Approximately 10% of autistic individuals have what society calls a ‘special talent’ (also known as ‘savant abilities’, ‘savant syndrome’ or ‘savantism’).
People on the autistic spectrum are generally very good at pattern spotting and enjoy the predictability of patterns. They often have exceptional memories for non social, very specific detail. If the pattern that fascinates a person with autism is something society deems ‘special’ like music, maths or language, that person is deemed to have a ‘special talent’ and may be called a ‘savant’.
It is important to remember that all autistic people have strengths and weaknesses, whether or not the are classed as a ‘savant’. It is up to us to support them to make the best of their strengths, whatever they may be.
Some well known autistic savants of the 21st Century are:
- Stephen Wiltshire – an artist who specialises in architectural drawings.
- Daniel Tammet – who has exceptional talents in maths and language learning.
- Derek Paravicini – an exceptional pianist who is not only autistic but also blind.
Autism is a pervasive developmental condition. That means that it affects many areas of the individual’s skills (‘pervasive’) and that it has been present since very early in life, developing and changing as the individual grows (developmental). Most current research suggests that autism is actually something that starts to develop well before a child is born. Autism is a continuum or ‘spectrum’ of difficulties from people who are very severely affected by their autism to those who are only mildly affected.
Most researchers are agreed that autism is defined by 3 key areas of difficulty, the ‘triad of impairment’. The triad is most widely defined and accepted as difficulties in the areas of social functioning, imagination/flexible thinking (restricted and repetitive patterns of interest) and communication. Some researchers argue that ‘social functioning’ and ‘communication’ should be one heading and that the third part of the triad should be problems with sensory processing. Interestingly, new diagnostic criteria being developed in the USA reduce the triad to two – ‘social communication and interaction’ and ‘restricted, repetitive patterns of behaviour, interests, or activities’ (includes sensory behaviours).
However you wish to define the triad, it is certainly the case that people who have autism have a central difficulty with something called ‘Theory of Mind’. Theory of Mind can be defined as the ability to ‘put yourself in someone else’s shoes’. It is what allows us to feel empathy for others, gauge how they are feeling, judge their motives and understand that other people have thoughts, knowledge and preferences that are different from our own. Imagine watching your partner hit their finger with a hammer, chances are you will wince and your stomach will flip. That is your Theory of Mind allowing you to appreciate the experience your partner is having and empathise with their feelings.
Theory of Mind is central to the development of communication and social interaction. The whole point of communication is to get an idea from your mind into someone else’s. If you do not understand that other people’s thoughts are not the same as yours, then you will not see the need to communicate. Often, the first job of speech and language therapist is to show their client the value of communication, especially when working with someone who is more severely autistic.
A good and reliable starting point for learning more about autism and getting the latest news on research into the nature of autism is the National Autistic Society’s website.
The short answer is that the possibilities are endless! A speech & language therapist can help someone who has autism with any aspect of communication as well as play skills and self-organisation. How a speech & language therapist helps a person on the autistic spectrum depends very much on what their specific needs are. For this reason, the first step for any speech & language therapist working with someone on the spectrum is to complete a comprehensive assessment of their communication skills.
Once the therapist has gained a clear understanding of where their client is up to with their communication skills development, the necessary support can be put in place. Support is offered in many ways, not just in the form of face to face therapy sessions (for example, it may be more effective for the therapist to train key people in their client’s life). The nature of support depends very much on the individual and their specific needs.
What follows will give you a flavour of the massive range of things a speech & language therapist might provide support with for someone who is on the autistic spectrum.
Before spoken language develops…
- Understanding the value of communication – For more severely autistic clients, the first thing a speech & language therapist will often do is to help their client to start to see the value of communication. This is important both from the point of view of asking for (and getting) what you need and forming positive, enjoyable social relationships with other people.
- Developing the fundamentals of communication – things like using and understanding facial expression, eye contact and gesture, taking turns with others, enjoying being with another person are all fundamental communication skills. Babies start learning these skills from a very early age in face to face interaction with their parents and other adults. Speech and language therapists will use the principles from this early parent child interaction to help people with complex needs and autism (or other conditions) learn these skills through approaches like Intensive Interaction.
- Developing play skills – Play is were children learn to share experiences and objects with others which is an essential learning skill. Imaginative play is also strongly linked to the development of something called ‘symbolic understanding’. Symbolic understanding is what ultimately allows us to realise that a collection of funny sounds (a word) relates to a real life object or action. Speech & language therapists help clients to develop interactive and imaginative play skills.
- Alternatives to speech – Often, a speech and language therapist will recommend using a picture, symbol or object-based communication system for people who are not developing useful spoken language. For many people the Picture Exchange Communication System (PECS) is very effective but this does not suit everyone. A speech & language therapist will work with their client (and family) to establish a system that works for them.
Once spoken language starts to develop…
Autism brings with it idiosyncratic learning patterns and unusual language processing. As a result, children who are on the spectrum often have problems developing spoken language. Many young people with autism learn spoken language in chunks without breaking what they hear down into individual words and sounds. That means they can often repeat long chunks of favourite stories or TV programmes without really understanding what they’re saying or being able to use any of the words in the chunk independently. A speech and language therapist will help with all aspects of spoken language development including:
- Speech errors – pronouncing words so that others can understand.
- Learning and recalling vocabulary.
- Putting words together to make phrases and sentences.
- Putting sentences together into stories (narrative) to express experiences to others.
- Understanding spoken words and sentences.
- Understanding specific vocabulary groups. Many children with autism have great difficulty with time concepts, abstract language and vocabulary that depends on context for meaning.
- Understanding language associated with reasoning skills.
- Understanding non literal language like idioms, hints and indirect instructions.
Using language socially…
For many young people on the autistic spectrum, social communication presents a massive challenge. Speech and language therapists can provide help and support to help negotiate the social minefield under the following headings:
- Self awareness – what are my hobbies, what am I like, what are my strengths and weaknesses…
- Awareness of others – what do others like/dislike, what are their strengths and weaknesses, what are their interests…
- Friendship skills – developing and maintaining friendships
- Feelings and emotions – understanding the vocabulary of emotion, reading and using facial expression, reading and using body language.
- Conversation skills – starting conversations, taking turns in conversation, staying on topic, how to change topics, active listening, ending conversations…
- Assertiveness in communication – saying ‘no’, asking for help…
- Developing self esteem.
- Understanding and making sense of real social situations – SLTs can ‘coach’ young people through problematic situations using a variety of approaches like Social Stories or Comic Strip Conversations to break the situation down, see what goes wrong and provide corrective strategies.
Other bits and bobs…
Speech & language therapists can provide advice and support to help clients use visual supports like visual timetables or organisers to help them with organisation and planning of daily life.
Speech & language therapists who are autism specialists are often a helpful resource when a client is becoming aware of and learning about their diagnosis and what it means.
So, as you can see, there is a huge range of support that SLTs can offer clients who have a diagnosis of autism. There will be some things I’ve missed out but hopefully this post will give you a flavour of what an SLT can do for you or your child.
Autism is as much part of a child as his or her personality is and it brings with it a range of strengths as well as weaknesses. Autism affects social interaction, imagination/flexible thinking and all areas of communication. Difficulty learning to speak is just one of the many different symptoms. While learning to speak will not make the autism go away, it is important to remember that just because a child has autism doesn’t mean they won’t ever learn to speak!
When a speech & language therapist sees a child with autism, they will assess many areas of communication, not just the child’s speech. To build up an overall picture of the child’s communication, the therapist will also assess the child’s understanding, expressive language, social interaction, play skills and non verbal communication. The therapist will then use the information from the assessment to put together a support plan (maybe including some speech work!) to help the child communicate to the best of their ability.
There is no known cure for autism, it is a lifelong condition. It most likely has multiple causes and certainly presents itself in many different ways. It may even be the case that future research will identify different forms of autism which have different causes. My view is that trying to cure autism is a bit like trying to ‘cure’ personality! Having autism is as much a part of a person as having a personality. Half the battle is understanding and accepting each individual’s strengths & weaknesses and appreciating them for the amazing individual that they are.
Having said that, it is important to understand that people with autism do have to live in a world where the majority of people are not autistic. They will therefore need help to learn how to interact with the non-autistic world. It’s a bit like learning the language of the country you’re going on holiday to. It doesn’t stop you from being who you are but it does help you to get what you need and communicate with others when you are there. A speech and language therapist can help an autistic child ‘learn the language’ of the non-autistic world and provide strategies that help the autistic person to cope in that world.
No-one really knows. I’m sure there’s a Nobel Prize in it for anyone who can identify a single cause of autism! It is clear that autism is a very complex condition which most likely has a variety of causes rather than a single one. You can find more detail about the current thinking on causes and genetics of autism on the National Autistic Society’s website.
The most important thing is to accept people with autism for who they are and to recognise that they have strengths as well as weaknesses. They will often need help to cope in a world that is mostly populated by ‘neurotypical’ people but that doesn’t mean we should try to stop them from being autistic. Autism is as much part of a person as their personality. Speech and language therapists (and other professionals) work with people who have autism to help them develop strategies that allow them to function in the world around them. (See FAQ ‘How do speech & language therapists help people with autism?‘)
It is important to understand that there is no scientific evidence that the MMR vaccination causes autism. Dr Ben Goldacre, who is a medical doctor specialising in research into epidemiology, talks about how the media fuelled the MMR scare in this extract from his book, Bad Science.