Autism Spectrum Disorders: Core
Symptoms and their Development
Rhea Paul, Ph.D., CCC-SLP
Southern Connecticut State University
Yale Child Study Center
Feb. 11-15, 2008
rhea.paul@yale.edu
Triad of symptoms
 Severe,
qualitative impairment in social
interaction
 Qualitative impairment in
communication
 Restrictive, repetitive or stereotyped
behaviors interests or activities
Social Interaction
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Gaze
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Attentional patterns
Eye contact
Joint Attention
Imitation
Emotion and attachment
Reciprocity
Play
Peer Relations
Eye Contact/Using Gaze to Share
Eye Contact
Gaze Patterns
Toddler with autism
Typically-developing toddler
2-year-olds with autism and typical development
viewing video of child playing
Gaze development in ASD
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Newborns show preference for faces
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prefer eyes by 2 mo.
Can detect direction of other’s gaze by 4 mo.
Children with ASD fail to develop these
patterns
Problems in gaze persist throughout the life
span, even in HFA
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Are resistant to intervention
Joint Attention (Intersubjectivity)
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Dyadic: infant looks at adult
Triadic: Begins w/ gaze following (6 mo.)
Progresses to following point (8-10 mo.)
Then to initiation w/ smiling and pointing at objects
of interest (12 mo.)
Lays basis for conversation
Very low frequency in ASD, appears later than TD
Can increase with age
Joint Attention
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Video examples:
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JA DD
JA Autism
Imitate JA
Imitation
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Emerges in infancy
Basis of learning
Fades in typical development
Role of mirror neurons
Less spontaneous imitation and less in
elicitation settings for children with ASD
Imitation
In normal development
http://www.youtube.com/watch?v=rWKSTtM6Ys
 In ASD
Haddia example
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Emotion and attachment
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Social referencing
Comfort seeking
Sharing emotion with
gaze
Children with ASD
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Do show attachment
Have difficulty recognizing
emotions: may be related to
difficulties in face perception
Less likely to coordinate
expression of emotion (smile)
with gaze
Difficulties in empathy (hurt
examiner experiment)
Decreased social referencing
(robot experiment)
Sharing emotions
Sharing emotions
Reciprocity
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Turn-taking emerges before language
Back-and-forth nature of social interaction
Deficits in reciprocity can be seen
in both verbal and
nonverbal individuals
Reciprocity: Preverbal
Reciprocity: Verbal
Play
Normal development:
 0-8 mo. All schemes to all objects
 8-12 mo. Functional play
 12-18 mo. Autosymbolic play
 18-24 mo. Single scheme symbolic play
 24-36 mo. Multischeme symbolic
 3-5 Pretend, role play
 5-12 games with rules
Play in ASD
Favor exploratory, means-ends, construction,
stereotypical play over pretend play
 Even symbolic play can be repetitive and
stereotypic
 May prefer solitary play
 May have difficulty w/ flexibility in games w/
rules
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Play
http://www.youtube.com/watch?v=zAu6ehEGMQc&feature=related
Peer Relations
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TD children move from family-centered to peercentered social relations
Children with ASD may
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Prefer to remain solitary
Be ineffective in approaching and engaging peers
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Make fewer approaches to peers
Respond less often to peer bids
Those w/ HFA may
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prefer adults to peers
Expand interest in peers during adolescence
Become depressed over loneliness and lack of friendships
Communication: Definitions
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Communication
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Language
 Rule-governed
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Message
Sender
Receiver
Conventional
Symbolic
Culturally Determined
Communication
Speech
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Vocal expression
Sounds of language
Language Domains
Communication is a primary
deficit in autism
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Of the triad of symptoms, communication is directly
involved in two
Communication deficits are a primary means of
identifying and diagnosing autism
Communication in autism involves both delay and
deviance.
Primary area of difficulty is in pragmatics
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BUT deficits in other areas can also be seen; sometimes are
similar to those of children with specific language impairments
(SLI).
Communication in Typical
Development
Communication Development:
Capacities at birth
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Vision best at face-to-face range
Infants show preferences for
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Faces over other visual stimuli
Speech over other sounds
Female voices over other voices
Own mother’s voice over other female voices
Motherese speech-style over adult directed style
Can discriminate phonemes of native and nonnative languages
Typical Communication Development:
Preverbal & Early Language
Perlocutionary Stage: 0-8 mo.
