Autism, neurodiversity, and language learning, Part VII

(Part VII in a series of posts that will soon take us to a highly contagious and dangerously inaccurate meme about what autism is.)

In my previous posts, I’ve made the following points:

–How much language you acquire, including how much language you comprehend, is correlated with how much attention you’ve paid, over the years, to other people’s speech and to what they are looking at and doing when speaking.

–Deficits in these attention behaviors, which are examples of what’s called Joint Attention, are among the core symptoms of autism. (If you don’t have deficits here, the diagnosis doesn’t apply).

–Therefore, the ability to acquire language and understand what other people saying is correlated with the severity of autism.

What all this means is that, if you understand most of the spoken or written language that surrounds you–from concrete labels to sophisticated psychological vocabulary; from simple, direct statements to jokes, innuendos, and other forms of figurative language–then, assuming you’re on the autism spectrum at all, you’re way far out on the mild end of it.

Now, as I discussed earlier, you might have a person who looks severely autistic even if they can do all these things. But the reason they look severely autistic isn’t because their autism is severe, but because they face additional challenges that limit their ability to actually produce language–to produce their own phrases, sentences, psychological vocabulary, jokes, innuendos, and figurative turns of phrase.

The most common culprit, as I noted, is apraxia of speech. Speech apraxia can severely limit one’s ability to produce spoken words. But it doesn’t affect writing and typing. I’ve witnessed a number of individuals on the autism spectrum who barely speak–if they speak at all–but can still produce phrases and sentences through independent typing.

(Most of these kids are still severely autistic–their joint attention behaviors are limited, and when they type they produce only a limited range of phrases, sentences, and vocabulary–but their comprehension skills are still significantly ahead of their oral skills).

However, as I noted earlier, it’s theoretically possible for there to be additional motor-control or body-awareness difficulties that prevent a person from producing written language, even if she has long been regularly attending to speakers and understands a great deal of the language that surrounds her.

Such people–profoundly apraxic, profoundly motor-impaired, yet only mildly autistic–are probably extremely rare. But that doesn’t diminish the tragedy of their situation: that of being full of language and thoughts but completely unable to communicate them. To the extent that we can help these “locked in” individuals, it’s urgent we do so.

One way would be to devise some sort of physical assistance that eliminates the motor-control or body-awareness barriers to writing or typing. Perhaps if some sort of human facilitator were to provide such assistance, a profoundly apraxic, motor-impaired person would suddenly be able to communicate all the thoughts they’ve had locked up inside.

Such barrier-surmounting assistance is purported to exist already: it goes under the name of “facilitated communication.” More on this anon.

Autism, neurodiversity, and language learning, Part VI

(Part VI in a series of posts that will soon take us to a highly contagious and dangerously inaccurate meme about what autism is.)

In my previous post, I discussed how there might be factors besides Joint Attention deficits that could contribute to the failure to acquire spoken language. As I wrote:

in some cases the primary culprit for lack of spoken language may be apraxia of speech rather than autism-related Joint Attention deficits. If so, then the autism itself may be relatively mild. In particular, the person’s receptive Joint Attention behaviors, along with his/her ability to pay attention to what people are doing when they speak, may be only mildly impaired. In this case, he or she should be able to acquire receptive language–to learn to understand what people say–even if he or can’t speak.

What this means is that the inability to speak doesn’t entail the inability to produce other forms of language–for example, written language or sign language.

Conversely (and not so surprisingly) the inability to write or use sign language doesn’t entail the inability to speak. Perhaps you no one has taught you how to read, write, or sign. Perhaps you have a visual impairment. Or perhaps you have a fine motor impairment that impedes writing, signing, or even typing.

While the last possibility–a fine motor impairment that impedes typing– is relatively rare, fine motor impairments can be co-morbid with autism.

So while autism at its severest levels (as I argued earlier) means being unable produce language in any medium, mild autism doesn’t necessarily mean the opposite. Theoretically, you could have someone who is tuned in enough (via Receptive Joint Attention) to acquire receptive language, but so severely apraxic and so severely impaired in their fine motor skills that they are unable to speak, sign, or type indepedently. Theoretically, you could have someone who understands everything they hear or read but still can’t produce, on their own, any language in any medium.

And, while it seems like such individuals would be highly atypical, even within autism, a slew of recent news reports, books, and movies would have us believe otherwise. Stay tuned for a closer look.

