Download docx - Autism Spectrum Disorder (ASD), signs, symptoms and language related problems

Autism Spectrum Disorder (ASD), signs, symptoms andlanguage related problems

Naser Ghafoori1

Associate Professor in TEFLDepartment of English, Tabriz Branch, Islamic Azad University,

Tabriz, [email protected]; [email protected]

Mobile: 09141160270

Heidar Ahmadi2 Ph.D Student in TEFL

Department of English, Tabriz Branch, Islamic Azad University,Tabriz, Iran

[email protected]: 09143914216

Abstract

Autism Spectrum Disorder (ASD) is a developmental disorder that

normally becomes evident in the first three years of a child’s life.

They have different kinds of problems in their language, speech,

communication and behavior. This paper focuses on language related

problems in the autism spectrum disorders (ASD) and common signs and

symptoms of autistic children in different stages of their

development. Being unaware of what kind of children can be placed as

autistic in proper period of life, causes difficulties for autistic

children in specific and for parents, teachers and educational system

in general, so this paper tries to shed light on characteristics and

features of autistic children and their common language, speech and

communication related problems so that it may help to the diagnosis

2 Corresponding Author: [email protected]

Ghafoori & Ahmadi - Autism Spectrum Disorder (ASD), signs, symptoms and language related problems

as soon as possible to take effective measures. Reviewing literature

and different publications show that most autistic children do not

make eye contact and have poor attention duration. They are often

unable to use gestures either as a primary means of communication, as

in sign language, or to assist verbal communication, such as pointing

to an object they want. Some autistic individuals speak in a high-

pitched voice or use robot-like speech. They are often unresponsive

to the speech of others and may not respond to their own names.

Keywords: Autism Spectrum Disorder (ASD), Causes, Symptoms, Speech

and language problems

Introduction

Autism Spectrum Disorder (ASD) is a developmental disorder

that normally becomes evident in the first three years of a child’s

life. It is a neurodevelopmental disorder characterized by impaired

social interaction, imagination, verbal and non-verbal communication,

and restricted and repetitive behavior (Young, 2004; Christie, et

al., 2009; American Psychiatric Association, 2000; Gabriels & Hill,

2007). Spencer & Simpson (2009) stated that there is considerable

variation in the severity of autism and its impact on development,

and it is considered a spectrum of disorders, or autism spectrum

disorder (ASD). The term spectrum is used because children with autism

differ widely from one another. Autism is found in children of all

levels of ability, from those who are above average in their

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intelligence to those who have low intelligence wıth severe learning

difficulties. Some children with autism may be able to read and

perform academic skills close to grade level, while others will have

considerably more severe cognitive problems. Some children with

autism are fluent speakers, while others may be nonverbal. Thus,

children with the same diagnosis will be different and they are given

different words to describe diagnoses by doctors. The term ‘Autism

Spectrum Disorder’ (ASD) refers to any one of the diagnoses like:

“autism (childhood autism or autistic disorder), Asperger syndrome or

Asperger disorder, Pervasive Developmental Disorder or Atypical

autism, High functioning autism (Spencer & Simpson, 2009)”. It is a

catch-all phrase to include all the diagnoses on the spectrum.

Considerıng the causes for autism, it is believed that there is

a biological basis for autism, with evidence of brain differences in

individuals with ASD. The brain structures found to be involved

include the cerebellum, cerebrum, limbic system, and brain stem

(Prelock, 2006). Genetic studies with twins and siblings of

individuals with autism support a genetic link for autism, although

the exact nature is not clear. Other suggested causes such as dietary

deficiencies, digestive problems, allergies, viruses, and

environmental toxins have not been substantiated scientifically

(Spencer & Simpson, 2009).

Possible Problems with Autistic Children

There are three areas of difficulty with autistic children

according to Christie, et al. (2009); Williams & Wright (2004);

Burkhardt (2008) and Lord & McGee (2001) as follows:

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-difficulty with language and communication

-difficulties in social relationships and social understanding

-a lack of flexibility in thinking and behavior

Possible problems regarding language, speech and communication are

going to be discussed in details in the following section, but other

problems will be scrutinized in another paper later.

Language, Speech and Communication Problems in Autistic Children

Autistic or Non-verbal people do possess their own language

system, external and internal speech. Most infants are born with an

inbuilt ability to develop communication skills. In children on the

autism spectrum these abilities are not as well developed. Some of

the communication problems children experience come from difficulties

such as “mindblindness and not getting the gist (Baghdashina, 2005)”

that will be discussed in details, but children on the autism

spectrum appear to have additional language difficulties. This varies

very much from person to person and may be shown in a number of ways.

