Communication in Autism
 How
Do Speech and Language Normally Develop?
What
Causes Speech and Language Problems in Autism?
What
Are the Communication Problems of Autism?
How
Are the Speech and Language Problems Treated?
What
Research Is Being Conducted?
How Do Speech
and Language Normally Develop?
The most intensive period of
speech and language development is during the first three years of life, a
period when the brain is developing and maturing. These skills appear to
develop best in a world that is rich with sounds, sights, and consistent
exposure to the speech and language of others. At the root of this
development is the desire to communicate or interact with the world.
The beginning signs of communication occur in the first few days of
life when an infant learns that a cry will bring food, comfort, and
companionship. Newborns also begin to recognize important sounds such as
the sound of their mother's voice. They begin to sort out the speech
sounds (phonemes) or building blocks that compose the words of their
language. Research has shown that by 6 months of age, most children
recognize the basic sounds of their native language.
As the speech mechanism (jaw, lips, tongue, and throat) and voice
mature, an infant is able to make controlled sound. This begins in the
first few months of life with "cooing," a quiet, pleasant,
repetitive vocalization. Usually by 6 months of age an infant babbles or
produces repetitive syllables such as "ba, ba, ba" or "da,
da, da." Babbling soon turns into a type of nonsense speech called
jargon that often has the tone and cadence of human speech but does not
contain real words. By the end of their first year, most children have
mastered the ability to say a few simple words. Children are most likely
unaware of the meaning of their first words, but soon learn the power of
those words as others respond to them.
By 18 months of age most children can say 8 to 10 words and, by age 2,
are putting words together in crude sentences such as "more
milk." During this period children rapidly learn that words symbolize
or represent objects, actions, and thoughts. At this age they also engage
in representational or pretend play. At ages three, four, and five a
child's vocabulary rapidly increases, and he or she begins to master the
rules of language. These rules include the rules of phonology (speech
sounds), morphology (word formation), syntax (sentence formation),
semantics (word and sentence meaning), prosody (intonation and rhythm of
speech), and pragmatics (effective use of language).
What Causes
Speech and Language Problems in Autism?
Although the cause of speech
and language problems in autism is unknown, many experts believe that the
difficulties are caused by a variety of conditions that occur either
before, during, or after birth affecting brain development. This
interferes with an individual's ability to interpret and interact with the
world. Some scientists tie the communication problems to a "theory of
mind" or impaired ability to think about thoughts or imagine another
individual's state of mind. Along with this is an impaired ability to
symbolize, both when trying to communicate and in play.
What Are the
Communication Problems of Autism?
The communication problems of
autism vary, depending upon the intellectual and social development of the
individual. Some may be unable to speak, whereas others may have rich
vocabularies and are able to talk about topics of interest in great depth.
Despite this variation, the majority of autistic individuals have little
or no problem with pronunciation. Most have difficulty effectively using
language. Many also have problems with word and sentence meaning,
intonation, and rhythm.
Those who can speak often say things that have no content or
information. For example, an autistic individual may repeatedly count from
one to five. Others use echolalia, a repetition of something previously
heard. One form, immediate echolalia, may occur when the individual
repeats the question, "Do you want something to drink?" instead
of replying with a "yes" or "no." In another form
called delayed echolalia, an individual may say, "Do you want
something to drink?" whenever he or she is asking for a drink.
Others may use stock phrases such as, "My name is Tom," to
start a conversation, even when speaking with friends or family. Still
others may repeat learned scripts such as those heard during television
commercials. Some individuals with higher intelligence may be able to
speak in depth about topics they are interested in such as dinosaurs or
railroads but are unable to engage in an interactive conversation on those
topics.
