Families of autistic and dysphasic children II. Mothers' speech to the children

Journal of Autism and Childhood Schizophrenia, VoL 7, No. 4, 1977

Families of Autistic and Dysphasic Children.

II. Mothers' Speech to the Children 1

Dennis P. Cantwell and Lorian Baker UCLA School of Medicine

Michael Rutter Institute of Psychiatry, London, England

This paper tests various hypotheses about deviance in the communication o f mothers to their autistic children. The language o f mothers o f 13 autistic boysis compared to the language o f mothers o f 13 boys with developmental receptive dysphasia. The two groups o f boys are o f similar age, nonverbal intelligence, and language level. The language samples come from hour-long taped interactions between the mothers and their children in their homes. Aspects o f maternal communication that are examined include." the amount o f language used, the frequency usage o f different types o f utterances, the syntactic complexity o f utterances, the grammaticality o f utterances, the clarity o f communication, and the tones o f voice used. No differences were found between the two groups o f mothers in level o f language usage, pattern o f functional interaction, or in overall clarity o f communication. In conclusion, the findings o f this study provide no support for the suggestion that autism is due wholly or in part to deviant patterns o f mother-child communication.

I N T R O D U C T I O N

Since K a n n e r ' s (1943) or ig ina l desc r ip t ion o f In fan t i l e A u t i s m there has been a con t inu ing deba t e over the na tu r e o f the cond i t i on (Rut ter , 1974; Orn i t z & Ri tvo , 1976). A var ie ty o f psychogen ic fac tors have been pos tu -

'Mrs. Patricia HoMin and Mrs. Rosemary Hemsley provided invaluable assistance in the con- struction and piloting of many of the measures used in this study. The study was supported in part by the following grants: NIMH Special Research Fellowship IF03MH 52205-0l, MH08467-13, MCH927 and Scottish Rite Schizophrenia Research Program grant.

313 This journal is copyrighted by Plenum. Each ar t ic le is ava i l ab le for $7.50 f rom Plenum Pub- lishing Corporat ion, 227 West 17th Street, New York, N,Y, 1001 ] ,

314 Cantwell, Baker, and Rutter

lated as etiologic influences. These include deviant parental personalities (Kanner, 1949; Meyers & Goldfarb, 1961), deviant parent-child interactions (Behrens & Goldfarb, 1958; Meyers & Goldfarb, 1961; Ferster, 1966; Lennard, Beaulien, & Embry, 1965), and severe stress early in childhood (Despert, 1951; Bettelheim, 1967). However, a solid body of both clinical and experimental evidence now exists strongly suggesting that autistic children suffer from a specific cognitive deficit involving a defect in the comprehension of language (Tubbs, 1966; Firth, 1970; Hermelin & O'Connor, 1970; Rutter, Bartak, & Newman, 1971; Bryson, 1972; Churchill, 1972; Bartak, Rutter, & Cox, 1975).

Although recent work indicates that this cognitive defect is a necessary

cause for the behavioral syndrome of autism to develop, the cognitive defect may not be a suf f ic ient cause. Thus the early psychogenic hypothesis cannot entirely be ruled out. If a receptive language deficit is a necessary but not sufficient cause, then it could be hypothesized that this language deficit must interact with some environmental circumstances for autism to develop. Some form of deviant parent-child interaction, particularly verbal communication between the child and his mother, has been implicated as an etiologic factor by a number of authors (Goldfarb, Goldfarb, & Scholl, 1966a; Goldfarb, Levy, & Meyers, 1966b, 1972; Meyers & Goldfarb, 1961; Lennard et al., 1965). This study was designed to test the hypothesis that the verbal communication between mother and child might play an etiologic role in autism.

P R E V I O U S R E S E A R C H

Lennard et al. (1965) looked at the occurrence of questions in family communications with autistic and normal children. They found that the families of autistic children asked more questions. It was concluded that these families were more "intrusive" and more discouraging of self-moti- vated behavior. The same data, however, could be used to support the conclusion that these families were simply trying to "draw out" their children to help them use the little speech they possessed.

