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The Role of Social Drivers of Health in Communication Abilities of Autistic Adolescents and Young Adults

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Title: The Role of Social Drivers of Health in Communication Abilities of Autistic Adolescents and Young Adults
Language: English
Authors: Teresa Girolamo (ORCID 0000-0003-1714-3545), Alicia Escobedo, Lindsay Butler (ORCID 0000-0003-4106-1849), Caroline A. Larson (ORCID 0000-0001-7940-2528), Iván Campos, Kyle Greene-Pendelton
Source: Autism: The International Journal of Research and Practice. 2026 30(2):329-345.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 17
Publication Date: 2026
Document Type: Journal Articles
Reports - Research
Descriptors: Autism Spectrum Disorders, Adolescents, Young Adults, Health, Communication Skills, Social Influences, Barriers, Needs, Community, Correlation, Language Skills
Assessment and Survey Identifiers: Social Responsiveness Scale, Clinical Evaluation of Language Fundamentals, Peabody Picture Vocabulary Test, Raven Progressive Matrices, National Longitudinal Transition Study of Special Education Students
DOI: 10.1177/13623613251380448
ISSN: 1362-3613
1461-7005
Abstract: Despite their relevance to outcomes in autism, little is known about how social drivers of health affect communication, especially in transition-aged autistic adolescents and young adults with structural language impairment. This knowledge gap limits our understanding of developmental trajectories and the ability to develop supports. This cross-sectional study examined the role of social drivers of health in the communication abilities of autistic individuals ages 13-30. Participants (N = 73) completed language, nonverbal cognitive assessments, and social drivers of health (sense of community, unmet services, barriers to services) measures. Data were analyzed descriptively and using mixed-effects modeling. More unmet service needs, more barriers to services, and a lower sense of community were associated with greater social communication impairment. In turn, both unmet service needs and barriers to services were negatively associated with functional communication. In regression modeling, language scores contributed to functional communication, and sense of community to social communication impairment. Findings support the relevance of language and social drivers of health in communication. Future work should focus on possible bidirectional relationships between these variables and explore and real-world translation.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1494608
Database: ERIC
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  Value: <anid>AN0190905300;f9d01feb.26;2026Jan19.05:34;v2.2.500</anid> <title id="AN0190905300-1">The role of social drivers of health in communication abilities of autistic adolescents and young adults </title> <p>Despite their relevance to outcomes in autism, little is known about how social drivers of health affect communication, especially in transition-aged autistic adolescents and young adults with structural language impairment. This knowledge gap limits our understanding of developmental trajectories and the ability to develop supports. This cross-sectional study examined the role of social drivers of health in the communication abilities of autistic individuals ages 13–30. Participants (N = 73) completed language, nonverbal cognitive assessments, and social drivers of health (sense of community, unmet services, barriers to services) measures. Data were analyzed descriptively and using mixed-effects modeling. More unmet service needs, more barriers to services, and a lower sense of community were associated with greater social communication impairment. In turn, both unmet service needs and barriers to services were negatively associated with functional communication. In regression modeling, language scores contributed to functional communication, and sense of community to social communication impairment. Findings support the relevance of language and social drivers of health in communication. Future work should focus on possible bidirectional relationships between these variables and explore and real-world translation. Where people live, work, and spend their time is important. Environments can have more or less services or differ in how much they help people feel like they belong to their community. These parts of the environment are called social drivers of health. Social drivers of health are important for outcomes in autism, but we do not know much about them in autistic teens or young adults. We recruited 73 autistic teens and young adults (ages 13–30 years) and 52 caregivers to our study. Autistic teens and young adults did language and NVIQ tests on Zoom. Autistic teens, young adults, and caregivers also answered questionnaires. Sense of community was important for social communication impairment, and language was important for real-world communication. These findings tell us two things. First, thinking about how to create supportive communication environments for autistic teens and adults is important. Second, understanding how social drivers of health shape outcomes is important. In the future, we should focus on how improving environments can help autistic teens and adults meet their communication goals.</p> <p>Keywords: adolescents; adults; autism spectrum disorders; communication and language; environmental factors</p> <p>Autistic individuals often face poor adaptive, employment, mental, and physical health, and social outcomes in adulthood ([<reflink idref="bib75" id="ref1">75</reflink>]). In the United States, the transition to adulthood is a vulnerable period, coinciding with the loss of child- and school-based services ("Individuals with Disabilities Education Improvement Act (IDEIA)," [<reflink idref="bib55" id="ref2">55</reflink>]; [<reflink idref="bib98" id="ref3">98</reflink>]). Despite growing attention to adult outcomes ([<reflink idref="bib51" id="ref4">51</reflink>]), understanding remains limited, especially considering the systematic exclusion of racially and ethnically minoritized communities in autism research ([<reflink idref="bib79" id="ref5">79</reflink>]). Recent studies reveal nuanced disparities in health outcomes. For example, Medicaid data—a joint federal and state program providing medical and health services to people with limited income ([<reflink idref="bib122" id="ref6">122</reflink>])—show higher rates of cardiovascular disease among Black and Hispanic autistic adults when data are disaggregated but not when comparing autistic to nonautistic adults ([<reflink idref="bib102" id="ref7">102</reflink>]). Other research highlights similarly complex disparities in hospitalization and diagnosis of mental health conditions ([<reflink idref="bib4" id="ref8">4</reflink>]; [<reflink idref="bib94" id="ref9">94</reflink>]) This heterogeneity has implications for examining other outcomes in the transition to adulthood.</p> <p>Person-environment fit is increasingly recognized as central to autism outcomes ([<reflink idref="bib62" id="ref10">62</reflink>]), aligning with a social-ecological model where individual-environment interactions shape development ([<reflink idref="bib19" id="ref11">19</reflink>]). Social drivers of health, or non-medical factors like social networks, economic stability, and physical setting, play a key role ([<reflink idref="bib25" id="ref12">25</reflink>]; [<reflink idref="bib29" id="ref13">29</reflink>]). Yet there is limited attention to social drivers of health in autism research, particularly beyond childhood ([<reflink idref="bib100" id="ref14">100</reflink>]). Most research on transition-aged autistic individuals focuses on family-level factors (e.g., income) and overlooks interpersonal- or community-level factors like social inclusion ([<reflink idref="bib7" id="ref15">7</reflink>]).</p> <p>Meanwhile, there is a robust literature on the importance of language skills in autism outcomes ([<reflink idref="bib18" id="ref16">18</reflink>]; [<reflink idref="bib72" id="ref17">72</reflink>]). Language is central to communication, which is a human right ([<reflink idref="bib81" id="ref18">81</reflink>]; [<reflink idref="bib121" id="ref19">121</reflink>]), and is often impaired. Over 60% of autistic individuals have structural language impairment (LI; [<reflink idref="bib15" id="ref20">15</reflink>]), or difficulty with grammatical aspects of language like morphology and syntax ([<reflink idref="bib99" id="ref21">99</reflink>]). Structural LI is tied to adult communication abilities, which influence educational, occupational, and social outcomes ([<reflink idref="bib57" id="ref22">57</reflink>]). Understanding communication in autism thus requires attention to both linguistic heterogeneity and social drivers of health.</p> <hd id="AN0190905300-2">Contextualizing communication in autism</hd> <p>Communication abilities in autistic adolescents and adults vary widely ([<reflink idref="bib6" id="ref23">6</reflink>]; [<reflink idref="bib11" id="ref24">11</reflink>]; [<reflink idref="bib46" id="ref25">46</reflink>]; [<reflink idref="bib52" id="ref26">52</reflink>]; [<reflink idref="bib68" id="ref27">68</reflink>]), in part due to differences in measurement. Functional communication refers to an individual ability to meet everyday communicative demands using verbal or written language ([<reflink idref="bib111" id="ref28">111</reflink>]). Social communication impairment reflects difficulties in social communication and interaction ([<reflink idref="bib30" id="ref29">30</reflink>]), consistent with a social-ecological model ([<reflink idref="bib19" id="ref30">19</reflink>]). Each frame communicates differently. For example, prior work shows functional communication scores in autistic adolescents and adults often fell ⩾2 <emph>SD</emph> below the mean, regardless of cognitive ability ([<reflink idref="bib42" id="ref31">42</reflink>]; [<reflink idref="bib77" id="ref32">77</reflink>]). Some autistic adults (ages 22–46) with low functional communication scores reported meaningful social inclusion ([<reflink idref="bib42" id="ref33">42</reflink>]), while others receive lower ratings in social interactions from nonautistic peers—even when their communication is effective ([<reflink idref="bib32" id="ref34">32</reflink>], [<reflink idref="bib33" id="ref35">33</reflink>]; [<reflink idref="bib84" id="ref36">84</reflink>]). These findings underscore the role of context.