Individuals with autism always have significant language impairments.
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Individuals with autism always have speech problems.
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Individuals with autism always have communication problems.
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Echolalia is a term used to describe when an individual repeats something that he hears, either immediately or at a later time.
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Echolalia should be discouraged and stopped.
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Nonspeaking individuals with autism benefit from learning sign language or another augmentative communication system.
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Once an individual with autism learns to talk, he is a good communicator.
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Individuals with autism have difficulty communicating in a flexible way.
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Communication is a _________.
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Speech, language and communication are all synonymous.
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Autism is a complex disorder characterized by three core symptoms: social impairments, communication impairments, and repetitive behaviors. Impairments in the development of social and communication skills profoundly impact every aspect of an individual's ability to learn and function. Our understanding of social and communication impairments is essential to learning how to help and teach individuals with autism. Repetitive behaviors, also referred to as ritualistic or stereotypic, are observed in the communication and social behaviors of individuals with autism. Their internal drive to repeat what they do contributes to their odd behavior patterns, and their repetitive speech patterns accentuate their atypical way of interacting with others
Autism looks very different in each individual with the diagnosis. The term autism "spectrum" disorder (ASD) is used to describe this wide range of differences. Some individuals have odd ways of interacting, while others show a complete lack of initiating contact with others. Some individuals communicate in atypical ways, while others use limited ways to communicate basic needs. This broad spectrum of disorders exists for two reasons:
(1) Autism is associated with other developmental disabilities, meaning a person may have autism as well as another disability.
(2) Autism is characterized by ritualistic and repetitive behaviors, which makes it unique from other developmental disabilities.
First, autism commonly occurs with other developmental disabilities, including a wide range of cognitive, language, and motor impairments. Language impairments in autism range from a total lack of speech to atypical patterns of developing language (Prizant, 1996). Most individuals with autism have motor impairments that range from motor-planning difficulties to severe dyspraxia (Hanschu, 1998). The cognitive, language, and motor impairments interface with the core social and communication impairments in very complex ways. The "pervasive" challenges faced by individuals with autism affect all aspects of their development.
Second, autism is characterized by ritualistic and repetitive behaviors. Ritualistic behavior is repetitious, and the individual may become upset when his/her repetitive behavior is interrupted. The emotional reaction to the interruption distinguishes a ritualistic behavior from other repetitive behaviors. Frequently observed categories of ritualistic behavior include social and communication behavior, such as the following.
Self-stimulatory object rituals: repeatedly performing an action using an object, such as spinning objects
Play rituals: insistence on playing in the exact same way every time, such as using a toy in only one way or playing a game with others in only one way
Verbal rituals: repeatedly saying a sound, word, phrase or sentence, including self-stimulatory vocalizations, immediate echolalia, and delayed echolalia
Conversation rituals: conversing in the same way, such as asking the same question repeatedly or talking about the same topic continuously
In this module, we will discuss two aspects of autism: language and communication characteristics. The module will review the developmental language and communication characteristics of autism and the range of problems observed. Emphasis will be placed on understanding how communication in autism differs from communication development in other individuals, with and without disabilities.
Because impaired communication development is a defining characteristic of autism, it is critical to understand communication issues in autism in order to meet the needs of individuals with this disorder. It is difficult for us to consider that someone does not understand how to relate and communicate with others. It is even more difficult to grasp that someone would be able to learn how to talk and still be unable to converse with others in a typical way.
The ability to talk is different from the ability to communicate.
Children with autism, with and without speech, struggle to learn how to communicate with others.
Definitions of Language, Speech, and Communication
It is important to understand the difference between the terms language, speech, and communication to better understand autism. The following pages will explain the differences.
Language is a formal symbol system that has structural qualities, including morphology, semantics and syntax:
Morphology - rules for how words are structured in a sentence (for example, word endings to mark plural [book/books])
Semantics - rules for how meaning is created by words and sentences (that is, word and sentence meaning)
Syntax - rules for the ordering of words in a sentence (that is, sentence grammar)
Language can be (a) oral/speech, (b) sign language, or (c) written language. An individual learns the rules of a particular language to understand the meaning of another person's needs, feelings, and ideas. The development of this knowledge is referred to as receptive language. An individual learns to use the rules of his or her particular language to express wants, needs, feelings, and ideas. The development of these skills is referred to as expressive language.
Speech is one form to express language. It is the ability to use all the speech sounds in a particular language. The development of speech is an oral-motor skill that follows a particular motor sequence. Most children learn to use all the speech sounds of their particular language by age five.
Communication is an interactive exchange between two or more people to express needs, feelings, and ideas. It is a fundamental social skill. An effective communicator has an inherent motivation to interact with others, something to express, and a means of communication. Unlike language, which is symbolic and rule based, communication is social, constantly changing and requires flexibility. An effective communicator is constantly thinking about the multiple contextual, language, social and emotional aspects of the situation and making ongoing adjustments in response to the behavior of others. The development of communication begins in infancy with a simple smile. Communication can be expressed verbally (by means of spoken, signed, voice-output communication device, or written language) or nonverbally (by using pictures, gestures, emotion, and other behaviors). The social conventions of communication are learned and refined throughout development.