The most extensive studies of mother-child communication have been carried out by Goldfarb and his colleagues. Their investigations have generally involved ratings of communication on somewhat impressionistic scales and comparisons with mothers of normal children. In one study (Goldfarb et al., 1966a) a speech pathologist rated language samples from mothers of "schizophrenic" children and mothers of normals. The language samples consisted of excerpts from an interview in which mothers discussed their role in the sexual education of their children. The speech pathologist rated

Mothers' Speech to Autistic and Dysphasic Children 315

the language samples for pitch, voice, phrasing, fluency, meaning, and mood.

It was concluded that mothers of schizophrenic children were poor models for their children to emulate and were impaired in their ability to communicate meaning and mood. Although the exact nature of the mother- child communication was not directly examined in this paper, it was suggested that mothers of schizophrenic children may be "unable to assist their children in refining and focusing their communicative strivings."

The nature of the mother-child communication itself was reported in another paper (Goldfarb et al., 1966b). The verbal encounter between the schizophrenic child and his mother was investigated in a standardized meeting consisting of a "surprise visit" by the mothers to their hospitalized children. A 20 minute recording was made of this visit, and the first 20 "communication units" (which, in the majority of instances, occurred within the first 2 minutes of the tape) were then appraised for "clarity." A general rating of from one to four was made, based on the summed score of the appearances of "clarity errors" (e.g., lack of elaboration, lack of response, reality distortion, indistinct speech, etc.). The number of "patterns of failure" (including failure to stimulate the child's interest in communication, failure to maintain a flow of communication, failure to reinforce normal communication, and failure to cope with deviances in communication) was found to be high in mothers of schizophrenics. No control group was used, but in a further study (Goldfarb, Levy, & Meyers, 1972) the surprise visit technique was used to compare mothers of hospitalized schizophrenic children and mothers of orthopedically hospitalized normal children. In this study, the schizophrenic children were sub- classed into two groups, "organic" and "nonorganic," depending on the presence of neurological abnormalities in the history or examination of the child. Evaluations of the clarity of the first 2 minutes of communication during these visits revealed the greatest clarity in the mothers of orthopedically handicapped children and the next greatest amount of clarity in the mothers of "organic" schizophrenic children.

In order to examine whether the mother of the schizophrenic child was able to assist the child in discriminating and ordering his world, an experiment was conducted by Goldfarb, Yudkovitz, & Goldfarb (1973). In this experiment, mothers were to describe certain objects to their children in order to aid them in a discrimination task. Mothers of schizophrenic and of normal children were involved. Mothers of schizophrenic children were found to be less capable of assisting their children.

Numerous criticisms have been made of Goldfarb's studies (Klein & Pollack, 1966; Howlin, Cantwell, Marchant, Berger, & Rutter, 1973; Cox, Rutter, Newman, & Bartak, 1975; Baker, Cantwell, Rutter, & Bartak, 1976)

316 CantweU, Baker, and Rutter

on the grounds of poor definition of the groups of children studied,failure to match groups on relevant variables, lack of suitable sampling techniques in the choice of comrols, unsuitable circumstances for eliciting language samples, excessively short samples of language, and loose definitions of language categories.

The present study set out to test the various suggestions about deviance in the communication of mothers to their autistic children.

M E T H O D

Previous studies of the language of mothers of autistic children have either compared the mothers of autistics to mothers of age-matched normals (Goldfarb et al., 1966a, 1972) or have used no controls (Goldfarb et al., 1966b). Such an approach was thought to be inadequate for the present study since it ignores the effect that a child's aberrant language may have upon a parent. There is now considerable evidence that the quantity and quality of adults' speech is affected by the verbal skills of the children with whom they interact (Siegel, 1963; Siegel & Harkins, 1963; Spradlin & Rosenberg, 1964; Moerk, 1974; Snow, 1972; Broen, 1971; Fraser & Ro- berts, 1975). Hence it is to be expected that the language of the mother of a language-impaired child would be different from that of the mother of a normal child of the same age. Thus, in order to determine whether the speech of mothers of autistic children has any specific characteristics it is necessary to compare it with that of mothers of children who are similarly retarded in language but who do no t share the social and behavioral features of autism. For the present study, children with developmental receptive dysphasia have been used as a comparison group because their language deficit most closely approximates that of autistic children (Rutter et al., 1971; Baker et al., 1976; Savage, 1968; DeHirsch, 1967).

