Download Introduction to communication and ASD

This lecture was produced for the VCU-ACE Foundations of ASD Course. The transcript is intended for use by
participants in the online course. Please do not disseminate this material without the permission of VCU-ACE
staff.
Slide 1: Introduction
My name is Dawn Hendricks and I am the Director of Training for the VCU Autism Center for Excellence. I
will be presenting on communication in autism spectrum disorders.
Slide 2: Communication
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Autism affects each person differently.
Think about a person you know who has autism.
The person may not be able to speak or is nonverbal.
The person may use alternative communication.
The person may talk but have a limited vocabulary.
There are two parts to communication: expressive and receptive communication.
Autism is a spectrum disorder and affects each person differently. Everyone has varied abilities, interests and
strengths. As Stephen Shore, a person with autism once said, “If you have met one person with autism you have
met ONE person with autism.” In this presentation we will focus on how widely autism affects communication
and some of the communication systems an individual might use. Before I begin, I would like you to pause the
presentation for a minute and think about a person you know who has autism. Some of the things you might
have said are: “he doesn’t talk or is nonverbal,” or “she uses only one or two words to communicate what she
wants.” Another possible response might be, “he is very verbose or can talk at length about a certain topic”. As
I said previously, impact on communication varies tremendously. Let’s talk about each of these in a little more
detail.
The person with whom you are familiar might not be able to speak or is nonverbal. If this is the case then he
might use vocalizations, gestures or behavior such as crying or screaming to get wants, needs or desires met. Or
he might use what is known as augmentative and alternative communication (AAC) such as the Picture
Exchange Communication System (PECS), sign language or a voice output communication aid (VOCA; This is
a device that talks for the person). The person with whom you are familiar might be able to talk but have a
limited vocabulary. This person might use only one or two words and may speak in short phrases
Now, I imagine many of you are thinking of a person who can talk and has a good command of language.
Perhaps the individual has a very extensive vocabulary and can talk at great length about a specific topic. You
may have thought, this person can talk so he must not have autism. For this person, while he or she can talk
extensively, the social components of communication are impacted. For example, he may only talk about one
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topic. I know a person who loves buses and can discuss in detail the bus routes, stations, and stops in his home
city. However, he has tremendous difficulty talking about baseball or football or other topics more appropriate
for a 9 year old boy! Another example is difficulty understanding figurative language and not being able to
understand jokes, sarcasm or teasing.
So, let’s take a detailed look at communication. Let’s take a minute to identify the two main parts of
communication. There is expressive communication, or what a person says or expresses. In other words, the
message a person wants to convey. Then there is receptive communication or what someone understands. With
each, there are verbal and nonverbal components.
Slide 3: Nonverbal communication
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There is more to communication than just words.
All people do not use nonverbal communication to the same extent.
We tend to look at a person when we talk.
We use our hands to gesture.
We use body posture to emphasize a point.
Non-verbal communication is a significant component of expressive communication.
People with ASD have difficulty with incorporating nonverbal communication into communication
attempts.
We’ll begin with nonverbal communication. There is more to communication than just words. Nonverbal
communication is made up of eye contact, facial expressions, body language, gestures and physical proximity.
As infants we learn the meaning of nonverbal communication. We learn if we hold up our arms we will get
picked up. We learn that when mom or dad gives us a “stern” look they are not happy with us. We also learn
how to pair more than one form of nonverbal communication to get our point across. For example, a young
child might protest against doing something by frowning, crossing her arms and stomping her foot. We
continue to learn and hone our skills as we get older. I’m sure we all know someone who is very gregarious or
expressive when they talk. You know those people who couldn’t talk if their hands were tied behind their
backs. While we all don’t use nonverbal communication to the same extent, we have learned how to integrate it
into our communication to get our message across. For example, we tend to look at the person we are talking to
and then look away when our point is less relevant or gain intense eye contact when our point is important. We
use our hands to gesture, incorporate facial expressions, and use body posture to help emphasize our point. We
typically stand about an arm’s length away from the person so as not in invade their personal space.
