Max is 10 years old. His conversations with others are always about where a person lives. Max has memorized the map of his city and always begins a conversation with another person with the question, "Where do you live?" When the person tells him, Max then gives her detailed directions from their house to his own. He then walks away and finds another person to repeat the same question/conversation. Max enjoys interacting with others about "directions," but his ritual is rarely mutually enjoyable, and his ability to engage in other topics of conversation is limited.
Difficulty Understanding Nonverbal Communication
Individuals with autism have difficulty understanding the meaning behind the social and emotional communication of others. They may only notice extreme expressions of emotion and miss subtle social and emotional messages. They easily misinterpret the meaning of these messages, making incorrect associations between a person's nonverbal communication behavior and the context.
Anne likes to climb, and frequently climbs up on the furniture in school and home. At home, her father goes over to Anne and, using his pointer finger, sternly says, "get down," and then helps her down. Anne liked her dad's attention, and did not interpret his stern voice or finger point as discipline, but rather playful. As a result, Anne started to climb more often on the furniture at home and school for the attention, and got excited when an adult told her to "get down." Anne was not doing the behavior because she wanted to be naughty; rather, she was doing it to have a "fun" interaction (as she perceived it).
Researchers are unsure of the exact reason, but studies suggest that children with autism have less understanding and ability to "read" facial expression and other emotional cues (Baron-Cohen, 1995) and may be highly sensitive and even averse to different social stimuli due to unusual sensitivities to sound, touch, and movement (Greenspan, 1995). The natural "curiosity" about people and social activity that you see in typically developing infants is either lacking or different in individuals with autism.
Consider the following scenario:
You go to another country and don't understand or speak the language. You need directions to a location and must rely on a nonverbal (not spoken or written language) interaction, using body language and gestures to get the information you need. Now imagine that you don't understand the nonverbal body language and gestures of the other person, and you need directions. This begins to resemble the social experiences and challenges of individuals with autism.
The meaning of eye gaze, facial expressions, and emotional expressions is difficult for individuals with autism to understand.
Difficulty with Reciprocal Interaction
Reciprocal interaction, by definition, means "back-and-forth interaction," "taking turns" and "sharing experiences." Reciprocal interaction can occur with and without language. Whenever two or more people are communicating, they take turns initiating a new idea, responding to what another person says or does. The "dance of interaction" seems to happen effortlessly. When interacting with an individual with autism, you may have the feeling that you are working very hard to get the person's attention, get a response, and maintain the interaction. At other times, you may find that the person with autism seems to have a single agenda when interacting with you (have her needs met) and is not interested in what you say or do. Other children seem to respond well to you, but the interaction never seems to go beyond the first question and answer.
At best, the "dance of interaction" between you and a person with autism often feels out-of-sync or different. Your personal experiences are real, and the person with autism is overwhelmed by the process of reciprocal interaction.
Case Study: Zachary
Zachary, age 13, had a lot of language skills but struggled to interact with others. He would typically begin talking without first getting someone's attention, so it looked like he was talking to himself. His teachers taught him to both (a) tap someone on the wrist and (b) say "excuse me" before talking. While Zachary was quick to learn this communication skill, unfortunately he could not understand when to use it and when not to use it. As a result, he was constantly tapping someone's wrist and saying "excuse me." One night at 3 am, Zachary needed to tell his mother something. To do so, he went over to her bed and pulled down the covers in search of her wrist. Once he found it, he tapped her on the wrist, said "excuse me," and then asked for help. His mom found him to have a fever. Although Zachary got his mom's attention, this is not the most effective way in this situation. The way he engaged with others, regardless of the social situation, was always done in precisely the same way.
Difficulty Bringing, Showing, or Pointing
One of the core symptoms defining social and communication impairments in autism is "a lack of spontaneous seeking to share enjoyment, interests or achievements with other people" (American Psychiatric Association, 1994, p. 70). The key terms are "spontaneous" and "sharing"; that is, individuals with autism are more able to request what they want or don't want and less able to initiate interactions with others to talk about what they are doing or what another person is doing. Similarly, there is a marked difference between their use of gestures to communicate what they want and sharing interests with others. For example, the individual may point to a book that he wants but is less likely to point to a picture in the book as a means of showing someone what he sees. The difference between communicating to request and communicating to share, or to have joint attention, is an important distinction in individuals with autism. Asking for something is a way to have a personal need met while sharing ideas is for social enjoyment.