Journal of Autism and Childhood Schizophrenia, Vol, 5, No. 4, 1975

Language Patterns of Adolescent Autistics' James Q. Simmons 2 and Christiane Baitaxe Neuropsychiatric Institute, University of California, Los Angeles

The language samples of seven verbal autistic adolescents were analyzed. Linguistic deficits were compared to characteristics reported for preteen autistics and described structurally. Only four subjects demonstrated linguistic impairments. These clustered primarily in the area of prosodic features, semantic cooccurrence constraints and general disfluency. No such clustering had been reported for the preteen population. No correlation between linguistic deficits, IQ, and age was found. However, performance on the Seashore Test for Musical Ability correlated highly with linguistic performance. Results suggest that (a) autism includes linguistically, and possibly etiologically, distinct subgroups; (b) the basic linguistic deficits in autism may be more specific than thought previously; and (c) perception of prosodic features may be crucial for decoding and encoding linguistic signals. Autistic children may be lacking in this ability. In addition to deficits in intellect, social and interpersonal relations, and abnormalities in other aspects of behavior, one of the outstanding features of childhood autism is deviant linguistic behavior. Beginning with Kanner's (1943) early characterization of the disorder, it has long been a practice to describe autism in terms of aberrant linguistic features such as immediate and delayed echolalia and pronominal reversal (Kanner, 1946; Goldfarb, Braunstein, & Lorge, 1956; Rutter, 1968; Shapiro, Roberts, & Fish, 1970). Disturbances of speech and language have been reported for children afflicted with the disorder regardless of age, although the language histories have shown considerable variation. Language development may not occur at all, may show considerable delay, or may be arrested after reportedly normal onset (Rutter, 1966a, 1972; Kelvin, Ounsted, Humphrey, & McNay, 'This study was supported in part by the Maternal and Child Health Grant No. 927. ~Requests for reprints should be sent to Dr. James Q. Simmons, Chief of Child Psychiatry and Associate Program Director, Mental Retardation and Child Psychiatry Program, Neuropsychiatric Institute, University of California, Los Angeles, California 90024. 333 0 1 9 7 5 P l e n u m P u b l i s h i n g C o r p o r a t i o n , 2 2 7 West ] 7 t h Street, N e w Y o r k , N . Y . 1 0 0 1 1 . N o part o f this p u b l i c a t i o n m a y be r e p r o d u c e d , stored in a retrieval system, o r t r a n s m i t t e d , in a n y f o r m o r bY any means, e l e c t r o n i c , m e c h a n i c a l , p h o t o c o p y i n g , m i c r o f i l m i n g , r e c o r d i n g , o r o t h e r w i s e , w i t h o u t w r i t t e n p e r m i s s i o n o f t h e publisher.

334

Simmons and Baltaxe

1971). However, the specific nature of the linguistic deficits still remains unclear, although language impairment is considered to be basic to the disorder (Rutter, 1970). Long-term follow-up studies have shown that in adolescence and young adulthood, linguistic deficits remain as one of the two major handicaps. There have been several major long-term follow-up studies of the behavioral characteristics of autistic children ranging in age from early adolescence to the middle thirties (Kanner & Eisenberg, 1955; Eisenberg, 1956; Eisenberg & Kanner, 1956; Kanner, 1971; Creak, 1963; Rutter, 1966b, 1970; Rutter, Greenfe!d, & Lockyer, 1967; Rutter & Lockyer, 1967; Reiser & Brown, 1964). All of these studies reported a generally poor outcome for the majority of their population. Although all cite good to fair social adjustment in 50% of their population, disabilities of speech and language remained the major handicaps in later development, and approximately half of each population remained mute. Each group of investigators found that the presence of some useful speech before the age of five or six years was the single most important prognostic factor, with Rutter (1966b) noting that this was particularly so when coupled with an IQ of 60 or better. The children who developed useful speech usually showed echolalia, often lasting for several years. Even though language is cited as a continuing dysfunction into adolesence and young adulthood, it has not been studied in depth during this period of life. The linguistic characteristics of the autistic population in the follow-up studies listed above were not described in detail apart from such general observations as "there was little lability," that "they lacked cadence or inflection," and that "there was a lack of ease of use of words" or that "there often were obsessive questions, a difficulty with abstract concepts" and that "their output gave an overall impression of mechanicalness and formality" (Rutter, 1966b). Since language disabilities appear to persist in the later stages of childhood autism, an analysis of the linguistic characteristics of this age group may be critical in understanding more precisely the nature of the linguistic deficit. Because of the clinical heterogeneity of children diagnosed as autistic (Rutter, 1972), in-depth linguistic analysis may also offer a technique for differentiating etiologically distinct subgroups. There are no studies in which spontaneous language samples have been used to describe the linguistic structures found in young autistic children. However, Goldfarb, Goldfarb, Braunstein, and Scholl (1972) have provided a most detailed listing of abnormal features of speech and language in preteen children with this disorder. 3 Some of the features described by 3Shapiro, Roberts, and Fish (1970) analyzedlanguagesamples of young schizophrenicand normalchildren,ages2 to 5. However,their data wereanalyzedonlyin terms of the relationship of the child's imitationto the adult's utterances.

