British Journal of Disorders of Communication, 24, 123-150 (1989) 123

@ The College of Speech Therapists, London

A new look at language and communication

in autism
Uta Frith
MRC Cognitive Development Unit

ABSTRACT
In this review the specific language and communication impairments of
autistic individuals are discussed and contrasted with non-specific
impairments. All the impairments that are unique to autism concern the
use of language for the purpose of intentional (but not instrumental)
communication. The specific communication failure can be identified
with a limitation in the computing of relevance and as a lack of taking
account of mental states. This is a consequence of a subtle, but far-
reaching, cognitive dysfunction. The dysfunction is likely to involve the
formation and use of second-order representations. The same problem
also leads to specific impairment in social relationships and imaginative
Play.
Key words: autism, language, communication.

INTRODUCTION
From the very beginning, evident even in Kanner’s (1943) and Asperger’s (1944)
first descriptions of autism, there was the idea that by studying their language
we should come nearer to understanding autistic children. Autistic children have
peculiar problems of speech and language and this has attracted the attention
of linguists and psychologists alike. As a result there is now an impressive
number of investigations. From these studies a surprising conclusion has
emerged: the speech and language problems that can be so freely observed in
autistic children are not actually at the core of the disorder. They are in fact con-
sequences of a broader communication failure. In this review I shall present
some of the evidence for this conclusion. I shall also try to show how the com-
munication failure can in turn be traced to a subtle but far-reaching cognitive
failure.
While language and communication problems have always held a central role
in theories of autism, attention has also been paid to problems in the develop-
ment of non-linguistic abilities, for instance those that are required in
perception and memory tasks (Hermelin & O’Connor, 1970). Some of these
124 FRlTH

problems turned out to be central and specific to autism, i.e. they are unique
to autistic children compared to other handicapped children, they occur even in
the presence of high intellectual ability and they are extremely persistent. In
rather general terms one can conclude that autistic children have a particular
kind of difficulty in making sense of incoming information. Relative to their
mental age and intelligence they are impaired when it is essential to extract
meaning from a wider context, and this is true with linguistic as well as non-
linguistic stimuli (Frith, 1970a,b).
The hypothesis of a specific cognitive dysfunction in information processing
has been confirmed by later research (for recent reviews see Frith & Baron-
Cohen, 1987; Sigman, Ungerer, Mundy & Sherman, 1987). Nevertheless there
has been some dissatisfaction, because it has been difficult to see just how cog-
nitive failure could ever explain the social-affective impairments that are the
defining features of autism (Fein, Pennington, Markovitz, Braverman &
Waterhouse, 1986; Hobson, 1986a,b). However, we are now beginning to see
a way of linking these problems with a circumscribed cognitive abnormality.
This same abnormality can also account for the distinctive and profound com-
munication failure that is characteristic of autism.

CONFUSIONS IN THE BEHAVIOURAL EVIDENCE

Before we consider this cognitive abnormality, we need to know what aspects
of the language of autistic children must be explained. Therefore we have to ask
some general questions about the linguistic performance and competence of
autistic children. There is no doubt that at least some autistic children seem to
possess linguistic abilities that are as high as might be expected relative to their
level of intelligence. On the other hand, there are many who show undisputed
and severe language and speech problems. What is to be made of this confusing
picture?
Obviously, competence is not reflected in performance in a straightforward
fashion. We have to infer competence rather indirectly from a large number of
performance assessments and this is no easy task. What strikes the observer first
is that there is an enormous range of individual differences. A proportion of
autistic children never speak at all. Should we call this a linguistic deficit? In
fact, we cannot draw any conclusions about linguistic competence in this case.
It is certainly not safe to assume that children who have no speech have no
language. For instance, there are anecdotal examples of phrases uttered under
extreme stress by children who are otherwise mute. There are also cases of the
sudden appearance of speech as late as adolescence.
At another extreme, there are those autistic individuals who are articulate and
literate and show highly sophisticated language when speaking and writing
(Grandin, 1984; Miedzianik, 1986). However, here too inferences about under-
lying competence have to be carefully tested. Real problems can be camouflaged
and become almost imperceptible. This can sometimes be done with devoted
teaching and persistent practice. Who, as a visitor to an autistic school, has not
had the experience of being thoroughly impressed by a particularly polite and
well-spoken child, only to find that every phrase is a carefully implanted
LANGUAGE AND COMMUNICATION IN AUTISM 125

‘record’ and has been heard countless times by those who know the child well?
Such ‘records’ are quite separate from the generative language system of the
normal child. Suspicion is also justified as regards the language competence of
autistic children with a normal or superior reading age, but with problems in
comprehension (Rutter & Bartak, 1973). These examples show how difficult it
can be to come to conclusions about the underlying linguistic and communicat-
ive competence of those autistic children who show good performance.
Some of the individual differences that are found in the autistic child’s per-
formance on language and communication tests can be set to one side without
fear of disregarding a vital clue. For instance, we know that performance
increases with age. We do not expect children at different stages of development
to perform the same or to have the same competence. Stage of language devel-
opment in handicapped children is assessed more appropriately relative to
mental age than chronological age. Differences that can be attributed to mental
age cannot be critical features of the language of autistic children and it would
be quite wrong to seek to explain them by a theory of autism. There are other
individual differences that are more difficult to account for. They concern
language problems that are not part of normal development. Some of these
might be connected with autism, others with a separate but superimposed
language disorder.

WHAT IS AUTISTIC IN THE LANGUAGE OF AUTISTIC CHILDREN?

Fortunately, there is a way of finding out which language problems are truly
specific to autism and which might be impairments shown by other handicapped
children as well. This is done by the same method as is used for finding out
specific as opposed to general cognitive dysfunctions: one needs to
systematically compare autistic children with non-autistic children of similar
levels of ability and look for qualitative differences. Of particular interest are
comparisons between able autistic children and children with specific language
impairment. Through such studies it has emerged that there are indeed some
peculiarities of speech, language and communication that appear to be unique
to autistic children, and these will occupy us in the main part of this paper.
Surprisingly perhaps, they do not include problems of phonology or grammar,
which might be thought of as typically linguistic problems. All the specific
problems relate to language use. They are formulated by Rutter and Schopler
in their 1987 update of the defining features of autism as follows:
1. Delay or total lack of the development of spoken language, not
compensated for by gesture or mime.
2. Failure to respond to the communication of others (e.g. when young not
responding when called by name).
3. Relative failure to initiate or sustain conversational interchange.
4. Stereotyped and repetitive use of language.
5 . Use of ‘you’ when ‘I’ is meant.
6. Idiosyncratic use of words.
7. Abnormalities of prosody (pitch, stress, rate, rhythm and intonation of
speech).
126 FRlTH

To these should be added two other features which - although perhaps

partially subsumed under the above points - also have a claim to be treated as
specific abnormalities of communication:
8. Semantic/conceptual difficulties.
9. Abnormalities of non-verbal communication.
Although the order of the different features seems somewhat arbitrary, and
although to list them as they are often listed might suggest that there is little
rhyme or reason to the assortment, they can in fact be rationalised and
explained by one single cognitive-social theory. It is the aim of this paper to
show how this might be done. First, however, we need to clarify what the theory
should not try to explain. This will lead us to consider what are the core features
of the syndrome of autism and what are merely peripheral features (although
not thereby less important to the child and his or her carers).