</p> <p>Two key limitations hinder understanding communication in transition-aged autistic individuals. First, studies often overlook linguistic heterogeneity. Autism can co-occur with LI and intellectual disability ([<reflink idref="bib2" id="ref37">2</reflink>]), but language and intelligence (IQ) can dissociate ([<reflink idref="bib74" id="ref38">74</reflink>]; [<reflink idref="bib109" id="ref39">109</reflink>]; [<reflink idref="bib126" id="ref40">126</reflink>]). Detecting this variation depends upon multi-domain assessment ([<reflink idref="bib60" id="ref41">60</reflink>]). For instance, [<reflink idref="bib10" id="ref42">10</reflink>] found links between language level and social communication impairment in autistic young adults, but language was based on a single caregiver-report item. In contrast, [<reflink idref="bib57" id="ref43">57</reflink>] directly assessed multiple language domains in autistic and nonautistic young adults with a history of LI (ages 24–26 years) and found varied correlations between language measures and functional communication scores (<emph>r</emph> =.31–.88). Relatedly, verbal IQ (VIQ) often underestimates ability in autistic youth, especially those with LI ([<reflink idref="bib48" id="ref44">48</reflink>]). Findings linking IQ to communication in autistic adolescents and adults are mixed ([<reflink idref="bib71" id="ref45">71</reflink>]; [<reflink idref="bib77" id="ref46">77</reflink>]; [<reflink idref="bib115" id="ref47">115</reflink>]), motivating attention in assessment.</p> <p>Second, social drivers of health are underexamined in relation to outcomes ([<reflink idref="bib16" id="ref48">16</reflink>]). Practices, such as binary comparison of white to minoritized participants (e.g. [<reflink idref="bib80" id="ref49">80</reflink>]), risk perpetuating monolithic stereotypes ([<reflink idref="bib92" id="ref50">92</reflink>]). US federal policies have shaped how race and disability intersect—including in service systems for autistic adolescents and young adults ([<reflink idref="bib93" id="ref51">93</reflink>]; [<reflink idref="bib120" id="ref52">120</reflink>])—and reflected external factors rather than any traits of minoritized autistic individuals themselves ([<reflink idref="bib9" id="ref53">9</reflink>]). Understanding communication in autistic adolescents and young adults thus requires attention to sampling that reflects the population ([<reflink idref="bib79" id="ref54">79</reflink>]), as well as to interpersonal- and community-level factors ([<reflink idref="bib7" id="ref55">7</reflink>]).</p> <p>Unmet service needs and barriers to services are two key social drivers for transition-aged autistic individuals within the United States ([<reflink idref="bib20" id="ref56">20</reflink>]; [<reflink idref="bib40" id="ref57">40</reflink>]; [<reflink idref="bib105" id="ref58">105</reflink>]). Young adults often report more unmet needs than youth ([<reflink idref="bib8" id="ref59">8</reflink>]; [<reflink idref="bib66" id="ref60">66</reflink>]; [<reflink idref="bib119" id="ref61">119</reflink>]), especially for communication-related supports ([<reflink idref="bib56" id="ref62">56</reflink>]; [<reflink idref="bib101" id="ref63">101</reflink>]). These needs may increase prior to high school exit ([<reflink idref="bib116" id="ref64">116</reflink>]). Barriers to services, such as cost, location, quality of services, and provider communication challenges, also may increase with age and persist into young adulthood ([<reflink idref="bib5" id="ref65">5</reflink>]; [<reflink idref="bib34" id="ref66">34</reflink>]; [<reflink idref="bib38" id="ref67">38</reflink>]).</p> <p>A third social driver of health is sense of community, or sense of belonging and feeling supported within a community ([<reflink idref="bib82" id="ref68">82</reflink>]). It is tied to community participation and adaptive behavior ([<reflink idref="bib23" id="ref69">23</reflink>]; [<reflink idref="bib73" id="ref70">73</reflink>]; [<reflink idref="bib114" id="ref71">114</reflink>]; [<reflink idref="bib127" id="ref72">127</reflink>]) but may be limited by structural constraints—especially among marginalized groups ([<reflink idref="bib70" id="ref73">70</reflink>]). Supportive environments promote community participation for autistic youth and adolescents ([<reflink idref="bib26" id="ref74">26</reflink>]; [<reflink idref="bib117" id="ref75">117</reflink>]), whereas a lack of community understanding about autism can reduce communication opportunities ([<reflink idref="bib12" id="ref76">12</reflink>]; [<reflink idref="bib85" id="ref77">85</reflink>]). To this end, US autistic young adults (ages 20–25 years) report greater social isolation than nonautistic peers with disabilities ([<reflink idref="bib89" id="ref78">89</reflink>]).</p> <hd id="AN0190905300-3">The current study</hd> <p>This report examines communication abilities in US-based autistic adolescents and young adults, focusing on social communication impairment and functional communication. Given heterogeneity within minoritized communities ([<reflink idref="bib92" id="ref79">92</reflink>]), the premise of this article is that systematic exclusion in research motivates purposeful inclusion of communities to help produce broadly applicable findings ([<reflink idref="bib79" id="ref80">79</reflink>]). The focus is on the extent to which individual differences, social drivers of health, and communication relate to one another. Specifically, this study asked:</p> <p></p> <ulist> <item> Does LI status differentiate groups in functional communication and social communication impairment scores and social drivers of health (sense of community, unmet service needs, and barriers to having service needs met), given NVIQ band?</item> <p></p> <item> To what extent do individual differences and social drivers of health contribute to differences in functional communication and social communication impairment scores?</item> </ulist> <p>In contrast to most prior work, this study directly assessed language across domains and NVIQ, which enhanced our confidence in our findings ([<reflink idref="bib48" id="ref81">48</reflink>]). In using norm-referenced measures, this approach also provides information that is readily interpretable and aligns with clinical practice patterns for service eligibility in the United States ("Americans with Disabilities Act of 1990," [<reflink idref="bib3" id="ref82">3</reflink>]; "Rehabilitation Act of 1973," [<reflink idref="bib96" id="ref83">96</reflink>]; [<reflink idref="bib104" id="ref84">104</reflink>]). Last, in using person-centered measures, this study provides new, expert-informed information on social drivers of health to help build the evidence base on services ([<reflink idref="bib21" id="ref85">21</reflink>]).</p> <hd id="AN0190905300-4">Method</hd> <p>This study received institutional board approval and followed all ethical guidelines. Our team also used a community-based participatory approach ([<reflink idref="bib123" id="ref86">123</reflink>]), which was tailored to a localized context in terms of providing accessible partnership and avoiding tokenization, such as by assuming partners wanted to be defined on the perceptions of <emph>others</emph> about race and disability ([<reflink idref="bib47" id="ref87">47</reflink>]). Partners chose their role and opted to join the team at all study stages, including co-development of the research questions and study design (methods, outcome measures, interpretation of the data), and dissemination (e.g. community-driven workshops). While the research team included individuals with lived, personal, and professional experiences pertaining to autism, including autistic people from the communities included in this study, team members did not know participants in this study.</p> <hd id="AN0190905300-5">Participants</hd> <p>Selection criteria were: (a) racially minoritized, ethnically minoritized, or both racially and ethnically minoritized according to US Census guidelines ([<reflink idref="bib88" id="ref88">88</reflink>]), which included: American Indian or Alaska Native, Asian, Black or African American, Native Hawai'ian or Pacific Islander, multiracial, and other for race and Hispanic/Latine for ethnicity, with the option to select multiple options for race and to write in options; (b) formal clinical diagnosis of autism, per requirements for inclusion in recruitment sources (e.g. community organizations providing services to autistic individuals), and confirmation using the Social Responsiveness Scale, 2nd Ed. (SRS-2; [<reflink idref="bib30" id="ref89">30</reflink>]) and expert clinical judgment; (c) ages 13–30, coinciding with when transition planning begins in some states within the United States and 10 years post-federal eligibility for special education services ("Every Student Succeeds Act," [<reflink idref="bib41" id="ref90">41</reflink>]; "IDEIA," [<reflink idref="bib55" id="ref91">55</reflink>]); (d) proficiency in English per self-report during screening, as assessments were in English; (e) adequate hearing and vision thresholds for responding to audiovisual stimuli on a computer screen; and (f) use of primarily spoken language to communicate, as study activities required oral responses. Participants could be of any sex at birth and gender, with the ability to self-report options.