Verbal Communication in Children with Autism

Table of Contents

Introduction

1 What Is Autism? A Definition of the Term
1.1 Classifications And International Criteria of Autism
1.2 The International Classification ofDiseases - ICD
1.2 The Diagnostic And Statistical Manual: DSMIV

2 Causes Of Autism

3 Inhibited or Retarded Language Production With Autism
3.1 Communication and Development in Autism
3.2 Word Use and Semantic Aspects ofLanguage
3.3Echolalia
3.4 Pragmatic Aspects ofLanguage
3.5 Verbal andNonverbal Cognitive Development

4 Isolated Areas of Exceptional Performance - Savant Skills in Autism
4.1 Frequency of Savant Syndrome
4.2Intriguing Abilities inAutistic Savants
4.3 The Polyglot (Language) Savant
4.4 The Asperger Syndrome

Conclusion

Bibliography

Introduction

“Ricky, say walk” - “Krrr.” - “No, say walk” - “Krrr.” - No Ricky, say walk.” - “Ergh.” - “Walk.” - “eek” - “Fine, Ricky!”... The first time I saw the video tape with my nephew on a horseback I had no idea what was going on in the paddock. I watched Ricky try to articulate the order and make the pony move. Whenever he managed to pronounce something different than a strange /x/ sound, the therapist who was holding the leash signalled the horse to walk on.

Ricky is a 12-year old boy who first developed normally, but spoke less and finally stopped talking shortly after his second birthday. By the time the video was made in 2003, the then 8-year-old and his family had run through six years of consultations, therapies and a lot of different medications.

Last year, while being to the US,I met my relatives for the very first time. I was given the opportunity to get an impression of the family’s everyday life and was especially attracted by Ricky and his unique ways of communicating. Although nobody really knows why Ricky does not talk at an age-appropriate level, it is interesting to see how he responds to communicative inputs, how he communicates by means of a specially designed computer.

Is he really autistic? What does autism mean? How can autism be measured and diagnosed? Why do autistic people not speak? Admittedly, there are a lot of questions to be answered and possibly even more that still need to be explored. As a matter of fact, this research paper cannot encompass all aspects of autism. Not only because oflanguage deficits being prominent in people with autism, but also because of personal experience in the writer’s family did we choose to concentrate on these communicative cognitive processes in human minds.

1 What Is Autism? A Definition of the Term

The Encyclopaedia Britannica defines “autism” as “a developmental disorder that affects physical, social, and language skills... Autism appears in the first three years oflife and is about four times more common in males.” Moreover, the reference guide says that 10to 20 per 10,000 children suffer from autism, a disorder still not completely understood.^[1]

Further information about the aforementioned developmental disabilities are provided on the University oflowa Regional Autism Services Program website. There are six categories which describe “varying degrees of atypical behavior” seriously interfering with the learning processes^[2]. They are as follows:

(1.) Communication: The student displays problems extending into many aspects of the communication process. Language, if present, may lack usual communicative function, content, or structure. Characteristics may involve both deviance and delay in both receptive and expressive language.

(2.) Social participation: The student displays difficulties in relating to people, objects, and events. Often students are unable to establish and maintain reciprocal relationships with people. The capacity to use objects in an age appropriate or functional manner may be absent, arrested, or delayed. The student may seek consistency in social events to the point of exhibiting rigidity in routines.

(3.) The repertoire ofactivities, interests, and imaginative development:

The student displays marked distress over changes, insistence on following routines and a persistent occupation with or attachment to objects. The student may display a markedly restricted range of interest and/or stereo-typed body movements. There may be a lack of interest or an inability to engage in imaginative activities.

(4.) Developmental rate and sequences: The student may exhibit delays, arrests, regressions in physical, social, or learning skills. Areas of precocious or advanced skill development may also be present while other skills may develop at normal or extremely depressed rates. The order of skill acquisition frequently does not follow normal developmental patterns.

(5.) Sensory processing: The student may exhibit unusual, repetitive or non­meaningful responses to auditory, visual, olfactory, gustatory, tactile, and/or kinesthetic stimuli. The student's behavior may vary from high levels of activity and responsiveness to low levels.

