Autism Blog: Echolalia, Semantic Pragmatic Language Disorder and the Long Road to Functional Communication.
I was asked by a parent of a son with autism about my language history. I hope there comes a day where we stop understand that serious language and communication disorders in those with autism actually have identifiable labels of their own with their own associated strategies and treatments and stop mystifying them as ‘the autism’. So here’s what I’d replied to the question.
I didn’t have Oral Dyspraxia nor significant Speech Apraxia, so unlike those with these conditions, I was able to pronounce words. However I was in late childhood by the time I could use ‘functional’ speech. My issues were about acquiring the ability to speak with interpretive meaning, ability to speak interactively, ability to use speech with intention and purpose, and ability to dare emotional and personal speech. Mine was a journey of Verbal Agnosia (meaning deafness) and Semantic Pragmatic Language Disorder with later episodes of Selective Mutism.
Unlike Temple Grandin’s language history before she could speak by age 3, my speech history wasn’t that I couldn’t pronounce three words, it was that I couldn’t RECEPTIVELY process a string of 3 words with meaning. Even if I ‘got’ the meaning of the first word, by the third it was meaningless jumble.
My speech history is that I was tested for deafness at age 2 but had delayed echolalia from 18 months, 2 hrs of self-directed stored chatter in my grandparents voices. There was no asking for a drink, no badly pronounced request for a ball (Temple Grandin at age 2 had requested ‘ball’ but pronounced it ‘bah’ and after intensive speech therapy had functional speech by age 3). I had echolalia but it’s not the same as saying I had ‘speech’ in any semantic or pragmatic terms. According to my father and aunt, in 1965, at age 2, after a 3 day inpatient hospital observation at St Elmo’s Private Hospital in Brunswick, Victoria, I was assessed as psychotic.
By age 4-5 I had immediate echolalia, repeating everything said to me, otherwise silent or self-directed songs, advertisements, strings from TV. This is the same degree of communicative speech that a speak-back electronic toy will give you.
By age 9 I had this immediate and delayed echolalia plus made-up words (Donna-isms) which you can read about in Autism And Sensing, The Unlost Instinct where I write about ‘sensing based language’ and how its a completely different system to ‘interpretive language’ (one word, one meaning, strung into sentences). Around this age I was labeled Emotionally Disturbed in my school records.
At age 9 my meaning deafness was finally understood (after another test for deafness). I had about 10 percent receptive speech. Then between age 9-11, a remedial reading teacher at school, taught me to linke writting language to pictures via gestures (the pic-word connection was hopeless as my visual processing and retention for meaning without gesture was shot) and finally I could begin to read with meaning.
At home, by age 10-11, gestural signing and communication via objects was used as well as simplified, slowed speech (this is all in Autism; An Inside Out Approach and is also in detail on my DVD called ‘Blah Blah Blah’).
I was put on zinc, multivitamin-minerals at age 9 and anxiety medication and because further testing for deafness revealed I was meaning deaf, my environment began to use very simplied speech, gestural signing and the use of representational objects … which I feel all contributed to me getting enough receptive meaning to acquire interpretive language and begin to dare use it (I was terrified to use it socially and it disturbed me to hear my ‘broken’ speech when I could use self-directed stored strings fluently). People don’t realise people with autism learning to speak may have NO simultaneous sense of self and other, so they are speaking into a perceptual void (this is outlined in Autism; An Inside Out Approach and also in The Jumbled Jigsaw). Add mood and anxiety disorders to this and its a major challenge for those with autism.
Social Anxiety peaked a result of emerging into a world of interpretive meaning and with it my mind, the world of conscious thought, began to awaken, and the result of this and using a quite clumsy new tool of the one-word-one-meaning system (someone said watching me try and string a meaningful sentence together was painful and took me ages) I developed Selective Mutism which came and went in episodes from age 9-12.
By age 13 I had two hour monologue litanies of every action of every classmate over the day… our marvellous language ‘breakthrough’… Donna ‘converses’… well, not exactly.
By age 17 I had 50 percent communication and 50 percent stored language strings. My receptive speech was about 50 percent.
