They all have one thing in common: the language feels unnatural. Hans Asperger (1944)
The DSM-IV states about AS people: ‘there is no clinically significant general delay in language’ but most clinicians consider unusual specific and more subtle aspects of language an essential characteristic of Asperger’s syndrome and should be included in the DSM.
Superficially the surface structure can be age-appropriate in terms of acquisition of syntax, grammar, and vocabulary, sometimes more typical of an adult and the ability to say quite complex sentences. However formal assessments show problems with receptive language abilities especially language comprehension such as understanding figures of speech and the interpretation, recall, and execution of increasingly complex oral directions. Most need guidance regarding reciprocal conversation, the art of conversation, and aspects of prosody such as the use of stress on keywords or syllables, and the fluency and tone of speech. The evaluation examines the ability to understand figures of speech, written language, narrative ability (the ability to tell a story), and aspects of nonverbal communication such as body language, the communication of emotions, and pedantry (creativity in the use of language).
There is often a significant difference between language knowledge and practice – the speed of language processing needed in real-life situations. They may have difficulty explaining a significant emotional event by talking about it in a face-to-face conversation yet show eloquence in written language – typing an account in a diary or on a computer, or by sending an email. The child can sometimes speak like a ‘little professor, yet in an adolescent, it can be a factor for social exclusion. There can be a natural curiosity about the physical world and how things work and a tendency to ask questions and provide fascinating facts. Articulation can be age-appropriate but unusual in being almost overly precise, or pronounced as it is written rather than spoken – language learned more by reading, watching TV, or films than by listening. The child may create their own words of neologisms. Humor perception is idiosyncratic with puzzling laughter and lateral thinking.
Modifying language according to the social event may be impaired. Typical children can engage in a reciprocal or ‘balanced’ conversation, aware of the knowledge, interests, and intentions of the other person and the social conventions that determine what to say, how to say it, and how to listen attentively or the pragmatic aspects of language.
The prosody and especially the vocal tone of speech can be unusual – a ‘flat’ vocal tone that is perceived as monotonous, problems with volume, being too loud or too quiet for the context, having a ‘nasal quality’, too rapid fluency or delivery of a speech or in contrast, unusually ponderous especially when the reply requires understanding what someone is thinking or feeling during a social conversation.
There may be a breakdown in communication ‘transmission’ where they are deep in thought, deciding what to say and, to ensure total concentration, avoid looking at the face of the other person. The temporary loss of conversational momentum and eye contact can be confusing to the other person, who expects an immediate response. It is best to wait patiently as interrupting can cause them to start the whole thinking process again. That same person may be notorious for interrupting or talking over the speech of other people. They may frequently change topics, unaware that the logical link between the topics is obvious. These conversations can appear to be without structure and are perceived as a stream of thoughts and experiences that lack coherence or relevance to the context. They may fail to acknowledge the perspective of the listener, who is trying to follow the logic and wondering what the ultimate point will be or wonder whether he or she will have an opportunity to contribute to the conversation. There can be a conspicuous lack of inclusive comments such as ‘What do you think” or “Have you had a similar experience?”
They may vocalize their thoughts rather than keep their thoughts to themselves. Eventually, talking to oneself is considered by typical people as a sign of mental disturbance. For the adolescent, “talking to myself” may help them figure out and practice how to express ideas ‘well’. They may like the sound of their own voice as it keeps them from feeling lonely. They may be rehearsing possible conversations, repeating previous conversations to try to understand them, or as a form of self-comfort and reassurance.
There may be secondary social consequences as other children may withdraw from playing or talking with the person due to their problems with conversation skills or be teased and ridiculed. Thus, improving language abilities can be an essential component of therapy.
The Art of Conversation
There are specific errors in the ability to have a normal conversation with failure to follow the conventional conversational rules regarding how to initiate, maintain and end a conversation. Children may have no ‘off switch’ as the child completes their predetermined and ‘practiced script.’ They usually appear oblivious to signs of embarrassment, confusion and desire to end the conversation. The appearance is one of talking, but not listening. They may be unaware of the subtle non-verbal signals that should regulate the flow of conversation – lack of appreciation of the context social hierarchy and conventions, and little attempt to incorporate the other person’s comments, feelings, or knowledge of the conversation.
Many people with Asperger’s syndrome consider a conversation to be primarily an opportunity to exchange information, to learn or to inform, and if there is no information to exchange, why waste time talking? They may be notorious for being verbose when interested in a topic, but when the subject matter is of little personal interest or has been introduced by someone else, they may be reluctant to participate in a conversation at all.
