Saturday, 16 April 2016

Long terms effects of communication by gesture and autism: a case report

As per previous entries on this blog, I'm not at all adverse to the idea that case reports (the so-called N=1) can offer some important insights into a heterogeneous (dare I say 'plural') condition like autism. Today, I'm once again heading down this route as I bring to your attention the letter from Webster and colleagues [1] talking about a 40 year follow-up note "About a Boy with Autism Taught to Communicate by Gestures when Aged Six."

Harking back to a paper published by some of the authors in 1973 [2] (published in the same journal albeit under a different title name), Webster et al provide some important details on how Geoff, a then 6-year old boy, was taught "a sign-language program" and how "at the time, it seemed to help Geoff and many other children." Fast forward some 40+ years and the authors note that things have changed but at the same time remained pretty much the same for Geoff. So: "Geoff has hung onto the signs taught to him early on" but also: "Geoff now “speaks” as he signs some words. This speech is easier to understand if you see him every day than if you see him only now and then." Indeed his vocabulary, whilst perhaps limited by other standards, does include many important words, mostly signed but some either said verbally or paired verbally with signing. Outside of things like food preferences, I was particularly happy to see that various emotions and states are represented in his vocabulary; never underestimate the power that being able to tell someone that you are 'happy' or 'angry' can bring to a person.

"His communications, both verbal and gestural, are constantly evolving to help him to express his wishes, and he seems very excited when he has made clear his needs or wants and we have understood them." What that sentence tells us is that communication is both a vital bridge and something that should be constantly 'worked on' when it comes to autism [3]. In these days where quite a lot of focus has turned towards the usefulness of early intervention for autism (see here for example), the message that learning is a lifelong thing can often get lost in the noise. I might add that said learning might be made a little easier by the rapid rise in technology [4].

Finally, I think it is important to draw your attention to another aspect of the Webster letter in terms of the use of residential and supported living arrangements and the autism spectrum. In line with the idea that the autism spectrum is truly wide and heterogeneous is the reality that for quite a few people, lifetime residential placement and care are an important part of their lives. Geoff, we are told "adjusted well to the residential setting" and continues to enjoy life in that setting. The authors acknowledge that despite their success in teaching sign to people like Geoff: "we tended to underestimate the long-term services that many of these children, as they grow into adolescence and adulthood, do actually require." I daresay that those sentiments ring as true today as they did 40 years ago.

To close, yet another DC comics film coming soon with an excellent trailer soundtrack...

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[1] Webster CD. et al. Lessons that Linger: A 40-Year Follow-Along Note About a Boy with Autism Taught to Communicate by Gestures when Aged Six. J Autism Dev Disord. 2016. March 28.

[2] Webster CD. et al. Communicating with an autistic boy by gestures. J Autism Child Schizophr. 1973 Oct-Dec;3(4):337-46.

[3] Mulhern T. et al. A systematic review and evaluation of procedures for the induction of speech among persons with developmental disabilities. Dev Neurorehabil. 2016 Apr 8:1-21.

[4] Lorah ER. et al. A Systematic Review of Tablet Computers and Portable Media Players as Speech Generating Devices for Individuals with Autism Spectrum Disorder. J Autism Dev Disord. 2015 Dec;45(12):3792-804.

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ResearchBlogging.org Webster, C., Fruchter, D., Dean, J., Konstantareas, M., & Sloman, L. (2016). Lessons that Linger: A 40-Year Follow-Along Note About a Boy with Autism Taught to Communicate by Gestures when Aged Six Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-016-2773-x