These are all things individuals with ASD often have difficulty with and because it is a challenge to incorporate
nonverbal communication into communication attempts they might have a hard time getting their point across. I
once worked with a student who would look at the ground or other objects when he talked. I was never really
sure if he was talking to me or someone else. Another person I know does not point or use any type of gestures
which makes it difficult to understand what he wants or where he wants to go. Tyler, a teenager with Asperger’s
syndrome, typically has flat affect and does not demonstrate an array of facial expressions making it difficult to
know if he is happy, sad, or even angry. Much of our communication is nonverbal. If a person is unable to use
it, there is tremendous challenge in relaying information and communicating effectively with others.
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Slide 4: Non-Verbal Communication
In the upcoming clip you will see several examples of ways that communication may be impacted in a person
with autism spectrum disorder. This gentleman is going to be talking about movies. First of all I want you to
notice his body language. Second pay attention to the intonation and the sound of his voice. Third notice what
he is talking about. He is talking about movies and he is able to list a plethora of movies that will be coming out
in the upcoming year. This seems to be an intense topic of interest and the only thing he wants to converse on.
Slide 5: Non-Verbal Communication
(video)
Boy: There is April 1st. Let’s see. Um Oh I know. Um I know , I know. Pirates of the Caribbean on Stranger
Tides.
Adult: Okay
Boy: Let’s see, um I know. Disney Pixar Cars 2. Harry Potter and the Deadly Hallows part 2. Um lets’ see
Dream Works Kung Fu Panda 2 and um the Smurfs, um Dream Works Puss n Boots and Author’s Christmas.
Slide 6: Nonverbal communication
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Nonverbal communication is not just about expressive communication.
Individuals with ASD have deficits in expressive and receptive language.
Monoprocessing means that a person uses one sense at a time.
Only 10% of what we communicate is said with words.
Individuals with autism may be missing out on 90% of the information being communicated.
Nonverbal communication is not just about expressive communication; it is also an important part of receptive
language. Individuals with ASD have deficits in both areas. Not only do they have difficulty incorporating it
into their expressive communication but they also have difficulty understanding nonverbal communication. A
person with ASD may not be able to follow your finger when you point to something across the room. Jake, a
seven year old with ASD is not able to understand the frown on my face that means I am upset. Most of us,
when talking to a person, would understand that a yawn indicates boredom with the conversation. Shelby, who
has Asperger’s syndrome, is unable to read this body language and change the conversation to something more
interesting. In the book “Communication Issues in Autism and Asperger’s: Do We Speak the Same Language?”
the author Olga Bogdashina refers to this as monoprocessing. Monoprocessing means that a person uses one
sense at a time. For instance if I am focusing on sight I can’t hear what you are saying or vice versa. Temple
Grandin, an individual with autism, describes this in her book, “Thinking in Pictures.” She says that when she is
listening to someone she can’t look at them because she gets distracted by all the flecks of color in the person’s
eye.
Research tells us that only about 10% of what we communicate is said with words. If individuals with ASD
have difficulty looking at their communicative partner then they are missing out on approximately 90% of the
information that is being conveyed.
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Slide 7: Nonverbal communication
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Behavior is communication.
Individuals with ASD may have challenging behaviors such as hitting, crying, or self-injury.
People use behaviors because it is the most effective way they have to communicate.
Our job is to figure out what a person is communicating through behavior.
Think of a person with ASD and challenging behaviors. What is the person trying to communicate?
I would like to make one more point about nonverbal communication which is, behavior is communication.
Some individuals with ASD will exhibit challenging behavior such as hitting, crying, or self-injury. Certainly
these are all forms of nonverbal behavior. Behavior is the most basic form of communication and when a person
uses behavior to communicate it is usually because they don’t have the words to express what they want or need
or it is too difficult to communicate. People use challenging behavior to communicate because it is the most
effective and efficient way they have to communicate. Sometimes they are saying “Leave me alone” or “I don’t
like this” or “I’m in pain.” It is our job to figure out what they are communicating through the behavior they
are using. For example, I once worked with Sam, a girl with ASD, who one day protested when she was asked
to drink her milk at lunch. She pushed it away and even threw it across the room. I knew she liked chocolate
milk because she had been drinking it all year; therefore, I didn’t understand why she didn’t want to drink it
now. After some investigating I discovered that the cooler where the milk was stored was set too low. It had
frozen the milk making it slushy. Sam was trying to communicate to us that the milk was too cold or in a form
(slushy) that she didn’t like. Take a minute to think about a person with ASD whom you know. Can you think
of a challenging behavior he or she exhibits? Now, can you think about what the person is trying to really
communicate?
