Increasing Expressive Skills for Verbal Children with Autism

by Susan Stokes Autism Consultant

If you reprint or use this article, or parts of it, please include the following citation:"Written by Susan Stokes under a contract with CESA 7 and funded by a discretionary grant from the Wisconsin Department of Public Instruction. "

What is Communication?

Communication is a range of purposeful behavior which is used with intent within the structure of social exchanges to transmit information, observations, or internal states, or to bring about changes in the immediate environment. Verbal as well as nonverbal behaviors are included, as long as some intent, evidenced by anticipation of outcome, can be inferred. Therefore, not all vocalization or even speech can qualify as intentional communicative behavior (9).

This definition emphasizes that communication takes place within a social context. Speech/verbalization becomes communication when there is a desire or intent to convey a message to someone else. Therefore these two areas, communication and social skills, are tightly interwoven and interdependent. Unfortunately for children with autism, these are also two primary areas of difficulty. Therefore children with autism, even those who are considered "verbal", usually experience significant communication difficulties.

When referring to verbal children with autism, we are considering a broad spectrum of verbal behaviors, from minimally verbal to quite verbose, with the common area of difficulty being in how the child uses his language to communicate. As stated earlier, because communication and social skills are interdependent, the characteristics and features of autism regarding social relations contribute to the child's significant difficulty in using verbal language skills to effectively communicate (11). That is, the child's general lack of knowledge concerning other people, especially in understanding that other people have thoughts, ideas and beliefs different from his own (11), significantly interferes with his ability to communicate. If a child does not understand the general "give and take" of social relationships", he is unlikely to engage in the purposeful and intentional exchange of information that defines communication.

Language intervention programs for verbal children with autism often focus on improving the child's language form or structure skills (e.g., sentence length, vocabulary skills, and sentence structure). However, for verbal children with autism, the language intervention programs' focus should be increasing the child's knowledge and understanding of social communication skills.

It is important to note that focus on communication is not the sole responsibility of the speech/language pathologist but should be addressed on a continual and on-going basis by everyone who comes in contact with the child. Therefore, the two-fold purpose of this article is to provide:

I Key questions to consider in order to determine the child's current communication abilities
II The development of a communication intervention program for the child with autism that is based on his communication needs.

  1. Questions to Consider.

In order to develop an appropriate communication intervention program for the verbal child with autism, the following questions should be considered to determine his current communication abilities/needs.

Echolalia - Definition and characteristics:

  • The most common form of unconventional verbal behaviors is echolalia (9). Echolalia is when the child repeats verbal information stated by others (e.g., people's conversational exchanges, videos, books read aloud, songs, etc.).
  • Echolalia can include repetition of part of the utterance as well as an identical repetition of the entire spoken utterance, sometimes including an exact replication of the inflectional pattern used by the speaker.
  • Echolalia can be both immediate (a repetition of something they have just heard) or delayed (a repetition of information heard previously - minutes, hours, days, weeks, months, years!).
  • Echolalia occurs in normal language development yet decreases as the typically developing child gains more spontaneous generative language. In children with autism, echolalia occurs with greater frequency and lasts for a longer period of time as the child with autism typically experiences significant difficulty developing spontaneous, generative language skills (9)
  • Echolalia is reflective of how the child processes information. The child with autism processes information as a whole "chunk" without processing the individual words that comprise the utterance. In processing these unanalyzed "chunks" of verbal information, many children with autism also process part of the context in which these words were stated, including sensory and emotional details. Some common element from this original situation is then triggered in the current situation which elicits the child's echolalic utterance.
  • Example: A student with autism became upset with his teacher over completing a task. He then verbalized loudly, "Go to hell lieutenant!" His parents reported that he had been watching the movie "A Few Good Men" quite frequently. This movie contains this exact same utterance in the emotional context of anger. This child with autism was unable to spontaneously generate language to communicate "I'm upset and I don't want to complete this assignment", but could pull forth an echolalic utterance which he had processed in the context of the emotional state of anger.

The presence of echolalia in children with autism can be a positive indicator for future meaningful language development (8). It indicates that the child is at least processing language, although at a "surface" level.