</p> <hd id="AN0190905300-6">Procedures</hd> <p>The research team recruited participants in a multi-step process: (a) sharing virtual flyers with information about the study with organizations serving autistic individuals; (b) providing personalized consultation about the study to individuals and families by phone, Zoom, or email; (c) obtaining informed consent using a dynamic process; and (d) collecting data. In this process, an examiner asked participants and caregivers about communication strategies, preferred modalities, and different communicative acts the participant might use to convey emotions or feelings, such as agreement or needing a break. The team used this information during informed consent and assessment. Participants provided informed consent if they were their own legal guardian. Caregivers provided informed consent if they were the legal guardian of participants, and participants provided assent. In all cases, the examiner went over the consent form line by line with participants (and caregivers, as appropriate), discussing concepts like "consent" and "confidentiality." The examiner also reviewed who participants could call if they had questions or concerns and options for sharing data (e.g. de-identified scores, transcripts, and/or recordings). Throughout this process, the examiner administered verbal checks and encouraged participants to ask questions (e.g., "Can you stop being in the study at any time?" or "If you stop being in the study, are there any bad consequences?"). If participants provided assent, depending on the communication profiles shared with the research team during consultation, the examiner asked tailored questions (e.g., "Can I tell other people you are in my study?," "Do you want to try the activities?"). Recruitment and data collection took place remotely on HIPAA-compliant Zoom. The first author administered a behavioral assessment protocol to participants and caregivers at their convenience using test developer guidance on remote assessment for measures of language and NVIQ ([<reflink idref="bib90" id="ref92">90</reflink>]). Participants and caregivers completed questionnaires.</p> <hd id="AN0190905300-7">Measures</hd> <p></p> <hd id="AN0190905300-8">Autism traits</hd> <p>Autism traits were assessed using SRS-2 caregiver and self-report forms for students and adults ([<reflink idref="bib30" id="ref93">30</reflink>]). Respondents indicate the frequency of 65 items on a four-point scale, yielding an overall <emph>t</emph>-score. <emph>T</emph>-scores of ⩽59 indicate sub-clinical, 60 to 65 mild, 66 to 76 moderate, and >76 high levels of autism traits. Formal diagnosis, SRS-2 <emph>t</emph>-scores, and expert clinical judgment were triangulated to determine autism traits. Overall <emph>t</emph>-scores of caregiver student forms, caregiver adult forms, and adult self-report forms did not significantly differ; see Supplementary Table 1.</p> <hd id="AN0190905300-9">Language skills</hd> <p>Participants completed a battery of normed assessments across linguistic domains: semantics, morphology, syntax, and phonology. Expressive language and receptive language were assessed by the Clinical Evaluation Language Fundamentals, 5th Ed. (CELF-5) Expressive Language Index and Receptive Language Index (M = 100, SD = 15; [<reflink idref="bib124" id="ref94">124</reflink>]). For those over age 21 (<emph>n</emph> = 25), CELF-5 age 21 norms were used per prior studies of adults ages 18 to 49 ([<reflink idref="bib14" id="ref95">14</reflink>]; [<reflink idref="bib27" id="ref96">27</reflink>]; [<reflink idref="bib43" id="ref97">43</reflink>]). Receptive and expressive vocabulary were assessed by the Peabody Picture Vocabulary Test, 5th Ed. (PPVT-5; [<reflink idref="bib39" id="ref98">39</reflink>]) and Expressive Vocabulary Test, 3rd Ed. (EVT-3; M = 100, SD = 15; [<reflink idref="bib125" id="ref99">125</reflink>]). Phonological working memory was assessed by percent accuracy on the Syllable Repetition Task (SRT), a measure of nonword repetition (M = 92, SD = 5.9 in 6-year-old autistic children with FSIQ ⩾ 70; [<reflink idref="bib106" id="ref100">106</reflink>]; [<reflink idref="bib107" id="ref101">107</reflink>]). LI was defined as ⩽−1.25 <emph>SD</emph> on ⩾2 measures: CELF-5 Expressive Language Index, CELF-5 Receptive Language Index, PPVT-5 standard, EVT-3 standard score, or SRT overall accuracy. This cutoff aligns with epidemiological criteria for LI in nonautistic US-based youth ([<reflink idref="bib118" id="ref102">118</reflink>]). While more stringent than the Ottawa study cutoff of −1 <emph>SD</emph> on local norms for a receptive vocabulary measure or omnibus language measure, the −1 <emph>SD</emph> cutoff and norms may not be broadly applicable ([<reflink idref="bib58" id="ref103">58</reflink>]).</p> <hd id="AN0190905300-10">NVIQ</hd> <p>Nonverbal general cognitive ability was assessed using the digital long form of the Raven's Progressive Matrices, 2nd Ed. (Raven's 2; M = 100, SD = 15) ([<reflink idref="bib95" id="ref104">95</reflink>]). As with language measures, administration followed test developer guidance for online administration ([<reflink idref="bib90" id="ref105">90</reflink>]). The Raven's 2 does not rely on language and is untimed, which enhances accessibility ([<reflink idref="bib48" id="ref106">48</reflink>]). NVIQ was classified into bands for group comparisons: <75, 75 to 84, and ⩾85. While prior work has used a cutoff as high as 80 on the Raven's for low NVIQ ([<reflink idref="bib108" id="ref107">108</reflink>]), guidelines suggest 70 to 75 on cognitive tests is clinically significant ([<reflink idref="bib1" id="ref108">1</reflink>]). Note that the Raven's alone does not convey intellectual disability, which requires comprehensive assessment ([<reflink idref="bib95" id="ref109">95</reflink>]).</p> <hd id="AN0190905300-11">Sense of community</hd> <p>Sense of community was measured using the Brief Sense of Community Scale ([<reflink idref="bib91" id="ref110">91</reflink>]), which assesses psychological sense of community following an empirical model comprising four constructs: needs fulfillment, group membership, influence, and emotional connection ([<reflink idref="bib82" id="ref111">82</reflink>]). This measure has been validated on racially and ethnically diverse youth and adults (ages 13–23+ years) from large, community-based samples that do not provide information on diagnoses (α = 0.92; [<reflink idref="bib24" id="ref112">24</reflink>]; [<reflink idref="bib65" id="ref113">65</reflink>]; [<reflink idref="bib64" id="ref114">64</reflink>]; [<reflink idref="bib91" id="ref115">91</reflink>]). Respondents rate statements (1 = strongly disagree, 5 = strongly agree): (a) I can get what I need in this neighborhood, (b) This neighborhood helps me fulfill my needs, (c) I feel like a member of this neighborhood, (d) I belong in this neighborhood, (e) I have a say about what goes on in my neighborhood, (f) People in this neighborhood are good at influencing each another, (g) I feel connected to this neighborhood, and (h) I have a good bond with others in this neighborhood ([<reflink idref="bib91" id="ref116">91</reflink>]). Item scores (a) and (b) are averaged to provide subscale scores for needs fulfillment (α = 0.80), (c) and (d) for group membership (α = 0.86), (e) and (f) for influence (α = 0.67), and (g) and (h) for emotional connection (α = 0.80), as well as an overall score. Higher scores indicate a higher sense of community. Respondents completed the original measure for themselves or as a proxy. Caregivers-reported scores were significantly higher than self-reported scores, corresponding to "neutral to somewhat agree" and "somewhat disagree to agree"; see Supplementary Table 1.</p> <hd id="AN0190905300-12">Unmet service needs and barriers to services</hd> <p>Unmet service needs and barriers to services were measured using survey items from the National Longitudinal Transition Study 2 (NLTS 2; [<reflink idref="bib87" id="ref117">87</reflink>]). The NLTS 2 followed a nationally representative sample of >11,000 adolescents (ages 13–18 years) receiving special education services from 2000 to 2010 and assessed services per federal special education legislation ("IDEIA," [<reflink idref="bib55" id="ref118">55</reflink>]; [<reflink idref="bib67" id="ref119">67</reflink>]). Per prior work ([<reflink idref="bib116" id="ref120">116</reflink>]), this study adapted NLTS 2 items to assess unmet needs and asked if each service not received was needed. Respondents were self or caregiver and reported if (a) each of 16 services were received (psychological, speech-language, speech-language therapy or communication, career counseling or vocational/job skills training, personal assistant or in-home/in-classroom aide, medical services or diagnosis/evaluation related to special needs, occupation/life skills therapy or training, tutor, transportation, social work, assistive technology, respite care, reader or interpreter, physical therapy, orientation and mobility, audiology, other). All respondents reported if each of 12 items were barriers to having service needs met (cost, location, doctor or specialist does not accept insurance, not available, scheduling conflicts, ineligible, lack of information, transportation, quality, lack of time, language barrier, physical accessibility). Item scores were summed to provide totals of unmet service needs and of barriers. Caregiver-reported and self-reported unmet service needs and barriers did not significantly differ; see Supplementary Table 1.