Case Study of Child with Autism

Published: 2021-07-10 18:40:05
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I became increasingly interested in Autism since I had the opportunity to work alongside kids with Autism this summer. Seeing how their minds worked and how they processed information was astounding to me. Ever since this experience, I have fallen in love with children with Autism and I am always thriving to learn more about them. With this being said, I am looking to do my research on a child with Autism. I will be looking into the question how does Autism affect language development in children?
Under this broad topic I will be specifically looking into why their pragmatic language is impaired. To find my information I will interview my child’s parents. I will do my own observations both in the home and at school. Finally, I will research scholarly articles that are based off of good scientific research in my subject field. I want to become more informed about children with Autism and why their language development is impaired in the ways that it is. In doing so, I feel that I can become a more informed teacher which I can use to my advantage in my classroom.
I will know how to make children with Autism that are in my class successful both in class and in social situations. Section 2: Research Article #1 Measuring Pragmatic Language in Speakers with Autism Spectrum Disorders: Comparing the Children’s Communication Checklist—2 and the Test of Pragmatic Language “1 in 165 children” (Phillips, Volden, 2010, p. 204). The number of children that are prevalent with some type of Autism Spectrum Disorder (ASD) as stated by Joanne Volden and Linda Phillips. It is a statistic that is on the rise and highly debated.
It is a statistic that greatly affects classrooms across the nation. And yet, how to we help these children to the best of our abilities? An aspect that is being highly overlooked is pragmatic impairments. Children with an ASD have a greater chance of having a pragmatic dysfunction than do ‘typical’ children (Phillips, Volden, 2010, p. 205). How do we help children that are having these issues? How do we even diagnose these types of Language Development impairments? This article points to two of the ways this is being done: The Test of Pragmatic Language and The Children’s Communication Checklist – 2.
This article examines the validity of two tests: The Test of Pragmatic Language (TOPL) and The Children’s Communication Checklist – 2 (CCC – 2) (Phillips, Volden, 2010, p. 205). Each test was made to identify “pragmatic impairments” in children with high functioning ASD (Phillips, Volden, 2010, p. 205). The study identifies the difficulties that children with ASD have with pragmatic language –these children have “peculiar and out of place (communication) in ordinary conversation” (Rutter, 1965, p. 41); may “fail to develop (a) topic by contributing new, relevant information” among other minor things (Phillips, Volden, 2010, p. 204). Each test was developed to measure pragmatic dysfunctions in children so they may receive the support needed to thrive in everyday life. “Pragmatic language has proven (to be) difficult to assess… (because) the (general) structure of formal testing procedures fails to capture flexible adjustment to changing circumstances” (Phillips, Volden, 2010, p. 205). The TOPL test “samples a range of typically developing pragmatic behaviors” (Phillips, Volden, 2010, p. 205). The test compares students that have typical development pragmatic skills and students that have been diagnosed with high functioning ASD.
The CCC-2, on the other hand is “designed to screen for clinically significant communication problem of any type and (identifies) pragmatic language impairments” (Phillips, Volden, 2010 p. 205-206). So while the CCC-2 does test of pragmatic language impairments it also screens for communication impairments as well. The TOPL test is scored using a summary score called the “Language Quotient” (Phillips, Volden, 2010, p. 207). The Language Quotient is expressed as a “standard score with a mean of 100 (SD = 15) (Phillips, Volden, 2010, p. 207). According to Phillips and Volden, Language Quotients of “70-79 are interpreted as poor, and quotients below 70 are interpreted as very poor” (2010, p. 207). The cutoff score indicating a pragmatic impairment in the child was designated as 79 (Phillips, Volden, 2010, p. 207). The CCC-2 on the other hand derives two composite scores that are interpreted allowing for a greater variety of information to be processed and taken into account while interpreting whether or not a child with high functioning ASD has pragmatic issues or not.
These two composite scores are the GCC that is expressed by a standard score “with a mean of 100 (SD = 15) and the SIDI (Phillips, Volden, 2010, p. 207). If a GCC score is less than 80, it indicated a communicative impairment: not a pragmatic impairment (Phillips, Volden, 2010, p. 207). On the other hand, a negative SIDI score represents a pragmatic issue. “If the SIDI score is -15 or below Bishop (2003) suggests that pragmatic language impairment is present regardless of the GCC score (Phillips, Volden, 2010, p. 207).