Their knowledge of how to repair a conversation is also impaired. When things get confusing, perhaps because the other person is imprecise or the reply is unclear, neurotypical people seek clarification to maintain the topic. When in doubt, the AS person can lack the confidence to admit ‘I don’t know’ or ‘I’m confused’ and, rather than saying I’m not sure what you mean by that,’ ‘This is not easy to talk about,’ or ‘I’m lost for words’, can take a considerable length of time to think of their reply, or may suddenly change to a topic they are familiar with to a tangential response. Unfortunately, the conversation eventually reverts to the person’s special interest, or is characterized by ‘and now for something completely different.’
If the conversational partner is confused, the AS person often lacks the mental flexibility to provide an explanation using other words or to facilitate understanding by using gestures or metaphors.
Another unusual feature is a tendency to make what appears to be irrelevant comments that are not obviously linked to the topic of conversation, as if they say the first thing that comes to mind. The reason may be a tendency to be impulsive and less able to formulate a logical structure of sequence, and the inability to consider the perspective of the other person. It is best to ignore the comment as if it had not occurred.
There can be a tendency to interrupt or talk over the speech of others. One issue is not being able to follow the rhythm of a conversation – with normal people, their speech and laughter follow a rhythm with a kind of electricity that goes on between people. They will all laugh together and then talk quietly until the next laughing cycle. AS people may interrupt conversations and have difficulty fitting into this rhythm. Such interruptions can imply the person with AS as being very rude when it is simply an aspect of Asperger’s and not due to a lack of respect.
During a typical conversation, there is the expectation that the person listening will show clear signs of paying attention to the speaker, and communicate signs of listening by nodding the head and making sympathetic facial expressions or vocalizations such as “uh-huh” or “yes”. These behaviours confirm a sense of rapport and being ‘in tune’ with the speaker. There should also be synchrony of gestures and movements, especially when there is a positive relationship between the two people. These signals can be less apparent when one of the conversational partners has AS. Although signs of disagreement may be clear, signs of agreement, attentive listening and sympathy may not be as conspicuous as one would expect. The person with AS is often perceived as a poor listener. This may not be too much of a problem for a casual acquaintance, but is of concern to a partner, close relative, friend, or colleague.
Sometimes the person with AS can be criticized for being tactless or socially naive during a conversation, perhaps saying something that is true but would hurt someone’s feelings or is inappropriate for the context. From early childhood, typical children adjust the topic of conversation according to whom they are talking to. Such modifications are based on an understanding of social hierarchies and conventions and the need to inhibit certain comments when taking into account the other person’s thoughts and feelings. In AS people, due to impaired or delayed Theory of Mind abilities, the conversation can be a social ‘minefield’ with the tendency for the conversational partner to be offended by the comments, criticisms, and value judgments of the person with AS. However, being offensive is not usually the intention of the person with AS, who tends to speak his or her mind and unfortunately has greater allegiance to facts and the truth than to someone’s feelings.
Sometimes the problem is not what was said by the person with AS, but the way they said it. This can give the impression that the person is overly critical, grudging with compliments, abrasive, argumentative, and impolite. Other people will know when to think rather than say something and how to avoid or subtly modify comments that could be perceived as offensive. Once again, it is important to recognize that there may be no malicious intent.
Impaired or delayed Theory of Mind skills can also explain why the person with AS can be unsure what the other person knows, or wants to know. When the mother of an AS child asks “What did you do today at school?”, the child can be dumbfounded in that the question is not precise. Does she want to know who I talked to, what I learned, where I went, who I played with, whether I was happy, whether someone teased me, or what the teacher said and did? The response can be avoiding answering altogether, or to embark on a detailed description of the day in the hope that something that is said will provide the right answer.
When asked to describe an event (provide a ‘narrative discourse’), the child with AS may have significant difficulty providing an organized and coherent framework for the story. At about six, a typical child can organize a story with a clear framework and logical sequence with an emphasis on key events, thoughts, and consequences. They can analyze the available information in order to determine which aspects are relevant and would be interesting to the listener and will give consideration both to the time needed to impart these facts and the amount of time available to tell the story. The AS child may have no clear beginning to the story, too much, or too little information, an absence of key information, and a tendency to be sidetracked with irrelevant information. There can be difficulty summarizing and getting to the point, which can be boring or irritating to the listener who expects a shorter and more coherent story. The facts may be there, but the logical structure and the thoughts and feelings of the participants are often missing. Other people may assume the person with AS is being deliberately obtuse and uncooperative, and thus there may be a reluctance to engage in a subsequent conversation.
