Autism spectrum disorder (ASD) is a complex developmental condition involving persistent challenges with social communication, restricted interests, and repetitive behavior. While autism is considered a lifelong disorder, the degree of impairment in functioning because of these challenges varies between individuals with autism. Communication is sending and receiving messages through verbal or nonverbal means, including speech or oral communication; writing and graphical representations (such as infographics, maps, and charts); and signs, signals, and behavior. More simply, communication is said to be «the creation and exchange of meaning.»
The act of communicating has different functions:
– Instrumental. Used to ask for something.
– Regulatory. Used to give directions and direct others.
– Interactional. Accustomed to interacting and socially conversing with others.
– Personal. Used to express a state of mind or feelings about something.
– Heuristic. Used to find out information.
– Imaginative. Used to tell stories and role play.
– Informative. Used to provide an organized description of an event or object.
These communicative functions appear early in babies, present long before the first words appear. For example, a 9-month-old baby who points with his finger has the purpose of sharing an interest by looking at the accompanying adult. However, the development of this capacity for interaction and communication is affected from the early stages of people’s lives with ASD. It, therefore, becomes one of the main elements of the intervention. To understand it in-depth, it is essential to be clear about a series of concepts. For example, not speaking does not imply not being able to communicate.
Formal language development is of little use if it is not used functionally and appropriately. It is essential to remember that each person will have different needs and require individualized support that each professional will have to assess and establish. To define communication and language characteristics in people with ASD, it is necessary to remember that the concept of «Autism Spectrum» implies that similar features will not be found in all people who present these conditions.
Therefore the difficulties in this area will manifest in a variety of ways. Regarding the communicative functions, we can find different affections:
– Lack of communication and instrumental behavior with people.
– Instrumental behaviors with people to achieve changes in the physical world, without other communication guidelines.
– Communicative behaviors to ask (change the physical world) but not share an experience or change the mental world.
– Communicative behaviors of declaring, commenting, etc., with few «subjective qualifications of experience» and statements about the inner world.
– There is no qualitative disorder of communicative functions.
About expressive language, affectations can also vary:
- Total or functional mutism. There may be verbalizations that are not adequately linguistic.
- Speech is composed of single words or echolalias. There is no creation of phrases and sentences.
- Sentence language. Some sentences are not echolalic, but they do not configure discourse or conversation.
- Speech and conversation, with limitations of flexible adaptation in conversations and selection of relevant topics. There are often prosodic anomalies.
- There is no qualitative expressive language disorder.
Finally, regarding receptive language, the characteristics vary:
- ”Central deafness.” Tendency to ignore language. There is no response to orders, calls, or directions.
- Association of verbal statements with their behaviors, without indications that the words are assimilated to a code.
- Comprehension (literal and not very flexible) of sentences, with some structural analysis. The speech is not understood.
- Speech and conversation are understood, but the literal meaning is distinguished from the intended purpose with incredible difficulty.
- There is no qualitative disorder of comprehension abilities. The most crucial alteration will be related to pragmatic aspects: the use made of the communication.
Therefore, within the spectrum, we can sometimes find people who do not even make basic requests. On other occasions, we can find people who cannot use appropriate courtesy formulas with fluent oral language development. Another essential aspect is the communicative modality. A percentage of people with ASD do not develop oral language or do so partially, making it necessary to provide tools that the person can use to communicate regardless of the work being done at the level of vocal production. Alternative Communication Systems are particularly relevant in this area. They are forms of expression other than spoken language (sign language, pictograms, digital systems, etc.), aiming to complement or replace oral language.
The person with ASD, regardless of the characteristics they show and how differentiated they may be in other areas, will always present needs within the field of communication and language. The prognosis and evolution of people with ASD are directly related to the type of care received, especially when it starts. A person who receives individualized and specialized treatment based on scientific evidence from a very early age will present more possibilities for development and a better quality of life. The first step to start intervening is to assess the characteristics and needs of the person.
