LANGUAGE IN INDIA

LANGUAGE IMPAIRMENT IN AUTISM
Shyamala Chengappa, Ph.D.

1. INTRODUCTION

Autism is a pervasive developmental disorder with severe behavioural manifestations and communication disorders. It is characterized by deficits in social, communication and motor behaviors. Speech and language abnormalities in autism show a lot of individualistic variation. Present study makes an attempt to describe the language and communication impairments seen in three autistic children as to aid in the planning of an appropriate therapeutic approach.

Key words for this article: Autism, Pervasive developmental disorder, Communication, Developmental delay, Behavioral abnormalities.

Autism-PDD is still poorly understood childhood disorder inspite of a fair amount of research in the area. Language disorder is an actual and integral entity in the multivariant symptomatology of this pathological group. This being so, it has not received as much of attention as needed. This problem and the need for investigation are all the more poignant in the multilingual context of India. Autism as a language disorder has made an impact on the domain of Indian speech and Language pathology. The present study has attempted to take another step towards such direction.

In this study, a few specific, isolated and salient features of phonological, morphological / lexical and syntactic aspects of expressive language behavior of a small clinical population are identified and gross similarities and difference across these autistic children are reported.

This paper incidentally is a small extract of the larger project on the study of speech and language characteristics in a cross linguistic autistic group.

2. NATURE OF AUTISM

Autism is a pervasive developmental disorder with severe behavioural manifestations. The etiology is not known yet specifically but the most accepted theory till date is some form of CNS dysfunction specifically involving physiological and or psycho-neurological processes occurring early in life. The onset of the disorder is within 36 months according to DSM IV R (1994).

The behavioral characteristics include the following :

1. Deficits in social behaviour: These are seen as failures to form interpersonal relationships with other human beings including his mother, father or any other caretaker from the beginning. These are evidenced by extreme aloofness, lack of eye contact, failure to smile on meeting any person.
2. Deficits in speech/ language /communication behaviour: These include mutism (no speech) and/or disordered or deviant speech and language development. The latter includes atypical vocabulary development (such as imbalanced acquisition of vocabulary. For ex. Acquisition of names of eatables only), Echolalia (repetition of heard speech immediately or later), perseveration (repetition of the word or phrase again and again in the absence of the original stimulus that prompts it), pronominal reversal & confusion (where first person pronoun is replaced by second or third person such as 'you'/he for 'I', lack of conversational skills spontaneous and conversational speech, when speaking extreme literalness of speech etc.
3. Demand for sameness in the environment: These children would be comfortable with a regular common routine and would resent any form of change as for ex, in the arrangement of furniture, clothing food etc. Any such attempt would bring about a temper tantrum that is pacified by resorting to prior routine.

4. Problems in responding to sensory stimuli of audition, vision, touch etc : Undersensitivity as well as oversensitivity to the sensory stimuli are both common among this clinical population. These children may appear deaf or blind because of their back of response to gross sound or visual stimuli such as calling or approaching cars. At the same time they may respond to smallest of stimuli's like rustle of paper or an ant crawling on the floor. They may also keep sniffing or mouthing objects (putting objects and toys in to the mouth).
5. Self-stimulatory behaviour: These include stereotyped physical abnormal postures and movements like rocking, jumping, twisting hands, looking from corner of the eye etc.
6. Self injurious behaviour: These include head banging, hand, finger or nail biting, self shaping, scratching, teeth grunting etc.

3. SPEECH-LANGUAGE-COMMUNICATION ABNORMALITIES IN AUTISM

Autistic children are known to exhibit the following speech/ language/ communication disorders behavior. These have to be observed (in assessment) with their individualistic variations in each child.

