Autism Spectrum Disorders: Core Symptoms and their Development Rhea Paul, Ph.D., CCC-SLP

1. Autism Spectrum Disorders: Core Symptoms and their Development Rhea Paul, Ph.D., CCC-SLP Southern Connecticut State University Yale Child Study Center Feb. 11-15, 2008 rhea.paul@yale.edu

2. Triad of symptoms • Severe, qualitative impairment in social interaction • Qualitative impairment in communication • Restrictive, repetitive or stereotyped behaviors interests or activities

3. Social Interaction • Gaze • Attentional patterns • Eye contact • Joint Attention • Imitation • Emotion and attachment • Reciprocity • Play • Peer Relations

4. Eye Contact/Using Gaze to Share

5. Eye Contact

6. Typically-developing toddler Toddler with autism Gaze Patterns 2-year-olds with autism and typical development viewing video of child playing

7. Gaze development in ASD • Newborns show preference for faces • prefer eyes by 2 mo. • Can detect direction of other’s gaze by 4 mo. • Children with ASD fail to develop these patterns • Problems in gaze persist throughout the life span, even in HFA • Are resistant to intervention

8. Joint Attention (Intersubjectivity) • Dyadic: infant looks at adult • Triadic: Begins w/ gaze following (6 mo.) • Progresses to following point (8-10 mo.) • Then to initiation w/ smiling and pointing at objects of interest (12 mo.) • Lays basis for conversation • Very low frequency in ASD, appears later than TD • Can increase with age

9. Joint Attention • Video examples: • JA DD • JA Autism • Imitate JA

10. Imitation • Emerges in infancy • Basis of learning • Fades in typical development • Role of mirror neurons • Less spontaneous imitation and less in elicitation settings for children with ASD

11. Imitation • In normal development http://www.youtube.com/watch?v=-rWKSTtM6Ys • In ASD Haddia example

12. Emotion and attachment • Social referencing • Comfort seeking • Sharing emotion with gaze • Children with ASD • Do show attachment • Have difficulty recognizing emotions: may be related to difficulties in face perception • Less likely to coordinate expression of emotion (smile) with gaze • Difficulties in empathy (hurt examiner experiment) • Decreased social referencing (robot experiment)

13. Sharing emotions

14. Sharing emotions

15. Reciprocity • Turn-taking emerges before language • Back-and-forth nature of social interaction • Deficits in reciprocity can be seen in both verbal and nonverbal individuals

16. Reciprocity: Preverbal

17. Reciprocity: Verbal

18. Play Normal development: • 0-8 mo. All schemes to all objects • 8-12 mo. Functional play • 12-18 mo. Autosymbolic play • 18-24 mo. Single scheme symbolic play • 24-36 mo. Multischeme symbolic • 3-5 Pretend, role play • 5-12 games with rules

19. Play in ASD • Favor exploratory, means-ends, construction, stereotypical play over pretend play • Even symbolic play can be repetitive and stereotypic • May prefer solitary play • May have difficulty w/ flexibility in games w/ rules

20. Play http://www.youtube.com/watch?v=zAu6ehEGMQc&feature=related

21. Peer Relations • TD children move from family-centered to peer-centered social relations • Children with ASD may • Prefer to remain solitary • Be ineffective in approaching and engaging peers • Make fewer approaches to peers • Respond less often to peer bids • Those w/ HFA may • prefer adults to peers • Expand interest in peers during adolescence • Become depressed over loneliness and lack of friendships

22. Communication: Definitions • Communication • Message • Sender • Receiver • Language • Rule-governed • Conventional • Symbolic • Culturally Determined • Communication • Speech • Vocal expression • Sounds of language

23. Language Domains Content Content Content Form Form Use Use

24. Communication is a primary deficit in autism • Of the triad of symptoms, communication is directly involved in two • Communication deficits are a primary means of identifying and diagnosing autism • Communication in autism involves both delay and deviance. • Primary area of difficulty is in pragmatics • BUT deficits in other areas can also be seen; sometimes are similar to those of children with specific language impairments (SLI).

