Within the past decade, autism awareness has increased tremendously. Research on the proposed causes, effects, and overall development has been a primary focus in special education. Moreover, speech and language development in children with autism not only has an effect on their overall development, but it also has an effect on their parents and other family members with different issues arising at different stages in the family cycle. All children have essential needs in common, and it is important to fulfill those needs in order to aim for success.
In this presentation, an overview of autism is given, detailing the definition and description of autism along with the symptoms, diagnosis, proposed causes and prevalence. Speech and language development is also discussed and includes how typically developing children progress in speech and language compared to how children with autism develop. Finally, implications for intervention are suggested with support from various empirical data.
According to the Autism Society of America (2008), “autism is a complex developmental disability that typically appears during the first three years of life and affects a person’s ability to communicate and interact with others” (para. 1). In addition, the Autism Society of America (2008) notes that autism is categorized as a Pervasive Developmental Disorder (PDD), which is a category of neurological disorders characterized by severe and pervasive impairment in several areas of development (para. 2). After researching in more depth on the definition of this complex disability, I found that along with autism, pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger Syndrome also fall under the PDD category (Landa, 2007). Often, the term Autism Spectrum Disorder (ASD) is used to refer to each of these diagnoses. Leo Kanner is responsible for first describing autism in 1943. A host of difficulties with social interactions, communication, and repetitive behaviors are among the characteristics associated with autism that describe this disability.
There are many different combinations of characteristics that could meet the definition of autism. However, the Diagnostic and Statistical Manual of Mental Disordersprovides details about the three main symptoms associated with autism and is often used by professionals when diagnosing autism. The three broad areas include reciprocal social interaction, verbal and nonverbal communication, and repetitive and unusual behaviors and/or interests.
Reciprocal social interaction is a social deficit that involves withdraws from social interaction but also involves difficulty with maintaining relationships. Preferring isolation and ignoring others, unresponsive behavior, showing no interest in playing with others, and rarely initiating social contact are characteristics that fall under this broad area. Children with autism also struggle with social sharing. They have trouble showing others something they have made or pointing out things that interest them (Brown & Percy, 2007). Not being aware of the feelings and thoughts of others is common as well. For example, they may not notice if a person is upset or may not display any sense of empathy. This also ties into the way they play with others. Pretend play is often difficult for them to engage in since they have very little imagination compared to a typically developing child. In addition, multiple deficits in non-verbal behaviors are among characteristics that define autism and fall under the category of reciprocal social interaction. These include such things as brief eye contact or almost non-existent; infrequent facial expressions such as smiling; and notable difficulty with the use of gestures and behaviors to establish joint attention (Brown & Percy, 2007).
Throughout the research process, I came across a considerable amount of information on joint attention skills associated with language development of children with autism. Joint attention “essentially involves the coordinated and shared visual attention between two people on an object or event” (Bono, Daley, & Sigman, 2004, p. 495). In other words, it is to engage the attention of another person socially. These three researchers conducted a study to investigate the relations among joint attention, intervention, and language gain in children with autism. The results of this study supported the idea that joint attention skills are prerequisites for language development. In addition, the relationship depended upon the child’s ability to respond to bids of joint attention from others (Bono, Daley, & Signman, 2004).
The second area of difficulty is impairments in verbal and nonverbal communication. Children with autism may display a delay in, or complete lack of, the development of spoken language, and this is one of the most concerning symptoms of autism(Koegel, Koegel, & Shirotiva, 2009). Semantics, orcomprehending language and understanding the meaning of language, is difficult for children with autism (Allman, Eidine, & Helmy, 2008). As for children who are nonverbal, it is difficult to point to objects or use gestures to communicate their needs. A common behavior they use to indicate their needs is to make use of another person’s hand, most likely a parent, as a tool to get what they want. In addition, difficulty with pragmatics, or understanding the meaning of language (Allman, et. al, 2008) is common among both verbal and nonverbal children. Echolalia, which is simply repeating words that are heard by others, is something that children with autism may exhibit. It occurs either right away (immediate echolalia) or some time later (delayed echolalia) (Brown & Percy, 2007). These communication skills have the potential to be essentially meaningful especially if the child understands what they are repeating. However, children with autism who are considered verbal, with adequate speech, lack the ability to initiate or maintain a conversation. It can become difficult when they do not understand what is being said or asked. If the child does not understand, they may use made-up words in response to a question or comment. A deficit in verbal and nonverbal language affects the child’s overall language development.