By age 20 I stopped mouthing EVERYTHING said to me and started to repeat it internally to try and grasp its meaning as there was still significant process delay. It was in my 20s I was formally diagnosed with autism (according to my father, it had already been suggested to my family when I was 10 by a female teacher who had taken me home after a family fight).
Following the publication of my first book, Nobody Nowhere, I was extensively interviewed and would answer people’s questions via typing. After about 50 typed interviews i could speak fluently on autism and via typing (which started with letter strings at age 9 and was developed by age 13 and academic by age 18 and literary by age 26) I came to be able to speak anything I’d already typed. 9 books and 100 interviews and lectures later, I can speak anything I’ve already typed but things I’ve never typed about I still struggle to speak fluently.
In my mid 20s tinted lenses (I now use some from BPI) helped with processing time by reducing visual overload re fragmented vision – this is in Like Colour to The Blind (note UK spelling and that this and my other books are all published by Jessica Kingsley Publishers).
By my 20s, now CF/GF/low salicylate/non-sugar and on omega 3s, calcium magnesium, mega B etc, and begining to openly use representational objects and gestural signing to better track my own speech and that of others, my processing and communication was on a good track.
At age 30 or so came Glutamine and finally flowing two way dialogue instead of rants, monologues, litanies and stored strings, became possible for reasonable bursts before the ‘batteries’ would go flat. Wtih Glutamine came a simultaneous sense of self and other ESSENTIAL to two way dialogue… this is in detail in Everyday Heaven.
And after age 30 came treatment for 2 primary immune deficiencies and medication for co-morbid mood, anxiety and compulsive disorders – meaning heaps more processing time and my personhood no longer flooded out by autism related challenges so I feel I’m more the person than the condition but before the condition dominated much of my experiences, perception, cognition and identity.
In my 40s I saw an audiologist specialising in language processing disorders and was diagnosed with a marked receptive language processing disorder even though I was only 30% meaning deaf by this time.
In terms of language disorder, mine was not an Asperger’s journey. Language hasn’t been an easy road. If I made it look easy, anyone whose read my books knows it took a long time and passion and effort and inovation to get where I am with communication.
Donna Williams
autistic author of 9 books in the field of autism.
www.donnawilliams.net
www.auties.org
Hi wonderful article.
I’ve been trying to learn about lots of things about autism.
I have a relative who’s severely autistic and wonderful. I specially am learning about non-verbal autism.
Can I ask for your help about this too?
I read along your blog and see about some non-verbal autistic persons. Wonderful stories and interviews with Amanda Bags and some others. I still have to read more though.
Wonderful writing and ideas here by you–
http://blog.donnawilliams.net/2008/03/17/diagnosis-autism-and-a-untidy-boxes/
[My diagnosis in 1990 was autism due to having dysfunctional language indicative of a significant language processing disorder. Though I was ‘functionally non-verbal‘ I always sang and recited advertisements, TV shows and bits of people’s sentences. Though I’ve had phases of Selective Mutism, I have never been non-verbal in the silent sense though due to meaning deafness until late childhood my language was highly idiosyncratic, non interactive and largely incomprehensible for much of my childhood.]
I think I can follow! Smart stuff :-)]
Is Amanda ‘functionally non-verbal’ or as you say ‘non-verbal in the silent sense’? What does this mean also, sorry to ask but I wasn’t alltogether sure. Is it mean, involuntarily non-verbal?
I can’t speak on behalf of Amanda.
I can say that in my case my episodes of Selective Mutism were many and ranged from days to months at a time. I can say that at those times it was as though my throat had frozen and I couldn’t dare to speak. The aversion to hearing my own voice in my own ears had become so unbearable and socially threatening (for it could invite the social invasion or responses of others) that fear had stolen volition from me. The Indirectly Confrontational Approaches in Exposure Anxiety; The Invisible Cage were always what would disarm the chronic fear and open me back up again to at least self-chatter.
Many people with autism are described as non-verbal but in fact virtually none of the hundreds of even severely functionally non-verbal people I’ve worked with were completely mute or silent. Most at least muttered or made intonation patterns or hummed or sung or had some echolalia whether poorly pronounced or not. Yet all are termed ‘functionally non-verbal’.
Donna *)
You’ve overcome so much. An example of a fighter. Wonderful 🙂 !
