The Impact of Bilingualism On The Narrative Ability and The

Journal of Communication Disorders 85 (2020) 105999
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Journal of Communication Disorders

journal homepage: www.elsevier.com/locate/jcomdis
The impact of bilingualism on the narrative ability and the

T
executive functions of children with autism spectrum disorders
Eleni Peristeria,*, Eleni Baldimtsib, Maria Andreouc, Ianthi Maria Tsimplid
a
Faculty of Medicine, University of Thessaly, 41110, Larisa, Greece
b
Medical School, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
c
SFB 1252 Prominence in Language, Luxemburgerstr. 299, 50939, Köln, Germany
d
Department of Theoretical and Applied Linguistics, University of Cambridge, English Faculty Building, Room TR-11, 9 West Road, CB3 9DP,
Cambridge, United Kingdom
A R T IC LE I N F O ABS TRA CT
Keywords: While there is ample evidence that monolingual children with Autism Spectrum Disorders (ASD)
Autism face difficulties with narrative story-telling and executive functions (EF), there is considerable
Bilingualism uncertainty about how bilingualism impacts these skills in autism. The current study explores the
Executive functions effect of bilingualism on the narrative and EF skills of forty 7-to-12-year-old bilingual and
Narratives
monolingual children with ASD, as well as forty age-matched bilingual and monolingual children
of typical development (TD). Narrative production data were elicited using the Edmonton
Narrative Norms Instrument (ENNI; Schneider et al., 2005), which was developed to measure
narrative production at a microstructural and macrostructural level. The same children were
administered two EF tasks, namely, a global-local visual attention task and a 2-back working
memory task. In story-telling, bilingual children with ASD achieved higher scores than mono-
lingual children with ASD on story structure complexity and use of adverbial clauses, and they
tended to use significantly fewer ambiguous referential forms than their monolingual peers with
ASD. In the global-local task, bilingual children with ASD were faster and more accurate in global
trials than monolingual children with ASD, who tended to be more susceptible to interference
from locally presented information than the other experimental groups. Higher accuracy and
faster response times were also observed for bilingual children with ASD in the 2-back task.
Further correlation analyses between the story-telling and EF tasks revealed that bilingual chil-
dren with ASD drew on a broader range of EF in narrative production than their monolingual
peers. The overall findings reveal that bilingual children with ASD outperformed their mono-
lingual peers with ASD in both the microstructure and macrostructure of their narrative pro-
duction, as well as in their visual attention and working memory skills.
1. Introduction
In recent years there has been increasing interest in the effects of bilingualism on the cognitive development of children with
Autism Spectrum Disorder (ASD). While extensive research has highlighted the advantages conferred by bilingualism on the narrative
performance (Andreou, 2015; Bonifacci, Tobia, Bernabini, & Marzocchi, 2016; Chen & Yan, 2011; Otwinowska et al., 2012; Tsimpli,
⁎
Corresponding author.
E-mail addresses: eperiste@uth.gr (E. Peristeri), empaldimt@auth.gr (E. Baldimtsi), mandreou@uni-koeln.de (M. Andreou),
imt20@cam.ac.uk (I.M. Tsimpli).
https://doi.org/10.1016/j.jcomdis.2020.105999
Received 7 January 2019; Received in revised form 16 March 2020; Accepted 16 March 2020
Available online 03 May 2020
0021-9924/ © 2020 Elsevier Inc. All rights reserved.
E. Peristeri, et al. Journal of Communication Disorders 85 (2020) 105999
Peristeri, & Andreou, 2016), and the executive function (EF) skills (Bialystok, Barac, Blaye, & Poulin-Dubois, 2010; Bialystok, Luk,
Peets, & Yang, 2010; Bialystok, 2011; Blom, Küntay, Messer, Verhagen, & Leseman, 2014) of typically-developing (TD) children, the
contribution of bilingualism to the skills of children with ASD is a largely underexplored area. This study aims to determine the extent
to which bilingualism affected ASD children’s narratives in both microstructure and macrostructure, and evaluate the way bilingual
children with ASD used their EF while telling a wordless picture-story.
1.1. Narratives and executive functions in autism spectrum disorders
Children with ASD exhibit a unique language and cognitive profile characterized by considerable inter-individual heterogeneity
(Groen, Zwiers, van der Gaag, & Buitelaar, 2008; Lord, Risi, & Pickles, 2004; Wittke, Mastergeorge, Ozonoff, Rogers, & Naigles,
2017). Narratives, which are under investigation in the current study, have been systematically used as a means of examining formal
language and cognitive skills in children with ASD. Relevant studies have predominantly focused on two levels of narrative analysis,
namely, macrostructure that includes the story’s plot elements; i.e., goals, attempts and outcomes, Theory of Mind (ToM) terms and
referential cohesion established through appropriate pronoun-referent mappings, and microstructure that includes vocabulary and
morphosyntax (Fichman & Altman, 2019; Hughes, McGillivray, & Schmidek, 1997; McCabe & Rollins, 1994). Studies on the narrative
development of children with ASD have not resulted in a consistent picture, sometimes because of variance in key language measures
of children’s formal language skills and pragmatic abilities. Although the microstructural and macrostructural properties of narratives
that have been coded in monolingual children with ASD vary widely from one study to another, macrostructural aspects of narrative
production has been shown to be more challenging for children with ASD relative to microstructure.
Commonly coded macrostructural properties in ASD children’s narratives are inclusion of (ir)relevant information, common
ground management, i.e. referring to story characters in a way that is accessible to the comprehender, coherence and use of terms
that describe the affective states of the story characters (or else, Internal State Terms; ISTs). Individuals with ASD have been shown to
have difficulty producing coherent narratives (Naigles & Chin, 2015; Norbury, Gemmell, & Paul, 2014; Stirling, Douglas, Leekam, &
Carey, 2014), and to demonstrate limited use of causal words and affective mental state terms (Losh & Capps, 2003). They have also
been reported to omit story events that involve characters’ thoughts and feelings, such as internal responses and plans (McCabe,
Hillier, & Shapiro, 2013); even when they occasionally do so, they tend to use pragmatically inappropriate words and phrases
(Loveland & Tunali, 1993; Schoen-Simmons, Paul, & Volkmar, 2014). Capps, Losh, and Thurber (2000), as well as Siller, Swanson,
Serlin, and Teachworth (2014) found significant correlations between ASD children’s ToM reasoning abilities and use of ISTs, yet, in a
later study Losh and Capps (2003) failed to replicate this finding. Looking at reference use, past research has provided mixed results,
with some studies (Arnold, Bennetto, & Diehl, 2008; Mäkinen et al., 2014; Meir & Novogrodsky, 2019b; Terzi, Marinis, Zafeiri, &
Francis, 2019) showing that referential form use is subject to the same developmental constraints regulating the choices of TD
children, and others showing high rates of ambiguous pronouns (Baldimtsi, Peristeri, Tsimpli, & Nicolopoulou, 2016; Novogrodsky,
2013; Novogrodsky & Edelson, 2016).
Most studies on the microstructural aspects of narrative production offer evidence that cognitively able (i.e. without intellectual
disability)-ASD children’s formal language skills are relatively more preserved than their pragmatic skills. Narrative studies that have
controlled for TD and ASD children’s formal language abilities have failed to exhibit striking differences between the two groups in
measures that tap onto grammatical abilities, such as, syntactic complexity and subordinate clauses per communication unit (Colle,
Baron-Cohen, & Wheelwright, 2008; Diehl, Bennetto, & Young, 2006; Peristeri, Andreou, & Tsimpli, 2017; Tager-Flusberg & Sullivan,
1995). Peristeri et al. (2017) have recently found a large correlation between verbal skills and syntactic complexity in the narratives
of children with ASD without intellectual disability, which suggests that ASD children’s ability to formulate complex propositions is
related to their verbal ability. Likewise, TD and ASD children have not been found to differ in lexical diversity, i.e. the number of
different words the children used in their narratives (Peristeri et al., 2017; Suh et al., 2017).
Many studies (Parish-Morris et al., 2013; Riby & Hancock, 2008; Sasson, Turner-Brown, Holtzclaw, Lam, & Bodfish, 2008, among
others) have claimed that difficulties in narration in children with ASD do not lie exclusively in language deficits per se, but in EF
weaknesses that have often been found to characterize children with autism relative to TD controls. Attention and working memory,
which are the focus of the present study, are two domains of executive functioning that have been shown to involve deficits in ASD.
More specifically, relevant research shows that individuals with ASD tend to focus on bottom-up details, making them overly sus-
ceptible to local (versus global) information (Happé & Frith, 2006; Happé, 1999; Koldewyn, Yuhong, Yuhong, Weigelt, & Kanwisher,
2013; Mottron, Burack, Iarocci, Belleville, & James, 2003; though, see Cardillo, Menazza, & Mammarella, 2018), while unimpaired
individuals focus their attention more on higher-level/top-down information (Jolliffe & Baron-Cohen, 2000). The source of this
attentional abnormality in autism has been much debated, with competing explanations invoking either a weakening of central
coherence mechanisms that hinders one’s ability to integrate disparate information in order to extract the gist of a situation (Happé,
1999), or a selective deficit in a distinct executive process that relies on a top-down control system (Soulières, Mottron, Saumier, &
Larochelle, 2007). Limited research has been conducted on the interaction between children’s detail-oriented processing style and
narrative performance, but there is some evidence that local attention biases may be linked to ASD children’s tendency to provide
more details and fewer ‘big picture’ components in story-telling tasks (Adlphs & Spezio, 2006; Barnes & Baron-Cohen, 2012; Skorich,
Gash, Stalker, Zheng, & Haslam, 2017). On the other hand, studies that have focused on working memory in ASD report mixed
results. Using an N-back letter task, Williams, Goldstein, and Carpenter (2005) found that high-functioning children, adolescents and
adults with ASD performed similarly to age-matched control groups, while Kana, Keller, Minshew, and Just (2007) found that
individuals with ASD exhibited lower accuracy performance than the control group. Though differences reported between individuals
with and without ASD in EF tasks indicate that their performance is subserved by different information processing styles, one
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challenge with research is to identify which narrative measures in microstructure and macrostructure are most affected by possible
attention and working memory differences between children with and without autism, and more importantly, whether bilingualism
potentially mediates the relation between EF and narrative ability in ASD.
1.2. Bilingualism and autism spectrum disorders
Investigation about component language and cognitive skills in bilingual children with ASD has not received much attention until
recently. The few existing studies have mainly focused on the language development of bilingual children with ASD, converging on
the finding that bilingualism does not halt certain aspects of language development in children with ASD relative to their TD bilingual
peers. Research demonstrates that multiple language exposure does not have an adverse effect on the vocabulary production and
comprehension, grammar, pronunciation and pragmatic language competence of children with ASD (Hambly & Fombonne, 2012;
Iarocci, Hutchison, & O’Toole, 2017; Meir & Novogrodsky, 2019a; Ohashi et al., 2012; Reetzke, Zou, Sheng, & Katsos, 2015; Valicenti-
McDermott et al., 2012). However, unclear from these studies remains the precise role of EF in language performance, whether
bilingual ASD children’s language processing is affected by domain-general cognitive control skills. Two recent studies of bilingual
children with ASD showed that multiple language exposure does not stymie EF skills. Gonzalez-Barrero and Nadig (2017) tested 20
bilingual children with ASD on set-shifting and working memory tasks, also considering parental reports on the children’s EF.
Bilingual children with ASD exhibited higher set-shifting abilities than their monolingual peers with ASD; however, the parental
reports indicated no such advantage for the children’s set-shifting behaviors in daily life (see also Iarocci et al., 2017). The present
study seeks to investigate the narratives and EF of bilingual children with ASD and determine whether narrative performance is
associated with EF in the same group of children.
1.3. The current study
This is a follow-up study building on the methodological design of Baldimtsi et al.’s (2016) study with a total of 24 children with
and without ASD (6 bilingual children with ASD, 6 monolingual children with ASD, 6 bilingual TD and 6 monolingual TD children).
The tasks in Baldimtsi et al.’s (2016) study and the current study are the same, yet, with no overlap in the experimental participants.
The current study addresses the impact of bilingualism on the narrative and non-verbal EF abilities of children with ASD. Our
main objective is to compare monolingual and bilingual ASD children’s narrative performance across microstructural and macro-
structural properties, and also pin down the type(s) of EF skills that matter most for the narrative performance of bilingual and
monolingual children with ASD. The literature on narratives and EF in bilingual children with ASD leaves many open questions about
whether verbal and domain-general non-verbal skills are associated among this population. The current study explores the narrative
and non-verbal EF abilities of 10-year-old bilingual and monolingual children with and without autism using an oral telling task, a
non-verbal global-local task and a 2-back working task that entails the online monitoring, updating and manipulation of remembered
digit information. Here we examined the effects of bilingualism on the children’s performance across the three tasks, and offer the
following research questions and hypotheses:
Question 1. Will bilingual children with ASD outperform their monolingual peers with ASD in narrative performance, and will
microstructural and macrostructural narrative properties be equally affected by bilingualism?
Hypothesis 1. We hypothesized that the narrative performance of the bilingual group with ASD would be superior to that of their
monolingual peers with ASD in macrostructure, and to a lesser extent in microstructure, as we speculated that bilingualism would
compensate for narrative aspects that are mostly (negatively) affected by autism (Losh & Capps, 2003; Naigles & Chin, 2015; Norbury
et al., 2014; Peristeri et al., 2017; Stirling et al., 2014).
Question 2. Will the EF performance of bilingual children with ASD differ from monolingual children with ASD?
Hypothesis 2. Enhancement of EF skills has been a highly reliable effect of bilingualism in TD children (see Bialystok & Craik, 2010
for a review). We thus expected that bilingual children with ASD would outperform monolingual children with ASD on both EF
measures, i.e. the non-verbal global-local and the 2-back task.
Question 3. Will EF skills affect narrative performance of monolingual and bilingual children with ASD? Will the influence of EF on
narrative performance be dissociable across the two groups?
Hypothesis 3. Based on previous evidence (Adlphs & Spezio, 2006; Barnes & Baron-Cohen, 2012; Skorich et al., 2017) that EF
mediate ASD children’s narrative performance mainly in macrostructure, we hypothesized that EF skills would be closely linked with
both monolingual and bilingual children’s performance in the narrative task. Though evidence on the EF of bilingual children with
ASD is rather mixed (Gonzalez-Barrero & Nadig, 2017; Iarocci et al., 2017), we speculated that an EF boost conferred by bilingualism
would probably permit ASD children to draw upon their enhanced EF resources, resulting in improved narrative performance
compared to their monolingual peers with ASD.
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2. Method
2.1. Participants
A total of 80 boys participated in this study, and were divided into four groups: 20 monolingual Greek-speaking children with ASD
(ASD-Mono; mean age: 9;8 (SD: 1.5), age range: 7;5–12;0); 20 bilingual children with ASD (ASD-Bi; mean age: 9;7 (SD: 1.3), age
range: 7;7–11;9); 20 TD monolingual Greek-speaking children (TD-Mono; mean age: 9;7 yrs (SD: 1.1; age range: 7;7–11;6); and 20 TD
bilingual children (TD-Bi; mean age: 9;8 yrs. (SD: 1.1), age range: 7;3–11;6). The reason for including only boys in our experimental
sample was recent evidence (Goddard, Dritschel, & Howlin, 2014; Kauschke, van der Beek, & Kamp-Becker, 2016) reporting that girls
with ASD tend to produce higher rates of ISTs in their narrative production than boys. Since one of the dependent measures of the
current study was ISTs (as part of the children’s narrative macrostructure), and to avoid gender-related confounds, we decided to
include only boys in the ASD sample. The children were matched across groups for chronological age on a 1:1 basis. Typically
developing children were selected for normal hearing; no speech, emotional, or behavioral problems; and no observed neurological,
articulation and phonological deficits. They were all recruited from regular public schools in central Greece. Also, experimental data
were collected following children’s parents’ formal written consent, children’s assent and obtainment of approval from the Research
Ethics Committee of the Greek Ministry of Education and the Institution of Educational Policy in Greece.
Children with ASD were recruited from Greek public primary schools’ inclusion classrooms charged with preparing them for the
secondary school environment. They were determined to meet the criteria for ASD based on expert clinical judgment of the child’s
social-adaptive functioning, which was conducted by a licensed child psychiatrist and multidisciplinary groups affiliated with public
centers of differential diagnosis, diagnosis and educational support licensed by Greece’s Ministry of Education. To be included in the
study, children with ASD had to obtain full-scale IQ scores above 70. Besides clinical judgment and the diagnostic center reports, the
Autism Diagnostic Interview–Revised (Lord, Rutter, & Le Couteur, 1994) was administered to the children’s mothers by the first and
second authors (see Table 1 for the ASD groups’ descriptive data). This standardized, semi-structured parent interview includes 93
items focusing on reciprocal social behavior, qualitative abnormalities in communication, and restricted range of interest and/or
stereotypical behaviors. Most items were rated separately for current behavior, as well as the period between the individual’s 4th and
5th birthdays or the point in the individual’s lifetime at which the behavior in question was regarded as most atypical. Algorithm cut-
offs for all domains had to be met or exceeded in order to achieve the instrument classification of autism. The children with ASD who
participated in the current study had scores above the ADI-R diagnostic cut-offs across all three domains of autistic symptomatology.
The details of participants’ characteristics and demographic information are presented in Table 1. The four groups were ad-
ministered the Performance IQ (PIQ) scales of the Greek version of the Wechsler Intelligence Scale for Children (Georgas,
Paraskevopoulos, Besevegis, Giannitsas, & Mylonas, 1997). Children’s socioeconomic status (SES) was measured through maternal
education (Blair et al., 2011; Ensminger & Fothergill, 2003; Hoff, Laursen, & Tardif, 2002; Rhoades, Greenberg, Lanza, & Blair, 2011),
and was calculated on a 5-point Likert-type scale, with 5 representing the highest educational level between compulsory primary
education and tertiary education (1=primary, 2=lower secondary, 3=higher secondary, 4=vocational, 5=tertiary; see Andreou,
Bongartz, Knopp, & Tsimpli, 2015).
Table 1
Participants’ Characteristics and Demographic Information.
TD-Mono (N = 20) M (SD) TD-Bi (N = 20) M (SD) ASD-Mono (N = 20) M (SD) ASD-Bi (N = 20) M (SD)
PIQ 115 (11.9) 111 (17.0) 109 (16.9) 105 (11.5)

