Improving Communication Skills in Autism

Recent years have seen improved understandings of the relationship between motor skills and the development of language, particularly in autism spectrum disorder (ASD). Given the core deficit in verbal communication in children and adults on the spectrum, the insights researchers have gained could, in time, aid them in better expressing themselves.

Using MEG, Maria Mody, principal investigator of the Martinos Center’s Developmental Language and Reading Research Laboratory, has highlighted one of the ways in which this could happen.

Circumventing Motor Deficits Can Help with Expression

Communication—whether spoken, written or signed—entails the planning and execution of gestures, which of course rely on motor skills. Not surprisingly, if speech gestures are difficult for a person, so too will be language.

“However,” says Mody, “what is becoming increasingly evident is that, despite their difficulties with speech, some individuals on the autism spectrum are capable of expressing themselves independently using either a tablet or an AAC (‘augmentative and alternative communication’) device.”

This makes sense, she says, as manually selecting words and pictures on a device is easier than producing speech. Using a device involves only simple and cognitively less demanding motor gestures: namely, pointing or pressing a button. Speech, in contrast, requires rapid and carefully orchestrated movements of the tongue, lips, larynx and more.

In 2017, Mody and colleagues set out to explore the potential benefits of using tablets or other devices as an alternative to spoken language in minimally verbal adults with autism. Using MEG during a simple motor task (pushing a button), they found significant differences in the supplementary motor area of the cortex between the subjects with autism and age-matched controls: an exciting result, Mody says, as it provided neurophysiological evidence of an underlying deficit in motor control in this population.

Mody believes that nurturing the development of literacy skills in people with autism may, in time, stimulate improvements in their speech capabilities.

“After all,” she says, “speech and print are flip sides of the same coin; reading co-opted spoken language areas in the brain. If we understand the cognitive capacities and sensorimotor capacities of individuals with ASD, we can build an intervention that allows them to use the pathways that are more comfortable for them.”

Motor deficits aren’t the only impairments contributing to the difficulties with verbal interactions. Oftentimes people with autism also have social communication deficits, which can make verbal exchanges especially challenging.

In fact, these social deficits can be the result of motor impairment. In the earliest months of life, motor skills facilitate vocal imitation and the mimicking of facial expressions as infants engage their parents or caregivers. In doing so they open the door to social reciprocity and interpersonal interaction—cornerstones of what we think of as social skills. Motor deficits can lead to disruption of those early activities, with cascading effects with respect to the development of social communication abilities.

And this isn’t the only obstacle individuals on the spectrum can face. In another 2017 study, the Martinos Center’s Nouchine Hadjikhani and colleagues looked at the tendency to avoid eye contact in people with autism and found that this is not simply due to a lack of engagement, as many had previously thought. Instead, the researchers showed, eye contact can cause overactivation in a particular part of the brain, so their avoiding eye contact is a way to mitigate this uncomfortable over-arousal.

All of which underscores the possible benefits of AAC and print communication for people with autism, Mody says.

“Because individuals on the spectrum have social communications deficits, verbal interactions can be particularly challenging. As such, print provides them a means to express themselves, while circumventing the social communication problems. Literary-focused intervention has the potential to open up new opportunities for expression and self-reliance as they seek to navigate society given their social and verbal limitations.”