I can’t seem to find info on amanda that much. I saw in your interview w/her http://blog.donnawilliams.net/2007/07/03/putting-autism-on-trial-an-interview-with-amanda-baggs/ you say/write– “featuring herself typing her communication, she featured on US TV and her video was seen by over a 1/4 of a million viewers, inspiring functionally non-verbal people with autism”
So I gathered she’s functionally non-verbal but I’m unclear of what this is technically. So she’s nonverbal right. I just didn’t know the technical sides of this. It’s been hard to learn.
In your article interview with her she gives some info. I worry if I got it wrong. But I think she’s replying to you she’s –nonverbal — but was a little verbal in her past –then lost verbal ability entirely –so is now nonverbal –can’t talk with mouth or lungs (well both go together right?).
What did you get from your interview with her on this? Am I way off. You guys are great writers and sometimes I can’t follow that well because of my unfamiliarity with the technicals lol.
From what I gather (and I may be wrong) Amanda likely had scripted speech in childhood and got by conversationally by her teens through copying the patterns of others. She experienced trauma, emotional breakdown and brain injury around puberty and lost many of her ‘functioning’ skills. Her speech became tumbled and unreliable as communication and she resorted to typed speech which remains intact and highly lucid.
So, yes, she can use her mouth and lungs fine for speech (though I’m not sure if she’s also experienced Selective Mutism) but she lost FUNCTIONAL speech, which is called being FUNCTIONALLY non-verbal. No, she is not mute.
As for me, Since adulthood, and especially by now in my 40s, I mostly have good functional speech though some situations still trigger a SMALL degree of Selective Mutism in me (so my voice goes to a whisper and I speak minimally). I experience some struggles with word order, especially when flustered, and I revert to some stored strings with those I’m comfortable with and generally sign, especially when receptive language processing gets pretty bad. Off Glutamine my language gets in tumbled order by day three and my receptive language processing reduces to a point I get aversive to listening to people talking to me. I speak clearly and well on topics I know, and otherwise my spoken language is ok but far simpler than my typed speech.
Donna Williams
http://www.donnawilliams.net
Thanks so very much for the information and help. Lots of technical things I didn’t know about. I guess what ‘non-verbal’ is, is not simple.
—Though I’ve to say I did think Amanda was incapable of any speech – not capable of making any words, aside from whether she was doing so with 100% meaning for her. I guess if you’ve the capacity to speak [make words, say something useful, regardless of if done with 100% meaning) then this wouldnt be ‘non-verbal’ right, well at least to me. Maybe “moderately verbal” or “partially verbal” or somthn like this. ??
I don’t think you understand FUNCTIONALLY non-verbal. If someone is functionally non-verbal they can EITHER be MUTE, they may have humming, singing, they may have stored language strings from advertisements or snipets from TV shows. What they don’t have is the ability to reliably use language with semantic MEANING and pragmatic PURPOSE.
If they have SOME ability to do so, then they are partially functionally non-verbal.
So, before I was 9 I had lots of songs, stored strings, immediate and delayed echolalia and I could sometimes answer yes or no. But even my eyes or no was unreliable 50% of the time… I’d say yes and have no idea what I was answering or say no when I meant yes and my other speech was sometimes funny and entertaining, but mostly people felt I was muttering to myself in uninteligible, meaningless self-directed chatter and to a degree they were right, but to me, I was enjoying the associations with pattern, theme, feel or enjoying the sounds, sound patterns or mouth shapes and I felt that copying them brought me closer to being ‘like them’.
There is a massive difference between ability to make words and be able to say something reliably meaningful. I’ve worked with many people with autism who have huge amounts of delayed echolalic strings but are 90% or more unable to use this reliably for communication and the 10% which does work is often just by default (eventually something will HAPPEN to sound appropriate).
There a huge difference between being verbal at any level and being FUNCTIONALLY verbal at any level.
Those with speech but no functional verbal communication are just as communicatively disabled as those who are mute, in fact sometimes moreso as their unintelligible or seemingly meaningless speech leaves them considered brain damaged, disturbed or psychotic.