So what does all of this mean? It was shown that both tests can in fact show whether or not a child with high functioning ASD has an issue with pragmatics. But how valid are these tests? Both tests ended with different results. The TOPL test showed that “9 out of 16 students with ASD were pragmatically impaired” while the CCC-2 identified “13 out of the 16” (Phillips, Volden, 2010, p. 208). While it is known that students with ASD do in fact have pragmatic impairments is there a chance that not every student will have this type of impairment?
It is hard to tell what test was more reliable in this situation for biases and cultural considerations were not taken into effect. However, it is a start. The article states that “the CCC-2 would be better at identification because the test included items designated to tap a broad range of pragmatic symptoms that are frequently reported as characteristic of ASD…. that would not occur in the course of typical development” (Phillips, Volden, 2010, p. 209). This study does prove to have a lot of vital information in regards to pragmatic dysfunctions in children with high functioning ASD.
However, it does say that the study was small: “This study is limited by its small sample size and by restricting participation to those who had structural language scores within typical limits” (Phillips, Volden, 2010, p. 210). With that being said, it would not be reliable to extrapolate the information from this study to schools across the nation. This study only used children that were diagnosed as high functioning ASD. It would be important that other studies be done using children across the spectrum to see if the results were reliable.
It would also be important to use other students with Intellectual Disabilities or even students that have been formally diagnosed with a Language Disorder to see how the validity of each test would withstand against these types of children. And although there is a lot that this study could have done further to prove their point, the information is still interesting and conclusive in its own regard. It is important that these types of tests continue to grow and evolve in our everyday world. If these tests can further prove to diagnose students with pragmatic impairments, it would be incredible in the world of teaching.
Students with pragmatic impairments are being over looked and swept under the rug because they are not diagnosed as atypical in this aspect of Language Development. And while not all children with high functioning ASD have pragmatic impairments, there are large numbers of children that do exhibit these dysfunctions. As teachers, it is vital that these children, diagnosed with ASD or not, get the necessary treatment plans and resources to allow them to excel. Whether that be through an IEP or 504 plan, students need not be ignored because there is not a way to formally diagnose their language dysfunction.
And while this article does state that the CCC-2 may be the better route to diagnose these children, it is important to use either the CCC-2 or the TOPL test rather than nothing at all as a start to diagnose a child. Once a child is assessed and diagnosed not only will that child be able to learn in the school setting but in the home setting as well. For although it may not always be good to label a child, having that label will allow for the child to have adequate and necessary treatment to allow for further success. Pragmatic dysfunctions, when treated early, can make a large impact on a child’s life.
Growing up to know when the right time is to say certain things can be essential when trying to obtain a job or just talking in public. As teachers, these language issue needs to be taken into account more often and more seriously. Children are slipping through the cracks because teachers are uneducated as to how to formally diagnose and help these issues. Article #2 Brief Report: Pragmatic Language in Autism Spectrum Disorder: Relationships in Measures of Ability and Disability Pragmatic language is something that we use on a day to day basis whether we know it or not.
Talking to a single person, talking to a group, or even listening to another person talk is all included in pragmatic language skills. Children, especially children with Autism, often lack pragmatic language. Children with Autism generally have more difficulties with pragmatic language than do any other children. If tested, they could even be diagnosed as having a pragmatic language dysfunction. Their speech is often considered “peculiar and out of place in ordinary conversations” and “irrelevant” (Bryson, Coolican, Garon, Volden, White, 2008, p. 388). “Pragmatics is consistently agreed upon as the domain that is specifically and universally impaired in Autism Spectrum Disorders” (Bryson, Coolican, Garon, Volden, White, 2008, p. 388). With this all being said, why is pragmatic language so often pushed to the side? Should pragmatic language be considered an important factor in considering a person’s long-term ability to function effectively in his or her community? Students with Autism may or may not have structural language difficulties paired with pragmatic language difficulties as well.
