Core Features of Autism - Communication
by Dr Avril Brereton
Communication problems are present in all children with autism. It
is one of the core symptoms that must be present if a child is given
the diagnosis of autism.
The DSM–IV criteria for
communication impairment in autism are:
Qualitative impairments in
communication as manifested by at least one of the following:
- Delay in, or total lack of, the
development of spoken language (not accompanied by an attempt to
compensate through alternative modes of communication such as
gestures or mime);
- In individuals with adequate
speech, marked impairment in the ability to initiate or sustain
a conversation with others;
- Stereotyped and repetitive use of
language or idiosyncratic language;
- Lack of varied, spontaneous
make-believe play or social imitative play appropriate to
developmental level.
(American Psychiatric Association:
Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition, Text Revision. Washington, DC, American Psychiatric
Association, 2000)
Communication problems in children
with autism present in a number of different ways with different
outcomes according to the problem type and severity. Some children
have severe communication problems and do not speak at all. Other
children have very delayed and unusual speech that makes it
difficult for them to make themselves understood. A smaller group
of children have superficially better speech but they still have
problems knowing how to use language to communicate well with other
people.
Recently, more attention has been paid
to the effects of communication problems on children’s behaviour.
It is important that parents and professionals understand the type
and severity of the communication problems a child has, in order to
work out more effective ways of communicating together and also
finding possible explanations of behavioural problems that may be
linked with communication problems.
VERBAL CHILDREN
Some young children with autism will
acquire functional speech. Typically, they will begin to speak
later than is normal and will acquire speech more slowly and
unevenly. A distinction is made between the ability to speak and
‘functional speech’ because some children use words but the words
are not used to communicate effectively and therefore are not seen
as being functional.
Expressive language problems
- Development of speech may occur
very slowly and some previously learned words may disappear once
learned.
- Speech may come in chunks or
complete sentences may be spoken out of the blue.
- Echolalia, the repeating of words
and phrases, may be present in a number of forms. For example,
the child may immediately repeat what you have just said to
him/her. Echolalia may also be delayed, with the child repeating
a word or phrase heard previously. Echolalia may also be
mitigated, with the child using some repeated words but adding
some of his/her own to get his/her message across.
- The same word or sound may be
repeated over and over.
- A word may be used out of context
or a made up word used for a particular object.
- Pronouns are often reversed and
confused.
- Tone, pitch and modulation may be
unusual. The child’s voice may sound flat, may have an unusual
accent or may be too loud or too soft.
Receptive language or
comprehension problems
- Difficulty understanding the
meaning of what others say.
- Difficulty understanding a
sequence of instructions.
- Lack of understanding of
metaphor, e.g. “shake a leg”.
- Literal use of language and
interpretation of what others say, e.g. “pull your socks up”.
There is also a range of difficulties
that verbal children have with conversation. Children with autism
usually have difficulty attending to other people. Conversation
relies on two people listening to each other and taking turns to
speak. For children with autism, this is a particular problem.
Although they may have a lot of useful speech, they do not speak
conversationally. The child with autism is more likely to talk at
you rather than with you. Initiating and sustaining a conversation
are also areas of difficulty. Some verbal children may have special
topics they want to talk about to the exclusion of all else, or may
bombard you with questions that no answer you give seems to satisfy.
NON-VERBAL
CHILDREN
Some children with autism do not
acquire functional speech. It is still not clear why this is so.
Some argue that it is because children with autism have such strong
underlying social deficits and problems with joint attention.
Others argue that it is because in autism there is a basic lack of
understanding that people have thoughts and feelings that can be
related to in the first place. Whatever the cause, children who are
non-verbal must be able to convey their needs and desires to others
in some way other than speech. It is important to assess how the
non-verbal child expresses his/her needs and gets his/her message
across to others.
Improving Non-verbal Communication
using Augmentative systems.
Follow up studies have shown that for
most children with autism who do not have useful speech by about the
age of 7 years, it is likely that their ability to communicate
verbally will remain severely impaired. It is important for these
children to have some form of augmentative communication system.
Augmentative communication helps children who don’t have speech to
communicate by using other systems. These systems are called
“augmentative” because they augment or increase the strength of the
child’s power to communicate. Simple pictures and line drawings
such as Compic® or PCS/Boardmaker®, signing systems such as Makaton
and also photographs are often used to augment communication for
children with autism.
1. Signing
Signing was probably the first
alternate system used with non-verbal children with autism. At
first, the signing systems used by the deaf were taught, but these
are complex systems that require finger spelling of words and use
abstract concepts. In the early 1980’s, a simpler system called
Makaton was devised to use with children with intellectual
disability. This system has varying degrees of difficulty, but at
its earliest level, signs are simple, concrete and do not require
difficult finger spelling. Many of the first signs use only one
hand. For example, the sign for ‘drink’ uses one hand in the shape
of a cup that is lifted to the mouth and tilted as if the child were
having a drink.
One advantage of signs is that they
are very portable and do not require the child to carry around
equipment. Another advantage of establishing a signing system is
that it has been found to encourage speech in children contrasting
to what some parents fear, that signing might reduce the chance of
their child talking. However, signing is not widely understood in
the community and the child may not always be well understood
outside the circle of those who can sign with him/her. Signing also
requires that the child attends to the person teaching the signs and
is able to imitate an action.
2. Pictographs (line drawings)
There are a range of computer
generated pictographs that are available and in use in Victoria,
including Compic® and PCS/Boardmaker®. These pictures consist of
simple and clear line drawings that represent a wide range of
objects, actions and feelings. They can be used initially at a very
simple, but practical level with young children who learn to point
at the picture or show the picture to indicate their needs. When
children are familiar with a number of these pictures, they can be
put into a wallet/book of pictures that the child carries with
him/her and uses to indicate his/her needs. The child gradually
builds up a vocabulary of pictures to meet his/her own special
needs.
Pictographs are widely available in
both computer software and loose-leaf book formats. Pictographs are
easily understood by everyone and do not require the child to learn
and remember complex actions, as does signing. Children who have
low cognitive skills can generally use a picture system in a simple
way to communicate more effectively.
3. Photographs and Objects
Photographs of objects, activities and
people in the child’s world can also be used effectively with low
functioning children who cannot master the use of symbols or line
drawings. Use of photographs usually requires that the child first
learns to match an actual object with an exact photograph of the
object. The child learns that the photograph represents the
object. The photograph must be simple, clear and uncluttered.
After the child has learnt to match photographs and objects, the
more complex concept of matching photograph and activity or action
can be taught.
Once the child is able to recognise a
number of photographs, a photo vocabulary can be built up in the
same way as a pictograph vocabulary. Photographs can be used to
help the child understand timetables or the steps involved in
completing an activity. For example, the playroom may have
photographs of the day’s activities pinned to the wall. When each
activity finishes, the child may put away that photograph.
Similarly, when the child is required to get dressed, the steps
involved may be pinned to his/her bedroom door in the correct
sequence and easily followed.
Objects can be used in a similar way
to photographs with children who have difficulty understanding
photographs. Object time-tables are useful. Objects that represent
activities can be laid out or stuck on the wall to show the child
what happens next. For example, a crayon means work at the table,
and the next object is a juice box straw to indicate that snack time
comes after work.
A great advantage of photographs and objects is that the child can
attend to them for as long as he/she needs to, and also return to
them to refresh his/her memory. This is not possible with a hand
sign which is gone once it has been demonstrated.
4. Picture Exchange Communication
System (PECS)
The Picture Exchange Communication
System (PECS) (Frost and Bondy, 1994) is another augmentative
communication system. Developed in the early 1990s, PECS is widely
used in early intervention and school programmes to teach children
how to initiate communication. An advantage of this system is that
it does not require complex or expensive materials and can be used
in a variety of settings by parents, carers and teachers. PECS
begins with teaching a student to exchange a picture of a desired
item with a teacher who immediately honours the request. Verbal
prompts are not used. Once this step is mastered, the system goes
on to teach discrimination of symbols and later simple "sentences”
are made from stringing together these symbols. Children can also
learn to comment and answer direct questions using the Compic system
symbols.
Each child must be carefully assessed
to determine which system will suit best. The majority of children
with autism have delayed imitation skills but better developed
visual recognition skills. Therefore a picture based system may be
more suitable than a signing system. Ultimately, the choice of
system to help improve the child’s communication will depend upon
his/her level of cognitive and language ability and developmental
profile of strengths and weaknesses.
|