Language Patterns of Adolescent Autistics

335

these authors, such as the presence of immediate or delayed echolalia, are generally cited as characteristic of autism. However, Goldfarb et al. ultimately characterized these deficits as widely variable and not unique to the disorder. These investigators noted that "while more schizophrenic children 4 than normal showed specific speech faults, no single or specific clustering of faults uniquely characteristic of childhood schizophrenia was in evidence. Also, more schizophrenic children exhibited a wide variation and presence of antipodal phenomena fluctuating from one extreme to the other in many voice and speech elements." Goldfarb's description of speech and language faults consisted of (1) faults of voice and speech phonation based on the parameters of volume, pitch level, and voice quality; (2) faults of rhythm based on the parameters of rate, phrasing, fluency, stress, intonation, and inflection; (3) faults of articulation, noting certain general features such as overprecision, laxness, omissions, and unrounding; and (4) faults of language listed in very general descriptive terms including babbling, misnaming, miswording, echolalia, perseveration, irrelevancies, repetitions of thought, condensations, excessive questioning, distortion of ideas, agrammatisms, limited usage of language, literalness, confused, not clear, and problems with pronouns. Goldfarb's approach represented a first step but has some weaknesses, specifically using a set of largely impressionistic terms which, at best, can be described as having only subjective value (compare in particular his categories of faults of voice and speech phonation). The interpretation of Goldfarb's terminology is further complicated by the absence of examples in his description which might clarify his categories. Although a caveat is necessary, our interests here are not an in-depth criticism of Goldfarb's terminology and its application. Whatever its faults, Goldfarb's list appears to be the most detailed available of speech and language faults in a large sample of preteen autistic children. Therefore, as such, it presents a useful first checkoff list to test for the types of faults which can still be detected in an older population. However, a formal analysis of linguistic structures will offer a more precise method for specifying the nature of the linguistic deficit and provide a better insight into autistic linguistic development over time (Baltaxe & Simmons, 1973, 1975). This is particularly true in terms of the more mature individual where some aspects of the language deficits of early childhood may be compensated for by continued adaptation and closer approximation to what has been experienced in the environment. The purpose of this paper is to analyze and describe more precisely the linguistic characteristics and structures in an older autistic group in order to establish what types of similarities and continuities in linguistic patterning "Although Goldfarb et al. (1956, 1972) use the larger term childhood schizophrenia, the category seems generallyto include early infantile autism.

336

Simmons and Baltaxe

exist between the earlier and later stages of the disorder. Accordingly, the linguistic characteristics of the grown-up childhood autistics will be examined, first by utilizing the Goldfarb analysis, and second by exploring the language disabilities more extensively in formal linguistic terms.

METHOD

Diagnostic Criteria Although there are many characterizations of childhood autism (Creak, 1961; Kanner, 1943, 1946; Ornitz & Ritvo, 1968; Rutter, 1968), which have many points in common, for the purpose of this paper, the patient population is defined using the criteria described by Simmons and Tymchuk (1973). They include: 1. An impairment of interpersonal relationships (e.g., aloofness, diminished physical contact with people, and reduced eye-to-face contact with others). 2. A deficit in the development of social behaviors (self-care skills, social amenities, cooperative play, and appropriate play with toys). 3. Stereotyped behaviors (self-stimulatory activity, preoccupation with sameness, and repetition). 4. Impairment of intellect (impaired school performance, concrete thought, and difficulties in judgment and abstract thinking). 5. Deficits in speech (mutism, echolalia, delay in development, and idiosyncrasies in word usage, speech modulation, and content). 6. History of onset prior to age 30 months.

Subjects Seven adolescent autistics (six boys and one girl), the total population available at the time, were included in the study. They ranged in age from 14 to 21. All had been diagnosed as autistic in childhood, and demonstrated behaviors characteristic of the disorder (see Table I).

Procedure Language samples were obtained by means of an interview in an informal situation. The interview questions had been developed for the purpose of the present study, and ranged from concrete to abstract. They included general information questions such as "Where do you live?" and

Age (yr) and sex

21M

16M

14M

18M

17F

17M

14M

Patient

LR

RD

SM

RH

SP

TT

FT

120

118

88

86

109

102

87

Present IQ-WAtS

No friends; preoccupation with cartoon drawing and almanac;speech has peculiar rhythm and intonation; hearing test normal.

Naive; no friends;jokes concrete; "stilted speech"; hearing test normal.

Isolated; preoccupation with colored bits of paper; many fears; speech content contains idiosyncratic references; hearing test normal.

Aggressive behavior; inappropriate laughing spells; poor judgment; repetitive questioning; decreased school performance; hearing test normal.

Preoccupation with sameness; lip grunting noises; poor school performance; isolated; hearing test normal.

No friends; poor judgment; poor school performance; finger flapping when excited; isolated; hearing test normal.

Isolated; stereotyped speech;erratic vocational performance; hearing test normal.

