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Communication and the Autistic Child 1 Communication and the Autistic Child Jennifer Tillman Charter Oak State College

Communication and the Autistic Child 2 Communication and the Autistic Child Visualize being a behavior therapist, and working in the same classroom for five days straight. On the first day, there is a child who is asked, “What day is it today?” The child replies, “What day is it today?” On the second day, that same child is asked, “How do you spell your name?” His response is “Spell your name.” This same scenario happens repeatedly for the next three days. Some other observations of this child include trouble making eye-contact and a preference to play alone or in a parallel play situation. Could there be an issue with this child? The initial symptoms indicate a possibility of this child having what is known as, Autism Spectrum Disorder (or ASD for short). When a child has a disorder, a person’s automatic response usually involves wanting to help them. Fully understanding what ASD is and how it is treated, leads to how a person can help them. Originally, autism was classified as a developmental and behavioral disorder (Wiseman, 2009). However, the book, Abnormal Psychology: Clinical Perspectives of Psychological Disorders is now defining it as a neurodevelopmental disorder incorporating a range of serious disturbances in the ways that individuals interact with and communicate with others (Whitbourne, 2017). Communication seems to be the biggest issue involved with those diagnosed with autism. They may seem socially awkward because of their lack of being able to communicate in a conventional way. In extreme cases, they may completely avoid social interactions, or at least not attempt to initiate interactions with other people (Whitbourne, 2017). In addition, children with autism are often more interested in and engaged by their own thoughts and sensations than by other people or even the outside world (Rudy, 2016). The unusual characteristics of autism spectrum disorder become more prominent from childhood onward [meaning the older they get, the more the autistic characteristics will be prevalent] (Whitbourne, 2017). [Therefore] intervention should be provided as early as possible (Gleason, 2016). To receive the proper treatment, a child must first be diagnosed. A child is diagnosed with Autism Spectrum Disorder based on the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). The DSM-5 is a set of criteria

Communication and the Autistic Child 3 clinicians use to diagnose individuals with mental disorders. Some of the criteria listed on the DSM-5 for ASD include persistent deficits in social communication and social interaction across multiple contexts (i.e. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions), restricted, repetitive patterns of behavior, interests, or activities (i.e. Stereotyped or repetitive motor movements, use of objects, or speech like lining up toys over and over again or having to do it every day), and whether these disturbances are not better explained by intellectual disability (intellectual developmental disorder, which sometimes can occur concurrently with ASD, but are not necessarily mutually exclusive) or global developmental delay (Autism Speaks Inc, 2012). Essentially, the DSM-5 is evaluating a certain set of patterns of behaviors these children display when they are communicating (or not communicating, as the case may be). Once the severity level has also been diagnosed, their therapist designs an IEP. An Individualized Education Plan or IEP, is an plan designed to list a child’s diagnosis, their treatment plan, and what their goals are. It is reviewed yearly. After the IEP is written and reviewed with the parents, the child can begin their therapy. [It is important to remember that people with ASD process information in their brain differently than other people (Indiana University, 2017). Fortunately, though, there are ways for these children to progress in life, and ways for them to learn to communicate better with others. The biggest deficit a child with autism faces is the lack of being able to use language effectively, and learning how socialize with others. The book, The Development of Language, lists four signs or symptoms involved in diagnosing autism. They are Joint Attention (JA), Theory of Mind (TOM), Language, and Echolalia. The idea that a child is not fully present during times when someone is communicating with them or around them is called, Joint Attention. For example, if a child is in circle time, and the teacher is reading to the group, the child with autism may be playing with their fingers or watching out the window. These children do not have the ability to follow eye gaze or orient on an

