978-1572305441

92 A MIND APART
on my part, I understand nothing. I have to see the world as William
does. He cannot make that imaginative leap to me; I have to construct a
metaphor of his world in my mind and then interpret what he says.
Only in this way can we play the same language game. I must have a hypertrophied
theory of mind to bridge the gap that separates us. To appreciate
the context, I have to see and imagine the world as experienced
by William, standing on the platform, waiting for the subway to arrive.
* * *
William’s parents have asked me on several occasions whether
these difficulties in initiating and sustaining a conversation can be improved.
I rather reluctantly tell them that very little research has been
done on this topic. Speech therapy is certainly an effective form of treatment
for very young children with ASD and, in particular, those who
are nonverbal and are just beginning to speak and to communicate their
needs and wants. But once speech develops, there are no standard interventions
that can improve the social use of language in conversation.
But having a conversation with William does suggest certain strategies
that might be helpful. These are based on the notion that the conversational
difficulties of people with ASD are caused by the difficulties in
theory of mind, the inability to use certain linguistic devices that are
typically used to initiate and sustain a conversation, and by the deficits
in executive function and weak central coherence that are so characteristic
of children with ASD (see Chapters 4 and 5). It is of no use to try to
teach children with ASD the use of metaphor or to have them practice
what they can’t do. Instead, we can teach them the specific rules they
need to get by in conversation with others. Slowly over time, the capacity
to hold a coherent conversation with another person improves as the
child’s social skills improve as well. This usually happens during the
teenage years, and it may be worthwhile to hold off implementing some
of these strategies until that time.
The intervention consists largely of having a conversation with the
adolescent, making sure that a shared context is explicitly present for
the conversation and practicing the rules that govern social intercourse.
This involves encouraging the child to use certain simple linguistic devices
that make conversation coherent. The focus is not on the use of
grammar or vocabulary or the meaning of individual words but on the
initiation and sustaining of a conversation. The objectives are to help
children become consciously aware of the listener’s needs in the conver-