Language Impairments in Autism: Early Signs and their Connection to Core Symptoms 

The National Autistic Society (NAS) reports that the UK is home to over 700,000 individuals with autism, with more than three million carers and family members. According to the American Psychiatric Association (2013), autism is a neurological divergence typically marked by challenges in communication, heightened sensitivity to sensory input, narrow or obsessive interests, social anxiety and repetitive behaviours. An early indicator of Autism Spectrum Conditions (ASC hereafter) often involves impairments in verbal communication. Recognising these signs early in a child’s development can lead to timely intervention, improving the child’s social and communication skills and therefore enhancing their quality of life. This essay aims to (1) analyse the early signs of difficulties in verbal communication in children with autism regarding language regression & delay, echolalia & narration; (2) discuss how these signs are related to the three core autistic symptoms: social interaction difficulties, restricted and repetitive behaviours, and sensory sensitivities. 

Early Signs of Verbal Communication Impairments 

Verbal communication is a critical aspect of typical childhood development, with a number of milestones indicating progress. Language impairments signal a range of clinical and neurodevelopmental conditions, including the Autism Spectrum. It is worth noting that though diagnoses can potentially occur before the age of three, the reliability of these early diagnoses is still a subject of debate (Fletcher-Watson and Happé, 2019). In the DSM-V, the delay or impairment in language is no longer classified as a central symptom. However, clinicians are mandated to identify whether a child has a coexisting language disorder (American Psychiatric Association, 2013). Common early signs of language impairments in autism, such as language regression and delay, echolalia and narration, will be discussed in turn in the following paragraphs. 

Language Regression and Delay    

The phenomenon of vocabulary loss in autistic children has been studied widely in the literature and yielded somewhat consistent results.  Approximately 25-30% of children with autism start to babble and utter words, only to cease verbal communication between 15 and 24 months old (Johnson et al., 2017). This echoes the work of Lord and colleagues (2004), which also demonstrated the loss of meaningful vocabulary during the second year of life in children who were later diagnosed with autism. In another study by Ozonoff and colleagues (2005), the researchers found 65% and 25% of autistic participants demonstrated the loss of all words and some words (respectively). Eye contact, an important feature of conversational speech, was lost in 91% of children. Though the loss of language is often linked with ASC, it does not occur in all cases, and some children can display a steady course of social-communication (typical or impaired) without regression (Barger et al., 2013). The reason for this loss of speech in some autistic children is not well understood, but it’s likely due to complex interactions between genetic, neurobiological and environmental factors (Barger et al., 2012; Tager-Flusberg, 2013). 

Language development trajectories in ASC vary greatly (Tager-Flusberg, 2016). A majority of children exhibit delays in typical milestones, particularly in terms of word and phrase usage. Standardized assessments often show receptive language to be relatively more impaired than expressive language. However, this discrepancy may be more associated with a general lack of social responsiveness rather than deficits in language processing (Tager- Flusberg, 2000). The postponement of language-related milestones could potentially be one of the most dependable early indications of ASC. However, this sign lacks specificity as children without ASC risks or those with other neurodevelopmental results may also exhibit language impairments (Tager-Flusberg, 2016). Language delays might be detected early because they represent one of the most recognisable areas for parents and caregivers. 

Echolalia and Narration 

Echolalia refers to the act of repeating words or phrases, often without comprehending their meaning. Echolalia can be immediate, where a child directly repeats what they’ve heard, or delayed, where the repetition occurs after a significant amount of time has passed (Sterponi & Shankey, 2014). While echolalia is also part of typical language development, it persists beyond the usual age in children with ASD and often becomes a dominant feature of their verbal communication (Prizant, 1983). The function and meaning of echolalic behaviours in autism are complex and multifaceted. Some children use it as a strategy for participation in social interactions, even though it may be seen as inappropriate or nonsensical (Sterponi & Shankey, 2014). Additionally, echolalia may serve a linguistic purpose by helping the child learn language structure and vocabulary, although this learning may not always be demonstrated in a typical or expected manner (Prizant & Duchan, 1981).

