Friday, June 18, 2010

Making Sense of How an Individual With Autism Communicates

Getting one's needs met and to exist happily in one's family, community and beyond is dependent on the ability to communicate. As non-autistic individuals we can use ourselves to communicate our needs and express our feelings. The individual with autism depending on his functioning level, has anywhere from extremely limited (nonexistent in some) to some ability to ask for his needs to be met. Some people with autism seem to communicate by persevering on a topic that seems to not relate at all to whatever the topic might be. For example, one child may become fixated on televisions and only be able to talk about this subject, no matter what else is being discussed. It is not unusual for individuals with autism to seem to come out of "left field" with what they might say. For example, the topic may be going to the grocery store and what will be bought at the store. The child may say, "you are pretty."
There are also individuals who are nonverbal, those who use echolalia and still others that can only express their needs by reversing their pronouns. When they want a cookie to eat, instead of saying "I want a cookie," the child may say, "you want a cookie."
Let's make sense of what is going on. It is my opinion that a person with autism has not had the benefit of a completed attachment, lacks the ability to use him/herself in relationship to others and is also in a state of dissociation which causes varying degrees of consciousness and awareness. This incomplete attachment compromises the child's ability to have relationships and to communicate. Let me explain how these different elements contribute to not only problems in communicating, but also relating to others.
It is important to remember that the individual with autism wants to communicate and in fact is always communicating about himself even though he may be nonverbal, echolalic or reversing pronouns. He is like any human being in that he has a need to communicate. Unfortunately, because he has had an incomplete attachment, he cannot identify his feelings, which are dissociated, and therefore cannot use those feelings to express his needs. In other words, he has not developed to a level where he has self-agency. This means he literally cannot ask for anything for his own benefit. This is not a physical problem, but instead a developmental problem that can change over time.
It is my opinion, that what one sees with the nonverbal child with autism is the reverse of what one sees with a typical child. I call this phenomenon Inside out, upside down. In other words, the unconscious part of the child is on the outside and the conscious part is in the inside. That is why some nonverbal children with autism seem out of control and low functioning, but with the use of a computer can communicate beautifully in writing. This is a very good example of the split or dissociation of the self. Most people are unfamiliar with seeing the unconscious. Because most people are unfamiliar with the workings of the unconscious, individuals with autism are constantly misunderstood.
The phenomenon of echolalia is also something that can be understood. One first needs to remember that the child with autism has minimal and varying (depending on their functioning level) ability to use himself in relationship to others. Also it is important to remember that an incomplete attachment precludes one from being able to use one's self. Thus echolalia is the result of not being able to use one's self. The child only has access to what they hear. They may hear "do you want a cookie?" Developmentally all the child can do is mimic the other person. There is no awareness and ability to use the self in response to the other. Thus the end result is a repetition of what the child heard.
The child who reverses his pronouns and uses 'you' to mean 'I' is beginning to use his self with others. The child uses 'you' because it is safer than 'me or I.' The child with autism does not feel safe in the world. Everything is confusing, awkward and anxiety producing. The use of 'you' as it refers to the self is another example of dissociation. As I mentioned before the child is split. As the child develops and he becomes less split and gains more agency, he will then move to using the pronoun 'me' and finally as he has more and more access to himself, he will be able to use 'I.' There seems to be a direct correlation to the use of 'I' and ability to know and access feelings and use them in relationship to others.
Now lets look at why the communication of individuals with autism appears inappropriate. First of all, I believe that an individual with autism is always communicating his state of existence. Unfortunately, most people perceive these communications from their own experience, which includes having completed the attachment process. In working with individuals with autism, many try to extinguish the "odd" behaviors of the child. In doing so, we are not understanding the message the child is trying to communicate through his strange behaviors. We in a sense are helping him to feel misunderstood versus understood and not seen versus seen. Instead these communications need to be understood within the context of a child who has never attached and cannot use the self to communicate. Every behavior that the child uses can be understood and must be understood so that the child can gain understanding and recognition, which are precursors to being able to attach. Our work with the person with autism is to understand, validate, accept and recognize him. If the caregiver or professional can recognize and see the child, then the child can start to see him or herself.
Examples may help to understand what I am communicating. I visited a three-year-old nonverbal boy, who had never seemed to play appropriately with his toys. In observing him, I noticed he was picking his lips. Instead of telling him not to pick his lips, I said, "you are telling me that something is going on around your lips and your inability to talk." He looked at me and then played appropriately with a toy. He had never done this before. Another example will help to highlight this point. I worked with another boy who liked to watch videos. He had certain ones he wanted to make sure I saw. One day, he showed me a video, which explained a complicated family dynamic. I interpreted the dynamic as it related to his family. As I was able to do that, he could begin to talk about his own personal experience. These are examples of how one interprets and uses projection with individuals with autism to help them gain access to their feelings.
In concluding, I want to restate that the perseverations, the out of context communications, the use of pronoun reversal, echolalia, and nonverbal communication, to name only a few, can be understood through the lens of an Incomplete Attachment which leaves the individual in a state of waiting for a completed attachment and without access to himself or what I call self-agency.
Karen Savlov is a psychoanalyst and Marriage and Family Therapist with a private practice in West Los Angeles, California. My specialty is Autism Spectrum Disorders, anger, dissociation, depression, anxiety and relationships. For new and creative ways to think about autism read and follow my blog at I can also be followed on Twitter at Autism Thoughts.

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