Language, writing, and activity disorder in the autistic spectrum

This comment is based on our research studies related to the development of written language in persons with Pervasive Developmental Disorders (American Psychiatric Association, 1998) who lacked language, or whose language was echolalic or bizarre, limited to few words and who did not communicate by means of sign language or handwriting. The interest of this comment is to explore the possibilities of developing communication by means of writing and to study differences between spoken and written language. In our studies we instrumented an approach focused on independent writing and we considered our conclusions only when independence was achieved. Another important point is that since it is supposed that written language is acquired after oral language it is common not to teach writing to patients with severe developmental disorders that lack language or whose language is sufficiently disturbed so as to presume lack of comprehension. However, the cases studied showed us that this strategy is possible for a series of them. It is possible to invert the order as a function of the child’s capabilities and predispositions to allow for a smooth transition from written to spoken language that is tailored to the individual. Finally, we consider it interesting that some patients could develop some functional language at a much older age than previously considered possible. To achieve the objetive we developed a “Writing Program for the Habilitation of Language.” The approach used attempts to help the individuals to communicate by means of writing using a computer or a similar device and using, only initially, physical support (holding the hand of the subject whom we want to assist so that he can initiate the action, control impulsivity and/or perseverations due to disorders in the elaboration of complex voluntary motor actions). We start out by pointing to figures, to later move on to copying words, completing blank spaces in a sentence (predictable and unpredictable) and the highest level expected is achieving open independently written conversations. In our approach, when physical support was necessary, we first tried to make the person write independently starting the process by copying words until they could write by themselves. Once the subjects could write independently we try to develop further language through writing, following the person’s interest and trying to increase communication abilities. This is in contrast to traditional “Facilitated Communication” (FC), the technique Developed by Crossley in Australia in the 70’s (Crossley, 1994), that do not necessarily promote independence in writing, which could lead to possible use of influence or induction from the facilitator (Jacobson et al., 1993). The fundamental principles for the instrumentation of the technique are, as in FC, based on the importance that, motor disorders (apraxias or dyspraxias) may have on these types of ailments. We consider that the FC technique is efficient for certain cases and not for others. In a study criticizing classical FC, published in 1994, Carol Vazquez concludes that in the cases in which the individuals needed physical support, in general, correct responses were written only when the facilitators knew the response. However, one case described in one study (Eva) was able to respond 9 out of 10 items correctly on her own (the facilitator was unaware of the figure that Eva had been shown) (Vazquez, 1994). “While the abilities of many persons with autism are overrated, habilitation of language through writing can focus attention on those cases with speech disorders that are truly educable and can benefit from individualized educational programs.” We agree with Vazquez in that efforts of intensive and controlled validation must be carried out in case by case studies to determine which persons would truly benefit from the technique. Every person that entered the program was simultaneously helped by two or more researchers, with a frequency of a 30min weekly session. During the course of the studies with more than 25 subjects between 6 and 25 years old, the process of acquirement of writing has been uneven among subjects. This enables us to consider that there may be cases in which the capacity of writing may be preexistent and may not have been identified, as well as others (not alphabetized) in which writing was constructed gradually from the strategies that were implemented. In any case, some of the children and adolescents that had no functional means of communication with others are now developing one. In the first consistent description of “early infantile autism” published 70 years ago in “Nervous Child” journal, Kanner writes that “Eight of the eleven children acquired the ability to speak at the normal age or with some delay. Three (Richard, Herbert, Virginia) have remained ‘mute’ until today. None of the eight children who ‘speak’ have been able to use language several years to communicate meaning to others” (Kanner, 1943). In a latter study on language (Kanner and Eisenberg, 1956), of a total of 42 cases studied that were reexamined by the authors over a period of several years, 19 had not acquired language, remaining in withdrawal and