The fourth and final post in our 4-part series on communication in children with autism spectrum disorder focuses on children who possess high verbal abilities, but may struggle with conversations and reciprocal social interaction.

In many ways, the ability to carry on a conversation is the culmination of the foundation skills of language and social communication development that have been described in previous posts.  We have conversations to tell our stories, enlighten or persuade others to our point of view, and to negotiate or resolve conflicts.  The ability to carry on conversations is an integral skill to function in our social world.

Conversations involve the ability to attend to others, process verbal and nonverbal information (i.e. words, gestures, facial expressions), access your personal knowledge about a topic or social situation (often from personal experience) and formulate an appropriate response.  Responses can be answers to questions, asking questions to gain information, relating personal stories, or making related comments.

Conversations involve appropriate turn-taking, the ability to stay on a topic, and the ability to modify what you do or say given the communication of your partner.  In addition, we need to interpret or “read” the nonverbal social cues and perspectives of others while simultaneously directing our own nonverbal communication via facial expressions, gestures and eye gaze that matches what we are saying.  Add to that the fact that social interactions are rarely the same and are an ever-evolving, dynamic process.  Quite a lot to do in a split second and sustain for the duration of an interaction!

People who have autism spectrum disorder often demonstrate difficulties with one or many of the above abilities.  We use the terms “social communication” or “pragmatic” language to describe the communicative abilities that are involved in social interactions (e.g. the “how” and “why” we communicate).

Children who present with social communication deficits often struggle with the reciprocal nature of social interactions and conversations.  Difficulties include dominating a conversation and speaking at length about one’s interests or responding to questions with short, specific answers without elaborating.  Children may have difficulty asking relevant questions to gain information about others and exhibit difficulty with attending to, recognizing, and interpreting the social intentions and emotional states of others.

Interestingly, many children with ASD who are at this stage of communication development have adequate, or even advanced abilities in the areas of vocabulary and grammar and may score well on standardized assessments that target those specific areas.  However, despite “age-appropriate” scores on standardized assessment, children with ASD often demonstrate significant deficits and differences in the area of social communication.  Furthermore, they may have difficulty with “higher level” language development, such as making inferences or understanding figurative language, expressions or slang.  These types of problems may not be picked up through traditional language assessment.

Support for communication difficulties at this level involves teaching communication across contexts (i.e. with a variety of people in a variety of situations).  Often children with ASD can state what they should do or say given a social situation.  However, they fail to demonstrate these abilities when opportunities arise in natural situations, such as peer interactions at school.

Speech-language therapy can be individual with targeted treatment to increase conversational skills such as turn-taking, maintaining topics, social initiation, and asking questions to gain information.  Nonverbal communication skills, such as eye gaze to interpret the facial expressions and body language of others, should also be targeted.  Conversational abilities should be quickly generalized to social groups, beginnings with dyads (two children at a time) and then to larger social opportunities, such as a “lunch bunch” or “recess club”.

Visuals can be used to help encourage communication development and specifically, to structure conversations.  Dialogue can be written down and read during 1:1 therapy:

Clinician: “I just got back from the airport.”

The child can be asked what questions he might ask following that statement.  It might help to prompt him with a selection of wh-questions such as:

Child: “Why did you go there?” or “Where did you go?”

A fairly easy and effective strategy for parents is the use of digital pictures.  Most of us have mobile technology (e.g., phones with a camera, tablets) with us all the time. Get into the habit of snapping pictures during special events (e.g. a trip to the zoo, a birthday party, a family vacation).  Think of yourself as a photojournalist for your child.  After the event, use the photos as reminders to help support retelling of the story.  Provide multiple opportunities to retell the story (with Mom or Dad, Grandma, a family friend), and then try to decrease reliance on the pictures to tell the story.

Role-playing and drama can provide opportunities and practice for a variety of social communication abilities.  Another common strategy is the use of social stories: pre-written and practiced stories that provide structure and predictability to social situations.  Social stories provide a script that a child can use to navigate certain social interactions (i.e. how to greet others, how to respond to an invitation to play, what to do during teasing or bullying).

Finally, curriculum such as the Social Thinking curriculum, developed by Michelle Garcia Winner, is increasingly being utilized in classrooms as a whole class strategy that can provide benefit to children with autism and their typically developing peers alike.

Part 1 in Series: Pre-intentional/Pre-verbal

Part 2 in Series: Emerging Verbal

Part 3 in Series: Verbal

Resources:

Social Thinking, in particular the “SuperFlex curriculum”

The New Social Story Book by Carol Gray & Tony Attwood

The Hidden Curriculum: Practical Solutions for Solving Unstated Rules in Social Situations by Brenda Smith Myles et al.

Navigating the Social World: A Curriculum for Individuals with Asperger’s Syndrome, High Functioning Autism and Related Disorders, Jeanette McAfee, M.D.

The Social Skills Picture Book: Teaching Play, Emotion and Communication to Children with Autism, Jed Baker, Ph.D.

Social Skills Training for Children and Adolescents with Asperger Syndrome and Social Communication Problems by Jed Baker

Thinking about You Thinking about Me, 2nd edition, by Michelle Garcia Winner

Diary of a Social Detective: Real-Life Tales of Mystery, Intrigue and interpersonal Adventure, by Jeffrey Jessum, PhD

Julia Cook’s books, such as My Mouth is a Volcano