THE SPECTRUM OF AUTISTIC DISORDERS

There is general agreement that language is an independent component of the
mind that can be separately affected by organic impairment. Language can be
spared in otherwise handicapped children (Bellugi, Marks, Bihrle & Sabo,
1988), and it can also be uniquely damaged, as in specific developmental
language disorder (Cromer, 1988). Could it be that there is some other com-
ponent which if faulty would lead to autism, but which could also be spared,
as might be the case in developmentally handicapped children who are never-
theless highly sociable and communicative?
There is a growing consensus that autism is ultimately caused by some
biological fault, presumably well before birth (Coleman & Gillberg, 1985).
Depending on the nature and extent of the damage, we might suppose that
autism can occur as a very ‘pure’ disorder, but can also occur together with
other impairments. We would not expect that autism’s association with specific
language handicap would be any closer than its association with sensory or
motor handicaps and autism. All of these combinations might be a result of
widespread damage that affects more than one brain system.
If different handicaps can be superimposed on autism, then the immense
individual variation in children diagnosed as autistic would be less puzzling.
This logic fits in well with the concept of the autistic spectrum or continuum.
This concept is largely due to the epidemiological studies of Wing and Gould
(1979). It has been elaborated by Wing (1988 a,b), and its implications are dis-
cussed by Bishop in this issue. The spectrum concept does not imply a watered
down view of autism as a disturbance with more or less recognizable autistic and
‘austistic-like’ symptoms. Instead it is based on the empirical finding of a
common and invariant constellation of three features, regardless of additional
handicap. The characteristic constellation has now become known as Wing’s
triad and is the strongest candidate yet for the core features of autism. The triad
refers to three kinds of impairment: social impairment, communicative impair-
ment and impairment of imaginative activity with substitution of repetitive
activity. These impairments give rise to different kinds of behaviour at different
ages and at different levels of ability. A major part of the individual variation
LANGUAGE AND COMMllNlCATlON IN AUTISM 127

however appears to be contributed by additional handicaps. Often there is

accompanying general developmental delay (from mild to severe), and there can
also be accompanying language problems (Rutter, Bartak & Newman, 1971)
and sensorimotor problems (DeMyer, 1976; Ritvo & Freeman, 1978).

Expraining the Triad

The triad of impairments has been shown to be persistent, but the manifestation
of the three impairments in behaviour shows vast variation. As one would
expect, the most important factors that cause variation are chronological age
and mental age (Wing & Attwood, 1987).
Wing and Gould (1979) showed that social impairment specifically affects
only a proportion of mentally handicapped individuals. Autism is very rare in
the normally intelligent population and very frequent in the mentally handi-
capped population. Quite independent evidence exists to show that normally
intelligent autistic individuals suffer from specific neuropsychological deficits
(Lincoln, Courchesne, Kilman, Elmasian & Allen, 1988; Rumsey & Hamburger,
1988) and it is also known that a variety of medical conditions can lead to
autism (Coleman & Gillberg, 1985). Observations such as these support the idea
that there is some subtle brain abnormality which can be linked to the triad, but
not to any other handicaps.
The nature and origin of this abnormality is unknown, but we can assume
that it involves a ‘final common pathway’. The concept of the final common
pathway is useful because it allows one to leave open the question of primary
cause while earmarking a particular brain system that, when damaged by what-
ever means, will always lead to a particular disorder. Extensive damage to the
brain leading to general developmental delay may affect this critical system as
well, but not necessarily so. Whatever the primary cause, autism cannot be
regarded as a haphazard collection of symptoms. Rather it is a distinct and
definable disorder, despite considerable individual variation and despite incon-
sistencies in diagnostic practice across different centres.
From this point of view it becomes an important aim to identify a single
cognitive deficit. Such a deficit would eventually need to be mapped onto a
brain system that corresponds to the final common pathway. For the same
reason we should be wary of explanations which involve separate cognitive
dysfunctions. If there really were several independent dysfunctions, then we
should not have found such a strong common denominator as is implied by the
triad.
Wing’s triad has recently been explained in terms of a single cognitive deficit
(Baron-Cohen, Leslie & Frith, 1985, 1986; Frith, 1987; Leslie, 1987; Baron-
Cohen, 1988). This deficit has important consequences for language and
communication development, and in this paper we shall be concerned with
exploring these consequences.

A KEY TO AN EXPLANATION: FIRST- AND SECOND-ORDER

REPRESENTATIONS
Briefly, the recent cognitive theory proposes that autism is caused by the faulty
development of one particular component of the child’s mind. This component
128 FRlTH

has to do with the capacity to form and use second-order representations. What
are second-order representations and why are they important?
The infant comes into the world with a remarkable set of cognitive abilities
which all have as their aim the veridical representation of the world. The child
analyses automatically what things are like and what people are like, and in this
way builds up considerable knowledge about his own relationships to the out-
side world. The child forms representations of such categories as bananas and
telephones, containing information about their physical appearance, properties
and function. We can imagine that there may be cases of impaired efficiency
in such first-order representations, for instance, in children with general mental
handicap caused by pervasive brain damage. However, this is not where we can
locate an explanation for Wing’s triad of impairments. For this we have to turn
to a fault in second-order representations.
Leslie (1987) illustrated the distinction between first-order and second-order
representations by considering the example of a mother playfully picking up a
banana and speaking into it as if it were a telephone. Why is the child not utterly
confused by this spectacle? In fact, in order not to be confused the child needs
to be able to form a second-order representation. This means representing
representations (rather than representing bananas as things to eat and tele-
phones as things to speak into). The thought ‘it is a telephone’ is no longer
directly related to reality if embedded in the thought ‘I pretend.. .’.
Leslie proposed that it is only from the second year of life that the normal
child unequivocally manifests the ability to form second-order representations.
The first clear manifestation is seen in the emergence of pretence. From then
on, more and more sophisticated developments take place, as available
knowledge extends beyond knowledge of the state of the world gained through
perceptual experience. It concerns knowing that such knowledge exists. This
recursive structure is what is meant by ‘second-order’. Second-order represen-
tations are the critical ingredient in the ability to pretend but also in many other
accomplishments. One of these is ‘mentalising’, i.e. thinking and reasoning
about the content of our own and of other people’s minds. The systematic appli-
cation of mentalising is due to our ‘theory of mind’. In the course of becoming
an adult every normal child develops such a ‘theory’ with profound effects on
social life and on communication in general. A theory of mind allows us to
interpret coherently overt behaviour by reference to invisible mental states. In
this way we can distinguish ‘really meaning it’ from ‘just pretending’, or,
indeed, tell a joke from a lie.
If there was a fault in metarepresentational ability (the ability to form second-
order representations), then this would be particularly devastating for the
development of a theory of mind. Without a theory of mind such everyday
sophistications as deception and bluff would be incomprehensible. The idea that
there is a way of knowing what ‘makes people tick’ would be totally alien. There
would be no inquisitiveness about other people’s beliefs. Also, there would be
none of the joy or embarrassment that can result from believing that one’s
thoughts about another have been recognised by that person. One effect of a
fully developed theory of mind is the appreciation of psychology as the study
of mental life, as opposed to the study of behaviour. The everyday theory of
mind is, of course, not a scientific theory, but folk psychology. It works because
LANGUAGE AND COMMUNICATION IN AUTISM 129

we are all similarly bent on explaining people’s behaviour in terms of psycho-

logical causes, such as motivations or attitudes. Without a theory of mind one
cannot participate in the ubiquitous psychologising that goes on in real life as
well as in fiction. One would merely be a detached observer of behaviour.
Once we have facility in forming metarepresentations we can take into
account what we and others think about the state of the world - as opposed to
what this state is in reality. This means that we can go beyond a mere literal
interpretation of what our perception conveys to us and what other people say
to us. We can playfully and seriously entertain hypothetical and fictional ideas.
We can understand perceptions as our own perceptions and memories as our
own memories, regardless of what other people may perceive and remember
about past events. We can understand that people not only have perceptions and
memories, but also opinions, beliefs and feelings about things. In order to do
justice to this understanding we develop a large vocabulary of mental state
words (think that, pretend that, wish that, believe that, guess that something is
the case). From these examples it is already clear that a dysfunction in second-
order representations would have most serious consequences in intellectual,
verbal, social and emotional understanding.

