ANALYSIS OF IMPAIRED NONVERBAL COMMUNICATION IN PEOPLE WITH AUTISM SPECTRUM DISORDERS

The impairment of nonverbal communication in people with autism spectrum disorders (ASD) is a differential-diagnostic criterion that predicts their development and, at the same time, it serves as a striking determinant of their socialization. In this paper, we focus on the analysis of nonverbal forms of communication in a group of individuals diagnosed with ASD. The presented conclusions are partial results of the specifi c research grant (IGA PdF_2012_021, researcher: Kate ina Vitásková).


Introduction to the issue
Impaired communication ability (ICA) is a specifi c dominant symptom of autism spectrum disorders (hereafter referred to as ASD) with marked insuffi ciency at all language levels, inhibited imitation, decreased production of gestures, hypomimia and lack of communication plan during somatic-conditional expression (Svoboda, Krej í ová, & Vágnerová, 2001).Already at early childhood (during the fi rst year of life), parents of children with ASD certainly detect symptoms that -from the diagnostic point of view -could be designated as specifi c for ASD diagnosis ( íhová & Vitásková, 2012).These symptoms include impaired speech development or directly its delay, problems with the initiation and retention of eye contact, and diffi culties in facial expression (Logopaedic intervention in people with autism spectrum disorders.Department of Special Education Studies.Faculty of Education, Palacký University in Olomouc, 2011/2012, IGA PdF_2011_010, íhová, Vitásková).A differentiating comparison of the communication ability in children with ASD and intact children was made by Phillips et al. (1995) in two-year old children.The resulting research data indicates signifi cant aberrations in skills implying the ability of nonverbally expressed requesting, and incentives for object-centred attention of people with ASD.At the same time, they also report problems coexisting with sharing attention and dedication of suffi cient concentration to the communication content.
Interesting investigations have been rendered focused on the quantifi cation of specifi c nonverbal communication in people with ASD and their subsequent qualitative analysis, biological conditionality and diverse characters with regard to a group of intact respondents.Jones,Carr, & Klin (2008) conducted a comparative study using a video-presentation; they 88 mapped and analysed the frequency of eye-mouth visual fi xation in 66 respondents aged two years (suspected ASD = 15, delay development = 15, intact = 36).The results clearly indicate that the group of children with suspected ASD showed a statistically signifi cant difference in the given activity with respect to both control groups.In children with ASD, fi xation on the eye as well the mouth areas was substantially lower; conversely, a higher percentage of fi xation represented focus on objects.This result correlates with the subsequent investigation and the issue that has engaged the interest of professionals -prosopagnosia, i.e. impaired recognition of familiar faces.Through FMR examinations of individuals with ASD without mental disabilities, Schultz et al. (2003) found that their right g. fusiformis and right lower temporal lobe react pretty homogeneously while watching faces, identical to the cortical areas of intact individuals when viewing objects.Repeated research has shown again that discrimination of faces in individuals with ASD is activated by the lower temporal lobe more than in the control group, specifi cally the left lobe.Dalton (2005) used magnetic resonance to evaluate eye movements and concluded that persons with ASD showed excessive amygdala excitation which, according to him, was in direct relation to unpleasant feelings (up to feelings which give rise to threat).Establishing and functional use of eye contact -which is quite natural and often a source of pleasant emotions in the intact population -has, therefore, a completely antagonistic character in persons with ASD.Consequently, a new and unexplored area of research is the study of genetic mechanisms affecting amygdala hyperfunction that serves as the basis for the development of therapeutic strategies aimed at abnormal amygdala function in autistic people (Meyer-Lindenberg et al., 2009).
The presented research results demonstrably show that defi cits manifested in the nonverbal communication component are the clear and dominant symptom of ASD clinical picture.In the national context (see, e.g., Hrdli ka & Komárek, 2004; Thorová, 2006), information about the issue of nonverbal communication in persons with ASD is absent or contained only in the minimum, marginal part of the text.Alternatively, nonverbal communication strategies are included rather under social manifestations (Beranová & Hrdlicka, 2012).One reason may be the fact that parents and professionals focus primarily on the development of communication in terms of the development of its verbal component, which they consider more important.However, the ability to produce and receive nonverbal information is an essential part of social learning as well as the determinant of the overall development of the child.Despite the fact that nonverbal communication implements homogeneous function as verbal communication, i.e. the interpersonal transmission of information, we register research surveys (Leathers, 1997; Burgoon & Hoobler as cited in deVito, 2008) drawing attention to specifi c functions for which the nonverbal communication becomes particularly important.It is the ability to create and manage impressions differentiated into subcategories such as credibility, likeability, attractiveness, dominance and skills to defi ne relationships and drive conversation and social interaction through this form of communication.Knapp and Hall (2006) complement infl uencing, deceiving and nonverbal expression with emotions that can be represented by postures and gestures, eye kinesics as well as pupil width.
The importance of nonverbal communication and the current lack of attention to this form of communication in people with ASD encouraged the implementation of the research (see IGA PdF_2012_021, researcher: Vitásková) whereof the particular research data shows that 56.52% of speech therapists in the Czech Republic (n = 69 clinical and school speech therapist) do not prefer the development of nonverbal communication in individuals with ASD within the realized speech therapy.At the same time, the given respondents (86.67%) report that they do not have diagnostic and interventional materials, preferring rather intuition or experience.
The primary goal of the research -which we will discuss in the next part of this paper -is to detect and analyse the specifi cs of nonverbal communication in a selected group of children with ASD based on systematic observation.In this paper, we will focus on these research objectives: detection of nonverbal expressions (eye contact, facial expressions, gestures, postures, proxemics and imitation) in children with ASD (using the application of Diagnostic scale from íhová & Vitásková, 2012) realized during the direct observation (in 4 month period), and the quantifi cation of the results using a specifi c numeric scale, and subsequent analysis of the defi cits represented by the arithmetic mean of the values using the numeric scale evaluating the partial forms of nonverbal communication and their mutual comparison.

