Underrepresentation of Females and Racial and Ethnic Minority Groups in Research on Pragmatic Language in Autism: A Scoping Review

Differences in language use in social contexts (i.e., pragmatics, such as conversational ability) serve as a defining clinical feature of autism, which can have an important impact on social functioning and well-being in a neurotypical society. Despite decades of research, most studies have not included representative samples, calling into question the generalizability of findings. This scoping review evaluates reporting practices and representation of autistic females and individuals from racially, ethnically (Hispanic/Latine), and linguistically diverse backgrounds. An initial pool of >1,800 articles were individually reviewed using a detailed coding system of exclusionary criteria, resulting in 308 empirical studies of pragmatic language in autism that were subjected to fine-grained analysis. Approximately 80% of studies reported sex, and about 70% documented language spoken. However, race and ethnicity were reported in less than 10% of studies. When reported, females and individuals from racial/ethnic minority backgrounds were starkly underrepresented. Reporting rates increased over time (1977–2022) for sex, ethnicity, and language spoken, and representation improved for racial minority groups and non-English speakers. Evidence suggests a striking bias towards inclusion of White, non-Hispanic/non-Latine males. This lack of representation has critical implications for interpretations of extant literature on pragmatics in autism, relevant to clinical characterization and future research. Lay Abstract Participation of Females and People from Racial and Ethnic Minority Groups in Studies of Social Communication in Autism Social communication, or “pragmatic” language, refers to skills like maintaining topics of conversation and telling stories. People with autism often show differences in social communication, such as going off-topic during conversation. Social communication differences are important in diagnosing autism. These differences can also impact an autistic individual's daily life, such as making it difficult to find friends. For several decades, researchers have studied social communication in people with autism. However, many argue that most of these studies did not include females with autism or autistic individuals from non-White races (e.g., Black, Asian) or ethnicities (e.g., Hispanic/Latine), or who speak languages other than English as their native language. In this study, we sought to assess and document this critique by conducting a wide-ranging search of all published research articles on social communication in autism. Over 1,800 articles were identified, with 308 articles meeting criteria of the study. We discovered that most, but not all, studies reported sex and native language of study participants, while race and ethnicity were rarely reported. When this information was reported, females and people from racial and ethnic minority backgrounds were not represented as often as White, non-Hispanic males. In summary, there is a striking bias towards including White, non-Hispanic males in research on social communication in autism. Future studies need to include more females and more people from diverse backgrounds to support accurate diagnosis of autism, intervention for social communication differences when appropriate, and education for the neurotypical population on communication styles in autism.