Do structural language difficulties predict pragmatic language difficulties? This study that was done measured the “contributions of nonverbal cognitive and structural language skills to the prediction of pragmatic language scores” (Bryson, Coolican, Garon, Volden, White, 2008, p. 391). The study was done on “37 children aged 6-13 years who met the criteria of Autism/ASD” (Bryson, Coolican, Garon, Volden, White, 2008, p. 389). This study showed that pragmatic language, as measured by the TOPL, is strongly related to, but not dictated by, structural language.
Structural language plays a part in pragmatic language, but it is not the driving force behind it. A student with Autism may have nearly perfect structural language but lack pragmatic language. Whereas another student may lack structural language and pragmatic language. Every student is different. These results simply state that structural language and pragmatic language are related in some way. How they are related, however, was not stated. The study also shows, as predicted, that if a child has better pragmatic skills, they were linked to fewer ASD communicative symptoms.
Better pragmatic language was also linked to fewer symptoms in the social domain. These findings underscores how central the theme is between ASD symptoms and social communication. This study, done mostly on children with High-Functioning Autism, increases the evidence that children with Autism cannot help the way that they act in social settings. They cannot help that they can’t hold a conversation, among other things. Children with Autism are different: in a good way. Although they may not be able to communicate effectively and appropriately, they are so good at so many different things.
Communication just happens to not necessarily be one of those things. This study has its flaws. The study should not be extrapolated to large groups, although the results are informative and interesting. The study was only done on a small sample size. The children that were selected “functioned within normal limits on most measures” (Bryson, Coolican, Garon, Volden, White, 2008, p. 392). Having a larger sample size with children of different ‘functions’ will prove to be more effective in showing the same results, assuming they will come out the same way.
So, what is the point of this study? It can be stated that students with ASD have pragmatic language difficulties. It can be stated that students with ASD have structural language difficulties. It can be stated that these are intertwined within one another. But what does this all mean in the life of the child? How can this information better the life of a student wit ASD? The study suggests the importance of developing a “comprehensive (assessment) of pragmatic language to help document a person’s level of disability” (Bryson, Coolican, Garon, Volden, White, 2008, p. 392).
With this information, professionals will be able to intervene in functional, community based contexts so students can develop social skills needed across all domains. Students will be able to grow individually to further their importance in their community. Should pragmatic language be considered an important factor in considering a person’s long-term ability to function effectively in his or her community? With the information given, all signs point to yes. Pragmatic language is an essential part in a student’s life. It allows students to function in everyday social situations.
Students that lack pragmatic language are set back because of their inability to function ‘normally’. “It stands at the intersection of language and social skills, impairments central to defining features of ASD” (Bryson, Coolican, Garon, Volden, White, 2008, p. 391). Article # 3: Diagnostic Differences of Autism Spectrum Disorder s and Pragmatic Language Impairment Children with Autism are generally associated with having pragmatic language impairments. However, not all children that have pragmatic language impairments have Autism. So, along with difficulty in social communication
settings, what else do these children have in common? Do children with Autism get labeled as having a pragmatic language impairments because they actually have a pragmatic language impairment or do their Autism symptoms overlap with those of pragmatic language impairments? Do children with Autism and children with pragmatic language impairments show comparable levels of behaviors associated with the ‘autism triad’ (Cornish, Frombonne, & Reisinger, 2011, p. 1701)? The study sought out to answer these questions. The Autism triad is composed of three components.
Component one involved the social and emotional aspect of development. Children with Autism in this area will have trouble with making friends, managing unstructured parts of the day, and working co-operatively. The second component is language and communication. Children with Autism will have difficulties in this area including difficulties understanding jokes and sarcasm, social use of language, literal interpretations, and body language and facial expressions. Finally, the third and final component of the Autism triad is flexibility of thought (imagination).
In this area, children will struggle with coping with changes in routine and empathy. The study was done with “forty-one children with communication impairments aged 7-15 years” (Cornish, Frombonne, & Reisinger, 2011, p. 1696). Each child was tested using both the Autism Diagnostic Observation Schedule (ADOS) and Social Communication Questionnaire (SCQ). The purpose of these tests was to compare the scores of children with ASD and children with PLI. These tests would then show whether the children have comparable levels of behaviors associated with the autism triad.
