqualityviavocabulary,plot,prose,characterdevelopment,andreaderinterest).Thesescaledscores(M=10,
SD=3)areusedtocalculateaSpontaneousWritingIndexcompositescore(M=100,SD=15).Asnostandardizedscoreforword
productionisprovided,thetotalnumberofwordsproducedwerecountedforeachsample.Thoughwordproductionmayserveasa
proxy for handwriting, this measure of word production is impacted by task demands. Therefore, word production is used as a
measureoftextproductionandshouldnotbeinterpretedasanisolatedhandwritingorfluencymeasure.
All writing samples were scored by two research assistants trained by the first author using the TOWL-4 scoring guidelines
(Hammill&Larsen,2009).Trainingwascompletedwhenresearchassistantsreached100%agreementacrossexamplesamplesand
couldarticulaterationalesforallscoringdecisions.Interraterreliabilitywascalculatedonarandomselectionofwritingsamples(n=
34)usingintraclasscorrelationcoefficientstreatedastwo-wayrandom(Shrout&Fleiss,1979).Interraterreliabilitywasgreat-to-
excellentforContextualConventions(α=0.94),StoryComposition(α=0.84),andwordproduction(α=1.00).
3.4. Tasktimespentengaged
Timespentengagedwasoperationalizedasthetotalduration(inseconds)participantsspent completingtheTOWL-4Writing
TaskStage.Participantswereprovidedamaximumof10min(600s)tocompletetheirwrittennarratives(whichwasreducedfrom
therecommended15minduetolargerstudyvisittimeconstraints).Thestartpointforcalculatingtimespentengagedbeganaftera
trainedresearchteammemberexplainedthewritingtaskandansweredanyclarifyingquestionsfromtheparticipant.Participants
receivedremindersatfiveandnineminutestocontinuewriting.Ifaparticipantusedtheentiretimeandwasstillwritingwhentime
wasup,theycouldfinishtheircurrentsentence.Thestoppointforcalculatingtimespentengageddiffereddependingonindividual
behaviors.Ifaparticipantremainedengagedwiththetaskforthefull10min,thenthestoppointwastheendofthetask(with600s
recordedfortimespentengaged).Ifparticipantssaidtheywerefinishedbeforethetaskwasdone,thenaresearchteammember
encouraged participants to try to write a full page and prompted participants to think about the details in the task picture. If
participantsthenrefusedtowritemoreorsaidtheyhadwrittenasmuchastheycould,thenthetaskwasended,andthestoptime
wasrecorded.
4. Dataanalysis
Analyses were conducted using SPSS 25 (IBM Corp., 2018). Groups were matched on age but differed on IQ (ASD=ADHD,
ASD < TD,andADHD < TD;Table1).Toaccountforthisdifference,groupcomparisonscovariedforFIQ.Toaddresstheresearch
questions, three sets of analyses were conducted. First, a univariate analysis of covariance (ANCOVA) with follow-up pairwise
comparisonswithaBonferroniadjustmentexaminedoverallgroupdifferencesontheTOWL-4SpontaneousWritingIndex.Second,a
multivariateanalysisofcovariance(MANCOVA)followedbyANCOVAswithaBonferroniadjustmentexaminedgroupdifferenceson
TOWL-4 writing scores (Contextual Conventions, Story Composition, and word production) and task time spent engaged. Third,
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M.C.Zajic,etal. Research in Autism Spectrum Disorders 76 (2020) 101590
Table1
DescriptiveStatisticsandGroupComparisonsforAge,CognitiveAbilities,andSymptomSeverity.
ASD ADHD TD
n=60 n=32 n=29
M(SD) Range M(SD) Range M(SD) Range F p 2
p
Age 12.63(2.11) 9.33−17.17 13.13(2.30) 9.64−17.31 12.74(2.29) 9.35−17.02 0.55 0.58 0.01
VCIb 95.92(15.48) 60−136 98.84(14.33) 72−128 111.24(13.79) 81−138 10.72 < 0.001 0.15
PRIb 102.25(16.86) 70−150 99.94(15.81) 74−126 116.83(14.14) 91−160 10.44 < 0.001 0.15
FIQb 98.73(15.13) 73−132 99.31(15.00) 74−131 115.62(12.82) 90−150 14.46 < 0.001 0.20
ADOS-2a,c 10.75(3.61) 7−24 4.14(3.81) 0−13 – – 62.80 < 0.001 0.42
SRSd 82.49(10.24) 52−91 61.29(14.66) 42−91 43.69(7.50) 34−66 127.01 < 0.001 0.69
Inattenb 73.97(11.19) 50−90 77.63(10.57) 54−90 46.90(10.67) 35−90 75.60 < 0.001 0.56
Hyperb 71.40(15.52) 39−90 71.13(17.27) 40−90 47.14(8.93) 38−73 29.58 < 0.001 0.33
Note. aOnly the ASD and ADHD groups received the ADOS-2. bASD=ADHD, ASD<TD, ADHD<TD. cASD>ADHD. dASD>ADHD,
ASD>TD, ADHD>TD. ASD=autism spectrum disorder. ADHD=attention-deficit/hyperactivity disorder. TD=typically developing.
