Language and Communication Pre-Assessment

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Case Study: Sammy

yellow cup

Sammy has a favorite yellow cup at home that he uses for his drinks. Whenever someone at home says, "Do you want a drink?" Sammy is shown his yellow cup or he goes and gets his yellow cup from the cabinet. When Sammy is in school and someone says, "Do you want a drink?" Sammy does not seem to understand. Why? Does Sammy understand the sentence, "Do you want a drink?" The answer is yes and no. He understands the meaning of the sentence within the narrow social context of his "yellow cup" at home but does not understand the meaning in other social contexts. As a result, Sammy's parents and his school team have different opinions about what he understands.

Other factors that can influence an individual's language comprehension are:

  • Language: The length or complexity of the sentence

  • Context: The relationship between the sentence and the "here and now"

  • Speaker: The use of gestures and other nonverbal cues

  • Motivation: The individual's interest in the topic

  • Routine: The individual's familiarity with the message

It is common to observe an individual with autism who appears to understand what is said in one context or with one person and then shows confusion in another context or responding to another person. Poor generalization of language meaning is common due to a limited ability to consider all aspects of the social context and the speaker. It is easy for adults to misinterpret context-specific language comprehension as intentional noncompliance or "not paying attention" on the part of the individual with autism. This video clip shows Nicky, an extremely capable individual, struggling to understand what is being communicated in the conversation with his supervisor.

Never assume that the individual with autism understands what you say!

Receptive: Poor Comprehension of Abstract Social Concepts

Individuals with autism tend to develop an understanding of concrete words and concepts, but may have difficulty understand more abstract language whose meaning is social and relationship-based. Compare the following vocabulary:

Examples of Social concepts













Examples of Nonsocial concepts













Abstract social concepts are embedded in our language use, both spoken and written. The individual with autism struggles to understand the meaning of these words whose meaning is linked to social understanding and one's own social-emotional relationships and experiences.

Case Study: Tasha

Tasha, age 18, is trying to learn the meaning of abstract social concepts. Her teacher helps her by developing a social dictionary of social concepts. The definition for each of these words is a list of Tasha's experiences; for example, the word "change" is defined by a list of specific situations in which Tasha was told it was time for a change. As a result of developing this dictionary, Tasha is learning the narrow meaning of "change," is able to say "I don't like change," but continues to struggle to understand all the subtle factors that link all of these similar experiences. That is, the ability to generalize the meaning of abstract concepts, particularly social concepts, is very challenging for her.

Receptive: Literal

Literal is defined as comprehension that adheres strictly to the basic, concrete meaning of a word or text without interpretation; it is an unimaginative way of understanding the facts. Comprehension is literal when an individual does not consider the speaker's social cues and the relationship between what has been said and the social context. Individuals with autism are very literal. They do not understand social cues like the emotional quality of a speaker's voice or facial expression in relation to what is said. They rely on the words "out of context" or use concrete cues in the environment rather than social cues to determine what someone means. This results in constant misunderstandings and misinterpretations of what others are saying, resulting in confusion and frustration.

Problems with literal understanding can occur in response to a single word, a sentence, a conversational exchange, and written language. Consider the multiple meaning of the following message: Mary likes John. This one simple sentence could mean five or more different things, depending on the speaker's intention; the emotion in the speaker's voice; the relation between the sentence and the ongoing topic; and many other factors. Imagine the impact of always interpreting a message like this in a literal way. It would complicate an already difficult social situation for the individual.

Watch as this boy demonstrates his amazing memory and then is confused by the phrase, "Give yourself a big hand!"

Be careful what you say to a person with autism, as their perspective may be different from your own.

stop sign

In the movie Rainman, which depicts an adult person with autism named Raymond, there is a scene when Raymond stops in the middle of a busy street when the traffic signal said "STOP." Without consideration of social consequences of standing among moving traffic, Raymond responded in the most literal way.

Expressive: Echolalia in Individuals with Speech

Echolalia refers to the repetition of others' speech that may occur immediately after hearing a message or significantly later. Immediate echolalia refers to repeating a word or phrase just spoken by another person, while delayed echolalia refers to repetition of a word or phrase that was previously heard and is used at a later time "out of context". Echolalia is observed in at least 85% of individuals with autism who acquire speech (Prizant et al, 1997). Due to the prevalence of echolalia in individuals with autism, it is essential to understand this aspect of their expressive language.

Example of Immediate Echolalia:

Adult: Do you want a drink?

Child: Want a drink

Adult: Do you want a drink?

Child: Want a drink

Adult: Do you want a drink, yes or no?

Child: Yes or no?

Adult: Do you want it, say yes.

Child: Say yes

In this example, the exact repetition of the adult's last few words was the child's attempt to communicate that he wanted a drink. He is still learning language syntax/grammar, and echolalia is one of the strategies that he uses to practice language structures and learn the meaning of phrases in various situations. In this situation, echolalia served as a means to learn the meaning of a phrase, maintain social interaction, and communicate what he wanted.

Example of Delayed Echolalia:

Adult: Do you want to go outside on the swing?

Child: If you're happy and you know it

Adult: You want to sing on the swing?

Child: If you're happy and you know it

Adult: We will sing "if you're happy and your know it" while I push you on the swing, ok?

Child: Go outside?

Adult: Yes, let's go.

