There's language in her eye, her cheek, her lip,
Nay, her foot speaks; her wanton spirits look out
At every joint and motive of her body. - From William Shakespeare, in Troilus and Cressida, Act IV, Scene V1
This issue of Topics in Language Disorders describes A Developmental Framework for Evidence-Based Practices for the Autism Spectrum. Planned by issue editors, Emily Rubin and Moira Lewis, it leads readers to look deeper into how people communicate about their thoughts and feelings using their bodies and, especially, their eyes. It is also about how to foster communication abilities in people with autism and other developmental disabilities and in their communication partners when such abilities do not develop naturally.
As perhaps the keenest observer of human interaction ever, Shakespeare captured the essence of communicating via eyes and body language, even the foot, in the passage quoted at the beginning of this article. Learning to make social connections through one's eyes and other motions comes early and naturally to most infants and toddlers, but not all. A central identifying feature of autism is difficulty in social communication, and one of its earliest signs is diminished quality and quantity of eye contact. But can sensitivity to the movements and thoughts of others be taught when it does not develop naturally? Does simply saying, "Look at me," and rewarding a response with a bit of food make a social connection happen, or does it just give the appearance that it has? Are there better ways to foster the development of shared attention and thinking? What about people with developmental difficulties who communicate unconventionally? Can adults seeking to understand those children's desires learn to do so when words are rare and body language is unconventional? And what about later in development when writers have to learn to imagine what their eventual readers might need to know and how to organize a particular type of discourse? Can students with autism learn to regulate their thoughts and discourse choices in writing as other students do? Similar questions arise about complex social situations that occur later in childhood and adolescence. Can children and adolescents with autism improve their ability to understand social thinking of others and to think socially themselves so that they can plan to act in ways that are expected and socially acceptable? The articles in this issue provide a framework, information, and evidence regarding interventions and measurement techniques related to these questions. The answers, although not simple, are mostly positive. Yes, changes can be made.
The issue begins with an article by Rollins (2016), who uses a theoretical framework to explain how children on the autism spectrum can learn words and phrases and use them for instrumental purposes (to request and protest), yet continue to struggle to develop true social language. Rollins posits that this may be because of early difficulty experiencing shared emotion so that children learn to share attention to objects for purposes of requesting or turn-taking but without the element of shared emotion for social enjoyment. She argues that stepping back and helping children experience shared emotions in dyadic face-to-face interactions may be a necessary precursor to later phases of shared attention and intention for social purposes and not just instrumental ones. As evidence, Rollins presents a case study with a toddler with autism, contrasting data from a socially grounded approach with data from a more purely linguistic approach that was used previously. This involved the clinician's positioning herself face-to-face with the child (on the child's level or below) while engaging in social sensory routines using animation and contingent imitation upon establishing eye contact. It involves intersubjective looking until the child looks reciprocally, at which point the child's looking is immediately reinforced with animation and imitative interaction. But this interaction is conducted without verbal or physical prompts and with minimal use of toys. Rollins provides single-subject data to document changes in the child's social communication actions when the social approach is introduced following the baseline gathered during the linguistic approach in which interactions were encouraged around objects.
In the second article, Greathead et al. (2016) in the United Kingdom take a different approach by looking closely at adults on the other side of the social communication equation. That is, they address the philosophical importance and practical skills that caregivers and teachers apply to read the body language and other nonverbal signals of children with severe or profound learning difficulties and complex communication needs. The primary focus of this second article is on observation tools and methods for documenting how people make sense of unconventional communicative actions and provide contingent feedback. An additional message that shines through the case studies is the importance and respect entailed in seeking to understand these children's and adolescents' views (not just their wants and needs in the more basic sense), even when they initiate infrequently and communicate in unconventional nonverbal ways. These authors show that, in the context of such interactions, adults can pursue the goal to support children's communication and allow them to make their views known and heard.
In the third article, Rice, Adamson, Winner, and McGee (2016) add contrastive evidence about developmental differences in relating to adults and peers from a cross-sectional study at three preschool ages (2, 3, and 4 years), comparing young children with autism with children developing typically at the same ages. I recommend reading the Rollins (2016) and Rice et al. (2016) articles back-to-back. A particularly striking consistency is that the young children with autism are more likely to engage in a joint state for instrumental purposes than for purely social ones and with adults than with peers. The work by Rice and colleagues argues for applying some of Rollins' recommendations for encouraging social engagement to promote learning how to enjoy sharing attention socially and the need for more research on how to do this with peers as well as with adults.
Asaro-Saddler (2016) addresses a different part of the population by systematically reviewing studies that applied self-regulated strategy development interventions to help school-age students with high functioning autism improve their writing skills. Collectively, the results of the identified studies show that such interventions can result in improved quality and quantity of writing, as well as use of more persuasive and narrative discourse elements. Improved self-regulatory abilities, such as self-monitoring and planning, also may be an outcome of teaching such self-regulatory routines in the context of written expression. In this realm too, I wondered about increasing the access to audience response so that the communicative effects of improved writing could be used to motivate additional sense of writing as a social activity.
Finally, Crooke, Winner, and Olswang (2016) describe how to apply cognitive behavioral therapy to teach social thinking with older children and adolescents with social communication difficulties, including autism. An essential component of this new way of thinking is to develop the underlying knowledge to interpret others' social intentions and social situational expectations so that participants can make social behavioral adaptations and engage in constructive social problem solving. As I see it, the key is to target more than behavior change, but to develop the cognitive and thinking skills about what others might be thinking, as well as the motivations that will lead to behavior change and satisfying social interactions. What I particularly value in this article is its promotion of concrete supports and ways of talking to adolescents on the autism spectrum about abstract social concepts that allow them to "see" socially in circumstances where social signals may have been invisible to them before.
A central theme of these articles is the need to go beneath words to encourage the development of emotional connections between people-to become keen observers of others and to imagine and share what others might be thinking. This involves appreciating aspects of social communication development that may be overlooked as part of development, perhaps because they are taken for granted when they emerge naturally. I predict that readers will agree that issue editors Rubin and Lewis have been successful in their purpose to raise awareness of how shared attention and social thinking develop and how to promote them when help is needed.
-Nickola Wolf Nelson, PhD
Editor-in-Chief
REFERENCES