Most autistic individuals do not make eye contact and have poor
attention duration. They are often unable to use gestures either as a
primary means of communication, as in sign language, or to assist verbal
communication, such as pointing to an object they want. Some autistic
individuals speak in a high-pitched voice or use robot-like speech. They
are often unresponsive to the speech of others and may not respond to
their own names. As a result, some are mistakenly thought to have a
hearing problem. The correct use of pronouns is also a problem for
autistic individuals. For example, if asked, "Are you wearing a red
shirt today?" the individual may respond with, "You are wearing
a red shirt today," instead of "Yes, I am wearing a red shirt
today."
For many, speech and language develop, to some degree, but not to a
normal ability level. This development is usually uneven. For example,
vocabulary development in areas of interest may be accelerated. Many have
good memories for information just heard or seen. Some may be able to read
words well before the age of five but may not be able to demonstrate
understanding of what is read. Others have musical talents or advanced
ability to count and perform mathematical calculations. Approximately 10
percent show "savant" skills or detailed abilities in specific
areas such as calendar calculation, musical ability, or math.
How Are the
Speech and Language Problems Treated?
If autism or some other
developmental disability is suspected, the child's physician will usually
refer the child to a variety of specialists, including a speech-language
pathologist, who performs a comprehensive evaluation of his or her ability
to communicate and designs and administers treatment.
No one treatment method has been found to successfully improve
communication in all individuals who have autism. The best treatment
begins early, during the preschool years, is individually tailored,
targets both behavior and communication, and involves parents or primary
caregivers. The goal of therapy should be to improve useful communication.
For some, verbal communication is a realistic goal. For others, the goal
may be gestured communication. Still others may have the goal of
communicating by means of a symbol system such as picture boards.
Treatment should include periodic in-depth evaluations provided by an
individual with special training in the evaluation and treatment of speech
and language disorders, such as a speech-language pathologist.
Occupational and physical therapists may also work with the individual to
reduce unwanted behaviors that may interfere with the development of
communication skills.
Some individuals respond well to highly structured behavior
modification programs; others respond better to in-home therapy that uses
real situations as the basis for training. Other approaches such as music
therapy and sensory integration therapy, which strives to improve the
child's ability to respond to information from the senses, appear to have
helped some autistic children, although research on the efficacy of these
approaches is largely lacking.
Medications may improve an individual's attention span or reduce
unwanted behaviors such as hand-flapping, but long-term use of these kinds
of medications is often difficult or undesirable because of their side
effects. No medications have been found to specifically help communication
in autistic individuals. Mineral and vitamin supplements, special diets,
and psychotherapy have also been used, but research has not documented
their effectiveness.
What Research
Is Being Conducted to Improve the Communication of Individuals with
Autism?
In addition to ongoing research
on other aspects of autism across the National Institutes of Health (NIH),
researchers at the National Institute on Deafness and Other Communication
Disorders (NIDCD) are also investigating the communication difficulties or
differences of people who have autism. At the heart of the research effort
is a five-year collaborative NIH effort between the NIDCD and the National
Institute of Child Health and Human Development (NICHD) which was launched
in May 1997. The effort involves more than 65 scientists at 24
universities from around the world, including the United States, Canada,
Britain, France, and Germany, who are examining how autism develops. In
addition, scientists are also exploring the speech and language features
in autism, evaluating current treatment practices, and designing new
treatments. Additional studies include investigations of brain development
and functioning in autism and the use and effects of certain drugs on
communication behavior.
This article was originally produced by the National
Institute of Child Health and Human Development. Excerpts are
reprinted here with permission.
October 1998
NIH Pub. No. 99-4315
For More Information Go
To:
Autism (Fact Sheet)
About Attention Deficit Disorder
Asperger’s Syndrome: A Developmental Puzzle
Current Research On Autism
Language Development
Books available from Amazon.com:
Activity
Schedules for Children With Autism : Teaching Independent Behavior (Topics
in Autism)
Behavioral
Intervention for Young Children With Autism : A Manual for Parents and
Professionals
Unraveling
the Mystery of Autism and Pervasive Developmental Disorder: A Mother's
Story of Research and Recovery |