Current characteristics

Under 1 yr

Under 1 yr

Under 1 yr

6 mo

9 mo

6 mo

1 - 2 yr

Age of onset

Table I. Patient Characteristics

Started speaking age 2; stopped talking to age 7; spelled before speaking words; called "lazy-lip".

Formed words age 2; stopped talking to age 5; echolalia; monotonous quality to speech; called "lazy-lip".

Speech delayed to age 3; echolaiic to age 5 ; norreal speech thereafter "with unusual content".

Speech delayed;first words age 3 ; "repeated endlessly"; sentences age 5.

Seemed to understand parental commands 15 mo; talked 18 mo; stopped talking 30 mo; reacquisition age 4; apparently normal useful speech.

Speech developed age 2; "content did not make sense"; normal useful speech developed later.

Delayed speech development to age 3; echolalic speech age 3; communicative speech at age 6; "bland in quality".

Early language history reported by parents

,~

m,

;~ =.

=.

=

338

Simmons and Baltaxe

"What are your favorite foods?" and more abstract judgmental questions such as "What would you do if you were the president?" and "What do you think of the Vietnamese War?" The interview was tape-recorded on a Sony TC 224 Cassette tape recorder and transcribed using gross phonemic transcription. The language samples were then analyzed, first, using the list of linguistic deficits prepared by Goldfarb for younger autistic children? These included faults in voice and speech phonation, faults of rhythm, faults in articulation, and faults in language. Next, an analysis was done in terms of structural characteristics according to the principles of formal linguistic analysis. The data were analyzed in terms of deficits in phonological, morphological, syntactic, and semantic patterning? In addition, the subjects were given a test for musical ability. Their responses were analyzed in terms of rhythm, perception, and tonal memory. In the rhythm subtest, the subjects were asked to identify whether the two patterns in a pair of rhythmic sequences were the same or different. The tonal memory subtest required the subject to identify, by number, which note in two sequences was different.7

RESULTS

Goldfarb A nalysis Essentially two patterns emerged from the analysis of the language samples of our subjects in terms of Goldfarb's categories. Four of the seven subjects demonstrated pathological linguistic features, while three did not. These features related to voice and phonation (Table II--volume, pitch, and quality) and rhythm (Table Ill--rate, phrasing, fluency, stress, intonation, and inflection). There were relatively few disturbances of voice quality (Table II), and few involving articulation (Table IV). The most preva~As noted above, some of Goldfarb's terms, in particular those relating to deviations in voice quality (such as throaty or husky), are so impressionistic that it is difficult to know what the authors meant, despite their definitions of these terms. They were interpreted to the best o f our ability as reference points in the analysis of our speech samples. 6Our methods of linguistic analysis are influenced by the principles o f contemporary linguistic theory as developed by C h o m s k y (1957, 1965) and others. Phonology refers to the study o f sound patterning o f language; morphology refers to the study o f the basic meaningful elements o f words; syntax refers to the way such elements are combined into utterances; and semantics refers to the study of the meaning of words and utterances. 7Disturbances of intonation constitute a significant finding in most commentaries on the language o f autistic children. To explore this further, it was felt that a fruitful extension o f the study would involve an analysis of r h y t h m and tonal perception, utilizing the Seashore Test, a memory test of perception of rhythmic patterns, and tone discrimination.

Language Patterns of Adolescent Autistics

339

Table 1I. Description of Faults in Voice and Speech Phonation of Subjects (After Goldfarb et al., 1972) Subject Fault

I II III

Volume Too loud Too weak Fading Screaming Whispering Excessive force for stress Insufficient force for stress

X X X X

Pitch level (average pitch range within which normal voice rises and falls) Too high Too low Excessive variation

X X X X

Voice quality Nasal Denasal Husky Tense Thin Throaty Breathy Tremulous

X X X

IV

V VI

VII

X X X X X

x

lent feature relating to articulation was one of overprecision. This appeared t o b e s e c o n d a r y t o f a u l t y s t r e s s ( T a b l e I I I ) i n t h a t all s y l l a b l e s w e r e i n t o n e d with equal stress. In audition, the four subjects who demonstrated faults in speech also demonstrated faults in language (Table V). (The remarks in parentheses in Table V indicate some correlation with the linguistic classification which will b e d e s c r i b e d b e l o w ? )

81n analyzing linguistic data, a distinction is frequently made between speech and language. Depending on the orientation of the authors, these terms are used in somewhat different senses. Goldfarb makes such a distinction. Tables II, III, and IV represent speech faults, and Table V, language faults. Language faults are then further defined as faults relating to the symbolic function of language, the expression of meaning, and the communication of interest, purpose, aim, and sense. Goldfarb's distinction is at considerable variance with a formal linguistic distinction between speech and language such that languagewould refer to the rules the native speaker uses in speaking and the native speaker's intuition about his linguistic code. Speech would relate to the actual act of speaking, or to how such rules are actualized in linguistic behavior. The term rule relates to any generalization which can be made about linguistic behavior. Linguistic theory is based on the assumption that all linguistic behavior has a structure and that this structure is governed by and reducible to a finite set of rules. The native speaker knows these rules intuitively; he intuits them about his language and applies them in language use. The linguist is able to abstract and express such rules formally.