VCI=VerbalComprehensionIndex.PRI=PerceptualReasoningIndex.FIQ=Full-ScaleIQ.ADOS-2=AutismDiagnosticObservationSchedule,
2nd Edition Total Score. SRS=Social Responsiveness Scale Total Score. Inatten=Conners 3 DSM-IV Inattentive Parent Report Scale.
Hyper=Conners 3 DSM-IV Hyperactive/Impulsive Parent Report Scale. Reprinted from Zajic, Solari, McIntyre, Lerro, & Mundy (2020) with
permissionfromElsevierwitheffectsizecalculationsadded.
Pearsonproduct-momentcorrelationswereconductedseparatelyforeachgrouptoexaminea)therelationshipsbetweennarrative
writingscoresandtimespentengagedandb)therelationshipsbetweenwritingandtaskengagementvariablesandage,cognitive
skills (VCI, PRI, and FIQ), and symptom severity (ADOS-2, SRS, and Conners 3). These interrelationships guided the building of
group-specifichierarchicalmultipleregressionspredictingContextualConventions,StoryComposition,andwordproductionscores
thatincludedvariablesatStep1(age,cognitiveskills,andsymptomseverityestimatesrelatedtothatTOWL-4score)andStep2(time
spent engaged). Models were examined for variance explained (R2) and change in variance explained between steps (ΔR2) with
contributionfromindividualpredictorsassessedviastandardizedbetacoefficients(β).
5. Results
Descriptive statistics are reported in Table 1. As mentioned, groups were matched on age but differed on cognitive abilities
(ASD=ADHD,ASD < TD,andADHD < TD;Table1).TheASDgroupdemonstratedelevatedsymptomseverityontheADOS-2
comparedtotheADHDgroupandontheSRScomparedtoADHDandTDgroups.TheASDandADHDgroupsdemonstratedelevated
ADHDsymptomseverityrelativetotheTDgroupbutdidnotdifferthemselves.Norm-referencedscoresfortheTOWL-4scoresforthe
ASD and ADHD groups predominantly fell in the below average to average ranges (TD fell in the average range), and groups
demonstratedwiderangesforthetotalnumberofwordsproduced(Table2).
5.1. GroupcomparisonsforTOWL-4scoresandtimespentengaged
2
GroupsdifferedontheSpontaneousWritingIndex,F(2,117)=7.96,p<0.001, p=0.12.TheASDgroupperformedlowerthan
Table2
MultivariateandUnivariateBetween-GroupEffectsforGroupbyTOWL-4WritingScoresandTimeSpentEngaged.
ASD ADHD TD
n=60 n=32 n=29
M(SE) Range M(SE) Range M(SE) Range F p 2
p
SpontaneousWritingIndex 101.09(2.18) 55−128 106.79(2.95) 58−135 117.54(3.35) 93−158 7.96 0.001 0.12
ContextualConventionsa 10.10(0.33) 2−15 10.15(0.45) 2−15 12.08(0.51) 8−18 5.28 0.006 0.08
StoryCompositiona 9.36(0.42) 2−16 11.13(0.57) 2−15 12.52(0.65) 8−20 8.68 < 0.001 0.13
WordProductiona 82.52(5.67) 2−183 107.75(7.67) 2−186 135.32(8.70) 74−230 12.78 < 0.001 0.18
TimeSpentEngaged(s)a 460.23(16.11) 112.48−600.00 537.77(21.79) 254.72−600.00 544.56(24.73) 421.08−600.00 6.10 0.003 0.09
Note.ASD=autismspectrumdisorder.ADHD=attention-deficit/hyperactivitydisorder.TD=typicallydeveloping.TOWL-4=TestofWritten
Language,4thEdition.SWI=SpontaneousWritingIndex.CC=ContextualConventions.SC=StoryComposition.FIQincludedasacovariatefor
allanalyses(FIQ=102.93).
a V=0.26,F(8,230)=4.24,p<0.001, 2p=0.13.
