Autism is commonly referred to as a pathophysiological condition of the patient that results in emotional and communicative dysfunction. Although the true causes of autism are still being determined and therapy methodologies are being developed, by now, it is clear that one of the most striking manifestations of psychiatric pathology is impaired speech formation. Thus, a patient diagnosed with ASD has problems speaking and writing. This research report aims to trace and discuss the key features of language disorders when an individual is diagnosed with an autism spectrum disorder.
Autism spectrum disorders should be considered significant human health problems whose causes are not fully understood. The global community has developed several clinical hypotheses that can be applied to individual autistic conditions and all manifestations of the pathology in general. It should be emphasized that research in this field is ongoing, so one cannot rule out the possibility that all relevant theories are valid, especially in light of the multiple pathogenetic manifestations of the disorder. Thus, the most common and formalized hypothesis is the hereditary nature of childhood autism, whereby endogenous disorders of fetal embryonic development are expressed during crisis periods, trauma, and infections (Cheroni et al., 2020). Such findings have been confirmed by both twin studies, in which the probability of developing autism was as high as 90%, and by family analysis, which showed a higher-than-average probability of having the disorder in the population (Almandil et al., 2019). Although the genetic cause of autism is not in doubt, identifying a specific gene or identifying its cascade is still a challenge. In this context, it should be noted that the genes themselves are critical to the development of the pathology and the environment in which the individual is raised. It is expected that two twins raised in different environments may not necessarily both have pronounced autism.
At the same time, there are theories that autism may be initiated by severe structural damage to the brain. It has been shown that the size of the cerebellum (normally responsible not only for coordinating the body in space but also for implementing higher nervous functions) is significantly smaller in children with the diagnosis, which may be reliable evidence for this theory (Laidi et al., 2017). Consequently, research in this area must continue to establish the precise mechanism of autism spectrum disorders.
In the context of autism spectrum conditions, it should be noted that this pathology is expected, and the trend in prevalence is rapidly increasing over time. Reference to the CDC unequivocally shows that between 2000 and 2016, the prevalence of this condition among children increased by almost 280% (CDC, 2020). These are impressive numbers that demonstrate an undesirable trend for the health care system to spread the pathology. At the same time, one of the most studied spectrum conditions, Asperger’s syndrome, has an average prevalence of 1:160, according to the WHO (WHO, 2021). This also confirms the high incidence of cognitive dysfunction. It is also noteworthy that the WHO postulates no statistically significant association between vaccinating children for critical human diseases at an early age and the development of autism, as previously suggested. Other scientific evidence on the epidemiology of the disease includes an increased prevalence of autism among boys and no pronounced imbalance in terms of ethnic differentiation. For example, boys are, on average, four times more likely to be diagnosed than girls (Maenner et al., 2020). On the other hand, any differences between morbidity among black and white children were determined more by differences in the availability of medicine and the perception of the health care system by communities as a whole rather than by the actual agenda. In sum, from an epidemiological perspective, autism is a hazardous phenomenon that also has a clear tendency to grow.
Without developed communication skills and language interaction with other individuals, socialization is difficult or impossible. Since the functional structures of the brain are responsible for the formation of speech, it is reasonable to postulate a disorder of cognitive development in such a patient. In other words, there is a state of language deficit, in which the individual cannot express his or her thoughts quite naturally and adequately, using speech constructions as a tool (Rear, 2017). Therefore, patients usually tend to be lonely and low communicative because they understand the technical difficulty of communicating with others. However, even if the child desires to communicate, he or she cannot maintain eye contact for long periods and constantly loses attention, which may be perceived from the outside as rude (Jiang et al., 2020). The above descriptions perfectly describe individuals with an autism spectrum diagnosis.
The manifestations of the linguistic disorder in children with autism spectrum disorders should be preliminarily emphasized. First, these patients are characterized by unclear identification between themselves and other people, or, to put it another way, people with autism differentiate their personality worse than healthy individuals. This manifests as frequent confusion in using personal pronouns when the person with autism uses “you” and “he/she” to describe himself/herself. Second, a serious linguistic problem also lies in the complete or partial lack of understanding of the speech addressed to the patient. Autistic people cannot sufficiently reliably identify the object of reference so that they may be utterly unresponsive to messages and messages to them. In this context, pragmatics is also impaired: patients cannot qualitatively distinguish the intonation of spoken speech (Matson, 2017). Consequently, a mother’s address to a child diagnosed as “Hold on tight, or you might fall” will often either not be perceived by such a patient or be seen as a call to fall. Third, the lack of personal perception and the impossibility to interact correctly with the incoming information cause a low activity of the individual to repeat phrases and ask questions imitatively. It should be emphasized that imitation is understood to be a conscious activity, where the repetition of what has just been saying is done to take some time for reflection, as is the case with healthy people. In contrast, echolalia, expressed as uncontrolled repetition of words heard, is characteristic of autistic people: as a rule, there is no understanding of the semantic core of what has been said (Shield, 2017). For example, some autistic people are characterized by spontaneous repetition of small numbers during a conversation, even when the subject of communication is unrelated to arithmetic. It can also be expressed in the repetition of phrases that the child has heard once, but their use is irrelevant in the given context. Finally, if a child with a diagnosis asks something, such a question is systematic, which means the verbal construction of the question is often repeated.
