Autism spectrum disorder (ASD) is a developmental disability characterized by notable difficulties in social interaction, communication, and behavior. Autism spectrum disorder (ASD) affects approximately 1.7% of the population. Individuals with ASD frequently experience challenges with language, with around 25% to 30% of children failing to develop functional language skills or remaining minimally verbal. The communication and language capabilities of children with ASD are influenced by their intellectual and social growth. While some may struggle to use speech or language for communication and may have limited verbal skills, others might possess extensive vocabulary and excel in discussing particular topics in depth. These challenges significantly impact the capacity of children with ASD to engage with others, particularly individuals of their age.
Social communication deficits in autism refer to difficulties individuals with autism spectrum disorder (ASD) experience in effectively engaging in social interactions and exchanging information with others. These deficits manifest in various ways, including challenges in understanding nonverbal cues, maintaining appropriate eye contact, interpreting social nuances, initiating and sustaining conversations, and developing and maintaining friendships. In neurotypical individuals, communication disorders primarily entail issues with language, while social interaction remains largely unaffected. However, individuals with autism spectrum disorder (ASD) face significant challenges when it comes to communicating effectively within social contexts. People on the autism spectrum often encounter difficulties across various verbal and nonverbal domains, encompassing grammar, appropriately applying pronouns, and responding to spoken cues. Variances in nonverbal communication elements like facial expressions and speech tempo might contribute to what others perceive as ‘awkwardness’ in individuals with autism. While there exists considerable diversity among individuals with autism, two distinct communication challenges frequently emerge: pragmatics, which refers to the skill of using language appropriately in social contexts, includes staying on topic during conversations, taking turns, asking relevant questions, and adjusting one’s tone of voice according to the setting (such as using a quieter voice in a classroom compared to a playground). Another aspect is the deficits in their prosody. Prosody is the rhythm and intonation of speech, encompassing verbal and nonverbal communication elements. It is conveyed through the spoken words and the pauses between them, serving various functions in communication.
It is crucial to teach children with ASD to enhance their communication skills to support them in realizing their full potential. While various approaches exist, the most effective treatment program typically commences early, during the preschool years, and is customized to the child’s age and interests. The treatment should encompass the child’s behavior and communication skills, consistently reinforcing positive actions. For many younger children with ASD, enhancing speech and language abilities is an attainable objective through treatment. Parents and caregivers play a crucial role in facilitating this progress by closely monitoring the child’s language development from an early age.
Here are some strategies commonly employed by speech therapists:
ASSESSMENT
Begin with a comprehensive assessment to identify the individual’s strengths, weaknesses, and specific communication goals. Like how toddlers learn to crawl before they walk, children typically develop pre-language skills before transitioning to verbal communication. These skills encompass using eye contact, gestures, body movements, imitation, babbling, and other vocalizations as means of communication. Children who exhibit delays in these skills may benefit from evaluation and intervention by a speech-language pathologist to mitigate potential developmental setbacks.
SOCIAL SKILLS TRAINING
Social skills training in autism aims to empower individuals with the necessary skills and confidence to navigate social interactions successfully, leading to improved social relationships and quality of life. It provides structured and explicit instruction on specific social skills, including but not limited to understanding nonverbal cues (e.g., facial expressions, body language), initiating and maintaining conversations, taking turns in social interactions, perspective-taking and empathy, making and maintaining friendships, and resolving conflicts peacefully. For slightly older children with ASD, the training focuses on teaching fundamental speech and language skills, such as using single words and phrases. Advanced training emphasizes the functional aspect of language, such as learning to engage in conversations with others, which involves staying on topic and taking turns speaking.
VISUAL SUPPORTS
Utilize visual supports such as social stories, visual schedules, and cue cards to help individuals with autism understand social expectations and navigate social situations more effectively. A social story describes a situation, skill, or concept regarding relevant social cues, perspectives, and common responses in a specifically defined style and format. A social story aims to share accurate social information with a patient in a reassuring manner easily understood by its audience. As such, it is a short story written for an individual describing a specific activity and the behavior expectations associated with it.
Social Stories can be implemented through different methods: they can be read independently or by a caregiver, or presented through audio or video equipment or computer-based programs. Research suggests that social story intervention is a beneficial tool in decreasing frustration behaviors exhibited in children with ASD.
VIDEO MODELLING
Video Modelling is a method that demonstrates a specific behavior by a video representation of that behavior. An intervention using video modeling consists of two stages: the concerned individual watches a video presentation and imitates the behavior modeled in the video on a later occasion. Video modeling uses predictable & repeated presentation of target behaviors, which are presented in video format, thus reducing variations in model performance. Video modeling has been demonstrated to increase social interactions, improve conversational skills, and improve play skills.
Types of video modelling include
- Basic video modeling: Explicit expected behavior is exhibited by another person or other people and shown to the learner through video.
- Video self-modeling: The learner is videotaped successfully demonstrating an explicit expected behavior, and the learner watches the video.
- Point-of-view video modeling: An explicit expected behavior is videotaped from the learner’s perspective (e.g., two hands tying shoelaces) and shown to the learner.
- Video prompting: The explicit expected behavior is broken down into discrete steps, videotaped, and shown to the learner.
ROLE-PLAYING AND MODELING
Engage in role-playing activities and model appropriate social behaviors to help individuals practice and generalize skills in different contexts. Role-playing involves individuals taking on different roles or characters in simulated social situations. These scenarios can be based on real-life or hypothetical scenarios relevant to the individual’s social goals.
AUGMENTATIVE AND ALTERNATIVE COMMUNICATION (AAC)
Introduce AAC systems such as picture exchange systems, communication boards, or speech-generating devices for individuals with limited verbal communication skills to facilitate social communication. Certain children with ASD may not develop oral speech and language skills. In such cases, the objective may involve learning alternative communication methods like gestures and sign language. For others, the goal may entail utilizing a symbol system where pictures represent thoughts or concepts. Symbol systems can vary from simple picture boards or cards to more advanced electronic devices that generate speech via buttons representing common items or actions.
PEER MEDIATED APPROACH
Another approach that plays a crucial role in promoting social communication in children with ASD is peer interaction. Various peer-related strategies have been developed and scientifically evaluated to enhance the social functioning of children with autism. These strategies involve leveraging socially competent peers to model and reinforce appropriate social behaviors. A vital aspect of these interventions is promoting peer involvement, which is achieved by adjusting peer expectations regarding their classmates with autism. Techniques may include creating specific situations or incentives to encourage optimal peer involvement, teaching peers methods to reinforce target skills in children with autism, instructing peers on initiating interactions with children with autism, and providing social skills training for children with autism themselves. These peer-related approaches are grounded in social learning theory. Numerous studies have demonstrated significant enhancements in the social interactions of children with autism resulting from implementing these strategies.
We should also encourage generalizing skills learned in therapy sessions to real-life situations by providing opportunities for practice and ongoing support. By implementing these strategies within a supportive and individualized speech therapy program, individuals with autism can significantly improve their social communication skills.
