Verbal language in autism: how to communicate?

The editorial staff of Emianopsia has the pleasure of hosting Dr Beatrice Ferrari, a neuropsychomotor expert of the developmental age. Dr Ferrari proposes an in-depth study of verbal language in autism.

The communication process

The communicative act is an action that goes towards the other, it is the desire to send a message, a means to interact with others and change the surrounding environment. It serves mainly to ask something: to demand attention, to refuse, to give information, to choose, to comment and to express emotions. Exchange, give-and-receive, is at the base of communication.

The ways in which the child communicates, which depend on its functioning, can be different:

• motor
• gestural
• signs
• vocal
• images.

For there to be communication, it is fundamental for the person to understand meaning and purpose of language.

Developing communication in autism 

Verbal and non-verbal communication is essentially abstract; verbal language in autism encounters some difficulty precisely because people with autism are essentially visual. To promote communication in people with autism, it is advised to use visual communication systems (in which the link between symbol and meaning is very evident).

A common feature for all autism spectrum disorders seems to be early speech delay, except for Asperger syndrome which differs in the absence of language delay. As there are many types of autism, it is difficult to predict when and if property of language will emerge in the child. However, scientific studies have made it possible to highlight some indices to predict an increase in vocabulary:

• width of vocabulary at the time of first consultation
• presence of verbal imitation
• presence of symbol
• number of gestures to start a sharing
• presence of vocalizations.

An early and individualized intervention makes it possible to understand how the child communicates and thus, ensure that they are in contact with their surroundings.

Communication issues

Linguistic communication underpins different skills including:

• phonology (ability to process sounds)
• syntax (ability to follow grammatical rules)
• semantics (ability to understand and create meaningful expression/sentences)
• pragmatic (ability to use language for communication purposes).

In people with autism there may be problems in the above components and also in comprehension. However, in all of them there is a difficulty in verbal and nonverbal pragmatics, thus in the ability to use language functionally in different contexts of daily life. There is evidence of a mismatch between language and context².

At an early age, there is little interest in verbal stimuli and a tendency not to execute verbal command requests. Such events would seem to depend on many factors including:

• hearing impairment
• negative or no reaction to verbal stimulation
• difficulty in understanding the surrounding environment.

This issue could originate from the impossibility of using nonverbal skills to decode the meaning of verbal messages, therefore in integrating linguistic information with experience from the world.

Autistic children tend not to show problems in the articulation of sounds, but one could observe verbal dyspraxia or difficulties in oro-motor movements, with consequent repercussions on the expressive language.

In children with autism, echolalia may be present ( repetition, with the same intonation, of words or phrases spoken by someone else ). It can be immediate or deferred, that is, it can be a reproduction of something that has been said immediately or something felt in the past. Some recent studies have identified in echolalia, some communicative functions including:

• allegations
• taking turns
• language processing support function.³.

Verbal language in autism: treatments

The choice of the communicative system must be personalized, it depends on the characteristics of the patient and their cognitive level. If communication is absent, it is necessary to increase the interest and curiosity of the child to the environment. Skills of intersubjectivity and understanding must therefore be enhanced.

Primary intersubjectivity

Primary intersubjectivity is the ability of the child to enter a direct relationship with the environment. It is a relationship that depends on the components of:

• orientation
• activation
• attention span
• interest in the human face
• eye contact and ability to alternate in shifts.

Secondary intersubjectivity

These prerequisites allow the person, when interacting with others, to share ideas and collaborate. This is a secondary intersubjectivity that depends on:

• joint attention
• imitation
• answer to the name
• joint emotion
• shift switching.

Understanding and learning process

When the child begins to learn the meaning of communication and manifest communicative intentionality, it could be helpful to associate words to the recognition of images and photographs that require a lower cognitive level than the word itself. Images have the advantage of being universal and therefore understandable to all.

In some circumstances it may be appropriate to use items, which inform the person about what is happening (such as handing over a fork to communicate to the person that it is time to eat). The concrete object requires a low level of abstraction.

Sign language

In addition to visual support, the child can be taught gestures to communicate their needs. You can draw from Sign Language (LIS) to associate a gesture to a certain word. However, they can be changed based on the specific needs of the child. It is necessary, in fact, to consider the age, the cognitive level and the fine motor skills of each patient.

When using the signs, the child immediately communicates their need, without external support. On the other hand, the signs are not immediately understood by those who do not know them.⁴.

It is essential that the tools inserted in the treatment are shared with the reference figures of the child so that they can generalize them and are free to communicate in every life contexts.

We thank Dr Ferrari for shedding light on verbal language in autism. To learn more about the autism spectrum, we suggest you to read the article Autism: a different functioning of the individual.

Bibliography

1. Theo Peeters e Hilde De Clercq, 2015, Autismo, Uovonero
2. L. Pfanner, R. Tancredi, M. Marcheschi, Comunicazione e linguaggio nei disturbi pervasivi dello sviluppo,  Giornale Neuropsichiatria Età Evolutiva 2008;28:59-74
3. Ibid.
4. AGSAS Onlus | Comunicazione aumentata alternativa.