The third area of difficulty to look for when diagnosing a child with autism is the pattern of unusual behaviors and interests he/she demonstrates. Obsessive preoccupations such as arranging books a certain way (Brown & Percy, 2007) or intense interests in one topic such as trains (Brown & Percy, 2007) are a common pattern of behavior associated with autism. They also may have trouble dealing with changes in routines or transitions. Another common behavior that is the most noticeable is repetitive behaviors. Motor movements such as rocking, hand flapping, pacing, or complex whole-body movements (Brown & Percy, 2007) are a few of the stereotyped behaviors linked with autism, and could also occur with objects. These behaviors essentially become distracting to the point where interaction with others is absent supporting the idea that it ultimately affects the ability to establish and maintain a relationship and also interact with others.
Since autism is so unique, it is important to understand that a child diagnosed with autism may display different symptoms than another child diagnosed with autism. Individuals with autism vary widely in ability, behavior, activity level, and personality (Brown & Percy, 2007). In addition, autism holds a very large spectrum of characteristics. Therefore, it is important to understand that if a child does not demonstrate all of the possiblesymptoms, it does not mean they do not have autism. It should not be ruled out instantly. When done properly, assessment through observations, knowledge of history, interviews with family, and various assessment tools can be extremely useful to answer any questions and guide intervention efforts
Research has been continuously done to determine the cause or possible causes of autism.Fombonne (2003) indicated that there are probably multiple causes resulting in a similar pattern of behavior or different subgroups with different causes. Various causes including ones that are genetic, associated with other disorders, a combination of factors, and a number of which are not yet well understood help to promote this idea. Determining the cause of autism is very difficult and a particular cause may never truly be identified.
Autism is not a rare disorder. In a recent journal article by Frank Sansosti (2010), it was noted that within the past two decades, the number of children diagnosed as having autism has considerably increased from 4 to 6 per 1,000 (or 1 in approximately 1,600) live births to the current estimation of 1 in every 150 live births. This estimation labels autism as the fastest growing developmental disability in the United States. Additionally, it is more common in males than it is in females and approximately 1 in 3 people with autism are completely non-verbal.
During the early years of life, children learn all of the many behaviors that characterize the human species: walking, talking, thinking, and socializing.The first year of life is known as the paralinguistic or pre-language phase. In typically developing children, body movements and sounds such as crying and laughing are used to convey their needs and feelings. They are very dependent on these body movements until about the second year of life. The major way of communicating within the second year is through speech in what is known as the linguistic, or language stage. Over the next three or four years, the child learns to put words together to form simple and then compound sentences that make sense. Between five and seven years of age, most children have become proficient at expressing their thoughts and ideas orally, and their vocabulary contains approximately 14,000 words or more.In typical development, linguistic, paralinguistic and pragmatic systems emerge in synchrony so that the level of skills in any one domain should be equal with the skills in another. Signs of delayed communication in children with autism can be seen as early as the first year of life. Early communication development in children with autism is characterized by early sharing of affective expression, delayed onset of babbling, as well as a delay in the use of gestures and responsiveness to others. Language development in children with autism is significantly delayed compared to typically developing children.
As autism continues to be a fast growing developmental disorder affecting the child, it has been researched to ultimately impact the family (e.g. Bordin, Duarte, Mooney & Yazigi, 2005; Hastings, 2003; Hodge, Hollman, Looney, Lopez-Wagner, & Sweeny, 2009; McIntyre & Quintero, 2010). Consistent results on the investigation of parenting stress have shown that parents of children diagnosed with autism have higher rates of depression and stress when compared to parents of typically developing children (McIntyre & Quintero, 2010). Generally, parents face the task of meeting the needs of the rest of the family. When a child with a disability is involved, it leaves the parents the job of restructuring and rebalancing their family’s needs. The demands placed on parents of children with autism may leave little time to spend with other members of the family (McIntyre & Quintero, 2010). Furthermore, responsibilities may be shifted to the siblings due to the overwhelming responsibilities the parents endure. Moreover, when deficits in speech and language are present, it makes it more difficult for the family to maintain social interaction and relationships with the child with autism.
