By definition, autism spectrum disorder is a neurodevelopmental condition; that is, children on the spectrum are born with differences in the brain structures, characterized by challenges in social communication, interaction and restricted or repetitive behaviours or interests. Beyond the classical red flags checklist in developmental milestones, let’s look at what skills are involved in communication and how they are impacted in ASD, giving us a clearer picture of what autism looks like.

Individuals on the spectrum have challenges with non-verbal communication. Imagine a typical four-year-old, English-speaking child that has parachuted into a deserted island whose inhabitants do not speak English- find him. Even though they would not understand any words from each other, they would be able to have a great deal of social communication. For example, the child could express to the inhabitants that he was afraid, sad and thirsty. The inhabitants could make him feel that he is welcome and that they will take care of him. Similarly, a typical child who is told by a peer, “Nice Job!” after missing a goal in a football match can figure out that he is being insulted despite the literal meaning of the words. This power of non-verbal communication is blunted in individuals with ASD.

To better understand what social communication means and the challenges children with ASD have, let’s look at the two aspects of communication – the urge to socialize and the ability to socialize.

The urge to socialize

Humans have a unique skill that aids in relating and empathizing with each other. This skill is The Theory of Mind: “I have a mind, you have a mind, and our minds may or may not know or feel the same way”. Without a theory of mind, communication has little or no point. Individuals with ASD lack a theory of mind, which makes it difficult for them to demonstrate an understanding of another person’s perspective. For example, a child with autism may assume that since he is sad, you should be sad too. This child may not understand that someone is deceptive or grasp the concept of white lies.

The ability to socialize

The ability to communicate socially utilizes a range of skills that help achieve meaningful interaction. These skills are defining features affected by ASD:

• Knowing what is appropriate to say and where and when to say it is key in social communication, which also depends on the theory of mind.  For example, a teacher asks a new student in his class where he comes from, and the child says, “from the hallway”. Here the spoken language is precise, but the child missed the purpose of the conversation.

• Unwritten rules are social virtues that are innate and self-taught in typical children. If you find yourself teaching a rule to a child while saying, “I shouldn’t be teaching you this, you might be dealing with an ASD symptom. For example, look at people when you talk.

• The ability to see things as a whole and not just fixate on one aspect. Individuals with ASD are unable to link information coherently into a meaningful whole. They may recall all the details of a story without remembering the narrative.  For example, coming second place in a hurdle race but fixating on not winning the race.

• Play is key in developing communication skills, and failure to establish representational, symbolic, and pretend play is a strong marker of ASD. For example, between 18-36 months, children progress in appreciating the representational meaning of a toy rather than just focusing on its physical attributes (A comb to brush hair). By 18 months, toddlers start to use objects as symbols of representation (A cup, for instance, for drinking but also a flowerpot), and by three years, children are good at pretend play (stuffed animals have feelings and needs). In contrast, children on the spectrum have more mechanical play, such as lining, sorting, dumping, or watching things spin.

• Joint attention is an essential form of social communication, a delay which is a significant marker of ASD.  For example, A child excitedly points to a rainbow so that you can share the experience with her.

• Facial expressions, gestures, eye contact, body language and tone of speech are all forms of communication that we use in our daily lives that are impaired in children with ASD.
• Rather than socializing, an autistic child has an inappropriately intense fascination with parts of an object. Typically, a child with ASD is inflexible and has ritualistic behaviours, including repetitive body movements.  For example, rocking, spinning and or arm flapping.

With social communication being affected significantly, children on the spectrum find it difficult to comprehend their surroundings. This further impacts a child’s mental health with comorbid anxiety, low self-esteem, and feeling isolated and socially unwelcome. Many children on the spectrum, especially those with no challenging behaviours, are often identified later since behaviours seem developmentally or culturally appropriate. For instance, girls struggling with social relationships may be mistaken for being extremely shy. Early intervention has a greater prognosis providing children with interventions to make sense of their world and build on their social and adaptive skills as they navigate their way in society.

Reference:

Kids in the syndrome mix of ADHD, LD, AUTISM SPECTRUM, TOURETTE’S, ANXIETY AND MORE! – Martin L. Kutscher

https://www.spectrumnews.org

Photo by Annie Spratt on Unsplash