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0-4 mo.: Preference for faces, speech
4-8 mo.: Development of vocal
communication
6-10 mo.:
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Emergence of preference for
ambient language patterns
Emergence of speech-like sounds
Communication Development:
Preverbal Form
Production
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0-2 mo.: Vegetative
sounds
2-4: Cooing & laughing
4-8 mo.: vocal play
6-10 mo.: canonical babble
8-18 mo.: jargon babble
with prosodic contours of
ambient language
Perception
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0-6 mo.: general speech
processing abilities that are
biologically determined and
“generic;” can apply to any
linguistic input (Eimas et al.,
1971.)
7-12 mo.: Change in
preferences from those that
would apply to any
language toward ones those
closely tuned to the sound
patterns of the environment
Perlocutionary Communication
Illocutionary Stage: 8-12 mo.
Use
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Development of intentional
communication expressed through
• Gestures, e.g., pointing
• Vocalization
• Gaze
Small range of functions expressed
• Proto-imperative
• Proto-declarative
2.5 communicative acts/minute
Emergence of prosodic patterns of
ambient language.
Illocutionary Stage: Content and
Form
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Expressive vocabulary starts slowly
 12 mo: 1-3 words
 15 mo.: 10 words
 18 mo. 50-100 words; first word combinations
First 50 words include proper and common nouns,
adjectives, verbs, social terms
Receptive vocabulary is larger: 50 words at 15 mo.
Most words have CV shape, one syllable
Sounds used are same as those found in
babble:
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/b/, /p/ /m/, /n/, /d/, /h/, /w/.
Illocutionary Stage: Gestures used
to express intents: Contact Point
Illocutionary Stage: Gestures used
to express intents: Reach
Illocutionary Stage: Gestures used
to express intents: Distal Point
Illocutionary Stage: Gestures used
to express intents: Show
Illocutionary Stage: Other
Conventional Gestures
Illocutionary Communication
Locutionary Communication: 12-18 mo.
First
words spoken
First
words comprehended
outside of routines
Rapid
increase in spoken
vocabulary:
Same
intents expressed with
gestures, vocalization now
expressed with words
New
discourse-related
intentions expressed
•request
information
–15
mo: 3 words
–18
mo.: 50-100 words (+/-100)
•answer
mo.: 300 words (+/-150)
•acknowledge
–24
Word
combinations begin
when vocabulary=50
5-7
communicative
acts/minute on average
Locutionary Development: Content
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Early two-word utterances express a small range of
meanings
 Agent, action, object combinations
 Possession
 Location
 Attributes
 Meanings related to
object permanence
Locutionary Communication
Communication Development: 18-24 mo.
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Repertoire of speech sounds increase
CVC and multisyllabic words increase; many still single syllable
Average child is 50% intelligible
Average expressive vocabulary size at 18 mo. Is 100 words (+/- 100)
Multiword utterances increase in frequency; vocabulary grows
Understanding of sentences is not far ahead of production
Pragmatic developments:
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New discourse-related communicative functions:
Discourse management
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Turns: increasing awareness of conversational
obligation
Topics: 1-2 turns/topic
Register variation
18-24 mo. Communication
Limitations in Communication is
ASD: Prelinguistic Level
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Delayed onset of speech (Stone et al., 1994)
Atypical preverbal vocalizations (Sheinkopf et al., 2000)
Depressed rate of preverbal communication (Wetherby,
Prizant & Hutchinson, 1998)
Restricted range of communicative behaviours, limited
primarily to regulatory functions (Mundy & Stella, 2000)
Low responsiveness to speech (Osterling & Dawson, 1994)
Delayed and deviant use of gestures (Dawson et al., 1998;
Stone, et al., 1997)
Dearth of pretend and imaginative play (Stone et al., 1994)
Laci of imitation orally, vocally, and verbally (Volkmar et al.,
1997)
TD: Comment
ASD: Comment
Developing Language
Communication Development: 24-36
mo. Form and Content
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Average expressive vocabulary size at 24 mo. Is 300 words (+/150); word classes include
 Object & action words
 Kinship terms
 Spatial terms
 Question words
 Color, shape words
Grammatical morphemes, verb phrase marking emerges;
some overgeneralization
Grammatical forms for sentences such as questions, negatives
are emerging
Sentence length is 3-5 words
Intelligibility increases from 50% to 70%
Communication Development: 48-60
mo.: Form & Content
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Vocabulary at school entry=6000 words
Basic grammatical forms mastered expressively
and receptively;
 few grammatical errors are heard
 Overgeneralization may persist
Average 4 year is 100% intelligible
 Speech errors may persist, but speech can be
understood
 Residual errors in /s/, /l/, and /r are last to resolve
Background: Pragmatics of
Language
 Pragmatic
domains:
Communicative functions
 Discourse management
 Register variation
 Presupposition
 Prosody
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Communication Development: 48-60
mo.: Use
Communicative functions
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Increase in range of functions