In conjunction with higher rates of parenting stress and depression, siblings are often exposed to increased parental expectations, decreased parental involvement, and increased responsibilities. Thetraditional sibling role changes leading to the potential responsibility of becoming the primary caregiver. As for parents, more specifically mothers, it becomes particularly stressful to take care of a child with a disability, and the symptoms associated with autism, such as the children’s language and communication difficulties, cognitive impairments, reactivity to frustrationand repetitive, self-stimulatory behavior have been found to be related to parents’ stress. In addition,minimal affective expression and increased difficulty in managing interpersonal situations between the mother and the child diagnosed with autism is present.
To support the researchon the effects it has on siblings, McIntyre and Quintero (2010) explored the differences in social, behavioral, and academic adjustment in siblings of children with and without autism. The researchers hypothesized that “typically developing siblings of preschool-aged children with autism would have higher teacher-reported and parent-reported problem behavior and lower social skills and academic competence” (p. 38). The results of the study suggested that siblings in both groups were in the average range for academic competence, social skills, and behavioral functioning.
In addition, in a study conducted by Hastings (2003), data was collected on siblings of children with disabilities (autism). Results showed that mothers of the siblings rated their behavior as being more problematic than the normative sample, which were siblings of children without autism. Moreover, according to reports from the mother, younger siblings of children with autism engaged in fewer pro-social behaviors, which are simply actions to help others because there is a sense of empathy.
In terms of language development and joint attention, social and communication behaviors of young siblings without a disability that have an older sibling with a disability were investigated (Filipek, Goldberg, Jarvis, Laulhere, Osan, Spence, & Straub, 2005). The results of this study suggested that social communicative behaviors differed from typically developing children but were similar to the social communicative behaviors of their older sibling diagnosed with autism.
There is evidence of experiencing higher levels of stress in mothers of children with autism compared to mothers of typically developing children (Hodge, et. al., 2009). According to values reported by Hodge, et. al. (2009), these means were at the 99th percentile for mothers in the autism group and at the 40th percentile for mothers without a child with autism. In other words, mothers of children with autism scored higher in stress level than 99% of mothers in the autism group and mothers of children without autism scored higher than only 40% of mothers in the same group. Therefore, parenting is associated with stress but less than the majority of parents without a child with autism showed a high stress level. This study also focused on mothers’ input on their child’s behavior (both with and without autism) and results showed that the more stressful and problematic they reported their child’s behavior to be, the less closeness they reported.
Lastly, to support the research of the effect on mothers, Bordin, Duarte, Mooney and Yazigi (2005) investigated the factors associated with stress in mothers of children with autism. Results determined that there was minimal affective expression and increased difficulty in managing interpersonal situations. Additionally, demographic and personality characteristics were significant factors in stress level for mothers of children with autism.
Generally, autism is considered a lifelong disorder that relies heavily on dependence. It lays on a very broad spectrum, with other related disabilities, which leads to the difficult task of distinguishing between and implementing a number of various implications for intervention that are successful depending on the diagnosis. The variability in children with autism is also found in their response to intervention. With better diagnosis, intervention and education programs differences are possible. Early intervention, response to intervention, and functional communication training has been shown to benefit the lives of children with autism including their speech and language development.
Behavioral early intervention programs have been shown to produce significant improvements in children’s cognitive level, language, and ability to function in school (Brown & Percy, 2007). Various characteristics have been identified to define successful early intervention programs; they begin in the preschool years, are intensive, use structured behavioral teaching principals, are comprehensive and individualized, use highly trained staff while involving parents, and incorporate inclusion (Brown & Percy, 2007). Dr. Ole IvarLovaas developed the first behavioral early intervention program that utilized applied behavioral analysis to provide behavioral intervention (Brown & Percy, 2007; Kasari, 2002).
Lovass’s intervention program showed remarkable change by providing data that indicated that the participants involved in the program were functioning successfully by first grade in the mainstream classroom and maintaining this success progressing into adolescence (Lovaas, 1987). Data from this program has highlighted how important comprehensive early intervention programs are to the overall development of children with autism. In addition, the program is designed to meet the varying needs of children diagnosed with autism. The program encompasses the same purpose but is designed based on the variability of each child.
Response to Intervention (RTI) is a service delivery approach for “providing interventions to students at increasing levels of intensity based on progress monitoring and data analysis” (Sansosti, 2010). The RTI model represents the assumption that all children deserve equal, effective, quality instruction. The use of RTI may vary from each environment, but there are three main components that remain standard despite the setting. RTI consists of quality teaching and the use of research-based interventions, data-collection procedures, and educational decision-making based off of the data collected (Sansosti, 2010). RTI should focus on a combination of school-wide, small group, and individualized supports in order to improve the social skills of children with autism. If appropriate social skills are not addressed or developed, failure to achieve functional social skills may be diminished. RTI is an implication for intervention that can be used to develop the speech and language deficits children with autism face.