340

Simmons and Baltaxe Table III. Description of Faults in Rhythm of'Adolescent Autistics (After Goldfarb et al., 1972) Subject Fault Rate Too rapid Too slow Excessive variation Insufficient variation Staccato Pauses too long Pauses too short Phrasing (grouping of words according to sense units) Too long Too short Incorrect Fluency Hesitations Repetitions Prolongations Nonfluencies Stuttering Cluttering Stress Incorrect sense stress Scanning Incorrect word stress Intonation and inflection Insufficient pitch rise for stress Excessive pitch rise for stress Excessive inflection Contraindicated inflection Stereotyped (singsong)

III

III

IV

X X X X X X X X X

X X

X X X X X X X X X

X X X

X X X X X X X X X X X

X X X X

X X X X X X

X X

X

X

X

X X X X

X X X X X X X

X X X X

V VI

VII

Table IV. DesCription of Faults in Speech Articulation of Subjects (After Goldfarb et al., 1972) Subject Fault Overprecision (too careful) Laxness Immature Omissions Additions Unrounding Insufficient bilabial closure Lisping Lalling

I

II III

X X

IV

V VI

X X

X

X X

VII

Language Patterns of Adolescent Autistics

341

Table V. Description of Faults in Symbolic Use of Language of Adolescent Children (After Goldfarb et al., 1972) Subject Fault a

I II III IV V VI VII

Babbling Neologisms Miswording/misnaming (semantic constraints) Echolalia Perseveration Irrelevancies (semantic, syntactic constraints) Repetitions of thought Condensations (semantic, syntactic constraints) Excessive questioning Distortion of ideas Agrammatisms (semantic, syntactic constraints) Limited use of language (situational constraints) Literalness (situational constraints) Confused, not clear (semantic, syntactic constraints) Problems with pronouns (semantic constraints)

X X X X X X X

X

X X X X X X

X X

X X X X

X

X X X

X

X X X

X

X X X

X

X X X

X

X

X X

aTerms in parentheses are linguistic characterizations of Goldfarb's categories.

Linguistic Analysis The most frequent and general characteristic encountered in each o f the four samples was a disruption or disfluency feature, the p r i m a r y effect o f which was the disruption o f the n o r m a l flow o f speech or the temporal sequencing o f linguistic elements. Linguistic patterning was disrupted o n various levels o f structure. P h o n o l o g i c a l or sound patterning was disrupted due to the repetition o f word-initial sounds, syllables, or the repetition o f entire words (Example: We have been f-f-fighting; the p r o b - - t h e p r o b l e m is; t h e y - - t h e y fall). M o r p h o l o g i c a l patterning was disrupted because o f the speaker's change in tense or person marker. A f t e r m a k i n g an initial choice, a switch was m a d e to a different m a r k e r (Example: I - I - - w e - w e - - h e probably left; if they n e e d - - i f they needed treatment). Syntactic patterning was disrupted because the speaker repeated part o f an utterance in order to change or expand its structure or because an utterance was not completed before the intrusion o f a new and different utterance (Example: This is the

342

Simmons and Baltaxe

first time--this is the first time--I did it; usually governors and--usually governors--usually people who become governors). Semantic patterning was disrupted because the speaker interrupted his utterance in order to change its initial meaning, or repeated an utterance or an intended thought several times (Example: I listen to--once in a great while when I have time and nothing else to do--I listen t o . . . ) . A frequency count of these types of disfluency in a 45-minute language sample amounted to 114. Disfluency also extended to the prosodic or "rhythmic" elements, and distorted the normal flow of speech by improper phrasing, incorrect stress placement, and frequent distortion of intonation patterns. In analyzing the language samples more specifically in terms of linguistic structure, the abnormalities found could best be characterized in terms of violations of linguistic rules and constraints. This means that certain rules which govern the co-occurrence of linguistic elements in speaking were broken. Based on the samples of the four linguistically impaired subjects, linguistic constraints were violated in three major areas: semantic, syntactic, and situational. The three remaining subjects showed none of the error patterns described above. Semantic constraints relate to the rules restricting the co-occurrence of elements of meaning (Example: A bachelor is married). This statement would constitute a breaking of a semantic constraint for the word bachelor since one of the features of being a bachelor is "unmarriedness." Syntactic constraints relate to the rules governing the co-occurrence of grammatical elements (Example: "Boys is laughing" is not grammatical because of violation of number agreement). Situational constraints relate to the rules governing the appropriateness of linguistic utterafices in specific situations (Example: "Good morning" would not be appropriate at night). Also, people tend to switch their styles depending on listener and situation (Example: "Sir" would not be an appropriate way to address a shoeshine boy, but would be appropriate in another situation). In terms of frequency, semantic constraints were violated most often in the samples analyzed. Syntactic and situational constraints also occurred with considerable frequency. An analysis of frequencies which appeared generally in all four samples revealed the following breakdown of violations in one 45-minute sample: semantic, 49; syntactic, 10; situational, continually. However, the most significant aspect of language disability, from a linguistic point of view, need not be reflected in quantitative terms, but more in terms of the recurring violations in these areas. Thus, the data discussed are more focused on the nature and periodicity of the violations. It is noteworthy that these constraints did not appear to be broken systematically. Rather, they seemed to represent a "slipping up" on the rules which should have been followed and in other instances were followed.

