ASD and Language Impairment; Sometimes, they don’t understand more than you think…

I’ve very often heard people say to me – as if it was an accepted maxim of all children’s development – that they can always understand more than what they can say. It’s also often said in regards to autistic children; that just because they can’t speak much doesn’t mean they don’t understand. However, my own son’s early language abilities didn’t give off this impression; his spoken language was obviously more limited than his peers, but it struck me too that his receptive language – how much he understood of what I said – was also severely limited compared to other children his age. His frustration and anger and anxiety weren’t eased by the right words or by explanations, it was like we had to deliberately construct his language from the ground up, starting with the seemingly simple task of developing joint-attention.

I remember the speech therapist insisting on the importance of working on joint-attention as the starting building block of language development, and me thinking she was wasting my time; surely getting him to look at the same thing as me, or work on the same task as me, wasn’t as crucial as she thought, shouldn’t we be working on some concrete language tasks rather than playing simple games with him? Similarly the skill of turn-taking, which my son also sorely lacked (and not in the bad-discipline sense of not wanting to share, it was far more fundamental and important than that); I used to wonder whether we were wasting precious early-intervention time on this skill, but the language therapist insisted it too was vital for teaching language.

These ideas – turn-taking, joint attention – their importance, and how to teach them, were not “natural knowledge” to me. Neither were they to those laypeople around me; those who offered advice that if I just spoke to my son more he would understand me (which was ridiculous, I talked to the poor boy all the time, and he went through an extended phase of hurting me when I talked). And the advice that he would just pick up language by himself, that simply being human meant he would and could figure it out himself like all the normal kiddies do.

I’m reminded of those early speech therapy lessons, and the importance of speech therapy, by an interesting piece I have come across of the SFARI site, entitled “Cognition and behavior: Language defect identified in autism.” That piece goes beyond a mention of what is taught in speech therapy though, it is more generally about the impact of having autism and intellectual disability (in tandem) on expressive and receptive language. It refers to a study that found what I think is an important and much overlooked truth; that autistic children don’t always understand more than they can say (the study compared that group to those with just intellectual disability, and those without either condition).

The reason I think this is so important and so overlooked, is that the public – and extended family members, if not immediate family members too – tend to assume that a child who can use complex phrases and say interesting words (seemingly beyond their physical age capacity), also understand what they are saying and more complex ideas than what they are already talking about. But echolalia, as a very typical feature of autism, can be deceptive. I know there were many times that others were astounded at what my son seemed to say of his own accord, though I’d know he was repeating a phrase repeated endlessly on a favourite DVD (for instance).

Having said that, echolalia is a complex thing, and can be present in various ways on the path to emerging meaningful language. I wouldn’t want to over-simplify this process (I find this particular post very insightful on the topic: Dr. Strangetalk or: How I Learned to Stop Worrying and Love Echolalia).

My son doesn’t have intellectual disability beyond his autism, as far as I know – and that was the specific group looked at by the study in the SFARI piece – but oddly enough I think my son’s intellectual ability also hampers the ability of others to accurately judge what he understands: My son is a highly adaptive little man, he finds ways to appear beyond his actual capacities; to give off the right look and learn to say the right sort of things, but when pressed for true comprehension or engagement, he isn’t quite there yet. It’s kind of like the idea of “passing” (I’ve discussed this notion and how it relates to my son in a previous post). Figuring out what he really understands and how well he’s really getting on, is never a simple task. So I tend towards thinking that expressive language exceeding receptive language, would be a truth beyond just those with both autism and intellectual disability, to also many of those with just autism. But here I am using pure conjecture, I’m just trying to sort out these challenges and issues for myself, and hoping to hear back from readers through comments to help me figure this out too!

I want to be clear that I don’t mean to say at all, that all autistic people’s expressive language exceeds their receptive language. That would be completely incorrect, since some autistic people cannot (or choose not to) communicate (in the conventional sense), yet clearly understand what is said to them and what is going on around them. But I do think it is important to realise that there is this unusual gap between expressive and receptive language for a significant portion of children with autism. Being aware of this can help to lessen frustrations when an autistic child seems to understand but refuses to “obey,” and can draw attention to the importance of building language from the ground-up for some of our children; not presuming comprehension and language competence based on the beautiful sentences our children sometimes come out with.

Perhaps the up-shot of all these thoughts, is not to take things for granted when it comes to autism and language, and not to assume that normal language development is at play (as if it is simply “delayed” but otherwise will be normal, as many seem to think). To treat each autistic child as a complex individual, rather than as a genius-in-hiding, or as a lost cause.

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6 Responses to ASD and Language Impairment; Sometimes, they don’t understand more than you think…

  1. Tsara says:

    Love this! At the risk of sounding like a broken record, my mom–I know, I know! Sorry!–was just the keynote speaker for a group and I was lucky enough to bring my boys along and be part of the audience. One of the things she had us, as attendees, repeat was the phrase, “Act as if, and then simplify.” I truly love this! It refers to language reception and more. In other words, act as if they understand, because often they do but not always, and then if they appear to not understand simplify the task or concept by breaking it down. This is a wonderful way not to risk offending your autistic kids or friends or uncles etc., while reminding us not to assume that they’re just pretending not to know. Also, my autistic brothers quite obviously experience the world VERY differently than me so it would be silly to believe that they are always understanding more than they seem to be. I’m sure that they often understand different… and I love that they have made me learn this skill because it is true of everybody. With autism in your life so often you get challenged to learn a truth that exists everywhere, but could easily be ignored if you didn’t love someone who NEEDED you to learn it! And, like you say here, how wonderful to choose to treat people as complex individuals rather than… well… anything else!

  2. Shazza says:

    This is so important. I think it’s an issue for a lot of kids in mainstream schools who appear outwardly to have a strong grasp of language, yet a delay in processing the incoming messages. This can lead to a confused child and teacher. Thanks for writing this.

  3. mattyangel says:

    This is just not something when dealing with children and autism =)

    I request that all communication done with me that is highly important, is done using email. People don’t understand this at all, but the truth is… I can’t understand about 50% of what is said to me in person, but if its said on the computer I can look the words up.

    But how can someone that uses big words in writing not be able to understand them in talk? For me its the processing time. I need time to sit and process what each word is, to look up what I can’t understand… and make sure if the word I am using is the correct word for the sentence.

    That is why I like google a lot, you just type define:mainstream or what is mainstream and it tells you what it means and if I don’t understand that, it usually has another word that I can look up to understand it =)!

    I sometimes think about what would happen if I had no way to look up the words or write, people would think I was really not so smart then. I think.

    • I understand what you’ve said Matty, and thank you for sharing it too.

      As for the “not just about children” bit, yes I know this will apply to many adults with autism too. It’s just the study was done on autistic children so I was trying to stick to that, also the expectations around development – and what others expect of still-developing children – was an important aspect of the post. I do think it is also very important to hear from adults with autism, and to recognise the existence and experiences of adults with autism too, so I really appreciate your comments, as always 🙂

  4. dion saenz says:

    I think you are right. My daughter slips in and out of understanding. Sometimes she gets it, sometimes she doesn’t. She is verbal and again sometimes she speaks(its really broken and shes seems like it takes a lot of mental energy) and sometimes its echolalia(which flows right off her tongue). I proved though that she is trying to understand. I looked her in the eye and I said “blah. blah. blah” for about 30 seconds. I could see she was trying to dicipher what I was saying. She finally said “yes”. Strange. I did not know what to make of this. I was thinking maybe these kids just have an Intergration Disorder and not autism. They are trying to figure things out, but its just very hard for them.

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