A Look at the Various Communication Disorders of Autism
In the diagnosis of autism spectrum disorders (ASD), a key feature is persistent deficits in communication that are not because of other developmental delays. This means that for a child to be diagnosed with autism, his/her speech and language skills must be different from typical development, not merely delayed and like those of a younger child.
Certainly, children with autism often do have delayed speech and language secondary to cognitive limitations, but these delays alone do not support an autism diagnosis. And of course, it is possible to have autism in addition to deafness, cerebral palsy, or other disabilities that result in communication problems. Children on the autism spectrum have a wide range of communication skills.
Some are nonverbal, with varying degrees of language comprehension. Others echo language, with differing amounts of more conventional communication mixed in, and some are highly verbal but literal and have unusual patterns of conversation. For a brief overview, let’s consider these three arbitrary groups, which blend together at the edges, and the characteristics that contribute to an autism spectrum diagnosis.
Children have little or no speech for a lot of reasons, including hearing impairment, severe cognitive limitations from brain injury or intellectual disability, dysarthria (paralysis or weakness of oral muscles) or dyspraxia (limitations in voluntary motor control of muscles of articulation despite an absence of paralysis or paresis). Any of these can and do occur with autism, but they do not qualify a person for an autism diagnosis. The typical autism features of children at this early developmental level of language acquisition involve a significant lack of attempts to communicate in ways that compensate for the limited speech.
For example, the child with autism is far less likely than the others to communicate by pointing, gesturing, communicative eye gaze and facial expression. A nonverbal child with autism may see a cookie on the table and stand beside you reaching for it and screaming or may climb to get it without making any direct effort to get you to help him. A child who is not talking because he is too young or is deaf or has cognitive delays is much more likely to look at you and then at the cookie or look at you and point to the cookie.
A common early spontaneous communication attempt for a child with autism is to take your hand and put it on an item he wants or a door he wants to be opened. But this is often done without eye contact as if your hand were simply a tool. Some children who are being taught sign language will take your hands to sign “all done” or “more” rather than doing the sign with their own hands.
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As speech, sign, or picture communication is taught or develops, it is apt to be mainly used to ask for things, rather than to comment, answer or share information, and frequently the functional uses of language have to be specifically taught, even for the most basic function of requesting. Those who can say a few words may say them infrequently or only with prompting. By contrast, typically developing children are able—through gesture, action, eye gaze, facial expression, and vocalization—to make requests, seek help, direct others, greet people, point out things of interest, protest specifically, and respond to conversation before they can talk.
Children with an autism spectrum disorder and more language may be echolalic. Echolalia is expressive language dominated by immediate or delayed repetition of the words and phrases of others, and it is accompanied by significant limitations in comprehension.
Echolalia is not intentional and does not change in response to adult commands or explanations. The echoing child is taking his conversational turn, depending on his strong auditory memory skills, and using language as he hears it without interpreting how it changes with each speaker.
Typically developing toddlers also imitate language a lot but they repeat mainly the key words and they shift the intonation to match their conversational role. Children with echolalia learn concrete vocabulary, especially names of objects, letters, and numbers, easily, but “I”and “you” pronouns are repeated as heard and, therefore reversed, and concepts like “yes,” “maybe,” and “I don’t know” are confusing. Interpreting question forms is usually difficult, and questions are often repeated instead of answered.
Children may develop beyond echolalia to more conventional speech and language without help, or after a lot of intensive intervention, or not at all. For some people, echolalia persists into adulthood. Children who echo may be quiet and passive and only speak when prompted or they may be extremely verbal and seem to talk nonstop. Usually, they show a combination of echoic and more appropriate conventional speech. Articulation may initially be poor as the child is repeating things such as movie scripts and book passages that he doesn’t understand, but clarity of speech typically improves as more conventional language develops.
There are also children and adults with autism who have essentially normal language structure, apparently good comprehension and strong academic skills. But here too there are differences. These are the people who have had to study the meanings of idioms, want to monologue repeatedly on their favorite topics, think social greetings are a waste of time because no information is shared, correct the smallest errors of teachers and professors, try to be social by telling jokes they don’t understand and get into arguments about their moral values. Some are able to read before they can converse, they typically prefer reading non-fiction instead of fiction, may resist and struggle with handwriting and they usually find it difficult to organize ideas to express themselves effectively in speech or writing.
At all levels of development, the communication difficulties of people with autism are challenging and overlap with their many behavioral, social, and learning difficulties. And at all developmental levels, there is always the potential for improvement.
Address: Autism Spectrum Consultant, 250 Main St. # 405, Hudson, MA, 01749
This article was featured in Issue 87 – Building ASD Awareness and Communication