Language and Communication
Pre-Assessment
Pre-Assessment
Individuals with autism always have significant language impairments.
Select an answer for question 648
Individuals with autism always have speech problems.
Select an answer for question 654
Individuals with autism always have communication problems.
Select an answer for question 655
Echolalia is a term used to describe when an individual repeats something that he
hears, either immediately or at a later time.
Select an answer for question 649
Echolalia should be discouraged and stopped.
Select an answer for question 650
Nonspeaking individuals with autism benefit from learning sign language or another
augmentative communication system.
Select an answer for question 651
Once an individual with autism learns to talk, he is a good communicator.
Select an answer for question 652
Individuals with autism have difficulty communicating in a flexible way.
Select an answer for question 656
Communication is a _________.
Select an answer for question 653
Speech, language and communication are all synonymous.
Select an answer for question 657
Overview
Autism is a complex disorder characterized by three core symptoms: social
impairments, communication impairments, and repetitive behaviors. Impairments in the
development of social and communication skills profoundly impact every aspect of an
individual's ability to learn and function. Our understanding of social and communication
impairments is essential to learning how to help and teach individuals with autism.
Repetitive behaviors, also referred to as ritualistic or stereotypic, are observed in the
communication and social behaviors of individuals with autism. Their internal drive to
repeat what they do contributes to their odd behavior patterns, and their repetitive
speech patterns accentuate their atypical way of interacting with others
Autism looks very different in each individual with the diagnosis. The term autism
"spectrum" disorder (ASD) is used to describe this wide range of differences. Some
individuals have odd ways of interacting, while others show a complete lack of initiating
contact with others. Some individuals communicate in atypical ways, while others use
limited ways to communicate basic needs. This broad spectrum of disorders exists for
two reasons:
(1) Autism is associated with other developmental disabilities, meaning a person may
have autism as well as another disability.
(2) Autism is characterized by ritualistic and repetitive behaviors, which makes it unique
from other developmental disabilities.
First, autism commonly occurs with other developmental disabilities, including a wide
range of cognitive, language, and motor impairments. Language impairments in autism
range from a total lack of speech to atypical patterns of developing language (Prizant,
1996). Most individuals with autism have motor impairments that range from motorplanning difficulties to severe dyspraxia (Hanschu, 1998). The cognitive, language, and
motor impairments interface with the core social and communication impairments in
very complex ways. The "pervasive" challenges faced by individuals with autism affect
all aspects of their development.
Second, autism is characterized by ritualistic and repetitive behaviors. Ritualistic
behavior is repetitious, and the individual may become upset when his/her repetitive
behavior is interrupted. The emotional reaction to the interruption distinguishes a
ritualistic behavior from other repetitive behaviors. Frequently observed categories of
ritualistic behavior include social and communication behavior, such as the following.
Social behavior:
o
o
Self-stimulatory object rituals: repeatedly performing an action using an object, such
as spinning objects
Play rituals: insistence on playing in the exact same way every time, such as using
a toy in only one way or playing a game with others in only one way
Communication behavior:
o
o
Verbal rituals: repeatedly saying a sound, word, phrase or sentence, including selfstimulatory vocalizations, immediate echolalia, and delayed echolalia
Conversation rituals: conversing in the same way, such as asking the same
question repeatedly or talking about the same topic continuously
In this module, we will discuss two aspects of autism: language and communication
characteristics. The module will review the developmental language and communication
characteristics of autism and the range of problems observed. Emphasis will be placed
on understanding how communication in autism differs from communication
development in other individuals, with and without disabilities.
Because impaired communication development is a defining characteristic of autism, it
is critical to understand communication issues in autism in order to meet the needs of
individuals with this disorder. It is difficult for us to consider that someone does not
understand how to relate and communicate with others. It is even more difficult to
grasp that someone would be able to learn how to talk and still be unable to converse
with others in a typical way.
The ability to talk is different from the ability to communicate.
Children with autism, with and without speech, struggle to learn how to
communicate with others.
Definitions of Language, Speech, and
Communication
It is important to understand the difference between the terms
language, speech, and communication to better understand
autism. The following pages will explain the differences.
Language
Language is a formal symbol system that has structural qualities, including morphology,
semantics and syntax:
o
o
o
Morphology - rules for how words are structured in a sentence (for example, word
endings to mark plural [book/books])
Semantics - rules for how meaning is created by words and sentences (that is, word
and sentence meaning)
Syntax - rules for the ordering of words in a sentence (that is, sentence grammar)
Language can be (a) oral/speech, (b) sign language, or (c) written language. An
individual learns the rules of a particular language to understand the meaning of another
person's needs, feelings, and ideas. The development of this knowledge is referred to
as receptive language. An individual learns to use the rules of his or her particular
language to express wants, needs, feelings, and ideas. The development of these skills
is referred to as expressive language.
Speech
Speech is one form to express language. It is the ability to use all
the speech sounds in a particular language. The development of
speech is an oral-motor skill that follows a particular motor
sequence. Most children learn to use all the speech sounds of
their particular language by age five.
Communication
Communication is an interactive exchange between two or more
people to express needs, feelings, and ideas. It is a fundamental
social skill. An effective communicator has an inherent motivation
to interact with others, something to express, and a means of
communication. Unlike language, which is symbolic and rule based, communication is
social, constantly changing and requires flexibility. An effective communicator is
constantly thinking about the multiple contextual, language, social and emotional
aspects of the situation and making ongoing adjustments in response to the behavior of
others. The development of communication begins in infancy with a simple smile.
Communication can be expressed verbally (by means of spoken, signed, voice-output
communication device, or written language) or nonverbally (by using pictures, gestures,
emotion, and other behaviors). The social conventions of communication are learned
and refined throughout development.
Tips to Remember
Tips to remember about the differences between language, speech, and
communication:
1. You can communicate without language. You can communicate nonverbally
through facial expression, gestures, and other behaviors.
2. You can use language without communicating. You can talk to yourself without
communicating to others. You can write information to yourself without communicating
with others.
3. You can use language without speech. You can use written language and sign
language.
4. You can communicate without speech. You can communicate with others through
written language, sign language, and nonverbal means, such as facial expression,
gestures, and behavior.
5. You can use speech without communicating. You can talk to yourself without
communicating to others.
The ability to talk is different from the ability to communicate.
Children with autism, with and without speech, struggle to learn how to
communicate with others.
Language and Communication Development
in Typically Developing Children
Gaining an understanding of how communication develops, how
language develops, and how receptive and expressive language
contribute to social language development is an important step in
being able to assess and support the emergence of language for
individuals with autism spectrum disorder. The following pages will
help with that awareness.
Communication in Younger Children
Typically developing young children are very effective
communicators before they learn to say their first word. The
young child uses many nonverbal means of communication to
express a wide range of functions. Eye gaze, gestures, facial
expression, and vocalizations are all combined in many ways to interact with others.
Without saying a word, the baby uses smiles and facial expressions to tell you what he
wants and does not want. By age one, the baby uses gestures such as pointing to ask
for things and to show others things of interest. By 18 months of age, children are using
nonverbal means of communication to make others laugh, call attention to themselves,
and comment on things around them. This complex level of communication occurs
without a word!
Consider this scenario:
James is 12 months old and enjoying his first birthday party. The family puts the cake in
front of him and begins to sing. James smiles and laughs, looks at everyone, sings by
rocking his head back and forth, points to the cake, claps when everyone else claps,
and vocalizes when everyone says, "Hurray!" James is socially engaged,
communicating his excitement and participating with others. The foundation of early
development centers around these social and communication milestones.
Communication in Older Children
As children grow older, their repertoire of communication skills becomes more complex
with the emergence of language. Through language, children develop the ability to