Donna Williams
http://www.donnawilliams.net
I think that a lot of people will try to find a cause for a loss of something that was previously there. Sometimes there is no external cause, sometimes it’s just a normal part of a person’s development to lose something that was only a facade anyway. It’s a little more complicated than Donna makes it sound, though. Typing for a long time followed speech and was largely not communicative in nature. And speech was never more than a small percentage actually conveying internal thoughts, it was just not built that way. The loss was gradual and no particular event came before it, other than total overload and inability to sustain something that had little foundation anyway. Around 17-36% of autistic people lose previously-gained abilities during puberty, and it is often only puberty that causes the changes. A lot of people wanted a scapegoat when it was happening, and a lot of people want a scapegoat now, but I do not think there is one, and if there is, it is probably not most of the things people have assumed it was. I can’t tell the whole story all over again, but it’s in my blog.
Basically, a lot of the time I am unable to speak in any sense at all, and a lot of the time there are sounds that come out of my mouth, but they have nothing to do with what I’m thinking, nor are they all word-sounds of any kind. I don’t understand why imitating a microwave would still have me called “non-verbal” and imitating a speech sound would have me called “verbal”, when imitating the speech sound has no more communicative content than the microwave beeping does. My experience of not speaking at all, and making a lot of noises some of which include speech, is identical from the inside. There is nothing special and communicative about having random echolalia and vocal tics, they’re just noises my mouth makes independent of my thinking.
I am not too fond of the term ‘non-verbal’, it’s mostly a term others put on me. I’m not saying that it’s inaccurate because of something about me, I’m just not big on the term applied to anyone, because they could have receptive verbal skills, or written verbal skills, etc., and on the outside you can’t tell things like that. But ‘non-verbal’ and ‘functionally non-verbal’ are both things that other people have called me, including professionals, and as far as the definitions fit anyone, I do fit them. Even autistic people who occasionally utter a communicative phrase are often considered non-verbal because they can’t do so on demand or on purpose, and it is so rare. And autistic people who have only non-communicative echolalia are also considered non-verbal by most people. When I say I am non-speaking, I mean that as far as communication goes, speech is not the way I can do it.
Remember also that there are degrees of everything, things are not black and white. To be considered blind, a person does not have to see absolutely nothing ever, a person is considered blind if their sight falls below a certain threshold (and can also be considered blind if they are able to see but totally unable to understand things they see, even enough to step out of the way of something moving towards them). To be considered ‘non-verbal’ there is a similar threshold. It is not “Does not ever say and has not ever said a word of any kind of any reason,” but rather “Can use such-and-such amount of speech to communicate” ranging from no communicative speech to a small and often erratic amount of communicative speech, and this can be with or without non-communicative speech added in.
fabulous answer oh eloquent one
🙂
Lots of technicalities to learn tks Amanda.
I read and listened to a Canada CBC.ca story today, very nice one, lots of articles and videos.
I saw this one CBC video with you http://www.cbc.ca/mrl3/23745/thenational/archive/autism-102708.wmv
From about 50 seconds on you comment about non-verbal. If I remember right. You say/type via voice synthesizer, you have the “motor capability of speech” but can’t convey meaning consistently via speech, and “it’s easier to type what I’m thinking than to say it with my mouth.” Does this mean that you prefer or choose to not speak?
Wonderful articles and cool video with you.
I got functional speech by late childhood.
I now CAN speak and on topics I’m used to retrieving it’s quite easy now sometimes
but some days its dead hard just to FIND the words and get them in the right order
and that’s with so much management – diet, supplements, medication, gestural signing etc in MY CASE.
and just tip one of those, of raise the stakes re tendency to Selective Mutism
and speech becomes extremely hard like digging ditches
so I then walk off or stay alone, prefer activities and people where verbal speech will not be required.
And you try digging ditches for a whole day, you get fatigued, it has to be WORTH the effort
and if its social banter which appears to have no purpose in your world,
why use a facility that takes great effort.
So, yes, when I was a kid I wished like hell other people could understand me and see I was inteligent, sane, and I often gave up or equally later feared them knowing me through speech (because it would mean they’d then expect it all the time), so I think you need to understand the broad levels of relationships to speech.
There are people with CP who CAN speak with great effort but prefer not to all the time.
