Express Yourself (Part Two)

“I’M NOT HAVING BREAKFAST! I DON’T WANT BREAKFAST AND I’M DOING SOMETHING ELSE INSTEAD!”

My son is laying down the law. Apparently it’s not the most important meal of the day and  I am, to use his words, “The Village Idiot.” As you can see, my son has few problems expressing himself when he needs to. Problems with manners and knowing what’s good for him, yes. But speech and language? It would appear not. I wrote last week of my son’s expressive language and how it has rapidly developed in recent months. He can certainly express what is on his mind, but how well-developed is his ability to receive information? The answer is not so good.

Receptive language is the comprehension of language – the ability to listen to and understand what is being communicated. It involves being attentive to what is said, the ability to comprehend the message, the speed of processing the message, and concentrating on the message. Difficulties with receptive language seem to me to be closely linked with Pragmatic Language Impairment. Here’s a description of Pragmatic Language Impairment from the resource I posted last week:

Kaleem has pragmatic language difficulties and does not stop talking. He has lots to say about many different subjects. He struggles to have proper conversations with people; he can’t wait for them to finish what they’re saying and often interrupts. Kaleem really finds it hard to stay on the same topic as everyone else and goes off on a tangent a lot. Kaleem is excellent at reading; he can read anything that’s put in front of him. The staff noticed, though, that although he was able to pass all the items on the phonics screening check, he never seemed to understand what was going on in his reading books.

This could easily be a description of my son, and although Kaleem is never specifically identified as being on the spectrum, it all sounds very familiar. As I’ve read up on receptive language over the last couple of weeks, I’ve found myself nodding in acknowledgement at several of the tell-tale signs of impairment or delay. Here are some of them:

• Difficulty in following conversational rules:  B’s speech is often one-sided or off topic. He is the king of the non-sequiter and will often throw whatever is on his mind into the conversation. You may think you are talking about his day at school, but he will wrong foot you with comments such as, “A massive spider chased me and I collected gems” (he’s been playing a video game called Temple Run). This can seem like an odd answer to the question “What did you do at school today?” It’s also very apparent a short way into the conversation that your primary function is as a listener. B is not interested in what you have to say on this topic. He loves to tell, but he’s less keen on hearing about something. He doesn’t really do turn-taking.

• Changing language according to the needs of a listener or situation: You might be his nan, the neighbour, the postman, shop assistant, six month old cousin or cousin J’s dog but the way B addresses you is unlikely to change. My son has little sense of audience or purpose when having a conversation and will stay on one track. Autism has been likened to the difference between driving a car and driving a train. Car drivers can change course at will, and deviate from a set path. The train driver is locked on one course, unable to adapt or change or go elsewhere. My son is a train driver.

• Tendency to be concrete or prefer facts to stories: Until just before Christmas, it would be true to say that only non-fiction held any interest to B. He loved his books on the solar system, his atlases and his car books. His (many) fiction books went untouched. Though he could read every single word of each one of them, they held no appeal. My guess is that stories, even ones heavily illustrated, have too many complex layers of implied meaning, or emotional responses and motivations in characters that he does not understand. It’s not as if we’re giving him Tolstoy to read. Even in a simple ‘Biff and Kipper’ book like the ones he’s sent home from school with, it can be difficult for him to comprehend why mum is smiling or what caused the dog to run away. Inference and deduction, the things we all do when reading (or speaking and listening) are some way off for B. I think this is part and parcel of his receptive language skills, albeit written not spoken. B is an excellent reader but his comprehension and understanding are only just emerging.

There have, since Christmas, been some breakthroughs. I am very grateful to whoever bought him the book ‘Zog’ by Julia Donaldson and Axel Scheffler. It is probably the first story that has really caught his imagination, that he has learnt by heart and that brings him a sense of utter joy when reading it. It has provoked his interest in the sounds of words and phrases in the way no other fiction book has. Best of all, he asks “Why?” as in, “Why did the horse stay with the dragons?” or “Why are they happy?” These questions are the start of major developments, I am sure.

 Other features of Pragmatic and Receptive Language Impairment include:

• Extracting salient points from a conversation, story or information

• Understanding jokes, idioms, metaphors and sarcasm (resulting in overliteral comprehension)

• Understanding and using non-verbal communication

• Making and maintaining friendships

All of these aspects of Pragmatic Language Impairment could, to varying degrees, be applied to my son.