A Fault in Secondorder Representations

A single fault, i.e. a dysfunction in forming and using second-order represen-
tations, can explain the triad of impairments:
1. The capacity to form and maintain sophisticated social relationships,
embodied as they are in a normal adult’s theory of mind, depends on
second-order representation.
2. Intentional communication depends on the ability to take account of
thought content and hence requires second-order representations.
3. Imaginative activity is first manifested in pretend play and this is known to
be absent or at least grossly delayed in autism (Wulff, 1985; Baron-Cohen,
1987; Lewis & Boucher, 1988). Pretence, as Leslie (1987) has cogently
shown, only emerges as a result of the capacity to handle second-order
representations.
What is excluded by the hypothesis of a fault in second-order represen-
tations? Does the hypothesis explain ‘too much’? Clearly, refinements will have
to be made in the future. However, even now, we can see that the hypothesis
excludes a fault in first-order representations. For ‘pure’ autism we must
assume that first-order representations are formed and used in line with mental
age. Autistic children of normal intellectual abilities can achieve such high levels
because these abilities are largely concerned with first-order information
processing. We would expect that all but those autistic children who are
suffering profound general impairments would show functional object play
which does not involve pretence. Likewise, we would expect that they can
recognise individual people and show emotional attachment. Primary social-
emotional responsiveness may not involve any symbolic representation at all
and certainly does not require a theory of mind. Furthermore, autistic children
should be able to show simple communicative behaviour, for instance,
requesting things and obeying simple commands. This type of communication
130 FRITH

only requires a ‘literal’ (first-order) interpretation of the message. There is

growing evidence that such first-order social and communicative abilities are in
fact present in autistic individuals (Lord & O’Neill, 1983; Wetherby & Prutting,
1984; Loveland & Landry, 1986; Mundy, Sigman, Ungerer & Sherman, 1986;
Sigman, Mundy, Sherman & Ungerer, 1986).
Certain precise predictions that arose from the hypothesis of a specific fault
in second-order (not first-order) representations have already been tested. For
instance, able autistic children can understand that one needs to look at some-
thing in order to see it. This is an example of an inference based on first-order
representations. At the same time they find it hard to understand that one can
only know something if one has seen it, but would not know it if one had not
see it (Leslie & Frith, 1988). This finding also confirms Hobson’s (1984) earlier
results on the autistic child’s unimpaired ability to take into account somebody
else’s perceptual point of view in visual perspective-taking tasks.
No more will be said at this stage about the theory which is still in the process
of being developed (Leslie, 1988a,b), but we shall discuss some of the evidence
when we have looked more closely at the communication and language
problems in autistic children.
In the following sections we shall avoid being sidetracked by those language
and communication impairments that are part and parcel of mental handicap.
We shall also avoid being led into considering specific language problems which
are merely coexisting with autism just as they might coexist with other disorders.
Instead we shall focus on phenomena that can be attributed to autism itself.

WHAT LINGUISTIC ABILITIES ARE INTACT?

On the basis of a comprehensive research review, Tager-Flusberg (1981) was
able to conclude that neither phonology nor syntax development is specifically
impaired in autistic children. This conclusion has only been strengthened by
more recent research. The literature has been summarised and interpreted in
some excellent state of the art papers (Schopler & Mesibov, 1985; Paul, 1987;
Tager-Flusberg, 1989).
Nevertheless, it is important to understand that even those linguistic abilities
which are available to an autistic child are not used in a normal way. For this
reason there is no contradiction in the finding that measures of verbal intelli-
gence tend to be markedly inferior to measures of non-verbal intelligence
(Wetherby & Gaines, 1982).
The pioneering work by Bartolucci and Pierce (1977) and Pierce and
Bartolucci (1977) on phonological and morphological problems has led to a
number of related studies. These authors found that there were certain
abnormalities in the performance of autistic children, but that these could be
accounted for by semantic or pragmatic problems (Bartolucci, Pierce &
Streiner, 1980). A recent well-controlled study by Beisler, Tsai and Vonk (1987),
using a test battery designed to assess aspects of syntactic comprehension,
showed that the performance of autistic children was very similar to that of IQ-
matched non-autistic children (with a variety of diagnoses). Their performance
was poorer (i.e. 5-year level) than would have been expected from non-verbal
mental age (i.e. 6-year level). This lag was the same for both groups. Similarly,
LANGUAGE AND COMMUNICATION IN AUTISM 131

Waterhouse and Fein (1982) had found that delay in several language measures
was fairly even and that deviance was present only in language use. For
instance, on a picture description task autistic children showed marked per-
severation and inappropriate attention to minor details.
Bartak, Rutter and Cox (1975) and Cantwell, Baker and Rutter (1978)
reported from their important investigation of high ability autistic children and
language-disordered, non-autistic children that there was relatively high
competence on morphological rules and on a wide range of sentence types.
Nevertheless, they also reported that the autistic children had very poor com-
prehension skills pointing to specific difficulties in semantics and pragmatics,
and possibly to conceptual problems.
The understanding of active and passive sentences (Paul, Dykens, Leckman,
Watson, Breg & Cohen, 1987), the comprehension and production of many
different grammatical forms including word order, past tense and negation
(Tager-Flusberg, 1989), are all within the capacity of autistic children. Tager-
Flusberg’s longitudinal study of nine high functioning autistic and six Down’s
syndrome children promises to be of particular importance. On the basis of this
study, which is still in progress, she has already been able to conclude that the
order and progress of syntactic development in high-functioning autistic
children shows large individual differences, but is not deviant. However,
abnormalities are also apparent: the autistic children exhibited a narrower range
of grammatical structures and showed restricted use of those structures which
were at their command.
Investigations of fluent autistic readers (Frith & Snowling, 1983; Snowling &
Frith, 1986) have prwided evidence for the understanding of syntax in written
language. For instance, autistic children tended to substitute a missing word of
the correct syntactic class rather than of the wrong class and showed excellent
ability to pronounce either voiced or voiceless final -s in such examples as ‘one
little bippis’ and ‘seven bippis’. The -s is voiced /z/ in the case of the plural but
not the singular.
From the wide-ranging array of studies of both production and reception of
grammar we obtain a consistent answer: far from being specific problem areas,
grammar and phonology can be remarkably intact in autistic children, possibly
representing islets of ability.

TACKLING THE LIST OF PROBLEMS

Muteness and Delay of Spoken Language

Achieving full control of the mechanics of speech production is not precluded
by autism. How is it then that a large proportion of autistic children never speak
at all? The proportion of non-speaking children has not yet been reliably esti-
mated, but a recent Canadian study showed that the incidence is strongly related
to the presence of severe general mental handicap (Bryson, Clark & Smith,
1988). In this sample of 21 autistic children, which was obtained by screening
a total population of 20 800 4-16 year olds, 4 had no speech whilst all others
showed deviant language and communication. Of these four children (who were
aged between 9 and 12 years) three had the lowest measured non-verbal mental
132 FRlTH

age (MA) of the sample. Two of these were profoundly handicapped with IQs
below 20. The one exception was a 9-year-old boy with a non-verbal MA of 4;4
years who proved quite untestable on a standard receptive picture vocabulary
test.
From these relatively small numbers it might be unwise to draw general con-
clusions. However, it may be tentatively suggested that a sizable proportion of
mute autistic children are so because they are of a mental age level which even
in normal development would not lead one to expect speech. The first words of
normal infants may sometimes not emerge until late in the second year.
However, there remains a question mark over those children who from their
non-verbal MA would be expected to speak. These children do not have such
indiscriminate neurological damage, and can often function at a relatively high
level in the non-verbal domain. Why do they not also develop a similar level of
linguistic competence? Cases of this kind are not uncommon in the literature on
the ‘idiot savant’. Hermelin and O’Connor (1989), for instance, described a
totally mute mathematically gifted boy who is able to calculate prime numbers
at high speeds. Whether or not the muteness of such extraordinary autistic
people is due to an associated specific (but not autism-specific) deficit or
whether it is explicable in terms of a broader communication failure awaits
further investigation.
We need to distinguish mute, non-communicative children from those who
are mute but who can communicate in some other way, for instance by means
of sign language. In fact, autistic children do not spontaneously substitute other
means of communication. Their muteness is the lesser problem when compared
to the inability to communicate. Clearly, communication does not totally
depend on the ability to speak. Speaking, taken by itself, is not the same as
communicating.
It could be argued that non-speaking, non-signing autistic children are likely
to be those who show an extremely diminished desire to communicate. If so, it
would be expected that their social relationships would also be extremely
impaired. In other words, their autism would be of a particularly severe degree.
The case of the relatively able mute boy in the Canadian population study pro-
vides some support for this notion. His score on the Vineland Adaptive
Behaviour Scales (Sparrow, Balla & Cicchetti, 1984) was only 1;6 years, in the
lowest quartile of the whole sample and well below what would be expected on
the basis of his non-verbal MA. Nevertheless, the interaction of autism and
muteness may go both ways.
Both absence of speech and delayed speech are plausible consequences of
general mental handicap. However, they are also plausible as indirect results of
a profound communication deficit. Even if almost all autistic children show
delayed language development (Rutter, 1978), this does not necessarily mean
that the delay is always due to the same cause. One cause might be pervasive
developmental delay, another might be an inability to take advantage of the
facilitative effects of a desire to communicate.