</p> <hd id="AN0190905300-13">Communication abilities</hd> <p>Social communication impairment was assessed using SRS-2 social communication impairment <emph>t</emph>-scores ([<reflink idref="bib30" id="ref121">30</reflink>]). Group means of caregiver student report, caregiver adult report, and adult self-report forms did not significantly differ; see Supplementary Table 1. Functional communication was assessed using the Vineland Adaptive Behavior Scales, 3rd Ed. (VABS-3) domain-level form communication standard score ([<reflink idref="bib111" id="ref122">111</reflink>]). Caregivers indicate the frequency with which their child completes items. Item-level scores provide a standard score (M = 100, SD = 15), with higher scores indicating higher skills.</p> <hd id="AN0190905300-14">Data diagnostics and analysis</hd> <p>Two trained research assistants independently scored and checked language and autism trait measures. The first author and research assistants discussed all disagreements until consensus was reached. NVIQ, functional communication, and social drivers of health measures were each auto-scored within their respective platforms. Next, data was examined for missingness. This study did not exclude any participant post-data collection. Missing data were minimal and came from different participants: (a) one missing language and NVIQ scores (did not complete assessment), (b) two missing SRS-2 scores (one for not completed, one form misplaced), and (c) two missing social drivers of health measures. Missing values (< 5%) were imputed using predictive mean matching, a semi-parametric method appropriate for non-normal data, with one imputation ([<reflink idref="bib69" id="ref123">69</reflink>]). Data diagnostics and analyses took place in SPSS 29 (IBM Corp., [<reflink idref="bib54" id="ref124">54</reflink>]). Prior to analysis, data were checked for multicollinearity (VIF < 4, α =.05), linearity, and normality. Data were not transformed for normality except for the second research question, which <emph>z</emph>-scored and averaged PPVT-5, EVT-3, and SRT scores. To facilitate interpretation of model results, NVIQ was centered on 100 ([<reflink idref="bib49" id="ref125">49</reflink>]).</p> <p>Forms for overall autism traits and social communication impairment <emph>t</emph>-scores were combined, given similar effects across respondents. Despite small to medium effect sizes ([<reflink idref="bib45" id="ref126">45</reflink>]), results were not statistically significant, and 95% confidence intervals were wide—and included zero—which indicates imprecision ([<reflink idref="bib28" id="ref127">28</reflink>]; [<reflink idref="bib31" id="ref128">31</reflink>]; [<reflink idref="bib63" id="ref129">63</reflink>]). Unmet service needs and barriers were also combined due to absence of significant results, wide 95% confidence intervals, small sample constraints, and unstable effect sizes ([<reflink idref="bib59" id="ref130">59</reflink>]). Though sense of community scores differed significantly by respondent, forms were combined to enable exploratory (vs inferential) interpretation and to address imbalance in group sizes (51 caregivers vs 20 self-report). This approach aligns with early-stage clinical research practices ([<reflink idref="bib36" id="ref131">36</reflink>]; [<reflink idref="bib78" id="ref132">78</reflink>]).</p> <p>To assess whether LI status differentiated participants in communication scores and social drivers of health, Wald χ<sups>2</sups> statistics tested for group differences, given NVIQ band, in social communication impairment scores, functional communication scores, overall sense of community score, number of unmet service needs, and number of barriers to services. Data were corrected for multiple comparisons using the Holm–Bonferroni method ([<reflink idref="bib50" id="ref133">50</reflink>]). Though not a primary outcome, Fisher's exact test assessed whether there was a significant association between LI status and NVIQ band, as well as descriptives (estimated marginal means (EMMs), 95% confidence intervals, percentages). To address to what extent individual differences and social drivers of health contributed to concurrent communication scores, given limited sample size, [<reflink idref="bib112" id="ref134">112</reflink>] correlations evaluated patterns between language, NVIQ, social drivers of health, and communication scores, with interpretation of was 0.25 as small, 0.40 as moderate, and 0.65 as large ([<reflink idref="bib45" id="ref135">45</reflink>]). Correlations of ⩾0.25 at an α <.05 were entered into regression models. As outcome variables were not normally distributed, separate generalized linear mixed-effects models estimated the extent to which language <emph>z</emph>-scores, NVIQ centered on 100, and social drivers of health contributed to differences in functional communication scores and social communication impairment scores. Models were fit with GLMM procedures in SPSS 29 (IBM Corp., [<reflink idref="bib54" id="ref136">54</reflink>]), with fixed effects of predictors and by-participant random intercepts. Model fit was assessed using information criteria and likelihood ratio tests, with an α of 0.05.</p> <hd id="AN0190905300-15">Results</hd> <p></p> <hd id="AN0190905300-16">Participant characteristics</hd> <p>Recruitment took place from 2022 to 2023, resulting in a sample of 73 participants (<emph>M<subs>age</subs></emph> = 19.69, SD = 4.71, 13.27–30.47 years); see Tables 1 and 2. Over half the sample was in educational programming (<emph>n</emph> = 41, or 56.2%), with 21 (28.8%) in secondary education and 20 (27.4%) in post-secondary educational programs (e.g. day habilitation). Fisher's exact test revealed an association between LI status and NVIQ band, <emph>p</emph> =.002, with six groups: (a) NVIQ < 75 without LI (<emph>n</emph> = 1), (b) NVIQ < 75 with LI (<emph>n</emph> = 10), (c) NVIQ of 75 to 84 without LI (<emph>n</emph> = 2), (d) NVIQ of 75 to 84 with LI (<emph>n</emph> = 8), (e) NVIQ ⩾ 85 without LI (<emph>n</emph> = 29), and (f) NVIQ ⩾ 85 with LI (<emph>n</emph> = 22). However, LI status and NVIQ band dissociated in over one-third of the sample. Three (4.11%) participants had NVIQ < 84 but not LI, and 22 (30.14%) had NVIQ ⩾ 85 plus LI.</p> <p>Table 1. Participant demographics.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" rowspan="2">Variable</th><th align="left" colspan="2">ASD(<italic>n</italic> = 32)</th><th align="left" colspan="2">ASD + LI(<italic>n</italic> = 40)</th></tr><tr><th align="left"><italic>n</italic></th><th align="left">%</th><th align="left"><italic>n</italic></th><th align="left">%</th></tr></thead><tbody><tr><td colspan="5">Race</td></tr><tr><td> American Indian, Native American, or Alaska Native</td><td>8</td><td>25</td><td>4</td><td>10.00</td></tr><tr><td> Asian</td><td>11</td><td>34.38</td><td>8</td><td>20.00</td></tr><tr><td> Black</td><td>13</td><td>40.63</td><td>24</td><td>60.00</td></tr><tr><td> Multiracial</td><td>14</td><td>43.75</td><td>12</td><td>30.00</td></tr><tr><td> Pacific Islander</td><td>2</td><td>6.25</td><td>2</td><td>5.00</td></tr><tr><td> White</td><td>10</td><td>31.25</td><td>10</td><td>25.00</td></tr><tr><td> Other</td><td>4</td><td>12.50</td><td>5</td><td>12.50</td></tr><tr><td>Hispanic/Latine: Yes</td><td>5</td><td>15.15</td><td>8</td><td>20.00</td></tr><tr><td colspan="5">Sex at Birth</td></tr><tr><td> Female</td><td>14</td><td>45.75</td><td>8</td><td>20.00</td></tr><tr><td> Male</td><td>18</td><td>56.25</td><td>32</td><td>80.00</td></tr><tr><td colspan="5">Gender</td></tr><tr><td> Female</td><td>14</td><td>45.75</td><td>9</td><td>22.50</td></tr><tr><td> Male</td><td>18</td><td>56.25</td><td>31</td><td>77.50</td></tr></tbody></table> </ephtml> </p> <p>1 ASD = autism. ASD + LI = autism plus language impairment. Multiracial not mutually exclusive with other racial/ethnic categories. Exact multiracial categories not reported to uphold participant privacy and confidentiality. One participant did not complete language assessment and is not included in groupings.</p> <p>Table 2. Participant clinical assessment scores.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" rowspan="2">Variable</th><th align="left" colspan="3">ASD(<italic>n</italic> = 32)</th><th align="left" colspan="3">ASD + LI(<italic>n</italic> = 40)</th></tr><tr><th align="left"><italic>n</italic></th><th align="left"><italic>M</italic></th><th align="left"><italic>SD</italic></th><th align="left"><italic>n</italic></th><th align="left"><italic>M</italic></th><th align="left"><italic>SD</italic></th></tr></thead><tbody><tr><td>NVIQ standard score</td><td>32</td><td>99.00</td><td>13.90</td><td>40</td><td>84.03</td><td>15.00</td></tr><tr><td>SRS-2 overall <italic>t</italic>-score</td><td>32</td><td>73.94</td><td>11.81</td><td>38</td><td>71.11</td><td>11.10</td></tr><tr><td>PPVT-5 receptive vocabulary standard score</td><td>32</td><td>106.25</td><td>12.57</td><td>40</td><td>80.65</td><td>18.91</td></tr><tr><td>EVT-3 expressive vocabulary standard score</td><td>32</td><td>107.8</td><td>10.51</td><td>40</td><td>82.9</td><td>14.43</td></tr><tr><td>SRT percent accuracy</td><td>32</td><td>94.56</td><td>5.57</td><td>40</td><td>87.25</td><td>10.39</td></tr><tr><td>CELF-5 Receptive Language Index</td><td>32</td><td>99.41</td><td>10.54</td><td>40</td><td>68.16</td><td>15.31</td></tr><tr><td>CELF-5 Expressive Language Index</td><td>32</td><td>92.94</td><td>9.85</td><td>40</td><td>64.98</td><td>14.88</td></tr></tbody></table> </ephtml> </p> <p>2 ASD = autism. ASD + LI = autism plus language impairment. NVIQ assessed using Raven's 2 Progressive Matrices ([<reflink idref="bib95" id="ref137">95</reflink>]). SRS-2 = Social Responsiveness Scale, 2nd Ed. ([<reflink idref="bib30" id="ref138">30</reflink>]). PPVT-5 = Peabody Picture Vocabulary Test, 5th Ed. ([<reflink idref="bib39" id="ref139">39</reflink>]). EVT-3 = Expressive Vocabulary Test, 3rd Ed. ([<reflink idref="bib125" id="ref140">125</reflink>]). SRT = Syllable Repetition Task ([<reflink idref="bib106" id="ref141">106</reflink>]). CELF-5 = Clinical Evaluation of Language Fundamentals, 5th Ed. ([<reflink idref="bib124" id="ref142">124</reflink>]). Scores replaced using single imputation of variable means for: CELF-5, PPVT-5, EVT-3, SRT, and NVIQ scores (<emph>n</emph> = 1), as well as SRS-2 total <emph>t</emph>-scores (<emph>n</emph> = 2). Twenty-five participants were >21 years.