The original sample of children studied by Bartak and his colleagues (1975) consisted of 19 autistic and 23 dysphasic children. However, the dysphasic children tended to improve more in language and so, in order to better match the groups at the time of the present study,the six "dysphasic" children with least receptive language retardation were dropped from the investigation. Two autistic and two "dysphasic" children had moved overseas or were untraceable and so could not be included. The families of two autistic children were unwilling or unable to participate in this part of the study. This left 15 autistic children and 15 "dysphasic" children for the follow-up study of families of which the present investigation forms a part (see Cantwell, Baker, & Rutter, 1977a, 1977b). In two families in each group, time restrictions (D.C. had to return to the U.S.A.) meant that language


samples were not obtained. Accordingly, the present study of language interaction is based on the families of 13 autistic and 13 "dysphasic" children.

The subjects of the present study consist of the mothers of 26 boys aged 6 years 6 months to 11 years 6 months with a nonverbal IQ of at least 70 and a disorder of language comprehension which had been present since infancy and which was not due to overt neurological disorder or peri- pheral deafness (see Bartak et al., 1975 for fuller details of sample selec- tion). Thirteen boys (mean age 9 years 0 months) met the diagnostic criteria (Rutter, 1971) for infantile autism: a profound and general failure to develop social relationships, ritualistic and compulsive phenomena, and a serious disorder of language. The other 13 boys (mean age 9 years 7 months) showed an uncomplicated receptive developmental language disorder; they are referred to as the "dysphasic" group. The two groups of boys were similar in age, nonverbal IQ, and level of speech (Cantwell et al., 1977a).

The mothers in the two groups were also similar in age (mean age = 37.3 years for the autistic group compared with 36.1 years for the dysphasic group) but not in social status. Whereas 9 out of 13 mothers of autistic children had husbands with professional or managerial jobs, this was so for only 6 out of 12 mothers of "dysphasic" children--social class not known in one case (see also Cox et al., 1975).

The language of all of these children is described in detail elsewhere (Cantwell et al., 1977a). While the autistic children scored considerably lower on standardized tests of language comprehension, the two groups did not differ in the morphological or syntactical complexity of speech used. The functional use of language for the two groups of children differed significantly in the number of spontaneous remarks and in the use of delayed echoes, thinking aloud/action accompaniments, and metaphorical language.

Language samples were obtained during routine interactions between the 26 children and their mothers in their homes. From an hour-long audio- taped language sample, the middle half hour, which proved to be the most representative of the total time (see Howlin et al., 1973), was used for analysis. First a functional analysis was done in which mother's utterances were classified according to their usage (Howlin et al., 1973). Second, a linguistic analysis was performed in which both the complexity and the grammar of the mothers' utterances were assessed. Third, an analysis was done of the tones of voice used by the mothers and of the appropriateness of these tones to the content of the utterances. Finally, an analysis of the "clarity" of expression of meaning was done using the categories of Gold- farb and his colleagues (Goldfarb et al., 1966b). All linguistic analyses were done with the linguist (L.B.) blind to the subjects' diagnoses.


R E S U L T S

Functional A nalys& of Maternal Language

The d i s t r ibu t ions for the d i f fe ren t types o f u t te rances used by the mothe r s o f the aut is t ic and dysphas ic ch i ldren are given in Tab le I. This

shows tha t the same genera l pa t t e rns o f l anguage use are e m p l o y e d by the two g roups o f mothe r s . In b o t h g roups , the mos t f requent ca tegor ies o f language used were ques t ions , d i rec t ions , and s ta tements ; and in b o t h the least f requent ca tegor ies were mi t iga t ed echoes, reduc t ions , and d i rec ted mimi -

cries. There was on ly one s ta t i s t ica l ly s ignif icant d i f fe rence be tween the two

groups ; the mo the r s o f aut is t ic ch i ld ren m a d e s igni f icant ly more " a f f e c - t iona te r e m a r k s " c o m p a r e d with the mothe r s o f dysphas ic chi ldren .