1. Mutism with severe delay or total lack of speech development.
2. If speech is present atypical or deviant behavior in terms of various aspects of spoken language are seen as the following:
   1. Voice, articulation and prosodic abnormalities seen as poor and inappropriate pitch, loudness and quality, misarticulations, inappropriate rate and rhythm in speech.
   2. Stereotyped and repetitive use of language such as echolalia, use of stock phrases on few topics only, repeated questions etc.
   3. Pronoun difficulties as in the confusion with pronouns, pronominal reversal as in the use of 'you' for 'I'.
   4. Atypical vocabulary development seen as patchy acquisition of vocabulary on a single or a few topics Ex. Names of objects, fascination with alphabet, date, numbers, etc. Example: a. A child could come out with names of 18 eatables at a stretch. b. Recitation of Sanskrit slokas.
   5. Idiosyncratic use of words as in the use of utterances the meaning of which is obscure to others indicating communicative failures.
   6. Failure to respond to the communication of others and failure to initiate (spontaneously) and sustain communication indicating problems with interpersonal two-way communication.
   7. Semantic and conceptual difficulties as in "case in concrete" use of learnt words and concepts, difficulties with conceptualization and comprehension of heard language, etc.
   8. Abnormalities in the use of nonverbal communication as seen in the poverty of facial expressions and gestures as pointing and showing, impaired emotion recognition and expression, etc.
   9. Morpho syntactic and Pragmatic Errors telegraphic speech, poor PNG markers, poor comprehension, imaginary observation.

4. METHOD

The verbal features that have been noted are a few phonological aspects including voice, articulation and prosody, lexical and syntactic aspects including speech output, lexicon, pronominal usage, echolalia, perseveration and idiosyncratic features in terms of all these. These aspects have been observed over ten sessions of 45 minutes each and one and half hours speech sample has been analyzed to illustrate and supplement the observations.

This one and a half hour's speech data is obtained based on the children's responsive speech, informal imitation and elicitation aided by picture books. The data has been transcribed with broad IPA transcription and analyzed. No formal tests except KAT (Babu et al 1980) was used.

5. SUBJECTS

The subjects were three males S1, S2 and S3 aged 5 years, 11 years and 6 years respectively. S1 and S2 spoke Kannada (a Dravidian language) as their mother tongue and S3 spoke Hindi (a language belonging to the Indo-Aryan family of languages). All of them had an exposure to English through nursery rhymes, etc. All the children were from upper middle class families with well-educated parents.

Although no strict criteria were adapted, the subjects S1 and S2 were categorized as having moderately severe and S3 mild degree of autism based on an appraisal of the severity of characteristics presented. All of them had normal intelligence.

6. PHONOLOGY

All the three children had vowel and consonant phonemes that could be traced as belonging to their respective languages inspite of the misarticulations of sounds they presented. The allophonic distribution of phonemes appeared to be normal, although it needs to be further analyzed.

7. RESULTS

(a) Articulation

These children showed inconsistent articulatory patterns. The various consonant phonemes involved, included fricatives, trill and laterals in S1, fricatives and trills in S2 and trills only in S3. Omissions and distortions were the main types (S1 had substitutions also) of articulatory errors seen irrespective of the position of the phoneme. These incorrect articulations were observed in both spontaneous and echolatic utterances. Besides, S1 had a peculiar articulatory style of uttering only a part of each word correctly, the first one or two syllables usually.

(b) Voice and prosody

All the three subjects had normal speech mechanism both in appearance and functioning.

The vocal characteristics included use of dull monotone for a length of time occasionally interrupted by an inconsistent use of high and low pitches. The pattern was as follows:

Generally S1 had a softer voice sometimes leading on to whisper or mere mumbling and unintelligible speech. Occasionally it was alternated by spells of loudness. He had a hoarse voice with faster rate of speech.

S2 generally had a louder volume alternated by extreme soft voice leading on to just mumbling. His voice had a harsh and nasal quality with faster rate of speech.

S3 had a more monotonous but normal voice chances with very less variations.

Prosody was certainly affected in all the three subjects. All of them had deviant intonation patterns. S2 had a fairly fast rate of speech; S1 had an extremely fast rate of speech so much so that speech was almost unintelligible. S3 however had an extremely slow rate of speech and he also had a peculiar way of speaking with excess and equal stress one each syllable.

Fluency was affected as the speech flow was interrupted by inappropriate pauses and inflections even with the faster rate of speech in S1 and S2. S3 however, had a consistent, stereotyped pause and prolongations. As a result, there was a bizarre appearance of disjointed utterances. Although the deviance in fluency could be compared to stuttering none of the children presented typical features of stuttering in terms of hesitations, repetitions, pause or prolongations. There was no struggle behavior or secondary features seen and it was observed even in highly automatized verbal material.

