Barbara L. Trommer MD Pediatric Neurology . Associate Director, Maimonides Developmental Center . Medical School: Columbia University . Fellowship: Children's Memorial Hospital Northwestern University Medical School Pediatric Neurology
Read the full transcript »

Okay, so switching from social skills to communication skills, let's talk about verbal communication skills. They can be anywhere from lack of speech, lack of communicative intent, lack of compensatory gestures. Presence of scripted speech, that's an abnormality. Kids used to recite TV commercials, now they recite videos. They sometimes use the scripted speech as the closest approximation they can get to what they want to communicate when they can't come up with the original language to describe it. For example, I remember reading my kids the book, 'Big Bird Goes to the Doctor', about how scared Big Bird was to go to the doctor, I have had patients come into my office quoting that book. They can't say to me I am scared or are you going to give me a shot or something like that, but they can recite a related script. Echolalia. Echolalia is one of the hallmarks of the abnormality in the speech of autistic children, but again, its different from the vocabulary burst of typically developing children. So you have all watched kids learn to acquire vocabulary by repeating the names of objects that their parents name for them, but echolalia in Autism, it can be the exclusive form of communication. It occurs not in the acquisition of vocabulary, but inappropriately in the response, as I said to you, to a question. For example, what are you going to do? What are you going to do? Instead of, I am going to take a bath. This notion of falsely advanced expressive skills with delayed receptive skills can be deceiving, and again, this can be related to scripted speech. Kids can learn how to recite things even if they don't understand and can't process language on their feet as you try to speak to them. One thing that I have seen over and over again is the sense of being overly independent, getting an object instead of asking for an object. There is a long period of time during development when asking for an object is a social interaction. I have gone so far as to say, when my, now 19-year-old, at the age of 16 would say, can you get me a glass of milk? It was not because she couldn't get milk for herself, it was because she wanted me to do something for her. But many times parents, and even docs will say, look at how intelligent this child is, he knows how to operate the VCR, he knows how to climb into the closet to get cereal. Yeah, he does, but what he should be doing at the age of 2 is asking for cereal or asking you to play his videos. It's a subtle point, that what looks like independence and competence could actually be an abnormal symptom. Then finally, another important aspect of verbal communication is the loss of language which occurs in 25-30% of kids on the spectrum. They simply stop speaking at somewhere between 15 months and 2 years, and that in itself is the topic of a whole another lecture, but is important to know, I think, to believe parents when they tell you that it happens. Of course, it's complicated because it often happens right at the time of vaccination and so there is a tendency to attribute. But I believe parents when they tell me, my kid used to be able to smile when we were taking pictures and said cheese, and stopped doing that, stopped using the language that he had. In Asperger Syndrome, the language deficits are not the same as they are in Autistic Disorder. The language may be a typical; its fluent, the topics may be limited. These are the kids who are pedantic, they sound like little professors. They have Impaired Pragmatics. They don't know how to take turns in a conversation. They don't know when to stop speaking and let you respond. They don't know how to answer questions. They, sort of, just talk about topics that they know a lot about. They don't react to body language. They can't tell when you are getting angry or bored by what they are saying so that they could let up on that topic and let you introduce a topic that you are more interested in, and that might sustain the conversation.

Advertisement
Advertisement
Advertisement