</p> <hd id="AN0190905300-17">Communication abilities and social drivers of health by LI status</hd> <p>Given NVIQ band, participants with and without LI did not significantly differ in communication scores, based on EMMs (see Table 3). However, clinical descriptions diverged. Functional communication scores were adequate for the autism group and moderately low for those with LI. Over three-fourths of participants with LI had low (29.4%) or moderately low (50%) functional communication scores compared to less than one-third of those without LI (29.4%; see Figure 1). Both groups showed moderate levels of social communication impairment, but distributions varied. Approximately two-thirds of participants with LI had moderate (32.5%) or severe levels of social communication impairment (32.5%), whereas those without LI more often had severe impairment (48.5%) than moderate impairment (15.2%).</p> <p>Table 3. Group communication scores and social drivers of health (N = 73).</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left" colspan="2">Autism(<italic>n</italic> = 33)</th><th align="left" colspan="2">Autism + LI(<italic>n</italic> = 40)</th><th align="left" rowspan="2">Wald χ<sup>2</sup></th><th align="left" rowspan="2">df</th><th align="left" rowspan="2"><italic>p</italic></th></tr><tr><th /><th align="left">EMM</th><th align="left">95% CI</th><th align="left">EMM</th><th align="left">95% CI</th></tr></thead><tbody><tr><td>Unmet service needs</td><td>3.31</td><td>[2.28, 4.82]</td><td>3.64</td><td>[2.72, 4.87]</td><td>0.16</td><td>1</td><td>0.693</td></tr><tr><td>Barriers to services</td><td>5.13</td><td>[3.90, 6.74]</td><td>6.01</td><td>[5.01, 7.21]</td><td>1.14</td><td>1</td><td>0.285</td></tr><tr><td>Sense of community</td><td>2.9</td><td>[2.54, 3.26]</td><td>3.04</td><td>[2.72, 3.37]</td><td>0.51</td><td>1</td><td>0.473</td></tr><tr><td>SRS-2 SCI <italic>t</italic>-score</td><td>74.1</td><td>[69.34, 79.18]</td><td>71.1</td><td>[67.62, 74.63]</td><td>1.26</td><td>1</td><td>0.261</td></tr><tr><td>VABS-3 communication</td><td>88.02</td><td>[79.15, 97.89]</td><td>76.3</td><td>[71, 81.95]</td><td>6.10</td><td>1</td><td>0.014</td></tr></tbody></table> </ephtml> </p> <p>3 LI = language impairment. EMM = estimated marginal means. Models fit with maximum likelihood estimation and robust covariance. Unmet service needs fit with a negative binomial distribution and log link. Barriers to services fit with a Poisson distribution and log link. Sense of community and VABS-3 communication scores fit with Gaussian distribution and identity link. SRS-2 SCI <emph>t</emph>-scores fit with Tweedie distribution and identity link. Wald χ<sups>2</sups> statistics and EMM control for NVIQ of <75, 75 to 84, and ⩾85. Data corrected for multiple comparisons using the Holm–Bonferroni method, with an adjusted α of <.01 ([<reflink idref="bib50" id="ref143">50</reflink>]). Sense of community = Brief Sense of Community Scale overall score ([<reflink idref="bib91" id="ref144">91</reflink>]). Unmet service needs and barriers to services = National Longitudinal Transition Survey-2 items ([<reflink idref="bib87" id="ref145">87</reflink>]), per [<reflink idref="bib116" id="ref146">116</reflink>]. SRS-2 SCI = Social Responsiveness Scale, 2nd Ed. social communication & interaction ([<reflink idref="bib30" id="ref147">30</reflink>]).</p> <p>Graph: Figure 1. Communication abilities by group. LI = language impairment.</p> <p>LI status, given NVIQ, also did not significantly differentiate groups in social drivers of health (Table 3). However, clinical descriptions diverged. Both groups had a wide range of overall sense of community scores, with group EMMs corresponding approximately to "neutral." Further, both groups reported varying unmet service needs (0–14) and barriers (0–11), with similar group EMMs of over three unmet service needs and five barriers. A majority of participants across groups reported receiving psychological or mental health services and medical services related to special needs; see Supplementary Table 2. Those with LI reported higher receipt of some services, such as personal assistant or in-class aide support (36.8% vs 6.8%) and speech-language therapy (47.4% vs 18.8%). Less common services received were orientation and mobility services, assistive technology, and respite care.</p> <p>Among participants not receiving a given service, both groups most frequently reported unmet needs in career counseling or vocational/job skills training, occupation or life skills therapy or training, and speech-language therapy or communication services. Those with LI endorsed all services except for assistive technology as unmet needs at higher rates those without LI. Speech-language services were an unmet need for 50% of the LI group versus 38.5% of those without LI. For personal assistant or in-home/in-class aide support, the respective rates were 45.8% and 16.7%.</p> <p>Endorsement of barriers to services was similarly high among both groups; see Supplementary Table 3. The most common barriers included the location of services, services not being available, providers not accepting insurance, ineligibility for services, cost, and scheduling conflicts; these were endorsed by a majority of participants with and without LI. Notably, those with LI endorsed poor service quality at over two times the rate of those without LI (57.9% vs 25%). Overall, LI status did not differentiate groups in communication scores or social drivers of health, but descriptive patterns suggest that those with LI may experience greater service gaps that are important for navigating daily life and communication.</p> <hd id="AN0190905300-18">Model results of social drivers of health on communication scores</hd> <p>Next, analyses examined patterns between social drivers of health and communication scores; see Table 4. Spearman correlations showed functional communication was positively associated with language and NVIQ, and negatively associated with unmet service needs, social communication impairment, and service barriers. That is, higher functional communication scores corresponded with higher language and nonverbal cognitive ability, fewer service challenges, and lesser social communication impairment. Social communication impairment was negatively associated with both unmet service needs and sense of community, and positively associated with barriers to services. In other words, lower levels of social communication impairment were linked to greater sense of community and fewer service-related challenges. Finally, higher language was associated with higher NVIQ and fewer unmet service needs. More unmet service needs and more barriers were associated with one another, as well as with lower sense of community. Overall, patterns indicate that language, NVIQ, and social drivers of health each relate to communication outcomes, but there was no one-to-one mapping.</p> <p>Table 4. Spearman's correlations of social drivers of health, language, NVIQ, and communication scores.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Variable</th><th align="left">1</th><th align="left">2</th><th align="left">3</th><th align="left">4</th><th align="left">5</th><th align="left">6</th><th align="left">7</th></tr></thead><tbody><tr><td>1. Language <italic>z</italic>-scores</td><td>–</td><td /><td /><td /><td /><td /><td /></tr><tr><td>2. NVIQ</td><td>.61<xref ref-type="table-fn" rid="tfn5">**</xref></td><td>–</td><td /><td /><td /><td /><td /></tr><tr><td>3. Unmet service needs</td><td>.31<xref ref-type="table-fn" rid="tfn5">**</xref></td><td>−.14</td><td>–</td><td /><td /><td /><td /></tr><tr><td>4. Barriers to services</td><td>−.19</td><td>−.08</td><td>.50<xref ref-type="table-fn" rid="tfn5">**</xref></td><td>–</td><td /><td /><td /></tr><tr><td>5. Sense of community</td><td>.03</td><td>.12</td><td>−.43<xref ref-type="table-fn" rid="tfn5">**</xref></td><td>−.27<xref ref-type="table-fn" rid="tfn5">*</xref></td><td>–</td><td /><td /></tr><tr><td>6. Social communication impairment</td><td>−.04</td><td>−.03</td><td>−.48<xref ref-type="table-fn" rid="tfn5">**</xref></td><td>.31<xref ref-type="table-fn" rid="tfn5">**</xref></td><td>−.47<xref ref-type="table-fn" rid="tfn5">**</xref></td><td>–</td><td /></tr><tr><td>7. Functional communication</td><td>.60<xref ref-type="table-fn" rid="tfn5">**</xref></td><td>.50<xref ref-type="table-fn" rid="tfn5">**</xref></td><td>−.41<xref ref-type="table-fn" rid="tfn5">**</xref></td><td>−.35<xref ref-type="table-fn" rid="tfn5">*</xref></td><td>.23</td><td>−.48<xref ref-type="table-fn" rid="tfn5">**</xref></td><td>–</td></tr></tbody></table> </ephtml> </p> <ulist> <item>4 Language <emph>z</emph>-scores = average of receptive vocabulary, expressive vocabulary, and nonword repetition. Unmet service needs and barriers to services = National Longitudinal Transition Survey-2 items ([<reflink idref="bib87" id="ref148">87</reflink>]), as in [<reflink idref="bib116" id="ref149">116</reflink>]. Sense of community = Brief Sense of Community Scale overall score ([<reflink idref="bib91" id="ref150">91</reflink>]). Social communication impairment = Social Responsiveness Scale, 2nd Ed. social communication & interaction <emph>t</emph>-score ([<reflink idref="bib30" id="ref151">30</reflink>]). Functional communication = Vineland Adaptive Behavior Scales, 3rd Ed. domain-level communication standard score ([<reflink idref="bib111" id="ref152">111</reflink>]).