Why focus specifically on the language of subjects with ASD (autism spectrum disorders)? This question is certainly less obvious than that of communication, behavioral problems or sensory particularities… Yet, "poor conversational (and prosody) skills can hinder the successful integration of children into classrooms and playgrounds" (Attwood, 2010) and jeopardize professional integration...
It should also be noted that to date, 50 % of people with ASD are still considered non-verbal and that it is considered to be of better prognosis the fact that children have language elements at 2 years of age (Rogers and DiLalla, 1990).
We know that oral is very impacted in subjects with ASD (understanding of the implicit, difficulty in grasping the polysemy of words...), but what do we know today of the age of occurrence, the possible damage of the central nervous system, the type of language impairment so as to help us to initiate useful remediations on which to base teaching practices?
People with ASD (or autism spectrum disorders) present (following the DSMV,2013 criteria) persistent deficits in social communication and interaction in different contexts, affecting pragmatic aspects of language from the outset:
- Socio-emotional reciprocity (an anomaly of the social approach, to maintain a conversation, to share interests or emotions).
- Non-verbal communication behaviours used for social interaction (eye contact, frequency, duration may reflect a misunderstanding or non-integration of social conventions in this area, as well as for body language, gestures, and facial expressions...).
- Deficits are also reported to develop, maintain or understand inter-individual relationships (whether it is difficulties in adjusting behaviour in response to social contexts or games or developing friendly relationships or peer interest).
These particularities of communication and relationship are also associated with patterns of restricted and repetitive behaviours, interests or activities (in at least 2 areas) among the following:
- repetitive motor movements (e.g. in the use of objects or language that may be partly stereotyped),
- some resistance to change (with possible construction and use, in response to perceived changes, routines, ritualized patterns of verbal or non-verbal behaviours to reassure themselves most often...),
- highly restricted and obsessive interests that are abnormal in intensity or by the theme,
- hyper or hyporeactivity possible in the face of sensory information or unusual interests in sensory aspects of the environment (for example, it may be an aversive response to sounds or textures... or visual fascination with lights or regular movements...).
These symptoms are present in the early developmental period and significantly impact social functioning, work or other important areas of the subject's functioning. Since the DSMV, the level of support the subject needs to exercise all of his rights must be specified (depending on the degree of severity of the particularities and deficits).
Let us explore a little more the linguistic peculiarities of subjects with Asperger's syndrome, which represent the "high range" of non-deficient ASD, vocabulary and syntax acquisition or intelligence development. They represent one in 250 births and are perfectly able to attend regular schooling with some facilities. We recognize them:
- A possible delay in the acquisition of the PSLD -style language (pragmatic semantic language disorder):with good syntax, good vocabulary and accurate phonology but misuse of language in a social context, with a risk of literal interpretation of the words of others (Rapin, 1982),
- A social withdrawal explained by the deficit social reasoning in Asperger's subjects (while language impairment is first in subjects with PSLD),
- A possible selective mutism in kindergarten with often associated with a SCD (disorder of social/ pragmatic communication),
- Difficulties in the social use of verbal and non-verbal communication, particularly in:
- the use of communication for social purposes (greetings, sharing of inappropriate information),
- the ability to modify communication to adapt to the context or needs of the interlocutor (talking identically in class and in the yard, to a child or adult, formal language...),
- the ability to follow the rules of conversation and storytelling (relative to taking turns, reformulations...),
- the ability to understand what is not explicitly expressed (inferences) and the non-literal or ambiguous meanings of language (humor, metaphors...).
These deficits lead to functional limitations in communication, social participation, academic success, or performance at work. These symptoms appear in the early development period and are not related to any other language or neurological pathology.
How to understand these specificities of language in subjects with ASD (Asperger's)?
The peculiarities of symbolic play and imitation would be related to the level of language reached, communication more in connection with interactions and social cognition impacted than to a real disorder of language organization (Rogé 2015). The use of communication signals would be more limited.
Indeed, even good-level ASD people with high grammatical abilities keep difficulties in following the social rules of conversation," Rogé, 2015, p89, showing that the use of communication (more than language structure) is affected.
On the other hand, there is a great variability in subjects "deficient" with ASD: people may not have developed functional verbal language at all (50% remaining non-verbal) as people can use functional but idiosyncratic language (Rogé, 2015).
When expressive language is present, it is usually:
- little or not completely adapted to social situations,
- intonation used can be "monotone" if not worked specifically,
- sometimes idiosyncratic and unconventional, with the risk of behavioural problems, self-harm or immediate or * delayed echolalia in the absence of an appropriate means of communication (the function of language is not necessarily understood, phrases, words, songs, advertisements, may be repeated without relation to context),
- marked by difficulties in using elements that may change meaning (these may be personal pronouns whose use of the "I/You" can change depending on the situation, the prepositions: in/on/above... apart from all-made expressions).
