A couple of years ago I was asked to speak to a group of parents about communication. It happened to be right around St. Patrick’s Day, so of course I started thinking in terms of the holiday. And that brought to mind lucky four-leaf clovers. So how does that relate to communication?
Well, communication might be looked at in terms of four different aspects:
- Verbal Communication
- Nonverbal Communication
- PECS and other technology.
Of course, there is a lot of overlap, for instance, both 3) and 4) are often used by people who do not speak and could fall under 2.) Nonverbal. Because American Sign Language (ASL) and Picture Exchange Communication System (PECS) and other Augmentative Assistive Communication (AAC) technology, are so widely used, I decided to give Signing and PECS & Techs each their own leaf on our four-leaf clover of communication.
Many (but not all) children with Autism are verbal; they may talk early and lecture like a Little Professor, or they may talk eventually after years of therapy, but at some point their primary mode of communication will be talking. This is what parents want for our children, because this is the way the majority communicates. It is typical, it is expected, and it makes life simpler.
However, it’s important to remember that the path to verbal communication is not the only path, and it is not necessarily smooth with no reversals.
Some toddlers start saying words, but then stop. Many begin talking again later after a plateau.
Some youngsters say dozens of words, but do not use their words to communicate with others. Many use words to label objects they see, or to ask for what they want, but cannot answer direct questions, or become overly stressed if questions come too quickly without plenty of time to process.
Others may readily answer questions they have learned, but if they need information they are unable to formulate questions themselves.
Some highly verbal individuals, with extensive and advanced vocabularies, may find themselves unable to talk at all when under stress. Just because a child can talk about any subject today, don’t assume that if he seems unable to talk on another day that he is “willfully” refusing to speak. Maybe today he is nonverbal. If you have a verbal child, wherever she is in this range of verbal ability, be aware that learning to communicate verbally often takes time and patience.
We often hear, with our typically-developing children, that we should talk and talk and talk so they will be surrounded by language. We narrate everything we are doing and seeing and thinking, and we use adult language rather than “baby talk.” For many children this is a great way to expand their language learning
But this is not necessarily the case with our students on the spectrum who have significantly delayed language. All that talk-talk-talk may sound like Charlie Brown’s teacher (wah, wah, wah.) They still need to hear language, but not be overwhelmed by it. Simplifying what you say, using single words or short phrases, helps a lot with comprehension. A simple, “No candy today,” or “No candy. Apple,” is easier for a child to process and accept than when we say, “I really don’t think it’s a good idea for you to have candy right now, because it’s too close to dinner time and when you have too much sugar it’s harder for you to control your behavior. Also, I want you to eat your dinner because I’m making something special. How about a piece of apple instead? You like apples, and it’s a healthier choice than candy.” By the time we reach the end of our explanation, the child may be melting down. He asked for candy, he got a lot of words that included the word “candy” more than once, but he did not get the candy and he does not know why. How frustrating! Imagine being in a country where you do not know the language, but you have learned the word for a thing you want or need. When you use your word, the people answer in a long string of unrecognizable words with your word sprinkled in among the nonsensical gibberish, and then the person hands you something you did not ask for and do not want. You might want to throw a tantrum yourself.
There is a lot to verbal behavior that we don’t always think about when a child is learning to talk. Some of B.F. Skinner’s types of “verbal operants” (how he organized the many kinds of verbal communication) include:
- MAND a verbal request, such as saying “candy” when the child wants candy.
- TACT a comment about something in the environment, such as labeling “candy” when the child sees a picture of candy.
- INTRAVERBAL a word, phrase or sentence that responds to someone else’s verbal behavior, such as answering a question.
- ECHOIC a word which is repeated after someone else has said it.
Let’s talk about echoics for a moment. Sometimes echoing is non-communicative, and the child is simply repeating a word heard long ago or on television, perhaps because it is fun to say or hear. Sometimes the child may seem to be echoing non-communicatively but is really trying to communicate something. If the last time he had popcorn was while watching Thomas the Tank Engine on television, and now he wants popcorn again, he may repeat a word or line form the show again and again. We think it means nothing, but he may be trying to communicate. Other times echoing is clearly communicative in nature, such as when we say, “Do you want candy?” and the child repeats, “Candy!” Just be aware that if we say, “Do you want beets?” and the child echoes, “Beets,” it may be that he was repeating the last word you said as a way of participating in a sort of “conversation” with you, not understanding what he was repeating. Again, imagine being in a foreign land, and a person approaches you and says, “Blork.” You may very well repeat, “Blork,” not knowing what it meant, but trying to learn.
