Communication in Autism Spectrum Disorders

Most people consider individuals diagnosed with Autism Spectrum Disorders (ASD) to have a social communication impairment. People with ASD do struggle socially for a variety of reasons. They struggle due to a difficulty in language processing. My discussion here of some of the types of language processing issues experienced by people on the autism spectrum will only scratch the surface. Language perceptual difficulties, however, are only part of the social communication story. People with ASD often find their perceptual difficulties and heightened levels of anxiety significantly affect their ability and their willingness to interact with other people.
When we talk about Language we often talk about it in terms of:
1. Language Form – how we put the words together in a grammatically correct fashion
2. Language Content -the words we select to convey the message
3. Language Use – how the message is conveyed in terms of tone of voice, eye contact, facial expression, the use of gesture etc.
In Autism there can be an impairment in all three aspects of language.
Children with ASD often have difficulty with the use of pronouns. Think of how provocative it is for a child who confuses the use of “ you” and “I” to say to a teacher “You hit my hands on the desk” when he meant to say “I hit my hands on the desk (and I know you don’t like it)”. The consequences for the latter statement are far less serious than the former but a statement like this could potentially do some very real harm to the rapport between this child and their teacher so insight into how a child communicates is very important. This can be fostered by having honest and open communication between home and school.
Children will ASD can often use delayed echolalia to convey a message. Delayed echolalia simply means repeating something you have heard some time later. It may be hours later or even several weeks. Take the example of a child who wants you to get to the end of a story telling task you are wanting him to participate in. He may say over and over “Did you like this book, if so go to the ibook store and select another”. Why is he saying this? In his mind this is what is said at the end of any book task connected with the computer, so his purpose is to convey “Can we finish now?” He is using something he has heard in conjunction with what he would like to happen to convey his message. Often we do not feel we know why a child is saying something but if we try to look at what he might be trying to say we are likely to have more of a clue.
The notion of common understanding is also very difficult for children on the spectrum. Common understanding simply refers to a mutual understanding of the reason why you are doing what you are doing. If you are making afternoon tea and say to your child with ASD “Go and ask Aunty Mary if she would like sugar in her coffee”, it is likely he/she will not return to say what Aunty Mary has said because the reason why you want to know this information is not clear to your child. If you want your child to come back and tell you what Aunty Mary’s answer was you are going to have to say “Go and ask Aunty Mary if she would like sugar in her coffee and come back and tell me what she says”. We NT’s (neurotypical individuals) learn common understanding by observing, but this is not the way children with ASD learn the purpose of why we do things.
Some Children with ASD have enormous difficulty recognising feelings. They also have enormous difficulty recognising their own feelings and the degree to which they are feeling them. As they are not aware of their anxiety building, they may not do anything until it has reached an intolerable level and then they may lash out by throwing something or hitting etc. When working on feeling recognition with children who have ASD, it is better to work on encouraging the child with to recognise his/her own feelings before they move onto recognising the feelings of others. One program which does this very well for older high functioning 8-12 year olds is the SAS Program. The Hanen “Talkability” Program addresses ways younger children can be made more aware of the feelings of others and gives strategies for talking about these feelings.
Our language is so puzzling for children on the spectrum. Why do we say” Wipe your feet” when we mean “Wipe your shoes”, or “Are you able to pass the pepper?” when we mean to do the action and actually “Pass the pepper” or “Have you tidied your room?” when we mean “If you haven’t tidied your room you had better do it now?” For individuals with ASD who interpret what we say based on what we have said, rather than how we say it, not matching our words to what we really mean can be confusing and anxiety provoking.
Individuals with ASD are not able to process the information conveyed in our body language the same way as we do so they may not benefit from facial expression clues, tone of voice or gesture in the same way. You are not necessarily making your message clearer to the child with ASD by accompanying it with gesture. They are likely to interpret what you are saying literally and ignore the gesture. So if you say to a child with ASD “Hi, welcome, come and sit here” and indicate with your arm where to sit, the child with ASD may hear “Sit here” and sit in the doorway. In a research task, when children with ASD were asked to imitate tapping with emotion they simply tapped, while the children without ASD were able to imitate the emotional content of the task by tapping angrily or happily.