(6.) Cognition: The student may exhibit abnormalities in the thinking process and in generalizing. Difficulties in abstract thinking, awareness and judgment may be present as well as persevering thinking and impaired ability to process symbolic information.

l.l Classifications And International Criteria ofAutism

Autistic disorder is classified in two well-documented medical diagnostic systems as follows:

Firstly, the World Health Organization’s (WHO) International Classification ofDiseases - ICD. now is released in its tenth version (ICD-10).

Secondly, the American Psychiatric Association’s Diagnostic and Statistical Manual - DSM. currently categorized in its fourth edition (DSM-IV).

These worldwide known systems are accepted as standard diagnostic systems. Both the ICD and the DSM system are valid methods. Among many others, ICD-10 and DSM-IV regard a “triad of impairments”. These impairments generally characterize autistic individuals such as their problems with social contacts, lack of communication skills and the richness ofimagination.^[3]

1.2 International Classification of Diseases - ICD

The WHO International Classification ofDiseases has already been accepted outside the USA. While the ICD-8 placed autism under schizophrenia, the latest revised edition, the ICD 10, classifies autism among “the psychoses with an origin in childhood.” It describes a number of separable categories under the general heading of pervasive developmental disorders:

- Childhood autism
- Atypical autism
- Rett's syndrome
- Other childhood disintegrative disorder
- Overactive disorder associated with mental retardation and stereotyped movements
- Asperger's syndrome
- Other pervasive developmental disorders
- Pervasive developmental disorder, unspecified^[4]

1.3 The Diagnostic and Statistical Manual: DSM IV

The American Psychiatric Association Diagnostic and Statistical Manual (DSM) has been undergone four major revisions as follows:

- DSM - III (1980)
- DSM- III - R (1987)
- DSM-IV (1994)
- DSM-IV-TR (2000 - present)

DSM - IV is still one of the most effective systems of analyzing autistic disorders because this set of guidelines defines autism perspicuously and gives an accurate method of diagnosis. Moreover, it has achieved acceptance among previous versions of the DSM systems with help of the inventive strategy using a “three-phase empirical approach”.

The following overview shows how the American Psychiatric Association DSM system for diagnosis of autism has developed from the 1980 DSM-III to the latest edition.^[5]

Abbildung in dieser Leseprobe nicht enthalten

Asperger's syndrome being understood as a form of autism by a variety of professionals, the fact that DSM-IV considers Asperger's syndrome an exclusion criterion indicates how controversially autistic disorders are discussed; there is hardly any agreement among experts as to define the phenomenon. The 4th chapter has more about Asperger.

To summarize, DSM and ICD made autism be classified as a subgroup ofindividuals with empathic impairments and cognitive deficits. Hence, autistic individuals have a stable characterization of their behavior and disease pattern. In the same way do ICD and DSM identify Asperger's syndrome, Rett's syndrome and Childhood disintegrative disorder as separate entities.

Consequently, DSM is on a par with ICD and being used all over the world for autistic diagnosis.^[6]

2 Causes Of Autism

There is no known single cause for autism, but it is generally accepted that it is caused by abnormalities in brain structure or function. Brain scans show differences in the shape and structure of the brain in children with autism versus neuro-typical children. Researchers are investigating a number of theories, including the link between heredity, genetics and medical problems.^[7]

Being one of the most important American institutions, the Autism Society of America (ASA) provides reliable information on various aspects of autism and related topics. Mainly for educational purposes and in order to serve as a consulting institution, the ASA is trying to inform of current findings in the fields of neuropsychology, psycholinguistics and many other autism-related disciplines. Seeking answers about the causes of autism, the ASA website goes on to expound on the three areas which are presumed to be responsible for atypical brain development and thus - in the end - autism.

