Strengths-based approach to autism language and communications research: Where are we? A brief report

Grace Joplin Ferreira(Main author, Corresponding author) Jay Getten (Co-author) Henri Pesonen (Co-author) | Dec 29, 2023 | 24 min read

Grace Joplin Ferreira (Main author, Corresponding author)
University of Helsinki
grace.ferreira@helsinki.fi

Jay Getten (co-author)
Montana's State University
jay.getten@bhcsmt.com

Henri Pesonen (co-author)
University of Oslo
henri.pesonen@isp.uio.no

Abstract

It is time for a change in the way scientific literature presents autism. But the diagnosis of autism is still very much dependent on language and social impairments, as such, it is predictable that language deficits, and delays of the diagnosed population have been widely studied by clinical and non-clinical researchers. The deficit model is dominant in autism research, due to the normativism account present in the medical paradigm. Consequently, a strengths-based approach in autism language and communications research has been neglected and underestimated, though it is confirmed the wide heterogeneity of autistic profiles in language use. We argue that research should either shift from a deficit-based approach to a strengths approach or that both could co-exist. A positive research agenda in which research should focus more on the things autistic people do well instead of the things they have difficulty with, brings emancipation, well-being, and better neurodiversity affirming practices. We review the literature with a particular focus on the strengths, in the social interactional level.

Strengths-based approach to autism language and communications research: Where are we? A brief report

Autism research is experiencing a crisis, one which begins with autism researchers (Botha and Cage, 2022). Considering that a strengths-based approach is a key type of policy that harnesses autistic persons strengths abilities and interests (Huntley et al., 2019) and that autism had been reviewed (Bölte et al., 2014) and reframed beyond traditional nosographic manuals such as those from the World Health Organization (WHO) (Bölte et al., 2019), it is, thus, surprising that little attention has been devoted to such approaches to autism language and communications research. A deficit-based approach applied to language and communication, predominant from the 1940s through 1970s and in the last decade (Eigsti et al., 2011) overlooks deficits, similarly, it maintains epistemological injustices (Chapman and Carol, 2022). Since no science is ideology-free (Botteuma-Beutel et al, 2023), the medical paradigm is clear, backed by abundant evidence from studies in numerous areas of research documenting the negative characteristics of autistic people with respect to their ability to use and understand language. As such, the following phrases typically describe present empirical and theoretical findings in autism language and communications research: odd and deficient speech, bizarre, and aberrant. One need not be an expert in linguistics to interpret the negativity embedded within these classifications from ableist language (Botteuma-Beutel et al., 2021) concentrated within the medical paradigm (Bottini et al., 2023; Pellicano and Houting, 2022). Thus, one interpretation arising from such descriptions is that autistic people have fewer, lower, poorer, and bad language features than nonautistic people. One consequence of such misconceptions related to language in autism (Gernsbacher et al., 2016) reinforces self-stigma and discrimination (Geelhand et al., 2021; Huggins et al., 2021).

Accordingly, the medical paradigm continues generating most autism discourses (Pellicano and Houting, 2022; Bottini et al., 2023, Dinishak, 2016; Kapp et al., 2013). At the center of this discourse lies the need for a referral or a formal diagnosis, which often gatekeeps access to services and care for the autistic community (Kapp et al., 2013). Therefore, focusing exclusively on the positive aspects of being autistic would not lead autistic people to a diagnosis and accessing support. That is, the paradox of the medical paradigm is that, while it endorses epistemological violence, it also renders individual’s dependent upon accessing services and support. We argue that a more useful approach would focus on how strengths that may coexist with difficulties were possibly underestimated given that the existing literature primarily considered only the deficits. Here, we advance the research agenda of Huntley and colleagues (2019), focusing on the academic and professional literature in which strengths and difficulties must remain equally balanced in various studies (Russell et al., 2019; Robertson, 2010). By no means do we deny the needs of autistic individuals in relation to language support or among others who seek support with language. However, given the wide variety along the spectrum particularly in relation to linguistic profiles (Schaeffer et al., 2023), and the difficulty to frame subtypes in autism (Waterhouse, 2022), it is paramount to shift the approach towards an appreciation of the diversity of being uniquely human (Prizant and Fields-Meyer, 2016), especially in the linguistic domain. We, therefore, argue that not only is autistic behavior not random, deviant, or bizarre, as many professionals have stated for decades (Prizant and Fields-Meyer, 2016), but neither is their use of language. Furthermore, this shift in approach will influence the language used to describe autistic lives, since autism acceptance involves using words that describe autism as part of someone's identity, emphasizing individual strengths and/or needs (Bottini et al., 2023). We argue that research must focus on testimonies about autistic wellbeing regarding language and communication, thereby adding additional perspectives and avoiding epistemological injustices related specifically to the stereotype that autism and happiness are inherently at odds with one another (Chapman & Carel, 2022).