5
M.C.Zajic,etal. Research in Autism Spectrum Disorders 76 (2020) 101590
yacross 5 0.300.330.360.31–0.200.220.180.24–0.220.06−0.08 ntextualOS-2=3DSM-
ndADHDSymptomSeverit 34 0.85***0.46*0.89***0.69***–0.65***0.65***–0.360.310.090.42*0.230.170.160.220.240.24––0.030.02−0.08−0.05−0.06−0.01 Edition.CC=TOWL-4Cox.FIQ=Full-ScaleIQ.ADortScale.Hyper=Conners
gagedwithAge,CognitiveSkills,andASDa TD 4512 0.64***0.35*–0.53**0.74***0.030.53**–0.78***0.340.85***0.89***–0.57**0.46*0.69***0.57**–0.300.330.54**0.33−0.020.200.310.130.230.16−0.06−0.020.130.150.140.070.230.19−0.18−0.16––−0.44*−0.26−0.110.140.120.18−0.03−0.09−0.26−0.32−0.130.04 TOWL-4=TestofWrittenLanguage,4thonIndex.PRI=PerceptualReasoningInde=Conners3DSM-IVInattentiveParentRep
weenTOWL-4WritingScoresandWritingTaskStageTimeSpentEn ADHD 345123 0.92***0.75***0.35**–0.56**0.87***0.96***0.80***0.49***0.56**–0.89***–0.83***0.46***0.87***0.89***–0.83***–0.54***0.64***0.74***0.78***0.46***0.54***–0.35*0.260.340.33*0.46***0.120.38*0.41*0.45*0.49***0.47***0.43**0.45*0.250.39*0.32*0.26*0.27*0.00−0.03−0.020.48***0.43**0.42**0.240.120.20−0.19−0.13−0.13−0.24−0.29−0.31−0.29*−0.19−0.20−0.22−0.46**−0.39*−0.13−0.040.110.21−0.020.10−0.12−0.060.04−0.02−0.33−0.20 ention/deficit-hyperactivitydisorder.TD=typicallydeveloping.=TOWL-4SpontaneousWritingIndex.VCI=VerbalComprehensiTotalScore.SRS=SocialResponsivenessScaleTotalScore.Inatten
Table3PearsonProduct-MomentCorrelationCoefficientsbetASD,ADHD,andTDGroups. ASD Variable12 1CC–0.77***2SC0.77***–3SWI0.92***0.96***4WordProduction0.75***0.80***5TimeSpentEngaged0.35**0.49***6Age0.28*0.33**7VCI0.46***0.45***8PRI0.34**0.27*9FIQ0.47***0.43**10ADOS-2−0.09−0.2511SRS−0.11−0.39**12Inatten−0.11−0.1313Hyper−0.12−0.10 Note.ASD=autismspectrumdisorder.ADHD=attConventions.SC=TOWL-4StoryComposition.SWIAutismDiagnosticObservationSchedule,2ndEditionIVHyperactive/ImpulsiveParentReportScale.***p<0.001,**p<0.01,*p<0.05.
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M.C.Zajic,etal. Research in Autism Spectrum Disorders 76 (2020) 101590
theTDgroup(p < 0.001)butnodifferentfromtheADHDgroup(p=0.36).TheTDandADHDgroupsdidnotdiffer(p=0.06).
TheMANCOVAfortheTOWL-4subtestscores,wordproduction,andtimespentengageddemonstratedheterogeneityofvariance-
covariance matrices (Box’s M=62.02, p<0.001). Groups differed on these scores, V = 0.26, F(8, 230)=4.24, p < 0.001,
2
p=0.13, with follow-up ANCOVA pairwise comparisons showing group differences across variables (ps<0.01; Table 2). On
ContextualConventions,theASDgroupperformedlowerthantheTDgroup(p=0.007)butnodifferentfromtheADHDgroup(p=
1.00).TheADHDgroupperformedlowerthantheTDgroup(p=0.02).OnStoryComposition,theASDgroupperformedlowerthan
theADHD(p=0.04)andTDgroups(p < 0.001).TheADHDandTDgroupsdidnotdiffer(p=0.36).Onwordproduction,theASD
groupproducedfewerwordsthantheADHD(p=0.03)andTDgroups(p<0.001).TheADHDandTDgroupsdidnotdiffer(p=
0.07).Ontimespentengaged,theASDgroupspentlesstimeengagedwiththetaskthantheADHD(p= 0.01)andTDgroups(p=
0.02).TheADHDandTDgroupsdidnotdiffer(p=1.00).
5.2. RelationshipsbetweenTOWL-4scoresandtimespentengaged
Correlation coefficients are reported in Table 3. For the ASD group, time spent engaged demonstrated moderate associations
acrossTOWL-4scores(rs=0.35−0.54,ps<0.01).FortheADHDgroup,timespentengagedwasmoderatelyassociatedwithword
production (r = 0.57, p = 0.001) and Contextual Conventions (r = 0.35, p = 0.05) while not significantly associated with the
SpontaneousWritingIndex(r=0.34,p=0.054)andStoryComposition(r=0.26,p=0.15).FortheTDgroup,timespentengaged
wasnotassociatedwiththeTOWL-4scores(rs=0.30−0.36,ps>0.05).