The pragmatic level (using language in a social context of communication) would remain the most impacted (Rogé, 2015), with appropriate language structures during language tests (in Asperger's subjects) but not in ecological situations, or with a disturbance of the signs of non-verbal communication (such as nodding, approval/non-approval behaviours, adjustment of mimics according to emotion felt, respect for the tricks).
In the field of oral language comprehension, are noted the following data:
- A correlation between receptive language and responses to joint attention (Murray et al., 2008).
- Oral language generally considered unattractive to the subject (except if this language may relate to his own interests).
- A limitation of literal understanding, including difficulties in inference and understanding indirect demands, metaphors...
- Facilitating understanding when the human environment leaves contextual cues, including visual ones, or even slows down the flow of language (Tardif and Gepner, 2009).
Why these communication problems: is it a specific and primary disorder of imitation? (Rogers and Pennington, 1991, Dawson et al 1999). At what levels should we support development?
Indeed, it is questionable whether young children with ASD experience a genuine deficit of imitation, involved in the development of language, or only difficulties to imitate that would already be the consequence of other characteristics such as an anomaly of sensory filtering of information, attention:
Charman (et al.) already reported fewer imitation behaviours in young children with ASD in 1997 than in their "neurotypical" peers. These difficulties in imitating are also mentioned in school-aged children as well as adults, particularly in the production of movement, which may be akin to a "dyspraxia" now known as coordination developmental disorder (Smith and Bryson, 1998). These include difficulties in imitating hand gestures (simple and sequential), such as sequential movements of the face, or mime (Rogers et al, 1996). These initial imitation difficulties would not be strictly lacking insofar as even so-called "low-level" autistic children demonstrate certain imitation skills (Nadel, 2002), in which several forms must be distinguished: subjects with ASD are more successful in immediate than delayed and induced rather than spontaneously (Rogers et al., 2008). Ramachandran et al. (2007) hypothesize a dysfunction of mirror neurons to explain the difficulties of imitation. Mirror neurons, located in the cingulate and insular cortex, are in principle, in a "neurotypical" person, activated by observing another person's movements or making their own movements. If mirror neurons are involved in the observation and execution of movements (leading to imitation for example), they would also be involved in language (understanding metaphors and 2nd degree), understanding the intentions and emotions of others, empathy.
However, in ASD subjects, mirror neurons would only be activated when they perform the movement themselves (and not or not completely when they observe it to mimic it). Oberman et al., 2005, consider it a "complex developmental disorder in which initial difficulties interact and gradually impede evolution because they prevent the child from taking advantage of the experiences that should fuel his cognitive and social development. Imitation deficits are indeed accompanied by difficulties in the field of pragmatic language, theory of mind and empathy" (Rogé, 2015, p. 112).
One might also think that it is not imitation that is first impacted but perhaps joint attention and attention. Indeed, they are also in deficit in people with ASD and especially preconditions for imitation: there is no clear social preference (for human faces versus objects) at 7 months in young children with ASD (yet predictive capacity for joint attention), nor fluid shifting of attention (Leekam 2005).
It may also be thought that these attentional or even sensory peculiarities (the problem of effective filtering of information) are at the root of the difficulty in constructing social preference, inducing an undervaluation of social stimuli (including faces and voice), which would explain the slightest commitment to social interactions (Dawson, 2004) and ultimately the slightest lived social experience. These skills can be supported through early intervention programs such as floor time or Denver ESDM, for example. Attentional abnormalities and sensory characteristics also lead to saturating working memory, with subjects having * a lack of central coherence and some difficulty in processing all oral verbal information in particular, appearing "too quickly" for subjects with ASD to have time to process them (Gepner and Tardif, 2009).
How to support these vulnerabilities in building language skills?
- To develop oral comprehension and communication, speech flow can be slowed down (Tardif and Gepner, 2014).
- To support the symbolic function, which is known to accelerate the development of language (Luiselli et al 2000), an early intervention program can be used between 2 and 4 years (at least 15 hours per week for two years). Indeed, the joint attention, the symbolic game driven early bring, between 3 and 4 years, significant benefits in the development of language (Kasari et al 2008).
- The introduction of a cognitively clear alternative communication tool (PECS) in subjects with non-verbal ASD appears to trigger the development of oral language after 13 months of practice (Bondy and Frost, 1994, 2001). It seems that oral language learning is based more on writing or visual in people with ASD and should always associate meaningful/signified as long as the relationship between the two is not firmly established (MEN, 2009).