Strategies to improve Conversational Skills
Explanations of the social context and conventions using Social Stories, the opportunity to learn and practice conversations, and activities to improve the maturity of Theory of Mind abilities.
Seeking or commenting on the opinions, abilities, and experience of the other person, offering sympathy, agreement, and compliments, knowing how to make the topic interesting, and knowing how and when to listen to and look at the other person, are remarkably complex and advanced skills. Improving conversation ability enhances listening skills, the ability to give and receive compliments and criticism, awareness of when and how to interrupt, the ability to make connecting comments to introduce a change of topic, the ability to use repair comments, and the knowledge of how to ask questions when confused as to what to say or do.
There can also be guidance and practice on the choice of topic when to relinquish control of the conversation, and closure, how to tell a story, to mentally highlight important information, and to create a clear and coherent structure.
For the teenager, integrating conversation into a drama class at high school can be a useful strategy. The scripts and skills can be applied in reality rather than on stage.
Comic Strip Conversations can be used to explain what someone may be thinking and feeling in a conversation. Tuition in the art of conversation can be a life-long program.
Literal Interpretations
The person with AS tends to make a literal interpretation of what the other person says, being confused by idioms, irony, figures of speech, innuendo, and sarcasm. They are not being deliberately lazy, obtuse, or defiant, but responding to the literal, not the hidden, implied, or multiple meanings.
Other children, and sometimes teachers, can have great fun exploiting their naivety. Ironic remarks are more likely to cause the person with AS to assume the person is lying. The hidden meaning is elusive. They may also not have the flexibility of thought to understand an alternative meaning, and rely on logic rather than symbolism, and that the other person is saying exactly what he or she means. Figures of speech are perceived as illogical and yet another example of how typical people fail to make their intentions clear.
Making a literal interpretation can also lead to the assumption of behaviour or conduct problems. The significance of what people say may be taken to apply only to that particular moment or situation.
Prosody
AS people may have unusual aspects of pitch, stress, and rhythm (the melody of speech). There can be a lack of vocal modulation such that the speech has a monotonous or flat quality, an unusual speech pattern, or even over-precise diction with stress on almost every syllable.
There are three levels of prosodic function: grammatical, pragmatic, and affective. The grammatical function is to communicate aspects such as whether the utterance was a question (with a rising pitch), a statement (with a falling pitch), or whether the word used is intended as a noun or a verb. The aspect of prosody appears to be the least affected in children and adults with Asperger’s syndrome.
The pragmatic function is to provide social information for the listener, using emphatic or contrastive stress to communicate thoughts, opinions, and intentions, or to draw the listener’s attention to information that is new to the conversation. This is the vocal equivalent of using a highlighter pen when reading.
Affective prosody functions as a means of communicating feelings and attitudes. For example, the simple request ‘Come here’ could be said with a tone of voice that would indicate the person has found something interesting and is happy, is anxious and needs reassurance, or is perhaps angry and about to administer an unexpected consequence.
Prosody in AS can be unusual, especially with regards to pragmatic and affective prosody. The person’s speech may not convey the amount of social and emotional information that one would expect.
The prosody can also be perceived as dysfluent in terms of the frequency of word repetitions, fewer pauses than would occur with the typical speaker of that age, and distortion or unusual pronunciation of a word. There can also be problems with the volume, which is often overly loud, and there is sometimes a nasal and/or high-pitched quality.
The child or adult with AS may also have difficulty understanding the relevance of the change in tone, inflection, or emphasis on certain words when listening to the speech of the other person. These subtle cues are extremely important in identifying the different intentions, thoughts, and emotions.
The following example illustrates how the meaning changes when the emphasis is put on a different word:
I didn’t say she stole my money.
I didn’t say she stole my money [but someone said it].
I DIDN’T say she stole my money [I definitely didn’t say it].
I didn’t say she stole my money [but I implied it].
I didn’t say she stole my money [but someone stole it].
I didn’t say she stole my money [but she did something with it].
I didn’t say she stole my money [she stole someone else’s].
I didn’t say she stole my money [she stole something else].
These are seven different meanings achieved simply by changing the emphasis of each word of the sentence.