5.3. RelationshipsbetweenTOWL-4scoresandtimespentengagedwithage,cognitiveskillsandsymptomseverity
CorrelationcoefficientsarereportedinTable3.FortheASDgroup,TOWL-4scoresshowedweak-to-moderateassociationswith
age(rs=0.28−0.46,ps<0.05)andcognitiveabilities(rs=0.27–0.49,ps<0.05).SRSTotalscoreshowedaweakassociationwith
theSpontaneousWritingIndex(r=-0.29,p=0.03)andamoderateassociationwithStoryComposition(r=−0.39,p=0.002).
ADOS-2 Total Score showed no significant relationships (ps>0.05). Neither Conners 3 parent report scores showed significant
relationshipswithTOWL-4scores(ps>0.05).Timespentengagedshowedweak-to-moderatecorrelationswithcognitiveabilities(rs
=0.27−0.43,ps<0.05)andnosignificantcorrelationswithageandADOS-2,SRS,orConners3scores(ps>0.05).
For the ADHD group, TOWL-4 scores showed overall moderate associations with age (rs = 0.38−0.54, ps<0.05). The
Spontaneous Writing Index and Contextual Conventions showed moderate associations with VCI and FIQ (rs = 0.39−0.45,
ps<0.03) but not PRI (ps>0.05). SRS Total Score showed moderate correlations with the Spontaneous Writing Index, Story
Composition,andwordproduction(rs=-0.39−-0.46,ps<0.05).ADOS-2TotalScoreandConners3parentreportscoresshowedno
significantassociationswithTOWL-4scores(ps>0.05).Timespentengagedshowednosignificantcorrelationswithage,cognitive
abilities,orsymptomseverity(ps>0.05).
For the TD group, only word production showed a moderate correlation with age (r = 0.42, p = 0.02) with no significant
correlationsbetweenTOWL-4scoresandcognitiveabilities orsymptomseverity (ps>0.05). Timespent engagedshowednosig-
nificantcorrelationswithage,cognitiveabilities,orsymptomseverity(ps>0.05).
5.4. Hierarchicalmultipleregressions
RegressionswereconstructedforContextualConventions,StoryComposition,andwordproductionseparatelyfortheASDand
ADHD groups. The TD group was excluded from these analyses due to the limited variability in time spent engaged and limited
correlationalevidencebetweentimespentengagedandTOWL-4scores.Step1variablesfortheASDandADHDgroupswereselected
basedonthesignificanceoftheircorrelationcoefficients(p<0.05).Step2forbothgroupsincludedtimespentengaged.
Hierarchical regression models for the ASD group are reported in Table 4. For Contextual Conventions, Step 1 (age and FIQ)
explained30%oftheoverallvariance,F(2,57)=12.05,p<0.001.FIQ(β=0.47,p<0.001)butnotage(β=0.27,p=0.25)
explaineduniquevarianceatStep1.TheinclusionoftimespentengagedatStep2resultedinanon-significantincreaseinadditional
varianceexplained,ΔR2=0.02,F(1,56)=1.24,p=0.27.ForStoryComposition,Step1(age,FIQ,andSRS)explained42%ofthe
overallvariance,F(3,55)=13.08,p<0.001.TheinclusionoftimespentengagedatStep2accountedforanincreaseinoverall
varianceexplained,ΔR2=0.06,F(1,54)=6.15,p=0.016.Age(β=0.33,p=0.002),FIQ(β=0.24,p=0.035),SRSTotalScore
(β=-0.33.p=0.002),andtimespentengaged(β=0.27,p=0.016)eachexplaineduniquevarianceatStep2.Forwordpro-
duction, Step 1 (age and FIQ) explained 39 % of the overall variance, F(2, 57)=18.14, p<0.001. The inclusion of time spent
engagedatStep2accountedforanincreaseinoverallvarianceexplained,ΔR2=0.11,F(1,56)=12.84,p=0.001.Age(β=0.41,
p<0.001),FIQ(β=0.26,p=0.02),andtimespentengaged(β=0.37,p=0.001)explaineduniquevarianceatStep2.