It’s important to remember that, even though we are trying to teach our child to talk, not everyone communicates verbally with spoken words. Some people with autism have never learned to communicate with verbal language, and some prefer not to speak and would rather type than talk. But that doesn’t mean they can’t communicate! Far from it!
Work together with your child’s teacher, case manager or Speech-Language Pathologist (SLP) to better understand where your child is on this path, what they are working on at school, and how you can support this progress at home.
Read more about this in THE VERBAL BEHAVIOR APPROACH: HOW TO TEACH CHILDREN WITH AUTISM AND RELATED DISORDERS by Dr. Mary Lynch Barbera, 2007, Jessica Kingsley Publishers, London, UK
Want to dig deeper? Delve into VERBAL BEHAVIOR by B. F. Skinner, 1957, 1992, Copley Publishing Group, Acton, MA (reprinted from the original in 2015) This is not for the faint of heart (it is very heavy reading!) but if you want to seriously get into the science behind verbal behavior, B.F. is the man. Skinner developed radical behaviorism and founded a school of experimental research psychology, the experimental analysis of behavior. He is considered one of the forefathers of modern Applied Behavior Analysis.
With very young children, we use the term “Pre-Verbal” rather than “Non-Verbal,” because we hope and expect that they will learn to talk. When a child is more than 5 or 6 years old and has not yet used any words to communicate, chances are that they may not use oral language to communicate; they may be nonverbal.
But nonverbal does not mean non-communicative. There are many ways people communicate without spoken words, and it is important to find each child’s personal best form of communication. We need to learn what works best for them. If we don’t find them a way to communicate their wants, needs, preferences and opinions, they may use their behaviors to communicate.
Always respect everyone’s right to communicate. If a student uses a technological communication device of some kind, make sure they know how to use it properly (it is not a toy) and that they always have it available. When a student is able to use assistive technology to communicate, and it is sometimes put away out of their reach, or only used to request food at snack or lunch time or during specific lessons, that is not okay. It is as if we are taking away their voice. We would never tape a verbal child’s mouth closed to prevent them from talking, and we must never deny a child’s communication device. In addition, we should accept and allow students to use their devices not only to request and to answer questions, but to comment and share their opinions, even if their opinion is negative. Typical children sometimes groan or say, “Oh, no, not a pop quiz!” to express their dismay. Nonverbal students need to be free to say, “I don’t like that,” or “I don’t want to.” They probably will still need to take the pop quiz (or whatever they are protesting) but they will have communicated how they feel about it. And that’s a good thing. We all want to be heard, even though we know things will not always go our way.
Another note about assistive technology devices: we can’t hand these to a student with autism and assume that she will immediately know how to use it appropriately. People need to be taught, and the SLP or Assistive Technology (AT) contact person at your child’s school will have a plan if your child is given an AT device. At first it may only be used at certain times, such as during a lesson on its use, or to request snacks, while proper use is being taught. If it is put away after these lessons because the child has not yet mastered how to use it correctly, do not assume they are depriving him of his voice. If a child is given an AT device and pushes buttons indiscriminately, or bangs it on the table, or throws it, or bites it, then it is not yet a communication device for the child. It is an object to be explored, or a toy. If the child is permitted to continue to treat the device like a toy, it will interfere with his understanding that it can become a powerful learning tool. At first, his teacher, SLP and/or AT specialist will limit when he has access to it to times when an adult can train him in how to use it correctly, and make sure that every time he pushes the button he immediately gets the reinforcer he requested. He needs to learn and understand how powerful it can be. If he sits with it alone and pushes the buttons and no one responds, that can get in the way. When used properly under supervision, at some point he may have an “Aha!” moment, like Helen Keller when she first realized that her teacher’s hand and finger movements meant water in The Miracle Worker.
After the child has had that epiphany, and has demonstrated that he has learned the power of the device to foster communication, then it should become a part of his daily life at all times. He understands that the real power of communication requires another person, a communicative partner, so he independently brings the device to a teacher or parent before pushing the buttons. When he uses it alone, as a toy rather than a voice, then he probably doesn’t get it yet. Don’t give his teachers and professionals a hard time about “taking away his voice” before it has actually become a voice for him. Always talk to your team if you feel that he is ready to have it with him all the time. Ask them for their reasons, and share what you see at home. Together you can come up with a plan for him to be the best communicator he can be.
Many people these days teach children American Sign Language as a nonverbal form of communication. It has become very popular, and for many it is an excellent choice. However, it is not for everyone. There are pros and cons to this form of communication.
