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Nonverbal autism, also called nonspeaking autism, is a subset of autism spectrum disorder (ASD) where the person does not learn how to speak. One study has shown that 64% of autistic children who are nonverbal at age 5 are still nonverbal 10 years later. [1] [ failed verification ]
Early intervention in nonspeaking autism emphasizes the critical role of language acquisition before the age of five in predicting positive developmental outcomes; acquiring language before age five is a good indicator of positive child development, that early language development is crucial to educational achievement, employment, independence during adulthood, and social relationships. [2] The likelihood of acquiring functional language in the future past this age is minimal. [3]
The biological basis of autism is unknown. However, the most obvious signs of autism, such as atypical social and language development, and restricted or repetitive behaviors and interests, often present themselves between the ages of two and three, and most children with ASD can be diagnosed in early childhood as a result. [4] : 63 Other disorders such as epilepsy, ADHD, gastrointestinal problems, sleep disorders, depression and anxiety often accompany ASD. [4] : 67–68 [5]
The causes of nonspeaking autism are unknown. However, there appears to be a relationship between joint attention and verbal communication. Joint attention occurs between two individuals when one draws the other's attention to an object through gesturing (i.e. eye gazing, pointing). [6] The ability to achieve joint attention at an early age plays a significant role in language development, and studies indicate severe lapses in joint attention in autistic children. [6] Research findings indicate that young children diagnosed with autism exhibit challenges in both initiating and responding to joint attention. [7] Notably, while the difficulties in responding to joint attention may improve with development, it has been observed that autistic children who have higher IQs and lower mental ages may display distinct joint attention deficits. [8] These deficits in joint attention are observed consistently across various age groups, spanning from infancy to adolescence within the autism spectrum. Moreover, there is a concurrent relationship between joint attention skills and language development, with joint attention abilities serving as predictors for long-term gains in expressive language among individuals with autism. [9] In one study, researchers suggest that a displayed pattern of delays, absences, or a general impaired response to stimuli (hyporesponsiveness) and a fascination with intense or repetitive stimulation (sensory seeking) is more likely in nonspeaking autistic children, suggesting that both hyporesponsiveness and sensory seeking is related to poor communication outcomes in children with ASD. [10]
There is a growing body of tentative evidence indicating the amygdala's involvement in the development of autism. The amygdala theory of autism focuses on the importance of the amygdala in relation to social functioning and observes that autism is largely a severe impairment of social functioning. The amygdala is thought to be associated with the fight-or-flight response in animals and its activity is heavily correlated with fear in humans. Additionally, it has been heavily implicated in relation to social functioning in various animal studies. Evidence suggests an amygdala hyperactivity model may be more accurate than one comparing it to a lesion. [11]
Lesion studies have shown that amygdala damage results in severe social impairment among animal models. Vervet monkey mothers with amygdala lesions were shown to be much less caring with their young, neglecting and even abusing them. [12] Rats with amygdala ablations become much more docile. [12] Monkeys with lesions to the anterior temporal lobe develop a disorder known as Klüver–Bucy syndrome, characterized by loss of fear, hypersexuality, hyperorality, and an inability to recognize visual objects (often, but not always). [12]
Evidence shows the amygdala accounts for the emotional, oral, and sexual abnormalities listed above. [12] These abnormalities coincide with several characteristics of the diagnostic guidelines for autism, at least passably for an animal model.
Post-mortem analysis of humans shows an increased neuronal density in the amygdala in autism compared to controls, indicating a potential linkage and supporting the hyperactivity model. [12]
Several studies presented subjects with ASD photographs of human eyes and had them report the emotional state of the person in the picture. A smaller amygdala was associated with increased response time but not decreased accuracy. [12] There was also significantly less amygdaloid activation in the brains of those with ASD than controls. Subjects compensated for this lack of amygdaloid activity with increased activation in the temporal lobe, and are associated with verbally labeling images. [11] This activity is thought to imply less usage of emotional/social cues to identify objects and rather more objective, factually based processing. One may extrapolate from this model that patients with autism may learn that a specific facial configuration represents an emotional state and what that emotional state implies socially, but they may not come to truly understand how that person feels. This supports a theory of mind deficit.
The left amygdala [13] is critical in the involvement of processing mental state and emotional information from complex visual stimuli, particularly the eye region. However, individuals with autism do not seem to engage the amygdala during tasks when processing the emotions of others. Instead, they exhibit greater reliance on temporal lobe structures, specialized for verbally labeling complex visual stimuli and processing faces and eyes. This shift in processing may serve as compensation for potential amygdala abnormalities in individuals with autism. [13]
Studies conducted specifically on nonspeaking autistic individuals[ which? ] provide similar evidence. Brain studies have shown several amygdaloid impairments among those with ASD. The amygdala in those with nonspeaking autism have less volume compared to controls, contain a higher density of neurons suggesting hyperconnection, and show a negative correlation between amygdala size and impairment severity among subjects. [11]
While infantile autism is actually associated with an oversized amygdala, there are developmental theories as to how this may occur. Research on major depressive disorder has shown that excessive activation such as stress or fear leads to allostasis, or degeneration of the neurons involved in creating the phenomenon. Initial hypertrophy results in atrophy and reduction of brain size in the given region. [11] Over time, this occurs in patients with severe depression, and they develop a decreased amygdala size. Some scientists[ who? ] theorize that this is happening early during infancy in the autistic brain, accounting for the initial overgrowth and later observed size reduction. [11]
When eye tracking software is employed to record where subjects focus their visual attention on images of human faces, small amygdala volume is associated with decreased eye fixation. [11] Eyes are considered to be especially important for establishing human connection and conveying emotion, thus fixation on them is considered to be a crucial part of identifying people and emotions in a social setting.
In addition to a negative correlation to eye fixation studies showed a smaller amygdala was associated with impairment in nonverbal communication skills as well. [11] This suggests that the amygdala is critical in developing all types of communicative abilities, not just verbal. This suggests the amygdala may play a crucial role in relating to other humans in a way that allows for behavioral mimicry.
Among nonspeaking autistic patients, researchers could predict symptom severity based on amygdala activity. Those with the least amygdala activity had the most impaired nonspeaking communication abilities, those with the most activity had the strongest communication abilities. [11]
The development of language, similar to the development of most physical skills, relies heavily on mimicry of other humans. [11] ASDs are known to impair one's ability to focus on and relate with people possibly as a result of a damaged amygdala. Nonspeaking autistics will often be able to learn more basic communicative skills such as pointing to objects or selecting a picture from a list. These skills are far more simple and do not require the degree of personal connection needed for language development.
When considering language abilities in autism, two main theories come into play: the theory of mind and the procedural deficit hypothesis (PDH). Both theories share a common approach, aiming to understand the connections between language and non-language domains and explore whether similar behavioral profiles can be elucidated by common neurocognitive substrates. [14] The theory of mind in autism provides an explanation for pragmatic impairments in language and communication, attributing them to social deficits and their underlying neurocognitive mechanisms. In contrast, the PDH suggests that grammatical impairments, encompassing syntax, morphology, and phonology, in individuals with autism can be predominantly attributed to abnormalities in the procedural memory system. Meanwhile, lexical knowledge, which relies on the declarative memory system, remains relatively unaffected. [15]
For nonspeaking autistic children and adolescents, augmentative and alternative communication and interventions with speech-language pathologists may be implemented to enhance language and communication outcomes. They are often given dedicated speech-generating devices that allow them to select icons to indicate requests or needs. [16] Continued interventions can be used to teach them more advanced operations on these devices (i.e. turning on the device, scrolling through pages) or add additional vocabulary, helping them enhance their communicative abilities independently. [16]
Nonspeaking autistic adolescents and adults may transition away from dedicated speech-generating devices, instead opting to use apps on their personal mobile devices, like Spoken or Avaz.
The Picture Exchange Communication System (PECS) is a form of spontaneous communication for children with autism in which an individual selects a picture indicating a request. [17] PECS can be utilized in educational settings and at the child's home. Longitudinal study suggest PECS can have long-term positive outcomes for school-aged children with nonspeaking autism, specifically their social-communicative skills, such as higher frequencies of joint attention and initiation, and duration of cooperative play, [17] which are all important roles in improving language outcomes.
It has been suggested that a significant stage in acquiring verbal language is learning how to identify and reproduce syllables of words. One study found that nonspeaking and minimally speaking autistic children are capable of enhancing their oral production and vocalizing written words by isolating each syllable of a word one at a time. [3] The process of breaking down a syllable at a time and having it visually displayed and audibly available to the child can prompt them to imitate and create nonrandom and meaningful utterances. [3]
Most of these studies contain small sample sizes and were pilot studies, making additional research significant to assess whether these findings can be generalized to all age groups of the same population. Furthermore, most studies on nonspeaking autism and communication with speech-generating devices were based on more basic skills, such as naming pictures and making requests for stimuli, while studies in advanced communication are limited. [18]
Asperger syndrome (AS), also known as Asperger's syndrome or Asperger's, is a diagnosis formerly used to describe a neurodevelopmental condition characterized by significant difficulties in social interaction and nonverbal communication, along with restricted, repetitive patterns of behavior and interests. Asperger syndrome has been merged with other conditions into autism spectrum disorder (ASD) and is no longer considered a diagnosis. It was considered milder than other diagnoses which were merged into ASD due to relatively unimpaired spoken language and intelligence.
In psychology, theory of mind refers to the capacity to understand other people by ascribing mental states to them. A theory of mind includes the understanding that others' beliefs, desires, intentions, emotions, and thoughts may be different from one's own. Possessing a functional theory of mind is crucial for success in everyday human social interactions. People utilize a theory of mind when analyzing, judging, and inferring others' behaviors. The discovery and development of theory of mind primarily came from studies done with animals and infants. Factors including drug and alcohol consumption, language development, cognitive delays, age, and culture can affect a person's capacity to display theory of mind. Having a theory of mind is similar to but not identical with having the capacity for empathy or sympathy.
Developmental disorders comprise a group of psychiatric conditions originating in childhood that involve serious impairment in different areas. There are several ways of using this term. The most narrow concept is used in the category "Specific Disorders of Psychological Development" in the ICD-10. These disorders comprise developmental language disorder, learning disorders, developmental coordination disorders, and autism spectrum disorders (ASD). In broader definitions, attention deficit hyperactivity disorder (ADHD) is included, and the term used is neurodevelopmental disorders. Yet others include antisocial behavior and schizophrenia that begins in childhood and continues through life. However, these two latter conditions are not as stable as the other developmental disorders, and there is not the same evidence of a shared genetic liability.
Diagnoses of autism have become more frequent since the 1980s, which has led to various controversies about both the cause of autism and the nature of the diagnoses themselves. Whether autism has mainly a genetic or developmental cause, and the degree of coincidence between autism and intellectual disability, are all matters of current scientific controversy as well as inquiry. There is also more sociopolitical debate as to whether autism should be considered a disability on its own.
High-functioning autism (HFA) was historically an autism classification to describe a person who exhibited no intellectual disability but otherwise showed autistic traits, such as difficulty in social interaction and communication, as well as repetitive, restricted patterns of behavior. However, many in medical and autistic communities have called to stop using the term, finding it simplistic and unindicative of the difficulties some autistic people face.
The following outline is provided as an overview of and topical guide to autism:
The Autism Diagnostic Observation Schedule (ADOS) is a standardized diagnostic test for assessing autism spectrum disorder. The protocol consists of a series of structured and semi-structured tasks that involve social interaction between the examiner and the person under assessment. The examiner observes and identifies aspects of the subject's behavior, assigns these to predetermined categories, and combines these categorized observations to produce quantitative scores for analysis. Research-determined cut-offs identify the potential diagnosis of autism spectrum disorder, allowing a standardized assessment of autistic symptoms.
Autism therapies include a wide variety of therapies that help people with autism, or their families. Such methods of therapy seek to aid autistic people in dealing with difficulties and increase their functional independence.
The empathising–systemising (E–S) theory is a controversial theory on the psychological basis of autism and male–female neurological differences originally put forward by English clinical psychologist Simon Baron-Cohen. It classifies individuals based on abilities in empathic thinking (E) and systematic thinking (S). It measures skills using an Empathy Quotient (EQ) and Systemising Quotient (SQ) and attempts to explain the social and communication symptoms in autism spectrum disorders as deficits and delays in empathy combined with intact or superior systemising.
Pivotal response treatment (PRT), also referred to as pivotal response training, is a naturalistic form of applied behavior analysis used as an early intervention for children with autism that invented by Robert Koegel and Lynn Kern Koegel. PRT advocates contend that behavior hinges on "pivotal" behavioral skills—motivation and the ability to respond to multiple cues—and that development of these skills will result in collateral behavioral improvements. It's an alternative approach to ABA from the more common form, sometimes called discrete trial training (DTT).
Social Stories were devised as a tool to help autistic individuals better understand the nuances of interpersonal communication so that they could "interact in an effective and appropriate manner". Although the prescribed format was meant for high functioning people with basic communication skills, the format was adapted substantially to suit individuals with poor communication skills and low level functioning. The evidence shows that there has been minimal improvement in social interaction skills. However, it is difficult to assess whether the concept would have been successful if it had been carried out as designed.
Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism, Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.
Autism, also called autism spectrum disorder (ASD), is a neurodevelopmental disorder characterized by symptoms of deficient reciprocal social communication and the presence of restricted, repetitive, and inflexible patterns of behavior. Autism generally affects a person's ability to understand and connect with others, as well as their adaptability to everyday situations, with its severity and support needs varying widely across the underlying spectrum. For example, some are nonspeaking, while others have proficient spoken language.
The relationship between autism and memory, specifically memory functions in relation to autism spectrum disorder (ASD), is an ongoing topic of research. ASD is a neurodevelopmental disorder characterised by social communication and interaction impairments, along with restricted and repetitive patterns of behavior. In this article, the word autism is used to refer to the whole range of conditions on the autism spectrum, which are not uncommon.
Sex and gender differences in autism exist regarding prevalence, presentation, and diagnosis.
Susan Ellis Weismer is a language and communication scientist known for her work on language development in children with specific language impairment and autism spectrum disorder (ASD). She is the Oros Family Chair and Professor of Communication Sciences and Disorders at the University of Wisconsin–Madison, where she is a Principal Investigator and Director of the Language Processes Lab. She has also served as the Associate Dean for Research, College of Letters and Sciences at the University of Wisconsin–Madison.
Marian Diamond Sigman (1941–2012) was a developmental and child clinical psychologist known for her research on autism spectrum disorder (ASD). At the time of her death, she was Professor Emeritus of Psychiatry and Biobehavioral Sciences and Psychology at the University of California, Los Angeles (UCLA).
Social (pragmatic) communication disorder (SPCD), also known as pragmatic language impairment (PLI), is a neurodevelopmental disorder characterized by difficulties in the social use of verbal and nonverbal communication. Individuals who are defined by the acronym "SPCD" struggle to effectively indulge in social interactions, interpret social cues, and may struggle to use words appropriately in social contexts.
The diagnosis of autism is based on a person's reported and directly observed behavior. There are no known biomarkers for autism spectrum conditions that allow for a conclusive diagnosis.
Peter Clive Mundy is an American developmental psychologist and an academic. He is an emeritus Distinguished Professor of education and psychiatry at University of California, Davis.