Language Patterns of Adolescent Autistics

343

The examples given below will illustrate further what is meant by the violation of semantic constraints. These violations fall into the following subcategories:

a. Inappropriate antecedent reference. 1. Mankind is considering--he is considering (Target: 9 Mankind is considering--it is considering). 2. I've been catching him every night so far otherwise I've had substitute drivers (Target: I've been catching him every night except when there have been substitute drivers). b. Opposite reference from that of target word. 1. He is getting rarer and rarer because so many of them are left (Target: . . . because so f e w of them are left). 2. It should have taken at least one year to stop the war two years at the most (Target: no more than one year). c. Inappropriate word use, where the word used belongs to the proper syntactic class, but had none of the semantic features of the target word. 1. The loopholes can be livid (Target: ? another adjective). 2 . . . . which one of the staged species (Target: endangered species). d. Inappropriate word use, where the word used belonged to the proper syntactic class and had some o f the semantic features o f the target word. 1. The only sport I like is drawing (Target: hobby). e. Inappropriate word use, where the word used belonged to the improper syntactic class, but had some of the semantic features of the target word. 1. Q: Why do you think he did it? A: Questions me. (Target: T h a t ' s what I would like to know, or, I am asking myself that, too. Target here may also be interpreted as "beats m e , " in which case it would have been the proper syntactic class.) f. Telescoping o f ideas where both syntactic and semantic constraints were broken. 1. Sometimes the foreman is- gets- and that's when- what gets the foreman angry- sometimes he asks stuff and that he couldn't get any answer out of such and such. g. Looseness of semantic constraints on words o f emotional connotation and personal reference (tendency to avoid "'I"). (The " y o u " of address in the question in each case related to singular use of pronoun.) 1. Q: Do you ever get unhappy? A: Maybe on the job, maybe workers would get unhappy on their jobs. 9Target word is to be defined as the word which normal speakers o f English could have intended in this context.

344

Simmons and Baltaxe

2. Q: Is that what you would do when you get married? A: Yes, that's exactly what people would do when they get married. 3. Q: Do you ever look through a magazine called Playboy? A: No, we- we've looked through a lot of magazines before. h. Idiosyncratic semantic usage (individual reference). 1 . . . . or standing up, just like a- just like lightning to a fireplace standing up to a fire. 2. He thinks when he wants to please people it's like an elephant. i. Meaningless additions and insertions. 1. Ads for different products more or less. 2. In their womb more or less. j. Vagueness o f referent. 1. Q: What are you planning to do? A: Just looking ahead in the future for all I care. 2. Q: What do you think of the governor? A: Well, I can't say, my opinion is undecided. The following will exemplify violations o f syntactic constraints. Several syntactic constraints were violated and included. a. Constraints involving prepositions. 1. He (the bird) was driven f r o m extinction. 2. H e (the bird) was driven under extinction. b. Tense agreement with antecedent adverbial 1. Last Wednesday nights now I watch (Target: Last Wednesday night I watched - - 3 . c. Constraints involving subject~verb agreement. 1. Golden eagles has been framed (Target: Golden eagles have been framed). 2. A few lambs gets missing (Target: A few lambs get lost). d. Deletions. 1. Then mankind foolishly cut down trees--not replacing e. Constraints on negative constructions. 1. Well, you don't hear about it every so often (Target: Well, you only hear about it every so often). The most prevalent violation of situational constraints is a general inability to switch codes. An example would be the inability to switch from a formal style of speaking to an informal style. In contrast with the categories of semantic and syntactic constraints, situational constraints--in particular the inability to switch codes depending on listener, social situation, and topic--appear to be vulnerable to constant violation. The subjects practically always used a formal style and were unable to switch to an informal one.

Language Patterns of Adolescent Autistics

345

Examples: Inability to switch codes (formal to informal). 1. Q: Do you have a girlfriend? A: No, I haven't met such a nice lovely young lady as yet. 2. Q: What do you think of the Lakers? A: Now the Lakers are battling for a playoff spot. Their big star suffered a ruptured knee tendon, the Lakers are a crippled team. 3. Q: What about that bird? A: The pelegrin (sic) falcon, it's an endangered species and tragically being wiped out because of insecticide.

The Seashore Test o f Musical Ability From the results of the language samples of all our subjects, we see that four of the subjects showed faulty features in all of the above categories, as well as the prosodic features of language, while three were relatively free from any of these faults. Results of the Seashore Test are shown in Table VI and Figure 1. As can be seen in Table VI, the correlation between performance on the Seashore Test and linguistic disturbances appear highly meaningful for the individual subjects. Those subjects who had demonstrated difficulties in the linguistic areas also did poorly on the Seashore Test. No correlations could be established based on a comparison for age or IQ scores which would account for the differences between the two groups.

