Autism Society records most keynote and concurrent sessions at their annual conferences. You can see and hear those recordings by purchasing full online access, or individual recordings.
As we continue to diagnose toddlers with autism at younger and younger ages, issues in early language development will be important to address. As early as four months of age, it is possible that lack of relatedness and warmth on the part of a child may be a risk factor for autism. At nine to twelve months, there is a lack of joint attention, and babbling is not becoming more complex. At twelve to fourteen months, single words may not be emerging; there is often a lack of reciprocity; and a lack of problem solving on the part of the child. At eighteen months, which is often the marker for parents noticing signs and symptoms of autism, there is an additional lack of motor gestures, pretend play is not emerging, and more importantly language is not emerging for social interaction. At 12 months of age, we may notice a lack of development of imaginative play. At 36 months of age, when most typically developing children are engaged in complex language exchanges, we may see in a child with autism lack of little or no pretend play, little or no ability to repair communication, and lack of topic maintenance in conversations.
If we look at the larger spectrum of speech, language and communication characteristics of individuals with autism, such can be categorized into three areas: expressive language, comprehension of language, and use of language or pragmatic language.
In regard to expressive language, there is a high rate of mutism in autism. Up to 35% of the autism population may not develop verbal language. This is not an unwillingness to speak, but an actual inability to speak, whether it is due to apraxia or cognitive deficit, there is a cause of mutism. Echolalia is another unique expressive language characteristic. There has been a significant amount of research done in this area, particularly by Dr. Barry Prizant. Echolalic children learn language through a Gestault process and therefore repeat back what is heard, sometimes immediate sometimes with a delay of time. Both immediate and delayed echolalia have specific functions that can be identified so that appropriate exrpessive language responses can be taught to the individual. Echolalia is both interactive and non-interactive, and it is critical that this is appropriately assessed so that appropriate treatment can be targeted. Another expressive language characteristic is perseveration, that is when an individual with autism gets “stuck” on a word or phrase and repeats is over and over again. There may be an obsessive-compulsive component to this, but it is clearly neurologically driven response. Another interesting expressive language characteristic of individuals with autism is the history of language developing appropriate and then the loss of language. This is commonly reported by parents during case histories. While there is no research to definitively identify the cause of this loss of language, it clearly points to some type of neurological action.
The second component to be reviewed is comprehension of language and the deficits associated with that. While professionals today seem reluctant to discuss cognitive deficits (mental retardation), this is a significant reason for some of the comprehension deficits we see with autism. Up to 75% of individuals with autism have some type of mental retardation, and the more severe the cognitive deficits the more apt it is to negatively impact comprehension of language. Because individuals with autism often struggle with language comprehension, there is a logical response on their part to be overly reliant on visual cues. In addition, many individuals with autism, particularly as young children, act as “deaf” because language, even if heard, has no meaning. Another aspect of comprehension of language which is significant with regard to this population is the difficulty that individuals with autism have understanding abstract concepts. This topic will be reviewed later when discussing unique characteristics of individuals with Asperger’s and high functioning autism.
Use of language, that is, difficulty with pragmatic language, is a hallmark area of deficit for individuals with autism. Many individuals with autism as young children do not develop the ability to initiate and maintain reciprocal interaction. Since communication is such a complex dynamic process, it seems evident that individuals with autism would struggle, as their ability to process and manage complex information is quite limited. Individuals with autism often struggle to understand the meaning behind others’ communication and, on a basic level, struggle with simple reciprocity. Individuals with autism may engage in maladaptive behavior to communicate their intent. A significant challenge is that many individuals with autism lack interest in communicating, which clearly has a significant impact on that individual’s relatedness to his or her world.
Another significant milestone in development that is often not observed in young children with autism is the ability to imitate. Research supports the critical role that imitation plays in the development of symbolic thought and social relationships. Symbolic play, which has again another significant impact on an individual’s development, is based in imitation.
The impact that social play has on development can be seen observing any typically developing child. Creative/imaginary play in young children is the beginning of creative, abstract thinking in older individuals. Children with autism typically struggle with make-believe imaginary play and if this does not develop it is prognostic for future development of creative imaginative thinking.
There is overlap with the characteristics of high functioning autism and Asperger’s Syndrome. Some characteristics, however, are specific to this end of the spectrum. There has been a great deal of recent research on theories of social deficits in autism. These theories include Theory of Mind, Executive Functioning, Central Coherence Theory, and Enactive Mind Theory, to name several. These theories present a variety of opinions as to why individuals with high functioning autism and Asperger’s Syndrome struggle with reciprocity and social interaction. On a more simplistic level, many individuals with high functioning autism and Asperger’s Syndrome struggle with initiating and sustaining a conversation. Part of this may be motivation and interest, but there is research to support that individuals with high functioning autism and Asperger’s Syndrome struggle with organization and flexibility that is required in a conversation. As part of the challenge of the lack of perspective taking that we see in high functioning autism and Asperger’s Syndrome, there is the lack of awareness of the listeners needs and wants, as well as that focus on “odd topics” that the individual with high functioning autism and Asperger’s Syndrome sees as interesting and does not appreciate other’s lack of interest in such a topic.
While some treatment strategies will be integrated into this workshop, it is the presenter’s intent to focus specifically on ensuring that the workshop participants leave with a deeper understanding of the complexity of speech, language and communication characteristics of individuals with autism, and more importantly how they impact their overall functioning.
Content Area: Communication
Anne S. Holmes, M.S., CCC, BCBA
Chief Clinical Officer
Eden Autism Services