Very much like Uta Frith, many experts are of the opinion that “Autism has a biological cause and is the consequence of organic dysfunction.”^[8] However, besides the medical point of view, a cluster of unstable genes interfering with brain development is as well examined as problems during pregnancy or environmental factors such as viral infections, metabolic imbalances, and exposure to chemicals. Since presenting all assumed causes of autism would by far exceed the extent of this research paper, only some of the most critical theories can be outlined here.

In order to find out whether or not genetics contribute to autism, genetic research studies examined same-sex twins. If particular genes were completely accountable for autism, both of monozygotic twins, who share the same genetic codes, would be expected to have autism any time one of them has it. This was true in more then 90% of the examined cases, which made genetic researchers infer that genetics must play an important role, even though it is not the only cause of autism. If it was, 100% should have been registered.^[9] Moreover, very little is known about the genetic influence on brain development and damage. Chapter 3.5 of the present research paper (“Verbal and Non-Verbal Cognitive Development”) presents some very basic assumptions about language and the brain and how various defects can influence cognitive processes as they are found in autism.

As of 1997, in-depth study of genetic disorders coinciding with what is diagnosed autism lead to the conclusion that autism is a genetic disorder. However, by then, the particular chromosomal impairment was unknown. The question to be answered was and probably still is: Does one single out of several suspect genetic abnormalities cause autism or do various abnormalities lead to the disorder?^[10]

Pregnancy and delivery are subject of Simon Baron-Cohen’s “Empathizing-Systemizing Theory (E-S)”. In his book “The Essential Difference”, University of Cambridge professor Baron-Cohen explains that human male brains generally tend to process information in a more systemizing way whereas females show a tendency towards empathy, i.e. the ability to understand another person’s feelings, experience, etc. The fact that autistic people often have unusual systemizing skills made the professor of psychology assume that the fetus was exposed to elevated testosterone levels. A series of experiments confirmed his assumption: The higher the level of the “male” hormone was, the faster the right hemisphere of the brain developed to the detriment of the left half of the brain.

As a result, mathematical skills outweigh not only empathy, but also language development. The brain is a “male” brain. Autistic individuals, especially those diagnosed with Asperger syndrome, could thus be the results of testosterone.^[11]

To sum up, Mesibov ascertains that most of the cases of autism cannot be explained. However, he is confident that a promising approach to autism may finally mean finding the needle in the haystack. This new theory focuses on abnormal neuronal growth in the prenatal development stage of the child.

[...]

^[1] “Autism.” Encyclopaedia Britannica 2005 Deluxe Edition. CD-ROM. Chicago: Encyclopaedia Britannica, 2005.

^[2] The University of Iowa and other institutions constitute the Regional Autism Services Program (RASP), striving to promote a quality of life for children and adults with autism and their families. For more details consult < http://www.medicine.uiowa.edu/autismservices/autism_definition.htm> (site valid as of 12 May 2008).

^[3] Cf. Trevarthen, Colwyn, Kenneth Aitken, Despina Papoudi, and Jacqueline Robarts. Children withAutism. Diagnosis andlnterventions toMeet TheirNeeds. London andBristol, Pennsylvania: Jessica Kingsley Publishers, 1996, 10-15.

^[4] Cf. Trevarthen etal. (1996), 11-12.

^[5] Trevarthenetal. (1996), 13.

^[6] Cf. Trevarthen etal. (1996), 14-15.

^[7] “What Causes Autism?” Autism Society of America. 25 January 2008. 16 May 2008 <http://www.autism-society.org/site/PageServer?pagename=about_whatcauses>.

^[8] Cf. Frith, Uta. Autism. Explaining the Enigma. Oxford: Basil Blackwell, 1989, 68.

^[9] Cf. Mesibov, Gary B., Lynn W. Adams, and Laura G. Klinger. Autism. Understanding the Disorder. New York and London: Plenum Press, 1997, 45-50.

^[10] Cf. Mesibov et al. (1997), 50.

^[11] Cf. Spiegel-Gesprach. “Frauen denken anders.” Spiegel special 4/2003 -01. November 2003. 17 May 2008 <http://www.spiegel.de/spiegelspecial/0.1518.272649.00,html>.