Table VI. Rhythm and Tonal Perception of Adolescent Autistics Seashore test a Subject

Age

Wechsler IQ

Rhythm

Tone

I II III IV V VI VII

17 14 18 21 14 16 17

118 120 86 87 109 102 88

55 40 1 55 97 99 73

20 18 3 16 53 24 61

apercentile equivalents of raw scores obtained in standardization sample of age level norms in the general population, Table X, page 10, C. Seashore, D. Lewis, & J. G. Saetvit, Manual for the Seashore Test o f Musical Talents (Rev. Ed.). New York: The Psychological Corporation, 1956.

346

Simmons and Baltaxe

% 100

ILl

7 0

0

9

50

I--

0

*t

10 10

50 RHYTHM

100%

Fig. 1. Percent correct identifications of rhythm and tone by 7 subjects. Triangles indicate combined scores of rhythm and tone of language-impaired subjects. Circles indicate combined scores of unimpaired subjects.

DISCUSSION

Linguistic Data--Comparison of Goldfarb "s Categories and Structural Linguistic Analysis The seven adolescent subjects fell into two groups: a linguistically impaired group and an unimpaired group. Contrary to Goldfarb's earlier finding involving the linguistic characteristics of his younger population, deficits in the adolescent population clustered in two general areas: (1) the area of prosodic features involving pitch, volume, rhythmic elements, stress, and intonation; and (2) the area of semantics. A generalized feature of disfluency, affecting linguistic patterning on all levels of linguistic structure, was observed for the deficient group. This disfluency feature cut across several of the subcategories listed by Goldfarb with faults of rhythm (Table III), faults of articulation (Table IV), and faults of language (Table V). Hesitations, which he included under rhythmic disturbances, were defined as "the incorrect utterance of sounds or syllables more than once in rapid succession." Linguistically, this is considered a disruption of phonological patterning. Goldfarb did not specifically mention starts into false sentences, which linguistically are considered a disruption of syntactic patterning, or starts into different thought patterns (linguistically a disruption of semantic patterning). The disfluency feature thus cut across Goldfarb's categories involving speech production (Tables III and IV), including the repetitions of sounds, syllables, and words, but also the repetition of whole utterances.

Language Patterns of Adolescent Autistics

347

The generalized.disruption or disfluency feature also relates to Goldfarb's language faults (Table V), and includes his perseveration category, defined as "the inappropriate repetition of the speaker's own utterance," and his repetition category, listed under language faults and defined as "the excessive repetition of a thought, though not expressed in an identical manner each time" (again linguistically speaking syntactic and semantic patterning). Since Goldfarb does not provide examples, it is difficult to make a distinction between his perseveration and repetition categories. A sample from our own data exemplifies this point: "The Lakers are a crippled team, they have been plagued by the injuries--they have been plagued by the injuries. They have Happy Hairston now from the Detroit Pistons--they have ex-Detroit Piston player Happy Hairston." From the point of view of Goldfarb's definitions, this sample could be cohsidered both perseverative and repetitive. The disfluency feature as it relates to repetitions or perseverations also includes many examples in the adolescent data, where the subject appears to want to change or expand the meaning of an utterance which he had started. (Even though this also happens in normal linguistic behavior, it occurs with inordinate frequency in the autistic samples.) An example from our data: "Mankind is considering--mankind is foolishly considering . . . . " The disruption or disfluency feature also relates to Goldfarb's condensation category, defined as "combining fragments of two or more ideas and expressing them in the patterns of a single phrase, or the telescoping of thoughts" (linguistically involving disfluency in the syntactic and semantic patterning). An example from our data: "They tried to distract the giant--the giant mulla--distract the giant mulla and some others--snatch the eggs--and get out of here before he returns--such a risk--but they--but they say it's worth it." The generalized disfluency feature at least partially included Goldfarb's confused category, defined as"incoherent, not clear, words or phrases lacking in precision and exactness" (again a disruption in syntactic and semantic patterning). Example from our data: " I mean that's stupidity--and the pre--and then of course there is other k--the pelegrin (sic) falcon." A feature found"in our language sample of the language-deficient adolescents, but not included in Goldfarb's categories, was the presence of what can be considered stereotyped utterances, and the repetition of a particular utterance throughout the entire sample (e.g., "I caused a lot of trouble, didn't I?"). This was repeated 14 times in a 10-minute tape segment. A further deviant feature not mentioned by Goldfarb was the tendency to slip into direct quotes to avoid indirectly quoting another person. (Example from our data: "Well, I asked my parents--I told my parents--I'd be good at home but I feel you're too old to be at home. We feel you should

348

Simmons and Baltaxe

be away.") This patterning is quite reminiscent of the echolalic pattern seen in younger autistic children. By utilizing this single feature of disfluency, which affects the four parameters of linguistic patterning (phonological, morphological, syntactic, semantic), a more parsimonious generalization concerning the linguistic deficit can be made. Analyzing the language sample based on violations, in semantic, syntactic, and situational constraints, a more relevant generalization is also possible. Stated more simply, one does not have to particulate the language deficits into overlapping and overly subjective categories.

