How Do Speech and Language Normally Develop?
The most intensive period of speech and language
development is during the first three years of life, a
period when the brain is developing and maturing. These
skills appear to develop best in a world that is rich
with sounds, sights, and consistent exposure to the
speech and language of others. At the root of this
development is the desire to communicate or interact
with the world.
The beginning signs of communication occur in the first
few days of life when an infant learns that a cry will
bring food, comfort, and companionship. Newborns also
begin to recognize important sounds such as the sound of
their mother's voice. They begin to sort out the speech
sounds (phonemes) or building blocks that compose the
words of their language. Research has shown that by 6
months of age, most children recognize the basic sounds
of their native language.
As the speech mechanism (jaw, lips, tongue, and throat)
and voice mature, an infant is able to make controlled
sound. This begins in the first few months of life with
"cooing," a quiet, pleasant, repetitive vocalization.
Usually by 6 months of age an infant babbles or produces
repetitive syllables such as "ba, ba, ba" or "da, da, da."
Babbling soon turns into a type of nonsense speech
called jargon that often has the tone and cadence of
human speech but does not contain real words. By the end
of their first year, most children have mastered the
ability to say a few simple words. Children are most
likely unaware of the meaning of their first words, but
soon learn the power of those words as others respond to
them.
By 18 months of age most children can say 8 to 10 words
and, by age 2, are putting words together in crude
sentences such as "more milk." During this period
children rapidly learn that words symbolize or represent
objects, actions, and thoughts. At this age they also
engage in representational or pretend play. At ages
three, four, and five a child's vocabulary rapidly
increases, and he or she begins to master the rules of
language. These rules include the rules of phonology
(speech sounds), morphology (word formation), syntax
(sentence formation), semantics (word and sentence
meaning), prosody (intonation and rhythm of speech), and
pragmatics (effective use of language).
What Causes Speech and Language Problems in Autism?
Although the cause of speech and language problems in
autism is unknown, many experts believe that the
difficulties are caused by a variety of conditions that
occur either before, during, or after birth affecting
brain development. This interferes with an individual's
ability to interpret and interact with the world. Some
scientists tie the communication problems to a "theory
of mind" or impaired ability to think about thoughts or
imagine another individual's state of mind. Along with
this is an impaired ability to symbolize, both when
trying to communicate and in play.
What Are the Communication Problems of Autism?
The communication problems of autism vary, depending
upon the intellectual and social development of the
individual. Some may be unable to speak, whereas others
may have rich vocabularies and are able to talk about
topics of interest in great depth. Despite this
variation, the majority of autistic individuals have
little or no problem with pronunciation. Most have
difficulty effectively using language. Many also have
problems with word and sentence meaning, intonation, and
rhythm.
Those who can speak often say things that have no
content or information. For example, an autistic
individual may repeatedly count from one to five. Others
use echolalia, a repetition of something previously
heard. One form, immediate echolalia, may occur when the
individual repeats the question, "Do you want something
to drink?" instead of replying with a "yes" or "no." In
another form called delayed echolalia, an individual may
say, "Do you want something to drink?" whenever he or
she is asking for a drink.
Others may use stock phrases such as, "My name is Tom,"
to start a conversation, even when speaking with friends
or family. Still others may repeat learned scripts such
as those heard during television commercials. Some
individuals with higher intelligence may be able to
speak in depth about topics they are interested in such
as dinosaurs or railroads but are unable to engage in an
interactive conversation on those topics.
Most autistic individuals do not make eye contact and
have poor attention duration. They are often unable to
use gestures either as a primary means of communication,
as in sign language, or to assist verbal communication,
such as pointing to an object they want. Some autistic
individuals speak in a high-pitched voice or use
robot-like speech. They are often unresponsive to the
speech of others and may not respond to their own names.
As a result, some are mistakenly thought to have a
hearing problem. The correct use of pronouns is also a
problem for autistic individuals. For example, if asked,
"Are you wearing a red shirt today?" the individual may
respond with, "You are wearing a red shirt today,"
instead of "Yes, I am wearing a red shirt today."
For many, speech and language develop, to some degree,
but not to a normal ability level. This development is
usually uneven. For example, vocabulary development in
areas of interest may be accelerated. Many have good
memories for information just heard or seen. Some may be
able to read words well before the age of five but may
not be able to demonstrate understanding of what is
read. Others have musical talents or advanced ability to
count and perform mathematical calculations.
Approximately 10 percent show "savant" skills or
detailed abilities in specific areas such as calendar
calculation, musical ability, or math.
How Are the Speech and Language Problems Treated?
If autism or some other developmental disability is
suspected, the child's physician will usually refer the
child to a variety of specialists, including a
speech-language pathologist, who performs a
comprehensive evaluation of his or her ability to
communicate and designs and administers treatment.
No one treatment method has been found to successfully
improve communication in all individuals who have
autism. The best treatment begins early, during the
preschool years, is individually tailored, targets both
behavior and communication, and involves parents or
primary caregivers. 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 individuals respond well to highly structured
behavior modification programs; 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 efficacy of these approaches is
largely lacking.
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.
No medications have been found to specifically help
communication in autistic individuals. Mineral and
vitamin supplements, special diets, and psychotherapy
have also been used, but research has not documented
their effectiveness.
What Research Is Being Conducted to Improve the
Communication of Individuals with Autism?
In addition to ongoing research on other aspects of
autism across the National Institutes of Health (NIH),
researchers at the National Institute on Deafness and
Other Communication Disorders (NIDCD) are also
investigating the communication difficulties or
differences of people who have autism. At the heart of
the research effort is a five-year collaborative NIH
effort between the NIDCD and the National Institute of
Child Health and Human Development (NICHD) which was
launched in May 1997. The effort involves more than 65
scientists at 24 universities from around the world,
including the United States, Canada, Britain, France,
and Germany, who are examining how autism develops. In
addition, scientists are also exploring the speech and
language features in autism, evaluating current
treatment practices, and designing new treatments.
Additional studies include investigations of brain
development and functioning in autism and the use and
effects of certain drugs on communication behavior.
Tags:
autism,
communication,
spectrum disorders