Failure to Respond to and Failure to Initiate and Sustain Communication

There is unanimous agreement that ordinary two-way communication is a
source of many problems for autistic individuals. These difficulties are clearly
LANGUAGE AND COMMUNICATION IN AUTISM 133

at the heart of the disorder. They involve cognitive impairments (in the control
of information and its channels), affective impairments (in the unusual
emotional responses and, in particular, a lack of empathy or reading between
the lines), and social impairments (in the lack of social role recognition and
misunderstanding of turns, interruptions, starts and endings of conversations).
One of the earliest signs of communication failure is the lack of response to
speech, and even more poignant, the lack of response to the child’s own name
being called. Normally, hearing your native speech, but especially hearing your
own name, acts as a powerful ostensive stimulus for communication. According
to Sperber and Wilson (1986) such a stimulus carries a guarantee that the utter-
ance to come will be of relevance to the listener. Orientation towards the source
of the utterance is normally automatic. The guarantee of relevance on the
speaker’s part and the presumption of relevance on the listener’s part are vital
aspects of the process that makes comprehension possible. If there is something
amiss in these vital aspects, then the whole process of learning to communicate
would be compromised.
Two-way communication with autistic children has increasingly become a
target of research. Baltaxe (1977) and Baltaxe and Simmons (1977) were among
the first to carry out an analysis of the pragmatic features of autistic language.
They presented material from autistic adolescents of high verbal ability and
were able to show some striking examples such as the confusion of the polite
and informal second person pronouns (Sie and Du) by German-speaking
autistic children. This particular confusion highlights the fact that normal con-
versations include a continuous awareness of the nature of the relationship
(formal or informal) with the partner.
Baron-Cohen (1988) reviewed the studies that have explicitly considered
features that are the proper subject of pragmatics. Every single one of the
features studied was shown to be at fault in some way. The studies are often
based on the analysis of two-way communications with autistic people (Shapiro
8z Huebner, 1976; Caparulo 8z Cohen, 1977; Bernard-Opitz, 1982; Wetherby,
1986; Curcio 8z Paccia, 1987) and concern such conversational principles as turn
taking, foregrounding and backgrounding of old and new information, inter-
ruption of the speaker at inappropriate moments, and faulty use of eye gaze
during conversation. Stilted language, pedantic language and lack of reference
to information that is shared by speaker and hearer are other important
examples of problems that have been observed in the language use of autistic
people.
Some of the ideas on pragmatic deficits were expanded and presented in a
more general framework of communicative and cognitive deficits by Fay and
Schuler (1980). Their monograph is a useful source for the review and dis-
cussion of the peculiar use of language in autistic children. Fay and Schuler
contrast studies of pragmatic skill development in normal children with the
absence of such skill in autistic children. They also consider those examples of
autistic speech that are held to be spontaneously communicative (‘truck! ’, ‘shoe
off‘, ‘home after bread’). Such examples often turn out to be simply instru-
mental speech, i.e. they are instances of the child learning that certain verbal
behaviour will result in certain desired consequences.
There is still much need for investigations of two-way communication that go
134 FRlTH

beyond sensitive observation and interpretation of case material. Control

groups quite often have not been included in studies of pragmatic competence
and this is a problem. Presumably, the readiness to dispense with controls was
motivated by the conviction that the abnormalities to be seen are at once
striking and unique. This may be so, but it would be useful to have proper con-
firmation. What is also missing is a theory that can predict exactly which aspects
of communication should be impaired, which aspects should be intact, and for
what reason. This theory should provide the means of distinguishing different
kinds of communication failure. Sperber and Wilson’s (1986) theory of rel-
evance is ideally suited for this purpose.
Rather than listing various oddities of language use it should be possible to
find a logical and systematic way to account for them all, and to predict other
oddities for which we have yet to look. Many of the abnormalities that occur
in conversations can be explained by the autistic individual not taking into
account the speaker’s states of mind. From this assumption it becomes easy to
see why autistic people repeat information which the listener knows already,
why they do not know when to say what, why they do not avoid embarrassing
remarks, remarks that appear to be rude, or remarks that appear to be over-
formal and inappropriate given a close affective relationship to the listener. It
would also explain why they often do not know when to stop and when to inter-
rupt. Hurtig, Ensrud and Tomblin (1982) showed that autistic children do not
know how to maintain the flow of conversation even though they may try to
engage the adult by asking questions. Coggins and Frederickson (1988) docu-
mented how an autistic boy, Bryan, excessively used the stereotypical phrase
‘Can I talk’ when interacting with his father. Apparently, he used this phrase
in order to regulate turn-taking. Normally, of course, other less disruptive
signals, in particular eye gaze, are used for this purpose.
Meanwhile, from the field of linguistics the ideas of Grice (1975) about the
nature of speech acts became known and seemed instantly applicable to the
language peculiarities of autistic people. According to Grice there are a number
of maxims of communication, nine in all, that the speaker obeys quite uncon-
sciously. They exist because for successful communication there have to be
standards of truthfulness, informativeness and comprehensibility. For instance,
it is necessary that we make our contributions to a conversation exactly as infor-
mative as is required (maxim of quantity). We expect and are expected to say
neither too much nor too little. We trust that we are told only what we need to
pay attention to. Another principle is that we say what we believe is true (maxim
of quality). This is not contradicted by the deliberate use of lying. After all the
lie only works because of the general principle that what the communicator says
is true. There is also the maxim of relevance. If we did not conform to this we
would not understand what others are talking about at all. The maxim of
manner makes us assume that we and our partner should be brief and should
avoid ambiguity. Again, if we did not have this standard we would not be able
to notice, let alone complain when our partner goes on and on, or confuses us.
Of course, the computation that underlies the process of communication, and
uses these maxims, goes on without our having to think about it. What Grice’s
ideas teach us is that the very act of communicating creates expectations in the
hearer which are then exploited to convey meaning.
LANGUAGE AND COMMUNICATION IN AUTISM 135

Where do the maxims come from? One might agree that they make communi-
cation work, but it is difficult to see why. This problem has now been
ingeniously tackled by Sperber and Wilson (1986) who explain how Grice’s
maxims might follow from the mind’s natural search for relevant information.
As we shall see in a later section there are links to be made between ‘relevance’
and ‘theory of mind’. Combining the hypotheses of a fault in second-order
representation and of a fault in the computing of relevance is an attractive goal.

Stereotyped and Repetitive Use of Language

For a long time the lack of spontaneous speech has been a familiar complaint
about autistic children’s language despite proven ability on language tests
(Shapiro, Fish & Ginsberg, 1972; Ricks 8z Wing, 1976). Instead of spontaneous
speech we find the use of stock phrases, the use of echoed speech and generally
repetitive speech about a few narrow topics only. This observation too is
illuminated by the single notion that the autistic individual does not take into
account the mental state of the listener. What we mean by ‘spontaneous speech’
is the knack to say the right thing at the right moment - even if it is a stereo-
typical phrase (e.g. ‘I love you’). What we want to hear from an autistic child
and so rarely receive is something that requires the ability to guess and antici-
pate what the listener might wish to hear - at that precise moment. For this
reason lack of spontaneous speech is not cured by turning taciturn individuals
into chatterboxes. Instead non-verbal responses, such as an occasional smile,
would be better than speech that sounds as if rehearsed. Of course, nobody has
yet come up with a programme that could teach either verbal or non-verbal
‘spontaneous’ communication of the kind that is so sadly missing in autistic
people. One would not be surprised, however, if it was missing in some quite
normal people as well!
Echolalia has been a much researched topic in autism and justifiably so.
Schuler and Prizant (1985) aptly summarise and interpret the research from
Kanner’s (1943) observations to Prizant and Duchan’s (198 1) studies of the
functional significance of echolalia. These authors concluded that despite some
interesting differentiation that can be found in the use of echoing by autistic
children, echolalia is the net result of limited communicative competence and
normal speech skills. In this sense the echoing is to be seen as accidental
behaviour which should not be imbued falsely with communicative relevance.
McEvoy, Loveland and Landry (1988) have shown that the communicative
value of echolalia is extremely limited. They draw attention to the fact that
echolalia has not yet been investigated longitudinally, but suggest that one may
continue to assume that the more generative language a child possesses, the less
he or she will use echoed speech.
So-called formulaic speech often involves speech fragments which are outside
the child’s generative language system and which are used ‘lock, stock and
barrel’ even when only marginally appropriate to the context. Tager-Flusberg
(1989) found an excess of formulaic language in the able autistic children whose
progress she studied. A particularly frequent form of stereotyped speech is
repetitive questioning. Normal listeners feel strong pressure to respond to direct
questions, but they feel distress if it is always the same question. Did they not
give the desired answer? Was their answer not understood? Was the question
136 FRlTH