Use of echolalia for Non-Communicative and Communicative Purposes:

It is important to consider how the child is using echolalic utterances, for non-communicative and/or communicative purposes. In either case, it is important to note that, although he may be using sophisticated utterances (e.g., lengthy sentences, advanced vocabulary and grammatical forms), these echolalic utterances are generally being repeated without a clear or complete understanding of the meaning of the utterance (8).

Non-Communicative Purposes: Echolalia used without communicative intent occurs when the child does not anticipate a response to his verbalization (8). Some examples include:

  • Echolalic utterances which do not appear relevant to the situation or context (e.g., a child repeats utterances from a Disney video during a group calendar activity);
  • Utterances that may be triggered by something in the situation or context (e.g., a child walks into the lunchroom and begins to engage in echolalic utterances which have been heard in this context: "Everyone find a seat and start eating.")
  • Utterances that may be used as self-direction for his own actions (e.g., a child produces echolalic utterances to engage in a previously taught verbal routine to wash his hands: "Turn on the water. Get some soap. Rinse hands. Turn the water off. Get a towel and dry hands.").

Sometimes, children with autism engage in echolalia when they are feeling stressed or anxious. It is important to determine whether the child's arousal level could be a precipitating factor for the presence of his echolalia.

Example: A child walks into a classroom that he attended the previous school year. He begins to engage in a variety of delayed echolalic utterances spoken by the teacher from the previous school year. This child may be exhibiting an increase in stress and anxiety because he does not understand why he is in this environment again.

Communicative Purposes: As the child's cognitive and language skills develop, his use of echolalia may become more functional and communicative (8). When echolalia is used more communicatively, the child will generally exhibit an increase in spontaneous, appropriate eye gaze and/or body orientation. Echolalia can be used communicatively for the following functions:

  • Conversational turn taking: The child recognizes when he is to take a conversational turn and that some sort of response is required. However, the child lacks the spontaneous generative language to engage in the conversation, so he relies upon an echolalic utterance to take his "turn" in the conversation.
  • Example: A person says, "What did you do in gym?" The child with autism responds with "Everyone line up in your gym spots." The child takes his conversational turn by using an echolalic utterance from the gym teacher.

  • Initiation of communicative interactions: The child is beginning to recognize and notice others. Because he lacks the spontaneous generative language skills to initiate a communicative interaction with someone, he uses an echolalic utterance.
  • Example: A child with autism approaches an adult, spontaneously engages in direct eye contact and says, "Susan, I think I'm going to die tonight". Upon further investigation, it is discovered that the child has been watching the movie "Charlotte's Web". In order to initiate a communicative interaction, he uses an echolalic utterance obtained from the movie.

  • Requesting: The child uses echolalia to request a desired object, action or event.
  • Example: The child says: "Do you want a snack?" to indicate that he wants a snack.

  • Indicating affirmation in response to a previous utterance: The child uses echolalia to respond affirmatively to the previous utterance.
  • Example: Another person says, "Want to go swing?" The child responds with the echolalic response, "Want to swing?"

Perseverative speech/incessant question asking - Definition:

Perseverative speech and incessant question asking are persistent repetitions of speech or questions which can be used both communicatively or non-communicatively.

Perseverative speech/incessant question asking -Communicative purposes.

This occurs when perseverative speech or incessant questions are used to initiate or maintain a communicative interaction, and the child anticipates a response. However it is perseverative, because the child repeats the speech act either immediately or shortly thereafter, even after receiving a response.

Example: A child with autism repeatedly says, "Watch Goof Troop", and becomes increasingly anxious and repetitive until someone responds to his perseverative utterance. Even though a response is given, the child continues to repeat the utterance.

Perseverative speech and incessant question asking may be related to the child's processing difficulties and/or his emotional state.

Example: A child with autism is very anxious about where he will be going after school as the destination changes frequently. He says repetitively throughout the day, "Go to grandmas? "

Perseverative speech/incessant question asking - Non-communicative purposes:

Perseverative speech and incessant question asking may also be non-communicative in that the child repeats the utterances/questions without anticipating a response from someone. In this case the verbal repetitions may be calming or pleasurable to the child.

Example: A child says the words, "New Haven Coliseum", repeatedly throughout the day for no communicative purpose, yet exhibits a big smile. He also engages in repetitive motor movements while saying the word.