</item> <item>5 <emph>p</emph> < 0.05. **<emph>p</emph> < 0.01.</item> </ulist> <p>Generalized linear mixed model results showed that language scores, but not NVIQ, unmet service needs, or barriers, significantly contributed to differences in functional communication scores; see Table 5 and Figure 2. Baseline variability was significant, <emph>τ</emph><sups>2</sups> = 151.06, <emph>z</emph> = 2.55, <emph>p</emph> =.012. Including language, NVIQ (centered on 100), unmet service needs, and barriers to services improved model fit and explained 40.5% of the variance. Interindividual variability remained significant, <emph>τ</emph><sups>2</sups> = 94.38, <emph>z</emph> = 2.40, <emph>p</emph> =.016. The expected score at baseline (language <emph>z</emph>-score = zero, NVIQ = 100, no unmet service needs or barriers) was 95.08, or an "adequate" functional communication level. Each one-unit increase in language <emph>z</emph>-scores was associated with a 5.54-point increase in functional communication scores.</p> <p>Table 5. Model results of functional communication scores.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" rowspan="2">Parameter</th><th align="left" colspan="3">Model 1</th><th align="left" colspan="3">Model 2</th></tr><tr><th align="left">β</th><th align="left">SE</th><th align="left">95% CI</th><th align="left">β</th><th align="left">SE</th><th align="left">95% CI</th></tr></thead><tbody><tr><td>Intercept</td><td>83.20<xref ref-type="table-fn" rid="tfn7">**</xref></td><td>2.41</td><td>[78.36, 88.04]</td><td>95.08<xref ref-type="table-fn" rid="tfn7">**</xref></td><td>4.12</td><td>[86.79, 103.37]</td></tr><tr><td>Language <italic>z</italic>-scores</td><td /><td /><td /><td>5.44<xref ref-type="table-fn" rid="tfn7">**</xref></td><td>1.67</td><td>[1.94, 8.93]</td></tr><tr><td>NVIQ centered on 100</td><td /><td /><td /><td>0.16</td><td>0.11</td><td>[−0.07, 0.40]</td></tr><tr><td>Unmet service needs</td><td /><td /><td /><td>−0.65</td><td>0.66</td><td>[−2.00, 0.71]</td></tr><tr><td>Barriers to services</td><td /><td /><td /><td>−0.96</td><td>0.69</td><td>[−2.34, 0.43]</td></tr><tr><td>AIC</td><td>435.62</td><td /><td /><td>405.44</td><td /><td /></tr><tr><td>BIC</td><td>439.19</td><td /><td /><td>408.82</td><td /><td /></tr><tr><td>Marginal pseudo-<italic>R</italic>2</td><td>.000</td><td /><td /><td>0.405</td><td /><td /></tr><tr><td>Conditional pseudo-<italic>R</italic>2</td><td>.500</td><td /><td /><td>0.702</td><td /><td /></tr><tr><td>−2 LL</td><td>431.37</td><td /><td /><td>401.16</td><td /><td /></tr><tr><td>df</td><td>2</td><td /><td /><td>6</td><td /><td /></tr><tr><td>LRT</td><td /><td /><td /><td>30.21<xref ref-type="table-fn" rid="tfn7">***</xref></td><td /><td /></tr></tbody></table> </ephtml> </p> <ulist> <item>6 Functional communication scores = Vineland Adaptive Behavior Scales-3 communication domain standard scores ([<reflink idref="bib111" id="ref153">111</reflink>]). Language <emph>z</emph>-scores = average of receptive vocabulary, expressive vocabulary, and nonword repetition. Unmet service needs and barriers to services = National Longitudinal Transition Survey-2 items ([<reflink idref="bib87" id="ref154">87</reflink>]), as in [<reflink idref="bib116" id="ref155">116</reflink>]. Models fit with a Gaussian distribution and identity link function, with a random intercept, variance components structure, Satterthwaite approximation, and robust covariance estimation. LRT = likelihood ratio test, using a chi-square statistic with 4 degrees of freedom.</item> <item>7 <emph>p</emph> < 0.05. **<emph>p</emph> < 0.01. ***<emph>p</emph> < 0.0001.</item> </ulist> <p>Graph: Figure 2. Observed language z -scores by Vineland Adaptive Behavior Scales, 3rd Ed. communication standard scores, based on model results including language z -scores, NVIQ, unmet service needs, and barriers to services. Circles = autism plus language impairment. Triangles = autism without language impairment. Language z -scores = average of receptive vocabulary, expressive vocabulary, and nonword repetition accuracy.</p> <p>In contrast, sense of community significantly contributed to differences in social communication impairment, whereas unmet service needs and barriers to services did not; see Table 6 and Figure 3. There was significant baseline variability, <emph>τ</emph><sups>2</sups> = 61.65, <emph>z</emph> = 3.04, <emph>p</emph> =.002. Adding sense of community, unmet service needs, and barriers to services improved model fit and accounted for 27.3% of the variance in social communication impairment scores. At baseline (no unmet service needs or barriers to services), the expected <emph>t</emph>-score was 79.50, indicating a "high" level of social communication impairment. Each one-unit increase in sense of community was associated with a 4.18-point decrease in impairment scores. Individual variability remained significant in the final model, <emph>τ</emph><sups>2</sups> = 46.21, <emph>z</emph> = 2.94, <emph>p</emph> =.003.</p> <p>Table 6. Model results of social communication impairment scores.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" rowspan="2">Parameter</th><th align="left" colspan="3">Model 1</th><th align="left" colspan="3">Model 2</th></tr><tr><th align="left">β</th><th align="left">SE</th><th align="left">95% CI</th><th align="left">β</th><th align="left">SE</th><th align="left">95% CI</th></tr></thead><tbody><tr><td>Intercept</td><td>71.88<xref ref-type="table-fn" rid="tfn9">**</xref></td><td>1.29</td><td>[69.30, 74.45]</td><td>79.50<xref ref-type="table-fn" rid="tfn9">**</xref></td><td>5.51</td><td>[68.51, 90.50]</td></tr><tr><td>Sense of community</td><td /><td /><td /><td>−4.18<xref ref-type="table-fn" rid="tfn9">**</xref></td><td>1.50</td><td>[−7.17, −1.19]</td></tr><tr><td>Unmet service needs</td><td /><td /><td /><td>0.77</td><td>0.45</td><td>[−0.13, 1.67]</td></tr><tr><td>Barriers to services</td><td /><td /><td /><td>0.47</td><td>0.39</td><td>[−0.32, 1.25]</td></tr><tr><td>AIC</td><td>559.45</td><td /><td /><td>533.40</td><td /><td /></tr><tr><td>BIC</td><td>563.83</td><td /><td /><td>537.69</td><td /><td /></tr><tr><td>Marginal pseudo-<italic>R</italic>2</td><td>.000</td><td /><td /><td>.273</td><td /><td /></tr><tr><td>Conditional pseudo-<italic>R</italic>2</td><td>.500</td><td /><td /><td>.637</td><td /><td /></tr><tr><td>−2 LL</td><td>555.27</td><td /><td /><td>529.22</td><td /><td /></tr><tr><td>df</td><td>2</td><td /><td /><td>5</td><td /><td /></tr><tr><td>LRT</td><td /><td /><td /><td>26.05<xref ref-type="table-fn" rid="tfn9">***</xref></td><td /><td /></tr></tbody></table> </ephtml> </p> <ulist> <item>8 Social community impairment scores = Social Responsiveness Scale-2 (SRS-2) social communication impairment <emph>t</emph>-scores ([<reflink idref="bib30" id="ref156">30</reflink>]). Sense of community = Brief Sense of Community Scale overall score ([<reflink idref="bib91" id="ref157">91</reflink>]). Unmet service needs and barriers to services = National Longitudinal Transition Survey-2 items ([<reflink idref="bib87" id="ref158">87</reflink>]), as in [<reflink idref="bib116" id="ref159">116</reflink>]. Models fit with a Gaussian distribution and identity link function, with a random intercept, variance components structure, Satterthwaite approximation, and robust covariance estimation. LRT = likelihood ratio test using a chi-square statistic with 3 degrees of freedom.</item> <item>9 <emph>p</emph> < 0.05. **<emph>p</emph> < 0.01. ***<emph>p</emph> < 0.0001.</item> </ulist> <p>Graph: Figure 3. Observed sense of community by Social Responsiveness Scale, 2nd Ed. Social communication impairment t -score, based on model results including sense of community, unmet service needs, and barriers to services.</p> <hd id="AN0190905300-19">Discussion</hd> <p>This report is a first step in understanding social drivers of health in autistic adolescents and young adults ranging in language skills. Findings are consistent with prior reports on persistent communication difficulties in adults with LI ([<reflink idref="bib58" id="ref160">58</reflink>]), as well as on the relevance of community supportiveness in enhancing social inclusion and community participation ([<reflink idref="bib37" id="ref161">37</reflink>]; [<reflink idref="bib114" id="ref162">114</reflink>]). In this study, communication and social drivers of health were variable. These results are important for understanding linguistic heterogeneity in autism beyond childhood. Findings lay groundwork for better understanding the transition to adulthood ([<reflink idref="bib72" id="ref163">72</reflink>]; [<reflink idref="bib102" id="ref164">102</reflink>]).</p> <hd id="AN0190905300-20">Measurement issues: LI and communication</hd> <p>Calls for multi-domain assessment of language in autism have grown, as over-relying on individual measures leads to low clinical validity ([<reflink idref="bib99" id="ref165">99</reflink>]). Criteria for LI in this study spanned semantics, morphology, syntax, and phonology. This approach, consistent with prior work ([<reflink idref="bib58" id="ref166">58</reflink>]), avoids reliance on cognitive referencing and reflects the fact that language and NVIQ can dissociate in autism ([<reflink idref="bib74" id="ref167">74</reflink>]; [<reflink idref="bib109" id="ref168">109</reflink>]; [<reflink idref="bib126" id="ref169">126</reflink>]).</p> <p>Still, limitations remain. To our knowledge, no recent, comprehensive normed expressive-receptive language tools exist for adults over age 21 years, which affects classification reliability (e.g. [<reflink idref="bib43" id="ref170">43</reflink>]; [<reflink idref="bib58" id="ref171">58</reflink>]). Observational tools, such as natural language sampling, may offer additional insight ([<reflink idref="bib22" id="ref172">22</reflink>]), but were not feasible in this study. Especially with a sample that is historically marginalized in research, time is a constraint. Thus, this study balanced duration of activities with administration of behavioral assessment and questionnaires.