combine nonverbal and verbal means of communication to initiate, maintain, and repair
reciprocal social interactions. For example, they can begin an interaction by combining
words with a touch or facial expression; they maintain interactions through speech, eye
contact, and other nonverbal means of communication; and they can use words and
facial expressions to ask for clarification when unsure what another person means. With
language, they communicate their needs, express their ideas, seek information, share
experiences and express feelings.
Over time, children develop the ability to understand that others have
thoughts, ideas, and feelings that differ from their own (i.e., theory of
mind). This ability to understand the perspective of others plays a
significant role in communication interactions. For instance, in
conversation, children need to continually monitor what the
communication partner knows and expects in order to make information relevant. Only
with this social perspective can children interpret the meaning and intent of what others
are saying. Social perspective taking also allows children to continually adjust their own
language and communication with others. With all of these essential skills, they can
have a conversation about present, past, and future events. Throughout childhood, they
develop the more complex aspects of conversation, such as maintaining appropriate
topics, considering the listener's perspective, and interpreting the nonverbal
communication behaviors of others. They acquire the ability to use nonverbal
conversational skills, such as voice quality and eye contact, in more flexible ways.
Refinement of these conversational skills across different social contexts and with
different conversational partners continues into young adulthood.
Charles automatically knows that he needs to express himself and interact differently
when conversing with his parents versus his teachers versus his friends. His nonverbal
communication behavior looks more or less formal depending on the social setting. An
observer can see how he communicates the same message "I forgot my homework" to
his parent (serious) as compared to his teacher (worry) or his peers (humor). Mastery of
social-communication skills is intimately linked to social acceptance.
Language in Younger Children
Language is the understanding and use of conventional symbols, particularly speech.
The development of language is motivated by both social and nonsocial factors.
Typically developing children rapidly acquire an understanding of vocabulary
(semantics) and language structures (syntax/grammar) and use them proficiently by the
time they reach school age. By age 2, children have some words and understand what
their parents say in familiar routines, relying on contextual cues to "guess" the meaning.
The preschool years is the time when children rapidly acquire vocabulary and go
through the process of using the language structures they hear (e.g., English, Spanish,
French, Russian, Chinese). A key indicator of children's active role in learning language
is seen in the "mistakes" that they say, such as using words like "goed" for "went" or
"mouses" for "mice" and using sentences with creative errors such as "him jumped the
higher" instead of "he jumped the highest"!
Maria, four years old, comes home from preschool and tells her mother about her
morning. "Carlos got a sticker. Mrs. Carey said that Janie should say 'sorry', but I didn't
do the project today." Maria's mother needs to put the missing pieces of the story
together to make sense of it.
Language in Older Children
Through the school years, vocabulary continues to grow, and children learn to use more
complex sentence types. Increased language competence is linked to the child's ability
to integrate his personal experiences, social experiences, and knowledge base in a
flexible way. The school years are also associated with the acquisition of literacy skills;
that is, reading and writing abilities. Here the child masters the ability to integrate
knowledge of spoken and written language needed for academic and social success.
Maria, nine years old, comes home from school and tells her mother about her day.
"Mom, today in school, our class had to do a history project. Jamie, Carlos, and I
worked together. Carlos and I did all the work, and Jamie didn't do anything. Carlos and
I decided to tell Mrs. Carey. Jamie needed to apologize. But the best part is that Mrs.
Carey really liked our work and ..." Maria's mom easily understood Maria's story.
The rapid acquisition of language is linked to the child's cognitive, social, and emotional
development. Language appears to develop effortlessly for the typical child, who is
neurologically ready to master the language of any culture from birth.
Receptive Language
Receptive language is the ability to comprehend the meaning of what others say. It is a
complex process. Consider the meaning of the following words and sentence:
1.
2.
3.
4.
See
Happy
Friend
Anne's friend was happy to see her.
It is likely that you understand the meaning of the first three words and can infer the
meaning of the sentence, but true comprehension of this sentence is more than an
understanding of each of the words, or the relationship between the words. Rather, it is
determined by the connection between the speaker, the sentence, and the context that
determines the true meaning. Word and sentence meaning is intimately linked to social
content and communication cues. If, for example, Anne had recently had an argument
with her friend, then the meaning of the sentence would be dramatically different than
you likely assumed. Similarly, if the speaker said the sentence with an exaggerated,
surprised tone of voice, the meaning also changes.
In order to comprehend language, we need to consider (a) who is talking (b) what they
said, (c) how the speaker says the words, (d) how the words relate to what is
happening, and (e) how the words relate to what we know about the topic. The social
context contributes greatly to understanding the meaning of language.
You may be familiar with this video clip that demonstrates how complicated language
can be for all people.
Expressive Language
Expressive language is the ability to use oral and written
language in a conventional way. It is a complex process, but
develops rapidly and effortlessly in typically developing children.
Consider when most typically developing children can say the
following:
1. "Banana" - 18 months
2. "Look mama, it's a teddy bear!" - age 2-yrs
3. "Actually, I think Mickey would have more fun at the park." - age 4-yrs
4. "If you really want to go to the movies later, why don't you come over to my house
after lunch?" - age 6-yrs
Expressive language develops as a result of learning (a) vocabulary concepts, (b)
sentence grammar (syntax), (c) how to use words and sentences that are related to
what is happening, and (d) how to use words and sentences that will be understood by
the listener. Cognitive, social, and emotional knowledge are linked to meaningful
expressive language use.
Communication Development in Individuals
with Autism Spectrum Disorders
Communication differences are one of the diagnostic characteristics of autism spectrum
disorders (ASD). Becoming familiar with the communication traits an individual with
ASD may exhibit can help those supporting them increase the ability to have meaningful
interactions.
Communication Characteristics
A diagnosis of autism is largely driven by impaired social
development and impaired communication. Communication
features listed in the DSM criteria for autism (American
Psychiatric Association, 2000) include:
o
o
o
o
o
o
Impaired understanding and use of nonverbal communication, such as eye gaze,
facial expression and gestures
Impaired ability to understand and maintain reciprocal interaction (i.e., the give-andtake or turn-taking quality of interacting with another person)
Lack of using verbal or nonverbal means to bring, show, or point out things of
interest
Impaired ability to communicate for a variety of different reasons
Impaired ability to initiate and maintain a conversation
Ritualized use of language when interacting with others
The pervasive nature of these impairments cannot be overstated. Individuals with
autism are profoundly impacted by their struggle to understand how to communicate
with others. They do their best to interact with others, but it looks very different from
typical interactions.
Behaviors as Communication
In the absence of understanding how to communicate in
conventional ways, individuals with autism use a range of positive
and negative behaviors to communicate their needs and feelings.
All of their behaviors, positive and negative, are communication.
Laughter is communication; a temper tantrum is communication; smiles are
communication; running away is communication. Saying the same word repeatedly can
be communication; asking the same question, even when the answer has been given a
hundred times, is an attempt to communicate. The challenge is to figure out what the
individual with autism is trying to communicate through his behaviors.
This video clip shows a young child very upset when he has just woken up. Mom is
trying to help him calm down and move on with his day. Then the same child is shown
identifying shapes while in an extremely happy mood. He is trying to communicate
something by his behavior when he awakens that his parents are trying to figure out.
Routines and Rituals as Communication
In the absence of understanding how to communicate in conventional ways, individuals
with autism also seek to communicate with others in routine, ritualized ways. They are
easily confused when interacting with others and, therefore, want to minimize change
and maximize routines. They want you to say the same thing in specific situations,
and/or they say the same thing in specific situations. They appear to experience comfort
from familiar routines, including routine ways of interacting with others. This differs
significantly from natural interactions that constantly change and are not predictable (for
example, Do you know what I will say next?). In life, very few conversations are routine
(such as the beginning of a conversation on the telephone or greeting someone in a
public place), and most conversations require us to be "flexible" moment to moment.
The ability to communicate in a flexible way is severely impaired in individuals with
autism. They need to know what you will say next and derive comfort from the familiar
