Research has identified two core communication deficits in children with autism: joint attention and symbol use (Dawson et al., 1990; Kasari et al., 1990; McArthur and Adamson, 1996; Mundy et al., 1990; Sigman and Ruskin, 1999; Stone et al., 1997; Wetherby et al., 1998).
Joint attention refers to problems coordinating attention between people and objects. An autistic child with poor joint attention may have problems:
- paying attention to a social playmate
- shifting their gaze between people and objects
- sharing their emotions with others
- understaning/monitoring the emotions of others
- following the gaze of another person
- getting another personsí attention in order to have a shared experience
Joint attention is a significant predictor of language outcome and should be a primary goal for early communication intervention.
A deficite in symbol use refers to a difficulty learning conventional or shared meanings for symbols. For example an autistic child may:
- not use conventional gestures
- have difficulty learning conventional meanings for words
- make up their own words
- not use objects functionally
- have difficulty with symbolic play
Children with autism usually donít compensate for their lack of verbal skills with gestures; they show limited gestural use, both in quantity and quality. They predominantly use primitive gestures to communicate (i.e., leading, pulling or manipulating anotherís hand). They lack the use of many conventional gestures, such as showing, waving, pointing, nodding the head and symbolic gestures depicting actions (Loveland and Landry, 1986; McHale et al., 1980; Stone and Caro-Martinez, 1990; Stone et al., 1997; Wetherby et al., 1998; Wetherby et al., 1989).The Process of Learning to CommunicateEcholalia
The majority of children with autism who do learn to talk go through a period of using echolalia, repeating the speech of others. The repetition or ďechoĒ of speech may be immediate, the child repeats a word or phrase that was just spoken, or delayed the child repeats a word or phrase they have heard before (Prizant et al., 1997).
Not all echolalia is functional language. For example, a child may repeat a phrase over and over again as a means of alieviating stress, instead of attempting to communicate.
When children learn to use echolalia purposefully to communicate, it usually starts as a single word or a label for a situation or event. Over time the child learns to break down larger chunks of language into smaller meaningful units (Prizant and Rydell, 1993).
Children with autism who progress beyond echolalia usually acquire more advanced aspects of grammar: that is, they develop grammatical skills in the same general progression as typically developing children, but show persisting problems in joint attention and pragmatic language, following the social rules and shifting between speaker and listener roles of conversation (Baltaxe, 1977; Tager-Flusberg, 1996).Symbolic Play and Language Development
At this stage children with autism show comparable use of communication to request and protest as typical developing peers, but significantly less use of gaze shifts, shared positive affect, conventional gestures, and communication for joint attention. They performed at comparable levels of constructive play but significantly poorer levels of language comprehension and symbolic play Stone et al. (1997) and Wetherby et al. (1998). A lack of varied, spontaneous make-believe play and limited abilities in functional play significantly tie in to the development of receptive and expressive language (Mundy et al., 1987; Sigman and Ruskin, 1999).
Children with autism who have a greater capacity to coordinate attention and affect are more likely to communicate for more social reasons, to use a larger repertoire of conventional gestures, to have a higher rate of communicating, and to employ better repair strategies Wetherby et al. (1998). These findings underscore the importance of addressing joint attention in therapy.