Introduction

The following exercise is a case study of a woman (‘Mary’) of 28 years of age who was studied by Dobbinson et al. (Reference Dobbinson, Perkins and Boucher1998). Mary has autism, a neurodevelopmental disorder which has significant implications for all aspects of an individual's functioning. A clinical description of autism was first given in 1943 by Leo Kanner. Today, a diagnosis of autism is based on criteria that are contained in the Diagnostic and Statistical Manual of Mental Disorders (DSM). For a diagnosis of autism spectrum disorder to be made, the fifth edition of DSM states than an individual must display persistent deficits in social communication and social interaction, and restricted, repetitive patterns of behaviour, interests or activities. Moreover, these symptoms must be present in the early developmental period (American Psychiatric Association, 2013). The case study is presented in five sections: primer on autism spectrum disorder; client history and cognitive-communication status; focus on topic management; focus on conversational overlaps; and focus on conversational pauses.

Primer on autism spectrum disorder

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder which is found in all countries and cultures. In a recent study of the epidemiology of ASD, it was estimated that in 2010 there were an estimated 52 million cases of ASD worldwide (Baxter et al., Reference Baxter, Brugha, Erskine, Scheurer, Vos and Scott2014). This equates to a prevalence of 7.6 per 1,000 population or 1 in 132 persons. Alongside the high prevalence of ASD, there is also evidence that the disorder has a large and increasing incidence, and that there is a significant difference in the number of males and females who develop ASD. Hinkka-Yli-Salomäki et al. (Reference Hinkka-Yli-Salomäki, Banerjee, Gissler, Lampi, Vanhala, Brown and Sourander2014) calculated the annual incidence rate in the Finnish population to be 53.7 per 100,000. Also, there was an eightfold increase in the incidence rates of ASD in children born between 1987 and 1992. This study also obtained a sex ratio (boys:girls) of 3.5:1. ASD has a complex, heterogeneous, multifactorial aetiology which involves genetic and neurobiological factors (Parellada et al., Reference Parellada, Penzol, Pina, Moreno, González-Vioque, Zalsman and Arango2014). Many individuals with ASD have comorbid conditions such as intellectual disability, epileptic disorders and attention deficit hyperactivity disorder (ADHD) (Memari et al., Reference Memari, Ziaee, Mirfazeli and Kordi2012).

There is a broad spectrum of communicative disability in children and adults with ASD. Approximately 50% of individuals with autistic disorder do not develop functional speech (O'Brien and Pearson, Reference O'Brien and Pearson2004). For those individuals who do become verbal communicators, early vocal anomalies (atypical non-speech vocalisations) as well as receptive and expressive prosodic impairments have been identified (Peppé et al., Reference Peppé, McCann, Gibbon, O'Hare and Rutherford2007; Schoen et al., Reference Schoen, Paul and Chawarska2011). In terms of phonology, developmental phonological processes (e.g. cluster reduction) and non-developmental errors (e.g. phoneme-specific nasal emission) have been identified in the speech of children with ASD (Cleland et al., Reference Cleland, Gibbon, Peppé, O'Hare and Rutherford2010). Studies of syntax in ASD have produced conflicting findings. Although some studies have failed to find syntactic deficits in ASD (Allen et al., Reference Allen, Haywood, Rajendran and Branigan2011; Naigles et al., Reference Naigles, Kelty, Jaffery and Fein2011), there is evidence that aspects of complex syntax such as the comprehension of subject and object relative clauses are disrupted (Durrleman et al., Reference Durrleman, Hippolyte, Zufferey, Iglesias and Hadjikhani2015). In terms of lexical semantics, word learning in children with ASD is compromised, with impairment related to these children's reduced sensitivity to the social informativeness of gaze cues (Norbury et al., Reference Norbury, Griffiths and Nation2010). By far the most significant language deficits in ASD are found in pragmatics. The understanding of figurative utterances, the comprehension of inferred meaning and the appreciation of humour have all been reported to be impaired in ASD (Lewis et al., Reference Lewis, Woodyatt and Murdoch2008; MacKay and Shaw, Reference MacKay and Shaw2004). Children with ASD also have difficulty drawing inferences that are needed to understand metaphor and produce speech acts (Dennis et al., Reference Dennis, Lazenby and Lockyer2001). Not all aspects of pragmatics are impaired in ASD. There is evidence, for example, that scalar inferences are intact in individuals with ASD (Chevallier et al., Reference Chevallier, Wilson, Happé and Noveck2010; Pijnacker et al., Reference Pijnacker, Hagoort, Buitelaar, Teunisse and Geurts2009).

