Children on the Autistic Spectrum have difficulty with communication, specifically spoken language. It is one of the critical criteria in diagnosis, and even students diagnosed with Asperger's Syndrome, who often have large vocabularies, have difficulty with nuance, irony, humor and inference. Delays in speech are among the most common symptoms of the disorder, and in some instances speech never appears independently at all. Communication, and communication with language, is foundational to the future functional, social and academic success of children on the spectrum.
Early intervention is critical for children on the spectrum. Most children can be diagnosed before the age of 3, although high functioning children, or children with Asperger's can sometimes be missed or misdiagnosed until school age. Those children who are not diagnosed until later often have good language, but behaviors surrounding their low tolerance for noise, physical stimuli or frustration may be diagnosed with oppositional defiance disorder, bi polar disorder or some other behavioral label.
The inability to communicate wishes can sometimes lead children on the spectrum to have explosive rages and destructive behavior because of the level of their frustration, paired with their poor impulse control.
Communication Before Speech
Some children on the spectrum may never produce speech as we know it. It may involve fine motor problems in the mouth, which occur in some children. Some children have auditory discrimination problems and may not be able to distinguish speech from ambient noise around them. Since children with autism do not have (or have very weak) joint attention, they are not paying attention to the faces and gestures of their mothers or other significant adults, and understanding their relationship to communication of meaning.
Often these children develop behavior repertoires which function as communication, often behaviors that are counterproductive. They may shreek or bang their head in order to indicate that they want attention, or perhaps a preferred food or item. Visual communication systems can often be used to get the "communication ball" rolling while at the same time provide a platform to build speech.
American Sign Language (ASL) Developed as a means for hearing impaired and deaf people to communicate, American Sign Language is a system (language) of hand gestures used to communicate. Fluent ASL is not "signed English" but a language with different syntax. In the last few years parents have been teaching infants ASL for the same reason it is a successful strategy for children on the Autism Spectrum: it permits them to communicate wants and desires efficiently while they are still mastering the difficult and many stepped process of imitating and producing spoken language. When paired with spoken language by the parents, teachers or therapists, ASL can be used to scaffold verbal language.
Picture Exchange Systems: (PECS) This is a trademarked system using simple pictures, often paired with words, to help children with significant communication deficits to communicate. Severely physically disabled children, such as children with Cerebral Palsy, often find PECS a successful way to communicate throughout life. They can communicate their wishes by touching or indicating a PECS picture with a mouth held stylus or a head mounted laser pointer. PECS, when paired with speech, can be used to help children with autism communicate, and like ASL, often can be withdrawn as a support as the child creates spoken language.
Verbal Behavior Analysis
A very effective early intervention is Verbal Behavioral Analysis, the language cousin of Applied Behavioral Analysis. Based on the work of BF Skinner, Verbal Behavior Analysis is used by trained therapists in a structured way that introduces Mands, Tacts and Intraverbals in ways that help children develop at first a limited but later a rich repertoire of word symbol and speech patterns to help communicate a wide variety of needs, wants and interests. VBA uses the techniques of Applied Behavior Analysis, including mass trials and variable reinforcement schedules.
In VBA, the therapist/teacher will begin with a lot of verbal imitation, rewarding progressive approximations. Then, once the child can imitate words, the therapist will introduce Mands, which are requests. The therapist will present alternative preferred items (often food) and require the child to request the desired item. It is the foundation of future language, once the child discovers that he or she can get what they want by "manding" or requesting it. Once a child has success with "Mands" the therapist will start introducting "Tacts" which basically is the process of naming things. Some Speech and Language Pathologists make the mistake of introducing vocabulary, or tacting first, and the child often doesn't understand the power and function of spoken language.
After a child understands the power of language through "manding," and has built a rich vocabulary through "tacting," the next step is to broaden the use of language through "intraverbals," which will help the child express the relationships between words, ideas and the child's wants, dreams and hopes.
Once children with autism succeeds in producing language, they continue to need the support of a speech language therapist to expand their language and social interaction skills.