Whi le the two g roups d i f fe red somewha t in the p r o p o r t i o n s o f " c o r r e c t i o n s , " " s t a t e m e n t s , " and " d i r e c t i o n s , " the d i f ferences fell shor t o f s ta t is t ical s ignif icance, due to ra ther large wi th in -g roup var iance which also d i f fe red be tween the g roups .

Table I. Classification of Mothers' Speech by Type of Utterance

Percentage of total utterances

Mothers of Mothers of autistics dysphasics

Functional type of utterance Mean SD Mean SD

Questions 30.7 15.3 27.7 13.5 Answers 0.9 2.2 1.8 4.7 Imitations 2.8 2.5 3.2 2.7 Mitigated echoes 0.2 0.6 0.5 0.8 Reductions 0.2 0.4 0.5 0.7 Expansions 1.9 1.8 1.2 1.5 Corrections 1.7 1.6 5.6 5.7 Directed mimicry 0.4 1.1 0.2 0.4 Prompts 2.6 3.0 3.5 2.3 Direct reinforcements 2.9 3.4 3.4 3.8 Direct reinforcements (one word) 6.4 9.9 4.1 6.5 Directions 18.1 14.9 10.3 8.4 Statements 18.9 9.8 31.9 15.4 Affectionate remarks 5.3 a 5.3 0.7 a 1.0 Critical remarks 3.4 4.6 1.1 2.5 Other (interjections, incom-

prehensible) 3.8 5.2 4.3 7.1

Total number of utterances 178.9 106.9 160.4 92.3

ap < .01 (t test).

Mothers' Speech to Autistic and Dysphasic Children

Table II. Classification of Mothers' Speech by General Language Functions

General language functions


Mothers of Mothers of autisfics dysphasics

Mean SD Mean SD

Language in response to child's language

Language in response to child's actions (including general statements)

Other

50.61 19.0 51.7 19.0

45.6 18.8 44.0 24.1

3.8 5.2 4.3 7.1

319

The a m o u n t of language was not significantly different for the two groups. The mothers of autistic children had a mean of 178 utterances in the half-hour sample, whereas the mothers of dysphasic children had a mean of 160 utterances. This slight difference in amount of utterances may again reflect the greater initiative behavior on the part o f some of the dysphasic children in engaging in independent activities such as reading or game play- ing; i.e., for these children, less of the mothers ' attention was necessary.

These functional categories of language were grouped into three broader general categories (Howlin et al., 1973): "Language in response to the child's language," "Language in response to child's activities and general commen t s , " and "o ther language."

"Language in response to the child's language" includes questions, answers, imitations, mitigated echoes, reductions, expansions, corrections, directed mimicry, prompting, and direct reinforcements. "Language in response to child's activities and general comment s" includes directions and suggestions, statements and observations, affectionate and approving remarks, and criticisms and disapproving remarks. The results of this analysis are presented in Table II.

These data reveal that there are no significant differences in the patterns of language use with regard to these three general classes of language for the two groups of mothers. The mothers of autistics had a mean of 51% "language in response to the child's language," whereas the mothers of dysphasics had a mean of 52%. The mothers of autistics had a mean of 46~ " language in response to the child's activities or general comments , " whereas the mothers of dysphasics had a mean of 44%. Both groups of mothers had a mean of 4% "other language."


Linguistic Analysis o f Maternal Language

The analysis of the structure of the utterances in the mothers ' samples consisted of a quantitative analysis of linguistic sophistication and grammatical usage using well established measures (Bee, van Egeren, Streissguth, Nyman, & Leckie, 1969; Olim, 1970; Snow, 1972).

These data are presented in Table III . There were no significant differences between the two groups of mothers on any of these measures. Thus, it appears that th e language of the two groups of mothers was equally complex (as evidenced by the sentence lengths, mean pre-verb lengths, and number of phrases). The language of the two groups of mothers appeared equally grammatical (as evidenced by the scores for ungrammaticali ty, corrections for ungrammaticali ty, and repetitions of ungrammatical utterances). And finally, the language of the two groups of mothers was equally detailed (as evidenced by the number of repetitions, one-word utterances, and inexplicit commands).

