Fact sheet on communication issues with Autism,  the most common pervasive developmental disorder


Speech development in people with autism takes different paths than the majority of neurotypical children. The effects of autism on communication are extremely varied. autism is increasingly referred to as being part of the autism spectrum due to the variability and degree of its effects. Most children will not have any trouble with pronunciation. The problems lie in using language effectively.


Common problems are lack of eye contact, poor attention, being able to point objects to others, and difficulty with the 'give and take' in normal conversation. In severe cases, some children remain mute throughout their lives but with varying degrees of literacy. They may communicate in other ways – images, visual clues, sign language, and typing may be far more natural to them. Contrary to the prevailing traditional stereotype of mute people with Kanner-type autism, around one third of people diagnosed with this type of autism will develop what is often viewed as dysfunctional verbal language - communication may have no content or information, but relies on rote learning of phrases, songs, jingles and advertisements. Those with the autism spectrum condition of Semantic Pragmatic Disorder fall into this group.

Those who do speak sometimes use language in unusual ways, retaining features of earlier stages of language development for long periods or throughout their lives. Some speak only single words, while others repeat a mimicked phrase over and over. Some may have a condition called echolalia which is a repetition of something previously heard. Sing-song repetitions in particular are a calming, joyous activity that many autistic adults engage in. Many people with autism have a strong tonal sense, and can often understand at least some spoken language, whilst others can understand language fluently.


Lack of interest in social interaction

People on the moderate to severe end of the autism spectrum often display an indifference or dislike for interaction. Infants might arch their backs when picked up to avoid contact, while older children may escape or have an emotional outburst when someone interacts with them. There is research that suggests the pleasure-inducing chemicals normally released in the brain by social interaction don't seem to emerge for many individuals on the autism spectrum. Many adults with autism report that they avoided social interaction for a range of sensory reasons - voices that hurt their hearing, unpleasant skin contact and so on.


Conversational issues with autism

Some children may exhibit only slight delays in language, or even seem to have precocious language and unusually large vocabularies, but have great difficulty in sustaining typical conversations. The “give and take” of non-autistic conversation is hard for them, although they often carry on a monologue on a favorite subject, giving no one else an opportunity to comment. When given the chance to converse with other autistics, they comfortably do so in “parallel monologue”—taking turns expressing views and information. The theory of mind is one suggestion for these conversational issues.


There is no 'one size fits all' in Autism Spectrum Disorders, and this is especially so with communication. In some cases, individuals on the autism spectrum avoid virtually all forms of social interaction, and may ignore someone talking to them, have an emotional outburst or escape. There is growing evidence from interviews with autistic adults that a common cause of this could be hypersensitivity due to sensory problems. Individuals on the autism spectrum may simply be indifferent to other people, or actively seek friendships but be unable to maintain these due to difficulties with social skills.


Issues with reading the subtext of speech

Just as people without autism have trouble understanding autistic body languages, vocal tones, or phraseology, people with autism similarly have trouble with such things in people without autism. In particular, autistic language abilities tend to be highly literal; people without autism often inappropriately attribute hidden meaning to what people with autism say or expect the person with autism to sense such unstated meaning in their own words.

Some people with high-functioning autism demonstrate advanced cognitive ability, but lack the skills or are not inclined to interact with others socially. An example of the this is the noted autistic Temple Grandin, who holds a PhD and is a successful developer of livestock handling technologies. She describes her inability to understand the social communication of people without autism as leaving her feeling “like an anthropologist on Mars.” Temple’s case was described by neurologist Oliver Sacks in his 1995 book titled An Anthropologist on Mars: Seven Paradoxical Tales.

Some infants who later show signs of autism coo and babble during the first few months of life, but stop soon afterwards. Others may be delayed, developing language as late as the teenage years. Still, inability to speak does not mean that people with autism are unintelligent or unaware. Once given appropriate accommodations, some will happily converse for hours, and can often be found in online chat rooms, discussion boards or websites and even using communication devices at autism-community social events.


Difficulties with non-verbal communication in autism

Sometimes, the body language of people with autism can be difficult for other people to understand. Facial expressions, movements, and gestures may be easily understood by some other people with autism, but do not match those used by other people. Also, their tone of voice has a much more subtle inflection in reflecting their feelings, and the auditory system of a person without autism often cannot sense the fluctuations.


What seems to non-autistic people like odd prosody; things like a high-pitched, sing-song, or flat, robot-like voice may be common in autistic children and some will have combinations of these prosody issues. Some autistic children with relatively good language skills speak like little adults, rather than communicating at their current age level, which is one of the things that can lead to problems.


Expressing needs appropriately

Since non-autistic people are often unfamiliar with the autistic body language, and since autistic natural language may not tend towards speech, autistic people often struggle to let other people know what they need. As anybody might do in such a situation, they may scream in frustration or resort to grabbing what they want. While waiting for non-autistic people to learn to communicate with them, people with autism do whatever they can to get through to them.


Communication difficulties may contribute to autistic people becoming socially anxious or depressed or prone to self-injurious behaviors. Recently, with the awareness that those with autism can have more than one condition, a significant percentage of people with autism are being diagnosed with co-morbid mood, anxiety and compulsive disorders which may also contribute to behavioral and functioning challenges.


Intervention for communication Problems

No one treatment method has been found to successfully improve communication in all individuals who have autism. The best treatment usually entails the following:

• Intervention begins early, ideally during the preschool years

• Intervention is individually tailored to meet the child's needs

• It targets both behavior and communication

• Both parents or primary caregivers are involved.


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 children respond well to highly structured behavior modification programs such as Applied Behavior Analysis; 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 success of these approaches is largely lacking. The use of social stories is increasing as a tool for helping autistic children learn social skills.


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. One theory holds that individuals on the autism spectrum have higher levels of naturally occurring opiates in the brain, so they don't seek social interaction to trigger these pleasure-inducing opiates. Naltrexone blocks the effects of these opiates and some claim this leads to better communication skills, but to date no medications have been found to specifically help communication as an evidence-based treatment. Mineral and vitamin supplements, special diets, and psychotherapy have also been used, but research has not documented their effectiveness.


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Both Autism and Asperger's syndrome will create a variety of communication issues