SES 2.9 (0.9) 2.3 (0.7) 2.6 (1.0) 2.9 (0.7)
Expressive vocabulary 42 (3.2) 35 (7.1) 41 (4.5) 37 (5.2)
Sentence repetition 30.5 (1.5) 27.6 (4.2) 22.4 (6.9) 14.6 (8.2)
ADI-R
Social Interaction (cutoff = 10) 20.3 (4.4) 17.4 (3.7)
Communication (cutoff = 8) 12.1 (2.8) 13.1 (2.5)
Stereotyped Patterns (cutoff = 3) 4.0 (0.9) 3.8 (0.8)
Dominant language
Home language history Greek Dominant: 25 % Greek Dominant: 30 %
Balanced: 40 % Balanced: 40 %
Other Dominant: 35 % Other Dominant: 30 %
Current literacy input Greek Dominant: 65 % Greek Dominant: 55 %
Other Dominant: 15 % Other Dominant: 10 %
Current language use Greek Dominant: 55 % Greek Dominant: 60 %
Other Dominant: 20 % Other Dominant: 5%
Note: TD-Mono: monolingual typically developing children; TD-Bi: bilingual typically developing children; ASD-Mono: monolingual children with
Autism Spectrum Disorder; ASD-Bi: bilingual children with Autism Spectrum Disorder; PIQ: Performance Intelligence Quotient; SES: socio-economic
status; ADI-R: Autism Diagnostic Interview–Revised.
4
2.1.1. Language screening

Two standardized language screening tests were administered to evaluate the children’s formal language skills in Greek; namely,
an expressive vocabulary and a sentence repetition task. Children with ASD have been reported to demonstrate a delay in vocabulary
development (e.g. Hudry et al., 2010; Smith, Mirenda, & Zaidman-Zait, 2007), while no such delay has been reported for cognitively
able ASD individuals (Meir & Novogrodsky, 2019a; Peristeri et al., 2017). Sentence repetition, on the other hand, has been found to
be impaired in ASD in a number of studies, and thus serves an important function in evaluating structural impairments in children
who fall within the spectrum (Meir & Novogrodsky, 2019a; Riches, Loucas, Baird, Charman, & Simonoff, 2010). The two screening
tests were administered in a single session one week before the study’s main experimental tasks.
2.1.2. Bilingual status

The bilingual children with and without autism came from bilingual households; they had at least one immigrant parent and were
simultaneous bilinguals, being exposed to both languages from birth (Paradis, Genesee, & Crago, 2011). Their language of instruction
in school was Greek. Their mother tongues varied, half being Albanian-, three English-, two Russian-, two Swedish-, two German-,
and one Ukrainian-speaking. The language pairs across bilingual children with and without ASD were not matched strictly, with
thirteen of the TD bilingual children being Albanian-, three Russian-, two Swedish-, and two German-speaking. To obtain more
information on the bilingual profile of the participating children, their parents were asked to complete a language questionnaire
(Andreou, 2015; Torregrossa, Andreou, Bongartz, & Tsimpli, 2017). The questionnaire elicited information about home language
history in terms of the proportion of oral language input by father and mother in each language prior to schooling (i.e., up to the age
of four), current literacy, and current use of both languages with family members and friends. To analyze the questionnaire data,
points were assigned for input in each language according to the number of people interacting with the child. When parents answered
that both languages were used to an equal extent, the points were divided between the two languages. The percentage score for the
input that each child received for the other language was subtracted from that received for the Greek language; the difference
between the two percentages was converted into a z-score. The z-scores were then categorized and used as an index of language
dominance, with negative scores indicating dominance in the other language, positive scores pointing to dominance in Greek, and
scores which ranged above or below 0.5 SD from the mean indicating a balance between the two languages. This procedure was
followed for the home language history, current literacy and current language use measures. According to the analyses, more than
half of TD-Bi and ASD-Bi children appear as Greek dominant with respect to current language use and literacy input. The analyses of
home language history show more mixed results, since 8 TD-Bi and 8 ASD-Bi children were balanced, 5 TD-Bi and 6 ASD-Bi children
were Greek-dominant, and 6 TD-Bi and 7 ASD-Bi children were dominant in the other language.
2.2. Materials and procedure
All four groups of children completed the two language screening tests and three tasks in a single session, and in a fixed order:
expressive vocabulary and sentence repetition, an oral narrative task and two non-verbal EF tasks, namely, a visual attention global-
local task and a 2-back working memory task. Children were tested individually at school or in a quiet area of their home by the first
and second authors, who are trained to test children with language or affective disorders. Narratives were elicited in Greek, and were
audiotaped with a digital voice recorder for later transcription and coding. The EF tasks were run on a computer using E-Prime
software (Schneider, Eschman, & Zuccolotto, 2012). Data were collected between September 2014 and June 2015.
2.3. Language screening tasks
2.3.1. Expressive vocabulary task