HierarchicalregressionmodelsfortheADHDgrouparereportedinTable4.ForContextualConventions,Step1(ageandVCI)
explained 27 % of the overall variance, F(2, 29)=5.47, p = 0.01. VCI (β=0.37, p = 0.03) but not age (β=0.28, p = 0.10)
explained unique variance at Step 1. The inclusion of time spent engaged at Step 2 accounted for a non-significant increase in
additionalvarianceexplained,ΔR2=0.05,F(1,28)=2.17,p=0.15.ForStoryComposition,Step1(ageandSRS)explained29%of
theoverallvariance,F(2,28)=5.59,p=0.01.SRSTotalScore(β=-0.36,p=0.04)butnotage(β=0.23,p=0.10)explained
unique variance at Step 1. The inclusion of time spent engaged at Step 2 accounted for a non-significant increase in additional
varianceexplained,ΔR2=0.00,F(1,27)=0.34p=0.56.Forwordproduction,Step1(ageandSRS)explained38%oftheoverall
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M.C.Zajic,etal. Research in Autism Spectrum Disorders 76 (2020) 101590
Table4
HierarchicalMultipleRegressionsforTOWL-4WritingScoresfortheASDandADHDGroups.
ASD Model1 Model2
R2 ΔR2 B SE β t p B SE β t p
ContextualConventions
Step1 0.30 –
Age 0.36 0.15 0.27 −1.16 0.25 0.34 0.15 0.26 2.28 0.03
FIQ 0.09 0.02 0.47 4.20 < 0.001 0.08 0.02 0.41 3.33 0.002
Step2 0.31 0.02d
TimeSpentEngaged 0.00 0.00 0.14 1.12 0.27
StoryComposition
Step1 0.42 –
Age 0.66 0.19 0.37 3.53 < 0.001 0.59 0.18 0.33 3.26 0.002
FIQ 0.09 0.03 0.34 3.25 0.002 0.06 0.03 0.24 2.16 0.035
SRS −0.13 0.04 −0.37 −3.48 < 0.001 −0.12 0.04 −0.33 −3.22 0.002
Step2 0.48 0.06a
TimeSpentEngaged 0.01 0.00 0.27 2.48 0.016
WordProduction
Step1 0.39 –
Age 9.29 2.13 0.45 4.37 < 0.001 8.41 1.95 0.41 4.31 < 0.001
FIQ 1.20 0.30 0.42 4.04 < 0.001 0.74 0.30 0.26 2.48 0.02
Step2 0.50 0.11b
TimeSpentEngaged 0.10 0.03 0.37 3.58 0.001
ADHD Model1 Model2
R2 ΔR2 B SE β t p B SE β t p
ContextualConventions
Step1 0.27 –
Age 0.35 0.20 0.28 1.72 0.10 0.24 0.21 0.19 1.11 0.28
VCI 0.07 0.03 0.37 2.28 0.03 0.07 0.03 0.37 2.27 0.03
Step2 0.33 0.05d
TimeSpentEngaged 0.01 0.00 0.25 1.47 0.15
StoryComposition
Step1 0.29 –
Age 0.40 0.23 0.29 1.71 0.10 0.36 0.25 0.26 1.46 0.16
SRS −0.08 0.04 −0.36 −2.15 0.04 −0.08 0.04 −0.35 −1.99 0.06
Step2 0.29 0.00d
TimeSpentEngaged 0.00 0.01 0.10 0.59 0.56
WordProduction
Step1 0.38 –
Age 9.33 3.24 0.45 2.88 0.01 7.12 3.04 0.35 2.34 0.03
SRS −0.96 0.52 −0.29 −1.87 0.07 −0.75 0.47 −0.23 −1.58 0.13
Step2 0.51 0.13c
TimeSpentEngaged 0.18 0.07 0.39 2.70 0.01
Note.TOWL-4=TestofWrittenLanguage,4thEdition.ASD=autismspectrumdisorder.ADHD=attention-deficit/hyperactivitydisorder.FIQ=
Full-ScaleIQ.TimeSpentEngaged=TimespentcompletingtheTOWL-4spontaneouswritingsubtest.VCI=VerbalComprehensionIndex.SRS=
SocialResponsivenessScaleTotalScore.
a p=0.016.
b p=0.001.
c p=0.012.
d p>0.05.
variance,F(2,28)=8.62,p=0.001.TheinclusionoftimespentengagedatStep2accountedforanincreaseinoverallvariance
explained,ΔR2=0.13,F(1,27)=7.25,p=0.012.Timespentengaged(β=0.39,p=0.01)andage(β=0.35,p=0.03)butnot
SRSTotalScore(β=-0.22,p=0.13)explaineduniquevarianceatStep2.
6. Discussion
This study had three main goals to understand differences and relationships in narrative writing and time spent engaged in
childrenwithASDcomparedtopeerswithADHDorTDpeers:1)examinegroup-leveldifferencesinnarrativewritingandtimespent
engaged;2)examinegroup-specificrelationshipsbetweennarrativewritingandtimespentengagedaswellastoage,cognitiveskills,
andsymptomseverity;and3)examineiftimespentengagedexplainsadditionalvarianceinnarrativewritingaftercontrollingfor
relatedvariables(age,cognitiveskills,andsymptomseverity).
