In addition to social difficulties, autism spectrum disorders usually involve communication problems. In fact, the most prominent feature of classic autism, at least in the minds of most people, is the inability to speak. What is less well understood is that even those with Asperger syndrome and high-functioning autism experience some difficulties with communication. This, it turns out, is one of the most confusing parts of the diagnostic puzzle and often leads to misdiagnoses when the child is young. You may have had autism raised as a possibility at some point in your child's life, only to have it "ruled out" or be told later that he or she couldn't possibly be autistic because the child speaks so well. Indeed, it is part of the definition of Asperger syndrome that language be fluent, not only at the age the child is seen for evaluation, but even at ages 2 and 3. A smaller, but not insignificant, number of children with high-functioning autism begin talking early and soon speak articulately in a manner that seems advanced. Parents may first believe their child is gifted based on his or her precocious language skills. Yet there are virtually always differences in the way language is used, particularly in social contexts, that can cause problems. The child, adolescent, or adult with AS-HFA may dominate conversations, talking on and on without giving others the chance to say anything. The pedantic or overly formal manner of speaking that Joseph uses is common in both Asperger syndrome and high-functioning autism. At age 7, Joseph begins many statements the way a professor might, saying, "Actually . . . " or "I do believe. . . . " He has a vast vocabulary and loves to use unusual words—the bigger the better. When asked his favorite color, he pointed to a yellow balloon and said with a smile "chartreuse." Clint defines terms that don't need defining. He readily tells people that he is autistic, hastening to add, "Autistic is the adjective for the noun autism" as if we would not know what the word meant without this explanation. While there is nothing technically wrong with phrasing things so formally, it certainly makes Clint and Joseph stand out from their peers and often makes them the target of teasing. Joseph's mother likens his speech patterns to someone who speaks English as a second language: other people can figure out what he is trying to say, but the way he phrases even simple statements makes it seem as if English is not his native tongue.
Some children with AS-HFA memorize things that other people say (or phrases or dialogue from videos and books) and then incorporate them into their own speech. This memorized speech is called delayed echolalia and, while idiosyncratic, does indicate that the child has a well-developed verbal memory. Sometimes the echoed phrases are used in context and make sense, as when Joseph exclaimed, "Oh no, it's my worst nightmare!" (dialogue from a Disney movie) after spilling milk on one of his maps. Other times, the link between the phrase and the context is less clear. Seth's mother reported that as a small child he would say "He's a happy man right there" whenever he put on or took off a hat. For years, she and Seth's dad had no idea where this comment came from or what it meant. Then one day they happened to be watching an old golf video they had taped several years earlier. They were astounded to see one of the golfers make a hole-in-one and then tip his cap to the audience as the announcer said, "He's a happy man right there." Seth had associated this phrase with hats, and the two remained linked in his mind, although the phrase made little sense to others and didn't help him communicate his wants or needs.
Another communication problem for children with AS-HFA is their literal interpretation of what is said. As we all know, often what we say is not exactly what we mean. When his mother sarcastically commented that Seth, who had ignored her request to clean his room, "was doing a really good job," he nodded and continued playing Nintendo. He didn't appreciate his mother's frustration, conveyed by her tone of voice and facial expression, or notice the mismatch between her statement and the context. Another boy, when I called his house and asked if his mother was home, answered "Yes" and then hung up the phone. He took my question literally, rather than understanding it as a polite but indirect way of asking to speak to his mother.
Still another common communication problem of people with AS-HFA is how they speak. Children with these disorders may speak very loudly or, conversely, too softly to be heard well. Words may tumble out of their mouths at breakneck speed or crawl out as if on a recording played at the wrong speed. Or their speech may have an unusual rhythm, with emphasis placed on the wrong words in sentences, a rising conclusion to a statement, making it sound like a question, or little inflection, giving their voice a flat tone. There may be fewer of the natural pauses we usually make in conversation, resulting in run-on speech. Or they may take breaths at unusual points during speaking, such as in the middle of a word or phrase. Often children with AS-HFA are unaware of how different from others they sound.
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Autism is a developmental disorder that manifests itself in early childhood and affects the functioning of the brain, primarily in the areas of social interaction and communication. Children with autism look like other children but do not play or behave like other children. They must struggle daily to cope and connect with the world around them.