really about something else? In any case they experience an acute sense of com-
munication failure. It may be tempting to the listener to look here for some
deeper meaning behind the repetition, but the true significance may well be of
the same kind as for other repetitive actions. Such actions are characteristic of
autistic individuals and they occur both outside and inside interpersonal
interactions.
Unfortunately, the explanation of repetitive behaviour in autism is still a
largely uncharted area. In any case we cannot explain this phenomenon (which
in itself is not part of Wing’s triad) in terms of a fault in second-order represent-
ation. An attempt has been made to explain repetitive behaviour in relation to
the cognitive processes that are also involved in metarepresentation (Frith,
1989)’ but this is another story.

Pronoun Difficulties
Pronouns are members of a syntactic class that is acquired relatively late. The
‘I’ and ‘me’ distinction is often not made correctly even by normal adults in
terms of the standard grammar of adult speakers. ‘I,, ‘you’, ‘he’ and ‘she’ are
confused by small children quite frequently, and 3 year olds often tend to use
proper names, including their own, when the pronouns ‘I’ and ‘you’ would be
correct. In autistic children’s language too, all these problems are present, but
there is the belief that if personal pronouns such as ‘you and I’ or ‘your and
my’ are confused by autistic children, then this must have personal significance.
There might be quite literally a confusion of self and other. Curiously, when
normal children produce such reversals confusion of self and other is not
suspected. Bartak and Rutter (1974) showed that reversals can often be
explained as a consequence of echolalia. As reviewed by Jordan in this issue,
autistic children’s difficulty with pronouns is not the same as a tendency to
reverse first and second person pronouns. In particular, autistic children do not
show a confusion of the identity of the persons to whom the pronouns refer.
In Landry and Loveland’s (1988) study of communication behaviours a
correlation was found between correct pronoun use and degree of joint atten-
tion behaviour. Thus pronoun use improves when reciprocal social interactions
improve. This relationship suggests that autistic children’s difficulties in
pronoun use are not specific but have the same root as their other difficulties
in social interaction. This root could well be a poor conceptualization of their
own and others’ mental states.

Idiosyncratic Use of Language

Kanner (1946) devoted a paper to the extraordinary phrases that can occur in
the speech of autistic children. These phrases are purely idiosyncratic expres-
sions whose meaning is obscure to others. For instance, there is the now famous
phrase ‘don’t throw the dog off the balcony’ quoted by Kanner (1943). In this
case the origin of the remark which the child, Paul, was in the habit of saying
almost every day, could be traced to a real incident years before, when his
mother said these words about a toy dog. The occurrence of such obscure
phrases is clearly a symptom of communication failure. The autistic speaker is
not considering the work that the listener has to do in order to comprehend an
utterance. Normally, if we use an obscure phrase for effect we follow it up with
LANGUAGE AND COMMUNICATION IN AUTISM 137

an explanation. Idiosyncratic phrases without any attempt at explanation will

leave the listener baffled. They are therefore strong indications of the kind of
communication handicap that is characterised by some limitation in the
computing of relevance.

Abnormalities of Prosody
The prosodic aspects of language are a major carrier of meaning and of the
intentions that motivate communications in the first place. Important words are
stressed, questions are marked by a rising tone and emotional aspects are
reflected in the timbre. Studies of the prosody of autistic speech are still few and
far between, but those that exist all indicate some profound abnormalities (Fay
& Schuler, 1980; Baltaxe & Simmons, 1985). Von Benda (1983) compared the
speech of autistic and language-impaired children and found gross and subtle
differences in terms of certain acoustic features. There was high variability both
within and between individuals. This relates to the clinical observations of
staccato speech, monotonous speech, inappropriate questioning intonation, and
‘sing-song’, all of which are sometimes observed in the same individual.
Especially interesting was a blind rating task which von Benda asked speech
therapists to do while listening to recordings of randomly ordered utterances of
either autistic or language-impaired children. The autistic group was rated in
markedly more negative terms. Comments such as ‘pressed’, ‘careless’, ‘hard’,
‘overemphasized’, were frequently used for recordings that had come from
autistic children, while in the case of language-impaired, non-autistic children,
comments often included some mitigating adverbs, such as ‘somewhat
monotonous’ or, ‘not very clear’. The negative assessments presumably reflect
the listener’s puzzlement and indeed annoyance at contradictory signals which
can occur in autistic speech, but which are not meant to convey contradictory
meanings.
The use of sentence stress in ordinary matter-of-fact type statements and the
use of contrastive stress in contradictions and corrections has also been studied
in autistic children (Baltaxe, 1984; Baltaxe & Guthrie, 1987). As one would pre-
dict on the basis of intact first-order linguistic skill, stress in news type sentences
that were given in answer to the question ‘what is happening?’ was similar in
autistic children and normal children. However, autistic children’s production
of contrastive stress was highly abnormal. When the experimenter here asked
‘is the baby drinking milk?’, the correct answer was ‘no the baby is drinking
coke’. In this case the stress should be on the word ‘coke’. This is what one
would do taking into account the processing demands made on the listener. The
stress, in effect, conveys immediately where the disagreement with the listener’s
utterance lies: in the emphasised word. In this sort of situation autistic children
made twice as many incorrect stress assignments as controls.

Conceptual Difficulties and Word Meaning

The language of autistic children has been described as overly concrete (Ricks
& Wing, 1976). Fay and Schuler (1980) say that whenever words are used mean-
ingfully, they tend to refer to concrete referents, and that language that derives
from imaginative activity is poorly developed. Autistic children seem to have
very patchy vocabulary acquisition: in matters that evoke their interest, they
138 FRlTH

may rapidly acquire a set of technical terms (names of different colours, shapes,
flowers, airplanes, to mention some examples in cases known to me). However,
at the same time they may lack words for very common concepts normally of
great significance (mental states for instance). Such unevenness in semantic
knowledge would be worth studying. Similarly, we as yet know little about the
connection between acquisition of word meanings and a diminished desire or
ability to communicate. In normal child-adult interactions intense activity is
directed simultaneously at what each partner ‘has in mind’. If this were not the
case then the learning of new words would be a precarious affair.
The study of semantic abilities can be approached from the point of view of
categorisation skills (Tager-Flusberg, 1985a,b; Ungerer & Sigman, 1987). The
ability to classify objects and words has been consistently found to be mental
age appropriate for autistic children. Clearly, it is not here that the problem lies.
Tager-Flusberg (1981) was able to show, however, that autistic children were
less influenced by high probabilities of events which are normally taken into
account when we listen to speech and work out its content. For example, it is
easy to understand that ‘the girl is holding the baby’, but harder to understand
that ‘the baby is holding the girl’. This difference in ease of comprehension was
less pronounced in autistic children. Lord (1985) argued that high event prob-
ability for most normal children might be different for autistic children. In this
case autistic children might succeed with what were for them highly familiar
constellations. Paul, Fischer and Cohen (1988) found that autistic children were
indeed able to make use of probable event strategies, but preferred to use syn-
tactic word-order based strategies when acting out sentence commands. The
opposite was true for a non-autistic, language-impaired control group.
When we talk of semantics we talk not only of the meaning of single words.
The meaning that is conveyed in a sentence as opposed to a jumbled-up string
of words does not depend on knowing exactly what every single word means.
‘Twas brillig and the slithy toves did gyre and gimble in the wabe. . .’ is a good
example of this sort of meaning. It is as yet quite mysterious how we can extract
meaning in this way, but we do and we benefit from this ability. One immediate
benefit is that we can increase our memory for sentences as opposed to mere
word strings. Experiments by Hermelin and O’Connor (1970) and by Hermelin
and Frith (1971) showed that autistic children were less affected by differences
between meaningful and random strings when they had to recall them. They
remembered meaningful sentences better than meaningless ones, but not as
dramatically better as non-autistic children.
Recently, Klin (1988), in an unpublished PhD thesis, reported results of a
simple preference test where young autistic and mentally handicapped children,
aged around 5 years, could choose either to listen to coherent speech or to super-
imposed speech, which was recorded in a noisy canteen and was neither coherent
nor meaningful. In this study the autistic children showed no preference while
non-autistic children overwhelmingly preferred to listen to normal speech.
From Klin’s recent results as well as from those obtained in the recall exper-
iments it would seem that the attraction or salience of meaningful spoken
language is low for autistic children, but high for non-autistic children. This
finding suggests that the drive for relevance that Sperber and Wilson (1986) pro-
pose as the key to normal pragmatic understanding is missing or weak in autism.
LANGUAGE AND COMMUNICATION IN AUTISM 139

