Developmental language disorder in autism and Asperger’s syndrome
Scientists and laymen alike are well aware that one of the major issues that people on the autism spectrum face is a problem with social functioning. Unfortunately, a related but lesser-known issue is often left in the shadows: developmental language disorder, DLD.
While deficits in social functioning can appear as a hard time understanding vague signals and body language, a language disorder first and foremost takes the form of a lower than normal ability to express oneself verbally and understand verbal instructions.
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Language impairments are often co-morbid with Asperger’s syndrome
Developmental language disorder seems to be present in roughly 50% of all children with some form of autism. Even in those with high-functioning autism – Asperger’s syndrome – around 40% exhibit a deficient lingual ability.
According to researchers at the Gillberg Centre, who specialize in neuropsychiatric disorders, there appears to be a stronger correlation between autism and language disorder in individuals with high functioning autism than in autism in combination with intellectual disability.
In the case of intellectual disability, any problems related to language development are assumed to be caused by the disability itself – as a lower intellectual ability is associated with impaired language development. This regardless of whether one has autism or not.
Since high functioning autism and Asperger’s syndrome are associated with normal-to-high intellectual ability, there is no such connection. Therefore it is assumed that language impairments in these cases are consequences of the autism itself.
DLD – a disorder with many faces
“Language disorder” is an umbrella term used for many different limitations and impairments related to one’s lingual ability. Deficits in this area can, therefore, manifest itself in numerous ways in different individuals, but the language disorder can also change form and intensity depending on circumstances and current mental and physical state.
Since developmental language disorder in people with high functioning autism often appears objectively mild, it’s common to suffer from a lack of understanding and to not receive the necessary help and support.
As an example, the Gillberg Centre states that children with high functioning autism could see improvements in their language impairments if only they had access to a speech and language therapist. Moreover, they think that speech and language therapists should be a part of the evaluation team whenever autism is suspected.
Developmental language disorder is usually split into four subcategories:
- Phonology – pronunciation and rhythm
- Semantics – vocabulary
- Pragmatics – situational adaptation
- Grammar – sentence structure and inflection
Individuals who suffer from a developmental language disorder can have issues with one or more of the subcategories. Any issues may also change or improve over time, so that language difficulties can take different forms in childhood and adulthood or even disappear completely during the course of life.
Phonological problems
Difficulties with pronunciation and rhythm sometimes take the form of the classic, monotone manner of speaking that sometimes is seen in people with various kinds of autism. There is no emphasis on syllables that require such, and one is often seen as neutral, bored, or robotic.
Other people with autism instead speak too loudly or with the wrong intonation, so that statements are mistaken for questions and vice versa.
Unusual pronunciation is so common in autism spectrum disorders, that it could be used as a diagnostic tool. Despite this, an atypical manner of speaking isn’t currently a part of the diagnostic repertoire in either low- or high functioning autism.
Phonological impairments can also appear as an inability to pronounce certain vowels, such as mixing up Y and U, or exchanging one consonant for another. As an example, it’s common for children with a language disorder to switch out G for a D because the latter is easier to vocalize. Other common impairments are difficulties pronouncing the rolling R, as well as avoiding lisping when pronouncing the letter S.
Semantic problems
Language impairments related to semantics primarily come in the form of a lacking vocabulary. It’s common to find coming up with synonyms difficult, and one can also have a hard time categorizing words. There may also be some issues with remembering certain words even though one knows them by heart.
Some people who suffer from semantic language impairments experience difficulties understanding oral and/or written instructions. They, therefore, have issues with e.g. plans and schedules in school. There are often co-morbid problems with reading and writing, which makes school even more difficult for the student.
Both adults and children that suffer from semantic language disorder commonly make up their own vocabulary as compensation for the inability to recall certain words. For example, the word “cat” can be turned into “meow-meow” by young children, whereas adults with a more extensive vocabulary instead might rephrase themselves to bypass the blanked out word.
Moreover, there are often difficulties with grouping and categorizing words – e.g. one may know that a banana and an apple both are fruits, yet still find it difficult to recall them when asked to list all personally known fruits.
Because the semantic abilities are tightly tied to vocabulary and the understanding of e.g. pre- and suffixes, a lacking ability can lead to severe issues with forming social bonds.
It’s very difficult to share thoughts and emotions when one’s ability to express oneself is below average, and it’s even harder for people on the autism spectrum who already have other communicative impairments such as alexithymia and an inability to understand and/or exhibit facial expressions and body language.
