An expert look at ways you can help your child with autism un-jumble the chaos of noise and language for better communication.
Imagine for a moment, a laundry basket full of clean clothes straight from the dryer. Socks, shirts, undies, pajamas, and pants belonging to all members of the family are jumbled together. There is a mess of colors, fabrics, and sizes, but you are able to compare, recognize, and match. These skills enable you to create order out of the chaos and make a tidy pile belonging to each family member. You have “processed” the laundry!
Language to some children on the autism spectrum is noise as chaotic as that unsorted laundry basket, and they lack the skills to sort it out.
What is auditory processing?
“Auditory processing is a term used to describe what happens when your brain recognizes and interprets the sounds around you.” (National Institution on Deafness and Other Communication Disorders—US Department of Health and Human Services).
A child with auditory processing difficulties can hear words loud enough, but the sounds and words may sound alike or get mixed up with each other, so ‘cat’ may sound like ‘chat’, e.g. The chat is purring. ‘House’ and ‘mouse’ may sound the same, e.g. There are four people living in my mouse.
In addition, the child may have difficulty remembering language so he/she forgets part of a directive or command, or carries out the steps in the wrong order. He/She may have difficulty answering questions about information he/she has been given.
He/She may be uninterested in listening to the “noise” of a language he/she does not understand, so he/she may be easily distracted and frustrated or may simply “tune out”.
Since he/she does not understand all that is said, he/she may avoid conversation initiated by others and prefer to talk about “safe”, overly familiar subjects.
Auditory processing difficulties result in weak receptive (understanding) language skills and delayed expressive language and, depending on the severity, may affect a life-time of learning and social interaction.
Therapy for Tim
Tim, a child on the autism spectrum, was seven years old when his parents enrolled him in private therapy to augment his program at school. Tim could express his wants and needs in single words, phrases, and some incomplete sentences and he could follow routine directions. However, he could not comment on everyday occurrences, listen to a story, or answer questions.
Building a strong foundation for auditory processing
Tim’s language therapy began with developing his listening skills (auditory, memory, and discrimination). He practiced listening to and imitating a series of sounds made by noise makers, unrelated word series, and short unrelated sentences. We sang songs together and played musical instruments.
Using concrete items and pictures, we worked simultaneously to develop Tim’s vocabulary of nouns, verbs, prepositions, and descriptors and his ability to understand and use question words like “what?”, “who?”, and “where?” e.g. What is he riding? Who is reading a book? Where is the ball?
In preparation for Tim’s next goal, we taught him the prepositions “beginning”, “middle”, and “end” as they applied to a series of objects, e.g. Toy cars going into a garage—show me the car at the end of the line. Show me the car in the middle. Which car is at the beginning? Is the blue car at the beginning or the end?
Developing auditory processing without concrete items or pictures
Goal: To process an isolated sentence without object or picture support and answer a “what?”, “who?”, or “where?” question related to information that occurred in a specified position within the sentence, e.g. Kyle drives his truck. What does Kyle drive? His truck (the answer is at the end); Who drives his truck? Kyle (the answer is at the beginning).
At the start, Tim was told what the question word would be and where in the sentence the answer to the question would occur (beginning, middle, or end). We then used a four-part procedure:
- A sentence was read to Tim.
- Tim repeated the sentence out loud (so we knew he could recall all the words).
- The therapist asked Tim a question pertaining to the sentence.
- Tim replied to the question.
We presented a series of 10 unrelated sentences during each session and began with sentences where the answer to the question occurred at the end of the sentence since it is easier for us to recall the most recent information we hear.
We provided Tim with prompts and repetitions as he needed and did not introduce a new, more difficult step until the previous one was well established. We gradually increased the length of the sentences as his ability to process improved.
As Tim became more successful and his confidence grew, it was a delight to see the glimmer of excitement in his eyes when he truly knew he was going to give the correct answer!
Step 1: Question word “what?” related to information at the end of the sentence, e.g. “I saw an elephant?” Tim repeats: “I saw an elephant.” Therapist: “What did I see?” Tim: “An elephant.”
‘What?’ Question word
10 sentences were presented using this format in this and subsequent steps, e.g. John has three dogs. Sue climbed a tree, etc.
Question word ‘what?’ related to information at the beginning of the sentence, e.g. Doors have handles. What have handles? (doors).
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Question word ‘what?’ related to information at the beginning or the end of the sentence (mixing steps one and two).
Question word ‘what?’ related to information in the middle of the sentence, e.g. Put the bags in the truck. What shall I put in the truck? (the bags).
Following these steps, Tim was able to answer correctly ‘what?’ questions related to information in any position in a short sentence.
‘Who?’ Question word
The same procedure was now used to teach Tim to process the question word ‘who?’ related to information at the beginning of the sentence, e.g. Dan and Peter like scrambled eggs. Who likes scrambled eggs? (Dan and Peter).
Once established, ‘what?’ and ‘who?’ questions were then presented at random in the practice setting.
‘Where?’ Question word
The last step in our goal was to develop Tim’s understanding of ‘where?’ questions related to information at the end of the sentence, e.g. The rabbit ran around the field. Where did the rabbit run? (around the field).
Over time, following these steps, Tim developed the ability to process ‘what?’, ‘who?’, and ‘where?’ questions referring to information in any position in unrelated sentences in the structured setting. He carried over this skill and was much better able to answer questions in his everyday life.
Auditory processing—an essential part of therapy
Specific training such as described above is an essential part of on-going therapy for children with language difficulties on the autism spectrum. They must learn to recognize and interpret the sounds around them and process the “noise” and “chaos” (just like that laundry basket!). As auditory processing skills improve, so will overall receptive and expressive language skills.
This article was featured in Issue 112 – Understanding Diagnosis & Disorders