Communication in Autism: Connecting with the World in a different way!

By: Anagha Joshi

“Autism…offers a chance for us to glimpse an awe-filled vision of the world that might otherwise pass us by.”- Dr. Colin Zimbleman

Autism is a complex, lifelong neurodevelopmental disorder that typically appears during early childhood and can impact not only on a person’s social skills, relationships, self-regulation behavior but also communication. It ispredominantly characterized by impaired social functioning and communication disturbances, interpersonal relationships, and social interaction across different environments.  Autism is a “spectrum condition” which affects people at different levels and to varying degrees.

Apart from the major signs & symptoms of Autism Spectrum Disorder like self-regulation behavior, social skills, repetitive behavior & other behavioral aspects, Communication deficits are one of the core symptoms of Autism Spectrum Disorders (ASD). People with ASD may start talking late, or may not learn to talk at all; others may learn to produce words and sentences but have difficulty using them somehow to accomplish social interactions.

Regarding communication deficits, people with ASD who also face problem with not developed sufficient language skills which might reflect through act out like screaming or crying to express their needs. Apart from verbal communication, people with Autism also exhibit being non-verbal or having atypical speech patterns. This may include typical signs like having trouble understanding nonverbal communication cues including eye contact, showing a lesser amount of facial expressions, unresponsiveness, lack of understanding ofsocial cues (like tone of voice or body language). Further they also exhibit signs like having a monotone, difficulty making and keeping friends, limited attention to speech.

Often people with autism face poor communication situations like failure to respond to name, difficulty maintaining typical back-and-forth conversation pattern. It is important to note that people with ASD may vary widely in their level of functioning, and not all people with ASD will experience all of the symptoms.

If we focus on only communication deficits among people with autism, interventions may include different forms of communication therapies. There are a number of therapies which can help people with autism to improve their abilities to communicateand reduce their symptoms.Intervention methods for communication in young children with ASD attempts to address all the mentioned range of difficulties.

Speech Therapy

People with ASD may have major problems with both verbaland nonverbal communication. Social interaction is difficult for them. So for treating people with autism, speech therapy plays a major role inthe treatment. Speech therapy can address a wide range of communication problems for people with autism like children not talking at all, humming or talking in a musical way, babbling with word-like sounds, cries, utter grunts, throaty or harsh sounds, using different or meaningless words, robotic like speech, echolalia (often repeating or parroting what another person says), language comprehension, using right phrases and sentences with flat & unexpressive tone of voice.

Apart from these communication issues, people with autism face trouble with producing sounds to communicate effectively with others. It further includes more challenges in communication; such as trouble with basic conversation skills including eye contact & gestures, difficulty in understanding word meanings, little understanding of word meanings or different symbols, lack of creative language. With all these challenges, children with autism have to learn more than just merely speaking which includes use of language for communication, how to converse with others, understanding both verbal & nonverbal cues from others such as facial expressions, tone of voice and gestures, body language.

Speech therapy helps to improve communication through various techniques. It depends on the level of communication deficits person with autism is facing. Throughout this therapy, the speech-language pathologist also coordinates & works closely with the parents, caregivers, teachers & other professionals like doctors and occupational therapist. Speech therapist use various techniques if someone with autism is not talking much (nonverbal) or having major trouble with speech.

Usually in this part of therapy, techniques like electronic talkers, developing sign languages or typing, using picture boards with words, use of sounds to which a person is over or under sensitive is focused. Further challenging areas in communication and speech are improving pronunciations by some lips or muscles exercising or massaging, encouraging person with autism to sing songs and helping them to match with rhythm & flow of sentences are also work out.

The use of speech therapy in intervention of ASD is beneficial as it helps to give positive results in terms of well articulation of words, improvement in both verbal as well as non-verbal communication, comprehending verbal and nonverbal communication &understanding the intentions of others in different settings. Speech therapy also helps in terms of learning to take initiative to start communication without anyone’s prompting, understanding social skills like knowing the appropriate time and place to communicate something, for example, when to greet “Hello”, “Good Morning”, “Good evening” & developing more conversational skills & interaction with peers.

Speech therapy can also involve non-verbal skills, like making eye contact, taking turns in a conversation, and using and understanding gestures. It might also teach children to express themselves using picture symbols, sign language, or computers.

