Communication in Autism

Understanding the link between autism and communication challenges can help a parent figure out how to help a child with autism. While a number of communication difficulties are common in pervasive developmental disorders, the right treatment plan can make a positive difference.


What Is Autism?

The brain disorder autism begins in early childhood and persists throughout adulthood affecting three crucial areas of development: verbal and nonverbal communication, social interaction, and creative or imaginative play.

Autism is the most common of a group of conditions called pervasive developmental disorders (PDDs). it involve delays in many areas of childhood development. The first signs of autism are usually noticed by the age of three. Many individuals who are autistic also develop epilepsy, a brain disorder that causes convulsive seizures, as they approach adulthood. Other characteristics may include repetitive and ritualistic behaviors, hand flapping, spinning or running in circles, excessive fears, self-injury such as head banging or biting, aggression, insensitivity to pain, temper tantrums, and sleeping and eating disturbances. Autistic individuals live a normal life span, but most require lifelong care and supervision.

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 Common Problems of Autism?

Every person experiences autism differently and not everyone experiences the same set of symptoms. Autism is generally diagnosed in early childhood. Parents will notice a certain set of communication impairments.
Common autism communication problems can include:

• Social Skills Problems: The child may have difficulty interacting with others. He may prefer solitude and show no interest in making friends. Or he may want to make friends but does not know how to approach others and hold appropriate conversation.

• Verbal and Language Challenges: He displays a poor response to verbal instruction or misunderstands verbal speech.

• Speech Limitations: The child has limited to no verbal speech or unusual speech patterns. If he has speech, he has trouble sustaining a two-way conversation. He may seem to talk at people during a conversation.

• Echolalia: He might have patterns of repeating a word or phrases out of context. For example, he may hear a phrase on TV and then hours later repeat it.

• Mindblindness: He may have problems understanding the emotions of others and respond inappropriately. The difficulties understanding emotional responses can lead to misunderstandings in communication and social situations.

• Sensory Issues: There may be certain sounds, tastes or sights that bother him or provoke an unusual response. His response may not make sense to others and he does not know how to communicate the reasons for the response.

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 Parents can do to Help

Parents can improve autism and communication difficulties by learning as much as possible about autism and the latest treatment options. They should pay close attention to how their child responds to different therapies and situations to figure out how the child best communicates and learns. The parents need to work closely with therapists, doctors and teachers. All of these things can help parents advocate for their child to find the best solution for his specific needs.

A child's rate of improvement depends upon the level of impairment, which can vary greatly in autism. Yet, once parents find the right treatment plan for their child, significant improvements in communication skills are possible.