Communication issues and autism
For many children with autism, communication issues are one of the first telltale signs of autism spectrum disorder (ASD). As autism covers a spectrum of challenges, children can present communication issues differently from one another. Some children might have a large vocabulary and learn to read at a young age but struggle to contextualize what they have read or answer who, what, where, when, why, and how questions.
Other children may be able to carry conversations but have trouble understanding non-verbal aspects of communication such as gestures, facial expressions, and body language. And then some children with autism may be entirely non-verbal.
The Diagnostic and Statistical Manual of Mental Disorders v.5 (DSM-5) determines the diagnostic criteria for ASD with the first criterion listed as:
“A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):
- Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
- Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
- Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.”
According to the National Institute of Deafness and Other Communication Disorders (NIDCD), children with autism generally display one of the following patterns of language and use of behaviors: (“Autism Spectrum Disorder: Communication Problems in Children,” 2017)
Repetitive or rigid language
- Sing-song tone or robot-like or high pitched speech
- Responding to questions with questions
Narrow interests and exceptional abilities
- Delivering in-depth monologue about a topic that holds their interest
- Inability to hold a two-way conversation about the same topic
Uneven language development
- May develop a strong vocabulary in a particular area of interest very quickly
- May be able to read words before age five but may not comprehend what they have read
- Often do not respond to the speech of others and may not respond to their names
Poor nonverbal conversation skills
- Unable to use gestures—such as pointing to an object—to give meaning to their speech
- Avoid eye contact
Another child may be entirely non-verbal. According to Bev Long of the Diagnostic Center of Central California, “As many as 50% of individuals with autism are non-verbal, and up to 80% are intellectually challenged.” (Long)
The success of assistive communication devices and strategies
A variety of assistive communication devices and strategies have proven successful in assisting many children to develop methods of communicating and even developing speech. These devices are usually prescribed by a speech-language pathologist and are a part of augmentative and alternative communication interventions (AAC).
This comprehensive research summary by Débora R. P. Nunes for the International Journal of Special Education discusses 56 studies that took place from 1980-2007. Nunes concludes:
“Some of the advantages of using sign language included (a) its portability; (b) its characteristic of being a true language system and, (c) the possibility of communication occurring at a faster pace. Among the positive aspects of using a visual-graphic system were: (a) its iconicity; (b) its nontransient nature; and (c) the limited motor requirements for its use. SGDs were considered advantageous for (a) they allowed communication to occur at larger distances; (b) they permitted messages to be easily deciphered, and (c) required limited cognitive and motor demands.” (Nunes, 2008).
In an article written by speech-language pathologist Jessica Lenden-Holt and special education teacher Forrest Holt, two case studies are reviewed of high school aged teenagers with autism. These teenagers were given instruction on high-tech communication devices for the first time, three times a week for an hour each session. Both students were able to use their devices to communicate their needs give spontaneous answers and utterances. Additionally, this article proves that high school students have not necessarily met their full language potential by their teenage years, and the appropriate AAC interventions can help them improve and develop communication skills. (Holt, 2017).
Available assistive communication devices and strategies
A variety of assistive communication devices and strategies are available. The most common are visual boards, a picture exchange communication system (PECS), sign language, gestures, and low technology interventions, and high technology electronic devices.
Visual boards help children with autism express their preferences, emotions, understand rules, and schedules. Visual boards usually consist of a series of pictures, sometimes with words labeling each picture that children can point to or arrange in order to express their needs or desires. Visual boards can be modified to an individual child’s needs by showing simple or more complex images. Often times, the images are attached to the board with Velcro or other adhesives so that children can arrange them into their desired schedule or place the appropriate image after a question (e.g., What do you want to eat?).
Picture Exchange Communication System
PECS are broken down into six progressive phases: how to communicate, distance and persistence, picture discrimination, sentence structure, responsive requesting and commenting. These buildable skills teach functional communication and even help some children develop speech. Children begin at stage one showing their teacher or communication partner a picture of something they desire—a cookie or juice, for example, and their requests are immediately honored. As students progress, they arrange pictures into sentences and then use to learn modifiers, initiate conversation, and answer questions. Pictures can be bought in a set or made at home to customize them to your child’s exact needs.
