Difficulties in language and communication processing with those experiencing autistic spectrum disorders

Language and communication difficulties are well known in those experiencing autism. Janzen20 described this characteristic as not being able to process auditory information efficiently or reliably. This means that while their hearing can be very good, the deficit lies in the processing of the auditory information transmitted to the brain. It can be very perplexing for a parent or caregiver to have a child with excellent hearing who can show extraordinary ability in music. This can include a true musical ear (i.e. singing in tune, playing a musical instrument by ear at a level well beyond normal development), but yet have the most fundamental difficulties with language. Excellent hearing does not preclude other auditory processing difficulties.38 The lack of normal development in language and communication is usually the first apparent sign of the disability and can be detected in toddlers as young as 2 years old.

These individuals are unable to communicate and respond to human interactions and situations in a normal way. They are often unable to understand the nuance of statements such as “Pull your socks up,” or “How many times have I told you……?” Even the most capable and verbal children with autistic spectrum disorders are concrete and literal in their understanding and use of language.20 In the above cases, an autistic person will literally pull their socks up and give the number of times they have been told without understanding the underlining meaning.

The auditory channel is still the most common means of communication and imparting of knowledge. Autistic individuals often have exceptionally good visual skills, which in many cases is far superior to their auditory skills39. They can remember visual images in surprising detail, and it is based upon this strength, that many new frameworks for initiatives in communication are based.

Hodgson39 describes in detail as to why this is thought to be the case. Those experiencing autism experience difficulty smoothly and accurately controlling the shifting and re-establishing of attention, which current research suggests is due to cerebellar deficits. The early acquisition of social skills and communication skills requires an ability to rapidly select, prioritise and process of information. Their central nervous system cannot perform this complex function adequately.39

Hodgson39 also describes the difficulty in attending to foreground sounds and disregarding or blocking out background noise. It is well known that in typical environments many simultaneous sound sources exist (doors banging, chatter, traffic etc) and intentional communication has to compete with such noises. A normal listener is able to focus attention selectively on the information, which is important, such as communication from the teacher for example, and selectively block out background noise to a considerable extent.39 This is a particularly important skill in education and one which creates severe disadvantages for autistic children in receiving and processing information from the teacher. This selective processing of auditory information is a learned process and not fully developed until adulthood.40 However some listeners are unable to carry out such selective processing and receive all auditory information with equal intensity.39 Communication modes such as speech, hand signals and gestures are transient as they remain only for a short time. Individuals with autism and other forms of communication disorders have major difficulties in carrying out tasks that require sequential processing of transient information.39 As an example, the giving of several discreet commands at once such as, “Eat your breakfast, then wash your face, collect your bag and wait in the car.”

It is not difficult to appreciate the implications for a student with autistic spectrum disorder who experiences such difficulties to try and make sense of a transient message in a noisy environment. Often the spoken message will have passed by before the student can focus enough to receive it.39

A key development in the communication framework is the use of visual communication messages which give a child the opportunity to engage his/her attention before the message disappears. Such stability permits enough time for adequate processing, as these individuals appear to understand much better what they see than what they hear. A student can return to a visual message to refocus as needed.39 Extensive work has already been conducted on such visual tools and strategies.

Shields22 advocates the PECs (picture exchange system) as a means of initiating a request and expressing their needs. A child wanting something is trained to take a picture of what they want and give it to a person such as a parent to action. During this process language is reduced to the absolute essential.

Taking the case of command to be actioned in sequence, visual schedules are prepared showing the child what has to be done in stepwise fashion. These techniques originally developed for autism have also been found to be very useful for a range of children with auditory deficits and communication problems such as hearing impairment. They are likely to be extremely useful in classroom situations where children with hearing impairment and other auditory disorders are present.

It is now recognized that a completely different language structure and framework is needed to communicate with autistic individuals. Efforts are now being made to educate parents in these new techniques so that they can interact educate and positively contribute to the development of their children.20,22,39 One such initiative, the Early Bird Programme,22developed by Shields and the National Autistic Society (UK) was introduced on trial in 2000 in New Zealand with joint funding by the Ministries of Health and Education. A small number of families with autistic preschool children were selected for an intensive programme of formal instruction, guidance and observation in working with their children. Due to the initial success of the trial programme, the government has committed funding to extend the programme to families throughout the country on an ongoing basis.