 

Autism, neurodiversity, and language learning, Part V

(Part V in a series of posts that will eventually take us to a highly contagious and dangerously inaccurate meme about what autism is.)

My previous post drew a connection between the severity of autism (whose diagnostic measures include Joint Attention behaviors) and the severity of the language impairment associated with autism. This connection, I suggested, explains why a significant proportion of people on the spectrum (somewhere around 25%) are nonverbal.

But does this mean that everyone who is nonverbal is so because of Joint Attention deficits? Are there other reasons why someone on the autism spectrum might be, or appear to be, nonverbal?

The answer to this question depends in part on what we mean by “nonverbal.” Do we mean unable to produce any language at all, or unable to speak?

As far as not being able to speak goes, there are other culprits besides Receptive Joint Attention. Profound hearing loss is one. If you can’t hear other people’s speech or your own oral output, then, absent intense speech and language therapy, you’ll likely remain orally nonverbal. Apraxia of speech is another. From the NIH:

AOS is a neurological disorder that affects the brain pathways involved in planning the sequence of movements involved in producing speech. The brain knows what it wants to say, but cannot properly plan and sequence the required speech sound movements.

I highlight this definition of Apraxia of Speech not just because the condition is less familiar than deafness, but because it has been found to be co-morbid with autism. This means that a significant number of nonverbal individuals have both autism and AOS.

Putting all this together, we see that in some cases the primary culprit for lack of spoken language may be apraxia of speech rather than autism-related Joint Attention deficits. If so, then the autism itself may be relatively mild. In particular, the person’s receptive Joint Attention behaviors, along with his/her ability to pay attention to what people are doing when they speak, may be only mildly impaired. In this case, he or she should be able to acquire receptive language–to learn to understand what people say–even if he or can’t speak.

But the inability to speak doesn’t entail the inability to produce other forms of language–for example, written language or sign language. For more on the broader sense of verbal/nonverbal, stay tuned.

Autism, neurodiversity, and language learning, Part IV

(Part IV in a series of posts that will eventually take us to a highly contagious and dangerously inaccurate meme about what autism is.)

So in my previous posts on the subject (starting here), I discussed how Receptive Joint Attention

JointAttention2

correlates with language learning, and how reduced Receptive Joint Attention behaviors impede the acquisition of both spoken and written language.  When RJA behaviors are at a minimum, so is the amount of language learned–whether we’re talking about spoken or written language.

What does any of this have to do with autism?

The connection goes back to the clinical definitions of autism: the definitions that guide how psychologists and psychiatrists make their diagnoses. In the U.S., there’s the Diagnostic and Statistical Manual of Mental Disorders (DSM); worldwide, there’s the World Health Organization’s International Classification of Diseases (ICD).

In both these guidelines, Joint Attention figures prominently. The criteria for autism in the most recent DSM (the DSM V), for example, include these:

  • Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
  • Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

And this:

  • Symptoms must be present in the early developmental period.

The things I’ve bold-faced–particularly responding to social interactions and making eye contact–are the sorts of Receptive Joint Attention behaviors that, I argue earlier, are essential for the acquisition of written and spoken language. Reduced RJA behaviors in early development–when language acquisition begins–mean significant limits on language acquisition.

Another of the criteria relates indirectly to Receptive Joint Attention:

  • Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).

Highly restrictive interests, combined with a preference for objects over people (which is an early predictor of autism in infants), is one reason for reduced Receptive Joint Attention behaviors in autism.

Here is one more DSM guideline:

  • Severity is based on social communication impairments and restricted, repetitive patterns of behavior.

Collectively, what all this means is that the more severe the autism, the more limited the acquisition of spoken and written language. At its most severe, autism means total lack of language–a.k.a. non-verbal autism.

But for some people, severe/non-verbal autism has come to mean something completely different… Stay tuned.

Autism, neurodiversity, and language learning, Part III

(Part III in a series of posts that will eventually take us to a highly contagious and dangerously inaccurate meme about what autism is.)

Let’s begin here by augmenting the scenario discussed in part II: Imagine yourself going to another country where you don’t know the language and spending several years there seemingly immersed in that language, and that:

  1. all your basic needs are taken care, such that you don’t actually need to interact with anyone, and
  2. for whatever reason, you mostly choose not to interact with anyone, even passively, such that:
  3. even as you hear the syllables coming out of people’s mouths, you manage to hardly ever pay attention to what those who utter these syllables are doing, looking at, or otherwise attending to.

In this situation, I argued, you would learn very little of the spoken language.

