**2. Communication in children with Autism Spectrum Disorders (ASD)**

#### **2.1. Difficulties with communication and language as part of the spectrum**

Major advances have been made over the two past decades in understanding the socialcommunication difficulties of children with ASD, resulting in greater emphasis on early socialcommunication features in the diagnostic criteria. Most parents of children with autism first begin to be concerned that something is not quite right in their child's development because of early delays or regressions in the development of speech [1]. Problems with communication, in terms of both understanding and expression, are often said to be one of the main causes of the severe behaviour problems that are common among persons with severe autism and mental retardation [2]. The lack of meaningful, spontaneous speech by age five has been associated with poor adult outcomes [3,4,5,6]. Certainly, communication and communication problems are at the heart of what ASD is all about.

Although all persons diagnosed with autism have problems with communication, their type and degree vary a lot and the work of identifying different subgroups has just begun. It has

© 2013 Thunberg; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

been estimated that between one-third [7] and one-half [8] of children and adults with autism have no speech. However, more recent research results indicate that the proportion of nonspeaking children with ASD is much smaller, approximately 14% to 20%, among those who received very early intervention [9].

The few longitudinal studies of language acquisition in children with ASD suggest that progress within each domain of language follows similar pathways as it does in typical‐ ly developing children [9, 12]. However, the speech of children with ASD is also charac‐ terized by some typical deviations. One of the most salient aspects is the occurrence of echolalia, which can be either immediate or delayed. Although some echolalia seems to be self-stimulating, both types of echolalia can serve communicative purposes for the speaker [12]. At an early stage of language development, this may be the only way in which the child can actually produce speech. Tager-Flusberg et al. (1990) found that, over the course of development, echolalia rapidly declined for all the children with ASD and Down's syndrome in their study. Another prominent feature of language in children with ASD is general problems with deixis, which are most often manifested as pronoun confusion [10]. Features such as vocal quality, intonation and stress patterns often result in problems for persons with ASD, although there is a lack of research in this field. Tak‐ en together, the findings suggest that the difficulties are due not only to problems in so‐

Early Communication Intervention for Children with Autism Spectrum Disorders

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cial intent but also to problems affecting a more basic aspect of vocalization [12].

linguistic structures' [12, p. 350].

**children with ASD**

ing joint reference or shared topics [12, p. 354].

**3.1. History and different theoretical approaches**

Less research attention has focused on the comprehension skills of individuals with ASD although deviations in response to language and comprehension have been found to be strong indicators of ASD [18]. According to Tager-Flusberg et al. [14], it seems that ASD children 'not only may have limited ability to integrate linguistic input with real-world knowledge but also may lack knowledge about social events used by normally develop‐ ing children to buttress emerging language skills and to acquire increasingly advanced

The pragmatic aspects of language have been studied in numerous ways. Children with autism share important similarities across different language levels [12]. The speech acts that are missing or rarely used in the conversations of children with autism often con‐ cern social, rather than regulatory, uses of language [22]. Ramberg, Ehlers, Nydén, Jo‐ hansson, and Gillberg [24] found that children with ASD were impaired in taking turns during dyadic conversations. A higher proportion of initiations rather than responses was found in a study [25]. Although the basic intention to communicate often exists, the person with autism has impaired skill in participating in communicative activities involv‐

**3. Interventions to support communication and language development in**

The first reports on language interventions were published in the mid-1960s. The intervention at that time built on the operant tradition developed by Skinner during the 1950s. The teaching sessions in this method, referred to as discrete trial teaching or didactic teaching, are marked by a high level of adult control and direction, massed-practice periods for preselected tasks,

Two phenotypes of speaking children with ASD were identified by Tager-Flusberg and Joseph [10]: children with normal linguistic abilities (phonological skills, vocabulary, syntax, and morphology) and children with impaired language that is similar to the phenotype found in specific language impairment. Another potential subgroup may experience verbal dyspraxia or dyspraxia of speech [11; 12; 13]. Voluntary motor control is disturbed in children with dyspraxia, which also affects their ability to imitate. The new research on the role of the 'mirror neurons' in the parietal and frontal lobes may provide some answers on the relationships between motor control and imitation but also on the possible link with the development of intersubjectivity [11].