As was appropriate, the mean sentence lengths and mean pre-verb lengths for these two groups of mothers (though not significantly different f rom each other) were considerably lower than would be expected for the mothers of normal children of a comparable age (Snow, 1972). Thus, while the language of the mothers of autistic children was less sophisticated than

Table III. Linguistic Analysis

Measures


Mean SD Mean SD

Linguistic sophistication Mean sentence length (in words) 4.9 1.0 4.3 1.0 Mean pre-verb length (in woids) 2.3 4.4 2.0 7.8 Phrases (as percentage of total

utterances) 16.2 6.3 14.7 4.9

Grammatical usage Ungrammatical utterances 2.2 3.0 0.8 0.9 Reinfordng poor grammar 0.2 0.5 0.2 0.2 Failing to correct poor

grammar 2.3 2.4 1.8 1.7 (All as percentage of total ut-

terances)

Complexity Repeating self 3.3 4.4 3.8 5.0 One-word utterances 9.5 7.9 22.5 13.6 Inexplicit commands 0.6 0.8 0.9 1.9 (All as percentage of total

utterances)


Table IV. Clarity Errors



Type of error Mean SD Mean SD

1. Lack of clarity (conno- tative) 0.8 0.8 2.5 2.5

2. Lack of clarity (denota- tive) 0.5 0.9 1.4 3.0

3. Inconsistency 0.6 0.7 0.7 0.7 4. Irrelevance 0.2 0.4 0.4 0.5 5. Lack of elaboration 1.6 a 1.2 5.0 a 3.8 6. No response (statements) 0.0 0.0 0.3 0.7 7. No response (questions) 0.9 3.3 0.1 0.3 8. Reality distortion 1.5 2.1 1.4 1.4 9. Misinterpretation 0.1 0.2 0.3 0.6

10. Interruption 0.1 0.2 0.0 0.1 11. Simultaneous speech 0.1 0.2 0.1 0.2 12. Multiple topics 0.1 0.2 0.0 0.6 13. Excessive elaboration 0.2 0.6 0.6 1.4 14. Topic change - premature 0.8 0.8 0.2 0.3 15. Topic change - awkward 0.1 0.2 0.0 0.5 16. Failure to correct - clarity 0.3 0.8 1.0 1.2 17. Failure to correct - situation 0.8 2.0 0.5 1.0

Total errors 8.7 7.1 14.5 8.8

ap < 0.0t (t test).

the l anguage o f mo the r s o f no rma l s , it was c o m p a r a b l e to the l anguage o f m o the r s o f ch i ld ren with a d i f fe ren t t ype o f l anguage a b n o r m a l i t y .

Analysis o f Clarity Errors

The analysis o f the express ion o f mean ing in the u t te rances cons is ted o f a " c l a r i t y a n a l y s i s " fo l lowing the scheme o f G o l d f a r b ( G o l d f a r b et a l . , 1966b). A l t h o u g h this m e t h o d o f analys is is somewha t subjec t ive and im- precise , it appea r s to be the m o s t de ta i l ed m e t h o d o f charac te r iz ing " c l a r i t y " ava i lab le .

Tab le IV presen ts the resul ts o f the analys is for c la r i ty e r rors . There is a s igni f icant d i f fe rence be tween the two g roups o f m o t h e r s for on ly one o f the er ror types , " l a c k o f e l a b o r a t i o n . " The mo the r s o f the dysphas ics showed more l ack o f e l a b o r a t i o n t han the mo the r s o f aut is t ics .

In conc lus ion , this analys is o f c la r i ty e r rors d id no t p rov ide any sup- po r t for the t heo ry tha t mo the r s o f aut is t ic ch i ld ren p rov ide an unc lear m o d e l o f c o m m u n i c a t i o n o f mean ing . The l anguage o f the mo the r s o f aut is-


tic children was more clear than the language of the mothers of dysphasic children.

