Communication and Autism

On Monday I focused on the area of Social Interactions in regards to the DSM IV (how autism is diagnosed.)  Today I'm would like to continue on to Communication.  As I said in my last post, just because someone has some of these characteristics, does not necessarily mean they have autism.  They must also meet the criteria in the areas of Social Interaction and Repetitive Behaviors.

According to the DSM IV, at least one of the following are present.

• Delay in or total lack of, the development of spoken language (also without gestural communication)
• Individuals with adequate speech have a marked impairment in the ability to initiate or sustain conversations
• Stereotyped and repetitive use of language or idiosyncratic language
• Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

Spoken Language and Gestural Language.  Many times the lack of spoken language is the most obvious sign for parents that their child may have delays.  Typically, kids should have several  consistent words they are using by 18 months.  You would start seeing more gestural communication, like pointing, around 14 months.  Here is a great blog about language development (Playing With Words 365), and particularly, here is a post about red flags in communication.  It gives some great timelines on language development.

Initiating and Sustaining Conversations.  There are some kiddos who have tons of words they know, but making their words functional can be more difficult.  Conversations are a give and take process, we build relationships when we have good conversations.  Some kids may know how to talk, but they do not participate in a back and forth interactions with others.  Some kids are good at responding, and will answer questions, but will not go further than that.  Others will initiate, but will rarely let others respond, thus they are very good at the giving part, but not so much at the taking part.

Stereotyped and Repetitive Language.  Some parents will report that their children speak in movie quotes.  Sometimes it's in context with the situation, but a lot of times it is not.  Some kids may get fixated on certain phrases and will repeat them continuously.  Other kids will repeat what you say or other things they hear, this is called echolalia.  Echolalia includes when they immediately repeat what they hear, or they may also repeat what they heard hours ago.

Make-believe Play or Social Imitative Play.  Make-believe can be difficult for some kids with autism because it involves an understanding of what other people are feeling and doing.  It also requires imitation skills.  When playing with others in pretend play, this skill also requires that the child is able to see the points of view of other people and explain his/her point of view to them to create the experience that they want.  Many kids with autism prefer to play on their own, and may focus more on sensory type play.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children with Autism

photo credit: Diego Dalmaso via photopin cc

On Monday I focused on the area of Social Interactions in regards to the DSM IV (how autism is diagnosed.)  Today I'm would like to continue on to Communication.  As I said in my last post, just because someone has some of these characteristics, does not necessarily mean they have autism.  They must also meet the criteria in the areas of Social Interaction and Repetitive Behaviors.

According to the DSM IV, at least one of the following are present.

• Delay in or total lack of, the development of spoken language (also without gestural communication)
• Individuals with adequate speech have a marked impairment in the ability to initiate or sustain conversations
• Stereotyped and repetitive use of language or idiosyncratic language
• Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

Spoken Language and Gestural Language.  Many times the lack of spoken language is the most obvious sign for parents that their child may have delays.  Typically, kids should have several  consistent words they are using by 18 months.  You would start seeing more gestural communication, like pointing, around 14 months.  Here is a great blog about language development (Playing With Words 365), and particularly, here is a post about red flags in communication.  It gives some great timelines on language development.

Initiating and Sustaining Conversations.  There are some kiddos who have tons of words they know, but making their words functional can be more difficult.  Conversations are a give and take process, we build relationships when we have good conversations.  Some kids may know how to talk, but they do not participate in a back and forth interactions with others.  Some kids are good at responding, and will answer questions, but will not go further than that.  Others will initiate, but will rarely let others respond, thus they are very good at the giving part, but not so much at the taking part.

Stereotyped and Repetitive Language.  Some parents will report that their children speak in movie quotes.  Sometimes it's in context with the situation, but a lot of times it is not.  Some kids may get fixated on certain phrases and will repeat them continuously.  Other kids will repeat what you say or other things they hear, this is called echolalia.  Echolalia includes when they immediately repeat what they hear, or they may also repeat what they heard hours ago.

Make-believe Play or Social Imitative Play.  Make-believe can be difficult for some kids with autism because it involves an understanding of what other people are feeling and doing.  It also requires imitation skills.  When playing with others in pretend play, this skill also requires that the child is able to see the points of view of other people and explain his/her point of view to them to create the experience that they want.  Many kids with autism prefer to play on their own, and may focus more on sensory type play.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children with Autism

photo credit: Diego Dalmaso via photopin cc

Social Interactions and Autism

According to the DSM IV (which I mentioned earlier will soon be DSM-5 as early as May 2013), at least two of the following are present in the area of Social Interaction when an individual is being diagnosed with autism.

• Marked impairments in the use of multiple nonverbal behaviors such as eye contact, facial expression, body posture, and gestures to regulate social interactions
• —Failure to develop peer relationships appropriate to developmental level
• —A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people
• —A lack of social or emotional reciprocity

Now just because someone has some of these characteristics, doesn't mean they have autism. They also have to have symptoms in the areas of Communication and Repetitive Behaviors, which I will talk about next week.

Let's break this down a little.