Tips to Remember
Tips to remember about the differences between language, speech, and communication:
1. You can communicate without language. You can communicate nonverbally through facial expression, gestures, and other behaviors.
2. You can use language without communicating. You can talk to yourself without communicating to others. You can write information to yourself without communicating with others.
3. You can use language without speech. You can use written language and sign language.
4. You can communicate without speech. You can communicate with others through written language, sign language, and nonverbal means, such as facial expression, gestures, and behavior.
5. You can use speech without communicating. You can talk to yourself without communicating to others.
The ability to talk is different from the ability to communicate.
Children with autism, with and without speech, struggle to learn how to communicate with others.
Language and Communication Development in Typically Developing Children
Gaining an understanding of how communication develops, how language develops, and how receptive and expressive language contribute to social language development is an important step in being able to assess and support the emergence of language for individuals with autism spectrum disorder. The following pages will help with that awareness.
Typically developing young children are very effective communicators before they learn to say their first word. The young child uses many nonverbal means of communication to express a wide range of functions. Eye gaze, gestures, facial expression, and vocalizations are all combined in many ways to interact with others. Without saying a word, the baby uses smiles and facial expressions to tell you what he wants and does not want. By age one, the baby uses gestures such as pointing to ask for things and to show others things of interest. By 18 months of age, children are using nonverbal means of communication to make others laugh, call attention to themselves, and comment on things around them. This complex level of communication occurs without a word!
Consider this scenario:
James is 12 months old and enjoying his first birthday party. The family puts the cake in front of him and begins to sing. James smiles and laughs, looks at everyone, sings by rocking his head back and forth, points to the cake, claps when everyone else claps, and vocalizes when everyone says, "Hurray!" James is socially engaged, communicating his excitement and participating with others. The foundation of early development centers around these social and communication milestones.
Communication in Older Children
As children grow older, their repertoire of communication skills becomes more complex with the emergence of language. Through language, children develop the ability to combine nonverbal and verbal means of communication to initiate, maintain, and repair reciprocal social interactions. For example, they can begin an interaction by combining words with a touch or facial expression; they maintain interactions through speech, eye contact, and other nonverbal means of communication; and they can use words and facial expressions to ask for clarification when unsure what another person means. With language, they communicate their needs, express their ideas, seek information, share experiences and express feelings.
Over time, children develop the ability to understand that others have thoughts, ideas, and feelings that differ from their own (i.e., theory of mind). This ability to understand the perspective of others plays a significant role in communication interactions. For instance, in conversation, children need to continually monitor what the communication partner knows and expects in order to make information relevant. Only with this social perspective can children interpret the meaning and intent of what others are saying. Social perspective taking also allows children to continually adjust their own language and communication with others. With all of these essential skills, they can have a conversation about present, past, and future events. Throughout childhood, they develop the more complex aspects of conversation, such as maintaining appropriate topics, considering the listener's perspective, and interpreting the nonverbal communication behaviors of others. They acquire the ability to use nonverbal conversational skills, such as voice quality and eye contact, in more flexible ways. Refinement of these conversational skills across different social contexts and with different conversational partners continues into young adulthood.
Charles automatically knows that he needs to express himself and interact differently when conversing with his parents versus his teachers versus his friends. His nonverbal communication behavior looks more or less formal depending on the social setting. An observer can see how he communicates the same message "I forgot my homework" to his parent (serious) as compared to his teacher (worry) or his peers (humor). Mastery of social-communication skills is intimately linked to social acceptance.
Language in Younger Children
Language is the understanding and use of conventional symbols, particularly speech. The development of language is motivated by both social and nonsocial factors. Typically developing children rapidly acquire an understanding of vocabulary (semantics) and language structures (syntax/grammar) and use them proficiently by the time they reach school age. By age 2, children have some words and understand what their parents say in familiar routines, relying on contextual cues to "guess" the meaning. The preschool years is the time when children rapidly acquire vocabulary and go through the process of using the language structures they hear (e.g., English, Spanish, French, Russian, Chinese). A key indicator of children's active role in learning language is seen in the "mistakes" that they say, such as using words like "goed" for "went" or "mouses" for "mice" and using sentences with creative errors such as "him jumped the higher" instead of "he jumped the highest"!
Maria, four years old, comes home from preschool and tells her mother about her morning. "Carlos got a sticker. Mrs. Carey said that Janie should say 'sorry', but I didn't do the project today." Maria's mother needs to put the missing pieces of the story together to make sense of it.
Language in Older Children
Through the school years, vocabulary continues to grow, and children learn to use more complex sentence types. Increased language competence is linked to the child's ability to integrate his personal experiences, social experiences, and knowledge base in a flexible way. The school years are also associated with the acquisition of literacy skills; that is, reading and writing abilities. Here the child masters the ability to integrate knowledge of spoken and written language needed for academic and social success.