Now let’s consider the written version of the new language. Imagine that the language uses a completely different alphabet—say the Georgian alphabet, which, in this sample text, looks like this:

Georgian

Imagine that you are as immersed in the written language as you are in the spoken language, and just as unfamiliar with it.

But suppose that, while you pay little attention to what people are doing when they speak, you pay lots of attention to print. You find these strings of squiggly shapes fascinating to look at, and so you’re constantly looking at signs and labels, paging through books and magazines, and scanning the captions to TV shows and movies.

street2

How much of the written language would you learn under these circumstances? Given that you haven’t picked up much at all of the spoken version, to what extent would you eventually be able to read and write the language?

In the case of a phonemic writing system like Georgian, the route to mastery is phonics. But without having learned the spoken language, you would have limited information about the sounds of these written words. TV captions might theoretically get you somewhere, but in general the captioned speech, and the captions themselves, go by too quickly, and aren’t sufficiently synchronized, for you to form clear associations. It’s therefore unlikely that you would glean enough information to learn, on your own, the general rules for sounding words out phonemically.

For shorter words that appear regularly as labels for concrete objects, you might manage some limited “whole word” learning, associating a particular string of squiggles with a particular referent. For example, you might eventually learn to recognize ქუჩა as the word for “street.”

But, no matter how much time you spend scanning the written language on your own, you will never get to the point of fully comprehending even the simplest texts in picture books like this one:

picturebook

…let alone being able to write or type out simple, grammatical sentences on your own.

What does this mean for autism? Stay tuned.

Autism, neurodiversity, and language learning, Part II

(Part II in a series of posts that will eventually take us to a highly contagious and dangerously inaccurate meme about what autism is.)

So why is Receptive Joint Attention, as I noted in my last post, so crucial to language learning?

JointAttention2

One way to see why is to imagine yourself going to another country where you don’t know the language and spending several years there seemingly immersed in that language. The key word here is “seemingly.” For imagine, as well, that:

(1) all your basic needs are taken care, such that you don’t actually need to interact with anyone, and

(2) for whatever reason, you mostly choose not to interact with anyone, even passively, such that:

(3) even as you hear the syllables coming out of people’s mouths, you manage to hardly ever pay attention to what those who utter these syllables are doing, looking at, or otherwise attending to.

Under these circumstances, how much of the language would you pick up?

Perhaps you would, willy-nilly, learn the meanings of a few really regular patterns—for example, the phrases for “hello,” “goodbye”, “please,” and “thank you”—along with a few labels for whatever concrete objects are deliberately pointed out to you.

But, since you aren’t routinely linking the ambient syllable sounds in your new environment with what the speakers are doing while uttering them, most of those speech sounds will continue to be just that: syllables without meaning.

In other words, language immersion works its magic only if you’re actually paying attention to speakers.

What about written language? Stay tuned for the next post…

Autism, neurodiversity, and language learning, Part I

Recent events—including the publicity surrounding the movie “Far from the Tree” and a highly contagious and dangerously inaccurate meme about what autism is–have me bursting with things to say about autism and language learning. There’s way too much for one post, and it’s hard to know where to begin.

So I’ll begin where it all begins: Joint Attention.

This is what Joint Attention looks like:

JointAttention1

In words: two or more people attending the same thing.

Joint Attention is often a two-step process. First, Person A first notices that Person B is directing his attention at something (e.g., by noticing that Person B’s eyes are pointing fixedly in a particular direction). Next, Person A, perhaps curious about what it is that has grabbed Person B’s attention, shifts his own attention to the same thing:

JointAttention2

Sometimes Joint Attention involves leading as well as following: Person B might deliberately try to direct the Person A’s attention over to a particular thing that Person B wants both parties to attend to (for example by saying “look” and/or pointing to it). This more active joint attention is at play not just in informal showing & sharing moments (“Look at my new toy!”), but also in deliberate teaching (“This is a right triangle.”).

But when it comes to learning, especially language learning, it turns out that the more passive variety of Joint Attention (a.k.a. Receptive Joint Attention) is critical. According to a recent meta-analysis, frequency of Receptive Joint Attention behaviors is significantly correlated with language development. That correlation holds for both neurotypical children and children on the autism spectrum. But for children with ASD, the correlation between Receptive Joint Attention and language development turns out to be especially strong.

Why might this be and what are the implications for autism and language learning… and for the accuracy of current memes about autism?

Stay tuned.