The diagnostic cut-off scores of each test were examined and measured. Overall, the results from the ADOS and SCQ showed that children with PLI have less severe impairments related to the autism triad as compared to children with ASD. However, the sub domains of these tests could not always differentiate between children with PLI and children with ASD in reference to their scores. When the combined measures were being used, it was possible to separate out the children with PLI and children with ASD that show signs of PLI. 7 cases could not be differentiated (Cornish, Frombonne, & Reisinger, 2011, p. 1701). Therefore, it was concluded that using ADOS and SCQ alone were not strong predictors in differentiating between ASD and PLI. This study then goes on to support the theory that there are subtle differences between ASD and PLI. Children with PLI have “significant difficulties socializing” (Cornish, Frombonne, & Reisinger, 2011, p. 1702). Because of these difficulties, children with PLI have an increased risk for problem behaviors related to Autism.
The difficulties that these children have in relation to their socialization lead to an increased risk of frustration and anxiety, and in turn “an increase in expression of abnormal behaviors” (Cornish, Frombonne, & Reisinger, 2011, p. 1702). This same relationship was not found in children with ASD. This may be due to the fact that children with ASD lack a sense of awareness of their surroundings and do not allow their surroundings to get to them in the way that children with PLI may. This is not true, however, of all children with ASD. This study examined children with ASD that were not diagnosed in having PLI.
Children that are comorbid with ASD and PLI will experience the frustration, the anxiety, and the increased behaviors. Even some children that have ASD but not PLI could essentially still show these frustrations in social contexts. Looking back at the Autism triad after reading this article, children with PLI and children with ASD really only share equal difficulties in one area: language and communication. And not to say that this will always be what is shared amongst these two different diagnoses, but this is what will be most common amongst the two.
The overlapping symptoms does not mean that children who have been diagnosed with PLI should also be diagnosed with ASD, but rather that they share common characteristics about their speech and communication, especially in social situations. Article #4 An Exploration of Causes of Non-Literal Language Problems in Individuals with Asperger Syndrome It is known that children with Autism show difficulties in pragmatic language. “One of the key features characteristic of individuals with high functioning Autism is a marked disruption to the ability to engage in social communication” (Martin & McDonald, 2004, p. 311). The question that is never brought up, however, is why these children are at an increased risk for having pragmatic language difficulties. Article after article, case study after case study all talk about the signs and symptoms of pragmatic language impairments (PLI) in children with Autism Spectrum Disorders (ASD). They talk about how to test for PLI and intervention techniques that can prove to be beneficial for the child. This article explores what others do not: the why of pragmatic language.
Knowing the cause of pragmatic language impairments in children should essentially lead to potential remedies to help treat children that are affected. There are two competing hypotheses that are correlated with pragmatic deficits. The first is Theory of Mind (TOM). This may be “the most prominent position on the causation of social communication in ASD” (Martin & McDonald, 2004, p. 311). TOM encompasses the ability to form representations of “other individual’s mental states, and, furthermore, to use those representations to understand predict, and judge others’ utterances and behavior” (Martin & McDonald, 2004, p. 312). The ability to infer mental states of another individual is pivotal in engaging in effective pragmatic communication. “Deficits in TOM have been observed in individuals with ASD across a range of age groups and IQ ability” (Martin & McDonald, 2004, p. 312). The comprehension of non-literal language relies on a person’s TOM capacity. Therefore, children with ASD who have difficulty understanding metaphors or irony in another person’s speech could essentially blame their lack of TOM. With a lack of TOM, children will not be able to communicate effectively with another person.
Their speech will be egocentric and will lack empathy. The second hypothesis that is correlated with pragmatic deficits seen in children with ASD is the notion of weak central coherence (WCC). WCC is not as strong of a thesis as TOM is. WCC refers to how language is processed. It’s argued that, according to the WCC theory, “language is processed in a kind of fragmented isolation without reference to the social context in which it occurs” (Martin & McDonald, 2004, p. 312). In accordance with WCC, children with ASD display difficulties when they interpret words according to the context of the sentence given.
