CLINICAL TOPICS

Autism

Overview

Incidence and Prevalence

Signs and Symptoms

The population of ASD presents with tremendous heterogeneity. Individuals can have abilities ranging from significant cognitive and language impairments (e.g., nonverbal) to superior cognitive and language abilities (e.g., college- and career-bound). However, regardless of these differences, the common characteristics and challenges associated with ASD impact the development of critical social communication skills.

The core features of ASD [PDF] include (a) impairments in social communication, language, and related cognitive skills and behavioral and emotional regulation and (b) the presence of restricted, repetitive behaviors. These core features are significantly influenced by an individual's developmental level of language acquisition (e.g., pre-symbolic, emerging language, and conversational language) and the level of severity of the disorder. In addition to these core features, sensory and feeding issues can also be present.

Awareness of individual and cultural differences is necessary to differentiate differences from disordered behaviors. For example, direct eye contact with an authority figure may be considered disrespectful due to cultural influences, and silence may be valued as a sign of respect. In a U.S. school system, these behaviors could easily be misinterpreted as socially inappropriate and a warning sign or symptom of a disorder such as ASD. When observing signs and symptoms, an SLP must be sure to account for cultural factors that influence social communication skills.

The following is a list of signs and symptoms common to ASD. Specific areas of deficit will vary; no one individual will have every sign and symptom.

Social Communication

Joint Attention

Deficits in joint attention include

  • difficulty orienting to people in a social environment,
  • limited frequency of shared attention,
  • impaired monitoring of emotional states,
  • restricted range of communicative functions to seek engagement and comfort from others,
  • limitations in considering another's intention and perspective.

Social Reciprocity

Deficits in social reciprocity include

  • difficulty initiating and responding to bids for interaction,
  • limitations with maintaining turn-taking in interactions,
  • problems with providing contingent responses to bids for interaction initiated by others.

Social Cognition

Social cognition refers to the mental processes involved in perceiving, attending to, remembering, thinking about, and making sense of the people in our social world (Moskowitz, 2005).

Deficits in social cognition include

  • deficits in social and emotional learning including difficulty
    • managing emotions,
    • appreciating the perspectives of others,
    • developing prosocial goals,
    • using interpersonal skills to handle developmentally appropriate tasks
      (Payton et al., 2000);
  • difficulty differentiating one's own feelings from the feelings of others (i.e., Theory of Mind);
  • difficulty integrating diverse information to construct meaning in context (i.e., central coherence) (Frith & HappÈ, 1994).

Language and Related Cognitive Skills

Deficits in language and related cognitive skills include

  • impaired acquisition of words, word combinations, and syntax—
    • initial words are often nouns and attributes, while words representing social stimuli, such as people's names (i.e., subjects) and actions (i.e., verbs), are delayed;
    • the child loses words previously acquired;
  • use and understanding of nonverbal and verbal communication—
    • facial expressions, body language, and gestures as forms of communication are delayed in the latter part of the first year of life and remain unconventional throughout development;
    • unconventional gestures (e.g., pulling a caregiver's hand toward an item) emerge prior to more conventional gestures (e.g., giving, pointing, and head nods/headshakes);
    • understanding of gaze shifting, distal gestures, facial expressions, and rules of proximity and body language is limited;
    • receptive language appears more delayed than expressive;
    • use of immediate echolalia and/or delayed echolalia (scripted language) is observed;
  • vocal development deficits, including
    • atypical response to caregiver's vocalizations,
    • atypical vocal productions beyond the first year of life,
    • abnormal prosody once speech emerges (speech may sound robotic);
  • symbolic play deficits, including
    • delayed acquisition of functional and conventional use of objects,
    • repetitive, inflexible play,
    • limited cooperative play in interactive situations;
  • conversation deficits, including
    • limitations in understanding and applying social norms of conversation (e.g., balancing turns, vocal volume, proximity, and conversational timing);
    • provision of inappropriate and unnecessary information in conversational contexts;
    • problems taking turns during conversation;
    • difficulty initiating topics of shared interest;
    • preference for topics of special interest;
    • difficulties in recognizing the need for clarification;
    • challenges adequately repairing miscommunications;
    • problems understanding figurative language, including idioms, multiple meanings, and sarcasm;
  • literacy deficits, including difficulty
    • reading for meaning (functional use of books),
    • understanding narratives and expository text genres that require multiple perspectives (e.g., persuasive and comparative/contrastive),
    • getting the main idea and summarizing,
    • providing sufficient information for the reader when writing;
  • executive functioning deficits, including
    • lacking/limited flexibility,
    • poor problem solving,
    • poor planning and organization,
    • lack of inhibition.

Behavior and Emotional Regulation

Deficits in behavior and emotional regulation, including

  • problems dealing with changes in routine and/or changing from one activity to the next;
  • problems generalizing learned skills;
  • using objects in unusual ways and uncommon attachments to objects;
  • difficulty sleeping;
  • crying, becoming angry, or laughing for no known reason or at inappropriate times;
  • anxiety and/or social withdrawal (possibly due to factors such as misinterpretation of social events and failure to identify salient or irrelevant information);
  • using early-developing and/or idiosyncratic strategies for self-regulation (e.g., chewing on clothing, rocking, hand flapping, vocal play);
  • using unconventional behavioral strategies and emotional expressions (e.g., aggression, tantrums, bolting from situations);
  • restricted, repetitive patterns of behavior, interests, or activities (e.g., immediate echolalia and scripted language);
  • problems with self-management.

Sensory and Feeding

Sensory and feeding challenges, include

  • sensory modality difficulties, including over-responsiveness, under-responsiveness, or mixed responsiveness patterns to environmental sounds, light, visual clutter, and social stimuli (e.g., social touch, proximity of others, voices);
  • preference for nonsocial stimuli leading to intense interests with sensory aspects of objects and events;
  • patterns of food acceptance or rejection based on manner of presentation or food texture;
  • consumption of a smaller variety of foods than the variety consumed by other family members.

Special Considerations: Adolescents and Adults With ASD

In addition to adults diagnosed with ASD as children, some live with undiagnosed or newly diagnosed ASD. Some of these individuals may seek out various supports and services (e.g., vocational/career counseling), particularly when they begin to experience problems in work and/or social settings. When a diagnosis of ASD is presented to a previously undiagnosed individual, it is essential that this be done with the utmost sensitivity.

For transitioning adolescents and adults with ASD, social communication is a particularly important skill area to consider. For example, social communication is important in the "peer arena," where adolescents explore different relationships and learn about friendship, loyalty, and individual differences (Seltzer, 2009). Communication rules in adolescent social interactions are often subtle and unspoken, and successful navigation within social settings requires awareness of these rules. In addition, the social, emotional, and critical thinking demands during adolescence are constantly evolving; managing these demands can be challenging for all adolescents, including students with social learning challenges such as ASD (Winner & Crooke, 2011). Similar social communication skills are important for young adults with ASD in workplace interactions with supervisors, coworkers, and the public. Other areas of importance include executive functioning and problem-solving skills needed to achieve greater independence in all settings.

Causes

Roles and Responsibilities

Assessment

Treatment

Resources

References

Content Disclaimer: The Practice Resource Project, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.