25. Communication in Typical Development

26. Communication Development: Capacities at birth • Vision best at face-to-face range • Infants show preferences for • Faces over other visual stimuli • Speech over other sounds • Female voices over other voices • Own mother’s voice over other female voices • Motherese speech-style over adult directed style • Can discriminate phonemes of native and non-native languages

27. Typical Communication Development: Preverbal & Early Language Perlocutionary Stage: 0-8 mo. • 0-4 mo.: Preference for faces, speech • 4-8 mo.: Development of vocal communication • 6-10 mo.: • Emergence of preference for ambient language patterns • Emergence of speech-like sounds

28. Production 0-2 mo.: Vegetative sounds 2-4: Cooing & laughing 4-8 mo.: vocal play 6-10 mo.: canonical babble 8-18 mo.: jargon babble with prosodic contours of ambient language Perception 0-6 mo.: general speech processing abilities that are biologically determined and “generic;” can apply to any linguistic input (Eimas et al., 1971.) 7-12 mo.: Change in preferences from those that would apply to any language toward ones those closely tuned to the sound patterns of the environment Communication Development: Preverbal Form

29. Perlocutionary Communication

30. Illocutionary Stage: 8-12 mo.Use • Development of intentional communication expressed through • Gestures, e.g., pointing • Vocalization • Gaze • Small range of functions expressed • Proto-imperative • Proto-declarative • 2.5 communicative acts/minute • Emergence of prosodic patterns of ambient language.

31. Illocutionary Stage: Content and Form • Expressive vocabulary starts slowly • 12 mo: 1-3 words • 15 mo.: 10 words • 18 mo. 50-100 words; first word combinations • First 50 words include proper and common nouns, adjectives, verbs, social terms • Receptive vocabulary is larger: 50 words at 15 mo. • Most words have CV shape, one syllable • Sounds used are same as those found in babble: • /b/, /p/ /m/, /n/, /d/, /h/, /w/.

32. Illocutionary Stage: Gestures used to express intents: Contact Point

33. Illocutionary Stage: Gestures used to express intents: Reach

34. Illocutionary Stage: Gestures used to express intents: Distal Point

35. Illocutionary Stage: Gestures used to express intents: Show

36. Illocutionary Stage: Other Conventional Gestures

37. Illocutionary Communication

38. Locutionary Communication: 12-18 mo. • Same intents expressed with gestures, vocalization now expressed with words • New discourse-related intentions expressed • request information • answer • acknowledge • 5-7 communicative acts/minute on average • First words spoken • First words comprehended outside of routines • Rapid increase in spoken vocabulary: • 15 mo: 3 words • 18 mo.: 50-100 words (+/-100) • 24 mo.: 300 words (+/-150) • Word combinations begin when vocabulary=50

39. Locutionary Development: Content • Early two-word utterances express a small range of meanings • Agent, action, object combinations • Possession • Location • Attributes • Meanings related to object permanence

40. Locutionary Communication

41. Communication Development: 18-24 mo. • Repertoire of speech sounds increase • CVC and multisyllabic words increase; many still single syllable • Average child is 50% intelligible • Average expressive vocabulary size at 18 mo. Is 100 words (+/- 100) • Multiword utterances increase in frequency; vocabulary grows • Understanding of sentences is not far ahead of production • Pragmatic developments: • New discourse-related communicative functions: • Discourse management • Turns: increasing awareness of conversational obligation • Topics: 1-2 turns/topic • Register variation

42. 18-24 mo. Communication

43. Limitations in Communication is ASD: Prelinguistic Level • Delayed onset of speech (Stone et al., 1994) • Atypical preverbal vocalizations (Sheinkopf et al., 2000) • Depressed rate of preverbal communication (Wetherby, Prizant & Hutchinson, 1998) • Restricted range of communicative behaviours, limited primarily to regulatory functions (Mundy & Stella, 2000) • Low responsiveness to speech (Osterling & Dawson, 1994) • Delayed and deviant use of gestures (Dawson et al., 1998; Stone, et al., 1997) • Dearth of pretend and imaginative play (Stone et al., 1994) • Laci of imitation orally, vocally, and verbally (Volkmar et al., 1997)

44. TD: Comment

45. ASD: Comment

46. Developing Language

47. Communication Development: 24-36 mo. Form and Content • Average expressive vocabulary size at 24 mo. Is 300 words (+/-150); word classes include • Object & action words • Kinship terms • Spatial terms • Question words • Color, shape words • Grammatical morphemes, verb phrase marking emerges; some overgeneralization • Grammatical forms for sentences such as questions, negatives are emerging • Sentence length is 3-5 words • Intelligibility increases from 50% to 70%

48. Communication Development: 48-60 mo.: Form & Content • Vocabulary at school entry=6000 words • Basic grammatical forms mastered expressively and receptively; • few grammatical errors are heard • Overgeneralization may persist • Average 4 year is 100% intelligible • Speech errors may persist, but speech can be understood • Residual errors in /s/, /l/, and /r are last to resolve

49. Background: Pragmatics of Language • Pragmatic domains: • Communicative functions • Discourse management • Register variation • Presupposition • Prosody

50. Communication Development: 48-60 mo.: Use Communicative functions • Increase in range of functions • New genre: narration • Increase in decontextualized talk Discourse management • Requires less support from adults; still needs some • Longer turns; more turns/topic