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.
National Autistic Society 2017
Autism rarely occurs in isolation and commonly co-occurs with a range of speech, language and communication support needs. This can affect:
- Nonverbal communication
- Comprehension or understanding of other people’s communication
- Expressive Language
- Social communication
In order to support autistic learners in school and those with related needs, it is essential that those around them understand their communication stage across these 4 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 don’t 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, 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. Communication can also be 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.
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.
1. Pre-verbal or Social Partner stage
Individuals have less than 10 words. Communication may be through behaviour and actions rather than words. Joint attention with others may be difficult, with attention focussed 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.
2. 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.
3. Conversation Partner stage
Conversation Partners can engage in conversations with others. First at a simple level and over time 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.
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.
Many young people with autism require only understanding, tolerance and encouragement to support their communication. For others, socialising and communicating can be challenging and isolating affecting the development of desired friendships and relationships.
Eye Contact and Joint attention
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.
Typical children develop joint attention in the first year of life and by 9-18 months start to use pointing, with co-ordinated 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 focussed 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.
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 focussed 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.
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.
Comprehension or understanding of other people’s communication
It is common for understanding of autistic people to be overestimated. Although we see a range of stages from not understanding words, to having excellent language skills. The NAS campaign about ‘Too Much Information’ highlights some of the ways understanding 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
At least 50% of autistic people have a co-occurring developmental language disorder which can affect their speech, language and communication. Typical stages of language development can be found on these websites:
- Language can be measured in the words we use (vocabulary) and the way we put these together (grammar) and length of utterance
- Expressive Language may include echolalia (repeating words and phrases from people, TV or computers) or spontaneous and creative speech
- Verbal Dyspraxia affects the fluent articulation of speech, due to difficulties with planning motor movements for speech
- Language can be expressed through words, pictures or signs
Difficulty understanding and using social communication according to the conventions of the local context affects individuals across the lifespan. This is not something that can be ‘fixed’. Social communication skills do develop and can be scaffolded, however as individuals transition to new roles and activities in life, additional support might be required at each stage.
Some difficulties may be more apparent, such as those who talk repetitively or endlessly about a favourite topic. Others may be more subtle, such as those who ‘copy’ social behaviours or very rarely initiate and wait for other to take the lead in social interactions.
At the conversation partner stage children begin to develop the ability to reflect upon their knowledge, learning and actions. Prior to this stage social skills groups are not recommended (see NAIT Guidance on Social Communication Groups).
Peer interaction is often harder than interaction with those older and younger. Adults are likely to make adaptations and younger children’s communication is likely to be less sophisticated and demanding.
Groups can be more difficult than 1:1 interaction and therefore collaborative learning can present challenges. Reasonable adjustments may include allocation of clear roles, scripts, sticking to familiar rather than new activities in groups, having a familiar and supportive peer and having predictability. A range of visual supports can assist.
At the secondary stage, individuals with good language skills and motivation to make friends might benefit from taking part in focussed work on this (e.g. the PEERS Programme).
Masking and Camouflaging
Some autistic people use masking and camouflage as coping strategies. These may be intentional or unconscious habits (Hull et al. 2017, “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions).
The information above and Cognitive Theories (e.g. Theory of Mind, Weak Central Coherence, Executive Functioning, Context Blindness) can help explain some of the social communication difficulties observed and experienced.
A helpful description of the way social communication develops can be found on www.socialthinking.com.
Difficulties in social communication might affect the ability to:
- Respond to group instructions
- Take turns appropriately in group discussion
- Understand ‘implied’ meanings, affecting aspects of literacy
- Process information and respond within expected time
- Organise several instructions given together
- Remember or follow information or instructions given verbally.
As highlighted some autistic learners may have delayed language but the degree of impairment varies greatly. Some may remain non-verbal throughout their life. Others may have limited skills, only using speech to communicate their needs.
Supporting Communication – Key strategies
- Reduce your language
- Use the person’s name, to cue them in
- Focus on teaching the names of key people
- Provide opportunities for initiation
- Use Visual Supports
- Allow time … wait
Individualised, stage specific strategies and supports can be discussed with the team around the child.