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

Differences in language use in social contexts (i.e., pragmatics, such as conversational ability) serve as a defining clinical feature of autism, which can have an important impact on social functioning and well-being in a neurotypical society. Despite decades of research, most studies have not included representative samples, calling into question the generalizability of findings. This scoping review evaluates reporting practices and representation of autistic females and individuals from racially, ethnically (Hispanic/Latine), and linguistically diverse backgrounds. An initial pool of >1,800 articles were individually reviewed using a detailed coding system of exclusionary criteria, resulting in 308 empirical studies of pragmatic language in autism that were subjected to fine-grained analysis. Approximately 80% of studies reported sex, and about 70% documented language spoken. However, race and ethnicity were reported in less than 10% of studies. When reported, females and individuals from racial/ethnic minority backgrounds were starkly underrepresented. Reporting rates increased over time (1977-2022) for sex, ethnicity, and language spoken, and representation improved for racial minority groups and non-English speakers. Evidence suggests a striking bias towards inclusion of White, non-Hispanic/non-Latine males. This lack of representation has critical implications for interpretations of extant literature on pragmatics in autism, relevant to clinical characterization and future research.