This problem could well be a consequence of some other deeper problem with
information processing. As Frith (1972) showed, the inability to extract mean-
ing from structured sequences could equally be observed for non-linguistic
material.
Are there then specific difficulties with sentence meaning over and above the
difficulties that one would expect from a broader conceptual failure? At present
the evidence is insufficient to answer this question. What the failure would have
to involve is a problem in the nature of the associations between different words
or concepts. The form and availability of these associations may be deviant in
autistic language, perhaps because they were acquired in a deviant fashion.
However, it may turn out that even in this respect the language of autistic chil-
dren is not worse than would be expected from mental age.
Snowling and Frith (1986) investigated the comprehension ability of both
autistic and mentally handicapped, non-autistic children who were superior
(hyperlexic) readers. When they had to detect odd words that were surrep-
titiously embedded in text, they often made the wrong choice. The embedded
words, however, were always plausible within a narrow context and only
became implausible if one considers them in a wider context. For instance: ‘(The
mother beaver taught her young). . . how to rip leaves and bark from twigs and
showed them where to find horrible water lilies.’ People with good comprehen-
sion skills jar at the word ‘horrible’. Presumably they expect the mother beaver
to show her children only good things to eat, and in order to accept that the
water lilies are ‘horrible’, one would certainly require some further explanation.
Hyperlexic readers were quite happy to accept the word ‘horrible’, presumably
because they did not take into account the wider context of the utterance. This
subtle failure was not unique to autistic children. It remains to be seen whether
other semantic or conceptual problems can be accounted for by non-specific
cognitive difficulties.

Non-verbal Communication
Asperger (1944) deserves to be credited with the recognition that abnormalities
of non-verbal communication are a hallmark of autistic individuals. He was
particularly interested in the ideas of Ludwig Klages (1913, 1936) who studied
the expressive phenomena of appearance and movement in normal people. It
was therefore highly noticeable to him that even in very able autistic individuals
there was a distinct oddness and poverty of expressive features. Ricks and Wing
(1976) pointed out that the gestures of autistic children are impoverished, and
Bartak, Rutter and Cox (1975) confirmed this observation in experiments. The
absence of protodeclarative pointing in autistic children in comparison to their
mental age was first demonstrated by Curcio (1978). Recently, Baron-Cohen
(1989a) has shown that while protodeclarative pointing (a sign of shared atten-
tion) was impaired in autistic children relative to controls, protoimperative
pointing (a means of obtaining an object) was not.
The understanding of emotional expressions in autistic and mentally handi-
capped children has been investigated in a series of important experiments by
Hobson (1986a,b) and Hobson, Ouston and Lee (1988a,b). Hobson used the
following paradigm: the children were presented with stimuli, each p o r t r a w
one of four basic emotions (happy, sad, angry, afraid). The stimuli could beqs
140 FRlTH

schematic face, a photograph, a body, a voice or an action sequence. What the

child was required to do in each case was to match a given target stimulus
against one of four choice stimuli. The matching was always across modalities.
For instance, an angry sounding voice had to be matched to an angry looking
face rather than a sad looking one.
The outcome of Hobson’s studies was that autistic children, relative to their
non-verbal mental age, are impaired at emotion recognition. However, from his
more recent studies it becomes apparent that non-autistic, mentally handi-
capped children may have a similar difficulty when matched to autistic children
in terms of verbal mental age. It is therefore still an open question how specific
the difficulties of autistic children are when they have to read emotions from
expressive phenomena. Nevertheless, it is a surprising finding that any difficult-
ies in cross-modal emotion matching should exist at all in children of high
non-verbal ability.
Landry and Loveland (1988) observed communicative behaviour in autistic
children around age 9 years and language-delayed children around age 5 years
and found a marked absence of certain gestures (pointing and showing) in the
autistic group, namely of those gestures that regulate shared attention. The con-
cept of shared attention refers to the fact that a young child, even before speech,
by pointing or bringing and showing indicates that an object is the target of his
or her attention. The object is thus temporarily important for him or her and
this fact (not necessarily the object) is therefore important to the partner. At the
same time Loveland and Landry found a surprisingly high degree of instrumen-
tal communicative behaviours in the autistic group which included touching and
looking. Very similar findings, but with much younger (2- to 4-year-old) autistic
children were obtained by Sigman and Ungerer (1984), Sigman et al. (1986) and
Mundy and co-workers (Mundy et al., 1986; Mundy, Sigman, Ungerer &
Sherman, 1987) in their important studies on attachment behaviour.
These consistent results suggest an important dissociation. First, autistic chil-
dren show more social approach behaviour ,verbally and non-verbally,than one
might have initially expected. They also show signs of attachment. Secondly,
there is a gross and persistent problem with the skills that are necessary for
ordinary two-way communication, including such basic skills as sharing atten-
tion. The reason for this particular problem may well relate to an inability to
understand that other people have interests that can be shared, or that they have
feelings and thoughts about things.
An investigation of gestures, both artificially elicited and spontaneously used,
was carried out by Attwood, Frith and Hermelin (1988). The main finding was
that autistic children of all levels of ability were all able to understand a set of
simple instrumental gestures (e.g. go away, come here) and furthermore used
them spontaneously in social interactions. Whilst the level of their social activity
was very low, significantly lower than that of a comparable group of Down’s
syndrome children, they used non-verbal, manual gestures proportionally just
as often as the Down’s group. Interestingly, however, autistic children were
never observed to use spontaneously an expressive gesture (e.g. hiding one’s
face in embarrassment). On the other hand expressive gestures were extremely
common in the social interactions of Down’s syndrome children. This result
parallels the observations that have been made on the use of speech for
LANGUAGE AND COMMUNICATION IN AUTISM 141

instrumental (but not spontaneously expressive) purposes by Fay and Schuler

(1980).
What is the difference between instrumental and expressive gestures or
between instrumental and expressive use of language? What is the difference
between the ability to request something and ability to share attention? If there
really is a blatant failure in sharing attention and in expressing and recognising
feeling states, then what does it mean?
With instrumental gestures the aim is to influence and manipulate people just
as one might operate a TV set. Expressive gestures are aimed at showing mental
states and possibly influencing other people’s mental states. Only first-order
representations are needed for instrumental behaviour and autistic children pos-
sess these if they are able to negotiate the physical environment. For expressive
gestures, on the other hand, second-order representations are necessary, i.e. it
is not only necessary to know or to feel something, which autistic children
undoubtedly do, but also to know THAT one knows or feels something. If one
is aware that one has a particular mental state (in this case a feeling about some-
thing) then one is also aware that other people have such states. It follows that
one might wish to influence and manipulate these states as well as to communi-
cate the content of one’s own mental states. This would be analogous to
influencing what TV programmes are transmitted, rather than to adjusting the
controls on the set.
We are not talking here of involuntary expressions of inner states (e.g. mak-
ing a face when tasting something bitter; smiling when feeling happy; crying
when feeling sad). Of course these involuntary expressions also act as signals to
others, but in order to show them or to recognise them one does not need an
awareness of mental states. Such signals may not depend on any symbolic rep-
resentation at all. It is clear that it is not the intensity of the behaviour which
identifies the kind of expressive gesture that depends on second-order represen-
tation, but the communicative intent behind it. In fact, minimal stimuli, such
as a slightly raised eyebrow, or ‘deafening’ silence, may have profound
communicative effects. Little hints, often given non-verbally, regulate our inter-
actions to great effect. For instance, we do not usually overstay our welcome.
It is precisely such hints that are reputed to be ineffective with high-functioning
autistic people.

