Language And Communication Disorders Of Autistic Children: An Interdisciplinary Approach

The involvement of perceptive-motor structures in language development

- organization of corporeal scheme and laterality: identification of certain body parts and of their role; representation of the corporeal scheme and of its functionality; representation of actions; the body-environment relationship; the body-objects relationship;

- behavior and perceptive-motor structure of colour: colour identification, colour differentiation; operation- classification;

- behavior and perceptive-motor structure of form: identification, differentiation, operation;

- perceptive skills: kinaesthetic differentiation, spatial perception of positions, directions and size, visual differentiation: acuity, globular movement, constancy of perception, auditory differentiation, tactile differentiation;

- behavior and perceptive-motor structure of space: perception of space and one's rhythm and motion;

- behavior and perceptive-motor structure of space in the lexical or graphic fields, direction behavior in a spatial field: left, right, forwards-backwards, up-down; in space areas: near, far, very far;

- organization, spatial and temporal structuring: relating time to one, differentiation of chronological sequence, differentiation of duration of actions, events, etc.

Psycholinguistic profile of the autistic child

It is estimated that more than 50% of autistic people does not develop language, therefore cannot communicate on a regular basis, while some others can be, apparently, truly fluent in speaking. Autistic people who develop language usually start speaking later, in an unusual manner, specific to their disorder. Thus, verbal behavior is manifest through: immediate or retarded echolalia, pronoun inversion, rendering context without comprehension of the figurative meaning of some words or without understanding nuances and adapting communication to various social contexts, etc.

Analysis of the results of the test for identifying the language psychological age

Preschool age is particularly important in language development. Lack of language communication leads to isolation, blockage at the level of social interaction, defective behavior. This study applies the test for identifying the language psychological age (Alice Descoeudres) on a group of 23 pre-schoolers, aged 4.5 - 6 (8 girls and 15 boys).

The test for identifying the language psychological age Alice Descoeudres (Vrasmas & Oprea, 2003) has been applied to each subject with a view to acknowledging their respective language psychological age. It is made up of 7 subtests, which point to: identifying resemblance and differences between various objects or images of objects; filling the lacunae in a spoken text, memorizing digits or numbers, naming colours, imitating actions (proving knowledge of the meaning of some verbs), establishing antonymy in the absence of images or objects, naming materials of which some objects are made. Each subtests has its own score, which is further referred to a standard, which gives the psychological age. The average of the ages obtained in the seven subtests represents the language psychological age of the child subjected to the test. Mention should be made that 8 subjects included in the research proved difficulty in pronouncing certain phonemes (6 boys and 2 girls).mu. In subtest 1, each child was presented 10 objects with antonymic properties (small-large, tall-short, hard-soft, etc.), being required to identify the corresponding adjectives. The children with normally developed language showed interest in questions, quick thinking and, in the end, recorded positive results. In subtest 2, filling the lacunae in a spoken text, it has been noted that the mean of the language age corresponds to the chronological age, including for children who had pronunciation difficulties. Children have a relatively rich language, they know various nouns and verbs which denote qualities or states. Vocabulary issues have been recorded in the case of 2 pre-schoolers diagnosed with autistic notes. Difficulties were also noted in subtest 3 (memorizing numbers). Only 3 out of 23 children in the study received a coefficient of 5 out of a maximum of 6, corresponding to their biological age. In the subtest related to the identification of materials, the language psychological age corresponds to the chronological age in the case of 60.8% of the children tested. There were no significant differences between children with dyslalia (2 of them, pre-schoolers diagnosed with autistic trends) and non-dyslalic children. In the cases of subtests antonymy in the absence of objects or images and naming colours: 33% of the non-dyslalic children provided correct answers to all questions, as opposed to only 12.5% of the dyslalic children who were capable of this performance. Therefore, data shows that in the lot of non-dyslalic children, language age is higher than that of dyslalic children. This can be a consequence of the pronunciation disorder or its associated problems (as in the case of autistic pre-schoolers), which can, in turn, influence the communication development as a whole and, implicitly, the language psychological age (Figure 1 ).

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62.5% of the dyslalic children tested have a language psychological age lower than their biological age, in the case 25% of them, the ages correspond, and in only 12.5% cases, the language age is higher than the biological one. Language delays can be determined by inferior hereditary information or by social-emotional causes: family’s disinterest in the child’s language development or cerebral dysfunctions (autism). If the pre-primary school teacher elaborates individual files for psycho-pedagogical description of the pre-schooler and adopts differentiated teaching, it is possible for some dyslalic children to outgrow their biological age, from a linguistic perspective.

Therapeutic program

Objectives: development of the mobility of photo- articulatory organs, learning to breathe, development of phonematic hearing, correct pronunciation of sounds (e.g. k, t, ts, sh, l, r, etc.), through their fixation in current speaking.

General therapy was pursued with:

Physical exercises for the development of body mobility (neck, arms, hands gymnastics)

Exercises for the development of photo- articulatory organs (tongue, roof of the mouth, jaw bones – opening and closing the mouth, lifting the tongue to the roof, coiling the tongue towards the throat, swallowing, imitating coughing, stretching the lips with the mouth closed or showing teeth, imitating throat wash, gasping, panting, etc.)

Breathe learning was pursued as a game. Breathing therapy has two coordinates. It starts with breathing in the absence of speaking, which is a preliminary stage for breathing while speaking. Children were required to imitate various actions: blowing a candle, inflating a balloon, blowing in water with a straw, blowing the trumpet, pipe, whistle, flute, harmonica, paper sheets, steaming the mirror, move the paper boat on water, etc.

The use of myogymnastics with a musical background helped the children to relax during exercises.

The development of breathing while speaking was carried out by:

• pronouncing vowels slowly, rhythmically, effortlessly during breathing-out;

• rhythmic pronunciation of consonants or vowel groups (ai, ei, oi, ua, ue, etc.) while breathing out;

• pronouncing syllables with vowel or vowel consonants groups while breathing-out (aie, oie, uie, sta, ste, stri, cra, cre, tre, tre, tre, etc.);

• rhythmic breathing exercises accompanied by movement and singing (walking while counting, singing, reciting, telling riddles or proverbs that include the sounds which need to be consolidated).

The development of phonematic hearing was carried out using games such as: what does the x say? , auditory differentiation of sounds in the same articulatory area (k, g), auditory and visual differentiation of phonemes C-T, J-Z; intervention through graphic elements; phonetic analysis: hyphenating, identification of sounds in syllables, identification of the sound position in the word (initial, middle, final), differentiation of the initial and ending sound of a word, etc.

The initial stage: identification of language disorders

According to the independent speaking test, in which the investigator (from the interdisciplinary team) pronounces sounds in order to have them identified in initial, medium and ending position), 8 children with logopathies have been identified, out of whom:

• 2 pre-schoolers, diagnosed with autistic disorders, omitted the sound r in certain words, and also sounds like ts, sh, z. These two also presented high attention deficit.

• 4 children substituted the sound sh with s. They were diagnosed with monomorphic dyslalia – parasigmatism.

• 1 child substituted the sound k with t. She was diagnosed with simple dyslalia.

• 1 child substituted the sound r with l and was diagnosed with monomorphic dyslalia – pararhotacism.

Among the dyslalic forms identified, parasigmatism is the most frequent pronunciation disorder (50%). According to the information in the literature, the sounds that are most affected are those occurring later in the ontogenetic development of the child: sounds r, s, z, sh and dj, these deficiencies being also obvious in the case of autistic children.

Alternative- applicative therapies

Correction in a timely manner of functional pronunciation deficiencies contributes in the decrease of reading/ writing mistakes, both at the pre-school and early school stage. To this end, we have employed various therapeutic programs for the correction of defective phonemes, applying alternative therapies useful in teaching children with language disorders and, particularly, children diagnosed with autism (figure 2 ).

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It has been acknowledged that game therapy has had a special impact on language stimulation and correction. Therapeutic game is the most effective means for language and thinking development of pre-schoolers. The game has multiple functions, making the autistic or dyslalic child open to communication more than any other alternative therapy.

Examples of game adapted to children with pronunciation disorders or associated disorders (in our case, autism): Lost Words – the game aims at enriching the active vocabulary of the child, at developing phonematic hearing, by the correct differentiation of sounds, at consolidating certain letters by realizing the phoneme-grapheme correspondence, and at developing attention in various contexts; Who Knows Wins! - the aim of this game is the correct observation and pronunciation of the sounds in a word, the differentiation of syllables, as well as the consolidation of the skill of correct writing of capital letters on the magnetic board, using 3D letters; the teaching game Change the letter/ change the syllable aims at developing thinking and language expressivity, phonological awareness (preschool children form new meaningful words by replacing the first or the last letter/ syllable), the main objective being the differentiation of the sounds in syllables, words and syntagma.