Slide 8: Examples of Behaviors
Behavior
Riley is taking his fourth grade science test. Science has
always been a difficult topic for him, and this unit was
especially hard. Riley attempts to answer 5 questions. On the
sixth question, Riley throws his paper and pencil on the floor
and runs out of the room.
Shaundra is in high school and is walking to math class. She
is in a busy hall with a lot of students who are laughing,
talking and bumping into her. Shaundra drops her books and
hits a student.
Jason is on the home computer. His sister walks up and starts
pushing buttons. Jason screams.
Communication
“This test is too hard!”
“I need a break!”
“It’s too loud!”
“I don’t like people bumping
into me!”
“I need some space!”
“I want to play by myself.”
On this slide, there is a table that provided examples of challenging behavior and the communication the person
intends. Sometimes, what the person is trying to communicate is obvious. We can figure it out pretty quickly
based on the situation. Other times, we might need to do more investigating. Like the example on the previous
slide, it wasn't apparent at first why Sam was upset and throwing her milk. After a little time, I was able to
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figure it out. Now, look at the examples on the slide and figure out what might be communicated in the
situation.
Riley is the student in our first example. Riley is taking his fourth grade science test. Science has always been a
difficult topic for him, and this unit was especially hard. Riley attempts to answer 5 questions. On the sixth
question, Riley throws his paper and pencil on the floor and runs out of the room. What may Riley be telling
us? Perhaps he is saying, "The test is too hard!" Or, he may be saying, "I need a break!"
Shaundra is the student in our second example. Shaundra is in high school and is walking to math class. She is
in a busy hall with a lot of students who are laughing, talking and bumping into her. Shaundra drops her books
and hits a student. What is Shaundra trying to tell us with her behavior? She may be saying, “It’s too loud!” “I
don’t like people bumping into me!” “I need some space!”
Finally, Jason is our third student example. Jason is on the home computer. His sister walks up and starts
pushing buttons. Jason screams. Jason may be trying to communicate, “I want to play by myself.”
Slide 9: Verbal Communication
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The other part of communication is verbal communication.
Speech develops first through repetitive sounds.
Individuals with ASD have limited verbal language.
Individuals with ASD use single words or phrases that provide access to highly preferred items.
The other part of communication is verbal communication. Verbal communication includes sounds, words or
vocabulary, sentences, volume and tone. All of these components are important. Before we talk about speech
delays in ASD, let’s review what typical speech development looks like. Speech develops first through
repetitive sounds such as, /d/ /d/ /d/. As adults, we build on that sound. We extend that /d/ sound by saying,
“That’s right. It’s “daddy.” The child then expands the /d/ to a /da/ and the process repeats itself until the child
has many sounds that are shaped into words. The child says /da/ sees dad and hears dad saying, “Dad.” They are
all connected in the infant’s brain. The difference is that, the child’s brain with ASD is not wired the same way.
They don’t make that connection on their own. They need our help in order to connect all the pieces of taking
sounds and turning them into words.
I have talked a little about how some individuals with ASD have limited verbal language. They might use single
words or short phrases to communicate wants, needs or desires. These are typically words that provide them
access to highly preferred items such as a favorite toy or food item. For example, Jason says, “All done” to
indicate he is finished or wants to move to something new. He even uses this phrase when he wants the
computer off or the TV channel changed. Sam primarily uses single words and is able to say milk, chip, up, and
ride.
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Slide 10: Verbal Communication
In the upcoming clip you will see an example of a young man who uses short phrases to communicate. He is
stating that he needs a pencil in order to do his work. However if you pay close attention you will notice that he
is actually upset and he is communicating that he wants something on the page erased. He does not have the
language in order to accurately convey what he is trying to express so instead he uses a known short phrase to
say he needs a pencil.
Slide 11: Verbal Communication
Video
Boy: Can I use a pencil? Can I use a pencil? Can I use a pencil?
Adult: What do you need a pencil for?
Boy: Erase
Adult: There is no pencil this is a pen.