(c) Verbal Output

The spontaneous speech was restricted highly to automatic speech, echolalia, perseveration and talking-to-the self behaviour (The illustrations are given in the appendix). Sustained dialogue was impossible with all the three subjects. The utterances in responsive speech were in majority inappropriate and irrelevant. Some appropriate (and relevant to the immediate context) responses could be obtained but they could be traced back to highly habitualized verbal material. This is illustrated in IA.

IA Appropriate utterances
         Bella kodata:re
S1       (granny) jaggery gives

This was always the response given to the questionajji ninge:n kodta"re 'what does grand mother give you?'.

S2          pen gi:ctini
         (I will) Pen scribble

This was usually the response given to any verbal stimuli dealing with pen. This was in particular a response to the question.

Pen ya;k ninge
Pen why you (need)

S3          ye;mo:ta:rbo:t hai
         This motorboat is

This was the response to any question asking about a thing/object on water.

The incorrect/inappropriate responses were identified as being so, because they were incorrect responses to the verbal stimuli (as discerned by a contextual appraisal) although a semantic association could be established between the verbal items of the stimuli and the child's response (IB)

IB Inappropriate response (on the bases of contextual observation)

S1          pesa (for paisa) 'Coin'.

This was in response to the question angdi:ge Ya:r ho:gta're 'Who goes to the petty shop?'. The semantic interpretation was between 'petty shop' and 'money given there'.

S2          sartu ma:dde
Shirt (I) did.

This was in response to the question -

Ni: e: n ha: ko idiya
You what wearing

S3          Ca:y
Tea

This was a response to the question -

Tum ne kya: kha:ya
You what ate.

Object naming was the best form of spontaneous response that could be elicited with least promptings and persuasions. Even here, however there were incorrect responses and in some semantic associations could be established between the correct (and the appropriate) and incorrect responses (IC)

IC Inappropriate object naming

Ka:lu
Leg (kai 'hand')

This was in response to the hand.

S1 cendu
Ball

This was in response to a question -

E:n a:ta a:dti da : le avalu
'What game playing is she' pointing to a picture of a girl skipping

S3 pe : nta
'a cold drink'.

When pointing to the picture of a glass filled with water and asking -

Ye: kya hai
This what is?

(d) Lexicon

The lexical choice mainly consisted of open-class (content) words than function (pivot-class) words except when being echolalic. Nouns and in lesser quantity the verbs, were found to be abundant. There were very few adjectives, adverbs and prepositions and conjunctives used except in echolalic utterances.

There appeared to be a preponderance of the lexical development towards certain categories such as eatables (in S1 and S2), vehicles (in S1, S2 and S3) and names of things (in S1, S2 andS3) irrespective of whether they served any communicative function or not. S1 could come out with as many as 8 names of eatables and S2 with 17, S3 could name seven vehicles at a stretch aided by the word a:me:le (then,) or u: (nasalized vowel) prompted by the investigator.

(e) Automatic speech

This was the best form of verbalization that could be sustained for a longer time. All the children could name the days of the week, the names of months, could count the numbers, could remember the letters of the alphabet and could recite some nursery rhymes. S1 could even recite long Sanskrit verses.

However, these children differed in terms of the promptings needed in between. S1 needed a prompting for every word or occasionally for every small phrase, S2 for every sentence, and S3 for every 2-3 sentences. Every prompt was either a repetition of what he had recited earlier or a partial utterance of the next intended form. For instance, S1 would utter b the letter of the alphabet only when the previous letter a was uttered by the other person. S2 would need to be prompted with matte meaning 'then' or 'then after', after his naming every line of a nursery rhyme.

(f) Pronominal usage

The pronominal forms of I person, II person and III person viz., na;nu; ni:nu, ni;vu: adu, avanu, avalu, avaru respectively in their singlular and plural (or honorofic) forms in Kannda and mai, ham, tum, a:p, and vo: respectively in Hindi were very rarely seen in these children's speech except as echolalic or perseveratory utterances. However, the PNG markers were found correctly used occasionally (IIA).