Children with ASD may develop language later than other children and

have limited receptive (understanding what is said) and expressive

(knowing how to say things) language skills (Christie, et al., 2009

and Spencer & Simpson, 2009). On the other hand, children with

Asperger syndrome will have apparently normal language development in

infancy; problems only occur later when abstract language and the

social use of language are being developed. There are different signs

and symptoms for autistic children. Different aspects of language

related problems in autistic children are described in details.

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Cooing, babbling, gesturing and communicating in babies

At different times in their development babies will coo and

babble in response to the noises an adult makes. This goes hand-in-

hand with the mimicry of facial movements and smiling at faces. We

now know that this is a result of genetic programming that gears

babies up to respond to their caregivers. It is nature’s way of

hooking parents in emotionally for the benefit of the child. In

Autistic Children, absence of cooing and babbling, absence of or

minimal eye contact, resistance to physical contact, failure to

respond to their name, lack of gestures to communicate and lack of

desire to interact are among common observable indicators and

symptoms from early babyhood to fifteen months of age (Schüler, 2002;

Cohen, 2005). Children with ASD are much less likely to respond to

their caregivers. Williams & Wright (2004) stated that some children

with ASD don’t learn to speak or gesticulate. However, the majority

do. Many young children with ASD don’t point when communicating, and

nodding or shaking the head may be rare. These skills may develop

later. Often there is a very different quality in the way talking

develops compared with the development of other children. Some use

words or gestures but not in a communicative way. Some learn

communication skills at a much slower rate.

Apparent regression and Repetitive noises or language

Some autistic children normally acquire words earlier at their

life, but then stop talking altogether for several months and show

apparent regression. Later, they start talking again with their

slower rate of language development (Siegel, 2008). Some children

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with ASD may use language sounds in very vocal ways to screech, grunt

or shout. The purpose of these noises is usually not communicative,

although the noise may change in tone when the child is excited or

angry. Toddlers with ASD who have some language skills may repeat

phrases over and over again. These phrases may be unrelated to what

is going on around them. A child may repeat made-up words

(neologisms) or words they have heard (or misheard) from an adult or

the television (echolalia) (Williams & Wright, 2004). Some children

with ASD have language ability but don’t use language much to

communicate, have their needs met, chat and solve their problems.

This leads to frustration, loss of temper and other problems in them.

Some people with ASD are aware of their needs and how to get what

they want for themselves. However, they are not aware that other

people can also help and so may not approach others, or they have

unique ways of sorting out the problem in a way that is not

acceptable to others.

Intonation and the production of sound and Mixing up pronouns:

Intonation and the way language is used may be different in

children with ASD. The child may have an unusually flat, slightly

expressionless tone of voice or may not regulate the volume of his

voice. Their volume control seems stuck on loud! The classic picture

of an autistic individual includes an impoverished ability to

interpret or express emotion. The prosody of spoken language in

autistic children is thought to lack emotional content (Hubbard

& Trauner, 2007). Children with ASD may get the pronouns ‘I’ and ‘you’

mixed up: ‘You want a drink’ meaning ‘I want a drink’ (Boghdashina, 2005). They

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might also continue to refer to themselves by their own names, for

example, ‘Jonathan wants a biscuit’. Although these things happen to most

children, those with ASD may struggle with this concept for a great

deal longer.

Williams & Wright (2004) discussed the following problems in

autistic children when conversation develops.

1. Starting a conversation

The child’s introduction to a conversation may be unusual. For

example, the child might find less-than-subtle ways of attracting the

adult’s attention, maybe moving the adult’s head, pushing or pulling

the person’s cloth so that he can talk to her or using the adult’s

hand as if it were a tool.

2. Facts, not thoughts and feelings

The conversations of a child with ASD may be about factual

information rather than being related to thoughts, feelings and

opinions. Indeed, they may have some difficulty understanding what

other people mean when they try to talk about their feelings.

3. Repetitive language and borrowed phrases

The language used by children with ASD may be repetitive rather than

conversational. They may borrow phrases they have heard elsewhere,

from a video, TV program, school or adults. These phrases are often

used appropriately but have a slightly odd quality to them. Some

professionals call this ‘delayed echolalia’ (Boghdashina, 2003).

4. One-sided conversation

The child may want to talk about his own interests, unaware and

uninterested in the response. Even if someone is bored or giving cues

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that they want to get away, the child on the autism spectrum may not

have noticed. Building on a conversation that doesn’t center on the

child’s topic of interest may be difficult. Turn-taking in

conversation is also difficult for these children. In fact, in many

ways a conversation with one of them is not a conversation at all

because a conversation implies a movement to and from, the giving and

receiving of information that can lead in many directions. To those

conversing with children on the autism spectrum this give and take

often feels absent, and the listener may feel that the conversation

is only going in one direction, controlled by the child with ASD.