Methodology
The research group consisted of children with autism spectrum disorders at preschool age (3-6 years) attending a kindergarten for children with special education needs.The total number of children was 12, 7 boys and 5 girls (see Figure 1).From the diagnostic point of view, they were children with childhood autism (n = 8, 3 girls, 5 boys), atypical autism (n = 3, 2 girls, 1 boy) and combined cerebral palsy and atypical autism (n = 1, 1 boy).

Research results and discussion
The fi rst area discussed is the evidence of defi cits associated with diffi culties in making eye contact, facial expressions, gestures and pointing to (asking for) objects (see Table 1).

Asking
D1-D8: children with childhood autism D9-D11: children with atypical autism D12: child with CP and atypical autism X: the item cannot be evaluated 0: absence of ability in the given nonverbal communication 1: limited ability or presence of specifi cs in the given nonverbal communication 2: adequate ability in the given nonverbal communication If we look at the absence of monitored areas (i.e.eye contact, facial expressions, gestures, pointing to objects and asking for objects), we record it in the frequency of 38.This represents a 45.24% inclination to value 0 which is present in all studied areas of nonverbal communication; in the utmost rate, it is registered in the case of gesticulation expression (n = 7) and its average frequency is observed in various forms of nonverbal communication 5 times.
Limited ability in nonverbal communication such as insuffi cient frequency of establishing eye contact, facial mimic perception or perception of gestures with help, expression of gestures or facial expression only in the case of transparent expressions or facilitation during pointing to and asking for objects, we recorded in 32 cases of assessment (38.10%; value 1).The value 1 is also present in all studied forms of nonverbal communication with relatively uniform frequency distribution.The greatest frequency was observed in the reception of gestures (n = 6); in the smallest degree, it was registered in the ability to ask for objects through nonverbal communication (n = 3).
The highest value related to the intact ability in selected areas of nonverbal communication was recorded 11 times (13.10%) while it was absent in the case of perception of gestures and facial mimic perception.For these reasons, the given forms of nonverbal communication in people with ASD must be seen as very problematic.This value was most often recorded in the case of 3 records relevant to pointing to and asking for objects.During observations, we also used "X" value which indicates an obstacle to the possibility of evaluating the monitored area.This value was detected in two areas of nonverbal communication -facial mimic perception and expression of gestures (n = 2).
If we look at the distribution of evaluation categories in terms of ASD diagnoses, it is clear that value 2 (absence of impairment in the given form of nonverbal communication) is present in individuals with ASD diagnosed with atypical autism and atypical autism combined with cerebral palsy.The given value is recorded only in one case (pointing to objects, D8, see Table 2).Category "X" relating to interference in the assessment (for example due to a lack of effective cooperation) is registered in 3 children diagnosed with childhood autism.Regarding the monitored nonverbal expressions, we applied the methods of arithmetic mean, median and mode for statistical reasons.The arithmetic mean in the monitored nonverbal areas (eye contact, facial mimic perception and facial expression, perception and expression of gestures, pointing to and asking for objects) has a specifi c value in the range of 0.5, i.e. between the scales 0 and 1. Inclination to scale 1 is obvious in the case of pointing to and asking for objects, and eye contact.On the other hand, the proximity to scale 0 is evident in the facial mimic perception.Even in the case of median, the value of 0.5 dominates; regarding the mode, it is obvious that also scales 0 and 1 alternate in uniform representation.