If there is a family member who is deaf and uses sign language to communicate, then it is an obvious choice for everyone in the family to learn sign.
Some parents believe their children have already started to learn sign on their own without being taught, and they feel that it is important to build and expand on that. However, on taking a closer look, it may be that their child simply likes to clap or tap their fingertips together as a stereotyped mannerism. This can look similar to an approximation of the sign for “more.” Parents have reported that when their child makes this motion, and they offer the child another cookie the child accepts it, which seems to support that the child intended to request it. But sometimes it’s just a thing they like to do, and who would say no to a cookie? (Not I.) This child may or may not be ready for sign language, but appearing to sign “more” repetitively does not necessarily support choosing sign language as the communication system.
Here are some of the pros and cons:
- Sign language does not require oral-motor imitation skills; if they have apraxia or are not yet able to form words and sounds with their mouths, they may find it easier to use their hands to sign.
- They will always have their hands available to sign; no extra materials are required.
- Not everyone in the world understands sign language; there is a restricted range of communicative partners.
- Some children with poor oral-motor imitation skills also have poor fine-motor imitation skills, and signing is difficult for them.
- Many children on the spectrum use their hands for self-regulating “stimming” or self-stimulatory behaviors, such as flapping or tapping their hands or wiggling their fingers. This can get in the way of signing.
Learn more about sign language and autism at the Autism Research Institute, www.autism.com/advocacy_signing
PECS AND TECHS
Picture Exchange Communication System (PECS) is a widely used form of visually supported augmentative and alternative communication. It was developed by Lori Frost and Andy Bondy in 1985 and is licensed by Pyramid Educational Consultants, Inc. This is an evidence-based intervention for students with autism spectrum disorders, and is supported by research. Training is required to properly teach a student how to use the system, which consists of picture icons which can be stored in a binder and displayed or put together using Velcro strips.
Although it may seem simple (if he wants popcorn, there is a picture icon of popcorn,) there are steps and procedures which are important to follow. For example, the communicative exchange is an important part of the system. If a student learns to point to a picture of popcorn in a book or a picture of a burrito on the refrigerator, and an adult happens to see this and provide the popcorn or burrito, then it seems as if the child has successfully communicated. However, this is not the case. If that is how we use PECS, it is as if we are trying to teach the child how to use a vending machine rather than how to communicate with a person. With a vending machine, you see the picture of the thing you want and you push a button, and the item appears almost as if by magic. (As long as you have also put money in the machine.) In a communicative exchange, the student takes the picture of popcorn or a burrito out of his book, and goes to find a person to communicate with. He gets the other person’s attention and hands them the icon (or a sentence strip with “I want ___” and the icon in place.) That communicative partner receives the communication by taking the proffered icon, and responds by saying, “Oh, you want popcorn,” or “Oh, you said, ‘I want burrito.’” Then the other person provides the requested item. Without a communicative partner, the picture icons alone are not a communication system.
There are a number of levels or stages of communication which are explained in a PECS training. If your student will be using PECS, ask if their teacher and staff members have been trained, and if you can also be trained to use PECS at home.
Learn more at www.pecs.com
There are many more Assistive or Augmentative Communication (AAC) devices which may be useful with students with autism and other disorders. If you’ve seen the television show Speechless, about a teenager with Cerebral Palsy and his family, you’ve seen him use a communication board which allows him to point at words with a laser pointer attached to his head. Most autistic individuals are able to use their hands, so this would not be necessary, but a similar board allowing them to push a button and have a voice say the word aloud has been helpful for some.
If you and your child’s team choose something like a GoTalk or Proloquo2Go make sure everyone on the team (including parents) are taught how to use it. If you choose a device that allows someone to dictate the desired words into the machine, make sure the voice matches the child. No kid on the playground wants to try to say, “Can I play with you?” and when they push the button on their machine, the voice of their mother or SLP comes out. That is not conducive to being inclusive! Find someone of the same gender as your child, and maybe a year or two older. If your school has a drama club or class, they might want to participate. Your child might even want have students audition and choose his or her own voice actor. Then that student would spend some time speaking the words related to the buttons on the device into the recorder. If there are a lot of words and it will take time, consider paying or rewarding the student who volunteers with something special.
Find out more about AAC devices for students with autism at www.wati.org/content/supports/free/pdf/ASDManual-1.pdf
In my next blog post I’ll talk about four more ways to look at communication. As always, contact me with any suggestions or questions you’d like me to answer here. DrWendy@AdultAutismAssessment.com