5. Conversational speed

In a conversation the slow processing speed of a child with ASD may

make the listener feel uncomfortable and want to stop the

interaction. The level of detail from the young person on the autism

spectrum may be far too great or sometimes too little, with few cues

to the listener about what the conversation is about or where it is

going. Sometimes a child with ASD may start a conversation halfway

through the story, leaving his listener feeling very perplexed.

6. Miscommunication and literal understanding

Miscommunication is common among children with ASD. For example, the

young person may misinterpret what is said. She may hear ‘We’re not going

to the park’ as ‘going park’. She may have difficulty weaving all parts of

the sentence into an understood whole or may not understand the

crucial importance of the word ‘not’ that reverses the whole meaning.

Another example of miscommunication is literal understanding. The

child may understand the teacher’s words ‘Take your seats’ in class as an

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instruction. He may pick up his chair and want to know where to take

it.

The social use of language

It is necessary to highlight that children with ASD

communicate differently from normally developing children. According

to Williams & Wright (2004) and Boghdashina (2005), Autistic children

are often unaware of the needs of their listeners and do not pick up

the non-verbal clues in people’s faces. Their behavior can sometimes

appear to be cheeky because they have not grasped the gist of a

comment within a particular social setting. One girl was reprimanded

by her teacher when she walked out of the classroom with her pencil

after her teacher asked all of the children to, ‘Take out your pencils’.

Understanding language appears to require a great deal more

concentration from children with ASD than for other children. It is

not surprising that they sometimes ‘switch off ’, ignore us or seek

comfort in some repetitive familiar tasks. For those children who are

very slow in learning about communication or have very little or no

speech, there is still a great deal that can be done to help.

The semantics and pragmatics of language

Christie, et al., (2009) stated that one of the major

difficulties for children with autism is in developing social empathy

in the same way as other children. Typically developing children move

steadily towards becoming competent communicators during their first

year of life through their repeated interactions and dialogues with

adults, through what are known as the ‘pragmatics’ of language. These

pragmatics include body language (such as gesture, facial expression,

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eye-contact, posture and stance), listening skills, using intonation

and volume, understanding intention, sharing understanding and turn-

taking.

Williams & Wright (2004) also differentiated between the

semantics and pragmatics of language. The semantics of language refers to

the meaning of words and putting words, phrases and sentences

together as we speak. This relates to understanding and expression of

language. Pragmatics is slightly different in that it relates to how

we use language socially. It is to do with knowing when and how to

say things; for example, knowing to turn-take in conversation,

noticing non-verbal communication such as body language, knowing how

to use eye contact and facial expression alongside language, knowing

where to start a conversation, knowing what level of language to use

depending on whom you are talking to, knowing how to maintain a topic

or change one appropriately in conversation. Children with autism

often have problems with semantics and pragmatics. Children with

Asperger syndrome may have normally developing semantic skills but

poor pragmatic language skills; for this reason their language is not

picked up as a problem until the social use of language becomes more

important in communication. Children with autism find it very

difficult to take advantage of their social opportunities at a very

early age because of the difficulties they have in making sense of

these pragmatics, which are the building- blocks, or first steps, in

developing communication.

Getting the Gist: (from a picture, a sentence in a book, the real world)

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Normally, people have the ability to draw together lots of

information from a situation in order to make sense of it. They can

see the whole picture. According to Williams & Wright (2004), this is

called the ‘drive for central coherence’ (They call it ‘getting the

gist’). For example, if people heard church bells and saw a large

group of people dressed up in fine clothes and hats, throwing

confetti at a couple outside a church, they might guess that this was

a wedding. Children with ASD appear to experience great difficulty in

drawing together information in this way to understand the gist of

what is going on or what is expected from them. In the example of the

wedding given above, the child with ASD might focus on the church

bells, or the pieces of paper floating around, but fail to recognize

the event as a wedding. If students were sitting in a classroom and

the teacher said, ‘Take your pencils out’, they might understand that a

lesson was about to begin and they we would be expected to write

something down. People relate the details of the words in the

sentence to the context. A child with ASD, however, might quite

literally take his pencil out of the room. In other words, children

with ASD have difficulty getting the gist. They may not understand

the overall meaning when presented with the details. They may become

preoccupied with detail. This difficulty in getting the gist applies

to the child’s use of language as well as his understanding of

pictures, stories, events and objects. Children with autism may jump

to the wrong conclusion because they have problems referring context

and detail backwards and forwards to each other. Most people do it

intuitively without thinking about it.