The person with AS who has problems with prosody, in terms of both production and perception, will require guidance in understanding the messages conveyed by prosody. Role plays, listening to audio recordings, and drama activities can be used to explain how and why the emphasis changes. Stress on a word can be conceptualized as similar to using a highlighter pen to convey thoughts, feelings, and information that are important to the listener.
It is also important that children with AS understand how their volume, speed of speech, intonation, and so on affect the listener’s ability to understand what they are saying. An audio recording can provide valuable insight.
Pedantic Speech
The speech of children and adults with AS can be perceived as being pedantic, overly formal, and pretentious. The characteristics include providing too much information, an emphasis on rules and minor details, a tendency to correct errors in the previous utterance of the other person, the use of overly formal sentence structures, and making a rigid interpretation of what someone says that could be perceived as being argumentative rather than corrective. The person with AS is often characterized as being a pedant, a comment which is not intended as a compliment.
Sometimes the child’s choice of words and phrases would be more appropriate for an adult than a child. The child’s language style has been absorbed and imitated from listening to and preferring to interact with adults rather than peers. Adults, rather than other children, may be the more important influence in the development of speech patterns, perhaps maintaining their parent’s accent, when the family has moved to an area with a different accent. Once the child has heard a particular word or phrase, the original enunciation will be continued.
Abstractions and a lack of precision are rarely tolerated. Family members may have learned to avoid comments or replies using words such as ‘maybe’, ‘perhaps’, ‘sometimes’, or ‘later’. The uncertainty causes inner distress, in a cognitive way, over what may or may not occur. The indecision over events extends to indecision over other things, such as where objects are put or found and over what people are expected of them. When anxious, the person with AS can become increasingly pedantic.
Auditory Perception and Distortion
Problems with focusing on one person’s voice are an issue when several people are talking. Many voices make speech difficult to understand and confusing especially if they are all talking about the same thing, as occurs in the background chatter in a classroom. They are not very good at using moments when the background noise subsides to work out the gist of the conversation, i.e. to ‘fill in the gaps’ in order to understand what a person is saying. The child should be as close to the teacher as possible. The problem is one of auditory perception, not necessarily inattention.
Selective deafness is not a hearing problem but a problem with how the brain processes someone’s speech. The child should be encouraged to ask the person to repeat what they said, simplify the comment or instruction or put it into other words. Unfortunately, children with AS can be reluctant to seek help because of fear of being considered stupid or annoying the adult. A strategy is to ask the child to repeat aloud what you just said. It may also help to pause between each sentence to allow the person to process what you have said and to use written instructions.
They are more likely to understand if they have to focus on only one voice or reading rather than listening to understand. This can be especially important in a job that may have complex spoken instructions.
Some children develop precocious reading abilities and decoding print, but their level of understanding or comprehension is limited by their level of language development.
Verbal Fluency
The child with AS may talk too much or too little. Sometimes the child’s genuine enthusiasm for their special interest leads to garrulous speech and questions that can be endearing but tedious. They may have to learn the cues that indicate when to be quiet.
In contrast, some are genuinely ‘lost for words’ or even mute. Some will talk only to their parents and are electively mute with other adults or in the classroom. Verbal fluency is affected by anxiety.
One of the most frustrating things is that it is very difficult to explain how you are feeling when something hurts or frightens you or when you are feeling unwell and can’t stick up for yourself. Beta-blockers sometimes reduce the physical symptoms of fear. Some stutter when anxious.
Aspergerese
This is a conversational style that can be developed by neurotypical people when engaged in a conversation with someone with AS. Avoid figures of speech and pause momentarily between each statement to allow the person with AS to process the spoken words, prosody, body language, and facial expression. It is important to make your intentions clear, avoiding ambiguity or unnecessary subtlety. Allow the person with AS some time to collect their thoughts before anticipating a response to a question, and not feel uncomfortable with momentary silences and a lack of eye contact.
Facial expressions need to be clear and consistent with the topic of conversation; teasing and sarcasm are often best avoided. If possible, ensure background noise and chatter is minimized. It is also important not to be offended by the direst honesty and to be aware that the person is not naturally talented in the art of conversation.
Foreign Languages
A special interest can be a natural talent in foreign languages. They may speak many languages without the pronunciation errors expected when a normal person learns that language. This can lead to a successful career as a translator or interpreter. However, they may still have difficulty learning the social language. When there is a social conversation, it’s like a different language. By encouraging social language at an early age, children with AS may eventually speak this second language like a native.