Group-leveldifferencesinnarrativewritingshowedtheASDgroupgenerallyperformedlowerthantheADHDandTDgroups(i.e.,
SpontaneousWritingIndex,StoryComposition,andwordproduction).ThispatterndifferedforContextualConventions,wherethe
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M.C.Zajic,etal. Research in Autism Spectrum Disorders 76 (2020) 101590
ASDandADHDgroupsdidnotsignificantlydifferbutperformedlowerthantheTDgroup.Inonlyonescore(SpontaneousWriting
Index)wastheredifferentiationbetweentheASDandTDgroupswhiletheADHDgroupdidnotdifferfromeithergroup.Group-level
differencesintimespentengagedshowedtheASDgroupspentlesstimeengagedrelativetotheADHDandTDgroups.Within-group
relationshipsshowedtimespentengagedwasassociatedmorestronglytoawiderarrayofnarrativewritingscoresintheASDgroup
comparedtotheADHDandTDgroups.TimespentengagedexplainedadditionalvarianceinStoryCompositionandwordproduction
scoresintheASDgroupbutonlyinwordproductionscoresfortheADHDgroup(afterincludingassociatedfactors).
6.1. Narrativewritingscores
TheASDgroupscoredaroundaverageontheSpontaneousWritingIndexandContextualConventionswithslightlylowerthan
average performance on Story Composition. However, not all children scored in the average ranges, as seen by the wide scoring
rangesthatvariedfromverylowtoveryhigh(Table2).TheADHDgroupperformedsimilarlytotheASDgroup(withoverallscores
around average but with very wide scoring ranges). These findings support previous findings from both groups that have shown
heterogeneousgroup-levelwritingskillswherechildrenoftenscoreasagroupintheaveragerangebutshowhighlyvariablescoring
ranges(Graceetal.,2017;Grahametal.,2016;Mayes&Calhoun,2006a,2006b,2008;Zajic&Wilson,2020).
Overallfindingsoflowerscoresfortextorganizationandqualityandaveragescoresforspelling,grammar,andpunctuationfor
the ASD group align with previous research findings (Brown et al., 2014; Dockrell et al., 2014; Mayes & Calhoun, 2006a; Price,
Martin, Chen, & Jones, 2020; Zajic et al., 2018). The ADHD group, in contrast, demonstrated average spelling, grammar, and
punctuationskillswhileshowingslightlyelevatedgroup-leveltextgenerationandorganizationskills.Thesefindingsdeviatefrom
some past research findings that highlighted text organization and quality as areas of concern using different writing tasks (e.g.,
DeBonoetal.,2012;Mayes&Calhoun,2006a).Additionally,whilesomepriorresearchhasfoundchildrenacrossbothgroupsto
demonstrate challenges with skills like spelling that were assessed as part of Contextual Conventions (e.g., DeBono et al., 2012;
Finnegan&Accardo,2018),currentfindingsofnogroup-leveldeficitsmaybepartiallyduetothelackofisolatedskillassessments.
TheASDgroupscoredlowerintextorganizationandqualityrelativetoboththeADHDandTDgroups,highlightingapotential
areaofdifficultyonthisassessmentinrelationtothecomparisongroups.Thismoderategroup-leveldifferenceissupportedbyprior
researchhighlightingtextgenerationasanareaofdifficultyforsomechildrenwithASD(Brownetal.,2014;Dockrelletal.,2014;
Priceetal.,2020).Furthermore,theASDgroupproducedthefewestnumberofwordsrelativetobothcomparisongroups,andthe
ADHDgroupproducedfewerwordsrelativetotheTDgroup.Difficultieswithwordproductionmayberelatedtohandwritingand
graphomotordifficultiesnotedascommoninchildrenwithASDandADHD(e.g.,Dirlikovetal.,2017;Mayesetal.,2019a).However,
withoutanisolatedassessmentofhandwritingskills,thesedifferencesmayhavealsobeenduetodifficultiesrelatedtogenerating
textinlinewithnarrativetaskdemandsinadditiontopotentialtranscriptiondifficulties(seeBerninger&Amtmann,2003;Berninger
&Winn,2006).
FindingsdifferfromthreestudiesimplementinganearlierversionoftheTOWL(TOWL-3;Hammill&Larsen,1996)withchildren
with either ASD or ADHD. A key difference between the two versions is the TOWL-3 produced three scores for the spontaneous
writingsubtest:ContextualConventions,ContextualLanguage,andStoryConstruction.Troybetal.(2014)foundnogroupdiffer-
encesbetweentheirASDandTDgroupsinwordproduction,ContextualConventions,ContextualLanguage,andStoryConstruction.
