Autism Spectrum and Communication

Most people have heard of the term "autism" and many might know someone that is autistic, but not many people understand what it means or how it relates to their everyday life. Autism is a spectrum disorder, meaning the diagnosis carries varying degrees of severity of symptoms. There are also specific points of diagnosis on the scale for certain disorders that have more specific symptoms or behaviors. No one knows what causes autism and there is no cure or prevention for it. The general symptoms or behaviors associated with autism include developmental delays in cognitive ability especially with communication and social skills. The condition revolves around the lack of appropriate communication skills and ability to socialize with others, the different severities of which are the basis for placement on the spectrum (Clinical Research Systems, p281-282). Those severely afflicted with autism probably will not develop verbal speech and will be unable to socialize successfully (Barstow). At the other end, the higher functioning might develop language communication at age appropriate levels but simply lack social skills to apply successful communication. Between the two extremes, there would be a balance of delayed verbal or nonverbal communication development and different severity of social skill impairment. My goal is to illuminate the characteristics of the autistic spectrum as related to communication and to show the increasing communication capability, and thus social skills, with movement towards the higher functioning end of the spectrum.

Autism falls under the Pervasive Developmental Disorder Spectrum. This spectrum includes generalized autism or PDD not-otherwise-specified (with its inherent levels of severity) and the specific points on the scale termed Rett's Syndrome and Aspergers Syndrome. The spectrum is based on functionality; mental retardation is often associated with autism and would constitute the lower end of the spectrum or the "low functioning." Autistic persons (based on severity) generally develop communication skills much more slowly than would be otherwise age appropriate. There is a seeming language block that inhibits the cognitive learning ability. Low functioning autistics often never develop communication at all. Those with autism have varying degrees of relational skills, they often live in their own worlds inside of their minds and only interact with others when necessary or when they are willfully prompted or given specific directional instructions. Towards the lower end of the spectrum, autistics would avoid social interaction and instead focus on whatever objects they might be intensely focused on or almost obsessed with (Turkington). People with autism often need strict schedules because they are easily flustered with changes or over stimulated by loud noises, strong smells, or strange feeling objects. Deviating from the schedule or the comfort zones create stress because of the inability to adapt to social situations or how to deal with new information or scenarios (Turkington).

Autism relates heavily to the ability of communication and its appropriate social application. Depending on severity, communication skills can be nonexistent, developmentally delayed according to age, or completely age appropriate. This communication development involves vocabulary use, grammatical capability, and proper use of pronouns, as well as the will to relate with others. A mildly autistic person at nineteen years old might have the mental development of a thirteen year old. The severity of the delay is the reference for placement on the spectrum. Verbal communication can be very difficult for autistic children to learn so often times simple sign language is substituted. Another alternate option is a Picture Exchange Communication System (PECS), which can be a variety of devices ranging from an electronic touch screen to a binder with sticky pictures, that allows the user to point or show pictures of everyday items or actions to communicate when necessary (Cafiero, 114). PECS usually require prompting or directional instructions for use and are not always effective. Studies of autistic children reveal the necessity of imagination and shared meaning to the development of good communication skills. These traits are often lacking in children with autism, resulting in an inability to share non-literal meaning (Ochs et al, 143). Those with autism have difficulty reading social situations and determining the appropriate responses to normal situations and dialogue (Meyer). The combination of less developed communication skills and less developed social skills are evident in the frequent inability of those with autism to find central meaning, symbolism, and connection of main ideas (Solomon, 260). Successful interpersonal communication requires feedback and the perception of signals and unspoken messages, a major problem area for anyone with autism. Without shared meaning beyond the direct message, communication is crippled.

Rett's Syndrome is a specific diagnosis as a subcategory of the autism spectrum and is considered in the low functioning end of the spectrum. It is almost exclusively diagnosed in females. It is characterized by normal development during early years of life followed by severe regression to a point where the female will lose interest in social communication and her ability to learn and to communicate will be severely impaired. It is also associated with the loss of motor skills, specifically the wringing of hands and clumsy leg control (Child Health and Human Development). Because of the severe developmental challenges in learning, communication, and social skills as well as the propensity for lower spectrum persons to also be afflicted with mental retardation, those that suffer from Rett's Syndrome are severely impaired when it comes to communication. Rett's Syndrome is very rare, especially considering that autism affects four times as many males as females (CHHD). The symptoms and characteristics of Rett's Syndrome are very similar to other severe cases of autism, despite lacking specific criteria to be diagnosed as Rett's syndrome. Rett's syndrome combines both the severe lack of developed communication and subsequently the absence of social awareness or general social skills at the lower end of the autistic spectrum.