Applied Behavior Analysis (ABA)

The application of ABA therapy gives reinforcement for positive behaviors and helps the people with ASD to learn new skills using rewards. In this therapy, child with autism is given regular (moment-by-moment) feedback by their parents & caregivers. The ABA therapy goals on individual’s needs which may include communication, social skills, personal care.

Applied Behavior Analysis (ABA)

The ABA therapy uses rewards to reinforce positive behaviors and learn new skills. Parents and other caregivers are trained so they can give the autistic child moment-to-moment feedback. There are different types of ABA including Discrete Trial Training (DTT) for behavioral training, Early Intensive Behavioral Intervention (EIBI) for younger children (under five years), Pivotal Response Treatment (PRT) for important developmental areas like self-management and coping with social situations and importantly Verbal Behavior Intervention (VBI) and Picture Exchange Communication System (PECS) applicable for speech and communication skills.

Among all these different types of ABA, Verbal Behavior Intervention (VBI) is highly useful for improving a child’s verbal skills. This therapy technique works on behaviorist B.F.Skinner’s principles of operant conditioning. VBI is helpful in teaching communication & language by encouraging people with autism by connecting words with their purposes. It does not focus on words as labels only (dog, apple, car etc.), rather it teaches students why we use words (purpose) and how they are useful in making different types of communication ideas and skills. Thus through this technique the students learn that words will help them to get their desired objects or results.

In one of the techniques of ABA, Picture Exchange Communication System (PECS) children learn to trade pictures for items or activities. This therapeutic method is mainly designed for those who don’t speak, can’t understand or have difficulty in understanding. PECS usuallybegins with teaching single word requests by means of exchanging a picture for an object, then moves on to building sentence structure. PECS further integrates initiatives of child’s communication actions. This is achieved by asking the child to take initiative of an exchange by giving a picture to the therapist or teacher in order to get the desired object. Usually the verbal stimuli like “what do you want?’ are avoided to get the natural spontaneous requests by child. Once a strongreinforce is identified, the child is required to exchange a picture card with the therapist or teacher or trainer for the desired item. This spontaneity of picture exchanges are addressed by application of this therapy methods in different environments with involvement of different types of people (parents, caregivers, teachers, trainers) and importantly by focusing on different reinforcers. This method helps to improve in communication though researches in this area have also found little or gains in speech.

Social – Pragmatic methods: In this developmentally based approach, children with autism who do not speak are encouraged to use other means of communication, typically using variety of nonverbal forms of communication. The central idea behind this approach is using nonverbal communication forms as a stepping stone to speech. This includes encouraging a child to lead for interaction, follow their attentional lead; allowing a child to choose the way of interaction and also allowing to use of material for communication. This approach tries to provide intense opportunities for children with autism to get engage in those types of activities which will be similar to those activities which typically their developing peers are also engaged. This helps to improve for learning their social as well as communication skills.

Play therapy:

Another therapy that plays an important role in improving social and emotional skills among children with autism is Play therapy. This therapy helps to improve & increase language and communication skills. In the play therapy, one of the common method is known as Floor time. This method aims to develop symbolic, interactive communication through shared play and affect.  In the floor time teachers, therapists and parents are trained to provide multiple, daily ‘floor time’ sessions in which usually adult follows the child’s lead, give comments on the child’s actions, providing various opportunities for reciprocal actions as well as challenges and difficulties to ‘stretch’ the child’s capacities. Thus in floor time, therapist or teacher gets down on the floor to play on the terms put by child. In a way, an adult takes part by playing the same way by following the child and in progression an adult makes some additions in the game. The main aim behind this floor time activities is to create a play that will encourage child to increase communication and add some new dimensions to play.

From the overall studies on communication therapy which is useful in the intervention for the people with ASD, it is clear that children with autism benefit from intensive, early intervention that focuses on increasing the frequency, form, and function of communicative acts. So let’s be more open, understanding and neutral to have a fair communication with people with autism. Let’s break those communication barriers to reach out to this one of the most special part of our society!

Anagha Joshi
Counselling Psychologist & Psychotherapist
Asst. Professor, Department of Psychology,
Dr. D.Y.Patil Arts, Commerce & Science College, Pune

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