Mylesetal.(2003)foundnogroupdifferencesbetweentheirASDandTDgroupsinContextualConventions,ContextualLanguage,
andStoryConstruction,however,theynotedasignificantdifferenceinwordproduction(TD > ASD).DeBonoetal.(2012)foundno
group differences across subscales between their ADHD group and their subclinical ADHD group while also reporting no group
differences in word production. The differences between these studies and the current study may be due to scoring sensitivity
concernspresentintheTOWL-3thatwerebetteraddressedbytheTOWL-4(seeHammill&Larsen,2009).However,thesedifferences
mayalsobeduetosampledemographics,shorteningoftheallottedSpontaneousWritingTaskadministrationtimeforthisstudy,or
statisticalpowerduetolimitedsamplesizes.
6.2. Timespentengaged
TheASDgroupspentlesstimeengagedwiththeoverallwritingtaskcomparedtotheADHDandTDgroups.Onaverage,theASD
groupengagedfor460s(7min,40s)whiletheADHDgroupengagedfor537s(8min,57s)andtheTDgroupengagedfor544s
(9min,4s).ThoughtheASDandADHDgroupsshowedawiderrangeofdurationsfortimespentengagedwiththetaskrelativetothe
TD group, the ASD group remained lowest in terms of overall time spent engaged. The low engagement noted in the ASD group
appearssimilartorecentfindingsshowingthatchildrenwithASDdemonstrategreaterdifficultiesgettingstartedwithandstayingon
task during expository writing (Hilvert et al., 2020). Time spent engaged appeared most strongly associated with cognitive skills
(predominantlyverbalskills)onlyfortheASDgroup,asnootherrelationshipsappearedsignificantacrossothervariablesorother
groups.Thisfindingsuggeststhatverbalknowledgeandtaskengagementmaybepositivelyrelated,whichalignswithpriorresearch
findingrelationshipsbetweenlinguisticprocessesandwritingskillsinchildrenwithASD(e.g.,Brownetal.,2014;Dockrelletal.,
2014; Hilvert et al., 2020). Additionally, the lack of significant associations between time spent engaged with age and symptom
severity also suggest that task engagement was not related to the age of the participants or the degree of either ASD or ADHD
symptomseverity.However,itisimportanttoconsiderthattheserelationshipsmaydifferinanon-picture-basedtask,giventhat
childrenwouldnothaveavisualstimulustofocuson.Additionally,therelationshipsfortheADHDandTDgroupsremainednon-
significant.Oneexplanationforthelackofsignificantrelationshipsinthesegroupsmaybeduetolessheterogeneityobservedintime
spentengagedwiththetask(asaveragetimesforbothgroupsappearedclosertotheoveralltotalallottedtime).
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M.C.Zajic,etal. Research in Autism Spectrum Disorders 76 (2020) 101590
LowertimespentengagedwiththetasksuggestspotentialchallengesfortheASDgroupthatmayberepresentativeofstruggling
writers,suchasdifficultywithassessingcompletenessoftaskdemands,navigatingthegoalsofthetask,orfeelingoverwhelmedby
thedemandsofthetask(Graham&Perin,2007;Harris&Graham,2016).Lowertimespentengagedmayalsosuggestmotivation
difficultieswithcompletingthetaskdemandsthatmayberelatedtofrustrationswithtranscriptionortextgeneration.Motivation
towardswritinginfluenceshowindividualsseethemselvesaswriters(Graham,2018)andhasbeensuggestedasanareaofdifficulty
forsomewriterswithASD(e.g.,Boucher&Oehler,2013)butwithlittlecurrentempiricalexamination.However,notallindividuals
withASDendedthetaskbeforetheendoftheallottedtime,suggestingthatremainingengagedforthedurationofthewritingtaskis
notadifficultyforallchildrenwithASD.ItisalsoimportanttonotethatwhiletheADHDgroupspentmoretimeengagedoverallwith
thetaskthatdidnotsignificantlydifferfromtheTDgroup,therewerechildrenwithADHDwhoendedthetaskwellbeforethealloted
time.
6.3. Relationshipsbetweenwriting,timespentengaged,age,cognitiveabilities,andsymptomseverity
Resultsindicatedthatrelatedfactorslikeage,cognitiveskills,andsymptomseverityaccountedfor30–42%and27–39%ofthe
varianceinthewritingscoresfortheASDandADHDgroups,respectively.Theadditionoftimespentengagedaccountedforad-
ditionalvarianceexplainedfortwoscoresfortheASDgroup(StoryComposition:42%increasedto48%;wordproduction:39%
increasedto50%)andonescorefortheADHDgroup(wordproduction:38%increasedto51%).Modelsforbothgroupsincluded
agewhilemostincludedcognitiveskillsandASDsymptomseverity.NomodelsincludedADHDsymptomseverity.
