Autism – Language Development and Diagnosis

Vivienne Foley examines the conditions and characteristics of Autistic Spectrum Disorders (ASD), and the state of play for the immediate future, for people who present with them.

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  • An individual with Autism varies hugely from non-verbal to a very articulate speaker.
  • Older children, adolescents and adults may have difficulty following  the social rule of politeness, and knowing with whom and when to share information – thus there is a vulnerability in this population.
  • A number of children with Autism will also have a language impairment and/or literacy difficulties.
  • Reading and spelling difficulties have also been documented in this population.
  • We must also continue to identify the talents, originality and social challenges of people with autism and strive to provide more opportunities around common interests for them in order to improve their quality of life.

The language and social-communicative profile of an individual with an Autistic Spectrum Disorder (ASD) varies hugely from non-verbal functioning to a very articulate, even pedantic speaker. Social-communication differences exist from birth, but if subtle, may not be recognised.

Developmentally, the restricted code of communication evident in children with autism may include non-verbal communication deficits observed as impaired joint attention with lack of showing and sharing. These precede the impairments of verbal communication and may be considered ‘the fundamental impairments’ (Tantam, 2009). The cognitive difference in autism has a profound impact on communication because the essential social motivation which lies in the drive to share intentions, thoughts and emotions is lacking or absent (Rutter, 1985).

Both non-verbal and verbal communication involve the ability to engage with and maintain a shared focus with another. Poor eye contact, interrupting, failure to appreciate the rules of turn-taking and repetitive questioning, result in difficulties with discourse and narrative. Failure to establish joint attention, lack of perspective taking, failure to recognise norms in relation to proxemics (body distance) breach the reciprocal dance of social-communication.  Social cognition or social thinking is impaired, so unsurprisingly the triad of impairments in autistic spectrum disorders (ASD) involves social understanding, social communication and imagination.

In typically developing children, joint attention (social engagement evident by smiling and pointing) are observed in early infancy. Language development increases dramatically with words strings becoming longer and more complex between the ages of 2-5 years. Imaginative play emerges as children ‘decentre’ and engage in pretend play. Verbal reasoning develops in line with comprehension, so children begin to perceive the world less in terms of ego / self, and include another’s perspective, referring to a theory of mind. This is followed by abstract language development involving deception, sarcasm, inference and irony.

Using the term autistic spectrum disorder on the basis of a core triad of impairment (Wing, 1981), it is recognised that autism exists on a continuum, but variation can be explained in terms of degree of severity. Such variance depends on the severity of social and cognitive and associated co-morbidities. Developmentally, the child with autism may present with absent or delayed pointing, absent or variable eye contact, a preference for solitary, functional or constructive play, or communicative functions may be limited to request / reject. By contrast, the individual with autism may be a literal interpreter with well-developed expressive skills and unusual tone. Older children, adolescents and adults may have difficulty following  the social rule of politeness, and knowing with whom and when to share information appropriately – thus there is an innate vulnerability in this population. There may be academic competence or excellence in the context of poor peer relationships or bullying, as there will always be deficits in social (pragmatic) language development.

Defined as ‘autism specific’ rather than attributable to a more general learning disability (Haddock & Jones, 2005), social skills deficits are one of the defining characteristics of individuals with an autistic spectrum disorder. The social difficulty observed in autism is associated with difficulties in emotional recognition and expression (American Psychiatric Association, 1994, Volume, Carter, Grossman & Klin, 1997), which results in ‘a failure to develop peer relationships appropriate to the child’s developmental level’ (Attwood, 2000) and difficulty forming friendships. Attwood (2000) refers to the fact that friendship skills are highly valued by ordinary adults in their professional and personal lives. Significant social skills deficits ‘may contribute to clinical problems such as anxiety, depression and /or other behavioural disorders’ (Elder, Caterino, Chao, Shacknai and de Simone, 2006).

A significant number of children with ASD will also have a co-existing language impairment   and/or literacy difficulties. In my clinical experience, this group of children have a more  positive prognosis than those without a language delay, as when the language develops with intervention, the social difficulties may recede. The implication is that the effect of this early developmental delay on autistic symptomatology is lessened with the acquisition of language skill (Dickerson, Mayes & Calhoun, 2001). Reading and spelling difficulties have also been documented in this population. The type of problems that have been noted relate to reading comprehension (hyperlexia) and spelling (dyslexia). Speech, language and literacy difficulties are viewed as existing on a continuum (Snowling & Stackhouse, 1996), so these literacy difficulties are a manifestation of the primary oral language deficits in written form.

Differential diagnosis of language, autism and/or mental health difficulties is critical because co-morbidities are the norm rather than the exception. Recognised labels have the advantage of determining which individuals access health services and receive additional educational supports, including reasonable accommodations in certificate examinations. This can make the difference between an individual with ASD remaining in the school system or not. There is a high perecntage of school drop-outs reported within the ASD population, particularly at post primary level. Professionals, together with parents and educators,  have a repsonsibility to advocate in this respect, as doing so ensures that the person with ASD actualises his/her potential and has a career direction for the future. We must also continue to identify the talents, originality and social challenges of people with autism and strive to provide more opportunities around common interests for them in order to improve their quality of life.

References

American Psychiatric Association, (1994) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Washington D.C: APA.

Attwood, T.  (2000). Strategies for improving the social integration of children with Asperger’s Syndrome. Autism, 4, (1), 85-100.

Dickerson Mayes, S & Calhoun, S.L. (2001).Non-significance of early speech delay in children with autism and normal intelligence with implications for Asperger’s Disorder. Autism, 5 (1) 81-94.

Elders, L.M., Caterino, L.C., Chao, J., Shacknai, D & de Simone, G. (2006). Efficacy of social skills treatment for children with Asperger’s Syndrome. Education and Treatment of Children, 29 (4), 635-663.

Haddock, K & Jones, S.P (2005). Social Impairment in Autism: A Literature Review. The Irish Psychologist, 31 (8), 229-236.

Rutter, M (1985). Classification. In M Rutter & L Herson (Eds), Child and Adolescent Psychiatry: Modern Approaches (2nd edition). Oxford: Blackwell.

Snowling, M., & Stackhouse, J. (1996). Dyslexia, Speech and Language: A Practitioners Handbook. London: Whurr.

Tantam, D. (2009). Can the World Afford Autistic Spectrum Disorder? Non-verbal communication, Asperger Syndrome and the Interbrain. London: Jessica Kingsley Publishers.

Volkmar, F.R., Carter, A., Grossman, j., & Klin, L (1997). Social Development in Autism. In D.J Cohen & F.R. Volkmar (Eds). Handbook of Autism and Developmental Disorders. New York: Wiley.

Wing, L (1981). Asperger Syndrome: A clinical account. Psychological Medicine,11, 115-129.

Vivienne Foley M. Sc., is a Consulting Speech & Language Therapist at Child and Adolescent Mental Health Services (CAMHS), HSE-South, Cork.

1 COMMENT

  1. shame you wasted space on a piece of non-expert, out of date, speculation, generalisation and ableist nonsense. could you not have maybe just maybe got an actual autistic advocate to do a piece instead? or maybe even just stick to what you know and stop trying to pretend you have *any* expertise regarding autistics and wasting peoples’ time with misguided and erroneous stuff like this which just results in distress for autistics and a huge waste of time spent trying to clean up the mess you made. dreadful rubbish. sigh. again. not impressed. 2/10

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