routines.
Case Study: Max
Max is 10 years old. His conversations with others are always about
where a person lives. Max has memorized the map of his city and
always begins a conversation with another person with the question,
"Where do you live?" When the person tells him, Max then gives her
detailed directions from their house to his own. He then walks away and finds another
person to repeat the same question/conversation. Max enjoys interacting with others
about "directions," but his ritual is rarely mutually enjoyable, and his ability to engage in
other topics of conversation is limited.
Difficulty Understanding Nonverbal
Communication
Individuals with autism have difficulty understanding the meaning behind the social and
emotional communication of others. They may only notice extreme expressions of
emotion and miss subtle social and emotional messages. They easily misinterpret the
meaning of these messages, making incorrect associations between a person's
nonverbal communication behavior and the context.
Sample nonverbal social behaviors:
o
o
o
"come here and show me" - facial expression
"come play with me" - gesture
"I don't understand" - body posture
Sample nonverbal emotional behaviors:
o
o
o
angry voice
sarcastic voice
affectionate touch
Case Study: Anne
Anne likes to climb, and frequently climbs up on the furniture in school and home. At
home, her father goes over to Anne and, using his pointer finger, sternly says, "get
down," and then helps her down. Anne liked her dad's attention, and did not interpret his
stern voice or finger point as discipline, but rather playful. As a result, Anne started to
climb more often on the furniture at home and school for the attention, and got excited
when an adult told her to "get down." Anne was not doing the behavior because she
wanted to be naughty; rather, she was doing it to have a "fun" interaction (as she
perceived it).
Researchers are unsure of the exact reason, but studies suggest
that children with autism have less understanding and ability to
"read" facial expression and other emotional cues (Baron-Cohen,
1995) and may be highly sensitive and even averse to different social stimuli due to
unusual sensitivities to sound, touch, and movement (Greenspan, 1995). The natural
"curiosity" about people and social activity that you see in typically developing infants is
either lacking or different in individuals with autism.
Consider the following scenario:
You go to another country and don't understand or speak the language. You need
directions to a location and must rely on a nonverbal (not spoken or written language)
interaction, using body language and gestures to get the information you need. Now
imagine that you don't understand the nonverbal body language and gestures of the
other person, and you need directions. This begins to resemble the social experiences
and challenges of individuals with autism.
The meaning of eye gaze, facial expressions, and emotional expressions is
difficult for individuals with autism to understand.
Difficulty with Reciprocal Interaction
Reciprocal interaction, by definition, means "back-and-forth interaction," "taking turns"
and "sharing experiences." Reciprocal interaction can occur with and without language.
Whenever two or more people are communicating, they take turns initiating a new idea,
responding to what another person says or does. The "dance of interaction" seems to
happen effortlessly. When interacting with an individual with autism, you may have the
feeling that you are working very hard to get the person's attention, get a response, and
maintain the interaction. At other times, you may find that the person with autism seems
to have a single agenda when interacting with you (have her needs met) and is not
interested in what you say or do. Other children seem to respond well to you, but the
interaction never seems to go beyond the first question and answer.
At best, the "dance of interaction" between you and a person with autism often feels
out-of-sync or different. Your personal experiences are real, and the person with autism
is overwhelmed by the process of reciprocal interaction.
Case Study: Zachary
Zachary, age 13, had a lot of language skills but struggled to interact with others. He
would typically begin talking without first getting someone's attention, so it looked like he
was talking to himself. His teachers taught him to both (a) tap someone on the wrist and
(b) say "excuse me" before talking. While Zachary was quick to learn this
communication skill, unfortunately he could not understand when to use it and when not
to use it. As a result, he was constantly tapping someone's wrist and saying "excuse
me." One night at 3 am, Zachary needed to tell his mother something. To do so, he
went over to her bed and pulled down the covers in search of her wrist. Once he found
it, he tapped her on the wrist, said "excuse me," and then asked for help. His mom
found him to have a fever. Although Zachary got his mom's attention, this is not the
most effective way in this situation. The way he engaged with others, regardless of the
social situation, was always done in precisely the same way.
Difficulty Bringing, Showing, or Pointing
One of the core symptoms defining social and communication impairments in autism is
"a lack of spontaneous seeking to share enjoyment, interests or achievements with
other people" (American Psychiatric Association, 1994, p. 70). The key terms are
"spontaneous" and "sharing"; that is, individuals with autism are more able to request
what they want or don't want and less able to initiate interactions with others to talk
about what they are doing or what another person is doing. Similarly, there is a marked
difference between their use of gestures to communicate what they want and sharing
interests with others. For example, the individual may point to a book that he wants but
is less likely to point to a picture in the book as a means of showing someone what he
sees. The difference between communicating to request and communicating to share,
or to have joint attention, is an important distinction in individuals with autism. Asking for
something is a way to have a personal need met while sharing ideas is for social
enjoyment.
Case Study: Nicholas
Nicolas, age 8, enjoys tickling games and swinging on the swing. He will use eye gaze,
move another person's hands to his belly, point to the swing, tell an adult "tickle me
again" or "push me higher" to continue an activity that he finds enjoyable. He uses
communication to request what he wants. However, Nicolas never uses eye gaze,
pointing, or words to talk about what he and others are doing or feeling. He does not
point to things of interest to him while playing or swinging, or says something like "look
at this," "thanks, Dad," or "this is fun."
The following video clip shows a boy at a birthday party who definitely wants some food
or cake, but is not directing his cues to anyone. He is having difficulty bringing items to a
person to communicate his wants or showing his gestures to someone so they could
help him meet his needs.
Limited Range of Communicative Functions
Communicative function is a key term used in any discussion about communication in
autism. Communicative function refers to the many purposes or reasons to
communicate a single message. Common communicative functions can be divided into
several categories:
o
o
o
o
o
o
Requesting to satisfy personal needs - such as asking for a preferred object
Responding to others - such as answering a simple question
Commenting - such as describing what he is doing
Requesting information - such as asking who, what, where, why questions to obtain
NEW information
Expressing feelings - such as saying "I feel sick"
Use prosocial statements - such as saying "thank you" or giving a compliment
At all stages of language development, individuals with autism have a limited repertoire
of reasons to communicate. At both the nonverbal stage (use of gestures, facial
expression) and verbal stage (use of language), they are more likely to communicate for
the purposes of having their needs met and less likely to communicate for social
pleasure. Therefore, communicative functions are more commonly used to:
o
o
o
Request personal needs
Respond to others
Request information
Communicative functions less commonly observed include:
o
o
o
o
Comments to share interests
Requests for new information
Expressing feelings
Using prosocial statements or verbal acts of kindness
It is more common to hear "I want _______," "I don't want _______" (an object, an
activity, or a topic of conversation) rather than "we have ________," "you can
________," "do you want ________?" (an object, an activity, a feeling, a shared
experience). Communication that results in a concrete personal outcome is more likely
than communication that results in a shared social experience.
Case Study: Carlos
Carlos, age 15, is verbal and able to speak in full sentences. In school, he is able to tell
others what he wants, including asking for food, objects, toys, school materials, and
help with his school work. He tries to interact with his peers but asks the same question
every time. For example, he approaches a peer with the question "where do you live?"
even when he knows the answer. He gets excited when the peer answers and
frustrated when the peer ignores him. He uses communication to satisfy his need and
get a clear and immediate result.
Impaired Ability to Initiate and Maintain a
Conversation
Conversation skills involve all the features of communication discussed thus far, and
much more. Conversation requires:
o
o
o
Listening to another person's spoken message
Paying attention to another person's nonverbal message (such as facial expression
and emotion conveyed in the words)
Interpreting the meaning of another person's spoken and nonverbal message in
relation to the social situation
o
o
o
o
o
Understanding the perspective of the other person - what he knows, feels - in order
to keep the conversation relevant
Expressing ideas related to the topic of conversation
Taking turns
Adjusting to the ongoing language, social, communicative and emotional changes
of the other person
Doing all of the above at the same time!
Given that individuals with autism have difficulty with each of the separate features
required for an effective conversation, the skill of pulling all the pieces together at the
same time to have a reciprocal conversation with another person is extremely difficult
