The social and symbolic quality of autistic children's ... - Springer Link

Journal of Autism and Developmental Disorders, Vol. I0, No. 3, 1980

The Social and Symbolic Quality of Autistic Children's Communication' Susan M. McHale, Rune J. Simeonsson, 2 Lee M. Marcus, and J. Gregory Olley University of North Carolina at Chapel Hill

The developmental status o f the communicatory behavior o f 11 autistic children was assessed. ChiMren were observed during free play sessions under two conditions: (a) when teachers were present to direct the children "s behavior and (b) when teachers were absent and the children played among themselves. Mean changes in the children's communicatory behavior were measured over time (8 months) using the behavior scale designed f or this study. The relationship between the developmental status o f the children "s communicatory behavior and standardized measures o f their social and cognitive functioning (e. g., IQ, Vineland Social Age) was also assessed. The results revealed that the quantity and social quality o f autistic children "s communicatory behavior were greater in the teachers'presence than in their absence and that the symbolic and social quality o f the children's communicatory behavior increased over 8 months. Also, positive correlations were f o u n d between social and symbolic levels o f communication and standardized tests o f social and cognitive functioning. The implications o f these findings for the assessment o f autistic children are discussed. The purpose of this study was to describe autistic children's communicat i o n in t e r m s o f its d e v e l o p m e n t a l c h a r a c t e r i s t i c s . T h i s a p p r o a c h g r o w s o u t

'This research was supported by a grant from the Spencer Foundation. The preparation of this report was also supported in part by the Bureau of Education for the Handicapped, U.S. Office of Education, DHEW, Contract Number 300-7%0309. However, the opinions expressed do not necessarily reflect the position or policy of the U.S. Office of Education, and no official endorsement by the U.S. Office of Education should be inferred. Portions of this research were presented at the annual meeting of the American Association on Mental Deficiency, Miami, May 1979. The authors wish to thank the teachers involved in this study, Susan Boswell, Bob Foster, Mary Harmon, Karen Lovejoy, Faye Williams, and Marian Wooten, and research assistants Patricia Dockery, Ann Hager, and Chickery Kasouf. 2Address all correspondence to R. J. Simeonsson, Frank Porter Graham Child Development Center, 301 NCNB Plaza, Chapel Hill, North Carolina 27514. 299 0162-3257/8010900-0299503.00/0 9 1980 Plenum Publishing Corporation

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of current research in pragmatics, that is, the study of language in the social context of its usage (Bates, 1976). In this field of research, investigators stress the importance of defining the development of communication in terms of children's social and cognitive development rather than regarding language acquisition as a separate domain. Thus continuities in children's development from precommunicative schemes to preverbal (intentional) communication (e.g., eye contact and pointing) to verbal interaction (e.g., words) are emphasized (Bates, Benigni, Bretherton, Camaioni, & Volterra, 1977). The present study reflects this concern for assessing autistic children's communication in the context of their overall development. This approach is particularly important because social, cognitive, language, and perceptual-motor skills often do not develop concurrently in these children, but they display asynchronies in development across different domains (Freeman & Ritvo, 1977). Thus an autistic child may be able to articulate an intelligible word or echo an entire string of words because his or her rote memory skills are highly developed. The social and symbolic competence of this child, however, may be relatively immature and the inference that the child is using words symbolically (meaningfully) or socially (for the purpose of communication) cannot readily be made. Thus the communicatory skills of autistic children may be studied more accurately within the social context of their occurrence rather than through the assessment of verbal skills. The knowledge that a child produces three intelligible words will tell us little unless we know the meaning those symbols hold for that child and the social context in which they are used. In this context, communication is viewed as an integral part of the child's general development. If children are presymbolic in other aspects of their development (e.g., their play or problem-solving skills), one would not expect them to communicate symbolically. Similarly, if children display low-level social behaviors, one would not expect them to use language intentionally in initiating or maintaining interactions with others.

