Written by Dr. Carrie Pfeifer
God has created us to interact with each other using the gift of receptive and expressive language. The communication areas of the brain are seen in the Broca’s and Wernicke centers. The Broca center in infants activates when language is spoken to them (Imuda et al. 2006). When a child begins to use language, the Wernicke center of the brain is activated, even in children who are communicating with a non-oral language such as American Sign Language (Campbell et al., p. 3, 2008).
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM V), one of the criteria for Autism Spectrum Disorder (ASD) is persistent deficits in social communication and social interaction across multiple contexts (Autism Diagnosis Criteria). These deficits are seen in non-verbal and verbal communication. Students with deficits in communication may encounter barriers across school, home, community and work that can lead to problem behaviors (Perner and Delano, p. 45. 2013). Therefore, it is vital to understand the early signs of language deficits in children with ASD so that interventions can be implemented for these children as early as possible.
COMMUNICATION PROGRESSION
Babble
Shumway and Wetherby (2009) determined that by 18 to 24 months of age, children later diagnosed with ASD showed a unique profile of communication, with core deficits in communication rate, joint attention, and communicative gestures. Neurotypically developing children begin babbling around six to seven months and begin to match intonation and prosody of those speaking to them. Autistic children may almost appear to be deaf, not responding to their name or when spoken to. Kuhl et al. 2005 noted that autistic children had a preference for nonspeech sounds while others use little to no language at all. Lack of babbling by the age of 12 months is one of the “red flags” for autism (Learn the Signs of Autism).
Young autistic children may stare fixedly at specific objects and do not integrate with the visual environment that surrounds them (Dawson et al. 1998). Eye gaze may be less direct at people, often looking in a person’s direction, but appearing to look through them.
Gestures
A typically developing infant will use gestures beginning at nine months. The use of gestures helps the toddler begin to participate in conversations and turn-taking. Gestures in autistic children are very different. These children may use a technique called leading to get an object they desire. Instead of interacting with an adult, they use the adult’s hand or arm to point to what they want. The typical gestures that children use are either absent or incorrectly imitated by autistic children. For example, when autistic children wave “bye-bye,” instead of the hand waving with the palm out, the children may turn the palm inward, essentially waving at themselves.
Joint Attention
Joint attention is when children identify what another person is paying attention to and can draw other’s attention to something that interests them. Wetherby et al. (2000) states that joint attention deficits are one of the hallmarks of ASD. Difficulties with joint attention impact a child’s ability to make a connection with another person, an object or event, as well as sharing of emotional states.
SUPPORTING COMMUNICATION DEVELOPMENT
It is critical for families to work with a speech-language pathologist to determine what types of activities and interventions should be used to support communication and communication growth for an autistic child. Applied behavior analytic (ABA) approaches may include augmentative or alternative communication (AAC) devices, sign language, Picture Exchange Communication Systems (PECS), and teaching of communication skills through the Natural Language Paradigm (NLP), Joint Action Routines (JARS), and incidental teaching structures.
Picture Exchange Communication System (PECS)
AAC incorporates both receptive and expressive language elements and works to make communication both functional and effective for the child. Affordable AAC options include a book of symbols, an alphabet board for communicating, or sometimes flash cards and electronic flashcards, such as Boom Cards. There are the more expensive eye gaze-enabled devices, such as a Dynavox device. If a child has appropriate fine motor control and imitation skills, some therapists teach autistic children to communicate basic needs using manual signs. AAC is seen as a more long-term solution for communication, while the Picture Exchange Communication System (PECS) is the use of pictures that are intended to be faded out over time. There are six phases involved in PECS training, progressing from a request made with a single picture or object to more complex commands and requests by both the child and the parent or teacher.
Natural Language Paradigm (NLP)
Parents and therapists may use Natural Language Paradigm (NLP) when a child shows interest in a specific activity. The four elements of NLP are the stimulus item that has interested the child, prompts that the adult provides when the child engages with the stimulus item, a response to all approximations engagement with the stimulus, and reinforcement consequences when the child engages with the activity around the stimulus.
Joint Action Routines (JARS)
Joint Action Routines (JARS) implement communication signals around specific routines. Incidental Teaching immerses the child in language-developed experiences in structured environments where the language and skill are practiced by the child (and others) in the setting. This can be effective in a classroom if the teacher uses active, social instruction and feedback/reinforcers, such as checklists, for the child to use and share with others.
TEAM APPROACH
Supporting a child with communication deficits takes a team approach. Teachers of autistic children will need to collaborate with the student’s family and speech and language pathologist to determine what communication supports can be used in the classroom and throughout the school day. Consistent use of speech and language support is vital to the language development of autistic children.
Dr. Carrie Pfeifer serves as a professor of education at Bethany Lutheran College-Mankato MN and an adjunct graduate faculty professor at Martin Luther College-New Ulm MN.
References
Autism Diagnosis Criteria: DSM-5. (n.d.). Retrieved from https://www.autismspeaks.org/autism-diagnosis-criteria-dsm-5
Campbell, R. MacSweeny, M, and Waters, D. (2008). Sign language and the brain: A review. Journal of Deaf Studies and Deaf Education, 13(1), 3–20.
Dawson, G., Meltzoff, A. N., Osterling, J., Rinaldi, J., & Brown, E. (1998). Children with autism fail to orient to naturally occurring social stimuli. Journal of Autism and Developmental Disorders, 28(6), 479–485.
Imada, T., Zhang, Y., Cheour, M., Taulu, S., Ahonen, A., & Kuhl, P. K. (2006). Infant speech perception activates Broca’s area: A developmental magnetoencephalography study. NeuroReport, 17(10), 957-962.
Learn the Signs of Autism. (n.d.). Retrieved from https://www.autismspeaks.org/signs-autism
Perner, D. E., & Delano, M. E. (2013). A guide to teaching students with autism spectrum disorders. Council for Exceptional Children, Division on Autism and Developmental Disabilities.
Shumway, S., & Wetherby, A. M. (2009). Communicative acts of children with autism spectrum disorders in the second year of life. Journal of Speech, Language, and Hearing Research, 52(5), 1139–1156.
Wetherby, A. M., Prizant, B. M., & Schuler, A. L. (2000). Understanding the nature of communication and language impairments. In M. Wetherby, & B. M. Prizant (Eds.), Autism spectrum disorders: A transactional developmental perspective (pp. 109-141). Brookes.