Pragmatic problems
When there are impairments in the pragmatic aspects of the lingual ability, one has a hard time adapting one’s language to different situations. One frequently uses difficult or scientific words in everyday situations or, in contrast, makes use of slang in essays and formal applications.
It’s quite common for people with high functioning autism to use old-fashioned, advanced words while participating in discussions or socializing. This is called idiosyncratic speech and involves using words that are factually correct, but that aren’t fitting for the current situation.
As an example, one might say “archaic” instead of “old-fashioned”, “obsolete” rather than “outdated”, or “arid” instead of “dry”. These synonyms aren’t incorrect but are hard to understand for most people and rarely suitable for everyday conversation.
Individuals with high functioning autism or Asperger’s syndrome, and who have a substantial verbal ability, might learn a few advanced words from a book or documentary. From the context, or through using a thesaurus, they come to learn the factual meaning of the word. However, they fail to comprehend that a certain word doesn’t work in all situations and that one should adapt one’s vocabulary depending on the social context.
For instance, it is often more suitable to say that one enjoys cooking and eating rather than calling oneself a gourmand, or presenting oneself as a reptile lover instead of claiming to have an avid interest in herpetology.
Just like semantic impairments, pragmatic deficits can make it harder to form friendships for autistic children and adults alike. Idiosyncratic use of the language makes communication harder and increases the risk of getting misunderstood, or a – sometimes only seemingly – high verbal ability can mask other issues, such as difficulty with mathematics or general problem solving, or make those issues mistakenly appear less severe.
Grammar problems
When there are issues related to the use of grammar, there are primarily two problems that stand out: difficulty forming correct sentences, and an inability to use proper inflection.
For instance, someone who suffers from grammatical language disorder may have a hard time remembering the correct plural of certain words. This can be especially true in languages where there are many different forms of plural word endings, such as Spanish or Swedish.
For English speakers, there can be issues with the inflection of e.g. man –> men, or goose –> geese. There can also be issues with using proper tense, such as “do”, “did”, “have done”, so that these tenses are mixed up. Instead of “Yesterday, I went to the movies”, an individual with developmental language disorder might instead say “Yesterday, I go to the movies”.
Despite incorrect grammar, the afflicted individual can usually be easily understood by others. Therefore, there is a lower chance of issues with one-on-one communication compared to some of the other forms of developmental language disorder.
Nevertheless, abnormal use of language – regardless of what form it takes – increases the risk of getting bullied. Impairments in expressing oneself have a negative influence on the development of social relationships, and indirectly affects one’s self-esteem as well as self-confidence.
Language- and speech impairments are related to autism
A person with autism, who also suffers from developmental language disorder, can thus experience issues with one or more of the previously described subcategories. It’s not uncommon for language impairments to improve or completely vanish throughout the course of life.
Adults are commonly able to compensate for their difficulties but certain situations – e.g. unknown places or people – can impair the lingual ability and temporarily bring back previous issues.
Speech disorders are also sometimes co-morbid with autism; both high- and low functioning.
Echolalia – a disorder where a certain word or phrase is compulsively and meaninglessly echoed (repeated) – is found in as many as 75% of all individuals on the autism spectrum.
There are two variants of echolalia: an immediate variant where one echoes something another person has said right away, and a delayed variant where one echoes the phrase weeks or even years after having heard it.
Echolalia shouldn’t be mixed up with palilalia, which also is co-morbid with various forms of autism. In the case of palilalia, instead of echoing someone else, one instead compulsively repeats a word or phrase oneself has uttered.
As an example, echolalia can make oneself echo e.g. a commercial one has heard on the radio, while in the case of palilalia one can instead repeat the phrase “the sky is blue” over and over again.
Stuttering is sometimes co-morbid with autism, although the exact correlation is currently unclear. This because there are very few scientific studies of the matter.
Stuttering in individuals with autism can, similarly to stuttering in general, express itself in several ways: the repetition of a certain letter (“b-b-book”), getting stuck on a certain word and being unable to utter a letter or syllable, or an unintentional prolongation of a syllable – an inability to finish it properly.
Despite the fact that severe language impairments, such as complete mutism, aren’t found in high functioning autism and Asperger’s syndrome (selective mutism, however, is not unheard of), there exist numerous difficulties related to the spoken language.
Nevertheless, individuals with autism very rarely get diagnosed with a developmental language disorder, in large part because there is some overlap between actual language disorder and various forms of impairments in social functioning.
Another aggravating factor is that the diagnosis of Asperger’s syndrome per definition requires a normal childhood language development – even though 40% of individuals with Asperger’s syndrome and atypical autism suffer from some kind of developmental language disorder.