Qualitative impairment in verbal communication

Delays and abnormalities in language and speech are frequent presenting complaints of parents, and up to 50 percent of autistic children remain without spoken language. Babbling, which precedes words, may be absent. Autistic children often do not comprehend language spoken to them or have a selective disinterest. Autistic children without language often do not point or use gestures to communicate their needs but may grab their parents’ hand and use it as a tool to get a desired object. Language, if acquired, is acquired slowly. Many autistic persons who acquire language have difficulty with semantics (the meaning of words and phrases), and all have difficulty with pragmatics (the use of language in context). Some children have difficulty understanding that a particular word represents a category of meaning, so that use of the word may be confined to the specific association and context in which it was learned; if categories are formed, they may be based on perceptual similarities rather than functional attributes. There may be difficulty in understanding that words can have multiple meanings. Words for which some understanding of context is required are particularly difficult to understand; examples are prepositions, directional verbs (give, take), and pronouns, which also require the child to shift perspective.

Autistic children often repeat words immediately heard (immediate echolalia) or heard in the past (delayed echolalia) without intent to communicate. When asked a question, they may repeat the question asked so that the pronoun is reversed or they are calling themselves by their own name; even when not repeating phrases, more able autistic children continue to reverse pronouns, calling themselves “you” long after normal children have learned to use pronouns correctly. They may talk to themselves, repeating jingles or snatches of dialogue heard on the television, or they may inappropriately repeat those phrases to another person in social situations where those phrases are irrelevant. Word use may be idiosyncratic or quasi-metaphorical; for example, a child may say the word “nine” each time he sees a train. One 5-year-old boy would sing “Mama little, little, is dressed that way” each time his mother wore a particular raincoat. Neologisms may be observed, as may close approximations to words and phrases, such as the boy who called teddy bears “stuffed-up animals.”

Autistic children who do have communicative speech have difficulty having a conversation as they do not know how to take turns, maintain a topic, or look at their conversational partner. They may repeat questions over and over again even though they know the answer, or they may engage in lengthy monologues on subjects of interest only to themselves. Literal-mindedness, lack of flexibility, and concrete thinking preclude understanding humor, word puns, metaphor, and sarcasm in most autistic persons.

Autistic persons also show impairment in prosody, or the melody of speech. Their speech is often described as monotonous, wooden, or mechanical, or as having a singsong quality. There may be an overly pedantic, formal, uncolloquial quality to the speech of higher-functioning autistic persons. In addition, a person may have trouble modulating the voice volume and may be unaware of the need to lower the volume, depending on the social situation (for example, when in a restaurant or when discussing personal matters). Because prosody gives speech its affective coloring, the autistic person has difficulty expressing emotions through tone of voice.

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