Adapting to the needs of a child with these receptive language issues is difficult. On almost a daily basis I will make the mistake of overloading my boy with instructions or expectations that, if I stopped to think, I would realise were simply asking too much. “Put your shoes on and get your coat. In the hall.” I will instruct, not realising that I have just given him three instructions in one. B might make it to the hall (if something does not distract him on the way, which it always does) but once he gets there, the original request has been forgotten. Using visuals still helps with this, as does the use of ‘Now and Next’. We need to learn how to communicate appropriately with him as much as he needs to learn to communicate with us.

Even as his parents we frequently fall into the trap of thinking B understands more than he does. This is because of the gap between his expressive language and his receptive language. I’ve written before about the invisibility of autism; not only does my child show no physical signs an impairment or disability, but also appears very articulate and to a stranger comes across as a master conversationalist. This impression does not last long. Just because he speaks well doesn’t mean he understands well. But from my own experience and the experience of others, I know how utterly frustrating it is for parents who struggle to help people see this. That this sometimes includes close relatives only makes it all the more trying.

Most of us learn language incidentally; we just soak up the language spoken around us and, without being told, develop an understanding of its nuances and uses. For the autistic individual, learning language seems to be less intuitive and more like hard work. I watch my son sometimes struggle to find the right words to articulate what he wants to say. He will stop and start, correct and re-phrase several times. You can almost hear his brain working as he flicks through his mental archive of words and phrases. Eventually he will get there, but the process has clearly been a cognitive one, rather than instinctive. Good job then that he’s such a clever chap.

One interesting aspect of my son’s developing speech is the emergence of telling lies. Apparently the ability to lie develops around the ages of 2-5 (and is a quite natural stage in a child’s development). Aged 5, B has just begun to develop the ability to tell porky-pies. One memorable lie was the day he declared he had been sent to the headteacher’s office for bad behaviour. “Why were you sent there?” asked my wife, horrified. “Playing too rough with Adam”, he replied. “What did the headteacher say?” she asked. “He shouted” was the reply. My wife’s heckles were up immediately. What was the idiot head doing shouting at an autistic child who gets non-stop support due to the intensity of his needs? “What did he say?” she asked through gritted teeth.

“He said he was going to set my bum on fire”, he replied.

The TAs at school had a good laugh over that one. Not only had the head not threatened to set my child’s arse on fire, but B had not even been sent to see him.

B will also lie about things when most children his age would realise it was futile, that the game was up. For example, when B has regularly been scraping paint off the doors or radiators with his teeth, and his lips and tongue are covered in white paint, he will deny it vehemently. Being caught in the act makes little difference. There’s only one truth, and that’s B’s truth. We’ve learnt to take his version of events at school with a pinch of salt. Most of the time the tales are so unlikely or just plain wrong (“I hurt myself and Mr P took me to the hospital” he will say. “Wow,” replies Mum, “you’d think they’d have mentioned it to me.”)

But something wonderful is happening here. It may be divorced from reality, but my son is storytelling. He’s creating narratives and is being imaginative. Thank Zog for that.

Recently, instead of trying to steer the unsteerable we have been taking the time to let ourselves be passengers on B’s train of thought. My wife and I sat on our bed with B this week and for about ten minutes just let him talk and talk. We asked him about his favourite things and off he went. Occasionally,we picked up on his points and asked him further questions. We made him completely and utterly the centre of our attention and allowed him to take us where he wished. It was mostly expressive language, as in he did the talking, but for once, the only ones needing receptive skills were us, his parents. There was no need for him to understand or process instructions, no unfamiliar concepts to grasp, no threads of conversation to follow other than the ones he was creating. It was a pleasure to listen to him enthusiastically chat away, see him make eye contact and speak with intonation, expression and variety. When allowed to speak on his own terms, there was nothing wrong with this child’s speech. For those ten minutes he was not autistic.

More than that, it felt like a taster of what the future could hold. Twelve months ago my son’s speech was very limited. Now he has excellent, almost age appropriate (expressive) language. Receptive language skills will surely follow. I’m looking forward to it.

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