As a general rule, in the intervention in autism, the achievement and generalization of the objectives related to the function are prioritized over those related to the form; that is, learning to make a functional request that provides the person with the necessary tool to get what he wants is more important than insisting on making the request verbally and with the correct pronunciation.
When the person’s communicative needs are basic (learning basic behaviors of request or rejection), the most appropriate approach is to offer a response through Alternative Communication Systems. It is essential to choose the most suitable for each person, and this selection will be extraordinary influence by the development of the capacity for abstraction. Cognitive development, in this case, is essential and significant because the different require Alternative Communication Systems have different levels of representation.
On the other hand, the need changes when the person can communicate fundamentally. The focus is no longer on implementing a tool that allows them to share, but on developing an increase in their communicative repertoire, both in function and in form (through the gradual complexity of, for example, morphosyntactic structures or the increase in vocabulary).
The more complex the communication skills that the person presents, the needs arising in this area will have an associated component of a more social nature, especially in cases where an elaborate verbal language is shown, and support is required for its use in complex pragmatic functions, such as conversational or in more social contexts. All existing intervention models provide resources and strategies to intervene in communication and language. It is common to use elements from different programs to achieve a more complete or personalized intervention.
Multiple professional teams support and allow progress in achieving maximum development. Any intervention must be shared and coordinated between the parents, the school, and the therapist responsible for the child. Parents and professionals must know the specific needs of their children and apply the appropriate strategies to each particular child. Both in the diagnosis and the design of the intervention, the team must be multidisciplinary, made up of speech therapists, occupational therapists, psychologists, social educators, caregivers, and teachers, and have the opportunity to collaborate with other specialties if considered appropriate.
Regarding the general principles of intervention, the following stand out:
- Start the intervention the sooner, the better. It is essential to consult with a speech therapist.
- Spontaneity, the search for information and generalization to the most significant number of contexts, is prioritized by overtraining to respond to initiatives or questions from the adult.
- It is essential to be guided by the child’s interest, always considering their emotional wellbeing.
- Reinforce communicative attempts, even if they are very slight, to reinforce their motivation or communication.
- Reinforce efforts with “rewards” directly related to the task.
- Promote natural, genuine, and functional work environments.
- Establish routines and structured situations, and then make them more flexible.
- Select functional objectives necessary for the person, choosing the vocabulary they need.
- Teach self-initiated communicative behaviors that do not require support or cues from an adult. – Start intervention without considering teaching prerequisites (attention skills, gaze control, etc.).
- Carry out teaching in natural contexts: routines of daily life, significant planned activities, or unexpected situations.
- Involve the family in the intervention process.
- Promote the teaching of production objectives versus comprehension, especially in the initial phase, to encourage motivation towards communication.
- Take advantage of strengths, such as particular interests. Try to turn weakness into a strength. At a general level, it is essential to rely on their strengths and, therefore:
– Present information visually since it remains in time and space, making the invisible tangible.
– Eliminate distracting stimuli to focus attention on relevant aspects.
– Establish routines to learn and develop different skills that will allow greater independence of the person, constantly introducing a component of flexibility.
– Employ structured learning. The structure is an excellent ally in the intervention with ASD.
– Promote autonomy by establishing a good support base that can be gradually withdrawn.
– Use positive reinforcement, taking advantage of the person’s interests by implementing reinforcement programs.
In addition to these methodological strategies, it is necessary to always take into account two aspects that will make the interventions successful: proposing practical learning, which has a real utility for the person in the vital moment in which he finds himself, and promoting generalization so that learned skills can be developed in different contexts.
Finally, it is essential to emphasize that the responsibility for success should not be placed on the interlocutor with the most significant difficulties. As mentioned above, there is an essential section within the intervention programs that concern parents, educators, therapists, speech therapists, etc., and it is related to facilitating communication by attributing communicative intention, where it is not seen so clearly or when it cannot be expressed in the «conventional» way. It is mainly in the hands of therapists and parents to facilitate fluency in exchanging these communicative messages.