“WCC predicts that individuals with Autism should be impaired in their ability to achieve local linguistic coherence” (Martin & McDonald, 2004, p. 313). Children with Autism are also less able to “draw coherence inferences, or themes across, a set of statements” (Martin & McDonald, 2004, p. 313). While these two theories are seemingly informational and reliable, their validity is questionable. Therefore, a study was performed to establish validity among the two theories. “The primary aim of this study was to compare the competing theories of social interference” (Martin & McDonald, 2004, p. 315). Two predictions were made about TOM and WCC: “If deficits in TOM underlie pragmatic ability, then deficits in social interference should be significantly associated with deficits in pragmatic ability. However, impairments in social inference making should not be associated with either general inference ability, or the ability to integrate perceptual information. If WCC underlies pragmatic ability, then the ability to organize perceptual details into meaningful wholes should be significantly associated with the ability to make pragmatic inferences.
Furthermore, this ability should be related to the capacity to make general and social inferences, as both these abilities require the capacity of drawing together disparate sources of information to infer meaning” (Martin & McDonald, 2004, p. 315). The results showed that “students with ASD were found to be impaired on both the mental inference questions and the non-mental control inference questions” (Martin & McDonald, 2004, p. 325). Therefore, their difficulty with TOM reasoning extended from one activity to the next, whereas WCC was only seen a small portion of the activities performed.
WCC was assessed and found to not be related to pragmatic language ability. However, this study was done solely on testing children on processing visual-spatial information. It is unclear and not studied whether WCC would play a role “in the processing of auditory verbal information” in accordance with pragmatic communication (Martin & McDonald, 2004, p. 326). More research, of course, would have to be done to replicate the information done in this study. This small sample size that was used has limited power in showing the true difference between the two competing theories that are TOM and WCC.
Furthermore, with more research, it could be shown what other types of language deficits are applicable using these explanations. Article #5: The Social Communication Intervention Project: A randomized controlled trial of the effectiveness of speech and language therapy for school-age children who have pragmatic and social communication problems with or without autism spectrum disorder There has recently been a strong push to increase language therapy for students with Pragmatic Language Impairments (PLI).
Pragmatic language is an underexplored field that has increasing numbers of diagnoses year to year. No real therapy is implemented in school systems for children that have PLI. “There is little robust evidence of effectiveness of speech-language interventions which target the language, pragmatic or social communication needs of these children” (Adams, Earl, Freed, Gailet, Green, Law, Lockton, McBean, Nash, & Vail, 2012, p 233). This study aimed to assess the effectiveness of one particular type of language therapy aimed at children with PLI with or without Autism Spectrum Disorder.
The aims of the study at hand were to “examine the effectiveness of an intensive manualized social communication speech and language intervention in improving language skills and observed pragmatic ability” (Adams, Earl, Freed, Gailet, Green, Law, Lockton, McBean, Nash, & Vail, 2012, p 233). The study that was performed was a small-scale randomized controlled trial. The trial was aimed to compare the effects of Social Communication Intervention (SCIP) compared with treatment as usual (TAU) on a standardized language assessment. Children either received SCIP intervention or TAU intervention.
The results then showed what type of intervention was more effective for children with PLI. Participants that received SCIP ceased all other intervention programs when they began this formal intervention program. Children that were receiving SCIP sat down for “16 to 20 individual face-to-face one hour sessions of intervention in school over the course of one school term” (Adams, Earl, Freed, Gailet, Green, Law, Lockton, McBean, Nash, & Vail, 2012, p 236). Each child received an individualized intervention strategy that was derived from a manual as to ensure that intervention was consistent amongst all participants.
Two specialist speech and language therapists and five specially trained therapy assistants delivered the experimental treatment. Children that received TAU continued with their regular/typical treatment that was being provided by their local speech and language therapy services. After the children had finished their intervention treatment plan for their pragmatic language impairment, they took the CLEF-4 to measure their general language ability. The participants also took a secondary outcome measure titled the Targeted Observation of Pragmatics in Children’s Conversation (TOPICC).
The outcomes of the CLEF-4 along with secondary measures did not show a significant intervention effect for SCIP compared with TAU. The article does state, however, that “the overall conclusion provided in SCIP is effective at improving overall conversational quality in 6-11 year olds who have significant pragmatic and social communication needs compared with TAU” (Adams, Earl, Freed, Gailet, Green, Law, Lockton, McBean, Nash, & Vail, 2012, p 242). These conclusions do not match the evidence that the study provides, however.
