3.3 Communication and autism
‘Communication happens when one person sends a message to another person. This can be verbally or non-verbally. Interaction happens when two people respond to one another – two-way communication.’
Autism rarely occurs in isolation and commonly co-occurs with a range of speech, language and communication support needs. This can affect:
- non-verbal communication
- comprehension or understanding of other people’s communication
- expressive language
- social communication.
In order to support autistic learners and those with related needs in early learning centres and schools, it is essential that those around them understand their communication stage across these four areas of communication. One of the biggest causes of ‘distressed behaviour’ in this group is a mismatch between the individual’s capacity for communication and the way others around them do or do not adapt.
Speech and Language Therapists can provide expert assessment, training, coaching and advice around communication. However, all those involved with the child on a day-to-day basis at school and at home support success with two-way communication.
Communication can be pre-intentional and intentional
Pre-intentional
Where the learner says or acts without intending to affect those around them. This type of communication can be a reaction to something or can be used to self-sooth.
Intentional
Where the learner says or acts with the purpose of sending a message to another person. This type of communication can be used to ask for something or to object.
Communication stages
There are many ways we can think about stages of speech, language and communication development, and sources of detailed information about this. In the Toolbox, the following three stages (as described in the SCERTS model, Prizant et al, 2006) might be useful ways to think about the strategies we use and how they fit the child’s stage.
Pre-verbal or social partner stage
Individuals have less than ten words. Communication may be through behaviour and actions rather than words. Joint attention with others may be difficult, with attention focused on objects of interest. The individual may be communicating intentionally but may not. They may have some words, but these are not used consistently or effectively.
Language partner stage
At this stage individuals may have developed over 100 words, which they use with meaning. They may put words together in short phrases or sentences. Often at this stage they are able to talk best about the ‘here and now’ and find it harder to talk about the past or future. They may be able to say what they like and don’t like and, although they can learn emotion vocabulary, their theory of mind is at an early stage. They understand symbols and benefit from visual supports to support verbal communication.
Conversation partner stage
Conversation partners can engage in conversations with others. First, at a simple level, and then over time they can become sophisticated communicators. At this stage they can have an excellent vocabulary and mastery of language. They are likely to still need visual supports appropriate to their stage, and they may be able to use language or ‘meta-cognitive’ skills to overtly learn strategies to manage the social world. They may become able to mask some of their social communication difficulties and what we might notice are signs of anxiety or difficulties with social aspects of communication. The way we understand and use social communication develops over our lives and we should not underestimate the significant impact of social communication challenges for individuals at this stage.
Variability
When anxious or stressed, individuals do not understand and communicate in the way they do when calm and well regulated. We need to make bigger adaptations in reducing language and reducing expectations. It is recognised that communication skills observed can be ‘deceptive’ and people around them may judge that the person’s communication is at a higher stage than it is. For example, they may have good vocabulary around topics that interest them but have gaps in common vocabulary, or they may use echolalia, where they repeat words or phrases heard elsewhere.
Social communication
Social communication occurs between people and involves understanding of social signals and using social signals in more or less expected ways. It can require coordination of verbal and non-verbal messages.
Social communication differences are present in autistic individuals. These are lifelong but present in different ways at different stages.
For autistic learners, this can lead to feeling misunderstood or as if they are getting things ‘wrong’. Adults might notice unexpected behaviours in social situations. Peer relationships are often most successful with small groups or individuals with shared interests.
Eye contact
Reduced use or understanding of eye gaze for social purposes is core to autism. Some children will be overtly avoidant and seem to almost find direct gaze painful, whilst others will not have obvious outward difficulty with eye gaze. You do not have to have poor eye contact to be diagnosed with autism.
Joint attention
Typical children develop joint attention in the first year of life and by 9–18 months start to use pointing, with coordinated eye gaze, to both request and share attention as if saying ‘look at that’. They can have sophisticated communication turns with others with or without words because they know where other people are looking and that others have seen where they look.
A common early sign of autism is delay or absence of pointing to share attention by 18 months.
Joint attention is a precursor to social play and theory of mind. Older autistic learners may have developed simple joint attention but still have difficulty working out what others are focused on, interested in, what they feel or believe through joint attention, and interpreting other people’s non-verbal behaviour.
Prosody and American accents
We convey a range of meaning with our intonation, pitch and stress. For example, the phrase ‘cup of tea’ could be a question, a refusal, could indicate pleasure, an acceptance, a comment etc.
Autistic learners can have difficulties understanding prosody and therefore the intention behind the way teachers or peers say things, which in turn leads to social difficulties.
It is more common in autism than in other conditions for UK speakers to speak with an American accent. It is thought that they may give equal weight to language and intonation heard on TV as they do to that of their social world and family. Other children are likely to unconsciously give preference to the accent of their family over those with whom they have no social connection.
Body language
Autistic people may have difficulty processing or interpreting facial expressions, gestures and body language of others and therefore they miss social cues communicated in this way. They may not know they are being spoken to unless the other person uses their name first.
They may not notice body language at all because their attention is not focused on that. They may understand it in some contexts, in pictures or in discussion, but have difficulty interpreting it ‘in the moment’ or in context.
They may not notice body language at all because their attention is not focused on that. They may understand it in some contexts, in pictures or in discussion, but have difficulty interpreting it ‘in the moment’ or in context.
Prosopagnosia
Although not present in all autistic people, some may have a co-occurring difficulty with recognising people’s faces, judging ages or gender – including family members and close friends or even their own face. They may use alternative strategies, such as remembering clothes or places people are commonly seen. They may appear to be ignoring people and find it hard to use names correctly.
Autistic people may have difficulty processing or interpreting facial expressions, gestures and body language of others and therefore they miss social cues communicated in this way. They may not know they are being spoken to unless the other person uses their name first.
They may not notice body language at all, because their attention is not focused on that. They may understand it in some contexts, in pictures or in discussion, but have difficulty interpreting it ‘in the moment’ or in context.
While signing can be helpful as part of a ‘Total Communication’ approach, use of signing can be difficult for individuals who have difficulty with joint attention or noticing other people’s actions. For these individuals, objects, symbols or picture exchange systems can be more effective as communication supports.
Some autistic people may also use facial expressions and body language in an unexpected or idiosyncratic way, for example, smiling when anxious.
Comprehension or understanding of other people’s communication
It is common for understanding of autistic people to be overestimated. Although, we do see a range of stages, from not understanding words to having excellent language skills. Below are some examples of how the understanding of autistic individuals can be affected.
- Understanding varies with context and demands at any one time.
- Expressive language may be in advance of comprehension.
- Echolalia (repeating words or phrases immediately or after a delay) is often a sign of poor comprehension. Even when individuals are conversation partners, they can be ‘overliteral’ in their understanding and not pick up when people say one thing but mean another.
- The combined challenge with understanding non-verbal information, social information, unspoken and spoken messages means that the risk of misunderstanding is common.
3.2 Cognitive theories – overview