In writing, subjects with ASD are more permeable to a reading approach consisting of first working the address path (constituting a lexicon of words known globally) before working the assembly to decipher unknown words (but always associating meaning/signified, whole word/syllables), ibid. Indeed, some students with ASD live as a real deconstruction of reading or even an activity that is meaningless and disturbing the fact of being encouraged to cut into smaller units (to read it) a word that they can already read by addressing having memorized the auditory image of the word quite quickly (without necessarily accessing its meaning for that matter). The issue is more about access to meaning than to decoding itself.
In the production of free writings, it is useful to show the narrative structure or scenarios of a story (source) before asking to write a new text (target) with the same structure and encourage the student with TSA to proceed by substitution (with materialized substitutable elements) when he fails to invent a sequel (which does not already exist, which is complicated for a student with TSA). Doing so would make sense of the activity and would not put the student with TSA at a dead end to invent a sequel or a story.
We can find supporting the learning of the lexicon, syntax but also the recognition of emotions, for example among the media proposed by autisme-apprentissages.org (to stabilize the vocabulary, learn the sounds / look for the syllables composing the words while keeping the overall image of the word to be reconstructed ...). Social skills also benefit from specific work, in parallel with schooling, work that can be carried out in CRA (autism resource centre) or in services of the type of accompaniment of schooling during this school or even upstream of it (service of the type SESSAD during schooling, or CAMSP type in prevention, in France)...
At the developmental level, language is finally touched quickly, from the earliest stages of acquisition (even in subjects without intellectual disabilities formerly qualified As Asperger's, in understanding the polysemy of words and access to implicit). It is therefore from the earliest stages that language must be sustained, with particular care to preserve the trace of the signified, visually, while the language signifier is presented.
- Executive functions are involved in the occurrence if not the maintenance of difficulties. Common impairments of working memory and attention (visuo-attentional notebook and phonological loop) are reported in many language disorders, as is still the case in students with ASD, except that the reported difficulties seem to be secondary to difficulties in filtering sensory information and managing novelty (in subjects with autism), other difficulties (in dyslexics for example) would be affected in the first degree when the information relates to the recognition and coordination of signs of written language with their phonological equivalent (in subjects with dyslexia). It is also reported that mental planning and flexibility are generally impacted in students with autism (Labruyère, 2018). This means that for teaching, the organizing tools of activity planning and s backing to help subjects move from one task to another (flexibility) are to be implemented as soon as possible in the classroom.
- Indeed, in the production of writings, the addition of metacognitive organizers (procedure sheets, criteria review grid, ...) will be helpful for both student profiles but for different reasons. In subjects with ASD, their atypical functioning makes it easier for them to process abstract information (already purified in relation to raw sensory perceptions) to process concrete information, creating a sensory filter to grasp the task. On the other hand, organizing tools have the advantage of making the task cognitively clear, with sub-goals identified and valid precisely, supporting planning.
- The use of reading pathways also shows us that the automation of reading decoding (phonemes /grapheme conversion) is not necessarily accompanied by understanding in the subject with ASD and that it is appropriate, as long as the meaningful/meaning association is not stable, to maintain it, often much longer than in all-comers and ensure that understanding is present. Similarly, students with autism are often much more comfortable with the pathway identified as a reading path, having facilities to retain the overall image of words, at least in the early stages of learning to read. The formation of a lexical stock is often first in subjects with autism. The assembly path comes only afterwards, to unambiguate the unknown words.
Thus, among the recommended pedagogical tracks, I can only encourage teachers:
- to slow down their speech flow during instructions and synthesis times of a given teaching,
- to support the symbolic function for at least up to 4 years (symbolic games, imitation,...) with a strong visual anchoring of the activity media,
- to contribute to the establishment of an alternative communication tool cognitively clear from 18 months of developmental age and as long as oral communication does not make sense,
- to carry out a specific work on the vocabulary of emotions, the understanding of emotional causality (and their recognition on purified media first, pictured, photos but also in situations, depending on the degree of abstraction that students have at the time of this work),
- to writing, to approach reading by first focusing on the address path and keeping the whole word visually accessible (and the meaning image or picto) even if it must be cut auditory for a syllabic or phonemic search, this as long as the auditory image association of the word/ the spelling/sense is not stable,
- to make appear/recall (in free writing production) the narrative structure or scenarios of a story (source) before asking to write a new text (target) with the same structure (accessible via a reference available clarifying the steps and criteria of each expected step) and encourage the student with TSA to proceed by substitution as long as he does not have this internal model autonomously,
- to conduct explicit learning and focus on organized visual media,
- to help students move from one task to another...