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People are able to get the gist of the meaning of phrases and

sentences intuitively, but sometimes they make mistakes. You may be

able to recall situations yourself when you have focused on a

particular word in a sentence incorrectly. The whole meaning of the

sentence and the social intent that surrounded it may have been lost.

For children with difficulties on the autism spectrum, their own

language may seem as confusing as foreign languages seem to the

majority of people. Often this is because they struggle to get the

gist of the situation because they fail to understand the meaning of

words within the correct context.

In addition, autism seems to create problems with ‘‘mind

reading’’ (e.g., knowing what another person might be thinking)

(Barron-Cohen, 2007). Most people can observe others and guess,

through a combination of tone and body language, what’s ‘‘really’’

going on. Clearly, without help and training, autistic people cannot

pick up social skills. ‘‘Mindblindness’’ can lead even the highest-

functioning person on the autism spectrum to make social blunders

that cause all kinds of problems by not caring for their feelings,

interests and thinking. ‘Mindblindness’ refers to being blind to the

minds of other people. It means that people with Autism Spectrum

Disorders (ASDs) have great difficulty understanding the point of

view or the thoughts or feelings of someone else. Some researchers

have called this poor ‘Theory of Mind’, as shorthand for saying that

children with ASD have poor understanding of what other people are

thinking or feeling: a poor understanding of the minds of others.

‘Theory of Mind’ (TOM) refers to our ability to make accurate guesses

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about what people might be thinking or feeling or help us to predict

what they are going to do. This is a crucial skill for being able to

get on socially. Mindblindness is where we have problems with this. A

child with severe autism may have a totally impaired TOM but more

often TOM is developmentally delayed. In other words, children on the

autism spectrum develop these skills later and to a lesser degree

than others.

There are different signs and symptoms for autistic children.

Parents and teachers should care for them in order to take proper

decisions in instructing, educating and treating with them. Most

scholars including Williams & Wright (2004) believe that in the first

six months, there are no obvious symptoms for autistic children, but

they generally seem to be very passive, distraught or inconsolable

babies. Some babies rarely look at their parents faces or eyes and do

little babbling or imitating of their parent’s movements or sounds.

They further explained that as a general rule, from six to

twelve months children can usually crawl or move about, stand with

support, say single words such as ‘momma’ or ‘dada’ and use simple

gestures such as waving ‘bye bye’. If your child has not reached

these milestones, he or she may develop these skills over the

following few months, but in case of delay, the child’s progress

should be monitored by health professionals. This does not

necessarily mean that your child has ASD, but may signal other

general developmental difficulties, speech and language delay or

delay in physical development. Children should be using two words

together with meaning by the age of 24 months and failure to do this,

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or any loss of language in this period, is a reason for you to see a

health professional. Some children with ASD will have learnt skills

which they then appear to lose. In particular, some children with ASD

gain and subsequently appear to lose language skills.

Most scholars and researchers including Siegel (2008); Myles

and Simpson (2002); Williams & Wright (2004); Attwood (1998, 2007);

Prelock, (2006); Stokes (n.d.) and Christie, et al., (2009) have

summarized some common causes for concern at three to five years.

Autistic children may have the following problems:

• impaired nonverbal behaviors such as eye contact, facial

expressions, body posture, and gestures

• not sharing enjoyment, interests, or achievements with others, such

as by leading others to, pointing

to, or showing off things of interest

• playing alone rather than showing interest in playing with other

children

• showing an unusual reaction to distress in others, for instance

ignoring them or laughing

• standing out as behaving differently at playgroup; for example,

they may continue to wander around

the room when the other children are sitting down at story time

• using language that may seem different from that of the other

children at nursery. For example, they

may:

- have very little language or a great deal of language (but this

may be very repetitive or verbose)