In this example, the child says a phrase from a song that he has heard in the past. It appears that the child's words are completely unrelated to the adult's question. However, the adult understands the child's intent and acknowledges his message as meaningful. The adult knows that the child likes to sing when on the swing. One of his favorite songs is "If you're happy and you know it." The child makes associations between words heard and specific situations and struggles to learn the meaning of these words. Here, delayed echolalia is one of the strategies he uses to communicate, although what he says and why he says it do not seem related.

Function of Echolalia

There has been extensive research into the function of echolalia for persons with autism. It is now understood that both immediate and delayed echolalia are not always rote or meaningless repetition, but are used for a variety of reasons. Both immediate and delayed echolalia can be either (a) language and communication strategies used by individuals with autism or (b) noninteractive ritualized speech. (Prizant et al, 1997)

1. Echolalia as a means to learn language and communication

Both immediate and delayed echolalia can be used as a means of learning language (both syntax/grammar and semantics/meaning) and maintaining social-communication. Immediate and delayed echolalia should be viewed and encouraged as the person's way to:

  • Learn syntax/grammar

  • Learn language meaning

  • Maintain social interaction

  • Communicate with you

Echolalia is not always meaningless repetition, but is often used in functional ways.

Focus on the communicative intent, not the echoed words, to understand what the person means.

2. Echolalia as noninteractive ritualized speech

Most individuals with autism also use immediate and delayed echolalia in noninteractive ways. The person may "talk to himself" in a highly repetitive way for a number of reasons, including:

  • Remind oneself what to do (for example, "put it away, put it away, put it away")

  • Calm oneself in a difficult situation (for example, recite the alphabet repetitively)

  • Express anxiety in a difficult situation (for example, repeats phrase previously heard in a stressful situation)

  • Withdraw from a particular situation

  • Express some other emotion

Several factors increase the likelihood of hearing noninteractive echolalia. For example, noninteractive echolalia is more likely to be used in unstructured or overwhelming situations, with new people or situations, during emotionally stressful situations, and when a person is experiencing language comprehension difficulties. The following video clip shows a young boy making every effort to understand what his mom is asking, including using echolalia to try to increase his comprehension.

A person's use of echolalia sometimes signals the need to modify the environment, simplify what you say, and be mindful of the person's emotional state.

Expressive: Verbal Rituals in Individuals with Speech

Repetitive, ritualized behaviors are a dominant characteristic in autism. Verbal rituals are defined as any use of language that is repetitive, insistent, and often expressed with intense emotion. Verbal rituals include some forms of echolalia (previously discussed), as well as perseverative speech and incessant questioning. Perseverative speech is described as persistent repetition of a word, phrase, or topic with no clear communicative intent. Incessant questioning is repeatedly asking one or more questions and persisting even after the question has been answered multiple times.

These verbal rituals, like other ritualistic behavior, can occur for a variety of reasons, including:

  • An individual's best effort to interact with others

  • The individual's expression of anxiety

  • The individual's means calm himself

  • An expression of poor inhibition

car ride

Example of Perseverative Speech:

Child: (child recites a few lines from a favorite story book continuously, without pause)...

Situation 1: Riding in the car with his father

Situation 2: Waiting to see the doctor with his father

In the first situation, the perseverative speech appears to be an expression of poor inhibition and has no social or communicative value. In the second situation, the child's perseverative phrases are spoken with high emotion, and the father senses his son's anxiety about the doctor visit.

Focus on the emotion and the context, not the perseverative words, to understand what the person means.

chocolate milk

Example of Incessant Questioning:

Child: "Do we have chocolate milk for lunch?"

Situation: Asked repeatedly every morning in school

In this example, the school team determined that the reason for the incessant questioning was related to the child's fears. In this situation, the child is anxious about the school schedule, uncomfortable in the school lunch room, and the fact that the only food that is consistent at every lunch is chocolate milk. So, his intent is to express anxiety about school lunch and he uses incessant questioning in an attempt to cope with the situation.

Verbal rituals for persons with autism can occur for a number of reasons, including:

  • Calming oneself in a difficult situation

  • Expressing anxiety in a difficult situation

  • Withdrawing from a particular situation

  • Expressing some emotion

Several factors increase the likelihood of hearing verbal rituals. For example, they are more likely to be used in unstructured or overwhelming situations, with new people or situations, during emotionally stressful situations, and when a person is experiencing any learning difficulties.

A person's use of echolalia sometimes signals the need to modify the environment, simplify what you say, and be mindful of the person's emotional state.

Expressive: Benefits of Augmentative and Alternative Communication (AAC) for Non-Speaking Individuals

pecs use

Approximately 30% or more of individuals with autism remain nonspeaking, although this statistic is continuously changing due to advances in early diagnosis and treatment. A nonspeaking individual is either mute or, in some instances, says an occasional word inconsistently. Some nonspeaking individuals are unable to use speech as a means of communication, but are able to learn to use an alternative language such as sign language, a symbol-based language, or written language. Other nonspeaking individuals learn to use more basic symbols as a means of communication, such as photographs or other graphic icons. These alternatives to speech are called augmentative and alternative communication (AAC) systems and include voice-output communication devices. There are four examples of AAC usage on the next page.

Benefits of using AAC systems with nonspeaking individuals include:

1. Increased communication competence

2. Increased rate of developing speech in comparison to those who do not use AAC systems

3. Decreased rate of problem behaviors associated with poor communication skills

The ritualized nature of autism is observed in their language use. This is true for both the verbal individuals and the person with no speech. Regardless of what AAC system is taught to a nonspeaking individual, persons with autism may be driven to engage in repetitive, ritualized behaviors.

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