When my son was diagnosed with autism, the assessment team gave us a detailed report of all of his “deficits” — mostly his communication style. His eye contact was not typical. His speech was scripted. He didn’t gain attention before speaking. He reversed his pronouns. They recommended that we contact a speech therapist immediately.
In the confusion and panic that followed the diagnosis, I spent much time and energy on this task. I had read that speech therapy is one of the few interventions for autism that has been proven effective with solid scientific research. I read a lot about the “critical window of cognitive development.” We had to get him started Right Now Hurry Quick! while his brain was still plastic. After a grueling three-month quest involving 15 evaluations and two grievances and appeals to our HMO, we were finally approved for eight sessions.
I really like our therapist. She is competent and warm and very good at engaging with M. She was so highly recommended by other parents that when I finally met her, I felt like I was meeting a celebrity. And she really is that good. After just a couple sessions, we saw changes.
But in the months since I first began the search for a therapist, my thinking has changed considerably about our reasons for wanting that therapy. So much so that I now feel somewhat conflicted about continuing it.
M started talking early, and can usually express his needs pretty clearly. Anybody familiar with autism can tell he’s on the spectrum, but people who don’t know just see a bright, talkative boy who sometimes asks the same question a dozen times in a row. He doesn’t always make eye contact, and he struggles with conversational turn-taking. There are lots of other smaller quirks, most of them noticeable only to me and the many SLP’s who evaluated him.
He’s the kind of kid who might not have been diagnosed with autism 30 years ago. By all accounts, kids like M eventually grow out of the pronoun reversal and the echolalia, with or without speech therapy.
Most of the research on the importance of early intervention and speech therapy is based on work with kids whose communication is much more profoundly affected. If M had not developed expressive language at all, I would not be navel-gazing about speech therapy. I am not questioning whether the ability to communicate your needs to the rest of the world is an asset.
But I do wonder about the urgency we attach to early intervention and therapy for kids whose language development is only slightly atypical — kids who are able to communicate, but who do so a little differently than their peers. Or who simply develop or perfect that ability later than normal. When M is 30, will it matter if he grew out of the echolalia when he was two or when he was eight?
Each time I hear myself correcting his pronoun usage — even though I understood what he meant — I think of Steven Pinker’s wonderful book, The Language Instinct. Pinker spends an entire chapter skewering the Language Mavens — the self-appointed authorities on the English language who spend their days pointing out split infinitives. He argues that most “rules” of English grammar were invented in 18th-century London as a way to enforce class distinctions. Only the upper class, with access to education and grammar manuals, knew how to speak the “best” version of English. When we use scrupulously correct formal English, we are really communicating something about our social class, culture, and level of education. This theme is addressed in Pygmalion, later remade as the film My Fair Lady.
When I correct M’s pronouns, am I helping him learn to communicate? Or am I instinctively trying to squelch a reminder that he is autistic, and that his speech is atypical? I know he will grow out of the pronoun reversal, whether I correct him or not. So why am I in such a hurry to “fix it” right now?
Of course, I want to get M any kind of therapy that might help him. Just as all immigrants to this country want their children to learn English, I want M to learn how neurotypicals communicate. We are not teaching him to be neurotypical — but knowing how to speak their language can only help him.
Still, all the emphasis on early intervention and “correcting” his speech makes me wonder how much of this is really for M’s benefit and how much is motivated by our own discomfort with his difference.
I had been thinking about all of this for weeks, and then I read Ari Ne’man’s recent interview in Wired:
As a society, our approach to autism is still primarily “How do we make autistic people behave more normally? How do we get them to increase eye contact and make small talk while suppressing hand-flapping and other stims?” The inventor of a well-known form of behavioral intervention for autism, Dr. Ivar Lovaas, who passed away recently, said that his goal was to make autistic kids indistinguishable from their peers. That goal has more to do with increasing the comfort of non-autistic people than with what autistic people really need.
It’s true that many therapies are aimed at increasing the comfort of non-autistic people. But can’t we find a way to teach our children to recognize and understand the conventions of the dominant culture, in a way that is respectful, without any implication that their own behavior or habits are less valid? What if we look at speech therapy for kids like M as more of an ESL class than a remedial therapy — an opportunity to learn a language that is widely used and useful, but not intrinsically better than the language they already speak?
M’s therapist chooses her words carefully. She always talks about reinforcing “more typical behavior;” she never tells me M is doing it wrong. She has clearly spent years dealing with the prickly, defensive parents of newly-diagnosed kids. In our very first visit, she earned my respect and trust instantly when she asked how I felt about discussing M’s speech issues, diagnosis, and goals in front of him.
I guess in the end I think that if he gains any advantage from the therapy, then it is worth doing. None of us intend to send the message that the way he naturally communicates is wrong. But he’s too young to tell me how he feels about any of it, so for now it’s all about my perception of his needs. Some day, the way his peers respond to his behavior will become a motivator. At that point, fluency in neurotypical conversational styles may help him make friends, and maybe he will be glad that he had the chance to work on skills that do not come naturally to him.
But I’ll probably have to wait a decade or so for M’s answer to that question.