Participants’ expressive vocabulary in Greek was measured with a picture naming test (Vogindroukas, Protopapas, & Sideridis,
2009; the Greek version was adapted from Renfrew, 1997). This task is normed for 3-to-10-year-old Greek-speaking monolingual
children, and includes 50 black-and-white pictures of common objects that each child was asked to name. Each correct answer earned
one point, with a maximum score of 50.
2.3.2. Sentence repetition task

The sentence repetition task was developed within the COST Action IS0804 (Chondrogianni, Davies, & Thomas, 2013). The Greek
version of the task includes 32 sentences distributed over 8 sets of syntactic structures of varying complexity; namely, Subject-Verb-
Object sentences, sentences containing factual and non-factual negation, structures with clitics in clitic left dislocation and clitic
doubling contexts, complement clauses, coordinated sentences, adverbial clauses, referential and non-referential object wh-questions,
and subject and object relative clauses. All sentences across the eight different structures were matched for length and word fre-
quency. Regarding scoring, we were mainly interested in investigating whether children’s utterances remained grammatical, but did
not discern between different errors committed in each clause. In order to measure grammaticality we used the 0–1 scale with a
maximum score of 32.
2.4. Narrative production task
Narratives were elicited using the Edmonton Narrative Norms Instrument (ENNI; Schneider, Dubé, & Hayward, 2005), which was
designed to collect language data from children aged 4–9 through storytelling. The story used to elicit narratives (telling) in the
5
present study was the three-main-character Giraffe/Elephant story from Set A, which consists of eight pictures and two complete
episodes. The pictures were placed in a binder with two pictures appearing on each page. A minimum of 15 verb clauses was a
prerequisite for including a narrative in our sample. Narrative length has been measured in number of verb clauses.
2.4.1. Procedure
First, the examiner showed each page in the binder to the child. After the child previewed each page she asked him/her “to tell the
story that the pictures made”.
2.4.2. Transcription and scoring of narratives

The children’s tellings were audiotaped and transcribed by the second author. One in four recordings (25 %) was randomly
selected to be re-transcribed by the first author for reliability purposes. Transcripts were then compared word-for-word, with the
comparison reaching 98 % agreement. They were then scored following the guidelines of the Multilingual Assessment Instrument for
Narratives tool (Gagarina et al., 2012), which was previously adapted into Greek and piloted among Greek-speaking monolingual and
bilingual children (Tsimpli et al., 2016). Both the microstructural and macrostructural properties of each child’s narrative were
coded.
For microstructure, the following scores were calculated: lexical diversity (i.e., number of content word types divided by the total
number of content word tokens); syntactic complexity (i.e., number of complex – coordinate and subordinate – sentences divided by
the total number of simple and complex sentences); subordination index (i.e., number of subordinate sentences divided by the total
number of complex sentences); and types of subordinate sentences (i.e., number of complement, relative and adverbial sentences
divided by the total number of subordinate sentences in each child’s narrative). Examples of complement, relative and adverbial
clauses in the ASD children’s narratives are provided in the examples 1–3 below:
(1) Complement clause
O navaγosostis ipe stin elefadina na kaθisi sto pagaki

the lifeguard saidPAST.3SG to-the elephant to sitPAST.3SG on-the bench
‘The lifeguard told the elephant to sit on the bench.’
(2) Relative clause
I elefadina ide kati pu kanume vuties

the elephant sawPAST.3SG something that doNON-PAST.3PL dives
‘The lifeguard saw something from which we dive.’
(3) Adverbial clause
Otan efije o navaγosostis pire afstiro ifos

when leftPAST.3SG the lifeguard tookNON-PAST.3SG strict look
‘When (he) left, the lifeguard looked stern.’
For macrostructure, the following scores were calculated:
Story structure complexity (Story Grammar Model; Stein & Glenn, 1979). Each of the two episodes in the story consisted of a Goal
for the Main Character (MC), an Attempt made by the MC to reach the goal, and the Outcome of the MC’s attempt to reach the goal.
The child was awarded 3 points per episode for the correct production of Goal, Attempt and Outcome; 2 points for producing two
elements, one being the Outcome, so either Goal and Outcome or Attempt and Outcome; 1 point for producing two elements but with
the Outcome missing (i.e., Goal and Attempt); and 0 points for expressing only one element. Finally, 2 points were also awarded for
correctly producing the Setting and the Time frame of the story, while 1 point was given for introducing each of the three characters
of the story. The maximum story structure complexity score for each child was 11.
Diversity in the use of Internal State Terms (ISTs). The specific category was split into two subcategories; namely, ISTs related to
ToM (henceforth, +ToM-related ISTs) and ISTs not related to ToM (henceforth, –ToM-related ISTs). More specifically, the first
category included lexical items that conveyed emotion (e.g., sad, happy, scared) and cognitive states referring to the characters’
thoughts, desires and beliefs (e.g., think, desire, want). On the other hand, linguistic (e.g., say, call, shout), perceptual (e.g., feel, hear,
smell) and physiological items (e.g., thirsty, hungry, tired) were characterized as –ToM-related ISTs, since they did not provide
insight into the story characters’ beliefs, thoughts and emotions. Both + ToM- and –ToM-related ISTs were calculated by dividing
each category by the total number of main clauses in each child’s narrative.
Referential ambiguity or the use of ambiguous pronouns. Ambiguous pronouns in the children’s narratives included null and
strong pronouns in syntactic subject position, as well as clitics in object position. Infelicitous (ambiguous) reference in the case of
strong subject pronouns and clitics was created in discourse environments wherein the critical pronoun was preceded by two
antecedents marked with the same gender feature, such that it was impossible for the comprehender to discover the exact referent of
the critical pronoun. Null pronouns in Greek, on the other hand, always appear in subject position; in the children’s narratives, null
subject pronouns were able to refer to either of the two preceding antecedents. Referential ambiguity was calculated by dividing the
number of ambiguous strong and null pronouns in the syntactic subject position, and clitics in the object position, by the total number
6
of pronouns produced in each child’s narrative. Examples of referentially ambiguous null pronouns, strong overt pronouns in subject
position and clitic pronouns are provided in the examples 4–6 below:
(4) Null subject pronouns
I kamiloparδali anakufistike pu i elefadina itan mia hara. Otan Ø efije, o babas pire afstiro ifos.
the giraffeNOM.SING.FEM was-relieved that the elephant-girlNOM.SING.FEM was fine. When Ø left the dad took strict look
‘The giraffe-girl relieved that the elephant-girl was fine. When (she) left, the dad looked stern.’
(5) Strong overt pronouns in Subject position
Ine o elefadas ke o kamiloparδalis ki aftos ehi astio lemo

is the elephantNOM.SING.MASC. and the giraffeNOM.SING.MASC and heNOM.SING.MASC. has funny neck
‘There is the elephant and the giraffe and he has a funny neck.’
(6) Clitic pronouns
I elefadina jlistrise ke i kamiloparδali pije mazi. O babas elefadas tin eδiokse.

the elephant-girlNOM.SING.FEM. slipped and the giraffeNOM.SING.FEM went along. The dad-elephantNOM.SING.MASC. herCL.ACC.SING.FEM.
set away
‘The elephant-girl slipped and the giraffe-girl went along. The dad-elephant sent her away’
Twenty-five percent of the transcribed narrative samples were randomly selected and independently scored by the first two
authors. The output was checked to identify instances of omissions or double coding. Collapsing across the microstructural and
macrostructural scoring, the percentage agreement mean (and range) for scoring the narrative samples was 97.8 % (96 %–100 %).
Differences between scorings were discussed, changes were made where necessary, and the adjusted scorings were used for statistical
analyses.
2.5. Executive function task: visual attention global-local task
2.5.1. Materials
The visual stimuli consisted of the big (global) shapes of circles, Xs, triangles and squares made up of smaller (local) shapes (i.e.,
small shapes inside much larger ones). The shapes were designed with the AutoCAD 2012 software and had perfect analogy (the scale
from global to local was 10:1, see Fig. 1). This task was modeled after Navon (1977).
2.5.2. Procedure
The children were asked to focus on a shape (circle, X, triangle or square) and report, as quickly and accurately as possible, the
number of lines needed to form the shape. The task included two separate blocks: in the global block, children were asked to identify
whether the big shape was a circle, an X, a triangle or a square, and to respond by pressing one of the four keys (‘1’, ‘2’, ‘3’ or ‘4’)
corresponding to the number of lines needed to form that shape. For the local block, the children were asked to focus on the local
shapes that made up the global figure, and to identify the number of lines needed to form the small shape by pressing one of the
response keys that they also used in the global block. Besides manipulating the children’s attention level (i.e., focusing on either the
global shape or the local shapes it was made up of), within-shape congruency was also manipulated. Specifically, in congruent trials,
Fig. 1. The set of shapes used in the global local switching task. The scale from global to local was 10:1.
7
global and local information was consistent (e.g., a big circle made up of smaller circles), while in incongruent trials, global and local
information was inconsistent (e.g., a big triangle made up of smaller Xs). The analyses in the current study were conducted using data
from global and local trials.
The children first pressed the space bar when a shape was displayed in the center of a white screen. The stimulus remained visible
until a response was given or the time granted for a response had elapsed (3000 msecs after the stimulus was displayed). Each block
consisted of 48 trials that were evenly divided into congruent and incongruent trials. The order of the stimuli presentation in each
block was randomized across the children. To avoid response bias, half of the children in each group were administered the ‘Global-
first’ version and the other half the ‘Local-first’ version of the task. Prior to each block, children viewed instructions on the screen that
indicated which level they had to attend to (global or local), and also received verbal feedback in case they needed more clarification
about the task. The instructions were followed by a 16-item practice session. Both RT and accuracy were recorded. Both blocks were
completed by each child in a single session that lasted approximately 10 min.
2.6. Executive function task: 2-back task
2.6.1. Materials
The children saw on the computer screen a sequence of digits (2, 5, 7, 8). The task contained a total of 20 to-be-responded-to
(target) digits with 60 total trials.
2.6.2. Procedure
The children were asked to remember if the digit they saw on the screen was the same as the one presented two positions back in
the sequence; if it was, they were instructed to press a pre-specified key (‘J’) with their index finger. No responses were required for
non-target digits. The children were familiarized with the task through a practice session of 20 trials. Each trial consisted of a black,
12mm-tall digit that was presented for 500 msecs, followed by a blank page for 2500 msecs, after which the next digit stimulus was
presented.
The 2-back task has been claimed to implicate a broad range of executive functions, including working memory, inhibition and
updating (Friedman & Miyake, 2004; Hasher, Chung, May, & Foong, 2002). Immediately following the initial activation of a new
digit, executive functions need to come into play to regulate the activation levels of the digits held in working memory. These
functions include both an excitatory mechanism that increases the activation of task-relevant information (i.e. a digit that also
appeared two positions back in the sequence) and an inhibitory mechanism that suppresses the activation of irrelevant information.
The type of inhibitory control that has been found to be beneficiary to performance in a 2-back task is deletion, i.e. the process
through which interfering digit information is cleared out from memory as soon as it can be identified as irrelevant. If the deletion
mechanism is intact, interference from competitor activation in previous trials will be decreased, thus, facilitating the recall of task-
relevant information.
2.6.3. Scoring
An accuracy composite score was computed for each child by calculating the percentage means of correct hits and false hits (i.e.,
by dividing the number of correct hits by the 20 target trials and the number of false hits by the 40 non-target trials, respectively) and
then by subtracting the percentage mean of false hits from the percentage mean of correct hits. Statistical analyses were conducted on
the composite accuracy scores and on the children’s RT for correct hits only.
2.7. Analysis plan
2.7.1. Participants’ clinical and demographic traits