Eye Contact.  Sometimes eye contact can be very aversive to a person with autism, you may get occasional glimpses here and there, but it can be fleeting.  As you go through your day, take note to how much we communicate with our eyes.  It can be very difficult to teach someone to communicate and read "eye language", it's all so subtle.  You can see how that can affect someone's social skills.

Facial Expression.  You may or may not have heard the expression "flat affect."  Sometimes individuals with autism show very little expressions through on their face.  They have the same expression when they're bored as they do when they're excited.  Other times you may find that their facial expressions are a bit rigid and unnatural.  Again, reading facial expressions can be difficult for some people with autism, but in general it's a bit easier to teach than reading the eyes.

Body Posture and Gestures.  How often do we communicate with gestures?  All the time!  Many times, young kids with autism are unable to follow a point or use a point themselves.  We point with our fingers, and we point with our eyes for joint attention.  We are having an interaction as we are both focused on the same thing.  Gestural communication is very important in our social interactions.  It is usually learned through imitation, which many kids with autism are lacking in.

Peer Relationships.  There are different types of play, and depending on the child's age, different types of peer interactions are more appropriate than others.  Usually when parents start to see the gap is when it is time that their child should start socializing with their peers (associative or cooperative play.)  For some kids, they would rather participate in solitary play away from everyone else.  Some kids are only able to play near others for short periods of time.  For other kids they may want to play with other kids, but they don't know how to join in, or they don't know how to participate.  Some kids are able to talk, but they lack the understanding that conversations should be a give and take exchange.  And some kids like playing with others, but they have a hard time when they don't have total control over the activity.  All of these things can affect peer relationships.

Sharing Enjoyment.  At a young age kids will pick up a toy to show their mom.  Typically a toddler will learn the phrase "look" or "look at me!" and will use it quite often.  Once again, that is part of joint attention.  Focusing together on one thing.  Some kids with autism will not participate in exchanges like this.

Social or Emotional Reciprocity. When we are connected to each other, we have back and forth interactions with one another.  We are able to read each others gestures, their tone of voice, their emotions, and their words.  We take these things as cues and we respond to them accordingly.  Many people with autism have a difficult time with this because they lack theory of mind.

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Services for Children with Autism

photo credit: MikeWren via photopin cc

According to the DSM IV (which I mentioned earlier will soon be DSM-5 as early as May 2013), at least two of the following are present in the area of Social Interaction when an individual is being diagnosed with autism.

• Marked impairments in the use of multiple nonverbal behaviors such as eye contact, facial expression, body posture, and gestures to regulate social interactions
• —Failure to develop peer relationships appropriate to developmental level
• —A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people
• —A lack of social or emotional reciprocity

Now just because someone has some of these characteristics, doesn't mean they have autism. They also have to have symptoms in the areas of Communication and Repetitive Behaviors, which I will talk about next week.

Let's break this down a little.

Eye Contact.  Sometimes eye contact can be very aversive to a person with autism, you may get occasional glimpses here and there, but it can be fleeting.  As you go through your day, take note to how much we communicate with our eyes.  It can be very difficult to teach someone to communicate and read "eye language", it's all so subtle.  You can see how that can affect someone's social skills.

Facial Expression.  You may or may not have heard the expression "flat affect."  Sometimes individuals with autism show very little expressions through on their face.  They have the same expression when they're bored as they do when they're excited.  Other times you may find that their facial expressions are a bit rigid and unnatural.  Again, reading facial expressions can be difficult for some people with autism, but in general it's a bit easier to teach than reading the eyes.

Body Posture and Gestures.  How often do we communicate with gestures?  All the time!  Many times, young kids with autism are unable to follow a point or use a point themselves.  We point with our fingers, and we point with our eyes for joint attention.  We are having an interaction as we are both focused on the same thing.  Gestural communication is very important in our social interactions.  It is usually learned through imitation, which many kids with autism are lacking in.

Peer Relationships.  There are different types of play, and depending on the child's age, different types of peer interactions are more appropriate than others.  Usually when parents start to see the gap is when it is time that their child should start socializing with their peers (associative or cooperative play.)  For some kids, they would rather participate in solitary play away from everyone else.  Some kids are only able to play near others for short periods of time.  For other kids they may want to play with other kids, but they don't know how to join in, or they don't know how to participate.  Some kids are able to talk, but they lack the understanding that conversations should be a give and take exchange.  And some kids like playing with others, but they have a hard time when they don't have total control over the activity.  All of these things can affect peer relationships.

Sharing Enjoyment.  At a young age kids will pick up a toy to show their mom.  Typically a toddler will learn the phrase "look" or "look at me!" and will use it quite often.  Once again, that is part of joint attention.  Focusing together on one thing.  Some kids with autism will not participate in exchanges like this.

Social or Emotional Reciprocity. When we are connected to each other, we have back and forth interactions with one another.  We are able to read each others gestures, their tone of voice, their emotions, and their words.  We take these things as cues and we respond to them accordingly.  Many people with autism have a difficult time with this because they lack theory of mind.

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Services for Children with Autism

photo credit: MikeWren via photopin cc