Aperger's Syndrome is a diagnosis point at the high functioning end of the spectrum. Those with Asperger's develop language at average or above average ages and are considered very proficient in communication and may have large vocabularies and good control of grammar and pronouns. The difference is that with Asperger's, the social skills are still not quite developed particularly at earlier ages in adolescence. Many afflicted with Asperger's use much too formal language for daily situations and are not very good at reading feedback of their listeners. A study on teenagers with Asperger's Syndrome found that they were much less able to read facial expressions and body language in conversation (Ochs et al, 171). Their speech is very one sided and not recognizant of the all participants, instead focusing on their own ideas or the things they had prepared to say. This can create social problems and make for competent but awkward communication on a personal level. Studies of those with Asperger's Syndrome show that although their vocabularies are often above average, they have difficulty speaking in turn or recognizing nonverbal cues in communication (Ochs et al, 175). Besides using inappropriately formal language, those with Asperger's use language very literally and are less able to use imaginative or metaphorical symbols. Asperger's Syndrome is considered high functioning autism because there is no developmental delay or lack of communication skills, but solely a lack of appropriate social application.

It is important to recognize the spectrum nature of autism and the inherent differences in social and communication abilities. It is also important to realize that each individual has their own unique level of severity and the spectrum does not represent concrete numbers or quantitative measurements, but is based on dynamic behavior observations (Sigman et al, 349). It is easier to understand the different symptoms or behaviors of one disease when it is understood as a spectrum disorder. At the lower end of the spectrum, such as the example or Rett's Syndrome, the severity is much more profound and the dual communication aspects of the disease (lack of communication skills and social skills) are very noticeable. The communication development block prevents the social skills from being used in the first place and the lack of social relations compounds the "isolation" of those affected. While moving towards the higher end of the spectrum, like Asperger's Syndrome, the communication skills improve even while the social skills might still be lacking. The further development of communication skills such as vocabulary and grammar proficiency allows for the development or at least use of social skills. At the higher end of the spectrum, those with Asperger's have normal verbal communication but even at this part of the spectrum they have limited social interaction skills to interact at the social norm.

With these criteria and observations it becomes easier to understand the difficulties faced by those with autism at varying levels. It is important for development and teaching to understand the limitations or strong points of each individual on the autism spectrum so a specific plan can be made to meet their needs. Communication at every level of the spectrum is difficult, but is especially inhibited in the lower functioning cases. Now if the reader meets someone who may be autistic they can understand the difficulties there might be in communication, but are also better prepared to recognize and adapt to create a situation where shared meaning is possible.

_____Works Cited:

Autism and Pervasive Developmental Disorder (Behavioral Health Advisor) Clinical Reference Systems. January 1, 2004 Edition, p281-282

Turkington, Carol A, PhD. Autism. Gale Encyclopedia of Medicine Second Edition. Vol. 5. Farmington Hills, MI: Gale Group, 2001.

Barstow, Donald G, RN. Pervasive Developmental Disorders. Gale Encyclopedia of Medicine Second Edition. Vol. 5. Farmington Hills, MI: Gale Group, 2004.

Cafiero, Joanne. Communication Power for Individuals with Autism. Focus on Autism & Other Developmental Disabilities; Summer 98. Vol 13(2). P113-121.

Rett Syndrome. Child Health and Human Development. NIH Publication No. 01-4960. National Institute of Child Health and Human Development. 2001.

Ochs, Elinor; Kremer-Sadlik, Tamar; Gainer Irota, Karen; Solomon, Olga. (2004). Autism and the social world: an anthropological perspective. Discourse Studies, 6(2), 147-183.

Sigman, Marian; Spence, Sarah J; Wang, A. Ting. Autism From Developmental and Neuropsychological Perspectives. Annual Review of Clinical Psychology. 2006. 2:327-55

Ochs, Elinor; Solomon, Olga. Introduction: Autism and Discourse. Discourse Studies, 6(2), 139-146.

Solomon, Olga. Narrative Introductions: Discourse Competence of Children with Autistic Spectrum Disorders. Discourse Studies, 6(2), 253-276.

Meyer, Jessica; Hobson, Peter R. Orientation in Relation to Self and Other: The Case of Autism. Tavistock Clinic and Institute of Child Health, University College London.