New genre: narration
Increase in decontextualized talk
Discourse management
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Requires less support from adults; still
needs some
Longer turns; more turns/topic
Communication Development: 48-60
mo.: Use
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Register variation
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New polite forms:
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permission requests, permission directives,
some indirect requests
4-7: hints
Ability to use ‘motherese’
Preschool Conversation
Early Verbal Communication in ASD
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Pronoun reversals
Idiosyncratic word use
Use of immediate and delayed echolalia
(communication strategy)
Perseverative conversation
Atypical voice and prosodic features
Echolalia
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http://www.youtube.com/watch?v=sniGZoVB
0R4&feature=related
Conversation in ASD
Communication Development in
Later Childhood and Adolescence
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Syntax/Semantics
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Increases in oral and written forms
Increases in figurative, nonliteral language
Pragmatics
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Discourse Genres
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Narration
Persuasion/negotiation
Exposition
Ambiguity/sarcasm
Register variation
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Slang
Figurative language
Communication in Youth
Impairments in Higher Level Language Skills in
ASD
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Reduced topic management skills
 appropriate topic termination
 Responding to cues to change topic
 Commenting contingently; say something relevant
Reduced presuppositional skills due to “theory of mind” (ToM)
deficits
 Poor ability to share topics
 infer other’s informational state
Obsessive, circumscribed interests
Sparse conversation OR overly
talkative about special interests
Gaze and prosodic deficits persist
Discourse Management Example
Presupposition Example
Prosody Example
Circumscribed Interest Example
Repetitive behaviors
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http://www.youtube.
com/watch?v=6blmKiPe9c&feature
=related
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http://www.youtube.co
m/watch?v=MB9UDDLJf
KM&feature=related
Controversial Treatments
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Promise to cure the core symptoms of ASD
Definition of the core deficits often lacks solid
empirical evidence (e.g., metabolic problems,
exposures, ‘visual processing’)
Offer vague benefit (e.g., improve focus)
Lack of empirical evidence
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Reliance on uncontrolled studies, single-case testimonials
Claim that ‘they cannot be studied ‘
Often claim persecution form the scientific
establishment
Staying open-minded
Gluten- Free & Cassien-Free Diet
(GFCF)
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“Leaky gut” -> peptides crossing blood-brain barrier ->
disrupted neurotransmitter breakdown -> increase of
opiotoids -> activity-autism.
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“Leaky gut” could be caused by: yeast overgrowth,
gastrointestinal disease due to immunization, etc.
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No evidence for these causal relationships
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Systematic study of GFCF diet initiated at University
of Rochester
Ethyl Mercury (Thimerosal) Exposure
Danish “Natural Experiment”
1.
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2.
1970 – 1992 petrussis vaccine contained Thimerosal
1992-1997: same vaccine w/o Thimerosal
1997: different petrussis vaccine w/o Thimerosal
Danish Psychiatric Register Data: contrary to
prediction, no difference in rates of autism was
found between groups who received Thimeraosal
and those who did not
Chelation Therapy
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Hypothesized toxic effects of mercury exposure, mercury
accumulates in internal organs (hair trace analysis)
Chelation: introduction into the blood stream agents that
bond with specific metals in the body
Purely hypothetical connection between mercury poisoning
and autism
No empirical evidence supporting the claim, no reports of
curing autism or improving symptoms following chelation
Possible side-effects of chelation: washes out valuable
minerals, very costly diagnostic process
Two children have died following chelation.
Supplements
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Assumption that developmental disabilities may be
caused by innate biochemical errors
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E.g., B6+magnesium supplements
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Lack of well-controlled, long-term follow up studies
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Possible side effects: high dose of B6: possible
neuromotor side effects in adults, magnesium:
potentially toxic metal in high doses
Secretin
Pancreatic hormone assisting digestion
 “Cure” of autism (Horvath et al., 1998) after
single injection of the hormone
 Controlled studies: secretin has the same
effect as placebo (Carey et al., 2002; Chez et
al., 2000; Owley et al., 1999)
 Positive effect on children with autism and
diarrhea, but no reduction in aberrant
behaviors; no effect on those w/o diarrhea
(Kern et al., 2002)
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