Why does autism sometimes impede the ability to produce speech?

Question

My seventeen year old brother is severely autistic and unable to communicate. He can produce sounds, and imitate words, but he doesn't respond to words in a way that suggests he understands them. His imitations are always imperfect, and this is what interests me most. For example, he can sort of say the first twenty numbers ('ah', 'tih', 'ee', 'hoh', that sort of thing.) He sort of gets rhythm, but not intonation or pitch.

Of course, every child is different, but are there reasons why an autistic teen who can clearly hear words has never in 17 years learned to accurately reproduce them? Dad once speculated that it was auditory, that he can't hear the sounds properly, but I suspect that it's physiological. I'd like to hear thoughts from people who know what they're talking about.

Answer 1

Difficulties with language is not actually a symptom of autism. Autism Spectrum Disorder involves difficulties in social communication and interaction, as well as restricted and repetitive interests or behaviours (DSM-V, 2013). The term "social communication" is referring to difficulties in the social aspects of language and other communication, such as matching verbal and non-verbal behaviour, rather than difficulties in language.

The language difficulties as described in the question sound like they could be related to the age-equivalence of the individual, although of course physiological hearing difficulties can't be ruled out until it is assessed. All children progress through a sequence of language development (Tager-Flusberg et al., 2010):

1. Pre-Verbal

   • Babbling, gestures
   • Typically developing children aged 6-12 months

2. First Words

   • Non-imitated, spontaneous single words
   • Some of the speech is intelligible, and uses consonant sounds typical in babble
   • Typically developing children aged 12-18 months

3. Word Combinations

   • 2 and 3 word combinations, including nouns, adjectives and verbs
   • Typically developing children aged 18-30 months

4. Sentences

   • Children create sentences, now using plurals and prepositions
   • Typically developing children aged 30-28 months

5. Complex Language

   • Language for a range of topics, using complex grammar, in different discourse contexts
   • Pre-school aged typially developing children

Tager-Flusberg et al. (2010) have a great table (Table 1) in their article outlining their proposed benchmarks for each of these phases. As the child progresses, their phonology (speech sounds) improves as well as their vocabulary, grammar, etc. Thus, your brother may be imitating the sounds he hears as best he can within his level of language development.

Answer 2

What is Autism?

Psychologists, psychoanalysts and neuroscientists all commonly apply a triune model of the brain :

• The Reptilian complex (aka “instinct” aka “the Id”) : where primitive subconscious emotions (such as sadness, anger, fear and happiness) reside and which is correlated to primitive neurochemical algorithms that measure one’s capacity to take care of oneself.
• The Paleomammalian complex (aka “consciousness” aka “the Ego”) : where individual consciousness resides, and which is correlated to defensive, perceptual, intellectual-cognitive, and executive functions.
• The Neomammalian complex (aka “intuition” aka “the Super-ego”) : where collective consciousness resides, and which is highly correlated to the internalization of cultural rules, mainly taught by parents applying their guidance and influence.

In Autistic individuals, the Neomammalian complex does not behave as it normally should, which could have any of a multitude of causes. In essence, that means that Autistic people are lacking what is commonly refered to as a “gut feeling”. Autistic people can’t just follow “whatever their heart desires”. So they need to analyse whatever data they have all the time to compensate for that lack.

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Autism and emotions

The emotional life of Autistic people is no less intense than that of other people (if not more intense), but — due to the lack of a “gut feeling” — it is not as layered. Much of the wide range of subtle nuances in their emotional spectrum of “Neurotypicals” (aka “normal people”) is completely alien to Autistic people.

The Autistic emotional life is almost exclusively an expression of the level of (dis)comfort one experiences at any given time. While that may seem a very limited range of emotions, the emotional life of people with Autism can nevertheless be just as intense as (if nor more than) that of “Neurotypicals”.

Because Autistic people need to analyse everything all the time whenever “Neurotypicals” can just rely on their “gut feeling”, Autistic people are far more sensitive to a multitude of stress factors, but also far more capable of experiencing a state of Zen-like tranquility when stress factors are minimal.

This means that Autistic people and “Neurotypicals” experience a vastly different emotional spectrum, with different triggers, different sensitivities, different preferences, etc. The obvious consequence thereof is that Autistic people struggle to comprehend the emotional spectrum of “Neurotypicals”.

Perhaps less obvious is that it’s no different the other way around. It is not just difficult for Autistic people to understand and communicate with “Neurotypicals”, but also for “Neurotypicals” to understand and communicate with Autistic people, because their perception of themselves and the world around them is so vastly different.

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Implicit learning and language

Because the Neomammalian complex does not behave as it normally should, Autistic people don't just lack only “gut feeling”. They also lack a mechanism known as “implicit learning” (or their capacity for “implicit learning” is very limited). This is a mechanism that allows humans to learn through observation at a sub-conscious level.

Because Autistic people can't learn at the sub-conscious level, they need to learn pretty much everything at a conscious level. Learning something at a conscious level is a lot harder and requires a lot more intelligence than learning something at a sub-conscious level. Because one's native language is typically learnt implicitly, Autistic people therefore require more effort and intelligence to be able to learn their first (native) language than other people.

Communication difficulties between individuals with Autism and so-called "Neurotypicals" therefore exist at two levels. Not only do both have a different emotional spectrum, but they also learn to express their thoughts and emotions in different ways, further widening the gap between Autistic and "Neurotypical".

Answer 3

There are often motor control issues, the case study below exemplifies these and an approach to overcoming them with help from technology. As well as the below, there are many personal accounts such as those of Carly Fleischman and Tito Mukhopadhyay that describe the struggle to align output with inner thought.

Language is More than Speech: A Case Study Morton Ann Gernsbacher, Ph.D. Abstract: Some individuals face severe challenges with producing oral language (i.e., speech). In this article a case study of a child who experienced severe challenges with speech development is presented. Medical records, historical home videos, audio recordings, and photographs, in conjunction with an extensive journal maintained by the child’s mother provide the basis for this report, which profiles the child’s development from birth to age 8;0. This child’s development demonstrates the necessity of distinguishing between language—the mental representation of concepts and their relations—and speech—one means for communicating mental representations. Journal of Developmental and Learning Disorders, Vol.8, 81-98.