ASSESSMENT OF SOCIAL AND SYMBOLIC DIMENSIONS OF COMMUNICATION The present research deals with the analysis of communicatory development from its most rudimentary, presymbolic, and asocial levels. The social dimension selected for analysis is based on the work of Bates (1976) and others (e.g., Bruner, 1975, 1974/75; Piaget, 1954) and focuses on behavior with other persons that becomes increasingly intentional, directed, and coordinated. In the context of Piaget's theory, social development is

Communication of Autistic Children

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explained as a progressive loss o f egocentrism or, alternatively, as an increasing awareness of others and their perspectives of the world. Investigators o f language (e.g., Bates, 1976; Lock, 1978) have translated this aspect o f social development into the child's developing intention to communicate. That is, as children become more aware of others and o f their points of view, they also begin to understand the need to communicate. The cry of a young infant signals a need to the caretaker, who responds to that need. Only with development, however, do infants use their behavior to intentionally communicate needs or desires (Bates, 1976; Harding & Golinkoff, 1979). The symbolic dimension of communicatory behavior studied here is derived from Piaget's (1954) description o f development, in which children move from a sensorimotor to a symbolic level o f interaction with the world. At the same time, their means o f expression becomes progressively more "distanced" (Sigel, 1970) from their own perceptual experience and concrete reality. In the present study, communicatory behaviors were classified according to three symbolic levels (motoric, signal, and symbolic) depending upon the relation between the referent and reference of the communicative act. The referent is the means o f communication (word, sign, or gesture), and the reference is the object, person, or event that is the subject of communication. At the lowest symbolic level of communication are motoric gestures in which the child physically directs the behavior o f another to achieve some end. For example, the child may pull a teacher across the room because s/he wishes the teacher to come to the window. The reference, " I want you to c o m e , " is equivalent to the referent, pulling the teacher across the room. As children reach a higher symbolic level of communication, they use signals to indicate their needs or ideas. In using signal gestures, children hold a one-to-one correspondence between the communicatory act and their message, but there is distance between the two; i.e., referent and reference are not one. The child points to a toy or a cookie, indicating a desire for the object (the referent), but the means o f communication is not equivalent to the message. Children are unable to communicate the message that they are hungry or that they want to play (though this may be inferred by the teacher). Rather, children are limited to a specific and unitary referent for their messages--that they want a particular toy or a particular cookie. As children develop, they eventually achieve a symbolic level o f communication, which Piaget and others have described as being related to other aspects of symbolic functioning, such as pretend play or conceptual thought. On this level, not only is there distance between the referent and reference of a communicatory act but there is not a one-to-one relation between what is being referred to and the symbols used in communication.

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In symbolic communication, there is an arbitrary but socially agreedupon relationship between the referent and reference of a communicatory act. A cookie can therefore refer to any cookie. Moreover, there is no necessary relation between the word cookie (the reference) and its referent (the object itself). In this way children progressively distance themselves from the physical world. They move from concrete and physical means o f expression to the use of arbitrary but socially agreed-upon symbols. In this aspect of development children's communication becomes more economical and efficient. Research on the development of communication is limited, and descriptive behavioral norms have only begun to be defined (e.g., Bates, 1976; Carter, 1975; Lock, 1978). To assess the developmental status of autistic children's communication, the social and symbolic levels o f operationally defined target behaviors were measured. Social and symbolic levels were defined based upon our theoretical framework; communicatory behaviors were determined and operationally defined based upon 5 weeks of pilot observation in a class o f autistic children. Again, the primary purpose of this study was .to describe the developmental status o f autistic children's communiqation. To this end, the social and symbolic qualities o f children's communicatory behavior were observed and recorded during the children's free play. Also, the degree of association between the children's communciation and other measures of their level of functioning was assessed. Next, because communication was seen from within the social context of its occurrence, it was important to assess the influence of social partners upon the children's communicatory behavior. Thus the quality o f autistic children's communication during interactions with their classmates (who displayed little spontaneous social behavior) and during interaction with their teachers were compared. Finally, to begin to define the process o f the children's growth in communication, it was important to measure short-term changes over time in the quality of their communicatory behavior.

METHOD Subjects

The subjects of this study were 11 children attending one of two special classes for autistic children. They each had a primary diagnosis o f autism based on an evaluation at the Piedmont T E A C C H Center in the Department o f Psychiatry at the University of North Carolina. The


303

diagnosis was made prior to classroom placement, and it was based upon data derived from the Psychoeducational Profile (Schopler & Reichler, 1979) and the Childhood Autism Rating Scale (Schopler, Reichler, DeVellis, & Daly, 1980). The C A R S classifies children into three categories by degree o f autism: 1 = absence; 2 = mild-moderate; 3 = moderatesevere. These children all received scores of 2 or 3 and displayed disorders of social, affective, cognitive, and perceptual functioning such as stereotypic and ritualistic behaviors, deficiencies in social relatedness, and communication deficits. There were two girls and nine boys between the ages of 4 and 9 years with MAs ranging from 1 V2 to 4 years. Three of the boys were black and the remaining children were Caucasian. The length of time the children had attended their special classes ranged from 1 month to 4 years. The children attended special classes for autistic children. Classroom A was one o f several special demonstration classrooms located in a research facility of a university hospital. Classroom B was located in a public school in an urban community. Both classes had one teacher and one aide, and occasionally volunteers worked in the classroom. In addition to their formal education, the teachers received ongoing inservice training and consultation oriented toward the education of autistic children. The research assistants involved in data collection frequently visited the classrooms and were familiar to the children.

Design There are two factors in the design of this study. One factor is the conditions, of teacher present and teacher absent, under which the classrooms were observed. The second factor is t i m e - - o n e classroom was observed with teachers present on two separate occasions.

Factor 1. Teacher Presence Teacher Present (TP). In this condition, observations were made only when at least two teachers (or aides) and four children were present in the classroom. Observers recorded data during these sessions from behind a one-way mirror. Teachers were told to interact with the children as they would normally do during play sessions. They were told that they could initiate interactions with the children but that they should allow children to terminate interactions if the children wished.

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Teacher Absent (TA). During these sessions teachers' supervision was replaced by observers who recorded data from within the classroom ~ because it was impossible to leave the children with no adult supervision. The observers supervised the children's play, interacting with the children (directing their behavior) only when it was essential for the children's well-being. All observations were made during a 3-month period o f time. In Classroom A, all data for the T A play time were collected first, and, subsequently, data for the T P play time were collected. In Classroom B, data were collected in reverse order (TP followed by TA). Factor 2. Time The five children attending Classroom A were initially observed in the teacher-present condition only. Eight months later they and the children in Classroom B were observed in both teacher-present and teacher-absent conditions. Procedure

All observations were made during the children's daily free play sessions, which lasted approximately V2 hour. Behaviors were observed in 10-second discontinuous time epochs, each followed by a 5-second recording period, for a total o f 3 minutes, or 2 minutes of observation time. Children were observed in r a n d o m order with the constraint that each child present during a play session was observed once before a second observation was made o f any other child. For each experimental situation described above, each child was observed for six coding periods, a total o f 12 minutes' observation time.

Dependent Measures A scale of c o m m u n i c a t o r y behaviors was developed based upon our theoretical f r a m e w o r k and earlier observations of the children's behaviors. Behaviors were chosen that bore resemblance to verbal and nonverbal c o m m u n i c a t o r y behaviors exhibited by children across all levels of normal development. These behaviors were classified into a developmental hierarchy based on their level o f symbolism, and were also scored for their 'During three play sessions one teacher sat in one corner of the classroom (Classroom A) because one of the children had displayed a great deal of distress at the absence of the teachers. No observations were made while the teacher interacted with the children.

(1)

Solitary

Asocial

Respond to other (2)

Social Level

Initiate (3)

Social Interact (4)

Symbolic (arbitrary, not unitary relation between referent and reference)

(3)

(2) Signal ( 1 : 1 correspondence between referent and reference but referent distanced from reference)

(1) Motoric (referent = reference)

words signs

Gestures: point hold up reach out clap

Physically direct: push pull contact other

Symbolic level

Table 1. Social and Symbolic Levels of Communications Scale

t~

0

0

ta

g-

O

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degree o f social maturity. Thus all behaviors were classified according to the two-dimensional matrix shown in Table I. Symbolic Levels. The operationally defined communicatory behaviors derived from pilot observations were classified a priori into three symbolic levels: motoric-gestural communication, signal-gestural communication, and symbolic communication. Behaviors were categorized based on the correspondence between the reference (the communicatory act) and the referent (the subject of communication). Social Levels. The social dimension of the scale described behaviors with communicatory potential. The operationally defined communicatory behaviors were scored in coding during each 15-second observation interval as I, 2, 3, or 4, depending upon whether the child's behavior was nondirected (even if it was responded to by another), a response to another's initiation or prompt, an initiation on the part o f the target child, or in the context of an interaction (e.g., a game) between the target child and another individual. One third of all observations were coded independently by two observers to assess interobserver agreement. Agreement was calculated for each behavior category across the 2-minute observation periods and averaged across protocols. Percentage agreement for individual behavior categories ranged from approximately 78~ (contact other) to 93~ (verbalizations), averaging in the mid-80s.

RESULTS

Statistical Comparisons Teacher Presence. The unit of analysis for all statistical comparisons was the number of 10-second intervals during which a behavior o f any given type occurred. The mean frequencies o f communicatory behaviors o f different social and symbolic levels were compared across the T P and T A play times in an analysis of variance for repeated measures. Mean frequencies in each of the sessions are shown in Table II. Analyses revealed that, overall, children displayed significantly more social communication and less self-directed or asocial communicative behavior in the T P situation than in the T A situation (F(1,10) = 1 3 . 1 , p < .005, and F(I,10) = 5.2, p < .05, respectively). Differences in children's social communication between the T P and T A situations were seen on two symbolic levels: the children showed more motoric gestures (e.g., push, pull, contact other) and more symbolic communication (e.g., words and signs) in the T P condition than in the T A condition (F(1,10) = 15.1, p < .003, and F(1,10) = 6.7, p < .03,


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Table 11. Mean Frequencies of Communication by Social and Symbolic Levels in Teacher-Present and Teacher-Absent Conditions (N= 11) Condition

I. Symbolic levels 1. Motoric Asocial Social 2. Signals Asocial Social 3. Symbolic Asocial Social II. Social levels 1. Asocial (Total) 2. Interactive (Total)

Teacher absent

Teacher present

NA a 2.6

NA a 13.1 c

21.0 3.1

9.0 5.8

2.9 1.3

1.4 6.0 b

23.9 7.0

10.4 b 24.9 c

aMotor gestures require physical contact by other persons and are thus inherently social. bp < .05. Cp < .005.

respectively). No differences between the two situations were observed in children's use of signal gestures (e.g., point, wave). Similarly,.the difference between the children's asocial (self-directed) symbolic communication in the two situations did not achieve statistical significance. Time. Observations of five autistic children's communicatory behavior in the T P situation were made at two time periods (across 8 months). The mean frequencies o f communicatory behaviors at each time period are displayed in Table III. An analysis of variance for repeated measures revealed that, overall, the autistic children displayed an increase in interactive communication (F(1,4) = 10.2, p < .03). The absolute decline in the frequency of asocial (self-directed) communicatory behavior did not, however, achieve statistical significance. Changes in children's communication also occurred on two symbolic levels: children displayed an increase in their use o f social motoric gestures (F(1,4) = 12.4, p < .03) and a decrease in their use o f asocial signal gestures (F(1,4) = 8.1, p < .05).

Correlations with Other Measures

The correlations between children's communicatory behavior and their scores on clinical assessment devices were assessed using the Pearson

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McHale, Simeon&son, Marcus, and Olley Table III. Mean Frequency of Communication by Social and Symbolic Levels Across Time (8 months) (N = 5)

1. Symbolic dimension 1. Motoric Asocial Social 2. Signals Asocial Social 3. Symbolic Asocial Social II. Social dimension 1. Asocial (Total) 2. Interactive (Total)

Teacher absent

Teacher present

NAa 5.0

NAa 18.0 b

9.2 .2

3.8 b 5.6

.4 1.4

.0 3.2

9.6 2.8

3.2 13.0 b

aMotor gestures require physical contact with other persons and are thus inherently social. bp < .05. p r o d u c t - m o m e n t statistic. T h e f r e q u e n c y o f o c c u r r e n c e o f high-level social a n d s y m b o l i c c o m m u n i c a t o r y b e h a v i o r s was positively related to IQ, V i n e l a n d Social Ages, a n d scores on the P s y c h o e d u c a t i o n a l P r o f i l e (Schopler & Reichler, 1979), p a r t i c u l a r l y in the t e a c h e r - p r e s e n t s i t u a t i o n , as is illustrated in T a b l e IV. T h e f r e q u e n c y o f high-level social a n d s y m b o l i c c o m m u n i c a t i o n was, in general, u n r e l a t e d to clinical ratings o f psychosis o n the C A R S (Schopler et al., 1980). In a final analysis, we m e a s u r e d the r e l a t i o n s h i p b e t w e e n c h i l d r e n ' s use o f s y m b o l i c l a n g u a g e a n d their e x h i b i t i o n o f s y m b o l i s m in a n o t h e r d o m a i n , play. T h a t is, c o r r e l a t i o n s were assessed b e t w e e n the f r e q u e n c y o f s y m b o l i c or p r e t e n d play exhibited by each child in the T A s i t u a t i o n (no Table IV. Correlations Between Communicatory Behaviors in Teacher-Present and Teacher-Absent Play Time and Standardized Test Scores (N = 10) IQ

Vineland Social age

PEP score

CARS

Interactive Communication (social level four)

Teacher present Teacher absent

.76 b .09

.56 a .80 c

.78b .56 a

.10 .26

Symbolic communication (symbolic level) three)

Teacher present Teacher absent

.74 b .51

.65 a .44

.86 c .64 a

.20 .25

ap < .05. bp < .01. Cp < .005.


309

symbolic play was observed in the TP situation) and the child's use of symbolic communication (words and signs) in the TP and TA conditions. The results of this analysis indicated that the exhibition of symbolic play was positively correlated with the exhibition of symbolic communication in both the TP (r = + .97, p ( . 0 1 ) and the TA (r = + .74, p ( . 0 1 ) situations.

DISCUSSION The developmental status of the communicatory behavior of 11 autistic children was assessed. The results revealed that the children's social communication was predominantly in a motoric-gestural mode. Furthermore, a large proportion of autistic children's behavior (almost 75% in the TA condition) was asocial: their "communications" were not directed toward another person. The data also indicated that the children's communicatory behavior changed in the presence of their teachers: in the teacher-present condition the children displayed higher frequencies of social communication and lower frequencies of asocial behavior. The children's communicatory behavior changed across time as well, becoming increasingly more interactive over a period of 8 months. Although the children showed more social behavior across time and in the TP condition, it should be noted that their interactions generally involved their teachers rather than their autistic classmates. Finally, correlations were obtained between high social and symbolic levels of communictory behavior exhibited during free play and children's cognitive and social skills as measured by standardized tests. In particular, children's symbolic language usage was highly correlated with their symbolic functioning in other domains (i.e., symbolic play). The findings are consistent with those reported by other investigators (Wing, Gould, Yeates, & Brierley, 1977). Because of the small sample size and the variability of the subject group, these findings must be accepted with reservation. Autistic children represent a highly variable population and are diagnosed according to diverse criteria. Assessment of this particular group of children indicated that most were fairly low-functioning, both socially and cognitively. The present findings may not generalize to autistic children who are only mildly impaired. On a practical level, the developmental model of autistic children's communication presented here has implications for teachers and therapists who work with these children. By measuring broadly based attributes of autistic children's communication (i.e., its social and symbolic qualities), the teacher is provided with a clearer understanding of the nature of a particular child's deficit. Furthermore, the use of a developmental model provides implicit information about successive treatment goals, that is, a

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McHale, Simeonsson, Marcus, and OUey

clear d e l i n e a t i o n o f w h a t skills o r c o n c e p t s t h e c h i l d " h a s " at p r e s e n t a n d the o r d e r in which new skills o r c o n c e p t s s h o u l d be p r e s e n t e d . T h e d e v e l o p m e n t o f the a u t i s t i c child c a n n o t be a c c u r a t e l y assessed t h r o u g h the a p p l i c a t i o n o f i s o l a t e d b e h a v i o r a l n o r m s b e c a u s e these c h i l d r e n m a y s h o w a s y n c h r o n o u s rates o f d e v e l o p m e n t a c r o s s d i f f e r e n t d o m a i n s (e.g., m e m o r y , social, s y m b o l i c , a n d linguistic f u n c t i o n i n g ) . As the d a t a f r o m the p r e s e n t s t u d y i n d i c a t e , an a u t i s t i c child m a y " h a v e " m a n y w o r d s in t e r m s o f s p o k e n v o c a b u l a r y b u t use n o n e o f t h e m in a s o c i a l c o n t e x t . A l t e r n a t i v e l y , an a u t i s t i c child m a y h a v e n o o r a l l a n g u a g e b u t r e a d i l y d i s p l a y i n t e n t i o n a l and d i r e c t e d c o m m u n i c a t o r y b e h a v i o r . O u r o b s e r v a t i o n s s h o w e d t h a t , even w h e n a u t i s t i c c h i l d r e n p r o d u c e d w o r d s , t h e y were j u s t as likely to use t h e m a s o c i a l l y as they were to use t h e m socially. In t e r m s o f the s y m b o l i c l a n g u a g e t h e y p r o d u c e d , s o m e o f these c h i l d r e n were at t h e level o f a 2 - y e a r - o l d . In t e r m s o f the w a y t h e y used s p o k e n l a n g u a g e , t h e y were, in g e n e r a l , m o r e d e l a y e d . A d d i t i o n a l r e s e a r c h o f this k i n d is n e e d e d to d e f i n e the ways in which a u t i s t i c c h i l d r e n a d h e r e to a n d d e v i a t e f r o m patterns of normal development.

REFERENCES

Bates, E. Language and context. New York: Academic Press, 1976. Bates, E., Benigni, L., Bretherton, I., Camaioni, L., & Volterra, V. From gesture to the first word: On cognitive and social prerequisites. In M. Lewis & R. A. Rosenblum (Eds.), Interaction, conversation and the development of language. New York: Wiley, 1977. Bruner, J. S. From communication to language--a psychological perspective. Cognition, 1974/1975, 3, 255-287. Bruner, J. S. The ontogenesis of speech acts. Journal of Child Language, 1975, 2, 1-19. Carter, A. The transformation of sensorimotor morphemes into words: A case study of the development of "more" and "mine." Journal of Child Language, 1975, 2, 233-250. Freeman, B. J., & Ritvo, E. R. Current status of biochemical research in autism. Journal of Pediatric Psychology, 1977, 2, 149-152. Harding, C. G., & Golinkoff, R. M. The origins of intentional vocalizations in prelinguistic infants. Child Development, 1979, 50, 33-40. Lock, A. Action gesture and symbol." On the emergence of language. New York: Academic Press, 1978. Piaget, J. The construction of reality in the child. New York: Ballantine, 1954. Schopler, E., & Reichler, R. J. Individualized assessment and treatment for autistic and developmentally disabled children. Vol. 1. Psychoeducational Profile. Baltimore: University Park Press, 1979. Schopler, E., Reichler, R. J., DeVellis, R. F., & Daly, K. Toward objecti.ve classification of childhood autism: Childhood Autism Rating Scale (CARS). Journal of Autism and Developmental Disorders, 1980, 10, 91-103. Sigel, I. E. The distancing hypothesis: A causal hypothesis for the acquisition of representational thought. In M. R. Jones (Ed.), Miami symposium on the prediction of behavior 1968: Effects of early experience. Coral Gables, Florida: University of Miami Press, 1970. Wing, L., Gould, J., Yeates, S. R., & Brierly, L. M. Symbolic play in mentally retarded and autistic children. Journal of Child Psychology and Psychiatry, 1977, 18, 167-178.