Group differences in clinical and demographic variables were examined through one-way ANOVA analyses with ADI-R, PIQ and
SES scores as the dependent variables. Significant group effects were subsequently explored through post-hoc (Tukey) tests. The
demographic measures that produced significant differences between groups were subsequently used in the analyses of the narrative
and the EF tasks as covariates.
2.7.2. Language screening tasks

Group differences in language screening were examined through one-way ANOVA analyses with expressive vocabulary and
sentence repetition scores as the dependent variables. Significant group effects were subsequently explored through post-hoc (Tukey)
tests. The measures that produced significant differences between groups were used in the analyses of the narrative and EF tasks as
covariates.
2.7.3. Narrative production task

We conducted three analyses. In Analysis 1, we examined group differences in narrative length, which was measured by counting
verb clauses. Group differences were examined through a one-way ANOVA analysis with narrative length scores as the dependent
variable. Narrative length was intended to be included as covariate in the analyses of the narrative microstructural and macro-
structural measures if children with ASD produced shorter narratives than controls. In Analysis 2, we examined differences in mi-
crostructure between groups by clinical (TD, ASD) and language experience (monolingual, bilingual) profile, while controlling for the
children’s language ability traits. A two-way multivariate analysis of covariance (MANCOVA; Wilk’s F) was performed with
8
microstructural (i.e. lexical diversity, syntactic complexity, subordination index, frequencies of relative, adverbial and complement
clauses) measures as the dependent variables; Autism (TD, ASD) and Bilingualism (monolingual, bilingual) as the between-subjects
variables; and language ability scores ascovariates. Significant MANCOVA effects were subsequently analyzed using univariate
analysis of variance (ANOVA). In Analysis 3, we examined group differences in macrostructural measures (i.e. story structure, +ToM,
-ToM, referential ambiguity) following the design of Analysis 2.
2.7.4. Visual attention global-local task

We conducted three analyses (adapted from Guy, Mottron, Berthiaume, and Bertone (2016) methodological design). In Analysis 1,
we ran bivariate Pearson correlations between RT and accuracy scores in the global and local trials to exclude the possibility that
children’s performances were due to a trade-off between processing cost (fast vs. slow RT) and accuracy (low vs. high). In Analysis 2,
we examined group differences in RT and accuracy scores in the global and local trials of the task without considering the effects of
stimulus congruency, and thereby, interference. Measures of RT and accuracy in both global and local conditions were collapsed
across congruent and incongruent shapes. A two-way multivariate analysis of covariance (MANCOVA; Wilk’s F) was subsequently
performed with RT and accuracy in the global and local trials as the dependent variables; Autism (TD, ASD) and Bilingualism
(monolingual, bilingual) as the between-subjects variables; and language ability scores as covariates. Significant MANCOVA effects
were subsequently analyzed using univariate analysis of variance (ANOVA) and post-hoc (Tukey) comparisons when appropriate.
In Analysis 3, we examined group differences in RT and accuracy scores in trials that contained conflicting information and thus
interference. Interference effects were calculated in trials where participants had to attend to global shapes consisting of local
incongruent shapes (Local-to-global interference) and trials where participants had to attend to local shapes making up an incongruent
global shape (Global-to-local interference). For the RT measure, the Global-to-local and local-to-global interference effects were
computed by subtracting incongruent local RT from congruent local RT, and incongruent global RT from congruent global RT,
respectively. This procedure essentially standardizes RT across groups and individuals, allowing baseline discrepancies between RT to
be eliminated and interference effects to be clearly identified without being masked by inter-subject variability. For the accuracy
measure, the Global-to-local interference effect was computed by subtracting the accuracy rates (%) of the local incongruent trials
from the accuracy rates of the local congruent trials, and dividing the subtraction score by the accuracy rates of the local congruent
trials. On the other hand, the local-to-global interference effect was computed by subtracting the accuracy rates of the global in-
congruent trials from the accuracy rates of the global congruent trials, and dividing the subtraction score by the accuracy rates of the
global congruent trials. A two-way multivariate analysis of covariance (MANCOVA; Wilk’s F) was subsequently performed with
Global-to-local and local-to-global interference effects in both RT and accuracy as the dependent measures; Autism (TD, ASD) and
Bilingualism (monolingual, bilingual) as the between-subjects variables; and language ability scores as covariates. Significant
MANCOVA effects were subsequently analyzed using univariate analysis of variance (ANOVA) and post-hoc (Tukey) comparisons
when appropriate.
2.7.5. 2-Back task

We conducted two analyses. In Analysis 1, bivariate Pearson correlations were conducted between RT and accuracy scores in each
group to exclude the possibility that children’s performances were influenced by trade-off effects. In Analysis 2, group differences
were examined through a one-way ANCOVA analysis with RT on accuracy composite scores as the dependent variable and Group
(TD-Mono, TD-Bi, ASD-Mono, ASD-Bi) as the between-subjects factor, also controlling for the covariance of language ability scores.
2.7.6. Correlations between narrative and executive function measures

Partial correlation analyses investigated possible associations between each group’s scores in narrative microstructure (i.e. lexical
diversity, syntactic complexity, subordination index, frequencies of relative, adverbial, and complement clauses) and macrostructure
(i.e. story structure complexity, ± ToM-related ISTs, proportions of referential ambiguity), and scores in the global-local and 2-back
task, while controlling for expressive vocabulary and sentence repetition (see Supplementary Tables 1–8).
The analyses across tasks were conducted using the SPSS for Windows software, version 11.0, and the statistical significance level
was set at p ≤ .05.
3. Results
3.1. Participants’ clinical and demographic traits
One-way analyses of variance (ANOVA) on ASD children’s scores in each of the three domains of the ADI-R revealed a statistically
significant difference in reciprocal social interaction between the two groups with ASD, F (1, 39) = 5.193, p = .028, η2 = 0.12,
which stemmed from the fact that the ASD-Bi children scored significantly lower than their ASD-Mono peers. There was no statis-
tically significant difference between the monolingual and bilingual groups with ASD on communication abnormalities, F (1, 39) =
2.323, p = .136, η2 = 0.06, or on stereotypical behaviors, F (1, 39) = .487, p = .489, η2 = 0.02. Furthermore, a one-way ANOVA
analysis on PIQ scores showed no significant differences across groups, F (3, 79) = 1.664, p = .182, η2 = 0.248. There was no
significant group effect in SES, F (3, 79) = 2.004, p = .120, η2 = 0.07 (see Table 1).
9
3.2. Language screening tasks
The groups differed significantly in their expressive vocabulary ability, F (3, 79) = 10.261, p < .001, η2 = 0.54. Subsequent post-
hoc Tukey tests indicated that this difference stemmed from bilingual children’s significantly lower expressive vocabulary scores than
their monolingual peers (difference between ASD-Mono and ASD-Bi children: p < 0.001; difference between TD-Mono and TD-Bi
children: p = 0.003).
The analysis also revealed a significant group effect in sentence repetition, F (3, 79) = 29.820, p < .001, η2 = 0.54, which was
attributed to the fact that ASD-Mono and ASD-Bi children produced fewer grammatical sentences than their TD-Mono and TD-Bi
peers, respectively; also, ASD-Bi children scored significantly lower than ASD-Mono children (p < 0.001 for all comparisons). There
was no significant difference between TD-Mono and TD-Bi children (p = 0.366) (see also Meir & Novogrodsky, 2019a for similar
findings).
In order to capture heterogeneity in the language skills of the children with ASD, we identified the number of children whose
expressive vocabulary and sentence repetition scores were 1.5 or more standard deviations (SD) below the mean (Falcaro et al., 2007;
Marton & Schwartz, 2003; Norbury et al., 2014; Peristeri et al., 2017; Reilly, Losh, Bellugic, & Wulfeck, 2004). Three children from
the ASD-Mono group met the cutoff for expressive vocabulary, while 17 children from the ASD-Mono and 15 children from the ASD-
Bi group met the cutoff for sentence repetition. The TD children had scores that fell within the average range on both the expressive
vocabulary and the sentence repetition task.
3.3. Narrative production task
3.3.1. Analysis 1: narrative length

The four groups were comparable in terms of the length of their narratives, F (3, 79) = .402, p = 0.752, η2 = 0.12 (TD-Mono;
mean: 21.9 (SD: 4.0), range: 16–33; TD-Bi; mean: 21.6 (SD: 4.9), range: 15–30; ASD-Mono; mean: 20.7 (SD: 3.8), range: 15–31; ASD-
Bi; mean: 22.2 (SD: 5.2), range: 15–33).
3.3.2. Analysis 2: narrative microstructure

