Toward Neurodiversity: How Conversation Analysis Can Contribute to a New Approach to Social Communication Assessment.

PURPOSE: The purpose of this clinical focus article was to illustrate the potential of employing conversation analysis (CA) as a method for assessing social communication that is neurodiversity affirming. METHOD: This clinical focus article will provide an overview of CA and explain how it offers a theoretically grounded means of analyzing autistic children's everyday social interactions. Our aim is not simply to add a new assessment instrument to the disciplinary toolbox but to use the occasion to spur a reconsideration of how social communicative competence is currently conceptualized in the field and how those assumptions are reified through assessment practices. We will present a case illustration of a bilingual autistic child and his family. We will discuss the implications of a CA-informed assessment for reconceptualizing autistic social communicative competence. RESULTS: The case study illustrates the contributions of CA for (a) shifting the focus of assessment from social communication as an individual skill to social communication as an interactional achievement and (b) surfacing social communicative competencies that may be dismissed as pathologies. CONCLUSIONS: CA offers a relational understanding of autistic communication and sociality that is compatible with a critical stance on disability. Insights from CA problematize deeply entrenched notions of autism and social communication in speech-language pathology.

A room of one's own: Moments of mutual disengagement between doctor and patient in the oncology visit.

OBJECTIVE: This paper examines a previously neglected phenomenon in doctor-patient interaction studies, i.e. the achievement of mutual disengagement-a specific state of coordination, in which participants suspend reciprocal gaze and turn into separate axes of involvement. In the specialized setting of the oncology visit, which we consider in this study, mutual disengagement is linked to important tasks that the oncologist has to carry out, notably the scrutiny of the histological exam during the diagnostic assessment phase. METHODS: Our data corpus includes 56 video-recorded oncology visits. We employ conversation analysis to discern how mutual disengagement is achieved, sustained and ended. RESULTS: Our analysis shows that suspension of mutual engagement is a joint accomplishment that requires intersubjective cooperation. It also reveals that when talk and reciprocal engagement are suspended, intersubjective alignment is more vulnerable to breakdown. CONCLUSION: Our findings eschew a characterization of the oncologist as solo arbiter of the interactional exchange. An alignment with the patient is key to the felicitous accomplishment of the visit. We also suggest that a successful medical encounter is not only characterized by harmonious verbal communication, between doctor and patient, but also by felicitous pauses in their joint engagement. PRACTICE IMPLICATIONS: In building a room of one's own, the oncologist has the responsibility to co-construct with the patient an experience of interactional attunement and mutual understanding.

Structuring times and activities in the oncology visit.

In this paper we examine how doctor and patient coordinate actions in interaction towards the smooth accomplishment of the medical visit. Such coordination entails primarily the management of time and praxis, i.e. the apportionment of time to the tasks to be completed during the visit; and it is not an easy enterprise, for a number of reasons: 1) the tasks to be carried out during the visit are not familiar in equal measure to doctor and patient; 2) the extent of attention to be devoted to each task cannot be fully determined in advance but requires ongoing judgment and calibration; 3) generally, the timeframe of the visit is relatively limited. Our ethnographic and conversation analytic study of oncological visits shows that doctor and patient rely on a range of semiotic resources to achieve mutual understanding and coordinated actions. In particular, our analysis has identified textual artifacts and metapragmatic utterances as key semiotic components in the coordination and negotiation of the temporal trajectories and courses of actions that constitute and traverse the oncology visit.

A Multidimensional Reappraisal of Language in Autism: Insights from a Discourse Analytic Study.

In this article, we leverage theoretical insights and methodological guidelines of discourse analytic scholarship to re-examine language phenomena typically associated with autism. Through empirical analysis of the verbal behavior of three children with autism, we engage the question of how prototypical features of autistic language-notably pronoun atypicality, pragmatic deficit, and echolalia-might conceal competencies and interactional processes that are largely invisible in mainstream research. Our findings offer a complex picture of children with autism in their use of language to communicate, interact and experience others. Such a picture also deepens our understanding of the interactional underpinnings of autistic children's speech. Finally, we describe how our findings offer fruitful suggestions for clinical intervention.

Rethinking language in autism.

In this article, we invite a rethinking of traditional perspectives of language in autism. We advocate a theoretical reappraisal that offers a corrective to the dominant and largely tacitly held view that language, in its essence, is a referential system and a reflection of the individual's cognition. Drawing on scholarship in Conversation Analysis and linguistic anthropology, we present a multidimensional view of language, showing how it also functions as interactional accomplishment, social action, and mode of experience. From such a multidimensional perspective, we revisit data presented by other researchers that include instances of prototypical features of autistic speech, giving them a somewhat different-at times complementary, at times alternative-interpretation. In doing so, we demonstrate that there is much at stake in the view of language that we as researchers bring to our analysis of autistic speech. Ultimately, we argue that adopting a multidimensional view of language has wide ranging implications, deepening our understanding of autism's core features and developmental trajectory.

Rethinking echolalia: repetition as interactional resource in the communication of a child with autism.

Echolalia is a pervasive phenomenon in verbal children with autism, traditionally conceived of as an automatic behavior with no communicative function. However, recently it has been shown that echoes may serve interactional goals. This article, which presents a case study of a six-year-old child with autism, examines how social interaction organizes autism echolalia and how repetitive speech responds to discernible interactional trajectories. Using linguistic, discourse, and acoustic analyses, we demonstrate that the child is able to mobilize echolalia to mark different stances, through the segmental and suprasegmental modulation of echoes. We offer an interpretive framework that deepens our understanding of the complex interactions that children with autism can engage in by using echoes, and discuss the implications of this perspective for current views of atypical language development in autism.