Sign language is considered one of the most practical and functional forms of communication for children with autism. Sign language is widely recognized by a variety of communities including the deaf and hearing impaired community and is a formally recognized form of language. Children with autism often benefit from Signing Exact English (SEE) as opposed to American or British Sign Language. SEE follows the speech pattern and sentence structure of spoken English making transferring their signs to speech as their language develops much easier. A variety of methods are available to help a child with autism learn sign language ranging from flashcards to videos or taking lessons from a certified sign language instructor. Children who are visual or tactile learners may pick up sign language easier than auditory learners do.
As with all communication methods, different children will do better with different interventions. For some children with autism, gestures can be particularly difficult to associate with language, while others will more easily connect gestures to phrases and desires. Children with some speech skills might do better with gestures than their nonverbal peers. By pairing speech with gestures to fill in gaps of their spoken language. Gestures may be supplementary to sign language or of the child’s invention. It is important for caregivers and parents to be aware of these gestures and their meaning so that the child’s needs can be met.
Low technology AAC interventions
Low technology AAC interventions are generally “parts of a whole.” These may include the Velcro for visual boards, adaptive writing tools including weighted pencils, large ruled paper, stress balls, or other manipulatives. These low technology interventions usually assist children in accessing language and speech skills they already have.
High technology electron devices
High technology electron devices are quickly rising in popularity as they become more obtainable. These devices can vocalize speech for children who can either type or identify pictures. Apps are available for smartphones and tablets for children to try to see if the technology works for them before trying more intricate devices. These devices will not necessarily stop children from talking, and many even develop speech after using AAC devices. It is important to note that it may take months or even years for a child to master a device.
How to access the best assistive devices for your child
Choosing the best assistive device for your child and ensuring he or she has consistent access to a chosen device or communication method can be a daunting task for many families. A great first step is to find a speech-language pathologist (SLP) who connects well with your child. Referrals can be made by a pediatrician, occupational therapist, psychologist, or psychiatrist. Children with individualized education plans (IEP) will have access to a SLP through their school district. The SLP will be able to conduct an AAC evaluation to match your child with the best methods or devices for his or her learning style and skill level. Rebecca Eisenberg, MS CCC-SLP wrote a comprehensive article on this process that you can find in Autism Parenting Magazine.
As Eisenberg notes, there is a zero reject policy for AAC. Children who need the devices will not be rejected based on their abilities. She also notes that an ACC evaluation can be funded through private insurance, Medicaid, or your child’s school district. Including your child’s teacher and his or her observations of your child in the AAC evaluation can be invaluable in ensuring your child’s SLP has the fullest picture possible of his or her needs and skills.
As children develop their communication and speech skills, it is important that caregivers and teachers learn along with them. This learning curve can be frustrating and nonlinear, but patience is key to ensuring your child gets the most out of his or her AAC device. Sitting in on your child’s sessions with the SLP can ensure you are on the same page as your child and help him or her during technology glitches or moments of frustration. As children gain a greater understanding of speech and language and develop greater communication skills, they often experience lower levels of frustration and gain further confidence in their abilities.
N. (2017, December 12). Autism Spectrum Disorder: Communication Problems in Children. Retrieved February 02, 2018, from https://www.nidcd.nih.gov/health/autism-spectrum-disorder-communication-problems-children#3“As many as 50% of individuals with autism are non-verbal and up to 80% are intellectually challenged.”
Long, B. (n.d.). Autism Basics. Retrieved February 02, 2018, from http://www.dcc-cde.ca.gov/af/afbasic.htm
Nunes, D. R. (2008). AAC Interventions for Autism: A Research Summary. International Journal of Special Education, 23(2), 17-26. Retrieved February, 2018, from https://files.eric.ed.gov/fulltext/EJ814395.pdf.
Holt, J. L. (2017, December 01). Has My Child Reached Full Communicative Potential? Retrieved February, 2018, from https://www.autismparentingmagazine.com/has-my-child-reach-full-communicative-potential/
Katherine G. Hobbs is a freelance journalist and university student studying English, with an emphasis on journalism, and psychology. She is interested in the impact of having a special needs child on the family dynamic. Katherine is dedicated to bringing awareness of resources to families and providing help to those who love their autistic children. You can find her online at katherineghobbs.com.