Lenguaje y autismo

Language Disorders in Children With Autism
Isabelle Rapin and Michelle Dunn
Language development is delayed in most children on the autistic spectrum. The children are dysphasic as well as autistic. Comprehension and pragmatics are invariably affected. Lower level mixed receptive/expressive disorders involve phonological and syntactical processing, whereas higher level processing disordersinvolve semantics and formulation of discourse. In some children, lower level disorders may be so severe as to preclude speech, whereas in others phonology may be deficient in spontaneous production but not in repetition. Abnormal features of autistic language include aberrant prosody, immediate and delayed echolalia (scripts), and perseveration. Electrophysiological studies indicate thatbrainstem-evoked potentials are normal. Even in fully verbal individuals with autism, early and late cortical components of auditory, but not visual, event-related potentials are abnormal. Appropriate intervention must address language and behavioral issues. In children with severely defective auditory language, provision of visual language to supplement speech is essential. Copyright 9 1997 by W.B. SaundersCompany

HE AUTISM SPECTRUM or pervasive developmental disorder (PDD) according to DSM IV 1 refers to a developmental disorder of the immature brain that affects sociability, verbal language, and nonverbal communication, and symbolic play. It is associated with abnormal behaviors, such as perseveration, stereotyped movements, a narrow range of interests, lack of behavioral flexibility and ofinsight into the effects of one's behavior on others and what others might be experiencing or thinking (so-called "theory of mind" ).2 Individuals with autism vary greatly in their cognitive ability, which ranges from profound mental deficiency to superior intelligence, but is almost always characterized by an uneven profile of abilities. Most persons on the autistic spectrum have deficient cognitiveskills. Most, but not all, have better visual/perceptual skills than verbal skills; some have a superior rote memory; and some have truly astounding talents, for example, for music, mathematical computation, or jigsaw assembly, in the face of otherwise mediocre or compromised overall cognitive ability. 3-5 Extremely delayed language acquisition or, in some 30% of cases, regression of earlylanguage development, is the presenting symptom in all but

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the mild autistic subtype referred to as Asperger's syndrome in DSM IV. Children with Asperger's syndrome do not speak late, yet their communication skills are impaired in rather specific ways, as described later. Their IQ is normal or superior. Their performance IQ is often lower than or equal to their verbal IQ, and they may be clumsy.6 Whether Asperger's syndrome is a genetically separate syndrome within the PDD spectrum or represents the upper tail of the autistic distribution is debated. 7
LANGUAGE ACQUISITION AND LEVELS OF LANGUAGE

From the Saul R. Korey Department of Neurology, the Department of Pediatrics, and the Rose E Kennedy Center for Research in Mental Retardation and Human Development, Albert Einstein Collegeof Medicine, Bronx, NY. Supported in part by Program Project Grant NS 20489 from the National Institute of Neurologic Disorders and Stroke and by the Jack and Mimi Leviton Amsterdam Foundation. Address reprint requests to lsabelle Rapin, MD, Room 807 Kennedy Center, Albert Einstein College of Medicine, 1410 Pelham Parkway South, Bronx, NY 10461. Copyright 9 1997 by W.B. Saunders Company1071-9091/97/0402-000455.00/0
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All young children with autism have a language disorder. 8 To make sense of autistic language deficits, it is important to keep in mind the levels of language (Table 1 and see article by Hall found elsewhere in this issue) and the timetable of normal language acquisition (see article by Rescorla elsewhere in this issue). Normal children who are in the process of...