THEORY OF MIND
The hypothesis that autistic children lack the capacity for second-order rep-
resentations allows us to explain WHY they have a profound communication
failure. The hypothesis is that somewhere in the process that is responsible for
forming and using second-order representations there is a circumscribed fault.
This is a very powerful hypothesis and also a very specific hypothesis. It is
powerful because it can explain the triad of impairments that forms the com-
mon denominator of all the symptoms in the spectrum of autistic disorders. It
is specific because it allows for the possibility that a whole important sector of
information processing is intact. This sector includes primary abilities in percep-
tion, thought and also in language.
The ability to conceive of mental states plays a key role in this explanation.
This ability enables the child to acquire knowledge about people and their
142 FRlTH

relationships with each other and leads eventually to a ‘theory of mind’. This
achievement might also be called ‘mentalising’ or ‘psychologising’. What the
author means by this is that we normally tend to interpret behaviour as caused
not by physical events, but instead by some mental state. In everyday life we
tend to perceive behaviour in ourselves and others as being the result of inten-
tions, ulterior motives, hidden desires or manifest feelings, attitudes and beliefs.
The ability to make inferences about what other people believe to be the case
in a given situation allows us to predict what they will do. It allows an under-
standing of intentional and unintentional non-verbal gestures and verbal
utterances. It also allows us to understand and practise deception. Experimental
evidence shows that the vast majority of autistic children are impaired in just
these abilities.
What exactly would lack of mentalising entail? If one did not mentalise, then
this would lead to an impoverished understanding of human relationships and
behaviour in everyday situations. In fact it would lead to the kind of under-
standing that a behaviourist scientist imposes on himself or herself as a
discipline when observing animals or people. The behaviourist tries to deduce
general rules from behaviour alone without making any assumptions about
internal states or drives. This is very different from folk psychology.
Mentalising is an important feature of imaginative activity even where it
appears to be suppressed. Take for example the literary genre of the ‘nouveau
Roman’. One may think of the way Alain Robbe-Grillet describes in minute
detail the physical features of a room in his novel Jealousy. The opposite can
be found in a novel such as Thomas Mann’s Buddenbrooks where even the
weather is empathic to the events of the story and where heavy symbolic inter-
pretation of physical events is fully intended. The reader, of course, interprets
in either case. Much of the enjoyment of fiction derives from the awareness of
inner psychological states which the characters may not reveal to each other or
even to themselves. In the case of Robbe-Grillet the reader is inclined to
attribute menacing and paranoid feelings on the basis of an apparently objective
and neutral description. It is no coincidence that able autistic people are
reportedly unable to enjoy plots of novels and films that depend on
‘mentalising’.
It might well be helpful to look at the autistic person’s social skills as similar
to those of a behaviourist. From this point of view it would become quite under-
standable that certain social routines are eminently within the reach of an
autistic individual. The reading of emotions from purely behavioural evidence
should be teachable, e.g. smile equals happy. Obviously, the limitations of such
an approach are severe. First of all, there is the problem of interpreting individ-
ual differences in the expression of emotions such as happiness. One person may
only ever smile with his eyes, another laugh loudly at the slightest provocation.
Secondly, there is the problem of interpreting whether or not an expression was
sincere or merely a fake. In normal interactions the constant interpretation of
mental states and the constant attribution of ‘psychological’ motives for behav-
iour makes the interpretation of expressions less ambiguous than it might
otherwise be.
We now need to turn to the explanation of the specific impairment of com-
munication that makes autistic individuals stand out at all ages and all levels of
LANGUAGE AND COMMUNICATION IN AUTISM 143

ability and that affects their very acquisition of language. It will be obvious
from the examples of the failure to understand pretending and deception that
a similar explanation will apply to the failure to understand humour and irony.
These, however, are very sophisticated concepts even for the normal child. We
must look at evidence for the ability to use second-order representation at
appropriate levels of development. If we then find that autistic children of the
right mental age lack such ability then we can justify the systematic exploration
of a whole field of communication problems. This has yet to be done. But we
have some beginnings.

COMMUNICATING WHAT IS OF INTEREST TO THE LISTENER

Perner, Frith, Leslie and Leekam (1989) report an experiment which involves
the following scenario: the experimenter produces two closed boxes and says
that he would like to show their contents to the child and to a second exper-
imenter. One box contains a pretty looking wax apple, the other a crumpled
tissue. Now, the second experimenter leaves the room on some pretext after only
one of the two boxes has been opened. The child is shown the content of the
other box when this experimenter is out of the room. She comes back, but both
boxes are closed again. Now, in a normal context it might be natural for the
child to tell the experimenter what it was that was in the second box. After all,
she had shown interest in the content of both boxes but had seen only one. In
an artificial situation we cannot rely on such spontaneous behaviour. Therefore,
the second experimenter deliberately said she wanted to see what was in the box,
pretended to be unable to open it, put it back, and then asked the child ‘What’s
in there?’
In the case of ordinary two-way communication the child says whatever it was
that was in the box the experimenter had not seen. This seems perfectly obvious,
hardly worth mentioning. However, this deceptively simple behaviour is based
on the ability to compute ‘she does not know what I know, and I am now in
a position to tell her something new and therefore interesting’. This compu-
tation clearly involves the ability to mentalise. Normal 4 year olds do all this
without trouble, but not so autistic children with a mental age of 4. Most of the
autistic children quite readily answered the question of the experimenter, but
they were quite likely to mention the object that the experimenter already knew
about, or they would say the correct thing on one occasion but not on another.
They were quite likely to mention the attractive apple even when it would have
been correct to mention the crumpled tissue which the experimenter did not
know about. From the pattern of results and from a further experiment where
the children again had to supply missing knowledge the conclusion was that
most autistic children with a mental age of over 3 years were definitely impaired
on this sort of task. They could certainly not be relied upon to give a consist-
ently correct performance.
In a study of conversational interchange, McCaleb and Prizant (1985) found
a very similar result. Here speech was analysed in order to compare instances
when old and new information was conveyed. These two types of information
were clearly not discriminated by autistic children. Nevertheless the ability to
single out novelty for interest in communication is only one stepping stone in
the process that in the normal child leads to a full theory of mind.
144 FRITH