Table 2 provides descriptive statistics for the microstructural measures, including lexical diversity, syntactic complexity, sub-
ordination index and the three types of subordinate clauses (i.e. relative, adverbial, complement) (all measures appear in percen-
tages).
The MANCOVA analysis revealed significant effects for Autism, F (1, 74) = 8.184, p < 0.001, ηp2 = .56, and Bilingualism, F (1,
74) = 5.645, p < 0 < 0.001, ηp2 = .47, as well as a significant Autism × Bilingualism interaction effect, F (1, 74) = 4.212,
p < 0.001, ηp2 = .40, even after controlling for expressive vocabulary, F (1, 74) = 3.309, p = 0.006, ηp2 = .23, and sentence
repetition, F (1, 74) = .384, p = 0.887, ηp2 = .03. The follow-up univariate analyses for the Autism effect yielded a significant
difference between TD children and children with ASD on lexical diversity, syntactic complexity, subordination index, use of relative
clauses and complement clauses (see Table 3). TD children had significantly lower scores than children with ASD on lexical diversity
(p < 0.001) and complement clauses (p = 0.009), while children with ASD had significantly lower scores than their TD peers on
syntactic complexity (p = 0.013), subordination (p = 0.023), and relative clauses (p = 0.016). Expressive vocabulary was found to
significantly co-vary with lexical diversity only (p < 0.001). Univariate analyses for the Bilingualism effect yielded significant dif-
ferences between monolingual and bilingual children on the subordination index, the use of adverbial and complement clauses.
Bilingual children had significantly higher scores than their monolingual peers in subordination and adverbials (p < 0.001 for both
differences). On the other hand, bilingual children scored significantly lower than monolinguals in the use of complement clauses (p
= 0.002). The Autism × Bilingualism interaction effect was observed on the use of adverbials and complement clauses. Independent
samples t-tests revealed that bilingual children with ASD had significantly higher scores than monolingual children with ASD on
adverbial clauses, t (38) = 7.619, p < 0.001, while the reverse pattern was shown for the use of complement clauses, t (38) = 6.355,
p < 0.001.
Table 2
Groups’ Mean Scores (and SDs) on Microstructural Variables.
Microstructural measures TD-Mono (N = 20) M (SD) TD-Bi (N = 20) M (SD) ASD-Mono (N = 20) M (SD) ASD-Bi (N = 20) M (SD)
Lexical diversity (%) 44.4 (20.2) 37.8 (22.4) 59.3 (6.7) 65.0 (11.1)
Syntactic complexity (%) 59.5 (18.8) 60.3 (23.0) 53.0 (16.2) 52.5 (18.1)
Subordination index (%) 56.5 (18.4) 70.2 (16.7) 36.8 (14.4) 60.2 (22.4)
Types of subordinates
Relative (%) 25.8 (13.1) 24.3 (21.2) 14.9 (15.8) 11.0 (17.1)
Adverbial (%) 35.9 (13.7) 43.6 (15.7) 16.3 (16.4) 60.6 (20.1)
Complement (%) 38.3 (19.4) 32.1 (22.5) 68.8 (17.0) 28.4 (22.8)
Autism Spectrum Disorder; ASD-Bi: bilingual children with Autism Spectrum Disorder.
10
E. Peristeri, et al.
Table 3
Autism, Bilingualism and Autism x Bilingualism interaction effects on narrative microstructure, after controlling for expressive vocabulary and sentence repetition scores (Analysis 2).
Autism Bilingualism Autism x Bilingualism Expressive vocabulary Sentence repetition
Dependent measures in ANCOVAs df F- value p-value ηp2 F- value p-value ηp2 F- value p-value ηp2 F- value p-value ηp2 F- value p-value ηp2
Lexical diversity 1 13.650 < .001*** .16 1.993 .162 .03 .802 .374 .01 16.497 < .001*** .18 1.296 .259 .02
Syntactic complexity 1 6.473 .013* .08 1.176 .282 .01 2.526 .116 .03 .367 .546 .01 1.077 .303 .02
Subordination index 1 5.357 .023* .07 14.964 < .001*** .17 1.008 .319 .01 .166 .685 .00 .200 .656 .00
11
Relative 1 6.126 .016* .08 .733 .395 .01 .153 .697 .00 .085 .771 .00 .528 .470 .01
Adverbial 1 .127 .723 .00 20.111 < .001*** .22 12.115 .001** .14 1.322 .254 .02 .068 .795 .00
Complement 1 7.259 .009* .09 10.057 .002** .12 12.257 .001** .14 .984 .324 .01 .632 .429 .01
Error 74
*** Significant at the < 0.001 level.

** Significant at the < 0.005 level.
* Significant at the < 0.05 level.
Table 4
Groups’ Mean Scores (and SDs) on Macrostructural Variables.
Macrostructural measures TD-Mono (N = 20) M TD-Bi (N = 20) M ASD-Mono (N = 20) M ASD-Bi (N = 20) M (SD)
(SD) (SD) (SD)
Story structure (total score; maximum score 11) 8.5 (2.6) 9.2 (2.5) 5.0 (2.5) 7.6 (1.8)
ISTs
+ToM (%) 18.0 (9.1) 24.5 (8.4) 18.1 (6.5) 25.4 (16.1)
–ToM (%) 21.7 (9.8) 23.1 (16.5) 22.8 (10.4) 19.8 (10.3)
Referential ambiguity (%) 29.5 (15.6) 30.9 (16.6) 58.5 (20.9) 36.0 (13.4)
Autism Spectrum Disorder; ASD-Bi: bilingual children with Autism Spectrum Disorder; IST: Internal State Terms; +ToM: internal state terms related
to ToM; –ToM: internal state terms not related to ToM.
3.3.3. Analysis 3: narrative macrostructure

Table 4 provides descriptive statistics for the macrostructural measures, including the total scores of story structure complexity,
percentages of ± ToM-related ISTs, and proportions of referential ambiguity.
The MANCOVA analysis revealed significant effects for Autism, F (1, 74) = 5.717, p < 0.001, ηp2 = .25, and Bilingualism, F (1,
74) = 3.740, p = 0.008, ηp2 = .18, as well as a significant Autism × Bilingualism interaction effect, F (1, 74) = 2.893, p = 0.028, ηp2
= .14, even after controlling for expressive vocabulary, F (1, 74) = 2.330, p = 0.064, ηp2 = .11, and sentence repetition, F (1, 74) =
.621, p = 0.649, ηp2 = .03. The follow-up univariate analyses for the Autism effect yielded a significant difference between TD
children and children with ASD on story structure complexity and referential ambiguity (see Table 5). TD children had significantly
higher story structure complexity (p = 0.004) and fewer referentially ambiguous pronouns (p = 0.024) than children with ASD.
Univariate analyses for the Bilingualism effect yielded significant differences between monolingual and bilingual children on story
structure complexity and +ToM-related terms. Bilingual children had significantly higher scores than their monolingual peers in
both measures (p = 0.020 and p = 0.004, respectively). Expressive vocabulary significantly co-varied with the use of –ToM terms (p
= 0.005). The Autism × Bilingualism type interaction effect was observed on referential ambiguity scores, while the interaction
effect on story structure complexity was reduced to a trend level. Independent samples t-tests revealed that bilingual children with
ASD had significantly higher scores than monolingual children with ASD on story structure complexity, t (38) = 3.695, p = 0.001,
while the reverse pattern was shown for referential ambiguity, t (38) = 3.063, p = 0.004. The differences between TD monolingual
and bilingual children in the above measures were not statistically significant (p > 0.327).
3.4. Summary
Overall, the analyses revealed a significant difference between bilingual and monolingual children with ASD on the macro-
structural measure of referential ambiguity; bilingual children with ASD were more efficient at mapping referents onto pronouns in a
pragmatically unambiguous manner relative to their monolingual peers with ASD. The marginal effect for story structure complexity
provides support for the idea that bilingual children with ASD were more efficient than their monolingual peers at encoding event
relations in the story, yet, we should be cautious when interpreting the specific finding. Considering microstructure, most measures
were found to be affected by both autism and bilingualism; more specifically, lexical diversity was found to be enhanced by autism,
while rates of subordination were boosted by bilingualism but were negatively affected by the autism spectrum effect.
Table 5
Autism, Bilingualism and Autism x Bilingualism interaction effects on narrative macrostructure, after controlling for expressive vocabulary and
sentence repetition scores (Analysis 3).
Dependent df F- value p-value ηp2 F- value p-value ηp2 F- value p-value ηp2 F- value p-value ηp 2
F- value p-value ηp2
measures in
ANCOVAs
Story structure 1 9.101 .004** .11 5.671 .020* .07 3.080 .06 .05 .297 .587 .00 .376 .542 .00
+ToM 1 .906 .344 .01 8.725 .004** .11 .035 .852 .00 1.212 .275 .02 .441 .509 .01
-ToM 1 2.136 .148 .03 .643 .425 .01 .910 .340 .01 8.439 .005* .10 1.856 .177 .03
Referential 1 5.282 .024* .07 1.558 .216 .02 5.220 .025* .07 .148 .702 .00 .005 .944 .00
ambiguity
Error 74

12
Table 6
Mean RT and accuracy scores in the global and local trials collapsing over the congruency factor, and global-to-local and local-to-global interference
effects in RT and accuracy.
Attention level TD-Mono (N = 20) M (SD) TD-Bi (N = 20) M (SD) ASD-Mono (N = 20) M (SD) ASD-Bi (N = 20) M (SD)
RT Accuracy RT Accuracy RT Accuracy RT Accuracy
Global 1281 (234) 97.8 (2.6) 1328 (369) 97.1 (3.1) 2018 (445) 81.3 (8.1) 1125 (174) 97.9 (5.5)
Local 1510 (317) 94.9 (7.7) 1523 (387) 93.7 (4.2) 1677 (371) 96.3 (2.6) 1288 (239) 95.7 (8.5)
Global-to-local interference 188 (156) 3.2 (3.6) 106 (226) 4.0 (3.2) 142 (182) −1.2 (7.8) 169 (202) 3.4 (4.5)
Local-to-global interference 210 (192) 2.7 (4.6) 192 (235) 4.1 (5.7) 341 (287) 12.4 (8.9) 119 (213) 2.7 (7.0)
Autism Spectrum Disorders; ASD-Bi: bilingual children with Autism Spectrum Disorders; RT: reaction times (in msecs).
3.5. Executive function task: visual attention global-local task
Table 6 provides descriptive statistics for the groups’ mean RT and accuracy scores in the global and local trials, collapsing across
congruent and incongruent trials, as well as the groups’ global-to-local and local-to-global interference effects in RT and accuracy. RT
more than 2 SD above or below the mean of each condition were identified as outliers and were removed.
3.5.1. Analysis 1: bivariate Pearson correlations

RT in the global and local condition did not correlate significantly with accuracy for ASD-Mono (r (20) = −0.103, p = .666 and r
(20) = −0.373, p = 0.105, for the global and local condition, respectively) and ASD-Bi children (r (20) = −0.342, p = .140 and r
(20) = 0.264, p = 0.261, for the global and local condition, respectively). The same pattern was observed for the TD-Mono (r (20) =
−0.180, p = 0.448 and r (20) = 0.138, p = 0.561, for the global and local condition, respectively) and TD-Bi group (r (20) = 0.335
p = 0.149 and r (20) = 0.324, p = 0.164, for the global and local condition, respectively). The overall results indicate that the
groups’ performance in the global-local task did not stem from speed-accuracy trade-off effects.
3.5.2. Analysis 2: No-Interference contexts

The MANCOVA analysis revealed significant effects of Autism, F (1, 74) = 4.478, p = 0.003, ηp2 = .20, and Bilingualism, F (1,
74) = 4.981, p = 0.001, ηp2 = .22, as well as a significant Autism × Bilingualism interaction effect, F (1, 74) = 9.476, p < 0.001, ηp2
= .35, even after controlling for expressive vocabulary, F (1, 74) = 2.240, p = 0.302, ηp2 = .07, and sentence repetition, F (1, 74) =
2.772, p = 0.034, ηp2 = .14. Follow-up univariate analyses for the Autism effect yielded a significant difference between TD children
and children with ASD on accuracy in global trials (see Table 7). TD children were more accurate (p = 0.011) than children with ASD
in global trials. Univariate analyses for the Bilingualism effect yielded significant differences between monolingual and bilingual
children on global trials in both RT and accuracy. Bilingual children were significantly faster (p = 0.003) and more accurate (p =
0.015) than monolingual children in global trials. Sentence repetition was found to significantly co-vary with RT and accuracy in the
local trials of the task (p = 0.046 and p = 0.043, respectively). Likewise, the Autism × Bilingualism interaction effect was observed
on global trials in both RT and accuracy. Independent samples t-tests revealed that bilingual children with ASD were significantly
faster, t (38) = 3.940, p < 0.001, and more accurate, t (38) = 2.238, p = 0.031, than monolingual children with ASD on global trials.
The differences between TD monolingual and bilingual children in the above measures were not statistically significant (p > 0.269).
3.5.3. Analysis 3: interference contexts