Your son sounds similar to mine. He reversed his pronouns until he was 3 and a half, after which it faded away, without therapy. While I agree with your post in terms of respecting atypical neurology, I do want to note that the pronoun reversal was making it more difficult for my son to communicate. I remember several occasions when he and another child reached the slide at the same time. “It’s your turn,” he would say, and the other child would climb up the ladder, leaving him confused and frustrated at the bottom.
Hi Christina
Thanks for your comment. I agree that the pronoun reversal is an impediment to communication, and didn’t mean to trivialize it. We (parents and others who see my son often) understand what he means, of course, but it’s very confusing to everybody else.
I was just pointing out that it appears to be a pretty standard developmental stage for “high-functioning” kids with a gestalt language acquisition style, and that most of them move past it at some point — with or without therapy. I’m glad to hear your son figured it out on his own by three and a half.
Although our wonderful speech therapist has helped my son with other things (turn-taking, gaining attention, other pragmatic issues), nothing seems to have had an effect on the pronoun issue. Which makes me wonder why we focus energy on “training” kids to correct their pronouns if they’re going to get there eventually even without the therapy.
Interesting thoughts here. I was one of those who is considered “not autistic enough.” Aspergers was not even in the DSM-IV until twenty one years after I had graduated high school, and was not diagnosed until I was fifty three – last Christmas eve to be exact.
I always knew I was different in the way I thought, and had no problem with that. I in the second grade I read Winston Churchill’s “the Second World War” but never did my homework. In my senior year of high school I could not even spell the word does correctly. I have learned much quicker at my own pace, and have very good language skills at this point. As a person with autism, I take exception to the present system that equates high and low function on verbal skills alone. Physically I was low functioning – I could not color in the lines throw and catch a ball, run well, my penmanship as an adult despite years of practice is still a disgrace – all of which were a source of teasing and bullying in my school years. Thee reason I sought diagnosis in the first place at an old age, was for these physical symptoms of autism – physical weakness, clumsiness and a host of others including swallowing issues – the work of a physical and occupational therapists as well as speech therapists. The one thing no health insurance plans pay for with an underlying diagnosis of autism.
As an adult I realized that about 75% of the bullying and teasing I received and continue to receive were the result of my physical differences. On a scale of 1-10 a bully needs social skills of about 2. The by standers who sit back and enjoy the show need social skills of about 1, those who try to intervene need social skills of 5-6 and the bullied need skills of 8-10 to extricate themselves from the situation without over reacting, and still feel good about themselves at the end of the day.
In my humble opinion the single greatest thing you can do for your son is to remediate the physical symptoms – if he has swallowing and coordination issues, rather than making sure he does not end his sentences with prepositions.
Hi Dan
Thanks for your comment.
Like most parents of kids on the spectrum, I have a lot of the same symptoms as my son — although they don’t quite add up to an official diagnosis. I have been incredibly uncoordinated my entire life (learned to swim at age 27, learned to ride a bike at 30). Even before my son was born, I worried that he might inherit this, and spent a lot of time thinking about what I could do for him as a young child to help him ‘catch up’ in these areas.
My experience was similar to yours; most of the bullying and teasing I experienced as a child was the result of my clumsiness, poor balance, physical weakness, fear of heights, and inability to perform a cartwheel (which my elementary-school teachers insisted was a crucial skill for young girls). I imagine this is probably worse for boys — I think the bar is set lower for physical performance for girls.
So this is something I’ve thought about and definitely want to help him with. We’re still on a very long waiting list for occupational therapy, but I know there are other less formal ways to encourage him to develop better strength and balance.
[...] [...]
our sons sound a lot alike. He was (is) very verbal – it’s just how he communicates that is atypical. Our school district, after evaluation, did not allow direct speech therapy as part of his IEP, but rather opted for a group social skills approach monitored by the school SLP and facilitated by his one-on-one aide. He still gets the pronouns confused and I correct him by repeating it back with the right pronouns. I don’t know if he’s getting it, or ever will. But I agree that with HFA kids, the speech therapy approach has to be a little different. At least in our house.
My son will be starting a social skills group soon. I’m curious to see if that is any more or less effective at modifying his speech, or whether it will just change as he gets older regardless of what we do. I kind of suspect that he will grow into more typical communication over time no matter what, but of course it’s impossible for me to NOT pursue a therapy that might help him if I can’t be sure.
He seems to really enjoy the speech therapy — the therapist is engaging and fun, and we all like her — but I’m not sure if I see any huge differences in the way he communicates. I think being around other kids his age may be the motivation he needs to communicate in a way they understand.
Interesting question to raise. My son has progressed to the point where his speech therapy is focused on pragmatics/social skills, and we are fortunate to have an SLP in our school who is excellent at this. Because she mixes individual/small group sessions with times where she does social skills lessons with my son’s entire 2nd grade class, there is a lot more generalization of skills than we might see otherwise.
My son is also gaining awareness of his differences, so I factor that into therapy decisions now. I try to be respectful of the amount and type of therapy he is getting while helping him to address the issues that bother him the most. I think the parent’s role will change as the child develops, so there really isn’t one good answer.
I agree. Ideally, as our kids get older, they’ll take more of a role in deciding what’s helpful and what’s a waste of time.