Jennifer Keluskar, Ph.D.
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that involves trouble with using communication for social purposes, such as having back and forth conversation or expressing wants, needs, and emotions. For kids with ASD, careful assessment is needed to determine the social quality of their language and communication skills.
For example, imagine a child who is drawing with a pencil. The child then requests a red crayon by saying, "I want red" without looking up and making eye contact. While the child is technically using verbal language to communicate their request, the lack of communication of social intention via eye contact will likely dilute the effectiveness of their request, or the likelihood that they will get their needs met.
Another language difficulty that is common in ASD, and one that the rest of this post will focus on, is trouble with language processing, meaning how language is comprehended and interpreted. When people with ASD show differences in language processing, they may respond to these difficulties by acting out in the form of problem behaviors. While it is important to address such behaviors, we can do so in a positive way by understanding the contribution of language processing difficulties and knowing how to address them.
What To Know
There are various factors that contribute to language processing differences in individuals with ASD. Consider the following characteristics that we know to be common in ASD:
1. Differences in Auditory Processing
Research has highlighted differences in how youth with ASD process auditory stimuli (Foss-Feig, J.H. et al., 2017). When distinct sounds are presented, some individuals require longer intervals between these different sounds in order to recognize them as distinct. This might lead to misunderstandings, such as thinking one heard "coo" instead of "school." Similarly, my son has referred to the villain in the cartoon Duck Tales as "Duck Wing Duck" as opposed to "Dark Wing Duck."
In children with ASD specifically, having more trouble recognizing distinctions in speech sounds contributes to their comprehension of language. .
2. Trouble with Episodic Memory
Open-ended questions can be difficult for individuals with ASD. One reason for this is that such questions require the use of episodic memory (Anger et. al., 2019), or a memory of everyday events in the context of an individual’s own life., which tends to be difficult for individuals with ASD. Examples of open-ended questions that require the use of episodic memory include, "What did you do at school today?" or "What landmarks did you visit during your trip?"
3. Problems with Controlling Attention
Individuals with ASD have difficulty focusing on the task at hand. This may be due to their tendency to fixate or "get stuck" on internal thoughts, which distract them from the task they are supposed to be focusing on. Problems with focusing can interfere with processing and understanding spoken directions or requests.
4. Trouble Making Shifts in Internal Language
Similar to the "getting stuck" concept highlighted above, fixations on a specific internal rule can make it more difficult to adapt that rule to novel information. For example, when I ask children what they think the term, "catching up" means, they will often describe physically moving closer to a person who has moved ahead of them. I will acknowledge this as being one meaning of the phrase, and then add that in the context of our conversations, "catching up" means telling about events that have transpired since our last meeting. Oftentimes, when I ask them again the following week to tell me what I mean by "catching up," they will tell me the same definition they originally provided (moving closer to someone who has moved away from them). It might take several repetitions before they understand what I mean by this phrase in the context of our sessions.
5. Literal Thinking
The above point brings us to the concept of literal thinking. Literal interpretations of others' communicative efforts distract people away from honing in on the "gist" of others' message. For instance, saying something like, "Let's table that discussion for now" can take longer for individuals to comprehend fully if they are fixated on the mental image of their family's dining room table.
What to Do
Keeping the above factors in mind can help inform our responses to unexpected behaviors children show when we attempt to communicate with them. Here are some suggestions for what to do:
1. Obtain Attention First
Your child is more likely to respond effectively to your prompt (question, command, etc.) if they are paying attention to you. Minimizing distractions (e.g. shutting window shades and turning off screens), and physically moving your body so that your gaze is in line with your child's field of vision, will help accomplish this.
2. Pause to Allow Extra Time for Language Processing
Slow down your speech and make sure you are speaking as clearly as possible without "talking down" to your child (as many children and adults will pick up on this). In older children, you can make this more natural by acting as if you are contemplating how you want to phrase something. When I work with individuals in psychotherapy, I will sometimes purposefully take a sip of water as to minimize the discomfort of the pause.
If the child automatically responds "No," this could also be a sign that they need time to process the information. It could be helpful to wait before responding. "No" is a safer and therefore often automatic response because it allows avoidance of a task that may be too difficult or exhausting. When I pause, children sometimes will spontaneously change their response to "Yes" or "OK."
3. Don't Pause for Too Long
On the other hand, pausing for too long can lead to an awkward silence. Too much of this stillness is uncomfortable for children with ASD, who thrive on structure and predictability. Try repeating the question or request, and if there is still no response, then try changing up the wording to see if this leads to better comprehension. Don't be afraid to use an old script that you are sure they will understand or like better. Connecting with your child is the priority at these moments.
4. Accompany Verbal Prompts with Visual Presentations
Showing the individual what you mean will maximize verbal comprehension. Point to a picture or object or model the behavior yourself. If possible, having photos on hand of the child completing the task previously will ease any discomfort they have about the task itself.
5. Break down the Task into Smaller Chunks
When we ask a child to identify a shape and they do not respond, we have to consider a number of factors. Is their lack of response due to not understanding the direction, lack of knowledge of shape names, not wanting to do what I am asking, or a combination of all of the above?
To address these potential factors, try to shift to a simpler direction. One might offer clues like "This is a shape that has 3 sides" or offer choices like "Is it a triangle or a square?" Of course, our goal is to have the child complete tasks with fewer prompts, but children might first need more support to get into the groove of completing tasks.
In order to sustain attention, you may also wish to have the child work for a discrete window of time followed by a break or offer tokens (stickers, points, poker chips, etc.) that can be exchanged for a small reward like screen time or playing a preferred game.
Overall, remember that difficulties are not always apparent on the surface when interacting with children with ASD. In many cases, it is helpful to consider difficulties or differences that might be contributing to whatever obstacles are presenting themselves at the moment. Doing so can inform how we approach individuals with ASD and enhance their level of engagement in daily living activities and learning tasks.
References
Anger, M. Wantzen, P., Le Vaillant, J.L., Malvy, J., Bon, L., Guénolé, F., Moussaoui, E., Barthelemy, C., Bonnet-Brilhault, F., Eustache, F., Baleyte, J., and Guillery-Girard, B. (2019). Positive effect of visual cuing in episodic memory and episodic future thinking in adolescents with autism spectrum disorder. Frontiers in Psychology. doi: 10.3389/fpsyg.2019.01513
Foss-Feig, J.H., Schauder, K.B., Key, A.P., Wallace, M.T., Stone, W.L. (2017). Audition-specific temporal processing deficits associated with language function in children with autism spectrum disorder. Autism Research, 10 (11), 1845-1856.