</p> <p>Findings also have implications for conceptualizing communication. Communication is variably defined and may refer to verbally expressing needs, managing social situations, or self-perceived abilities ([<reflink idref="bib34" id="ref173">34</reflink>]; [<reflink idref="bib97" id="ref174">97</reflink>]; [<reflink idref="bib113" id="ref175">113</reflink>])—and does not necessarily consider structural language skills. Here, more participants without LI had adequate functional communication ([<reflink idref="bib111" id="ref176">111</reflink>]), which is consistent with prior work on adults with LI ([<reflink idref="bib58" id="ref177">58</reflink>]). However, groups did not differ by LI status in communication scores. These results demonstrate how over-reliance on measures and broad comparisons may mask variation.</p> <p>Overall, findings emphasize the trade-offs in approaches to measurement. Broad classification (e.g. LI) can obscure nuance, while narrowly focused tools may miss important variability. While there is no consensus on LI or communication, measurement should be guided by clear goals and an understanding of how data will be used ([<reflink idref="bib83" id="ref178">83</reflink>]).</p> <hd id="AN0190905300-21">Patterns between social drivers of health and communication abilities</hd> <p>Communication scores were associated with individual differences in language and sense of community, but not services or NVIQ. As this was a cross-sectional analysis, results do not imply causality or directionality. While a higher sense of community corresponded with lower social communication impairment, it is plausible that greater impairment limits access or participation in community settings, thus reducing sense of community. Descriptively, sense of community was lower in this sample than in primarily white adults from the general population (2.9–3.04 vs 3.81; [<reflink idref="bib91" id="ref179">91</reflink>]). Though beyond the scope of this study, research on Black and Hispanic youth and adults suggests these lower scores may reflect social marginalization ([<reflink idref="bib24" id="ref180">24</reflink>]; [<reflink idref="bib35" id="ref181">35</reflink>]; [<reflink idref="bib103" id="ref182">103</reflink>]).</p> <p>This study included social drivers of health, language, and NVIQ to avoid collapsing heterogeneity among autistic adolescents and young adults ([<reflink idref="bib19" id="ref183">19</reflink>]; [<reflink idref="bib92" id="ref184">92</reflink>]). However, interpreting heterogeneity is complex. Language scores corresponded with, but did not contribute to, functional communication scores when accounting for NVIQ, unmet service needs, and barriers to services. Prior work found 12.8% of autistic and nonautistic adults with a history of LI reported "normal speech and language functioning" ([<reflink idref="bib58" id="ref185">58</reflink>]), and use of full-scale IQ confounds links between cognitive abilities and functional communication in autism remain confounded by use of full-scale IQ ([<reflink idref="bib48" id="ref186">48</reflink>]; [<reflink idref="bib77" id="ref187">77</reflink>]). In addition, counts of unmet service needs and barriers may miss nuanced differences within and between individuals ([<reflink idref="bib20" id="ref188">20</reflink>]).</p> <p>Community support may play a role in supporting self-expression and communication during the transition to adulthood ([<reflink idref="bib42" id="ref189">42</reflink>]). Social communication impairment more directly aligned with expected results, according to theory ([<reflink idref="bib19" id="ref190">19</reflink>]) and prior work on adults from the general population ([<reflink idref="bib114" id="ref191">114</reflink>]). For autistic adults, peer understanding may affect social interaction more than individual traits, such as social motivation or cognition ([<reflink idref="bib32" id="ref192">32</reflink>]; [<reflink idref="bib84" id="ref193">84</reflink>]). Hence, higher impairment could arise from external factors that reduce community access and lower sense of belonging ([<reflink idref="bib23" id="ref194">23</reflink>]). Finally, lower sense of community in this sample may reflect intersecting experiences of race and disability ([<reflink idref="bib13" id="ref195">13</reflink>]; [<reflink idref="bib70" id="ref196">70</reflink>]). Individuals may opt out of communication experiences when environments do not offer supports and feel exclusionary ([<reflink idref="bib70" id="ref197">70</reflink>]). However, the dynamics between agency and structural constraints are unknown.</p> <hd id="AN0190905300-22">Implications for autistic individuals and community members</hd> <p>Though there is growing awareness of heterogeneity in language in autism ([<reflink idref="bib99" id="ref198">99</reflink>]) and of the transition to adulthood ([<reflink idref="bib98" id="ref199">98</reflink>]), documenting this variability is critical for advocacy. Rather than rely on limited information–which risks reinforcing stereotypes–developing a nuanced understanding of autistic adolescents' and young adults' profiles is essential to recognizing them as whole individuals ([<reflink idref="bib60" id="ref200">60</reflink>]). Amid ongoing emphasis on individual traits over social drivers of health in research on transition-aged autistic individuals ([<reflink idref="bib7" id="ref201">7</reflink>]; [<reflink idref="bib72" id="ref202">72</reflink>]), attending to all relevant factors is key to understanding autism across the lifespan ([<reflink idref="bib100" id="ref203">100</reflink>]). Doing so is prerequisite to enhancing person-environment fit ([<reflink idref="bib62" id="ref204">62</reflink>]), align supports with individual goals, and to shift intervention to improve outcomes toward community-level change rather than placing the onus solely on autistic individuals. Findings from this study also underscore the value of using appropriate conceptual approaches for understanding heterogeneity ([<reflink idref="bib92" id="ref205">92</reflink>]). While identifying disparities in outcomes is relevant for developing targeted interventions, broad, binary comparisons require clear justification.</p> <hd id="AN0190905300-23">Limitations</hd> <p>This study had several limitations. The sample was small and included transition-aged individuals who used primarily language to communicate ([<reflink idref="bib53" id="ref206">53</reflink>]). The cross-sectional design limited the ability to examine directionality or causality among observed relationships, which are relevant, as service needs may evolve across early to later adulthood ([<reflink idref="bib100" id="ref207">100</reflink>]). Also, although this study was motivated by a social-ecological model ([<reflink idref="bib19" id="ref208">19</reflink>]), analysis did not examine bidirectional patterns between social drivers of health and communication abilities. These limit the generalizability of findings. Different respondents also completed questionnaires, which may have contributed to the observed differences in sense of community; robust sampling and replication are needed to determine whether effects are "true" ([<reflink idref="bib36" id="ref209">36</reflink>]). Moreover, including qualitative measures to elucidate how the intersection of race with disability shapes experiences ([<reflink idref="bib9" id="ref210">9</reflink>]), such as sense of community and services access, would strengthen interpretation of the data. Given concerns of feasibility, this study did not comprehensively assess multi-level, multi-domain social drivers of health that shape the communication environment ([<reflink idref="bib86" id="ref211">86</reflink>]), or clinical traits, such as mental health conditions ([<reflink idref="bib61" id="ref212">61</reflink>]). Finally, the clinical and real-world utility of communication abilities, as assessed in this study, is unknown.</p> <hd id="AN0190905300-24">Future directions</hd> <p>Findings and limitations highlight priorities for future research. Social drivers of health measures used in this study may differ from those used in clinical settings (e.g. economic stability; [<reflink idref="bib110" id="ref213">110</reflink>]), and understanding how these intersect is essential for improving outcomes in autism ([<reflink idref="bib100" id="ref214">100</reflink>]). Although prior work documents healthcare barriers for autistic adults, such as healthcare communication, sensory sensitivities, and mismatches in care delivery, there is little attention to nuance in barriers across communities or language profiles ([<reflink idref="bib76" id="ref215">76</reflink>]). Similar gaps exist in tailoring mental and physical healthcare delivery for autistic adults, including clinician knowledge and environmental factors (e.g., sensory environment in service delivery settings; [<reflink idref="bib17" id="ref216">17</reflink>]). Addressing these challenges requires robust sampling and longitudinal data to examine how language, communication, and social drivers of health interact over time. Future work should integrate clinical communication assessments with person-centered measures, as both individual differences and contextual factors shape communication in autistic adults ([<reflink idref="bib34" id="ref217">34</reflink>]). Enhancing the ecological validity of measuring social drivers of health in this way is key to reducing support gaps in the transition to adulthood. Given multi-level factors in services delivery and limited provider preparation to interact with autistic adults ([<reflink idref="bib38" id="ref218">38</reflink>]), incorporating perspectives from autistic adolescents and young adults, caregivers, providers, and organizations as expert evidence is necessary to generate solutions-oriented research ([<reflink idref="bib44" id="ref219">44</reflink>]).