Linguistic Data Related to Test of Tonal and Rhythm Perception A definite correlation existed between abnormalities of rhythm, pitch, volume, stress, and intonation and abnormalities in the area of semantics. Subjects were impaired either in both areas or in neither. The deficits were consistent across all four impaired subjects. While no correlations for a subgrouping were found between the IQ scores and age as well as language disabilities, definite correlation existed between linguistic deficits and performance on the Seashore Test. The dichotomization of the subjects into a language-impaired and a language-unimpaired group suggests that some individuals who appear by history to have the disorder show very little in the way of a language disturbance in adolescence and young adulthood. This opens up the possibility that only four of the subjects had a common disorder, while three may have been etiologically distinct. The finding of a difference fulfills one of the original expectations of this study that the individuals suffering from the disorder could be subclustered and that significant correlations might be made with findings in other areas. The results of the structural linguistic analysis suggest that the linguistic disturbance in autism may be more specific than had previously been considered. The persistent disturbances in the prosodic features and in semantics, as well as the unique clustering in these two areas of the languageimpaired group, suggest that these abnormalities could be more "critical" to the dysfunction in autism. Deficits in other areas of speech production relating to phonological and syntactic patterning, which had been reported for the younger population (Goldfarb et al., 1972), could perhaps be considered "less severe" and thus could have been compensated for earlier and more easily in development. The correlation between linguistic disabilities and performance on the Seashore Test was entirely unexpected, and opens up the possibility that the test may be a valid measure to subcategorize autistic subjects. Further, the correlation between the subjects' scores on the Seashore Test and their linguistic performance opens several interesting areas of speculation: (1) This

Language Patterns of Adolescent Autistics

349

subgroup of four adolescents had been severely impaired to the degree that several linguistic areas, as well as perception in the musical sphere, had been affected. (2) Perception of rhythm and tone could be related to the suprasegmental linguistic features of intonation and stress. It could then be hypothesized that children who are in some way deficient in their perception of rhythm and tone also cannot produce what they don't perceive. In terms of language development, this would mean that they cannot adequately control and acquire the rhythmic, intonational, volume, and stress patterns of their language. (3) The four subjects with the suprasegmental or prosodic disabilities also had deficits relating primarily to semantic co-occurrence constraints. In order to establish a correlation between the prosodic disabilities and these faulty semantic features, a greater degree of speculation is necessary. To date, there have been no definitive studies which place the so-called suprasegmental or prosodic features in a model of language function and brain function. It is generally taken for granted that the left hemisphere is dominant for language function (Wada & Rasmussen, 1960; Penfield & Roberts, 1955). Dichotic listening and aphasia studies have implicated the right hemisphere for musical ability (Kimura, 1964; Shankweiler, 1966). But when pitch is used distinctively as a linguistic signal in a tone language such as Thai, recent dichotic studies have found pitch to be lateralized in the left hemisphere (Van Lancker & Fromkin, 1973). Psycholinguistic research in child language appears to have demonstrated that children acquire the intonational patterns or the suprasegmental features of their language before they actually develop the ability to produce words. It has been hypothesized that intonational and stress contours may serve as a " m o l d " into which words and sentences "are formed" (Pike, 1972). Autistic children have been observed to have abnormal responses to sounds. Sometimes they will ignore loud noises (absence of startle response), while at other times they will react to very low noises. This is considered, by some, to be evidence of perceptual inconstancy (Ornitz & Ritvo, 1968). Autistic children also have been reported to lack the prelinguistic intonation contouring observed in normal children. This allows one to hypothesize the existence of some regulatory mechanism involving rhythmic and prosodic perception, which is important for the decoding and encoding of linguistic stimuli. When children first learn language, such a mechanism might aid in the decoding and encoding of meaningful linguistic units. Autistic children, possibly impaired in the function of such a mechanism, would have difficulties in breaking down the normal flow of speech into its constituent parts. With this type of impairment, and unaided by prosodic contouring, they may be unable to perceive the constituent parts as separate units, leading to difficulty in differentiating words from one another in the sound continuum which constitutes speech. The alternative open to the autistic child would be to encode entire utterances chunk-style. This would seem to be the case, judging from the echolalic output of young autistic

350

Simmons and Baltaxe

children. In developing an approximation of useful language, the echolalic child may therefore have to rely on other strategies for breaking down the utterances he hears in his environment. Perhaps as his perception improves, possibly due to maturational factors, his linguistic abilities also improve. But, the unique language deficit, particularly affecting semantic development, appears to remain. The above findings open up possibilities for further studies which may well offer an alternative to currently used language intervention techniques. They suggest that before the commencement of formal language training, an effort might be directed at training in the suprasegmental aspects of language. This may incude exercises in pitch and tone perception and in contouring, including exercises in the production of stress and intonation patterning.