Boy: Then I don’t erase
Adult: I’m going to take this for you.
Slide 12: Echolalia
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Echolalia is when someone repeats words or phrases heard previously.
Echolalia may also be delayed and the person repeats what is heard at a later time.
Echolalia is a natural part of language development.
The key is to know the context of the child’s communication.
Individuals who use single word or short phrases sometimes also use echolalia as a form of communication.
Echolalia is when someone repeats words or phrases heard previously. The person can immediately repeat what
is heard. For example, if I was to ask my friend Joey, “Do you want a cracker or cookie?” he would repeat my
question back to me. Echolalia may also be delayed and the person repeats what is heard at a later time. This can
often be seen when a child repeats phrases from favorite TV shows or movies. I taught a 10 year old with ASD
who would list the Baskin Robin 31 flavors of ice cream. This did not mean that he wanted ice cream, he was
communicating that he was hungry.
Echolalia is a natural part of language development and should be looked at as meaningful communication.
Some individuals with ASD use phrases from their favorite TV program to try to get a point across. Echolalia is
not limited to TV shows, movies, or video games. The person might be repeating what a family member or a
teacher said and using it in a different situation. For example, I once had a student ask who would ask me to
“rewind” when he wanted me to do something again. The key is to know the context of the child’s
communication.
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Slide 13: Echolalia
In the upcoming video clip you will see an example of immediate echolalia. Immediate echolalia refers to
replicated utterances that are echoed immediately or almost immediately after they are heard. In this video you
will see a young boy echoing what the man in the front of the car is saying as he is placing an order at a fast
food restaurant.
Slide 14: Echolalia
(video)
Man and boy: Hello, can we get a number nine, medium, and ahh Sprite, junior bacon cheese burger, and a
chicken nuggets kids meal, with a Dr. Pepper, that’ll be it. Alright, thank you.
Slide 15: Verbal Communication
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Components of verbal communication include volume, intonation, and rhythm.
Some individuals with ASD talk too loudly while others too soft.
Some have limited intonation meaning their voices are monotone.
Other components of verbal communication include volume, intonation, and rhythm. Individuals with ASD have
difficulty with all of these. Some talk too loudly while others too soft. Some have limited intonation in their
voices meaning their voices are monotone or sounds like a robot. Many of us have seen the movie Rainman.
Think about Raymond’s voice. What was his voice quality like? If you have never seen the movie, he talks in a
monotone voice. On the next slide we will talk about the different functions of communication.
Slide 16: Functions of Communication
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All communication has a function.
The most common use of communication for individuals with ASD is to gain access to something that
they want.
The next function is to protest an activity or an object through challenging behaviors.
Another function is to gain attention.
Or, the function may be to ask for help.
We have talked about both verbal and nonverbal communication, now I would like to talk about the function of
communication. All communication has a function. We communicate for many reasons. We do it to gain
attention, to gain access to an object or assistance or to refuse an object or an activity. We also communicate to
gain information, and to comment on information that has been shared.
For individuals with ASD, there may be limited functions. The most commonly used function of
communication by many individuals with ASD is to make requests or to gain access to something they want.
This can take many forms. For example, the person might lead an adult in their environment to the refrigerator,
indicating they want a drink or may tell his mom, “I want to go outside!” A second common function of
communication for many individuals with ASD is to protest an activity or object. Many times we see this in the
form of challenging behavior expressed by dropping to the floor on the way to the cafeteria or before entering a
department store or by saying, “NO!”
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Another function of communication is gaining attention; this might be done verbally, by asking for “more
tickles”, may be in the form of jumping on a person or perhaps through challenging behavior, or it could be as
simple as them walking over to you and standing next to you. A fourth common reason to communicate is to
ask for help. The person may request assistance verbally, may lead you to the item or may hand you the item
they need help with. For example, a student I once taught would frequently lead me to the computer as his way
of asking for help turning it on.
Now, we have discussed the most common functions of communication for a person with autism. What I want
you to think about are the functions not mentioned. While many with autism may use communication for other
reasons, for some, the function of their communication is limited due to their disorder and by the simple fact that
they don’t have a communication system that works for them. For example, we all seek information throughout
our day. For the person with autism, gaining information that would help them understand their environment and
know what is going on may not happen. I taught a girl named Amy. When she didn’t know what to do, she
would walk over to me and just stand in front of me. Clearly, Amy did not seek information in a way that would
help her.
