Section 5: Communication. Part 1: Early Warning Signs. Theresa Golem. December 5, 2012

Transcription

1 Section 5: Communication Part 1: Early Warning Signs Theresa Golem December 5, 2012

2 Deficits in the area of communication are one of the key characteristics of autism spectrum disorders (ASD). Early warning signs in the area of communication may be some of the first indicators a parent or caregiver observes that may cause him/her to have concern about his/her child s development. Early warning signs in the area of communication may include delays in early social communication behaviors such as social smiling, responding to his/her name, and looking at faces (Boyd, Odom, Humphreys, & Sam, 2010). Warning signs may also be observed in verbal and nonverbal communication skills including vocalizations and gestures (Boyd et al., 2010). Early identification using warning signs such as those that will be discussed in this section are important because early identification of ASD allows for earlier access to intervention. Social Communication The social use language (verbal and non-verbal) is called pragmatics and can be problematic for children with ASD. Smiling socially is an example of a pragmatic language skill. Typically developing children begin smiling socially around four months of age and children with ASD will likely not smile at people (Learn the Signs. Act Early, 2012). Responding to sounds and speech in the surrounding environment is another social communication skill. By nine months, typically developing children are able to copy sounds and gestures made by others, orient to someone saying their names, imitate sounds, imitate facial expressions, and respond to sounds in the environment by making sounds (Learn the Signs. Act Early, 2012). Parents or caregivers may be concerned if their child does not respond to sounds in the environment or does not orient to his/her

3 name and often parents initially suspect that their child has a hearing deficit (Heflin & Alaimo, 2007). Play is another social aspect of communication that may show early warning signs of ASD. Typically developing children engage in reciprocal play games such as peek-aboo by 9-12 months of age and begin to engage in simple pretend play by 16 months (Learn the Signs. Act Early, 2012). A lack of engaging in pretend play by 36 months is another early warning sign of ASD (Learn the Signs. Act Early, 2012). Children with ASD often demonstrate difficulty with both functional play (using toys appropriately such as pretending to feed a baby doll) and symbolic play (e.g. using a toy banana and pretending that it is a phone) (Heflin & Alaimo, 2007). Difficulties in the area of play may have a negative impact on later language development (Heflin & Alaimo, 2007). By 48 months, typically developing children generally demonstrate a preference for playing with other children while children with ASD often appear to prefer to play alone (Learn the Signs. Act Early, 2012). Joint attention is another aspect of social communication, which may function as an early warning sign of ASD. Joint attention is a child s ability to pay attention to something that another person is attending to or directing someone else s attention to something of interest in order to share that interest with a communication partner (Heflin & Alaimo, 2007). Joint attention serves as an indictor of a child s desire to interact with others in his/her environment and also helps develop language by eliciting language models from his/her communication partners (Heflin & Alaimo, 2007). Delays in joint attention are seen in many children with ASD and not frequently seen in children with

4 other developmental delays, which makes it an important warning sign for ASD (AAP Council on Children With Disabilities Autism Subcommittee, 2012). By months of age, typically developing children will look in the direction of where an adult is pointing and will imitate an adult s facial expression (AAP Council on Children With Disabilities Autism Subcommittee, 2012). In contrast, children with ASD often ignore adults attempts to engage in joint attention and adults may be concerned that the child has a hearing deficit (AAP Council on Children With Disabilities Autism Subcommittee, 2012). By months of age, typically developing children are able to point to an object that they want while a child with ASD will lead an adult to the item without engaging in eye contact (AAP Council on Children With Disabilities Autism Subcommittee, 2012). Finally, by months of age, typically developing children will point to an object that they are interested in and look back and forth between the object and an adult to be sure that the adult is attending to the object (AAP Council on Children With Disabilities Autism Subcommittee, 2012). Children with ASD will only point to objects for an adult to retrieve the objects and does not attempt to engage the adult in joint attention to share an interest (AAP Council on Children With Disabilities Autism Subcommittee, 2012). Deficit in the area of joint attention is one of the key warning signs for ASD. Non-Verbal Language Communication/Gestures The use of gestures as non-verbal communication is another form of communication that may display early warning signs of ASD. By nine months of age, typically developing children begin to use fingers to point to objects that they want (Learn the Signs. Act Early, 2012). Children with ASD are more likely to use a

