Autism and First Words

Click here to read an original op-ed from the TED speaker who inspired this post and watch the TEDTalk below.

A glance at any baby book shows how much baby's first word is revered -- and hints at it's unending pleasure for parents. And as a clinical Speech-Language Pathologist for almost four decades, I am endlessly struck by the phenomenon of firsts: words, phrases, and sentences. But it was not until I met my first group of kids with classic autism two decades ago that I became completely enamored with the questions, "How do kids on the autism spectrum (ASD) develop their first words? Can they accomplish this naturally?" The conventional wisdom was that these kids could not develop real language systems at all, and that they needed to be taught survival phrases, and drilled to say them, like so many skills.

But as I learned, this was not the case. I learned that kids with ASD can develop natural language -- but not in the way the textbooks said: the way analytical kids did. The analytic processors kids, often girls, really did start their language systems with first words. Rewarding to caregivers, these children followed eye gaze, and fingers, and uttered the same single word as caregivers. Mom pointed to a ball, said "ball," and the little analytic processor did the same thing. These children tended to set the bar, and they were even called "typical." In contrast, boys seemed to be simply delayed.

But deep in the annals of linguistic and language development research from the 1970s and '80s were descriptions of the 'other half,' the gestalt processors. These kids tended to be behind their analytic counterparts in using single words, but seemed to be the natural storytellers. They were called "intonation babies," (as opposed to "word babies"), and their speech was often hard to understand. I learned that ASD kids were like this.

As a highly-detailed look at gestalt children, Deb Roy's work is illuminating. His son's six month evolution from "ga ga" to "water" was a story of the reciprocity of caregiver and child, a dance of alignment that Roy describes as a "finely tuned child-caregiver feedback loop." Caregiver utterance length systematically decreased as his little boy got closer to speaking the single word, "water." And after the word "was born," caregiver utterance length increased, as did the child's.

What Dr. Roy captured was the perfect language environment for the gestalt processor. In his household, astute caregivers parsed their language over time, isolated single words when his little boy was ready, and modeled how single words could be used in self-generated sentences. Dr. Roy amply demonstrated the journey from the large (gestalt), to the small (single word), by way of "mitigating" the sentence: paring it down when the child was ready. Then at the "birth of a word," the caregivers modeled original phrases that employed that new word. This is exactly the sequence of gestalt language processing: the journey from the gestalt, to mitigated phrases, single words, and then self-generated phrases and sentences.

But how does this relate to kids on the autism spectrum? Conventional 'wisdom' aside, early researchers in linguistics and speech and language had an inkling that ASD kids were no different from other gestalt processors -- just delayed. But, over time, the story of those kids got lost. The numbers of kids with ASD now outstrips the potential of our educational systems to assess their real potential. Our delayed gestalt processors with ASD look very different from little boys who take six months to develop the single word, "water." Twelve year olds who still say, "Do you want a glass of water?" when they're thirsty, defy our abilities to recognize the gestalt processors they are. And with the plethora of media now providing inadvertent language "models," our ASD kids of today sound more like a movie or a video game than a little boy echoing his caregiver. We are as likely to hear language like, "Get over there, man, and give me a drink," which barely resembles the language a toddler is likely to hear. Gestalt processors echo the language around them. ASD kids do too.

What I learned in the last two decades is that ASD language processors are no different from other gestalt processors except that their timeline is much longer. And because of that, their sources of language input include much more media than natural language of a household. The bank of language inside the head of the child with ASD becomes enormous, and, thus, more difficult to parse. Mitigation is very difficult, and that elusive, naturally-derived "first word" is even more delayed.

Precious few Speech-Language Pathologists share a memory of the '70s and '80s. But, the need was never greater, and our ASD kids need for us to remember -- and to help them find "water" amidst the chatter of our world.

Ideas are not set in stone. When exposed to thoughtful people, they morph and adapt into their most potent form. TEDWeekends will highlight some of today's most intriguing ideas and allow them to develop in real time through your voice! Tweet #TEDWeekends to share your perspective or email to learn about future weekend's ideas to contribute as a writer.