Baron-Cohen et al. (1985, 1986) reported two experiments which showed that
the understanding of false belief was absent in a majority of autistic children
when compared to much less able Down’s syndrome children. For the false
belief task an object is transferred while its owner is absent. The inference that
has to be made is that this person would falsely believe the object to be still in
the old place. Most autistic children cannot make this inference. For this reason
it presumably never occurs to them in their everyday life to trick someone by
hiding their possessions or to play similar pranks.
Attributing a false belief is more difficult than attributing a true belief. Here
the child is invited to hide an additional object at some arbitrary hiding place,
while the first object remains in its old place. Thus no trickery is involved.
Nevertheless, autistic children do not reliably infer that the person who was
absent when the new object was hidden cannot know where it had been placed.
Few normal 4 year olds would make this error. On such a task Leslie and Frith
(1988) found only marginally less failure in able autistic children than on a false
belief task. Whilst a minority of the more able and older autistic children suc-
ceeded on true and false belief tasks, all of them failed on a yet more difficult
mentalising task, where a false belief about another’s belief has to be attributed
(Baron-Cohen, 1989b).
These results together demonstrate that even if autistic children show varying
degrees of impairment overall, there is at least a gross delay in their ability to
attribute knowledge and beliefs to others. In short, their ability to mentalise or
their ‘theory of mind’ is poorly developed. Furthermore, since there is also gross
delay in the development of pretend play, since there is a very persistent impair-
ment of communication, and since all of these are connected through the single
recursive cognitive mechanism that underlies metarepresentation, we can pro-
pose a parsimonious theory. It is possible to trace all these key features of
autism to a problem in just one single cognitive component.
There are also secondary consequences of a lack of mentalising. Many of
these have to do with emotional understanding and with the expression of
shades of feelings in words and gestures. Clearly, if deception is not understood,
then the feelings of triumph, guilt or shame associated with such an achievement
are missed out on. If the ignorance of another person is not appreciated, then
the feeling of glee or superiority, or, if it is in relation to one’s own ignorance,
of inferiority or of being left out, cannot be experienced.
Many of the impairments reported in investigations of pragmatics can be con-
sidered as immediate consequences of lack of mentalising. For instance, there
are disastrous effects if account is not taken of a listener’s knowledge or ignor-
ance. Other conversational skills, including appropriate recognition and
expression of emotions, politeness or calculated rudeness, depend on the ability
to take into account both one’s own and the partner’s mental state. Similar
explanations for a whole number of findings in the literature on pragmatics in
autism have been suggested by Baron-Cohen (1988). It is clear too that some
apparently linguistic problems, for instance, regarding the correct use of tense
or the correct use of pronouns, can be explained parsimoniously as a result of
not keeping track of the listener’s knowledge. For instance, an event that is
regarded as prior to another event by the speaker, may not be so regarded by
the listener unless he is told about the priority. Likewise, using ‘me’ when
LANGUAGE AND COMMUNICATION IN AUTISM 145

uttering a sentence that was referring to somebody else, in indirect speech, may
be perfectly correct, except that the listener was not made aware that the
pronoun is embedded in indirect speech.

RELEVANCETHEORY
It is clear that the communication difficulties in autism are still in need of
exploration. It is also clear that they cannot be seen in isolation from the impair-
ment of social relationships that would be caused by a poorly deveIoped theory
of mind. Much progress has recently been made in the study of normal
children’s developing theories of mind (Astington, Harris & Olson, 1988).
However, for the explanation of communication difficulties the recently
proposed theory of relevance (Sperber & Wilson, 1986) is of particular
significance.
Sperber and Wilson point out that there is a gap between the meaning of
sentences and the thoughts actually conveyed in utterances. This gap, they say,
is filled by inference. Could it be that inference processes are impaired in autistic
children? This question certainly deserves to be addressed by research. How-
ever, we already hypothesise that the object of the inferences, namely the
speaker’s intention, may not be a prominent part of the concepts that autistic
people use. Intentions are of course mental states and it seems likely that many
autistic children have only dim awareness, if any, of the mind and its contents.
This is obviously not the place for a full account of Sperber and Wilson’s
theory, but a brief summary of its major implications makes clear its usefulness
for understanding the specific communication handicap in autism. Sperber and
Wilson begin with the general premise that the mind inevitably turns its
attention to what seems relevant, i.e. capable of yielding significant gain in
information for a minimum of cognitive effort. The degree of relevance is very
simply determined by the balance of costs and benefits for effect and effort.
Sperber and Wilson’s other main point is that to communicate is to claim the
listener’s attention for what the listener automatically believes to be a worth-
while message. Speaker and listener unconsciously operate from the same
premise: the speaker only communicates what he or she believes is relevant and
the listener only interprets the communication from the point of view that it will
be relevant. For this reason communication can be said to follow the principle
of relevance. In Sperber and Wilson’s words ‘every act of ostensive communi-
cation communicates the presumption of its own relevance’.
Communication can be achieved in two ways: first, by encoding and decoding
(which Sperber and Wilson believe to occur when linguistic meaning is extracted
from a sound pattern), and secondly, by inferential communication (which
occurs when evidence is being computed about the speaker’s informative inten-
tion). It could be that this central inferential process is what fails in autism,
making the individual incapable of understanding the intentions behind the
message while allowing him to decode and to recall the message (verbatim rather
than as the gist of the utterance). Inferential communication actually involves
two things: the speaker produces a stimulus with an ‘informative intention’,
namely to inform the hearer of something, but also with a ‘communicative
intention’, namely to inform the listener of his intent to inform. Therefore,
communicative intention is one level of representation up and can be seen as
146 FRlTH

second-order informative intention. To take an example, the raised eyebrow (an

ostensive stimulus) might say something like ‘I disapprove’ and at the same time
‘I want you to know that I disapprove’. In another context the raised eyebrow
says ‘I disapprove’ and ‘I want you to observe that I make a disapproving sign
even though you know I really approve’. In this case the listener knows that the
disapproval is not to be taken at face value, but as an expression of irony.
A full appreciation of meaning must involve the understanding of the second-
order representation of ‘informative intention’. If second-order representations
are impaired we would expect this aspect of communication to be impaired.
Sperber and Wilson say that ‘communication exploits the well-known ability of
humans to attribute intentions to each other’, an ability which as we have seen
may be impaired in autism. In this way a ‘theory of mind’ and ‘relevance’ are
linked together. One would certainly expect failure in one to be associated with
failure in the other.
Clearly, utterances not only convey straightforward meanings, but they are
often used to convey mental states, i.e. feelings, attitudes or beliefs. Take for
example the scene in The Importance of Being Earnest when Lady Bracknell
leaves Gwendolen and Jack alone together for a brief moment. Gwendolen says
to Jack: ‘Pray don’t talk to me about the weather, Mr Worthing. Whenever
people talk about the weather, I always feel quite certain that they mean some-
thing else. And that makes me so nervous.’ What she has in mind of course is
that Jack should not be afraid of talking quite directly about marriage, because
she has already decided to accept him. However, everyone knows that such
matters could not possibly be approached bluntly - besides, the play is still in
its first act. Inferences of this kind, which are all in accordance with the prin-
ciple of relevance, are essential if we are to enjoy the comedy.
This example also shows that saying something apparently irrelevant (talking
about the weather) can in itself be highly relevant, indicating pointedly that one
is not talking about a certain topic at all. It is precisely with sophisticated com-
munication of this type that we find persistent failure in even the most able
autistic individuals. We do not find communication failure that concerns
straightforward messages, requests, commands or questions of information.
Therefore it is the failure with higher-order levels of communication that a
theory of autism must primarily address. Of course, when we go below a certain
mental age, even in perfectly normal children, but particularly in children with
severe learning difficulties, we would expect only a limited ability to form infer-
ences - and a very limited interest in the plays of Oscar Wilde. As a research
strategy it is important therefore that studies are focused on able autistic
individuals. Only through systematic studies of this kind can we sort out what
problems are due to autism and what problems are due to additional handicaps.

CONCLUSIONS
In this review we have focused on what is autistic in autistic language. For
nearly a decade, most researchers have drawn the conclusion that there is
nothing autistic in the language itself, just in the use of language. Only in the
last few years has it become clear that the impaired use of language in autistic
children is part of a subtle cognitive failure. We discussed the nature of the
LANGUAGE AND COMMUNICATION IN AUTISM 147

failure - a difficulty in the use and formation of second-order representations

- and examined the consequences of this failure for language use. Consider-
ation was given to higher-order cognitive concepts, those which depend on the
existence of second-order representations, namely ‘theory of mind’ and ‘rel-
evance’. In all autistic children the development of these concepts is abnormal
or at least grossly delayed.
We did not need to hypothesise a primary socio-affective impairment in
autistic children in order to understand their communication failure. Such an
impairment may exist in some autistic children, just as it may exist in other chil-
dren. In any case, there is much evidence of attachment and social approach
behaviour in autistic individuals. Higher-level socio-affective impairment is,
however, a universal characteristic of autism. It reveals itself in quite subtle but
nevertheless serious problems in the communication and perception of mental
states, and it reveals itself in a failure to attend to what is most relevant in ordi-
nary two-way communication. This conclusion is addressed by the hypothesis
of a cognitive impairment in second-order representations.
The simplicity of the hypothesised fault is such that it is possible to account
for Wing’s triad of impairments: impairment of social abilities, impairment of
communicative abilities and impairment of imaginative abilities. We are now
beginning to make sense of the puzzling constellation of symptoms that
uniquely and universally characterise autism.

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Received March 21 1989.