Communication impairments in Asperger’s disorder
I am writing regarding the article on autism by David J. Posey, MD, and Christopher J. McDougle, MD (July).
As a speech and language pathologist with an interest in autism spectrum disorders, I appreciate the authors’ attempt to differentiate such disorders from other neurologic and psychiatric conditions. However, the authors note in Table 4 that people with Asperger’s disorder do not experience communication impairment.
That is clearly untrue. Despite strengths in vocabulary, strong funds of knowledge, and other verbal abilities, many of my students have difficulty with reading comprehension skills, understanding sarcasm and jokes, commenting, requesting, and interrupting. They may have trouble understanding the rules of conversation, including initiating an appropriate topic, providing context for the listener, maintaining or changing the topic, and ending the conversation.
Other pragmatic aspects of language often pose a challenge to my students. These include understanding and using nonverbal/social communication skills such as eye contact, facial expressions, gestures, body language, body proximity, and tone of voice. Those with compromised auditory processing skills respond to more visual approaches to help them negotiate the overwhelming world of language.
Noting that people with Asperger’s disorder do not have communication issues is misleading. Clearly there are issues with several components of language that sometimes prevent people with Asperger’s syndrome from becoming successful communicators. This is an important point to clarify, because understanding the communication needs of people with Asperger’s syndrome helps us as clinicians become clearer, more successful communicators.
Ruth Levine-Arnold, MS
Drs. Posey and McDougle respond
Ms. Levine-Arnold is indeed correct. Persons with Asperger’s disorder do often have problems with social conversations and pragmatic language. In addition, such patients often benefit from speech and language therapy with a therapist skilled in the pragmatic aspects of language. Perhaps our table simplified matters too much.
Our table was based on DSM-IV criteria in which persons with Asperger’s disorder lack an early childhood history of language delay. The symptom criteria for Asperger’s disorder are almost identical to those for autistic disorder minus the four symptoms of communication impairment. This can be misleading because persons with Asperger’s disorder often do have problems with speech prosody and with making socially appropriate conversation. These deficits are usually not as marked as those seen in autistic disorder, however. Affected persons also do not have the severe impairments in communication that are frequently seen with autistic disorder (e.g., echolalia, pronominal reversal).
Readers interested in a comprehensive review of these issues along with the finer points (and disagreements) about Asperger’s disorder may be interested in a recently published work by Klin and colleagues at Yale.1
David J. Posey, MD
Christopher J. McDougle, MD
- Klin A, Volkmar FR, Sparrow SS (eds.). Asperger syndrome. New York: Guilford Press, 2000.