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Communication and the Autistic Child 4 object or activity of interest to a conversational partner (Gleason, 2016). These children may also have a difficult time making eye-contact even when asked to do so. While Joint Attention may not necessarily be a problem some of the time, it can limit a child’s ability to learn through imitation, develop play and social skills, and attend in a learning situation such as a classroom (Rudy, 2016). There is treatment for this symptom and all the others as well. Theory of Mind is the unique failure of children with ASD to develop an understanding of the intentions and mental states of others in their environment (Gleason, 2016). For example, if a person is angry, the ASD child may not understand how or why that person could be angry. It is a somewhat similar to the concept of empathy or in relation to an autistic child, their lack of empathy for others. Empathy is defined as an understanding of another’s feelings on a personal level. Also, these children may also have a difficulty predicting how another child may behave or feel in future scenarios (Autism Speaks Inc, 2012). These children may be able to learn how to read individuals better as they go through their treatment process. Language is the next symptom. Many children with autism do not develop a large vocabulary. Approximately 20 to 25 percent of children with autism do not achieve more than a five-word spoken vocabulary (Gleason, 2016). A lack of vocabulary development may cause a child with ASD to fall behind socially and academically from their peers. Syntactic development is delayed, and a reversal of personal pronouns (e.g., using you rather than I) may reflect the difficulty that the child with autism has in conceptualizing roles and perspectives in conversation (Gleason, 2016). It seems like these children do not learn how to talk to communicate with others like most of the population does, therefore it also seems to make sense why they would lag behind those who are learning language to communicate with others. It is a possibility for an autistic child to learn to speak for the purpose of communicating with others once they are getting the help they need.

Communication and the Autistic Child 5 The last component concerning communication in an autistic child is called, Echolalia. Echolalia in simple terms means being repetitive, but not an ordinary type of repetitiveness. The average child may want to play with the same toy repeatedly, but the repetitiveness for an autistic child is different. For example, an autistic child may play with colored blocks, but they line all the like colors in rows, and when they are done with all the colors, they will start all over again. This could happen several times before that child moves on to another toy. There is another way an autistic child can be repetitive. A child with autism may not answer questions like the average child does. They may just repeat back to the person questioning them with the exact same question they were asked. This type of repetition is known as Immediate Echolalia. Immediate Echolalia refers to replicated utterances that are produced or echoed immediately or almost immediately after they are heard (Indiana University, 2017). A parent or teacher may wonder why they do this. This may be due to how they process information differently than the average person. Some questions are easier to answer than others for these children. For example, the child may be asked, “Where did you go on Sunday?” and their answer may be, “Where did you go on Sunday?” however, if the child is asked, “Did you go to Grandma’s house?” they may at first repeat the question, but they may then say, “Grandma’s house no, zoo yes.” ( Indiana University, 2017). This somewhat proves that autistic children have an easier time processing yes or no questions. This like the other symptoms can be helped with therapy. Lack of communication skills seems to be the biggest concern in regards to children with ASD, but when they participate in treatments, their communication skills will also benefit. The scope of research in treatments for ASD grows almost daily (Gleason, 2016). There are therapies that aid in language skills, self-help skills, and even a therapy that helps with nutrition. There is also a nutritional therapy. One of the therapies involving language development is called, Hanen/More Than Words. This therapy has four goals. They are improved two-way interaction, learning more mature and conventional ways to communicate, learning to communicate better for social purposes, and understanding language

Communication and the Autistic Child 6 (Wiseman, 2009). This therapy mostly deals with the social aspect of using language. Another therapy that helps with language skills is called, Verbal Behavior (VB) therapy. This therapy was developed using B.F. Skinner’s ideas for teaching language. Basically, the child is taught what an object is (for example, showing them a cupcake, and calling it a cupcake repeatedly), and then they are asked to request the item in any way they can. They could ask for it verbally, using sign language, or any other way they can. They are also asked to find the object (a cupcake in this case) when asked to do so (Wiseman, 2009). They would also be asked questions related to the object. The objective of this exercise would be for the child to choose the correct object. For example, if the object were a cupcake, the therapist may ask questions like “what do you eat” or “what has frosting” (Wiseman , 2009). The last part of this treatment involves asking the child questions when the object is not around. For instance, the therapist may say, “tell me what you eat” or “tell me something with frosting,” (Wiseman , 2009). The objective of this part is for the child to use their words when asked about the object. Speech and language therapists specifically deal with developing communication skills in children with autism and other speech issues. Depending on the verbal aptitude of the individual, the goal of speech and language therapy might be to master spoken language or it might be to learn signs or gestures to communicate (Autisms Speaks Inc, 2012). Occupational therapists may also play a role in helping children with autism. The goals of an occupational therapist might include teaching skills to help with independent dressing, feeding, grooming, and use of the toilet, as well as improving social, fine motor, and visual perceptual skills (Autisms Speaks Inc, 2012). Children with autism may also have some sensory issues. They may experience sensory overload in some teaching situations which has led to the exploration of technology- assisted interventions (Gleason, 2016). These individuals may not want to do activities involving their sense of touch or their sense of smell. Computer and tablet-assisted programs have fairly strong evidence of effectiveness, across levels of severity [for children with sensory issues] (Gleason, 2016). BrainPro is one of the programs some families use to help their children with memory, attention, and