Client history and cognitive-communication status

Mary is 28 years old. She was diagnosed at 6 years of age with autism. At the time of study, Mary was a resident in a community in Yorkshire, England, for people with autism. The principal caregiver at her residential centre and Mary's parents provided background information for the study. Mary attended playschool and mainstream school despite her mother's concerns that she was experiencing psychological problems. From around the time of her third year, Mary's mother reported that she had concerns about her daughter. Mary exhibited late global development in these early years including delayed walking and spoken language development. Mary's mother recalls her as an anxious child who cried excessively. Mary exhibited no spontaneous play. Instead, she perseveratively waggled objects such as tissues. She did not display ordering or spinning behaviours. Mary preferred to sit on her potty rather than approach her mother for comfort when she was overcome with anxiety. She displayed a lack of interest in her peers and elder sibling. As a child, Mary had imaginary friends. However, these did not assume the role of a passive interlocutor.

Mary is considered by those involved in her care to be a talkative individual. Her talk mostly takes the form of lengthy monologues on her favourite topics. These topics, several of which she pursues obsessively, include the dates of birthdays of her acquaintances, the British royal family and politics. Over time, Mary's obsessive interests can decrease. Mary keeps a diary which she uses to express her anxieties and troubles. She enjoys music and sometimes sings in a monotonous fashion. There is restricted use of tone and pitch movement in her spoken language. Mary can read with comprehension. Her mother taught her to write before beginning school using a system in which specific letters were associated with colours. On the Wechsler Adult Intelligence Scale – Revised (WAIS-R; Wechsler, Reference Wechsler1981), Mary had a full scale IQ of 66. There was a slight disparity between her verbal and performance subscale scores which were 70 and 65, respectively. Mary displayed fairly even performance on the verbal tests. Subtest analysis revealed that she had relatively good short-term memory skills for number sequences.

Focus on topic management

During a series of visits to Mary's residential centre, conversational data were collected. Audio-recordings were transcribed using the notation shown below. Some sessions were also video-recorded. The conversations were informal in nature, with topics arising naturally between Mary (M) and the researcher (R). Occasionally, other participants were also present. The specific setting of these conversational exchanges varied between rooms in the centre that were used for structured activities, and the living room and kitchen of Mary's satellite house. In extract 1, the conversation opens with Mary and the researcher discussing Mary's participation in the mini-olympics. In extract 2, Mary and the researcher are continuing their conversation from extract 1 with a discussion of Amy's birthday cake. In extract 3, Mary is discussing the topic of housework.

Focus on conversational overlaps

When speech takes place simultaneously between the participants in a conversational exchange, overlaps arise. Overlaps can occur for a number of reasons including a desire to take the turn from the current speaker and to support a speaker in his or her turn (e.g. the use of backchannel behaviours such as ‘uh-huh’). The management of overlapping talk requires conversational skills which may not be present in individuals with autism spectrum disorder. It is interesting to consider if Mary, who makes extensive use of overlapping talk, exhibits the skills that are needed to manage this talk. To this end, consider the following conversational extracts between Mary and the researcher:

Focus on conversational pauses

Mary's conversational data contains many pauses, a substantial number of which are of long duration (they exceed 1 second). Pauses are often revealing of the cognitive processes that attend conversation, with both their location and duration conveying important information about their function. Several of Mary's long pauses are shown below: