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Communication Problems and Children with Autism

April 9, 2021


“Much of the time, I feel like an anthropologist on Mars.” Dr. Temple Grandin made history when she spoke those profound words during an interview with the late Dr. Oliver Sacks. Parents observing their children with autism trying to communicate in a neurotypical world, may grasp the significance of her words.

Communication Problems and Children with Autism

Communication is vital to human existence; we need it to share information, to transfer knowledge, and to form relationships. More importantly, for children, communication may be one of the few tools they have to control their environment. The importance of expressing ourselves cannot be overemphasised, which is why so many parents with children on the spectrum seek help for their children’s social communication issues.

In a very insightful presentation for the Autism Parenting Summit, Dr. Ron Malcolm spoke to the essence of why children with autism need to communicate adequately. In his many years of working with children with autism, he says, whenever he gets a phone call about a severe behavioral issue or reaction, it’s almost always linked to the child trying to communicate but lacking in verbal skills to do so successfully. 

He goes on to say that communication is about power and controlling your environment. He uses examples of being able to say no and communicating when not feeling well—every child should have that power. Dr. Malcolm uses practical examples throughout the presentation to emphasize the importance of communicating well for children on the spectrum.

In this article, we will look at the reasons behind communication problems for people with an autism spectrum disorder (ASD). We will also share possible ways to improve communication with your child on the spectrum (including nonverbal children). Even though long term studies are lacking in this field, conclusions from relevant studies and research will be discussed to illustrate the effectiveness of interventions to improve communication for children with ASD.

The struggle may be their reality

For children with autism it may feel like the deck is stacked against them. For starters a conversation usually begins non-verbally with eye contact—something many people with autism struggle with.

If the child is older, his/her language skills may be tested when the verbal part of social communication commences with greetings and small talk; social niceties he/she may not “get”. Other nuanced elements of  social interaction and communication like tone of voice, facial expressions, and “appropriate” gestures may come naturally to neurotypical individuals; but for those with autism spectrum disorders these communication skills may have to be learned.

When it comes to language skills, some children with ASD are actually ahead of their neurotypical peers. These children may possess a vocabulary beyond their years, or use language in a formal, almost business like manner. Often these children are skilled at memorizing the rules of language, they may therefore be particularly good at spelling and learning new words. However, the application and everyday use of language for social interaction could be challenging for them.

Speech therapists and autism professionals use the term “pragmatic communication” to refer to the way language is used to communicate rather than the way it is structured (Ciccia, 2011).

In other words, it’s the way we use language in the appropriate way during different social interactions. In the presentation referred to earlier, Dr. Malcolm referred to pragmatics as “social language”. 

According to Bates (1976), pragmatics include three main domains:

  • Communication functions
  • Discourse skills
  • Presuppositions

Using language which is appropriate for a specific context goes beyond memorising grammatical rules and acquiring vocabulary; the abstract nature of pragmatics include making assumptions, using the correct language for a given situation, and changing language according to the needs of the listener.

Imagine having to get all those elements in place just to have a simple social interaction—no wonder it is challenging for adults and even more so for children with ASD.

Adults and children on the spectrum vary immensely in the way they talk and interact, the very nature of a spectrum disorder means it’s possible for some individuals to have savant-like language skills while others are nonverbal. There are, however, certain characteristics which have been identified as common to the communication style of children on the autism spectrum.

How do children with autism communicate?

Children with ASD often have very specific interests; they may like to talk about such an interest at great length, without regard for their listener or social situation. Turn-taking and asking about the other person’s interests may simply not occur to them. Social cues are often missed.

They may also speak in a manner which is viewed as different to the norm by neurotypical individuals; this could include talking in a sing-song or high pitched voice, quoting excerpts from movies not related to the conversation, or repeating the same phrase over and over again. Children on the spectrum may also not grasp the sensitivity of their audience to certain topics and they may speak about things regarded as inappropriate or taboo for general conversation. 

Their difficulty with pragmatic language may be challenging for parents who want their children to experience positive social interaction with peers. It’s important to consider just how difficult it must be to partake in something where the rules are never the same and no one can explain precisely what to expect from each new communication encounter. Then, we realize just how much empathy and understanding children with ASD need when it comes to communication.


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Improving communication 

Every child should be able to communicate in some capacity, and they should not be deprived of this right because they don’t use speech. Teaching nonverbal skills to communicate can sometimes lead to verbal communication; the child who is able to communicate a need, or control his/her environment may have the motivation to improve communication by verbalizing needs.

In a study (Paul, 2008) reviewing programs aimed at language development in high functioning children with ASD, the importance of shifting the focus from words and sentences to the social function of communication (when developing interventions) was emphasised.

The study also detailed developmentally based, social-pragmatic strategies to facilitate improved communication even for nonverbal children. The idea of this approach is to begin by using nonverbal forms of communication to form a bridge to actual speech.

Some central ideas of this approach include (Paul, 2008):

  • The child sets the attentional tone and makes the choices regarding materials
  • Giving children with ASD “intensified opportunities” to participate in activities similar to those their neurotypical peers engage in—this is seen as the most effective context for improving and learning communication skills
  • Use teachable moments occurring naturally during interactions, especially in the course of daily activities like meal times
  • Set functional goals for communication. The targeted behavior should be taught and practiced to be applicable to the child’s daily activities in a meaningful way
  • Teaching the “prerequisite” role of nonverbal communication to social interactions, by emphasising the importance of eye contact, body language, and gestures to develop social language

Helping your nonverbal child communicate

A child’s communication needs should be met whether he/she chooses to verbalize their needs or not. Nonverbal children should be helped to communicate in a way that makes them feel heard. More studies are needed to establish the most beneficial way of communicating with a nonverbal child; some ideas include (Paul, 2008):

  • Sign language could be an effective way to communicate with a nonverbal child with autism. Research does not necessarily suggest sign language as a path to further language development but it could be the tool a parent needs to communicate with their child while verbal skills are acquired
  • Drawings and Picture Exchange Communication Systems (PECS) are effective teaching tools because they rely on the child initiating the communication exchange. The child begins the interaction by choosing (or drawing) a picture which he/she hands to an adult in exchange for a desired object. In this way, single word requests are taught to the autistic child. Communication boards and cue cards are helpful for nonverbal children and can support verbal children in stressful situations
  • Technology can be incorporated to teach a comprehensive visual language to children using pictures, symbols, and video clips on electronic devices, according to Shane and Weiss-Kapp (2005)
  • Some studies have also noted success with peer training programs

Parents of nonverbal children with autism may worry extensively about whether their child is able to communicate his/her needs. It is therefore encouraging to observe results from studies (Wodka et al, 2013) indicating that non-verbal children can acquire verbal skills later, with some reaching encouraging levels of fluency in adolescence.

If your child is verbal but lacks pragmatic or social skills and you want to help him/her communicate better, the following suggestions may be helpful:

  • If you’re not on the spectrum, remember your child with autism might not possess the natural understanding of language and social interactions neurotypical individuals take for granted. Approach communication from his/her perspective and help him/her progress from their own starting point
  • It may be helpful to orchestrate intensified communication learning situations with peers, where your child can practice functional communication skills
  • Allow your child opportunities to communicate. As parents we want to give our kids everything they need and, as we anticipate needs, we often deprive them of the opportunity to communicate their actual needs. Wanting or needing something provides an excellent opportunity for your child to communicate, negotiate and practice verbal and non-verbal skills
  • The same goes for sharing of interests. Even though parents may be frustrated by their child’s monologues involving their current interest; it may create an opportunity to teach your child about turn taking and asking about others’ interests in conversation
  • Be careful of over training a child when it comes to social communication. A child who’s been instructed to memorise communication content for specific social situations may sound robotic. Instead, practice and model appropriate communication in real life situations where your child gets a chance to see how communicating his/her needs makes him/her feel in control and powerful

For more creative solutions for helping children with autism communicate needs in educational settings, listen to Dr. Malcolm’s presentation where he shares some of the creative solutions he’s come up with to help autistic children communicate in school based settings. 

Summing-up

When it comes to helping children with autism communicate better, our aim should be to empower children. Communication goes much deeper than language, speech, and fulfilling neurotypical expectations for social interactions. Instead, the emphasis of communication improvement is to help the child thrive by getting some control over their environment.

References: 

Bates E. (1976b). Language and context: The acquisition of pragmatics. New York: Academic Press.

Ciccia A. (2011) Pragmatic Communication. In: Kreutzer J.S., DeLuca J., Caplan B. (eds) Encyclopedia of Clinical Neuropsychology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-79948-3_914

Paul R. (2008). Interventions to improve communication in autism. Child and adolescent psychiatric clinics of North America, 17(4), 835–x. https://doi.org/10.1016/j.chc.2008.06.011

Shane, H. C., Sorce J., & Weiss-Kapp S. (2005). Video Technology for Language Instruction for Children with ASD. Paper presented at the annual meeting of the American Speech-Language-Hearing Association, San Diego, CA.

Wodka EL, Mathy P, Kalb L. Predictors of phrase and fluent speech in children with autism and severe language delay. Pediatrics. 2013 Apr;131(4):e1128-34. doi: 10.1542/peds.2012-2221. Epub 2013 Mar 4. PMID: 23460690.

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