Examples of a strengths-based approach to autism research more generally include the implementation of science, technology, engineering and mathematics (STEM) programs in high schools specifically designed to meet autistic advantages (Lee et al., 2023); the action briefing policy created in partnership with leading autistic and nonautistic researchers in the UK, Sweden and Australia (Huntley et al., 2019); the identification and recognition of professional skills such as the honesty, efficiency and creativity of autistic people from several different countries in the workplace (Remington and Cope, 2022); and their cognitive skills and superior auditory capacity (Remington and Fairnie, 2017; Remington and Brinkert, 2020). In addition, theoretical research on perceptual processing skills suggests that future research must consider autistic strengths and avoid deficit paradigms. At times, the atypical perceptual abilities of autistic individuals should not be categorized simply as impairments or divergent perceptions because many of the difficulties and differences experienced by autistic individuals also represent a part of their unique strengths (Proff et al., 2022). These lines of inquiry follow a strengths-based approach, a holistic portrait of autistic people in which not only their difficulties but also what they do well are identified. Through this holistic perspective, we avoid the predominant deficit-focus and degrading constructions influencing public opinion and policy and popular culture (Davidson and Orsini, 2013; Pesonen et al, 2021). Thus, it is crucial to counter the scenario of an overly medical model classifying differences as impairments or difficulties, towards viewing the strengths, differences and weaknesses associated with neurodiversity as central to an identify and pride in belonging to a minority group (Cherewick and Matergia, 2023; Russell et al., 2019; Kapp et al., 2013; Robertson, 2010; O’Dell et al., 2016).

While the medical paradigm recognizes the importance of investigating autism-related skills, it simultaneously does not clearly advocate for the appreciation of diversity in autistic communication as a part of one’s identity. Eigsti and colleagues (2011) recommended the importance of identifying patterns of strengths in language and communications research, since such strengths can serve to illuminate the influence of associated social and cognitive processes. In other words, research would benefit from understanding which of the documented autistic strengths might overlap with other faculties, such as how honesty (an autistic strength) affects pragmatics and social interaction (social and cognitive processes). This might prove a promising future area for a strengths-based approach, given that it endorses the neurodiversity identity. Yet, Eigsti and colleagues do not specify which autistic strengths can be studied further in future. Naigles and Tek (2017) confirmed that characterizing strengths and weaknesses can shed light on the degree to which different aspects of language rely on the meanings and intentions that social interaction afford. However, it remains unclear if they are referring to the realm of social interactions between autistics or autistic–nonautistic interactions. The literature has already documented that social interactions among similar dyads are effective when among themselves, since autistic peers support social norms not encouraged under a neuronormativity benchmark (Heasman & Gillespie, 2019; Crompton et al., 2020). A neurodiversity-affirming practice would encourage the possibility of exploring whether the imagination and creativity of autistic people (strengths) influence the production of fictional stories, for example (Chapple et al., 2022).