Tone of Voice

Finally, tone of voice was rated for all occasions when mothers spoke to their children. In both groups most speech was neutral in tone, but the mothers of autistic children used significantly more positive tone and significantly less neutral tone (see Table V). In order to determine how ap- propriately tone of voice was used by the mothers, tone of voice was reex- amined separately for each type of communication, as judged by the words used (see Table VI). As might be expected, approving comments were usually positive in tone, and critical tone of voice was almost restricted to disapproving or correcting utterances. In other words, the content of the words and the tone used in saying them were usually consonant. This was so for both groups o f mothers. However, the groups did differ significantly with respect to the tone of voice used in disapproving comments; the mothers of autistic children were less likely to use negative tone and more likely to use neutral tone.

Social Class Differences

As the parents in the autistic group were of higher social class, it was possible that this might have biased our findings. To check on this possibility we pooled the groups and compared social classes I and II (i.e., professional and managerial) with the rest on all measures. No significant differences were found. Middle class (I and II) mothers used rather more utterances (195.9 vs. 140.7), more often employed a positive tone of voice (in 19.7 vs. 9.1% of utterances) and made fewer clarity errors (8.9 vs. 13.7), but none of these differences was statistically significant at the 5~ level.

Table V. Tones o f Voice Used by Mothers

Mothers of Mothers o f autistics dysphasics

Percentage of ut terances with: Mean SD Mean SD

Neutral tone 71.4 a 17.7 87.5 a 10.1 Positive tone 22.6 a 18.0 7.8 a 7.0 Negative tone 5.4 5.2 4.6 5.3 Flat tone 0.8 2.9 0.1 0.3

ap < 0.05 ( M a n n - W h i t n e y U Test).

Mothers' Speech to Autistic and Dysphasic Children

Table VI. Appropriateness of Tones of Voice

323


Mean SD Mean SD

During approving speech % of utterances of neutral tone 13,0 15.6 34.1 49.5 % of utterances of positive tone 87.0 15.6 65.9 49.5 % of utterances of negative tone 0.0 0.0 0.0 0.0

During disapproving speech % of utterances of neutral tone 60.4a 30.5 7.4a 10.3 % of utterances of positive tone 2.4 5.4 1.3 3.3 % of utterances of negative tone 37.2 a 27.3 92.3 a 9.1

During confirming speech % of utterances of neutral tone 65.9 31.8 76.1 11.3 % of utterances of positive tone 32.6 29.5 23.7 10.8 % of utterances of negative tone 0.5 1.9 0.2 0.8

During correcting speech % of utterances of neutral tone 76.0 30.9 77.7 26.9 % of utterances of positive tone 11.5 12,5 10.0 7.2 % of utterances of negative tone 12.5 17,2 12.3 14.6

During neutral speech % of utterances of neutral tone 82.0 16.1 93.4 5.7 % of utterances of positive tone 16.6 16.9 4.8 5.2 % of utterances of negative tone 1.4 4.1 0.8 1.3

ap < 0.01 (t test).

However , as there were a few nons ign i f i can t t rends, the whole of the autis t ic-dysphasic analysis was repeated after restricting bo th groups to social classes I and II . The pa t t e rn of f indings remained substant ia l ly the same.

D I S C U S S I O N

The results o f the present s tudy show that the pat terns of language

and c o m m u n i c a t i o n used by the mothers of autistic chi ldren are closely comparab le to those used by mothers of nonaut i s t i c chi ldren with a similar level o f speech impa i rmen t .

Thus , the two groups of mothers did no t differ in their level of lan-

guage usage, in their pa t te rn of func t iona l l inguistic in teract ion, or in their overall clari ty of c o m m u n i c a t i o n . The only s ignif icant differences (out of m a n y compar isons) were tha t the mothers of autistic chi ldren made more affect ionate or wa rm remarks , more e labora t ions , and tended, when mak-

ing d isapproving comments , to use a neur t ra l ra ther t han a critical tone.

324 Cantweli, Baker, and Rutter

This last item is the only one which might be taken to reflect maladaptive functioning in that it could be said to make it more difficult for children to get the message. However, this was one rather isolated significant difference. Furthermore, only 3~ of remarks were disapproving, so that the overall effect was likely to be rather minor. It is clear that the maternal model of speech was generally similar in the case of autistic and "dysphasic" children. The findings provide no support for the suggestion that autism is due in whole or in part to deviant patterns of parent-child communication.