for even the most able person with autism. Conversational turn-taking can be learned
via "scripts" written for a communication device, but the partner's topics must stay within
the confines of the script. While not a true, open-ended conversation, these can be a
means to introduce the individual with ASD to the back and forth flow of real
conversations. Consider how this man with Asperger Syndrome describes what it is like
to try to carry on a conversation.
Researchers have compared the development of conversational skills in children with
autism to control groups of typically developing children and individuals with other
disabilities. As language abilities increased in control groups, there was a parallel
increase in conversational skills. That is, children added new information, introduced
new topics and used effective nonverbal communication skills. In contrast, as language
skills increased in children with autism, improvements in conversational skills did not
occur. (Tager-Flusberg & Anderson, 1991). Regardless of the level of language ability,
conversation skills were significantly impaired because of their limited ability to
understand and use nonverbal communication such as eye gaze, facial expression and
gestures, understand social perspectives, talk out things of interest, and communicate
for a variety of social reasons.
Case Study: Edward
Edward is 5 years old and speaks in full sentences. He talks about what he wants and
what he doesn't want. He asks peers to play but struggles to have a conversation with
them. He is very motivated to talk about his movie interest with peers, but is unable to
"read" their lack of interest in his topics. He repeatedly asks them questions about
specific scenes of different movies and does not understand their frustration with his
constant questions. Edward knows the answer to his questions, but asks because one
of the only aspects of conversation that he understands is "take turns asking or
answering a question." He understands that conversation requires partners to take
turns, but lacks all the other features of conversation, especially perspective taking,
needed to engage in a reciprocal, mutually enjoyable conversation.
Ritualized Communicative Behaviors
Using a ritualized style of interacting with others is how individuals with autism
compensate for their social and communication impairments. These ritualized
communicative behaviors include, but are not limited to:
The nonspeaking child:
o
o
Making communicative vocalizations
Using the same behavior to get someone's attention
The child with emerging spoken language:
o
Repeating the last word that someone has just said (one form of immediate
o
echolalia **)
Saying the same word repeatedly (one form of delayed echolalia **)
The child with spoken language
o
o
o
o
Repeating the phrase of sentence that someone has just said (one form of
immediate echolalia **)
Saying the same phrase or sentence repeatedly (one form of delayed echolalia **)
Asking the same questions repeatedly (spoken or on a communication device)
Talking about the same topic repeatedly
Listen as this three year old boy uses jargon with rhythm and changes in tone to attempt
communication.
All of these examples can be the child's attempt to communicate and interact. In
addition, these examples can be used for nonsocial reasons; that is, the individual may
repeat things to himself without any intent to interact with others.
** Echolalia is the most common form of communication rituals observed in autism. The
two basic forms of echolalia, immediate and delayed echolalia, are discussed in more
detail in the section on language characteristics in autism.
Repetitive, ritualized behaviors are a dominant characteristic of all individuals with
autism. Communication rituals can occur for a variety of reasons, including:
1. Communication rituals are social and the individual's best effort to interact with
others.
2. Communication rituals are nonsocial and are used by the individual to express
anxiety.
3. Communication rituals are nonsocial and are used by the individual to calm himself.
4. Communication rituals are nonsocial and are an expression of poor inhibition in the
individual.
Case Study: Kim
Kim was a fifth-grade student whose communication intentions were
often difficult for others to understand. She spoke in full sentences, but
the purpose of many of her messages appeared unrelated to what was
happening around her. Kim's favorite activity was watching movies.
She often made unusual associations between people that she met
and characters from a movie. For example, the first time she met her teacher, she
repeatedly said "there's no place like home," a phrase from the movie Wizard of Oz.
Kim's mother noticed that the teacher often wore a red pair of shoes, and this seemed
to remind Kim of Dorothy's ruby slippers in the movie. During the entire school year, Kim
would approach her teacher saying "there's no place like home" each time her teacher
wore the red shoes to work. This message, an example of delayed echolalia, was Kim's
unusual way of initiating communication with her teacher. Her words actually meant "Hi,
you are wearing the red shoes today just like Dorothy in the Wizard of Oz who says
'there's no place like home' when she wants to go home. Do you want to go home
now?" Kim's short message, once understood by the teacher, had a different meaning
and the teacher could acknowledge and respond to her differently.
Imagine
You travel to a remote island in the middle of the pacific. You
encounter people who speak a foreign language and have social
conventions that you do not understand. What would you do during
your visit?
1. Would you isolate yourself from the people because you are overwhelmed, anxious
and confused?
2. Would you observe the people from afar and try to figure out patterns to their
language, social and communication behaviors?
3. Would you try to use your language and social communication skills to interact with
them even though they might not understand you?
4. Would you use the one or two communication patterns that you see most often in the
people to interact with them?
5. Would you focus your attention on how to have your personal needs met (food,
drinks, shelter, preferred activities)?
Individuals with autism have sometimes been referred to as "anthropologists on Earth";
individuals whose neurological make-up is such that they struggle to learn the social
and communication conventions that most of us take for granted. They perceive our
communication and social skills as foreign and difficult to understand. Each individual
with autism uses a somewhat different compensatory strategy - some isolate
themselves, some are passive observers, some pick up patterns that they hear
frequently in the environment to communicate with others (especially words heard most
often spoken by adults, and TV, radio, movies), some learn a few fundamental social
rules and use them continuously, and most learn the best means to have their personal
needs met.
The atypical communication patterns observed in individuals with autism are
their best effort to get their needs met and to interact with others.
Comparison to Typically Developing
Individuals
Important communication development milestones to consider:
Age
Sample Milestone #1
Sample Milestone #2
12
months
Uses a variety of nonverbal means to Uses requests, comments, and other
communicate
basic communicative functions
24
months
Combines gestures and words to
communicate
Asks questions, expresses feelings,
uses prosocial functions
2-3
years
Maintains a simple conversation
exchange with adults
Comments and describes ongoing
events
4-5
years
Maintains a simple conversation with
peers
Knows how to respond to other's
feelings during interactions
Takes into account the listeners'
Adjusts conversation according to the
6+ years
perspective to maintain a reciprocal
listener's needs
conversation
(Quill, 2000, p. 46)
When you remember these fundamental, yet critical communication characteristics that
define autism, it will enhance your ability to understand the person's perspective and
become more successful in your efforts to interact and teach individuals with autism.
Important communication features in autism to consider:
Individuals with autism want to interact, but don't understand how
Communication is generally used for a specific outcome and is used
Developmentally less for social pleasure
Different
Communication interactions look very different from typical
interactions
Communication rituals are the individual's means of compensating
for social confusion
Individuals with autism struggle to understand: reciprocity, nonverbal
signals, how to share experiences, and other's perspectives
Some final points about communication to consider:
1. The individual with autism may understand what you say but not what you mean.
2. The individual with autism uses ritualistic interactions when he does not know what
else to do or say.
3. The individual with autism often uses challenging behaviors to express his social and
communication frustrations.
You are the competent communicator. Adjust your interaction style to the level of
the person with autism.
Language Development in Individuals with
Autism
Language develops as a result of learning (a) vocabulary concepts, (b) sentence
grammar, and (c) how to link words and sentences what is happening in a meaningful
way. Cognitive, social and emotional knowledge are linked to the development of
meaningful language.
A wide range of language impairments are observed in individuals with autism due to
the diverse developmental disabilities associated with the disorder, including cognitive
and motor impairments. As a result, some "high-functioning" individuals have minimal
differences in how their language develops; individuals with cognitive or motor deficits
have specific language impairments; and individuals with severe cognitive deficits have
significant delays in their development of language. However, impairments in social and
emotional understanding profoundly affect the quality of language understanding and
use for all individuals with autism.
On the following pages in this section, we will examine language characteristics that are
most commonly associated with autism. These specific language differences are linked
to the social and communication impairments and repetitive behavior patterns that
define autism.
Language characteristics commonly associated with autism for:
Receptive language are



