A Closer Look at Language
Like the general population, individuals with autism communicate in a variety of ways. Some speak vocally, others use sign, some use pictures, and some use other ways to communicate like gestures. In addition, some individuals have minimal communicative skills or lack them all together. It is a natural tendency to think that individuals who do not speak, do not understand. This is simply not true.
Expressive Language is the ability to communicate with others using language
Receptive language is the ability to listen and understand language
It is important to learn how the individual communicates with their parent/caregiver and it is important to learn what type of communication the individual understands. For example, a child’s expressive language may be pictorial (meaning they show you an image), while their receptive language may be vocal (meaning they understand what you say).
Here are two more useful definitions in understanding language used by individuals with ASD.
Functional language is the use of appropriate language in the correct context. For example, someone with ASD might repeat long sentences or phrases from movies, but they may not be able to use those same words spontaneously on their own or in a different context. If this is the case, the long sentence or phrase is not functional, meaning it does not help the patient get what they want or need. This is of note because sometimes we hear a patient repeating complex sentences and phrases and then expect them to respond to our questions or to the dental situation using similar complex responses. This is erroneous on our part. It is important to find out if the patient can appropriately respond to yes/no questions, and how they communicate pain or discomfort (see Appendix A for parent interview form).
Echolalia is when the individual with autism repeats words or phrases they hear from others. For example, the question may be asked, “Do you want bubblegum or cherry?” The individual may respond with the entire question, “Do you want bubblegum or cherry?” or may simply repeat the last word, “cherry”. To see if the patient is truly answering the question or just echoing a portion of the question, ask in a different way, “Do you want cherry or bubblegum?” If they say “bubblegum,” then it is possible the patient is only echoing what is heard. In these cases, it is helpful to show the child the options and say something like “pick one” or “choose one.”