There are people with autism in the same situation.
Amanda,
Interesting discussion here. Kind of complicated.
I was also curious about the post above Donna’s last post. This one….
“Lots of technicalities to learn tks Amanda.
I read and listened to a Canada CBC.ca story today, very nice one, lots of articles and videos.
I saw this one CBC video with you http://www.cbc.ca/mrl3/23745/thenational/archive/autism-102708.wmv
From about 50 seconds on you comment about non-verbal. If I remember right. You say/type via voice synthesizer, you have the “motor capability of speech†but can’t convey meaning consistently via speech, and “it’s easier to type what I’m thinking than to say it with my mouth.†Does this mean that you prefer or choose to not speak?
Wonderful articles and cool video with you.”
That one’s been misinterpreted a lot. I don’t prefer or choose not to speak, I just have pretty much no communicative speech capacity at all.
I do prefer to use a communication device. (Which is the phrase that got misconstrued by some people.) What I meant when I said that, is the same as “I would prefer to use a communication device rather than have no means of communication by words.” Believe it or not, there are people who can’t speak at all, and deliberately choose not to use communication devices. I have known a few. That’s probably one reason I use language like “prefer”. But to most people, it would be a non-choice, because most people would not view not communicating in words as a viable choice. So they’d say I have no choice but to use a communication device, and mean the same thing I do when I say I prefer to use one.
(Which language I use for it depends on which phrase my phrase-bank grabs. I wouldn’t take the difference in phrasing as seriously as you seem to. Even ‘choosing not to speak’ was a borrowed phrase I used at one point to explain why I tried to deflect people’s attention away from my repetition of a word like ‘cabbage’ out of context and with zero communicative content.)
But I don’t choose speech (if it can even be called that — repetition of sounds might be a better term to avoid confusing you) to be non-communicative, nor choose not to speak. I could not, for instance, decide one day that I was tired of typing, and begin speaking, not even if you had a gun to my head. (And please don’t try that approach.)
If you are the same person who has kept commenting, your repetition of the question several times despite a ton of information being provided to you, makes me wonder whether you care about learning about my means of communication, or whether there is a subtext here that I am missing. It reminds me of when people ask a gay couple “Which one is the man and which is the woman?” and then when they try to explain the reality of their relationship, just repeating “Yeah but which one is the man and which is the woman?”
Or also reminds me of a reporter (I’ve dealt with a lot of those by now) who is fishing for a particular soundbite that they are going to quote endlessly out of context and insist has a particular meaning that it doesn’t. For instance, one reporter asked me “Do you consider autistic people disabled?” and I said of course I do, explained our connection to the disability community, and so on and so forth. But she kept asking the question over and over again. When I did not give her the answers he was hoping for (“no”), she just made one up and used something about “Seeing autistic people as different, not disabled” in the headline.
Or of a person trying to catch me in a perceived contradiction (“She said she can’t speak, but she repeats words like ‘cabbage’! Oh no, the world is ending, it couldn’t possibly be that repeating ‘cabbage’ over and over doesn’t constitute speech as we know it, can’t be used in conversation, doesn’t have anything to do with her thoughts, isn’t voluntary, and isn’t enough for a speech pathologist to consider a person ‘verbal’. Just the fact that she can repeat the word proves she wasn’t telling the truth when she said she couldn’t speak, and proves that she’s really choosing not to talk.”)
I’m hoping that none of those are your reasons. And if they’re not (especially if you’re an autistic person with language trouble yourself who can’t figure out how to rephrase your question), I’m sorry for bringing them up. It’s just after being put on a microscope by one too many people who don’t care what I actually have to say and who twist what I do say beyond recognition, I get sensitive to certain communication patterns. Keep in mind I have both receptive and expressive language problems even outside of speech, and language is very divorced from my experience of the world even when I’m at my most communicative. These can make communication a little overly interesting on its own, and can also mean I grab the wrong phrase from time to time.
Hi Amanda, I agree, the repetition of the same question is getting tedious and exhausting which is what trolls do and though this person isn’t being nasty I think we both are whole people with broader interests than going over and over answering the same question so I’m closing this post to further questions now.
warmly,
Donna *)