Slide 17: Communication Challenges
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Individuals with ASD have difficulties in both the sender and the receiver roles of communication.
By the end of the first year, most children can say a few simple words.
By 18 months, children learn that words represent objects, actions, and thoughts.
Many children with ASD do not apply meaning to the sounds and words heard.
Individuals with ASD often have difficulty applying different meanings to a word.
Understanding the different meanings for one word can be challenging.
In order to have communication, you have to have a speaker (or sender) a message and a listener (or receiver).
Individuals with ASD have difficulties in both the sender and the receiver roles. We have talked about some of
the challenges they might have when in the role of the “speaker.” Now we’re going to take a look at
communication through the “ears” of the person with ASD.
I have talked a little about how typical speech develops. I talked about the chain of development with the child
beginning with cooing. Usually by 6 months of age an infant produces repetitive syllables such as "/ba/, /ba/,/
ba/" or "/da/, /da/,/ da/." This is the foundation for how words and vocabulary develop. By the end of their first
year, most children have mastered the ability to say a few simple words. By 18 months of age most children can
say 8 to 10 words and, by age 2, are putting words together in crude sentences such as "more milk." During this
period children rapidly learn that words symbolize or represent objects, actions, and thoughts and the child’s
vocabulary develops rapidly. This development of vocabulary for individuals with ASD is a challenge. Many
do not apply meaning to the sounds and words heard. Therefore, they may not understand a wide array of
vocabulary. This leads to many challenges related to understanding the communication of others. They may
have difficulties when words are put together into sentences. Often, I will hear teachers talk about a person who
was noncompliant. However, when we explore the situation further it is often determined the person with ASD
did not understand the instruction!
Individuals with ASD often have difficulty applying different meanings to a word. The English language is full
of words with multiple meaning. Take a minute and write down all the definitions for the word, “hot" temperature (it is hot outside), attractive (he or she is hot), stolen (Jim found a hot computer), newest (hot off the
press) or to make unpleasant (I was in the hot seat). Young children quickly learn multiple meanings for words.
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They learn the word “ball” and the meaning of the word as a round object that you roll, throw or kick. Then they
learn that Cinderella went to a ball and that means that she attended to a fancy dance. The might also hear an
adult tell them they look like they are having a ball when they are having fun. However for children with ASD,
understanding all the different meanings for one word can be challenging.
Additionally, individuals with ASD take the meaning of words literally and think very concretely.
Understanding figurative language is a challenge. For example, I once had a student who was playing a game of
kickball with his friends. Ishan was up to kick. He kicked the ball and ran to first base. The next student came
up and kicked the ball. He kicked it hard and far. Ishan just stood on first base. All of the kids yelled, “Run
home!” Ishan started running but in the direction of his home not home plate. He did not understand he was to
run to home plate. They may also have a hard time understanding idioms such as, “It’s raining cats and dogs”
when what we are really saying is “It’s raining really hard outside.”
Slide 18: Auditory Processing
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Individuals with ASD require more time when processing auditory information.
Individuals with ASD can take 10 to 20 seconds to process auditory information.
Allow time for individuals to process.
An important issue related to understanding communication effectively is related to auditory processing.
Research has shown that individuals with ASD require more time when processing auditory information. In
other words, it takes more time for the person to hear the information, understand it, and make sense of it. It has
been reported by individuals with ASD that it can take 10 to 20 seconds to process auditory information. As a
speaker, we might perceive the person with ASD is uninterested in what we are talking about or is noncompliant
if we are give them an instruction and it is not followed. Allow time for individuals to process. This can feel
uncomfortable at first but after a couple of times of doing it you will begin to feel more comfortable.
Slide 19: Conversation
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A conversation is the exchange of information between two or more parties.
Individuals with ASD struggle with interactions that we often take for granted.
The introduction of a conversation requires understanding who you are talking to and appropriate topics
of discussion.
Maintenance of a conversation requires reciprocating.
