Autism and Communication (cont.)
Roxanne Dryden-Edwards, MD
Roxanne Dryden-Edwards, MD
Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
Communication is usually severely impaired in persons with autism. What the individual understands (receptive language) as well as what is actually spoken by the individual (expressive language) are significantly delayed or nonexistent. Deficits in language comprehension include the inability to understand simple directions, questions, or commands. Persons with a high-functioning autism spectrum disorder might understand simple speech but still have difficulty interpreting the more subtle meaning in conversation. There may be an absence of dramatic or pretend play and these children may not be able to engage in simple age-appropriate childhood games such as Simon Says or Hide-and-Go-Seek. Teens and adults with autism may continue to engage in playing with games that are for young children and may seek to establish friendships with people much younger than them.
Individuals with autism who do speak may be unable to initiate or participate in a two-way conversation (reciprocal). Frequently the way in which a person with this disorder speaks is perceived as unusual. Their speech may seem to lack the normal emotion and sound flat or monotonous. The sentences are often very immature: "want water" instead of "I want some water, please." Those with autism often repeat words or phrases that are spoken to them. For example, you might say, "Look at the airplane!" and the child or adult may respond "at airplane," without any knowledge of what was said. This repetition is known as echolalia. Memorization and recitation of songs, stories, commercials, or even entire scripts is not uncommon. While many feel this is a sign of intelligence, the autistic person usually does not appear to understand any of the content in his or her speech.
Persons with autism often exhibit a variety of repetitive, abnormal behaviors. There may also be a hypersensitivity to sensory input through vision, hearing, or touch (tactile). As a result, there may be an extreme intolerance to loud noises or crowds, visual stimulation, or things that are felt. Birthday parties and other celebrations can be disastrous for some of these individuals. Wearing socks or tags on clothing may be perceived as painful. Sticky fingers, playing with modeling clay, eating birthday cake or other foods, or walking barefoot across the grass can be unbearable. On the other hand, there may be an underdeveloped (hyposensitivity) response to the same type of stimulation. This individual may use abnormal means to experience visual, auditory, or tactile (touch) input. This person may head bang, scratch until blood is drawn, scream instead of speaking in a normal tone, or bring everything into close visual range. He or she might also touch an object, image, or other people thoroughly just to experience the sensory input.
Children and adults who have autism are often tied to routine and many everyday tasks may be ritualistic. Something as simple as a bath might only be accomplished after the precise amount of water is in the tub, the temperature is exact, the same soap is in its assigned spot, and even the same towel is in the same place. Any break in the routine can provoke a severe reaction in the individual and place a tremendous strain on the adult trying to work with him or her.
There may also be nonpurposeful repetition of actions or behaviors. Persistent rocking, teeth grinding, hair or finger twirling, hand flapping, and walking on tiptoe are not uncommon. Frequently, there is a preoccupation with a very limited interest or a specific plaything. A child or adult may continually play with only one type of toy. The child may line up all the dolls or cars and the adult line up their clothes or toiletries, for example, and repeatedly and systematically perform the same action on each one. Any attempt to disrupt the person may result in extreme reactions on the part of the individual with autism, including tantrums or direct physical attack. Objects that spin, open and close, or perform some other action can hold an extreme fascination. If left alone, a person with this disorder may sit for hours turning off and on a light switch, twirling a spinning toy, or stacking nesting objects. Some individuals can also have an inappropriate bonding to specific objects and become hysterical without that piece of string, paper clip, or wad of paper.
Reviewed by William C. Shiel Jr., MD, FACP, FACR on 8/21/2012
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Autism Spectrum Disorder - Types Question: What type of autism were you or your child diagnosed with? Please discuss your experience.
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