IIA Correct P N G markings

S1           bikket tinti;ni
         (I) biscuit (will) eat

S2           barde nenne
         (I) wrote yesterday

S3           doudta: hai
         (that) is running

It was observed that there was a reversal in the pronoun use as evidenced by the person markers or endings (IIB).

IIB Reversed person markers

S1           III person marker substituted for 1 person
di:pak tindi tinta:ne
(he) eatable eats
substituted for
tindi tinti:ni
(I) will eat eatables

S2           I persons marker substituted for II person chitra:nna Ma'd kodtini
Substituted for
Chitra:nna madkodu
The 'eatable' (you) prepare give (me)

S3           II persons marker substituted for III persons
Da;ggi: doud ja:vo
'dog (your) go run'
for da:ggi: doudta hai
'dog running is'
pointing to a picture of dog running

(g) Echolalia

All the three children presented both immediate and delayed echolalia and their speech had an abundance of both. "Immediate echolalia" was defined as the parrot like repetition of a word or group of words in a given immediate context, without reference to the meaning (IIIA).

IIIA Immediate echolalic utterances

S1           e:n be:ku
What (do you) want
Repeated twice after the question
e:n be:ku ninge
What do you want?

S2           pa:pa malkondida:ne
Baby (is) sleeping
After my uttering
Pa:pa malkondia:ne no:du
Baby (is) sleeping look

S3           ladka dau:d
'boy milk (is) drinking'
after my utterance
ladka du:d pi:ta hai de kho
'boy milk is drinking look'

"Delayed echolalia" was the meaningless repetition of a previously stored verbal material in a novel and often inappropriate situation (IIIB).

IIIB Delayed echolalia

S1           passu gissu
'parsu girsu' (reduplicative form) for 'purse) for the question :g ellig ho:g be:ku
now where (do we) go?

S2           mani kodtini mani kodtini
(I will ) bead give bead give
This was a response for the question -
kudre e:n ma:dtide no:du
horse what (is) doing look

S3           machli jalki ra:ni
Fish water queen (a phrase form a lullaby mother used to sing to him).
This was in response to the question.
Kaha: khelenge ham
Where play shall we

Mitigated echolalia refers to the modified form of echolalia that is nearly appropriate or comparable to the target response. This is considered as the best and most contextualized form of echolalic utterance and is considered as a sign of efforts towards normalization of autistic responses. For example,

Question : How are you ?
Autistic Ans.: How are me? Oh fine.

This echolalic behaviour of the children contributed greatly to the bizarre nature of speech. Relevance and appropriateness of the responses suffered in part, because of echolalia. The echolalic utterances were either full or partial repetitions of the utterances (usually sentences) of the previous speaker. The utterances were repeated regardless of sentence types in terms of form and function.

(h) Verbal perseveration

Verbal perseveration as found in these subjects was a consistent and continuous repetition of a verbal item in the absence of original stimuli that triggered of in the first instance. S2 had a great many number of these, S1 had this in a slightly lesser degree and S3 lesser still (IVA).

IVA Verbal perseveration

S1           said the following for five consecutive questions put to him - Bikket 'biscuit'

S2           said the following thrice continuously for different verbal stimuli - Ca:ya 'a name'

S3           uttered the following at a stretch for four different verbal stimuli - Kva:k kva:k 'duck's cry'.

(i) Length and word order

Single word utterances were the major trends in all the three. All these children used a few 2-word telegraphic phrases/sentences and S2, the older child could use 3-4 word sentences very occasionally in spontaneous speech. Echolalic utterances however, had no such restrictions in terms of the length of utterances. No gross deviances in the word order were observed.

For example: u:ta a:ytu di:pak
Lunch over Deepak's

8. CONCLUSIONS

It was felt that there were certainly a developmental delay as well as a deviance in these children in terms of acquisition / use. It was noted that, although certain similarities across these children could be discerned at a gross level, each child presented an idiosyncratic picture as to differentiate himself from the others in terms of language behaviour. An in depth analysis of this aspect is emphasized for a finer understanding and management of each autistic child in terms of language.

REFERENCE

Chengappa, S. Study of Language Behaviour in Autism (forthcoming)

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