</p> <hd id="AN0190905300-25">Conclusions</hd> <p>In examining a sample of autistic adolescents and young adults ranging in language skills and NVIQ, this cross-sectional study documented relationships between social drivers of health and communication abilities. Patterns between language and functional communication, as well as sense of community and social communication impairment, support a model of communication outcomes as arising from individual-environment interactions. Findings emphasize the importance of the environment in shaping communication for autistic individuals during the transition to adulthood, as well as of a holistic approach to assessment and services.</p> <hd id="AN0190905300-26">Supplemental Material</hd> <p>Graph: Supplemental material, sj-docx-1-aut-10.1177_13623613251380448 for The role of social drivers of health in communication abilities of autistic adolescents and young adults by Teresa Girolamo, Alicia Escobedo, Lindsay Butler, Caroline A Larson, Iván Campos and Kyle Greene-Pendelton in Autism</p> <ref id="AN0190905300-27"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref108" type="bt">1</bibl> <bibtext> Teresa Girolamo</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibl id="bib2" idref="ref37" type="bt"></bibl> <bibtext>https://orcid.org/0000-0003-1714-3545 Lindsay Butler</bibtext> </blist> <blist> <bibl id="bib3" idref="ref82" type="bt"></bibl> <bibtext>Graph</bibtext> </blist> <blist> <bibl id="bib4" idref="ref8" type="bt"></bibl> <bibtext>https://orcid.org/0000-0003-4106-1849 Caroline A Larson</bibtext> </blist> <blist> <bibl id="bib5" idref="ref65" type="bt"></bibl> <bibtext>Graph https://orcid.org/0000-0001-7940-2528</bibtext> </blist> <blist> <bibtext> Teresa Girolamo: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Visualization; Writing—original draft; Writing—review and editing.Alicia Escobedo: Data curation; Formal analysis; Methodology; Writing—review and editing.Caroline A Larson: Conceptualization; Formal analysis; Methodology; Writing—review and editing.Lindsay Butler: Formal analysis; Methodology; Writing—review and editing.Iván Campos: Conceptualization; Methodology; Writing—review and editing.Kyle Greene-Pendelton: Conceptualization; Methodology; Writing—review and editing</bibtext> </blist> <blist> <bibtext> The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: TG was supported by an American Speech-Language-Hearing Foundation New Investigators Research Grant (PI: Girolamo), NIDCD T32 DC001703 (PI: Eigsti), and NIDCD R21 DC021769-01A1 (PI: Girolamo).</bibtext> </blist> <blist> <bibtext> The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> Data for this article are unavailable due to ethical reasons. 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Header DbId: eric
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An: EJ1494608
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PubType: Academic Journal
PubTypeId: academicJournal
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: The Role of Social Drivers of Health in Communication Abilities of Autistic Adolescents and Young Adults
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Teresa+Girolamo%22">Teresa Girolamo</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-1714-3545">0000-0003-1714-3545</externalLink>)<br /><searchLink fieldCode="AR" term="%22Alicia+Escobedo%22">Alicia Escobedo</searchLink><br /><searchLink fieldCode="AR" term="%22Lindsay+Butler%22">Lindsay Butler</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4106-1849">0000-0003-4106-1849</externalLink>)<br /><searchLink fieldCode="AR" term="%22Caroline+A%2E+Larson%22">Caroline A. Larson</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-7940-2528">0000-0001-7940-2528</externalLink>)<br /><searchLink fieldCode="AR" term="%22Iván+Campos%22">Iván Campos</searchLink><br /><searchLink fieldCode="AR" term="%22Kyle+Greene-Pendelton%22">Kyle Greene-Pendelton</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Autism%3A+The+International+Journal+of+Research+and+Practice%22"><i>Autism: The International Journal of Research and Practice</i></searchLink>. 2026 30(2):329-345.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 17
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2026
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Young+Adults%22">Young Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Health%22">Health</searchLink><br /><searchLink fieldCode="DE" term="%22Communication+Skills%22">Communication Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Influences%22">Social Influences</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22Needs%22">Needs</searchLink><br /><searchLink fieldCode="DE" term="%22Community%22">Community</searchLink><br /><searchLink fieldCode="DE" term="%22Correlation%22">Correlation</searchLink><br /><searchLink fieldCode="DE" term="%22Language+Skills%22">Language Skills</searchLink>
– Name: SubjectThesaurus
  Label: Assessment and Survey Identifiers
  Group: Su
  Data: <searchLink fieldCode="SU" term="%22Social+Responsiveness+Scale%22">Social Responsiveness Scale</searchLink><br /><searchLink fieldCode="SU" term="%22Clinical+Evaluation+of+Language+Fundamentals%22">Clinical Evaluation of Language Fundamentals</searchLink><br /><searchLink fieldCode="SU" term="%22Peabody+Picture+Vocabulary+Test%22">Peabody Picture Vocabulary Test</searchLink><br /><searchLink fieldCode="SU" term="%22Raven+Progressive+Matrices%22">Raven Progressive Matrices</searchLink><br /><searchLink fieldCode="SU" term="%22National+Longitudinal+Transition+Study+of+Special+Education+Students%22">National Longitudinal Transition Study of Special Education Students</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/13623613251380448
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1362-3613<br />1461-7005
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Despite their relevance to outcomes in autism, little is known about how social drivers of health affect communication, especially in transition-aged autistic adolescents and young adults with structural language impairment. This knowledge gap limits our understanding of developmental trajectories and the ability to develop supports. This cross-sectional study examined the role of social drivers of health in the communication abilities of autistic individuals ages 13-30. Participants (N = 73) completed language, nonverbal cognitive assessments, and social drivers of health (sense of community, unmet services, barriers to services) measures. Data were analyzed descriptively and using mixed-effects modeling. More unmet service needs, more barriers to services, and a lower sense of community were associated with greater social communication impairment. In turn, both unmet service needs and barriers to services were negatively associated with functional communication. In regression modeling, language scores contributed to functional communication, and sense of community to social communication impairment. Findings support the relevance of language and social drivers of health in communication. Future work should focus on possible bidirectional relationships between these variables and explore and real-world translation.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2026
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1494608
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1494608
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/13623613251380448
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 17
        StartPage: 329
    Subjects:
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Adolescents
        Type: general
      – SubjectFull: Young Adults
        Type: general
      – SubjectFull: Health
        Type: general
      – SubjectFull: Communication Skills
        Type: general
      – SubjectFull: Social Influences
        Type: general
      – SubjectFull: Barriers
        Type: general
      – SubjectFull: Needs
        Type: general
      – SubjectFull: Community
        Type: general
      – SubjectFull: Correlation
        Type: general
      – SubjectFull: Language Skills
        Type: general
      – SubjectFull: Social Responsiveness Scale
        Type: general
      – SubjectFull: Clinical Evaluation of Language Fundamentals
        Type: general
      – SubjectFull: Peabody Picture Vocabulary Test
        Type: general
      – SubjectFull: Raven Progressive Matrices
        Type: general
      – SubjectFull: National Longitudinal Transition Study of Special Education Students
        Type: general
    Titles:
      – TitleFull: The Role of Social Drivers of Health in Communication Abilities of Autistic Adolescents and Young Adults
        Type: main
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            NameFull: Teresa Girolamo
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            NameFull: Alicia Escobedo
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            NameFull: Caroline A. Larson
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            NameFull: Iván Campos
      – PersonEntity:
          Name:
            NameFull: Kyle Greene-Pendelton
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          Dates:
            – D: 01
              M: 02
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-print
              Value: 1362-3613
            – Type: issn-electronic
              Value: 1461-7005
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            – TitleFull: Autism: The International Journal of Research and Practice
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