Treatment of Communication Impairment in Individuals with Autism Spectrum Disorders

Autism Spectrum disorders (ASD) have been characterized by severe chronic impediments to social interaction, communication and interests. These impairments themselves interrelate and affect the trajectory to assess, diagnose and treat of individuals with ASD. We can note for instance that difficulties in both verbal and non-verbal communication have a significant impact on social development. As a consequence, a great deal of research has focused on approaches for improving communication skills for individuals with autism spectrum disorders (ASD), in particular for those who are non-verbal.

Numerous individuals with autism spectrum disorders do not develop useful speech. 25-50% of individuals with ASD never develops spoken language or learns to express themselves in any functional way or use gestures or other forms of communication to compensate. Individuals with ASD usually experience little use of conventional gestures, reduced attention to others’ face and voices, reduced integration of gaze, gestures and vocalization and difficulty to joint attention. We have a lot of hypotheses about why individuals with autism spectrum disorders (ASD) fail to develop verbal communication or expressive language skills. Some researchers have hypothesized that some of the reasons are low cognitive ability, deficits in receptive language, failure of symbolic capacity, failure to understand the function and value to communicate with others, and imitation deficits among others problems. Moreover, persistent lack of speech of some individuals with autism spectrum disorder that involve receptive and expressive language deficits has been attributed to abnormalities in lateral temporal cortex, small amygdalae and linkage to chromosome 7q31–33.

There are many different approaches to improve communication skills in individuals with autism. However, only a few of them have evidence-based with randomized research studies. Before naming a few of these approaches, it is important to recognize that the first step to improving communication skills and develop an effective communication intervention plan for the non-verbal individuals with autism is to determine the individual’s current communication abilities. Also, we need to understand the function of the communication: Behavioral regulation, social interaction or joint attention.

As mentioned, different approaches have emerged in trying to give an answer to the problem of how we can treat communication deficits in autism spectrum disorders (ASD).

• A few studies suggested that Picture Exchange Communication System (PECS) in conjunction with applied behavior analysis increase social-communicative behaviors, spontaneous language, speech, higher percentage of independent “mands” (requests for preferred items) and decrease problem behaviors, but the improvement takes long period of time. The picture exchange communication system (PECS) is a pictorial system that was developed for children with social-communication deficits. The system uses basic behavioral principles and techniques such as shaping, differential reinforcement, and stimulus control to teach children functional communication using pictures. In addition, PECS has been associated with spontaneous increases in spoken language.

• Another approach, Motor Communication Training (MCT) shows better effect than PECS in small children with autism.

• Children treated with More Than Words (MTW) showed increase in vocabulary, but not in social communication.

• Another approach is Relationship Development Intervention (RDI), which does not focus on communication, but in social relationships. DRI approach does not teach skills, but helps to develop pleasure in relating to others. Although some studies show improvement in functional emotional abilities in decreasing autistic symptoms, however, this approach did not show statistically significance improvement in communication.

• Sign Language treatment studies suggested that non-verbal children fail to use any signs functionally and children using Sign Language did not make progress. For both participants, sign language training produced a higher percentage of vocalizations during training.

• Children with autism spectrum disorders using Augmentative Alternative Communication devices (AAC), non-PECS communication boards, Voice Output Communication Aids (VOCAs) show modest improvement in speech production, although there is no scientific evidence that these devices will lead to speech development.

• Although there is no single best approach for all individuals to treat language development, Discrete Trial Instruction (DTI) and Rapid Motor Imitation Training (RMIT) have been shown to be effective in eliciting first spoken words from preverbal children. DTI is a specialized form of instruction that breaks down tasks into their component parts with instruction delivered in small units (e.g., “Stand up” and “Touch your nose”). RMIT consists of imitating rapid motor imitation sequences of actions, and then a simple word for a preferred item (reinforcer/reward) is added to the end of the sequence to be used as a request.

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(Van Droof et al. 2010; Tager-Flusberg, 1993; Tager-Flusberg, et al. 2005)
(Paul, 2010; Chawarska, et al. 2007)
(Nacewicz et al. 2006)
(Bondy & Frost, 1994; Siegel, 2000; Yamall, 2000; Ganz & Simpson, 2004; Tincani, 2004)
(Carr & Durand, 1985; Stokes, et al. Stokes, Fowler, & Baer, 1978).)
( Magiati & Howlin, 2003)
(Frost & Bondy, 1994)
(Charlop-Christy et al, 2002).
(NRC, 2001, Paul 2010)
(Voder 2002, 2006)
(McConachie et al., 2005)
(Greenspan Wekder, 2006)
(Barteh, 2004; Chzyh, 2006)
(Gustein & Sheely, 2002)
(Layton & Watson, 1995; Voder & Layton, 1988; Grove & Dockrell, 2000)
(Miller, Light & Schlower, 2006; Brady, 2000; Garrison-Harrell et al., 1997.)
(Lovaas, 1987; Kates-McElrath & Axelrod, 2006)