Teaching those with ASD to 'talk things through' may help them plan

February, 2012

A study showing that those with ASD are less likely to use inner speech when planning their actions, a failure linked to their communication ability, has implications for us all.

I’ve reported before on evidence that young children do better on motor tasks when they talk to themselves out loud, and learn better when they explain things to themselves or (even better) their mother. A new study extends those findings to children with autism.

In the study, 15 high-functioning adults with Autism Spectrum Disorder and 16 controls (age and IQ matched) completed the Tower of London task, used to measure planning ability. This task requires you to move five colored disks on three pegs from one arrangement to another in as few moves as possible. Participants did the task under normal conditions as well as under an 'articulatory suppression' condition whereby they had to repeat out loud a certain word ('Tuesday' or 'Thursday') throughout the task, preventing them from using inner speech.

Those with ASD did significantly worse than the controls in the normal condition (although the difference wasn’t large), but they did significantly better in the suppression condition — not because their performance changed, but because the controls were significantly badly affected by having their inner speech disrupted.

On an individual basis, nearly 90% of the control participants did significantly worse on the Tower of London task when inner speech was prevented, compared to only a third of those with ASD. Moreover, the size of the effect among those with ASD was correlated with measures of communication ability (but not with verbal IQ).

A previous experiment had confirmed that these neurotypical and autistic adults both showed similar patterns of serial recall for labeled pictures. Half the pictures had phonologically similar labels (bat, cat, hat, mat, map, rat, tap, cap), and the other nine had phonologically dissimilar labels (drum, shoe, fork, bell, leaf, bird, lock, fox). Both groups were significantly affected by phonological similarity, and both groups were significantly affected when inner speech was prevented.

In other words, this group of ASD adults were perfectly capable of inner speech, but they were much less inclined to use it when planning their actions.

It seems likely that, rather than using inner speech, they were relying on their visuospatial abilities, which tend to be higher in individuals with ASD. Supporting this, visuospatial ability (measured by the block design subtest of the WAIS) was highly correlated with performance on the Tower of London test. Which may not seem surprising, but the association was minimal in control participants.

Complex planning is said to be a problem for many with ASD. It’s also suggested that the relative lack of inner speech use might contribute to some of the repetitive behaviors common in people with autism.

It may be that strategies targeted at encouraging inner speech may help those with ASD develop such skills. Such strategies include encouraging children to describe their actions out loud, and providing “parallel talk”, whereby an observer plays alongside the child while verbalizing their actions.

It is also suggested that children with ASD could benefit from verbal learning of their daily schedule at school rather than using visual timetables as is currently a common approach. This could occur in stages, moving from pictures to symbols, symbols with words, before finally being restricted to words only.

ASD is estimated to occur in 1% of the population, but perhaps this problem could be considered more widely. Rather than seeing this as an issue limited to those with ASD, we should see this as a pointer to the usefulness of inner speech, and its correlation with communication skills. As one of the researchers said: "These results show that inner speech has its roots in interpersonal communication with others early in life, and it demonstrates that people who are poor at communicating with others will generally be poor at communicating with themselves.”

One final comment: a distinction has been made between “dialogic” and “monologic” inner speech, where dialogic speech refers to a kind of conversation between different perspectives on reality, and monologic speech is simply a commentary to oneself about the state of affairs. It may be that it is specifically dialogic inner speech that is so helpful for problem-solving. It has been suggested that ASD is marked by a reduction in this kind of inner speech only, and the present researchers suggest further that it is this form of speech that may have inherently social origins and require training or experience in communicating with others.

The corollary to this is that it is only in those situations where dialogic inner speech is useful in achieving a task, that such differences between individuals will matter.

Clearly there is a need for much more research in this area, but it certainly provides food for thought.

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