The MANCOVA analysis revealed significant effects of Autism, F (1, 74) = 4.896, p = 0.043, ηp2 = .12, and a significant Autism
Table 7
Autism, Bilingualism and Autism x Bilingualism interaction effects on accuracy and RT in the global and local trials, after controlling for expressive
vocabulary and sentence repetition scores (Analysis 2).
zz Autism Bilingualism Autism x Bilingualism Expressive vocabulary Sentence repetition
Dependent df F- value p-value ηp2 F- value p-value ηp2 F- value p-value ηp2 F- value p-value ηp 2
F- value p-value ηp2
measures in
ANCOVAs
Global (RT) 1 .346 .558 .00 9.379 .003** .12 19.858 < .001*** .22 .735 .394 .01 2.495 .119 .03
Local (RT) 1 2.528 .116 .03 1.113 .295 .02 3.895 .056 .05 3.634 .06 .04 4.123 .046* .05
Global (Accuracy) 1 6.781 .011* .09 6.155 .015* .08 16.029 < .001*** .18 .217 .642 .00 .017 .896 .00
Local (Accuracy) 1 .477 .492 .01 .984 .325 .01 .244 .623 .00 .107 .744 .00 4.225 .043* .06
Error 74

13
E. Peristeri, et al.
Table 8
Autism, Bilingualism and Autism x Bilingualism interaction effects on the Global-to-local and local-to-global interference effects, after controlling for expressive vocabulary and sentence repetition scores
(Analysis 3).
2 2 2 2
Dependent measures in ANCOVAs df F- value p-value ηp F- value p-value ηp F- value p-value ηp F- value p-value ηp F- value p-value ηp2
Global-to-local (RT) 1 .000 .996 .00 .315 .577 .00 .841 .362 .01 .669 .416 .01 1.796 .184 .02
14
Local-to-global (RT) 1 .023 .880 .00 .932 .337 .01 .586 .446 .01 .039 .844 .00 .838 .363 .01
Global-to-local (Accuracy) 1 1.369 .246 .02 .662 .418 .01 4.185 .044* .05 .032 .859 .00 .069 .793 .00
Local-to-global (Accuracy) 1 6.981 .01* .19 1.185 .215 .02 4.249 .04* .10 .034 .854 .00 3.314 .073 .04
Error 74

Table 9
Groups’ Mean Accuracy scores and RT on correct responses (and SDs) per group in the 2-back task.
TD-Mono (N = 20) M (SD) TD-Bi (N = 20) M (SD) ASD-Mono (N = 20) M (SD) ASD-Bi (N = 20) M (SD)
Accuracy (correct hits minus false hits) 14.8 (13.1) 22.2 (15.4) 17.3 (14.3) 31.5 (18.0)
RT on correct hits 373 (46.2) 385 (63.2) 383 (53.9) 342 (42.0)
Autism Spectrum Disorder; ASD-Bi: bilingual children with Autism Spectrum Disorder.
× Bilingualism interaction effect, F (1, 74) = 4.748, p = 0.045, ηp2 = .12, even after controlling for expressive vocabulary, F (1, 74)
= 0.186, p = 0.945, ηp2 = .01, and sentence repetition, F (1, 74) = 1.304, p = 0.277, ηp2 = .07. The effect of Bilingualism was not
found to be significant, F (1, 74) = 1.286, p = 0.284, ηp2 = .07. Follow-up univariate analyses for the Autism effect yielded a
significant difference between TD children and children with ASD on the Local-to-global interference effect in accuracy (see Table 8).
Children with ASD exhibited higher local-to-global interference scores than TD children (p = 0.01). The Autism × Bilingualism
interaction effect was observed on both Local-to-global and Global-to-local interference accuracy data. Independent samples t-tests
revealed that monolingual children with ASD had significantly higher local-to-global scores than bilingual children with ASD, t (38)
= 2.137, p = 0.045, while bilingual children with ASD had significantly higher global-to-local scores than monolingual children with
ASD, t (38) = 2.141, p = 0.039. The differences between TD monolingual and bilingual children in the above measures were not
statistically significant (p > 0.399).
The results confirmed our hypothesis that bilingualism would affect the performance of children with ASD. Specifically, bilingual
children with ASD were faster and more accurate than their monolingual peers with ASD in global trials. Crucially, the results in the
‘Interference’ condition also revealed differences between the attentional biases exhibited by each group, since bilingual children
with ASD experienced less interference from local processing biases than their monolingual peers with ASD.
3.6. Executive function task: 2-back task
The results confirmed our hypothesis that bilingual children with ASD would outperform their monolingual peers with ASD.
Bilingual ASD children’s performance differed from their monolingual peers in both accuracy and speed of responses.
Table 9 presents the mean RT on correct responses, and the accuracy rates (i.e., the composite raw score of the number of correct
hits minus the number of false hits) per group. Reaction times more than 2 SD below or above the mean were identified as outliers
and were removed.
3.6.1. Analysis 1: bivariate Pearson correlations

The analyses indicated no significant correlations for either group (r (20) = -0.376, p = 0.103 for ASD-Mono, r (20) = 0.007, p =
0.978 for ASD-Bi, r (20) = 0.376, p = 0.103 for TD-Mono, and r (20) = -0.045, p = 0.849 for TD-Bi children).
3.6.2. Analysis 2: Group differences in RT and accuracy

There was a significant main effect of Group on RT, F (1, 74) = 2.542, p = 0.05, ηp2 = .10, stemming from the fact that the ASD-
Bi group was marginally significantly faster than both TD-Bi and ASD-Mono children (p = 0.06). Considering accuracy, there was a
significant effect of Group, F (1, 74) = 5.812, p = 0.018, ηp2 = .09, which was due to the fact that ASD-Bi children were significantly
more accurate than both TD-Mono (p = 0.012) and ASD-Mono children (p = 0.034); also, TD-Bi children were significantly more
accurate than their TD monolingual peers (p = 0.047). Sentence repetition, F (1, 74) = 6.131, p = 0.016, ηp2 = .08, was found to
significantly co-vary with accuracy in the 2-back task.
3.6.3. Summary of executive function tasks