Three possible objections may be raised with respect to our findings. First, the autistic children were all of normal nonverbal intelligence and this applies to only about a quarter of autistic children. However, this choice was deliberate in order to maximize the possibility of finding psychosocial causes of autism. Mentally retarded autistic children show a greatly raised incidence of epileptic fits (Bartak & Rutter, 1976) and it is highly likely that organic brain damage is usually present in this low-IQ group. On the other hand, fits are much less frequent in autistic children of normal intelligence and it is in this group that psychosocial determinants are most likely to be found.

Second, although the two groups of children were closely matched, the parents differed in social class (the families of autistic children being of higher social status). It might be suggested that the language of mothers of autistic children would be superior simply as a reflection of their middle class background. However, it is unlikely that the difference in social class could account for our findings. Although the social classes do differ in their styles or codes of linguistic usage, they do not necessarily differ in those aspects of language assessed in this study. Indeed we failed to find any social class differences in the measures we used.

Third, our measures were necessarily taken after the children became autistic. We were not able to test the suggestion that autism may be due to abnormal patterns of communication which were evident very early in infancy but which did not persist as the children grew older. However, while our data cannot be used to examine this hypothesis, equally it must be said that there are no other data which provide support for this notion.

If then it is accepted that our negative findings are valid, it has to be explained why our results differ so markedly from those of Goldfarb and his colleagues (1966a, 1966b, 1972, 1973). Three main reasons may be suggested. First, the groups of children studied were different. Our sample comprised well-diagnosed autistic children, whereas Goldfarb's sample consisted of "childhood schizophrenics," no operational criteria for diagnosis being provided. It is highly probable that his sample was more hetero- geneous than ours and it may be that the parental language abnormalities he


found apply particularly to nonautistic schizophrenic children. Second, whereas our study used long representative language samples obtained in the natural environment of the family home, Goldfarb et al. (1966b, 1972) used very short samples obtained in the artificial situation of a "surprise visit" to the hospital. It is likely that Goldfarb's technique resulted in a very unrepresentative sample of speech. Third, and most important, our comparison group consisted of children without autism but with language impairment. In contrast, Goldfarb's control group consisted of children with normal language (Goldfarb et al., 1966a, 1972). This is a crucial difference because of the evidence that mothers modify their language usage according to the level of their child's language. Thus, the mothers in both our groups used shorter sentences than expected for mothers of normal children (Snow, 1972), although the "dysphasic" and autistic families did not differ from each other in this respect.

For all these reasons it appears that Goldfarb's findings are likely to be an artifact of poor sampling of language or of inappropriate controls; and to the extent to which they are valid they may well apply to schizophrenic children who do not fulfill the criteria for autism. Whatever the expla- nation, it seems that our measures are more likely to provide a valid reflection of the family communications received by autistic children.

Finally, it could be argued that the lack of a difference between the autistic and "dysphasic" groups is a consequence of both co,aditions being due to deviant patterns of family communication. This hypothesis, of course, would leave totally unexplained why one group showed all the social and behavioral features of autism whereas the other did not. However, it is in any case implausible for three other reasons. First, the suggestion relies on the possibility that patterns of communication in families of children with developmental dysphasia are abnormal, but there is no evidence for this. Second, in cases where psychosocial adversity does lead to speech delay or abnormality, the clinical picture is very different from both autism and "dysphasia" (Rutter, 1972, 1977). Third, there is evidence from twin comparisons (undertaken since this study) that the language impairment in autism is due in part to genetic factors or to biological hazards (Folstein & Rutter, 1977).

In summary, on all counts the current study gives no support to the notion that certain aspects of mother-child communication are necessary causes for the syndrome of Infantile Autism. It may be that in some children a basic cognitive defect is both a necessary and a sufficient cause. In others, this basic defect may be a necessary b~at not sufficient cause, so that some other additional factors may contribute to the etiology. However, there is no good evidence that this contributing factor consists of any kind of disturbance in mother-child communication.


R E F E R E N C E S

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Documents

Families of autistic and dysphasic children II. Mothers' speech to the children