Eye contact
The above-presented Figure 3 provides a comparative view of eye contact, facial mimic perception and facial expression.The highest value (scale 2) was observed in eye contact and facial expression in clients diagnosed with atypical autism and atypical autism combined 92 with cerebral palsy.Figure 3 shows that value 1 is recorded 14 times, and value 1 relating to the lack of ability associated with the given skill is recorded 16 times in relation to all forms of nonverbal communication and primarily in the diagnoses of childhood autism with the exception of two descriptions in atypical autism.When comparing gestures, pointing to and asking for objects, we obtained value 2 which is presented in 7 records relevant to pointing to objects (n = 3), asking for objects (n = 3) and expression of gestures (n = 1).Antagonistic value 0 is recorded 22 times, which can be considered as a signifi cant quantitative indicator.
The other research area of nonverbal communication in persons with ASD was the analysis of spheres that include the use of another person's body, active interest in people and things, the ability to imitate, respond to own name, posture and proxemics.Table 3 below presents the given areas in monitored preschool children with ASD.The arithmetic mean in the observed nonverbal areas (use of another person's body, active interest in people and things, imitation, response to own name, physical posture and proxemics) has a specifi c value ranging from 0.63 to 1.92 with variance of 1.29.The lowest frequency value is specifi c to imitation; on the contrary, the highest described indicator is that for active interest in people.The median is characterized by predominance of value 1, which also dominates the mode.
In the next section, we present a visual comparison of the selected forms of nonverbal communication mentioned in the above-presented Table 3. From the above chart 5, we can deduce that the dominant status over other categories regarding homogeneous frequency representation is occupied by scale 1 and scale 2 (n = 12; 33.33%).The highest scores (scale 2 and 3) implementing smooth nonverbal communication identifi ed with the ability homogeneous with the intact population are detected 18 times (44.44%).When focusing on antagonistic value (scale 0) and with regard to the abovepresented chart 5, we can state that the given value was detected 8 times (22.22%)within the research survey in the selected group of respondents.
The comparison of nonverbal communication in the area of imitation, response to own name, posture and proxemics clearly shows that the representation of value 0 is typically 33.33%, the following scale 1 is present in 43.75%, and that the highest value (scale 3) was observed in 11 respondents (22.92%).

Conclusions
Autism spectrum disorders -representing a heterogeneous group of specifi c and nonspecifi c symptoms -have a common defi cit area pervading all diagnostic units, i.e. impaired communication ability that is signifi cantly manifested also in aberrations affecting nonverbal communication.
Nonverbal communication implies a wide range of communication (eye contact, facial expressions, gestures, posture and others) and any impairment of its receptive or expressive component always represents signifi cant interference in the communication plan.
As evidenced by the above results of individual researches as well as analysis of nonverbal communication in the monitored group of children with ASD, defi cits associated with this form of communication are clear and, at the same time, individually manifesting in each child.As we further found, the defi cient area also represents a targeted focus on its development in the context of speech therapy.
For these reasons, the issue of nonverbal communication in persons with ASD constitutes an important research sector that deserves more attention not only at the level of logopaedic care but also in terms of psychological, medical and special education engagement.
In the time period March 2013 -June 2013, a study within a grant specifi c research was conducted at the Department of Special Education Studies, Faculty of Education, Palacky University in Olomouc (Communication defi cits in selected forms of impaired communication ability with the view to assess partial determinants of verbal and nonverbal components of communication in special education practice, PdF UP, PdF_2012_021, 2013/2014, researcher: doc.Mgr.Kate ina Vitásková, Ph.D.).The aim of the presented research implemented within the framework of the specifi c research grant at the Faculty of Education in Olomouc was to detect and compare the specifi cs of nonverbal communication in a group of children with ASD through longitudinal observation, particularly through direct observation carried out during individual logopaedic interventions with the view to detect, analyse and compare nonverbal communication in a selected group of preschool children diagnosed with ASD.

Figure 1 .
Figure 1.Distribution of the research group of children with ASD by gender

Figure 2 .
Figure 2. Diagnostic categories of children with ASD

Figure 3 .
Figure 3.Comparison analysis of eye contact, facial mimic perception and facial expression Note: For better visual record in the chart, individual scales correspond to: scale X: -1 scale 0: 1 scale 1: 2 scale 2: 3

Figure 4 .
Figure 4. Comparison analysis of gestures, pointing to objects and asking for objects Note: For better visual record in the chart, individual scales correspond to: scale X: -1 scale 0: 1 scale 1: 2 scale 2: 3

Figure 5 .
Figure 5.Comparison analysis of the use of another person's body, active interest in people and active interest in things Note: For better visual record in the chart, individual scales correspond to: scale X: -1 scale 0: 1 scale 1: 2 scale 2: 3 scale 3: 4

Table 4 .
Arithmetic mean, median and mode