The overall results provide evidence for bilingualism effects in ASD on both EF tests. Bilingual children with ASD performed faster
in global trials and experienced less interference from local stimuli in the global trials of the global-local task. In the 2-back task,
bilingual children with ASD showed higher accuracy and faster responses on correct hits than the other groups.
3.7. Correlations between narrative and executive function measures
Supplementary Tables 1–8 (see Supplementary Material) display each group’s results of the partial correlation analyses, which
focused on the exploration of possible associations between the children’s scores in narrative microstructure (i.e. lexical diversity,
syntactic complexity, subordination index, types of subordination, i.e. relative, adverbial, complement clauses) and macrostructure
(i.e. story structure complexity, ± ToM-related ISTs, proportions of referential ambiguity), and scores in the global-local and 2-back
task, while controlling for expressive vocabulary and sentence repetition.
The results of the partial correlation analyses show that attention cues were mostly relevant for microstructural rather than
macrostructural measures, and for TD-Mono, TD-Bi and ASD-Bi, but not ASD-Mono children. Regarding microstructure, lexical di-
versity was found to correlate positively with local attention biases for TD-Mono children (see Supplementary Table 1), and with both
local and global attention biases for TD-Bi children (see Supplementary Table 2), while inversely correlating with global attention
15
cues for ASD-Bi children (see Supplementary Table 4). Syntactic complexity positively correlated with local cues and inversely
correlated with global cues for TD-Mono children (see Supplementary Table 1), while positively correlating with both global and
local cues for the TD-Bi group (see Supplementary Table 2). Subordination positively correlated with global attention cues for
bilingual children with and without ASD (see Supplementary Tables 2 and 4). Relative clauses inversely correlated with global
attention for TD-Mono, TD-Bi and ASD-Bi children (see Supplementary Tables 1,2 and 4, respectively). Adverbial clauses positively
correlated with local attention for the TD-Mono group (see Supplementary Table 1), while correlating with global attention for TD-Bi
and ASD-Bi children (see Supplementary Tables 2 and 4, respectively). Complement clauses inversely correlated with local attention
for both TD groups (see Supplementary Tables 1 and 2), and positively correlated with global attention for the ASD-Bi group (see
Supplementary Table 4). Regarding macrostructure, story structure complexity inversely correlated with local attention for both TD
groups and ASD-Bi children (see Supplementary Tables 5,6 and 8, respectively), while inversely correlating with global attention for
ASD-Mono children (see Supplementary Table 7). Finally, +ToM-related terms correlated positively and negatively with global and
local attention, respectively, for the TD-Bi group (see Supplementary Table 6).
Crucially, correlations between narrative measures and the 2-back task were only found for bilingual children with and without
autism (see Supplementary Tables 2 and 4 for microstructure; Supplementary Tables 6 and 8 for macrostructure); specifically, RT in
the 2-back task inversely correlated with subordination, relative, adverbial clauses and referential ambiguity across both groups,
while accuracy in the same task positively correlated with the use of –ToM-related terms. Also, accuracy in the 2-back task positively
correlated with lexical diversity and + ToM-related terms for TD-Bi children, and with adverbials and + ToM-related terms for the
ASD-Bi group.
4. Discussion
This study set out to contribute to the investigation of narrative telling performance and non-verbal EF skills among 7-to-12-year-
old bilingual children with ASD, along with age-matched monolingual children with ASD and two groups of TD monolingual and
bilingual children. The research investigated the following specific questions: (a) Will bilingual children with ASD outperform their
monolingual peers with ASD in narrative performance, and will microstructural and macrostructural narrative properties be affected
by bilingualism to an equal extent? (b) Will the EF performance of bilingual children with ASD differ from monolingual children with
ASD? (c) Will EF skills be associated with the narrative performance of monolingual and bilingual children with ASD? Will the
relation between executive functions and narrative performance be dissociable across the two groups with ASD?
4.1. Bilingualism effects in macrostructural aspects of children with ASD
Our first research hypothesis proposed that bilingual children with ASD would achieve higher scores than their monolingual peers
with ASD in the macrostructural rather than microstructural aspects of narrative production. Our prediction was not fully verified,
since bilingualism effects were evident at both the microstructural and macrostructural level of narrative analysis.
More specifically, at the macrostructural level, the bilingual children with ASD achieved marginally higher scores in story
structure complexity and produced significantly fewer referentially ambiguous expressions than the monolingual children with ASD.
Narrative is a useful linguistic manifestation of one’s ability to establish global coherence over the events of a story, as an effective
narrator has to relate the various events to each other (Rumpf, Kamp-Becker, Becker, & Kauschke, 2012), but also needs to consider
how the story characters’ motives lead to actions producing consequences that transcend the boundaries of local events (Stein &
Glenn, 1979). It seems that bilingualism enhanced ASD children’s ability to establish connections between the story elements
(character, setting, initiating event, attempts, complications, consequences), thereby creating continuity across the episodes. Much
research has indicated that story structure complexity is particularly vulnerable in autism, with children's narratives being dis-
organized, and often missing key information relating to the characters’ goals and motivations (Capps et al., 2000; King, Dockrell, &
Stuart, 2013; Norbury et al., 2014). These findings seem to be validated by the current study, as the ASD-Mono group exhibited the
lowest story structure complexity score among the experimental groups. Crucially, the results of the correlation analyses provide
evidence that the ASD-Mono children's narrative structure was affected by distinct attentional biases relative to the rest of the groups.
Specifically, while story structure complexity was significantly negatively and positively correlated with local and global attention,
respectively for ASD-Bi, TD-Mono and TD-Bi children, it inversely correlated with global attention for the ASD-Mono group only. This
suggests that episodic structure for the ASD-Mono group was likely affected by bottom-up attentional processes. On the other hand,
story framing among bilingual children with ASD and TD children was rather affected by an interplay of bottom-up and top-down
attention cues, leading to greater efficiency in encoding links between the events and the characters’ perspectives. Nevertheless, the
fact that the Autism by Bilingualism interaction showed only a trend for story structure complexity confirms the need for cautious
interpretation of the particular finding.
Macrostructural differences between ASD-Mono and ASD-Bi children also included the use of referentially ambiguous forms,
which is a useful metric for evaluating the use of common-ground principles in autism; i.e., whether children consider the perspective
of the listener when making linguistic choices (de Marchena & Eigsti, 2016; Novogrodsky & Edelson, 2016). Bilingual children with
ASD produced significantly fewer ambiguous referential expressions than their monolingual peers; in fact, more than half of the
monolingual ASD children’s referential expressions were ambiguous. The group effect implies that ASD-Bi children were more
sensitive to the listener’s perceived knowledge of the story, adjusting the information density of their referential expressions to a level
that they expected their addressee to be able to process. Past research has provided mixed evidence on the nature and extent of
reference use difficulty in ASD, with some narrative studies showing that the referential form choices of children with ASD are subject
16
to the same discourse constraints that guide TD children’s referential choices (Arnold et al., 2008; Mäkinen et al., 2014; Meir &
Novogrodsky, 2019b; Terzi, Zafeiri, Marinis, & Francis, 2017), and others showing high rates of ambiguous pronoun use in oral
production (e.g., Baldimtsi et al., 2016; Novogrodsky, 2013; Novogrodsky & Edelson, 2016). In fact, Terzi et al. (2017) found no
group difference in the use of referentially felicitous and infelicitous clitic pronouns in the narratives of Greek-speaking, kindergarten
children with ASD and age- and verbally-matched TD children. While the use of referentially inappropriate discursive forms in autism
has been linked to children’s difficulty identifying the saliency of referents and possible changes in their discourse status (e.g., de
Marchena & Eigsti, 2016; Peristeri & Tsimpli, 2020; Terzi, Marinis, & Francis, 2016), the exact nature of the deficit and the cause of
the wide variability across studies remain open questions. Note that the groups did not differ in their general cognitive skills (i.e.,
PIQ); also, their language ability (i.e., expressive vocabulary and sentence repetition) was controlled for in the current analyses and
did not significantly influence group effects in referential ambiguity scores. This suggests that general cognitive and formal language
skills were not sufficient to account for group differences in referential ambiguity scores. The significant correlations between the 2-
back task and ambiguous reference in the current study likely mark EF skills as an important factor contributing to bilingual ASD
children’s low rates of referentially ambiguous forms. The rates of ambiguous pronouns inversely correlated with RT in the 2-back
task for TD-Bi and ASD-Bi children only, suggesting that bilingual children’s updating skills likely enhanced their ability to make
appropriate pronoun-referent mapping choices. The present findings are consistent with the majority of studies (de Marchena &
Eigsti, 2016; Diehl et al., 2006; Norbury & Bishop, 2003; Novogrodsky & Edelson, 2016), demonstrating that pragmatic deficits
during narratives and discourse, including reference use, extend beyond impairments in formal language skills to include domain-
general cognitive skills. We speculate that the conflicting results between our study and Terzi et al. (2017) study stem from the fact
that the children in the latter study were much younger than ours. Reference use in autism seems to be impacted by children’s
domain-general updating abilities, and ASD-Bi (but not ASD-Mono) children exhibited an updating cost for the use of referentially
unambiguous pronouns. If updating the discourse model with presupposed information declines with age in autism (Happé &
Charlton, 2012), this may partially account for the variation in the data obtained from monolingual children with ASD across the two
studies. Of course, it is possible that other steps besides monitoring and updating the listener’s discourse model were involved in
children’s choices of referential forms. However, the association between the 2-back and the ambiguous reference measure provides
evidence that EF were more broadly implicated in bilingual (versus monolingual) children’s effort to accommodate the listener’s
perspective while telling a story.
4.2. Bilingualism effects in microstructural aspects of children with ASD
Differences between ASD-Mono and ASD-Bi children were also found at the microstructural level of narrative analysis. More
specifically, evidence drawn from subordinate syntax use revealed that ASD-Bi children’s production of adverbial clauses was sig-
nificantly higher than that of ASD-Mono children, while rates of complement clauses were considerably lower. Note that the over-
whelming majority of complement clauses contained communication verbs and referred to dialogues between the story’s MCs. The
reader is also reminded that the overwhelming majority of the children comprising both groups with ASD suffered from a syntactic
deficit, as their performance in the sentence repetition screening task was below the cutoff score for grammaticality of sentences (see
Table 1). Also, though the subordination index of ASD-Mono children’s tellings was lower than that of ASD-Bi children, the difference
between the two groups was not found to be significant when language was controlled for, suggesting ostensibly comparable lan-
guage impairment levels across both groups with ASD. One possible explanation for this finding is that children with ASD tend to
exhibit a delay in language skills development, with more complex aspects of grammar being acquired during school-age years
(Luyster, Lopez, & Lord, 2007; Tager-Flusberg, Paul, & Lord, 2005). It may also be possible that the asymmetry between adverbial and
complement clauses across the two groups with ASD stemmed from differences in the computational processes underlying each type
of clause, and the way bilingualism affected these processes. We assume that the higher proportion of adverbial clauses in ASD-Bi
children’s narratives was likely driven by the group’s enhanced ability to establish causal-motivational, temporal and conditional
links between the story events; it seems that bilingualism enhanced ASD children’s understanding of the conceptual representations of
the story, allowing event information to be easily extracted and encoded in adverbial clauses while narrating. This is not expected
with complement clauses whose production is driven by language-specific morpho-syntactic properties (Haegeman, 2010); thus, the
interface between complement clauses and the causal and temporal coherence of the story is more limited than with adverbials.
The idea that bilingualism facilitated abstraction from story event knowledge to adverbial clauses among the bilingual children
with ASD fits well with our previous finding that the ASD-Bi group structured the story with coherent complexity more efficiently
than their monolingual peers. Adverbial clauses have been claimed to serve important functions in discourse coherence by prag-
matically combining utterances and integrating two or more (often) juxtaposed states of affaires into one grammatical unit (Brooks &
Tomasello, 1999; Diessel, 2004). Bilingual children with ASD produced more adverbial clauses than their monolingual peers, sug-
gesting that they were more successful at integrating temporal, cause-and-effect, and conditional relations in their story-tellings. This
indicates a positive bilingualism effect within the ASD group for integrating discourse-level event semantics into adverbial sub-
ordinate clauses. On the other hand, we hypothesize that the more frequent use of complement clauses by the ASD-Mono group may
reflect a general avoidance of verbalizing temporal and/or causal relationships between the events of the story, and a focus on the
MCs’ verbal interactions instead. This account is in line with Baron-Cohen, Leslie, and Frith’s (1986) narrative study with 12-year-old
children with ASD, which found that children had no problem describing the interactions between the characters of the stories they
were asked to narrate, but they had difficulty establishing cohesive links between the events. This also ties with the frequent
characterization of monolingual children with ASD as providing descriptive narratives rather than structured stories with causal
connectedness (Diehl et al., 2006; Losh & Capps, 2003; Marinis, Terzi, Kotsopoulou, & Francis, 2013; Peristeri et al., 2017).
17
The analyses on microstructure have also revealed higher lexical diversity scores for both groups with ASD when compared to
their TD peers. Though a delay in lexical development has been a common finding in studies with children with ASD (Hudry et al.,
2010; Smith et al., 2007), there is evidence that children with ASD are more efficient at retrieving low-frequency words than TD
children, drawing on a specific strength in autism, namely, their enhanced lexical and semantic declarative memory (Walenski,
Mostofsky, Gidley-Larson, & Ullman, 2008). It is possible that children with ASD while telling the ENNI story were more efficient at
activating the conceptual, and subsequently, the phonological representations of objects and characters, that actually corresponded to
low-frequency words in the pictured story (e.g. giraffe, pool-board, lifeguard, patch, bench, sign, swimming pool). ASD children’s
heightened sensitivity to lexical frequency information, given autism-related strengths in semantic declarative memory, might ex-
plain the discrepancy between their performance in the expressive vocabulary task and the lexical diversity measure of the narrative’s
microstructure; ASD children’s performance in the expressive vocabulary task was not found to differ from their TD peers possibly
due to the fact that the picture-naming task included commonplace, high frequency words (Vogindroukas et al., 2009), thus ob-
scuring any between group difference. Of course, further studies are needed to clarify the exact processes underlying lexical learning
in autism and the ways in which word processing is affected in individuals with ASD.
Overall, in contrast to the ASD-Mono group, bilingual children with ASD earned marginally higher scores in story structure
complexity, used more adverbial clauses that enhanced the temporal and causal coherence of a story, and used fewer referential
ambiguous forms. This pattern of findings suggests that bilingualism effects were evident at both the microstructural and macro-
structural level of ASD children’s narrative production.
4.3. Bilingualism effects in EF in ASD
Our study revealed that bilingual children with ASD outperformed their monolingual peers with ASD in both the visual attention
global-local and the 2-back working memory task. In keeping with our hypothesis, bilingual children with ASD performed better on
the EF tasks than their monolingual peers. More specifically, in the global-local task and the ‘No interference’ trials, the ASD-Mono
children were overall slower and less accurate than ASD-Bi children in global trials. In the experimental conditions inflicting
‘Interference’, on the other hand, the two groups with ASD displayed inverse patterns of performance in the accuracy measure: ASD-
Mono children exhibited a stronger Local-to-global interference effect than ASD-Bi children, suggesting that the former group ex-
perienced greater interference from local information in global trials. On the other hand, ASD-Bi children exhibited a stronger Global-
to-local interference effect than their monolingual peers, implying that their attention system was able to tune more efficiently to
global trials than ASD-Mono children. The overall findings of the global-local task point towards distinct cognitive styles across the
two groups with ASD; the ASD-Mono group displayed a robust local bias at the expense of global processing, in contrast to ASD-Bi
children, who seemed to have preserved attention-shifting skills from the local to the global level of the task. The finding that the
monolingual group with ASD exhibited global processing weaknesses is consistent with several previous studies that offer evidence in
favor of local processing biases in autism (see Happé & Frith, 2006 for a review). Here, we discovered that bilingualism may
compensate for typical processing styles in autism by decreasing children’s detail-oriented focus and/or enhancing their sensitivity to
global configurations of stimuli. These findings are in line with Gonzalez-Barrero and Nadig’s (2017) recent study, which found that
bilingualism mitigated the attention-shifting weakness detected in a non-verbal set-shifting task among children with ASD.
The 2-back task, on the other hand, provided convergent support for the bilingualism effect on ASD children’s non-verbal ex-
ecutive functioning. The bilingual group with ASD was significantly more accurate than the other experimental groups; in fact, apart
from obtaining the highest accuracy score in the task – which was calculated by subtracting the percentage mean of false hits from the
percentage mean of correct hits – the majority (i.e., 14 out of 20) of ASD-Bi children exhibited zero false hits, or absolute success in
suppressing the response to a non-target digit. Zero false hits were not observed in any of the other participating experimental groups.
ASD-Bi children’s superior performance in the 2-back task was rather unexpected given its high complexity (Ciesielski, Lesnik, Savoy,
Grant, & Ahlfors, 2006; Gevins & Smith, 2000; Kane et al., 2007). To break down the complexity of the task, children had to
simultaneously monitor a series of digits, update a continuing stream of information to integrate recently presented digits, and inhibit
temporally distant digits while retaining the information in working memory, comparing consecutive digit trials and shifting at-
tention between digits. These cognitive operations can only be fulfilled successfully if they are coordinated. Though we cannot pin
down the exact cognitive mechanisms that were enhanced by bilingualism and enabled ASD-Bi (and TD-Bi) children to outperform
their monolingual peers in the 2-back task, the finding that the ASD-Bi children were the only group with zero false hits hints at the
group’s greater efficiency in inhibiting prepotent responses (Aron, 2007; Friedman & Miyake, 2004). Problems in prepotent response
inhibition have been reported in many studies on autism (Bishop & Norbury, 2005; Christ, Holt, & White, 2007; Corbett &
Constantine, 2006; Geurts & Vissers, 2012; Kilinçaslan, Motavalli Mukaddes, Sözen Küçükyazici, & Gürvit, 2010; Xiao, Quinn, Ge, &
Lee, 2012). To our knowledge, this is the first study to show that bilingualism can compensate for the inhibition impairment in ASD.
The overall evidence shows that bilingualism improved ASD children’s EF performance. In the global-local task, ASD-Bi children
were generally faster and more accurate than their monolingual peers in the task’s global trials, managing to tune into global
attention demands more efficiently. In the 2-back task, the ASD-Bi group was more accurate than the ASD-Mono group, and was more
efficient at retracting non-target responses. These findings confirm our second hypothesis, that ASD-Bi children would exhibit su-
perior performance to their monolingual peers in the non-verbal EF tasks.
4.4. The relation between narrative performance and EF in ASD
Through the two EF tasks the two groups with ASD manifested distinct attention processing styles and working memory resources.
18
Moreover, the correlations between EF and the narrative performance of monolingual and bilingual children with and without autism
allow us to examine possible correspondences between non-verbal cognitive skills and children’s narrative performance in micro- and
macrostructure.
More specifically, the correlation analyses indicated that EF were more dynamically engaged in story-telling by the bilingual than
the monolingual children with ASD. Global attentional biases seemed to be dominant in regulating both microstructural and mac-
rostructural properties of ASD-Bi (and TD-Bi) children’s narratives, such as lexical diversity, subordination index, adverbials, story
structure complexity, complement clauses and + ToM-related ISTs (the latter measure correlated with attention only for TD-Bi
children). Crucially, the mappings between narratives and EF across the TD-Bi and ASD-Bi groups were highly (almost directly)
comparable, suggesting that the cognitive mechanisms underlying story-telling performance were qualitatively similar across the two
groups. Monolingual children with ASD, on the other hand, had difficulty to defocus local information and mainly relied on local
attentional cues when producing units of information that involved the setting, characters, events, and outcomes of the story, as well
as the characters' thoughts and feelings. One can speculate that ASD-Mono children’s robust local attention biases may have con-
tributed to attenuating the saliency of important units of information in the pictured story, thus, making it more difficult for them to
tie different pieces of information into a global, integrated whole. This result is in line with Joseph, Keehn, Connolly, Wolfe, and
Horowitz’s (2009) study in which correlational analyses revealed no specific association between monolingual ASD children’s ex-
ecutive performance and language ability. For TD-Mono children, local attention biases have been shown to correlate mainly with
microstructural properties of their narratives, such as syntactic complexity, relatives, lexical diversity and adverbial clauses, while
global attention biases were mostly relevant to macrostructure, namely, story structure complexity. Interestingly, performance in the
2-back digit task was only reported to correlate with narrative macrostructure, more specifically the use of + ToM-related ISTs and
referentially unambiguous forms, only among ASD-Bi and TD-Bi children. It appears that the bilingual children’s updating and
monitoring skills were critical in promoting the efficient coordination of lexical knowledge and discourse/pragmatic information in
macrostructure, an operation we suggest was demanding and likely benefited from higher-order cognitive control processes.
With these findings in mind, the current study suggests that EF were mostly relevant to macrostructural properties of the nar-
ratives of bilingual children with ASD. There is evidence of global attention affecting story structure complexity, and of a close link
between updating and the ability to use + ToM-related ISTs and referentially unambiguous forms in the narratives. The latter finding
implies that inhibition was involved in preventing ASD-Bi- children’s selection of pronouns that would not be explicit from the
listener’s point of view. Enhanced working memory and inhibition skills in the ASD-Bi group might have boosted their ability to
inhibit referentially ambiguous pronouns and convey relevant plot content, along with initiating events, attempts and story outcomes
that improved the overall structure complexity of their narrative production. The finding that the relationship between EF, especially
updating, and microstructure in the ASD-Bi group was weaker compared to macrostructure implies that microstructure was not
affected by ASD-Bi children’s enhanced EF to an equal extent as macrostructure. Perhaps the language demands of the story may have
been an important bottleneck in children’s performance in microstructure, particularly in syntactic complexity. Further studies on the
relationship between EF and narrative performance of monolingual and bilingual children with ASD are definitely needed to identify
how bottlenecks in language processing and EF are likely to affect narrative microstructure in these populations.
Though the findings of the correlations in the current study do not offer a clear answer about the directionality of the relation
between narrative and EF skills, the finding of significant correlations between narrative production and higher-order cognitive
abilities among bilingual children with and without ASD raises the important question of whether enhanced EF triggered by bi-
lingualism could be involved in bilingual children’s narrative development.
5. Concluding remarks
This study has shed new light on the effects of bilingualism on the narrative performance and executive functioning of children
with ASD, as well as on the ways in which domain-general cognitive control systems relate to the process of story-telling among this
population. Bilingual children with ASD exhibited higher scores than their monolingual peers with ASD in both narrative micro-
structure and macrostructure, while bilingualism was also found to robustly enhance ASD children’s visual attention, working
memory, monitoring and updating skills. Notably, while cognitive control was relatively unengaged in story-telling by monolingual
children with ASD, cognitive control skills were found to be associated with both the microstructural and macrostructural aspects of
ASD-Bi children’s narratives. The engagement of higher-level cognitive skills in ASD-Bi children’s oral telling performance reveals a
cognitive basis for their enhanced narrative production, which could have important clinical implications regarding the ways bi-
lingualism may impact communication skills among children with ASD. The findings suggest that exposure to a second language does
not adversely impact on the EF and narrative skills of children with ASD, and that bilingualism has potential benefits to EF, mi-
crostructural and especially macrostructural aspects of children’s narrative performance. These results can inform educational po-
licies and clinical practices used in community and clinical settings to support ASD children with diverse language experiences.
Although we interpret our data as suggesting that bilingualism mitigates processing weaknesses typically found on the autism
spectrum in both EF and narratives, we view our findings less in terms of firm conclusions and more as an attempt to further explore
language and cognitive control skills among children with ASD who grow up in bilingual environments.
CRediT authorship contribution statement
Eleni Peristeri: Conceptualization, Visualization, Methodology, Investigation, Formal analysis, Writing - original draft, Writing -
review & editing. Eleni Baldimtsi: Conceptualization, Investigation, Methodology, Visualization, Writing - original draft, Writing -
19
review & editing. Maria Andreou: Investigation. Ianthi Maria Tsimpli: Conceptualization, Writing - review & editing, Supervision.
Acknowledgments
We would like to thank the children and their parents for their participation in the study.
Appendix A. Supplementary data
Supplementary material related to this article can be found, in the online version, at doi:https://doi.org/10.1016/j.jcomdis.2020.
105999.
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Contents lists available at ScienceDirect