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Communication and the Autistic Child 7 learning social skills. BrainPro uses a video ’s game-like concept to help children develop those skills. Another program that helps children with autism is called, Friends Like You, Friends Like Me . Essentially, this program aides in learning how to make friends. Non-verbal students may not benefit from these programs. A therapy that may benefit those with little or no speech is called, Picture Exchange Communication System (PECS). There are several phases involved in learning PECS. The first phase involves the nonverbal child with autism being trained to initiate requests using pictures of desired items (Gleason, 2016). For example, a child may learn to use a picture of milk to request a glass of milk. When the child is given the item they requested, it reinforces the communication that has taken place. The sixth and final phase of this treatment (which is the most complex) involves the child being able to spontaneously make comments about things they see or hear in the environment (Wiseman, 2009). For instance, the child is on a walk with their class, and spontaneously states to the teacher, “I see yellow leaves.” This therapy teaches the importance of speaking to communicate wants and needs. Another treatment is nutritional therapy. Nutritional therapy is a form of treatment that may reduce medical conditions (Wiseman, 2009). In relation to autism, there have been great improvement in children when prescribing diets that reduce or eliminate foods with gluten, foods the child is allergic to, foods that cause yeast growth in the intestines, carbohydrates that cause an adverse reaction, foods that increase blood sugar levels, and foods high in oxalates (Wiseman, 2009). It is important to work with a professional before changing a child’s diet. Those are just a few of the possible therapies used in treating individuals with Autism Spectrum Disorder. Some may work better than others depending on the child. Unfortunately, as of right now, autism is not going away. In fact, over time there has been a steady increase in the number of those being diagnosed. During the 1980s 2 to 5 in 10,000 were diagnosed (Autism Reading Room, no date). In the 1990s, 18.7 in 10,000 people had autism (Autism Reading Room, no date). Of the children born in 2002 an estimated 1 in 68 children were diagnosed

Communication and the Autistic Child 8 (Whitbourne, 2017). Early intervention seems to be the answer in helping those with the diagnosis of Autism Spectrum Disorder. Once the child is diagnosed, they can begin a regimented treatment process. The more treatment the better off the individual will be. Imagine the child mentioned earlier. Fast- forward about six months. He was indeed diagnosed as being on the spectrum, and is in a special program where he is learning skills that help him communicate every day. One day his teacher said, “I’m ti red today.” He said, “Why?” The teacher said, “I didn’t get enough sleep.” He said, “Oh.” She said, “Are you tired?” He said, “No.” Two words to describe that interaction: amazing and remarkable. This child may not have been able to have this short conversation six months earlier. His treatments are clearly working. Maybe one day, those diagnosed with Autism Spectrum Disorder may not even need therapy anymore. Growing evidence suggests that a small minority of persons with autism progress to the point where they no longer meet the criteria for a diagnosis of autism spectrum disorder (ASD) (autism speaks).

Communication and the Autistic Child 9 References Autism Reading Room (no date) Available at: http://readingroom.mindspec.org/?page_id=5662 (Accessed: 6 March 2017). Autism Speaks Inc (2012) Available at: https://www.autismspeaks.org/ (Accessed: 6 March 2017). Gleason, J.B. (2016) The Development of Language . 9th edn. Boston: Pearson. Indiana University (2017) Functional Categories of immediate Echolalia . Available at: https://www.iidc.indiana.edu/pages/Functional-Categories-of-Immediate-Echolalia (Accessed: 6 March 2017). Rudy, L.J. (2016) Available at: https://www.verywell.com/what-is-lack-of-joint-attention-in- autism-259890 (Accessed: 6 March 2017). Whitbourne, S.K. (2017) Abnormal psychology: Clinical Perspectives on Psychological Disorders . 8th edn. New York, NY: McGraw Hill Higher Education. Wiseman, N.D. (2009) Autism Spectrum Disorders: An Essential Guide for the Newly Diagnosed Child . Cambridge, MA: Da Capo Press.

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