This may be due to the fact that the children that were selected for this individualized intervention program were so diverse in their backgrounds and diagnoses. This sample was also small. Providing more research with a more consistent group may show results more of what the study intended. The amount of therapy was also constrained by the study. In reality, some of the children may have needed more or less therapy to achieve maximum potential. Although the results of the study were not consistent with the conclusion, the article does make some good points.
More research must be done to show the effects of a structured individualized intervention program for students with PLI and ASD. With the increasing numbers of ASD diagnoses, PLI diagnoses soon too will be on the rise. Children deserve the best possible intervention and therapy needed, so why are children with PLI getting cut short of this due to lack of research? In the upcoming years, there is sure to be more done on this particular topic to ensure that students will in fact receive the treatment that they need.
Section 3: Data Collection I had the opportunity to work with a student that I taught over the summer. ‘A’ is 8 years old and is in third grade. He is an energetic, fun, loving boy. A has Autism and trouble with his pragmatic language. Although A has never been formally diagnosed with a Pragmatic Language Impairment, it is evident that he shows the signs and symptoms. As discussed in the interview paper, A’s mother does not want him to be diagnosed with PLI for she does not want him to have another label on top of the others he already has.
As I mentioned, I observed A first over the summer while I taught him at a camp which was for students with Autism and social difficulties. At first, A was a quiet and compliant student for the first week or so. However, I later found out he was only testing the waters. After A felt comfortable in the classroom, he swore on a regular basis, had social outbursts, never raised his hand, etc. A went from being an angel to one of the most difficult children in the classroom. I was baffled as to what we were supposed to do.
On a regular basis, A was talking out of turn and was talking in ways not appropriate for students of his age. I also observed that A, when talking with a peer, did not allow his peer to engage in a conversation with him. It was a one-sided conversation, all with A talking. After talking to A’s mother about our concerns, I, along with my other classroom staff members, came up with a positive behavior plan that A used in his classroom and at home. I distinctly remember A’s mother telling us that she was so sorry that he was acting the way that we was and that it was probably because he wasn’t in his typical routine.
I also remember her telling us that once we put into action this behavior plan that his pragmatic language difficulties would slightly decrease. And, just like she had promised, they did. A still swore when he was frustrated but instead of condemning him for this, we applauded him for using his words to communicate. However, we then asked him why he would use the words that he chose and once he calmed down we would ask him if he felt those words were appropriate for the context he used them.
We would then brain storm together ideas of words that he could use instead of the swear words (or even inappropriate words). We would then replay the situation and A would use the words that were brainstormed rather than the original words that he chose. Another thing we began to do, not just with A, but with all of our children in our classroom was to use a tennis ball when having a conversation. We encouraged the children to pass the tennis ball back and forth when they were talking with one another to discourage one sided conversations.
We told the children that they should not have the tennis ball the whole time they were talking and that you could only talk for long sentences if you had the tennis ball in your hands. We saw a great improvement not only in A’s conversations but in the conversations in all of the children as well. Along with my experiences with A over the summer, I got to see A in his classroom this year. Although I only got to spend a little over two hours with him, I saw a lot of the same techniques used over the summer in his classroom here as well.
I think this is because of what his mother said to us over the summer: A does well with a consistent routine. The thing that I found interesting about A in his classroom is that his Therapeutic Support Staff (TSS) was the one who would talk to A if he had an outbreak. I am sure that this is because the teacher does not always have time to sit down and talk to A individually, but I personally feel that it is important to help shape A’s pragmatic language. Finally, I observed A in his home as well. I feel that A acts different in his home than in school because he knows how to push his mom and dad’s buttons.
They of course use the same techniques in the classroom as they do at home. However, they are more firm with him. They expect a lot out of A. It is extremely evident that they love and care for him and they only want the best for him. That is why they have gone to such extreme measures to make him be as successful as possible in regards to his pragmatic language. (Checklist Attached from Observation) Section 4 Interview A=Student Where do you see (student) have the most difficulties with pragmatic language (i. e. in the classroom, at home, out in public)? -We feel that A has the most trouble with his pragmatic lang

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