A critical statement is warranted regarding what we currently know not only about autism communication but also about language and communication in general. Most of the data and the knowledge produced based on these data come from WIERD populations—that is, populations which are Western, educated, industrialized, rich and democratic (Henrich et al., 2010). This focus is currently a major flaw in research because these individuals do not represent the global population (Sanches De Oliveira & Baggs, 2023). Linguistic theories are no exception. Turning to autism studies, basic and clinical research has traditionally relied on the gold standard test for diagnosing autism in children and adults. Since autism depends on its medicalization (Timimi et al., 2019), findings are typically presented using data extracted from standardized tests, namely, the ADOS-2, Vineland, and ADI-R (Agelink Van Rentergem et al., 2021). One disadvantage of relying on standardized testing is that, by definition, such measures are not naturally occurring (Yu and Sterponi, 2023), which means language is also manipulated in specific environments. Importantly, in the context of language and social interaction measured by ADOS-2, for example, mechanistic views of how social interaction occurs and can be manipulated are pathologized. Thus, alternative interpretations are not tolerated. In this context, the scenarios and tasks are designed as if the examiner, their actions and the environment exist as completely controllable, whereby whatever emerges irrefutably demonstrates patients’ social abnormalities (Timimi et al., 2019). The usefulness of standardized tests may also be limited regarding predicting language use in conversational contexts. More precisely, while standardized tests assess one’s understanding or knowledge of a specific language structure or vocabulary, they often do not measure whether the same individual uses that structure or word in their natural speech, how often or in which situations (Boo et al., 2022).

Language use in social communication

In autism research, some consider language and communication as constituting a divide (Durrleman et al., 2022), while others disagree (Eigsti & Schuh, 2017). In this field, it is possible to account for other instruments beyond standardized language and cognitive assessment tests, whereby the autistic individual rather than the researcher lies at the center. People-centered approaches view communication as more inclusive; thus, a descriptive analysis of language enters the space of normative analysis, such that we may be relying more on sociology than on pure linguistic theories—in other words, we rely on social interactions. Within social interaction research, discourse analysis (DA) and conversational analysis (CA) methodologies exist, to name a few. Both DA and CA can underpin novel approaches to the assessment, intervention, identification of therapeutic progress, reflective practice, and training. These types of work carry great potential relevance for working with autistic populations (O’Reilly et al., 2016). For instance, Harvey Sacks applied CA methodologies, viewing speech as a collective production, and meaning as constructed through co-operation between conversationalists (Sacks et al., 1992). Many researchers have implemented CA to better understand autism communication, particularly oral language communication. One crucial benefit to analyzing communication employing CA is that the participant remains at the center of the analysis, not the researcher. Therefore, CA grants participants the right to be in their own home or in any environment in which bad experiences such as anxiety, stress and humiliation stemming from a clinical setting can be avoided (Ashworth et al., 2021). In this section, we present findings that debunked the deficit framework in the context of using CA, bearing in mind that other studies using the same methodology adhere to the medical paradigm.

At the beginning of his testimonial, Muskett (2017) declared that his career as a speech and language pathologist shifted when he analyzed traditional assumptions of communicative competence as being overlooked by psychometric tests. In his case study, he analyzed conversations between an 11-year-old autistic child and a 19-year-old adult employing CA in the context of play, with a focus on the phenomenon of idiosyncrasy. In the transcripts of the child’s verbal production, he concluded that the interlocutor had no issue in turn-taking or understanding the child’s unusual language, despite such remarks breaking the linguistic perspective of selection restriction rules (Chomsky, 1965). Debunking the deficit framework, Muskett affirmed that unusual language is by no means clearly interactionally problematic according to the co-speaker in an interaction. Recently, Yu and Sterponi (2023) conducted a study with a bilingual autistic child to analyze the context of a family reunion during dinner time. The data derived from recorded interactions with the family were clinically relevant in several ways. First, they made it clear that Ethan had competencies in many of the areas of social communication his parents initially thought were lacking, including initiating communication, responding to questions, and engaging in extended reciprocal conversational exchanges. Second, the data showed that, rather than being an obstacle to participation, Ethan’s use of scripts and echolalic utterances often served as resources propelling and scaffolding interactions. Yu and Sterponi’s conclusions align with the claim of Gernsbacher and colleagues (2016) regarding misconceptions about echolalia in autistic children’s language because clinicians believe that autistic children say more than they know. Such misconceptions persist today. For instance, Naples and colleagues (2022) described the speech of autistic people with low verbal skills as repeating sentences without knowing the meaning.