5 technique called leading in which they guide an adult to an object that they want rather than pointing (Heflin & Alaimo, 2007). By 12 months of age, typically developing children are able to use simple gestures such waving or shaking their head while children with ASD are less likely to use these types of gestures (Learn the Signs. Act Early, 2012). Verbal Language Communication Finally, communication also includes the comprehension and use of vocalizations beginning with cooing and babbling as an infant and progressing to the use of words. Typically developing children begin cooing by two months of age, babbling (the production of speech-like sounds) and imitating sounds by four months of age (Learn the Signs. Act Early 2012). If a child does not begin babbling by nine months of age, this may be an indicator of ASD (Learn the Signs. Act Early, 2012). By 12 months of age, typically developing children are able to respond to simple requests, use adult-like intonation in speech, imitate words, and begin to develop a vocabulary of single words (Learn the Signs. Act Early, 2012). If a child does not develop the use of the expressive single words or demonstrates unusual intonation, these may be warning signs for ASD (Learn the Signs. Act Early, 2012). Typically developing children are able to say no and have a single word expressive vocabulary of more than one word by 16 months of age (Learn the Signs. Act Early, 2012). A failure to develop single word expressive vocabulary and lack of imitating others by 16 months of age may be a warning sign of ASD (Learn the Signs. Act Early, 2012). By 24 months of age, typically developing children are able to point to objects or pictures when named (a display of receptive vocabulary), are able to follow simple instructions, and are able to use 2-4 word phrases (Learn the Signs. Act Early, 2012). If a

6 child does not use 2-word phrases, does not imitate others, and/or is not able to follow simple instructions there may be a possibility that the child has an ASD. By 36 months, typically developing children can name familiar objects (expressive vocabulary) and can use some simple pronouns (Learn the Signs. Act Early, 2012). A 36 months, children with ASD may not be speaking in sentences, may not follow simple instructions, and may demonstrate difficulty with eye contact (Learn the Signs. Act Early, 2012). Finally, by 48 months, typically developing children continue to expand their use of pronouns and are able to retell stories. Children with ASD often reverse pronouns (e.g. reversing me and you ) and are not able to retell stories. These early warning signs may be indicators of ASD in children. If these signs are observed, parents should consult their pediatrician as soon as possible for the appropriate evaluations. Early diagnosis of ASD is important to allow for early access to appropriate interventions.

7 References American Academy of Pediatrics Council on Children with Disabilities Autism Subcommittee. (2012). Autism spectrum disorders. Retrieved from: disabilities/pages/autism-spectrum- Disorders.aspx?nfstatus=401&nftoken= &nfstatusdescription=ERROR%3a+No+local+token. Boyd, B.A., Odom, S.L., Humphreys, B.P., & Sam, A.M. (2010). Infants and toddlers with autism spectrum disorder: Early identification and early intervention. Journal of Early Intervention, 32, (2), Centers for Disease Control and Prevention. (2012). Learn the signs. Act early. Retrieved from: Heflin, L.J., & Alaimo, D.F. (2007). Students with autism spectrum disorders: Effective Instructional Practices. Upper Saddle River, NJ: Pearson Education, Inc.

8 Quick Reference Guide of Typical Development and Early Warning Signs 2 months Typical Cooing Orienting to sounds in environment 4 months Typical Smile socially Imitate movements and facial expressions Babbling (speechlike sound) Imitate sounds Differentiate crying for different messages (e.g. hunger, tired) Warning Signs: Does not smile at people Does not coo Does not make sound 6 months Typical Likes to play with others Responds to sounds in environment Orient/respond to someone saying his/her name Begins to produce earlydeveloping consonant sounds (/m, b/)

9 Warning Signs: No demonstration of affection for caregivers No response to sounds Doesn t produce vowel sounds

10 Quick Reference Guide of Typical Development and Early Warning Signs 9 months Typical Understands no Copies sounds and gestures Uses fingers to point Warning Signs: No babbling Does not respond to name Does not look where you point 12 months Typical Plays games (peeka-boo) Able to respond to simple requests Use simple gestures (e.g. waving) Using intonation Attempts to imitate words Warning Signs: No single words in expressive vocabulary No use of gestures No pointing 16 months Typical Engage in simple pretend play Pointing for joint attention Has more than 1 word in vocabulary Able to say no

11 Warning Signs: Not gaining expressive vocabulary Not imitating

12 Quick Reference Guide of Typical Development and Early Warning Signs 24 months Typical Point to things/pictures when named Knows names of familiar people Uses 2-4 word phrases Follows simple instructions Warning Signs: Does not use 2- word phrases Does not imitate Does not follow simple instructions 36 months Typical Takes turns in games Shows wide range of emotions Can name familiar items Uses some pronouns Understand some spatial concepts (e.g. on, under, in) Warning Signs: Not speaking in sentences Can t follow simple instructions Doesn t engage in pretend play No eye contact No engagement with other children

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14 Quick Reference Guide of Typical Development and Early Warning Signs 48 months Typical Prefers to play with other children rather than alone Engage in more creative pretend play Able to use pronouns (he/she) Able to tell stories Warning Signs: Doesn t appear interested in interactive games Unable to retell stories Does not use pronouns appropriately Does not appear to understand same and different **Information in this quick reference guide was obtained from:

15 Centers for Disease Control and Prevention. (2012). Learn the signs. Act early. Retrieved from: