Is it possible to teach adults with autism to speak?
Unfortunately, the simple answer is that we don’t know because there is no research evidence that tells us one way or the other. There are reports of individuals which indicate that it may be possible (see for example http://www.theguardian.com/society/2015/apr/29/unlock-secrets-autism-national-project), but what works for one individual may not work for another. Because of that we cannot make any predictions about particular individuals. However, it is important not to assume anything. Experiences through work, reading of the research literature, and listening to the personal stories of people with autism and their families lead us to think that we can’t predict what individual people with autism can or cannot learn, and we shouldn’t give up trying to help them to learn skills. We shouldn’t be surprised by surprises.
A speech pathologist will be in the best position to offer specific advice and support. The speech pathologist is likely to start with trying to learn a lot more about a person’s communication more broadly. This includes the listening and comprehension skills or the adult with autism (let’s assume it’s a man), as well as the reasons why he communicates (e.g., to express his preferences, to share interests and ideas, to protest) and the ways that he communicates (e.g., facial expression, body language, gestures and actions, showing and/or handing people objects, writing). As a general rule, the chances that a person will start using speech to communicate are much greater when s/he is already showing clear intentional communication in other ways (e.g., through actions, gestures, handing objects, writing) that is directed towards other people. To put it simply, it is easier to teach speech when a person is already communicating effectively with other people in other ways.
The speech pathologist will also establish the adult with autism is using any speech, including any sounds, syllables and words, and if so, to what extent he directs these sounds, syllables or words to other people and for what purposes. Similar to above, as a general rule, if people are using speech sounds and words in an intentional and directed fashion to communicate, they are more likely to further develop their speech. If people are only using speech when prompted to do so, or they are not directing their speech to other people, they may be missing the essential social aspect of communication. It is this that motivates us to develop our spoken language skills. There are quite a lot of people with autism who learn to use a small set of words but who do not go on to develop a large spoken vocabulary or to talk in multi-word sentences. The reason for this is not entirely clear, but appears to reflect a combination of social interest and understanding, as well as overall understanding of language.
The speech pathologist will also try to find out whether the adult with autism draws objects or writes words, because when we use written words or drawings to express our ideas, we are using ‘symbolic communication.’ Spoken language is another form of ‘symbolic communication,’ and the research literature suggests that if a person learns to use one form of symbolic communication (e.g., writing), other forms (e.g., speech) may follow more easily.
Clearly, there are many factors that need to be considered when attempting to predict how a person’s speech (or any other skill) will develop over time. What is clear from the literature is that current best practice for supporting the communication of children, adolescents, and adults with autism, like all people, is to encourage and support multi-modal communication for meaningful and motivating purposes. In essence, it is through recognising and supporting each person’s full range of communication skills that we not only understand them better and form stronger and closer relationships, but also demonstrate the power of communication.
Written in consultation with Dr David Trembath
NHMRC ECR Fellow, Menzies Health Institute Queensland, Griffith University
Adjunct Research Fellow, Olga Tennison Autism Research Centre