In spite of the heterogeneity of language abilities in children with ASD, social-communication or pragmatic impairments are universal across all ages and ability levels [14]. According to Wetherby [15], the social-communication deficits in children with ASD can be organized into two major areas: (1) the capacity for joint attention and (2) the capacity for symbol use. Since joint attention emerges before words, this deficit may be more fundamental and a number of longitudinal studies provide evidence of a relationship between joint attention and language outcomes [16, 17]. According to Wetherby [15] p. 11, 'deficits in initiating and responding to joint attention have a cascading effect on language development since language learning occurs within the context of the modelling by the caregiver of words that refer to objects and words that are jointly regarded'. Wetherby [15] states that deficits in imitation and observa‐ tional learning are other main causes of the problems with symbol use experienced by children with ASD. Learning shared meanings, imitating and using conventional behaviours, and being able to decontextualize meaning from the context constitute the symbolic deficits in children with ASD [13].

#### **2.2. Development of communication and language in children with ASD**

Because autism is usually not diagnosed until age three or four, there is relatively little information about language in very young children with autism [10]. Retrospective studies using parent reports and/or videotapes collected during infancy, together with studies of children considered likely to develop autism, show severely delayed language acquisition with respect to both receptive and expressive skills [18, 19, 20]. Another typical phenomenon described by 25% of parents of children with ASD is language loss after initially developing some words [21]. Lord, Schulman, and DiLavore [22] found that this language regression is unique to autism and does not occur in other children with developmental delays. Chawarska et al. [21] hypothesize that these early-acquired speech-like productions are lost by children with ASD because the link between these expressions and a network of symbolic communi‐ cation fails. There is significant variability in the rate at which language progresses among children with ASD who do acquire speech.

The few longitudinal studies of language acquisition in children with ASD suggest that progress within each domain of language follows similar pathways as it does in typical‐ ly developing children [9, 12]. However, the speech of children with ASD is also charac‐ terized by some typical deviations. One of the most salient aspects is the occurrence of echolalia, which can be either immediate or delayed. Although some echolalia seems to be self-stimulating, both types of echolalia can serve communicative purposes for the speaker [12]. At an early stage of language development, this may be the only way in which the child can actually produce speech. Tager-Flusberg et al. (1990) found that, over the course of development, echolalia rapidly declined for all the children with ASD and Down's syndrome in their study. Another prominent feature of language in children with ASD is general problems with deixis, which are most often manifested as pronoun confusion [10]. Features such as vocal quality, intonation and stress patterns often result in problems for persons with ASD, although there is a lack of research in this field. Tak‐ en together, the findings suggest that the difficulties are due not only to problems in so‐ cial intent but also to problems affecting a more basic aspect of vocalization [12].

Less research attention has focused on the comprehension skills of individuals with ASD although deviations in response to language and comprehension have been found to be strong indicators of ASD [18]. According to Tager-Flusberg et al. [14], it seems that ASD children 'not only may have limited ability to integrate linguistic input with real-world knowledge but also may lack knowledge about social events used by normally develop‐ ing children to buttress emerging language skills and to acquire increasingly advanced linguistic structures' [12, p. 350].

The pragmatic aspects of language have been studied in numerous ways. Children with autism share important similarities across different language levels [12]. The speech acts that are missing or rarely used in the conversations of children with autism often con‐ cern social, rather than regulatory, uses of language [22]. Ramberg, Ehlers, Nydén, Jo‐ hansson, and Gillberg [24] found that children with ASD were impaired in taking turns during dyadic conversations. A higher proportion of initiations rather than responses was found in a study [25]. Although the basic intention to communicate often exists, the person with autism has impaired skill in participating in communicative activities involv‐ ing joint reference or shared topics [12, p. 354].