REFERENCES Baltaxe, C., & Simmons, J. Language patterns of adolescent autistics. Paper presented at the Annual Convention of the American Speech and Hearing Association. Detroit, Michigan, October 1973. Baltaxe, C., & Simmons, J. Language in childhood psychosis. Journal of Speech and Hearing Disorders, 1975, in press. Chomsky, N. Syntactic structures. The Hague: Mouton & Co., 1957. Chomsky, N. Aspects of the theory of syntax. Cambridge, Massachusetts: MIT Press, 1965. Creak, M. Schizophrenic syndrome in childhood: Progress report of a working party. Cerebral Palsy Bulletin, 1961, 3, 501-504. Creak, M. Childhood psychosis: A review of 100 cases. British Journal of Psychiatry, 1963, 109, 84-89. Eisenberg, L. The autistic child in adolescence. American Journal of Psychiatry, 1956, 112, 607-612. Eisenberg, L., & Kanner, L. Early infantile autism: 1943-1955. American JournalofOrthopsychiatry, 1956, 26, 556-566. Goldfarb, W., Braunstein, P., & Lorge, I. A study of speech patterns in a group of schizophrenic children. American Journal of Orthopsychiatry, 1956, 26, 544-555. Goldfarb, W., Goldfarb, N., Braunstein, P., & Scholl, N. Speech and language faults in schizophrenic children. Journal of Autism and Childhood Schizophrenia, 1972, 2(3), 219-233. Kanner, L. Autistic disturbances of affective contact. Nervous child, 1943, 2, 217-250. Kanner, L. Irrelevant and metaphorical language in early infantile autism. American Journal of Psychiatry, 1946, 103, 242-246. Kanner, L. Follow-up study of eleven autistic children, originally reported in 1943. Journal of Autism and Childhood Schizophrenia, 1971, 1(2), 119-145. Kanner, L., & Eisenberg, L. Notes on the follow-up studies of autistic children. In H. Hoch & J. Zubin (Eds.), Psychopathology of childhood. New York: Grune & Stratton, 1955. Kimura, D. Left-right differences in the perception of melodies. Quarterly Journal of Experimental Psychology, 1964, 14, 355-358. Kolvin, I., Ounsted, C., Humphrey, M., & McNay, A. The phenomenology of childhood psychoses. British Journal of Psychiatry, 1971, 118, 385-395. Ornitz, E. M., & Ritvo, E. R. Perceptual inconstancy in the syndrome of early infantile autism and its variants. Archives of General Psychiatry, 1968, 18, 76-98.

Language Patterns of Adolescent Autistics

351

Penfield, W., & Roberts, L. Speech and brain mechanisms. Princeton, New Jersey: Princeton University Press, 1955. Pike, K. Several characteristics of intonation. In D. Bolinger (Ed.), Intonation. Baltimore, Maryland: Penguin Books, Ltd., 1972. Reiser, D. E., & Brown, J. L. Patterns of later development in children with infantile psychosis. Journal of the American Academy of Child Psychiatry, 1964, 3, 650-667. Rutter, M. Behavioural and cognitive characteristics of a series of psychotic children. In J. K. Wing (Ed.), Early Childhood Autism: Clinical, Educational and Social Aspects. London: Pergamon Press, 1966. (a). Rutter, M. Prognosis: Psychotic children in adolescence and early adult life. In J. K. Wing (Ed.), Early Childhood Autism: Clinical, Educational and Social Aspects. London: Pergamon Press, 1966. (b) Rutter, M. Concepts of autism: A review of research. Journal of Child Psychology and Psychiatry, 1968, 9, 1-25. Rutter, M. Autistic children: Infancy to adulthood. Seminars in Psychiatry, 1970, 2, 435-450. Rutter, M. Childhood schizophrenia reconsidered. Journal of Autism and Childhood Schizophrenia, 1972, 2, 315-337. Rutter, M., Greenfeld, D., & Lockyer, L. A five to fifteen year follow-up study Of infantile psychosis. II. Social and behavioral outcome. British Journal of Psychiatry, 1967, 113, 1183-1199. Rutter, M., & Lockyer, L. A five to fifteen year follow-up study of infantile psychosis. I. Description of the sample. British Journal of Psychiatry, 1967, 113, 1169-1182. Shankweiler, D. Effects of temporal lobe damage on the perception of dichotically presented melodies. Journal of Comparative Physiological Psychology, 1966, 62, 115-119. Shapiro, T., Roberts, A., & Fish, B. Imitation and echoing in young schizophrenic children. Journal of the American Academy of Child Psychiatry, 19"/0, 9(3), 548-567. Simmons, J. Q., & Tymchuk, A. J. The learning deficits of childhood psychosis. Pediatric Clinics of North America, 1973, 20(3), 665-679. van Lancker, D., & Fromkin, V. A. Hemispheric specializations for pitch and "tone": Evidence from Thai. Journal of Phonetics, 1973, 1, t01-109. Wada, J., & Rasmussen, T. Intracarotid injection of sodium amytal for the lateralization of cerebral spee.ch dominar~ce. Journal of Neurosurgery, 1960, 17, 266-282.