To address the communication and behavioral needs of children with autism, functional communication training (FCT) can be implemented.Boman and Mancil (2010) note that FCT involves “assessing the function of a behavior through analogue assessment methodology, referred to as functional analysis, and then replacing the challenging behavior by teaching a communicative response that serves the same function” (p. 238). FCT has been successful with both verbal and nonverbal children. It has helped restructure aggression, tantrums, oppositional behavior, and hand flapping (Boman & Mancil, 2010). Like RTI, FCT has a standard three-step process that researchers and practitioners use. This process includes the assessment of the function of behavior conducted through a functional behavior assessment, the identification of a communicative response that matches the function, and the replacement of the challenging behavior with a communicative response that serves the same function as the behavior specified in the intervention plan(Boman & Mancil, 2006).
Alter, Conroy, Mancil, and Nakao (2006) note that FCT is useful in the child’s natural environments. In their study conducted in the participant’s home, the child (with autism) showed an increase in communication and a decrease in challenging behavior (Alter et. al., 2006).
Language is a fundamental component of all known human societies. The process of language learning is often taken for granted. To several people, language is just a basic instinct that is simple and appears naturally. However, language is a complex skill to learn. Individuals who are diagnosed with autism that define impairments in social interaction, communication and behavioral flexibility struggle with the ability to achieve independence in speech and language development. Not only is it a challenge for them, but it also affects their families, more specifically their parents and siblings. The study of language in autism is a difficult effort because of the diversity of language skills presented by members of the population. However, various approaches to help children with autism succeed have been implemented and identified and proven to increase their speech and language abilities. If the signs of delayed communication in children are identified early enough, interventions that meet the individual needs to help improve their overall well-being will be successful.
Michelle Gielarowski Thesis Presentation 2010
Speech and Language DevelopmentTHE OVERALL EFFECT ON THE LIVES OF CHILDREN WITH AUTISM MICHELLE GIELAROWSKI UNIVERSITY OF PITTSBURGH
Contents Overview of autism Description and Definition Symptoms and Diagnosis Causes Prevalence Speech and Language Development Typical Development vs. Development in Autism Effect on child Effect on family (parents and siblings) Implications for Intervention Early Intervention Response to Intervention (RTI) Functional Communication Training (FCT)
Overview of AutismDefinition Description Complex developmental Leo Kanner 1943 disability appearing Difficulties with social during the first three interaction and years of life affecting the communication, and ability to communicate and interact displaying repetitive behaviors PDD (Persuasive Developmental Disorder) (Autism Society of America, 2008; Landa, 2007)
Overview of AutismSymptoms Reciprocal social interaction Verbal and nonverbal communication Repetitive/unusual behavior and/or interests
SymptomsReciprocal Social Interaction A social deficit that involves withdraws from social interaction and difficulty with maintaining relationships. Isolation preferable Ignoring others, unresponsive behavior, showing no interest in playing with others, and rarely initiating social contact Difficulty with social sharing Brief eye contact, infrequent facial expressions, and difficulty with establishing joint attention(Brown & Percy, 2007)
Bono, Daley, &Signman Study Relations Among Joint Attention, Amount of Intervention, and Language Gain in Autism (2004) Investigated relationship between amount of intervention and language development Proposed joint attention skills as characteristics to moderate relationship Results showed conditional relationship between amount of intervention and language development with dependence on joint attention skills
SymptomsVerbal and Nonverbal Communication A delay in, or complete lack of, the development of spoken language Difficulty with semantics Use of gestures/pointing to communicate needs Difficulty with pragmatics Exhibits echolalia (Allman, Eidine, &Helmy, 2008; Brown & Percy, 2007; Koegel, Koegel, &Shirotiva, 2009)
SymptomsRepetitive and Unusual Behaviors and Interests Obsessive preoccupations Difficulty dealing with change Repetitive behaviors that include motor movements(Brown & Percy, 2007)
Diagnosis Understand the complexity of the disability Consider all possible symptoms Do not rule out autism immediately; look at all aspects Accurate assessment through observations, knowledge of history, interviews with family, and various assessment tools provides guidance (Brown & Percy, 2007)
Overview of AutismCauses No known cause of autism Possibility of multiple causes with similar pattern of behavior (Fombonne, 2003)
Overview of AutismPrevalence Children diagnosed with autism increased from 4 to 6 per 1,000 (or 1 in approximately 1,600) live births to 1 in every 150 live births More prevalent in males vs. females 1 in 3 people are nonverbal (Sansosti, 2010)
