Expert: Dr. Sharon A. Mitchell - 3/3/2007

Question
My son will be 4 this May & was diagnosed with mild autism this past January.  I am very frustrated because he will not see his doctor again until May & I have no idea what I can do to help facilitate his conversation skills.  It was determined that his language skills are a year & a half behind.  He has a hard time answering simple yes or no questions, has difficulty understanding pronouns, & his answers are always short & robotic.  I want to have a conversation with him & I would like to help prepare him for preschool because I am afraid that other children will give him a hard time for "talking like a baby".  Any tips ... I really was given NO INFORMATION from his doctors.  

Answer
Kelli, it can be very frustrating to receive a diagnosis but then feel like you're left danglling on your own without the guidance of experts.

But keep in mind that while others may know lots about autism, you are the expert on your child. There are lots of things you can do, even if you won't see the doctor again until May.

It's likely that your instincts are right on. You sensed something might be wrong and took your son to see a doctor. You are worried about his language development and how he will fare socially in school.

Rest assured that when your son reaches his preschool, he will not be the only child present with language delays. There's a continuum of what is "normal" for four years and although your little guy is struggling, he likely will not be alone in that.  Here's a chart of language development milestones. Note the wide variety of ages. http://www.asha.org/public/speech/development/child_hear_talk.htm

You mention that he has difficulty answering questions and gives brief responses. Although an assessment by a Speech/Language Pathologist would of course be ideal, you can glean useful information by observing your son yourself.

Since your boy responds to questions, I'm assuming that his hearing is all right. But if he's had a history of ear infections, it might not hurt to have his hearing acuity checked.

Even when a person's hearing is just fine, it is still possibly to have difficulties, not so much in hearing what is said but in interpreting and responding to those words. These auditory processing difficulties are not uncommon in people with autism.

Does your child seem to have more difficulty listening and responding in noisy situations? Unfamiliar situations? When there are strangers around? When many things are competing for his attention?

There are a few things you can try if your son is having auditory processing difficulties, such as:

- wait until you have his attention before speaking to him
- speak clearly (don't mumble) and don't speak over your shoulder or with your back to him
- speak a bit more slowly than normal
- speak in short phrases, say 4 or 5 words, then pause before saying the next bit
- after you speak or give you direction, pause and give him time to process what you said before you expect him to respond. This required "wait time" varies from person to person but may be as long as 10 seconds. Just wait. Don't show your impatience or restlessness.
- during this wait time, don't try to speed things up or make them clearer by rephrasing what you just said. To some people with auditory processing weaknesses, it can seem like you are now starting a whole new topic, when they were only half way through processing the last one. In such cases, rewording what you originally said does not help but actually can hinder or at least slow down understanding.
- try not to have several people talk to your son at once. While that's often the way we carry on conversations, it's easier for a person with auditory processing difficulties to concentrate on just one voice at a time.
- keep your tone neutral. Heightened emotions can complicate things. The child may be trying to decipher your loud or angry or excited voice tone as well as your words, resulting in a confused mishmash. (Remember the old Charlie Brown cartoons where the teacher's voice would sound like, "Wha, wha, wha, wha wha"?)

It's a fairly safe assumption that anyone with autism has stronger visual than auditory skills. This means that your son likely takes in information better through what he sees than through what he hears. You can use this information to your advantage. Couple what you're saying with visuals. Visuals can consist of pictures, photographs, stick figures, or actual objects. Show him the picture while you say it's label. Let him respond with a visual rather than just requiring him to speak to you. Some parents are afraid that letting their child use visuals might hinder his spoken language development. Research instead shows that the use of visuals actually enhances the development of spoken language.

There are a couple of books that you might find helpful:

Making Visual Supports Work in the Home and Community (http://www.amazon.com/dp/096725146X?tag=autismhelpf0e-20&camp=14573&creative=327...) by Jennifer Savner

Linda Hodgdon has an excellent book called, Visual Strategies for Improving Communication : Practical Supports for School & Home (http://www.amazon.com/dp/0961678615?tag=autismhelpf0e-20&camp=14573&creative=327...)

There's a video that may give you confidence in your ability to help in your son's language development. It's
called, Oh Say What They See. It shows how you can use the nature way you play with your child as a fun, non-threatening therapy session. Several distributors handle it if you do an internet search, such as this one: http://www.edpro.com/products/detail.aspx?ID=27&type=1 . On that site, there's a free brief video clip to show what
the method is about. You can watch it here: http://www.edpro.com/video/GT01.mov

Before you go spending a lot of money on such things, check with your local library. They may carry or be able to order this video or the above books for you. You local Public Health department may also carry Oh Say What They See.

The American Speech-Language-Hearing Association has excellent, free information available on their website. There is a section that helps you locate therapists in your vicinity http://www.asha.org/public/

Language is not something that is learned in weekly half hour sessions. It's something that flows naturally as part of your child's day. Here's a list of some activities you and your son can do together that will help his language skills: http://www.asha.org/public/speech/development/Parent-Stim-Activities.htm

Pragmatics are sort of our social niceties of language. While most of us picked up these unspoken rules all on our own, often kids with autism need to be taught these rules explicitly. Here's some information on pragmatics that you can incorporate into your interactions with your boy: http://www.asha.org/public/speech/development/Pragmatic-Language-Tips.htms

When you see a child every day, it's hard to note progress. Often growth happens in those little stages that are hard to notice. You could consider tape recording or videorecording your son right now while he's playing alone and with someone else. Then put that tape away for a couple months while you try some of the suggestions above. Then, replay the tape to see the changes. This could be a useful tool to show your physician or therapist as well.

My apologies for taking a number of days to reply. I was away at a conference and neglected to let All Experts know I would be away. Best of luck to you and your family,

Sharon A. Mitchell
www.autismsite.ca