When neurotypical children (NT’s) learn language they use a term to describe many different things. For example many children refer to anything to do with water as “bah”. So the tap, the sink, the bath, the shower and the toilet are all referred to as “bah”. The child with autism may use a word for a very specific thing. For example, the child with ASD may use the word “horse” to describe a tall, white horse in Aunty Kate’s paddock. Any horse of another size, colour or shape may not be considered to be a horse. To the child with ASD these other horses are simply some different entity. This is because children on the spectrum notice the details of the object more than the object itself. They do not see the entire forest, they see each individual tree. Think of the memory space you would need to have a different name for every different kind of object. Knives would not be collectively termed knives, there would be different names for the bigger carving knives to the serrated knives to the bread and butter knives to the shiny knives, the plastic knives, the coloured knives, the ones with wooden handles and the list would go on. Having different names for every individual example of an object group is not practical, so children with ASD need help with their sorting and classification skills. For the child with different names for different horses, a task might be let’s find all the horses and later let’s find all the animals, clothes, furniture etc. You need to help the child with ASD see the similarities between objects as they are very good at telling the differences even when two objects appear to be identical to us.
Because of their ability to notice things in minute detail, children with ASD may only see a part of an object or individual elements. Children with ASD are not good at facial recognition because they may not be taking note of the whole face. What they might see are the angle of the eyebrows, the arrangement of freckles on the nose, the frown lines etc. so how they recognise familiar people might be very different to the way we do.
Our society values eye contact but looking into someone’s eyes can be quite anxiety provoking for a child with ASD. It is often better to work side by side with someone with autism and they can look at us when they are comfortable. We need to be careful when teaching children with ASD about eye contact because there are fine differences in our society between looking and staring and there are different consequences for looking versus staring in different contexts.
For the child with ASD play is work. They do not learn from play the way NT children do. However, play is an important activity to encourage your child with ASD to engage in. If you would like a child with ASD to use social skills when engaging in play with other children, you will need to give him/her a task they can do. Concentrating on more than one difficult task is likely to be an unreasonable demand for you to make of a child with ASD.  A positive approach is to get the other children to imitate what the child with ASD is doing. If he plays with trucks by spinning the wheels, the other children could imitate this. Such a task allows the child with ASD to be in control and being in control means they are likely to feel less anxious in a social situation. There are some play based interventions for children with ASD such as LEGO therapy which have had good outcomes.
One of the key areas we need to support children with ASD with is how to say “No”. These children are often victims of bullying and will interpret a threat such as “I’m going to kick you in the shins” as something which is inevitable. We need to make sure children with ASD realise they have choices in this situation and prompt them with information on what those choices are. We also need to support these children and adolescents in the recognition of how NT’s say no. We express “no” verbally but we also send very clear messages with our body language and the recognition of these messages becomes really important in relationships.
Rather than ask a child with ASD not to do a particular behaviour it is often better to make it a rule e.g. It is important to have an arm’s distance between you and someone else when you are talking with them. Children on the spectrum often recognise rules and who is in charge so this way you may spend much less time telling a child not to do something. If you are teaching rules, remember to teach the exceptions as well so you encourage some flexibility and adaptability which are important life skills. If a child is stuck and upset, it is probably best to provide them with an alternative rather than repeating the same thing over and over. For example if a child is sitting in the doorway not letting others past, it might be better to open another door to allow them to leave.
In a classroom situation and out in the playground, a buddy system has proven to be very effective. Class information sessions such as “Celebrating our Differences” (described in the SAS program) which foster discussion about Autism and the strengths and challenges of children on the spectrum has been found to be an effective way of managing bullying in schools. Peers are very effective therapists when they understand why a child may be reacting in a certain way. Who better to teach a child about the social conventions of our society than one of their peers.
This information has been compiled as a result of my personal reading in the area of Autism in relation to communication skills, which are only a part of the overall challenges experienced by people on the Autism Spectrum. My knowledge has enriched by a recent workshop by Professor Rita Jordan. No two individuals with Autism are the same and they all experience challenges to a greater or lesser degree. Articles such as this may guide you with regard to what some of those challenges might be. I hope you have a little more insight into some of the communication challenges experienced by people with Autism and through that understanding, your relationships with people on the Autism spectrum will be strengthened.

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