Maria, nine years old, comes home from school and tells her mother about her day. "Mom, today in school, our class had to do a history project. Jamie, Carlos, and I worked together. Carlos and I did all the work, and Jamie didn't do anything. Carlos and I decided to tell Mrs. Carey. Jamie needed to apologize. But the best part is that Mrs. Carey really liked our work and ..." Maria's mom easily understood Maria's story.
The rapid acquisition of language is linked to the child's cognitive, social, and emotional development. Language appears to develop effortlessly for the typical child, who is neurologically ready to master the language of any culture from birth.
Receptive language is the ability to comprehend the meaning of what others say. It is a complex process. Consider the meaning of the following words and sentence:
Anne's friend was happy to see her.
It is likely that you understand the meaning of the first three words and can infer the meaning of the sentence, but true comprehension of this sentence is more than an understanding of each of the words, or the relationship between the words. Rather, it is determined by the connection between the speaker, the sentence, and the context that determines the true meaning. Word and sentence meaning is intimately linked to social content and communication cues. If, for example, Anne had recently had an argument with her friend, then the meaning of the sentence would be dramatically different than you likely assumed. Similarly, if the speaker said the sentence with an exaggerated, surprised tone of voice, the meaning also changes.
In order to comprehend language, we need to consider (a) who is talking (b) what they said, (c) how the speaker says the words, (d) how the words relate to what is happening, and (e) how the words relate to what we know about the topic. The social context contributes greatly to understanding the meaning of language.
You may be familiar with this video clip that demonstrates how complicated language can be for all people.
Expressive language is the ability to use oral and written language in a conventional way. It is a complex process, but develops rapidly and effortlessly in typically developing children. Consider when most typically developing children can say the following:
1. "Banana" - 18 months
2. "Look mama, it's a teddy bear!" - age 2-yrs
3. "Actually, I think Mickey would have more fun at the park." - age 4-yrs
4. "If you really want to go to the movies later, why don't you come over to my house after lunch?" - age 6-yrs
Expressive language develops as a result of learning (a) vocabulary concepts, (b) sentence grammar (syntax), (c) how to use words and sentences that are related to what is happening, and (d) how to use words and sentences that will be understood by the listener. Cognitive, social, and emotional knowledge are linked to meaningful expressive language use.
Communication Development in Individuals with Autism Spectrum Disorders
Communication differences are one of the diagnostic characteristics of autism spectrum disorders (ASD). Becoming familiar with the communication traits an individual with ASD may exhibit can help those supporting them increase the ability to have meaningful interactions.
A diagnosis of autism is largely driven by impaired social development and impaired communication. Communication features listed in the DSM criteria for autism (American Psychiatric Association, 2000) include:
Impaired understanding and use of nonverbal communication, such as eye gaze, facial expression and gestures
Impaired ability to understand and maintain reciprocal interaction (i.e., the give-and-take or turn-taking quality of interacting with another person)
Lack of using verbal or nonverbal means to bring, show, or point out things of interest
Impaired ability to communicate for a variety of different reasons
Impaired ability to initiate and maintain a conversation
Ritualized use of language when interacting with others
The pervasive nature of these impairments cannot be overstated. Individuals with autism are profoundly impacted by their struggle to understand how to communicate with others. They do their best to interact with others, but it looks very different from typical interactions.
Behaviors as Communication
In the absence of understanding how to communicate in conventional ways, individuals with autism use a range of positive and negative behaviors to communicate their needs and feelings. All of their behaviors, positive and negative, are communication. Laughter is communication; a temper tantrum is communication; smiles are communication; running away is communication. Saying the same word repeatedly can be communication; asking the same question, even when the answer has been given a hundred times, is an attempt to communicate. The challenge is to figure out what the individual with autism is trying to communicate through his behaviors.
This video clip shows a young child very upset when he has just woken up. Mom is trying to help him calm down and move on with his day. Then the same child is shown identifying shapes while in an extremely happy mood. He is trying to communicate something by his behavior when he awakens that his parents are trying to figure out.
Routines and Rituals as Communication
In the absence of understanding how to communicate in conventional ways, individuals with autism also seek to communicate with others in routine, ritualized ways. They are easily confused when interacting with others and, therefore, want to minimize change and maximize routines. They want you to say the same thing in specific situations, and/or they say the same thing in specific situations. They appear to experience comfort from familiar routines, including routine ways of interacting with others. This differs significantly from natural interactions that constantly change and are not predictable (for example, Do you know what I will say next?). In life, very few conversations are routine (such as the beginning of a conversation on the telephone or greeting someone in a public place), and most conversations require us to be "flexible" moment to moment. The ability to communicate in a flexible way is severely impaired in individuals with autism. They need to know what you will say next and derive comfort from the familiar routines.