Narration, a key aspect of language development, involves the ability to tell stories or recount events, which requires an understanding of temporal sequences, causal relationships, theory of mind, and the use of complex sentences. The study of narrative skills in autistic populations serves a significant purpose as it effectively detects discourse difficulties that may not be identified through standardised language assessment. Past research on the narrative abilities of children with autism has underscored the crucial influence of pragmatic competence and social cognition through their storytelling skills (Tager-Flusberg, 1995). They often provide fewer narrative elements, make fewer references to character’s mental states, and their stories are less likely to form a coherent and structured whole, which might reflect the local-processing style (over global) as suggested by research in central coherence (Diehl et al., 2006).

Relationship between Verbal Communication Impairments and Core Autistic Symptoms 

The relationship between verbal communication impairments and the core symptoms of ASC is multifaceted and interconnected. The social-communication deficits and restricted, repetitive behaviours, which constitute the diagnostic criteria of autism, are inextricably linked with the challenges in verbal communication observed in these individuals (American Psychiatric Association, 2013). The changes in language skills were often accompanied by regressions in other areas beyond the lexicon, notably in social engagement and other communicative abilities (Lord et al., 2004; Goldberg et al., 2003). 

Impairments in social-communication, often reflected in diminished social reciprocity and, in extreme cases, non-verbal communication, can manifest as challenges in verbal communication. For instance, a child with ASC may struggle with the pragmatics of conversations, such as turn-taking, topic maintenance, or using language for different purposes (Volden et al., 2019). A review suggests that regression, defined as loss of language, social skills or both, occurs in 20% to 40% of children with autism (Ozonoff et al., 2005). This is an important anecdote because the language and social domains influence one another, more often than not.

On the other hand, restricted and repetitive behaviour can also contribute to verbal communication challenges. Echolalia and narration, as previously explored, are closely tied to the communication characteristics seen in autism. Research has found that children with autism may resort to these phenomena to express their inner thoughts via their favoured topics or animated series (though it may happen with a delay) (Sterponi and Shankey, 2014). Thus, in such situations, echoing can be seen as a unique form of self-expression to make up for the lack of pragmatic conversations they may have with their interlocutors. Moreover, certain forms of echoes, such as impersonal or other-echoes, may serve as linguistic deflections aimed at steering the interlocutors' attention away from a less desirable path and towards more engaging subjects (Sterponi and Shankey, 2014). While echolalia and narration may serve certain functions, their repetitive and monologue characteristics in children with autism can potentially inhibit the generation of reciprocal, spontaneous speech (Volden et al., 2019). 

It is also worth noting that the relationship between verbal communication impairments and core ASC symptoms is not merely unidirectional. Difficulties in comprehending verbal language could exacerbate the core symptoms of ASC by hindering social interactions such as pretend play, joint attention or imitation (Charman et al., 1997). This could lead to a perceived strangeness or irregularity in the communication style of individuals with autism, which can complicate social interactions. Such communication characteristics might have a negative influence on the process of language development and vocabulary acquisition. 

Understanding this complex interplay between verbal communication impairments and the core symptoms of ASC can inform intervention strategies. Instead of trying to eliminate echolalia, approaches that address both these aspects simultaneously, such as social communication interventions or naturalistic developmental behavioural interventions, can be particularly effective (Kasari et al., 2008). 

In conclusion, the understanding and recognition of verbal communication impairments in autism have far-reaching implications. It is clear that these impairments are multi-dimensional and significantly linked to the core symptoms of Autism Spectrum Conditions (ASC). The characteristics of language regression & delay, echolalia, and impaired narrative abilities underscore the complexities within autistic communication. Further studies are needed to explore and elaborate on the intricate relationship between these communication impairments and core autistic symptoms to enable more personalized and effective interventions. 

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Tager-Flusberg, H. (2016b). Risk Factors Associated With Language in Autism Spectrum Disorder: Clues to Underlying Mechanisms. Journal of Speech Language and Hearing Research, 59(1), 143–154. https://doi.org/10.1044/2015_jslhr-l-15-0146

What Is Autism Spectrum Disorder?

https://www.psychiatry.org/patients-families/autism/what-is-autism-spectrum-disorder