6.3.1. Age
Initialcorrelationalanalysesshowedweak-to-moderateassociationsforageacrossallnorm-referencednarrativewritingscoresin
theASD andADHD groupswhileshowingnon-significantassociationsfortheTDgroup.Allgroups showedamoderate-to-strong
relationship between ageand word production and non-significant associationsbetween age and time spent engaged in the task.
However,whenaccountingforadditionalfactors,ageremainedasignificantpredictorfortheASDgroupforonlyStoryComposition
andwordproduction(withoutandwithtimespentengaged)andfortheADHDgroupforwordproduction(withoutandwithtime
spentengaged).
Giventhat word productionis expectedtoincrease withage (astheinvolved processesbecomemore automatic;Berninger&
Amtmann,2003), the associationsbetweenage andword productionwere expected acrossgroups. Furthermore,as thenarrative
writing scores were norm-referenced by age groups, the lack of association between age and Contextual Conventions was also
expected.Unexpected,however,wasthesignificantassociationbetweenageandStoryCompositionfortheASDgroup.Priorstudies
involvingchildrenwithASDhaveoftenincludedageasavariableofinterestorasacontrolvariableduetotheuseofnon-stan-
dardizedwritingmeasuresorwidesampleageranges(e.g.,Brownetal.,2014;Dockrelletal.,2014;Hilvertetal.,2019).Findings
fromthecurrentstudy,however,suggestthatageexplaineduniquevarianceintextqualityandorganizationfortheASDgroupina
norm-referenced narrative writing score while accounting for cognitive skills and symptom severity. This distinction for Story
CompositionisimportantgiventhattheTOWL-4hasbeenarecommendedassessmentofnarrativewrittenlanguageskillsofchildren
withASD (Corbett &Iqbal, 2018). Possible explanationsfor this association might include transcription, textgeneration, and ex-
ecutivefunctionskilldifferencesacrosstheincludedageranges(e.g.,olderchildrenwrotetextmorefluentlythatmetthenarrative
taskdemandduetounderstandingtheunderlyingnarrativestorystructure)aswellasthepotentialforthistobeduetoshortening
theoverall task-timelength (e.g., older children are more able to meet the task demands in the shortened duration compared to
younger children). Understanding the influence of age requires further insights across the school-age years (see Zajic, Dunn, &
Berninger,2019forfurtherdiscussion).
6.3.2. Cognitiveskills
Initial correlational analyses showed overall cognitive skills to be most strongly related to narrative scores in the ASD group
comparedtotheADHDandTDgroups.TheASDgroupshowedmoderaterelationshipsbetweenverbalskillsandnarrativescoresand
weakrelationshipsbetweenperceptualskillsandnarrativescores.Acrossmodels,overallcognitiveskillsremainedauniquepredictor
ofnarrativewritingscores(withoutandwiththeinclusionoftimespentengaged).Incontrast,theADHDgroupshowedmoderate
relationships between verbal skills and Contextual Conventions with no significant relationships between perceptual skills and
narrative scores. Verbal skills were only included in the model explaining Contextual Conventions (where they explained unique
variance).TheTDgroup,incontrasttobothothergroups,showednosignificantrelationshipsbetweenverbalorperceptualskillsand
narrativescores.
Current results support prior findings of the relationships between verbal and perceptual skills in relation to writing skills in
childrenwithASDandADHD.Inonepriorstudy,MayesandCalhoun(2008)reportedasimilarfindingthatwrittenlanguageskillsin
childrenwithASDwererelatedsimilarlytobothverbalandperceptualskills.Thestrongerrelationshipfoundforverbalskillsrather
thanperceptualskillsmayalsoberelatedtorecentfindingsoftheimportanceoflanguagetothewrittenlanguageskillsofchildren
withASD(e.g.,Brownetal.,2014;Dockrelletal.,2014;Priceetal.,2020).TurningtochildrenwithADHD,MayesandCalhoun
(2006b) found verbal skills to be more strongly related to writing scores than perceptual skills in children with ADHD, which is
similartothecurrentfindings.However,MayesandCalhoun(2006b)reportedoverallcognitiveskillstohavethestrongestasso-
ciationwithwritingforchildrenwithADHD,whichwasnotthecaseforthecurrentstudy.Onereasonforthisdifferencemaybethe
useoftheWASI-IIratherthantheWechslerIntelligenceScaleforChildren(WISC;Wechsler,2003).TheFIQestimatefromtheWASI-
IIisderivedfromverbalandperceptualreasoningabilitiesthatdonotassessworkingmemoryandprocessingspeedskillsthathave
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