The patient’s speech disorders have a more comprehensive range of manifestations. Notably, the nonverbal part of communication is almost absent in children with autism syndrome (Matson, 2017). A concrete illustration of this feature can be seen in the frequent absence of a pointing gesture when an individual wants to draw the attention of others to some object: he or she cannot. Consequently, the individual develops a persistent sense of inability to express his or her feelings, emotions, and desires through the communicative tools of speech that healthy people use. These children often tend to use loud words and indistinguishable sounds to share their experiences.
In part, a child on the autism spectrum initiates his or her impaired socialization. The technical difficulty or inability to express oneself correctly and adequately leads such patients to become frustrated in communication. Their speech should be characterized as egocentric and autonomous, and addressing specific topics is usually not connected with the general subject of conversation. Consequently, children often decide to abandon attempts to establish communication because they understand in advance that they may seem rude or uninteresting to the interlocutor.
Assessment and Treatment
One of the earliest signals of development on the autism spectrum in a child may be pronounced loneliness of the individual, during which he tends to engage in trivial, routine activities. Any additional delays associated with delayed development of speech functioning and self-awareness mechanisms may be sufficient evidence of the formation of an individual’s cognitive dysfunction. In this case, parents should contact a professional physician from an early age to perform a reliable clinical evaluation of the child.
A competent clinician can use both informal and formal cues in clarifying the diagnosis. The following oddities may cause the clinician to suspect the child is on the autism spectrum: lack of eye contact, mixing up pronouns, mooing instead of separate words, possible tantrums and aggression, and some fear of light (Jiang et al., 2020). After identifying these cues, the doctor may administer a short three-question test to clarify the diagnosis. The first question consists of tracking the direction of the child’s gaze, primarily if pointing him or her to a specific object. The second question is to examine the child’s ability to point at an object with his or her finger in an attempt to draw attention to it. The third issue is to observe patterns of the child’s play behavior to understand whether he or she can imitate the actions of adults.
On the contrary, in light of the trend toward highly accurate diagnosis, as many independent instruments as possible should confirm the disorder. For example, the clinician may use several types of screening, diagnostic tests, and benchmark assessments. The M-CHAT, ASSQ, and CARS fall under screening tests, which use a checklist system to make a diagnosis through observation of the child (Eltyeb, 2017). Differences in tests are due to the age at which one or the other methodology is applied. In the context of linguistic deficits, diagnostic tests such as ADOS and ADI-R are often used. ADOS is characterized as a play scale in which the child moves sequentially around the room with the clinician (Lefort-Besnard et al., 2020). The ADI-R is an interview format in which a conversation is conducted with an adult who is familiar with the patient’s history. Finally, the ATEC benchmark assessment is used by the clinician to assess the effectiveness of therapy systematically.
It must be recognized that there is no single cure-all pill that can altogether remove all of the adverse effects of the disease. On the contrary, the patient’s therapy is a long and complex linguistic and cognitive correction mechanism, which requires careful use of the methodology. On the one hand, speech therapists can strengthen the mouth and neck muscles, on the formation of the child’s correct sound system, and the development of a comparison of meaning with the image depicted in the picture. On the other hand, the methodology may include the use of alternative communication expressed through iPads, PECS, or Dynavox (Kurniawan, 2018; Lorah et al., 2018). This correlates well with the new method of using anthropomorphic and zoomorphic robots, allowing the child to develop better language structures (Szymona et al., 2021). Finally, the most advanced forms of treatment may include music therapy as an effective form of developing the child’s creative and cognitive skills (Li, 2016). As a result, the individualized nature of the clinical approach to each child should be emphasized, beginning with assessing the condition and ending with the choice of a specific treatment methodology.
The fact that life for parents with a child with an autism spectrum disorder requires a great deal of effort should be emphasized. Unlike healthy children, interacting and raising such a child takes much more effort and time, so parents need to be optimistic and patient. If a parent shows a negative attitude toward the child or expresses an apparent disinterest in support, it cannot be an effective solution for the patient’s therapy. The speech therapy discussed above is only one component of a complete treatment system to address linguistic dysfunction. Other treatment formats include video therapy, social skills training, and even treatment through occupational therapy (Lofland, 2014; Matson, 2017). However, it should be understood that even if speech therapists and remedial therapists can achieve some early treatment results, the transition to school can significantly exacerbate the adverse effects. In this regard, it is crucial that teachers follow the patient’s individualized teaching methodology and do not impede the consolidation of the toddler’s communicative, social, and linguistic competencies.
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