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Research has identified two core communication deficits in children with autism: joint attention and symbol use(Dawson et al., 1990 Kasari et al., 1990 McArthur and Adamson, 1996 Mundy et al., 1990 Sigman and Ruskin,1999 Stone et al., 1997 Wetherby et al., 1998). Joint attention refers to problems coordinating attention betweenpeople and objects. An autistic child with poor joint attention may have problems:

paying attention to a social playmateshifting their gaze between people and objectssharing their emotions with othersunderstaning/monitoring the emotions of othersfollowing the gaze of another persongetting another persons attention in order to have a shared experience

Joint attention is a significant predictor of language outcome and should be a primary goal for early communicationintervention.

A deficite in symbol use refers to a difficulty learning conventional or shared meanings for symbols. For example anautistic child may:

not use conventional gestureshave difficulty learning conventional meanings for wordsmake up their own wordsnot use objects functionallyhave difficulty with symbolic play

Children with autism usually dont compensate for their lack of verbal skills with gestures they show limited gesturaluse, both in quantity and quality. They predominantly use primitive gestures to communicate (i.e., leading, pulling ormanipulating anothers hand). They lack the use of many conventional gestures, such as showing, waving, pointing,nodding the head and symbolic gestures depicting actions (Loveland and Landry, 1986 McHale et al., 1980 Stoneand Caro-Martinez, 1990 Stone et al., 1997 Wetherby et al., 1998 Wetherby et al., 1989).

The Process of Learning to Communicate

Echolalia

The majority of children with autism who do learn to talk go through a period of using echolalia, repeating the speechof others. The repetition or echo of speech may be immediate, the child repeats a word or phrase that was justspoken, or delayed the child repeats a word or phrase they have heard before (Prizant et al., 1997).

Not all echolalia is functional language. For example, a child may repeat a phrase over and over again as a means ofalieviating stress, instead of attempting to communicate.

When children learn to use echolalia purposefully to communicate, it usually starts as a single word or a label for asituation or event. Over time the child learns to break down larger chunks of language into smaller meaningful units(Prizant and Rydell, 1993).

Children with autism who progress beyond echolalia usually acquire more advanced aspects of grammar: that is, theydevelop grammatical skills in the same general progression as typically developing children, but show persistingproblems in joint attention and pragmatic language, following the social rules and shifting between speaker and

listener roles of conversation (Baltaxe, 1977 Tager-Flusberg, 1996).

Symbolic Play and Language Development

At this stage children with autism show comparable use of communication to request and protest as typicaldeveloping peers, but significantly less use of gaze shifts, shared positive affect, conventional gestures, andcommunication for joint attention. They performed at comparable levels of constructive play but significantly poorerlevels of language comprehension and symbolic play Stone et al. (1997) and Wetherby et al. (1998). A lack of varied,spontaneous make-believe play and limited abilities in functional play significantly tie in to the development ofreceptive and expressive language (Mundy et al., 1987 Sigman and Ruskin, 1999).

Children with autism who have a greater capacity to coordinate attention and affect are more likely to communicate formore social reasons, to use a larger repertoire of conventional gestures, to have a higher rate of communicating, andto employ better repair strategies Wetherby et al. (1998). These findings underscore the importance of addressing

joint attention in t herapy.

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