Communication is the relay of a message and conversation takes communication to the next level. With a
conversation, there is exchange of information between two or more parties. Conversational exchange is a
cooperative event in which all parties work together in regulating the flow of information. For example, I say,
“Good morning. How are you?” You reply, “I’m good. How was your weekend?” I reply, “Great. I went to a
birthday party for a friend.” At this point you would likely ask a question about the birthday party and the
conversation would continue. Once, I had described the birthday party, the conversation would likely end. I
know this is a simple example of a conversation that many of us have on a daily basis but individuals with ASD
struggle with interactions that we often take for granted. Conversations can be a challenge at all levels including
the introduction of a conversation, maintenance of a conversation, as well as the termination of one. The
introduction of a conversation requires understanding who you are talking to and appropriate topics of
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discussion. This can be difficult for the person with ASD who may talk only about an item of interest such as a
favorite TV show or types of trains, or who may talk about an inappropriate or taboo topic. Tyra, with
Asperger’s syndrome, announced her cousin was in jail at a church function and described the details that had
led to his arrest. Needless to say, it did not go over well. Maintenance of a conversation requires reciprocating,
or going back and forth based on what was said previously. The person may make statements that are unrelated
or may not respond at all. Finally, ending a conversation can often be a challenge, for all of us! Sean, an adult
with Asperger’s syndrome will often say to his communication partner, “I’m done talking now,” and leave the
room. Andrea will sometimes walk away without warning, while Juan continues to talk even after his partner
has ended the conversation. All of these are examples of challenges with conversation.
Slide 20: Alternative Forms of Communication
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Communication systems may be used use in place of or to supplement verbal language.
PECS is an evidence-based practice. An individual is taught to initiate communication by exchanging
pictures to communicate.
VOCA is a device that is programmed to speak for the individual.
Sign language is another system that has been used by individuals with ASD.
The system used should be based on the person’s strengths and needs.
Now I would like to introduce you to some of the communication systems individuals with ASD might use in
place of verbal language or to supplement their verbal language. Again, talking may be difficult, or for the
person who can talk, getting a specific point across may be a challenge. For these individuals, an augmentative
or alternative communication system will be needed. This section is simply designed to provide you with an
overview on various types of communication systems available and is not designed to teach their use. Since
communication is such a core component of a person, it is important to be aware of various types of systems you
may encounter.
First let’s talk about the Picture Exchange Communication System (PECS). PECS is an evidence-based practice
where an individual is taught to initiate communication by exchanging pictures to communicate wants, needs
and desires as well as to comment or ask questions. PECS was developed by Andy Bondy and Lori Frost at the
Delaware Autism Program. It is can be used with individuals of all ages. The Picture Exchange Communication
System is often misunderstood. Keep in mind, for it to be PECS, the person must give a picture to a person in a
communication exchange.
Voice Output Communication Aids (VOCA) is a device that is programmed to speak for the individual. There
are many different types of VOCA some that can only be programmed for one word or phrase and others that
can hold thousands of word and phrases. There are devices specifically built to be a voice output system, such as
a Dynavox. However, voice output may be on applications used with smart phones and iPads as well.
Another communication system that is used by individuals with ASD is sign language. It is a system of
communicating through the use of gestures and symbols made with your hands. Some individuals are able to
use sign very effectively to communicate as the motor planning involved in making signs is different than the
motor planning involved in making sounds.
Every person must be able to communicate making these all good alternatives. The communication system used
with any individual should be based on the person’s strengths and needs and must help them to communicate
effectively and efficiently. It is a misconception that only those who are nonverbal may use an augmentative or
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alternative communication device. AAC may be used to supplement communication for anyone who needs
support.
Slide 21: Augmentative and Alternative Communication
View the upcoming video clip. In it you will see a child asking for a turn with a voice output communication aid
or VOCA. She then chooses a picture of a classmate she would like to dance with during the activity.
Slide 22: Augmentative and Alternative Communication
(video)
Girl: My turn.
Teacher: Okay, Emma.
Slide 23: Augmentative and Alternative Communication
In the upcoming video clip you will see a child get up and remove a picture of a trampoline from a
communication book and place it in the hand of a paraprofessional. This is done to request a turn to jump on the
trampoline.
Slide 24: Augmentative and Alternative Communication
(video)
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