Speech and Language DevelopmentTypical Children Children with Autism Paralinguistic stage: Early sharing of includes body affective expression movements and sounds Delayed onset of Linguistic Stage; babbling communicates orally Delay in use of gestures Forms sensible sentences; first simple and responsiveness then compound Vocabulary extends (Allen &Marotz, 2003; Landa, 2007)
Effect on the Family Higher levels of stress Signs of depression Responsibility is shifted to siblings Difficult for family to maintain social interaction and positive relationships
Effect on the FamilySiblings Mother Exposed to increased Increased amount of parental expectations, stress decreased parental involvement, and Minimal affective increased responsibilities expression Traditional sibling role Increased difficulty in changes; the potential managing responsibility of becoming the primary interpersonal caregiver is likely situations
McIntyre & Quintero Study Sibling Adjustment and Maternal Well-Being: An Examination of Families With and Without a Child with an Autism Spectrum Disorder (2010) Differences in social, behavioral, and academic adjustment in siblings of children with and without autism Results showed siblings in both groups were in the average range for academic competence, social skills, and behavioral functioning
Hastings Study Brief Report: Behavioral Adjustment of Siblings of Children with Autism (2003) Data was collected on 22 siblings of children with autism and rated by their mothers as having more behavior problems and fewer pro-social behaviors Results showed that children with siblings who have autism, and also those younger than their sibling with autism, engaged in fewer pro-social behaviors
Filipek, Goldberg, Jarvis, Laulhere, Osan, Spence, & Straub Study Brief Report: Early Social Communication Behaviors in the Younger Siblings of Children with Autism (2005) Data was collected on young children with autism, younger siblings in families with an older child with autism, and young typically developing children Results showed the social communicative behaviors of the younger siblings differed from typically developing children but not from the behaviors displayed by the autism group
Hodge, Hollman, Looney, Lopez-Wagner, & Sweeny Study Mothers of Typically Developing Children and Mothers of Children with Autism (2000) Data using the Parenting Stress Index was collected on stress levels of mothers of children with autism and mothers of typically developing children Results showed higher stress levels in mothers of a child with autism versus mothers of a typically developing child
Bordin, Duarte, Mooney &Yazigi Study Factors Associated with Stress in Mothers of Children with Autism (2005) Investigated possible reasons for stress in mothers of children with autism Results showed that poor affective expression, little interest in people, being an older mother, and having a younger child contributed to increased stress level
Implications for Intervention Early Intervention Response to Intervention (RTI) Functional Communication Training (FCT)
Implications for InterventionEarly Intervention Improves cognitive level, Dr. Ole IvarLovaas language, and ability to function in school responsible for Successful early developing first early intervention programs include: early start, intervention program intensive, structured utilizing applied behavioral teaching behavior analysis principals, comprehensive, individualized, trained staff Involves parents; supports inclusion
Lovaas Study Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children (1987) Investigated the effects of behavior modification treatment on children with autism Results showed that the participants involved functioned successfully by first grade in the mainstream classroom while maintaining success
Implications for InterventionResponse to Intervention Approach for providing 3 tiers of support: interventions to students quality teaching/use of at increasing levels of research-based interventions intensity based on data-collection procedures progress monitoring and educational decision-making data analysis School-wide, small group Believes all children and individualized deserve equal, effective, supports combine for quality instruction success
Implications for Intervention Functional Communication Training Addresses Success with communication and verbal/nonverbal children behavioral needs Restructures aggression, tantrums, oppositional Involves assessing the behavior, and hand flapping function of a behavior 3 step process: through analogue Assessment of the function of assessment behavior methodology; then Identification of a communicative response replacing challenging Replacement of the challenging behavior by teaching a behavior with a communicative response communicative response
Alter, Conroy, Mancil,&Nakao Study Functional Communication Training in theNatural Environment: A Pilot Investigation With a Young Child with Autism Spectrum Disorder (2006) Investigated FCT in the child’s natural environment Results showed an increase in communication/decrease in challenging behavior
Conclusions Language is a fundamental component Independence in speech and language development is difficult to achieve for children with autism Affects the child and also the family; siblings, parents, mother Interventions improve overall well-being and development