Journal of Communication Disorders

The impact of bilingualism on the narrative ability and the

1.1. Narratives and executive functions in autism spectrum disorders

1.2. Bilingualism and autism spectrum disorders

1.3. The current study

PIQ 115 (11.9) 111 (17.0) 109 (16.9) 105 (11.5)

2.1.1. Language screening

2.1.2. Bilingual status

2.2. Materials and procedure

2.3. Language screening tasks

2.3.1. Expressive vocabulary task

2.3.2. Sentence repetition task

2.4. Narrative production task

2.4.2. Transcription and scoring of narratives

(1) Complement clause

O navaγosostis ipe stin elefadina na kaθisi sto pagaki

(2) Relative clause

I elefadina ide kati pu kanume vuties

(3) Adverbial clause

Otan eﬁje o navaγosostis pire afstiro ifos

(4) Null subject pronouns

(5) Strong overt pronouns in Subject position

Ine o elefadas ke o kamiloparδalis ki aftos ehi astio lemo

(6) Clitic pronouns

I elefadina jlistrise ke i kamiloparδali pije mazi. O babas elefadas tin eδiokse.

2.5. Executive function task: visual attention global-local task

2.6. Executive function task: 2-back task

2.7. Analysis plan

2.7.1. Participants’ clinical and demographic traits

2.7.2. Language screening tasks

2.7.3. Narrative production task

2.7.4. Visual attention global-local task

2.7.5. 2-Back task

2.7.6. Correlations between narrative and executive function measures

3.1. Participants’ clinical and demographic traits

3.2. Language screening tasks

3.3. Narrative production task

3.3.1. Analysis 1: narrative length

3.3.2. Analysis 2: narrative microstructure

*** Signiﬁcant at the < 0.001 level.

3.3.3. Analysis 3: narrative macrostructure

*** Signiﬁcant at the < 0.001 level.

RT Accuracy RT Accuracy RT Accuracy RT Accuracy

3.5. Executive function task: visual attention global-local task

3.5.1. Analysis 1: bivariate Pearson correlations

3.5.2. Analysis 2: No-Interference contexts

3.5.3. Analysis 3: interference contexts

*** Signiﬁcant at the < 0.001 level.

*** Signiﬁcant at the < 0.001 level.

3.6. Executive function task: 2-back task

3.6.1. Analysis 1: bivariate Pearson correlations

3.6.2. Analysis 2: Group diﬀerences in RT and accuracy

3.6.3. Summary of executive function tasks

3.7. Correlations between narrative and executive function measures

4.1. Bilingualism eﬀects in macrostructural aspects of children with ASD

4.2. Bilingualism eﬀects in microstructural aspects of children with ASD

4.3. Bilingualism eﬀects in EF in ASD

4.4. The relation between narrative performance and EF in ASD

CRediT authorship contribution statement

Appendix A. Supplementary data