Wednesday, February 9, 2011

Communication and language in Autism

Children with ASD have problems with communication and language. This can be delayed or undeveloped spoken language; an impairment in the ability to initiate or sustain a conversation; idiosyncratic language; or a lack of spontaneous make-believe play or social imitative play.

Communication is not the same as language. With non-verbal children we have to be aware that ALL behaviour is a form of communication. We therefore have to be aware that although a child has no language, they will be communicating their intent to us and we should recognise and honour that communication.

There are many forms of communication:
  • Self-injurious behaviour
  • Aggressive behaviour
  • Tantrums
  • Idiosyncratic speech and gestures
  • Need for proximity to an object or person
  • Re-enactments of previous events
  • Facial expressions
  • Gaze and Gaze shift
  • Physical manipulation
  • Echolalia (repetition of speech or sentences immediately after hearing or repeating of previously heard speech out-of-context)
  • Conventional gesturing
  • Sign Language
Children with ASD will often express communication behaviourally instead of verbally. When a child is not able to express a "protest" effectively they will resort to protesting behaviourally. Therefore a behavioural issue on the surface is probably a communication issue.

Behaviour when used as a form of communication has four functions:
  • Escape or avoidance (I DON'T WANT..)
  • Sensory avoidance or seeking
  • Attention (gain or escape, usually gain via a social bid)
  • Tangible (I WANT...)
The function of communication is to give information, make observations and change the immediate environment.

The sequence of language development is:
First: the notion of communication
Second: Non-verbal communication (pre-language)
Third: Language

We have to understand that communication ALWAYS pre-ceeds language, even in children with ASD, therefore we should NEVER try to reverse the process by stressing language development at the expense of communication. We should strive to supply the words to a non-verbal request. Comprehension also comes before meaningful comprehension. In order for words to be used meaningfully by a child they must first comprehend what they are saying. It is possible to speak without meaning, i.e. echolalia or meaningless repetition.

We have to be aware that individuals with Asperger's Syndrome although appear to have normal language, do not. It is common to overstate their abilities due to their level of language and assume competence.

One of the most important issue to realise that, in all the features of language, it is the pragmatic elements that are most impaired in children with ASD. There are three crucial area of Pragmatic knowledge:
  • The ability to employ speech acts to express intentionality in order to accomplish a given purpose
  • The ability to make judgements about the listener's needs and capabilities and regulate our speech style.
  • The ability to apply the rules of discourse in order to engage in co-operative conversational exchanges.
People with ASD have difficulty what the listener needs to know as information during the conversation so therefore may start the conversation in the middle of an idea. They will also fail to regulate the style or content of their speech to fit the situation.

People with ASD will also violate the Four Maxims of conversational interaction
  1. Quantity - the rule of being informative without being verbose. People with ASD will speak non-stop with no regard to social distress of the listener
  2. Quality - the rule of being truthful. Confabulation (filling in the gaps with false information which the speaker believes to be true) is a sign of difficulty with this maxim
  3. Relevance - the rule to contribute only the information with is pertinent to the topic.
  4. Clarity - the rule that the information conveyed is clear and understandable by the listener.
The Receptive Communication deficits of children with ASD are:
  • Early semantic concepts of recurrence, non-existance and agent-object relations
  • Complex or long directions
  • Simple unfamiliar directions
  • Verb tenses
  • Variations in word order
  • Negatives
  • words other than nouns and verbs
  • words that appear early in a sentence (usually due to processing delays)
  • Abstract concepts such as "truth" or "happiness"
  • Multiple meaning words
  • idioms or other figures of speech
  • Wh questions
  • conjunctions such as because, if, or, so
  • Pronouns (I, we, him,you)
  • Relative pro-nouns (here, there)
Please see this link on how to communicate with verbal Autistic children:

Tthe "Picture Exchange Communication System (PECS). This is a way for a non-verbal child, (or a verbal child who has decreased language because of an overwhelming environment) to be able to communicate their needs. It has been shown that instead of hindering language, the PECS system actually facilitates the growth of language.

The PECS system teaches the child to:
  • Locate a communication partner
  • Present a picture for a desired item
  • Get the item in exchange for the picture
  • The exchange is intentional
  • Initiative is taught
  • Is a child centred approach
The PECS system should follow the child's level of comprehension of reality regarding the item. A line drawing of an object maybe beyond a child's level of understanding, if this is the case, then the PEC symbol should then be downgraded to an actual photograph. Likewise, if an actual photograph is beyond a child's comprehension then you shouldn't use a "picture" but the actual object. The development of comprehension of symbols is as follows (1-8):
  1. Actual Object (then miniature)
  2. Similar object
  3. Photograph of actual object
  4. Photograph of similar object
  5. Colour line drawings
  6. Black line drawings
  7. Pictorial Symbols (PCS)
  8. Written words
There are 6 stages in the PECS system. Below is an indication of how the PECS system works. Remember you need to be specifically training in how to preform the PECS system.
Phase One:
There are usually two people helping the child; the Communicative partner (the person the child should make the request to) and the physical prompter (the person who give physical prompting if required). During stage 1-2 there should be no verbal prompting because the phrase, "what do you want?" will become intrenched and will not facilitate the child's independence in requesting what they want. They will always wait for the verbal prompt instead of initiating the request. A preferred item is placed before a child, the natural response is for the child to grab the item. The physical prompter will move the child's hand to the PEC symbol and then hand the PECS symbol to the communicative partner. The communicative partner will respond as if he/she has been asked for the item, and then hand the item to the child. This stage is complete when there in no physical prompt.
Phase Two:
The communicative partner will move away from the child. The child should move towards the PEC and then move towards the partner. If there is reluctance then a physical prompt is implemented.
Phase Three:
Discriminating training. A child is asked to choose between a preferred and a non-preferred item. The child should choose the PEC of the preferred item. If the non-preferred PEC is chosen then the child should be given the non-prefered item. Always ensure the correct item is delivered with the correct PEC
Phase Four:
Sentence strip. The child should place the PEC symbol on a board with "I WANT.." preceding the PEC symbol. The whole sentence strip including the PEC symbol should be handed to the partner.
Phase Five:
The sentence strip should be given in response to a question: "What do you want?"
Phase Six:
The sentence strip should now include commentary or explanatory information; i.e "I SEE.." or "I WANT BLUE CANDY"

1 comment:

  1. This blog has given me is much more knowledge on the autistic spectrum. I've recent become a SEN teaching assistant and find myself learning something new everyday. This information will defiantly help my further practice.

    Do you have any useful sites that could help with the visual learning of an autistic child?