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- repeat phrases from films, videos or TV programs or copy

phrases she has just heard

- have difficulty understanding

• having little or no interest in pretend play or being puzzled by

the imaginative play of other children

• not interested in joining in group games or may be insistent on

playing them in a particular way

• very preoccupied with particular games or toys (i.e. playing with

the same thing every day for many

hours at a time) and becomes extremely upset if prevented from

continuing

• preoccupied with unusual things for a young child, such as lamp

posts, grids, potato peelers, maps,

road signs, traffic lights, logos

• have difficulty making sense of the way adults talk to them from a very

early age: not just the words,

but the whole of ‘conversation’, with its finely timed two-way flow,

eye-contact and other social

signals

• insisting on things being the same – for example ornaments being in

exactly the same position

• showing a liking for routine – for example having to go into a

particular room and sit on a particular

chair before doing anything else

• making unusual movements such as spinning round or rocking

repeatedly

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• making unusual hand or finger movements such as flapping his hands

or moving his fingers in front

of his eyes

• fascinated by patterns or movement in everyday objects such as

lining up books or cars and moving

her hand back and forth repeatedly, watching the patterns she makes

• sensitivity to noise, e.g. often putting his hands over his ears or

becoming very upset at the sound of

loud noises which do not seem to upset other people and sensitivity

to smells, e.g. very often smelling

food before eating it or sniffing clothes or people repeatedly

• sensitivity to touch, e.g. stroking items for long periods of time

or hating the feel of certain fabrics to

the point of distress

Many of these behaviors can be seen in children who are

developing in a healthy way. However, in that case they usually stop

after a few days or weeks. You should see your doctor if you are

worried.

Generally, problems on the autism spectrum are detected before a

young person reaches adolescence. Some autistic children will have

more subtle difficulties (especially Asperger syndrome) and they may

have escaped the notice of those around them until they are older and

social skills are required more. As a child becomes older adults and

peers are less tolerant of wide variations in social behavior than

they are when the child is in infancy. Social difficulties begin to

stick out more as the child grows. They signs and symptoms from six

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to seventeen years of age are the same as those mentioned for

children from three to five years. They continue most of the problems

outlined above in social behaviors, verbal and non-verbal

communication, learning, speech and language, but they are

highlighted in social and interactional aspects of autistic children.

Children with ASD have problems in social relationships,

social understanding, thinking, imagination and behavior. Some the

common problems in these aspects are as follows: mindblindness, poor

use of facial expressions, imagination difficulties, problems in

(playing, problem-solving, getting on with others, sense of humor,

understanding abstract concepts ,literal thinking, time perception,

planning, memory), problematic interest in parts of objects and

pictures , difficulty with sensory and visual interests and

sensitivities: temperature, vibration, touch and texture, smell,

taste, sound, pain, gestalt perception, hypersensitivity

(hypervision, hyperhearing, olfactory hypersensitivities,

hypertactile, vestibular hypersensitivity, proprioceptive

hypersensitivity), and hyposensitivity (hypo-vision , hypohearing,

hypotaste or hyposmell , hypotactility , vestibular hyposensitivity ,

proprioceptive hyposensitivity, hypoproprioceptive ).

Conclusion:

Parents never want to believe that their precious bundle has

a problem. But when it comes to autism, catching it early—ideally by

the age of eighteen months—makes a huge difference. The younger your

child, the greater the impact of treatment on symptoms of autism. But

no matter your child's age, don't lose hope. Treatment can reduce the

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disorder's effects and help your child learn, grow, and thrive. The

signs and symptoms of autism vary widely, as do its effects. Some

autistic children have only mild impairments, while others have more

obstacles to overcome. However, every child on the autism spectrum

has problems, at least to some degree, in the following three areas:

Communicating verbally and non-verbally

Relating to others and the world around them(social problems)

Thinking and behaving flexibly

There are different opinions among doctors, parents, and

experts about what causes autism and how best to treat it, and much

that we still don’t know. But on one fact, everyone agrees: early and

intensive intervention helps. Parents are in the best position to

spot the earliest warning signs of autism. They know their child

better than anyone. They should know what’s normal and what’s not.

They are advised to monitor their child’s development, take action if

they are concerned and not to accept a wait-and-see approach.

If autism is caught in infancy, treatment can take full

advantage of the young brain’s remarkable plasticity. Although autism

is hard to diagnose before 24 months, symptoms often surface between

12 and 18 months. If signs are detected by 18 months of age,

intensive treatment may help to rewire the brain and reverse the

symptoms. The earliest signs of autism involve the absence of normal

behaviors—not the presence of abnormal ones—so they can be tough to

spot. In some cases, the earliest symptoms of autism are even

misinterpreted as signs of a “good baby,” since the infant may seem

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quiet, independent, and undemanding. However, you can catch warning

signs early if you know what to look for.

While there's no proven cure yet for autism spectrum disorder

(ASD), treating ASD early, using school-based programs, knowing how

to treat them and getting proper medical care can greatly reduce ASD

symptoms and increase your child's ability to grow and learn new

skills (Magnusen, 2005). Research has shown that intensive behavioral

therapy during the toddler or preschool years can significantly

improve cognitive and language skills in young children with ASD.

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