Context-specific comprehension
Poor comprehension of abstract social concepts
Literal
Expressive Language are



Echolalia
Verbal rituals
AAC
Receptive: Context-Specific Comprehension
In order to comprehend language, we need to consider (a) who is talking, (b) what the
person said, (c) how the speaker says the words, (d) how the words relate to what is
happening, and (e) how the words relate to what we know about the topic. The social
context contributes greatly to understanding the meaning of language.
In autism, individuals have difficulty understanding the relationship between the words
and the social context. As a result, they often make a concrete association between
what they hear and what they see in the environment, which results in a constrained
understanding of what is said. The following example shows how this problem is
observed in a child with significant delays.
Case Study: Sammy
Sammy has a favorite yellow cup at home that he uses for his
drinks. Whenever someone at home says, "Do you want a drink?"
Sammy is shown his yellow cup or he goes and gets his yellow
cup from the cabinet. When Sammy is in school and someone
says, "Do you want a drink?" Sammy does not seem to understand. Why? Does
Sammy understand the sentence, "Do you want a drink?" The answer is yes and no. He
understands the meaning of the sentence within the narrow social context of his "yellow
cup" at home but does not understand the meaning in other social contexts. As a result,
Sammy's parents and his school team have different opinions about what he
understands.
Other factors that can influence an individual's language comprehension are:





Language: The length or complexity of the sentence
Context: The relationship between the sentence and the "here and now"
Speaker: The use of gestures and other nonverbal cues
Motivation: The individual's interest in the topic
Routine: The individual's familiarity with the message
It is common to observe an individual with autism who appears to understand what is
said in one context or with one person and then shows confusion in another context or
responding to another person. Poor generalization of language meaning is common due
to a limited ability to consider all aspects of the social context and the speaker. It is easy
for adults to misinterpret context-specific language comprehension as intentional
noncompliance or "not paying attention" on the part of the individual with autism. This
video clip shows Nicky, an extremely capable individual, struggling to understand what
is being communicated in the conversation with his supervisor.
Never assume that the individual with
autism understands what you say!
Receptive: Poor Comprehension of Abstract
Social Concepts
Individuals with autism tend to develop an understanding of concrete words and
concepts, but may have difficulty understand more abstract language whose meaning is
social and relationship-based. Compare the following vocabulary:
Examples of Social concepts
NOUNS
Friend Teacher Aunt
VERBS
Share
Pretend Remember
ADJECTIVES
Happy Pretty
Frustrated
Examples of Nonsocial concepts
NOUNS
Truck Book
Shoe
VERBS
Build
Read
Go
ADJECTIVES
Red
Empty Two
Abstract social concepts are embedded in our language use, both spoken and written.
The individual with autism struggles to understand the meaning of these words whose
meaning is linked to social understanding and one's own social-emotional relationships
and experiences.
Case Study: Tasha
Tasha, age 18, is trying to learn the meaning of abstract social concepts. Her teacher
helps her by developing a social dictionary of social concepts. The definition for each of
these words is a list of Tasha's experiences; for example, the word "change" is defined
by a list of specific situations in which Tasha was told it was time for a change. As a
result of developing this dictionary, Tasha is learning the narrow meaning of "change,"
is able to say "I don't like change," but continues to struggle to understand all the subtle
factors that link all of these similar experiences. That is, the ability to generalize the
meaning of abstract concepts, particularly social concepts, is very challenging for her.
Receptive: Literal
Literal is defined as comprehension that adheres strictly to the basic, concrete meaning
of a word or text without interpretation; it is an unimaginative way of understanding the
facts. Comprehension is literal when an individual does not consider the speaker's
social cues and the relationship between what has been said and the social context.
Individuals with autism are very literal. They do not understand social cues like the
emotional quality of a speaker's voice or facial expression in relation to what is said.
They rely on the words "out of context" or use concrete cues in the environment rather
than social cues to determine what someone means. This results in constant
misunderstandings and misinterpretations of what others are saying, resulting in
confusion and frustration.
Problems with literal understanding can occur in response to a single word, a sentence,
a conversational exchange, and written language. Consider the multiple meaning of the
following message: Mary likes John. This one simple sentence could mean five or more
different things, depending on the speaker's intention; the emotion in the speaker's
voice; the relation between the sentence and the ongoing topic; and many other factors.
Imagine the impact of always interpreting a message like this in a literal way. It would
complicate an already difficult social situation for the individual.
Watch as this boy demonstrates his amazing memory and then is confused by the
phrase, "Give yourself a big hand!"
Be careful what you say to a person with autism, as their
perspective may be different from your own.
In the movie Rainman, which depicts an adult person with autism
named Raymond, there is a scene when Raymond stops in the middle
of a busy street when the traffic signal said "STOP." Without
consideration of social consequences of standing among moving traffic,
Raymond responded in the most literal way.
Expressive: Echolalia in Individuals with
Speech
Echolalia refers to the repetition of others' speech that may occur immediately after
hearing a message or significantly later. Immediate echolalia refers to repeating a word
or phrase just spoken by another person, while delayed echolalia refers to repetition of
a word or phrase that was previously heard and is used at a later time "out of context".
Echolalia is observed in at least 85% of individuals with autism who acquire speech
(Prizant et al, 1997). Due to the prevalence of echolalia in individuals with autism, it is
essential to understand this aspect of their expressive language.
Example of Immediate Echolalia:
Adult: Do you want a drink?
Child: Want a drink
Adult: Do you want a drink?
Child: Want a drink
Adult: Do you want a drink, yes or no?
Child: Yes or no?
Adult: Do you want it, say yes.
Child: Say yes
In this example, the exact repetition of the adult's last few words was the child's attempt
to communicate that he wanted a drink. He is still learning language syntax/grammar,
and echolalia is one of the strategies that he uses to practice language structures and
learn the meaning of phrases in various situations. In this situation, echolalia served as
a means to learn the meaning of a phrase, maintain social interaction, and
communicate what he wanted.
Example of Delayed Echolalia:
Adult: Do you want to go outside on the swing?
Child: If you're happy and you know it
Adult: You want to sing on the swing?
Child: If you're happy and you know it
Adult: We will sing "if you're happy and your know it" while I push you on the swing, ok?
Child: Go outside?
Adult: Yes, let's go.
In this example, the child says a phrase from a song that he has heard in the past. It
appears that the child's words are completely unrelated to the adult's question.
However, the adult understands the child's intent and acknowledges his message as
meaningful. The adult knows that the child likes to sing when on the swing. One of his
favorite songs is "If you're happy and you know it." The child makes associations
between words heard and specific situations and struggles to learn the meaning of
these words. Here, delayed echolalia is one of the strategies he uses to communicate,
although what he says and why he says it do not seem related.
Function of Echolalia
There has been extensive research into the function of echolalia for persons with
autism. It is now understood that both immediate and delayed echolalia are not always
rote or meaningless repetition, but are used for a variety of reasons. Both immediate
and delayed echolalia can be either (a) language and communication strategies used by
individuals with autism or (b) noninteractive ritualized speech. (Prizant et al, 1997)
1. Echolalia as a means to learn language and communication
Both immediate and delayed echolalia can be used as a means of learning language
(both syntax/grammar and semantics/meaning) and maintaining social-communication.
Immediate and delayed echolalia should be viewed and encouraged as the person's
way to:




Learn syntax/grammar
Learn language meaning
Maintain social interaction
Communicate with you
Echolalia is not always meaningless repetition, but is often used in functional
ways.
Focus on the communicative intent, not the echoed words, to understand what
the person means.
2. Echolalia as noninteractive ritualized speech
Most individuals with autism also use immediate and delayed echolalia in noninteractive
ways. The person may "talk to himself" in a highly repetitive way for a number of
reasons, including:

Remind oneself what to do (for example, "put it away, put it away, put it away")

Calm oneself in a difficult situation (for example, recite the alphabet repetitively)
Express anxiety in a difficult situation (for example, repeats phrase previously heard
in a stressful situation)
Withdraw from a particular situation
Express some other emotion



Several factors increase the likelihood of hearing noninteractive echolalia. For example,
noninteractive echolalia is more likely to be used in unstructured or overwhelming
situations, with new people or situations, during emotionally stressful situations, and
when a person is experiencing language comprehension difficulties. The following video
clip shows a young boy making every effort to understand what his mom is asking,
including using echolalia to try to increase his comprehension.
A person's use of echolalia sometimes signals the need to modify the environment,
simplify what you say, and be mindful of the person's emotional state.
Expressive: Verbal Rituals in Individuals
with Speech
Repetitive, ritualized behaviors are a dominant characteristic in autism. Verbal rituals
are defined as any use of language that is repetitive, insistent, and often expressed with
intense emotion. Verbal rituals include some forms of echolalia (previously discussed),
as well as perseverative speech and incessant questioning. Perseverative speech is
described as persistent repetition of a word, phrase, or topic with no clear
communicative intent. Incessant questioning is repeatedly asking one or more questions
and persisting even after the question has been answered multiple times.
These verbal rituals, like other ritualistic behavior, can occur for a variety of reasons,
including:




An individual's best effort to interact with others
The individual's expression of anxiety
The individual's means calm himself
An expression of poor inhibition
Example of Perseverative Speech:
Child: (child recites a few lines from a favorite story book
continuously, without pause)...
Situation 1: Riding in the car with his father
Situation 2: Waiting to see the doctor with his father
In the first situation, the perseverative speech appears to be an expression of poor
inhibition and has no social or communicative value. In the second situation, the child's
perseverative phrases are spoken with high emotion, and the father senses his son's
anxiety about the doctor visit.
Focus on the emotion and the context, not the perseverative words, to
understand what the person means.
Example of Incessant Questioning:
Child: "Do we have chocolate milk for lunch?"
Situation: Asked repeatedly every morning in school
In this example, the school team determined that the reason for the
incessant questioning was related to the child's fears. In this situation, the child is
anxious about the school schedule, uncomfortable in the school lunch room, and the
fact that the only food that is consistent at every lunch is chocolate milk. So, his intent is
to express anxiety about school lunch and he uses incessant questioning in an attempt
to cope with the situation.
Verbal rituals for persons with autism can occur for a number of reasons, including:

Calming oneself in a difficult situation

Expressing anxiety in a difficult situation
Withdrawing from a particular situation
Expressing some emotion


Several factors increase the likelihood of hearing verbal rituals. For example, they are
more likely to be used in unstructured or overwhelming situations, with new people or
situations, during emotionally stressful situations, and when a person is experiencing
any learning difficulties.
A person's use of echolalia sometimes signals the need to modify the
environment, simplify what you say, and be mindful of the person's emotional
state.
Expressive: Benefits of Augmentative and
Alternative Communication (AAC) for NonSpeaking Individuals
Approximately 30% or more of individuals with autism remain
nonspeaking, although this statistic is continuously changing due
to advances in early diagnosis and treatment. A nonspeaking
individual is either mute or, in some instances, says an occasional word inconsistently.
Some nonspeaking individuals are unable to use speech as a means of communication,
but are able to learn to use an alternative language such as sign language, a symbolbased language, or written language. Other nonspeaking individuals learn to use more
basic symbols as a means of communication, such as photographs or other graphic
icons. These alternatives to speech are called augmentative and alternative
communication (AAC) systems and include voice-output communication devices. There
are four examples of AAC usage on the next page.
Benefits of using AAC systems with nonspeaking individuals include:
1. Increased communication competence
2. Increased rate of developing speech in comparison to those who do not use AAC
systems
3. Decreased rate of problem behaviors associated with poor communication skills
The ritualized nature of autism is observed in their language use. This is true for both
the verbal individuals and the person with no speech. Regardless of what AAC system
is taught to a nonspeaking individual, persons with autism may be driven to engage in
repetitive, ritualized behaviors.
Case Study: Ben
Ben uses a voice output computer as his AAC system. While he uses the system to
effectively communicate his wants and needs, he also uses the computer to repetitively
touch his favorite phrase that is build into the system, "How are you today?" It seems he
likes the sound of this phrase and listens to it (in a noncommunicative way) hundreds of
times a day. So while a voice output system may or may not be the best choice of an
AAC system for Ben, consideration needs to be given to his ritualized use of the
system. His ritualized use of the AAC system interferes with his social acceptability. He
also needs to be taught an alternative skill to replace this ritual in order to limit his
noncommunicative use.
Select an AAC system that increases the child's communicative competence!
AAC Usage Examples
There are four examples of AAC usage on this page. The third clip shows a person with
autism utilizing a letter board for spelling. The other clips are individuals with a variety of
disabilities, but are used here to show an assortment of device usage.
Comparison to Typically Developing
Individuals
Important language development milestones to consider:
Age
Receptive Language
Expressive Language
12
months
Understands some words
Uses babbling, jargon and word
approximations
24
months
Understands simple sentences in
routine contexts
Uses over 100 words and some
phrases
2-3
years
Understands simple conversations in
natural contexts
Uses simple sentences
4-5
years
Understands complex sentences in
routine and natural contexts
Masters syntax/grammar and uses
complex sentences
6+ years
Understands abstract concepts and
continues to build vocabulary
Continues to build vocabulary
When you remember these fundamental, yet critical language characteristics that are
common in individuals with autism, it will enhance your ability to understand the
person's perspective and become more successful in your efforts to interact and teach
individuals with autism.
Important language features in autism to consider:
Developmentally Different
Context-specific comprehension
Receptive language
Poor comprehension of abstract
social concepts
Literal
AAC rituals
Expressive language
Echolalia
Verbal rituals
Some final points about language to consider:
1. The individual with autism may understand you in routine contexts but not novel
situations.
2. The individual with autism is more likely to understand concrete, not abstract
information
3. The individual with autism often uses echolalia as a means to learn language and
interact with others.
4. The individual with autism exhibits ritualistic language use for a variety of reasons,
one of which is anxiety.
Do not assume language comprehension because an individual is verbal.
Remember the important distinction between expressive language and
communication.
Frequently Asked Questions
Question: What is language?
Answer: Language is a formal symbol system that has structural qualities, including
morphology, semantics, and syntax.
o
o
o
Morphology - rules for how words are structured in a sentence (for example, word
endings to mark plural (book/books)
Semantics - rules for how meaning is created by words and sentences (that is, word
and sentence meaning)
Syntax - rules for the ordering of words in a sentence (that is, sentence grammar)
Language can be (a) oral/speech, (b) sign language, or (c) written language. An
individual learns the rules of a particular language to understand the meaning of another
person's needs, feelings, and ideas. The development of this knowledge is referred to
as receptive language. An individual learns to use the rules of his or her particular
language to express wants, needs, feelings, and ideas. The development of these skills
is referred to as expressive language.
Question: What is speech?
Answer: Speech is one form of expressing language. It is the ability to use all the
speech sounds in a particular language. The development of speech is an oral-motor
skill that follows a particular motor sequence. Most children learn to use all the speech
sounds of their particular language by age 5.
Question: What is communication?
Answer: Communication is an interactive exchange between two or more people to
express needs, feelings, and ideas. It is a fundamental social skill. An effective
communicator has an inherent motivation to interact with others, something to express,
and a means of communication. An effective communicator is constantly thinking about
the multiple contextual, language, social and emotional aspects of the situation and
making ongoing adjustments in response to the behavior of others. Communication can
be expressed verbally (by means of spoken, signed, or written language) or nonverbally
(by using pictures, gestures, emotion, and other behaviors). The social conventions of
communication are learned and refined throughout development.
Question: What are the unique communication characteristics of individuals with
autism?
Answer:

Difficulty understanding nonverbal communication





Difficulty with reciprocal interaction
Difficulty understanding how to point out things of interest
Limited range of communicative functions
Impaired ability to initiate and maintain conversation
Ritualized communication
Question: What are the unique language characteristics of individuals with autism?
Answer:
Receptive:



Context-specific comprehension
Poor comprehension of abstract social concepts
Literal interpretation of what others say
Expressive:



AAC rituals
Echolalia
Verbal rituals
Citation and References
Citation

If included in presentations or publications, credit should be given to the authors
of this module. Please use the citation below to reference this content.

Quill, K. (2011). Language and Communication (Columbus, OH: OCALI). In Ohio
Center for Autism and Low Incidence (OCALI), Autism Internet Modules,
www.autisminternetmodules.org. Columbus, OH: OCALI.
References
 American Psychiatric Association. (1994). Diagnostic and statistical manual for
mental disorders (4th ed.). Washington, DC: Author.
 American Psychiatric Association. (2000). Diagnostic and statistical manual for

mental disorders (4th ed., text revision). Washington, DC: Author.
Baron-Cohen, S. (1995). Mindblindness. Cambridge, MA: The MIT Press.


Greenspan, S. (1995). The challenging child: Understanding, raising and
enjoying the five difficult types of children. Reading, MA: Addison Wesley
Longman.
Hanschu, B. (1998). Evaluation and treatment of sensory processing disorders.

Paper presented to the Sensory Integration Consortium, Boston.
Prizant, B.M. (1996). Brief report: Communication, language, social and
emotional development. Journal of Autism and Developmental Disorders, 26,

173-178.
Prizant, B. M., Schuler, A., Wetherby, A.M. & Rydell, P. (1997). Enhancing
language and communication development: Language approaches. In Cohen,
D.J. & Volkmar , F.R.(eds.) Handbook of autism and pervasive developmental


disorders,(2nd ed.).. New York, NY: John Wiley and Sons, Inc.
Quill, K. (2000). DO-WATCH-LISTEN-SAY: Social and communication
intervention for children with autism. Baltimore: Brookes.
Tager-Flusberg, H., & Anderson, M. (1991). The development of discourse in
autistic children. Journal of Child Psychology and Psychiatry, 32, 1123-1134.
Resources



Books on the Characteristics of Autism Spectrum Disorders:
Attwood, T (1998). Asperger's Syndrome: A guide for parents and professionals.
London: Jessica Kingsley.
Brosen, S. K. (2006). Do you understand me? My life, my thoughts, my autism
spectrum disorder. London, UK: Jessica Kingsley Publishers.
Bruey, C. T. (2004). Demystifying autism spectrum disorders: A guide to
diagnosis for parents and professionals - Topics in autism. Bethesda, MD:

Woodbine House.
Cohen, D. J. & Volkmar, F. R (Eds.). (1997). Handbook of Autism and pervasive
developmental disorders (2nd ed.). New York: John Wiley & Sons.

Grandin, T. (2006). Thinking in pictures, expanded edition: My life with autism.

New York: Doubleday.
Janzen, J. (1996). Understanding the nature of autism: A practical guide. San


Antonio, TX: Therapy Skill Builders.
Powers, M., & Poland, J. (2003). Asperger syndrome & your child: A parent's
guide, Unlocking your child's potential. New York: Harper Resource.
Powers, M. D. (2000). Children with autism: A parents' guide. Rockville, MD:
Woodbine House.
Books on Language and Communication Issues in Individuals with ASD :
 Beukelman, D. R., & Mirenda, P (2005). Augentative and alternative
communication: Supporting children and adults with complex communication
needs (3rd ed.). Baltimore: Paul H. Brookes.
 Freeman S., & Dake, L. (1998). Teach me language: A language manual for
children with autism, asperger syndrome, and related developmental disorders.


Langley, BC: SKF Books.
Frost, L., & Bondy, A. (1994). PECS: The Picture Exchange Communication
system. Cherry Hill, NJ: Pyramid Educational Consultants.
Koegel, R. L., & Koegel, L. K. (2006). Pivotal response treatments for autism:
Communication, social and academic development. Baltimore: Paul H. Brookes.

Prizant, B., Wetherby, A., Rubin, E., Laurent, A., & Rydell, P. (2006). The
SCERTS Model: A comprehensive educational approach for children with autism
spectrum disorders. Baltimore: Brookes.

Quill, K. (Ed.) (1995). Teaching children with autism: Strategies to enhance
communication and socialization. Albany, NY: Delmar.
Sussman, F. (1999). More than words: Helping parents promote communication
and social skills in children with autism spectrum disorder. Toronto, Canada:


Hanen Centre Publication.
Schopler, E., & Mesibov, G. (Eds.). (1985). Communication problems in autism.
New York: Plenum.
Books on Typical Language and Communication Development:
 Bates, E. (1976). Language in context: The acquisition of pragmatics. San Diego:

Academic Press.
Hart, B., & Risley, T. R. (1999). The social world of children learning to talk.

Baltimore: Paul H. Brookes.
Owens, R. (2000). Language development. Columbus, OH: Charles Merrill.
Post-Assessment

Post-Assessment

Individuals with autism always have significant language impairments.

Select an answer for question 658

Individuals with autism always have speech problems.


Select an answer for question 659
Individuals with autism always have communication problems.

Select an answer for question 660

Echolalia is a term used to describe when an individual repeats something that
he hears, either immediately or at a later time.

Select an answer for question 661

Echolalia should be discouraged and stopped.


Select an answer for question 662
Nonspeaking individuals with autism benefit from learning sign language or
another augmentative communication system.

Select an answer for question 663

Once an individual with autism learns to talk, he is a good communicator.


Select an answer for question 664
Individuals with autism have difficulty communicating in a flexible way.

Select an answer for question 665

Communication is a _________.
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Select an answer for question 666
Speech, language and communication are all synonymous.
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Select an answer for question 667
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