Examining symmetric interactions reveals a well-developed set of social norms for handling and interpreting the very behaviors that the traditional literature identifies as potentially misconstrued by nonautistic people, i.e. the idea that autistic people avoid social engagements due to a lack of social motivation (Jaswal & Akhtar, 2018). In contrast, Heasman and Gillespie (2019) argue that a solution to the problem identified by the deficit approach may already be known by autistic people themselves. Namely, we should broaden the norms around the expected communication styles of neurodivergent people because autistic–autistic interactions tolerate many more behaviors that neurotypicals marked as disengaged or disruptive, including shouting, obscure topic shifts, long detailed monologues, ignored turns in speech and unreciprocated jokes. Drawing upon this understanding, we see that communication from the perspective of an autistic speaker is more inclusive and tolerant. We conveniently conclude this last section with Yu and Chen’s (2023) study, which declares that any solution to the acquisition of social skills in the context of communication that conforms with neurotypical norms should be rejected, just as the doble empathy problem assigns similarly (Milton, 2012). Instead, research should aim to honor and bridge differences making the social participation of autistic individuals more accessible.

We argue that the deficit model would produce neurodiversity affirming practices if it co-existed with a strengths-based approach. Schroeder and colleagues (2023) reported that autistic children did not differ significantly regarding either the frequency of different noun phrases or verb phrase types employed. Nor did they differ in terms of the frequency of verbal errors or the rate of their use of internal state language across groups. These findings could be further explored alongside additional linguistic capacities documented in previous research. For instance, researchers could examine various grammatical constructions (subject‒verb–object word order, grammatical aspect and wh-questions) similar to their typically developing peers (Su and Naigles, 2022); very good comprehension of reflexive pronouns (Janke & Perovic, 2015; Perovic et al., 2013); appropriate third-person pronouns (Novogrodsky, 2013); and the correct use of grammar, but not all ambiguous pronouns (Novogrodsky & Edelson, 2016). And finally, the straightforwardness in the production of speech (Woods and Estes, 2023).

Conclusions

The nature and directionality of interactions between linguistic skills, extralinguistic abilities and autistic characteristics are the subjects of current debate (Schoeder et al., 2023). However, little is known about advocating for neurodiversity-affirming practices in language and communications research. Thus, it is time for autism researchers—particularly, nonautistic researchers—to revisit linguistic evidence in an unbiased manner. Thus, a strengths-based approach is crucial for rethinking about autism more holistically (Kapp et al., 2013), not only for the sake of science in attempts to undermine research bias (Woods & Estes, 2023), but also in striving towards a human right–based approach, since it safeguards wellbeing and boosts confidence among autistic people (Jones et al., 2023). We, therefore, answer the initial question in this report: Where are we? We stand at the very beginning of producing research not reliant upon a deficit-based approach, albeit rather far from enabling narratives from empirical findings that honor and legitimize autistic styles of communicating either among themselves or with nonautistic individuals.

Acknowledgments

The authors would like to thank autistic and non-autistic researchers who dedicated their precious time to provide insightful comments for this manuscript: Elizabeth Abreu, George Watts, Steven Kapp, Morton Ann Gernsbacher, Jeff Good, Rachel Chen, Martti Vainio, Don Killian, Inge Marie Eigsti. We would like to thank the Editor Jill Fosted for their helpful comments on the pre-approval of this manuscript.

Funding Sources

The main author of this article has received financial support from Zonta International Foundation.

Conflict of interest

The authors declared no conflict of interest.

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